Maxillary Central Incisor Region Research Articles

Comparison of implant placement at crestal and subcrestal levels in aesthetic zone: A finite element analysis.

The success rate of the implant treatment, including aesthetics and long-term survival, relies heavily on preserving crestal peri-implant bone, as it determines the stability and long-term outcomes. This study aimed to demonstrate the stress differences in the crestal bone resulting from dental implant placement at various depths relative to the crestal bone level using finite element analysis. Three study models were prepared for implant placement at the crestal bone level (CL), 1 mm depth (SL-1),and 2mm depth (SL-2). Implants were placed in the maxillary central incisor region of each model, and 100 N vertical and oblique forces were applied. The von Mises, maximum principal (tensile), and minimum principal (compressive) stresses were evaluated. The CL model exhibited the highest stresses on the implant, abutment, and abutment screws under vertical and oblique forces. For maximum principal stress in the crestal bone under vertical force, the SL-2, SL-1, and CL models recorded values of 6.56, 6.26, and 5.77MPa, respectively. Under oblique forces, stress values for SL-1, SL-2, and CL were 25.3, 24.91, and 23.76MPa, respectively. The CL model consistently exhibited the lowest crestal bone stress at all loads and the highest stress values on the implant and its components. Moreover, considering the yield strengths of the materials, no mechanical or physiological complications were noted. Placing the implant at the crestal level or subcrestally beyond the cortical layer could potentially reduce stress and minimize crestal bone loss. However, further studies are warranted for confirmation.

Surgical Management of Radicular Cyst with the Application of a Natural Platelet Concentrate and Ostoden: A Case Report

ABSTRACT The most frequent cystic lesions that affect the jaw are radicular cysts. The current case report describes the surgical management of a radicular cyst in the periapical region of maxillary central and lateral incisors, and highlights the efficacy of natural platelet concentrate [platelet-rich fibrin (PRF)] along with Ostoden bone graft material used for postoperative healing. A 46-year-old male patient presented to the department with swelling in the palatal aspect of the maxillary anterior region. On radiographic examination, a radiolucent periapical lesion was evident in relation to the left maxillary central and lateral incisor. In the maxillary anterior region, root canal therapy was performed, followed by periapical surgery, and PRF with Ostoden bone graft was placed in the surgical site to initiate the healing at a faster rate. The patient was recalled at follow-ups after 7 days, 3, 6, and 9 months. No symptoms such as pain, inflammation, or discomfort were observed during the review period.

Multidisciplinary Treatment: Follow-Up of Dental Autotransplantation for 10 Years.

The objective is to present a clinical case of dental autotransplantation managed with surgery, orthodontics, endodontics, periodontics, and aesthetic rehabilitation. A 10-year-old boy sought treatment after avulsion of the maxillary left central incisor, which was not reimplanted. Based on anamnesis, clinical examination, and complementary examinations, agenesis of the maxillary and mandibular second premolars except the mandibular right second premolar was observed. After a multidisciplinary planning, the space in the maxillary left central incisor region was opened to receive the transplanted mandibular right second premolar. The receptor site was created in a single surgical procedure. Pulp necrosis was noted in the transplanted tooth, which was treated endodontically, and the agenesis spaces were closed using fixed orthodontic appliances. After removing the appliance, gingivectomy with osteotomy was performed in the maxillary right central incisor and the transplanted tooth regions to harmonize the height and shape of the gingival contour. Next, aesthetic readjustment was performed with tooth whitening, using office and home techniques, followed by microabrasion of the vestibular surface of the maxillary right central incisor. Direct composite resin restorations were placed in the maxillary incisors, and the teeth were rehabilitated using incisal and palatal guides. A multidisciplinary approach is essential for reestablishing the function and aesthetics of complex cases involving dental autotransplantation.

Management of a rotated upper central incisor associated with impacted supernumerary tooth

supernumerary teeth are often found in the maxilla, the extra teeth may be tuberculate, conical, or supplementary or like odontome in shape. The maxillary central incisor region contains mesiodens, a conical kind of supernumerary teeth that maybe unerupted. The adjacent maxillary incisors may rotate, unerupt, or misalign if mesiodens are present.We discuss a case of rotation of the maxillary central incisor with impacted mesiodens in this article, where treatment included surgical removal of impacted mesiodens and orthodontic alignment with 2X4 appliance.

Autogenous solid dentin for horizontal ridge augmentation with simultaneous implantation in a severe bone defect: A 3.5-year follow-up clinical report

Autogenous dental root placement is an available approach for horizontal alveolar ridge augmentation in patients with severe bony defects. However, in previous reports, bone augmentation has been done before the implant placement. This clinical report describes the use of dentin grafting for alveolar ridge augmentation and simultaneous implant placement in the maxillary left central incisor region with a severe horizontal bone defect. Under strict adherence to the recommended indications, dentin grafting and simultaneous implantation could be clinically feasible protocols.

Anatomical variation of the incisive canal: A CBCT study at Universitas Airlangga Academic Dental Hospital

Incisive canal located in maxillary anterior of hard palate around maxillary central incisor region that acts as a tunnel between the oral cavity and the nose. Incisive canal provide sensory innervation to the nasal septum and the anterior mucosa of the hard palate. The anatomical shape of the incisive canal varies individually, hence, should be considered before surgical intervention in the oral cavity. To determine the distribution of anatomical variations of the incisive canal in the sagittal section at Universitas Airlangga Academic Dental Hospital using Cone Beam Computed Tomography (CBCT). Fifty-four samples were obtained from the interpretation report of sagittal section of CBCT at Universitas Airlangga Academic Dental Hospital from 2015 – 2021. Observations of the incisive canals were carried out by agreement of authors by classifying the variations into cylindrical shape, funnel shape, banana shapes and hourglass shapes. In 54 samples with an age range of 12 - 70 years, the variations of the incisive canal were Cylindrical shape (63%), Banana shape (19%), Funnel shape (17%) and Hourglass shape (2%). Based on gender, Cylindrical shape was most commonly found in men (56%) and women (73%). Four variations of anatomical variations of the incisive canals were found at Universitas Airlangga Academic Dental Hospital, with cylindrical shape as the most prevalent variation. Therefore, observation of the incisive canal anatomy is necessary before surgical intervention.

Microsurgical Approach for the Coverage of Gingival Recession Defects using Vestibular Incision Subperiosteal Tunnel Access (VISTATM) Technique- A Case Report

Gingival recession which is described as the loss of gingival attachment due to apical migration of the gingival margin from the cementoenamel junction leading to the exposure of the root surface, is one of the most prevalent diseases in the world. The treatment of gingival recession is therefore essential to achieve good aesthetics, relieve root hypersensitivity, prevent root caries and cervical abrasions. Till date, many root coverage techniques have been implicated for the coverage of recession defect. This case report focuses on the Vestibular Incision Subperiosteal Tunnel Access (VISTATM) technique for the root coverage procedure and simultaneous application of the microsurgical principles helps in executing the procedure in the most minimally invasive manner. Here, this technique has been accomplished in a 24-year-old female, with the chief complaint of poor aesthetics in the region of maxillary central incisors due to recession defects. Furthermore with the use of microsurgical instruments and magnifying loupes; complete coverage of the recession defects was achieved in a single stage surgery along with superior aesthetics, causing minimal trauma to the patient that was followed by an uneventful inflammatory phase.

A common cyst in an uncommon location

OKC is the rare and noteworthy developmental odontogenic cyst which arises from dental lamina. Around 7.8% of all cysts of the jaw are categorized in to this type and grow in an antero-posterior direction in the medullary cavity of the bone without causing bone expansion until & unless when expansion is large. The frequent location is the mandibular posterior body. It is uncommon in the maxilla and only 13% occur in the anterior region. An interesting case of OKC in the maxillary central and lateral incisor region of a 36-year-old male patient is being presented. Such a case can be a diagnostic challenge for the clinician, as it can closely mimic the inflammatory cysts in the anterior region.

Effect of the buccal gap width following immediate implant placement on the buccal bone wall: A retrospective cone-beam computed tomography analysis.

The effect of the buccal gap width on the clinical outcome of socket graft and immediate implant placement (IIP) at maxillary central incisor sites has not been investigated. Thus, the aim of the present study was to evaluate the effect of the width of the buccal gap on the thickness of the newly formed buccal wall. Forty-two patients and 51 maxillary central incisor sites treated with IIP and ridge preservation by means of graft of the buccal gap at the maxillary central incisor region were included in the study. The width of the buccal gap was measured and filled with deproteinized bovine bone mineral. Implant sites were divided into two groups: wide gap (WG, >2 mm; n=34) and narrow gap (NG, ≤2 mm; n=17). After at least 1year in function (5 ± 4), CBCT scans were obtained and assessed by a calibrated examiner. The thickness of the buccal and palatal bone walls, the percentage of the implant height covered by bone in the buccal and palatal aspects and the position of the buccal and palatal crests were compared between the two groups. A linear regression model was performed to assess predictors of the thickness of the buccal bone. The buccal bone was significantly thicker in the WG group than the NG group at all levels observed (overall 1.9 ± 0.9 mm and 0.5 ± 0.6 mm, respectively). The thickness of the palatal bone was similar between both groups (>2 mm). The percentage of the implant height covered by bone at the buccal aspect was significantly higher in the WG group (95 ± 16.6%) than in the NG group (59.4 ± 42.3%). The position of the buccal crest in relation to the implant shoulder was significantly more coronal (0.3 ± 2.2 mm) in the WG group than in the NG group (-4.7 ± 5.6 mm). The regression analysis model indicated that the width of the buccal gap was the only predictor of the thickness of the newly formed buccal bone wall (p < 0.001). Grafting of >2 mm-wide buccal gaps following IIP promoted a thicker buccal bone wall.

Effect of the implant-supported provisional restoration on the accuracy of digital peri-implant mucosa replication-A clinical study.

This study aimed to quantitatively evaluate the effect of implant-supported provisional restorations (ISPRs) on the accuracy of the intraoral scanned peri-implant soft-tissue profile in the esthetic area. Sixteen patients with a single ISPR in the maxillary central incisor's region were recruited for this study. Three impression methods were sequentially used in each patient: (1) an intraoral scanning (IOS) with the ISPR, (2) a conventional impression using the ISPR as impression coping, and (3) a routine IOS without the ISPR. The stereolithography files of the three impression methods obtained from the same patient were superimposed, and the conventional impression method was used as the reference model. Two-dimensional (2D) and three-dimensional (3D) analyses were performed to measure the peri-implant soft-tissue deviation between the reference models and IOS from the groups with or without the ISPR, respectively. Data were presented as the means±standard deviations. Two-way analyses of variance with post hoc Sidak's multiple comparisons and paired t-tests were performed for 2D and 3D analyses, respectively. The significance level was set at p<.05. The peri-implant mucosa without the ISPR immediately collapsed (<20s), particularly on the palatine side of the labial mucosa and labial side of the palatine mucosa. Consequently, the IOS without the ISPR led to 414.7±116.0μm of overall dimensional deformation in the cuff-like submucosal region, which was significantly larger (p<.0001) than that in the IOS with the ISPR (230.6±85.5μm). Implant-supported provisional restorations are important for accurate replication of the intraorally scanned peri-implant soft-tissue profile.

Application of digital prosthodontics and connective tissue grafting in the management of peri-implant mucosal recession around a malpositioned 1-piece implant: A clinical report

This clinical report describes a conservative approach to improve an unesthetic implant-supported crown and peri-implant mucosal recession around a malpositioned, 1-piece implant in the maxillary right central incisor region by using digital technology. In such clinical situations, the implants are usually removed because of an unpredictable definitive esthetic outcome. However, this clinical report describes the preservation of such a compromised implant by improving the esthetic outcome with a connective-tissue graft, and a digital approach used a 1-step preformed zirconia coping technique with an appropriate emergence profile.

Epidemiological, clinical, and 3-dimentional CBCT radiographic characterizations of supernumerary teeth in a non-syndromic adult population: a single-institutional study from 60,104 Chinese subjects.

This study was aimed to delineate the prevalence, clinical, and 3-dimentional radiographic characteristics of adult supernumerary teeth (ST found) in a Chinese non-syndromic, dental population. Medical records and cone beam computed tomography (CBCT) images were utilized to identify adult patients with ST in a tertiary referral dental hospital between June 2012 and December 2018. CBCT scan coupled with 3-dimentional reconstruction was used to characterize the detailed location, morphology, orientation of ST, and their relationship with adjacent teeth and neighboring structures. All relevant information regarding age and gender of patients, morphology, and 3-dimentional topography of ST as well as ST-associated complications were recorded and statistically analyzed. A total number of 1149 ST was identified in 921 eligible patients screened from 60,104 subjects with the prevalence of 1.5%. Male patients outnumbered females with a gender ratio of 1.76:1. The majority of ST was single, located in the maxilla, especially the maxillary central incisor region. Most ST were conical shape, inverted orientation, and impacted. ST-associated complications including impaction or root resorption of adjacent teeth, and cystic/tumor-like lesions were totally found in 13% ST and significantly associated with location, orientation, and morphology of ST. Most ST in Chinese adults were conical, inverted, impacted, and located in the maxillary central incisor region, and associated with various complications. Our findings offer valuable information concerning the prevalence, clinical, and radiographic characteristics of ST in non-syndromic Chinese adults. These findings are beneficial for clinicians to comprehensively understand the incidence, pathogenesis, and clinical management of ST.

Peripheral gaint cell granuloma in a 9 year old girl

The peripheral giant cell granuloma (PGCG) is a relatively common benign reactive lesion of the oral cavity, originating from the periosteum or the periodontal ligament. It occurs as a result of local trauma or chronic irritation. This article presents a case of peripheral giant cell granuloma with review of literature. A 9 year old girl reported with a nodular lesion in the maxillary right central incisor region of two months duration. The lesion was excised and sent for histopathologic examination. The lesion was diagnosed as PGCG. The usual line of treatment for PGCG is local excision down to the bony base along with elimination of the local etiologic factors. The clinical one year follow up revealed there was no uneventful soft tissue healing or recurrence. Keywords: Peripheral giant cell granuloma, Epulis, Giant cells, First decade, Female.

Odontome associated with impaction of maxillary central incisor: An orthodontic case report

Odontomas are the most common type of odontogenic tumors. They are included under the benign calcified odontogenic tumors. Odontomas are basically classified into two types, complex and compound odontomes. Generally, Odontomes are asymptomatic. Occasionally, signs and symptoms relating to their presence do occur in form of impactions. The presence of odontomes in the anterior region more often leads to the impaction of the impaction of the permanent anterior teeth. We report a case of a 13year old male, who came to the Department of Orthodontics and Dentofacial Orthopedics, Uttaranchal Dental and Medical Research Institute, Dehradun, Uttarakhand with left maxillary central incisor impaction due to the presence an odontome in the left maxillary central incisor region. The surgical removal the odontome was carried out. Combined approach with surgical exposure and the application of an orthodontic force brought the impacted left maxillary central incisor down to its proper position in the dental arch. Keywords: Odontomes, Impaction, Maxillary Central Incisor Impaction.

Pulp sensibility to electric stimuli in the Caucasian population

The aim of the study was to determine electric sensibility of the pulp in the Caucasian population depending on tooth morphotype, age and sex. Dental pulp sensibility was determined in 279 patients (2640 teeth). The study group consisted of 226 patients (1296 teeth), 110 men and 116 women aged 55-101. The control group consisted of 53 patients (1344 teeth), 23 men and 30 women aged 20-30. A statistically significant lower sensory threshold and increased pulp sensibility in the study group were noted. These affected the lower incisors, the second upper premolars and the first and second upper molar. The differences in the pulp sensibility were found in the region of maxillary central incisors, maxillary premolars, mandibular lateral incisors and mandibular premolars. The pulp sensibility threshold was lower for the aforementioned groups of teeth in the study group. The correlation between sensibility of the pulp and sex was not confirmed.

Maxillary Incisive Canal Characteristics: A Radiographic Study Using Cone Beam Computerized Tomography.

Background The incisive canal located at the midline, posterior to the central incisor, is an important anatomic structure of this area to be considered while planning for immediate implant placement in maxillary central incisor region. The purpose of the present study is to assess incisive canal characteristics using CBCT sections. Materials and Methods CBCT scans of 79 systemically healthy patients, with intact maxillary incisors, were evaluated by two calibrated and independent examiners. Assessments included (1) mesiodistal diameter, (2) labiopalatal diameter, (3) length of the incisive canal, (4) shape of incisive canal, and (5) width of the bone anterior to the incisive foramen. Results The mean width of the foramen labiopalatally and mesiodistally was 3.12 ± 0.94 mm and 3.23 ± 0.98 mm, respectively. Mean canal length was 18.63 ± 2.35 mm and males have significantly longer incisive canal than females. The mean width of bone anterior to the incisive canal was 6.32 ± 1.43 mm. As age of the subjects increased, incisive foramen diameter and incisive canal length were found to be increased. Cylindrical shaped incisive canals were seen in most of the individuals followed by funnel shaped and hour-glass shaped canals, and banana-like canal is least prevalent type. Conclusion The findings from the present study suggest that the diameter and length of incisive canal vary among different individuals and presence of very thin bone anterior to the canal would suggest that a pretreatment CBCT scan is a valuable tool to evaluate anatomic variations, morphology, and dimensions of incisive foramen before immediate implant placement in maxillary central incisor region.

Evaluation of Different Preosteotomy Determinants as Affecting the Success of Implant Therapy: A “CBCT”-based Clinical Study

The success of implant therapy is of greatest concern for clinicians because a minor negligence can lead to ultimate failure of treatment. However, comprehensive and precise treatment planning can ensure high success rate of implant therapy. Cone-beam computed tomography (CBCT) is an innovation that allows clinicians to explore all related factors in details. This study was conducted to evaluate different preosteotomy determinants as affecting the success of implant therapy in the maxillary anterior region using CBCT. This study was conducted on 98 partially or complete denture patients willing for artificial replacement of their missing teeth by implant or implant over-denture. Demographic details of participating patients were collected. Furthermore, comprehensive local examination was also done to finalize the site of placement of implant. Cone-beam computed tomography was attempted in all patients for determining accurate implant location, status of bone, and other interrelated determinants of implant success. Cone-beam computed tomography was also prescribed for patients so as to have presurgical idea of implant dimensions as shown in virtual placement of implant. To rule out any interobserver bias, the interpretations of CBCT images were completed by two independent experienced observers. In the 98 studied patients, 61 were males and 37 were females. The study was restricted to the maxillary anterior region only. The studied preosteotomy determinants were available bone height and width in the edentulous region from ridge crest up to the maxillary sinus floor or the nasal fossa floor. A total of 107 implants were placed virtually (on CBCT) in the maxillary anterior region and compared quantitatively in postosteotomy phases. Implant placement sites were the maxillary central incisor region (39), the lateral incisor region (31), and canine (37). Authors also noticed that the relative length and width of virtual implant remained unaffected in 97% of the cases. Cone-beam computed tomography showed accurate status of various presurgical determinants like trabeculae, peri-ridiculer pathology, and amount of horizontal and vertical bone losses. Hence, it was further concluded that all these presurgical determinants greatly affect the final success rate of implant therapy. It is therefore deemed necessary to judiciously consider and clinically manage such factors before attempting implant in the maxillary anterior region. Presurgical evaluation of factors associated with implant dimensions significantly assists clinicians in deciding the finest treatment option. All additional information provided by CBCT genuinely led to a change in the treatment plan that provides enhanced clinical outcome with lesser postoperative complications. How to cite this article: Jain S, Kapoor K, Sethi K, et al. Evaluation of Different Preosteotomy Determinants as Affecting the Success of Implant Therapy: A "CBCT"-based Clinical Study. J Contemp Dent Pract 2019;20(10):1212-1216.

Mesiodens: A Hospital Based Study.

A cross-sectional retrospective data collection was done from hospital dental records of children who visited the institution from December 2015-December 2016. Radiographic characteristic of mesiodens including the number, shape, position, direction of crown and complication caused by mesiodens were recorded. Data were analyzed using IBM SPSS v.20.0. Out of 1871 dental records, it was found that 40 children had 53 mesiodens, with male female ratio of 3:1 and most of them were discovered at 8 years. Majority of mesiodens, 54.7% were erupted, conical, palatally placed with 77.3% vertically directed crown.Complications associated with it were crowding followed by diastema and delayed eruption. Among 40 children, one had three mesiodens, eleven had two mesiodens and rest had one each. Radiographically fully formed tooth was seen in 29 mesiodens. Immature apex was seen in 38 central incisors associated with mesiodens. Management undertaken was simple/surgical extraction and only few cases were kept for periodic observation. Periodic radiographs act as an important tool for clinicians in detecting and managing mesiodens.

Connective Tissue Graft (CTG) A Saviour to Regain Smile Following Complication of Modified Whales Tail Technique

The etiology of gingival recession is multi-factorial while the treatment of gingival recession is based on the assessment of etiological factors and the amount of tissue involved. Modified Whale’s tail technique can be used to access the intra-bony defect following the placement of the required graft to achieve closure of the defect. The purpose of this case report is to describe the complication following modified Whale’s tail technique to achieve primary closure and thereby, leading to gingival recession in relation to right central incisor and its management with connective tissue graft (CTG) by creating a pouch in the interdental region of maxillary central incisors.

Evaluation of the chelating effect of chitosan solubilized in different acids.

Aim:This study aimed to compare, through dentin microhardness and colorimetric analysis, the chelating effect of 0.2% chitosan solubilized in different acids.Materials and Methods:The second and third cuts of the cervical region of maxillary central incisors were divided into four quadrants, resulting in eight specimens, which were treated with 50 μL of solution for 5 min according to their group (n = 10): GI – 0.2% chitosan solubilized in 1% acetic acid; GII – 0.2% chitosan solubilized in 3.3% citric acid; GIII – 0.2% chitosan solubilized in 0.00145% hydrochloric acid; and GIV – 0.2% chitosan solubilized in 0.00112% nitric acid. A control was made from the chelating properties of the following acids: GV – 3.3% citric acid, GVI – 0.00145% hydrochloric acid, GVII – 0.00112% nitric acid, and GVIII – control (distilled water). Afterward, they were subjected to the Knoop microhardness tester with a load of 10 g for 15 s, resulting in three indentations of the root canal toward the cement. The measurements obtained were subjected to the one-way ANOVA test followed by Tukey's test (α =0.05). Subsequently dispensing the chitosan solutions, the same were subjected to colorimetric analysis.Results:Chitosan solubilized in acetic acid, followed by chitosan in citric acid, provided a greater reducing effect compared to the other groups. Similar results were observed in the colorimetric analysis.Conclusion:It was concluded that the chelating ability of the chitosan solution solubilized in acetic acid is higher than solubilization in citric, hydrochloric, and nitric acids.