Pathologic migration--spontaneous correction following periodontal therapy: a case report.

Periodontal disease is often associated with pathologic migration, which becomes an esthetic concern. A 17-year-old girl developed increasing gaps among her maxillary incisors. She had gingival enlargement in the palatal maxillary anterior region. The central incisors had pathologically migrated, resulting in a 2-mm diastema. Periodontal treatment was planned and completed. Following periodontal treatment, there was "spontaneous" repositioning of the central incisors. The 6-month follow-up revealed no change or deterioration of the periodontal condition. The patient was referred for orthodontic closure of the remaining diastema between the central and lateral incisors.     

Esthetic enhancement of ceramic crowns with zirconia dowels and cores: a clinical report

There has been an increase in the use of esthetic metal-free ceramic crowns in restoring endodontically treated teeth or teeth with severe coronal destruction. Tooth-colored dowels and cores are used to enhance the esthetic result. This report describes the treatment of a patient with bilateral maxillary supernumerary lateral incisors, a severe malocclusion, and maxillary anterior tooth discoloration. Treatment included heat-pressed, metal-free ceramic crowns supported by zirconia ceramic dowel-and-core foundations.     

Endodontic and orthodontic treatment of fused maxillary central incisors: a case report

Abstract – The purpose of this case report was to describe combined endodontic and orthodontic treatment of a patient who had permanent maxillary central incisors fused with supernumerary teeth. A severe esthetic problem and crowding in the maxillary arch were present clinically. Radiographic examination demonstrated two separate crowns, roots and pulpal canals on each side. The therapy was initiated with endodontic treatment. Six months after the completion of endodontic therapy, mesio‐distal trimming was performed and the defects were restored with anterior resin composites in order to re‐establish the esthetics. Orthodontic treatment was performed for the alignment of the upper arch. Follow‐up at 4 years demonstrated that the teeth were asymptomatic and neither root nor alveolar bone resorption was found. In conclusion, instead of extracting the supernumerary teeth, the anomaly was treated successfully in a conservative way.     

Combined orthodontic and prosthodontic treatment in an adolescent patient with traumatically ankylosed incisors: A case report

Symmetric extraction of premolars is a frequently used orthodontic treatment for dental crowding and protrusion. However, when a patient has incisors with ankylosis, the establishment of a treatment protocol often plagues orthodontists. An adolescent patient with a history of incisor trauma sought treatment for dental protrusion and crowding. Upon percussion of his infrapositioned maxillary central incisors, characteristic dull metallic sounds were noted, and a lack of normal mobility of these teeth under the application of external forces was detected. Follow-up radiographs after the trauma showed replacement root resorption of the maxillary central incisors. Based on clinical and radiological findings, ankylosis of the maxillary central incisors was tentatively diagnosed. A combination of orthodontic and prosthodontic treatment options involving extraction of the maxillary central incisors and mandibular first premolars was chosen to resolve the functional and esthetic problems. After treatment, well-aligned dentition, improved smile esthetics, and a more harmonious facial profile were achieved, and these outcomes remained stable during the follow-up period. This case report illustrates a viable treatment strategy for tackling predicaments caused by ankylosed incisors, which is unusual in the literature.     

Polyethylene Ribbon and Fixed Orthodontic Retention and Porcelain Veneers: Solving an Esthetic Dilemma

Abstract: The patient, a 58-year-old woman, had started orthodontic treatment to correct spacing between the maxillary anterior teeth 6 year prior to presentation with a chief complaint of tooth discoloration and spacing. The treatment had consisted of the use of a removable appliance to retract the maxillary anterior teeth. The patient continued to wear the appliance sporadically. When she presented, the maxillary incisors were in primary occlusal trauma with Grade 2 mobility. The patient discontinued wearing the appliance. The periodontal condition was addressed with initial therapy. As part of the treatment plan to stabilize the maxillary anterior teeth and provide the patient with an esthetic result, it was decided to do a limited occlusal adjustment of the maxillary anterior teeth to control fremitus, and to place a fixed, composite resin, polyethylene ribbon-reinforced splint, using a facial approach. The esthetic restoration of these teeth was accomplished with bonded porcelain veneers.     

A multidisciplinary treatment of congenitally missing maxillary lateral incisors: a 14-year follow-up case report

Absence of the maxillary lateral incisor creates an aesthetic problem which can be managed in various ways. The condition requires careful treatment planning and consideration of the options and outcomes following either space closure or prosthetic replacement. Recent developments in restorative dentistry have warranted a re-evaluation of the approach to this clinical situation. Factors relating both to the patient and the teeth, including the presentation of malocclusion and the effect on the occlusion must be considered. The objective of this study was to describe the etiology, prevalence and alternative treatment modalities for dental agenesis and to present a clinical case of agenesis of the maxillary lateral incisors treated by the closure of excessive spaces and canine re-anatomization. A clinical case is presented to illustrate the interdisciplinary approach between orthodontics and restorative dentistry for improved esthetic results. In this report, the treatment of a girl with a Class II malocclusion of molars and canines with missing maxillary lateral incisors and convex facial profile is shown. Treatment was successfully achieved and included the space closure of the areas corresponding to the missing upper lateral incisors, through movement of the canines and the posterior teeth to mesial by fixed appliances as well as the canines transformation in the maxillary lateral incisors. This is a 14-year follow-up case report involving orthodontics and restorative dentistry in which pretreatment, post-treatment, and long-term follow-up records for the patient are presented.     

An interdisciplinary approach for improved esthetic results in the anterior maxilla

This clinical report describes an interdisciplinary (orthodontic, periodontic, and prosthodontic) approach for the coordinated treatment of a patient diagnosed with peg-shaped maxillary lateral incisors, diastemata, short clinical crowns, excessive gingival display, and orthodontic malocclusion. The patient's specific esthetic expectations for the anterior maxilla were successfully met through phased treatment, including orthodontic tooth movement, provisional restorations, periodontal surgery for lengthening of the clinical crown, porcelain laminate veneers, and direct composite restorations. Such coordinated interdisciplinary evaluation and treatment are necessary for improved esthetic results in maxillary anterior areas esthetically compromised in several aspects.     

Combined periodontal, orthodontic, and restorative treatment of pathologic migration of anterior teeth: a case report

Pathologic tooth migration related to periodontal disease is a common chief complaint of periodontal patients. This paper describes the treatment of a case of severe periodontal disease and disfiguring pathologic migration of maxillary central incisors, which required a multidisciplinary approach. After conventional periodontal treatment was performed, the anterior diastema was closed using a combination of orthodontic therapy and restorative treatment. A 6-month follow-up examination of this case revealed resolution of the anterior pathologic migration, with gains in clinical attachment levels and a successful esthetic and functional final result.     

Long-term follow-up of conservative treatment of severely traumatized maxillary incisors

Abstract We present the case of a 26-year-old man who at the age of 9 suffered severe trauma to both maxillary central incisors. The underlying malocclusion was skeletal and classified as dental Class II/1 with severe crowding. Both the maxillary central incisors and the two lower first premolars were extracted and the patient was treated with an edgewise appliance for 2 years. Acceptable occlusal relationships were achieved following orthodontic and adjunctive treatment which consisted of reshaping the maxillary lateral incisors with composite materials and grinding the canines to resemble lateral incisors. A critical evaluation of the esthetic and functional results at the age of 26 years is presented.     

Detailed three-dimensional orthodontic tooth repositioning to improve restorative outcome:: A case report

The case describes the interdisciplinary treatment of a 23-year-old woman with a Class III malocclusion, missing an upper right lateral incisor, abrasion of the maxillary incisal edges, anterior gingival margin discrepancies, and gingival recession. Initially, the patient was treated with fixed appliances combined with orthognathic surgery. The extraction of the upper left lateral incisor and bilateral canine substitution plan was chosen. At the end of the surgical and orthodontic treatment, the restorative treatment with six veneers was accomplished to improve smile esthetics. Despite the missing lateral incisors, the patient showed a natural, good-looking final result. A symmetric incisal plane was established, a functional occlusion with average vertical and horizontal overlap was set, and the bone scallop and consequently the gingival margins were leveled. The interdisciplinary approach hid all of the initial esthetic defects of the case. The result highlights how to obtain a remarkable improvement of the smile outcome with a well-functioning masticatory system.     

Restoration of maxillary incisors with a zirconia all-ceramic system: a case report.

The increase in patient demands for enhanced esthetics has prompted the development of several all-ceramic restorative systems. Despite their esthetic advantage, unsatisfactory mechanical properties have restricted the clinical indications of all-ceramic restorations. Recently, densely sintered zirconia-based restorations have become available. This material appears to have adequate strength and toughness to allow for the fabrication of anterior and posterior crowns and fixed partial dentures. This clinical report describes the procedures used for the restoration of maxillary incisors with the zirconia-based Lava system.     

Equilibration of a progressive anterior open occlusal relationship: a clinical report

This clinical report described the initial phase of treatment of a progressive anterior open occlusal relationship. Trial equilibration on duplicate mounted diagnostic casts demonstrated centric contacts on all posterior teeth by reducing only the maxillary palatal cusps until the central incisors coupled. Anterior guidance and posterior teeth disclusion were confirmed with wax augmentation of maxillary canine palatal contours. Palatal surface and occlusal matrix reduction guides were used to visualize and measure the amount of planned tooth structure removal required to achieve a programmed occlusion. Intraoral composite resin augmentation of maxillary central incisor and canine palatal surfaces provided anterior guidance. Equilibration was limited to the maxillary palatal cusps and one lower molar. The initial 3 mm open dimension between the maxillary and mandibular incisors was eliminated. Accurate evaluation of the equilibrated duplicate casts resulted in a more conservative final result with less posterior tooth reduction and increased maxillary palatal contours. A comfortable and stable occlusion was established without any esthetic change prior to definitive restoration with multiple individual crowns.     

Autogenous attachment technique with esthetics in mind: trauma management case report

The majority of dental trauma involves anterior teeth, especially the maxillary central incisors. A crown fracture with pulp tissue involvement, severe sensitivity, and pain is certainly unpleasant for the patient. This case report will discuss the endodontic therapy and restoration with an autogenous tooth fragment attachment technique. When treating an emergency situation that involves trauma, it is challenging to provide the patient with both pain relief and esthetic restoration.     

Treatment of a patient with a crowded Class I malocclusion and a congenitally missing mandibular incisor

This case report describes the management of maxillary and mandibular crowding in a patient with facial esthetic concerns and a tooth-size discrepancy due to a missing mandibular central incisor. The treatment included extracting the remaining mandibular central incisor and the 2 maxillary first premolars. The mandibular canines were repositioned to substitute for lateral incisors, and the mandibular premolars were used as canines.     

Orthodontic intervention in Fanconi's anemia: A case report

The objective of this case report was to present the orthodontic treatment of an 8-year-old female patient with Fanconi's anemia and Class III skeletal pattern and agenesis of maxillary lateral incisors. Patient presented in the late mixed dentition with a Class III malocclusion with anterior and posterior crossbites. Rapid maxillary expansion and facemask therapy was performed for 12 months. Phase II was simplified with a 6 × 2 fixed appliance only in the mandibular arch for solving the anterior crowding. Maxillary canines were reshaped as lateral incisors and the central incisors were augmented for closing spaces. Although the systemic disease, orthodontic intervention is possible if individual limitations are considered and treatment is simplified.     

Multidisciplinary approach of complicated crown fractures of both superior central incisors: a case report

Abstract –  Anterior crown fractures are a common form of traumatic dental injuries that mainly affect the maxillary central incisors, in children and teenagers. Since the development of the adhesive dentistry, many case reports of crown fractures restored using adhesive reattachment techniques were published. Complex cases, in which more than one tooth are involved, with fractures differing from each other, require specific treatment of each fracture, taking different advantages of the different remaining tooth structures. This case report describes a patient with dissimilar crown fractures of both superior central incisors. After the endodontic treatment, the patient was treated using the combination of several techniques: periodontal surgery (crown lengthening with apically repositioned flap and osseous resective surgery), adhesive technique and cast restoration plus esthetic crown. The periodontal procedure re-created the biologic width and proved to be a reliable adjunctive procedure to the adhesive and the prosthetic techniques used.     

Selecting treatment options and sequencing treatment in the replacement of 2 maxillary central incisors with implants: a case report

This article describes treatment provided to replace 2 maxillary central incisors with implant-supported restorations. The site of a missing maxillary central incisor was treated utilizing a bone expansion technique to augment the labial hard and soft-tissue profiles at the time of implant placement. The adjacent central incisor tooth, although destined to be extracted, was retained to serve as an abutment for a fixed provisional restoration until the first implant was deemed to have successfully integrated. At the appointment to uncover this implant, the fractured tooth was extracted and an implant was immediately placed into the socket. The first implant was then used to support the provisional restoration during the healing phase of the second implant. The techniques utilized resulted in optimum soft-tissue contours, allowed the patient to have a comfortable and esthetic provisional restoration, and minimized the number of surgical procedures.     

Distraction osteogenesis: a treatment tool to improve baseline conditions for esthetic restorations on immediately placed dental implants--a case report

Replacement of two adjacent teeth in an anterior maxilla with deficient hard and soft tissues appears to be the utmost challenge in implant dentistry in the esthetic zone. In this case report, baseline conditions for implant placement were improved by alveolar distraction to enhance hard and soft tissues around the maxillary central incisors. Three months after the active phase of distraction, the roots of the central incisors were extracted and two screw-type dental implants were immediately placed into the extraction sockets. For immediate provisionalization, acrylic resin crowns were fabricated on UCLA abutments, providing the ideal emergence profile to support the periimplant soft tissue. Six months after implant placement, the prosthetic restoration of the case was finished with ceramic crowns cemented to individually fabricated zirconium oxide abutments. The described treatment strategy appears to have a great potential to restore natural esthetics in cases with major tissue deficiencies in the esthetic zone.     

A multidisciplinary approach to enhance implant esthetics: case report

Esthetic implant-supported restorations in the anterior maxilla present a number of clinical challenges to the dentist, including the need to preserve or restore the periimplant hard and soft tissue architecture around the implant site. In this clinical case report, two implant systems were used to restore two missing maxillary central incisors to make use of the physical properties in each system. Two different surgical protocols were used to place each implant, and the deficient alveolar bone was restored with an autogenous bone graft. After a detailed clinical evaluation, a comprehensive treatment plan was developed to address the unique demands of the patient. Both teeth were fully restored with esthetic, implant-supported, single-tooth restorations, and clinical results were recorded postoperatively.     

Multidisciplinary treatment of "twinned" permanent teeth: two case reports

Twinned teeth usually appear in the anterior region of the dental arch. Besides orthodontic malocclusions, such as protrusion, crowding, or diastema, they also cause esthetic problems. Different treatment methods can be used according to the requirements of the situation. This article reports multidisciplinary treatment of 2 patients whose maxillary central teeth were twinned with supernumerary incisors. The twinned tooth was reshaped following endodontic treatment in 1 of the patients and orthodontic treatment was performed with edgewise mechanics. In the second case, however, it was determined that the twinned tooth had 2 separate roots. There was also another supernumerary lateral incisor in the dental arch that increased the severity of the crowding. The twinned tooth was hemisected and the other supernumerary tooth was extracted. The patient wore a removable appliance for initial tooth movements and treatment was finished with fixed appliances.