The esthetic challenge of a malpositioned peg-shaped lateral incisor and a missing contralateral maxillary tooth: report of a case.

A peg-shaped maxillary lateral incisor is an underdeveloped, small, malformed permanent tooth that erupts following the loss of a primary tooth. The maxillary lateral irregularly shaped incisor may be unilateral, on both sides of the central incisors, or accompanied by a missing lateral tooth on the contralateral side of the arch. Peg-shaped maxillary lateral incisors receive a great deal of attention, play a significant role in the displayed smile, and present a treatment challenge during all stages of a patient's life. Clinicians are called to plan the treatment and the timing from as early as the beginning of growth and development. Careful diagnosis may dictate postponing a treatment to later stages of life, especially if the tooth is malpositioned in the arch. The goal of this clinical report was to present a combined treatment for a case with a palatal malpositioned peg-shaped maxillary lateral incisor and a missing contralateral permanent maxillary lateral incisor, creating an esthetic challenge. Moving the malpositioned peg-shaped lateral tooth to the arch simplified and eased the final prosthetic treatment procedure, increasing the treatment predictability. The presented sequence of therapy further stresses the importance of incorporating minor tooth movement, without referring to a specialist, in the daily practice of a prosthodontic-oriented general clinic, by simple accessible means.

Accelerated healing of endodontically treated teeth with a periapical lesion as a result of orthodontic extrusion: evaluation and rationale.

Resolution of a periapical periodontal lesion as determined by radiographic examination may take a year or longer. Orthodontic movement is known to have a positive effect on the bone topography and morphology. The literature presents no information about the effect of orthodontic movement on the rate of periapical endodontic healing following a root canal treatment. The aim of this report was to present the use of orthodontic root extrusion in cases with a periapical lesion, where other options are ruled out. Three case reports involving endodontically treated teeth with a periapical lesion are presented. In each case, the performed orthodontic extrusion resulted with healing of the periapical environment towards a predictable crown fabrication or replacing a hopeless tooth more safely with an implant-supported crown. In all cases presented, signs of radiographic healing were demonstrated in a relatively shorter time than is considered acceptable, following the extrusive orthodontic movement, with no clinical sensitivity to percussion or periodontal pockets. In conclusion, orthodontic extrusion of endodontically treated teeth with periapical lesions presented positive radiographic healing signs along with no clinical symptoms of pain and mobility and a positive effect on marginal bone level and soft tissues, at a faster rate than was expected. This report may assist in supporting a clinical decision to apply vertical extrusive forces on compromised endodontically treated teeth presenting with a periapical lesion. Healing signs may be observed within a shorter time period, which may allow better prediction for the prosthetic phase.

A nouveau collagen scaffold to simplify lateral augmentation of deficient ridges between natural teeth.

The volume of the bone in a site past an extraction degrades significantly and thus it is imperative to evaluate the situation for implant placement. Besides the need for sufficient bone, the amount and quality of the soft tissue covering the bone in the missing tooth area and nature of the adjacent teeth must be carefully assessed. In anterior sites, reconstructive surgery is usually performed to restore these hard and soft tissues, mainly for esthetic reasons, but it is equally essential in posterior sites to ensure adequate functional support. In guided bone regeneration procedures, barrier membranes block the augmented areas, provide and maintain space for regenerative material, and protect the blood clot, allowing a normal wound stability process. Clinicians prefer using resorbable membranes in most cases, whereas a nonresorbable membrane is selected to correct large defects. This report proposes the use of a collagen scaffold as a core material for guided bone regeneration in the case of a missing tooth between two existing teeth, when there is sufficient bone to place an implant but a horizontal defect is present in the crestal ridge. The tested question is whether a thick, reinforced, resorbable collagen scaffold (Ossix Volumax) can provide a stable basis for restoring the lost volume of a deficient ridge. The regeneration procedure presented with the collagen scaffold resulted in restoration of the lost tissue volume and a favorable lifelike emergence profile for the implant-supported crown. This augmentation procedure is simpler to perform in certain cases than existing procedures with bone substitute material and/or an interpositional connective tissue graft harvested from a remote donor site, the harvest of which is not required.

Influence of jaw opening on occlusal vertical dimension between incisors and molars.

STATEMENT OF PROBLEM: Modification of the occlusal vertical dimension (OVD) is a significant procedure in prosthodontics. Improper estimation of the space available between opposing teeth may lead to an improper framework design. PURPOSE: The purpose of this clinical study was to evaluate the average opening ratio in the molar area in relation to the extent of opening in the incisor area. MATERIAL AND METHODS: A total 34 adults with a complete dentition and stable occlusion participated in the study. The change in vertical distance was evaluated in 3 areas: between the maxillary and mandibular central incisors, between the maxillary and mandibular canines, and between the maxillary and mandibular first molars. Digital photographs were made at the intercuspal position (ICP) and at a 2-mm and 8-mm OVD increase. The OVD opening was standardized with the aid of a Woelfel sliding guide device. The measurements were made by recording the distance between the maxillary and mandibular teeth at different openings. For calibration and quantitative evaluation of the photographs, image-processing analysis was used. RESULTS: The collected data showed that the average ratio of the opening between the first molars and the opening between the central incisors was 0.73. The average ratio of the opening between the canines and the opening between the central incisors was 0.95. The values were plotted, and a mathematical model was derived. CONCLUSIONS: A vertical dimension opening of 1 mm between the central incisors resulted in 0.73 mm of occlusal clearance in the first molar region and 0.95 mm in the canines.

Antibacterial Effect of a Temporary Cement-Dissolving Liquid.

PURPOSE: Methods for removing temporary cement with an antibacterial effect might improve prosthetic treatment prognosis. MATERIALS AND METHODS: Three removal methods were assessed: (1) immersion of an acrylic provisional restoration in a temporary cement dissolver (Temp-off); (2) mechanical removal with a dental explorer; and (3) sandblasting. Two temporary cements, one with eugenol (Temp-Bond) and one without eugenol (Temp-Bond NE) and of two thicknesses (100 µm and 250 µm), were examined. RESULTS: Immersion in Temp-off produced the most effective bacterial count decrease compared to the other methods (P < .05). No significant difference was found between the two cement types, although the decrease in count was more evident in the thicker (250 µm) cement layer. CONCLUSION: Temp-off dissolving liquid used for removal of temporary cement exhibited an antibacterial effect and nonmechanical cleaning ability.

Antibacterial Effect of Provisional Cements with Incorporated Polyethyleneimine Nanoparticles: An In Vivo Study.

PURPOSE: Provisional restorations exhibit various degrees of microleakage when cemented. Incorporation of quaternized polyethyleneimine nanoparticles (QPEI) into provisional cements may be effective against bacteria in vivo. MATERIALS AND METHODS: Nine polymethylmethacrylate provisional restorations in human volunteers were evaluated after cementation with and without QPEI nanoparticles. Bacterial load in the provisional cement was assessed after 1 week of cementation. RESULTS: The number of colony-forming units in the cement with QPEI was significantly lower (P < .05) than in the control cement. CONCLUSION: The results of this in vivo study clearly indicate that provisional cement incorporating QPEI nanoparticles significantly reduces viable bacterial counts in the provisional cement in all patients.

Prosthetic rehabilitation of congenitally missing canines: a case series.

Hypodontia is a relatively common finding, although rarely are the canines the missing teeth. Congenitally missing canines are challenging to treat because of their unique role in the masticatory system and the fact that they are in the esthetic zone. This article discusses two patients with missing permanent canines, various treatment planning considerations, and the provided prosthetic solutions.

The temporomandibular opening index, report of headache and TMD, and implications for screening in general practice: an initial study.

OBJECTIVE: The cardinal signs and symptoms of temporomandibular disorder (TMD) are pain in joints and/or muscles, joint sounds, and limitation of movement. They are also associated with other complaints, one of which is headache. Myogenous TMD patients can be divided into those with a high and low temporomandibular opening index (TOI). These two subgroups appear to vary in several ways, including symptom severity. The objective was to assess the relationship between reported headache and TMD patients and a control group with no TMD and to compare the report of headache in high- and low-TOI myogenous TMD patients. METHOD AND MATERIALS: Sixty-six patients with TMD were included in the study. Fortythree were diagnosed with myogenous TMD, 23 with arthrogenous TMD, and 20 with no TMD were included as a control. Patients reported a history of headache using a four-point Verbal Rating Scale for both severity and frequency. Multiple logistic regression analysis was performed, after adjusting for confounders of sex and age. This helped investigate the association between the study groups and reported headache. Seventeen of the myogenous TMD patients were studied further. Seven were assigned to the high and 10 to the low-TOI group. Mean ages were 38.43 years and 33.00 years respectively. The Mann Whitney test was used to examine the difference in report of headache between these two groups. RESULTS: 76.7% of the myogenous group, 26.1% of the arthrogenous group, and 35% of the control group reported headache. Age and myogenous TMD were significantly associated with reported headache (P = .001 and .01, respectively). Myogenous TMD is a significant risk factor (OR = 5.20, P = .01) for reported headache while arthrogenous TMD is not (OR = 0.75, P = .69) A significant difference in report of headache between the two myogenous TMD groups was found (P = .0067). CONCLUSION: The risk for reported headache is 5.20-times greater for myogenous TMD patients compared to the control group, but no difference was noted between the arthrogenous TMD and the control group. Age serves as a mild protective for reported headache. Younger patients tend to report more headaches. More frequent and severe headache occurred in the high-TOI group. This study serves as a reminder for clinicians in general practice to consider the effect of comorbidity when faced with TMD patients with headache.

The temporomandibular opening index and condylar asymmetry in myogenous TMD and non-TMD patients: report of a pilot study.

OBJECTIVE: The temporomandibular opening index (TOI) is endfeel distance divided by active and passive mouth opening. The asymmetry index (AI) is a measure of difference in left and right condylar heights. This study examined the relationship between AI and TOI in myogenous TMD and non-TMD patients. METHOD AND MATERIALS: Fourteen myogenous TMD patients diagnosed by the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were recruited (1 man and 13 women) and 14 non-TMD patients (6 men and 8 women) were included as controls. Differences between the TMD patients and control group of non-TMD patients were determined by the two-tailed t test, while multiple linear regression analysis was used to examine the correlation between AI and TOI adjusting for sex and age. RESULTS: AI and TOI were significantly higher (P = .001 and P = .045, respectively) among TMD patients. A significant positive correlation was found between TOI and AI for the TMD group (r = 0.84, P = .01) but not for the control group. CONCLUSION: A positive correlation was found between TOI and AI in the myogenous TMD group.

Prospective clinical trial evaluating a new implant system for implant survival, implant stability and radiographic bone changes.

BACKGROUND: There are a few prospective studies reporting on new implant systems. When a new implant is brought to market, prospective trials should be carried out to determine the predictability of that system. PURPOSE: This prospective study evaluates implant survival, Resonance Frequency Analysis (RFA), and crestal bone level changes for a new implant system (Neoss System, Bimodal surface, Neoss Ltd, Harrogate, UK). MATERIALS AND METHODS: Seventy-six patients, 38 females (age ranging from 23 to 57 years) and 38 males (ranging in age from 17 to 85 years) received 100 Neoss implants. Patients were consecutively enrolled in the study if they were missing one or more teeth in either arch, or a single tooth was scheduled for removal and immediate implant replacement. Evaluated implants were 4, 4.5, or 5 mm wide and were 7, 9, 11, 13, or 15 mm long. A one-stage approach was followed. At first stage and prior to healing abutment placement RFA measurements were taken. Measurements were retaken at second stage. Fifty-one implants were placed for restoration of single missing teeth and 49 were for short span implant bridges. RESULTS: The cumulative survival rate at 1- to 2-year interval was 93%. Average initial RFA measurement for all implants was 72.06, while the average final score was 72.58. These changes were not statistically significant. Changes in RFA scores for maxillary implants were insignificant. Forty-two paired mandibular RFA measurements were evaluated. Initial and final mean mandibular RAF measurements were 73.65 (SD 9.203) and 77.186 (SD 6.177), respectively. These changes were statistically significant (p = .02). Sixty-four paired radiographs were available for evaluation. Between examinations, there was an average -0.6 mm of bone loss, which was statistically significant (p = .03). On average, 4.0-mm-wide implants lost 0.1 mm of bone when compared with 5-mm-wide implants. These differences were insignificant (p = .86). Bone loss was adjusted for implant length, and tooth position and there were small, but clinically insignificant changes. Five-millimeter-wide implants lose 0.2 mm more than 4.0-mm-wide implants (p = .7). Maxillary incisors lose the least amount of bone 0.152 (p = .33). CONCLUSIONS: The implants tested in this study had initially high RAF readings, indicating good primary stability. RFA readings for implants placed in the mandible improved from baseline and the changes were statistically significant. Marginal bone levels revealed clinically insignificant bone loss from implant installation to second stage. Loss of seven implants with initially high RFA readings is surprising.

Efficiency and thermal changes during implantoplasty in relation to bur type.

BACKGROUND: Implantoplasty is one of the options in treating peri-implantitis. The efficacy of the dental bur used can reduce the time needed for the procedure and, as a consequence, minimize the risk of overheating that can negatively affect the remaining bone surrounding the implant. PURPOSE: The aim of this study was to evaluate the efficacy of three dental burs in removing implant substance (titanium) and to determine the amount of heat generated by each bur. MATERIALS AND METHODS: Four burs with different surface properties (diamond, diamond - Premium Line, carbide, and smooth bur - control [Strauss Co., Raanana, Israel]) were attached to a high-speed handpiece and applied to a titanium implant for a total of 60 seconds after cooling by water spray. Variations in temperature were recorded every 5 seconds, and the amount of implant substance removed (reduction in weight of the implant) was evaluated. RESULTS: The diamond Premium Line bur removed 59.24 mg; carbide, 29.39 mg; diamond, 11.35 mg; and smooth bur (control) 0.19 mg, statistically significant. Only minimum thermal changes (∼1.5°C) were recorded for all four burs. CONCLUSIONS: There are considerable differences in efficiency of different burs working on titanium. Selecting the proper bur can reduce working time. Under proper cooling conditions, implantoplasty does not generate excess temperature increases that can damage soft tissue or bone surrounding the treated implant.

Existing concepts and a search for evidence: a review on implant occlusion.

The prevalence of dental implant treatment raises the question: What factors may challenge osseointegration? The dental literature presents two main approaches, which are well-documented: loss of bone around the implant due to infection and a presumed association between implant load and bone loss. This article discusses the effect of load or overload on the bone loss around dental implants. The dental literature is reviewed to assess the scientific evidence related to the effect of occlusal load on osseointegration. Recommendations found in the literature for occlusal schemes for implant-supported prostheses are examined and discussed, and statements regarding implant occlusion are assessed for their validity today, after more than four decades of implants service in prosthetic dentistry.

Colocação de implantes Mk IV em áreas ósseas comprometidas e com enxerto: resultados radiográficos em 61 sítios de 27 pacientes com acompanhamento longitudinal entre três e sete anos / Placement of brånemark mk IV implants in compromised and grafted bone: radiographic outcome of 61 sites in 27 patients with 3- to 7-year follow-ups

Objetivo: sítios onde osso é reduzido em altura ou qualidade criam desafios na reconstrução estética e no suporte para carregamento, gerando maior risco de falha. O sistema Mk IV com superfície TiUnite foi especialmente desenhado para colocação em osso macio. Este artigo descreve os resultados pós-carregamento de 103 implantes Mk IV, com ênfase na preservação óssea em sítios ósseos comprometidos durante remodelamento precoce, estabilidade e conexão do pilar, após três e sete anos de colocação dos implantes. Material e Métodos: uma série de 103 implantes Mk IV (4 mm de diâmetro, 10 mm de comprimento) foi colocada na maxila de 25 mulheres e 14 homens; 23 pacientes também receberam enxertos ósseos em etapas e dois passaram pelo aumento do alvéolo e enxertos. Áreas com infecções prévias foram preparadas mecanicamente e quimicamente. Para garantir estabilidade inicial primária, o tamanho da osteotomia e o número de entradas foi minimizado. Após um protocolo de carregamento tardio, todos os pacientes receberam próteses parciais fixas. Para análise da estabilidade óssea, os níveis ósseos marginais nos aspectos mesiais e distais foram mensurados com sete vezes de aumento por um radiologista envolvido no tratamento. Resultados: três implantes foram perdidos, um implante nunca foi carregado embora tivesse osseointegrado, 14 implantes não estavam disponíveis para acompanhamento após a conexão do pilar e cinco possuíam qualidade radiográfica inadequada. A perda óssea marginal entre a inserção do implante e o carregamento foi 1,21 ± 0,86 mm (n = 80). As diferenças nos níveis de remodelamento ósseo em sítios enxertados e não enxertados não foi significativa. Os dados foram relatados em 103 implantes em 39 pacientes consecutivos até a conexão do pilar, com acompanhamento radiográfico entre três e sete anos pós-colocação para 27 pacientes...

Forced eruption as an alternative to tooth extraction in long-term use of oral bisphosphonates: review, risks and technique.

BACKGROUND: Osteonecrosis of the jaw (ONJ) is a painful condition secondary to bisphosphonate (BP) therapy. It occurs at a much higher rate in patients receiving intravenous (IV) versus oral BP treatment. BPs are prescribed in the treatment of bone diseases such as osteoporosis, multiple myeloma, cancer metastases and Paget disease. Patients' risk of developing ONJ is of concern to medical and dental teams alike and requires open communication between the disciplines. If dental surgery is indicated, it must be performed before commencement of IV BP therapy, and it should be considered for patients receiving oral BP therapy. However, the dental literature pertaining to the two therapeutic modalities stresses the low risk of ONJ's developing in patients receiving oral BP therapy (especially in the early stages) compared with that in patients receiving IV administration. CASE DESCRIPTION: The authors used forced eruption to extrude hemisected hopeless distal roots of first and second mandibular molars from within their alveolar sockets in a patient receiving long-term oral BP therapy. Just before the extraction, they placed orthodontic separating bands around the distal roots to further exfoliate the roots. This so-called bloodless extraction is an alternative treatment for patients at risk of developing ONJ. CLINICAL IMPLICATIONS: The combination of orthodontic extrusion and bloodless extraction is aimed at minimizing trauma and enhancing the health of the surrounding tissues in patients at risk of developing ONJ or when the patient refuses to undergo conventional tooth extraction.

Reinforced composite restoration following trauma to a mandibular tooth: technique and follow-up treatment.

The loss of an entire tooth in the anterior region is accompanied by impairment of esthetics, function, phonetics, and self-esteem. It is common knowledge that treatment with implants during childhood or early adolescence is not an option. Splinting of adjacent teeth during growth and development may interfere with the independent process of teeth realignment and repositioning during that phase of life. Other creative solutions must be offered, such as free-standing composite buildup restorations on compromised broken teeth or single wing/cantilevered restorations adhered to one neighboring tooth during the growth period. The positive effects of reinforced composite materials were researched and presented in the literature. Their use is clearly indicated for interim and economical restorations. Long-term follow-up on a mandibular incisor that experienced trauma, losing its clinical crown and vitality when the patient was 12 years of age, is discussed with all the various aspects of material selection, future considerations, and long-term follow-up to adulthood, when a conventional crown was prepared and delivered.

Placement of Brånemark Mk IV implants in compromised and grafted bone: radiographic outcome of 61 sites in 27 patients with 3- to 7-year follow-ups.

OBJECTIVE: Sites in which bone is reduced in quality or height create challenges in esthetic reconstruction and loading support, which leads to a higher risk of failure. The Mk IV system with a TiUnite surface was designed specifically for placement in soft bone. This paper describes postloading outcomes of 103 Mk IV implants, with a focus on bone preservation in compromised bone sites during early remodeling, stability after abutment connection, and a 3- to 7-year follow-up from implant placement. METHOD AND MATERIALS: A series of 103 4-mm (diameter), ≤ 10-mm (length) Mk IV implants were placed in the maxillae of 25 females and 14 males. Twenty-three patients also received staged bone grafts, and two underwent socket augmentation as well as grafts. Areas of previous infection were prepared mechanically and chemically. To ensure primary implant stability, the size of the osteotomy and the number of entries were minimized. Following a delayed loading protocol, all patients were restored with fixed partial dentures. For analysis of bone stability, the marginal levels on the mesial and distal aspects of the implants were measured at 7x magnification by a radiologist not involved in the treatment. RESULTS: Three implants were lost, 1 implant was never loaded although it integrated, 14 implants were not available for follow-up after abutment correction, and 5 had poor-quality radiographs. The mean marginal bone loss between implant insertion and loading was 1.21 ± 0.86 mm (n = 80). The differences in bone-remodeling levels in grafted and nongrafted sites were not significant. Data are reported on 103 implants in 39 consecutive patients through abutment connection, with radiographic follow-up from 3 to 7 years postimplant placement on 27 patients. CONCLUSION: It is critical to ensure optimal three-dimensional orientation and minimize site preparation, particularly when placing implants in compromised bone. With bone of poor preoperative density using a customized site preparation technique, excellent short-term implant survival and long-term bone stability have been demonstrated. Further follow-up will determine whether the Mk IV implant is the optimal design for compromised bone, including associated soft tissue stability.

Gaining adequate interdental space with elastic separating rings against implants: a case series.

BACKGROUND: It is clinically challenging to place and restore an implant when the mesio-distal space is limited or reduced at the occlusal plane and/or the bone level. Placing implants in these cases while ignoring the clinical difficulties and compromising treatment could limit the successful outcome. Treatment options include strategic extractions, sectional orthodontics, and minor orthodontic movements. PURPOSE: To discuss the clinical problems and difficulties arising from limited edentulous mesio-distal space interdentally and to present a treatment modality and technique. MATERIALS AND METHODS: Orthodontic elastic separating rings are used to open interdental space between teeth and implants, exerting forces against implants for regaining the needed space and restoring implants with ease. RESULTS: The advantages of this technique are illustrated by clinical cases. CONCLUSIONS: Implants placed in limited interdental edentulous ridges may well assist in regaining lost spaces after loading. Neither an orthodontic background nor special instruments are required for this technique.

Optimising the dose of oral midazolam sedation for dental procedures in children: a prospective, randomised, and controlled study.

BACKGROUND: Midazolam sedation poses a significant dilemma in paediatric dentistry, which is to find out the optimal dosing with minimal undesirable adverse events. In this study, we aimed to compare the effect of three doses of oral midazolam (0.5, 0.75, and 1 mg/kg) on the sedative state and cooperative behaviour of children during dental treatment. We further compared completion rates, parent satisfaction, and all adverse events. DESIGN: Ninety children aged 3-10 years were randomised to three equal groups. Groups A, B, and C received 0.5, 0.75, and 1 mg/kg of oral midazolam, respectively. Levels of sedation, cooperative behaviour, procedures completion rates, parent satisfaction, and adverse events were prospectively recorded. RESULTS: Sedation scores in B and C were higher (P < 0.001) than in A. Cooperation scores (CS) in B and C were higher (P < 0.001) than in A. Significant increase in completion rates was observed between A and C (P = 0.025). Parent satisfaction was greater in B and C (P < 0.001) compared to A. Adverse events were higher in C (P < 0.05) than in A or B. CONCLUSION: Amount of 0.75 mg/kg oral midazolam appears to be the optimal oral dose in terms of effectiveness, acceptability, and safety for dental treatments in paediatric patients, when administered by an experienced, paediatric anaesthetist.

Is endodontic re-treatment mandatory for every relatively old temporary restoration? A narrative review.

OBJECTIVES AND BACKGROUND: In this review, the authors examine whether there is any decisive evidence to support the revision of root fillings that have been exposed to the oral environment for more than three months, undertaken solely because of suspicions of microleakage. Researchers in numerous endodontic studies have addressed the evaluation of coronal microleakage by using different tracers and techniques. The need to achieve a tight, permanent coronal seal as soon as possible after the completion of endodontic treatment is obvious. However, the clinical importance of microleakage studies recently has been questioned because of their wide range and even contradictory results, and findings from only a few clinical investigations have demonstrated a clear relationship between the endodontic success rate and failure rate owed to coronal microleakage in cases involving high-quality endodontic therapy. METHODS: The authors analyzed commonly cited articles regarding the clinical relevance of microleakage studies and the success rate of teeth with compromised restorations. CONCLUSIONS: In a review of the literature, the authors found no clear evidence to support immediate replacement of well-obturated endodontic treatment that has lasted more than three months solely because of suspicions of microleakage. It may be prudent in such cases to make a new coronal restoration immediately and to observe the tooth for at least three months before placing the permanent crown.