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ABSTRACT: Multiple treatment options are available to patients with impacted manibular canines in addition to a retained deciduous canine. This article describes the treatment of a prepubertal girl, aged 10 years 6 months, with a skeletal Class I, dental Class II Division 1 malocclusion, retrognathic mandible, deep overbite, proclined maxillary incisors, midline diastema, and bilateral mandibular canine impaction. The orthodontic treatment plan included extraction of the deciduous canine and forced eruption of the impacted canines. A modified lip bumper appliance was used both for forced eruption and to reinforce anchorage. Through the collaborative efforts of an orthodontist and an oral surgeon, an excellent esthetic and functional outcome was achieved.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 03/2013; 143(3):393-403. · 1.33 Impact Factor
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ABSTRACT: Abstract Objective: To compare the dentoskeletal effects and treatment efficiency of the Twin Force Bite Corrector (TFBC) appliance in Class II correction of patients treated before or after the pubertal growth spurt. Materials and Methods: Forty-one normodivergent Class II patients treated with the TFBC appliance were divided into two groups based on their cervical vertebral maturation stage (CVMS). Group 1 (G1) consisted of 23 patients (mean age 12.44 ± 1.59 years) where treatment was initiated before the pubertal growth spurt (CVMS I and II), while group 2 (G2) consisted of 18 patients (mean age 13.76 ± 1.44 years) where treatment was started after the pubertal growth spurt (CVMS III to V). Dentoskeletal measurements were made on lateral cephalograms taken before (T1) and after orthodontic treatment (T2). Results: During treatment, G1 had significantly greater skeletal correction than G2, with more dentoalveolar effects being observed in G2 than G1. However, on comparing both groups at the end of treatment (T2) when growth is complete, no differences in the parameters measured were observed. Overall, treatment time was significantly longer for G1 (3.67 ± 1.45 years) compared to G2 (2.75 ± 1.07 years). Conclusions: There is no difference in overall dentoskeletal effects obtained at the end of treatment by the TFBC appliance in normodivergent prepubertal vs postpubertal patients. However, treatment efficiency based on treatment timing is significantly greater for the postpubertal group.
The Angle Orthodontist 11/2012; · 1.21 Impact Factor
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ABSTRACT: The aim of this prospective study was to quantify the display of the dentition through the soft tissue frame during speech using videography for different age groups. Two hundred and sixty-one subjects were initially screened and were divided into five groups: group 1 (G1) (15-19 years), G2 (20-29 years), G3 (30-39 years), G4 (40-49 years), and G5 (≥50 years). Groups were also made on the basis of gender and history of orthodontic treatment. Video equipment was used to capture video and each frame was analysed out of which two frames that best represented the maximal display of maxillary incisors (MDMI) during speech and the widest transverse display of dentition (WTDD) during speech were selected. The data obtained was analysed using one-way analyses of variance with Fisher's least significant difference post hoc test. MDMI and WTDD were found to be highly significant during speech across all age groups (P < 0.05). G1-G3 displayed approximately similar levels of maxillary incisor (P > 0.05) but was greater (P < 0.05) than G4 and G5. The buccal corridor showed significant differences as a function of age (P < 0.05). Orthodontic treatment had a significant impact on the display of the maxillary incisors (P < 0.05) but not on the buccal corridors (P > 0.05). Mandibular incisor display was relatively stable across G1-G3, increasing only for G4 and G5. It appears that the maximum display of maxillary incisors decreases with age and the decline is particularly rapid with increasing age. Females tend to display more teeth both in the transverse and vertical directions.
The European Journal of Orthodontics 11/2012; · 0.89 Impact Factor
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ABSTRACT: SUMMARY The purpose of this study was to measure the efficacy of anchorage control between differential moments mechanics and temporary anchorage devices in a clinical trial. Forty-six patients requiring extraction of maxillary first premolars were allocated into 2 treatment groups. The differential moments group (G1) received a nickel titanium (NiTi) intrusion arch and a 150g NiTi closing coil spring for separate canine retraction, followed by a continuous mushroom loop archwire for the retraction of the incisors. The TAD group (G2) received one miniscrew placed between maxillary second premolars and first molars with a 150 g NiTi closing coil spring connecting the miniscrew to a hook placed in the archwire between the lateral incisor and canine. Lateral cephalograms were taken before (T1) and after incisor retraction (T2). The ratio of molar protraction to incisor retraction was calculated and intragroup and intergroup changes in upper lip, maxillary incisor and molar position were analyzed by paired and independent t-tests. Twenty-eight patients were analyzed after 18 patients did not receive the intervention, were lost to follow-up, or discontinued treatment. The ratio of molar protraction to incisor retraction in G1 was 0.44 and in G2 was -0.11, which was significantly different. There was a statistically significant change in upper lip from T1 to T2 but no difference between the two groups. Moreover, there was a significant distal molar tipping and lingual incisor tipping in G2. There is a significant difference in the amount of anchorage control using differential moments mechanics compared to TADs. Although statistically significant retraction of upper lip was observed in both groups, there was no significant difference between the two groups.
The European Journal of Orthodontics 08/2012; · 0.89 Impact Factor
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American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 05/2012; 141(5):532-3. · 1.33 Impact Factor
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ABSTRACT: The purpose of this research was to evaluate microdamage accumulation after mini-implant placement by self-drilling (without a pilot hole) and self-tapping (screwed into a pilot hole) insertion techniques. The null hypothesis was that the mini-implant insertion technique would have no influence on microcrack accumulation and propagation in the cortical bones of the maxillae and mandibles of adult hounds.
Mini-implants (n = 162; diameter, 1.6 mm; length, 6 mm) were placed in the maxillae and mandibles of 9 hounds (12-14 months old) with self-drilling and self-tapping insertion techniques. The techniques were randomly assigned to the left or the right side of each jaw. Each hound received 18 mini-implants (10 in the mandible, 8 in the maxilla). Histomorphometric parameters including total crack length and crack surface density were measured. The null hypothesis was rejected in favor of an alternate hypothesis: that the self-drilling technique results in more microdamage (microcracks) accumulation in the adjacent cortical bone in both the maxilla and the mandible immediately after mini-implant placement. A cluster level analysis was used to analyze the data on the outcome measured. Since the measurements were clustered within dogs, a paired-samples t test was used to analyze the average differences between insertion methods at both jaw locations. A significance level of 0.05 was used for both analyses.
The self-drilling technique resulted in greater total crack lengths in both the maxilla and the mandible (maxilla: mean difference, 18.70 ± 7.04 μm/mm(2); CI, 13.29-24.11; mandible: mean difference, 22.98 ± 6.43 μm/mm(2); CI, 18.04-27.93; P <0.05), higher crack surface density in both the maxilla and the mandible (maxilla: mean difference, 10.39 ± 9.16 μm/mm(2); CI, 3.34-17.43; mandible: mean difference, 11.28 ± 3.41 μm/mm(2); CI, 8.65-13.90; P <0.05).
This study demonstrated greater microdamage in the cortical bones of adult hounds in both the maxilla and the mandible by the self-drilling insertion technique compared with the self-tapping technique.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 05/2012; 141(5):538-46. · 1.33 Impact Factor
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Journal of clinical orthodontics: JCO 02/2012; 46(2):85-91; quiz 123.
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ABSTRACT: Despite the known influence of early treatment on the facial appearance of growing patients with skeletal Class III malocclusion, few comparative reports on the long-term effects of different treatment regimens (1-phase vs 2-phase treatment) have been published. Uncertainty remains regarding the effects of early intervention on jaw growth and its effectiveness and efficiency in the long term. In this case report, we compared the effects of early orthodontic intervention as the first phase of a 2-phase treatment vs 1-phase fixed appliance treatment in identical twins over a period of 11 years. Facial and dental changes were recorded, and cephalometric superimpositions were made at 4 time points. In spite of the different treatment approaches, both patients showed identical dentofacial characteristics in the retention phase. Through this case report, we intended to clarify the benefits of undergoing 1-phase treatment against 2-phase treatment protocols for treating growing skeletal Class III patients.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 01/2012; 141(1):e11-22. · 1.33 Impact Factor
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ABSTRACT: Cuspid gigantism or radicomegaly is a rare occurrence often associated with a hereditary, X-linked condition, called oculo-cardio-facio-dental (OFCD)syndrome. This syndrome is also characterized by atrial septal defects and/or ventricular septal defects, congenital cataracts and unusual facial characteristics.Confirmation of this syndrome is often provided by dentists or orthodontists when they diagnose an extremely large canine root length from the panoramic radiograph. The following case report shows a multidisciplinary approach to the dental treatment of a patient with OFCD syndrome and a canine-first premolar transposition. The orthodontic approach required a mini-plate to achieve significant mesial movement of a gigantic maxillary canine that erupted in close contact with the first molar.
Journal of Orthodontics 12/2011; 38(4):282-9.
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ABSTRACT: The purpose of this study was to compare the activation and deactivation forces generated during first-order archwire deflections when different sizes and types of NiTi wires are paired with conventional and self-ligating brackets (SLBs) and to evaluate the rotational control between these same archwire and bracket combinations. Four maxillary premolar SLBs (Damon 3MX, SmartClip, Carriere, and In-Ovation R) and one conventional twin bracket (Victory) were paired with seven archwires [0.014, 0.016, 0.018, 0.016 × 0.022 Ultra Therm (thermal A(f)80-90°F), 0.016, 0.018 SPEED Supercable, and 0.017 × 0.025 Turbo]. A cantilever test design was used and 10 trials per bracket/archwire combination were performed. Load/deflection data were captured over 4 mm first-order archwire deflections. Forces generated were compared across all bracket/archwire combinations. Among thermal archwires, for a given deflection, forces increased with increasing archwire size. Supercable archwires displayed less force than their same size thermal counterparts. The Turbo archwire generated force values in between those of 0.016 and 0.018 thermal archwires. Rotational control improved with increasing wire dimensions and for a given archwire size. Rotational control among brackets generally ranked as follows: In-Ovation R > SmartClip > Carriere and Damon 3MX.
The European Journal of Orthodontics 10/2011; · 0.89 Impact Factor
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ABSTRACT: To compare the treatment effects of maxillary anterior teeth retraction with mini-implant anchorage in young adults with Class II division 1 malocclusion undergoing extraction of the maxillary first premolars with similar patients treated by a fixed functional appliance.
Thirty-four young adult female patients (mean age 16.5 ± 3.2 years, overjet ≥ 6 mm) with a Class II division 1 malocclusion were divided into two groups: group 1 (G1), in which overjet correction was obtained with a fixed functional appliance (FFA), and group 2 (G2), in which upper first premolars were extracted, followed by space closure with MIs as anchor units. Dentoskeletal and soft tissue changes were analyzed on lateral cephalograms taken before (T1) and after (T2) correction of the overjet.
Both methods were useful in improving the overjet and interincisal relationships. Extrusion and mesial movement of the lower molar, together with lower incisor proclination, were noted in G1. G2 showed distalization and intrusion of the upper molar. The nasio-labial angle became more obtuse in G2, while lower lip protrusion was seen for G1.
The two treatment protocols provided adequate dental compensation for the Class II malocclusion, but did not correct the skeletal discrepancy. There were significant differences in the dental and soft tissue treatment effects between the two treatment protocols.
The Angle Orthodontist 08/2011; 82(2):294-303. · 1.21 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the dimensional changes of the alveolar ridge in patients with congenitally missing maxillary lateral incisors. The width and height of the alveolar ridge were compared before and after opening space for an endosseous dental implant between the central incisor and canine. Pre- and post-treatment dental stone models of 31 patients (8 males, 23 females; mean age 15.1 ± 7.9 years pre-treatment, 17.6 ± 8 years post-treatment) with unilaterally or bilaterally, congenitally missing maxillary lateral incisors were used in this study. Pre- and post-treatment measurements included: the space between the maxillary central incisor and canine, the depth of the labial concavity, and the width and height of the lateral incisor alveolar ridge. Two different techniques were used to measure the ridge width. Student's paired samples t-test was used to test for significance. The alveolar ridge underwent statistically significant width loss (Method 1: 4-8 per cent, Method 2: 13-15 per cent) during the course of orthodontic treatment. A 6-12 per cent loss in ridge height was also noted. The depth of the labial concavity between the maxillary central incisor and canine nearly doubled. There was a significant decrease in the width and height of the alveolar ridge in patients congenitally missing a maxillary lateral incisor who received orthodontic treatment to create space for an endosseous dental implant.
The European Journal of Orthodontics 07/2011; · 0.89 Impact Factor
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ABSTRACT: Oculofaciocardiodental syndrome is a rare genetic disorder affecting ocular, facial, dental, and cardiac systems. The clinical diagnosis of oculofaciocardiodental syndrome can be challenging due to a wide variety of symptoms. Oculofaciocardiodental syndrome is found only in females due to its X-linked inheritance pattern and embryonic lethality for males. Radiculomegaly of canines is the most consistent finding in these patients. In this report we present a female patient with characteristic facial features, as well as a comprehensive overview of oculofaciocardiodental syndrome. Diagnosis of oculofaciocardiodental syndrome in this patient was verified by genetic analysis, during which we found a novel mutation in BCOR.
The Cleft Palate-Craniofacial Journal 07/2011; 49(5):e55-60. · 0.82 Impact Factor
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Journal of clinical orthodontics: JCO 04/2011; 45(4):223-8.
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Journal of clinical orthodontics: JCO 03/2011; 45(3):145-55.
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ABSTRACT: To develop a mouse orthodontic organ culture model and examine early-induced changes in osteoblast differentiation markers within the periodontal ligament (PDL) and alveolar bone.
Mandibles from 4- to 12-week-old transgenic mice were dissected and hemisected. A conventional superelastic orthodontic spring (25 grams) was bonded to the incisor and first molar on one side of the mandible; the other side served as a control. Dissected mandibles were cultured for 6 hours and then were histologically analyzed for proliferation (BrdU immunostaining) and fluorescent protein expression. Additionally, an in vivo model using the same methods was applied to 3.6 Col1-GFP transgenic mice.
In vitro, after 6 hours of orthodontic loading, a significant increase was noted in 3.6Col1-GFP- and BSP-GFP-positive cells within the tension side of the PDL compared with unloaded controls. On the compression side, a significant decrease in positive cells in 3.6Col1-GFP mice was observed in the PDL compared with unloaded controls. In vivo, the same tendencies were found.
This novel in vitro mandibular tooth movement organ culture model coupled with transgenic mouse technology provides a powerful tool for delineating initial cellular and molecular events of orthodontic tooth movement.
The Angle Orthodontist 03/2011; 81(2):284-91. · 1.21 Impact Factor
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ABSTRACT: The purposes of this study were to determine the incidence of open gingival embrasures after a single mandibular incisor extraction and to investigate whether age, sex, interproximal pretreatment and posttreatment contact location, or the type of mandibular incisor were predictors of the incidence and magnitude of open gingival embrasures.
Pretreatment and posttreatment intraoral frontal photos of 51 adults who had 1 mandibular incisor extracted were evaluated to determine the incidence and magnitude of open gingival embrasures.
The incidence of open gingival embrasures was 68%; the embrasures were moderately noticeable to very noticeable in 52% of those patients. Age, sex, incisor type, and location of interproximal contact before treatment were not predictors of open gingival embrasures after mandibular incisor extractions. An interproximal contact in the incisal third at the end of treatment was associated with the formation of an open gingival embrasure.
Open gingival embrasures are a common finding after the extraction of a mandibular incisor, and the magnitude of this embrasure is clinically noticeable.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 01/2011; 139(1):49-54. · 1.33 Impact Factor
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ABSTRACT: Implant site development through orthodontic extrusion can regenerate hard and soft tissue volumes lost to periodontal disease. This extrusive procedure is indicated especially when a maxillary incisor is severely compromised and the esthetic demands are high. This article describes a novel approach to alveolar bone development that enhanced the volume of the implant site. The technique involves tipping the maxillary incisor in the direction of the angular defect to increase alveolar bone volume in the implant site; simultaneous improvement of the interproximal papillary height can also be expected. With this procedure, immediate loading of the endosseous implant is possible due to the quality of the bone developed.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 11/2010; 138(5):649-55. · 1.33 Impact Factor
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ABSTRACT: INTRODUCTION: The objective of this study was to compare the degrees of skeletal and dental asymmetry between subjects with Class II subdivision malocclusions and subjects with normal occlusions by using cone-beam computed tomography. METHODS: Thirty subjects with Angle Class II subdivision malocclusions (mean age, 13.99 years) and 30 subjects with normal occlusions (mean age, 14.32 years) were assessed with 3-dimensional cone-beam computed tomography scans. Independent t tests were used to compare orthogonal, linear, and angular measurements between sides and between groups. RESULTS: Total mandibular length and ramus height were shorter on the Class II side. Pogonion, menton, and the mandibular dental midline were deviated toward the Class II side. Gonion and the anterior condyle landmark were positioned more posteriorly on the Class II side. The mandibular dental landmarks were located more latero-postero-superiorly, and the maxillary dental landmarks more latero-antero-superiorly on the Class II side. There was loss of maxillary arch length, and the mandibular molar was closer to the ramus on the Class II side. CONCLUSIONS: The etiology of Class II subdivision malocclusions is primarily due to an asymmetric mandible that is shorter and positioned posteriorly on the Class II side. A mesially positioned maxillary molar and a distally positioned mandibular molar on the Class II side are also minor contributing factors.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 11/2010; 138(5):542-3. · 1.33 Impact Factor
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ABSTRACT: The objective of this study was to compare the degrees of skeletal and dental asymmetry between subjects with Class II subdivision malocclusions and subjects with normal occlusions by using cone-beam computed tomography.
Thirty subjects with Angle Class II subdivision malocclusions (mean age, 13.99 years) and 30 subjects with normal occlusions (mean age, 14.32 years) were assessed with 3-dimensional cone-beam computed tomography scans. Independent t tests were used to compare orthogonal, linear, and angular measurements between sides and between groups.
Total mandibular length and ramus height were shorter on the Class II side. Pogonion, menton, and the mandibular dental midline were deviated toward the Class II side. Gonion and the anterior condyle landmark were positioned more posteriorly on the Class II side. The mandibular dental landmarks were located more latero-postero-superiorly, and the maxillary dental landmarks more latero-antero-superiorly on the Class II side. There was loss of maxillary arch length, and the mandibular molar was closer to the ramus on the Class II side.
The etiology of Class II subdivision malocclusions is primarily due to an asymmetric mandible that is shorter and positioned posteriorly on the Class II side. A mesially positioned maxillary molar and a distally positioned mandibular molar on the Class II side are also minor contributing factors.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 11/2010; 138(5):542.e1-20; discussion 542-3. · 1.33 Impact Factor
