Versatility and Importance of Bichat's Fat Pad in Dentistry: Case Reports of Its Use in Occlusal Trauma.

INTRODUCTION: The knowledge of the anatomy surrounding Bichat's fat pad, as well as its clinical applications, is essential to indicate and to safely perform its removal. This surgery is indicated not only for esthetic purposes, but also for functional reasons. When used properly, Bichat's fat pad is composed of stem cells that have a similar phenotype to adipose stem cells, useful in the treatment of pathologies and/or complications, such as maxillary sinus membrane perforation, oroantral/oronasal communications, peri-implantitis, ulcers, fibrosis of the oral mucosa, soft tissue reconstruction, among others. Due to its location, it is prone to suffer clinically significant pathologies, as well as constant trauma. AIM: The aim of this study is to report two clinical cases and subsequent follow-ups, where bichectomy was performed to avoid dental trauma to mucosal tissues during the masticatory function. Also, literature review on the application of Bichat's fat pad in dentistry is provided. CASE REPORT: Two female patients (20 and 24 years) reported discomfort and constant pain in the oral mucosa caused by dental trauma. At the clinical examination, patient presented augmented and injured mucosa. The surgical sequence of Bichat's fat pad removal, as well as the extra-/intraoral photographic follow-up (8, 15, 30, and 180 days) of the patients is described. CONCLUSION: In order to indicate and/or accomplish surgical procedures involving Bichat's fat pad, it is fundamental to know its anatomy and possible applications, not only for esthetic purposes, but also for functional purposes. The patients showed evident improvements following the removal of Bichat's fat pad. CLINICAL SIGNIFICANCE: Application of Bichat's fat and its removal should be evaluated, being an alternative in patients who constantly undergo mucosal injury during masticatory function.

Complications of an Ageing Dentition Part 1: Occlusal Trauma and Cracked Teeth.

A growing problem in dentistry is complications associated with failing amalgam restorations that have been in place for many years. At present, there is a wide variety of treatment options available in the clinician's armamentarium when this situation arises, however, without the correct diagnosis, the prognosis for the tooth may quickly diminish, despite the clinician's best efforts. A confusing array of symptoms and failures may confound even the most experienced dentist, which will inevitably lead to invasive and time consuming approaches in a desperate attempt to rectify the initial problem. This paper, the first part of a three-part series, discusses the possible aetiological factors responsible for restoration failure, including occlusal issues and cracks within the tooth structure. The second part of the series will focus on restorative options and root-treated teeth. The third, and final, part of the series will provide an overview of the previous papers and conclude with a case report. Clinical relevance: Failure of amalgam restorations is a commonly encountered clinical problem in general practice and no one case presents in the same way. A competent diagnosis regarding the occlusion and tooth structure, followed with implementation of the most appropriate, minimally invasive treatment option, requires an adequate knowledge of current literature.

Teeth under High Occlusal Force may Reflect Occlusal Trauma-associated Periodontal Conditions in Subjects with Untreated Chronic Periodontitis.

OBJECTIVE: To determine the association of high occlusal force (HOF) with the signs of occlusal trauma and periodontal conditions in periodontitis patients, and elaborate the relevant clinical implications. METHODS: Periodontal parameters and signs of occlusal trauma were recorded for 807 teeth in 30 subjects with untreated chronic periodontitis. The T-scan II occlusal analysis system determined the HOF during maximum intercuspation, lateral excursion and protrusive excursion. The correlation of HOF with periodontal parameters and signs of occlusal trauma was analysed. RESULTS: Overall, the teeth with HOF existed mainly in molars and presented with deeper probing depth (PD) and higher frequency of bleeding on probing (BOP) than those without HOF. The fixed-effect analysis showed that HOF was positively correlated with PD and BOP (P < 0.05) in posterior teeth; widened periodontal ligament space on radiographs in upper (r = 0.179, P < 0.01) and lower posterior teeth (r = 0.205; P < 0.05); as well as functional mobility in upper posterior teeth (r = 0.168; P < 0.05). CONCLUSION: This study suggests that the posterior teeth with HOF in subjects with chronic periodontitis may reflect occlusal trauma-associated periodontal conditions that could probably increase the risk of further periodontal destruction. These findings may improve the clinical assessment of occlusal trauma and related periodontal conditions for better patient management and treatment outcomes.

Occlusal trauma and mucositis or peri-implantitis?

BACKGROUND AND OVERVIEW: The aim of this study was to describe the effects of bruxism in peri-implant bone loss 6 years after the placement of a successful implant-supported prosthesis, to describe its treatment, and to propose a differential diagnosis of the lesion. CASE DESCRIPTION: A 62-year-old, nonsmoking, systemically healthy partially edentulous woman received 2 osseointegrated implants in the mandibular left region, which supported a 3-element fixed prosthesis. Six years later, the patient reported the development of bruxism. Clinical examination results indicated bleeding on probing, deepening of the peri-implant sulcus, and marginal soft-tissue overgrowth. Radiographic images suggested peri-implant bone loss. The authors diagnosed the lesion as trauma from occlusion and mucositis. Treatment involved anti-infective therapy and the use of a bite platform, resulting in bone recovery after 10 months. These results were maintained for 4 years. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Considering the existing contradictions in the literature, this case highlights the role of trauma from occlusion in the onset, progression, and treatment of lesions produced by occlusal overload around osseointegrated implants. In addition, it provides clinical background on the outcomes of anti-infective therapy associated with the use of a bite platform in the treatment of combined lesions of mucositis and trauma from occlusion in osseointegrated implants.

Trauma oclusal: compreendendo a lesão / Occlusal trauma: understanding the injury

O termo “trauma oclusal” refere-se a uma “lesão” ou a um conjunto de alterações teciduais e estruturais promovidas por causas como interferências oclusais, bruxismo e apertamentos. Em outras palavras, a etiologia da lesão trauma oclusal é uma oclusão traumática resultante dessas interferências ou sobrecargas. Distinguir minuciosamente a “lesão” e sua causa faz parte de um pressuposto diagnóstico de tratamento seguro de determinadas situações patológicas, tal como deve ser com o trauma oclusal. Contribuir com o discernimento conceitual e prático entre a “lesão” trauma oclusal e sua etiopatogenia constitui o objetivo desse trabalho.

Increased vertical dimension of occlusion: signs, symptoms, diagnosis, treatment and options.

During the planning of oral rehabilitation, the vertical dimension of occlusion (VDO) is one of the first parameters to be measured since its improper restoration can lead to the failure of any prosthetic rehabilitation. A decreased VDO can lead to the appearance of lesions, such as angular cheilitis, facial disharmony, and temporomandibular disorders; meanwhile, an increased VDO may lead to the onset of joint and muscle pain, tension in functional speech, difficulty in swallowing, impaired chewing, tooth sensitivity due to traumatogenic forces, pathologic bone resorption, abnormal wearing of teeth, the appearance of an elongated face, and a facial expression of fatigue. Most scientific articles deal with methods and techniques for re-establishing VDO in edentulous patients or those who have lost their tooth reference due to prosthetic preparations. However, patients with increased VDO are also found in everyday practice. One treatment option for these patients is occlusal adjustment by selective tooth wear; it is still possible to perform orthodontic intrusion and/or orthognathic surgery in severe cases. The aim of this study was to discuss signs, symptoms, diagnosis, and treatment, and to report a clinical case of a patient with increased VDO.

Lateral lower lip piercing--prevalence of associated oral complications: a split-mouth cross-sectional study.

OBJECTIVE: To investigate via a split-mouth cross-sectional study the prevalence of gingival recessions associated with lateral lower lip piercing in a population obtained from a nondental setting. METHOD AND MATERIALS: A split-mouth study was performed in a sample of 47 patients with one lateral lower lip piercing. Teeth in direct contact with the intraoral closure of the stud were defined as test teeth; contralateral teeth were selected as controls. Clinical examination included full-mouth plaque and bleeding indices, probing depth, recession, clinical attachment level, periodontal biotype, evaluation of hard tissues, occlusal trauma, stud characteristics, and mucosal inspection and palpation. RESULTS: Midbuccal recession was noted in four test teeth compared with one control tooth (8.5% and 2.1%, respectively; P = .250). The canine and first premolars were the most affected. Tooth chipping occurred in one test tooth and no control teeth. Plaque levels were significantly higher in test than control teeth (P < .001). CONCLUSION: Lateral lower lip piercing is associated with significantly higher plaque accumulation on adjacent teeth. A small percentage of lateral lower lip piercings may cause tooth chipping or buccal recession in adjacent teeth.

A systematic approach to recreate a patient's former smile.

In this case involving a 29-year-old woman with a history of stomach-acid-related reflux and extensive loss of tooth structure, the patient desired to regain the smile she "used to have." The treatment goals throughout the process were to manage risk, use minimally invasive procedures, and improve the prognosis in each of the four dental categories-periodontal, biomechanical, functional, and dentofacial. The treatment plan utilized a systematic approach to sequentially restore and protect the young woman's dentition. It included esthetic crown lengthening, establishing the ideal esthetic position of maxillary anterior and posterior teeth, addressing the mandibular plane of occlusion, and achieving optimal function.

Tooth surface loss: tools and tips for management.

UNLABELLED: Tooth surface loss is becoming increasingly prevalent. Many cases can be managed with preventive measures, although there remain a number of patients for whom restorative intervention is indicated. Traditional treatment modalities have entailed extensive 'full-mouth' indirect restoration, although this approach has a number of disadvantages. Contemporary restorative techniques allow for a broader range of treatment options: this paper presents an overview of common issues and clinical techniques to overcome these. CLINICAL RELEVANCE: Treatment options and guidance for managing patients who present with tooth surface loss.

Non-carious cervical lesions and occlusion: a systematic review of clinical studies.

Non-carious cervical lesions (NCCLs) are a group of lesions that affect the cervical area of the teeth. Different aetiological factors have been reported, among them tooth brushing force, erosive agents and occlusal forces. The aim of this study was to ascertain, by means of a systematic review, the association between NCCLs and occlusion. A search was performed in the MEDLINE database, retrieving a total of 286 articles. After title and abstract screening, the clinical investigations were read in full to select those that evaluated the occlusal aspects of NCCL aetiology. This systematic review describes the results of three prospective and 25 cross-sectional studies. As there is an extreme heterogeneity in design, diagnostic criteria, forms of analysis and associated factors, a meta-analysis was not possible. The wide variety of classification and diagnostic criteria reflects a high range of reported prevalence. An extensive heterogeneity of independent variables was noted, even in occlusal analysis, which helps to mask any conclusion about the role of occlusion in NCCL aetiology. The literature reveals that studies on this topic are subject to a substantial amount of bias, such as evaluation (use of non-blinded examiners) and confounding bias (no control of others aetiological factors). Up to now, it has been impossible to associate NCCLs with any specific causal agent, and the role of occlusion in the pathogenesis of non-carious cervical lesions seems as yet undetermined. Therefore, additional studies, properly designed to diminish bias, are warranted.

[Prosthetic rehabilitation of a traumatic occlusion due to bulimia nervosa. Case report]. / Prothetische Rehabilitation eines durch Bulimia nervosa beeinträchtigten Erosionsgebisses. Ein Fallbericht.

Because of the typical localisation of erosions in anorectic/bulimic patients, the dentist is frequently the first medical person to discern this general illness (anorexia and bulimia nervosa). From the dental viewpoint, the aim should be to preserve sound dental tissue and to prevent further toothwear. A restorative treatment is to be carried out only after causal therapy and after resolving the basic disease. By means of this procedure a good long-term prognosis can be expected. Considering the patient's young age, dentistry should be preservative using the adhesive technique. This case report documents the systematic procedure of the functional and esthetic rehabilitation of an eroded dentition and shows factors essential to the treatment.

A combined prosthodontic and orthodontic treatment approach in a case of growth inhibition induced by dental implants: a case report.

Functional and esthetic results can improve significantly when a combined prosthodontic-orthodontic treatment approach is employed in cases requiring extensive oral rehabilitation. The patient presented in this case report was treated in his late teens with dental implants as a replacement for his maxillary incisors. Ten years later, the entire maxillary anterior segment was in infraocclusion compared to the rest of the dentition and lip line. Since prosthodontic follow-up treatment alone could not achieve an optimal functional and esthetic outcome, the patient was treated orthodontically prior to renewing the restoration. A fixed appliance was used to intrude the mandibular anterior teeth as well as vertically align the infrapositioned maxillary lateral incisors.

Longitudinal changes in tooth/single-implant relationship and bone topography: an 8-year retrospective analysis.

PURPOSE: To evaluate longitudinal changes in tooth/implant relationship and bone topography at single implants with a microthreaded, conical marginal portion (Astra Tech ST® implants, Astra Tech AB, Mölndal, Sweden). MATERIAL AND METHODS: Thirty-one subjects with single implant-supported restorations in the esthetic zone were included. Radiographs obtained at crown installation and 1, 5, and 8 years of follow-up were analyzed with regard to changes in (1) bone level at the implant and adjacent teeth and (2) vertical position of adjacent teeth relative to the single implant. RESULTS: The mean marginal bone loss amounted to 0.1 mm at both implants and adjacent teeth during the 8 years of follow-up. Regression analysis failed to identify significant explanatory factors for observed variance in bone level change at the adjacent tooth surfaces. Vertical change in position of the teeth relative to the implants was more frequent and significantly greater in incisor compared with premolar tooth region but not associated with gender or age. CONCLUSIONS: The marginal bone level at teeth adjacent to single implants with a microthreaded conical marginal part was not influenced by horizontal and vertical tooth-implant distances. Continuous eruption of adjacent teeth may result in infraocclusal positioning of a single-implant restoration.

Combination syndrome symptomatology and treatment.

Combination syndrome (CS) is one of the most fascinating oral conditions yet is poorly understood and underappreciated in the literature and clinical practice. This article reviews the most important literature on this subject and analyzes the etiology, symptomatology, diagnosis, and current therapeutic modalities for treatment in an attempt to better understand CS. The syndrome represents an example ofa complex pathologic condition of the entire stomatognathic system with a multitude of hard-tissue, soft-tissue, and occlusal changes. These changes, initiated by a certain sequence of events, beginning with a prolonged period of tooth loss, can lead to severe bone atrophy in different regions of the jaws, loss of masticatory function, and the need for complex treatment. Implant rehabilitation of these patients in a preventative approach with cooperation of the entire dental team is emphasized.

Traumatic dental injuries to primary incisors and the terminal or occlusal plane relationship in Indian preschool children.

OBJECTIVE: To determine the prevalence of traumatic dental injuries to primary incisors in 3-5 year-old preschool children and to study the relationship between dental injuries and age, gender and terminal plane relation. BASIC RESEARCH DESIGN: A cross-sectional study was conducted in 1,126 preschool children aged three to five years enrolled in eleven private and public nursery schools, randomly selected in Chennai, India. METHOD: Data regarding the age, gender, cause and type of trauma and terminal plane relation were recorded. Maxillary and mandibular primary incisors were examined for traumatic injuries and were recorded according to the method described by Andreasen & Andreasen (1994). Data were analyzed through descriptive analysis and chi-square test. RESULTS: Traumatic injuries to primary incisors were identified in 6.2% of children. No significant gender differences in prevalence were seen (p > 0.05). Enamel fractures (57.3%) dominated amongst the type of injuries. Majority of children who sustained traumatic dental injuries to their primary incisors were associated with mesial step molar relation. CONCLUSION: Mesial step molar relation may be considered one of the possible predisposing factors to trauma in primary dentition. Further, there is need to intensify oral health education targeted at both parents and teachers at nursery schools to inform them about consequences of primary teeth injuries on permanent dentition and emphasize the importance of prevention of dental injuries in children.

Ankylosis of permanent first molars: genetics or environment? A case report of a discordant twin pair.

The rare condition of secondary retention has been reported in the literature as being of genetic origin, with some authors suggesting an autosomal dominant pattern. We report the unusual case of two monozygotic biamniotic, bichorionic male twins, who were discordant for permanent first molar secondary retention, involving ankylosis. Twin A showed normal occlusion and eruption patterns, whereas Twin B displayed a left open bite, in relation with a totally submerged primary second molar leading to retention of the underlying premolar (35), and severe infraocclusion of the adjacent permanent molar (36). After orthodontic failure to close the open bite, ankylosis of 36 was confirmed, whereas 26 became severely infraoccluded.The mother had a history of bilateral molar ankylosis and presented reduced posterior alveolar height. Discordance in this twin pair demonstrates that environmental influences, in addition to epigenetic and local factors, may play a role in secondary retention, which is difficult to diagnose and challenging to treat.

Effect of experimental jaw muscle pain on occlusal contacts.

The aim of the study was measuring the effect of experimental jaw muscle pain on number and position of posterior occlusal contacts. Eleven adult voluntary subjects were enrolled. A lower impression was taken for each subject and two dental casts were obtained from each impression. The study was carried out in a randomised cross-over fashion. Each subject participated in two experimental sessions (30-day interval) in which he/she received an injection in the central part of the right masseter muscle consisting of 0·5 mL of either hypertonic or isotonic saline. Each subject was asked to rate pain intensity on a visual analogue scale. Three occlusal bite checks (polyvinylsiloxane) at the maximal intercuspal position were obtained during the experimental session: the first before the injection, the second between 60 and 90 s after the injection and the third 15 min after the injection. Evaluation of contacts was performed on dental casts with the use of different colours (black for baseline, red for intermediate and green for final contacts). Repeated-measures analysis of variance was used to compare the overall number of contacts among groups and the number of contacts of different colours. No significant difference was found between the overall number of occlusal contacts (P>0·05), but significant differences were found between contacts according to different colours: confirmed (P=0·006), disappeared (P=0·007) and new (P<0·001). Assuming different colours as change in contact position, the overall number of contacts did not change, but the position did. Experimentally induced jaw muscle pain affected the pattern of posterior occlusal contacts.

[Does the combination syndrome exist? A case report]. / Existiert das Kombinationssyndrom? Ein Fallbericht.

This case report documents the prosthetic rehabilitation of a patient showing the typical features of combination syndrome. This case documentation gives a general overview of the suspected development and the prevalence of this "syndrome". A treatment option should be shown by the example of a patient from the starting situation until the prosthetic therapy by means of a complete maxillary denture and an implant-supported mandibular overdenture rigidly retained with a milled bar.