The position of the gingival margin as expressed by clinical crown height in children aged 6-16 years.

The position of the gingival margin, as indicated by clinical crown height, was determined in the permanent teeth of 237 Caucasian children aged between 6 and 16 years. With increasing age, a shift of the gingival margin towards the cementoenamel junction was observed in all the teeth with the exception of the lower second molar. This development levelled off after the age of 12 in the case of the mandibular central incisors, canines, second premolars and first molars. In the remaining teeth the gingival margin continued to recede until 16 years, the oldest group in the study     

Three-dimensional inclination of the dental axes in healthy permanent dentitions--A cross-sectional study in a normal population

The 3-dimensional (3-D) inclination of the facial axis of the clinical crown (FACC) and the size of the clinical crowns were measured in 100 white northern Italians. The subjects consisted of 22 girls and 21 boys, ages 13-15 years (adolescents), and 31 women and 26 men, ages 16-26 years (adults), all with a complete permanent dentition and Class I dental relationships. The 3-D coordinates of dental landmarks were obtained with a computerized electromagnetic digitizer. Clinical crowns heights and FACC inclinations in the anatomical frontal and sagittal planes relative to 2 reference planes, maxillary and mandibular (between the incisive papilla and the intersection of the palatal/lingual sulci of the first permanent molars with the gingival margin), were calculated. Ages and sexes were compared by ANOVA. On average, the frontal plane FACCs of most teeth converged toward the midline plane of symmetry. In contrast, the incisors diverged from the midline plane or were nearly vertical. Within each quadrant, the inclinations of the postincisor teeth progressively increased. In the sagittal plane, most teeth had a nearly vertical FACC. FACC inclinations showed sex- and age-related differences (P < .05). In the frontal plane, the canines, premolars, and molars were more inclined in adolescents than in adults. In the sagittal plane, a large within-group variability was observed. Clinical crown height was significantly larger in males than in females in all maxillary and mandibular canines, premolars, second molars, maxillary central incisors, and first molars. With age, some degree of dental eruption was found in maxillary and mandibular canines, maxillary second premolars, and molars. The age-related decrease in FACC inclination may be the effect of a progressive buccal and mesial drift.     

Interrelation of tooth crown diameters

The purpose of this study was to clarify the interrelation of the tooth crown diameters using statistical methods. The material consisted of 414 dental casts from orthodontic patients in the Japanese female. The mesiodistal diameters of all permanent teeth on the left side were measured, excluding the third molars. These values were examined by correlation coefficient matrix and multivariate analyses such as multiple regression, principal component and canonical correlation, etc. The results were as follows: 1) The tooth crown diameters showed a strong intercorrelation within each jaw and between both jaws. 2) When the incisors and the canine were large in size, the premolars and the molars tended to be small. 3) When the incisors and the molars were large in size, the canine and the premolars tended to be small. 4) When the incisors and the premolars were large in size, the canine and the molars tended to be small. 5) All of the teeth except the upper lateral incisor were classified according to size into the four groups of incisors, canines, premolars and molars. 6) The dentition with small teeth tended to show a spaced arch.     

Dental and occlusal changes during mandibular advancement splint therapy in sleep disordered patients

The aims of this longitudinal, observational study were two-fold: first, to determine in adults with sleep disorders the extent of dental and occlusal changes following the use of a mandibular advancement splint (MAS) and, second, to determine the time course of these changes. One hundred adult subjects (87 males, 13 females) diagnosed with obstructive sleep apnoea (OSA) and/or asymptomatic snoring were treated with non-adjustable MAS. At the outset each subject was randomly assigned to a group and reviewed 6, 12, 18, 24 or 30 months after placement of a splint. There were 20 subjects in each group. Craniofacial changes were measured on lateral cephalometric radiographs taken at the initial and review appointments. When the changes in all subjects were examined, the SNA, ANB angles, ANS-PNS length and face height increased, and the mandibular first molars and the maxillary first premolars significantly overerupted. Significant retroclination of the maxillary incisors and proclination of the mandibular incisors were accompanied by reductions in maxillary arch length, overbite and overjet. When the changes over time were determined, the mandibular symphysis was significantly lower at all review periods. An increase in face height and reductions in overbite and overjet were evident at 6 months, and over-eruption of the maxillary first premolars and mandibular first molars, and proclination of the lower incisors were found at 24 months. Significant positive correlations were also found between the amount of anterior opening by the appliances and changes in overbite at 24 and 30 months. The appliance used produced small, unpredictable changes in the occlusion that tended to occur after 24 months' wear. It is postulated that the changes in overbite might be lessened by keeping the bite opening to a minimum.     

Effectiveness of computer-assisted orthodontic treatment technology to achieve predicted outcomes

Objective:To evaluate the effectiveness of computer-assisted orthodontic treatment technology to produce the tooth position prescribed by the virtual treatment plan.Materials and Methods:Posttreatment models of 23 patients treated with SureSmile were digitally superimposed on their corresponding virtual treatment plan models utilizing best-fit surface-based registration. Individual tooth-position discrepancies between virtual treatment plan and actual outcome were computed. Discrepancies less than 0.5 mm in mesial-distal, facial-lingual, and vertical dimensions, and less than 2° for crown torque, tip, and rotation were considered clinically ideal. One-sided test of equivalence was performed on each discrepancy measurement, with P < .05 considered statistically significant.Results:Mesial-distal tooth position was clinically ideal for all teeth with the exception of maxillary lateral incisors and second molars. Facial-lingual tooth position was clinically ideal for all teeth except maxillary central incisors, premolars, and molars, and mandibular incisors and second molars. Vertical tooth position was clinically ideal for all teeth except mandibular second molars. For crown torque, tip, and rotation, discrepancy exceeded the limits considered clinically ideal for all teeth except for crown torque on mandibular second premolars and crown tip on mandibular second premolars and first molars.Conclusions:The effectiveness of computer-assisted orthodontic treatment technology to achieve predicted tooth position varies with tooth type and dimension of movement.     

阻生前磨牙的临床研究现状

阻生牙是口腔中较常见的一种发育畸形,以尖牙、第三磨牙、中切牙、前磨牙及第二磨牙的阻生多见,尤以下颌第三磨牙及上颌尖牙阻生的患病率最高。目前国内外学者对阻生牙的研究主要集中在上颌尖牙和第三磨牙方面,对阻生前磨牙的研究甚少。临床上,很大一部分正畸患者需要进行拔牙矫治,且拔牙牙位主要位于前磨牙区,可见阻生前磨牙对正畸矫治设计及预后影响极大。本文对阻生前磨牙现有的研究状况进行综述,对阻生前磨牙的流行病学特点、临床定位和治疗方法进行总结,以期为正畸医生制定正畸矫治计划提供参考。     

Gingival recession in tooth types in high fluoride and low fluoride areas

The prevalence of gingival recession in individual teeth in 1,884 dentate adults, aged 15–65 years, continuously resident in the natural fluoride area of Hartlepool (1·5–2·0 ppm F) was compared with that found in 2,015 dentate adults from the low fluoride town of York (0.15–0.28 ppm F). In each tooth type, gingival recession increased steadily with age. A distinctive pattern of gingival recession was observed in each community. Mandibular incisors showed the highest prevalence of gingival recession, followed by maxillary first molars, mandibular first molars, premolars, maxillary second molars, mandibular second molars and canines. Maxillary incisors showed the lowest prevalence of gingival recession. There was an extremely high correlation between Hartlepool and York data, for each group of teeth. It was therefore concluded that fluoride in drinking water, at least up to 2 ppm F, has no effect on the pattern of gingival recession in adults.     

A case of oculo-facio-cardio-dental syndrome with integrated orthodontic-prosthodontic treatment.

OBJECTIVE: Oculo-facio-cardio-dental (OFCD) syndrome is a very rare condition that requires comprehensive dental management because of associated multiple dental anomalies such as canine radiculomegaly, delayed dentition, oligodontia, persistent primary teeth, microdontia, and macrodontia. This report presents a case of OFCD in a Japanese girl (13 years 1 month old). We analyzed cephalograms, panoramic roentgenograms, and dental casts and discuss our integrated orthodontic-prosthodontic treatment. DESIGN: The sizes of the tooth crown and root as well as lateral cephalograms were compared with those from a Japanese control group. The outcome of orthodontic treatment was evaluated by comparing cephalograms taken before and after treatment. RESULTS: Radiculomegaly was found not only in the upper and lower canines but also the upper central incisors and lower first premolars. Macrodontia was found in the upper central incisors, upper canines, lower canines, and lower first premolars. Microdontia was found in the upper lateral incisor. Lateral cephalometric analysis showed a remarkable hypoplastic midface in both the sagittal and vertical dimensions, coupled with a significantly decreased cranial base length and an increased gonial angle. Serial lateral cephalograms during orthodontic treatment from 13 to 23 years of age demonstrated only slight maxillary growth and significant downward mandibular growth with clockwise rotation in addition to pronounced labial tipping of the upper central incisors. CONCLUSIONS: Characteristic dental anomalies together with a unique craniofacial dysmorphology were clarified. Successful oral rehabilitation was achieved by integrated orthodontic-prosthodontic treatment.     

Anatomic crown width/length ratios of unworn and worn maxillary teeth in white subjects

STATEMENT OF PROBLEM: Dimensions of teeth have been available for a century. Some significant and clinically relevant aspects of dental esthetics, however, such as the crown width/length ratios, have not been presented in tooth morphology sources until recently. PURPOSE: The purpose of this study was to analyze the anatomic crowns of 4 tooth groups (central incisors, lateral incisors, canines, and first premolars) of the maxillary dentition with respect to width, length and width/length ratios and determine how these parameters are influenced by the incisal edge wear. MATERIAL AND METHODS: Standardized digital images of 146 extracted human maxillary anterior teeth from white subjects (44 central incisors, 41 lateral incisors, 38 canines, 23 first premolars) were used to measure the widest mesiodistal portion "W" (in millimeters) and the longest inciso-cervical/occluso-cervical distance "L" (in millimeters). The width/length ratio "R" (%) was calculated for each tooth. A 1-way analysis of variance was used to compare the mean values of W, L, and R for the different groups ("unworn" and "worn" subgroups, except for premolars). Multiple least significant difference range tests (confidence level 95%) were then applied to determine which means differed statistically from others. RESULTS: There was no influence of the incisal wear on the average value of W (width) within the same tooth group. The widest crowns were those of central incisors (9.10 to 9.24 mm) > canines (7.90 to 8.06 mm) > lateral incisors (7.07 to 7.38 mm). Premolars (7.84 mm) had similar width as canines and worn lateral incisors. The L-value was logically influenced by incisal wear (worn teeth were shorter than unworn teeth) except for lateral incisors. The longest crowns were those of unworn central incisors (11.69 mm) > unworn canines (10.83 mm) and worn central incisors (10.67 mm) > worn canines (9.90), worn and unworn lateral incisors (9.34 to 9.55 mm), and premolars (9.33 mm). Width/length ratios also showed significant differences. The highest values were found for worn central incisors (87%) and premolars (84%). The latter were also similar to worn canines (81%), which constituted a homogeneous group with worn lateral incisors (79%) and unworn central incisors (78%). The lowest ratios were found for unworn canines and unworn lateral incisors (both showing 73%). CONCLUSIONS: Along with other specific and objective parameters related to dental esthetics, average values for W (mesiodistal crown dimension), L (inciso-cervical crown dimension), and R (width/length ratio) given in this study for white subjects may serve as guidelines for treatment planning in restorative dentistry and periodontal surgery.     

Teeth and gingival display in the premolar area during smiling in relation to gender and age

There is limited knowledge concerning tooth and gingival display in the maxillary premolar area during smiling. The purpose of this study was to investigate maxillary premolar and associated gingival display during smiling, and to reveal possible differences related to gender and age. The study consisted of 90 males and 113 females (mean age 38 years, s.d. = 13.83) receiving regular dental care. Two pictures of each subject, one with lips in maximum smile, and the other a retracted frontal view, were made. Clinical crown length, tooth and gingival display were measured for the left maxillary premolars. Central incisors and canines were used as controls. anova with Bonferroni post hoc multiple comparisons tests was used to assess any statistically significant impact of gender and age on tooth and gingival display, and determine differences among gender and age groups (at 5% significance level). Premolars were partially visible in more than 80% of the smiles, and displayed more than 65% of their clinical crown length during smiling. The least display (P < 0.001) was recorded for first and the greatest for second premolars. Tooth display was greater in females, but statistically significant only in central incisors (P < 0.05). No significant differences were revealed between age subgroups. Gingival display was greater for premolars compared with both central incisors (P < 0.001) and canines (P < 0.05). Displayed gingiva was found in first and second premolars in 44 and 49% of subjects, respectively. More gingival display was recorded in females and in younger subjects.     

Electric pulp test threshold responses in healthy incisors,canines, premolars and molars

The purpose of this study was to determine the range of threshold responses of healthy dental pulps and test the reproducibility of the electric pulp test (EPT). Forty‐nine dental students participated in the study. Sound teeth in both arches, except third molars, were included. The teeth were isolated using cotton rolls and dried with compressed air, and the threshold responses were recorded. Participants stopped the stimulus increase by pressing the switch at the first sensation of discomfort. The measurements were repeated after 30 days. The obtained data were analysed using SPSS^®16.0. The mean thresholds for the maxillary incisors, canines, premolars and molars were 10.77, 21.07, 21.88 and 34.07 μA, and for mandibular incisors, canines, premolars and molars 9.81, 18.7, 19.24 and 30.1 μA respectively. The differences between the two measurements were statistically significant for teeth 32, 31, 41 and 42. The EPT was shown to be reproducible for all the teeth tested except mandibular incisors.     

Absolute anchorage with universal t-loop mechanics for severe deepbite and maxillary anterior protrusion and its 10-year stability

An adult patient with severe maxillary protrusion and deepbite who was congenitally missing two mandibular incisors was treated successfully by maximum retraction of the maxillary anterior teeth after extraction of the maxillary first premolars using a moment differential between the anterior and posterior segments created by a universal T-loop. Anterior teeth were moved with controlled tipping, and little anchorage loss of the posterior segments was experienced using the universal T-loop spring. Reduction of overbite was performed by absolute intrusion of both maxillary and mandibular anterior teeth. With retraction of the maxillary anterior teeth and recontouring of the mandibular canines, proper overjet and overbite were achieved. This report shows the 10-year stability of the case treated with the universal T-loop for the first time.     

A rare case of dens invaginatus in a mandibular canine

Dens invaginatus (dens in dente) is a common dental anomaly with a reported prevalence of between 0.04% and 10%. It typically affects permanent maxillary lateral incisors, central incisors and premolars. These developmental lesions are less common in mandibular teeth and are extremely rare in canines and molars. This report describes a rare case of dens invaginatus (Oehlers type II) in a permanent mandibular canine. The tooth was mature with a closed apex and showed apical pathosis. The tooth was treated endodontically using a non-surgical technique with hand endodontic files, and then followed up after a period of 8 months. A follow-up radiograph showed some healing of the lesion.     

Change in dentition over 20 years from third decade of life

PurposePrevious studies have documented long-term, age-related change in the teeth, dental arches and occlusion. However, very few studies have investigated longitudinal age-related change in the dentition using 3-dimensional (3-D) measurement. The purpose of this study was to clarify age-related change in the dentition using a laser scanner.Materials and methodsWe used dental casts obtained from the same subjects in their twenties and forties. Subjects were selected based on near-normal occlusion. We investigated age-related variation in the dentition using 3-D measurement.ResultsAge-related change in the dentition was characterized by a decrease in maxillary and mandibular width, an increase in maxillary length, and a decrease in mandibular length. Measurement of angulation revealed that the maxillary canines and molars were mesially inclined. We observed labial inclination of the maxillary incisors, and lingual inclination of the mandibular incisors, as well as the maxillary and mandibular canines and molars. Overjet, overbite, and the irregularity index all showed an increase, while occlusal vertical dimension showed a decrease. Multiple regression analysis indicated that lingual inclination of the lower central incisors was related to an increase in the irregularity index, and that lingual inclination of the upper canines and decrease in occlusal vertical dimension of the anterior teeth were related to increased overbite.ConclusionThe present findings showed that age-related changes in angulation and inclination of each tooth should be taken into account when providing occlusal rehabilitation or post-orthodontic retention.     

Is mild dental invagination a risk factor for apical root resorption in orthodontic patients?

The purpose of this retrospective study was to assess if dental invagination is a risk factor for root resorption during orthodontic treatment. The sample consisted of 91 patients (32 males, 59 females) with a mean age of 13.1 years (range 9.3-32.1 years) with complete orthodontic records, including periapical radiographs of the maxillary incisors before and after treatment. Forty-nine patients had at least one maxillary incisor invaginated, whilst the remaining 42 patients were free of dental invaginations. Variables recorded for each patient included gender, age, Angle classification, extraction or non-extraction therapy, ANB angle, overjet, overbite, trauma, habits, agenesis, tooth exfoliation, treatment duration, Class II elastics, body-build, general factors, impacted canines, and root form deviation. Crown and root length of the maxillary incisors were measured on pre- and post-treatment long cone periapical radiographs corrected for image distortion. The percentage of root shortening and root length loss in millimetres was then calculated. Most of the invaginated teeth were minor type 1. Statistical analysis revealed no significant difference in the severity of apical root resorption between invaginated and non-invaginated incisors in patients without dental invaginations, nor was the extent of dental invagination related to the severity of apical root resorption. However, invaginated teeth had malformed roots more often than non-invaginated teeth. Dental invagination, and particularly type 1, cannot be considered a risk factor for apical root resorption during orthodontic tooth movement.     

Relationship between tooth length and three-dimensional mandibular morphology

Objectives:To clarify the relationship between tooth length and three-dimensional mandibular morphology in a healthy Japanese population.Materials and Methods:This study included 181 Japanese adults: 66 men and 115 women. Cone-beam computed tomography (CBCT) images were acquired with a dentofacial cone-beam x-ray CT scanner. Tooth length was measured with open-source OsiriX medical image processing software. Crown height and root length were measured in the maxillary and mandibular central incisors, lateral incisors, canines, first premolars, second premolars, first molars, and second molars. Based on these measurements, principal component (PC) analysis was performed. The following measurements were used to assess three-dimensional mandibular morphology: CD-GO, GO-GN, RCD-LCD, RGO-LGO, RCP-LCP, and the gonial angle. Stepwise multiple regression analysis was performed to examine the associations between three-dimensional mandibular morphology and the patterns of crown and root lengths using the mandibular measurements as explanatory variables and each PC as the dependent variable.Results:CD-GO was positively associated with PC1, which represented overall tooth length. RGO-LGO was positively associated with PC2, whereas GO-GN, RCP-LCP, and gonial angle were negatively associated with PC2, which was the axis denoting relatively longer root (+) vs higher crown (−). Being female was associated with PC3, which was the axis denoting relatively longer posterior tooth (+) vs anterior tooth (−).Conclusions:The present clinical study effectively used CBCT images and PC analysis to reveal significant correlations between tooth length and mandibular morphology in a modern human population, confirming in part the statement that “large teeth necessitate large jaws.”     

Gingival phenotypes in young male adults

Abstract In a previous study on 42 young adult, periodontally healthy subjects without any attrition, abrasion or crown restoration, gingival thickness (GTH) was determined at facial aspects of premolars, canines and incisors by a novel ultrasonic device. GTH strongly depended on periodontal probing depth, width of gingiva (WG), and tooth type. Whereas the ratio of crown width to its length (CW/CL) was not identified as an explanatory variable, a significant influence of the subject was ascertained. The aim of the present study was to extend these analyses in order to identify subjects with different morphological characteristics of gingiva, i.e., gingival phenotypes. When employing cluster analysis on standardized parameters mean GTH, WG and CW/CL of upper canines, lateral and central incisors, 3 clusters were identified. Cluster A comprised 2/3 of subjects, displaying “normal” GTH, WG and CW/CL. Cluster B (n=9, 21%) had a significantly thicker and wider gingiva, and a more quadratic form of upper front teeth. A 3rd cluster (cluster C, n=5, 12%) was identified showing “normal” GTH, high CW/CL, but a narrow zone of keratinized tissue. Some characteristics of gingival phenotype of the upper front tooth region were also found at upper premolars (WG, CW/CL) but in general not at mandibular teeth. Present results clearly indicate evidence for the existence of different gingival phenotypes. Clinical relevance of these observations has to be tested in longitudinal studies.     

Design and implementation of a hybrid genetic algorithm and artificial neural network system for predicting the sizes of unerupted canines and premolars

The aim of this study was to develop a novel hybrid genetic algorithm and artificial neural network (GA-ANN) system for predicting the sizes of unerupted canines and premolars during the mixed dentition period. This study was performed on 106 untreated subjects (52 girls, 54 boys, aged 13-15 years). Data were obtained from dental cast measurements. A hybrid GA-ANN algorithm was developed to find the best reference teeth and the most accurate mapping function. Based on a regression analysis, the strongest correlation was observed between the sum of the mesiodistal widths of the mandibular canines and premolars and the mesiodistal widths of the mandibular first molars and incisors (r = 0.697). In the maxilla, the highest correlation was observed between the sum of the mesiodistal widths of the canines and premolars and the mesiodistal widths of the mandibular first molars and maxillary central incisors (0.742). The hybrid GA-ANN algorithm selected the mandibular first molars and incisors and the maxillary central incisors as the reference teeth for predicting the sum of the mesiodistal widths of the canines and premolars. The prediction error rates and maximum rates of over/underestimation using the hybrid GA-ANN algorithm were smaller than those using linear regression analyses.     

基于锥形束CT的多生牙新分类方法临床意义研究

 目的　应用锥形束CT（cone-beam CT，CBCT）对多生牙进行新的临床分类，并分析新分类方法的临床意义。方法　收集2016-2019年首都医科大学附属北京友谊医院口腔科的CBCT影像资料5100例，其中多生牙患者209例，共计多生牙278颗。应用CBCT对多生牙进行新的临床分类，包括萌出型、骨埋伏高位型、骨埋伏低位型、骨埋伏复杂型和牙弓外型，并分析其临床意义。结果　（1）临床资料分析：多生牙发生率为4.1%，其中有1颗多生牙的患者占76.6%，有2颗多生牙的患者占19.1%，有3颗及以上多生牙的患者占4.3%。多生牙好发部位依次为：上颌切牙区、上颌磨牙区、下颌尖牙及前磨牙区、上颌尖牙及前磨牙区、下颌磨牙区。34.9%的多生牙对邻近恒牙产生了继发影响，以萌出错位及阻生为主，主要发生在上颌切牙区。（2）新分类方法的临床意义分析：上颌切牙区多生牙以骨埋伏低位型及萌出型为主，尖牙、前磨牙及磨牙区多生牙以萌出型为主。不同类型多生牙对邻近恒牙产生继发影响的发生率不同或不全相同（χ2 = 26.057，P < 0.001），提示对邻近恒牙易产生继发影响的多生牙类型依次为：萌出型、骨埋伏复杂型、骨埋伏高位型、牙弓外型、骨埋伏低位型。结论　基于CBCT的多生牙新分类方法简单实用，其中萌出型、骨埋伏复杂型及骨埋伏高位型多生牙更易产生错牙合畸形，建议尽早拔除多生牙、定期随访，必要时正畸治疗。     

Normal torque of the buccal surface of mandibular teeth and its relationship with bracket positioning: a study in normal occlusion

This study evaluated the degree of buccolingual inclination of mandibular tooth crowns relative to torque. For such purpose, mandibular and maxillary stone casts from 31 Caucasian Brazilian adults with normal occlusion, pleasant facial aspect and no history of previous orthodontic treatment were examined. A custom device was developed for measuring the degree of inclination (torque) of bracket slots of orthodontic appliances relative to the occlusion plane, at three bonding height: standard (center of clinical crown), occlusal (0.5 mm occlusally from standard) and cervical (0.5 mm cervically from standard). Except for the mandibular incisors, which presented a small difference in torque from one another (lingual root torque for central incisors and buccal root torque for lateral incisors), the remaining average values are close to those found in the literature. Due to the convexity of the buccal surface, the 1-mm vertical shift of the brackets from occlusal to cervical affected the values corresponding to the normal torque, in approximately 2 degrees in central and lateral incisors, 3 degrees in canines and 8 degrees in premolars and molars.