A central giant cell granuloma in a patient seeking orthodontic treatment.

BACKGROUND: This case report illustrates the need to consider central giant cell granuloma, or CGCG, in the differential diagnosis in cases of greatly displaced teeth and facial deformity. The authors review the literature regarding CGCG and emphasize the importance of early diagnosis and treatment. CASE DESCRIPTION: A 9-year-old boy was seen in an orthodontic office with the chief complaint of overlapping front teeth. On radiographic examination, the authors noted a large maxillary midline radiolucency. The child was referred to an oral and maxillofacial surgeon for definitive diagnosis and treatment. CLINICAL IMPLICATIONS: Patients may come to dental offices for treatment of malaligned teeth. The dentist needs to be aware of possible oral pathology when malaligned teeth are present. CGCG should be included in the differential diagnosis for patients with greatly displaced teeth and facial deformity.

A bonded functional ramp to aid in asymmetric expansion of unilateral posterior crossbites.

Unilateral posterior crossbite is a common finding in patients seeking orthodontic treatment. When treating this condition with a rapid maxillary expander, clinicians occasionally observe no resolution of the crossbite and document an unnecessary overexpansion of the contralateral dentition. This article describes a method for treating unilateral posterior crossbite and, specifically, the lack of crossbite correction after expansion with a rapid maxillary expander. A composite ramp is bonded to the mesial buccal cusp of the maxillary first molar in crossbite. The necessary materials and instruments are typically found in an orthodontic office. This adjunctive procedure requires no more than 5 extra minutes during an examination, and no additional appointments are necessary.

Condylar positional changes after mandibular advancement surgery with rigid internal fixation.

The purpose of this retrospective investigation was to describe condylar positional changes in patients after mandibular advancement surgery. By superimposing on clearly identifiable cephalometric landmarks (ie, mandibular symphysis and rigid fixation screws), condylar positional changes from immediately after surgery to orthodontic appliance removal were extrapolated. Although the mandibular symphysis generally moved in either an anterior or posterior direction after surgery, condylar movements were exclusively in an upward vertical direction. Correlations were found between several measured variables, including a tendency for increased superior postsurgical movement of the condyles with increasing magnitudes of surgical advancement of the mandible. This long-term instability of skeletal relationships may be caused by a wide variety of interacting factors and events.

Prevalence of orthodontic asymmetries.

Epidemiological studies of the occlusal status of the US population do not include the prevalence of orthodontic asymmetries. To estimate the magnitude of dental and facial asymmetries in adolescents with no history of orthodontic treatment, data were analyzed from two mass orthodontic screenings that had been conducted on public schoolchildren in Florida. An analysis of orthodontic records of patients in treatment at the Virginia Commonwealth University graduate orthodontic clinic provided prevalence data on dental and facial asymmetries in a population of orthodontic patients. In the Florida studies, the two screenings yielded 5,817 untreated children (mean age, 9.3 +/- 0.8 years) and 861 untreated children (mean age, 14.4 +/- 0.5 years). Sagittal molar asymmetry was found in 30% of the children in the first screening and in 23% in the second screening. Additional asymmetry assessments in the second screening showed 12% facial asymmetry and 21% noncoincidence of dental midlines. Among orthodontic patients, the most common asymmetry trait was mandibular midline deviation from the facial midline. This occurred in 62% of patients, followed, in descending order of frequency, by lack of dental midline coincidence (46%), maxillary midline deviation from the facial midline (39%), molar classification asymmetry (22%), maxillary occlusal asymmetry (20%), mandibular occlusal asymmetry (18%), facial asymmetry (6%), chin deviation (4%), and nose deviation (3%).

Orthodontic treatment priority: a comparison of two indices.

Approval for state sponsored funding of orthodontic treatment is often decided using an index of malocclusion. The purpose of this study was to determine whether two indices used for prioritizing patients would identify different groups of individuals qualifying for orthodontic treatment funding approval. In addition, the characteristics of patients approved using different indices were compared. The records of 40 patients previously submitted for state medicaid funding approval were evaluated by three study examiners using two orthodontic treatment priority indices, the Salzmann Handicapping Malocclusion Assessment (Salzmann) and the Index of Orthodontic Treatment Need (IOTN). Comparisons were made between state medicaid and study examiner Salzmann scores, rankings, and funding decisions, and between study examiner Salzmann rankings, IOTN rankings, and funding decisions. Correlation and rank correlation coefficients between the state and study examiners' Salzman scores were high (r = 0.74; p < 0.001, and R = 0.77; p < 0.001). Rank correlation analysis of the study examiners' Salzmann and IOTN values demonstrated a weaker relationship (R = 0.40; p < 0.02). Agreement on funding decisions, evaluated by the Kappa statistic, was greater between the two Salzmann evaluations (K = 0.57) than between the study examiners' Salzmann and IOTN evaluations (K = 0.14). As expected, depending on the method used to determine orthodontic treatment funding priority, different patients were likely to be identified for treatment approval. The characteristics of patients whose treatment was approved was closely related to the criteria defined by the method employed.

Occlusal traits and perception of orthodontic need in eighth grade students.

In 1994, 1155 eight-grade students in Alachua County, Fla., were asked about self-perception of and level of concern for their occlusal status. Clinical assessments of orthodontic parameters were also recorded. Twenty-five percent of the students had a history of orthodontic treatment. Of the remaining students who had no history of orthodontic treatment, 74% reported satisfaction with the way their teeth looked, 64% expressed no perceived need for braces, and 57% were judged clinically to have optional or no orthodontic needs. Sex, soft tissue profile, overjet, anterior crowding, and molar classification were significantly associated with the perception of need for braces while race and overbite were not. Clinical judgment of orthodontic need differed significantly among levels of satisfaction with teeth. Eighth graders with no history of orthodontic treatment were generally satisfied with the appearance of their teeth and perceived less need for braces than clinicians.

Pilot study comparing parents' and third-grade schoolchildren's attitudes toward braces and perceived need for braces.

An instrument developed for third-grade schoolchildren and their parents was pilot-tested for its ability to measure orthodontic attitudes and perception of the child's need for braces. Seventy-eight children and 54 parents were surveyed. Forty-six percent of the children wanted braces while 61% believed that they needed braces. Correlation between desire for braces and perceived need was 0.47, suggesting that desire and perceived need were only moderately correlated in children. Sixty-three percent of the parents believed that their child needed braces. Despite such proportions of children and parents perceiving a need for treatment, three-fourths of the children and two-thirds of the parents were satisfied with the appearance of the child's teeth. Attitude subscales, derived from the attitude survey, and clinical orthodontic parameters were used to model children's and parents' perceived need for braces in the child. No clinical parameter was a significant correlate in either children's or parents' model of perceived need. Neither race nor gender contributed significantly to either model. The subscales Concern for Appearance and Social Aspects of Braces were the strongest covariates of children's perceived need for braces. Concern for Appearance was the most important correlate in the parents' model. These data suggest that parents' perceived need for orthodontic treatment for their third-grade children is determined primarily by a concern for appearance rather than clinical status. In third-graders, perceived aesthetics and social aspects apparently have more influence than clinical status in creating a perception of need for braces.

Effect of bone grafts on stability of maxillary expansion in cleft palate patients: review of the literature.

Bone grafting of maxillary cleft patients is a procedure that is very commonly done after expansion of the maxilla. Some practitioners assume that after expansion, grafting of the cleft area with bone will maintain arch form and allow long-term retention of the maxillary expansion. Other practitioners believe that physical retention, either short or long-term, is necessary to maintain the maxillary expansion. Still others believe that no matter what procedures are done and what type of retention is used, maxillary expansion of cleft sites is doomed for relapse. A thorough and critical review of the literature reveals the inadequacy of past studies with the resulting conclusion that a well-controlled study is necessary to ask this important clinical question.

Effect of a resorbable bone graft material on orthodontic tooth movement through surgical defects in the cat mandible.

beta-Tricalcium phosphate ceramic, a resorbable synthetic bone material, was implanted into surgically created alveolar defects mesial to the mandibular first premolars of 12 adult male cats. Similar defects on the contralateral side were allowed to heal naturally. Six weeks later, nickel-titanium coiled springs were ligated between the mandibular canine and first premolar on both sides and activated to deliver 100 g of force. The distance between the canine and first premolar was measured with dial calipers at 0, 3, 6, and 9 weeks after appliance placement. Regression analysis of amount of tooth movement between the two teeth showed no significant difference between grafted and control sides. This suggests that placement of a resorbable synthetic bone material may have useful applications in situations where loss of alveolar width following extractions may compromise orthodontic tooth movement.

Effect of disinfectant solutions on the wettability of elastomeric impression materials.

The wettability of impression material affects the number or volume of air bubbles generated during the pouring of gypsum casts. This study was done to determine the effect of various commercial disinfectant solutions on the wettability of elastomeric impression materials. The technique of measuring advancing contact angles of aqueous solutions of calcium sulfate was used to determine changes in the wettability of four types of impression material before and after immersion in one of five disinfectants. All disinfectant solutions that were tested increased the wettability of polysulfide. Chlorine dioxide produced the greatest increase in the wettability of polysulfide by decreasing the contact angle on polysulfide at least 48 degrees. All disinfectants decreased the wettability of hydrophilic addition silicone by increasing the contact angle up to approximately 30 degrees. The differences were significant as determined by paired Student t-tests. Addition silicone was the material most resistant to change in contact angle. Chlorine dioxide had the greatest beneficial effect on wettability.