Journal of Dental Medicine

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Statement of Problem:The determination of the dental midline is necessary in most dental procedures.One of the methods to fulfill this goal is to determine the facial midline based on the midpoints of the forehead, nose, upper lip and chin. However, for various reasons, this method has not always been proved successful. In such cases, different techniques, based on the investigations in the edentulous
patients, have been suggested.
Purpose: The aim of this study was to investigate the conformity of some landmarks such as labial frenum, incisive papilla and mid palatal suture with dental and facial midlines among people with natural dentition in order to obtain accurate anatomic landmarks for denture replacement.
Materials and Methods: In this descriptive study, 96 dental students, having all their permanent teeth and without any orthognathic problem, were chosen. For each subject, Alginate impressions and dental casts were prepared. Then, centric occlusion was recorded with a biting wax and the facial mid line was determined on the anterior part of it. The distances from the facial midline to the upper teeth midline,
incisive papilla, labial frenum and mid palatal suture were determined with a special tool and were measured by a VERNIEH two times. In order to analyze the results, Chi- Square and t-student tests were used.
Results: The average of facial midline distance to the upper teeth midline, the labial frenum, the incisive papilla and the mid palatal suture were 0.83±0.60, 0.67±G.54, 0.83±00.63 and 0.81±0.62 mm,respectively. There was no significant difference between males and females. Labial frenum showed the minimum distance to the facial midline, while the incisive papilla had the maximum. There was no significant difference between these anatomic landmarks, in conformity or unconformity with the facial midline
Conclusion: Considering the low percentage of the subjects with complete conformity and the lack of significant differences between these three landmarks, it is suggested that there is no superiority among these landmarks for the determination of facial midline. The similar distances from the facial midline to the incisive papilla and upper teeth midline indicate that using incisive papilla to determine the upper
teeth midline in edentulous patients lead to normal face.

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Background and Aim: Improving esthetics is a major goal in periodontal treatments and specially reconstruction of dental papilla is of great importance. Different techniques have been developed, however the results are not completely predictable. The aim of the present study was to compare the possibility of papilla reconstruction using connective tissue graft with and without Emdogain.

Materials and Methods: In this clinical trial, 40 class II lost interdental papilla (Nordland- Tarnow classification) in 18 patients (4 male and 14 female) were studied. Samples were randomly devided into two groups. Case group was treated by connective tissue graft and emdogain (Straumann-USA) and controls were treated using connective tissue graft only. Periodontal parameters including papilla height (PH), periodontal pocket depth (PPD) and clinical attachment level (CAL) were measured before surgery, and 3 and 6 months after treatment. At the tenth days and 1 month after treatment only the papilla height was measured. Repeated measures analysis was used for data analysis with p<0.05 as the level of significance.

Results: In the control group the mean papilla height changed from 3.38 0.89 to 2.85 0.93 on the 3rd month and 2.90 0.95 on the 6th month. The mean PPD changed from 2.8  0.68 to 2.55 0.70 on the 3rd month and 3.06 1.25 on the 6th month. The mean CAL changed from 3.88 1.29 to 3.79 1.25 on the 3rd month and 4.11 1.44 on the 6th month. In test group the mean papilla height changed from 2.98 0.91 to 2.45 1.55 on the 3rd month and 2.55 1.48 on the 6th month. The mean PPD changed from 2.75 1.49 to 2.63 1.38 on the 3rd month and 2.88 1.39 on the 6th month. The mean CAL changed from 3.75 1.24 to 4.01 1.45 on the 3rd month and 4.28 1.63 on the 6th month. These differences were not significant between the studied groups (P>0.05).

Conclusion: Based on the results of this study, use of connective tissue with or without emdogain is not effective in interdental papilla reconstruction.

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Background and Aim: Soft tissue condition around dental implant is an essential part for long term healthy and esthetic outcome. The aim of this study was to compare soft tissue dimensions between implant supported single  tooth replacement and the contra-lateral natural tooth.

Materials and Methods: This retrospective study was performed on dentate patients treated with anterior single  tooth implant at least 1 year ago. Of twenty eight, fourteen patients had been treated with one stasge method and others with two stage method. Biologic width (BW), papilla index (PI), and mucosal thickness (MT) were evaluated around implants and contra-lateral teeth clinically and compared with each other. The Wilcoxon test, Mann-Whitney test, and Student pair t-test were used to assess the differences between one stasge and two stage implants, and implant and tooth groups.

Results: The mean BW around one stasge implants, two stage implants, and contra-lateral teeth were 1.42±0.48 mm, 1.67±0.48 mm, and 1.47±0.60 mm, respectively. The mean PI adjacent to one stasge implants, Two stage implants, and contra-lateral teeth were 2.50±0.52, 2.53±0.55, and 2.72±0.47, correspondingly. The mean MT around one stasge implants, two stage implants, and contra-lateral teeth were 3.10±0.48, 3.09±0.75, and 2.57±0.88, respectively. There was no statistically significant difference among one stasge implants, two stage implants, and contra-lateral teeth with regard to measured variables.

Conclusion: Based on the results of this investigation, in standard condition, it seems that there is no noticeable difference in indicators of biologic width, papilla index, and mucosal thickness around one stasge implants, two stage implants, and contra-lateral teeth.