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Improvement in esthetic appearance and functional occlusion are the pillars of contemporary orthodontic procedures. The aim of this study was to assess variations in facial proportions between skeletal classes I, II, III populations in order to establish objective departures from Golden Proportion norms. The study sample was divided into three groups based on the skeletal malocclusion, namely skeletal class I, class II and class III groups. Various markers were identified in these photographs in order to define facial symmetry and balance with the ideal values. Golden Proportion values were compared with that of the obtained results, and these values were checked for skeletal class I, II, III malocclusions. Our study showed a significant difference between skeletal class II and III malocclusions when correlated with Golden Proportion values. Skeletal Class I malocclusions showed a greater correlation with golden proportion values. Golden proportion ratios are more valid in cases of skeletal class I malocclusions. Hence, the objective of treating class II and class III malocclusions should be more focused on attaining values closer to the desired ratio for optimal facial balance and symmetry.

Infective endocarditis associated with orthodontic treatment is a rare occurrence. Unfortunately, many orthodontic practitioners do not treat patients potentially at risk of developing endocarditis due to the lack of practical guidelines and fear of precipitating the infection. Additionally, many patients that undergo orthodontic treatment are inappropriately prescribed antibiotic cover for procedures that have a minimal bacteraemia risk. In this paper the literature linking orthodontic treatment and infective endocarditis was examined. The appropriate management were recommended for patients with risk of infective endocarditis during orthodontic procedures. Keywords: Infective endocarditis, Orthodontist, Treatment.

Patients with congenital craniofacial anomalies often require orthodontic treatment to correct malocclusion. Numerous case reports about craniofacial anomalies have been published, but for many syndromic diseases the pathology of malocclusion and/or solutions for it remain elusive. In this study, we investigated craniofacial features as well as orthodontic treatment outcomes of patients with glucose transporter 1 deficiency syndrome (GLUT1-DS), which is an autosomal dominant genetic disease. Cross sectional study was performed using 9 GLUT1-DS patients, aged from 8 to 49 years old. All of the participants underwent intraoral and radiographic examinations. Lateral cephalogram measurement was performed for investigating possible craniofacial features in GLUT1-DS patients. Most of them showed skeletal discrepancy with large overjet. Some patients had a history of trauma to their maxillary incisor(s). In order to correct the patients’ malocclusion, we employed conventional orthodontic appliances and obtained good treatment outcomes. Based on these results, we summarized features associated with the deficiency of GLUT1-DS and also showed the benefit of correcting the malocclusion using conventional orthodontic procedures. Through this report, we showed the craniofacial characteristics and malocclusion of the GLUT1-DS patient which could be treated with conventional orthodontic approach.

A la presente fecha, los diferentes organismos de salud internacionales y locales han publicado recomendaciones, regulaciones y protocolos para atención odontológica durante de la pandemia COVID-19, ajustados a las diferentes etapas de la misma. La Asociación Latinoamericana de Odontopediatría, en su misión apoyar y llevar la mejor información disponible a todos los colegas latinos, ha publicado guías prácticas y documentos de apoyo fáciles de utilizar y compartir con todo el personal odontológico que trabaje en ambiente hospitalario, clínicas gubernamentales, instituciones educativas y clínicas privadas, que presten atención a niños, adolescentes y pacientes en situación de discapacidad.1-3 Diferentes países se encuentran en diferentes etapas de la pandemia por lo que las recomendaciones pueden incluir limitar el tratamiento odontológico a los casos de urgencia o con necesidad de tratamiento prioritario. Esto puede implicar la suspensión temporal de los controles periódicos de ortodoncia interceptiva. El objetivo de esta revisión es proporcionar directrices en el manejo de la atención de pacientes con tratamiento de ortodoncia interceptiva el periodo de Pandemia por COVID-19, utilizando la literatura disponible y la opinión de los expertos. Son muchos los pacientes pediátricos que utilizan aparatos o que necesitan terapia a corto plazo, situaciones que requieren de planificación de tratamiento según la etapa de la pandemia en la cual se encuentre cada localidad. Aunque los procedimientos de ortodoncia generalmente se consideran optativos, hay situaciones en cuales son prioritarios. Siendo así en este documento se busca definir el término de urgencias ortodóncicas durante el confinamiento COVID-19, determinando cuáles situaciones pueden ser manejadas en el hogar a través de la teleodontología y cuáles requieren la asistencia personal a la consulta odontológica. Igualmente, busca describir las maloclusiones que requieren tratamiento prioritario luego del confinamiento COVID-19, realizando algunas recomendaciones terapéuticas basadas en diferentes niveles de evidencia, para la etapa de dentición primaria o mixta temprana. Las recomendaciones que a continuación se proponen están vinculadas a la situación excepcional de pandemia y pueden diferir de las prácticas clínicas habituales. No constituyen un protocolo clínico exhaustivo de todos los tratamientos posibles, sino una guía de orientación, sin sustituir regulaciones locales, protocolos específicos, ni leyes vigentes en cada país y son susceptibles a evolucionar y cambiar en función de la situación sanitaria. Se insta a los profesionales a realizar seguimiento a las actualizaciones que puede haber sobre este documento.

Rapid maxillary expansion is one of the most common orthodontic procedures performed in the pediatric population, easy to accomplish and compliance free, therefore really effective. Nevertheless, a careful diagnosis and frequent clinical follow-up appointments are necessary during the first weeks of active treatment. The purpose of this article was to report two cases of unexpected complications during orthopaedic maxillary expansion, involving two 7-year-old female patients, one presenting a saddle nose with suborbital hematoma and the other one an asymmetric palatal expansion. In both cases, the clinical situation progressively relapsed during the months following expansion appliance removal.

Introduction. Enamel loss is a common problem during various orthodontic procedures. The study aims to compare the efficacy of a desensitizer and remineraliszer in the reduction of the dentin hypersensitivity ( DH) associated with enamel microcracks after orthodontic debonding. Methods. A unicentric two arm parallel study with 30 subjects randomly assigned to each groups following debonding. Group-1 subjects were treated with Gluma® desensitizer(5% glutaraldehyde and 35% hydroxyethyl methacrylate (HEMA)) and the Group-2 intervention included a remineralizing agent GC Tooth Mousse Plus® ( casein phospho peptide and amorphous calcium Fluro phosphate ( (CPP:ACFP). The Visual Analogue Scale (VAS) was utilized to evaluated DHas subjective perception of pain following the Air blast test and cold test. The VAS scale was indexed from 0-10 markings based on the intensity of perception. Five different time points T0 and T1-immediately after debonding and intervention on day 1, T2- 48 hours, and T3 after 72 hours were taken for the assessment of VAS scores. Results. The VAS scores for the airblast test for group 1 were (2.73,0, 0.06, 0.03) and group 2 (2.46,0,0.16.0.13) at different periods. The sensitivity scores for the cold blast test for group 1 were (2.73,0, 0.13, 0.03) and for group 2 (2.46,0, 0.16, 0.13). There was 98 percent reduction in DH between T0 and T3 and was statistically significant( p

Although orthodontic treatment is commonly indicated for young healthy individuals, recent trends showed an increase in number of older individuals undergoing orthodontic interventions. The increased age resulted in a proportionate increase in the prevalence of systemic diseases facing dentists during orthodontic procedures, especially diabetes mellitus. This necessitates that dentists should be aware of the diagnosis of diabetes mellitus and its early signs particularly in teeth and oral cavity. It is also essential for them to understand the implications of diabetes on orthodontic treatment and the measures to be considered during managing those patients. In this review, we focused on the impact of diabetes mellitus on orthodontic treatment. We also summarized the data from previous studies that had explained the measures required to be taken into consideration during managing those patients. We included both human and animal studies to review in depth the pathophysiological mechanisms by which diabetes affects orthodontic treatment outcome. In conclusion, this review emphasizes the need to carefully identify early signs and symptoms of diabetes mellitus in patients demanding orthodontic treatment and to understand the considerations to be adopted before and during treating these patients.

Introduction There has been no epidemiologic study of malocclusion prevalence and treatment need in the United States since the Third National Health and Nutrition Examination Survey, conducted from 1988 to 1991. In this descriptive study, the authors sought to estimate orthodontic treatment prevalence by examining a nationally representative survey to assess current pediatric dental and orthodontic utilization. Methods The 2009 and 2013 Medical Expenditure Panel Surveys were used to categorize and compare all types of pediatric dental and orthodontic procedures in children and adolescents up to 20 years old. Descriptive variables included dental insurance, poverty level, and racial/ethnic background. Results Visits for orthodontic procedures constituted the third largest treatment category (14.5%) and were greatest among the uninsured and higher income populations. Children with public insurance had the fewest orthodontic visits (9.4%). Racial/ethnic disparities were most pronounced among orthodontic visits, with black and Hispanic children receiving the fewest orthodontic procedures (8.89% and 10.56%, respectively). Conclusions Orthodontic treatment prevalence data suggest that significant disparities exist in orthodontic utilization based on race/ethnicity, poverty level, and insurance status. To establish the burden of malocclusion, describe populations in greatest need of interventions, and craft appropriate programs and policies, an active orthodontic surveillance system is essential.

Medicine targets health in issues of saving life and improving quality of life. Most orthodontic procedures deal with the latter goal. Medical necessity is presented within the scope of pediatric orthodontics, stratified in medically guided treatment, when orthodontic procedures contribute to the correction of a systemic problem, whether or not associated with a local orofacial problem (respiration and sleep disorders, emotional problems, and hospital calls); and orofacial-guided treatment, when addressing growth matters, craniofacial anomalies, and orofacial functions (mastication, understandable speech, and temporomandibular pain). Medical necessity that may involve the care of the orthodontist alone or in a medical team, also brings up the issue of separation between dentistry and medicine, at educational and various operational levels, posing a challenge regarding their integration in the context of health being indivisible.

Summary: Investigation findings on tooth roots resorption are not trustworthy because they aresubmitted to some special study characteristics like sample number, important factors control,measuring methods and some characteristic elements related to research types. It’s well known thatthe grate incidence of this type of pathology occur on frontal tooth upper incisive central,incisive lateral and canines and on lower incisive laterals and canines because theirs longer andsharper roots. When through the radiography findings it is possible clearly identify the root teethtype we are able to predict the possibility of root resorption during the forces application neededto orthodontic tooth movements and also we have the capability to inform to parents and the patientabout this possible risk, but we also have the opportunity to stablish the preventive actions inorder to minimize undesirable effects of the orthodontic treatment. Key words: Teeth rootsresorption. Orthodontic treatment complications. Preventive oriented information to parents andpatients.

The orthodontic treatment of patients with medical disorders is becoming an increasing aspect of modern-day practice. Orthodontic treatment is no longer reserved for only healthy patients. With better management of serious medical problems, increased quality of life expectations, and greater ambulation, medically compromised individuals are now regular visitors to orthodontic practices. While orthodontic treatment has been historically considered to be completely noninvasive, specific orthodontic procedures may place some patients at risk for serious sequelae. Among the most common of these conditions are those associated with cardiovascular disease, bleeding disorder, respiratory disorder, neurological disorder, renal disease, musculoskeletal system, endocrine disorder, liver disease, allergies, and drug side effects. Aggressive risk assessment is the key factor in the identification and prevention of medically associated problems. Assessment and management of patients at risk for endocarditis, bleeding, and asthmatic attacks are discussed. The orthodontic treatment of patients with medical disorders is becoming an increasing aspect of modern-day practice. The influences of various systemic diseases on orthodontic treatment have been discussed and various recommendations to overcome the potential problems have been highlighted in this article.

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated coronavirus disease (COVID-19) has spread to almost every country of the world with the number of cases increasing exponentially almost everywhere. Recently, the number of cases in India are also on a rise, expecting to reach its peak very soon. The deadly virus has its impact on almost every sector and it has serious implications on dentistry. Dentists and particularly orthodontists treat a number of cases in a day without being able to maintain the appropriate distance between the individuals as advised by the WHO, which brings them to the top of high-risk group. This review is an attempt to compile material from the available literature to help reduce the risks involved the performing orthodontic procedures, prevent the transmit of this contagious disease at the orthodontic office and also suggests certain home remedies which the patient can use to tackle short-term orthodontic emergencies.

OBJECTIVES: The aim was to find out if children who have gone through orthodontic and invasive treatment have less dental fear than children who have experienced only invasive treatment or no treatment at all. MATERIALS AND METHODS: The data consisted of 910 9- to 15-year-old children from Jyvaskyla and Kuopio, Finland. A questionnaire was used that contained 11 dental fear-related questions and family member’s dental fear and questions on oral health habits and family characteristics. Information on treatment procedures from three preceding years was collected from patient records. To study the association between dental fear and treatment experiences, analysis of variance, and multiple logistic regression analyses were performed. RESULTS: Dental fear was found more often in children who had experiences of orthodontic treatment experiences and invasive treatment than in children with invasive treatment only or no treatment experiences at all.LIMITATIONS: Different orthodontic treatment experiences were not analysed individually, and the study was retrospective. CONCLUSION: Familiarization to dental treatment via orthodontic procedures does not necessarily decrease dental fear among children.

OBJECTIVE: The purpose of this study was to analyze the psychological aspects of adult patients who sought and underwent orthodontic treatment, evaluating their expectations and discomfort during treatment, as well as their satisfaction after completion of dental movement. RESULTS AND CONCLUSIONS: Data obtained from previous published papers, and also from questionnaires answered by 54 patients, showed that adult patients stood out for their attention to details and high interest in the esthetic improvements provided by treatment, and also for a greater perception of their initial malocclusion. On the other hand, the same data showed that adult patients, once informed about the limitations of their treatment and having confidence on the orthodontist, presented a high level of satisfaction with treatment results, revealing themselves as good patients for indication and execution of orthodontic procedures. OBJETIVO: o propósito desse trabalho foi analisar as características psicológicas dos pacientes adultos que procuraram e se submeteram a tratamentos ortodônticos, avaliando suas expectativas, desconforto durante o tratamento e satisfação final após a conclusão das movimentações dentárias propostas. RESULTADOS E CONCLUSÕES: os dados obtidos por meio de uma revisão bibliográfica e de questionários realizados com 54 pacientes demonstraram que os pacientes adultos se destacaram por serem mais detalhistas e exigentes em relação às melhoras estéticas proporcionadas pelo tratamento, e por apresentarem uma maior percepção de sua má oclusão antes do início do tratamento. Por outro lado, esses mesmos dados demonstraram que os pacientes adultos, uma vez bem esclarecidos sobre as limitações peculiares ao seu tratamento e sentindo-se bem amparados e orientados pelos profissionais responsáveis, apresentaram um alto índice de satisfação frente aos resultados finais do tratamento, sendo ótimos pacientes para a indicação e execução de procedimentos ortodônticos.

This review considers oral trauma and its relationship to orthodontics with respect to prevention and primary, secondary, and tertiary care. The level of evidence is not high in regard to this topic, but recommendable approaches to trauma at each stage are discussed on the basis of available literature and published guidelines. Simplified biomechanics are presented to aid treatment.

Previously scoffed by many as runny composites with limited usage, flowables have slowly but gradually found its way into many orthodontic procedures. This article comprises of the wide array of use of flowable composite in orthodontics other than bonding brackets.

AIM AND OBJECTIVE: This article reviews root resorption with micro implant assisted intrusion BACKGROUND: Orthodontic intrusion is a common treatment approach in managing orthodontic esthetic and functional problems, including gummy smile and deep bite. Amongst, different type of orthodontic procedures, intrusion is found to be undoubtedly a difficult procedure. Micro implants are found to produce offer an effective skeletal anchorage which is an assist to orthodontist since it renders the intrusion of both anteriors and posterior teeth an increasingly streamlined procedure from mechanical support. Apical root resorption is abnormal consequences in orthodontic treatment. Root resorption produce shortening and breakdown the integrity of teeth from the arch. This article reviews the systemic evaluation of root resorption with micro implants assisted intrusion REASON: The purpose of the systemic review is evaluate the various factor of root resorption with micro implant assisted with intrusion.

Background The objective of this study is to evaluate the prevalence of malocclusion and treatment needs in transfusion dependent β-thalassemia major children. Methods One hundred transfusion dependent β-thalassemia major children visiting the Department of Pediatrics were selected randomly and evaluated for malocclusion with Angle’s classification and Dewey’s modification. The orthodontic treatment needs were also assessed using Grainger’s treatment priority index (TPI). The orthodontic treatment needs were compared to normal children. Results The assessment of treatment needs revealed a higher prevalence of handicapping and severely handicapping malocclusion in thalassemic children compared to normal children. The thalassemic patients were found to show significantly more Angle’s Class II malocclusion (55 % vs. 15.7 %) when compared to normal children. Conclusions The higher prevalence of Angle’s Class II malocclusion and definitive malocclusion in thalassemic children indicates the importance of preventive orthodontic procedures and efforts towards providing orthodontic treatment to these children.

Introduction For over 50 years, the American Heart Association has made recommendations for the prevention of infective endocarditis. The first guidelines were published in 1955; since then, they have been updated 9 times, most recently in 2007. There is still confusion about which orthodontic procedures are most prone to generate bacteremias and lead to infective endocarditis in susceptible patients. The aim of this study was to conduct a survey to determine orthodontists' knowledge, attitudes, and in-office behaviors regarding the American Heart Association's guidelines. Methods A 4-page online survey consisting of 3 sections was sent to members of the American Association of Orthodontists by using a random number generator. The first section consisted of demographic information, the second consisted of questions about the respondents' practice characteristics, and the third included questions about the respondents' knowledge and management of the treatment of patients at risk for infective endocarditis. There were 78 responses. Results and Conclusions Orthodontists are screening for cardiac problems in the patient's medical history but to a lesser extent are requesting written medical clearance from the patient's physician before starting orthodontic treatment. Many of the orthodontists surveyed believed that their knowledge of the American Heart Association's guidelines and management of high-risk patients was in the good-to-excellent range. Orthodontists recommend antibiotic prophylaxis most frequently during band placement and removal. Patients at risk for infective endocarditis are somewhat likely to inquire about possible treatment sequelae associated with previous cardiac problems.

Crohn's disease is a chronic inflammation of the small intestine; it can involve other organs, such as the skin, eyes, lungs, and joints. Oral manifestations are common, especially ulcers and stomatitis, which macroscopically and histologically resemble those found in the gastrointestinal tract. However, orthodontic alterations are not yet known. This article reviews aspects related to the diagnosis of Crohn's disease and clinical considerations for an orthodontic patient.

BAYRAK, SULE/0000-0001-7023-2358 WOS: 000288158100024 PubMed: 21392687 Introduction: The aim of this study was to compare dental development in a group of children with mild-to-moderate hypodontia with a matched group. Methods: A study group of 70 children (43 girls, 27 boys) with hypodontia, aged 5.3 to 12.5 years, was matched for race, age, and sex with 140 healthy, normal control subjects. The children's dental ages were calculated by using a modified dental-age estimation method. Differences between dental and chronologic ages were analyzed by t tests, and the correlations between differences in dental and chronologic ages and the numbers of missing teeth were analyzed with the Spearman correlation test. Results: Dental development in children with mild-to-moderate hypodontia was significantly delayed compared with the control group (P < 0.05); however, the mean difference did not exceed 0.3 years in either sex. No correlation was observed between the differences in dental and chronologic age and the severity of hypodontia. Conclusions: Children with mild-to-moderate hypodontia had delayed dental development of a few months; this was statistically significant. Because of individual variations, each patient should be carefully examined. (Am J Orthod Dentofacial Orthop 2011;139:334-8)

Aim: The aim of this study was to assess the association between lip print pattern and different types of skeletal malocclusion. Materials and Methods: A sample of 60 individuals (18–30 years old) with skeletal Class I, Class II Division 1, Class II Division 2, and Class III malocclusion as confirmed by Angle between point A and point B. angle were taken for the study and were named as Groups I, II, III, and IV, respectively. Lip print was recorded by lipstick-paper method and was classified according to Tsuchihashi classification as Type I, Type I', Type II, Type III, Type IV, Type V. Results: It was seen that partial vertical groove (PVG) lip pattern was most prevalent for all the groups. In skeletal Class I, PVG lip pattern was most prevalent, whereas in skeletal Class II Division 1, intersecting groove, in skeletal Class II Division 2, PVG, and in skeletal Class III, complete vertical groove were prevalent. The difference between the four malocclusion groups of each type of lip print was significant except for Type II. Conclusion: Lip print will help in sorting out participants in more reliable manner in cases of mass disaster or criminal investigations. Furthermore, they help in predicting type of malocclusion beforehand for the successful execution of preventive and interceptive orthodontic procedures.

Introduction The American Board of Orthodontics’ discrepancy index (DI) was designed to objectively quantify the complexity of a malocclusion before orthodontic treatment. In this study, we assessed the influence of age and sex on the DI distribution of a large mixed sample of patients. An additional objective was to ascertain the effectiveness of the DI for predicting the probability that 1 resident can complete the treatment of the malocclusion in a 24-month residency. Methods A group of 6 calibrated investigators independently determined the DI scores for 716 consecutive patients in the permanent dentition from the patient pool of Indiana University’s graduate orthodontics program over 7 years. The DI was scored and compared with the patient’s sex and age, and it was noted whether the patient was transferred to a second resident when the first one graduated. Results The DI is not significantly related to sex or age, but it was a significant predictor for patients who required transfer to a second resident for completion of treatment. Conclusions The DI was a relatively stable index for measuring malocclusion complexity. It is independent of sex or age but is a consistent indicator of the greater time and effort required to complete treatment, because of the significant correlation to the necessity to transfer patient care to a second resident.

Dentinogenesis imperfecta is an inherited dentinal dysplasia involving several risks for orthodontic treatment. This case report describes the multidisciplinary treatment of a 17-year-old girl whose Class II Division 1 malocclusion was complicated by dentinogenesis imperfecta type II and maxillary anterior trauma.

Introduction In this study, we aimed to evaluate the reasons for failure of orthodontic treatment for impacted maxillary canines and to recommend measures to overcome them. Methods Twenty-eight patients (ages, 17.4 ± 4.3 years) with 37 maxillary impacted canines were referred after a failed attempt to resolve the impaction. Reasons for failure were analyzed, and corrective measures undertaken. The success rate of the revised treatments and the durations of both treatments were recorded. Results The mean duration of the failed treatments was 26.2 ± 17.2 months. The failed treatments were mostly based on plane radiographs, intra-arch dental anchorage, and elastic traction directly to the labial archwire. The major reasons for failure were inadequate anchorage (48.6%), mistaken location and directional traction (40.5%), and ankylosis (32.4%). In several patients, there was more than 1 possible reason for failure. The success rate of the revised treatments was 71.4%, and the mean duration was 14.4 ± 7.2 months. Repeat surgery was needed for 62.9% of the canines in which corrective treatment was started, mostly to redirect the ligature wires. The corrective measures included the use of 3-dimensional imaging and a change in the direction of traction. Anchorage was reinforced by dental and skeletal means. Conclusions Inaccurate 3-dimensional diagnosis of location and orientation of impacted teeth and failure to appreciate anchorage demands were the major reasons for failure in the treatment of impacted canines.

The objective of this study was to evaluate natural changes in maxillary posterior alveolar height (MPAH) and axial inclination of the maxillary first molars (AIMFM) in subjects with Class II malocclusion to determine the validity of predictive equations.Longitudinal records of 30 untreated white subjects (13 girls, 17 boys) with skeletal Class II malocclusion were collected at ages 9, 12, 14, and 16 years. They had participated in the Burlington Growth Centre study, and cephalograms were analyzed with Dentofacial Planner Plus software (version 2.0, Dentofacial Planner, Toronto, Ontario, Canada). Serial means were compared with the Bonferroni post-hoc test (P0.05). Predictive equations were obtained and studied with the analysis of agreement.Gradually, means of MPAH had statistical increments with sexual dimorphism from 14 to 16 years of age. A distal mean of AIMFM was found at 9 years of age that decreased significantly during growth, with sexual dimorphism between the ages of 9 and 12 years. Changes in AIMFM varied among subjects in distinct stages. Values of MPAH were predicted with high validity at intervals of 3 years or longer, whereas estimations for AIMFM were unreliable.In this study group, there was significant alveolar growth, with a natural tendency to upright the distal inclination at the maxillary first molars.

This article describes a patient whose permanent canines and premolars had not erupted at age 14 years, although their root formation was complete, with closed apices. Surgical and orthodontic treatment was planned to correct the multiple impactions. The orthodontic traction used 5 strategic teeth and allowed for the eruption of all 12 impacted teeth. The surgical-orthodontic treatment of many impacted teeth yielded good esthetic and periodontal results, as shown by the patient's satisfaction and the periodontal probing 2 years after the treatment. Multiple impacted teeth are a rare eruption disturbance that requires early detection: no signs of a genetic syndrome or an endocrine disorder had been found, or failure to move along the eruption path, which is a characteristic of another syndrome, primary failure of eruption.

The first permanent molar (FPM) is commonly subject to significant compromise which may arise due to caries or endodontic complication, or from developmental anomalies such as hypoplasia. Compromised teeth with questionable prognosis may result in short and long-term clinical dilemmas. This review article highlights the factors that require careful consideration when a compromised FPM is detected and the importance of timely FPM extraction. Several clinical cases are described in detail to discuss possible treatment options from the orthodontic perspective.

Introduction The aims of this study were to assess the peer assessment rating (PAR) index in relation to perceived treatment needs for maxillary protrusion in Japanese subjects and to investigate how perceived orthodontic treatment needs change with increased experience in dentistry and orthodontics. Methods The subjects were 155 persons (73 men, 82 women; mean age, 24.2 years; SD, 4.7 years) including dental students, residents, and orthodontists. We showed them casts from 10 patients with untreated maxillary protrusion and gave them a questionnaire with a 100-point visual analog scale (VAS), concerning their perceptions of orthodontic treatment needs. The PAR index was used for cast evaluation. Results The PAR index showed significant correlations with the VAS scores. On the casts evaluated with a PAR index below 17, there was no difference in VAS scores between the 3 groups; however, orthodontists perceived significantly greater treatment needs than did students and residents on casts with a PAR index of 18 or 19. The VAS scores were significantly increased when casts with a PAR index of more than 20 and overjet above 5.0 mm were evaluated. Orthodontists and residents perceived greater treatment needs than students on assessing occlusions with severe maxillary protrusion. Conclusions The PAR index is clinically useful to evaluate malocclusion, and the perception of treatment needs was significantly greater when the maxillary protrusion cast had a PAR index of more than 20 and overjet above 5.0 mm. Perceived needs for orthodontic treatment for maxillary protrusion changed with increasing experience and skills in dentistry and orthodontics.

Les desordres temporo-mandibulaires rassemblent tous les problemes cliniques concernant les muscles masticateurs et/ou l'articulation temporo-mandibulaire. Ils ont une origine multifactorielle et la responsabilite des malocclusions et des traitements orthodontiques est actuellement tres contestee. Cet article, a travers une revue de la litterature, tente d'eclaircir les donnees actuelles.

This case report describes the management of a partially edentulous adult with a severe deepbite malocclusion and a collapsed buccal segment because of supraeruption of the maxillary second and third molars. The treatment involved placement of an endosseous dental implant to achieve absolute intermaxillary and intramaxillary anchorage. Rare-earth magnets embedded in acrylic bite-blocks were used to intrude the supraerupted maxillary molars on the right side. After use as an anchorage device, the implant was restored and brought into occlusion. Good occlusal and esthetic results were achieved with this cost-effective treatment.

Panoramic radiography is a radiographic technique that uses tomography principles to involve the maxillomandibular complex and to enable an extensive way to visualize and analyze teeth and supporting structures in a unique radiographic film. Panoramic image is very important in mixed dentition phase because the evaluation of permanent teeth buds position and intraosseuos development stage enables to identify deviations in normal pattern of eruption that causes occlusion disorder. The great number of malocclusion cases has beginning in mixed dentition phase and the orthodontic intervention in this period increases the possibilities to drive the growth and to conduct the occlusion, eliminating or decreasing the severity of future orthodontic problems. In this context, this paper shows the importance of panoramic radiography in the diagnosis and treatment planning of mixed dentition phase. Literature review was carried out and showed that panoramic radiography is very important in mixed dentition phase because becomes evident the dental development anomalies that can change the chronology, sequence and place of permanent teeth eruption, which determine dental arch perimeter changes and occlusion disorders. Local etiology factors of the malocclusion visualized in panoramic radiography help the general practitioner, the pedodontist and the orthodontist in obtaining the early diagnosis to plan preventive orthodontic procedures to aim dental arch integrity and occlusion good development.

In the age of evidence-based dentistry, an interesting question is whether dentists' subjective or general assessments of preadolescent orthodontic treatment need are correlated with objectively determined need. In addition, because children from socioeconomically disadvantaged and underrepresented minority backgrounds in the United States have limited or no access to orthodontic treatment, it is worthwhile to investigate whether unmet orthodontic treatment need is correlated with preadolescent smile assessments and desire for braces. Our objectives were to explore (1) whether pediatric residents' objective and subjective assessments of preadolescent orthodontic treatment need are correlated and also correlate with the treatment recommendations made, (2) whether preadolescent responses concerning their smile-related quality of life and desire for braces are correlate, and (3) whether dentist and patient assessments are related.Data were collected from 1566 preadolescents (age range, 8-11 years; 47.3% boys, 52.7% girls; 55.7% black, 39.7% white, 2.9% Hispanic) in oral examinations and face-to-face interviews. Malocclusion was determined with the index of orthodontic treatment need.Objective and subjective orthodontic treatment need indicators were correlated (r = .719, P0.001). Pediatric residents' recommendations for orthodontic treatment were correlated with both the objective assessment of treatment need (r = .547, P0.001) and the subjective assessment of treatment need (r = .522, P0.001). Both sets of malocclusion indicators correlated with the patients' self-perceptions (r = -.145, P0.001; r = -.177, P0.001) and their desire for braces (r = .106, P = 0.001; r = .141, P0.001). Patient desire for braces was significantly correlated with smile-related quality-of-life scores (r = .665, P0.001).Although subjective and objective assessments of preadolescent orthodontic treatment need are rather consistent, the percentage of actual treatment recommendations exceeded both the subjective and objective assessments of treatment need. Preadolescent self-assessments and desire for braces were significantly correlated, and also correlated with the treatment recommendations and the objective and subjective components of the index of orthodontic treatment need score.

Neste estudo, apresenta-se relato de caso clínico de um paciente do gênero masculino, com 11 anos e 2 meses, portador de maloclusão de classe II de Angle, sobremordida e curva de Spee acentuadas e tendência de crescimento equilibrado. Após análise do perfil do paciente, dos modelos de estudo e da avaliação cefalométrica, optou-se pelo tratamento com disjunção, exodontia de quatro pré-molares, intrusão dos dentes anteriores inferiores, segundo a técnica do arco segmentado. Essa técnica consiste em uma seqüência de procedimentos ortodônticos baseados em princípios mecânicos, guiados por sistemas de forças, que regem a movimentação dos dentes, o que possibilita controlá-la da melhor maneira, levando em consideração a magnitude e o ponto de aplicação da força, a localização do centro de resistência e a rotação para aplicação da técnica. Neste trabalho, tem-se como objetivo analisar essa opção de tratamento da mordida profunda e também sua filosofia e princípios mecânicos.

This case report describes the treatment of a patient whose maxillary left first premolar was impacted horizontally, and both maxillary canines were transposed relative to the first premolars. The patient was treated without extractions, and both canines were brought to their correct positions in the maxillary arch. Treatment mechanics during the various stages are discussed.

In the past few decades, more patients have been treated orthodontically, but no longitudinal study has compared orthodontic bands and brackets microbiologically and clinically.This longitudinal trial (split-mouth design) included 24 patients. Microbiology (sub- and supragingival), probing depth (PD), bleeding on probing (BOP), and gingival crevicular fluid flow (GCF) were assessed at baseline (band placement) and at weeks 18 (bracket bonding) 20, 24, and 36. A statistical comparison was made over time and among the banded, bonded, and control sites.The aerobe/anaerobe ratio of sub- and supragingival colony forming units decreased significantly (relatively more anaerobes) over the study period for the banded and bonded sites (P0.001). This decrease was accompanied by significant elevations in PD, BOP, and GCF. These changes occurred faster after bonding compared to banding. No significant changes were observed 18 weeks after banding with the exception of increased PD (P0.001). At week 36, all microbial and clinical variables at the bonded site had changed significantly in the negative direction (P0.001) compared to week 18. The control sites did not show any significant changes over time, indicating that the effects were localized.The placement of fixed orthodontic appliances had a significant impact on microbial and clinical variables. The changes occurred faster at the bonded sites compared to the banded sites, probably because wire insertion caused difficulties in approximal cleaning. Over the long term, banding did not lead to more adverse microbial and periodontal effects than bonding.

Introduction: In this study, we assessed agreement and disagreement among pairs of Chinese and US orthodontists in the ranking for “facial attractiveness” of end-of-treatment photographs of growing Chinese and white orthodontic patients. Methods: Two groups of orthodontist-judges participated: from the University of the Pacific, School of Dentistry, in California and from Peking University School and Hospital of Stomatology in China. Each judge independently ranked standard clinical sets of profile, frontal, and frontal-smiling photographs of 43 white patients and 48 Chinese patients. Pearson correlations were generated for a total of 1980 rankings by pairs of judges. Results: The resulting correlations ranged from +0.004 to +0.96 with a median of +0.54. Of these, 18.7% were lower than 0.4; 41.0% were lower than 0.5; 68.8% were lower than 0.6; 91.6% were lower than 0.7; and only 8.4% were greater than 0.7. As had been anticipated, correlations between judges were higher when they ranked patients of their own ethnicity than when they ranked patients of different ethnicity, but the differences were smaller than had been expected. The rankings of no pair of judges correlated negatively. This is to say that no pair of judges, whether of the same or different ethnicity, ranked the patients so that those 1 judge tended to find attractive were consistently found unattractive by the other. Conclusions: The distribution of levels of agreement between pairs of orthodontists did not differ substantially whether the pairs included 2 US orthodontists, 2 Chinese orthodontists, or 1 US and 1 Chinese orthodontist. As might be expected, the pairs of Chinese orthodontists agreed with each other slightly better on average when ranking Chinese patients, and the pairs of US orthodontists agreed with each other slightly better on average when ranking white American patients, but the overall differences were small. These findings appear consistent with the inference that, on average, judgments of “facial attractiveness” by orthodontists at the 2 venues are more similar than had been expected for patients of Chinese and white ethnicity.

Introduction: The esthetic impact of the soft-tissue profile might play a major role in deciding on premolar extraction or nonextraction treatment, particularly in borderline patients. The purpose of this study was to compare the esthetic impact of extraction and nonextraction therapy on Korean patients. Methods: Panels of 50 dentists and 50 laypersons evaluated randomly presented pretreatment and posttreatment soft-tissue profiles of 50 extraction and 50 nonextraction patients. As subjects in this study, borderline patients were selected based on their initial diagnostic records. Two panels were asked to compare the pretreatment and posttreatment profile tracings and to quantify their perceptions of the esthetic impact of treatment change using a visual analog scale. Results: Premolar extraction patients showed greater improvement in facial profile compared with nonextraction patients, regardless of the panel. Based on the results of regression analysis to determine the degree of lip protrusion at which the retraction that commonly follows premolar extraction would be needed, the intersection was about 3.0 mm behind the Ricketts’ E-line; this is far behind the Korean norm. Conclusions: The results indicate that premolar extraction is more beneficial than nonextraction treatment in terms of facial profile improvement in Korean borderline patients.

Orthodontists typically make judgments of facial attractiveness by examining groupings of profile, full-face, and smiling photographs considered together as a "triplet." The primary objective of this study was to determine the relative contributions of the 3 photographs-each considered separately-to the overall judgment a clinician forms by examining the combination of the 3.End-of-treatment triplet orthodontic photographs of 45 randomly selected orthodontic patients were duplicated. Copies of the profile, full-face, and smiling images were generated, and the images were separated and then pooled by image type for all subjects. Ten judges ranked the 45 photographs of each image type for facial attractiveness in groups of 9 to 12, from "most attractive" to "least attractive." Each judge also ranked the triplet groupings for the same 45 subjects. The mean attractiveness rankings for each type of photograph were then correlated with the mean rankings of each other and the triplets.The rankings of the 3 image types correlated highly with each other and the rankings of the triplets (P.0001). The rankings of the smiling photographs were most predictive of the rankings of the triplets (r = 0.93); those of the profile photographs were the least predictive (r = 0.76). The difference between these correlations was highly statistically significant (P = .0003). It was also possible to test the extent to which the judges' rankings were influenced by sex, original Angle classification, and extraction status of each patient. No statistically significant preferences were found for sex or Angle classification, and only 1 marginally significant preference was found for extraction pattern.Clinician judges demonstrated a high level of agreement in ranking the facial attractiveness of profile, full-face, and smiling photographs of a group of orthodontically treated patients whose actual differences in physical dimensions were relatively small. The judges' rankings of the smiling photographs were significantly better predictors of their rankings of the triplet of each patient than were their rankings of the profile photographs.

Summary Background There is a possibility that bacteria may enter the blood stream during some non-surgical manipulation procedures, which include orthodontic treatment procedures (alginate impression taking, separator placement, band cementation, and archwire change). Objectives The aim of this study was to determine the prevalence and intensity of bacteraemia associated with orthodontic procedures in patients seen at the Lagos University Teaching Hospital, Nigeria. Methodology A total of 100 subjects who presented at the Orthodontic Clinic of the Lagos University Teaching Hospital and who met the inclusion criteria were recruited for the study. Four orthodontic procedures were investigated: alginate impression taking, separator placement, band cementation and archwire placement. Subjects were randomly placed in one of the four procedure groups. Peripheral blood was collected for microbiologic analysis before the orthodontic procedures and within 2 min of completion of the procedures. The BACTEC automated blood culture system and the lysis filtration method of blood culturing were used for microbiological analysis of the blood samples. The Wilcoxon signed rank test, the McNemar χ 2 test, the Mann–Whitney U -test, and Spearman and point bi-serial correlations were used for statistical evaluation at the P Results A significant increase in the prevalence and intensity of bacteraemia was observed following separator placement. The predominant bacteria isolated from the blood cultures were Streptococcus viridans and Staphylococcus species. Conclusion Separator placement induced the highest levels of bacteraemia. Use of a 0.2% chlorhexidine mouth rinse is recommended prior to separator placement in orthodontic patients.

Profile photographs can be a valuable, noninvasive tool for early orthodontic diagnosis and treatment planning.Left-side profile photographs were obtained of 181 normal, healthy children at age 6 years. Standardized landmarks were digitized on the photographs, and several linear and angular measurements were computed. The children were divided according to dental class and sex. Comparisons were made by 2-way analyses of variance.Facial convexity (larger in boys than in girls), Sn-N-Sl, and nasolabial and interlabial angles differed significantly (P.01) between the sexes. Girls had significantly less labial protrusion than boys. Facial height was significantly greater in children with dental Class II, without sex differences. All analyzed angles were significantly influenced by dental class. Facial convexity was smaller in children with dental Class II. Cutaneous class was larger, and lips were more prominent in children with dental Class II than in those with dental Class III.The significant relationship between dental and cutaneous classes has important implications for orthodontic diagnosis and treatment. Dental class can usefully represent facial esthetics, and orthodontic procedures that modify dental occlusion might cause important repercussions to facial soft tissues.

Although some early orthodontic procedures have come under scrutiny in recent years, the need for early identification and treatment of the skeletal Class Ill malocclusion has become even more universally accepted. Most Class Ill patients display a retruded maxilla with a normal to deep overbite and are ideally suited for treatment with maxillary expansion and protraction. In addition to maxillary advancement, facemask therapy rotates the maxilla in a counterclockwise direction, and the mandible in a clockwise direction, which results in an increase in lower face height and a profile that is more convex. Early intervention is associated with better patient compliance and possibly a better orthopedic response; however, treatment in the mixed or permanent dentition can produce favorable results. Overcorrection is recommended because treated patients grow similarly to untreated Class Ill patients after treatment. Treatment in the short term (2-3 years) shows good stability with a minority of patients requiring later facemask therapy.

Orthodontic therapy is no longer reserved for only healthy patients. With better management of serious medical problems, increased quality of life expectations, and greater ambulation, medically compromised individuals are now regular visitors to orthodontic practices. While orthodontic therapy has been historically considered to be completely noninvasive, specific orthodontic procedures may place some patients at risk for serious sequelae. Among the most common of these conditions are those associated with cardiac disease, bleeding disorders and asthma. Aggressive risk assessment is the key factor in the identification and prevention of medically-associated problems. Assessment and management of patients at risk for endocarditis, bleeding and asthmatic attacks are discussed.

論文(Article)

Objective This paper reports the experience with a two-stage approach to surgical correction of the complete cleft palate, wherein timing of the second stage is dependent on the judgment of the speech pathologist and the orthodontist together with the surgeon. Patients Of a total of 35 patients having complete unilateral clefts a sample of 22 were available for postsurgical assessment. The first-stage repair of the palate was carried out at an average age of 10.7 months (range 6 to 17 months), and the second-stage repair of the residual cleft was completed at an average age of 32.7 months (range 26 to 34 months). Interventions The first-stage repair of the soft palate defect involved mobilizing two short posteriorly based flaps, which extend onto the posterior quarter of the hard palate thus including up to 1 cm of mucoperiosteum. Careful freeing of the muscle is followed by an intravelar veloplasty. The later closure of the residual cleft involved turnover hinge flaps and small mucoperiosteal flaps. Results Eighty-seven percent of the sample had good to excellent speech as assessed by the Great Ormond Street screening method. Only two patients showed evidence of recessive maxillae with Class III malocclusions. Conclusions A two-stage surgical closure of the palate using this procedure would appear to confer several valuable advantages to the patient. These include favorable outcomes for speech in the large majority of cases and minimal adverse effects on the growth of the midface region.

Orthodontic appliances that become dislodged can cause problems in the airway or the gastrointestinal tract. Accidental ingestion of an appliance during a chair-side procedure or because of inadequate retention of the appliance can create a medical emergency with potentially serious complications, including death from aspiration of the foreign body. This article reports the accidental ingestion of a fractured Twin-block appliance. The ease with which removable appliances can become dislodged if retention is inadequate is discussed, and some serious complications that can arise are described. Precautions the orthodontist can take to prevent such accidents are presented.

The purpose of this study was to investigate the possibilities of distraction osteogenesis to correct mandibular hypoplasia. Fourteen young patients (mean age 14.1 years) with a proven resistance to initial, functional orthodontic therapy, were treated by means of bilateral intraoral distractors. The corticotomy was performed in the region of the third molar. The latency time was six days and the stabilization period six weeks. In all cases the planned lengthening of the mandible and class 1 occlusion were achieved. Seven patients required additional elastic band traction to close a mild open-bite directly after active distraction. In the first seven patients, insufficient mobilization at the site of the corticotomy had resulted in a broken distraction rod in two patients and incomplete distraction of the lingual cortex in one patient. Adequate mobilization at the site of the corticotomy prevented these problems in later cases. No permanent sensory disturbances were seen. Twelve patients finished their orthodontic treatment within six months after distraction.