The digital POIP concept: Preorthodontic implant placement.

OBJECTIVE: The aim of this report is to present an interdisciplinary treatment involving periodontics, orthodontics, dental implant placement, and prosthodontics with a fully digital dentistry approach. CLINICAL CONSIDERATIONS: The patient presented with an edentulous ridge on the area of the lower left lateral incisor as well as gingival recession on the adjacent teeth. After performing a digital orthodontic setup and indirect bonding bracket placement, a dental implant placement was carried out before orthodontic treatment in combination with guided bone regeneration (GBR), connective tissue graft (CTG) and periodontal accelerated osteogenic orthodontics (PAOO). In a 6-month period, orthodontic treatment was fully completed and the dental implant was restored at 8 months. Following one-and-a-half years, significant gingival recession reduction was accomplished and soft tissue augmentation around the dental implant appeared stable with a good functional and esthetic result. CONCLUSION: The use of the digital POIP concept with a proper diagnosis and careful planning is crucial for reducing treatment time and enhancing precision.

Class II malocclusion and ectopic canine treated with Pendulum appliance and TADs in a high-relapse potential Ehlers-Danlos patient: A case report.

The aim of this case report is to present the treatment plan, progress, and retention difficulty of an adolescent with a skeletal Class II malocclusion and ectopic canine eruption using a Pendulum appliance and skeletal anchorage. The patient was diagnosed with benign hypermobile EDS towards the end of treatment. This patient went through frequent relapses in a short period, which should be considered while treating patients with similar condition. This report emphasizes that forces applied in patients with Ehlers Danlos Syndrome will accelerate tooth movement but the clinicians should be cautious enough to avoid potential periodontal breakdown due to disturbaces in collagen remodeling.

Gingival clefts revisited: Evaluation of the characteristics that make one more susceptible to gingival clefts.

INTRODUCTION: Orthodontic space closure after premolar extraction commonly results in the formation of a gingival cleft, which may contribute to orthodontic relapse and poor periodontal health. The purpose of this study was to examine clinical parameters that may predispose patients to gingival clefts. METHODS: Twenty-nine patients planned for treatment with premolar extractions (n = 87) and orthodontic space closure were evaluated in this prospective study. The clinical measures included width of keratinized buccal gingiva, thickness of buccal gingiva, thickness of buccal bone, time of space closure, and the occurrence (presence or absence) and severity (volume) of cleft formation. The association of the clinical measures with gingival cleft formation and severity was assessed separately for patients according to age group: young adolescent (≤13 years of age), adolescent (14-18 years of age), and adult (≥19 years of age). RESULTS: The overall incidence of gingival cleft formation was 73.2%, with a trend toward greater cleft formation in the young adolescents (79.4%) than in the adolescent and adult groups (69.2% and 68.2%, respectively). The mean severity of clefts exhibited a significant positive association with age group-young adolescent (26.6 mm2), adolescent (27.9 mm2), and adult (41.5 mm2). Buccal bone thickness was significantly correlated with gingival phenotype in the adolescent and adult groups (r = 0.42 and r = 0.52, respectively; both, P <0.05). Rate of space closure was significantly correlated with cleft formation (r = 0.71; P <0.001) in the adult group. CONCLUSIONS: The formation of gingival clefts is common after premolar extraction and space closure. Adults with a thinner gingival phenotype were more likely to develop gingival clefts of greater severity. The rate of space closure was significantly and inversely correlated with cleft formation in adults, reflecting a greater likelihood of cleft formation with slower space closure. Although various clinical parameters show a correlation to both severity and incidence of clefts, all patients undergoing postextraction space closure appear to be at risk and should be monitored.

Contact fatigue response of porcelain-veneered alumina model systems.

Fatigue damage modes and reliability of hand-veneered (HV) and over-pressed (OP) aluminum-oxide layer structures were compared. Influence of luting cement thickness on mechanical performance was investigated. Sixty-four aluminum-oxide plates (10 × 10 × 0.5 mm) were veneered with hand built-up or pressed porcelain (0.7 mm) and adhesively luted (50- or 150-µm cement thickness) to water-aged composite resin blocks (12 × 12 × 4 mm). Single-load-to-failure and fatigue tests were performed with a spherical tungsten carbide indenter (d = 6.25 mm) applied in the center of the veneer layer. Specimens were inspected with polarized-reflected-light and scanning electron microscopy. Use-level probability Weibull curves were plotted with two-sided 90% confidence bounds, and reliability at 75,000 cycles and 250 N load was calculated. For all specimens but two OP with 50-µm cement thickness, failure was characterized by flexural radial cracks initiating at the bottom surface of the alumina core and propagating into the veneering porcelain before cone cracks could extend to the porcelain/alumina interface. HV specimens showed higher reliability compared to OP. Those with 50-µm cement thickness were more reliable relative to their 150-µm counterparts (HV_50 µm: 95% (0.99/0.67); HV_150 µm: 55% (0.92/0.01); OP_50 µm: 69% (0.84/0.48); OP_150 µm: 15% (0.53/0.004)). Similar failure modes were observed in HV and OP specimens. Radial cracks developing in the core and spreading into the veneer are suggested to cause bulk fracture, which is the characteristic failure mode for alumina core crowns. However, the highest resistance to fatigue loading was found for the HV specimens with thin cement thickness, while the lowest occurred for the OP with thick cement layer.