The restoration space should be fully considered in designing the implant restoration for edentulous patients to accommodate the superstructure of implant dentures and prostheses and select the appropriate restoration method. However, no unified standard exists for the evaluation of restoration space in clinical practice. Mechanical or biological complications of implant dentures occur when the restorative space in the mouth does not match the prosthesis design. This study recommends recording the correct jaw relation retained by natural teeth or old dentures before implant treatment in edentulous patients. The complete digital information of the patient’s oral and maxillofacial region can be obtained using digital technology, and a three-dimensional virtual dental patient model can be constructed. A functional and aesthetically oriented implant restoration plan can be designed according to the measured vertical restoration space and horizontal relationship.
Complicated crown-root fracture is a serious type of dental trauma, involving dental hard tissues, tooth pulp and periodontal tissues. The most commonly recommended treatment methods by International Association of Dental Traumatology (IADT) include orthodontic extrusion, surgical extrusion, intentional replantation and adhesive coronal fragment reattachment, etc. The common feature of these treatment methods is to extract the broken coronal fragment, expose the fracture line and make the restoration. However, the extraction itself and the subsequent treatments will cause various problems, which severely compromise and challenge the long-term prognosis. Recently, we tried a technique including non-extraction of the coronal fragment and partial coronal fragment reattachment. I.E., the coronal fragment was retained instead of extraction, and the reattachment was only performed along the supragingival fracture line and subgingival fracture line across pulp cavity side only, while the subgingival fracture line across periodontal side was left untreated. Our technique, basing on the concept of periodontal preservation, and aiming at simplifying the operation procedure, reducing the re-injury to periodontal tissues to the greatest extent, and decreasing subsequent pe-riodontal complications as possible, has got satisfying clinical manifestation so far. However, the adhesive strength of the partial coronal fragments reattachment and their long-term prognosis need to be observed and evaluated further.
The occlusion and the mandible position are interrelated within a constantly changing balance. Alterations in occlusion can lead to changes in the mandible position, and vice versa. In clinical work, this balance can be disrupted due to changes in the bite, resulting in various corresponding manifestations; it can be rebuilt to achieve the therapeutic purpose by articulation. Given the limitation of tools, traditional interventions produce large systematic errors when adjusting the occlusal position, resulting in unstable clinical treatment effects with difficulties in operations. With the help of a no-vel digital workflow, a personalized fine digital occlusion model can be built based on the patient’s CT data and digital dental cast. Precise articulation is then entitled, with the previous systematic error eliminated. The clinical outcome is enhanced, and the treatment efficiency is improved. In addition, digitalization can standardize the clinical operation process, reduce the skill demand, and make remote diagnosis and treatment planning possible in near future.
Proximal caries are common clinical problems. Restoring proximal caries after cavity preparation with Class Ⅱ cavity restoration is a routine clinical procedure. The composite resin filling has become the preferred method for Class Ⅱ cavity restoration. With the development of composite resins, bonding techniques and matrix systems, the concepts and technologies of Class Ⅱ composite resin restorations have made various new progresses. Based on the latest li-terature evidence, this article elaborates on the key points of Class Ⅱ cavity composite resin restoration operation from eight aspects, including stress analysis, field isolation, cavity preparation, pulp protection, selection and placement of matrix system, bonding protocol, filling protocol, and finishing and polishing, to provide evidence-based medical guidelines for clinical practice of Class Ⅱ cavity composite resin restoration.
When missing maxillary posterior teeth require implantation, adopting maxillary sinus floor elevation routinely provides bone augmentation to meet the initial stability of the implant due to insufficient bone volume. It is very difficult to eliminate the infection completely from the complex root canal system of maxillary posterior teeth by root canal treatment, which results in the chronic apical periodontitis after treatment. The close anatomy relationship among the maxillary posterior teeth, maxillary bone and sinus, termed as maxillary tooth-alveolar-process-sinus complex, makes it easy for the infection to spread into the maxillary sinus. When endodontic microsurgery is needed, the surgical access is often established through maxillary sinus floor elevation, which is named as tooth-related maxillary sinus floor elevation. It is necessary to put forward the tooth-related maxillary sinus floor elevation as it is different biologic basis from the traditional dental implantation-related maxillary sinus floor elevation in anatomy, etiology and pathology.
Enhanced recovery is important for head and neck tumor patients, especially for those with free flap reconstruction which have numerous complications after surgery. Prevention and treatment of postoperative complications an important part for enhanced recovery after free flap reconstruction of head and neck tumor patients. In this article, we summarized the experiences in some published articles and authors’ clinical practice for the reference of related doctors, including airway management, hemorrhage control, prevention of postoperative infection, prevention of complications related to free flap reconstruction and functional complications prevention in oral and maxillofacial surgery, which could promote the application of enhanced recovery in free flap reconstructive surgery for oral and maxillofacial tumor patients.
Unilateral microform cleft lip involves mild but extensive abnormalities among cutaneous, muscular, and cartilaginous tissues in the nasolabial region. To date, no standardized protocol is available for microform cleft lip ma-nagement. Diversified surgical techniques can be adopted for each single deformity feature, and randomness is common during surgeons’ decision-making. Individualized management features a random combination of surgical techniques but requires a precise workflow. Basing on a comprehensive review of options for critical surgical maneuvers, we propose re-commendations for the establishment of standardized management philosophy for unilateral microform cleft lip.
When an implant-related surgery is in areas in proximity to a periapical lesion of the adjacent tooth, the chronic apical periodontitis of adjacent teeth could become a potential source of infection to cause the failure of surgery. Unlike traditional treatment procedures, the combined treatment modality of performing implant-related surgery with simultaneous endodontic microsurgery of adjacent teeth was proposed in this study. This novel strategy ensured the early safety of implant-related surgery and increased the long-term predictability of oral treatment. It also seemed to be a more cost-effective treatment strategy. This article presented the clinical procedures and practical cases on the clinical application of the novel combination therapy strategy in different clinical situations.
In the clinical practice of dental implants, the implant-related surgery in areas with proximity to a periapical lesion of adjacent teeth was relatively particular but not uncommon. Chronic apical periodontitis of adjacent teeth could become a potential source of infection in bone augmentation surgery and cause early surgery failure/or extend to the apical area of the implant and cause retrograde peri-implantitis. Unlike the traditional treatment modality, a novel digital treatment modality involves the performance of implant-related surgery in conjunction with endodontic microsurgery of the adjacent tooth during one process to control the potential risk originating from apical periodontitis, completely remo-ving the infection from the apex of adjacent teeth and establishing sufficient apical sealing. This combined surgery aimed to eliminate the potential source of infection of adjacent teeth during implant-related surgery. Meanwhile, the autologous bone retained in the apical surgery could avoid a second operating area for bone harvesting in bone augmentation surgery, significantly improving the efficiency of surgery and thus further reducing patient trauma and saving medical costs. This article discussed the application basis and clinical indications of this novel combined treatment strategy.
The establishment of principles for assessing the difficulty in bracketless invisible orthodontic treatment for malocclusion based on the treatment plan and tooth movement patterns has practical significance and social value for improving the level of invisible orthodontic treatment in China and for promoting the rational distribution of medical resources. Malocclusion is one of three major oral diseases. China has a large demand for orthodontic medical resources, which used to be dominated by traditional fixed orthodontic technology. However, with the economic and social development of China and the advancement of invisible orthodontic technology, the demand for invisible orthodontic treatment is increasing. A reasonable assessment of the difficulty of implementing invisible orthodontic treatment plans to assist in clinical treatment plan decisions and to implement orthodontic tiered medical services has become a clinical problem that must be urgently solved. The author summarizes the research progress and individual clinical experience about the difficulty in assessment of invisible treatment. On the basis of the material mechanics of clear aligners and the principle of clinician-led treatment planning, the present paper discusses the key factors of assessment difficulty from the sagittal, vertical, and horizontal directions in extracted cases and non-extracted cases, as well as other factors that affect the difficulty of invisible orthodontic treatment. The author hopes that this paper can guide the clinical diagnosis and treatment of invisible orthodontics in China, promote the establishment of scientific and standardized tiered treatment, attract more clinicians and researchers to participate in the innovation of invisible orthodontic technology, and promote both academic and clinical levels of invisible orthodontics in China.
Adenotonsillar hypertrophy is the most frequent cause of upper airway obstruction and related dentofacial abnormalities in children. Its clinical symptoms, including sleep snoring, mouth breathing, and restless sleep, have been increasingly noticed by the children’s parents. Adenotonsillar hypertrophy does not only cause prognathism or retrognathism malocclusion in children but also pediatric obstructive sleep apnea (OSA), the clinical diagnosis and treatment of which often requires multidisciplinary collaboration. To our knowledge, most of the existing studies have paid more attention to Class Ⅱ malocclusion caused by adenoid hypertrophy in children, and only a few have investigated Class Ⅲ malocclusion associated with tonsillar hypertrophy. With the aim of providing reference for orthodontic treatment, this paper examines the clinical diagnosis and treatment strategies of Class Ⅲ malocclusion with tonsillar hypertrophy in children based on a literature review and actual clinical experience.
Orthognathic surgery is the most common treatment for malocclusion deformity. Orthognathic surgery has entered the digital stage, but it has many problems, such as complicated manual operation, low reproducibility, low efficiency, time consuming, and high error rate of manual design. Artificial intelligence is an effective method and research frontier to solve these problems. Our research team explored an algorithm model by artificial intelligence and established a software system for the diagnosis and surgical design for patients with malocclusion deformity. Relevant clinical trials were conducted to verify its feasibility and accuracy. The artificial intelligence software system for orthognathic surgery is expected to be applied to assist the diagnosis and treatment of dentofacial deformity.
The interrelationship between periodontics and prosthetics has been widely discussed by dentists. A healthy and stable periodontal condition is a necessary prerequisite for the success and long-term stability of prosthetic therapy and should be paid close attention to before, during, and after prosthetic therapy. At the same time, soft and hard tissue defects, aesthetic problems, and tooth loss related to periodontal issue need to be solved by prosthetic therapy. Periodontal considerations in prosthetic dentistry are of great clinical significance. Therefore, this paper will discuss the periodontal preparation and health maintenance before, during, and after prosthetic treatment, the influence of prosthetic treatment on periodontal health, and the relationship between periodontics and implantology to provide basis for clinical work of dentists.
Oral infectious disease is one of the most common diseases during pregnancy. However, some dentists choose to refuse or postpone treatment of oral diseases during pregnancy due to concerns about safety and uncertain outcomes. As an important part of pregnancy health, proper intervention on oral diseases during pregnancy is beneficial to the physical and mental health of patients and may reduce the mother-to-child transmission of oral pathogens. Therefore, under the premise of following the principles of safety, necessity, comfort, and multidisciplinary cooperation, scientific and standardized management of oral infectious diseases is thus recommended. This strategy requires choosing the right time, according to the specific physiological characteristics of the patient during pregnancy. Prevention and treatment should also be carried out. In this paper, we summarize existing relevant literature and evidence and analyze the main points of the clinical management of common oral infectious diseases during pregnancy. We aim to provide a reference for the implementation of safe and favorable management decisions for oral infections during pregnancy.
A full crown is one of the most widely used restorations for defects in molars. However, the strength of the prepared tooth is compromised because of the large extent of tooth cutting during crown preparation. With the development of bonding technology and mini-invasive restoration, inlays and onlays have become the most popular restorations for defect in molars because the extent of tooth cutting is less than that of crown. This article reviews the mate-rials, indications, advantages, preparation key points, and bonding techniques to provide recommendations for clinical practice.
This article introduces some new concepts and techniques of local anesthesia for dental treatment. The signi-ficant measures that ensure local anesthesia’s safety are to evaluate the dental patients’ physical and mental state before local anesthesia, rationally use drugs depending on the results of physical state evaluation, and conduct necessary psychological counseling sedation for nervous and fearful patients. Articaine is highly prevalent in clinical practices because of its relative safety, good anesthetic efficacy, and diversity of applicable methods. The new painless syringes will make patients comfortable with local anesthesia and improve the safety of local anesthesia. The application of proper local anesthetics and painless needles will bring about several changes in local anesthesia methods and techniques. Local infiltration anesthesia has become the first choice of local anesthesia for dental treatment. Periodontal membrane anesthesia has become routine anesthesia, and customized and distinctive nerve block anesthesia has emerged. The safety, comfort, and efficacy of local anesthesia depend on the standardized operation. Under this circumstance, an imperative formulation of “Ope-rational Standard of Oral Local Anesthesia” has been established in the Chinese Stomatological Association.
Good soft and hard tissue conditions are important for the successful placement of dental implants.However, following tooth extraction, the alveolar ridge undergoes physiological remodeling that results in vertical and horizontal bone reduction, which affects prosthetically driven implant restoration. Alveolar ridge preservation can effectively preserve and reconstruct the volume of alveolar bone. Alveolar ridge preservation with minimally invasive extraction and minimally flap at molar extraction sites with severe periodontitis is strategically recommended to clinicians. This article discusses the changes in soft and hard tissues after natural healing of tooth extraction sockets, the influencing factors of successful alveolar ridge preservation, and the characteristics of alveolar ridge preservation at tooth extraction sites with severe periodontitis.
Given their high biocompatibility and esthetic potential, zirconia materials are a suitable alternative to metal-based restorations for many indications within restorative dentistry. Zirconia frameworks are usually veneered with veneering ceramics, but the latter is easily broken from the former. Recent years have demonstrated a clear trend toward monolithic zirconia restorations in dental clinics. Because of the great number of options currently available, selection of the most suitable restorative zirconia materials in everyday clinical practice has become a complex and challenging task. Zirconia materials can be divided into four generations according to their mechanical and optical properties. This review describe the constituents, physical properties, and indications of the four types of available zirconia materials.
In orthodontic treatment, the torque of anterior teeth is of great significance, which affects not only the appearance of anterior teeth but also the occlusal relationship of posterior teeth. Thus, how to control the torque of an anterior tooth with digital technology has become a focus of research on orthodontic applications. However, controlling the torque of anterior teeth is difficult, and current designs have been confusing many orthodontists. Basing on the literature and clinical cases, we discuss the characteristics, key points, and design skills of for controlling the torque of anterior teeth of individualized labial appliance, individualized lingual appliance, and invisible appliance, to help orthodontists and provide a reference for the digital design of anterior teeth torque in clinic.
