Premaxilla Region Research Articles

EWING'S SARCOMA IN THE PREMAXILLA OF A PEDIATRIC PATIENT: A CASE REPORT

In August 2019, a 5-year-old female pediatric patient was diagnosed with primary non-metastatic Ewing sarcoma. She began chemotherapy treatment in September 2019, ending in November 2019. Subsequently, she was referred to a head and neck specialist, where a tumor was observed in the upper anterior alveolar edge. A biopsy was performed which confirmed Ewing´s sarcoma and showed an infiltrate in the entire premaxilla without posterior or midface involvement. Surgery for tumor resection was performed in March 2020, with a conclusive biopsy of small and round cell malignant neoplasm, consistent with Ewing´s sarcoma, the surgical margins were compromised, thus requiring complementary radiotherapy treatment. The rehabilitation was performed with a polypropylene obturator prosthesis in the premaxilla region. The patient returned for a check-up, without complaints, and was able to express herself in an intelligible manner, with her stomatognathic functions in balance. In August 2019, a 5-year-old female pediatric patient was diagnosed with primary non-metastatic Ewing sarcoma. She began chemotherapy treatment in September 2019, ending in November 2019. Subsequently, she was referred to a head and neck specialist, where a tumor was observed in the upper anterior alveolar edge. A biopsy was performed which confirmed Ewing´s sarcoma and showed an infiltrate in the entire premaxilla without posterior or midface involvement. Surgery for tumor resection was performed in March 2020, with a conclusive biopsy of small and round cell malignant neoplasm, consistent with Ewing´s sarcoma, the surgical margins were compromised, thus requiring complementary radiotherapy treatment. The rehabilitation was performed with a polypropylene obturator prosthesis in the premaxilla region. The patient returned for a check-up, without complaints, and was able to express herself in an intelligible manner, with her stomatognathic functions in balance.

Three-dimensional Finite Element Stress Pattern Analysis in Bone around Implant-supported Abutment with Different Angulations under Axial and Oblique Load.

The goal of this research was to compare the stress distribution in the bone adjacent to the implant where three different angled abutments were loaded in both the axial and oblique directions. The premaxilla region was digitally recreated in 3-dimension (3D) using a finite element model, with a solid 4.2 mm by 13 mm implant and abutments at 0°, 15°, and 25° of rotation. Axial load (100 N) and oblique load were also applied to the abutments (178 N). Six models were made and used with a fixed bases. The coefficient of friction was set at a constant value of 0.02. The CITIA program was used for the stress analysis. In this investigation, we employed linear static analysis. Each abutment and crown in the model has subjected to an arbitrary vertical load as well as the oblique load. The cortical bone around the implant with a 25° angled abutment experienced a maximum von Mises stress of 187.692 Mpa under oblique load. This stress was increased with the degree of abutment angulation. As abutment angulation was increased, axial and oblique burdens were also increased. In both cases, we were able to identify the source of the observed growth. When we looked at the effect of stress on angulation, we found that the peaks were seen in the area of abutment and cortical bone. Since it was difficult to predict the stress distribution around implants with varying abutment angles in a clinical setting, finite element analysis (FEA) was chosen for this investigation as a more cutting-edge approach. It is a herculean task calculating the prompted forces clinically, FEA has opted for this study as it's a progressively wielded tool to prognosticate the stress allocation in the region of the implants with different angled abutments.

A MULTIDISCIPLINARY APPROACH TO MANAGING BIMAXILLARY HYPERHYPODONTIA: A CASE REPORT

Bimaxillary hyperhypodontia (BHH) is a very rare numeric anomaly with a prevalence of 0.002% to 3.1% described by the presence of a supernumerary tooth in the premaxilla region and a missing mandibular incisor tooth. This case highlights the multidisciplinary management of a child presenting with BHH who complies with the recommended protocol by surgically removing the supernumerary tooth and then proceeding with orthodontic treatment for function and aesthetics. A 9-year-old healthy Malay boy presented with a fully erupted tooth 21, a labially palpable bulge of unerupted tooth 11, a missing tooth 32, and a tendency for an anterior and posterior crossbite. The radiographs showed an inverted, unerupted, conical-shaped supernumerary tooth overlapping the unerupted tooth 11 and hypodontia of tooth 32. The management was surgical removal of the supernumerary tooth and the placement of an upper removable appliance with a palatal expansion screw followed by comprehensive fixed orthodontics.

Heterozygous Variants in FREM2 Are Associated with Mesiodens, Supernumerary Teeth, Oral Exostoses, and Odontomas

Supernumerary teeth refer to extra teeth that exceed the usual number of dentitions. A mesiodens is a particular form of supernumerary tooth, which is located in the premaxilla region. The objective of the study was to investigate the genetic etiology of extra tooth phenotypes, including mesiodens and isolated supernumerary teeth. Oral and radiographic examinations and whole-exome sequencing were performed on every patient in our cohort of 122 patients, including 27 patients with isolated supernumerary teeth and 94 patients with mesiodens. A patient who had multiple supernumerary teeth also had odontomas. We identified a novel (c.8498A>G; p.Asn2833Ser) and six recurrent (c.1603C>T; p.Arg535Cys, c.5852G>A; p.Arg1951His, c.6949A>T; p.Thr2317Ser; c.1549G>A; p.Val517Met, c.1921A>G; p.Thr641Ala, and c.850G>C; p.Val284Leu) heterozygous missense variants in FREM2 in eight patients with extra tooth phenotypes. Biallelic variants in FREM2 are implicated in autosomal recessive Fraser syndrome with or without dental anomalies. Here, we report for the first time that heterozygous carriers of FREM2 variants have phenotypes including oral exostoses, mesiodens, and isolated supernumerary teeth.

Occurence of Dens Invaginatus in Two of the Four Impacted Mesiodentes - A Rare Case Report

Supernumerary teeth are defined as excess number of teeth as compared to normal dental formula. Mesiodens is a supernumerary tooth in the central region of premaxilla between two central incisors. Multiple Mesiodens are called Mesiodentes. This additional tooth structure may cause disturbance in eruption or position of adjacent teeth. Dens Invaginatus (DI) is a rare tooth malformation showing an infolding of enamel and dentin of affected tooth sometimes extending deep into the pulp cavity and root portion. This paper aims to present a rare association of DI in two of the four impacted Mesiodentes in a 10-year-old girl patient causing eruption disturbance and unaesthetic appearance in anterior maxilla.

Horizontal Bone Augmentation in the Pre-Maxilla Region with Used the Bone Block Xenogeneic Origin - Clinical and Tomographic Analysis

Tooth loss, especially in the anterior region, generates a loss of local bone structure affecting the aesthetics and function for the patient and a viable tactic is the use of deproteinized bovine bone block graft. This reconstructive method allows the possibility of partial or total reconstruction of the maxilla and mandible in a safe and predictable way, where it seeks the maintenance of the three-dimensional structure, viability of bone neoformation and favoring implant-supported rehabilitation. This case report aims to reveal and support the longitudinal follow-up of 5 years of a horizontal alveolar reconstruction in the anterior maxillary region with heterogeneous bone block and subsequent implantation and rehabilitation with metal-ceramic crown.

Utilização de fios de polidioxanona (PDO) associado à preenchedor facial e toxina botulínica – relato de caso

Facial aging is a continuous process, accompanied by changes in facial structures that culminate in the appearance of wrinkles, infraorbicular bags and skin sagging. The use of polydiaxone spiked threads (PDO) has been showing satisfactory results as a minimally invasive modality for the treatment of facial ptosis. Clinical observations suggest that the effects of facelift with PDO threads are prolonged when combined with other aesthetic treatments. Considering this, the present work aims to present a clinical case where the association of techniques for facial rejuvenation was carried out, using PDO threads, hyaluronic acid for facial filling and botulinum toxin. A 61-year-old female patient sought professional help with interest in performing minimally invasive cosmetic procedures for facial rejuvenation. For the first clinical session, the application of botulinum toxin and the insertion of PDO spiked threads were planned. It was applied 56U of botulinum toxin to the upper third of the face and 8 spiculated threads were inserted for face lifting in the middle third of the face with the aim of reducing ptosis in the adipose compartments. After 2 months, a new clinical session was performed in order to fill in and add volume in strategic points of patient’s face. Hyaluronic acid was applied in the premaxilla region. Patient presented a rejuvenated facial appearance after the procedures performed, reflecting evident improvements in the quality of life, resulting in physical and emotional well-being for the treated patient.

Anatomical characteristics of nasopalatine canal using cone beam computed tomography images

It is widely accepted that any interventional treatment, such as surgery, requires a precise and predetermined treatment plan. Moreover, conventional images do not allow for the presentation of all canal dimensions, and patients concepts of beauty and their expectations are greater for the premaxilla region. Therefore, the use of three-dimensional images is essential in surgical procedures, such as pathological lesions or implant placement surgeries. In cone-beam computed-tomography images, the nasopalatine canal was examined in sagittal, coronal, and axial planes. The diameters of nasopalatine and incisive foramina were separately measured, and the length of the nasopalatine canal was found by measuring the distance between the mid-levels of the nasopalatine foramen and incisive foramen. The shape of the canal was assessed in the sagittal and coronal planes in the mid-level of the canal. In addition, the shape of the canal and posterior borders were examined in the mid-level of the canal in the axial plane. The nasopalatine angle was measured as an anterior angle between the long axis of the canal and the hard palate. The number of canals in the midline and openings in each plane was also counted. The nasopalatine canal in the sagittal plane was classified into six groups: conical (33.2%), cylindrical (25.6%), hourglass (24.7%), funnel-shaped (9.8%), reverse-cone (4.3%), and spindle (2.4%). In the coronal plane, the shape of the canal was assigned to three categories: single channel (59.2%), Y-shaped (31.2%), and dual-channel (9.6%), and the posterior border of the nasopalatine canal was classified into four groups: U-shaped (42.5%), V-shaped (37.2%), reverse-V-shaped (154%), and Y-shaped (4.9%). Finally, in the axial plane, the canal shape was classified into four groups: round (40.5%), oval (31.1%), heart-shaped (21.3%), and triangle-shaped (7%). The use of three-dimensional images should be strongly considered in all surgical interventions involving the nasopalatine canal, such as dental implant placement since any error in surgical interventions will bring about serious consequences due to higher aesthetic expectations for the anterior maxillary region. Due to the lack of correct diagnosis of canal morphology in conventional images, such as periapical and panoramic radiography, it seems necessary to use three-dimensional radiography when performing surgical interventions in this region.

Premaxilla Stress Distribution and Bone Resorption Induced by Implant Overdenture and Conventional Denture.

To relate the principal stress, strain, and total deformation in the premaxilla region beneath a complete denture to the pattern of premaxilla bone resorption when opposed by a conventional complete denture (CD) or by a two-implant-retained overdenture (IOD) using finite element analysis (FEA). Three-dimensional solid models of the maxilla, mucosa, and denture of a selected edentulous patient were created using Mimics and CATIA software. The FEA model was created and duplicated in ANSYS 16.0 to perform two simulations for the IOD and the CD models. The values of maximum stress and strain and total deformation were obtained and compared to the outcomes of premaxilla resorption from a parallel clinical study. The maximum principal stress in the premaxilla in the IOD model ranged from 0.019 to 0.336 MPa, while it ranged from 0.011 to 0.193 MPa in the CD model. The maximum principal strain in the IOD model was 1.75 times greater than that in the CD model. Total deformation was 1.8 times higher in the IOD model. Greater bone resorption was observed in regions of higher stress, which were on the occlusal and buccal sides of the premaxilla residual ridge. Stress, strain, and total deformation values present in the premaxilla area beneath a CD were approximately two times greater in a comparison between an opposing mandibular two-IOD and an opposing mandibular CD. The results were consistent with a parallel clinical study in which the rate of premaxilla bone resorption was almost three times greater in the IOD group.

Clinical Significance of Impacted Supernumerary Teeth of a Group of Sri Lankan Children Aged 7 to 13 Years

Aim: The objective of this study was to investigate the characteristics of impacted supernumerary teeth (SNT) and their sequalae in a group of Sri Lankan children. Methods: Data were collected from the archives of patient's records and radiographs. Descriptive analysis was made from data using Minitab Statistical Software. Results: A total number of 58 impacted SNT were found in 49 children. The mean age of the sample was 9.89 ± 2.01 years and male to female ratio was 2.77: 1. Out of 49 subjects 81.6% had one impacted supernumerary tooth and 18.4% had two. The majority of the children with impacted SNT were in the age range of 8-10 years (44.9%) followed by 11-13 years (40.82%) and 5-7 years (14.28%). While 57 (98.3%) SNT were identified in the region of premaxilla only one was seen in the canine region. The commonest shape was conical (63.8%), followed by tuberculate (20.75%), odontomes (12.1%) and supplemental (3.4%) respectively. Regarding the direction of impaction of SNT, many (48.3%) were inverted followed by vertical orientation (37.9%) and other directions (13.78%). The common sequalae associated with impacted SNT were delayed eruption of the permanent teeth (46.55%) and malocclusion (20.68%). There were considerable numbers of cases without any clinical effects (29.31%) at the time of presentation to the clinic. Vertically oriented SNT caused more clinical problems (72.72%) than the inverted impacted SNT (64.28%). Conclusion: SNT were more prevalent among males (M:F = 2.77:1) than females and were mostly diagnosed in the age range between 8 - 13 years. DPT (Dental Panaromic Tomogram) radiological investigation is suggested when the patient presents with one SNT as there is a tendency for paired supernumeraries.

Effect of platelet-rich plasma in alveolar distraction osteogenesis: a controlled clinical trial

We have evaluated the effect of the use of platelet-rich plasma in alveolar distraction osteogenesis. Fourteen patients who were partly edentulous in the anterior premaxilla region were selected and randomised into two groups (n=7 in each group). Those in the experimental group were give platelet-rich plasma at the time of distraction, and the control group had only distraction. Selected cases had defects in the alveolar ridge of more than 3mm, and a minimal bone height of 7mm from the alveolar ridge crest to important anatomical structures. The plaque index and gingival index were recorded on days 3, 7, 14, 21, 28, 45, 60, 75, 90, and 105 postoperatively. There was a strong negative correlation between the gingival index and augmentation of bone, and a strong positive correlation between the mean gingival index and loss of bone from the transported segment. The addition of platelet-rich plasma had a protective effect on the mucosa around the distractor, which decreased the potential for complications.

Bilateral Maxillary Central Incisor Impaction associated with Developing Supernumerary Premolars in the Mandibular Arch

Impaction of maxillary permanent incisor is not a frequent case in dental practice, but its treatment is challenging because of its importance to facial esthetics. Various local causes responsible for impaction, such as odontoma, supernumerary teeth and space loss supernumerary teeth are the main cause of impaction of upper incisor. We report a case of 15-year-old girl with bilaterally impacted supernumeraries in the premaxilla region associated with asymptomatic impacted developing supernumerary premolars in the mandibular arch. The supernumeraries of premaxilla region impeded the eruption of the permanent maxillary central incisors. The impacted supernumerary tooth was surgically removed and brackets bonded to the central incisors to apply orthodontic extrusive force which brought the central incisors down to their proper position in the dental arch.

Three Dimensional Finite Element Analysis of Stress Distribution Around Implant with Straight and Angled Abutments in Different Bone Qualities

The aim of the study was to compare the stress distribution around implant in different bone qualities of D1, D2, D3, and D4 with straight and angled abutments using three dimensional finite element analysis. A three dimensional finite element model of the premaxilla region, and two solid 4.3×10mm implant, one with a straight abutment and the other with an angled abutment was done. Four distinctly different bone qualities of D1, D2, D3, and D4 were made. A static load of 178N was applied at the centre of incisal edge along the long axis of each abutment. The maximum equivalent von Misses stress values around the implants were recorded. The distribution of stresses changed considerably with abutment angulation. As angulation increased from 0° to 15° the concentration of Von Misses stresses shifted to the cortical layer of bone on the facial side of the fixture. Although Von Misses stress increased in straight abutment as the bone quality changed from D1 to D4, it was more noticeable under the loading side of the angulated abutments. The high stresses induced through angled abutments at the cervical zone of the implant due to forces and moments could be a dominant factor that may aggravate the peri-implant bone loss or changes the existing peri-implantitis direction.

Association of Mesiodentes and Dens Invaginatus in a Child: A Rare Entity

Supernumerary teeth are defined as any teeth in excess of normal number. Mesiodens is a supernumerary tooth, in the central region of premaxilla between two central incisors. Dens invaginatus is a developmental anomaly resulting from invagination in the surface of tooth crown before calcification has occurred. Radiographically, it is observed as infolding of a radioopaque ribbon like structure, with equal density as enamel, extending from cingulum into a root canal and sometimes reaching the root apex. This paper aims to present a rare association of dens invaginatus with two mesiodentes in a child causing the eruption disturbance and unaesthetic appearance in anterior maxilla.

The development of supernumerary teeth in the mandible in cases with a history of supernumeraries in the pre-maxillary region

This article presents four cases in which delayed formation and late eruption of supernumerary teeth in the mandible occurred in patients with a history of supernumerary formation in the premaxilla region. In all cases, the premaxillary supernumeraries prevented eruption of the associated permanent incisor(s).

Clinical application of cone beam digital volume tomography in children with cleft lip and palate

The diagnostic advantages of digital volume tomography (DVT) over conventional imaging and computed tomography are demonstrated in terms of the respective radiation exposure. The potential role for three-dimensional imaging in cleft lip and palate patients is illustrated on the basis of clinical examples. The radiation exposure resulting from scans using a cone beam DVT (NEW TOM QR-DVT 9000, Marburg, Germany) was measured with an Alderson-Rando-Phantom (The Phantom Laboratory, New York, NY) and compared with that resulting from other standard imaging modalities. The patient sample consisted of young children with cleft lip and palate on whom orthodontic and surgical treatment was planned on an interdisciplinary basis at the University-Hospital of Heidelberg. Digital volume tomography allows high-quality three-dimensional imaging of the premaxilla region, with an effective equivalent investigation dose of (110 kV, 5.4 mA) 0.342 mSv based on ICRP recommendations. While the effective equivalent investigation dose for DVT is higher than that for standard imaging techniques (for example digital panoramic radiograph Orthophos Plus DS Ceph (66 kV, 8 mA) 0.016 mSv), it is much lower than that for a normal CT scan (e.g. Picker International Inc., Highland Heights, OH) adjusted at (spiral 130 kV, 125 mA, and 30 mA, 1.5 s) 2.27 mSv. Digital volume tomography provides extensive data important in clinical decision making. The clinical examples show the good applicability of DVT with a reduced radiation dose.

Supernumerary teeth at primary and permanent dentition

Development disturbance originate in the odonthogenesis and begin around the 40 TH week. It might occur on both dentitions, being scarcer in the primary one. Several hypotheses are mentioned for etiology of the supernumerary teeth and, among them, that one about hyperactivity of the Dental Blade, what would cause increment in the quantity of dental elements. There are correlations among the alteration in the quantity of teeth and systemic diseases, several syndromes as: Cleidocranian Displasia, Gardner Syndrome and Labial and Palatal Fissures. The clinical case of a male patient, 8 years old, leukoderm, which upper deciduous central incisors never exfoliated. The clinical examination demonstrated the presence of two erupted deciduous supernumerary elements between the elements 52 and 53. The radiographic tests (orthopantomography and per apical R-X of the incisors region) indicated the presence of further two impacted permanent supernumerary elements in the pre-maxilla region. The treatment plan selected was therapy for space maintenance in the arch with surgical removal of the supernumerary elements and orthodontic motion. Multidisciplinary approach provided adequate diagnosis and treatment to the patient.

New remains of Sphagesaurus huenei (Crocodylomorpha: Mesoeucrocodylia) from the Late Cretaceous of Brazil

ABSTRACT Recent discovery of an almost complete skull of Sphagesaurus huenei, a previously poorly known form from the Late Cretaceous of southern Brazil, shows unexpected morphology for a crocodyliform, including an extreme heterodonty with small lower incisors, large upper caniniforms, and reversed triangle-like postcanines; edentulous anterior region of premaxilla; and maxilla with posterior wall over the anterior margin of the suborbital fenestra. The postcanine teeth have extensive wear facets, implying an alternate unilateral occlusion and suggesting the presence of both lateral and fore-aft movement of the jaw. These characteristics appear unique within the crocodyliform lineage, showing that feeding diversity was wider than thought in this clade. The phylogenetic relationships of Sphagesaurus huenei are evaluated through a parsimony analysis. Sphagesaurus lies within a monophyletic group formed by Cretaceous and Tertiary taxa traditionally referred as notosuchians and sebecosuchians. Interestingly, several mammal-like tooth morphologies were present in this clade of terrestrial crocodyliforms.