Maxillary Midline Research Articles

Change in frequency of the maxillary midline diastema appearing in photographs of Caucasian females in two fashion magazines from 2003 to 2012

To ascertain if there has been a change in the frequency of appearance of maxillary midline diastema in two leading women's fashion magazines over a decade. Two observers counted the frequency of maxillary midline diastema that appeared in Caucasian female models featured in British Vogue and Glamour (UK). An increase in the frequency of maxillary midline diastema appearing in both publications was observed between 2003 and 2012. This change may indicate an increase in the acceptance of the maxillary midline diastema, which may in turn, influence orthodontic and aesthetic dentistry treatment planning.

‘M’ Mechanics for the Management of Maxillary Midline Diastema

‘M’ Mechanics for the Management of Maxillary Midline Diastema

Assessment of the perception of smile esthetics by laypersons, dental students and dental practitioners

The aim of this study was to determine the esthetic perception of some components of the smile such as gingival exposure, level of the gingival margins, length of the crowns, maxillary midline and inter-incisor diastema by laypersons, dental students and dental professionals. Six hundred and thirty-four Portuguese people (292 laypersons, 241 dental students and 101 practitioners) assessed the esthetics of 13 altered pictures of the same smile arranged at random. The manipulated components (gingival exposure, level of the gingival margins, length of the crowns, maxillary midline and inter-incisor diastema) were altered using Adobe Photoshop® CS6 software. The classification of the pictures was done using the visual analogue scale (VAS), scored 1 to 10. The responses were then analyzed and processed with SPSS® version 21.0 using tests of average equality and correlation. The medium smile was the most appreciated smile, whereas the high smile and diastemas were considered to be the least esthetic. Among all the modified parameters, the midline shift was the least perceptible. The preference for asymmetry of the gingival margin at the maxillary lateral incisors (MLI) and the symmetry in the length of the crowns of the maxillary central incisors (MCI) reflected the importance given to MCI during smiling. Gender did not influence the scores given, except for gummy smiles, while younger people gave the highest scores. Regarding academic/professional training, there was an intra-group homogeneity of opinions as laypersons tended to give higher scores and professionals tended to give lower scores, but with no correlation between the variables. The fact that the laypersons had received orthodontic treatment, or not, had no influence on their perception. Laypersons, dental students and dental professionals had different perceptions of attractiveness when evaluating different modified features, except for diastemas, but with no significant differences between them. Gender was correlated with a very high smile. Age did not correlate with the judgment of the evaluators. There was no difference between the perceptions of laypersons, whether they had received orthodontic treatment or not.

�M� Mechanics for the Management of Maxillary Midline Diastema

Maxillary midline diastema is commonly occurring malocclusion. Variety of treatment modalities are suggested for the management of diastema. This article presents a case report in which 14-year-old female patient was treated for the maxillary midline diastema of size 3 mm after extraction of supernumerary tooth between upper central incisors. The index of orthodontic treatment was mild (Grade 2). MBT 0.022'' brackets were bonded on the maxillary central incisors. M spring was fabricated, activated and ligated initially with round archwire followed by rectangular archwire. Successful closure of diastema was seen with total treatment duration of 4 months. This method is efficient, effective, require less inventory. This saves precious chairside time of orthodontics and reduces treatment duration as well.

An aesthetic and rapid approach to treat midline diastema

Maxillary midline diastema is a common esthetic problem of patients which adversely affects body image and self-esteem, especially in adults. Often, patients are more conscious about the spaces between front teeth and seek treatment for cosmetic reasons. Different treatment modalities include restoration, orthodontics, prosthodontics, surgery, and various combinations of the above. Orthodontic procedures are routinely used to close diastema; however, there may be concerns with the appearance of braces especially in adults limiting its use. Here, we describe a case where a clear thermoplastic retainer was modified to close the midline diastema in relatively shorter time period.

Sectional porcelain veneers for a maxillary midline diastema closure: a case report.

Diastema closure is a frequently requested, technique-sensitive cosmetic procedure. There are many techniques and materials that can be employed to close diastemas. While direct composite techniques can be economical and successful, they do present challenges in achieving satisfactory clinical and esthetic results. Traditional porcelain veneer placement may offer an excellent esthetic result, but typically requires the removal of tooth structure; as such, this is an irreversible procedure. The present article reports the case of a maxillary midline diastema closure in a healthy dentition by means of sectional porcelain veneers simply cemented onto the natural teeth and without tooth preparation. A step-bystep procedure is proposed for illustrating the proper implementation of an additive-only and noninvasive indirect technique that yields a satisfactory clinical and esthetic outcome for clinician and patient.

Molariform Mesiodens in Primary Dentition

Mesiodens is a midline supernumerary tooth commonly seen in the maxillary arch, and incidence of molariform mesiodens in the maxillary midline is rare in permanent dentition and extremely uncommon in primary dentition. A midline supernumerary tooth in the primary dentition can cause ectopic or delayed eruption of permanent central incisors which will further alter occlusion and may compromise esthetics and formation of dentigerous cysts. This paper reports a rare case of the presence of a molariform mesiodens in the primary dentition. On clinical and radiographic examination, flaring of the primary central incisors was seen, with a molariform mesiodens consisting of multiple lobes or tubercles on the occlusal surface with the well-formed root. The treatment plan consisted of the extraction of the supernumerary tooth and regular observation of permanent central incisors for proper eruption and alignment.

The Surgical Landmark for Facial Foramen

ABSTRACTObjectiveTo study the localization and relative of the supratrochlear, supraorbital, infraorbital and mental foramen in Thai cadavers to external landmarks for helps the surgeon to easily and practically identify these foramen.Materials and methodsThe localization of the supratrochlear, supraorbital, infraorbital and mental foramen in adult Thai cadavers were studied in 110 cadevers (220 sides) from 2008 until 2012. The analyses were also performed to compare differences between sexes and sides.ResultsMean length of supraorbital foramen from nasal midline on the right side was 2.76 cm, left side 2.75 cm, above supraorbital rim right side 0.23 cm, left side 0.23 cm. Mean length of supratrochlear foramen from nasal midline on the right side was 1.77 cm, left side 1.76 cm. Mean length of infraorbital foramen from maxillary midline on the right side was 3.06 cm, left side 3.07 cm, from infraorbital rim on the right side was 0.94 cm, left side 0.92 cm. Mean length of mental foramen measurement straight to symphysis menti on the right side was 3.19 cm, left side 3.18 cm. Measurement along curvature of the mandible on the right side was 3.49 cm, left side 3.49 cm.ConclusionThe knowledge gained from this study is quite important, since it helps the surgeon to easily and practically identify supraorbital notch/foramen, supratrochlea foramen, infraorbital foramen and mental foramen. This will help avoid injury of the neurovascular bundles passing though these sets of foramen.How to cite this articleTungkeeratichai J, Bhongmakapat T, Saitongdee P, Orathai P. The Surgical Landmark for Facial Foramen. Int J Otorhinolaryngol Clin 2013;5(3):121-124.

The Surgical Landmark for Facial Foramen

ABSTRACTObjectiveTo study the localization and relative of the supratrochlear, supraorbital, infraorbital and mental foramen in Thai cadavers to external landmarks for helps the surgeon to easily and practically identify these foramen.Materials and methodsThe localization of the supratrochlear, supraorbital, infraorbital and mental foramen in adult Thai cadavers were studied in 110 cadevers (220 sides) from 2008 until 2012. The analyses were also performed to compare differences between sexes and sides.ResultsMean length of supraorbital foramen from nasal midline on the right side was 2.76 cm, left side 2.75 cm, above supraorbital rim right side 0.23 cm, left side 0.23 cm. Mean length of supratrochlear foramen from nasal midline on the right side was 1.77 cm, left side 1.76 cm. Mean length of infraorbital foramen from maxillary midline on the right side was 3.06 cm, left side 3.07 cm, from infraorbital rim on the right side was 0.94 cm, left side 0.92 cm. Mean length of mental foramen measurement straight to symphysis menti on the right side was 3.19 cm, left side 3.18 cm. Measurement along curvature of the mandible on the right side was 3.49 cm, left side 3.49 cm.ConclusionThe knowledge gained from this study is quite important, since it helps the surgeon to easily and practically identify supraorbital notch/foramen, supratrochlea foramen, infraorbital foramen and mental foramen. This will help avoid injury of the neurovascular bundles passing though these sets of foramen.

A Clinical Report of Nonsyndromic Concomitant Hypo-Hyperdontia

Although hypodontia and supernumerary teeth are often considered as mutually exclusive conditions, this case report presents an unusual case of hypodontia and a supernumerary tooth occurring simultaneously. An adolescent male was referred to the local hospital department regarding upper arch crowding. Plain film radiographs confirmed the congenital absence of both lower lateral incisors in addition to an unerupted conical supernumerary tooth in the maxillary midline. This condition has been called hypo-hyperdontia and in this paper, we discuss the clinical findings and treatment planning considerations in relation to the limited number of previously reported cases. The case report raises awareness of concomitant hypo-hyperdontia and serves to highlight that concomitant anomalies should be excluded when hypodontia or supernumerary teeth are diagnosed.

Anatomical Variations of Infraorbital Foramen in Dry Human Adult Egyptian Skulls, Anthropometric Measurements and Surgical Relevance

ABSTRACTObjectivesEvidence supports a clear racial variation in the position of the infraorbital foramen (IOF). Therefore detailed knowledge of the population specific data on biometric features of (IOF) will facilitate therapeutic, diagnostic and surgical manipulations in the maxillofacial region. The goal of this study was to elucidate the morphological features and precise anatomical position of the (IOF) with reference to surrounding anatomical landmarks in an adult Egyptian population.Materials and methodsFifty-nine adult dry Egyptian skulls (32 males and 27 females) were assessed to determine the number, shape, orientation, vertical and transverse diameters of the IOF, transverse distance from the IOF to the maxillary midline, the zygomaticomaxillary suture and the vertical distance from the IOF to the infraorbital rim and accessory infraorbital foramen using a metal casting digital vernier caliper. The position of the IOF was determined in relation to the maxillary teeth. The findings indicated that the size of the IOF and the mean distances from the IOF to the maxillary midline, infraorbital rim and foramen was significantly larger in males than in females.ResultsThe majority of IOF among the skulls were semilunarshaped in 59.4% in male skulls and 48.1% in female skulls. The majority were directed inferomedially in 88.9% in female skulls and 78.1 % in male skulls. Accessory foramina were found in 21.87% of male skulls and 18.5% of female skulls. All had bilateral double foramina except for one male skull and one female skull.ConclusionThe racial and gender differences of the IOF emphasize the need for meticulous preoperative evaluation of the IOF in patients who are candidates for maxillofacial surgeries and regional block anesthesia.How to cite this articleElsheikh E, Nasr WF, Ibrahim AAS. Anatomical Variations of infraorbital Foramen in Dry Human Adult Egyptian Skulls; Anthropometric Measurements and Surgical Relevance. Int J Otorhinolaryngol Clin 2013;5(3):125-129.

Nasopalatine Duct Cyst: Report of 52 Cases in a Retrospective Epidemiological Study

Introduction. Nasopalatine duct cysts (NPDCs) are the most common developmental epithelial non-odontogenic cysts of the upper maxilla. Their etiological origin is still uncertain; NPDCs are often asymptomatic and are usually found randomly through local radio-diagnostic investigations carried out for other reasons. Main body. The aim of this investigation is to analyze and discuss the etiology, differential diagnosis, clinic-pathological characteristics of these lesions as well as to report the relative frequency and distribution of nasopalatine duct cysts in general population (NPDCs) with a literature’s review on the topic. The retrospective study was carried out using 52 clinical cases, with histopatological confirmation for NPDC, radiographs and oral photographs. Data included age and gender of the patient, radiographic findings, etiological factors, treatment, and prognosis of NPDC. Few surgical consideration are discussed. The study results report a NPDCs’ incidence of 2.39% and a male predilection with a 2:1.25 ratio. No statistically significant correlation was observed between the size of the lesion and patient’s gender. Lesions were usually asymptomatic (73%). All cysts were located in the anterior maxillary midline region. Panoramic X-rays and computed tomography was used to identify the lesion. Surgical treatment was performed under local anesthesia including the dissection and the removal of the cyst, usually adopting a palatine approach with an enveloping flap from 1.4 to 2.4. Relapse occured in 15.4% of the cases. Conclusions. The etiology of NPDC is unclear and a male predilection was observed. The histological analysis of cystic lesions was fundamental for the final diagnosis. Simple surgical resection was recommended, followed by clinical and radiological control to ensure the correct and complete resolution of the case.

Localization and morphometric evaluation of Supraorbital and Infraorbital foramen in Dravidian Population of Southern India: A paleoantropological study on dry skulls.

Purpose:To determine the morphology and morphometric distance of supraorbital foramen/ notch(SOF/N) and infrorbital foramen(IOF) from different important anatomical landmark. Method:Sixty-five dry adult Dravidian skulls(130 sides) of Southern India were investigated to analyze the frequency of occurrence of SOF/N and shape of IOF. Fourty skulls (80 sides) were assessed to measure the width and positioning of SOF/N and IOF. Results: Mean width of S0N/F and IOF was 2.86mm and 3.85 respectively. The average distance of SOF/N was 25.9mm lateral to nasion, 28.5mm medial to temporal crest of the frontal bone, 0.92mm superior to supraorbital rim. The distance between right and left SOF/N was 49.6mm.The IOF was at an average of 44.08mm lateral to nasion,41.36mm lateral to maxillary midline, 6.82mm below infraorbital rim, 2.8mm medial to zygomaticomaxillary suture,34.8mm lateral to anterior nasal spine and 27.45mm from the alveolar crest. SOF/N was located at an average of 8.3 degree from IOF. IOF was in line with maxillary second premolar and the direction of opening was pointed inferomedially. The mean value of all the measurements was made between the right and left sides using independent t-test showed no statistical significance (where p>0.05).Conclusion: These morphometric measurements facilitate the professionals to locate the neurovascular bundles passing through the foramen and also assist in non-invasive as well as invasive surgical procedures. Key-Words: Anatomical Variation; Dravidian , Foramen, Location, Skull .

Anatomical Variations of Infraorbital Foramen in Dry Human Adult Egyptian Skulls, Anthropometeric Measurements and Surgical Relevance

ABSTRACTObjectivesEvidence supports a clear racial variation in the position of the infraorbital foramen (IOF). Therefore detailed knowledge of the population specific data on biometric features of (IOF) will facilitate therapeutic, diagnostic and surgical manipulations in the maxillofacial region. The goal of this study was to elucidate the morphological features and precise anatomical position of the (IOF) with reference to surrounding anatomical landmarks in an adult Egyptian population.Materials and methodsFifty-nine adult dry Egyptian skulls (32 males and 27 females) were assessed to determine the number, shape, orientation, vertical and transverse diameters of the IOF, transverse distance from the IOF to the maxillary midline, the zygomaticomaxillary suture and the vertical distance from the IOF to the infraorbital rim and accessory infraorbital foramen using a metal casting digital vernier caliper. The position of the IOF was determined in relation to the maxillary teeth. The findings indicated that the size of the IOF and the mean distances from the IOF to the maxillary midline, infraorbital rim and foramen was significantly larger in males than in females.ResultsThe majority of IOF among the skulls were semilunarshaped in 59.4% in male skulls and 48.1% in female skulls. The majority were directed inferomedially in 88.9% in female skulls and 78.1 % in male skulls. Accessory foramina were found in 21.87% of male skulls and 18.5% of female skulls. All had bilateral double foramina except for one male skull and one female skull.ConclusionThe racial and gender differences of the IOF emphasize the need for meticulous preoperative evaluation of the IOF in patients who are candidates for maxillofacial surgeries and regional block anesthesia.

English

Maxillary midline diastema is a common esthetic problem in mixed and permanent dentition. The space can occur either as a transient malocclusion or created by developmental, pathological or iatrogenic factors. Many innovative therapies are available from restorative procedures such as composite build-up to surgery (frenectomies) and Orthodontics is available. Treatment depends upon the correct diagnosis of its etiology and early intervention relevant to the specific etiology. Presented herewith case reports which were treated by Orthodontic treatment and also composite build-up.

Prevalence of developmental maxillary midline diastema in Taiwanese children

Background/purposeMidline diastema in mixed dentition is a concern for both parents and children; therefore, determining the timing of closure of developmental diastema is essential for clinical practice. Data on midline diastema in Taiwanese children are scant. The purpose of this study was to investigate the prevalence of maxillary midline diastema in different age groups of children in Taiwan and to determine the time of closure of the developmental diastema. Materials and methodsThe sample population comprised elementary school children in Taichung City, Taiwan, whose ages were between 6 and 12 years. We screened a total of 1136 children and selected 917 for this study. Inclusion criteria were the presence of both permanent maxillary central incisors and absence of obvious dental or dentofacial abnormalities. Children who had a history of orthodontic treatment or crown restoration of anterior teeth were excluded. Diastema widths were measured clinically with a Boley gauge. ResultsThe prevalence of diastema was 64.6% among 6-year-old children but only 14.3% among the 12-year-olds. The prevalence of diastema was higher in boys than girls after the age of 9. There were statistically significant differences between boys and girls in the prevalence of diastema at ages 9 and 12. The mean size of diastema was 1.9 mm for 6-year-olds and 1.21 mm for 12-year-old children, indicating a significant reduction of diastema size with age. Before the eruption of lateral incisors, the prevalence of midline diastema was 60.4% among all children, and it declined to 14.5% after the eruption of canines. ConclusionThe prevalence of midline diastema decreased with age. It also declined with lateral incisor and canine eruption; it was 14.5 % after canine eruption. Therefore the orthodontic intervention of diastema should be delayed until canine eruption.

Smile characterization by U.S. white, U.S. Asian Indian, and Indian populations

With growing demand for high esthetic standards, dentists must understand patient perception and incorporate their preferences into treatment. However, little is known about how cultural and ethnic differences influence esthetic perception. The purpose of this study was to determine whether differences in ethnic background, including the possibility of assimilation, affected a layperson's perception of esthetic and smile characteristics. A survey was developed containing images that were digitally manipulated into a series of barely perceptible steps, changing 1 smile parameter to form a strip of images that displayed that parameter over a wide range. Data were collected with a customized program which randomly displayed a single image and allowed the subject to use the mouse to adjust an on-screen slider according to displayed instructions, that is, "Please move the slider to select the image you find to be most ideal"; or "Please move the slider to select the first image that you find unattractive." A convenience sample (n=288) comprised of U.S. whites, U.S. Asian Indians, and Indians living in India was surveyed. This sample provided a power of .86 to detect a difference of ±1.5 mm. Subjects evaluated images showing the smile arc, buccal corridor, gingival display, vertical overlap, lateral incisal step, maxillary midline to midface, and maxillary to mandibular midline. Rater reliability was assessed with the Fleiss-Cohen weighted Kappa (Kw) statistic and corresponding 95% confidence interval after each question was repeated in a random sequence. Choice differences due to ethnicity were assessed with a multiple randomization test and the adjusted P value with the step-down Bonferrroni method of Holm (α=.05). The Kw for the 17 variables in all 3 groups ranged from 0.11 for ideal vertical overlap to 0.64 for ideal buccal corridor space. Overall reliability was fair to moderate. Differences attributed to ethnicity were demonstrated between the Asian Indians and U.S. whites. Differences attributed to assimilation were demonstrated between U.S. Asian Indians and Asian Indians. Differences between U.S. Asian Indians and U.S. whites can be instructive and demonstrate the relative power of ethnicity and assimilation. A difference between these groups shows the power of ethnicity and no difference between these groups shows the power of assimilation. The ratings of the Asian Indians and the U.S. whites showed a clinically significant difference for Ideal Buccal Corridor and Maximum Smile Arc. There were no significant differences between the U.S. Asian Indians and Asian Indians. There were clinically significant differences between the U.S. Asian Indians and U.S. whites only for Ideal Buccal Corridor. Ethnicity had a significant effect on the esthetic choices for Buccal Corridor and Smile Arc. There is no conclusive evidence for assimilation.

An in vivo study to determine the range of posterior teeth disclusion on working side in canine-guided occlusion

This study was done with the objectives to determine the range of functional zone between the intercuspal positions and edge to edge position, the range of incomplete and complete disclusion of posterior teeth in canine-guided occlusion, and to have a gender comparison and comparison between right and left sides of the obtained values. Thirty-five subjects showing canine-guided occlusion and Angle's class I canine and molar relation were chosen for the study. Maxillary midline and a corresponding line on the mandible were marked in maximum intercuspation with marker pen in the patient's mouth. Lines from 1 to 5 mm were marked on maxillary central incisor with marker pen. A dental floss was looped around the distal surface of mandibular last molar and the subject was asked to make left lateral movement (working side) at 1-mm intervals. The point at which floss was freed posteriorly was considered as initial disclusion and the point at which edges of maxillary and mandibular canines contacted was considered as complete disclusion. Most of the male and female subjects in the study showed progressive disclusion on right side and delayed disclusion on left side. The range of complete disclusion was 3-4 mm in males and 2-3 mm in females irrespective of the side. The range of functional zone was 1-4 mm irrespective of side or gender. There is a need to redefine canine guidance in terms of immediate disclusion, delayed disclusion, and progressive disclusion.

Clinical and surgical considerations for impacted mesiodens in young children: An update

Background: Most supernumerary teeth are located in the anterior maxillary region and are classified according to their form and location. Their presence may give rise to a variety of clinical problems. Detection of supernumerary teeth is best achieved by thorough clinical and radiographic examination. Supernumerary teeth may be encountered by the general dental practitioner as a chance finding on a radiograph or as the cause of an impacted central incisor. Design: This article presents an overview of the clinical problems associated with supernumerary teeth and includes a discussion of the classification, diagnosis, and management of this difficult clinical entity. Conclusion: The most common supernumerary tooth, which appears in the maxillary midline, is mesiodens. Their diagnosis and management should form part of a comprehensive treatment plan. Treatment depends on the type and position of the supernumerary tooth and on its effect on adjacent teeth. The article throws a light on various modalities for investigation and treatment of supernumerary teeth, which is important for an early intervention in children to avoid major complications.

Maxillary midline diastema among Saudi schoolchildren in Riyadh: prevalence and some related etiological factors

The aim of this study is to investigate the maxillary midline diastema in Saudi schoolchildren in Riyadh; particularly prevalence and some likely related etiological factors with regard to gender and age. The present epidemiologic study was undertaken in intermediate schools of Riyadh City. A total of 1,825 Saudi schoolchildren (1007 boys and 818 girls) aged 12 to 16 years were randomly selected. Clinical examination was carried out in the schools within the students’ classrooms by two experienced examiners using simple plain mouth mirror, small light source and stainless steel ruler. Students with a history of orthodontic treatment or prosthodontic restorations in the upper anterior teeth and periodontal disease were not included in the sample. An especially composed chart was used to record demographic dataand inter arch parameters. All data were analyzed using SPSS program and simple descriptive statistics with regard to boys and girls. Results revealed the prevalence of maxillary midline diastema was 394 (22%) out of 1825 students examined. A similar figure, though slightly greater prevalence of maxillary midline diastema in boys (22%) than in girls (21%). The highest prevalence was observed in 13 years age group (7.7%). The width of maxillary midline diastema ranged between 1-2 millimeters demonstrated (79.2%) of total sample, greater in boys (91%) than girls (64.4%), and (100%) in 16 years age group. The maxillary midline diastema width of 3-4 millimeters occurred more in girls (35%) than boys (9%), and in 12 years age group (35.5%) than other age groups with decrease up to 16 years of age. Among the observed etiological factors in both sexes and different age groups, spacing in anterior region (35.5%) was the most frequent etiological factor associated with maxillary midline diastema. Followed by increased ovejet (15.7%), missing tooth (11%), while the frequency of deep bite and anterior open bite was 6.3% and 5.8% respectively. It was concluded that maxillary midline diastema is a common occurrence in Saudi children associated with multifactorial etiology. Consideration of etiological factors and individual treatment planning are essential in the proper management of maxillary midline diastema.