Upper Lip Horizontal Line: Characteristics of a Dynamic Facial Line.

Background: Upper lip appearance received major attention with the introduction of diverse treatment modalities, including lip augmentation, rhinoplasty surgery, and dental treatment designed to support the upper lip. Our objectives were to define the prevalence and characteristics of the upper lip horizontal line (ULHL), which is a dynamic line appearing during a smile, in relation to gender, malocclusions, aging, and facial morphology. Methods: First, the prevalence and gender distribution of ULHL was examined from standardized en-face imaging at full smile of 643 randomly selected patients. Second, cephalometric and dental cast model analyses were made for 97 consecutive patients divided into three age groups. Results: ULHL appears in 13.8% of the population examined, and prevailed significantly more in females (78%). The prevalence of ULHL was not related to age nor to malocclusion. Patients presenting ULHL showed shorter upper lip and deeper lip sulcus. The skeletal pattern showed longer mid-face, shorter lower facial height and greater prevalence of a gummy smile. Conclusions: Female patients with short upper lip, concavity of the upper lip, and gummy smile are more likely to exhibit ULHL. The ULHL is not age-related and can be identified in children and young adults. Therefore, it should be considered when selecting diverse treatment modalities involving the upper lip.

Implant-supported restoration of congenitally missing teeth using cancellous bone block-allografts.

BACKGROUND AND OBJECTIVE: Patients with congenitally missing teeth may present with undeveloped alveolar bone morphology, making implant reconstruction a challenge. The aim of the present study was to evaluate the outcome of dental implants after ridge augmentation with cancellous freeze-dried block bone allografts in patients with congenitally missing teeth. STUDY DESIGN: Twelve patients with a mean age of 21 ± 4 years, were included. Congenitally missing teeth included maxillary lateral incisors, a maxillary canine, and mandibular central and lateral incisors. A bony deficiency of ≥3 mm horizontally and ≤3 mm vertically according to computerized tomography served as inclusion criteria. Twenty-one implants were inserted after a healing period of 6 months. Five out of 21 implants were immediately restored. Bone measurements were taken before bone augmentation, during implant placement, and at second-stage surgery. RESULTS: Nineteen cancellous allogeneic bone-blocks were used. The mean follow-up time was 30 ± 16 months. Bone block and implant survival rates were 100% and 95.2%, respectively. Mean bone gain was statistically significant (P < .001): 5 ± 0.5 mm horizontally and 2 ± 0.5 mm vertically. All of the patients received a fixed implant-supported prosthesis. Soft tissue complications occurred in 4 patients (30%). Complications after cementation of the crowns were seen in 1 implant (4.8%). All implants remained clinically osseointegrated at the end of the follow-up examination. There was no crestal bone loss around the implants beyond the first implant thread. CONCLUSION: Cancellous bone block-allografts can be used successfully for implant-supported restorations in patients with congenitally missing teeth.