Treatment Options in Congenital Missing Teeth

The clinician is often encountered with missing teeth in orthodontic practice. In this review, clinical incidence, etiology and especially treatment options are described. Treatment options of the most common congenital missing lateral and premolar teeth are presented with advantages and disadvantages to provide a brief guide for daily practice

An Evaluation of Pain Induced by Intermaxillary Elastic Use

Aim:Intermaxillary elastics, which are frequently used in fixed orthodontic treatment, cause pain and discomfort and this affects patients' cooperation negatively. The aim of this study is to evaluate pain levels during intermaxillary elastic use for the first time.Subjects and Methods:Sixteen orthodontic patients (9 girls, 7 boys; mean age 16.21 ± 3.01) whom were to use intermaxillary elastics for the first time agreed to participate to the present study. A visual analog scale form was given to each patient to measure the subjective pain levels. After the collection of the forms, pain levels were measured on the forms by the same investigator using a digital caliper. Data evaluation was made with descriptive statistical analysis.Results:The pain level was started to increase two hours after the elastic application. The highest pain level was achieved at 6th hour and the same night. The pain level was started to decrease at the day 2 and at the day 7 only a few patients reported that they had still pain. The pain perception during biting was felt at the posterior teeth more than the anterior teeth.Conclusion:As a conclusion, the patients should be informed about the pain during intermaxillary elastic use and analgesic use for the first 3–4 days is strongly recommended to increase cooperation

Extraction Orthodontic Treatment in an Autistic Patient

Autism is a condition that restricts brain development. Early diagnostic criteria are as follows: less responsive to social stimuli, inability to develop natural speaking skills, lack of communication skills, and limited and repetitive behaviors. Orthodontic treatment is a challenging process for doctors in autistic patients. The clinical and cephalometric examination of a 17-year and 7-month-old autistic patient revealed class I malocclusion, increased vertical dimensions, proclined upper and lower incisors, and inconsistent lip closure. The treatment plan involved four premolar extractions from each quadrant. Upper and lower 1. premolar extraction with fixed treatment caused reduction in vertical dimensions and significant improvement in lip closure and incisor inclination. Due to the increased metabolic activity in these patients, treatment was completed in 13 months. As a result, autistic patients can be successfully treated. In this process, it is important to include communication as a major part of treatment

Maxillary Expansion Via Palatal Mini-Implants: A Preliminary Study

Objective:This study evaluates the skeletal and dental effects of a mini-implant supported maxillary expansion (MISME) appliance that applied forces directly to the maxilla.Materials and Method:Records of 9 patients (5 female and 4 male patients; mean age = 12 years 8 months) with indications of maxillary expansion were included in this study. After insertion of four miniscrews (1.6 mm in diameter, 7 mm in length), an acrylic expansion device was bonded on the screws. Two miniscrews were placed in the anterior palate bilaterally, 3–4 mm lateral to the suture and 3–4 mm posterior to the incisive foramen. Two miniscrews were placed bilaterally between the second premolar and first molar roots in the palatal alveolus. The MISME appliance was activated with a semi-rapid protocol until the desired expansion was achieved. The average treatment duration was 97.1 ± 62.2 days. Measurements from cephalometric, posteroanterior radiographs and dental casts taken before and after expansion were evaluated statistically. The nonparametric Wilcoxon test was used for not normally distributed parameters (i.e., Nperp-A), and the parametric paired t test was performed for normally distributed parameters. A finding of p < 0.05 was considered to be statistically significant.Results:Forward movement of the maxilla (p<0.05) as well as an increase in nasal and maxillary skeletal and dental widths (p<0.001) were observed in the sample group. Maxillary intermolar, intercanine, and palatal widths also increased (p<0.001) without buccal tipping of molars. A slight posterior rotation of the mandible was seen. Dentoalveolar measurements did not show any significant changes.Conclusion:The MISME appliance showed successful expansion of the maxilla without such side effects as buccal tipping of molars and bite opening. This appliance, which provides parallel expansion, can be a simple and economic alternative to transpalatal distraction

Dentoalveolar Effects of Miniscrew Implant Supported Distalization System

Aim:The aim of this prospective clinical study is to evaluate the treatment effects of the miniscrew implant supported distalization system in patients with Class II malocclusion.Subjects and Methods:The study sample consisted of 10 patients (5 girls and 5 boys) with a mean age of 14,9 years. Two titanium intermaxillary fixation screws were placed lateral to the foramen incisivum in the anterior paramedian region of the palate. Alginate impressions were taken and appliances were constructed on the model casts. The MISDS was cemented on the upper first molars, then connected to the miniscrews by means of metallic ligatures. The appliance was activated by squeezing the open coil springs. 200 g of distalization force was applied on each side. Lateral cephalometric radiographs were obtained before (T0) and after (T1) the distalization were measured. Data was analysed by SPSS.Results:The mean maxillary first molar distalization was 2,45 mm (p<0.05) and 1° (p<0.05) slight distal tipping accompanied distalization. Maxillary second molars distalized 4.35 mm (p<0.05) and tipped 2°(p<0.05) distally. The upper second premolars showed 3 mm distal drift following the upper first molars and tipped 2.3° distally, while 2.35 mm spontaneous distalization and 1.6° distal tipping were seen on the upper first premolars. Upper incisors were retroclined 1.45° (p<0.05), which decreased the overjet 0.8 mm.Conclusion:MISDS is an efficient way of noncompliance maxillary molar distalization which results with almost translatory distal upper molar movement

Comparison of the initial levelling efficiency of two different self-ligating brackets

Aim: The objective of this study, to evaluate the initial alignment effectiveness of two different passive self-ligating brackets (SLBs) and to compare the differences in arch widths. Materials and Methods: The patients with no skeletal discrepancy, Little’s irregularity index (LII) greater than 3 mm on both arches, who were treated with SLBs and whom had undamaged plaster models at the beginning (T0), 10th week (T1), and 20th week (T2) of their treatment period were enrolled to the study group. Group 1 (Damon) was consisted of 17 patients (mean age=14.5 years) and Group 2 (SmartClip) was consisted of 18 patients (mean age=13.6 years). The analogue dental casts were transferred to a digital model by scanning. Maxillary and mandibular intercanine, intermolar widths and LII were measured by MeshLab software. Wilcoxon signed-rank and Mann Whitney U tests was used for statistical evaluation. Results: There were no significant differences between the groups for the mean LII in T0 (maxillary LII, Group 1= 6.59 mm; Group 2= 6.32 mm; mandibular LII, Group 1= 5.95 mm, Group 2= 5.73mm). The rate of decrease in the LII between T0-T2 and between T1-T2 were found to be significantly higher for Group 1 in the mandible but there was no significant difference between T0-T1 (P= 0.031, P= 0.042, P= 0.113). There was no significant difference for the rate of decrease in the LIIs between the groups in the maxilla. When changes of intermolar and intercanine widths were compared according to the follow-up times, no significant differences were found for the treatment groups. Conclusion: Both SLBs groups were effective for reducing the crowding in maxillary arch. The increases in intercanine and intermolar widths were found to be similar for both groups. Group 1 was found to be better in the speed of the resolution of the crowding only in the lower incisor region

Periodontal and Periapical Responses to Mandibular Incisor Intrusion: Conventional Method Vs. Bone Anchorage

Aim:To investigate the gingival and periapical side effects of mandibular incisor intrusion using mini-implants and to compare these with those of a conventional mandibular incisor intrusion mechanic, the utility arch.Subjects and Methods:26 deep bite patients were enrolled to one of the 2 groups. In the first group, mandibular incisors were intruded using 2 mini- implants and in the second group, using a conventional utility arch. The gingival reactions following intrusion were evaluated by pocket depth (PD), gingival index (GI), plaque index (PI), the width of keratinized gingiva (WKG) measurements at pretreatment (T0), pre-intrusion (T1) and at the end of intrusion (T2). Presence of root resorption was evaluated using both periapical radiographs and computed tomograms. Intragroup comparisons were made using a Paired t-test or Wilcoxon test. Intergroup comparisons were made using Student's t-test or Mann Whitney-U test.Results:In both groups, SD in the buccal side, GI, PI, WKG on buccal side and on lingual SD showed an increase at T2 compared to T0 and T1. PI on lingual side showed an increase from T0 to T2 in implant group but no differences were noted in utility arch group. Intergroup differences were found similar. Some amount of root shortening (0.08%% to 4.4%%) was measured on both periapical radiographs and tomograms.Conclusions:Similar changes in SD, GI, PI and WKG and root resorption were found with intrusion using the two methods. Root density measurements on CT images showed only minor density changes

Perception of Orthodontic Treatment Need Among Orthodontists, General Dentists and Lay People

Aim:The main objective of our study was to examine the possible differences in dental esthetic perceptions among dentists, orthodontists and laypeople.Subjects and Methods:The participants of the study consisted of 3 different groups as orthodontists, dentists who have at least 4 years clinical experience and laypeople. Thirty individuals were selected for each group. All the selected people were asked to complete the questionnaires. Assessment of treatment need was obtained by evaluating the Aesthetic Component (AC) of Index of Orthodontic Treatment Need (IOTN). This index contains a series of 10 black and white photographs of anterior teeth displaying varying degrees of malocclusion. The participants of this study were asked to rank each black and white photograph between 1 and 10 according to their perception of orthodontic treatment need.Results:There were only minor differences in perception of orthodontic treatment need. Differences were detected in photographs 1 and 9. In photograph 1, orthodontists and dentists gave similar scores but lay people scored higher than dental professionals.Conclusion:The present study aimed to investigate the possible differences in perception of orthodontic treatment need among orthodontists, general dentists and lay people and the results found only minor differences between the groups