Maxillary canine-first premolar transposition - Restoring normal tooth order with segmented mechanics

Tooth transpositions present at a relatively low incidence in the world population and primarily affect maxillary canines and premolars. Treatment of this disturbance should take into account aspects such as facial pattern, age, malocclusion, tooth-size discrepancy, stage of eruption, and magnitude of the transposition. Mechanics for correction should be entirely individualized, reducing the risks and adverse effects. Practitioners often select simpler options, indicating extraction of permanent teeth, which is an irreversible procedure that may bring about damages to the patient. This study presents a case report and treatment of unilateral transposition of maxillary canine and premolar with repositioning of affected teeth to their respective normal positions.

Mandibular skeletal growth and modelling between 10 and 15 years of age

This study pertains to a random sample of untreated French-Canadian adolescents (79 females and 107 males) evaluated at 10 and again at 15 years of age. Superimpositions on natural reference structures were performed to describe condylar growth and modelling of 11 mandibular landmarks. Superimpositions on natural cranial/cranial base reference structures were performed to describe mandibular displacement and true rotation.The results showed significant superior and posterior growth/modelling of the condyle and ramus. Males underwent significantly (P < 0.01) greater condylar growth and ramus modelling than females. With the exception of point B, which showed significant superior drift, modelling changes for the corpus landmarks were small and variable. The mandible rotated forward 2-3.3 degrees and was displaced 9.6-12.7 mm inferiorly and 1.9-2.7 mm anteriorly. Individual differences in ramus growth and modelling, both amount and direction, can be explained by mandibular rotation and displacements. Multivariate assessments revealed that superior condylar growth and ramus modelling were most closely associated with forward rotation and inferior mandibular displacement. Posterior growth and modelling were most closely correlated with anterior mandibular displacement and forward rotation. Modelling of the lower anterior border was independent of rotation and displacement.

Panoramic evaluation of mesiodistal axial inclinations of maxillary anterior teeth in orthodontically treated subjects

The objectives of this study were to evaluate, through panoramic radiographs, the mesiodistal axial inclinations of the maxillary anterior teeth at the beginning and end of nonextraction orthodontic treatment, and to compare the results with the mesiodistal axial inclinations of a control sample with normal (acceptable) occlusions. Methods: the experimental sample consisted of 40 white patients (20 male, 20 female; mean age, 14 years) with Class I maloccusions who were treated orthodontically with a standard edgewise (not preadjusted) technique without extractions. The mean treatment period was 1.6 years. The control sample comprised 42 white subjects (14 male, 28 female; age range, 12-17 years) with untreated normal (acceptable) occlusions. Panoramic radiographs were taken of the patients at the beginning (T1) and end (T2) of treatment. The mean values of the mesiodistal axial inclination at T1 were compared with the mean values at T2, and both were compared with the mesiodistal axial inclinations of the control sample. Results- the mesiodistal axial inclinations of the maxillary anterior teeth of the experimental group at T1 were different from those of the control group for 50% of the evaluated teeth. In contrast, the inclinations at T2 were consistent with the normal anatomical configuration of the controls. Conclusions: the panoramic radiograph is an effective tool for evaluating the mesiodistal axial inclinations of maxillary anterior teeth.

Comparative study of the Frankel (FR-2) and bionator appliances in the treatment of Class II malocclusion

The purpose of this investigation was to compare the dentoalveolar and skeletal cephalometric changes produced by the Frankel (FR-2) and bionator appliances in persons with Class 11 malocclusion. Lateral cephalograms were available for 66 patients of both sexes, who were divided into 3 groups of 22. The control group included untreated Class 11 children, with an initial mean age of 8 years 7 months; they were followed without treatment for 13 months. The FR-2 appliance group had an initial mean age of 9 years; those children were treated for a mean period of 17 months. The bionator group initially had a mean age of 10 years 8 months; on average, they were treated for 16 months. The results demonstrated no significant changes in maxillary growth during the evaluation period. Both appliances showed statistically significant increases in mandibular growth and mandibular protrusion, with greater increases in patients treated in the bionator group. Both experimental groups showed an improvement in the maxillomandibular relationship. There were no significant changes in growth direction, while the bionator group had a greater increase in posterior facial height. Both appliances produced similar labial tipping and protrusion of the lower incisors, lingual inclination, retrusion of the upper incisors, and a significant increase in mandibular posterior dentoalveolar height. The major treatment effects of bionator and FR-2 appliances were dentoalveolar, with a smaller, but significant, skeletal effect.

Transverse skeletal base adaptations with Bionator therapy: A pilot implant study

The purpose of this randomized, controlled trial was to evaluate transverse skeletal base adaptations to Bionator therapy. The sample included 25 patients (15 male, 10 female) aged 6.9 to 11.2 years with Class II Division 1 malocclusion. The patients were randomly allocated to either a control (n = 11) or treatment (n = 14) group and followed longitudinally for approximately 12 months. Treatment consisted of a Bionator only, constructed to remain approximately 2 mm from the buccal dentition. Transverse maxillary and mandibular changes were evaluated cephalometrically according to 4 bilateral maxillary and 2 bilateral mandibular implants. Untreated Class II controls exhibited significant increases between posterior maxillary implants but no significant changes between the anterior maxillary or mandibular implants. There were no significant width differences between the control and treated groups before treatment. Posterior maxillary implant widths increased significantly (P < .05) in both groups, but the treated group showed significantly greater width increases than the control group. The treated group also showed greater increases between mandibular implants, but the differences were not statistically significant. These results suggest that transverse skeletal base adaptations occur as a result of Bionator therapy.

Influence of surgical repositioning of mature permanent dog teeth following experimental intrusion: a histologic assessment

The aim of this study was to evaluate, through histologic examination, the effect of surgical repositioning of intruded dog teeth upon the pulpal and surrounding tissues. Thirty teeth in 10 adult dogs, aged 2-3 years, were used. Fifteen teeth were intruded, surgically repositioned and fixed using orthodontics wire, composite resin, and enamel acid conditioning. All these teeth served as the experimental group. The remaining intruded teeth were not treated ( control group). The animals were sacrificed to allow observations at 7,15, and 30 post-operative days. The maxillary and mandibular archs were removed and processed for histologic exam. Based on the methodology and observed results, we concluded that: pulpal necrosis, external root resorption and ankylosis were common sequelae to severe traumatic intrusion; a careful immediate surgical repositioning of severed intruded permanent tooth with complete root formation has many advantages with few disadvantages.

Comparative in vitro study of the shear bond strength of brackets bonded with restorative and orthodontic resins

The aim of this study was to evaluate the shear bond strength of brackets bonded with different restorative systems and compare it with that afforded by an established orthodontic bonding system. Seventy human bicuspids were used, divided into five different groups with 14 teeth each. Whereas a specific orthodontic bonding resin (Transbond (TM) XT) was used in the control group, the restorative systems Charisma, Tetric Ceram, TPH Spectrum and Z100 were used in the other four groups. Seven days after bonding the brackets to the samples, shear forces were applied under pressure in a universal testing machine. The data collected was evaluated using the ANOVA test and, when a difference was identified, the Tukey test was applied. A 5% level of significance was adopted. The mean results of the shear bond strength tests were as follows: Group 1 (Charisma), 14.98 MPa; Group 2 (Tetric Ceram), 15.16 MPa; Group 3 (TPH), 17.70 MPa; Group 4 (Z100), 13.91 MPa; and Group 5 or control group (Transbond (TM) XT), 17.15 MPa. No statistically significant difference was found among the groups. It was concluded that all tested resins have sufficient bond strength to be recommended for bonding orthodontic brackets.

Tooth separation: A risk-free procedure?

This article reports the case of a 12-year-old patient with tooth extrusion, pain, gingival bleeding, and localized periodontitis near the maxillary second premolar. Despite probing and radiographic examination, it was not possible to establish the etiology. Tooth extraction was indicated because of the severe tooth mobility and extrusion. Curettage of the tooth socket revealed a rubber separator. Preventive approaches are suggested to avoid iatrogenesis and legal problems. (Am J Orthod Dentofacial Orthop 2012; 142:402-5)

Changes over time in canine retraction: An implant study

Introduction: The objective of this study was to analyze rates of canine movement over the first 2 months of continuous retraction, when rate changes are expected. Methods: Ten patients with bone markers placed in the maxilla and the mandible had their canines retracted over a 2-month period. Retraction was accomplished with beta-titanium alloy T-loop springs. Standardized 45 degrees oblique cephalograms where taken initially and every 28 days thereafter. The radiographs were scanned and digitized twice (the average was used for the analyses). The radiographs were superimposed by using the bone markers and oriented on the functional occlusal plane. Paired t tests were used to compare side and jaw effects. Results: There were no significant differences between sides. The maxillary cusp was retracted 3.2 mm, with less movement during the first (1.1 mm) than during the second 4 weeks (2.1 mm). The maxillary apices did not move horizontally. There were no significant vertical movements in the cusps and apices of the maxillary canines. The mandibular cusp was retracted 3.8 mm-1.1 mm during the first and 2.7 mm during the second 4 weeks. The mandibular apices were protracted 1.1 mm. The cusps and apices were intruded 0.6 and 0.7 mm, respectively. The only difference between jaws was the greater protraction of the mandibular apices during the second 4 weeks and in overall movement. Conclusions: The rate of canine cusp retraction was greater during the second than the first 4 weeks. The mandibular canines were retracted by uncontrolled tipping whereas the maxillary canines were retracted by controlled tipping. (Am J Orthod Dentofacial Orthop 2009; 136: 87-93)

Midsymphyseal distraction osteogenesis: A new alternative for the treatment of dental crowding

In this article, we describe a midsymphyseal distraction osteogenesis treatment with a novel dentally supported appliance. This approach differs from that used in previous reports because the incisors were allowed to move during the distraction procedure. This report shows that midsymphyseal distraction osteogenesis can be used to expand both arches to produce a wider smile. Borderline cases can be treated with this technique without the compromising effects commonly observed with conventional therapy. (Am J Orthod Dentofacial Orthop 2009;135:530-5)

Photoelastic analysis of forces generated by T-loop springs made with stainless steel or titanium-molybdenum alloy

Introduction: The purpose of this study was to use photoelastic analysis to compare the system of forces generated by retraction T-loop springs made with stainless steel and titanium-molybdenum alloy (TMA) (Ormco, Glendora, Calif) with photoelastic analysis. Methods: Three photoelastic models were used to evaluate retraction T-loop springs with the same preactivations in 2 groups. In group 1, the loop was constructed with a stainless steel wire, and 2 helicoids were incorporated on top of the T-loop; in group 2, it was made with TMA and no helicoids. Results: Upon using the qualitative analysis of the fringe order in the photoelastic model, it was observed that the magnitude of force generated by the springs in group 1 was significantly higher than that in group 2. However, both had symmetry for the active and reactive units related to the system of force. Conclusions: Both springs had the same mechanical characteristics. TMA springs showed lower force levels. (Am J Orthod Dentofacial Orthop 2011;140:e123-e128)

Optimizing the design of preactivated titanium T-loop springs with Loop software

ATMA (Ormco Corp, Glendora, Calif) T-loop spring (TTLS), preactivated with a gable bend distal to the loop, holds promise for producing controlled tipping of the canines and translation of the posterior segment. However, there is currently no consensus as to where the preactivated gable bend or the loop should be placed, what the height of the loop should be, or how the interbracket distance changes the moments produced. Using the Loop software program (dHal, Athens, Greece), we systematically modified a .017 x .025-in TTLS (10 x 6 mm) that was preactivated with a 45 degrees gable bend distal to the loop, and simulated the effects. As the gable bend was moved posteriorly, the moment increased at the posterior bracket more than it decreased at the anterior bracket. As the loop was brought closer to the anterior bracket, the posterior moment decreased at the same rate that it increased anteriorly. As the loop was increased in size, the moments increased both posteriorly and anteriorly. As the interbracket distance increased, the posterior moment decreased, and the anterior moment remained constant. We concluded that the size of the loop should be slightly increased, to 10 x 7 mm, and it should be placed 2 mm from the anterior bracket, with a preactivation bend of 45 degrees, 4 to 5 mm from the posterior bracket (after 4 mm of activation).

Group A T-loop for differential moment mechanics: An implant study

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Loss of space and dental arch length after the loss of the lower first primary molar: A longitudinal study

The premature loss of primary teeth may harm the normal occlusal development, although there are debates relating to the necessity of using space maintainer appliances. The aim of the study is to evaluate the changes in the dental arch perimeter and the space reduction after the premature loss of the lower first primary molar in the mixed dentition stage. The sample consists of 4 lower arch plaster models of 31 patients, within the period of pre-extraction, 6, 12 and 18 months after the lower first primary molar extraction. A reduction of space was noted with the cuspid dislocation and the permanent incisors moving toward the space of the extraction site. It was concluded that the lower first molar primary premature loss, during the mixed dentition, implicates an immediate placement of a space maintainer.