Orthodontic Treatment Options Research Articles

Utilização dos mantenedores e recuperadores de espaço na ortodontia interceptativa: Revisão dos conceitos atuais

A dentição decídua é fundamental para que ocorra um bom desempenho nas funções mastigatórias, deglutição, fonação e oclusão. Existem vários fatores que podem interferir no equilíbrio do desenvolvimento da dentição decídua e/ou mista, dentre esses fatores destacam-se a perda prematura dos decíduos. O objetivo desse estudo foi realizar uma revisão de literatura abordando a utilização de mantenedores e recuperadores de espaço na odontologia. De acordo com a literatura foi observado que os mantenedores de espaço são dispositivos ortodônticos utilizados a fim de substituírem um ou mais dentes decíduos, preservando o espaço destinado ao dente permanente sucessor. Eles são classificados em, funcionais e não funcionais e fixos e removíveis, sendo selecionados de acordo com a idade do paciente e número de dentes perdidos. Já os recuperadores são dispositivos ortodônticos dinâmicos, e a sua finalidade é recuperar espaços que foram perdidos após a exodontia dos dentes decíduos. É fundamental que o cirurgião-dentista realize um diagnóstico precoce dos problemas decorrentes do espaço nas dentições decíduas ou mistas, conhecendo os fatores etiológicos envolvidos na perda prematura, bem como, as opções de tratamento ortodôntico disponíveis.

Interest in orthodontic tooth alignment in adult patients affected by periodontitis: A questionnaire-based cross-sectional pilot study.

Orthodontic treatment can successfully align pathologically migrated teeth and lead to improvement of periodontal stability in patients with periodontitis. Periodontic-orthodontic approaches have gained increasing attention in the past years. Here, we investigated the interest of adults affected by chronic periodontitis in undergoing orthodontic treatment as well as patient-related and tooth-related influence factors. Periodontal and orthodontic measurements/indices were taken from 115 adult patients with moderate-to-severe periodontitis. The study participants answered a questionnaire investigating patient demographics, quality of life aspects, and their interest in undergoing orthodontic treatment. Correlations between clinical data, questionnaire responses, and this interest were analyzed by means of an age- and sex-adjusted multiple regression model. Two-thirds of the participants were interested in orthodontic therapy and indicated long-term healthy and esthetically appealing teeth as their main motives. A significant correlation was found between subjectively felt impaired dental esthetics and an interest in orthodontic treatment. However, there were no correlations with the severity of periodontitis, tooth alignment, or patient demographics, including sex. Older patients were significantly more often interested in orthodontic treatment. Most participants had never been provided with information about orthodontic treatment options for adults. A considerable number of adult patients with periodontitis were interested in orthodontics to improve tooth alignment. However, severity of periodontitis and tooth misalignment or demographic factors may not be indicative thereof. Therefore, dental practitioners need to be aware of patients wishing to align their teeth and to provide them with the relevant information and, if appropriate, enable interdisciplinary treatment planning.

Orthodontic/restorative interface part 2

Establishing optimal aesthetics, function and periodontal health in patients with missing teeth is a complex and challenging process, which demands the interaction of several dental specialties for effective multidisciplinary management. The most frequent scenario encountered within the orthodontic-restorative interface is missing teeth; this article focuses on the management of missing teeth, discussing diagnosis, the treatment planning process, treatment outcome and retention. This is demonstrated throughout a series of clinical cases treated within a multidisciplinary team. CPD/Clinical Relevance: The management of patients with missing teeth is often challenging; with a variety of orthodontic and restorative treatment options for the general practitioner.

Skeletal anchorage in orthodontics: possibilities and limits

This presentation highlights the new treatment options by the introduction of Temporary Anchorage Devices (TADs) in orthodontics with special respect to the palatal implants and miniscrews. The indications and limitations of such TADs are presented on the basis of clinical cases and the scientific literature. TADs are mainly indicated for space closure of tooth agenesis, treatment of asymmetries and the extension of orthodontic treatment options in orthognathic borderline cases. The knowledge of the limits of such systems and their special biomechanics are fundamental. In growing children though, conventional anchorage systems may often be preferable.

An Evaluation of knowledge and preference of prosthodontic, orthodontic or integrated treatment options for peg shaped maxillary lateral incisors among general practitioners in Kingdom of Saudi Arabia-A Survey

Background and objective: The requirement for dental specialties and the number of specialists in each country depends mainly on the complex oral health care needs of the society. Missing lateral incisor or Peg shaped lateral incisor is such a condition. The aim of this study was to assess the awareness of general practitioners regarding needs of prosthodontic, orthodontic, or integrated treatment approach for management of peg shaped lateral incisor through a self-represented survey.Methodology: A Cross-sectional study was planned to conduct a survey using questionnaire containing 16 questions which were mailed and distributed to random sample of 292 general dental surgeons who voluntarily took part in the study.Results: Results were self-descriptive due to simple form of questionnaire. Most important goal for the treatment according to 80.7% responders was improvement in esthetics. According to responders, malocclusion was the most important factor (41.6%) which influences the treatment plan. 73.9 % responders told that the prefer to refer the patient to specialist when patients are reported with malocclusion and highly esthetic demand. Almost 40% responders do the diagnostic wax up in such cases. 43.2% responders decided to plan prosthetic treatment after completion of orthodontic treatment and for that full coverage crown was the most preferred choice for rehabilitation. 90.1% of responders believed that combination of both orthodontic and prosthodontic approach was best to achieve the perfect treatment outcome.Conclusion: Pre restorative orthodontic treatment is best for management of peg lateral incisor. Multidisciplinary approach towards the complex dental treatment is always better for the best treatment outcome. Referral system is also developed by such means.

Awareness of orthodontic modalities and preference of appliance and payment options in Saudi Arabia

Background: Awareness of available treatment devices and methods influences the seeking of appropriate treatment. With the lack of prior orthodontic awareness baseline, the present study aims to measure awareness level of various orthodontic treatment options along with ranking available orthodontic appliances and payment options. Materials and Methods: A total of 350 Saudi participants have completed a survey listing various orthodontic modalities next to its images, as well as payment plan options. Likert awareness scale was used to assess the awareness of nine orthodontic modalities and participants were asked to rank the most preferred orthodontic appliance and payment method options. Results: Stainless steel and ceramic brackets, along with clear aligners displayed moderate-to-high awareness levels. However, statistically significant lower recognition of early treatment tools, namely, expander, headgear, and functional appliances was evident (P Conclusions: Community awareness program along with dental practitioners should aim toward improving population's knowledge on dentofacial orthopedic treatments in specific, as per the study findings.

Lower incisor extraction as an orthodontic treatment option: A case report

Incisor extraction in orthodontics treatment has been one of the options since there are very few patients who are considered for such treatment. Proper and detailed diagnosis should be done so that good results can be obtained. A case report of a 20 year old female is presented who has Class II, Division 1 malocclusion with crowding in the lower arch. Keywords: Mandibular Incisor Extraction Orthodontics, Crowding

Great expectations of patients with missing lateral incisors: when are space opening and space closure appropriate?

On average, 2% of the UK population have agenesis of the permanent maxillary lateral incisors. Reopening the space for restorative replacement or closing the space and subsequent reshaping of the canine depends on a number of factors. Among these are the aesthetics of the canines, level of the smile line, gingival architecture and occlusion. Joint orthodontic and restorative planning to determine the appropriateness of space opening or space closing, with a discussion of these in context with the expectations of the patient/parent, is important before commencing treatment. Despite advances in materials and techniques within both restorative and orthodontic specialties resulting in improvements in the aesthetic outcomes of hypodontia cases, the management of patient/parent expectations is key to overall success. This paper details the contemporary restorative–orthodontic treatment options for the management of missing lateral incisors, the orthodontic biomechanics and restorative approaches involved in treatment.

Surgical-orthodontic treatment in a class II malocclusion patient. Case report

Regardless of the different orthodontic treatment options for patients with subdivision class II malocclusions, the involvement of skeletal structures is signifi cant. It is desirable to combine orthodontic and surgical treatment to achieve a stable and more esthetic result, as illustrated in this case report, which describes the treatment of a 41-year-old woman with a skeletal class II malocclusion and a history of temporomandibular joint pain. She also presented an anteroposterior discrepancy and a convex profi le. Intraorally, she had an overjet of 7 mm. Mandibular surgical rotation coupled with a non-extraction orthodontic approach was performed to reduce the overjet and minimize the temporomandibular joint disorder. The purpose of this report is to show the importance of developing an individualized treatment plan, tailored to the patient’s specifi c dental and skeletal problems, as well as to his or her needs and desires.

Oro-facial characteristics and the surgical correction of patients affected by beta-thalassaemia: a review of the literature and report of a case

Abstract Despite the fact that recent medical advances have improved the quality of life and increased the life expectancy of patients suffering from thalassaemia, no standard strategy or clinical guidelines are available for the correction of the presenting craniofacial anomalies. The aim of the present study is to review the craniofacial features of affected patients, and to discuss the orthodontic and orthognathic surgical treatment options available to manage the associated and characteristic facial deformity.

Perceptions of dental professionals and laypeople to altered dental esthetics in cases with congenitally missing maxillary lateral incisors

BackgroundThe smile perception of patients is not strictly related to standardized protocols and technical implications which certainly affect clinicians' decisions. The absence of maxillary lateral incisors could affect smile esthetics either with treatment or not. The aim of the present study was to investigate if different perceptions on altered smiles due to missing maxillary lateral incisors, with or without treatment, exist among different groups of people (laypersons, adult orthodontic patients, general dentists, and orthodontists).MethodsAn ideal smile model was selected and altered simulating different malocclusions and treatment options. Twelve simulations were submitted to four categories of respondents: laypeople, adult orthodontic patients, general dentists and orthodontists. They were asked to express smile perception for each simulation by ranking and rating simulations using a 0 to 100 visual analog scale. Analysis of variance was used to determine if there were statistically significant differences in values assigned among the four categories of respondents for each simulation.ResultsSignificant differences in smile perceptions were found between professionals (dentists and orthodontists) and laypeople. Presence of dental tipping and marked diastema in the arch were disharmonious aspects less tolerated in a smile by all categories of evaluators. Simulations associated with space closure orthodontic treatment were ranked as the most attractive smile and significantly ranked higher by dental professionals than patients and laypeople.ConclusionsTreatment, absence of diastema, and symmetry were the most accepted characteristics by all categories of respondents. Ideal orthodontic treatment options might be overestimated by clinicians when compared to laypeople's smile perception.

Progressive Condylar Resorption: Pathologic Processes and Imaging Considerations

Progressive condylar resorption (PCR) of the temporomandibular joint (TMJ) occurs mostly in adolescent female individuals, who are likely to request orthodontic treatment. They can be among the most challenging of orthodontic patients to successfully treat, especially if orthognathic surgery is involved in the treatment process. This article will review the basic anatomy, pathophysiology, detection, natural history, and progression of PCR of the TMJ, and the local and regional growth effects of PCR also will be discussed. PCR proceeds through 3 distinct anatomic stages that have clinical relevance when considering orthodontic diagnosis, treatment options, and treatment timing: soft-tissue phase, destructive (active) phase, and reparative phase. Anatomic assessment of the TMJ hard and soft tissues and facial skeleton can be performed using cone-beam computed tomography and magnetic resonance imaging. The application of these imaging modalities to this severe clinical condition is discussed in some detail. It is generally recommended that definitive orthodontic/orthognathic treatment be postponed until PCR has stabilized. Imaging plays an important role in assessing stability of the resorptive process, but other clinical criteria also must be considered.

Changes in the pattern of patients receiving surgical-orthodontic treatment

The characteristics of patients who seek and accept orthognathic surgery appear to be changing over time but have not been well documented in the 21st century. Records for patients who had orthognathic surgery at the University of North Carolina from 1996 to 2000 and from 2006 to 2010 were reviewed to collect data for changes in the prevalence of patients with mandibular deficiency (Class II), maxillary deficiency or mandibular prognathism (Class III), long face, and asymmetry problems. The changes were compared with those in previous time periods and at other locations. Between 1996 and 2000 and between 2006 and 2010, the percentage of Class III patients increased from 35% to 54%, and the percentage of Class II patients decreased from 59% to 41%, while the percentages for long face and asymmetry showed little change. The decrease in Class II patients was accentuation of a long-term trend; the increase in Class III patients occurred only after the turn of the century. A similar but less-marked change has been noted at some but not all other locations in the United States. It appears to be related primarily to an increase in the numbers of African Americans, Native Americans, Hispanics, and Asians who now are seeking surgical treatment, but it also has been affected by changes in where orthognathic surgery is performed, decisions by third-party payers (insurance and Medicaid) about coverage for treatment, and the availability of nonsurgical orthodontic treatment options for Class II patients.

Orthodontic uprighting of severely impacted mandibular second molars

The prevalence of impacted second molars is low, varying from 0% to 2.3%. The etiology of an impaction can involve systemic, local, and periodontal factors, as well as a developmental disruption of the tooth germ. A number of surgical and orthodontic treatment options have been suggested in the literature, including leaving the tooth in situ, removing the impacted second molar, orthodontic uprighting, and autotransplantation. Removal of third molars has been suggested as an adjunct for space creation. This article presents the treatment of a girl with bilateral severely impacted mandibular second molars as well as an ectopic maxillary left canine and severe crowding affecting both the maxillary and mandibular arches. Her treatment was successfully completed with fixed preadjusted edgewise appliances (0.022 × 0.028-in slot size) and MBT prescription (APC precoated Gemini Brackets; 3M Unitek, St. Paul, Minn), along with the removal of 4 first premolars. The maxillary left canine and the mandibular second molars were surgically exposed. The treatment mechanics show that even severely impacted second molars can be uprighted by routine straight-wire techniques, which are easy to apply. The center of rotation of the second molar lies in the bifurcation of the roots of this tooth, and this biomechanical property was used to its full advantage. The techniques applied comprised bracket repositioning, bypass of brackets, conversion of molar tubes to brackets, thermoelastic copper-nickel-titanium archwires, and a push-coil spring. Other orthodontic treatment mechanics, which require complex sectional or segmental techniques, auxiliaries, or artistic wire bending, that have been suggested in the literature were not used here. The third molars were not removed.

An overview of aesthetic solutions in orthodontics

This article aims to review current aesthetic orthodontic treatment options. The advantages and disadvantages of techniques, such as clear fixed braces, lingual braces and aligners are discussed in turn along with some clinical implications for practice.

Orthodontic-orthognathic surgical treatment in a patient with Class II subdivision malocclusion: Occlusal plane alteration

Despite the different orthodontic treatment options for patients with Class II subdivision malocclusions, the involvement of the skeletal structures is significant. It is desirable to combine orthodontic and surgical treatment to achieve a stable and better esthetic result, as illustrated in this case report. The occlusal plane was canted to the right as a part of the patient's facial asymmetry. Consequently, a 3-mm differential impaction of the maxilla on the left side allowed occlusal plane leveling. Mandibular rotation with advancement on the right side corrected the right Class II malocclusion. The successful attainment of the treatment goals was accomplished through teamwork and integration between the orthodontist and the maxillofacial surgeon.

Prevalence of impacted premolars in a Turkish population and considerations for surgical treatment

The aim of this study was to identify the prevalence, associated pathology and symptoms, and treatment of impacted premolars in a Turkish population. This retrospective study examined panoramic radiographs and clinical records of 9,000 patients who presented consecutively at our oral and maxillofacial surgery clinics between January 1998 and January 2009. In addition to demographic data (patient sex and age), data was compiled on the number and location of impacted missing maxillary and mandibular premolars, retained deciduous molars, associated pathologies and symptoms, and treatment methods. A total of 105 impacted maxillary or mandibular premolars were observed in 93 patients (1.03%). Of these, 48 (51.6%) were female (age range: 13-57 years) and 45 (43.4%) were male (age range: 13-58 years). Impacted mandibular second premolars accounted for 55.2% (n=58) of all impacted premolars. Migration was observed in only 11.83% of patients (n=11). Pathological changes and symptoms were noted in 15.05% of patients. Our results suggest that the prophylactic extraction of non-migrated impacted premolars may not be necessary. If the patient is cooperative, a "wait and see " approach may be preferable. Orthodontic or prosthetic treatment options should also be considered when planning treatment of non-migrated impacted premolars. Migrated impacted premolars should be kept under observation and should only be removed if they are associated with pathology or if extraction is required for prosthetic or orthodontic treatment.

Conforto e fonação com a nova geração de bráquetes ortodônticos linguais individualizados

TEMA: recentemente o número de pacientes desejando um tratamento ortodôntico e estético ao mesmo tempo aumentou consideravelmente. A técnica lingual oferece a opção mais estética de tratamento ortodôntico, pois os bráquetes ficam invisíveis colados na superfície lingual dos dentes e os lábios não ficam protuberantes. Apesar da grande vantagem estética, essa terapia possui desvantagens como restrição no conforto oral, na fala, na higiene, irritações na língua, restrição no espaço da língua e dificuldades na alimentação. Para amenizar essas desvantagens uma nova geração de bráquetes linguais otimizados ao máximo através da individualização das bases dos bráquetes, da posição de colagem e dos fios utilizados no tratamento ortodôntico foi desenvolvida recentemente. OBJETIVO: realizar uma revisão sistemática da literatura para verificar a adaptação do paciente a diferentes dispositivos ortodônticos linguais e a influência desses dispositivos no conforto e na fala, principalmente. CONCLUSÃO: atualmente a literatura suporta que os bráquetes linguais de última geração individualizados por computador proporcionam maior conforto e facilidade na fonação quando comparados aos bráquetes tradicionais da técnica lingual. No entanto, o sucesso na terapia requer orientações detalhadas sobre o potencial de restrição do conforto oral, articulação de palavras, mastigação e higiene oral, independente do sistema de bráquetes a ser utilizado.

Intrabony migration of impacted teeth.

Intrabony migration of impacted teeth is a rare dental anomaly, which occurs only in the permanent dentition of the lower jaw. The teeth involved in this phenomenon are the mandibular lateral incisor, canine, and second premolar. Migration of the lateral incisor is usually in a distal direction, resulting in transposition with the canine. Migration of the canine is most frequently in a mesial direction, resulting in transmigration across the mandibular symphysis to the opposite side of the dental arch. The second premolar most often migrates distally, sometimes past the gonial angle and as far as the coronoid process. Surgical and orthodontic treatment options are presented for the three intrabony migrating teeth.

Success rate of palatal orthodontic implants: a prospective longitudinal study

AbstractAim: The purpose of this prospective cohort study was to assess the survival and success rates of palatal implants.Material and methods: Seventy patients (56 female, 14 male; age 25‐6 ± 10‐8 years) receiving Orthosystem® (Straumann AG, Basel, Switzerland) palatal implants from March 1999 to November 2006 were included. The indication was established according to the required anchorage for orthodontic therapy. All implants were placed in a mid‐sagittal, median or paramedian palatal location by the same surgeon. They were orthodontically loaded after a healing period of 8–16 weeks (Mean: 12.8 weeks).Results and discussion: Of the initially 70 consecutively admitted patients, two implants in two patients were not primary stable after installation and had to be removed. Of the 70 initially installed palatal implants, 67 implants or 95.7% osseointegrated successfully and were loaded actively and/or passively for approximately 19 months. Only one implant of the 67 osseointegrated implants lost its stability under orthodontic loading. By the time of re‐evaluation, 20 palatal implants were still used for orthodontic therapy, while 46 implants had been removed after completed orthodontic therapy. By only analyzing those, the success rate of the initially installed implants was 92%.Conclusions: Orthodontic palatal implants with a rough surface are predictable and highly reliable devices for a multitude of maxillary orthodontic treatment options. The survival and success rates for palatal orthodontic implants are comparable to dental implants installed for dental prostheses.