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Objective This case will illustrate the interdisciplinary management of an adolescent female patient with amelogenesis imperfecta (AI). It will contrast this approach and compare it to the previous "multidisciplinary" treatment rendered before the patient was referred for a second opinion. Clinical considerations The patient had a family history of AI affecting all of her permanent teeth. There were many impacted teeth. The majority of her family and relatives afflicted by this opted for dentures. The patient had undergone 2 years of treatment and was told that her "braces would be removed next week." Her new dentist was concerned because the case was not ready to restore. Conclusion He recommended referral to another orthodontist for a second opinion and formulation of an interdisciplinary treatment plan that would include a periodontist, endodontist, and restorative dentist. The patient's family accepted the second opinion referral and restarted treatment with an interdisciplinary team. The restorative dentist was the quarterback for this integrated and sequenced approach. The case was ultimately restored. A 35 year follow-up shows stability with a caries free, periodontally healthy, esthetic result.

Objective To describe a novel CONsolidated Standards of Reporting Trials (CONSORT) adherence strategy implemented by the American Journal of Orthodontics and Dentofacial Orthopedics (AJO-DO) and to report its impact on the completeness of reporting of published trials. Study design and setting The AJO-DO CONSORT adherence strategy, initiated in June 2011, involves active assessment of randomized clinical trial (RCT) reporting during the editorial process. The completeness of reporting CONSORT items was compared between trials submitted and published during the implementation period (July 2011 to September 2013) and trials published between August 2007 and July 2009. Results Of the 42 RCTs submitted (July 2011 to September 2013), 23 were considered for publication and assessed for completeness of reporting, seven of which were eventually published. For all published RCTs between 2007 and 2009 (n = 20), completeness of reporting by CONSORT item ranged from 0% to 100% (Median = 40%, interquartile range = 60%). All published trials in 2011-2013, reported 33 of 37 CONSORT (sub) items. Four CONSORT 2010 checklist items remained problematic even after implementation of the adherence strategy: changes to methods (3b), changes to outcomes (6b) after the trial commenced, interim analysis (7b), and trial stopping (14b), which are typically only reported when applicable. Conclusion Trials published following implementation of the AJO-DO CONSORT adherence strategy completely reported more CONSORT items than those published or submitted previously.

4 Impacted teeth are often encountered during the diagnosis and treatment of malocclusions in adolescent orthodontic patients. After the third molars, the most commonly impacted tooth is the maxillary canine with an incidence of 1% to 3%, which varies depending on the ethnicity of the sample population. Although the canine crown can be impacted either labially or palatally, it is more frequently positioned in the palate. Although most palatally displaced canines can be positioned orthodontically in the alveolus, several problems might accompany the management of these ectopically positioned teeth. First, the overall length of orthodontic treatment is increased when the patient has a palatal impaction. Second, there are often problems of alveolar bone loss around the adjacent lateral incisor andpremolar aswell as the canine.Third, root resorption of the adjacent lateral incisor is a common aftermath of treating a palatally impacted canine. Finally, gingival recession on the labial or palatal surfaces can accompany the treatment of these teeth. All of these potential problems can result in an increased risk of litigation between the orthodontist and an unhappy patient. In the United States, lawsuits for mismanagement of palatally impacted canines rank second in frequency, just behind periodontal problems developing during the orthodontic treatment of adults. Why do these problems exist? Is it because of the orthodontic mechanics? Is it because of the surgical technique of uncovering these teeth? Or is it a combination of factors?

Dr. Kokich, it has always been a pleasure to read your articles and to listen to your lectures, especially those you gave during your farewell appearance in Dubrovnik in September 2009. All of your presentations and your publications have given us much food for thought as well as practical suggestions we could use in our daily practices. This interview affords me the opportunity to thank you for your immense contributions to orthodontics.

Palatally impacted maxillary canines are a challenge for any orthodontist. Often the surgeon will perform an incorrect uncovering technique, the orthodontic mechanics to erupt the tooth could be inappropriate, and as a result the periodontal and esthetic outcome could be disastrous. However, in the adolescent patient, the management of palatally impacted maxillary canines can be predictable, stable, and esthetic. However, to accomplish these results, the orthodontist and surgeon must select the appropriate method of surgical uncovering. This article discusses the advantages of preorthodontic uncovering and autonomous eruption of palatally impacted maxillary canines. The surgical technique will be described and illustrated, and consecutively treated cases will be displayed. An evidence-based discussion will feature the benefits of preorthodontic uncovering and autonomous eruption of palatally impacted maxillary canines.

Introduction A survey of the members of the Angle Society of Europe showed that 60% of orthodontists took their own clinical photographs, 35% assigned the task to an auxiliary, and 5% hired professional clinical photographers. It is always useful to ensure that orthodontists' time is used to maximum effect. Clinical photography could be delegated to auxiliary staff. In this study, we assessed the quality of photographs taken by orthodontists to see whether those taken by orthodontic auxiliaries and clinical photographers are of comparable quality. Methods Fifty sets of orthodontic photographs were collected from each of 3 types of photographers: orthodontists, orthodontic auxiliaries, and professional clinical photographers. Four assessors scored each set for quality and detailed errors. The results were compared to determine whether there were differences between the quality of the photographs taken by the different groups. Results and Conclusions Most of the photos taken by the 3 groups of photographers were judged to be good or acceptable. The results for extraoral photographs showed no statistically significant differences between the 3 groups for good ( P = 0.398) and acceptable ( P = 0.398) images. The results for intraoral photographs did not differ significantly for acceptable and unacceptable photographs, but orthodontists produced significantly more good-quality intraoral photographs ( P = 0.046).

Occasionally, general dentists are challenged with providing restorative treatment for a postorthodontic patient who has had moderate to severe root resorption. When this happens, a number of questions about the cause of such resorption and the appropriate treatment arise in the dentist's mind. This article will describe the orthodontic and restorative management of three patients with severe maxillary incisor root resorption, provide a thorough discussion of the currently available literature on the topic of root resorption, and answer clinical questions regarding this relatively infrequent but devastating sequel to orthodontic treatment.

Background The authors examined the effects of orthodontic intrusion of abraded incisors in adult patients to facilitate restoration, focusing specifically on changes in alveolar bone level and root length. Methods The authors analyzed records of 43 consecutive adult patients (mean age 45.9 years). They identified intrusion by means of cephalometric radiographs and bone level and root length by means of periapical radiographs. They calculated treatment differences from the pretreatment period to the posttreatment period. Results In general, bone level followed the tooth during intrusion, but a small amount of bone loss occurred ( P Conclusions and Clinical Implications Incisor intrusion in adults moves the dentogingival complex apically and is a valuable adjunct to restorative treatment. Potential iatrogenic consequences of alveolar bone loss and root resorption are minimal and comparable with the consequences of other orthodontic tooth movements.

Today's dentist does not just repair teeth to make them better for chewing. Increasingly, his or her work involves esthetics. With patients demanding more attractive teeth, dentists now must become more familiar with the formerly independent disciplines of orthodontics, periodontics, restorative dentistry, and maxillofacial surgery. This article provides a systematic method of evaluating dentofacial esthetics in a logical, interdisciplinary manner. In today's interdisciplinary dental world, treatment planning must begin with well-defined esthetic objectives. By beginning with esthetics, and taking into consideration the impact on function, structure, and biology, the clinician will be able to use the various disciplines in dentistry to deliver the highest level of dental care to each patient.

Introduction: The purpose of this study was to evaluate differences in periodontal status, root length, and visual assessment in patients with palatally impacted maxillary canines that were surgically exposed, allowed to erupt freely into the palate, and orthodontically aligned. Methods: Clinical examinations of the maxillary lateral incisors, canines, and adjacent premolars were performed on 16 patients with unilaterally impacted canines and 6 with bilaterally impacted canines treated in this manner. The average age was 23 years 7 months, and the average posttreatment observation period was 2 years 11 months. Data from the bilaterally impacted canines were not used in the central analysis. Results: Differences in probing attachment level were found at the distolingual region of the lateral incisor and at the distobuccal region of the premolar adjacent to the treated canine. Crestal bone height was lower at the mesial and distal regions of the lateral incisor adjacent to the previously impacted canine, and the roots of the treated canine and adjacent lateral incisor were shorter than those of the contralateral control teeth. Twenty-three orthodontists and 9 second- and third-year orthodontic residents could identify the previously impacted canine in the unilateral patients an average of 78.9% of the time, but to a statistically significant degree in 66% of all patients. Conclusions: The overall consequences to the impacted canine of surgical exposure and free eruption are good compared with closed exposure and early traction, whereas consequences to the adjacent teeth, particularly the lateral incisor, are similar. Future research directly comparing the 2 methods with a larger sample and randomization could yield further insight.

Although the mechanical management of impacted teeth is a routine task for most orthodontists, certain impactions can be frustrating, and the esthetic outcome can be unpredictable if the surgeon uncovers the impacted tooth improperly. When referring a patient to have an impacted toothuncovered,theorthodontist might assume incorrectly that the surgeon knows which surgical procedure to use. However, if not instructed properly, the surgeon could select an inappropriate technique, leaving the orthodontist with the difficult if not sometimes lengthy and challenging task of erupting the impacted tooth into the dental arch. On the other hand, if the correct uncovering technique is chosen, the eruption process can be simplified, resulting in a predictably stable and esthetic result. This is especially true for impacted maxillary canines. After the third molars, the maxillary canines are the most commonly impacted permanent teeth. About one third of impacted maxillary canines are positioned labially or within the alveolus, and two thirds are located palatally. In most situations, the appropriate timing and surgical procedure for uncovering an impacted canine are determined by specific criteria. This article will review the surgical and orthodontic management of impacted maxillary canines.

Implants are commonly used to replace congenitally missing lateral incisors in adolescent orthodontic patients. However, these restorations are often challenging for the orthodontist, surgeon, and restorative dentist. In some patients the space across the alveolar crest is too narrow to permit the surgeon to place the implant. Occasionally the root apices of the adjacent central incisor and canine are in close proximity. In other cases the ridge thickness could be inadequate and require augmentation. When the orthodontist opens the space, the papilla heights are adversely affected. Some adolescent patients have altered passive eruption after orthodontic treatment, which affects the level of the gingival margins. Finally, questions commonly arise regarding the appropriate age for implant placement in these young patients. If not addressed, these issues could compromise the aesthetics of the implant restoration. This article will use several clinical examples to discuss each of these 6 potential problems and provide guidelines for their solutions.

Orthodontic finishing is a continual challenge for the orthodontist. In some situations, it seems that the teeth simply "fall together" into their correct relationship with little effort on the part of the clinician. However, in other patients, it takes considerable effort and skill to achieve an excellent occlusal result after appliance removal. Futhermore, the increase in adult patients has brought a new challenge to the orthodontist. How should the teeth be positioned if the patient will require minor or major restoration of the teeth after orthodontic treatment? How should the clinician finish the occlusion if the patient has had significant periodontal bone loss before orthodontic therapy? How can the esthetics of a debilitated adult dentition be improved to resemble the nonworn, nonrestored, nonperiodontally involved adolescent dentition? These questions will be addressed in this article that identifies the occlusal, periodontal, and esthetic parameters for orthodontic finishing in the adolescent dentition, and provides useful guidelines for finishing in the adult perio-restorative patient.

The purposes of this study were to determine the prevalence of posttreatment open gingival embrasures in adult orthodontic patients and to examine the association of pretreatment maxillary incisor malalignment, posttreatment alveolar bone height, interproximal contact position, root angulation, crown shape, and embrasure area with open gingival embrasures. Posttreatment intraoral photographs of 337 adult orthodontic patients were evaluated to determine the prevalence of open gingival embrasures. A subsample of 119 patients was identified for measurement and divided into 2 groups: normal gingival embrasures and open gingival embrasures. Digital images of the pretreatment maxillary models and posttreatment maxillary central incisor periapical radiographs were made to measure the pretreatment and posttreatment variables. The prevalence of posttreatment open gingival embrasures in adult orthodontic patients was 38%. Pretreatment maxillary central incisor rotation and overlap were not statistically associated with posttreatment open gingival embrasures. A posttreatment alveolar bone-interproximal contact distance greater than 5.5 mm was associated with open gingival embrasures. Short and more incisally positioned posttreatment interproximal contacts were associated with open gingival embrasures. Open gingival embrasures were found to have more divergent root angulations and more divergent or triangular-shaped crown forms than normal gingival embrasures. Embrasure areas larger than 5.09 mm(2) were also correlated with open gingival embrasures. Increased alveolar bone-interproximal contact distance and increased root angulation demonstrated the greatest increase in the odds of an association with an open gingival embrasure. This investigation indicates that open gingival embrasures are common in adults who have undergone orthodontic treatment and that posttreatment variables are significant factors in open gingival embrasures.

Orthodontists treat many patients who are missing maxillary lateral incisors and/or mandibular second premolars. In the past, if the canines could not be substituted for lateral incisors, conventional full-coverage bridges were the common restoration. Recently, resin-bonded Maryland bridges became a popular substitute for conventional bridges to avoid crowns on the nonrestored abutments. However, resin-bonded bridges have a poor long-term prognosis for retention, lasting on average about 10 years. Since implants were introduced into dentistry by Swedish researchers in the mid-1980s, they have become a promising substitute for conventional or resin-bonded bridges. However, to successfully place and restore single-tooth implants in young orthodontic patients several questions must be answered. This article will discuss the many interdisciplinary issues that are involved in placing and restoring single-tooth implants in orthodontic patients.

Occasionally, patients require restorative treatment during or after orthodontic therapy. Patients with worn or abraded teeth, peg-shaped lateral incisors, fractured teeth, multiple edentulous spaces, or other restorative needs may require tooth positioning that is slightly different from a nonrestored, nonabraded, completely dentulous adolescent. Generally, orthodontists are not accustomed to dealing with patients who require restorative intervention. Should the objectives of orthodontic treatment differ for the restorative patient compared with the nonrestorative patient? How should the teeth be positioned during orthodontic therapy to facilitate specific restorations? Should teeth be restored before, during, or perhaps after orthodontics? The answers to these and other important questions are vital to the successful treatment of some orthodontic patients. This article will provide a series of eight guidelines to help the interdisciplinary team manage treatment for the orthodontic-restorative patient.

Today implants are commonly used to replace missing teeth in partially edentulous adult orthodontic patients. Because these patients are missing teeth, orthodontic mechanics may be complicated or often impossible because of insufficient anchorage. In these situations, it may be feasible to use the implant initially as an orthodontic anchor to facilitate complex tooth movement and secondarily as an abutment for a crown or fixed prosthesis. This article will discuss the ramifications and requirements for using implants as anchors and abutments in adult orthodontic patients.

As we complete the 20th and progress into the 21st century, orthodontists worldwide are experiencing a gradual but significant change in their practices. The number of adult patients has increased substantially. Although adults cooperate better than adolescents, they present a different set of challenges for the orthodontist. Adults may have worn or abraded teeth, uneven gingival margins, missing papillae, and periodontal bone loss, all of which can jeopardize the esthetic appearance of the teeth after bracket removal. This article will discuss the solutions for managing these challenging orthodontic-periodontic-restorative situations to produce a more ideal esthetic result.

The aim of the study was to test the hypothesis that the gene defect causing congenital absence of maxillary lateral incisors also causes narrowing of the dentition. A total of 81 patients with one or two congenitally missing lateral incisors were retrieved; 52 (64.2 per cent) patients presented bilateral agenesis, whereas 29 (35.8 per cent) had unilateral agenesis. The control group consisted of 90 consecutively treated patients. The largest mesiodistal crown dimension for all teeth, except for the maxillary second and third molars, was measured on plaster casts using a digital caliper to the nearest 10th of a millimetre. Statistical testing was performed using the analysis of variance model (P < 0.05) to test for differences in the mesiodistal dimension between the sample and the control group. Significance has been assessed using a P-value threshold level of 5 per cent. Agenesis of maxillary lateral incisors was found to be a significant predictor of tooth size. Patients who were missing maxillary lateral incisors had smaller teeth compared to control subjects, except for the maxillary right and left first molars. This finding was true for both unilateral and bilateral lateral incisor agenesis. Interaction between maxillary lateral incisor agenesis and gender was not significant. Patients with congenitally missing lateral incisors have narrower teeth than patients without any dental anomalies, except for maxillary first molars. A higher prevalence of microdontic contralateral incisors was found in patients with unilateral agenesis with respect to the control group.

As orthodontists, most of us believe that we are among the best in our community at what we do—straightening teeth. Of course, we know that alignment is not the only important outcome of orthodontic therapy. We also strive to produce a good occlusal result and a well-balanced face. But how do you measure the quality of your treatment results? Are you consistent? One method is to take and pass the American Board of Orthodontics (ABO) phase III examination. Those of you who have accomplished this milestone realize how much you learn about the general quality of your treatment results when you start searching for cases that will qualify. Some clinicians wish they would have banded or bracketed those maxillary second molars so that the alignment and occlusal contacts would be perfect. Others wonder how they could have missed the marginal ridge discrepancies between the molars and the premolars. But suppose you manage to assemble 6 to 10 cases that satisfy the board’s requirements. Is this a true measure of the consistency of your clinical ability to finish patients? Probably not. It is simply 1 snapshot of a small portion of the patients that you have treated. But what the ABO process does provide to orthodontic clinicians is the tools with which they can continuously measure the quality of their treatments throughout their entire careers. Let me share with you how I use the ABO testing procedures to make me a better clinician. Twice a year, in January and July, I ask my receptionist to give me the pretreatment and posttreatment records of 10 consecutively debanded orthodontic patients from the previous 6 months. I take these records home, and, usually early on a Saturday morning, I sit down at my desk with a cup of coffee to review these 10 consecutively completed cases. I use the ABO objective grading system to score the posttreatment dental casts and intraoral radiographs, as well

This article discusses the vertical position of the maxillary incisors and its relationship to esthetics. Two situations are discussed. The first, a discrepancy between the incisal plane and the interpupillary line, is corrected by maxillary surgery, orthodontic intrusion/extrusion, or orthodontics and restorative dentistry. The correct decision depends on the interrelationship of the posterior occlusal plane, incisal plane, interpupillary line, and the crown length of the incisors. The second discrepancy in the vertical position of the maxillary incisors is the “gummy” smile. This problem, due to either overdevelopment of the entire maxilla or over-eruption of the maxillary incisors, is solved by maxillary surgery, orthodontic intrusion of the over-erupted teeth, or orthodontics and restorative dentistry. The proper choice of treatment depends on the interrelationship of the posterior occlusal plane, incisal plane, crown length of the maxillary incisors, and the level of the gingival margins of the maxillary anterior teeth.

The purpose of this report is to review the orthodontic treatment of a patient with a Class III malocclusion who was treated nonsurgically with extraction of the mandibular first premolars. The basis for this treatment approach is presented, and the final treatment result reviewed. Important factors to consider when establishing a Class III molar relationship are discussed.

2). O ccas ional ly , orthodontists and genera l dentists encounter a patient who has traumatically avulsed a maxillary central incisor or a pa tient with a geminated or fused maxillary central incisor that must be removed. In either situa tion, a decision must be made about the eventual restoration of the anterior edentulous space. Several options exist for replacing a missing maxillary central incisor. If the tooth has been avulsed, the simplest long-term solution is to replant it. However, the success of reimplantation depends on the status of the tooth root, 4 the ability to perform endodo tics, and the length of time that the tooth is out alveolar socket. 5 If reimplantation is not possib autotransplantation might be an option. 6 However, the patient must have an arch-length deficiency, so that a premolar from a posterior quadrant can be transplanted to the edentulous site. A third solution is to maintain the edentulous space during childhood and adolescence, and to place a bridge or implant during adulthood. A fourth possible solution is to close the edentulous space and substitute the ipsilateral lateral incisor for the central incisor. 7 The choice of the appropriate soluti for the missing maxillary central incisor depends on the specific characteristics of each situation.

Background Dental esthetics has become a popular topic among all disciplines in dentistry. When a makeover is planned for the esthetic appearance of a patient's teeth, the clinician must have a logical diagnostic approach that results in the appropriate treatment plan. With some patients, the restorative dentist cannot accomplish the correction alone but may require the assistance of other dental disciplines. Approach This article describes an interdisciplinary approach to the diagnosis and management of anterior dental esthetics. The authors practice different disciplines in dentistry: restorative care, orthodontics and periodontics. However, for more than 20 years, this team has participated in an interdisciplinary dental study group that focuses on a wide variety of dental problems. One such area has been the analysis of anterior dental esthetic problems requiring interdisciplinary correction. This article will describe a unique approach to interdisciplinary dental diagnosis, beginning with esthetics but encompassing structure, function and biology to achieve an optimal result. Clinical Implications If a clinician uses an esthetically based approach to the diagnosis of anterior dental problems, then the outcome of the esthetic treatment plan will be enhanced without sacrificing the structural, functional and biological aspects of the patient's dentition.

Introduction: Congenital absence of mandibular second premolars affects many orthodontic patients. The orthodontist must make the proper decision at the appropriate time regarding management of the edentulous space. These spaces can be closed or left open. Implications: If the space will be left open for an eventual restoration, the keys during orthodontic treatment are to create the correct amount of space and to leave the alveolar ridge in an ideal condition for a future restoration. If the space will be closed, the clinician must avoid any detrimental alterations to the occlusion and the facial profile. Significance: Some early decisions that the orthodontist makes for a patient whose mandibular second premolars are congenitally missing will affect his or her dental health for a lifetime. Therefore, the correct decision must be made at the appropriate time. Purpose: In this article, we present and discuss various treatment alternatives for managing orthodontic patients with at least 1 congenitally missing mandibular second premolar.

Introduction Single-tooth implants are commonly used to replace congenitally missing teeth in adolescent orthodontic patients. However, if implants are placed before cessation of facial growth, they will submerge relative to the adjacent erupting teeth. Therefore, it is important to know when facial growth is complete in postpubertal orthodontic patients. The purposes of this study were to determine and quantify the amount of vertical growth of the facial skeleton and the amount of eruption of the central incisors and the maxillary first molars after puberty. Methods Two or 3 lateral cephalograms taken at pretreatment, posttreatment, and 10 years postretention of 142 males and 159 females were evaluated. Linear regression models were used to determine changes in the parameters with increasing age. Results The findings indicate that (1) the growth of the facial skeleton continues after puberty; (2) there is a difference in the amount of growth between the sexes during the second decade of life, and after age 20 the intergender difference is substantially diminished; and (3) the rate of eruption of the maxillary central incisors in females seems to be greater than in males. Prediction tables are provided to help the clinician determine when to take cephalometric radiographs to assess the cessation of facial growth. Conclusions The growth of the facial skeleton continues after puberty, but the amount of growth decreases steadily and after the second decade of life seems to be clinically insignificant.

Introduction: Previous studies evaluated the perception of laypersons to symmetric alteration of anterior dental esthetics. However, no studies have evaluated the perception of asymmetric esthetic alterations. This investigation will determine whether asymmetric and symmetric anterior dental discrepancies are detectable by dental professionals and laypersons. Methods: Seven images of women’s smiles were intentionally altered with a software-imaging program. The alterations involved crown length, crown width, midline diastema, papilla height, and gingiva-to-lip relationship of the maxillary anterior teeth. These altered images were rated by groups of general dentists, orthodontists, and laypersons using a visual analog scale. Statistical analysis of the responses resulted in the establishment of threshold levels of attractiveness for each group. Results: Orthodontists were more critical than dentists and laypeople when evaluating asymmetric crown length discrepancies. All 3 groups could identify a unilateral crown width discrepancy of 2.0 mm. A small midline diastema was not rated as unattractive by any group. Unilateral reduction of papillary height was generally rated less attractive than bilateral alteration. Orthodontists and laypeople rated a 3-mm distance from gingiva to lip as unattractive. Conclusions: Asymmetric alterations make teeth more unattractive to not only dental professionals but also the lay public. (Am J Orthod Dentofacial Orthop 2006; 130:141-51)

Background The authors describe the treatment of three patients who had severe apical root resorption of maxillary lateral incisors caused by ectopically erupting canines. Ectopically erupting canines derive from a normal path of eruption and may cause resorption of the adjacent teeth. Case Description The authors present the three cases of severe root resorption caused by ectopically erupting canines. They then discuss various prosthetic options; the indications, advantages and disadvantages of various treatment modalities; the long-term retention and esthetic concerns of the patients; and the inherent limitations of restorative treatment. Clinical Implications Increased tooth mobility and long-term retention are significant concerns in cases of patients who have severe root resorption. Attaining stability with lingual splinting can cause esthetic problems. An interdisciplinary approach is necessary to provide optimal care for the patient.

Introduction Orthodontic space opening during adolescence is a common treatment for congenitally missing maxillary lateral incisors. Because of continued facial growth and compensatory tooth eruption, several years can elapse between completion of orthodontic treatment for a teenage patient and implant placement. There are reports that, after successful orthodontic opening of the implant space, the central incisor and canine roots reapproximate during retention and prevent implant placement. Methods To study this phenomenon, the records of 94 patients with missing maxillary lateral incisors were collected. Periapical and panoramic radiographs were used to measure intercoronal and interradicular distances between the central incisor and the canine adjacent to the missing lateral incisor before and after orthodontic treatment and at implant placement. Results Although root approximation between the adjacent central incisor and canine during retention did not occur consistently, 11% of the patients experienced relapse significant enough to prevent implant placement. Conclusions To ensure sufficient space for implant placement, we recommend at least 6.3 mm of intercoronal space and 5.7 mm of interradicular space between the adjacent central incisor and canine. A bonded wire or resin-bonded bridge will help to reduce root approximation that might occur during retention.

Some adult patients have mild to moderate periodontal disease before orthodontic treatment. These patients may be at risk of developing further periodontal breakdown during orthodontic therapy. However, careful diagnosis and judicious management of these potentially volatile patients can alleviate the risk. In this article, the diagnosis and management of several periodontal problems is discussed. The need for and timing of preorthodontic periodontal surgery for these situations is elucidated. In addition, the types of tooth movement that will ameliorate these problematic situations is described. This information is valuable for the orthodontist who treats patients with underlying periodontal problems.

This study investigated changes in ridge width over time in patients who were congenitally missing mandibular second premolars. Data were obtained from stone casts and radiographs of 35 edentulous sites on 22 patients representing three time periods: (1) before extraction of the primary mandibular second molar, (2) completion of orthodontic treatment, and (3) long-term evaluation. The findings indicate that ridge width decreases 25% within 3 years after primary molar extraction. The rate of decrease diminishes to 4% over the next 3 years. The change in ridge width had a weak association with the age of the patient at the time of the extraction but a small predictive value. No correlation was found between changes in ridge width and height and the time since the extraction or the age of the patient at the time of extraction.

After I had been in orthodontic practice for 3 or 4 years, I received a referral from one of the finest restorative dentists in our community. I had not worked with this person before but had certainly heard of his reputation. He was not only a skilled clinician, but also a very demanding person. At that time, there were 10 orthodontists in town, and this dentist had worked with all of them except me. But no orthodontist to whom I had spoken had reported that it was a pleasant experience. This dentist wanted to play a major role in directing the orthodontic care for his patients, and, if the orthodontist would not agree, this dentist would stop referring to that orthodontist. Let’s get back to the referral. I received background information about the patient and a letter that stated that this dentist wanted to meet with me after I had examined the patient. The patient was an adult with several missing teeth and moderate to severe periodontal disease. It was a difficult case, but I had some ideas about what orthodontics could do to assist in the overall restorative treatment. So the dentist and I met for breakfast to discuss the treatment of this patient. I will never forget that meeting. The discussion about the patient went fairly well, and I suggested some treatment options to achieve the dentist’s restorative goals. This must have impressed him, because he then stated that he wanted to begin referring all of his orthodontic patients tome. I smiled and said, “That would be great!” And then came the caveat. He looked directly at me, pointed a finger in my direction and emphatically stated, “Here is the rule when you treat my patients: I tell you when to remove the brackets.” Now, I understood why the other orthodontists in town stopped working with this guy. Who would want the general dentist dictating when orthodontic appliances should be removed? Although I wanted to tell this dentist “thanks, but no thanks” for his referrals, I simply stated, “Sure, that’s fine

Last year, the American Association of Orthodontists (AAO) Board of Trustees appointed President Lee Graber and me to a joint task force along with the current president of the American Academy of Periodontology and another practicing periodontist. Our charge was to determine how orthodontists can avoid being sued for periodontal problems that arise during orthodontic treatment. Is this a real problem? Most definitely! Here are the facts. According to conversations with the claims manager for the AAO Insurance Company, periodontal problems that develop or exacerbate during orthodontic treatment currently account for the largest portion of liability claims against orthodontists. The purpose of the task force was to determine how to avoid this trend. Lee Graber and I began a series of conference calls with the 2 periodontists. Our goal was to establish a protocol so that orthodontists can determine which adult patients are at risk of developing periodontal problems. Obviously, the first key is to have a thorough health history, consisting of specific questions that might uncover a risk for potential periodontal complications, such as smoking, diabetes, or past periodontal therapy. A second major ingredient in determining periodontal risk is to have appropriate intraoral radiographs. Most orthodontists take panoramic radiographs before treatment. These radiographs will show significant bone loss, but they are inadequate to diagnose subtle interproximal bone loss. And since the x-ray tube makes a curved path around the patient’s head during the radiographic exposure, it causes overlapping of some posterior contacts and further blurs the image of the crestal bone. The periodontists informed us that the gold standard for diagnosing posterior bone levels is a vertical bitewing. With this image, the x-ray beam passes through the occlusal surfaces of the posterior teeth, and therefore the distance from crestal bone to cementoenamel junction (CEJ) is accurate. In the maxillary and mandibular anterior regions, periapical radiographs are the best for evaluating bone levels. Usually, 3 maxillary and 3 mandibular anterior periapicals are necessary to make a thorough assessment. The periodontists advised that CEJ to bone levels of 5 mm

This article has discussed the medio-lateral relationship of the maxillary anterior teeth relative to esthetics. In this dimension, common problems include asymmetric crown widths, inadequate pontic width, midline deviation, and improper angulation of the maxillary incisors. In all four of these situations, the proper solution depends on a coordinated, interdisciplinary approach involving well-planned and well-choreographed orthodontics and restorative dentistry.

Introduction Orthodontic space opening during adolescence is a common treatment for congenitally missing maxillary lateral incisors. Because of continued facial growth and compensatory tooth eruption, several years can elapse between completion of orthodontic treatment for a teenage patient and implant placement. There are reports that, after successful orthodontic opening of the implant space, the central incisor and canine roots reapproximate during retention and prevent implant placement. Methods To study this phenomenon, the records of 94 patients with missing maxillary lateral incisors were collected. Periapical and panoramic radiographs were used to measure intercoronal and interradicular distances between the central incisor and the canine adjacent to the missing lateral incisor before and after orthodontic treatment and at implant placement. Results Although root approximation between the adjacent central incisor and canine during retention did not occur consistently, 11% of the patients experienced relapse significant enough to prevent implant placement. Conclusions To ensure sufficient space for implant placement, we recommend at least 6.3 mm of intercoronal space and 5.7 mm of interradicular space between the adjacent central incisor and canine. A bonded wire or resin-bonded bridge will help to reduce root approximation that might occur during retention.