Age as compromising factor for implant insertion

Pre-implant surgery complexity for achieving implant-supported prosthetic rehabilitation in oligodontia patients: a retrospective study

INTRODUCTION

Oligodontia is a rare dental developmental pathology that requires prolonged, complex and multidisciplinary treatment. Although bone augmentation is frequently required during a complete implant treatment of oligodontia. Therefore, we evaluated the ability to predict pre-implant surgery complexity based on age, number of missing teeth, and number of implants required to achieve implant-supported prosthetic rehabilitation.

MATERIAL AND METHODS

This retrospectively registered study included all patients who underwent surgical treatment for oligodontia in our Oral and Maxillofacial Surgery Department between January 2012 and May 2023. Demographic data, number and location of missing teeth, pre- and per-implant surgical procedures, and the number of planned implants were recorded. A quantitative variable called "complexity score of pre-implant surgery" was created. This 10-point score was calculated by adding one point for each preimplant surgical procedure registered. A simple linear regression was calculated to explain the number of targeted implants based on number of missing teeth. A multiple linear regression model was used to explain the complexity score of pre-implant surgery and age, number of missing teeth and number of targeted implants.

RESULTS

119 oligodontia patients were included in the study. The median number of tooth agenesis was 10. A total of 825 implants were placed, 14 (1.7%) of which failed. A significant regression equation was used (F(1,118) = 1098,338; p < 0.0001) to explain the number of targeted implants based on number of missing teeth, with a R2 of 0.903. A significant regression equation was found (F(3,116) = 107,229; p < 0.0001) to explain the complexity score of pre-implant surgery and age, number of missing teeth and number of targeted implants, with a R2 of 0.735.

DISCUSSION

These results based on patient data indicate that age, number of missing teeth and number of targeted implants could reliably explain the complexity of pre-implant surgery.

Alveolar ridge augmentation for implant placement in a growing patient

BACKGROUND

Partial edentulism in growing children due to aplasia or trauma poses a difficult situation to manage. We present a case of horizontal ridge augmentation in a growing patient who had trauma in childhood when it was too early to place implants.

METHODS AND RESULTS

This patient had a history of trauma, at age 13, that resulted in mandibular fracture and loss of teeth #23-27. The definitive restorative treatment plan was postponed due to the patient's continued growth. At age 18, horizontal bone augmentation was performed in a severely resorbed anterior mandible. After 7 months of healing, 7-8 mm ridge augmentation was achieved, and three implants were placed. Soft tissue augmentation by free gingival graft was performed at implant second stage surgery 4 months later.

CONCLUSIONS

When considering the timing of implant placement in adolescents, the clinician walks a fine line between waiting as long as possible to place the implants and racing against continued resorption of the edentulous alveolar ridge. 70/30 mineralized/demineralized cortical bone allograft and injectable platelet-rich fibrin mix combined with tenting screws and resorbable membranes are useful measures for horizontal ridge augmentation in growing patients.

KEY POINTS

Why is this case new information? There are insufficient data available when considering implant treatment in younger patients. The present case was managed with a variation of the sausage technique described by Urban. The use of allograft, I-PRF, and tenting screws replaced the use of autogenous bone and resulted in exceptional results. What are the keys to the successful management of this case? Delaying treatment until after the critical growth period has passed. Adequate flap release, tension-free primary flap closure, and space maintenance through the use of tenting screws and tacking the membranes using tacking pins provided support for the grafted site. What are the primary limitations to success in this case? The continued growth may cause infra occlusion of the implant-supported bridge.

Recording jaw relation of a pediatric patient with ectodermal dysplasia and complete anodontia using a digital mini arch tracer: A case report

Children with ectodermal dysplasia and complete anodontia experience difficulties in oral rehabilitation because of the small arch size. A case of a 7-year-old boy, whose arch size (length and width) was 30-40% smaller than that of a male adult and who presented with difficulties in jaw relation recording using commercially available devices is described. A digital workflow involving a mini arch tracer was introduced. Primary impressions were made using three-dimensionally (3D) printed mini trays produced based on the patient's computed tomography images, and digital primary casts were obtained based on the scanned and reversed primary impressions. The final custom impression trays with mini tracing plates were designed based on the primary casts. In addition, the hand shank, retention plate, and retainers were placed on the designed custom trays and 3D-printed to produce an individual arch tracer system. In addition, two height-checking buckles were designed to help adjust the height of a tracing screw. Finally, the jaw relation of the patient was recorded and transferred, and a set of complete dentures were delivered, satisfying both the patient and his family.

Dental implants in growing patients: A systematic review and meta-analysis

BACKGROUND: Dental implants provide a suitable and reliable treatment for the replacement of missing teeth. Very few studies have been reported in the literature regarding the application of dental implants in growing and developing patients. OBJECTIVE: This systematic review with meta-analysis aimed to systematically review the available literature regarding the application of dental implants in growing and developing patients. METHODS: A detailed search in the literature was performed with the help of keywords such as dental implants, treatment planning, children, adolescents, growing patients, and developing jaws. PubMed, Scopus, Web of Sciences, and Ovidsp databases were searched for papers published between 1980 and 2021. The papers focused on children, adolescents, developing jaws, and implants. In this systemic review, the dataset concerned with the type of study, aim, number of patients and specimens included, age of patients, total number of implants placed, total number of implants evaluated, medical history of developmental disorders of teeth such as ectodermal dysplasia, congenital absence of teeth, were evaluated. RESULTS: Out of the total literature searched, 33.45% of studies and case reports documented no complications in any implant treatment. In 47.21% of studies and case reports, there was both success and failure of implants while in 13.21% of studies and case reports there was a complete failure of implants. The most common cause for loss of permanent teeth in growing children and adolescent patients was dental trauma (73.13%) followed by congenital developmental disturbance of teeth (18.19%). CONCLUSION: It can be concluded from this systematic review that the use of implants in edentulous growing patients is determined by several parameters, including the patient’s overall health, the stage of jaw growth, the number of teeth to be replaced, and soft and hard tissue anatomic features. Still, the use of a conservative treatment strategy for missing teeth management in patients with developing jaws is common and recommended until the patient’s growth is completed, as there are chances of changes in the position of dental implants placed in the developing and growing jaws due to the continuous changes taking place in their body. However, placement of implants can be done in these patients successfully with proper treatment planning and taking into account the phase of growth with proper follow-up.

Craniofacial growth and morphology among intersecting clinical categories

Differential patterns of craniofacial growth are important sources of variation that can result in skeletal malocclusion. Understanding the timing of growth milestones and morphological change associated with adult skeletal malocclusions is critical for developing individualized orthodontic growth modification strategies. To identify patterns in the timing and geometry of growth, we used Bayesian modeling of cephalometrics and geometric morphometric analyses with a dense, longitudinal sample consisting of 15,407 cephalograms from 1,913 individuals between 2 and 31 years of age. Individuals were classified into vertical facial types (hyper-, normo-, hypo-divergent) and anteroposterior (A-P) skeletal classes (Class I, Class II, Class III) based on adult mandibular plane angle and ANB angle, respectively. These classifications yielded eight facial type-skeletal class categories with sufficient sample sizes to be included in the study. Four linear cephalometrics representing facial heights and maxillary and mandibular lengths were fit to standard double logistic models generating type-class category-specific estimates for age, size, and rate of growth at growth milestones. Mean landmark configurations were compared among type-class categories at four time points between 6 and 20 years of age. Overall, morphology and growth patterns were more similar within vertical facial types than within A-P classes and variation among A-P classes typically nested within variation among vertical types. Further, type-class-associated variation in the rate and magnitude of growth in specific regions identified here may serve as targets for clinical treatment of complex vertical and A-P skeletal malocclusion and provide a clearer picture of the development of variation in craniofacial form.

Distribution of congenitally missing teeth and treatment options for the lower second premolars in patients referred to special care

OBJECTIVE

The aim was to evaluate the distribution of congenitally missing teeth and the treatment provided for congenitally missing lower second premolars in an eleven-year cohort of patients referred to a publicly funded source of specialist care.

MATERIAL AND METHODS

This was a retrospective, register-based cohort study. Search for patients referred to a publicly funded source of specialist care based on ICD10 diagnosis code K00.00 (partial anodontia) and treatment codes EBA00, EBA05, EBA10, EBA12, EBB10 and EBB20 during the period 1.1.2009-27.10.2019 yielded 232 patients (151 females, 81 males), of whom 218, born in 1941-2009, were eligible. Data collected from medical files were presented in the form of descriptive statistics and analysed using Fisher's exact test.

RESULTS

The 218 subjects possessed 876 congenitally missing teeth (males 307, females 569) (third molars excluded). The most common missing teeth were upper second premolars and lateral incisors, and lower second premolars and central incisors. No difference in laterality was found. Statistically significant associations were found between the choice of treatment and both the patient's age at referral and the patient's year of birth. Most common treatment for adult patients (age 18-56 years) was placement of an implant (67%), while autotransplantation (11%) was the preferred option for children at the mixed dentition stage (age 9-15 years).

CONCLUSIONS

The congenitally missing teeth most commonly involved in referrals of patients to publicly funded specialist care were lower second premolars. The most frequent treatment was insertion of an implant for adults and autotransplantation at the mixed dentition stage.

Anterior Incisal Onlay—A Minimally Invasive Non-Surgical Approach to Correct an Esthetic Complication of an Implant Supported Crown in the Anterior Zone

The growing demand for re-treatment of existing implant supported restorations in the anterior area due to esthetic complications poses a clinical challenge. One-piece implant supported restoration adds to the clinical complexity. Single implant crown restorations appear short as a result of expected cranio-facial changes. In the presented clinical case, a minimally invasive approach is offered as a solution for such an esthetic difficulty. The clinical old crown was prepared to receive an anterior incisal onlay (AIO) made from lithium disilicate and felspathic porcelain. The manufactured addition was adhesively cemented, presenting a simple prosthetic solution for an esthetic complaint, with no need for surgical procedure, while not challenging the one-piece implant body. As the variety of materials and methods for predictable adhesion increases, non-surgical and non-invasive treatment options will receive high priority. When correctly diagnosed and meticulously performed, the presented solution will meet the patient expectations and provide a satisfying result.

Management of Root Perforation due to Internal Resorption: A 1-year Follow-up Study

Diagnosing tooth resorption is critical for effective management. Internal resorption is a rare phenomenon, presenting with a pathognomonic clinical sign of a “pink spot” in the crown. In case of infection-induced tooth resorption, endodontic therapy needs to be carried out to decrease bacterial load within the pulp space and facilitate repair of resorbed tooth structure. Following inflammation of the pulpal tissue, clastic cells infiltrate the pulp chamber along with physiological blood supply and thereby initiate the process of internal tooth resorption. Tooth resorption involves two phases: an initial injury phase and the subsequent stimulation phase. The injury phase pertains to the pulpal tissue getting injured by a noxious stimulus, whereas stimulation is caused by the infection present in the vicinity of the tooth. Additionally, in a case where the resorption is caused due to trauma, a multidisciplinary approach becomes imperative so that the long-term solution is achieved. This paper presents a case with internal resorption with a poor prognosis. However, surgical intervention was made to preserve the tooth until a definitive procedure can be instituted.

How to cite this article: Deep A, Thakur S, Singhal P, et al. Management of Root Perforation due to Internal Resorption: A 1-year follow-up Study. Int J Clin Pediatr Dent 2021;14(4):593–595.

The application of orthodontic bone stretching for correcting malpositioned dental implants

Background

Dental implants are sometimes initially placed in a wrong position leading to esthetic damage, which is difficult to solve with prosthetics. Moreover, implants placed in the anterior sector, like ankylosed teeth, are frequently found in a wrong position over time with infraocclusion because of continuous anterior alveolar growth. Different treatments have been proposed to manage the consequences of malpositioned dental implants.

Case presentation

This paper describes a surgical and orthodontic new procedure that can be used to relocate an implant in a wrong position: the Orthodontic Bone Stretching technique (OBS), which involves deep partial osteotomies combined with heavy orthodontic forces. The applied force facilitates esthetic rehabilitation with a movement towards the occlusal plane and can modify the implant axis and the gingival line alignment. This relocation is made possible thanks to a bone stretching phenomenon in the surgical area without immediate mobilization or repositioning of an alveolar segment. Three cases with the need for implant repositioning are presented here and were treated with the OBS technique.

Conclusion

In the three cases presented, implant relocation was successfully performed with the OBS technique and the prosthetic crown was modified to improve esthetic results.

Tissue reaction to novel customized calcium silicate cement based dental implants. A pilot study in the dog

OBJECTIVES

The purpose of this study was to determine the level of periodontal tissue regeneration in a canine model following post-extraction placement of an implant molded from a composite material made from extracted tooth dentin and a calcium silicate cement (CSC) material. The investigation used autologous dentin in conjunction with a CSC material to form a composite implant designed for immediate tooth replacement.

METHODS

Two (2) beagles had a periodontal and radiographic examination performed to rule out any pre-treatment inflammation, significant periodontal disease, or mobility. Then, ination eleven (11) teeth were extracted and polyvinyl siloxane molds were made to fabricate three different types of implants: Particulate Implant (Test Group 1, n = 4), Shell Implant Alone (Test Group 2, n = 2), Shell Implant with Emdogain® (Test Group 3, n = 3). Teeth in the control group were extracted, scaled (n = 2), and then re-implanted into their respective fresh extraction sockets. At 4 weeks, a clinical, radiographic, and histologic assessment was performed.

RESULTS

Clinical evaluation revealed no mobility in any of the test or control implants and no radiographic evidence of significant bone loss or active disease. Based on the MicroCT analysis, direct bone to implant contact was observed in some areas with an apparent periodontal ligament space. Implant-related inflammation, on average, was similar among all groups, with low numbers of infiltrates. Implant-related inflammatory reaction was generally minimal and not interpreted to be adverse.

CONCLUSION

The proposed novel composite materials revealed that not only do these materials demonstrate high biocompatibility, but also their successful integration in the alveolus is likely secondary to a partial ligamentous attachment. The current investigation may lead to the use of calcium silicate-based materials as custom dental implants. Further research on this novel composite's biomechanical properties is necessary to develop the optimal material composition for use as a load-bearing dental implant.

What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis?

PURPOSE

To evaluate and assess the current knowledge about apexification and regenerative techniques as a meaningful treatment modality and to map the scientific evidence for the efficacy of both methods for the management of traumatised immature teeth with pulp necrosis and apical periodontitis.

METHODS

This systematic review searched five databases: PubMed, Web of Science, Cochrane Library, Ovid (Medline), and Embase. Published articles written in English were considered for inclusion. The following keywords were used: Regenerative endodontic treatment OR regenerat* OR revital* OR endodontic regeneration OR regenerative endodontics OR pulp revascularization OR revasculari* OR 'traumatized immature teeth'. Only peer-reviewed studies with a study size of at least 20 cases followed up for 24 months were included. Eligibility assessment was performed independently in a blinded manner by three reviewers and disagreements were resolved by consensus. Subgroup analyses were performed on three clinical outcomes: survival, success, and continued root development.

RESULTS

Seven full texts out of 1359 citations were included and conventional content analysis was performed. Most of the identified citations were case reports and case series.

CONCLUSIONS

In the present systematic review, the qualitative analysis revealed that both regenerative and apexification techniques had equal rates of success and survival and proved to be effective in the treatment of immature necrotic permanent teeth. Endodontic regenerative techniques appear to be superior to apexification techniques in terms of stimulation of root maturation, i.e. root wall thickening and root lengthening. Knowledge gaps were identified regarding the treatment and follow-up protocols for both techniques.

The risk for infraposition of dental implants and ankylosed teeth in the anterior maxilla related to craniofacial growth, a systematic review

BACKGROUND

The aim of the study was to evaluate a potential association between individuals with different craniofacial types or other exposures, and the risk of infraposition due to continued growth/eruption of adjacent teeth in the anterior maxilla.

MATERIALS AND METHODS

This is a systematic review in which primary studies as well as other systematic reviews are scrutinised. A search of PubMed (Medline), Scopus, Web of science and Health technology assessment (HTA) organisations and a complementary handsearch was carried out. Selected studies were read in full-text by several reviewers. The quality of the included primary studies was assessed using a protocol for assessment of risk of bias in exposure studies.

RESULTS

The literature search resulted in 3,296 publications. Title and abstract screening yielded 25, whereof one systematic review, potential publications allocated for full-text inspection. The quality assessment resulted in a total of seven studies with a low/moderate risk of bias and four studies with a high risk of bias.

CONCLUSION

In conclusion, a long-term risk for infraposition of dental implants, or ankylosed teeth, among natural teeth can be observed in some cases. The predisposing factors are still not fully understood since the current scientific evidence is very limited.

Does timing of implant placement affect esthetic results in single-tooth implants? A cohort evaluation based on mPES

OBJECTIVE

This study sought to use the mPES to assess various maxillary implant surgical results and placement timing in the esthetic zone.

MATERIALS AND METHODS

This cohort study was conducted on 146 patients undergoing immediate, early, and late implantation. They received maxillary single-tooth implants in the anterior region during the past 5 years. Patients were clinically examined to determine their mPES and patient-/implant-related parameters. Simple and multiple nominal regression analyses were applied to show how such parameters correlated with mPES.

RESULTS

The results were found to be in three categories namely the most clinically excellent, acceptable, and unacceptable. Although the most frequent clinically excellent results were noted in the late implantation (late 49.0%, early 25.6%, immediate 24.1%); early implantation was the group with the least frequent clinically unacceptable results (late 16.3%, early 4.7%, immediate 14.8%). The mean width of keratinized tissue was significantly more in patients with clinically excellent results (P-value = 0.01).

CONCLUSION

Within the limitations of this study, the author(s) drew the following conclusions: (a) the late implant placement was more likely to be reliable and esthetically acceptable, (b) early implant placement remained the safest method to prevent unaesthetic appearance, and (c) Width of keratinized gingiva (≥3 mm) was a significant factor to achieve implant esthetic results.

CLINICAL SIGNIFICANCE

Maxillary single-tooth implants in the anterior region often have optimal osseointegration and functional performance, but esthetic plays a significant role in the success of these implants. So the aim of the present study was to employ mPES to assess the effect of placement timing and other patient and implant-related variables on esthetic outcomes.

Primary oral manifestation of Langerhans cell histiocytosis refractory to conventional therapy but susceptible to BRAF-specific treatment: a case report and review of the literature

Langerhans cell histiocytosis (LCH) is a diagnostic and therapeutic challenge. We report on a rare case of its primary oral manifestation that was treated successfully with the BRAF-specific agent, vemurafenib, after insufficient standard LCH treatment. This case underlines the importance of proper diagnosis and the evaluation of targeted therapy as a valuable tool in LCH treatment. Furthermore, the close collaboration of surgeons, oncologists, and dentists is mandatory to ensure adequate treatment, restore the stomatognathic system in debilitating post-treatment situations, improve quality of life, and ensure effective disease control in infants and young patients.

Adverse Effects of Implants in Children and Adolescents: A Systematic Review

OBJECTIVE

To determine the evidence on the adverse effects of placing dental implants in healthy growing children.

STUDY DESIGN

A systematic search was conducted in five electronic databases: PubMed, Ovid, Cochrane, EBSCO host, ProQuest. Studies on implants placed in children below the age of 19 years, with loss of tooth either due to trauma or caries were included, whereas, studies on mini implants and implants placed due to congenital absence of teeth were excluded. The articles that fulfilled the inclusion criteria were analyzed based on the predetermined criteria of success.

RESULTS

A total of 8 publications fulfilled the inclusion criteria. All the included articles were case reports/series, involving a total of 16 implants (15 maxillary, one mandibular) in 11 adolescents (7 boys and 4 girls). The age of implant placement ranged between ten to 17 years with a mean age of 13.4 years and the follow up period, 4.5 months to 13 years. Pain, paresthesia, mobility or peri-implant radiolucency was not reported in any case report, indicating good integration. Radiographic crestal bone loss, probing depth and implant esthetics were not mentioned. The infraocclusion was not reported in 5 cases (age: 11-17 years, follow up: 4.5 months-two years), however, it was an adverse effect in 6 cases (age: ten-17 years, follow up: three-13 years).

CONCLUSION

There is insufficient evidence to contradict the placement of dental implants in healthy growing children; the only reported adverse event is infraocclusion, the management of which too is discussed. However, as all the data is from case reports, the result should be interpreted with caution. Therefore, well-designed randomized controlled trials are needed to address this gap in the literature.

Evaluation of maxillary sinus expansion in children due to maxillary first molar extraction

Purpose:

This study is aimed at understanding the effects of maxillary first molar extraction on the expansion of maxillary sinus in children.

Subjects and methods:

119 patients (aged 11-17 years) who had only one extracted maxillary first molar were included in the study. The superoinferior differences of the sinus floor position were measured in both dentate and edentulous sites on panoramic radiographs. The expansion of the maxillary sinus after maxillary first molar extraction was investigated in relation to fixed anatomic structures. The interorbital line (IL) and two zygomatic process lines (IZ) were used as a reference. The vertical distances between the IL and the inferior border of the maxillary sinus (IS) in edentulous (ISX) and in dentate sites (IST) were measured. The data was analyzed statistically.

Results:

The amount of maxillary sinus expansion in ISX was statistically significant in comparison to IST (p<0.001). The most prominent sinus expansions were found in subjects with extractions over six months prior to analysis (p<0.001). A negative correlation was detected between the amount of maxillary sinus expansion and IST (r = -0.438, p<0.001). There was a positive correlation between the amount of maxillary sinus expansion and IZT (r = 23.8, p<0.009).

Conclusion:

This study showed that the extraction of one maxillary first molar resulted in a negligible amount of sinus expansion in children. The results could be attributed to there being only one tooth extraction and a transferring of functional forces to the area of the neighboring teeth.

Treatment options for permanent teeth with coronal one-third root fractures

BACKGROUND AND OVERVIEW

Teeth with coronal one-third root fractures are considered to have a poor prognosis. Historically, such teeth were likely to be extracted. Observations have indicated that at least some teeth with such fractures can survive for a significant amount of time.

CASE DESCRIPTIONS

The authors report on 2 cases of coronal one-third root fractures that have survived for 10 and 35 years and suggest that the long-term splinting of these teeth aided in their survival.

CONCLUSION AND PRACTICAL IMPLICATION

Stabilizing teeth with coronal one-third root fractures may allow such teeth to survive for long periods, which can be of great benefit, especially for young patients.

Controversies in Implant Surgery

Dental implants are a mainstream treatment protocol to replace missing teeth. Patient and clinician demands have led to shorter length and narrower diameter implants, immediately placed implants into infected sites, and the use of implants in children. This article reviews some of the controversial topics in implant dentistry, and presents the evidence that supports and challenges these newer techniques. Because long-term studies are often not available, especially for implants in infected sites, mini implants, and implants in the growing patient, the field continues to evolve.

Chronological Age as Factor Influencing the Dental Implant Osseointegration in the Jaw Bone

The objectives of this study were to evaluate osseointegration of dental implant in the jaw bone in the young and elderly population and comparing the results to assess indicators and risk factors as age for the success or failure of dental implants. A retrospective study of 107 implants (Impladent, LASAK, Czech Republic) was prepared. The patients at implants surgery were divided in three groups. The patients were followed-up for a 7-year period. We evaluated osseointegration from long term point of view as a change of marginal bone levels close to dental implant. Marginal bone levels were recorded and analysed with regard to different patient- and implant-related factors. An influence of chronological age on change of marginal bone levels during 6-year retrospective study vas evaluated. The study examined 47 patient charts and 107 implants from the Second Faculty of Medicine, Charles University and University Hospital Motol. We proved that young healthy patients with long bridges or Branemarks have the same progression of marginal bone levels changes. The chronological age hasn't therefore direct influence on the osseointegration from long term point of view. But we found that the length of dental suprastrucure-prosthetic construction negatively influences marginal bone changes, though these results weren't statistically significant. More extensive dental implant suprastrucure undergoes smaller osseointegration. On the other hand the length of dental suprastrucure (prosthetic construction) negatively influences dental osseointegration in both groups of patient.

Treatment of Necrotic Teeth by Apical Revascularization: Meta-analysis

Each year ~5.4 million children and adolescents in the United States suffer from dental infections, leading to pulp necrosis, arrested tooth-root development and tooth loss. Apical revascularization, adopted by the American Dental Association for its perceived ability to enable postoperative tooth-root growth, is being accepted worldwide. The objective of the present study is to perform a meta-analysis on apical revascularization. Literature search yielded 22 studies following PRISMA with pre-defined inclusion and exclusion criteria. Intraclass correlation coefficient was calculated to account for inter-examiner variation. Following apical revascularization with 6- to 66-month recalls, root apices remained open in 13.9% cases (types I), whereas apical calcification bridge formed in 47.2% (type II) and apical closure (type III) in 38.9% cases. Tooth-root lengths lacked significant postoperative gain among all subjects (p = 0.3472) or in subgroups. Root-dentin area showed significant increases in type III, but not in types I or II cases. Root apices narrowed significantly in types II and III, but not in type I patients. Thus, apical revascularization facilitates tooth-root development but lacks consistency in promoting root lengthening, widening or apical closure. Post-operative tooth-root development in immature permanent teeth represents a generalized challenge to regenerate diseased pediatric tissues that must grow to avoid organ defects.

Implant-supported Oral Rehabilitation in Child with Ectodermal Dysplasia - 4-year Follow-up

Ectodermal dysplasia (ED) is an anomaly determined by genetic factors that alter ectodermal structures such as skin, hair, nails, glands, and teeth. Children affected by this condition require extensive, comprehensive, and multidisciplinary treatment. An 8-year-old female patient visited the Dentistry Clinic of the Federal University of Santa Catarina with the chief complaint of multiple missing teeth. The mother reported that the patient had ED. Clinical and radiographic examination revealed the congenital absence of several primary and permanent teeth and tooth germs. Subsequent oral rehabilitation comprised the application of a maxillary denture and mandibular implant-supported fixed prosthesis. The child was also supplied with a wig for further enhancement of esthetics aimed at improving her emotional wellbeing. Psychological follow-up and speech therapy were also provided. After 4 years of follow-up, implant-supported oral rehabilitation has proved to be a satisfactory treatment option, allowing restoration of masticatory, phonetic, and esthetic function, as well as an improvement in the patient's self-esteem and social wellbeing.

Dental implants in children: A multidisciplinary perspective for long-term success

Congenital hypodontia or trauma is a frequent cause of loss of teeth in children. The absence of teeth leads to loss of function and lack of normal alveolar growth, along with unpleasant esthetics that hamper the psychosocial development of the young child. Traditionally, the management of tooth loss in the young child is done by conservative means. None of those methods of treatment are completely satisfactory and have their own drawbacks. Dental implants in a young child would be an ideal mode of treatment for the absence of teeth. One of the main deterring factors for implant placement in children is the impending growth. Growth in the maxilla and mandible does not happen uniformly in one plane. It is multidirectional, occurring in sagittal, vertical, and transverse planes. It does not happen at a fixed pace, slow periods of growth are followed by phases of accelerated growth called the growth spurts. Successful implant treatment in children has been achieved by several clinicians when they incorporated a multidisciplinary approach in their treatment plan. The design and type of implant system used in pediatric patients is also responsible for successful treatment outcome. The purpose of this review is to understand the implications of growth and growth assessment and recommendations for the formulation of the treatment plan in pediatric dental implant patients.

Regenerative Endodontics by Cell Homing

Apical revascularization (AR) and platelet-rich plasma have been used to restore dental pulp vitality in infected immature permanent teeth. Two regenerative therapies are cell transplantation and cell homing. This article updates and benchmarks these therapies with cell homing. A case report concluded that AR increased root length; however, quantitative and statistical assessments disproved this. Regenerative endodontic therapies require prospective clinical trials demonstrating safety and efficacy. These therapies are intrinsically susceptible to procedural and patient variations. Cell homing uses novel molecules that drive therapeutic efficacy, and may be less sensitive to procedural and patient variations.

A Digital Approach to Improved Overdentures for the Adolescent Oligodontia Patient

OBJECTIVE

The use of overdentures for treatment of oligodontia in adolescent patients using conventional techniques has described limitations. The aim of the case report is to demonstrate the use of CAD (Computer Aided Design) CAM (Computer Aided Manufacture) technology to produce an esthetic monolithic polymethylmethacrylate prosthesis that is retentive and stable on insertion.

CLINICAL CONSIDERATIONS

Adolescent oligodontia patients are typically not suitable candidates for dental implant therapy. Overdentures provide interim or definitive restorative advantages. Given the important esthetic, psychological, and social functions of the prosthesis, an important therapeutic goal for the overdenture prosthesis is esthetics. A CAD-CAM approach to overdenture manufacture can provide a highly esthetic, strong, and retentive prosthesis.

CONCLUSIONS

CAD-CAM manufacture of monolithic acrylic overdentures offer several advantages that include (1) improved planning and clinical communication, (2) high fidelity manufacture, (3) improved flexural strength, impact strength, and porosity, (4) improved prosthesis integrity and durability (due to the monolithic design), (5) CNC control of occlusal contacts, (6) high esthetic potential due to quality of bulk material and iterative design, and (7) archival nature of the digital prosthesis. CAD-CAM manufacture of monolithic overdentures is a viable approach to completing high value esthetic management of the adolescent oligodontia patient.

CLINICAL SIGNIFICANCE

This case report identifies a new way to utilize CAD CAM technology to produce an improved overdenture for the oligodontia patient. It will be of interest to many and underscores the fundamental principles of smile design transfer to the digital environment. (J Esthet Restor Dent, 2016).

Dental Implants - Perceiving Patients' Satisfaction in Relation to Clinical and Electromyography Study on Implant Patients

The aim of this study is to evaluate the satisfaction of patients with posterior implants in relation to the clinical success criteria and surface electromyography (sEMG) findings of the masseter and temporalis muscles. Total 42 subjects were investigated. Twenty one subjects with posterior dental implants were interviewed using a questionnaire and the clinical success criteria were determined based on The International Congress of Oral Implantologists. The myofunction of the masticatory muscles were assessed using sEMG (21 subjects) and compared to the control group of subjects without implants (21 subjects). Out of 21 subjects, all were satisfied with the aesthetics of their implant. Twenty of them (95.2%) were satisfied with its function and stability. As for clinical criteria, 100% (50) of the implants were successful with no pain, mobility or exudates. sEMG findings showed that patients have significantly lower (p<0.01) basal or resting median power frequency but with muscle burst. During chewing, control subjects showed faster chewing action. There was no difference in reaction and recovery time of clenching for both groups. In conclusion, the satisfaction of implant patients was high, and which was in relation to the successful clinical success criteria and sEMG findings.

Restoring Congenitally Missing Maxillary Lateral Incisors Using Zirconia-Based Resin Bonded Prostheses

OBJECTIVE

This clinical report describes an alternative treatment modality for the replacement of congenitally missing maxillary lateral incisors in a 17-year-old patient.

CLINICAL CONSIDERATIONS

Zirconia-based resin-bonded fixed partial dentures (RBFPDs) were selected as a viable and conservative treatment option in a young individual with highly aesthetic expectations. Fabrication of all-ceramic RBFPDs followed specific preparation design and features to accommodate two retainers. The zirconia frameworks with bilateral wings were digitally designed and then milled by a computer-aided design and computer-aided manufacturing (CAD/CAM)-controlled milling machine. Zirconia surface was treated with a two-step chairside tribochemical silica-coating/silane coupling surface treatment protocol, and adhesive resin luting cement was used to achieve micromechanical and chemical bonding. Completion of the treatment resulted in a functional and aesthetic successful outcome and a 17-month follow-up presented uneventful.

CONCLUSION

Contemporary adhesive techniques involving resin-bonded zirconia-based prostheses can be utilized successfully and predictably in young patients with single missing teeth when implant therapy is currently not a treatment of choice and a less invasive approach is desired.

CLINICAL SIGNIFICANCE

The zirconia-based resin-bonded prosthesis constitutes a viable and conservative treatment modality for the replacement of missing teeth either congenitally or from another etiology in young patients in which implant therapy and a fixed partial denture are currently contraindicated.

Separation of overlapping dental arch objects using digital records of illuminated plaster casts

Background

Plaster casts of individual patients are important for orthodontic specialists during the treatment process and their analysis is still a standard diagnostical tool. But the growing capabilities of information technology enable their replacement by digital models obtained by complex scanning systems.

Method

This paper presents the possibility of using a digital camera as a simple instrument to obtain the set of digital images for analysis and evaluation of the treatment using appropriate mathematical tools of image processing. The methods studied in this paper include the segmentation of overlapping dental bodies and the use of different illumination sources to increase the reliability of the separation process. The circular Hough transform, region growing with multiple seed points, and the convex hull detection method are applied to the segmentation of orthodontic plaster cast images to identify dental arch objects and their sizes.

Results

The proposed algorithm presents the methodology of improving the accuracy of segmentation of dental arch components using combined illumination sources. Dental arch parameters and distances between the canines and premolars for different segmentation methods were used as a measure to compare the results obtained.

Conclusion

A new method of segmentation of overlapping dental arch components using digital records of illuminated plaster casts provides information with the precision required for orthodontic treatment. The distance between corresponding teeth was evaluated with a mean error of 1.38% and the Dice similarity coefficient of the evaluated dental bodies boundaries reached 0.9436 with a false positive rate \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$FPR=0.0381$$\end{document}FPR=0.0381 and false negative rate \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$FNR=0.0728$$\end{document}FNR=0.0728.

Evaluation of dental morphometrics during the orthodontic treatment

BACKGROUND

Diagnostic orthodontic and prosthetic procedures commence with an initial examination, during which a number of individual findings on occlusion or malocclusion are clarified. Nowadays we try to replace standard plaster casts by scanned objects and digital models.

METHOD

Geometrically calibrated images aid in the comparison of several different steps of the treatment and show the variation of selected features belonging to individual biomedical objects. The methods used are based on geometric morphometrics, making a new approach to the evaluation of the variability of features. The study presents two different methods of measurement and shows their accuracy and reliability.

RESULTS

The experimental part of the present paper is devoted to the analysis of the dental arch objects of 24 patients before and after the treatment using the distances between the canines and premolars as the features important for diagnostic purposes. Our work proved the advantage of measuring digitalized orthodontic models over manual measuring of plaster casts, with statistically significant results and accuracy sufficient for dental practice.

CONCLUSION

A new method of computer imaging and measurements of a dental stone cast provides information with the precision required for orthodontic treatment. The results obtained point to the reduction in the variance of the distances between the premolars and canines during the treatment, with a regression coefficient RC=0.7 and confidence intervals close enough for dental practice. The ratio of these distances pointed to the nearly constant value of this measure close to 0.84 for the given set of 24 individuals.

Treatment planning the endodontic-implant interface

One of the most challenging treatment planning decisions in restorative dentistry is the retention of a root filled tooth or its extraction and replacement with an implant. Making an informed judgement relies upon not only clinical experience and expertise but also interpretation of the published clinical evidence. In the last few years, more robust data and closer scrutiny of the evidence has helped to understand the advantages and disadvantages of each of these treatment modalities. The purpose of this paper is to provide a narrative review of some of the factors that may influence treatment planning for root canal treated teeth and indications for whether these teeth would be better replaced by an implant. From the evidence presented it is clear that both treatments have a place in contemporary restorative dental treatment and that survival for both root filled teeth and implants are similar. Unsurprisingly, both these treatment choices require high standards of clinical expertise and careful planning to ensure the best outcome.

Implants in adolescents

Implants have gained tremendous popularity as a treatment modality for replacement of missing teeth in adults. There is extensive research present on the use of implants in adults, but there is a dearth of data available on the same in adolescents. The treatment planning and execution of implant placement in adolescents is still in its infancy. This review article is an attempt to bring together available literature.

Management of dental trauma to a developing permanent tooth during endotracheal intubation

Anesthesiologists consistently work in the mouth of patients but are not exposed to comprehensive education of teeth, the surrounding structures, and intraoral prosthesis. One of the most common adverse events related to anesthesia is perioperative dental damage. To minimize these dental injuries, a preoperative assessment of patient's dentition and intra-oral tissues should be undertaken.

Attachment and proliferation of human osteoblast-like cells (MG-63) on laser-ablated titanium implant material

Demand is increasing for shortening the long (3-6 months) osseointegration period to rehabilitate patients' damaged chewing apparatus in as short a time as possible. For dental implants, as for biomaterials in general, the bio- and osseointegration processes can be controlled at molecular and cellular levels by modification of the implant surface. One of the most promising of such surface modifications is laser ablation, as demonstrated by our previous results [46]. Commercially pure (CP4) sand-blasted, acid-etched titanium disks (Denti® System Ltd., Hungary) were irradiated with a KrF excimer laser (248 nm, fluence 0.4 J/cm(2), FWHM 18 ns, 2000 pulses), or with a Nd:YAG laser (532 nm, 1.3 J/cm(2), 10 ns, 200 pulses) then examined by SEM, AFM, and XPS. In vitro attachment (24 h) and proliferation (72 h) of MG-63 osteoblast cells were investigated via dimethylthiazol-diphenyl tetrazolium bromide (MTT), alamarBlue (AB) assays alkaline phosphatase quantification (ALP) and SEM. SEM and AFM revealed significant changes in morphology and roughness. XPS confirmed the presence of TiO2 on each sample; after Nd:YAG treatment a reduced state of Ti (Ti(3+)) was also observed. MTT, AB and ALP measurements detected an increase in the number of cells between the 24- and 72 hour observations; however, laser treatment did not affect cell attachment and proliferation significantly.

Stem cells in dentistry--Part II: Clinical applications

New technologies that facilitate solid alveolar ridge augmentation are receiving considerable attention in the field of prosthodontics because of the growing requirement for esthetic and functional reconstruction by dental implant treatments. Recently, several studies have demonstrated potential advantages for stem-cell-based therapies in regenerative treatments. Mesenchymal stem/stromal cells (MSCs) are now an excellent candidate for tissue replacement therapies, and tissue engineering approaches and chair-side cellular grafting approaches using autologous MSCs represent the clinical state of the art for stem-cell-based alveolar bone regeneration. Basic studies have revealed that crosstalk between implanted donor cells and recipient immune cells plays a key role in determining clinical success that may involve the recently observed immunomodulatory properties of MSCs. Part II of this review first overviews progress in regenerative dentistry to consider the implications of the stem cell technology in dentistry and then highlights cutting-edge stem-cell-based alveolar bone regenerative therapies. Factors that affect stem-cell-based bone regeneration as related to the local immune response are then discussed. Additionally, pre-clinical stem cell studies for the regeneration of teeth and other oral organs as well as possible applications of MSC-based immunotherapy in dentistry are outlined. Finally, the marketing of stem cell technology in dental stem cell banks with a view toward future regenerative therapies is introduced.

Implant-prosthetic rehabilitation of a patient with nonsyndromic oligodontia: a clinical report

Oligodontia is defined as the absence of 6 or more permanent teeth due to the hypodevelopment of tooth germs. This familial abnormality is attributable to various mutations or polymorphisms of genes and associated with malformative syndromes. This clinical report presents the multidisciplinary dental treatment planning for a 27-year-old woman who exhibited oligodontia. After radiographic and clinical evaluations, 7 retained primary teeth and 2 mandibular third molars were extracted. Three dental implants were placed into the maxillary alveolar process. After the osseointegration period, complete-arch fixed prostheses in both maxilla and mandible, supported by a combination of implants and teeth, were fabricated. Osseointegration of the implants, peri-implant mucosa health, and prosthesis function were assessed every 6 months. At the end of the 3-year clinical follow-up, the patient was satisfied with the esthetics, function, and phonation of her prosthesis. To attain the best esthetic and biological results, an interdisciplinary approach could be used to synergistically combine surgery and restorative dentistry for the restoration of maximal esthetics and function.

Long-term function of single-implant restorations: a 17- to 19-year follow-up study on implant infraposition related to the shape of the face and patients' satisfaction

BACKGROUND

Various levels of infraposition of single-implant restorations have been observed in long-term follow-up studies, but little knowledge is available on the biological mechanism behind this pattern.

PURPOSE

The primary aim of this study is to report the frequency and severeness of implant infraposition in the anterior single-implant application after 17 to 19 years in function and, secondly, to try to relate these observations to anatomical appearance of the shape of the face of the patient.

MATERIALS AND METHODS

The present study comprised of 57 patients who were provided with 65 CeraOne™ single-tooth restorations (Nobel Biocare AB, Gothenburg, Sweden) between 1989 and 1991. Altogether 46 of these patients were treated with single implants in the anterior region. Besides clinical and radiographic data, clinical photographs, study casts, and patient's assessment of the long-term aesthetic result (visual analog scale) was collected at the termination of the present study. The degree of implant crown infraposition was related to assessed facial shape and to patient and clinical assessment of the aesthetic result by means of Pearson's correlation test. To increase the numbers of patients, another group of 25 patients presented in another similar study were pooled with the present material for prevalence calculations.

RESULTS

Altogether 47 patients showed up for the final examination after an average of 18 years (82%). Two implants failed (18 years cumulative survival rates [CSR]- 96.8%) and eight original single-crown restorations were replaced (CSR 83.8%). Three of the replaced crowns were replaced because of infraposition of the crowns. About 40% of the patients showed signs of infraposition, similar in younger and older age groups, but more frequently observed in female patients at termination of the study (p < 0.05). There was a weak trend indicating an association between "long-face" appearance and infraposition of the crown restoration (p > 0.05), and patients were more satisfied with the aesthetic clinical result than the participating clinicians (p < 0.05).

CONCLUSION

Single-implant restorations in the anterior upper jaw may present small degrees of infraposition in long-term perspectives. Female patients seem to be at a higher risk of infraposition (p < 0.05), but no clear relationship between age at implant placement or facial shape and degree of infraposition was possible to establish (p > 0.05). Patients were more satisfied with the aesthetic result, as compared with the clinicians (p < 0.05), and patients seemed to pay less attention to the degree of infraposition in their aesthetic assessments, as compared with most of the clinicians.