Missing Anterior Teeth Research Articles

Evaluation of Stress Patterns in Bone Around Implants for Different Abutment Angulations Under Axial and Oblique Loading in Anterior Maxillary Region—A Finite Element Analysis

Abstract Introduction Replacing missing anterior teeth with a prosthesis that resembles natural form and function has always been challenging for a prosthodontist. Removable and fixed options both have been extensively studied and researched upon. In modern dentistry, implants have proved to be a more logical option for the same. The morphology of bone present in the premaxilla serves as guide to plan implant angulation during osteotomy. Factors such as age-related bone resorption, trauma or pathologic bone resorption due to periodontitis, etc. causes implants to be placed at angles that are difficult to restore with conventional straight abutments. Angled abutments can help build up favorable functional prosthesis in such cases, but they experience the drawback of transferring unfavorable forces to the implant or bone, thereby compromising the prognosis of the treatment. Clinically, the effect of these forces is difficult to evaluate, so a finite element analysis was done to estimate stress distribution at the bone implant interface. Materials and Methods In this study, premaxilla was modeled with 15 mm in bone height, 7 mm in bone length, and 12 mm in bone width with 1.5 mm thick cortical bone surrounded by a core of cancellous bone. The implant was modeled as a cylindrical, round-ended device with dimensions, 4.3 mm × 11.5 mm. Abutments with angulations 0°, 10°, 15° and 25° were used. To simulate clinical conditions, a 100 N load axially and 30 N load obliquely was applied. Result It was seen that, as the abutment angulation changes from 0° to 25°, both the compressive as well as tensile stresses increased; however, they were within the tolerance limit of the bone. Conclusion The study suggests angled abutments can be used with reasonable success, keeping in mind the basics of implant prosthodontics intact.

Tooth loss as a potential risk factor for deficient sleep: an analysis of a nationally representative sample of adults in the USA.

Sleep deficiency is implicated as a risk factor for several systemic conditions. Loss of teeth has a profound effect on the individual's physiologic and psychologic health and quality of life. This study aimed to assess the association between tooth loss and sleep duration and determine if anterior and/or posterior tooth loss is a significant predictor. A total of 22,483 individuals ≥ 18years who participated in the United States National Health and Nutrition Examination Survey (NHANES) 2005-2016 cycles were included. Multinomial logistic regression adjusted for age, gender, race/ethnicity, smoking, diabetes, body mass index, socioeconomic level, education, alcohol, and depression was performed to examine the association between sleep duration and tooth loss. Compared to individuals with > 20 remaining teeth, those who were completely edentulous, had 1-10 or 11-20 teeth remaining were more likely to be in the deficient sleep category (OR [95% CI] = 1.59 [1.35-1.87], 1.29 [1.07-1.54], and 1.26 [1.11-1.43], respectively). When the numbers of both missing anterior and posterior teeth were entered in the model, only posterior teeth were significant. There was a 4% increase in the odds of being in the deficient sleep category for each missing posterior tooth (OR [95% CI] = 1.04 [1.02-1.05]). Tooth loss was significantly associated with deficient sleep and posterior tooth loss appeared to be the main contributor. Although further research is needed to clarify the nature of this association, our results suggest that improving oral health might have an impact on overall health and quality of life.

An alternative technique to replace missing anterior tooth - A case report

Missing anterior teeth is a significant social life problem for an individual. It is our duty, being a specialist in field of dentistry to replace and restore the missing anterior teeth. Various treatment options are available such as, conventional fixed partial denture, Maryland Bridge and implant supported prosthesis are considered for replacement of missing anterior teeth. The emergence of fiber reinforced composite has shown promising results because it is minimally invasive, less time consuming, cost effective and most importantly it restores the esthetics and functions of missing anterior teeth to its best way as immediately as possible. This case report presents a clinical case of replacement of missing anterior tooth by restoring with direct fiber reinforced composite. Keywords: Fiber reinforced composite, Ever Stick, Missing anterior teeth

Severely angled implant with custom abutment and a screw retained prosthesis: A case report

Edentulousness is one of the human disabilities. Dental implants have increased the quality of life as it restores both function and aesthetics. Due to anatomic challenges, implants can be placed with inclinations and angled abutments can be used. This articles presents a case report of management of mandibular anterior missing tooth with the placement of angled implant using custom abutment along with screw retained prosthesis. Keywords: Dental implant, Surgery, Custom abutment, Fixed prosthesis.

Growth-enabling modified Groper appliance for the replacement of permanent maxillary incisors: Report of two cases

Abstract The aim of this case report is to introduce a modified Groper appliance that enables transverse growth of the maxilla in addition to improving the aesthetics of patients with missing anterior teeth. Patient 1 was a 16-year-old young woman in the late stages of growth who presented with a congenitally missing maxillary lateral incisor. Patient 2 was a nine-year-old girl missing both of her maxillary central incisors due to trauma. The missing teeth were replaced by artificial acrylic teeth bonded onto growth-enabling, maxillary, fixed palatal space maintainers. A tube was soldered onto one of the arch wires of the maintainer and the opposite arch wire was threaded into this tube, allowing it to slide until the patient completed growth. Intermolar width increased by approximately 1.9 mm in Patient 1 and 2.6 mm in Patient 2 over the three-year review period. The in-tube mechanical design of the device allowed transverse growth of the maxilla without interference during and throughout long-term wear.

A Modified Pontic Appliance for Missing Maxillary Incisors.

A modified pontic technique is presented that simplifies the management of patients with missing anterior teeth during the course of comprehensive orthodontic care. This technique demonstrates a lingual arch attached to lingual sheaths with the pontic placed on the lingual arch. Information presented includes appliance design, improved bond strength of the bracket on the pontic tooth, preparing the appliance for use as anchorage, and the incorporation of an anterior biteplate in the appliance. A modified pontic appliance improves esthetics and function when treating patients with missing maxillary anterior teeth.

A Retrospective Study on Implant Prosthesis in Missing Maxillary Anteriors among Middle-Aged Adults.

The ultimate goal of modern dentistry is to restore the normal comfort, contour, function, aesthetics, health, and speech of a patient's dentition while restoring or replacing teeth. When it comes to the anterior region, particularly the maxillary anteriors, aesthetics is of prime importance as it shapes the smile and builds confidence. The most ideal treatment option for replacement of a single missing tooth in the anterior region is placement of an implant. This study aims to analyze the age and gender prevalence of middle-aged adult patients undergoing implant placement in the anterior region of the maxilla. A retrospective study was performed among patients visiting the Department of Implantology opting for implant prosthesis placement in the maxillary anterior region within the age group of 30 to 60 years. Data were collected from case sheets of patients visiting a private dental hospital in Chennai, India, and tabulated; descriptive statistics were extracted. A total of 2,563 patients were identified with missing maxillary anterior teeth and had been advised to undergo implant prosthesis. Out of these, only 55 patients opted for implant prosthesis. The prevalence of males (51%) opting in was greater than that of females (49%), p > 0.05. Patients within the age group of 41-50 years were more willing to have implant placement in the maxillary anterior region (49.1%). Overall, number 22 was the most replaced tooth by implant prosthesis (21.8%) followed by number 23 (20.0%). In females, canines were the most replaced tooth; incisors, in males.

Preference of Fixed partial denture in aesthetic anterior vs functional posterior regions of patients

The fixed partial denture has been regarded as the standard of replacement of single or multiple missing teeth over the years. Esthetic and functional replacement of the missing anterior teeth plays a major role and is quite challenging. Most common cause of missing anterior teeth is due trauma. Failure to replace a missing posterior tooth may result in disruption of the occlusion and making it difficult to replace in the future as the adjacent tooth might tilt or extrusion of the opposing teeth may occur. This was a retrospective study which was performed in a university setting where the required data of patients treated for fixed partial denture patients in the department of prosthodontics at a private teaching hospital, Chennai from June 2019 to March 2020, was collected by reviewing patients records and the analysis of data of 86000 patients. The collected data was cross verified using photographs, reviewed by a reviewing expert and tabulated in Microsoft excel . The Sample size of the study included n=809 fixed partial dentures fabricated for 632 patients which included 343 male patients and 289 female patients with a mean age of 38.41土12.5. The number of fixed partial dentures fabricated in the anterior region n=391, posterior region n=418.The tabulated data was imported to SPSS software ( statistical package for social studies ) version 22.0 ( IBM corporation ) for statistical analysis . To minimize sampling bias, collection of data was done by simple random sampling methods within the university. There is high internal validity and low external validity. Incomplete , censored and repeated data were excluded from the study. Total number of patients involved in this study included 632 patients of which 343 male patients and 289 female patients with a mean age of 38.41土12.5. The total number of fixed partial dentures fabricated for 632 patients were n=809 of which 48.3% of the fixed partial dentures were fabricated for the anterior region while 51.7% were fabricated for the posterior region. Association between gender and age with site of fixed partial denture showed statistical significance with males commonly treated for anterior fixed partial denture and females mostly for posterior region, while with regard to age the fixed partial denture was mostly fabricated among the age group of 31 to 50 years old patients. From this study it can be observed that most of the patients were treated for fixed partial denture in the posterior region (n=418) than anterior region.

Esthetic rehabilitation of anterior missing teeth due to early childhood caries

Esthetic rehabilitation is one of the greatest challenges in the child under the age of 5 years who has suffered multiple tooth loss subsequent due to early childhood caries. An anterior esthetic appliance may be used to replace lost teeth. The appearance of the child is affected due to missing of the anterior teeth and also led to the loss of space, masticatory function, and speech development along with the development of detrimental oral habits. This case report discussed the management of anterior missing teeth with the Hollywood bridge.

Performance of bone-level implants with conical connections in the anterior maxilla: A 5-year prospective cohort study.

To assess clinical, radiographic and aesthetic outcomes, and satisfaction of patients treated with single implant restorations in the maxillary aesthetic region 5years after final restoration. Sixty patients (29 male/31 female, mean age 37years) with a missing anterior tooth in the maxilla (39 central incisors/10 lateral incisors/5 cuspids/6 first premolars) received a bone-level implant with conical connection. In 29 patients, a bone augmentation procedure was necessary before implant placement (autogenous bone grafts mixed with spongiosa granules). All implants (12 with 3.3mm diameter/ 48 with 4.1mm diameter) were loaded after 3months of submerged healing. The restoration consisted of an individually designed full-zirconia abutment veneered with porcelain. Follow-up with clinical and radiographic assessment was conducted until 60months after the final restoration. Aesthetic outcome of the restoration was determined with the Pink Esthetic Score-White Esthetic Score (PES-WES). Patient satisfaction was assessed with a VAS scale and satisfaction questionnaire. Fifty patients completed the 5-year follow-up. Implant survival was 100%, restoration survival 98%. Mean bone-level change was -0.13±0.66mm with a median (IQR) pocket probing depth of 2.75 [2.25; 3.25]. The mean PES and WES scores were 6.6±1.7 and 7.8±1.5, respectively. Patient satisfaction was high (92.1±7.8 on 100mm VAS scale). There were no differences between patients with or without a bone augmentation procedure. Bone-level implants with a conical connection are a reliable treatment option in single-tooth replacements in the maxillary aesthetic zone.

Ribbond reinforced composite bridge: a case report

Various options are presently available to address the challenge of immediately replacing a missing anterior tooth. These include a removable /fixed temporary/ permanent acrylic prosthesis, or resin-bonded bridges. Ribbond single-visit bridges provide strength, durability, and immediate convenience. They are cost effective and reliable and are excellent for emergencies like: implant temporization, congenitally missing teeth and patients who cannot afford conventional lab fabricated bridgework. In place of the pontic, a natural tooth, denture tooth can be used or composite build-up can be done. Conclusions: The procedure was completed at the chair side, thereby avoiding additional laboratory costs. Creating an adhesive FRC bridge by using a composite resin pontic is a successful treatment option for the direct aesthetic replacement of missing anterior teeth. Keywords: Ribbond, Fiber reinforced.

Simultaneous stabilization and prosthetic rehabilitation of cleft maxilla using modified palatal arch holding appliance

Introduction: Various prostheses have been tried for intermediate restoration of esthetics, function, and speech in cleft patients but are usually associated with frequent breakages and oral hygiene problems. Hence, this modified arch holding appliance was designed to simultaneously replace the missing anterior teeth and stabilize the transverse changes in the maxillary arch, so as to restore the form and esthetics. Fabrication: Pickup impression with the molar bands was recorded; casts were poured in type III dental stone. Palatal arch holding appliance was fabricated and soldered to the molar bands on the first molars. Stainless steel wires were soldered vertically over labial aspect of the arch holding appliance forming plus (+)-shaped attachment, at positions of missing teeth. Acrylic teeth matching the patient's teeth were selected and adapted over this plus attachment and acrylized. Conclusion: This appliance may provide dual benefits to cleft lip and palate patients by restoration of esthetics while maintaining the transverse changes. It is easy to fabricate, durable, economical, and esthetically acceptable to the patient.

Modification of maxillary splint for simultaneous protraction and esthetic rehabilitation of anterior teeth

Cleft lip and palate (CLP) patients struggle from multiple limitations, both functionally and esthetically, impeding their social and psychological development. These patients adapt fairly to the functional requirements, but esthetic aspect is always compromised, which play a significant role in their overall development and their acceptance in the society. Early rehabilitation of the esthetic component in the form of replacement of the missing anterior teeth has a positive impact on the quality of life of these patients, which is usually neglected in the early phase of orthodontic treatment. This paper attempts to address the esthetic aspect of CLP patient with a clinical modification of conventional treatment modality.

Modified Cantilever Bridge; A Novel Approach towards the Replacement of Missing Primary Anterior Teeth

Early childhood caries or dental trauma may lead to premature loss of primary anterior teeth which might lead to unaesthetic appearance, psychological impairment and speech abnormality. Pediatric dentists face great challenges in the aesthetic rehabilitation of these young children. Parents are becoming more concerned about the esthetic appearance of their child which needs immediate replacement of the missing teeth. These case reports highlight a specific design for the replacement of anterior missing tooth which can be used successfully in day to day clinical practice.

Anterior maxillary sandwich osteotomy technique with simultaneous implant placement: A novel approach for management of vertical deficiency.

The introduction of sandwich osteotomy technique with simultaneous implant placement allowed various procedures to be carried out with a level of great precision and accuracy thus saving time for the patient and clinician. The aim of the current study is to evaluate the efficacy of this new technique regarding increasing the anterior maxillary alveolar height with simultaneous implant placement. Nine patients suffering from multiple missing anterior maxillary teeth were selected with vertical dimension not less than 10 mm. anterior maxillary sandwich osteotomy technique was carried out for all patients using xenograft bone particulate with simultaneous implant placement at single stage surgery. For two patients, four implants showed significant marginal bone loss with maximum marginal bone loss up to 2.8 mm. However, the immediate postoperative follow up went uneventful for all nine patients included in the present study. None of them showed any complication regarding postoperative wound dehiscence, infection, or segment mobility. Four months postoperative upon the prosthetic phase, all the 18 placed implant were clinically osseointegtated. All 18 implants were successfully integrated in the present study. The prosthetic phase started after 4 months for all cases and there was no need for harvesting of autogenous bone from the patient. But further studies are required to evaluate the viability of such approach in single implant placement cases.

A retro-prospective long-term follow-up of Brånemark single implants in the anterior maxilla in young adults. Part 1: Clinical and radiographic parameters.

Single implant restorations have become the primary treatment option for young adults with missing anterior teeth. Yet, long-term studies of single-implants are limited in the literature. To report long-term survival, success, and complications in young adults with single-implants in the anterior maxilla. A group of 42 patients (mean age 20.7 years) received 53 anterior maxillary single-implants during 1996 and 1997. Data were collected at delivery of the crown, at 1-year examination, and at 14-20-year examination. Descriptive statistics, estimated cumulative survival rates, Pearson correlation test, and t-test were performed. After 14-20 years, 40 out of 42 patients were examined. Two patients were lost to follow-up, two implants failed and ten original single-crown restorations were replaced. Estimated cumulative survival rates were 96.1% for implants and 80.4% for implant-supported crowns. Complications were seen in 21 patients. Mean probing depth was 4.0 ± 1.8 mm and mean marginal bone loss was 0.1 ± 1.1 mm. No correlation was found between marginal bone loss and probing depth, occlusal contact in maximal intercuspal position or usage of nicotine. Long-term prognosis of single implant treatments in the anterior maxilla in young adults must be regarded as good, with high survival and success rates.

Aesthetic and functional rehabilitation of anterior teeth after trauma: a case report

Lesões dentárias traumáticas são problemas clínicos comuns durante a infância e podem ter etiologias complexas, causando deficiências físicas e fisiológicas. O objetivo deste estudo foi relatar um caso de lesão dentária traumática grave em uma paciente de 8 anos de idade, vítima de um acidente de moto, que foi levada para uma clínica de odontopediatria três meses depois do acidente. Exames clínicos e radiológicos diagnosticaram a avulsão dos incisivos centrais superiores permanentes, do incisivo lateral esquerdo permanente e do canino esquerdo decíduo, com considerável interposição da língua, interferindo na fala e deglutição. A paciente apresentou baixo risco de cárie e bom comportamento durante as consultas. No entanto, ela demonstrou estar envergonhada para sorrir. Além do tratamento preventivo para a cárie, o plano de tratamento incluiu atendimento imediato e acompanhamento posterior do restabelecimento psicossocial da paciente. Para este efeito, uma prótese parcial acrílica foi feita para substituir os dentes anteriores que faltavam, mantendo as características da dentição mista e preservando sua estética e função. Consultas de acompanhamento foram realizadas em um, três e seis meses após a primeira visita, com o objetivo de monitorar a adaptação da prótese, bem como o crescimento e desenvolvimento da dentição da criança. Assim, a reabilitação estética e funcional foi alcançada considerando a satisfação da paciente, permitindo sua reinserção social imediata.

Speech evaluation in children with missing anterior teeth and after prosthetic rehabilitation with fixed functional space maintainer

Speech and language development in children is a dynamic process. Development of vocal sound into meaningful speech was one of the major discoveries which have made the human beings to reach the pinnacle of the animal kingdom. The ability to speak is determined by the flow of air into the mouth which affects pronunciation of various words and phrases. This study aimed to evaluate speech changes before and after prosthetic rehabilitation with fixed functional space maintainer in children with missing maxillary anterior teeth. The study sample comprised of 25 children in the age range of 3-6 years having at least two maxillary anterior teeth indicated for extraction or had already got extracted. Speech therapist evaluated articulation of [v], [ph], [n], [d], [dh], [th], [t], [s.],[s], and [l] speech sounds of patients preoperatively (T0), postoperatively after the appliance insertion (T1), and postoperatively after 7 days (T2) using Weiss Comprehensive Articulation Test. The data obtained were analyzed using Chi-square and Mcnemar's test. There was statistically significant (P < 0.05) correction in [v], [ph], [d], [dh], [th], [t], [s.], and [s] speech sounds immediately after prosthetic rehabilitation (T1). While, the assessment of speech sounds after 7 days of appliance insertion (T2) showed statistically nonsignificant differences. The results suggested that treatment of a patient with missing anterior teeth should not be restricted to esthetic and functional oral rehabilitation, but also comprehend with the speech, as premature loss of the primary maxillary incisor appears to have long-term effect on the speech development.

Enhancing the esthetics with all-ceramic prosthesis

All-ceramic restorations are widely and successfully used for a fixed dental prosthesis. The properties such as biocompatibility, high strength, and superior esthetic have made this veneering material popular among the dental practitioners and patients. This case report describes the enhancement of esthetics by replacing missing anterior teeth with a zirconia-based all-ceramic prosthesis.

Anterior single implants with different neck designs: 5 Year results of a randomized clinical trial.

The design of the implant neck might be significant for preservation of marginal bone. To compare the 5-year radiographic and clinical outcome of single anterior implants provided with a smooth neck, a rough neck or a scalloped rough neck. 93 Patients with a missing anterior tooth in the maxilla were included. At random, patients received an implant with a 1.5 mm smooth neck ("smooth group"), a rough neck with grooves ("rough group") or a scalloped rough neck with grooves ("scalloped group"). Implants were installed in healed sites. Follow-up visits were conducted after final crown delivery and 1 year and 5 years later. Scalloped implants showed significantly more initial marginal bone resorption. The total amount of bone loss was 1.26 ± 0.90 mm in the smooth group, 1.20 ± 1.1 mm in the rough group and 2.28 ± 0.97 mm in the scalloped group (P < .05). Survival rates were 96.2% for the smooth and scalloped group and 100% for the rough group. Scalloped implants showed deeper pocket depths, more bleeding and more technical complications. There were no differences in esthetic outcome nor in patient satisfaction. For anterior single tooth replacements, scalloped implants show less favorable radiographic and clinical outcome compared to regular implants with a smooth neck or rough neck.