Management of lingually displaced mandibular canine teeth in five bull terrier dogs

Lingually displaced mandibular canine teeth (304, 404) were treated by applying inclined planes in five bull terrier dogs aged 10-19 months. The inclined planes produced interrupted tipping forces and were left in place for 3 weeks. The orthodontic movement technique successfully resolved the malocclusions. In two cases the treatment had to be repeated, perhaps because the animals were 10 and 12 months old and the device was removed too early. Canine teeth occlusion was normal in all five dogs when last examined 3 months following completion of treatment.     

Outcomes of the surgical exposure, bonding and eruption of 82 impacted maxillary canines

BACKGROUND: Advances in bonding techniques and materials allow for reliable bracket placement on ectopically positioned teeth. This prospective study evaluates the outcome of forced orthodontic eruption of impacted canine teeth in both palatal and labial positions. METHODS: Eighty-two impacted maxillary canines in 54 patients were included in the study and were observed for 18 to 30 months after exposure. Following exposure by means of a palatal flap or an apically repositioned buccal flap, an orthodontic traction hook, with a ligation chain attached, was bonded to each impacted tooth using a light cured orthodontic resin cement. A periodontal dressing was placed over the surgical site for a period of time. RESULTS: All teeth were successfully erupted. Complications consisted of: failure of initial bond, at the time of surgery, which required rebonding; premature debonding at the time of pack removal and; debonding of brackets during orthodontic eruption. There was no infection, eruption failure, ankylosis, resorption or periodontal defect (pocket greater than 3 mm) associated with any of the exposed teeth. Attached gingiva of less than 3 mm was seen in only two of the buccally positioned canines (9%). CONCLUSION: Forced orthodontic eruption of impacted maxillary canines with a well bonded orthodontic traction hook and ligation chain, used in conjunction with a palatal flap or an apically repositioned labial flap, results in predictable orthodontic eruption with few complications.     

The Orthosystem--a new implant system for orthodontic anchorage in the palate

The present report describes the design and first clinical experiences of a newly developed endosseous orthodontic implant anchor system (Orthosystem, Institut Straumann, Waldenburg, Switzerland) for palatal anchorage. The 1-piece fixture made of titanium consists of a screw-type endosseous implant body (sandblasted, acid-etched, diameter 3.3 mm, lengths: 4 and 6 mm), a cylindrical polished transmucosal neck and an abutment. Clamp-caps provide attachment of square commercially available orthodontic wires (0.032 x 0.032 inch, SS) to the abutment (transpalatal bars). In a pilot study 1 fixture (implant body length: 6 mm) was inserted into the midsagittal anterior palatal region in each of 6 adult patients with Angle class II malocclusion (distocclusion 7 to 8 mm, overjet: approximately 9 mm). The treatment plan included extraction of the first maxillary premolars and retraction of the anterior teeth based on maximum anchorage of the posterior teeth without using compliance-dependent anchorage aids (headgear, class II elastics). Due to the design of the fixture only 1 simple surgical procedure was required for insertion (nonsubmerged method, 1-stage surgery). Accordingly the need for surgical exposure of the abutment for connection and wire insertion was eliminated. Thus, inconvenience to patients was reduced to a minimum. The patients are now at varying active treatment stages. The course of treatment of the most advanced case is described. Evaluation of the clinical and radiological findings after 12 months of treatment (3 months implant healing, 9 months active orthodontic treatment which is equal to the implant loading period) revealed no implant mobility/dislocation, favourable peri-implant soft tissue conditions, no marked mesial movement (approximately 0.5 mm) of the implant/transpalatal bar supported posterior teeth, and 8 mm retraction of the anterior teeth. Retrieval of the fixture and post-operative wound healing were uncomplicated. In the treatment of this case, no compliance-dependent extraoral anchorage was used, and the well aligned mandibular dentition was not bonded provide anchorage support (class II elastics).     

Costochondral grafts to replace mandibular condyles in juvenile chronic arthritis patients: long-term effects on facial growth

Long-term facial growth and clinical outcome after replacement of arthritic mandibular condyles by costochondral grafts and postoperative orthodontic guidance of the occlusion were studied until completion of facial growth in patients (n = 12) with juvenile chronic arthritis (JCA) affecting their temporo-mandibular joints (TMJs). The patients were between 10.1 and 16.7 years of age at surgery. Clinical records and radiographs for cephalometric measurements were taken preoperatively, 6-8 weeks after surgery and after completion of facial growth. A considerable potential for growth of the costochondral graft/mandible unit was demonstrated in all patients. The results also indicated a considerable risk of asymmetrical mandibular overgrowth (n = 8), which could not be correctly assessed until after skeletal maturation was complete. Without any active orthodontic treatment, compensatory growth of the alveolar processes closed the lateral open bites, which were created during surgery. The functional results of the reconstructed temporo-mandibular joints were good and the morbidity rate was low. Costochondral grafting is a versatile treatment when the TMJs are severely affected by JCA, but requires supervision of patients until skeletal maturation, to monitor possible mandibular overgrowth. Advantages of this method were re-established mandibular growth, good mandibular function, a low morbidity rate and early aesthetic improvement.     

The prevalence of epilepsy follows the distribution of onchocerciasis in a west Ugandan focus

A study was made to determine whether skeletal alterations usually produced by rapid maxillary expansion may be compensated for in time by growth and/or comprehensive orthodontic treatment. In 30 patients, orthodontic treatment was started with rapid maxillary expansion, followed by fixed appliances, not combined with any other form of orthopedic device. Mean treatment time was 3.1 years. Nine measurements from the Ricketts analysis were studied, based on lateral cephalometric radiographs. Records were taken before orthodontic treatment and after completion of active therapy. A statistical analysis was made of the nine variables used, reflecting the vertical and anteroposterior skeletal proportions of the face, contrasting the changes before and after treatment. Of all the variables studied, the four that change with age according to the Ricketts analysis (mandibular plane angle, maxillary height, facial depth and facial convexity), yielded statistically significant differences after treatment, indicative of normal growth. The five remaining variables that remain constant with age according to the Ricketts analysis (facial axis, lower facial height, total facial height, palatal plane inclination and maxillary depth) showed no significant changes after treatment, also indicative of normal growth.     

Caregiver burden and coping strategies used by informal caregivers of minority women living with HIV/AIDS

Physiotherapy including laser exposure was used in the treatment of 243 patients aged 13-34 years with abnormal occlusion. The results indicate that laser exposure effectively relieved pain after fixation and activation of permanent orthodontic devices, treated gingivitis before and during orthodontic treatment, prevented exacerbations of periodontitis, and accelerated eruption of retained teeth.     

Interdisciplinary concepts in treating adult patients

Pre-prosthetics, as a part of orthodontic treatment in adults has gained increasing importance during recent years. Through coordinated orthodontic, prosthetic and periodontal treatment plans, patients with partial dentition can be offered further treatment possibilities. Such planning would allow for fixed prosthetic treatment possibilities and the survival of critical teeth. They would provide for better aesthetics and avoid functional disturbances. The aim of the present study was to present reports of patients treated by coordinated work at the Dental School of Hamburg University. In patients with partial dentition, premolars were uprighted and distally moved and molars were extruded to be used as abutments for fixed prosthetic reconstructions. Following trauma, the position of the remaining anterior teeth was improved to provide for optimal aesthetics after prosthetic treatment. Extraction of a subalveolarly fractured tooth is avoided through root extrusion and post-core reconstruction. The results demonstrate the advantages of pre-prosthetic treatment as regards stability, aesthetics and function. With the help of pre-prosthetic orthodontic treatment, complicated treatment situations could be handled more successfully than would have been the case without such treatment.     

Immunohistochemical localization of endothelin-1 in placenta and fetal membranes in term and preterm human pregnancy

A case is reported in which an intruded incisor was initially treated by an endodontic dressing with calcium hydroxide and then extruded using a removable orthodontic appliance. A follow-up examination seven years after completion of endodontic therapy and bleaching showed a favourable response. A review of the relevant literature indicates that intrusion occurs in five to twelve per cent of luxation cases. In this type of injury maximum damage occurs to the pulp and all supporting structures because the tooth is driven into the alveolar process. Complications which have been reported include: pulp necrosis, apical radiolucencies, partial or total pulp calcification, root resorption (surface, inflammatory or replacement), marginal periodontal bone breakdown, and arrested or disturbed root development. The prognosis for pulp survival after intrusion is much more favourable for teeth with incomplete root formation than for teeth with complete root formation. Treatment options available to bring an intruded tooth into alignment are: to await spontaneous re-eruption which may occur if root formation is incomplete, uncovering of the intruded crown, orthodontic extrusion which is allied with gentle luxation if the tooth does not move, and immediate surgical repositioning.     

Bone grafting the piriform aperture deformity in isolated cleft lip patients: indication, technique, and results

PURPOSE: This study was undertaken to determine the effect of a bone graft in the piriform aperture on the nasal deformity and orthodontic treatment of the cleft side teeth in isolated cleft lip patients. PATIENTS AND METHODS: All primary cleft lip repair was done 3 months after birth. Nine patients, four female and five male, with a mean age of 12.5 years (range, 8.2 to 24.8 years) and with a repaired cleft lip, were bone grafted between 1992 and 1996. The mean postoperative period was 2 years (range, 1 to 4 years). An iliac crest bone graft was placed in the piriform aperture deformity on the side of the cleft lip. The improvement in the nasal symmetry and angulation of the cleft side teeth were evaluated. The eight growing cleft lip patients (mean age, 11 years; range, 9 to 13 years) were compared with a control group of eight healthy growing children (mean age, 11 years; range, 9 to 13 years). The improvement of nasal symmetry was measured by the formula of the lobule portion of the columella index preoperatively and postoperatively. RESULTS: The mean lobule portion of the columella index preoperatively was 41.8% (SD, 4.4%; SE of Mean, 1.5%) and postoperatively was 44.2% (SD, 4.9%; SE of Mean, 1.6%) (P > .006, t-test for paired samples). The angulation of the cleft side teeth was improved by orthodontic treatment. CONCLUSION: Bone grafting the piriform aperture deformity results in a stable result and improves nasal symmetry and the angulation of the cleft side teeth.     

Appendiceal ultrasonography performed by nonradiologists: does it help in the diagnostic process?

OBJECTIVE: In this study, the effects of pulsed Nd:YAG laser irradiation during root canal treatment of infected teeth were investigated histopathologically in dogs. SUMMARY BACKGROUND DATA: Effects of Nd:YAG laser on infected root canal treatment have not been reported in vivo. METHODS: One hundred thirty-five teeth with a single root, including incisors and premolars, in 15 healthy adult beagle-strain dogs were used in this study. After inducing infection in the teeth, each root canal was shaped with at least a # 40 K-file, then the canal was irradiated using the following parameters: 1 W, 30 pps for 1 and 2 sec; 2 W, 30 pps for 1 and 2 sec. Efficacy of debris removal and evaporation on the root canal walls at 2 weeks, and the degree of inflammation of the periapical region at 2, 4, and 8 weeks after laser irradiation were examined histopathologically by light microscopy. RESULTS: Effective debris removal was observed in all cases of the laser-treated groups. No evaporation was observed except at the conditions of 2 W for 2 sec. Inflammation of periapical region in the laser-treated groups was similar in the control group at 2 weeks, but was significantly less than that in the control group at 8 weeks (p < 0.05). CONCLUSION: These results suggest that pulsed Nd:YAG laser is useful for one-visit root canal treatment of infected teeth in dogs, if appropriate parameters are selected, and this is a potential therapy for human apical lesions of teeth.     

Nerve degeneration within the dental pulp after segmental osteotomies in the baboon (Papio ursinus)

Following dentofacial surgical procedures, teeth in segments often do not sense thermal or electric stimuli. This study was undertaken to assess changes in the neural component of the dental pulp after posterior maxillary and mandibular segmental osteotomies, with or without interpositional autogenous bone grafting, in 26 Chacma baboons. Innervation was assessed histologically immediately after operation, and at 3, 6, 12 and 18 months. Statistically significant differences were present between the experimental and control groups. Even after 18 months no nerves were present in any of the mandibular teeth. In maxillary teeth, 50 per cent had demonstrable nerves in the graft group and 40 per cent in the no graft group. As nerve degeneration was present in the experimental teeth, patients should be warned of possible change in tooth sensibility, following these operations. Careful post-operative follow up for long periods in humans following dentofacial surgical procedures is thus essential.     

Histological evaluation of therapy using a calcium hydroxide dressing for teeth with incompletely formed apices and periapical lesions

Periapical tissue response was evaluated histologically in teeth of 6-month-old dogs with incomplete root formation and periapical lesions in order to compare the effects of two calcium hydroxide-containing pastes prepared with different vehicles on induced root apex formation and repair of the periapical region. A group of teeth with no root canal dressing was used as control. After induction of the periapical lesion, the root canals were instrumented and filled with one of the two pastes (Calen and Calasept), which were renewed monthly for 90 days. At the end of the follow-up period (3 months), the animals were killed. Block sections from the actual areas were dissected free and prepared for histopathological analysis. Both calcium hydroxide pastes helped induce apical sealing and repair of the region, but the Calen paste yielded better results than Calasept. The induced mineralized tissue was predominantly of the cementoid type after the use of both pastes, but the inflammatory infiltrate was significantly less intense with the use of the Calen paste. In the control group, the absence of a root canal dressing impaired the process of periapical repair and yielded no apical root closure in any of the cases analyzed.     

A case of hyperodontia with twenty-two supernumeraries: its surgical-orthodontic treatment

A 10.1-year-old boy showed no permanent teeth, with the exception of the lower central incisors. An x-ray examination revealed that eruption of the permanent dentition was obstructed by 1 deciduous supernumerary and 22 permanent supernumeraries ectopically. Treatment consisted of the following steps: (1) extracting all deciduous and supernumerary teeth; (2) waiting for the roots of the permanent teeth to develop and fitting two temporary partial prostheses; (3) assisting eruption of the permanent teeth by removing the bone that covers the remaining teeth and applying crowns to stimulate the eruption; and (4) bringing the permanent teeth into occlusion with orthodontic treatment. The problem of limiting treatment time was made more difficult by the amount of repositioning needed to bring the teeth into occlusion and by delayed root formation. Therefore the orthodontist decided to use extreme caution in applying forces; as a result, treatment time was lengthened. Success was due to good teamwork between the surgeon with an orthodontic background and the orthodontist, who was familiar with surgical procedures.     

Barodontalgia among flyers: a review of seven cases

Once referred to as "flyer's toothache," barodontalgia is defined as tooth pain occurring with changes in ambient pressure. It usually occurs in people who fly or dive. It can develop in conjunction with sinusitis, and in teeth experiencing pulpitis after restorative treatment, new and recurrent caries, intra-treatment endodontic symptoms, dental and periodontal cysts, or abscesses. Although the causal process of barodontalgia is not well understood, it may be related to pulpal hyperemia, or to gases that are trapped in the teeth following incomplete root canal treatment. Patients who are frequently exposed to changes in ambient pressure should be encouraged to follow good oral health practices, attend regularly-scheduled dental recall examinations and accept the timely completion of restorative treatment to minimize the possibility of developing barodontalgia. By employing a classification system to document cases of barodontalgia, dentists will be better prepared to provide appropriate and successful treatment. Seven case reports of barodontalgia are presented and compared to previously documented cases. The author also reviews the reasons why military flyers are more likely to develop barodontalgia than others, although the passengers and crews of commercial airliners may also suffer from this condition.     

Clinical comparison between a glass ionomer cement and a composite for direct bonding of orthodontic brackets

The clinical performance of a glass ionomer cement for direct bonding of orthodontic brackets was compared with a composite resin routinely used in this procedure. Brackets were bonded, using both materials, in alternate quadrants of 16 patients of the Orthodontic Clinic of the State University of Rio de Janeiro. A total of 225 teeth, 112 in the glass ionomer cement group and 113 in the composite group, were tested. Bond failure frequencies were recorded for 12 months, and chi-square statistical test was carried out comparing the failure rates of the materials. The composite showed a statistically significant lower failure rate (7.96%) than the glass ionomer cement (50.89%), regardless of the dental arch tested. Although the glass ionomer cement presents important properties not observed in the composite, it is necessary to increase its cohesive strength to permit its clinical use for direct bonding of orthodontic brackets.     

Orthodontic retention

This article briefly describes several factors that should be considered during orthodontic retention. These factors may influence occlusal stability following the completion of the active phase of orthodontic therapy. Orthodontic retention is an important part of orthodontic treatment. It should always be considered and included in the initial stages of treatment planning, rather than added on at the end of treatment as an after-thought.     

Biochemical and histological changes in blood, erythrocytes and tissue of rats on feeding Dryopteris juxtaposita fern

One tenet of successful orthodontic therapy is to complete treatment without decalcification, hypocalcification, or discoloration of the natural dentition. Fluoride application has been shown to reduce demineralization of enamel. The purpose of this study was to see if fluoride could be incorporated into enamel before orthodontic bracketing without adversely affecting bond strength. Forty extract adolescent human premolars were randomly divided into two equal groups with 20 teeth each. Group 1 served as control group, and group 2 (experimental) was immersed in 1.23% acidulated phosphate fluoride for 4 minutes after acid etching. The buccal surfaces of all 40 teeth were then bonded with the same type of metal bracket and debonded with an Instron machine. The debonding interface was observed with scanning electron microscopy (SEM). The mapping was calculated with energy dispersive x-ray spectrometry. The results showed that the bond strength of group 1 was significantly greater than that of group 2. The enamel detachment (enamel fracture) was found in the experimental group only. Although the application of acidulated phosphate fluoride to a tooth can prevent dental decay or decalcification, the bond strength decreases and enamel detachment is found after debonding. The result shows that the application of acidulated phosphate fluoride after acid etching enamel has an adverse effect on orthodontic bond strength of human enamel.     

Behavior problems of residents with dementia in special care units

188 patients with high-turnover type post-menopausal osteoporosis were treated for 18 months with 4 different treatment regimens of S-calcitonin nasal spray. For a total of 18 months group 1 was given 100 IU/day, continuously; group 2, 100 IU/day daily for 30 days every other month ("ciclically"); group 3, 200 IU/day continuously, and group 4, 200 IU/day, ciclically. To monitor the effects of treatment, MOC of L2-L4, as well as serum osteocalcin and urinary hydroxyproline: creatinine levels were measured, on initiation of therapy, then at 9, 12 and 18 months, and finally at 6 and 12 months after completion of therapy. Analysis of the results yields the following major points: (A) The peak increase in bone mass occurs at 9 months the continuous therapy groups, and at 18 months in the cyclic therapy groups. In absolute values, the peak are higher in the continuous groups than in the cyclic groups. (B) The long-term increase in bone mass (measured at one year after completion of therapy) does not differ significantly between cyclic and continuous treatment groups at the same dosage. (C) During treatment, a dose-effect relationship exist when comparing dosages of 100 IU/day and 200 IU/day. However, this disappears by one year after completion of therapy. (D) There seems to be a "rebound effect" on osseous turnover after cessation of S-calcitonin therapy. The magnitude and rapidity of onset of this effect appear to correlate directly with the dosage of S-calcitonin administered.     

Kinetic analysis of transcytosis of epidermal growth factor in Madin-Darby canine kidney epithelial cells

OBJECTIVE: Treatment outcome in sexually abused preschool children was evaluated 6 and 12 months after treatment. METHOD: Forty-three sexually abused preschool children and their parents were evaluated 6 and 12 months after completion of either Cognitive-Behavioral Therapy for Sexually Abused Preschoolers (CBT-SAP) or nondirective supportive therapy (NST). Parents completed the Child Behavior Checklist, Child Sexual Behavior inventory, and Weekly Behavior Report to measure a variety of symptoms in their children. RESULTS: Repeated-measures analyses indicated that there were significant group by time interactions on several outcome measures from the beginning of the study to the end of the 12-month follow-up period, with the CBT-SAP group exhibiting significantly more improvement over time than the NST group. Clinical findings also indicated the superior effectiveness of CBT-SAP over NST in reducing sexually inappropriate behavior. CONCLUSIONS: Findings support the superior efficacy of CBT-SAP over NST in maintaining symptom reduction in the year after treatment completion. The importance of using cognitive-behavioral interventions for sexually inappropriate behaviors and including nonoffending parents in the treatment of sexually abused preschool children is discussed.     

Adhesion receptors on bone marrow stromal cells: in vivo expression of vascular cell adhesion molecule-1 by reticular cells and sinusoidal endothelium in normal and gamma-irradiated mice

Periradicular surgery combined with final laser sterilisation was performed on 62 teeth of 50 patients by 3 trained oral surgeons, according to a well defined treatment protocol. It concerned a 5 Watt continuous wave CO2-laser. After a follow-up period ranging from 6 to 17 months all patients were recalled. 28 patients (56%) or 33 teeth (53%) could be evaluated. The success rate was determined by a questionnaire, a standard clinical examination and an X-ray evaluation. Complete surgical healing was found in 59% of the teeth and incomplete healing in 23%. Uncertain healing and unsatisfactory healing were observed in respectively 11% and 7% of the teeth. Better healing results were found in elements with one endodontic canal (67% complete healing) and when endodontic treatment was combined with the intervention (71% complete healing). Comparison of the results of the present study with comparable studies without laser sterilisation, showed however no statistical significant improvement.