Dental Deformities Research Articles

Dental abnormalities and ectopic eruption in patients with isolated cleft palate.

The aim of this study was to evaluate the influence of cleft size and surgical treatment on the development of permanent teeth in patients with isolated cleft palate. The series comprised 109 children with isolated cleft palate, 70 girls and 39 boys, including 14 patients with Robin sequence. The patients were grouped according to the sagittal extent of the palatal cleft, measured on dental casts obtained before the primary palate surgery. Forty-six children were treated by one-stage palatoplasty, and 63 in two stages. The dentition was studied on orthopantomograms taken at 5, 8, 11, and 14 years of age. Congenitally missing permanent teeth (third molars excluded) were found in 33 subjects (30%). Children with large clefts had significantly more missing teeth than children with small clefts. The tooth most usually missing was the mandibular second premolar, followed by the maxillary lateral incisor, and the upper second premolar. The incidence of dental malformation was 23%, mostly mild forms. Ectopic eruption of the upper first permanent molars was seen in 23 (45%) of the subjects with large clefts, and in 18 (31%) of those with small clefts. The surgical method did not significantly affect the direction of the eruption. There is a correlation between cleft size and hypodontia, dental deformity, and ectopic eruption. Children with Robin sequence had almost the same incidence of hypodontia, malformed teeth, and ectopic eruption as children with large clefts. There was no correlation between surgical method and ectopic eruption of the maxillary first permanent molars.

Management and subsequent 13‐year progress of a mandibular fracture with malocclusion in a child – case report

Under acute conditions, maxillofacial injuries may be treated without the opportunity for an assessment of occlusal irregularities, even when there are mandibular fractures, because life-threatening injuries have priority over occlusion. Consequently, mandibular fractures may result in post-trauma malocclusion and facial deformity. The case history reported is of a male patient who had been involved in a traffic accident in childhood and suffered mandibular fractures. The initial incomplete management resulted in persistent deformation of the mandible, disturbance of dental occlusion and difficulty in mastication. These irregularities were corrected during childhood by non-operative orthodontic treatment. When the patient reached adulthood, some permanent teeth were malformed because the fractures had damaged some tooth germs. However, the permanent dentition in general was almost normal as a result of the corrected primary dentition. Although the alveolar deformity due to the injury remained, the mandibular base was satisfactorily remodelled. The case reported supports the view that early restoration of normal dental occlusion before the eruption of permanent teeth contributes to the establishment of good functional dental occlusion of the permanent teeth.

Acquired rotational digital deformity in children as a result of finger sucking

Although most attention to the harmful effects of finger sucking by infants has been on the potential dental deformities, finger deformities also occur. The three cases presented in this article describe radial rotation of the index finger as a result of persistent finger sucking. In the majority of cases rotational deformities spontaneously resolve once finger sucking ceases. In a few cases, particularly when the habit is unduly prolonged, deformities may persist and cause functional impairment. In these patients surgical intervention is indicated. In our cases the rotational digital deformities were treated successfully by rotational osteotomy of either the metacarpal or the proximal phalanx.

Features of the treatment of deformities of the dentition and bite before prosthetics

Orthopedic offices of dental clinics are often visited by patients who, along with defects in the dentition, have deformations of the dentition and malocclusion. We differentiate dental anomalies and deformities, meaning by the first congenital and acquired at an early age deviations from the normal development of the dental system, and by the second acquired after the formation of a permanent bite; in everyday practice, such deformities are eliminated by prosthetics, while the design of the prosthesis is adapted to the existing bite [1, 5].

The development and significance of septal and dental deformity from birth to eight years.

The septa of a series of 145 babies at birth was assessed into 3 types: type A--in the midline, type B--unilateral bending or kinking at the vomerine junction, type C--deformed to both sides. These were reassessed aged 5-6 years with the primary dentition present, and 90 cases reassessed aged about 8 years. In some there was a change to types B and C, but none changed to type A. Of 15 cases of external deformity of the nose at birth, 10 (66%) had irregularity of the columella. The children had dental examination and plaster casts made, an ear, nose and throat examination, and were photographed. The chances (which were statistically significant) of developing dental abnormalities and malocclusion, palatal asymmetry, upper respiratory tract infections and ear disease were found to be mostly in type B cases, less in type C cases and least in type A cases. Thus ear troubles were found in 45% type B, 25% type C and only 10% of type A cases. The palatal height was not related to any septal deformity.

The development of septal and dental deformity from birth.

The findings on the development of dental, facial and septal conditions from birth to about 6 years of age include the following: 1) Septal configuration can be readily tested at birth, and if deformity is present, then deformity will still be present at age 6 years. 2) The internal septal configuration can be categorized into three types: type A: The septum is in the midline. type B: There is unilateral bending or kinking of the septum at the vomerine junction. type C: The septum is deformed to both sides in an S configuration. 3) Height of the palate does not predispose to septal deformity. 4) Dental abnormalities of rotation, compression or crowding of the teeth, asymmetry of width and height of the palate, and shift of the mandibular arch from the midline occur most frequently in cases of type B (88%), much less in type C and least in type A. 5) At birth one can predict that type B babies will have considerably more likelihood of developing occlusal abnormalities than type A babies. 6) The dental abnormalities in many of these subjects are of sufficient degree to expect that malocclusion will undoubtedly develop. Thus the same etiological factors producing septal abnormalities at birth must be considered to be factors producing many malocclusions.

Hamartomatous dental cusps in hypomelanosis of Ito

Multiple dental cusps, protruding from the crowns of both deciduous and permanent incisors, were observed in a 4-year-old girl affected with hypomelanosis of Ito. This unusual dental anomaly has been described in one previous report of this neurocutaneous syndrome. In contrast to ordinary talon cusps, the dental outgrowths observed in hypomelanosis of Ito appear to be of hamartomatous origin. Apparently, these dental deformities are characteristic of hypomelanosis of Ito and may help to identify the syndrome in cases where other findings are minimal or atypical.

The combined surgical and orthodontic treatment of mandibular prognathism.

Patients with severe mandibular prognathism are best managed with a combined orthodontic-surgical approach. In our patients, the orthodontic treatment consisted of six to eighteen months of presurgical preparation, which in some patients may accentuate the dental deformity. This is done to provide two well-aligned dental arches that will fit accurately at surgery. The surgical procedure used was an oblique subcondylar osteotomy. This was followed by six to eight months of orthodontic treatment to complete dental alignment. Thirty patients were treated using this combined approach, with excellent results and few complications.

Surgical Repair of Cleft Palate

There are three major objectives in cleft palate surgery: to produce normal speech, to produce anatomic closure, and to minimize maxillary growth retardation and dental alveolar deformity. Any discussion of cleft palate surgery must be related to these objectives.

Odontodysplasia

Odontodysplasia is a rare dental deformity which manifests itself clinically as one or more quadrants of hypoplastic, hypocalcified, and late-erupting teeth. Histologically, the teeth affected by odontodysplasia present abnormalities in all derviatives of the tooth germ. To date, no particular etiologic factor has been commonly agreed upon as the cause of this dental malformation. Two cases of odontodysplasia are presented in this article. In the first case the condition manifested itself throughout the entire maxillary left quadrant. In the second case the condition was contained within the left maxillary central incisor region. Histologic examination of both cases revealed many similarities. The possible etiologies of the two cases are discussed, and the conclusion is that, despite the differences between regional and singular odontodysplasia, the histologic similarities support a common etiology.

Idiogram and trisomy of the water vole (Arvicola terrestris L.), a favourable animal for cytogenetic research.

The chromosomes of the water vole (Arvicola terrestris L.) were investigated in 2 female and 5 male animals from three different parts of Sweden. The somatic chromosomes were studied in direct preparations of cornea and bone marrow and in tissue cultures of testis, lung and heart. Meiosis was studied in one male. The chromosome number was 2n=36. No differences in regard to chromosome number and morphology were found among the seven control animals studied. Different chromosome types are represented and the karyotype of the species is favourable for chromosome studies. — An idiogram of the water vole was constructed from measurements of complete chromosome sets from ten heart cells. — In addition to the above normal material one young water vole, trapped in nature, was found to have 37 chromosomes and was trisomic for the smallest autosome. This autosome had a secondary constriction and took part in “satellite associations”. The cytologic similarities to Down's syndrome in man are striking and it is hoped that the water vole will become a valuable laboratory mammal, especially for elucidation of the chromosomal mechanisms of non-disjunction. The trisomic water vole had no obvious phenotypic abnormalities, but at least one feature was not within normal limits — its tail was unusually short. Also, the development of certain teeth was somewhat aberrant. Whether short tail and dental deformities are symptoms correlated with trisomy for the smallest autosome in the water vole is an open question so far.

Objectives of mixed dentition treatment in orthodontics

During the early mixed dentition, facial structures are passing through a period of rapid development, with growth centers that are at the peak of their activity. Orthodontics should take advantage of this developmental phase rather than permit it to proceed in an unfavorable direction. Moving upper first permanent molars distally in developing Class II malocclusions places these teeth in their proper positions in relation to other skeletal structures; it also sets the stage for the subsequent eruption of the remaining permanent teeth into their normal occlusal positions with their lower opponents. Conversely, if left untreated, all the remaining unerupted teeth ultimately will assume the same Class II positions as the malposed upper first molars. Structural imbalance will increase, as will muscular imbalance also, and each will add to the severity of the other if these misdirected forces are permitted to continue without interruption. The picture then will be that of a fully matured dental deformity after growth has ceased and the damage has been done. Treatment of these more severe malocclusions can often be accomplished without extraction, but early treatment provides greater insurance against an extraction compromise. At an early age, moreover, response is rapid and excellent results can be achieved with a minimum of mechanical therapy compared to that required when treatment is postponed to the permanent dentition. Despite the fact that these may appear to be “easy” cases, this is not a procedure to apply indiscriminately in every potential patient who, when first examined, appears to be progressing into an authentic Class II malocclusion. The greater challenge lies in a precise diagnosis. This demands an exacting study based not on technical skill but on analytical judgment and extensive experience in the correction of all types of malocclusion if improper treatment is to be avoided. A differentiation must be made between those cases that need immediate attention and those that should be postponed for comprehensive treatment during the postpubertal “growth spurt.” At such an early age, moreover, there is no pressing urgency for a diagnostic decision. A more conservative approach is to first place these children under periodic observation to determine the future developmental trend, for some of these irregularities tend to become self-corrective with the passing of time. The recurring question is whether sufficient development can be created to accommodate all the teeth. We have no reliable method of predicting growth; yet we do not have the right to discount it entirely in the preliminary diagnosis and treatment of these patients. Even with potential premolar extraction cases, the prudent course is first to attempt correction with a full complement of teeth. It takes only a few months to determine whether it can be done, and the sense of accomplishment is gratifying indeed when extraction can be avoided. This should always be our goal, and we should take every precaution to attain it.

NEED FOR COLLABORATION OF PEDIATRICIAN AND ORTHODONTIST

At the Forsyth Dental Infirmary, Boston, the orthodontist, pediatrician, nutritionist and child psychiatrist collaborate to promote a more comprehensive approach to the patient with malocclusion of the teeth. Each discipline contributes a special facet to the total clinical assessment of the child. The diagnostic conference serves as an important educational experience in the program of the postgraduate fellows in orthodontics. The active participation of the orthodontist in this approach broadens his view of orthodontics as a health service and makes it possible for him to follow the same methods and procedures in his own practice. He is in a better position to determine when to consult medical specialists and to solicit their collaboration. In turn, the pediatrician learns to recognize the handicaps that dental and facial deformities can exert on the physical and psychologic well-being of his patients. He becomes aware of the significance of the different varieties of malocclusion and of the proper timing for orthodontic treatment.

Ehlers-Danlos syndrome with ectopic bone formation.

Individuals afflicted with the Ehlers-Danlos syndrome exhibit a curious and striking complex of genetic abnormalities affecting the skin and its blood vessels, the joints, and the subcutaneous tissues. The skin can be raised in high folds which, when released, retract spontaneously and more or less completely. There is passive and active hypermobility of the joints, particularly of the fingers and toes. Fragility and friability of the skin and its blood vessels are present and are responsible for hematomas which develop following minor trauma. Trivial injuries also produce gaping skin wounds which heal with difficulty, leaving irregular scars. Small, cyst-like, movable subcutaneous nodules are often observed. These are the classical findings, usually present as a group, representing true instances of the syndrome. Occasional cases will exhibit one or more of a variety of associated abnormalities, among which have been reported clubfoot, dental deformities, lymphangiectatic tumors, acrocyanosis, and mental deficiency. Of unknown cause, the syndrome is frequently dominant hereditary, manifesting itself in infancy and persisting throughout life (13). In recent years reports of the Ehlers-Danlos syndrome have become quite frequent and several comprehensive reviews have been published (13, 16, 21, 33). This work has appeared almost exclusively in the dermatologic and pediatric literature, while the syndrome has otherwise remained relatively unknown. The dermatologists, Johnson and Falls (13), state: “It seems … that the syndrome should have been recognized and emphasized by others. For instance, the orthopedists should have been recording the joint symptoms; the surgeon, the friability of the skin; the roentgenologist, the roentgenologic findings; the pathologist, the tissue changes; the internist, the ecchy-moses and hemorrhages; and the geneticists, the familial characteristics.” Since roentgen study of the patient whose case history forms the basis for this report revealed the hitherto unrecorded presence of true ectopic bone formation in addition to most of the classical clinical features of the syndrome, and because the initial clue to the nature of a peculiar group of clinical findings was derived from roentgen studies, we feel that this report should be added to the radiologic literature. Case Report History A 38-year-old white male was admitted to the Veterans Administration Hospital, Brooklyn, N. Y., on Feb. 19, 1953, for repair of bilateral inguinal hernia. He knew of no abnormalities suggestive of the Ehlers-Danlos syndrome in members of his family. Since 1943, the patient had had essential hypertension, with headache and blurred vision. Also in 1943, he had first experienced dull aching pains in the left hip, anteriorly.

A psycho-somatic study into the nature, prevention and treatment of thumb-sucking and its relationship to dental deformity: By A. G. H. Lawes, D.D.Sc., D. J. Australia, 22: 167–194, April, 1950

A psycho-somatic study into the nature, prevention and treatment of thumb-sucking and its relationship to dental deformity: By A. G. H. Lawes, D.D.Sc., D. J. Australia, 22: 167–194, April, 1950

Oral Rehabilitation: Complete Occlusal Reconstruction, Treatment of Dental Deformities and Related Subjects, The Closed Bite

Oral Rehabilitation: Complete Occlusal Reconstruction, Treatment of Dental Deformities and Related Subjects, The Closed Bite

Birth Conditions and Dental Deformities

Birth Conditions and Dental Deformities

Fragmentation and scarring of the tarsal and metatarsal bones: An index of dental deformity

Fragmentation and scarring of the tarsal and metatarsal bones: An index of dental deformity

The lymphoid tissue problem in the upper respiratory tract

T HE early recognition of pharyngeal lymphoid tissue and tonsils as etiological factors in malocclusion and in the abnormal development of the environmental tissue and adjacent parts and the indications and contraindications for surgical interference, should be of paramount interest to the orthodontist as well as to the rhinologist. I take it for granted that the orthodontists are pretty well agreed that mechanical methods alone are not sufficient for the proper guidance of the developing teeth and jaws, and for permanent maintenance thereafter. There are many other factors which must be considered as having some relationship to the problem of the causation of maldevelopment. These we can only mention here in passing on to the subject under discussion. The role played by endocrine glands, by general malnutrition as in rickets, by allergy, and by heredity must never be omitted from the study of a patient who needs orthodontic attention. The subject assigned to me is a twofold one: The first is to discuss the relationship of the lymphoid tissue of the upper respiratory tract to the developmerit of malocclusion; and the second, the effect of this tissue on the adjacent structures, the sinuses and the ears, and what to do about it. While these two topics may appear distinct from each other, they do have, on closer examination, a definite interrelationship. For example, in a patient whose respiration through the nose or pharynx is impeded sufficiently to cause more or less continuous blockage over a period of time, we may expect a disturbance in general nutrition. This condition is due to restlessness at night, poor appetite, perverted metabolism from insufficient oxygenation, all of which factors must inevitably affect the growth of all the body structures, particularly those adjacent to the nose and pharynx, i.e., the jaws and teeth as well as the sinuses and ear passages. TO be specific, we want to know whether the adenoid or pharyngeal tonsils and the other lymphoid masses can cause such changes in the development of the jaws and teeth as will lead to the various forms of malocclusion. For many years the prevailing opinion was that the adenoids were the main cause of palatal and dental deformity. In 1908, however, McKenzie1 studied the history of 222 children with adenoids. He concluded that there was no interference with the jaws and palate. Layton2 in 1914 felt the same way. Then Brash in 1929, after an extensive research, stated that, “It is still to be proved that there is any significant correlation between the presence of adenoids and the incidence of deformity of the jaw and palate.” He suggested heredity as the most likely factor.

Malocclusion and associated dental deformities

Malocclusion and associated dental deformities