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

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

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

Gingival crevicular fluid alkaline phosphate activity during the retention phase of maxillary expansion in prepubertal subjects: A split-mouth longitudinal study

NTRODUCTION: The aim of this study was to monitor the alveolar bone formation at the tension sites of teeth supporting the appliances for rapid maxillary expansion (RME) during the retention phase according to the local gingival crevicular fluid (GCF) alkaline phosphatase (ALP) activity. METHODS: This split-mouth prospective study included 23 prepubertal subjects (15 girls, 8 boys; mean age, 9.0 \ub1 1.4 years) who had a constricted maxillary arch and were undergoing RME. Periodontal parameters, including probing depth, were recorded at 3 and 6 months after RME. Furthermore, the GCF ALP activity was measured at the tension sites of the supporting test teeth (TT) and at the antagonist control teeth (CT) sites. RESULTS: Periodontal parameters were generally similar between the TT and CT sites during the study, with the exception that probing depth underwent a slight increase at the TT sites. At baseline, the GCF ALP activity was similar between the TT and CT sites; however, at both 3 and 6 months, significantly greater enzymatic activity was seen at the TT sites. The overall probing depth changes were not significantly correlated with the corresponding GCF ALP activity changes for either the TT or the CT sites. CONCLUSIONS: Alveolar bone formation at the tension sites would last up to 6 months of retention after RME. These results warrant more comprehensive studies to assess whether the GCF ALP activity has potential as a diagnostic tool for bone formation during the retention phase of RME

Bullying and malocclusion in adolescence: a case report

ABSTRACT Introduction: Adolescents with bad malocclusion can more often be victims of bullying and the improvement of their facial appearance through oral rehabilitation is nowadays an important issue. The aim of this case report was to describe the orthodontic treatment in a teenager with a dentoskeletal malocclusion exposed to bullying to correct his occlusal problems and improve facial esthetics and quality of life. Case presentation: The patient, a boy aged 13.5 years, had a class II, division 1, malocclusion with hyperdivergent pattern, mandibular asymmetry, constricted maxillary arch and molar crossbite, increased overjet, lower mild crowding and lip sucking. A two-phase approach was necessary to achieve proper occlusion, better esthetics and promote the patient\u27s self-esteem with consequent greater serenity of his family. Conclusion: Treatment of adolescent patients with severe dento-skeletal malocclusions is among the most difficult challenges for orthodontists. Orthodontic therapy cannot simply aim a simple occlusal correction but also have to establish a valid methodology to remove the "cause" of bullying and to treat the patient, together with appropriate psychological support

Pyostomatitis vegetans : a review of the literature

Pyostomatitis vegetans (PV) is a rare condition characterized by pustules that affect the oral mucosa. It is a highly specific marker for inflammatory bowel disease and its correct recognition may lead to the diagnosis of ulcerative colitis or Crohn?s disease. Thus, a presumptive diagnosis of PV should suggest a complete gastrointestinal investigation. PV pathogenesis is as yet unknown, although immunological and microbial factors have been suggested as possible aetiological factors. Pyostomatitis vegetans is characterized by erythematous, thickened oral mucosa with multiple pustules and superficial erosions. A peripheral eosinophilia has been observed in most cases reported. Histology shows epithelial acanthosis and superficial ulceration with intraepithelial and ? or subepithelial abscesses containing large numbers of eosinophils. The underlying connective tissue exhibits neutrophil and eosinophil infiltration, with miliary abscesses in some cases. Treatment of PV focuses on control of the underlying disease

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

Efecto de la prolongación de la máscara facial en el desarrollo de los caninos maxilares impactados: un estudio retrospectivo.

Objective: The aim of the present study was to evaluate if maxillary protraction with facemask increases the risk of maxillary canine impaction. Materials and method: The records of 76 skeletal Class III subjects with a cervical vertebral maturation stage between CS1 and CS3 and a displaced maxillary canine were retrospectively collected. Intraoral photographs, orthopantomography and lateral cephalograms were collected, and patients were divided into three groups depending on the type of treatment received – a Rapid Palatal Expander (RPE), a RPE in conjunction with a facemask (RPE-FM), or a Class III functional appliance (FA). The patient’s records were used to determine if the maxillary canines were correctly erupted after that phase of treatment. A binary logistic regression was used to evaluate the effect of treatment modality and skeletal maturation stage on the chance of maxillary canine impaction. Results: No effect of the three different treatment modalities and of the skeletal maturation stage on the risk of canine impaction was observed. Conclusions: The protraction facemask can be used in growing skeletal Class III subjects without increasing the risks of maxillary canine displacement.El objetivo del presente estudio fue evaluar si la protracción maxilar con mascarilla aumenta el riesgo de impactación canina maxilar. Materiales y método: se recogieron retrospectivamente los registros de 76 sujetos esqueléticos de Clase III con una etapa de maduración vertebral cervical entre CS1 y CS3 y un canino maxilar desplazado. Se recogieron fotografías intraorales, ortopantomografía y cefalogramas laterales, y los pacientes se dividieron en tres grupos según el tipo de tratamiento recibido: un expansor palatino rápido (RPE), un RPE junto con una máscara facial (RPE-FM) o un aparato funcional (FA) clase III. Los registros del paciente se usaron para determinar si los caninos maxilares entraron en erupción correctamente después de esa fase del tratamiento. Se utilizó una regresión logística binaria para evaluar el efecto de la modalidad de tratamiento y la etapa de maduración esquelética sobre la posibilidad de impactación canina maxilar. Resultados: no se observó ningún efecto de las tres modalidades de tratamiento diferentes y de la etapa de maduración esquelética sobre el riesgo de impactación canina. Conclusiones: la mascarilla de protracción se puede usar en sujetos esqueléticos clase III en crecimiento sin aumentar los riesgos de desplazamiento canino maxilar