Tratamento integrado para correção do sorriso gengival: relato de caso / Integrated treatment for correction of gingival smile: case report

O sorriso gengival possui inúmeras causas, podendo acontecer por motivos esqueléticos, musculares ou por alteração no desenvolvimento dos tecidos de suporte. No entanto, na atualidade, a estética vermelha e a branca têm se apresentado completamente passíveis de transformações e com uma gama de procedimentos cirúrgicos ou não cirúrgicos para sanar as queixas dos pacientes. O objetivo geral deste trabalho é mostrar o poder que a odontologia tem frente às questões estéticas, como, por exemplo, a vergonha de sorrir por não se sentir confortável com os dentes curtos e com uma grande faixa de gengiva sendo exposta. O método utilizado foi um relato de caso. Que descreve todos os passos clínicos do tratamento de um paciente de 40 anos, que estava insatisfeita com o seu sorriso por apresentar erupção passiva alterada juntamente com hiperatividade do lábio superior. O plano de tratamento escolhido foi de realizar a cirurgia de aumento de coroa clínica estético, seguido de clareamento dentário e posteriormente um reposicionamento labial, com ajuda da toxina botulínica. Finalizando, para ajudar na cicatrização, o uso de laserterapia. O resultado de todo o processo cirúrgico envolvido neste trabalho, é satisfação do paciente, materializando o sonho deste, devolvendo segurança e espontaneidade ao sorrir. Pôde-se observar que através da combinação de técnicas cirúrgicas periodontais para tratar o sorriso gengival, obtém-se êxito tanto no sentido científico quanto no biológico, alcançando um sorriso esteticamente mais atrativo(AU)

Gummy smile has numerous causes, which can occur for skeletal or muscular reasons or due to changes in the development of supporting tissues. However, nowadays, the red and white aesthetics have been completely capable of transformation and with a range of surgical or non-surgical procedures to resolve patients' complaints. The general objective of this work is to show the power that dentistry has in the face of aesthetic issues, such as, for example, the shame of smiling due to not feeling comfortable with short teeth and a large strip of gum being exposed. The method used was a case report. Which describes all the clinical steps of the treatment of a 40-year-old patient, who was dissatisfied with her smile due to an altered passive eruption together with hyperactivity of the upper lip. The chosen treatment plan was to perform aesthetic clinical crown augmentation surgery, followed by tooth whitening and later lip repositioning, with the help of botulinum toxin. Finally, to help with healing, the use of laser therapy. The result of the entire surgical process involved in this work is patient satisfaction, materializing the patient's dream, restoring security and spontaneity when smiling. It was observed that through the combination of periodontal surgical techniques to treat gummy smile, success is achieved both in the scientific and biological sense, achieving a more aesthetically attractive smile(AU)

Evaluation of the Golden Proportion, Golden Percentage, and Recurring Esthetic Dental Proportion in Kenyans of African Descent.

OBJECTIVES: To evaluate the validity of the Golden Proportion, Golden Percentage, and Recurring Esthetic Dental (RED) Proportion among Kenyans of African descent with naturally well-aligned teeth. MATERIALS AND METHODS: Standardized frontal photographic images of the smiles of 175 participants aged 18-35 years were obtained, and Adobe Photoshop was used to analyze and measure the frontal widths of the maxillary central and lateral incisors and canines in triplicate. The average teeth widths were calculated to determine the existence of the Golden Proportion, Golden Percentage, and RED Proportion, and their validity using independent sample t-tests to compare the differences in the mean teeth widths at α < 0.05. RESULTS: The number of male and female participants was 107 (61.1%) and 68 (38.9%), respectively. The Golden Proportion between the maxillary central and lateral incisors was found in 4.0% on the right and 2.8% on the left of all the participants, but between the maxillary lateral incisors and canines was found in only 0.6% on the right of male participants (p < 0.0001). The RED Proportion between the maxillary lateral and central incisors was in the range of 67%-70%, and between the canines and lateral incisors was 82%-84% (p < 0.0001). The proportion of RED was not constant, and gradually increased distally. The Golden Percentage of 15% was observed in the lateral incisors bilaterally; however, in the central incisors and the canines, the Golden Percentage was 22% and 12%, respectively. CONCLUSION: The Golden and RED Proportions were invalid determinants of anterior teeth proportions. The Golden Percentage existed only in the lateral incisors. The Golden Proportion, RED Proportion, and Golden Percentage theories may not be applicable to all populations when designing smiles. Racial and ethnic backgrounds are important considerations to establish objective quantifiable values of anterior tooth proportions that are beneficial for esthetic restorations.

Biological interaction, esthetics, handling, and loss rate of temporary luting cements - a clinical single-blind randomized controlled trial.

OBJECTIVES: To evaluate three temporary luting cements in terms of their restoration loss rates, biological interactions, esthetic properties, and handling characteristics. MATERIALS AND METHODS: 75 adults requiring fixed prosthodontics voluntarily participated in a single-blind, randomized controlled trial. After preparation, temporary restorations were luted with a randomly selected temporary luting cement (either Provicol QM Plus (PQP), Bifix Temp (BT), or Provicol QM Aesthetic (PQA)). Clinical examinations were performed one to two weeks after cementation. The following criteria were evaluated: tooth vitality, percussion, hypersensitivity, gingival bleeding, odor formation, esthetics, cement handling, removability, cleanability, and retention loss. Antagonistic teeth served as controls. Statistical analysis was performed using the paired t-test, one-way ANOVA, Pearson's chi-square and Fisher's exact test, where appropriate. RESULTS: The overall loss rate of temporary restorations was 16.0%, showing no cement-specific differences. Postoperative hypersensitivity occurred in 8% of cases regardless of cement type. Esthetic impairment was reported by 31% of the PQP-fixed restorations, compared with 4.0% and 4.2% of the BT and PQA-bonded restorations. Cement application was reported to be easy in 100% of cases, excess removal in 88-96%, depending on the cement used. CONCLUSIONS: The choice of luting material affects the esthetic appearance of a temporary restoration and should be considered, particularly in restorations in esthetically demanding areas. No significant differences between the cements were identified regarding biocompatibility, handling, and loss rate. CLINICAL RELEVANCE: Translucent cements can help to reduce color interferences, resulting in a more appealing appearance of the temporary restoration.

[Effect of zirconia personalized gingival penetration on peri-implant soft and hard tissue of thin gingival biotypes in the anterior region: a retrospective study].

Objective: To investigate the effect of zirconia personalized gingival structure on peri-implant soft and hard tissue stability after single-tooth implant restorations in patients with thin gingival biotypes in the anterior region, with a view to provide a clinical guideline. Methods: This retrospective study included 20 patients with thin gingival biotype and implant restorations in the anterior region. These patients included 9 males and 11 females, and the age was (35.2± 10.3) years. The patients were from the Department of Periodontal Implantology, Stomatology Hospital, Southern Medical University from January 2018 to December 2022. Computer-aided design/computer-aided manufacturing (CAD/CAM) techniques were used to fabricate a titanium base zirconia personalized gingival structure to maintain the soft-tissue perforated gingival contour of the anterior esthetic zone. This structure consists of two modalities: titanium base + zirconia outer crown or titanium base personalized zirconia abutment + zirconia outer crown. Clinical outcomes were recorded immediately and after delivery of the final restorations. Implant retention was recorded, esthetic scoring was performed using the pink esthetic index, the amount of bone resorption at the implant margins was measured based on digitized apical radiographs, and periodontal health was evaluated using the modified plaque index and the modified bleeding index. Results: The survival rate of the 20 implants was 100% after 3 years of wearing the final restorations, with a pink aesthetic score of 9.3±0.9. Bone resorption at the proximal and distal mesial margins of the implants was 0.09 (-0.21, 0.20) mm, 0.17 (-0.12, 0.27) mm after 3 years, respectively, and the difference was not statistically significant when compared to bone resorption immediately after placement of the final restoration [0(0, 0) mm] (Z=-1.03, P=0.394; Z=-2.05, P=0.065). Conclusions: Zirconia personalized gingival structure maintains the stability of peri-implant hard and soft tissues of thin gingival biotypes in the anterior region.

Emerging trends and clinical recommendations for zirconia ceramic crowns: a concise review.

Introduction A little over ten years ago, zirconia crowns made their debut in the field of dentistry. Despite early problems with the chipping of veneering porcelain, clinical studies have demonstrated excellent performance. It is essential for a ceramic crown to have good aesthetic qualities, in addition to having good mechanical characteristics. The exceptional mechanical qualities of zirconia crowns and the simplicity with which they may be machined, employing computer-aided design and computer-aided manufacturing schemes, are primarily responsible for the widespread use of these materials in clinical settings. New ceramic-based materials, including monolithic zirconia, zirconia-containing lithium disilicate ceramics, and graded glass/zirconia/glass, have recently been launched in the field of dentistry. These newly discovered zirconia crown materials stem from varied technological approaches, each likely to lead to additional clinical advancements. At this point, it seems imperative to offer a concentrated report on the newer developments, along with essential clinical recommendations for best clinical outcomes with zirconia crowns.Types of studies This review article is a consolidation of several case studies, cohort studies and systematic reviews, as well as experimental and observational randomised control trials and other peer-reviewed articles.Results On reviewing, a concise list of clinical recommendations is generated, demonstrating that monolithic zirconia offers some clinical advantages over veneered zirconia crowns.Conclusion This review article discloses various clinical revelations and in-office recommendations for favourable usage of zirconia ceramic crowns that can lead to better patient outcomes and long-term clinical success rates.

Effect of two esthetic digitally produced materials used in fabrication of extracoronal attachments on the stresses Induced in removable partial dentures.

BACKGROUND: Preservation of the remaining structures while maintaining an esthetic appearance is a major objective in removable partial prosthodontics. So, the aim of the current study was to compare the stresses induced on the supporting structures by two digitally produced esthetic core materials; Zirconia and Polyetheretherketone when used as an extracoronal attachment in distal extension removable partial dentures using strain gauge analysis. METHODS: A mandibular Kennedy class II stone cast with the necessary abutments' preparations was scanned. The mandibular left canine and first premolar teeth were virtually removed. An acrylic mandibular left canine and first premolar teeth were prepared with heavy chamfer finish line and scanned. Virtual superimposition of the acrylic teeth in their corresponding positions was done. Two strain gauge slots were designed: distal to the terminal abutment and in the residual ridge. Two models and two sets of scanned teeth were digitally printed. The printed teeth were then placed in their corresponding sockets in each model and scanned. The attachment design was selected from the software library and milled out of Zirconia in the model ZR and Polyetheretherketone in the model PE. Five removable partial dentures were constructed for each model. The strain gauges were installed in their grooves. A Universal testing machine was used for unilateral load application of 100 N (N). For each removable partial denture, five measurements were made. The data followed normal distribution and were statistically analyzed by using unpaired t test. P value < 0.05 was considered to be statistically significant. RESULTS: During unilateral loading unpaired t test showed statistically significant difference (p = 0.0001) in the microstrain values recorded distal to the abutment between the models ZR (-1001.6 µÎµ ± 24.56) and PE (-682.6 µÎµ ± 22.18). However, non statistically significant difference (p = 0.3122) was observed in the residual ridge between them; ZR (16.2 µÎµ ± 4.53) and PE (15 µÎµ ± 3.74). CONCLUSIONS: In removable partial dentures, Polyetheretherketone extracoronal attachment induces less stress on the supporting abutments compared to the zirconia one with no difference in the stresses induced by them on the residual ridge.

Evaluating malocclusion patterns in children with autism spectrum disorder using the index of complexity, outcome and need: a cross-sectional study.

BACKGROUND: The purpose of this study was to evaluate the complexity of malocclusion and existing patterns in children with autism spectrum disorders (ASD) using the index of complexity, outcome and need (ICON). METHODS: This cross-sectional study included children diagnosed with ASD, aged 9-15 years. A group of healthy children with the same demographic characteristics was randomly selected as the control group. Malocclusion was assessed according to ICON scoring protocol. The following parameters were recorded: dental aesthetics, upper arch crowding/spacing, presence of crossbite, anterior-vertical relationship (open and deep bite) and buccal segment anterior-posterior relationship. Finally, an overall ICON score was derived and reported for each patient. Descriptive analysis was performed for all investigated variables. Significance level was set at p < 0.05. RESULTS: A total of 324 children, divided into ASD (162) and control (162) groups, comprised the study population. Our results demonstrated that the average overall ICON score was significantly higher in the ASD group compared to the control group (38.77 vs. 27.43, p < 0.001). ASD children also obtained significantly higher scores regarding the dental aesthetics component (3.84 vs 2.78, p < 0.001). Study groups were significantly different in terms of the prevalence of incisor overbite and open bite (p = 0.002 and p < 0.001, respectively). Patients in the ASD group showed a higher prevalence of Class II and Class III malocclusions (p < 0.001). CONCLUSION: ASD children obtained significantly higher overall ICON scores, indicating more complex and severe malocclusions. These children also exhibited a greater tendency towards Class II and III malocclusions.

Guidelines for Immediate Vs Delayed Dental Implant Placement in the Esthetic Zone.

The placement of immediate dental implants in the esthetic zone is a highly successful procedure, however it requires careful case selection. Depending on the structural integrity of the alveolar socket and the gingival level, either an implant can be placed immediately and provisionalized or its insertion may need to be delayed. If the extraction site is compromised, implant placement should be deferred to allow bone or soft-tissue grafting or a combination of both to facilitate esthetic implant placement. In addition, two other treatment factors need to be considered with regard to immediate placement: (1) if the implant has low primary stability (ie, low insertion torque value), a custom healing abutment should be fabricated to maintain tissue contour and retain bone placed into the buccal gap; (2) if there is high primary stability (ie, high insertion torque value), fabrication of an immediate fixed provisional will preserve tissue contour, hold a buccal gap bone graft in place, and provide an esthetic result. At sites where the implant will be placed, factors favoring immediate placement include the following: coronal position of the gingiva compared to adjacent teeth, a type I socket classification, and class I or II sagittal root position. The purpose of this article is to present clinical guidelines that can aid in the decision-making process for delayed versus immediate implant placement.

Digital-assisted multidisciplinary treatment for complex occlusal rehabilitation: an 18-month follow-up case report.

BACKGROUND: This case report highlights the importance of standardized and fully digital sequential treatment in complex occlusal rehabilitation cases. To fully resolve the patient's dental needs, such cases often require multidisciplinary interventions including periodontal therapy, endodontic treatment, anterior esthetics, implant restoration, and prosthetic rehabilitation. A fully digital workflow (including facial scanners, intraoral scanners, jaw motion tracking systems, virtual articulators, and computer-aided design software) streamlined the complex treatment, enhancing workflow simplicity, efficiency, visibility, and precision. CASE PRESENTATION: The patient presented with decreased chewing efficiency of the upper and lower prostheses, along with unsatisfactory esthetic appearance of the anterior teeth. After physical examination and radiological assessment, this complex occlusal rehabilitation case required periodontal therapy, anterior esthetic enhancement, implant restoration, and fixed prosthetic rehabilitation. Therefore, a fully digital workflow was adopted. Full-crown prostheses were placed on teeth 13, 23, and 34; a fixed bridge encompassed positions 32 to 42, and single implant crowns were placed on teeth 35 and 36. Implant-supported fixed bridges were constructed for teeth 12 to 22 and 44 to 46, anchored by implants at teeth 12, 22, 44, and 46. All definitive prostheses were fabricated from zirconia ceramics, chosen for their durability and esthetic characteristics. Finally, restorations with satisfactory esthetic and functional characteristics were seated, preserving the tooth and its supporting structures. During treatment and follow-up, the T-scan occlusal analysis system was utilized to continuously monitor and guide the adjustment of occlusal distribution across the patient's dental arches. After 18 months, the patient remains satisfied with the definitive restorations. CONCLUSIONS: This report is intended to help dentists understand and implement standardized and fully digital workflows during the management of complex occlusal rehabilitation cases; it may also facilitate harmonious integration of esthetic and functional characteristics.

Clinical and radiographic outcomes of a two-piece ceramic implant: one year results from a prospective clinical trial.

OBJECTIVE: To describe the clinical and radiographic performance and survival rate of a new two-piece ceramic implant system after at least 12 months of follow-up. MATERIALS AND METHODS: Sixty-five implants were placed and followed up for at least 12 months (12.3 ± 1.5), in 50 patients. The implants were installed both in fresh extraction sockets and in healed sites and received provisional restoration when the clinical insertion torque was greater than 35Ncm. The primary results describe the survival rate of these implants. Clinical performance was evaluated through the evaluation of the Pink Esthetic Score (PES) and the degree of satisfaction of the patients. Bone loss was measured through radiographic measurements of the marginal bone loss in the mesial (MBLM) and distal (MBLD) sites. RESULTS: The survival rate was 98.5%. The average MBLM was 0.24 mm (± 0.53) and the MBLD was 0.27 mm (± 0.57). A statistical difference was observed only when comparing immediate implants with delayed ones (MBLM - p = 0.046 and MBLD - p = 0.028) and when they received immediate provisionalization or not (MBLM - p = 0.009 and MBLD - p = 0.040). The PES before the intervention (T0) was 13.4 (± 0.8) and the PES at T2 (12-month follow-up) was 12.9 (± 1.5) (p = 1.14). CONCLUSION: The new two-piece ceramic implant used in the present study showed predictable and reliable results, similar to those found with titanium implants after one year of follow-up. CLINICAL RELEVANCE: These implants can be used as an alternative to titanium implants in terms of the marginal bone loss and the degree of patient satisfaction.

Intra-radicular retention with custom designed CAD-CAM fibRe-reinforced composite post-core: a dental technique.

A technique is outlined for utilising a polymeric composite reinforced with glass fibres in a three-dimensional mesh as a post-core in aesthetic cases. The clinical procedure involves obtaining an impression of the root canal space, scanning the definitive cast, and milling a fibre-reinforced composite post-core. Subsequently, the intra-radicular post-core is cemented using an adhesive resin cement. The use of custom-made computer-aided design-computer-aided manufacturing (CAD-CAM) fibre-reinforced composite post-core facilitates repairability, provides better adaptation to the root canal space, avoids uneven cement thickness, ensures chemical adhesion to resin cement, and promotes favourable aesthetics when combined with all-ceramic crowns.

Advanced restorative management of focal microdontia: A brief review and case report.

Focal microdontia is a dental anomaly characterized by the presence of a single abnormally small anterior or posterior tooth. The objective of this article is to provide an updated review of the literature on the advanced restorative management of focal microdontia, and to document a clinical case where the reviewed advanced restorative approaches were applied to treat a young adult presenting with a non-syndromic asymmetrical focal microdontia.We conducted a preliminary examination of the existing literature on the advanced restorative management of focal microdontia. Additionally, we presented a minimally invasive approach to the treatment of an 18-year-old female patient with non-syndromic asymmetrical focal microdontia. The primary advantage of adhesive dentistry is that it can better preserve the structure of smaller teeth. A review of literature reveals a paucity of reports on localized microdontia in the maxillary anterior region of the mouth. However, novel minimally invasive restorative procedures satisfy patients' aesthetic and functional preferences. Well-executed additive diagnostic wax-ups and intraoral mock-ups can serve as a permanent restoration blueprint, providing predictable results for focal dental anomalies in the aesthetic zone. In conclusion, the use of minimally invasive dental approaches in young patients with focal microdontia can result in long-term satisfactory aesthetic outcomes.

Study on the Association between anterior tooth Colour Preference based on the FAHP and individual factors.

BACKGROUND: The relationship between tooth colour and individual satisfaction in oral aesthetics has long been a topic of interest. In this study, we utilized the fuzzy analytic hierarchy process (FAHP) to investigate the impacts of sex and age on tooth colour preference. The findings of this study should provide a scientific basis for oral aesthetic practice. METHODS: In the current study, a random selection method was employed, and a survey was completed by 120 patients. To obtain tooth colour data, standard tooth colour charts were used. Smile photos were taken as template images using a single-lens reflex camera. The FAHP was utilized to conduct a weight analysis of tooth colour preferences among patients of different sexes and age groups. RESULTS: There were significant differences in tooth colour preference based on sex and age. Men tend to prefer the B1 colour, while women may prioritize the aesthetic effects of other colours. Additionally, as patients age, their preferences for tooth colour become more diverse. These findings offer valuable insights for oral aesthetics practitioners, enabling them to better address the aesthetic needs of patients across different sexes and ages. This knowledge can aid in the development of more personalized treatment plans that align with patients' expectations. CONCLUSION: In this study, we utilized scientific analysis methods to quantify the popularity of different tooth colours among various groups of people. By doing so, we established a scientific foundation for clinical practice. The findings of this study offer valuable insights for oral aesthetic research, enhancing our understanding of tooth colour. Additionally, these findings have practical applications in the field of oral medicine, potentially improving patients' quality of life and overall oral health.

Transfer of Guided Emergence Profile Developed Using Customized Provisional Implant Restoration and Cementation Using an Abutment Replica Technique: A Case Report.

The long-term success of dental implants depends not only upon implant osseointegration, but also on the surrounding soft tissue health and profile. An ideal emergence profile contributes to the aesthetics of an implant restoration. It maintains long-term implant health by preventing potential food accumulation and forming a barrier against bacterial ingress. This article describes a method for obtaining an impression of implants that will capture the custom guided peri-implant soft tissue contours accurately, thus contributing to a final restoration with favorable aesthetics. We also describe a technique for reducing excess cement in a cement retained implant crown, thereby contributing to the health of the peri-implant tissues.

[Comparison of clinical esthetic effects of two abutments of maxillary anterior dental implants with single crown].

Objective: To compare and evaluate the clinical esthetic effect of angle screw channel abutment and personalized zirconia adhesive abutment for single crown restoration in esthetic area. Methods: A total of 44 patients (21 males and 23 females), aged (37.4±13.5) years (18-67 years) who completed single crown restoration in the esthetic area of the Department of Oral Implantology, Dalian Stomatological Hospital from January 2018 to June 2022 were retrospectively selected. A total of 44 implants were inserted. According to the abutment selected for final restoration, the patients were divided into angle screw channel abutment group and personalized zirconia bonding abutment group, with 22 patients and 22 implants in each group. The implant survival rate, complication rate, pink and white esthetic score and marginal bone resorption were compared between the two groups. Results: Follow-up to 12 months after final restoration, implant survival rates were 100% (22/22) in both groups, and there was no statistically significant difference in the incidence of mechanical complications between the two groups [9% (2/22) in the angle screw channel abutment group and 0(0/22) in the personalized zirconia bonding abutment group, χ2=2.10, P=0.148]. In the follow-up appointment 12 months after final restoration, the pink esthetic score of the angle screw channel abutment group (12.95±1.05) was significantly better than that of the personalized zirconia bonding abutment group (11.45±2.02) (t=3.10, P=0.003). There was no significant difference in white esthetic scores between the two groups (t=1.27, P=0.212). There was no significant difference in the marginal bone resorption between the two groups (t=0.32, P=0.749). Conclusions: When a single implant supported restoration is delivered in the esthetic area of the anterior maxilla, high implant survival rate and stability of the marginal bone can be obtained by using the angle screw channel abutment or the personalized zirconia bonding abutment. The clinical efficacy of the angle screw channel system is reliable, and it will provide clinicians with a new treatment option.

Aesthetic assessment of maxillary lateral and canine implant-supported crowns by laypersons and orthodontists.

INTRODUCTION: The objectives of this study were to evaluate how laypersons and orthodontists evaluate and rank aesthetic parameters of an implant-supported crown (ISC) on the canine position (ISC-C) and lateral position (ISC-L). METHODS: A digital survey of 11 cases, 5 ISC-C, 5 ISC-L and 1 control case without ISC, was distributed to 207 laypersons and 296 orthodontists. All cases included one extraoral photograph and three intraoral photographs. The respondents were asked to identify the ISC and to evaluate the aesthetic parameters regarding colour of the implant (CI), shape of the implant (SI) and gingival colour around ISC (GCI). Differences within and between the groups were tested using Chi-2-test and Independent-Samples t-test. RESULTS: All invited laypersons and 184 orthodontists (62% response rate) answered the survey. Orthodontists (89%) more correctly identified the ISC, regardless of its position, than laypersons (50%) (p < 0.001). Both laypersons (54%) and orthodontists (23%) rated higher proportions of acceptance of CI, SI and GCI in favour for the ISC-L than ISC-C (laypersons: 40%, orthodontists: 10%) (p < 0.001). Assessing each parameter separately, orthodontists rated higher for ISC-L, compared to the ISC-C (p < 0.001). In general, laypersons and orthodontist ranked tooth colour (mean, standard deviation [SD]:8.0,1.5 and 9.0, 1.0) and tooth shape (mean, SD: 8.0, 1.7 and 8.8, 1.2) as aesthetically higher than the gingival colour (mean, SD: 7.2, 2.2 and 8.0, 1.7) (p > 0.001).  Conclusion: Laypersons and orthodontists consider the ISC-L as aesthetically more preferable, compared to the ISC-C.

Orofacial esthetics, chewing function, and oral health-related quality of life in Kennedy class I patients with mini-implant-retained removable partial dentures: A 3-year clinical prospective study.

This prospective clinical study aimed to assess self-reported orofacial esthetics, chewing function, and oral health-related quality of life (OHRQoL) over three years in the Kennedy Class I patients without posterior dentition who received free-end saddle removable partial dentures (RPDs) retained by two mini dental implants (MDIs) inserted in the canine/first premolar region. The study's robust findings reaffirm the viability of MDI-retained RPDs as a treatment modality in contemporary prosthodontics, instilling confidence in the dental community. MATERIALS AND METHODS: 92 participants with posterior edentulism in the maxilla or mandible received 184 MDIs and 92 RPDs. After one year, three participants were excluded, and another seven were excluded after three years. The final sample was 82 participants. Self-perceived orofacial esthetics was assessed by the Orofacial Esthetic Scale (OES), chewing function by the Chewing Function Questionnaire (CFQ), and the OHRQoL by the OHIP-14. Statistical analysis utilized multivariate regression analysis, standardized effect size calculation, Wilcoxon Signed Rank test, and Friedman's test. RESULTS: OHRQoL and chewing function significantly improved (p < 0.001) one month after MDI loading by the new RPDs and continued to improve over the observation period (p < 0.05). The OES also significantly improved (p < 0.001) and remained almost unchanged over the next three years (p = 0.440). CONCLUSION: Despite the limitations of this study, the MDI-retained RPD appears to be a viable treatment modality in contemporary prosthodontics from the patients' perspective.

Demystify Treatment Planning With a Correct Functional Diagnosis.

Obtaining an accurate assessment of the causes of severe dental destruction is crucial when planning a clinical workflow for full-mouth rehabilitation cases. Some cases that initially appear extremely challenging may be surprisingly straightforward, especially if the patient presents with an acceptable functional occlusion. In the seemingly highly complex case presented, only a Lucia jig was required to obtain a reliable restorative reference point for the full-mouth rehabilitation. Increasing the vertical dimension of occlusion allowed for predictable restoration of function and esthetics. The treatment was completed in phases for patient comfort, and the final outcome provided the patient with regained confidence in his smile and comfort when eating.

Management of an extensive soft tissue deficiency prior to immediate implant in the aesthetic zone: a 4-year follow-up.

Soft tissue deficiency in a tooth extraction site in the aesthetic area is a common and challenging clinical situation. This case report demonstrates the successful treatment of extensive gingival recession and buccal bone dehiscence associated with a hopeless tooth. Initially, a connective tissue graft was used to cover the root and thicken the soft tissue. After 2 months, the tooth was extracted, an implant was immediately placed, and a temporary restoration was installed. After 3 months, the soft tissue exhibited a natural and harmonious architecture. A custom zirconia abutment and crown were then fabricated and placed. At the 4-year follow-up, the peri-implant tissue displayed satisfactory aesthetics, with a well-structured buccal bone plate and healthy peri-implant indicators. This two-stage approach, addressing gingival recession first and proceeding with immediate implant placement after soft tissue healing, proved to be a safe and effective method with stable long-term results.