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1/30. Molarization of the lower second premolars.

    This paper presents a case of extreme tooth variation. The patient was first observed during the mixed dentition period, when she presented a mild Class II malocclusion with increased overjet and acceptable overbite. In a panoramic radiograph, the presence of lower second premolars of disproportionate dimensions was discovered. When these oversized premolars erupted, the Class I malocclusion tended toward Class III, with an edge-to-edge bite. This created an unstable occlusion and the possible need for extractions.
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2/30. Nonsurgical and nonextraction treatment of skeletal Class III open bite: its long-term stability.

    Two female patients, aged 14 years 5 months and 17 years 3 months with skeletal Class III open bite and temporomandibular dysfunction are presented. They had previously been classified as orthognathic surgical cases, involving first premolar removal. The primary treatment objective was to eliminate those skeletal and neuromuscular factors that were dominant in establishing their malocclusions. These included abnormal behavior of the tongue with short labial and lingual frenula, bilateral imbalance of chewing muscles, a partially blocked nasopharyngeal airway causing extrusion of the molars, with rotation of the mandible and narrowing of the maxillary arch. Resultant occlusal interference caused the mandible to shift to one side, which in turn produced the abnormal occlusal plane and curve of Spee. As a result, the form and function of the joints were adversely affected by the structural and functional asymmetry. These cases were treated by expanding the maxillary arch, which brought the maxilla downward and forward. The mandible moved downward and backward, with a slight increase in anterior facial height. Intruding and uprighting the posterior teeth, combined with a maxillary protraction, reconstructed the occlusal plane. A favorable perioral environment was created with widened tongue space in order to produce an adequate airway. myofunctional therapy after lingual and labial frenectomy was assisted by vigorous gum chewing during and after treatment, together with a tooth positioner. Normal nasal breathing was achieved.
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3/30. Restoring esthetics and anterior guidance in worn anterior teeth. A conservative multidisciplinary approach.

    BACKGROUND: Developments in adhesive dentistry have given the dental profession new restorative materials and technology to restore esthetics and function to the worn anterior dentition. This article illustrates, through a clinical case study, the clinical requirements for restoring esthetic harmony and functional stability to the worn anterior dentition. CASE DESCRIPTION: The author presents the case of a 24-year-old man who sought esthetic dental treatment because he was unhappy with the appearance of his maxillary anterior teeth. The review of his dental history revealed that he ground his teeth at night. The author performed a complete evaluation of the causes of the patient's bruxism and created a diagnostic preview to, among other things, develop the relationship between the condylar and anterior guidance and to establish the esthetic requirements for the final restorations. Treatment included periodontal recontouring, tooth preparation and placement of temporary and then permanent restorations; the patient also was given an occlusal guard to protect the restorations against future bruxing. CLINICAL IMPLICATIONS: Whatever the cause of occlusal instability, it is important that the restorative dentist be able to recognize its signs--such as tooth hypermobility, tooth wear, periodontal breakdown, occlusal dimpling, stress fractures, exostosis, muscle enlargement and loss of posterior disclusion. When restoring the worn dentition, the clinician should bear in mind the five P's: proper planning prevents poor performance.
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4/30. Intrusion of overerupted molars by corticotomy and magnets.

    Although posterior tooth intrusion in an adult patient is a difficult procedure, it can be achieved without extruding the adjacent teeth by performing a corticotomy and using magnets. In carrying out this procedure on 2 adult patients whose molars had overerupted due to the early loss of antagonists, tooth movement was rapidly achieved without discomfort or side effects.
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5/30. A question of space: options for the restorative management of worn teeth.

    The prevalence of tooth surface loss has increased in recent years. The essence of management is an effective preventive regime; however, in many instances restoration may also be necessary. A number of strategies is available for creating sufficient space to enable restoration and several techniques for restoration known. This article reviews the significance of the vertical dimension of occlusion and describes the restorative management of a patient affected by severe tooth wear.
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6/30. Locating the centric relation prematurity with a computerized occlusal analysis system.

    Locating the first tooth contact that interferes with freedom of movement in and out of centric relation has been the diagnostic and treatment objective of most occlusal therapies. The centric relation prematurity can be located by various methods, which involve operator-guided mandibular positioning combined with the patient's subjective assessment of his or her perceived first tooth contact. The method known as bimanual manipulation has been widely recognized and accepted as a predictable method of determining and verifying the centric relation position. The first occlusal contact that results when the mandible is closed on a correct centric relation axis is known as the centric relation prematurity. An alternative procedure combines bimanual manipulation with the simultaneous recording of the sequence of resultant tooth contacts using a computerized occlusal analysis system. This alternative offers a significant improvement in the precision of locating the first tooth contact. This article describes a method of identifying the first tooth contact while not relying on the patient's subjective assessment of his or her perceived occlusal feel.
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7/30. replantation of an avulsed incisor after prolonged dry storage: a case report.

    Management of tooth avulsion in the permanent dentition often presents a challenge. Definitive treatment planning and consultation with specialists is seldom possible at the time of emergency treatment. replantation of the avulsed tooth can restore esthetic appearance and occlusal function shortly after the injury. This article describes the management of a child with an avulsed maxillary permanent incisor that had been air-dried for about 18 hours. The replanted incisor retained its esthetic appearance and functionality 2 years after replantation, yet the long-term prognosis is not good because of progressive replacement root resorption.
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8/30. Restorative management of the worn dentition: 2. Localized anterior toothwear.

    This is the second paper in a four-part series detailing the relative merits of the treatment strategies, clinical techniques and dental materials for the restoration of health, function and aesthetics for the dentition. In this paper the management of wear in the anterior dentition is discussed, using three case studies as illustration.
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9/30. Infraclusion of primary molars: a review and report of a case.

    The term infraclusion is usually used to define mandibular primary teeth in posterior region that remain below the occlusion level. The degree of infraclusion depends on some factors like deviation below the occlusal plane, and infraclusion of tooth in the alveolar bone. Deficient eruptive force, disturbed metabolism of the periodontal ligament, trauma, local inflammation, deficient local vertical bone growth, disturbance in interaction between normal resorption and hard tissue repair, ankylosis and hereditary components have been given as etiological factors. Complications of infraclused primary molars are tipping of the neighboring teeth, space loss, supraeruption of the antagonists, and dislocations of permanent teeth lying under the primary tooth. In this case report, after reviewing the literature a patient with infraclused mandibular primary second molar has been examined to observe the complications of infraclusion. With an appropriate treatment approach, a proper condition was prepared for the eruption of permanent teeth.
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10/30. Talon cusp causing occlusal trauma and acute apical periodontitis: report of a case.

    - The talon cusp, or dens evaginatus of anterior teeth, is a relatively rare dental developmental anomaly characterized by the presence of an accessory cusp-like structure projecting from the cingulum area or cemento-enamel junction. This occurs in either maxillary or mandibular anterior teeth in both the primary and permanent dentition. One of the main problems caused by accessory cusps are occlusal interferences. The anomalous cusp even can generate occlusal trauma and reversible acute apical periodontitis of the opposing tooth. This article reports a case of talon cusp affecting the permanent maxillary left lateral incisor that caused clinical problems related to occlusal trauma and apical periodontitis caused by a premature contact. The treatment of the occlusal interference produced by the taloned tooth is described.
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