Anterior Alveolar Region Research Articles

The clinical efficacy of periodontally accelerated osteogenic orthodontics in patients with bone fenestration and dehiscence: a retrospective study

PurposeThe objective of the study was to explore the effect of periodontally accelerated osteogenic orthodontics (PAOO) in orthodontic patients with bone dehiscence and fenestration in the anterior alveolar region of the mandible.MethodsA retrospective study was performed in 42 patients with bone dehiscence and fenestrations in the anterior alveolar region of the mandible who underwent the PAOO technique. The bleeding index (BI), probing depth (PD), keratinized gingiva width (KGW), gingival recession level (GRL), and gingival phenotype were recorded and assessed at baseline and 6 and 12 months postoperatively. Cone-beam computerized tomography was used to measure bone volume in terms of root length (RL), horizontal bone thickness at different levels, and vertical bone height at baseline and 6 months and 12 months after surgery.ResultsThe sample was composed of 42 patients (22 males and 20 females; mean age, aged 25.6 ± 4.8 years) with 81 teeth showing dehiscence/fenestrations and 36 sites presenting gingival recessions. There was no significant difference in BI, PD, or KGW (between baseline and 6 or 12 months postoperatively) based on the clinical evaluations (P > 0.05). Gingival recession sites demonstrated a significant reduction in the GRL after surgery (P < 0.05). Furthermore, the proportion of teeth with a thick gingival phenotype increased from 33.61% at baseline to 53.13% at the end of the follow-up. In addition, the bone thickness measurements at the mid-root and crestal levels were markedly increased compared with the baseline values (P < 0.05), although the increase in thickness at the apical level was not statistically significant (P > 0.05).ConclusionsWithin the limitations of the study, the results show that the PAOO technique is beneficial to periodontal conditions in terms of soft and hard tissue augmentation. The PAOO procedure may represent a safe and efficient treatment for orthodontic patients with bone dehiscence and fenestration.Trial registrationThis study was approved by the ethics committee of the stomatological hospital affiliated with Xi'an Jiaotong University (xjkqll [2019] No. 016) and registered in the Chinese Clinical Trial Registry (ChiCTR2100053092).

Evaluation of Orthodontic Mini-Implant Placement in the Maxillary Anterior Alveolar Region in 15 Patients by Cone Beam Computed Tomography at a Single Center in South India.

BACKGROUND In this study, we aimed to evaluate orthodontic mini-implant placement in the maxillary anterior alveolar region by cone beam computed tomography (CBCT) in 15 patients at a single center in South India. MATERIAL AND METHODS A total of 15 CBCT scans of orthodontic patients after completion of leveling and aligning stage were included. The thickness of labial alveolar bone, labio-palatal bone, and inter-radicular distance between the maxillary central incisors (U1-U1), maxillary central and lateral incisor (U1-U2), and maxillary lateral incisor and canine (U2-U3) at vertical levels 4 mm, 6 mm, and 8 mm above the interdental cementoenamel junction were measured. Descriptive statistics, ANOVA, and Tukey post hoc tests were done to assess the differences among the groups. An independent t test was done to analyze differences by sex. RESULTS The thickness of cortical bone in the labial region was higher in the U2-U3 site than in the U1-U1 site, at a height of 4 mm. Also, there was a significant difference between 4 mm and 8 mm heights in the U2-U3 region. No significant difference was noted in bone dimensions among men and women and in the labio-palatal bone thickness among the different sites. The inter-radicular distance was the highest between the U2-U3 site, while it was the lowest in the U1-U2 site. CONCLUSIONS The findings from this center showed that when CBCT was used to evaluate orthodontic mini-implant placement in the maxillary anterior alveolar region, the U2-U3 and U1-U1 locations at heights between 6 mm to 8 mm apical to the interdental cementoenamel junction were optimal for placement of the mini-implants.

A new subgingival sling suture technique for periodontally accelerated osteogenic orthodontics.

This study aimed to design a modified subgingival sling suture for periodontally accelerated osteogenic orthodontics (PAOO) as well as evaluate postoperative effects including gingival recession (GR), alveolar bone crest resorption, dental plague accumulation on sutures and alveolar bone augmentation. Twelve patients with bone defects in the anterior alveolar region of the mandible were included in this study. Subgingival sling suture, developed from traditional sling suture, was applied in modified PAOO operation. Probing depth, bleeding index, and GR were assessed, and cone-beam computerized tomography and laser microscope for thread surface were evaluated at baseline, postoperative 1 and 3 months to analyze the effects. Alveolar bone thickness on the labial side at the midpoint of the middle third of the root increased from 0.96 ± 0.28 mm to 3.38 ± 0.61 mm (P < .01), and that of the apical third advanced from 1.26 ± 0.33 mm to 3.61 ± 1.02 mm (P < .01), both exhibiting significant increase. No significant alveolar bone crest loss, probing depth increase, GR, and attachment loss was observed. This modified PAOO operation, associated with novel subgingival sling suture, productively augments alveolar bone volume and addresses problems in terms of GR and vertical loss of alveolar bone.

A new modified bone grafting technique for periodontally accelerated osteogenic orthodontics.

The aim of this study was to introduce an improved surgical technique using a pouch design and tension-free wound closure for periodontally accelerated osteogenic orthodontics (PAOO) in the anterior alveolar region of the mandible.Patients with bone dehiscence and fenestrations on the buccal surfaces of the anterior mandible region underwent the modified PAOO technique (using a pouch design and tension-free closure). Postoperative symptoms were evaluated at 1 and 2 weeks intervals following the procedure. Probing depth (PD), gingival recession depth (GRD), and clinical attachment level (CAL) were assessed at the gingival recession sites at baseline, postoperative 6 and 12 months. Cone-beam computerized tomography (CBCT) was used for quantitative radiographic analyses at baseline, 1 week and 12 months after bone-augmentation procedure.The sample was composed of a total of 12 patients (2 males and 10 females; mean age, 21.9 years) with 72 teeth showing dehiscence/fenestrations and 17 sites presenting with gingival recessions. Clinical evaluations revealed a statistically significant reduction in swelling, pain, and clinical appearance from postoperative week 1 to week 2 (P < .05). Moreover, gingival recession sites exhibited a significant reduction in the GRD and an increase in CAL after surgery with mean root coverage of 69.8% at the end of observation period (P < .01). Both alveolar bone height and width increased after surgery (P < .01) and decreased during the 12-month follow-up (P < .01). However, compared with the baseline records, there was still a significant increase in alveolar bone volume (P < .01).This modified PAOO technique may have advantages in terms of soft and hard tissue augmentation, facilitating extensive bone augmentation and allowing the simultaneous correction of vertical and horizontal defects in the labial aspect of the mandibular anterior area.

Growth of Palate in Unilateral Cleft Lip and Palate Patients Undergoing Two-stage Palatoplasty and Orthodontic Treatment.

The purpose of this study was to investigate the long-term effects of two-stage palatoplasty on the morphology of the maxillary alveolar arch and occlusion using plaster models of the maxilla and mandible obtained from patients with unilateral complete cleft lip and palate who also underwent orthodontic treatment. A total of 20 patients undergoing two-stage palatoplasty by Perko's method (Group T) were enrolled. Plaster models of the maxilla and mandible were obtained from each patient at Time 1, on commencement of orthodontic treatment in the mixed dentition period; at Time 2, on that of orthodontic treatment in the permanent dentition period; and at Time 3, on completion of active orthodontic treatment. Analysis of occlusion and morphological analysis were performed using a 3-dimensional measuring system. The results were compared with 15 patients who underwent one-stage palatoplasty by the push-back method using a mucoperiosteal flap (Group P). Alveolar morphology and the relationship between the maxilla and mandible were satisfactory in Group T. The palates in Group T were deeper and larger than those in Group P. Alveolar collapse in Group T was milder, and impairment of the alveolar morphology less notable than in Group P, as surgical invasion to the anterior alveolar region was avoided during the palatal growth period. These results suggest that two-stage palatoplasty is advantageous for jaw development.

3D Printed Medical Model to Resolve Cleft Alveolus Defect: A Case Study

3D printing or Additive Manufacturing (AM) technology has been in existence for more than 30 years. The footprint of this technology has been entered into almost each and every industry such as medical, dental, aerospace, construction, automobile, etc. One of the most benefited industries using AM is medical industry. In case of medical or maxillofacial surgical field, each and every patient has a unique anatomy. The traditional way of analyzing the patient anatomy was by using X-ray with single layer or CT scans with multiple layers information is available that too as soft data. 3D printing technology provides a physical model from virtual data of the patient anatomy using CT/MRI/CBCT information with the help of medical software. The physical 3D printed medical model is very useful for pre planning complex surgeries. The current case study is regarding a 35 years male patient, who presented with a defect in maxillary anterior alveolar region and nasal regurgitation of fluids. Based on chief complaint, history and clinical examination, a diagnosis of cleft alveolus was made. CT scan was advised to see the defect in all the 3 planes. The surgery was planned for reconstruction of the bony defect and to prevent escape of oral fluids into nasal cavity. Treatment planning and mock surgery were performed on the 3D printed medical model, which reduced about 30% of total surgery time thereby decreasing the complications.

Positional Guidelines for Orthodontic Mini-implant Placement in the Anterior Alveolar Region: A Systematic Review

To investigate the adequacy of potential sites for insertion of orthodontic mini-implants (OMIs) in the anterior alveolar region (delimited by the first premolars) through a systematic review of studies that used computed tomography (CT) or cone beam CT (CBCT) to assess anatomical hard tissue parameters, such as bone thickness, available space, and bone density. MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched to identify all relevant papers published between 1980 and September 2011. An extensive search strategy was performed that included the key words "computerized (computed) tomography" and "mini-implants." Information was extracted from the eligible articles for three anatomical areas: maxillary anterior buccal, maxillary anterior palatal, and mandibular anterior buccal. Quantitative data obtained for each anatomical variable under study were evaluated qualitatively with a scoring system. Of the 790 articles identified by the search, 8 were eligible to be included in the study. The most favorable area for OMI insertion in the anterior maxilla (buccally and palatally) and mandible is between the canine and the first premolar. The best alternative area in the maxilla (buccally) and the mandible is between the lateral incisor and the canine, while in the maxillary palatal area it is between the central incisors or between the lateral incisor and the canine. Although there is considerable heterogeneity among studies, there is a good level of agreement regarding the optimal site for OMI placement in the anterior region among investigations of anatomical hard tissue parameters based on CT or CBCT scans. In this context, the area between the lateral incisor and the first premolar is the most favorable. However, interroot distance seems to be a critical factor that should be evaluated carefully.

Three-dimensional evaluation of soft tissue changes in the orofacial region after tooth-borne and bone-borne surgically assisted rapid maxillary expansion

This study seeks to three-dimensionally assess soft tissue changes in the orofacial region following tooth-borne and bone-borne surgically assisted rapid maxillary expansion (SARME). This prospective cohort study included 40 skeletally mature patients with transverse maxillary hypoplasia. A tooth-borne distractor (Hyrax) was used for expansion in 25 patients. In the remaining 15, a bone-borne distractor (transpalatal distractor, TPD) was used. Cone beam computed tomography (CBCT) scans were acquired before treatment (T0) and 22 months later (T1). 3D models were constructed from CBCT data and superimposed using voxel-based matching. Distance maps between the superimposed 3D models were computed to evaluate the degree of skeletal and soft tissue changes in the maxillary region. Distance maps showed negative distances (mean -1.25 (±1.5) mm) in the middle of the upper lip, indicating posterior repositioning of this area. The cheek region showed positive changes (mean 1.66 (±1.1) mm), reflecting the underlying increase in maxillary width. There was no significant difference between the two groups in all measured distances (p > 0.05). Retro-positioning of the upper lip accompanied skeletal remodeling in the anterior alveolar region at a mean ratio of 88 %, while the cheek region followed 32 % of the alveolar expansion. Soft tissue changes following SARME include posterior repositioning of the upper lip and increased projection of the cheek area. These changes were comparable between bone-borne and tooth-borne appliances. This study provides clinicians with more information over the expected orofacial soft tissue changes following SARME.

Three-dimensional prospective evaluation of tooth-borne and bone-borne surgically assisted rapid maxillary expansion

AimTo three-dimensionally (3D) assess the long-term effects of tooth-borne and bone-borne surgically assisted rapid maxillary expansion (SARME). Subjects and methodsThis prospective cohort study comprised 45 consecutive skeletally mature non-syndromic patients with transverse maxillary hypoplasia. In 28 patients, a tooth-borne distractor (Hyrax) was used for expansion, whereas in the remaining 17 a bone-borne distractor (transpalatal distractor, TPD) was used. Cone beam computed tomography (CBCT) scans were performed before treatment (T0) and 22 months later, after fixed appliance treatment (T1). 3D models were constructed from CBCT data and superimposed using voxel-based matching. Distance maps between the superimposed models were computed to evaluate the amount of skeletal changes. ResultsThe distance maps of the superimposed models showed positive distances on the right and left posterior alveolar segments of the maxilla indicating lateral expansion. The anterior maxillary region showed negative distances or posterior displacement and remodelling of the anterior alveolar region. There was no statistically significant difference between TPD and Hyrax for the three alveolar segments (p values ranged 0.63–0.81). ConclusionBone-borne and tooth-borne SARME were found to produce comparable results at the end of fixed appliance treatment regarding skeletal changes.

¿Escorbuto en los neandertales? Posibles casos en Combe-Grenal (Domme, Francia)

This paper analyzes three human bones found by F. Bordes in the French cave of Combe-Grenal. They are part of the twenty-eight fossils from level 25 (~75/65 ky) assigned to H. s. neanderthalensis and accompanied by Mousterian (Quina) culture. Chronostratigraphic and faunal data document very cold climatic conditions corresponding to OIS 4. The fossils consist of a small parietal fragment (Combe-Grenal A), and two incomplete mandibles, the juvenile Combe-Grenal III-IV, and the child Combe-Grenal I. The three remains show bony lesions which have altered the cortical bone. These are interpreted as the result of a reaction to chronic haemorrhages. In the parietal the periostitis may be due to the rupture of some parts of the middle meningea arteria media. In the subadult mandible it is related with the deep vasculature associated with the temporalis muscle function, while in the child the reactive bone is probably connected to the mentalis artery and stress at the anterior alveolar region. The lesions are interpreted as possible the result of scurvy, considering the bony reactions on the parietal and two mandibles, the identified cases published, the aethiology of this disease, and the periglacial environmental conditions in which these Neanderthals lived.

臨床病理学的に診断に苦慮した上顎前部無色素性悪性黒色腫の１例

Amelanotic malignant melanoma rarely occurs in the oral cavity. We encountered and treated patient with a nodular amelanotic malignant melanoma arising in the maxilla. An 84-year-old woman was referred to our hospital because of a painless, pedunculated, nonpigmented tumor in the center of the anterior alveolar region of the maxilla. The clinical diagnosis was a benign tumor, and the lesion was excised. However, the histopathological diagnosis was malignant fibrous histiocytoma.Three months later, a small, partially pigmented tumorous lesion appeared in the same region. The tumor was resected, and minute quantities of melanin granules were observed in some tumor cells histologically. The specimen was diagnosed as amelanotic malignant melanoma. We performed immunohistochemical studies, and positive immunoreactivity for HMB-45 was found in each specimen, confirming the diagnosis.Although the patient subsequently underwent rotation radiotherapy to the maxilla, recurrence was found in the nasal cavity and ethmoidal sinuses 13 months after radiation therapy. The tumor grew rapidly, and the patient died 2 years 5 months after presentation.

Palatal Changes after Lip Surgery in Different Types of Cleft Lip and Palate

This study concerns palatal development during 6 months following primary lip closure. The sample consisted of 75 children with different forms of cleft lip and palate and 51 noncleft children. The palate was measured at 3 months of age, just before lip surgery, after surgery at 6 months, and again at 9 months of age. The results showed that lip closure has a strong effect in the anterior alveolar region. This effect was restricted to 3 months after surgery. The changes in complete clefts were more explicit than in incomplete cleft forms. Furthermore, the data showed that arch depth reduction due to lip surgery was compensated for by continued anteroposterior palatal growth. Early orthopedics appeared to prevent major palatal collapse immediately after lip surgery. Finally simultaneous closure of the alveolar cleft at the nasal side resulted in continued reduction of anterior cleft width.

Influence of surgery on maxillary growth in cleft lip and/or palate patients

Using a sample of 204 caucasian adults of both sexes, with complete unilateral cleft lip and alveolus, isolated cleft palate and complete unilateral cleft lip, alveolus and palate, the influence of surgery on maxillary morphology and spatial position for the three main types of cleft lip and/or palate were evaluated. 113 cleft patients operated on at conventional timings were compared to 91 cleft patients who had never been operated on. Findings permit the conclusion that cheiloplasty in cleft lip and alveolus patients is associated with osseous remodelling in the anterior alveolar region, without significant changes in anterior nasal spine or other areas of the maxilla. In isolated cleft palate subjects palate repair does not promote significant changes in maxillary morphology and spatial position. The most evident effects were seen in the cleft lip, alveolus and palate group: reconstructive surgery in these patients leads to a severe maxillary retroposition associated with a downward rotation.

上顎に発生した腺様嚢胞癌の２症例

The predilection places of adenoid cystic carcinoma are the submandibular gland of the major salivary glands and the palatine gland of the minor salivary glands.In this paper 2 cases of adenoid cystic carcinoma of the maxilla are presented. The sites of the tumors were the anterior alveolar region and the relatively anterior region of the hard palate, and these sites wee considered to be fairly rare.

下がく前歯部歯肉に発生したゆうぜい状がんの１例

Verrucous carcinoma was first described by Ackerman in 1948, and is generally referred to as “Ackerman tumor”. In Japan, a case was reported in 1967 by Kozaki et al, followed by a report by Ishikawa et al, in 1970. This tumor is regarded clinically and histopathologically as a squamous cell carcinoma with relatively benign characteristics. It is relatively rare and found in the oral cavity region.The authors reported a case of verrucous carcinoma in a 73 year old male. The patient felt irritation in his lower anterior alveolar region with his tongue, one month prior to visiting the Oral Surgery Dept. on October 23, 1980. Due to the lack of subjective symptoms, he failed to apply for a medical examination. At his first visit, his chief complaint as a slight increase in tumor. The case was examined at our clinic at the Department of Oral Surgery, School of Dentistry Higashi Nippon Gakuen University.Upon examination, the tumor was found to be a peduncular the last part of this sentence is not clear tumor with a relatively soft and wide base. It extended over the lower anterior alveolar crest region from 3 to 4 mediodistal region. It reached the mucolabial fold on the lip side and touched the mouth floor mucosa on the tongue side with a surface that resembled califlower. The tumor was suspected to be a gum papilloma or possible carcinoma and was extirpated. After extirpation of the left glandula submandibularis and the gum and alveolar process from 3 distal region to 4 distal region in a lump, ilium transplantation into the region was conducted. Four years and 8 months after the operation the recovery course may be considered favorable.Pathohistologically, the tumor was a papillary proliferation of stratified epithelium accom panied by slender connective tissues. Rather than penetrating deeply into the lamina propria, it appeared as a papillary proliferation of the epithelium in a downward direction. The point of the leading portion of the proliferation base was higher than the line drawn between the ends of the circumferential mucous menbrane. At the same time, a somewhat deep and narrow cleft was seen between the papillary epithelia, but no substance filling the cleft was seen. Histologically, the tumor comprised mainy of acanthosis with a slight degree of parakeratosis. In the basal layer atypia of epithelial tumor cells to a slight degree was seen. On the other hand the basement membrane was preserved but phlogocyte infiltration was intensive and destroyed the basement in places. Thus, the tumor was determined to be verrucous carcinoma from the histopathological diagnosis.

Chondrogenic tumors of the jaws

Abstract 1. 1. Chondrogenic tumors of the jaws are extremely uncommon as is evident from the small number of cases reported in the literature. 2. 2. According to the literature reviewed, chondrogenic tumors appear to be more often malignant than benign when occurring in the jaws. Thirty-six cases of chondrosarcoma have been reported, as compared to eighteen cases of benign cartilaginous tumors. 3. 3. The histologic differentiation between benign and malignant chondrogenic tumors does not often accurately predict the conduct of the tumor and, therefore, 20 per cent of the cases reported in the literature were inadvertently underdiagnosed at the first microscopic interpretation. 4. 4. When benign, chondrogenic tumors grow very slowly, are locally invasive, difficult to remove completely and, therefore, are apt to recur. It is feasible that some of them, after long periods of time, may undergo malignant transformation. 5. 5. Chondrogenic tumors occur with almost equal frequency in the maxilla and mandible. In the maxilla, the most common site of involvement is the anterior alveolar region. In the mandible, the pre-molar and molar regions, the symphysis and the coronoid and condylar processes may be involved. 6. 6. The average age of patients with chondrosarcomas of the jaws (thirty-six cases) is approximately forty years. Eighty per cent of the cases occurred from the third to the sixth decades with the highest incidence in the third and fifth decades. (Fig. 10.) 7. 7. Chondrogenic tumors showed no racial predilection in the reported cases. However, both cases discussed in detail in this paper occurred in Negroes. 8. 8. Chondrosarcomas of the jaws seem to offer a more serious prognosis than osteogenic sarcomas. The five year survival rate in chondrosarcomas of the jaws appears to be much lower than the 31 per cent reported by Kragh [21] in osteogenic sarcomas. 9. 9. Radical surgical treatment appears to be the method of choice. Radiation therapy may be used as an adjunct in recurrences and as a form of palliation.

Chondrogenic tumors of the jaws

1. 1. Chondrogenic tumors of the jaws are extremely uncommon as is evident from the small number of cases reported in the literature. 2. 2. According to the literature reviewed, chondrogenic tumors appear to be more often malignant than benign when occurring in the jaws. Thirty-six cases of chondrosarcoma have been reported, as compared to eighteen cases of benign cartilaginous tumors. 3. 3. The histologic differentiation between benign and malignant chondrogenic tumors does not often accurately predict the conduct of the tumor and, therefore, 20 per cent of the cases reported in the literature were inadvertently underdiagnosed at the first microscopic interpretation. 4. 4. When benign, chondrogenic tumors grow very slowly, are locally invasive, difficult to remove completely and, therefore, are apt to recur. It is feasible that some of them, after long periods of time, may undergo malignant transformation. 5. 5. Chondrogenic tumors occur with almost equal frequency in the maxilla and mandible. In the maxilla, the most common site of involvement is the anterior alveolar region. In the mandible, the pre-molar and molar regions, the symphysis and the coronoid and condylar processes may be involved. 6. 6. The average age of patients with chondrosarcomas of the jaws (thirty-six cases) is approximately forty years. Eighty per cent of the cases occurred from the third to the sixth decades with the highest incidence in the third and fifth decades. (Fig. 10.) 7. 7. Chondrogenic tumors showed no racial predilection in the reported cases. However, both cases discussed in detail in this paper occurred in Negroes. 8. 8. Chondrosarcomas of the jaws seem to offer a more serious prognosis than osteogenic sarcomas. The five year survival rate in chondrosarcomas of the jaws appears to be much lower than the 31 per cent reported by Kragh [21] in osteogenic sarcomas. 9. 9. Radical surgical treatment appears to be the method of choice. Radiation therapy may be used as an adjunct in recurrences and as a form of palliation.

A Gorilla Skull with Abnormal Denture

The skull described above has an apparent chin, due to marked recession of the anterior alveolar region of the mandible, as a result, presumably; of destruction of the anterior alveolar tissue. The molars and premolars, both upper and lower, are deeply pitted, and the cusps are unusually prominent. The articular surfaces are very irregular and show marked departures from the normal plane. The jaw had little side to side swing. The comparatively deep and asymmetrical glenoid fossae, as well as the irregularities of the articular surfaces of the teeth are doubtless functionally related to the up and down movement of the jaw, which was due in part to the fact that the constricted anterior portion of the mandible forced the median line of the lower teeth well within the median line of the upper.