Transitional Dentition Research Articles

Оцінка якості гігієнічного догляду за порожниною рота у дітей з вродженими незрощеннями губи та піднебіння у процесі ортодонтичного лікування

Introduction. Systematic monitoring of the of oral hygiene and professional hygiene with the use of modern, individually selected basic and additional hygiene products and items during orthodontic treatment is a mandatory component of the comprehensive rehabilitation of children with congenital cleft lip and palate (CLP). The aim: to evaluate the quality of individual oral hygiene care of children with congenital unilateral cleft lip and palate in the course of orthodontic treatment in the period of transitional dentition. Materials and methods. The determination of the hygienic condition of the oral cavity in the course of orthodontic treatment was done using the «Differentiated index for determining the indicator of individual oral hygiene, adjusted to take into account the different quality of hygiene on the upper and lower dental rows (DIOH). Results and their discussion. Prevention of diseases of hard tissues of teeth and periodontal tissues in children is important from birth and is especially necessary in the course of orthodontic treatment using removable and fixed orthodontic designs. Children with CLP have an increased risk of developing dental caries for a variety of reasons. Differential examination of the state of dental hygiene on the upper and lower jaws allows giving more targeted recommendations regarding oral hygiene, i.e. personify them. Conclusions. The use of hygiene indices, in particular those that reflect the difference between the level of hygiene on the jaw where the orthodontic appliance is placed and where it is absent, is appropriate for assessing the state of oral hygiene in children with dentognathic anomalies and providing recommendations for its improvement. Key words: congenital unilateral cleft lip and palate, hygiene index, prevention, diseases of hard tissues of teeth and periodontal tissues.

Evaluation of Gingival Phenotype in the Early Transitional Dentition Phase in Children-Comparison of Three Non-Invasive Methods.

Gingival phenotype (GP) is determined based on the thickness and width of the gingival tissue. An evaluation of GP is essential for adequate treatment planning and outcome monitoring, including orthodontic treatments in a paediatric population. The present study aimed to compare the reliability of the visual and TRAN methods with that of the ultrasound biometer measurements in the early transitional dentition phase. One hundred ninety three generally healthy, 7-year-old children were examined. An assessment of GP was performed by a paedodontist and a periodontist. The average thickness of the gingiva was 0.76 ± 0.36 mm, which was classified as a thin GP. The agreement between a visual assessment and the biometric ultrasound measurements reached the highest (94%) level when assessing a very thin GP (Spearman's rank correlation coefficient r = 0.37, p < 0.01). Similarly, 99% agreement in the diagnosis of a thin GP was recorded for the TRAN and ultrasound methods (Spearman's rank correlation coefficient r = 0.49, p < 0.001). In total, 86% of cases diagnosed as having a thick GP using the TRAN method turned out to be thin according to the ultrasound measurements. The dentist's specialization and professional experience in the assessment of GP were irrelevant (Spearman's rank correlation coefficient r = 0.49, p < 0.001). All methods tested in the present study were proven to be easy to perform and well accepted by the children. The visual assessment and TRAN methods, despite the fact that they enabled the diagnosis of a thin GP (crucial for treatment planning), cannot be recommended during the teeth replacement period. A misdiagnosis of thick GP may deprive a young at-risk patient of special supervision, which may develop into mucogingival deformities. A biometric ultrasound, although expensive, allows for reliable assessment of the gingiva thickness when needed.

Gingival Phenotype Changes and the Prevalence of Mucogingival Deformities during the Early Transitional Dentition Phase-A Two-Year Longitudinal Study.

Thin gingival phenotype (GPh) may contribute to periodontal tissue breakdown and recession development. Thus, the early identification of thin GPh in children can allow proper preventive care and the identification of children at risk during orthodontic treatment. The present long-term study aimed to monitor GPh changes, i.e., thickness (GT) and width of attached gingiva (AGW) during the early transitional dentition phase, as well as its potential associations with the mucogingival deformities. Materials and Methods: 83 systematically healthy children were examined twice with an interval of 2 years. Probing depth, GT and AGW at mandibular incisors, vestibular depth, type of lower lip frenum attachment and mucogingival defects were recorded. Results: 95.2% of participants at baseline and 93.9% at 2-year examination expressed thin GPh. During the transition from the deciduous to permanent dentition, GT and AGW declined, but the GT of permanent incisors already erupted at the baseline examination increased in the observation period. Conclusions: Gingival phenotype undergoes changes in the early transitional dentition phase. In spite of the thin gingival phenotype, only single pseudo-recessions and primary shallow vestibule were noticed.

Preventive and Interceptive Orthodontics Treatment

Preventive orthodontics is that part of orthodontic practice which is concerned with patients and parents education, supervision of the growth and development of the dentition and cranio-facial structures. The diagnostic procedures undertaken to predict the appearance of malocclusion and the treatment procedures instituted to prevent the onset of malocclusion. Interceptive orthodontics has been defined as that phase of science that can recognize and eliminate potential irregularities and malpositions of the developing dento-facial complex. Many of procedures are common in preventive and interceptive orthodontics, but the timings are different. Preventive procedures are undertaken in anticipation of development of a problem, whereas interceptive procedures are taken when the problem has already manifested. Orthodontic problems in children can be divided conveniently into non skeletal and skeletal problems, which are treated by tooth movement and by growth modification. Such treatment may take place in deciduous or transitional dentition and may include redirection of ectopically erupting teeth, slicing or extraction of deciduous teeth, correction of isolated dental crossbites of recovery of minor space loss.

The attached gingiva thickness in the mandibular anterior region during the early transitional dentition phase.

Objectives: Adequate gingival thickness provides a stable base for appropriate oral hygiene maintenance and mucogingival lesion prevention. The study aim was to assess attached gingiva thickness in relation to its width, probing depth, crowding, and tooth position in the arch during the early transitional dentition phase. Method and materials: A cross-sectional study in 193 children aged 7 years with healthy mucogingival complex was conducted, and PIROP ultrasonic biometer measurement of gingival thickness of mandibular incisors was applied. To compare qualitative variables across different dentition groups, chi-square test or Fisher exact test were used, and for quantitative variables Kruskal-Wallis test plus post-hoc analysis (Dunn test). Spearman correlation coefficient was used to correlate gingival thickness with width of attached gingiva, as well as Kruskal-Wallis test and post-hoc analysis to assess the relationship between gingival thickness and tooth position in the arch, type of incisor, and eruption phase. Results: The mean gingival thickness value was less than 1 mm in all incisor type groups. The thinnest gingiva was noticed at permanent newly erupted incisors (0.72 ± 0.36; P < .001). Thickness of attached gingiva positively correlated with its width and with probing depth (r = 0.164, P < .001). Gingival thickness was significantly thinner at incisors positioned labially. No correlation of attached gingiva thickness with transitional crowding in mandibular incisor segment was observed. Conclusions: The results revealed thin gingiva at mandibular incisors in white children during the early transitional dentition phase. Objective, ultrasound measurements were used for the first time in a pediatric population, and the device was simple and well tolerated.

A new traversodontid cynodont with a peculiar postcanine dentition from the Middle/Late Triassic of Namibia and dental evolution in basal gomphodonts

We here present a new gomphodont cynodont from the Ladinian/Carnian Upper Omingonde Formation of central Namibia. Etjoia dentitransitus gen. et sp. nov. is a medium-sized (skull length of 88.5 mm) omnivorous gomphodont represented by an almost complete skull and a few cervical vertebrae. This new taxon is diagnosed by divergent first left and right lower incisors that bear large apically inclined denticles, a third lower gomphodont postcanine with a well-separated mesial cingulum, four distal upper and lower sectorial teeth, and a lingually offset last upper sectorial postcanine. Etjoia is particular in having a transitional dentition between basal gomphodonts and traversodontids. It shares with some non-traversodontid gomphodonts a high number of sectorial postcanines and ovoid mesial-most upper gomphodont postcanines with a centrally positioned transverse crest. Etjoia was, however, recovered as a basally branching Traversodontidae in phylogenetic analyses performed on different data matrices. It shares with traversodontids upper gomphodont postcanines with a high transverse crest, sub-rectangular and mesiodistally elongated lower gomphodont postcanines, and a mesially displaced transverse crest in the lower gomphodont postcanines. We explored dental evolution in basal cynognathians based on a dentition-oriented data matrix. The acquisition of gomphodont postcanines, which allowed tooth-to-tooth occlusion, in basal-most gomphodonts was followed by a loss of shearing planes between the upper and lower gomphodont postcanines in non-diademodontid gomphodonts, and the development of deep basins and tall transverse crests in gomphodont teeth and shearing planes between the upper and lower gomphodont postcanines in basal traversodontids. These dental transformations likely resulted from three shifts in feeding ecologies, from a carnivorous to an omnivorous diet in basal-most gomphodonts, followed by an adaptation to a specialized feeding ecology possibly made of insects and hard plant material in basal-most neogomphodonts (traditional ‘trirachodontids’), then an increase in the consumption of plant-material in basal traversodontids. http://zoobank.org:pub:28DE1B1F-2D4A-4712-9D2C-80B8DBB7527D

Residents' journal review

Residents' journal review

Dental root abnormalities in four children with PHACE syndrome

PHACE(S) syndrome is a condition characterized by posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, eye abnormalities, sternal cleft, and supraumbilical raphe. We present four children with PHACE(S) syndrome who have absence of or severe malformation of the roots of their permanent first molars (PFMs). Root abnormalities in the children's molars were bilateral and not restricted to the segments affected by cutaneous hemangioma. The reason for root abnormalities is unknown, but given the rarity of these findings in healthy children, it is likely an additional dental manifestation of PHACE syndrome. The absence of functional roots in the PFMs can result in significant consequences. Therefore, we recommend a panoramic dental radiograph during transitional dentition for children with PHACE syndrome to screen for dental root abnormalities.

Alveolar Fracture Caused by Tooth Extraction at Home

Injuries to the teeth and surrounding structures are relatively common. Although traumatic injuries caused by falls or activities related to sports are widely discussed, the same cannot be said regarding accidents arising from non-professional extraction of primary teeth. The present study reports a 6-year-old male child who underwent mandibular alveolar bone fracture during non-professional extraction of his central lower left incisor at home, performed by his 30-year-old aunt. The root of the tooth was with an irregular physiological resorption, which acted as a lever component for the mechanical force applied, leading to bone fracture. Although not common, the possibility that dental roots with irregular resorption can act as a possible risk factor for accidents if the parents or guardians of children during the period of transitional dentition try to perform intentional extraction of primary teeth should be highlighted. Parents should always consult a professional, preferably a pediatric dentist, for monitoring this period of transitional dentition.

'The Cystic Adventure It's Lucent Yet Obscure'

Cystic lesions are a diagnostic dilemma when they occur in transitional dentition. In this case report we present a large maxillary radicular cyst in a pediatric patient with unique clinical presentation which posed a diagnostic predicament. Through this case report we will emphasize the indicators that will help in identification of such lesions and thus aid in the accurate treatment.

Space supervision and guidance of eruption in management of lower transitional crowding: A non-extraction approach

Mandibular incisor crowding in the mixed dentition is one of the most common problems presenting to the orthodontist. Asymmetry of alignment, premature loss of primary canine(s), and disruption in arch integrity are all early benchmarks of a tooth size/arch length discrepancy in the transitional dentition that can occur independent of any skeletal discrepancy. Space supervision and guidance of eruption refer to treatment interventions during the early to mid-mixed dentition periods that influence the eruption patterns and positioning of the permanent teeth during their transition. Generally considered applicable to individuals with adequate overall arch dimensions to accommodate a normal complement of permanent teeth with an acceptable esthetic and functioning occlusion, guidance of eruption involves the implementation of directed interventions to optimize the eruption and alignment patterns of the permanent teeth as part of a non-extraction protocol.

Mandibular rotation during the transitional dentition

To determine whether dentoalveolar changes or vertical condylar growth is more closely related to the true forward rotation of the mandible during the transition between the late primary and early mixed dentition stages of development. The sample included 50 subjects (25 males and 25 females) with Class I (N = 25) and Class II (N = 25) molar relationships. They were selected based on the availability of lateral cephalograms at two developmental stages: T1: last film with complete primary dentition (5.8 ± 0.4 years) and T2: first film with permanent incisors and permanent molars fully erupted (8.0 ± 0.2 years). Seventeen landmarks were identified and 22 measurements were calculated. The mandibles at T1 and T2 were superimposed using natural reference structures in order to measure true mandibular rotation. The mandible underwent -2.4° ± 2.6° of true rotation, 1.9° ± 2.4° of remodeling, and -0.6° ± 1.8° of apparent rotation. There were no significant sex or Class differences in true rotation, remodeling, and apparent rotation. There was a moderate correlation (r = 0.76) between true rotation and remodeling and a moderately low correlation (r = 0.40) between true rotation and apparent rotation. There was a weak correlation between true rotation and SNA (r = 0.28). True rotation was most closely associated with the increases in U1/S-N (r = -0.34), increases in U1/PP (r = -0.36), and decreases in Id-Me (r = 0.36). Independent of sex and Class, the true mandibular rotation that occurred between the late primary and early mixed dentition was mostly masked by angular remodeling, resulting in limited amounts of apparent rotation. True rotation was significantly related to anterior dentoalveolar changes but not to the vertical growth changes that occurred.

Secondary alveolar bone grafting: Radiographic and clinical evaluation.

Introduction:Secondary bone grafting of maxilla and residual alveolar clefts at the stage of transitional dentition was first introduced by Boyne and Sands. The aim of this prospective case control study was to clinically and radiologically evaluate the success rate of anterior iliac crest graft in primary alveolar cleft.Methods and Material:In this study we evaluated 10 patients who underwent secondary alveolar bone grafting for various types of cleft palate with autologous iliac crest graft. Type of septum measured radiologically was taken as the outcome measure.Results:Postoperative radiographic evaluation revealed Type I inter alveolar septum in 7 cases (87.5%), with complete unilateral cleft lip, palate and alveolus. Non-eruption of canine occurred in 5 patients (50%). Periodontal Examination revealed presence of pocket formation (less than 4 mm) and Grade II mobility in 2 cases (20%).Conclusions:In conclusion, secondary alveolar bone grafting done during the time of transitional dentition, before the eruption of permanent canine is an excellent treatment modality.

Efficacy of Nickel-Titanium Palatal Expanders

Objective: Timely treatment of narrow maxilla by means of maxillary expansion during the primary or transitional dentition is recommended to reestablish optimal function in order to normalize dental, skeletal and neuromuscular growth. The aim of this study was to assess the amount of orthodontic and orthopedic expansion achieved in the maxilla and to evaluate cephalometrically the various postural changes in the maxilla and mandible with the use of nickel-titanium palatal expander. Materials and methods: A total of ten subjects, five males and five females were selected from a survey conducted on 2000 children in age range of 7 to 15 years, belonging to various schools. Their study cast, cephalograms and occlusal radiographs were used for the study. Maxillary intermolar width, maxillary intercanine width and mandibular intermolar width were measured on study cast using Vernier caliper. Certain measurements were done on the cephalogram and occlusal radiograph. The data obtained out of various measurements made on study casts, frontal, lateral cephalograms and occlusal radiographs at the pretreatment, postexpansion and postretention stages were statistically analyzed. All the observations were made by two observers. The interexaminer variability was calculated using t-test. The mean and standard deviations were calculated and student's t-test (paired) was applied to determine the amount of change, variability of change and significance of change, respectively. Results: A constant force exerted by nickel-titanium palatal expander had orthopedic effects in growing age group indicated by statistically increase in the maxillary width. The ratio of relative orthodontic to orthopedic effect with this appliance was 6:1. Consequent to maxillary expansion, there occurred a significant downward movement of the maxillae and downward and backward rotation of the mandible. There was opening of midpalatal suture during active phase followed by suture remineralization during the retention period. Conclusion: To conclude, a Ni-Ti expander brings about expansion by a combination of orthodontic and orthopedic effects by an increase in maxillary intermolar, maxillary intercanine and mandibular intercanine widths as also the opening of the midpalatal suture.

Orthodontic education programs: An international comparison of students’ views and experiences

The purpose of this study was to identify the demographic characteristics of students completing certificate programs in orthodontics, and the curriculum and financial characteristics of orthodontic programs in the English-speaking world. An online survey was used to question orthodontic students studying in the 93 programs worldwide in countries where the first language is English. The questionnaire was built by using the online survey tool www.surveymonkey.com, and the students were predominantly contacted directly via e-mail. Of the 301 respondents (an estimated response rate of 33%), the majority were men, had an average age of 29.8 years, and were mostly from programs in the United States. The mean program durations were 31.0 months in the United States and 37.1 months in the Commonwealth, with mean total patient loads of 84 and 106, respectively. Various treatment modalities were used in both groups. The mean annual tuition fee was considerably higher in the United States. The overall mean debt at graduation was $118,200, and the mean expected income 5 years after graduation was $283,200. Private practice was the most popular career path (90.3%), with fewer than a third of the respondents stating that they would consider an academic career. This study indicates that the demographic characteristics of orthodontic students are similar to those most recently reported, with the proportion of female students continuing to increase. The numbers of transitional dentition patients and total patient case loads are increasing, and students are being exposed to an increasingly wide range of treatment techniques. A continuing increase in tuition fees was reported, along with increased levels of debt at graduation, and fewer students intend to have an academic career.

The relationship between overjet size and dentoalveolar compensation

The purpose of this study was to investigate the effect of overjet size and the dento-alveolar compensation in subjects with normal class I molar relationship. Lateral cephalometric head records of 59 Egyptian children (34 boys and 25 girls) aged 7.5 to 10.5 years with mean age of 8.69+/-0.73. All had normal class I type of occlusion. The sample was classified into four quartiles according to the overjet size and the cephalometric analysis was based on seven linear and eight angular measurements using a dental tracer programme. showed that, in spite of presence of high significant over jet size differences between the groups; there was no significant differences in all the studied parameters were found. Applying the least significant differences (LSD) test and coefficient correlations between the studied parameters clarifying that there was a significant differences in angular measurements (SN-AB, SN-Occl, I-I, I-ML, I-NB). during transitional dentition there was a sufficient dento-alveolar adaptation to growth changes in the saggittal jaw relation ship to attain normal class I type of occlusion. This compensation is pronounced in angular parameters and clustered in the lower arches particularly in incisal area.

Development of the curve of Spee

Ferdinand Graf von Spee is credited with characterizing human occlusal curvature viewed in the sagittal plane. This naturally occurring phenomenon has clinical importance in orthodontics and restorative dentistry, yet we have little understanding of when, how, or why it develops. The purpose of this study was to expand our understanding by examining the development of the curve of Spee longitudinally in a sample of untreated subjects with normal occlusion from the deciduous dentition to adulthood. Records of 16 male and 17 female subjects from the Iowa Facial Growth Study were selected and examined. The depth of the curve of Spee was measured on their study models at 7 time points from ages 4 (deciduous dentition) to 26 (adult dentition) years. The Wilcoxon signed rank test was used to compare changes in the curve of Spee depth between time points. For each subject, the relative eruption of the mandibular teeth was measured from corresponding cephalometric radiographs, and its contribution to the developing curve of Spee was ascertained. In the deciduous dentition, the curve of Spee is minimal. At mean ages of 4.05 and 5.27 years, the average curve of Spee depths are 0.24 and 0.25 mm, respectively. With change to the transitional dentition, corresponding to the eruption of the mandibular permanent first molars and central incisors (mean age, 6.91 years), the curve of Spee depth increases significantly (P < 0.0001) to a mean maximum depth of 1.32 mm. The curve of Spee then remains essentially unchanged until eruption of the second molars (mean age, 12.38 years), when the depth increases (P < 0.0001) to a mean maximum depth of 2.17 mm. In the adolescent dentition (mean age, 16.21 years), the depth decreases slightly (P = 0.0009) to a mean maximum depth of 1.98 mm, and, in the adult dentition (mean age 26.98 years), the curve remains unchanged (P = 0.66), with a mean maximum depth of 2.02 mm. No significant differences in curve of Spee development were found between either the right and left sides of the mandibular arch or the sexes. Radiographic measurements of tooth eruption confirm that the greatest increases in the curve of Spee occur as the mandibular permanent incisors, first molars, or second molars erupt above the pre-existing occlusal plane. On average, the curve of Spee initially develops as a result of mandibular permanent first molar and incisor eruption. The curve of Spee maintains this depth until the mandibular permanent second molars erupt above the occlusal plane, when it again deepens. During the adolescent dentition stage, the curve depth decreases slightly and then remains relatively stable into early adulthood.

Arch width Changes with a Rapid Maxillary Expansion Appliance Anchored to the Primary Teeth

To examine the dimensional changes after rapid maxillary expansion (RME) carried out in the transitional dentition with the primary teeth as anchorage. Group A was composed of 31 consecutive transitional dentition patients with posterior quadrant crossbites treated with a Haas-type RME appliance anchored on the maxillary primary molars and canines. No treatment was administered after palatal expansion. Study models were made before RME (T1), at appliance removal (T2), and at least 1 year after appliance removal (T3). A control sample of 60 individuals with posterior quadrant crossbites who had had no orthodontic treatment was categorized into group B (30 individuals with an average age comparable with the treated patients at T2) and group C (30 individuals with an average age comparable with the treated patients at T3). Permanent molar crossbites were corrected at T2, and this correction was maintained at T3 in all patients. The mean permanent maxillary intermolar width was 42.6 +/- 2.3 mm at T1, 46.7 +/- 1.9 mm at T2 (P < .01), and 46.3 +/- 1.8 mm at T3 (P < .01) in group A; 42.9 +/- 2.7 mm (P < .01) in group B; and 44.4 +/- 3.0 (P < .01) in group C. Premolar and canine widths were slightly wider than the control at T3. To avoid undesirable treatment-induced effects on maxillary permanent molars, a stable transverse correction could be achieved with the RME appliance anchored on the primary teeth.

Alveolar cleft surgery

Secondary bone-grafting of the maxilla and the residual alveolar clefts at the stage of transitional dentition, and in conjunction with orthodontic treatment, has become a well-accepted treatment modality. It has been incorporated in the management protocol of many cleft/craniofacial teams as an adjunct procedure aiming to further improve the functional and aesthetic habilitation of patients with unilateral or bilateral cleft of the lip and palate.

Transition of molar relationships in different skeletal growth patterns

This study investigated maxillary and mandibular growth differences and their effect on the changes in molar relationships from early transitional dentition to adult permanent dentition. Various landmarks were identified and measurements made on the longitudinal cephalometric radiographs of 40 people. The subjects were classified into 3 groups based on the amount of sagittal skeletal growth difference between the jaws. In group A, the mandible grew more than did the maxilla; in Group B, growth was about the same; and in group C, the maxilla grew more than did the mandible. The results revealed that skeletal growth differences between the jaws significantly influenced the changes in molar relationship during the transitional dentition, not only by translating basal bones but also by altering the amount of physiologic mesial shift in the dentition. However, the skeletal growth difference during the permanent dentition did not influence the changes in molar relationship. The sagittal growth difference between the jaws was largely absorbed by a dentoalveolar compensation. Tooth movement showed different characteristic features depending on the amount of the skeletal growth difference: (1) If the mandible grew more than did the maxilla, the growth difference was mostly absorbed by mesial displacement of the maxillary first molars and counterclockwise rotation of the occlusal plane. Anterior occlusion was adjusted by mesial displacement and labial inclination of the maxillary incisors and lingual inclination of the mandibular incisors. (2) If the maxilla grew more than did the mandible, the growth difference was mainly absorbed by mesial displacement of the mandibular molars. Then the maxillary molars showed minimal mesial displacement. The occlusal plane also showed minimal rotational change. Anterior occlusion was adjusted by lingual tipping of the maxillary incisors and mesial displacement and labial tipping of the mandibular incisors. (Am J Orthod Dentofacial Orthop 2002;121:280-90)