[The mental foramen or "the crossroads of the mandible." An anatomic and clinical observation]

This paper presents a clinical and anatomical review of the mental foramen (MF) based on recent publications (since 1990). Usually, the MF is located below the 2nd premolar or between the two premolars, but it may also be positioned below the 1st premolar or below the mesial root of the 1st molar. At the level of the MF, lingual canals may join the mandibular canal (hence the term "crossroads"). Accessory MF are frequently described in the literature with large ethnic variations in incidence. The emergence pattern of the mental canal usually has an upward and posterior direction. The presence and extent of an "anterior loop" of the mental canal may be overestimated with panoramic radiography. Limited cone-beam computed tomography currently appears to be the most precise radiographic technique for assessment of the "anterior loop". The mental nerve exiting the MF usually has three to four branches for innervation of the soft tissues of the chin, lower lip, facial gingiva and mucosa in the anterior mandible. The clinician is advised to observe a safety distance when performing incisions and osteotomies in the vicinity of the MF.

Complication sévère d’une contention collée linguale mandibulaire

Le collage d’un fil torsadé souple sur les faces linguales des six dents antérieures mandibulaires est une modalité de contention couramment utilisée. Les complications sont rares mais peuvent être assez sérieuses pour provoquer des dégâts biologiques. Cet article présente une complication sérieuse d’un fil de contention torsadé souple, collé en lingual. Quatre ans après son traitement orthodontique, un homme de 20 ans a consulté pour la rupture d’un fil de contention torsadé souple. L’examen clinique a montré un torque radiculo-vestibulaire d’environ 35° d’une dent. Une image en tomographie volumique à faisceau conique (Cone-Beam Computed Tomography ou CBCT) a montré que la racine et l’apex de la dent étaient presque totalement hors de l’os du côté vestibulaire. Étonnamment, la vitalité de la dent était préservée. La dent a été ramenée presque jusqu’à sa position initiale; cliniquement, seule une récession gingivale a persisté. Les orthodontistes et les dentistes devraient être conscients des complications possibles des contentions collées. Les patients devraient être clairement informés de la manière dont les problèmes peuvent être détectés à un stade précoce.

Indication and timing of soft tissue augmentation at maxillary and mandibular incisors in orthodontic patients. A systematic review.

OBJECTIVE To assess the indication and timing of soft tissue augmentation for prevention or treatment of gingival recession when a change in the inclination of the incisors is planned during orthodontic treatment. MATERIALS AND METHODS Electronic database searches of literature were performed. The following electronic databases with no restrictions were searched: MEDLINE, EMBASE, Cochrane, and CENTRAL. Two authors performed data extraction independently using data collection forms. RESULTS No randomized controlled trial was identified. Two studies of low-to-moderate level of evidence were included: one of prospective and retrospective data collection and one retrospective study. Both implemented a periodontal intervention before orthodontics. Thus, best timing of soft tissue augmentation could not be assessed. The limited available data from these studies appear to suggest that soft tissue augmentation of bucco-lingual gingival dimensions before orthodontics may yield satisfactory results with respect to the development or progression of gingival recessions. However, the strength of the available evidence is not adequate in order to change or suggest a possible treatment approach in the daily practice based on solid scientific evidence. CONCLUSIONS Despite the clinical experience that soft tissue augmentation of bucco-lingual gingival dimensions before orthodontic treatment may be a clinically viable treatment option in patients considered at risk, this treatment approach is not based on solid scientific evidence. Moreover, the present data do not allow to draw conclusions on the best timing of soft tissue augmentation when a change in the inclination of the incisors is planned during orthodontic treatment and thus, there is a stringent need for randomized controlled trials to clarify these open issues.

Bone dimensions in the posterior mandible: a retrospective radiographic study using cone beam computed tomography. Part 2- analysis of edentulous sites.

A precise radiographic evaluation of the local bone dimensions and morphology is important for preoperative planning of implant placement. The purpose of this retrospective study was to analyze dimensions and morphology of edentulous sites in the posterior mandible using cone beam computed tomography (CBCT) images. This retrospective radiographic study measured the bone width (BW) of the mandible at three locations on CBCT scans for premolars (PM1, PM2) and molars (M1, M2): at 1 mm and 4 mm below the most cranial point of the alveolar crest (BW1, BW2) and at the superior border of the mandibular canal (BW3). Furthermore, the height (H) of the alveolar process (distance between the measuring points BW1 and BW3), as well as the presence of lingual undercuts, were analyzed. A total of 56 CBCTs met the inclusion criteria, resulting in a sample size of 127 cross sections. There was a statistically significant increase from PM1 to M2 for the BW2 (P < .001), which was not present for BW1 and BW3 values. For the height of the alveolar process, the values exhibited a decrease from PM1 to M2 sites. Sex was a statistically significant parameter for H (P = .001) and for BW1 (P = .03). Age was not a statistically significant parameter for bone width (BW1: P = .37; BW2: P = .31; BW3: P = .51) or for the height of the alveolar process (P = .41) in the posterior mandible. Overall, 73 (57.5%) edentulous sites were evaluated to be without visible lingual undercuts; 13 (10.2%) sites exhibited lingual undercuts classified as influential for implant placement. Precise evaluation of the alveolar crest by cross-sectional imaging is of great value to analyze vertical and buccolingual bone dimensions in different locations in the posterior mandible. In addition, CBCTs are valuable to diagnosing the presence of and potential problems caused by lingual undercuts prior to implant placement.

Susceptibility of enamel to initial erosion in relation to tooth type, tooth surface and enamel depth

This study aimed at assessing the susceptibility of different tooth types (molar/premolar), surfaces (buccal/lingual) and enamel depths (100, 200, 400 and 600 μm) to initial erosion measured by surface microhardness loss (ΔSMH) and calcium (Ca) release. Twenty molars and 20 premolars were divided into experimental and control groups, cut into lingual/ buccal halves, and ground/polished, removing 100 μm of enamel. The initial surface microhardness (SMH 0 ) was measured on all halves. The experimental group was subjected to 3 consecutive erosive challenges (30 ml/tooth of 1% citric acid, pH 3.6, 25 ° C, 1 min). After each challenge, ΔSMH and Ca release were measured. The same teeth were consecutively ground to 200, 400 and 600 μm depths, and the experimental group underwent 3 erosive challenges at each depth. No difference was found in SMH 0 between experimental and control groups. Multivariate nonparametric ANOVA showed no significant differences between lingual and buccal surfaces in ΔSMH (p = 0.801) or Ca release (p = 0.370). ΔSMH was significantly greater in premolars than in molars (p < 0.05), but not different with respect to enamel depth. Ca release decreased significantly with increasing depth. Regression between Ca release and ΔSMH at 100 μm depth showed lower slope and r 2 value, associated with greater Ca release values. At 200-600 μm depths, moderately large r 2 values were observed (0.651-0.830). In conclusion, different teeth and enamel depths have different susceptibility to erosion, so when Ca release is used to measure erosion, the depth of the test facet in enamel should be standardized, whereas this is less important if ΔSMH is used.

Periodontal regeneration - furcation defects: a consensus report from the AAP Regeneration Workshop

BACKGROUND Treatment of furcation defects is a core component of periodontal therapy. The goal of this consensus report is to critically appraise the evidence and to subsequently present interpretive conclusions regarding the effectiveness of regenerative therapy for the treatment of furcation defects and recommendations for future research in this area. METHODS A systematic review was conducted before the consensus meeting. This review aims to evaluate and present the available evidence regarding the effectiveness of different regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy. During the meeting, the outcomes of the systematic review, as well as other pertinent sources of evidence, were discussed by a committee of nine members. The consensus group members submitted additional material for consideration by the group in advance and at the time of the meeting. The group agreed on a comprehensive summary of the evidence and also formulated recommendations for the treatment of furcation defects via regenerative therapies and the conduction of future studies. RESULTS Histologic proof of periodontal regeneration after the application of a combined regenerative therapy for the treatment of maxillary facial, mesial, distal, and mandibular facial or lingual Class II furcation defects has been demonstrated in several studies. Evidence of histologic periodontal regeneration in mandibular Class III defects is limited to one case report. Favorable outcomes after regenerative therapy for maxillary Class III furcation defects are limited to clinical case reports. In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although generally Class I furcation defects may be treated predictably with non-regenerative therapies. There is a paucity of data regarding quantifiable patient-reported outcomes after surgical treatment of furcation defects. CONCLUSIONS Based on the available evidence, it was concluded that regenerative therapy is a viable option to achieve predictable outcomes for the treatment of furcation defects in certain clinical scenarios. Future research should test the efficacy of novel regenerative approaches that have the potential to enhance the effectiveness of therapy in clinical scenarios associated historically with less predictable outcomes. Additionally, future studies should place emphasis on histologic demonstration of periodontal regeneration in humans and also include validated patient-reported outcomes. CLINICAL RECOMMENDATIONS Based on the prevailing evidence, the following clinical recommendations could be offered. 1) Periodontal regeneration has been established as a viable therapeutic option for the treatment of various furcation defects, among which Class II defects represent a highly predictable scenario. Hence, regenerative periodontal therapy should be considered before resective therapy or extraction; 2) The application of a combined therapeutic approach (i.e., barrier, bone replacement graft with or without biologics) appears to offer an advantage over monotherapeutic algorithms; 3) To achieve predictable regenerative outcomes in the treatment of furcation defects, adverse systemic and local factors should be evaluated and controlled when possible; 4) Stringent postoperative care and subsequent supportive periodontal therapy are essential to achieve sustainable long-term regenerative outcomes.

Visor Osteotomy of the Anterior Mandible

Current techniques for three-dimensional correction of the chin in patients with mandibular retrusion may increase mentolabial fold depth, but have limited effect on the lips. The authors present a single surgical technique to support the mentolabial fold and improve labial competence. The visor osteotomy is performed from canine to canine. The bone fragment pedicled to the lingual periosteum is coronally mobilized and fixed in the new position. Preserved vascularization is supposed to minimize the amount of bone resorbed. Visor osteotomy of the anterior mandible may improve the existing treatments for micrognathia by creating an aesthetic mentolabial fold and a competent lip seal.

Space requirement of a prefabricated bar on two interforaminal implants: a prospective clinical study

OBJECTIVES This clinical study measured the dimensional changes of existing lower complete dentures due to the integration of a prefabricated implant bar. Additionally, the impact of this dimensional change on patient satisfaction and oral function was analyzed. METHODS Twenty edentulous patients (10 men/10 women; aged 65.9 ± 11.8 years) received two interforaminal implants. Subsequent to surgery, a chair side adapted, prefabricated bar (SFI Bar(®), C+M, Biel, Switzerland) was inserted, and the matrix was polymerized into the existing lower denture. The change of the denture's lingual dimension was recorded by means of a bicolored, silicone denture duplicate that was sectioned in the oro-vestibular direction in the regions of the symphysis (S) and the implants (I-left, I-right). On the sections, the dimensional increase was measured using a light microscope. Six months after bar insertion, patients answered a standardized questionnaire. RESULTS All dentures exhibited increased lingual volume, more extensively at S than at I (P = 0.001). At S, the median diagonal size of the denture was doubled (+4.33 mm), and at I, the median increase was 50% (I-left/-right = +2.66/+2.62 mm). The original denture size influenced the volume increase (P = 0.024): smaller dentures led to a larger increase. The amount of denture increase did not have negative impact on either self-perceived oral function or patient satisfaction. Approximately, 95% of the patients were satisfied with the treatment results. CONCLUSIONS The lingual size of a lower denture was enlarged by the integration of a prefabricated bar without any negative side effects. Thus, this attachment system is suitable to convert an existing full denture into an implant-supported overdenture.

Dislocated Tongue Muscle Attachment and Cleft Palate Formation

In Pierre Robin sequence, a retracted tongue due to micrognathia is thought to physically obstruct palatal shelf elevation and thereby cause cleft palate. However, micrognathia is not always associated with palatal clefting. Here, by using the Bmp7-null mouse model presenting with cleft palate and severe micrognathia, we provide the first causative mechanism linking the two. In wild-type embryos, the genioglossus muscle, which mediates tongue protrusion, originates from the rostral process of Meckel's cartilage and later from the mandibular symphysis, with 2 tendons positive for Scleraxis messenger RNA. In E13.5 Bmp7-null embryos, a rostral process failed to form, and a mandibular symphysis was absent at E17.5. Consequently, the genioglossus muscle fibers were diverted toward the lingual surface of Meckel's cartilage and mandibles, where they attached in an aponeurosis that ectopically expressed Scleraxis. The deflection of genioglossus fibers from the anterior-posterior toward the medial-lateral axis alters their direction of contraction and necessarily compromises tongue protrusion. Since this muscle abnormality precedes palatal shelf elevation, it is likely to contribute to clefting. In contrast, embryos with a cranial mesenchyme-specific deletion of Bmp7 (Bmp7:Wnt1-Cre) exhibited some degree of micrognathia but no cleft palate. In these embryos, a rostral process was present, indicating that mesenchyme-derived Bmp7 is dispensable for its formation. Moreover, the genioglossus appeared normal in Bmp7:Wnt1-Cre embryos, further supporting a role of aberrant tongue muscle attachment in palatal clefting. We thus propose that in Pierre Robin sequence, palatal shelf elevation is not impaired simply by physical obstruction by the tongue but by a specific developmental defect that leads to functional changes in tongue movements.

Escala de medición del miedo a la atención dental

El miedo al dolor constituye un obstáculo que interfiere la consul- ta dental del paciente y, con el objeto de prevenirlos, se diseña una escala de exploración del miedo a la consulta dental y de las estra- tegias deseables para disminuirlo. Se utilizó el Método de Escalonamiento de Likert y se aplicó a 105 pacientes en la Facultad de Odontología de la Universidad Nacional de Cuyo, Mendoza. Los pacientes responden que sienten mucho miedo a que el odontólo- go pueda trasmitirles una infección, ser revisados sin guantes, o que no se los cambie, y a las consecuencias de la mala higiene. En segundo lugar tienen mucho miedo a que el odontólogo pueda tocar un nervio, que perfore excesivamente, que se quiebre una pieza dentaria o se equivoque en el diagnóstico. La mayoría desea ser tratada comprensivamente y que se le explique los procedi- mientos y anticipe lo que va a sentir.

MIRACLE at Ad-Hoc CLEF 2005: Merging and Combining Without Using a Single Approach

This paper presents the 2005 Miracle’s team approach to the Ad-Hoc Information Retrieval tasks. The goal for the experiments this year was twofold: to continue testing the effect of combination approaches on information retrieval tasks, and improving our basic processing and indexing tools, adapting them to new languages with strange encoding schemes. The starting point was a set of basic components: stemming, transforming, filtering, proper nouns extraction, paragraph extraction, and pseudo-relevance feedback. Some of these basic components were used in different combinations and order of application for document indexing and for query processing. Second-order combinations were also tested, by averaging or selective combination of the documents retrieved by different approaches for a particular query. In the multilingual track, we concentrated our work on the merging process of the results of monolingual runs to get the overall multilingual result, relying on available translations. In both cross-lingual tracks, we have used available translation resources, and in some cases we have used a combination approach.

Challenges for the Multilingual Web of Data

The Web has witnessed an enormous growth in the amount of semantic information published in recent years. This growth has been stimulated to a large extent by the emergence of Linked Data. Although this brings us a big step closer to the vision of a Semantic Web, it also raises new issues such as the need for dealing with information expressed in different natural languages. Indeed, although the Web of Data can contain any kind of information in any language, it still lacks explicit mechanisms to automatically reconcile such information when it is expressed in different languages. This leads to situations in which data expressed in a certain language is not easily accessible to speakers of other languages. The Web of Data shows the potential for being extended to a truly multilingual web as vocabularies and data can be published in a language-independent fashion, while associated language-dependent (linguistic) information supporting the access across languages can be stored separately. In this sense, the multilingual Web of Data can be realized in our view as a layer of services and resources on top of the existing Linked Data infrastructure adding i) linguistic information for data and vocabularies in different languages, ii) mappings between data with labels in different languages, and iii) services to dynamically access and traverse Linked Data across different languages. In this article we present this vision of a multilingual Web of Data. We discuss challenges that need to be addressed to make this vision come true and discuss the role that techniques such as ontology localization, ontology mapping, and cross-lingual ontology-based information access and presentation will play in achieving this. Further, we propose an initial architecture and describe a roadmap that can provide a basis for the implementation of this vision.

Influencia de la configuración geométrica de placas prefabricadas para forjados en las tensiones originadas por la transferencia del pretensado en elementos realizados con armaduras pretesas ancladas por adherencia

Las piezas pretensadas de hormigón presentan zonas muy solicitadas correspondientes a la zona de transferencia. En muchos casos se ha detectado figuración en tales zonas cuyo origen está ligado a la transferencia de la fuerza de pretensado, pudiendo llegar a causar el rechazo de la pieza. En el caso de las piezas prefabricadas con armaduras pretesas adherentes, no siempre es posible disponer armado transversal para controlar esta fisuración, ya sea por el proceso constructivo, ya sea por disponer en general de secciones transversales muy optimizadas. Recientemente se desarrolló una nueva tipología de piezas de hormigón prefabricado para forjados unidireccionales pretensadas con armadura activa pretesa y sin armadura transversal. La tipología se asimila a una sección en PI invertida, con alas de gran envergadura en comparación con el ancho de nervio, y armadura activa distribuida en las alas. Este diseño parece propenso a la aparición de fisuración en el momento de la transferencia del pretensado. Así, se han producido fallos de carácter frágil: colapso de piezas ya colocadas en obra, separándose la losa inferior de los nervios y cayendo sobre el piso. Las herramientas de análisis usuales han resultado inútiles al aplicarse a la investigación de esta patología. Para afrontar el estudio de los problemas detectados en la tipología, se ha analizado el fenómeno de las tensiones de tracción en la zona de transferencia, usualmente denominadas exfoliación y estallido, así como los métodos de análisis aplicables a elementos pretesos sin armadura transversal. En algunas ocasiones se trata del resultado de trabajos desarrollados para piezas postesadas, o para calcular cuantías de armadura transversal, adaptados a posteriori. También existen métodos desarrollados específicamente para piezas pretesas sin armadura transversal. Junto a los factores considerados en los métodos existentes se han localizado otros, no tenidos en cuenta habitualmente, pero que pueden ser determinantes en piezas no convencionales, como son: la existencia de pretensado superior e inferior, la falta de simetría de la sección transversal, el ancho variable de las piezas, una relación entre el ancho del ala y el espesor de los nervios elevada, la distribución transversal del pretensado en relación al ancho variable. Además, la mayoría de los métodos se han basado en simplificaciones bidimensionales. Para tener en cuenta la influencia de estos factores, se han modelizado piezas en las que varían tanto la geometría de la sección transversal y la cuantía de pretensado, como la ley de adherencia o la distribución de armadura activa en la sección. Estos modelos se han analizado mediante el método de elementos finitos, efectuándose u análisis elástico lineal tridimensional. En general, los métodos existentes no han predicho adecuadamente las tensiones obtenidas mediante elementos finitos. Sobre los resultados obtenidos por elementos finitos se ha desarrollado un ajuste experimental, que presentan un alto grado de correlación y de significación, así como una reducida dispersión y error relativo. En consecuencia, se propone un método de obtención de la tensión máxima de exfoliación, consistente en varias ecuaciones, que tienen en cuenta las peculiaridades de la configuración de las piezas citadas y permiten considerar cualquier ley de adherencia, manteniendo la coherencia con la longitud de transmisión. Las ecuaciones se emplean para la obtención de la tensión máxima de exfoliación en piezas de la tipología estudiada cuya armadura activa se sitúe fuera del núcleo central de la sección transversal. Respecto al estallido, se propone una modificación de los métodos existentes que, comparado con los resultados del análisis por elementos finitos, mejora el valor medio y la dispersión a valores admisibles y del lado de la seguridad. El método considera la geometría de la sección y la distribución del pretensado en la losa inferior. Finalmente, se ofrecen estrategias de diseño para piezas de la tipología o semejantes. End zones of prestressed concrete members are highly stressed. Cracking have often appeared at end zone, and its beginning is related to prestress release. Some members become rejected because of these cracks. Sometimes it is not possible having transverse reinforcement in order to control cracking, when referring to pretensioned precast members. The reason may be the construction process or highly optimized crosssections. A new typology of precast concrete members designed for one-way composite floors was recently developed. The members, without transverse reinforcement, are prestressed with pretensioned wires or strands. This typology is similar to an inverted TT slab, with a large flange related to the web thickness and prestressing reinforcement spread across the flange. This design is highly susceptible to appear cracking at prestress release. Therefore, brittle failures have been reported: fail of slabs laid in place on a construction site, resulting in the separation of the flange from the webs,, and the subsequent fall on the lower floor. Usual analytical methods have been useless to study the failure. End zone tensile stresses have been analysed to study the detected typology problems. These tensile stresses are usually called spalling and bursting (also called splitting in the U.S.). Analysis methods applicable to pretensioned members without transverse reinforcement have been analysed too. Some methods were originally developed for postensioned concrete or for obtaining the amount of transverse reinforcement. In addition, there are methods developed specifically for pretensioned members without transverse reinforcement. Some factors, frequently ignored, have been found, such as lower and upper prestress, lack of symmetry in the cross section, variable width, a high ratio between flange width and web thickness or prestressing reinforcement location related to variable width. They can play a decisive role in non-conventional members. In addition, most methods are based on 2D simplifications. Finite Element modelling has been conducted in order to consider the influence of these factors. A linear 3D approach has been used. The modelled members vary according to cross section geometry, bond behaviour, or prestressing reinforcement location. In general, the obtained tensile stresses don’t agree with existing methods. An experimental adjustment has been conducted on the obtained results, with a high correlation ratio and significance level as well as a low dispersion and relative error. Therefore, a method to obtain the maximum spalling stress is proposed. The proposal consists on some equations that consider the special features of the typology and bond behaviour. Consistency between transmission length and bond behaviour is considered too. The equations are used to calculate maximum spalling stress for the studied typology members whose prestressing reinforcement is located out of the core of the cross section. In relation to bursting, a modification of existing methods is proposed. Compared to finite element results, the proposal improves mean value and dispersion, whose ranges are considered acceptable and secure. The method takes into account cross section geometry and location of prestressing reinforcement across the lower flange. Finally, strategies to design members of this typology or similar are proposed.