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To ensure eruption of the dentition in patients with cleidocranial dysostosis, close collatoration between the oral surgeon and the orthodontist is essential to determine the sequence of extraction, the teeth to be ligated, the preferred technique of ligation, and the approach for surgical exposure.
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.
Many dental practitioners do not use adhesive bridges because of concerns over high failure rates. Techniques for these restorations should be based on the fundamental principles of bridge design which require rigid, accurately fitting frameworks and careful control of the occlusion. The abutments generally require little if any tooth preparation. Greater security will result from more extensive coverage of abutment teeth: the routine use of relative axial tooth movement is a predictable method for creating the space that this approach requires.
The problem of impaction of the maxillary anterior teeth can be solved under cooperation of the oral and maxillofacial surgeon and the orthodontist. In that way unerupted teeth which in the past were scheduled to be extracted, nowadays can be saved and take their place in the dental arch. There are various surgical techniques of exposure of unerupted anterior maxillary teeth, for orthodontic management. Decision of the most suitable for each individual case can be taken after careful analysis of the diagnostic data from the surgeon and the orthodontist taking under consideration the location of the unerupted tooth, the periodontal status and the patients' cooperation. In this paper reference is being made in different techniques of surgical exposure for orthodontic traction with regard to the maintaining of a good tooth-gingiva relationship. Same clinical cases are also presented.
The historical movement towards the adoption of the bioprogressive technique for postgraduate teaching on the Cardiff course is outlined. The department's experience in routinely teaching and using the appliance is described, with illustrations from a number of post-graduate cases. The advantages and disadvantages of a pre-adjusted sectional mechanics system are considered. The place of sectional mechanics in the future is discussed together with how such techniques may be included, with advantage, in any taught preadjusted appliance system.
Forced eruption offers a method of treatment of teeth fractured close to the alveolar crest. We introduce a modification of this common technique. The fractured fragment of a patient's crown is bonded to the adjacent teeth and used as anchorage, permitting the root extrusion while offering acceptable aesthetics. The bonded crown does not impede the eruption of the root so that the frequent occlusal adjustment of other methods is not required. The final result is acceptable and a low cost alternative to common techniques.
Impacted maxillary canines in oblique horizontal positions may make orthodontic appliance treatment hazardous or impossible. Autotransplantation may be considered but the removal of the canine is often difficult and since atraumatic removal of the transplant is essential, autotransplantation is then impossible. A new possibility is orthodontic pre-treatment with distal and vertical traction of the impacted maxillary canine to bring the maxillary canine to a more favourable position and facilitate surgical removal and autotransplantation. Eight canines were surgically exposed and pre-treated prior to autotransplantation. Of 21 autotransplantations of maxillary canines, 20 were successful, among them all eight pre-treated cases. The orthodontic and surgical technique is described and illustrated in two case reports.
Treatment of impacted teeth is often a combination between oral surgery and orthodontics. This study evaluates the gingival condition of impacted teeth after surgical-orthodontic treatment, where two different surgical methods were used. In one group (n = 11) the teeth were radically exposed and orthodontically moved to their final position. In the other group (n = 11) the teeth were partially exposed by raising a mucoperiosteal flap. Orthodontic traction was then applied; whereafter the flap was sutured back into place. The results showed that one of the teeth in the partial exposure group and seven in the radical exposure group showed loss of attachment. This study indicates that a combination of mucoperiosteal flap technique and applied orthodontic traction is prefered to minimize the loss of attachment in cases of displaced impacted teeth.
After a brief description of Dr. Mollin's technique, the article reports the case history of a twelve year-old girl on whom transposition of retained canines was performed by such procedure.
In cases of orthodontic traction of unerupted teeth, gingival recession and long clinical crowns are often seen. Satisfactory esthetic demands are not always met. A case of an unerupted maxillary central incisor is presented, in which traction was used, with emphasis on the surgical technique and the direction of the pull. The result was clinically favorable. The appearance of gingival margin was restored.
Distraction osteogenesis (DO) has been used recently to correct maxillary hypoplasia with predictable and stable results. In patients with clefts of the secondary palate, DO can also be used to aid in vertical alveolus augmentation and rapid orthodontic tooth movement. If an osteotomized dental arch can be transported to a new position without complications, it would reduce or eliminate the need for a secondary bone graft to the cleft alveolus in cleft patients and help prevent dentoalveolar defects by approximating the native alveolar bone and gingiva. Mobilizing a segment in the dentoalveolar region also results in the creation of new bone and attached gingiva. This report shows that the application of DO for skeletal expansion and rapid movement of tooth-bone segments should receive more careful consideration in the treatment of patients with clefts of the palate.
A new and simple technique for aesthetic tooth replacement during orthodontic treatment, with a pontic using orthodontic wire mesh, is described and appears in the author's clinical practise to be superior to the other techniques reported previously. These pontics may be used in maxillary first bicuspid extraction cases, and with adaptation where anterior teeth have to be replaced because of agenesis, extractions, or traumatic loss. This technique thus also provides the clinician with an aesthetic and dependable space maintainer for anterior teeth whilst orthodontic treatment is being completed.
Dilaceration is one of the causes of maxillary central incisor eruption failure. Surgical excision is frequently the first choice of treatment for a severely dilacerated incisor. In this article, the case of a horizontally impacted and dilacerated maxillary central incisor was diagnosed and treated by surgical exposure using the apically repositioned flap technique combined with orthodontic traction. The dilacerated incisor was successfully moved into alignment, with pulpal vitality and periodontal health present 2 years following treatment.
Different designs of Begg torquing auxiliary have been tested to measure the forces produced at the apex of a tooth. Forces at the tooth surface ranged from 0.4 to 3.3 N, equivalent to 0.1-0.9 N at the root apex.
This article reports a case of a maxillary second premolar which on presentation was partially erupted, and which resisted attempts at orthodontic extrusion. The crown of the tooth was eventually restored using an adhesive composite onlay technique. The patient subsequently complained of pain and the root of the tooth showed radiographic evidence of resorption. The root of the extracted tooth had a vital pulp but massive external resorption was evident, with repair with bone-like material.
BACKGROUND: The aim of this 2-year longitudinal study was to compare the width of keratinized gingiva after orthodontic therapy for buccally erupting premolars that had been pretreated by extraction of deciduous teeth alone versus interceptive mucogingival surgery. METHODS: In 8 patients (aged 9 to 12 years) who presented with bilateral buccal eruption of homologous teeth (premolars), one side was randomly treated with extraction of the deciduous molar and mucogingival surgery (test site), while the other side was treated only by extraction of the deciduous molar (control site). All of the subjects underwent orthodontic treatment with fixed appliances. RESULTS: At the baseline visit prior to any treatment, there was no significant difference between the mean amount of keratinized gingiva at test sites (3.06 mm) and control sites (2.93 mm). Two years later, upon completion of orthodontic treatment, there was a significant difference between test (2.93 mm) and control (1.37 mm) sites in the mean width of keratinized tissue. In the control (untreated) group, 2 sites exhibited 1 mm of gingival recession after orthodontic treatment. CONCLUSIONS: Mucogingival interceptive surgery is an effective technique to maintain keratinized tissue in correspondence with buccally-erupted teeth.
Palatally impacted permanent maxillary canines are a relatively common dental anomaly of unknown etiology. Early diagnosis of these impactions and subsequent intervention reduce the risk of further complications and may even remedy the impactions. Additionally, several surgical techniques can be used to resolve the impactions when intervention is not sufficient. An understanding of effective diagnosis and treatment of these impactions is imperative to the health and well-being of the teeth and supporting periodontium.
A technique is described for bonding gold traction chain directly to the enamel surface of unerupted teeth using a visible light-cured adhesive. This method obviates the need for a bracket and relies on direct, rather than transmitted illumination.