Radiographic evaluation of the distance between the restoration margin and the alveolar bone crest in dental implant patients: A retrospective study.

OBJECTIVES: The recently introduced Implant Disease Risk Assessment (IDRA) identifies a restoration margin-alveolar bone crest (RM-AC) distance of less than 1.5 mm as a key risk factor for peri­implant disease among eight major risk factors. This study evaluated the impact of the RM-AC distance on marginal bone loss (MBL) through radiographic analysis. METHODS: This retrospective cross-sectional study included 77 partially edentulous patients (39 females and 38 males, aged 22 to 76 years) with 202 platform-switched conical connection implants, cement-retained, implant-supported fixed restorations, and bone-level implants placed between 2016 and 2021. Dental implants were followed for least 6 to 36 months at follow up functional loading. Study participants were categorized into Group A (RM-AC distance ≤ 1.5 mm, n = 69) and Group B (RM-AC distance > 1.5 mm, n = 133). Twelve patients in Group B and five patients in Group A had no history of periodontal disease. The MBL was measured radiographically from the most coronal point of the implant shoulder to the alveolar bone, and the RM-AC distance was measured from the restoration margin to the alveolar crest. Multinomial logistic regression analysis was used for statistical evaluation. RESULTS: The incidence of MBL in Group A was statistically significant and 3.42 times higher than that in Group B. The rate of MBL in periodontitis Stage 4 was found to be 26.31 times higher than that in periodontitis Stage 2. The incidence of MBL was 6.097 and 5.02 times higher with increasing implant diameter and length, respectively. CONCLUSION: This study conclusively demonstrates that RM-AC distance ≤ 1.5 significantly increases the risk of MBL, particularly in patients with a history of periodontal disease. CLINICAL SIGNIFICANCE: This study highlights the critical role of maintaining an RM-AC distance greater than 1.5 mm in the prevention of MBL, particularly in patients with a history of periodontal disease. Since implant diameter and length have a significant impact on the risk of MBL, it emphasizes that implant demographics should also be carefully evaluated.

A deep learning approach for dental implant planning in cone-beam computed tomography images.

BACKGROUND: The aim of this study was to evaluate the success of the artificial intelligence (AI) system in implant planning using three-dimensional cone-beam computed tomography (CBCT) images. METHODS: Seventy-five CBCT images were included in this study. In these images, bone height and thickness in 508 regions where implants were required were measured by a human observer with manual assessment method using InvivoDental 6.0 (Anatomage Inc. San Jose, CA, USA). Also, canals/sinuses/fossae associated with alveolar bones and missing tooth regions were detected. Following, all evaluations were repeated using the deep convolutional neural network (Diagnocat, Inc., San Francisco, USA) The jaws were separated as mandible/maxilla and each jaw was grouped as anterior/premolar/molar teeth region. The data obtained from manual assessment and AI methods were compared using Bland-Altman analysis and Wilcoxon signed rank test. RESULTS: In the bone height measurements, there were no statistically significant differences between AI and manual measurements in the premolar region of mandible and the premolar and molar regions of the maxilla (p > 0.05). In the bone thickness measurements, there were statistically significant differences between AI and manual measurements in all regions of maxilla and mandible (p < 0.001). Also, the percentage of right detection was 72.2% for canals, 66.4% for sinuses/fossae and 95.3% for missing tooth regions. CONCLUSIONS: Development of AI systems and their using in future for implant planning will both facilitate the work of physicians and will be a support mechanism in implantology practice to physicians.

Implant-to-root dimensions projected by panoramic radiographs inthe maxillary canine-premolar region: implications for dental implant treatment.

BACKGOUND: This study aimed to compare panoramic radiography (PAN) and cone beam computed tomography (CBCT) determinations of implant-to-root dimensions (IRD) in anterior and posterior maxillary regions, and to help determine in which instances increased radiation exposure from CBCT scans may be justified. METHODS: IRD measured by PAN (PAN-D) from implant-to-root sites (central incisor, lateral incisor, canine, first premolar, and second premolar) was collected from 418 implant sites in 110 adults. The CBCT technique was used as the reference method for the estimation of IRD. The PAN analysis equations were developed using stepwise multiple regression analysis and the Bland-Altman approach was applied to assess the agreement between PAN and CBCT methods. RESULTS: The odds ratio that an implant at the canine-to-first premolar (9.7:1) (P = 0.000) or at the first premolar-to-second premolar region (4.5:1) (P = 0.000) belongs to the underestimation group was strong and highly significant. The root mean square error (RMSE) and pure error (PE) were highest for the canine-to-first premolar (RMSE = 0.886 mm, PE = 0.45 mm) and the first premolar-to-second premolar region (4.5:1) (RMSE = 0.944 mm, PE = 0.38 mm). CONCLUSIONS: This study provides evidence of site-specific underestimations of available horizontal bone dimensions for implants when assessed by PAN. These data suggest that the canines and first and second premolars may have to be excluded when assessing root angulations via PAN.

Radiographic evaluation of bone density in dentulous and edentulous patients in Riyadh, KSA.

BACKGROUND: The Cone Beam Computed Tomography (CBCT) is currently being used as the most common diagnostic method to evaluate the bone density of the maxilla and the mandible for planning dental implant. Aim: The aim of the study is to check the quantitative alveolar bone density in complete or partial edentulous and dentulous male and female patients among Riyadh sample population in Saudi Arabia. MATERIALS AND METHODS: The study involved a cross-sectional analysis of 231 consecutive CBCT images of 231 different patients (115 males and 116 females). The scans were of Saudi National patients who were partially or completely edentulous without any bone infections in the maxilla and the mandible. The findings are presented as descriptive statistics and inferential statistics: student -t-test for two group means, ANOVA for three groups, Post-hoc LSD test for multiple comparisons, Levene statistics for testing the homogeneity of variances and a statistical significance at 5% level. RESULTS: Comparison of mean alveolar bone density in maxillae of dentulous male smokers showed a statistically significant difference for bucco-cortical plate and cancellous bone among different regions. In dentulous male nonsmokers, no significant difference was observed for maxillary regions, while in mandibular areas, a statistically significant difference was seen for buccal cortex, palatal cortex, and cancellous bone among different regions. While studying the scans of female dentulous patients, a statistically significant difference was observed in alveolar bone density for all the areas. CONCLUSION: Evaluation of bone density is an important step in treatment planning and this study was aimed to provide insight into bone density patterns of population in Riyadh, Saudi Arabia. Further similar studies in different populations can help in planning for more efficient treatment outcomes.

Undesirable course of an oral implant rehabilitation in a patient with a long history of bulimia nervosa: case report and review of the literature.

BACKGROUND: Bulimia nervosa is an eating disorder resulting in an intended weight loss due to decreased food intake, induced vomiting, or hyperactivity, and is observed frequently between 12 and 25 years of age. One of the complications is early tooth loss. Moreover, since bulimia nervosa patients suffer from increased atrophy of the alveolar processes, oral rehabilitation even with short dental implants may be impossible. In these cases, lateralization or transposition of the inferior alveolar nerve (IAN) followed by implant placement can be useful. CASE PRESENTATION: A 40-year-old woman with a long-lasting history of bulimia nervosa requested a fixed rehabilitation of her partially edentulous mandible. In 2012, a bilateral IAN transposition approach was performed using piezosurgery, and without any postoperative neurosensory alterations. Two years later, bilateral insertion of each two implants was followed by an inflammatory destabilization of the lower left mandible; subsequent to the implant removal, a fracture occurred, and the latter was stabilized by osteosynthesis plates. In 2017, three additional implants were placed, finally providing the patient with a fixed restoration on five implants. CONCLUSION: Eating disorders may have a tremendous impact on both physical condition and oral health, resulting in early tooth loss and severe bone atrophy. IAN transposition is a viable treatment option to enable installing fixed prostheses via dental implants, but the latter will clearly increase the risk of inflammation and interruption of mandibular continuity. Close clinical and radiologic monitoring is mandatory to adequately respond to complications such as peri-implant mucositis, peri-implantitis, osteomyelitis, or concomitant fractures.

Comparing 4-mm dental implants to longer implants placed in augmented bones in the atrophic posterior mandibles: One-year results of a randomized controlled trial.

BACKGROUND: Short implants have been proposed as an alternative for the rehabilitation of atrophic edentulous areas. PURPOSE: To evaluate the efficacy of 4-mm implants vs longer implants in the atrophic posterior mandibles. MATERIALS AND METHODS: Eleven patients with bilateral atrophic mandibles were rehabilitated with two to four 4-mm implants and 10 or 8-mm long implants in augmented bone using Guided Bone Regeneration procedure. One side of the mandibles was randomly allocated to vertical augmentation with mixed autogenous bone and allograft. Implants were placed in both sides of the mandible after 6 months, and loaded after another 2 months. Subsequently, implant and prosthesis failures, marginal bone levels changes, and any complication were evaluated after 1-year follow-up. RESULTS: In this study, one patient dropped out and no failures occurred. However, 4-mm implants loss of 0.30 ± 0.34 mm peri-implant marginal bone and long implants loss of 0.47 ± 0.54 mm marginal bone were observed after 1-year of follow-up. The difference between the two groups was not statistically significant (difference = -0.16 ± 0.68 mm; P = 0.46). Eight complications occurred in five augmented sites of the patients, and no complication was found to occur in the short implants sites. CONCLUSIONS: One-year after loading, 4-mm implants had similar outcomes as long implants in augmented bone. Therefore, short implants might be a feasible treatment in atrophic mandibles.

Alveolar ridge dimensions in mandibular posterior regions: a retrospective comparative study of dentate and edentulous sites using computerized tomography data.

PURPOSE: To evaluate ridge dimensions at edentulous, mandibular posterior sites, and contralateral dentate sites. METHODS: Computerized tomography scans of 24 patients with one fully edentulous and one fully dentate mandibular posterior region were retrospectively selected. Relative ridge position (rRP), bone height (BH), alveolar canal height (ACH), basal bone height (BBH), and bone width (BW) at 1, 3, and 5 mm apically to the most coronal point of the alveolar crest (BW1mm, BW3mm, and BW5mm, respectively) were measured at posterior dentate sites and contralateral edentulous sites. The proportion of edentulous sites with BH ≥ 9 mm and BW1mm ≥ 6 mm and/or BH ≥ 11 mm and BW3mm ≥ 6 mm was calculated. RESULTS: When compared to dentate sites, edentulous sites showed lower BH, a more apical position of the ridge, lower BW1mm, lower ACH, and similar BBH. The difference in rRP, BH, ACH, BBH, BW1mm, BW3mm, and BW5mm between edentulous and contralateral dentate sites was not significantly different between females and males. The prevalence of edentulous sites with BH ≥ 9 mm and BW1mm ≥ 6 mm and/or BH ≥ 11 mm and BW3mm ≥ 6 mm was higher in females (83.3%) compared to males (58.3%) at second premolar, while was higher in males compared to females at the first molar (83.3 vs 66.6%) and second molar (83.3 vs 75.0%). CONCLUSIONS: In the posterior mandible, edentulous sites show a reduced height and bucco-lingual ridge width compared to contralateral dentate sites. Gender seems to have a limited impact on the extent of ridge resorption following the loss of posterior mandibular teeth.

Influence of the abutment height and connection timing in early peri-implant marginal bone changes: A prospective randomized clinical trial.

AIM: The aim of this study was to compare the influence of the abutment height and insertion timing on early marginal bone loss (MBL) in posterior mandibular partial implant-supported restorations. MATERIAL AND METHODS: The study was planned as a prospective, randomized, controlled parallel group including subjects in need of at least two implants for the restoration of an edentulous posterior mandibular area. The patients were allocated into Groups A (implants immediately connected to 2-mm height abutments), B (immediately connected 1-mm height abutments), and C (2-mm abutments were inserted in a second-stage surgery). Each subject was placed in a 1-year follow-up program, including examination assessment of various soft tissue and bone-level parameters. RESULTS: A total of thirty-three patients, including sixty-eight implants, were enrolled in this study. One implant was lost on group C after the first month of healing. A mean MBL change of 0.719 ± 0.361, 0.651 ± 0.379, and 0.754 ± 0.672 mm was computed for groups A, B, and C, respectively, with no significant differences found. The early MBL at T1 was an independent predictor variable for the marginal bone alterations that were assessed at T3 (p < 0.001). CONCLUSION: The first-month MBL variation is a predictor factor of the bone alterations that might occur after 1 year of treatment. The early connection of final prosthetic abutments with distinct heights does not seem to reduce the 1-year MBL rate when compared with traditional treatment protocols.

Marginal bone level and survival of short and standard-length implants after 3 years: An Open Multi-Center Randomized Controlled Clinical Trial.

OBJECTIVES: The present multi-center randomized controlled clinical trial sought to compare the marginal bone level (MBL) changes and survival of 6- and 11-mm implants. MATERIAL AND METHODS: Ninety-five patients receiving a total of 209 dental implants were enrolled. Subjects were randomly allocated to two cohorts: test (4.0 × 6 mm; N = 108) or control (4.0 × 11 mm; N = 101) implant groups. To be randomized, all edentulous sites were anatomically qualified to receive 11 mm implant. Two to three implants were placed in maxillary or mandibular posterior regions and loaded with splinted provisional restoration after 6 weeks and definitive restoration 6 months thereafter. Test and control implants were followed by clinical and radiographic examinations on an annual basis up to 3 years. RESULTS: Radiographic assessment of MBL 3 years after loading revealed the bone to be located at 0.27 mm (±0.40) and 0.44 mm (±0.74) apical to the implant platform in the test and control groups, respectively. During the 3 years of follow-up since loading, 0.04 mm (±0.43) MBL gain and 0.02 mm (±0.76) of MBL loss were observed in the 6-mm (test) and 11-mm (control) groups, respectively. The MBL's for test and control were significantly different (p = 0.000) in favor of short implants. The cumulative survival rates from placement after 3 years were 96% and 99% for the 6- and 11-mm implants, respectively, with no statistical significance. CONCLUSIONS: Reconstruction of partially edentulous posterior maxilla or mandible with 6- or 11-mm implants led to stable marginal bone level and high implant survival rate after 3 years.

New classification of maxillary sinus contours and its relation to sinus floor elevation surgery.

BACKGROUND: It is complicated to select an appropriate sinus floor elevation and the procedure for sinus floor elevation lacks of consensus. Sinus contour plays an important role in choosing a surgery approach. But there are still no published articles revealing the influence of sinus contours to sinus floor elevation surgery. PURPOSE: We propose a new classification depending on sinus contours from cone-beam computed tomography (CBCT), analyze clinical characters of different types, and investigate the relationship between sinus contours and sinus floor elevation. MATERIALS AND METHODS: We divide sinus into five categories: narrow tapered, tapering, ovoid, square, and irregular. For the first four types, subtypes are classified into three categories: without recess, with buccal-sinus-recess (BSR), and with palate-nasal-recess (PNR). For irregular type, subtypes are classified into three categories: tooth protruding into sinus floor, irregular floor, and septa/exostosis on sinus floor. Then the distribution features of sinuses of 698 patients are described. Sinus widths are measured at second premolar, first and second molar on both sides, and are compared among different types and subtypes. RESULTS: Narrow tapered sinus occupies 88% at second premolar sites, while tapered sinus occupies almost 50% at first and second molar sites. At second premolar and first molar sites, 62% are without recess types. While 92% are without recess types at second molar. Sinuses with BSR present in only three of 3765 sites. There is an increasing trend of sinus width from narrow tapered to irregular type. Sinus width of the group with recesses is significantly higher than the one without recess. At the end, we provide corresponding treatment recommendations for each sinus types and subtypes. CONCLUSION: This is the first classification system that gives treatment recommendations for sinus floor elevation surgery based on sinus contours. The classification system is consistent, easy to visualize, and practicable.

Crestal Bone Level Around Tissue-Level Implants Restored with Platform Matching and Bone-Level Implants Restored with Platform Switching: A 5-Year Randomized Controlled Trial.

PURPOSE: The aim of this randomized clinical trial with a 5-year follow-up was to assess the differences in radiographic levels of peri-implant bone crest between tissue-level implants restored with platform matching (control group) and bone-level implants restored with platform switching (test group) in the posterior region. MATERIALS AND METHODS: To assess marginal bone level changes, periapical radiographs were taken at the moment of prosthesis delivery (baseline), at 1 year, and at 5 years after the definitive restoration. RESULTS: One hundred subjects, partially edentulous in the posterior region, were selected for this study. There were 54 men and 46 women between the ages of 25 and 70 years (mean = 50.5 years). A total of 202 implants were assigned to both groups using a randomized procedure (100 implants in the control group and 102 in the test group). The mean marginal bone level (MBL) changes for tissue-level implants restored with platform matching were 0.26 ± 0.55 mm at baseline to 1 year, 0.34 ± 0.54 mm at 1 year to 5 years, and 0.61 ± 0.73 mm at baseline to 5 years. The mean MBL changes for bone-level implants restored with platform switching were -0.03 ± 0.74 mm at baseline to 1 year, -0.17 ± 0.67 mm at 1 year to 5 years, and -0.20 ± 0.75 mm at baseline to 5 years. The mean difference between the two groups was 0.31 mm at baseline to 1 year, 0.53 mm at 1 year to 5 years, and 0.85 mm at baseline to 5 years. There was a statistically significant difference in MBL (P < .001). Both implant systems showed good and similar survival rates (98% for tissue-level implants restored with platform matching and 96.1% for bone-level implants restored with platform switching). CONCLUSION: In this randomized controlled trial, the following observations were made. Radiographic levels of peri-implant bone crest in tissue-level implants restored by platform matching were statistically significant in the three interval times. Meanwhile, MBL changes for bone-level implants restored with platform switching were not statistically significant in the different times studied. Nevertheless, the mean difference between the two groups was statistically significant.

Assessment of Lingual Concavities in Submandibular Fossa Region in Patients requiring Dental Implants-A Cone Beam Computed Tomography Study.

AIM: The present study was aimed at assessing the lingual concavities in the submandibular fossa region in patients requiring dental implants with the help of cone beam computed tomography (CBCT). MATERIALS AND METHODS: The present study included 140 patients who visited the department with the missing mandibular posterior teeth. CBCT images were obtained using planmeca machine. Cross sections of 1 mm of submandibular fossa in the region of 1st and 2nd molar were studied and Type I to III lingual concavities were analyzed by a radiologist. RESULTS: Type I lingual concavity (< 2 mm) was seen in 23%, type II (2-3 mm) in 62% and Type III (> 3 mm) in 15% of patients. The difference was significant (p < 0.05). Males had slightly higher mean ± S.D value at 1st molar (2.6 mm ± 0.94) and 2nd molar (2.8 mm ± 0.90) on the left side and (2.7 mm ± 0.92) at 1st molar and (2.9 mm ± 0.93) at 2nd molar on the right side. The difference was nonsignificant (p > 0.05). Females had mean ± S.D value at 1st molar (2.3 mm ± 0.90) and (2.5 mm ± 0.92) at 2nd molar on the left side and (2.4 mm ± 0.91) at 1st molar and (2.8 mm ± 0.93) at 2nd molar. The difference was nonsignificant (p > 0.05. The difference between both genders was statistically nonsignificant (p > 0.05). CONCLUSION: Type I bone is the best for placing an implant. The chances of complications are more in type II and III bone. CBCT provides necessary information before planning implant in the edentulous area. CLINICAL SIGNIFICANCE: Cone beam computed tomography (CBCT) is the best radiographic aid which is effective in delineating different types of bone in the mandibular posterior region.

Histologic and Histomorphometric Analysis at 26 Months of a Bovine Hydroxyapatite Maxillary Sinus Graft: A Case Report.

A variety of biomaterials are used when performing sinus augmentation techniques. Bovine hydroxyapatite (BH) has already been demonstrated to present osteoconductive properties. The aim of this article is to provide a histologic and histomorphometric analysis, at 26 months, of a bone specimen extracted from a BH maxillary sinus graft. Histomorphometric results showed 64.4% bone density and 24.4% biomaterial density. Histologic analysis revealed marked bone formation and high osteoconductive properties in the BH particles, with no associated signs of inflammation. Resorption appeared minimal. BH seems to present high biocompatibility and osteoconductive properties.

Association Between Missing Posterior Teeth and Occurrence of Temporomandibular Joint Condylar Erosion: A Cone Beam Computed Tomography Study.

PURPOSE: To determine a possible association between asymptomatic temporomandibular joint (TMJ) condylar erosion and the number of missing posterior teeth and their location, as well as the number of dental quadrants with missing posterior teeth. MATERIALS AND METHODS: This case-control study involved 210 patients (male to female ratio = 98:112) aged 16-74 years, with 105 asymptomatic patients with TMJ condylar erosion and a control group of 105 patients without TMJ condylar erosion. Cone beam computed tomography images were evaluated to classify the severity of TMJ condylar erosion as grade 0 (absence of erosion), grade I (slight erosion), grade II (moderate erosion), or grade III (extensive erosion). RESULTS: The number of missing posterior teeth (mean ± standard deviation [SD]; 2.7 ± 2.4 vs 0.7 ± 1.2) (P < .001), number of dental quadrants with missing posterior teeth (1.5 ± 1.3 vs 0.6 ± 0.9) (P < .001), and bilateral location of missing posterior teeth (41 ± 39.0 vs 10 ± 9.5) (P < .001) were all significantly higher in patients with erosion than in those without erosion. The condylar erosion grade was significantly associated with the number of missing posterior teeth (odds ratio [OR] = 1.24; P = .006), the number of dental quadrants with missing posterior teeth (OR = 1.36; P = .006), and the bilateral occurrence of missing posterior teeth (OR = 3.03; P = .002). CONCLUSION: The findings from this study suggest a possible association between TMJ condylar erosion grades and the number of missing posterior teeth, the number of quadrants with missing posterior teeth, and the bilateral occurrence of missing posterior teeth.

Clinical factors in prosthodontic treatment of children with genetic defects.

BACKGROUND: Prosthodontic treatment of children with genetic disorders is an area that is rarely examined in the current specialist literature. Few prosthodontists will undertake treatment of such patients, who will more often be referred to an orthodontic specialist. After examining the 4 cases of children with genetic disorders described in this paper, it can be concluded that when a prosthodontist includes a few additional procedures in the treatment process, he or she can successfully help such patients. OBJECTIVES: The aim of this paper is to indicate the clinical difficulties faced by prosthodontists who undertake prosthodontic rehabilitation of children with genetic disorders. MATERIAL AND METHODS: The paper is based on data collected during the prosthodontic treatment of 4 children, aged 5-12 years with genetic defects, and analysis of the body of work concerning these defects and their treatment. RESULTS: Presentation of guidelines for the prosthodontic treatment process and creation of dentures for treated children based on extended procedures. CONCLUSIONS: A prosthodontist is a crucial person in a team of specialists treating disorders within the face among children with a genetic predisposition. A basic knowledge of orthodontics and psychology facilitates the treatment. Prosthetic restoration in the treatment group does not always require complicated operations. Individualization of the tools for downloading orthodontic impressions, designing denture elements and an increased number of checkups are the additional procedures. For the clinician, the emotional aspect of the treatment is the main impediment. Maintaining a good relationship with a patient and his or her caregivers requires interpersonal skills.

Immediate loading of subcrestally placed dental implants in anterior and premolar sites.

PURPOSE: Immediate loading of dental implants has been evolving into an appropriate procedure for the treatment of partially edentulous jaws. The purpose of this study was to evaluate the clinical success and radiological outcome of immediately and delayed loaded dental implants in anterior and premolar sites. MATERIALS AND METHODS: In this retrospective study, data of 163 individuals requiring tooth removal with subsequent implant placement in anterior and premolar sites were analyzed. Implants were immediately loaded by provisional acrylic resin bridges or loaded with delay. Implants were followed up annually for up to 9 years including intraoral radiographs. RESULTS: A total of 285 implants in 163 patients were placed. 218 implants were immediately loaded and 67 implants with delay. Fifteen implants failed during the follow-up period resulting in survival rates of 94.5% for immediate loading and 95.5% for delayed loading. After an initial decrease of 0.3 mm in the first 12 months the marginal bone level remained stable. No statistically significant differences were found in marginal bone loss between immediately and delayed loaded implants (P = 0.518, 95% CI). CONCLUSION: Within the limits of this study, immediate loading of immediately subcrestally placed dental implants in anterior and premolar sites is a reliable treatment option for dental rehabilitation.

Radiographic Screening of Patients in a Dental School using the Prosthodontic Diagnostic Index.

INTRODUCTION: Organization of the findings associated with various diagnostic aids plays a key role in formulating the treatment plan of the patients undergoing dental and medical treatment. Enhanced consistency in diagnosing and classifying prosthodontic patients is the basic purpose of various classification systems. Hence, we planned this study to classify partially edentulous patients and completely dentate patients at the undergraduate clinics using the prosthodontic diagnostic index (PDI). MATERIALS AND METHODS: This study included classification of 13,599 edentulous patients who attended the clinics of undergraduate students of all the levels. Screening of all the patients was done radiographically with a digital orthopantomograph (OPG), and the data were saved in the computer system. The intraoral periapical radiographs (IOPA) taken for all the affected areas were also saved in the system. Based on the OPG and IOPA, the patients were classified into various classes. All the data of the patients were recorded and analyzed. RESULTS: Total number of patients screened was 17,220, out of which 3,621 were under 18 years of age and were excluded from the study. Most of the patients belonged to the age group of 31 to 45 years: 5,360 (39.4%) patients (3,817 [43.0%] males and 1,543 [32.5%] females) were class I; 2,730 (20.0%) patients (1,729 [19.5%] males and 1,001 [21.1%] females) were class II; 4,576 (33.7%) patients (2,835 [32.0%] males and 1,741 [36.8%] females) were class III; and 933 (6.9%) patients (483 [5.5%] males and 450 [9.5%] females) were class IV. CONCLUSION: There is a need to introduce PDI as a screening tool during the initial examination of the patient and to achieve a proper distribution of the patients among various levels of students, interns, and postgraduates. CLINICAL SIGNIFICANCE: Introduction of PDI will improve the treatment planning and prognosis of edentulous patients.

Lateral open bite and crossbite correction in a Class III patient with missing maxillary first premolars.

Posterior and Class III elastics were used to correct lateral open bite and anterior crossbite in a 29-year-old man. His occlusion, smile esthetics, and soft tissue profile were significantly improved after 25 months of active orthodontic treatment combined with 4 anterior restorations.

Mesiodistal dental movement toward remodeled edentulous alveolar ridge: Digital model assessment.

INTRODUCTION: The aims of this study were to compare the changes in posterior dental inclination and angulation, and the posterior tooth crown sizes and alveolar ridge thicknesses consequent to the orthodontic procedures of closing and opening of mandibular first molar edentulous spaces. METHODS: The sample comprised 16 patients (4 men, 12 women) with an initial mean age of 34.17 years and unilateral or bilateral absence of mandibular permanent first molars. The space closure group (SCG) comprised 12 hemiarches with a mandibular first molar edentulous space varying from 2 to 7 mm, orthodontically treated with space closure. The space opening group (SOG) comprised 14 quadrants with a mandibular first molar edentulous space varying from 7.1 to 12 mm, orthodontically treated with space reopening for prosthetic replacement. Digital dental models were obtained before treatment and after space closure or opening, and posterior tooth angulation and inclination, cervico-occlusal crown height, and alveolar ridge thickness were evaluated. Interphase and intergroup comparisons were performed with dependent t tests and t tests, respectively (P <0.05). RESULTS: Mandibular second molar uprighting and changes in buccolingual inclination of the posterior teeth were similar in the groups. The second molar cervico-occlusal crown height increased in the SCG and decreased in the SOG. The alveolar ridge thickness increased in the SCG and remained stable in the SOG. CONCLUSIONS: The only significant intergroup differences were that the second molar cervico-occlusal crown height and the alveolar ridge thickness increased in the SCG, and decreased and remained stable in the SOG.

Analyzing Dental Implant Sites From Cone Beam Computed Tomography Scans on a Tablet Computer: A Comparative Study Between iPad and 3 Display Systems.

PURPOSE: The aim of this study was to compare a medical-grade PACS (picture archiving and communication system) monitor, a consumer-grade monitor, a laptop computer, and a tablet computer for linear measurements of height and width for specific implant sites in the posterior maxilla and mandible, along with visualization of the associated anatomical structures. MATERIAL AND METHODS: Cone beam computed tomography (CBCT) scans were evaluated. The images were reviewed using PACS-LCD monitor, consumer-grade LCD monitor using CB-Works software, a 13″ MacBook Pro, and an iPad 4 using OsiriX DICOM reader software. The operators had to identify anatomical structures in each display using a 2-point scale. User experience between PACS and iPad was also evaluated by means of a questionnaire. RESULTS: The measurements were very similar for each device. P-values were all greater than 0.05, indicating no significant difference between the monitors for each measurement. The intraoperator reliability was very high. The user experience was similar in each category with the most significant difference regarding the portability where the PACS display received the lowest score and the iPad received the highest score. CONCLUSIONS: The iPad with retina display was comparable with the medical-grade monitor, producing similar measurements and image visualization, and thus providing an inexpensive, portable, and reliable screen to analyze CBCT images in the operating room during the implant surgery.