Maxillary lateral incisor agenesis and microdontia: Minimally invasive symmetric and asymmetric esthetic rehabilitation

Maxillary lateral incisor agenesis is a condition that significantly compromises smile esthetics, which is particularly worrying in young patients. This article shows how the combination of non-invasive treatments and current restorative options may improve clinical outcomes following orthodontic treatment for symmetric and asymmetric maxillary lateral incisor agenesis and microdontia. Teeth were treated with conservative resin restorations in three separate cases: two of congenitally missing maxillary lateral incisors (i.e., unilateral and bilateral) and one of microdontia. After presenting the clinical results, this article summarizes how bleaching, enameloplasty, and bonding with composite resin can enhance esthetics and functions following orthodontic space closure. The cases reveal that carefully planned, methodically executed orthodontic and restorative approaches can achieve predictable, esthetic outcomes that will improve the patient’s self-esteem with a minimally invasive solution.

Molar space closure: To do or not to do?

Missing or compromised permanent molars can complicate orthodontic treatment planning and mechanics. Molar extraction should be considered in appropriate situations, but clinicians must decide between closing and regaining the edentulous space. Several factors should be taken into consideration to achieve appropriate molar space management, such as the need for space, asymmetry, periodontal status, sinus pneumatization, and the terminal molar position. Herein, three sample cases are reported to demonstrate the treatment options for molar space closure and maintenance with these factors taken into consideration during treatment planning. The understanding of mechanics played a crucial role in anchorage preparation and side effect prevention. If the third molar substitution was managed in advance and adequate space between the ramus and third molar was obtained via second molar protraction, the tooth spontaneously erupted in a favorable position without requiring further treatment. This case series can aid clinicians in molar space management. Regardless of whether the space is to be closed or regained, the treatment plan should conform to the patient’s expectations and improve occlusion with minimal side effects and treatment duration.

Long-term follow-up of mandibular dental arch changes in patients with complete non-syndromic unilateral cleft lip, alveolus, and palate

Background Treatment of cleft lip and palate (CLP) requires a comprehensive interdisciplinary approach and long-term follow-up. Only a few studies are available that reported on changes after treatment, which showed that in particular the transverse dimension, in patients with CLP is prone to changes after treatment. However, those studies did not pay attention to concomitant changes in the mandibular arch that occur after treatment. Objectives To evaluate mandibular transverse dental arch dimensions and interarch transverse changes in patients with complete non-syndromic unilateral cleft lip, alveolus, and palate (CUCLAP) up to five years after treatment. Material and Methods Retrospective longitudinal study in 75 consecutive patients with CUCLAP directly after comprehensive treatment (T0), two (T2), and 5 years after treatment (T5). Great Ormond Street, London and Oslo (GOSLON) scores were available for all patients. Three-dimensional scans of all dental casts were made. Inter premolar and intermolar distances between the mandibular contralateral teeth were measured. The modified Huddart Bodenham (MHB index) was applied to assess the transverse interarch relationship. Paired t-tests and ANOVA were used to analyze transverse and interarch transverse changes. Linear regression analysis was done to define contributing factors. Results Paired t-tests showed a significant decrease of the mandibular inter first and second premolar distances (p < 0.05) and an increase of the inter second molar distance, whilst the MHB Index deteriorated at all time points for all segments and for the total arch score (p < 0.05). Linear regression showed no significant contributing factors on the decrease of the transverse distances. However, inter arch transverse relationship was significantly affected by age at the end of treatment, missing maxillary lateral incisor space closure, and the GOSLON Yardstick score at the end of treatment (p < 0.05), especially during the first two years after treatment. Conclusions Changes occurred in the mandibular arch expressed as changes in the transverse dimensions and interarch relationship measured by the MHB Index. A younger age at the end of treatment, space closure for a missing maxillary lateral incisor and a higher GOSLON score at the end of treatment negatively influence the interarch transverse deterioration especially in the first two years after treatment. For the transverse dimensional changes in the mandibular arch such influencing factors could not be determined.

Effectiveness of platelet rich fibrin versus demineralized bone xenograft in periodontally accelerated osteogenic orthodontics: A pilot comparative clinical study

ABSTRACT Objectives To compare the rate of extraction space closure between periodontally accelerated osteogenic orthodontics (PAOO) using platelet-rich fibrin (PRF) (Group 1) and PAOO using demineralized bone xenograft (DMBM) (Group 2) and to compare the level of wound healing between the PRF group vs the DMBM group after PAOO. Materials and Methods A two-arm prospective single blind pilot study with a split-mouth design was used in which 14 patients requiring premolar extraction were divided into two groups: PRF and DMBM. En-masse space closure was carried out with using mini implants after the PAOO procedure. The amount of space closure was measured at five time points with 2-week intervals within 2 months. The gingival healing levels were assessed using early wound healing scores on the first postoperative day. Results The rate of extraction space closure was faster in the experimental quadrant at all time points (T1-T4) in the PRF group and at time points (T3, T4) in the DMBM group. Comparison between experimental quadrants showed a significant increase in the rate of space closure in the PRF group T1 to T3 (P &lt; .05). The PRF group showed higher total early healing scores than the DMBM group. Conclusions PRF, when used in the PAOO procedure, produces a faster rate of space closure with better early wound healing than DMBM.

Space Closure Rate in Mandibular Canine Retraction by Elastomeric Power Chain: A Clinical Trial

Background : On a daily basis, orthodontic patients present with malocclusions and orofacial imbalance. Often times, teeth must be extracted in order to obtain proper esthetics, occlusion, and stability as well as extraction of teeth is often a need to close residual space, after the initial decrowding and aligning. Pre adjusted fixed orthodontic appliances commonly utilize sliding mechanics for space closure with different types of force delivery systems. A variety of materials have been used as force delivery systems to close spaces between teeth as in the case of canine retraction after the extraction of premolars. Elastomeric auxiliaries are relatively consistent in producing tooth movements. The purpose of the study to evaluate the rate of mandibular canine retraction by elastomeric power chain. Materials and methods : This obervational study was designed as split mouth study. A total number of 20 patients (40 quadrants),who required canine retraction into first premolar extraction sites as part of their orthodontic treatment in the Department of Orthodontics, BSMMU as study population. The quadrants were affixed by elastomeric power chain (Dentaurum) with 200gm force measured by Correx Tension Gauge. Space closure was measured by means of direct measurement from the mesial surface of mesial wing of the 2nd premolar bracket and the distal surface of distal wing of the canine bracket with digital Vernier Calipers. Results: Mean space closer rate in mandibular canine retraction was 0.99 ± 0.08 mm/month in elastomeric power chain method with p value<0.001. Conclusion : This study revealed that space closer rate in mandibular canine retraction was 0.99 ± 0.08 mm/month by elastomeric power chain. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 28-31

Space Closure Rate in Mandibular Canine Retraction by Ni-Ti Closed Coil Spring: A Clinical Trial

Introduction: In Majority of patients seeking orthodontic treatment, teeth must be extracted in order to obtain proper esthetics, occlusion, and stability as well as extraction of teeth is often a need to close residual space, after the initial decrowding and aligning. Pre adjusted fixed orthodontic appliances commonly utilize sliding mechanics for space closure with different types of force delivery systems. A variety of materials have been used as force delivery systems to close spaces between teeth as in the case of canine retraction after the extraction of premolars. Among all sliding or frictionless methods of canine retraction, super-elastic nickel titanium coil spring has a particular property in producing light continuous force at a long range of action, compared with previously available materials. Nickel-titanium closed coil spring, with a continuous action, might have some advantages in fixed appliance space closure mechanics. Materials and Methods: Over the period of one year from May 2015 to April 2016, this clinical trial was carried out and A total number of 20 patients (40 quadrants), who required canine retraction into first premolar extraction sites as part of their orthodontic treatment in the Department of Orthodontics of BSMMU selected as study population. The quadrants were affixed by nickel titanium closed coil springs (medium force, Ni-Ti extension spring, Ormco) with 200gm force measured by Correx Tension Gauge. Space closure was measured by means of direct measurement from the mesial surface of mesial wing of the 2nd premolar bracket and the distal surface of distal wing of the canine bracket with digital Vernier Calipers. Results: Mean space closer rate in mandibular canine retraction was 1.07 ± 0.12 mm/month by nickel-titanium (Ni-Ti) closed coil spring method with p value<0.001. Conclusion: This study revealed that space closer rate in mandibular canine retraction by nickel-titanium (Ni-Ti) closed coil spring is 1.07 ± 0.12 mm/month. Medicine Today 2021 Vol.33(2): 90-93