Prosthetic rehabilitation of maxillary lateral incisors agenesis using dental mini-implants: a multicenter 10-year follow-up

Interdisciplinary Orthodontic-Aesthetic Makeover Treatment of Nonsyndromic Hypodontia Case

This case study demonstrates treating maxillary lateral incisor agenesis in a male with class II div. 2 malocclusion using space closure and canine re-anatomization. It emphasizes the importance of a multidisciplinary team approach for minimally invasive, aesthetically pleasing results in orthodontic and restorative dentistry.

Treatment Options for Unilateral Agenesis of the Maxillary Lateral Incisor Combined with Contralateral Microdontic or Peg-Shaped Lateral Incisor: A Systematic Review

Background: Managing unilateral maxillary lateral incisor agenesis (UMLIA) with an associated microdontic or peg-shaped contralateral incisor (Mi or Peg MLI) presents clinical and esthetic challenges. Deciding between orthodontic space opening (OSO) or closure (OSC) and whether to restore or extract the Mi or Peg MLI are critical factors for achieving optimal treatment outcomes. Methods: A systematic review was conducted using a dual strategy across Scopus, Web of Science, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases. The Cochrane RoB2 tool was used for randomized controlled trials (RCTs), the ACROBAT-NRSI tool for non-randomized studies, and the JBI Manual for case reports. High-quality case reports were included when the literature was limited. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) tool evaluated the certainty of evidence, considering bias, inconsistency, indirectness, imprecision and other considerations. Results: Thirty-five studies met the inclusion criteria, assessing treatment modalities, esthetic outcomes, periodontal health, and occlusal and temporomandibular joint (TMJ) function. Both OSO and OSC demonstrated similar occlusal and TMJ outcomes, while slight differences in esthetic and periodontal results were noted between the two approaches. Direct composite and indirect ceramic restorations showed comparable effectiveness for reshaping the Mi or Peg MLI. Extraction combined with OSC contributed to improved smile symmetry. Conclusions: A personalized, multidisciplinary approach is essential for treating UMLIA with an Mi or Peg MLI. Both OSO and OSC are viable options, and the choice should be tailored to the patient's specific clinical scenario, with attention to achieving the best esthetic and periodontal outcomes. Further research is needed to refine treatment protocols and support clinical decision-making.

Traumatic Ulceration of the Vestibular Mucous Membrane After Insertion of Four Mini-Implants in the Atrophied Mandible: A Case Report

This clinical report describes how a decubital ulcer arose from the direct contact of the vestibular movable mucous membrane against mini-implant balled-type heads after the mini-implant insertion in the edentulous atrophic mandible of a 78-year-old patient who was not wearing a conventional mandibular complete denture for more than 10 years. Due to severe alveolar ridge atrophy, mini-implant insertion (2.0 mm wide) was an option without extensive surgical procedures. The patient signed the informed consent. A few days after the implant insertion, injury, inflammation, and induration of the vestibular movable mucous membrane were observed on the movable vestibular mucosa on the right side, opposing the mini-implants. The cause of inflammation was attributed to increased perioral muscle tonus which pushed the movable mucosa onto the mini-implant heads and caused mechanical trauma. During the period of edentulism, the perioral muscle tonus increased, directing the mucous membrane of the lips and cheeks against residual ridge to enable food comminution. To treat the persistent decubitus, a bulk of dental composite resin was placed around mini-implant heads and light-cured to protect the mucosa from further mechanical trauma, as the patient did not possess an old mandibular denture to cover the mini-implant heads. Vestibuloplastic surgery (disinsertion of movable attachments and deepening of the vestibulum) was also done. After the surgery, a silicone splint, resembling an occlusal rim, was made to protect the mucous membrane, keep medicaments for faster epitalization in place, to decrease perioral muscle tonus before the new dentures' delivery, and to prevent movable tissue relapse. The custom impression, jaw relationship determination, and try-in of the artificial teeth setup were made with sutures still in place. After the denture delivery and implant loading, the patient was instructed to sleep with the dentures to protect the movable mucous membrane. One year later, almost no peri-implant marginal bone loss was observed, attached and peri-implant mucosa were healthy, and the patient was delighted.

State of the Art in the Treatment of Congenital Agenesis With Implant-Supported Prosthesis: A Comprehensive Multidisciplinary Management

Congenital dental agenesis, particularly in younger adults, can have a profound impact on aesthetics and overall quality of life. The scientific literature offers various management strategies for this condition, with orthodontic movement and implant-supported rehabilitation being central to treatment. However, achieving predictable and successful outcomes necessitates a comprehensive multidisciplinary approach. Such an approach integrates diverse professional perspectives to ensure accurate diagnosis, prognosis, and treatment planning, ultimately aiming to restore dental function and address aesthetic concerns effectively. In this case report, we present the successful rehabilitation of a young patient with congenital agenesis of the mandibular central incisors. The treatment strategy combined oral surgery (extraction of deciduous teeth and autogenous bone graft), orthodontic movement (opening spaces to allow implant installation), periodontics (connective tissue graft), implantology, and prosthetic planning. We detail the specific surgical approaches employed and discuss how their integration contributed to the overall success of the case. This multidisciplinary treatment approach not only restored dental function but also met the patient's aesthetic expectations and enhanced the patient's quality of life, highlighting the importance of a coordinated approach in managing complex dental conditions.

Implant-supported crowns on maxillary laterals and canines-a long-term follow-up of aesthetics and function

OBJECTIVES

To assess the long-term aesthetic and functional aspects of implant-supported crowns in lateral (ISC-L) and canine positions (ISC-C).

MATERIALS AND METHODS

Thirty-two patients (14 males, 18 females, mean age: 23.1, SD:2.0) with an ISC-L or ISC-C participated in this prospective cohort study at baseline (T0) and in the long-term follow-up (T1, mean years: 11.1, SD: 1.0). Twenty-four patients (11 males, 13 females) participated in T1. Patient-reported outcomes (PROM) were rated using surveys with questions related to aesthetics and function. The colour of the implant crown and the buccal gingiva, the appearance of the papilla, periodontal health and temporomandibular disorder (TMD) outcomes were assessed in a clinical examination. The Mann-Whitney, Chi-square and Signed Rank tests were performed.

RESULTS

Patients with an ISC-L and ISC-C were equally satisfied with the crown shape and colour at T0 and T1. No differences in TMD outcomes were reported by the patients and no clinical signs of TMD were observed. At T1, ISC-C had more bleeding on probing and a three mm greater pocket depth than ISC-L (p = 0.03, p = 0.01, respectively). At T0, operators graded the crown colour of ISC-L as being too dark (35%) and ISC-C as being too light (40%). At T1, no difference was seen between the two groups regarding crown colour, gingiva colour and the papilla (p = 0.2749, p = 0.2099, p = 0.8053, respectively).

CONCLUSIONS

The PROM and clinical examination show that ISC-L and ISC-C are equivalent with regard to aesthetics and function in the long term.

CLINICAL RELEVANCE

Although ISC-L and ISC-C are aesthetically and functionally comparable in the long term, ISC-Cs are more likely to impact periodontal health.

Interdisciplinary Management of Bilateral Congenital Lateral Incisor Agenesis

Management of lateral incisor agenesis is a real challenge and needs a strong collaboration between surgical, aesthetic, and orthodontic dentistry. This case report managed upper lateral incisor agenesis with an orthodontic treatment leading to open spaces and placement of cuspids in lateral incisor area to avoid implant placement in maxillary anterior region. Temporary rehabilitation phase, using resin injected tray and removable partial denture, has been placed to maintain mesiodistal dimensions and restore aesthetic during pre-implant analysis and osseointegration. Once osseointegration was fully obtained, keratinized tissue augmentation has been obtained using connective tissue graft. Then, temporary implant fixed crowns allowed soft tissue modeling during interim rehabilitation. Finally, screw-retained permanent crowns were placed to fully restore aesthetic and function. This case goal was to optimize final results and reach patient complete satisfaction using orthodontic treatment combined with implant rehabilitation, and coupled with interdisciplinary management and well-time sequencing treatment.

A digital workflow for pair matching of maxillary anterior teeth using a 3D segmentation technique for esthetic implant restorations

We investigated a state-of-the-art algorithm for 3D reconstruction with a pair-matching technique, which enabled the fabrication of individualized implant restorations in the esthetic zone. This method compared 3D mirror images of crowns and emergence profiles between symmetric tooth pairs in the anterior maxilla using digital slicewise DICOM segmentation and the superimposition of STL data. With the outline extraction of each segment provided by 100 patients, the Hausdorff distance (HD) between two point sets was calculated to identify the similarity of the sets. By using HD thresholds as a pair matching criterion, the true positive rates of crowns were 100, 98, and 98%, while the false negative rates were 0, 2, and 2% for central incisors, lateral incisors, and canines, respectively, indicating high pair matching accuracy (> 99%) and sensitivity (> 98%). The true positive rates of emergence profiles were 99, 100, and 98%, while the false negative rates were 1, 0, and 2% for central incisors, lateral incisors, and canines, respectively, indicating high pair matching accuracy (> 99%) and sensitivity (> 98%). Therefore, digitally flipped contours of crown and emergence profiles can be successfully transferred for implant reconstruction in the maxillary anterior region to optimize esthetics and function.

Bone Dimensional Change Following Immediate Implant Placement in Posterior Teeth with CBCT: A 6-Month Prospective Clinical Study

This prospective clinical study aimed to evaluate the peri-implant hard tissue dimensional change at 6 months of immediate implant placement with bone graft materials in the posterior area using cone-beam computed tomography (CBCT). Twelve dental implants were placed concurrently following tooth extraction in the posterior area and filled with xenograft particles. The CBCT images were taken immediately after surgical procedures and then at 6 months follow-up. To evaluate the hard tissue changes, the vertical and horizontal bone thickness were analyzed and measured using ImageJ software. Paired t-test or Wilcoxon match-pair signed-rank test was done to analyze the changes of hard tissue values at the same level between immediately and 6 months following immediate implant placement. Independent t-test or Mann-Whitney U test was used to analyze the dimensional change in the vertical and horizontal direction in buccal and lingual aspects. The level of significance was set at p value = 0.05. All implants were successfully osseointegrated. At 6 months follow-up, the vertical bone change at the buccal aspect was -0.69 mm and at the lingual aspect -0.39 mm. For horizontal bone thickness, the bone dimensional changes at 0, 1, 5, and 9 mm levels from the implant platform were -0.62 mm, -0.70 mm, -0.24 mm, and -0.22 mm, respectively. A significant bone reduction was observed in all measurement levels during the 6 months after implant placement (p value < 0.05). It was noted that even with bone grafting, a decrease in bone thickness was seen following the immediate implant placement. Therefore, this technique can be an alternative method to place the implant in the posterior area.