Distraction Osteogenesis to Treat the Sequel of Early Undiagnosed Childhood Trauma.

Undiagnosed trauma to the condylar head can later cause growth deficits secondary to mechanical restrictions created by scarring and loss of motion. This case illustrates how through a multidisciplinary team effort, distraction osteogenesis was successfully used with a hybrid functional appliance to correct a mandibular asymmetry caused by early undiagnosed childhood trauma. An intra-oral distraction device was placed to lengthen the mandibular ramus and body. Following distraction, a hybrid functional orthodontic appliance was used during growth to correct the cant of the occlusal plane. The patient's growth potential was advantageous in this case because it allowed for selective and controlled eruption on the deficient side using the hybrid functional appliance while impeding further vertical development on the left side by using a bite plane. This bite plane was serially reduced to achieve gradual eruption of the maxillary teeth and alveolar process. In this way, the patient's own growth potential was harnessed to correct the maxillary cant, which, if left uncorrected, would have necessitated orthognathic surgery once skeletal growth was complete. Through liaison with the surgeon and the orthodontist, there was substantial improvement in facial symmetry and occlusion.

Supernumeraries in Nicolaides-Baraitser Syndrome.

BACKGROUND: Nicolaides-Baraitser Syndrome(NCBRS) is an extremely rare condition which has been reported in only a few cases. NCBRS is a distinct clinical condition with typical clinical features of pre- and post-natal global developmental delay, impaired speech, and seizures. Microcephaly, sparse hair, anteverted alae nasi, undefined philtrum, prominence of distal phalanges and interphalangeal joints, and short metacarpals are also typical of NCBRS. CASE REPORT: There are no reported cases in the literature of patients with NCBRS presenting with multiple dental impactions, and to the authors' knowledge, this is the 28th fully documented case of NCBRS and only 75 cases identified as potentially having NCBRS. The clinical features, diagnosis, and course of management are also described. CONCLUSION: Although NCBRS is very rare, it is important to assess dental development in view of the possibility of multiple supernumerary teeth which can have detrimental effects on the occlusion.

Anatomic landmarks and availability of bone for placement of orthodontic mini-implants for normal and short maxillary body lengths.

INTRODUCTION: Increasing numbers of orthodontic mini-implants are placed in the anterior maxilla. To our knowledge, bone levels and root proximity of patients with cephalometrically short maxillae have not been investigated before. The first, second, and third rugae were used as clinical reference lines, and the aim of this study was to measure bone availability in that area by comparing patients with short and normal maxillary body lengths. METHODS: The sample consisted of 21 patients in each group: short maxillary body length and normal maxillary body length. The patients' study models were bisected, and the outline of the palatal contour was marked on the surface. The models were scanned, and the palatal contours were superimposed on the palatal structures of their respective initial cephalometric headfilms, and the vertical and oblique bone levels of the sagittal plane were compared using the Student t test. The level of significance was set at P <0.05. RESULTS: Compared with maxillae of normal maxillary body length, less bone was available in maxillae of short maxillary body length. However, the differences did not reach clinical or statistical significance (P >0.05) at the third rugae. CONCLUSIONS: Almost equivalent average bone depth at the third rugae in patients with normal and short maxillary body lengths suggests that this site can be used for 8-mm long obliquely inserted orthodontic mini-implants.

In vitro comparison of contemporary radiographic imaging techniques for the measurement of inter-radicular width.

OBJECTIVE: To assess the reliability of inter-radicular measurements taken using dental pantomograms (DPT), long cone periapical radiographs (LCPA) and cone bean computed tomography (CBCT). MATERIALS/METHODS: A typodont simulating a hypodontia patient undergoing fixed appliance treatment was used. LCPAs, DPT, I-CAT and Accuitomo CBCT images were taken and the distances between the edentulous spans were measured at the midpoint of the roots and the cemento-enamel junctions (CEJ) of adjacent teeth. The results of each modality were compared to each other to the actual inter-radicular space. RESULTS: The DPT overestimated inter-radicular widths by 2 mm or more [mean: 2.48; 95% confidence interval (CI): -1.09 to 6.05 mm]. The LCPA overestimated the inter-radicular widths by 1.5 mm with a 95% CI of -0.095 to 4.03 mm. The mean differences between gold standard (model) and Accuitomo was 0.57 mm (95% CI: -0.37 to 1.51 mm) for the root mean and 0.22 mm (95% CI: -0.52 to 0.96 mm) for the CEJ. This was similar to the differences between the model and I-CAT where the inter-radicular root mean difference was 0.38 mm (95% CI: -0.38 to 1.14 mm) and the CEJ mean difference was 0.21 mm (95% CI: -0.50 to 0.92 mm). CONCLUSION: The CBCT overestimated the root distance by 0.48 mm and the CEJ width by 0.22 mm, which is clinically irrelevant for implant placement. The DPT overestimated inter-radicular width by 2 mm and the LCPA by 1.5 mm and this difference may put roots of adjacent teeth at risk during implant placement.