Maxillary Anterior Dentition Research Articles

Split/Dual Tray Impression Technique with a Digital Workflow

Split/Dual Tray Impression Technique with a Digital Workflow

Relationships between perception of black triangles appearance, personality factors and level of education

This analytical cross-sectional study evaluated the perception of black triangles (BT) and examined the relationships between the perception of BT, personality factors, different educational backgrounds and demographic factors. 435 participants were included and divided into four groups: dentists, clinical (4th and 5th year) dental students, pre-clinical (3rd year) dental students, and laypeople. Participants’ perception of the attractiveness of smile profiles of maxillary and mandibular anterior dentition with BT was rated using a ten-point VAS scale with 0 being the least, and 10 being the most attractive smile profile. The personality was assessed using the NEO-FFI personality questionnaire. The smile profile with multiple large BT was rated the least attractive for the maxillary (mean = 3.6) and mandibular (mean = 3.9) tested profiles. The smile profile without BT was rated the most attractive for the maxillary (mean = 9.1) and mandibular (mean = 8.8) tested profiles. The dental professionals perceived the maxillary smile profile with multiple large BT as less attractive than the non-dental participants (t = − 2.715, P = 0.007). Being a male, having dental education, having lower Neuroticism scores, as well as having higher Openness, Agreeableness, Conscientiousness, and Extraversion scores predicted and contributed more towards perceiving various tested smile profiles as more attractive. These findings show that black triangles negatively impacts the perception of smile attractiveness, and that personality traits and having dental education impact the perception of smile attractiveness for smiles with black triangles.

Stresses Along the Root Surfaces of Maxillary Anterior Dentition During Retraction in Labial and Lingual Mechanics with Varying Level of Bone Support: A Finite Element Study

Objective The aim of this study was to evaluate and compare the stress along the root surfaces of anterior maxillary dentition during retraction in labial and lingual mechanics with varying level of bone support. Materials and methods Eight 3D finite element models (FEM) having 340,215 nodes and 211,543 elements were created with normal periodontium and different levels of alveolar bone loss; four with labial brackets and four with lingual brackets. Sliding mechanics were simulated as en masse retraction of the anterior dentition. The equivalent stresses along the roots of six anterior maxillary teeth were measured in all the models. Results Equivalent stresses in pascals (Pa) generated at the root surfaces of central incisors are always higher in labial technique (right: 4.6013 × 10−2; left: 7.1158 × 10−2) and of canines (right: 10.003 × 10−2; left: 16.789 × 10−2) are always higher in lingual technique. Conclusion In labial technique, central incisor roots are experiencing maximum stress, which might be the explanation of commonly seen higher incidence of root resorption in them during en masse retraction. In lingual technique, canine roots are experiencing higher stresses as compared to other anterior teeth during en masse retraction. Equivalent stresses generated at the root surfaces of canines are more irrespective of the alveolar bone loss in lingual technique.

New insight into prehistoric craft specialisation. Tooth-tool use in the Chalcolithic burial site of Camino del Molino, Murcia, SE Spain

The study of non-alimentary tooth wear is an excellent tool to identify the development of specific activities and thus, to delve deeper into the social organisation and complexity of past populations. This paper analyses extra-masticatory wear in the dentition of a sample of 102 articulated skeletons from Camino del Molino, a unique collective tomb that housed 1,348 individuals throughout two contiguous phases spanning much of the 3rd millennium BC. After preliminary macroscopic observation of the dental sample, 8 individuals with cultural dental wear were identified and 5 of them were analysed with SEM. In all cases, the maxillary anterior dentition displays evidence that can be defined as occlusal and interproximal grooves consisting of fine, parallel striations, as well as labial notches and chipping of the enamel. The results suggest that 8 individuals, mostly women, used their dentition in craft tasks, such as in the processing of fibres for textile production, hence representing the earliest evidence of craft specialisation in the Iberian Peninsula and potential proof of a possible sex-based division of labour in a Chalcolithic community.

Finite Element Analysis of Maxillary Anterior Dentition During Retraction With Varying Level of Bone Support

AbstractThis study is being carried out to evaluate and compare the stress along the root surfaces of anterior maxillary dentition during retraction in labial and lingual mechanics with varying level of bone support. Eight three-dimensional finite element models (FEM) were created with normal periodontium and different levels of alveolar bone loss; four with labial brackets and four with lingual brackets. Sliding mechanics were simulated as en-masse retraction of the anterior dentition. The equivalent stresses along the roots of six anterior maxillary teeth were measured in all the models. Equivalent stresses generated at the root surfaces of central incisors are always higher in labial technique and of canines are always higher in lingual technique, suggesting the increased vulnerability toward root resorption in both cases. Stresses at the root apices of all the teeth are increasing progressively when the bone loss is progressively more than 2 mm in labial technique. In labial technique, the stresses at the root apices of all the teeth are increasing progressively when the bone loss is progressively more than 2 mm. In Lingual technique, equivalent stresses generated at the root surfaces of canines are more than central and lateral incisors irrespective of the alveolar bone loss, suggesting increased susceptibility to root resorption.

The development of a novel Orthodontic Alignment Index and its use to evaluate the effect of residual overjet on the stability of the alignment of the maxillary anterior dentition

BackgroundIt is thought that achieving a normal overjet may help to stabilise the alignment of the maxillary anterior dentition. Little’s Irregularity Index is limited in assessing discrete post-orthodontic changes, fails to account for reciprocal rotations and is not sensitive to dental changes in three planes. A more holistic tool for the assessment of post-treatment change is therefore required.AimTo compare the post-treatment stability of maxillary anterior dental alignment in subjects treated either to a Class I incisor relationship or an increased overjet (> 4 mm) following fixed appliance-based orthodontics using a novel measurement tool.Materials and methodsThe Orthodontic Alignment Index (OAI) was developed and validated using a panel of 63 raters. The new index accounts for a range of weighted features including contact point displacement, spacing, reciprocal rotations, inclination, angulation and vertical discrepancy. A retrospective cohort study was undertaken at the Institute of Dentistry, Queen Mary University of London. Recruitment took place over a 4-year period. All participants had removable retainers in the maxillary arch only. The stability of maxillary anterior teeth was assessed using Little’s Irregularity Index (LII) and the OAI. Subjects were recruited at least 12 months following completion of dual-arch fixed appliance-based treatment.ResultsEighty-two participants were included with a positive correlation observed between LII and OAI at the 12-month post-treatment review with a 1-mm increase in LII associated with a 2-point increase in the OAI (P < 0.001). Limited relapse was observed in both groups: normal overjet group (OAI = 1.28; LII = 0.52); residual overjet group (OAI = 0.88; LII = 0.47). Median regression analysis failed to identify a significant association between an increased overjet at debond and the alignment of the maxillary anterior segment when assessed with OAI (P = 0.389) and LII (P = 0.577). Furthermore, age, gender, extraction protocols and retention regime were not predictive of post-treatment change.ConclusionsUsing a novel index (OAI) and LII, there was limited post-treatment relapse in alignment of the maxillary anterior dentition over a 12-month period. Based on this retrospective evaluation, achieving a normal overjet at the end of treatment may have little bearing on the post-treatment stability of maxillary anterior alignment at 12 months.

Influence of different ligation methods on force and moment generation in a simulated condition of the maxillary crowded anterior dentition with linguo-version and rotation.

Most orthodontic cases consist of varying degrees of crowding. To manage crowded dentitions, nickel-titanium archwires with various ligation methods are often used. We aimed to investigate the effect of different ligation methods with respect to force and moment and suggest the efficient ligation method for treating rotation and displacement simultaneously. We built a model that simulated the three anterior teeth of the maxilla. The teeth on the two ends were fixed, and the middle tooth was set in several different positions by manipulating the amount of displacement in bucco-lingual direction and rotation angle. The measurements were taken with three different ligation methods of self-ligation (SL), elastomeric o-ring ligation on both side wings (EB), and on one side wings (EO). The magnitude of linguo-buccal force exceeded the standard optimal force in each condition examined and was significantly larger in EB than in other ligation methods. Moreover, the magnitude of moment generation with SL was suitable in the 0.0mm linguo-version, whereas it was suitable with EO in the linguo-version ranging 1.0-3.0mm. The ligation method significantly affected the force and moment. SL and EO are recommended in dentitions with light and deep lingual displacements, respectively.

Third-Order Effects and Maxillary Incisor Control in Lingual Orthodontics – A Finite Element Study of a Ribbon Arch and Edgewise Straight Wire System

Introduction: The aim of the present study was to analyze the effects of retraction mechanics on torque control when retraction forces were applied on the maxillary anterior dentition in two distinct lingual appliance systems. Materials and Methods: A three-dimensional bilateral maxillary model was created where the first premolar extraction case was included. 150 g (1.47 N) of retraction force was applied on each side from canine (C) hook to molar for both edgewise straight wire system and ribbonarch appliances. Results: In the edgewise appliance, it was observed in the X-axis that there was less amount of tipping of the six anterior teeth of the canine and central incisor (CI) when compared with the lateral incisor (LI) at occlusal point. In the Y-axis, overall extrusion was observed. In the Z-axis, there was less lingual crown movement. In the ribbonarch appliance, it was observed in the X-axis that there was less tipping, prominently in the canine and CI than in the LI. In the Y-axis, overall extrusion was observed. In the Z-axis, there was less lingual crown movement, whereas the CI and canine showed less movement when compared with the LI. Conclusions: It was observed that there was greater torque loss and extrusion in the edgewise appliance along with greater maximum principal stress in the cervical half of the facial side in the periodontal ligament (PDL) and minimum principal stress on the cervical half of the palatal side in the PDL when compared with the ribbonarch appliance.

Palatal Anterior Teeth Retraction Assisted by Temporary Anchorage Devices - A Review

Successful orthodontic resolution of bimaxillary dentoalveolar protrusion depends on successful retraction of anterior dentition, which also involves acquiring proper buccolingual inclination and vertical position of anterior teeth. To fulfill these requirements, clinicians have devised numerous biomechanical and surgical orthodontic options. A palatal retractor for retraction of maxillary anterior dentition is the result of clinician’s long-time creative endeavors and an evolution of the biomechanical design. A palatal retractor splints the maxillary anterior dentition on the lingual side with bonded mesh plates connected by a supporting wire. Two long palatally extended arms are soldered to the supporting wire where adequate retraction force can be applied. Palatal retractors have several advantages over conventional bracket/wire systems. The two most prominent ones are biomechanical superiority and esthetic invisibility. As the palatal retractor is positioned on the lingual surface of the maxillary anterior dentition, it is not visible from the frontal view and since the anterior dentition retraction constitutes a significant portion of the total treatment time in extraction orthodontic treatment, it is a distinct esthetic advantage. Biomechanical disadvantage of the conventional bracket/wire system lies in its innate ineffectiveness of the torque and vertical control because of the long distance between the point of force application and the center of resistance of the anterior dentition. A combination of TADs and palatal retractors provides the possibility of maximizing control of both the torque and vertical position. This article aims to describe clinical considerations, applications, and results of palatal retractor use in clinical cases. Keywords: extraction treatment, anterior teeth retraction, palatal retractors, temporary anchorage devices.

Is apicectomy with retrograde filling still relevant in contemporary dental practice? A 25‐year retrospective review

AbstractBackgroundApicectomy with retrograde filling has always been a viable treatment option for a tooth when conventional endodontic therapy is not indicated, impossible or unsuccessful.ObjectiveTo determine reasons for apicectomy with retrograde filling, dentitions affected, age and gender of the patients, including complication(s) 4 years after the procedures.Materials and MethodsThis is a 25‐year retrospective cohort study of consecutive patients treated in the study centre. Clinical symptoms and signs of morbidity and mortality of tooth‐like pain, tenderness to percussion and evidence of discharging sinus or fistula formation, swelling, tooth mobility and loss were recorded 4 weeks after the procedures. Descriptive and bivariate statistics were computed.ResultsA total of 567 procedures were done in 567 patients, 34 (6.0%) failed to meet the inclusion criteria. Consequently, of the 533 patients used for analysis, 58.4% were males whilst 41.6% are females with a male to female ratio of 1.4:1 (p = 0.04). A majority (94.2%) of the patients are in the age group of 17–46 years (p = 0.000). The indications for the procedures showed that failed root canal therapy (78.2%) was significant (p = 0.001). More cases were done in the maxillary anterior dentition (82.7%, p = 0.001), and 97.8% (p = 0.000) was treated successfully.ConclusionThis study shows that a significant majority of the patients were successfully managed, which suggests that the procedure is still an indication for the management of the conditions diagnosed.

Comparative evaluation of gingival zenith positions and levels of maxillary anterior dentition in males and females

Comparative evaluation of gingival zenith positions and levels of maxillary anterior dentition in males and females

Outcomes of clear aligner treatment with and without Dental Monitoring: A retrospective cohort study

Theeffects of Invisalign clear aligner treatment with and without Dental Monitoring (DM) were compared for treatment duration, number of appointments, refinements and refinement aligners, and accuracy of Invisalign in achieving predicted tooth positions (aligner tracking). The null hypothesis was that there are no differences between Invisalign with and without DM in these parameters. A sample of 90 consecutively treated Invisalign patients (45 control, 45 DM) fitted the inclusion and exclusion criteria. Treatment duration, number of refinements, number of refinement aligners, time to first refinement, number of appointments, number of emergency visits, and accuracy of predicted tooth movement were observed for differences. The 2 groups were homogeneous (P>0.05) for sample size, age, gender, Angle classification, maxillary and mandibular irregularity index, and the number of initial aligners. There was a significant (P=0.001) reduction in the number of appointments by 3.5 visits (33.1%) in the DM group. There was also a significant (P=0.001) reduction in the time to the first refinement (1.7months) in the DM group. Compared with Invisalign predicted tooth positions, actual tooth positions were statistically (P<0.05) more accurate for the DM group for the maxillary anterior dentition in rotational movements and mandibular anterior dentition for buccal-lingual linear movement. Invisalign therapy without DM was closer to predicted tooth positions for the maxillary posterior dentition for the tip. None of these differences surpassed the clinically significant thresholds (>0.5mm or>2°); however, the DM group achieved this in 1.7 fewer months. DM with Invisalign therapy resulted in a reduced number of appointments by 3.5 visits (33.1%). The DM group also achieved a clinically similar accuracy in obtaining predicted tooth movements compared with the control group in 1.7 fewer months, indicating improved aligner tracking in the DM group.

Analysis of Crown Morphology and Gingival Shape in the Maxillary Anterior Dentition.

From a sample of 108 periodontally healthy volunteers with different combinations of morphometric data related to maxillary central anterior teeth and the surrounding soft tissues, this article aims to categorize gingival phenotypes according to tooth and gingival parameters, as well as assess the relationships between tooth shape and gingival characteristics, such as the papillary height (PH) and faciolingual thickness (FLT) of the papilla base. The periodontal phenotypes of 108 volunteers were confirmed using the periodontal probe transmission method for Kan classification. The FLT, PH, and the crown width to crown length (CW/CL) ratio for maxillary anterior teeth were measured. K-clustering was used to classify the anterior tooth shape into three groups: triangular, square, and compound. The mean CW/CL ratio for the maxillary anterior tooth position of the thick phenotype was greater than that of the thin phenotype. The PH and FLT for the maxillary anterior interdental papillae were greater for the thin phenotype group than for the thick phenotype group. A negative correlation was observed between the CW/CL ratio and both PH and FLT (P < .05 for both). However, a significant positive correlation was observed between FLT and PH. CW/CL ratio, FLT, and PH were all associated with the gingival phenotype with significant statistical correlations (P < .05 for all). Triangular teeth were correlated with scallop-shaped gingiva in the faciolingual area, while square teeth were associated with a flat gingiva.

Pink Esthetics: A Study on Significant Gingival Parameters

The aim of the study was to quantify the specific spatial displacement of gingival zenith (GZ) and determine a representative value for the interdental papilla height as a percentage ratio of clinical crown length (CL), as measured from GZ in the maxillary anterior dentition. A total of 100 subjects and 1,200 interdental papillae were included. Eighty percent of the population presented with the gingival margin of lateral incisor (LI) teeth positioned coronally to the GZ of the ipsilateral canine (C) and central incisor (CI). No significant difference was found between mesial and distal papilla proportion (DPP) of maxillary incisor groups. In the C group, numerical values showed higher DPP. The data achieved provide the ideal numerical values for prosthetic, restorative, periodontal, implant, postorthodontic, and esthetic treatment outcomes. The study describes the importance of quantifying the ideal numerical values for prosthetic, restorative, periodontal, implant, postorthodontic, and esthetic treatment outcomes. The readers should understand to quantify the specific spatial displacement of GZ and determine a representative value for the interdental papilla height as a percentage ratio of clinical CL, as measured from GZ in the maxillary anterior dentition.

Strategy of Esthetic Implant Restoration in Maxillary Anterior Teeth with Severely Resorbed Labial Bone Plate: A Case Report

As implant procedures become more common, many patients require more aesthetic restoration and shorter treatment periods. Maxillary anterior dentition is very challenging site for esthetic final restoration. It becomes more difficult at the site of labial bone resorption. A strategy for esthetics is necessary before extraction. Nineteen years old girl had maxillary anterior teeth with external root resorption and severe resorbed labial plate due to inflammation. Before extraction, antibiotics and anti-inflammatory drugs were administered to relieve the infection and inflammation. Eight weeks after extraction, implant was placed using computer guided surgery. Guided bone regeneration with transmucosal healing was performed and then, fixed provisional restoration was delivered immediately. Soft tissue molding was performed with modification of provisional crown for 6 months. We achieved esthetic final implant restoration in compromised maxillary anterior teeth.

Quantitative assessment of papillary proportions of the maxillary anterior dentition in the south Indian population.

Quantitative assessment of papillary proportions of the maxillary anterior dentition in the south Indian population.

SURVEY OF THE GINGIVAL ZENITH POSITION AND PAPILLA PROPORTION IN THE MAXILLARY ANTERIOR DENTITION

Background: Gingival morphology and contour play an essential role in creating a beautiful smile. Understanding and establishing these characteristics are prerequisites during treatment planning for maxillary anterior dentition. The aim of study was to evalute the position of gingival zeniths and to quantify papilla proportion in relation to clinical crown length in maxillary anterior region. Methods: Descriptive cross-sectional study was conducted on 123 students from faculty of Odonto-Stomatology. For each student, maxillary alginate impression was taken and a diagnostic cast was poured with dental stone. The gingival zenith postions (GZP) of six anterior teeth were marked on dental casts. Using a digital vernier caliper to measure these parameters: the distance from GZP to vertical bisected midline of these teeth, the distance from GZP of maxillary lateral incisor to the gingival line, mesial and distal papilla proportion of each maxillary anterior tooth. Results: Central incisors, lateral incisors and canines showed distal displacement from VBM with a mean average of 0.96 mm, 0.46 mm and 0.26 mm respectively. The GZs of maxillary lateral incisors were more coronal to the gingival lines by approximately 0.77 mm. Mean mesial and distal papilla proportion for maxillary anterior dentition were 43.37% and 44.42% respectively. Conclusions: All maxillary anterior teeth showed distal displacement of GZPs from the VBM. The GZPs of maxillary lateral incisors were more coronal to the gingival lines. Papilla proportions were approximately 43,9% for all tooth groups. Key words: Gingival zenith, vertical bisected midline, papilla height, papilla proportion

Changes in Peri-implant Soft Tissue Thickness with Bone Grafting and Dermis Allograft: A Case Series of 15 Consecutive Patients.

Immediate implant placement and provisional restoration has become a popular and well-supported method of tooth replacement in the maxillary anterior dentition. Aside from achieving osseointegration, esthetic demands have grown with better understanding of the behavior of hard and soft tissues following this mode to therapy. Stability of gingival contours, texture of the surrounding tissues, and blending of prosthetic components with the natural dentition are critical for successful outcomes to be maintained long-term. Increasing soft tissue thickness at the time of therapy plays an important role in this regard. A technique combining the proven principles of immediate implant placement and provisional restoration with hard and soft tissue augmentation using nonautogenous materials is demonstrated with comparisons to nongrafted, temporized historical controls.

Oral Rehabilitation of Severe Early Childhood Caries and Associated Challenges: Two Case Reports

Early Childhood Caries (ECC) is defined in the Guidelines of the American Association of Paediatric Dentists as a condition in children aged between 3-5 years where there is “The occurrence of one or more decayed (not cavitated or cavitated lesions). Teeth are missing (due to decay), or restored tooth surfaces†in any primary tooth in a child 71 months and below [1]. Also, the filled smooth surfaces in primary maxillary anterior teeth, or a decayed, missing or filled a score of >4 (age 3), >5 (age 4), or >6 (age 5) surfaces constitutes Severe-ECC. ECC is a public health problem with biological, social and behavioral diet [2]. Amongst the most prevalent chronic disease childhood is dental caries [3].Caries in very young children known as Early Childhood Caries (ECC) may be defined as at least one carious lesion affecting an anterior maxillary tooth in preschool- aged children [4]. The age for ECC is defined from 3years to 5 years where there is one or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth. A decayed, missing or filled a score of ≥4 surfaces age three-years, ≥5 tooth surfaces for age 4years or ≥6 affected tooth surfaces for age five years constitute severe-ECC [5]. In Kenya, a prevalence of 63.5% has been reported with a mean dmft of 2.95 among 3-5-yr old children and in a different study a mean dmft of 1.35 and 1.88 for 3yr-olds and five-year-olds respectively [6,7]. Milnes [5] show that carries on maxillary anterior primary dentition has the highest prevalence in Africa [4].The risk factors which have been associated with ECC the child’s low birth weight, maternal education, and duration of feeding at infancy and toddler stage, low socioeconomic status among others [3,6] .Dental caries is an infectious disease that is modified by diet. The biological mechanisms of dental caries are well established [2].

Clinical effect of orthodontic-repair combined therapy for maxillary anterior teeth dentition defect with malocclusion

Objective To investigate the clinical effect of orthodontic-repair combined therapy in the treatment of maxillary anterior teeth dentition defect and malocclusion. Methods The clinical data of 68 patients with maxillary anterior dentition defect and malocclusion were analyzed retrospectively.They were divided into control group (repair treatment) and study group (orthodontic-repair treatment) according to the different methods of treatment, 34 cases in each group.The tooth occlusal relationship, the occlusion of the anterior teeth and the arrangement of the teeth, clinical treatment effect and the treatment cost were analyzed.The satisfaction of the patients after treatment was investigated by questionnaire.The debris index and attachment loss index were detected. Results The good rate of tooth occlusal relationship, good rate of anterior teeth coverage and teeth order rate in the study group were 82.35%(28/34), 88.24%(30/34), 94.12%(32/34), respectively, which were significantly higher than those in the control group[58.82%(20/34), 67.65%(23/34), 73.53%(25/34)](χ2=4.53, 4.19, 4.53, P=0.03, 0.04, 0.03). The total effective rate of the study group was 94.12%(32/34), which was significantly higher than that of the control group[70.59%(24/34)](χ2=6.50, P=0.03). The average treatment cost of the study group was (8 124.63±386.58)yuan, which was significantly higher than (2 179.86±276.82)yuan of the control group (t=72.90, P=0.00). The patients' satisfaction of the study group was was 88.24%(30/34), which was significantly higher than that of the control group[52.94%(18/34)](χ2=10.20, P=0.00). The debris index and attachment loss index in the study group were (0.14±0.07), (5.06±1.38), respectively, which were significantly lower than those in the control group[(0.63±0.18), (6.52±1.58)](t=14.79, 14.79, P=0.00, 0.00). Conclusion Orthodontics combined with orthodontic treatment can help to improve the patients' tooth deformity, and the effect is remarkable, which can win the patients' praise, but the cost of the method is high, so patients should be considered in the selection. Key words: Tooth loss; Tooth abnormalities; Orthodontic; Repair