Alveolar Dehiscence Research Articles

Prevalence and extent of Alveolar dehiscence and fenestration in Class I hyperdivergent subjects with different buccolingual inclinations of maxillary molar teeth

Buccolingual position of teeth could affect the prevalence of alveolar bone defects. Presence of alveolar defects may have a deleterious effect on orthodontic treatment. The aim was to assess the prevalence and extent of dehiscence and fenestration in Class I hyperdivergent subjects and correlate it with buccolingual inclinations(BL) of maxillary first molar teeth. Methods: This retrospective study involved 80 CBCTs of class I hyperdivergent subjects divided into two groups - group A (n=33) buccolingual inclination >9º and group B (n=47) buccolingual inclination <9º. Prevalence and extent of alveolar bone dehiscence and fenestrations were measured in CBCTs using OSIRIX Lite software. Descriptive statistics, Mann Whitney U test and Spearman correlation were done for evaluating intergroup differences and correlation with Buccolingual inclination. Results: Overall prevalence of dehiscence and fenestration in maxillary first molars was 60.95% and 5% respectively. In the buccal alveolar bone, prevalence of dehiscence was highest in group A (84.6%) for 16 and in the lingual alveolar bone prevalence of dehiscence was highest in group B (71.4%) for 26 . On intergroup comparison, the extent of lingual alveolar bone dehiscence (26) in group B was significantly higher (p value <0.05) than in group A. No significant correlation between the extent of dehiscence and fenestration with buccolingual inclination of molar teeth was noted. Conclusion: Molar teeth with BL inclinations of more than 9º had higher prevalence of dehiscence on the buccal side and molar teeth with BL inclinations less than 9 degrees had more dehiscence on the lingual side. But no significant correlation of BL inclination with prevalence and extent of dehiscence and fenestration was noted.

Key-point based automated diagnosis for alveolar dehiscence in mandibular incisors using convolutional neural network

ObjectiveThe aim of this study was to propose an automated diagnosis method for alveolar dehiscence in the anterior teeth using Convolutional Neural Network (CNN). MethodsThe Cone-Beam Computed Tomography (CBCT) scanning was performed on 387 orthodontic patients at Shanghai Stomatological Hospital. A total of 1017 mandibular incisors with the largest labiolingual sectional images were obtained from the CBCT data. Among the 1017 incisor images, 371 specimens were diagnosed with alveolar dehiscence. We proposed two strategies of automated diagnosis methods for alveolar dehiscence. The first strategy (referred to as the Binary Classification Method (BCM)) was to take the task directly as a classic binary classification, and five classification networks (ResNet50, ResNet101, VGG16, AlexNet, MobileNet) were tested in this task. The second strategy (referred to as the Key-Point based Method (KPM)) was to use the CNN to search two key points (i.e., the Cement-Enamel Junction (CEJ) and the Alveolar Crest (AC)) firstly and then make a diagnosis according to the distance between the two key points. At the same time, we proposed an image preprocessing method for the approximate location of mandibular incisors and an improved key point selection method to avoid the problems of missed detection. In both CNN strategies, 90% of the mandibular incisor images were assigned to the training dataset, and the rest 10% were assigned to the testing dataset. ResultsThe BCM showed limited performance in the diagnosis of alveolar dehiscence, with diagnostic accuracy below 70% for all the five classification networks. The KPM showed superior diagnostic performance with an accuracy of 90.2%, a sensitivity of 86.2% and a specificity of 92.6%, respectively, in the testing dataset. The proposed image preprocessing procedures also played an essential role in the diagnosis process, significantly improving the diagnostic accuracy by 7.0% in KPM. ConclusionThe results proved that the diagnosis of alveolar dehiscence could be realized using convolutional neural network and the proposed KPM have the advantage of high accuracy and real-time performance. This study suggests that the key-point based convolutional neural network might have the potential for the diagnosis of alveolar dehiscence in the clinic.

Presentation of a novel surgical technique in periodontally accelerated osteogenic orthodontics. CBCT assessment of the buccal alveolar dimensional changes: a proof-of-concept report of four cases.

The aim of this report was to present the effectiveness of a novel augmented corticotomy performed before orthodontic treatments in the prevention of buccal alveolar dehiscence and gingival recession. Four periodontally healthy individuals presenting crowding and thin bone morphotype in the mandibular anterior area were treated with a double-layer tunnel flap, piezotomy, and hard and soft-tissue augmentation. Patients were divided into two groups according to the utilized graft material. The exclusive use of demineralized bovine bone minerals (group 2) was compared to the use of autologous concentrated growth factor-enriched bone graft matrix, "sticky bone" (group 1). CBCT measurements were performed before and 6 months after surgery. Orthodontic treatment was initialized 1 week after surgery. Postoperative wound healing was uneventful, and tooth alignments were successful in all cases. Postoperative buccal hard tissue dimensions were favorable in both groups, with no occurring bone dehiscence or gingival recession. The seemingly better results of group 2, in terms of quantitative hard tissue changes, did not have any clinical significance according to the objective to be achieved. In contrast, qualitative radiographic analysis showed a more homogenous tissue formation around teeth in group 1. It can be concluded that the presented preorthodontic treatment approach seems to be successful in preventing alveolar dehiscence and gingival recession around buccally inclined mandibular anterior teeth.

The Spontaneous Correction of Gingival Recession of the Mandibular Lateral Incisor through Orthodontic Torque Control: A Case Report

In this clinical case, we report the effectiveness of the orthodontic treatment in correcting severe gingival recession and bone dehiscence by repositioning the root into the alveolar bony housing of a 29-year-old female patient. Cone-beam computed tomography was used to assess the 3-dimentional root position and bone parameters before and after treatment. The root of the mandibular left lateral incisor, which was buccally positioned and the root apex was out of the alveolar bone, was moved toward the center of the alveolar bone by applying additional root lingual torque. After treatment, the root was moved into the alveolar bone and the gingival recession was corrected. This clinical case reports that orthodontic treatment, without periodontal surgery, can spontaneously correct the gingival recession and alveolar dehiscence.

Key-Point Based Automated Diagnosis for Alveolar Dehiscence in Mandibular Incisors Using Convolutional Neural Network

Key-Point Based Automated Diagnosis for Alveolar Dehiscence in Mandibular Incisors Using Convolutional Neural Network

Periodontally accelerated osteogenic orthodontics in clinical treatment

Orthodontic tooth movement inevitably affects adjacent periodontal tissue. The labiobuccal alveolar bone is generally thin, and patients with dental crowding often present alveolar dehiscence and fenestration. These may lead to prolonged treatment time, even gingival atrophy, tooth loosening and other complications in the orthodontic tooth movement. Periodontally accelerated osteogenic orthodontics (PAOO) could accelerate the orthodontic tooth movement and promote the formation of new bone by using corticotomy and bone grafting. This article, starting from the influence of orthodontic treatment on periodontal hard tissue, describes the application of PAOO in orthodontic treatment.

Assessment of dehiscence and fenestration in children and adolescents using cone beam computed tomography

Objectives: To define the prevalence of dehiscence and fenestration and classify them in terms of the localization of fenestrations in a random sampled group of children and adolescent patients using cone-beam computed tomography (CBCT).Methods: CBCT performed at the Department of Oral and Maxillofacial Radiology of patients referred by the paediatric dentistry clinic were included in this retrospective study. Image evaluations were performed by dentomaxillofacial radiologist (AA, asst. prof.), and these images were examined in three dimensions of the axial, coronal, and sagittal planes. Intraexaminer agreement for the evaluations were found acceptable. The presence/absence of dehiscence and/or fenestration, fenestration’s classification type, and localization of defects were recorded. Moreover, the presence/absence of periapical lesion in related root with dehiscence and fenestration was noted. For statistical analysis, The Chi-Square test, Fisher Freeman Halton Test, and Yates' Continuity of Correction were used.Results: 3061 roots in 1801 teeth of 120 cases were analyzed. The mean age was 9.97±2.22 years. Dehiscence was detected in 261(8.5%) roots of 161(8.9%) teeth, and fenestration was detected 63(2%) roots of 36(2%) teeth. The most common fenestration type was Type I, followed by Type II and IV. Dehiscence was observed more frequently in primary teeth than permanent teeth, and the difference was statistically significant (p:0.000). Dehiscence and fenestration incidence in maxillary teeth was significantly higher than in the mandibular teeth (pdehiscence:0.000, pfenestration:0.004). Apical lesions were observed more in primary teeth than permanent teeth for both defects.Conclusions: This study concludes that alveolar dehiscence and fenestrations are more common in primary teeth than permanent teeth. Moreover, these defects were detected more for the teeth in the maxilla. Concerning endodontic and orthodontic therapies in maxilla, use of CBCT is useful in determining the region's anatomical structure accurately in suspected cases of child and adolescent patients.

Nomogram prediction of vulnerable periodontal condition before orthodontic treatment in the anterior teeth of Chinese patients with skeletal Class III malocclusion

Objective To establish and verify models predictive of thin periodontal phenotype and alveolar fenestration/dehiscence in the anterior teeth of patients with skeletal Class III malocclusion. Material and methods Retrospective data of 669 anterior teeth (305 in maxillae and 364 in mandibles) from 80 patients with skeletal Class III malocclusion before augmented corticotomy were collected. Distribution of thin periodontal phenotype and alveolar fenestration and dehiscence were evaluated and their associations with potential influencing factors were explored using univariate and multivariate analyses. The predictive models were visualized as nomograms, the accuracy of which was tested by receiver operating curve analyses. Results Thin phenotype was associated with Mazza bleeding index, sex, tooth type, probing depth and width of keratinized gingiva (WKG). Labial dehiscence was associated with age, jaw, labial bone thickness, mandibular plane angle, sagittal root position (SRP), sex, tooth type, and WKG. Labial fenestration was associated with sex, tooth type, SRP, and periodontal phenotype. The areas under the curves of nomogram prediction models for periodontal phenotype, alveolar dehiscence, and alveolar fenestration were 0.84, 0.81, and 0.73, respectively. Conclusions Female sex, lateral incisor, and limited WKG may be risk factors for thin periodontal phenotype. Age, canine, male sex, mandible, thin labial bone thickness, and root positioned against the labial plate may be risk factors for labial dehiscence; and female sex, thick phenotype, root positioned against the labial plate, lateral incisor, and canine may be risk factors for labial fenestration. The predictive performance of the models was acceptable.

Prevalence of and risk factors for alveolar fenestration and dehiscence in the anterior teeth of Chinese patients with skeletal Class III malocclusion

Introduction This study investigated the prevalence of and risk factors for alveolar fenestration and dehiscence in the anterior teeth of Chinese patients with skeletal Class III malocclusion. Methods This study included clinical and radiographic examinations and intraoperative observations of 460 anterior teeth from 54 patients who underwent corticotomy and periodontal regenerative surgery before orthodontic treatment. Fenestration and dehiscence were detected and recorded during open-flap surgery. Univariate and multivariate analyses were performed to assess relationships between fenestration and dehiscence and age, sex, history of previous orthodontic treatment, mandibular plane angle, dentition, tooth position, sagittal root position, periodontal biotype, gingival recession, width of keratinized gingiva, and width of the basal bone. Results The prevalence of buccal alveolar bone defects was 16.1% (fenestration) and 20.7% (dehiscence) at the tooth level. Multivariate logistic regressions showed that fenestration was significantly associated with tooth position (canine vs central incisor, odds ratio [OR] = 3.324; P = 0.006; lateral incisor vs central incisor, OR = 5.588; P Conclusions Buccally positioned teeth in the osseous housing, lateral incisors, and canines were more likely to exhibit alveolar fenestration. Mandibular teeth and canines, patients who were older, were male, and had a history of orthodontic treatment, were more likely to exhibit alveolar dehiscence.

Alveolar bone defects in adults reporting for orthodontic treatment - A CBCT study

Identifying alveolar bony fenestration and dehiscence preceding orthodontic treatment, especially arch expansion, is needed. An unrevealed and undiagnosed buccal alveolar bone defect leads to treatment relapse and further loss of bony support. The aim of this study was to determine the extent of posterior alveolar bony dehiscence and fenestration in adults undergoing orthodontic treatment. A total of 20 subjects in the age range 18-35 years were selected for this study randomly and their CBCT records were retrieved from the Department of Orthodontics, Saveetha dental college. All statistical analysis was performed using SPSS. Chi-square test was used to determine the association of extent of fenestrations and dehiscence between males and females. Females presented with wider and extensive dehiscence defects than males (p=0.019, p<0.05). On the other hand, there was a statistically non-significant association of fenestration severity between males and females. (p=0.178, p>0.05) Within the limits of this study, it was observed that females presented with more severe bony alveolar dehiscence than males.

Bone regeneration after alveolar dehiscence due to orthodontic tooth movement – A case report

This article presents the orthodontic treatment of a 15 year old male patient with an Angle class I malocclusion with a class II skeletal base, lower incisor proclination along with a hyperdivergent facial pattern. Such situations that involve camouflage treatment, usually results in further lower incisor proclination which can be reduced to an extent by adding buccal root torque. Placement of additional torque in this case however, resulted in positioning of the root apex of the lower right lateral incisor outside the alveolar housing, although no gingival signs were present. The mechanics were then reversed and at the end of 21 months of treatment, the apices were back within the alveolar housing. A 4-year post-treatment cone-beam computed tomography showed normal bone coverage of the affected tooth; and no clinical signs of gingival pathology were present. Orthodontists should be aware of possible complications of excessively torqueing lower incisors in order to prevent proclination. If root apices are inadvertently moved through the cortex, a good long-term prognosis is possible using orthodontics alone by reversing the mechanics, if no gingival complications are present.

Changes of alveolar bone dehiscence and fenestration after augmented corticotomy-assisted orthodontic treatment: a CBCT evaluation

BackgroundTo evaluate the changes of alveolar dehiscence and fenestration after augmented corticotomy-assisted orthodontic treatment on cone-beam computed tomography (CBCT) compared with traditional pre-surgical orthodontics, both quantitatively and qualitatively.MethodsTwo hundred and four anterior teeth from 17 skeletal class III malocclusions were divided into four groups. Groups G1 (upper teeth) and G3 (lower teeth), comprising 120 teeth, accepted traditional pre-surgical orthodontics; groups G2 (upper teeth) and G4(lower teeth), comprising 84 teeth, accepted augmented corticotomy-assisted pre-surgical orthodontics. The changes of alveolar bone dehiscence and fenestration of each tooth in all groups were evaluated with the help of CBCT.ResultsQuantitative analysis for comparing both groups: For the upper teeth, d1 − d0 was different between both groups while f1 − f0 was not statistically different. For the lower teeth, d1 − d0 was statistically different between both groups while f1 − f0 was not statistically different. Qualitative analysis: For the teeth that had no dehiscence before treatment, G2 and G4 had a better transition than did G1 and G3. For those having dehiscence before treatment, G4 had a better transition than did G3. For teeth having no fenestration before treatment, there was no statistically significant difference in transition between the control and treatment groups. For those having fenestration before treatment, G4 had a better transition than did G3.ConclusionsFor skeletal class III patients, augmented corticotomy-assisted orthodontic treatment is a promising method of improving alveolar bone dehiscence and fenestration for lower anterior teeth, and it also has the potential to protect both lower and upper anterior teeth against dehiscence.

Brief Case Report: Alveolar Dehiscence in a 20 Year Old Male Patient

The two main alveolar defects are: dehiscence and fenestration, which are quite commonly observed and this brief case report describes Alveolar Dehiscence in a 20 Year Old Male Patient and its subsequent treatment.

Ill Effects of Technology: Dehiscence Encountered Following Laser Depigmentation: A Case Report

Deformities of the alveolar process discovered during mucogingival procedures can present surgical dilemmas which may seriously affect the outcome of treatment Fenestration and dehiscence are localized defects of the cortical bone which covers the teeth. Etiologic factors include developmental anomalies, frenum attachments, orthodontic tooth movement, periodontal and endodontic pathosis, trauma from occlusion, tooth size, and tooth position. The present report describes a case of alveolar dehiscence in relation to maxillary canine encountered three months following diode laser depigmentation

Healing of buccal dehiscence defects at implants installed immediately into extraction sockets – an experimental study in dogs

To evaluate the influence of implant positioning into extraction sockets on bone formation at buccal alveolar dehiscence defects. In six Labrador dogs the pulp tissue of the mesial roots of (4) P(4) was removed and the root canals were filled. Flaps were elevated bilaterally, the premolars hemi-sectioned and the distal roots removed. The implants were placed in contact with either the buccal (test site) or with the lingual (control site) bony wall of the extraction sockets. Healing abutments were affixed and triangular buccal bony dehiscence defects, about 2.7mm deep and 3.5mm wide, were then prepared. No regenerative procedures were done and a non-submerged healing was allowed. After 4months of healing, block sections of the implant sites were obtained for histological processing and peri-implant tissue assessment. After 4months of healing, the bony crest and the coronal border of osseointegration at the test sites were located 1.71±1.20 and 2.50±1.21mm apically to the implant shoulder, respectively. At the control sites, the corresponding values were 0.68±0.63 and 1.69±0.99mm, respectively. The differences between test and control reached statistical significance (P<0.05). Residual marginal bone defects were found both at the test and control sites. A statistically significant difference between test and control sites was only found at the lingual aspects (depth 2.09±1.01 and 1.01±0.48mm, respectively). Similar heights of the buccal biological width were observed at both sites (about 5.1mm). The placement of implants in a lingual position of the extraction sockets allowed a higher degree of bone formation at buccal alveolar dehiscence defects compared with a buccal positioning.

Evaluation of dehiscences using cone beam computed tomography

To validate the use of three-dimensional (3-D) surface rendering (SR) images to quantify the height of alveolar dehiscences. Twenty-four dehiscences were created on 9 incisors, 9 canines, and 6 premolars on 4 cadaver skulls. i-CAT cone beam computed tomography scans (CBCTs) were taken of each skull at .2 mm voxel size. Each dehiscence was quantified by 21 orthodontic residents using 3-D SR. The principal investigator (PI) also quantified each dehiscence using the 2-D multiplanar (MP) image and the 3-D SR image. Results of this study showed an average method error of the residents as a group to be 0.57 mm with an intraclass correlation (ICC) of 0.77%. Residents' method error ranged from 0.45 mm to 1.32 mm, and the ICC ranged from 0.201% to 0.857%. Systematic error was low at -0.01 mm for the direct measurement compared with the residents' average 3-D SR at 1365 density value (DV) measurement. The 3-D SR at 1365 DV images were compared with the MP and 3-D SR images at 1200 DV, and no significant differences in measurements and low systematic error were noted. The method error of the PI was 0.45 mm, 0.45 mm, and 0.41 mm for 3-D SR at 1365 DV, 3-D SR at 1200 DV, and 2-D MP, respectively. 3-D SR and 2D MRP can be used to measure dehiscences of the periodontium with similar levels of accuracy.

Prevalence of dehiscences and fenestrations in modern American skulls.

The purpose of this study was to examine the prevalence, distribution, and features of alveolar dehiscences and fenestrations in modern American skulls and correlate their presence with occlusal attrition, root prominence, and alveolar bone thickness. A representative sample of 146 dentate modern American skulls from a collection at the National Museum of Natural History were examined. The skulls were from subjects ranging in age from 17 to 87 years old (mean 49.1 years). The mean number of teeth per skull was 22.7 and the mean number of either dehiscence or fenestration defects per skull was 3.0. Of the 3,315 individual teeth examined, 4.1% (135) had dehiscences and 9.0% (298) had fenestrations. A dehiscence was present in 40.4% of the skulls, and a fenestration was present in 61.6% of skulls. Mandibular canines were most often affected by dehiscences (12.9%), while maxillary first molars were most often affected by fenestrations (37.0%). Sixty-seven percent of dehiscences were found in the mandible, and 58% of fenestrations were found in the maxilla. The presence of dehiscences and fenestrations were positively correlated with thin alveolar bone and negatively correlated with occlusal attrition. African-American males and Caucasian females were significantly more likely to have dehiscences, while African-American females were significantly more likely to have fenestrations.

Alveolar dehiscences and fenestrae in dried South African Negro mandibles.

The buccal and lingual roots of 1077 teeth from 100 mandibles of South African Negroes were examined for the presence of dehiscences and fenestrae. All specimens were obtained from cadavers of known sex, tribe, and stated age; 10.5% of teeth were affected. Canines and first premolars were the most common teeth associated with dehiscences and fenestrae. Dehiscences occurred more commonly than fenestrae (1:0.49). The defects were found exclusively in the buccal plate of the alveolar process.

The effects of facial bone from facial tipping of incisors in monkeys.

Four male monkeys were utilized to determine whether alveolar dehiscences of fenestrations could be produced by facial tipping of mandibular incisor teeth. Two experimental teeth and two controls were chosen in each monkey. The experimental incisors were moved facially from 2.1 to 5.0 mm over a period of 36 to 95 days. Following movement, the teeth were placed in retention and the monkeys were sacrificed at 0, 30, 60, and 120 days. Clinical measurements were made prior or orthodontic movement by laying a mucoperiosteal flap and measuring the height of the alveolar crest. Measurements were also taken at the time of sacrifice and experimental and control tooth in each animal was used for histological examination. The results were as follows: 1. There was no significant difference in bone loss between the control and experimental teeth. 2. No dehiscences or fenestrations developed with the facial movement of the experimental teeth.