Lower Anterior Area Research Articles

A Novel 3D Tunneling Surgical Technique (3DT) for the Treatment of Gingival Recessions with Reconstruction of the Deficient Interdental Papilla and Interproximal Attachment Regeneration: Case Series.

Current concepts in periodontology emphasize an important distinguishing aspect of the interproximal attachment, assigning its major influential significance as a key diagnostic and prognostic factor. A complete regeneration of the interproximal clinical attachment has become a primary determinant of the periodontal success. Since mid - 20th century have been published numerous articles on root coverage procedures but mostly for non-proximal gingival recessions. When it comes to the interdental area, literature does not inspire the same level of confidence. This study is aimed to introduce an innovative 3D - Tunneling Surgical Technique for the gingival papilla reconstruction and supra-alveolar interproximal attachment regeneration. The technique is described step by step and shown on three selected clinical cases of multiple bilateral adjacent gingival recessions type 2 and 3 in the lower anterior area with follow - up results of up to 6.5 years. A total of 18 proximal, mid-buccal and mid-lingual recessions were treated simultaneously. Mean root coverage up to 88.9% has been achieved in the proximal area. Within its limits, this study demonstrates a possibility of treating gingival recessions with deficient papilla in the mandibular anterior region, achieving a significant clinical improvement with the long-term stability.

Impact of Implant Diameter on the Early Survival Rate of Dental Implants in the Saudi Population: A One-Year Retrospective Study.

Introduction The use of dental implants provides a revolutionary solution to the problem of missing teeth in the oral cavity. The aim of this study was to assess the early implant survival rate in relation to implant diameter and site of placement. Methods The data were collected from 186 patients treated between January 2019 and June 2021. All the implants were evaluated and restored after three months of implant placement. The early implant survival was calculated for different implant diameters with the odds ratio (OR). Results A total of 373 implants were placed. Implants were placed in the following areas: upper posterior area (UPA), n = 123, upper anterior area (UAA), n = 49, lower posterior area (LPA), n = 184, and lower anterior area (LAA), n = 17. Implants of the following diameters were placed: 3.5 mm (n = 129), 4.3 mm (n = 166), and 5 mm (n = 78). The overall early survival rate was 97.32% after three months of placement. The highest early survival rate was at LAA (100%) and the lowest early survival rate was at UAA (95.9%). The implants 5 mm in diameter had the highest early survival rate (98.72%), while the implants 3.5 mm in diameter had the lowest early survival rate (94.57%). The ORs of the early implant survival were 4.7 [95% confidence interval (CI): 0.96-23.05)] and 4.42 (95% CI: 0.53-36.61) for the 4.3 mm and 5 mm implants, respectively, with no statistical significance. Conclusions The implants placed in the oral cavity had acceptable survival rates regardless of implant diameter or site of placement.

Denture use and dental risk factors associated developing osteoradionecrosis after head and neck radiotherapy: A retrospective analysis of hospital records

ObjectivesThis study aimed to assess the association between denture use and occurrence of osteoradionecrosis (ORN) following radiotherapy for head and neck cancer (HNC). Materials and methodsMedical records of 439 HNC patients treated with radiotherapy at Guy’s & St Thomas’ NHS Foundation Trust (London, UK) (2014–2019) who had missing teeth at the time of discharge were reviewed. Descriptive statistics were used to summarise the participant characteristics and outcome measures. Logistic regression analysis was used to identify factors associated with occurrence of ORN. ResultsPatients had an average of 14 missing teeth and 39 % wore dentures. Twenty-two (5 %) developed ORN. Out of 22 who developed ORN, 11 (50 %) wore dentures. Of these, 5 patients developed ORN in areas contacted by dentures. Denture use was not significantly associated with the occurrence of ORN (OR = 1.94; 95%CI = 0.79–4.81; p-value = 0.150). Longer duration of radiotherapy (OR =1.03; 95%CI = 1.00–1.06; p-value= 0.048) and more missing teeth in the lower anterior area (OR = 1.11; 95%CI = 1.01–1.22; p-value = 0.024) were significantly associated with the development of ORN. ConclusionsWithin the limitations of this single-centre study in which few patients developed ORN, denture use may not be a risk factor for ORN following radiotherapy for HNC. This is likely to be the case if dentures are well-fitting and not causing sores or irritation. Clinical significanceReplacement of the missing teeth with dentures in HNC patients post-radiotherapy may be a suitable choice for many HNC survivors. However, a powered study in a large cohort that includes clinical evaluation of dentures and the quality of fit alongside denture wearing experience would be useful to further assess the impact of denture use on the development of ORN.

Digital evaluation of supracrestal gingival thickness induced by periodontal regenerative and corticotomy surgery in patients with skeletal class Ⅲ malocclusion

Objective: To establish a quantitative three-dimensional method based on intraoral scan to evaluate the changes of soft tissue, and to evaluate the changes of supracrestal gingival thickness (SGT) in skeletal class Ⅲ patients induced by periodontal regenerative and corticotomy surgery (PRCS). Methods: Twenty-two systematically and periodontally healthy skeletal class Ⅲ patients (4 males and 18 females, aged between 19 and 35 years), who were in need of combined orthodontic-orthognathic treatment and referred to the Department of Periodontology from the Department of Orthodontics and the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from January, 2018 to March, 2019, were collected in the study. The teeth involved were 112 anterior teeth (46 maxillary anterior teeth and 66 mandibular anterior teeth). PRCS in anterior tooth area was conducted before orthodontic decompensation. Probing depth (PD), bleeding index (BI) and keratinized gingiva width (KGW) were recorded before surgery and 6 months post-surgery. The intraoral digital impressions of maxillary and mandibular anterior teeth were obtained by 3-shape intraoral scanner before surgery and 6 months after surgery. The Standard Tessellation Language (STL) files were processed using Geomagic qualify 12.2 software to establish the soft tissue morphological measurement model, and to quantitatively analyze the changes of gingival thickness situated 1 to 2 mm apical to the free gingival margin on the median sagittal measurement plane. Results: Probing depth and bleeding index had no significant difference before and 6 months after operation (P>0.05). KGW in 6-month post-operation group [(5.18±2.32) mm] was significantly higher than that in pre-operation group [(4.22±1.43) mm] (P<0.05). Supracrestal gingival thickness situated 1 to 2 mm apical to the free gingival margin also significantly increased 6 months after surgery (P<0.05). The changes of gingival thickness situated 1 to 2 mm apical to the free gingival margin in the upper anterior area were (0.68±0.56) and (1.00±0.69) mm, respectively. The changes in the lower anterior area were (0.38±0.42) and (0.58±0.45) mm, respectively. The gingival changes of the upper anterior teeth were also significantly higher than those of the lower anterior teeth (P<0.01). Conclusions: The described quantitative measurement based on intraoral scan could be an effective method for quantitative evaluation of the changes of soft tissue. PRCS could safely increase the supracrestal gingival thickness as well as KGW in skeletal class Ⅲ patients who were in need of combined orthodontic-orthognathic treatment.

Implant placement with Bio-Oss mixed platelet rich fibrin after ridge splitting in lower anterior area

Objective: to evaluate clinically and radiographically implant placement with Bio-Oss mixed with platelet rich fibrin after ridge splitting in lower anterior area. Methods: This study included 10 male patients suffering from loss of lower anterior teeth with bone loss leaving 7-8 mm of bone height and need implant to restore function in anterior region. The patients divided into two groups: In group (I) the patients treated with dental implant placement with Bio-Oss mixed platelet rich fibrin after ridge splitting in lower anterior mandible. In group (II) the patients treated with dental implant placement without the use of any graft material after ridge splitting in lower anterior mandible. Clinical examination was made to edentulous regions: Quality, quantity of the mucosa, contour of the underlying bone and crown to bone relationship. Preoperative Cone Beam Computed Tomography (CBCT) was taken for patient to determine alveolar bone height and width. The Bio-Oss graft mixed with PRF was packed carefully around implant and between buccal and lingual plate. Follow up was made to detect changes in bone density, ridge width and implant stability. All readings were recorded and analyses statistically. Results: the study showed a statistical improvement in ridge width, bone density and implant stability. Conclusion: PRF mixed with Bio-Oss provides a stable widening of the alveolar ridge, prevent soft tissue migration to gap around implant and prevent collapsed buccolingual plate of bone after ridge splitting technique.

Feasibility of lung ultrasound to assess pulmonary overflow in congenital heart disease children.

Pulmonary overflow (PO) is one of the most common complications in congenital heart disease (CHD) children with an incidence of 48-60% approximately. This study explored the feasibility of using lung ultrasound (LUS) to assess pulmonary overcirculation in CHD children and compare the diagnostic performance of LUS and chest radiography (CXR) for the detection of pulmonary overcirculation. The upper anterior area, lower anterior area, upper lateral area, and lower posterior area, in each hemithorax were scanned in 59 children in the supine position. A-lines, B-lines in each scanned region were recorded, and the worst LUS abnormality in the video clip was considered to characterize the examined region. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of LUS and CXR were compared using computed tomography (CT) as a standard criterion. PO was diagnosed in 53% (31/59), 63% (37/59), and 51% (30/59) children with CT, CXR, and LUS, respectively. The sensitivity, specificity, and diagnostic accuracy of PO were 96%, 94%, and 95% for LUS and 74%, 50%, and 63% for CXR. The percentage of mild, moderate, and severe PO diagnosed via LUS were 31% (18/59), 19% (11/59), and 2% (1/59), respectively. Furthermore, the PO incidence diagnosed by LUS in CHD children less than 1 year old were significantly higher than those beyond 1 year old. LUS is a noninvasive and useful tool for the detection and assessment of PO in CHD children at the operating room, and is better than CXR in sensitivity and specificity, comparable to CT.

Hard tissue augmentation to minimize a risk of buccal gingival recession in lower anterior teeth associated with orthodontic treatment: case report

Patients with malocclusion may present with preexisting mucogingival problems susceptible to attachment loss during or after orthodontic treatment. Lower anterior teeth especially show a high prevalence of gingival recession following orthodontic treatment. This case report demonstrates hard tissue augmentation of labially thin or deficient alveolar bone (dehiscences and fenestrations) to prevent attachment loss during or after orthodontic treatment. Three patients presented clinically prominent root surfaces and dehiscences and fenestrations on cone-beam computed tomography (CBCT) in lower anterior teeth. Labial hard tissue augmentation of lower anterior teeth was performed with deproteinized bovine bone mineral and collagen membrane. Six months later, hard tissue augmentation reduced root prominence and created a greater volume of hard tissue on lower anterior area in clinical and radiographic findings. Hard tissue augmentation using xenograft could prevent attachment loss associated with orthodontic treatment and maintain stability of healthy periodontium.

Comparison of tooth angulations on CBCT to those on conventional panoramic and panoramic-like images in different head orientations

BackgroundThe purpose of this study was to compare cone-beam computed tomography (CBCT) to conventional panoramic and panoramic-like radiography with regard to the accuracy of angulation measurements between the long axes of adjacent teeth using different head orientations. MethodsThis cross-sectional study used pretreatment records from 30 orthodontic patients who had undergone concurrent (interval, <6 months) CBCT imaging in a 12-in field of view and conventional panoramic radiography. Three panoramic-like images were constructed on each CBCT scan: 1) ideal head position (0°); 2) head rotated upward (+10°); and 3) head rotated downward (−10°). The upper and lower right central and lateral incisors as well as the upper and lower right premolars were selected on each image. The angles between adjacent teeth on frontal and lateral views on CBCT were measured and compared to the corresponding angles on the panoramic views. ResultsInterdental angles on CBCT imaging were significantly greater compared with those on panoramic (P ≤ 0.001) and panoramic-like (P ≤ 0.003) imaging in the upper and lower anterior areas. At +10° on panoramic-like imaging, the interdental angles between the upper central and lateral incisors tended to be decreased significantly compared with those on CBCT. Other sites did not show significant variations. ConclusionsIn the present study, the anterior teeth showed more parallelism on panoramic imaging (conventional or panoramic-like) compared with CBCT. In contrast, the posterior region showed no differences between CBCT and radiography. Interdental angles in the anterior region of panoramic like image are more close to CBCT measurements when head oriented ideally or slightly downward.

An unusually large asymptomatic periapical lesion that presented as a random finding on a panoramic radiograph

This report presents an asymptomatic case of a large mandibular periapical lesion that was discovered as a random finding on a panoramic radiograph. A panoramic radiograph was asked for removal of wisdom tooth's roots. The radiograph revealed an unusually large lesion extending from lower premolar to opposite lower canine. Upon clinical examination a discolored lower central incisor and an elevation of the vestibule were visible. The discolored tooth did not respond to thermal and electrical vitality tests and was not tender to percussion. No history of trauma was recorded and all other teeth in the lower anterior area were vital. Surgical excision of the lesion was decided after denial of conservative treatment by the patient. The result was satisfactory and 6 months after the operation new bone was formed at the site of the lesion. Dentists should be very careful on clinical examination and should not omit any details. Before beginning any treatment a careful and complete clinical and radiographic examination is needed to supply all the required information. Small clinical signs such as a discolored tooth should alert the dentist.

The effect of removal of all third molars on the dental arches in the third decade of life.

The intent of this study was to evaluate any change in the dental arches of adults in the third decade of life after the removal of all third molars in relation to occlusal factors, gender and the status of the third molars prior to extraction. The subjects were 24 healthy students (9 women, 15 men; mean age 23.2; age range 20-32) whose third molars were all removed. All extractions in the lower arch were performed because of impaction and complicating symptoms such as pain and swelling. Full occlusal registrations were performed before the extractions and one year afterwards, including the production of dental casts. The dimensions of the lower dental arch showed a small, but significant, increase one year after the removal of all the third molars. No significant change took place in the lower anterior area during the year. In the maxillary arch (in the lateral and transversal dimensions), the direction of change was similar to that of the lower arch, but smaller than in the mandibular arch. This indicated a minor space gain during the year after the removal of all third molars. The changes in the dental arches did not correlate significantly with changes in craniomandibular disorders (CMDs). It can be concluded that the extraction of an impacted third molar allows at least the second molar to drift posteriorly and laterally in the dental arch. The results give no further indication, in this age group, to extract the lower third molars in order to prevent lower anterior crowding.

Mutans Streptococci and Non-mutans Streptococci Acidogenic at Low pH, and in vitro Acidogenic Potential of Dental Plaque in Two Different Areas of the Human Dentition

Samples of human dental plaque were obtained from sound tooth surfaces in the lower anterior and upper posterior areas of each of 11 subjects with various degrees of caries experience. Both types of plaque were compared for: (1) their pH-lowering potential [pH at 10 and 60 min after sugar addition and the pH drop between 0 and 10 min (delta pH)] with an in vitro method involving dispersed plaque suspensions and excess glucose supply; (2) the proportions of mutans streptococci; and (3) the distribution of the predominant non-mutans streptococci according to their final pH in glucose broth. Compared with plaque from the lower anterior area, plaque from the upper posterior area exhibited a significantly higher pH-lowering potential, i.e., a lower pH at 10 and 60 min and a greater delta pH and significantly higher levels of mutans streptococci. The final pH values for the non-mutans streptococci exhibited a wide range from about 4.4 to over 5.0. The proportions of such organisms designated as capable of acidogenesis at low pH (final pH less than 4.6), whether expressed as a percentage of the total non-mutans streptococci or of the total plaque flora, were significantly increased in plaque from the upper posterior area. The proportions of non-mutans streptococci capable of acidogenesis at low pH in plaque from the upper posterior area were also significantly increased, with decreasing pH values at 10 and 60 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of folate mouthwash on experimental gingivitis in man

Although the experimental gingivitis model has been used extensively since 1965, some doubts exist concerning the nature of the tissue response in this model. Accordingly, the present study was designed to determine whether or not experimental gingivitis responded to 0.1% folate mouthwash (MW) in a similar manner to that already reported for established gingivitis. 20 male dental students took part in a double blind cross-over study which involved two 3-week experimental periods with random allocation to folate or placebo MW. The experimental site was the lower anterior area and 24 points of gingival examination were made at baseline and weeks 1, 2 and 3. Inflammation was assessed by presence or absence of colour change, and bleeding being slight, profuse or absent when gingivae were stroked with a blunt probe. A plaque sample was evaluated using dark field microscopy, and dry weight of accumulated plaque was measured at the end of each experimental period. Folate MW did not appear to have any statistically significant effects on accumulated plaque, or clinical signs of experimental gingivitis in this study. The different response of experimental gingivitis to folate MW, compared with the response of established gingivitis already reported, further suggests that experimental gingivitis may not represent an authentic replica of the cellular and immunological responses occurring in established gingivitis.

An Unusual Foreign Body Reaction—A Case Report

This case documents the course and treatment of a severe reaction to an unusual foreign body. A tooth brush bristle was lodged in the lower anterior areas between the cuspid and lateral incisor teeth. Although the patient noted some original discomfort, severe pain and bone destruction did not occur until 6 weeks after the original symptoms began. Treatment involved full thickness flap reflection of the involved area. The histologic examination showed a typical foreign body reaction to the bristle. All teeth remained vital throughout the disease process and healing phase. Healing was uneventful and the lost bone completely regenerated.