The effect of optimum, indication-specific imaging fields on the radiation exposure from CBCT examinations of impacted maxillary canines and mandibular third molars.

OBJECTIVE: Indication-specific optimum field-of-views (FOVs) have been assessed for CBCT scans of impacted maxillary canines and mandibular third molars, as 40∅ × 35 mm and 35∅ × 35 mm, respectively. The objective was to investigate possible changes in absorbed organs and effective doses, for these two imaging indications, performing CBCT examinations with optimum FOV sizes instead of commonly used FOVs. Additionally, radiation exposure-induced cancer risk was calculated for both imaging indications with optimum FOVs. METHODS: An adult female head phantom (ATOM 702-D, CIRS, Norfolk, VA, USA) was scanned using Planmeca Viso G7 CBCT-device (Planmeca, Helsinki, Finland). Scanning factors, different FOV sizes, dose-area product (DAP) values and anatomical FOV locations were used for Monte Carlo PCXMC-simulation and ImpactMC software. In the PCXMC- simulation, 10-year-old child and 30-year-old adult phantoms were used to estimating effective and absorbed organ doses. RESULTS: The effective dose varied from 58 µSv to 284 µSv for impacted maxillary canines, and from 38 µSv to 122 µSv for mandibular third molars, the lowest dose value for each corresponding to optimum FOV. Effective dose reduction between the optimum FOV and the smallest common FOV of 50∅ × 50 mm, maintaining other scanning factors constant, was 33% for impacted maxillary canines, and 45% for mandibular third molars. At all examinations, the highest absorbed organ doses were in salivary glands or in oral mucosa. CONCLUSIONS: Optimum FOVs, 40∅ × 35 mm for impacted maxillary canine and 35∅ × 35 mm for mandibular third molar, could decrease effective doses received by young patients, and improve radiation safety in these common CBCT imaging procedures.

Association between the occurrence of buccally displaced canine and palatal and craniofacial morphology in adolescents.

The main objective of the present research study is to evaluate the association between the occurrence of buccally displaced canine (BDC) and the palatal as well as the craniofacial morphology in adolescents in accordance at the early permanent dentition. As the experimental group, 100 adolescents of Chinese ethnicity (mean age 13.05 years) with crowding and buccally displaced canine (BDC-c) were selected in comparison with the same number of candidates (mean age 12.59 years) without BDC and crowding as control group. Digital dental casts and cephalograms were collected for three dimensional (3D) and cephalometric measurements. An independent sample T-test was used to compare the cephalometric values between the two groups. Logistic regression as commonly statistical methods used in empirical study including categorical dependent variables was used to identify the joint effects of the dental variables' 3D measurements. When comparing the groups with above analysis, patients with BDC showed a statistically significant narrower and higher palatal vault. For the cephalometric variables, the anterior cranial base length, sagittal position of the maxilla (SNA), sagittal position of the mandible (SNB), and skeletal relationship between maxilla and mandible (ANB) appeared to be smaller, whilst palatal plane angle (SN-PP), Frankfort-mandibular plane angle (FMA), anterior facial height, and lower facial height were larger in BDC-c control group (p < 0.05). A smaller inter-first premolar width was significant in the prediction model (p = 0.002). This study highlights that BDC-c participants in early permanent dentition exhibited a narrower dental arch and higher palatal vault, of which a smaller inter-first premolar width would significantly increase the occurrence of BDC.

Influence of the maxillary dimensions and lateral incisor anatomy on the palatal impaction of maxillary permanent canines: A three-dimensional case-control study.

OBJECTIVE: The diagnosis of impacted upper permanent canines (IUPC) is a relatively common clinical finding. The aim of this study was to investigate associations between the upper permanent canines palatal impaction, lateral incisors morphology and the maxilla bone base. MATERIAL AND METHODS: Cone-beam tomography files from 62 subjects were divided into 2 groups: impaction group (ICG/n=31; mean age 14.3±2.4) with 45 canines impacted on the palatal side and age- and sex-matched control group (CG/n=31; mean age 14.3±2.3), with 62 normally erupted canines. Linear and volumetric measurements of the lateral incisors, linear transversal measures and the maxillary anterior perimeter were taken. Independent Student's t-test was used for intergroup analysis with correction of Bonferroni. RESULTS: Significant differences were found for crown length and root diameter (buccal-palatal) (P<0.005). The maxillary anterior perimeter in the ICG was reduced in relation to the GC but not significantly (P=0.008). The transverse skeletal variables of the maxilla were equivalent in the intergroup comparison (P>0.005). CONCLUSION: Smaller dimensions in the crown length and in the upper permanent lateral incisors root buccal-palatal diameter were associated with the impaction of upper permanent canines on the palatal side. The maxillary transverse morphology did not show any association with the occurrence of this condition.

Guided Autotransplantation of Impacted Canines Using a CAD/CAM Surgical Template.

Autotransplantation is a potential treatment alternative when orthodontic traction of an impacted tooth is difficult. In this article, we describe two cases of guided autotransplantation of an impacted canine using a computer-aided designed and manufactured surgical template. The impacted canine was segmented on preoperative cone-beam computed tomography images to ensure a sufficient periodontal ligament space and placement of the donor tooth with the least pressure on it. The canine was virtually transposed using a simulation program considering the adjacent teeth. The surgical template, which was connected to the occlusal stop on adjacent teeth, was designed and 3D-printed with polymer resin. The recipient site was prepared using the surgical template, followed by immediate transplantation of the surgically extracted canine into the socket. The transplanted donor tooth was positioned in planned infra-occlusion to prevent occlusal interference. It was then splinted with the adjacent teeth for initial stabilization. During follow-up, one transplanted tooth showed pulp canal obliteration and the other had suspected pulp necrosis; endodontic treatment was performed. One year after the procedure, the periradicular condition of both teeth was favorable.

Maxillary lip dynamics and gingival display revisited: Utilizing standardized metrics.

OBJECTIVE: This study was initiated to validate a predictable system for establishing maximum maxillary lip dynamics and highlight the clinical significance of the findings. MATERIALS AND METHODS: Seventy-five subjects, ranging in age from 25 to 71 years old were photographed with lips in maximum and minimum reveal. The images were digitally analyzed using set references. The statistical analysis was performed using Meta. Numerics version 4.1.4. A Pearson correlation coefficient (r) was carried out to identify relationships between age and maxillary lip dynamics. A p-value less than or equal to 0.05 was considered to be significant. RESULTS: A greater percentage of participants have posterior gingival display than anterior gingival display. There is greater movement of the maxillary lip at the cuspid than at the central incisor. CONCLUSION: There was a tendency for lip dynamics to increase at the right central incisor when there is an increase in lip dynamics at the right cuspid. Lip dynamics does not appear to decrease with age. CLINICAL SIGNIFICANCE: Accurately recording and considering maximum lip dynamics helps avoid asymmetric, excessive or insufficient gingival architecture, insufficient or excessive tooth length and visible restorative margins.

Comparison of Maxillary Canine Retraction Using Split-Mouth Design With Dual Force Cuspid Retractor and T-loop Segmental Arch: A Split-Mouth Randomized Clinical Trial.

Introduction This study was designed to explore the differences between two frictionless mechanics for canine retraction i.e., dual force cuspid retractor and T-loop segmental arch. T-loop for canine retraction creates a biomechanical system to deliver a predetermined force and a relatively constant moment-to-force ratio whereas dual force cuspid retractor uses power arms on buccal as well as palatal aspects for canine retraction. Bodily tooth movement can be achieved by both methods, but in this study, our main focus was to reduce the canine retraction timing with better three-dimensional control. Method This split-mouth study was conducted on a total of 20 cuspids of ten patients (five male and five female). Where one side of the arch was selected for T-loop and the other side for dual force cuspid retractor, randomly. Inclusion criteria for this study were; no congenitally missing teeth (excluding third molar), class I or class II molar relationship, no previous history of orthodontic treatment, good oral periodontal status, patients in whom extraction of maxillary first premolar during treatment was indicated. Both groups were compared for the duration of canine retraction, anchorage loss; tipping, and rotation of cuspid and molar, individually, after retraction. Result The result of this study showed that the duration of canine retraction was significantly less in group one, i.e., dual force cuspid retractor 73.8 ± 12.38 days, than in group two, i.e., T-loop 109.4 ± 16.71 days. The anchorage loss in group one was 0.60 ± 0.61 mm and that in group two was 2.40 ± 0.87 mm. Also, the amount of tipping and rotation of the cuspid and molar individually was significantly lesser in group one than in group two. Conclusion In this study, the dual force cuspid retractor shortens the duration of canine retraction with better three-dimensional control and better anchorage preservation when compared to T-loop.

Consequências da perda/extração precoce de dente(s) decíduo(s) anterior(es) em bebês e crianças / Consequences of premature loss/extraction of primary anterior teeth in babies and children

Avaliaram-se consequências da perda precoce de dentes decíduos anteriores por meio de três fases. Na 1a, realizou-se levantamento da evidência científica disponível por meio de revisão sistemática e meta-análise (RS), revisão crítica da literatura (RC) e e-book. A RS foi dividida em seleção dos artigos, extração de dados, risco de viés, meta-análise e certeza da evidência; na RC, realizou-se compilação dos dados e análise crítica. Por fim, as informações foram organizadas em e-book com fins educativos. Na 2a, realizaram-se dois estudos (Es) de concordância e reprodutibilidade, para avaliar instrumentos em modelos de estudo (Es1) e na clínica (Es2). No Es1, dois avaliadores treinados e calibrados realizaram mensurações diretamente com paquímetro digital e compasso de pontas secas em 40 modelos de gesso de bebês/crianças com idade entre 1 e 5 anos, com e sem perdas dentárias, comparados à medidas digitais feitas em software pós escaneamento 3D. Foram avaliadas 6 medidas dentárias lineares (MDL): espaço mésio-distal da perda dentária (EPD) (se houvesse), perímetro do arco, comprimento do arco, largura do arco, comprimento intercaninos e largura intercaninos. O Es2 comparou paquímetro digital e compasso de pontas secas para mensuração clínica do EPD realizada por dois operadores independentes em 15 bebês/crianças com idade entre 2 a 6 anos. Na 3a, estudo longitudinal de coorte avaliou consequências da perda precoce anterior nos arcos dentários e no desenvolvimento da oclusão de outros 15 bebês/crianças de 1 a 5 anos comparados à bebês/crianças sem perdas dentárias após 24 meses de acompanhamento. Foram realizados exame de oclusão, mensuração clínica do EPD com paquímetro digital e documentação com fotografias intrabucais e confecção de modelos de estudo pela impressão dos arcos. Essas etapas foram realizadas no tempo zero (T0) e repetidas após 24 meses (T1). Os modelos foram escaneados em scanner ótico 3D e realizaram-se MDL em software digital. As medidas digitais foram repetidas após 1 mês para avaliação do erro do método. A análise estatística de cada fase foi desenvolvida individualmente utilizando: coeficiente de correlação intraclasse (CCI), Bland-Altman, teste-t, Shapiro-Wilk e teste de Levene's, adotando nível de significância de 0,05%. Dos estudos selecionados na meta-análise (n=4), verificouse que crianças que perderam dentes decíduos anteriores apresentaram maior chance de sofrer distorção da fala do que crianças sem perdas com baixa certeza de evidência (OR 5,466 [1,689, 17,692] p=0,005). Por outro lado, não houve diferença estatística entre esta perda e omissão ou substituição de fonemas, ambos com muito baixa certeza de evidência. Com relação ao Es1, o CCI inter-examinador foi considerado excelente variando de 0,93 a 1,00 e a concordância entre os instrumentos foi boa com média da diferença variando de -0,034mm (-1,077; 1,145) a -1,002mm (-2,632; 0,627). No Es2, o CCI inter-examinador também foi excelente com valor médio de 0,99 e houve concordância entre os instrumentos. No estudo de coorte, não houve diferença clínica significativa no EPD (p=0,938). Valores CCI intraexaminador foram variaram de 0,73 a 1,00. A precisão do método foi adequada, sem evidência de viés de proporção. Não houve diferenças estatisticamente significativas nas MDL tanto do grupo exposto quanto do não-exposto (p>0,05). Alterações nos arcos dentários e no desenvolvimento da oclusão puderam ser evidenciadas por meio da análise descritiva, incluindo: esfoliação e erupção de dentes decíduos, erupção de dentes permanentes, autocorreção e estabelecimento de maloclusões, entre outros. A presente tese concluiu que a perda precoce anterior pode causar distorção da fala, com baixa certeza de evidência. Demonstrou que MDL podem ser realizadas com boa concordância e reprodutibilidade em modelos de gesso com paquímetro digital e compasso de pontas secas e em modelos digitais com software. Demonstrou que, paquímetro digital e compasso de pontas secas podem ser utilizados com boa concordância e reprodutibilidade para mensuração clínica do EPD. Por fim, não houve diferenças nos arcos dentários e no desenvolvimento da oclusão de bebês/crianças com perda precoce anterior em comparação aos sem perdas. Entretanto, alterações fisiológicas e patológicas foram diagnosticadas clinicamente em ambos os grupos, destacando a importância da análise clínica e qualitativa. AU)

Consequences of premature loss of primary anterior teeth were evaluated through three phases. In 1st, a survey of available scientific evidence was conducted through systematic review and meta-analysis (SR), critical literature review (CR), and e-book development. SR was divided into article selection, data extraction, risk of bias, meta-analysis, and certainty of evidence; while CR was composed by data compilation and critical analysis. Finally, all data were organized into an e-book for educational purposes. In 2nd, two studies (S) of agreement and reproducibility were performed to evaluate measurement instruments in study models (S1) and in the clinic (S2). In S1, two trained and calibrated operators performed dental linear measurements (DLM) with compass and digital caliper directly on 40 plaster models of infants/children aged from 1 to 5 years old, with and without tooth losses, compared to digital measurements made in software after 3D scanning. Two trained and calibrated operators measured models with compass, digital caliper, and digital software. Six DLM were evaluated: missing tooth space (MTS) (if any), arch perimeter, arch length, arch width, intercanine length and intercanine width. S2 compared compass and digital caliper for clinical measurement of MTS in 15 infants/children aged between 2 and 6 years old. In 3rd, a longitudinal observational cohort study was conducted to evaluate consequences of premature anterior loss on dental arches and occlusion development in 15 infants/children aged 1 to 5 years compared to participants without teeth losses. Occlusion examination was performed, MTS measurement with digital caliper, and recording through intraoral photographs and study models preparation by impression of upper and lower arches. These steps were performed at baseline (T0) and repeated after a minimum of 24 months (T1). The models were scanned with a 3D optical scanner and DLM were performed with digital software. All digital measurements were repeated after 1 month to evaluate method error. Statistical analysis of each phase was individually Shapiro-Wilk and Levene's test, adopting a significance level of 0.05%. From the studies selected in meta-analyses (n = 4), it was found that children who lost primary anterior teeth had a greater chance of suffering speech distortion than children without tooth loss with low certainty of evidence (OR 5.466 [1.689, 17.692] p=0.005). On the other hand, there was no statistical difference between tooth loss and phoneme omission and substitution, both with very low certainty of evidence. Regarding E1, inter-rater ICC was considered excellent varying from 0.93 to 1.00 and agreement between the instruments was good, varying from 0.034mm (-1.077; 1.145) a -1.002mm (-2.632; 0.627). In E2, inter-rater ICC was also considered excellent with mean value being 0.99 and there was no statistically significant difference between the instruments, also indicating agreement, regardless of the operator. In cohort study, there was no significant change in clinical MTS measurement (p = 0.938). ICC values ranged from 0.73 to 1.00. Method accuracy was adequate and there was no evidence of proportion bias. There were no statistically significant changes in DLM of both exposed and non-exposed groups (p>0.05). Changes in dental arches and occlusion development were evidenced by descriptive analysis, including: exfoliation and eruption of primary teeth, eruption of permanent teeth, self-correction and establishment of malocclusion, among others. In this thesis, it was concluded that premature loss of primary anterior teeth could cause speech distortion, with low certainty of evidence. It was shown that DLM could be performed with good agreement and reproducibility both on plaster models with compass and digital caliper, and on digital models with software. It was also demonstrated that both compass and digital caliper could be used with good agreement and reproducibility for MTS measurements. Finally, there were no statistically changes in dental arches and occlusion development of infants and children with premature loss of primary anterior teeth compared to those without losses. However, physiological and pathological changes were clinically diagnosed in both groups, highlighting the importance of clinical follow-up and descriptive analysis. (AU)

Surgery traction canine of impacted in the maxillary: a case report / Cirurgia de tracionamento de canino impactado em maxila: relato de caso

ABSTRACT Permanent canines are essential for the preservation of the stomatognathic system, as they are part of the occlusal and aesthetic function and balance. During the normal development of occlusion, canines follow a long and complex trajectory until their eruption, that is, they are more likely to suffer disturbances during this process. Removal of the permanent canine should only be considered in extreme cases, where the canine itself is not susceptible to orthodontic traction. Orthodontic traction is the most indicated treatment due to the high morphofunctional and aesthetic value of the permanent canine. The aim of this study is to report a clinical case of traction surgery of the superior permanent canine included in the maxilla. A 13-year-old female patient attended the dental clinic at the Nilton Lins University accompanied by her guardian, referred by an orthodontistfor canine traction surgery. during the examIn the clinical analysis, tooth 13 was absent from the dental arch. The patient had a computed tomography scan, where it was possible to verify the actual position of the toothimpacted with the partially erupted crown on the alveolar ridge. After planning, surgery was performed to install an orthodontic button and adapt the ligature with a 0.30 mm wire. After the 10-month follow-up period, the presence of the tooth in arch, completely erupted, was observed, showing effectiveness in the proposed treatment. Therefore, the procedure for bonding the orthodontic device was performed satisfactorily without complications or intercurrences, making it possible to continue the orthodontic treatment. The patient remains under follow-up.

RESUMO Os caninos permanentes são essenciais para a preservação do sistema estomatognático, visto que, fazem parte da função e equilíbrio oclusal e estético. Durante o desenvolvimento normal da oclusão, os caninos seguem uma longa e complexa trajetória até seu irrompimento, ou seja, estão mais propensos a sofrerem distúrbios no decorrer desse processo. A extração do canino permanente só deve ser considerada em casos extremos, onde o próprio não se encontra suscetível à tração ortodôntica. O tracionamento ortodôntico é o tratamento mais indicado devido ao alto valor morfofuncional e estético do canino permanente. Sendo assim, o objetivo deste estudo é relatar um caso clínico de cirurgia de tracionamento de canino permanente superior incluso em maxila. Paciente de 13 anos, gênero feminino, compareceu a clínica odontológica da Universidade Nilton Lins acompanhado de seu responsável, encaminhada por um ortodontista para cirurgia de tracionamento de canino. Durante o exame clínico observou-se ausência do dente 13 na arcada dentária. A paciente apresentou a tomografia computadorizada, onde foi possível verificar o real posicionamento do dente impactado com a coroa parcialmente irrompida no rebordo alveolar. Após o planejamento, realizou-se a cirurgia destinada a instalação de botão ortodôntico e adaptação da amarrilha com fio 0,30 mm. Posteriormente ao período de acompanhamento de 10 meses, observou-se a presença do dente em arco, totalmente erupcionado, mostrando efetividade no tratamento proposto. Portando, o procedimento de colagem de dispositivo ortodôntico ocorreu de forma satisfatória sem complicações ou intercorrências, tornando possível a continuidade do tratamento ortodôntico. A paciente permanece em acompanhamento.

Rare non-syndromic bilateral maxillary and mandibular permanent canine agenesis.

Oligodontia or absence of teeth such as the Canines is rare and is often accompanied with several other missing teeth. This condition may also be accompanied with morphological and growth related changes in the teeth and the maxillofacial complex. Complete agenesis of the permanent canines in the maxilla and the mandible is extremely rare and occurs in association with syndromic oligodontia. Non-syndromic absence of canines however, is extremely rare and has only been reported twice. Studies have shown that the incidence of missing canines is more in females. This report describes a sporadic case of congenital absence of maxillary and mandibular bilateral canines. The patient reported to the clinic with a chief complaint of crowding and wanted alignment. On intra-oral examination it was observed that the patient had all permanent canines missing with no prior history of extractions, crowding in both the arches and class I molars on both sides. With no other symptoms fixed orthodontic therapy was planned for the patient with premolars substituted for the canines.

Dental and Skeletal Age in Patients with Palatally Displaced Canines.

Objective: To determine potential associations between dental and skeletal maturation and palatally displaced canines (PDC) considering gender and chronological age. Material and methods: This study included pretreatment panoramic and lateral cephalometric radiographs of 43 subjects with PDCs and 203 randomly selected orthodontic subjects with normally erupted canines. Both groups were non syndromic patients. Chronological age of subjects was rounded and noted in years with decimal points and compared with chronological age according to Demirjian's dental age assessment. Skeletal maturation was determined by cervical vertebrae changes on cephalometric radiographs. Results: Female subjects with PDC were more affected by left side canine displacement than males (p=0.027) with five times higher odds ratio (OR = 4.9; 95% CIL=1.2-19.7). A comparison of chronologic and skeletal age indicated that PDC subjects were skeletally younger than unaffected groups with statistically significant differences at the age of 10, 12 and 13. (p=0.05). Conclusion: Young subjects with PDCs showed skeletal maturation delay compared to control group, indicating that skeletal maturation assessment could be one of unexplored predicting factors of a PDC, especially at the age between 10 and 13 years in both genders. Subjects with PDC showed intensive growth spurt after the age of 12 years in females, and after the age of 13 in males. Dental maturation delay showed no statistical significance in PDC prediction.

[Prognosis of impacted canines according to their position in the upper maxillary using different radiographic analyzes]. / Pronóstico de caninos impactados según su posición en el maxilar superior mediante diferentes análisis radiográficos.

Introduction: Canine impaction is an anomaly in which the tooth is prevented from erupting. It occurs when eruption has been delayed and there is radiographic evidence. Objective: To determine the prognosis of impacted canines according to their position in the maxilla by means of different analyses: Ericson & Kurol, Warford and Power & Short; in patients attending private clinics in the city of Asuncion from 2015 to 2020. Methodology: The design is observational descriptive, cross-sectional, using panoramic radiograph measurements. Results: The sample consisted of 37 patients and the 48 canines. It was found that the presence of impacted canines was more frequent in women (69.44%), with unilateral location (70.27%) and palatal position (68.75%). In more than half of the cases the prognosis was unfavorable, however, the concordance was only 75%. There was greater concordance in Warford's prognosis with that of Power & Short (95.91%), while the concordance was lower with that of Ericson & Kurol (81.25%). Conclusion: The frequency of impacted canines in a Paraguayan sample was higher in females, unilaterally located and positioned by palatine. Being unfavorable in more than half of the cases. It is suggested to combine the analyses for projection.

Tratamiento ortodóncico quirúrgico en un caso de inclusión bilateral de caninos superiores / Orthodontic surgical treatment in a patient with maxillary impacted canine teeth

RESUMEN Introducción: El tratamiento ortodóncico quirúrgico puede ser una terapia de elección para los caninos impactados, ya que estos deben conservarse en las arcadas por sus beneficios estéticos y funcionales. La inclusión bilateral de estos en el maxilar es menos frecuente y su tratamiento más complejo. Objetivo: Describir los resultados del tratamiento ortodóncico quirúrgico, en una paciente con inclusión bilateral de caninos superiores. Caso clínico: Paciente femenina de 16 años con antecedentes de salud, que acudió a consulta de Estomatología General Integral en compañía de la madre, preocupada por el aspecto de sus colmillos más blancos y pequeños. Al examen bucal, se observó una completa dentición permanente, excepto los caninos que, en su lugar, se encontraban los dientes 53 y 63. Presentó relieve anormal de la zona anterior de la mucosa palatina, con ligero aumento de volumen a la palpación. Se realizó radiografía panorámica y periapicales y se confirmó la presencia de ambos dientes impactados. Se realizó tratamiento ortodóncico quirúrgico. Conclusiones: El tratamiento ortodóncico quirúrgico devolvió a la paciente la función y la estética, mediante la correcta ubicación de ambos caninos en las arcadas.

ABSTRACT Introduction: Orthodontic surgical treatment could be a therapy of choice for the impacted canines, as they should be kept in the dental arches for their functional and aesthetic benefits. The bilateral impaction of these in the maxillary bone is less frequent and their treatment is more complex. Objective: To describe the results of the orthodontic surgical treatment in a female patient with bilateral impaction of upper canines. Case report: A 16-year-old female patient with a health history was assisted by a general dentist in the company of the mother, because she was worried about the aspect of her cupids which were whiter and littler. The oral examination showed the presence of a permanent and complete dentition with the exception of the upper canines, in their place, were teeth number 53 and 63. It was also found an abnormal relief in the anterior zone of the hard palate with a slight increase of volume at palpation. It was taken panoramic and periapical X-ray and it was confirmed the presence of both impacted teeth. It was made orthodontic surgical treatment. Conclusions: Orthodontic surgical treatment gave back the patient the function and aesthetic by means of the correct location of both teeth in the dental arches.

Implications of impacted mandibular cuspids on mental foramen position.

OBJECTIVE: To determine the horizontal and vertical locations and dimensions of the mental foramen (MF) in digital panoramic images (DPI), and to evaluate the effect of impacted mandibular cuspids (IMC) on the position of the MF. MATERIALS AND METHODS: 715 Digital panoramic images were obtained from the archives of oral radiology clinics of the College of Dentistry, Jouf University. Altogether 236 DPI that met inclusion and exclusion criteria were investigated. One specialist principal investigator examined and analyzed the DPI on a computer screen for horizontal location, average position, and vertical location of the MF. RESULTS: The most common horizontal location of MF with the apices of the teeth in the non-impacted group (NIG) was found to be c = 64.70%, and in the impacted group (IG) d = 47.10%. The average magnitude of MF relative to the apex of second bicuspid in the NIG was found to be 47.10% on the mesial side, and in IG 44.10% on the distal side. The average vertical distance of MF from the lower border of the mandible to the lower border of MF (DLM) in NIG was 14.13 mm (SD ± 1.75 mm), and in IG was 16.85 mm (SD ± 3.06 mm). The average vertical distance of MF from the alveolar crest to the superior border of MF (DAC) in NIG was 6.56 mm (SD ± 2.02 mm), and in IG was 6.67 mm (SD ± 2.28 mm). CONCLUSION: The impacted mandibular cuspid has a definite influence on the location and position of the MF.

Sella Turcica Abnormalities, Dental Age and Dental Abnormalities in Polish Children.

The frequency of some sella turcica abnormalities on cephalometric radiographs is age related. Chronological age might not overlap with growth; however, no studies could be found on the association between sellar morphology and dental age. Although an association exists between sella turcica bridging and dental abnormalities, no studies have been found correlating sellar abnormalities other than bridging with dental abnormalities. The aim of this study was to find any correlations between sella turcica abnormalities and dental age or dental abnormalities. METHODS: Lateral cephalograms and panoramic radiographs of 206 children aged 6-15 years were analyzed for sela turcica abnormalities, Demirijan dental age, and dental abnormalities. RESULTS: The prevalence of dental abnormalities in patients with sela turcica abnormalities was 16.98%, while in those with normal sella, it was 3%. The differences between dental and chronological age were higher in patients with sella turcica abnormalities (p = 0.002). Dental abnormalities were more prevalent (p = 0.001) in patients with sellar abnormalities other than sellar bridging than in those with sellar bridging or normal sella. CONCLUSIONS: Sella turcica abnormalities are correlated with delayed dental age. Dental abnormalities are more frequent in patients with sellar abnormalities. Dental abnormalities are less frequent in subjects with sellar bridges compared to those with other sellar abnormalities.

Pulsatile varicose veins: an uncommon presentation of a common condition.

Varicose veins of the lower limbs are common. However, pulsatile varicose veins are unusual. They could be an indicator of a sinister underlying pathology, such as severe cardiac dysfunction. It is easy to miss these rare cases during clinical workup, which can result in futile treatment with potentially dangerous consequences. In this report, we describe 2 cases of pulsatile varicose veins that highlight different etiologies and management strategies for this condition.

Varizes dos membros inferiores são comuns. Entretanto, varizes pulsáteis são raras, podendo ser indicadoras de uma patologia subjacente sombria como disfunção cardíaca grave. É fácil deixar passar esses casos raros durante exames clínicos, o que pode resultar em tratamento fútil com consequências potencialmente perigosas. Neste relato, descrevemos dois casos de varizes pulsáteis que evidenciam as diferentes etiologias e estratégias de manejo para essa condição.

Manejo quirúrgico de la reabsorción radicular externa de incisivos ocasionada por un canino retenido / Surgical management of external root resorption of incisors caused by impacted canine

RESUMEN Fundamento: prevenir la pérdida prematura de dientes permanentes es el objetivo fundamental del cirujano dentista. La reabsorción externa puede ser una causa de la pérdida dentaria. Objetivo: presentar el manejo quirúrgico de un caso de reabsorción radicular externa de un incisivo central y lateral superior izquierdo, ocasionada por un canino superior retenido. Presentación del caso: paciente femenino, de 16 años de edad que acudió a consulta porque sintió movilidad de sus incisivos, al examen clínico intra bucal se apreció la ausencia en boca del canino superior izquierdo y se constata movilidad grado I de Miller de los incisivos central y lateral del mismo lado. Se hizo la evaluación radiográfica y tomográfica, se evidenció la presencia de reabsorción radicular de los dos incisivos. Se planteó la extracción quirúrgica del canino acompañado de regeneración ósea, para prevenir que la reabsorción externa siga en progreso. Se evaluó por radiografía a los seis meses post cirugía, donde se evidenció que ya no existe progresión de la reabsorción y hay una buena estabilidad de los incisivos comprometidos. Conclusiones: con la extracción del canino retenido y la regeneración ósea, el paciente pudo prevenir que la reabsorción externa siga en progreso y recuperar la estabilidad de sus incisivos.

ABSTRACT Background: preventing the premature loss of permanent teeth is the fundamental objective of the dental surgeon. External reabsorption can be a cause of tooth loss. Objective: to present the surgical management of a case of external root reabsorption of a central and left lateral incisor, caused by a retained upper canine. Case report: 16-year-old female patient who comes to the office because she feels mobility of her incisors; the intra-oral clinical examination showed the absence in the mouth of the upper left canine and Miller's degree 1 mobility of the central and lateral incisors is observed on the same side. The radiographic and tomographic evaluation is done, and the presence of root reabsorption of the incisors is evidenced. Surgical removal of the canine accompanied by bone regeneration is proposed, to prevent external reabsorption from progressing. It is evaluated radiographically at 6 months after surgery, showing that there is no progression of reabsorption and there is a good stability of the compromised incisors. Conclusions: with the removal of the impacted canine and bone regeneration, the patient was able to prevent the external reabsorption from progressing and recover the stability of his incisors.

Evaluation of facial asymmetry by stereophotogrammetry in individuals with unilateral maxillary impacted canine.

PURPOSE: The aim of this study is to compare the symmetry of the facial and dentoalveolar structures of patients with unilateral impacted maxillary canine teeth with a control group of individuals without impacted teeth using three-dimensional face scans. METHODS: The study included 28 patients (10 females, 18 males) with unilateral impacted maxillary canine teeth and 28 patients (15 females, 13 males) without any impacted maxillary canine between 12 and 25 years of age. The 3dMDface™ (3dMD Inc., Atlanta, GA, USA) imaging system was used to obtain 3D face images. 3dMD Vultus® (3dMD Inc., Atlanta, GA, USA) software was used for the measurements. RESULTS: According to the study findings, there were differences in linear measurements and volume measurements between the right and left sides of the face in patients with an impacted canine. However, these differences were not statistically significant. In patients with an impacted canine, surface differences between the right and left halves of the face were not found to be statistically different from the control group. CONCLUSION: There was no difference in the amount of facial asymmetry between patients with unilateral maxillary impacted canine and patients with normal tooth alignment in the control group.

Dental arch perimeter changes as a result from premature loss of primary anterior teeth due to trauma: A case series in infant and pre-school children.

BACKGROUND: The premature loss of primary anterior teeth in deciduous arches is a controversial topic in the literature, especially due to the lack of robust scientific evidence about the consequences in the arch perimeter space and magnitudes of the effects involved. AIM: Evaluate the association between premature loss of primary anterior teeth and dental arch perimeter changes, according to clinical variables as deciduous arch type, erupted primary canines, midline involvement and deleterious oral habits, on infants and pre-school children. DESIGN: Patients with avulsion or referral to extraction due to traumatic dental injuries (TDI) were evaluated. After the tooth loss, two trained operators measured the tooth/teeth space, both with a digital caliper and a dry tip compass. The clinical documentation included photographs and radiographs. Follow-up visits occurred from the baseline and every two months over a 12-month period. Chi-square test was used to evaluate the association between arch perimeter changes and clinical variables (α = 0.05). A descriptive statistic was performed to explore the magnitude of space changes, with 95% confidence intervals. RESULTS: Eighteen infants/children (mean, 2.78 ± 1.39 years) were included. Nine patients presented space loss (50.0%) (mean, -1.32 mm), six patients gained space (33.3%) (mean, +1.55 mm), and three patients presented space maintenance (16.7%). Clinical variables did not influence dental arch perimeter changes. CONCLUSIONS: Premature loss of primary anterior teeth, as well as deleterious oral habits, deciduous arch type, midline involvement and erupted primary canines, were not associated with dental arch perimeter changes.

Effects of cone beam computed tomography measurement of maxillary anterior teeth on implant success and patient satisfaction of maxillary anterior teeth / 中国基层医药

Objective:To investigate the effects of cone beam computed tomography measurement of maxillary anterior teeth on implant success and patient satisfaction of maxillary anterior teeth.Methods:120 patients who underwent maxillary anterior teeth implantation in Hangzhou Dental Hospital from October 2017 to October 2019 were included in this study. They were randomly assigned to receive either conventional maxillary anterior teeth implantation (control group, n = 60) or cone beam computed tomography measurement of maxillary anterior teeth and maxillary anterior teeth implantation (study group, n = 60). The implant success rate was compared between the two groups. Alveolar bone thickness and ISQ value immediately, 3 and 12 months after implantation as well as patient satisfaction were compared between the two groups. Results:Implant success rate in the observation group was significantly higher than that in the control group [96.67% (58/60) vs. 85.00% (51/60), χ2 = 4.904, P < 0.05]. In the observation group, alveolar bone thickness at 3 and 12 months after implantation was (1.53 ± 0.05) mm and (1.78 ± 0.12) mm, respectively, which was significantly higher than that in the control group [(1.46 ± 0.04) mm, (1.64 ± 0.10) mm, t = 9.839, 8.066, both P < 0.001]. In the observation group, ISQ value at 3 and 12 months after implantation was (76.83 ± 5.49) and (82.91 ± 4.85), respectively, which was significantly higher than that in the control group [(67.81 ± 4.61), (74.18 ± 5.21), t = 11.324, 11.038, both P < 0.001). Total satisfaction rate in the observation group was significantly higher than that in the control group [95.00% (57/60) vs. 81.67% (49/60), χ2 = 5.175, P < 0.05]. Conclusion:Cone beam computed tomography measurement of maxillary anterior teeth can help increase implant success rate and patient satisfaction.

Prosthodontic Rehabilitation of Bilateral Maxillary Lateral Incisors Agenesis: A Case Report with One-Year Follow-Up

ABSTRACT@#Globally, non-syndromic tooth agenesis is commonly seen in clinical practice. However, its management is often complex and requires a multidisciplinary team approach for the maximal outcome. While various treatment options are possible, considerations for the treatment are not only based on the dentofacial conditions but also cultural and social background and personal preference of the patient. Thus, patientcentred care approach should always be practised for an optimal outcome. In the present case, a patient with established craniofacial growth presenting with bilateral agenesis of maxillary lateral incisors and over-retained deciduous maxillary left canine sought for aesthetic improvements. The patient did not prefer any orthodontic treatment citing a prolonged treatment duration and sub-optimal motivation as a hindrance. Thus, a prosthodontic only approach was taken by providing a conventional cantilever bridge and ceramic veneers to achieve the aims of treatment. This article discusses the possible limitation of such prosthodontic only solution in managing tooth agenesis.