Incisor Region Research Articles

Incidence and clinical risk factors associated with the development of labial protuberances after orthodontic treatment

Distinct, irregular, and hard, nodular labial protuberances (LPs) that were due to differential alveolar bone modeling can be noted on the labial gingival surface of the incisors after orthodontic treatment. Clinically, LPs cause patient discomfort and esthetic issues, but information on this phenomenon is limited. This study aimed to evaluate the incidence of LPs and demonstrate the etiology and clinical risk factors associated with this phenomenon. Differential alveolar bone modeling was defined as present (+) when ≥1 distinct LPs (diameter>1 mm) developed after orthodontic treatment by comparing pretreatment and posttreatment intraoral photographs and casts of an orthodontic patient cohort treated with fixed appliances (n= 872). The incidence rate, affected sites, and their association with age, sex, and orthodontic treatment modalities were evaluated. The incidence rate of differential alveolar bone modeling among orthodontic patients was 3.2% (28 out of 872). The maxillary lateral incisor region was the most frequently affected site. Males (vs females) (odds ratio, 2.56 [95% confidence interval, 1.155-5.604]), adults (aged ≥ 20 years) (vs teens) (12.84 [3.003-54.866]), and those who had orthodontic extraction (vs nonextraction) (11.60 [3.434-39.156]) demonstrated significantly higher odds of developing LPs after orthodontic treatment (P<0.05). The incidence rate of the development of notable LPs after orthodontic treatment was 3.2%. Adult males and those who undergo orthodontic extraction have a higher risk of developing LPs. Clinicians should be aware that distinct LPs may develop when large amounts of incisal retraction are planned in adults.

A common cyst in an uncommon location

OKC is the rare and noteworthy developmental odontogenic cyst which arises from dental lamina. Around 7.8% of all cysts of the jaw are categorized in to this type and grow in an antero-posterior direction in the medullary cavity of the bone without causing bone expansion until &amp; unless when expansion is large. The frequent location is the mandibular posterior body. It is uncommon in the maxilla and only 13% occur in the anterior region. An interesting case of OKC in the maxillary central and lateral incisor region of a 36-year-old male patient is being presented. Such a case can be a diagnostic challenge for the clinician, as it can closely mimic the inflammatory cysts in the anterior region.

Is "Bite force" a reliable parameter to compare masticatory efficiency restoration following ORIF of anterior mandibular fractures?

ObjectivesMandible is an integral part of masticatory system, and it is expected that it’s fracture will have a significant impact on occlusal forces, range of motion, muscle activity levels, and occlusion. The main objective of this study was to compare the efficacy of 3-dimensional (3D) miniplate and conventional miniplates for fixation of anterior mandibular fractures on the basis of bite force as a main parameter.Methods66 patients having isolated anterior mandibular fractures were randomized into two groups equally: Conventional miniplates and 3D miniplates. The bite force at incisor, canine, and molar regions was measured preoperatively and postoperatively at weekly intervals until the sixth week, and the mean bite force as well as changes in mean bite force were compared between two groups.ResultsAn increase in bite force was noted at each subsequent follow up in both the groups across all sites. Statistically significant difference was found in mean bite force values between both the groups during mid-follow up period. The difference in changes in the mean bite force too was observed to be statistically significant during the mid to late follow up period.Interpretation & conclusionBite force is a reliable parameter to assess restoration of masticatory efficiency following open reduction and internal fixation (ORIF). 3D miniplates when used in anterior mandibular fractures management are efficient enough to withstand masticatory forces throughout the healing process, providing better stability of fractured segments against torsional forces during immediate post-operative period.

The ability of mucoadhesive gingival patch loaded with EGCG on IL-6 and IL-10 expression in periodontitis.

The mucoadhesive gingival patch is a topical drug delivery process it does not cause any irritation in the mucosa. EGCG (Epigallocatechin-3-gallate) it has potent antioxidant, antiangiogenic and antitumor effects. The present study investigates the ability of mucoadhesive gingival patch loaded with EGCG on periodontitis and its impact on IL-6 and IL-10 expression. Periodontitis model was developed in Wistar rat by induction of Porphyromonas gingivalis. Application of mucoadhesive gingival patch loaded with EGCG (GP-EGCG), mucoadhesive gingival patch loaded with doxycycline (GP-doxy) and blank patch, was done for treated periodontitis 1h each day during 21 days. Indirect immunohistochemical analysis of IL-6 and IL-10 expressions were analyzed in the mandibular preparation of the anterior incisive region of animal. The GP-EGCG treatment for 3 days until 21 days, consistently increased the IL-10 expression in periodontitis (p<0.05). In other hand, GP-EGCG treatment lowered the IL-6 expression after 7, 14 and 21 days (p<0.05). The GP-EGCG is promising for the periodontitis treatment by interfere the IL-6 and IL-10 expression.

Distribution of dense bone island in the jaw based on the classification of radiopaque areas and their location on panoramic radiographs

Objectives: This study is aimed to find out the distribution of DBI in the jaw based on the classification of radiopaque areas and their location using panoramic radiographs at RSKGMP Universitas Airlangga Surabaya.&#x0D; Materials and Methods: This research was a descriptive observational study with total sampling method. The study used secondary data from panoramic radiographs at the RSKGMP Airlangga University Surabaya during 2018–2021, which had a DBI appearance, and analyzed them based on the classification of radiopaque areas and locations. The results of the analysis are then presented in the form of tables and pie charts.&#x0D; Results: Classification of DBI based on radiopaque areas was found in type 5 separate (47.81%), type 4 apical (29.82%), type 3 apical and interradicular (17.54%), type 1 interradicular (3.07%), and the least in type 2 interradicular and separate (1.75%). The most common locations of the lesions were in the premolar region (42.54%), the molar region (27.63%), the canine region (12.28%), the canine-premolar region (8.33%), the premolar-molar region (6.58%), and the least common location in the incisor and incisor-canine regions (1,32%).&#x0D; Conclusion: Classification of DBI based on the most common radiopaque area was found to be type 5 separate, with the most lesion locations in the premolar region. While the least classification was found in type 2 interradicular and separate, the incisive and incisive-canine regions had the fewest lesion locations.&#x0D;

Oral Cleft Related-Genes may be Involved in Root Curvature of Maxillary Lateral Incisors.

The maxilla is formed by the medial nasal and maxillary processes fusion. The dental lamina develops from 2 origins connecting in the lateral incisor. The maxillary lateral incisor region is often affected by dental anomalies and clefting. It is possible that genes involved in oral cleft could also be associated with a variety of phenotypic variations in the maxillary lateral incisor. In this phenotype–genotype study, we explored the association between polymorphisms in the oral-cleft-related genes BMP2 and BMP4 and root curvature of maxillary lateral incisors. Cross-sectional study. Universities and private clinics. Panoramic radiographs and DNA from 231 patients were analyzed. Schneider method (1971) was applied to estimate the degree of root curvature of the maxillary lateral incisors and to classify the root as straight (5° or less) or curved (higher than 5°). Genetic polymorphisms in BMP2 (rs235768 and rs1005464) and BMP4 (rs17563) were genotyped. Statistical analysis was performed. A total of 401 teeth (199 left and 202 right) were evaluated. Genetic analysis demonstrated trends toward association for the rs1005464 in BMP2 ( P = .025) in co-dominant model and in dominant model ( P = .026) for left incisors. The rs235768 in BMP2 showed trends toward association with the degree of root curvature in left incisors in the recessive model ( P = .031). rs17563 in BMP4 also showed trends toward association with the degree of the root curvature in left incisors ( P = .019). BMP2 (rs235768 and rs1005464) and BMP4 (rs17563) might be involved in maxillary lateral incisor root curvature.

CHANGES IN DENTAL DEVELOPMENT IN CHILD WITH KABUKI SYNDROME

Kabuki syndrome (KS) is a rare congenital syndrome characterized by facial dysmorphia, mild to moderate mental impairment, and skeletal and dental abnormalities, and it may present associated syndromes. An 8-year-old male patient diagnosed with KS and with the association of Pierre Robin sequence was examined, and there was a delay in the eruption of permanent teeth and the presence of eruption cysts in the region of the upper central incisors. In the general physical examination, the child presented difficulties in speech, walking, and generalized spasm. A cone beam computed tomography (CBCT) scan revealed the presence of all germs of the permanent teeth but with delay and alteration in the eruption trajectory. The child is being followed up at the stomatology clinic. In view of the occurrence of dental and developmental anomalies in individuals with KS, dental findings can be useful and an additional way to support the diagnosis of KS in children.

Successful outcome of surgical reintervention for implant placement in borderline aesthetic area related to agenesis: a case report

The aim of this study is to illustrate and discuss the fundamentals of a well-succeeded and minimally invasive technique of surgical reintervention for installing implant in the reduced area of the alveolus, affected by agenesis, and traumatized by an unsuccessful intervention. Materials and methods: A 27-year-old patient sought dental care and her main cause was the great dissatisfaction with the aesthetic sequelae in the region of the right upper lateral incisor, in addition to the uncertainty regarding the predictability of a new unitary implant. Imaging exams showed trauma in the middle and apical region of the canine root surface. The dimensions of the edentulous area varied between 4.6 and 5.52 mm. A small diameter implant (BLT 2.9mm SC, Loxim SLActive® 12 mm, TiZr - Straumann Dental Implant System) was planned and installed, in addition to a subepithelial connective graft. Results: The results achieved allowed to restore the desired function and aesthetics, with excellence, low morbidity, in addition to a predictability favored by the benefits related to small diameter implants. Conclusions: The concept of minimally invasive dentistry is becoming an effective surgical approach and, although these implants present a higher risk for fracture than do large-diameter implants, implant fractures are rarely observed.

Are Mini Dental Implants Suitable for Support of Crowns or Small Bridges in the Mandibular Incisor Region? A 5-year Longitudinal Study

It has not been previously studied whether 1-piece category 1 narrow dental implants (≤2.5mm wide) can successfully support crowns or small bridges. The purpose of this study was to evaluate the long-term benefits of the fixed-type mini dental implants (MDIs) for replacement of mandibular incisors. In a prospective cohort study, fixed-type 1-piece MDIs, replacing single or multiple mandibular incisors, supporting metal-ceramic single crowns (unsplinted group), or splinted crowns/small bridges (splinted group) were observed over the period of 5years. The primary predictor was the splinting status. The primary outcome variables were peri-implant marginal bone level (MBL) change, success, and survival rates (assessed as per Pisa Consensus Conference). The secondary outcomes were dental patient-reported outcome measures (dPROMs) and oral hygiene assessment. Descriptive statistics, Chi-squared test, t-test, Mann-Whitney and Wilcoxon tests, Kaplan-Meier survival analysis, log-rank (Mantel-Cox) comparison, Cox proportional hazard analyses adjusting for number of implants, Spearman correlation, and repeated measures were used for data analysis. From 44 participants (mean age 56.02±5.72years), 40 completed the 5-year study: 23 in the splinted and 17 in unsplinted group. Three subjects did not respond, while 1 MDI failed (third year) in the unsplinted group. Mean marginal bone level (MBL) change in both groups was small; however, it increased over time (-0.22±0.38mm after 1 year; -0.54±0.56mm after 5years; P<.05). After 5years mean MBL change was -0.59±0.71mm in the unsplinted and -0.50±0.41mm in the splinted group (P>.05). Survival analysis revealed no significant difference between the unsplinted (85.7% success, 4.8% failures, and 9.5% satisfactory survivals) and splinted group (93.4% success and 6.6% satisfactory survivals) (P>.05). The group affiliation (unsplinted vs splinted) and number of implants were not significant predictors of MDI failure or survival rates (P>.05). Significant improvement in dPROMs after rehabilitation remained unchanged over 5years (P>.05). Modified plaque index significantly increased over time, correlating with the MBL loss. MDIs supporting crowns and/or small bridges in the mandibular incisor region showed small rates of marginal bone loss, acceptable success, and survival rates and improved dPROMs over a 5-year observation period.

Anterior mandibular alveolar bone measurements between diabetic and non-diabetic individuals using cone-beam computed tomography.

An adequate alveolar facial bone thickness (FBT) and facial bone height (FBH) in the mandibular anterior region is essential for implant placement. However, the diabetic condition may affect FBT and FBH. The aim of the study is to compare the alveolar FBT and FBH in the anterior mandibular region of diabetic and non-diabetic individuals utilizing Cone Beam Computed Tomography (CBCT) images. This cross-sectional study was conducted in dental clinics of Riyadh Elm University, Riyadh, Saudi Arabia. A total of 46 CBCT images belonging to the diabetic (n=23) and non-diabetic (n=23) individuals were obtained from the radiographic image database of the hospital. The alveolar FBT and FBH in the anterior mandibular region were measured directly on CBCT images using Galileos 3D Digital Imaging System in Sagittal and cross-sectional view. The comparison of mean FBT between non-diabetic and diabetic individuals in central incisors (0.96±0.25 vs. 0.79±0.24, p=0.025) and lateral incisors (1.00±0.23 vs. 0.78±0.17, p=0.001) showed a statistically significant difference. Similarly, the mean FBH between non-diabetic and diabetic individuals differed significantly in central (31.37.96±2.98 vs. 26.07±6.58, p=0.001) and lateral incisor (31.20±3.05 vs. 26.79±6.83, p=0.008) regions. Based on our study, non-diabetic individuals showed higher alveolar FBT and FBH levels than diabetic individuals. Hence, diabetic condition affects the alveolar FBT and FBH around the central and lateral incisor regions.

Evaluation´ of mandibular alveolar bone in patients with different vertical facial patterns : Across-sectional CBCT study.

The study aimed to investigate the morphological and structural differences of mandibular alveolar bone between different vertical facial patterns (VFP). In all, 66CBCT scans of patients were selected for the study: 24were designated as hyperdivergent, 25as normodivergent, and 17as hypodivergent. Fractal values of the interdental alveolus were measured at the incisor, canine, premolar, and molar regions. The minimum trabecular bone width (MTBW) of the alveolus, the buccal and lingual cortical bone thicknesses, and the total alveolar width (AW) at the minimum trabecular bone level were measured. One-way analysis of variance and Tukey test were used to compare the groups. The correlations between FMA (Frankfurt mandibular plane angle) and other measurements were analyzed by Pearson analysis. No significant differences were detected in fractal values and buccal and lingual cortical bone thicknesses between the groups. The MTBW and AW of the hypodivergent individuals were found to be higher in the anterior and premolar interdental sites. FMA was found to be significantly correlated with MTBW and AW. The patients with different VFPs did not exhibit significant differences in the trabecular complexity of the mandibular alveolus. Hypodivergent patients tend to have thicker trabecular and alveolar bone widths than normodivergent and hyperdivergent individuals.

Mandibles of twenty species of short horned grasshoppers (Orthoptera: Caelifera) have variations among different species

Mandibles are prominent masticatory structures in the mouth parts of grasshoppers provided an opportunity to analyze the structural variations among different species of grasshoppers. In this study structural variations in mandibles of twenty species of short horned grasshoppers are examined for two reasons - whether the grasshopper mandibles bear any taxonomic significance and to test if one could use mandible structures to establish inter species relationships among the grasshoppers. The morpho plan of mandibles having incisor, molar and basal regions remained consistent. The incisor region had variations in its teeth or denticles, the molar region had an architecture prominently represented in the form of ridges and grooves running along the length. The number of ridges and projections varied from species to species. The morphometric values of these regions showed variations between the species. The dendrogram constructed based on morphometric values followed three ways clustering. The molar structures in two species of Pyrgomorphidae exhibited different structures from that of Acrididae members. Adaptation of mandibles to the food habit and possible relationships among species of grasshoppers are discussed.

Management of malocclusion with pre-fabricated myofunctional appliance in the primary dentition

The most common malocclusion presented during primary dentition are anterior crossbite and deep overbite.If the primary dentition does not show severe skeletal discrepancy, it is possible to treat malocclusion using pre-fabricated myofunctional appliance that is easily applied to children. By improving the malocclusion in the primary dentition, normalization of the oral muscle function can be induced. In addition, the normal occlusion of the primary incisor region and ideal position of the lips can make a desirable occlusal relationship at the transition of incisors. If factors such as growth pattern, patient cooperation, and post-treatment maintenance are carefully judged and implemented, the interceptive treatment of primary dentition can contribute to normal growth and development.

Morphometric Analysis of the Mandibular Lingual Foramina Using Cone-Beam Computed Tomography in Elderly Korean

The aim of this study was to determine the morphologic characteristics of the lingual foramen and lateral lingual foramen using cone-beam CT in elderly Korean. Cone-beam CT images were obtained from 80 Korean older than 50 years (mean age, 65.2 years). The prevalence of the lingual and lateral lingual foramina at the lingual aspect of the mandible was determined. The diameter and height to the upper margin of the foramina from the mandibular inferior margin, and the bone height to the alveolar crest from the mandibular inferior margin were measured. In addition, the location of the lateral lingual foramen, the direction of its canal, and the presence of communication with the mandibular canal were evaluated. All of elderly Korean possessed at least one lingual foramen, with two or three foramina occurring in 77.5 % of Korean. A lateral lingual foramen was observed in 91.3 % of Korean, with the prevalence being highest at the second premolar in dentulous cases (21.6 %; 33/153). The very high frequencies of these foramina were attributable to high frequencies of relatively small-diameter inferior lingual foramen and lateral lingual foramen in the incisor region. The prevalence of a large-diameter (≥1 mm) superior lingual foramen was high, at 31.0 %. A large-diameter lateral lingual foramen in the premolar region occurred at a frequency of 17.0 %; communication with the mandibular canal was observed in 70.0 % of these cases. These quantitative data on the lingual and lateral lingual foramina of the mandible provide valuable information that could help to avoid surgical complications during implant placement in elderly Korean.

Alveolar Bone Thickness around Anterior Teeth in Different Classifications of Malocclusion: A Systematic Review

Considering the alveolar bone thickness (ABT) in orthodontic treatment needs special attention. The movement of teeth depends on the mechanism of bone remodeling and tissue response to orthodontic forces to evaluate ABT of the maxillary and mandibular anterior teeth in various types of malocclusion. Methods: Only prospective original articles reporting ABT in subjects who have not undergone orthodontic treatment were selected. A total of 10 studies met the eligible criteria. Most all studies measured the thickness using CBCT. ABT on the labial side of the lower anterior teeth in the class I malocclusion group was thicker than in class II. The lingual side of the apical region of the mandibular incisors was lower in the class III group than in class I or II. ABT of the maxillary teeth on the labial surface showed no significant difference among the groups, whereas the palatal side of normal occlusion had a wider bone thickness. The inclination of the upper and lower anterior teeth was influenced by differences in the skeletal malocclusion pattern, which affected the thickness of the bone. Fenestration was more common in class II malocclusion. The results showed that ABT around anterior teeth varied according to the different classifications of malocclusion. The inclination of the upper and lower anterior teeth seemed to be influenced by the sagittal discrepancies. The pattern of facial growth also affected the thickness of the bone. Accurate evaluation is very important to prevent iatrogenic risks during orthodontic treatment.

Digital assessment of gingival thickness changes after initial periodontal treatment: comparison of central and interdental areas in the anterior maxillary region

To develop digital parameters for direct evaluation of gingival thickness changes (GTC) and to test their correlations with standard periodontal parameters. Ten Stage III/IV periodontitis patients were treated with conventional debridement protocol using ultrasonic scaler (PiezoLED, KaVo) and Gracey curettes (Hu-Friedy). Before recording baseline and 3-months re-evaluation probing pocket depth (PPD) and gingival recession (REC) with Williams probe (POW6, Hu-Friedy), patients underwent intraoral scanning (CEREC Omnicam AC, Dentsply Sirona). Digital assessment (GOM Inspect 2017) was made on superimposed digital models of 3-mm wide gingival margin region of maxillary incisors and canine for evaluation of GTC. The GTC was evaluated in the central region (C) and interdental buccal region (INT). For different differences in REC (diffREC) points, GTC distribution was plotted on a Box diagram. Correlations were calculated between diffPPD, diffREC and GTC for C and INT regions. The median GTC in C and INT regions was -0.24 mm (range: -0.18 mm to -0.38 mm) and -0.50 mm (range: -0.30 mm to -0.72 mm), respectively (Mann-Whitney, p < 0.001). Wider variability of GTC distribution at neutral diffREC value in INT than in C region was also apparent on color–coded superimposed models. GTC in INT region correlated with diffPPD (Spearman rho = 0.57, p < 0.0001). The proposed digital parameters revealed dimensional changes after initial periodontal treatment undetected by standard periodontal parameters. As clinically significant changes were detected in aesthetically important regions of interdental papillae, new parameters can be recommended for the evaluation of different periodontal treatment modalities.

Effect of the buccal gap width following immediate implant placement on the buccal bone wall: A retrospective cone-beam computed tomography analysis.

The effect of the buccal gap width on the clinical outcome of socket graft and immediate implant placement (IIP) at maxillary central incisor sites has not been investigated. Thus, the aim of the present study was to evaluate the effect of the width of the buccal gap on the thickness of the newly formed buccal wall. Forty-two patients and 51 maxillary central incisor sites treated with IIP and ridge preservation by means of graft of the buccal gap at the maxillary central incisor region were included in the study. The width of the buccal gap was measured and filled with deproteinized bovine bone mineral. Implant sites were divided into two groups: wide gap (WG, >2 mm; n=34) and narrow gap (NG, ≤2 mm; n=17). After at least 1year in function (5 ± 4), CBCT scans were obtained and assessed by a calibrated examiner. The thickness of the buccal and palatal bone walls, the percentage of the implant height covered by bone in the buccal and palatal aspects and the position of the buccal and palatal crests were compared between the two groups. A linear regression model was performed to assess predictors of the thickness of the buccal bone. The buccal bone was significantly thicker in the WG group than the NG group at all levels observed (overall 1.9 ± 0.9 mm and 0.5 ± 0.6 mm, respectively). The thickness of the palatal bone was similar between both groups (>2 mm). The percentage of the implant height covered by bone at the buccal aspect was significantly higher in the WG group (95 ± 16.6%) than in the NG group (59.4 ± 42.3%). The position of the buccal crest in relation to the implant shoulder was significantly more coronal (0.3 ± 2.2 mm) in the WG group than in the NG group (-4.7 ± 5.6 mm). The regression analysis model indicated that the width of the buccal gap was the only predictor of the thickness of the newly formed buccal bone wall (p < 0.001). Grafting of >2 mm-wide buccal gaps following IIP promoted a thicker buccal bone wall.

A rare cause of upper gastrointestinal bleeding; giant lesion in esophagus!

Fibrovascular polyps are one of the benign esophageal tumors and rare gastrointestinal bleeding reasons. They are mostly located in the proximal esophagus. Swallowing and breathing problems, mass feelings, discomfort when swallowing, nausea, weight loss, and a persistent cough are the most common symptoms. Endoscopic resection or esophagectomy are the two main options for treatment. A 60-year-old male patient was admitted for epigastric pain and melena. Endoscopy showed a 15-centimeter-long pedunculated polyp originating from the proximal esophagus and extending to the cardia, narrowing the lumen. The lesion was excised with multiple incisions using surgical ligature and an endoscopic knife after endoscopic ultrasonography and computed tomography examinations. The lesion was too big to be endoscopically removed from the esophageal lumen. Therefore, nearly a 3-4 cm incision was made on the abdomen skin. Under the guidance of the endoscope, the polyp was removed from the incision region using a clamp. Following hemostasis, the stomach was reconstructed and the procedure ended. No problems occurred. The patient is protected from major surgical and operational risks with endoscopic removal of large polyps. Patients who are candidates for endoscopic resection should consider it.

Object Tracking Based Surgical Incision Region Encoding using Scalable High Efficiency Video Coding for Surgical Telementoring Applications

Object Tracking Based Surgical Incision Region Encoding using Scalable High Efficiency Video Coding for Surgical Telementoring Applications

MINIMALLY INVASIVE SOLUTIONS FOR THE TREATMENT OF WHITE SPOTTS BY FLUOROSE

Objectives: The proposal of this clinical case report was to show the solutions that generate minimal tooth structure wear on treatment of white spots by dental fluorosis, showing the benefits and limitations by suggesting a minimally invasive dentistry. Case report: Patient 28 year old, women, attended in Integrated Dentistry Clinic of the University Center UNIEURO complaining about the aesthetics of her smile, noticed the presence of uniform white spots in the incisal region of the anterior teeth with notorious opacity. The treatment with Dental Whitening started with home bleaching technique for 1 month, then the Icon® system (DMG, Hamburg, Germany) as recommended by the manufacturer. Conclusion: The results were satisfactory, the techniques were excellent for the resolution of the case, there was an improvement in the aesthetics of the smile, also directly enhancing the self-esteem and self-confidence of the patient in their social life, when smiling and talking.