Maxillary Anterior Segment Research Articles

Nasolabial and Interincisal Angle Evaluation in Anterior Maxillary Distraction Osteogenesis: A Case Study:

Maxillary hypoplasia is a common developmental problem in cleft lip and palate deformities. These deformities have traditionally been corrected by means of orthognathic surgery. Management of skeletal deformities in the maxillofacial region has been a challenge for maxillofacial surgeons and orthodontists. Distraction osteogenesis (DO) is a surgical technique that uses body's own repairing mechanisms for optimal reconstruction of the hard and soft tissues. We present four cases of anterior maxillary distraction osteogenesis with tooth-borne distraction device— Hyrax, which were analyzed retrospectively using cephalometrics. Changes in nasolabial angle and interincisal angle after distraction of anterior maxillary segment were studied to conclude that there was no much change in the the nasolabial angle while the interincisal angle showed marked improvement.

Anesthetic efficacy of anterior middle superior alveolar injection in single-visit endodontic therapy: an in vivo study.

To evaluate and compare the anesthetic efficacy of anterior middle superior alveolar (AMSA) injection in single-visit endodontic therapy, an in vivo study. Teeth in the maxillary anterior segment (N= 60) requiring single-visit endodontic (SVE) therapy were selected. A conventional syringe with 26-guage needle containing 1.5ml lignocaine with 1:80,000 epinephrine was used for the AMSA injection. The SVE therapy was performed using standard protocol. Profoundness of anesthesia during therapy was evaluated at 15-, 30-, 60-, and 90-min intervals using pain rating score and marked on visual analogue scale. In patients who reported pain/ineffectiveness of anesthesia during the course of endodontic therapy, additional supplemental anesthesia (buccal/labial infiltration) was administered. Depending on effectiveness of anesthesia with the AMSA injection alone or the need for additional supplementary injections, patients were divided as: group I-only AMSA and group II-AMSA with one or two supplemental anesthesia. The AMSA injection was effective in 91.67% of the patients undergoing the SVE therapy and the duration of anesthesia for the AMSA injection alone was adequate until the completion of the SVE therapy. Supplementary injections were required in 8.33% of cases at 15-min interval to achieve profound anesthesia. The AMSA injection technique could be used as an alternative to the conventional infiltration technique for anesthetizing teeth in maxillary anterior segment during the SVE therapy. The AMSA injection provides profound pulpal anesthesia of teeth in maxillary anterior segment during endodontic therapy.

Prevalence, Causes and Pattern of Tooth Loss among Elderly People in Port Harcourt, Nigeria

Tooth loss constitutes a condition of public health interest and can be used as a measure of the oral health of a population. The study was undertaken to determine the prevalence, pattern and causes of tooth loss among the elderly in Port Harcourt, Nigeria. The study was an observational research design carried out using pensioners 60 years and above. Subjects were selected by systematic random sampling and data was collected by the use of questionnaire and clinical oral examination. Collected data was analyzed using SPSS version 20. No case of complete edentulousness was recorded in this study. The prevalence of tooth loss was 43.6%. Although the prevalence was higher in males than in females and older than younger age group, the difference was not significant. The mean tooth loss was 8.9±2.1. Tooth loss was higher in the maxillary anterior segment (14.2%) than the mandibular anterior segment (13.3%) and in the mandibular posterior segments (38.8%) than the maxillary posterior segments (33.7%). These differences were however not significant. Periodontal disease accounted for 50.3% (2435) of the tooth loss, dental caries and trauma accounted for 44.2% (2142) and 5.5% (264) of tooth loss respectively. The prevalence of tooth loss was high among the study population. Periodontal disease and dental caries were the main cause of tooth loss in this group. Therefore, there is need to educate and promote oral health among the populace geared towards improving oral hygiene and change in dietary pattern.

Management of impacted primary maxillary central incisor: A report

Impaction of primary tooth is a rare and unusual finding, particularly in the maxillary anterior segment. A variety of reasons are listed in literature for such condition. Here is a case report of impacted primary maxillary left central incisor in a 4-year-old child. The condition was diagnosed with the help of clinical examination, intraoral periapical radiograph, and cone-beam computed tomography. The tooth was surgically removed, and the patient was asked for periodic check-up.

Assessment of the Removable Orthodontic Treatment Outcome Using Peer Assessment Rating Index

Background and objectives: Removable orthodontic appliances are useful in a variety of situations but present the inherent disadvantage of the treatment being in the control of the patient. Evaluation of orthodontic treatment result, aids to establish aims and reach a measurable finish for completed treatment for patients. In order to study the quality of treatment, it is advisable to assess the results of treatments. To achieve this aim, an accepted index is required to assess the occlusion and the positions of teeth in the arch. Peer Assessment Rating (PAR) is a typical mean to evaluate the result of orthodontic treatments. The aim of the study is to assess the results of orthodontic treatments by removable appliances on the basis of PAR index. Patients and methods: Treatment of patients has been done by dental students by using removable orthodontic appliances, therefore the dental study casts of 64 consecutively completed removable appliance cases were examined before and after orthodontic treatment using the PAR index. Results: On the basis of weighted PAR criteria, the difference between scores before and after treatment was significant for anterior maxillary segment (P<0.001), overjet (P<0.001), overbite (P<0.001), midline (P<0.001), buccal occlusion in transverse and anteroposterior direction (P<0.01). On the other hand, a non-significant difference was recorded regarding buccal occlusion in vertical sections (P=0.99). Conclusion: The average of PAR index reduction was higher in girls than in boys. The proper selection of cases for Phase I orthodontic treatment is critical to the success of the treatment. Removable orthodontic appliances are useful for correction of minor abnormalities, especially in anterior region.

The use of mini-anchorage screws in the surgical orthodontic treatment of stage-III periodontitis: a clinical case

The use of miniscrews for orthodontic anchorage combined to periodontal treatment in aggressive periodontitis: case report and review of the literature. Introduction: Miniscrews (MSs) have gained rapid popularity among orthodontic specialists over the past decade. Subsequently, as general dental practitioners continue to provide general care for patients undergoing orthodontic treatment they are likely to encounter MSs. Observation: A 60-year-old woman concerned about generalized agressive periodontitis (generalized periodontitis stage-III) with complaints of diastema and spacing in the upper arch, received for ten years nonsurgical therapy via scaling and root planning combined with systemic antibiotics. Maxillary periodontal flaps achieved this primary periodontal treatment. As she complained of protrusion of her maxillary incisors she was referred for orthodontic treatment with palatinal MSs to retract and align the maxillary anterior segment. A 26 months follow-up showed esthetic and functional stability of the result. Discussion: This case report demonstrates efficacity of combined periodontal and orthodontic treatments using palatinal MSs in order to successfully contribute to treatment of stage-III periodontitis.

Republication: Conservative Management of Skeletal Class II Malocclusion with Gummy Smile, Deep Bite, and a Palatally Impacted Maxillary Canine

A 21-year-old female presented with chief complaints of crooked teeth, canine impaction, deep bite, and “gummy smile” (excessive maxillary gingival exposure when smiling). Increased facial convexity (15.5°), increased lower facial height (56%), and incompetent protrusive lips (E-line to upper left 2 mm, E-line to lower left 2 mm) were associated with a severe Class II malocclusion (nearly a full cusp bilaterally). There was 7.5 mm of overjet, 100% anterior deepbite, and a left posterior buccal crossbite. Cephalometrics revealed a skeletal discrepancy due to a protrusive maxilla and a retrusive mandible (SNA 85°, SNB 78°, and ANB 7°). Cone-beam computed tomography imaging revealed a palatally impacted right maxillary canine (UR3) near to the adjacent lateral incisor (UR2). The retained right primary canine (URc) was extracted. A simplified open-window technique was utilized to surgically expose its impacted successor. A maxillary anterior mini-screw provided anchorage to align the UR3 in its correct anatomical position. Nonextraction treatment with a passive self-ligating fixed appliance was indicated to align and level both arches. Anchorage provided by infrazygomatic crest bone screws, and maxillary anterior miniscrews were used for the correction of Class II malocclusion and gummy smile. To achieve more esthetic crown lengths in the maxillary anterior segment, gingivectomy was performed with a diode laser 2 months after fixed appliances were removed. This challenging skeletal Class II malocclusion with a Discrepancy Index of 38 was treated in 32 months to excellent outcomes: Cast-radiograph evaluation score of 25 and an pink and white dental esthetic score of 2. All facial and dental corrections were stable at the 6 months follow-up evaluation (Int J Orthod Implantol 2017;48:24-46). Republished with permission from: Ariel Wong, Chang CH, Roberts WE. Conservative Management of Skeletal Class II Malocclusion with Gummy Smile, Deep Bite, and a Palatally Impacted Maxillary Canine. Int J Orthod Implantol 2017;48:24-46.

Rigid External Distraction with Intranasal Bone-borne Traction Hooks for Midfacial Hypoplasia

Rigid external distraction is currently performed to correct cases of severe maxillary hypoplasia. As an improvement of this technique, we propose the use of an intranasal bone-borne traction hook. This study is a retrospective chart review of the intranasal bone-borne traction hooks used in the treatment of severe maxillary hypoplasia. There were 110 patients treated with the hooks from 2005 to 2017. The maximum traction force was 7.75 kg, and there were few complications encountered during distraction. There were 76 patients who had the hooks removed under local anaesthesia. A cephalometric analysis was conducted in 56 patients. The average advancement of A-point was 9.9 ± 4.2 mm, 8.4 ± 2.5 mm, 11.0 ± 3.7 mm, 17.9 ± 4.4 mm for the trans-sutural distraction osteogenesis (DO), maxillary anterior segment DO, Le Fort I osteotomy DO and Le Fort III/II osteotomy DO, respectively. The average changes of sella-nasion-point A (SNA) were 8.89 ± 4.30 degrees, 8.21 ± 3.17 degrees, 10.49 ± 3.26 degrees, and 15.10 ± 4.00 degrees, respectively. The A point-nasion-B point (ANB) also showed increases in all procedures with P < 0.001. In conclusion, this technique sufficiently advances the midface and ensures the scars are concealed in the nasal base. The traction hook can bear a large traction force, causes minimal complications and is easily removed.

Modified Rotational Anterior Segmental Osteotomy for Prevention of Common Complication (Aged Appearance).

Although anterior segmental osteotomy (ASO) is powerful procedures in treating the patient who has bimaxillary dentoalveolar protrusion, there is significant change in all soft and hard tissue parameters. Soft tissue changes in response to ASO can have a deleterious effect of an aged appearance. To prevent this aged appearance, the authors tried to rotate the maxillary anterior segment rather than simply posteriorly translating the segments. The application of a clockwise pivot rotation method during ASO can prevent overcorrection by controlling the degree of setback of the piriform aperture, and it can also affect convexity of the facial profile.

Different pontic design for porcelain fused to metal fixed dental prosthesis: Contemporary guidelines and practice by general dental practitioners.

Objective:The current study aimed to assess the knowledge and practice of pontic design selection by the general dental practitioners (GDPs) in the light of contemporary guidelines.Materials and Methods:This cross-sectional study was conducted among the GDPs of Karachi. A questionnaire was designed to collect data from 100 GDPs. The questionnaire included general/demographic information (practitioner's education, experience, and place of practice) and an average number of fixed prosthesis constructed by the GDP. The questionnaire was further categorized to evaluate the knowledge/practice of pontic design selection and latest recommendations.Results:For the maxillary anterior segment, the ridge lap pontic was the most common (32%) followed by the modified ridge lap (28%). In the maxillary posterior segment, the ridge lap pontic was the most common (37%) followed by sanitary design (34%). For the mandibular anterior segment, the modified ridge lap (50%) was the most common followed by ridge lap pontic (17%). In case of the mandibular posterior segment, the sanitary design (34%) was the most common followed by ridge lap pontic (30%).Conclusions:The pontic design selection for the fixed prosthesis is a neglected domain. The contemporary guidelines are not followed with full spirit by the GDPs leading to wide variations in the pontic design selection.

Efficacy of Maxillary Anterior Segmental Distraction Osteogenesis in Patients With Cleft Lip and Palate.

To evaluate the effects of maxillary anterior segmental distraction osteogenesis (MASDO) in patients with cleft lip and palate (CLP) and to identify risk factors for increased relapse. A retrospective study. Thirty-one Japanese patients with CLP who underwent MASDO were eligible for study inclusion. We evaluated lateral cephalograms obtained before (T1), at 3 months (T2), and at 1 year (T3) after MASDO, and measured changes from T1 to T2 (δT1T2), from T2 to T3 (δT2T3), and from T1 to T3 (δT1T3). We also evaluated the risk factors associated with an increased relapse. Overall (δT1T3), MASDO improved retrusion of the maxilla. We measured a significant advancement (6.1 mm) of the anterior maxillary segment in δT1T2 (A-McNamara classification) and increases in the overjet and the SNA, ANB, and nasolabial angles. However, skeletal relapse was evident in δT2T3, and the median percentage of relapse was 10%. To explore the risk factors, we subdivided patients with a δT1T2 of >5 mm into 2 groups based on the percentage of relapse (>15% vs ≤15%). There were significant differences between these groups in the vertical positions of the anterior nasal spine and point A, and the angle formed by the SN and palatal planes (SNPP), suggestive of intraoperative counterclockwise rotation of the maxilla. MASDO is effective for correcting midfacial deficiencies, but counterclockwise rotation of the maxilla during surgery may cause relapse.

Assessment of gingival zenith position and distance from vertical bisecting midline in the maxillary anterior dentition − An observational study

Background: Esthetics in the maxillary anterior segment is determined by both the hard and soft tissues. Gingival contour plays a vital role in pink esthetics. The most common apical position of the marginal gingiva is referred to as gingival zenith (GZ). This study aimed to assess the position and distance of the GZ from the vertical bisecting midline (VBM) in the anterior maxillary dentition in a sample of South Indian population. Materials and Methods: A total of 105 participants were recruited based on specific inclusion and exclusion criteria. Following recruitment, alginate impressions were made, and dental cast were poured. A total of 630 anterior teeth were evaluated on the cast. The position of the GZ was marked, and a vertical line was drawn through the point. The VBM was drawn on the cast based on the crown width. Using magnification loupes (2.5×) and calibrated digital vernier caliper, the distance between the GZ and VBM was measured twice for each tooth, and the average reading was recorded. The position of GZ was recorded as mesial, distal, or coinciding with the VBM. Results: Majority of the right and left maxillary central incisors and lateral incisors were placed distal to the VBM measuring a mean distance of 0.7 ± 0.4 and 0.76 ± 0.36 mm, respectively, for centrals and 0.59 ± 0.3 and 0.62 ± 0.31 mm, respectively, for laterals. The GZ of both the right and left canines were mesial to the VBM at a mean distance of 0.59 ± 0.4 and 0.61 ± 0.3 mm, respectively. Conclusion: Familiarity with the position and distance of the GZ enables the dentist to plan an appropriate esthetic rehabilitation for the patients based on the population in question.

Long-term clinical and radiographic stability of anterior maxillary setback using biodegradable Inion plates for osteosynthesis

Purpose The aim of this study was to evaluate the long-term stability of the anterior maxillary setback after anterior maxillary osteotomies and osteosynthesis using Inion biodegradable bone plates in patients with maxillary protrusion. Patients and methods Eight patients suffering from maxillary protrusion indicated and planned for anterior maxillary setback included in this study. Inion biodegradable bone-plate and screw system was used for immobilization of the anterior maxillary osteotomy. Evaluation was done both clinically and radiographically over 5 years period for detection of postsurgical stability criteria. Radiographically, panoramic and lateral cephalograph radiographs had been taken immediately, then 3 and 6 months, 1 year and 5 years postoperatively to evaluate the radiographic stability of the measurements. Results Patients' ages ranged from 18 to 32 years, with a mean of 24 years. Six (75%) patients were females and two (25%) were males. The clinical and esthetic improvement of patients during the follow-up periods that extended to 5 years were compatible with the cephalometric changes as the tipped-out upper incisors were corrected, the upper lip protrusion was greatly improved, the nasolabial angles were increased and the interincisal angles were also increased. A very minimal insignificant change was noted, and the esthetic and functional improvement were maintained throughout the follow-up periods. Conclusion The used biodegradable bone plates and screws in this study were proved to be very effective in maintaining long-term stability of the repositioned osteotomized anterior maxillary segment without reported postoperative complications.

Tooth wear and gingival recession in 210 orthodontically treated patients: a retrospective cohort study.

To assess the association between tooth wear (TW) and gingival recession (GR). Two hundred and ten orthodontically treated participants (100 males) were evaluated. GR and TW were rated independently by four raters on plaster models at four time points: before treatment (T1), mean age 13.8 years (SD = 3.7); after treatment (T2), mean age 16.7 years (SD = 3.9); 3 years after treatment (T3), mean age 19.7 years (SD = 4.2); and 7 years after treatment (T4), mean age 23.9 years (SD = 4.8). Univariable and mulitvariable random effects logistic regression analyses were performed with scores for GR as dependent variables and with TW, age, gender, dental segments (maxillary and mandibular anterior and posterior segments), time points, and Angle classification as independent variables. Method reliability was assessed with kappa statistics. Mandibular incisors, mandibular and maxillary first premolars and maxillary first molars were most vulnerable to GR. The prevalence of GR increased during the observation period. At T1 20.5% participants had one or more recession sites, at T4 85.7 % of the participants had at least one GR. There was evidence of association between moderate/severe TW and GR-for a tooth with moderate/severe wear, the odds of recession were 23% higher compared to a tooth with no/mild wear (odds ratio 1.23; 95% CI: 1.08-1.40; P = 0.002). Age, dental segment, and time were also significant recession predictors, whereas gender was not. There is evidence that moderate/severe TW is associated with the presence of gingival recession. Clinical significance of this can be limited.

Bimaxillary concomitant hypohyperdontia in a 10-year-old child

Numerical anomalies, either addition or deletion, are quite a common findings in human dentition. However, it is extremely rare to find both hypodontia and hyperdontia simultaneously in the same individual....

Effect of Crown Angulation of Maxillary Incisor on Effective Arch Perimeter.

It has been postulated that crown angulation and inclination has potential space implication within the arch. With the insight of space implication of the axial relations of teeth, cases of genuine tooth size discrepancies can be dealt with improved stability. This in vitro study was designed to investigate and quantify the influence of angulation and inclination of maxillary incisors on the effective arch perimeter. Acrylic teeth were arranged over typhodont frame with spaced maxillary anterior segment. Known value of tip and torque in increments were incorporated to maxillary incisors through bracket positioning and corresponding consumption of the interdental spaces were measured using coordinate measuring machine. Study revealed that increase in maxillary incisor crown angulation by 1o results in consumption of approximately 0.012 mm of arch perimeter. Similarly, there is a consumption of 0.021 mm of arch perimeter with each degree increase in labial crown inclination. The knowledge of the space implication can be included in the space analysis during the orthodontic treatment planning. Depending upon the amount of space discrepancy, an accurate degree of required alteration in the axial relation of one or more teeth can be planned.

Techniques for the Treatment of Maxillary Hypoplasia in Cleft Patients: An Overview

Purpose of review Maxillary hypoplasia is often unavoidable sequelae in cleft lip and palate patients who had undergone timely surgical and orthodontic intervention. Since 1970s these deformities have been traditionally corrected by means of orthognathic surgery. Numerous published studies have tried different techniques to combat the same. The advantages and disadvantages of the various techniques are overviewed. Recent Findings Distraction osteogenesis is one of the recent major developments in the field of oral and maxillofacial surgery and provides promising outcome. Tooth borne device hyrax proved good skeletal stability of distracted anterior maxillary segment. Distraction forces when directly transferred to the bone resulted in significant dentoalveolar compensation. This modern technique has also been used to evaluate its immediate and long term impact on nasal index as well which showed significant increase. This technique overcomes significant disadvantages of relapse and velopharyngeal insufficiency and also helps to produce better normal facial esthetics and profiles and masticatory function. Summary The oral and maxillofacial surgeons have widely accepted the use of maxillary distraction osteogenesis as an attractive alternative to treat malocclusion in CLP patients and this has broadened the reconstructive spectrum. Recent advancements have led to a wider clinical application and improved acceptance.

Esthetic management of a recurrent gingival fibroma

Peripheral reactive lesions of gingiva are common lesions of the oral cavity that dentists come across in daily life. Among these are focal fibrous hyperplasia, pyogenic granuloma, peripheral giant cell granuloma, and peripheral ossifying fibroma. Localized irritation fibroma is a gingival growth, usually arising from interdental papilla due to the presence of some chronic irritation due to dental calculus or other iatrogenic factors. This article reports a case of a 39-year-old male with a recurrent irritation fibroma in the maxillary anterior gingiva treated by excision. The presence of growth in the esthetic maxillary anterior segment and the possibility of unesthetic defect due to excision of the growth have been discussed. The importance of treating the chronic infectious irritational factor and regular follow-up to prevent long-term recurrence of the growth has been discussed.

Evolution of treatment mechanics and contemporary appliance design in orthodontics: A 40-year perspective.

Until the early 1970s, successful treatment with the Begg technique and the Tweed edgewise technique required tedious wire bending. The introduction of Andrews' straight wire appliance changed that, and it was one of the most significant contributions in the history of orthodontics. The straight wire appliance significantly reduced the amount of wire bending and also brought along other options in treatment mechanics. Retraction of the canines with elastic chains and ligature wires became more common. Sliding mechanics in place of closing loops became the method of space closure for a significant number of clinicians. Edgewise force levels were initially used to close spaces; however, it was soon observed that lighter forces were more effective with sliding mechanics. Along with these changes, it became apparent that compensation in the appliance was needed, depending on the type of malocclusion and particularly with varying extraction sequences. Various appliance designs were developed to accommodate changes in mechanics and force levels. These modifications improved tooth positions at the end of treatment as long as the brackets were properly placed. These major changes in appliances, force levels, and treatment mechanics can be traced back to the work of Dr Lawrence Andrews and the straight wire appliances.

A Clinical Assessment of Corticotomy Facilitated Orthodontics in the Retraction of Maxillary Anterior Segment

A Clinical Assessment of Corticotomy Facilitated Orthodontics in the Retraction of Maxillary Anterior Segment