Left Central Incisor Research Articles

MULTIDISCIPLINARY APPROACH OF IMPACTED PERMANENT MAXILLARY LEFT CENTRAL INCISOR AND CANINE

ABSTRACT Background: The permanent maxillary canines have significant incidence of impaction, being the most affected teeth after the third molars, while impacted maxillary insicor is the third most commonly impacted tooth. Objective: This case report is about a multidisclipinary orthodontic treatment of 12 years old female with chief complaint of unerupted anterior upper teeth. Case: A case with unerupted of permanent maxillary left central incisor tooth and permanent maxillary left canine tooth, with Angle Class 1 molar relation and crowded of mandibular teeth. Panoramic and occlusal radiograph showed impacted 21 tooth with severely root dilacerations and impacted 23 tooth in palatal and horizontal position. Case Management: The patient was treated with Edgewise technique. Surgical approach was applied 3 months after levelling and unravelling stage to extract 21 tooth due to its severely root dilaceration and to bond lingual button on palatal side of 23 tooth. Orthodontic traction of impacted 23 tooth was applied a week after being exposed to the position of 21 tooth. Thirteen months after traction, 23 tooth was totally erupted and need 8 additional months to reach its final position. The crown of 23 was reshaped with porcelain fused to metal crown and 63 tooth was left still and got conservative treatment with composite. Conclusion: Orthodontic traction and reshaping of impacted 23 tooth was succeeded to replace the position of 21 tooth with good occlusion and esthetic. Based on OPG after treatment, all teeth were in good root paralleling. The patient was satisfied with good occlusion and esthetic. Keywords: Impacted maxillary canine, Impacted maxillary incisor, Root dilaceration, Orthodontic treatment, Surgical exposure

Partial Ceramic Veneer Technique for Challenging Esthetic Frontal Restorative Procedures

Frontal darkened teeth have shown to be one of the most challenging treatments for esthetic dentistry in recent years. This case report, along with a 30-month follow-up, describes the application of a partial ceramic veneer, restricted to the mid-cervical third region, made in the upper left central incisor darkened by trauma. The procedure consisted of maintenance of the entire incisal face, as well as esthetic and morphological rehabilitation of the smile line with veneers and ultra-thin partial ceramic veneers. The planning process was thoroughly elaborated by photographs, study models, a virtual smile designed, diagnostic waxing, and reproduction in the patient's mouth through mock-up. Following, dental home bleaching, esthetic gingival contouring, and minimally invasive tooth preparation were performed. Two types of glass ceramics (lithium disilicate and feldspathic) were used in different regions due to the peculiar characteristics of resistance, finishing, and polishing. According to the present case report, preparing a cervical partial ceramic veneer is an innovative, viable, and safe approach to maintaining the incisal portion of the tooth preserved and setting a detailed tooth morphology/color. The application of partial ceramic veneer provides incisal edge preservation and simplifies the reproduction of the adjacent tooth characteristics, avoiding multiple esthetic appointments.

Accuracy of static computer-aided implant surgery (S-CAIS) using CAD-CAM surgical templates fabricated from different additive manufacturing technologies

Statement of problemDifferent 3D printers are available for guided implant surgery, but studies that evaluate their source of errors and their cost-effectiveness are lacking. PurposeThe purpose of this in vitro study was to compare the accuracy of different 3-dimensional (3D) printed surgical templates made using different additive manufacturing technologies and to evaluate the effect of implant location on the accuracy of fully guided implant placement. Material and methodsFifty partially edentulous maxillary typodonts with edentulous sites in the right second premolar (SP), right lateral incisor (LI), left central incisor (CI), and left first molar (FM) locations were scanned and printed from the standard tessellation language (STL) datasets. The study compared 5 groups for the fabrication of implant surgical templates: Varseo S–Bego (Bego), Polyjet–Stratasys (Poly), Low Force Stereolithography–FormLabs (LFS), P30+–Straumann (P30), and M2–Carbon (M2). After fully guided implant placement, the typodont was scanned, and the 3D implant positions were compared with the master model by superimposing the STL files. Descriptive statistics were calculated for groups and subgroups, and comparisons among the groups and subgroups were conducted via 2-way mixed analysis of variance, Tukey honest significant difference, and post hoc Bonferroni tests (α=.05). ResultsThe results were site specific and not consistent within each group. For angle deviation, the within-group analysis for P30 demonstrated significantly lower values for implants positioned at site SP (1.4 ±0.8 degrees) than for sites LI (2.3 ±0.7 degrees; P=.001) and CI (2.3 ±0.8 degrees; P=.007). For 3D offset at base for implant CI, LFS was significantly higher than Bego (P=.002), Poly (P=.035), or M2 (P=.001); P30 was also significantly higher than Bego (P=.014) and M2 (P=.006). LFS had a significantly higher 3D offset at the tip than Bego (P=.001) and M2 (P=.022) for implant CI. ConclusionsThe choice of 3D printer seemed to influence fully guided implant surgery in terms of the final implant position compared with initial implant planning. However, although statistically significant differences were present across groups, all additive manufacturing technologies were within clinically acceptable values.

Age determination on panoramic radiographs using the Kvaal method with the aid of artificial intelligence.

This study aimed to assess and compare age estimation on panoramic radiography using the Kvaal method and machine learning (ML). 554 panoramic radiographs were selected from a Brazilian practice. To estimate age using the Kvaal method, the following measurements were performed on the upper left central incisors and canines: tooth, pulp and root length; root and pulp width at three different levels: at the enamel-cementum junction (ECJ); midpoint between the enamel-cementum junction and; at the mid root level. For ML age estimation, radiomic, semantic and the radiomic-semantic attribute extractions were assessed. Nineteen semantic and 14 radiomic attributes and a single set of 33 semantic-radiomic attributes were extracted. Logistic Regression, Linear Regression, KNN, SVR, Decision Tree Reg, Random Forest Reg, Gradient Boost Reg e XG Boosting Reg were used for ML classification. For the Kvaal method, Mann-Whitney test, Spearman correlation coefficient, Student's t-test and linear regression with its respective coefficient of determination were used to estimate age and to assess data variability. Mean absolute error (MAE) and standard error estimate (SEE) were assessed. For the Kvaal method, upper incisors presented higher precision than canines (R²: 0.335, SSE: 7.108). Males presented better MAE and SEE values (5.29,6.96) than females (5.69,7.37). The radiomic-semantic attributes presented superior precision (MAE: 4.77) than the radiomic and semantic (MAE: 5.23) attributes. The XG Boosting Reg classifier performed better than the other six assessed classifiers (MAE: 4.65). ML (MAE: 4.77 presented higher age estimation precision than the Kvaal method (MAE: 5.68). The use of ML on panoramic radiographs can improve age estimation.

Shade match comparison of CAD-CAM single crowns to a lithium disilicate crown.

To assess the shade match ability of four varieties of all-ceramic crowns to a neighboring bilayered lithium disilicate crown. A dentiform was used to fabricate a bilayered lithium disilicate crown on the maxillary right central incisor, following the anatomy and shade of a selected natural tooth. Two crowns (one full-contour, one cutback) were then designed on a prepared maxillary left central incisor, following the contour of the neighboring crown. The designed crowns were used to manufacture monolithic lithium disilicate, bilayered lithium disilicate, bilayered zirconia, and monolithic zirconia crowns, 10 each. An intraoral scanner and a spectrophotometer were used to assess the frequency of matched shades and to calculate the color difference (ΔE) between the two central incisors at the incisal, middle, and cervical thirds. Kruskal-Wallis and two-way ANOVA were used to compare the frequency of matched shades and ΔE values, respectively (α=0.05). There was no significant (p>0.05) difference in frequencies of matched shades for each group at the three sites; except bilayered lithium disilicate crowns. Bilayered lithium disilicate crowns had significantly (p<0.05) higher match frequency than monolithic zirconia at the middle third. The ΔE value was not significantly (p>0.05) different among the groups at the cervical third. However, monolithic zirconia had significantly (p<0.05) higher ΔE values than bilayered lithium disilicate and zirconia at the incisal and middle thirds. Bilayered lithium disilicate and zirconia appeared to most closely match the shade of an existing bilayered lithium disilicate crown.

Aesthetic consideration in patient management of severe periodontitis aggravated by oral dexamethasone

Background: The treatment of severe periodontitis must consider immune responses and local conditions, including the aesthetical aspects. The tooth loss in the anterior area can lead to a psychological issue in some patients, and the daily use of dexamethasone contributes greatly to the severity of aesthetical aspects. Periodontal treatments must be cautious of these aesthetical effects. Purpose: To report the aesthetical consideration in patient management of severe periodontitis aggravated by oral dexamethasone. Case: The 44-year-old female patient reported having tooth mobility in the upper right and left central incisor and lower right and left posterior. Due to the condition, the central anterior needed to be extracted. The patient had seafood allergies and consumed oral dexamethasone periodically to prevent allergic reactions for two years. Case management: The initial periodontal therapy was designed prior to the tooth extraction, socket preservation, and immediate denture on teeth 11 and 21. A metal frame combined with an acrylic denture was designed to support the tooth splint and replace the teeth on the mandible. The patient was treated with 20 mg of sub-antimicrobial-dose doxycycline twice a day for three months, and vitamin E was prescribed once a day. Since dexamethasone may contribute to immune response and osteoclastogenesis, dexamethasone was replaced by cetirizine. Conclusion: The treatment of severe chronic periodontitis must consider immune responses, local conditions, and aesthetical aspects. In this case, the use of dexamethasone might worsen the periodontal breakdown. However, the periodontal treatment, use of host modulation therapy, and replacement of dexamethasone with cetirizine are expected to improve these conditions.

Polychromatic Composite and Resin Infiltration Restorations in the Esthetic Zone: A Five-year Clinical Report.

This case report describes the use of a combination of a polychromatic resin composite restoration and resin infiltration to achieve a satisfactory esthetic outcome that has lasted over five years. The patient's primary complaint was a desire to replace an existing stained resin composite on the facial and mesial surfaces of the maxillary left central incisor, and a white spot on the facial surface of the maxillary right central incisor. After clinical evaluation, the patient was offered either replacement of the restoration with a polychromatic restoration simulating a white spot, or a combined treatment with polychromatic composite and resin infiltration restorations, which was recommended. The patient selected the latter treatment. A putty matrix was fabricated, and a quick mock-up was done using various enamel and dentin shades of resin composite to determine proper material selection. The previous resin composite restoration was removed, and layers of new dentin, body, and enamel composite were placed. An interproximal matrix was used in order to provide ideal contour and contact. Finishing and polishing procedures were performed. The maxillary right central incisor was treated with resin infiltration in order to subdue the white spot on the facial surface. Polychromatic resin composite and resin infiltration restorations to replace a stained restoration and mask a white spot can achieve desired results in the esthetic zone and maintain them for five years.

Restoration of Missing Central Incisor with Cantilevered Zirconia Resin Bonded Fixed Dental Prosthesis

Missing teeth in the anterior region can be a source of great aesthetic concern for the patient and its restoration presents an even greater challenge to the dentist. Invasive prosthodontic treatment modalities have many biological and biomechanical shortcomings. This clinical report presents a minimally invasive treatment option for a 17-year-old boy who wanted a replacement for his missing upper left central incisor, primarily due to aesthetic concerns. Missing tooth was restored with cantilevered zirconia resin bonded fixed dental prosthesis that has a durable functional and aesthetic outcome

Evaluation of Marginal and Internal Fit of Ceramic Laminate Veneers Fabricated with Five Intraoral Scanners and Indirect Digitization.

The long-term success of ceramic laminate veneers (CLVs) is influenced by the marginal and internal fit of the restorations. However, studies comparing the fit of CLVs using different intraoral scanners or the indirect digitization technique are lacking. The purpose of this study was therefore to assess the marginal and internal fit of CAD/CAM-milled CLVs using different intraoral scanners and the indirect digitalization technique. An ivorine typodont maxillary left-central incisor was prepared; the tooth and the neighboring teeth were scanned and used as a template to print ninety 3D partial models. Thereafter, ceramic laminate veneers (CLVs) (N = 90) were milled from IPS-Emax CAD blocks and divided into six equal groups (15 specimens each) according to the type of intraoral scanner (IOS), as follows: Omnicam IOS, SC3600 IOS, Trios 3 IOS, Emerald IOS, I500 IOS. Fifteen further CLVs were fabricated using the conventional indirect digitalization technique. After cementation on the resin dies and embedding in clear epoxy resin, specimens were sectioned inciso-gingivally and mesio-distally. At the incisal and cervical positions, the marginal discrepancy was measured and evaluated in addition to the internal gap at six locations using SEM (200×). Differences between gap measurements among the six groups were determined using ANOVA. Games-Howell multiple comparisons for homogenous variances and LSD multiple comparisons for non-homogenous variances were used with 95% confidence intervals. The significance level was set at 0.05. The lowest mean absolute marginal gap at the incisal margins (AMGI) was recorded for Omnicam group (203.28 ± 80.14) µm, while the highest mean absolute marginal gap at the cervical margins (AMGC) was recorded for Omnicam group (147.16 ± 59.78) µm. The mean AMGC was reported to be significantly different between the conventional technique (146.75 ± 38.43) µm and Trios 3 (91.86 ± (35.51) µm; p = 0.001) and between Emerald (112.37 ± (50.31) µm; p = 0.042) and I500 (86.95 ± (41.55) µm; p < 0.001). The mean MGI was found to be significantly different between the conventional technique (114.11 ± (43.45) µm and I500 group (186.99 ± (73.84) µm) only (p = 0.035). However, no significant differences were found in the mean MGI between all types of IOSs. The means of AMG and MG were significantly different at incisal or cervical areas between the conventional technique and IOSs and within the scanner groups (p > 0.05). Marginal gaps were higher in the incisal region compared to the cervical region with both the indirect digitization technique and the IOSs. Ceramic laminate veneers (CLVs) fabricated using IOSs produced overall internal and marginal fit adaptation results comparable to CLVs fabricated from the indirect digitalization method, and both techniques produced clinically acceptable results.

MINI DENTAL IMPLANT AS TREATMENT OF CHOICE IN A LATE TOOTH AVULSION WITH BONE RESORBTION: CASE REPORT

Tooth avulsion is a severe condition of traumatic dental injury. The long-time effect of untreated tooth avulsion is alveolar bone loss. The mini dental implant can be a treatment for single tooth replacement in a late tooth avulsion with bone resorption. The purpose of this study is to present a case report of the mini dental implant in a late avulsion of an anterior maxillary tooth without bone augmentation. Thirty years old male patients came to clinic with the left upper central incisor avulsed due to a traffic accident three years before. There has been mild vertical and horizontal bone resorption and diastemas. He wanted to replace the missing tooth with a fixed denture, and the patient refused any bone augmentation. The mini dental implant was an alternative treatment for this case. Orthodontic treatment was performed to regain space before mini dental implant placement because some teeth had been migrated, causing some diastemas. After seven months of orthodontic treatment, we inserted a 3.0 x 13.0 mm nobel active implant bone level and installed the healing abutment. The prosthetic crown was screwed carefully using a manual torque wrench with a maximum torque force not exceeding 15 Ncm. The mini dental implant could be a treatment for a late avulsion case without bone augmentation.

Interdisciplinary orthodontic camouflage treatment with extraction of fractured maxillary central incisor and tooth substitution to treat skeletal bimaxillary protrusion- A case report

Malformed or fractured central incisors with poor prognosis could be the choice of teeth for extraction when space is required for orthodontic treatment. This case report refers to a 14-year-old girl who had a fractured upper left central incisor associated with bimaxillary protrusion. She expressed her concern to correct her dental appearance and enhance her smile aesthetics. The patient had class I malocclusion with bimaxillary proclination and severe crowding in the lower arch. Due to the increased space requirement, extraction of teeth was required as part of orthodontic treatment. Patient had a class 2 skeletal profile with prominent upper front teeth and therefore increased space requirement in the upper arch in order to retract the prominent teeth to achieve favourable aesthetics. The choice of teeth for extraction were 14,34,44 and 21. In the second quadrant the central incisor was extracted due to its poor prognosis, and the lateral incisor, canine and first premolar were substituted for the central incisor, lateral incisor and canine respectively. In the lower dental arch the first premolars were extracted. The end of treatment objectives- class 1 molars, canines, incisors were achieved with greatly improved smile aesthetics. KEYWORDS Interdisciplinary orthodontics, Teeth substitution, Poor prognosis, Incisor extraction.

Study on mandibular movement trajectory and virtual occlusal pre-adjustment under light and heavy bite force

Objective: To investigate the influence of light and heavy bite force on the mandibular movement trajectories, and the influence of bite force on virtual occlusal pre-adjustment of digital full crown. Methods: From October 2021 to March 2022, 10 postgraduate volunteers (3 males and 7 females, aged 22-26 years) were recruited from Peking University School and Hospital of Stomatology. Maxillary and mandibular digital models of the participants were obtained by intraoral scanning. Jaw relations were digitally transferred under heavy bite force and mandibular movement trajectories under light and heavy bite force were recorded by jaw motion analyser. Three mandibular markers were chosen, namely the mesial proximal contact point of the central incisor (incisal point) and the mesial buccal cusp tips of the bilateral first molars. The three-dimensional displacements of the markers under two kinds of bite force in the intercuspal position (ICP), the sagittal projection of the three-dimensional displacements in the protrusive edge-to-edge position, and the coronal projection of the three-dimensional displacements in the lateral edge-to-edge position of upper and lower posterior teeth were measured. Single-sample t-test was used to compare the three-dimensional displacements and the corresponding sagittal projection and coronal projection with 0, respectively. The left maxillary central incisor and left mandibular first molar were virtually prepared by the reverse engineering software. Then dental design software was used to design digital full crown using the copy method. The mandibular movement trajectories under light and heavy bite force were separately used to guide virtual occlusal pre-adjustment. The three-dimensional deviations (mean deviations and root mean square) between the lingual surface of the left maxillary central incisor or the occlusal surface of the left mandibular first molar and that of the natural tooth before preparation were calculated (light bite force group and heavy bite force group), and the differences between the two groups were compared by the paired t-test. Results: Under the two kinds of bite force, the three-dimensional displacements of the markers in the ICP were (0.217±0.135), (0.210±0.133) and (0.237±0.101) mm, respectively; the sagittal projection of the three-dimensional displacements of the markers in the protrusive edge-to-edge position were (0.204±0.133), (0.288±0.148) and (0.292±0.136) mm, respectively; the coronal projection of the three-dimensional displacements of the mesial buccal cusp tips of the bilateral first molars in the lateral edge-to-edge position were (0.254±0.140) and (0.295±0.190) mm, respectively. The differences between the above displacements and 0 were statistically significant (P<0.05). The results of occlusal pre-adjustment showed that the mean deviations of the lingual surface of the left maxillary central incisor in the light and heavy bite force groups were (0.215±0.036) and (0.195±0.041) mm (t=3.95, P=0.004), respectively. The mean deviations of the occlusal surface of the left mandibular first molar were (0.144±0.084) and (0.100±0.096) mm (t=0.84, P=0.036), respectively. Conclusions: Both the light and heavy bite force have an influence on the mandibular movement trajectories. Virtual occlusal pre-adjustment of prostheses with mandibular movement trajectories under heavy bite force can obtain morphology of lingual or occlusal surfaces closer to the natural teeth before preparation.

Black Ethnicity Influences Gingival and Bone Thickness: A Cross-Sectional Study.

The present study aimed to use CBCT to compare the influence of White and Black ethnicity on gingival and bone thickness. A total of 84 individuals of both genders, aged between 18 and 59 years old, were divided into Black (BG; n &#61; 42) and White (WG; n &#61; 42) groups and were analyzed from June 2020 to April 2021. The gingival thickness (GT) and buccal bone plate thickness (BBPT) were measured using CBCT in all maxillary anterior teeth. Mann-Whitney, t test, chi-square, Pearson correlation, and Spearman correlation were used for comparisons and correlations with a 5% signif- icance level. Black individuals had mean GT (1.45 ± 0.29 mm) and BBPT (1.07 ± 0.21 mm) significant- ly thicker (gingival: P < .0001; bone: P &#61; .0002) than White individuals (1.17 ± 0.28 mm and 0.91 ±0.17 mm, respectively). The variables presented greater values for men. A positive correlation be- tween the BBPT and GT was found in two teeth in the WG (left and right central incisors) and one tooth in the BG (left canine). Moreover, a correlation between BBPT and GT immediately below the alveolar bone crest (0 mm) was found in four teeth in the WG (left and right lateral and central incisors) and the BG (left and right canine, left lateral and central incisors). Black race was shown to significantly influence the GT and BBPT, with Black patients presenting thicker structures than White patients.

An In vitro study to evaluate the depth of reduction achieved by three different techniques for porcelain fused to metal crown preparation

Introduction: A near-ideal preparation lays the foundation and is required for adequate retention and resistance for fixed partial dentures. It is advisable to achieve a near-ideal preparation for the longevity of the prosthesis. Materials and Methods: Thirty maxillary left central incisors were mounted on the acrylic block. The samples were divided into groups with ten specimens: Group A-Free hand, Group B-Index, and Group C-Depth gauge. Group A was prepared using the freehand method, Group B was prepared using the putty index, and Group C was prepared using depth gauge bur. An index was prepared before and placed back on the tooth after preparation, and the gap was filled with low-viscosity elastomer. The thickness of the impression was measured at five different points under the microscope. The statistical analysis was done using one-way analysis of variance and Student's t-tests. Results: The preparations (dimensions) achieved by the freehand method were 2.02 mm, 1.70 mm, 1.11 mm, 0.90 mm, and 0.60 mm respectively at five predetermined points. Similarly, for putty index these were 1.76 mm, 1.21 mm, 0.95 mm, 1.32 mm, 0.71 mm respectively at five predetermined points. Likewise, with depth gauge bur it were 1.88 mm, 1.35 mm, 0.77 mm, 1.09 mm, 0.73 mm, respectively, at five predetermined points. There was a significant difference between the Groups (P < 0.001). Intergroup comparisons between Group A, Group B and Group C showed a significant difference. Group A showed near-ideal preparation in the palatal cervical region compared to Group B and Group C. Conclusion: The freehand technique was the least effective of the three techniques. The use of depth gauge bur had yielded the preparation near the ideal and should be considered during tooth preparation.

Navigating the clinical ambiguity of implant placement in two young pubescent patients: an insight from two case reports

The horizon of implant dentistry has been ever-expanding owing to its long-term success in rehabilitating partially or completely edentulous cases. This perennial success and efficiency have encouraged clinicians to use osseo-integrated implants to replace teeth lost in children either due to trauma or congenital absence. Although a myriad of studies and publications suggest the placement of implants only after the attainment of skeletal maturity, as the growth-related changes such as remodelling, displacement, and mesial drift can put the future of implant and restoration in jeopardy, the use of implants in young pubescent or adolescent looks promising due to its evident psychological and social advantages over other contemporary alternatives such as a removable prosthesis or resin-bonded bridge. The first case report highlights a 16-year follow-up of a young girl treated at the age of 10 with an implant-supported prosthesis for the replacement of a missing maxillary left central incisor. The second case report centers around a 19-year-old teenage girl who underwent rehabilitation with a permanent fixed prosthesis, replacing her previous implant-supported temporary prosthesis. The implant was initially placed when she was 10 years old.

Impact of low intensity pulsed ultrasound on volumetric root resorption of maxillary incisors in patients treated with clear aligner therapy: A retrospective study.

The aim of this study was to evaluate the volumetric root resorption in maxillary incisors following clear aligner therapy (CAT) with low-intensity pulsed ultrasound (LIPUS), and compare the results to CAT alone. This retrospective study evaluated pretreatment (T0) and post-treatment (T1) cone-beam computed tomography imaging of 42 adult patients. Twenty-one patients (14 females, 7 males, mean age= 38.1±12.96 years) were treated using CAT with LIPUS device, whereas the other twenty-one matching controls patients (15 females, 6 males, mean age= 35.6±11.7 years) were treated using CAT alone. Images were analyzed and a segmentation protocol was applied on the maxillary incisors. Each segmented tooth volume was exported as a surface mesh in the Visualization Toolkit (VTK) file format. The VTK files for all maxillary incisors were coded and corresponding teeth volumes from T0 and T1 were superimposed. Clipping the crown of each tooth was done, then measurements of root volumes and differences between groups were performed. Changes in root volumes were assessed (p<0.05). Root loss was evident in all teeth in both groups, but was significantly increased in all maxillary incisors of the control group (p<0.001) and in upper left central incisor of LIPUS group (p=0.009). When both groups were compared, there was statistically significant minimal volumetric root loss in LIPUS group (3.50-7.32 mm3), when compared to control group (11.48-12.95 mm3) (p<0.05). LIPUS group showed less volumetric root resorption compared to control group during the studied treatment time using clear aligners.

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

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

Minimal Intervention in A Baby after Severe Intrusive Luxation: A Case Report

This report describes a case of a 20-month-old baby with severe intrusive luxation. Axial displacement of the teeth in the labial direction was found through the lateral radiograph of nose. Minimal intervention treatment was proposed by periodic follow-up. After 30 days, the teeth started to re-erupt spontaneously without the need for surgical or orthodontic assistance. At eight months, it had erupted completely, showing slight gyroversion of the left upper central incisor. The mother was alerted to monitor the permanent eruption. Conservative treatment in this case of severe dislocation in a baby showed a clinically satisfactory result.

Comparative evaluation between conventional endodontic therapy and a non-instrumental technique

Aim: Dental pulp necrosis is a complication caused mainly by dental caries and lesions. No consensus has been reached on the best technique and materials for endodontic treatment in the primary dentition. The objective was to present a clinical case report in which different endodontic approaches were performed in traumatized and necrotic homologous teeth. Methods: A one-year-and-eight-month-old boy suffered dentoalveolar trauma after a fall and sought out the Deciduous Trauma Dental Center of the Federal University of Minas Gerais in October 2018 for clinical and radiographic evaluation. The left maxillary central incisor presented enamel and dentin fracture without pulp exposure, while the right maxillary central incisor presented a small intrusive dislocation. Both presented the development of periapical lesions. Results: The teeth were treated respectively, using the non-instrumental technique with CTZ paste and the conventional endodontic therapy with Guedes-Pinto paste. Clinical and radiographic follow-ups after treatments revealed asymptomatic teeth and evidence of periapical healing. Conclusion: The use of CTZ paste in this case report presented satisfactory and similar results to traditional therapy in the short term.

Trueness and precision of artificial teeth in CAD-CAM milled complete dentures from custom disks with a milled recess

Statement of problemStudies on the movement of artificial teeth during the manufacturing of computer-aided design and computer-aided manufacturing (CAD-CAM) complete dentures using the custom disk method with milled recesses and on whether the movement is within a clinically acceptable range are lacking. PurposeThe purpose of this in vitro study was to assess the trueness and precision of the artificial teeth on custom disks the recesses of which were manufactured using a milling machine and to compare the results with the recesses manufactured using a 3-dimensional (3D) printer. Material and methodsFour types of artificial teeth (maxillary left central incisors [Max-L1], mandibular left central incisors [Man-L1], maxillary left first premolars [Max-L4], and maxillary left first molars [Max-L6]) were prepared. Milling data were created, and 3 of each type of tooth were attached to each disk made up of 3 concentric circles (large, medium, and small). Five each of the 3D-printed custom disks and custom disks with milled recesses were milled based on the milling data. Standard tessellation language data were obtained through cone beam computed tomography and superimposed by using a CAD software program. Mean absolute error (MAE) values were calculated to assess trueness and precision; MAE values of artificial teeth in custom disks with milled recesses and 3D-printed custom disks were statistically compared by using the 2-way analysis of variance test with 2 factors, 2 types of custom disks and 4 types of artificial teeth, and the Tukey post hoc comparison (α=.05). ResultsRegarding position trueness, the MAE value of Man-L1 on the milling custom disk was significantly lower than that of the 3D-printed custom disk (P<.001), whereas the MAE values of Max-L4 and Max-L6 on the milling custom disk were significantly higher than those on the 3D-printed custom disk (P<.001). No significant difference was found in the MAE value of the position trueness of Max-L1 between the milling and 3D-printed custom disks. Regarding position precision, the MAE values of Max-L1, Man-L1, and Max-L4 on the milling custom disk were significantly lower than those on the 3D-printed custom disks (P=.002, P<.001, P=.025, respectively). However, no significant difference was seen in the MAE value of position precision of Max-L6 between the milling and 3D-printed custom disks (P=.180) ConclusionsMovement of artificial teeth during the manufacture of dentures using the custom disk method and custom disks with milled recesses was within a clinically acceptable range.