Evaluation of Cortical Thicknesses and Bone Density Values of Mandibular Canal Borders and Coronal Site of Alveolar Crest.

Objectives: The objectives of this retrospective study are to measure the amount of the alveolar crest cortication and cortication around the mandibular canal, and to evaluate bone density values of alveolar crest, cortication around mandibular canal, and possible implant placement area for edentulous sites. Material and Methods: Six hundred forty-two cone-beam computed tomography scans from 642 subjects were evaluated in four centers. Cortical thicknesses of alveolar crest and mandibular canal cortical borders (buccal, lingual, apical, and coronal) in each mandibular posterior teeth region were measured. Bone density of alveolar crest and mandibular canal cortical borders (buccal, lingual, apical, and coronal) in each mandibular posterior teeth region were recorded. The correlations between numeric variables were investigated using Pearson's correlation test. Results: The largest cortical border of the canal was measured 1.1 (SD 0.71) mm at the left second molar area and in coronal side of the mandibular canal (MC). Left and right first premolar regions showed higher bone density values compared to the other sites in all bone density values evaluations. The buccal side of the canal at the right first premolar region showed the highest bone density values (832.32 [SD 350.01]) while the coronal side of the canal at the left second molar region showed the lowest (508.75 [SD 225.47]). The bone density of possible implant placement area at the both left (692.25 [SD 238.25]) and right (604.43 [SD 240.92]) edentulous first premolar showed the highest values. Positive correlations between the bone density values of alveolar crest and the coronal side of MC were found in molar and left second premolar regions (P < 0.05). Conclusions: Results may provide information about the amount of cortication and bone densities tooth by tooth for posterior mandible to surgeons for planning the treatment precisely.

Effects of Crest Morphology on Lingual Concavity in Mandibular Molar Region: an Observational Study.

Objectives: The aim of this radiological study is to evaluate the lingual concavity dimensions and possible implant length in each posterior tooth region according to posterior crest type classification by using cone-beam computed tomography. Material and Methods: According to inclusion criteria, 836 molar teeth regions from 209 cone-beam computed tomography images were evaluated. Posterior crest type (concave, parallel, or convex), possible implant length, lingual concavity angle, width, and depth were recorded. Results: In each posterior tooth region, concave (U-type) crest was detected most frequently while convex (C-type) was the lowest. Possible implant length values were higher in second molar regions than first molars. Lingual concavity width and depth were decreasing from second molars to first molars for both sides. Additionally, lingual concavity angle showed higher values in second molar sites than first molars. In all molar teeth regions, lingual concavity width values were the highest in concave (U-type) crest type while they were the lowest in convex (C-type) crest type (P < 0.05). Lingual concavity angle values were recorded as the highest in concave (U-type) and the lowest in convex (C-type) crest type at the left first molar and right molars (P < 0.05). Conclusions: The lingual concavity dimensions and possible implant length may vary according to crest type and edentulous tooth region. Due to this effect, the surgeons should examine crest type clinically and radiologically. All parameters in the present study are decreasing while moving from anterior to posterior as well as from concave (U-type) to convex (C-type) morphologies.

Three-Dimensional Evaluation of Autogenous Ramus Block Graft Donor Site and Its Relation to Mandibular Canal.

Sufficient bone volume is necessary for placing a dental implant in an ideal position. To restore severely insufficient bone volume, autogenous block graft procedures with various intraoral donor sites are presented in the literature. The aims of this retrospective study are to present the dimensions and volume of the potential ramus block graft site, and to evaluate possible effect of mandibular canal diameter and its position in relation to mandibular ramus block graft volume. Two-hundred cone-beam computed tomography (CBCT) images were evaluated. The maximum length, width, height, and volume of the potential ramus block graft site, mandibular canal diameter, mandibular canal-mandibular basis distance, and mandibular canal-crest distance were measured. Mandibular canal diameter, mandibular canal-crest distance, and mandibular canal-mandibular basis distance were 3.139 ± 0.446 mm, 15.376 ± 2.562, and 7.834 ± 1.285 mm, respectively. In addition, the dimensions of the potential ramus block graft sites were measured 11.156 ± 2.297 mm × 10.390 ± 3.420 mm × 8.816 ± 1.720 mm (height × length × width). Moreover, the potential ramus bone block volume was calculated as 1.076 ± 0.398 cm3. While a positive correlation was detected between mandibular canal-crest distance and the potential ramus block graft volume (r = .160, P = .025), a negative correlation was found between mandibular canal-mandibular basis distance and the potential ramus block graft volume (r = -.020, P = .001). Mandibular ramus is one of the predictable intraoral donor sites for bone augmentation procedures. However, ramus has some volumetric limitations related to its neighboring anatomic structures. It seems to be important to evaluate lower jaw in a 3-dimensional manner to prevent surgical complications.

Possible Association between the Quantity of Peri-implant Crevicular Fluid, Clinical Indices, and the Dimensions of Endosseous Implants.

Objectives: The objectives of this clinical observational study are to measure peri-implant crevicular fluid volume based on dental implant diameter and length, and to evaluate the possible relationship between peri-implant crevicular fluid/gingival crevicular fluid volumes and clinical periodontal indices. Material and Methods: The information about length and diameter of dental implants was noted. Clinical indices (probing depth, plaque index, gingival bleeding time index, and gingival index) were recorded. Peri-implant crevicular fluid (PICF)/gingival crevicular fluid (GCF) volumes were measured from 4 sites (mesial, buccal, distal, and lingual/palatal) of each dental implant including its one or more equivalent natural tooth/teeth. Results: One-hundred-sixty-one loaded dental implants and 221 natural teeth of 101 patients were evaluated. The length of dental implant had no effect on PICF volume (P > 0.05). However, PICF volumes of narrow (< 3.5 mm) and wide (> 4.5 mm) diameter implants were higher than standard diameter implants (≥ 3.5 mm, and ≤ 4.5 mm) (P < 0.05). PICF and GCF volumes of areas with peri-implant/periodontal diseases were significantly higher than healthy areas (P < 0.05). PICF and GCF volumes showed positive correlations with clinical indices (P < 0.05). Conclusions: In accordance with the results of the present study, the implant diameter, not the implant length, affects peri-implant crevicular fluid volume.

The Radiological Evaluation of Mandibular Canal Related Variables in Mandibular Third Molar Region: a Retrospective Multicenter Study.

Objectives: The aim of this retrospective study was to investigate anatomical structure of mandibular canal and the factors those increase the possibility of inferior alveolar nerve damage in mandibular third molar region of Turkish population. Material and Methods: Overall 320 participants with 436 mandibular third molars were included from four different study centers. Following variables were measured: type and depth of third molar impaction, position of mandibular canal in relation to third molars, morphology of mandibular canal, cortication status of mandibular canal, possible contact between the third molars and mandibular canal, thickness and density of superior, buccal, and lingual mandibular canal wall, bucco-lingual and apico-coronal mandibular canal diameters on cone-beam computed tomography scans. Results: Lingual mandibular canal wall density and thickness were decreased significantly as the impaction depth of mandibular third molar was increased (P = 0.045, P = 0.001 respectively). Highest buccal mandibular canal wall density and thickness were observed in lingual position of mandibular canal in relation to mandibular third molar (P = 0.021, P = 0.034 respectively). Mandibular canal with oval/round morphology had higher apico-coronal diameter in comparison to tear drop and dumbbell morphologies (P = 0.018). Additionally, mandibular canals with observed cortication border and no contact with mandibular third molar had denser and thicker lingual mandibular canal wall (P = 0.003, P = 0.001 respectively). Conclusions: Buccal and lingual mandibular canal wall density, thickness and mandibular canal diameter may be related with high-risk indicators of inferior alveolar nerve injury.

Dental caries and associated salivary biomarkers in patients with cystic fibrosis.

PURPOSE: To evaluate the caries status of the Cystic fibrosis (CF) children and adolescents with the comparation of some biochemical markers, secretory-immunoglobulin-A (sIgA), and antimicrobial peptides in the saliva. METHODS: In this cross-sectional descriptive study, the approval Ethics Board was obtained. Unstimulated saliva samples were collected from CF and healthy control children (non-CF) patients. Both groups underwent the same dental and periodontal evaluation scheme of the assessment. Human beta defensin (HBD1), human alpha defensin (HNP-1), cathelicidin (LL-37), sIgA in saliva were evaluated by enzyme-linked immunoassay method. A general biochemical analysis was performed. Statistical analysis was performed by using Statistical Package for the Social Sciences Version 20.0 (SPSS Inc.). RESULTS: A total of 21 (9 male, 12 female) CF and 23 (11 male, 12 female) control patients were participated with the mean age of 10.17 ± 3.38 and 9.52 ± 2.15 years, respectively. In control children, DMFT/S (decayed-missing-filled-tooth/surface-in-permanent-dentition), dmft/s (decayed-missing-filled-tooth/surface-in-primary-dentition) values were higher; DT (decayed-tooth in permanent dentition), ft (filled-tooth in primary dentition) and plaque index values were statistically significantly higher (p = 0.042, p = 0.005, p = 0.038, respectively) than CF patients. Bicarbonate was higher in control group; sodium, chloride, and total protein were higher in CF group; magnesium, calcium and phosphate levels were similar in each group (p > 0.05). Alpha and beta defensin-1 levels in control group was statistically significantly higher (p = 0.037 and p = 0.020, respectively), while LL37 and sIgA were not statistically significantly higher (p > 0.05) than CF group. CONCLUSIONS: Children with CF had lower caries in permanent teeth, filling in primary teeth, and an altered salivary biomarker profile, especially in HNB1, HNP1. Therefore, it is important to conduct periodic oral-dental controls among CF patients during their childhood.

Inferior alveolar nerve topography and its bifurcation features: a cone beam computed tomography evaluation.

BACKGROUND: Mandibular canal (MC) is the most important vital structure in mandible to prevent from complications such as bleeding and paresthesia. The aims of the present study were to inform the features (diameter, distances to the mandibular borders, and distance to tooth apex) of the MC for each posterior tooth region, and to present the bifurcation features of the MC. METHODS: Four-hundreds-eighteen MC images of 209 patients were evaluated. The parameters were recorded from right and left hemi-mandibles for each posterior teeth region: 1) MC diameter; 2) MC and mandibular basis distance; 3) MC and crest distance; 4) MC and tooth apex distance; 5) MC and buccal plate distance; 6) MC and lingual plate distance; and 7) possible implant length (the distance between 2 mm coronal of the MC and 1 mm apical of the crest). Additionally, MC bifurcation type and bifid mandibular canal length were noted for right and left sides. RESULTS: While higher MC diameter values were recorded at molars, MC diameter in first premolars bilaterally were the lowest. In premolars, MC and mandibular basis distance showed higher values than molars. There was a trend of decrease in MC and crest distance from molars to premolars. The highest MC and tooth apex distance was measured in second molar; however, the lowest was in the first premolar. Additionally, MC and buccal plate distances were higher in molars, while MC and lingual plate distances were higher in premolars. Possible implant length in first premolar was the lowest, when it was the highest in second molars. CONCLUSIONS: For simulating overall MC topography, it extended bucco-coronally from molars to premolars. Due to this topography, possible implant length increased from premolars to molars.

Association between ridge morphology and complexity of implant placement planning in the posterior mandible.

STATEMENT OF PROBLEM: Uncertainties regarding the 3D ridge morphology of the posterior mandible can greatly increase the risk of surgical complications during dental implant placement. By using cone beam computed tomography (CBCT) imaging and a computer-guided implant treatment software program before any invasive procedure, it is possible to assess ridge morphology and understand the surgical complexity and risk level. PURPOSE: The purpose of this radiological clinical study was to evaluate a large series of CBCT images to evaluate ridge shape variations along posterior mandibular edentulous regions and to clarify their associations with the level of implant planning complexity. MATERIAL AND METHODS: One hundred and twenty CBCT files were analyzed retrospectively for a total 240 hemimandibular sites. Images of each edentulous region of the mandibular first and second premolar and first and second molar sites were evaluated in the sagittal plane. Ridge morphology and implant planning complexity per site were assessed. Categorical variables were presented as number of events and percentages. The chi-square test was used to compare the categorical variables (P=.05). RESULTS: Of 491 partially edentulous mandibular sites, 235 were on the right, and 256 were on the left. Forty-two sites had a distal adjacent tooth, while 266 sites had no distal adjacent tooth. The sagittal bone sections demonstrated oblique (40.53%), straight (31.77%), S-shape (24.24%), hourglass (2.44%), and basal bone (1.02%) ridge morphologies. Implant complexity was deemed straightforward in 66.19% of sites, while 31.6% were identified as advanced and 2.54% as complex. When ridge morphology was evaluated from straight to basal-round bone shape, the implant complexity followed the same trend of change from a straightforward to complex procedure (P=.001) for edentulous second and first molar regions. No significant differences were noted at edentulous second premolar sites (P=.063). The missing second molar sites with oblique morphology were predicted to have 60.9% straightforward complexity, and first molar sites with oblique morphology had 55.8% straightforward implant complexity. Second premolars with straight ridge morphology had 71.7% straightforward complexity, whereas first premolars with the same shape had 92.5% straightforward implant complexity. CONCLUSIONS: Careful evaluation of sagittal CBCT images can provide significant clinical information regarding ridge shape and anticipated surgical complexity before and at the time of implant placement. Surgical complexity is greatest at the most posterior mandibular edentulous sites, and extra attention and caution should be exercised during the surgical planning phases of implant surgery.

Treatment of Excessive Gingival Display by Using Botulinum Toxin-A Targeting Yonsei Points and Zygomatic Major Muscles.

ABSTRACT: The aim of this clinical report is to present satisfying and unsatisfying treatment results of a patient with excessive gingival display (EGD) treated via botulinum toxin injections in different time points. A 22-year-old male patient referred to the Department of Periodontology with a complaint of EGD. The patient opted the treatment with botulinum toxin-A injections. During the first treatment, injections at Yonsei points were performed. After the first EGD treatment, the patient did not satisfy with his smile. The closure of gingival display was not sufficient, especially in posteriors. However, he did not demand for reinjection. Six months after the first treatment, he was advised to have 2 injection points per side including zygomatic major muscles as well as Yonsei points. Two weeks after the second treatment, the patient totally satisfied with his new smile. Yonsei point is a safe and repeatable injection point for the practitioners. However, the authors suggested injections targeting zygomatic major muscles as well as Yonsei point injections to treat the patients with mixed EGD.

Quantity and Quality of Intraoral Autogenous Block Graft Donor Sites with Cone Beam Computed Tomography.

PURPOSE: The autogenous bone block graft is regarded as the gold standard material due to reported osteoconductive, osteoinductive, and osteogenic properties. Various intraoral donor sites for autogenous block grafts are presented in the literature. The aim of this study was to radiographically evaluate the maximum dimensions, volume, and bone quality values of these sites. MATERIALS AND METHODS: According to the inclusion criteria, 50 cone beam computed tomography (CBCT) images from 50 subjects were evaluated. The maximum length, width, height, and volume of autogenous regions where block grafts could be harvested were measured. Radiographic bone quality was calculated by using Hounsfield units derived from CBCT (CBCT-HU). RESULTS: The mean age of 50 subjects (19 men and 31 women) was 55.84 ± 15.9 years. In this study, the symphysis was the largest potential donor site (3.14 ± 1.05 cm3), while maxillary tuberosity was the smallest (0.53 ± 0.34 cm3). These results correlated with bone density values, where the symphysis retained the highest values (937.31 ± 160.59 CBCT-HU) and the maxillary tuberosity had the lowest values (360.87 ± 141.48 CBCT-HU). CONCLUSION: Intraoral bone blocks have restrictions due to surrounding vital anatomical structures. The surgeons should consider these vital structures using accurate CBCT evaluation. The volume and density of the maximal bone harvest from the symphysis was statistically higher in comparison with ramus, palatal, and maxillary tuberosity bone blocks.

A Modification for Treatment of Excessive Gingival Display: Tooth-Based Lip-Repositioning Technique.

Exposure of maxillary gingiva more than 3 mm while smiling is referred to as "excessive gingival display" or "gummy smile." Various treatment options for excessive gingival display are published in the literature, including lip repositioning, crown lengthening, botulinum toxin-A injections, and orthognathic surgeries. This case report aims to present a novel approach to the lip-repositioning procedure for treatment of excessive gingival display. The patient, who visited the department to demand a more esthetic smile, was diagnosed with excessive gingival display caused by hyperactivity of upper lip muscles. Lip repositioning procedure was considered. While evaluating the patient's smile, the amount of gingival display for each tooth region varied. A novel tooth-based modification was planned for the patient for a more precise result. No complication was noted during 10- and 30-day follow-ups. The amount of gingival display while smiling was less than 3 mm for each tooth region. The tooth-based lip-repositioning technique may provide an opportunity to more precisely treat patients with gummy smile.

In-depth morphological evaluation of tooth anatomic lengths with root canal configurations using cone beam computed tomography in North American population.

OBJECTIVE: This study aimed to assess the association between tooth size and root canal morphology by using CBCT analysis. METHODOLOGY: In this retrospective study, tooth anatomic lengths (crown and root lengths, buccolingual and mesiodistal dimensions) of 384 patients were assessed and correlated with Vertucci's root canal morphology classification. Data was analyzed for gender-related differences using the independent sample t-test, ANOVA, and the Pearson's correlation for a possible relation between anatomic lengths and canal morphology. RESULTS: The maxillary first and second premolars showed a greater predilection for Type IV and II variants, respectively, while the mandibular first premolar showed a greater predilection for Type II canal system. The root canal system of the mandibular second premolar showed maximal diversity (47% Type I, 30% Type II, and 20% Type III). The dimensions were greater in men regardless of tooth type. The most significant relation (p<0.05) between the anatomic size and canal morphology was observed in the maxillary first premolars, followed by the mandibular canines (buccolingual dimension) and the lower second premolars (crown length). Negative correlations existed between the crown length and the patient's age for the anterior teeth and mandibular second premolar (r=-0.2, p<0.01). CONCLUSIONS: The most common canal formation for anterior teeth was the Type I. The anatomic lengths had the strongest influence on the canal configuration of the maxillary first premolar, with Type IV being the most common root canal system. The mandibular second premolars showed maximal diversity in the canal classification terms and had a significant correlation with their crown lengths. CLINICAL RELEVANCE: The complex relationship between the canal morphology and anatomic tooth sizes need meticulous awareness and recognition during endodontic procedures, in conjunction with the demographic variabilities.

Levels of pro- and anti-inflammatory cytokines in cystic fibrosis patients with or without gingivitis.

BACKGROUND: Inflammatory periodontal diseases are caused by interaction between gram negative, anaerobic bacteria and host response. Persistent infection of Pseudomonas aeruginosa in cystic fibrosis (CF) patients also cause increased pro-inflammatory response and the imbalance of pro- and anti-inflammatory response in brochoalveolar lavage fluid which leads to destruction of lungs. The aim of this study is to evaluate periodontal status of CF patients, to measure level of cytokines and biochemical molecules in gingival crevicular fluid (GCF), and to detect presence of P. aeruginosa in dental plaque samples. MATERIALS AND METHODS: GCF samples were collected from 41 CF patients and 39 healthy (non-CF) subjects. Interleukin (IL)-1ß, IL-17, IL-10, human neutrophil elastase (HNE), cystic fibrosis transmembrane regulator (CFTR) protein, and human ß-defensin-1 (HBD1) in GCF were evaluated by ELISA method. Dental plaque samples were collected from 18 CF patients with history of P. aeruginosa colonization and 15 non-CF subjects. Presence of P. aeruginosa was evaluated by using conventional culture methods and molecular methods. RESULTS: Levels of IL-1ß, HNE, and HBD1 in CF patients were significantly higher than non-CF subjects. However, IL-10 level was significantly lower in CF patients. Increased pro-inflammatory (IL-1ß) and decreased anti-inflammatory (IL-10) cytokine levels were observed in GCF samples from CF patients, irrespective of their periodontal status. P. aeruginosa were detected in four samples of 18 CF patients, and all were negative in non-CF group. CONCLUSIONS: As a result of this study, CF coexists increasing pro-inflammatory and decreasing anti-inflammatory response locally. Due to increasing pro-inflammation, CF patients should be followed-up more often than non-CF children.

In-depth morphological evaluation of tooth anatomic lengths with root canal configurations using cone beam computed tomography in North American population

Abstract Objective This study aimed to assess the association between tooth size and root canal morphology by using CBCT analysis. Methodology In this retrospective study, tooth anatomic lengths (crown and root lengths, buccolingual and mesiodistal dimensions) of 384 patients were assessed and correlated with Vertucci's root canal morphology classification. Data was analyzed for gender-related differences using the independent sample t-test, ANOVA, and the Pearson's correlation for a possible relation between anatomic lengths and canal morphology. Results The maxillary first and second premolars showed a greater predilection for Type IV and II variants, respectively, while the mandibular first premolar showed a greater predilection for Type II canal system. The root canal system of the mandibular second premolar showed maximal diversity (47% Type I, 30% Type II, and 20% Type III). The dimensions were greater in men regardless of tooth type. The most significant relation (p<0.05) between the anatomic size and canal morphology was observed in the maxillary first premolars, followed by the mandibular canines (buccolingual dimension) and the lower second premolars (crown length). Negative correlations existed between the crown length and the patient's age for the anterior teeth and mandibular second premolar (r=−0.2, p<0.01). Conclusions The most common canal formation for anterior teeth was the Type I. The anatomic lengths had the strongest influence on the canal configuration of the maxillary first premolar, with Type IV being the most common root canal system. The mandibular second premolars showed maximal diversity in the canal classification terms and had a significant correlation with their crown lengths. Clinical Relevance The complex relationship between the canal morphology and anatomic tooth sizes need meticulous awareness and recognition during endodontic procedures, in conjunction with the demographic variabilities.

Morphological Classification of Extraction Sockets and Clinical Decision Tree for Socket Preservation/Augmentation after Tooth Extraction: a Systematic Review.

OBJECTIVES: The aim of present study was to review current literature concerning extraction socket classification immediately following tooth extraction and the rationales for socket preservation/augmentation procedures and with reference to it suggest novel clinical decision tree for extraction socket preservation/augmentation in aesthetic and non-aesthetic area. MATERIAL AND METHODS: The search protocol used the electronic MEDLINE (PubMed) and EMBASE databases for articles published between January 1 2009 and May 1 2019. The search included only human studies published in English. Outcomes were the indications and reasons for socket preservation/augmentation and classification of extraction sockets. RESULTS: Ten studies fulfilled the inclusion criteria and were selected for the study. Although there are various types of extraction socket classifications none of them could completely evaluate all morphological parameters of alveolar ridge. Furthermore, present study revealed that indications for extraction socket preservation/augmentation have wider spectrum than socket morphology and are related to surrounding tissue anatomy or dental implantation operation indications and timing. Based on currently proposed extraction socket classifications and rationales, a novel decision tree for extraction socket preservation/augmentation immediately after tooth extraction in aesthetic and non-aesthetic area was suggested. CONCLUSIONS: The need of extraction socket preservation/augmentation immediately after tooth extraction should be determined by the aesthetic, functional and risk-related viewpoint. A novel clinical decision tree for extraction socket preservation/augmentation immediately after tooth extraction in aesthetic and non-aesthetic zones can be useful tool in socket preservation/augmentation procedures.

The 2nd Baltic Osseointegration Academy and Lithuanian University of Health Sciences Consensus Conference 2019. Summary and Consensus Statements: Group I - Biological Aspects of Tooth Extraction, Socket Healing and Indications for Socket Preservation.

INTRODUCTION: The task of Group I was to review and update the existing data concerning the physiologic process of socket healing, in the absence or presence of grafting materials or platelet concentrates, addressing the associated molecular and cellular events that culminate in the restoration of the lost tissue architecture and functionality. The second task was to review current literature concerning extraction socket classification immediately following tooth extraction and the rationales for socket preservation/augmentation procedures and with reference to it suggest novel clinical decision tree for extraction socket preservation/augmentation in aesthetic and non-aesthetic area. MATERIAL AND METHODS: The main areas indicated by this group were as follows: socket healing process, including haemostasis and coagulation, inflammatory phase, proliferative phase, bone tissue modelling and remodelling; socket healing with graft materials and autologous platelet concentrates; extraction socket classifications; indications and reasons for extraction socket preservation/augmentation. The systematic reviews and/or meta-analyses were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. The literature in the corresponding areas of interest was screened and reported following the PRISMA (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. Method of preparation of the systematic reviews, based on comprehensive search strategies, was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic reviews and/or meta-analyses is presented in Preface chapter. RESULTS: The results and conclusions of the review process are presented in the respective papers. One theoretical review-analysis and one systematic review were performed. The group's general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article.

Ideal Dose and Injection Site for Gummy Smile Treatment with Botulinum Toxin-A: A Systematic Review and Introduction of a Case Study.

The objective of this article is to review ideal injection point and ideal dose of botulinum toxin-A injections to treat different types of gummy smile, and to present a case treated with the recommended method. An electronic search of literature was carried out by using PubMed, Embase, and Google Scholar. Reference lists of studies were also hand-searched for relevance. According to inclusion and exclusion criteria, five prospective studies with 135 subjects were included in this systematic review. Injection of botulinum toxin-A is a noninvasive and temporary treatment option for gummy smile, and the Yonsei point is a safe and reproducible injection point for treatment by practitioners of all types of gummy smile.

Effects of clinical local factors on thickness and morphology of Schneiderian membrane: A retrospective clinical study.

BACKGROUND: It was informed that the thickness of maxillary sinus membrane may be affected by the local and patient-related factors in the literature. PURPOSE: The aim of this retrospective study is to evaluate factors that may have an influence of the thickness and morphology of the maxillary sinus membrane. MATERIALS AND METHODS: A total of 414 cone beam computed tomography images of 207 patients were evaluated. Radiographic parameters were evaluated at each maxillary premolar and molar tooth regions. Statistical analysis was performed to assess the association between the maxillary sinus mucosa thickness and morphology. The following factors including gender, periodontal bone loss (PBL), bone density, amount of residual alveolar bone at the edentulous space, vitality of the teeth present, and anatomical relationship between the sinus floor and posterior teeth were evaluated. RESULTS: The mean thickness of maxillary sinus membrane ranged between 1.47 to 2.92 mm and was significantly thicker in male subjects (P < .05). Positive correlation was detected between the sinus membrane thickness values in each posterior tooth region (P < .05). Thickening of the membrane was noted in 53% of the scans. The most commonly observed morphological change was flat thickening of the membrane (21%). No correlation was found between the evaluated local factors on the thickness and morphology of the maxillary sinus membrane (P > .05). CONCLUSIONS: Tooth vitality, residual alveolar bone height, and PBL seem to have no effect on the thickness and morphology of the maxillary sinus membrane.

The radiological evaluation of posterior superior alveolar artery topography by using computed tomography.

BACKGROUND: Posterior superior alveolar artery (PSAA) is the most important limiting anatomic structure while lateral approach sinus surgeries. PSAA should be taken into consideration to avoid bleeding during preparation of bony window. PURPOSE: The aim of this article was to inform topography of PSAA and to evaluate measurements of this vital structure. MATERIALS AND METHODS: Three hundred and fifty-four cone-beam computed tomography (CBCT) images of PSAA from 177 patients were evaluated retrospectively. Localization of PSAA, diameter of PSAA, classification of PSAA diameter, distance between PSAA and crest, buccal bone thickness, palatal bone thickness, crest height, and crest width were recorded for each posterior tooth separately. RESULTS: The mean age of 177 patients was 54.05 ± 18.33 years. Although the most frequent localization of PSAA was intraosseous in premolar region, they were below Schneiderian membrane in molars. PSAA diameter was measured frequently less than 1 mm for all posterior teeth. Although palatal bone thickness was higher in premolar region than molars, no statistical relationship was found between tooth region and buccal bone thickness (P > 0.05). The width of residual ridge was measured both wider apically and posteriorly. Positive correlation was observed between buccal bone thickness and PSAA diameter in first molar and premolar regions (P < 0.05). CONCLUSIONS: Detailed evaluation of patients by CBCT provided us the opportunity to draw topography of PSAA and inform about overall measurements of PSAA in all posterior teeth region.

Treatment of Various Types of Gummy Smile With Botulinum Toxin-A.

The objective of this article is to present 3 various types of gummy smile treated with botulinum toxin-A injection per site at Yonsei points. The patients, who visited the department to demand a more aesthetic smile, were classified according to gummy smile type: asymmetric, anterior, and mixed. Botulinum toxin-A injection at Yonsei point was considered. Preinjection and postinjection pictures were taken, and the severity of excessive gingival display was measured for each tooth between second premolars. Two weeks after botulinum toxin injections, no complication was noted. The amount of excessive gingival display for each tooth between second premolars was measured less than 3 mm, and the percentage of improvement for each case was calculated 100%. The botulinum toxin injection at Yonsei point may be a predictable and noninvasive treatment option for various types of gummy smile.