Role of impacted teeth in dental arch crowding

Estimates show that the prevalence of mandibular dental anterior crowding is high and might be up to 40%. The etiology of the condition has been multifactorial and evidence regarding the impact of mandibular third molars is still controversial. We discussed the potential role that impacted teeth (particularly mandibular third molars) might have in developing dental arch crowding. Evidence from different original studies and reviews regarding the impact of lower third molars on dental crowding was controversial. However, most of these studies showed that the correlation between these events was insignificant and additional studies might be needed for further validation. We have also identified many factors that can lead to dental arch crowding among the relevant studies in the literature. These factors might include general factors (including gender and age), skeletal factors (including malocclusion and growth of jaws) and dental factors (including primary tooth loss and tooth crown size), all of which were extensively discussed in the current study. Accordingly, further attention should also be paid to studying these factors.

Relationship of maxillary and mandibular effective base length, arch length and dental crowding in different vertical growth pattern

Objectives: The objectives of the study were to assess, measure, and correlate the maxillary and mandibular effective base length, arch length to the amount of dental crowding in different vertical growth pattern patients. Materials and Methods: Sample comprising 100 pre-treatment lateral cephalograms and study models (age group – 16–25 years) was randomly selected. The sample was divided into two groups, that is, clockwise (50) and anticlockwise (50) rotation based on the measurement of the gonial angle. The gonial angle and maxillary and mandibular effective lengths were measured on pre-treatment lateral cephalograms. Dental crowding and arch length were measured on the pre-treatment dental casts. Intergroup comparisons of effective base length, arch length, and crowding were performed with unpaired t-tests. Correlations between effective base length, arch length, and dental crowding were examined by means of Pearson’s correlation coefficient (P < 0.05). Results: Subjects with clockwise rotation significantly had more mandibular dental crowding and significantly decreased mandibular arch length compared to the anticlockwise group. An inverse correlation was found between maxillary and mandibular effective base length, arch length, and dental crowding while a positive correlation was found between maxillary and mandibular base length and arch length in both the groups. Conclusion: Clockwise rotation of the mandible along with skeletal and dental factors such as decreased effective base lengths and arch length, respectively, constitutes an important factor leading to dental crowding.

Association between Crowding and the Effective Maxillary and Mandibular Length among Orthodontic Patients of Kathmandu, Nepal.

Background: During orthodontic consultation, the most frequent major complaint of the patients is dental crowding, which is caused by a disparity between the arch length and tooth size. Objective: The purpose of this study was to evaluate the association between crowding and the effective maxillary and mandibular length in Nepalese orthodontic patients.Methods: The orthodontic records of 390 people (from January 2018 to December 2020) were randomly selected and classified into three skeletal malocclusions based on the ANB angle (Angle formed by point A and point B at the nasion). Subjects with skeletal malocclusions were subdivided into two groups depending on the degree of crowding in the mandibular arch: Group 1 had crowding of < 3mm, and Group 2 had crowding of >3mm. On pretreatment casts, digital vernier calipers (Digimatic, Precise, India) were used to assess dental arch crowding, whereas, on a pretreatment lateral cephalogram, digital cephalometric analysis (Vistadent OC 1.1, USA) was done to quantify effective maxillary and mandibular length. Inter-group comparisons were assessed using a one-way analysis of variance. The correlation was assessed by Pearson’s correlation coefficient (p≤0.05).Results: There was a statistically significant difference in effective maxillary and mandibular length among skeletal malocclusions (p<0.05). Skeletal Class II malocclusion had the greatest mandibular crowding, while skeletal Class III malocclusion had the least. The effective maxillary and mandibular lengths and dental crowding had a significant but weak inverse correlation, whereas a strong but moderate positive correlation existed between the maxillary and mandibular effective lengths (r=0.674) and also between maxillary and mandibular crowding (r=0.631).Conclusion: Effective maxillary length was highest in skeletal class II malocclusion whereas effective mandibular length was highest in skeletal class III malocclusion. The shorter effective maxillary and mandibular lengths showed a weak association with dental crowding.

Necessary diagnostic criteria of dental crowding in children during mixed dentition with different facial skeleton growth patterns

Annotation. Pathology of dental crowding during mixed dentition is one of the most common and difficult in the practice of dentist-orthodontist. Its prevalence, according to modern scientific data reaches 77% and occurs in all pathologies of occlusion (malocclusions). The aim of our study is to establish the relationship between the formation of dental crowding and the growth patterns of facial skeleton during mixed dentition in order to improve the effectiveness of orthodontic treatment. We used 42 pairs of plaster models and 42 slices of cone-beam computed tomography images (CBCT) for patients aged 7 to 11 years. Randomization of patients into study groups was performed according to the facial skeleton growth patterns and the Little index value. The analysis was performed by the method of variation statistics taking into account the mean values (mode, median, arithmetic mean) and mean error (M) with the assessment of reliable values by Student’s t-test, as well as determining the correlation coefficient using the Pearson pairwise method to detect connections between the obtained indicators at the minimum probability threshold p<0.05 using the statistical package EZR v. 1.35. According to the results of the examined patients: 30 people (71.4%) had a severe degree of dental crowding on both maxilla and mandible (LII> 8 mm.), more often it was associated with the neutral type of growth – 82% (with vertical – 60%). Statistically significant correlations were found between severe degree of dental crowding and vertical and neutral facial skeleton growth patterns (p<0.05). The results of the CBCT study showed that narrowing of the upper pharyngeal airway (UP) according to McNamara was more common in patients with neutral (85%) and vertical (80%) growth patterns with skeletal II and I class malocclusions according to Engle, which were 55% and 35%, respectively. The study revealed that the vast majority of children with dental crowding with different facial skeleton growth patterns had clinically significant disorders of the development of both maxillary and mandibular apical bases and airways which required immediate interceptive orthodontic treatment.

Numerical abnormalities of permanent dentition - a case report

Tooth number abnormalities may occur under the influence of genetic or environmental factors which intervene in the tooth formation stages (induction and proliferation), most commonly the permanent dentition being affected. The result is the appearance of dental anomalies with numerical deficiency (hypodontia, anodontia), or with dental excess (hyperodontia, over-teeth). In this paper we report a case of a 15-year-old boy with associated abnormalities of permanent dentition: mesiodens and palatal impacted cuspid at the maxillary dental arch and incisor anodontia at the mandibular dental arch. Orthodontic treatment aimed at resolving maxillary dental crowding, obtaining dental alignment, a stable and functional occlusal relationship and a satisfactory smile for the patient.

Implications of Permanent Teeth Dimensions and Arch Lengths on Dental Crowding during the Mixed Dentition Period

Dento-alveolar disharmony with crowding is a common reason for orthodontic treatment with not fully understood or unequivocally demonstrated causes. This study investigated the correlations between teeth dimensions, arch lengths, and crowding during the mixed dentition period. A cross-sectional study on 100 dental casts of patients with class I malocclusions was performed. Dental arches were classified as non-crowded, moderately crowded, severely crowded, and spaced. The mesio-distal widths, bucco-lingual sizes, and crown proportions of permanent teeth were assessed. The results indicated that arch length measurements showed smaller values in crowded arches. The mesio-distal dimensions of upper central incisors and lower lateral incisors were larger in patients with crowding. The bucco-lingual dimensions of upper incisors were decreased, the bucco-lingual dimensions of lower central incisors and permanent first molars were increased in crowded arches. Upper incisors and lower lateral incisors presented larger crown proportions in crowding cases. Low negative correlations were found between mesio-distal diameters of maxillary central incisors, lower lateral incisors, lower permanent first molars, and the values of arch space discrepancies. In conclusion, crowding in the mixed dentition could be associated with reduced arch lengths, increase in mesio-distal sizes of incisors and lower permanent first molars, and variations of bucco-lingual dimensions and crown proportions of incisors and lower permanent first molars.

Oro-Dental Manifestations in a Pediatric Patient Affected by Helsmoortel-Van der Aa Syndrome

Aim: Aim of this case report is to describe oro-facial abnormalities in a patient affected by Helsmoortel-Van der Aa syndrome, a rare autism syndrome, with not well described dental and cranial malformations. Case Report: Helsmoortel-Van der Aa Syndrome is a rare autosomal genetic syndrome causing mental impairment and autism, craniofacial dysmorphism, chest deformity and multiple organs dysfunction. Oro-facial involvement in Helsmoortel-Van der Aa syndrome has not been thoroughly described yet. The present article reports a case of a 9 years old male patient affected by Helsmoortel-Van der Aa Syndrome, presenting with oral breathing typical facies, high arched palate, II class and dental crowding. The patient teething was adequate to his age. The enamel of incisors and molars showed demineralization areas and dark spots, a clinical picture consistent with molar incisor hypomineralization syndrome. These hypo-mineralized areas are more susceptible to cavities, in fact the patient’s 4.6 tooth was decayed. The child was brought to our attention due to a mucocele on the lower lip, confirmed by histopathologic examination. Available data on oro-dental manifestation of this syndrome are rather poor and inconsistent, also due to the rarity of the disease. The finding of enamel abnormalities in the presented case could suggest a potential genetic etiopathogenesis linked to the same genes causing Helsmoortel-Van der Aa syndrome.

Mutation in ZDHHC15 Leads to Hypotonic Cerebral Palsy, Autism, Epilepsy, and Intellectual Disability

ObjectiveTo determine whether mutations reported for ZDHHC15 can cause mixed neurodevelopmental disorders, we performed both functional studies on variant pathogenicity and ZDHHC15 function in animal models.MethodsWe examined protein function of 4 identified variants in ZDHHC15 in a yeast complementation assay and locomotor defects of loss-of-function genotypes in a Drosophila model.ResultsAlthough we assessed multiple patient variants, only 1 (p.H158R) affected protein function. We report a patient with a diagnosis of hypotonic cerebral palsy, autism, epilepsy, and intellectual disability associated with this bona fide damaging X-linked variant. Features include tall forehead with mild brachycephaly, down-slanting palpebral fissures, large ears, long face, facial muscle hypotonia, high-arched palate with dental crowding, and arachnodactyly. The patient had mild diminished cerebral volume, with left-sided T2/FLAIR hyperintense periatrial ovoid lesion. We found that loss-of-function mutations in orthologs of this gene cause flight and coordinated movement defects in Drosophila.ConclusionsOur findings support a functional expansion of this gene to a role in motor dysfunction. Although ZDHHC15 mutations represent a rare cause of neurodevelopmental disability, candidate variants need to be carefully assessed before pathogenicity can be determined.

Management of severe maxillary discrepancy in unilateral cleft lip and palate: six year follow up in a patient with tongue graft

<p class="abstract">The purpose of this original case study was to present the efficiency of combined orthodontic and distraction osteogenesis (DO) in severe maxillary hypoplasia along with importance of tongue graft for closure of large residual palatal defect. DO has been successfully chosen in lengthening and widening the maxilla transversely to relieve anterior dental crowding and transverse discrepancies between the dental arches. A UCLP (unilateral cleft lip and palate), 15 year old male with the chief complaint of esthetic and functional problems because of skeletal class III malocclusion with anterior crossbite and severe midline shift was taken up for this modality of treatment. Considering the severity of malocclusion, combined orthodontic and DO treatment was considered adequate which was likely less invasive and equally stable procedure. RED (rigid external distractor) was used for distraction after initial alignment followed by closure of residual large palatal defect with tongue graft. Result obtained was esthetically good with acceptable occlusion considering the severity with pleasing soft tissue profile. The review was done after six year which showed remarkable skeletal stability with no dehiscence of tongue graft in palate area. The combined use of DO and orthodontic correction in ULCP case had substantial skeletal stability, improving patient esthetic and self-esteem.</p>

Prevalence of Dental Crowding in the Kabul Dental Hospital, Kabul-Afghanistan

Background: Dental crowding, also called overcrowding, is a condition in which there is not enough space in the mouth for the steady growth of permanent teeth. Common problems that crowding can cause for a person include difficulty chewing food, speech problems, tooth decay, enamel loss, premature tooth loss, pressure on the jaws and pain, gingival resorption, and tenderness. Crowding always creates an unpleasant appearance for a person and even causes a person to be isolated from society and reduce self-confidence due to an ugly appearance. Crowding raises serious functional and aesthetic concerns for many patients. Aims: Conduct a descriptive study in this field with 1000 patients of the (OPD) Outpatient Department of Kabul Dental Hospital on the prevalence of crowding and to finding the relationship between the incidence of crowding according to the upper and lower jaws and the anterior and posterior segments of each jaw. Methods and materials: The sampling method were systematic random sampling that 1000 people were randomly selected from all OPD service clients during nine months and were included in the study. The required information was obtained by clinical examination of patients above the dental unit, under adequate light and the kit of dental examination equipment with direct clinical examination of the patient, and a pre-prepared questionnaire was inserted. The information obtained from the questionnaire reached the coding page, and it was entered into IBM_SPSS-25 software, and its analysis was performed. Results: From the results of this study, it was found that the prevalence of crowding was 59.1%, with the highest incidence of 28.6% in the lower jaw. Also, the highest rate of crowding events was 44.9% in the anterior segment of the mandible. Crowding events were received in the upper jaw 12.7%, with the highest incidence of 29.3% in the anterior segment.