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PubMed1996

Three-dimensional interpretation of periodontal lesions and remodeling during orthodontic treatment. Part III.

In a clinical study of 11 adult patients, HR-CT-examinations were performed before or during and after orthodontic treatment with fixed appliances. The treatment period between the first and second CT-scanning varied from 12 to 24 months. Comparison of the first and second CT-examination permits three-dimensional evaluation of osteoclastic and osteoblastic alveolar remodeling. The incidence of periodontal lesions such as bone dehiscences, fenestrations and root resorptions was assessed in relation to the initial periodontal situation and the orthodontic treatment concept. Anatomical risks were a small alveolar process, thin buccal or lingual bone plates, eccentric position of teeth, basally extended maxillary sinus and progressive alveolar bone loss. Therapeutic risks were uncontrolled sagittal or vertical movements of incisors and cortical or intermaxillary anchorage preparation. CT-scanning of the alveolar process during orthodontic treatment with HR-CT allows three-dimensional interpretation of the alveolar osteodynamics, especially the development and repair of orthodontically induced bone dehiscences in relation to tooth movement.

Adolescent↗

PubMed1995

[Problems and risks in the movement of the mandibular anterior teeth].

The key role of the lower anterior incisors as well as the complicated anatomical relationship of this area play a significant part in orthodontic treatment planning. Three fundamental points of view are selected here for discussion: 1. the variability and clinical relevance of the initial periodontal findings, 2. the importance of the symphysis to sagittal and vertical tooth movement, and, 3. the specific problem associated with periodontal bone loss. The few clinical and experimental studies found in the literature indicate that every anterior tooth movement has to be oriented according to the structure and facio-lingual width of the alveolar bone and that movement should progress in a controlled fashion. Rapid tipping tooth movements are to be avoided so as to minimize the risk of bone dehiscences and root resorption. Orthodontic tooth movement should be avoided when the initial findings show a narrow symphysis or questionable labiolingual bone coverage. Pre-orthodontic thin gingiva and alveolar mucosa can be an indication for a mucosal graft aimed at preventing subsequent bone and gingival dehiscences. In the future, systematic 3-D CT analysis of pre-orthodontic and post-orthodontic findings will contribute to a better estimation of the case specific potential of compensatory bone apposition.

Humans↗

PubMed2000

[Odontogenic tumors].

The clinical symptoms of odontogenic tumors are non-specific. On the roentgenographs one most often sees radiolucencies within the bone, sometimes in combination with scattered or diffuse radioopacities. Root resorptions may be another important feature. After a short historical introduction on the development of today's classification of odontogenic tumors (WHO), each individual type of neoplasm is discussed briefly. Out of this, a therapeutic regime is developed that places each of the 22 entities into one of the following four groups: malignant, locally aggressive, tumors with recurrences, and non-recurrent ones.

Adult↗

PubMed2005

Frequency of and complications in the use of RPE appliances--results of a survey in the Federal State of Hesse, Germany.

AIM: A questionnaire was sent to orthodontists with private practices in the German State of Hesse to obtain information about the frequency of rapid palatal expansion and complications during treatment with rapid palatal expansion appliances (RPE-A). MATERIAL AND METHOD: A series of questions therein inquired as to the types of RPE-As used, their activation rhythm, the extent and the duration of the active expansion and retention; what their age limit was, starting from when surgical assistance was deemed necessary. Another series of queries concerned any technical and medical complications observed. RESULTS: The most frequently used type was the Hyrax screw (75%) soldered to bands. Technical problems arose with all applied indicated types. Although the answers to the first series of questions showed great variance, the majority of the orthodontists activated the screw twice a day (range 1-6 times a day) by a quarter turn for 2-3 (range 1-12) weeks. The retention phase amounted to 12 (range 4-26) weeks and the age limit for the indication of a surgical intervention was on average 17 years, with a range of 10-35 years. Medical complications such as pain and decubitae were reported by a third of the inquired offices, a non-opening suture was observed in one of every five practices. This meant that 1.7% of the sutures failed to open, and tooth tilting and rarely, extreme root resorptions and/or bone dehiscences were observed. Solid carious lesions were observed in one case after removal of an adhesive RPE. Extraoral changes such as those in the nose were reported by one in every ten practices. CONCLUSIONS: The RPE represents a common treatment means during which side effects are often temporary and permanent damages rather rare. It is important to inform the patient about both positive effects and possible complications, in particular pain and extraoral changes.

Adolescent↗

PubMed2006

Force systems in the initial phase of orthodontic treatment -- a comparison of different leveling arch wires.

BACKGROUND AND AIM: The determination of orthodontically-effective forces and moments places great demands on the technical equipment. Many patients report severe pain after fixed appliance insertion. Since it is assumed that pain from orthodontic appliances is associated with the force and moment levels applied to the teeth and since the occurrence of root resorption is a common therapeutic side effect, it would seem important to know the actual magnitudes of the components of the active orthodontic force systems. The aim of the present study was therefore to measure initial force systems produced by different leveling arch-wires in a complete multi-bracket appliance and to assess whether force and moment levels can be regarded as biologically acceptable or not. MATERIAL AND METHODS: The actual bracket position in 42 patients was transferred onto a measurement model. Forces and moments produced by a super-elastic nickel-titanium (NiTi) archwire, a 6-strand stainless steel archwire, and a 7-strand super-elastic NiTi archwire were determined experimentally on different teeth. RESULTS: Average forces and moments produced by the super-elastic NiTi arch wires were found to be the highest. In spite if their larger diameter, the stranded arch wires' average force and moment levels were lower, especially that of the stranded super-elastic archwire. Nevertheless, maximum force levels sometimes exceeded recommended values in the literature and must be considered as too high. CONCLUSIONS: The measured arch wires' initial force systems differed significantly depending on the type of archwire and its material structure. Stranded arch wires produced lower force and moment levels, and we recommend their use in the initial phase of orthodontic treatment.

Bite Force↗

PubMed2002

[Comparison of secondary and tertiary cleft jaw osteoplasty. 20 year analysis].

BACKGROUND: The aim of secondary cleft osteoplasty is to provide alveolar bone for the complete eruption of the canine and sometimes of the lateral incisor to the occlusal plane and, thus, preservation of a continuous dental arch. This concept has not changed during the last 20 years in our clinic, providing an opportunity for an analysis of a homogeneous group of cleft patients. This group of patients was compared with a similar group of tertiary osteoplasties, performed during the same time span in our clinic. MATERIAL AND METHODS: From 1980 to 1999, 376 cleft osteoplasties were performed in 295 patients, 264 of whom (136 secondary and 128 tertiary osteoplasties) were available for continuous prospective follow-up. Special emphasis was put on preoperative orthodontic treatment with removal of crossbites, oral hygiene, and meticulous disinfection. Autogenous cancellous iliac bone was used exclusively. RESULTS: The postoperative height of the interalveolar septum (Abyholm classes) was I (1/1, 69.4%/45.8%), II (> 3/4, 28.2%/41.7%), III (< 3/4, 2.4%/10%), and IV (complete failure, 0%/2.5%) (secondary vs tertiary). Complications were infections (6.6% vs 14%), fistulae (0.7% vs 5.8%), and external root resorption (0% vs 7.4%). The lateral incisor was aligned into the arch in 55.5% vs 29.8% and the canine was in the correct position in 100% vs 83.6% (secondary vs tertiary). CONCLUSION: Secondary cleft osteoplasty was more advantageous than tertiary due to better preservation of the neighboring teeth.

Adolescent↗

PubMed1977

Severe mandibular retrognathism: orthodontic versus surgical orthodontic treatment.

1. Treatment of Class II, Division 1 malocclusions should be accomplished by normalization of the abnormal structures that are identified diagnostically. 2. In the presence of mandibular retrognathism and unfavorable growth potential (limited amount, undesirable direction), surgical mandibular lengthening should be incorporated into the treatment plan. 3. Compensation for mandibular retrognathism by conventional orthodontic and facial orthopedic treatment incurs the risk of (a) increase in nasolabial angle, (b) reduction in upper lip support, (c) increase in lower facial concavity, (d) excessive proclination of lower incisors with compromise of labial periodontal support, and (e) protracted duration of appliance therapy and accompanying detrimental periodontal and root resorption effects.

Adolescent↗

PubMed1985

Ankylosed teeth as abutments for maxillary protraction: a case report.

It has been recognized that using the maxillary teeth to deliver extraoral force to the maxilla not only results in sutural remodeling but also periodontal remodeling and tooth movement. In patients with severe maxillomandibular malrelationships, the potential for tooth movement often limits the amount and duration of extraoral force and, consequently, affects the success of treatment. This case report describes a technique to intentionally ankylose deciduous teeth in a patient with severe maxillary retrusion. The ankylosed teeth were used as abutments to deliver an anteriorly directed intermittent extraoral force. After 12 months of treatment, the anterior crossbite was nearly corrected. At that point the ankylosed teeth loosened because of root resorption and the treatment was terminated. Cephalometric superimposition demonstrated that the occlusal correction was the result of anterior maxillary movement with little mandibular growth and no movement of the ankylosed teeth. The results suggest that intentionally ankylosed teeth may be used as abutments for extraoral traction in patients with a severe disturbance in maxillary growth.

Acrocephalosyndactylia↗

PubMedDate not supplied

Mechanical responses of the periodontal ligament in the transverse section of the rat mandibular incisor at various velocities of loading in vitro.

Stress-strain curves of the periodontal ligament (PDL) were obtained at various velocities of extrusive loading of 1, 10, 10(2), 10(3) and 10(4) mm/24 h in vitro. Significant increases of the maximum shear stress, tangent modulus and failure strain energy density were found with increases in the velocity of loading. The maximum shear strain increased from a velocity of 1 to 10 mm/24 h but decreased from 10 to 10(4) mm/24 h. It was shown histologically that the free surface of the PDL adhering to the cementum after mechanical testing was rough and irregular at higher velocities and rather smooth at lower velocities. These results showed that the mechanical properties and mode of failure of the rat incisor PDL were greatly dependent on the strain rate. It is possible that the PDL of the continuously erupting rat incisor has mechanical characteristics favourable for resisting weakly to slow and small eruptive forces but strongly to the fast and large occlusal forces as suggested previously [Chiba and Komatsu, The Biological Mechanisms of Tooth Eruption and Root Resorption (1988)].

Alveolar Process↗

PubMed1975

Healing after tooth reimplantation in monkeys. A radioautographic study.

The purpose of this study was to examine radioautographically the dynamics of tissue changes during healing after reimplantation of maxilliary incisors in adult rhesus monkeys. The period selected for the study was 1 day to 4 months. The study revealed that a new attachment will be restored after tooth reimplantation. Epithelial tissues start to proliferate immediately after reimplantation; this proliferation reaches its peak in 3 days. After 7 days a new junctional epithelium is re-established. Connective tissue proliferation reaches its peak in 7 days and starts mainly from the supracrestal connective tissue and the bone marrow spaces. The interface is undetectable after 7 days, being replaced by young connective tissue which re-establishes the continuity of the periodontal membrane and the supracrestal connective tissue. Orientation and maturation of the fibers are not observed until 4 months after reimplantation. Changes toward root resorption and ankylosis can be seen as early as 14 days after reimplantation.

Animals↗

PubMed1985

Clinical observations regarding the treatment of traumatically avulsed mature teeth. Part 1.

A documented case involving the simultaneous avulsion of two maxillary incisors, intraorally and extraorally, was reported. Long-term observations following replantation treatment revealed several interesting clinical features: The prognosis of replanted teeth may be more favorable following intraoral avulsions. The intrusion phenomenon associated with replanted incisors appears to be directly related to replacement root resorption or ankylosis; occlusal forces may be a factor. Teeth extraorally avulsed for a few hours may still provide a useful function, albeit temporary, with replantation treatment. These teeth may not reveal clinical ankylosis or replacement resorption for periods of 1 to 2 years, or possibly longer, following replantation. Long-term studies can help evaluate replantation techniques.

Child↗

PubMed1987

Central giant cell lesions of the mandible and maxilla: a clinicopathologic and cytometric study.

Computer-assisted image analysis was used to measure four histopathologic parameters (number of giant cells, mean number of nuclei per giant cell, fractional surface area, and relative size index) in two groups of patients with central giant cell lesions in a search for possible histologic predictors of clinical behavior. The lesions of 22 patients were classified clinically into nonaggressive and the lesions of 10 patients were classified into aggressive categories in accordance with the method of Chuong and Kaban. The majority of patients with aggressive lesions had recurrent tumors within 2 years and/or experienced pain, root resorption, and cortical perforation. Giant cells were selected in 25 random high-power magnification (X400) fields and measured by means of the Leitz Texture Analysis System-Plus. Linear stepwise discriminant analysis was applied to each parameter studied. Clinically aggressive giant cell lesions were characterized by a higher number of giant cells and greater fractional surface area when compared with the nonaggressive tumors. With the use of the "jackknife" classification procedure, the accuracy of the two statistically significant parameters (number of giant cells and fractional surface area) in predicting the aggressiveness or the nonaggressiveness of our group of central giant cell granulomas was, respectively, 70% and 82%. This study provides further evidence that the use of cytometric analysis of giant cells may be helpful in predicting prognosis and in planning treatment for these often difficult-to-manage lesions.

Adolescent↗

PubMed1993

Central giant cell lesions of the jaws. A clinical, radiologic, and histopathologic study.

The histology, radiographs, and follow-up information for 142 cases of central giant cell lesions of the jaws were reviewed in an effort to determine which, if any, microscopic features could be correlated with clinical behavior. The majority of these lesions were asymptomatic and relatively innocuous. However, some displayed a more aggressive clinical course characterized by root resorption, pain or paresthesia, and cortical perforation. The over-all recurrence rate in the 142 cases was 16%. Adequate follow-up information (mean, 48 months) was only obtained for 47 patients, and 23 (46%) of these experienced one or more recurrences. Statistically significant histologic differences in distribution of giant cells and frequency of osteoid within the lesions were found in lesions that recurred as opposed to those that did not. The concept that giant cell lesions of the jaws are not totally different entities from giant cell tumors is discussed.

Adolescent↗

PubMed1987

Long-term results after secondary bone grafting of alveolar clefts.

The aim of this study was longitudinally to evaluate the treatment results after secondary bone grafting in 224 cleft patients with an observation period of more than four years. The patients were divided into three groups according to age and eruption stage of the canine at the time of surgery. Group A included 94 patients with a mean age of 10 years, operated before eruption of the canine; group B included 72 patients with a mean age of 13.1 years operated after eruption of the canine; and group C included 58 patients operated after the age of 16 years (mean age, 20.4 years). The evaluation of the treatment results included longitudinal comparison of marginal bone level, periodontal status on cleft-related teeth, dental status in the bone grafted region, esthetical and functional properties of the reconstructed alveolar process, as well as the influence on growth of the maxilla. The marginal bone level was found to be significantly higher among unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) patients in the youngest groups as compared to the other groups. The number of UCLP and BCLP patients who could be treated without bridgework was significantly higher in the youngest age group than in the other groups, as were the esthetic and functional properties of the reconstructed alveolar process. External root resorption occurred in 17 patients in groups B and C. No influence of the procedure on sagittal growth of the maxilla could be demonstrated, whereas the anterior facial height was reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1996

Autotransplantation of premolars and molars in patients with tooth aplasia.

OBJECTIVES: The purpose of this study was to investigate retrospectively a group of patients who had undergone autotransplantation of teeth. METHODS: The study group comprised 29 patients who had had a total of 31 teeth autotransplanted (22 premolars and nine molars). Seventeen premolars and one molar were moved from the upper to the lower jaw. The remaining premolars and molars were moved within the same quadrant. Twenty-three teeth were transplanted in cases of agenis, two in cases of ectopic eruption, and six after loss of the first molar. The observation period varied from 3 to 16 years (average 8 years). The patients were examined clinically, and radiographs were taken of the autotransplanted teeth. In addition, the patients were asked to complete a questionnaire. RESULTS: By the end of the observation periods, four autotransplanted teeth had been extracted due to root fracture, caries, or external root resorption. In three of the patients who had lost their transplanted teeth and where no replacement had been inserted, the dentition had remained stable without tipping, rotations, or elongation. Most of the patients were happy with the autotransplantation and satisfied with the information that they had received in connection with the surgery. CONCLUSION: Although not a frequent procedure, it was concluded that autotransplantation had a good prognosis after an (average) observation period of 8 years.

Adolescent↗

PubMed1986

Autotransplantation of cryopreserved tooth in connection with orthodontic treatment.

In orthodontic treatment of certain cases of tooth loss, aplasia, or ectopia, autotransplantation is sometimes a valid treatment alternative and often provides an improved result, compared to conventional orthodontic treatment, if an appropriate donor tooth is available and the anatomic circumstances permit it. However, in some cases autotransplantation is not immediately possible as a one-step procedure. In such cases cryopreservation provides a clinically useful technique when an extraoral storage period of months or years is needed to orthodontically prepare the recipient region. In the present case a mature upper first left premolar was stored for 18 months. During this period sufficient space was achieved in the contralateral recipient region between the upper left first and second premolars. The thawed graft was autotransplanted to this position. Endodontic treatment was initiated 4 weeks after transplantation. Four years after transplantation, the periodontal healing of the grafted tooth appeared clinically and radiographically normal without any signs of root resorption. The presented case demonstrates the capacity of a cryopreserved tooth to regenerate what seems to be a normal periodontium after transplantation. If these findings are confirmed in further clinical trials, the technique could be a valuable tool in future orthodontic treatment planning.

Adult↗

PubMed2005

Rapid canine retraction and orthodontic treatment with dentoalveolar distraction osteogenesis.

PURPOSE: Duration of treatment is one of the things orthodontic patients complain about most. To shorten treatment time, a new technique of rapid canine retraction through distraction osteogenesis was introduced. The effects of dentoalveolar distraction on the dentofacial structures are presented in this article. MATERIAL: The study sample consisted of 20 maxillary canines in 10 growing or adult subjects (mean age, 16.53 years; range, 13.08-25.67 years). First premolars were extracted, the dentoalveolar distraction surgical procedure performed, and a custom-made intraoral, rigid, tooth-borne distraction device was placed. The canines were moved rapidly into the extraction sites in 8 to 14 days, at a rate of 0.8 mm per day. RESULTS: Full retraction of the canines was achieved in a mean time of 10.05 (+/-2.01) days. The anchorage teeth were able to withstand the retraction forces with minimal anchorage loss. The mean change in canine inclination was 13.15 degrees +/- 4.65 degrees, anterior face height and mandibular plane angle increased, and overjet decreased significantly at the end of dentoalveolar distraction. No clinical and radiographic evidence of complications, such as root fracture, root resorption, ankylosis, periodontal problems, and soft tissue dehiscence, was observed. Patients had minimal to moderate discomfort after the surgery. CONCLUSIONS: The dentoalveolar distraction technique is an innovative method that reduces overall orthodontic treatment time by nearly 50%, with no unfavorable effects on surrounding structures.

Adolescent↗

PubMed2005

Three-dimensional localization of maxillary canines with cone-beam computed tomography.

INTRODUCTION: Precise 3-dimensional (3D) localization of impacted canines is central to their clinical management. Recently introduced dental 3D volumetric imaging systems make precise localization possible. The purpose of this study was to describe the spatial relationship of impacted canines by using images obtained with the NewTom QR-DVT 9000 (QR Srl, Verona, Italy). METHODS: Unilaterally and bilaterally impacted canines (n = 27) from 19 consecutive patients (15 female, 4 male) were evaluated on images taken with the NewTom QR-DVT 9000. The spatial relationships of the impacted canines relative to adjacent structures and incisor resorption were assessed with 3D visualization software. RESULTS: Most (92.6%) of the 27 impactions were palatal. Incisor resorption adjacent to the impacted canine was present in 66.7% of the lateral incisors and 11.1% of the central incisors. Follicle size did not play a major role in influencing impacted canine position. The alveolus was narrower at the impacted canine side compared with the erupted canine side; however, the width of the alveolus on the impacted canine side is independent of the deciduous canines. A correlation was found between the proximity of the impacted canine to the incisors and their resorption. There was no common location where eruption was arrested, and great variation in the inclination of the impacted canine was found. CONCLUSIONS: 3D volumetric imaging of impacted canines can show the following: presence or absence of the canine, size of the follicle, inclination of the long axis of the tooth, relative buccal and palatal positions, amount of the bone covering the tooth, 3D proximity and resorption of roots of adjacent teeth, condition of adjacent teeth, local anatomic considerations, and overall stage of dental development. In short, 3D imaging is clearly advantageous in the management of impacted canines.

Adolescent↗