Cases reported "Malocclusion"

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1/175. Occlusal rehabilitation using implants for orthodontic anchorage.

    osseointegration is defined as a direct interaction of bone to an implant surface. As a result, the implant fixture is immobilized in the bone and lends itself to function as an anchor for orthodontic tooth movements. When properly treatment-planned, these implants can also be used as prosthodontic abutments for single crowns, or removable or fixed partial dentures. This article describes how implant fixtures were surgically placed within the maxillary and mandibular arches of a partially edentulous patient, and used for orthodontic anchorage to reposition the remaining teeth into a more favorable arch position, creating increased posterior interocclusal space. The fixtures were then restored with fixed partial dentures to rehabilitate the patient into a mutually protected occlusion.
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2/175. Long-term stability of mandibular orthopedic repositioning.

    Mandibular anterior repositioning appliances attempt to diminish temporomandibular joint pain, soft tissue noise, and myofascial discomfort by altering condyle-disc relationships. Secondary stabilization of the occlusion to this arbitrary anterior position through orthodontic tooth movement may significantly alter functional and muscular relationships. A case report is illustrated to show that as the functional environment attempted to reestablish equilibrium through adaptation, relapse occurred as the condyles "seated" posteriorly and superiorly toward their original relationship within the fossa. For all practical purposes, complete relapse of the orthodontic treatment result took place over time.
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3/175. Distraction osteogenesis in silver Russell syndrome to expand the mandible.

    Distraction osteogenesis is a method commonly used to activate bone regeneration in nonunions and osseous defects and for lengthening procedures of tubular bones. This technique involves the sectioning of a bone and the subsequent deliberate, controlled movement of the opposing sectioned edges to lengthen, widen, or reposition a bone, or all three. In this report, a patient with silver Russell syndrome and severe mandibular hypoplasia was treated by means of distraction osteogenesis of the midsymphysis to widen the mandible in concert with sagittal-ramus osteotomies to lengthen the mandible. This treatment created significantly increased arch length in the mandible, which was necessary to facilitate the patient's orthodontic treatment. We believe this is the first reported case of distraction osteogenesis to widen the mandible with the use of a tooth-borne appliance.
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4/175. Cephalometric soft tissue facial analysis.

    My objective is to present a cephalometric-based facial analysis to correlate with an article that was published previously in the American Journal of Orthodontic and Dentofacial orthopedics. Eighteen facial or soft tissue traits are discussed in this article. All of them are significant in successful orthodontic outcome, and none of them depend on skeletal landmarks for measurement. Orthodontic analysis most commonly relies on skeletal and dental measurement, placing far less emphasis on facial feature measurement, particularly their relationship to each other. Yet, a thorough examination of the face is critical for understanding the changes in facial appearance that result from orthodontic treatment. A cephalometric approach to facial examination can also benefit the diagnosis and treatment plan. Individual facial traits and their balance with one another should be identified before treatment. Relying solely on skeletal analysis, assuming that the face will balance if the skeletal/dental cephalometric values are normalized, may not yield the desired outcome. Good occlusion does not necessarily mean good facial balance. Orthodontic norms for facial traits can permit their measurement. Further, with a knowledge of standard facial traits and the patient's soft tissue features, an individualized norm can be established for each patient to optimize facial attractiveness. Four questions should be asked regarding each facial trait before treatment: (1) What is the quality and quantity of the trait? (2) How will future growth affect the trait? (3) How will orthodontic tooth movement affect the existing trait (positively or negatively)? (4) How will surgical bone movement to correct the bite affect the trait (positively or negatively)?
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5/175. Apex formation during orthodontic treatment in an adult patient: report of a case.

    This clinical report describes an apexification procedure on a maxillary left central incisor in a 34-year-old male who was also receiving active orthodontic treatment. The pulp of the tooth had become necrotic following a traumatic injury when the patient was 8 years of age. Despite the tooth undergoing active orthodontic repositioning with fixed appliances, root-end closure occurred uneventfully and within 3 years.
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6/175. The role of orthognathic surgery in the treatment of severe dentoalveolar extrusion.

    BACKGROUND: When mandibular molars are not replaced after extraction, the long-term problem of inadequate interarch space for either a fixed or removable prosthesis can occur. In the past, practitioners needed to decide whether to shorten the teeth, extract the supererupted maxillary molars to recapture space or leave the area unrestored. The authors present another option. CASE DESCRIPTION: A 61-year-old man was referred to a periodontist by his general dentist for placement of mandibular implants in the posterior sextant. Extreme supereruption of the maxillary dentoalveolar segment prevented restoration of the opposing edentulous area. An oral and maxillofacial surgeon performed a segmental osteotomy of the posterior right maxilla to gain needed interarch space. After the osteotomy was stabilized, the periodontist placed implants that were subsequently restored with a fixed prosthesis. CLINICAL IMPLICATIONS: The role of orthognathic surgery in treatment planning should not be overlooked in the comprehensive management of severe extrusion. It offers patients the opportunity to gain both function and esthetics that might otherwise be impossible.
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7/175. The surgical uncovering and orthodontic positioning of unerupted maxillary canines.

    1. The presence of the maxillary canine is vital to the function and esthetics of the dental complex. The availability of this tooth must be carefully considered during an orthodontic diagnosis. Lack of space is the most common cause of canine impaction. Other contributing factors are that this tooth has the longest period of developmenent and that it is bigger longer, and travels farther while erupting than any other tooth. 2. Proper management of unerupted canines is a challenge to the dental practitioner. Maxillary canines are found impacted to both the buccal and the lingual. Palatal impactions are much more common than labial impactions, but, of the two, labial impactions are more difficult to manage. 3. An appropriate surgical procedure which opens to the crowns of unerupted teeth is a key to uneventful orthodontic positioning of these teeth. Packing the follicular space with baseplate gutta-percha and keeping the crown open to the oral cavity with surgical WondrPak is an effective method of making the tooth erupt into the oral cavity. 4. Modern preformed bands and improved cements make the placement of attachment on malposed teeth relatively easy. Direct bonding techniques are also of value in the management of unerupted teeth. 5. It is practical to move teeth orthodontically from seemingly impossible positions into ideal alignment. Such teeth will function normally, and no evidence will be left of their original position or of their having been moved over long distances.
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8/175. Multiple extraction patterns in severe discrepancy cases.

    Thirty-five cases have been collected from colleagues which illustrate that removal of additional maxillary teeth, following first bicuspid extractions, can allow the successful resolution of difficult discrepancy and anchorage cases. charts 1 and 2 describe the amounts of space that might be expected by removal of additional upper bicuspids, upper first molars, and upper second molars. The findings on upper second molars are admittedly limited. Anchorage values as expressed by an efficiency percentage were approximately what would be expected from a study of anchorage values of the roots of teeth. The removal of upper second bicuspids has a better anchorage efficiency potential than the upper first molar, but this may be overcome somewhat by the greater size of the molar. Clear guidance cannot be given as to which teeth to remove in a specific case, but it is the observation of the author that for cases that are still in full Class II following four bicuspid space closure, upper second bicuspid removal would be more helpful from an anchorage perspective, whereas for cases that are in end-to-end molar relationship or require only a few millimeters to move into Class I, the upper first molar might be the tooth of choice. Also, the supper first molar removal allows for a more "normal" appearing arch assuming normal alignment and size of the upper second and third molars. The comparison with the nonextraction control group showed an enormous difference in the amount of incisor retraction that extractions provide when related to the maxilla. The nonextraction control group, though experiencing dramatic correction of Class II relationships, showed no incisor movement within the maxilla. Some problems which appeared in the sample were described. Removal of upper teeth in addition to the four first bicuspids can be a solution to an occasional anchorage, skeletal, growth or cooperation problem.
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9/175. Open-bite relapse. Report of a case.

    Although the tooth positioner was initially helpful in promoting improved esthetics and stability, it in effect became an orthodontic appliance by maintaining the original, treated occlusal plane. Subsequently, the lower third molars erupted above the occlusal plane and caused the mandible to rotate downward and backward, resulting in an unsightly bite opening. Removal of the etiologic factors, the tooth positioner, and third molars corrected the open-bite relapse.
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10/175. Masticatory movement in two cases with unusual alignment of the maxillary canine.

    Masticatory function was analysed before and after orthodontic treatment in two cases where tooth alignment remained unusual after treatment. The Sirognathograph Analyzing System was used to analyse the masticatory function. In both cases, the right maxillary first premolar was located where the maxillary canine is normally positioned. The results of orthodontic treatment were satisfactory both morphologically and aesthetically, and masticatory function was greatly improved. However, some problems remained in the mandibular movement due to the abnormal contact between the mandibular teeth and the maxillary first premolar. These findings support the need for examination of masticatory function when treating patients with an unusual tooth alignment even if the results of orthodontic treatment are both morphologically and aesthetically successful.
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