Anterior Tooth Area Research Articles

A case report of three supernumerary teeth in the maxillary anterior tooth area formed at different stages

A case report of three supernumerary teeth in the maxillary anterior tooth area formed at different stages

Enhancement plaque control in preschool children by an intelligent brushing guide device.

This study aims to investigate the impact of a tooth-brushing guidance system on the enchancement of the dental plaque removal in preschool children. In this study, we selected a group of 124 healthy children in which their aged were between 3 and 5 years old following by treatment at the Pediatric Dentistry Center at Jinzhou Stomatological Hospital (JinZhou, Liaoning Province, China). We then followed up to check and identify the Turesky modification of the Quigley-Hein plaque index (TMQHPI). Study group was randomly assigned to an experimental group in which they received constantly guidance on intelligent tooth-brushing and a control group which was used by manual brushing techniques. The total numbers in each group were 62 participants that were gone under the clinical investigation for seven days. The plaque index of both groups were assessed by using a plaque display instrument and a periodontal probe for up day 28. It was shown that the experimental group had a lower average TMQHPI value (0.98 ± 0.15) in comparison with control group (1.41 ± 0.17), and this difference was statistically significant (p < 0.05). The experimental group had a significantly lower TMQHPI value (0.89 ± 0.13) on the tongue/palatal side of the anterior teeth area in comparison with control group (1.41 ± 0.17) (p < 0.05). We observed that experimental group showed significantly lower TMQHPI value (1.16 ± 0.12) on the tongue/palatal side of the posterior dental region in comparison with control group (1.70 ± 0.13) (p < 0.05). It was confirmed a significant difference in the average plaque clearance rate between the experimental and control groups (p < 0.05). Our study clearly indicates that a developed method of toothbrush guide effectively improved the removal rate of plaque compared with manual tooth-brush, specifically in hard-to-reach areas like the tongue and palate.

Fully digital workflow for the fabrication of occlusal stabilization splints based on individual mandibular movement

ObjectiveThis study was conducted to present a completely digital workflow for the fabrication of occlusal stabilization splints using CAD/CAM systems and a digital face bow based on optical sensor technology. MethodsDigital scans of the maxillary and mandibular arches of 20 volunteers were obtained using an intraoral scanner. Jaw relation and mandibular movements were recorded with a digital face bow via optical sensors. The virtual increase of the vertical dimension of occlusion (VDO) was then performed, after which computer-aided design (CAD) of the occlusal stabilization splints was carried out. The corresponding splints were then manufactured using digitally controlled technology. ResultsA completely digital workflow for the manufacturing of occlusal stabilization splints was found to be clinically feasible. The corresponding data analysis revealed high congruence between virtual and physical occlusal contacts on the occlusal splint. Moreover, the appropriate guidance of the anterior teeth area was easily obtainable, and the time for adjusting the occlusion was less. ConclusionsThis study demonstrated that the fabrication of occlusal stabilization splints using a fully digital workflow is feasible. Compared to traditional impression-based manufacturing, several advantages of digital manufacturing include easy accessibility, time-efficient manufacturing, high-level accuracy in splint quality, and potential to manufacture duplicate splints. Clinical significanceThe proposed fully digital approach may help young dentists fabricating stable occlusal splints with beneficial curative effects. Meanwhile, it could also improve the production efficiency of stable occlusal splints, saving time for both doctors and patients while reducing labor costs.

Multivariate analysis of alveolar bone dehiscence and fenestration in anterior teeth after orthodontic treatment: A retrospective study.

To compare the prevalence of fenestration and dehiscence between pre- and post-orthodontic treatment and to explore the factors related to fenestration and dehiscence in the anterior teeth after treatment. This study included 1000 cone-beam computed tomography (CBCT) scans of 500 patients before (T1) and after (T2) orthodontic treatment. These images were imported into Dolphin 11.9 software to detect alveolar fenestration and dehiscence in the anterior teeth area. The chi-square test and Fisher's exact test were performed to compare the prevalence of alveolar bone defects between time points T1 and T2. A total of 499 patients were selected for logistic regression analysis to examine the correlation among age, sex, crowding, sagittal facial type, extraction, miniscrew use and fenestration or dehiscence post-treatment. Except for the maxillary lingual fenestration and labial fenestration of mandibular canines, a significant change in the prevalence of fenestration and dehiscence was noted between time points T1 and T2 (P < .025). Multinomial logistic regression showed that age, miniscrew use and extraction highly influenced the prevalence of anterior lingual dehiscence (P < .05). Dehiscence of the mandibular labial side (skeletal Class III vs. I, OR = 2.368, P = .000) and fenestration of the mandibular lingual side (skeletal Class II vs. I, OR = 2.344, P = .044) were strongly correlated with the sagittal facial type. Dehiscence of the maxillary labial side (moderate vs. mild, OR = 1.468, P = .017) was significantly associated with crowding. Older age, maxillary moderate crowding, skeletal Class III, extraction and miniscrew potentially significantly affect the prevalence of anterior teeth dehiscence. Adult females, skeletal Class III patients on the mandibular labial side and skeletal Class II patients on the mandibular lingual side should be monitored for anterior teeth fenestration.

A retrospective study of dynamic navigation system-assisted implant placement

BackgroundTo evaluate the accuracy of implant placement assisted by a dynamic navigation system, as well as its influencing factors and learning curve.MethodsAt Macao We Care Dental Center, 55 cases of implant placement using dynamic navigation were retrospectively evaluated. To evaluate their accuracy, the apex, tip, and angle deviations of preoperatively planned and postoperatively placed implants were measured. The effects of the upper and lower jaws, different sites or lateral locations of dental implants, and the length and diameter of the implants on accuracy were analyzed, as well as the variation in accuracy with the increase in the number of surgical procedures performed by dentists.ResultsThe implant had an apex deviation of 1.60 ± 0.94 mm, a tip deviation of 1.83 ± 1.03 mm, and an angle deviation of 3.80 ± 2.09 mm. Statistical differences were observed in the tip deviation of implants at different positions based on three factors: jaw position, lateral location, and tooth position (P < 0.05). The tip deviation of the anterior teeth area was significantly greater than those of the premolar and molar areas. There were no statistically significant differences in apex deviation, tip deviation, or angle deviation between the implants of different diameters and lengths (P > 0.05). There were significant differences in the angle deviation between the final 27 implants and the first 28 implants. Learning curve analysis revealed that angle deviation was negatively correlated with the number of surgical procedures, whereas the regression of apex deviation and tip deviation did not differ statistically.ConclusionsThe accuracy of dynamic navigation-assisted dental implants meets the clinical needs and is higher than that of traditional implants. Different jaw positions, lateral locations, and implant diameters and lengths had no effect on the accuracy of the dental implants guided by the dynamic navigation system. The anterior teeth area had a larger tip deviation than the posterior teeth area did. As the number of dynamic implantation procedures performed by the same implant doctor increased, the angle deviation gradually decreased.

TREATMENT OF GRANULOMATOUS EPULIS USING LASER

Background: Epulis is an epithelial tumor that is non-osteogenic. Epulis can be found in the oral cavity both on the gingiva and in the alveolar mucosa. Epulis is a benign enlargement of soft tissue. Granulomatous epulis is one type of epulis that is often found. This granulomatous epulis is a granulative tissue reaction with the characteristics of bleeding easily and having a reddish color. This epulis can disturb the patient both psychologically because there is a large mass in the oral cavity, causing it to be unaesthetic if it occurs in the anterior teeth area, disrupting the chewing process and even disrupting the speech process if it is in the posterior teeth. Apart from causing discomfort to the patient, there are several types of epulis that can cause pain. Objective: To find out how to make a diagnosis of granulomatous epulis accompanied by treatment using a laser. Case: A 45 year old female patient came with complaints of enlarged gums since 1 year ago. The patient initially used dentures, but currently the dentures cannot be used and the patient feels uncomfortable because he cannot chew food due to a large lump in the oral cavity. Case Treatment: At the first visit, an etiotropic phase is carried out in the form of elimination of local factors, then the patient is referred for supporting examinations in the form of panoramic radiography and FNA-B examination. This examination functions to determine whether there is malignancy or not. After the results showed no malignancy, we continued with the surgical phase in the form of excision of granulomatous epulis using a laser. Conclusion: Granulomatous epulis therapy using laser accompanied by removal of remaining tooth roots shows satisfactory therapeutic results. Keyword: Epulis, Epulis Granulomatosa, Excision, Laser

Clinical investigation of gingival papilla recession after orthodontic treatment in adults.

To investigate the incidence, severity, susceptibility sites of gingival papillary recession (GPR) in adults after orthodontic treatment and the clinical impact of tooth extraction on GPR. A total of 82 adult patients were recruited and then divided into extraction and non-extraction groups according to whether the orthodontic teeth were extracted (teeth that needed to be extracted when performing orthodontic treatment). The gingival conditions of the two groups of patients before and after treatment were recorded using intraoral photos, and the incidence, severity and predilection sites of GPR after correction were investigated. The results indicated that GPR occurred in 29 patients after correction, with an incidence rate of 35.4%. A total of 1648 gingival papillae were recorded among the 82 patients after correction, of which 67 exhibited atrophy, with an incidence of 4.1%. All occurrences of GPR were classified as papilla presence index 2 (PPI 2) (mild). The condition is most likely to occur in the anterior tooth area, especially in the lower incisor area. The results indicated that the incidence of GPR was substantially higher in the extraction group than in the non-extraction group, with the difference statistically significant. Following orthodontic treatment, adult patients will have a certain proportion of mild GPR, which is more common in the anterior tooth area, especially the lower anterior tooth area.

Evaluation of sagittal root position and labial alveolar bone concavity in the maxillary anterior tooth area for immediate implant placement.

The anatomical characteristics of the maxillary labial alveolar bone play a crucial role in the treatment planning of immediate implant placement. The sagittal root position (SRP) and alveolar bone concavity are closely related to anatomical characteristics in determining the ideal implant position. This study evaluated the SRP and labial alveolar bone concavity in the maxillary anterior teeth area. Cone-beam computed tomography images of 120 samples involving 720 teeth were uploaded to the medical imaging software. The SRP was classified as Class I, II, III, or IV, and the concavity of labial alveolar bone was measured. A T test was performed to compare measurements between the central and lateral incisors, between the central incisors and canines, and between the lateral incisors and canine. The majority of the SRPs of the maxillary anterior teeth were class I (engaging the labial cortical plate) with frequencies of 98.3%, 85.8%, and 81.7% for the canines, lateral incisors, and central incisors, respectively. In terms of concavity of labial alveolar bone in maxillary tooth area, canines also had the largest mean value (139.5°), followed by lateral incisors, whereas central incisors has the smallest mean value (131.7°). The results of the T test revealed a significant difference ( p < 0.001) in labial alveolar bone concavity between central and lateral incisors, between central incisors and canines, and between lateral incisors and canines. Most maxillary anterior teeth were classified as Class I SRP, Class III SRP was the least prevalent, and the concavity of the labial alveolar bone significantly differed between the central and lateral incisors, between the central incisors and canines, and between the lateral incisors and canines. In addition, the canines had the highest mean alveolar bone concavity angle, indicating that less concavity in the canines area.

Clinical decision making of implant guidance methods guided by new classification of surgical area mouth ope-ning.

When selecting implant guidance methods or judging whether the patient can be implanted, many doctors ignore or only use visual inspection to estimate a patient's mouth opening. This phenomenon often leads to failure to complete the implantation due to insufficient mouth opening or the deflection of the implant due to limited angle, resulting in the high incidence of corresponding complications. The main reason is that doctors lack accurate analysis and control of the overall geometric conditions of the intraoral surgical area, and three-dimensional position blocking of surgical instruments occurs during the operation. In the past, mouth opening was defined as the distance between the incisor edges of the upper and lower central incisors when the patient opens his mouth widely, and the implant area could be in any missing tooth position. When it is in the posterior tooth area, the specific measurement scheme of the mouth opening could not be simply equivalent to the previous measurement method in the anterior tooth area. However, how to measure quickly and conveniently the mouth opening of any surgical area to determine whether it could be implanted and meet the needs of the selected guidance method remains unclear. This paper introduces new concepts, establishes new classification and corresponding accurate measurement scheme of implant area, and establishes a decision tree of implant methods guided by the actually measured value. Results provide a quantitative basis for rational formulation and implementation of implant treatment.

Evaluation of the accuracy of T-scan system and Cerec Omnicam system used in occlusal contact assessment

PurposeThe objective of the present study was to determine the accuracy of T-scan system and Cerec Omnicam system with respect to the evaluation of occlusal contact by quantitatively comparing the occlusal contact areas and the overlapping ratios of occlusal contact areas obtained from these systems. Material and methodsThe occlusal contact of 20 adolescents with normal occlusion was measured with the T-scan system and the Cerec Omnicam system, respectively. The occlusal contact areas in the intercuspal position were then quantified with Adobe Photoshop CS6 Software. The same procedure was repeated for each subject using with 8 μm articulating paper as the control group. The overlapping ratio of T-scan system and Cerec Omnicam system was calculated respectively, which is defined as the ratio of overlapping areas comparing with those obtained from articulating paper. To examine the accuracy of T-scan system and Cerec Omnicam system, the Paired t-test was applied. The reproducibility of T-scan system was evaluated with Wilcoxon matched-pairs signed-ranks test by comparing the occlusal contact areas between two repeated measurements. In all statistical analysis, the level of significance was set to α = 0.05. ResultsResults demonstrated measured occlusal contact areas were significantly different between those obtained between T-scan system and Cerec Omnicam system (P < 0.05). The tooth position of two-dimensional virtual dental arch established by T-scan system based on the width of the central incisor was in disagreement with the actual tooth position. The overlapping ratios obtained from Cerec Omnicam system were higher than those obtained from the T-Scan system (P < 0.05). The sensitivity of T-Scan system in anterior teeth area decreased when sensors are used more than once (P < 0.05). ConclusionsIn the intercuspal position, the accuracy of Cerec Omnicam system for occlusal contact assessment is higher than that of T-scan system. The T-scan system demonstrates good reproducibility in the premolar region and the molar region, but poor reproducibility in the anterior teeth region. Clinical implicationsIn the intercuspal position, Cerec Omnicam system is more accurate than T-scan system, which can quantitatively analyze occlusal relationship in terms of number, position, size and distribution of occlusal contact points. When evaluating occlusal contacts, the accuracy of T-scan system in anterior teeth region is significantly lower than that of premolar and molar regions.

Appropriate fabrication method for pressure-formed mouthguards using polyolefin sheets.

Polyolefin sheet mouthguards are usually formed in the same manner as ethylene-vinyl acetate sheet mouthguards. However, the heating condition of the polyolefin sheet for the pressure-forming process has not been determined. The aim of this study was to examine the appropriate heating condition for polyolefin sheet mouthguards when fabricated with the pressure-formed technique. Mouthguard sheets of 3.0mm polyolefin were pressure formed on working models at three heating temperatures: 90°C, 105°C, and 120°C. The thickness of the mouthguard was measured at the labial surface of the central incisor, and the buccal and occlusal surfaces of the first molar. The fit of the mouthguard was examined at the central incisor and the first molar by measuring the distance between the mouthguard and the cervical margin of the working model. Differences in the thickness and fit of the mouthguards according to the heating conditions and the measured regions were analyzed using two-way analysis of variance. Mouthguard thickness varied among the measured regions of the central incisors and first molars (p<.01). The greatest thickness was found at the labial surface of the central incisor in mouthguards fabricated with the heating temperature of 90°C (p<.01). The greatest thickness was found in mouthguards fabricated with the heating temperature of 105°C at the buccal surface of the first molar (p<.01), and 105°C or 120°C at the occlusal surface of the first molar (p<.01). The fit was not significantly different among the three heating conditions both at the central incisor and the first molar. The appropriate heating condition for pressure-formed mouthguards using polyolefin sheets was 90°C to maintain the mouthguard thickness at the anterior teeth area with proper fit.

Influencing factors and esthetic considerations of emergence profile of implant dentures in the anterior teeth area

The emergence profile of implant restorations plays an important role on the final esthetic outcome. This article intends to review the emergence profile design of implant restorations in the anterior teeth area, and analyse the factors that affect the emergence profile of implant restorations: implant neck design (non-platform-switching bone level implants, platform-switching implants, and soft tissue level implants), implant position and inclination (implant depth, buccal-lingual position, mesiodistal position, and axial inclination), the type of the abutment, quality and quantity of peri-implants soft tissues. The article aims to provide clinical guidelines for the emergence profile design of implant prostheses based on existing literatures and clinical experiences.

Long-term evaluation of factors affecting removal torque of microimplants

BackgroundThe current study aimed to evaluate factors affecting the long-term stability of microimplants using removal torque and the correlation between removal torque and clinical variables.Materials and methodsThis research evaluated 703 microimplants placed in 354 patients (mean age: 30.4 ± 12.1 years). The removal torque was evaluated according to various clinical variables including sex, age, placement site, microimplant size, and placement method (self-drilling versus pre-drilling). Pearson correlation and stepwise multiple linear regression analyses were performed to investigate different variables and their association with removal torque.ResultsThe mean removal torque was significantly higher in the mandible (4.46 N cm) than in the maxilla (3.73 N cm). The values in the posterior teeth/retromolar areas were significantly higher than those in the anterior teeth area. There were no significant difference in terms of sex. Teenagers had a lower removal torque than older adults in the mandible, but not in the maxilla. Microimplants with a greater length and diameter, except for those with a greater diameter in the maxilla, was associated with a higher removal torque. Regardless of placement torque, the removal torque convergently reached approximately 4 N cm in both placement methods. The removal torque was significantly correlated with screw length in the self-drilling group and with diameter in the pre-drilling group.ConclusionsRemoval torque was related with placement site, age, placement method, and length and diameter of microimplants.

Plaque accumulation at the fitting surface and cleaning status in patients with full-arch implant-supported fixed prostheses: a cross sectional study

Objective: To observe the plaque accumulation at the fitting surface and oral hygiene status in patients with full-arch implant-supported fixed prostheses, and explore the possible influencing factors. Methods: Twenty-eight patients [17 males and 11 females, (63.0± 10.8) years old] with 40 full-arch implant-supported fixed prostheses (18 maxillary and 22 mandibular) were collected from January 2012 to September 2020 in Department of Implantology, Peking University School and Hospital of Stomatology. Plaque accumulation at the fitting surfaces were evaluated during the follow-up visit after 6 months following definitive prostheses delivery, by analyzing the digital photographs recorded by ImageJ. Meanwhile, the cleanliness of the fitting surface of prostheses and oral hygiene status were recorded. The oral hygiene habits and the patients' satisfaction with the prostheses were investigated by questionnaire, and the difference of plaque accumulation between different cleaning habits of dentures were compared. Results: The debris index of the fitting surface of the 40 full-arch implant-supported fixed prostheses were 3.28±0.75, and the percentage of area covered with plaque was (51.6±19.0)%. The debris index and plaque accumulation of the mandibular prostheses were significantly higher than that of the maxillary prostheses (P<0.05). In most mandibular prostheses (16/22), calculus was attached to the lingual side of the anterior tooth area. The reserved cleaning space of the restoration showed more plaque accumulation than in other parts. There was no significant difference in the percentage of area covered with plaque between groups with different cleaning habits. The satisfaction survey results indicated the "clean" project had a lowest score. Conclusions: The cleanliness of patients with full-arch implant-supported fixed prostheses was poor, and the hygiene status of the mandibular prostheses was worse than that of maxillary, especially in the anterior tooth area of mandibular prostheses. The influence of different cleaning habits on plaque accumulation was not observed.

Clinical study on the accuracy of occlusal contacts on digital model

Objective: To explore the accuracy of occlusal contacts on digital model made by intraoral scanner. Methods: Twenty healthy subjects [6 males, 14 females, (24.4±1.4) years old] with intact dentition were randomly recruited from postgraduate students in Capital Medical University School of Stomatology who volunteered to participate in this study. For each participant, the 2nd and 3rd quadrant of natural dentition was scanned. A diagnostic test design was performed. The occlusal contacts of the maximal intercuspal position (MIP) were extracted with the transillumination of silicone interocclusal records, and the extraction threshold was set as ≤50 μm. Intraoral scanning system was used to scan in MIP and generate occlusal contacts on digital model. Five groups were designed as test groups according to included tooth position: group 1 (buccal scanning ranged from tooth 21 to 23), group 2 (buccal scanning ranged from tooth 23 to 26), group 3 (buccal scanning ranged from tooth 24 to 26), group 4 (buccal scanning ranged from tooth 25 to 26), group 5 (buccal scanning ranged from tooth 21 to 26). Five groups occlusal contacts on digital model were generated respectively. According to the relevant literature, the upper occlusal surface was divided into 28 partitions, and the accuracy of occlusal contacts on digital model was calculated with the transillumination of silicone interocclusal records as the reference standard. Subgroup analysis was performed according to anterior teeth area, premolars area and molars area. Results: The accuracy of occlusal contacts on digital models of the half dentition in five buccal scanning positions were: group 1 (86.8%), group 2 (92.0%), group 3 (90.7%), group 4 (91.1%), group 5 (90.4%), and the accuracy of occlusal contacts in group 1 was significantly lower than those in the other four groups (P<0.05). The accuracy of anterior teeth area were 85.6%-93.9%; the accuracy of premolar area were 92.5%-94.4%; the accuracy of molar area were 77.3%-93.6%, group 1 was significantly lower than those in the group 4 in molars area (P<0.05), the accuracy of anterior area was statistically less than premolars area and molars area in group 1 (P<0.05). There was no statistical difference in pairwise comparison between the three sections (P>0.05). Conclusions: The digital models scanned intraoral methods provide accurate, quantitative measures of occlusal contacts when transillumination contacts are the reference standard.

Measurement of proximal enamel thickness of 182 permanent teeth

Objective: To measure the proximal enamel thickness (PET) at the mesial and distal contact areas of the permanent teeth and to provide a reference for interproximal enamel reduction (IPR). Methods: From May 2016 to February 2018, 182 isolated permanent teeth were collected and screened from patients who underwent extraction at Department of Oral and Maxillofacial Surgery, Capital Medical University School of Stomatology. These teeth were extracted for orthodontic purpose or due to severe periodontitis. The patients having teeth extracted were all Beijing residents, Han nationality, and aged (39.5±10.6) years. Ninety percent of the teeth came from patients under 50 years old. These teeth were classified according to different tooth type. The mesial and distal contact areas of these teeth were marked with fluid resin. The isolated teeth were scanned using micro-CT and the enamel thickness was measured and analyzed. The parameters measured included mesial PET (PETm), distal PET (PETd), the distance from mesial contact area to occlusal plane (CAm-OP), the distance from distal contact area to occlusal plane (CAd-OP), the distance from mesial contact area to the cementoenamel junction (CAm-CEJ), the distance from distal contact area to cementoenamel junction (CAd-CEJ) and tooth width (TWmd). Results: The PET gradually increased from the anterior tooth area [(0.63±0.16) mm] to the molar area [(1.46±0.25) mm]. The sum of the PET from the second molar to the contralateral second molar in the maxillary dentition was 31.60 mm, and that of the PET from the second molar to the contralateral second molar in the mandibular dentition was 29.68 mm. The contact areas were located on the occlusal third of the proximal walls of anterior teeth and the middle third of the proximal walls of posterior teeth. The PET were positively correlated with the tooth width between the mesial and distal contact areas (P<0.05). Conclusions: The PET was thinner in the incisor area and thicker in the molar area. IPR should be carried out close to the occlusal side of the proximal walls in anterior teeth and the cementoenamel junction side of the proximal walls in posterior teeth.

Stereolithography-based additive manufacturing of lithium disilicate glass ceramic for dental applications.

With additive manufacturing (AM) on the rise in industrial production, different industries are looking for a way to benefit from the advantages over conventional manufacturing methods like milling or casting. The layer by layer approach allows the parallel construction of different complex structures with simultaneous customization of the parts, while waste material is significantly reduced. This is especially interesting for the processing of advanced ceramic materials, where often customized and single parts are required. Regarding ceramics, Lithographic Ceramic Manufacturing (LCM) provides the highest surface quality and achievable precision compared to any other AM technologies, which is necessary to meet the high demands from dental industry regarding accuracy and reproducibility. At TU Wien, we achieved expertise in printing different kinds of ceramics and glasses by using specially developed stereolithography printers based on digital light processing (DLP) followed by a thermal debinding and sintering processes. In dental industry, glass ceramic materials are widely used for customized and aesthetic restorations. This work deals with the processing of lithium disilicate via an AM technology, offering highly dense (>99%), full ceramic parts which meet the requirements for the use as dental restorations. With outstanding mechanical properties of over 400MPa flexural strength, excellent translucency and accuracy, veneers, crowns and even bridges, especially for the anterior tooth area can be reproducibly printed, debinded and sintered.

Incidental radiographic finding of charm needle or “susuk” in orthodontic panoramic and lateral cephalometric radiograph: a case report

Background: The most common radiographic examinations in orthodontic are panoramic and lateral cephalometry. In panoramic and lateral cephalometric images in adult patients, sometimes can be found a fine foreign object which sometimes confuses as it scattered the radiographic image, such as needles. The needles found in the patients are known as “susuk” in Malay and Indonesian language or charm needles which believed to enhance beauty, charism, health, youth, luck, and to relieve pain. This case reports aim to elaborate the incidental radiographic finding of charm needle or “susuk” in orthodontic panoramic and lateral cephalometric radiograph.Case Description: There was four adult woman conducted panoramic and cephalometric radiograph as a routine procedure before orthodontic treatment. The number of susuk inserted were varied, as it considered that the more needle increases the magical potency. In Case 1, the panoramic image depicts one “susuk” in the middle of the root of 44 (FDI notation) tooth. Besides, the cephalometric radiographs also show a “susuk” horizontally inserted at the root of the anterior lower teeth area. The panoramic image reveals one susuk around chin area below the apex of 42 teeth on Case 2 as well as on the soft tissue chin area in front of the apex of 41 teeth on cephalometric radiographs. In Case 3, two “susuk” were found inserted bilaterally symmetric at the upper premolar area by the panoramic image. Then, five “susuk” in the mandible and four “susuk” at the upper area of the maxilla were found in Case 4 by the panoramic image. Conclusion: The susuk are often exposed as incidental findings in panoramic and lateral cephalometric radiographs that are taken before performing routine orthodontic treatments. Understanding the presence of susuk is essential to avoid misdiagnosis and mismanagement and help radiologists to prevent confusion while interpreting images.

Digital evaluation of supracrestal gingival thickness induced by periodontal regenerative and corticotomy surgery in patients with skeletal class Ⅲ malocclusion

Objective: To establish a quantitative three-dimensional method based on intraoral scan to evaluate the changes of soft tissue, and to evaluate the changes of supracrestal gingival thickness (SGT) in skeletal class Ⅲ patients induced by periodontal regenerative and corticotomy surgery (PRCS). Methods: Twenty-two systematically and periodontally healthy skeletal class Ⅲ patients (4 males and 18 females, aged between 19 and 35 years), who were in need of combined orthodontic-orthognathic treatment and referred to the Department of Periodontology from the Department of Orthodontics and the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from January, 2018 to March, 2019, were collected in the study. The teeth involved were 112 anterior teeth (46 maxillary anterior teeth and 66 mandibular anterior teeth). PRCS in anterior tooth area was conducted before orthodontic decompensation. Probing depth (PD), bleeding index (BI) and keratinized gingiva width (KGW) were recorded before surgery and 6 months post-surgery. The intraoral digital impressions of maxillary and mandibular anterior teeth were obtained by 3-shape intraoral scanner before surgery and 6 months after surgery. The Standard Tessellation Language (STL) files were processed using Geomagic qualify 12.2 software to establish the soft tissue morphological measurement model, and to quantitatively analyze the changes of gingival thickness situated 1 to 2 mm apical to the free gingival margin on the median sagittal measurement plane. Results: Probing depth and bleeding index had no significant difference before and 6 months after operation (P>0.05). KGW in 6-month post-operation group [(5.18±2.32) mm] was significantly higher than that in pre-operation group [(4.22±1.43) mm] (P<0.05). Supracrestal gingival thickness situated 1 to 2 mm apical to the free gingival margin also significantly increased 6 months after surgery (P<0.05). The changes of gingival thickness situated 1 to 2 mm apical to the free gingival margin in the upper anterior area were (0.68±0.56) and (1.00±0.69) mm, respectively. The changes in the lower anterior area were (0.38±0.42) and (0.58±0.45) mm, respectively. The gingival changes of the upper anterior teeth were also significantly higher than those of the lower anterior teeth (P<0.01). Conclusions: The described quantitative measurement based on intraoral scan could be an effective method for quantitative evaluation of the changes of soft tissue. PRCS could safely increase the supracrestal gingival thickness as well as KGW in skeletal class Ⅲ patients who were in need of combined orthodontic-orthognathic treatment.

Application value of non-flapping technique in immediate implant prosthesis in aesthetic area of anterior teeth

Objective To explore the application value of non-flapping technique in immediate implant prosthesis in aesthetic area of anterior teeth. Methods From March 2016 to September 2017, 104 patients who received immediate implant restoration of anterior teeth in the First Hospital of Jiaxing were divided into observation group (53 cases) and control group (51 cases) according to random number table method.The control group was treated with conventional flap immediate implantation, while the observation group was treated with non-flap immediate implantation.The red aesthetic index (EPS), alveolar bone resorption and patients' satisfaction were compared between the two groups. Results The PES scores of the observation group were (6.17±1.21)points, (5.94±1.03)points and (5.12±0.85)points, respectively after repair 3 months, 6 months and 12 months, which were significantly higher than those of the control group [(5.38±0.96)points, (4.79±0.76)points, (4.05±0.70)points] (t=3.679, 6.459, 6.993, all P<0.05). At 3 months, 6 months and 12 months after restoration, the alveolar bone resorption in the observation group was(0.29±0.04)mm, (0.63±0.12)mm, (1.07±0.17)mm, respectively, which was significantly lower than that in the control group [(0.36±0.07)mm, (0.95±0.24)mm, (1.28±0.26)mm] (t=6.291, 8.649, 4.893, all P<0.05). At 12 months after repair, the satisfaction rate of patients in the observation group was 98.11% (52/53), which was significantly higher than 84.31% (43/51) in the control group (χ2=4.637, P<0.05). Conclusion The application of non-flapping technique in immediate implant prostheses in aesthetic area of anterior teeth has good effect, which can obtain better aesthetic effect, reduce alveolar bone absorption and improve patients'satisfaction with prostheses.However, in clinical work, it is necessary to strengthen preoperative examination and measurement of patients, accurately grasp the direction of implants and avoid the occurrence of bone wall perforation during operation. Key words: Mouth diseases; Tooth; Tooth preparation, prosthodontic; Dental implantation; Oral hygiene index; Alveolar bone loss; Esthetics, dental; Patient satisfaction