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[The surgical-orthodontic classification of retained and dystopic teeth of the second dentition in dysostosis cleidocranialis].

Dysostosis cleidocranialis concerns both teeth and jaw and is characterized by supernumerary teeth, dentitio tarda, tooth impaction and eventually follicular cysts. The concept of treatment can be divided in two stages: 1. At the beginning of the delayed secondary dentition (dentitio tarda) the operative removal of the supernumerary tooth germs and 2. corresponding to the belated morphological development (dentitio tarda) the operative exposure of the impacted teeth of the secondary dentition. The first operation facilitates a morphological development and especially a vertical drift without any obstacles. The second becomes necessary when only the morphological development, but not the vertical drift of the teeth of the secondary dentition takes place. The operative exposure is done using a self-developed technique [13, 18]. At the same time as the exposed teeth undergo a spontaneous vertical drift, orthopedic treatment for anomaly is started.

Adolescent↗

[Early deciduous tooth loss--the mature or immature eruption of their permanent successors].

On the basis of 147 panoramic radiographs of 49 patients, this study investigated the influence of the premature loss of deciduous teeth on the formation of their permanent successors at the time of their eruption. Furthermore the study investigated the eruptive movement of the successor teeth at the time of eruption. In addition to detecting the accelerated emergence of still immature successor premolars, the study also determined that the extraction ot the deciduous molars before the age of eight years delayed the eruption of the permanent successors given the absence of an infected deciduous tooth with abscess formation. In relation to the eruptive movement of the permanent molars due to the premature loss of the second deciduous molar, the study ascertained a mesial movement of the first permanent molars and an accelerated eruption of the second permanent molars.

Age Factors↗

Management of an extremely displaced maxillary canine.

CASE REPORT: Aligning a displaced maxillary canine into the dental arch is one of the most complicated problems in orthodontics. In cases of extremely high displacement, the tooth is frequently removed surgically. Because of the upper canines' significance to dental esthetics and functional occlusion, such a decision is a very serious one. This case report illustrates the treatment of an extremely high displaced maxillary canine. CLINICAL FINDINGS: The main diagnosis was the displacement and the retention of tooth 13 (in nearly horizontal position, apical to the neighboring teeth); further diagnoses were: transversal maxillary deficiency with frontal crowding and a distal bite of one premolar in width, a deep bite of 6 mm with contact in the palatal mucosa, mandibular midline deviation of 2.5 mm to the right, lingual eruption of teeth 32 and 42, retroinclination of the maxillary incisors, and retarded eruption of the permanent teeth. THERAPY: Initial treatment with active and functional appliances to correct the distal bite, midline deviation and deep bite. Surgical exposure of the high displaced canine at the age of 14. Onset of cuspid elongation with removable appliances and elastics, further movement with a transpalatinal bar and welded arm, and full alignment of the upper and lower arches with fixed appliances in both jaws. Stabilization of the orthodontic treatment results with retention devices. Duration of treatment: 5 years and 8 months. For the alignment of tooth 13, 2 years and 10 months were required; 1 year and 4 months were necessary with complete fixed appliance. CONCLUSIONS: The aim of this case report was to demonstrate the potential of aligning an extremely displaced canine. Because of the esthetic and functional importance of the upper canines, therapeutic alignment should be initiated, provided there are no indications to the contrary.

Child↗

Maximum anchorage in orthodontics with the palatal implant: maximum anchorage in orthodontics with the palatal implant.

Maximum anchorage in the maxilla can only be achieved by using headgear worn full-time or by using an implant. As full time wear requires considerable patient cooperation, we describe a technique for use of the Straumann Ortho Implant, exemplified by a case presentation. The cephalometric analysis at the end of therapy confirms that the upper molars did not slip forward during treatment (no anchorage loss).

Bone Screws↗

Alignment of displaced or impacted teeth with the traction chain.

To align those teeth in the dental arch that cannot erupt or are displaced, they must be surgically exposed. After the traction device is attached, the tooth is again covered with the mucoperiosteal flap to protect the tissues involved. For this reason, the loss of this traction device must be absolutely avoided in order to prevent another surgical intervention. Here at the University of Ulm, we have developed and tested an optimized traction chain for that purpose. The chain is attached to the tooth with a laser-roughened pad applying the acid-etching technique. The chain links serve as fixation elements for traction devices such as elastic ligatures or piggyback archwires. At the same time, one can determine the distance covered by the tooth by the number of the erupting chain links. We demonstrate the clinical application of this traction device in two cases.

Child↗

The displaced maxillary canine--a retrospective study.

OBJECTIVE: The re-alignment of retained maxillary canines was studied in relation to the degree of displacement in panoramic radiographs, mesiodistal root deviations, length of treatment and side-effects. The aim was then to determine whether the decision between surgical removal and orthodontic re-alignment can be made on the basis of panoramic radiographs alone. MATERIALS AND METHODS: Forty-seven panoramic radiographs with 59 displaced canines were used to determine their distance and inclination to the occlusal plane (similar to the method described by Dausch-Neumann [8]), the position of the crown tip, and the frequency of mesiodistal root deviations. The length of active treatment was recorded and analyzed statistically in relation to the degree of displacement and incidence of root deviation. Finally, pre- and post-therapeutic panoramic radiographs were compared to determine the incidence of root resorptions and marginal bone defects. RESULTS: The mean values for the angle of inclination and the distance of the maxillary canines from the occlusal plane were 57.4 degrees (+/- 14.3 degrees ) and 10.5 mm (+/- 3.8 mm), respectively. In 21 canines, the crown tips projected most frequently between the central and lateral incisors. Twelve canines presented root deviations. Treatment lasted an average of 1.9 years (+/- 0.7 years). No correlation was found between the treatment time and the canine's distance from the occlusal plane (r = 0.03), its angle of inclination (r = 0.06), position of the crown tip (r = 0.12), or root deviation (r = -0.07). Root resorptions were found in nine canines (15.3%) and marginal bone defects in 24 canines (40.7%). CONCLUSION: Fifty-nine retained maxillary canines, some showing extreme displacement, were re-aligned in an average of 1.9 years. There was no correlation between the degree of canine displacement in the panoramic radiographs or the incidence of mesiodistal root deviations and active treatment time. For this reason, the indication to remove displaced maxillary canines should not be taken from panoramic radiographs alone.

Adolescent↗

Second premolar serial extraction.

Serial extraction of mandibular second premolars should be considered if they are impacted or in cases with moderate arch length deficiency combined with an absence of dentofacial protrusion. The favorable dental changes associated with this approach greatly minimize future orthodontic treatment complexity and time.

Anodontia↗

Mucogingival problems and the movement of mandibular incisors: a clinical review.

In recent years "mucogingival problems" have received considerable attention in the literature. This clinical review distinguishes between variations in gingival morphology having minimal attachment and frank localized pathosis. It is suggested that some cases of potential or actual mucogingival deficiencies may be improved by tooth movement. Since orthodontic and conservative periodontal therapy may induce changes in the character and level of the attached gingiva, surgical grafts may be unnecessary or at least deferable.

Adolescent↗

Orthodontic management of mandibular canine-incisor transposition.

This article presents five cases of an unusual dental anomaly--transposition of mandibular canine and lateral incisor. While every one of the presented cases had its individual characteristics, there are certain common traits. For instance, deciduous canines are usually retained, and the anomaly is found concurrent with other dental problems, such as congenital absence of teeth or peg-shaped lateral incisors. Many transposition cases also have a severe arch length discrepancy, which in itself may be an etiologic factor. In two of our cases orthodontic management included extraction of the transposed lateral incisor, whereas in the remaining three cases teeth were left in their transposed positions. On the basis of the longitudinal records of one of our cases, we speculate that there are early signs of transposition in the making, signs which should be recognized and which could possibly make transposition preventable.

Adolescent↗

Orthodontic therapy for the restorative patient. Part I: The biomechanic aspects.

The integration of interspecialty treatment before the restorative and prosthodontic efforts of the dentist can eliminate conditions that have the potential to jeopardize successful completion of the proposed treatment. Adult dentitions that have deteriorated because of neglect, fear, caries, extractions, or trauma can be restored to stability, health, function, and esthetics. In "Part I, The biomechanic aspects," the orthodontic paralleling of proposed abutment teeth displays premolar (buccolingual) and molar (mesiodistal) uprighting procedures that achieve improved force distribution to these teeth. Molar intrusion (occlusoapical) to improve an occlusal plane distribution of adverse forces to the proposed opposing fixed partial denture is discussed. These vexing problems facing successful reintegration of the altered states of occlusal relationships frequently can be answered by the incorporation of preprosthodontic corrections.

Adult↗