Incisive Papilla Research Articles

Subjective and Quantifiable Analysis of Palatal Rugae Pattern in Punjab Population

Abstract 
 Background: - Palatal Rugae are irregular, asymmetric ridges of mucous membrane extending laterally from incisive papillae and anterior part of palatal raphe. Palatal rugae patterns are relatively unique to individuals and are well protected by lips, buccal pad of fat and teeth.
 Aims & Objectives: - The aim of the study was to identify pattern of palatal rugae in terms of number, size, and shape and also to compare rugae patterns in males and females of Punjab population.
 Materials & Methods: - A total of 280 maxillary casts that were randomly collected and were examined using graphite pencil and magnifying glass under adequate light with equal number of males & females. Statistical analysis was done by T-test using SPSS software version 20.
 Results: - The mean rugae were found to be more in females than males. Most prevalent form on basis of shape is found to be straight and on basis of size is primary form. Statistically, significant values were found in curved and secondary type, both more in females than males.
 Conclusion: - Palatal rugae pattern is definitely a sufficient characteristic to discriminate between the genders. The present study highlighted the prevalence of palatal rugae in individuals of Punjab population. It is unique to an individual and can be used successfully in identification.

English

BACKGROUND Palatine rugae are small transverse structures present in the anterior 2 / 3rd of the palate. These rugae are protected by various structures of the oral cavity. They are immovable structures but variations in the oral cavity may lead to alterations in these small structures. There have been many studies that have quoted changes in these rugae patterns with various tooth movements whereas various other studies demonstrate no significant changes. None of the studies in specific have mentioned about palatal rugae changes with myofunctional appliances. The objective of this research was to evaluate the palatal rugae morphology and its stability after myofunctional therapy, as expansion and movement of teeth might lead to changes in these rugae. METHODS A total of 90 maxillary casts, 30 of Class I, 30 of Class II pre-treatment and casts of same subjects after myofunctional therapy, patients age ranging between 10 and 13 years were selected for the study. Length, intermedial and interlateral distances, angle of divergence and position of rugae were studied based on Lysell Classification 1955 and Thomas and Kotze Classification 1983. RESULTS Secondary and fragmentary rugae were found to be statistically significant as they were increased in Class II samples compared to Class I. The rugae in Class II samples were found to be shorter and therefore significant results were seen. IM1, IM2, IM4, IM5 and IM6 were found to be statistically significant respectively. Similarly, IL2, IL4, IL5 and IL6 were appreciable. IM1 was found to be appreciable. IL1, IL2, IL3 and IL4 were statistically significant. Significant difference was found in mean rugae value among Class I and Class II pre-treatment groups. Statistically significant difference was found in mean rugae value among Class I and Class II pre-treatment group. Incisive papilla to posterior border of last rugae (IP-PBA) was found to be statistically significant. CONCLUSIONS Myofunctional therapy did have an effect on the rugae pattern. But the age group of 10 – 13 years consisted of growing individuals. Therefore, it could not be concluded as to whether the changes were because of growth taking place or because of myofunctional therapy. KEY WORDS Palatine Rugae, Myofunctional Appliances, Class II Malocclusion

ASSESSMENT OF MEAN DISTANCE BETWEEN CENTRAL INCISOR AND INCISIVE PAPILLA WITH RESPECT TO STANDARDIZED ARCH FORM IN DENTATE SUBJECTS

BACKGROUND & OBJECTIVE: Edentulous patients require accurate positioning of artificial maxillary anterior teeth in complete dentures to recover the esthetic and phonetic characteristics. This positioning is guided by measuring distance between central incisor (CI) and incisive papilla (IP) in dentate subjects which varies according to the ovoid, square and tapered maxillary arch forms.
 Objectives: 1- To determine the frequency of three different arch forms in dentate patients;
 2- To assess the mean distance between central incisor and incisive papilla in each of the three maxillary arch forms.
 METHODOLOGY: 130 cases were selected by non-probability consecutive sampling, which included both genders and age range of 20-40 years. Impressions of maxillary arches were recorded and their casts photocopied. Arch form template was used to standardize the assessment of arch forms by best-fit method on the photocopies. The distance between mesio-incisal edge of CI and posterior border of IP was measured with digital verniercalipers (SparkFun,Colorado).
 RESULTS: Out of 130 subjects, 54 males and 76 females were present. The ovoid arch form was the most frequent form recorded at 67% (n=87) while the tapered arch was the least at 14% (n=18). The overall mean distance between central incisor (CI) and incisive papilla (IP) was 11.34mm (7.58mm - 16.45mm). The mean distance was the highest for ovoid arch form (11.58mm) and lowest for square (10.49) with a statistically significant difference (p=0.016) between the two arch forms.
 CONCLUSION: The ovoid arch was the most frequent arch form found in dentate subjects. The mean distance recorded was highest for ovoid arch followed by tapering arch and least for square arches.

Freio labial superior: Quando e como intervir?

O freio labial superior é uma estrutura anatômica triangular que sofre alterações de forma, função e posição durante o desenvolvimento da criança. Um deslocamento para a porção mais apical cerca de 3 a 4 mm acima da gengiva marginal é esperado. Quando este não ocorre, ficando o freio inserido na papila incisiva, caracteriza-se uma anomalia de desenvolvimento chamada freio teto labial persistente. O momento e o tipo de intervenção nestas situações geram muita controvérsia; a avaliação de fatores como inserção baixa no rebordo alveolar, presença ou não de isquemia da papila palatina quando o freio é tracionado, presença de diastema interincisivos, dificuldade de higienização e/ou alimentação e retração gengival auxiliam na decisão de tratamento. Sendo assim, o objetivo deste trabalho foi apresentar 8 casos clínicos sobre abordagens de freio labial superior, discutindo diferentes momentos. Crianças de distintas idades foram avaliadas e submetidas às seguintes condutas: frenectomia, reposicionamento pela técnica de Chelotti ou acompanhamento clínico para posterior reavaliação. Concluiu-se que, apesar de existir uma indicação frequente de intervenção apenas após a erupção dos caninos superiores permanentes, existem outras situações em que uma abordagem precoce pode trazer mais benefícios ao paciente.

Assessment of posterior tongue mobility using lingual-palatal suction: Progress towards a functional definition of ankyloglossia.

BackgroundA functional definition of ankyloglossia has been based on assessment of tongue mobility using the tongue range of motion ratio (TRMR) with the tongue tip extended towards the incisive papilla (TIP). Whereas this measurement has been helpful in assessing for variations in the mobility of the anterior one‐third of the tongue (tongue tip and apex), it may be insufficient to adequately assess the mobility of the posterior two‐thirds body of the tongue. A commonly used modification is to assess TRMR while the tongue is held in suction against the roof of the mouth in lingual‐palatal suction (LPS).ObjectiveThis study aims to explore the utility and normative values of TRMR‐LPS as an adjunct to functional assessment of tongue mobility using TRMR‐TIP.Study DesignCross‐sectional cohort study of 611 subjects (ages: 3‐83 years) from the general population.MethodsMeasurements of tongue mobility using TRMR were performed with TIP and LPS functional movements. Objective TRMR measurements were compared with subjective self‐assessment of resting tongue position, ease or difficulty elevating the tongue tip to the palate, and ease or difficulty elevating the tongue body to the palate.ResultsThere was a statistically significant association between the objective measures of TRMR‐TIP and TRMR‐LPS and subjective reports of tongue mobility. LPS measurements were much more highly correlated with differences in elevating the posterior body of the tongue as compared to TIP measurements (R2 0.31 vs 0.05, P < .0001).ConclusionsThis study validates the TRMR‐LPS as a useful functional metric for assessment of posterior tongue mobility.

Diffuse palatal pigmentation

A 47-year old Asian man was referred to the Columbia University oral and maxillofacial pathology service for evaluation of a pigmented lesion involving the palate. The lesion was found incidentally by the patient’s dental care provider. The patient’s medical history was significant for chronic myeloid leukemia, which was diagnosed in 2015. At the time of the consultation, the patient was considered to be in remission. The only reported medication being taken by the patient was imatinib (Gleevec, Novartis). There were no significant findings on extraoral examination. Intraoral examination revealed a diffuse, well-demarcated, flat, blue-gray pigmentation in the midline of the hard palate extending from the incisive papilla to the junction of the hard and soft palates (Figure). Mr. Stanbouly is a second year dental student, Columbia University College of Dental Medicine, New York, NY. Dr. Shackelford is a resident, Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY. Dr. Peters is an assistant professor, Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, 630 W 168th St PH1562W, New York, NY 10032.

MYOFUNCTIONAL THERAPY IN ANTERIOR DEEP BITE AND TMD PATIENT-CASE REPORT

Deep bite is perhaps one of the most common dental malocclusions seen in children as well as in adults and is very demanding to be treated successfully. A skeletal or dental overbite is caused by genetic or environmental factors, or a combination of both. The ideal overbite in a normal occlusion may range from 2 to 4 mm. Mild deep bite typically requires no correction, unless correction for aesthetic reasons. Severe overbite, considered as a clinical problem may affect the temporomandibular joint, causes periodontal problems and tooth wearing, as well as traumatizing the incisive papilla or interfering with mastication function. Anterior deep bite could be caused by overeruption of upper and/or lower incisors or undereruption of posterior teeth. Correction of deep overbite has always been challenging to orthodontists, especially in adult cases. There are different modalities in orthodontic treatment of this malocclusion. Deep bite correction can be treated with intrusion of incisors, extrusion of posterior teeth, combination of both, and orthognathic surgical modality. The aim of this case report was to present treatment protocol for an adult patient with skeletal deep bite, Class II Division 1 malocclusion and temporomandibular disorder (TMD) managed with conventional orthodontics therapy combined with orofacial myofunctional exercises. The modality of exercise therapy included improvement of proprioception, tonicity and mobility, working with the facial and cervical musculature, as well as with stomatognathic functions - respiration, mastication, deglutition and speech. The most important thing is to aid long-term retention. Keywords: anterior deep bite, TMD, myofunctional therapy.

Stress Pattern and Deformation in Mid-palatal Suture and Posterior Dentoalveolar Area With Two Different Types of Rapid Maxillary Expansion Appliances: A Finite Element Method Study

Objective: The study was conducted to evaluate stress pattern and deformation in mid-palatal suture and posterior dentoalveolar area during maxillary expansion therapy with two different types of rapid maxillary expansion by finite element method study. Methods and Methodology: The finite element analysis was performed on a model of maxilla, with narrow maxillary base and teeth digitally reconstructed, based on CBCT images, acquired by child (age 12.5 years) but not in permanent dentition stage from available pool data. Result: More amount of stress was observed in mid-palatal suture and posterior dental alveolar area by using the Hyrax appliance as compared to the Haas appliance. Stress pattern evaluated in mid-palatal suture depicts maximum stress concentration on the anterior region of mid-palatal suture at the position of incisive papilla. Deformation in maximum quantity is observed in central incisors. Maximum stress generation and deformation are observed in lingual region of premolar and molar areas. Minimum stress generation and deformation are observed in the posterior part of last molars. Conclusion: Hyrax produces more stress and deformation in mid-palatal suture as well as in the posterior alveolar segment in comparison to Haas appliance. Better results in the immediate skeletal response were obtained by the Hyrax-type expander as compared to the Haas type.

Palatal rugae positional changes during orthodontic treatment of growing patients.

To investigate the anteroposterior and vertical changes of the median rugae area, which is commonly used as dental model superimposition reference, relevant to its underlying skeletal structures. Retrospectively collected pre- and post-treatment cephalometric radiographs and 3D digital dental models of 24 orthodontic patients (age at treatment start: 12.26±0.83 years; assessment period: 2.13±0.68years) were analysed. All had mild to moderate malocclusions that were treated non-extraction with full fixed appliances. The incisive papilla and rugae points were placed on the dental models that were then registered to the cephalometric radiographs. Afterwards, the radiographs were superimposed on Sella, ANS-PNS, and through a maxillary structural method. The vertical and horizontal movements of the papilla and the rugae points, as well as of a central incisor, were measured (Viewbox 4 software). The incisive papilla and the three rugae points remained stable anteroposteriorly, but moved downwards in the vertical dimension (approximately 1-2 mm), in a similar manner (P>.05). However, the anteroposterior position of the papilla and the first rugae points were affected by changes in anterior tooth position and inclination (P<.05). Both the second and third rugae can be used as superimposition references for tooth movement assessment. The use of the papilla and the first rugae area is not recommended, because they are affected by tooth movement. The outcomes of a palatal superimposition are comparable to those of a maxillary skeletal superimposition in the anteroposterior, but not in the vertical dimension.

Movimentos mandibulares durante a fala antes e depois da frenectomia lingual

O objetivo desse estudo foi analisar a velocidade e a amplitude dos movimentos mandibulares durante a fala, antes e depois da frenectomia lingual, em uma amostra composta por 10 sujeitos entre 15 e 21 anos, com diagnóstico de anquiloglossia. Inicialmente foi realizada a aferição da abertura máxima de boca com paquímetro, bem como, da velocidade de abertura e fechamento de boca e da amplitude dos movimentos mandibulares durante a fala, com eletrognatógrafo- BioEGN. Os sujeitos diagnosticados com anquiloglossia foram encaminhados para realização da frenectomia lingual. Após 30 dias do procedimento cirúrgico, novos registros foram obtidos. Para análise dos dados foram aplicados os testes Shapiro-Wilk e o teste t-Student. Quando comparados os movimentos mandibulares antes e depois da frenectomia lingual, a análise das variáveis mostrou que os sujeitos apresentaram diferença estatistica­mente significante dos movimentos mandibulares durante a fala, mostrando que a anquiloglossia interfere na realização desses movimentos. O presente estudo mostra que a velocidade e amplitude dos movimentos mandibulares durante a fala foram melhoradas após frenectomia lingual em pacientes com anquiloglossia.

Intrauterine maxillary development and maxillary dental arch biometry: a fetal cadaver study

IntroductionThis study's goal was to determine normal maxillary development on fetal cadavers. Materials and methodsThis study was carried out on 45 fetuses aged between the 17th - 40th weeks of gestation (24 male, 21 female). The distance between the widest left and right points of the maxillary dental arch (MDA) on the transverse plane, the distance of the papilla incisiva (PI) to the widest left and right points of the maxillary dental arch (MDAW), and the PI and posterior nasal spine (PNS) were measured. The average arch forms of the MDA were created according to trimester groups using the MATLAB program. The one-way ANOVA test was used to make a comparison between trimester groups, and ANOVA followed by post hoc analysis using the Bonferroni test was applied for comparisons. Pearson's correlation analysis was used for correlation analysis. ResultsThe data in the present study did not differ between genders. In the comparison between trimester groups, we did not find any difference between the 3rd trimester and full-term groups only in the PI-MDAW measurement. Other parameters increased with age. In the correlation analysis, the measurement values by age showed a strong positive correlation. The MDAW exhibited the best correlation with age (rweek = 0.919). When the average MDA forms created using the MATLAB program were evaluated, it was observed that the PI-MDAW of the average MDA in the 3rd trimester and full-term intersected. ConclusionsThis study provides a basis for a better understanding of fetal maxillary growth processes and can be useful to standardize the detection of malformations or intrauterine growth restrictions.

Effect of printing direction on stress distortion of three-dimensional printed dentures using stereolithography technology

Fabrication of complete dentures using a 3D printer is quicker and more economic than conventional methods. However, the photopolymer resins used in 3D printers has a lower flexural strength than heat-cured resin. Furthermore, photopolymer resins exhibit anisotropic properties depending on the printing direction, but no studies have evaluated their mechanical properties. The impact of stress distribution caused by changing the printing direction of the 3D printed denture has not been clarified. This study aimed to investigate the effect of different printing directions (0°, 45°, and 90°) of stereolithography (SLA) 3D printed dentures on stress distribution. Artificial mucosa was fabricated to fit a maxillary edentulous model, which was scanned to generate a standard tessellation language (STL) file. Subsequently, the upper denture was designed using computer-aided design (CAD) software, output as an STL file (master data), and set in three different printing directions (0°, 45°, and 90°). It was printed by the SLA 3D printer using photopolymer resin (n=6, in each printing direction). The stress distributions of the dentures were monitored using four rosette strain gauges, which were cemented to the midline of each denture as follows: above the labial frenum (A), at the incisive papilla (B), at the endpoint of the denture (D), and at the mid-point of B and D (C). A load was applied to the posterior region at a loading rate of 20 N/s from 0 N to 200 N using a universal testing machine. Changes in the applied load and strain at each point were recorded. The maximum principal strain (MPS) and the direction of the MPS (θ) were calculated. Each mean MPS was compared using Kruskal–Wallis and Steel–Dwass multiple comparison tests (p < 0.05). The stress distribution showed that the MPS for 45° printing was the lowest at each measurement point except for A under 200 N loading. The MPS at C for 0° was significantly different from that at C for 45° and 90°. The MPS at D in all the printing directions showed significant differences. The MPS at B for 45° was significantly different from that at B for 90°. The MPS at A in all printing directions showed no significant difference. Within the limitations of this study, differences in printing direction affected the stress distribution of SLA 3D printed dentures. The results showed that the stress distribution of the denture printed at 45° by the 3D printer system was the smallest compared with dentures printed at 0° and 90°. These results suggest that a printing direction of 45° is preferable when fabricating dentures using a 3D printer in clinical setting.

Frenulectomy with Diode Laser Technology in Paeditric Patients: Quantitative and Qualitative Evaluations. Randomized Double- Blind Clinical Trial

Background: Ankyloglossia is an anatomical alteration of the frenulum length, volume, compactness, and insertion. It can lead to alterations in the ability to swallow and chewing, and dysfunctional coordination amongst cranio-facial muscles; these alterations are often responsible for respiratory alterations, skeletal malocclusions and dyslalia or the delay of speech. The aim of this study is to estimate the efficacy of lingual frenulectomy with diode-laser technology through a qualitative and quantitative evaluation. Methods: One hundred and twenty-five pediatric patients were recruited: 100 with a lingual pathological frenulum were randomly divided into four operating groups; the other 25 with a borderline pathological frenulum were recruited as a control group. Each patient was included in a follow-up program (T0-T1-T2-T3-T4) for a quantitative and qualitative evaluation: the first through an accurate measurement of Kotlow’s free tongue measurement (≥16), Mouth Opening with Tongue Tip to incisive papilla (MOTTIP), Maximal Intercisal Mouth Opening (MIO) and Protrusion; and the second using the Assessment Tool for Lingual Frenulum Function (ATLFF), Bristol Tongue Assessment Tool (BTAT), and grade of tongue functionality. Results: The increase of the aforementioned quantitative parameters was circa 10 mm, and all patients reacquired full functionality of the tongue. Conclusions: Diode-laser technology is efficient and innovative in the treatment of pathological lingual frenulums.

Determining the occlusal plane using hamular notch incisive papilla plane evaluator: An in vivo study

Aims:Identification and establishment of the occlusal plane in patients with impaired occlusal plane, presents a major hurdle for the execution of natural esthetics, speech, and function. The aim of this study was to minimize such errors while occlusal rehabilitation, and employ hamular notchincisive papilla (H.I.P) plane as landmark and scribe it on the cast using H. I. P evaluator and utilise for occlusal corrections.Settings and Design:HIP plane being parallel to the occlusal plane could ease the operator when it could be scribed on cast to analyze and restore the compromised occlusal plane.Materials and Methods:Dentulous casts of two hundred participants were mounted on the Hanau Wide–Vue articulator. Reference points were marked on the maxillary right central incisor and maxillary molars on casts for attaining different occlusal planes, the incisive papilla and hamular notch region were also marked for HIP plane. A plane parallel HIP was scribed on cast using HIP Evaluator. The casts were then scanned using a three-dimensional coordinate measuring machine attached to perception V5 laser scanner and measurements were made using Geomagic X design software. The most parallel occlusal plane to HIP plane was evaluated, and the reliability of HIP evaluator was verified.Statistical Analysis Used:ANOVA test, Post hoc-Bonferroni test, and independent sample “t”-test were carried out for the comparison between occlusal planes, among the genders and for the analysis of the angle of deviation of scribed plane on the cast to HIP plane on the right and left sides.Results:Occlusal plane III (Mesio-labial incisal edge of upper right central incisor to Mesio-buccal cusp tips of upper second molars) showed least angle of deviation with 1.316° ± 1.158° to HIP plane among tested subjects. There is no significant difference between the genders. The plane scribed on the cast with H. I. P evaluator showed relative parallelism to H. I. P plane with minimum deviation of 0.010° ± 0.363°.Conclusion:Occlusal plane III is more parallel to H. I. P plane. Scribed plane on the cast using H. I. P evaluator is parallel to H. I. P plane. H. I. P evaluator can be used as an alternative tool to establish the occlusal plane to rehabilitate patient with deficient dentition or disordered occlusal plane.

Evaluation of esthetics of incisor position in relation to incisive papilla to replicate in the denture prosthesis.

Background:The distance between the central incisor to incisive papilla (CI-IP) is constant and regarded as one of the landmarks for the placement of artificial teeth in the prosthesis. Earlier studies were done in relation to anterior border of papilla but after extraction the incisive papilla recedes changing the position of anterior border.Materials and Methods:In this study, 100 dentulous subjects were divided into two groups (males and females) with 50 in each group. Maxillary alginate impressions were made and base poured using levelling instrument to standardize all casts and surveyed on the surveyor for uniformity of the casts. The measured distances were analyzed using Student t-test analysis.Results:The ovoid arch was the commonest arch form found in both males and females with slightly more prevalent in females. Analysis was done using Student t-test analysis and found that the mean distance from CI-IP was found to be at 12.85 mm and 12.39 mm in males and females, respectively.Conclusion:When square arch form (both male and female) mean CI-IP was compared with the total sample mean CI-IP, the mean CI-IP of square arch form was less than that of total sample with greater significance (P < 0.05). When ovoid arch form (both male and female) mean CI-IP was compared with the square arch form (both male and female) mean CI-IP, the mean CI-IP of ovoid arch form was greater than that of square arch form with greatest significance (P = 0).

The medicolegal importance of establishing human identity by using dactyloscopy and rugoscopy: A comparative study.

Background:Palatal rugae are irregular and asymmetric mesenchymal ridges that extend in a lateral direction away from the incisive papilla and mid-palatine raphe. Their unique characteristics and environmental stableness justify their inclusion in forensic investigations. Dermatoglyphics or fingerprint patterns are epidermal ridges, which are genetically controlled and are specific to an individual. Hence they are used as a forensic tool.Objectives:The study aimed to assess the reliability of Rugoscopic and Dermatoglyphic patterns for gender identification.Materials and Methods:A total of 200 subjects were recruited in this prospective study. All subjects were between the age range of 18 and 55 years. The subjects were categorized into 100 males and 100 females. Fingerprint dermatoglyphic patterns were recorded using stamp pad, ink, and A4 size white sheets. A subject's fingers were pressed onto the stamped ink pad and lightly pressed over a sheet of paper. Obtained patterns were coded and analyzed as per Galton's criteria into arch, loop, and whorl patterns. Palatal rugae patterns were obtained by making alginate impression material and impression trays. Obtained casts were analyzed for rugae pattern analysis using Kapali's classification. An unpaired t test was used as a statistical tool.Results:On analyzing dermatoglyphic patterns, the arch pattern was most common among male subjects, whereas loop pattern was found to be most common among females. On rugoscopic pattern analysis, Straight pattern was most frequent among males, whereas the circular pattern was common among females.Conclusion:A statistically significant difference was noted between gender and rugoscopic patterns (P = 0.02) and dermatoglyphic patterns (P = 0.03).

Palatal Rugae Patterns in Forensic Identification

Palatal rugae (rugae palatinae or plicae palatinae transversae) refer to a series of transverse ridges on the anterior part of the palatal mucosa on each side of the median palatal raphe and behind the incisive papillae. Palatoscopy or palatal rugoscopy is the study of palatal rugae in order to establish a person's identity. MATERIALS AND METHODS: The study population consisted of 100 healthy subjects, 50 males and 50 females were randomly selected. All subjects were of Indian origin, aged 20 years and above. Impressions were made and poured with type III dental stone. The palatal rugae patterns were highlighted using black graphite pencil on the cast and were analyzed following the classification of Martin dos Santos. RESULTS: Each individual had an unique rugae pattern. Curve form (34%) of rugae was the most common in both males and females whereas none of the casts exhibited the point form of rugae. Following the curve form, the sinuous form was common in males and line form was common in females. CONCLUSION: Palatal rugae can be used as an effective tool in forensic identification. Its internal position, antemortem resistance, uniqueness, and regional variation provide a potentially reliable source of identification to the researchers.

Assessment of the Relationship Between Facial and Dental Midlines with Anatomical Landmarks of the Face and Oral Cavity.

The purpose of the present study was to determine the facial anatomical landmarks, in order of accuracy, closest to the midline of the face, as well as oral cavity midline, and to specify which intraoral anatomical landmarks are closer to the dental midline. Three commonly used anatomical landmarks including nasion, nose, and philtrum tips were marked clinically in 108 subjects. A frontal full-face digital image was used for midline analysis in accordance with the esthetic frame. Deviations from the facial and oral midlines were measured for the three clinical landmarks. Dental midline was considered as the fourth landmark. Alginate impressions were taken, and casts were analyzed under standardized conditions. The labial frenum and incisive papilla were marked. Cast images were taken and analyzed. Data showed difference between the mean ratios of the selected anatomical landmarks and the facial and oral midlines (p≤0/05). The anatomical landmark hierarchies, in proximity to the facial midline, are commissural midlines, nasion, philtrum tip, nose tip, and dental midline, respectively. The anatomical landmark hierarchies, in proximity to the commissural midline, include dental midline, philtrum tip, nose tip, and nasion. The labial frenum was less deviated from the dental midline than the incisive papilla. With respect to shortcomings, the results showed that all of the anatomical landmarks were deviated from the facial and oral midlines. The order of proximity of the anatomical landmarks to the facial midline was as follows: commissural midline, nasion, philtrum, and dental midline.

Distance Between the Most Prominent Labial Surface of Maxillary Central Incisors to the Posterior Limit of Incisive Papilla in Various Arch Forms

Introduction: Arranging artificial teeth has always been a challenging work since edentulous alveolar ridges are in a constant verge of physiological resorptive changes. Incisive papilla is a reliable biometric guide which can be used as a reference for arrangement of anterior teeth, since it is a stable intraoral anatomical landmark unless surgically modified.&#x0D; Objective: This study was conducted to determine the mean distance between the most prominent labial surface of maxillary central incisors to the posterior limit of incisive papilla in various arch forms.&#x0D; Materials and Methods: The study was carried out among 170 undergraduate students of BPKIHS, after obtaining ethical clearance from Institutional Review Committee, BPKIHS. Maxillary impressions were made with alginate impression materials and casts were poured with dental stone. Distance from the posterior limit of incisive papilla to maximum convexity of central incisor (Papillo-Incisal Distance, PID) was measured with a Digital Vernier caliper with a precision of 0.01mm. The arch forms were analyzed and classified into ovoid, tapering and squarish arch, subjectively based on morphological parameters. The intra-examiner reliability of the measurement was tested in 17 casts calculating Cronbach’s Alpha. Pearson Chi-square test was applied to explore the relation of the arch forms with age and gender. One-way ANOVA was used to check the association between the mean PID between with different arch forms.(p value = 0.05)&#x0D; Results: The mean distance from the labial surface of maxillary central incisors to the posterior limit of incisive papilla was 11.58±1.32 mm. The mean papillo-incisal distance varied with respect to different arch forms which was statistically significant (P&lt;0.05). The mean PID of oval, squarish and tapering arch forms were 11.86 mm, 10.82 mm and 11.93 mm respectively.&#x0D; Conclusion: Incisive papilla is a valuable starting point in the preliminary location of maxillary incisors during fabrication of dentures. The suggested mean PID for arranging central incisors is 11.58 mm.

Assessment of techniques used for superimposition of maxillary and mandibular 3D surface models to evaluate tooth movement: a systematic review.

Superimposition of three-dimensional (3D) digital models offers great opportunities to assess tooth movement during time. In the literature, several superimposition techniques are described. To summarize and critically assess the available evidence from studies on serial digital 3D dental model superimposition. MEDLINE via Ovid and PubMed, EMBASE via Ovid, Cochrane Register of Diagnostic Test Accuracy Studies, and Google Scholar were searched with no time limit (last update: December 2018). Hand and unpublished literature searches were also performed. Studies of any design that had a sample size ≥5 and tested superimposition of serial 3D digital dental models to assess tooth movement were included. Study selection, data extraction, and risk of bias assessment were performed independently by the authors. Twelve studies met the eligibility criteria. The total risk of bias (QUADAS-2 tool) of 10 studies was high, whereas only 2 studies had unclear bias. Ten studies had high and two studies low overall applicability concerns. From these, one study tested the mandibular alveolar bone area, three studies the rugae area, nine studies a larger palatal area, and two studies the incisive papilla area. The high heterogeneity in samples, outcomes, and methods did not allow for synthesis of a considerable amount of studies in any case. The high heterogeneity among studies and the limited evidence did not allow for solid conclusions. The following areas of the maxilla could provide reliable outcomes: (1) the medial two-thirds of the third rugae and the area 5 mm dorsal to them and (2) an area including all rugae, with the lateral margins located at least 5 mm from the gingival margins and a distal margin that does not extend beyond the first molars. No recommendation is possible for other regions of the mouth. There is an urgent need for further research in the field. PROSPERO (CRD42019124365).