Orthodontics and its interactions with other dental disciplines

Preservation or alteration of the natural dentition to an optimal state of health, function, comfort, and esthetics remains the primary goal of dentistry. However, referral of patients by general dentists to orthodontic specialists may be complex as it involves the interaction of the two dental professionals and the patient. Because there is a marked variation in referral rates between the dentists and many patients may be referred inappropriately, a clear understanding of what is known about current orthodontic treatment possibilities, limitations and inherent risks is necessary. The purpose of this article is to outline the existing orthodontic therapeutic possibilities for adjunctive dental work and to emphasize the importance of teamwork among the general dentist, the orthodontic specialist and possibly other dental specialists during treatment planning.

Replacement of hopeless retained primary teeth by immediate dental implants: a case report

Hopeless retained primary teeth without permanent successors represent a restorative challenge for clinicians, along with esthetic and functional problems for patients. While various treatment approaches for congenitally missing teeth have been proposed, the replacement of a missing tooth with a dental implant offers specific advantages, such as preservation of the alveolar crest and elimination of the need to restore the adjacent teeth, over other options for tooth replacement. The aim of this article was to illustrate the surgical and prosthetic treatment with implants of a patient with primary teeth without permanent successors.

X-linked hypohidrotic ectodermal dysplasia: a ten-year case report and clinical considerations

BACKGROUND

Ectodermal Dysplasias (EDs) are a large group of syndromes that are heterogeneous under clinical and genetic aspects, and are characterised by anomalies in the structures of ectodermal origin. In EDs dental anomalies in shape and number (oligo-hypodontia) occur frequently and severely and can affect both the primary and permanent dentition.

CASE REPORT

The oral habilitation of a child affected by X-linked Hypohidrotic-Ectodermal Dyspasia with oligodontia over a period of ten years is described. This report includes discussion of the aetiology of EDs as well as discussion of the long-term prognosis for the patient.

CONCLUSION

The success of treatment in the case reported is based on an early diagnosis and a correct timing of interventions addressing the preservation of the existing dental elements, early functional rehabilitation and aesthetic correction.

Updated implant-retained restorative solutions in patients with hypodontia

Hypodontia is often found during orthodontic screening and occurs with a prevalence of between 5% and 10%. One or more congenitally missing permanent teeth is a clinical finding that affects both male and female patients. Although maintaining deciduous teeth is an option in a few cases, the majority of patients with agenesis of teeth require extraction and orthodontic space closure or restorative treatment. Depending on the number and location of missing teeth, implant-supported fixed single-tooth restorations provide excellent long-term results. Choosing appropriate treatment techniques and materials will result in long-term clinical function, stability, and esthetic success.

Replacement of congenitally missing lateral incisors with implant crowns

Esthetic adolescent dental treatment has become a staple of the restorative office. The combined interdisciplinary efforts of the orthodontist, oral surgeon, and restorative dentist were necessary to achieve an esthetic and functionally successful result. Implant placement and restoration is a preferred solution for the replacement of missing teeth in any age group but is particularly beneficial for younger patients.

Orthodontic and nonorthodontic root resorption: their impact on clinical dental practice

Occasionally, general dentists are challenged with providing restorative treatment for a postorthodontic patient who has had moderate to severe root resorption. When this happens, a number of questions about the cause of such resorption and the appropriate treatment arise in the dentist's mind. This article will describe the orthodontic and restorative management of three patients with severe maxillary incisor root resorption, provide a thorough discussion of the currently available literature on the topic of root resorption, and answer clinical questions regarding this relatively infrequent but devastating sequel to orthodontic treatment.

Defining new paradigms for assessment of implant receptor sites. The use of CT/CBCT and interactive virtual treatment planning for congenitally missing lateral incisors

An emerging technology that encompasses computed tomography, cone-beam computed tomography, and interactive software applications has slowly progressed and evolved into a necessary tool for diagnosis, treatment planning, and delivery of dental implant and associated restorative and surgical procedures. The integration of these innovative tools is helping to define new methods for appreciating anatomy, improving accuracy, and enhancing presurgical prosthetic planning to achieve true restorative-driven implant dentistry. This article will demonstrate how computed tomography combined with interactive virtual treatment-planning software applications can empower clinicians with enhanced diagnostic capabilities for implant receptor-site assessment, generating new paradigms that eventually may supersede older methods of presurgical planning for dental implant reconstruction.

Optimizing esthetics and function through interdisciplinary dentistry

Esthetic dentistry has evolved dramatically over the years to the point of becoming an expectation from most patients. It is not a fad but is becoming a standard of care for the majority of dental treatment. By learning to practice good quality interdisciplinary dentistry, it is possible to turn a general practice into a comprehensive care practice that caters to high-quality esthetics and function. This article discusses incorporating interdisciplinary dentistry into the general practice and offers some clinical examples.

Hybrid type anterior fibre-reinforced composite resin prosthesis: a case report

A variety of therapeutic modalities, from implant to conventional Maryland prosthesis, can be used for the replacement of a missing anterior tooth. In patients refusing implant treatment, when minimal teeth reduction is preferred, a fibre reinforced composite (FRC) prosthesis can be a good alternative to conventional prosthetic techniques. The purpose of this case report is to describe the clinical procedure for fabricating hybrid type FRC prosthesis with pre-impregnated unidirectional E-glass fibres. Fibre-reinforced composite, in combination with adhesive technology, appears promising treatment option for replacing missing teeth. However, further clinical investigation will be required to provide additional information on this technique.

Management of over-retained mandibular deciduous second molars with and without permanent successors

The objective of this article is to describe the various clinical situations of prolonged retention of mandibular deciduous second molars. Indications for orthodontic space closure in the absence of permanent successors and treatment alternatives in space opening, including retaining the deciduous molars, are described. Periodic monitoring, composite buildups, and indications and timing of extraction of infraoccluded and ankylosed deciduous molars with and without permanent successors are reviewed.

Interdisciplinary management of a patient with skeletal anteroposterior discrepancy, impacted canine, and missing teeth

For patients with complex dentofacial problems, orthodontic treatment is often not enough to obtain optimal esthetic and functional results. This case report demonstrates the treatment of a patient with skeletal anteroposterior discrepancy through an interdisciplinary approach and emphasizes the importance of collaboration with other dental disciplines to achieve the desired esthetic results.

Mini-implant anchorage for a skeletal class II malocclusion with missing mandibular incisors: a case report

This case report describes the treatment of an adult female with a severe Class II malocclusion and congenitally missing mandibular incisors. It was decided to extract the maxillary first premolars and use mini-implants for en masse retraction of the maxillary anterior teeth. More than 13 mm of maxillary incisor retraction was obtained, with little change in the mandibular incisor inclination. The patient's facial esthetics showed dramatic improvement. The upper and lower lips were retracted by 6 mm and 7 mm, respectively. This helped reduce the mentalis strain and improve chin projection. In the mandibular arch, the canines were reshaped to substitute for lateral incisors and the first premolars were used as canines. After 25 months of retention, the results have been maintained. In this report, mini-implants proved to be an effective alternative to orthognathic surgery.

Clinical management of the congenitally missing maxillary lateral incisor and mandibular second premolar: a clinical perspective

The decision to close maintain, or open space at the agenesis sites of the maxillary lateral incisor and mandibular second premolar is generally based on several factors, including the class of malocclusion, skeletal pattern (divergence), esthetics, function, and periodontics. Replacement of congenitally missing maxillary lateral incisors, the second most commonly missing teeth, can involve (1) canine replacement, (2) tooth-supported restoration, and (3) implants. This paper contrary to the opinion of other authors, favors replacement of the congenitally missing lateral incisors in one of several ways, versus orthodontic space closure.

Using digital photography to visualize, plan, and prepare a complex porcelain veneer case

Visualization and pre-operative plan are critical to efficient and thorough case preparation. Congenitally missing teeth, coupled with improper tooth positioning, can compromise the aesthetic rehabilitation outcome. Utilizing pre-treatment digital photography as an outline for tooth reduction and laser tissue re-contouring may help to create a symmetric and pleasing smile, even under less ideal conditions.

The management of developmentally absent maxillary lateral incisors – a survey of orthodontists in the UK

OBJECTIVE

To investigate the orthodontic management of patients with developmentally absent maxillary lateral incisors.

MATERIALS AND METHODS

A questionnaire was mailed to all orthodontists on the specialist list held by the British Orthodontic Society.

RESULTS

The questionnaires (57.3% response) were analysed in two groups: Group 1 consisted of orthodontists who worked only in an orthodontic practice environment; Group 2 consisted of orthodontists who worked full-time or part-time in an environment where there were restorative dentists available for advice. Group 1 orthodontists were significantly more likely to recommend (p = 0.006) space closure in the management of developmentally absent maxillary lateral incisors. Group 2 orthodontists were significantly more likely to recommend (p = 0.004) minimal preparation bridges. Group 2 orthodontists also saw significantly more patients with hypodontia (p <or=0.001) and were significantly more likely to routinely obtain a restorative dentistry opinion before orthodontic treatment commenced (p = 0.001). Group 1 orthodontists were significantly more likely to assess the space required for implants by measurement between the crowns of adjacent teeth (p = 0.001). Group 2 orthodontists were significantly more likely to assess the space by use of intraoral radiographs (p = 0.019) or by measurement between teeth at the gingival margin (p = 0.029).

CONCLUSIONS

The management of developmentally absent maxillary lateral incisors by orthodontists in the UK appeared to be influenced by their practice environment, their experience and the availability of restorative dentistry advice. The influence of these factors was greater for the treatment options of space closure or replacement via resin-retained bridges but less so for implant treatment. This reinforces the need for multidisciplinary involvement.

Kenny-Caffey Syndrome: oral findings and 4-year follow-up of overlay denture therapy

Kenny-Caffey Syndrome (KCS) is an extremely rare osteosclerotic bone dysplasia associated with hypocalcemia and ocular abnormalities. Although the condition is well reported in the medical literature, dental manifestations have not been discussed in great detail. The purpose of this report is to present specific oral features and prosthetic management in a KCS patient. Overlay dentures were utilized in the management of low vertical dimension of occlusion, congenital absence of several permanent teeth, and problems associated with function and esthetics. Results of the 4-year follow-up overlay denture therapy are presented.

Orthodontic Treatment of a Patient with Stickler Syndrome

Stickler syndrome (MIM 108300, 604841, 184840) is an autosomal dominant disease characterized by midfacial flattening and variable disorders of vision, hearing and articulation. There are three types of the syndrome caused by mutations in different genes (type 1, COL2A1; type 2, COL11A1; and type 3, COL11A2). About 20% of type 1 patients have cleft palate or bifid uvula, but there have been no case reports of orthodontic treatment of this syndrome so far. The Japanese female patient presented here with Stickler syndrome was characterized by a flat midface and had high myopia, sensorineural hearing loss, enlarged joints, and cleft of the soft palate. She had fairly small SNA and SNB angles and a steep mandibular plane with an enlarged gonial angle. The incisors of both arches were retroclined, and a large overjet and overbite were noted. Orthodontic treatment was initiated at 11 years of age using a lingual arch appliance followed by an edgewise multibracket appliance. Stable functional occlusion was obtained after the treatment. Most of the other seven Stickler syndrome patients exhibited pretreatment characteristics of small SNA and SNB angles, steep mandibular planes, enlarged gonial angles, and retroclined incisors of both arches, demonstrating the characteristic skeletal and occlusal features of this syndrome.

Esthetic and Functional Rehabilitation of a Patient with Nonsyndromic Oligodontia: A Case Report from China

STATEMENT OF THE PROBLEM

Oligodontia (severe partial anodontia) is a developmental dental anomaly. It is either an isolated trait or part of a syndrome. Oligodontia is characterized by the congenital absence of more than six permanent teeth except the third molars. Treatment often calls for facilitated surgical techniques, but less severe cases can be treated conventionally in a normally equipped dental office.

CASE PRESENTATION

A case of oligodontia treated with prosthetic rehabilitation is presented in this article to remind clinicians of the anomaly. A medical history was taken and clinical and radiographic examinations were made. It is emphasized that conventional prosthetic treatment can lead to a satisfactory result. The patient was treated with fully extending denture prostheses. An overdenture was designed in the maxillary arch, while a removable partial denture was made in the mandibular arch.

RESULTS

The patient's speech and masticatory function improved greatly. He was also pleased with better facial esthetics. Observed temporomandibular joint dysfunction also ameliorated after the treatment.

CONCLUSION

Dental clinicians should keep in mind that there are good possibilities with conventional prosthodontic techniques to help patients with dental anomalies. Treatment not only improves speech and masticatory function but also has psychological implications that may greatly help in regaining self-confidence. CLINICAL SIGNIFICANCE Patients suffering from oligodontia may have severe psychological, esthetic, and functional problems. Thus, early diagnosis and treatment of these patients are necessary.