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1/76. Class II malocclusion correction: an American board of orthodontics case.

    A Class II open bite malocclusion with a narrowed maxilla, an increased lower anterior facial height, and a tooth size discrepancy are presented. The malocclusion was treated nonextraction in 2 phases. The mixed dentition phase of treatment was maxillary molar uprighting followed by a bonded rapid palatal expander. The vertical dimension was managed with a vertical pull chincup. The full appliance phase included buildups of the maxillary lateral incisors and mechanics to control lower incisor position.
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2/76. Orthodontic, genetic, and periodontal considerations in the treatment of impacted maxillary central incisors: A study of twins.

    Treatment of twins each with one impacted maxillary central incisor and a mesiodens is described. Treatment included rapid expansion, extraction of the mesiodens, surgical exposure of the impacted central incisor, and its forced eruption. The impacted incisor was brought into functional position in one patient but was lost in the other because of insufficient root length and high mobility. Orthodontic, genetic, and periodontal considerations of these 2 cases are evaluated.
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keywords = eruption
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3/76. Reconstruction of an alveolar cleft for orthodontic tooth movement.

    Bone grafting to repair an alveolar cleft has long been an integral part of the treatment of persons with unilateral and bilateral clefts of the lip and alveolus. The presence of the cleft places a limitation on the orthodontist who would like to move teeth in the area of the cleft. Various grafting materials have been placed in alveolar clefts in an attempt to solve this problem. The case to be presented is a patient with a Class II, Division 2, malocclusion with a left unilateral alveolar cleft and a repaired cleft lip. Ten months after initiating orthodontic treatment, a free gingival graft procedure was performed because of insufficient vestibular depth and the narrow width of the keratinized attached gingiva at the left maxillary lateral and central incisor region. Two months after periodontal surgery, a mix of decalcified freeze-dried bone allograft and a granular bioactive glass graft material (1:1) were applied subperiostally on the buccal aspect of the edentulous cleft region. Six months later, the teeth adjacent to the grafted alveolar cleft were orthodontically moved into the edentulous area. The treatment results indicated that orthodontic, periodontal, and surgical interventions resulted in a successful closure of the alveolar cleft as well as improved periodontal conditions of the teeth adjacent to the cleft area. From the orthodontic point of view, tooth movement can be achieved successfully into a bone graft made of freeze-dried bone and bioactive glass.
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4/76. Treatment of a Class II Division 1 malocclusion with a severe unilateral lingual crossbite with combined orthodontic/orthognathic surgery.

    A 24-year-old woman had a Class II Division 1 malocclusion with a severe unilateral crossbite. The crossbite was due partially to the maxilla being much wider than the mandible, allowing the mandibular left canine and first and second premolars to overerupt, impinging on the palatal tissue in habitual occlusion. The maxillary left segment from the lateral incisor to the first molar also overerupted producing 2 planes of occlusion. The malocclusion was treated successfully with comprehensive orthodontics, combined with a 2 piece Lefort I osteotomy procedure, a 3 tooth mandibular segmental osteotomy procedure, and a bilateral sagittal split osteotomy procedure.
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5/76. The Royal london Space Planning: an integration of space analysis and treatment planning: Part II: The effect of other treatment procedures on space.

    The Royal london Space Planning process is carried out in 2 stages. The first stage, assessing the space required to attain the treatment objectives, was described in Part I of this report, published earlier. In Part II, the process of integrating space analysis with treatment planning continues with consideration of the effects other treatment procedures have on space. These procedures include tooth enlargement or reduction, tooth extraction, the creation of space for prosthetic replacement, and mesial and distal molar movement. The effects of favorable and unfavorable growth are also considered. A brief case report is presented to demonstrate use of the Royal london Space Planning.
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6/76. Orthodontic tooth movement after extraction of previously autotransplanted maxillary canines and ridge augmentation.

    A case report is detailed in which autotransplanted maxillary canines were removed and the spaces closed. Substantial surrounding bone loss was associated with the upper right canine, and a bone graft was needed to reestablish normal dentoalveolar ridge morphology. Bone was taken from the maxillary tuberosity and placed in the canine extraction site, fixed with a bone screw, and covered with GoreTex. Seven months after placement of the bone graft, the GoreTex and stabilizing screw were removed to allow for consolidation of the bone. The upper left canine and lower second premolars were extracted, and fixed appliances were placed in both arches to align the teeth and close the spaces. Protraction of the upper right first premolar and retraction of the lateral incisor into the graft site were kept slow and constant with continued periodontal assessment. During the space closure, there was some concern that the bone in the graft site might resorb, leaving the teeth with compromised periodontal support. However, no significant periodontal attachment loss occurred despite ongoing concern about the amount of keratinized tissue. Perhaps the relatively slow rate of tooth movement provided for bone to be maintained and recreated ahead of the tooth. Almost complete closure of the upper canine extraction spaces was achieved. The upper premolars were substituted for the maxillary canines, and unfavorable prosthetic options were thus avoided. The lower arch was aligned, and the extraction spaces completely closed.
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7/76. Treatment of a Class II Division 2 malocclusion with space reopening for a single-tooth implant.

    This case report describes the treatment of an adolescent girl with a skeletal Class II Division 2 malocclusion and impinging overbite. One of 2 previously extracted premolars had to be replaced by a single-tooth implant after adequate space reopening. An optimal overbite-overjet relationship was achieved through significant intrusion and proclination of maxillary and mandibular incisors. A horizontally impacted mandibular second molar was repositioned to ensure a 2-molar arch integrity. Resolution of the gingival smile line and favorable facial changes were also obtained.
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8/76. Spontaneous improvement in position of canines from apparently hopeless positions.

    Two cases are presented, each with both unerupted maxillary canines so badly positioned that eruption seemed unlikely. However, over a period of approximately three years, three out of the four initially displaced canines did erupt; the improvements in position being unrelated to whether or not the associated primary canine was extracted. Three out of four primary canines were removed. These cases highlight the difficulties in predicting canine eruption for individual patients.
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ranking = 0.051009513850986
keywords = eruption
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9/76. Primary failure of eruption in the permanent dentition of siblings.

    Primary failure of eruption is a condition where there is eruption failure in the permanent dentition with no obvious mechanical cause. It has previously been reported in the literature as a cause of posterior openbite, with a varying degree of familial inheritance. This case report describes two sisters that experienced eruption failure in the permanent dentition, most notably of the first and second molars, with greater severity in the younger sister. Teeth were exposed in both patients and orthodontic traction was applied with little or no success. The report provides further evidence of the genetic contribution to the aetiology of this condition and also highlights the problems in attempting treatment, including exposing to the oral environment teeth that are infra-occluded and difficult to clean effectively.
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10/76. Extraction as a treatment alternative follows repeated trauma in a severely handicapped patient.

    Handicapped patients with protruding maxillary incisors are prone to repeated dental trauma. A 13-year-old girl with cerebral palsy, severe mental retardation and seizure disorder was referred to our department for restoring the traumatized anterior teeth. Despite drug combination, the frequency of seizure attack was around 10 times a month. The oral examination showed multiple caries, gingival hyperplasia, class II malocclusion with 14 mm overjet and deep overbite. During the first 3 years of a 7-year follow-up period, six episodes of anterior tooth trauma due to seizure attack occurred. The trauma-related treatment performed included endodontic therapy, multiple composite restorations, apical repositional flap, and finally extraction of all four upper incisors with fabrication of a semi-fixed band-retained denture. The denture restored normal overbite and overjet with improved esthetics. For 4 years following the fabrication of denture, no trauma occurred to the anterior teeth in later seizure attacks. Considering inadequate control of seizure disorder, little ability of the patient to receive comprehensive orthodontic treatment, poor prognosis of restorations, and possible future injuries, the removal of non-functional, nonesthetic, trauma-susceptible incisor teeth can be justified as an alternative to tooth preservation.
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