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ABSTRACT: BACKGROUND: Tooth autotransplantation has developed into a safe and predictable procedure, which preserves the continuity of the dental arch and the alveolar process and provides an acceptable aesthetic and physiological outcome. AIM: To describe our experience with autotransplantation of the developing mandibular premolar to the iliac crest grafted alveolar cleft as part of the cleft patient's treatment protocol. MATERIAL AND METHODS: Four cleft affected patients were referred to the Orthodontic and Craniofacial Department, Rambam Health Care Campus, Haifa, Israel due to loss of teeth in the cleft area. In all cases, orthodontic closure of the missing teeth space in the maxillary dental arch was considered inappropriate and therefore autotransplantation of the extracted mandibular premolar to the bone-grafted alveolar cleft site was conducted. RESULTS: None of the transplanted teeth in the reported cleft affected patients had signs or symptoms of progressive root pathology, gingival disease or advanced tooth mobility. Long-term clinical follow-up examination revealed improved facial aesthetics and occlusal relationships along with increased self-esteem and welfare of the patients' with no need for future dental restorative treatment. CONCLUSION: Autotransplantation of mandibular premolars should be considered an alternative to prosthodontics in cleft affected patients as an integral part of the cleft patient's treatment protocol.
Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 12/2012; · 1.25 Impact Factor
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ABSTRACT: Abstract Objective. The aim was to review the literature on aggressive periodontitis diagnosed during or before the initiation of orthodontic treatment and to propose preventive recommendations before, during and after orthodontic treatment. Materials and methods. Literature searches of free text and MeSH terms were performed by using PubMed, Embase and the Cochrane Library and the appropriate studies were selected. The retrieved articles were analyzed and the relevant data was tabulated according to different parameters. Results. A total of 220 articles were found in the preliminary search. Eighteen studies, all case reports, describing 21 cases from this search met all the criteria. The mean age of the reported cases was 21.12 years, all treated with combined periodontal and orthodontic modalities. Most of the reported cases were female. Conclusion. An interdisciplinary dental team must approve the periodontal health prior to and during the course of the orthodontic therapy. In subjects with periodontal pathology, a periodontal consultation and interceptive/corrective therapy should be performed prior to commencing with orthodontic treatment. Orthodontic treatment should be postponed or replanned in order to shorten treatment duration and reduce the orthodontic forces exerted on the aggressive periodontitis involved dentition.
Acta odontologica Scandinavica 12/2012; · 1.41 Impact Factor
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ABSTRACT: Magnetic resonance imaging (MRI) is one of the most powerful tools in diagnostic imaging. With the growing rates of orthodontic treatment, there are increasing chances of post-orthodontic treatment patients permanently wearing fixed retainers who shall undergo MRI examination.Three adolescent patients were referred for craniofacial MRI examination. All the patients had completed full orthodontic treatment with a retention protocol of permanently wearing bonded gold solder-filled wire fixed retainers. In the first 2 cases, the MRI examination was performed on a 1.5-T system and in the last case on a 3-T system.All the images achieved were of good quality and high resolution. No adverse effects were reported by the first 2 patients including no complaint of heat sensation or any other discomfort in the anterior teeth area. The third patient complained of a headache during the MRI examination.Radiologists and technicians may consider allowing performance of MRI examination using 1.5-T systems when a gold solder-filled wire fixed retainer is involved with no concern regarding the patient's health or the accuracy of the MRI scans.
The Journal of craniofacial surgery 11/2012; 23(6):e654-7. · 0.81 Impact Factor
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ABSTRACT: OBJECTIVE: This study aimed to investigate PDL's cytokine concentration fluctuations after induction of orthodontic force with and without extracorporeal shock wave therapy in a rat model. MATERIALS AND METHODS: An orthodontic appliance was fabricated and applied between the molars and the incisors of rats. The rats were treated by a single episode of 1000 shock waves and gingival crevicular fluid was collected for 3 days. The expression and concentration of IL-1β and VEGF were evaluated by ELISA assay. On day 3 all rats were sacrificed and histologic and immunohistochemical assays were applied. RESULTS: IL-1β concentration rose in both the treated and non treated shockwave groups on the first day, however it was statistically significantly higher in the treated group on day 2. No statistically significant difference was detected between the groups on day 3. The number/area of TRAP positive cells was higher in the non shockwave group than in the treated group. The percentage of cells expressing VEGF displayed the opposite trend. The findings regarding the immunohistochemical assay for IL-1β corresponded with those of the ELISA assay on day 3. CONCLUSION: The application of shockwaves during orthodontic tooth movement influences the expression of IL-1β and VEGF and may alternate the periodontal remodelling expected rate.
Archives of oral biology 10/2012; · 1.65 Impact Factor
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ABSTRACT: Cleft-affected cases present a variable degree of transversal constriction of the maxilla. Our aim is to present a new method for differential expansion of the premaxillary area in unilateral cleft lip and palate-affected patients.The reverse quad helix appliance is made of a 0.036-in stainless-steel wire soldered to 2 bands placed on maxillary deciduous canines or first primary molars (or first permanent premolars). It incorporates 4 helical loops forming an inverse W-arch design. The spring is positioned posterior to the banded teeth; thus, the expansion effect is focused in the anterior maxillary region.A reverse quad helix appliance was activated and cemented in 20 patients for premaxillary expansion. Upper arch width was assessed by means of plaster study models in the anterior and posterior maxillary regions. The mean anterior occlusal expansion achieved by the reverse quad helix (9.60 [±5.24] mm) is statistically significantly larger than that achieved in the posterior region (5.50 [±3.07] mm) (P < 0.0001). The reverse quad helix is an efficient appliance for differential expansion of the anterior maxillary region as a preparatory stage for secondary bone graft procedures in unilateral cleft lip and palate-affected patients.
The Journal of craniofacial surgery 09/2012; 23(5):e440-3. · 0.81 Impact Factor
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ABSTRACT: Distraction osteogenesis is used to increase the vertical and transverse bone volume of the alveolar ridge and requires 3-dimensional vector controls. Temporary anchorage devices (TADs) may be inserted into the transported segment, enabling distraction vector control by exerting orthodontic force. The authors' aim was to describe a combined orthodontic surgical technique involving vertical alveolar distraction using TADs.
Four patients who presented with extensive anterior alveolar ridge bone loss combined with the incisors and canines underwent treatment according to a combined surgical orthodontic protocol, including presurgical orthodontic preparation and a preimplantation surgical augmentation stage involving vertical distractor insertion. During the active vertical alveolar distraction process, 3 TADs were inserted. Intraoral orthodontic elastics were attached to the main orthodontic archwire exerting multidirectional forces to control the vertical distraction vector. After 4 to 5 months of vector controlling and active bone molding, the TADs were removed.
Anterior alveolar ridge augmentation using distraction osteogenesis was achieved. The application of TADs for better anterior segment curvature enabled dental implant insertion, ideal positioning, and restoration.
A combined surgical orthodontic management protocol involving vertical alveolar distraction osteogenesis for augmentation purposes using TADs enables improved alveolar ridge volume and architecture for the preimplantation stage.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 06/2012; 70(8):1815-26. · 1.58 Impact Factor
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ABSTRACT: The authors reviewed the literature regarding inhalation and ingestion of orthodontic appliances and suggest ways to manage and prevent these events.
The authors conducted literature searches of free text and Medical Subject Headings terms by using PubMed and Embase databases and selected appropriate studies. They analyzed retrieved articles according to several parameters: inhalation or ingestion event, number of cases, patient's sex and age, type of orthodontic appliance, in-office event or out-of-office event, and medical treatment.
The authors found a total of 2,279 articles in their preliminary search. Eighteen reports of 24 cases from this search met all of the search criteria (that is, clinical studies, case reports or reviews limited to English, Hebrew or Arabic on any form of aspiration or inhalation of orthodontic appliances). Most cases (67 percent) involved ingested objects, and of those cases, the majority (57 percent) occurred in female patients. Most cases (85 percent) occurred outside the orthodontist's office. Seventeen patients (71 percent) had been treated with a fixed orthodontic appliance. In 60 percent of cases, the maxilla was involved. With one exception, no severe complications were reported (only seven patients were examined in a hospital emergency department), and patients were discharged uneventfully from the orthodontic office or emergency department.
Orthodontists and team members should participate in medical emergency management courses that emphasize the use of guidelines in cases of inhalation or ingestion of orthodontic objects. Each orthodontist's office should develop written emergency protocols for out-of-office events and present them to patients and their parents at the start of treatment.
Journal of the American Dental Association (1939) 01/2011; 142(1):45-52. · 1.77 Impact Factor
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ABSTRACT: The mandibular internal curvilinear distractor design produces a curvilinear vector to provide ideal three-dimensional curvilinear movements compared with the limited straight unidirectional predecessor devices. In this manner, it corrects craniofacial deformities as anatomically as possible, allowing simultaneous bidirectional (rotational and translational) mandibular movement and multidirectional distraction. The aim of this study was to quantify the sagittal and vertical mandibular changes achieved through curvilinear distraction and to assess the long-term effect of this generated bone.
Forty patients (20 male and 20 female), with ages ranging from 5 to 55 years, who underwent mandibular distraction from December of 1999 to August of 2007 at Lucile Packard Children's Hospital in Stanford, California, were included. Preoperatively, postoperatively, and at follow-up (at least 2 years following distraction), panoramic and lateral cephalometric radiographs were traced by plotting different skeletal landmark points and were then analyzed.
All patients tolerated the curvilinear distraction process well through completion. The average of the mandibular body elongation recorded was 8 to 9 mm and 6 to 8 mm in the panoramic and cephalometric radiographs, respectively; whereas the vertical change of the mandibular ramus achieved was 10 to 12 mm and 10 to 11 mm, respectively. The curvilinear distraction effect on the mandible was found to be significantly stable when the long-term follow-up measurements were compared with the postoperative data revealed in the panoramic and lateral cephalometric radiographs for the two dimensions.
The internal curvilinear device is an effective tool that achieves a stable mandibular distraction, resulting in the correction of craniofacial deformities.
Plastic and reconstructive surgery 06/2010; 125(6):1771-80. · 2.74 Impact Factor
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ABSTRACT: This article reviews the management of mandibular body fractures in young children. Treatment principles of this fracture type differ from that of adults due to concerns regarding mandibular growth processes and dentition development. The goal of this fracture treatment is to restore the underlying bony architecture to its preinjury position in a stable fashion as non-invasively as possible and with minimal residual esthetic and functional impairment. The management of mandibular body fractures in children depends on the fracture type and the stage of skeletal and dental development; treatment modalities range from conservative non-invasive, through closed reduction and immobilization methods to open reduction with internal fixation. Disruption of the periosteal envelope of the mandibular body may have an unpredictable effect on growth. Thus, if intervention is required closed reduction is favored.
Dental Traumatology 09/2009; 25(6):565-70. · 1.20 Impact Factor
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ABSTRACT: The distraction osteogenesis principle that was originally developed by orthopedists for purposes of limb lengthening can now be used successfully for bones of the craniofacial region, including cleft palate deformities. Advancement of the cleft maxilla by means of distraction is based on the concept of using stretching forces to separate two bony elements at the midface region. The role of orthodontists in skeletal treatment of the maxilla utilizing distraction osteogenesis should be collaborative and adjunctive as part of a team approach to rehabilitate the patient. Advances over traditional techniques are mainly because of simultaneous adaptation of the surrounding soft-tissue envelope which contributes to the stability of the reconstruction, thus lessening the risk of relapse.
Alpha Omegan 104(3-4):85-96.
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ABSTRACT: Axenfeld-Rieger syndrome is a rare genetic disorder characterized by ocular and dental abnormalities. This case demonstrates a comprehensive review of the syndrome's clinical and dental features and describes a case of a 13-year-old boy presenting with it. The patient showed severe hypodontia, microdontia, and short roots. Different treatment options are discussed. Early diagnosis and an interdisciplinary approach are necessary to provide the best short- and long-term treatment plans, as well as treatment and follow-up for individuals with the syndrome.
Pediatric dentistry 33(5):440-4. · 1.02 Impact Factor
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ABSTRACT: Aggressive periodontitis is diagnosed mainly by clinical and radiographic examination. Diagnosis in the primary dentition indicates a choice between conservative and radical treatment that involves extractions, depending on the severity of the case. The purpose of this report was to present a case of aggressive periodontitis in a systemically healthy child and to discuss the periodontal and orthodontic aspects. A 7-year-old girl presented with bleeding on probing of approximately half of the dentition, deep periodontal pockets around all primary molars, and increased tooth mobility. An individual oral hygiene program was initiated. The primary maxillary right molar and all primary mandibular molars were extracted, and clear vacuum-formed removable retainers were fabricated and used as space maintainers. The patient was followed longitudinally for 2 years, and no space loss was recorded. Clear vacuum-formed removable retainers mainly involve occlusal crown attachment and, therefore, decrease the risk of plaque accumulation, gingival irritation, and aggressive periodontitis in the permanent dentition.
Pediatric dentistry. 34(3):254-8.
