Long-term bone remodeling of maxillary anterior teeth with post-treatment alveolar bone defect in adult patients with maxillary protrusion: a prospective follow-up study

BACKGROUND

Alveolar bone defects, particularly palatal bone dehiscence (PBD) and labial bone fenestration (LBF), occur frequently as a result of retraction of the maxillary anterior teeth. The study aims to explore the long-term bone remodeling of maxillary anterior teeth in adult patients with post-orthodontic treatment PBD and LBF.

MATERIALS AND METHODS

The study includes 24 adult patients with maxillary protrusion (8 males, 16 females) who were treated with extraction of four first premolars and had alveolar bone defects (PBD or LBF) in maxillary anterior teeth following orthodontic treatment. Cone-beam computed tomography imaging measurements were obtained before (T1), after (T2) orthodontic treatment, and after at least 1-year removable thermoplastic retainer retention (T3). The maxillary anterior teeth with PBD or LBF at T2 were divided into the PBD or LBF groups, respectively. The labial and palatal alveolar bone height (ABH), alveolar bone thickness (ABT), and movement of maxillary anterior teeth were measured during retraction (T2-T1) and retention (T3-T2) periods.

RESULTS

The incidence of PBD and LBF in maxillary anterior teeth significantly increased after orthodontic treatment and decreased during the retention period. In the PBD group, the palatal ABH of all maxillary anterior teeth significantly increased from T1 to T2 but decreased from T2 to T3. The ABT of the maxillary central incisor and canine significantly increased on the palatal side and decreased on the labial side during the retention period. In the LBF group, the labial ABT of the maxillary central incisor at the apical level showed a significant decrease from T1 to T2, followed by an increase from T2 to T3. In both groups, the maxillary central incisor showed significant labial movement, with a relative intrusion during the retention period.

CONCLUSION

For adult patients with maxillary protrusion, the alveolar bone defect of maxillary anterior teeth caused by orthodontic retraction significantly improved during the retention period, indicating good long-term bone remodeling. Our findings suggest that a combination of spontaneous reorientation of maxillary anterior teeth and bone remodeling contributed to alveolar bone covering in these patients.

The orthodontic implant site-switching technique: a preliminary study in dogs

BACKGROUND

To evaluate the quantity and quality of bone in the newly formed edentulous area produced by the orthodontic implant site-switching technique.

METHODS

The bilateral maxillary first premolars of five beagle dogs were extracted and bone defects were created. The right and left sides of the maxilla were randomly divided into control and experimental sides. On the experimental side, the maxillary second premolar was mesially moved into the position of the missing first premolar. On the control side, the second maxillary premolar was extracted. Six months later, the beagles were euthanized. Microcomputer tomography was used to analyze bone microstructure parameters, alveolar bone height and alveolar bone width of the regenerated bone. Histological analysis was performed by staining tissue sections with toluidine blue.

RESULTS

Median BV/TV values in the experimental group (81.78%) were significantly larger than those in the control group (35.67%; p = 0.04). Median Tb.Sp values in the experimental group (0.14 mm) were significantly lower than those in the control group (0.54 mm; p = 0.04). Median Tb.Th values in the experimental group (0.48 mm) were significantly higher than those in the control group (0.21 mm; p = 0.04). Median Tb.Pf values in the experimental group (0.65/mm) were significantly lower than those in the control group (3.15/mm; p = 0.04). There was no significant difference in the trabecular number (Tb.N) between the two groups (p = 0.23). The median alveolar bone height values in the experimental group (-0.81 mm) were significantly higher than those in the control group (-2.11 mm; p = 0.04) at a distance 5 mm from the mesial CEJ of the third premolar. The median alveolar bone height values in the experimental group (0.45 mm) were significantly higher than those in the control group (-1.70 mm; p = 0.04) at a distance 6 mm from the mesial CEJ of the third premolar. There was no significant difference in alveolar bone width when compared between the two groups (p > 0.05).

CONCLUSIONS

The newly formed edentulous area created by orthodontic treatment had more compact and thicker trabeculae than the extraction socket. Furthermore, the newly formed edentulous area had a greater alveolar bone height available for the placement of implants.

The Orthodontics-Periodontics Challenges in Integrated Treatment: A Comprehensive Review

Orthodontics and periodontics are intricately linked since adult orthodontics often implicate the periodontium. Periodontal intervention is needed throughout all phases of orthodontic treatment, from orthodontic diagnosis to mid-treatment periodontal assessment and postoperative evaluation. Invariably, periodontal health affects orthodontic success. Conversely, orthodontic tooth movements may serve as adjunctive therapy in patients with periodontal disease. This review aimed to provide a comprehensive understanding of the orthodontic-periodontic relationship for optimizing therapeutic strategies and achieving the best treatment outcomes in patients.

Bone Modeling after Orthodontic Extrusion: A Histomorphometric Pilot Study

During osteogenesis and bone modeling, high vascularity and osteoblastic/osteoclastic cell activity have been detected. A decrease in this activity is a sign of complete bone formation and maturation. Alveolar bone maturation seems to occur within weeks and months; however, the precise timing of the alveolar bone modeling is still unknown. The aim of this clinical pilot study was to investigate the bone modeling of neo-apposed tissue during orthodontic extrusive movements, through a histomorphometric analysis of human biopsies. This study was conducted on third mandibular molars sockets, and all teeth were extracted after orthodontic extrusion between 2010 and 2014. After different stabilization timings, extractions were performed, and a specimen of neo-deposed bone was harvested from each socket for the histomorphometric analysis. Histological parameters were evaluated to identify bone quantity and quality. This study included 12 teeth extracted from 9 patients. All specimens were composed of bone tissue. Bone samples taken after 1 and 1.5 months of stabilization presented remarkable percentages of woven bone, while after 2 months, a relevant decrease was observed. Histomorphometric analysis suggested that after orthodontic extrusion, a period of stabilization of 2 months allows the neo-deposed bone to mature.

Assessment of infrazygomatic crest dimensions in different vertical facial growth types for miniscrew insertion: A cone-beam computed tomography study

INTRODUCTION

This study aimed to assess the depth and height of the infrazygomatic crest (IZC) located in the posterior maxilla at the junction with the zygomatic process in patients with different vertical facial growth types as a potential miniscrew insertion site.

METHODS

The sample consisted of cone-beam computed tomography scans of 117 patients (42 males and 75 females), with a mean age of 22.9 ± 2.7. The population was divided into 3 groups according to the measured SN-GoGn angle: Decreased facial proportions (n = 28), average facial proportions (n = 62), and increased facial proportions (n = 27). Bone depth was assessed at 5 levels: apex, 1, 2, 3, and 4 mm vertically from the apex. The measurements were performed on the mesiobuccal and distobuccal roots of the first molar and the mesiobuccal root of the second molar. Repeated-measure analysis of variance followed by univariates analyses and Bonferroni multiple comparisons were performed to compare the mean bone thickness between groups. The IZC height was assessed through a vertical line ranging from the furcation of the maxillary first molar to the sinus floor. Analysis of variance followed by Tukey (honestly significant difference) post-hoc tests was used to compare the mean height between groups.

RESULTS

Mean bone depth between the 3 groups were significantly different at the mesiobuccal root region of the first molar at all the measured levels. It was smaller for average, intermediate for decreased, and elevated for increased facial proportions. No statistical difference was shown at the distobuccal root of the first molar except for the apex level and the mesiobuccal root of the second molar except for the apex and 4 mm levels. The mean bone height was significantly different between subjects with increased facial proportions and the 2 other groups.

CONCLUSIONS

Subjects with increased facial proportions tend to present a longer and deeper IZC followed by decreased facial proportions, then average facial proportions.

Implant treatment after traumatic tooth loss: A systematic review

BACKGROUND/AIMS

Treatment after traumatic tooth loss is challenging and is currently guided by expert opinion and the individual patient situation. The aim of this study was to provide an overview on the outcome of dental implant treatment in the anterior maxilla after traumatic tooth loss, based on a systematic review of the existing evidence.

MATERIALS AND METHODS

A systematic search of the literature was performed on PubMed, Cochran Library and Web of Science following the PRISMA guidelines based on a structured research question (PICO). All clinical studies of five patients or more with follow-up of at least 1 year after implant loading were included. Patients were at least 18 years of age. Cohen's Kappa-coefficient was calculated. The Newcastle-Ottawa Scale was applied to assess the quality of the included studies. Descriptive statistical methods were applied.

RESULTS

Nine hundred and ninety-nine articles were identified through the systematic search. Finally, six articles were eligible for inclusion. The studies comprised prospective and retrospective cohort studies and case series. From these, 96 patients with 120 implants were included. The age ranged from 18 to 59 years. The survival rates of implants and superstructures were 97% and 95%, respectively, after a mean follow-up of 3.5 years. Mean marginal bone resorption was 0.56 mm (range 0.21-1.30 mm). Complication rates were 7% and 11% on implant and superstructure level, respectively. Patient-reported outcome measures and objective evaluations showed a high level of satisfaction with the aesthetic outcome. Bone augmentation was performed in 60 implant sites. Three patients underwent pre-surgical orthodontic treatment. The maxillary central incisor was the most frequently replaced tooth (70%).

CONCLUSIONS

This systematic review revealed a low level of evidence on the outcome of dental implant treatment after traumatic tooth loss. Systematic reporting of treatment outcomes of tooth replacements after dental trauma is highly encouraged to further guide dentists for the benefit of these challenging patients.

Bidimensional system for space closure treatment of missing lateral incisors: 10 years follow-up

INTRODUCTION:

Missing lateral incisors represent a common condition that normally requires specific anchorage conditions to be treated with space closure mechanics to protract upper teeth creating a proper occlusal relationship.

CASE PRESENTATION:

Two cases showing Class II malocclusion with missing lateral incisors in developing age are presented, both treated with the same approach of maximum anterior anchorage applied using the Bidimensional Technique system. Long-term follow-up of 10 years is shown.

MANAGEMENT AND OUTCOME:

Bidimensional technique is a modified edgewise technique that uses sliding mechanics for protraction of the posterior segments by placing vertically slotted brackets of different sizes on the anterior (.018” x 0.025”) and posterior teeth (.022” x 0.028”). When a .018” x .022” wire is inserted in the .018” x .025” brackets slot on the incisors, third-order control is created in the incisor segment while the wire is undersized in the rest of the arch. Lateral brackets have been positioned on the canines, while the canine brackets have been positioned on the first premolars respecting a differential bonding height able to produce canine extrusion and first premolars intrusion and proper torque expression. Full Class II molar relationship and Class I substituted canine relationship has been reached in both cases and kept stable in the long-term follow-up (10 years).

DISCUSSION:

The described approach provided anterior anchorage with more simple mechanics expressing the anterior torque with a full engagement concept and adding few auxiliaries (uprighting springs) which do not require compliance.

A Communication Guide for Orthodontic-Restorative Collaborations: Digital Smile Design Outline Tool

Ideally, Orthodontic-Restorative cases are planned alongside from the beginning, however, in some instances the restorative dentist encounters the patient for esthetic evaluation near the end of orthodontic phase. This is a high-stakes evaluation because the decision to remove brackets implies that refinement of tooth positioning cannot occur unless the patient re-enters orthodontic treatment. One challenge in multidisciplinary treatment is accommodating effective communication between providers and employing Digital Smile Design outline tool as a visual aid can help optimizing treatment outcome. This article discusses the importance and steps utilizing digital outline tool to provide quick and effective communication on treatment progress and recommendations.

Barbell Technique: A Novel Approach for Bidirectional Bone Augmentation: Technical Note

Horizontal bone reconstruction is a common augmentation procedure used in implant dentistry to achieve adequate 3-dimensional ridge reconstruction to permit proper dental implant positioning. However, most available techniques are focused on unidirectional bone reconstruction (grafting only on the buccal side). This study was carried out to validate an innovative device that is indicated for bidirectional bone augmentation. The study consisted of 4 patients who required bidirectional horizontal bone augmentation of the upper jaw. Two computerized tomographies were performed (T0 at baseline and T1 at 6 months postoperative examinations). Mean bone thickness in the studied sites at T0 was 2.30 ± 0.65 and mean bone thickness achieved was 9.11 ± 1.08 mm at T1, with an overall bone gain of 6.81 ± 1.33 mm. Concerning the specific gains in direction, buccal and palatal bone augmentations were 4.89 ± 0.94 and 1.92 ± 0.42 mm, respectively. Based on these results, it can be concluded that the use of this novel device allows for the achievement of bidirectional horizontal bone augmentation.

Vestibular Incision Subperiosteal Tunnel Access (VISTA) for Surgically Facilitated Orthodontic Therapy (SFOT)

Surgically Facilitated Orthodontic Therapy (SFOT) in combination with bone augmentation and the placement of anchorage devices installed into bone have been used to accelerate and facilitate orthodontic treatment. This is usually performed after flap surgery, which is associated with moderate morbidity, as well as possible negative sequale such as gingival recession. The present case report illustrates the clinical benefits of vestibular incision subperiosteal tunnel access (VISTA) for SFOT, and tissue augmentation to facilitate orthodontic therapy. VISTA entails making vertical incision(s) in the vestibule followed by subperiosteal elevation of tunnels to provide direct access to the facial alveolar bone. Unlike previously reported vestibular access surgical procedures, VISTA allows for wider elevation of an access tunnel for clear visual and surgical access to perform careful inter-radicular corticotomy. The present report describes VISTA for corticotomy surgery (anterior mandible and maxillary teeth) in combination with the placement of titanium fixation devices and bone augmentation to facilitate orthodontic treatment of an adult female with borderline Class II Division 1 malocclusion, with excessive overjet and deepbite. In view of the fact that VISTA does not require surface incisions in the gingival margins or papillae, it potentially minimizes gingival recession that sometimes accompanies flap surgery.

Relationship between dental calcification of mandibular teeth and cervical vertebrae maturity in patients with unilateral complete cleft lip and palate

OBJECTIVE

The purpose of this study was to investigate the relationship between the dental calcification stage (DCS) of the mandibular teeth and the cervical vertebral maturation stage (CVMS) in patients with unilateral complete cleft lip and palate (UCLP).

METHODS

One hundred sixty-two UCLP patients (100 males and 62 females) between 8-16 years old were included in this study. The DCS was estimated by the Demirjian method and was converted to the dental age (DA). The CVMS was evaluated by the Baccetti method. The DA of mandibular teeth on two sides of the cleft were analyzed using a t-test. Spearman correlation was used to study the association between CVMS and DCS. The correlation coefficient between the two sides of the cleft was then compared.

RESULTS

The total DA was significantly smaller on the cleft side than on the noncleft side in males (p = 0.022). The Spearman rank correlation coefficient revealed a significant correlation between the DCS of each examined tooth and the CVMS (r = 0.627-0.793 in males and r = 0.806-0.899 in females). Additionally, the correlation of the two sides was not significantly different (p > 0.05). The DCS of the first premolar showed the strongest correlation with the CVMS.

CONCLUSION

The results confirm the utility of the DCS on both sides of the mandible in male UCLP patients as a simple first-level diagnostic test to evaluate growth and development. The findings also indicate that both the DCS and the CVMS should be assessed if the maturity stage of a growing UCLP patient is relevant to clinical practice.

Anterior loop of the mental nerve in Saudi sample in Riyadh, KSA. A cone beam computerized tomography study

Background

The portion of inferior alveolar nerve (IAN) existent anterior to the mental foramen, before parting the canal, is referred to as the anterior loop (AL) of the IAN. The presence of AL is important when placing the implant interforaminal area of the mandible. These anatomical discrepancies can be assessed by cone-beam CT (CBCT), for evaluating its position and exact location. The AL is classified into Types I, II and III. In Type I, Y-shaped anatomy; in Type II, anatomy is T-shaped; and in Type III, Y-shaped anatomy is seen, and the incisive branch is thicker as compared to the main branch.

Aim

In this study, we aim to analyse the prevalence of different types of AL of the IAN in Saudi sample population.

Materials and Methods

The present study is a retrospective analysis of 149 (86 female & 63 male) CBCT images of patients records from 2018 June to 2018 September in the department of implant dentistry, KSMC, Riyadh. The age range of the patients who participated in the study was 30–60 years. The mean age of female participants is 42.5 ± 5.8, for the male participants is 48.6 ± 11.4 years respectively.

Results

The most frequent type of AL of mental nerve noticed on the right side was of type I (59.1%), followed by type II (27.5%) and type III (13.4%). The most frequent type of AL of mental nerve noticed on the left side was type I (61.7%), followed by type II (26.8%) and type III (11.4%).

Conclusion

The results of the study encourage the usage of CBCT for planning implant treatment. We also suggest that it is obligatory for professionals to categorise the presence of AL and to measure them appropriately when planning for the procedures in the interforaminal region.

Oral Rehabilitation of Hypodontia Patients Using an Endosseous Dental Implant: Functional and Aesthetic Results

Hypodontia often leads to limited bone availability of the alveolar ridges. Oral rehabilitation of severe hypodontia patients is challenging. In this retrospective study, we evaluated the functional and aesthetic results after dental implants in hypodontia patients, corroborated by Albrektsson implant success criteria. Over a period of 15 years (2000–2015), a total of 43 patients were diagnosed with hypodontia and 165 dental implants were inserted. Six patients who received 10 implants were lost in the follow-up. We examined 155 implants in 37 patients between December 2015 and May 2017. Besides family history, patients evaluated the general satisfaction, functionality, and aesthetics of the implants. Study subjects were between 17 and 44 years old (mean ± SD: 21.4 ± 5.6). Hypodontia patients were missing one to five teeth (n = 28), whereas patients diagnosed with oligodontia (≥6 missing teeth, n = 9). In this study, 24 patients (64.9%) with hypodontia had a positive family history; the remaining 13 patients had no family member with hypodontia. The final follow-up time ranged between 5 and 189 months after implant placement. Orthodontic treatment was performed in 32 patients (86%) before implant placement. Rehabilitation resulted in 62% of the cases being treated with 1–2 implants and 38% treated with 3–15 implants. However, out of 155 inserted dental implants, 18 implants failed to meet Albrektsson criteria, under which two implants were removed. Only autografts were used for bone augmentation with 97 implants. More than two-thirds of the patients showed high general satisfaction and masticatory function (69.4%) as well as phonetic ability (80.6%). The aesthetic outcome was rated as excellent by 17 patients (47.2%). The findings emphasize the importance of interdisciplinary treatment of hypodontia, leading to a satisfactory, functional, and long-term fixed prosthodontics using dental implants.

Multidisciplinary Approach for Treating Malocclusion of Patient With Basal Cell Nevus Syndrome: A Case Report

Basal cell nevus syndrome (BCNS) is a rare genetic disorder that can be caused by mutation of multiple genes, including PTCH1, PTCH2, and SUFU, in an autosomal dominant manner. The symptoms include some craniofacial features such as keratocystic odontogenic tumors (KCOTs), macrocephaly, and cleft lip and/or palate. Although comprehensive orthodontic treatment is frequently required for some of these craniofacial deformities, there are few reports that show the outcomes of comprehensive orthodontic treatment. Here, we report a case of BCNS with multiple KCOTs, macrocephaly, skeletal class III malocclusion, asymmetric dental arch, and mandibular crowding, which was successfully treated with comprehensive orthodontic treatment.

Implementation of orthodontic extraction for pre-implant soft tissue management: A systematic review

OBJECTIVE

This systematic review aims to define the recommendations allowing an optimized clinical implementation for orthodontic extraction as a pre-implant soft tissue management procedure.

MATERIALS AND METHODS

A digital search was performed in the Cochrane Library, PubMed, Scopus, and DOSS databases; a pre-screening was conducted according to the title and summary of the articles. After a complete reading, only the articles meeting all of our inclusion criteria were selected, and a second search, this time manual, was performed within their references. The selected articles were then analysed according to twelve parameters.

RESULTS

Thirty-nine articles were included. Despite low statistical evidence in the available literature, some principal guidelines, which seem generally accepted by the scientific community, could be highlighted based on this analysis. However, no ideal clinical protocol could be established.

CONCLUSIONS

Orthodontic extraction is an efficient procedure for pre-implant soft tissue management, however, further studies are needed to establish full clinical recommendations and optimize its clinical implementation.

Healing at the Interface Between Autologous Block Bone Grafts and Recipient Sites Using n-Butyl-2-Cyanoacrylate Adhesive as Fixation: Histomorphometric Study in Rabbits

The aim of the present split-mouth (split-plot) study was to describe the sequential healing in the interface between autologous bone grafts and recipient parent bone, fixed using an n-butyl-2-cyanoacrylate adhesive with or without an additional titanium fixation screw. Bone grafts were collected from the calvaria and fixed to the lateral aspect of the mandible in 24 rabbits. The cortical layers of the recipient sites were perforated, and the grafts were randomly fixed using an n-butyl-2-cyanocrylate adhesive, either alone or in conjunction with a 1.5 mm × 6.0 mm titanium fixation screw. The animals were sacrificed after 3, 7, 20, and 40 days, and histomorphometric evaluations of the interface between graft and parent bone were performed. Only 2 of 6 grafts in each group were partially incorporated to the parent bone after 40 days of healing. The remaining grafts were separated from the parent bone by adhesive and connective tissue. It was concluded that the use of n-butyl-2-cyanoacrylate as fixation of an autologous bone graft to the lateral aspect of the mandible was able to maintain the fixation over time but did not incorporate the graft to the recipient sites. Use of fixation screws did not improve the healing.

Bilateral agenesis of maxillary permanent canines: Review of the literature

Oligodontia, or agenesis of six or more teeth, excluding third molars, which involves canine agenesis is rare, and restorative management can be challenging. Bilateral agenesis of a permanent canine in the general population often indicates a several missing adult teeth. The most common sign of it is the primary canine retention beyond its exfoliation age. The multistage restorative management includes the early diagnosis, excluding associated medical problems as well as assessment of patient's malocclusion and facial skeletal pattern, life span of deciduous teeth, possibility of premolar substitution, minimum required number of prosthetic units, patient's preferences, and the cost of treatment. A 10-year-old boy with bilateral agenesis of maxillary permanent canines is described. Some thoughts on the multidisciplinary restorative management of this case are discussed.

A multidisciplinary treatment of congenitally missing maxillary lateral incisors: a 14-year follow-up case report

Absence of the maxillary lateral incisor creates an aesthetic problem which can be managed in various ways. The condition requires careful treatment planning and consideration of the options and outcomes following either space closure or prosthetic replacement. Recent developments in restorative dentistry have warranted a re-evaluation of the approach to this clinical situation. Factors relating both to the patient and the teeth, including the presentation of malocclusion and the effect on the occlusion must be considered. The objective of this study was to describe the etiology, prevalence and alternative treatment modalities for dental agenesis and to present a clinical case of agenesis of the maxillary lateral incisors treated by the closure of excessive spaces and canine re-anatomization. A clinical case is presented to illustrate the interdisciplinary approach between orthodontics and restorative dentistry for improved esthetic results. In this report, the treatment of a girl with a Class II malocclusion of molars and canines with missing maxillary lateral incisors and convex facial profile is shown. Treatment was successfully achieved and included the space closure of the areas corresponding to the missing upper lateral incisors, through movement of the canines and the posterior teeth to mesial by fixed appliances as well as the canines transformation in the maxillary lateral incisors. This is a 14-year follow-up case report involving orthodontics and restorative dentistry in which pretreatment, posttreatment, and long-term follow-up records for the patient are presented.