Traumatic dental injuries to primary teeth may adversely affect the development and eruption of permanent successors. This case report presents a rare example of spontaneous eruption of a permanent maxillary central incisor following avulsion of its primary predecessor. A 5-year-old girl experienced avulsion of the primary maxillary left central incisor, and delayed eruption of the permanent successor was noted at 8 years of age. Clinical and radiographic assessment revealed an unerupted permanent maxillary central incisor positioned high in the anterior maxilla near the nasal floor, without an obstructive etiology. Owing to the potential morbidity of surgical intervention, a conservative approach involving space maintenance and long-term follow-up was adopted. Despite a prolonged period of non-eruption, spontaneous eruption occurred. At the 10-year follow-up, the tooth remained vital, asymptomatic, and free of periapical pathology, and esthetic rehabilitation was successfully completed. This case highlights that spontaneous eruption may be possible even in initially unfavorable positions, underscoring the importance of individualized treatment planning.

Nasopalatine duct cysts may present with atypical radiographic features when arising in grafted alveolar cleft regions. A patient with cleft lip and palate presented with a well-defined radiolucent lesion in the anterior maxilla following alveolar bone grafting. Imaging demonstrated a unilocular lesion associated with displacement of the incisive canal, mimicking other odontogenic and nonodontogenic cysts. The unusual location and surgical history posed diagnostic challenges. Local trauma related to grafting may have contributed to cyst development. Careful radiographic assessment is essential for accurate differential diagnosis and appropriate management.

This observational study employed dental cone-beam computed tomography (CBCT) to evaluate the incidence and anatomical features of neurovascular structures within the lateral incisive canal (LIC). Images obtained from 221 patients were evaluated to determine the presence, diameter, and length of the LIC. Lateral incisive canals were identified in 24.4% of the CBCT images examined (bilaterally in 61.1% and unilaterally in 38.9%). One LIC was observed in 57.4% of cases, 2 in 16.7%, and 3 in 14.8%, with only a minority of cases displaying 4 to 6 LICs. The mean diameter of the LIC was 0.7±0.3 mm (0.3-1.8 mm) while that of the foramen was 0.8±0.4 mm (0.3-2.3 mm). Moreover, the mean length of the LIC was 8.9±4.1 mm (2.1-32.3 mm). The incidence of LICs (24.4%) was lower than that reported in previous CBCT studies of Asian populations. However, there may be regional differences in the incidence of anatomical structures, even among individuals of the same ethnic group. These results show that using CBCT to identify LICs can provide valuable information in the planning of surgical procedures involving the anterior maxilla.

This in vitro pilot study aimed to determine the impact of two different CBCT fields of view, intraoral scan areas and surgical template sizes on the accuracy of static computer-aided implant surgery. A total of 20 implant sites in the anterior maxilla of 20 polyurethane models of partially edentulous arches were divided into four groups based on CBCT field of view and intraoral scan area. The groups used either a small (40 × 40 mm) or medium field of view (50 × 100 mm), a full-maxilla or partial intraoral scan area and a full or partial surgical guide. CBCT and intraoral scan data were registered for implant planning, and surgical templates (either supported by all the remaining teeth or only by teeth 11 and 23) were designed accordingly. The implants were randomly placed through the template in a fully guided manner. Postoperative surface scans were superimposed on the preoperative planning data to evaluate the angular and spatial deviation between the planned and inserted implants. Descriptive statistics were followed by a non-parametric Kruskal-Wallis test to compare the differences between the groups. No significant differences were found when comparing the effect of the size of field of view, intraoral scan area and surgical template on the accuracy of static computer-aided implant surgery (P > 0.05). Preliminary findings indicate that field of view size, intraoral scan area and surgical template dimensions do not significantly affect the accuracy of static computer-aided implant surgery in the partially edentulous anterior maxilla, supporting the application of As Low As Diagnostically Acceptable being Indication-oriented and Patient-specific principles. The authors declare there are no conflicts of interest relating to this study.

Odontomas are the most common odontogenic tumors and are composed of dental tissues such as enamel, dentin and cementum. They are classified into compound and complex types. Compound odontomas usually appear as tooth-like structures in the anterior maxilla, whereas complex odontomas present as irregular masses of dental tissues, most frequently in the posterior mandible. Although odontomas are generally slow-growing and asymptomatic, large lesions can cause jaw expansion, facial asymmetry, and delayed tooth eruption. Various surgical approaches have been described, ranging from intraoral to extraoral incisions, with or without fixation. In the present study, we present a 21-year-old Iranian woman with a large mandibular complex odontoma extending from the first molar to the ramus. The lesion was removed via an intraoral approach without pathological fracture or the need for fixation. At the 4-month follow-up, the patient experienced uneventful healing and no signs of recurrence. This case highlights that even large mandibular odontomas can be managed intraorally without the need for fixation devices, with favorable short-term outcomes.

Traumatic dental injuries in immature permanent teeth present significant diagnostic and therapeutic challenges, particularly when associated with root fractures. A 7‐year‐old boy presented with trauma to the anterior maxilla after a fall on the pavement. Right central incisor (#11), previously unerupted due to premature extraction of the primary predecessor, erupted rapidly within 2 weeks post‐trauma, likely facilitated by dental trauma. Initial radiographic examination revealed an immature root with an open apex (Cvek Stage 1) and an oblique root fracture extending from the cervical region toward the middle–apical third. No other clinical signs were present. The patient remained asymptomatic throughout the observation period, reporting no pain or discomfort at any time. Cone beam computed tomography (CBCT) obtained 3 months later confirmed the root fracture and demonstrated dentin bridge formation, isolating the coronal pulp associated with the root fracture from the unaffected pulp. A sinus tract developed 6 months post‐trauma, but definitive treatment was delayed because of insufficient clinical crown for access. A month later, sufficient eruption allowed access cavity preparation. Under high magnification, a thick, continuous tertiary dentin bridge was observed overlying the pulp, with a localized pulpal exposure at the junction with the distal dentinal wall; bleeding confirmed pulpal vitality. The coronal pulp space above the bridge was gently irrigated with 1% NaOCl and 17% EDTA without mechanical instrumentation and subsequently sealed with a calcium silicate‐based cement up to 2 mm below the cementoenamel junction. Clinical and radiographic follow‐up for up to 2 years showed continued root development, dentin bridge formation, canal narrowing, and absence of symptoms. Conservative vital pulp therapy may be a viable treatment option in selected cases of root fractures in immature permanent teeth when pulp vitality is preserved.

This study evaluated the accuracy, time efficiency, and workflow consistency of artificial intelligence (AI)-assisted versus human expert (HI) implant planning in the esthetic anterior maxilla. Thirty-five single-tooth anterior maxillary cases with paired cone beam computed tomography (CBCT) and intraoral scans (IOS) were retrospectively recruited. A hybrid AI framework (Relu Automate), integrating rule-based constraints (≥ 2 mm labial bone, ≥ 1 mm palatal bone) with deep learning segmentation, was compared with conventional HI. The performance of each planning approach was evaluated based on the following: coronal and apical linear deviations, angular deviation, bone thickness, wax-up alignment, surgical guide fit, planning time, and consistency. Statistical analyses were performed with a significance level of 5% (α = 0.05). AI-assisted planning demonstrated clinically acceptable accuracy with mean coronal, apical, and angular deviations of 0.96 ± 0.6 mm, 1.24 ± 0.66 mm, and 4.3° ± 2.9°, respectively, meeting clinical thresholds in 94.3% (coronal), 85.7% (apical), and 94.3% (angular) of cases. Bone thickness measurements were equivalent between groups (labial: 2.0 mm for both groups; palatal: 1.5 mm AI versus 1.3 mm HI; p > 0.05). AI-assisted planning decreased the median planning time by 41.4% (p < 0.0001) while achieving perfect consistency compared to human experts (p < 0.05). ICC analysis revealed excellent agreement (≥ 0.9) across all spatial coordinates between AI and HI planning. AI-assisted implant planning achieved accuracy comparable to expert planning with improved efficiency and consistency, while AI-designed surgical guides demonstrated fit comparable to human-designed guides in the maxillary esthetic zone.

ABSTRACTBackgroundThis study aimed to evaluate the prevalence of peri‐implant soft tissue deformities, including dehiscences (PSTDs) and deficiencies, around bone‐level (BL) and tissue‐level (TL) implants in the anterior maxilla, assess associated variables, and patient‐reported outcomes (PROs).MethodsAdults with implant‐supported prostheses (ISPs) in the anterior maxilla were recruited. Clinical and digital assessments were performed, and related variables were analyzed.ResultsA total of 205 ISPs in 193 patients were evaluated. Mean follow‐up after implant placement was 11.3 ± 1.4 years. PSTD prevalence was comparable between BL and TL implants (88.8% vs. 94.4%; p = 0.19), or when PSTD ≥ 1 mm (23.9% vs. 22.5%; p = 0.97). Similarly, 99.25% and 100% of BL and TL showed deformities, p = 1.00. Prevalence of prosthetic interface/abutment (12.7% vs. 2.5%) and implant shoulder exposure (4.2% vs. 0%), and overcontoured ISP (35.2% vs. 12.7%) was significantly higher in TL implants (p < 0.01). Greater papilla dimensions and lower volume deficiency (90.3% vs. 98.6%; p < 0.01) were observed around BL implants, while mucosal discoloration was similar between groups (16.4% vs. 15.5%; p > 0.05). Greater PSTD depth was associated with older age, reduced keratinized mucosa width (< 2 mm), wider implant diameter, prosthetic overcontouring, lower mucosal volume, and papilla deficiencies (p < 0.05). Wider prosthetic emergence angles were associated with reduced papilla dimensions (p < 0.05). Thin mucosa (< 2 mm) was associated with grayish mucosal discoloration (OR = 2.79). Despite these findings, OHIP‐14 scores were low, and PROs were high, with no significant differences between groups.ConclusionsPrevalence of peri‐implant soft tissue deformities in the anterior maxilla is high irrespective of implant type and is associated with age, soft tissue phenotype, mucosal volume, papilla deficiencies, wider implant diameters, and prosthetic overcontouring. However, this does not seem to have a measurable impact on patient perception.

Introduction: The Nasopalatine Canal (NPC) is a vital structure in the anterior maxilla that contains the neurovascular bundle for the blood and nerve supply. It shows considerable anatomical variation, which influences the surgical and implant procedures in the anterior maxilla. Thus, with the help of Cone Beam Computed Tomography (CBCT), these variations can be evaluated more precisely to enhance treatment planning and for positive clinical outcomes. Aim: To evaluate the morphology and dimensions of NPC using CBCT and to determine the variability in relation to gender. Materials and Methods: The present retrospective crosssectional study was conducted in the Department of Oral Medicine and Radiology AB Shetty Memorial Institute of Dental Sciences for a period of one year from January 2024 to December 2024. A total of 200 CBCT scans in which complete NPC was visible were included in the study. The reconstructed sagittal sections were assessed for the shape, length, width at nasal and oral end, angulation and volume of NPC. Out of 200 scans, 100 were of females and 100 males with the age range of 20- 70 years. The statistical analysis between the groups was done using unpaired t-test and One-way Analysis of Variance (ANOVA) test. The categorical data was compared using Chi-square test. The p-value less than 0.05 was considered significant. Results: The most common shape was found to be cylindrical with no variation in relation to gender. The mean length of the canal was 13.56±2.3 mm in males and 11.6±2 mm in females, showing a statistically significant difference (p=0.001). Also, with advancement in age the length of the canal increased significantly (p=0.032). The width of the canal at oral end was greater with increase in age (p=0.001) and more in males than females (p=0.001) which was statistically significant. There was no significant difference in angulation and volume of canal in relation to age and gender. Conclusion: The present study highlights the variation in the morphology and dimensions of the NPC. The cylindrical shape was the most common. With increasing age, the length and width of the canal tends to increase, being greater in males than in females. The canal volume is greater in males than in females and increases with age. The angulation of the canal, however, demonstrates no significant variation with either age or gender.

Periodontal regenerative approaches have demonstrated predictable outcomes mainly in contained intrabony defects, where residual bony walls provide space maintenance and wound stability. Non-contained vertical periodontal defects lack these anatomical prerequisites and are therefore generally considered unsuitable for regenerative treatment, often leaving resective approaches or tooth extraction as the only therapeutic options. The objective of this proof-of-concept report was to describe a novel reconstructive surgical technique =(PerioTAG (tuberosity autogenous graft for periodontal reconstruction) designed to recreate a stable three-dimensional compartment to support periodontal reconstruction and defect stabilization, and to illustrate its clinical feasibility through representative cases. Three patients presenting with non-contained vertical periodontal defects in the anterior maxilla were treated using the PerioTAG technique. This approach involves reconstruction of the defect with an autogenous corticocancellous block graft harvested from the maxillary tuberosity and rigidly fixed to re-establish a three-dimensional bony compartment. Clinical and radiographic outcomes were evaluated over follow-up periods of up to three years. In all cases, the PerioTAG technique allowed stabilization of non-contained vertical periodontal defects, contributing to the preservation of the affected teeth and maintenance of periodontal support. Healing was uneventful, and clinical and radiographic follow-up demonstrated stable periodontal conditions with minimal impact on the esthetic appearance. Within the limitations of this proof-of-concept report, the PerioTAG technique may represent a reconstructive option for the management of non-contained vertical periodontal defects not amenable to conventional regenerative or resective approaches. Further controlled studies are required to assess its predictability and long-term stability.

Reverse compensation technique achieves accurate robotic-assisted implant surgery in the anterior maxilla: A prospective case series.

Prosthodontic rehabilitation using a patient-specific implant in an anterior maxilla with severe alveolar bone deficiency: A clinical report.

Anatomical complexities and socket configuration in anterior maxilla often results in challenging immediate implant placement, where implants tend to be facially positioned. Implants with facially placed shoulders exhibited three times more midfacial recession. Despite using surgical guides, osteotomy drills tend to follow the least resistance path dictated by socket anatomy. This prospective clinical trial aimed to measure the deviation from the planned implant position during immediate implant placement in the anterior maxilla and its impact on esthetic outcomes, utilizing a new computer-guided plateau drilling protocol. Twenty-six patients (7 males and 19 females, ages 20-42) with non-restorable maxillary anterior teeth participated in this study. Virtual planning was done using the Safe Angle Concept and the implants were placed with a partially guided approach. Standard tessellation language files obtained from scanned casts and initial computed tomography scans were used to plan the virtual position of the implants and surgical guides fabrication. Angular, global platform and global apex deviations from the planned implant position were measured after three-months. Bone formed labial to the implant and pink esthetic score were assessed after nine-months. The current investigation showed that the use of the new computer-guided plateau drilling protocol resulted in clinically acceptable ranges of angular, global platform, and global apex deviation 4.56 ± 3.14°, 0.91 ± 0.61mm, 1.47 ± 0.88mm respectively. Radiographic analysis revealed mean mm amount of bone formed labial to the implant of 2.13 ± 0.99mm and pink esthetic score displayed a mean of 11.89 ± 1.75, with a median of 12.5 after nine months. The virtual safe angle planning concept combined with plateau drilling protocol showed promising accuracy in immediate implant placement in the anterior maxilla. The resultant deviation had no influence on the esthetic outcomes. The current trial was registered at Clinical trials.gov (ID: NCT05750004, Date: 19-February-2023).

Orthodontic perspective on treatment recommendations for missing maxillary incisors: A contemporary guideline.

Accurate implant osteotomy positioning in the anterior maxilla remains a clinical challenge because the precision of different surgical guide fabrication methods has not been fully established. Therefore, it is of interest to compare the accuracy of osteotomy preparation using conventional vacuum-formed, desktop 3D-printed and industrially milled surgical guides in standardized anterior maxillary resin models. Thirty identical maxillary resin models with simulated central incisor edentulous sites were allocated into three groups (n=10 each) and osteotomy deviations from a single virtual implant plan were assessed using post-operative CBCT superimposition software for coronal, apical, angular and depth discrepancies. Industrially milled guides showed the lowest mean deviation at both the coronal (0.38 ± 0.14 mm) and apical (0.52 ± 0.18 mm) levels, followed by 3D-printed guides (0.54 ± 0.19 mm and 0.78 ± 0.22 mm), whereas conventional guides showed the greatest deviation. Digitally fabricated guides, particularly industrially milled guides, provided significantly greater osteotomy accuracy than conventional vacuum-formed guides in anterior maxillary implant placement.

Effect of Intracapsular Pressure on Pulp Sensitivity in Teeth Affected by Jaw Cysts: A Clinical Study Combined With Finite Element Analysis

Analog emergence profile conditioning after simultaneous hard- and soft-tissue augmentation: A 5-year clinical report.

Reconstruction of emergence profile using a digital mirroring technique in a custom biological definitive abutment and interim restoration in immediate implant placement in esthetic area: A clinical report with 4-year follow-up.

The anterior superior alveolar nerve (ASAN), a branch of the infraorbital nerve, provides sensory innervation to the anterior maxilla, lateral nasal wall, and maxillary dentition. Owing to its anatomical proximity to the anterior maxillary wall and piri-form aperture, the ASAN is vulnerable during lateral nasal wall surgery. Although postoperative sensory disturbances such as gingival hypoesthesia or dental numbness are frequently re-ported, prospective data combining subjective symptoms with objective sensory testing across different surgical techniques remain limited .

This prospective study evaluated the short- and long-term outcomes of dental implants over a 36-month follow-up according to the achieved insertion torque values. Patients requiring a single implant were recruited and classified by insertion torque (IT): low (10-29 Ncm), regular (30-50 Ncm), high (51-100 Ncm), and very high (> 100 Ncm). Outcomes assessed over 36 months included implant survival, success, marginal bone loss (MBL), and postoperative pain (POP), measured with a 10-cm VAS immediately after surgery, and at 24 hours, day 2, day 4, week 1, week 2, and week 3. Survival was analyzed using Kaplan-Meier estimates and Cox regression, and multivariate models were applied to identify predictors of MBL and POP. A total of 230 patients were included. At week 3, the POP in the very high-IT group (3.08 ± 2.77) was significantly higher than other groups (0.08 ± 0.55, P .001). A total of 15 implants failed in the first 2 months. The overall survival rate after 36 months was 78.1% for the very high-IT group and 97.9% for the regular-IT group. The survival rate was also reduced in patients who smoked compared with nonsmokers (78.1% and 98.3%, respectively). Significant failure predictors included: high IT (HR = 5.24), smoking (HR = 13.96), and maxillary placement (HR = 9.03). The multivariate analysis revealed significantly increased MBL associated with four key factors: high IT (> 100 Ncm), type I bone density, smoking status, and anterior maxillary placement (P .001). IT exceeding 100 Ncm was associated with increased POP, greater MBL, and reduced implant survival rates. The combination of high IT creating excessive interfacial stresses in dense (type I) bone, compounded by smoking-impaired healing and the thin cortical bone of the anterior maxilla, resulted in significantly greater MBL.