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.

Evaluation of mandibular indices and cephalometric parameters in adolescents with impacted maxillary canines

Objectives: Maxillary impacted canines have an important place in orthodontics for the reason of being a common anomaly and its treatment is time consuming and difficult. The aim of this study was to investigate the mandibular indexes and cephalometric parameters in adolescents with impacted maxillary canines. Materials and Methods: The radiographs of 4026 patients aged 12–19 years old were scanned and a total of 155 patients were included in the study. Subjects were divided into three groups according to the permanent maxillary canines: Bilateral impacted canine (BIC) (52 subjects; mean age 15.02 ± 1.74 years), unilaterally impacted canine (UIC) (51 subjects; mean age 14.89 ± 1.39 years), and the control (52 subjects; mean age 14.84 ± 1.65 years) groups. Skeletal, soft tissue and dental measurements were performed on cephalometric radiographs. Mandibular index analyzes including the panoramic mandibular index (PMI), mental index (MI), antegonial index (AI), and gonial index (GI) measurements and also angular measurements of impacted maxillary canines were performed on panoramic radiographs. Data were analyzed statistically and P < 0.05 was considered significant. Results: Maxillary skeletal and dental measurements showed retrusive positioned maxillary dental arch in the sagittal direction in the impacted canine groups (P < 0.05). PMI and MI values were greater in the BIC and UIC groups than in control group (P < 0.05). There was no statistically significant difference in AI value among groups (P < 0.05). GI value of BIC group was found statistically lower than other groups (P < 0.05). Conclusion: Individuals with impacted maxillary canines have more retrusive maxillary dental arch and soft-tissue components. Furthermore, mandibular cortex was thicker in subjects with impacted maxillary canine than individuals with not and clinicians should keep in mind this when examine the panoramic radiographs in terms of early diagnosis of impacted maxillary canine teeth.

Orthodontic Treatment of Bilateral Transposition of Maxillary Canines and Lateral Incisors

Dental transposition is a severe disturbance of tooth position and its eruptive sequence. It may affect any tooth, and it may occur at any location within the dental arch, although some teeth may be more frequently affected than others. There are several types of dental transposition, and their classification depends on the type of teeth involved. The aetiology of transposition is not very clear and has always been the subject of controversies, and it is still not completely understood. The prevalence of dental transposition and the factors related to this dental anomaly have been well documented in the literature. When treating dental transposition, many factors which may affect the treatment results must be considered, such as aesthetics, occlusion, treatment duration, patient comfort, patient cooperation, and periodontal support. Various treatment options are currently available for the treatment of dental transposition. Successful treatment outcomes depend on the patient’s age, concern about facial and dental aesthetics, motivation of the patient, functional requirements, type of malocclusion, and the position of the root apices. The present case report is aimed at outlining the orthodontic treatment of a young adult patient diagnosed with bilateral maxillary canine-lateral incisor transposition.

Radiographical Measurements of Overeruption in Unopposed Posterior Teeth Among Selected Population of Saudi Arabia

The suspended replacement of extracted teeth may disrupt the structural integrity of the whole dental arch, particularly in posterior maxillary or mandibular tooth/teeth. This phenomenon often has consequences of masticatory deficiency and temporomandibular joint disorders. This work aims to assess and measure the overeruption of posterior teeth from panoramic radiographs (OPGs) and its relation to gender, age, tooth type, arch, sides, and cause of tooth loss. A total of 100 OPGs were included in this in vitro study. The level of posterior overeruption was measured in mm using the panoramic digital radiograph machine and its software systems. Other variables such as gender, tooth/teeth involved, arches, and side were considered. All parameter values were inputted to a software program and assessed. P value < 0.05 was considered as statistically significant. Males accounted for 63% of the OPGs. Age groups 18–30 and 31–45 years had the highest frequency and percentage (34%). Approximately 74% of the patients got their tooth/teeth extracted 4–6 years ago. The 0.7–1.2 mm overeruption subgroup had the highest proportion of 41%. The rate of overeruption in mandibular molars was 36%, which was the highest among the subgroups. Males had higher percentage than females in ≥60 and 31–45 age groups (84.65% and 76.5%, respectively), 4–6 years post-extraction time (85.7%), with significant differences, also, mandibular molars (85.0%) and mandibular arches (74.3%) were the higher among males. The highest level of overeruption was 0.7–1.2 mm, and mandibular molars were the most affected type. Significant differences between genders were detected in age groups, years after tooth loss, and arch side but not in cause of tooth loss, supra-erupted tooth type, and arch type parameters.

Fit accuracy of removable partial denture metal frameworks produced by CAD-CAM – a clinical study

Objectives: To assess the effect of a CAD-CAM protocol fabrication on the clinical fit accuracy of removable partial denture metal frameworks to abutment teeth. Methods: Fifteen patients with partial edentulism were selected to participate in this clinical study, and twenty dental arch rehabilitations were planned. For each dental arch (n=20), two cobalt-chromium frameworks were produced through two protocols: CAD-CAM production (experimental group); and conventional lost-wax casting technique (control group). Clinical fit accuracy was assessed using an indirect quantitative method to evaluate the gap between the framework occlusal rest and the corresponding rest seat. A silicone mold of that gap was obtained, digitized, and analyzed by micro-computed tomography. The two silicone molds obtained for each occlusal rest were overlapped and evaluated for thickness and volume. Data were analyzed with the paired t test for silicone thickness results and the Wilcoxon test for silicone volume results (α= 0.05). Results: Considering the two dependent variables under study, no statistically significant (p=0.441 for silicone thickness and p=0.204 for silicone volume) differences were found between groups. Conclusions: The results of this study suggest that the CAD-CAM protocol applied is a viable method for the production of removable partial denture metal frameworks. (Rev Port Estomatol Med Dent Cir Maxilofac. 2021;62

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.

3Shape Digital Design Software in Splints Creation—A Pilot Study

Objectives Digital technologies have widened their horizons into the world of dental medicine and now further expanding to cover all branches. This new modern technology replaces traditional laboratory techniques allowing effective patient care. Patients who suffer from bruxism—the act of involuntary habitual grinding of teeth—have widely been benefited by splint treatments. The aim of this article is to display the variety of occlusal splints that can be created by the 3Shape Digital Design Software and their application in specific clinical situations. Materials and Methods Six variations in the splints were created digitally—three with uncombined designs and the remaining three with a combination of two of the main options available. During this study, 36 splints were made for patients aged 24 to 55 inclusively. Results The largest number of splints according to the clinical picture were made of “raise to antagonist cusp tips” (14 pieces) and the remaining were of combined type “raise to antagonist cusp tips + raise to antagonist plane” (12 pieces). There thickness was within the range of 1.5 and 5 mm. Conclusion 3Shape Digital Design Software—Splint Studio is a suitable system for designing and creating occlusal splints with respect to certain clinical situations. It is possible to combine the three main types in a separate section of the dental arch according to the case.

Graft Tulang Alveolar dan Pemberian Terapi Oksigen Hiperbarik pada Gnatoschizis: Laporan Kasus

Gnatoschizis is a congenital disorder due to complex causes involving many genetic and environmental factors. The shape and complexity of the cleft varies greatly, which will determine the final outcome of the reconstruction. The management involves a multidisciplinary approach including orthodontics, prosthodontics, as well as speech and psychological therapist. Bone grafting materials such as iliac crest (corticocancellous autogenous), bone morphogenetic proteins and recombinant human proteins have shown good long-term results. An additional method that is considered effective in accelerating bone growth is the administration of hyperbaric oxygen therapy (HBOT) which has been reported to increase the accumulation of minerals needed for osteogenesis, such as calcium, magnesium, and phosphorous. We reported a case of a 14-year-old girl with gnatoschizis who underwent an alveolar bone graft surgery and one day after the operation was immediately followed by administration of (HBOT) to improve the bone healing process. cleft location. Autogenous iliac bone graft was used for closure of the bony defect at the site of the cleft. Follow up at day-14 showed a satisfying result. In conclusion, in this patient continuity of upper dental arch was achieved as well as optimal alar basis, no fistula, stabile upper dental arch for orthodontic treatment, and ideal alveolar morphology that supported the ultimate goal of cleft palate treatment - improvement of quality of life.Keywords: gnatoschizis; alveolar bone graft; hyperbaric oxygen therapy Abstrak: Gnatoschizis merupakan kelainan kongenital dengan penyebab kompleks yang meli-batkan banyak faktor genetik dan lingkungan. Bentuk dan kompleksitas sumbing sangat bervariasi, yang akan menentukan hasil akhir rekonstruksi. Tatalaksananya melibatkan pendekatan multi-disiplin termasuk ortodontik, prostodontik, serta terapi wicara dan psikologis. Bahan pencang-kokan tulang seperti krista iliaka (corticocancellous autogenous), protein morfogenetik tulang dan protein manusia rekombinan telah menunjukkan hasil jangka panjang yang baik. Salah satu metode tambahan yang dianggap efektif mempercepat pertumbuhan tulang ialah pemberian terapi oksigen hiperbarik (TOHB) yang telah dilaporkan meningkatkan akumulasi mineral yang dibutuh-kan untuk osteogenesis, seperti kalsium, magnesium, dan fosfor. Kami melaporkan kasus seorang anak perempuan berusia 14 tahun dengan gnatoschizis yang menjalani operasi cangkok tulang alveolar dan satu hari setelah operasi langsung dilanjutkan pemberian TOHB untuk meningkatkan proses penyembuhan tulang. Cangkok tulang iliaka autogenous digunakan untuk penutupan defek tulang di lokasi sumbing. Follow up pada hari ke 14 di poliklinik dengan pemeriksaan fisik pada defek lokasi sumbing mendapatkan hasil yang memuaskan. Simpulan laporan kasus ialah pada pasien ini diperoleh kontinuitas lengkung rahang atas, basis alar yang optimal, fistula dihilangkan, segmen rahang atas yang stabil untuk perawatan ortodontik, dan morfologi alveolar yang ideal yang menyokong tujuan akhir tatalaksana sumbing yaitu perbaikan kualitas hidup.Kata kunci: gnatoschizis; cangkok tulang alveolar; terapi oksigen hiperbarik

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.