Hard Tissue Changes Research Articles

Modifications of the Dental Hard Tissues in the Cervical Area of Occlusally Overloaded Teeth Identified Using Optical Coherence Tomography.

Background and objectives: Occlusal overloads produce a series of manifestations in teeth, especially attrition and non-carious cervical lesions (NCCL). Optical Coherence Tomography (OCT) can highlight and evaluate tooth lesions. The aim of this study was to examine the changes of dental hard tissues in the cervical area because of occlusal overload by macroscopic examination and using in vitro Swept Source OCT examination. Materials and Methods: The study was performed on 21 extracted teeth with occlusal trauma. After macroscopic and OCT examination, the 2D OCT images were transformed into 3D images using ImageJ software. Statistical analysis of macroscopic and OCT images was performed with Statistical Package for Social Sciences. Results: On 21 teeth, 88 cervical lesions (cracks) were identified. Upper premolars with an occlusal Smith and Knight tooth wear score of 2 had the most NCCL. Statistical analysis revealed significant differences in the median widths of cervical lesions between teeth with score 1 and score 3. Additionally, we obtained statistically significant differences in median widths between the buccal and oral surfaces. Conclusions: These cracks can be considered precursors of NCCL. NCCL can be located on dental surfaces in the cervical area other than the buccal one. A 3D reconstruction of OCT images emphasized that cracks are located especially at enamel level, evolving towards the enamel–dentin junction, with multiple ramifications.

Preservation of the alveolar ridge in exodontia: a systematic review of the major aesthetic aspects

Introduction: In the work of implant placement in the post-extraction of single teeth, the esthetic zone has been a topic of great interest in the last 4 decades. Significant advances are being made in tissue biology knowledge in terms of post-extraction hard and soft tissue changes, helping to better understand the etiology of these esthetic complications. Objective: The present study carried out a concise systematic review of the tooth extraction process in light of minimally invasive extraction to preserve the esthetic area. Methods: The present study followed a concise systematic review model, following the rules of systematic review – PRISMA. The search strategy was carried out in the PubMed, Embase, Ovid, Cochrane Library, Web Of Science, and Scopus databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 104 studies were found and, after that, 36 studies of high to medium quality. As a result, it became evident that the extraction of a tooth initiates a series of reparative processes involving hard tissue (alveolar bone) and soft tissue (periodontal), gingiva). Alveolar bone changes after tooth extraction can compromise prosthetic rehabilitation. Alveolar ridge preservation has been proposed to limit these changes and improve prosthetic and esthetic results when implants are used. Alveolar ridge preservation techniques can minimize the overall changes in residual ridge height and width six months after extraction, but the evidence is very uncertain. There is no evidence of differences in the need for additional augmentation at the time of implant placement, implant failure, esthetic outcomes, or any other clinical parameters due to a lack of long-term information or data.

The Accuracy of Jaws Repositioning in Bimaxillary Orthognathic Surgery in Patients with Cleft Lip and Palate Compared to Non-Syndromic Skeletal Class III Patients.

Background: The present study aims to compare the accuracy of jaw repositioning in bimaxillary orthognathic surgery using digital surgical planning in cleft lip and palate patients and in non-syndromic skeletal class III patients in order to investigate if orthognathic surgery achieves different results in the first group of patients. Method: This study included 32 class III adult patients divided into 2 groups: cleft lip and palate (A, n = 16) and non-cleft (B, n = 16). For each patient, a 2D pre-surgical visual treatment objective was performed by the surgeon to predict hard tissue changes, and the surgical outcome was compared with that planned by using cephalometric measurement (ANB, SNA, SNB, Ar-Go-Me, S-Ar-Go). The statistical analysis showed equivalence between obtained and planned results for each measurement both in group A and in group B, but the difference between the planned and the obtained result was smaller in group B regarding ANB angle. Conclusions: Digital surgical planning ensures better predictability of the surgical results and higher accuracy of surgery in complex patients, such as those with cleft lip and palate.

Assessment of the influence of soft tissue biotype on the marginal bone changes around dental implants

Background: Changes in peri-implant hard and soft tissues, as well as restorative and patient-based subjective measures are the most widely used parameters for evaluating the outcomes of implant therapy. The present study was conducted to assess the influence of soft tissue biotype on the marginal bone changes around dental implants. Materials & Methods: 58 patients who received dental implants of both genders were included. In all patients, initial mucosal thickness, marginal bone levels on radiographs, pain, and exudation were evaluated. All these parameters were recorded at the time of implant placement, at the time of cementation of final restoration, 6 months and 12 months post cementation. Results: Out of 58 patients, males were 20 and females were 38. The mean mucosal thickness at baseline, second stage, at cementation, 6 months and 12 months was 2.82, 1.90, 1.54, 2.62 and 3.42 in thick mucosa and 1.65, 0.84, 0.69, 1.14 and 1.62 at thin mucosa. The difference was significant (P< 0.05). The mean pocket depth at cementation was 2.52, at 6 months was 3.20 and at 12 months was 3.24 in thick and 2.12 at cementation, 3.10 at 6 months and 3.16 at 12 months in thin biotype respectively.

Assessment of soft-tissue vs hard-tissue changes after isolated functional genioplasty

This study aimed to determine the vertical and horizontal soft-tissue vs hard-tissue changes after isolated functional genioplasty and to revisit hard-tissue remodeling at the symphysis. Seventy-five patients who underwent genioplasty as an isolated procedure at the end of their orthodontic treatment were divided into 3 groups on the basis of their age at surgery:<15 years (group 1), 15-18 years (group 2), and ≥19 years (group 3). Patients were evaluated at 3 time points: immediately before surgery (T1), immediately after surgery (T2), and 2 years after surgery (T3). In addition, 25 patients who did not accept genioplasty, were age-matched with group 1, and had a follow-up radiograph 2 years after the end of their orthodontic treatment were used as a control group. From T2 to T3, group 1 showed less forward horizontal hard-tissue and soft-tissue changes at pogonion (Pg) than the control group; however, no difference was noted for vertical changes at Me & Me'. From T1 to T3, the horizontal hard-tissue and soft-tissue changes at Pg were 6.39 mm and 6.72 mm, respectively, for surgical groups. Vertical hard-tissue change at menton (Me) showed a reduction of 1.63 mm (95% confidence interval [CI], -3.37 to 0.11) and 3.89 mm (95% CI, -5.83 to -1.95) in nongrowing female and male patients, respectively. The vertical soft-tissue change reduction was similar for nongrowing male and female patients (1.7 mm [95% CI, -2.96 to -0.45]). Soft-tissue thickness change at Pg (0.33 mm) was not significant. In contrast, a small but significant increase in soft-tissue thickness was noted at Me (0.54 mm). Linear regressions were calculated for all groups and allowed for predicting long-term soft-tissue changes (T3-T1) using the amount of surgical displacement (T2-T1). The horizontal hard-tissue change was stable for nongrowing patients, and the horizontal soft-tissue change was 92% of hard-tissue. Vertical soft-tissue change is less predictable. Variation of soft-tissue thickness after genioplasty can be explained by skeletal changes and the achievement of an unforced labial occlusion. These results support the functional and esthetic benefits of this surgery. Comparison with the control group showed that genioplasty does not change the growth pattern, and bone remodeling is likely to explain the difference noted at Pg.

Lateral cephalometric changes and stability of BSSO versus IVRO for mandibular setback surgery: A systematic review and meta-analysis.

The aim of this review is to examine the lateral cephalometric hard tissue changes and the stability of the end result of bilateral sagittal split osteotomy (BSSO) and the intraoral vertical ramus osteotomy (IVRO) techniques for mandibular setback surgery. A systematic review of MEDLINE (via PubMed), Scopus, and Cochrane Library databases (last search date: August 22nd, 2021) was performed according to the PRISMA guidelines. Only studies that directly compare BSSO and IVRO were included. Random-effects model meta-analyses were performed. Ten studies, comprising a total of 331 patients, 169 patients undergoing BSSO and 162 patients undergoing IVRO were identified. No statistically significant differences were observed regarding the angular measurements: Sella/Nasion/B point (SNB) angle post-operatively (standardized mean difference [SMD]= 0.39, 95% Confidence Interval [CI]: [-0.15] – [0.94], p=0.16, I2=57.09%) and 1 year after surgery (SMD= 0.72, 95% CI: [-0.08] – [1.53], p=0.08, I2=80.83%), gonial angle post-operatively (SMD=0.45, 95% CI: [-0,26] – [1.15], p=0.21, I2=72.54) and 1 year after surgery (SMD= 0.15, 95% CI: [-0.79] – [1.08], p=0.75, I2=91.56%), and MP angle 1 year after surgery (SMD=-0.46, 95% CI: [-1.64] – [0.72], p=0.45, I2=90.81%). In addition, no statistically significant differences were observed regarding the linear measurements, the relapse of the mandible as measured by the relapse of B point 1 year after surgery in the horizontal axis (SMD= 0.73, 95% CI: [-0.25] – [1.72], p=0.15, I2=86.43%) and vertically (SMD= -0.76, 95% CI: [-1.97] – [0.45], p=0.22, I2=90.09%). BSSO and IVRO have similar results in terms of SNB and gonial angle relapse post-operatively and 1 year after surgery, MP angle 1 year after surgery and horizontal and vertical relapse, measured in reference to B point 1 year after surgery.

Immediate implant placement with or without socket grafting: A systematic review and meta-analysis.

To assess the effect of grafting the gap (SG) between the implant surface and alveolar socket on hard and soft tissue changes following single immediate implant placement (IIP). Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase and Cochrane databases as well as a manual search to identify eligible clinical studies up to August 2021. Randomized controlled trials (RCTs) comparing IIP with and without SG were included for a qualitative analysis. Meta-analyses were performed when possible. Out of 3627 records, 15 RCTs were selected and reported on 577 patients who received 604 single immediate implants (IIP + SG: 298 implants in 292 patients; IIP: 306 implants in 285 patients) with a mean follow-up ranging from 4 to 36 months. Two RCTs showed low risk of bias. Meta-analysis revealed 0.59 mm (95% CI [0.41; 0.78], p< 0.001) or 54% less horizontal buccal bone resorption following IIP + SG when compared to IIP alone. In addition, 0.58 mm (95% CI [0.28; 0.88], p< 0.001) less apical migration of the midfacial soft tissue level was found when immediate implants were installed with SG. A trend towards less distal papillary recession was found (MD 0.60 mm, 95% CI [-0.08; 1.28], p= 0.080) when SG was performed, while mesial papillae appeared not significantly affected by SG. Vertical buccal bone changes were also not significantly affected by SG. Insufficient data were available for meta-analyses on horizontal midfacial soft tissue changes, pink esthetic score, marginal bone level changes, probing depth and bleeding on probing. Based on GRADE guidelines, a moderate recommendation for SG following IIP can be made. SG may contribute to horizontal bone preservation and soft tissue stability at the midfacial aspect of immediate implants. Therefore, SG should be considered as an adjunct to IIP in clinical practice.

Craniofacial Bones and Teeth in Spacefarers: Systematic Review and Meta-analysis.

Estimating the risk of dental problems in long-duration space missions to the Moon and Mars is critical for avoiding dental emergencies in an environment that does not support proper treatment. Previous risk estimates were constructed based on the experience in short-duration space missions and isolated environments on Earth. However, previous estimates did not account for potential changes in dental structures due to space travel, even though bone loss is a known problem for long-duration spaceflights. The objective of this study was to systematically analyze the changes in hard tissues of the craniofacial complex during spaceflights. Comprehensive search of Medline, Embase, Scopus, the NASA Technical Report Server, and other sources identified 1,585 potentially relevant studies. After screening, 32 articles that presented quantitative data for skull in humans (6/32) and for calvariae, mandible, and lower incisors in rats (20/32) and mice (6/32) were selected. Skull bone mineral density showed a significant increase in spacefaring humans. In spacefaring rodents, calvariae bone volume to tissue volume (BV/TV) demonstrated a trend toward increasing that did not reach statistical significance, while in mandibles, there was a significant decrease in BV/TV. Dentin thickness and incisor volume of rodent incisors were not significantly different between spaceflight and ground controls. Our study demonstrates significant knowledge gaps regarding many structures of the craniofacial complex such as the maxilla, molar, premolar, and canine teeth, as well as small sample sizes for the studies of mandible and incisors. Understanding the effects of microgravity on craniofacial structures is important for estimating risks during long-duration spaceflight and for formulating proper protocols to prevent dental emergencies. Avoiding dental emergencies in long-duration spaceflights is critical since this environment does not support proper treatment. Prior risk estimates did not account for changes in dental structures due to space travel. We reviewed and synthesized the literature for changes in craniofacial complex associated with spaceflight. The results of our study will help clinicians and scientists to better prepare to mitigate potential oral health issues in space travelers on long-duration missions.

A Prospective Registry Analysis on Soft-to-Hard Tissue Ratios in Profile View; Midline Changes in the Lip Region after Mono- and Bimaxillary Repositioning Surgery

Introduction We aimed to determine the ratios of the lower and upper lip landmarks in the sagittal and vertical direction for maxillary osteotomies and mandibular lengthening surgeries, in a prospective way. Methods This prospective cohort study is the second part of the OSRES (Orthognathic/orthofacial Surgery RESearch group); patients that underwent mandibular and/or Le Fort I surgery without genioplasty were included. Pearson correlation determined significant patient and surgical variables. The relationship between hard and soft tissue changes was determined by correlation analysis. Results An average ratio of 103% was found for sB:B for mandibular advancement surgery without genioplasty and 83% for sB:Pg with genioplasty. Lower jaw surgery yielded a ratio of 68% for Li:Ili in the horizontal direction and 69% with a genioplasty. Displacement of the upper jaw gave a ratio of 83% for Ls:Iui anteriorly for all surgery groups combined. Horizontal displacement of the upper jaw yielded a strong correlation with a ratio of 88% for sA:A. Conclusions The equations presented in this study for landmark sB, sA, labrale inferius, and labrale superius can aid preoperative planning of lip position. No accurate way was found to predict stomion inferius and stomion superius. Highlights We prospectively arranged for computerized measurements of sB:B, Li:Ili, Ls: Iui, Stoi:Ili, Stos: Iui, and sA:A ratios on lateral cephalograms using FaceWizz. The influences of direction and the type of surgery were studied. Moderate to strong correlations were found for horizontal ratios of sB:B, Li:Lli, Ls:Iui, and sA:A. Weak correlations were found for vertical movement of Stos:Iui and Stoi:Ili.

A novel approach to assess volumetric bone loss at immediate implant sites and comparison to linear measurements: A pilot study

ObjectivesStudies have evaluated changes in hard tissue following immediate implant placement (IIP) through cone beam computed tomography (CBCT) imaging. This study compared the 3D volumetric changes of the alveolar bone at immediate implant sites with 2D linear measurement outcomes by using a novel image analysis workflow. MethodsPreoperative and 6-month postoperative CBCT images of patients who underwent IIP and bone grafting in the maxillary esthetic area were acquired. Linear and volumetric measurements of buccal bone dimensions were taken using a specially designed workflow. The 2D and 3D measurements were compared, and their correlations were determined. ResultsImages from 13 patients (13 implants) were analyzed. Linear measurements revealed that the general linear buccal bone loss was less than 1mm in all segments. The 3D volumetric bone reduction (reported as median [first quantile, third quantile]) in the vertical, cervical, middle, and apical segments was 14.27 [11.33, 30.66] mm3 (51.30 [42.78, 66.91]%), 16.20 [10.35, 30.52] mm3 (18.20 [9.88, 24.74]%), 17.48 [8.42, 21.17] mm3 (24.05 [12.39, 28.22]%), and 6.87 [3.88, 9.45] mm3 (11.34 [5.14, 22.54]%), respectively. Significant positive correlations between 2D and 3D measurements were consistently identified in the cervical and middle segments, but no significant correlation was noted in the vertical segment. ConclusionsThe results revealed that linear measurements could not fully represent volumetric bone dimensional changes. Performing volumetric measurements and 3D rendering could be valuable in presenting the actual amount and topography of peri-implant bone remodeling. Clinical SignificanceLinear measurements only partially represent the real-life event of 3D bone changes at immediate implant sites. Factors affecting hard tissue alterations following IIP should be reassessed using 3D volumetric measurement outcomes.

Influencing Hard and Soft Tissue Changes Following Tooth Extraction

Influencing Hard and Soft Tissue Changes Following Tooth Extraction Abstract. Influencing Hard and Soft Tissue Changes Following Tooth Extraction The loss of a tooth leads to the initiation of resorption processes and thus to the remodeling of the tissues of the alveolar process. At the hard tissue level, this resorption mainly affects the bundle bone at the buccal side of the extracted tooth and occurs most rapidly in the first weeks and months after extraction. Tissue changes occur not only at the level of the hard tissue (bone), but also at the level of the soft tissue. These changes lead to a significant loss of volume, especially at the buccal area of the alveolar ridge. They are responsible for a volume loss of the alveolar ridge contour of up to 50 %.

Peri-implant Tissue Health in Bone-Level Implants with Repeated Abutment Replacements Versus Tissue- Level Implants with a Definitive Abutment: A Randomized Controlled Trial.

The present randomized controlled study was undertaken to evaluate and compare peri-implant hard and soft tissue changes between implants restored with multiple disconnections and reconnections of the abutment (control group) vs implants restored with a definitive abutment (test group). Twenty edentulous sites from 13 systemically healthy participants were selected for the study. The recorded clinical parameters were bleeding on probing (BOP) and peri-implant pocket depth (PIPD). The measured radiographic parameter was peri-implant marginal bone loss (PMBL). Two parameters were measured both clinically and by CBCT: distance from the cementoenamel junction to the alveolar crest and alveolar ridge width. At the time of surgery, sites were randomly assigned to either the control or test group. At 6 months, (1) BOP was absent in both groups, (2) PIPD increased in both groups and was significantly greater in the control group, and (3) the mean PMBL was significantly higher in the control group than the test group. Thus, it can be concluded that the use of implants with a definitive abutment could be more beneficial in achieving better maintenance of marginal peri-implant tissue health.

Bone Dimensional Change Following Immediate Implant Placement in Posterior Teeth with CBCT: A 6-Month Prospective Clinical Study.

This prospective clinical study aimed to evaluate the peri-implant hard tissue dimensional change at 6 months of immediate implant placement with bone graft materials in the posterior area using cone-beam computed tomography (CBCT). Twelve dental implants were placed concurrently following tooth extraction in the posterior area and filled with xenograft particles. The CBCT images were taken immediately after surgical procedures and then at 6 months follow-up. To evaluate the hard tissue changes, the vertical and horizontal bone thickness were analyzed and measured using ImageJ software. Paired t-test or Wilcoxon match-pair signed-rank test was done to analyze the changes of hard tissue values at the same level between immediately and 6 months following immediate implant placement. Independent t-test or Mann–Whitney U test was used to analyze the dimensional change in the vertical and horizontal direction in buccal and lingual aspects. The level of significance was set at p value = 0.05. All implants were successfully osseointegrated. At 6 months follow-up, the vertical bone change at the buccal aspect was −0.69 mm and at the lingual aspect −0.39 mm. For horizontal bone thickness, the bone dimensional changes at 0, 1, 5, and 9 mm levels from the implant platform were −0.62 mm, −0.70 mm, −0.24 mm, and −0.22 mm, respectively. A significant bone reduction was observed in all measurement levels during the 6 months after implant placement (p value < 0.05). It was noted that even with bone grafting, a decrease in bone thickness was seen following the immediate implant placement. Therefore, this technique can be an alternative method to place the implant in the posterior area.

Improved lip esthetics in patients with skeletal Class III malocclusion and facial asymmetry after isolated mandibular orthognathic surgery

Asymmetry of the lips severely affects facial esthetics and is often one of the chief complaints of orthognathic patients, especially those with Class III malocclusion. The objectives of this study were to investigate the changes in lip symmetry in patients with mandibular prognathism and deviation and the relationships between jaw hard tissue and lip soft-tissue changes. Three-dimensional facial scan and cone-beam computed tomography scan data of 30 orthodontic-orthognathic patients treated with bilateral sagittal split ramus osteotomy were combined to conduct the research. Paired-sample t test and Pearson correlation coefficient were applied to compare the differences in the same variable before and after the orthognathic surgery and the potential correlations between the changes in hard and soft variables. To explore the important hard tissue variables influencing the lip soft-tissue changes, linear regression analysis was performed. Although there was significant upper lip asymmetry presurgery, the upper lip asymmetry was corrected postsurgery. Surgical correction of the mandibular deviation was also accompanied by lengthening of the bilateral philtrum crests. Improvement in lip asymmetry and lengthening of the philtrum crests were primarily related to the transverse correction of the mandible rather than sagittal changes. The corresponding prediction formulas were established. The isolated mandibular bilateral sagittal split ramus osteotomy surgery can substantially improve the upper and lower lip asymmetry in patients with mandibular prognathism and deviation, but one should be wary of the unesthetic effects associated with lengthening of the philtrum crests.

Cone-beam computed tomographic evaluation of dimensional hard tissue changes following alveolar ridge preservation techniques of different bone substitutes: a systematic review and meta-analysis.

PurposeThis study was conducted to evaluate and compare the effects of different graft materials used in alveolar ridge preservation on dimensional hard tissue changes of the alveolar ridge, assessed using cone-beam computed tomography (CBCT) scans.MethodsA systematic electronic search of MEDLINE and the Cochrane Central Register of Controlled Trials and a manual search were conducted from November 2019 until January 2020. Randomized controlled trials were included if they assessed at least 1 variable related to vertical or horizontal hard tissue changes measured using CBCT scans. After a qualitative analysis of the included studies, subgroups were formed according to the graft material used, and a quantitative analysis was performed for 5 outcome variables: changes in vertical alveolar bone height at 2 points (midbuccal and midpalatal/midlingual) and changes in horizontal (buccolingual) alveolar bone width at 3 different levels from the initial crest height (1, 3, and 5 mm).ResultsThe search resulted in 1,582 studies, and after an independent 3-stage screening, 16 studies were selected for qualitative analysis and 9 for quantitative analysis. The meta-analysis showed a significantly (P<0.05) lower reduction of alveolar ridge dimensions for the xenogenic subgroup than in the allogenic subgroup, both vertically at the midbuccal aspect (weighted mean difference [WMD]=−0.20; standard error [SE]=0.26 vs. WMD=−0.90; SE=0.22) as well as horizontally at 1 mm (WMD=−1.32; SE=0.07 vs. WMD=−2.99; SE=0.96) and 3 mm (WMD=−0.78; SE=0.11 vs. WMD=−1.63; SE=0.40) from the initial crest height. No statistical analysis could be performed for the autogenic subgroup because it was not reported in sufficient numbers.ConclusionsLess vertical and horizontal bone reduction was observed when xenogenic graft materials were used than when allogenic graft materials were used; however, the loss of alveolar ridge dimensions could not be completely prevented by any graft material.

Cone-beam computed tomographic evaluation of dimensional hard tissue changes following alveolar ridge preservation with leucocyte and platelet-rich fibrin techniques: a pilot study

Objective: This study evaluated the effect of leucocyte and platelet-rich fibrin (L-PRF) techniques used in alveolarridge preservation on dimensional hard tissue changes of the alveolar ridge assessed using cone-beam computedtomography (CBCT) scans. Material and Methods: Elective alveolar ridge preservation surgeries were performedon seven systemically healthy patients who underwent single posterior tooth extraction. Patients were randomlytreated with PRF mixed with a commercial bone xenograft (n = 3) or PRF plug (n = 4). CBCT scans weretaken immediately after tooth extraction and then four months later, just before implant surgery. Dimensionalalterations in socket height (SH), socket area (SA) and socket volume (SV) were evaluated on CBCT scans bypercentage differences before and after treatments. Results: Sockets treated with PRF plus bone xenograft had atendency to maintain alveolar bone dimensions over time (SH= 11.22% to 82.74%, SA= 1.84% to 48.91% andSV= 9.11% to 203.62%), while sockets treated only with PRF plug technique presented only a modest increasein height (SH= 1.47% to 11.11%) but greater alveolar ridge resorption confirmed by a decrease in socket areaand volume dimensions (SA= 0.21% to -24.09% SV= 8.53% to -54.12%). Conclusion: Within the limitationsof this study, the maintenance of alveolar socket dimensions was observed when PRF was associated with axenograft. However, the loss of alveolar ridge dimensions was not entirely prevented by PRF treatment alone. KEYWORDSAlveolar bone loss; Bone substitutes; Cone-beam computed tomography; Platelet-rich fibrin; Tooth socket.

Evaluation of Dentoalveolar and Soft Tissue Changes in Adult Class II Malocclusions Treated with Different Modalities

Class II correction demands various approaches depending upon the patient&rsquo;s growth potential, severity of malocclusion, and patient compliance. Aim is to evaluate the orofacial soft and hard tissue changes with three different treatment approaches namely enmasse distalization, AMO and Camouflage treatment. 45 adult skeletal class II patient records equally segregated into three clusters based on the treatment approach employed. Both pre-treatment and post-treatment lateral cephalograms wer

Improving lip aesthetics in the face profile after treatment of class II, division 2 malocclusion.

The aims of our research were as follows: 1) Description of changes in the position of the upper and lower lips, as a result of the change in the position of upper and lower incisors after orthodontic treatment of malocclusion of Class II, division 2 type. 2) Determination of correlation between changes in the position of lips and incisors in the profile of the face after orthodontic treatment of malocclusion of Class II, division 2 type.MATERIALS ANDMETHODS: Our study analyses the documentation of 115 patients with malocclusion of Class II, division 2 type treated with a fixed orthodontic appliance in the upper and lower dental arches at the Orthodontic Department of the Clinic of Dentistry in Olomouc from January 1, 1996 to December 31, 2017. There were 78 women and 37 men aged 11 to 36 years included in the database. Cephalometric images of patients from the group taken before and after the treatment were used for the purpose of cephalometric analysis according to Kamínek (1) and Burstone's analysis (2) of soft tissues. Subsequently, all output data were processed statistically. While the protrusion of the incisors after treatment of malocclusion of Class II, division 2 type was 3 mm, the facial profile showed statistically significant changes in soft tissues in the ventral direction by 1 mm on average just in the area of the upper and lower lips, which means a shift corresponding to one third of teeth movement. A statistically significant change in the position of incisors, soft tissues as well as correlation between changes in hard and soft tissues in the face profile after orthodontic treatment of malocclusion of Class II, division 2 type were demonstrated. The more the incisors were inclined, the more the lips moved forward, and the patient's profile turned out to be aesthetically improved (Tab. 2, Fig. 3, Ref. 39).

Hard and soft tissue augmentation with occlusive titanium barriers in jaw vertical defects: a novel approach

Aim: The aim of this study was to evaluate hard and soft tissue changes following guided bone regeneration (GBR), with occlusive titanium barriers (OTB), in the rehabilitation of partially edentulous atrophic jaws. Vertical bone gain (VBG), horizontal bone width (HBW), and flap thickness (FT) changes, observed between the first and the second surgical stages, were evaluated. Methods: The study included 35 patients (9 men and 26 women; mean age 60 ± 10.53 years) in need of vertical bone augmentation for implant placement. Seventy implants were placed, 44 with a one-stage approach (Group A) and 26 with a two-stage approach (Group B). VBG, HBW, and FT were measured and statistically compared. Results: VBG for implants placed in Group B was significantly higher than those placed in Group A (P = 0.006). The increased HBW in Group B was highly significant compared to that exhibited in Group A (P = 0.000). A highly significant difference was found in FT before and after the GBR in the two groups considered together, for both the upper and lower jaws (P = 0.000 for both). Conclusions: OTBs are reliable devices in GBR, yielding predictable results in terms of bone augmentation. In almost all cases (94.3%), a spontaneous increase of the FT, at the second surgical phase, was observed. This could be due to the titanium surface features which increases spontaneously the thickness of soft tissues over the OTB.

Management of Root Sensitivity following Socket Shield Technique with Anterior Single Immediate Implant Placement and Provisionalization.

It is challenging for implants in the esthetic zone to maintain the facial soft tissue contour and interimplant papillae. To counteract the inevitable hard and soft tissue changes after tooth extraction, the socket shield technique (SST) has been advocated as means to maintain the facial and/or interproximal osseous and gingival architecture. As SST is a technique-sensitive procedure, various complications related to SST have been reported. This article presents a unique complication after a socket shield procedure and a novel management of the complication.