Maxillary Central Incisors Research Articles

Evaluation of anterior teeth crown-root morphology and alveolar bone structure in patients with closed deep overbite using cone beam computed tomography

This retrospective study used cone-beam computed tomography to investigated the crown-root morphology and alveolar bone structure in incisors region in subjects with closed deep overbite and comparison the difference between gender and age. The CBCT images for 40 subjects (group C) with Angle II division 2 were selected from patients of the HeFei Stomatological Hospital from November 2023 to March 2024.20 individual normal occlusion subjects (group A),20 patients with Angle II division 1(group B) were included. The crown-root ratio of the maxillary and mandibular anterior teeth, crown-root angle and alveolar bone structure were measured on the CBCT images, the data were statistically analyzed. In addition to mandibular lateral incisor, the crown-root ratio of maxillary and mandibular anterior teeth in the Class II division 2 group was higher than that in the individual normal occlusion group and the Class II division 1 (P < 0. 05). The crown-root angle of maxillary anterior teeth in the Class II division 2 group was smaller than that in the individual normal occlusion group and the Class II division 1 (P < 0. 05). The alveolar bone thickness of the maxillary central incisor was comparatively smaller, while the alveolar bone height was relatively higher in the Class II division 2 group. Age and gender were associated with change in root lengths and crown-root angle for the Class II division 2 group (P < 0. 05). Patients with closed deep overbite malocclusion exhibit a significant difference compared to the controls for most measurements. The patients presenting with Class II division 2 malocclusion exhibit excessive inward positioning of the anterior teeth, resulting in evident crown-root angle, a large crown-root ratio, and minimal labial alveolar bone. In order to keep the tooth movement within the safe range of alveolar bone movement, it is necessary to strictly control the torque and use appropriate orthodontic force to reduce the risk of bone fenestration, bone dehiscence, gingival recession and root resorption.

Conservative Management of Facial Talon Cusp in a Permanent Maxillary Central Incisor: A Case Report

Conservative Management of Facial Talon Cusp in a Permanent Maxillary Central Incisor: A Case Report

Rehabilitation of a Severe Anterior Ridge Defect with a Fixed-Removable Prosthesis

Significant anterior ridge abnormalities might be difficult to restore with prosthesis. To attain good speech and aesthetics necessitate not only the restoration of the missing teeth but also the closure of the problematic region. One recommended treatment option for individuals with substantial ridge abnormalities is the Andrews bridge which is a fixed-removable prosthesis. The prosthesis correctly replaces the missing teeth and corrects the ridge defect area and restore speech and appearance. A 35-year-old female patient reported with the principal complaint of spacing in her lower front teeth and difficulty in phonetics and poor appearance. On clinical examination spacing was seen in the maxillary central incisors along with pro-clination and 31,32,33,41,42,43 teeth were missing and the edentulous defect area was coming under Seibert's Class III category. Rehabilitation of such defect with an Andrews bridge described in this case report, which used natural teeth as abutments for its permanent component and a detachable superstructure.

Comprehensive Management of an Impacted Maxillary Central Incisor: A Case Report

Comprehensive Management of an Impacted Maxillary Central Incisor: A Case Report

Orthodontic-Surgical Management of Triple Impacted Mesiodens and Maxillary Incisors - A Case Report

Abstract Rationale: Mesiodens are supernumerary teeth located in the pre-maxilla between the two central incisors with a prevalence rate of 0.15–1.9%. An impacted mesiodens may cause delayed eruption of permanent incisors, ectopic eruption, pathological disturbances and malalignment of teeth. Patient Concerns: The patient complained of missing upper front teeth associated with pain in the same region for two weeks. Diagnosis: Upon clinical and radiographic examination, it was diagnosed as triple impacted mesiodens with impacted permanent maxillary central incisors. Treatment: The clinicians in the study approached the issue by surgical removal of the impacted mesiodens and orthodontic treatment for extrusion of the impacted permanent maxillary central incisors. Outcomes: The patient was relieved of the pre-operative concerns and followed up regularly for the eruption of permanent maxillary central incisors. Take-away Lessons: The authors advocate the importance of timely diagnosis and proper management of such rare pathologies.

Artificial Intelligence in Aesthetic Dentistry: Is Treatment with Aligners Clinically Realistic?

Smile aesthetics are increasingly prioritized in dental practice, with accurate orthodontic assessment and treatment planning being crucial for optimal outcomes. This study evaluates Invisalign® SmileView™ (SV), an AI-based tool that simulates post-treatment smiles, focusing on its ability to present potential orthodontic outcomes to patients. Background/Objectives: This research aims to study whether SV can simulate predictable orthodontic results and if it makes anatomical modifications to the teeth. Additionally, it will evaluate whether SV displays smiles that conform to the orthodontic criteria described in the literature. Finally, the study will analyze whether the software can align the dental with the facial midline. Methods: A total of 51 subjects were recruited in Madrid, Spain. The operator took a frontal photograph of the subjects with a social smile (T0), following the application’s instructions. Subsequently, the subjects followed the steps to modify their smile (T1), resulting in a new image of the subject with a different smile. The following variables were collected, analyzed, and compared with the standards defined in the literature: smile width, vertical exposure of the maxillary central incisor, width of the maxillary central and lateral incisors, proportion of the maxillary lateral incisor width to the central incisor, anterior gingival exposure level, position of the upper and lower dental midlines relative to the facial midline. Results: 58% of the sample showed dental expansion, with an excessive expansion (&gt;5 mm) observed in 8%. In the maxillary arch, 5.9% of incisors exceeded predictable aligner movement (&gt;1.5 mm), with 3.9% showing excessive extrusion and 2% excessive intrusion. For the lateral incisors, the mesiodistal size was reduced less than 0.5 mm in 31.4% of cases, with excessive interproximal reduction (&gt;0.5 mm) in 5.9%. Additionally, 62.7% of cases would require multidisciplinary treatment due to an increase in size. SV centered the upper midline in 77.9% of these cases. Among the sample, the upper midline was initially centered in 74.5% of subjects, and SV maintained it centered in 84.2% of these subjects. Conclusions: SV tends to generate simulations of broader smiles, which are mostly achievable through aligner treatments, from an orthodontic perspective, and showed high predictability regarding the vertical movements of the incisors that can be achieved with aligners. Moreover, it adjusted the mesiodistal size of the upper incisors in its simulations and demonstrated the ability to identify and correct deviations of the dental midlines relative to the facial midline.

Early intervention of unerupted maxillary central incisor: A case series

Early intervention of an impacted maxillary central incisor is crucial to avoid space loss with tipping of the adjacent teeth and allows normal root development. This case series demonstrates the clinical considerations of a surgical-orthodontic approach in managing this eruption anomaly and its challenges. All three cases involved young patients aged 7–9 years with an impacted upper left central incisor and a positive history of dental trauma. An upper sectional fixed appliance was bonded to facilitate the closed eruption of the impacted central incisor. The treatment duration increases when more space is required for the impacted tooth. There was a marginal gingival discrepancy of all the treated central incisors with vertical relapse seen upon review, indicating the need for a careful surgical approach with good hygiene maintenance and a bonded retainer as retention. Early referral for the management of an impacted maxillary central incisor through a surgical-orthodontic approach is often successful, but treatment risks, duration, and retention regimen should be discussed with the parents for informed consent.

Vertical root fracture detection with cone-beam computed tomography in Biodentine™ filled teeth

PurposeThis study aimed to evaluate the accuracy of detecting vertical root fractures in Biodentine™-filled teeth using the Promax 3Dmax cone-beam computed tomography (CBCT) unit compared to periapical radiographs. It tested hypotheses regarding CBCT’s diagnostic superiority in non-root-filled and Biodentine™-root-filled maxillary central incisors and assessed the impact of smaller field of view and lower intensity settings on detection accuracy.Materials and methodsExtracted maxillary incisors were divided into groups based on fracture status and root filling material, then placed in a Thiel-embalmed skull to simulate clinical conditions. The teeth were imaged using periapical radiographs and the CBCT unit under different settings. Fracture thickness was measured with microcomputed tomography for accuracy benchmarking. Multiple observers assessed the images, and statistical analyses were conducted to evaluate diagnostic performance.ResultsIntra-rater reliabilities of consensus scores ranged from good to very good. Specificities were generally higher than sensitivities across all imaging modalities, but sensitivities remained constantly low. None of the Area Under the Curve scores exceeded 0.6, indicating poor overall accuracy for all imaging modalities. Paired comparisons of the area differences under Receiver Operator Characteristic curves revealed no significant differences between the CBCT and periapical radiograph techniques for detecting vertical root fractures in either Biodentine™-filled or non-root-filled teeth.ConclusionsThere was no significant accuracy improvement of the current CBCT device (Promax 3Dmax, Planmeca, Finland) over periapical radiographs in detecting small vertical root fractures in both non-root-filled and Biodentine™-root-filled maxillary central incisors. A smaller field of view with lower intensity did not enhance detection accuracy. These results highlight the challenges in accurately detecting small VRFs, emphasizing the need for further research and technological advancements in this domain.

Treatment of Dento-alveolar Traumatic Injuries in a Child with Autism Spectrum Disorder (ASD)

This case report details the multidisciplinary management and follow-up of a 9-year-old boy diagnosed with autism spectrum disorder (ASD). He presented with severe intrusion injuries after a fall to his permanent maxillary central and lateral incisor teeth. The patient was initially seen in the emergency department by the maxillofacial team. Owing to the complexity of the dento-alveolar injury, it was felt that a multidisciplinary approach would improve patient outcomes. In theatre, both maxillofacial and paediatric dental teams managed the acute trauma. The paediatric dental team continued to review and follow-up with the child. A multidisciplinary team is ideal for managing paediatric patients with severe dental trauma and complex behavioural needs. This approach ensures the best care for patients and favourable outcomes. CPD/Clinical Relevance: Multidisciplinary management is important in paediatric dento-alveolar trauma.

Analysis of factors affecting bone volume changes after immediate implantation in the maxillary central incisor.

This study aimed to evaluate the clinical outcomes of immediate implantation of single maxillary central incisor and explore factors affecting post-implant bone volume. Clinical data and imaging records from pre-surgery, the day of surgery, and 6 months post-surgery of 100 patients (100 implants) with non-salvageable maxillary central incisors who underwent immediate implantation were collected. Bone thickness at the cervical, middle, and apical regions of the implant's labial and palatal sides were measured immediately post-surgery and at 6 months, and bone volume changes were observed. A regression analysis model was used to assess predictive factors for labial and palatal bone plate thickness. At 6 months post-surgery, the labial bone thicknesses at the cervical, middle, and apical regions were 2.35, 2.29, and 3.28 mm, respectively, and those of the palatal side were 0.00, 2.40, and 6.05 mm, respectively. The cervical region had the highest alveolar crest collapse rates, with 32.87% on the labial side and 62.20% on the palatal side. The regression model indicated that factors influencing the thickness of bone at the cervical labial side of the implant included initial bone thickness, the implant center to adjacent tooth center angle, implant diameter, and the type of implant closure (P<0.05). The initial bone thickness on the palatal side was the sole predictor for bone thickness on the palatal side (P<0.05). Immediate implantation of single maxillary central incisors yields effective clinical results. The thickness of new bone around the implant is influenced by multiple factors. A comprehensive consideration of these factors in the planning of immediate implantation is necessary to achieve optimal therapeutic outcomes.

Evaluating anchorage and torque control in adolescent patients with Class II Division 1 malocclusion among 3 appliances

The objective of this study was to compare the differences in anchorage and torque control among the Tweed edgewise, Roth, and physiological anchorage Spee-wire systems (PASS) appliances (Zhejiang Xinya Technology Co, Ltd, Hangzhou, China). A sample of 90 adolescent patients with Angle Class II Division 1 malocclusion (30 Tweed edgewise appliances, 30 Roth appliances, and 30 PASS appliances) with maximum anchorage requirements in the maxilla were collected for this study. The pretreatment baseline levels of the 3 groups were compared initially, and then the differences between the 3 appliances in anchorage and torque control were analyzed after superimposing the pretreatment and posttreatment lateral cephalograms and maxillary 3-dimensional (3D) digital models, respectively. There was no statistical difference in the pretreatment baseline levels of 3 groups, including gender, age, sagittal skeletal types (ANB), vertical skeletal types (SN-GoGn), anchorage requirements, and occlusal plane inclination (SN-OP). After superimposing the pretreatment and posttreatment lateral cephalograms and 3D digital models, respectively, no statistical differences were observed between the measurement results obtained from lateral cephalograms and 3D digital models. Among the measurement variables assessed in this study, statistical differences were observed in the mesial displacement of maxillary first molars, the incisor retraction, and the torque variation of maxillary central incisors among the 3 groups. Specifically, the Tweed group exhibited lower mesial displacement of maxillary first molars compared with the PASS and Roth groups. Furthermore, the Tweed group exhibited the greatest amount of incisor retraction and torque variation of maxillary central incisors, followed by the Roth group and then the PASS group. The remaining measurement variables for the 3 groups showed no statistical differences, including vertical variation of maxillary first molars and central incisors, torque variation of maxillary first molars and canines, mesiodistal inclination variation of maxillary first molars and canines, width variation between maxillary first molars, and width variation between maxillary canines. Compared with contemporary preadjusted straight wire appliances, the Tweed edgewise appliance has superiority in molar anchorage control. In contrast, compared with the Roth appliances, the PASS appliances without any auxiliary anchorage devices could make full use of physiological anchorage to achieve adequate control of molar anchorage. Clinical orthodontists may need to pay extra attention to physiological anchorage. The difference in torque control varies depending on the respective characteristics of bracket designs.

Surgical Endodontic Management Of Maxillary Incisors: A Case Report

In the root canal system, infection of the pulp tissue caused by caries or other pathways is the primary cause of apical periodontitis. The ultimate goal of the endodontic treatment is to create adequate conditions for periradicular tissue healing. Nonsurgical endodontic treatment is a highly predictable treatment option in most cases, but surgery may be indicated for teeth with persistent periradicular pathosis unresponsive to nonsurgical approaches. The aim of this article is to highlight the possibility of the successful outcome of surgical endodontic treatment following failed non-surgical treatment of right maxillary central incisor. With proper case selection and operator skill, periradicular surgery can be considered predictable, cost-effective alternative to tooth extraction and tooth replacement.

Orthodontic Space Opening of Early Extracted Maxillary Central Incisor

Orthodontic Space Opening of Early Extracted Maxillary Central Incisor

Talon Cusp Management of a Maxillary Central incisor

Talon Cusp Management of a Maxillary Central incisor

Non-Surgical Endodontic Management of Teeth with Aberrant Anatomy: A Case Series

The root canal therapy aims to remove the necrotic and vital pulp tissue remnants from the root canal to treat the periradicular inflammation. The knowledge of the tooth anatomy is essential to ensure a successful treatment. However, the deviation of the tooth anatomy complicates the diagnostic and treatment processes. Effective management of such complexities requires a tailored approach, utilizing detailed imaging and precise endodontic techniques to achieve successful outcomes and restore patient function and comfort. This case series presents the endodontic management of three different anatomic variations of permanent teeth that include taurodontism in the mandibular molar, two rooted mandibular canine and dilacerated maxillary central incisor and underscores the importance of personalized treatment planning and advanced diagnostic tools in managing complex dental anomalies.

Solitary Median Maxillary Central Incisor Syndrome (SMMCI)

Solitary Median Maxillary Central Incisor Syndrome (SMMCI)

Assessment of Severity and Pattern of Early Childhood Caries Using ICDAS II Criteria: A Descriptive Cross-sectional Study

Introduction: Early childhood caries is highly prevalent worldwide. The International Caries Detection and Assessment System incorporates both the non-cavitated and cavitated carious lesions with acceptable reliability. The objective of the present study was to assess the severity and pattern of early childhood caries among children visiting outpatient department of a dental college in Nepal. The study also aimed to compare the severity and pattern based on individual tooth type. Methods: A cross-sectional study was conducted among children of age group 24-71 months in primary dentition stage. The International Caries Detection and Assessment System II criteria was used to detect dental caries, and its severity and pattern. The ethical approval was taken from the institutional ethical committee (IRC Ref. No.: 1, 36, 2079/2080 IRC PDCH 2022 21).Results: The dental cries in children of age group 48-60 months was 1338 (33.46%) and dentinal caries (Code 5) was observed in 112 (8.37%). Multi-surface caries was 644 (16.15%), and occlusal surface caries was 481 (12.06%). Among the study population, 227 (5.69%) of the teeth assessed were associated with restoration and sealants. Enamel caries among the maxillary second molars (55/65) (Code 3) was in 94 (23.5%), and the dentinal caries (Code 5) in maxillary central incisors (51/61)was in 90 (22.78%). Conclusions: Majority of the children enrolled in the study had multiple cavitated and non-cavitated carious teeth involving different surfaces. Severity and pattern of caries also varied among individual tooth type.

Tooth Eruption Disorders: Literature Review and Clinical Case Reports

Introduction and purpose: Tooth eruption disorders are complex issues that can affect both primary and permanent teeth. The process of tooth eruption is a natural stage of development, but it can sometimes be disrupted. Common eruption disorders include delayed eruption, tooth impaction, premature eruption, and abnormalities in the location and direction of eruption. In each case, consultation with a specialist is required, along with early diagnosis and subsequent planning of appropriate treatment. State of knowledge: Impacted teeth are a common occurrence in dentistry and they occur in 0.8–3.6% of the general population The most frequently impacted teeth, in decreasing order of prevalence, are third molars, maxillary canines, mandibular premolars, and maxillary central incisors. Factors contributing to tooth impaction can be general, local, or genetic. Impacted teeth and difficulties with eruption may be associated with complications such as follicular cysts and a variant of these cysts known as eruption cysts. Summary: Tooth eruption disorders require an individualized diagnostic and therapeutic approach. Depending on the issue, treatment may involve observation, orthodontic interventions, and in some cases, surgical procedures. Early diagnosis and appropriate treatment are crucial to prevent complications such as malocclusion, damage to adjacent teeth, or unsatisfactory aesthetics. Radiographs can help confirm the presence of impacted teeth or in some cases, CBCT may be used for more detailed imaging.

Diagnosis and management of impacted dilacerated maxillary central incisors

Diagnosis and management of impacted dilacerated maxillary central incisors

Can deep learning-designed anterior tooth-borne crown fulfill morphologic, aesthetic, and functional criteria in clinical practice?

ObjectivesThis study aimed to compare the design outcomes of anterior crowns generated using deep learning (DL)-based software with those fabricated by a technician using conventional dental computer-assisted design (CAD) software without DL support, with a focus on the evaluation of crown morphology, function, and aesthetics. MethodsTwenty-five in vivo datasets comprising maxillary and mandibular arch scans of prepared maxillary central incisors were utilized to design anterior crowns by using three methods: 1) a DL-based method resulting in as-generated outcome (DB), 2) a DL-based method further optimized by a technician (DM), and 3) a conventional CAD-based method (NC, control). Evaluations were conducted for crown morphology (total discrepancy volume (TDV), root mean square (RMS), positive average (PA) and negative average (NA) deviations), functional aspects (incisal path: deviations, length, and mean inclination), and aesthetics (crown width, height, width-to-height ratio, angular radius of mesioincisal line angle, proximal contact length, and tooth axis angle). ResultsSignificant differences in TDV ratio were noted between the DB–NC (32.3 ± 8.5 %) and DM–NC (26.5 ± 5.4 %) pairs (P = 0.006). No significant differences were observed in TDV between the DB–NC (65.3 ± 24.4 mm3) and DM–NC (54.3 ± 21.0 mm3) pairs (P = 0.095). For the entire palatal surface, significant differences in RMS and PA values were observed between the DB–NC and DM–NC pairs (P < 0.037). Significant differences in RMS values for the incisal half (P = 0.021) and in PA values for the cervical half (P = 0.047) of the palatal surface were also noted between these pairs. Significant differences in the deviation of the incisal path were observed between the DB–NC (290.4 ± 212.4 μm) and DM–NC (132.0 ± 122.3 μm) pairs (P < 0.001). However, no significant differences were found among the groups (DB, DM, and NC) in terms of the length and mean inclination of incisal paths or in aesthetic outcomes. ConclusionsA DL-based method can result in promising outcomes with clinically acceptable morphology and aesthetics for anterior crowns. Minor deviations in incisal path of the crowns may lead to anterior guidance discrepancies, which can be corrected by the dental technician at the design stage. Clinical significanceWith the potential of DL-based design methods in dental applications, integrating AI technology into dental CAD workflow can enhance the clinical efficiency and consistency of anterior crown design, although human intervention may be required to refine functional aspect.