Objective: This diagnostic accuracy study aims to present the first measurements of gingiva thickness around lower anterior teeth using dental magnetic resonance imaging (MRI) and to compare these measurements with two established methods: (1) gingival phenotype assessment via periodontal probing, and (2) the superimposition of cone-beam computed tomography (CBCT) scans with intraoral scans of teeth and gums. Materials and methods: Ten patients with substantial orthodontic treatment need and anterior mandibular crowding were consecutively included in this clinical case series. After periodontal probing, each patient underwent a CBCT scan, an intraoral scan of the mandible, and an MRI investigation using a novel mandibula 15-channel dental coil. Results: The mean gingiva thickness was 0.72 mm measured on MRI and 0.97 mm measured on CBCT, with a mean difference between the measurement methods of 0.17 ± 0.27 mm (p < 0.001). Measurement agreement between the index tests (MRI and CBCT) and the clinical reference standard (probing) yielded an overall percent agreement of 64.94% and 47.02% for MRI and CBCT, respectively. Teeth with thin phenotypes were associated with lower soft tissue dimensions in both free (MRI: 0.56 mm vs. CBCT: 0.79 mm) and supracrestal gingiva (MRI: 0.75 mm vs. CBCT: 1.03 mm) when compared to those with thick phenotypes. However, only the measurements obtained from MRI scans showed statistically significant differences between the two phenotypes. Conclusion: Dental MRI successfully visualizes delicate structures like the gingiva in the anterior mandible and achieves a high correlation with superimposed CBCT scans, with clinically acceptable deviations. Clinical relevance: The present study helps to establish dental MRI as a radiation-free alternative to conventional radiographic methods.

Background: Fragile gingival tissue is a risk factor for the development of gingival recessions. Despite the fact that gingival recessions are more commonly seen around anterior mandibular teeth, previous research has predominantly concentrated on the gingival dimensions in the anterior maxilla. The objective was to systematically compare buccal gingival thicknesses between the upper and lower jaws in individuals with healthy gingival conditions in the aesthetic zone. Methods: A comprehensive search of three databases was carried out until October 2023. Gingival thickness differences between the maxilla and mandible were evaluated by calculating the mean differences along with the corresponding 95% confidence interval (CI). Subgroup analysis was conducted based on the measurement area, measurement method, and tooth category. Results: A total of seventeen studies were included in this systematic review. Eleven studies were included in the quantitative analysis. Quantitative analysis comparing gingival thickness around 2100 teeth in the anterior mandible to 2056 teeth in the anterior maxilla revealed a statistically significant thinner buccal gingiva in the mandible (mean difference: 0.16 mm; 95% CI [−0.24, −0.07]; p = 0.0003). Conclusions: The present systematic review revealed a more delicate buccal gingiva in the anterior mandible. However, further scientific validation is required due to the considerable heterogeneity in study design and the potential presence of confounding variables.

Background and objective: Agenesis of the maxillary lateral incisor occurs in up to 4% of all individuals and requires multidisciplinary treatment. Its developmental origins, however, are not fully understood. Earlier studies documented genetic factors contributing to agenesis but also an association with craniofacial morphology. In this study, we assessed the association between maxillary morphology and lateral incisor agenesis by a geometric morphometric approach to disentangle the roles of developmental plasticity and genetic factors. Materials and methods: We quantified the maxillary alveolar ridge by 19 two-dimensional landmarks on cross-sectional images of 101 computed tomography scans. We compared the shape and size of the alveolar ridge across patients with unilateral or bilateral agenesis of maxillary lateral incisors and patients with extracted or in situ incisors. Results: The maxillary alveolar ridge was clearly narrower in patients with agenesis or an extracted incisor compared to the control group, whereas the contralateral side of the unilateral agenesis had an intermediate width. Despite massive individual variation, the ventral curvature of the alveolar ridge was, on average, more pronounced in the bilateral agenesis group compared to unilateral agenesis and tooth extraction. Conclusions: This suggests that pleiotropic genetic and epigenetic factors influence both tooth development and cranial growth, but an inappropriately sized or shaped alveolar process may also inhibit normal formation or development of the tooth bud, thus leading to dental agenesis. Clinical relevance: Our results indicate that bilateral agenesis of the lateral incisor tends to be associated with a higher need of bone augmentation prior to implant placement than unilateral agenesis.

During orthodontic treatment, the risk of gingival recession may increase, especially in the mandibular anterior region due to thin alveolar bone. This prospective pilot study aimed to develop a standardized evaluation method based on magnetic resonance imaging (MRI) for analysing tooth movements and tissue dimensions and to investigate the impact on periodontal parameters during orthodontic levelling. Participants aged 12 to 18 with lower jaw crowding underwent MRI scans before (T0) and five months into orthodontic treatment (T1). The following tissue dimensions were analysed: thickness of free and supracrestal gingiva (FGT, SGT), thickness of buccal alveolar bone (ABT) at three measurement levels (ABT2, ABT4, ABT8), and gingiva and alveolar bone height (GH, ABH). Additionally, tooth positions (apex position and tooth axis inclination) were determined. Ten patients (60% female, 40% male) aged 14.33 ± 1.35 years were included after the exclusion of 3 datasets due to motion artefacts. MRI measurements showed significant changes in tooth inclination (2.93 ± 4.77°, p < 0.001), bucco-lingual apex position (-0.45 ± 1.03 mm, p = 0.006), SGT (-0.07 ± 0.19 mm, p = 0.020), ABT8 (0.42 ± 0.59 mm, p < 0.001), ABH (-0.29 ± 0.68 mm, p = 0.006) and GH (0.31 ± 0.9 mm, p = 0.030) between T0 and T1. Inclination changes correlated negatively with FGT (R = -0.422, p < 0.001) and positively with ABT8 (R = 0.404, p = 0.032). Furthermore, ABT8 correlated negatively with buccal apex movement (R=-0.392, p = 0.042). Intra- and interclass correlation coefficients were excellent (0.988 and 0.975). Periodontal tissue changes correlated with tooth inclination or apex position changes due to orthodontic treatment. The pilot study has demonstrated the feasibility of dental MRI as a radiation-free alternative to cone-beam computed tomography for monitoring orthodontic treatment. However, the methodology was susceptible to motion artefacts. ISRCTN, ISRCTN12689212. Registered 11 April 2024 Retrospectively registered, http//www.isrctn.com/ISRCTN12689212 .

Objective: Patients aiming for clear aligner therapy (CAT) have a distinct expectation regarding their orthodontic treatment. The aim of this prospective cohort study was to increase our knowledge on these specific patients’ needs, expectations, and concerns regarding CAT. Methods: Patients, who were about to start CAT, were asked to answer both, a 32-item questionnaire addressing expectations regarding CAT, rated on a 10-point visual analogue scale, and the Oral Health Impact Profile (OHIP-14) questionnaire. In addition, demographic and clinical data were collected. Results: A total of 82 patients participated (mean age 35 ± 12 years; 74.4% female). Patients strongly expected CAT to treat their malocclusion as effectively as orthodontic brackets (9.5 ± 0.9 points) and they would seek a second opinion if they were told treatment with CAT would not be possible (7.2 ± 3.3 points). In addition, patients appeared not willing to compromise on the planned treatment outcome, even if it would decrease treatment time (2.1 ± 2.3 points) or costs (2.4 ± 2.5 points). Further, they highly expected that the treatment result would endure for their lifetime (8.8 ± 2.1 points), they wanted to avoid visibility of orthodontic brackets (7.9 ± 2.8 points), prevent potential future problems (9.1 ± 1.5 points), and see a simulation of the expected treatment outcome (7.5 ± 2.9 points). The most important limitations with CAT expected by the participants were pain during treatment (7.7 ± 2.7 points) and restricted eating and drinking habits (7.3 ± 2.8 points). Conclusion: Patients considering CAT exhibit high expectations, particularly regarding treatment outcomes, aesthetics, and efficiency and they appear not willing to accept any compromise due to choosing CAT. Clinical relevance: Knowledge about these expectations can support our patient communication and thereby improve patients’ satisfaction with the treatment outcome.

Linda Schwarz, Philipp Mitteröcker, Michael H. Bertl. Korean J Orthod 2026;56:327-34. https://doi.org/10.4041/kjod25.291