The not-so-harmless maxillary primary first molar extraction.

BACKGROUND: Premature loss of primary molars has been associated with space loss and eruptive difficulties, especially when the loss occurs to the primary second molars and when it occurs early. This has not been thought to be the case for primary first molars. METHODS: The author revisited 13 cases from an earlier study on the effects of premature loss of maxillary primary molars. These longitudinal cases were scrutinized, using serial panoramic radiographs, to explain the irregular response in terms of dental migration. The author presents two case reports. RESULTS: In the earlier study, the author used digitized study casts and the concept of D + E space--the space occupied by the primary first and second molars--to describe the dental migration that occurred after premature tooth loss. Using analysis of variance on data generated using an instrument capable of measuring in tenths of millimeters, the author produced findings regarding the amount of space loss, rate of space loss, effect of age at loss, amount of space regained at the time of replacement by the permanent tooth and effect on Angle's classification. Finally, the author created a simulation describing directional change; this revealed that the maxillary primary first molar loss resulted in a mesial displacement of the permanent canine during eruption. CONCLUSIONS: When the maxillary primary first molar is lost prematurely, the first premolar erupts in a more mesial direction than normal, as a result of the mesial incline of the primary second molar, and consumes the space of the permanent canine, which becomes blocked out. CLINICAL IMPLICATIONS: Rather than use a space maintainer after the premature loss of the maxillary primary first molar, the author suggests, clinicians can choose from a number of other options for preventing the first premolar from erupting too far in a mesial direction.

Surgically assisted rapid maxillary expansion: a comparison of technique, response, and stability.

The purpose of this study was to evaluate the differences in treatment effects between adult patients who underwent surgically assisted rapid maxillary expansion employing buccal corticotomies and those who had midpalatal splits as well. Responses and sequelae of these treated patients were compared with adults who were expanded orthopedically and adults who were treated orthodontically without expansion. The sample comprised 37 patients who were expanded and 5 controls. Dental study casts were taken prior to treatment, at debanding, and at the posttreatment follow-up. The results indicated that maxillary expansion in adults was predictable and stable, corrected crossbites remained corrected, palatal depth was reduced in SARME, palatal width increased (more dramatically in patients treated with a combined procedure), and tipping was controlled and stable. The long-term buccogingival condition was more acceptable in adults expanded with surgical augmentation than in those expanded orthopedically.

Effects of premature loss of deciduous molars.

A statistical exploration of space changes following early loss of deciduous molars, developing a picture of closure from both directions with district differences between upper and lower arch changes.

D E space--a realistic measure of changes in arch morphology: space loss due to unattended caries.

By using only a portion of the dental arch, rather than some geometric construction that conforms to the dental arch, more pertinent information can be gathered regarding the sequelae of some event or insult to the arch. The measurement, D E Space, has been explained and utilized to describe the effectss of unattended dental caries on arch form. Only caries which become severe have a significant effect on the dental arch--a reduction in D E Space, which can be interpreted as relative arch length (depth) and is significant only for the year after its exfoliation. This occurs one year early and is also significant.

Autogenic tooth transplantation. The "state of the art".

With proper case selection and technique, autogenic tooth transplantation can be a viable treatment modality. The authors present a number of transplant cases and suggest the procedure be considered as an adjunct in orthodontic treatment planning. A comprehensive review of the literature, combined with the authors' opinions and clinical demonstrations, has culminated in a discussion of indications and contraindications, special considerations, optimal timing, technique, and prognosis. It is thought that appropriate utilization can simplify or eliminate prosthetic requirements, reduce the complexity of many orthodontic treatment plans, and convert into routine certain cases heretofore thought to be inoperable.