Maxillary Anterior Region Research Articles

Comparative Evaluation of Hard- and Soft-tissue Changes in Immediate Implant Placement Using Flapless Approach with and without Demineralized Freeze-dried Bone Allograft Clinically and Radiographically Using Cone-beam Computed Tomography.

The present study evaluated hard- and soft-tissue changes in immediate implants using flapless approach with and without demineralized freeze-dried bone allograft (DFDBA) clinically and radiographically using cone-beam computed tomography (CBCT). Thirty-two sites in patients requiring immediate implants in the maxillary anterior region including the premolars were grouped according to the treatment provided with (test group) or without (control group) DFDBA. Plaque index, probing depth, soft-tissue assessment using Testori Esthetic Score (TS), and ridge width were recorded at baseline and postoperatively at 6 and 12 months, while crestal bone height (CBH), buccal bone thickness (BBT), jump space (JS), and gingival thickness were evaluated using CBCT at baseline and 12 months. Considerable differences among the different time lines and the groups in favor of the test group were prominently seen on the midfacial aspects at 12 months, with CBH values of -0.28 ± 0.17 mm in the test group as compared to -0.78 ± 0.34 in the control group (P < 0.0001). The JS was maximum on the buccal aspects being 1.42 ± 0.87 mm in the test group and 1.12 ± 0.81 mm in the control group which reduced at 12 months to 0.13 ± 0.35 mm and 0.73 ± 0.79 mm, respectively. Immediate implants with DFDBA augmentation using a flapless protocol demonstrated reduced CBH with resolution of JS and increased BBT, especially at the coronal aspects which influence the tissue stability and overall esthetics.

Single-piece zirconia versus single-piece titanium, narrow-diameter dental implants in the anterior maxilla: 5-year post-loading results of a randomized clinical trial.

The aim of this study was to evaluate esthetic parameters in the anterior maxillary region by comparing single-piece zirconia versus titanium narrow-diameter implants. Additionally, clinical, radiological and patient-reported outcome measures (PROMs) were analyzed. Thirty implants (tissue level implant) were placed in 30 patients in the maxillary esthetic sector. Depending on randomization, a zirconia (test) or titanium implant (control) was placed. Esthetic, clinical, and radiological parameters, including the implant crown esthetic index (ICAI), pink esthetic score (PES), probing pocket depth, bleeding on probing, plaque index, and marginal bone levels, were evaluated at 12, 36 and 60 months after loading. Sixty months after crown placement, no significant differences were found between groups. The ICAI values were 5.25 ± 4.21 and 4.50 ± 2.98 for the test and control groups, respectively. The corresponding PES values were 7.44 ± 1.93 and 7.43 ± 1.74 for the test and control groups, respectively. There were no significant intergroup differences for the rest of the parameters evaluated. It can be suggested that monotype zirconia implants may serve as a potential alternative to titanium implants in selected clinical scenarios. While the results demonstrated comparable esthetic, clinical, and radiological aspects for zirconia implants as compared to titanium implants after a 5-year follow-up period, further research with larger sample sizes and longer-term follow-up is recommended.

Advanced restorative management of focal microdontia: A brief review and case report.

Focal microdontia is a dental anomaly characterized by the presence of a single abnormally small anterior or posterior tooth. The objective of this article is to provide an updated review of the literature on the advanced restorative management of focal microdontia, and to document a clinical case where the reviewed advanced restorative approaches were applied to treat a young adult presenting with a non-syndromic asymmetrical focal microdontia.We conducted a preliminary examination of the existing literature on the advanced restorative management of focal microdontia. Additionally, we presented a minimally invasive approach to the treatment of an 18-year-old female patient with non-syndromic asymmetrical focal microdontia. The primary advantage of adhesive dentistry is that it can better preserve the structure of smaller teeth. A review of literature reveals a paucity of reports on localized microdontia in the maxillary anterior region of the mouth. However, novel minimally invasive restorative procedures satisfy patients' aesthetic and functional preferences. Well-executed additive diagnostic wax-ups and intraoral mock-ups can serve as a permanent restoration blueprint, providing predictable results for focal dental anomalies in the aesthetic zone. In conclusion, the use of minimally invasive dental approaches in young patients with focal microdontia can result in long-term satisfactory aesthetic outcomes.

Diagnosis and Management of a case of impacted central incisor associated with compound odontoma in a 4 years old girl

Odontomes are benign tumors developing from the epithelial and mesenchymal cells which are completely differentiated into ameloblasts and odontoblasts that forms enamel and dentin. They are of two types, complex and compound. Complex odontomes are typically seen in the mandibular posterior region where as compound odontomes have a preference towards the maxillary anterior region. They are rarely associated with deciduous dentition. This article presents a case of compound odontoma in a child below 4 years old who reported with a history of missing deciduous left central Incisor. Key words: Compound odontome, Deciduous Dentition, Odontome

Rehabilitation of aesthetic zone with narrow maxillary ridge by staged implant protocol

It can be difficult to achieve an aesthetically pleasing implant-supported restoration in the maxillary anterior region. With regard to the variety of factors that could affect the therapy, the treatment planning for an implant restoration is distinct. A number of elements, including those linked to the patient, careful planning of the course of treatment, implant and abutment selection, soft tissue contour, implant axis, occlusion, and other considerations, all contribute to the final clinical result. Implant supported restorations can have more prosthetic flexibility as a result of the option to select multi-unit abutments in oral implantology. Multi-unit abutments have advantages in that they provide good fit and performance together with predictable aesthetics, which significantly increases the efficacy of prostheses supported by implants. This case report describes the rehabilitation of a 42-year-old male patient with a partially edentulous arch in the maxillary anterior area using an implant-supported restoration and a multi-unit abutment.

Accuracy analysis of robotic-assisted immediate implant placement: A retrospective case series

ObjectivesThis study aimed to investigate the accuracy of a robotic computer-assisted implant surgery (r-CAIS) for immediate implant placement. MethodsPatients requiring immediate implant placement in the maxillary anterior region were enrolled for r-CAIS. Before surgery, the patients underwent a cone beam computed tomography (CBCT) scan with a positioning marker. Virtual implant placement position and drilling sequences were planned. Following spatial registration and calibration, the implants were placed with the robotic system under supervision. A postoperative CBCT was taken to control the actual implant positions. The DICOM data of the virtually planned and the actually placed implant were superimposed and registered through the accuracy verification software of the robotic system. The accuracy was calculated automatically. The deviation at the mesial–distal, labial–palatal, and apico-coronal directions were recorded. ResultsFifteen patients with 20 implants were included. No adverse surgical events or postoperative complications were reported. The global platform, apex, and angular deviation were 0.75 ± 0.20 mm (95 % CI: 0.65 to 0.84 mm), 0.70 ± 0.27 mm (95 % CI: 0.57 to 0.82 mm), and 1.17 ± 0.73° (95 % CI: 0.83 to 1.51°), respectively. Moreover, the vertical platform and apex deviation were 0.50 ± 0.31 mm, (95 % CI: 0.35 to 0.64 mm) and 0.48 ± 0.32 mm, (95 % CI: 0.33 to 0.63 mm), respectively. All the placed implant positions were further labial and apical than the planned ones, respectively. ConclusionsHigh accuracy of immediate implant placement was achieved with the robotic system. Clinical significanceOur study provided evidence to support the potential of the robotic system in implant placement, even in challenging scenarios.

Assessment of the Nasopalatine Canal Length and Shape Using Cone-Beam Computed Tomography: A Retrospective Morphometric Study.

The anatomical position of the nasopalatine canal in the anterior maxilla makes it one of the most important vital structures in the region. Surgical and implant procedures in this area require local anesthesia to be administered. It is, therefore, important to morphologically assess the length and shape of the nasopalatine canal for performing surgical procedures with more accuracy in this area. Cone-Beam Computed tomography scans were scrutinized using inclusion criteria of age 18 years and above, absence of any pathological lesions/fracture/surgery in the nasopalatine area, absence of orthodontic treatment or maxillary jaw correction surgeries, and exclusion criteria including CBCT scans with artifacts or error s in the area of interest, anterior implants, absence of bone diseases, trauma, surgeries, and impactions in the area of interest. A total of 360 scans were analyzed for the length and shape of the nasopalatine canals. The results of the study showed that the mean nasopalatine canal length was 12.51 mm. The hourglass shape of the canal was most common and had the highest representation in both genders, with male 80.62% and female 87.01%. A statistically significant difference (p < 0.001) was noted in nasopalatine canal length between males and females. The study provides insight into the significant association of gender with the canal's shape and length of the canal. The length of the canal does not influence with age. These parameters are helpful for surgical planning and interventions in the anterior maxillary region.

Comparative evaluation of the pontic shield technique versus whole tooth extraction on labial crestal bone resorption using cone-beam computed tomography in the maxillary anterior region: A randomized controlled clinical trial

Abstract: Introduction: Following tooth extraction, there is comparatively more bone loss at the buccal aspect at 3 months of healing, which may result in 56% bone loss due to resorption of the bucco-facial ridge contour. In the socket shield technique, a tooth is planned for extraction in such a way that the tooth is sectioned in two halves, a palatal section is removed and the facial part is retained. Materials and Methods: Twenty-six sites, i.e., 13 sites requiring partial tooth extraction (test sites) and 13 sites with whole tooth extraction (control sites), in the maxillary anterior region were included. In each patient, at least two sites were included (one test and one control). After both procedures, a collagen sponge was placed in the socket and sutured with silk suture. The height of the labial crestal bone and width of the socket at both sites were evaluated by the cone-beam computed tomography examination preoperatively at baseline and after a 3-month follow-up period. Results: The mean differences in labial crestal bone height and socket width from baseline to 3 month follow up were significantly lower in the test group than in the control group (P &lt; 0.05). Conclusion: Labial crestal bone resorption was significantly less at the site where the pontic shield technique (PST) was used than at the site with whole tooth extraction. The reduction in socket width (bucco-lingually) was also significantly less at the site where the PST was used compared to whole tooth extraction sites.

Design and Biomechanical Analysis of Customized Angled Abutment Based on Tooth Inclination Angle for Immediate Implant Placement on Maxillary Anterior Region.

Finite element analysis and an in vitro experiment were employed to investigate the loading effects of angled abutments, comparing various customized angled abutments derived from the average angle of incisors in patients with a commercial 15°∆ angled abutment, on both the implant and surrounding bone. Four customized angled abutment models (21.9°∆, 24.15°∆, 20.22°∆, 33°∆) were developed using cone-beam computed tomography (CBCT) images of incisor inclination from various age groups of patients. 3D maxillary bone models were created from CBCT images of four individual patients. Finite element analysis and in-vitro strain gauge experiments were conducted, applying 100N or 50N of axial or oblique force, to assess the differences in stress/strain between the customized and the commercial 15°∆ angled abutments in both the implants and surrounding bone. Under axial loading, the stress values in the dental implant and surrounding bone were elevated due to the relatively higher angles of the customized angled abutments (21.9°∆, 24.15°∆, 20.22°∆, 33°∆) when compared to the commercial 15°∆ angled abutment; however, under oblique loading the commercial 15°∆angled abutment exhibited higher stress values in both the implant and surrounding bone. For in vitro experiment, there is no statically difference in bone strain between the customized (21.9°∆) and the commercial 15°∆ angled abutments in axial loading. Nevertheless, in oblique loading using a commercial 15°∆ angled abutment induced the higher bone strains. Customized angled abutments offer lower stress/strain under oblique loads but higher stress/strain under axial loads compared to commercial ones. Therefore, in the design and application of angled abutments, careful consideration of the occlusal load direction is paramount for achieving biomechanical success of dental implant.

Analyzing the impact of different implant placement protocols on the esthetic stability of single implants: A comprehensive systematic review and meta-analysis.

Aims: To analyse impact of different implant placement timings on the esthetic stability of a single implant restoration in maxillary anterior region. Materials and methods: The systematic review and meta-analysis adhered to the PRISMA guidelines and were registered in the PROSPERO database. In addition to systematic searches on the national library of medicine (MEDLINE PubMed), Cochrane library, Google Scholar, and EbscoHost, manual searches were also conducted to identify articles published from January 1, 2000, to December 1, 2020. The included studies comprised randomized controlled trials, as well as prospective and retrospective cohort clinical studies. The assessment of risk of bias employed the Cochrane Collaboration's tool, MINORS tool, and a quality appraisal checklist. Utilizing the Review Manager software tool, a meta-analysis was conducted, and the robustness of the meta-analytic findings was duly evaluated. Results: Out of 313 studies screened, seven met the predetermined inclusion and exclusion criteria for incorporation into the systematic review. The meta-analysis disclosed an effect on marginal bone loss associated with different implant placement timings. However, the overall impact on esthetic stability was not statistically significant. Furthermore, there is moderate evidence suggesting a decrease in marginal bone loss following immediate implant placement, with a mean difference of -0.33mm. Conclusions: The timing of implant placement appears to have some impact on both marginal bone loss and pink esthetic score. However, no statistically significant difference was observed when comparing various implant placement timings in terms of pink esthetic score and marginal bone loss. The evidence lacked sufficient strength to firmly support the aforementioned observations, emphasizing the need for additional well-designed randomized clinical trials to draw definitive conclusions. Conflict of interest statement: The author reports no conflicts of interest related to this study.This study received no external funding.

Comparative evaluation of effectiveness of three versus four mini-implants for simultaneous intrusion and retraction of maxillary anterior teeth: A 3D FEM study.

To evaluate and compare the displacement pattern of maxillary anterior teeth in the sagittal and vertical planes and evaluate the stress distribution in pdl, bone, teeth of the maxillary anterior region, and around the mini-implants during simultaneous en-masse retraction and intrusion using two, three, and four mini-implants combinations. A three-dimensional FEM model of maxillary teeth and periodontal ligament housed in the alveolar bone with extracted first premolarswasgenerated. The models were broadly divided into three groups according to the number of mini-implants. Mini-implants were placed bilaterally between the second premolar and molar in group I, and along with bilateral implants, an additional mid-implant was placed between the central incisors as in group II, whereas in group III, anterior mini-implants were placed in between lateral incisors and canine bilaterally. The two mini-implant model showed the maximum amount of retraction in the sagittal plane followed by three and four mini-implant models. In the vertical plane, all six anterior teeth showed intrusion only in the four mini-implant model. The stress in cortical bone, cancellous bone, PDL, around the mini-implants, and in lateral incisor was maximum in the three mini-implant model, followed by four mini-implants with the least stress in the two mini-implant model. The four mini-implant model is better than the three and two mini-implants model as there is a more even distribution of force in the four mini-implants model as compared to the three mini-implants model.

Effect of Advanced Platelet-Rich Fibrin and Concentrated Growth Factor on Tissues Around Implants in the Maxillary Anterior Region.

Tissue repair surrounding implants is essential for the cosmetic maxillary anterior zone to respond favorably to implant therapy. Grafting platelets from an individual's blood was developed to overcome the esthetic requirements and speed up healing. Advanced platelet-rich fibrin (APRF) and concentrated growth factor (CGF) are used for good healing. Our aim was to evaluate the impact of APRF and CGF on healing of tissues around dental implants in the anterior region of the maxilla. A total of 60 patients who underwent dental implant placement procedures were included in this study. They were divided into two categories: category 1 consisted of patients who underwent dental implant placement procedures without APRF and CGF (n = 30) and category 2 consisted of patients who underwent dental implant placement procedures with APRF and CGF (n = 30). Assessment of alveolar bone height and bone density was conducted using CBCT at baseline and second, fourth, and sixth month postoperatively. The alveolar height and alveolar bone density in APRF group and CGF group patients was greater compared to control group patients at all follow-ups. APRF and CGF have a positive effect on the tissues around dental implants, promoting faster and better tissue healing around dental implants.

Rapid maxillary expansion for maxillary atresia and mandibular alignment: A mixed dentition case report

Introduction: Posterior crossbite is a common malocclusion in orthodontics. It often accompanies maxillary atresia, leading to unilateral or bilateral posterior crossbite. Rapid maxillary expansion (RME) is an approach to treat atresia, correct transverse discrepancies, and increase the perimeter of the maxillary arch. Objective: To present the case of an 8-year-old patient with maxillary atresia, skeletal Class I, dental Class I, and no space in the maxillary anterior and mandibular regions for the alignment of the incisors. Clinical procedures: RME was performed using a HYRAX type expander. After 20 days of daily activations, there was a change in the morphology of the palate, an increase in the arch perimeter, facilitating the eruption of incisors and canines. Final considerations: RME is an effective and efficient orthopedic treatment, recommended for correcting transverse deviations, normalizing structural and functional problems. As positive side effects, the indirect action on the mandibular molars and canines allowed the alignment of the incisors.

Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level.

The objective of this study was to assess marginal bone level around single implants inserted in fresh extraction sockets in the anterior maxillary region and instantly restored with computer-aided design/computer-aided manufacturing customized temporary crowns cemented on the final abutment. A total of 20 patients (15 females and 5 males, with a mean age of 30 years), where 20 were placed in fresh extraction sockets. After raising a full-thickness flap, atraumatic extraction was performed the implant site was prepared and fixtures were stabilized on the palatal bone wall. The implant location was immediately transmitted to the prepared master model using the pick-up impression coping seated in the surgical guide template. Prefabricated abutments were used as the final abutment on the master model, scanned and the crown was planned using computer-aided manufacturing customized software. Later on 8th weeks, abutments were torqued as per the manufacturer's recommendation, and the final crowns were cemented. Using personalized intraoral radiographs marginal bone level was evaluated mesially and distally to the implant shoulder as a reference at implant placement, 8 weeks, 1, 3, 5, and 10 years after loading. Wholly implants were osteo-integrated positively after 10 years of practical loading, but only 18 were available for clinical and radiological follow-up, and 2 patients with two implants were excluded from the study due to relocation abroad without any implant failure. The average marginal bone loss (MBL) in the current report was 0.16 ± 0.167 mm at crown cementation, 0.275 ± 0.171 mm after 1 year, 0.265 ± 0.171 mm after 3 years, 0.213 ± 0.185 mm after 5 years, and 0.217 ± 0.194 mm at 10 years. The strategy of inserting and not removing the final abutment at the time of implant placement facilitates the establishment of adequate attachment of both soft and hard tissues to the abutment surface, ensuring uninterrupted organization of tissue architecture and offers advantages in helping maintain soft tissue maturation and preventing marginal bone level. Immediately loaded implants in freshly extracted sockets lead to a significant reduction in marginal ridge resorption. The use of a temporary crown on a prefabricated abutment, exclusive of successive abutment manipulation, proved effective in preserving the primarily founding blood clot and served as a prototype for shaping the soft tissue around the previously wounded gum. How to cite this article: Berberi A, El Zoghbi A, Aad G, et al. Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level. J Contemp Dent Pract 2024;25(3):213-220.

Management of Acute Hemorrhage in the Anterior Maxillary Region from an Aberrant Blood V

Implant placement for missing teeth has become a routine procedure to establish functional and aesthetics needs of the patient. And just like any surgical procedure, complications like bleeding, infection, etc can occur during implant placement as well. Bleeding from alveolar antral artery is one such complication which causes bleeding and any clinician should be prepared for its management. Authors have discussed one such case here and its management and that CBCT is a very important diagnostic tool which should be used for every case possible.

An enchiridion on the socket shield technique

Abstract Socket shield technique is one of the recent innovative techniques of immediate implant placement. The importance of this technique is maintenance of both hard and soft tissues, especially in esthetically critical areas like maxillary anterior region. It involves preservation of a portion of root followed by immediate placement of implant. It has various advantages over other ridge preservation procedures like conventional immediate implant placement, socket preservation methods, and ridge augmentation procedures. This review briefly summarizes the classification, surgical technique, variations, and potential complications of this technique.

Surgical Treatment of Supernumerary Elements for Orthodontic Purposes: Clinical Case Report

Introduction: Hyperdontia is a type of dental development disorder linked to various factors, characterized by an excessive number of teeth in relation to the normal dental formula. This anomaly can affect both jaws and dentitions, but the anterior maxillary region and the permanent dentition are the most affected, and it is more prevalent in male patients. Early diagnosis and immediate treatment are of the utmost importance to avoid complications. Objective: To describe a surgical procedure involving the removal of bilateral mandibular supernumerary teeth in a 17-year-old patient for orthodontic purposes. Materials and Methods: This is a descriptive study of a clinical case, carried out by a student and a team of professors from the postgraduate course in minor oral surgery, at the Dentistry school clinic of the Integrated College of Patos (UNIFIP). The procedure was carried out in two surgical procedures, with a 30-day interval between the surgeries. Conclusion: There are several consequences that supernumerary elements can cause and this case report raises awareness and provides evidence for the clinical characterization and optimal treatment of supernumerary teeth.

Tumor odontogénico adenomatoide. Reporte de un caso clínico

The Adenomatoid Odontogenic Tumor (AOT) is an uncommon benign neoplasm, characterized by slow and progressive growth, in most cases asymptomatic. It is an intraosseous pathology, which can be follicular or extrafollicular, with the follicular type being the most common. It occurs in both men and women, with a predilection for the female sex. Histologically, it is composed of odontogenic epithelium organized in different histoarchitectonic patterns, embedded in a stroma of mature fibroconnective tissue. We describe the clinical case of a 25-year-old female patient with increased volume in the left anterior maxillary region, extending to the base of the nose, causing deviation of the midline to the right and having one year of evolution.

Profilometric, esthetic, and patient-reported outcomes of the L-shape technique combined with delayed connective tissue grafting in the maxillary anterior region: A 3-year case series study.

To evaluate the profilometric, esthetic, and patient-reported outcomes of peri-implant tissues in the maxillary anterior esthetic zone following guided bone regeneration (GBR) using the L-shape technique combined with delayed connective tissue grafting (CTG). Profilometric and pink esthetic score (PES) measurements were performed at the time of implant surgery with GBR (T0) and at the 1- (T1), 2- (T2), and 3-year (T3) follow-up. Patient-reported outcomes were also assessed using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. Statistical analysis over 3 years of follow-up assessed changes at time points (T0, T1, T2, and T3) and time periods (T0-T1, T0-T2, and T0-T3) using the Wilcoxon signed-rank test. A total of 12 patients (57.5 ± 12.3 years) were included in this study. The mean profilometric change in peri-implant tissues over the 3-year follow-up period was 3.49 ± 1.11 mm, and the buccal contours were not significantly different between the comparison periods. The PES remained stable, while all OHIP-14 domain scores improved significantly. Simultaneous implant placement and GBR using the L-shape technique combined with delayed CTG in the maxillary anterior region provides stable buccal profiles and consistent esthetics and improves patient-reported quality of life over a 3-year period. This study demonstrated that GBR using the L-shape technique combined with delayed CTG in the maxillary anterior region improved the buccal profile, esthetics, and patient-reported quality of life.

Modification on Window Technique in Full Edentulous Patient with Hyperplasia

Complete denture is often used by patients that have edentulism. However, a long-term denture wearers commonly showed the hyperplastic growth of tissue called hyperplasia. This condition will present some difficulties for impression and retention. A 77 year old male patient reported to the RSGM UMY with a loose-fitting denture. He has been using it for 10 years. His old denture has suction cup on the palatal which no longer retentive and stable. The clinical examination showed the maxillary and mandibular complete edentulous ridge with flabby ridge area in the maxillary and mandibular anterior region. Patient is given treatment complete denture with acrylic resin material. In this case, window technique is used as the impression technique for a flabby ridge. Denture-induced hyperplasia is a condition of enlarged of fibrous tissue that could leads to poor denture retention, support, and stability. In the presence of hyperplasia, fabrication of as stable denture can be very arduous challenge. Special impression technique, like window technique frequently used on a case with flabby ridge. Window technique is a technique which use medium body impression material for the un-displaceable tissue whereas the flabby tissue impressed by using light body elastomer impression that must be freed from pressure. In patient with flabby ridge or hyperplasia due to denture, fabrication of impression need special technique like window technique which can be proven to ensure a final impression of the flabby ridge to improve denture stability, retention, support, and patient comfort.