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Introduction Basic research in orthodontics is commonly conducted in rodents. However, experimental studies on orthodontic tooth movement (OTM) lack a standard method to examine OTM and periodontal changes. This study describes a unifying protocol for the analysis of OTM and associated bone microarchitectural changes in mice using microcomputed tomography (µCT). Methods Mice (10 animals/group) were divided into control and OTM groups. OTM was generated by anchoring a nickel–titanium closed-coil spring to the upper incisors to pull the upper left first molar. A third group of TNFα −/− mice was added since these are known to have slower OTM. Using µCT, we implemented and tested a number of methods to measure OTM distance and examine 3D bone morphometric parameters associated with OTM in mice. Results In total, we tested five methods to measure the OTM distance in mice. The results indicated that measuring the intermolar diastema, and assessing tooth movement relative to the anterior root of the zygomatic arch, displayed the lowest standard deviation and enabled optimal detection of intergroup differences. We also developed two protocols for µCT analysis of the periradicular bone that yielded no false-positive results. Our results revealed that including the width of the periodontal ligament rather than excluding it from the region of interest in mice detected more statistically significant differences in the morphometric parameters between the OTM and control sides and between WT and TNFα −/− mice despite more subtle differences. Conclusions We, therefore, propose new guidelines for a standardized μCT-based method to analyse OTM and the extent of the periradicular bone structural changes in mice.

The objective was to investigate the effect of extracorporeal shock wave therapy (ESWT) on the magnitude of orthodontic tooth movement, in a rat model, based on a previously established treatment protocol.In conjunction with orthodontic force commencement, rats underwent ESWT. The amount of tooth movement along with different microarchitectural parameters were measured after three weeks by means of microcomputed tomography. In addition, the percentage of cells expressing vascular endothelial growth factor, the number of tartrate-resistant acid phosphatase (TRAP) positive cells/area and blood vessel density were evaluated both for the pressure and tension sides.The addition of ESWT to the orthodontic force after three weeks more than doubled the average tooth movement. The addition of ESWT on the pressure side induced a significant decrease in volumetric bone mineral density. Blood vessel density and the number of TRAP positive cells were higher after the application of ESWT.The induction of ESWT during orthodontic tooth movement in a rat model increases the rate of tooth movement by accelerating bone resorption on the pressure side and possibly enhances bone formation on the tension side.

Tooth root resorption is an unwanted result of orthodontic tooth movement, and it can be expressed by a reduction in cementum thickness. The aim of this experimental study was to evaluate the effect of intraligamentary injection of osteogenic-induced gingival fibroblasts (OIGF) on cellular and acellular tooth root cementum thickness in modeled orthodontic tooth movement. Six beagle dogs were used in the study. All the upper and lower third and fourth premolars were subjected to mechanical loading for 4 weeks, which induced orthodontic tooth movement. Fifteen premolars were assigned to the OIGF group, which received a single OIGF injection through the periodontal ligament near the root apex (n = 7 teeth), and to the control group, which received a single injection of Dulbecco's modified eagle's medium in the periapical area (n = 8 teeth). The evaluation of histomorphometry was performed to assess the thicknesses of cellular and acellular cementum at the root apex and four bilateral sites distal to the apex. We found no statistically significant enhancing effects of gingival fibroblasts on either cellular or acellular cementum thicknesses when compared with the control group. We conclude that a single intraligamentary injection of OIGF does not stimulate the formation of tooth root cementum in the dog model of orthodontic tooth movement. Thus, OIGF is unlikely to prevent orthodontic-induced tooth root resorption.

Tooth root resorption is an unwanted result of orthodontic tooth movement, and it can be expressed by a reduction in cementum thickness. The aim of this experimental study was to evaluate the effect of intraligamentary injection of osteogenic-induced gingival fibroblasts (OIGF) on cellular and acellular tooth root cementum thickness in modeled orthodontic tooth movement. Six beagle dogs were used in the study. All the upper and lower third and fourth premolars were subjected to mechanical loading for 4 weeks, which induced orthodontic tooth movement. Fifteen premolars were assigned to the OIGF group, which received a single OIGF injection through the periodontal ligament near the root apex (n = 7 teeth), and to the control group, which received a single injection of Dulbecco's modified eagle's medium in the periapical area (n = 8 teeth). The evaluation of histomorphometry was performed to assess the thicknesses of cellular and acellular cementum at the root apex and four bilateral sites distal to the apex. We found no statistically significant enhancing effects of gingival fibroblasts on either cellular or acellular cementum thicknesses when compared with the control group. We conclude that a single intraligamentary injection of OIGF does not stimulate the formation of tooth root cementum in the dog model of orthodontic tooth movement. Thus, OIGF is unlikely to prevent orthodontic-induced tooth root resorption.

Extracorporeal shockwaves are noninvasive mechanical forms of sound wave treatment. They were introduced in medical therapy approximately 30 years ago in order to disintegrate kidney stones. Over the last 15 years, extracorporeal generated shockwaves have been used in many fields of medicine due to their versatility and ability to stimulate healing processes by inducing neovascularization and differentiate stem cells into cells of the injured tissue to allow proper healing and regeneration.

Introduction: The main points to consider in secondary alveolar bone grafting (ABG) of cleft patients are age at the time of surgery, the type of bone graft, and pre/postorthodontic expansion of the upper jaw. Purpose: The aim of this study is to evaluate the reverse quad-helix (RQH) expander device. Does RQH improve the surgical procedure before ABG? We will evaluate the outcome of the procedure, duration of the operation, hospitalization time, satisfaction of the surgeon with this procedure and the success of the bone graft in the long-term. Patients and Methods: We reviewed the medical records of 103 cleft patients who underwent secondary bone grafting at our institution between 2001 and 2012. All patients were treated presurgically with a RQH appliance to expand the cleft area. The following data were recorded for each of the patients: Unilateral/bilateral cleft, surgery time, hospital stay, success/failure, and follow-up. Conclusion: Presurgical orthodontic application of the RQH expander in the cleft area enabled improved anterior expansion rather than posterior expansion. This technique improves access for surgery and bone grafting, the use of RQH facilitates the improved manipulation of the nasal mucosa via direct view due to the wide separation of the alveolar segments in the cleft area. Furthermore, this gap enables improved access for the bone grafting procedure, shortens the surgery time and provides stable maxillary transverse correction.

Background and Objective Extracorporeal shock wave therapy has been used in various clinical conditions as a result of its ability to stimulate healing processes in acute and chronic inflammatory states. Orthodontic force application triggers an inflammatory reaction in the periodontal tissue surrounding the involved teeth, resulting in tooth movement. Preliminary work revealed that extracorporeal shock wave therapy increased the expression of the inflammatory cytokines involved. Our aim was to investigate the expression of inflammatory cytokines in the periodontal tissues following orthodontic force induction, with and without shock wave therapy, in experimental rats. Material and Methods An orthodontic appliance was fabricated and applied between the molars and the incisors of adult Wistar rats. In conjunction with orthodontic force commencement, the rats were treated with a single episode of 1000 shock waves. Every day, during the 3 d of the study, rats were killed and the immunolocalization of RANKL, interleukin (IL)-1β, IL-6 and tumor necrosis factor-alpha was evaluated. Results The percentage of the area staining positively for all inflammatory cytokines during the first 2 d decreased statistically significantly more in the shock wave-treated group compared with the nontreated control group. On the first day, the percentage of the area staining positively for IL-1β and RANKL on the compression side peaked in both groups, with a sequential rise in the number of TRAP-positive cells. Conclusion The induction of shock wave therapy during orthodontic tooth movement influences the expression of different inflammatory cytokines in the tissue and might alter the expected periodontal remodeling rate.

The purpose of this study was to evaluate the developmental stage of teeth adjacent to the agenesis site in comparison to their antimeres.Panoramic views of 39 patients with unilateral dental agenesis and 42 normal controls were evaluated. The dental developmental stage (normal or delayed) of the teeth adjacent to the agenesis site was determined for each patient using the Haavikko's method, while the overall dental age was determined by Becker's method.No statistically significant difference was found in the developmental stage of teeth adjacent to the agenesis, compared to their antimere and to the same teeth in the normal control group. However, the prevalence of cases with no difference in development was almost double for the tooth distal to the agenesis site compared to the tooth mesial to the agenesis site in the hypodontia group (84.6% distal and 43.6% mesial; p0.001) and in the control group (83.3% distal and 52.4% mesial; p0.002). In most of the cases the tooth distal to the agenesis site was the 1st permanent molar.(1) No difference was found between the developmental stage of teeth adjacent to the agenesis site and their antimeres. (2) Teeth mesial to the agenesis site showed some delay in development compared to teeth distal to the agenesis site, in this study. (3) The 1st molars, which were in most of the cases the distal adjacent tooth to the site of agenesis, showed developmental stability. (4) Additional longitudinal studies are needed to examine the dental developmental pattern in patients with agenesis.

Traumatic lesion of the lip buccal mucosa may develop due to a repetitive lip sucking habit, secondary to a dental space which opened in the dental in adult patients. The non surgical treatment approach is based on increasing of patient's awareness to the sucking habit along with the creation of a change in the oral and dental surrounding tissues. The following case included a failure to identify a traumatic habit of lower lip sucking, resulting in a buccal mucosa overgrowth. Combined conservative periodontal and orthodontic approach will be presented to address this clinical issue without any need for surgical intervention.56 year old female patient presented with a complaint of unaesthetic appearance of the intraoral right buccal mucosa of the lower lip at rest position due to an intensive repetitive sucking habit of the right lower lip segment. We initiated a non surgical treatment approach including increasing the patient's awareness to the sucking habit, controlling the periodontal disease and orthodontic treatment to align and level the dental arch and to close the residual space.The soft tissue overgrowth on the lip buccal mucosa almost completely subsided spontaneously as a result of conservative dental and behavioral management without the need for any oral surgery intervention. A 10 years follow-up revealed no repetitive oral mucosa overgrowth, no spaces reopening and no sucking habit redevelopment.Implementation of a morphological correction will assist the patient in breaking the habit and creating an environment that may effectively prevent the reoccurrence of the habit.

Objectives To estimate the prevalence of platybasia in patients with velopharyngeal incompetence (VPI) and its relation with palatal anomalies and syndromes. Design and Settings Retrospective case analysis. Setting A university-affiliated hospital. Patients The VPI patients (n =366) included five groups with either cleft lip and palate (CLP), cleft palate (CP) only, submucous cleft palate (SMCP), occult submucous cleft palate (OSMCP), or non-CP. The control group (n = 126) comprised healthy, normal-speech individuals. Outcome Measures The cranial-base angle was measured by lateral cephalometric radiography. The prevalence of platybasia (defined as cranial base angle > 137°) was estimated and the patient's syndromes were recorded. Results The prevalence of platybasia was significantly higher in the VPI group (28.7%) than in the normal controls (2.4%) (P < .001). A significant difference (P < .01) was found in the prevalence of platybasia among the five VPI groups: 16.7%, 20.3%, 28.8%, 33.7%, and 40.3% for CLP, CP only, SMCP, OSMCP, and non-CP, respectively. No significant difference was found between the cranial-base angle of VPI patients and of controls and between the cranial-base angle of the five VPI groups. The VPI nonplatybasic patients had a significantly smaller cranial-base angle than normal controls (P < .01). Platybasia was the highest among patients with velocardiofacial syndrome (50%), followed by those with Pierre Robin syndrome (27.3%). Conclusions Platybasia, which may cause enlargement of the nasopharyngeal space and difficulties in achieving velopharyngeal closure, can be found in high numbers of VPI patients with or without CP. This supports the belief that velopharyngeal anomaly may be part of a more complex craniofacial anomaly influenced by the cranial-base flexure.

Background Tooth autotransplantation has developed into a safe and predictable procedure, which preserves the continuity of the dental arch and the alveolar process and provides an acceptable aesthetic and physiological outcome. Aim To describe our experience with autotransplantation of the developing mandibular premolar to the iliac crest grafted alveolar cleft as part of the cleft patient's treatment protocol. Material and methods Four cleft affected patients were referred to the Orthodontic and Craniofacial Department, Rambam Health Care Campus, Haifa, Israel due to loss of teeth in the cleft area. In all cases, orthodontic closure of the missing teeth space in the maxillary dental arch was considered inappropriate and therefore autotransplantation of the extracted mandibular premolar to the bone-grafted alveolar cleft site was conducted. Results None of the transplanted teeth in the reported cleft affected patients had signs or symptoms of progressive root pathology, gingival disease or advanced tooth mobility. Long-term clinical follow-up examination revealed improved facial aesthetics and occlusal relationships along with increased self-esteem and welfare of the patients' with no need for future dental restorative treatment. Conclusion Autotransplantation of mandibular premolars should be considered an alternative to prosthodontics in cleft affected patients as an integral part of the cleft patient's treatment protocol.

Objective This study aimed to investigate PDL's cytokine concentration fluctuations after induction of orthodontic force with and without extracorporeal shock wave therapy in a rat model. Materials and methods An orthodontic appliance was fabricated and applied between the molars and the incisors of rats. The rats were treated by a single episode of 1000 shock waves and gingival crevicular fluid was collected for 3 days. The expression and concentration of IL-1β and VEGF were evaluated by ELISA assay. On day 3 all rats were sacrificed and histologic and immunohistochemical assays were applied. Results IL-1β concentration rose in both the treated and non treated shockwave groups on the first day, however it was statistically significantly higher in the treated group on day 2. No statistically significant difference was detected between the groups on day 3. The number/area of TRAP positive cells was higher in the non shockwave group than in the treated group. The percentage of cells expressing VEGF displayed the opposite trend. The findings regarding the immunohistochemical assay for IL-1β corresponded with those of the ELISA assay on day 3. Conclusion The application of shockwaves during orthodontic tooth movement influences the expression of IL-1β and VEGF and may alternate the periodontal remodelling expected rate.

Magnetic resonance imaging (MRI) is one of the most powerful tools in diagnostic imaging. With the growing rates of orthodontic treatment, there are increasing chances of post-orthodontic treatment patients permanently wearing fixed retainers who shall undergo MRI examination.Three adolescent patients were referred for craniofacial MRI examination. All the patients had completed full orthodontic treatment with a retention protocol of permanently wearing bonded gold solder-filled wire fixed retainers. In the first 2 cases, the MRI examination was performed on a 1.5-T system and in the last case on a 3-T system.All the images achieved were of good quality and high resolution. No adverse effects were reported by the first 2 patients including no complaint of heat sensation or any other discomfort in the anterior teeth area. The third patient complained of a headache during the MRI examination.Radiologists and technicians may consider allowing performance of MRI examination using 1.5-T systems when a gold solder-filled wire fixed retainer is involved with no concern regarding the patient's health or the accuracy of the MRI scans.

Objective: Beta Thalassemia (βT) patients present a unique facial appearance and specific craniofacial, jaw and dental patterns. Although this anomaly often requires orthodontic management, βT patients have received scant attention in the orthodontic and dental literature over the past 50 years. The aim of this article is to review the characteristic craniofacial and dental manifestation pattern of βT patients and to emphasize their preferred orthodontic management protocol by presenting a βT orthodontic treated patient. Case report: A 10 year old patient presented with a complaint of severe esthetic and functional disorders due to her diagnosis of βT. We initiated orthodontic treatment including a combined orthopedic and functional treatment modality to improve facial appearance. Results: Maxillary restraint and increased mandibular size during treatment along with an increase in the vertical dimension were achieved. The patient presented with Angle class I molar relationship, with reduction of the excessive overjet and deep overbite. Conclusion: Orthodontic treatment comprised of maxillary orthopedic treatment directed especially toward premaxilla with light forces, and mandibular modification by functional appliance along with fixed orthodontic treatment is recommended in βT patients.

Cleft-affected cases present a variable degree of transversal constriction of the maxilla. Our aim is to present a new method for differential expansion of the premaxillary area in unilateral cleft lip and palate-affected patients. The reverse quad helix appliance is made of a 0.036-in stainless-steel wire soldered to 2 bands placed on maxillary deciduous canines or first primary molars (or first permanent premolars). It incorporates 4 helical loops forming an inverse W-arch design. The spring is positioned posterior to the banded teeth; thus, the expansion effect is focused in the anterior maxillary region. A reverse quad helix appliance was activated and cemented in 20 patients for premaxillary expansion. Upper arch width was assessed by means of plaster study models in the anterior and posterior maxillary regions. The mean anterior occlusal expansion achieved by the reverse quad helix (9.60 [±5.24] mm) is statistically significantly larger than that achieved in the posterior region (5.50 [±3.07] mm) (P < 0.0001). The reverse quad helix is an efficient appliance for differential expansion of the anterior maxillary region as a preparatory stage for secondary bone graft procedures in unilateral cleft lip and palate-affected patients.

Shockwave therapy is used in medicine due to its ability to stimulate healing processes. The application of orthodontic force evokes an inflammatory reaction resulting in tooth movement. Shockwave therapy might have an effect on both inflammatory and periodonal ligament cytokine profiles. Our aim was to evaluate the fluctuations of different inflammatory cytokines after orthodontic force induction with and without shockwave therapy. An orthodontic appliance was applied between the rats' molars and incisors. In conjunction with the commencement of orthodontic force, the rats were treated with a single episode of 1000 shock waves and the gingival crevicular fluid was collected for 3 days. The expression and concentration of different cytokines was evaluated by a commercial 4-multiplex fluorescent bead-based immunoassay. The level of all cytokines displayed a similar trend in both shockwave-treated and untreated groups; the concentration peaked on the first day and declined thereafter. In all cases, however, the cytokine levels were smaller in the shockwave-treated than in untreated animals; a significant difference was found for sRANKL and borderline difference for IL-6 on Day 1. We conclude that shockwave therapy during the induction of orthodontic tooth movement influences the expression of inflammatory cytokines.

Background The authors reviewed the literature regarding inhalation and ingestion of orthodontic appliances and suggest ways to manage and prevent these events. Types of Studies Reviewed The authors conducted literature searches of free text and Medical Subject Headings terms by using PubMed and Embase databases and selected appropriate studies. They analyzed retrieved articles according to several parameters: inhalation or ingestion event, number of cases, patient's sex and age, type of orthodontic appliance, in-office event or out-of-office event, and medical treatment. Results The authors found a total of 2,279 articles in their preliminary search. Eighteen reports of 24 cases from this search met all of the search criteria (that is, clinical studies, case reports or reviews limited to English, Hebrew or Arabic on any form of aspiration or inhalation of orthodontic appliances). Most cases (67 percent) involved ingested objects, and of those cases, the majority (57 percent) occurred in female patients. Most cases (85 percent) occurred outside the orthodontist's office. Seventeen patients (71 percent) had been treated with a fixed orthodontic appliance. In 60 percent of cases, the maxilla was involved. With one exception, no severe complications were reported (only seven patients were examined in a hospital emergency department), and patients were discharged uneventfully from the orthodontic office or emergency department. Clinical Implications Orthodontists and team members should participate in medical emergency management courses that emphasize the use of guidelines in cases of inhalation or ingestion of orthodontic objects. Each orthodontist's office should develop written emergency protocols for out-of-office events and present them to patients and their parents at the start of treatment.

To cite this article: Hazan-Molina H, Molina-Hazan V, Schendel SA, Aizenbud D: Reliability of panoramic radiographs for the assessment of mandibular elongation after distraction osteogenesis procedures Orthod Craniofac Res 2011;14:25–32 Structured Abstract Authors – Hazan-Molina H, Molina-Hazan V, Schendel SA, Aizenbud D Objectives – To determine whether panoramic radiographs could be used for evaluation of changes in the vertical and horizontal dimensions following internal curvilinear mandibular distraction osteogenesis. Study Design – A retrospective cohort study included 25 patients who underwent bilateral mandibular distraction surgery. Three panoramic radiographs and lateral cephalograms from each patient were available: before distraction, immediately upon termination of the distraction process, and at the end of the follow-up period. The radiographs were traced by plotting Condylion, Gonion, and Menton. The linear distances between Condylion and Gonion and between Gonion and Menton were measured on each side, and the correlation was calculated. Results – No significant differences were found between the values of the linear measurements determined by lateral cephalograms and panoramic radiographs (p ≥ 0.079), excluding one measurement. The correlation test for these radiographs showed very high, positive and statistically significant correlations, for both sides of the internal mandibular distraction (r > 0.77, p ≤ 0.0001), apart from three measurements. Conclusion – Panoramic radiographs, with mandibular length (Co–Go and Go–Me) measurements, can be used as an alternative to lateral cephalograms, i.e. as a reliable tool for assessing vertical and horizontal dimensional changes resulting from internal mandibular distraction achieved by a curvilinear distractor.

BACKGROUND The mandibular internal curvilinear distractor design produces a curvilinear vector to provide ideal three-dimensional curvilinear movements compared with the limited straight unidirectional predecessor devices. In this manner, it corrects craniofacial deformities as anatomically as possible, allowing simultaneous bidirectional (rotational and translational) mandibular movement and multidirectional distraction. The aim of this study was to quantify the sagittal and vertical mandibular changes achieved through curvilinear distraction and to assess the long-term effect of this generated bone. METHODS Forty patients (20 male and 20 female), with ages ranging from 5 to 55 years, who underwent mandibular distraction from December of 1999 to August of 2007 at Lucile Packard Children's Hospital in Stanford, California, were included. Preoperatively, postoperatively, and at follow-up (at least 2 years following distraction), panoramic and lateral cephalometric radiographs were traced by plotting different skeletal landmark points and were then analyzed. RESULTS All patients tolerated the curvilinear distraction process well through completion. The average of the mandibular body elongation recorded was 8 to 9 mm and 6 to 8 mm in the panoramic and cephalometric radiographs, respectively; whereas the vertical change of the mandibular ramus achieved was 10 to 12 mm and 10 to 11 mm, respectively. The curvilinear distraction effect on the mandible was found to be significantly stable when the long-term follow-up measurements were compared with the postoperative data revealed in the panoramic and lateral cephalometric radiographs for the two dimensions. CONCLUSION The internal curvilinear device is an effective tool that achieves a stable mandibular distraction, resulting in the correction of craniofacial deformities.

Shockwave therapy is used in medicine due to its ability to stimulate healing processes. The application of orthodontic force evokes an inflammatory reaction resulting in tooth movement. Shockwave therapy might have an effect on both inflammatory and periodonal ligament cytokine profiles. Our aim was to evaluate the fluctuations of different inflammatory cytokines after orthodontic force induction with and without shockwave therapy. An orthodontic appliance was applied between the rats' molars and incisors. In conjunction with the commencement of orthodontic force, the rats were treated with a single episode of 1000 shock waves and the gingival crevicular fluid was collected for 3 days. The expression and concentration of different cytokines was evaluated by a commercial 4-multiplex fluorescent bead-based immunoassay. The level of all cytokines displayed a similar trend in both shockwave-treated and untreated groups; the concentration peaked on the first day and declined thereafter. In all cases, however, the cytokine levels were smaller in the shockwave-treated than in untreated animals; a significant difference was found for sRANKL and borderline difference for IL-6 on Day 1. We conclude that shockwave therapy during the induction of orthodontic tooth movement influences the expression of inflammatory cytokines.

Dentofacial deformities are traditionally treated by maxillary and mandibular osteotomies conducted separately or simultaneously. Recently, distraction osteogenesis has become an irreplaceable part of the surgical armamentarium, for its ability to induce new bone formation between the surfaces of bone segments that are gradually separated by incremental traction, along with a simultaneous expansion of the surrounding soft-tissue envelope. The aim of this article is to describe a combined surgical technique consisting of simultaneous maxillary Le Fort I advancement and mandibular surgical repositioning by means of bilateral sagittal split osteotomy with a curvilinear distractor based on a preliminary computerized presurgical prediction.

Advancements in computers, prototyping, and imaging, especially over the last 10 years, have permitted the adoption of three-dimensional imaging protocols in the health care field. In this article, the authors present an integrated simulation system for craniofacial surgical planning and treatment. Image fusion technology, which involves combining different imaging modalities, was utilized to create a realistic prototype and virtual image that can be manipulated in real time. The resultant data can then be shared over the Internet with distantly located practitioners.

The aim was to review the literature on aggressive periodontitis diagnosed during or before the initiation of orthodontic treatment and to propose preventive recommendations before, during and after orthodontic treatment.Literature searches of free text and MeSH terms were performed by using PubMed, Embase and the Cochrane Library and the appropriate studies were selected. The retrieved articles were analyzed and the relevant data was tabulated according to different parameters.A total of 220 articles were found in the preliminary search. Eighteen studies, all case reports, describing 21 cases from this search met all the criteria. The mean age of the reported cases was 21.12 years, all treated with combined periodontal and orthodontic modalities. Most of the reported cases were female.An interdisciplinary dental team must approve the periodontal health prior to and during the course of the orthodontic therapy. In subjects with periodontal pathology, a periodontal consultation and interceptive/corrective therapy should be performed prior to commencing with orthodontic treatment. Orthodontic treatment should be postponed or replanned in order to shorten treatment duration and reduce the orthodontic forces exerted on the aggressive periodontitis involved dentition.

Introduction Endodontic treatment of immature permanent teeth with necrotic pulp, with or without apical pathosis, poses several clinical challenges. There is a risk of inducing a dentin wall fracture or extending gutta-percha into the periapical tissue during compaction of the root canal filling. Although the use of calcium hydroxide apexification techniques or the placement of mineral trioxide aggregate as an apical stop has the potential to minimize apical extrusion of filling material, they do little in adding strength to the dentin walls. It is a well-established fact that in reimplanted avulsed immature teeth, revascularization of the pulp followed by continued root development can occur under ideal circumstances. At one time it was believed that revascularization was not possible in immature permanent teeth that were infected. Methods An in-depth search of the literature was undertaken to review articles concerned with regenerative procedures and revascularization and to glean recommendations regarding the indications, preferred medications, and methods of treatment currently practiced. Results Disinfection of the root canal and stimulation of residual stem cells can induce formation of new hard tissue on the existing dentin wall and continued root development. Conclusions Although the outcome of revascularization procedures remains somewhat unpredictable and the clinical management of these teeth is challenging, when successful, they are an improvement to treatment protocols that leave the roots short and the walls of the root canal thin and prone to fracture. They also leave the door open to other methods of treatment in addition to extraction, when they fail to achieve the desired result.

Aggressive periodontitis is diagnosed mainly by clinical and radiographic examination. Diagnosis in the primary dentition indicates a choice between conservative and radical treatment that involves extractions, depending on the severity of the case. The purpose of this report was to present a case of aggressive periodontitis in a systemically healthy child and to discuss the periodontal and orthodontic aspects. A 7-year-old girl presented with bleeding on probing of approximately half of the dentition, deep periodontal pockets around all primary molars, and increased tooth mobility. An individual oral hygiene program was initiated. The primary maxillary right molar and all primary mandibular molars were extracted, and clear vacuum-formed removable retainers were fabricated and used as space maintainers. The patient was followed longitudinally for 2 years, and no space loss was recorded. Clear vacuum-formed removable retainers mainly involve occlusal crown attachment and, therefore, decrease the risk of plaque accumulation, gingival irritation, and aggressive periodontitis in the permanent dentition.

The distraction osteogenesis principle that was originally developed by orthopedists for purposes of limb lengthening can now be used successfully for bones of the craniofacial region, including cleft palate deformities. Advancement of the cleft maxilla by means of distraction is based on the concept of using stretching forces to separate two bony elements at the midface region. The role of orthodontists in skeletal treatment of the maxilla utilizing distraction osteogenesis should be collaborative and adjunctive as part of a team approach to rehabilitate the patient. Advances over traditional techniques are mainly because of simultaneous adaptation of the surrounding soft-tissue envelope which contributes to the stability of the reconstruction, thus lessening the risk of relapse.

Axenfeld-Rieger syndrome is a rare genetic disorder characterized by ocular and dental abnormalities. This case demonstrates a comprehensive review of the syndrome's clinical and dental features and describes a case of a 13-year-old boy presenting with it. The patient showed severe hypodontia, microdontia, and short roots. Different treatment options are discussed. Early diagnosis and an interdisciplinary approach are necessary to provide the best short- and long-term treatment plans, as well as treatment and follow-up for individuals with the syndrome.

Purpose Distraction osteogenesis is used to increase the vertical and transverse bone volume of the alveolar ridge and requires 3-dimensional vector controls. Temporary anchorage devices (TADs) may be inserted into the transported segment, enabling distraction vector control by exerting orthodontic force. The authors' aim was to describe a combined orthodontic surgical technique involving vertical alveolar distraction using TADs. Materials and Methods Four patients who presented with extensive anterior alveolar ridge bone loss combined with the incisors and canines underwent treatment according to a combined surgical orthodontic protocol, including presurgical orthodontic preparation and a preimplantation surgical augmentation stage involving vertical distractor insertion. During the active vertical alveolar distraction process, 3 TADs were inserted. Intraoral orthodontic elastics were attached to the main orthodontic archwire exerting multidirectional forces to control the vertical distraction vector. After 4 to 5 months of vector controlling and active bone molding, the TADs were removed. Results Anterior alveolar ridge augmentation using distraction osteogenesis was achieved. The application of TADs for better anterior segment curvature enabled dental implant insertion, ideal positioning, and restoration. Conclusions A combined surgical orthodontic management protocol involving vertical alveolar distraction osteogenesis for augmentation purposes using TADs enables improved alveolar ridge volume and architecture for the preimplantation stage.

The authors reviewed the literature regarding inhalation and ingestion of orthodontic appliances and suggest ways to manage and prevent these events.The authors conducted literature searches of free text and Medical Subject Headings terms by using PubMed and Embase databases and selected appropriate studies. They analyzed retrieved articles according to several parameters: inhalation or ingestion event, number of cases, patient's sex and age, type of orthodontic appliance, in-office event or out-of-office event, and medical treatment.The authors found a total of 2,279 articles in their preliminary search. Eighteen reports of 24 cases from this search met all of the search criteria (that is, clinical studies, case reports or reviews limited to English, Hebrew or Arabic on any form of aspiration or inhalation of orthodontic appliances). Most cases (67 percent) involved ingested objects, and of those cases, the majority (57 percent) occurred in female patients. Most cases (85 percent) occurred outside the orthodontist's office. Seventeen patients (71 percent) had been treated with a fixed orthodontic appliance. In 60 percent of cases, the maxilla was involved. With one exception, no severe complications were reported (only seven patients were examined in a hospital emergency department), and patients were discharged uneventfully from the orthodontic office or emergency department.Orthodontists and team members should participate in medical emergency management courses that emphasize the use of guidelines in cases of inhalation or ingestion of orthodontic objects. Each orthodontist's office should develop written emergency protocols for out-of-office events and present them to patients and their parents at the start of treatment.

Postoperative inferior alveolar nerve (IAN) neurosensory impairment was prospectively evaluated in 20 consecutive patients with mandibular prognathism who underwent bilateral sagittal split osteotomy. Routine presurgical imaging was obtained for all patients in study and control groups (10 patients each). Cone beam CT of the mandibular ramus and body was performed in 10 randomly selected patients (study group) and the precise location of the IAN was determined preoperatively and intraoperatively. Nerve sensation was evaluated by subjectively monitoring the physical feeling of the lower lip and the chin skin preoperatively and at different times postoperatively. Exact nerve location was successfully determined in all 10 cases in the study group. There were almost no significant differences between patients' sensation scores at the chin skin and lip sites. No significant differences were found between the two sides of the 20 patients. A significant increase in the score trend along the timeframes, in both groups, could be clearly seen together with a statistically significant difference ( P ≤0.004) between the study and the control groups. In conclusion, precisely locating the IAN using CT is a significant means for efficiently minimizing nerve damage during sagittal split osteotomy.

This report describes a combined orthodontic surgical technique involving vertical alveolar distraction using temporary anchorage devices (TADs) in cases of massive alveolar ridge bone and teeth loss. A combined surgical orthodontic protocol included presurgical orthodontic preparation and a preimplantation surgical augmentation stage for insertion of a vertical distractor. During the active vertical alveolar distraction process TADs were inserted. Intraoral orthodontic elastics were attached to the main orthodontic archwire exerting multidirectional forces to control the vertical distraction vector. After 3 months of vector controlling and active bone moulding, the TADs were removed. Anterior alveolar ridge augmentation using distraction osteogenesis was achieved. The application of TADs for better anterior segment curvature enabled dental implant insertion, better positioning and restoration. A combined surgical orthodontic management protocol involving vertical alveolar distraction osteogenesis for augmentation purposes is an efficient treatment method to improve alveolar ridge volume for the preimplantation stage.

This article reviews the management of mandibular body fractures in young children. Treatment principles of this fracture type differ from that of adults due to concerns regarding mandibular growth processes and dentition development. The goal of this fracture treatment is to restore the underlying bony architecture to its preinjury position in a stable fashion as non-invasively as possible and with minimal residual esthetic and functional impairment. The management of mandibular body fractures in children depends on the fracture type and the stage of skeletal and dental development; treatment modalities range from conservative non-invasive, through closed reduction and immobilization methods to open reduction with internal fixation. Disruption of the periosteal envelope of the mandibular body may have an unpredictable effect on growth. Thus, if intervention is required closed reduction is favored.

Background:Dentofacial-deformities are traditionally treated by maxillary and mandibular osteotomies conducted separately or simultaneously. Recently, distraction osteogenesis (DO) has become an irreplaceable part of the surgical armamentarium. Our aim is to describe a combined surgical technique of simultaneous maxillary Le-Fort I advancement as a skeletal template for mandibular surgical repositioning by means of bilateral-sagittalsplit-osteotomy (BSSO) with a curvilinear distractor based on a preliminary computerized presurgical prediction. Methods: Seven patients, all suffering from obstructive sleep apnea, who presented with a large skeletal open bite and severe mandibular retrusion were included. The presurgical procedure included orthodontic preparation and computerized planning. After performance of Le-Fort I maxillary advancement, a BSSO predistraction procedurewas initiated facilitating finalmandibular position as dictated by the surgical splint. Thereafter a curvilinear distractor was attached to the osteotomized mandible and the jaw was released allowing the distractor to be expanded freely until it could be fixed to the distal component. Then a simultaneous curvilinearDOwas conducted and the respective spiralmovement of the mandible was achieved. Lateral cephalometric X-rays, before and after surgery, were traced by plotting different skeletal landmark points and were then analyzed. Results: All patients tolerated the procedures well through completion. The average vertical change at point I for the maxillary and mandibular incisors and at points A and B was similar (3.14–4.21mm). However, the average horizontal changes at points I (of the mandibular incisors) and B were almost 5 times larger (14.28mm and 15mm, respectively). Conclusion: A simultaneous maxillary and mandibular surgical advancement protocol using maxillary Le-Fort I and mandibular BSSO with curvilinear DO is a useful and accurate technique for dentofacial-deformity management. This technique allows the surgeon to refine the reliability of the distraction and the final occlusion. Additionally this technique is preferable in terms of operation-time and expanses.