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Taking the guesswork out of mandibular symphyseal distraction osteogenesis.

Mandibular symphyseal distraction osteogenesis has recently been introduced as a means of resolving arch length deficiencies in the anterior segment and as a method of reducing large vestibular spaces related to a narrow mandible. Accurately relating the required distraction for a given anterior tooth mass and desired future anteroposterior location of the central incisors has not been possible until recently. The relationship between these 3 controlling factors has been mathematically described by the hyperbolic cosine function and a computer program designed for easy use by the clinician. Two clinical cases illustrate the application of the program. A Web site where the program can be downloaded at no cost is mentioned.

Algorithms↗

Segmental odontomaxillary dysplasia: an unusual orthodontic challenge.

Segmental odontomaxillary dysplasia has only recently been delineated from other osseo-odontogenic dysplasias. Yet, this seldom-reported developmental abnormality might be diagnosed by a unique combination of clinical, radiographic, and histologic findings. Unilateral maxillary hyperplasia combined with displaced molars and unusual bone trabeculation is quite obvious at an early age. Recognition and subsequent reporting by dental specialists is encouraged to more clearly define the natural progression and the appropriate treatment of this abnormality.

Bone Diseases, Developmental↗

Reperfusion of autotransplanted teeth--comparison of clinical measurements by means of dental magnetic resonance imaging.

OBJECTIVE: Dental magnetic resonance imaging (dMRI) with administration of contrast material is one method of assessing pulpal perfusion. The purpose of this study was to evaluate the level of contrast enhancement displayed by means of dMRI after transplantation of teeth and to compare these findings with the results of tooth mobility, pocket depth, cold, and electrical tests. STUDY DESIGN: Twenty-three teeth with either complete root formation or incomplete root formation (IRF) were investigated by using dMRI and were clinically examined at intervals of 2, 4, 8, and 12 weeks, as well as 6 months and 12 months after transplantation. RESULTS: An analysis of the enhancement in the dental images revealed a significant difference between teeth with IRF and teeth with complete root formation. In addition, the time to occurrence of a positive reaction to the cold test was significantly longer for teeth with IRF. CONCLUSIONS: The findings of this study indicate that transplanted IRF teeth are associated with reperfusion seen by means of dMRI as well as with delayed occurrence of a positive cold test.

Adolescent↗

Analysis of the morbidity of submerged deciduous molars: the use of imaging techniques.

A case is presented of a 13-year-old patient who had a class I occlusion on a class I skeletal base but with a retained and submerged deciduous molar causing impaction of the second premolar. Diagnostic imaging illustrates the potential challenges of the removal of the retained deciduous molar. Magnetic resonance imaging used to identify the path of the inferior alveolar neurovascular bundle clearly delineates its intimate association with the impacted teeth and underscores the risk of trauma during extraction. This is discussed with regard to other cases of submerged molars, and a strategy is outlined.

Adolescent↗

Chronic inflammation around painless partially erupted third molars.

OBJECTIVES: We sought to assess the histologic host response in chronic, symptomless pericoronitis. STUDY DESIGN: Gingival mucosal (n = 20) and dental follicle (n = 20) samples were collected during extraction from patients with pericoronitis and clinically healthy control subjects. Antibodies-recognizing macrophages (CD68), natural killer cells (CD56), T cells (CD2), helper T cells (CD4), suppressor/cytotoxic T cells (CD8), and neutrophils (lactoferrin) were applied in a labelled streptavidin-biotin method by using a DAKO TechMate staining robot. RESULTS: Macrophage was the most numerous kind of cell in pericoronitis, but CD2+ T lymphocytes, with a normal CD4/CD8 ratio, were also increased (P < .01). Neutrophils were not increased and did not show signs of activation. Dental follicles did not contain increased numbers of inflammatory cells. CONCLUSION: This type of pericoronitis is a chronic/smoldering, rather than an acute/purulent, infection. Because of the chronic and often symptomless nature of pericoronitis, various long-term sequelae may result, which may lead to the need for extraction.

Adult↗

Lingual forced eruption orthodontic technique: clinical considerations for patient selection and clinical report.

Lingual forced eruption is a treatment modality that minimizes esthetic impairment during orthodontic treatment. Use of this technique can enhance the acceptance of orthodontic treatment by adult patients and minimize unnecessary compromises in the treatment planning of submerged roots. In this clinical report, a treatment modality for forced eruption therapy is described, clinical considerations for patient selection are identified, and the advantages and limits of the lingual orthodontic technique are discussed.

Crown Lengthening↗

Diagnostic value of clinical examination for the identification of children in need of orthodontic treatment compared with clinical examination and screening pantomography.

Ninety children in the 5th school grade (means age = 11.9 years) participated in this investigation. As part of the orthodontic screening examination, pantomograms of all children had been performed as a routine procedure. Prior to assessment of the pantomograms each child was assigned to one of the following treatment categories based on clinical examination: -T (no indication for orthodontic treatment), O (observation of dentition development) and +T (indication for orthodontic treatment). Children, in whom clinical symptoms gave rise to a radiographic examination, were selected and their pantomograms assessed. Finally, the pantomograms of all children were interpreted, and the clinically established treatment categories re-evaluated on basis of the findings on the pantomograms. Fifteen children were selected for pantomography, but only one changed treatment category (from O to +T) due to observation of developmentally missing premolars. Three of the children not selected for pantomography changed categories from -T; two to O and one to +T. Clinical examination with selective pantomography was thus able to correctly identify 97 per cent of children in need of immediate orthodontic treatment, while it was able to correctly exclude 94 per cent of the healthy children. On the basis of these results, routine screening pantomography may be omitted.

Anodontia↗

Arrested eruption of the permanent lower second molar.

The incidence of retention/impaction of the permanent lower second molar (M2inf) lies between 0.6/1000 and 3/1000. Therefore, the purpose of the present study was to investigate the craniofacial morphology, the frequency of dental anomalies and the inclination of the affected M2inf and the adjacent first molar in patients with arrested eruption of M2inf. The overall goal was to elucidate the aetiology of arrested tooth eruption and to present the characteristics of these patients in order to improve diagnosis and treatment planning. Radiographic material (profile radiographs and orthopantomograms) from 19 patients (nine females and 10 males; 13-19 years of age at the time of referral) were analysed. The ages of the patients when profile radiographs were taken for cephalometric analysis varied from 8 to 16 years. The study shows that this group of patients, compared with a reference group, had an increased sagittal jaw relationship (Class II). Specifically, the mandibular prognathism was less, the mandibular gonial angle smaller, the mandibular alveolar prognathism enlarged and the maxillary incisor inclination less than in the reference group. Furthermore, this group of patients had a more frequent occurrence of morphological tooth anomalies, such as root deflections, invaginations, and taurodontism. However, none of the patients with arrested eruption of M2inf had agenesis of the lower third molar. The study did not reveal an association between the degree of inclination of the M2inf and that of the first molar in the same region. The results of this investigation show that conditions such as the craniofacial morphology and deviations in the dentition are associated with arrested eruption of M2inf. Therefore, it is important to evaluate these conditions in future diagnosis and treatment planning of patients with arrested eruption of M2inf.

Adolescent↗

Unilateral primary or secondary retention of permanent teeth, and dental malformations.

The purpose of the present investigation was to describe the dentition in subjects with local primary or secondary unilateral retention of two or more permanent teeth, and to elucidate the aetiology by comparing the regions of retention with the innervation pattern of the jaws. The material comprised radiographic dental orthopantomograms (OTP) from 12 patients with an age range of 6-18 years (six females and six males). The locations of retention and the dental morphology in the affected regions were analysed. Comparison with contralateral teeth was undertaken and the innervation pattern of the affected field was considered. Varying degrees of dental root malformation were found to be associated with primary and secondary retention. More pronounced root malformations were observed in subjects with several affected teeth. A connection between unilateral retained permanent teeth and temporary or permanent disruption of the nerve supply to the affected region is suggested.

Adolescent↗

Orthodontic treatment need and demand in 12-14-year-old north Jordanian school children.

This study was undertaken to assess the need and demand for orthodontic treatment among 12-14-year-old north Jordanian school children. In total, 1002 students randomly selected to represent five geographical areas of Irbid were examined. The examinations were carried out twice, first on the pupils in the school premises and then using study models taken from each student. The dental health (DHC) and aesthetic (AC) components of the Index of Orthodontic Treatment Need (IOTN) were used as an assessment measure of the need for orthodontic treatment. The demand for orthodontic treatment was measured by asking the students 'if it was necessary, would they like to have their teeth straightened by an orthodontist'. The results showed that approximately one-third (34 per cent) of the children examined had a definite need for orthodontic treatment. Within this group, 73.5 per cent were in need of orthodontic treatment according to the DHC, 23.5 per cent had both DHC and AC great need scores, and 3 per cent were in need according to the AC only. Severe contact point displacement of more than 4 mm was the most common occlusal feature in the definite treatment need group, followed by impeded eruption of teeth, hypoplasia of a single tooth and increased overjet of more than 6 mm but less than or equal to 9 mm. The demand for orthodontic treatment among the students was 49 per cent. Approximately half of them (54 per cent) had a definite need for orthodontic treatment. This study provides baseline data on the need and demand for orthodontic treatment among a Jordanian population, which is important for planning public orthodontic and dental services.

Adolescent↗

The clinical features and aetiological basis of primary eruption failure.

Primary failure of eruption (PFE) is a poorly understood condition associated with tooth eruption failure. This investigation systematically reviews the literature, evaluates clinical features and associations with PFE, and describes five further cases. Publications were selected and identified as describing PFE when there was no identifiable aetiological factor contributing to eruption failure and no evidence of successful orthodontic extrusion of the affected tooth or teeth. A data abstraction form recorded the following additional information; subject age, gender, general health status, and teeth present. Eighteen publications were sourced that detailed at least one case of PFE in a manner conforming to the selection criteria; these papers included a total of 35 individual cases, to which five previously unreported subjects were added. Within the whole sample of 40 cases, a total of 24 (60 per cent) were females and 16 (40 per cent) males. First and second molar teeth were most commonly affected; incisors, canines, and premolars were also involved, but with a reduced individual frequency. There was no significant difference in incidence between the maxilla and mandible, or between left and right sides. A family history of eruption failure was found in almost 50 per cent of the sample, with eruption failure or ankylosis affecting at least one primary tooth, also a common finding. Within the 40 cases, hypodontia was present at levels higher than population norms. PFE appears to be a condition that predominantly affects the molar dentition. The increased frequency of hypodontia in affected individuals and common findings of a family history regarding tooth eruption problems suggests a significant genetic component to the aetiology of this rare condition.

Adolescent↗

Primary retention of first permanent mandibular molars in 29 subjects.

This study consisted of two parts: the first part describes the aetiology behind primary retention of first permanent mandibular molars by comparing the affected molar region with the contralateral region, and the second the follow-up of the retained molars. The material comprised dental pantomograms from 29 patients (17 males and 12 females; aged 6 years 2 months to 12 years 5 months) which were sent by Danish public dental clinics to the Department of Orthodontics at Copenhagen Dental School for treatment guidance (Part 1). Questionnaires were later sent to the dentists for follow-up information regarding the affected teeth (Part 2). Part 1-aetiological evaluation: From each radiograph, the number and location of the molars, maturity of individual molars, and deviations from normal morphology were recorded. The findings showed that, in an affected region, disruption of normal dental development and eruption had occurred, causing a delay in dental maturity as well as arrested eruption of the first molar. Part 2-follow-up of eruption: Completed questionnaires and radiographs were returned for 25 subjects. In 10, eruption had occurred, six after surgical removal of mucosa covering the retained first molar. In eight patients the molar had been removed while in seven the observation time from first diagnosis was too short to evaluate eruption. The results indicate that retained first permanent mandibular molars have the ability to erupt and suggest that a unilaterally retained first permanent mandibular molar may represent a temporary delay in eruption rather than permanent failure.

Child↗

Severe Infra-occlusion and failed eruption of deciduous molars associated with eruptive and developmental disturbances in the permanent dentition: a report of 28 selected cases.

Retrospective analysis of 28 children suffering from severe infra-occlusion and/or primary failure of eruption of deciduous molars revealed an association with eruptive and developmental disturbances in the permanent dentition, including ectopically placed teeth and aplasia of teeth. Taurodont permanent molars were evident in 19 of the 28 selected cases which suggests a possible developmental relationship between these factors. Problems in relation to treatment of these cases are discussed.

Adolescent↗