Premaxillary Region Research Articles

Topic: All-on-Four Concept Literature Review

In patients with total edentulism, dental implant treatment is a treatment model which has been accepted scientifically, and with long-term outcomes [1,2]. Dental implants with immediate function by making implant-supported fixed full-arch restorations are becoming the gold standard in dental implantology [3-5]. Normally in literature successful prostheses are made using [6-8] implants in the maxilla and 6 implants in the mandible and applying posterior cantilever extension where it is necessary, in these treatments, hygiene controls can be easily performed especially in full arch screw-retained fixed prostheses [7-9]. In some cases maxillary sinuses for maxilla restricts the implant placement in the posterior region. The posterior implant treatment is also difficult in patients with resorbed mandible with a mandibular nerve located at the top of the alveolar crest. The all-on-four implant concept has been developed to prevent these disadvantages presented by Malo for the first time in 2003 and the all-on-four concept that began to be used in atrophic full arch mandibular and in the maxilla in 2005. In this technique implants are positioned in the pre-maxillary region in the maxilla and in the inter-foraminal region in the mandible.Anterior implants are placed to the lateral incisor sites or canine/first premolar region, posterior implants are placed to the second premolar or first molar region [12-16].

The radioanatomization of the Nasopalatine canal on Cone Beam Computed Tomography – an eloquent study

The Nasopalatine Canal (NPC) was investigated using Cone Beam Computed Tomography (CBCT) to better comprehend its significance and semantic attributes in the diagnosis and treatment of pathologies and reconstructive surgeries involving the premaxilla, as it is more susceptible to progressive resorption and alterations in the morphometrics of the NPC, which increases its clinical significance. Axial, coronal, and sagittal CBCT sections were analysed in a sample of 60 individuals between the ages of 18 and 70. The chi-square test was used to examine differences between categorical variables, while the independent t test and the ANOVA test were used to examine differences between continuous variables. A statistically significant adjudication vis-à-vis the transverse and longitudinal diameters of the Stensen foramen in the axial section, the transverse dimension of the NPC at Level C, and the labial bone length and labial bone width at Level 2 in the sagittal section bequeathed scientific acreage to this study. The Labial bone length and Labial bone width at Level 2, which were not contemplated in other researches, constitute this study as yardstick for imminent inquiries of NPC in these demeanours. This interpretation made an assay of various parameters of NPC, elaborated on the relevance of NPC in the anterior maxilla, and emphasised chartering a protocol to facilitate excellent surgical planning techniques in the placement of dental implants and surgical implants in the premaxillary region, admonishing maxillofacial trauma impacting the aesthetics, and ministration of the various pathologies.

Breastfeeding Effect on Primary Teeth Emergence in Relation to Craniofacial Growth among Iraqi Infants

Background: Breastfeeding is more than just nutrition; it can be viewed as a natural orthotic device for the harmonious development of the face. Sucking has an impact on a child’s premaxillary region’s growth, and mandibular movements encourage mandibular growth. Along with the advantages for general health, breastfeeding also helps with the right development of teeth, face muscles, and occlusion. Hence symmetric, well-proportioned face and appropriate occlusion depend on balanced facial growth. Objectives: This study aims to evaluate the effect of breastfeeding on the timing of teething in relation to craniofacial development. Materials and Methods: This study is a cross sectional comparative study concerning craniofacial growth assessment, with prospective view concerning timing of eruption. Sample was composed of 100 breastfed infants compared with 100 infants depending on formula milk. Clinical examinations and follow-up for teeth emergence was done for whole sample. Results: Breastfeeding was found to be associated with early teeth emergence. Additionally, although, there were no significant differences between facial growth and feeding pattern there was a significant correlation between delay eruption time of primary dentition and facial growth parameters (mandible and maxilla depths) among bottle-feeding group. Conclusion: The current study confirms the effect of breastfeeding on the early teething emergence of primary dentition; however, there were no significant differences between type of feeding and facial growth parameters. While a significant relation between delay eruption time and facial growth parameters (mandible and maxilla depths) was found among bottle-feeding infants.

A Comparative Measurement of Edentulous Bone Between Cone Beam Computed Tomography vs. Dentascan CT in Implant Patients: In Vivo Study

Aim: To compare the linear and mesiodistal measurement of alveolar edentulous bone between CBCT and Dentascan CT. Vivo-comparative study. Materials and Methods: 30 implant patients were selected among the partially edentulous ridge in pre-maxillary region. After using a radiographic stent splint (3×3 mm square), a CBCT and Dentascan was scanned. Linear and mesiodistal radiographic evaluations were performed from a built-in software tool. The student unpaired t-test was used for finding significant difference in between and within group. P-value less than 0.05 was considered to be statistically significant. Results: Linear Radiographic Evaluation by Dentascan was 20.75 ± 2.14 and by CBCT was 20.86 ± 2.18, Mesiodistal Radiographic Evaluation by Dentascan was 6.71 ± 0.70 and by CBCT was 6.79 ± 0.70. Conclusion: The linear assessment of the implant site taken on Dentascan was almost similar to that recorded on CBCT and P-value is not significant (>0.05).

Management of atrophic jaws with all-on 4 concept - A review article

A typical condition in older patients is the event of edentulous, which can be the after effect of many factors like poor oral hygiene, dental caries, and periodontal problems. It has negative social and psychological effects on individuals that include adverse impacts on facial and oral esthetics, masticatory function, and speech abilities, that when combined, are translated into significant reductions in patients’ quality of lives. conventional removable complete dentures, implant-supported removable, & fixed prosthesis are all the alternatives prosthetics options for restoring the edentulous jaws. The all-on-four concept is offered as an alternative to conventional implant applications in which four implants are placed in the inter foraminal region in the mandible and in the pre-maxillary region in total edentulism cases. The two anterior implants follow the jaw anatomy and the two distal implants are tilted at 45° angulation posteriorly. This arrangement allows for good implant anchorage, short cantilever length, and large inter implant distance thus favoring fruitful outcome of the treatment. The goal of this review is to determine the underlying principles of this concept and to illustrate the method's benefits and drawbacks.

En-masse Distalisation of Mandibular Dentition with Ramal Miniplate for Correction of Class III Malocclusion: A Case Report

Mandibular arch distalisation is a non extraction camouflage treatment modality for class III malocclusion, and the introduction of skeletal anchorage devices has enabled its use with minimal patient compliance and reciprocal side effects. The aim of this case report was to show the efficacy of the retromolar fossa as a suitable skeletal anchorage site for mandibular dentition distalisation. Inter-radicular miniscrews are the most commonly used forms of skeletal anchorage; however, they are often problematic in the mandible because of their high failure rate in the posterior region. In order to avoid these issues, some clinicians place miniscrews extraradicularly in the buccal shelf area or in the retromolar area. This approach is demonstrated through a case report of an 18- years-old male patient with a chief complaint of extra teeth and spacing in the upper front teeth. The diagnosis formulated was a Class III skeletal pattern, anterior divergence, Angle’s Class III malocclusion with an edge-to-edge bite and presence of mesiodens in the premaxillary region. The treatment approach was to use skeletal anchorage to distalize the mandibular arch with ramal plates after extraction of the mandibular third molars, since the patient refused the surgical treatment. At the 1 year follow-up appointment, there was no noticeable relapse or signs or symptoms of adverse effects like gingival recession, mobility and bone loss.

Clinical, Histological, and Scintigraphic Comparative Study of the Use of Mandibular Bone Marrow and Peripheral Blood in Bone Neoformation

Materials and Methods The study included 16 patients with maxillary atresia. The region was grafted with xenograft blocks associated with the following treatments: G1, the patient's peripheral blood during surgery, and G2, dripping of mandibular bone marrow blood until the xenograft was completely wet. After 7 and 14 days, scintigraphic images of the regions of interest (ROI) were taken to quantify pixels, which indicate osteogenic activity. Additionally, trephined samples obtained at the time of implant placement were stained in H&E, and newly formed bone tissue was quantified. The data were tabulated and statistically analyzed at a significance level of 5%. Results Scintigraphic data showed greater osteogenic activity with mandibular bone marrow blood (G2) at all times evaluated (p < 0.05). As for the histomorphometric analysis, a greater amount of bone tissue was observed in samples treated with mandibular bone marrow blood (G2) compared to peripheral blood (G1) (p < 0.05). Conclusions The appositional bone reconstruction technique in the block associated with mandibular bone marrow blood increased bone neoformation and osteogenic activity compared to conventional graft treatment with peripheral blood.

Cysticercosis of head and neck region

&lt;p class="abstract"&gt;Cysticercosis is a major public health problem especially in developing countries like ours. Disease can be prevented by increasing the public awareness about personal hygiene and sanitation. The disease commonly affects the central nervous system and the condition is referred to as neurocysticercosis. Neurocysticercosis is probably is the commonest parasitic infestation of the central nervous system (CNS). Although the extracranial involvement is exceedingly rare. The head and neck regions commonly affected are tongue, sternocleidomastoid muscle, masseter muscle and strap muscles of the neck. Isolated cases of cysticercosis have been reported in the literature in head and neck region. We are reporting the case series of seven cases of extracranial cysticercosis presenting in different parts of head neck region. Two cases presented with a tongue nodule, two cases in the region of masseter muscle, one case in the pre-maxillary region and one in the sternocleidomastiod muscle in the neck. All cases were dealt with a clinical suspicion of cysticercosis as the condition is endemic in our region. The empirical treatment was started in all the cases after demonstration of cyst on ultrasonography. The cases responded to the oral albendazole combined with corticosteroid therapy. As the disease is a common entity in our country all cases presenting with firm, long standing, single swelling in the head neck region should be dealt with suspicion of cysticercosis. Early diagnosis and treatment can prevent the hazardous intracranial complications and mortality.&lt;/p&gt;

Congenital Epulis: A Two-Case Report

Congenital epulis is a rare benign tumor of the newborn that could be detected in the prenatal period. Females are more often affected than males and the premaxillary region is usually the predilection site for this oral mass. Excision is the treatment of choice and no recurrences have been reported so far. We present our experience with two cases of congenital epulis, detected in the second trimester of gestation and treated shortly after birth with no further complications. Histopathology should differentiate between congenital epulis and other congenital oral tumors even if its clinical appearance is usually enough to make a tentative diagnosis. A multidisciplinary assessment in the management of this tumor can avoid unwanted complications such as airway obstruction or bleeding.

Gross Anatomical Study of Congenital Meningoencephalocoele and Craniofacial Deformities in A Kid

Background: Occurrence of congenital anomalies are less common in small ruminants, especially in goats compared to sheep. Most common cause for the congenital deformities in new born ruminants is due to the ingestion of toxic plants during gestation. Congenital meningoencephalocoele with associated craniofacial deformities is a rare occurrence in goats. Materials: A day old crossbred kid was presented with cranial defects and protrusion of brain through the defect. Detailed examination of the animal revealed cranioschisis in the frontal and parietal region along with presence of cleft lip, cleft palate and accessory ear lobe on the right side. Herniation of meninges and brain was exposed directly and was not covered by skin. There were two parietal cranial defects separated by a plate of bone. Result: Postmortem examination of the animal showed bilateral cleft lip and cleft palate with lateral deviation of nasal septum and deformation of premaxillary region. On reflection of skin over the frontal region, revealed frontal cranioschisis and the brain was situated subcutaneously. There were total of three cranial defects (two in the parietal and one in the frontal region) separated by small plates of bone in between them. This present study explains the anatomical aspects of cranioschisis, meningoencephalocoele, cleft lip, cleft palate and associated craniofacial abnormalities in a day old kid.

Rare presentation of Aspergillus as cystic swelling in pre-maxillary region

&lt;p class="abstract"&gt;Subcutaneous fungal infections are caused by penetration of the causative fungi into the subcutaneous layer and usually present as single, localised non-tender nodular swelling. The diagnostic process is a vital dynamic process that requires effective communication and efficient collaboration. Aspergillus hyphae invade host tissues through release of various toxins like proteases, phospholipases, hemolysins, gliotoxin, aflatoxin, phthioic acid and other toxins. Under general anesthesia and proper aseptic conditions using Moure incision surgical debulking of the pre-maxillary mass was done and post-operatively oral antifungal medication was started. Multiple cystic swelling was sent for histopathological examination and found to be non-invasive Aspergillus fungal infection. Subcutaneous form of aspergillosis manifest as subcutaneous fungal infection. We presented an unusual case report of 45 years old immunocompetent female with cystic presentation of aspergillosis involving premaxillary region.&lt;/p&gt;

Biomechanical performance of the cranio-mandibular complex of the small notosuchian Araripesuchus gomesii (Notosuchia, Uruguaysuchidae).

Notosuchia is a clade of crocodyliforms that was highly successful and diverse in the Cretaceous of Gondwana. Araripesuchus gomesii is a small notosuchian from the Early Cretaceous of Brazil that belongs to Uruguaysuchidae, one of the subgroups of notosuchians that first radiated, during the Aptian-Albian. Here we present a finite element analysis of A. gomesii based on a model reconstructed from CT scans and performed using published bone properties for crocodiles. The adductor musculature and their respective attachment areas were reconstructed based on Extant Phylogenetic Bracket. Different functional scenarios were tested applying an estimated 158 N bite force: unilateral bite, bilateral bite, pullback, head-shake, and head-twist. The results obtained were compared with those of Alligator mississippiensis, one of its closest living relatives. In the different simulations, the skull and lower jaws of Araripesuchus suffers more stress in the head-shake movement, followed by the unilateral and pullback bites with stress focalized in the premaxillary region. In contrast, the head-twist is the one with smaller stress values. Araripesuchus possess an oreinirostral skull that may provide greater overall resistance in the different scenarios on average, unlike Alligator that has a platyrostral skull with less resistance to dorsoventral mechanical loads. Previous hypotheses that considered A. gomesii as omnivorous coupled with our results, its small size, and likely limited bite force, suggest this taxon probably fed on small prey and other trophic items that could catch and handle entirely with its mouth, such as insects and small vertebrates.

Various Supernumerary Teeth in the Mandibular Premolar and Premaxillary Regions

Various Supernumerary Teeth in the Mandibular Premolar and Premaxillary Regions

Facial rehabilitation with implant-retained nasal prosthesis of acrylic resin: a case report

ABSTRACT The objective of this study was to report a clinical case of facial rehabilitation with an acrylic implant-retained nasal prosthesis after partial rhinectomy resulting from the resection of a basal cell carcinoma in the patient, a 53-year-old Caucasian, normosystemic, professional cowboy. After clinical examination and in possession of computed tomography images, surgery was performed for the placement of conventional dental implants in the premaxillary region (left side). After the surgery, a three-month period of waiting was observed to allow osseointegration of the implants. Later, the nasal prosthesis was prepared, and at the end of treatment, this presented satisfactory peripheral adaptation, retention and esthetics. The patient has returned for follow-up every 6 months, regarding analysis of the prosthesis color, peri-implant health, hygiene, and exchange of the magnets and relays when necessary. The authors concluded that this therapy may be well indicated in patients with partial and total nasal defects, provided that there is correct planning and execution of the surgical, clinical and laboratory phases.

Técnica vista em enxerto de tecido conjuntivo em área estética peri-implantar – relato de caso

Obtaining a satisfactory soft tissue architecture is a requirement of fundamental importance in rehabilitation with dental implants, especially in aesthetic areas. The objective of this paper is to report a clinical case, in which a connective tissue graft was used by the VISTA technique (Vestibular Incision Subperiosteal Tunnel Access) to gain thickness of the peri-implant mucosa in the premaxillary region. Conclusion: the technique proved to be satisfactory and predictable of success, and could be an excellent alternative for procedures to increase the thickness of the peri-implant mucosa.

Bilateral Nasopalatine Duct Cyst: A Diagnostic Quandary Solved

The Nasopalatine Duct Cyst (NPDC) also commonly referred to as the anterior midline palatine cyst is a developmental cyst derived from the proliferation of embryonic epithelial remnants of nasopalatine duct. It is unique for the reason that it develops in only one location, which is the midline of anterior maxilla in close relationship to the nasopalatine canal. Radiographically, it presents as a well-demarcated ovoid or heart shaped cystic structure which is seen in close proximity to the apex of maxillary central incisors. Due to its anatomical location, it can be sometimes misdiagnosed as central giant cell granuloma, periapical cyst or follicular cyst. Chronic, large periapical lesions following traumatic injuries are challenging to diagnose and treat. The present case report described the successful management of a rare case of bilateral NPDC in a 30-year-old male patient, who gave a presentation closely mimicking that of an infected periapical cyst. The case was treated by both conventional endodontic therapy and surgical intervention. The NPDC tends to show a predilection in giving rise to squamous cell carcinomas which commonly occur in the anterior part of the maxilla. Therefore, cystic lesions seen in the premaxillary region require a thorough analysis so as to successfully treat the lesion and to avoid further complications that may arise due to a missed diagnosis.

Evaluation of Changes in Nasopalatine Canal Morphology According To Dentition Status by Computed Tomography

Objective: The nasopalatine canal (NPC) is one of the important anatomic structures in anterior maxilla. The aim of this study was to evaluate the changes in NPC morphology according to dentition status in the maxillary anterior region by computed tomography (CT). Methods: Computed tomography images of 100 patients were screened retrospectively. Images were divided into two groups by dental status: an edentulous group (EG) of 50 patients who have edentulous premaxilla and a control group (CG) of 50 patients who have all incisor teeth in the premaxillary region. After recording the age, sex, and dentition status of the patients, the NPC diameter, NPC length, incisive foramen (IF) diameter, and angle between the NPC and palatine bone were measured in sagittal sections, and the number of NPCs was determined in axial sections. Results: There was no significant difference between NPC angle and dentition status (p=0.151). The NPC diameter was significantly higher in the EG (p=0.002), as was the IF diameter (p=0.041). In addition, NPC length was significantly higher in the CG (p&amp;lt;0.001). A statistically significant and negative correlation was found between age and NPC length (p&amp;lt;0.001), and a positive correlation was found between age and NPC diameter (p=0.004). In addition, no statistically significant difference was found between sex and other parameters (p&amp;gt;0.05). Conclusion: The NPC length and diameter vary according to the age and dentition status of the patient. Changes in this anatomic structure should be evaluated pre-operatively in elderly patients by three-dimensional radiographic evaluation.

Premaxillary Deficiency: Techniques in Augmentation and Reconstruction.

Progressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communities, or in cleft lip nasal deformity, and may represent a challenge for the plastic and reconstructive surgeon attempting correction in the setting of facial contouring, rhinoplasty, or reconstruction following oncologic resection or trauma. Aesthetically, premaxillary retrusion may be coincident with an acute nasolabial angle and ptotic nasal tip. Minor deformities may be addressed with use of either alloplastic implants, autogenous tissue, lipotransfer, or injectable filler. Larger composite defects may require reconstruction with implementation of free tissue transfer. Herein, we describe techniques that aim to augment, or reconstruct, the premaxillary region in the context of nasal deformity, osseous resorption, or composite maxillofacial defects.

Periodontal Evaluation of One-Piece and Two-Piece Single Implant Loaded in Esthetic Zone

Background: Soft tissue around dental implant is an important anatomical feature contributing to the long-term implant success and esthetics, different factors may influence the soft tissue-implant interface. The purposes of the current study were to evaluate the soft tissue profile around one-piece and two-piece implants loaded in esthetic zone. Method: Totally thirty patients who had single missing tooth in premaxillary region were included in the study. Fifteenth patients’ group-A were assigned to immediate loading one-piece implant and fifteen patients’ group-B were assigned to early loading two-piece implant protocol. Flapless approach was performed for both groups. In group-A, implants were loaded immediately with a temporary crown within 48h, while group-B, were loaded after two months following conventional impression for metal ceramic crown. Clinical outcomes were evaluated after two and six months in terms of success rate, papillary index, plaque index and width of keratinized mucosa. Results: The success rate in group-A found to be 80%, which was lower than the success rate in group-B (100%). On comparison, there was no statistically significant difference in success rate between the two study groups. There was no statistically significant difference between both groups over time in clinical parameters like plaque index, width of keratinized gingiva and papillary index. Conclusion: The results of this study indicated that using either immediately loading one-piece implants or early loaded two-piece implants protocol demonstrated the same enhancements of implant esthetics

Andrew's bridge system: A boon for huge ridge defect in aesthetic zone

Tooth loss may pose a challenge for prosthetics when several missing teeth are associated with huge vertical and horizontal bone defects due to cleft palate, road traffic accidents, congenital defects etc.This case report presents prosthetic rehabilitation of a 22 year old male patient of cleft lip and palate with missing upper front teeth along with severe ridge defect since 1 year due to surgical intervention in premaxillary region. The extensive soft and hard tissue defect in aesthetic region was evident and it made the prosthetic rehabilitation more challenging. Among treatment options, fixed partial denture (FPD) was not feasible due to long edentulous span and extensive soft and hard tissue loss. Psychologically, patient was not ready for removable prosthesis. Patient was also not ready for next implant or bone augmentation surgery procedure. The patient presented with Kennedy class IV edentulous area with Seibert's class III ridge defect, so fixed-removable prosthesis was planned to compensate soft and hard tissue defect. The patient with several missing teeth and extensive visible bony defect in the anterior region was successfully rehabilitated using fixed-removable Andrew's bridge system. Although it is not commonly used by dentist so this present case report shows effective management of huge defect case by very simple and conservative technique.