Anterior Mandibular Area Research Articles

A Large Mandibular Anterior Swelling—A Diagnostic Dilemma: A Case Report

AbstractHybrid lesions are lesions that combine characteristics of many pathologies. The literature has shown a rare relationship between aneurysmal bone cysts, fibro-osseous lesions, and a central giant cell lesion. In this case, we describe an unusual hybrid lesion in the mandibular anterior area. As a result, the goal of this article is to highlight the significance of comprehensive clinical, radiographic, and histological investigation in addition to presenting a rare instance of hybrid lesion. This will lessen the likelihood of misdiagnosis in these situations and aid in prompt treatment planning of the lesion.

Evaluation of Failure Rate for Cortical Dental Implants Placed in the Mandibular Anterior Region: A Systematic Review

Introduction: To enhance the success of dental implants, it is crucial to understand the factors contributing to implant failure. Practitioners should carefully evaluate the relevance and impact of critical risk factors associated with the mandibular anterior region to gauge the potential for implant failure. Aim: To assess the rates of implant failure for implants placed in the mandibular anterior region. Materials and Methods: For this systematic review, the eligibility criteria for present study included randomised and non randomised clinical trials, prospective cohort studies, and retrospective studies published in the English language between 2000 and 2022. These studies specifically documented dental implant failure rates in the anterior mandible, excluding reviews, in-vitro, cadaveric, and animal studies, as well as case series studies. The participants considered were systemically and mentally healthy individuals aged 18-90 years who had undergone oral restoration using dental implants in the anterior mandibular area. Exclusion criteria involved patients who did not undergo oral restoration with dental implants in the anterior mandibular region, those with systemic diseases affecting implant success, serious cardiac diseases, deficient homeostasis, blood dyscrasias, and psychological diseases. The intervention focused on patients rehabilitated with cortical dental implants in the mandibular anterior region, without a specific comparator or control. Based on the mentioned criteria, nine studies were included. The main outcome of interest was the dental implant failure rate. Results: The review's included studies indicated the placement of 3,718 implants in the mandibular anterior region, with 86 failures, resulting in a 2.31% failure rate, suggesting an approximate 3% failure rate for implants in this area. Conclusion: Given the multifactorial nature of implant failure, the available literature does not support the designation of the mandibular anterior region as a specific risk factor for such failures.

Evaluation of Stress Distribution in Platform Switch Short Dental Placed at Different Depths in D1 bone – An in Vitro 3D FEM Study

Context: FEA has been extensively used in implant dentistry to predict the biomechanical behavior of various dental implant designs, as well as the effect of clinical factors for predicting clinical success. Stress patterns in implant components and surrounding bone are well studied. Objective: To investigate the pattern of stress distribution in terms of equicrestal and subcrestal implant placement at various depths using short platform switching dental implants. Materials and Methods: 3D FEM of the mandibular anterior area was modelled with a uniformly cortical bone of 0.5 mm with an inner core of cancellous bone (FEM) using ANYSIS soft wear. Four implant modes were used with the following dimensions. Model 1. (6x4.6x3.5mm), models 2 (7.5x4.6x3.5mm), 3 (6x5.8x4.5mm), and 4 (7.5x5.8x4.5mm). For a realistic simulation, 100N and 200N of force were applied in axial and oblique directions (0°, 15°, and 30°, respectively). At different depths, both cancellous and cortical bone is evaluated for von Mises stress. Ten-noded tetrahedron components with three degrees of freedom per node are used to interpret translations on the x, y, and z axes. Results: Based on bone shape, force direction, and depth of implant placement, each of the five positions of platform-switched short osseointegrated implants examined by FEM simulations had a unique stress-based biomechanical behavior. Conclusions: Axial forces were less harmful than oblique forces. The cortical and cancellous bone experienced less stress because of the implantation of subcrestal implants. According to recent research, platform-switched short subcrestal implant models result in improved stress distribution around peri implant areas in D1 bone and the conservation of marginal bone loss.

Gingival Biotypes and its Relation to Biologic Width, Alveolar Bone Thickness, Dehiscence and Fenestration in Mandibular Anterior Region: A CBCT Analysis Study.

Gingival biotype and its relationship to biologic width and alveolar bone thickness may affect surgical periodontal therapy outcomes. Hence, it is vital to assess the gingival biotype prior to any of these treatments for its success. The study aims to compare the thick and thin gingival biotype in the mandibular anterior region concerning biologic width, buccal bone thickness, prevalence and distribution of dehiscence, and fenestration in lower anterior teeth. A total of 30 patients were selected for the study based on the inclusion and exclusion criteria. The Cone Beam Computed Tomography analysis was performed in the mandibular anterior area to assess gingival thickness (biotype), biologic width, buccal bone thickness, dehiscence, and fenestrations. The data were analyzed using SPSS version 26. An independent t-test was used to assess the relationship between the variables. Our study identified an increased biologic width in the thick gingival biotype, a higher frequency of dehiscence in the thin gingival biotype than in the thick biotype, and a greater mean alveolar bone thickness in the thick biotype group. A statistical difference was not observed between the groups; however, the thick biotype showed better results than the thinner biotype for the periodontal parameters examined.

Survival Rate of Dental Implants in the Irradiated Jaw Bones of Patients with Oral and Head & Neck Malignancies

Purpose: This study aimed to analyze and report the survival rate of dental implants in patients who underwent radiation therapy for head and neck malignancies. Materials and Methods: A total of 23 patients (male:female ratio = 13:10; mean age 61 years, range, 44–86 years) who underwent dental implant placement after radiation therapy between 2010 and 2020 were enrolled in this study. The cumulative survival rate (CSR) was analyzed using the Kaplan–Meier method, considering variables such as the location of the dental implant, radiation dose, and types of cancers that patients had. Implant placement was considered successful if it showed no mobility, did not cause pain or bleeding, or a minimal marginal bone level change at follow-up.Results: There were two cases of death during the follow-up period. Seven of the 83 implants failed. Among the seven failure cases, four implants were applied in the posterior mandibular area, one in the anterior mandibular area, and two in the posterior maxillary area. When each variable was considered, the CSR of the implant was 91.6%. The correlation between CSR, implant location, and the types of cancer was statistically significant. However, there was no correlation between the CSR and average radiation dose.Conclusion: The survival of implants in the irradiated area of the jaw was lower than that in the normal jawbone. The survival rate of the implants in the irradiated maxillary jaw was lower than that of the implants in the mandible. Additionally, the radiation dose was not significantly correlated with implant failure rate. Also, when compared between patients who had oral cavity cancer and other head and neck cancers, implant survival in patients with oral cavity cancer was lower than that in patients with other head and neck cancers.

Prosthetic Treatment of Implant-supported Double-crown Retained Removable Denture in a Failure Case of Implant-supported Fixed Dental Prosthesis

A 78-year-old female patient presented with implant failure in the maxillary and mandibular anterior areas due to medication-related osteonecrosis of the jaw. Implant-supported fixed dental prosthesis (FDP) in the maxilla and mandible were removed, and implants with osteomyelitis were removed in the anterior area (three implants in the maxilla and two implants in the mandible). After the healing period, the maxillary anterior area was recovered with 6-unit implant-supported FDP, and the mandible was reconstructed using an implant-supported double-crown-retained removable denture with friction pins. The patient was satisfied with the functionality and maintenance of the new prostheses.

Periosteum coverage versus collagen-membrane coverage in periodontally accelerated osteogenic orthodontics: a randomized controlled clinical trial in Class II and Class III malocclusions

BackgroundPeriodontal accelerated osteogenic orthodontics (PAOO) is a widely-used clinical procedure that combines selective alveolar corticotomy, particulate bone grafting, and the application of orthodontic forces. Different modifications of PAOO such as collagen-membrane coverage can better benefit patients from preventing displacement of grafts. Due to its stability, collagen-membrane coverage gradually gained popularity and became a widely-used procedure in traditional PAOO technique.ObjectivesTo quantitatively investigate the radiographic changes of alveolar bone, periodontal soft tissue changes of the mandibular anterior teeth and postoperative complications in periosteum-covered techniques compared with traditional surgical technique in PAOO.MethodsOrthodontic camouflage for dental Class II or decompensation for skeletal Class III malocclusions were included; Patients with bone defects on the buccal aspects of the anterior mandible regions confirmed by clinical and radiographic examination were randomly divided into the periosteum coverage group or traditional technique group for PAOO. Cone-beam computerized tomography (CBCT) scans were obtained before treatment (T0) and 1 week (T1) and 12 months (T2) after operation. The primary outcome variable was the vertical alveolar bone level (VBL), the secondary evaluation parameters included labial horizontal bone thickness at the midpoint of the middle third (MHBT) or apical third (AHBT) to the limit of the labial cortical surface during a 12-month follow-up. Postoperative sequelae were evaluated after 2 days and 7 days in both the groups. Periodontal parameters were analyzed at T0 and T2.ResultsThirty-six adult subjects were eligible and recruited in the present study. Although experimental group exhibited more severe infection, no significant differences of the postoperative symptoms or periodontal parameters was found between the 2 groups (P > 0.05). All patients were examined respectively using CBCT at baseline (T0), postoperative 1 week (T1) and 12 months (T2). Both alveolar bone height and width increased from T0 to T1 (P < 0.001) and then reduced from T1 to T2 (P < 0.001) in both groups. However, significant bone augmentation was achieved in each group from T0 to T2 (P < 0.001). Furthermore, the vertical alveolar bone augmentation in the experimental group increased significantly than that in the traditional surgery (P < 0.05).ConclusionsCompared with traditional PAOO surgery, the periosteum-covered technique provides superior graft stabilization and satisfactory vertical bone augmentation in the labial mandibular anterior area.

A patient with large congenital epulis in the maxillary and mandibular anterior areas accompanied by impaired suckling

AbstractBackgroundCongenital epulis is a rare tumor of the newborns.Case PresentationWe found a case of soft elastic pedunculated masses in the left maxillary anterior (26 × 14 × 11 mm) and left mandibular anterior (55 × 44 × 11 mm) areas, protruding out of the oral cavity. The large multiple masses interfered with suckling. These masses were excised using a carbon dioxide laser under general anesthesia. They were diagnosed histopathologically and immunocamically as congenital granular cell epulis. These were no complication after surgery.ConclusionWe report a 1‐day old female infant with large congenital epulis in the left anterior deciduous tooth regions of the upper and lower jaws, accompanying impaired suckling. The histopathological finding of masses was congenital granular cell epulis.

Creeping attachment after gingival augmentation using a free gingival graft. A case report

Introduction: Gingival recession presents an apical proliferation of the gingival margin to the cemento-enamel junction of the tooth and can be accompanied by aesthetics dissatisfaction and be associated with insufficient width of keratinized gingiva. Some surgical interventions are proposed for augmentation of gingival tissues when there is an insufficient width of keratinized gingival tissues. Such surgical approach is the use of a free gingival graft. This technique shows good results in gingival augmentation and treatment of shallow recessions with depth less than 3 mm. Aim: The aim of this case report is to demonstrate the creeping attachment of the gingival margin after use of a free gingival graft for augmentation of the width of keratinized gingival tissues on the vestibular side of the mandibular anterior area. Case Presentation: Lack of keratinized attached gingival tissues apically to the mandibular central incisors is established. A free gingival graft is used for augmentation of the width of the insufficient keratinized gingiva. Results : Three months after gingival augmentation with a free gingival graft, the reduction of the depth of gingival recessions was not significant. Compared to baseline, a significant increase in the width of keratinized attached gingiva was reported 6 months later. The depth of gingival recessions was reduced and gain of clinical attachment level was achieved on the vestibular side in both lower central incisors. Conclusion: The presented case report confirmed that, due to creeping attachment, a reduction of depth of gingival recessions and vestibular clinical attachment level gain were recorded after gingival augmentation with a free gingival graft.

Evaluation of Implant Overdenture Retention with Two Different Attachments at 23mm Standard Inter-Implant Distance

Purpose: Evaluation of implant overdenture retention at 23mm standard inter-implant distance using OT Equator and locator attachments. Materials and methods: Twelve completely edentulous patients were selected for this study. For all patients, conventional complete dentures were constructed. Mandibular dentures were replicated into stereolithographic implant placement guide using CBCT. Every participant received 2-implants in the anterior mandibular area with inter-implant distance of 23 mm. After the osseointegration period, the mandibular conventional dentures were converted into implant retained overdentures attached with Locator attachment for (group I) (six patients) and OT Equator attachments for (group II) (six patients). Retention was evaluated for conventional mandibular complete dentures (T0), 3-months (T3) and, 6-months (T6) after overdenture insertion using digital force-meter. Results: Results revealed that there was a statistically significant difference between the study groups representing mean retention force (P&lt;0.05) except at T0 (baseline evaluation with conventional dentures) with higher mean values for group I (Locator attachment) than group II (OT Equator attachment). Conclusion: Regarding the limitations of this study: -Inter-implant distance of 23 mm for 2-implant overdentures could be considered a reliable modality for edentulous mandible. -Locator attachment may be preferable than OT Equator attachment regarding 2-implant overdenture retention at 23 mm inter-implant distance.

Recording and incorporating Oromuscular balance for a complete denture prosthesis

Excessive and loose movable flabby tissue is often present in the mandibular anterior residual alveolar ridge area and mild to moderate cases resolve by oral physiotherapy. However, they compromise denture stability to a large extent. The use of the neutral zone to locate placing artificial denture teeth enhances stability since the orofacial musculature does not tend to unseat the denture in such cases. We present a case of an elderly male patient who was wearing a two-month-old complete denture and had developed mild to moderate flabby tissue in the mandibular anterior residual alveolar ridge. While most of the flabby tissue was resolved by physiotherapy, the location of artificial denture teeth in the neutral zone ensured faster denture adaptation of the patient thus producing better compliance. A novel technique of recording and incorporating neutral zone using zinc oxide eugenol impression paste on the occlusal rims have also been described.

Effects of soft tissue grafting prior to orthodontic treatment on preventing gingival recession in dogs.

PurposeThis study was conducted to assess the efficacy of prophylactic gingival grafting in the mandibular anterior labial area for preventing orthodontically induced gingival recession.MethodsEight mongrel dogs received gingival graft surgery at the first (I1) and third (I3) mandibular incisors on both sides based on the following group allocation: AT group (autogenous connective tissue graft on I1), AT-control group (contralateral side in the AT group), CM group (xenogeneic cross-linked collagen matrix graft on I3) and CM-control group (contralateral side in the CM group). At 4 weeks after surgery, 6 incisors were splinted and proclined for 4 weeks, followed by 16 weeks of retention. At 24 weeks after surgery, casts were made and compared with those made before surgery, and radiographic and histomorphometric analyses were performed.ResultsDespite the proclination of the incisal tip (by approximately 3 mm), labial gingival recession did not occur. The labial gingiva was thicker in the AT group (1.85±0.50 mm vs. 1.76±0.45 mm, P>0.05) and CM group (1.90±0.33 mm vs. 1.79±0.20 mm, P>0.05) than in their respective control groups.ConclusionsThe level of the labial gingival margin did not change following labial proclination of incisors in dogs. Both the AT and CM groups showed enhanced gingival thickness.

Guided tissue regeneration therapy after root canal therapy for long standing periodontal-endodontic combined lesion in the mandibular anterior area: case report

Guided tissue regeneration therapy after root canal therapy for long standing periodontal-endodontic combined lesion in the mandibular anterior area: case report

A new modified bone grafting technique for periodontally accelerated osteogenic orthodontics.

The aim of this study was to introduce an improved surgical technique using a pouch design and tension-free wound closure for periodontally accelerated osteogenic orthodontics (PAOO) in the anterior alveolar region of the mandible.Patients with bone dehiscence and fenestrations on the buccal surfaces of the anterior mandible region underwent the modified PAOO technique (using a pouch design and tension-free closure). Postoperative symptoms were evaluated at 1 and 2 weeks intervals following the procedure. Probing depth (PD), gingival recession depth (GRD), and clinical attachment level (CAL) were assessed at the gingival recession sites at baseline, postoperative 6 and 12 months. Cone-beam computerized tomography (CBCT) was used for quantitative radiographic analyses at baseline, 1 week and 12 months after bone-augmentation procedure.The sample was composed of a total of 12 patients (2 males and 10 females; mean age, 21.9 years) with 72 teeth showing dehiscence/fenestrations and 17 sites presenting with gingival recessions. Clinical evaluations revealed a statistically significant reduction in swelling, pain, and clinical appearance from postoperative week 1 to week 2 (P < .05). Moreover, gingival recession sites exhibited a significant reduction in the GRD and an increase in CAL after surgery with mean root coverage of 69.8% at the end of observation period (P < .01). Both alveolar bone height and width increased after surgery (P < .01) and decreased during the 12-month follow-up (P < .01). However, compared with the baseline records, there was still a significant increase in alveolar bone volume (P < .01).This modified PAOO technique may have advantages in terms of soft and hard tissue augmentation, facilitating extensive bone augmentation and allowing the simultaneous correction of vertical and horizontal defects in the labial aspect of the mandibular anterior area.

Ameloblastoma uniquístico intramural, reconstrucción tardía y rehabilitación con implantes dentales. Reporte de caso

Introducción: el ameloblastoma uniquístico es considerado una variante del ameloblastoma, con características clínico-radiográficas e histológicas particulares, mostrando un mejor pronóstico que la forma sólida. Objetivo describir el manejo y procederes de un paciente con ameloblastoma uniquístico intramural (AUIM) en línea media mandibular con énfasis en la reconstrucción tardía y su rehabilitación. Materiales y métodos: se presenta un varón de 18 años con una lesión indolora en la zona anterior de la mandíbula, relacionada con un diente retenido. Radiográficamente, mostraba imagen unilocular, corticalizada, que causaba expansión de las corticales óseas. Se realizó la resección segmental y ajuste de placa de reconstrucción; en un segundo tiempo quirúrgico se colocó injerto óseo autólogo y, posteriormente, se procedió a la rehabilitación con implantes. Discusión: en el artículo se discute la elección del tratamiento basado en el comportamiento biológico del AUIM, así como la necesidad de restablecer la estética y la función después de una cirugía radical.

Bone height changes around hybrid implants in three implant retained mandibular Overdentures

Objective: The purpose of this RCL was to evaluate bone height changes around hybrid implants in three implant- retained mandibular overdenture with locator attachment.Materials & Methods: Ten completely edentulous male patients were enrolled in this study. Preoperative Cone beam computed tomography (CBCT) had been made to evaluate bone height & density in areas for implant installation. Patients had received three hybrid implants installed in midline & mandibular canine areas following flapless technique. Implants were early loaded; two weeks after implant installation. Overdentures were functionally fitted onto the locator attachment of the hybrid implants by direct pick-up technique.Evaluation: Bone height changes were evaluated with the aid of CBCT at the time of implants’ loading, six months and twelve months later. Mesial & distal crestal bone heights were calculated from reconstructed corrected sagittal views.Results: The results had revealed that there was no significant difference in peri-implant bone level throughout the follow-up periods on comparing the three implant sites. However, there was slightly higher bone resorption around the distal implants than the midline ones.Conclusions Three implant retained overdentures with locator attachments may preserve peri-implant bone in the anterior mandibular area. Midline implant in three implant overdentures may not be subjected to more stresses than the two distal implants

Immediate versus delayed loading of a new conical connection implant in the esthetic zone: a randomized study with 2-year follow-up

Aim The aim of this study is to compare immediate versus delayed loading protocol of a new conical connection implant in the esthetic zone. Materials and methods Patients requiring single-tooth extraction for root fractures or periodontal disease in the maxillary or mandibular anterior or premolar areas were selected for the present study. After extraction, implants were placed immediately in fresh sockets. After randomization process, in group A immediate loading was performed while in group B a delayed loading protocol was followed. In both groups mean marginal bone loss was measured through intraoral digital radiographs at 3, 6, 12 and 24-month follow-up. Results At 24-month, a survival rate of 100% was reported. For group A a mean marginal bone loss of 0.10 ± 0.09 mm was found, while for group B a value of 0.11 ± 0.08 mm was measured. No statistically significant differences between groups were found at each time point (P>0.05). Conclusion When used in postextraction immediate and delayed loading implant rehabilitation, the new conical connection implant showed a good clinical outcome at 24-month follow-up.

Soft Tissue Enhancement and Implant Placement Following Partial Mandibulectomy Due to Squamous Cell Carcinoma.

Many dental procedures allow for implant placement in partially or totally edentulous patients. Despite the availability of various implant and abutment types on the market, it often becomes quite challenging to achieve the biological and esthetic goals in a patient who has ridge deficiencies. Problems arise from the lack of adequate bone quality and quantity. 1 , 2 Soft tissue form and maintenance is also a consideration to evaluate. 3 Primary reconstructive techniques following segmental mandibulectomy is evolving and improves quality of life. A seldom encountered complication is the discovery and treatment of a malignant process (for example, squamous cell carcinoma). Oral squamous cell carcinoma (OSCC) is one of the most aggressive malignancies worldwide and accounts for more than 90% of all oral cancers. 4 It is ranked as the sixth leading cause of cancer mortality worldwide. The most common sites of OSCC are the lateral ventral surface of the tongue, the floor of the mouth and buccal mucosa. For most oral cavity cancers, surgery is the initial treatment of choice (often involving the full or partial removal of bony jaw structure). 5 Radiation or chemoradiation is added postoperatively if disease is more advanced or has high-risk features. Successful cancer therapy can affect the quantity and quality of soft tissue in areas where implants are planned, thus affecting the initial placement and the long-term success of the implants. Complications can be numerous; especially difficult is implant treatment in the mandibular anterior area where inadequate alveolar height results in the lingual floor and the vestibule becoming contiguous. 6 Further complicating treatment is the presence of scar tissue (often found following cancer surgery and radiotherapy). The present case is a report of the combination of a soft tissue enhancement and implant placement following partial mandibulectomy resulting from the treatment of oral squamous cell carcinoma. A video abstract is available for viewing at https://youtu.be/dZ9t3j4ufOc?list=PLvRxNhB9EJqbqjcYMbwKbwi8Xpbb0YuHI .

A silent transformation of keratocystic odontogenic tumour to squamous cell carcinoma: A case report and review of literature

Till date cases reported elsewhere in the world regarding keratocystic odontogenic tumor transformation to squamous cell carcinoma are very sparse. It has been usually noticed in adult males, with the predominant location being posterior mandibular area. We hereby report a case of squamous cell carcinoma involving anterior mandibular area to posterior mandibular region in a 65-year-old female patient with no evidence of any ulceration and growth intraorally, suggesting that the tumor had a bony origin. Therefore, thorough monitoring of such tumours is necessary to arrive at a proper diagnosis, followed by providing treatment at the earliest.

A Novel Surgical Technique for Augmented Corticotomy-Assisted Orthodontics: Bone Grafting With Periosteum

To introduce grafting fixed with the periosteum (dumpling technique) as an alternative surgical technique for augmented corticotomy-assisted orthodontics in the lower anterior region and evaluate the preliminary outcomes. Eleven patients (9 women, 2 men; mean age, 21.4yr) with a thin alveolus or alveolar defect in the lower anterior region by clinical and radiographic examination underwent an augmented corticotomy using the new dumpling technique. Cone-beam computerized tomography was used to evaluate morphologic changes of the lower anterior ridge before treatment (T0) and 1week (T1) and 6months (T2) after the bone-augmentation procedure. Repeated-measures analysis of variance with Bonferroni multiple-comparison test was used to compare variables at each time point. No severe postsurgical complications occurred in any patient. The mean alveolar bone thickness of the labial plate increased from T0 to T1 (P < .001) and decreased from T1 to T2 (P < .001). However, compared with T0, there was still a significant increase in horizontal bone thickness at T2 (P < .05). The vertical alveolar bone level increased from T0 to T1 (P < .001) and was maintained from T1 to T2 (P > .05). No significant differences were found in root length of the lower anterior teeth at these 3 time points (P>.05). In this preliminary study, the dumpling technique for augmented corticotomy-assisted surgical orthodontics showed alveolar bone augmentation by increasing the vertical alveolar height and the horizontal bone thickness in the labial aspect of the anterior mandibular area. However, long-term follow-up is necessary.