The long-term fate of persisting deciduous molars and canines in 42 patients with severe hypodontia: a 12-year follow-up.

OBJECTIVES: The decision to preserve or to extract a deciduous tooth without a successor hinges upon whether it can be expected to be stable over time. This study aimed to record the number and location of deciduous teeth and to examine the condition of deciduous canines and molars in a group of patients with severe hypodontia, both at baseline and at follow-up. MATERIAL AND METHODS: A total of 50 patients participated in a follow-up study. The average age was 13.9 years (range 7-25 years) at baseline and 25.6 years (range 18-38 years) at follow-up. Of the 50 subjects, 44 had at least one persisting deciduous tooth at follow-up and 42 had at least one deciduous canine or molar at baseline. The presence of persisting deciduous teeth was identified on panoramic radiographs. Deciduous canines and second molars were classified as good or poor based on infraocclusion, root resorption, and restorations. RESULTS: The mean number of persisting deciduous teeth per patient was 6.3 (range 1-16) at baseline and 2.6 (range 0-9) at follow-up. The tooth types with the highest tendency to remain were canines and second molars, and in particular canines in the mandible. Among the 42 participants with a deciduous canine or molar, 183 teeth were present at baseline, of which 112 were classified as good. At follow-up, 86 (77 per cent) of these were still present, with 65 (58 per cent) classified as good. The number of teeth classified as poor due to infraocclusion decreased much more from baseline to follow-up than those classified as poor due to root resorptions and restorations, indicating that infraoccluded teeth were lost during the observation period. CONCLUSIONS: Preserving deciduous canines and molars in good condition is often a dependable choice. Early infraocclusion is detrimental to the prognosis and often leads to tooth loss. Teeth with short roots proved to be more stable over time.

Comparison of Activator-Headgear and Twin Block Treatment Approaches in Class II Division 1 Malocclusion.

The purpose was to compare the treatment effects of functional appliances activator-headgear (AH) and Twin Block (TB) on skeletal, dental, and soft-tissue structures in class II division 1 malocclusion with normal growth changes in untreated subjects. The sample included 50 subjects (56% females) aged 8-13 years with class II division 1 malocclusion treated with either AH (n = 25) or TB (n = 25) appliances. Pre- and posttreatment lateral cephalograms were evaluated and compared to 50 untreated class II division 1 cases matched by age, gender, ANB angle, and skeletal maturity. A paired sample, independent samples tests and discriminant analysis were performed for intra- and intergroup analysis. Treatment with both appliances resulted in significant reduction of skeletal and soft-tissue facial convexity, the overjet, and the prominence of the upper lip in comparison to untreated individuals (p < 0.001). Retroclination of maxillary incisors and proclination of mandibular incisors were seen, the latter being significantly more evident in the TB group (p < 0.05). Increase of effective mandibular length was more pronounced in the TB group. In conclusion, both AH and TB appliances contributed successfully to the correction of class II division 1 malocclusion when compared to the untreated subjects with predominantly dentoalveolar changes.

Tooth replacements in young adults with severe hypodontia: Orthodontic space closure, dental implants, and tooth-supported fixed dental prostheses. A follow-up study.

INTRODUCTION: Children with severe hypodontia have a substantial impairment of their dental health starting early in life. The purpose of this study was to describe types and locations of substitutes for missing teeth in patients with severe hypodontia and to compare the crown and soft tissue morphologies of orthodontic space closure, dental implants, and tooth-supported fixed dental prostheses for replacing teeth in the anterior region. METHODS: Fifty patients missing 6 or more teeth and aged 18 years or older (mean age, 25.6 years) took part in a follow-up study. The patients were examined clinically with panoramic radiographs and clinical photographs. Crown and soft tissue variables (mucosal discoloration, crown morphology, color, and papilla index) were compared for orthodontic space closure, dental implant fixtures, and fixed dental prostheses. RESULTS: Dental implants, orthodontic space closure, and retaining deciduous teeth were the most commonly prescribed treatments. Persisting deciduous teeth showed a good survival rate at the follow-up examination. Mucosal discoloration was seen only for implant fixtures and was evident for almost all fixtures in the anterior mandible and two thirds of those in the anterior maxilla. The papilla index scored poorer for both implant fixtures and fixed dental prostheses compared with orthodontic space closure. CONCLUSIONS: Dental implants in the anterior region proved to be an inadequate treatment modality in patients with severe hypodontia because of pronounced mucosal discoloration.

Anterior tooth alignment: A comparison of orthodontic retention regimens 5 years posttreatment.

OBJECTIVE: To assess orthodontic treatment outcome at debonding and at 3 and 5 years after orthodontic treatment and to investigate the influence of different retention protocols on anterior tooth alignment. MATERIALS AND METHODS: Using the Peer Assessment Rating (PAR) Index, 169 patients (74 boys, 95 girls) were analyzed at four stages: pretreatment (T0), posttreatment (T1), 3 years posttreatment (T3), and 5 years posttreatment (T5). The PAR anterior component scores (ACSs) were compared between groups with different retention protocols. In the maxilla, protocols were removable retainer until T3 (MAX1), removable and fixed retainer until T3 (MAX2), and removable retainer until T3 and fixed retainer until T5 (MAX3). In the mandible, protocols were no retainer (MAND1), fixed 3-3 retainer until T3 (MAND2), and fixed 3-3 retainer until T5 (MAND3). RESULTS: Mean weighted improvement in PAR score was 88.3% at T1, 86.4% at T3, and 82.1% at T5. The ACS for the maxilla showed no significant differences between the retention protocols at any time point. In the mandible, the group without retention showed a gradual but not significant deterioration in ACS throughout the posttreatment period. At T5 there was a significant difference in ACS between the group that had the retainer removed at T3 and the group that kept the retainer. CONCLUSION: The 5-year treatment outcome, as measured by the PAR Index, was good. Stability of the maxillary anterior alignment 5 years posttreatment did not appear to be influenced by choice of retention protocol. Mandibular anterior alignment was significantly better for the group using a fixed retainer compared with the group where the retainer was removed 3 years posttreatment.

Discriminative ability of the generic and condition specific Oral Impact on Daily Performance (OIDP) among adolescents with and without hypodontia.

BACKGROUND: The aims of this study were to (1) investigate to what extent the generic and condition specific (CS) forms of the oral impact of daily performance (OIDP) inventory discriminate between a group of patients with hypodontia and a group of patients having malocclusion, (2) assess the association of the generic and CS OIDP with severity and localisation of hypodontia, whilst adjusting for patients' age and sex. METHODS: A total of 163 patients aged 10-17 years were included in a cross-sectional study. Two groups were investigated: 62 patients with non-syndromic hypodontia and 101 non-hypodontia patients. Both groups had a malocclusion of similar treatment need. All patients underwent a clinical and radiographic examination and completed a Norwegian version of the generic and the CS OIDP inventory. CS scores were established for impacts attributed to hypodontia. RESULTS: The mean number of missing teeth in the hypodontia group was 6.2. The prevalence of generic and CS oral impacts in the hypodontia group were 64% and 30%, and the corresponding rates in the non-hypodontia group were 62% and 10%. The generic OIDP did not discriminate between the two groups with respect to overall scores. The CS OIDP discriminated strongly between patients with and without hypodontia regarding problems with emotional status, showing teeth, social contact, speaking and carrying out work. Compared to the non-hypodontia group, patients with hypodontia, with severe hypodontia (≥ 6 missing teeth) and upper anterior hypodontia were respectively 3.4, 2.5 and 7.0 times more likely to report any oral impact attributed to small teeth, gaps between teeth and missing teeth. CONCLUSIONS: Hypodontia and malocclusion patients report a considerable burden of oral impacts. The CS-OIDP measure discriminated most effectively between patients with and without hypodontia and was related to severity and upper anterior localisation of hypodontia.

The prognosis of retained primary molars without successors: infraocclusion, root resorption and restorations in 111 patients.

This study aimed to assess infraocclusion, root resorption and restorations and their importance for the prognosis of retained primary mandibular molars lacking successors. The sample comprised 188 persisting primary mandibular second molars in 111 subjects, 48 males and 63 females, with a mean age of 12.6 years. The patients had been referred to an interdisciplinary clinic because of extensive hypodontia, missing 8.4 teeth on average. All persisting primary mandibular molars were included in the study, as no decision had been made as to whether they should be kept or extracted. Panoramic radiographs were used to assess infraocclusion, resorption of the mesial and distal roots and whether restorations were present. Clinically significant infraocclusion was observed in 43.6 per cent of the patients and classified as severe in 18.8 per cent. The mesial and distal root exhibited no resorption in 18.9 and 33.3 per cent, respectively (P = 0.01). Most primary molars had no restorations (78.4 per cent). A significant correlation was found between root resorption and infraocclusion. Age was found to be weakly but significantly correlated with root resorption and infraocclusion. No significant relationship was observed between gender and either infraocclusion or root resorption. In conclusion, infraocclusion was estimated to be a more critical factor for the prognosis of retained primary molars than root resorption.

Average craniofacial development from 6 to 35 years of age in a mixed group of patients with juvenile idiopathic arthritis.

OBJECTIVE: To investigate long term the average changes in craniofacial morphology in a group of Norwegian juvenile idiopathic arthritis (JIA) patients with mixed diagnosis from 6 to 35 years of age. A matched group of healthy individuals was included as controls. MATERIAL AND METHODS: Craniofacial development in 38 females and 16 males with JIA was followed on lateral cephalograms from childhood for 23-31 years. The patients were compared with the healthy individuals at the ages of 6, 9, 12, and 35 years. RESULTS: At 6 and 9 years of age, the average craniofacial morphology in the JIA patients was similar to that of the control subjects. At 12 years of age, significant craniofacial morphological differences between the JIA and the control subjects appeared. These included a steeper mandibular plane angle and a more retrognathic position of the mandible. The length of the mandible (ar-gn), the height of the ramus (ar-tgo), and the length of the corpus (tgo-gn) were significantly smaller in the JIA patients. The average growth direction of the chin was more downward in the JIA patients. A smaller posterior facial height and a higher ratio between the anterior and posterior facial heights were also observed. The differences in craniofacial morphology between the patients and the control group were more pronounced at 35 years of age than at earlier ages. CONCLUSION: The typical craniofacial morphological pattern in JIA patients was established between 9 and 12 years of age. From the age of 12 until the age of 35, this morphological pattern remained relatively stable, in contrast to the pattern in the healthy control subjects.