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Objective: To evaluate the crest height and facial alveolar bone thickness of the maxillary anterior teeth within the aesthetic zone among dentate adults in Pakistan. Study Design: Cross-sectional Analytical study. Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Sep 2024 to Feb 2025. Methodology: The assessment of alveolar bone thickness was done in 43 patients with use of cone beam computed tomography (CBCT). The thickness of the alveolar bone facial plate was determined for each tooth type (at three different points i.e., A, B, and C) using a CBCT image and an integrated digital caliper. The analysis included bilateral upper canines (UC), upper lateral incisors (UL), and upper central incisors (UCI). Comparative analysis at 0.05 significance level was done using SPSS software (version 20). Results: Out of the 258 teeth measured, 86 were canines, 86 were lateral incisors and 86 were central incisors. The mean thickness of the alveolar bone facial plates in upper anterior teeth was 1.04±0.09 mm for the lateral incisors, 1.29±0.04 mm for the canines, and 0.98±0.04 mm for the central incisors. These values differed significantly (p<0.001). No significant correlation was observed between age and facial bone plate thickness (p>0.05). Conclusion: There were significant differences in alveolar bone thickness in maxillary anterior region among Pakistani population. Facial plate thickness is an essential factor in determining optimal strategies for early implant placement in the aesthetic zone.

Class III malocclusion represents a growth-related dentofacial deformity with mandibular prognathism in relation to the maxilla and/or cranial base. Its prevalence varies greatly among and within different races, ethnic groups, and geographic regions studied. Class III malocclusion has a multifactorial etiology, which is the expression of a moderate distortion of normal development as a result of interaction between innate factors or genetic hereditary with environmental factors. Various skeletal topographies of underlying Class III malocclusion are due to discrepancy in the maxillary and mandibular growth along with vertical and/or transverse problems apart from sagittal malformations. The spectrum of complications for Class III malocclusion ranges in gravity from dentoalveolar problems with functional anterior shift of the mandible to true skeletal problems with serious maxillomandibular discrepancies, which makes its diagnosis highly challenging in growing children. Concern regarding early treatment and the need for interceptive care in the case of Class III malocclusion has always been a dilemma, knowing that not all problems will be solved in these cases until maxillomandibular growth is further completed, and the long-term outcome of various treatment approaches may depend on the growth tendency of an individual. Interceptive treatment of Class III malocclusions should be undertaken if it prevents damage to the oral tissues and/or significantly reduces the amount or severity of future orthodontic and surgical interventions. This paper presents an overview of developing Class III malocclusion, with the emphasis on challenges and their solutions based on the best current available evidence.

Abstract We present a unique case of primary intraosseous paraganglioma (PGL) originating from maxillary bone. PGL is a neurosecretory neoplasm that arises from cells believed to originate from the neural crest. A 30-year-old woman presented with right facial pain and swelling, along with palpitations. Computed tomography (CT) imaging revealed a 3.3 × 3.1 × 2.3 cm mass in the anterior maxilla, and biochemical results showed elevated plasma dopamine, 3-methoxytyramine, and chromogranin A levels. Biopsy confirmed a PGL, with positive expression of synaptophysin, chromogranin A, and GATA-3. Whole-body positron emission tomography/computed tomography (PET/CT) scans showed avidity on 18F-fluorodopa (18F-FDOPA), 68Ga-DOTA(0)-Tyr(3)-octreotate ​​ (68Ga-DOTATATE), and 18F-fluorodeoxyglucose (18F-FDG). No other lesions (primary or metastatic) were found. Proton beam therapy was chosen over surgery due to potential complications and patient's preference. Following radiotherapy, she experienced symptom relief, with dopamine levels decreasing and chromogranin A normalizing, with the lesion remaining stable on 11-month follow-up imaging. This case highlights the rarity of primary bone PGLs and underscores the importance of comprehensive diagnostic approaches combining physical examinations, biochemical testing, functional imaging, and histopathological analysis properly guiding personalized treatment strategies. Additionally, proton beam therapy emerges as a highly suitable treatment option for head and neck paragangliomas (HNPGLs), offering effective tumor control with minimal complications.

Purpose The maxillary tuberosity, a critical anatomical landmark in dentistry and maxillofacial surgery, is burdened by terminological confusion. This inconsistency hampers clinical practice and communication across disciplines. Method Different resources were used to argue for the necessity of standardising the terminology related to maxillary tuberosity to enhance diagnostic precision and ultimately improve patient outcomes. Results Most clinical and surgical studies dealing with the distal alveolar bone of the maxilla erroneously indicate it as “maxillary tuberosity”. By recognising the diverse definitions of this structure, errors and misinterpretation of studies could be reduced, and interdisciplinary collaboration could be improved. The term “alveolar tuberosity” is recommended to refer specifically to the distal end of the alveolar process of the maxilla. Anatomically, the maxillary tuberosity belongs to the body of the maxilla and forms part of the posterior wall of the maxillary sinus; therefore, it should not be located in the alveolar process. Conclusion Adhering to the Terminologia Anatomica will clarify the critical clinical and surgical landmarks and enhance communication in clinical and academic settings.

Introduction:  Maxillary sinus floor defects pose a notable challenge in posterior maxillary implant planning due to their complex anatomy and frequent association with insufficient bone volume. This study aimed to evaluate the anatomical characteristics of such defects, introduce a topographic-anatomical classification system, and assess its clinical utility for guiding augmentation techniques and implant timing. Materials and methods: A retrospective cohort study was conducted on 91 patients who underwent evaluation for posterior maxillary implant rehabilitation at Bogomolets National Medical University (2021–2024). Defects were classified based on size, extent, and bony wall integrity. CT data were analyzed using Mimics Medical 23.0 to assess defect area, mesiodistal and vestibulo-oral dimensions, and residual bone height. ANOVA and Kruskal–Wallis tests were used to compare defect types and assess treatment feasibility. Results: Defects varied widely in size and morphology. Type I defects (37.4%) were small and surrounded by four walls, while Type IV (18.6%) were extensive and involved major wall loss. Types I and II could support transcrestal sinus lift and simultaneous implantation, while Types III and IV typically required staged lateral augmentation and additional ridge reconstruction. Residual bone height did not differ significantly across types ( p >0.05), but linear dimensions and area increased progressively ( p <0.001). Conclusion: The proposed classification supports individualized treatment planning by integrating defect dimensions and wall integrity, potentially improving outcomes in posterior maxillary implantology.

Background Ameloblastic fibrosarcoma (AFS) is a rare malignant odontogenic tumor, commonly occurring in young adults and typically affecting the mandibular region. We report an exceptionally rare and highly atypical case of AFS in an elderly female patient originating from the maxillary bone. Case presentation A 66-year-old woman was admitted with a two-week history of a lump in her left upper molar. CT scans suggested a cyst in the maxillary bone. An incisional biopsy revealed a spindle cell neoplasm. MRI showed abnormalities in the left maxilla, indicating a possible tumorous lesion. The patient underwent a subtotal maxillectomy, wide tumor excision, intraoral epithelial flap transplantation, and dental extraction. Histology identified atypical tumor cells with visible mitotic figures. Immunohistochemistry showed negative for PCK and CD34 expression, but positive for Vimentin and SMA expression. The Ki-67 proliferation index ranged from 30 to 50%. These findings suggested a potentially malignant soft tissue tumor in the left maxilla, leaning towards a diagnosis of AFS. The patient received postoperative radiotherapy. There was no recurrence during the six-month follow-up. Conclusion Based on repeated pathological evidence, we report a rare case of an elderly female with AFS originating from the maxillary bone. Surgery and postoperative radiotherapy resulted in a favorable outcome.

Background Numerous clinical variables may influence early marginal bone loss (EMBL), including surgical, prosthetic and host-related factors. Among them, bone crest width plays a crucial role: an adequate peri-implant bone envelope has a protective effect against the influence of the aforementioned factors on marginal bone stability. The aim of the present study was to investigate the influence of buccal and palatal bone thickness at the time of implant placement on EMBL during the submerged healing period. Methods Patients presenting a single edentulism in the upper premolar area and requiring implant-supported rehabilitation were enrolled following inclusion and exclusion criteria. Internal connection implants (Twinfit, Dentaurum, Ispringen, Germany) were inserted after piezoelectric implant site preparation. Mid-facial and mid-palatal thickness and height of the peri-implant bone were measured immediately after implant placement (T0) with a periodontal probe and recorded to the nearest 0.5 mm. After 3 months of submerged healing (T1), implants were uncovered and measurements were repeated with the same protocol. Kruskal-Wallis test for independent samples was used to compare bone changes from T0 to T1. Multivariate linear regression models were built to assess the influence of different variables on buccal and palatal EMBL. Results Ninety patients (50 females, 40 males, mean age 42.9 ± 15.1 years), treated with the insertion of 90 implants in maxillary premolar area, were included in the final analysis. Mean buccal and palatal bone thickness at T0 were 2.42 ± 0.64 mm and 1.31 ± 0.38 mm, respectively. Mean buccal and palatal bone thickness at T1 were 1.92 ± 0.71 mm and 0.87 ± 0.49 mm, respectively. Changes in both buccal and palatal thickness from T0 to T1 resulted statistically significant (p = 0.000). Changes in vertical bone levels from T0 to T1 resulted not significant both on buccal (mean vertical resorption 0.04 ± 0.14 mm; p = 0.479) and palatal side (mean vertical resorption 0.03 ± 0.11 mm; p = 0.737). Multivariate linear regression analysis showed a significant negative correlation between vertical bone resorption and bone thickness at T0 on both buccal and palatal side. Conclusion The present findings suggest that a bone envelope > 2 mm on the buccal side and > 1 mm on the palatal side may effectively prevent peri-implant vertical bone resorption following surgical trauma. Trial Registration The present study was retrospectively recorded in a public register of clinical trials ( www.clinicaltrials.gov - NCT05632172) on 30/11/2022.

Background: Vertical atrophy of the maxilla has traditionally been treated with sinus lift procedures and implant placement, performed in one or two surgical stages. Subsequently, the transcrestal sinus lift technique was introduced, offering distinct advantages in terms of indications and reduced morbidity. Most recently, short implants have emerged as a valid alternative to these procedures, even in cases of severe horizontal resorption, allowing for direct placement in many cases. This study was designed to assess the clinical outcomes of short implant placement in alveolar ridges with severe bone atrophy, compared with conventional-length implants placed in areas undergoing conventional sinus elevation. Methods: A retrospective split-mouth study was conducted to compare conventional sinus elevation with standard-length implants versus short implants for addressing vertical bone atrophy in the posterior maxilla. The primary variable was the variation in the marginal bone level. The secondary variables were implant survival and complications. The evaluation of the statistical significance of the difference in categorical variables was accomplished by Chi-squared test or Fisher’s exact test. The comparison between the study groups in continuous variables was performed using Wilcoxon test. The statistical significance was set at p-value < 0.05. Results: The study sample consisted of 24 patients and a total of 73 dental implants. The lateral sinus elevation group (LSEG) included 39 implants, while the short implants group (SIG) included 32 implants. All prostheses were screw-retained. Changes in marginal bone levels indicated a marginal bone loss of less than 0.5 mm in both groups, with no statistically significant difference. In the LSEG, two cases of mucositis were identified, attributed to improper use of an interdental brush. Additionally, two cases of prosthetic screw fracture were reported in the LSEG as technical complications. Conclusions: Long-term outcome data have provided evidence that the use of short implants is comparable to a state-of-the-art procedure (sinus grafting and placement of implants) regarding implant survival, marginal bone remodeling, and complication rates.

Background This study used micro-focus X-ray Computed Tomography (micro-XCT) to examine the anatomical differences and dimensions of the maxillary incisive canal (MIC) in a South African population. The accurate imaging yielded dependable results that support earlier research and enhance anterior maxilla surgery planning. Furthermore, these anatomical features are compared between various racial and gender groupings in the study. Methods Using a micro-XCT scanner, 108 human cadaver skulls from the Pretoria Bone Collection were scanned and included in the study. Advanced volume rendering software was employed for measuring the MIC length, diameter, shape, and the buccal bone wall measurements in relation to the MIC. Results Significant anatomical variation in the size and shape of the MIC was identified in the population, with variations seen between racial and gender groups. The incisive foramen (ICO) mean diameter was 6.61 mm, and the MIC length varied from 4.96 to 20.10 mm. There were significant differences in the buccal alveolar bone height between different ethnic groups and gender. Regarding morphological patterns in coronal and sagittal views, single canals were more common in the black population while Y-shaped canals were more common in the white population. The study also introduced a new metric by measuring the mean distances between teeth #11 and #21 and the ICO (1.83 mm and 1.88 mm respectively). Conclusions The complex anatomical differences of the MIC in a South African population were clarified. Clinicians should be aware of tooth sockets in near proximity to the MIC and perform accurate preoperative assessment using sophisticated 3-D imaging and preferable guided implant placement in the anterior maxilla.

Maxillary intraosseous hemangiomas are rare benign vascular lesions, accounting for less than 1% of all primary bone tumors. Clinical examination often reveals a hard, painless swelling mass that is rarely pulsatile. Imaging not only helps to make a positive diagnosis but also contributes to therapeutic management. We report a case of a left maxillary intra osseous hemangioma Some authors have proposed exclusive embolization as a treatment for maxillary angiomas, but this requires several sessions for complete devascularization.