Interdisciplinary orthodontic-periodontal treatment of unerupted permanent maxillary incisors following traumatic injury to deciduous teeth. Case report with long-term follow-up (11 years).

Orthodontic and periodontal treatment of the permanent maxillary teeth, which were retained due to trauma on the deciduous dentition, showed a perfect alignment of the teeth associated with healthy and stable periodontal tissues during an 11-year follow-up.

Agenesis of a maxillary lateral incisor associated with bilateral canine inclusions: A noninvasive multidisciplinary approach.

OBJECTIVE: The treatment of congenitally missing maxillary lateral incisors is often complex and requires a multidisciplinary approach, which demands continuous collaboration among the different specialists involved in the rehabilitation. In young patients, implant therapy or the preparation of intact teeth for fixed prostheses is not indicated. CLINICAL CONSIDERATIONS: Two complex cases of double maxillary canine inclusion were treated with combined surgical, orthodontic, and conservative prosthetic treatments. Orthodontic therapy allowed the creation of the necessary interocclusal space to fabricate the all-ceramic resin-bonded fixed partial dentures without the preparation of the abutment teeth. CONCLUSIONS: Carefully planned and meticulously executed orthodontic and prosthetic therapies allowed for a noninvasive rehabilitation of patients with maxillary lateral incisor agenesis. CLINICAL SIGNIFICANCE: This article provides clinicians with a noninvasive solution for agenesis of lateral incisors associated with canine inclusions. Indications for the choice of material of all-ceramic resin-bonded fixed partial dentures are discussed and presented.

Ultra-Thin Veneers Without Tooth Preparation in Extensive Oligodontia.

Dental agenesis is the most commonly encountered dental anomaly in humans. Oligodontia, however, is a rare condition that involves the congenital absence of six or more teeth, excluding the third molars. Treatment of oligodontia requires an interdisciplinary approach. The prosthetic treatment plan should carefully consider esthetic and functional rehabilitation but should take a conservative approach. Adhesive techniques, combined with the new ceramic materials, permit functional and esthetic prosthetic restorations that are more conservative in comparison to those used in the past. Ultrathin occlusal veneers without tooth preparations may represent a good esthetic and conservative approach for oral rehabilitation of patients affected by severe hypodontia.

Esthetic treatment of a diffuse amelogenesis imperfecta using pressed lithium disilicate and feldspathic ceramic restorations: 5-year follow up.

OBJECTIVE: The treatment of a diffuse and severe case of amelogenesis imperfecta represents a challenge for the dental team and in particular for the dentist who perform the prosthetic restorations. CLINICAL CONSIDERATIONS: The enamel alterations, which are characteristic of the disease, determine different problems that need to be carefully planned and solved before the beginning of the treatment, with particular regard to the materials used to perform the restorations. In order to create the best conditions to perform the prosthetic restoration, the treatment plan should be multidisciplinary. In addition, the young age of the patients usually affected by the disease imposes a very conservative and cautious approach. The main goals of the therapy are represented by the need to protect the occlusal dental surfaces from the abrasion and provide a satisfactory esthetic result. In particular, dental abrasions if not treated may determine the loss of the vertical dimension as well as a diffuse and marked dentinal hypersensitivity. CONCLUSIONS: A correct treatment plan and the use of the new adhesive ceramic materials made it possible to obtain good results both from a functional and esthetic point of view with a much more conservative approach compared with the traditional one. CLINICAL SIGNIFICANCE: This clinical report describes the prosthetic rehabilitation of an adult female patient with a diffuse amelogenesis imperfecta using feldspathic ceramics for the esthetic regions and monolithic lithium disilicate material for the posterior areas.

Two bilateral transposed and infraosseus impacted maxillary canines: a two-step combined periodontal and orthodontic approach.

An extremely rare case presenting two bilateral transposed and infraosseus impacted maxillary canines was treated with a combined two-step periodontal and orthodontic technique. The canines were transposed mesially and buccally to the lateral incisors, close to the midline and in a horizontal position. Direct orthodontically guided traction of the teeth toward the center of the alveolar ridge was not possible due to the roots of the lateral incisors. The procedure consisted of two distinct treatment phases for each side preceded by an initial orthodontic treatment to achieve the palatal inclination of the roots of the lateral incisors, creating a parallel buccal inclination of the crowns. This approach provided a submucosal buccal space into which the canines could be moved buccally and distally, avoiding any contact with the roots of the lateral incisors. In the first phase, the transposed canines were guided distally. When the canines, still in a submucosal position, were freed from those obstacles, the second phase was begun. The teeth were exposed, permitting the orthodontically guided traction toward the center of the ridge, simulating a proper physiologic eruption alignment pattern in the arch. The combined two-step periodontal and orthodontic approach used to treat two bilateral transposed and infraosseus impacted maxillary canines was extremely successful, resulting in adequate alignment in the arch associated with a physiologic sulcus depth, adequate keratinized tissue width, and absence of marginal recession at the end of the active treatment and 5 years postsurgery.

Factors affecting the clinical approach to impacted maxillary canines: A Bayesian network analysis.

INTRODUCTION: The aim of this study was to apply Bayesian networks to evaluate the relative role and possible causal relationships among various factors affecting the diagnosis and final treatment outcome of impacted maxillary canines. METHODS: A total of 168 patients with infraosseous impacted maxillary canines had a combined surgical-orthodontic approach aimed to guide the impacted tooth to the center of the alveolar ridge. Demographic, orthodontic, and periodontal variables were recorded and analyzed by means of Bayesian network analysis. RESULTS: All 168 impacted canines were successfully moved and aligned in the dental arches with healthy periodontiums. According to the Bayesian network analysis, bilateral impaction was associated with palatal impaction and longer treatment; the pretreatment alpha-angle was a determinant for the duration of orthodontic traction, also because of the associations between greater angulation of impacted canines with more severe tooth displacement and with greater distance of the impacted canine from the occlusal plane; the posttreatment periodontal outcome was not related to the pretreatment radiographic variables. CONCLUSIONS: Bayesian network analysis was useful to identify possible relationships among the variables considered for diagnosis and treatment of impacted canines.

Tunnel technique for the treatment of impacted mandibular canines.

The tunnel technique is a combined therapeutic approach that includes both surgical exposure of the impacted canine and orthodontic traction of the tooth to the center of the alveolar ridge, followed by final orthodontic alignment. A healthy periodontium at the completion of therapy is the expected outcome. The tunnel technique has been shown to be effective in the treatment of impacted maxillary canines and can be suggested for the treatment of infraosseous impacted canines in the mandible when the corresponding primary canine is still present. Through the description of clinical cases, the management of the tunnel technique is reported.

Combined surgical and orthodontic approach to reproduce the physiologic eruption pattern in impacted canines: report of 25 patients.

The purpose of this study was to evaluate the periodontal variables of impacted maxillary canines that were treated with a combined surgical and orthodontic approach aimed at reproducing the physiologic eruption pattern of canines. Twenty-five patients who presented with unilateral impacted maxillary canines were consecutively enrolled (age range, 13.2 to 23.2 years). They were treated with a surgical flap and orthodontic traction directed to the center of the crest and were evaluated periodontally at the end of treatment and again at a follow-up visit (2 to 5 years posttreatment). Pocket depth, keratinized tissue width, and gingival recession were recorded. At the end of orthodontic treatment, all 25 treated canines presented with normal pocket depth (2.0 +/- 0.3 mm) and a normal amount of keratinized tissue (5.0 +/- 1.2 mm). No sites showed gingival recession. At the follow-up visit, both pocket depths and keratinized tissues were slightly reduced. The combined technique permits traction of the impacted canines to the center of the crest, simulating the physiologic eruption pattern and resulting in correct alignment and good periodontal status.

Orthodontic and periodontal outcomes of treated impacted maxillary canines.

OBJECTIVE: To evaluate the influence of pretreatment radiographic features (alpha-angle, d-distance, and s-sector) on (1) the duration of active orthodontic traction and (2) the posttreatment periodontal status (pocket depth [PD] and keratinized tissue width [KT]) of impacted maxillary canines treated by a combined surgical (flap approach) and orthodontic (direct traction to the center of the ridge) treatment. MATERIAL AND METHODS: A study population of 168 patients (168 canines) was evaluated. Multiple regression analysis was used. RESULTS: Pretreatment radiographic variables were associated significantly with the duration of orthodontic traction. Age, sex, and site of impaction did not significantly affect the duration of traction. No significant differences in PD and KT were present at the end of surgical-orthodontic treatment with respect to any of the variables considered. The analysis of PD and KT variables after orthodontic treatment revealed a healthy periodontium. CONCLUSIONS: alpha-angle, d-distance, and s-sector are valid indicators for the duration of orthodontic traction. They are not prognostic indicators of final periodontal status of orthodontically-repositioned canines.

Pre-treatment radiographic features for the periodontal prognosis of treated impacted canines.

AIM: The aim of this study is to evaluate the prognostic role of the pre-treatment radiographic features on the post-treatment periodontal status of intra-osseous impacted maxillary canines. MATERIAL AND METHODS: A study population of 168 patients (211 canines) was evaluated at the end of the overall surgical-orthodontic treatment consisting of a combined surgical (flap) and orthodontic (direct traction to the centre of the ridge) approach. The pre-treatment variables on the panoramic radiograph were alpha-angle, d-distance and s-sector while the post-treatment periodontal variables were pocket depth (PD) and keratinized tissue width (KT). Multilevel statistical analysis was used to evaluate the role of the pre-treatment radiographic factors on the post-treatment periodontal variables at patient, tooth and site levels. RESULTS: No significant differences in PD or KT were found at the end of surgical-orthodontic treatment with respect to age, gender, site of impaction or pre-treatment radiographic position of the impacted canine. The only statistically, but not clinically, significant difference (about 0.5 mm) was found for the KT that was greater for the palatally impacted canines than for the buccally impacted ones. CONCLUSIONS: alpha-angle, d-distance and s-sector measured on the pre-treatment panoramic radiographs did not represent prognostic indicators of final periodontal status of orthodontically re-positioned canines.

Orthodontic treatment of impacted maxillary canines: an appraisal of prognostic factors.

AIM: The aim of the study was to evaluate the influence of pre-treatment radiographic features (alpha-angle, d-distance and s-sector) on the duration of active orthodontic traction of impacted maxillary canines treated by a combined surgical (flap approach) and orthodontic (direct traction to the center of the ridge) treatment. MATERIAL AND METHODS: A study population of 168 patients (168 canines) was evaluated. Multiple regression analysis was used. RESULTS: Pre-treatment radiographic variables were associated significantly with the duration of orthodontic traction. Age, gender and site of impaction did not affect the duration of traction significantly. CONCLUSIONS: Alpha-angle, d-distance and s-sector are valid indicators for the duration of orthodontic traction.

Short- and long-term periodontal evaluation of impacted canines treated with a closed surgical-orthodontic approach.

AIM: The aims were to evaluate and compare the periodontal status of unilateral impacted maxillary canines treated by a combined surgical-orthodontic technique with that of normally erupted controlateral canines. MATERIAL AND METHODS: One hundred and twenty-five patients, consecutively enrolled, aged between 12.8 and 52.0 years, 31 males and 94 females, presented one impacted maxillary canine (test group) and the controlateral canine normally erupted (control group). All cases were treated by a surgical flap and orthodontic traction directed to the centre of the crest and evaluated periodontally at the end of treatment. Fifty-eight patients were followed up for a mean of 3.4 +/- 0.5 years. Pocket depth (PD), keratinized tissue width (KT) and gingival recession were recorded. Multilevel models were created. RESULTS: At the end of the orthodontic treatment, PD and KT of the 125 impacted canines were slightly, but statistically significantly higher than controls. Only one treated canine showed a recession (1 mm). At follow-up (58 patients), this difference decreased and the two groups were not significantly different. CONCLUSIONS: The combined technique permitted the traction of the impacted canines to the centre of the crest, thus simulating a physiological eruption pattern. Correct alignment and good periodontal status were obtained.