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PubMed1982

Clinical assessment of injuries in orthodontic movement of impacted teeth. I. Methods of attachment.

Recent studies have indicated ankylosis, loss of attachment, and external resorption occurring as sequelae of orthodontic movement of impacted teeth when these teeth are ligated around the cervix with wire. The purpose of this study was to record the effects of two commonly employed methods of attachment to impacted teeth--the wire ligation and the direct bond. Twenty subjects who had previously undergone full-banded orthodontic treatment involving a unilateral impacted maxillary canine were studied. The contralateral non-impacted maxillary canine served as a control. In eight of the subjects the impacted canine was ligated at the cervix with wire at the time of surgical exposure. In the other twelve subjects the impacted tooth also was exposed surgically but then an orthodontic bracket was bonded directly to the tooth approximately 2 weeks after the surgical exposure. The criterion for the diagnosis of ankylosis was failure to move the tooth for at least 3 months. The diagnosis of external resorption was made from radiographs. Loss of periodontal attachment was measured by comparing the level of attachment on the previously impacted tooth with the contralateral canine 3 months after debanding. The results indicated that three of the eight patients in the group receiving wire ligation exhibited external resorption and ankylosis. Also, there was an average of 1.36 mm. greater loss of attachment in all four proximal and lingual probing measurements of teeth ligated with ligature wire but no significant differences in the direct buccal probing measurement.

Adolescent↗

PubMed1982

Assessment of the therapeutic position for orthodontic diagnosis and treatment.

The authors discuss the influence of mandibular displacement in intercuspal position (ICP) on orthodontic planning and treatment. The correct therapeutic position in orthodontics should be assessed on the basis of clinical and radiographic parameters. Posteroanterior cephalograms can be of great diagnostic value; deviation from the norm of some measurements is highly indicative of a mandibular displacement in ICP. A repositioning occlusal splint is then constructed in the therapeutic position before the definitive orthodontic treatment is started; the splint should lead to improvement of the clinical and cephalometric data.

Adolescent↗

PubMed1986

Clinical crown length and reduction in overjet, overbite, and dental height with orthodontic treatment.

To evaluate the clinical crown length relative to fixed-appliance orthodontic treatment of excessive overjet and deep overbite and to correlate such changes to the vertical dental height, the following measurements were undertaken for 12 females and 8 males, between the ages of 16 and 20 years, on three separate occasions--2 days before banding, 2 days after debanding, and 12 months after debanding: (1) overjet, overbite and dental height measured from right lateral cephalometric x-ray films; (2) clinical crown length, measured from study models, of 400 teeth divided into four groups--maxillary incisors and canines (120 teeth), maxillary second premolars and first molars (80 teeth), mandibular incisors and canines (120 teeth) and mandibular second premolars and first molars (80 teeth); and (3) gingival condition by means of the gingival index of Löe and Silness. Fixed edgewise orthodontic appliances were used and the four first premolars were extracted. From the results of the investigation, the following conclusions were evident: after a 12-month follow-up observation period, the achieved reduction in overjet, overbite, and dental height showed relapses of 9%, 11%, and 29%, successively; only 7% of the 400 teeth examined showed reductions in clinical crown length. This change was probably the result of gingival hyperplasia. The gingival condition greatly improved by approximately 64% after 12 months of debanding, accompanied by 25% to 50% relapse in the amount of change in clinical crown length (noted 2 days after debanding); and the intrusive tooth movement during orthodontic correction of deep overbite was the result of vertical movement of the tooth, with its investing tissues and soft-tissue attachment, into the jaws.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1986

Differential diagnosis and treatment planning for the adult nonsurgical orthodontic patient.

Increasing numbers of adult patients are seeking orthodontic care and some, despite significant skeletal malocclusions, elect not to have combined orthodontic-surgical treatment. The purpose of this article is to outline some of the diagnostic and therapeutic principles that can be used in the adult nonsurgical orthodontic patient. The importance of realistic goal setting in the face of compromised occlusions is emphasized. Diagnosis should include evaluation of all three dimensions and recognize the limitations of therapy in each dimension for the nongrowing patient. Periodontal considerations, extraction decisions, and retention regimens are of vital importance to the achievement and maintenance of an optimum result. Clinical records will demonstrate four commonly seen problems and their resolution.

Adolescent↗

PubMed1991

Occlusal contacts: comparison of orthodontic patients, posttreatment patients, and untreated controls.

Orthodontic treatment may severely alter tooth contacts during early treatment, but after its completion the number of contracts increases with settling of the occlusion. Long-term changes are sparsely documented and this investigation examined changes by comparing adequate control groups before treatment, during treatment, and several years after treatment. Although the number of contacts is gradually elevated after orthodontic treatment, the present data suggested that orthodontic patients may not realize the same number of contacts as untreated controls despite prolonged periods out of retention. The functional significance of this finding remains unknown and suggests the need for further research.

Adolescent↗

PubMed1988

New attachment through periodontal treatment and orthodontic intrusion.

The present study was performed to investigate the tissue reaction related to orthodontic intrusion of teeth with a reduced periodontium and further to evaluate the influence of oral hygiene on this reaction. In each of five Macaca fascicularis monkeys, periodontal tissue breakdown was induced around the premolars and the upper incisors by placing orthodontic elastic ligatures around the teeth. The breakdown procedure was continued until a minimum of four pockets could be measured on probing. Following removal of the elastics, a flap operation was performed. The pocket epithelium and granulation tissue were excised. During the surgical procedure, a notch was placed just above the bone. The teeth were divided postoperatively into four groups according to treatment: group 1 = flap operation, no oral hygiene program; group 2 = flap operation plus oral hygiene program three times per week; group 3 = flap operation plus intrusion, no oral hygiene program; and group 4 = flap operation plus intrusion plus oral hygiene. Groups 3 and 4 were subdivided into two observation periods. A total of 60 teeth corresponding to 120 approximate surfaces were studied. The animals were killed with perfusion; histologic sections were produced and stained alternatively with hematoxylin and eosin, and van Gieson's solution. The histologic analysis showed that new cementum formation and new collagen attachment were observed following the surgical procedure if the oral hygiene was maintained, but also demonstrated that the intrusion improved the quantity of new attachment if carried out under healthy conditions. New attachment was a consistent finding in group 4, but varied from 0.7 to 2.3 mm. In case of intrusion without oral hygiene, the results varied from moderate new attachment to an aggravation of the periodontal bone loss. On the basis of the results presented here, the combination of periodontal treatment and orthodontic intrusion seems to be a method by which improvement of the periodontal condition can be obtained, provided that both the biomechanical force system and the oral hygiene are kept under control.

Animals↗

PubMed1989

Leukotrienes in orthodontic tooth movement.

Prostaglandins (PGs) and leukotrienes (LTs) are products of arachidonic acid conversion. PGs have an established role in mediating orthodontic tooth movement. The role of LTs in modulating or mediating orthodontic tooth movement was investigated in this study. One hundred thirty-two Sprague-Dawley rats were used; the animals weighed 300 to 400 gm with equal numbers of male and female rats. They were divided into five main groups of 24 animals each and a sham group of 12 animals. An orthodontic appliance was placed and activated on all the animals except the sham group; in this group the appliances were not active. Each main group was given one of the following treatments daily: distilled water, 5% gum arabic solution, PG synthesis inhibitor indomethacin, LT synthesis inhibitor AA861, and a combination of both drugs. Each group was divided into six subgroups of four animals; the animals were killed at either 1, 3, 5, 7, 10, or 14 days, and tooth movement measured. The three sham subgroups received distilled water and were killed at 1, 7, or 10 days. The first maxillary molar (the moved tooth) and surrounding tissues were removed from all animals in the sham group and the subgroups killed at 1, 7, and 10 days in the gum arabic solution group and the LT synthesis inhibitor group. Prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) were extracted, measured with radioimmunoassay (RIA), and standardized per milligram of protein in the sample. A significant inhibition of tooth movement occurred beginning on day 7 in the indomethacin, AA861, and combination groups; there was no significant difference among these groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

Changes in the morphology of the buccal alveolar bone of protruded mandibular permanent incisors secondary to orthodontic alignment.

The cephalometric radiographs of 17 children and adolescents whose orthodontic treatment involved lingual positioning of procumbent mandibular central permanent incisors were examined to determine the morphologic changes in the buccal alveolar bone that resulted from orthodontic treatment. Comparison of tracings fom radiographs taken before and after treatment indicated that the alveolar height increased in 58.8% of the cases. In these cases a significant increase in the distance from the incisal edge to the "D" point was evident (t = 2.5, p less than or equal to 0.03), whereas this dimension decreased significantly in the rest of the cases (t = 3.0, p less than or equal to 0.02). In addition, a significant positive correlation (r = 0.95) was found between the changes in the distances from the "D" point to the incisal edge and the alveolar bone height. These findings indicate that during orthodontic treatment that involves lingual positioning of procumbent teeth but no intrusion, an increase in the amount of buccal alveolar bone may take place.

Adolescent↗

PubMed1991

An in vivo study on the merits of two glass ionomers for the cementation of orthodontic bands.

The purpose of this study was to investigate the cariostatic effect of two glass ionomer cements on in vivo demineralization of partly uncovered enamel beneath orthodontic bands. A 4-week clinical trial was conducted on a group of five patients with nine pairs of premolars to be extracted for orthodontic purposes. Specially designed orthodontic bands were cemented with either Ketac-Cem (K-C) or Aqua-Cem (A-C). A local cariogenic milieu was created between the buccal surface of the premolars and the inner surface of the bands to secure plaque accumulation. The mineral content of the teeth was quantified by microradiography. The data were compared with data from a previous study of patients in the same age group with bands that had been cemented with a non-F cement. After comparison with the non-F group, the lesion depth (ld) was reduced by 63% for K-C and by 55% for A-C. This reduction was statistically significant at the 2.5% level (t test). The total mineral loss in teeth cemented with glass ionomer cements (delta Z) was reduced, in comparison with the loss in teeth cemented with non-F cement, by 49% with K-C and by 27% with A-C. The differences were statistically significant only for the K-C group (t test, p less than 0.025). There were no significant differences between the two glass ionomer cements with respect to either lesion depth or total mineral loss values (paired t test; p greater than 0.05). This investigation shows that fluoride released from glass ionomer cements contributes substantially to demineralization "reduction." However, these cements do not provide complete caries protection in sites where access is difficult.

Acrylic Resins↗

PubMed1992

Orthodontic risk factors for temporomandibular disorders (TMD). I: Premolar extractions.

Concern about claims that premolar extractions may put patients at risk for temporomandibular disorders (TMD) led to this study. We report first findings from a longitudinal study of orthodontic patients begun in 1983. By using the methods of Helkimo, we collected TMD data before initiation of orthodontic treatment, between 0 and 12 months after debanding, and 12 to 24 months after debanding. Analyses related Helkimo scores with premolar extractions in 65 patients for whom orthodontic treatment had been completed. Twenty-six patients were treated without premolar extractions, 25 had four premolars extracted, and 14 had two upper premolars extracted. Tests for significance of differences between mean Helkimo scores were conducted for the nonextraction group compared with the extraction groups, and between pretreatment and posttreatment Helkimo scores for each group. Results included: (1) no significant intergroup differences between mean pretreatment or posttreatment scores, and (2) small but statistically significant (p less than 0.05) differences (in the direction of improvement) between mean pretreatment and posttreatment scores for both the nonextraction group and for the four premolar extraction group.

Adult↗

PubMed1993

Serum and alveolar bone phosphatase changes reflect bone turnover during orthodontic tooth movement.

Acid and alkaline phosphatase changes have been demonstrated histochemically and biochemically during the early stages of an orthodontic tooth movement cycle. However, quantitative data on neither alveolar bone nor serum phosphatase changes over an entire tooth movement cycle have been reported. This study examined acid, tartrate-resistant acid (TRAP), and alkaline phosphatase changes in serum and alveolar bone during an orthodontic tooth movement cycle in 288 adult male Sprague-Dawley strain rats. The effect of differing initial force magnitudes on phosphatase changes was also examined. Data were obtained from four groups: sham control and three treatment groups (20, 40, and 60 gm activations). Each group (n = 72) was subdivided equally into six sacrifice subgroups (1,3,5,7,10, and 14 days). Treated animals received a precisely loaded orthodontic tipping force to the maxillary molars. Phosphatase measures were obtained by colorimetric assays. Analysis of variance (ANOVA) procedures were performed to examine for differences within groups across time and among groups at each time point. Data from treated animals were combined, adjusted for control values, and examined across time to permit comparisons with previously described histomorphometric changes. Analysis of variance indicated no differences occurred in the control group across time. Significant differences in serum values occurred across time within the force groups (p < 0.01), and among force and control groups at various times in both sera and bone (p < 0.05). In the pooled treatment data, a peak in serum acid phosphatase occurred at day 1 and in bone at day 3 (the later mirroring histomorphometric findings) (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Phosphatase↗

PubMed2004

Emergency orthodontic treatment after the traumatic intrusive luxation of maxillary incisors.

Treatment of traumatically intruded teeth is based largely on empirical clinical experience rather than on scientific data. The aim of this qualitative meta-analysis was to provide an evidence base to evaluate the orthodontic repositioning approach. In a MEDLINE search of the literature in English, 14 reported patients involving 22 teeth were found to have been treated by this modality. Additionally, 3 new patients, involving 9 intruded teeth and presented herein, were combined to form a total study sample of 17 subjects (7 girls, 10 boys, aged 8.9 +/- 1.2 years). Orthodontic extrusive forces were applied in the immediate posttrauma period (up to 3 months), with a variety of orthodontic appliances. Repositioning was achieved for 90.3% of the affected teeth but failed in 9.7% because of inflammatory resorption (2 teeth) or a misdiagnosis of root fracture (1 tooth). Early complications included loss of pulp vitality and external root resorption. All intruded teeth with closed root apices lost their vitality regardless of the degree of intrusion, whereas among those with incomplete apices, 45.5% that had been moderately intruded remained vital. External resorption was encountered in 54.8% of the teeth. Loss of marginal bone support was rarely encountered. Late complications included inflammatory root resorption in teeth with closed apices, in which endodontic treatment was not initially performed, and obliteration of the pulp tissue in teeth that remained vital. The results show that this method is superior to other treatment alternatives.

Child↗

PubMed2005

Factors of importance for the development of dehiscences during labial movement of mandibular incisors: a retrospective study of adult orthodontic patients.

PURPOSE: Labial movement of mandibular incisors has traditionally been considered a risk factor for gingival recession. The aims of this study were to assess changes in prevalence and severity of gingival recession of mandibular incisors during orthodontic treatment of adults in whom the incisors had been moved labially and to identify parameters that could predict recession. MATERIAL: The sample consisted of 150 adult patients (aged 33.7 +/- 9.5 years, mean +/- SD) treated nonextraction with fixed appliances. Pretreatment overjet, overbite, degree of crowding, presence of tooth rotation, canine relationship, vertical face height, and position of the mandibular incisor to A-pogonion and mandibular lines were registered on study casts and lateral headfilms. Pretreatment gingival recession, width of keratinized gingiva, gingival biotype, gingival inflammation, and visible plaque accumulation were recorded, as was posttreatment gingival recession. Labial movement was determined by measuring pretreatment and posttreatment casts. Descriptive statistics were used to describe gingival recession at baseline and follow-up. Variables to be included in a logistic regression analysis as possible predictors of recession were identified with a bivariate correlation analysis. RESULTS: No significant increase in the mean gingival recession was observed during treatment. The prevalence of gingival recession greater than 0.1 mm increased from 21% before treatment to 35% after (P < .05). Only 2.8% of the subjects developed recession greater than 2 mm, and 5% of the pre-existing gingival recessions improved. The presence of baseline recession (P < .001), gingival biotype (P < .0179), and gingival inflammation (P < .003) were identified as possible predictors of recession. None of the orthodontic variables was significantly associated with recession. CONCLUSIONS: Gingival recession of mandibular incisors did not significantly increase during orthodontic treatment. After treatment, fewer than 10% of subjects had gingival recession greater than 2 mm, and, at follow-up, 5% of the pre-existing gingival recession had improved. Thin gingival biotype, visual plaque, and inflammation are useful predictors of gingival recession.

Adult↗

PubMed2005

Orthodontic treatment of a traumatically intruded tooth with ankylosis by traction after surgical luxation.

This report presents the treatment of a patient with anterior crossbite and displacement of ankylosed maxillary and mandibular right lateral incisors. The maxillary lateral incisor, which was traumatically intruded, was successfully treated with 2 surgical luxations followed by orthodontic traction. The mandibular lateral incisor, which was avulsed and replanted, experienced replacement root resorption during orthodontic treatment and was ultimately extracted. Two years after active orthodontic treatment, the occlusal results were considered satisfactory.

Cephalometry↗

PubMed2005

Augmentation of faciolingual gingival dimensions with free connective tissue grafts before labial orthodontic tooth movement: an experimental study with a canine model.

PURPOSE: The aim of this study was to determine in an animal model whether any increase in gingival thickness after placement of free connective tissue autografts is maintained after labial orthodontic tooth movement. MATERIAL: In a split-mouth technique, the maxillary second and third incisors of 4 adult greyhounds were used as experimental, control, and sham-control teeth. The experimental teeth underwent gingival augmentation surgery. Two to 3 months later, the teeth were moved with a bonded orthodontic appliance over 2 to 3 months. Baseline and 2-month retention clinical measurements of gingival height were taken before the animals were killed. Histometric measurements recorded the free gingival height and the gingival thickness at 5 graduated levels down the teeth. RESULTS: Clinical measurements of changes in gingival margin position revealed a mean coronal shift of 0.44 mm over grafted teeth, with 50% of nongrafted teeth and 100% of the sham-control teeth experiencing small amounts of gingival recession. The histometric results showed that gingival thickness measurements for the grafted teeth were, on average, between 0.13 and 0.18 mm thicker at all levels of measurement than for the nongrafted teeth (P < .01). CONCLUSIONS: Free connective tissue grafts placed on the labial aspect of incisors might help prevent the faciolingual thinning of the gingival tissues that can occur as a result of labial orthodontic tooth movement. Further research is required to confirm these results in a larger sample and determine the long-term benefits of preorthodontic gingival augmentation to prevent gingival recession.

Animals↗

PubMed2006

Physical properties of root cementum: part 6. A comparative quantitative analysis of the mineral composition of human premolar cementum after the application of orthodontic forces.

INTRODUCTION: The aim of this study was to examine quantitatively with electron probe microanalysis (EPMA) the calcium (Ca), phosphorus (P), and fluoride (F) concentrations in human first premolar cementum after the application of light and heavy orthodontic forces. METHODS: Thirty-six maxillary and mandibular first premolars (18 experimental, 18 control) were extracted from 16 subjects (10 male, 6 female; mean age, 13.9 years; range, 11.7-16.1 years) who were randomly assigned to the light-force or the heavy-force group. In the light-force group, 25 g of buccally directed force was applied to the experimental premolar; in the heavy-force group, 225 g of buccally directed force was applied to the experimental premolar. The contralateral premolar served as the control. The experimental and control premolars were extracted 28 or 29 days after initial force application and prepared for EPMA. The Ca, P, and F concentrations were measured on the buccal and lingual surfaces at the midpoint of the cervical, middle, and apical thirds of the root from the outer to the middle to the inner third of the cementum. RESULTS: Little change was found in the mineral composition of cementum after the application of light forces; however, there was a trend toward an increase in the mineral composition (Ca, P, and F) of cementum at various areas of periodontal ligament compression. The application of heavy forces caused a significant (P = .000) decrease in the Ca concentration of cementum at certain areas of periodontal ligament tension. The application of both light and heavy orthodontic forces did not appear to influence the F concentrations in cementum. CONCLUSIONS: Heavy orthodontic forces cause alterations in the mineral content of cementum; light forces cause little change.

Adolescent↗

PubMed2006

Orthodontic treatment in a patient with Van der Woude's syndrome.

Van der Woude's syndrome (VDW; #OMIM 119300) is an autosomal dominant disease characterized by cleft lip and/or palate and lower lip pit (fistula). The precise skeletal characteristics are unclear, and there have been no case reports of orthodontic treatment of patients with VDW. The Japanese girl whose treatment is reported here had VDW, including bilateral cleft lip and palate and bilateral symmetric lower lip pits. Orthodontic treatment started when she was just 3 years old, with a removable maxillary expansion appliance, followed by an edgewise multibracket appliance in both arches. Retention began at 11 years of age, and a secondary bone graft was performed for the alveolar cleft. She received prosthetic treatment and achieved a desirable occlusion at 18 years of age. Early intervention helped achieve a satisfactory treatment result for our patient. In contrast, her mother also had VDW, with a severe Class III skeletal pattern, but she had not been treated orthodontically; she had an anterior and lateral crossbite even after prosthetic treatment. The pretreatment characteristics of 4 other subjects with VDW are discussed; they show wide variations in the sizes of the maxilla and the mandible, suggesting that a common skeletal pattern is not generally seen in VDW.

Adult↗

PubMed1997

Periapical replacement resorption of permanent, vital, endodontically treated incisors after orthodontic movement: report of two cases.

Radiographic observations show that periapical replacement resorption (PARR) is a frequent and unpredictable sequella of orthodontic movement of permanent maxillary incisors. Only the apical root portion undergoes resorption, and it is subsequently replaced with normal bone. PARR also occurs without orthodontic tooth movement, but these resorptions differ as to type and location. PARR clearly occurs in teeth with vital pulps after orthodontic movement; however, our two cases and a review of 43 other cases indicate that endodontically treated incisors show a statistically significant lesser frequency and severity of apical resorption than untreated teeth. The role the vital pulp plays in this apical resorption is yet to be determined. A hypothetical explanation is offered suggesting that pulpal neuropeptides may be involved in PARR in both vital and endodontically treated incisors. The role calcium hydroxide plays in endodontically treated teeth is also considered.

Adolescent↗