Evaluation of Impacting Factors on Facial Bone Thickness in the Anterior Maxillary Region.

BACKGROUND: The goal of the current study was to measure the width of the labial alveolar bone of the overlying maxillary anterior teeth, based on cone-beam computed tomography (CBCT) images, and the distance between cementoenamel junction (CEJ) and bone crest in adult patients. METHODS: A cross-sectional study was performed using a sample of 132 tomographic scans. Intact maxillary anterior with healthy periodontium and teeth was randomly selected and afterwards assessed by 2 calibrated and independent reviewers. RESULT: The average bone thickness at 2 mm from the CEJ of the maxillary right central incisors was 0.63 ±â€Š0.69 mm and over the maxillary left central incisors was 0.59 ±â€Š0.71 mm. Moreover on the right and left lateral maxillary incisors, the crestal bone width averaged 0.64 ±â€Š0.81 and 0.61 ±â€Š0.7 mm, respectively. Concerning the maxillary canine region on both sides, the crestal bone thickness averaged 0.72 ±â€Š0.9 and 0.66 ±â€Š0.69 mm, in the maxillary right and left the canine regions, respectively. Furthermore, according to the gender and systemic disease, there were some recognizable differences in the facial bone thickness between the left and the right side. CONCLUSIONS: The current study has advocated the outcome of a mostly thin buccal bone overlying the maxillary anterior teeth; hence, clinicians should always consider the thickness of the facial cortical plate of the extraction site and the positioning of the implant placement in the socket.

Autogenous Tooth Fragment Adhesive Reattachment for a Complicated Crown Root Fracture: Two Interdisciplinary Case Reports.

Trauma of anterior teeth is quite a common occurrence in both children and adults. Various degrees of trauma leading to fracture may affect teeth in different ways depending on the age of the patient and extent of fracture and other factors that will be discussed. Guidelines have been given as to how each of these situations should be treated. In the past, often more aggressive restorations were performed to restore fractured teeth. However improved and more efficient adhesion may affect the type of treatment we decide to carry out, leading to more conservative therapies through an increased preservation of tooth structures.

Gummy Smile and Short Tooth Syndrome - Part 2: Periodontal Surgical Approaches in Interdisciplinary Treatment.

One of the most frequent causes of gummy smile is an altered eruption, ie, the gingival margins are located at a more coronal position than normal. These cases can be successfully treated with a periodontal surgical approach. Several techniques may be used, depending on the different anatomic variations. The surgery must be carefully planned so as to avoid discrepancies between the soft tissues and the teeth. Clinical examination and radiographic evaluation will allow clinicians to determine the position of the gingival margin, bone crest, and cemento-enamel junction and thus elicit a correct diagnosis of the subtype of altered eruption. The periodontist will need to consider these factors in order to obtain a satisfactory outcome, especially in multidisciplinary cases.

Gummy Smile and Short Tooth Syndrome--Part 1: Etiopathogenesis, Classification, and Diagnostic Guidelines.

Treating patients with "gummy smiles" and improving smile esthetics has become an integral part of dentistry. It is necessary to conduct an accurate diagnosis of what may be multiple causes that coexist simultaneously. Though all causes may not be resolved following treatment, they should be identified; otherwise it might not be possible to conduct an adequate order of treatment, which could involve multidisciplinary collaboration between various dental specialists, and may lead to unexpected and unacceptable final results. The authors propose a complete adult classification of the causes identified for gummy smile (GS) and short tooth syndrome (STS) to ascertain the etiopathogenetic origin(s). Used in combination with the proposed diagnostic procedure, which involves an "outside-in" evaluation of the patient, the classification system will enable clinicians to provide patients an accurate prediction of final results and determine the treatment required.

Relationship Between Biotype and Bone Morphology in the Lower Anterior Mandible: An Observational Study.

BACKGROUND: Different clinical parameters have been advocated as potential predictors of alveolar and basal jawbone morphology. The aim of this study is to describe, by tomographic means, alveolar and basal osseous dimensions of the anterior mandible in healthy individuals and evaluate potential correlations with biotype, along with other clinical parameters. METHODS: One hundred consecutive healthy patients needing surgery in the posterior mandible were enrolled in this observational study (group 1 = 50 patients with thin biotype; group 2 = 50 patients with thick biotype). Data were collected for: 1) Little irregularity index for anterior crowding; 2) molar and canine class relationship; 3) previous orthodontic treatment; 4) gingival recession; and 5) band of keratinized gingiva for each of the six anterior mandibular teeth (#22 through #27). At the most mid-buccal computerized tomography slice of each tooth, other parameters were measured, including: 1) distance from the cemento-enamel junction to the bone crest; 2) tooth torque (TT); 3) labial cortical bone thickness (BT) for alveolar and basal bone; and 4) BT 5 and 10 mm apical to the tooth apex. Data were statistically analyzed, and significance was set at P ≤0.05. RESULTS: Mean thickness of alveolar bone ranged from 6.66 to 4.51 mm (standard deviation [SD] = 1.46 for tooth #27; SD = 1.01 for tooth #25) whereas mean thickness of basal bone ranged from 8.9 to 8.2 mm (SD = 2.06 for tooth #22; SD = 2.06 for tooth #26). Mean thickness of bone at 5 mm from apex ranged from 11.94 to 10.47 mm (SD = 2.96 for tooth #25; SD = 2.22 for tooth #22), whereas mean thickness of bone at 10 mm from apex ranged from 13.75 to 11.08 mm (SD = 2.79 for tooth #25; SD = 2.53 for tooth #27). No statistically significant differences were detected among biotypes, whereas: 1) TT, 2) age, and 3) smoking habit were often predictors of reduction in BT in a multiple linear regression model. Male sex was often a predictor of positive changes in BT, and previous orthodontic therapy was a protective factor against developing bone loss >5 mm. CONCLUSIONS: Although some differences were detected among biotypes, data indicate that biotype does not play a fundamental role in influencing alveolar BT, whereas other variables (i.e., TT, sex, age, and smoking habit) do influence alveolar BT. Further studies are needed to better understand the extent of influence of each clinical variable.

Soft and Hard Tissue Management in Implant Therapy-Part II: Prosthetic Concepts.

The ongoing pursuit of aesthetic excellence in the field of implant therapy has incorporated prosthetic concepts in the early treatment-planning phase, as well as the previously discussed surgical concepts. The literature has addressed these prosthetic and laboratory approaches required to enhance and perfect the soft and hard tissue management (SHTM). After surgically providing an acceptable hard tissue architecture and adequate timing of loading of the implant, the prosthetic phase is responsible for the soft tissue modeling, through correctly planned and executed procedures, which induce a satisfactory soft tissue profile by considering the microvasculature, the abutment connection and positioning, and the implementation of an adequate provisional phase. The objectives are the modeling of the soft tissues through the use of a conforming periorestorative interface which will produce desired and stable results.

Soft and hard tissue management in implant therapy-part I: surgical concepts.

Implant therapy has become a reliable and predictable treatment alternative for the replacement of missing teeth with conventional removable and fixed partial dentures. Recently though, in the pursuit for improved esthetics, the literature has dedicated a considerable amount of its research on the successful maintenance and regeneration of the surrounding gingiva and bone, which are lost following extraction of a tooth. Thoroughly analyzing the anatomic situation and well-planned treatment has become a requirement, because incorrectly planned and positioned implants may jeopardize long-term esthetic and functional prognosis. In addition, many types of biocompatible materials, autogenous hard and soft tissue grafts, and different surgical techniques have been developed, and their viability has been investigated. As a result, implant specialists have gained a greater understanding of the dynamics and anatomical and biological concepts of the periodontium and peri-implant tissues both at the surgical and prosthetic phases of treatment, which contributes to better soft and hard tissue management (SHTM). This may further contribute to achieving a superior final result which is obtained by having a harmonious soft tissue profile, a correctly placed and contoured final restoration, and the reestablishment of masticatory function and phonetics.

The thickness of facial alveolar bone overlying healthy maxillary anterior teeth.

BACKGROUND: A facial bone (<2 mm) overlying maxillary anterior teeth may be prone to resorptive processes after extraction and immediate implant placement. A thin bone contributes to risk of bone fenestration, dehiscence, and soft-tissue recession. This study measures the distance between the cemento-enamel junction (CEJ) and alveolar bone crest and the thickness of facial alveolar bone at points 1 to 5 mm from the bone crest for the six maxillary anterior teeth. METHODS: Sixty-six tomographic scans (31 males and 35 females; aged 17 to 69 years; mean age: 39.9 years) of intact anterior maxilla were randomly selected and evaluated by two calibrated and independent examiners (MG and TP). RESULTS: A high variation of CEJ-bone crest (0.8 to 7.2 mm) was detected. A significantly larger CEJ-bone crest was measured in smokers (P <0.05) and patients who were ≥50 years old (P <0.05). The average bone thickness at 3 mm from the CEJ for the maxillary right central incisor was 1.41 mm and for the maxillary left central incisor was 1.45 mm. For the maxillary right and left lateral incisors, the crestal bone thickness averaged 1.73 and 1.59 mm, respectively. For the maxillary right and left canines, the crestal bone thickness averaged 1.47 and 1.60 mm, respectively. CONCLUSIONS: The present study supports the finding of a predominantly thin facial bone overlying the six maxillary anterior teeth. Therefore, it is essential to make informed treatment decisions based on thorough site evaluation before immediate implant placement.