Anterior Maxilla Research Articles

Implant-supported single all-ceramic crowns made from prefabricated (stock) or individualized CAD/CAM zirconia abutments: A 5 year randomized clinical trial.

The aim of this randomized, prospective, and clinical multicenter study was to compare the overall clinical performance of two restorative options over a 5-year period: individualized CAD/CAM abutments veneered with a hand-layered ceramic, and prefabricated zirconium dioxide abutments veneered with press ceramic and inserted into a single edentulous gap in the anterior maxilla. Forty subjects were recruited from two universities: 20 from the University of XX and 20 from the University of XY. Each subject received an implant to restore a single edentulous gap in the maxillary anterior region (14-24 FDI). 20 patients were randomized into each Group. Group A received a one-piece single crown produced from a prefabricated zirconia abutment with pressed ceramic and Group B received an individualized CAD/CAM zirconia abutment with a hand-layered technique. After 5 years, the aesthetic and radiographic parameters were assessed. Group A had four dropouts and one failure, resulting in a 95% survival rate and 95% success rate. Group B had two dropouts and two failures which resulted in a 90% survival rate and 90% success rate. No crestal bone level changes were observed, with a mean DIB of 0.06 mm in Group A and 0.09 mm in Group B. No statistically significant differences were present at baseline, 6 months, 1 year, 3 years, or 5 years for DIB values between time points and groups. Pink aesthetic score/white aesthetic score, Peri-Implant and Crown Index, and Implant Crown Aesthetic Index values were stable over time at all five points for both groups. Both implant-supported restorative options represent a valuable treatment option for the restoration of implant crowns in the anterior maxilla. In general, the use of ceramic abutments in the anterior zone represents a valuable treatment procedure with both standardized and CAD/CAM individualized abutments and following the recommendations from the respective manufacturer(s).

Orbital Structure Involvement in Midface Fractures Impacting Ocular Injury at a Tertiary Hospital in Eastern Indonesia

ABSTRACT Introduction: The midface is a complex anatomical area consisting of several areas. Although various factors protect the eye from trauma, such as orbital rim, blink reflex, elasticity of ocular structures, and protective eye movements by hands and head, ocular injuries remain common in patients with midface fractures, with an incidence rate of up to 90.6%. This study, the first of its kind conducted in Indonesia, aims to evaluate the characteristics and incidence of ocular injuries in midface fractures and to examine the relationship between the treatment. Methods: This observational analytic study employed a retrospective cohort design, utilizing medical record data of midface fracture patients. The independent variables included age, sex, cause, incidence, segment and severity of ocular injury, number of orbital wall involvements, and treatment options. The dependent variable was midface fracture patients. The Mann–Whitney and Fisher’s exact tests were employed to analyze the multivariate data. Results: Individuals aged 32–37 were most commonly affected due to accidents, with the anterior ocular segment and maxilla bone frequently affected. There are no special factors that differentiate a person from experiencing an ocular injury in a midface fracture (P > 0.05). Ocular injuries correlated with orbital wall injury (P = 0.008) at least one discontinuity. Impaired functions included movement and visual disturbances, diplopia, and dystopia (P = 0.134). Conclusions: No significant relationship was found between age, sex, and cause of trauma with ocular injuries in patients with midface fractures. However, a significant relationship was observed between the amount of orbital rim involvement and at least one wall discontinuity occurring in midface fracture patients.

Determining the Checkpoint of Transition from Thin to Thick Periodontal Phenotypes in the Maxillary and Mandibular Anterior Regions of South Indian Population

Abstract Aim: The aim of this study was to compare and investigate the tissue thickness at the maxillary and mandibular central incisors utilizing the probe visibility method and traditional way of measuring gingival thickness (GT) by endodontic files. Methodology: In 200 selected patients, the GT was measured at both the maxillary and mandibular anterior using an endodontic file after local infiltration at the mid-distance from the gingival margin to the mucogingival junction. The checkpoint of transition from thin to thick periodontal phenotype was determined by probe visibility method in the following age groups: Group A: 21–30 years; Group B: 31–40 years; Group C: 41–50 years; and Group D: 51–60 years. Results: GT varied from 0.3 to 1.9 mm. Gingival translucency was observed up to the thickness of 0.7 mm. At 0.8 mm of GT, there was no probe visibility. Conclusion: According to the present research, the gingiva appears transparent up to a thickness of around 0.7 mm. The checkpoint of transition between thin and thick periodontal phenotypes at both the maxillary and mandibular anterior was associated with a GT of 0.8 mm.

Integrated correlation analysis of the thickness of buccal bone and gingiva of maxillary incisors.

This study aimed to validate the integrated correlation between the buccal bone and gingival thickness of the anterior maxilla, and to gain insight into the reference plane selection when measuring these two tissues before treatment with implants. Cone beam computed tomography (CBCT) and model scans of 350 human subjects were registered in the coDiagnostiX software to obtain sagittal maxillary incisor sections. The buccal bone thickness was measured at the coronal (2, 4, and 6 mm apical to the cementoenamel junction [CEJ]) and apical (0, 2, and 4 mm coronal to the apex plane) regions. The buccal gingival thickness was measured at the supra-CEJ (0, 1mm coronal to the CEJ) and sub-CEJ regions (1, 2, 4, and 6 mm apical to the CEJ). Canonical correlation analysis was performed for intergroup correlation analysis and investigation of key parameters. The mean thicknesses of the buccal bone and gingiva at different levels were 0.64~1.88 mm and 0.66~1.37 mm, respectively. There was a strong intergroup canonical correlation between the thickness of the buccal bone and that of the gingiva (r=0.837). The thickness of the buccal bone and gingiva at 2 mm apical to the CEJ are the most important indices with the highest canonical correlation coefficient and loadings. The most and least prevalent subgroups were the thin bone and thick gingiva group (accounting for 47.6%) and the thick bone and thick gingiva group (accounting for 8.6%). Within the limitations of this retrospective study, the thickness of the buccal bone is significantly correlated with that of the buccal gingiva, and the 2 mm region apical to the CEJ is a vital plane for quantifying the thickness of these two tissues.

High-Grade Chondrosarcoma of Mandibular Molar Region- A Case Report and Review of Literature

Chondrosarcomas are malignant tumors of cartilaginous origin with only 5-10% reported in the head and neck region. Intraorally it has higher incidence of occurrence in anterior maxilla followed by posterior mandible. The 5-year survival and metastases rates are adversely affected by the grade of tumor, which necessitates its early diagnosis. Histopathology and immunohistochemistry are vital for its accurate diagnosis. Chondrosarcomas being radio-and chemoresistant are treated surgically although adjuvant radiotherapy helps in prevention of local recurrences. A case of high-grade chondrosarcoma of the mandibular molar region is presented, along with pertinent review of literature.

AESTHETIC IMPROVEMENT IN ONE VISIT PERIODONTAL PLASTIC SURGERY USING SCALPEL AND LASER SURGICAL TECHNIQUE (CASE REPORT)

Introduction: A charming smile is formed from good harmonization of teeth and gums. Short teeth clinical crown, dark gingival color, diastema between the maxillary central incisors can interfere the aesthetic of the smile. This case report aims to describe the treatment of periodontal plastic surgery in form of aesthetic crown lengthening, gingival depigmentation and frenectomy to improve function and aesthetic in one visit using scalpel and laser. Case: A 23 year old male patient complained that the maxillary front teeth spaced, short and small, and the gum of the upper jaw is dark, which caused aesthetic discomfort. Objective examination showed high frenal attachment reaching the interdental papilla to palatal, diastema of the maxillary central incisors, short clinical crown and brownish maxillary gingiva. aberrant frenum labialis superior, altered passive eruption and gingival hyperpigmentation diagnoses was made in this case. Case Treatment: Aesthetic crown lengthening treatment with scalpel, gingival depigmentation using scrapping technique and frenectomy using combination of laser and scalpel surgical technique was carried out in one visit. Discussions: The advantages performing three periodontal plastic surgeries in one visit is require just once preparation of surgical materials and instruments, once surgical trauma, once prescription and less number of control visits. Conclusions and Suggestions: Treatment of crown lengthening, gingival depigmentation and frenectomy in one visit are considered effective and efficient based on time, trauma, and costs required. The periodontal plastic surgery technique can be choosing based on clinical finding on patient, patient’s needed and clinical skills of operator.

SPACE SEARCH FOR MINOR CROWDING CASES WITH EXPANSION PLATE IN PATIENTS WITH A HISTORY OF ANTIDEPRESSANT DRUG CONSUMPTION

Introduction: Gaining space in malocclusion cases using expansion plate removable orthodontic appliances. Depression is a mental health disorder that is treated with antidepressants. There is a correlation between a history of long-term antidepressant medication use and orthodontic treatment. Case: A 21-year-old female patient with a history of antidepressant medication complained of slightly advanced maxillary front teeth and crowded mandibular front teeth. Clinical examination revealed the first permanent molar relation Angle Class I modified Dewey type 2 malocclusion with malposition of individual teeth. Arch discrepancy analysis showed a space deficiency of 4 mm in the maxilla and 2.85 mm in the mandible. Case Management: The first stage used a removable orthodontic appliance for maxillary and mandibular expansion plates to obtain space deficiency. The expansion results showed that the maxillary dental arch was successfully expanded by 4.52 mm and the mandibular by 4 mm. Discussion: The slow-type expansion plate functions to expand the dental arch. Conclusion and Suggestion: Expansion plate removable orthodontic treatment effectively gains space in patients with a history of antidepressant drug use. Patients' cooperativeness in wearing the appliance influences the expansion plate removable orthodontic appliance treatment result.

Atypical Neurofibroma Masquerading an Odontogenic Cyst-A Case Report

Neurofibroma is a benign tumor characterized by perineural fibroblast proliferation. It is common in the head and neck region but rare in the oral cavity. Most of these lesions are asymptomatic but sometimes may be associated with pain and paraesthesia. Neurofibromas with atypical features are quite rare and only a few cases are reported in literature. Here is a case of a female patient presented with pain and swelling in the anterior maxilla, which was clinically diagnosed as a periapical cyst. Radiographic evaluation of the lesion revealed dilated incisive canal and a Nasopalatine duct cyst was suspected. The patient was advised to take antibiotics for one week. The symptoms were sustained in the follow-up visit and an incision biopsy was made. Microscopic examination revealed pleomorphic spindled and round cells. Immunohistochemistry was performed to identify the origin of these pleomorphic cells. Based on the histopathological examination, special staining, and immunohistochemistry, we concluded the diagnosis as neurofibroma with atypical features. The current case emphasizes the significance of clinical, radiological, histopathological, and immunohistochemical evaluation of oral lesions. The presence of atypical features in Neurofibroma must be considered cautiously as as it is more prone to progress into Malignant Peripheral Nerve Sheath Tumor (MPNST).

A multi‐centre randomized controlled trial on alveolar ridge preservation with immediate or delayed implant placement: Need for soft‐tissue augmentation

AbstractAimTo assess the impact of the timing of implant placement following alveolar ridge preservation (ARP) on the need for soft‐tissue augmentation (STA) and to identify the risk factors for horizontal and vertical soft‐tissue loss.Materials and MethodsPatients with a single failing tooth in the anterior maxilla (15–25) were treated at six centres. Following tooth extraction, they were randomly allocated to the test group (immediate implant placement, IIP) or control group (delayed implant placement, DIP). ARP was performed in both groups and implants were immediately restored with an implant‐supported provisional crown. Six months after tooth extraction and ARP, a panel of five blinded clinicians assessed the need for STA on the basis of anonymized clinical pictures and a digital surface model. Lack of buccal soft‐tissue convexity and/or mid‐facial recession qualified for STA. Pre‐operative and 6‐month digital surface models were superimposed to assess horizontal and vertical soft‐tissue changes.ResultsThirty patients were included per group (test: 20 females, 10 males, mean age 53.1; control: 15 females, 15 males, mean age 59.8). The panel deemed STA as necessary in 24.1% and 35.7% of the cases following IIP and DIP, respectively. The difference was not statistically significant (odds ratio [OR] = 1.77; 95% confidence interval [CI] [0.54–5.84]; p = .343). Loss of buccal soft‐tissue profile was higher following DIP (estimated mean ratio = 1.66; 95% CI [1.10–2.52]; p = .018), as was mid‐facial recession (mean difference [MD] = 0.47 mm; 95% CI [0.12–0.83]; p = .011). Besides DIP, regression analysis identified soft‐tissue thickness (−0.57; 95% CI [−1.14 to −0.01]; p = .045) and buccal bone dehiscence (0.17; 95% CI [0.01–0.34]; p = .045) as additional risk factors for mid‐facial recession. Surgeons found IIP significantly more difficult than DIP (visual analogue scale MD = −34.57; 95% CI [−48.79 to −20.36]; p < .001).ConclusionsThis multi‐centre randomized controlled trial failed to demonstrate a significant difference in the need for STA between IIP and DIP when judged by a panel of blinded clinicians. Based on objective soft‐tissue changes, patients with thin buccal soft tissues, with a buccal bone dehiscence and treated with a delayed approach appeared particularly prone to soft‐tissue loss.

Effects of screw channel angulation on the fracture resistance of one-piece zirconia crown with titanium base.

The design of the angulated screw channel in implant restorations allows the possibility to correct angulation discrepancies, especially in the anterior maxilla. However, the effects of varied screw channel angulations on fracture resistances and fracture patterns of the implant restorations are still uncertain, and thus the aim of this study. Angulated screw channel monolithic zirconia crowns (Nobel Biocare) with three different angulation groups-straight (ASC1), 15° (ASC15), and 25° (ASC25)-were digitally designed from a left central incisor prototype scan. Following fabrication, 10 samples of each group were individually mounted onto implant replicas embedded in standardized type V stone gypsum cylinder jigs (25mm × 25mm). All screws were manually torqued to 35 Ncm according to the manufacturer's recommendation, and screw access openings were subsequently sealed with resin composite. To mimic the off-axis loading of the central incisor, the specimens were then loaded at a cephalometric interincisal relationship of 135° between the long axis of the crown and the Instron force applicator, with crosshead speed set at 0.5mm/min. Fractured abutment surfaces were examined, and selected specimens were further evaluated by scanning electron microscopy. Screw torque values were also measured after the catastrophic loading. One-way ANOVA was used to compare load-to-fracture values between groups, with the statistical significance set at 0.05 (p values). The mean load-to-fracture values in descending order were 331.24N (±34.00N) in ASC15, 325.22N (±35.50N) in ASC25, and 302.04N (±45.10N) in ASC1, with no statistically significant differences between groups. Considerable screw torque losses were found in all groups after catastrophically loading. The average torque loss was 84% in ASC1, 86% in ASC15, and 94% in ASC25. 16 out of 30 specimens experienced screw loosening; one ASC1 screw underwent slight deformation. Crowns of all tested groups exhibited cohesive fracture patterns at the screw-metallic-zirconia interfaces. Within the limitations of this in vitro study, one-piece monolithic zirconia implant crowns with varied screw channel angulations shared similar fracture-strength and fracture-mode characteristics. The zirconia-titanium base junctions exhibited the weakest link of all restorations.

Digital PBL-CBL teaching method improves students' performance in learning complex implant cases in atrophic anterior maxilla.

The clinical teaching of esthetic implant-supported restoration of the atrophic maxilla is challenging due to the complexity and unpredictability of bone and soft tissue augmentation. The traditional problem-based learning and case-based learning method (PBL-CBL method) with a full digital workflow (digital PBL-CBL method) provides the students a chance to view clinical cases in a more accurate and measurable way. The aim is to evaluate the effectiveness of the new digital PBL-CBL method in teaching complex implant cases in esthetic area. A full digital workflow of dental implant therapy was established for patients with severely atrophic anterior maxilla. The digital data of cases done in the new workflow was used as teaching materials in digital PBL-CBL teaching. Fifty-four postgraduate students were randomly selected and divided into three groups, including traditional PBL-CBL group (students taught in a PBL-CBL method with no digital cases), digital PBL-CBL group (students taught in a PBL-CBL method with full digital cases) and control group (students taught in didactic teacher-centered method). After training for three months, a study of the students' opinions on the corresponding teaching method was carried out through a feedback questionnaire. A theory test was used to evaluate students' mastery of knowledge about tissue augmentation and esthetic implant restoration. A case analysis was used to determine whether students could apply the knowledge to problem solving. The digital PBL-CBL method resulted in a higher rate of satisfaction than the traditional PBL-CBL method and the didactic teacher-centered method in all items except for "This approach decreases extracurricular work". Case analysis scores of the digital PBL-CBL group were significantly higher than that of the traditional PBL-CBL group and the control group. For the theory test, the digital PBL-CBL group (61.00±6.80) but not traditional PBL-CBL group (55.22±9.86) obtained a significant higher score than the control group (45.11±12.76), although no significant difference was found between the digital PBL-CBL group and the traditional PBL-CBL group. Compared with other methods, students taught with the digital PBL-CBL method showed higher satisfaction and better performance in acquisition of academic knowledge and ability in solving practical clinical problems. The digital PBL-CBL method provided a promising alternative for teaching complex implant cases at the anterior maxilla.

Dental Implant Treatment Planning in the Post-Traumatic Rehabilitation of the Anterior Maxilla: A Report of Three Cases

Evidence-based algorithms guiding treatment of traumatic dentoalveolar injuries prescribe specific interventions in the presence of various sets of historical and clinical cues. However, the staging of dental implant placement in post-traumatic rehabilitation—indeed, whether to consider implant therapy at all—remains more art than science, prior authors cautioning that universal rules do not apply. The purpose of this report is to present treatment approaches applied in three traumatic episodes involving the anterior maxilla. Three patients presented to the Department of Periodontics, Army Postgraduate Dental School, Postgraduate Dental College, Fort Eisenhower, GA, USA, following traumatic injuries to the anterior maxilla with varying degrees of severity. In two cases, central incisors were replaced using immediate implants and immediate provisionalization (IIPP). At one IIPP site, extraction was delayed for eight weeks to permit healing of an alveolar fracture. In the third case, the patient received a non-implant rehabilitation due to severe alveolar destruction. Both patients receiving IIPP expressed satisfaction with immediate esthetics, and in both cases, the provisional restoration prevented extraction-related soft tissue collapse. Trauma adds an element of uncertainty to the technically demanding task of implant placement in the esthetic zone. When appropriate, IIPP in the post-traumatic rehabilitation of the anterior maxilla may mitigate some of the known biopsychosocial consequences of oral trauma and facilitate development of favorable mucosal and osseous architecture at the site. Individualized treatment planning is critically important due to wide variability in site characteristics and injury complexity.

Measuring the binary thickness of buccal bone of anterior maxilla in low-resolution cone-beam computed tomography via a bilinear convolutional neural network.

The thickness of the buccal bone of the anterior maxilla is an important aesthetic-determining factor for dental implant, which is divided into the thick (≥1 mm) and thin type (<1 mm). However, as a micro-scale structure that is evaluated through low-resolution cone-beam computed tomography (CBCT), its thickness measurement is error-prone under the circumstance of enormous patients and relatively inexperienced primary dentists. Further, the challenges of deep learning-based analysis of the binary thickness of buccal bone include the substantial real-world variance caused by pixel error, the extraction of fine-grained features, and burdensome annotations. This study built bilinear convolutional neural network (BCNN) with 2 convolutional neural network (CNN) backbones and a bilinear pooling module to predict the binary thickness of buccal bone (thick or thin) of the anterior maxilla in an end-to-end manner. The methods of 5-fold cross-validation and model ensemble were adopted at the training and testing stages. The visualization methods of Gradient Weighted Class Activation Mapping (Grad-CAM), Guided Grad-CAM, and layer-wise relevance propagation (LRP) were used for revealing the important features on which the model focused. The performance metrics and efficacy were compared between BCNN, dentists of different clinical experience (i.e., dental student, junior dentist, and senior dentist), and the fusion of BCNN and dentists to investigate the clinical feasibility of BCNN. Based on the dataset of 4,000 CBCT images from 1,000 patients (aged 36.15±13.09 years), the BCNN with visual geometry group (VGG)16 backbone achieved an accuracy of 0.870 [95% confidence interval (CI): 0.838-0.902] and an area under the receiver operating characteristic (ROC) curve (AUC) of 0.924 (95% CI: 0.896-0.948). Compared with the conventional CNNs, BCNN precisely located the buccal bone wall over irrelevant regions. The BCNN generally outperformed the expert-level dentists. The clinical diagnostic performance of the dentists was improved with the assistance of BCNN. The application of BCNN to the quantitative analysis of binary buccal bone thickness validated the model's excellent ability of subtle feature extraction and achieved expert-level performance. This work signals the potential of fine-grained image recognition networks to the precise quantitative analysis of micro-scale structures.

Esthetic reconstruction of a localized severely resorbed anterior maxilla associated with peri-implantitis: A clinical report

This clinical report described the esthetic reconstruction of a localized severely resorbed right anterior maxilla associated with peri-implantitis. For vertical bone augmentation, guided bone regeneration surgery was performed by raising a flap with the remote incision technique, followed by soft tissue grafting and vestibuloplasty. The biologically oriented preparation technique was used to improve the health and stability of the peri-implant tissues. The surgical treatment and a novel method of prosthetic rehabilitation provided excellent esthetic and functional outcomes.

Considerations for predictable outcomes in static computer- aided implant surgery in the esthetic zone.

To provide technical and clinical recommendations for implementing a digital workflow in Static Computer-Aided Implant Surgery in the anterior maxilla. An optimal 3D implant position is crucial for achieving satisfying results in implant rehabilitation in the esthetic area. Due to its complexity, implant placement in the esthetic zone should be executed with precision and predictability. Static Computer-Aided Implant Surgery requires thorough planning and detailed attention to every step of the digital workflow protocol. Implant positioning in the esthetic zone using Static Computer-Aided Implant Surgery is a technique-sensitive procedure that requires precise execution of each step. This approach ensures accurate prosthetically driven 3D implant placement and prevents potential errors that could lead to inaccurate positioning. The proper implementation of Static Computer-Aided Implant Surgery may increase the level of agreement between the planned and definitive implant 3D positions in the esthetic zone, thus enhancing the esthetic outcomes of implant rehabilitation.

Malignant Melanoma of the jaw and oral mucosa - A rare diagnosis to consider when assessing high-grade tumors on small biopsies

Abstract Introduction/Objective Malignant melanoma arises from neural crest-derived cells called melanocytes. These melanocytes migrate to several sites, including the skin and the mucous membranes. Oral melanoma (OM) cases account for &amp;lt;1% of all melanoma cases and &amp;lt;2% of all oral malignancies. Primary malignant melanoma of the jaw is an even rarer entity. Most OM cases arise in the palate and the maxillary alveolar gingivae. Other sites, such as mandibular gingiva and buccal mucosa, are rarely involved. The etiopathogenesis remains unclear, with stimulation of melanoblasts being one of the proposed hypotheses. The incidence is highest in the fifth and sixth decades of life and occurs more commonly in males than females. Clinically, it remains an asymptomatic pigmented growth until it reaches advanced stages. Diagnosis in advanced stages leads to OM having an overall survival (OS) rate of just 15.4% at 10 years with an abysmal prognosis. These neoplasms are highly invasive and metastasize quickly. Of mutations, KIT (14.6%), BRAF (7%) and NRAS (5.6%) were the most frequently encountered in OM cases. Methods/Case Report We searched for “oral melanoma” in our healthcare system for the last 10 years- from 2013 to 2022. 4 cases were selected for this case series, and pertinent information was pulled from CoPath and Epic software. The cases were then analyzed, and the results were reported. Results (if a Case Study enter NA) In our case series, we found the mean age to be 78.5 years, with 75% (3 of 4) of the patients being male and the rest 25% (1 of 4) female. Three cases were diagnosed with melanoma or malignant melanoma, while the 4th case had atypical melanocytic proliferation favoring malignant melanoma as the diagnosis. Regarding the tumour site, 1 case arose in the right anterior maxilla, 2 cases involved the mandible (left mandible and right anterior mandibular vestibule, respectively), and 1 case was present in the buccal mucosa. Microscopic findings and immunohistochemistry results concurred with the diagnoses. Conclusion Herein, we present 3 cases (out of the 4) from rarer sites, such as the mandible and oral mucosa, as opposed to the typical sites- the palate and the maxilla. Discussing rarer cases helps physicians to keep these in the differential while examining similar tumors. Additionally, having rarer cases adds to the literature and focuses attention on entities that require more study and research. Since these neoplasms are highly invasive and metastasize quickly, they necessitate an early diagnosis for effective management.

Three-dimensional analysis of the alveolar ridge profiles of maxillary central incisors in children for autotransplantation

BackgroundSufficient alveolar housing is fundamental to ensure the favorable prognosis of autotransplanted teeth. However, little is known about the alveolar ridge profiles of the anterior maxilla in children. Therefore, this study aimed to investigate the alveolar ridge profiles of the anterior maxilla in growing children. MethodsA total of 169 Korean children aged 10–13 years old were included in this retrospective study. Demographic data and cone-beam computed tomography scans of 244 maxillary central incisors were collected. For each tooth, the alveolar ridge thickness was determined at 1-, 3-, and 5-mm levels below the cemento-enamel junction. The alveolar process height and labial concavity were also evaluated. Statistical analyses were performed to evaluate differences according to age and sex. ResultsThe alveolar ridge thickness did not differ according to age. The alveolar ridge thickness in males was significantly greater than that in females among those aged 10 and 11 years. The average alveolar process height was 17.43 ± 2.22 mm. The alveolar process height hardly changed with age from 10–13 years, whereas the alveolar process height of males was significantly greater compared with that of females among those aged 10 years. The labial concavity was approximately 150˚, with no significant differences between age and sex. ConclusionsWithin the limits of this study, the anatomy of the alveolar ridge in the maxillary central incisors showed sufficient capacity as a recipient site for autotransplantation using mandibular premolars, especially in males. These findings serve as a valuable resource for facilitating autotransplantation in children.

Fixed Dental Prostheses on Six Zirconia Implants for an Anterior Maxillary Rehabilitation: Case Report with 10-Year Follow-up.

This article reports a case of maxillary rehabilitation with implant-supported fixed dental prostheses on six zirconia implants. A woman with impacted maxillary canines attended our dental clinic seeking a metal-free maxillary restoration. After the extraction of both impacted maxillary canines and the placement of autogenous bone graft, six two-piece zirconia implants with straight abutments were placed in the anterior maxilla. Two zirconia fixed dental prostheses with porcelain veneering, separated at the midline, were placed on these zirconia implants. The 10-year follow-up monitored the adequate evolution of both implants and restorations with no signs of peri-implant disease.

A retrospective analysis of the patient journey for children with an unerupted maxillary central incisor.

Maxillary central incisors (MCI) are the third most impacted teeth. Timely multidisciplinary management is indicated as unerupted incisors can cause functional- and appearance-related distress. To assess the patient journey for children with unerupted MCI, including referral, clinical assessment, surgical management and follow-up treatment, and highlight areas for improvement, as well as identify factors impacting orthodontic treatment burden (OTB). A retrospective service evaluation of children aged 6-16 years who had surgical management of unerupted MCI under general anaesthetic (GA) between 2018 and 2021. Fifty-two children with 62 unerupted MCI were identified. Mean age at referral was 8.8 years. Most children (82.7%) had supernumerary teeth in the anterior maxilla. Mean time between listing for GA and surgery increased from 4.3 to 15.2 months following the COVID-19 lockdown. Mean age at surgery was 10.4 years. Supernumerary removal and incisor exposure and bond was the most common treatment (56.6%). Most patients required hospital orthodontic treatment post-surgery (65.4%). Most children referred were below 9 years (60.1%); these children had reduced OTB compared to those who had been referred at an older age. Stage of root development was also a significant predictor in OTB. An unexpected finding was that conical supernumeraries were found to prevent MCI eruption.

Guided immediate implant with and without using a mixture of autogenous and xeno bone grafts in the dental esthetic zone. A randomized clinical trial

PurposeThis in vivo study aims to assess the pink esthetic score in the anterior maxilla after computer-guided immediate implant installation and fully digital immediate temporalization with and without grafting the jumping gap with a mixture of 1:1 autogenous and xenograft particulates.Materials and methodsTwenty-four patients with non-restorable upper anterior teeth in the aesthetic zone have undergone a traumatic extraction for the non-restorable tooth followed by immediate implant placement using a 3D-printed surgical guide according to prosthetically driven implant placement. The patients were divided into two groups. The study group received the dental implant after grafting the jumping gap with 1:1 autogenous and xenograft particulates, while the control group received the dental implant without grafting the jumping gap. Each patient received a digitally fabricated, immediate, nonfunctional temporary prosthesis. The esthetic outcome was compared between the two groups using the pink esthetic score at implant insertion and after 6 months of follow-up. Statistical comparisons were carried out between the studied groups using the Mann-Whitney U test.ResultsImmediately postoperatively, there was no statistically significant difference between the median PES in the two groups (P-value = 0.746). After six months, the study group showed a statistically significantly higher median PES than the control group (P-value = 0.048).ConclusionsGrafting the jumping distance in the immediate implant protocol helps achieve a better esthetic outcome.Clinical relevanceThe use of immediate guided implant placement along with grafting the jumping gap followed by immediate digital temporalization guarantees a better esthetic outcome while preserving time, cost, and the number of clinical visits.Trial registrationThe study was registered on clinicaltrials.gov with registration number NCT04096209. (19/9/2019)