Search

A boy aged 8 years 11-months with 4 missing teeth in his mandibular arch and with a skeletal Class II pattern was treated with autotransplantation of developing premolars from his maxillary arch with the aid of temporary skeletal anchorage devices. The active treatment duration was 25 months. After treatment, he had a normal occlusion, and his profile was improved. Posttreatment records at 12 months showed stable occlusion and successfully autotransplanted premolars.

Class III malocclusions with mild to moderate skeletal discrepancies can be camouflaged by orthodontic tooth movement. Conventional methods using Class III elastics can correct Class III into Class I molar relationships. These mechanics show side-effects such as labioversion and intrusion of the maxillary incisors, extrusion of the maxillary molars, linguoversion and extrusion of the mandibular incisors, and intrusion of the mandibular molars along with flattening of the occlusal plane. Conventional mechanics can improve occlusal relationships and some profile esthetics but may produce detrimental smile esthetics by reducing the amount of maxillary incisor exposure. Recently, with the advent of temporary skeletal anchorage devices (TSADs), clinicians are able to achieve total distalization of the mandibular dentition and therefore improve the occlusal relationship without worsening smile esthetics. With the use of TSADs, the en masse movement of an entire dentition can be easily accomplished using a statically determinate force system, which makes treatment plans easier and treatment results more predictable. Finite element studies have identified the location of the center of resistance of the entire dentition and simulated displacement of the dentition depending on the force angulations and have thus provided the theoretical basis for 3-dimensional tooth movement patterns. This article provides the biomechanical considerations and clinical applications of total distalization of the mandibular dentition depending on various force angulations to the mandibular occlusal plane for camouflage treatment of various types of skeletal Class III malocclusions.

A 9-year-old female was referred by her general dentist for an evaluation of an impacted maxillary left central incisor. Her maxillary left primary incisors showed crossbites and her right central incisor showed an edge-to-edge bite which caused gingival recession on the mandibular right central incisor. After treatment, the impacted maxillary central incisor erupted successfully. An optimal overbite and overjet were also achieved, and her gingival recession was improved.

INTRODUCTION This study aimed to compare the skeletodental and soft tissue changes with total arch distalization using a modified C-palatal plate (MCPP) and maxillary first premolar extraction treatment in Class II malocclusion patients with severe overjet. SETTING AND SAMPLE POPULATION The sample consisted of 46 adult patients who had Class II Division 1 malocclusion with severe overjet; 25 of them received non-extraction treatment with MCPPs (age, 22.5 ± 7.2 years), and 21 received maxillary first premolar extraction treatment (age 23.4 ± 6.5 years). METHOD A total of 26 variables were measured on pre- and post-treatment lateral cephalograms. To evaluate the differences between pretreatment and post-treatment in each group, t tests and Wilcoxon rank-sum tests were used. To compare the amount of change between the two groups, MANOVA test was used. RESULTS The overjet was significantly reduced in the MCPP and extraction groups by 4.8 mm and 5.4 mm, respectively. However, the two groups had no significant difference in the sagittal, vertical and angular changes of the maxillary incisors. In addition, regarding soft tissue changes, the MCPP and extraction groups showed an increased nasolabial angle of 7.5° and 9.4°, decreased upper lip to the true vertical line of 1.8 mm and 2.2 mm, respectively (P

Objectives: The aim of study was to evaluate skeletodental and soft tissue treatment effects and the amount of maxillary molar distalization with modified C-palatal plates vs. Greenfield molar distalizer appliances in adolescents. Study design: The samples consisted of pre- and posttreatment lateral cephalograms collected from 39 patients with Class II malocclusion. The MCPP group was comprised of 21 patients (mean age: 11.7 ± 1.3 years) treated with MCPP appliances while the GMD group included 18 patients (mean age: 11.2 ± 0.9 years) treated with GMD. Fixed orthodontic treatment started with the distalization process in both groups. From each cephalograpm, twenty-nine variables were measured for analysis and then the two groups were compared. Descriptive statistics, a paired t-test, and multivariate analysis of variance were performed to compare the treatment effects within and between the groups. Results: There was significant treatmentrelated change in the sagittal position of the maxilla and the mandible within each group. However, there were no statistically significant inter-group differences. The mean maxillary first molar distalization was 3.96 mm in the MCPP group vs. 2.85 mm in the GMD group. Both groups showed minimal distal tipping, but the maxillary incisors were significantly extruded by 3.04 ± 0.89 mm (P < .001) in GMD group. There was no significant difference in treatment duration between the groups. Conclusions: The maxillary first molars of both the MCPP and GMD groups were effectively distalized and there were significant skeletal changes in the maxilla. However, the maxillary incisors were significantly extruded in the GMD group.

Temporary skeletal anchorage devices were used to correct the gummy smile of a 27-year-old woman. She was also missing her maxillary left second molar and mandibular right central incisor. Her mandibular anterior missing space was closed with orthodontic treatment. Her occlusion, smile esthetics, dental midline, and soft tissue profile were significantly improved after her orthodontic treatment. A 2-year follow-up showed that the patient had a stable occlusion and the results of the orthodontic treatment were maintained.

Objectives To estimate the optimal bending angles in the running loop for mesial translation of a mandibular second molar using indirect skeletal anchorage and to clarify the mechanics of tipping and rotating the molar. Methods A three-dimensional finite element model was developed for predicting tooth movement, and a mechanical model based on the beam theory was constructed for clarifying the force systems. Results When using a running loop without bends, the molar tipped mesially 14.4° and lingually 0.6°, rotated counterclockwise 4.1°, and the incisors retracted 0.02 mm and intruded 0.05 mm. These angles were about the same as those estimated by the beam theory. When the amount of tip back and toe-in angles was 11.0°, mesial translation of the molar was achieved, and incisors retracted 0.10 mm and intruded 0.30 mm. Conclusions Mesial translation of a mandibular second molar without any significant movement of anterior teeth was achieved during protraction by controlling the tip back and toe-in angles and enhancing anterior anchorage with the combined use of a running loop and indirect skeletal anchorage.

Objectives: To evaluate the condyle-fossa relationship in adolescents with various skeletal patterns using cone-beam computed tomography (CBCT). Materials and Methods: CBCT images obtained in 120 adolescent patients were used for this study. The patients were divided into 3 groups according to 3 criteria: (1) age (early, middle, and late adolescence); (2) facial height ratio or Jarabak quotient (hyperdivergent, normodivergent, and hypodivergent); and (3) ANB classification (Class I, Class II, and Class III). Temporomandibular joint space (TMJS: AS, anterior space; SS, superior space; PS, posterior space; MS, medial space; LS, lateral space), width and depth of the condyle (MLT, mediolateral thickness; APT, anteroposterior thickness), articular slope (ArS) and vertical height of the fossa (VHF) were measured and compared using CBCT. Results: Differences in condyle-fossa relationships were not significantly different between male and female adolescents, but were significantly different (P < .05) between left and right sides. The mean values showed no statistical differences according to age and skeletal pattern. Most measurements in the sagittal view showed that SS was the greatest, and the mean ratio of AS to SS to PS was 1.00 to 1.27 to 1.19, respectively. The mean values of coronal MS and LS were not significantly different. Conclusions: There were almost no statistical differences in the TMJS in adolescents across various factors except between left and right sides.

The development of temporary anchorage devices (TADs) has allowed for the creation of anchorage in situations where there once was none. Many studies have suggested that the most significant cause of miniscrew failure is insufficient distance between the surface of a root and the miniscrew. In order to reduce the miniscrew failure rate, a modified surgical stent has been shown to not only increase TAD insertion accuracy but also to increase TAD success rates.

Traditionally, the superimposition of serial, two-dimensional cephalometric radiographs has been used for the evaluation of growth and treatment effects. Nowadays, the superimposition of cone-beam computed tomography (CBCT) images has become an important tool for three-dimensional (3D) assessment of changes with growth or treatment. However, the assessment of changes with 3D image superimposition poses many challenges such as accuracy and reproducibility. Various methods for the reconstruction of 3D CBCT images have been used in diagnosis, treatment planning, and simulation. In this article, the various 3D CBCT superimposition techniques and relevant evidences are discussed. Furthermore, their clinical applications, benefits, and limitations are addressed.

Background This case report discusses the management of a patient diagnosed with cleidocranial dysplasia. Methods In terms of dental characteristics, cleidocranial dysplasia features supernumerary teeth, prolonged retention of the primary teeth, and late eruption of the permanent teeth. The patient was given interdisciplinary treatment combined with orthodontic and surgical procedures, as well as traction of seven permanent teeth. Results At the end of treatment, both the occlusion and the facial appearance were improved. The 2-year post-treatment records showed stable results, with no new supernumerary teeth. Conclusions To obtain an accurate treatment plan for patients with cleidocranial dysplasia, we recommend using cone-beam computed tomography to evaluate the supernumerary and impacted teeth, to observe the development of the permanent teeth, and to make the correct decision about which teeth to extract.

The aim of this finite element study was to analyze and clarify the mechanics of tooth movement patterns for total distalization of the mandibular dentition based on force angulation.Long-term orthodontic movement of the mandibular dentition was simulated by accumulating the initial displacement of teeth produced by elastic deformation of the periodontal ligament.Displacement of each tooth was caused by movement of the whole dentition, elastic deflection of the archwire, and clearance gap between the archwire and bracket slot. The whole dentition was rotated clockwise or counterclockwise when the line of action of the force passed below or above the center of resistance. Elastic deflection of the archwire induced a lingual tipping of the anterior teeth. It became larger when increasing the magnitude of angulation. The archwire could be rotated within the clearance gap between the archwire and the bracket slot, and thereby the teeth tipped.Mechanics of total mandibular distalization was clarified. Selective use of force angulation with a careful biomechanical understanding can achieve proper distalization of the whole mandibular dentition.

During the mixed dentition stage, adolescents experience rapid dental and skeletal development. Unfortunately, many of them do not visit the orthodontist early enough and miss out on the opportunity to take advantage of preventive and interceptive orthodontic treatment. This article describes the management of regaining leeway space and correcting anterior crossbite using a modified maxillary molar distalizing appliance.

A 15-year-old girl with a convex profile and a retrognathic chin was referred for improvement of her profile. Nonextraction orthodontic therapy with temporary skeletal anchorage devices was used to improve her facial balance in a total active treatment time of 26 months. Her occlusion and profile were significantly improved by the treatment. Posttreatment records after 12 months showed excellent results with good occlusion and facial harmony.

A 33-year-old woman with severe facial asymmetry and unilateral lingual crossbite was treated with orthodontics combined with differential maxillary impaction and intraoral vertical ramus osteotomy. After 12 months of preoperative orthodontic treatment, 2-jaw surgery was performed. The total active treatment time was 18 months. Both her occlusion and facial appearance were significantly improved by the surgical-orthodontic treatment. The occlusion was stable after 5 years of retention. Posttreatment records after 5 years showed excellent results with good occlusion and long-term stability.

Temporary skeletal anchorage devices (TSADs) provide anchorage for intruding the maxillary posterior teeth to correct an anterior open bite while simultaneously retracting the anterior teeth. The intrusion of posterior teeth with TSADs produces autorotation of the mandible and helps to correct a skeletal Class II pattern. Mandibular incisor extraction has been regarded as an additional treatment option in the correction of malocclusion. In this case report, a 37-year-old woman with a skeletal Class II malocclusion, anterior open bite and severe overjet was corrected with camouflage treatment. Both her occlusion and facial appearance were significantly improved after 23 months of treatment with TSADs and the extraction of her maxillary first premolars and one mandibular incisor.

This clinical article reports an esthetic treatment option for managing a Class II malocclusion in an adult. The patient, a woman aged 24 years 2 months, had crowding and a convex profile. She was treated with maxillary first premolar extractions, a double J retractor, and temporary skeletal anchorage devices in the maxillary arch. Posttreatment records after 2 years showed excellent results with good occlusion and long-term stability.

Treatment of children with several congenitally missing teeth is challenging, because growth and development of the oral structures must be considered. The treatment options include retaining the deciduous teeth and postponing treatment until later or extracting the deciduous teeth and doing one of the following: allowing the space to close spontaneously, closing the space orthodontically, or in patients whose growth is finished, using a prosthetic or implant replacement. One other viable option, if donor teeth are available, is autotransplantation. The treatment plan for patients with missing teeth should be based on a comprehensive evaluation of the patient's age, occlusion, and space requirements as well as on the size and shape of the adjacent teeth. This case report presents the management of a patient in the early mixed dentition with multiple missing teeth. The treatment consisted of a combination of autotransplantation of the maxillary right first premolar to the mandibular right first premolar region and orthodontic treatment with a 5-year follow-up after autotransplantation.

Treatment of a patient with a cleft lip and palate can be challenging. A woman, aged 26 years 8 months, was referred for orthodontic evaluation of her anterior crossbite. She was unhappy with the unesthetic appearance of her maxillary anterior teeth, which were behind her mandibular anterior teeth. She had a unilateral cleft lip and palate and had received primary lip repair and palatoplasty when she was younger, as well as rhinoplasty and a secondary lip repair when she was 15. At the pretreatement evaluation, she had a concave profile with an overjet of −9 mm, a Wits appraisal of −3.8 mm, and a transposed ectopic maxillary right canine. She was treated with orthodontic treatment alone, without orthognathic surgery. The posttreatment records 9 years later showed excellent results with good occlusion, facial balance and harmony, and long-term stability.

The purpose of this study was to determine the accuracy of a new high resolution digital camera-based three-dimensional system called Di3D by comparing with traditional direct anthropometry using digital calipers. The study sample consisted of 20 young adults, 10 male and 10 female. Facial soft tissue landmarks were identified and five linear distances were measured between the landmarks for each subject using the two methods; Di3D camera system and a digital caliper. No statistically significant differences (P › 0.05) were found for all five facial soft tissue distances measured by the Di3D camera system and the digital caliper. The magnitude of differences was very small (mean = 0.73 mm). Good congruence was observed between the means derived from the Di3D system and the digital caliper.The overall mean differences of the five measurements with these two methods were small enough to be clinically insignificant. The results show that both methods are concordant and one method can replace the other in clinical use.

The congenital absence of one or more maxillary lateral incisors poses a challenge to effective treatment planning for general dentists and dental specialists. An evaluation of anterior smile esthetics must include both static and dynamic evaluations of frontal and profile views to optimize both dental and facial appearance. This article presents a case with canine substitution treatment to replace a missing maxillary lateral incisor combined with the extraction of two mandibular lateral incisors and a small maxillary lateral incisor. Both the patient's occlusion and facial appearance were significantly improved after orthodontic treatment.

Autotransplantation can provide patients with all the benefits of a natural tooth, but is seldom considered as a treatment option, in large part because of a lack of knowledge about periodontal tissue or the anatomy of teeth. The authors conducted a literature search using the PubMed database. They searched for key words including "autotransplantation," "clinical indications," "sequence and treatment procedures," "healing factors and prognosis" and "treatment options". Autotransplantation demonstrates as a viable treatment alternative,especially in growing adolescents. It provides a biological and economical treatment option for tooth replacement.

Clinicians agree that, regardless of gender or race, tooth agenesis has become more prominent in recent societies. The congenital absence of one or more maxillary lateral incisors poses a challenge to effective treatment planning for the restorative dentist. However, the one-sided orthodontic approach of just moving canines mesially to eliminate restorative procedures leads to compromise. Adult patients presenting with malocclusions, missing lateral incisors, or anterior crowding but who fail to get proper orthodontic treatment, requesting instead esthetic solutions that do not establish a stable occlusion, proper alignment, and proper axial inclination of the teeth will have compromised esthetic and periodontal results. An evaluation of anterior smile esthetics must include both static and dynamic evaluations of frontal and profile views to optimize both dental and facial appearance. This article presents how orthodontics is combined with other specialties in treating a congenitally missing lateral incisor. One case is used to illustrate how orthodontic treatment is progressed in collaboration with other specialists.

A girl, aged 11 years 4 months, with a skeletal Class II pattern and a severe overjet (10 mm) was treated with a Twin-block appliance. After 9 months of appliance therapy, the skeletal Class II was overcorrected. After 26 months of retention, when the occlusion was stable and the growth rate was diminishing, fixed orthodontic appliances using temporary skeletal anchorage devices were initiated. The total active treatment time with fixed orthodontic appliances was 30 months. Posttreatment records after 18 months demonstrated excellent stability: a functional occlusion and a pleasing facial balance. Cone-beam computed tomography was used to visualize temporomandibular joint adaptations after the functional and fixed orthodontic therapies.

Objective The purpose of this study was to predict the optimal bending angles of a running loop for bodily protraction of the mandibular first molars and to clarify the mechanics of molar tipping and rotation. Methods A three-dimensional finite element model was developed for predicting tooth movement, and a mechanical model based on the beam theory was constructed for clarifying force systems. Results When a running loop without bends was used, the molar tipped mesially by 9.6° and rotated counterclockwise by 5.4°. These angles were almost similar to those predicted by the beam theory. When the amount of tip-back and toe-in angles were 11.5° and 9.9°, respectively, bodily movement of the molar was achieved. When the bend angles were increased to 14.2° and 18.7°, the molar tipped distally by 4.9° and rotated clockwise by 1.5°. Conclusions Bodily movement of a mandibular first molar was achieved during protraction by controlling the tip-back and toe-in angles with the use of a running loop. The beam theory was effective for understanding the mechanics of molar tipping and rotation, as well as for predicting the optimal bending angles.

When treating young patients with Class III malocclusion, factors such as timing and an accurate prediction of growth of the mandible are very important. Even though early interceptive treatment of Class III might often be successful, clinicians should be careful to not initiate early treatment with premolar extractions which will compromise the success of orthognathic surgery later due to mandibular prognathism. This case report presents an adolescent female patient who developed a severe Class III skeletal discrepancy during growth and was treated with surgery after her growth had finished.

Ectopically erupting maxillary canines can cause problems that necessitate surgical, orthodontic, and restorative treatment. When a canine eruption disturbance causes resorption and requires subsequent extraction of the affected teeth, the resulting spaces are candidates for orthodontic repositioning and recontouring of the remaining teeth. To achieve successful results, the clinician must have a proper knowledge of tooth anatomy, root angulation, gingival margin position, restorative techniques, and occlusion. A collaborative effort from the pediatric dentist, orthodontist, and surgeon is required to produce an esthetic and functional result. This case report describes the substitution of maxillary canines for both the left central and right lateral incisors and substitution of the maxillary right lateral incisor for the maxillary right central incisor.

It can be difficult to formulate a definitive diagnosis and treatment plan for patients with hypodontia while dental development is still in progress. Proper radiographs should be used periodically to check for the possibility of delayed tooth development to reduce the potential of misdiagnosis and improper treatment. This article presents a case with orthodontic treatment of hypodontia and delayed development of a maxillary second premolar.

A 42-year and 9-month-old female with an impacted supernumerary tooth was treated with limited fixed orthodontic appliances. As seen in this case, it is possible to successfully treat impacted teeth in adults even though the most common time to treat impactions is during adolescence.

A 12-year-old female with Klippel-Feil syndrome (KFS) combined with Turner syndrome (TS) and a submucous cleft palate (CP) was presented. The patient reportedly had TS and had received growth hormone (GH) therapy. Because of her skeletal Class III pattern with a steep mandibular plane angle, facial asymmetry, and fused cervical vertebrae, the effects of the GH on her craniofacial complex needed to be considered at the start of orthopedic/orthodontic treatment. To manage submucous CP with severe maxillary deficiency, a rigid external distraction (RED) device was used. The total active treatment time was 34 months including distraction osteogenesis (DO). Treatment improved both her occlusion and facial appearance.

Canine impaction is a relatively frequent clinical presentation in dentistry, with challenges that should be resolved. A good understanding by the clinician of the situation and treatment options can have a significant impact on the treatment outcome. Therefore, clinicians should be competent to perform the proper investigation, provide a correct diagnosis, develop an optimum treatment plan, and render appropriate treatment for each individual patient so each patient realizes the best outcome possible.

The purpose of this paper was to describe the clinical case of a 12-year-old female patient with Klippel-Feil syndrome (KFS) combined with Turner syndrome (TS) and a submucous cleft palate (CP). The patient's general appearance was characterized by KFS, a clinical triad consisting of congenital fusion of at least 2 of 7 cervical vertebrae with a short neck, limited head motion, and a low posterior hairline. Three-dimensional images from cone-beam computed tomography (CBCT) revealed cervical vertebrae anomalies and submucous CP. It was reported that the patient had TS and has been administered growth hormone (GH) therapy. Due to a skeletal class III pattern with a steep mandibular plane angle, facial asymmetry, and fused cervical vertebrae, GH's effects on the craniofacial complex should be considered before orthopedic/orthodontic treatment is started.

A 28-year-old female with a Class III malocclusion and facial asymmetry was treated with orthodontics combined with intraoral vertical ramus osteotomy (IVRO). She had severe skeletal Class III (Wits: -9.7 mm). She was missing her maxillary left central incisor and had a fixed three-unit bridge on her maxillary anterior teeth. The patient presented a concave profile with a protrusive mandible. Her dental and mandibular midline was shifted 3 mm toward the left. After presurgical orthodontic treatment, IVRO was performed. The total active treatment time was 16 months including surgery. Both occlusion and facial appearance were significantly improved by the surgical-orthodontic treatment. Posttreatment records after 2 years showed excellent results with good, stable occlusion, facial balance and harmony, and long-term stability.

Objective: The purpose of this study was to explore the 3-dimensional (3D) accuracy of magnetic resonance imaging (MRI) on cone-beam computed tomography (CBCT) images after the registration of MRI images on CBCT images. Materials and Methods: Three Japanese adult females volunteered for this study. To transform digital imaging and communication in medicine (DICOM) data derived from MRI and CBCT images into polygon data, five software programs were used. CBCT and MRI images were obtained within one week, and both were registered by the iterative closest point (ICP) method. To assess the accuracy of the composite MRI-CBCT, the measurement errors of the MRI-CBCT were verified. Measurement values were compared using frontal and cephalometric soft-tissue landmarks. Differences were analyzed using the non-parametric Mann-Whitney U test. Results: There were no significant linear measurement errors (P ≯ 0.05) when the images were measured from the superimposed MRI-CBCT images. Conclusion: The MRI images attained from MRI - CBCT registration showed accurate 3D linear measurements.

A common dilemma in adult orthodontic treatment is deciding how best to treat missing posterior teeth. One treatment option is to orthodontically close the space. But closure can be difficult, especially if the open space is in the maxillary posterior area, because tooth movement through the maxillary sinus is limited. The increased difficulty of moving teeth in the maxillary sinus is similar to moving a tooth in the atrophic posterior mandibular ridge. If space closure is selected as a treatment method, proper mechanics and light forces should be applied. In this article, we report movement of teeth through the maxillary sinus and discuss various implications related to orthodontic treatment in the maxillary sinus.