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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. A comparison of autotransplantation and orthodontics in a case exhibiting two ectopic upper cuspids.

    Bilateral severely ectopic maxillary cuspids were treated differently on each side. On one side the ectopic cuspid was moved into position orthodontically, and on the other, the ectopic cuspid was positioned by autotransplantation. The orthodontic positioning took a long time and the tooth exhibited root resorption. Treatment time for the autotransplantation positioning was far quicker, and there was no resorption nor were there any other side effects.
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4/30. Severe dental open bite malocclusion with tongue reduction after orthodontic treatment.

    We treated a 21-year-old woman with a severe open bite and macroglossia with a standard edgewise appliance and without partial glossectomy. This was followed by retention using a Begg-type plate retainer for the upper dental arch and a fixed canine-to-canine for the lower arch. A crib was added to the upper plate retainer for suppression of a tongue thrust. The lower arch relapsed during the retention period, with a widening of the intermolar distance, flaring of the anterior teeth, and increased mobility of the teeth. We chose tongue reduction to resolve these problems and one-third of the middle dorsal part of the tongue was excised. After the tongue reduction, the patient experienced no functional problem in mastication, swallowing, and gustation, but she complained of mild speech difficulty and slight pain on the dorsal portion of her tongue. These symptoms disappeared 6 months after surgery. At this time, the mandibular dental arch was markedly improved. The flared lower dental arch had returned to an upright position and the tooth mobility reduced to normal. No appliance was used after surgery. Most of the recovery changes occurred within 4 months. This case highlights the importance of the teeth tending to move toward a balance between the tongue pressure from the inside and labio-buccal pressure from the outside.
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5/30. Reduction of the hypocone of the maxillary first molar and Class III malocclusion.

    This study was conducted to examine the incidence of evolutionary changes of the maxillary molars in orthodontic patients and to investigate the association of this event with craniofacial growth. Among 4,892 Japanese patients treated at the orthodontic clinic of Hiroshima University Dental Hospital, 59 patients presented with a defect of the distolingual cusp of the maxillary first molar. They consisted of 52 female patients and seven male patients with a mean age of 14.7 years. Eruption of the maxillary first and second molars was delayed and the third molar was congenitally missing in all of these patients. Thirty-seven patients exhibited Class III malocclusion (Class III evolution group). The Z scores of cephalometric measurements were compared between the Class III evolution group and the Class III control group. The latter group consisted of 37 Class III subjects with no evolutionary dental anomalies and no orthodontic history. The tooth developmental score (TDS) for each age at the initial record was compared with Nolla's standard tooth developmental score (STDS) for equivalent ages using paired t-tests. The Z scores for Ptm'-A and Ar-A were significantly smaller in the Class III evolutionary group than in the Class III control group (P < .05). The TDS for the maxillary first and second molars were significantly smaller than the STDS for these molars (P < .01). The TDS for the maxillary second molar was significantly larger than the STDS for the maxillary third molar (P < .01). This study revealed that an evolution change of the maxillary molar is more common (P < .05) in female patients than in male patients, is more frequent (P < .05) in subjects with Class III malocclusion, and is related to the anteroposterior undergrowth of the maxilla.
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6/30. amelogenesis imperfecta: diagnosis and resolution of a case with hypoplasia and hypocalcification of enamel, dental agenesis, and skeletal open bite.

    A case of amelogenesis imperfecta with hypoplasia, hypocalcification of the enamel, congenital absence of teeth 12 and 22, delayed eruption of tooth 23, edge-to-edge incisal relationship, open bite, and bilateral posterior cross bite at the level of the first and second premolars is presented. Lateral skull teleradiography indicated a Class III skeletal pattern of maxillary origin associated with a dolichofacial pattern with multiple indicators of facial hyperdivergence. The patient presented a major esthetic abnormality of the face and required orthodontic treatment prior to a prosthetic solution with full-coverage metal-ceramic crowns in both the maxilla and the mandible. The diagnosis of cases such as this one and the therapeutic implications from an orthodontic and prosthetic standpoint are reported.
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7/30. Restorative management of the worn dentition: 3. Localized posterior toothwear.

    In the management of localized posterior occlusal toothwear, care must be taken not only in determining whether the worn teeth are restorable, but also the desirable occlusal scheme. Assessments of the periodontal, endodontic, and coronal tooth tissues, and the occlusal relationship are necessary for a comprehensive treatment plan for worn posterior teeth.
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8/30. Treatment of severe mandibular prognathism in combination with maxillary hypoplasia: case report.

    We performed a Le Fort I osteotomy and sagittal split ramus osteotomy (Obwegeser-Dal Pont) combined with mandibular anterior segmental osteotomy without tooth extraction for a patient with severe mandibular prognathism accompanied by a hypoplastic maxilla, anterior open bite and normal anterior mandibular vertical dimension. The results of facial appearance and occlusion were excellent. This combined surgical method appears to be satisfactory for treating severe mandibular prognathism with hypoplastic maxilla.
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9/30. Implant replacement of congenitally missing lateral incisor: a case report.

    The therapeutic goal of reconstruction dentistry is to provide our patients with a dentition that is in harmony with the patient's musculature and temporomandibular joints. malocclusion can contribute to both muscular and joint dysfunction. This case report demonstrates the reconstruction of a malocclusion caused by a congenitally missing lateral incisor utilizing a combination of orthodontic treatment and a dental implant to replace the congenitally missing tooth.
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10/30. Maxillary canine displacement; further twists in the tale.

    This report describes two cases seen over a 5-year period, each with a labially impacted maxillary canine found in close proximity to the adjacent first permanent premolar, which had a deviated palatal root. The issue as to whether the premolar root deviation either produced the canine impaction or vice versa is discussed, both with reference to the processes considered to be involved in normal tooth eruption, and to three previously published similar cases.
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