Implants and/or teeth: consensus statements and recommendations.

In August 23-25, 2007, the Scandinavian Society for Prosthetic Dentistry in collaboration with the Danish Society of Oral Implantology arranged a consensus conference on the topic 'Implants and/or teeth'. It was preceded by a workshop in which eight focused questions were raised and answered in eight review articles using a systematic approach. Twenty-eight academicians and clinicians discussed the eight review papers with the purpose to reach consensus on questions relevant for the topic. At the conference the consensus statements were presented as well as lectures based on the review articles. In this article the methods used at the consensus workshop are briefly described followed by the statements with comments.

Craniofacial morphology in young patients with Turner syndrome.

The craniofacial morphology of 33 Turner syndrome patients, aged 7-16.7 years, was evaluated by standard cephalometric methods. The sample was subdivided according to karyotype and 72 normal girls aged 7.1-16.1 years served as controls. The size of the calvarium and face was generally smaller in the Turner group than in the controls. The morphology was characterized by a flattened cranial base angle, a marked reduction in posterior cranial base length, facial retrognathism and short and posteriorly rotated jaws. The same morphological pattern was found in all the karyotypes, but the deviations were most pronounced in monosomy X (45X) patients. The results indicate that a deviating pattern of craniofacial size and morphology has already been established in childhood. It is suggested that the deviations originate in the fetal period, when the primary cartilages form the craniofacial skeleton.

Occlusal morphology in Turner syndrome.

The prevalence of malocclusion in 32 Turner syndrome patients, age 7-16.7 years, was investigated. The sample was subdivided according to karyotype, and 72 normal girls, aged 7.1-16.1 years, served as controls. Compared with normal girls overjet did not differ significantly while overbite was significantly reduced in 45X patients. The prevalence of distal molar occlusion, anterior and lateral open bite and lateral crossbite was significantly increased. Most significant differences were found between 45X patients and controls. Mosaic and isochromosome for the long arm of X karyotypes showed the same pattern of malocclusion, but with greater variation. No significant differences were found comparing 45X patients with mosaic and isochromosome for the long arm of X karyotypes. The results indicate that patients with structural and/or numerical aberration of the X chromosome, develop a specific pattern of malocclusion with deviations in sagittal, vertical and transversal directions.

Root length, crown height, and root morphology in Turner syndrome.

Root length, crown height, and root morphology were studied on intraoral and panoramic radiographs in 33 Turner syndrome patients aged 7.0-16.7 years, subdivided on the basis of karyotype. Thirty-three normal girls aged 10.2-16.4 years served as controls. In the 45X patients and, with the exception of a few teeth, also in the isochromosome and mosaic karyotypes, root length and crown height of incisors, canines, and premolars were significantly reduced. Some teeth showed altered crown-root proportions. Maxillary first premolars showed a significantly increased number of two-rooted and three-rooted variants. Mandibular premolars and molars had a complex root morphology, and a classification system was established including four premolar and six molar root types. Premolars had a significantly increased number of root components. Some of the variants, such as a molar-like second premolar, are apparently specific for these patients. On several first molars a radix entomolaris was identified. Two separate mesial and one or two separate distal roots were also frequently seen. Our investigation demonstrates that X-chromosome deficiency influences root formation.

Tooth crown size and morphology in Turner syndrome.

The aims of this investigation were to analyze permanent tooth crown size and morphology and to perform symmetry analysis between corresponding teeth on the right and the left side. The material comprised 32 Turner syndrome patients aged 7-16.7 years. As controls served 33 normal girls 10.2-16.7 years old. The mesiodistal diameter was significantly reduced for every tooth measured except for the maxillary canine. The buccolingual dimension was reduced only for some teeth. Eleven morphologic traits were defined. Ten of these were identified in the Turner patients; seven occurred in the controls as well, but at a lower frequency. Some of the traits have not been described earlier for this group of patients. There was a significant difference between Turner and control patients both in the number of patients with bilateral tooth asymmetries and in the number of corresponding tooth pairs in the maxilla with bilateral asymmetry. No significant differences were found between the 45X patients and the other karyotypes. Maxillary central incisors showed a surprisingly high relative frequency (38.5%) of bilateral asymmetry.

Skeletal maturity, dental maturity, and eruption in young patients with Turner syndrome.

A major problem for patients with Turner syndrome is their small body height. The rapid biotechnologic development has now made treatment with growth hormone possible at a larger scale. The aim of this investigation was to evaluate skeletal maturity, dental maturity, and eruption in a group of young patients before hormone therapy. The material comprised 33 patients aged 7-16.7 years. The skeletal maturity, as judged from hand radiographs, was on an average 2.3 years retarded (p < 0.001) and showed increasing retardation with increasing age. The dental maturity, assessed from the formation stages of the permanent teeth on panoramic radiographs, was accelerated, with a mean value of 1 year (p < 0.001). The timing of clinical eruption did not differ significantly from that of our reference material; the Turner girls were on an average 3.7 months ahead. Several patients had local eruption problems, especially in the maxillary lateral segments. It is suggested that disharmony between tooth size and arch size may contribute to this problem.