Single-tooth anterior implant: a word of caution. Part II

Invisible treatment of an asymmetric adult class II malocclusion related to unilateral upper lateral incisor agenesis with a straight wire lingual appliance, mini-screw and premolar extraction: A case report

This case report describes a complex full-step class II malocclusion with unilateral upper lateral incisor agenesis in an adult patient treated with lingual straight-wire appliance and premolar extraction, with the two-fold aim of obtaining ideal occlusal relationship and smile aesthetic improvement. In view of this, it underlines how an appropriate treatment strategy, including extraction choice and anchorage control during space closure, is needed to achieve the planned results with a completely invisible lingual appliance combined with aesthetic veneers.

Evaluation of influence factors on the width, length, and width to length ratio of the maxillary central incisor: A systematic review and meta-analysis

OBJECTIVES

The aim of this study was to analyze whether symmetry of left and right sides, gender, measuring method, and ethnicity have influences on width (W), length (L), and width to length ratio (W/L) of the maxillary central incisor (MCI) and provide a reference for dental treatment planning in the esthetic zone.

MATERIALS AND METHODS

An electronic search was conduct of the dental literature. Studies reporting data about measurements were included. Data were extracted and analyzed for the differences between left and right, male and female, different measuring methods, and ethnicities by Review Manager and Stata statistical software.

RESULTS

Seventeen studies were included. There were no differences between measurement of the left and right groups, perceived and actual measuring groups. However, differences were found between genders in MCI's W and L but no difference in W/L. Differences were also found between Asians and Caucasian subjects in MCI's W, L, and W/L.

CONCLUSIONS

The results of this meta-analysis suggest that symmetry of left and right sides and measuring method do not influence MCI dimension. Gender and ethnicity are found as influence factors for MCI dimension. We believe these findings can be helpful for dentists to decide and design the dimensions of the restorations for maxillary anterior teeth in clinical practices.

CLINICAL SIGNIFICANCE

In the process of designing maxillary anterior teeth for implantation, the contralateral MCI can be helpful to create a symmetrical esthetic restoration. For patients with maxillary anterior tooth loss or diastemas, dentists should divide the left and right space equally and keep the MCI contact area aligned with the midline. Dentists should take face size and gender into consideration when making treatment plans for the MCI. Facial parameters as well as the size ratios of the previous teeth can be evaluated and may influence the size and shape of the teeth. When measuring anterior teeth or facial dimensions for esthetic evaluation, the recommended method is to measure the perceived sizes of a facial view image created by a digital camera. Slight discrepancies may exist between the actual and measured values due to the curvature of the arch and the angle in which the photograph was taken.

Esthetic Considerations for Reconstructing Implant Emergence Profile Using Titanium and Zirconia Custom Implant Abutments: Fifty Case Series Report

Titanium and zirconia custom implant abutments are now commonly used for esthetic implant dentistry. Custom implant abutments allow the clinician to improve an implant's emergence profile, to customize cervical margins in accordance with the anatomy of the natural root, and to compensate for poor implant angulation. All of these are essential for optimum esthetic outcomes. Computer-aided design/computer-aided machining (CAD/CAM) technology allows the clinician to design custom implant abutment configurations and create natural-looking superstructures that are in harmony with the adjacent dentition and soft tissue. The CAD/CAM technique provides precise fit, reduces the cost of the procedure, and eliminates dimensional inaccuracies inherent in the conventional waxing and casting technique. The aim of this report is to describe a simplified technique for reconstructing emergence profiles during implant restoration using milled titanium and zirconia custom implant abutments. The results of 50 consecutive cases are reported.

Outcome of orthodontic space closure with a missing maxillary central incisor

Orthodontic space closure is one of the treatment alternatives when a maxillary central incisor is missing. Because no systematic analysis of such treatment results is available, a sample of 20 consecutively treated patients was examined in a follow-up study. All patients had received orthodontic treatment with the objective of closing the space for the missing central incisor. Biologic features and the clinical appearance of the recontoured lateral incisor (test tooth) replacing the missing tooth were compared with the neighboring intact central incisor, which served as control tooth. The patients' opinions regarding the treatment and the result were recorded in a questionnaire. The position of the examined teeth and the appearance of the surrounding soft tissues were similar in the test and control teeth. However, in some patients (25%), certain aspects of the recontoured incisor crown (such as the width at the gingival margin) mismatched the appearance of the controls. A somewhat increased mobility and probing pocket depth on the mesial aspect was recorded for some test teeth. No obvious detrimental effects were observed on the radiographs. Most patients expressed satisfaction with the treatment result. It is concluded that orthodontic mesialization of the lateral incisor to replace a missing central incisor is a valid treatment modality, if the indications for such treatment are present and careful attention to detail in orthodontic and restorative treatment is exercised.

Outcome of tooth transplantation: survival and success rates 17-41 years posttreatment

The literature contains no follow-up studies of transplanted teeth with mean observation times exceeding 10 years. This article describes long-term outcomes, including gingival and periodontal conditions, and the patients' attitudes about treatment and outcome. The material comprised all accessible patients in the files of the Department of Orthodontics, University of Oslo, Norway, on whom treatment had been performed at least 17 years ago (n = 28). Established clinical criteria were used to assess tooth mobility, plaque and gingival indexes, and probing pocket depth. Standardized radiography was used to evaluate the presence of pathology, pulp obliteration, and root length. Similar recordings were obtained from the in situ tooth contralateral to the initial position of the grafted tooth. Criteria for determining treatment success were established. All patients responded to questions about their treatment using visual analogue scales. The mean age at surgery was 11.5 years, and the mean observation period was 26.4 years (range, 17-41 years). Of the 33 teeth transplanted in the 28 patients, 3 teeth were lost after 9, 10, and 29 years, respectively. Therefore, the 30 teeth in the 25 patients we examined yielded a survival rate of 90%. The success rate was 79% because 2 transplants had ankylosed, and 2 others failed to fulfill the proposed criteria. The patients generally responded very favorably regarding their perception of the treatment. Their only hesitation was related to some discomfort during surgery. It was concluded that survival and success rates for teeth autotransplanted when the root is partly developed compare favorably in a long-term perspective with other treatment modalities for substituting missing teeth.

Autotransplantation of premolars to replace maxillary incisors: a comparison with natural incisors

The published literature contains no comprehensive studies that compare the outcome of premolar autotransplantation to the maxillary anterior region with natural incisors in the same patients. This article describes the gingival and periodontal conditions around premolars transplanted to the maxillary incisor region, subsequent to restoration. Forty-five premolars autotransplanted to the maxillary incisor region in 40 adolescent patients were evaluated after a mean observation period of 4.0 years. Mean age at surgery was 11.0 years. Established clinical criteria were used to assess tooth mobility, plaque and gingival indexes, probing pocket depth, and percussion. Recession and hyperplasia of interproximal gingival papillae were assessed according to a recently proposed index. Standardized radiography was used to evaluate presence of pathosis, pulp obliteration, root length, and crown-root ratios. Clinical variables for transplants did not differ from those of the natural incisors, except for increased mobility and more plaque in a few transplanted premolars. The interproximal gingival papillae adjacent to all transplanted teeth were normal or slightly hyperplastic. Radiographically, all transplants showed varying degrees of pulp obliteration, but no signs of pathosis. Crown-root ratios were similar for natural and transplanted teeth as were distances from cementoenamel junction to marginal bone. The overall status of the transplanted premolars and surrounding tissues indicated that this treatment modality may be recommended when maxillary incisors are missing in adolescents. In addition, tooth transplantation represents an inherent potential for bone induction and reestablishment of a normal alveolar process.