Eruption Pattern of Third Molars in Orthodontic Patients Treated with First Permanent Molar Extraction: A Longitudinal Retrospective Evaluation.

The aim of this study was to evaluate angular and positional changes in the second (M2) and third molars (M3) of orthodontically treated patients undergoing a first molar (M1) extraction. A retrospective longitudinal study with a sample of 152 pre- and post-treatment panoramic radiographs was conducted. Thirty-nine patients (51.3%) were orthodontically treated with M1 extraction and thirty-seven (48.7%) were treated without extraction. Angulations of M2 and M3 relative to the infraorbital (IOP) and the palatal planes (PP) were measured and compared between the groups before orthodontic treatment (T1) and after the completion of orthodontic space closure (T2). The prognosis of M3 eruptions was evaluated by assessing their horizontal and vertical position (inclination) using different classification systems. The angular (p < 0.001) and inclination improvement (p < 0.01) of the maxillary M3 was significant for the M1 extraction group. The mandibular M3 inclination significantly improved (p < 0.01), whereas the groups' angulation and vertical position were not significantly different. These findings suggest that extraction therapy has a favorable effect on the maxillary M2 and M3 angulation, but not on the mandibular. M1 extraction showed a signi- ficant effect on the horizontal position of M3 and thus may improve the eruption space and prognosis.

Angular and positional changes of the maxillary third molars after orthodontic treatment with different premolar extraction patterns.

OBJECTIVES: To evaluate the angular and positional changes of the maxillary second (M2) and third molars (M3) after orthodontic premolar extraction treatment according to patient skeletal classification and growth pattern. MATERIALS AND METHODS: Panoramic radiographs of patients treated with extraction of the first or second premolars (n = 116) and patients treated without extraction (n = 92), taken before orthodontic treatment (T0) and after completion of multibracket appliance therapy (T1) were analyzed. Angle classification, growth pattern, crowding, and incisor inclination were recorded. The palatal (PP) and interorbital planes (IOP) were used as reference lines. Changes in the M3 angulation relative to PP and IOP (T0-T1) within the same group were evaluated with paired t-tests. One-way analysis of variance (ANOVA) and Kruskal-Wallis tests were used for comparisons between the groups. Accordingly, pairwise comparisons were performed with Mann-Whitney U-tests or independent t-tests (P < .05). RESULTS: The M3 angulation related to the PP and the IOP did not differ significantly between the extraction and nonextraction groups. The M2 angulation improved in the premolar extraction group between T0 and T1 (M2/PP, P < .001). According to Archer's classification, the change in the vertical position of M3 differed significantly between the extraction and nonextraction groups (P < .001). CONCLUSIONS: The angulation of M3 improved over time regardless of the extraction decision. The vertical eruption pattern of M3 was positively influenced only in the extraction group. M2 became significantly more upright in the orthodontic extraction treatment groups.

Esthetic and functional rehabilitation of severe facial asymmetry and dental attrition in a patient with hemifacial microsomia: an interdisciplinary treatment outcome.

The treatment management of patients with hemifacial microsomia (HM) includes both surgical and nonsurgical approaches and depends primarily on the degree of deformity of the facial and skeletal structures. In this context, the combined efforts of the maxillofacial surgeon, the orthodontist, and the prosthodontist are essential for a satisfactory functional and esthetic outcome. Case presentation: A 31-year-old man presented with a chief complaint of facial asymmetry. The patient had been diagnosed with HM on the right side, with severe external ear deformity, and hypoplasia of the facial muscles and the zygomatic bone. The intraoral examination showed a Class I molar and canine relationship with a reduced horizontal overlap and an occlusal plane canting. The maxillary anterior teeth were severely worn due to traumatic occlusion. Orthodontic treatment in conjunction with combined orthognathic surgery was planned to address the facial asymmetry. Ramus distraction osteogenesis was carried out, followed by conventional presurgical orthodontic treatment. The treatment was completed by prosthetic rehabilitation for the reconstruction of the maxillary teeth and fine occlusal adjustment. Conclusion: The cooperation between the orthodontist, surgeon, and prosthodontist becomes indispensable when treating complex cases of HM. An interdisciplinary approach should be adopted from the start of treatment, promoting integrated customized care.

Comparison of early and conventional autogenous secondary alveolar bone graft in children with cleft lip and palate: A systematic review.

PURPOSE: The literature is scarce on studies comparing secondary alveolar bone graft (SABG) performed early at approximately 5-6 years and at the conventional time at 9-11 years. This systematic literature review(SLR) aimed to compare clinical outcomes after two different timings of SABG in children with unilateral and bilateral cleft lip and palate. METHODS: The inclusion criteria were autogenous iliac grafts and the following study designs: case control, cohort, clinical controlled trial (CCT), randomized CCT (RCCT), and previous SLRs. Ovid MEDLINE, Ovid EMBASE, Web of Science, Scopus, Cochrane, ProQuest and Google Scholar were the primary databases. Two calibrated examiners worked independently to select the articles. The MINORS evaluation method for surgical non-RCTs was used to assess for quality. RESULTS: 1,111 articles were retrieved and 19 qualified. Different clinical and radiographic outcomes such as bone level, periodontal status, canine eruption and cleft-side tooth survival were evaluated by different assessment methods such as CBCT volume, computed tomography, periodontal evaluation, panoramic, intraoral radiographs, and Bergland scale. No RCCT or meta-analysis was found. None of the studies received the ideal score, which is 16 for non-comparison studies and 24 for comparison studies. CONCLUSION: Methodological variation, lack of standardization for initial cleft dimension and low-quality level rendered a fair comparison unfeasible. Although further studies are necessary, it can be assumed that early SABG also can be an acceptable option, but this was based on a single study with a reasonable level of evidence.

Age effect on orthodontic tooth movement rate and the composition of gingival crevicular fluid : A literature review.

PURPOSE: To evaluate and form a comprehensive understanding of the effect of patient age on bone remodeling and consequently on the rate of orthodontic tooth movement (OTM). METHODS: A systematic search in PubMed and Embase from 1990 to December 2017 was performed and completed by a hand search. Prospective clinical trials which investigated the rate of OTM and/or studies assessing age-related changes in the composition of gingival crevicular fluid (GCF) in older compared to younger study groups were included. Study selection, data extraction and risk of bias were assessed by two authors. RESULTS: Eight studies fulfilled the inclusion criteria. Among them, four evaluated the rate of OTM and six investigated mediators in the GCF (prostaglandin E2, interleukin [IL]-1ß, IL­6, IL­1 receptor antagonist, receptor activator of nuclear factor kappa­Β ligand, osteoprotegerin, granulocyte-macrophage colony-stimulating factor, pentraxin 3). Patient age ranged between 16 and 43 years for older and <16 years for younger groups. In most of the studies, the younger patients showed faster OTM in the first phase of treatment and more pronounced cytokine levels. Older patients had a delayed reaction to orthodontic forces. CONCLUSION: The small number of included studies and large heterogeneity in study design give limited clinical evidence that the older patients are less responsive to orthodontic force in comparison to younger patients. The initial cellular response to orthodontic force is expected to be delayed in older patients. Control intervals during orthodontic treatment should be adjusted to the individual's treatment response.

Apical root resorption after orthodontic treatment in patients with unilateral cleft lip and palate.

OBJECTIVES: The aims of this retrospective longitudinal study were to present the incidence of external apical root resorption (EARR) in the maxillary anterior teeth of patients with complete unilateral cleft lip and palate (CUCLP) and to evaluate the influence of orthodontic treatment variables on the development of EARR. MATERIAL AND METHODS: Forty-one patients with CUCLP participated in the study. Orthopantomograms (OPGs), taken before (T2) treatment with multiband orthodontic appliances (MBA), and periapical radiographs (PAs) of the maxillary anterior teeth taken at the end (T3) of orthodontic treatment (OT) were assessed for EARR. RESULTS: The incidence of EARR at T3 (97.6%) was considerably higher than at T2 (51.2%). Central incisors and canines on the cleft side showed a significantly higher score (p < 0.01, p < 0.05 respectively) of EARR in comparison to the same group of teeth on the non-cleft side. Preexisting EARR and abnormal root morphology were identified as predisposing factors for EARR. CONCLUSIONS: Patients with CUCLP treated with MBA have higher incidence of EARR on the maxillary anterior teeth of the cleft side. Severe EARR is rather rare but more often seen on central incisors of the cleft side. CLINICAL RELEVANCE: As most of the patients with cleft lip and palate undergo a challenging and long-term OT with MBA, it is of importance to identify the predisposing factors related to the special anatomical features of the bone and teeth located in the cleft area, as well as the special OT needs of these patients.

Update on 13 Syndromes Affecting Craniofacial and Dental Structures.

Care of individuals with syndromes affecting craniofacial and dental structures are mostly treated by an interdisciplinary team from early childhood on. In addition to medical and dental specialists that have a vivid interest in these syndromes and for whom these syndromes are of evident interest, experts of scientific background-like molecular and developmental geneticists, but also computational biologists and bioinformaticians-, become more frequently involved in the refined diagnostic and etiological processes of these patients. Early diagnosis is often crucial for the effective treatment of functional and developmental aspects. However, not all syndromes can be clinically identified early, especially in cases of absence of known family history. Moreover, the treatment of these patients is often complicated because of insufficient medical knowledge, and because of the dental and craniofacial developmental variations. The role of the team is crucial for the prevention, proper function, and craniofacial development which is often combined with orthognathic surgery. Although the existing literature does not provide considerable insight into this topic, this descriptive review aims to provide tools for the interdisciplinary team by giving an update on the genetics and general features, and the oral and craniofacial manifestations for early diagnosis. Clinical phenotyping together with genetic data and pathway information will ultimately pave the way for preventive strategies and therapeutic options in the future. This will improve the prognosis for better functional and aesthetic outcome for these patients and lead to a better quality of life, not only for the patients themselves but also for their families. The aim of this review is to promote interdisciplinary interaction and mutual understanding among all specialists involved in the diagnosis and therapeutic guidance of patients with these syndromal conditions in order to provide optimal personalized care in an integrated approach.

Tooth agenesis patterns in unilateral cleft lip and palate in humans.

OBJECTIVE: To characterize tooth agenesis patterns and their overall prevalence in patients with complete unilateral cleft lip and palate (CUCLP). DESIGN: Panoramic radiographs of 115 non-syndromic patients (78 males and 37 females) with CUCLP (85 patients had a cleft on the left and 30 on the right) from the Cleft Palate Craniofacial Unit in Nijmegen (The Netherlands) were evaluated. Third molars were not included in the evaluation. The Tooth Agenesis Code (TAC) was used to identify tooth agenesis patterns. RESULTS: Agenesis of at least one tooth was found in 48.7%, and agenesis outside the cleft was observed in 20.9% of patients. The lateral incisor of the maxillary cleft quadrant was the tooth most frequently missing (39.1%), followed by the maxillary lateral incisor (8.7%), and the mandibular second premolar (7.8%) in the non-cleft quadrants. Thirteen different tooth agenesis patterns were identified. Maxillary and/or maxillary and mandibular second and/or first premolars were involved in all patterns. CONCLUSION: A higher prevalence of tooth agenesis is observed in patients with CUCLP, even outside the cleft region, compared with the general population. Thirteen different patterns were observed, of which 6 were unique patterns. Certain teeth were involved in all agenesis patterns. Both the prevalence of orofacial clefting as well as hypodontia is more frequently observed on the left side.

Tooth agenesis patterns in bilateral cleft lip and palate.

Individuals with cleft lip and palate present significantly more dental anomalies, even outside the cleft area, than do individuals without clefts. Our aim was to evaluate the prevalence of tooth agenesis and patterns of hypodontia in a large sample of patients with complete bilateral cleft lip and palate (BCLP). Serial panoramic radiographs (the first radiograph was taken at 10.5-13.5 yr of age) of 240 patients with BCLP (172 male patients, 68 female patients) were examined. Third molars were not included in the evaluation. Agenesis of at least one tooth was present in 59.8% of patients. Upper laterals and upper and lower second premolars were missing most frequently. Using the tooth agenesis code (TAC), 52 different agenesis patterns were identified, of which simultaneous agenesis of 12, 22, 15, 25, 35, and 45 was the most frequent pattern. Nine of the 240 patients showed combined BCLP and oligodontia.

Load-deflection characteristics of superelastic nickel-titanium wires.

OBJECTIVE: To determine the mechanical properties of commercially available thermodynamic wires and to classify these wires mathematically into different groups. MATERIALS AND METHODS: The samples examined were 48 nickel-titanium (NiTi) alloy orthodontic wires commercially available from five manufacturers. These samples included 0.016-inch, 0.016- x 0.022-inch, 0.017- x 0.025-inch, and 0.018- x 0.025-inch wires. The superelastic properties of the NiTi wires were evaluated by conducting the three-point bending test under uniform testing conditions. The group classification was made under mathematically restricted parameters, and the final classification was according to their clinical plateau length. RESULTS: The orthodontic wires tested are classified as follows: (1) true superelastic wires, which presented a clinical plateau length of >/=0.5 mm; (2) borderline superelastic with a clinical plateau length of <0.5 mm and >0.05 mm; and (3) nonsuperelastic, with a clinical plateau length of