Early extraction of the first permanent molars: a five-year follow-up study.

AIM: Early extraction of first permanent molars (FPMs) is generally considered successful when the second permanent molar and premolar come into contact, regardless of whether the patient has a healthy occlusion. In this study, we aimed to investigate cases in which early extraction had a successful prognosis. METHODS: Study design: Pre-extraction orthopantomograms of children whose one or more FPMs were extracted were examined retrospectively. Post-extraction parameters such as status of the extraction gap, any other diastema formation, and midline shift were evaluated clinically and radiographically. For the dental age estimations, development levels of the teeth were scored using the Demirjian method and the developmental status of a particular tooth was calculated in years based on tables given by Willems et al. [2001]. The ICON index was used to determine the orthodontic treatment needs of patients. STATISTICS: Descriptive analyses and the Kruskal-Wallis test were used for the statistical analysis of the data. CONCLUSION: Early extraction of FPM should be considered successful when there is no formation of any other diastema in the relevant quadrant, midline shift, or orthodontic treatment needs due to extraction.

Pathological tooth migration-spontaneous correction of diastema after surgical periodontal therapy: a case report.

A common consequence of moderate to extreme periodontitis is pathologic migration. This denotes tooth movement when the periodontal disease interjects the equilibrium among the elements that preserve physiological tooth position. The balancing factors can migrate the teeth in any direction. The etiology of pathological migration tends to be multifactorial, thus achieving early diagnosis is imperative, which will ultimately lead to the prompt removal of the etiological factors while avoiding severe bone destruction. In this case maxillary central incisors had diastema due to pathological migration with mobility grade I in maxillary left central incisor. Many cases of moderate to severe pathological migration need a suitable, interdisciplinary approach. Nevertheless, since it is possible to detect mild cases of Pathological tooth migration (PTM) at an early stage, spontaneous correction of migrated teeth can be accomplished by periodontal therapy alone. Regardless of the treatment selected, maintenance of stable results should be considered as an aim of treatment.

Association between superior labial frenum and maxillary midline diastema - a systematic review.

BACKGROUND: Pediatric otolaryngologists have seen an increased focus on upper lip frenum as a possible culprit for feeding difficulties and the development of maxillary midline diastema (MMD). This increase may be encouraged by parents' exposure to medical advice over the internet about breastfeeding and potential long-term aesthetic concerns for their children. Subsequently, there has been increased pressure on pediatric otolaryngologists to perform superior labial frenectomies. There has been a reported 10-fold increase in frenectomies since the year 2000. However, there is no consensus within the literature regarding the benefit of superior labial frenectomy in preventing midline diastema. OBJECTIVE: To provide physicians and parents with the most updated information by systematically reviewing the available literature for the association between superior labial frenum and midline diastema. METHODS: A literature search was performed in MEDLINE (PubMed), EMBASE, Web of Science, the Cochrane Library and Dental and Oral Sciences Source (DOSS). Using the Covidence platform, a systematic review was conducted. The initial 314 articles identified underwent systematic review and 11 studies were included in the final review. RESULTS/DISCUSSION: Available data, primarily from the dental literature, showed that two subtypes of frenum: papillary and papillary penetrating frenum, are associated with maxillary midline diastema. Superior labial frenectomy should be delayed until permanent lateral incisors have erupted, as this can spontaneously close the physiological MMD. Current literature recommends against frenectomy before addressing the diastema with orthodontics, which helps to prevent diastema relapse. It is also imperative to rule out other odontogenic and oral cavity causes of diastema, such as thumb sucking, dental agenesis, and other causes. Online information may not always be fully representative and should be interpreted in the full context of the patient's medical history before referral for surgical intervention.

Arch parameters and dental discrepancy (crowding and spacing) in a sample of an Afro-Colombian population.

The aim of this study was to determine the differences in arch length, inter-canine distance, inter-premolar distance, intermolar distance and arch shape between dental discrepancies (crowding and spacing) in a sample of dental casts from the Afro-Colombian population of San Basilio de Palenque. An analytical, cross-sectional study was conducted on a convenience sample of 63 subjects aged 11 to 57years, of Afro-Colombian origin, with full dentition from first molar to first molar, without extensive caries or restorations, and excluding casts with defects due to loss. The differences between arch (upper and lower) variables were analyzed according to dental discrepancies. Plaster models digitalized with a TR1OS3 Mono scanner with exactitude (6.9 ± 0.9 pm) and precision (4.5 ± 0.9 pm) were analyzed with Orthonalyzer software. Statistical analyses were done on SPSS software (Version 20 for Windows) and Real Statistics. Spacing discrepancy of68.25% was found for upper arch and 66.66% for lower arch; crowding discrepancy of 19.04% for upper arch and 20.63% for lower arch, and an adequate ratio of 12.69% for both arches. No statistically significant difference (p>0.05) was found between arch parameters except for inter-premolar distance on the lower arch. The most frequent arch shape in the population was oval for both upper arch, with 76.19%, and lower arch, with 71.42%. Tooth size was larger in males than females but the difference was not statistically significant.

El objetivo de este estudio fue determinar las diferencias en longitud de arco, distancia intercanina, interpremolar, intermolar y la forma de arco entre discrepancias dentales (apiñamiento y espaciamiento), en una muestra de modelos dentales de la población afrocolombiana de San Basilio de Palenque. Se realizó un estudio analítico transversal, en una muestra por conveniencia de 63 sujetos con un rango de edad entre 11 y 57 años, de origen afrocolombiano, quienes tuvieron dentición completa de primer molar a primer molar, sin caries extensas, ni restauraciones; se excluyeron los modelos con defectos por el vaciado. Se analizaron las diferencias entre las variables de los maxilares (superior e inferior) con las discrepancias dentales. Se utilizaron modelos de yeso que fueron digitalizados con el escánerTR1OS3 Mono con una exactitud de (6.9 ± 0.9 pm) y una precisión de (4.5 ± 0.9 pm)y analizados con el software Orthonalyzer. Los análisis estadísticos se llevaron a cabo utilizando el software SPSS (Versión 20 para Windows) y Real Statistics. Se encontró una discrepancia de espaciamiento de un 68,25% para el arco superior y 66,66% en el arco inferior; y una discrepancia de apiñamiento en el arco superior de 19,04% e inferior de 20,63% y una relación adecuada de 12,69% para los dos arcos. No se encontraron diferencias estadísticamente significativas (p>0.05) en los parámetros de arco a excepción de la distancia interpremolar del arco inferior. La forma de arco más frecuente en la población fue ovalada tanto en el arco superior con un 76,19% como en el arco inferior con un 71,42%. En cuanto al tamaño dental, se presentó mayor tamaño en los hombres que en las mujeres, pero este no fue estadísticamente significativo.

Arch parameters and dental discrepancy (crowding and spacing) in a sample of an Afro-Colombian population / Parámetros de arco y discrepancia dental (apiñamiento y espaciamiento) en una muestra de población Afrocolombiana

The aim of this study was to determine the differences in arch length, inter-canine distance, inter-premolar distance, intermolar distance and arch shape between dental discrepancies (crowding and spacing) in a sample of dental casts from the Afro-Colombian population of San Basilio de Palenque. An analytical, cross-sectional study was conducted on a convenience sample of 63 subjects aged 11 to 57years, of Afro-Colombian origin, with full dentition from first molar to first molar, without extensive caries or restorations, and excluding casts with defects due to loss. The differences between arch (upper and lower) variables were analyzed according to dental discrepancies. Plaster models digitalized with a TR1OS3 Mono scanner with exactitude (6.9 ± 0.9 pm) and precision (4.5 ± 0.9 pm) were analyzed with Orthonalyzer software. Statistical analyses were done on SPSS software (Version 20 for Windows) and Real Statistics. Spacing discrepancy of68.25% was found for upper arch and 66.66% for lower arch; crowding discrepancy of 19.04% for upper arch and 20.63% for lower arch, and an adequate ratio of 12.69% for both arches. No statistically significant difference (p>0.05) was found between arch parameters except for inter-premolar distance on the lower arch. The most frequent arch shape in the population was oval for both upper arch, with 76.19%, and lower arch, with 71.42%. Tooth size was larger in males than females but the difference was not statistically significant.

El objetivo de este estudio fue determinar las diferencias en longitud de arco, distancia intercanina, interpremolar, intermolar y la forma de arco entre discrepancias dentales (apiñamiento y espaciamiento), en una muestra de modelos dentales de la población afrocolombiana de San Basilio de Palenque. Se realizó un estudio analítico transversal, en una muestra por conveniencia de 63 sujetos con un rango de edad entre 11 y 57 años, de origen afrocolombiano, quienes tuvieron dentición completa de primer molar a primer molar, sin caries extensas, ni restauraciones; se excluyeron los modelos con defectos por el vaciado. Se analizaron las diferencias entre las variables de los maxilares (superior e inferior) con las discrepancias dentales. Se utilizaron modelos de yeso que fueron digitalizados con el escánerTR1OS3 Mono con una exactitud de (6.9 ± 0.9 pm) y una precisión de (4.5 ± 0.9 pm)y analizados con el software Orthonalyzer. Los análisis estadísticos se llevaron a cabo utilizando el software SPSS (Versión 20 para Windows) y Real Statistics. Se encontró una discrepancia de espaciamiento de un 68,25% para el arco superior y 66,66% en el arco inferior; y una discrepancia de apiñamiento en el arco superior de 19,04% e inferior de 20,63% y una relación adecuada de 12,69% para los dos arcos. No se encontraron diferencias estadísticamente significativas (p>0.05) en los parámetros de arco a excepción de la distancia interpremolar del arco inferior. La forma de arco más frecuente en la población fue ovalada tanto en el arco superior con un 76,19% como en el arco inferior con un 71,42%. En cuanto al tamaño dental, se presentó mayor tamaño en los hombres que en las mujeres, pero este no fue estadísticamente significativo.

Dental anomalies and orthodontic characteristics in patients with pseudohypoparathyroidism.

BACKGROUND: Pseudohypoparathyroidism (PHP) is a rare and inherited disease caused by mutations in the GNAS-gene or upstream of the GNAS complex locus. It is characterized by end-organ resistance to PTH, resulting in hypocalcemia and hyperphosphatemia. We aimed to investigate the dental anomalies according to tooth types and the orthodontic characteristics of patients with PHP. METHODS: Using a cross-sectional design, 29 patients (23 females) with PHP, living in Denmark, were included, and their clinical intraoral photos and radiographs were examined. RESULTS: Pulp calcification was found in 76% of the patients. Blunting of root apex was present in 55% and shortening of root in 48% of the examined patients. Blunting and shortening of roots were seen more often in premolars than in other tooth types (pboth < 0.01). Crowding of lower anterior teeth was frequently observed (36%) as well as diastema in the upper arch (25%), midline diastema (18%), and Class III malocclusion (11%). CONCLUSION: In the present study population, the teeth were frequently affected by pulp calcification and/or deviation of the root morphology. Blunting and shortening of root(s) were more often seen in premolars than in other tooth types. Class III malocclusion was relatively prevalent. It is important to pay attention to dental anomalies and occlusion in order to provide adequate care for patients with PHP.

Management of the Maxillary Diastema by Various Dental Specialties.

PURPOSE: There is considerable controversy in the literature concerning the indications for frenectomy for treating a maxillary diastema and for timing of the procedure. The purpose of this study was to survey pediatric dentists, orthodontists, and oral and maxillofacial surgeons on their opinion of this matter to develop a consensus. MATERIALS AND METHODS: An anonymous 7-item electronic questionnaire was sent to members of the American Academy of Pediatric Dentists, the American Association of Orthodontists, and the American Association of Oral and Maxillofacial Surgeons asking about the etiology of the maxillary diastema, its diagnosis, and treatment. RESULTS: Although there was no agreement among the oral and maxillofacial surgeons for the timing of frenectomy and when the diastema should be closed, the pediatric dentists and orthodontists generally agreed that frenectomy should not be performed before the permanent canines are erupted and that the operation should follow orthodontic closure of the space. CONCLUSION: Although there was no complete consensus among the 3 groups, a logical treatment approach for the maxillary diastema is proposed.

Oral manifestations in children with mucopolysaccharidosis / Manifestações orais de mucopolissacaridose em crianças

BACKGROUND: Patients with mucopolysaccharidosis have several changes of the stomatognathic complex, representing a challenge for dentists. OBJECTIVE: The study aimed to evaluate and characterize oral health in patients with mucopolysaccharidosis in a reference center of Portugal. METHOD: The sample consisted of twelve participants with mucopolysaccharidosis followed in Metabolic Diseases Unit of the S. João Hospital Centre and twelve healthy participants followed at Faculty of Dental Medicine, University of Porto. The clinical oral evaluation was performed by a complete extra-oral and intra-oral examination to assess the presence of oral pathologies, gingival index and occlusion status. RESULTS: Mucoplysaccaridosis patients and controls presented similar age ranges and sex distribution. In comparison to controls, children with mucopolysaccharidosis presented a higher prevalence of tooth decay, gingival bleeding, macroglossia, dental hypoplasia, lingual interposition, delayed tooth eruption, anterior open bite, right and left posterior cross-bite, limitation of mouth opening, alteration on the size and shape of the teeth, diastemata and maxillary compression. CONCLUSIONS: Patients with mucopolysaccharidosis have a high prevalence eruption delay, teeth morphology alterations, occlusal problems, dental caries and bleeding gums, highlighting the need of oral health care providers to improve diagnostics and preventive protocols to overcome the factors that limit the oral health of these patients and promote together with parent/caregiver efficient oral care strategies.

INFORMAÇÕES GERAIS: Os pacientes com mucopolissacaridose apresentam diversas alterações do complexo estomatognático, representando um desafio para os médicos dentistas. OBJETIVO: O estudo pretendeu avaliar e caracterizar a saúde oral em pacientes com mucopolissacaridose num centro de referência em Portugal. MÉTODO: A amostra foi constituída por doze pacientes com mucopolissacaridose (MPS) seguidos na Unidade de Doenças Metabólicas do Centro Hospitalar de São João e doze participantes saudáveis seguidos na Faculdade de Medicina Dentária da Universidade do Porto. A avaliação clínica oral consistiu num completo exame extra-oral e intra-oral para avaliação de patologias orais, índice gengival e perfil oclusal. RESULTADOS: Pacientes com MPS e controlos apresentaram médias similares de idade e de distribuição de género. Em comparação com os controlos, crianças com mucopolissacaridose apresentam maior prevalência de dentes cariados, sangramento gengival, macroglossia, hipoplasia dentária, interposição lingual, erupção dentária atrasada, mordida aberta anterior, mordida cruzada posterior direita e esquerda, limitação da abertura da boca, alteração do tamanho e forma dentária, diastemas e compressão maxilar. CONCLUSÃO: Pacientes com mucopolissacaridose apresentam maior prevalência de erupção dentária atrasada, alterações morfológicas dentárias, problemas oclusais, cáries dentárias e gengivas inflamadas, reforçando a necessidade de prestadores de saúde oral para melhorar diagnósticos e protocolos preventivos para ultrapassar os fatores que limitam a saúde oral destes pacientes e promover em conjunto com pais/cuidadores estratégias de saúde oral eficientes.

Diastema size and type of upper lip midline frenulum attachment.

BACKGROUND: Diastema is a space between teeth. The most often is maxillary midline diastema between upper central incisors. One of the main causes of diastema is enlarged upper lip frenulum attachment. The aim of the study was to assess frenulum attachment in patients with diastema and investigate if type of upper lip frenulum attachment has an impact on the width of diastema. MATERIALS AND METHODS: Upper lip frenulum attachment was assessed clinically in two groups of adult patients: study group with diastema and control group without diastema. Moreover the width of diastema was measured on plaster models of dentition. The results were statistically analysed. RESULTS: In study material the most often was diastema in range more than 2 mm. There were statistically significant differences between study and control group in upper lip frenulum attachment (p < 0.05). Normal frenulum attachment (mucosal or gingival) was typical for group without diastema, but enlarged frenulum (papillary or papilla penetrating) was characteristic for diastema group. Type of frenulum had significant (p < 0.05) impact to the width of diastema. Small diastema (≤ 2 mm) more often coexisted with normal frenulum. Oversized frenulum was observed in the big diastema (> 2 mm). CONCLUSIONS: Patients with diastema have more often oversized upper lip frenulum attachment then patients without diastema. The most often type of frenulum in patients with diastema is papillary and papilla penetrating type. Type of upper lip frenulum attachment has an impact to the size of diastema.

Measurement of Incisor Overjet and Physiological Diastemata Parameters in Quarter Horse Foals.

Cephalometric studies are important to quantify abnormalities of jaw length and positioning. In this study, 4 to 7-month-old Quarter horse foals (n = 51) were examined to determine overjet (horizontal overlap) prevalence and measure the size of the physiological diastemata. Results were analyzed in relation to age, sex, and lineage. Another aim of this study was to develop a simple field technique for measuring incisor malocclusion and physiological diastemata dimensions that could be used to monitor the growth of the rostral components of maxilla, incisive bone, and mandible. The overall prevalence of overjet lesions in these foals was 51%. Females were overrepresented (61.5%). Overjet occurred more commonly in show foals (50% prevalence) than other working (7.7%) and race (42.3%) lineage foals. Significant differences were found between maxillary and mandibular physiological diastemata lengths in foals of all ages and, as expected, there was a positive statistical correlation between age and maxillary and mandibular physiological diastemata measurements. Incisor overjet was present in 44.4% of 4-month-old foals, 45.5% of 5-month-old foals, 58.3% of 6-month-old foals, and 60% of 7-month-old foals. There was a weak positive correlation between age and the presence of incisor overjet. It was concluded that incisor overiet was common among Quarter horse foals, especially those from show and race lineages. The field technique for physiological diastema measurements was considered effective.

Diastema Mediano Superior: Aspectos Etiológicos / Superior medline diastema: etiological aspects

O estudo proposto teve como objetivo apresentar a correlação entre o diastema mediano superior com hábitos bucais deletérios, hereditariedade, problemas respiratórios e os tipos de freios labiais. Clinicamente, foi avaliada uma amostra composta por 102 indivíduos de ambos os sexos, encaminhados ao Serviço Especializado em Odontologia (SEO) da Rede Pública Municipal da cidade de Divinópolis, Minas Gerais, que apresentavam diastema mediano superior com indicação de frenectomia. Os dados coletados em uma ficha específica foram tabulados, revelando que na amostra estudada o diastema interincisal não está relacionado aos hábitos deletérios, com a hereditariedade e as doenças respiratórias, e são mais presentes nos freios de inserção papilar e penetrante na papila.

Prevalence of artificially created maxillary midline diastema and its complications in a selected nigerian population.

BACKGROUND: Maxillary midline diastema (MMD) is generally regarded as a symbol of beauty in Nigeria. The desperation to look beautiful has caused many individuals to seek the creation of artificial midline diastema and that comes often with undesirable side effects. AIM: To determine the prevalence of artificially created maxillary midline diastema (MMD) and its complications in a selected Nigerian population. METHOD: A cross-sectional study using a semi-structured questionnaire as the instrument for data collection was done among patients attending a private clinic in Owerri the capital of Imo state in Nigeria over a period of 18 months. The data were retrieved from the questionnaires and analyzed using the SPSS version 20. RESULTS: There were 141 respondents comprising 58(41.1%) males and 83(58.9%) females, giving a male to female ratio of 1:1.4. The prevalence of artificially created MMD was 34.0% with increased frequency in: the 21-30 years age group; among the females and in respondents with tertiary level of education. Majority of the respondents (69.5%) desire MMD and 20.8% of those without it wanted it created through cosmetic dentistry. Twenty of the 48 respondents with artificial MMD had it done to enhance personal beauty and aesthetics. The commonest complication was tooth sensitivity (44.8%), followed by toothache (41.4%). CONCLUSION: The prevalence of artificially created MMD was 34.0% in this study; and it is commoner in females and younger age group .The commonest complication was tooth sensitivity. Enhancement of personal beauty and aesthetic was the major reason for having it done.

Closure of large midline diastema by a "HIV-Spring".

Midline diastema is a common orthodontic problem in mixed dentition caused by various factors like genetic, supernumery teeth, abnormal frenum attachment, habits and microdontia etc. Large diastemas need closure for the eruption of adjacent teeth. I present here a newly designed customized self active HIV-Spring (Hari Inverted 'V' Spring) for closing a large diastema with minimum orthodontic materials and less activation visits. The spring can be modfied for the three dimensional movement of central incisors.

Non-Orthodontic, Non-Restorative Closure of Acquired Diastemata.

AIM: To illustrate the reversibility of "pathologic tooth migration" in several patients that were managed by periodontal therapy alone, along with a review of the relevant literature. BACKGROUND: Pathologic tooth migration (PTM) is a common phenomenon among patients seeking dental care. Different etiologic factors have been implicated in PTM: loss of periodontal support, occlusal interferences, posterior bite collapse, and various oral habits such as: lip biting, tongue thrusting, and playing wind instruments. Identification of all the causative factors involved in PTM is crucial for a successful treatment outcome. Managing severe cases of acquired diastemata may necessitate a complex and a sequential intervention involving periodontic, orthodontic and prosthodontic measures. However, "spontaneous regression" of teeth to their original position may occur in certain cases after elimination of the offending factors. CONCLUSION: "Spontaneous" closure of acquired diastemata could occur following surgical and/or non-surgical periodontal therapy or removal of occlusal interferences. Correction of pathologically migrated teeth without orthodontic or restorative treatment is feasible, but unpredictable.

The influence of etiological factors in the occurence of diastema mediana.

Even from the distant past the aesthetic perception in an individual was diminished by the presence of gap between the central incisors. This condition is found under the term "dents du bonheur" or "lucky teeth" and is encountered even among world famous figures including Brigitte Bardot, Eliah Wood, Madonna, Zac Efron, Amy Winehouse and Elton John. The teeth gaps are still considered main reasons for dissatisfaction of the dental patients and reasons for the requirement of aesthetic treatment. The purpose of this study is to exhibit the influence of the etiological factors in the occurrence of diastema mediana classified according to the dominance of their occurrence expressed in percentage values. Materials of this investigation were 100 patients with diastema mediana from the following factors: inheritance, disproportion in the dental arches, inborn or acquired missing teeth, harmful oral habits, high insertion of the labial frenulum as well as mesiodens. After the diagnosis and evaluation of the etiological factor for diastema mediana was performed, a decision regarding the course of treatment was made in direction of the removal of the etiological factor at an early age and orthodontic treatment. The end of the orthodontic treatment in a group of the patients was the beginning of prosthodontic reconstruction. From our clinical investigation we came to the realization that in 49 patients (49%) the hereditary influence was a dominant factor, next followed disproportions and discrepancies in the dental arch in 14 (14%), inborn or acquired missing teeth in 11 patients (11%), harmful oral habits in 10 (10%), high frenulum insertion in 4 (4%), and pathological objects between central incisors, mesiodens, iatrogenic factors and periodontal disease, in 3 of the clinical cases (3%) each. We concluded that the occurrence of diastema mediana is multi-causal. The dominant place is occupied by the hereditary factors. With regard to the mutual relationship between the multitudes of factors in the occurrence of diastema mediana, the diagnosis should be made conciliary and the clinical treatment should be interdisciplinary including a prosthodontist, orthodontist and oral surgeon.

Midline diastema and its aetiology--a review.

Maxillary midline diastema is a common aesthetic complaint of patients. Treating the midline diastema is a matter of concern for practitioners, as many different aetiologies are reported to be associated with it. The appearance of midline diastema as part of the normal dental development makes it difficult for practitioners to decide whether to intervene or not at an early stage. The aim of this article is to review the possible aetiology and management options which will help the clinician to diagnose, intercept and to take effective action to correct the midline diastema. The available data shows that an early intervention is desirable in cases with large diastemas. Treatment modality, timing and retention protocol depends on the aetiology of the diastema. Therefore, priority needs to be given to diagnosing the aetiology before making any treatment decisions. Clinical Relevance: This article aims to determine and evaluate the aetiology and possible treatment options of midline diastema.

Influence of application techniques on contact formation and voids in anterior resin composite restorations.

This study evaluated the influence of three different application techniques on contact formation and voids in anterior resin composite restorations. Artificial ivorine teeth were randomly assigned to three experimental groups, with 20 specimens in each group. One operator performed all restorations using the Teflon tape, pull-through, or bioclear matrix technique. The treatment time required for each restoration was recorded. An examiner blinded to the treatment group performed the visual evaluation of six criteria, including proper contact formation. The restored teeth were cut to yield a total of 180 sections for microscopic evaluation. The Kruskal-Wallis procedure was performed to evaluate the significance of treatment time, number of voids, percent porosity area, and void diameter. There were significant differences in treatment time among the three groups (p<0.05). The bioclear matrix technique required the least time for the treatment of one diastema closure (p<0.05). The Teflon tape technique resulted in proper contact formation in 80% of specimens, a rate that was significantly lower than that associated with the pull-through and bioclear matrix techniques (p<0.05). Out of 540 imaging areas 160 images were free of voids. The number of voids and the percent porosity area were not significantly different among the three techniques (p>0.05). However, the mean void diameter was greater with the bioclear matrix technique compared to the other two techniques (p<0.05).

Modified frenectomy: a review of 3 cases with concerns for esthetics.

The maxillary labial frenum is a normal anatomical structure in the oral cavity. An abnormal labial frenum causes localized gingival recession and midline diastema, both of which can interfere with oral hygiene procedures, and eventually affect esthetics. When the frenum maintains its high papillary attachment, frenectomy is the treatment of choice. Though this technique has undergone many modifications, the zone of attachment and esthetics in the anterior maxillary region have been neglected. This article highlights a new frenectomy technique that results in good esthetics, excellent color match, gain in attached gingiva, and healing by primary intention at the site of thick, extensive abnormal frena.

Atrição: o envelhecimento da forma dentária, os diastemas e seus significados / Attrition: aging tooth shape, the spacing and their meanings

A atrição pode explicar certas alterações que ocorrem depois de meses ou de anos de tratamento reabilitador, ocasionando mudanças na forma e nos tamanhos mesiodistal e oclusoapical das coroas dentárias, mudando a posição e a relação dos implantes dentários. A atrição dentária pode: 1) representar um sinal de desajustes oclusais; 2) indicar hábitos parafuncionais, como o apertamento e o bruxismo; 3) reduzir o perímetro da arcada dentária, pois os pontos de contato proximal transformam-se em facetas de contato ao longo dos anos; 4) envelhecer a boca, isso por causa de alguns detalhes morfológicos que variam conforme a faixa etária do paciente, como a eliminação dos serrilhados por meio de alisamento da margem incisal, até o aparecimento de dentina, como uma linha ou faixa amarelada escura entre o esmalte vestibular e o lingual, na incisal dos incisivos e caninos; 5) agravar ainda mais o envelhecimento promovido pelo apinhamento dentário; 6) exacerbar o envelhecimento, pela perda de dimensão vertical da face; 7) estar associada ao aparecimento de diastemas entre os implantes osseointegrados e os dentes naturais, depois de alguns anos de concluído o tratamento reabilitador.

Attrition may explain certain alterations identified after months and years of rehabilitation treatment. Such alterations may be explained by changes in mesiodistal as well as occlusal - apical shape and size of dental crowns, which change in relation to the position and relationship established with dental implants. Dental attrition can: 1 . represent a sign of occlusal maladjustment ; 2 . indicate parafunctional habits such as clenching and bruxism; 3 . reduce arch perimeter, since the contact points are transformed into proximal contact facets over the years; 4. age the mouth due to some morphological details that vary according to the age of the patient, including the elimination of jaggies with smoothing of the incisal edge until the dentin appears as a line or dark yellowish band between the buccal and lingual enamel incisal incisors and canine 5. further aggravate aging promoted by crowding ; 6 . age due to loss of vertical dimension of the face 7. be associated with diastema occurring between dental implants and natural teeth a few years after the rehabilitation treatment is finished.