Interdisciplinary treatment of a patient with amelogenesis imperfecta: Case report with a 35-year follow-up.

OBJECTIVE: This case will illustrate the interdisciplinary management of an adolescent female patient with amelogenesis imperfecta (AI). It will contrast this approach and compare it to the previous "multidisciplinary" treatment rendered before the patient was referred for a second opinion. CLINICAL CONSIDERATIONS: The patient had a family history of AI affecting all of her permanent teeth. There were many impacted teeth. The majority of her family and relatives afflicted by this opted for dentures. The patient had undergone 2 years of treatment and was told that her "braces would be removed next week." Her new dentist was concerned because the case was not ready to restore. CONCLUSION: He recommended referral to another orthodontist for a second opinion and formulation of an interdisciplinary treatment plan that would include a periodontist, endodontist, and restorative dentist. The patient's family accepted the second opinion referral and restarted treatment with an interdisciplinary team. The restorative dentist was the quarterback for this integrated and sequenced approach. The case was ultimately restored. A 35 year follow-up shows stability with a caries free, periodontally healthy, esthetic result.

Analysis of crown widths in subjects with congenitally missing maxillary lateral incisors.

The aim of the study was to test the hypothesis that the gene defect causing congenital absence of maxillary lateral incisors also causes narrowing of the dentition. A total of 81 patients with one or two congenitally missing lateral incisors were retrieved; 52 (64.2 per cent) patients presented bilateral agenesis, whereas 29 (35.8 per cent) had unilateral agenesis. The control group consisted of 90 consecutively treated patients. The largest mesiodistal crown dimension for all teeth, except for the maxillary second and third molars, was measured on plaster casts using a digital caliper to the nearest 10th of a millimetre. Statistical testing was performed using the analysis of variance model (P < 0.05) to test for differences in the mesiodistal dimension between the sample and the control group. Significance has been assessed using a P-value threshold level of 5 per cent. Agenesis of maxillary lateral incisors was found to be a significant predictor of tooth size. Patients who were missing maxillary lateral incisors had smaller teeth compared to control subjects, except for the maxillary right and left first molars. This finding was true for both unilateral and bilateral lateral incisor agenesis. Interaction between maxillary lateral incisor agenesis and gender was not significant. Patients with congenitally missing lateral incisors have narrower teeth than patients without any dental anomalies, except for maxillary first molars. A higher prevalence of microdontic contralateral incisors was found in patients with unilateral agenesis with respect to the control group.

Interdisciplinary Management of a Complex Esthetic Dilemma.

Esthetic dilemmas often require an interdisciplinary approach to achieve an optimal result. This article describes such a case in which the patient presented with unesthetic porcelain crowns on structurally compromised maxillary anterior teeth. The maxillary incisors had failing root canals, advanced mobility, and deep periodontal pockets. In addition, there was a congenitally missing maxillary lateral incisor. The canine substitution created a severely canted appearance exacerbated by the patient's high smile line. A coordinated interdisciplinary treatment plan was put into action to satisfy the patient's chief complaints and achieve a successful outcome. In this instance, this approach involved a periodontist, orthodontist, and prosthodontist, as well as initial input from an endodontist.

Postorthodontic root approximation after opening space for maxillary lateral incisor implants.

INTRODUCTION: Orthodontic space opening during adolescence is a common treatment for congenitally missing maxillary lateral incisors. Because of continued facial growth and compensatory tooth eruption, several years can elapse between completion of orthodontic treatment for a teenage patient and implant placement. There are reports that, after successful orthodontic opening of the implant space, the central incisor and canine roots reapproximate during retention and prevent implant placement. METHODS: To study this phenomenon, the records of 94 patients with missing maxillary lateral incisors were collected. Periapical and panoramic radiographs were used to measure intercoronal and interradicular distances between the central incisor and the canine adjacent to the missing lateral incisor before and after orthodontic treatment and at implant placement. RESULTS: Although root approximation between the adjacent central incisor and canine during retention did not occur consistently, 11% of the patients experienced relapse significant enough to prevent implant placement. CONCLUSIONS: To ensure sufficient space for implant placement, we recommend at least 6.3 mm of intercoronal space and 5.7 mm of interradicular space between the adjacent central incisor and canine. A bonded wire or resin-bonded bridge will help to reduce root approximation that might occur during retention.

Quality of clinical photographs taken by orthodontists, professional photographers, and orthodontic auxiliaries.

INTRODUCTION: A survey of the members of the Angle Society of Europe showed that 60% of orthodontists took their own clinical photographs, 35% assigned the task to an auxiliary, and 5% hired professional clinical photographers. It is always useful to ensure that orthodontists' time is used to maximum effect. Clinical photography could be delegated to auxiliary staff. In this study, we assessed the quality of photographs taken by orthodontists to see whether those taken by orthodontic auxiliaries and clinical photographers are of comparable quality. METHODS: Fifty sets of orthodontic photographs were collected from each of 3 types of photographers: orthodontists, orthodontic auxiliaries, and professional clinical photographers. Four assessors scored each set for quality and detailed errors. The results were compared to determine whether there were differences between the quality of the photographs taken by the different groups. RESULTS AND CONCLUSIONS: Most of the photos taken by the 3 groups of photographers were judged to be good or acceptable. The results for extraoral photographs showed no statistically significant differences between the 3 groups for good (P = 0.398) and acceptable (P = 0.398) images. The results for intraoral photographs did not differ significantly for acceptable and unacceptable photographs, but orthodontists produced significantly more good-quality intraoral photographs (P = 0.046).

Using orthodontic intrusion of abraded incisors to facilitate restoration: the technique's effects on alveolar bone level and root length.

BACKGROUND: The authors examined the effects of orthodontic intrusion of abraded incisors in adult patients to facilitate restoration, focusing specifically on changes in alveolar bone level and root length. METHODS: The authors analyzed records of 43 consecutive adult patients (mean age 45.9 years). They identified intrusion by means of cephalometric radiographs and bone level and root length by means of periapical radiographs. They calculated treatment differences from the pretreatment period to the posttreatment period. RESULTS: In general, bone level followed the tooth during intrusion, but a small amount of bone loss occurred (P< .0001). There were no significant associations with age, sex, treatment time, intrusion or pretreatment bone level. All intruded teeth exhibited significant root resorption during treatment (mean=1.48 millimeters). However, the change was similar to that seen in incisors that were not intruded. There were no associations with age, sex, treatment time or intrusion, but there was a positive relationship between pretreatment root length and root resorption. CONCLUSIONS AND CLINICAL IMPLICATIONS: Incisor intrusion in adults moves the dentogingival complex apically and is a valuable adjunct to restorative treatment. Potential iatrogenic consequences of alveolar bone loss and root resorption are minimal and comparable with the consequences of other orthodontic tooth movements.