Abstract: Orthodontic management for patients with single or bilateral congenitally missing permanent lateral incisors is a challenge to effective treatment planning. Over the last several decades, dentistry has focused on several treatment modalities for replacement of missing teeth. The two major alternative treatment options are orthodontic space closure or space opening for prosthetic replacements. For patients with high aesthetic expectations implants are one of the treatment of choices, especially when it comes to replacement of missing maxillary lateral incisors and mandibular incisors. Edentulous areas where the available bone is compromised to use conventional implants with 2,5 mm or more in diameter, narrow diameter implants with less than 2,5 mm diameter can be successfully used. This case report deals with managing a compromised situation in the region of maxillary lateral incisor using a narrow diameter implant. Key words: Orthodontics, Correction of unilateral missing maxillary lateral incisors. Minimal invasive technique, narrow diameter implant
The maxillary lateral incisor is the second most frequently missing tooth. Females are more likely to be affected than males. Agenesis of the maxillary lateral incisor is often associated with other dental anomalies and requires complex multidisciplinary treatment. The two main treatment approaches are space closure using the canine or space opening for a prosthetic replacement, with the decision based on factors like malocclusion, crowding, facial profile, and canine characteristics.
Managing congenitally missing lateral incisors with single tooth implants Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. Several treatment
options exist for the replacement of congenitally missing lateral incisors. These options include canine substitution, resin bonded fixed partial dentures, cantilevered
fixed partial dentures, conventional fixed partial dentures and single tooth implants. Depending on which treatment option is chosen, a specific criterion has to be
addressed. Interdisciplinary treatment plays a vital role to achieve an excellent, esthetic result for a most predictable outcome. This paper describes the therapeutic use
of osseointegrated implants to replace congenitally missing upper lateral incisors. Highlighting the importance of the Orthodontic/Restorative interface.
Management of Congenitally Missing Lateral Incisors with Orthodontics and Sin...Abu-Hussein Muhamad
This case report describes the management of a congenitally missing maxillary lateral incisor using an interdisciplinary approach involving orthodontics, bone grafting, dental implant placement, and prosthodontics. Specifically, orthodontic treatment was used to create sufficient space between the central incisor and canine for an implant. A bone graft was then used to augment the alveolar ridge prior to placing a dental implant. After osseointegration, a crown was placed on the implant to replace the missing lateral incisor. Follow up after one year showed successful treatment outcomes with good esthetics, function, and periodontal health.
Congenitally Missing Maxillary Lateral IncisorNoha Ali
This document discusses congenitally missing teeth, specifically missing maxillary lateral incisors. It provides information on the definition, prevalence, clinical features, diagnosis and relationship to canine impaction. Key points include:
- Congenitally missing lateral incisors is a common developmental anomaly and has a genetic basis.
- Clinical features include midline diastema, retained primary teeth, and canine impaction.
- Diagnosis involves radiographs and examination to determine treatment planning factors like space, tooth size and position.
- Absent lateral incisors can disrupt eruption of the canine, increasing risk of impaction.
This document contains a diagnostic summary, clinical examination, radiographic findings, problem list, treatment aims and objectives, cephalometric interpretation, and treatment plan for an orthodontic patient. Key details include that the patient presented with a Class I incisor relationship on a Class II skeletal base with vertical proportions. Clinical findings show good oral hygiene and tooth quality with no pathology. The treatment plan is to use a functional appliance to improve the skeletal relationship, followed by fixed appliances to detail the occlusion. Retention will involve upper and lower retainers.
1. Solitary Median Maxillary Central Incisor Syndrome (SMMCI) is characterized by the presence of a single tooth in the middle of the upper jaw where two central incisors would normally be.
2. Diagnostic criteria for SMMCI include a solitary central incisor tooth in the maxilla, a V-shaped palate, nasal obstruction in over 90% of cases, and potential issues like cleft lip/palate or holoprosencephaly.
3. Management of SMMCI involves treating any nasal airway issues at birth, regular dental care, and eventual orthodontic treatment to make space for an artificial tooth on one side during permanent dentition.
Primary failure of eruption (PFE) is characterized by the non-syndromic failure of permanent teeth to erupt in the absence of a mechanical obstruction or known local/systemic cause. It can result in complete failure or initial eruption followed by failure. The cause is unknown but has a genetic component. It occurs in 1% of first molars and more commonly in females and molars. Diagnosis is often retrospective as orthodontic extrusion is unsuccessful. Treatment options include restorative work, segmental osteotomy, or extraction. Multiple failure of eruption can be due to local factors like supernumeraries or arch deficiency, systemic factors like genetic disorders or endocrinopathies, or be id
This document summarizes the normal development of primary and permanent dentition. It discusses the chronology of tooth development, including calcification and eruption times. It also describes the typical stages of postnatal dental development, from the edentulous stage to the functional permanent dentition stage. Abnormalities during development like natal or neonatal teeth are also addressed.
The maxillary lateral incisor is the second most frequently missing tooth. Females are more likely to be affected than males. Agenesis of the maxillary lateral incisor is often associated with other dental anomalies and requires complex multidisciplinary treatment. The two main treatment approaches are space closure using the canine or space opening for a prosthetic replacement, with the decision based on factors like malocclusion, crowding, facial profile, and canine characteristics.
Managing congenitally missing lateral incisors with single tooth implants Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. Several treatment
options exist for the replacement of congenitally missing lateral incisors. These options include canine substitution, resin bonded fixed partial dentures, cantilevered
fixed partial dentures, conventional fixed partial dentures and single tooth implants. Depending on which treatment option is chosen, a specific criterion has to be
addressed. Interdisciplinary treatment plays a vital role to achieve an excellent, esthetic result for a most predictable outcome. This paper describes the therapeutic use
of osseointegrated implants to replace congenitally missing upper lateral incisors. Highlighting the importance of the Orthodontic/Restorative interface.
Management of Congenitally Missing Lateral Incisors with Orthodontics and Sin...Abu-Hussein Muhamad
This case report describes the management of a congenitally missing maxillary lateral incisor using an interdisciplinary approach involving orthodontics, bone grafting, dental implant placement, and prosthodontics. Specifically, orthodontic treatment was used to create sufficient space between the central incisor and canine for an implant. A bone graft was then used to augment the alveolar ridge prior to placing a dental implant. After osseointegration, a crown was placed on the implant to replace the missing lateral incisor. Follow up after one year showed successful treatment outcomes with good esthetics, function, and periodontal health.
Congenitally Missing Maxillary Lateral IncisorNoha Ali
This document discusses congenitally missing teeth, specifically missing maxillary lateral incisors. It provides information on the definition, prevalence, clinical features, diagnosis and relationship to canine impaction. Key points include:
- Congenitally missing lateral incisors is a common developmental anomaly and has a genetic basis.
- Clinical features include midline diastema, retained primary teeth, and canine impaction.
- Diagnosis involves radiographs and examination to determine treatment planning factors like space, tooth size and position.
- Absent lateral incisors can disrupt eruption of the canine, increasing risk of impaction.
This document contains a diagnostic summary, clinical examination, radiographic findings, problem list, treatment aims and objectives, cephalometric interpretation, and treatment plan for an orthodontic patient. Key details include that the patient presented with a Class I incisor relationship on a Class II skeletal base with vertical proportions. Clinical findings show good oral hygiene and tooth quality with no pathology. The treatment plan is to use a functional appliance to improve the skeletal relationship, followed by fixed appliances to detail the occlusion. Retention will involve upper and lower retainers.
1. Solitary Median Maxillary Central Incisor Syndrome (SMMCI) is characterized by the presence of a single tooth in the middle of the upper jaw where two central incisors would normally be.
2. Diagnostic criteria for SMMCI include a solitary central incisor tooth in the maxilla, a V-shaped palate, nasal obstruction in over 90% of cases, and potential issues like cleft lip/palate or holoprosencephaly.
3. Management of SMMCI involves treating any nasal airway issues at birth, regular dental care, and eventual orthodontic treatment to make space for an artificial tooth on one side during permanent dentition.
Primary failure of eruption (PFE) is characterized by the non-syndromic failure of permanent teeth to erupt in the absence of a mechanical obstruction or known local/systemic cause. It can result in complete failure or initial eruption followed by failure. The cause is unknown but has a genetic component. It occurs in 1% of first molars and more commonly in females and molars. Diagnosis is often retrospective as orthodontic extrusion is unsuccessful. Treatment options include restorative work, segmental osteotomy, or extraction. Multiple failure of eruption can be due to local factors like supernumeraries or arch deficiency, systemic factors like genetic disorders or endocrinopathies, or be id
This document summarizes the normal development of primary and permanent dentition. It discusses the chronology of tooth development, including calcification and eruption times. It also describes the typical stages of postnatal dental development, from the edentulous stage to the functional permanent dentition stage. Abnormalities during development like natal or neonatal teeth are also addressed.
This report, prepared by the student at the College of Dentistry, Hassan Atheed , in the third phase discusses scientific topics, but it maybe did not be 100% complete.
Diastema, which means interval in Greek, is a gap or space between two or more consecutive teeth. It occurs more frequently in the median plane of the maxillary arch between the two central incisors and hence called the median, central or midline diastema.[1,2]Maxillary midline diastemas are an aesthetic concern for many patients and their parents. The diastema seen in many children as part of normal development in the mixed dentition, disappears naturally in most cases as dental development proceeds.It may however persist either because of its width or other associated factors. If it is to be closed satisfactorily by orthodontics an understanding of the aetiology is essential.
حسن عضيد
This document discusses impacted and unerupted maxillary incisors. It provides information on prevalence, causes such as supernumerary teeth or odontomes, and classifications of delayed eruption. For management, it recommends examining patient history, radiographs, and surgical exposure techniques. Surgical exposure can be open, involve an apically repositioned flap, or use a closed eruption procedure. Factors like position, angulation, and amount of attached gingiva determine the best exposure technique. Orthodontic treatment may involve space creation, surgical exposure with orthodontic alignment, or tooth removal and space management. Complications of orthodontic treatment include relapse, non-compliance, root resorption,
Principles, indications and contraindications of removal ofijazkhan2222
This document discusses the principles, indications, and contraindications of removing impacted teeth. It defines an impacted tooth as one that fails to erupt into the dental arch within the expected time. Common causes of impacted teeth and which teeth are most likely to become impacted are described. Indications for removing impacted teeth include preventing periodontal disease, dental caries, pericoronitis, root resorption, issues under dental prosthetics, cysts/tumors, jaw fractures, facilitating orthodontic treatment, and obstruction of normal tooth eruption or unexplained pain. Classification systems for impacted teeth include describing the angulation, relationship to the ramus, and relationship to the occlusal plane.
First Chapter of Orthodontics, Notes & Short Summary of First Chapter of Orthodontics from Contemporary Orthodontics, William R. Proffit. These are Notes for Final Year Students of Undergraduate Dentistry.
Osteogenesis imperfecta is a genetic disorder characterized by brittle bones that fracture easily from minor trauma or stress. It is caused by mutations in the COL1A1 and COL1A2 genes which encode type 1 collagen. Common features include bone fractures, spinal curvature, loose joints, bluish sclera, early hearing loss, and translucent teeth. Dentinogenesis imperfecta is a related condition that causes discolored, opalescent teeth that are prone to wear, breakage, and loss. Amelogenesis imperfecta is another related condition that results in abnormal enamel formation and causes teeth to have abnormal color, increased sensitivity, and rapid wear.
ESTHETIC MANAGEMENT OF CONGENITALLY MISSING LATERAL INCISORS WITH SINGLE TOOT...Abu-Hussein Muhamad
This document discusses the esthetic management of congenitally missing lateral incisors with single tooth implants. It begins with definitions of hypodontia and discusses prevalence and etiology. Treatment involves an interdisciplinary approach between orthodontics and restorative dentistry. Specifically, the paper describes a case study where osseointegrated implants were used to replace missing maxillary lateral incisors. Key steps included orthodontic space opening, implant placement, and prosthetic restoration. The advantages and disadvantages of the single tooth implant approach are summarized.
The document discusses third molar impaction, including prevalence, causes, types of impaction, problems that can be caused by impacted third molars, and debates around their relationship to crowding. It also outlines recommendations and guidelines for management and treatment of impacted third molars, indicating when removal may or may not be advisable based on factors like symptoms, risk of complications, and orthodontic considerations. Complications of removal are also discussed.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses impacted maxillary canines, including:
- Unerupted canines is a common clinical problem, with prevalence ranging from 0.8-2.8%.
- Normal development involves calcification starting at age 1 and eruption around 11-12 years old.
- Factors that can cause impaction include crowding, prolonged retention of primary canines, abnormal position of tooth buds, and genetic factors.
- Diagnosis involves inspection for delayed/asymmetric eruption, palpation of buds, and diagnostic imaging to determine location, development stage, and other anatomical details of unerupted canines.
Treacher Collins Syndrome (TCS) is a rare genetic disorder characterized by deformities of the face, eyes, ears and jaw. It is caused by mutations in the TCOF1 gene. Clinical features include downward slanting eyes, ear abnormalities, cleft palate and a recessed chin. Treatment involves surgery to reconstruct facial structures and manage airway issues in infancy. Further reconstructive surgeries are often needed as the child grows. Prognosis is good with treatment, though facial differences typically remain.
This document defines and describes different types of tooth transpositions, including true transposition where both crowns and roots are exchanged, and pseudo-transposition where only crowns are affected. It also discusses the prevalence, aetiology, classification, and treatment options for transpositions. Transpositions are most common in the maxilla, affect females more, and the most frequent type involves the maxillary canine transposing with the first premolar. Treatment depends on the specific case but may involve early intervention, orthodontics to correct positioning, or leaving transposed teeth in place. Intraosseous migration of teeth, like a canine migrating to the opposite side of the jaw, is also discussed.
Class I malocclusion is defined as when the lower incisors occlude directly beneath the upper incisors with an overjet of 2-3mm. It is one of the most common malocclusions, affecting 44-50% of populations. Treatment may involve addressing traits like crowding, crossbites, deep bites, spacing issues, and impacted or missing teeth. Treatment approaches can include extractions, interproximal reduction, arch expansion, orthodontic appliances, and sometimes orthognathic surgery. The goal of treatment is to relieve crowding, achieve normal overjet and overbite, align and level teeth, and detail the occlusion.
Dr. Muhammad Sohail presented information on tooth agenesis/hypodontia, which is characterized by the absence of one or more teeth. Some key points include:
- The prevalence is 2.7-12.2% in permanent dentition excluding third molars.
- Genetic and environmental factors can contribute to its etiology.
- Treatment depends on the number and location of missing teeth and may include space closure, autotransplantation, or prosthetic replacement.
- Management requires a multidisciplinary approach including orthodontics, prosthodontics, oral surgery and restorative dentistry.
Third molar /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The document discusses impacted third molars, providing information on their prevalence, causes, classifications, indications for removal, surgical removal process, and potential complications. Specifically, it notes that 17% of people over 20 have an impacted tooth, with mandibular third molars being the most common at 18%. Reasons for removal include recurrent pericoronitis, dental disease, cyst formation, and prophylactic reasons. The surgical procedure involves raising a mucoperiosteal flap, removing bone, and extracting the tooth, with risks including nerve damage, bleeding, and fracture.
This document provides an overview of tooth development from embryology through adulthood. It discusses the stages of prenatal tooth formation beginning at 4-6 weeks of gestation. Genetic control of tooth development is also reviewed. The postnatal development of the dentition is described in 6 stages: edentulous, pre-eruptive, early primary dentition, late primary dentition, mixed dentition, and full permanent dentition. Common dental anomalies associated with each developmental stage are listed. Theories of tooth eruption mechanisms are also briefly discussed.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. Impacted teeth can be defined as those prevented from eruption at the expected time due to physical barrier. The etiology, frequency of impactions are given. Classification systems are based on the depth, angulation, and available space. Complications associated with lower third molar impaction are discussed and methods of treatment are explained. Comparison between maxillary third molar and mandibular one is given. Upper canine is the second most commonly impacted tooth after third molars. It form the foundation of an esthetic smile. The management of impacted canine is interdisciplinary management comprises of a team of an orthodontist, oral surgeon, and periodontist.
This document provides an overview of the management of impacted third molars and maxillary canines. It discusses the causes and prevalence of impacted teeth, classifications of impactions, indications and contraindications for extraction, surgical procedures, and complications. Impacted third molars are the most common impacted teeth, with mandibular molars more prevalent than maxillary. Classification systems describe angulation, depth of impaction, and root morphology. Extraction is indicated for pathology but not for asymptomatic teeth. Surgical procedures involve exposure, bone removal if needed, tooth sectioning or elevation, and closure. Post-operative issues may include pain, swelling, and nerve injury.
This document summarizes the 4 stages of dental development: gum pad, primary dentition, mixed dentition, and permanent dentition. It describes normal sequences of eruption and development as well as some abnormalities that can occur such as natal teeth, eruption cysts, delayed or failed eruption, premature loss of primary teeth, retained primary teeth, impacted permanent molars, dilaceration, supernumerary teeth, and habits affecting development. It provides guidance on management of space issues and timing of extractions in the mixed dentition to facilitate proper alignment of permanent teeth.
This document provides an introduction to the field of oral biology. It discusses the main topics covered in oral biology, including the origin, growth, development, structure and functions of oral tissues. Some key areas covered are dental anatomy, the different types of human dentitions, anatomical landmarks of teeth, and tooth anatomy. It also discusses oral histology, the microscopic study of cells and tissues in the oral cavity. Specific topics in oral histology mentioned are the structures of bone, enamel, dentin, and pulp tissues, as well as methods for preparing tissue samples for examination under light and electron microscopes.
The maxilla is the second largest bone of the face that forms the upper jaw. It has a pyramidal shape with a body and four processes. It encloses the maxillary sinus and contains teeth. Unerupted and impacted teeth can occur due to various local and systemic factors. Impacted third molars and maxillary teeth are most common. Surgical removal requires careful planning including imaging and flap design. Complications may occur during surgery or postoperatively. Displaced teeth may require additional procedures like exposure through the maxillary sinus or removal from the buccal space.
Unilateral Maxillary Lateral Incisor Agenesis with Mini Implant Prostheses: A...Abu-Hussein Muhamad
Orthodontic management for patients with single or bilateral congenitally missing permanent lateral incisors is a
challenge to effective treatment planning. Over the last several decades, dentistry has focused on several treatment
modalities for replacement of missing teeth. The two major alternative treatment options are orthodontic space
closure or space opening for prosthetic replacements. For patients with high aesthetic expectations implants are one
of the treatment of choices, especially when it comes to replacement of missing maxillary lateral incisors and
mandibular incisors. Edentulous areas where the available bone is compromised to use conventional implants with
2.5 mm or more in diameter, narrow diameter implants with less than 2.5 mm diameter can be successfully used.
This case report deals with managing a compromised situation in the region of maxillary lateral incisor using a
narrow diameter implant.
Congenitally Missing Bilateral Incisors with Single-Tooth Implants: Clinical ...Abu-Hussein Muhamad
Agenesis, the absence of permanent teeth, is a common occurrence among dental patients. The total incidence of tooth agenesis is about 4.2% among patients that are seeking orthodontic treatment and with the exception of third molars, the maxillary lateral incisors are the most common congenitally missing teeth with about a 2% incidence . Esthetically correcting congenitally missing maxillary lateral incisors is a common challenge that every orthodontist and dental team will face, and dentists must consider the treatment options that are most appropriate for each patient.
This paper describes the therapeutic use of osseointegrated implants to replacε congenitally missing upper lateral incisors. Highlighting the importance of the Orthodontic/Restorative interface.
This report, prepared by the student at the College of Dentistry, Hassan Atheed , in the third phase discusses scientific topics, but it maybe did not be 100% complete.
Diastema, which means interval in Greek, is a gap or space between two or more consecutive teeth. It occurs more frequently in the median plane of the maxillary arch between the two central incisors and hence called the median, central or midline diastema.[1,2]Maxillary midline diastemas are an aesthetic concern for many patients and their parents. The diastema seen in many children as part of normal development in the mixed dentition, disappears naturally in most cases as dental development proceeds.It may however persist either because of its width or other associated factors. If it is to be closed satisfactorily by orthodontics an understanding of the aetiology is essential.
حسن عضيد
This document discusses impacted and unerupted maxillary incisors. It provides information on prevalence, causes such as supernumerary teeth or odontomes, and classifications of delayed eruption. For management, it recommends examining patient history, radiographs, and surgical exposure techniques. Surgical exposure can be open, involve an apically repositioned flap, or use a closed eruption procedure. Factors like position, angulation, and amount of attached gingiva determine the best exposure technique. Orthodontic treatment may involve space creation, surgical exposure with orthodontic alignment, or tooth removal and space management. Complications of orthodontic treatment include relapse, non-compliance, root resorption,
Principles, indications and contraindications of removal ofijazkhan2222
This document discusses the principles, indications, and contraindications of removing impacted teeth. It defines an impacted tooth as one that fails to erupt into the dental arch within the expected time. Common causes of impacted teeth and which teeth are most likely to become impacted are described. Indications for removing impacted teeth include preventing periodontal disease, dental caries, pericoronitis, root resorption, issues under dental prosthetics, cysts/tumors, jaw fractures, facilitating orthodontic treatment, and obstruction of normal tooth eruption or unexplained pain. Classification systems for impacted teeth include describing the angulation, relationship to the ramus, and relationship to the occlusal plane.
First Chapter of Orthodontics, Notes & Short Summary of First Chapter of Orthodontics from Contemporary Orthodontics, William R. Proffit. These are Notes for Final Year Students of Undergraduate Dentistry.
Osteogenesis imperfecta is a genetic disorder characterized by brittle bones that fracture easily from minor trauma or stress. It is caused by mutations in the COL1A1 and COL1A2 genes which encode type 1 collagen. Common features include bone fractures, spinal curvature, loose joints, bluish sclera, early hearing loss, and translucent teeth. Dentinogenesis imperfecta is a related condition that causes discolored, opalescent teeth that are prone to wear, breakage, and loss. Amelogenesis imperfecta is another related condition that results in abnormal enamel formation and causes teeth to have abnormal color, increased sensitivity, and rapid wear.
ESTHETIC MANAGEMENT OF CONGENITALLY MISSING LATERAL INCISORS WITH SINGLE TOOT...Abu-Hussein Muhamad
This document discusses the esthetic management of congenitally missing lateral incisors with single tooth implants. It begins with definitions of hypodontia and discusses prevalence and etiology. Treatment involves an interdisciplinary approach between orthodontics and restorative dentistry. Specifically, the paper describes a case study where osseointegrated implants were used to replace missing maxillary lateral incisors. Key steps included orthodontic space opening, implant placement, and prosthetic restoration. The advantages and disadvantages of the single tooth implant approach are summarized.
The document discusses third molar impaction, including prevalence, causes, types of impaction, problems that can be caused by impacted third molars, and debates around their relationship to crowding. It also outlines recommendations and guidelines for management and treatment of impacted third molars, indicating when removal may or may not be advisable based on factors like symptoms, risk of complications, and orthodontic considerations. Complications of removal are also discussed.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses impacted maxillary canines, including:
- Unerupted canines is a common clinical problem, with prevalence ranging from 0.8-2.8%.
- Normal development involves calcification starting at age 1 and eruption around 11-12 years old.
- Factors that can cause impaction include crowding, prolonged retention of primary canines, abnormal position of tooth buds, and genetic factors.
- Diagnosis involves inspection for delayed/asymmetric eruption, palpation of buds, and diagnostic imaging to determine location, development stage, and other anatomical details of unerupted canines.
Treacher Collins Syndrome (TCS) is a rare genetic disorder characterized by deformities of the face, eyes, ears and jaw. It is caused by mutations in the TCOF1 gene. Clinical features include downward slanting eyes, ear abnormalities, cleft palate and a recessed chin. Treatment involves surgery to reconstruct facial structures and manage airway issues in infancy. Further reconstructive surgeries are often needed as the child grows. Prognosis is good with treatment, though facial differences typically remain.
This document defines and describes different types of tooth transpositions, including true transposition where both crowns and roots are exchanged, and pseudo-transposition where only crowns are affected. It also discusses the prevalence, aetiology, classification, and treatment options for transpositions. Transpositions are most common in the maxilla, affect females more, and the most frequent type involves the maxillary canine transposing with the first premolar. Treatment depends on the specific case but may involve early intervention, orthodontics to correct positioning, or leaving transposed teeth in place. Intraosseous migration of teeth, like a canine migrating to the opposite side of the jaw, is also discussed.
Class I malocclusion is defined as when the lower incisors occlude directly beneath the upper incisors with an overjet of 2-3mm. It is one of the most common malocclusions, affecting 44-50% of populations. Treatment may involve addressing traits like crowding, crossbites, deep bites, spacing issues, and impacted or missing teeth. Treatment approaches can include extractions, interproximal reduction, arch expansion, orthodontic appliances, and sometimes orthognathic surgery. The goal of treatment is to relieve crowding, achieve normal overjet and overbite, align and level teeth, and detail the occlusion.
Dr. Muhammad Sohail presented information on tooth agenesis/hypodontia, which is characterized by the absence of one or more teeth. Some key points include:
- The prevalence is 2.7-12.2% in permanent dentition excluding third molars.
- Genetic and environmental factors can contribute to its etiology.
- Treatment depends on the number and location of missing teeth and may include space closure, autotransplantation, or prosthetic replacement.
- Management requires a multidisciplinary approach including orthodontics, prosthodontics, oral surgery and restorative dentistry.
Third molar /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The document discusses impacted third molars, providing information on their prevalence, causes, classifications, indications for removal, surgical removal process, and potential complications. Specifically, it notes that 17% of people over 20 have an impacted tooth, with mandibular third molars being the most common at 18%. Reasons for removal include recurrent pericoronitis, dental disease, cyst formation, and prophylactic reasons. The surgical procedure involves raising a mucoperiosteal flap, removing bone, and extracting the tooth, with risks including nerve damage, bleeding, and fracture.
This document provides an overview of tooth development from embryology through adulthood. It discusses the stages of prenatal tooth formation beginning at 4-6 weeks of gestation. Genetic control of tooth development is also reviewed. The postnatal development of the dentition is described in 6 stages: edentulous, pre-eruptive, early primary dentition, late primary dentition, mixed dentition, and full permanent dentition. Common dental anomalies associated with each developmental stage are listed. Theories of tooth eruption mechanisms are also briefly discussed.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. Impacted teeth can be defined as those prevented from eruption at the expected time due to physical barrier. The etiology, frequency of impactions are given. Classification systems are based on the depth, angulation, and available space. Complications associated with lower third molar impaction are discussed and methods of treatment are explained. Comparison between maxillary third molar and mandibular one is given. Upper canine is the second most commonly impacted tooth after third molars. It form the foundation of an esthetic smile. The management of impacted canine is interdisciplinary management comprises of a team of an orthodontist, oral surgeon, and periodontist.
This document provides an overview of the management of impacted third molars and maxillary canines. It discusses the causes and prevalence of impacted teeth, classifications of impactions, indications and contraindications for extraction, surgical procedures, and complications. Impacted third molars are the most common impacted teeth, with mandibular molars more prevalent than maxillary. Classification systems describe angulation, depth of impaction, and root morphology. Extraction is indicated for pathology but not for asymptomatic teeth. Surgical procedures involve exposure, bone removal if needed, tooth sectioning or elevation, and closure. Post-operative issues may include pain, swelling, and nerve injury.
This document summarizes the 4 stages of dental development: gum pad, primary dentition, mixed dentition, and permanent dentition. It describes normal sequences of eruption and development as well as some abnormalities that can occur such as natal teeth, eruption cysts, delayed or failed eruption, premature loss of primary teeth, retained primary teeth, impacted permanent molars, dilaceration, supernumerary teeth, and habits affecting development. It provides guidance on management of space issues and timing of extractions in the mixed dentition to facilitate proper alignment of permanent teeth.
This document provides an introduction to the field of oral biology. It discusses the main topics covered in oral biology, including the origin, growth, development, structure and functions of oral tissues. Some key areas covered are dental anatomy, the different types of human dentitions, anatomical landmarks of teeth, and tooth anatomy. It also discusses oral histology, the microscopic study of cells and tissues in the oral cavity. Specific topics in oral histology mentioned are the structures of bone, enamel, dentin, and pulp tissues, as well as methods for preparing tissue samples for examination under light and electron microscopes.
The maxilla is the second largest bone of the face that forms the upper jaw. It has a pyramidal shape with a body and four processes. It encloses the maxillary sinus and contains teeth. Unerupted and impacted teeth can occur due to various local and systemic factors. Impacted third molars and maxillary teeth are most common. Surgical removal requires careful planning including imaging and flap design. Complications may occur during surgery or postoperatively. Displaced teeth may require additional procedures like exposure through the maxillary sinus or removal from the buccal space.
Unilateral Maxillary Lateral Incisor Agenesis with Mini Implant Prostheses: A...Abu-Hussein Muhamad
Orthodontic management for patients with single or bilateral congenitally missing permanent lateral incisors is a
challenge to effective treatment planning. Over the last several decades, dentistry has focused on several treatment
modalities for replacement of missing teeth. The two major alternative treatment options are orthodontic space
closure or space opening for prosthetic replacements. For patients with high aesthetic expectations implants are one
of the treatment of choices, especially when it comes to replacement of missing maxillary lateral incisors and
mandibular incisors. Edentulous areas where the available bone is compromised to use conventional implants with
2.5 mm or more in diameter, narrow diameter implants with less than 2.5 mm diameter can be successfully used.
This case report deals with managing a compromised situation in the region of maxillary lateral incisor using a
narrow diameter implant.
Congenitally Missing Bilateral Incisors with Single-Tooth Implants: Clinical ...Abu-Hussein Muhamad
Agenesis, the absence of permanent teeth, is a common occurrence among dental patients. The total incidence of tooth agenesis is about 4.2% among patients that are seeking orthodontic treatment and with the exception of third molars, the maxillary lateral incisors are the most common congenitally missing teeth with about a 2% incidence . Esthetically correcting congenitally missing maxillary lateral incisors is a common challenge that every orthodontist and dental team will face, and dentists must consider the treatment options that are most appropriate for each patient.
This paper describes the therapeutic use of osseointegrated implants to replacε congenitally missing upper lateral incisors. Highlighting the importance of the Orthodontic/Restorative interface.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Interdisciplinary Management of Congenitally Agenesis Maxillary Lateral Incis...Abu-Hussein Muhamad
Abstract: The present paper reports the treatment of a young adult woman with congenitally missing maxillary lateral incisors who underwent orthodontic treatment for improvement of teeth alignment and occlusal balance previous to dental implant surgery. This treatment also allowed appropriate space for the future lateral incisors crowns. Then, Implants were positioned and prosthetic abutments installed. Ceramic laminates were planned on central incisors in order to improve anterior aesthetics. All-ceramic crowns and laminates were made using lithium dissilicate-based ceramic The multidisciplinary association of orthodontic, implant and prosthetic techniques resulted in successful functional and aesthetic rehabilitation of the case, which was maintained after 1 year follow up. Keywords: Dental agenesis. Dental implants. Ceramic laminates. Esthetic.
Two Treatment Approaches for Missing Maxillary Lateral Incisors: A CaseAbu-Hussein Muhamad
Missing maxillary lateral incisors create an esthetic problem with specific orthodontic and prosthetic considerations. The aim of the present study is to evaluate the clinical success of the transmucosal flapless implant placement and immediate loading of the implants to restore the agenic lateral incisors after completing the orthodontic treatment and during the retention period.
Prevalence of Missing Lateral Incisor Agenesis in an Or¬thodontic Arabs Popul...Abu-Hussein Muhamad
This study examined the prevalence of congenital absence (agenesis) of maxillary lateral incisors in 2,200 orthodontic patients of Arab descent in Israel. The researchers reviewed panoramic radiographs from 2006-2013 and found that 24 patients, or 1.1%, had agenesis of one or both maxillary lateral incisors. Specifically, 13 females (54.2%) and 11 males (45.8%) were missing their lateral incisors. This suggests the prevalence of maxillary lateral incisor agenesis in this population is 1.1%, providing data to compare to other studies on tooth agenesis frequencies.
Modern Treatment for Congenitally Missing Teeth : A Multidisciplinary Appro...Abu-Hussein Muhamad
The maxillary lateral incisor is the second most common congenitally absent tooth. There are several treatment options for replacing the missing maxillary lateral incisor, including canine substitution, tooth-supported restoration, or single-tooth implant. Dental implants are an appropriate treatment option for replacing missing maxillary lateral incisor teeth in adolescents when their dental and skeletal development is complete. This case report presents the treatment of a patient with congenitally missing maxillary lateral incisors using dental implants. Finally, the importance of interdisciplinary team treatment planning is emphasized as a requirement for achieving optimal final esthetics
The maxillary lateral incisor is smaller than the central incisor in most dimensions except root length. It varies more in form than other teeth. The crown is typically shorter and narrower mesiodistally than the central incisor, but the root is often longer. Developmental grooves and other anomalies can occur. The lateral incisor plays a supporting role to the central incisor in functions like biting and aesthetics.
The management of congenitally missing lateral incisors h rosenbergnatalie_archer
The document discusses several treatment options for managing congenitally missing lateral incisors including canine substitution, tooth-supported restorations, and single tooth implants. It provides criteria for determining the appropriate treatment including the patient's malocclusion, facial profile, characteristics of the canine tooth, and gingival display. The ideal treatment is considered the most conservative option that satisfies individual esthetic and functional needs.
This document summarizes the morphology and dimensions of the maxillary central and lateral incisors. It describes the labial, lingual, mesial, distal, and incisal surfaces of the central incisor and provides measurements of crown length, root length, and cervical line curvature. It also briefly outlines the chronology of central incisor development and eruption and notes that the lateral incisor is smaller than the central incisor and has more rounded mesioincisal and distoincisal angles and more prominent marginal ridges and cingulum lingually.
Prosthodontic-Orthodontic Treatment Plan with Two-Unit Cantilevered Resin-Bon...Abu-Hussein Muhamad
Abstract: Congenitally missing lateral incisors create an esthetic problem with specific orthodontic and prosthetic considerations. Selecting the appropriate treatment option depends on many factors, such us the malocclusion, the anterior relationship, specific space requirements, bone volume, root proximity, the condition of the adjacent teeth, and esthetic prediction mainly when the canine must be reshaped.Resin bonded bridges were considered to be doomed owing to their very high decementation rate, have come alive once again because of newer resin based cements. This article will discuss the variety of treatment managements in case of space opening and treated with two 2-unit cantilevered resin-bonded fixed partial dentures supported by the cuspids. This conservative treatment plan was cost-effective without having any significant biological cost. Keywords: Agenesis, Resin- bonded fixed partial denture, interim prosthesis.
Prosthodontic-Orthodontic Treatment Plan with Two-Unit Cantilevered Resin-Bon...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. The available treatment modalities to replace congenitally missing teeth include prosthodontic fixed and removable prostheses, resin bonded retainers, orthodontic movement of maxillary canine to the lateral incisor site and single tooth implants. Implants are a viable option for replacement of congenitally missing lateral incisors and should be considered before the commencement of definitive treatment plan. Early diagnosis, and proper planning can achieve excellent aesthetics. Interdisciplinary treatment plays a vital role to achieve an excellent, esthetic result for a most predictable outcome. This article aims to present a case report of replacement of bilaterally ,congenitally missing maxillary lateral incisors with dental implants .
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. The available treatment modalities to replace congenitally missing teeth include prosthodontic fixed and removable prostheses, resin bonded retainers, orthodontic movement of maxillary canine to the lateral incisor site and single tooth implants. Implants are a viable option for replacement of congenitally missing lateral incisors and should be considered before the commencement of definitive treatment plan. Early diagnosis, and proper planning can achieve excellent aesthetics.
Interdisciplinary treatment plays a vital role to achieve an excellent, esthetic result for a most predictable outcome. This article aims to present a case report of replacement of bilaterally ,congenitally missing maxillary lateral incisors with dental implants .
Esthetic Management of Congenitally Missing Lateral Incisors With Single Toot...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. Several treatment options exist for the replacement of congenitally missing lateral incisors.This case report addresses the fundamental considerations related to replacement of a congenitally missing lateral incisor by a team approach.
Esthetic Management of Congenitally Missing Lateral Incisors With Single Toot...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. Several treatment options exist for the replacement of congenitally missing lateral incisors.This case report addresses the fundamental considerations related to replacement of a congenitally missing lateral incisor by a team approach.
Pre prosthetic orthodontic implant for management of congenitally unerupted l...Abu-Hussein Muhamad
The maxillary lateral incisor is one of the most common congenitally missing teeth of the permanent dentition. With the advent of implants in the field of restorative dentistry, a stable and predictable fixed prosthetic replacement has become a reality, especially for young adult patients who suffer from congenital absence of teeth. The dual goals of establishment of functional stability as well as enhancement of esthetic outcomes are made achievable by the placement of implants. A multidisciplinary team approach involving the triad of orthodontist, periodontist and restorative dentist will ensure the successful completion of the integrated treatment approach in these patients. The present case report achieved successful implant based oral rehabilitation in a patient diagnosed with congenital absence of bilateral maxillary lateral incisors utilizing a preprosthetic orthodontic implant site preparation for the purpose of space gain.
Pre-Prosthetic Orthodontic Implant for Management of Congenitally Unerupted L...Abu-Hussein Muhamad
The maxillary lateral incisor is one of the most common congenitally missing teeth of the permanent
dentition. With the advent of implants in the field of restorative dentistry, a stable and predictable fixed
prosthetic replacement has become a reality, especially for young adult patients who suffer from congenital
absence of teeth. The dual goals of establishment of functional stability as well as enhancement of esthetic
outcomes are made achievable by the placement of implants. A multidisciplinary team approach involving the
triad of orthodontist, periodontist and restorative dentist will ensure the successful completion of the integrated
treatment approach in these patients. The present case report achieved successful implant based oral
rehabilitation in a patient diagnosed with congenital absence of bilateral maxillary lateral incisors utilizing a
preprosthetic orthodontic implant site preparation for the purpose of space gain.
Keywords: Preprosthetic, interdisciplinary treatment, implant placement
This case report discusses the treatment of a patient with congenitally missing upper lateral incisors. There were two treatment options considered: opening the spaces for prosthetic replacement or closing the spaces via canine substitution. The parents chose to close the spaces orthodontically. Fixed appliances were used to retract the canines into the lateral incisor spaces and extract mandibular premolars to relieve crowding. After treatment, the canines were reshaped to resemble lateral incisors. The final result had a Class I occlusion and improved esthetics. The report evaluates considerations for treating missing lateral incisors cases.
This document provides an overview of tooth autotransplantation, including:
1) Tooth autotransplantation involves moving a tooth from one position to another within the same person and has a long history dating back to ancient Egypt.
2) Successful transplantation depends on factors like the developmental stage of the donor tooth root, surgical technique, and periodontal ligament healing at the recipient site.
3) Indications for autotransplantation include replacing teeth lost to dental caries, trauma, agenesis or other pathologies when it can maintain alveolar bone and provide esthetic and functional benefits over alternatives.
- Extractions for orthodontic purposes have always been controversial, as some believe all teeth can be aligned without extractions while others believe extractions are sometimes necessary to treat malocclusions.
- Factors like a patient's medical history, oral hygiene, dental health, and the quality of their teeth affect whether extractions are recommended.
- While premolars are most commonly extracted, other teeth may be extracted depending on the specifics of the malocclusion and what is needed to achieve the best possible alignment and occlusion.
This document compares and contrasts different approaches for treating congenitally missing lateral incisors: restorative, implant, and orthodontic. It outlines the orthodontic approach of canine substitution, noting the ideal malocclusion and canine traits. Extensive planning is advised to predict esthetic and functional outcomes and additional needed treatments. The implant approach uses a single tooth implant for a conservative option when adjacent teeth have no issues. While osseointegration and function are excellent, esthetics can be challenging. An interdisciplinary plan is usually needed to determine the best individualized approach.
Combined orthodontic and prosthetic therapy special considerations.(52)Abu-Hussein Muhamad
Agenesis, the absence of permanent teeth, is a common occurrence among dental patients. The total incidence of tooth agenesis is about 4.2% among patients that are seeking orthodontic treatment and with the exception of third molars, the maxillary lateral incisors are the most common congenitally missing teeth with about a 2% incidence. The maxillary lateral incisor is the second most common congenitally absent tooth. There are several treatment options for replacing the missing maxillary lateral incisor, including canine substitution, tooth-supported restoration, or single-tooth implant. Dental implants are an appropriate treatment option for replacing missing maxillary lateral incisor teeth in adolescents when their dental and skeletal development is complete. This case report presents the treatment of a patient with congenitally missing maxillary lateral incisor using dental implants. The paper discusses the aspects of pre-prosthetic orthodontic diagnosis and the treatment that needs to be considered with conservative and fixed prosthetic replacement.
Congenital absence of maxillary lateral incisors is a frequent clinical challenge which must be solved by a multidisciplinary approach in order to obtain an
esthetic and functional restorative treatment. . Fixed prosthodontic and removable prostheses, resin bonded retainers, orthodontic movement of maxillary
canine to the lateral incisor site and single tooth implants represent the available treatment modalities to replace congenitally missing teeth. This case report
demonstrates the team approach in prosthetic and surgical considerations and techniques for managing the lack of lateral incisors. The aims of this case
report of replacement of bilaterally congenitally missing maxillary lateral incisors with dental implants.
Multidisciplinary Approach in the Rehabilitation of Congenitally Maxillary C...Abu-Hussein Muhamad
Objective: This case report describes the multidisciplinary
approach to treat a congenitally missed maxillary canine, how to
improve patient’s smile using orthodontic fixed appliance, endosseous
dental implant, and porcelain veneer to achieve the treatment results of
function and esthetic.
Materials and procedures: Unilateral agenesis of the permanent
maxillary canines in healthy individuals is extremely rare. This
paper presents the case of a female patient diagnosed with congenital
unilateral agenesis of the permanent maxillary canines as well as
occlusal abnormalities in the form of left-side crossbite. To restore the
proper aesthetics and function, interdisciplinary therapeutic treatment
was implemented. In the case presented in this paper, the aim of
oral rehabilitation was to restore a functional balance by obtaining
proper skeletal relationships, creating optimal occlusal conditions and
obtaining arch continuity.
Conclusion: Interdisciplinary treatment combined of orthodontics,
implant surgery, and prosthodontics was useful to treat a nonsyndromic
oligodontia patient. Especially, with the new strategy, implantanchored
orthodontics, which can facilitate the treatmentand make it
more simply with greater predictability.
Treatment of Patients With Congenitally Missing Lateral Incisors: Is an Inter...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. The available treatment modalities to replace congenitally missing teeth include prosthodontic fixed and removable prostheses, resin bonded retainers, orthodontic movement of maxillary canine to the lateral incisor site and single tooth implants. Dental implants offer a promising treatment option for placement of congenitally missing teeth. Interdisciplinary approach may be needed in these cases. This article aims to present a case report of replacement of bilaterally congenitally missing maxillary lateral incisors with dental implants.
The document discusses treatment options for congenitally missing maxillary lateral incisors, including canine substitution, single-tooth implants, and tooth-supported restorations. It provides details on the benefits and drawbacks of each approach. Space closure through canine substitution is presented as having the advantage of accomplishing treatment in one phase and producing permanent results independent of residual growth. However, achieving high esthetic standards requires restorative work on canines and premolars. A six-step clinical procedure is outlined to close spaces and perform restorations for an optimal esthetic outcome. Risks of biological complications with the implant approach over time are also noted.
Overdentures are a useful treatment option in many clinical situations. A simple complete lower overdenture which encloses the roots of two root-treated canines has been shown above (Fig. 12.51). Cases can be more complicated than this. The reduction in the crowns of the teeth may have occurred due to tooth wear from a combination of erosion and attrition. In the elderly, where such tooth reduction has occurred, root canal treatment may not be necessary. The removal of the roots will not benefit the patient and the overdenture is the best form of treatment.
Less common situations, such as partial anodontia, cleft palate or loss of tooth crown substance in dentinogenesis imperfecta, may also require restoration using overdentures. The distinction between an onlay and an overdenture is not clear-cut and a potentially difficult partial denture treatment, such as the restoration of a free end saddle, may be helped by the coverage of a canine or molar tooth with a reduced crown rather than a more involved crown restoration.
In the case illustrated in Figure 12.53, an elderly patient has severe tooth surface loss. The aetiology of this wear must be diagnosed before treatment is commenced. For instance, is this wear a result of parafunction or erosion from the consumption of acidic drinks? The remaining dentition has been restored and a definitive overdenture placed.
Esthetic Evaluation of ImplantsPlaced after Orthodontic Treatment in Patients...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the
proper treatment plan. Several treatment options exist for the replacement of congenitally missing lateral incisors.
These options include canine substitution, resin bonded fixed partial dentures, cantilevered fixed partial dentures,
conventional fixed partial dentures and single tooth implants. Depending on which treatment option is chosen, a
specific criterion has to be addressed. Interdisciplinary treatment plays a vital role to achieve an excellent, esthetic
result for a most predictable outcome. This article aims to present a case report of replacement of bilaterally
congenitally missing maxillary lateral incisors with dental implants
Key words: congenitally missing lateral incisor, interdisciplinary treatment, dental impla
Congenitally Missing Lateral Incisor with Orthodontics, Bone Grafting and Sin...Abu-Hussein Muhamad
This case report describes the interdisciplinary treatment of a congenitally missing maxillary lateral incisor. The treatment involved orthodontics to create sufficient space, a chair-side bone graft using autograft bone harvested with trephine drills to augment the alveolar ridge width, and placement of a single dental implant. After orthodontic space opening, bone was harvested from the mandibular ramus using trephine drills and grafted to the alveolar ridge. Then a dental implant was placed. The patient underwent supportive periodontal therapy and prosthetic rehabilitation with an implant-supported crown, providing an esthetic replacement for the missing lateral incisor.
Similar to Interdisciplinary Management Of Maxillary Lateral Incisors (20)
Aesthetic Management of Fractured Anteriors: A Case ReportAbu-Hussein Muhamad
Introduction: Coronal fracture of anterior teeth is an important topic for esthetic dentistry. Such fractures may jeopardize esthetics, function, tissue biology
and occlusal physiology, thus endangering tooth vitality and integrity. Coronal fractures resulting from dental trauma most frequently occur to the maxillary
anterior teeth of adolescents and less frequently to mandibular teeth. Adult teeth may also suffer traumatic fracture, although less frequently than for
adolescents.
Case Report: In our case, an economical and time-saving novel technique has been described for direct composite restoration in a young patient with
uncomplicated fractured maxillary anterior tooth.
Conclusion: As restoring a fractured tooth is a complex procedure, this technique can prove as a simple, effective and appropriate technique that will fulfill all
the requirements of dental personnel. This technique can also prove to be easy for inexperienced beginner clinicians without requiring special skills in
providing the patients with direct composite restorations.
Impacted Maxillary Central Incisors: Surgical Exposure and Orthodontic Treat...Abu-Hussein Muhamad
The maxillary permanent central incisor develops early in life and forms part of an aesthetic smile. Disruption of the formation or eruption of the permanent
central incisor has multiple etiological factors. Treatment options depend to some extent on the cause of failure of eruption of the central incisor. Generally,
the earlier treatment is provided, the higher the likelihood of success and the less the complexity. Our results suggest that close monitoring and interdisciplinary
cooperation during the treatment phases led to a successful esthetic result, with good periodontal health and functional occlusion.
Excess of space in the dental arch is diagnosed as a
generalised spacing or a local divergence, often
observed in the maxillary anterior region, as a median
diastema, traumatic loss of central incisors, or
congenital absence of lateral incisors. Furthermore,
spacing is observed in aging individuals, due to
pathological migration of teeth caused by
periodontitis. Finally, adult individuals with partial
edentulous jaws demand pre-prosthetic orthodontic
treatment from functional aspects. Thus, indication for
orthodontic treatment in subjects with spacing of teeth
exists for aesthetic reasons, but also for facilitating
prosthetic restorations with optimal occlusalstability.
Dental implants represent one of the most successful treatment modalities in dentistry.
However, failures do occur in the range from 5 to 8% for routine procedures and up to 20% in major grafting
cases after at least 5 years of function . The majority of implant losses may be explained as biomechanically
induced failures, since low primary implant stability, low bone density, short implants and overload have been
identified as risk factors . Hence, achievement and maintenance of implant stability are pre-conditions for a
successful clinical outcome with dental implants.
The review focuses on different methods used to assess implant stability and recent advances in this field.
This document provides guidance on how to write and publish a scientific paper in 3 steps:
1. Plan adequate time for writing a high-quality paper that will be accepted for publication. Previous studies show lack of time is the top reason papers are not published.
2. Carefully review the instructions for authors on the target journal's website and adhere strictly to formatting requirements. Ignoring guidelines is a common reason for rejection.
3. The paper should have key sections - an informative abstract, introduction establishing the study's purpose and novelty, thorough methods section, clear results, and conclusions tying it all together. Following best practices increases the chances of successful publication.
Aesthetic Management of Fractured Anteriors: A Case ReportAbu-Hussein Muhamad
Introduction: Coronal fracture of anterior teeth is an important topic for esthetic dentistry. Such fractures may jeopardize esthetics, function, tissue biology
and occlusal physiology, thus endangering tooth vitality and integrity. Coronal fractures resulting from dental trauma most frequently occur to the maxillary
anterior teeth of adolescents and less frequently to mandibular teeth. Adult teeth may also suffer traumatic fracture, although less frequently than for
adolescents.
Case Report: In our case, an economical and time-saving novel technique has been described for direct composite restoration in a young patient with
uncomplicated fractured maxillary anterior tooth.
Conclusion: As restoring a fractured tooth is a complex procedure, this technique can prove as a simple, effective and appropriate technique that will fulfill all
the requirements of dental personnel. This technique can also prove to be easy for inexperienced beginner clinicians without requiring special skills in
providing the patients with direct composite restorations
Orthodontic tooth movement is basically a biologic response towards a mechanical force. Osteoclast and osteoblast cells mediate bone resorption and apposition, which eventually produces tooth movement. Researches showed that the rate of orthodontic tooth movement can be altered by certain drugs locally or systemically. The Objective of this article is to discuss the current data concerning the effect of drugs on orthodontic tooth movement.
The multifactorial factors influenc cleft Lip-literature review Abu-Hussein Muhamad
Congenital cleft-Lip and cleft palate have been the subject of many genetic
studies, but until recently there has been no consensus as to their modes of
inheritance. In fact, claims have been made for just about every genetic
mechanism one can think of. Recently, however, evidence has been
accumulating that favors a multifactorial basis for these malformations. The
purpose of the present paper is to present the etiology of cleft lip and cleft palate
both the genetic and the environmental factors. It is suggested that the genetic
basis for diverse kinds of common or uncommon congenital malformations may
very well be homogeneous, whilst, at the same, the environmental basis is
heterogeneous.
Dental implants represent one of the most successful treatment modalities in dentistry.
However, failures do occur in the range from 5 to 8% for routine procedures and up to 20% in major grafting cases after at least 5 years of function . The majority of implant losses may be explained as biomechanically induced failures, since low primary implant stability, low bone density, short implants and overload have been identified as risk factors . Hence, achievement and maintenance of implant stability are pre-conditions for a successful clinical outcome with dental implants.
The review focuses on different methods used to assess implant stability and recent advances in this field
Over time, progressively shorter implants have been placed such that short implants are now available that are less than 6 mm in length. The viability and high success rates seen with short implants can be explained by osseointegration, the macro geometric design of the implant, as well as physics and the distribution of forces. This paper was aimed to review the stability and survival rate of short implants under functional loads. Numerical and clinical studies were reviewed. Keywords: Short dental implants, sinus augmentation, factors affecting bone regeneration in dental implantology
Porcelain laminate veneers are among the most esthetic means of creating a more pleasing and beautiful smile. Porcelain veneers within reason allow for the alteration of tooth position, shape, size and color. They require a minimal amount of tooth preparation, approximately 0.5 mm to 0.7mm of surface enamel reduction. This study describes the use of ceramic veneers without tooth wear, reinforcing the concept that minimally invasive porcelain laminate veneers could become versatile and conservative allies in the fi eld of esthetic dentistry. Keywords: Ceramics, dentin-bonding agents, esthetics
Immediate Restoration of Single Implants Replacing Lateral Incisor Compromis...Abu-Hussein Muhamad
Today, the diagnosis of internal root resorption is significantly improved by the three-dimensional imaging. Furthermore, the CBCT’s superior diagnosis accuracy resulted in an improved management of the resorptive defects and a better outcome of Implant therapy of teeth with internal resorption.Implant has become a wide option to maintain periodontal architecture. Diagnosis and treatment planning is the key factors in achieving the successful outcomes after placing and restoring implants placed immediately after tooth extraction. The purpose of this clinical update is to report on the success and survival of Immediate restoration of single implants replacing right lateral incisor compromised by internal resorption.
Immediate Implant Placement And Restoration With Natural Tooth In The Maxilla...Abu-Hussein Muhamad
Anterior tooth loss and restoration in the esthetic zone is a common challenge in dentistry today. The prominent visibility of the area can be especially distressing to the patient and requires a timely and esthetically pleasing solution. Immediate single-tooth implantation followed by immediate provisionalization is becoming an increasingly desirable treatment that offers numerous benefits over conventional delayed loading. Provisionalization for immediately-placed implants using the patient’s existing tooth can enhance the final aesthetic outcome if certain steps are
followed. If the natural tooth is intact and can be used as a provisional, the emergence profile can be very similar to the preoperative condition. This article outlines a technique to use the patient’s natural tooth after extraction to provisionalize an implant.
Clinical Management of Bilateral Impacted Maxillary CaninesAbu-Hussein Muhamad
Introduction: Impaction of maxillary canines is a frequently encountered clinical problem in orthodontic therapy. When a preventive
approach fails, treatment involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the
dental arch. The aim of the present report was to demonstrate by case reports of an adult patient with bilateral impacted maxillary canines
treated with surgical exposure and orthodontic treatment.
Material and Methods: A 15year-old female with various degrees of bilateral palatal impaction of maxillary canines were managed
by the described technique.
Results and Discussion: Autonomous eruption of the impacted canines after surgical uncovering was witnessed in all patients
without the need for application of a vertical orthodontic force for their extrusion.
Conclusion: The described method of surgical uncovering and autonomous eruption created conditions for biological eruption of the
palatally impacted canines into the oral cavity and facilitated considerably the subsequent orthodontic treatment for their proper alignment
in the dental arch.
Keywords: Impacted canines; Surgical; Tooth exposure; Orthodontic treatment
“One-Piece” Immediate-Load Post-Extraction Implant In Maxillary Central IncisorAbu-Hussein Muhamad
Abstract: This case report describes extraction of a fractured left maxillary central incisor tooth, followed by immediate placement of an one-piece implant in the prepared socket and temporization by a bonded restoration.
Materials And Methods: The tooth was extracted with minimal hard and soft tissue trauma and without flap reflection. The socket was prepared to the required depth and a Implant was inserted.
Results: The atraumatic operating technique and the immediate insertion of the one-piece Implant resulted in the preservation of the hard and soft tissues at the extraction site.
Conclusion: The “One-piece” dental implant and provisional restoration provided the patient with immediate esthetics, function, comfort and most importantly preservation of tissues. The one-piece implant design resulted in a high cumulative implant survival rate and beneficial marginal bone levels.
Single Visit Replacement of Central Maxillary Using Fiber-Reinforced Composi...Abu-Hussein Muhamad
Fiber reinforced composites are high strength filling materials composed of conventional composites and glass fibres. They exhibit extensive applications in different fields of dentistry. This clinical report present a case where FRC technology was successfully used to restore central maxillary incisor edentulous area in terms of esthetic-cosmetic values and functionality.
Zirconium Dental Implants And Crown for Congenitally Missing Maxillary Latera...Abu-Hussein Muhamad
Zirconia implants were familiarized into dental implantology. Zirconia appears
to be an appropriate implant material due to its low plaque affinity, tooth like color, biocompatibility and mechanical properties. The following a case presentations will show how the acid-etched zirconia Implant can be used to functionally and aesthetically replace congenitally missing left lateral incisor tooth germ in the maxilla, and achieve optimal soft tissues and health.
Surgery of Labially Impacted Canine & Orthodontic Management – A Case ReportAbu-Hussein Muhamad
Maxillary canines are one of the most common teeth that are impacted among patients seeking orthodontic treatment. Depending on the position of these impacted teeth, various surgical techniques have been employed for their exposure. His primary goal of surgical phase is to provide the means for correct position of orthodontic anchorage. Additionally, the technique used must ensure favorable tissue anatomy that will permit long-term maintenance of periodontal health. In the present case, a labially impacted maxillary left canine was surgically exposed using an apically positioned flap. Orthodontic extrusion was carried out further.
Taurodontism is a rare dental anomaly in which the involved tooth has an enlarged and elongated body and pulp chamber
with apical displacement of the pulpal floor. Endodontic treatment of a taurodont tooth is challenge to a clinician and
requires special handling because of the proximity and apical displacement of the roots. The present article describes the
diagnosis and management of hypertaurodontism by endodontic treatment in a left mandibular second molar.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
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Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
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Ageing, the Elderly, Gerontology and Public Health
Interdisciplinary Management Of Maxillary Lateral Incisors
1. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 12 Ver. VIII (Dec. 2015), PP 00-00
www.iosrjournals.org
DOI: 10.9790/0853-1412XXXX www.iosrjournals.org 1 | Page
Interdisciplinary Management Of Maxillary Lateral Incisors
Agenesis With Mini Implant Prostheses: A Case Report
Dr.Azzaldeen Abdulgani,. Dr.Nikos Kontoes, Dr.Georgos Chlorokostas,
Dr.Abu-Hussein Muhamad*
DDS,MScD,MSc,MDentSci(PaedDent) ,FICD 123Argus Street, 10441 Athens, Greece
Abstract: Orthodontic management for patients with single or bilateral congenitally missing permanent lateral
incisors is a challenge to effective treatment planning. Over the last several decades, dentistry has focused on
several treatment modalities for replacement of missing teeth. The two major alternative treatment options are
orthodontic space closure or space opening for prosthetic replacements. For patients with high aesthetic
expectations implants are one of the treatment of choices, especially when it comes to replacement of missing
maxillary lateral incisors and mandibular incisors. Edentulous areas where the available bone is compromised
to use conventional implants with 2,5 mm or more in diameter, narrow diameter implants with less than 2,5 mm
diameter can be successfully used. This case report deals with managing a compromised situation in the region
of maxillary lateral incisor using a narrow diameter implant.
Key words: Orthodontics, Correction of unilateral missing maxillary lateral incisors. Minimal invasive
technique, narrow diameter implant
I. Introduction
Many terms can be used to describe missing teeth. Anodontia is the complete absence of teeth;
Oligodontia or partial anodontia means absence of six or more teeth; hypodontia denotes missing teeth, but
usually less than six and often the size and shape of remaining teeth are altered as well, congenitally missing
teeth or agenesis is defined as teeth that failed to develop or are not present at birth. Agenesis of any tooth can
cause dental asymmetries, alignment difficulties, and arch length discrepancies but when the missing tooth is in
the anterior region of the maxilla, the discrepancies can be quite noticeable.[1,2] The maxillary lateral incisor is
the second most frequently missing tooth after the mandibular second premolar even though Muller et al. found
that maxillary lateral incisors experience the most agenesis (not including third molars). Agenesis of the
maxillary lateral incisor is also linked with anomalies and syndromes such as agenesis of other permanent teeth,
microdontia of maxillary lateral incisors (peg laterals), palatally displaced canines and distal angulations of
mandibular second premolars.[5] Absence of any tooth can cause treatment difficulties, but agenesis of the
maxillary lateral incisor poses a unique set of restorative challenges. Because the maxillary lateral incisor is
located in the esthetic zone, it is essential that bone height, papilla height, enamel color, and shape match the
surrounding teeth. Clinicians attempt to maintain the proper anterior overbite, overjet and ideal interarch
relationships of the canine teeth while creating enough space for a fixed partial denture or more commonly, an
implant with a single crown restoration, but few treatment options are available for patients with agenesis of one
or both maxillary lateral incisors. One option is to close the space(s) and restore the remaining teeth accordingly
and the second is to open the space for a fixed partial denture or implant .[3,4] Kokich believes that canine
substitution can be an excellent option for some patients, especially if they are Angle Class II with excessive
overjet or are Class I with enough crowding in the mandibular arch to warrant extractions. The profile of the
patients is another factor to consider. Protrusive faces are often more esthetically conducive for canine
substitution than creating space for an implant by proclining the incisors and potentially making the lips more
protrusive. The color and shape of the canines also needs to be taken into account before choosing this as the
best option for treatment. If the canines are overly bulky or more yellow in hue than the central incisors, they
may need bleaching, enameloplasty or restoration before treatment is complete.[6,7,8] One prosthetic option for
replacing the missing lateral incisor is a resin bonded (Maryland) bridge, cantilevered bridge, or full-coverage
bridge. Some benefits to these restorations include being less invasive than an implant, they can be completed in
a growing individual, and there is more freedom with the space requirements when compared to the minimum of
6mm required for an implant. Kokich reports that the resin bonded bridge is especially conservative since the
preparations are only on the lingual of the incisors when compared to the fullcoverage abutments of a traditional
bridge. A cantilevered bridge is the second most conservative option, followed by the full-coverage bridge.
Mobility of the abutment teeth, angulations of the incisors, gingival contours and occlusion are all factors to take
into account before choosing one of these treatments for a patient.[3,4,7,8]
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Replacing the missing lateral incisor with an implant is another prosthetic alternative to closing the
space. Kokich states that the smallest implant for this site is about 3.2mm in diameter and recommends having
at least 1mm of bone between the implant and adjacent tooth. Therefore, the implant alone requires at least
5.2mm of space and with the restoration of the crown at least 6mm of space in required. Frequently, clinicians
cannot maintain the proper occlusion and create a minimum of 6mm of space for an implant. Kokich advises the
interproximal reduction of the central incisors, canines, or premolars to create enough space for an implant when
this situation arises. More recently, he recommended only slenderizing teeth distal to the canines so as not to
adversely affect anterior papillae in the esthetic zone. [6,7,8]
Brook et al. have shown thatsome genes are implicated in the agenesis of teeth, including PAX9,
MSX1 andAXIN2. The PAX9 gene is on chromosome with a controlling factor for dentaldevelopment and
mutations related to missing teeth.20 Brook et al. measured the tooth sizes on maxillary and mandibular dental
casts in the test group, 10 people with a known PAX9 mutation in one family and 10 people in a control group
matched for sex, age and ethnicity, who were not related to the test group and did not have the PAX9 mutation.
Differences in the test group with the mutation and hypodontia were found; these teeth were significantly
smaller than controls. Canines and first molars were least affected in the test group.[9,10] This contradicts
Bailit’s theory that genetics mostly affects the first tooth in each group: the central incisor, canine, first premolar
and molar[9,10]. Brook et al. found that the second tooth in each group was more affected by the PAX9
mutation. The study concluded that the PAX9 mutationnot only decreased tooth number, but also tooth size
throughout the dentition. large role in tooth size and agenesis with the PAX9 and MSX1 mutations; however
some authors suspect that the local environment is important factor. EGF, EGFR, FGF-3 and FGF-4 are not
shown to be linked to incisor-premolar agenesis, but it is possible that signaling factors early in embryologic
development may contribute to agenesis.[9] Through the work of Pirinen et al. and Arte et al., it is evident that
incisor premolar hypodontia is genetically inherited, with strong links to other dental anomalies such as
palatally impacted canines. Incisor-premolar hypodontia is an autosomal dominant gene inheritance with
incomplete penetrance.[11,12]
The incidence of congenitally missing maxillary lateral incisors has been reported to range from
between 1% and 2%1 to as high as 5%. Maxillary lateral incisors are the most common congenitally missing
teeth after upper and lower second premolars. Sex differences have been found to be negligible, with slightly
more females affected as compared with males. Treatment options include orthodontic movement of cuspids
into lateral incisor sites, prosthodontic restorations including fixed and removable prostheses and resin-bonded
retainers, and single tooth implants.[9] Implants do not require preparation of natural teeth and thus can be
considered the most conservative approach. Orthodontic space opening may be necessary but on occasion can
compromise esthetics, periodontal health, and function.[1,2,3,4]
Parents and professionals must often decide at a child’s early age on how to cope with congenitally
missing maxillary lateral incisors. Orthodontic treatment to create space for implants should not be initiated
before the age of 13. This will avoid the potential for alveolar bone atrophy and the risk of relapse and
subsequent retreatment.[3,4]
The management of small restorative areas in the esthetic zone has posed significant problems for the implant
and restorative team. The lack of bone available for the
surgeon as well as the lack of restorative space available between the adjacent
teeth makes tooth replacement with implants challenging for both the restorative dentist and the laboratory
technician. In the past, patients with congenitally missing teeth or microdontia have been treated with resin-
bonded bridges, removable retainers, or cantilever crowns to avoid the use of standard-diameter implants and
prosthetics in this area.[1,3]
The two common treatment options include orthodontic space opening for future restorations or
orthodontic space closure utilizing the adjacent permanent canine teeth. With a paradigm shift in the patient
expectations towards functional as well as esthetically appealing replacements for edentulism, the implant based
oral rehabilitation has emerged as a sole winner in fulfilling all aspects of patient needs.[1,2,3,4]
The orthodontist plays a key role in determining and establishing space requirements for patients with
congenitally missing maxillary lateral incisors .However, the implant based treatment option in such patients
requires an interactive and interdisciplinary management approach. This interdisciplinary approach may involve
preprosthetic orthodontic treatment following consultations with an oral surgeon or periodontist and restorative
dentist to ensure orthodontic alignment will facilitate the surgical, implant and restorative treatment.
Too often, surgeons attempting to place standard-diameter implants have forced the restorative team to
manage these small dimensions with a lack of adequate prosthetics because of the size and diameter of the
fixture head.
In addition, surgical complications, such as contact with the adjacent roots, dehiscences of the labial
plate, or the “show through” of the titanium through thin soft tissues, has posed a significant complication risk
when attempting to use implants for tooth replacement in these situations.
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Recently, manufacturers in the implant industry have offered a 3-mm diameter implant design to
address these challenges. Most of the implants available in the 3-mm size have been one-piece or unibody
implants, which often necessitate conventional tooth-preparation techniques by the restorative team as well as
standard cord-impression techniques for indexing the restorative margins. With some systems, there is no need
for preparation due to a cervical marginal collar that can be captured utilizing a snap-in impression transfer.
This case report deals with managing a compromised situation in the region of maxillary lateral incisor using a
narrow diameter implant.
II. Methods And Materials:
A 15 years old Arab girl was seen in private orthodontic clinic in Israel . She was an intelligent,
college student, co-operative, and conscientious about her oral health and aesthetics. The patient was undergoing
an active treatment of orthodontic treatment for past years, the aim of which was to close the residual space
between her upper anterior teeth. Examination revealed good facial symmetry profile complicated by the
presence of class I malocclusion. The patient was in permanent dentition with unilateral congenitally missing
maxillary lateral incisors and retained
deciduous lateral incisors. The maxillary arch presented with spacing between anterior teeth and in addition
there was minor crowding of lower arch.
Fig.1a,b;(a) Missing #10. Short clinical crown #7.Diastema between #9 and 11(b) Pre-op periapical
radiograph. #9 angled slightly distally, #11 slightly mesially
Objectives of the orthodontic treatment were:
a- To provide adequate space for restoration of missing lateral incisors.
b- Closure of residual spaces in the upper jaw.
c- Correction of the crowding of lower anteriors using edge wise brackets
(non-extraction)
A multidisciplinary approach was discussed which included the patient, orthodontist, oral surgeon, restorative
dentist and dental technician and following treatment plan was agreed upon as a team:
a- To wait for a year to have complete bone healing prior to placement an implant.
b- To restore the maxillary with lateralincisor implant supported crown.
The patient is a 17 yr old female with congenitally missing left lateral incisor. She just recently completed 2
years of orthodontic therapy. She was fitted with a retainer with 22 teeth on the retainer. Orthodontic treatment
was only able to provide for 4mm between the upper left central incisior and the upper left cuspid. The patient
was referred to my office for consultation for implant therapy.
Fig.2a-c;(a) 1.4 pilot drill(b) Reangulated pilot drill(c) 2.5 x 16 Intralock MDL in place - checking orientation
again before placement into final position
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Fig.3a,b;(a) Post-op photograph of implant and gingivectomy(b) Final periapical of implant in position
After preliminary investigations and thorough medical history patient was selected suitable for implant
placement. The mesio-distal width of available alveolar bone between the maxillary right central incisor and
maxillary right canine was 4 mm through the radiographic analysis. Single piece 2.5x16 mm implant was
selected according to the bone width available. Prophylactic antibiotic regimen was started one day prior to the
implant placement. After following the disinfection protocol,
an infiltration of local anesthesia (Xylocaine 2% Adrenalin 1:200000) was administered in the labial vestibular
region, in the region of missing tooth and a full thickness flap was raised. The labio-palatal alveolar bone
diameter was confirmed as 4 mm using osseometer. Then pilot drill was made at implant site using 2mm pilot
drill to the required full depth and no sequential drill was used as the proposed implant diameter was 2.5 mm .
By maintaining torque at 35N, using motor driven
implant hand piece, implant was inserted into the prepared site. The flap was sutured back and haemostasis was
achieved The implant abutment was checked for any interference and is five day antibiotic protocol was
followed. After the primary soft tissue closure around the implant impressions were recorded, temporary crown
was
fabricated and luted using non-eugenol cement. Non functional immediate loading protocol was followed and all
the contacts and interferences were removed.
Results:
Fig.4. Post -op crown cemented with temp cement Patient is scheduled in 2 weeks for follow up
The implant was allowed to osseointegrate for a period of 6 months, and a final impression was made using
putty wash technique and a final prosthesis was
fabricated . Prosthesis was tried in patient mouth and after checking the esthetics, the prosthesis was luted with
GIC type 1 luting cement . Excellent esthetics and emergence profile were obtained through this technique .
III. Discussion;
Small diameter implants provides advantages for the patients those normally would have preceded
with a fixed or resin-bonded prosthesis with preparation and/or reduction of the adjacent natural dentition.
Implants help in preserving the leftover alveolar ridge in the area of missing tooth and reduction of natural tooth
structure as in the case of tooth supported fixed dentures can be avoided. In our case the mesio-distal diameter
of alveolar bone is around 4 mm which is a difficult situation for placing the conventional implant.[13]
Regular implant systems usually have 3.0 mm as their starting diameter. But 3.0 mm implant can't be
placed in this situation due to lack of alveolar bone width. According to Carl E Mish, after placing the implant
minimum of 1.0 mm bone should be present around the implant. As the available bone is only 4 mm, in this
5. Interdisciplinary Management Of Maxillary Lateral…
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compromised mm situation, a 2.5mm diameter implant is selected and successfully placed. So by placing
narrow diameter implants we preserve not only the remaining alveolar bone from resorption but also helps in
achieving optimal esthetics.[14] One of the most difficult areas for implant reconstruction has been the anterior
maxilla, or what is known as the “esthetic zone”. Improved technology involving the surface of the implant
body, abutment connection and prosthetic reconstruction of implants provided successful osseointegration with
raised possibility of totally mimicking the esthetics and function of natural teeth at this area .[15]
In the early implantation the treatment protocol was to follow a two stage implantation to secure full
osseointegration before loading machined surfaced implants, where it achieved over 81% success rate in 15
years.5 To advocating
Load free osseointegration, transitional implantation had been developed. Transitional implants were designed
with smaller diameter of near 2mm at various lengths. Mainly as abutments for interim overdenture and loading
were placed immediately after implantation until the definitive prosthesis were delivered. On histological and
clinical evaluation have revealed that successful osseointegration were observed in immediately loaded
transitional implants.[16]
Marco Degidi et al did a 3 year randomized clinical trial on immediate versus onestage restoration of small
diameter implants for a single missing maxillary lateral incisor and concluded that in the rehabilitation of a
single missing maxillary lateral incisor, no statistically significant difference was assessed between immediately
and one-stage restored small-diameterimplants with regard to implant survival, mean
marginal bone loss and probing depth. 3.0 mm diameter implants proved to be a predictable treatment option in
their test and control groups when strict clinical protocol was followed.[17]
Dong-Seok Sohn et al did a retrospective multicenter analysis of immediate provisionalization using one-piece
narrow-diameter (3.0 mm) implants and concluded that for missing maxillary lateral incisors and mandibular
incisors with compromised labio-lingual and mesio-distal available bone, one piece narrow diameter implants
could be used successfully.[18]
Anitha Balaji et al did a pilot study of mini implants as a treatment option for prosthetic rehabilitation of ridges
with sub-optimal bone volume and concluded that failure rate of mini implants placed to replace single missing
tooth was low and narrow diameter implants could be used in clinical situations in which available bone
volumes did not permit placement of conventional implants.[19]
Azfar A. Siddiqui et al used mini implants for replacement and immediate loading of two single-tooth
restorations and concluded that mini implants were indicated for areas where the use of narrow diameter
implants (3.0 mm) were contraindicated. Until long-term longitudinal clinical data on mini dental implants are
available, their use should be limited to areas with potentially less occlusal load.[20]
Reddy MS et al studied initial clinical efficacy of 3 mm implants immediately placed into function in
conditions of limited spacing and concluded that in the areas of compromised bone spaces single piece
immediately loaded narrow diameter implants could be used for predictable success.[21]
Selection of the patients, correct surgical techniques, suitable implant design, complete understanding of the
concepts of occlusion, and the correct timing of implant placement are mandatory for optimum outcomes Bone
growth with complete dentoalveolar and facial growth should be completed before implant insertion. It takes
place in males around the age of 21 while in females it occurs at age of 16 years. This coincides with the
selected age range of the subjects included in this study. The females selected were older than 16 years while the
males were between 21 and 23 years.[22,23]
Another study using four to six Midi one-piece implants in the maxilla to support maxillary
overdentures proved that it was ideal for most types of bone qualities, quantities and for atrophic ridges. The
study reported that it is a reliable and cost effective treatment option that brings secure dentures within the reach
of many patients, who are medically or financially compromised contributing to a higher degree of implant
treatment acceptance due to less discomfort and generally shorter treatment times .[24]
Different studies recommended that placement of the implants should be done after completing the
orthodontic treatment and ending the retention period in order to achieve soft and hard tissue stabilization.[25]
In a study by Van de Velde et al. on immediately loaded one-piece implants, only three of 12 implants
were considered successful, showing a bone loss of 1.7 mm after two years of function.[26]
The mean peri-implant marginal bone loss was 2.1 mm after one year. A mean bone loss of 1.6 mm
after 12 months of loading of MDIs (3 mm) placed in the maxillary lateral and mandibular incisor area was
observed, while 18% of the implants showed more than 3 mm of bone loss.[27]
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Sohn et al. reported that mean marginal bone loss after 12 months of loading was 0.53 ± 0.37 mm.[28] In a
study involving 115 one-piece implants, a failure rate of 5.2% due to excessive marginal bone loss was
observed.[29]
Proussaefs and Lozada reported that the mean marginal bone loss of immediately loaded two-piece single-
tooth implants was 1.05 mm after 12 months of loading.[30]
In mesio-distal bone width compromised cases when all the factors are favorable, narrow diameter implant is the
ideal choice for replacement of maxillary lateral incisor for achieving better esthetics as shown in our case. The
long term success rate of these implants with various loading protocols has been assessed and the success rates
of these implants were encouraging.
IV. Conclusion
Planning for space management is best carried out before initiating orthodontic treatment. The time of
implantation should be close to the end of orthodontic treatment. As opposed to starting orthodontic space
closure early, orthodontic space opening before implantation should be started late. Finally, the importance of
interdisciplinary team treatment planning is emphasized as a requirement for achieving optimal final esthetics.
References
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[18] Dong-Seok Sohn, Min-Su Bae, Jeong-Uk Heo, Jun-Sub Park, Sun-Hae Yea, Georgios E. Romanos. Retrospective Multicenter
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[19] Anitha Balaji, Jumshad B. Mohamed, R.Kathiresan. A Pilot Study of Mini Implants 82 as a Treatment Option for Prosthetic
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[20] Azfar A. Siddiqui, Mark Sosovicka, Mark Goetz. Use of mini implants for replacement and immediate loading of 2 single-tooth
restorations: A Clinical
[21] Case Report. Journal of Oral Implantology 2006;32(2): 82-86.
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