Restorative and orthodontic treatment of an adolescent patient with amelogenesis imperfecta.
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The dental arch post-therapeutic modification plays a significant role in relapse phenomenon. This article describes the design work of the dental arches used as a base for the study of modifications that have arisen during orthodontic treatment then during the retention stage using pre-formed arch wires. ARCAD'Image software tries to design the patients dental arches by submitting a linear regression mathematical design on some characteristic landmarks of a photograph of the buccal impression. The designed dental arch can then be considered as being the closest/nearest to the patients morphology. This model enables the practitioner to bend the arch wire and is used as a base for the study of arch shape modifications. Our study shows that the term "relapse" appears to be used excessively; it would be more matter of evolution due to changes in neuro-muscular balance along with facial aging.
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The occlusions of sixty-five patients, treated by one private specialist orthodontist with consistent philosophy and goals, were assessed according to the PAR Index. For each patient, pre-treatment, post-treatment and follow-up study models were assessed. Follow-up models were taken at least 6.5 years following the removal of all retention appliances. Mean-weighted PAR scores were calculated for the total sample and various sub-groups at each stage. Mean percentage changes in weighted PAR scores were also calculated. The relationships between the occlusal standards at the end of active treatment and at the end of the follow-up period, and specific diagnostic and treatment factors were then investigated to search for any factors that might be predictive of long-term post-treatment occlusal stability or instability. The overall mean-weighted pre-treatment, post-treatment and follow-up PAR scores were 25.5, 3.0 and 7.0, respectively. There was an 85.6 per cent decrease with treatment in the overall mean-weighted PAR score. This was followed by a 15.2 per cent increase in that overall mean during the follow-up period. In this introductory study, neither the PAR score at the end of active treatment, nor the amounts of occlusal change occurring during or after active treatment, were found to be predictive of the amount of post-treatment occlusal change.
The 13-year-old female patient presented for correction of a severe Class III malocclusion with a Class III skeletal pattern. This was considered an appropriate age for treatment as earlier treatment may have been subject to relapse because significant facial growth may have occurred after treatment, and because treatment at a later age may have required orthognathic surgery. Initially, maxillary expansion was provided to widen the maxilla and to free the circum-maxillary sutures. Maxillary protraction headgear was worn to perform sagittal skeletal improvement. Fixed orthodontic appliances were placed to align the dentition and Class III elastics were used to improve intercuspation and stability. Patient cooperation was crucial for success. The skeletal changes provided rewards that included significantly improved facial and dental appearance, while avoiding orthognathic surgery.
The (in)stability of orthodontic treatment is a daily problem in orthodontics. This implies that retention--in whatever way--also remains an actual subject. There is however scarce valid scientific evidence on the topic of retention.
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This case presentation concerns the correction of a moderate Angle Class II division 1 malocclusion of a patient whose treatment began during the late mixed dentition. Owing to the need to preserve and improve the existing facial aesthetics, treatment was started with a non-extraction approach and, in order to exploit favourable dentofacial growth changes and to avoid the possibility of extraction of teeth, was timed to coincide with the patient's expected adolescent growth spurt. Fixed appliances only were used. Special consideration had to be made for the patient's fractured upper central incisor teeth. An aesthetically pleasing treatment outcome was achieved within the expected time frame for correction. The case shows the successful combination of typical Begg mechanotherapy used during the early stages of treatment and Tip-Edge rectangular archwire mechanotherapy as used for the later and finishing stages.
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Historically there has been a long-standing debate regarding the orthodontic management of dentitions with missing maxillary lateral incisors. Whether to provide space for prosthetic replacements or to close space utilizing the canines as substitute lateral incisors are the options of treatment planning for an individual. This presentation is directed at the orthodontic management of those patients who were orthodontically treated in the past by providing space for replacement lateral incisors and now at dental maturity or even later, seek a prosthetic replacement in the form of an osseointegrated fixture. In many instances there will be inadequate interradicular bone space and yet at the time of debanding adequate space often was present and now some years hence the patient is faced with orthodontic re-treatment to provide that space again. Whilst that is a challenge in itself, there is a further apparent problem to be met for those younger patients requiring space opening mechanics in deciding upon and implementing at the debanding phase, the form of retention that will hold the teeth and the roots firmly in position until the time is right for an osseointegrated fixture to be placed and treatment finalized.
Even in the most stable types of orthodontic treatment, any relapse at all may be unacceptable cosmetically. Through the placement of a reinforced composite splint, the teeth can be held in position and more significantly recontoured, thus augmenting the final result. Subsequent splint removal can be done incrementally 3 to 5 years after placement as the patient desires.
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A temporomandibular joint case with an anterior open bite and a high mandibular plane angle was treated by erupting the posterior teeth after creating a posterior open bite using a Garcia Distraction Appliance and a Garcia Pivot Splint.
Orthodontic treatment has as its goal in most patients to achieve a cosmetic and functional result. There are functional goals for all orthodontic treatment and in some few cases the functional outweigh the cosmetic; an example would be a cleft-palate case. Orthodontic finishing to a specific condylar position is not routinely a goal of orthodontic care. The reason for this is that only patients who have pain, dysfunction and a negative change in quality of life from their temporomandibular apparatus need this tangential type of treatment. Research has shown that most patients suffering from a temporomandibular disorder (TMD) have displacement of the temporomandibular disk(s). Research has shown that when the mandibular condyle is repositioned to the Gelb 4/7 position that the temporomandibular joint disk is recaptured to a normal position between 85% and 96% of the time. The Gelb 4/7 position has been equated to the physiologic position of the mandibular condyle in the glenoid fossa. TMJ condyle repositioning to the physiologic position has been correlated to disk recapture proven by magnetic resonance imaging (MRI). A case is shown in which a displacement without reduction is manipulated into reduction and maintained with orthodontic correction. TMJ disk displacement without reduction is usually preceded by TMJ disk displacement with reduction. Pumping of the upper joint compartment can assist in reducing the TMJ disk displacement without reduction. Magnetic resonance imaging before and after the manipulation and after orthodontic treatment are shown. A detailed method of orthodontic finishing that maintains a specific condylar position and TMJ disk recapture is shown.
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