Interdisciplinary orthodontics-implants management of a challenging hypodontia case complicated by a class II division 2, bimaxillary retroclination.

INTRODUCTION: The case in this study had moderate hypodontia, with both lower lateral incisors and the lower-left second premolar missing. A Class II division 2 relationship with severe crowding in the upper arch and a traumatic deep bite over a skeletal I base complicated the occlusion. MATERIALS AND METHODS: The plan was to extract the upper first premolars to relieve upper arch crowding and the lower-left impacted second premolar to preserve the bilateral class I molar relationship. A class I occlusal relationship was achieved through space opening in the lower lateral incisors region and space closure in the upper and lower premolars regions. RESULTS: The use of orthodontic screws for bite opening and anterior segment retraction, in conjunction with bi-metric slot size selection in bracket prescription, was effective in controlling incisor inclination and interincisal angle. The use of an implant fixture before beginning the finishing stage allowed for a reduction in total treatment time and facilitated the provision of the final prosthesis before debonding the case. As a result, the patient was able to receive a satisfactory occlusion on the day of debonding. CONCLUSION: This case of moderate hypodontia was successfully resolved by combining space closure and space opening effectively. To solve the arch problems in such Class II division 2 cases with severe crowding, extractions were required. To complete the case, this was combined with intrusive and retractive mechanics. In hypodontia cases, implants are an excellent choice for both aesthetics and functional restoration.

MH-SETUP, combining Kesling wax-setup with indirect bonding and custom-made brackets for labial/lingual techniques to eliminate the finishing phase.

OBJECTIVE: A novel technique, named the MH setup (MH is an abbreviation for the author's name), was developed to provide an accurate yet simplified method to produce custom-made brackets without bonding errors. This setup aimed to simplify the treatment and eliminate the finishing phase, so that the orthodontist was able to provide better care with less time and lower costs. MATERIALS AND METHODS: The setup was performed in two major steps: direct bonding on the cast followed by cutting and setting the teeth into precise positions using brackets. The first set of brackets, bonded directly onto casts, oriented the teeth by setting them ideally into wax rims with full control over first-, second-, and third-order bends. The fully engaged archwire used allowed for precise control over the arch symmetry and form. Setting teeth in wax allowed the clinician to refine the occlusion and correct any minor errors that arose during the initial bonding. The second set of brackets, mounted on the fully engaged archwire, featured custom-made composite bases. The transfer tray combined the benefits of its soft inner and hard outer layers, providing control over bonding and later ease of peeling from the brackets. RESULTS: The patient was satisfied with a full bonding procedure lasting 15 min that remained simple without unnecessary stress. The clinician was confident that the procedure allowed the precise positioning of brackets and simple bonding for all teeth in the arch, combined with the elimination of the finishing phase. CONCLUSION: The MH technique offered a simple, precise, and inexpensive improvement to the Kesling wax setup. The process allowed for precise bonding without errors or expensive armamentarium. The brackets were transformed into custom-made prescriptions and could be used with labial or lingual techniques. The method allowed for teeth addition, trimming, or overcorrection according to the clinician's preferences. The MH setup facilitated visualization of the treatment objectives with precise locations and the opportunity to revise the treatment plan or to discuss further options with the patient.

MH cortical screws, a revolutionary orthodontic TADs design.

OBJECTIVE: MH cortical screws were designed to combine the advantages of thick mini-implants with the versatility of micro-screws while avoiding the disadvantages of both. MATERIALS AND METHODS: An MH cortical screw (MH is an abbreviation for the author's name) was made from titanium material. The screw has a 3 mm-long amphora-shaped shank of 2 mm thickness at its thinnest and 3 mm at its thickest part. Uniform 4 mm diameter threads blend into a 1 mm cutting tip. An external hexagonal head with side retentive ligature holes and a central hole for attachments was fabricated on a saucer-shaped gingival collar. Multiple attachments have been prepared for amending to the central hole. RESULTS: The shank design allowed cortical plate retention. The uniform threads and the amphora design provided maximum primary and secondary stability, respectively. The self-drilling tip allowed for a flapless technique, while the hexagonal head with side holes facilitated screwdriver control and allows for ligature wire anchorage. Cleats and buttons facilitated the use of elastics and springs, together with bracket-heads and eyelets for titanium molybdenum alloy and nickel-titanium wires inclusion. Adjustable hooks and chains provided versatility of line of action. Cover screws to retain extra-tissue mini-plates applied skeletal anchorage and long-term retention with flapless manipulations. CONCLUSION: MH cortical screws are a novel and important introduction to orthodontic anchorage. They combine primary and secondary stability with avoidance of root damage together with insertions into attached gingiva only. Multiple and versatile attachments allow for the application of biomechanical techniques according to the clinician's preferences. Extra-tissue mini-plates facilitate maximum anchorage for skeletal control and long-term retention without surgery.

Factors That Guide the Diagnosis and Treatment Planning for Impacted Canines Using Three-Dimensional Cone-Beam Computed Tomography: A Cross-Sectional Study.

Objective: Impacted canines are one of the significant challenges in orthodontics that should be appropriately assessed to provide the best treatment to the patients. Materials and Methods: In the present study, 57800 patients were examined over six years to investigate the prevalence, diagnostic procedures, and treatment methodologies for impacted canine cases. Prevalence and diagnosis were tested using history taking, clinical examination, and three-dimensional cone-beam radiographs. The cases were tested for impaction site, gender, age, signs, and symptoms. The groups were classified for impaction location according to Mupparapu's classification. Result: The causative factors and the treatment methodology selected were plotted according to age and gender distribution. The total prevalence was 3.9% of canine impaction cases in relation to the total sample cases. The results showed a strong correlation between the site of impaction toward the upper arch and with distribution following Mupparapu's classification. The pain was the most detectable complication in all age groups, while root resorption was the least. Conclusion: Most of the younger age groups were sent for exposure and orthodontic traction, while the mid-aged groups elected for observation, and follow-up as their primary concern was esthetics. However, the adult patients were into exposure and traction to improve their function.

The MH-WIRE, a novel coil-springe wire system: A prototype design.

OBJACTIVE: The authors introduced a novel wire system aiming to achieve optimal goals of tooth movement without multiple wire changes or sophisticated wire bending. MATERIALS AND METHODS: The system was composed of a single wire for all phases of treatment. The archwire was composed of NiTi coil springs connecting delta-shaped segments of 0.018˝ × 0.025˝ Titanium Molybdenum Alloy (TMA) segments to fit the 0.018˝ × 0.025˝ bracket slot, or 0.022˝ × 0.028˝ TMA segments to fit the 0.022˝ × 0.028˝ bracket slot. The coil spring was closed and packed in design. The coil-spring loops were constructed with 3 mm lumen. The wires were designed in three sagittal forms and the system provided nine forms of archwires. RESULTS: The wire systems have been an important component of treatment since the development of orthodontic science. Over time, the philosophy has evolved from endorsing wire bending to straight-wire treatment and then to custom-made archwires. CONCLUSION: This wire system was designed to be used as a "single-wire for the case" across all stages of treatment to achieve the ideal goals without any biological damage.