Clinical Crown Research Articles

Different cavity disinfectant efficacy against S.mutans and shear bond strength of caries affected dentin bonded to resin restoration

AimsThe existing study aimed to assess the survival rate of S.mutans and shear bond strength (SBS) of resin adhesive restoration bonded to carious affected dentin (CAD) after using different cavity disinfectants (Chitosan, Fotoenticine®, and CO2 laser) in comparison to Chlorhexidine (CHX). Materials and methodsThe study included human mandibular molars assessed on International Caries Detection and Assessment System (ICDAS) score 4 and 5. The cusp part of the clinical crown was cut off until the reduction reaches the central fossa while being continuously supplied with water coolant till the tooth cementoenamel junction (CEJ). The root sections were embedded in polymethyl methacrylate acrylic resin followed by culturing S.mutans biofilm on the CAD surface. Specimens were arbitrarily allocated into four groups(n = 10) based on the type of disinfection. Group 1 (2% CHX), Group 2 (Chitosan), Group 3 (Fotoenticine), and Group 4 (CO2 laser). S.mutans survival rate was assessed and CAD was restored with a composite restorative material. Thermoocycling of the samples was performed and a universal testing machine (UTM) and Stereomicroscope were used to identify bond integrity and type of fracture. ANOVA and Tukey multiple comparison tests were used to assess SBS. Data on the survival rate of S. mutans were compared between groups using the nonparametric Kruskal-Wallis test ResultsOutcomes revealed that Group 1 (CHX) displayed the highest survival rate (0.65 ± 0.10). However, lowest survival rate was demonstrated by Group 3 (Fotoenticine) treated specimens (0.25 ± 0.06). It was also discovered that CHX unveiled highest bond strength values (21.48 ± 1.39 MPa). Nevertheless, Group 2 (Chitosan) showed lowest SBS (11.01 ± 1.00 MPa). Intergroup comparison analysis presented that group 1, and group 4 (Co2 laser) (17.76 ± 0.41 MPa) displayed no significant difference in their bond integrity achieved. (p > 0.05). However, group 3 (Fotoenticine) (16.28 ± 0.51 MPa) and group 2 demonstrated comparable outcomes of SBS. (p > 0.05) ConclusionThe use of CHX and CO2 lasers as disinfectants on the CAD surface resulted in a positive impact on the SBS of resin composite, according to the study's findings. However, it is worth noting that Fotoenticine exhibited better antimicrobial efficacy against S. mutans

Histological analysis on tissues around orthodontically intruded maxillary molars using temporary anchorage devices: A case report

Before progress was recently made in the application of temporary anchorage devices (TADs) in bio-mechanical design, orthodontists were rarely able to intrude molars to reduce upper posterior dental height (UPDH). However, TADs are now widely used to intrude molars to flatten the occlusal plane or induce counterclockwise rotation of the mandible. Previous studies involving clinical or animal histological evaluation on changes in periodontal conditions after molar intrusion have been reported, however, studies involving human histology are scarce. This case was a Class I malocclusion with a high mandibular plane angle. Upper molar intrusion with TADs was performed to reduce UPDH, which led to counterclockwise rotation of the mandible. After 5 months of upper molar intrusion, shortened clinical crowns were noticed, which caused difficulties in oral hygiene and hindered orthodontic tooth movement. The mid-treatment cone-beam computed tomography revealed redundant bone physically interfering with buccal attachment and osseous resective surgeries were followed. During the surgeries, bilateral mini screws were removed and bulging alveolar bone and gingiva were harvested for biopsy. Histological examination revealed bacterial colonies at the bottom of the sulcus. Infiltration of chronic inflammatory cells underneath the non-keratinized sulcular epithelium was noted, with abundant capillaries being filled with red blood cells. Proximal alveolar bone facing the bottom of the gingival sulcus exhibited active bone remodeling and woven bone formation with plump osteocytes in the lacunae. On the other hand, buccal alveolar bone exhibited lamination, indicating slow bone turnover in the lateral region.

Pre-restorative crown lengthening surgery: influence of restorative treatment timing on clinical outcomes-a pilot study.

Aim of this study was to assess the influence of restorative treatment timing on the periodontal, patient and operator-reported outcomes following crown lengthening surgery (CLS). Eighteen study participants requiring CLS were divided into two groups based on prosthetic rehabilitation timing (6 or 14weeks postoperatively). Clinical parameters were recorded around treated and neighboring teeth before and after surgery, 6 and 14weeks postoperatively, at prosthesis delivery, and three and six months after. Soft tissue and radiographic bone changes were evaluated. Patients assessed their perception of the procedure by means of a questionnaire. The final treatment outcome was rated by both patients and prosthodontists. CLS resulted in statistically significant and stable apical displacement of the gingival margin, at both treated and adjacent sites. Plaque and bleeding scores remained low throughout. No statistically significant differences were observed between groups for any clinical or radiographic parameter examined. Healing was uneventful and treatment outcome was satisfying for both patients and prosthodontists, without statistically significant differences between groups. The present study has been characterized as pilot, because it was not possible to reach the sample size indicated by the a priori power analysis. CLS is an effective pre-prosthetic procedure as long as it is performed under a certain surgical protocol which predicts for at least a 3mm distance between bone crest and the flap margin at suturing. Within the limitations of this study, six weeks after surgery may be an adequate healing time for the onset of prosthetic restoration. Crown lengthening surgery is commonly performed in daily clinical practice with the aim to restore teeth with short clinical crowns. Based on periodontal, patient and operator-reported criteria, 6weeks after CLS may be adequate healing time before the onset of prosthetic restoration. ClinicalTrials.gov Identifier: NCT03947658, 13/05/2019, retrospectively registered.

Effective management of mandibular second premolar with root anomalies

The enigma of successful treatment of mandibular second premolars with taurodontism has been explored for very long due to its rarity of occurrence. This case report aimed to enumerate the successful nonsurgical endodontic management of left mandibular second premolar #35 with three roots and taurodontism. A 34-year-old Saudi male patient with a noncontributory medical history was referred from the prosthodontic department for nonsurgical root canal treatment of tooth #35. Clinical examination revealed rotated clinical crown with caries related to tooth #35. Pulp sensibility cold test of the tooth showed no response, with the absence of pain on percussion and/or visible pocket depth. Radiographic examination showed long and deep pulp chamber and rotated and curved roots with broken apical lamina dura. The tooth was diagnosed with necrotic pulp and asymptomatic apical periodontitis. After making an access to the pulp chamber, two orifices were easily detected while the third one was found by the aid of surgical microscope. The canals were cleaned and shaped using ProTaper Gold file and then obturated with BioCeram Sealer and Gutta-Percha points, using hydraulic bonded obturation technique. Tooth immediately received the final crown. Clinical and radiographical examination after a 3-month follow-up revealed successful peri-apical healing with no symptoms. A literature search was organized to review the past publications about management of mandibular second premolar with taurodontism or anomalies in the root canal system. The search was focused on cases reported in Medline, Scopus, and Google Scholar databases. The conclusion of the seven selected studies and reported cases revealed that proper visualization with advanced microscopes or computer imaging radiographs, negotiation of the root canals, and efficient instrumentation and obturation enhance endodontic success.

Visagism: An Essential Concept in Esthetic Dentistry

Creating an aesthetic dental rehabilitation that is as harmonious as possible is unquestionably a complex operation that requires understanding of a wide range of factors such as modelling a restoration including tooth alignment dimensions of the clinical crown and occlusion. Aesthetic treatments are increasingly in demand particularly in the field of dentistry as peoplersquos concerns about appearance have grown. Due to a mismatch between the patientrsquos personality and the smile design the final aesthetic results might fall short of the patientrsquos expectations. Dental professionals have been attempting to match the shapes of the teeth with the entire face based on factors like gender personality and age for decades but successful results have proven elusive. The Visagism concept aids dental clinicians in creating restorations that take into consideration not only the aesthetics of the created image but also its psychosocial components which have an impact on patientsrsquo feelings sense of identity behaviour and self-esteem. Since the patient can take part in the design of his smile with Visagism the professional can be more certain of the treatment outcome. This article aims to glorify the novel idea of Visagism so that the clinician can create smiles that are meant worthy of the patient. The relationship between a patientrsquos smile and personality is one that is unintentionally overlooked during the course of treatment.

Closure of maxillary lateral incisor agenesis space in unilateral cleft lip and palate: a digital model assessment

To compare dental positional and gingival parameters of maxillary anterior teeth in unilateral cleft lip and palate (UCLP) after orthodontic treatment with canine substitution due to lateral incisor agenesis. This split-mouth study comprised 57 subjects with UCLP (31 male, 26 female) and agenesis of maxillary lateral incisor at the cleft side, from a single center. Canine substitution was completed after the secondary alveolar bone graft. Dental models were taken between 2 to 6 months after debonding (mean age: 20.4 years). The following variables were measured in the maxillary anterior teeth: crown height, width, proportion, and symmetry, as well as steps between incisal edges, gingival margins, tooth mesiodistal angulation and labiolingual inclination. Paired t-tests with Bonferroni post-hoc correction was used for comparisons between cleft and non-cleft sides (p<0.05). At the cleft side, canines replacing missing lateral incisors had a higher crown height (0.77mm) and an increased width (0.67mm), and first premolars showed a shorter crown height (1.39mm). Asymmetries were observed in the gingival level of central and lateral incisors, with a greater clinical crown at the cleft side (0.61 and 0.81mm, respectively). Cleft side central incisors were more upright than their contralaterals (2.12º). Maxillary anterior teeth demonstrated positional, size and gingival height differences between cleft and non-cleft side after space closure of maxillary lateral incisor agenesis. Slight asymmetries in tooth position and gingival margin in the maxillary anterior teeth should be expected after orthodontic treatment in UCLP patients.

Schematic Analysis and Fiducial Point of Tooth for Root Canal Therapy

The purpose of this study is to identify schematic relationships between root canal axis, the cementoenamel junction (CEJ), and the contour of the clinical crown’s facial surface in maxillary central incisors. 72 radiographic images of extracted maxillary central incisors with previous root canal treatment were collected. Angles (tangent angle) between the root canal axis and lines tangent to fiducial points on the facial surface 3.5 mm, 4.0 mm, 4.5 mm, 5.0 mm, and 5.5 mm cervical to the incisal edge were measured using ImageJ software. Facial-palatal CEJ widths were measured and divided into facial and palatal CEJ by the root canal axis. Generalized linear models were used to assess any relationship between CEJ widths and the constructed tangent angles. The Paired Difference T-test was performed to determine the ratio of palatal CEJ to facial CEJ widths. The correlation between CEJ width and angle measurements was statistically significant except at 3.5 mm (P < 0.05). The tangent angle values decreased from the most incisal point (22.8°) to the most cervical point (18.4°). The average value of total CEJ widths was 7.44 mm. Palatal CEJ was on average 0.22 mm greater than facial CEJ widths (P = 1.61e-6). Using CEJ width and the tangent angle at the fiducial point, the root canal axis of the maxillary central incisor can be predicted.

Surgical Crown Lengthening: Restoring Aesthetics and Function

Short clinical crown affects appearance and retention of the restoration placed within aesthetic zone. Thereafter, Surgical crown lengthening procedure is done to increase crown length for restorative or aesthetic reasons without breaching the biologic width. Herewith, we present a case of crown lengthening procedure along with osseous reduction on maxillary anteriors in a 25 years female patient referred to our department which resulted harmonious appearance and symmetry of tissues on follow up. Aesthetic crown lengthening procedure can be challenging. So, appropriate case selection with accurate diagnostic and interdisciplinary approach are essential for getting enhanced and conservative results in aesthetic areas.

Clinical Crown Length, Width and the Width/Length Ratio of the Maxillary Central Incisor Among Patients Reporting to a Tertiary Care Center in Nepal

Introduction: The most important aspect of dental and facial esthetics is the display of anterior teeth. It becomes a primary consideration to restore the correct size and proportion of anterior teeth for patients seeking prosthodontic treatment. There is tremendous influence of geographic location, race, ethnic background, gender in determining the size and proportion of anterior teeth. There is paucity of data regarding the width, length and width/length ration of central incisors in Nepalese population. Methods: An Observational, descriptive study was conducted in patients visiting T.U. Dental Teaching Hospital. Maxillary impression was made in alginate impression material and poured in dental stone. A digital caliper was used for the measurements, with a precision of 0.01 mm. The maximum mesiodistal width and the maximum crown length of the maxillary central incisors was recorded for each tooth. These data was tabulated and the width/length ratio was calculated. Data was analyzed using Statistical Package for Social Science Version 17 (SPSS Ver. 17) and descriptive statistics was calculated. Results: A total of 127 participants were included in the study of which 64 (50.39%) were males and 63 (49.61%) were females. The mean width/length ratio for right and left central incisors are 0.89 and 0.86 respectively for males and 0.89 on both the sides for females. In case of right central incisors, males had higher mean crown width and length than female and these differences were found to be statistically significant. In case of left central incisor, there was a statistically significant difference in mean crown length between male and female, males having higher length score than female. Conclusion: Males had higher mean crown width and length than female and these differences were found to be statistically significant. The width/length ration for central incisor ranged from 0.86 to 0.89. Knowledge about the size and proportion of upper anterior teeth allows dental rehabilitation taking into consideration the local parameters of a population.

Trueness of crowns fabricated by using additively and subtractively manufactured resin-based CAD-CAM materials

Statement of problemAdvancements in digital dental technologies have enabled the use of different resin-based materials that can be fabricated either additively or subtractively. However, knowledge on the fabrication trueness of these materials is scarce. PurposeThe purpose of this in vitro study was to investigate the trueness of crowns fabricated by using different resin-based computer-aided design and computer-aided manufacturing (CAD-CAM) materials. Material and methodsA complete crown for a mandibular right first molar with a 30-μm cement space was designed in standard tessellation language (STL) format. This master STL (MC-STL) was used to fabricate 40 complete crowns with 4 different resin-based CAD-CAM materials and either additive (Crowntec [MS]) or subtractive techniques (Brilliant Crios [BC], breCAM.monoCOM [PMMA], and G-CAM [GR]; n=10). All crowns were digitized with an intraoral scanner (CEREC Primescan SW 5.2) to generate their STL files (TC-STLs). MC-STL and TC-STLs were transferred into a 3-dimensional analysis software program (Medit Link v2.4.4), and a trueness (overall, external, occlusal, intaglio occlusal, and marginal) analysis was performed by using the root mean square (RMS) method. The Kruskal-Wallis and Dunn tests were performed to analyze data (α=.05). ResultsThe test groups had significantly different deviations on all surfaces (P≤.001). MS crowns had higher overall (P≤.007) and external surface (P≤.001) deviations than GR and PMMA crowns, while the differences between GR and PMMA crowns were not significant (P≥.441). BC crowns had higher external surface deviations than GR crowns (P=.005), higher occlusal deviations than GR and MS crowns (P≤.007), and higher intaglio occlusal deviations than GR and MS crowns (P≤.009). However, BC crowns had lower marginal deviations than MS and GR crowns (P≤.018). ConclusionsThe brand of resin-based CAD-CAM materials affected the trueness of crowns. Additively manufactured crowns (MS) mostly had lower overall and external surface trueness than the other groups. Nevertheless, the deviation values of occlusal, intaglio occlusal, and marginal trueness were generally small; thus, the effect of the tested materials on clinical crown fit may be negligible.

Genetic, Epigenetic and Environmental Factors Influence the Phenotype of Tooth Number, Size and Shape: Anterior Maxillary Supernumeraries and the Morphology of Mandibular Incisors

The aim of this study is to investigate whether the genetic, epigenetic and environmental factors that give rise to supernumeraries in the maxillary incisor region and larger dimensions of the adjacent maxillary incisors are also associated with variations in the morphology of the mandibular incisors. If so, this would contribute to understanding the distribution and interactions of factors during dental development and how these can be modelled. The sample consisted of 34 patients with supernumerary teeth in the maxillary anterior region, matched for gender, age and White Caucasian ethnicity with 34 control subjects. The average ages of the supernumerary and control groups were 12.8 and 12.2 years, respectively. Study models of all subjects were constructed and imaged using a previously validated system. Using custom software, each of the mandibular incisor teeth were measured to obtain 17 parameters from the labial view and 17 from the occlusal view. Principal component analysis (PCA) was used to summarize the measurements into a smaller set representing distinct features of the clinical crowns, followed by a comparison between the supernumerary and control groups using 2-way ANOVA. Seven factors of tooth size of the mandibular central incisors and six factors of the mandibular lateral incisors were identified as major features of the clinical crowns. All parameters of both mandibular incisors were greater in the supernumerary group than in the control, with three of these, located in the incisal and cervical regions of the mandibular lateral incisors, being statistically significantly larger. The findings of this study indicate that the aetiological factors associated with supernumerary teeth in the maxillary anterior region also affect tooth crown dimensions of mandibular incisors. This new evidence enhances several models of the interactions of genetic, epigenetic and environmental components of dental development and supports a multi-model approach to increase understanding of this process and its variations.

Clinical outcomes of single crown and 3-unit bi-layered zirconia-based fixed dental prostheses: An upto 6- year retrospective clinical study: Clinical outcomes of zirconia FDPs

ObjectivesThe aim of this retrospective clinical study was to evaluate the survival and the occurrence of technical and biological complications in bi-layered zirconia-based (Zi) single crown and 3-unit fixed dental prostheses (FDPs). Also, the study aimed to analyze the effects of tooth vitality (vital versus non-vital), abutment location (anterior versus posterior), and luting cement (self-adhesive resin versus resin-reinforced glass ionomer) on clinical outcomes. MethodsA total of 147 prostheses (in 94 patients) placed by undergraduate dental students in a university dental center during the period 2015–2021 were examined clinically using modified United States Public Health Service (USPHS) and California Dental Association (CDA) criteria. The mean duration of follow-up was 37 months (range, 6 - 63 months) for the single crowns (n = 77) and 25 months (range, 6 - 68 months) for the 3-unit FDPs (n = 70). Data were descriptively analyzed to determine the types and rates of complications based on USPHS and CDA criteria. The Kaplan-Meier survival estimation method was used to determine the cumulative survival and success rates of the prostheses (α=0.05). Differences in clinical outcomes (survival or failure) according to tooth vitality, luting cement, and location were statistically analyzed using cross-tabulations and Х2 test (α=0.05). ResultsThe Kaplan-Meier cumulative survival rate was estimated as 96% for the Zi 3-unit FDPs after 5.5 years, and 90% for the Zi single crowns after 4.8 years. The 5-year estimated success rate was 68% for both 3-unit FDPs and single crowns. Seven (9.1%) 77Zi single crowns and 70 2 (2.9%) Zi 3-unit FDPs were recorded as failures with occlusal roughness being the most commonly-observed complication (crowns: 4 [5.6%]; 3-unit FDPs: 8 [11.4%]). In terms of clinical outcomes, statistically significant differences were found between all included vital and non-vital teeth (p = .006), and cement types (p = .028). Taking single crowns alone, significant differences in clinical outcomes according to tooth vitality were noted (p = .036), but not for PFDPs. The location of the prostheses did not produce any significant differences in the clinical outcomes, for both prostheses types independently or combined (p > .05). ConclusionsThe estimated cumulative survival rates in this study for single crowns and 3-unit Zi FDPs concurred with the ranges reported in systematic reviews. Zi-based prostheses on vital teeth produced better clinical outcomes than those placed on non-vital teeth, and type of luting cement influenced the final clinical outcome. Clinical significanceZi crowns and 3-unit PFDPs fabricated using the specific CAD-CAM system used in the controlled environment of this study showed good clinical performance with minimal veneer porcelain chipping. Root canal treated teeth seem to be at higher risk for failure of Zi prostheses compared with vital teeth.

The predictability of expansion with Invisalign: A retrospective cohort study

Few studies have evaluated the predictability of expansion with Invisalign for the current SmartTrack material. Pretreatment, predicted, and posttreatment digital models from Invisalign's ClinCheck software were obtained for 57 adult patients with a planned arch expansion of at least 3 mm. Arch width measurements were collected using a software measuring tool (MeshLab), Invisalign's arch width table, and the centroid of the clinical crown. Data for 30 patients were remeasured for each method to assess intrarater reliability. Predictability of expansion was calculated by comparing the amount of achieved expansion to predicted expansion. The predictability of expansion across centroids for the maxillary teeth was: 72.2% canines, 78.9% first premolars, 81.1% second premolars, 63.5% first molars, and 41.5% second molars. The predictability of expansion across centroids for the mandibular teeth was: 82.3% canines, 93.0% first premolars, 87.7% second premolars, 79.8% first molars, and 42.9% second molars. The average expansion was significantly different from that predicted for each type of tooth in both the maxilla and mandible. Both underexpansion and overexpansion were observed. Arch width measurement reliability for each employed method was as follows: MeshLab (average error 0.197 mm); calculated centroids (0.002 mm); ClinCheck arch width table (0.000 mm). On average, the amount of predicted expansion is not achieved with the Invisalign system and varies according to tooth type and arch. Discretion is required when overcorrecting to compensate for expansion inaccuracy. Both underexpansion and overexpansion were observed; further investigation into factors influencing underexpansion and overexpansion is required.

Efficacy of combining clinical crown lengthening surgery and botulinum toxin A injection in gummy smile treatment

In many cases, the cause of a gummy smile is a combination of many simultaneously occurring factors. Therefore, a single method is certainly not effective in achieving the maximum aesthetic requirements. This study aims to evaluate the efficacy of combining clinical tooth crown lengthening surgery and subsequent BTX-A injection in gummy smile treatment using clinical and photographical assessment. 21 patients with an average length of excessive gingival display of at least 4 mm at maximum smiling point and with the height of keratinized gingiva ≥ 3 mm were recruited. Gingival exposure (GE) and clinical crown length (CCL) were measured at baseline (T0), two months after clinical crown lengthening surgery (T1), two weeks after BTX-A injection (T2), two months after BTX-A injection (T3). GE values at T1, T2 and T3 were significantly different (p &lt;0.001). CCL was significantly changed after gingivectomy surgery (T1) compared to preoperative value (T0) (p &lt;0.001). BTX-A could be considered a favorable adjunctive treatment for gummy smile patients after gingivectomy surgery.

Radicular Dens in Dente: Review of the Literature with Report of a Rare Case in a Child

Introduction: Dens invaginatus is an extremely rare developmental disturbance that can occur in primary, permanent, or supernumerary teeth due to invagination of the enamel organ into the dental papilla during tooth development. The clinical recognition of the radicular variant of dens in the dente is challenging as it is mostly asymptomatic with a normal-appearing clinical crown and is incidentally discovered in radiographs. Case presentation: This report describes a case of the radicular variant of dens in dente that involved the mandibular lateral incisor in an 8-year-old child. The affected tooth was symptomatic and was extracted as a part of treatment. Conclusion: Although the present case required extraction since it was associated with periapical infection, in other cases, treatment may be rendered with appropriate restorative/endodontic procedures with a keen intent to avoid sacrificing the involved tooth as has been reported earlier and reviewed herein.

Finite Element Study to Compare Stress Distribution and Displacement in the Palatal Implant in Lingual Orthodontics in Four Different Combinations of Palatal Implant and Lever Arm

Introduction: The choice of orthodontic appliance depends upon the patients age, profession and availability of them. Lingual orthodontic appliances are preferred over labial by patients because of its invisibility. The aim of this research is to compare the Von Mises stress distribution and displacement of palatal implants in the lingual orthodontic system among four different combinations of palatal implant and lever arm. Materials and Method: Four Finite element models were constructed for the bilaterally extracted first premolar maxillary arch. In all these models 0.018” slot lingual brackets were placed at the center of the clinical crown. A similar retraction force (150gm) was applied with the help of NiTi closed coil spring for all the models but the length of the lever arm vary as well as the palatal implant position also varies in these models. Finite element analysis was then performed to compare the Von Mises stress distribution, and displacement of the palatal implant using ANSYS 12.1 software. Result: In this study, displacement was the same (0.0005 mm) for all four models. Highest amount von mises stress was observed in Model 3 (3.4798 MPa) as a comparison to Model 1 (2.5442 MPa), Model 2 (2.5018 MPa), and Model 4 (3.3854 MPa). The stress value for the palatal implant was within the acceptable fatigue limit of the titanium of 193 MPa therefore all four models combination was safe for the clinical application. Conclusion: Double palatal implant systems were more effective in comparison to the single palatal implant system in lingual orthodontics. In this study, we found that the displacement of the palatal implants was not affected by the length of the lever-arm and the amount of stress was decreased when we increase the length of the lever-arm.

Anterior maxillary teeth crown lenghtening and indirect veneer for esthetics rehabilitation: A case report

Background: Crown Lengthening is a surgical procedure performed to create a symmetrical gingival line and is carried out to expose necessary additional tooth structure. A short clinical crown occurs as a result of dental malformations, eruption disharmony, and genetic variation. Purpose: The purpose of this case report is to explain the treatment management of Crown Lengthening over the case of diastema closure by indirect veneer restoration. Case: 32 years old female presented with a chief complaint over a space between her anterior maxillary teeth. She wants to rectify her smile. Case Management: The management in this case are preparation of Digital Smile Design (DSD), Crown Lengthening on 11 and 21, and Indirect Veneer on 11, 21, 22. Conclusion: Aesthetical rehabilitation could be attained by an indirect veneer treatment followed by a gingival management which is Crown Lengthening.

Antеrior esthеtic Crown lеngthеning surgеry: A casе rеport

Maintaining hеalthy pеriodontium during tееth rеstoration procеdurеs is an indispеnsablе condition for obtaining rеgular functionning and еsthеtics. Crown lеngthеning is a surgical procеdurе dеsignеd to incrеasе thе еxtеnt of thе supragingival tooth structurе, so that thе clinician can rеstorе thе tooth. Thе crown lеngthеning procеdurе (CLP) is commonly usеd to maintain thе dеntogingival complеx in optimal conditions and to corrеct aеsthеtic dеfеcts through a smilе dеsign. Difficulty in maintaining appropriatе gingival biological width (GBW) is a frеquеnt problеm еncountеrеd in this typе of rеconstruction. Thе idеal situation for pеriodontium is localizing thе filling/complеmеnt bordеr supragingivaly, which is at lеast 3 mm from alvеolar procеss еdgе. In thе casе, whеn thе abovе conditions arе impossiblе to fulfil, еlongation of clinical crown is a mеthod of choicе. Thе aim of thе currеnt casе rеports is to еvaluatе thе implications of CL in routinе dеntal practicе. Thе diagnosis rеquirеmеnts, pеriosurgеry procеdurеs of crown lеngthеning, importancе of crown lеngthеning and еsthеtic improvеmеnts aftеr crown lеngthеning arе discussеd in diffеrеnt sеssions.

Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults with the Dutch Maxillary Expansion Device: a prospective clinical cohort study

ObjectivesTo provide a higher degree of evidence on the efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults, thereby applying the Dutch Maxillary Expansion Device (D-MED).Materials and methodsD-MED was developed as an individualized, 3D-designed, and fabricated MARPE appliance supported by 4 palatal miniscrews. Patients from the age of 16 onwards with transverse maxillary deficiency were enrolled consecutively. Pre-expansion and immediate post-expansion CBCTs and intra-oral scans were acquired and measurements of skeletal, alveolar, and dental expansion as well as dental and periodontal side-effects were performed.ResultsThirty-four patients were enrolled (8 men, 26 women) with mean age 27.0 ± 9.4 years. A success rate of 94.1% was achieved (32/34 patients). The mean expansion duration, or mean observation time, was 31.7 ± 8.0 days. The mean expansion at the maxillary first molars (M1) and first premolars (P1) was 6.56 ± 1.70 mm and 4.19 ± 1.29 mm, respectively. The expansion was 60.4 ± 20.1% skeletal, 8.1 ± 27.6% alveolar, and 31.6 ± 20.1% dental at M1 and 92.2 ± 14.5% skeletal, 0.0 ± 18.6% alveolar, and 7.8 ± 17.7% dental at P1, which was both statistically (p < 0.001) and clinically significant. Buccal dental tipping (3.88 ± 3.92° M1; 2.29 ± 3.89° P1), clinical crown height increase (0.12 ± 0.31 mm M1; 0.04 ± 0.22 mm P1), and buccal bone thinning (− 0.31 ± 0.49 mm M1; − 0.01 ± 0.45 mm P1) were observed, while root resorption could not be evaluated.ConclusionsMARPE by application of D-MED manifested its efficacy in a prospective clinical setting, delivering a high amount of skeletal expansion with limited side-effects in late adolescents and adults.Clinical relevanceHigher quality evidence is supportive of MARPE as a safe and successful non-surgical treatment option for transverse maxillary deficiency.

Analysis of Width, Height and Width/Height Ratio of Crowns of Maxillary Anterior Teeth

Background: The vital role of the prosthetic dentistry is not only the restoration of function, comfort and health of oral tissues but also esthetics in general. Upper jaw anteriors commonly seen in smile and contribute to the beauty of a smile. This study may help us to determine standard ideal tooth dimension of maxillary anterior six teeth to restore pleasing esthetics. Aim: To determine the mean width, height and width/height ratio of clinical crowns of natural maxillary anterior six teeth. Setting: Department of Prosthodontics, dental OPD LUMHS Jamshoro. Duration: Six months from 2018 to 2019 Design: Cross-sectional descriptive. Methods: A total of 101 Volunteer subjects with maxillary anterior six teeth present in mouth were included in the study. Impression of maxillary arch was made. The maximum mesiodistal width perpendicular to the longitudinal axis of the tooth and maximum cervicoincisal (CI) length parallel to the longitudinal axis of the maxillary central incisors, lateral incisors, and canines were recorded and width/height ratio was calculated. The final measurements were recorded into proforma. Results: The average age of the subjects was 24.74±3.89 years. The average crown width / length ratio was 0.78±0.12mm for right central incisor and 0.78±0.12mm left central incisor. The average crown W/H ratio was 0.63±0.16mm for right lateral incisor and 0.63±0.14mm left central incisor. Similar the mean crown W/H ratio was 0.64±0.16mm right canines and 0.65±0.18mm left canine. Conclusion: The tooth dimension showed high precision in length/width ratio. Since it showed the least variance in both genders, the crown width-to-length ratio was recognized as the most reliable standard. Keywords: Crown length, Crown width, Ideal tooth dimensions, Maxillary anterior teeth.