Tooth Replacement Research Articles

ORTHODONTIC EXTRUSION TECHNIQUE AS A METHOD FOR ALVEOLAR BONE VOLUME INCREASE BEFORE DENTAL IMPLANTATION. CLINICAL CASE

Objectives: Tooth extraction and replacement with dental implant represents a common treatment choice, when teeth are hopeless. We presented a clinical case, the treatment of which was carried out by the method of orthodontic extrusion technique. This technique can increase alveolar bone level and also soft tissue level. The increased amount of alveolar bone can improve primary implant stability and be compared with bone regeneration techniques. The purpose of presenting this clinical case is to emphasize the efficiency of orthodontic extrusion. Methods and materials: A 45-year-old female patient referred by the general dentist regarding cosmetic defect and tooth mobility in the area of the anterior upper teeth. During the examination, her upper right central incisor was found to be mobile, with diastema and slight congestion in the anterior teeth Photographs, CT and X-ray studies of the patient were used. The patient was bonded with .018 slot Roth prescription ceramic brackets (Dentaurum, Germany). After achieving the optimal results of orthodontic treatment and the necessary extrusion of the upper right central incisor, the tooth was removed and replaced with a dental implant. After six months, the patient had a crown with a screw fixation of zirconium dioxide with ceramic application Results: As a result of orthodontic extrusion, clinically significant increase in alveolar bone and gingival tissue was reported. This resulted significant qualitative and quantitative improvements in the implant site. As the clinical case was in aesthetic zone, we could also rehabilitate beautiful smile of patient and increase her self-esteem. Conclusions: Summing up the above and the results of the treatment of this patient, we can definitely say that orthodontic extrusion technique is effective for implant site development. As we have described, this can effectively move the facial gingival margin and allow for esthetic restoration of implant placed in the extruded tooth position without any bone graft.

Are we gaining valid consent for dental extractions? A retrospective audit on restorability assessment at one dental institution.

Introduction This paper explores the widely relevant topic of obtaining valid consent in dental practice, focusing on assessing restorability of teeth planned for extraction. The General Dental Council stresses discussing treatment options, benefits and risks for informed decision-making. The study evaluates if pertinent factors, including tooth structure, endodontic status, periodontal health and patient considerations, are considered before consent.Aim To ensure restorability has been assessed and all options communicated with patients for completeness of the consent process before tooth extraction.Objective To assist clinicians in their systematic assessment of a tooth's restorability and provide a framework for contemporaneous documentation.Materials and methods A two-week retrospective audit of oral surgery outpatients at a dental hospital in London was conducted, analysing the frequency of restorability discussions and patient involvement in decision-making. A simplified restorability guide and educational interventions were introduced to target the set standard of 100% of consenting clinicians to discuss restorability with patients.Results Results from two audit cycles show a significant increase in documented restorability discussions and consideration of patient factors.Discussion The study recognised restorability assessment subjectivity, thus creating a simplified tool for clinicians. Patients may lack awareness of restorability options, consequences of edentulism, future costs and tooth replacement considerations, emphasising the importance of documented discussions.Conclusion Educational interventions and a simplified restorability guide proved beneficial and showed significant improvement in communication with patients regarding restorability and gaining valid consent. Further consideration should be given to barriers patients face when opting for tooth extraction of their restorable teeth, including discussions regarding long-term consequences.

Management of Ellis Class IX Fracture in Primary Dentition: Review with a Case Report

Introduction: Ellis Class IX type of luxation injuries are frequently observed in the primary dentition. The pulp and periodontium are damaged as a result of intrusion, which forces the tooth to go more deeper into the tooth socket. The care of these injuries is difficult due to the chances of harming the permanent tooth germ. It is crucial to conduct a thorough clinical and radiographic assessment and to follow up often. A case of Ellis Class IX fracture i.e., Intrusive Luxation of Incisors of a 3 years old child was reported. Intrusion was grade III Hence, teeth underwent extraction and anterior esthetic fixed space maintainer was placed with a pontic natural tooth offers a replacement of a main anterior tooth, which is important for speech development, appearance, and self-esteem.

Oral Health-Related Quality of Life Among Non-institutionalized Elderly in Malaysia: A Teaching Hospital-Based Survey.

Background In Malaysia, the Geriatric Oral Health Assessment Index (GOHAI) has been recognized as a vital instrument for evaluating oral health-related quality of life among the elderly population. Its integration into the National Health and Morbidity Survey (NHMS) in 2018 demonstrates the country's dedication to understandingand addressing the unique oral health challenges faced by older individuals. The NHMS, led by the Ministry of Health Malaysia, serves as a crucial platform for identifying and addressing healthcare needs, while also working towards achieving sustainable development goals. This study aimed to provide valuable information for stakeholders and researchers by investigating the relationship between quality of life related to oral health and demographic factors, with the ultimate goal of enhancing oral healthcare for older individuals. Objective The objective of this research was to identify the variables that impact the Oral Health-Related Quality of Life (OHRQoL) of non-institutionalized elderly individuals who visit the Klinik Pergigian Manipal University College Malaysia (MUCM). By utilizing the OHRQoL, dental practitioners can gain insight into the elderly's oral health-related quality of life, which is crucial information for dental healthcare providers to effectively reach out to and cater to the elderly at the institution. Methodology A cross-sectional design was employed, utilizing a non-probability sampling method to select eligible elderly individuals at the clinic. A validated questionnaire comprising 18 items covering sociodemographic details and the Geriatric Oral Health Assessment Index (GOHAI) was distributed to individuals above 60 years via printed forms. One way ANOVA, unpaired t-test and multiple linear regression analysis were performed to analyze the data. Results The overall mean GOHAI score among non-institutionalized elderly attending Klinik Pergigian MUCM was 48.38±9.33, indicating poor OHRQoL. The psychosocial impact domain had a mean score of 19.33±5.21, surpassing the pain and discomfort domain with a score of 10.73±2.82, highlighting the significant impact of psychosocial factors on poor oral health-related quality of life. Multiple linear regression analysis revealed no significantassociations between OHRQoL and factors such asethnicity, living arrangements apart from spouse and family, or tertiary education among older individuals after adjusting for confounding variables. Conclusions This study indicates that sociodemographic aspects have minimal impact on the OHRQoLof seniors. Further examination is needed to understand the economic aspects of tooth replacement options and preventive measures in this age group. To enhance the OHRQoLof older adults, especially those not living infacilities like nursing homes or assisted living centers,tailored oral healthcare plans and strategies arecrucial. Interdisciplinary collaboration among mental health professionals, geriatric experts, and oral healthcare providers is crucial for empowering both healthcare practitioners and seniors to maintain optimal oral health.

Determination of Micromovements in Removable Prosthesis during Mastication: A Pilot Study with 3D Electromagnetic Articulography.

Edentulism can generate negative impacts on self-esteem, interpersonal relationships, and oral functions. Removable prostheses are commonly used for tooth replacement, but they may cause discomfort due to micromovements during mastication. Objective and quantifiable methods are needed to evaluate these micromovements. A pilot study was conducted to determine the micromovements in removable prostheses during mastication using a 3D electromagnetic articulography (EMA-3D) system. One elderly participant wearing lower removable prostheses and an upper total well-fitting removable prosthesis was studied. The EMA-3D system was used to record movements in three spatial planes. Peanuts were given as test food, and the participant was instructed to chew normally while recordings were carried out until feeling the need to swallow. Analyses of the upper total prosthesis show micromovements ranging from 0.63 ± 0.11 to 1.02 ± 0.13 mm. During simultaneous analyses of the upper prosthesis and lower partial prosthesis, interference was not observed. This pilot study demonstrated the feasibility of using the EMA-3D system to evaluate micromovements in removable prostheses during mastication. Further research is needed to evaluate a larger sample and assess the clinical implications of these micromovements.

Uprighting A Horizontally Impacted Mandibular Third Molar Using Modified Bach’s Technique

There are a number of techniques with which such horizontal impactions can be treated, with no single technique being favored over the other, as these all have pros and cons. Horizontally impacted third molars are usually indicated for extraction, and only in situations where the first or the second molar has to be extracted due to decay is when these are uprighted for replacement of the missing teeth. In contrast to vertically impacted molars there is a higher chance of success in uprighting horizontally impacted third molars as the cause is lack of space or blockage of the eruptive pathway.

Zirconia Hybrid Dental Implants Influence the Biological Properties of Neural Crest-Derived Mesenchymal Stromal Cells.

Dental implants are regularly employed in tooth replacement, the good clinical outcome of which is strictly correlated to the choice of an appropriate implant biomaterial. Titanium-based implants are considered the gold standard for rehabilitation of edentulous spaces. However, the insurgence of allergic reactions, cellular sensitization and low integration with dental and gingival tissues lead to poor osseointegration, affecting the implant stability in the bone and favoring infections and inflammatory processes in the peri-implant space. These failures pave the way to develop and improve new biocompatible implant materials. CERID dental implants are made of a titanium core embedded in a zirconium dioxide ceramic layer, ensuring absence of corrosion, a higher biological compatibility and a better bone deposition compared to titanium ones. We investigated hDPSCs' biological behavior, i.e., cell adhesion, proliferation, morphology and osteogenic potential, when seeded on both CERID and titanium implants, before and after cleansing with two different procedures. SEM and AFM analysis of the surfaces showed that while CERID disks were not significantly affected by the cleansing system, titanium ones exhibited well-visible modifications after brush treatment, altering cell morphology. The proliferation rate of DPSCs was increased for titanium, while it remained unaltered for CERID. Both materials hold an intrinsic potential to promote osteogenic commitment of neuro-ectomesenchymal stromal cells. Interestingly, the CERID surface mitigated the immune response by inducing an upregulation of anti-inflammatory cytokine IL-10 on activated PBMCs when a pro-inflammatory microenvironment was established. Our in vitro results pave the way to further investigations aiming to corroborate the potential of CERID implants as suitable biomaterials for dental implant applications.

Survival time analysis of remaining teeth following replacement of unilateral free-end missing teeth: A comparison between fixed implant-supported prostheses and removable partial dentures.

This retrospective study aimed to investigate the differences in tooth loss rate between fixed implant-supported prostheses (FISPs) and removable partial dentures (RPDs) in cases of unilateral free-end missing teeth. The data of 324 patients who underwent treatment with FISPs or RPDs for unilateral free-end missing teeth and satisfied the applicable criteria, were evaluated (47 in the FISPs group and 277 in the RPDs group). After propensity score (PS) matching, which was used to extract patients with similar background factors related to prosthetic selection at baseline, survival time analyses were performed with tooth loss as the endpoint. The adjusted variables were age, sex, number of restored teeth, periodontal status, and the practicing dentist's experience in years. The remaining teeth were classified into subcategories in relation to the missing molars. Overall, 58 patients (29 in each group) selected by PS matching were evaluated in the final analysis. The total number of lost teeth was 35 (FISPs group: n = 10; RPDs group: n = 25). The mean (±SD) period to tooth loss and the 10-year survival rates in the FISPs and RPDs groups were 51.6 (±30.1) months and 42.3 (±29.7) months, 70.5% and 16.4%, respectively. The log-rank test showed that significantly longer survival time in FISPs compared with RPDs. After adjustments for confounding factors using PS matching, replacing unilateral free-end missing teeth with FISPs may exhibit a lower tooth loss rate in adjacent and contralateral teeth compared to replacing with RPDs.

The potential causal path between periodontitis stage diagnosis and vegetable consumption is mediated by loss of posterior functional tooth units and masticatory function.

Emerging evidence points to a two-way relationship between periodontitis and dietary choices and, thus, nutrition. This study aimed to assess the potential cause-effect relationship between the periodontitis stage, loss of functional tooth units (FTUs), masticatory function, and intake of different food groups using path analysis. A single calibrated examiner determined the periodontitis stage of a consecutive sample of 241 Chinese subjects reporting for tooth replacement. Their masticatory function was quantified by the mixing ability of a two-colour chewing gum. Validated food frequency questionnaires were used to calculate the intake of 33 food group items by an experienced calibrated rater. After verification of assumptions, visual structural equation modeling was performed with Amos 23. The consistency of results and the potential modifying effect of age were assessed in 9043 subjects from the NHANES database. Highly significant models were constructed using periodontitis stage and age as exogenous factors. Periodontitis stage diagnosis significantly affected the number of posterior FTUs and oral health-related quality of life (OHRQoL, path coefficient [PC] = -0.55 and -0.20, p < .05, respectively). In the model, FTUs also had an independent effect on OHRQoL (PC = 0.23, p < .05). FTUs determined the level of masticatory function (PC = -0.38, p < .05), which in turn affected vegetable intake but not fruit or meat intake (PC = -0.18, p < .0.5, PC = 0.06, NS and PC = 0.11, NS, respectively). The effect of age was significant for vegetable and meat intake and was also correlated with periodontitis stage diagnosis. Analysis of the NHANES database confirmed the negative impact of periodontitis on the number of occluding pairs and vegetable consumption for the 18-44, 45-60 and >60 age groups. Periodontitis showed a potential cause-effect pathway affecting vegetable intake across cultures and age groups. The size of the effect is potentially of clinical and public health significance. Additional studies, including intervention trials, are required to test this potential mechanism linking oral health to nutrition.

People's Knowledge and Opinions about getting Dental Implants with other Conventional Treatment Modalities in Herat City Habitats, Afghanistan

Objectives This study aimed to evaluate the people's understanding, expectations, and knowledge of dental implants compared with other treatment modalities as a treatment option for replacing missing teeth among a selected sample of Herat urban habitats in Herat City, Afghanistan. Materials and Methods This descriptive cross-sectional study was done on a randomly selected 420 Heart City habitats from all 15 districts over one month, from May to June 2022, to assess the knowledge and opinion of Herat City habitats toward dental implants as an option for replacing missing teeth. An organized questionnaire collected the data with open questions, a direct interview, and the introduction and demonstration of a short animation about the dental implant procedure. The data were categorized by similar answers, interred, and analyzed with IBM-SPSS version 25. Results Among the 420 participants in this study, 67.9% of respondents had heard about dental implants, and 28.6% had information about dental implant and surgical procedure. Among all participants, 59% preferred dental implants for their missing teeth replacement, and 3.8% had received dental implants before. Education significantly influenced the information about surgical procedures of dental implants (p &lt; 0.05), knowledge about dental implants (p &lt; 0.05), and priority of dental implants for missing teeth replacement (p &lt; 0.05). According to the source of information, most of them got information from medical staff and their family and friends. Other sources of information are dedicated to television, cyberspace, and advertisements. Conclusion The survey concluded that there was an unacceptable level of awareness regarding using dental implants as a treatment option for replacing missing teeth. Medical staff, family, and friends are the main sources of information. The level of education has an essential role in knowledge and awareness about dental implants.

Influence of Implant Location, Number, and Design in Ischemic Zone for Implant Prosthesis Success Rate: A Comparative Three-Dimensional Finite Element Analysis.

The performance of an implant-supported prosthesis depends on the implant type, number, implant location, and prosthesis design which is directly associated with the distribution of the occlusal forces during mastication. Thepurpose of the present study is to analyze with three-dimensional (3D) finite element comparative analysis, the influence of implant location, number, and prosthesis design in the mandibular posterior region where multiple posterior teeth replacement is indicated, which in turn is associated with the longevity or Implant success rate. Mandibular posterior section, where 4 teeth are missing, based on the space available for implants and following the surgical guide instructions, a standard make four implants (1st and 2nd premolars {3.8 mm × 11.5 mm}, 1st and 2nd molar {5.1 mm × 11.5 mm}) were selected and with standardization for placement, 4 groups were created with different implant location, number and prosthesis design from the selected implants as model FM1, FM2, FM3, FM4. Finite element analysis was carried out usingANSYS software, version 14.5 (ANSYS Inc.,Canonsburg, PA, USA) for assessment of stress, strain, and deformation around implant and bone. Maximum von Mises stress on vertical loading was highest for FM4 (139.55MPa) model (center of prosthesis on premolar and molar pontics) and lowest for FM3 (53.65MPa) model (on 2ndpremolar pontic) with values in decreasing order as FM4 ˃ FM2 ˃ FM1 ˃ FM3. Maximum von Mises stress on oblique loading was highest at the distal of 1stmolar implant pontic for FM2 (539.81MPa) and lowest at the 2ndpremolar pontic for FM3 (352.48MPa) model with values as FM2˃FM1˃FM4˃FM3. Deformation for vertical and oblique loading was observed minimum at the buccal cusp and buccal crestal bone of 2ndpremolar, 1stmolaron FM3 model against highest deformation on buccal and lingual crestal bone, cuspal area of 2ndpremolar, 1stmolar implants. For oblique loading minimum deformation was seenfor the 2ndpremolar, 1stmolar cuspal area in FM3,and maximum at the 2ndpremolar region in FM1. Four single implants may be chosen if there is enough mesiodistal and buccolingual space to allow for a minimum inter-implant and inter-implant-tooth distance that can be maintained while putting the least amount of stress on the implants and bone. To reduce stress on the bone and implants, it is best to avoid long-span implant-supported prostheses when using fixed implant-supported prostheses.

Characterization of dental calculus in the South American Quaternary proboscidean Notiomastodon platensis (Ameghino, 1888)

ABSTRACTDental calculus, or tartar, is a mineralized biofilm that develops on the teeth, and is often observed on the teeth of the South American proboscidean Notiomastodon platensis. This structure can provide details on paleoecological, paleoenvironmental and paleopathological aspects of a species. However, characterization of tartar in N. platensis is lacking. The aim of this study was to provide a macromorphological characterization of tartar on N. platensis molars, and evaluate its prevalence, distribution patterns and severity. A total of 117 molariforms from Brazilian Quaternary fossiliferous assemblages were analyzed. Thirty‐five (29.9%) molars presented tartar. The majority displayed moderate severity. Calculus was present at least on one inteloph(id) of each molar, and prevailed on the posterior region. It predominated on lower and third molars. Adult individuals showed a predominance compared to juveniles. These patterns in N. platensis are probably due to the susceptible oral environment, molar morphology, mature age and tooth replacement. These results suggest that N. platensis and probably other proboscideans were relatively susceptible to tartar development.

Exceptionally rapid tooth development and ontogenetic changes in the feeding apparatus of the Komodo dragon.

Dental developmental and replacement patterns in extinct amniotes have attracted a lot of attention. Notable among these are Paleozoic predatory synapsids, but also Mesozoic theropod dinosaurs, well known for having true ziphodonty, strongly serrated carinae with dentine cores within an enamel cap. The Komodo dragon, Varanus komodoensis, is the only extant terrestrial vertebrate to exhibit true ziphodonty, making it an ideal model organism for gaining new insights into the life history and feeding behaviours of theropod dinosaurs and early synapsids. We undertook a comparative dental histological analysis of this extant apex predator in combination with computed tomography of intact skulls. This study allowed us to reconstruct the dental morphology, ontogeny, and replacement patterns in the largest living lizard with known feeding behaviour, and apply our findings to extinct taxa where the behaviour is largely unknown. We discovered through computed tomography that V. komodoensis maintains up to five replacement teeth per tooth position, while histological analysis showed an exceptionally rapid formation of new teeth, every 40 days. Additionally, a dramatic ontogenetic shift in the dental morphology of V. komodoensis was also discovered, likely related to changes in feeding preferences and habitat. The juveniles have fewer dental specializations, lack true ziphodonty, are arboreal and feed mostly on insects, whereas the adults have strongly developed ziphodonty and are terrestrial apex predators with defleshing feeding behaviour. In addition, we found evidence that the ziphodont teeth of V. komodoensis have true ampullae (interdental folds for strengthening the serrations), similar to those found only in theropod dinosaurs. Comparisons with other species of Varanus and successive outgroup taxa reveal a complex pattern of dental features and adaptations, including the evolution of snake-like tongue flicking used for foraging for prey. However, only the Komodo dragon exhibits this remarkable set of dental innovations and specializations among squamates.

SURFACE MATTERS THAN THE IMPLANT ITSELF-A REVIEW

Nowadays dental implants are a predictable and popular treatment option for tooth replacement in completely or partially edentulous patients. Implants are preferred over conventional treatment due to certain advantages it offers like preservation of bone; preservation of adjacent teeth, durability, better mastication and speech etc.Implant comes in direct bone contact and anchors through osseointegration. Successful osseointegration revolves around many factors such as biocompatibility of the implant material, quality and quantity of the available bone, surface treatment of the implant, loading and surgical protocol and various other systemic and local factors. Predictability of clinical success of dental implants can be enhanced by using newer materials or alterations in designs, surgical or loading protocols on the basis of available literature. Various studies have suggested that rough surface of implant enhances its integration with bone than a smooth implant surface. Several approaches are used to attain a rough surface and to improve the process of osseointegration of titanium dental implants. The present paper reviews different methods of treating implant surfaces to enhance bone implant interaction starting from the basic material used in dental implant manufacture.

Intraoral Radiographic Study of the Pulp Cavity of the Shortfin Mako Shark (Isurus Oxyrinchus).

The shortfin mako shark (Isurus oxyrinchus) is a large pelagic predator that inhabits coastal and ocean waters. It has several teeth arranged in rows that run from the rostral to the lingual face. These teeth are in several stages of maturation, where the teeth closest to the rostral face are more mature and functional and the teeth closest to the lingual face are still in development. The tooth supply of the shark is unlimited throughout its life. The mechanism of tooth replacement follows that, when the front teeth are discarded physiologically, the posterior teeth replace it. This study us used a head and dental arch of I. oxyrinchus. Intraoral radiographs were obtained with the aim to show details of the pulp cavity. The study concluded that the pulp diameter varies according to the stage of dental maturation.

Armadillosuchus arrudai (Sphagesauridae, Crocodyliformes), Adamantina Formation (Turonian – Santonian), Bauru Basin, southeastern Brazil: Dental development aspects

Armadillosuchus arrudai, an extinct crocodyliform, has a complex pattern of tooth replacement. Replacement of functional teeth followed an alternating numerical and directional wave from posterior to anterior. Notably, the presence of an initial fossa in some teeth indicated root resorption and facilitated the development of tooth replacement. These aspects suggest a coordinated tooth replacement process, enabling the animal to maintain functional dentition. This study provides insights into the unique dental dynamics of Armadillosuchus arrudai, highlighting its lifelong polyphyodonty and the meaning of alternating replacement patterns. Microtomography allowed the comprehension of these intricate tooth replacement processes.

Sequelae of Primary Dental Trauma: A Case Series

Trauma to the primary dentition is a common occurrence affecting approximately 1 in 5 young children globally. Damage to the successor tooth may present as a localized enamel defect, dilaceration and disturbed eruption, with subsequent functional and social impact. Appropriate management of acute primary dental trauma, regular review and timely specialist referral upon detection of eruption sequence abnormalities is, therefore, imperative for long-term outcome to be optimal. This article presents a series of four case reports of paediatric patients with a history of severe primary dental trauma that resulted in significant dental anomalies requiring multidisciplinary treatment. CPD/Clinical Relevance: Information on the consequences of primary dental trauma and the advice to give to affected families is of value.

Oral Health Literacy and Tooth Loss and Replacement in Older Adults at a University Dental Clinic in Colombia.

Oral health literacy (OHL) is the ability of individuals to obtain, process, and understand oral health information and services, allowing them to make appropriate oral health decisions. The association between OHL and tooth loss and replacement have not been well understood. We aimed to determine the association between OHL and tooth loss and replacement in a Colombia population. A cross-sectional study of 384 older adults age 65 to 89 years from Pasto, Colombia was carried out. The number of lost and replaced teeth was assessed intraorally; sociodemographic and prosthetic characteristics were collected, and the Health Literacy in Dentistry questionnaire was used to evaluate OHL. Generalized linear models were estimated to assess associations between independent variables (including OHL) and the number of lost and replaced teeth. There were 224 (58.3%) men and 160 (41.7%) women. The mean (standard deviation [SD]) number of lost and replaced teeth was 27.78 (4.03) and 12.53 (9.89), respectively. One hundred fifty five (40.4%) individuals had full removable dental protheses, 122 (31.8%) partial removable dental protheses, 68 (17.7%) fixed prosthetics, and 36 (9.4%) dental implants. OHL was 33.29 (6.59) and significantly positively associated with the number of replaced teeth (β = 0.65, 95% confidence interval [CI]: 0.52-0.78, p < .001), but not with lost teeth. OHL may foster individuals' capabilities to replace lost teeth, although we did not find it associated with reduced tooth loss, likely as tooth loss was highly common in this older population. [HLRP: Health Literacy Research and Practice. 2024;8(1):e21-e28.].

Enhancing Esthetics Using Modified Ovate Pontic: A Case Series

Abstract The prosthetic tooth design is dictated by esthetics, function, ease to maintain oral hygiene, and patient comfort. Correct design is important for long-term success. An ovate pontic fulfills both esthetic and functional requirements. The convex design of this pontic mimics a tooth erupting from the gingiva. Also nowadays, patients avoid long, drawn-out dental treatment. The time span between extraction and healing after loss of tooth in the anterior esthetic zone can be esthetically and psychologically devastating for the patient. In such a situation, immediate tooth replacement with an ovate pontic on a provisional bridge is a good alternative. However, ovate pontic design has some disadvantages. The modified ovate pontic design was developed to circumvent the problems encountered with the ovate pontic. A report of three cases will be presented where the modified ovate pontic design was used for replacing upper anterior teeth.

The dentition of the Late Jurassic dwarf sauropod Europasaurus holgeri from northern Germany: ontogeny, function, and implications for a rhamphotheca-like structure in Sauropoda.

The basal macronarian sauropod Europasaurus holgeri is known only from the Late Jurassic of the Langenberg Quarry near Goslar, Lower Saxony, Germany. Europasaurus has been identified as an insular dwarf and shows a clear resemblance to Camarasaurus and Giraffatitan. This study provides a detailed description of the dentition of Europasaurus based on an array of fossils outstanding in their abundance, variety of preservation, and ontogenetic range. Dental morphology for the replacement and functional dentitions, the tooth replacement pattern, and implications for food intake are described for the Europasaurus dentition, which is characterized by broad-crowned teeth. Characteristic features for Europasaurus are the presence of denticles on replacement teeth, the wrinkled enamel, and large wear facets both on the apex and on the carinae of the tooth crowns. The partially articulated skull SNHM-2207-R and isolated tooth rows DfmMh/FV 580.1 and DfmMh/FV 896.7 suggest the presence of strong connective tissue partially covering the teeth. This connective tissue would have provided stability and protection for the teeth. Evidence for this connective tissue include exposed tooth necks, in-situ teeth with strongly resorbed roots which no longer would have been connected to the jaw bone, and wrinkled enamel and its surface pattern. The same features can be observed in other sauropod taxa as well. We therefore suggest that eusauropods in general possessed this connective tissue structure, which may be an autapomorphy of the group. Possibly, this hypothetical structure is homologous to the rhamphotheca in birds and some non-avian theropods, which, however rarely, show such a close integration of keratinous tissue and teeth that we hypothesize here.