Non-routine extractions in orthodontic treatment

A four-unit symmetrical premolar extraction case demands meticulous levelling, overjet reduction, space closure, rotating, paralleling and torqueing to justify the gambit of having extracted the teeth at the commencement of treatment. This involves the patient in complex therapy which may, for any of several reasons, be contra-indicated for that particular patient, though a decision based on the plaster casts alone may have upheld such an approach. The purpose of this article is to discourage automatic decisions to extract first premolars in orthodontic extraction cases. The clinician is offered a classification of special cases in which an alternative should be sought, based on careful consideration of the general dental, facial, physical, psychological and economic state of the patient.

[Contribution to familial ectodermal dysplasia]

The frequent occurrence of the clinical picture of ectodermal dysplasia in the family P. is described. The differences between subjects in symptomatology are discussed in detail. The author's experience speaks well for a great variability of the hereditary mode of this disease. Furthermore, advice is given on the detection and regular ambulatory supervision by the stomatologist.

Indications for autotransplantation in cases of missing premolars

The postoperative behavior of premolars transplanted before completion of root formation and the long-term prognosis for such teeth have recently been studied. After postoperative observation periods ranging between 3 years 4 months and 13 years 9 months, all of the thirty-four teeth in question were found to still be in place. Root formation had continued, supporting tissues had developed, and the teeth had erupted. In most instances they had functioned normally without giving rise to problems of any kind. Their status during the re-examination implied that most of them would function normally for many years to come, perhaps for a lifetime. Autotransplantation of missing premolars in many cases is the only alternative to prosthetic substitution, and it is our method of preference. However, substitution by autotransplantation cannot be applied unless a suitable transplant is available. Any premolar destined to be extracted for orthodontic reasons is a possible transplant. In young patients it is also a suitable one. In orthodontic extraction cases, therefore, suitable transplants are usually available. In nonextraction cases, none is available unless teeth in other dental arch quadrants are "sacrificed." In the present report six cases are presented as examples of solutions to the problem of missing premolars by autotransplantation. The main combinations of missing teeth and types of malocclusion in which premolars extracted for orthodontic reasons can advantageously be used as substitutes for other premolars are defined. Also, the justification for "sacrificing" a premolar in one quadrant to the advantage of another quadrant is discussed.

[Prosthetic measures in the mixed dentition]

Prosthetic measures in the mixed dentition must allow for the actualities of this developmental phase. Traumatic or developmental injuries to enamel and dentine, accidental tooth loss and hypodontia or oligodontia are indications for prosthetic treatment in school children, at which orthodontic aspects should always be considered. The prosthetic approach is characterized by the respect to preventive aspects related to the further biomorphosis of the dentition. With reference to the different phases of mixed dentition, methodical suggestions are given in the form of tables.

Management of cases with upper incisors missing

A problem often confronting the orthodontist is that of missing upper incisors. In evaluation of the individual case, the dicision as to space closure or space regaining and eventual prosthetic reconstruction can be perplexing. Various diagnostic criteria, such as skeletal relation, arch-length analysis, inclination of teeth, and dental esthetics, must be evaluated. On the basis of this diagnostic information, treatment alternative is chosen to correct the malocclusion. The solution may be found in maintaining space, necessitating postorthodontic prosthetic replacement, or closing space and thus avoiding the need for artificial teeth. Four cases are shown to illustrate different approaches to the treatment of patients with upper incisors missing. Other solutions are possible anc correct. Each case must be weighed on its own merits.