Spontaneous space closure in patients treated with early extraction of the first permanent molar: a retrospective cohort study using radiographs

OBJECTIVES

To assess the success rate of spontaneous space closure after extraction of the first permanent molar (FPM) in the maxilla and the mandible, and to identify the factors that make spontaneous space closure most favorable in each.

MATERIALS AND METHODS

A retrospective records-based cohort study was conducted through a search of the database of the Public Dental Service, Stockholm County Council, Stockholm, for young adults born between 2000 and 2001, who underwent extraction of one or more FPM between 2006 and 2016. A total of 995 extracted teeth were identified, of which 203 teeth in 155 patients met the inclusion criteria.

RESULTS

Of the 203 extracted teeth, 166 (81.8%) did not receive any orthodontic treatment. The success rate for space closure in orthodontically treated patients was 91.9%. The success rate for spontaneous space closure was 84.3%. All unsuccessful spontaneous space closure in the maxilla occurred in patients older than 12 years. The dental developmental stage of the second permanent molar (SPM) had a statistically significant association with spontaneous space closure in the mandible (P < .001).

CONCLUSIONS

The success rate of spontaneous space closure was high (84.3%) and was higher in the maxilla (94.1%) than the mandible (74.1%). Age at time of extraction and dental developmental stage of the SPM were significant factors for successful spontaneous space closure in the maxilla and mandible, respectively.

The effect of micro-osteoperforations on the rate of maxillary incisors' retraction in orthodontic space closure: a randomized controlled clinical trial

BACKGROUND

This single-centered randomized controlled clinical trial aimed to evaluate the effectiveness of micro-osteoperforations (MOPs) in accelerating the orthodontic retraction of maxillary incisors.

METHODS

Forty-two patients aged 16-40 were recruited and randomly assigned into two groups, one which underwent MOPs (MOPG) in the buccal and palatal region of all maxillary incisors immediately before the start of retraction and one which did not (CG). Eligibility criteria included the orthodontic need for maxillary first premolars extraction and space closure in two phases. The primary outcome of the study consisted of measuring the rate of space closure and, consequently, the rate of incisors' retraction using digital model superimposition 14 days later and monthly thereafter for the next 4 months. The secondary outcomes included measuring anchorage loss, central incisors' inclination, and root length shortening, analyzed using cone beam computed tomography scans acquired before retraction and 4 months after retraction. Randomization was performed using QuickCalcs software. While clinical blinding was not possible, the image's examinator was blinded.

RESULTS

Twenty-one patients were randomly assigned to each group. However, due to various reasons, a total of 37 patients (17 male and 20 female) were analyzed (mean age: 24.3 ± 8.1 years in the MOPG; 22.2 ± 4.2 years in the CG) during the trial. No statistically significant difference was found between the MOPG and the CG regarding the incisors' retraction measured at different time points at the incisal border (14 days, 0.4 mm vs. 0.5 mm; 1 month, 0.79 mm vs. 0.77 mm; 2 months, 1.47 mm vs. 1.41 mm; 3 months, 2.09 mm vs. 1.88 mm; 4 months, 2.62 mm vs. 2.29 mm) and at the cervical level (14 days, 0.28 mm vs. 0.30 mm; 1 month, 0.41 mm vs. 0.32 mm; 2 months, 0.89 mm vs. 0.61 mm; 3 months, 1.36 mm vs. 1.10 mm; 4 months, 1.73 mm vs. 1.39 mm). Similarly, no statistically significant differences were detected in the space closure, anchorage loss, central incisors' inclination, and radicular length between groups. No adverse effect was observed during the trial.

CONCLUSIONS

MOPs did not accelerate the retraction of the maxillary incisors, nor were they associated with greater incisor inclination or root resorption. Trial registration ClinicalTrials.gov NCT03089996. Registered 24 March 2017- https://clinicaltrials.gov/ct2/show/NCT03089996 .

Effect of premolar extraction and anchorage type for orthodontic space closure on upper airway dimensions and position of hyoid bone in adults: a retrospective cephalometric assessment

Background

This study aimed to assess the effect of premolar extraction and anchorage type for orthodontic space closure on upper airway dimensions and position of hyoid bone in adults by cephalometric assessment.

Methods

This retrospective study was conducted on 142 cephalograms of patients who underwent orthodontic treatment with premolar extraction in four groups of (I) 40 class I patients with bimaxillary protrusion and maximum anchorage, (II) 40 class I patients with moderate crowding and anchorage, (III) 40 class II patients with maximum anchorage, and (IV) 22 skeletal class III patients with maximum anchorage. The dimensions of the nasopharynx, velopharynx, oropharynx, and hypopharynx, and hyoid bone position were assessed on pre- and postoperative lateral cephalograms using AudaxCeph v6.1.4.3951 software. Data were analyzed by the Chi-square test, paired t-test, and Pearson's correlation test (alpha = 0.05).

Results

A significant reduction in oropharyngeal, velopharyngeal, and hypopharyngeal airway dimensions was noted in groups I, III, and IV (P < 0.001), which was correlated with the magnitude of retraction of upper and lower incisors (r = 0.6 - 0.8). In group II, a significant increase was observed in oropharyngeal and velopharyngeal dimensions (P < 0.001). A significant increase in nasopharyngeal dimensions occurred in all groups (P < 0.001). Also, in groups I and III, the position of hyoid bone changed downwards and backwards, which was correlated with reduction in airway dimensions (r = 0.4 - 0.6).

Conclusion

According to the present results, extraction orthodontic treatment affects upper airway dimensions and hyoid bone position. Maximum anchorage decreases airway dimensions while moderate anchorage increases airway dimensions.

A cost analysis of orthodontic space closure and implant treatment in patients missing maxillary lateral incisors with a long-term perspective

OBJECTIVE

Few studies within orthodontics present both economic and clinical findings. Missing maxillary lateral incisors is a frequently occurring anomaly. The treatment alternatives most used are orthodontic space closure and prosthetic replacement of the missing tooth. Our aim is to compare the total societal costs of orthodontic space closure (SC) and implant therapy (IT) in patients missing maxillary lateral incisors.

METHODS

Records of 32 patients treated with SC (n = 18) or IT (n = 14) due to missing maxillary lateral incisors were retrieved from the archives. Direct costs and indirect costs in the short- and long-term were analysed using a cost analysis with a societal perspective up of to 12 years post-treatment.

RESULTS

Comparing cases treated with SC and IT, the difference in direct short-term costs for treatment is €735.54, whereas SC is the least costly. There is no difference between SC and IT in short-term parent loss of productivity, long-term loss of productivity, costs for transportation, or direct long-term costs. A difference was found between SC and IT-in favour of SC-when comparing patients' loss of productivity (P = 0.007), short-term societal costs (P < 0.001), long-term societal costs (P = 0.037), and total societal costs (P < 0.001).

LIMITATIONS

There is a limited number of patient records. Local factors such as subsidies, urban versus rural areas, taxes, etc. can influence monetary variables, so the transferability to other settings may be limited.

CONCLUSION

Patients treated with SC have a lower total societal cost compared to patients treated with IT. There was a difference in productivity loss for patients between SC and IT; however, concerning other indirect parameters and direct long-term costs, there was no difference between the two treatments.

Comparing patient-centered outcomes and efficiency of space closure between nickel-titanium closed-coil springs and elastomeric power chains during orthodontic treatment

OBJECTIVES

To compare patient-reported pain, discomfort, and difficulty in maintaining proper brushing between nickel-titanium closed-coil springs (CS) and elastomeric power chains (PC) when used for space closure. The secondary aims were to compare plaque control and efficiency of space closure between these two force delivery systems.

MATERIALS AND METHODS

A total of 48 patients who required extractions of upper first premolars and distal movement of upper canines had the CS randomly allocated to either the right or left side. Blinding was applied at data collection and analysis. Primary outcomes were pain intensity measured on visual analog scale, pain onset and duration, discomfort, and difficulty in maintaining proper brushing from the start of canine retraction at baseline and at 6 and 12 weeks thereafter. Secondary outcomes were plaque scores and the rate of space closure.

RESULTS

No significant differences in mean pain scores, pain onset, and duration at different time intervals between CS and PC were observed. The CS side was significantly less comfortable than the PC (P < .0001) and more difficult to keep clean (P = .008). No significant differences in plaque scores were observed between CS and PC groups at any time interval. CS produced a faster rate of space closure than did PC (P = .008).

CONCLUSIONS

CS were less tolerated than PC by patients but produced an average of 0.5 mm more movement than did the PC during the 12-week study period.

A comparative assessment of the amount and rate of orthodontic space closure toward a healed vs recent lower premolar extraction site

OBJECTIVES

To investigate and compare the amount and rate of space closure and tooth tipping during orthodontic space closure toward a recent vs healed first premolar extraction site.

MATERIALS AND METHODS

The mandibular arches of 23 patients were included. Treatment plans included lower first premolar extractions. After reaching 0.019 × 0.025-inch stainless-steel archwires (SSAW), patients were subdivided into two groups (Group 1: space closure was carried out toward a healed first premolar extraction space and Group 2: space closure was carried out immediately after first premolar extraction). Elastomeric power chain from second molar to second molar was used to close lower extraction spaces. The following time points were defined: T1: just before space closure; T2-T4: 1-3 months after initial space closure. Records consisted of dental study models. The amount and rate of extraction space closure were evaluated at each time point.

RESULTS

In Group 1 (healed socket), a total amount of 1.98 mm (coronally) and 1.75 mm (gingivally) of space closure was achieved. The rate of space closure was 0.66 mm/month coronally and 0.58 mm/month gingivally. In Group 2 (recent socket), the total amount of space closure was 3.02 mm coronally and 2.68 mm gingivally. The rate of space closure was 1.01 mm/month coronally and 0.89 mm/month gingivally. Differences between the two groups were significant (P < .01). Tipping of adjacent teeth during space closure was similar in both groups (P > .05).

CONCLUSIONS

In the lower arch, the amount and rate of space closure toward a recent extraction site were higher than that toward a healed extraction socket with similar tipping of teeth in both groups.

Trends in orthodontic management strategies for patients with congenitally missing lateral incisors and premolars

OBJECTIVES

To identify changes in orthodontic management strategies in patients with hypodontia seen in 2000, 2010, and 2017/2018 (during a 1-year period).

MATERIALS AND METHODS

An assessment of the panoramic radiographs of 3701 patients from a Western Australian private practice identified 276 individuals demonstrating hypodontia. The location of missing teeth, age, sex, type of malocclusion, and the management strategies (space closure or opening) for each patient were noted.

RESULTS

Most hypodontia involved agenesis of three or fewer teeth (90%). Maxillary lateral incisors and mandibular second premolars were the most commonly missing teeth. Female preponderance was noted. When considering treatment, the odds ratio for orthodontic space opening and prosthetic replacement in 2000 was 3.266 (P value = 7e-04; 95% confidence interval [CI], 1.464-4.633) compared with patients seen in 2010 and 1.632 (P value = 7e-04; 95% CI, 0.811-2.434) compared with patients in 2017/2018. For patients demonstrating bilateral absence of maxillary lateral incisors, the odds ratio for orthodontic space opening was 3.185 (P value = 0.0215; 95% CI, 1.182-9.243) compared with counterparts with unilateral agenesis. None of the factors investigated were significantly associated with the types of treatment planned/provided for the patients with missing mandibular second premolars.

CONCLUSIONS

Maxillary lateral incisors and mandibular second premolars were the most commonly missing teeth. A trend away from space opening and prosthetic replacement toward orthodontic space closure was observed from 2000 to 2017/2018. This may reflect a change in attitude toward prosthetic replacement options and/or greater optimism with biomechanical strategies since the implementation of temporary anchorage devices to assist in space closure.

Multidisciplinary management of permanent first molar extractions

The first molar has been reported to be the most caries prone tooth in the permanent dentition. Orthodontists are treating more adult patients who are more likely to have missing and severely decayed first molars. This article will show the various orthodontic and restorative options for first molars that are already extracted or have to be extracted. The following clinical situations will be addressed: molar uprighting and its advantages for the future restoration vs orthodontic space closure, strategic extraction of salvable first molars, impacted molars, and early extraction of compromised permanent first molars in young children.

Frictionless Segmented Mechanics for Controlled Space Closure

The treatment of incisor protrusion by means of tooth extraction can be challenging for orthodontists, especially during the space closure phase. Moreover, the level of difficulty may increase when anterior movement of the posterior teeth is not desirable. Treatment alternatives may include the use of mini implants, mini plates, and extraoral devices to reinforce anchorage; however, some patients may oppose these aggressive methods. This article describes the use of frictionless segmented mechanics that provide differential moments for controlled space closure during full retraction of the incisors without using extraoral forces or temporary anchorage devices.

Comparison of orthodontic space closure using micro-osteoperforation and passive self-ligating appliances or conventional fixed appliances

OBJECTIVES

To examine the effect of micro-osteoperforation (MOP) on the space closure rate using passive self-ligating or conventional brackets.

MATERIALS AND METHODS

This was a two-arm parallel randomized controlled trial undertaken at the outpatient department of a dental college. There were 60 participants (30 women and 30 men) who fulfilled the inclusion criteria. Both the study and control groups were subjected to MOPs throughout the period of space closure. MOPs were repeated every 28 days. The experimental group (mean age 19.5 ± 1.66 years) was bonded with passive self-ligating brackets while the control group (mean age 19.9 ± 1.13 years) was bonded with conventional brackets. Both groups were examined and compared for rate of space closure. An evaluation was conducted for both groups until the entire extraction space was closed and confirmed by evaluation of a tight contact between the canine and the second premolar using a piece of dental floss.

RESULTS

Before the initiation of retraction, all initial criteria were similar between the two groups (P > .05). No difference was observed between the two groups in the rate of space closure (P > .05).

CONCLUSIONS

MOP in conjunction with passive self-ligation does not increase the rate of orthodontic space closure when compared with MOP used with conventional brackets.

Essay I: Orthodontic edentulous space closure in all malocclusions

In patients with missing maxillary anterior teeth, orthodontic space closure is an evidence-based, effective treatment option: probably the best if the goal is long-term periodontal health. Nowadays, this approach is possible in all malocclusions as the first step of an interdisciplinary approach, which aims not only at an optimum esthetic and functional result, but moreover at reducing the -invasiveness of the subsequent restorative treatment. Space closure should be considered the first alternative in growing patients and when the gingival margins are visible. This essay presents the rationale for space closure and provides clinical tips for interdisciplinary treatment planning and finishing.

Orthodontic extraction space closure with and without socket preservation: a comparative case analysis

Preorthodontic socket preservation after tooth extraction is intended to enhance favorable dentoalveolar ridge morphology and architecture, and facilitate orthodontic tooth movement (OTM) and extraction space closure. This 13-year-old skeletal Class II case presents a unique opportunity to evaluate and compare the OTM extraction space closure by means of a split-mouth analysis in a single patient. The comprehensive orthodontic-periodontal treatment included nonsimultaneous extraction of the bilateral periodontally compromised mandibular first molars and the eruption of bilateral impacted mandibular canines. While the right post-extraction space underwent a natural healing process, the left one was grafted using 4BONE BCH (hydroxyapatite β-tricalcium phosphate [HA-β-TCP], HA 60%, and β-TCP 40%). The 3-year multidisciplinary treatment approach resulted in Class I relationships on the right side and Class II on the left side, improved facial appearance, and dento-skeletal jaw relationships. However, a 3-mm residual alveolar space remained unclosed on the grafted left-site, along with an unerupted left third molar. This split-mouth comparative analysis of the orthodontic space closure demonstrated a significant clinical difference in the outcome. Preorthodontic placement of HA-β-TCP grafting material on the left segment, proved to be an obstacle for OTM extraction space closure, hindering the establishment of good occlusion.

Single-retainer resin-bonded fixed dental prostheses as an alternative to orthodontic space closure (and to single-tooth implants)

This article describes single-retainer resin-bonded fixed dental prostheses (RBFDPs) as an excellent alternative to orthodontic space closure or tooth replacement with implants or conventional fixed dental prostheses for congenitally and traumatically missing anterior teeth. Although the treatment with RBFDPs is technique sensitive, it is extremely reliable given a correct indication and adequate adhesive procedures.

The influence of premature loss of temporary upper molars on permanent molars

AIM

Premature loss of primary molars due to dental caries and their complications has been associated with space loss and eruptive difficulties, especially when the loss occurs early. The aim of our study was to determine the impact of premature loss of temporary upper molars upon the longitudinal axis of the first and second upper permanent molar.

MATERIAL AND METHODS

The study group included 64 patients 6-9 years old with premature loss of primary molars and a control group of 48 patients with intact temporary teeth. It was evaluated the angle between longitudinal axis of first and second upper permanent molars and occlusal plane. The sofware used is Easy Dent 4 Viewer®.The data were analyzed by using the Statistical Package for the Social Sciences (version 20.0; SPSS, Chicago, III).

RESULTS

It was observed that premature loss of upper second deciduous molars modifies greater the vertical axis of the permanent molars than the premature loss of first upper primary molar. First upper primary molar loss cause an acceleration eruption of first premolar, which will produce a distal inclintion of the both permanent molars.

CONCLUSIONS

The use of space maintainers after premature loss of the second upper temporary molar is a last solution in preventing tridimensional lesions in the dental arch and occlusion.

A clinical investigation of force delivery systems for orthodontic space closure

OBJECTIVE

To investigate the force retention, and rates of space closure achieved by elastomeric chain and nickel titanium coil springs.

DESIGN

Randomized clinical trial.

SETTING

Eastman Dental Hospital, London and Queen Mary's University Hospital, Roehampton, 1998-2000.

SUBJECTS, MATERIALS AND METHODS

Twenty-two orthodontic patients, wearing the pre-adjusted edgewise appliance undergoing space closure in opposing quadrants, using sliding mechanics on 0.019 x 0.025-inch posted stainless steel archwires. Medium-spaced elastomeric chain [Durachain, OrthoCare (UK) Ltd., Bradford, UK] and 9-mm nickel titanium coil springs [OrthoCare (UK) Ltd.] were placed in opposing quadrants for 15 patients. Elastomeric chain only was used in a further seven patients. The initial forces on placement and residual forces at the subsequent visit were measured with a dial push-pull gauge [Orthocare (UK) Ltd]. Study models of eight patients were taken before and after space closure, from which measurements were made to establish mean space closure.

MAIN OUTCOME MEASURES

The forces were measured in grammes and space closure in millimetres.

RESULTS

Fifty-nine per cent (31/53) of the elastomeric sample maintained at least 50 per cent of the initial force over a time period of 1-15 weeks. No sample lost all its force, and the mean loss was 47 per cent (range: 0-76 per cent). Nickel titanium coil springs lost force rapidly over 6 weeks, following that force levels plateaued. Forty-six per cent (12/26) maintained at least 50 per cent of their initial force over a time period of 1-22 weeks, and mean force loss was 48 per cent (range: 12-68 per cent). The rate of mean weekly space closure for elastomeric chain was 0.21 mm and for nickel titanium coil springs 0.26 mm. There was no relationship between the initial force applied and rate of space closure. None of the sample failed during the study period giving a 100 per cent response rate.

CONCLUSIONS

In clinical use, the force retention of elastomeric chain was better than previously concluded. High initial forces resulted in high force decay. Nickel titanium coil springs and elastomeric chain closed spaces at a similar rate.

Scissor bite in a young patient treated with an orthodontic-orthopedic device. A case report

BACKGROUND

Scissor bite is a rare malocclusion that often leads to minor facial asymmetry. An orthodontic and orthopaedic correction is advisable in young patients to prevent subsequent temporomandibular diseases requesting maxillofacial intervention.

CASE REPORT

In this case report a 8-year-old girl in mixed dentition with unilateral left scissor bite was treated with a modified Rapid Palatal Expander. To modify an overexpanded maxilla (width 39 mm measured between both upper first molars) the device was used to close rather than to expand, without need of patient compliance. Orthodontic correction was then completed with traditional bracketing. Results were tangible (width 36 mm) and remained stable even for at least 2 years after retention. This original device has proved to be useful in this kind of situations and can be easily applied to young patient to correct such malocclusions.

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.

Extraction of the lateral incisors to treat maxillary protrusion: quantitative evaluation of the stomatognathic functions

To treat morphological abnormalities, impaction, and severe malposition of the teeth, the lateral incisors are sometimes extracted, followed by orthodontic space closure. This procedure often requires special consideration, not only with regard to esthetics but also for functional issues. However, thus far, few reports that have performed a functional evaluation in such cases. The purpose of this article is to report the successful treatment of an adult patient with a Class II division 1 malocclusion who was treated with extraction of the upper lateral incisors. The female patient, aged 23 years and 6 months, had a chief complaint of maxillary incisal protrusion and crooked teeth. In this patient, the upper lateral incisors were extracted to fulfill the patient's strong request, followed by orthodontic treatment using edgewise appliances. A high-pull J-hook headgear on the lower dental arch was used to prevent further labial inclination of the lower incisors. The total active treatment period was 37 months. The resulting occlusion and a satisfactory facial profile were maintained during a 4-year retention period. Additionally, this treatment did not affect the stomatognathic functions as assessed by the following criteria: range of the incisal path or condylar motion during maximal open-close movement, protrusive excursion, lateral excursion, and the chewing test. In conclusion, extraction of the upper lateral incisors can be an effective treatment choice when the upper lateral incisors are dwarfed, are nonvital, or demonstrate severe malposition.

Camouflage treatment of severe bialveolar protrusion in skeletal Class II using miniscrew anchorage

The aim of this case report was to demonstrate the efficient use of miniscrew as anchorage in a 12-year-old male patient with skeletal and dental Class II and severe biprotrusion and lips procumbency. It was proposed a compensating orthodontic treatment with 4 premolar extraction and maximum anchorage. Since the patient abandoned treatment after one premolar extraction, loss of anchorage occurred and treatment plan was modified to maximize lower retraction with miniscrew anchorage and distalization of the upper arch using two methods: Class II elastics from lower miniscrews to the sliding jig and modified transpalatal arch using palatal miniscrew. The results showed a significant improvement of his facial appearance, lip protrusion and also dental esthetics and function. It was concluded that miniscrews can provide absolute anchorage for maximum anterior retraction in order to correct dentoalveolar biprotrusion in the presence of limited thickness alveolar bone.

Bisphosphonates as a risk factor for adverse orthodontic outcomes: a retrospective cohort study

INTRODUCTION

Bisphosphonates are a class of drugs commonly prescribed to treat osteoporosis. They act by decreasing the resorption of bone. Since tooth movement depends on bone remodeling, these drugs can impact orthodontic treatment. The purpose of this study was to evaluate the extent to which bisphosphonate therapy is a risk factor for poor orthodontic outcomes.

METHODS

Orthodontists were invited to participate in the study by performing case reviews of women over age 50 who were treated from 2002 through 2008. Women who used bisphosphonates were compared with women who did not have a history of bisphosphonate use. Outcomes assessed included treatment time, osteonecrosis of the jaws, incisor alignment, incomplete space closure, and root parallelism.

RESULTS

The records for 20 subjects with bisphosphonate exposure were collected, as well as records for 93 subjects without bisphosphonate exposure. In patients undergoing extractions, treatment times were significantly longer if they had a history of bisphosphonate use. No occurrences of osteonecrosis of the jaws were reported, nor did patients end treatment with incisor alignment discrepancies greater than 1 mm, regardless of bisphosphonate exposure. Among patients with extractions or initial spacing, there were higher odds of incomplete space closure (odds ratio, 13) and poor root parallelism (odds ratio, 26) at the end of treatment for patients using bisphosphonates.

CONCLUSIONS

Bisphosphonate use is associated with longer treatment times among extraction patients, increased odds of poor space closure, and increased odds of poor root parallelism.

Multidisciplinary approach to the establishment and maintenance of an esthetic smile: a 9-year follow-up case report

In addition to providing functionality to patients, contemporary dentistry strives for esthetic excellence. Patients with anterior impairments, such as shape, size, and position alterations, have compromised smile harmony. A multidisciplinary orthodontic-operative dentistry approach has improved the treatment of these patients, since the use of orthodontic appliances in association with direct composite restorations can solve many esthetic problems. Although this treatment strategy is rather widespread, professional skills are necessary for the correct reproduction of the main features of teeth. Moreover, treatment success is directly related to its longevity. With the aid of a 9-year follow-up case report, a simple direct technique associated with an orthodontic treatment for restoring the esthetic appearance of an impaired smile, with good short- and long-term outcomes, based on minimal but essential esthetic repair interventions is discussed. Such coordinated treatment proved to be effective for the establishment and maintenance of an esthetic and pleasant smile.

Complications of misdiagnosis of maxillary canine ectopic eruption

Ectopic eruption of maxillary canines can be associated with root resorption of adjacent teeth. This case report describes and discusses an interesting case of a 15-year-old girl with a Class III malocclusion and an impacted maxillary canine. Because of the unfavorable position of the ectopic canine and the severe root resorption of the maxillary left central and lateral incisors, the treatment options included extraction of the maxillary permanent canines. The mandibular first premolars were extracted to compensate for the Class III malocclusion. A panoramic radiograph taken earlier in the mixed dentition already indicated a possible eruption disturbance of the maxillary left permanent canine. The importance of early diagnosis of maxillary canine ectopic eruption is highlighted in this case report. The early identification of radiographic signs of an ectopic pathway of eruption should be followed by deciduous canine extraction to prevent canine retention and maxillary incisor root resorption.

Establishing the reliability of palatal rugae pattern in individual identification (following orthodontic treatment)

This study aims to determine the stability of palatal rugae before and after orthodontic treatment. 50 orthodontic cases were selected with pre- and posttreatment casts and 50 casts were randomly selected as variables. Landmarks on the palatal raphe and rugae were marked on the maxillary casts. Points were made on medial and lateral ends of first, second and third rugae. Each cast was photographed, measured and then trimmed leaving only the rugae area of the hard palate. In the pre and post-treatment group, changes in transverse measurements were significantly different for lateral points of first rugae and anteroposterior changes were significant for the distances between first and second rugae. All inter-point measurements of third rugae were stable in post-treatment casts. Thirty blinded examiners compared 50 trimmed preorthodontic casts to similarly prepared one hundred casts for possible matches based on pattern of rugae. The percentages of correct matches for examiners had a median of 90%. The matching of pre-operative and post-operative orthodontic casts demonstrated that although some changes do occur in the rugae during orthodontic treatment, the morphology of palatal rugae remains stable throughout life. Hence carefully assessed rugae pattern may have a definite role in forensic identification. Further, points associated with the third palatal ruage were the most immutable over a person's life and hence could be used as a reference to evaluate the changes in teeth positions during orthodontic treatment.

Congenitally missing maxillary lateral incisors: treatment

The 2 major treatment approaches for congenitally missing maxillary lateral incisors are space closure via orthodontic therapy, or space opening to allow prosthodontic replacements either with a fixed prosthesis or single-tooth implant. Both of these treatment approaches can potentially compromise aesthetics, periodontal health, and function. It is essential for an interdisciplinary dental specialty team to establish realistic treatment objectives, communicate the sequence of treatment, interact during treatment, evaluate dental and gingival aesthetics, and position teeth to permit proper prosthetic treatment. If this interdisciplinary approach is used, the aesthetics and long-term dental health of the patient following treatment will be greatly enhanced.

[Factors influencing the changes of lower third molars' angulation and space/crown width ratio by orthodontic treatment]

OBJECTIVE

To investigate the factors which influence the changes of lower third molars' angulation and space/crown width ratio by orthodontic treatment.

METHODS

Pretreatment and posttreatment panoramic radiographs of 120 orthodontically treated cases were taken. The lower third molars' angulation and space/crown width ratio were examined and the relative factors on changes were analyzed.

RESULTS

(1)The changes of the lower third molars' angulation and space/crown width ratio after orthodontic treatment were quite different among the cases. (2)The factors which influenced these changes mainly included extraction, mandibular plane angle, angulation and space/crown width ratio of lower third molar before orthodontic treatment. (3) Extraction was the most significantly variable associated with lower third molars' upright (angulation <30 degree) after orthodontic treatment.

CONCLUSION

Orthodontic extraction is helpful to upright the lower third molars and to increase the space for third molars; and the pre-treatment lower third molars' angulation and space/crown width ratio are important variables for the changes after treatment; cases with lower mandibular plane angle are apt to greater possibility for the lower third molars' upright.

Combined orthodontic-restorative management of maxillary central incisors lost following traumatic injury: a case report

A history of traumatic dental injury to the maxillary central incisors during preadolescence or adolescence is common and may result in premature loss. Treatment options include prosthetic implant replacement, autotransplantation, and orthodontic space closure with direct composite recontouring. This case report describes the treatment of an adolescent girl who presented with a crowded Class I malocclusion complicated by a history of trauma to the maxillary central incisors. The treatment plan consisted of orthodontic space closure following loss of both maxillary central incisors and mandibular premolars. This case highlights that orthodontic space closure can be a valuable treatment option in selected Class I crowded and Class II uncrowded malocclusions, producing predictable and efficient results.

Agenesis of maxillary lateral incisors: a global overview of the clinical problem

The agenesis of maxillary lateral incisors is a common developmental anomaly and represents a clinical problem impairing dental esthetics and function from a very young age. Several dental specialties deal with the management of this clinical problem because a multidisciplinary approach can cover the complete dental needs of patients with dental agenesis. There is controversy, however, about whether missing lateral incisor spaces should be orthodontically opened or closed using permanent canines to replace the missing teeth. The article presents a review of the existing literature about the prevalence, etiology, diagnostic evaluation, and treatment strategy of maxillary lateral incisor agenesis. Also, this article aims to present the key determinants leading to selection of space opening or closure and to report professional judgments and layperson perception concerning the available treatment alternatives. The English-language literature associated with this topic was searched via PubMed. The articles retrieved were then reviewed with an attempt to fulfill the aims of this review. Maxillary lateral incisors are one of the most common congenitally missing teeth, and to date, the origin of their agenesis has not been completely identified. Prompt diagnosis and careful evaluation of treatment determinants through a multidisciplinary approach are essential for the proper management of clinical problems. Each of the available means of rehabilitation has its own advantages, disadvantages, indications, and limitations. The configuration of the treatment plan should be devoid of clinician biases, whereas patients' realistic expectations should be taken into account.

Multidisciplinary management of multiple maxillary anterior supernumerary teeth: a case report

Supernumerary teeth are a relatively frequent disorder of odontogenesis. They may occur alone or in multiple; be unilateral or bilateral; and appear in the maxilla, mandible, or both. Mesiodens is a supernumerary tooth in the anterior maxilla between the two central incisors. This case report describes the treatment of maxillary central incisors displaced and impacted because of the presence of four mesiodens in a 12-year-old boy. After clinical and radiographic examination, surgical removal of the mesiodens and exposure of the maxillary right central incisor was performed. This resulted in a 14-mm space between the displaced central incisors. Successively, fixed orthodontic treatment was planned with cephalometric analysis. The central incisors were brought to the occlusal plane and aligned, and the space between the incisors was redistributed. Remaining minor spaces between the incisors were closed with composite resin buildup.

Aesthetic evaluation in subjects treated due to congenitally missing maxillary laterals. A comparison of perception in patients, parents and dentists

The treatment of the congenitally missing maxillary lateral incisor is a challenge to the dental profession. The demand for optimal orthodontic and prosthetic treatment is high because the condition has an impact on facial aesthetic. The aims of the present study were to determine how different outcome of treatment were perceived by professionals and laypeople and to identify situations that caused dissatisfaction or satisfaction after space closure or tooth replacement. A panel of four groups (patients with missing laterals, parents to these subjects, patients with other malocclusion and general dental practitioners) were included. Sixteen cases with uni- or bilateral missing maxillary lateral incisors, treated with space closure or with prosthetic replacements were presented photographically to the panel. The prosthetic replacements included resin-bonded bridges, porcelain bonded to gold bridges and implants. The panel was asked to rate the overall appearance of the mouth, to rank up to three disturbing features and to rank the most important treatment goals in case of treatment need. An obvious difference between the panel groups was found. The general practitioners were less critical than laypeople in rating the overall appearance. Amongst dentists the tooth colour, the tooth shape and asymmetry were the most disturbing factors whilst laypeople were disturbed by colour, spacing and tooth shape. Half of the dentists did not find any treatment need whilst the corresponding figure amongst laypeople was 19 per cent.When a treatment need was confirmed the most common treatment goals amongst dentists were to change the colour or the shape of the teeth. The laypeople wanted to change the colour, the space condition or the shape of the teeth. The study has shown that professionals and laypeople are of different opinion when rating treatment outcome in cases with missing maxillary laterals. Careful planning to achieve optimal aesthetics should be performed.

Treatment of a Class II subdivision malocclusion with multiple congenitally missing teeth

This case report describes the treatment of a patient with a Class II Division 1 subdivision right malocclusion with 8 congenitally missing teeth, incompetent lips, and incisor protrusion. The treatment plan included extractions and space closure with retraction of the anterior teeth; symmetric mechanics were used in the mandibular arch and asymmetric mechanics in the maxillary arch. Because of the mechanics used, some midline deviations were expected. Knowledge of diagnosis and treatment planning of asymmetric malocclusions and dental esthetics are essential for success when correcting asymmetic problems, but, even so, small clinical compromises should be expected.