A morphometric analysis of maxillary central incisor on the basis of facial appearance in Korea

PURPOSE

We aimed to identify a more esthetic width-to-length ratio by analyzing maxillary central incisor of Korean adult population. Information regarding tooth ratio in the Korean population may be useful to clinicians when restoring anterior teeth.

MATERIALS AND METHODS

A total of 40 men and 40 women were included in this study. The NON-MEDIA group included 40 non-celebrities, who were healthy and 25 to 39 years old, with normal dentofacial appearance. The MEDIA group consisted of 40 celebrities selected only on the basis of their soft-tissue facial appearance. The facial photographs of 40 celebrities were collected from the Internet websites. The width and length of the maxillary central incisor were measured using Adobe Photoshop® 7.0, a software for analysis, measurement and edition of photographs. Data were analyzed statistically using the Independent t-test at 5% statistical significance level.

RESULTS

The mean ratio for the MEDIA group was 0.77, whereas that of the NON-MEDIA group was 0.88. The difference between the two groups was statistically significant. No significant gender differences were found in the width-to-length ratio in MEDIA group. In NON-MEDIA group, however, there were significant differences between female and male.

CONCLUSION

After analyzing maxillary anterior teeth of Korean adults, our results were in accordance with the general Western standards of esthetics. A dentist restoring the natural look and beauty of teeth will have to consider those standards.     

Mesiodistal root angulation of permanent teeth in children with mixed dentition and normal occlusion

Objective

There is little information regarding the mesiodistal angulation of permanent teeth in mixed dentition. The aim of this study was to evaluate mesiodistal root angulation of permanent incisors, canines and first molars of 100 Brazilian children, using a new horizontal reference plane based on the midpoint of the intercuspation of primary canines and permanent first molars in panoramic radiographs during the mixed-dentition phase.

Material and methods

Children were equally divided between the genders with a mean age of 8.9 years (SD=0.76), normal occlusion and no eruptive disturbances.

Results

The angulation of the permanent maxillary first molars was close to the vertical, whereas the mandibular molars presented approximately 25 degrees of distal root angulation. The maxillary canines were the most distally angulated teeth, whereas the permanent mandibular canines were vertically positioned. The evaluation of the anterior maxillary area showed vertical position of permanent lateral, and central incisors with a slight distal angulation, whereas the permanent mandibular incisors tended to a mesial radicular convergence.

Conclusions

The proposed reference line could be useful in mixed dentition root angulation evaluation; there was a slight asymmetry in the mesiodistal angulation among homologous teeth, and also a small variation between the male and the female groups, but no difference between 8-and 10-year-old children.     

The level of buccal gingival margin around single and two adjacent implant restorations: a preliminary result

STATEMENT OF PROBLEM

Little information is available about the buccal gingival level of multiple implant restorations.

PURPOSE

This study was aimed to evaluate the relationship between width and height of buccal soft tissue around single and 2 adjacent implant restorations.

MATERIAL AND METHODS

Four implant restoration groups (first and second molars, single second molars, posterior single restorations between teeth, and anterior single restorations between teeth) were randomly chosen from one dental institute. Each group comprised of 6 patients. After 6 months of function, silicone impressions were taken and stone models were fabricated for each restoration group. The stone models were cut in bucco-lingual direction at the most apical point of buccal gingival margin. The height and width of buccal supra-implant soft tissue were measured. One way ANOVA and Tukey HSD post hoc tests were performed to analyze the data obtained (P < .05).

RESULTS

The most unfavorable width-height ratio was noted for the group, which was comprised of the second molar in the multiple adjacent (first and second molar) implant-supported restorations. The group also resulted in the shorter height of buccal supra-implant mucosa rather than that of anterior single implant restorations between natural teeth.

CONCLUSION

To achieve a favorable level of buccal gingival margin, greater thickness of buccal supra-implant mucosa is required for the implant restorations without a neighboring natural tooth compared to the implant restorations next to a natural tooth.     

The relationship between innercanthal dimension and interalar width to the intercanine width of maxillary anterior teeth in central Indian population

Statement of Problem:

Selection of proper sized maxillary anterior teeth is one of the difficult clinical steps in complete denture esthetics. Several studies have been reported to establish methods of estimating the combined width of maxillary anterior teeth.

Purpose:

The aim of this study was to determine whether a relationship exists between the innercanthal distance (ICD) and interalar width (IAW) with the combined width of maxillary anterior teeth.

Material and Methods:

The maxillary anterior teeth of 600 adult subjects were examined. ICD was measured between the median angles of the palpebral fissure. IAW was measured between the ala of the nose at their widest point. The mean combined width of the maxillary anterior teeth was determined intraorally at their widest dimension. Pearson''s correlation coefficients were calculated to determine the relationship between ICD, IAW and the combined width of maxillary anterior teeth (α =0.05).

Results:

Although the Pearson correlation coefficients were relatively small, a significant relationship existed between innercanthal dimension and IAW (P < 0001).

Conclusion:

Within the limitations of this study, the results suggest that ICD and IAW cannot be used as a preliminary method for determining the width of the maxillary anterior teeth for edentulous patients.Key Words: Innercanthal distance, interalar width, intercanine width     

Radiographic assessment of clinical root-crown ratios of permanent teeth in a healthy Korean population

PURPOSE

The aim of this study was to determine the absolute value of the root/crown ratio (R/C ratio) using panoramic radiographs (PRGs) in a healthy Korean population.

MATERIALS AND METHODS

In total, 99 patient radiographs (of 50 males and 49 females subjects; aged 16 to 24 years old) were examined, and 2,770 teeth were analyzed. Crown lengths and root lengths were measured with modified Lind''s measurements using PACS tools by two examiners in two separate sessions two months apart. All data were analyzed using SPSS. The independent t-test was used to assess for gender differences, and the paired t-test was used to compare both arches with a significance level of P<.05.

RESULTS

The mean R/C ratios varied from 1.29 to 1.89 (male: 1.28-1.84; females: 1.31-1.94). The highest R/C ratios were recorded for the mandibular canines (1.89), followed by the maxillary canines (1.79). The lowest R/C ratios were recorded for the maxillary second molars (1.31). In comparison with the maxillary teeth (1.29-1.78), the mandibular teeth yielded the higher R/C ratio (1.47-1.89), and this difference was significant in the females (P<.05). The difference between the genders was not statistically significant, except for the maxillary central incisors, mandibular canines and mandibular first premolars.

CONCLUSION

These data may enhance the understanding of the clinical R/C ratio as a useful guideline for determining the status of teeth and the ethnic difference.     

Correlation between iris diameter and the width of the maxillary central incisor with digital image analysis

Statement of problem

Various methods have been suggested for determining the width of maxillary anterior teeth for complete dentures. A straightforward and reliable technique for anterior tooth selection in complete denture is still needed.

Comparison of the Effectiveness of Lidocaine in Permanent Maxillary Teeth Removal Performed with Single Buccal Infiltration Versus Routine Buccal and Palatal Injection

Purpose

For many dental patients, palatal injection proves to be a very traumatic experience. Diverse methods have been suggested to reduce the discomfort of palatal injection. Nevertheless, the reliability of these methods is not obviously evident and they are not found to be universally effective. The desirable method to evade pain during palatal injection is just not to have one. Hence, the present study aims at investigating if lidocaine hydrochloride could provide palatal anesthesia in maxilla when only a buccal infiltration anesthesia is done for teeth extraction.

Patients and Methods

One hundred and fifty patients requiring extraction of maxillary teeth were included in the study. Patients were randomly allotted to two groups, study and control. Patients in study group received a single buccal infiltration of 1.5 mL of lidocaine with epinephrine for extraction of maxillary teeth. Patients in control group received 1.5 mL of buccal and 0.3 mL of palatal infiltration of lidocaine with epinephrine for the extraction. After achieving adequate palatal anesthesia the tooth was extracted with consistent technique. Pain level experienced by the patients during injection procedure and during tooth extraction was rated in an 11-point pain rating scale. Time taken to achieve palatal anesthesia following a single buccal infiltration of anesthetic solution was evaluated by regular pin-prick evaluation of palatal tissues.

Results

The overall success rate of palatal anesthesia achieved with a single buccal infiltration is 81.3 %. The success rate reduced as we proceed from anterior to posterior maxilla. Time taken to achieve successful palatal anesthesia by single buccal infiltration is 7–9 min.

Conclusion

The extraction of permanent maxillary anterior teeth and premolars is possible by depositing local anesthesia to the buccal vestibule of the tooth without palatal supplementation. However, the extraction of permanent maxillary posterior teeth with similar technique would result in fewer success rates suggesting its avoidance.     

Orthognathic surgical norms for a sample of Saudi adults: Hard tissue measurements

Objective

The aim of the study is to establish hard tissue cephalometric norms for orthognathic surgery for a sample of Saudi adults.

Materials and methods

Sixty-two lateral cephalometric radiographs for 31 females and 31 males, age range of 22–24 years, were analysed. The mean values of the hard and dental measurements were compared with those of European-American adults using Burstone analysis, as well as comparison between Saudi males and females.

Results

Saudi males had an increased cranial base length, the mandible lied more posterior to maxilla, increased mandibular plane angle and backward rotation of the mandible with less prominent chin, shorter maxillary length, and also less proclination of lower incisors compared to those of European Americans. Saudi females had similar cranial base length and shorter maxillary length than European Americans. In both gender; lower anterior and posterior dental heights were smaller when compared with the European-Americans’ values. A significant difference between Saudi males and females was found. Saudi males showed longer cranial base length, larger vertical skeletal proportion, increased dental values, longer maxillary and mandibular length than the female group.

Conclusion

This study may be useful in providing racially specific cephalometric norms for diagnosis and treatment planning for orthognathic surgery for a sample of Saudi adults.     

Mandibular Third Molar Position Influencing the Condylar and Angular Fracture Patterns

Purpose

The aim of this study was to assess the influence of position of mandibular 3rd molar on angle and condylar fractures.

Materials and Methods

Panoramic radiographs were used to determine the mandibular fracture patterns based on the presence or absence of the third molar.

Results

Of the 64 patients with mandibular fractures, condyle and angle fractures were found to be 67 and 33 % respectively. The greatest percentage (75 %) of condylar fractures were associated with erupted third molar teeth, and 25 % had impacted teeth. Subcondylar region was found to be the most common site that predisposes to fracture. Moderate force lead to condylar fracture when third molar is erupted or absent and mild force showed angle fracture when third molar is impacted. Increased incidence of angle fracture was observed when tooth is in mesioangular and distoangular position.

Conclusion

Impacted mandibular 3rd molar leads to an increased risk of angle fracture and decreased risk of condylar fracture especially when they are more deeply seated.     

A torque-measuring micromotor provides operator independent measurements marking four different density areas in maxillae

PURPOSE

Bone density at implant placement site is a key factor to obtain the primary stability of the fixture, which, in turn, is a prognostic factor for osseointegration and long-term success of an implant supported rehabilitation. Recently, an implant motor with a bone density measurement probe has been introduced. The aim of the present study was to test the objectiveness of the bone densities registered by the implant motor regardless of the operator performing them.

MATERIALS AND METHODS

A total of 3704 bone density measurements, performed by means of the implant motor, were registered by 39 operators at different implant sites during routine activity. Bone density measurements were grouped according to their distribution across the jaws. Specifically, four different areas were distinguished: a pre-antral (between teeth from first right maxillary premolar to first left maxillary premolar) and a sub-antral (more distally) zone in the maxilla, and an interforaminal (between and including teeth from first left mandibular premolar to first right mandibular premolar) and a retroforaminal (more distally) zone in the lower one. A statistical comparison was performed to check the inter-operators variability of the collected data.

RESULTS

The device produced consistent and operator-independent bone density values at each tooth position, showing a reliable bone-density measurement.

CONCLUSION

The implant motor demonstrated to be a helpful tool to properly plan implant placement and loading irrespective of the operator using it.     

Influence of Gender on the Patient's Assessment of Restorations on the Upper Anterior Teeth

Objective

The aim of this study was to assess the level of patients’ satisfaction with appearance of maxillary anterior teeth restorations and to determine if there is a significant difference in patients’ assessment of restoration appearance with regard to gender.

Materials and methods

Two hundred subjects evaluated the colour, anatomical shape and surface texture of maxillary anterior teeth restorations (composite fillings, acrylic faceted metal crowns, porcelain-fused-to-metal crowns and all-ceramic crowns) in comparison with adjacent natural teeth. The data were expressed in patients’ average assessment scores for colour, anatomical shape and surface texture as well as overall patients’ average assessment scores for every type of restoration and overall patients’ average assessment scores for colour, anatomical shape and surface texture of all the restorations in general. Patients also assessed the general impression of their maxillary anterior teeth restorations and rated it as satisfactory or unsatisfactory.

Results

There was a statistically significant gender difference in patient assessment of colour and surface texture for composite fillings and the overall patient average assessment score for colour of all assessments (p <0.05). Women were more dissatisfied with the general impression of their restorations on the upper teeth than men (p >0.05). Only overall patients’ average assessment score for composite restorations almost reached the level of significance (p = 0.069) on patients’ general impression.

Conclusion

Colour of the restorations and the composite material are significant factors which affect dental appearance of maxillary anterior teeth in patients.Key words: Patient Satisfaction, Dental restoration, Permanent, Crowns, Dental esthetics     

Geometric and mathematical proportions and their relations to maxillary anterior teeth

AIM: One of the critical aspects of esthetic dentistry is creating geometric or mathematical proportions to relate the successive widths of the anterior teeth. The golden proportion, the recurring esthetic dental (RED) proportion, and the golden percentage are theories introduced in this field. The aim of this study was to investigate the existence of the golden proportion, RED proportion, and the golden percentage between the widths of the maxillary anterior teeth in individuals with natural dentition. METHODS AND MATERIALS: Standardized frontal images of 376 dental student smiles were captured. The images were transferred to a personal computer, the widths of the maxillary anterior teeth were measured, and calculations were made according to each of the above mentioned theories. The data were statistically analyzed using paired student T-test (level of significance P<0.05). RESULTS: The golden proportion was found to be accurate between the width of the right central and lateral incisors in 31.3% of men and 27.1% of women. The values of the RED proportion were not constant, and the farther the one moves distally from the midline the higher the values. Furthermore, the results revealed the golden percentage was rather constant in terms of relative tooth width. The width of the central incisor represents 23%, the lateral incisor 15%, and the canine 12% of the width of the six maxillary anterior teeth as viewed from the front. CONCLUSIONS: Both the golden proportion and the RED proportion are unsuitable methods to relate the successive widths of the maxillary anterior teeth. However, the golden percentage theory seems to be applicable to relate the successive widths of the maxillary anterior teeth if percentages are adjusted taking into consideration the ethnicity of the population.     

Correction of a severely rotated maxillary central incisor with the Whip device

Objective

The aim of this case report was to introduce an appliance that can be used for correcting severe rotation of anterior teeth in pre-adolescent children.

Appliance design and testing

This is a case report of an 11-year-old Iranian boy with a mixed dentition Class I malocclusion defined by a severe rotation of upper left central incisor and a mesiodens between the centrals. The supernumerary tooth was first extracted, and then a Whip device including removable appliance, a cantilever spring and bonded tube on rotated tooth was inserted into his mouth. After 8 months, the upper left central incisor was orthodontically brought into proper alignment. Circumferential supracrestal fibrotomy was done next to overcorrection of the tooth and one week after surgery, the device was removed and the retention was started.

Conclusion

The whip device, a removable appliance can be very effective for correcting severe rotation of anterior teeth.     

Hybrid Implant: A Novel Implant System

Introduction

Replacement of missing tooth has evolved from removable dentures to fixed dentures and recently to dental implants. The need of sufficient bone around the endosseous implant is critical for the success of the implant. The present study was aimed to evaluate the efficacy of a novel implant (HYBRID IMPLANT-submitted for patency) for replacement of the missing teeth.

Materials and methods

1. Research design A prospective research design with a follow up after 1st week ,2nd week ,3rd week,1st month ,3rd month,6th month and 1st year postoperatively. 2. Sampling method Population: All patients who reported for replacement of missing teeth. Inclusion criteria 1. All patients above the age group of 16years 2. Patients who need replacement of single or multiple teeth in the anterior or posterior region of the maxilla and mandible. Exclusion criteria 1. Medically compromised patients. 2. Patients having craniofacial syndromes. 3. Sample size 5 patients were selected taking into consideration the inclusion and exclusion Criteria. Results PAIN All the patients were non symptomatic during the 1st month to 1st year postoperative periods.

Mobility

We experienced mobility during the 1st and 2nd postoperative periods where the implants were inserted in the mandibular molar region.

Bone loss

Radiographic assessment showed no bone loss during the postoperative periods.

Conclusion

The novel implant (hybrid implant) showed good stability and minimum patient discomfort during one year postoperative period evaluation. The implant system leads to new prospect in the field of prosthetic rehabilitation.     

Craniofacial characteristics of Caucasian and Afro-Caucasian Brazilian subjects with normal occlusion

Objective

The objective of this study was to compare the skeletal, dental and soft tissue characteristics of Caucasian and Afro-Caucasian Brazilian subjects with normal occlusion and to evaluate sexual dimorphism within the groups.

Material and Methods

The sample comprised lateral cephalograms of untreated normal occlusion subjects, divided into 2 groups. Group 1 included 40 Caucasian subjects (20 of each sex), with a mean age of 13.02 years; group 2 included 40 Afro-Caucasian subjects (20 of each sex), with a mean age of 13.02 years. Groups 1 and 2 and males and females within each group were compared with t tests.

Results

Afro-Caucasian subjects presented greater maxillary protrusion, smaller upper anterior face height and lower posterior face height, larger upper posterior face height, greater maxillary and mandibular dentoalveolar protrusion as well as soft tissue protrusion than Caucasian subjects. The Afro-Caucasian female subjects had less mandibular protrusion and smaller total posterior facial height and upper posterior facial height than males.

Conclusions

Brazilian Afro-Caucasian subjects have greater dentoalveolar and soft tissue protrusion than Brazilian Caucasian subjects, with slight sexual dimorphism in some variables.     

Full mouth rehabilitation of partially and fully edentulous patient with crown lengthening procedure: a case report

BACKGROUND

In order to restore severely attrited teeth properly, surgical intervention in the form of a crown-lengthening procedure may be required. And also, proper diagnosis and treatment sequencing is critical to obtain a successful results. Adequate diagnostic wax-up ensures good esthetics and healthy periodontal tissue.

CASE DESCRIPTION

This clinical case report describes a diagnostically based protocol for restoration on mandibular anterior teeth with crown lengthening procedure and the treatment of partially edentulous mandible combined with an edentulous maxilla. In addition, the effort to prevent the combination syndrome was described.

CLINICAL IMPLICATION

An interdisciplinary diagnosis and examination through visualization of the desired results ensure conservative and more predictable outcome.     

Mandibular cephalometric characteristics of a Saudi sample of patients having impacted third molars

Objective

To evaluate the cephalometric characteristics of mandibles of Saudi patients having impacted third molars and to compare them to those of patients having normally erupted third molars.

Material and methods

One hundred and twenty-one Saudi adult subjects (59 females and 62 males; age: 20–40 years) were divided into two groups based on the status of the mandibular third molars: (1) impaction group and (2) normal group. Means and standard deviations of 21 cephalometric measurements related to mandibular geometry were measured and compared between the two groups using the unpaired t-test. Males and females in the impaction group were also compared with their equivalent subgroups in the normal group using the unpaired t-test.

Results

Anteroposteriorly, space distal to second molar, ramal width and mandibular body length were significantly less in the impaction group than in the control group. In addition, posterior teeth were more upright in the impaction group. Vertically, posterior alveolar height was significantly less in the impaction group. The Y-axis was significantly increased in the impaction group.The significance of these measurements was variable between males and females.

Conclusions

Third-molar impactions in the Saudis living in the Western region of Saudi Arabia were more likely to occur when inadequate retromolar space is present. This can be attributed to certain mandibular skeletal and dental features, among which the increased width of mandibular ramus and backward inclination of posterior teeth seem to be the most influencing factors in both sexes.     

Role of mandibular displacement and airway size in improving breathing after rapid maxillary expansion

Background

Oral breathing and maxillary deficiency are often associated with steep mandibular plane angle, and retrognathic mandible compared with the faces of healthy controls. Some studies suggested that after rapid maxillary expansion, improvement in nasal breathing and repositioning of mandible with transitory increasing of facial height and, in some cases, spontaneous forward repositioning might occur. The abovementioned mandibular effects could contribute to enlarge oropharynx volume with repositioning of tongue and soft palate with an improvement of upper airway volume after treatment. The aim of this study was to investigate by cone beam computed tomography the role of oropharyngeal volume and mandibular position changes after rapid maxillary expansion in patients showing improved breathing pattern confirmed by polysomnography exam.

Methods

The final sample of this retrospective study comprised 14 Caucasian patients (mean age 7.6 years) who undergone rapid maxillary expansion with Haas-type expander banded on second deciduous upper molars. Cone beam computed tomography scans and polysomnography exams were collected before placing the appliance (T0) and after 12 months (T1). Mandibular landmarks localization and airway semiautomatic segmentation on cone beam computed tomography scans allowed airway volume computing and measurements.

Results

No significant differences were found between oropharyngeal airway changes and mandibular displacement after rapid maxillary expansion in growing patients.

Conclusions

The suggested improvement in upper airway and breathing after rapid maxillary expansion should be further related to different compartments of airway such as rhinopharynx and nasal cavity.     

Analysis of the golden proportion and width/height ratios of maxillary anterior teeth in Arab and Kurdish populations

Statement of problem

Dentists providing anterior restorations are guided by the principles of anatomic tooth dimension. Dental biometrics should consider ethnicity to produce a more comprehensive evaluation.

Dentoalveolar comparative study between removable and fixed cribs, associated to chincup,in anterior open bite treatment

Objective

The aim of this prospective study was to compare the dentoalveolar effects produced by two types of palatal crib, removable (Rpc+C) and fixed (Fpc+C), combined with chincup in growing patients with anterior open bite.

Material and Methods

Each group comprised 30 patients, in the mixed dentition phase, with similar cephalometric characteristics and skeletal ages. Group 1 (Rpc+C) presented initial mean age of 8.3 years and mean anterior open bite of 4.0 mm. Group 2 (Fpc+C) presented initial mean age of 8.54 years and mean anterior open bite of 4.3 mm. The evaluation period comprised 12 months between initial (T1) and second lateral radiograph (T2). The T2-T1 changes were compared cephalometrically in the 2 groups using the non-paired t-test.

Results

Vertical changes in the posterior dentoalveolar region were similar between the groups (about 1 mm) and no significant differences were found in molar mesialization. The Fpc+C group had in average 1.6 mm more improvement of the overbite as a result of greater maxillary incisor extrusion (1.3 mm). Patients in this group also presented less lingual tipping of maxillary incisors and more mandibular incisors uprighting.

Conclusions

The Fpc+C combination was more efficient in the correction of the negative overbite mainly due to greater extrusion of the maxillary incisors. However, the Rpc+C appliance promoted better upper and lower incisor inclination, resulting in a more adequate overjet.