Maxillary Centrals Research Articles

Esthetic rehabilitation of diastema between hypomineralised asymmetric maxillary centrals

Esthetic rehabilitation of diastema between hypomineralised asymmetric maxillary centrals

Staged Extractions and Implant Placement for Maxillary Central Incisors: A Case Report

A patient sought treatment at a prosthodontics practice to replace mobile maxillary centrals and exposed defective veneer margins on the maxillary laterals. Staged extractions and immediate implant placement were offered as the treatment option to preserve the hard and soft tissue around the implants and maximize the esthetic outcome. Staged extraction of adjacent teeth and immediate implant placement was performed to the maxillary central incisors. After osseointegration, custom impression copings were made to capture the gingival contours. The implants were restored with implant retained ceramic crowns and the maxillary laterals were restored with ceramic veneers. Although treatment time is lengthened staged extraction of adjacent anterior teeth and immediate implant placement can provide a predictable and successful treatment option to manage soft tissues and achieve a highly esthetic outcome. Keywords: Implants; Esthetics; Immediate Implants; Immediate Provisionals; Staged Extractions; Prosthetic Dentistry

Mandibular autorotation revisited: A retrospective study of accuracy and stability of maxillary impaction in retrognathic patients with condylar osteoarthritis

The aim of this retrospective study was to evaluate the accuracy of maxillary positioning with mandibular autorotation using the straight locking miniplate (SLM) technique and computer-aided design/computer-aided manufacturing (CAD/CAM) wafers on postoperative stability in patients with skeletal class II malocclusion and condylar osteoarthritis. Cephalometric analysis of the maxillary position and MA center (ARC) before (T0), 3 days (T1), 3 months (T2), and 1 year (T3) after surgery was performed. Analysis of 21 patients revealed a mean movement of −2.0 ± 2.2 mm (x-axis) and 5.4 ± 2.4 mm (y-axis) at U1 and of −1.5 ± 2.4 mm (x-axis) and 4.9 ± 1.6 mm (y-axis) at U7. The SNA, SNB, ANB, and SN-MP angles and ramus inclination at T0 were significantly different from those at T1, T2, and T3. The distance from the ARC to the Co of T2 and T3 was significantly smaller than that of T1 on the x-axis, indicating that the ARC converged horizontally to Co. There was no significant difference in the amount of rotation at any time point. Accurate maxillary positioning with mandibular autorotation using SLM and CAD/CAM wafers may correct the unstable rotation axis of the mandible and prevent early postoperative relapse.

Factors affecting the maxillary and mandibular incisors’ buccolingual inclinations and buccal and lingual cortical plate heights

IntroductionOrthodontics is closely related to periodontics. The buccolingual inclination (BLI) of the incisors and deficiencies in their buccal (BHd) and lingual (LHd) cortical plate heights may affect orthodontic outcomes. Identifying risk factors that can compromise buccal or lingual bone heights may have clinical value. The literature on BLI/BHd/LHd is not only scarce but also limited to one jaw. We aimed to examine, for the first time, factors affecting BLI/BHd/LHd not evaluated before as well as other factors with scarce literature about them.MethodsIn this two-phase epidemiological and analytical study, inclinations and cortical heights of 248 incisors (bilateral centrals and laterals) were evaluated blindly on 62 randomly selected high-resolution pretreatment cone-beam computed tomography volumes (30 maxillae [13 men, 17 women], 32 mandibles [13 men, 19 women]). The sample was balanced in terms of sexes, jaws, and ages. The BLI/BHd/LHd of bilateral incisors were measured (intraobserver agreement > 95%). The effects of jaws, sexes, age, sides, and incisor types on each of the anatomical variables (BLI/BHd/LHd) were analyzed using a Mixed-Model Multiple Linear Regression analysis. Correlations among continuous variables were assessed using a Pearson coefficient (α = 0.05).ResultsFor the maxillary centrals, BLI, BHd, and LHd were 106.79 ± 5.06, 1.94 ± 0.95, and 1.50 ± 0.76, respectively. These parameters were ‘110.56 ± 5.97, 1.81 ± 0.83, 1.23 ± 0.69’ for the maxillary laterals; ‘97.64 ± 8.26, 2.98 ± 1.48, 3.46 ± 1.45’ for the mandibular centrals; and ‘95.98 ± 6.80, 3.29 ± 1.72, and 2.73 ± 1.15’ for the mandibular laterals. BLI was greater in the maxilla compared to the mandible and in the lateral incisors compared to centrals (P < 0.05). BHd was greater (more deficient) in the mandible (P = 0.000). Age, sex, or side were not associated with BLI (P > 0.05). Age, sex, side, or incisor types were not associated with BHd (P > 0.05). LHd was greater in the mandible, older individuals, and centrals (P < 0.05). There were some significant but weak correlations between BLI with BHd and especially LHd (P < 0.05).ConclusionIn the maxilla, but not in the mandible, incisors’ BLI may determine LHd. Maxillary incisors may have greater BLIs as well as greater buccal and lingual alveolar bone heights compared to mandibular incisors. BLI might be greater in the laterals compared to the centrals in both jaws combined.

Antrochoanal polyp among children: A review

Abstract Antrochoanal polyp (ACP) or Killian polyp originates from the inflamed and edematous mucosa of the maxillary sinus. The etiopathogenesis of the ACPs is not clear. It has two components such as antral one which is always cystic and the nasal part is solid. The expanded intramural cyst enlarges to the point that it completely occupies the maxillary sinus, emerging through the natural ostium into the nasal cavity and extending towards the choana. The common clinical presentations are nasal obstruction and nasal discharge. Diagnostic nasal endoscopy, computed tomography (CT) scan, and magnetic resonance imaging (MRI)are needed for making the diagnosis and the treatment planning. Surgery is indicated for the treatment of ACP. The endoscopic technique consists of an uncinectomy and resection of the polyp and its attachment to the maxillary sinus via a wide middle meatal antrostomy. Endoscopic sinus surgery via middle meatal antrostomy combined with trans-canine sinuscopy ensures the complete removal of the antral part of the ACP in children. The use of a microdebrider through the canine fossa is helpful to resect a broad attachment of the ACP in the maxillary sinus and it may be indicated as complementary to endoscopic sinus surgery. Simple avulsion of the ACP has a high chance of recurrence, whereas the Caldwell Luc procedure is associated with damage to the maxillary and dental growth centers. More research is needed for establishing the exact etiopathology and newer treatment options for ACPs.

Premaxillary Setback in Bilateral Cleft Lip and Palate Repair

It is widely established in the literature that patients with cleft lip and palate (CLP) often display midface dysmorphism. However, there is ongoing debate as to the pathophysiology behind the deficient maxillary growth that leads to this deformity. While some argue that it is a result of hypoplastic tissues inherent to the cleft phenotype, others postulate that it is due to surgical disruption of the maxillary growth centers and postoperative scarring1,2. Bilateral alveolar clefts may render a protruding premaxilla, distorting the soft tissue envelope.

Estrogen deficiency during puberty affects the expression of microRNA30a and microRNA503 in the mandibular condyle

BackgroundThe aim of this study was investigated if estrogen deficiency during puberty affects the expression of miRNA30a and miRNA503 in maxillary and mandibular growth centers, and also evaluated if ERα and ERβ are correlated with miRNA30a and miRNA503 expressions. MethodsSamples from 12 female Wistar rats randomized into experimental group (OVX) and control group (SHAM). At an age of 45 days animals were euthanized for miRNA expression analyses. RT-qPCR was performed to determine miRNA30a and miRNA503 expression in growth sites: midpalatal suture, condyle, mandibular angle, symphysis/parasymphysis and coronoid process. The data was carried out using the parametric tests at 5% of significance level. ResultsmiRNA 30a and miRNA503 presented higher levels in the condylar site in SHAM group when compared with OVX (p = 0.002 and p = 0.020, respectively). In the growth centers, a statistical significant difference was observed only for miRNA30a (p = 0.004), when compared mandibular angle with condyle the in OVX group (p = 0.001). A strong positive correlation between miRNA503 and ERα in the condyle of OVX group was observed (r = 0.90; p = 0.039 and it also between miRNA503 and ERβ in the coronoid process of the OVX group (r = 0.88; p = 0.05). ConclusionThe results suggested that estrogen regulates specific miRNAs in maxillary and mandibular growth centers, which may participate in posttranscriptional regulation of estrogen-regulated genes.

Midface Growth Potential in Unoperated Clefts: A Systematic Review and Meta-Analysis.

Competing hypotheses for the development of midface hypoplasia in patients with cleft lip and palate include both theories of an intrinsic restricted growth potential of the midface and extrinsic surgical disruption of maxillary growth centers and scar growth restriction secondary to palatoplasty. The following meta-analysis aims to better understand the intrinsic growth potential of the midface in a patient with cleft lip and palate unaffected by surgical correction. A systematic review of studies reporting cephalometric measurements in patients with unoperated and operated unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and isolated cleft palate (iCP) abstracted SNA and ANB angles, age at cephalometric analysis, syndromic diagnosis, and patient demographics. Age and Region-matched controls without cleft palate were used for comparison. SNA angle for unoperated UCLP (84.5 ± 4.0°), BCLP (85.3 ± 2.8°), and ICP (79.2 ± 4.2°) were statistically different than controls (82.4 ± 3.5°), (all P ≤ 0.001). SNA angles for operated UCLP (76.2 ± 4.2°), BCLP (79.8 ± 3.6°), and ICP (79.0 ± 4.3°) groups were statistically smaller than controls (all P ≤ 0.001). SNA angle in unoperated ICP (n = 143) was equivalent to operated ICP patients (79.2 ± 4.2° versus 79.0 ± 4.3° P = 0.78). No unoperated group mean SNA met criteria for midface hypoplasia (SNA < 80). Unoperated UCLP/BLCP exhibit a more robust growth potential of the maxilla, whereas operated patients demonstrate stunted growth compared to normal phenotype. Unoperated ICP demonstrates restricted growth in both operated and unoperated patients. As such, patients with UCLP/BCLP differ from patients with ICP and the factors affecting midface growth may differ.Level of Evidence: IV.

ESTIMATION OF VERTICAL DISTANCE OF INCISIVE PAPILLA WITH MAXILLARY CENTRAL INCISOR AND THEIR CORRELATION IN VARIOUS ARCH FORM

Background: The relation of incisive papilla to the incisal edges of the maxillary central incisors in a vertical dimension could serve as a guide for inciso-cervical placement of anterior teeth in denture base according to the arch form of the edentulous patient. The aim of this study was to determine the vertical distance between incisive papilla and maxillary central incisor in different arch form. Methods: A cross-sectional study was conducted among 100 dentulous subjects. The vertical distance between the incisal edges of maxillary central incisor and center of incisive papilla was measured by a digital caliper on casts obtained from dentate subjects meeting inclusion criteria after which statistical analysis of data using SPSS v26 version. Results: The mean vertical distance between maxillary central incisor and incisive papilla were 5.97±1.03mm in ovoid, 6.09±0.98mm in square and 6.23±0.89mm in taper arch form. Conclusions: The result obtained in this study can be used as a clinical guideline for the fabrication of maxillary occlusal rim and may aid in determining the position of occlusal plane along with the reference of other anatomical landmarks.

Accuracy of periapical and panoramic radiography for detection of root morphologies: a comparative study.

Maxillary and mandibular incisors have increased risk for severe orthodontically induced inflammatory root resorption. A patient-related risk factor is aberrant root morphology. This study aimed to assess the frequency of detection of different root morphologies in anterior teeth using dental panoramic tomography (DPT) and long cone periapical radiographs (LCPAs). A retrospective cross-sectional design was used to assess a sample of 50 consecutive pre-treatment radiographic records of patients from a specialist orthodontic practice in Adelaide, Australia. A reference guide was developed that included three previously unreported morphologies: pipette and bent, bent and pointed, bent and blunt. Two trained and calibrated assessors examined each record against the inclusion criteria, then independently assessed each anterior tooth from DPTs and LCPAs to detect the type of root morphology present. Data were analysed using the chi-square statistical test. Radiographic records for 48 patients (48 DPTs and 161 LCPAs) were eligible, with 355 and 426 teeth on DPTs and LCPAs, respectively, included for assessment. Normal root morphology (119 teeth) was commonly observed in DPTs, while bent (154 teeth) was frequently observed using LCPAs. Mandibular incisors often had normal morphology in DPTs but bent in LCPAs. Bent was the most common morphology in maxillary lateral incisors using DPT and LCPAs, although maxillary centrals were mostly normal in DPTs but pointed in LCPAs. Differences using the two image acquisition methods were highly significant (p < 0.01). Aberrant root morphologies are more easily detected in anterior teeth using LCPAs compared to DPTs.

Cephalometric Evaluation of Maxillary and Mandibular Centers of Rotation Subsequent to Maxillary and Mandibular Surgery

Background: Due to significant effect of joint orthodontic and surgical treatment planning on the patients’ facial appearances, precise prediction of surgical outcomes is of great importance. Objectives: The aim of this study was to determine the maxillary and mandibular centers of rotation and its distance to center of condyle (CC) in patients who underwent maxillary impaction surgery concomitant with mandibular advancement or setback surgery and also to determine the correlation between maxillary center of rotation (MxCR) with that of mandible (MnCR) and also the direction of rotation in distal and proximal segments of the mandible. Methods: Preoperative and postoperative lateral cephalograms of 24 adult non-syndromic patients were studied. Using cephalometric tracings MxCR was located as the intersection of ANS-PNS (preoperative) and ANS’-PNS’ (postoperative) lines. MnCR was located using Reuleaux method, where perpendicular bisectors of B-B’ and Go-Go’ lines meet. Using statistical analysis of correlation and comparison, all the points’ coordinates and centers of rotation were compared. Results: The average distance of MnCR to CC was 10.45 cm and the average distance of MxCR to CC was 8.39 cm. MxCR and MnCR had positive correlation in horizontal plane and they had negative correlation in vertical plane but the correlation was insignificant (P &gt; 0.05). In addition, there seemed to be no specific pattern in the direction of mandibular proximal and distal segments’ rotations. Conclusions: The results showed that: (1) The center of rotation calculated for mandible after bimaxillary surgery was not located within the condylar area. But generally whenever MxCR was closer to ANS, MnCR was located more anteriorly. (2) In patients with decreased distance between MxCR and SN line, MnCR would be located more superiorly. Also, whenever MxCR had greater distance from condyle, the MnCR to condyle distance was greater too. (3) The direction of rotation in proximal and distal segments of mandible had no specific pattern.

Effects of transverse bodily movements of maxillary premolars on the surrounding hard tissue

This experimental study was designed to (1) produce buccal translation of maxillary premolars and (2) evaluate the effects on the buccal alveolar bone. A randomized split-mouth study was designed based on 7 adult male beagle dogs. The experimental side received a custom cantilever appliance fabricated to produce a translatory force through the maxillary second premolar's center of resistance. The contralateral second premolar received no appliance and served as the control. The premolars underwent 6-7weeks of buccal translation, followed by 3weeks of fixed retention. Biweekly tooth movements were evaluated using intraoral and radiographic measurements. Pretreatment and posttreatment models were measured to assess tipping. Three-dimensional microscopic tomography was used to quantify the amount and density of buccal bone. Bone formation and turnover were assessed using fluorescent labeling, hematoxylin and eosin staining, tartrate-resistant acid phosphatase staining, and bone sialoprotein immunostaining. The applied force (100g of force) translated (1.4mm) and minimally tipped (4°) the experimental teeth. Lateral translation produced dehiscences at the mesial and distal roots, with 2.0mm and 2.2mm loss of vertical bone height, respectively. Bone thickness decreased significantly (P<0.05) at the apical (∼0.4mm), midroot (∼0.4mm), and coronal (∼0.2mm) levels. Fluorescent imaging, hematoxylin and eosin staining, and immunostaining for bone sialoprotein all showed new bone formation extending along the entire periosteal surface of the second premolar's buccal plate. Tartrate-resistant acid phosphatase staining demonstrated greater osteoclastic activity on the experimental than that of control sections. New buccal bone forms on the periosteal surface during and after tooth translation, but the amount of bone that forms is less than the amount of bone loss, resulting in a net decrease in buccal bone thickness and a loss of crestal bone.

Effect of preheating and ultrasonic energy on penetration of low viscosity enamel resin infiltrant

Objectives: to determine the depth of resin infiltrated hybrid enamel after application of TTEMA/TEGDMA resin infiltration agent enriched with nano-hydroxy apatite applied on early carious enamel lesions.Materials and Methods: Sound maxillary centrals were coated with a nail varnish, leaving a window of 4 mm × 4 mm on buccal surface of sound and intact enamel. All specimens were subsequently immersed in a demineralizing solution to produce artificial enamel lesions then etched with a mixture of 2% chlorhexidine and 10% hydrochloric acid. After washing and drying the enamel was coated with a low viscosity TTEMA/TEGDMA resin infiltration agent followed by light polymerization. The effect of addition of 10% nano-hydroxy apatite, preheating at 45oC, and ultrasonic activation was tested in separate groups. Sectioned specimens were examined under a stereomicroscope equipped with a high-resolution digital camera for determining of the depth of penetration of the low viscosity resin in microns (α=0.05).Results: Data analysis revealed significant difference in depth of enamel hybrid layer between the tested groups (F=14.2, P<0.001). Average penetration depth was 185 ± 17 µm for TTEMA/TEGDMA resin infiltration agent. Addition of 10% nano-hydroxy apatite reduced penetration depth to 141± 19 µm. On the contrary, preheating and ultrasonic activation increased penetration depth to 211± 13 µm and 221 ± 12 µm respectively.Conclusions: Within the limitations of this study, the penetration depth of TTEMA/TEGDMA resin infiltration agent was significantly influenced by addition of nano-hydroxy apatite particles. Preheating and ultrasonic activation increased penetration depth significantly.

Apical root resorption in patients treated with en-masse retraction using skeletal anchorage system versus conventional method

Purpose: To compare external apical root resorption EARR in orthodontic patients treated with en-masse retraction with skeletal anchorage (miniscrews) versus two step procedures. Patients and methods: Forty patients were randomly divided into two equal groups. Group I consisted of 20 patients were treated by using mini-screw anchorage and en-masse retraction, while, group II, 20 patients were treated with two-step retraction and conventional methods of anchorage reinforcement. Lateral cephalometric and digital panoramic radiographs were used to evaluate treatment changes just before (T1) and immediately after (T2) retraction of the maxillary anterior teeth. Results: A significant positive correlation between age and root resorption. Shorter treatment duration was needed in group I with insignificant difference between both groups. Significant root resorption in maxillary central, lateral incisors, canines and first molars was found in both groups just after retraction. A significant root resorption was found for maxillary centrals and first molars in mini-implant group compared to conventional anchorage group. Upper first molars were intruded (-1.8 mm, P=0.041) in mini-implant group with no significant distalization (P=0.016) compared to conventional anchorage group. Upper incisors were significantly retracted (-7.8mm, P=0.001) and intruded (-2.3mm, P=0.017) in comparison to other group. Conclusion: Skeletal anchorage system tends to permit more root resorption than conventional anchorage procedure. A significant retraction and intrusion of maxillary incisors, and a significant intrusion and lack of distalization of maxillary first molars by using skeletal anchorage system during en-masse retraction was found when compared with conventional anchorage procedure.

Effect of Dental Treatment on the Quality of Life of Children with Traumatic Dental Injuries in Ibadan, Nigeria.

Background:Anterior dental trauma is known to be common in our environment as well as the complications that come with it. These injuries have been seen to impact the quality of life (QoL) of children significantly due to the fact that they compromise their dental health. This leads to aesthetic, psychological, social, and therapeutic problems impacting both the children and their parents. Treatment of these injuries has also been severely neglected possibly due to lack of awareness of where or how to access treatment as well as fear of dental treatment. However, treatment may on the other hand bring about a substantial improvement on the QoL of children in terms of their daily living.Aim:To assess the effect of dental treatment on the QoL of 12- to 15-year-old Nigerian school children previously identified as having had traumatized anterior teeth.Design:This is a follow-up study where secondary data were extracted from a cross-sectional study involving 1575 children attending public and private secondary schools in Ibadan, Nigeria. One hundred and ninety-six adolescents with evidence of dental trauma, previously identified as having their QoL negatively affected as a result of dental trauma, were called to take part in the follow-up study. The Child Perception Questionnaire (CPQ11-14) was used in assessing the QoL of participants with dental trauma before and after treatment. Data were analysed using the IBM® SPSS® Statistics version 20.0, and the effect of dental treatment on the QoL of the participants was assessed using the McNemar's test. Statistical significance was set at P < 0.05.Results:Fifty-one (26.0%) out of the 196 invited children participated; there were 31 males and 20 females. The mean age was 13.4 years (standard deviation 1.1 years). Eighty traumatized anterior teeth were involved, with the maxillary centrals being the commonest (68, 85%). Twenty-three (45.1%) participants had more than one traumatized tooth. The commonest dental trauma was enamel fracture, which involved the dentine (39, 48.8%). The main treatments given were composite build-up (36, 45%) and root canal treatment (42, 52.5%). With the CPQ11-14, in the oral symptoms domain, the number adversely affected before treatment fell from 30 (58.8%) to 3 (5.9%) (P < 0.001); in the emotional well-being domain, the number dropped from 35 (68.6%) to 10 (19.6%) (P < 0.001); and in the social well-being domain, the number fell from 34 (66.7%) to 22 (43.1%) (P = 0.004). However, in the functional limitation domain, the number adversely affected increased from 24 (47.1%) before to 46 (90.2%) after treatment (P < 0.001).Conclusion:Treatment resulted in a significant improvement in the QoL of participants, especially regarding their oral symptoms, and emotional and social well-being. However, there was worsening in the functional limitation domain. There is the need to introduce oral health into the school curriculum in order to encourage early reporting and prompt treatment of traumatic dental injuries.

Changes in root and alveolar bone before and after treatment by retracting the upper incisors

Using cone beam computed tomography (CBCT) in image measurement on the patients with maxillary protrusion, the study aims to identify the changes in root and alveolar bone before and after treatment by upper incisor retraction. The study was conducted on 37 patients who have received orthodontic treatment from January 2014 to December 2015. The sample comprised 17 males and 20 females, with an average age of 14.5 years. The patients underwent extraction of bimaxillary premolars and given maximum anchorage to retract the upper incisors. The adducent angle, adducent amount, and the amount of elongation of the upper incisor teeth were measured by cephalograms. The patients were scanned by NewTom VGi to obtain CBCT data before and after treatment with upper incisor retraction. Using the NewTom NNT tool, we obtained the multiple planar reconstruction and then adjusted the coronal, axial, and sagittal axis. The sagittal section of the long axis of the maxillary central incisor through the incisal edge and root apex was selected to measure the changes in the root and alveolar bone before and after incisional treatment. Before and after retracting the upper incisors, the adducent angle of central incisor measured 12.92°±6.43°. Adducent amount of the incisors reached (5.54±2.21) mm. Incisor extension amount totaled (0.60±0.95) mm. Root absorption length was (0.81±0.46) mm. Root absorption rate was 6.80%±3.60%. Statistical differences were observed in the changes in root length before and after incisor retraction (P<0.05). After upper incisor retraction, increasing distance from the labial side alveolar ridge to the cemento-enamel junction reached (0.20±0.22) mm. After treatment, we observed that the height of the labial-side alveolar bones decreased and showed statistical difference with the height of labialside alveolar bones before treatment (P<0.05). The results show the correlation between root absorption and horizontal displacement of maxillary center incisor and the distance from the upper incisor apex to labial cortical bone. A correlation also exists between the variable quantity of the labial-side alveolar bones and adducent angle of the upper incisor, with a correlation coefficient of 0.354. The results also show significant difference (P<0.05). After compensatory treatment of patients with maxillary protrusion, the root length of upper incisor was absorbed remarkably. The height of the labial-side alveolar bones was reduced. A greater tooth movement or beyond the anatomical limitations and alteration limits of the alveolar bone can easily lead to root resorption. A negative correlation exists between the variable quantity of the labialside alveolar bones and adducent angle of the upper incisor.

Fracture strengths of endocrown restorations fabricated with different preparation depths and CAD/CAM materials.

The objectives of this study were to compare the fracture strength of endocrown restorations fabricated with different preparation depth and various CAD/CAM ceramics, and to assess the fracture types. Endodontically treated 100 extracted human permanent maxillary centrals were divided into two preparation depth groups as short (S: 3-mm-deep) and long (L: 6-mm-deep), then five ceramic subgroups, namely: feldspathic-ceramic (Vita Mark II-VM2), lithium-disilicate glass-ceramic (IPS e.max CAD-E.max), resin-ceramic (LAVA Ultimate-LU), polymer infiltrated ceramic (Vita Enamic-VE) and monoblock zirconia (inCoris TZI-TZI) (n=10/subgroup). The endocrowns were fabricated by CAD/CAM and were cemented with resin cement (RelyX U200). The teeth were thermally cycled (5,000cycles) and fracture tests were performed at 45º angle to the teeth. The data were statistically analyzed (Kruskal-Wallis, Mann Whitney U), failure modes were evaluated with stereomicroscopy. Zirconia group provided the statistically highest fracture strength, but also exhibited non-repairable failures. Preparation depth has an effect on the fracture strength only for feldspathic ceramic.

Blood flow oxygen saturation of the dental pulp for prediction of revascularization after maxillary osteotomies

Introduction Pulse oximetry is a noninvasive method used in clinical medicine to record blood oxygen saturation levels during the administration of intravenous anesthetic agents, and it has recently been used to assess dental pulp vitality with the same objective. Objective Recording the approximate timing of revascularization of maxillary osteotomies and its impact on the healing process through measuring the dental blood flow oxygen saturation level using pulse oximetry. Patients and methods This research was carried out on eight patients collected from the outpatient clinic of Oral and Maxillofacial Surgery Department. All patients were complaining of dentofacial deformities; the maxilla was included in their surgical correction either using Le Fort I osteotomy or anterior maxillary osteotomy. In all patients, the pulpal blood flow of maxillary centrals and canines was evaluated using NellcorOximax sensor (pulse oximeter) and were compared with the reading of the index finger. The collected data were recorded and statistically analyzed. Results The mean values of the oxygen saturation levels started to be increased gradually from the third week till reaching the normal values at the sixth week without significant differences between dental pulps and the index fingers. Conclusion Pulse oximeter is a valuable, simple, noninvasive, and inexpensive tool that could be used clinically to accurately measure the oxygen saturation level of the dental pulp, and thus provides a great help in clinical evaluation of the revascularization process across the osteotomized bony segments. Accordingly, we recommend its routine use in similar situations.

Simulating Natural Dental Outlook in Esthetic Dentistry: A Case Report

Aesthetic dentistry is concerned not only with the dental appearance but also the enhancement of a person's smile. Creating a natural dental outcome harmonious with adjacent teeth is the main aim of aesthetic dentistry. A good observation, knowledge of dental anatomy and dental materials are required for this. Today's cosmetic dental treatments are more durable and predictable than before with the technological advancements in natural-looking, tooth-colored dental materials. Additionally, more conservative techniques are being used in order to mimic natural dental tissues, depending upon patients’ specific clinical situation. These kind of procedures can be held in a single visit by using aesthetic dental resins mostly without any preparations. This makes direct aesthetic dental rehabilitations such as smile designs more comfortable and convenient for the patients. In this case report a patient with dental aesthetic problems due to crown fractures on maxillary centrals, treated with direct aesthetic composite resin restorations in one appointment. In one-year recall, no discolorations, fractures, secondary caries or soft tissue pathologies were detected and the restorations were almost undetectable resulting in an aesthetic outlook. In conclusion it is considered that natural looking, functional, tooth-colored, seamless, long lasting and aesthetic restorations can be created by using direct aesthetic composite resins that may satisfy the patients’ demands.

Simulating Natural Dental Outlook in Esthetic Dentistry: A Case Report

Aesthetic dentistry is concerned not only with the dental appearance but also the enhancement of a person’s smile. Creating a natural dental outcome harmonious with adjacent teeth is the main aim of aesthetic dentistry. A good observation, knowledge of dental anatomy and dental materials are required for this. Today’s cosmetic dental treatments are more durable and predictable than before with the technological advancements in natural-looking, tooth-colored dental materials. Additionally, more conservative techniques are being used in order to mimic natural dental tissues, depending upon patients’ specific clinical situation. These kinds of procedures can be held in a single visit by using aesthetic dental resins mostly without any preparations. This makes direct aesthetic dental rehabilitations such as smile designs more comfortable and convenient for the patients. In this case reporta patient with dental aesthetic problems due to crown fractures on maxillary centrals, treated with direct aesthetic composite resin restorations in one appointment.In one-year recall, no discolorations, fractures, secondary caries or soft tissue pathologies were detected and the restorations were almost undetectable resulting in an aesthetic outlook. In conclusionit is considered that natural looking, functional, tooth-colored, seamless, long lasting and aesthetic restorations can be created by using direct aesthetic composite resinsthat may satisfy the patients’ demands. Keywords: Cosmetic Dentistry; Crown fractures; Dental aesthetic; Direct composite resins