Radiological, histological and clinical side effects of incisor trimming in rabbits.

INTRODUCTION: Incisor malocclusion in rabbits (Oryctolagus cuniculus) is a common clinical problem seen in general practice. Given that the growth rate is about 2 mm per week, a lack of wear quickly leads to feeding difficulties and soft tissue injuries. Therefore, pathologically elongated incisors must be shortened every three to six weeks. The goal of this study was to assess the potential adverse effects on dental and periodontal tissues associated with the three most commonly used trimming methods: nail cutter, diamond-coated cutting disc and diamond burr. The left mandibular incisor of 28 healthy New Zealand rabbits was subjected to four trimmings with one of the three cutting methods. After the fattening period, the mandibles were collected and both mandibular incisors were investigated on dental radiographs, micro-computed tomography scans and histological sections. Dental and periodontal tissue changes were evaluated. This study allowed a more accurate statement of the potential short-term adverse effects of the three trimming methods. At the clinical level, the nail cutter caused the formation of an irregular occlusal surface with sharp edges. Both engine-drive methods allowed the attainment of a smooth surface but the disc was less accurate. Histological evaluation revealed that the primary modifications, including coronal fractures, periodontal ligament widening and inflammation, reparative osteodentine, paracementosis and biofilm accumulation, were found in the nail cutter group.

INTRODUCTION: La malocclusion des incisives chez le lapin (Oryctolagus cuniculus) est un problème clinique courant en médecine générale. Étant donné que le taux de croissance est d'environ 2 mm par semaine, un manque d'usure entraîne rapidement des difficultés d'alimentation et des lésions des tissus mous. Par conséquent, les incisives pathologiquement trop longues doivent être raccourcies toutes les trois à six semaines. L'objectif de cette étude était d'évaluer les effets négatifs potentiels sur les tissus dentaires et parodontaux associés aux trois méthodes de taille les plus couramment utilisées: le coupeongles, le disque de coupe diamanté et la fraise diamantée. L'incisive mandibulaire gauche de 28 lapins néo-zélandais en bonne santé a été soumise à quatre tailles avec l'une des trois méthodes de coupe. Après la période d'engraissement, les mandibules ont été prélevées et les deux incisives mandibulaires ont été examinées sur des radiographies dentaires, des examens micro-tomodensitométriques et des coupes histologiques. Les modifications des tissus dentaires et parodontaux ont été évaluées. Cette étude a permis de mieux cerner les effets indésirables potentiels à court terme des trois méthodes de coupe. Au niveau clinique, le coupe-ongles a entraîné la formation d'une surface occlusale irrégulière avec des bords tranchants. Les deux autres méthodes de taille permettent d'obtenir une surface lisse, mais le disque est moins précis. L'évaluation histologique a révélé que les modifications primaires, y compris les fractures coronaires, l'élargissement et l'inflammation du ligament parodontal, l'ostéodentine réparatrice, la paracémentose et l'accumulation de biofilm, ont été trouvées dans le groupe coupe-ongles.

Pulpotomy versus pulpectomy in carious vital pulp exposure in primary incisors: a randomized controlled trial.

BACKGROUND: Pulpotomy as a minimally invasive pulp therapy technique is the treatment of choice for carious pulp exposures, however many pediatric dentists perform pulpectomies in vital primary incisors. The aim of this split mouth randomized controlled study was to compare formocresol pulpotomy and zinc-oxide and eugenol pulpectomy in the treatment of vital pulp exposure in primary incisors. METHODS: Contralateral pairs of incisors were randomly assigned to receive pulpotomy or pulpectomy in children aging from 18 to 66 months old and were followed up for 12 months. RESULTS: 39 pairs of incisors were included. Clinical and radiographical success rates showed no statistical significant difference (p = 1, p = 0.8 respectively). Relative risk measures for clinical success rates (RR = 1.03, 95%CI 0.87 to 1.23) and for radiographic success rates (RR = 1.03, 95%CI 0.83 to 1.29) with CIs including number one showing no difference between the two groups. The Survival rate using Kaplan-Meier survival analysis score showed 82% for pulpotomy and 74% for pulpectomy at 12 months (P = 0.2). CONCLUSIONS: Both pulpotomy and pulpectomy techniques can be used successfully in the treatment of carious vital pulp exposure in primary incisors. TRIAL REGISTRATION: The trial was retrospectively registered in Clinicaltrials .gov with this identifier NCT05589025 on 21/10/2022.

Entire Dental Arch Mesial Movement after Extraction of Maxillary Right Central Incisor due to Root Fracture Treated with Temporary Anchorage Devices.

This case report describes a 19-year-old woman with skeletal Class I crowding and an unsalvageable maxillary right central incisor. She visited our clinic with the chief complaint of mobility of the maxillary right central incisor due to a traffic accident. After extraction of the maxillary right central incisor, the space was closed orthodontically. All the maxillary right teeth were moved mesially with an elastic chain attached to a palatal lever arm which was connected to palatal temporary anchorage devices (TADs). After orthodontic treatment had been completed, the maxillary right lateral incisor and peg-shaped left lateral incisor were restored with a porcelain laminate veneer. The maxillary right canine was morphologically reshaped and built up with composite resin. Consequently, esthetically ideal occlusion and functional lateral guidance with uncontacted molars were obtained. These results show that mesial movement of the entire dental arch with TADs is a useful orthodontic treatment option in patients in whom the maxillary central incisor has been extracted.

Unusual approach to treat malocclusion with traumatically missing and hopeless maxillary unilateral incisors: A case report.

Orthodontic cases requiring tooth extraction sometimes involve post-traumatic incisors. For adolescent cases in which trauma causes the maxillary unilateral incisors to be missing or have poor prognoses, it is worth considering these teeth as candidates for extraction, and this unusual approach is seldom reported in the literature. An adolescent patient with a missing maxillary left lateral incisor and an ankylosed maxillary left central incisor sought treatment for dental protrusion and crowding. An unusual orthodontic approach was used, which involved the extraction of the maxillary left central incisor and mandibular first premolars. After treatment, the maxillary right central incisor was successfully translocated across the midpalatal suture and transformed into the left central incisor. Additionally, well-aligned teeth and enhanced smile aesthetics were achieved, and the treatment outcomes remained stable throughout the follow-up period.

Use of a hybrid soft tissue autograft for gingival phenotype modification lingual to mandibular incisors.

Presence of adequate dimensions of keratinized/attached gingiva (KT/AG) and gingival thickness (GT) is considered necessary to maintain optimal periodontal health and long-term stability of gingival margin. Gingival phenotype modification therapies to increase these two dimensions (GT and KT/AG) on the buccal aspect of teeth have been widely reported, but the literature on lingual gingival augmentation is scarce. The purpose of this paper is to report the outcomes of a case treated with an envelope flap combined with a hybrid soft tissue autograft (subepithelial connective tissue graft with an epithelial collar) for phenotype modification of gingiva lingual to mandibular incisors presenting with thin gingiva (<1 mm) and lack of AG in tooth # 31 and 42. At 12 months follow-up, a substantial gain in KT, AG and GT along with partial root coverage was achieved.

EAO Position Paper: Immediate Implant Placement: Managing Hard and Soft Tissue Stability from Diagnosis to Prosthetic Treatment.

In this position paper, the state of the art in immediate implant placement (IIP) at incisor-cuspid-premolar sites is described. The literature supports that the following prerequisites need to be simultaneously met for a predictable outcome: (1) there must be no acute infection; (2) there must be apical and palatal/lingual bone for implant anchorage; (3) the tooth must be inside the bone envelope; (4) the alveolar socket must have a favorable morphology (type I, IIa, IIb avoiding wide dehiscences); (5) there must be no midfacial recession; (6) the right implant must be selected; and (7) the surgeon needs to be experienced and skilled. A preoperative CBCT is required for IIP because multiple aforementioned prerequisites (2, 3, and 4) can only be assessed on the basis of 3D imaging. The final prerequisite relates to the importance of a perfect implant position, preferably leaving a horizontal gap of at least 2 mm between the implant shoulder and buccal bone wall. Guided surgery is preferred over free-hand surgery to accomplish this. Flapless surgery, socket grafting, connective tissue graft (CTG), and immediate provisionalization have been shown to contribute to hard and/or soft tissue stability. When the previously mentioned prerequisites are fulfilled, IIP may be considered over alternative treatment concepts (eg, early implant placement [EIP] and delayed implant placement [DIP]) based on time gain, minimal invasiveness, and similar outcomes in the literature. Given very strict selection criteria, clinicians should primarily screen patients for IIP before considering other treatment options with wider indications. Int J Prosthodont 2023;36:533-545.

The load capacity of maxillary central incisor with simulated flared root canal restored with different fiber-reinforced composite post and cementation protocols.

Background: This study aimed to evaluate the load capacity of maxillary central incisors with simulated flared root canal restored with different fiber-reinforced composite (FRC) post cemented with either self-adhesive or self-etch resin cement and its mode of fracture. Methods: Sixty-five extracted maxillary incisors were decoronated, its canal was artificially flared and randomly categorized into group tFRC (tapered FRC post) (n = 22), mFRC (multi-FRC post) (n = 21), and DIS-FRC (direct individually shaped-FRC (DIS-FRC) post) (n = 22), which were further subdivided based on cementation resin. The posts were cemented and a standardized resin core was constructed. After thermocycling, the samples were loaded statically and the maximum load was recorded. Results: The load capacity of the maxillary central incisor was influenced by the different FRC post system and not the resin cement (p = 0.289), and no significant interaction was found between them. Group mFRC (522.9N) yielded a significantly higher load capacity compared to DIS-FRC (421.1N). Overall, a 55% favorable fracture pattern was observed, and this was not statistically significant. Conclusion: Within the limitation of the study, it can be concluded that prefabricated FRC posts outperform DIS-FRC posts in terms of the load capacity of a maxillary central incisor with a simulated flared root canal. The cementation methods whether a self-adhesive or self-etch resin cement, was not demonstrated to influence the load capacity of a maxillary central incisor with a flared root canal. There were no significant differences between the favorable and non-favorable fracture when FRC post systems were used to restored a maxillary central incisor with a flared root canal.

Use of a 2-Piece Small Diameter Implant in the Esthetic Zone in a Site of Chronic Residual Periapical Lesion: A Case Report with 1-Year Follow-Up and Histopathological Examination.

BACKGROUND Replacing missing teeth in the anterior region of the jaw can be challenging due to the limited available interdental space. Improper selection or inadequate placement of a dental implant in this situation can affect the adjacent anatomical structures negatively. What if, in addition, a residual intraosseous chronic inflammatory lesion was present? The objective of this case report is to demonstrate the step-by-step surgical procedures of replacing a maxillary lateral incisor in a patient with a residual lesion with a satisfactory outcome. CASE REPORT A 63-year-old female patient with an extracted maxillary lateral incisor presented for implant placement. Radiographically, a residual periapical lesion with mild atrophy of the alveolar bone and fairly low density with sparse trabeculation was noted. Owing to the limited restorative space, a Straumann Bone Level Tapered Implant Ø2.9 mm (Small Cross-Fit connection, Roxolid, SLActive) was placed. Histopathological evaluation revealed a definitive diagnosis of periapical granuloma. After 1 year, the clinical examination revealed a successful outcome, and the patient was satisfied with the result. CONCLUSIONS This case report shows a successful clinical and radiographical outcome after 1 year of a 2-piece small diameter dental implant, the Straumann Bone Level Tapered Implant, diameter 2.9 mm, replacing a missing maxillary lateral incisor after enucleating the lesion with histopathological examination.

Clinical Guidelines for the Surgical/Orthodontic Management of Impacted Maxillary Central Incisors Based on a Decision Tree.

Maxillary central incisors are critical to occlusal function, smile esthetics, and even one's self-image. Furthermore, their impaction at an early age could have harmful psychological consequences on the individual. Maxillary central incisors can be impacted due to early dentoalveolar trauma to the upper anterior region that displaces the incisor in formation and, in rare instances, tooth germs are deformed. The aftermath of trauma during primary dentition is seen later during mixed dentition. Other causes are either an impediment in the eruption pathway of the maxillary central incisor due to the presence of odontomas or supernumerary teeth, an insufficient eruption space, or, very rarely, syndromic and/or other general medical conditions. Diagnosis is completed through a detailed medical/dental history, clinical evaluation, and appropriate imaging. Arch width increase, space opening, removal of obstructions if present, suitable soft-tissue management, well-designed orthodontic traction mechanics, and long-term periodontal follow-up are all essential elements in resolving cases of impacted maxillary central incisors.

Quantification of the apical palatal bone index for maxillary incisor immediate implant assessment: A retrospective cross-sectional study.

BACKGROUND: Apical palatal bone is important in immediate implant evaluation. Current consensus gives qualitative suggestions regarding it, limiting its clinical decision-making value. OBJECTIVES: To quantify the apical palatal bone dimension in maxillary incisors and reveal its quantitative correlation with other implant-related hard tissue indices to give practical advice for pre-immediate implant evaluation and design. MATERIAL AND METHODS: A retrospective analysis of immediate implant-related hard tissue indices in maxillary incisors obtained by cone beam computed tomography (CBCT) was conducted. Palatal bone thickness at the apex level (Apical-P) on the sagittal section was selected as a parameter reflecting the apical palatal bone. Its quantitative correlation with other immediate implant-related hard tissue indices was revealed. Clinical advice of pre-immediate implant assessment was given based on the quantitative classification of Apical-P and its other correlated immediate implant-related hard tissue indices. RESULTS: Apical-P positively correlated with cervical palatal bone, whole cervical buccal-palatal bone, sagittal root angle, and basal bone width indices. while negatively correlated with apical buccal bone, cervical buccal bone, and basal bone length indices. Six quantitative categories of Apical-P are proposed. Cases with Apical-P below 4 mm had an insufficient apical bone thickness to accommodate the implant placement, while Apical-P beyond 12 mm should be cautious about the severe implant inclination. Cases with Apical-P of 4-12 mm can generally achieve satisfying immediate implant outcomes via regulating the implant inclination. CONCLUSIONS: Quantification of the apical palatal bone index for maxillary incisor immediate implant assessment can be achieved, providing a quantitative guide for immediate implant placement in the maxillary incisor zone.

Combined surgical and conservative endodontic management of Oehler's type 3b dens invaginatus aided by guided tissue regeneration.

The present case describes the successful healing of a periapical lesion associated with the left maxillary lateral incisor (# 22, Federation Dentaire Internationale) having a type 3b dens invaginatus tooth morphology. The treatment was complicated by the presence of blunderbuss root apex and large periapical lesion (>10 mm) with through and through bone defect (Bucco palatal cortical bone perforation, Von Arx Type 1b). An adolescent boy reported palatal swelling and pus discharge in relation to tooth #22. A thorough clinical and radiographic examination revealed tooth #22 as having a type 3b dens invaginatus with an open apex and a diagnosis of pulp necrosis and acute apical abscess. The case was managed by non-surgical root canal treatment followed by endodontic surgery using principles of guided tissue regeneration. A 5-year recall revealed an asymptomatic functional tooth with complete healing.

Comparative Stress Analysis of Custom-Made PEEK Dental Post-Cores versus Conventional Post-Cores in Incisor Restorations: A Finite Element Study.

BACKGROUND We conducted a finite element analysis to evaluate stress levels in incisor teeth restored with custom polyetheretherketone (PEEK) dental post-cores compared to conventional post-cores. MATERIAL AND METHODS Using micro-computed tomography (µCT) imaging data, a 3D model of a maxillary incisor was created. For each material type, 3D mesh models were developed via specialized software. Two post diameters, 2.5 mm and 3.5 mm, were considered. Five different post materials were examined: Unfilled polyetheretherketone (Group UP); Glass fiber-reinforced polyetheretherketone (Group GP); Carbon fiber-reinforced polyetheretherketone (Group CP); Metal (Group M); and Zirconia ceramic (Group Z). Each model underwent finite element analysis, after which the von Mises equivalent stress values were determined. RESULTS For models involving both wide and narrow diameter posts across the crown, crown cement, post cement, and dentin, PEEK posts (Group UP, GP, and CP) exhibited higher von Mises stress values than Groups Z and M. However, the reverse trend was noticed in the post model itself. In the post cement model, stress values appeared similar only for the narrow-diameter post groups. Notably, results for Groups Z and M were largely consistent with each other. CONCLUSIONS PEEK posts, which have a lower modulus of elasticity, demonstrated different stress values when contrasted with zirconia and metal posts. As the post diameter expanded, the residual dentin decreased, influencing the stress values among various materials. Further in vitro and clinical examinations are essential to comprehensively understand PEEK posts.

Alveolar bone changes in the mandibular incisors after genioplasty, a three-dimensional study.

INTRODUCTION: Functional genioplasty aims to achieve lip competence at rest and reduces lip pressure against the mandibular incisors. The purpose of this study was to describe the radiographic changes in alveolar bone of the mandibular incisors after functional genioplasty. MATERIALS AND METHODS: Cone beam CT images from 36 patients were compared between immediate (T0) and delayed postoperative period (T1). The mean time to complete the second imaging was 10.9 ± 4.7 months. Dental and bone parameters were assessed: the vestibular bone height (BH), the bone thickness (BT) with regard to the apex of the central incisor (BT2) and at equidistance between the cementoenamel junction and the dental apex (BT1). The existence of fenestrations, the apical-root resorption and the incisor-mandibular plane angle (IMPA) were also collected. RESULTS: No significant change occurred in the BH. BT was improved of a mean 47.9% and 53.6% at the BT1 level on #31 and #41, respectively (p1=0.01 and p2=0.02, respectively); and of 53.0% at the level of the apex of both mandibular central incisors (p1=0.003 on #31 and p2=0.009 on #41). No difference in the number of fenestrations was observed between T0 and T1. A significant decrease in the root length on both mandibular incisors was observed on the delayed CBCT (from 21.96 ± 1.35 to 21.68 ± 1.32 mm for #31, p=0.0007; from 22.26 ± 1.66 to 21.96 ± 1.48 mm for #41, p=0.002). Finally, the IMPA remained stable between the two examinations with a mean 106.1 ± 7.38° vs 105.8 ± 6.51° (p=0.38). CONCLUSION: Functional genioplasty favours the alveolar bone formation of the mandibular central incisors, probably by direct bone grafting, but also by the relaxation of the perioral and chin musculature.

Mesiodens: a propósito de dos casos / Mesiodens: two cases

El mesiodens es el diente supernumerario más común, localizado en la línea media maxilar entre los incisivos centrales. Su etiología es incierta y se han planteado múltiples teorías. El diagnóstico y tratamiento precoz permite la erupción espontánea de los incisivos permanentes, evitar las complicaciones asociadas, así como tratamientos posteriores más complejos. En este artículo se presentan dos casos de mesiodens de pacientes que acuden a la consulta de Pediatría de Atención Primaria (AU)

The mesiodens is the most common supernumerary tooth, located in the maxillary midline between the central incisors. Its etiology is uncertain and multiple theories have been put forward. Early diagnosis and treatment allows the spontaneous eruption of the permanent incisors, and avoids associated complications as well as more complex subsequent treatments. In this article, two cases of mesiodens in patients attending the primary care pediatric outpatient clinic are presented. (AU)

Staged Treatment with Root Coverage Procedure Prior to Socket Shield: A Clinical Case Report.

After performing a tunneling mucogingival surgery procedure to cover generalized root recession in the anterior maxilla, a socket shield procedure was performed for immediate implant placement on a lateral incisor, leaving a root fragment coronal to the buccal bone margin with a long soft tissue attachment. This case report suggests that it is possible to achieve stable peri-implant results 30 months after the described therapy. Int J Periodontics Restorative Dent 2023;43:175-180. doi: 10.11607/prd.6238.

Root Canal Treatment of Oehlers Type III Dens Invaginatus in Maxillary Lateral Incisor and Remote Sinus Tract Using Dental Surgical Microscope and Cone-Beam Computed Tomography.

Dens invaginatus is a morphological abnormality of the tooth that results from a developmental anomaly during tooth formation, in which part of the enamel and dentin of the crown invaginates into the pulp cavity. This report describes a case of a maxillary lateral incisor with apical periodontitis apparently caused by Oehlers Type III dens invaginatus. The patient was a 69-year-old man who visited our clinic complaining of discomfort in the maxillary right lateral incisor. Cone-beam computed tomography (CBCT) revealed dens invaginatus of the maxillary lateral incisor and a sinus tract in the maxillary central incisor region, which was derived from apical periodontitis of the maxillary lateral incisor. The dens invaginatus was accompanied by a complex root canal morphology. Treatment, which was performed using a dental surgical microscope, had a favorable outcome. The patient remains in good condition at 1 year postoperatively.

CBCT Evaluation of Quality and Quantity of Bones for Immediate Implant Treatment Planning in Central Incisor Area in relation to Arch Form.

Understanding the quality of the ridge and facial cortical bone in the aesthetic zone is important for treatment with an immediate dental implant. This study aimed to analyze bone density and widths of the facial cortical bone and alveolar ridge at the central incisors in relation to arch form. A total of 400 teeth from 100 cone-beam CT images were divided equally between the upper and lower central incisors. The central incisor area was assessed for the width of the facial cortical and alveolar bones at three different points (3 mm, 6 mm, and 9 mm from the cementoenamel junction). Arch forms and densities of cortical and cancellous bones in the interradicular regions were evaluated. The difference in facial cortical bone thickness at 3 points was smaller for the upper teeth than for the lower teeth on both sides. The alveolar bone width was higher in the maxilla than the mandible with highly significant differences (P < 0.001). The highest bone density was at the buccal aspect of the mandible (897.36 ± 136.72 HU), while the lowest density was at the cancellous bone of the maxilla (600.37 ± 126.63 HU). The dominant arch form was ovoid 71%, followed by square 20% and the tapering arch form 10%. The tapering arch form has the highest alveolar bone width in the upper jaw without statistical significance. The facial cortical bone thickness needs to be evaluated before implantation in the anterior region because it is less than two millimeters in both jaws. CBCT is important for the immediate implant. The ovoid shape was the dominant arch form.

Survey of patients and parents on the autotransplantation of developing premolars to replace traumatised maxillary incisors.

BACKGROUND/AIM: There is a little research on the experiences and opinions of patients who have had autotransplantation of a tooth. The aim of the study was to assess the satisfaction of patients who underwent the autotransplantation of a developing premolar to replace a traumatised maxillary central incisor. MATERIALS AND METHODS: Eighty patients (with a mean age of 10.7-years) and 32 parents were surveyed with 13 and 7 questions, respectively, to determine their opinions about the surgery, post-operative period, orthodontic and restorative treatment they had received. RESULTS: Patients and their parents were very satisfied with the outcomes of the autotransplantation treatment. The majority of patients and all parents declared that they would choose this treatment again if needed. Patients who already had aesthetic restoration of the transplanted toothscored significantly better in position, similarity to other teeth, alignment and aesthetics, when compared to patients before restoration of the premolar to the shape of incisor. Patients after orthodontic treatment considered the alignment of the transplanted tooth between the adjacent teeth as better when compared to patients before or during their orthodontic treatment. CONCLUSIONS: Autotransplantation of developing premolars to replace traumatized maxillary central incisors proved to be a well-accepted treatment option. A delay of restoration of the transplanted premolars to the shape of the maxillary incisors did not have a negative impact on the satisfaction with the treatment.

Evaluation of sagittal root position and labial alveolar bone concavity in the maxillary anterior tooth area for immediate implant placement.

BACKGROUND: The anatomical characteristics of the maxillary labial alveolar bone play a crucial role in the treatment planning of immediate implant placement. The sagittal root position (SRP) and alveolar bone concavity are closely related to anatomical characteristics in determining the ideal implant position. This study evaluated the SRP and labial alveolar bone concavity in the maxillary anterior teeth area. METHODS: Cone-beam computed tomography images of 120 samples involving 720 teeth were uploaded to the medical imaging software. The SRP was classified as Class I, II, III, or IV, and the concavity of labial alveolar bone was measured. A T test was performed to compare measurements between the central and lateral incisors, between the central incisors and canines, and between the lateral incisors and canine. RESULTS: The majority of the SRPs of the maxillary anterior teeth were class I (engaging the labial cortical plate) with frequencies of 98.3%, 85.8%, and 81.7% for the canines, lateral incisors, and central incisors, respectively. In terms of concavity of labial alveolar bone in maxillary tooth area, canines also had the largest mean value (139.5°), followed by lateral incisors, whereas central incisors has the smallest mean value (131.7°). The results of the T test revealed a significant difference ( p < 0.001) in labial alveolar bone concavity between central and lateral incisors, between central incisors and canines, and between lateral incisors and canines. CONCLUSION: Most maxillary anterior teeth were classified as Class I SRP, Class III SRP was the least prevalent, and the concavity of the labial alveolar bone significantly differed between the central and lateral incisors, between the central incisors and canines, and between the lateral incisors and canines. In addition, the canines had the highest mean alveolar bone concavity angle, indicating that less concavity in the canines area.

Periodontal Phenotype Modification Using Subepithelial Connective Tissue Graft and Bone Graft in the Mandibular Anterior Teeth with Mucogingival Problems Following Orthodontic Treatment.

Among the complications of orthodontic treatment, mucogingival problems with gingival recession in the mandibular anterior teeth are challenging for clinicians. Mucogingival problems can lead to esthetic deficits, thermal hypersensitivity, tooth brushing pain, and complicated plaque control. Herein, we present a case of a 16-year-old female with gingival recession in the left mandibular central incisor after orthodontic treatment. The preoperative clinical findings showed a thin soft tissue biotype with root prominence in the mandibular anterior area. The interdental area was relatively depressed. After reflection of the full-thickness flap, root coverage using a bone graft substitute and subepithelial connective tissue graft obtained from the palatal mucosa was performed. The 6-month and 5-year postoperative clinical findings showed improved soft tissue phenotype. The cross-sectional CBCT scans 5 years after surgery showed a well-maintained labial bone plate in the mandibular incisors. Within the limitations of this case report, for patients with gingival recession in the mandibular incisors after orthodontic treatment, a successful biotype modification can be achieved with a combined procedure using subepithelial connective tissue graft with bone graft substitutes.