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Hypophosphatemic rickets (HR) is a genetic disorder with various types of inheritance. It results mainly from defects in factors that control mineral ion homeostasis such as 1,25(OH) 2 D (Calcitriol) and FGF23 (Fibroblast Growth Factor 23). The existing bibliography regarding orthodontic treatment in patients with hypophosphatemic rickets is extremely limited. The aim of this case report is to describe the orthodontic treatment of a 9-year old Caucasian female patient suffering from HR. The patient presented a healthy late mixed dentition and periodontium. She suffered from a mild Class III maxillary skeletal pattern. There was a bilateral posterior crossbite, short lingual frenulum, a right maxillary mesioposition with a Class II subdivision on this side and a moderate space deficiency in the dental arches. The disorder was controlled by medication. In specific, patient was taking 1.5mL of phosphate four times per day, 0.3mL of calcitriol twice per day and 50,000 IU of Vitamin D3 on a weekly basis. Given the Class III skeletal pattern, the medical condition and the absence of relevant bibliography, it was decided to perform maxillary expansion, facemask traction and orthodontic treatment with fixed appliances. By the end of treatment, Class I canine and molar relationships were achieved, overjet and overbite were corrected and space deficiency was addressed in both arches. PAR index was 27 at the beginning of treatment and became 2 by the end of treatment (92.5% correction). The aesthetic component of IOTN was 4 and changed to 1, while the dental component used to be 5i and became 2g. With regards to retention, upper and lower fixed retainers from canine to canine and upper and lower vacuum formed appliances were used. In conclusion, a patient with controlled HR was orthodontically treated in a successful way. Orthodontic therapy was performed in a minimally invasive manner. Thus, HR does not constitute a contraindication for orthodontic treatment, when the disorder is kept under control., (Copyright © 2020 CEO. Published by Elsevier Masson SAS. All rights reserved.)

The present study targeted patients with unilateral cleft lip and palate (UCLP) undergoing either one - (Wardill technique) or two-stage palatoplasty (Perko technique). Correlations between Goslon Yardstick scores and orthodontic appliances used and whether an osteotomy was performed were investigated. No differences were observed between the two types of palatoplasty in terms of Goslon Yardstick scores. A palatal expander and protraction facemask were used in Phase I of orthodontic treatment. The palatal expander was selected for most patients with UCLP in Phase I, regardless of the surgical technique used. A protraction facemask was used in patients undergoing the Wardill procedure who had a Goslon Yardstick score placing them in Group 3 or 4. In contrast, a protraction facemask was used in patients undergoing the Perko procedure who had a Goslon Yardstick score placing them in Group 4. No significant differences were observed in the Goslon Yardstick scores yielded by either type of procedure. The Goslon Yardstick score in relation to whether an osteotomy was performed in Phase II as part of orthodontic treatment was determined, focusing on the relationship between that score and the palatoplasty method used. A protraction facemask was used in patients undergoing the Perko procedure, which eliminated the need for an osteotomy at a future date. However, a protraction facemask was also used in patients undergoing the Wardill option, and those patients were likely to require an osteotomy. In other words, the results suggest that the type of palatoplasty selected will determine the effectiveness of any orthodontic appliances used.

This article describes a case report of a patient treated by the modified version of the Hyrax rapid palatal expander described by Farronato et al. in 2009. This device can be utilized for the treatment of patients in mixed dentition who, due to the maxillary hypoplasia and to the premature exfoliation of some deciduous teeth, manifest a migration of the permanent incisors with a reduction or closure of the space for the permanent teeth substituting those previously exfoliated. This expander presents a vestibular arm for correcting maxillary asymmetric transverse discrepancies. The activation method, the therapeutic benefits as well as the clinical advantages are described. The use of this appliance allows to restore the correct transverse maxillary diameters, to regain space and at the same time to restore the symmetry of the midlines up to 5-6 mm. Moreover, a recovery of the arch length can be obtained, as demonstrated by the case report presented. The expander with vestibular arm represents an interceptive treatment which can reduce the duration of the orthodontic therapy with fixed appliances.

Background: The long-term management of hypohidrotic ectodermal dysplasia (HED) from prepuberty to adulthood often necessitates orthodontic and orthopedic treatment in conjunction with prosthodontic care., Case Description: The authors present a report regarding the combined orthodontic and prosthodontic treatment of a child with HED-associated oligodontia from the ages of 10 to 18 years. The authors fabricated successive maxillary removable partial dentures, equipped with midline jackscrews, at different phases of the treatment and planned treatment to close the patient's midline diastema. After completion of the orthodontic therapy, three-dimensional analysis of the final dental casts showed a measurable increase in the transverse dimensions of the maxillary dental arch, and posttreatment cephalometric analysis revealed the face to have normal vertical dimensions and a mild retroposition of the maxilla., Conclusions: and, Clinical Implications: Orthodontic and orthopedic treatment in coordination with prosthetic restoration at the appropriate time may benefit the stomatognathic function, normal growth, esthetics and emotional well-being of young people with HED.

Routine othodontic management is unavoidable in all patients with cleft lip and palate after primary surgery. This management combines dental arch alignment with maxillary expansion of the lesser fragment before alveolar bone grafting. To treat dental arch asymmetry, the space of the missing lateral incisor is preserved until the age of dental implant. Otherwise, dento-orthopedic treatment attempts to normalize transversal dental dimension once alveolar bone grafting is done in order to prepare the surgical advancement of the maxilla.

Objective: To investigate the compensation of dental arch and teeth in patients with skeletal protrusion and deviation of mandible., Methods: Measurement of 11 dental models was performed, midline of palate was defined as central line, the distance of every contact point to the midline was measured in each side. The dental arch symmetry was observed. Occlusion plane was defined as conference plane, the buccal or lingual inclination of posterior teeth in upper and lower arch was measured., Results: Upper arch was asymmetry in these patients, the arch width of deviated side (the side that the chin was deviated to) was broader than the other side. The posterior teeth of upper and lower arch were more buccally and lingually inclined respectively., Conclusions: Skeletal protrusion and deviation of mandible may result in compensation of dental arch and teeth, the de-compensation is important in pre-operative orthodontic treatment.

A sample of 130 patients with vertical maxillary hyperplasia; mandibular hypoplasia with a high mandibular plane angle; narrow, tapered maxillary dental arch form; and anterior vertical open bite were collected from three different institutions to evaluate the stability of transverse maxillary arch dimensions after correction of the open bite. Surgical treatment consisted of Le Fort I or bimaxillary osteotomies. Intermolar, interpremolar, and anterior arch widths were measured three-dimensionally on dental casts using a Reflex microscope, and transverse stability after orthodontic or surgical maxillary expansion was analyzed. Orthodontic expansion followed by a one-piece Le Fort I intrusion osteotomy was performed in 77 patients, and surgical maxillary expansion by a multisegment Le Fort I intrusion osteotomy was performed in 53 patients. The increase of transverse arch width and the relapse after orthodontic or surgical expansion were not significantly different. The transverse arch width in these two groups did not relapse in 20% of the patients after a mean follow-up of 69 months. An additional bilateral sagittal split osteotomy had no detectable effect on stability. Patients who underwent a multisegment Le Fort I osteotomy stabilized with rigid internal fixation showed better transverse stability than those with intraosseous wire fixation and maxillomandibular fixation. Maxillary intermolar and interpremolar arch width relapses were not correlated with tongue interposition or loss of interdigitation. The relapse of these arch widths showed significant correlations with clockwise rotation of the mandible but not with changes of overbite or overjet.

This is a case report of a patient with a skeletal Class III malocclusion and maxillary arch length deficiency. The patient was treated without extraction or surgery by increasing the maxillary arch length. Protraction of the maxillary complex and A point was the result. Favorable growth of both the maxilla and the mandible resulted in a functional Class I occlusion and an improved skeletal relationship. [This case report was presented to the American Board of Orthodontics in partial fulfillment of the requirements for the certification process conducted by the Board.]

A study was undertaken to evaluate changing cleft widths and the timing of surgical repair of the lip in so far as it affects the types of cross-bite occlussion that result in cases treated by presurgical orthopedics (as practiced at Tufts-New England Medical Center Hospitals) and by purely surgical intervention. On the basis of the analyses carried out, the following conclusions were reached: 1. Both the alveolar cleft width prior to lip surgery and the arch form following lip surgery are significantly related, and are predictors of, the type of cross-bite occlusion that will result from purely surgical intervention. 2. Neither the alveolar cleft width prior to lip surgery nor the arch form following lip surgery is significantly related to, or is a predictor of, the type of cross-bite occlusion that will result from presurgical orthopedics. 3. For both presurgical orthopedic treatment programs and purely surgical treatment programs, there is a significant relationship between the arch form following palate surgery and the type of cross-bite occlusion that will result. 4. In cases treated by presurgical orthopedics there is a higher probability of achieving favorable occlusal relationships than in cases treated by purely surgical intervention. 5. In a period of 6 months following birth, but prior to lip surgery, presurgical orthopedics results in a smaller percentage reduction in alveolar cleft width than does treatment without the use of an appliance. However, the posterior cleft widths and posterior palate widths show comparable changes in size. 6. The larger anterior cleft width maintained by the use of presurgical orthopedics prior to lip surgery is completely compensated for following lip surgery, so that no significant difference remains between cases treated by presurgical orthopedics and those treated by purely surgical intervention. 7. Since previous findings showed a larger reduction in posterior cleft width in cases treated by presurgical orthopedics than in cases treated by purely surgical intervention and these results show that there is a comparable reduction in posterior cleft width when lip surgery is delayed until the age of 6 months, then early lip surgery tends to limit the natural reduction of the posterior cleft width. 8. Additional studies are needed. These studies must be based on as complete a description of the cleft and the treatment program as possible. It is the total implication for patient rehabilitation that must be considered in the evaluation of treatment outcomes.

Patients were aged 6 to 15 years. The first group (197 patients) was treated without teeth extraction, 2nd group had teeth extracted. The treatment of dentition anomalies was effective both in decidual and permanent occlusion. The duration of treatment, number of visits per one definitive course were virtually equal in both groups. The authors believe teeth extraction expedient only in grade II constriction of dental arches, grade I to II construction of apical basis and medial teeth shift with space unavailable for restricted teeth at least for 1/2 crown width, and in absolute or relative macrodontia.