Class I malocclusion treatment: influence of a missing mandibular incisor on anterior guidance

Z-plasty surgery combined with orthodontic-prosthodontic approach in the rehabilitation of aberrant frenum with congenitally multiple agenesis: A case report

INTRODUCTION

Orthodontists often encounter a clinical challenge while dealing with a big space of anterior teeth. Aberrant frenum with congenitally multiple agenesis is a complex case that requires an interdisciplinary approach. The purpose of this paper is to describe the well-synchronized periodontal surgery, orthodontic, and prosthodontic treatment of an aberrant frenum cases with congenitally multiple agenesis.

CASE PRESENTATION

A female patient, aged 20, presented with complaints of misaligned, spaced teeth, and several missing teeth. A Class III malocclusion type 1 with a high and hypertrophied maxillary labial frenum was found and diagnosed. A positive blanch test, diastemata, as well as persistent teeth 53, 71, and 81, were detected. Panoramic radiographs confirmed the teeth's agenesis. Orthodontic treatment was performed using the straightwire technique to close the spaces. The frenulum was corrected by a frenectomy utilizing the Z-plasty surgical procedure. Subsequently, prosthodontic treatment involved the fabrication of lucitone dentures to close the remaining space.

DISCUSSION

This case alerted periodontists, orthodontists, and prosthodontists that collaboration is essential to intervene in such specific congenital anomalies. An interdisciplinary effort should focus on eliminating the etiology of malocclusion, considering periodontal factors, maintaining dental arch integrity, addressing biomechanical elements, designing appropriate prostheses, ensuring better retention of tooth position, and achieving aesthetic appearance.

CONCLUSION

The Z-plasty frenectomy surgery treatment resulted in successful and rapid healing after the operation, with no occurrence of hypertrophic scar formation. The final outcome of orthodontic-prosthodontic treatment was also pleasing for both the patient's aesthetic and functional requirements and the operator's satisfaction.

Clinical Management of Hypodontia of Two Mandibular Incisors

This article presents the clinical management of a patient with bilateral congenitally missing mandibular incisors. This condition is relatively rare and always needs a careful diagnosis and treatment planning. The chosen treatment strategy for this patient included space closure by protraction of the mandibular posterior teeth and canine substitution of missing incisors. Furthermore, the problems arising from this treatment plan, such as premolar-protected occlusion and tooth size discrepancy, are discussed. From the case presented in this study, we can conclude that space closure may be considered an efficient treatment approach for achieving satisfactory functional and aesthetic results.

Dissipating tooth-mass discrepancy caused by a set of mandibular incisor anomalies

Dental anomalies are complicating factors of orthodontic treatment, especially when 1 or more anterior teeth are affected. In this case report, a girl, aged 12.5 years with a retrognathic chin; number, size, and position anomalies of the mandibular incisors; and bilateral Class I molar relationship sought orthodontic treatment. Tooth-size ratio discrepancy was dissipated without extraction or prosthetic rehabilitation, and the initial molar relationship was maintained, as well as the straight soft tissue profile. Tipping of maxillary and mandibular incisors, crown torque of canines, restoration of anomalous incisor, and maxillary interproximal enamel reduction were key points for successful treatment. After 18 months, the orthodontic records showed stable results, excellent static and functional occlusion, and good smile esthetics and facial appearance, in addition to a high degree of patient satisfaction with the achieved results.

Solutions for atypical problems in the incisors area: a transdisciplinary challenge

Introduction:

A significant increase in the number of adults in search of orthodontic treatment has raised a new challenge for orthodontists: the need to interact with other specialties to achieve excellent results, particularly when dealing with smile aesthetics and facial balance. Several factors should be considered to respond to their demand: adequate tooth leveling and alignment, individual tooth proportions between adjacent teeth and their contralateral teeth, shape and natural appearance of each tooth and gingival architecture, which should all be in agreement with facial harmony. Maxillary or mandibular incisors congenitally missing or lost due to caries or trauma and tooth-size discrepancies (Bolton) are some of the important aesthetic challenges for an integrated orthodontic treatment.

Objectives:

This study describes cases that illustrate the clinical challenges of treating the anterior area, as well as the multidisciplinary strategies required for their resolution.

Conclusion:

The increasingly frequent multidisciplinary orthodontic treatments of complex cases seem to effectively maximize aesthetic and functional results using a combination of procedures conducted by specialists in related areas, such as Surgery, Prosthetics, Implantology, Restorative Dentistry and Periodontics.

Management of an adult patient with missing one mandibular incisor, severe overjet, and midline discrepancy with asymmetric extraction, lingual appliance, and skeletal anchorage: A case report

This case report describes the lingual orthodontic treatment of an adult patient with Angle Class I malocclusion, agenesis of mandibular right central incisor, severe overjet and deep overbite, excessive proclination of maxillary and mandibular incisors, and midline discrepancy. Because of unique presentation, symmetric extraction could not be performed in the lower arch of this 34-year-old patient. She was treated with three premolar extractions and absolute anchorage with temporary anchorage devices for maximum retraction of upper anterior teeth. To correct the midline deviation and Bolton tooth-size discrepancy, the mandibular right lateral incisor, canine, and premolars were reshaped to reduce the mesiodistal width. The treatment approach greatly improved the patient's facial and dental appearance and provided a stable occlusion.

A patient with mandibular deviation and 3 mandibular incisors treated with asymmetrically bent improved superelastic nickel-titanium alloy wires

Skeletal and dental discrepancies cause asymmetric malocclusions in orthodontic patients. It is difficult to achieve adequate functional occlusion and guidance in patients with congenital absence of a mandibular incisor due to the tooth-size discrepancy. Here, we describe the orthodontic treatment of a 22-year-old woman with an asymmetric Angle Class II malocclusion, mandibular deviation to the left, and 3 mandibular incisors. The anterior teeth and maxillary canines were crowded. We used an improved superelastic nickel-titanium alloy wire (Tomy International, Tokyo, Japan) to compensate for the asymmetric mandibular arch and an asymmetrically bent archwire to move the maxillary molars distally. A skeletal anchorage system provided traction for intermaxillary elastics, and extractions were not needed. We alleviated the crowding and created an ideal occlusion with proper overjet, overbite, and anterior guidance with Class I canine and molar relationships. This method of treatment with an asymmetrically bent nickel-titanium alloy wire provided proper Class I occlusion and anterior guidance despite the mandibular deviation to the left and 3 mandibular incisors, without the need for extractions.

Use of Forsus fatigue-resistant device in a patient with Class I malocclusion and mandibular incisor agenesis

Orthodontic treatment in patients with congenitally missing teeth can be challenging. In this case report, we describe the treatment of a 15-year-old girl with mild dental crowding and 2 congenitally missing mandibular incisors. The Forsus fatigue-resistant device was used to move the mandible and the mandibular teeth forward. A new balanced and stable occlusion was achieved after treatment. When the treatment plan includes moving the mandibular teeth forward in a patient with mandibular incisor agenesis, the profile and the skeletal and dental features should be carefully scrutinized to ensure that balanced and esthetic results are achieved.

Mandibular incisor extraction: a systematic review of an uncommon extraction choice in orthodontic treatment

OBJECTIVES

To review the published literature in order to address clinical questions regarding the indications, effects and outcomes of mandibular incisor extraction in orthodontics.

DATA SOURCES

Three electronic databases were searched: PubMed (1950-January 2011), Ovid Embase+Ovid Embase Classic (1947-January 2011) and Cochrane library (6 Cochrane databases, 1996-January 2011). The following journals were additionally searched: American Journal of Orthodontics and Dentofacial Orthopedics (1960-January 2011), Angle Orthodontist (1960-January 2011), European Journal of Orthodontics (1970-January 2011) and Journal of Orthodontics (1974-January 2011). Grey literature was searched using Google Scholar and System for Information on Grey Literature in Europe. Secondary search of the references cited in the relevant articles was also conducted.

DATA SELECTION

Articles in vivo, in Humans, in English, concerning treatment of malocclusion with mandibular incisor extractions or missing mandibular incisors. Fifty-four publications met these inclusion criteria and were reviewed.

DATA EXTRACTION

Data were extracted independently by two reviewers with regard to: (1) indications; (2) contraindications; (3) effects; (4) outcomes; and (5) factors associated with successful outcomes.

DATA SYNTHESIS

Considering the descriptive nature of the studies found, a narrative synthesis was undertaken.

CONCLUSIONS

The descriptive nature of published articles precludes making strong evidence-based recommendations regarding this extraction choice, but it is clear that mandibular incisor extraction can be effectively used in the resolution of crowding, as well as intermaxillary malocclusion in carefully selected cases. Several factors that could lead to good outcomes of orthodontic treatment following mandibular incisor extraction were identified. Mild-to-moderate class III malocclusion, an edge-to-edge anterior occlusion or anterior crossbite, with mild anterior mandibular tooth size excess, and minimal open bite tendencies were the clinical situations most frequently treated with this unique extraction choice. On the other hand, clinicians should be careful to avoid poor outcomes such as gingival recession, open interproximal gingival embrasures, increased overjet and overbite.