Clinical assessment of the gingival contours and proximal contact areas in the maxillary anterior dentition

Gingival display has been identified as a critical element in a beautiful smile and thus in facial esthetics. The present study aimed to assess the gingival line angle (GLA); the distance between the gingival zenith of maxillary lateral incisor and the gingival line (LID); and the ratio between the height of the proximal contact area (PCA) and crown length, referred to as the proximal contact area proportion (PCAP). Fifty patients, aged 21-30 years, were recruited for study. Maxillary impressions were made using irreversible hydrocolloid and poured in dental stone, and facebow records were used to mount the master casts in an articulator. Standardized photographs of maxillary casts were taken, and image-processing software was used to assess GLA, LID, PCA, and PCAP. Data analysis revealed a statistically significant difference between bilateral measurements of GLA (r = 0.93; P < 0.001). The mean PCA dimensions decreased from mesial to distal sites in the maxillary dentition bilaterally. A paired t test exhibited a significant correlation between the parameters GLA and PCA and showed that an increase in GLA led to an increase in PCA. The gingival zenith of the canine was apical to that of the incisors (GLA less than 90 degrees). The results of the present study may be utilized in conjunction with clinical goals and subjective parameters to help the restorative dentist obtain a more predictable esthetic outcome.

The Effect of Piezoelectric Ultrasonic Scaler Tip Wear on Root Surface Roughness at Different Working Parameters: An Atomic Force Microscopic and Profilometric Study

OBJECTIVE

This study aimed to evaluate the influence of scaler tip wear and different working parameters, i.e., lateral force, power setting and tip angulation, on the roughness of root surfaces following treatment with piezoelectric ultrasonic scaling devices.

MATERIALS

Twenty piezoelectric ultrasonic scaler inserts (10 worn/10 new) were selected to examine the erosion ratio (ER) under atomic force microscopy (AFM). A total of 160 root samples were prepared and instrumented by new (n = 80) and worn inserts (n = 80) at different working parameters (tip angulation, power setting, lateral force). Roughness change (Rc) on root surfaces after instrumentation was examined by a contact profilometer.

RESULTS

Statistically significant differences were found between the mean ERs of new and worn tips (p < 0.0001). The various combinations of the assessed working parameters showed synergistic effects resulting in a wide range of root surface roughness. The present study found the higher Rc in the group with a 45° angulation, (P10) high power setting and 1.0 N lateral force (subgroup 8) when compared to other groups. Among the groups, the worn scaler tips subgroup 8 showed a higher Rc (5.692 ± 0.81) when compared to new scaler tips subgroup 8 (4.798 ± 0.51; p < 0.001).

CONCLUSION

The findings of the present study highlighted that scaler tip wear strongly influences the root surface roughness when used at higher tip angulation, lateral force and power settings. Hence, ultrasonic scaler tip wear should be periodically evaluated and should be considered as much as the other working parameters.

The Shape of the Maxillary Central Incisors and Its Correlation with Maxillary Anterior Papillary Display: A Clinical Study

The aim of this study was to define shapes of maxillary central incisors and determine their relationship with the visual display of interdental papillae during smiling. A sample of 100 patients aged 20 to 25 years were recruited. Photographs were taken and gingival angle, crown width (CW), crown length (CL), contact surface (CS), CW/CL ratio, CS/CL ratio, gingival smile line (GSL), and interdental smile line (ISL) were measured. The data showed an increase in GA leading to an increase in CW and CS/CL ratio. Women showed a higher percentage of papillary display compared with men. This study reinforces the proposed hypothesis that the shape of the teeth and papilla affect the periodontium.

Thesis, antithesis, and synthesis in periodontal and systemic interlink

The theory of focal infection, which was promulgated during the 19(th) and early 20(th) centuries, stated that "foci" of sepsis were responsible for the initiation and progression of a variety of inflammatory diseases such as arthritis, peptic ulcers, and appendicitis. In the oral cavity, therapeutic edentulation was common as a result of the popularity of the focal infection theory. Since many teeth were extracted without evidence of infection, thereby providing no relief of symptoms, the theory was discredited and largely ignored for many years. Recent progress in classification and identification of oral microorganisms and the realization that certain microorganisms are normally found only in the oral cavity have opened the way for a more realistic assessment of the importance of oral focal infection. It has become increasingly clear that the oral cavity can act as the site of origin for dissemination of pathogenic organisms to distant body sites, especially in immunocompromised hosts such as patients suffering from malignancies, diabetes, rheumatoid arthritis, or in patients undergoing other immunosuppressive treatment. A number of epidemiological studies have suggested that oral infection, especially periodontitis, may be a risk factor for systemic diseases.

Critical analysis of biomarkers in the current periodontal practice

Periodontal disease is a chronic microbial infection that triggers inflammation-mediated loss of the periodontal ligament and alveolar bone that supports the teeth. Because of the increasing prevalence and associated comorbidities, there is a need for the development of new diagnostic tests that can detect the presence of active disease, predict future disease progression, and evaluate the response to periodontal therapy, thereby improving the clinical management of periodontal patients. The diagnosis of active phases of periodontal disease and the identification of patients at risk for active disease represent challenges for clinical investigators and practitioners. Advances in diagnostic research are moving toward methods whereby the periodontal risk can be identified and quantified by objective measures using biomarkers. Patients with periodontitis may have elevated circulating levels of specific inflammatory markers that can be correlated to the severity of the disease. Advances in the use of oral fluids as possible biological samples for objective measures of the current disease state, treatment monitoring, and prognostic indicators have boosted saliva- and other oral-based fluids to the forefront of technology. Gingival crevicular fluid (GCF) is an inflammatory exudate that can be collected at the gingival margin or within the gingival crevice. This article highlights recent advances in the use of biomarker-based disease diagnostics that focus on the identification of active periodontal disease from plaque biofilms, GCF, and saliva.

Amelogenesis imperfecta: A challenge to restoring esthetics and function

Rehabilitation of complicated cases poses difficulty in clinical practice, both with respect to restoring function and with esthetics. One such clinical condition where the dentist has to give importance to proper planning of the treatment and execution of the plan is amelogenesis imperfecta (AI), a condition where both function and esthetics are accommodated. This article discusses both the functional and esthetic rehabilitation of a patient with AI. Both the esthetics and function were hampered in this patient due to the condition. As a result, the treatment was properly planned and executed. A number of treatment options are available for us today to treat such a case. There is no one technique to be followed as such. However, the aim was to properly diagnose the case and provide good function and esthetics to the patient.