Agenesis of maxillary lateral incisor and tooth replacement: cost-effectiveness of different treatment alternatives

Biomechanical reinforcement by CAD-CAM materials affects stress distributions of posterior composite bridges: 3D finite element analysis

OBJECTIVES

This 3D finite element analysis study aimed to investigate the effect of reinforcing CAD-CAM bars on stress distribution in various components of a posterior composite bridge.

METHODS

A virtual model mimicking the absence of an upper second premolar was created, featuring class II cavity preparations on the proximal surfaces of the adjacent abutment teeth surrounding the edentulous space. Five distinct finite element analysis (FEA) models were generated, each representing a CAD-CAM reinforcing bar material: 3-YTZP (IPS. emax ZirCAD MO; Zr), lithium disilicate (IPS e.max CAD; EX), nano-hybrid resin composite (Grandio Blocs; GB), Fibre-reinforced composite (Trilor; Tri), and polyetheretherketone (PEEK). A veneering resin composite was employed to simulate the replacement of the missing premolar (pontic). In the FEA, an axial force of 600 N and a transverse load of 20 N were applied at the center of the pontic. Subsequently, maximum von Mises (mvM) and maximum principal stresses (σmax) were computed across various components of the generated models. Additionally, shear stresses at the interface between the CAD-CAM bars and the veneering resin composite were determined.

RESULTS

CAD-CAM materials with high modulus of elasticity, such as Zr and EX, exhibited the highest mvM stresses and shear stresses while transferring the lowest stress to the veneering resin composite in comparison to other materials. Conversely, PEEK demonstrated the lowest mvM stresses but produced the highest stresses within the veneering resin composite. There was a uniform distribution of mvM stresses in the remaining tooth structure among all groups, except for a noticeable elevation in the molar region of Zr and EX groups.

SIGNIFICANCE

Reinforcing CAD-CAM bar materials with a high modulus of elasticity, such as Zr and EX, may result in debonding failures at the connector sites of posterior composite bridges. Conversely, GB, PEEK, and Tri have the potential to cause fracture failures at the connectors rather than debonding.

Cost-Effectiveness Analysis of Implant-Supported Single Crown and Tooth-Supported Fixed Dental Prostheses in Türkiye

OBJECTIVES

The most cost-effective option for replacing lost teeth is not evident because there is a dearth of evidence-based information on implant-supported single crowns versus tooth-supported fixed dental prostheses. This study conducted the analysis of cost-effectiveness of implant-supported single crown and tooth-supported fixed dental prostheses from a social perspective in Türkiye.

METHODS

Costs were calculated in the analysis from a social perspective for 2021. Costs and quality-adjusted prosthesis year (QAPY) values were computed over a 20-year period in the study using the Markov model. The computed values were discounted by 5%. The results are presented as the incremental cost-effectiveness ratio. To assess the impact of uncertainty on cost-effectiveness analyses, a tornado diagram and Monte Carlo simulations were created.

RESULTS

Throughout the 20-year time horizon, tooth-supported fixed dental prostheses cost $985.58 cumulatively, whereas implant-supported single crown cost $2161.64 (US $1 = 9.22 ₺ as of 15 October 2021). The calculated incremental cost-effectiveness ratio is 1.333 per QAPY. Compared with the implant-supported single crown tooth-supported fixed dental prostheses, it offers a QAPY of 0.882 over a 20-year period, while costing an additional $1176.06.

CONCLUSIONS

These results suggest that the implant-supported single crown provided higher QAPY value but was costlier. When the research's findings are compared with the literature, it becomes clear that Türkiye has lower dental care expenses than most other nations.

Resin-bonded fixed dental prosthesis versus implant-supported single crowns in the anterior region

BACKGROUND

Different treatment options exist for replacement of an anterior tooth, and as implant-supported single crowns (ISSC) and resin-bonded fixed dental prosthesis (RBFDPs) both are widespread treatment options, it is of clinical relevance to know which treatment modality can be considered superior.

PURPOSE

The purpose of this comparative study was to evaluate the 3- and 5-year survival and failure rate of tooth-supported resin-bonded fixed dental prosthesis compared to implant-supported single crowns. The null hypothesis was that there was no significant difference in survival rate, occurrence of complications or patient-reported outcome between RBFDPs and ISSCs.

MATERIALS AND METHODS

A total of 45 resin-bonded FDPs were inserted in 27 young patients (test group) with tooth agenesis in the anterior part of the maxilla or mandible and a control group of 28 patients also with tooth agenesis in the anterior region but treated with 40 implant-supported single crowns were included in this study. All patients and treatments were followed with a baseline and a 3- or 5-year examination. All patients had to fill out an Oral Health Impact Profile (OHIP-49) questionnaire at baseline and at the 3- or 5-year examination. The restorations were evaluated according to the Copenhagen Index Score (CIS).

RESULTS

For the RBFDP (test) group there was an 82% survival rate and 18% failure rate, that is, four RBFDPs were not in situ after 3 years and four RBFDPs were not in situ after 5 years. Correspondingly, the ISSC showed a survival rate of 98% and a failure rate of 2%, that is, only one failure (ceramic fracture) after 3 and none after 5 years. Of the 82% RBFDPs in situ, there were no complications in 78% of the cases, whereas 22% had complications after 3 (4 complications) and 5 years (4 complications). There were 92% of the ISSCs without any complications and 8% (ie, 3 ISSCs) with complications after 3 or 5 years. In general, there was a significant reduction in the OHIP-49 scores, for example, an improved oral health quality of life for both treatment options.

CONCLUSION

The results of this study indicate that ISSCs have lower complication and failure rates than RBFDPs. In general, the OHIP-scores were significantly reduced regardless of whether RBFDPs or ISSC were used.

Replacing Missing Maxillary Lateral Incisors by CAD/CAM PMMA Cantilever Bridges

Introduction

Management of missing maxillary lateral incisors can be a challenging endeavour for dentists. Whether from agenesis or tooth loss, several treatment modalities are currently present to tackle this task to ensure satisfactory aesthetics. Most patients, especially younger patients are more likely to prefer fixed prosthodontic rehabilitation. Among these options is the computer-aided design and computer-aided manufacturing polymethyl methacrylate (CAD/CAM PMMA) cantilever bridge. Case Descriptions. These two clinical cases describe the management of missing lateral maxillary incisors in two Tunisian female patients with different etiologies, using CAD/CAM PMMA cantilever bridge.

Conclusions

CAD/CAM technologies allow for a fairly quick and simple try-in thanks to their high accuracy as well as being predictable, minimally invasive, and affordable treatment options. This type of restoration can be put to use for mid- to long-term solutions to missing maxillary lateral incisors. However, its success depends mainly on patient selection regarding age, general health, occlusal context, and proper indication.

Tooth autotransplantation: An umbrella review

Tooth autotransplantation is a versatile procedure with several clinical applications among patients across different age groups. The success of this procedure depends on multiple factors. Despite the wealth of studies available, no single primary study or systematic review is able to report on every factor affecting the outcomes of autotransplantation. The aims of this umbrella review were to evaluate treatment-related and patient-related outcomes of autotransplantation and to assess the pre-, peri- or post-operative factors that could affect these. An umbrella review was conducted according to the PRISMA statement. A literature search of five databases was performed up to 25 September 2022. Systematic Reviews (SR) with and without meta-analysis evaluating autotransplantation were included. Calibration among reviewers was carried out prior to study selection, data extraction and Risk of Bias (RoB) assessment. Study overlap was calculated using corrected covered area. Meta-meta-analysis (MMA) was performed for suitable SRs. The AMSTAR 2 critical appraisal tool was used to evaluate the quality of evidence. Seventeen SRs met the inclusion criteria. Only two SRs were suitable for conduct of MMA on autotransplantation of open apex teeth. The 5-year and 10-year survival rates were >95%. A narrative summary on factors that could affect autotransplantation outcomes and comparisons of autotransplantation to other treatment options were reported. Five SRs were rated as 'low quality' and 12 SRs were rated as 'critically low quality' in the AMSTAR 2 RoB assessment. In order to facilitate a more homogenous pool of data for subsequent meta-analysis, an Autotransplantation Outcome Index was also proposed to standardise the definition of outcomes. Autotransplantation of teeth with open apices have a high survival rate. Future studies should standardise the reporting of clinical and radiographic findings, as well as the definition of outcomes.

A Multidisciplinary Approach to Maxillary Lateral Incisor Agenesis (MLIA): A Case Report

Maxillary lateral incisor agenesis (MLIA) is a condition that significantly compromises smile esthetics and is a particular concern in younger patients. The treatment options include orthodontics for space opening with rehabilitation or space closure with canine camouflage. Currently, there is some controversy regarding the most appropriate treatment. In this case report, we propose a multidisciplinary approach through the combination of orthodontic treatment, frenectomy, and a restorative finishing stage with composite resin and dental implants. More specifically, this treatment was planned to orthodontically close the anterior space by opening the premolar area for subsequent placement of implants and enameloplasty with a composite resin. The replacement of a missing lateral incisor by an implant is a predictable treatment approach, but it might best be deferred until dental maturity and then accurately placed in a well-developed site through a multidisciplinary approach. Precluding the closure of the anterior spaces and the opening of the posterior zone for implant placement, allows for a more stable and appealing esthetic and functional rehabilitation for young patients, in whom esthetic appearance and self-esteem play a primary role.

Implant treatment after traumatic tooth loss: A systematic review

BACKGROUND/AIMS

Treatment after traumatic tooth loss is challenging and is currently guided by expert opinion and the individual patient situation. The aim of this study was to provide an overview on the outcome of dental implant treatment in the anterior maxilla after traumatic tooth loss, based on a systematic review of the existing evidence.

MATERIALS AND METHODS

A systematic search of the literature was performed on PubMed, Cochran Library and Web of Science following the PRISMA guidelines based on a structured research question (PICO). All clinical studies of five patients or more with follow-up of at least 1 year after implant loading were included. Patients were at least 18 years of age. Cohen's Kappa-coefficient was calculated. The Newcastle-Ottawa Scale was applied to assess the quality of the included studies. Descriptive statistical methods were applied.

RESULTS

Nine hundred and ninety-nine articles were identified through the systematic search. Finally, six articles were eligible for inclusion. The studies comprised prospective and retrospective cohort studies and case series. From these, 96 patients with 120 implants were included. The age ranged from 18 to 59 years. The survival rates of implants and superstructures were 97% and 95%, respectively, after a mean follow-up of 3.5 years. Mean marginal bone resorption was 0.56 mm (range 0.21-1.30 mm). Complication rates were 7% and 11% on implant and superstructure level, respectively. Patient-reported outcome measures and objective evaluations showed a high level of satisfaction with the aesthetic outcome. Bone augmentation was performed in 60 implant sites. Three patients underwent pre-surgical orthodontic treatment. The maxillary central incisor was the most frequently replaced tooth (70%).

CONCLUSIONS

This systematic review revealed a low level of evidence on the outcome of dental implant treatment after traumatic tooth loss. Systematic reporting of treatment outcomes of tooth replacements after dental trauma is highly encouraged to further guide dentists for the benefit of these challenging patients.

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

Objectives

Implants are used to replace congenitally missing lateral incisors but often the space across the alveolar crest is too narrow to permit their use. This multicenter study (Dental Clinic of the University of Foggia, Odontostomatology Clinic of the University of L’Aquila) evaluated the efficacy of mini-implants in cases of maxillary lateral incisor agenesis with severe osseous atrophy in 10-year follow-up.

Materials and methods

Forty-seven mini-implants have been inserted in 35 patients affected by lateral incisors agenesis (23 single and 12 bilateral ageneses). All patients underwent orthodontic opening of the space of the upper lateral incisors. After the insertion of the implants, the immediate, non-functional loading, positioning of crowns, presence of pain during percussion and mini-implant function, horizontal and vertical movement when a force of 5 N was applied, ridge loss, and plaque index have been evaluated 1 month after loading, 1 year after loading, and then every 5 years in the following 10 years. Little’s test was used to evaluate the assumption that data of loss to follow-up implants are missing completely at random (MCAR) and that a complete-case scenario could be adopted. Wilcoxon test was carried out to look statistically significant differences between the various parameters resulting in the complete-case scenario and those assumed for the worst scenario. The software R (v. 3.6.1, 2019) was employed to perform the statistical analysis.

Results

The results obtained over 10 years range from 89% of success rate in a worst-case scenario to the 100% using a complete-case analysis with satisfactory values of marginal bone resorption and good conditions of the peri-implant tissue. Ten-year follow-up using complete-case analysis shows survival rates of 100% for implants with no signs of peri-implantitis, stability of the marginal bone levels and soft tissue around the dental implants.

Conclusions

The data collected show very good implant stability, absence of progressive peri-implantitis, and satisfactory aesthetical results in time (no signs of infraocclusion).

Clinical relevance

Mini-implants can be considered a valid and stable over time solution in the restorative treatment of maxillary lateral incisors agenesis.

Anterior fiber-reinforced ribbon composite resin bridge-A case report

The case describes the fabrication of a unilaterally fixed anterior fiber-reinforced composite bridge in a 14-year-old girl. Using this technique, it is possible to temporarily replace a missing anterior tooth until a definitive restoration can be inserted.

An Alternative Approach for Space Opening in a Bilateral Maxillary Lateral Incisor Agenesis Patient using Miniplates

AIM

This case report aimed to present an orthodontic mechanic alternative for space opening in a patient missing maxillary lateral incisors, using miniplates as anchorage, associated with self-ligating brackets.

BACKGROUND

Dental agenesis affects the population causing esthetic and functional damages. The prevalence of missing maxillary lateral incisors should be considered for its significant rate and negative impact on smile esthetics.

CASE REPORT

This treatment was chosen based on the presence of balanced facial pattern, large canine anatomy, the need to improve dental occlusion to prevent further wear, and patient's esthetic complaint. To obtain the results, upper third molars were extracted, and two miniplates were installed to distalize the upper arch with no need for patient compliance or auxiliary devices. Self-ligating brackets were used to reduce friction on posterior teeth, thus facilitating movement with light force application. At the end of 19 months, the patient presented with class I good overbite and overjet, and adequate space for implant and prosthetics; also, good facial esthetic was maintained.

CONCLUSION

When indicated, space opening may provide excellent esthetics and functional results, and even more predictable results when skeletal anchorage miniplates are used to distalize all posterior teeth.

CLINICAL SIGNIFICANCE

Considering the high level of esthetic and functional compromise caused by dental agenesis, the technique hereby described represents a viable mechanic alternative within orthodontic possibilities.

Occlusal rehabilitation in patients with congenitally missing teeth-dental implants, conventional prosthetics, tooth autotransplants, and preservation of deciduous teeth-a systematic review

Background

Implant patients with congenitally missing teeth share some common charateristics and deserve special attention.

Methods

The PICO question was “In patients with congenitally missing teeth, does an early occlusal rehabilitation with dental implants in comparison to tooth autotransplants, conventional prosthetics on teeth or preservation of deciduous teeth have better general outcomes in terms of survival, success and better patient centered outcomes in terms of quality of life, self-esteem, satisfaction, chewing function?”

After electronic database search, a total of 63 relevant studies were eligible, of which 42 qualified for numerical data synthesis, 26 being retrospective studies. A data synthesis was performed by weighted means for survival/success/annual failure rates.

Results

The mean survival of implants was 95.3 % (prosthesis survival 97.8 %), autotransplants 94.4 %, deciduous teeth 89.6 %, and conventional prostheses 60.2 %. The implant survival in children, adolescents, and adults was 72.4, 93.0, and 97.4 %. Annual failure rates of implants 3.317 %, autotransplants 1.061 %, deciduous teeth 0.908 %, and conventional prostheses 5.144 % indicated better results for natural teeth and more maintenance needs for the both prosthetic treatments. The mean OHIP score was 27.8 at baseline and a mean improvement of 14.9 score points was reported after implant prosthetics. The mean satisfaction rates were 93.4 (implants), 76.6 (conventional prostheses), 72.0 (autotransplants), and 65.5 % (orthodontic space closure).

Conclusions

In synopsis of general and patient-centered outcomes, implants yielded the best results, however, not in children <13 years. Autotransplants and deciduous teeth had low annual failure rates and are appropriate treatments in children and adolescents at low costs. Conventional prosthetics had lower survival/success rates than the other options. Due to heterogeneity and low number of studies, patient-reported outcomes in this review have to be interpreted with caution.

A wide mesio-distal gap in sites of congenitally missing maxillary lateral incisors is related to a thin alveolar ridge

OBJECTIVES

To evaluate (i) a possible correlation between the mesio-distal gap width and the alveolar ridge (AR) dimensions in patients missing the maxillary lateral incisor (I2) either due to agenesis or loss and (ii) the possibility of straightforward implant placement based on simulation.

METHODS

The bucco-palatal width, area, and height of the AR at the position of I2, and the mesio-distal gap width between the central incisor and the canine, were assessed in maxillary CT scans of three groups: Patients with (i) agenesis of I2 (T_A ; n = 40); (ii) I2 regularly erupted but extracted (T_L ; n = 24); (iii) I2 regularly erupted and in situ (C; n = 40). Further, the possibility of straightforward placement of an implant 3 or 3.5 mm in diameter ×10 mm in length, with 1 mm distance from the buccal and palatal plate of the alveolar ridge was simulated and compared to the actual treatment delivered.

RESULTS

Bucco-palatal width and area of the AR at I2 and the adjacent teeth was significantly reduced in T_A compared to T_L and C. Further, in T_A , but not T_L , an increasing mesio-distal gap width between the central incisor and canine resulted in a significantly reduced bucco-palatal width of the edentulous AR. This impeded a simulated straightforward implant placement in >50% of the cases in T_A , even with a reduced implant diameter.

CONCLUSIONS

In patients congenitally missing I2, an increased mesio-distal gap width correlates significantly with reduced edentulous AR dimensions. A mesio-distal gap of >6 mm was associated with thin bucco-palatal alveolar ridges, precluding straightforward implant placement in 60-80% of the cases.

Congenitally missing maxillary lateral incisors: update on the functional and esthetic parameters of patients treated with implants or space closure and teeth recontouring

Maxillary lateral incisor agenesis (MLIA) is a condition that affects both dental esthetics and function in young patients, and represents an important challenge for clinicians. Although several treatment options are available, the mesial repositioning of the canines followed by teeth recontouring into lateral incisors; or space opening/maintenance followed by implant placement have recently emerged as two important treatment approaches. In this article, the current and latest literature has been reviewed in order to summarize the functional and esthetic outcomes obtained with these two forms of treatment of MLIA patients in recent years. Indications, clinical limitations and the most important parameters to achieve the best possible results with each treatment modality are also discussed. Within the limitations of this review, it is not possible to assert at this point in time that one treatment approach is more advantageous than the other. Long-term followup studies comparing the existing treatment options are still lacking in the literature, and they are necessary to shed some light on the issue. It is possible, however, to state that adequate multidisciplinary diagnosis and planning are imperative to define the treatment option that will provide the best individual results for patients with MLIA.