Incisors Research Articles

Reabilitação estética de dente conóide: relato de caso

As aesthetics advance in modern dentistry, people's expectations of their smiles become ever higher. Microdontia or conoid tooth, which refers to teeth smaller than normal, is one of the abnormalities that causes major aesthetic complaints due to its characteristics. Conoid teeth have a prevalence of 0.6 to 9.9%, with conical upper lateral teeth affecting approximately 55,000 people, with women being more susceptible than men. Many factors must be considered when restoring anterior teeth, depending on patient expectations and dental practice. The direct composite resin technique has stood out for providing aesthetic benefits, preserving tooth structure, being performed in a single consultation, being cheaper and not requiring any laboratory process. The objective of this study was to report a clinical case of aesthetic rehabilitation in a conoid tooth in the upper left lateral incisor with composite resin restoration using the direct technique. Clinical planning is essential for choosing the technique and restorative material to be used. Despite the various techniques proposed for the treatment of conoid lateral incisors, the aesthetic reanatomization with a direct veneer of composite resin, with diagnostic waxing, used in this study, was effective and inexpensive, allowing a minimally invasive treatment and possible posterior adjustments, enabling the restoration of self-esteem and the harmony of the patient's smile.

3D-printed one-piece versus two-piece orthodontic clear aligner attachments bonded with provisional crowns: A proof of concept

ObjectivesThis study aimed to introduce a novel technique for fabricating provisional crowns integrated as a single unit with aligner attachments. MethodsA total of 60 crowns with attachments were prepared: 20 conventional (Protemp) and 40 3D-printed (20 bonded with attachments; 20 integrated with composite attachments as a single unit) using NextDent resin. Two central incisors were scanned (once without attachments and once with attachments) to create STL files for specimen printing. Half of the specimens (30, n = 10 per group) underwent thermal cycling (5000 cycles). Shear bond strengths (MPa) were evaluated using a universal testing machine. The debonded areas and attachment failures were analyzed to determine the fracture type. Data analyses were performed using ANOVA and post hoc Tukey tests (α = 0.05). ResultsThe 3D-printed specimens showed higher strength values than the bonded attachments per group (P < 0.001). The 3D-printed crowns with attachments demonstrated the highest strength (12.39 ± 1.92 MPa). Thermal cycling significantly decreased the bond strength of the attachments (P < 0.001), except in the 3D-printed crowns with composite attachments as a single unit, which showed no significant change after thermal cycling (P = 0.643). In the bonded attachment groups, the adhesive type was the predominant failure mode, while in the 3D-printed groups, attachment fractures were the primary cause of failure. ConclusionThe 3D-printed provisional crowns with attachments have high strength and is clinically appropriate for orthodontic treatment when temporization of teeth is indicated. Clinical SignificanceThe developed technique for fabricating 3D-printed provisional restorations with orthodontics attachments as a single unit is a promising approach. The technique may be incorporated into the digital orthodontic treatment workflow when temporization is indicated.

Reabilitação cirúrgica periodontal associado a enxerto ósseo: relato de caso

Periodontal disease (PD) is a pathology of inflammatory origin, multifactorial, affecting the tissues of insertion of dental elements. The treatment of PD is classified into non-surgical therapy and surgical therapy, therefore, multiple studies are developed to find effective techniques and materials in the reconstruction of defects generated in the supporting periodontium from PD. Patient V.M.P.S, female, 51 years old, without systemic problems, reported during anamnesis as her main complaint “I have a problem with my front teeth”. The treatment plan was planned with open-field periodontal scaling and bone grafting with sticky bone. A full-thickness mucoperiosteal incision was made, from the distal of unit 14 to the distal of unit 24, followed by scraping with Gracey curettes number 1-2 and number 5-6 with copious irrigation with saline solution. For Sticky bone formation, (PRF) platelet-rich fibrin and (i-PRF) liquid platelet-rich fibrin were deposited in a metal vat to which Bio-Oss bone substitute was added, with careful manipulation to obtain the agglutination of biomaterials. Based on this, the aim of our study was to report a clinical case of open field root scraping associated with bone grafting with Sticky Bone.

Thoracoscopic and endoscopic cooperative surgery for esophageal gastrointestinal stromal tumor: a case report

BackgroundEsophageal gastrointestinal stromal tumors (GISTs) are relatively rare, accounting for 2–5% of all GISTs. Typically, the treatment is surgery in nature. However, no standard procedure established for esophageal GISTs, and in many cases, subtotal esophagectomy or local resection via thoracoscopy or mediastinoscopy is performed. Thoracoscopic and endoscopic cooperative surgery (TECS) is a surgical approach similar to laparoscopic and endoscopic cooperative surgery used for gastric GIST; however, no reports of its use for esophageal GIST have been published to date. We herein report such a case along with a review of past literature.Case presentationThe patient was a 60-year-old man. Upper gastrointestinal contrast imaging revealed a subepithelial lesion in the esophagus. An 18 × 17 mm subepithelial lesion was identified in the left wall, 35 cm from the upper incisors, during upper gastrointestinal endoscopy, and was diagnosed as a GIST through endoscopic ultrasound-guided fine needle biopsy. TECS was therefore performed. The patient was placed in a prone position with his face to the left. After confirming the lesion under endoscopy and left thoracoscopy, the periesophageal area of the lesion was dissected under thoracoscopy. Subsequently, an endoscopic full-layer resection was performed. Finally, the excision site of the lesion was sutured under thoracoscopy. The operation took a total of 3 h and 22 min, with a blood loss of 50 mL.ConclusionsThe appropriate surgical procedure for esophageal GIST should be considered according to the location and size of the lesion. TECS ensures that the resection margins are secured using an endoscopic or thoracoscopic approach. Furthermore, TECS is minimally invasive, avoiding esophagectomy and reconstruction, which makes it a potential surgical option for esophageal GISTs.

Dentofacial and skeletal effects of two orthodontic maxillary protraction protocols: bone anchors versus facemask

BackgroundMaxillary retrognathia and/or mandibular prognathia are resulting in class III malocclusion. Regarding orthodontic class III malocclusion treatment, the literature reports several treatment approaches. This comparative clinical study investigated two maxillary protraction protocols including bone anchors and Delaire type facemask.MethodsCephalometric radiographs of n = 31 patients were used for data acquisition. The patients were divided into two groups according to their treatment protocol: bone anchored protraction (n = 12, 8 female, 4 male; mean age 11.00 ± 1.76 years; average application: 13.50 ± 5.87 months) and facemask protraction (n = 19, 11 female, 8 male; mean age 6.74 ± 1.15 years; average application: 9.95 ± 4.17 months). The evaluation included established procedures for measurements of the maxilla, mandibula, incisor inclination and soft tissue. Statistics included Shapiro-Wilk- and T-Tests for the radiographs. The level of significance was set at p < 0.05.ResultsThe cephalometric analysis showed differences among the two groups. SNA angle showed significant improvements during protraction with bone anchors (2.30 ± 1.18°) with increase in the Wits appraisal of 2.01 ± 2.65 mm. SNA angle improved also during protraction with facemask (1.22 ± 2.28°) with increase in the Wits appraisal of 1.85 ± 4.09 mm. Proclination of maxillary incisors was larger in patients with facemask (3.35 ± 6.18°) and ML-SN angle increased more (1.05 ± 1.51°) than in patients with bone anchors. Loosening rate of bone anchors was 14.58%.ConclusionsBoth treatment protocols led to correction of a class III malocclusion. However, this study was obtained immediately after protraction treatment and longitudinal observations after growth spurt will be needed to verify the treatment effects over a longer period. The use of skeletal anchorage for maxillary protraction reduces unwanted side effects and increases skeletal effects needed for class III correction.

Rehabilitation of a Severe Anterior Ridge Defect with a Fixed-Removable Prosthesis

Significant anterior ridge abnormalities might be difficult to restore with prosthesis. To attain good speech and aesthetics necessitate not only the restoration of the missing teeth but also the closure of the problematic region. One recommended treatment option for individuals with substantial ridge abnormalities is the Andrews bridge which is a fixed-removable prosthesis. The prosthesis correctly replaces the missing teeth and corrects the ridge defect area and restore speech and appearance. A 35-year-old female patient reported with the principal complaint of spacing in her lower front teeth and difficulty in phonetics and poor appearance. On clinical examination spacing was seen in the maxillary central incisors along with pro-clination and 31,32,33,41,42,43 teeth were missing and the edentulous defect area was coming under Seibert's Class III category. Rehabilitation of such defect with an Andrews bridge described in this case report, which used natural teeth as abutments for its permanent component and a detachable superstructure.

"In Their Own Words": Families' Experiences With Tooth Autotransplantation for the Replacement of Maxillary Incisors in Children.

To examine families' experiences, including motivation and barriers to undergoing tooth autotransplantation (AT), and their perceptions of associated esthetic and functional outcomes. Semi-structured, in-depth-interviews (IDIs) were conducted in person with families who had children that underwent the AT procedure. Interviews were audio recorded and transcribed. Transcripts were coded and thematically analyzed both deductively and inductively. A facilitatorsand barriers matrix and journey maps were created to draw inferences on patterns arising from main themes. Twenty families selecting AT as a solution for a missing maxillary incisor were recruited and interviewed. Overall, all families interviewed had a positive experience with the AT procedure. Motivating factors for undergoing the AT procedure included wanting an earlier intervention for the missing incisor, wishing to mitigate negative psychosocial effects, and the anticipated positive outcomes that would last into adulthood. Barriers to uptake of the AT procedure included the lack of dental practitioner awareness of AT as a potential solution and a large number of appointments and travel. Families were also initially concerned over potential complications that could arise from their child undergoing this procedure. The cost of the procedure was both a barrier and a facilitator for treatment. The study results demonstrate that the overall AT is favorably considered by the families of growing children for the replacement of maxillary incisors and highlight factors that may act as motivators or barriers to its uptake.

Association between molar incisor hypomineralisation and tooth agenesis: a cross-sectional study in Brazilian children and adolescents.

The aim of the present was to assess the association between MIH and tooth agenesis (TA) in orthodontic patients from the Federal University of Rio Grande do Norte, Natal, Brazil. A cross-sectional study was performed to evaluate the presence of MIH and TA in a sample of 371 pretreatment orthodontic records from patients aged 9-18years. Statistical analyses were performed using the Chi-square and Fisher's exact tests, and logistic regressions. There was a statistically significant association between the prevalence of tooth agenesis and MIH. A higher percentage of third molar agenesis, maxillary premolar agenesis, and mandibular second premolar agenesis was observed among children with MIH-affected teeth. Patients with MIH had a 2.43 times greater chance of third molar agenesis, and a 5.88 times higher likelihood of mandibular premolar agenesis. There is a weak association between MIH and TA. Furthermore, the presence of hypomineralised molars increases the risk of tooth agenesis.

Efficacy of Bone Anchored Pendulum Appliance Over Conventional Pendulum Appliance during Molar Distalization in the Orthodontic Management of Class II Malocclusion : A Systematic Review

Background: Pendulum appliance used commonly used to achieve molar distalization in the management of borderline class II malocclusion is associated with mesial tipping of the maxillary premolars and proclination of maxillary incisors post-distalization, resulting in round tripping and increased treatment time. Bone Anchored Pendulum Appliance (BAPA) is one of the modifications of the pendulum that could effectively prevent anchorage loss. Aim: To evaluate the effectiveness of Bone Anchored Pendulum Appliance(BAPA) over the Conventional Pendulum Appliance(CPA) for the distalization of maxillary molar in the management of Class II malocclusion. Materials and Methods: A web search was done in Google Scholar, MEDLINE, Web of Science, LILAC and COCHRANE Library databases using PRISMA guidelines. The search included RCTs and Non RCTs (Both Prospective and Retrospective studies) comparing distalization achieved by BAPA with CPA in Class II malocclusion. The Risk of bias was assessed using the ROBINS - I tool. Results: Of the initial 745 articles, 5 studies met the inclusion criteria and were included to the systematic review. The BAPA showed between 4.8 -6.4 mm of molar distalization and between 9 °-11.3° of distal tipping of molars while the distalization achieved with CPA was between 2mm -6.4mm with 6.67° -14.50° of distal tipping. While CPA groups showed mesial tipping of premolars, distal tipping of premolars was observed with the BAPA appliances. Conclusions: BAPA were found to significantly reduce anterior anchorage loss, distalise the premolars and molars. There is moderate evidence that BAPA provides greater distalization with reduced incidence of unwanted tooth movements.

Where do all the ewes go? Ewe culling and mortality in 34 sheep flocks in New Zealand

ABSTRACT Aims To describe rates of and reasons for culling and mortality of ewes between breeding and mid-lactation on New Zealand sheep farms; to investigate associations of these variables with farm demographic variables; and to describe rates of and reasons for culling of ewes at weaning. Methods Participants were a convenience sample of 34 farms from across New Zealand. Demographic data were initially collected for each farm via a questionnaire administered in-person to the flock owner or manager. During approximately 8 months from breeding to mid-lactation, ewe tally, culling and mortality data were collected and used to calculate various parameters related to flock performance and to investigate associations. During the main ewe-culling event at weaning, ewe-culling data were collected from 29/34 flocks participating in the study. Results There was considerable variation between flocks, but the between-flock mean replacement percentage was 29.2 (SD 5.0)%. Overall, a between-flock mean of 10.5 (SD 4.6)% of ewes presented for breeding were culled or dead/missing by mid-lactation and thus did not rear any lambs. Additionally, from 27 flocks that reported data on ewes’ success at rearing lambs, a between-flock mean of 3.9 (SD 2.5)% of ewes that remained alive at mid-lactation failed to rear any lambs, resulting in an overall between-flock mean loss of 23.1 (SD 6.3) potential lambs per 100 ewes. Two-thirds of ewe mortalities between breeding and mid-lactation occurred during the lambing period. Model results showed flocks with higher pregnancy scanning percentages had lower rates of culling and mortality between breeding and mid-lactation. However, apart from farm contour, from breeding to mid-lactation there were no associations for culling and mortality with farm size, flock size, number of ewes per labour unit, whether ewe hoggets (7–9 months of age) were presented for breeding, or duration of the breeding period. A between-flock mean of 16.5 (SD 8.3)% of ewes present at weaning were culled, and among mixed-age ewes, the most common reasons for culling at this time were age, incisor teeth defects and udder defects. Conclusions To reduce unnecessary ewe culling and mortality, attention should be focused on maximising conception rates, ensuring judicious culling decisions, optimising body condition score, and identifying farm-specific causes of death over the lambing period to facilitate targeted intervention strategies. Clinical relevance Identifying why and when ewes exit flocks, and comparing it with the data presented here, will facilitate the development of flock-specific interventions to reduce ewe culling and mortality. Abbreviations BCS: Body condition score; NI: North Island; SI: South Island

Orthodontic management of severe inversely impacted maxillary central incisors: a case series.

Abnormal positioning and dislocation of the central incisor can disturb tooth eruption. Generally, inversely impacted maxillary central incisors do not erupt naturally. Performing traction and applied extrusion of an inversely impacted maxillary central incisor with a high inclination angle of the crown is challenging. This study aimed to examine the possibility of orthodontic treatment for severely inversely impacted maxillary central incisors in a series of case studies. The inclination angle of the tooth crown, curvature of the tooth root, and length of the formed tooth root were measured using radiography. The teeth were then fenestrated and traction was applied using a lingual arch appliance with elastics. The average crown axis inclination was 113°, the degree of root curvature was 97.3°, and the root formation was 36.1%. Although the crown axis inclination and root curvature were severe, all the incisors were aligned in the correct position as vital teeth through surgical and orthodontic treatments. Traction should be performed in the early period of incisor development when root formation is not progressing, regardless of the tooth angle.

3D Printed Dual Reduction Guide: A Feasible Alternative for Conservative Gingivectomy and Minimally Invasive Preparation for Ceramic Veneers.

This case report describes a digital workflow for designing and 3D printing a guide with the dual purpose of gingivectomy and tooth preparation in the esthetic zone, to be followed by cementation of ceramic veneers under rubber dam isolation. The patient's primary concern was to improve her smile. After clinical evaluation, our recommendation was for a minimal gingivectomy to match the gingival zenith for both central incisors, to be followed by ceramic laminate veneers. A digitally designed and 3D printed guide was used for gingivectomy and tooth preparation for the ceramic veneers. Ceramic veneers were cemented under rubber dam isolation to maximize bonding properties. A single guide can be digitally designed and 3D printed to perform controlled gingivectomy and minimally invasive tooth preparations. The outcome of the gingivectomy improved the gingival architecture for central incisors, and the ceramic veneers fulfilled the patient's esthetic demands.

Comparing Three-dimensional Radiologic Outcomes Between Early Versus Late Secondary Alveolar Bone Grafting.

Secondary alveolar bone grafting (SABG) during mixed dentition is the standard of care for patients with complete cleft of lip and palate. Early SABG (E-SABG; 4 to 7y) occurs before the eruption of lateral incisors, whereas late SABG (L-SABG; 8 to 12y) occurs before the eruption of maxillary permanent canines. This study compares outcomes of E-SABG versus L-SABG among patients with unilateral cleft of lip and palate (UCLP). A prospective cohort study was conducted evaluating nonsyndromic patients with UCLP who underwent SABG from April 2018 to January 2020, 48 consecutive patients with UCLP were included. Preoperative and 6 to 10-month postoperative cone beam computed tomography imaging were obtained to assess graft and periodontal outcomes. Among 48 patients with UCLP, of which 21 were in the E-SABG group (6.9 ± 1.1y), and 28 were in the L-SABG cohort (10.4 ± 1.6y). The initial alveolar cleft width is significantly smaller in the E-SABG cohort compared with the L-SABG cohort (5.1 ± 1.5 versus 6.5 ± 2.0mm, P = 0.008). Compared with the L-SABG cohort, the E-SABG cohort had higher rates of bony bridge formation (77.3% versus 65.4%, P= 0.367), thicker bony bridges (5.7 ± 2.1 versus 3.9 ± 1.5mm, P= 0.004), lower Bergland scores [1.5 (interquartile range: 1 to 2) versus 2.25 (interquartile range: 1.5 to 3.5), P= 0.026], and greater alveolar bone coverage (79.8 ± 16.7% versus 67.9 ± 18.1%, 0.024). The authors' findings suggest that patients who undergo E-SABG at ∼7 years may have better graft outcomes and benefits to the periodontal bone support on cleft-adjacent incisor compared with L-SABG at 11 years.

Orthodontic-Surgical Management of Triple Impacted Mesiodens and Maxillary Incisors - A Case Report

Abstract Rationale: Mesiodens are supernumerary teeth located in the pre-maxilla between the two central incisors with a prevalence rate of 0.15–1.9%. An impacted mesiodens may cause delayed eruption of permanent incisors, ectopic eruption, pathological disturbances and malalignment of teeth. Patient Concerns: The patient complained of missing upper front teeth associated with pain in the same region for two weeks. Diagnosis: Upon clinical and radiographic examination, it was diagnosed as triple impacted mesiodens with impacted permanent maxillary central incisors. Treatment: The clinicians in the study approached the issue by surgical removal of the impacted mesiodens and orthodontic treatment for extrusion of the impacted permanent maxillary central incisors. Outcomes: The patient was relieved of the pre-operative concerns and followed up regularly for the eruption of permanent maxillary central incisors. Take-away Lessons: The authors advocate the importance of timely diagnosis and proper management of such rare pathologies.

Evaluation of a New Technique of Gingival Smile Reduction after Hyaluronic Acid Infiltration: A Cohort Study Focusing on Gingival Exposure and Patient-Oriented Outcomes.

A gummy smile is the visualization of more than 3 mm of gingiva above the maxillary incisors. This study aimed to evaluate the long-term effects on aesthetics and patient satisfaction of a new hyaluronic acid infiltration technique in reducing the gummy smile. Fifty patients with gummy smiles were treated using hyaluronic acid infiltration points by applying 0.1 mL per injection at specific points. Post-treatment evaluations were performed one week, one month, three months, six months, and 12 months later. A questionnaire assessed patient satisfaction, willingness to recommend the treatment, and side effects (pain and bruising during and after treatment). An average reduction of 2.5 mm in gingival exposure during smiling was observed. After one week, the reduction was constant. At six months, 40% of the original gingival exposure was recovered, and recovery was complete at 12 months. Patient satisfaction was 82.1%, and 100% of patients would recommend the treatment. Bruising, swelling, and pain decreased to 0% from the first month. In conclusion, this technique is a safe and effective option to improve the smile's appearance with minimal complications.

Reconstructing confidence: Fiber reinforced reattachment of a fractured maxillary lateral incisor – A clinical case report

AbstractA broken smile can be more than just a physical injury—it can impact self-esteem and confidence. This case highlights the successful reattachment of a fractured upper front tooth in a 32-year-old female following a recent fall. The comprehensive treatment strategy involved immediate root canal therapy to relieve pain, followed by a gingivectomy and osteotomy to correct the subgingival fracture and restore the biologic width. Advanced techniques, including fiber post and core reconstruction reinforced with ribbond fiber, were used to stabilize and support the tooth structure. The final touch is done with a layer of composite for optimal function and aesthetics. This holistic approach not only revived the patient's smile but also rejuvenated her confidence and psychological well-being.

Exploring the Learning Curve of Dental Implant Placement Using a Task-Autonomous Robotic System Among Young Dentists From Different Specialties-A Pilot Module Study.

The learning curve effect of dynamic computer-assisted implant surgery (D-CAIS) was observed among inexperienced novice surgeons. The learning curves can provide valuable information for novice surgeons and valid comparisons between new and conventional techniques. Recently, robotic computer-assisted implant surgery (R-CAIS) has shown promise as a novel dental implant surgical technique for both partially and edentulous patients. However, its learning curve remains unknown. The aim of this study was to explore the learning curve of dental implant placement surgery with a task-autonomous robotic system among young dentists with different specialties. Four young dentists (mean age: 25.3 ± 1.5 years at the beginning of their first attempt) with equal representation of males and females and with different specialties participated in this study. None of the participants had prior experience in R-CAIS. Each operator placed eight implants over eight attempts using a semi-active task-autonomous robotic system. Among the eight implants, four were straight lateral incisor implants, and four were 30°-tilted premolar implants. The implants were placed in each dental quadrant of the maxillary and mandibular jaw modules. The operation time was recorded. Coronal, apical, and angular deviations between the planned and actual sites of implant placement were measured by merging preoperative and postoperative cone-beam computed tomography (CBCT) scans. The data were analyzed with repeated-measures ANOVA (α = 0.05). The mean time for implant placement was associated with the number of attempts (p < 0.01). The time taken for the second attempt was significantly shorter than that of the first attempt (33.26 vs. 30.47 min; p < 0.001) then it plateaued. Three-dimensional (3D) angular (p = 0.31), coronal deviation (p = 0.26), and apical deviation (p = 0.06) did not differ significantly among attempts. The mean values and standard deviations of 3D coronal deviation, 3D apical deviation, and 3D angular deviation were 0.71 ± 0.31 mm, 0.72 ± 0.30 mm, and 0.94 ± 0.58°, respectively. Neither the position of the jaw (p > 0.59) nor the tilt angle of the implant (straight or 30°-tilted, p > 0.85) was related to implant placement accuracy. Dentists quickly learned the basic workflow of R-CAIS and thus facilitated the clinicians in the mastery of implant placement on edentulous jaw modules, leading to a comparable operating speed and high precision. Moreover, the accuracy of placement of straight and tilted implants in both the maxilla and mandible with R-CAIS was satisfactory.

Microsurgical Treatment of a Large Through-and-Through Periapical Lesion with Apicomarginal Defect using Guided Tissue Regeneration (GTR): A Case Report of a Two-Year Follow-Up

In case of a long-term periapical lesion, destruction of both vestibular and oral cortical plates is sometimes observed and even a through-and-through periapical lesion occurs. The success of the treatment decreases when an apicomarginal defect is added to the through-and-through periapical lesion. Large periapical lesions should be treated initially by orthograde root canal therapy. When the signs and symptoms of the infection don’t recede after the treatment, then surgical approaches should be considered. In this case report, a 22-year-old female with previously initiated therapy was referred for an endodontic microsurgery of tooth 22 (i.e., upper left lateral incisor). After the endodontic treatment the patient was referred to the oral surgeon for apicoectomy with augmentation of the bone defect. The sinus tract in the apex area of the tooth 22 remained active since the surgical intervention. Endodontic microsurgery and guided tissue regeneration were performed. The article presents diagnostic data, namely pre- and post-operative images of cone beam computed tomography (after 2 years), as well as pre-, intra- and post-operative clinical images. All pre- and intraoperative procedures and stages are detailed. In particular, separation of platelet-rich fibrin (PRF) from venous blood, retrograde preparation with an ultrasonic tip and a device using a dental operating microscope and the use of a collagen membrane. After two-year follow-up, radiographic examination revealed significant bone reconstruction and clinical signs and symptoms were absent. The patient hasn’t reported any symptoms since. The paper also analyzes scientific sources on the use of PRF and collagen membranes in bone defects of the jaws. Attention is also paid to the formation of a flap during operations of this type. The main six success factors in the treatment of such complex cases are highlighted. Rethinking the previously performed surgery (apicoectomy) in this patient, attention was paid to the main five factors that could contribute to the failure.

Sex determination and odontometric dimensions - A study of a North Indian population.

Sex determination is an indispensable parameter in identifying unknown deceased individuals. It can narrow down the chances of possible matches by 50%, providing a crucial lead in personal identification. In cases of commingled, decomposed, fragmented, charred and unidentifiable corpses, the importance of dental morphometrics cannot be overlooked due to the resistance of teeth to post-mortem degradation. Addressing this quality of teeth, a descriptive cross-sectional study was conducted in a North Indian population to evaluate sexual variations in dental dimensions and to identify the most sexually dimorphic dental dimension. The study included 207 participants (114 females and 93 males) in the age group of 21 to 45 years. Dental casts were prepared after obtaining informed consent from the participants and ethical clearance from the institute's ethical committee. Six odontometric dimensions, namely incisor-incisor distance, inter canine distance, combined width of central incisors, inter-premolar distance, inter-molar distance, and dental arch height of each participant were recorded on the dental casts using standard procedures. Analysis of the data elucidated the existence of statistically significant sexual dimorphism in the dental dimensions of the participants. The results of the discriminant function analysis show a sex determination accuracy of 68.1%, with a cross-validation accuracy of 65.2%. The study found the incisor-incisor distance to be the most sexually dimorphic trait, making it the best predictor of sex in the present population. The results of the present study may be helpful in sex determination and personal identification from dental remains in medico-legal and disaster victim identification cases.

TREATMENT OF TOOTH AVULSION: A CASE REPORT

Dental trauma (DT) refers to injuries caused by impacts to the teeth and/or the hard and soft tissues within or outside the oral cavity. Among the various types of DT, avulsion, characterized by the complete displacement of the tooth from its socket. The success of treatment depends on timely management and proper professional care during and after reimplantation in preserving the tooth in the oral cavity. This study describes a case report of an avulsion of the upper left central incisor (21) that underwent reimplantation. The patient, a 10-year-old boy, had a history of bicycle fall, presenting with extraoral injuries to the cheek and chin, lip abrasions, and avulsion of tooth 21. The tooth was stored in milk and reimplanted 30 minutes after the accident. Clinical and radiographic examinations showed no bone fractures but revealed mobility of teeth 11 and 12 and avulsion of tooth 21. Treatment included cleaning, repositioning of the avulsed tooth, stabilization with a semi-flexible splint, and administration of antibiotics and analgesics. Endodontic therapy with mechanical instrumentation was successfully initiated after 20 days. This case highlights the importance of proper tooth storage and timing of reimplantation, leading to the restoration of patient’s aesthetics, chewing function, and self-esteem.