Lower Anterior Teeth Research Articles

Anterior tooth wear and quality of life in a nursing home population.

The aim of the study was to assess the extent to which a relationship may exist between the wear of the anterior teeth and quality of life in a population of nursing home residents. A population (n = 100) of nursing home residents (mean age 75.7 years) was recruited all members of which had at least 4 upper and 4 lower anterior teeth and were assessed as cognitively intact by nursing personnel who were familiar with their behavior. The investigator evaluated the level of tooth wear of each subject according to the Tooth Wear Index of Donachie and Walls (Adapted) and then verbally administered the Geriatric Oral Health Assessment Index (GOHAI) of Atchison and Dolan. Analyses did not reveal significant differences in tooth wear between males and females nor between age and GOHAI score; however, tooth wear was positively related to age and inversely related to quality of life. Results suggest that tooth wear is negatively related to quality of life.

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.

Oral Health Status among Egyptian Preschool Children

Background: Oral health is a part of general health, as oral cavity is considered a gateway of the body. Health of dentition and mouth play a major role in the children’s life. Aims: this study aimed to obtain updated information of oral health statues including dental caries situation, gingival condition and traumatic injuries in Egyptian preschool children. Methods: This cross sectional study was carried out in Mansoura city on one thousand children with an age from 3 - 6 years who were attending private and public kindergarten. Children were examined for dental caries using dmft index of primary teeth. Gingival condition was assessed using PMA index (papillary, marginal, and attached gingiva). Upper and lower primary anterior teeth were assessed for signs of dental trauma: treated dental injury, enamel fracture, enamel/dentin fracture, pulp injury, and missing teeth due to trauma. Data were analyzed by Mann-Whitney, Kruskal-Wallis and Chi- square tests. Results: the prevalence of dental caries in preschool children was 61.4%, while the mean dmft was (2.930±3.281) in males and (2.332±2.852) in females. However, prevalence of gingival inflammation was 7.4%, and dental trauma was 10%. Enamel fracture was the highest followed by dentin fracture and discoloration. Conclusion: there was high prevalence of dental caries, while the prevalence of gingival inflammation and traumatic injury were low among Egyptian preschool children.

Stature estimation and its reliability in different types of dental alignment using the Carrea’s Index

Introduction: Estimation of stature holds a special place in the field of forensic medicine. Objectives: This study was designed to investigate the ability of estimating stature from the dimensions of lower anterior teeth. Method: The study was carried out by taking the measurement from the mesio-distal widths of lower central incisor, lateral incisor and canine of 100 undergraduate students for examination. Each hemiarch was considered separately equaling 200 inferior hemi-arches, which were divided according to the dental alignment into normal, crowded and diastema and the measurements (arch and chord) were made with a ‘divider caliper’. Result: A statistically significant difference between the types of dental arch was obtained for both males and females with regards to the different dental alignments; higher correlation between stature the arch for normal alignment (r=0.9658; r =0.8347); moderate correlation for crowded alignment (r=0.8097; r =0.6958); and a weaker correlation for diastema (r = 0.656, r = 0.3938) for male & female respectively. The left side of the hemiarch showed a higher success rate (82%) in comparison to right side (72%). Statistically significant differences were also found between the types of arches for both right and left side (p<0.005). Conclusion: The present study would be useful for stature estimation to the forensic experts.

A comparative radiographical evaluation of alveolar bone resorption in upper and lower anterior teeth

Alveolar bone loss is the atrophy of maxillary and mandibular bone that underlines and support the teeth lead to reduction in bone height and volume. The sample of this study was collected from patients who attended Al-Mammon center for specialist dentists. The patients usually complaing from bleeding gum, discomfort on eating and relative mobility of teeth. In this study 60 male patients with age between 20-49 years were selected and divided into three groups to assess bone loss by the aid of digital panoramic radiographs in the upper and lower anterior teeth. The results revealed that bone loss is more in lower anterior teeth than in upper anterior teeth in most of the age groups.

Bone dehiscences and fenestrations of the anterior mandibular facial bone wall: a retrospective cone beam computed tomography study.

To calculate the prevalence of dehiscences and fenestrations and measure the buccal alveolar bone width overlying healthy mandibular incisors and canines. Cone beam computerized tomographies (CBCTs) from patients aged 18 to 30 years were selected from a private database. The thickness of buccal bone in the sagittal scan was measured perpendicular to the long axis of 6 teeth at two locations: at the crest level and at the mid-root level. A single calibrated examiner performed all measurements. Descriptive and inferential statistics were performed. A total of 100 CBCTs (600 teeth) were selected for the analysis. The overall prevalence of dehiscences and fenestrations was 89.16% and 5.16%, respectively. Dehiscences and fenestrations were shown to have a mean length of 6.78±1.90 mm and 4.89±1.74 mm, respectively. This result was similar between young and old subjects as well as between men and women. Bone width at the crest level was significantly thinner in women (0.71±0.13 mm), whereas men were found to have a statistically significant thicker bone at the mid-root level of tooth #33. Comparisons of bone width at the mid-root level among the 6 analyzed teeth showed no statistical difference. A high prevalence of dehiscences and sites with thin buccal bone were identified in correspondence of the lower anterior teeth by means of CBCT analysis.

Lower Arch Crowding In Relation To Periodontal Disease

A clinical examination was done to study the relationship between crowding and periodontal health status in lower anterior region. The occurrence of crowding was recorded in fifty adult males with class I angle occlusal relationship who have not been received orthodontic treatment before. The sample was divided into two groups: a crowded group of 25 males presented with crowding in the lower anterior teeth, and a normal group of 25 males presented with normal occlusal features and with no crowding.Scaling (supra and sub gingival debridement) and polishing were done for all the subjects, plaque and gingival indices were scored before treatment, and then re-scored at one, two, three and four weeks after treatment.It was found that the gingival index and plaque index are reduced in their value in the normal group, while the gingival and plaque indices tend to return to their original pretreatment values in the group of crowded lower anterior teeth and much faster than that of a normal group.

Periodontal Flap Surgery along with Vestibular Deepening with Diode Laser to Increase Attached Gingiva in Lower Anterior Teeth: A Prospective Clinical Study.

Background:Chronic periodontitis in lower anterior teeth results in rapidly progressive gingival recession (GR), loss of alveolar bone, decreased vestibular depth (VD) with consequential tooth mobility, and tooth loss. Treatment option for such cases in this esthetically important area of the oral cavity includes extraction followed by implants for which sufficient bone height and mucogingival complex are a prerequisite. Henceforth, an attempt was made to prolong the life of lower anterior teeth and postpone the need for implants by the treatment of chronic periodontitis with periodontal flap surgery followed by vestibular deepening in single surgical procedure.Materials and Methods:In this clinical, prospective study, conventional periodontal flap surgery was done on 74 sites in lower anterior teeth in 16 patients with attachment loss >5 mm due to chronic periodontitis. Vestibular deepening with diode laser at (wavelength - 810 nm, output power: 0.5–7 W, continuous wave, contact mode) was done after suturing the flap. All the clinical parameters: GR, pocket depth (PD), clinical attachment loss (CAL), width of keratinized gingiva, width of attached gingiva, and VD were assessed preoperatively after Phase I therapy and 6 months postoperatively.Results:At all the 74 sites, there was highly significant gain in attached gingiva, keratinized gingiva, and VD (P ≤ 0.001). Highly significant reduction in PD (P ≤ 00.001), significant reduction in attachment loss (P ≤ 0.01) but no significant reduction in GR (P = 0.897) was observed.Conclusions:The combination of periodontal flap surgery with vestibular deepening with diode laser may be a suitable cost-effective treatment option to prolong the life of periodontally involved lower anterior teeth. The surgical technique can postpone the need for extraction of teeth along with all the intangible benefits of periodontal therapy.

Treatment of Class II division 1 malocclusion using forsus fatigue-resistant device

Functional orthopedic appliances are mostly used to treat Class II malocclusion originated from mandibular retrusion. Removable or fixed functional appliances are available to advance the mandible. Fixed appliances can be treated in tandem with multibarcket therapy, thus making it a single-phase treatment. The major disadvantage of fixed functional appliances is proclination of lower anterior teeth. To reduce this proclination, miniplates or miniimplants are being used; negative torque is added to the lower incisors. Despite these additions, the proclination could not be eliminated but minimized. This case report documents the successful treatment of skeletal Class II in late stages of puberty using forsus fatigue resistance appliance with soldered hooks placed distal to the lower canines.

Accuracy of orthognathic surgery using 3D computer-assisted surgical simulation

Abstract Objective To evaluate the accuracy of maxilla and mandibular repositioning during two-jaw orthognathic surgery using computerassisted surgical simulation (CASS) Materials and methods Fifteen patients who underwent two-jaw orthognathic surgery using CASS (VSP,® Orthognathics by 3D Systems) were evaluated to assess the accuracy of the simulation. Translational and rotational discrepancies of the centroids of the maxilla and mandible and the translational discrepancy of the dental midline between the planned and actual outcomes were reported using the root mean square error (RMSE). The number of cases that exceeded limits set for clinical significance, the direction of the error in relation to the direction of planned movement and the differences between segmental and non-segmental procedures were evaluated as secondary outcomes Results The largest translational RMSE was 1.53 mm along the y-axis in the maxilla and 1.34 mm along the y-axis in the mandible. The largest rotational RMSE was 1.9° about the x-axis in the maxilla and 1.16° about the x- and y-axes in the mandible. The largest RMSE for the dental midline was 1.6 mm along the y-axis in the maxilla and 1.34 mm along the y-axis in the mandible. A tendency for insufficient advancement of the maxilla was noted Conclusions CASS is an efficient and accurate way to develop the surgical plan and transfer the plan to the patient intraoperatively. While CASS is accurate on a population level, there remains the potential for clinically significant errors to occur on an individual basis Conclusion The present case indicated that the timely extraction of palatally-placed maxillary lateral incisors facilitated functional appliance therapy in the management of a skeletal Class II problem. The crowding of the lower anterior teeth was relieved and alignment of the upper arch was achieved with full fixed appliance therapy, resulting in improved aesthetics and a stable occlusion at one year review

Aesthetic perception of the smile related to the vertical position of the lower anterior teeth by afro-descendent laypeople

Introduction: To evaluate the influence of the vertical position of the lower anterior teeth in the aesthetic perception of the smile of Afro-descendent laypeople from different age groups. Materials and Methods: A standard smile was constructed from intraoral photographs of an afro-descendent individual. The vertical position of the lower anterior teeth was gradually changed by moving the teeth up and down within the lip frame in 0.5 mm increments ranging from -1.5 mm to 2.0 mm, regarding point zero. Using a visual analog scale, 150 Afro-descendent Brazilian lay individuals from three different age groups (15-19, 35-44 and 65-74) rated the attractiveness in relation to 8 smiles with altered gingival exposure. Results: There were no significant differences (p>0.05) between male and female raters for the three groups. All the age groups assigned higher scores for the smiles with 0.5 mm coverage of the lower lip on the lower central incisors. However, for the less attractive smiles, there were differences in the opinions of the age groups (p<0,05).Conclusions: the age groups shared similar preferences regarding the most pleasant smile regarding the vertical positions of the lower anterior teeth.

Single Sitting Surgical Treatment of Generalized Aggressive Periodontitis Using GTR Technique and Immediate Implant Placement with 10-Year Follow-Up

This case report exhibits a patient with generalized aggressive periodontitis who has been under maintenance for the past 12 years after being surgically treated in a single sitting and restored with dental implants. A 41-year-old systemically healthy male patient presented complaining of lower anterior teeth mobility and pain in the upper right quadrant. After clinical and radiographic examination, the upper right molars and lower anterior incisors were deemed unrestorable. Covered by doxycycline, the patient received a nonsurgical periodontal treatment. Three weeks later, teeth extraction, immediate implant placement, immediate nonloading provisional prosthesis, and a guided tissue regeneration were performed at indicated areas in a single sitting. The clinical decisions were based on patient compliance, the status of the existing periodontal tissues, and the prognosis of the remaining teeth. During the 12-year follow-up period, no residual pockets were observed and there was no exacerbation of the inflammatory condition. Marginal bone stability is present on all implants. For aggressive periodontal disease, a high risk of relapse as well as limited success and survival of dental implants should be considered. This case shows proper containment of the disease based on appropriate treatment planning and a strict maintenance program.

Fluoride in drinking water and other factors associated with the prevalence of fluorosis in children from 10 to 12 years of the Canton Colta Chimborazo province

Objective: Determine the prevalence of fluorosis in children of 10 to 12 years of the canton Colta Province Chimborazo and relate its presence with the percentage of fluorine present in drinking water and other associated factors. Materials and Methods: An epidemiological, observational and descriptive study was conducted with a sample of 219 children enrolled in the canton's educational units, which met the pre-established inclusion and exclusion criteria. They were evaluated by visual clinical examination with photographic record of their upper and lower anterior teeth. The photographs obtained were analyzed by three persons qualified and calibrated in the detection of fluorosis index TF (Thylstrup a Fejerskov). Applied to the parents of the children a previously validated survey. Results: The results showed a prevalence of fluorosis grade 2 and grade 3, 36% and 29% respectively. It found a direct relationship between the consumption of packaged beverages, intake of dentifric

Management of miller class II gingival recession by laterally positioned pedicle flap revised technique

Background and objective: Gingival recession is the apical migration of the gingival margin from its normal position on the crown of the tooth to the root apically beyond the cemento-enamel junction which can cause major functional and esthetical problems. It has been clinically related to higher incidence of root caries, attachment loss, hypersensitivity and esthetic related problems. The goal of this study was to evaluate the effective of a modification of surgical procedure to laterally repositioned flap for coverage of isolated recession. Methods: A total of 25 patients with miller class II gingival recession attended the Department of Periodontology in the College of Dentistry, Hawler Medical University for treatment of their problem. Their gingival recession about 2 to 5mm in the lower anterior teeth with shallow vestibule. After full preparation of patient which include scaling and polishing and root planning the laterally displaced revised flap technique were done. Patients were followed up in 2 week and 3 month interval to see the changes after treatment during this period. These parameter were taken pocket depth, clinical attachment loss and gingival recession which can be measured by the distance from CEJ to the base of pocket. Result: In the recipient side, the mean gingival recession was about 3.2 mm at base line, after 2 weeks the mean gingival recession became 0.6mm and after 3 months it became 0.38mm. In the donor side, the mean gingival recession was 0 mm at base line. After 2 weeks the mean gingival recession became 1.05mm and after 3 months it became 0.5mm. Conclusion: It can be concluded that laterally displaced revised flap technique in localized recession defects can be used to restore the esthetic and functional properties of labial gingiva of teeth by repairing gingival defect.

Estudio comparativo de la diversidad de las características clínicas dentales en poblaciones militares de Portugal y España

IntroductionDental characteristics were compared in population samples of Spanish and Portuguese military personnel. The main aim of this study was to identify those dental characteristics that could potentially serve to differentiate between these populations in a forensic analysis. Material and methodsA sample of 5136 individuals belonging to the professional military staff of the Portuguese and Spanish armed forces was studied. Dental data were recorded with the Forensic Dental Symbols® for the Dental Encoder® database. The population sample analysed in this study consisted of 68.1% Spanish and 31.9% Portuguese individuals. ResultsThe population was mostly male, with 86.6% men (88.1% in the Spanish sample versus 83.4% in the Portuguese sample), and 13.4% women (11.9% Spanish and 16.6% Portuguese). The frequency of unrestored teeth was lowest for first molars in all quadrants, and the highest frequency of unrestored teeth (>90%) was for the upper and lower anterior teeth and lower first premolars. The highest frequencies of restorative treatment were found for the first and second molars in all quadrants, and the highest frequencies of missing teeth were found for the third molars (always >28%). Concordance analysis showed that correlations between contralateral teeth were significantly higher than between antagonist teeth in both samples. ConclusionsOur findings provide potentially useful information on the importance of dental record databases and their value for identification purposes.

The position of the mental foramen in dentate and edentulous mandibles: clinical and surgical relevance.

The knowledge of the exact location of the mental foramen (MF) in dentate and edentulous mandibles is clinically important when constructing complete dentures, performing anaesthetic block of the lower-anterior teeth area and intervening in the MF nearby area. In edentulous mandibles, the bone resorption after teeth loss makes the mental nerve (MN) prone to damage due to the extreme location of the MF very close to the alveolar crest (AC). Chronic compression on the MN may result in pain in the area of MN distribution (ipsilateral face and cheek area) and numbness at the lower lip. The purpose of the current study is to evaluate the exact position of the MF, calculating the distances MF-superior border of the AC and MF-inferior border of the mandible (IBM) in dentate and edentulous mandibles. One hundred and two (36 edentulous and 66 dentate) adult dry Greek mandibles were studied. In 9 out of 36 edentulous mandibles (25%), the MF was found nearby the AC, while in 27 edentulous mandibles (75%), the MF was located at an average distance 6.4 mm from the AC and 12.6 mm from the IBM. In 38 out of 66 dentate mandibles (57.6%), the MF was located at an average distance 13.6 mm from the AC and 15.2 mm from the IBM. The dental status significantly affected (p = 0.001) the distances MF-AC and MF-IBM. Side symmetry was observed for both dentate and edentulous mandibles (p = 0.39 and p = 0.45). The MF is an important landmark and its location needs to be considered prior to dental implants placement in order to avoid the MN injury and related complications. The position of MF is altered in edentulous mandibles compared with the dentate ones. The MF is a symmetric structure in Greeks.

Lip changes after premolar extraction in Class I bimaxillary protrusion: A retrospective study in Thai female adults

PurposeTo determine the ratios of dental and lip changes and develop the predictive equations of lip changes in Class I bimaxillary protrusion in Thai female adults after orthodontic treatment with 4 premolars extraction. Materials and methodsThe sample consisted of pre- and post- treatment lateral cephalograms of 91 Thai subjects with Class I bimaxillary protrusion. The ages of the samples were between 17–39 years old (22.57±4.7). These patients had orthodontic treatment with four premolars extraction and retraction of upper and lower incisors. Pre-and post-treatment lateral cephalograms were traced and superimposed by using SN-7° plane. The parameters from cephalograms were measured with digital vernier caliper and cephalometric protractor. Statistical analysis was performed to analyze the dental and lip changes by paired t-test. Pearson’s correlation and stepwise multiple regression were made to determine factors that related with lip changes. ResultsSignificance antero-posterior changes after treatment were found both in dental and lip analysis but vertical changes were not significant. The correlations were found low to moderate relationship between dental and lip changes in both sagittal and vertical directions. The equations of upper and lower lip changes in sagittal and vertical dimensions were constructed. ConclusionThe ratios of upper and lower anterior teeth retraction and upper and lower lip changes were 1:0.56 and 1:0.87, respectively. The predictive equations of upper and lower lip reductions were ΔH-U-lip=0.34(ΔH-tUI)+1.19 and ΔH-L-lip=0.57(ΔH-cLI)+2.11, respectively.

Micrognathia with temporomandibular joint ankylosis and obstructive sleep apnea treated with mandibular distraction osteogenesis using skeletal anchorage: a case report

BackgroundWe describe the case of a 16-year-old female patient with micrognathia, temporomandibular joint (TMJ) ankylosis, and obstructive sleep apnea, who was treated with mandibular distraction osteogenesis (DO) combined with sliding genioplasty, using skeletal anchorage.Case presentationWe first performed interpositional arthroplasty, in which an interposition of fascia temporalis and surrounding fat tissue was inserted into the defect after bilateral condylectomy, increasing the maximum mouth opening from 5.0 to 32.0 mm. Subsequently, orthodontic treatment and advancement of the mandible were carried out by mandibular DO, using miniscrews and miniplates. Finally, sliding genioplasty was performed to bring the tip of the mandible forward. The total amount of mandibular advancement at the menton was 16.0 mm. An improved facial appearance and good occlusion were eventually achieved, and the apnea-hypopnea index decreased from 37.1 to 8.7. There was no obvious bone resorption or pain in the temporomandibular region, limited mouth opening (maximum mouth opening: 33.0 mm), myofascial pain or headache, downward rotation of the mandible, or lateral shift of mandibular position evident at 5 years and 6 months after mandibular DO.ConclusionMandibular DO using skeletal anchorage with intermaxillary elastics is useful for preventing extrusion of the upper and lower anterior teeth, thereby preventing rotation of the mandible. In addition, mandibular DO combined with sliding genioplasty is effective at improving both dentofacial deformities and impaired respiratory function.

Cemental tear: To know what we have neglected in dental practice.

Cemental tear is a special kind of root surface fracture, contributing to periodontal and periapical breakdown. However, it is a challenge for doctors to diagnose, resulting in delayed or improper treatment. We reviewed the predisposing factors, location, radiographic/clinical characteristics, diagnosis and treatments of cemental tears. From the literature, patients with cemental tear were mainly males, over 60 year-old. Possible predisposing factors include gender, age, tooth type, traumatic occlusal force and vital teeth. Cemental tears were common in upper and lower anterior teeth, single or multiple, and can be present in cervical, middle and apical third of roots. Morphology of cemental tears can be either piece-shaped or U-shaped. Clinically, cemental tear shows a unitary periodontal pocket and signs/symptoms mimicking localized periodontitis, apical periodontitis and vertical root fractures. Treatment of cemental tears include scaling, root planning, root canal treatment, periodontal/periapical surgery, guided tissue regeneration, bone grafting, and intentional replantation. Recurrence of cemental tear is possible especially when the fracture involves root apex. Extraction is recommended for teeth with poor prognosis. In conclusion, cemental tears can involve both periodontal and periapical area. Dentists should understand the predisposing factors and clinical features of cemental tears for early diagnosis/treatment to prevent bone loss/tooth extraction.

Clinical efficacy of clear aligners in treating bimaxillary protrusion

Objective: To evaluate the efficiency of clear aligners in treating bimaxillary protrusion patients with first premolar extractions. Methods: Eleven patients with bimaxillary protrusion were selected in this study. All of them were treated by using clear aligners with four first premolar extractions and need maximal anchorage. Cephalometric analysis was carried out before and after treatment. Results: Cephalometric analysis results showed that significant changes in teeth and profile could be detected after clear aligner treatment and no change could be found in skeletal pattern. Upper and lower anterior teeth were retracted. The control of anterior torque and posterior anchorage were effective. The soft tissue analysis showed that position of upper and lower lip was significantly changed which improve the profile of patients. After treatment, the distance of U1 to NA and L1 to NB reduced by (5.19±4.12) mm and (4.53±1.20) mm, respectively. The differences were statistically significant (P<0.01). Conclusions: Bimaxillary protrusion patients who needed premolar extractions and maximal anchorage could be treated with clear aligners.