Long term stability of a high-angle skeletal Class II open bite treated with high-pull headgear and modified transpalatal arch: A case report.

This case report describes the treatment of an adolescent patient with an Angle Class II malocclusion, severe open bite and overjet, proclined incisors, skeletal Class II anteroposterior dysplasia, high mandibular plane angle and convex profile. The importance of stopping of a prolonged thumb sucking habit, which was a major causative factor of the open bite is discussed. A combination of a high-pull headgear and a modified transpalatal arch with a loop embedded with resin, at a distance from the palate, were used along with an Edgewise appliance. Treatment timing, favourable growth and good patient response led to an optimal outcome with excellent stability of the treatment results five years and five months post-treatment.

Multidisciplinary management of permanent first molar extractions.

The first molar has been reported to be the most caries prone tooth in the permanent dentition. Orthodontists are treating more adult patients who are more likely to have missing and severely decayed first molars. This article will show the various orthodontic and restorative options for first molars that are already extracted or have to be extracted. The following clinical situations will be addressed: molar uprighting and its advantages for the future restoration vs orthodontic space closure, strategic extraction of salvable first molars, impacted molars, and early extraction of compromised permanent first molars in young children.

Interdisciplinary management of a patient with a bilateral cleft lip and palate and 12 congenitally missing teeth.

This article reports the interdisciplinary treatment of a girl born with a complete bilateral cleft lip and palate. She had congenitally missing maxillary lateral incisors and canines and mandibular incisors, canines, and second premolars in addition to third molars. At age 11 years 2 months, she was treated with rapid maxillary expansion followed by bonding of the maxillary arch. Cranial harvested alveolar bone graft surgery was done at age 17 years 2 months. Mandibular arch treatment was started at age 19 years using single tooth implants initially as orthodontic anchorage devices and secondarily as prosthetic abutments. Teeth were placed in strategic positions for a 4 incisor fixed partial denture cemented on the 2 lateral incisor implants and screw-retained crowns on premolar implants. The maxillary arch was restored with screw-retained crowns on canine implants with lateral incisors in cantilever and pink ceramic. Two years posttreatment records at age 22 years 6 months showed long-term stability with good occlusion, facial balance, and smile esthetics.

[Adult orthodontics for a better prosthesis]. / L'orthodontie adulte pour une meilleure prothèse.

INTRODUCTION: Adult patients are seen more frequently in our orthodontic offices. Unlike the adolescent, the adult patient will often need a multidisciplinary approach due to tooth migrations secondary to extractions or periodontal disease. MATERIALS AND METHODS: This article will address the indications and orthodontic solutions to various restorative problems relative to the adult patient. Specific orthodontic mechanics aimed at facilitating and improving the prosthetic outcomes will be described and illustrated with clinical cases.

Nonextraction treatment of a skeletal Class III adolescent girl with expansion and facemask: long-term stability.

This article describes the combined use of maxillary expansion and a protraction facemask in the correction of a skeletal Class III malocclusion after the patient's pubertal growth spurt. Treatment efficacy and the effects on facial and smile esthetics are presented. The nonextraction option with an arch-size increase and stability issues is discussed.

Treatment of a severe arch-length deficiency with anteroposterior and transverse expansion: long-term stability.

This article describes the nonextraction treatment of a girl in the late mixed dentition with a severe arch-length deficiency. Rapid maxillary expansion and molar distalization were combined with a lip bumper in the mandible, followed by fixed appliances. Although the literature has reported a high rate of relapse with this method of treatment, excellent stability was achieved at 5 years 3 months posttreatment. The merits of extraction vs nonextraction treatment and stability are discussed.

[Agenesis of the maxillary lateral incisors: orthodontic and implant approach]. / Agénésie des incisives latérales maxillaires: approche orthodontique et implantaire.

Missing maxillary lateral incisors create a major esthetic problem due to their strategic position in the smile. The two treatment approaches commonly taken are creating adequate space to prosthetically replace the missing lateral incisors or closing the spaces and replacing the missing lateral incisors by the canines. This article will discuss indications, advantages, disadvantages and problems encountered in cases of space opening and space closure for missing laterals. The amount of space to be created, the preparation and the timing for implant placement, the bone volume, the implant size and prosthetic considerations will also be discussed. The methods for reshaping canines and building them up to simulate lateral incisors in orthodontic space closure, and positioning the canines and first premolars - so that they resemble to the teeth they are replacing - will be described.

Management of over-retained mandibular deciduous second molars with and without permanent successors.

The objective of this article is to describe the various clinical situations of prolonged retention of mandibular deciduous second molars. Indications for orthodontic space closure in the absence of permanent successors and treatment alternatives in space opening, including retaining the deciduous molars, are described. Periodic monitoring, composite buildups, and indications and timing of extraction of infraoccluded and ankylosed deciduous molars with and without permanent successors are reviewed.

Tooth transposition: a review and clinical considerations for treatment.

This article reviews the literature on tooth transposition. Several cases with various types and combinations of tooth transposition are presented and treatment management and options are discussed. Indications, advantages, and disadvantages of correcting versus maintaining tooth order are shown.

Treatment of a unilateral Class II crossbite malocclusion with traumatic loss of a maxillary central incisor and a lateral incisor.

This case report describes the multidisciplinary management of an adolescent girl with traumatic loss of the maxillary right central lateral incisors, and a unilateral Class II crossbite malocclusion. A rapid palatal expansion appliance was used initially to correct the transverse deficiency and secondarily as an anchorage unit for unilateral molar distalization to correct the Class II molar relationship. Temporary incisors were extended from a Nance stabilizing appliance during premolar and canine retraction. A staged approach was used with bone grafting before the placement of 2 single-tooth implants. A favorable outcome was achieved through proper coordination among the orthodontist, the surgeon, and the restorative dentist.

Orthodontic objectives in orthognathic surgery: state of the art today.

In treating jaw discrepancies, camouflage and surgery have different treatment modalities, often involving opposite orthodontic mechanics and different extraction decisions. Pretreatment identification of surgical patients is therefore essential. Esthetics, function, stability, and treatment time have to be considered and patients provided the information they need to be part of the decision-making process. The goal of presurgical orthodontics is to position the teeth, allowing an optimal skeletal correction at surgery. While intra-arch alignment is similar to conventional orthodontics, leveling is not carried out automatically in surgical patients. In open-bite cases, steps within the arches are an indication for segmental surgery. Orthodontic leveling will be limited to the segments, and segments will be leveled with differential intrusion at surgery. In deep-bite/short-face cases, leveling a severe curve of Spee should be done after the occlusion is unlocked by surgery. Anteroposteriorly, dental compensations are removed by ideally positioning the teeth relative to their apical bases. This will make the malocclusion look worse presurgically, but it will unravel the true magnitude of the skeletal problem, thus allowing an optimal correction at surgery. It is important to recognize if a transverse problem is skeletal or dental in nature and if the correction should be done orthodontically, by segmental surgery, or by surgically assisted palatal expansion. No orthodontic expansion should be done presurgically in a patient who will have surgical expansion. Any tooth movement with relapse potential should be avoided presurgically. Postsurgical orthodontics will bring teeth into position and proper intercuspation within a reasonable time period.

Management of congenitally missing second premolars with orthodontics and single-tooth implants.

This article describes the treatment of an adolescent girl who was congenitally missing all 4 second premolars and had a retained mandibular second primary molar. Various treatment alternatives are discussed, and the final treatment plan of space opening for 3 implants and space closure of the maxillary left second premolar site is presented.

Treatment of a Class I crowded malocclusion with an ankylosed maxillary central incisor.

This article describes a Class I crowded malocclusion with an ankylosed maxillary central incisor that was in infraocclusion and labially displaced. Various treatment alternatives are discussed, and the option of extracting the ankylosed tooth followed by space closure with lateral incisor substitution is developed.