Anterior Maxillary Arch Research Articles

Design of protective splint for endotracheal intubation in patients with partially edentulous maxillary anterior arch

Design of protective splint for endotracheal intubation in patients with partially edentulous maxillary anterior arch

Analysis of the Facial Measurements and Dental Arch Dimensions for the Construction of Dental Prostheses among Adult Yemenis.

To investigate the dental arch dimension (width, length, and height) and facial measurements including inner-canthal width (ICW), bizygomatic width (BZW), inter-alar width (IAW), and mouth width (MW), and to assess the correlation between these facial measurements and dental arch width (canine width [CW], inter-first premolar width [I1PW], and inter-first molar width [I1MW]), to establish a preliminary reference for artificial teeth selection in Yemeni adult. The study included 80 individuals (40 males and 40 females) with symmetrical faces and normal class I occlusion ranging in age from 20 to 35. Maxillary and mandibular stone casts were made for each individual. The dimensions of dental casts and facial measurements, including ICW, BZW, IAW, and MW, were assessed using a digital caliper. The collected data were analyzed by using the SPSS software program. The descriptive statistics for each measurement were made. Differences between males and females were tested using an independent-sample t-test with p-values below 0.05 considered significant. Pearson correlation coefficient between facial measurements and dental arch width was also done. Most dental arch dimensions and facial measurements exhibited larger mean values in the male than in the female group, with the greatest significant difference in the maxillary dental arch width and the lowest in mandibular dental arch length. A highly significant correlation is observed between ICW and maxillary canine width (CW) (r = 0.318, p = 0.004). In contrast, no significant correlation between dental arch width and BZW, IAW, and MW is shown. Within this study's limitations, the ICW can determine the ideal dimension of the artificial teeth in the anterior maxillary arch. While the other facial parameters, including BZW, IAW, and MW, cannot be used for artificial teeth selection in Yemeni populations. The findings of this study established a reference database of facial measurements and their correlation to dental arch and teeth width in Yemeni populations. So, it can be implemented in artificial teeth and dental prostheses design and construction.

The lower bow-shaped curve as a novel reference frame to determine the lateral limit of the maxillary anterior arch for smile esthetics

Smile analysis in horizontally angled views is indispensable for esthetic assessment and could reveal teeth-to-lip disharmony, which might escape discovery in the frontal and profile views. However, evidence is lacking on where the anterior teeth should be positioned for esthetics in angled smiles. Based on 3-dimensional facial image processing and geometric analysis, the lip edges were projected to the horizontal plane, and the horizontal teeth-to-lip relation was simplified and represented by the distances from dental landmarks to lower bow-shaped curves (LBSC), with the distance from facial-axis (FA) point of the canine to LBSC (FA-tangent line [TL] distance) identified as the key parameter. Using photographic modification and esthetic assessment, the effect of FA-TL distances on the attractiveness of 45° angled smiles was tested, with esthetic ranges identified. A simplified method was developed to obtain the estimative LBSC and FA-TL distances using 2-dimensional photographs and geometric analysis to facilitate clinical application. The FA-TL distance remarkably affected the esthetics of 45° angled smiles. Smiles were attractive when the FA-TL distance ranged from -1.0 to 1.5 mm perceived by orthodontists and from -1.5 to 1.5 mm perceived by laypersons. The 2-dimensional photograph-derived estimative FA-TL distance was not significantly different from that obtained in a 3-dimensional image, validating the simplified method. The LBSC could serve as a reference frame to determine the lateral limit of the maxillary anterior arch for the esthetics of 45° angled smiles. The FA-TL distance, which represented the spatial relation of the maxillary canine with the lower lip, was an esthetically essential parameter. For females aged 20-30 years, the FA point of the maxillary canines should be positioned no more than 1.5 mm labial or lingual to the LBSC.

Bone and Soft Tissue Modifications in Immediate Implants Versus Delayed Implants Inserted Following Alveolar Ridge Preservation: A Randomized Controlled Clinical Trial. Part I: Esthetic Outcomes.

Soft tissue changes were evaluated over a period of 1 year in 48 patients who required extraction of a single tooth in the anterior maxillary arch (premolar to premolar) and its replacement with an implant. The patients were randomly divided into two groups: In group A, an immediate postextraction implant was placed, and the bone-to-implant gap was filled with bovine bone mineral; in group B, the alveolar ridge preservation technique was performed after extraction, and the implant was placed 4 months later. On the day of tooth extraction (T0) and 1 year after tooth extraction (T1), the soft tissue horizontal width, mesial and distal papillary levels, midfacial gingival level, and Pink Esthetic Score were evaluated in both groups. No significant differences were observed between the groups in any of the considered parameters. Statistically significant differences were found in the soft tissue horizontal width between T0 and T1. The clinical results of the two procedures were similar and comparable over time. When evaluating the stability of the soft tissue contour, and considering the specific indications of the two techniques, it is possible to choose either an immediate implant or an alveolar ridge preservation technique with staged placement.

Associations among the anterior maxillary dental arch form, alveolar bone thickness, and the sagittal root position of the maxillary central incisors in relation to immediate implant placement: A cone-beam computed tomography analysis.

PurposeThis study evaluated the associations of the dental arch form, age-sex groups, and sagittal root position (SRP) with alveolar bone thickness of the maxillary central incisors using cone-beam computed tomography (CBCT) images.Materials and MethodsCBCT images of 280 patients were categorized based on the dental arch form and age-sex groups. From these patients, 560 sagittal CBCT images of the maxillary central incisors were examined to measure the labial and palatal bone thickness at the apex level and the palatal bone at the mid-root level, according to the SRP classification. The chi-square test, Kruskal-Wallis test, and multiple linear regression were used for statistical analyses.ResultsSignificant differences were found in alveolar bone thickness depending on the arch form and SRP at the apex level. The square dental arch form and class I SRP showed the highest bone thickness at both levels of the palatal aspect. The taper dental arch form and class II SRP presented the highest bone thickness at the apex level of the labial aspect. No association was found between the dental arch form and SRP. Elderly women showed a significant association with thinner alveolar bone. Age-sex group, the dental arch form, and SRP had significant associations with alveolar bone thickness at the apex level.ConclusionThe patient’s age-sex group, dental arch form, and SRP were associated with alveolar bone thickness around the maxillary central incisors with varying magnitudes. Therefore, clinicians should take these factors into account when planning immediate implant placement.

Comparison of maxillary anterior mathematical proportions among 3 dental arch forms

Statement of problemRace and sex differences in the mathematical proportions of maxillary anterior teeth have been evaluated. However, studies exploring the relationship between the mathematical proportion of maxillary anterior teeth and maxillary dental arch form are lacking. PurposeThe purpose of this clinical study was to determine if a correlation exists between the mathematical proportions of maxillary anterior teeth and 3 dental arch forms. Material and methodsThree hundred young participants were recruited according to predefined criteria, and images and maxillary casts were obtained. The perceived width and length of the maxillary anterior teeth were measured on the images by using a software program, and mathematical proportions, including width ratios and width-to-length ratios, were calculated for each. The casts were used to categorize each specimen into tapered, ovoid, or square groups by using a specific classification method, and the width ratios and width-to-height ratios of the 3 dental arch forms were compared. Statistical analysis was performed by using analysis of variance (ANOVA) or the Kruskal-Wallis H test to compare the mathematical proportions of maxillary anterior teeth among the 3 dental arch forms (α=.05). The intraclass correlation coefficient (ICC) was used to test the reliability of the investigators. ResultsExcept for the width-to-length ratios of the central incisor, mathematical proportions were affected by the dental arch form. The perceived width ratios of the maxillary lateral incisor-to-central incisor gradually increased from the tapered arch to the ovoid arch and from the ovoid arch to the square arch, with mean ±standard deviation values of 0.71 ±0.04, 0.73 ±0.05, and 0.79 ±0.06, respectively. For the maxillary perceived width ratios of canine-to-lateral incisor, the ovoid arch had the maximum perceived width ratios (0.86 ±0.10), followed by the tapered (0.82 ±0.10) and square arches (0.77 ±0.11). The width-to-length ratios of the central incisor were not affected by the arch form (P=.075), and the width-to-length ratios of the lateral incisor increased as the arch form became flat, with respective values of 0.70 ±0.10, 0.74 ±0.10, and 0.76 ±0.10. For the width-to-length ratios of the canine, the ovoid arch had the maximum perceived width ratios (0.58 ±0.10), followed by the tapered (0.53 ±0.10) and square arches (0.52 ±0.10). ConclusionsThe mathematical proportions varied among the 3 dental arch forms, and the dental arch form should be considered during the prosthodontic design of maxillary anterior teeth.

Reliability of odontometric parameters in stature analysis.

Background:To emphasize the role of odontometric parameters which may be used as a reliable forensic tool especially in cases with partial remains of the individualAim:To assess the reliability of odontometric parameters in stature analysisMaterials and Methods:The study was conducted on 100 patients (50 male and 50 Female). Mesiodistal width of anterior teeth, inter-canine width, Inter-premolar width and maxillary arch length were the parameters included. The results were tabulated with a linear regression formula obtained for each parameter.Statistical Analysis:The data collected was statistically analysed using SPSS version 20 and a linear regression formula was obtained thereafter.Results:Mesio-distal widths of individual maxillary canines, total mesiodistal width of maxillary anteriors and arch length showed a significant co-relation with stature. The combined linear regression formula was obtained for all parameters.Conclusion:Odontometric parameters of mesio - distal widths of individual maxillary canines, total mesiodistal width of maxillary anteriors and arch length can be used as reliable parameters for stature analysis.

ESTHETIC TREATMENT OF HYPERPIGMENTED GINGIVA BY SCALPEL AND LASER: A COMPARATIVE CASE REPORT

BACKGROUND: Melanin pigmentation in the gingiva occurs as a result of excess deposition of melanin, due to which the gingiva appears black. Many people complain of dark gums as unesthetic. Gingiva is the most frequently pigmented intraoral tissue, more pigmentation concentrated in the incisor region which may interfere with the smile line and patient may feel conscious about the appearance. In such patients, esthetic periodontal plastic surgery can give excellent results. CASE REPORT: In this case report we have attempted and compared, two different depigmentation techniques using a semi-conductor diode laser technique in maxillary anterior arch and conventionally by scalpel technique in mandibular anterior arch. RESULT: Both scalpel and laser improved esthetics. However the laser treatment resulted in no post-operative bleeding and no post-operative pain as compared with scalpel technique. CONCLUSION: Use of diode laser is the safe and effective alternative procedure for the treatment of hyperpigmented gingiva. Its benefits include ease of usage, comfort in dental clinics, reduce trauma to the patient. KEYWORDS: Diode laser, Depigmentation, Melanin pigment.

Analysis of the relationship among maxillary anterior teeth width, anterior arch perimeter and anterior segment depth

To analyze the relationship between the width of the maxillary anterior teeth and the anterior arch perimeter, to analyze the change rule of the width of the anterior teeth and the anterior arch perimeter, when altered the convexity of the anterior arch, with the width of the maxillary anterior arch keeping constant, and to provide a reliable basis for later digitized and personalized aesthetic analysis of front teeth. In the study, 61 front teeth complete and well-arranged models had been selected from the working models after the prostheses in Department of Prosthodontics, Peking University School and Hospital of Stomatology, including 22 male models and 39 female models. A photograph was taken from the occlusal surface of each model using the fixed magnification with a single lens reflex camera. The width of anterior teeth, the width of anterior arch and the convexity of anterior arch had been measured using the Photoshop software. The ratio of the width of the anterior teeth to the width of the anterior arch was calculated. Keeping the width of anterior arch unchanged, the layer free transformation function used to add or decrease the curvature of the anterior arch from 1-5 mm, each circumference of the anterior arch was measured. According to the proportion of their anterior teeth in the anterior arch perimeter, the width of each anterior teeth crown under different convexities of anterior arch was calculated. SPSS 23.0 was used to analyze the ratio of the width anterior teeth to the anterior arch perimeter and correlation between the convexity of the anterior arch and the width of the anterior teeth. The percentages of the median length of the anterior arch in the central incisor, lateral incisor and canine were 36.2%±1.3%, 30.2%±1.5%, and 33.6%±1.4%, respectively. The proportions were normal distributions and not related to the perimeter of the anterior arch. When the width of the anterior arch was constant, there was a positive correlation between the convexity of anterior arch in the range of 5 mm and the width of anterior teeth or the front arch circumference. With each increase or decrease of 1 mm of the convexity of anterior arch, the width of the middle incisor increased or decreased by about 0.18 mm, the half circumference of the anterior arch increased or decreased by about 0.50 mm. The width of the anterior teeth in the middle-distal direction remained stable in the anterior arch circumference. Within a certain range, when the width of the maxillary anterior arch remains unchanged, the width of the anterior teeth and the perimeter of the anterior teeth are positively correlated to the convexity of the anterior arch.

Use of Anterolateral Thigh Flap and Fibula Flap in Oncologic Maxillary Reconstruction: An Algorithm Approach.

Maxillary defects after oncologic resection can lead to not only cosmetic deformity but also functional problem. Reconstruction of maxillary defects remains the most challenging endeavor for plastic surgeons. An algorithm to guide plastic surgeons in selecting either the anterolateral thigh flap or the fibula flap for oncologic maxillary reconstruction has not been well established. Patients who underwent oncologic maxillectomy and free flap reconstruction from August 2012 to April 2018 were enrolled for retrospective chart review. Their operative findings and postoperative outcomes were analyzed as a case series. The reconstructive plan was decided using the 4 essential components in sequence: the anterior maxillary arch, orbital floor, eyeball, and oro-sinonasal communication, which are the main considerations in the established classification systems. Accordingly, when the anterior maxillary arch was lost or when the orbital floor was lost with eyeball preservation, a fibula flap was used. Otherwise, an anterolateral thigh flap was used. Various maxillectomy defects were successfully reconstructed using an anterolateral thigh flap and a fibula flap. The defect types and corresponding reconstruction were fit into our proposed algorithm and classification. The corresponding outcomes were satisfactory. The proposed algorithm by using the anterolateral thigh flap and the fibula flap for oncologic maxillary reconstruction is feasible, simple, and effective.

Influence of teeth anatomical characteristics on the efficacy of manual toothbrushing manoeuvres

PurposeThe aim of the study was to investigate the efficacy of two toothbrushing techniques on the amount of plaque accumulation and to evaluate how the changes were correlated to the anatomical characteristics of the anterior maxillary arch. MethodsThirty subjects of both genders were included, they were asked not to brush for 12 h. Afterwards, they were asked to manually brush the left side of their maxillary arch with the modified Bass technique and the right side adopting the roll technique. The comparison of photographs taken before and after the manoeuvres, using a plaque disclosing agent, allowed the researchers to measure the changes in plaque accumulation measured using the Quigley and Hein plaque scoring classification. Linear regression analysis was used to evaluate the correlation between such changes and the teeth and arch anatomical characteristics. ResultsA mean reduction of 9.6 ± 5.2% considering both arches after brushing was observed. The changes in plaque accumulation were not different between the two techniques. The length of the line obtained joining the contact point between the central incisors and the contact point between the second premolar and the first molar on the left side and the distance between that line and the lateral incisor on the same side positively correlated to the decrease in the plaque scores (P = 0.046 and P = 0.044, respectively). ConclusionBoth tested techniques were effective in plaque removal in the anterior maxillary arches. However, the research for the anatomical factors influencing the amount of efficacy of the toothbrushing manoeuvres was inconclusive. We can hypothesise that the adoption of one adequate technique could be more important than the teeth characteristics.

Incisor malalignment and the risk of periodontal disease progression.

The objective of this study was to investigate the association between incisor crowding, irregularity, and periodontal disease progression in the anterior teeth. Data collected over 35years from men enrolled in the Veterans Affairs Dental Longitudinal Study included information concerning pocket depth and alveolar bone loss. Plaster casts of the maxillary (n=400) and mandibular (n=408) arches were available for baseline measurements. Periodontal disease in the anterior teeth was defined as per arch sum of pathologic pocket depth and sum of teeth with any alveolar bone loss in the anterior sextants. Incisor malalignment status was defined by the anterior tooth size-arch length discrepancy index and Little's Irregularity Index. Adjusted mixed effects linear models computed the beta (β) estimates and 95% confidence intervals (95% CI) of the amounts of change in periodontal disease outcomes by the level of malalignment. In the anterior maxillary arch, crowding and spacing were significantly associated with an increased per-arch sum of pathologic pocket depth (β, 0.70mm; 95% CI, 0.20-1.21, and β, 0.49mm; 95% CI, 0.06-0.91, respectively). In the anterior mandibular arch, incisor crowding and irregularity were significantly associated with an increased per-arch sum of pathologic pocket depth (mild crowding: β, 0.47mm; 95% CI, 0.01-0.93; severe irregularity: β, 0.94mm; 95% CI, 0.50-1.38), and the sum number of teeth with alveolar bone loss (mild and moderate-to-severe crowding: β, 0.45 teeth; 95% CI, 0.08-0.82; and β, 0.45 teeth; 95% CI, 0.13-0.83, respectively; moderate irregularity: β, 0.34 teeth; 95% CI, 0.06-0.62). Certain incisor malalignment traits (ie, maxillary incisor crowding, maxillary incisor spacing, mandibular incisor mild crowding, mandibular incisor moderate-to-severe crowding, mandibular incisor moderate irregularity, and mandibular incisor severe irregularity) are associated with significant periodontal disease progression.

Mathematical beta function formulation for maxillary arch form prediction in normal occlusion population.

The aim of this study was to assess the dental arch curvature in subjects with normal occlusion in an Iranian population and propose a beta function formula to predict maxillary arch form using the mandibular intermolar widths (IMW) and intermolar depths (IMD). The materials used were study casts of 54 adolescents with normal occlusion and mean age of 14.1years (25 males, 29 females, age range 12-16years). Curve-fitting analyses were carried out and the curves passing through the facial-axis point of the canines, premolars, first molars, and the incisal edges of the anterior teeth were studied using a 3D laser scanner. Using the measured IMW and IMD of the dental arches at the maxillary and mandibular first molar region, a beta function formula proposed for predicting maxillary arch form. The accuracy of the proposed formula was assessed on 10 randomly selected dental casts. The mean (SD) of the maxillary and mandibular IMW and IMD were 57.92 (4.75), 54.19 (5.31), and 31.59 (2.90) and 28.10 (2.59) mm, respectively. There was no gender dimorphism (P>0.05) for both variables (IMW, IMD). There was a strong positive association (n=10, Pearson r=0.98, P<0.05) between the measured (actual) maxillary arch length and proposed arch length derived from generated formula. The goodness of fit (whole arch) for the proposed beta function formula, using adjusted r square measure and root mean square in 10 patients averaged 0.97 and 1.49mm, respectively. The corresponding figures for the maxillary anterior arch (canine to canine) were 0.90 and 0.92mm, respectively. The proposed beta function formula used for predicting maxillary arch form based on two mandibular measures (IMW, IMD) was found to have a high accuracy for maxillary arch prediction in the Iranian population and may be used as a guide to fabricate customized arch wires or as an aid in maxillary reconstructive surgery.

An Evidence Based Restoration of Esthetically Challenged Maxillary Anterior Arch with Andrews Bridge System - A Case Report with 5 Years of Follow Up

The replacement of missing teeth and restoration of alveolar contour has always presented a problem in those patients who have suffered traumatic injuries to the anterior dentition and alveolar processes. Many of these injuries lead to excessive loss of the residual ridge and make it extremely difficult to restore with a conventional fixed prosthesis. Due to constrain of fixed pontic in relation to these residual ridges, the use of this modality is virtually eliminated as a successful means of restoring such defects. An approach to the treatment in such patients has been conceived whereby a removable pontic section is supported directly by adjacent abutment teeth in a manner similar to that of fixed prosthesis. This case report represents restoration of esthetically compromised partially edentulous maxillary anterior arch with a fixed-removable prosthesis. This article also illustrates the indications, advantages, disadvantages and limitations of the Andrews bridge system.

Three-Dimensional Changes of Maxilla after Secondary Alveolar Cleft Repair: Differences Between rhBMP-2 and Autologous Iliac Crest Bone Grafting.

Background:Recombinant human bone morphogenetic protein (rhBMP)-2 has been used as an alternative to autologous bone transferring, a standard method of treatment. However, its potential adverse effect on anterior maxillary arch is unknown. Thus, the purpose of this study was to quantify sagittal and transversal changes of anterior maxilla after secondary alveolar cleft repair using traditional iliac crest bone grafting versus rhBMP-2.Methods:Twelve unilateral complete cleft lip and palate patients were randomly divided into 2 groups. In group 1, patients underwent traditional iliac crest bone grafting transferring (n = 4), and in group 2, patients underwent alveolar cleft reconstruction using collagen matrix with lyophilized rhBMP-2 (n = 8). Computed tomography (CT) imaging was performed preoperatively and at 1 year postoperatively, using a previously standardized protocol. A three-dimensional (3D) CT cephalometric analysis of the linear and angular measurements of the sagittal and transverse maxilla planes was performed to assess intra- and intergroup maxillary changes.Results:Intra- and intergroup comparisons of the pre- and postoperative 3D CT cephalometric linear and angular measurements of the sagittal and transverse maxilla planes showed no significant (all P > 0.05) differences among all studied variables.Conclusions:There were no significant anterior maxilla changes after maxillary cleft repair either using iliac crest bone grafting or rhBMP-2.

Orofacial findings associated with obstructive sleep apnea in a group of Saudi Children.

Objectives:To evaluate orofacial and occlusion findings associated with obstructive sleep apnea (OSA) in a group of Saudi children.Methods:The sample consisted of 30 OSA patients, and 30 age and gender matched, healthy control. The following facial and occlusal features were evaluated: frontal view, facial profile, mandibular angle, tongue size, dental midline to facial midline, upper to lower dental midline, overjet, overbite, anterior open bite, cross bite, scissors bite, palatal vault, maxillary and mandibular arch crowding and spacing, molar and canine relationship.Results:Participants age ranged from 3 to 8 years. Study group had steeper mandibular angle, deeper palatal vault, and less spaced upper and lower arches. There was no statistically significant difference between the two examined groups regarding facial morphology, facial profile, midline, anterior openbite, tongue size, posterior crossbite, overjet or molar relationship.Conclusion:OSA children have a relatively different orofacial morphology compared with control children. OSA subjects had deeper palatal vault, steeper mandibular plane angle and less spaced upper and lower arches compared to control.

The modified “Wunderer” osteotomy for stabilization of the cleft-premaxilla – A new operative technique

The operative closure of bilateral cleft lip and palate is a difficult procedure that requires in most cases secondary corrections. Besides aesthetic improvements of lip and nose also the rehabilitation of the teeth, in particular of the maxillary arch is important for the improvement of the chewing function and also for the well being of the patient. One of the most disturbing factors for the construction of any type of prosthetic devices, like removable denture, fixed bridge or dental implants is the mobility and often also malposition of the premaxilla. This problem can only be solved by the insertion of bone grafts into the bilateral gaps of the anterior maxillary arch. This procedure however, is difficult due to the narrowness and poor overview that complicates the closure of the nasal mucosa, which is the precondition for the success. For facilitating the operation the premaxilla is osteotomized and reflected anteriorly according to the method of Wunderer (1962). Then, after the much easier closure of the nasal mucosa the bony defects can be filled with autogenous cancellous bone and finally the oral mucosa can be closed. A preoperatively prepared palatal acrylic plate helps to protect the palatal tissue and also stabilizes the position of the premaxilla. The blood supply to the osteotomized premaxilla is secured by a sound soft tissue pedicle of the buccal muco-periosteum. The effectiveness of the blood supply of the premaxilla was examined in experimental studies by several authors. Also investigations of the growth impediments of the premaxilla and the midface revealed that early osteotomies will interfere with the development of this region. Therefore it is advisable to carry out this procedure not before the patient has reached the age of 12–14 years, which is also depending on the race and the gender of the patient.

Malocclusion and orthodontic treatment need evaluated among subjects with Down syndrome using the Dental Aesthetic Index (DAI)

To determine the prevalence of malocclusion and need for orthodontic treatment among persons with Down Syndrome (DS). Study participants were 113 persons with DS from the selected community-based rehabilitation center who fulfilled the inclusion and exclusion criteria. Ten occlusal characteristics of the Dental Aesthetic Index (DAI) were measured on study models to determine the degree of malocclusion. A single score represented the dentofacial anomalies, determined the level of severity, and determined the need for orthodontic treatment. Crowding in the anterior maxillary and mandibular arch was the main malocclusion problems among the subjects with DS. Comparison between age group and genders revealed no significant differences in four categories of orthodontic treatment need (P > .05). Most of the subjects with DS (94; 83.2%) had severe and very severe malocclusion, which indicated a desirable and mandatory need for orthodontic treatment.

Palatal Rugae: A Potential Reference to Determine Key Anterior Maxilla Dimensions and Tooth Positions

Palatal rugae have been suggested as a stable landmark and potential biometric guide for positioning anterior maxillary teeth. This study aimed to evaluate the use of palatal rugae as a biomarker by establishing mathematical correlations with anterior maxillary dental arch geometry and tooth positions. One hundred dental casts were obtained from fully dentate individuals with normal occlusal relationships. Thirteen reference points were analyzed. Significant correlations were found between measurements in the anterior dental segment and palatal rugae measurements. Those correlation coefficients were, however, low. Although some correlation values obtained were statistically significant, they are not likely to have significant clinical predictive value.

Premaxillary characteristics in complete bilateral cleft lip and palate: A predictor for treatment outcome

Objectives:The aim of the current study was to investigate how bilateral cleft lip and palate (BCLP) cases responded differently to presurgical orthopedics (PSO) and primary lip repair (LR) based on premaxillary characteristics. We suggest a clinically oriented descriptive classification for BCLP based on premaxillary characteristics.Design and Setting:A retrospective longitudinal comparative study where available records of all non-syndromic patients with complete BCLP attending the Cleft Clinic, affiliated to the Oral and Maxillofacial Surgery department, Ain-Shams University, Cairo, Egypt were assessed.Sample Population and Methodology:Twenty-two cases were collected over a 4-years period from 2008 to 2011 (15 boys and 7 girls). Model assessment was performed for serial models representing four stages of treatment; M1: Prior to start of PSO, M2: At the end of PSO, M3: One month after LR, M4: Three months after LR. The premaxillary and vomerine widths were measured on M1. Models (M1-M4) were assessed for changes in anteroposterior projection, anterior arch width, intercanine width and posterior arch width and results were statistically analyzed. Intra-and postoperative surgical findings during and after primary LR were recorded. The sample was divided into two groups based on the premaxillary size and characteristics; Group R: Rudimentary premaxilla and Group P: Prominent premaxilla.Results:There was a highly significant difference in premaxillary width between the two groups (P = 0.00), changes in anteroposterior projection of the premaxilla were significant one and three months after LR. Changes in maxillary anterior arch width, intercanine and posterior arch widths were non-significant between groups. Mean age difference between the two groups was only statistically significant at the stage of LR. Surgical differences were noted between the two groups. Postoperatively as compared to group R; group P showed more premaxillary bulge and show at rest, as well as more prolabial stretching. In addition, facial profile was more convex in group P.Conclusion:The two types of BCLP outlined in this study are different from several aspects, and hence management should be modified according to each case. This descriptive classification provides a useful tool for evaluation and planning of patients with BCLP.