Treatment Protocol for Skeletal Class III Malocclusion in Growing Patients

Maxillary deficiency in growing patients with skeletal Class III malocclusion can be treated by either extraoral or intraoral appliances. Extraoral appliances include face mask, reverse chin cup, reverse headgear, and protraction headgear. Intraoral appliances include tongue appliance, fixed tongue appliance, tongue plate, Frankel III, miniplate in combination with Class III elastics, and miniscrew in combination with Class III elastics. Herein, we demonstrate our experience and treatment results in these patients

Missing upper incisors: A retrospective study of orthodontic space closure versus implant

Background: The aim of this retrospective study was to compare the esthetic, periodontal, and functional outcomes of orthodontic space closure versus implant substitution in patients with missing maxillary incisors 5 years after completion of treatment. Methods: The study group consisted of ten patients treated with orthodontic space closure (six males, four females, mean age 19 ± 2.1 years at the completion of treatment) and ten patients treated with implant insertion (five males, five females, mean age 20 ± 1.4 years at the time of implant insertion). Tooth mobility, plaque index, probing depth, infraocclusion, open gingival embrasure (black triangle), and temporomandibular joint function were recorded at the 5.6 years follow-up. Self-perceived dental esthetic appearance was also evaluated through a visual analog scale (VAS) questionnaire. T-test was used to evaluate the data. Results: All patients were equally satisfied with the appearance of their teeth 5.6 ± 0.4 years after the completion of treatment. No statistically significant differences were found in relation to the VAS scores of the subjects (P < 0.857). No significant differences were found in tooth mobility, plaque index (P < 0.632), and the prevalence of signs and symptoms of temporomandibular disorders. However, significant infraocclusion was noticed in all implant patients (P < 0.001). Probing depth was also significantly higher in implant patients (P < 0.001). Conclusions: Orthodontic space closure and implant of missing maxillary incisors produced similar, well-accepted esthetic results. None of the treatments impaired temporomandibular joint function. Nevertheless, infraocclusion was evident in implant patients. Space closure patients also showed better periodontal health in comparison with implant patients

Treatment of Maxillary Deficiency by Miniplates: A Case Report

Introduction. Numerous devices have been introduced for correction of Class III malocclusion and maxillary deficiency. Aim. To assess the dentoskeletal effects of miniplates combined with Class III traction in treating Cl III malocclusion and maxillary deficiency in growing patients. Methods. This case describes the treatment of a maxillary-deficient 11-year-old boy by using miniplates. The patient's parents rejected the use of extraoral appliances and major surgical correction; therefore the treatment was done by using Class III elastics connected from two mandibular miniplates to an upper removable appliance. Two miniplates were inserted in the anterior part of the mandible in the canine areas under local anaesthesia. The treatment lasted for 10 months after which favourable correction of the malocclusion was observed. Results. The SNA and ANB angles increased by 5.1° and 4.4°, respectively. Lower 1 to mandibular plane decreased by 3.4°. Conclusions. This case demonstrates that miniplates can be a suitable method to extraoral appliances and major surgery in maxillary deficiency cases

Biomarkers of Periodontal Tissue Remodeling during Orthodontic Tooth Movement in Mice and Men: Overview and Clinical Relevance

Tooth movement by orthodontic force application is dependent on remodeling in periodontal ligament and alveolar bone, involving the activation of complex cellular and molecular mechanisms correlated with several macro- and microscopic biological changes. The orthodontic process involves the activation of many complex cellular and molecular mechanisms mediated by the release of chemical substance cascades by many cells of the periodontium. Mainly during the early stage of application of orthodontic forces, an inflammatory process can occur in the periodontium as a physiological response to the tissue stress. Several potential biomarkers of the biological alterations after an orthodontic force application expressing bone resorption and formation, periodontal ligament changes, and vascular and neural responses, may be detected. The appropriate choice of the mechanical force to achieve the highest rate of tooth movement in the shortest time of treatment avoiding adverse consequences is a primary objective of a specialist. Thus, an insight into the biological phenomena occurring during the orthodontic therapies by evaluating these biomarkers may be quite relevant for the clinicians. In this chapter, two models of study, i.e., mice and men, were used to describe the clinical usefulness of some biomarkers in orthodontics

Oral Squamous Cell Carcinoma Associated with a Dental Implant: a case report and literature review

Objectives: Prosthodontic rehabilitation using dental implants has become a common practice in dentistry at the present time. Although severe complications related to dental osseointegrated implants are uncommon, in recent years several cases of oral squamous cell carcinoma adjacent to dental implants have been published. Study Design: A 67-year-old edentulous woman developed an oral squamous cell carcinoma around right mandibular implant about 12 months after receiving dental implants. The treatments involve chemotherapy, explantation of the implants and radiotherapy. Result and Conclusions: The use of endosseous implants has been associated with a low risk for the development of cancer. However, this case report serves as evidence to the importance of careful screening at routine dental examinations especially if the patient suffers from peri-implantitis, any mucosal erosion or discoloration, leukoplakia around implant, pain, implant loosening, bone loss around implant, mucosal erythema, and soft tissue inflammation

Cleft Lip and Palate Patients: Diagnosis and Treatment

Cleft lip or palate is one of the most common types of craniomaxillofacial birth anomalies. Midface deficiency is a common feature of cleft lip and palate patients due to scar tissue of the lip and palate closure. Cleft lip and palate patients should be carefully evaluated by the craniofacial team in order to detect potentially serious deformities. Craniofacial team is involved with diagnosis of facial morphology, feeding problems, guidance of the growth and development of the face, occlusion, dentition, hearing and speech problems, and psychosocial issues and jaw discrepancy of the patients with cleft lip and palate or craniofacial syndromes. Treatment for cleft children requires a multidisciplinary approach including facial surgery in the first months of life, preventive and interceptive treatment in primary dentition, speech therapy, orthodontics in the mixed dentition phase, oromaxillofacial surgery, and implant and prosthetics in adults. Treatment plan from orthodontic perspective can be divided into the following stages based on the dentition stages: (1) presurgical orthopedics, (2) primary dentition, (3) mixed dentition, and (4) permanent dentition. The aim of this chapter is to assess a rational team work approach in the management of the patient with cleft lip and/or palate from birth to adulthood

Treatment Considerations for Missing Teeth

Specific terms are used to describe the nature of tooth agenesis. Hypodontia is most frequently used when describing the phenomenon of congenitally missing teeth. Many other terms to describe a reduction in the number of teeth appear in the literature: oligodontia, anodontia, aplasia of teeth, congenitally missing teeth, absence of teeth, agenesis of teeth and lack of teeth. The term hypodontia is used when one to six teeth, excluding third molars, are missing, and oligodontia when more than six teeth are absent (excluding the third molars). The long‐term management of hypodontia in the aesthetic zone is a particularly challenging situation. Although there are essentially two distinct approaches to manage this problem, that is space closure or opening for prosthetic replacements, implant or autotransplantation. These patients often manifest with many underlying skeletal and dental problems and a multidisciplinary approach for management of this condition is recommended. Two treatment approaches including space closure and space reopening are described in details in this chapter

Comparison between rapid and mixed maxillary expansion through an assessment of arch changes on dental casts

Background: Aim of this retrospective observational study was to compare upper and lower dental changes in patients treated with Rapid Maxillary Expansion (RME) and Mixed Maxillary Expansion (MME), assessed by dental cast analysis. Methods: Treatment groups consisted of 42 patients: the RME group (n = 21) consisted of 13 female and 8 male subjects with the mean age of 8.8 years ± 1.37 at T0 and 9.6 years ± 1.45 at T1; the MME group (n = 21) consisted of 12 female and 9 male patients with a mean age of 8.9 years ± 2.34 at T0 and 10.5 years ± 2.08 at T1. The upper and lower arch analysis was performed on four dental bilateral landmarks, on upper and lower casts; also upper and lower arch depths were measured. The groups were compared using independent sample t-test to estimate dental changes in upper and lower arches. Results: Before expansion treatment (T0), the groups were similar for all examined variables (p>0.05). In both RME and MME group, significant increments in all the variables for maxillary and mandibular arch widths were observed after treatment. No significant differences in maxillary and mandibular arch depths were observed at the end of treatment in both groups. An evaluation of the changes after RME and MME (T1) showed statistically significant differences in mandibular arch depth (p<0.001) and maxillary intercanine widths (p<0.05). Differences in maxillary arch depth and arch width measurements were not significant. Conclusions: RME and MME can be considered two effective treatment options to improve transverse arch dimensions and gain space in the dental arches. A greater lower arch expansion was observed in the MME group, which might be attributed to the “lip bumper effects” observed in the MME protocol

Effect of Bionator and Farmand Appliance on the Treatment of Mandibular Deficiency in Prepubertal Stage

Objective:The present study aimed to compare dentoskeletal changes in mandibular-deficient patients treated with Bionator and Farmand appliances.Methods:This study included 54 subjects treated for class II division I malocclusion. All subjects fulfilled the following criteria: ANB>5°, SNB5 mm. The Bionator group consisted of 27 patients (15 girls, 12 boys) with the mean age of 11 (SD 1) years and the Farmand group consisted of 27 patients (17 girls, 10 boys) with the mean age of 11.1 (SD 1.4) years. Statistical analyses were performed using t-test, paired t-test, Wilcoxon, and Mann–Whitney test.Results:In the Farmand group, SNB significantly increased from 74.3° (SD 1.7) to 77.6° (SD 2.3) and ANB decreased by 3.2° (SD 1.7) (p<0.001). In the Bionator group, SNB significantly increased from 75.5° (SD 0.9) to 79° (SD 0.9), and ANB decreased by 3.3° (SD 1.3) (p<0.001). The increase in IMPA showed that the lower incisors were significantly tipped using both appliances. T-test did not show any significant differences between the two groups.Conclusion:Despite the different designs of the appliances, both were successful in the treatment of class II division 1 malocclusion in mandibular-deficient patients