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Treatment Progress. Closing loop on 0.017" × 0.025" TMA archwire to mesialize 21. Placement of fixed appliance on the upper left teeth, 0.016" NiTi archwire to align the teeth.
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This case report describes a 13-year-old boy with alveolar bony defect resulted from surgical removal of impacted upper canine transposed in the anterior region. The boy had a normal occlusion with malposition of upper central and lateral incisors. The treatment objectives were to align teeth, close spaces by mesial movement of the buccal segments...
Context in source publication
Citations
... Proponents of removal of such teeth 12,18,19 justify this choice due to the horizontal posture of the impacted canine, 19 proximity to the adjacent mandibular incisor roots, and thin buccal cortical plate. 19,20 This orientation of the impacted tooth could potentially cause root resorption of adjacent incisors, loss of buccal cortical plate, crestal bone loss, bone dehiscence, gingival recession, 18,20 and ankylosis. ...
... Proponents of removal of such teeth 12,18,19 justify this choice due to the horizontal posture of the impacted canine, 19 proximity to the adjacent mandibular incisor roots, and thin buccal cortical plate. 19,20 This orientation of the impacted tooth could potentially cause root resorption of adjacent incisors, loss of buccal cortical plate, crestal bone loss, bone dehiscence, gingival recession, 18,20 and ankylosis. 21 However, improved imaging techniques allow accurate discrimination of the impacted canine to incisor root relationship. ...
Impaction of both mandibular canine and lateral incisor is a rare clinical finding which is often treated by way of surgical extraction. This decision is often taken because of the anatomical limitations presented by the mandible, and the horizontal position of the impacted teeth, which have occasionally transmigrated, placing them in close proximity to the roots of neighboring teeth and with a high risk for causing their resorption. In addition, this condition significantly increases the likelihood that the area involved will undergo gingival recession and loss of crestal bone if an unsophisticated ortho-surgical approach is undertaken. The present report describes a novel ortho-surgical technique which maintains the alveolar crestal bone and utilizes a lingual arch attached to the first molars with traction through tunneling with super-elastic springs. This combined approach eliminated the need for extraction of the impacted teeth, and accomplished their full alignment without any of the aforementioned side effects. Every dentist (general practitioners as well as specialists) should be aware of this procedure and refer patients to a specialist.
... The treat- ment time was well worth if we consider the biological result we achieved. It is also possible to using this appli- ance to deliver light force with torque control [5]. Further studies are needed to compare the effect of this appliance on orthodontic movement with other appliances e.g. using closing loops or nickel titanium coil springs. ...
Orthodontic management of an ectopically erupted canine requires substantial amount of bodily movement which is difficult to perform and often results in root resorption.
A 9 year old girl presented with Class I malocclusion with crowding and ectopically positioned upper left canine (23). Treatment involved extraction of all first premolars. The alignment of the upper left canine was achieved by the modified 2 by 1 appliance.
The design of this modified 2 by 1 appliance allows individualized bodily tooth movement of canine, it provides light and continuous force for physiological orthodontic movement with minimal root resorption.
Aim
To assess the beneficial and adverse effects of periodontal-orthodontic treatment of teeth with pathological tooth flaring, drifting and elongation in patients with severe periodontitis on the dental and periodontal tissues.
Materials and methods
Nine databases were searched in April 2020 for randomized/non-randomized clinical studies. After duplicate study selection, data extraction, and risk-of-bias assessment, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta-regression analyses.
Results
A total of 30 randomized and non-randomized clinical studies including 914 patients (29.7% male; mean age 43.4 years) were identified. Orthodontic treatment of pathologically migrated teeth was associated with clinical attachment gain (-0.24 mm; 7 studies), pocket probing depth reduction (-0.23 mm; 7 studies), marginal bone gain (-0.36 mm; 7 studies), and papilla height gain (-1.42 mm; 2 studies), without considerable adverse effects, while patient sex, gingival phenotype, baseline disease severity, interval between periodontal-orthodontic treatment, and orthodontic treatment duration affected the results. Greater marginal bone level gains were seen by additional circumferential fiberotomy (2 studies; MD=-0.98 mm; 95% CI=-1.87 to -0.10 mm; P=0.03), but the quality of evidence was low.
Conclusions
Limited evidence of of poor quality indicates that orthodontic treatment might be associated with small improvements of periodontal parameters that don’t seem to affect long-term prognosis, but more research is needed.
Objective:
To assess the interdental septal thickness of grafted bone bridges using cone beam computed tomography (CBCT).
Patients:
Of 71 patients with cleft lip and/or palate having undergone alveolar bone grafting for the first time at least 6 months previously, 52 patients with 57 grafted sites rated type I or II based on the Bergland scale using occlusal radiographs were selected.
Interventions:
CBCT was performed for each bone-grafted alveolar cleft within 1 week after the occlusal radiographs were taken.
Main outcome measures:
The thickness of the grafted bone bridge was evaluated using CBCT according to the relationship between crest thickness and the root width of cleft-adjacent teeth, and the results were classified into four categories, with scores of 1 to 4 indicating that the thickness of the bony bridge was ≥100%, ≥75%, ≥50%, and <50% of the root width of the cleft-adjacent teeth, respectively.
Results:
Of the 34 grafted sites rated type I on the Bergland scale, 15 (44.12%), 10 (29.41%), 4 (11.76%), and 5 (14.71%) clefts were scored 1 to 4 on interdental septal thickness using CBCT, respectively. Of the 23 cases of type II, 3 (13.04%), 9 (39.13%), 1 (3.45%), and 10 (43.48%) clefts were scored 1 to 4, respectively.
Conclusions:
The interdental septal thickness of grafted bone bridges with clinically successful heights based on the Bergland scale (type I or II) using occlusal radiographs varied significantly in the evaluation using CBCT.
The present case is a 13-year follow up of a patient in which the treatment plan involved removal of unsatisfactory auto-transplanted maxillary canines together with a bone graft to re-establish normal dento-alveolar ridge morphology. Active tooth movement occurred in the graft site. At the time, this was a new approach and there was no information in the literature as to the outcome of this treatment modality. Long-term reports regarding the success of this treatment are lacking.
To assess the long-term outcome of active tooth movement into a site that required bone grafting.
The upper right canine was non-vital with poor periodontal support on its buccal aspect. Examination revealed a substantial bony defect with a loss of the buccal cortical plate following extraction. To augment the ridge defect bone was taken from the maxillary tuberosity and grafted in the upper right canine extraction site and fixed with a bone screw. Protraction of the first premolar and retraction of the lateral incisor into the graft site was slow and constant.
Significant closure of the upper canine extraction space was achieved. There were no significant detrimental bone changes in the interproximal areas of 14 and 12.
By employing a bone graft to reestablish alveolar bone prior to tooth movement, excellent bone support, periodontal health and a long-term stable result were obtained.
Extra-oral traction appliances were introduced more than a century ago and continue to be used to produce orthopaedic and/or dental changes in the maxilla. While force systems produced by asymmetric outer bows have been studied extensively, the force systems produced by asymmetric inner bows have been overlooked.
To analyse the forces acting on the maxillary first molars: when the size of one bayonet bend is increased; when the point of application of the distalising force on the inner bow is moved to one side; when one molar is displaced palatally.
Four FEM models of cervical headgear attached to maxillary first molars were designed in SolidWorks 2010 and transferred to an ANSYS Workbench Ver. 12.1. Model 1, each molar was 23 mm from the midpalatal line and the inner bow was symmetrical; Model 2, the left molar was displaced 4 mm towards the midpalatal line and the inner bow was symmetrical; Model 3, the molars were equidistant (23 mm) from the midpalatal line, but the left molar was engaged by a 2 mm larger bayonet bend; Model 4, the molars were equidistant (23 mm) from the midpalatal line but the join between the inner and outer bows was displaced 2 mm towards the left molar. In all FEM models, a 2N force was applied to the inner bow at the join between inner and outer bows and the energy transmitted to the teeth and the von Mises stresses on the molar PDLs were assessed.
There were marked differences in the strain energy on the teeth and the von Mises stresses on their PDLs. A 14 to 20 per cent increase in energy and force was produced on the tooth closer to the symmetric plane of the headgear. In addition, the increase in energy produced a 30 to 62 per cent increase in the von Mises stresses within the PDLs.
Small asymmetries in molar position, the size of a bayonet bend and the point of application of a force on an inner bow resulted in asymmetrical forces on the molars. These forces were higher on the molar closer to the symmetric plane of the headgear.
