Orthodontic Treatment of Patients With Clefts: Satisfaction and Psychological Aspects.

To assess parents' satisfaction with cleft child's facial appearance and function; compare these findings with orthodontist (expert) satisfaction and evaluate influence of various factors on satisfaction.Cross-sectional study.Sixty-three parents of non-syndromic patients with clefts (ages 7-20 years), and an orthodontist, completed the Cleft Hearing, Appearance and Speech Questionnaire. Two scores were produced: cleft-associated, and non-cleft-associated features. Additional open questions were presented to the parents.Both parents and orthodontist gave high satisfaction scores (mean: 8.4 & 8.2, respectively), significantly correlated, for the cleft-associated features (P < .001). Parents were least satisfied with appearance of teeth, then nose, then lips. Scores did not vary significantly with age and sex of patients. Higher parents' satisfaction was found in the unilateral cleft lip + alveolus (UCL + alveolus) group, compared with the unilateral cleft lip and palate (UCLP), regarding cleft-associated features, and compared with cleft palate (CP), regarding non-cleft-associated features (P < .05). Greater parents and orthodontist satisfaction were found when parents' education was >12 years. Parents of Jewish ethnicity showed higher satisfaction, compared with parents of non-Jewish ethnicity. Patients requiring future surgery received lower scores. Parents satisfaction was directly correlated to socioeconomic status.The following factors appear to lower parents' satisfaction: [1] cleft severity, [2] hearing or speech of CP/BCLP patients, [3] requirement for further surgery, and [4] low socioeconomic status.Severe cases may require additional explanation to parents in order to lower expectations. A more thorough explanation may be required in patients of lower socioeconomic status.

Maturation of teeth adjacent to dental agenesis site.

OBJECTIVE: The purpose of this study was to evaluate the developmental stage of teeth adjacent to the agenesis site in comparison to their antimeres. MATERIALS AND METHODS: Panoramic views of 39 patients with unilateral dental agenesis and 42 normal controls were evaluated. The dental developmental stage (normal or delayed) of the teeth adjacent to the agenesis site was determined for each patient using the Haavikko's method, while the overall dental age was determined by Becker's method. RESULTS: No statistically significant difference was found in the developmental stage of teeth adjacent to the agenesis, compared to their antimere and to the same teeth in the normal control group. However, the prevalence of cases with no difference in development was almost double for the tooth distal to the agenesis site compared to the tooth mesial to the agenesis site in the hypodontia group (84.6% distal and 43.6% mesial; p < 0.001) and in the control group (83.3% distal and 52.4% mesial; p < 0.002). In most of the cases the tooth distal to the agenesis site was the 1st permanent molar. CONCLUSIONS: (1) No difference was found between the developmental stage of teeth adjacent to the agenesis site and their antimeres. (2) Teeth mesial to the agenesis site showed some delay in development compared to teeth distal to the agenesis site, in this study. (3) The 1st molars, which were in most of the cases the distal adjacent tooth to the site of agenesis, showed developmental stability. (4) Additional longitudinal studies are needed to examine the dental developmental pattern in patients with agenesis.

Prevalence of dental features that indicate a need for early orthodontic treatment.

The aim of the study was to establish the prevalence of dental features that indicate a need for early orthodontic treatment (EOT). A group of schoolchildren in the mixed dentition stage (7-11 years old) (n = 432) was clinically screened for indications for EOT. Over 1/3 of the youngsters (34.7 per cent) presented at least one of the indications for EOT: anterior and posterior crossbites (including edge to edge occlusion) were found in 9.5 and 23.3 per cent, respectively; Angle Class III was found in 3 per cent; increased overjet (≥7 mm) prevailed in 3.7 per cent and was significantly related to risk for dental trauma (P = 0.001); while oral habits were practiced by 10.9 per cent, open bite was found only in 6.5 per cent, both predominantly among girls (P = 0.006 and P = 0.012, respectively); impinging overbite was present in 5.2 per cent, mainly in boys (P = 0.006); crowding >5 mm was found in 6.9 per cent for the maxilla and in 6 per cent for the mandible. Loss of tooth material affecting tooth position was found in 15.3 per cent. Normal occlusal relationships were found in 10.9 per cent only. The findings indicate that almost 1/3 of the examined children in the mixed dentition stage require EOT. Sexual dimorphism was demonstrated for several occlusal features.

Periodontal status of impacted maxillary incisors uncovered by 2 different surgical techniques.

PURPOSE: The aim of this retrospective study was to compare the postretention clinical appearance and the pulpal and periodontal status of surgically exposed and orthodontically aligned impacted maxillary central incisors, treated by 2 different surgical techniques-open eruption (OE) versus closed eruption (CE). PATIENTS AND METHODS: The OE group consisted of 11 patients, age 15 to 38 years. The 11 patients in the CE sample (aged 14-28 years) were selected from a larger group of patients treated by this method, by carefully matching them to the patients in the OE group, in terms of cause and height of impaction. The length of the follow-up period was comparable for both groups (median of 9 years for the CE group and 10 years for the OE group). The clinical and radiographic variables were compared by paired t and chi(2) tests. RESULTS: The only parameters where statistically significant differences between the 2 study groups were found were crown length and bone support; that is, the central incisors uncovered by the OE technique had longer clinical crowns (by a mean of 1.37 mm) and decreased bone support (7.5% less on the mesial side) compared with those treated with the CE technique. Pulp changes with crown discoloration were only seen in the trauma-related group, independent of surgical technique. CONCLUSIONS: The choice of surgical technique in the exposure of impacted central incisors has important implications in the success of the orthodontic treatment of impacted incisors, in the long term, in relation to periodontal support and to appearance.

Skeletal and dental patterns in patients with severe congenital absence of teeth.

INTRODUCTION: Children with severe congenital absence of teeth present uncommon morphologies and therapeutic challenges. This study was designed to investigate the characteristic skeletal and dental features of this group. METHODS: A group of 28 children with at least 10 congenitally missing teeth (excluding third molars) was examined roentgenographically. The data were collected from their intraoral series or panoramic views and lateral cephalograms. The results of their cephalometric analyses were compared with classic cephalometric norms and with local population norms. RESULTS: Specific patterns of incisor, premolar, and third molar absence emerged. The cephalometric parameters of the children with severe absence differed from the classic norms in bimaxillary retrognathism, chin angle, and maxillary incisor inclination. These children differed from the Israeli norms in almost all parameters examined. CONCLUSIONS: Patients with severe congenital absence of teeth have unique dental and skeletal patterns.

Buccal ectopia of maxillary canines with no crowding.

INTRODUCTION: Buccally displaced canines (BDC) are usually found in crowded dentitions. Nevertheless, a small but significant number of patients with BDC have no crowding. In this study, we compared BDC dentitions with no crowding (BDC-nc), BDC dentitions with crowding (BDC-c), and uncrowded dentitions with normally erupted canines (C). METHODS: The mesiodistal (MD) widths of maxillary permanent teeth, the prevalence of maxillary lateral incisor anomalies, and the dental age were compared in BDC-nc (n = 30; 17 male, 13 female), BDC-c (n = 41; 21 male, 20 female), and C dentitions (n = 40; 20 male, 20 female). RESULTS: No differences in the MD dimensions of the teeth in the BDC-nc and C subjects were found; teeth in the BDC-c group were slightly larger. Only the lateral incisor was consistently smaller in the BDC-nc group. The prevalence of lateral incisor anomalies was markedly increased in the BDC-nc (28.3%) compared with the BDC-c (7.6%) and the C (8.6%) groups. No discrepancies were found in dental age. CONCLUSIONS: These findings suggest that, in addition to a genetically based etiology, buccal displacement in BDC-nc subjects might also be the result of lack of guidance from an adjacent anomalous lateral incisor.

Occlusal patterns in patients with idiopathic scoliosis.

INTRODUCTION: Idiopathic scoliosis is an orthopedic condition characterized by faulty posture. It might also be associated with some mild forms of facial asymmetry or dental deviations. The aim of the study was to clinically examine the occlusions of patients with idiopathic scoliosis. METHODS: Ninety-six consecutive orthopedic patients with idiopathic scoliosis were examined. The orthopedic data of this group were recorded from their hospital files. The occlusal features of a random group of 705 Ashkenazi children served as the control. Frequency distributions were compared with the chi-square test. RESULTS: The distribution of the Angle classes of malocclusion was significantly different in the 2 groups (P = .0001) because of many Class II subdivision patients in the orthopedic group. Other evidence of asymmetrical malocclusion was found in upper (P =.002) and lower midline deviations (P =.0001), and a higher frequency of anterior (P = .024) and posterior (P =.020) crossbites. In the experimental group, no association was found between site, side, or severity of scoliosis and the appearance or site of the malocclusion features examined. CONCLUSIONS: Patients with idiopathic scoliosis have asymmetric features of malocclusion compared with a random population.

Conservative adjunct to esthetic orthodontic treatment in young patients.

The esthetic effect of orthodontic treatment in young patients may sometimes be incomplete without performing additional procedures related to the form and texture of the anterior teeth. Six young patients, aged 7 to 21 years, presented for orthodontic treatment to improve their dental esthetics. The problems of tooth staining, mutilation, congenitally missing teeth, tooth size/arch length discrepancy, and sequellae of dental trauma neccessitated a combined orthodontic-prosthodontic treatment. Changing morphology and texture by conservative prosthetic procedures proved to be a successful complement to orthodontic treatment.

Skeletodental patterns in patients with multiple congenitally missing teeth.

Congenitally missing teeth (CMT) are a relatively frequent phenomenon. In severe cases of multiple CMT, the skeletodental pattern can be unique. However, the characteristics of this pattern are still controversial. Thus, it was our aim to evaluate the skeletodental patterns of patients with multiple CMT and compare them with norms. Lateral cephalograms of 115 subjects with at least 3 CMT, of at least 2 different tooth groups (excluding third molars), were analyzed. The measurements were compared with classical and Israeli norms. Differentiation between anterior and posterior lack of teeth was also evaluated. In the CMT patients, the maxillary and mandibular basal bones were more retruded than in normal populations, but the intermaxillary relationship was normal. The profile was flatter than in the normal Israeli population but more convex than the classical norms. In the vertical dimension, the study group exhibited a reduced Frankfort mandibular plane angle when compared with Israeli norms. The dental pattern was characterized by upright incisors. When differentiation between anterior and posterior lack of teeth was undertaken, the above features were exacerbated in the patients with anterior tooth absence. It was concluded that patients with multiple CMT demonstrate a characteristic skeletodental pattern, especially those with missing incisors.

Closed-eruption surgical technique for impacted maxillary incisors: a postorthodontic periodontal evaluation.

The aim of this study was to evaluate the clinical appearance and pulpal and periodontal status of impacted maxillary central incisors that had been exposed and aligned after a closed-eruption surgical technique. Twenty-one patients were examined 4.5 years (median) postretention. The treated central incisors showed no significant differences in plaque and gingival indexes, widths of attached gingiva, and crown lengths, whereas a small, but statistically significant, increase was found in the mean pocket depth compared with the contralateral incisors. The bone support was reduced by 5% to 6% in the treated teeth, and, in one third of the cases, an abnormal gingival contour was recorded. The lateral incisors revealed similar plaque and gingival indexes and pocket depths on each side, but the lateral incisors immediately adjacent to the treated tooth showed decreased widths of keratinized gingiva and increased crown lengths. Even though statistically significant differences were found in some of the periodontal parameters measured, the overall clinical consequences of a conservative exposure and orthodontic alignment of impacted incisors by the closed-eruption technique are minimal.