Interdisciplinary management of a skeletal class II, hyperdivergent patient accompanied by multiple missing teeth and severe overeruption with orthodontic assisted space redistribution and implant restoration.

Orthodontic treatment for a patient with hypodontia involving the maxillary lateral incisors

Effectiveness of 3 methods of anchorage reinforcement for maximum anchorage in adolescents: A 3-arm multicenter randomized clinical trial

In most cases, damaged mandibular molars result in over eruption of the opposing maxillary molars. This by itself constitutes a complicated clinical scenario; since the rehabilitation of the edentulous mandibular space usually requires a pre-prosthetic intervention. Multiple treatment options are valid and the choice depends primarily on the severity of the problem. Orthodontic molar intrusion is one of these options. This case report shows how the supra erupted maxillary permanent molars were intruded with the help of temporary anchorage devices placed interradicularly between the maxillary posterior teeth. A total of nine months was enough to complete the treatment. Following the orthodontic molar intrusion, the lower edentulous spaces were restored with dental implant supported prosthesis in order to establish a stable functional occlusion.

ObjectiveThis study evaluated the efficiency of anchorage provided by temporary anchorage devices (TADs) in maxillary bicuspid extraction cases during retraction of the anterior teeth using a fixed appliance.MethodsPatients aged 12 to 50 years with malocclusion for which bilateral first or second maxillary bicuspid extractions were indicated were included in the study and randomly allocated to the TAD or control groups. Retraction of the anterior teeth was achieved using skeletal anchorage in the TAD group and conventional dental anchorage in the control group. A computed tomography (CT) scan was performed after alignment of teeth, and a second CT scan was performed at the end of extraction space closure in both groups. A three-dimensional superimposition was performed to visualize and quantify the maxillary first molar movement during the retraction phase, which was the primary outcome, and the stability of TAD movement, which served as the secondary outcome.ResultsThirty-four patients (17 in each group) underwent the final analysis. The two groups showed a significant difference in the movement of the first maxillary molars, with less significant anchorage loss in the TAD group than that in the control group. In addition, TAD movement showed only a slight mesial movement on the labial side. On the palatal side, the mesial TAD movement was greater.ConclusionsIn comparison with conventional dental anchorage, TADs can be considered an efficient source of anchorage during retraction of maxillary anterior teeth. TADs remain stable when correctly placed in the bone during the anterior tooth retraction phase.

Objective: This study was designed to evaluate the effect of corticotomy and miniplates’ usage as skeletal anchorage for maxillary molars’ intrusion during correction of skeletal anterior open bite (SAOB). Patients, materials and methods:A sample of 22 patients with an age range from 14 to 22 years, suffering from skeletal anterior open bite with increased posterior maxillary vertical height. The participants were randomly divided into two groups according to the corticotomy approach. Group I: both buccal and palatal corticotomies were performed. Group II: only buccal corticotomy was performed. Buccal miniplates and palatal mini-screws were used as skeletal anchorage for maxillary molars’ intrusion assisted by corticotomy. The measurements, including maxillary dento-alveolar heights (mm), bucal crestal alveolarbone heights (mm), bucco-palatal angulations (B-P˚) and mesio-distal angulations (M-D˚) of right and left maxillary first permanent molars, 4.5 months after intrusion commencement. Results: The dento-alveolar height as well as the buccal crestal alveolar height decreased significantly after intrusion in both groups (p≤0.001 and p≤0.05, respectively), but without significant differences between them. Similarly, the M-D and B-P angulations increased significantly after intrusion in both groups (p≤0.01 and p≤0.001, respectively), with no significant differences between both groups. Conclusions: The current corticotomy approaches and temporary anchorage devices (TADs) were similarly effective for maxillary molar intrusion in cases of (SAOB), but complete correction of SAOB was not achieved. Both the posterior maxillarydento-alveolar and buccal crestal alveolar bone heights diminished similarly in both corticotomy methods. Neither mesio-distal nor bucco-palatal angulations of maxillary first permanent molar crown revealed major changes in matching both approaches of intrusion.

Nonsurgical correction of occlusal canting using temporary anchorage devices: A systematic review

We report the case of a 35-year-old man with a complex odontoma in the posterior wall of the maxillary sinus. He was referred to our department for further investigations of a dentigerous cyst in the left maxillary sinus. On intraoral examination, an erupted left maxillary third molar was observed, with no swelling in the left maxillary molar region. Computed tomography confirmed thickening of the mucous membrane of the maxillary sinus associated with the left maxillary second molar and a spherical high-density shadow in the posterior wall of the left maxillary sinus. The mass was excised from the left maxillary sinus after extracting the left maxillary second molar with the patient under general anesthesia. Histopathological examinations confirmed the diagnosis of complex odontoma. We considered that the complex odontoma was derived from a distomolar germ because of the eruption of the left maxillary third molar. No evidence of postoperative recurrence of the left maxillary sinus has been observed.

Objective Objective To evaluate the treatment approach including 3D digital setup and eBrace customized lingual system, extraction pattern and anchorage design in adults with bimaxillary protrusion. Methods Fifteen Class I adults (1 men, 14 women; age, 25.5±3.1 years) treated with four first premolar extraction were included. Palatal miniscrews and transpalatal arch combined with customized lingual appliance were used. Lateral cephalometric radiographs and CBCT were obtained before and after treatment. The superimpositions of CBCT images were analyzed three-dimensionally for tooth position change. Results Cephalometric analysis showed the upper and lower incisors were retracted by 7.5 mm and 6.3 mm, respectively. The average value of UI-SN decreased (-13.2±5.2). Upper and lower lips were retracted by 4.0 mm and 6.3 mm, respectively. Mean point was retracted 1.2 mm. CBCT also showed significant retraction of incisor and canine crowns. Three-dimensional position change of maxillary molars showed no significant differences. Conclusions This study developed an approach of customized lingual orthodontics with the use of a customized transpalatal arch and anchorage design, which can be an effective modality for adults with severe bimaxillary protrusion. Key words: Customized lingual orthodontics; Severe bimaxillary protrusion; extraction; Temporary anchorage device; 3D analysis

Second Canal in Mesiobuccal Root of Maxillary Molars Is Correlated with Root Third and Patient Age: A Cone-beam Computed Tomographic Study

This report describes four cases of cracked tooth syndrome secondary to traumatic occlusion that mimicked trigeminal autonomic cephalalgias. All patients were referred by general practitioners to the Orofacial Pain Clinic at Nihon University Dental School for assessment of atypical facial pain. Case 1: A 51-year-old woman presented with severe pain in the maxillary and mandibular left molars. Case 2: A 47-year-old woman presented with sharp, shooting pain in the maxillary left molars, which radiated to the temple and periorbital region. Case 3: A 49-year-old man presented with sharp, shooting, and stabbing pain in the maxillary left molars. Case 4: A 38-year-old man presented with intense facial pain in the left supraorbital and infraorbital areas, which radiated to the temporoparietal and maxillary regions. All cases mimicked trigeminal autonomic cephalalgias, a group of primary headache disorders characterized by unilateral facial pain and ipsilateral cranial autonomic symptoms. Trigeminal autonomic cephalalgias include cluster headache, paroxysmal hemicrania, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/short-lasting neuralgiform headache attacks with cranial autonomic features. Pulpal necrosis, when caused by cracked tooth syndrome, can manifest with pain frequencies and durations that are unusual for pulpitis, as was seen in these cases. Although challenging, differentiation of cracked tooth syndrome from trigeminal autonomic cephalalgias is a necessary skill for dentists.

Esthetic orthodontic treatment with a double J retractor and temporary anchorage devices

The aim of the current work is to estimate the impact of posterior maxillary intrusion on the surrounding bone intensity during correction of anterior open bite (AOB). The sample was 14 patients suffering from mild to moderate (3-5mm) anterior open bite with increased posterior maxillary vertical height. This study sample was allocated into two groups according to the corticotomy the approach. Buccal miniplates and palatal mini screws were used as skeletal anchorage for maxillary molars’ intrusion. The density of the alveolar bone related to right and left maxillary first permanent molars were measured 4.5 months after intrusion commencement. The study revealed that the alveolar bone density of right and left first permanent molars had statistically significant decreases. In the right side, buccal and palatal cortical density had statistically significant decrease, however it was non significant for left both cortical bone. Absolute molar intrusion could be attained by skeletal anchorage miniplates and mini screws in patients with frontal open bite malocclusion. The variation of bone intensity between buccal and palatal sides may account for the variance bone thickness changes after intrusion from the buccal to the palatal sides.

A variety of treatment options may be implemented on a Class III malocclusion associated with skeletal discrepancy ranging from functional orthopedics at an early age to orthognathic surgery in adults. In the current scenario, many Class III malocclusion patients are referred for orthognathic surgery without even considering the options of an orthodontic camouflage, as orthodontists do not want to burden themselves with the tedious treatment planning and risks involved with treating such cases. This case report describes a 27-year-old female diagnosed with a skeletal Class III malocclusion, severe open bite, and periodontally compromised dentition. Although orthognathic surgery was proposed as the best treatment modality, it was denied by the patient due to financial and psychological constraints. She was treated with mild upper arch expansion using archwires and upper premolar intrusion using temporary anchorage devices (TADs) alongside retraction of lower anterior teeth using TADs and intermaxillary elastics. At the end of 18 months of active treatment, a decent result was achieved with good occlusion and facial esthetics. Post-treatment results showed an improved profile and Class I canine relationships, with optimal overjet and overbite. The anterior open bite was corrected, and the overall facial balance was greatly improved. Extraoral photographs displayed a relaxed lip closure and an esthetic smile meeting the patient’s expectations. Two-year follow-up records demonstrated a stable occlusion and optimal facial esthetics.

This study evaluated the anatomical characteristics of the maxillary premolars and molars and the maxillary sinus using cone beam computed tomography (CBCT) for dental implant treatment. Ten linear items and 1 angular item on 30 sites in 30 patients were measured on 3-dimensional computed tomography images using CBCT. The vertical relationship between the maxillary sinus and the maxillary molars was classified into 5 categories. The horizontal thickness of the buccal alveolar bone was thinnest on the maxillary first premolars, and the horizontal thickness of the palatal alveolar bone was thickest on the maxillary second molars. Type II was most common on the maxillary first molars. The internal angle at the maxillary premolars was significantly greater than that at the maxillary molars. The internal angle and vertical distance between the apex of the roots and the maxillary sinus floor showed a positive correlation on the maxillary first premolars (P = 0.003). For the selection of an appropriate approach on dental implant treatment, the evaluation of maxillary premolars and molars using of CBCT can be recommended.

Class II malocclusions, characterized by the mesial positioning of the maxillary molars relative to the mandibular molars, are among the most frequently encountered orthodontic issues. One of the widely adopted non-extraction approaches for addressing this malocclusion is maxillary molar distalization, which has been utilized for decades to create space within the dental arch. Historically, extraoral appliances such as headgear were commonly employed. However, with technological advancements, intraoral distalization devices, particularly those incorporating temporary anchorage devices (TADs), have gained prominence due to their compact size, not being visible externally, and improved patient acceptance. These appliances offer significant advantages, including being less invasive compared with extraction-based camouflage treatments, being more readily accepted by patients due to the absence of extraction spaces, and not requiring the complex biomechanical principles involved in extraction-based methods. TADs have revolutionized distalization techniques by providing superior anchorage control, reducing treatment duration, and offering a straightforward, patient-friendly application. The purpose of this comprehensive narrative review is to focus specifically on intraoral distalization techniques utilizing TADs, summarizing their efficacy and outcomes in the management of Class II malocclusions as reported in clinical studies over the past three decades.