Splintless orthognathic surgery: a novel technique using patient-specific implants (PSI)

In the past few years, advances in three-dimensional imaging have conducted to breakthrough in the diagnosis, treatment planning and result assessment in orthognathic surgery. Hereby error-prone and time-consuming planning steps, like model surgery and transfer of the face bow, can be eluded. Numerous positioning devices, in order to transfer the three-dimensional treatment plan to the intraoperative site, have been described. Nevertheless the use of positioning devices and intraoperative splints are failure-prone and time-consuming steps, which have to be performed during the operation and during general anesthesia of the patient. We describe a novel time-sparing and failsafe technique using patient-specific implants (PSI) as positioning guides and concurrently as rigid fixation of the maxilla in the planned position. This technique avoids elaborate positioning and removal of manufactured positioning devices and allows maxillary positioning without the use of occlusal splints.

Choosing a pre-adjusted orthodontic appliance prescription for anterior teeth

A common orthodontic task is to correct anterior tooth position using brackets whose torque, tip and in-out are pre-adjusted. Bracket prescription greatly influences final aesthetics and function. Pre-adjusted orthodontic brackets have in-built prescriptions of torque, tip and in-out which are optimized for average cases. Refinement of tooth position can be achieved by archwire adjustment or archwire auxiliaries. Modifications to bracket position such as inversion can also help achieve individual tooth movements. Planning bracket position must be considered at the outset of treatment to achieve the maximum benefit. A number of clinical scenarios will be discussed including: a Class II division 1 malocclusion with lateral incisors palatally displaced, and another case with absent lateral incisors for space closure. Also, Class III malocclusions with consideration given to: canine angulation; a palatally displaced canine requiring labial movement; absent upper central incisors (space closure), and finally, a Class III case where incisor inclination requires consideration. By using a typodont to illustrate some of the points, this article aims to (1) show how three pre-adjusted orthodontic bracket systems (Andrews, Roth and MBT) vary significantly in their ability to influence tooth position and appearance; (2) inform clinicians how modified bracket position can influence tooth position.

Orthodontic treatment in cherubism: an overview and a case report

INTRODUCTION

Cherubism is a rare hereditary disease that frequently manifests as a painless enlargement of the mandible and/or maxilla. The disease usually progresses rapidly during the first and second decades of life but it is self-limiting and often regresses. Although few orthodontic case reports describing cherubic patients exist, the timing and extent of surgical intervention is controversial.

AIM

This present paper aims to review the treatment literature and provide a case report of a patient who underwent orthodontic/surgical management.

METHODS

The patient presented with severe cherubism in her late teenage years; her main complaint was poor facial and dental appearance. Multiple teeth were missing and those present demonstrated significant preoperative root resorption. Treatment consisted of orthodontic alignment of the upper anterior teeth and a recontouring osteotomy.

RESULTS

Confirmed by the patient, the combination approach led to a significant improvement in facial aesthetics and better self-esteem. Tooth movement through the osseous lesions was uneventful and no further root resoption was observed.

CONCLUSION

Orthodontic treatment may be undertaken in those affected by Cherubism even with pre-existing idiopathic root resorption, but patients need to be appropriately informed and consented.

Absence of multiple premolars and ankylosis of deciduous molar with cant of the occlusal plane treated using skeletal anchorage

Ankylosis and the absence of premolars are two relatively common conditions encountered in the field of orthodontics. However, the absence of multiple premolars, particularly two adjacent premolars, along with ankylosis of deciduous teeth, is unusual. Herein, we present a case report and discuss some aspects related to these abnormalities. A 15-year-old boy was missing the upper right first and second premolars and the lower right and left second premolars. In addition, the deciduous lower left second molar was ankylosed and in infraocclusion, causing canting of the occlusal plane. The patient was treated with a mini-implant to correct the Class II malocclusion on the left side and a miniplate to correct the cant of the occlusal plan. After treatment, the upper right space was kept closed, with the canine in contact with the first molar, and the lower left space was opened to an implant-prosthetic rehabilitation.

Interdisciplinary treatment of a patient with bilateral cleft lip and palate and congenitally missing and transposed teeth

The comprehensive treatment of a patient with cleft lip and palate requires an interdisciplinary approach for functional and esthetic outcomes. A 20-year-old woman with bilateral cleft lip and palate had a chief complaint of unesthetic appearance of her teeth and the presence of oronasal fistulae. Her clinical and radiographic evaluation showed a dolichofacial growth pattern, a Class II skeletal relationship with retroclined maxillary central incisors, 5 mm of negative overjet, maxillary constriction, maxillary and mandibular crowding, congenitally missing maxillary right incisors and left lateral incisor, and a transposed maxillary left canine. Her treatment plan included the extraction of 3 premolars, maxillary expansion, segmental maxillary osteotomy, repair of the oronasal fistulae, rhinoplasty, periodontal surgery, and prosthodontic rehabilitation. To obtain a better occlusion and reduce the dimensions of the fistulae, orthognathic surgery comprising linear and rotational movements of the maxillary segments (premaxilla, right and left maxillary alveolar segments) in all 3 axes was planned by performing 3-dimensional virtual surgery on 3-dimensional computerized tomography. At the end of the interdisciplinary treatment, a functional occlusion, a harmonious profile, and patient satisfaction were achieved. Posttreatment records after 1 year showed stable results.

Preprosthetic interceptive orthodontics for missing lateral incisors in late mixed dentition

BACKGROUND

Different treatment alternatives are possible in the preprosthetic orthodontic management of missing of lateral incisors. We describe an efficient approach in a 12.11-year-old girl with incisors agenesis.

CASE REPORT

Treatment started with repositioning of the permanent canines in site 2 and the deciduous canines in site 3. After growth completion the deciduous canines will be extracted and replaced by dental implants. Permanent canines will then undergo reshaping in order to look like lateral incisors. The molar and cuspid relationships were finalised in Class I, with correct overjet and overbite. The mandibular and maxillary arch forms were acceptable without crowding and rotations. Opening the space offers different solutions for maintaining the alveolar bone for a future implant, with the advantage of a molar Class I relationship and a wider arch. It would also be possible to achieve distalisation of the permanent canine, following the Kokich's principle of alveolar development.

CONCLUSION

The described treatment is a valid alternative in the management of missing lateral incisors. This solution can avoid an additional orthodontic treatment in adulthood and allow easy management of the retention phase prior to final rehabilitation with single tooth implants

Solitary median maxillary central incisor syndrome associated with unique cleft palate: a rare case report

Solitary median maxillary central incisor (SMMCI) syndrome is a rare dental anomaly that affects 1:50,000 live births. SMMCI syndrome is characterized by the presence of a single central incisor located on the maxillary midline in both primary and permanent dentitions. It may occur as an isolated finding or in association with developmental defects and systemic involvement. Congenital anomalies associated with SMMCI syndrome can include short stature, mild forms of deviation in craniofacial morphology, mild to severe intellectual disability, congenital heart disease, and cleft lip and/or palate. This report describes a clinical case of a 7-year-old girl with SMMCI syndrome--in addition to bilateral residual cleft and associated nasal regurgitation--that was treated with a removable maxillary obturator.

A camouflage treatment of Class II division 1 malocclusion complicated by missing lateral incisor

This case report describes the treatment of a male patient, aged 16 years and 5 months, with a Class II division 1 malocclusion, who showed severe anterior protrusion and lower anterior crowding along with missing upper left lateral incisor. Treatment plan consisted of extraction of upper right first premolar and lower second premolars. No extraction was performed on the upper left quadrant instead canine was substituted as lateral incisor and premolar as canine to establish a good occlusion. Power arms were used for intrusion and retraction of the anterior teeth. After active treatment period of 21 months, the appliances were removed after establishing ideal overjet, overbite and other occlusal relationships.

Bilateral missing lower permanent incisors: a case report

AIM

This case report describes the treatment of a patient of African descent with bilateral congenitally missing mandibular incisors and a 10 mm overjet.

METHODS

The article discusses the incidence of tooth agenesis and the different approaches to treating patients with bilateral congenitally missing lower incisors. The current treatment involved lower canine substitution for the lower lateral incisors and upper premolar extractions because of malformation. Temporary micro-implants were placed to augment anchorage and to resolve the excessive overjet by the retraction of the upper anterior teeth while preserving a Class I molar relationship.

RESULTS

The Bolton disharmony created by the incisor agenesis and the extraction pattern proved to be a challenge and although an acceptable result was achieved, it was expectedly less than ideal.

Orthodontic treatment of unilateral cleft lip and alveolus patient with maxillary lateral incisor missing: case report

The esthetics of a patient with a cleft lip and alveolus and missing maxillary lateral incisor is important. A girl, aged 9 years 3 months with repaired left unilateral cleft of primary palate only was referred for orthodontic evaluation of her anterior tooth-crowding. She was unhappy with the unattractive appearance of her maxillary anterior teeth, which were behind her mandibular anterior teeth. Alveolar bone grafting along with canine substitution to replace her missing lateral incisor were recommended for this patient. The post-treatment results were excellent with good occlusion, acceptable profile, and remained stable one year after conclusion of active treatment.

Implants in children with hypohidrotic ectodermal dysplasia: an alternative approach to esthetic management: case report and review of the literature

Ectodermal dysplasia (ED) is a rare congenital disease that affects several ectodermal structures. Children with ED may have various manifestations of the disease that differ in severity. In addition to its other symptoms, ED causes anadontia and hypodontia of the primary or permanent teeth, impacted teeth, malformed and widely spaced peg-shaped teeth, and underdeveloped alveolar ridges. Since the oral rehabilitation of these cases is often difficult, particularly in pediatric patients, treatment should be provided by a multidisciplinary team. Dental implants are the treatment of choice when growth has stabilized, and implants can be used to support, retain, and stabilize the prosthesis. The purpose of this paper was to present a case report of implant placement in a 7-year-old girl with hypohidrotic ectodermal dysplasia and review the current literature to discuss the use of dental implants in such patients.

Movement of an upper central incisor across the midline in a patient with cleft of primary palate

Orthodontic treatment for a 10-years-old girl, with repaired bilateral cleft lip and left incomplete unilateral alveolar cleft, was performed by moving her right maxillary central incisor across the midline to replace her congenital missing central incisor and then moving the right lateral incisor toward the midline to act as a new central incisor. A malformed supernumerary tooth, positioned between the right central and lateral incisor, was extracted during incisor movement. Significant lip profile improvement was accomplished by maxillary and mandibular anterior teeth retraction into three-premolar extraction spaces. Not only natural functional occlusion, deviated midpalatal suture along the central incisor, and no obvious root resorption were obtained but also narrowing the alveolar bone cleft which was beneficial for bone continuity supporting dental structures, satisfactory results were possible for the patient with primary palate cleft.

Autogenous tooth transplants for the pediatric dental patient: report of three cases

There are select instances where autogenous tooth transplantation should be considered as part of the overall management of the developing occlusion in the child patient. These circumstances occur when there are missing mandibular premolars in Class II malocclusions with good faces, unevenly distributed agenesis, missing or lost incisors, and ectopic teeth. The purposes of this paper were to educate pediatric dentists about the autogenous tooth transplantation technique, its success, its potential advantages and disadvantages and to report on three cases treated with autogenesis tooth transplantation.

Space management: a technique for esthetic, conservative treatment of congenitally missing teeth

The successful treatment of congenitally missing teeth (CMT) a common dental anomaly that affects third molars and lateral incisors requires addressing multiple challenges that frequently accompany the missing teeth. The biggest concern among patients presenting with CMT usually is esthetics. In this case report, an interdisciplinary diagnostic approach is described for conservatively managing the anatomic and esthetic challenges of a 32 year old woman with this condition, whose main objective was to gain an appealing smile without compromising intact teeth. By utilizing space management techniques, a successful esthetic outcome was achieved without increasing the patient's risk profile.

Iatrogenic absence of maxillary canines: Bolton discrepancy treated with mandibular incisor extraction

This case report describes the orthodontic treatment of an adult patient with iatrogenic absence of the maxillary canines, moderate maxillary and severe mandibular dental crowding, a Bolton discrepancy with a large mandibular anterior excess, a maxillary right lateral incisor crossbite, and Angle Class II molar relationships. The treatment consisted of fixed appliance therapy, mandibular incisor extraction, tooth bleaching, and dental recontouring. This method of treatment maintained the patient's good facial appearance, improved the dental esthetics, and provided a good functional occlusion, eliminating the arch length and Bolton discrepancies and providing a good outcome with minimal undesirable effects.

[Prevalence of hypodontia at the department of pedodontics and orthodontics of Semmelweis University]

Examination of hypodontia as one of the most frequent developmental disorder receives high importance in the national as well as in the international literature. As the disorder can affect the dental and mental development of the children therefore early diagnosis and treatment are necessary. The authors analyzed the OP radiograms of patients aged 6 to 18 who were registered between 2006 and 2011 at the Department of Pedodontics and Orthodontics of Semmelweis University, excluding children suffering from general diseases or other syndromes. The aim of the examination was to determine the occurrence of missing teeth germ cases in the registered database of the Department, diagnose the prevalence of aplasia and compare the results with the national and international literature. Out of the 900 patients (372 boys and 528 girls) included in the examination missing germs were diagnosed in 94 cases (10,44%). In most cases the germ of the lower second premolars was missing (34,64%), then came the upper lateral incisors (27,38%) and the aplasia of the upper second premolars (21,23%). There was no relevant difference between the two sides. The number of affected girls was higher by 25% than the number of boys. Most of the results are close to the result in international literature.