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Biomedical subjects

V G Kokich

Publications and source records attributed to V G Kokich.

At least 19 recordsLinked to original sources
PubMed2001

Open gingival embrasures after orthodontic treatment in adults: prevalence and etiology.

The purposes of this study were to determine the prevalence of posttreatment open gingival embrasures in adult orthodontic patients and to examine the association of pretreatment maxillary incisor malalignment, posttreatment alveolar bone height, interproximal contact position, root angulation, crown shape, and embrasure area with open gingival embrasures. Posttreatment intraoral photographs of 337 adult orthodontic patients were evaluated to determine the prevalence of open gingival embrasures. A subsample of 119 patients was identified for measurement and divided into 2 groups: normal gingival embrasures and open gingival embrasures. Digital images of the pretreatment maxillary models and posttreatment maxillary central incisor periapical radiographs were made to measure the pretreatment and posttreatment variables. The prevalence of posttreatment open gingival embrasures in adult orthodontic patients was 38%. Pretreatment maxillary central incisor rotation and overlap were not statistically associated with posttreatment open gingival embrasures. A posttreatment alveolar bone-interproximal contact distance greater than 5.5 mm was associated with open gingival embrasures. Short and more incisally positioned posttreatment interproximal contacts were associated with open gingival embrasures. Open gingival embrasures were found to have more divergent root angulations and more divergent or triangular-shaped crown forms than normal gingival embrasures. Embrasure areas larger than 5.09 mm(2) were also correlated with open gingival embrasures. Increased alveolar bone-interproximal contact distance and increased root angulation demonstrated the greatest increase in the odds of an association with an open gingival embrasure. This investigation indicates that open gingival embrasures are common in adults who have undergone orthodontic treatment and that posttreatment variables are significant factors in open gingival embrasures.

Adult↗
PubMed1997

Guidelines for managing the orthodontic-restorative patient.

Occasionally, patients require restorative treatment during or after orthodontic therapy. Patients with worn or abraded teeth, peg-shaped lateral incisors, fractured teeth, multiple edentulous spaces, or other restorative needs may require tooth positioning that is slightly different from a nonrestored, nonabraded, completely dentulous adolescent. Generally, orthodontists are not accustomed to dealing with patients who require restorative intervention. Should the objectives of orthodontic treatment differ for the restorative patient compared with the nonrestorative patient? How should the teeth be positioned during orthodontic therapy to facilitate specific restorations? Should teeth be restored before, during, or perhaps after orthodontics? The answers to these and other important questions are vital to the successful treatment of some orthodontic patients. This article will provide a series of eight guidelines to help the interdisciplinary team manage treatment for the orthodontic-restorative patient.

Dental Restoration, Permanent↗
PubMed1997

Managing treatment for the orthodontic patient with periodontal problems.

Some adult patients have mild to moderate periodontal disease before orthodontic treatment. These patients may be at risk of developing further periodontal breakdown during orthodontic therapy. However, careful diagnosis and judicious management of these potentially volatile patients can alleviate the risk. In this article, the diagnosis and management of several periodontal problems is discussed. The need for and timing of preorthodontic periodontal surgery for these situations is elucidated. In addition, the types of tooth movement that will ameliorate these problematic situations is described. This information is valuable for the orthodontist who treats patients with underlying periodontal problems.

Adult↗
PubMed1997

Interdisciplinary management of single-tooth implants.

Orthodontists treat many patients who are missing maxillary lateral incisors and/or mandibular second premolars. In the past, if the canines could not be substituted for lateral incisors, conventional full-coverage bridges were the common restoration. Recently, resin-bonded Maryland bridges became a popular substitute for conventional bridges to avoid crowns on the nonrestored abutments. However, resin-bonded bridges have a poor long-term prognosis for retention, lasting on average about 10 years. Since implants were introduced into dentistry by Swedish researchers in the mid-1980s, they have become a promising substitute for conventional or resin-bonded bridges. However, to successfully place and restore single-tooth implants in young orthodontic patients several questions must be answered. This article will discuss the many interdisciplinary issues that are involved in placing and restoring single-tooth implants in orthodontic patients.

Adolescent↗
PubMed1997

Esthetics and vertical tooth position: orthodontic possibilities.

Throughout the 1990s, esthetic dentistry has become a prominent part of the treatment protocol of most dentists. Patients have become more conscious of the benefits of a beautiful smile and are willing to invest time and money to improve the appearance of their teeth. Many of these patients can be treated with routine restorative procedures (crowns, composites, laminates) to achieve the desired results. However, some patients have problems with tooth position that create significant discrepancies in gingival levels which can compromise the esthetic result of restorative dentistry. Prerestorative orthodontic therapy can often resolve these tooth position problems and enhance the esthetic restoration. This article describes the indication, methods, and results achieved when orthodontics preceded restorative dentistry in the treatment of various esthetic challenges.

Adult↗
PubMed1996

Esthetics: the orthodontic-periodontic restorative connection.

As we complete the 20th and progress into the 21st century, orthodontists worldwide are experiencing a gradual but significant change in their practices. The number of adult patients has increased substantially. Although adults cooperate better than adolescents, they present a different set of challenges for the orthodontist. Adults may have worn or abraded teeth, uneven gingival margins, missing papillae, and periodontal bone loss, all of which can jeopardize the esthetic appearance of the teeth after bracket removal. This article will discuss the solutions for managing these challenging orthodontic-periodontic-restorative situations to produce a more ideal esthetic result.

Adolescent↗
PubMed1996

Managing complex orthodontic problems: the use of implants for anchorage.

Today implants are commonly used to replace missing teeth in partially edentulous adult orthodontic patients. Because these patients are missing teeth, orthodontic mechanics may be complicated or often impossible because of insufficient anchorage. In these situations, it may be feasible to use the implant initially as an orthodontic anchor to facilitate complex tooth movement and secondarily as an abutment for a crown or fixed prosthesis. This article will discuss the ramifications and requirements for using implants as anchors and abutments in adult orthodontic patients.

Adult↗
PubMed1995

Uncovering labially impacted teeth: apically positioned flap and closed-eruption techniques.

The purpose of this study was to examine the esthetic and periodontal differences between two methods of uncovering labially impacted maxillary anterior teeth: the apically positioned flap and closed-eruption techniques. The sample consisted of 30 patients who were recalled a minimum of three months after orthodontic treatment of a unilateral labially impacted maxillary anterior tooth. Eighteen of the patients had undergone an apically positioned flap (APF) procedure, and the remaining twelve had undergone the closed-eruption (CE) technique. In the CE group, clinical examination showed less width of attached gingiva on the distal surface and increased probing bone level on the facial surface of the uncovered teeth relative to their contralateral controls. Uncovered teeth in the APF group showed more apical gingival margins on the mesial and facial surfaces; greater crown length on the midfacial surface; increased probing attachment level on the facial surface; increased width of attached gingiva on the facial surface; increased probing bone level on mesial, facial, and distal surfaces; and gingival scarring. Radiographic examination showed shorter roots on the uncovered teeth in both groups. Photographic examination revealed vertical relapse of the uncovered teeth in the APF group. We conclude that labially impacted maxillary anterior teeth uncovered with an apically positioned flap technique have more unesthetic sequalae than those uncovered with a closed-eruption technique.

Adolescent↗
PubMed1994

Alveolar ridge changes in patients congenitally missing mandibular second premolars.

This study investigated changes in ridge width over time in patients who were congenitally missing mandibular second premolars. Data were obtained from stone casts and radiographs of 35 edentulous sites on 22 patients representing three time periods: (1) before extraction of the primary mandibular second molar, (2) completion of orthodontic treatment, and (3) long-term evaluation. The findings indicate that ridge width decreases 25% within 3 years after primary molar extraction. The rate of decrease diminishes to 4% over the next 3 years. The change in ridge width had a weak association with the age of the patient at the time of the extraction but a small predictive value. No correlation was found between changes in ridge width and height and the time since the extraction or the age of the patient at the time of extraction.

Adolescent↗
PubMed1993

Surgical and orthodontic management of impacted teeth.

This article has accomplished four objectives. First of all, the most commonly impacted teeth have been identified. Aside from the third molars, these teeth include the maxillary canines, maxillary central incisors, mandibular second premolars, and mandibular second molars. Second, the cause of impaction has been discussed. In most situations, these unerupted teeth have been diverted or are angulated aberrantly during development. Once the root apex has closed, they lose their potential to erupt. Third, the various surgical procedures to uncover these impacted teeth have been described. Three different techniques (excision, apically positioned flap, and closed eruption technique) may be used to uncover the impacted tooth. The specific criteria used to select the proper surgical technique were stated. Last, the orthodontic mechanics and integration of tooth movement and surgical procedures were delineated and illustrated for each of the various types of impactions and uncovering techniques.

Combined Modality Therapy↗
PubMed1990

Stability of anterior openbite treated with crib therapy.

The records of 33 openbite patients treated with cribs were collected. The sample was divided into two groups with group one comprised of 26 growing patients and group two comprised of seven nongrowing patients. There was a significant increase in overbite for both groups during treatment. The nongrowing group also showed a significant increase in overbite during the posttreatment period. During the posttreatment time interval 17.4 percent of the growing sample and zero percent of the nongrowing sample exhibited relapse. However, all patients who achieved a positive overbite during treatment maintained a positive overbite posttreatment. These findings suggest that patients who achieve a positive overbite with crib therapy have a good chance of maintaining this correction after orthodontic treatment is completed. This statement appears to be true for both growing and nongrowing patients. The reason for this increased stability may be due to a modification of tongue position or posture.

Adolescent↗
PubMed1989

Stability of maxillary surgery in openbite versus nonopenbite malocclusions.

Lateral cephalometric radiographs were evaluated to determine the posttreatment stability of 66 patients treated with LeFort I osteotomies to reposition their maxillae superiorly. The sample was divided into three groups based on the degree of pretreatment overbite: openbite subsample--no incisal overlap; overlap subsample--incisal overlap and no incisal contact; contact subsample--incisal overlap with incisal contact. The cephalograms were superimposed and linear measurements were made at each interval (pretreatment, posttreatment, and at least one year posttreatment). The results clearly show that the three subsamples reacted differently during the posttreatment interval. 42.9 percent of the subsample with pretreatment openbite showed a significant increase in facial height, significant eruption of maxillary molars, and a significant decrease in overbite. 28.6 percent of the openbite subsample and 16.7 percent of the overlap subsample showed a significant increase in facial height, significant eruption of maxillary incisors, and no change in overbite. The contact subsample had no significant posttreatment changes. Possible reasons for the posttreatment instability in the openbite subsample are proposed.

Adolescent↗
PubMed1988

Osseointegrated titanium implants for maxillofacial protraction in monkeys.

Titanium implants were placed surgically into the maxillary, zygomatic, frontal, and occipital bones of four pigtail monkeys. After a 4-month healing period, the implants were exposed and abutments were placed. Extraoral traction appliances were then attached to the abutments. The cranial implants were used to support the framework of the traction appliance; those in the facial bones were used to attach springs that delivered a protraction force. The application of force varied among animals. In animal A, the force was applied to the maxilla. In animal B, the force was applied to the zygomatic bones. Animals C and D had force applied to both the maxillary and zygomatic bones. A tensile force of 600 gm per side was maintained until approximately 8 mm of maxillary anterior displacement had occurred. This amount of movement required 12 weeks of force application in animals A and B, and 18 weeks in animals C and D. Cephalometric and dry skull analyses showed that the amount of skeletal protraction was significant. The findings also demonstrated that it was possible to control the direction of maxillary protraction. The facial implants remained immobile throughout the experiment.

Animals↗