Closure of maxillary lateral incisor agenesis space in unilateral cleft lip and palate: a digital model assessment.

OBJECTIVE: To compare dental positional and gingival parameters of maxillary anterior teeth in unilateral cleft lip and palate (UCLP) after orthodontic treatment with canine substitution due to lateral incisor agenesis. METHODS: This split-mouth study comprised 57 subjects with UCLP (31 male, 26 female) and agenesis of maxillary lateral incisor at the cleft side, from a single center. Canine substitution was completed after the secondary alveolar bone graft. Dental models were taken between 2 to 6 months after debonding (mean age: 20.4 years). The following variables were measured in the maxillary anterior teeth: crown height, width, proportion, and symmetry, as well as steps between incisal edges, gingival margins, tooth mesiodistal angulation and labiolingual inclination. Paired t-tests with Bonferroni post-hoc correction was used for comparisons between cleft and non-cleft sides (p<0.05). RESULTS: At the cleft side, canines replacing missing lateral incisors had a higher crown height (0.77mm) and an increased width (0.67mm), and first premolars showed a shorter crown height (1.39mm). Asymmetries were observed in the gingival level of central and lateral incisors, with a greater clinical crown at the cleft side (0.61 and 0.81mm, respectively). Cleft side central incisors were more upright than their contralaterals (2.12º). CONCLUSIONS: Maxillary anterior teeth demonstrated positional, size and gingival height differences between cleft and non-cleft side after space closure of maxillary lateral incisor agenesis. Slight asymmetries in tooth position and gingival margin in the maxillary anterior teeth should be expected after orthodontic treatment in UCLP patients.

Comparative Assessment of Qmix as Endodontic Irrigant on Reversal of Bond Strength in Teeth Subjected to Irradiation: An Scanning Electron Microscope Study.

AIM: The aim of this current study was to compare and evaluate the reversal efficacy of Qmix and chitosan-based irrigation materials quantitatively through the assessment of the push-out bond strength of bioceramic sealer employing universal testing machine and to qualitatively analyze the sealer/dentin interface by scanning electron microscope (SEM) in the teeth subjected to fractioned radiation. MATERIALS AND METHODS: Ninety single-rooted straight human maxillary central incisors were randomly divided into six groups (n = 15) where in three groups comprise Chitosan, Qmix, and EDTA/sodium hypochlorite which were not exposed to irradiation while other three groups were challenged with irradiation protocols. Root canals were prepared with ProTaper universal system and all the samples were irrigated according to the final irrigation protocols and obturated with bioceramic sealers. Dentin slices were prepared with 1 mm thickness from each root third for the estimation of bond strength of sealers to dentin. Qualitative assessment of the sealer-dentin interface was done by scanning electron microscopy. Bond strength data were scrutinized by independent t-test and failure modes using the Chi-square test. RESULTS: Significantly lower bond strength (p <0.05) was recorded after irradiation compared with nonirradiated group. To quantify the results irrigation protocols, Qmix had highest bond strength followed by chitosan and EDTA/sodium hypochlorite group irrespective of irradiation status. Bond strength values reduced after irradiation in all root thirds irrespective of the irrigation materials. Scanning electron microscope images revealed traces of repair process for Qmix-based irrigation materials than the chitosan-based materials for both irradiated and nonirradiated specimens. CONCLUSION: All the irrigation materials employed in this study had good bond strength. The specimen irrigated with Qmix had comparatively higher bond strength than the chitosan-based materials. The teeth subjected to irradiation challenge were associated with a decrease in the push-out bond strength of sealers to intraradicular dentin with formation of more gaps and fewer tags at the sealer/dentin interface. CLINICAL SIGNIFICANCE: Selection of ideal irrigation protocols still remains a challenge for the clinical practitioners, and this study explored the utilization of novel materials used for irrigation, especially in the teeth subjected to radiation.

Assessment of dens invaginatus and its characteristics in maxillary anterior teeth using cone-beam computed tomography.

This cone-beam computed tomographic (CBCT) study aimed to evaluate the prevalence of dens invaginatus (DI) and its characteristics in maxillary anterior teeth in a Saudi population. A total of 505 CBCT scans were evaluated, including a total of 2790 maxillary anterior teeth. The patients' demographic data, including age and sex, were recorded. The presence of DI and the related characteristics including bilateral occurrence; DI type according to Oehlers classification; and presence of periapical radiolucency, open apex, and/or nearby impacted teeth were analyzed. The associations between DI and the other factors were analyzed using the chi-square and fisher exact tests. DI was detected in 7.3% of the patients and 1.6% of the teeth examined. Most of the DI-affected teeth were maxillary lateral incisors (76.1%), followed by mesiodens (19.6%) and maxillary central incisors (4.3%), while no DI was observed in the maxillary canines. Bilateral DI was found in 24.3% of the affected patients. Oehlers type I DI was the most frequent (80%). Periapical radiolucencies, open apices, and nearby impacted teeth were observed in 10.9%, 4.3%, and 30% of the invaginated teeth, respectively. DI was significantly associated with tooth type (P < 0.0001) but not with sex (P > 0.05). Although most of the DI cases are limited to the crown, CBCT imaging is essential for DI evaluation and management.

Radiographic Assessment of Dental Maturation in Children With Dental Agenesis.

BACKGROUND: Dental agenesis is the most common developmental anomaly in humans, frequently associated with disorders in dental development and maturation. AIM: The purpose of this study is to determine radiographic variations in dental maturation in a group of Venezuelan children with dental agenesis. STUDY DESIGN: 1,188 panoramic radiographs, from healthy patients ages 5 to 12 years old were studied for agenesis of permanent teeth. Dental maturation was assessed by relative eruption and dental age according to Nolla, comparing children affected with dental agenesis to a stratified control group selected from the same population, excluding children with premature loss of primary teeth in the left quadrants and unclear radiographs. Descriptive analysis, and differences between means and medians (Student t test, Kruskall-Wallis p=0.05) were performed. RESULTS: Medians for Nolla stages were similar between groups, with delay in tooth formation in the agenesis group for second molars (p<0.05) and maxillary lateral incisors and second premolars. Dental age was significantly underestimated for both groups, -0.89 (±0.78) for the control group and -1.20 (±0.95) for the study group. Tooth eruption was similar between groups. CONCLUSION: Dental age was significantly delayed in Venezuelan children with dental agenesis, with variable significance for tooth formation of studied teeth.

Limitations of a method used for adolescent assessment of smile aesthetics.

AIMS: To establish whether adolescent orthodontic patients with hypodontia have a preference between the aesthetic outcomes of two treatment strategies for lateral incisor agenesis. MATERIALS/METHODS: Standardized photographs of pre-orthodontic patients with missing lateral incisors were manipulated to produce images that represented space opening and tooth replacement in the lateral incisor space and space closure with canine substitution into the lateral incisor space. Adolescent orthodontic patients with hypodontia were recruited to assess the aesthetics of the images. A control group of subjects without tooth agenesis was recruited. Each examiner undertook two tests to assess the smile aesthetics of the images: (1) rating attractiveness using visual analogue scale (VAS) and (2) choice of preference between pairs of images. RESULTS: Difficulties experienced with image manipulation and poor intra-examiner reliability of the VAS make interpretation of the results challenging. Care should be taken if findings are used to aid clinical decisions, as the validity of the main findings is questionable. Results suggest that although adolescents perceive a difference in the aesthetic result of space opening and space closure for missing lateral incisors, the impact on the smile attractiveness is not clinically significant. When forced to choose between the aesthetics of space opening or space closure, the majority of examiners chose space opening with tooth replacement. No difference was found in smile ratings or preferences between adolescents with hypodontia and those with no missing teeth. CLINICAL IMPLICATIONS: The methods used in this study may not be reliable for adolescent assessment of aesthetics.

Agenesis of maxillary lateral incisor and tooth replacement: cost-effectiveness of different treatment alternatives.

PURPOSE: To evaluate the long-term cost-effectiveness of five treatment alternatives for maxillary lateral incisor agenesis where space maintenance and tooth replacement are indicated. MATERIALS AND METHODS: The following treatment modalities were considered: single-tooth implant-supported crown, resin-bonded fixed partial denture (FPD), cantilever FPD, full-coverage FPD, and autotransplantation. The cost-effectiveness for each treatment modality was determined as the ratio of the outcome of each modality divided by the cost. Direct costs, clinical and laboratory, were calculated based on national fee schedules and converted to international dollars using purchasing power parity exchange rates. Outcomes were based on the most recently published long-term (10-year) survival rates. Sensitivity analyses were carried out, testing the robustness of the cost-effectiveness analysis. RESULTS: The five treatment modalities ranked in the following order from most to least cost-effective: autotransplantation, cantilever FPDs, resin-bonded FPDs, single-tooth implants and implant-supported crowns, and full-coverage FPDs. Sensitivity analysis illustrated that the cost-effectiveness analysis was reliable in identifying autotransplantation as the most and full-coverage FPDs as the least cost-effective treatment modalities. CONCLUSIONS: When replacing a missing maxillary lateral incisor, the most costeffective, long-term treatment modality is autotransplantation, whereas the least cost-effective is full-coverage FPDs. However, factors such as patient age, the state of the dentition, occlusion, and tooth conservation should also influence the choice of restoration.

Cephalometric assessment of craniofacial dysmorphologies in relation with Msx2 mutations in mouse.

OBJECTIVES: To determine the role of Msx2 in craniofacial morphology and growth, we used a mouse model and performed a quantitative morphological characterization of the Msx2 (-/-) and the Msx2 (+/-) phenotype using a 2D cephalometric analysis applied on micrographs. MATERIALS AND METHODS: Forty-four three-and-a-half-month-old female CD1 mice were divided into the following three groups: Msx2 (+/+) (n = 16), Msx2 (+/-) (n = 16), and Msx2 (-/-) (n = 12). Profile radiographs were scanned. Modified cephalometric analysis was performed to compare the three groups. RESULTS: Compared with the wild-type mice, the Msx2 (-/-) mutant mice presented an overall craniofacial size decrease and modifications of the shape of the different parts of the craniofacial skeleton, namely the neurocranium, the viscerocranium, the mandible, and the teeth. In particular, dysmorphologies were seen in the cochlear apparatus and the teeth (taurodontism, reduced incisor curvature). Finally contrary to previous published results, we were able to record a specific phenotype of the Msx2 (+/-) mice with this methodology. This Msx2 (+/-) mouse phenotype was not intermediate between the Msx2 (-/-) and the wild-type animals. CONCLUSION: Msx2 plays an important role in craniofacial morphogenesis and growth because almost all craniofacial structures were affected in the Msx2(-/-) mice including both intramembranous and endochondral bones, the cochlear apparatus, and the teeth. In addition, Msx2 haploinsufficiency involves a specific phenotype with subtle craniofacial structures modifications compared with human mutations.

Prosthetic rehabilitation interventions in adolescents with fixed bridges: a 5-year observational study.

AIM: The aim of this work is to verify the rate of success and failure causes of 32 FRC-FPD (Fiber Reinforced Composite Fixed Partial Dentures) placed on 30 adolescents with dental agenesis, over a follow-up period of 5 years. MATERIALS AND METHODS: Our study sample involved 30 subjects (10 males and 20 females) aged between 13 and 17 years who have been rehabilitated with FRC Maryland bridges to treat agenesis of maxillary incisors (for a total of 32 FRC-FPD). The observational study spans 5 years following the general rules coded by the modified United States Public Health Service (USPHS) system. RESULTS: After 5 years of follow-up of a sample of 32 FRC-FPD bridges, 30 were still in effective use (so 2 were excluded). All the bridges were FRC, replacing a missing lateral incisor, and had a double wing retention. All requirements of stability, peripheral seal and morphology preservation were well satisfied. The two failed bridges had a structural failure after about two years from placement. DISCUSSION AND CONCLUSION: In adolescents our orientation about the edentulous rehabilitation is towards solutions that, when possible, provide an acceptable aesthetic and functional restoration with fixed partial dentures, or removable dentures in cases of severe oligodontia. Obviously, techniques involving the placement of dental implants before the end of skeletal growth were never adopted. In our study FRC bridges showed a great functional performance and good compliance from young patients. Considering the positive cost-benefit ratio and the reversibility of the treatment in case of failure, such interventions can be considered a highly reliable early rehabilitation. Further studies are necessary to verify the maintenance requirements tested for longer periods.

Palatally displaced maxillary canines: factors influencing duration and cost of treatment.

The purpose of this retrospective study was to assess the relationship between the initial position of palatally displaced canines (PDCs) on panoramic radiographs and the duration of the orthodontic treatment and further to estimate the costs of the treatment. Data from panoramic radiographs and patient records of 66 consecutive patients (mean age 14.9 ± 1.7 years) with PDC were analysed. The initial position of the canine, the distance between the canine cusp tip and the occlusal plane, and the inclination of the canine were significantly associated with treatment duration both unadjusted and adjusted for background characteristics. The average estimated cost of the treatment of PDC was €3200 per case. The total annual cost for treatment of PDC in Sweden may therefore be estimated at €600,0000. In this study, duration of treatment averaged 17 months for canines displaced in impaction zone 1 or 2, 2.6 [95% confidence interval (CI) -1.0 to 6.2] months longer for those in impaction zone 3, and 7.6 (95% CI 4.1-11.1) months longer for canines displaced in impaction zone 4 or 5. This information makes it easier, through study of the panoramic radiograph, to estimate the duration of treatment and to give patients more precise information about the expected length of their treatment.

The influence of patients' decisions on treatment planning in restorative dentistry.

UNLABELLED: As part of treatment planning, options are presented to patients by dentists. An informal discussion takes place involving a cost-benefit analysis and a treatment plan is agreed. Evidence-based dentistry takes into account the best available literature, clinical experience and patient factors to guide the dentist. Dentists exert considerable influence on which treatment modality is selected. This paper focuses on the importance of patient factors which lead to less than ideal, clinically acceptable, treatment plans that nevertheless give patient satisfaction over the long term. Though no universally accepted healthcare model exists for restorative dentistry, patients' decisions are most influenced by their relationship with their dentist over factors such as time, access and cost. Letters should be sent to patients clarifying the nature of all proposed options, including advantages and disadvantages, complications, success rates, biological and financial costs and what happens if no treatment is carried out. CLINICAL RELEVANCE: Many psychological and social determinants influence patients'values and decision-making when planning for restorative dentistry. These lead to a treatment plan agreed between the patient and the dentist. Often an element of compromise is considered acceptable to both parties when the evidence would suggest an alternative treatment to be preferable.

Prevalence of malocclusions and orthodontic treatment need in 8- to 12-year-old schoolchildren in Casablanca, Morocco.

OBJECTIVES: The purpose of this work was to evaluate the prevalence of malocclusions and orthodontic treatment need among schoolchildren in Casablanca, Morocco. MATERIALS AND METHODS: A sample of 1000 children aged between 8 and 12 years, with no history of orthodontic treatment, was chosen at random in state schools in different administrative areas of the city of Casablanca. Data was registered using the method of Bjork et al. (1964). Orthodontic treatment need was assessed with the index used by the Swedish National Board of Health (SweNBH). RESULTS: We found Angle Class I malocclusions in 61.4%, Class II in 24%, Class III in 10% and an indeterminate molar class with one or more missing molars in 4.6% of the children. Overjet was 1-4mm in 63.8%, 4-6 mm in 17.2% and >6 mm in 10%. Bite was normal in 65.4%, 23.6% presented an overbite greater than 4 mm, 1.7% an anterior open bite ≤3 mm, 1.2% an anterior open bite >3 mm and 0.2% a bilateral open bite. Half of the sample presented anterior crowding, while only 2.5% presented posterior crowding. In all, 84.2% of the subjects needed some orthodontic treatment, and 15.8% needed no treatment. No statistically significant difference was found between sex or age and orthodontic treatment need (P>0.05). CONCLUSIONS: This study found a strong need for orthodontic treatment, confirming the utility of implementing a programme of bucco-dental prevention and screening for malocclusion.

[How up-to-date are metal-based resin-bonded fixed partial dentures in the era of full-ceramics and dental implants? A case report]. / Wie aktuell sind metallkeramische Adhäsivbrücken im Zeitalter der Vollkeramik und der Implantologie? Ein Fallbericht.

Regardless of the success of preventive measures the replace¬ment of missing teeth in young patients with caries-free dentitions is a daily challenge for the clinician. The decision-making process concerning the different treatment options is difficult, based on several equivalent solutions. Thereby the significance of minimal invasive approaches is steadily increasing. In indicated cases, resin-bonded fixed partial dentures which were introduced in the last century still represent a well documented and minimally invasive procedure, even in the era of dental implants. In this article, clinical aspects of a conventional, metal-based resin-bonded fixed partial dentures are discussed according to the current literature and the clinical steps are presented in a clinical case.

A comparative diagnostic assessment of anterior tooth and bone status using panoramic and periapical radiography.

AIMS: The aim of the present study was to compare diagnostic assessments of anterior tooth and bone status in a randomised cohort of pre-orthodontic patients using panoramic and periapical radiographs. METHOD: Four hundred and forty-four cases with matched periapical and panoramic radiographs were examined by three observers. Two were final-year postgraduate endodontic students and the other, a final-year Honours degree dental student. Multi-rater Kappa values were used to assess the reliability of the observers, with a value of 1 equating to complete agreement. RESULTS: With the exception of endodontic Class 1 and 2 palatal invaginations, reliability exceeded 0.95 for all three observers. An assessment of the graduate endodontic students revealed only a marginal increase in the kappa values. Statistical analysis (p < 0.05) determined that developmental anomalies or tooth/bone pathoses were more reliably detected by observers using periapical radiographs compared with panoramic films. This finding has relevance given the likelihood of anterior dental trauma among young children. CONCLUSION: While there have been considerable improvements in the quality of dental panoramic radiography, the present study indicated that a reliable pre-orthodontic or post-trauma diagnostic assessment should include both panoramic and intra-oral radiographs.

[Assessment research on the inter-proximal mesial papilla height of single implant-supported maxillary central incisor].

OBJECTIVE: This prospective study was to observe the correlation between the mesial papilla's height of single implant-supported maxillary central incisor and the distance from the base of the contact point to the alveolar bone crest. METHODS: 56 patients involved in single implant-supported maxillary central incisor were included in this study. The distances from the base of the contact point to the alveolar bone crest in the digital periapical film of maxillary central incisor were measured using the software Planmeca Dimaxis Version 3.3.2. The time of measurements were as follows: The pre-surgical and post-surgical periods, before and after the crown installation, the follow-up examination of more than 0.5 year. To analyze the factor of influencing distance, and the correlation between the distance and the height of gingival papilla during the whole restored period. Correlation analysis between the distance and the height of gingival papilla during the whole restoration was done by the statistical software SPSS 12.0. RESULTS: The results demonstrated that the ratio of esthetic papilla can achieve 54.5% at the crown installation and 95.5% at the follow-up examination when the distance was between 3 mm and 5 mm. When the distance was between 5 mm and 6 mm, they dropped to 30.0% and 75.0%, respectively. However, when the distance increased to above 7 mm, the papilla could hardly be in an esthetic outcome. There was a significant change of the distance was found during the periods from the post-surgery to pre-restoration, and the scope of the changes was between -0.13 mm and 0.46 mm. A negative correlation was found between the distance and the index of papilla. The correlation coefficient r was -0.715 (P < 0.01). CONCLUSION: It is proposed that the pre-surgery distance of maxillary central incisor from the base of the contact point to the alveolar bone crest can be used as one of the important reference indexes to assess and predict the height conditions of gingival papilla.

The orthodontic-restorative interface: 2. Compensating for variations in tooth number and shape.

UNLABELLED: The aim of this second article in this series of two is to outline a variety of methods which may be used to compensate for variations in tooth shape and number using a combination of orthodontic and restorative approaches. It will also provide an overview of other areas of patient care which necessitate a multi-disciplinary orthodontic/restorative approach. The article will highlight the importance of combined planning from the outset and the close relationship between the different specialties, which must be maintained throughout treatment. The methods of compensating for variations in tooth number and shape will often require contributions from both orthodontist and restorative dentist. It is important that both disciplines are involved in the assessment and treatment planning process so that they know what will be expected of them during the patient's care. Treatment planning in isolation may lead to care being delivered which is below the optimum standard which can be achieved. The orthodontist and restorative dentist are likely to liaise with the patient's general dental practitioner so that he/she can provide the restorative treatment in some cases. CLINICAL RELEVANCE: Great improvements in aesthetics and function may be obtained using an interdisciplinary approach for patients who have variations in tooth number and shape.

Three-dimensional assessment of the eruption path of the canine in individuals with bone-grafted alveolar clefts using cone beam computed tomography.

OBJECTIVE: To evaluate the eruption path of the permanent maxillary canine during a 1-year period after secondary alveolar bone grafting and to (1) compare the canine eruption path on the cleft and noncleft side, (2) examine the number of congenially missing lateral incisors and the rate of canine impaction, and (3) examine the relationship between the eruption status of the canine and timing of alveolar bone grafting relative to age and canine root development using cone beam computed tomography (CBCT). METHODS: Cone beam computed tomography scans for 17 nonsyndromic unilateral cleft lip and palate (UCLP), and four bilateral cleft lip and palate (BCLP) consecutive cases of alveolar bone grafting surgery were obtained after orthodontic expansion and before alveolar bone grafting and at least 1 year postsurgery on the Hitachi MercuRay CBCT machine. The DICOM files were imported into Dolphin 3D Imaging 10.5 and reoriented for consistency. The X, Y, and Z coordinates were determined for the canine cusp tip and root tip on both the cleft and noncleft sides. The direction of movement of the canine in 1 year was determined. RESULTS: Most canines on both the cleft and noncleft sides moved incisally, facially, and mesially. Twelve percent of the canines on the cleft side appeared to require surgical exposure. Eighty percent of the canines had less than half root development at the time of bone grafting. The amount of root development did not affect the outcome in terms of eruption amount or direction. CONCLUSIONS: Most canines on both the cleft and noncleft side moved incisally, facially, and mesially.

Volumetric assessment of secondary alveolar bone grafting using cone beam computed tomography.

OBJECTIVE: To assess the radiographic outcome of secondary alveolar bone grafting in individuals with nonsyndromic unilateral or bilateral cleft lip and palate using cone beam computed tomography. METHODS: This prospective study was conducted at the University of California at San Francisco Center for Craniofacial Anomalies on 21 consecutive nonsyndromic complete cleft lip and palate individuals between 8 and 12 years of age who required alveolar bone grafting. Seventeen unilateral and four bilateral cleft lip and palate individuals had preoperative and postoperative cone beam computed tomography scans that were analyzed using Amira 3.1.1 software. RESULTS: The average volume of the preoperative alveolar cleft defect in unilateral cleft lip and palate was 0.61 cm(3), and the combined average volume of the right and left alveolar cleft defects in bilateral cleft lip and palate was 0.82 cm(3). The average percentage bone fill in both unilateral cleft lip and palate and bilateral cleft lip and palate was 84%. The outcome of alveolar bone grafting was assessed in relation to (1) type of cleft, (2) size of preoperative cleft defect, (3) presence or absence of lateral incisor, (4) root development stage of the maxillary canine on the cleft side, (5) timing, and (6) surgeon. None of these parameters significantly influenced the radiographic outcome of alveolar bone grafting. CONCLUSIONS: Secondary alveolar bone grafting of the cleft defect in our center was successful, based on radiographic outcome using cone beam computed tomography scans. Volume rendering using cone beam computed tomography and Amira software is a reproducible and practical method to assess the preoperative alveolar cleft volume and the adequacy of bone fill postoperatively.

Radiographic assessment of dental anomalies in patients with ectopic maxillary canines.

BACKGROUND: The aetiology of palatally and labially located ectopic maxillary canines is multifactorial. Accordingly, early prediction of this eruptional disturbance is in most cases not possible. AIM: The purpose of this study was to analyse dental deviations in cases with either palatal or labial ectopic canines. DESIGN: Panoramic and intra-oral radiographs from 50 patients with palatally located (38 females and 12 males) and 19 patients with labially located ectopic canines (11 females and 8 males), aged 10 years, 2 months-18 years, 1 month, were analysed. Dental deviations registered were crown and root malformations, agenesis, and eruption deviations. Registrations were performed in the maxillary incisor field and in the dentition in general. RESULTS: The study documented that palatally as well as labially located ectopic canines can occur in dentitions without other dental deviations. Dental deviations occurred in approximately two-thirds of all cases, more often in females and in cases with palatally located canines. More than half of the females with palatally located canines had deviations in the maxillary incisors and in the dentition in general. CONCLUSION: Dental deviations may be considered a risk factor for maxillary canine ectopia. Early identification of patients at risk and appropriate interceptive treatment may reduce ectopic eruption of maxillary canines.

Orthodontic extrusion in the transitional dentition: a simple technique.

Extrusion of teeth may be necessary in cases of delayed eruption, primary retention, traumatically intruded teeth, or subgingivally fractured teeth. Removable appliances are advantageous, as anchorage is not as tooth-dependant as in the case of fixed appliances. They are cost-effective, operator friendly, and a valuable treatment option to consider in cases where extrusion of anterior teeth in the transitional dentition is necessary. The purpose of this paper was to describe a simple, cost-effective technique using a removable appliance for extrusion of incisors in the transitional dentition.

Defining new paradigms for assessment of implant receptor sites. The use of CT/CBCT and interactive virtual treatment planning for congenitally missing lateral incisors.

An emerging technology that encompasses computed tomography, cone-beam computed tomography, and interactive software applications has slowly progressed and evolved into a necessary tool for diagnosis, treatment planning, and delivery of dental implant and associated restorative and surgical procedures. The integration of these innovative tools is helping to define new methods for appreciating anatomy, improving accuracy, and enhancing presurgical prosthetic planning to achieve true restorative-driven implant dentistry. This article will demonstrate how computed tomography combined with interactive virtual treatment-planning software applications can empower clinicians with enhanced diagnostic capabilities for implant receptor-site assessment, generating new paradigms that eventually may supersede older methods of presurgical planning for dental implant reconstruction.