Torturous path of an elastic gap band: Interdisciplinary approach to orthodontic treatment for a young patient who lost both maxillary central incisors after do-it-yourself treatment.

Spacing between the maxillary anterior teeth is a common concern for young patients and their parents. Patients often consider a diastema to be an annoying but minor problem; they might consult their general dentists for help, or try to address the issue themselves by applying elastic "gap bands." Moreover, parents, without any informed consent, sometimes accept this erroneous method as an easy and inexpensive treatment approach. A 9-year-old boy had severe acute periodontitis involving the maxillary central incisors caused by the placement of an elastic band and its apical migration. Despite periodontal and surgical interventions, the maxillary central incisors were finally extracted, and the patient started orthodontic treatment. The orthodontic treatment plan included maxillary lateral incisor substitution to replace the lost central incisors and mesialization of the maxillary posterior dentition. An interdisciplinary approach with excellent cooperation among the orthodontist, general dentist, and other dental specialists obtained an esthetically pleasing and optimized functional result. Treating the diastema between the anterior teeth with elastic gap bands and without fixed orthodontic appliances should be avoided. Patients should seek proper orthodontic advice for even small-scale orthodontic problems to prevent catastrophic outcomes, as exhibited in this case report.

Patterns of non-syndromic permanent tooth agenesis in a large orthodontic population.

OBJECTIVE: The aim of this study is to explore patterns of non-syndromic permanent tooth agenesis in a large orthodontic patient group. DESIGN: A record review was performed in various orthodontic clinics to identify white patients with non-syndromic permanent tooth agenesis, excluding 3rd molars. Four hundred and fourteen subjects fulfilled the inclusion criteria. RESULTS: In the 414 subjects with tooth agenesis, approximately 70% presented 1-2 missing teeth. Symmetric agenesis patterns were often observed in the sample (by jaw, by side, or crossed quadrants), with prevalence approaching 30% for cases with contralateral tooth agenesis within a jaw. In cases with 1 or 2 missing teeth, from the total number of potential tooth agenesis patterns in the sample, a certain part was evident, limiting the variation to 27.8% (44/158). In the entire sample, both in the maxilla and the mandible a certain incisor/premolar agenesis phenotype was observed in 59.0% of cases in isolated form. CONCLUSIONS: Although there was variation in the tooth agenesis patterns, our findings suggest the involvement of particular genetic, epigenetic, and/or environmental factors in the formation of the entire dentition, which often lead to specific tooth agenesis phenotypes in cases where this process is disrupted. The present study provides a comprehensive categorization of orthodontic cases with tooth agenesis and can assist in planning future epidemiological and genetic studies.

Esthetic, Functional, and Everyday Life Assessment of Individuals with Cleft Lip and/or Palate.

OBJECTIVES: To evaluate the level of satisfaction of individuals with cleft lip and/or palate (CLP) and their parents concerning the esthetic and functional treatment outcomes, the impact of the cleft on everyday life, and potential associations with treatment outcome satisfaction. SUBJECTS AND METHODS: The sample consisted of 33 patients (7 CP, 20 unilateral CLP, and 6 bilateral CLP; median age: 17.1, range: 9.0-33.1 years) and 30 parents, who responded to a questionnaire in an interview-guided session. All participants received their orthodontic treatment at the Department of Orthodontics in the University of Athens. RESULTS: Patients and their parents were quite satisfied with esthetics and function. Patients with UCLP primarily were concerned about nose esthetics (BCLP about lip esthetics and CP about speech). Increased satisfaction was associated with decreased influence of the cleft in everyday life (0.35 < rho < 0.64, P < 0.05). Parents reported significant influence of the cleft on family life, while patients did not. CONCLUSIONS: Despite the limited sample size of subgroups, the main concerns of patients with different cleft types and the importance of satisfying lip, nose, and speech outcomes for an undisturbed everyday life were quite evident. Thus, the need for targeted treatment strategies is highlighted for individuals with cleft lip and/or palate.

Maxillary canine impaction in orthodontic patients with and without agenesis: a cross-sectional radiographic study.

OBJECTIVE: To assess potential associations between maxillary canine impaction (MCI) and agenesis status as well as between MCI and gender. MATERIALS AND METHODS: The records of 182 orthodontic patients with agenesis (excluding the third molars) and 630 orthodontic patients without agenesis were examined. Diagnosis of MCI was based on pretreatment panoramic radiographs. Maxillary canines that had not erupted as a result of physical barrier or deflection in the eruption path at the dental age of at least 12 years were considered impacted. Logistic regression analysis was used to test for the associations of interest. RESULTS: MCI was detected in 5.6% (n = 35) of the nonagenesis group (28 female and 7 male participants) and in 18.1% (n = 33) of the agenesis group (20 female and 13 male participants). Bilateral impaction was detected in 12 patients (34.3%) of the nonagenesis group and in 11 patients (33.3%) of the agenesis group. There was evidence that maxillary lateral incisor agenesis (odds ratio = 5.1, 95% confidence interval [CI] 2.5-10.5, P < .001) and second premolar agenesis (odds ratio = 2.6, 95% CI 1.0-6.6, P = .042) were significant MCI predictors after adjusting for gender. The odds of MCI were 69% higher in female versus male subjects after adjusting for agenesis status (95% CI 0.97-2.92, P = .063). CONCLUSIONS: This study indicates that there is evidence that agenesis status is a strong predictor of MCI, whereas gender is a weak predictor of MCI. Caution should be exercised in interpreting the results because of the observational nature of the present study.

Comparative assessment of clinical performance of esthetic bracket materials.

OBJECTIVES: To compare the alterations in esthetic appearance and slot morphology/integrity of two main types of esthetic brackets caused after clinical use. MATERIALS AND METHODS: Sixteen ceramic (CR) and 16 plastic (PR) central incisor brackets were obtained from 16 young adult patients at the end of treatment in a prospective randomized manner. As controls, 12 ceramic (CC) and 12 plastic (PC) nonused brackets were also examined. Three representative slot width measurements were obtained through micrometric microscopy. Visual inspection of optical microscopy images, surface electron microscopy (SEM), and energy-dispersive x-ray spectroscopy (EDS) were also performed. RESULTS: Intraoral exposure time varied from 5 to 20 months (mean, 12.4; P  =  .73). Two-way analysis of variance revealed significant differences in slot width among the different materials and a significant interaction between the material effect and its status (P < .001). Bonferroni post hoc tests on material × status effect showed significant differences between CC (95% confidence interval [CI]: 434.5, 447.0) vs PC (95% CI: 460.2, 472.8), CC vs CR (95% CI: 453.2, 464.4), and PC vs PR (95% CI: 448.8, 458.9). Interestingly, a significant difference was not detected for CR vs PR. Slot width was correlated with the time under clinical use only for plastic brackets (PR: r  =  -.64, P < .01). Visual inspection of the optical microscopy images did not reveal any major macroscopic morphological disfigurements or significant discolorations. However, a rough and irregular slot wall surface was evident after clinical use (also with SEM), especially in the bottom of the slot. CONCLUSIONS: Both bracket types presented adequate clinical performance at least for the time period studied and in terms of esthetic appearance and morphologic integrity.