Missing Anterior Teeth Research Articles

Evaluation of the therapeutic efficiency of mandibular anterior implant-supported fixed bridges with cantilevers

Background Dental implant technology has developed rapidly in recent years. However, the use of implant-supported fixed bridges with cantilevers has been controversial. The purpose of this study was to evaluate the clinical results of the mandibular anterior implant-supported fixed bridges with a cantilever. Method Thirty-three patients (15 males, 18 females; mean age, 42.6 years; range 20-54 years) with two missing anterior mandibular teeth had single implant-supported fixed bridges with a cantilever. Clinical examination was recorded and radiographs were taken. The mean duration of follow-up was 30 months (15-44 months). Results All implants survived. Loosening or fracture of the prosthesis was not observed. All patients were satisfied with the treatment. The mean bone resorption values after 12, 24, and 36 months of implant loading were 0.94, 1.18 and 1.35 mm respectively. The changes of gingival papilla height ranged from 0 to 0.5 mm. There was significant difference between 1-year and 2 or 3 years restoration groups regarding the average gingival height changes (P <0.05). Conclusion After careful and precise selection of patients, restoration with a single implant-supported fixed bridge with a cantilever can be recommended if two anterior mandibular teeth are missing.

INCIDENCE OF LOSS OF ANTERIOR TEETH DUE TO CARIES IN SOUTH INDIAN POPULATION IN 2009

Abstract Aim: To evaluate the incidence of loss of anterior teeth due to caries in 2000 patients randomly selected from the South Indian population in 2009. Material and Methods: 2000 patients were examined for incidence of loss of anterior teeth due to caries and the recorded data was statistically analysed using Pearson Chi-Square test. Results:Incidence of loss of anterior teeth due to caries in the population of South Canara district was found to be 16.3 %. It was observed that there was increased incidence of loss of anterior teeth in age group above 65 years. No difference in incidence of anterior tooth loss was observed between urban and rural patients and also between males and females. There was high rate of replacement for the missing lost anterior teeth. Conclusion: This study showed that less than one fourth population of South Canara district had missing anterior tooth due to caries. Since anterior teeth occupies a strategic position in the dental arch, it is necessary to know the caries prevalence in this tooth and take adequate measures to prevent its progression and/or development of new carious lesions.

Cost-effectiveness of Anterior Implants versus Fixed Dental Prostheses

For the restoration of an anterior missing tooth, implant-supported single crowns (ISCs) or fixed dental prostheses (FDPs) are indicated, but it is not clear which type of restoration is more cost-effective. A self-selected trial was performed with 15 patients with ISCs and 11 with FDPs. Patient preferences were recorded with visual analog scales before treatment, 1 month following restoration, and then annually. Quality-adjusted tooth years (QATYs) were estimated by considering the type of reconstruction for replacing the missing tooth and its effect on the adjacent teeth. A stochastic cost-effectiveness model was developed using Monte Carlo simulation. The expected costs and QATYs were summarized in cost-effectiveness acceptability curves. ISC was the dominant strategy, with a QATY increase of 0.01 over 3 years and 0.04 over 10 years with a higher probability of being cost-effective. While both treatment options provided satisfactory long-term results from the patient’s perspective, the lower initial costs, particularly laboratory fees, were responsible for the dominance of ISCs over FDPs.

Natural Teeth Replacing Artificial Teeth in a Partial Denture: A Case Report

The aesthetic replacement of anterior teeth in cases of immediate partial denture is always a challenging work for prosthodontists. There is always problem of matching size, colour, shade and shape of the replaced tooth with those of the natural teeth. It was most difficult to satisfy the patients who have high aesthetic demands. Here is a report of a case where patient's own natural tooth was used for replacement in an immediate partial denture. An immediate denture is defined as "any removable dental prosthesis which is fabricated for placement immediately, following the removal of a natural tooth/teeth" . Patients with missing anterior teeth lack an impressive appearance aesthetically and as well as psychologically. Tooth loss leads to a certain degree of loss of function. This loss of function might lead to an impairment of oral health which is related to quality of life. An immediate denture can replace 1-16 teeth in either the maxillary or the mandibular arch, or in both arches. The need for the immediate replacement of a missing tooth is more in case of an anterior tooth, where aesthetics is of prime concern. The replacement of an anterior tooth is most technique sensitive, as it includes the patient's expectations, which include, matching with proper shade, shape and size as those of his/her natural teeth. So, here is a case presentation where modern day patient expectations were taken into consideration.

Creating a Single-Visit, Fibre-Reinforced, Composite Resin Bridge by Using a Natural Tooth Pontic: A Viable Alternative to a PFM Bridge

The rehabilitation of an anterior tooth space presents a confronting situation. Several modalities are presently available to address the challenge of an immediate replacement of a missing anterior tooth. These include a removable temporary acrylic prosthesis or resin-bonded bridges. Fibre-Reinforced Composite (FRC) bridges are preferable if they are fixed and if a cost-effective tooth replacement is desired. Also, they provide an aesthetic and a conservative treatment choice as the abutment teeth require a minimal or no preparation. This article is describing two cases with an immediate replacement of the maxillary incisor teeth by a single visit technique, with the use of FRC Resin (Ribbond) bridges and natural tooth crowns as pontics. The procedure was completed at the chair side, thereby avoiding the laboratory costs. A two year follow up of the cases has shown a successful outcome. Creating an adhesive FRC bridge by using a natural tooth pontic is a successful treatment option for the direct aesthetic replacement of missing anterior teeth.

Effect of framework design on the surface strain of zirconia fixed partial dentures

The purpose of this study was to evaluate the design of resin-bonded fixed partial dentures (RBFPDs) with zirconia frameworks. The abutment teeth were the upper central incisor and the canine. Three types of frameworks were fabricated as follows: 0.5-mm- and 0.8-mm-thick zirconia frameworks with grooves and holes (0.5ZrG, 0.8ZrG) and 0.5-mm-thick zirconia frameworks without grooves and holes (0.5Zr). The control group was designed as a 0.8-mm-thick metal framework with grooves and holes (0.8MG). Static loading was applied and the surface strain of the retainers was measured with strain gages. The magnitude of the principal strain of the 0.5ZrG framework was significantly lower than that of the 0.8MG and the 0.5Zr frameworks. This result suggests that the zirconia and retention form had a significant effect on decreasing the framework deformation, indicating that the RBFPDs that use a 0.5-mm thick zirconia framework are effective for replacing a single anterior missing tooth.

Relationship between implantation of missing anterior teeth and oral health-related quality of life

The aim of the present study was to investigate the relationship between anterior teeth implantation and oral health-related quality of life (OHRQoL). Participants completed the Chinese version of the Oral Health Impact Profile-14 (OHIP-14) prior to implantation and at 6months following crown restoration. Participant demographic information was recorded. Six months following implant crown restoration, participants were asked to self-assess their overall oral health and implant restoration. A Kruskal-Wallis test and Spearman correlation test were used for statistical analyses. A p value <0.05 was considered statistically significant. A total of 238 patients (133 women and 105 men) completed the study. OHP-14 scores were negatively correlated with self-assessment of both overall oral health (r=-0.788, p<0.001) and implant restoration (r=-0.739, p<0.001) after implant crown restoration. There were no significant differences between qualitative reasons for dissatisfaction or between quantity of reasons given for dissatisfaction (p=0.845). Six months following crown restoration, the overall OHIP-14 scores and the four common factors (disability, psychological discomfort, functional limitation, pain, and discomfort) decreased significantly compared to preimplantation scores (p<0.001). From the paired differences between genders before and after implantation, significant differences were observed in overall quality (p=0.044) and disability (p=0.029). Patients with a higher education level scored significantly higher on overall quality of life (p=0.031) and psychological discomfort (p=0.002) following crown restoration. Our findings indicate that the implantation of anterior missing teeth could significantly improve patient OHRQoL. Gender and education level were shown to affect implantation results.

Prosthetic reconstruction using gingiva-colored ceramic agent in fixed partial restoration in a 24-year old patient

Achieving an optimal esthetic result when replacing missing anterior teeth with a fixed partial denture can be a challenge. This is especially true when interdisciplinary treatment is needed and the patient refuses this for personal or financial reasons. Here we report a clinical case where a fixed partial denture was used to change the incisor relationship and to restore the normal tooth and gingival tissue shape, morphology, and relationship by including artificial gingiva within the fixed partial denture when the patient refused lengthy and costly multispecialty treatment options.

Performance of the Straumann Bone Level Implant system for anterior single‐tooth replacements in augmented and nonaugmented sites: A prospective cohort study with 60 consecutive patients

The purpose of this prospective study was to evaluate radiographic, clinical and aesthetic outcomes and patient satisfaction of cases treated with platform-switched single implant restorations in the aesthetic region of the maxilla. Furthermore, the influence of an augmentation procedure 3months before implant placement and the type of restoration (screw-retained vs. cement-retained) was evaluated. Sixty patients with a missing anterior tooth in the maxilla were treated with a Straumann Bone Level Implant. Bone augmentation was performed in 29 patients at 3months before implant placement. Implants were loaded after 3months of submerged healing. Follow-up was conducted at 7 and 18months after implant placement. Peri-implant mucosa and implant crown aesthetic outcomes were determined using the Implant Crown Aesthetic Index (ICAI) and the Pink Esthetic Score-White Esthetic Score (PES-WES). No implants were lost. At 18months after implant placement, mean bone level change was -0.10±0.27mm and mean probing pocket depth was 2.57mm. No differences were found between augmented and nonaugmented sites (P=0.28). The ICAI indicated satisfactory mucosa and crown aesthetics in 67% and 75% of the cases, respectively, while the PES score was 14.4. ICAI mucosa (P=0.004) and PES (P=0.02) scores were significantly less favourable for augmented sites compared with nonaugmented sites. Patient satisfaction was high (8.9±1.1 on VAS-score). From the present prospective, clinical study, it can be concluded that the Straumann Bone Level Implant shows an excellent survival rate, marginal bone stability and good clinical and aesthetic results. Bone augmentation before implant placement does not lead to more marginal bone loss. However, less favourable pink aesthetic outcomes were found in augmented sites compared with nonaugmented sites, while no differences were found between cement-retained and screw-retained restorations.

Non-invasive management of fused upper incisors

The union of two different dental sprouts which can happen in any phase of dental development is commonly called fusion. This developmental anomaly may cause clinical problems including esthetic impairment, which are mainly treated by endodontic and surgical treatments. There are a few reports of conservative not invasive treatment of fused incisors teeth through restorative or prosthetic techniques. They are rarely reported in mandibular posterior teeth. This paper presents an unusual case of fusion of 7 and 8, and also 9 and 10 teeth which was treated with a nonendodontic and nonsurgical conservative approach. Patient was a healthy18-year-old female with chief complaint of bad-looking teeth that in intraoral examination revealed the fusion of 7 and 8, and also 9 and 10 teeth. The space between the mesial of the 6 and 11 teeth was reconstructed. Diastema between the fused teeth was closed. A new lateral tooth was replaced between the fused teeth (7 and 8) and 6 tooth with direct fiber-reinforced composite. The space between the fused teeth (9 and 10) and also tooth 11 was partially closed. Gingival papillas were reconstructed using pink composite. The mandibular anterior missing teeth were replaced with rochett bridge. At the end of treatment the esthetic of the patient was improved. As the treatment was not invasive, major complications are not expected; however, there is potential for eventual long-term periodontal problems due to poor oral hygiene. Debonding of the rochett bridge may happen as well.

Single‐Tooth Implants with Different Neck Designs: A Randomized Clinical Trial Evaluating the Aesthetic Outcome

To evaluate the aesthetic outcome of single-tooth implants in the aesthetic zone with different neck designs from a professional's and patient's perception. Ninety-three patients with a missing anterior tooth in the maxilla were randomly assigned to be treated with an implant with a smooth neck, a rough neck with grooves or a scalloped rough neck with grooves. Implants were installed in healed sites. One year after definitive crown placement (18 months post-implant placement), photographs were taken and the aesthetic outcome was assessed according to two objective aesthetic indexes: pink esthetic score/white esthetic score (PES/WES) and implant crown aesthetic index (ICAI). A questionnaire was used to assess the aesthetic outcome and general satisfaction from a patient's perception. standardized radiographs were taken to measure marginal bone level changes. One implant was lost. Although there was a significant difference in marginal bone loss between the different implant neck designs (smooth neck 1.19±0.82mm, rough neck 0.90±0.57mm, scalloped neck 2.01±0.77mm), there were no differences in aesthetic outcome. According to the professional's assessments using PES/WES and ICAI, 79.3% and 62% of the cases showed acceptable crown aesthetics, and 59.8% and 56.5% of the cases showed acceptable mucosa aesthetics. Overall, patients were satisfied about the aesthetics of the mucosa (81.5%) and crown (93.3%), and general patient satisfaction was high (9.0±1.0 out of a maximum of 10). According to the professional's assessment, a pre-implant augmentation procedure was associated with less favorable aesthetics of the mucosa. This study shows that the aesthetics of single-tooth implants in the maxillary aesthetic zone appears to be independent of the implant neck designs applied but dependent on the need for pre-implant surgery.

Application of valplast dentures in the temporary restoration of single missing anterior tooth

To evaluate the value of valplast dentures in the temporary restoration of single missing anterior tooth. Totally 76 patients who needed temporary restoration of single missing anterior tooth were involved and equally divided into two groups according to their own choices of procedures: group A, with valplast dentures as their temporary dentures and group B, with conventional removable partial dentures as their temporary dentures. Meanwhile,38 patients who had their single anterior teeth pulled out and did not need temporary dentures were enrolled as control group without any temporary restoration, and impressions were taken immediately before the temporary dentures were used (2 weeks after tooth extraction) and before the initiation of permanent restorations (97-100 days after tooth extraction).The heights of clinical crowns of the adjacent teeth were also recorded twice from plaster models made from the impressions.The height of labial gingiva recession was calculated as the difference between the two heights recorded. The height differences of clinical crowns of the adjacent teeth was 0.5mm (range: 0.0-1.2mm) in group A, which was significantly larger than those in group B [0.0mm;(range: 0.0-0.6mm)](P<0.05) and in group C[0.0mm;(range: 0.0-0.4mm)](P<0.05).However, the difference was not significant between group B and group C (P>0.05). Application of valplast denture as temporary denture may cause labial gingival recession of the adjacent teeth, and therefore is not suitable for the restoration of single missing anterior tooth.

Autotransplantation of a maxillary first premolar to replace an ankylosed maxillary incisor: 7-year follow-up

To present the combined endodontic, surgical and orthodontic treatment of an autotransplanted maxillary first premolar for the replacement of an ankylosed maxillary incisor. This case report describes the autotransplantation of a maxillary premolar after the extraction of an ankylosed incisor in a 13-year-old boy. To allow better adaptation of the donor tooth, the buccal root of the first premolar was removed using a diamond bur and the denuded root site was filled with acid-etched composite resin. The palatal root canal was dressed with calcium hydroxide for 2 months before filling with gutta-percha. Autotransplantation of a remodelled maxillary first premolar was achieved to substitute for the ankylosed maxillary central incisor. Orthodontic treatment was performed to correct an Angle Class II malocclusion. Seven years after root canal treatment, the autotransplanted tooth and supporting tissues appeared healthy both clinically and radiographically and were functioning well. • Autotransplantation is a viable option for the treatment of a missing tooth or for the replacement of a traumatized tooth when there is a donor tooth available. • Autotransplantation of a premolar for replacement of a missing anterior tooth is sometimes a suitable alternative to conventional prosthetic rehabilitation or implant treatment in young individuals. • Proper combined endodontic and orthodontic treatment of autotransplanted teeth might be possible without periodontal complications.

Achieving a Desired Esthetic Outcome for a Single-Tooth Implant Restoration with Tissue Excess Using a Multidisciplinary Treatment Approach: A Clinical Report

Achieving ideal emergence profile and restoration contours for implant-supported prostheses in the anterior esthetic zone is a prime requisite. In this report, the patient presented with decreased restoration space and unfavorable tissue contours for an implant restoration. Correction of space deficiency and reshaping of excess bone height and soft tissue were planned and executed carefully prior to definitive restoration of a maxillary anterior missing tooth with an implant-retained prosthesis. Post-treatment evaluation of the papillary levels and soft tissue profile helped in assessing maintenance of the restored emergence profile.

Young people’s perceptions of photographs of dental trauma

Few studies have investigated how patients feel about traumatic injuries to teeth. Dentists may focus on treating an injury and neglect to address how the patient views the severity, or aesthetics. Addressing these issues may improve trauma management and communication between dentists and patients. The aim of the study was to compare children's, adolescents' and young adults' perceptions of common dental injuries to the maxillary central incisor teeth. A cross-sectional study was conducted with 138 participants selected by convenience sampling and divided into 6- to 10-year, 11- to 17-year and 18- to 24-year age groups. Participants were shown six coloured photographs of traumatic injuries to central incisors and asked four questions. Data were analysed using SPSS. Group differences were evaluated using Mann-Whitney U and Kruskal-Wallis H tests. There were statistically significant differences between the 6- to 10-year and 18- to 24-year age groups as to which traumatic injury would hurt the most (P < 0.05). Responses from younger participants appeared to be affected by the presence of blood in photographs, while young adults were more 'tooth-focused.' Younger children selected extrusion as the most painful injury, and the oldest group selected the complicated crown fracture. For the youngest age group, a missing anterior tooth was least concerning aesthetically, while young adults were most likely to choose discolouration (P < 0.05). Most in each age group thought crown fractures (particularly complicated ones) would be the most difficult for a dentist to treat. Statistically significant differences (P < 0.05) were found among the youngest and oldest age groups in their perceptions of which type of injury would hurt most and which injury was the least attractive. This study suggests that children and young adults may perceive the significance of their dental injuries quite differently than dental professionals.

Single implants with different neck designs in the aesthetic zone: a randomized clinical trial

To compare single implants in the aesthetic zone with different neck designs for marginal bone-level changes and clinical outcome measures. Ninety-three patients with a missing anterior tooth in the maxilla were randomly assigned to be treated with an implant with a 1.5 mm smooth neck ("smooth group"), a moderately rough neck with grooves ("rough group") or a scalloped moderately rough neck with grooves ("scalloped-group"). Implants were installed in healed sites and were loaded after 3 months. Follow-up visits were conducted at 6 and 18 months after implant placement. The scalloped group showed significantly more radiographic bone loss from implant placement to 18 months (2.01 ± 0.77 mm) compared with the smooth group (1.19 ± 0.82 mm) and rough group (0.9 ± 0.57 mm). Furthermore the scalloped group showed significantly deeper pocket depths and a higher bleeding score. There were no between-group differences in soft tissue levels. Survival rates were 97% for the smooth group and 100% for the rough and scalloped groups (P>0.05). No significant differences in outcome were found between the smooth group and rough group. For anterior tooth replacements, implants with a scalloped neck showed more marginal bone loss and less favourable clinical outcome compared with implants with a 1.5 mm smooth neck or implants with a rough neck.

The use of definitive implant abutments for the fabrication of provisional crowns: a case series

PurposeThe anterior region is a challenge for most clinicians to achieve optimal esthetics with dental implants. The provisional crown is a key factor in the success of obtaining pink esthetics around restorations with single implants, by soft tissue and inter-proximal papilla shaping. Provisional abutments bring additional costs and make the treatment more expensive. Since one of the aims of the clinician is to reduce costs and find more economic ways to raise patient satisfaction, this paper describes a practical method for chair-side fabrication of non-occlusal loaded provisional crowns used by the authors for several years successfully.MethodsTwenty two patients (9 males, 13 females; mean age, 36,72 years) with one missing anterior tooth were treated by using the presented method. Metal definitive abutments instead of provisional abutments were used and provisional crowns were fabricated on the definitive abutments for all of the patients. The marginal fit was finished on a laboratory analogue and temporarily cemented to the abutments. The marginal adaptation of the crowns was evaluated radiographically.ResultsThe patients were all satisfied with the final appearance and no complications occurred until the implants were loaded with permanent restorations.ConclusionsThe use of the definitive abutments for provisional crowns instead of provisional abutments reduces the costs and the same results can be obtained.

Rehablitation of mandibular fracture with anterior teeth loss

We report here on rehabilitating a case with mandibular fracture and lower anterior teeth loss. Three double-staged implants were placed in the lower anterior region; in an attempt to rehabilitate the condition of five missing lower teeth, two natural teeth were prepared to act as natural abutments. Teeth implant-supported prosthesis was fabricated. Patient with a right mandibular fracture and loss of lower anterior missing teeth was successfully rehabilitated with teeth implant-supported prosthesis and titanium bony plates.

Willingness to pay for implant therapy: a study of patient preference

This study determined the amount of willingness to pay (WTP) for implant treatment and identified the factors affecting WTP. Subjects attending a university dental hospital were recruited (n=59). They were presented with two hypothetical clinical scenarios: missing one anterior/posterior tooth. The clinical procedures, outcome and plausible complications of various replacement options (fixed and removable partial dentures, implants) and sequelae of no treatment were presented. They were then asked how much they were willing to pay for tooth replacement under the two situations using a bidding method, with a starting bid of Hong Kong (HK)$20,000 in HK$1000 increment/decrement if they were willing/unwilling to pay that amount (1 USD=7.8 HKD). The amount was recorded at which the subject chose the opposite option or it reached HK$0. Demographic data were also collected. WTP values were compared between anterior and posterior replacements, and among various demographic subgroups. Spearman's correlations and linear regression analysis were also conducted. Ninety-four percent and 84% of the subjects chose implant treatment to replace missing anterior and posterior teeth, respectively. The mean WTP amounts for anterior/posterior tooth replacement were HK$11,000/HK$10,000 (P>0.05). Higher WTP amounts were obtained from females, subjects without missing teeth or restorative need, and had attained higher level of education (P<0.05). Gender (P<0.05), level of education (P=0.042), and the presence of missing teeth (P=0.001) were independent predictors of WTP. The estimated WTP value for a single tooth replacement using dental implants was HK$10,000. Gender, level of education and presence of missing teeth were independent predictors that influenced WTP.

Preservation of Existing Soft‐Tissue Contours in the Transition from a Tooth to an Implant Restoration in the Esthetic Zone Using a Flapless Approach: A Clinical Report

Two-stage placement of a dental implant is a well-established method for restoring a missing anterior tooth; however, replacement of an anterior tooth by using two-stage implant surgery may result in changes in the interdental papilla height and loss of alveolar bone with compromised esthetic results. Alternatively, the use of a one-stage minimally invasive surgical technique followed by immediate provisionalization may facilitate achievement of esthetic and functional success with minimal discomfort and clinical time. This article presents a clinical case with a single anterior tooth replacement, illustrating ridge preservation with healing, delayed implant placement with immediate provisionalization of the implant to support the soft tissue, and a method of recording the soft-tissue contour in the final impression to achieve an optimal esthetic result.