Moving an incisor across the midline: A treatment alternative in an adolescent patient

A 13-year-old sought treatment for a severely compromised maxillary left central incisor and an impacted fully developed left canine. Extraction of both teeth became necessary. As the key component of the revised comprehensive treatment plan, the right maxillary central incisor was moved into the position of the left central incisor. All other maxillary teeth were moved mesially to close any gaps. Active orthodontic treatment was completed after 34 months. Frenectomy, minor periodontal surgeries, and bonded lingual retainers were used to improve aesthetics and stabilize the tooth positions. The patient was pleased with the treatment outcome. Cone-beam computed tomography provided evidence that the tooth movement was accompanied by a deviation of the most anterior portion of the median palatine suture. This observation may make relapse more likely if long-term retention cannot be ensured. Root resorption was not observed as a consequence of the major tooth movement. (Am J Orthod Dentofacial Orthop 2011;139:533-43

Variations in Function and Vocal Acoustic Characteristics After Orthognathic Surgery: Preliminary Results

Objective: To determine the effects of orthognathic surgery on oral function and vocal quality in order to assess the need for speech therapy after surgery. Material and Methods: Thirty-seven patients scheduled for mono-jaw surgery, specifically maxillary (G1:15 patients), mandibular advancement (G2:10 patients) or mandibular set-back (G3:12 patients), were recruited for this prospective cohort study. Evaluation of oral functions, video recordings of speech articulation and audio recordings of voice were obtained before surgery (T0), and at 1 (T1) and 6 months (T2) after surgery. Spectrographic analysis and self-evaluation questionnaire regarding the vocal performance (VAPP) were performed. Both qualitative and quantitative statistical analysis was performed, mainly using generalized linear models for dichotomous data (p<0.05). Results: The formant frequencies (F1 and F2) of the main vowels vary after orthognathic surgery according to the type of surgery. Before surgery, 84% of patients analyzed showed difficulties in breathing and positioning the tongue both at rest and swallowing. Thanks to surgical correction of the malocclusion, the major part of these issues were resolved within 6 months. In 25% of cases, a change in the voice and/or articulation had occurred. Conclusion: Vocality improves after orthognathic surgery and it changes in relation to the type of surgery. However, vocality did not normalize completely. Speech assessment should be considered after surgery in order to offer adequate speech therapy if necessary.&nbsp

Variations in Function and Vocal Acoustic Characteristics After Orthognathic Surgery: Preliminary Results

Objective: To determine the effects of orthognathic surgery on oral function and vocal quality in order to assess the need for speech therapy after surgery. Material and Methods: Thirty-seven patients scheduled for mono-jaw surgery, specifically maxillary (G1:15 patients), mandibular advancement (G2:10 patients) or mandibular set-back (G3:12 patients), were recruited for this prospective cohort study. Evaluation of oral functions, video recordings of speech articulation and audio recordings of voice were obtained before surgery (T0), and at 1 (T1) and 6 months (T2) after surgery. Spectrographic analysis and self-evaluation questionnaire regarding the vocal performance (VAPP) were performed. Both qualitative and quantitative statistical analysis was performed, mainly using generalized linear models for dichotomous data (p<0.05). Results: The formant frequencies (F1 and F2) of the main vowels vary after orthognathic surgery according to the type of surgery. Before surgery, 84% of patients analyzed showed difficulties in breathing and positioning the tongue both at rest and swallowing. Thanks to surgical correction of the malocclusion, the major part of these issues were resolved within 6 months. In 25% of cases, a change in the voice and/or articulation had occurred. Conclusion: Vocality improves after orthognathic surgery and it changes in relation to the type of surgery. However, vocality did not normalize completely. Speech assessment should be considered after surgery in order to offer adequate speech therapy if necessary

Judged Facial Attractiveness of Extraction and Non-Extraction Orthodontic Treatment in Repose and Smiling

Background and Objectives: More so than ever, the public is becoming exceedingly aware of esthetics, and will evaluate their treatment outcome based upon the improvement to their smile and overall enhancement of their facial appearance. There exists a debate in orthodontics, as to whether or not extractions harm the profile. The aim of this study was to determine if facial attractiveness is harmed in subjects having completed orthodontic treatment involving the extraction of four premolars both in repose and smiling when viewed in lateral profile. Another objective is to identify any impact upper incisor retraction has on facial attractiveness. Experimental Design and Methods: A sample of 39 subjects that had completed orthodontic treatment (19 extraction subjects and 20 non-extraction subjects) and had existing pre and post-treatment lateral cephalograms, and lateral repose and smiling photographs, were selected. Orthodontic professionals and laypersons were asked to view a presentation of all of the pre and post-treatment repose and smiling photos of the 39 subjects and asked evaluate facial attractiveness using a visual analogue scale. Amount of incisor retraction was calculated using superimpositions of pre and post-treatment lateral cephalograms. The data was analyzed using paired t-test, ANCOVA, and intra-class correlation coefficient. Results: For the repose data, a statistically significant difference between the pre-treatment and post-treatment ranking scores (p \u3c 0.05) was observed in 28 of the 39 subjects. 11 of the 39 subjects (28.2%) had a positive mean difference in repose. For the smiling data, a statistically significant difference between the pre-treatment and post-treatment ranking scores (p \u3c 0.05) was also observed in 28 of the 39 subjects. 30 of the 39 subjects (76.9%) had a positive mean difference in smiling. In repose, no statistically significant difference in attractiveness ranking scores between extraction and non-extraction subjects (p \u3e 0.05) was observed. A significant difference in attractiveness ranking scores between orthodontic professionals and laypersons was observed. Orthodontists gave higher attractiveness ranking scores than laypersons (p\u3c0.05) Additionally, a significant difference in attractiveness ranking scores among the different levels of retraction was found. Subjects in the \u3c-2mm and \u3e0 mm retraction groups were judged to be more attractive than subjects who are in the -2 – 0 mm retraction group (p\u3c0.05). In smiling, no significant differences were observed for any of the variables, nor when combined. Conclusions: Extraction therapy is not harmful to the repose profile or the smiling profile. More subjects were judged to be more attractive post-treatment in smiling than repose. Four premolar extraction made the profile more attractive in repose, whenever the incisors were retracted more than 2 mm. Orthodontists gave higher attractiveness ranking scores than laypersons in repose. There are no differences between judged facial attractiveness and non-extraction vs. extraction therapy, orthodontic vs. layperson, or amount of retraction in smiling

Treatment modalities of palatal impacted canines

Introduction: The orthodontic treatment of impacted maxillary canine remains a challenge to today’s clinicians. The treatment of this clinical entity usually involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the dental arch. The impacted palatal canine requires a combination of both treatment modalities: orthodontic management and oral surgical treatment. Two types of approach are commonly used: simple exposure, or exposure with bracketing at the time of oral surgery procedure. Bracketing is a well-established and effective method of managing the impacted canine though it has been criticized for increasing the operating time and being a more technique-sensitive procedure.Aim: The aim was to compare the outcome and complication rate for each type of procedure.Material and method: In this study 20 treated patients with both palatal impacted canines were included, one at which the ectopic tooth was surgically exposed alone and the other where an orthodontic bracket was bonded to facilitate early traction, and the flap replaced.Results: In 30 per cent of all cases exposed and bracketed a second surgical intervention was required, compared with 15 per cent in the simple exposure group.Conclusion: Bracketing, though effective, is a more costly and time-consuming procedure, and it is suggested that simple exposure provides an equally efficient and predictable method of managing the palatal impacted canine with obvious clinical and financial benefits

Current Treatment of Cleft Lip and Palate

Non-syndromic cleft lip and palate patients have the most common congenital anomalies that affect the middle and lower part of the face, and which impair aesthetic integrity. These anomalies also affect basic functions such as hearing, speaking, chewing, and breathing. Treatment of patients with cleft lip and palate requires multidisciplinary teamwork. The cleft child should be followed and treated by a team of experts from different disciplines who work well together. Although cleft surgery, orthodontic treatment, and speech therapy are the main disciplines, each of the other branches (maxilla-facial-surgeon, otolaryngologist, speech therapist, pediatric dentist, psychologist, nurse etc.) are also very important. In this book, we wanted to present the reader with the experiences and knowledge of some of these disciplines. This book also includes information on the quality of life of children with this anomaly and anesthesia evaluation, which is very important for the cleft surgery

Divergence between CBCT and Optical Scans for Soft Tissue Analysis and Cephalometry in Facial Imaging: A cross-sectional study on healthy adults

Background > Facial soft tissue analysis is becoming increasingly emphasized in orthodontic diagnosis and treatment planning. While traditional cephalometry primarily focuses on hard tissues, recent non-invasive imaging techniques offer the potential to comprehensively evaluate three-dimensional (3D) facial soft tissues. The aim of the study was to establish the geometrical 3D and cephalometric divergence between Cone Beam Computed Tomography (CBCT) derived images and scanned soft tissues. Crucial for enhancing orthodontic diagnosis, minimizing patient exposure to ionizing radiation and providing facial cephalometric parameters. Material and methods > A cross-sectional study was conducted from January 2020 to May 2023. CBCT and 3D facial scans were obtained simultaneously using a specialized imaging system. Reproducible landmark points were selected for both cephalometric and soft tissue analysis. Angular and linear measurements were recorded, and correlations between CT and facial scans were statistically assessed. Results > Comparisons between 10 CBCT-derived and 10 facial scan -based soft tissue representations resulted into 1.8 mm mean root median square (RMS). Angular measurements, such as ANB, right gonial angle, and left gonial angle, exhibited a 0.98 of difference with their respective soft tissue variables. In contrast, linear measurements of total anterior facial height showed a lower correlation coefficient, equal to 0.51. The correlation between soft tissues and underlying hard tissues was more pronounced for gonial angles. Conclusion > Facial soft tissue analysis using either 3D facial scans or CBCT-derived offers similar results for orthodontic diagnosis and treatment planning. These findings support the use of noninvasive diagnostic tools in orthodontics, although further investigations are needed to comprehensively understand the complexity of hard and soft tissue relationships

The Proposed Use of an Anatomically Marked Presurgically Fitted Prostheses With Infants Who Have Unrepaired Cleft Palates

Approximately one out of every 750 children are born with some type of an oral cleft (McWilliams, Morris, & Shelton, 1984) Children with clefts of the palate in general have a higher incidence of articulation disorders than do children without clefts. Typical speech problems which tend to occur are hypernasality and multiple articulation errors, often consisting of atypical tongue placement in the mouth or nontypical articulation at sites in the larynx or pharynx. These speech problems can be severe and may require years of expensive, long-term professional treatment to remediate

Orna face analysis: development of a clinical tool for facial aesthetic evaluation

Aim: Facial aesthetics is a dynamic field requiring precise professional assessment, considering beauty concepts, variability in cultural and ethnic facial features, and patient perception. This study aimed to develop the Orna Face Analysis (OFA), an integrated tool for detailed facial evaluation to improve the planning of aesthetic treatments. Methods: The OFA integrates multiple analysis methods, considering key aspects such as youthfulness, average appearance, symmetry, and dimorphic features to create a comprehensive evaluation protocol based on a critical review of the scientific literature searched through PubMed, Scielo, Web of Science, and Scopus databases without language or time restrictions. Results: The OFA was designed as an electronic form that can generate a printed file, allowing for a deep understanding of patients faces by highlighting these essential aspects. This approach enables detailed and personalized diagnostics essential for effectively planning facial aesthetic treatments and meeting patient expectations. The OFA emerges as a complementary and integrative tool in facial aesthetics, promoting a personalized and evidence-based approach to facial harmonization. After constructing the OFA prototype in electronic and printed formats, the tool was tested in a clinical setting (TRL 6 – technology readiness level) to assess its objectivity, clarity, coherence, precision, and usability. TRL 6 indicates that the system has been demonstrated in a relevant environment but requires further testing for full validation. Conclusion: A preliminary evaluation by a facial harmonization specialist confirmed that the OFA enables the creation of highly personalized treatment plans, accurately reflecting a range of aesthetic outcomes. Further validation will solidify its applicability across diverse patient populations and settings

Effectiveness of Elastodontic Devices for Correcting Sagittal Malocclusions in Mixed Dentition Patients: A Scoping Review

Elastodontics is an interceptive orthodontic therapy that uses light and biological elastic forces through preformed or custom-made removable orthodontic appliances. This study aims to evaluate the effects of elastodontic devices on correcting sagittal discrepancies in growing subjects with mixed dentition. Electronic research was conducted on four databases: PubMed, Scopus, EMBASE, and Web of Science. Data were extracted based on the first author, year of publication, setting and country, study design, sample characteristics, sample size calculation, type of malocclusion, intervention, control group type, compliance, follow-up, and cephalometric measurements. Sixteen studies were included in the final review. Most studies observed a statistically significant reduction (p < 0.05) in SNB and ANB angles. Ten studies reported a reduction in overjet, while eight studies found no change in facial divergence. Comparisons with conventional functional devices revealed no consensus on the skeletal and dentoalveolar effects. Elastodontic appliances significantly improve cephalometric and dentoalveolar parameters, potentially correcting skeletal and dental relationships. However, result variability and unclear advantages over traditional appliances highlight the need for further research