The dark side of fixed retainers: Case series.

This article focuses on on the presentation and management 9 adult patients who experienced complications because of their maxillary or mandibular fixed retainers 5-33 years after orthodontic treatment. Such complications include the development of an anterior crossbite, open bite, incisal cant, and twist- and x-effects. The detrimental effects on periodontal health were highlighted, especially in the mandibular canines. A range of fixed retainer types was identified, including flexible spiral wire bonded to 4 maxillary or 6 mandibular anterior teeth, rigid wire bonded to mandibular canines only and fiber-reinforced composite fixed retainer. Orthodontic retreatment was necessary in all patients using fixed appliances or clear aligners. Radiographic findings from cone-beam computed tomography or orthopantomogram before and after retreatment are presented when available. Despite the improvement of teeth position clinically, the cone-beam computed tomography scans taken directly after the completion of orthodontic retreatment did not show notable improvement with regards to root proximity to the cortical plates. The prevention of further complications was highlighted, including the use of dual retention, remote monitoring, frequent follow-up appointments and the importance of developing clear guidelines for monitoring patients in retention for treating clinicians and general dentists to promote early detection of adverse changes.

A clinical case treated with clear aligners.

There are a wide variety of techniques, prescriptions and materials that can be used to correct malocclusions. Esthetic and discrete appliances have gained popularity in recent years and there seems to be a continual search for new materials that can provide similar orthodontic results. This article will describe the relevant aspects of clear aligners and present clinical cases to document some of the applications of Invisalign.

Skeletal and dental asymmetries in Class II subdivision malocclusions using cone-beam computed tomography.

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.

Dentists' Awareness of Physical Therapy in the Treatment of Temporomandibular Disorders: A Preliminary Study.

Background: Physical therapy (PT) has been shown to be one of the most effective conservative treatments for temporomandibular disorders (TMD). Not all dentists are aware of the importance of the collaboration with physical therapists in the treatment of TMD pain. Objectives: To determine the awareness of dentists in Florida about the importance of PT for TMD pain and to create awareness related to collaborations. Methods: An online questionnaire was used. A contact list of dentists was obtained from the Florida Dental Association. The overall awareness and information on patient referral were presented per dentist specialty. Results: A total of 256 dentists completed the survey. Prior to the survey, 41% of the dentists reported not aware that PTs can treat TMD patients. Oral surgeons and orthodontists were more aware about PT compared to other specialties. After the survey, 81% of the dentists were more likely to refer their TMD patients to PT, and 80% were interested to know more about the benefits of collaborations. Conclusion: This study shows the lack of dentists' awareness in Florida about the benefits of PT for TMD treatment. This study increased the awareness of the surveyed dentists in Florida about the benefit from a multidisciplinary approach.

Quantification of skeletal asymmetries in normal adolescents: cone-beam computed tomography analysis.

BACKGROUND: The detection and quantification of skeletal asymmetries is a fundamental component to diagnosis and treatment planning in orthodontics. The purpose of this study was to identify and quantify the characteristics of facial and dental asymmetries in a normal, adolescent population using 3D imaging. METHODS: Thirty consecutive Class I patients (mean age 14.32 years, SD 1.67) meeting the inclusion criteria were analyzed by three-dimensional cone-beam computed tomography (CBCT). Dental, maxillary, mandibular, and cranial base variables were measured with Dolphin 3D. CBCT analysis consisted of the localization of 34 anatomical landmarks. All reference points were digitized in 3D and analyzed using 67 skeletal and dental measurements. Student's t tests for paired samples were used with a significance level of p < 0.05. RESULTS: Minor right-left discrepancies were noted in all planes. The most anterior point of the glenoid fossa and most condylar points were positioned more superior and lateral on the right side, compared to the left side. Porion was also located more superiorly on the right side relative to the left side. The posterior nasal spine was found to be located to the right of the midsagittal plane. Slight dental midline discrepancies were found, and the dental arch lengths were slightly longer on the left side compared to the right. The height of the ramus, in both 3D and 2D, and the inclination of the ramus were greater on the right than that on the left side. CONCLUSIONS: The findings of this study suggest minor asymmetries exist and are likely a common occurrence in the normal human craniofacial complex. Additionally, a natural compensatory mechanism may exist which controls the size and shape of specific tissues in order to maintain functional symmetry.

Aparelhos ortodônticos sequenciais removíveis - considerações gerais e apresentação de caso clínico / Sequential removable orthodontic appliances - general considerations and presentation of a clinical case

Introdução: Atualmente, há uma grande diversidade de técnicas, prescrições e materiais disponíveis para correção das más oclusões. Os pacientes têm valorizado cada vez mais aparelhos estéticos e discretos, impulsionando a busca constante do desenvolvimento de dispositivos que atendam a essas expectativas e com os quais seja possível uma abordagem ortodôntica adequada. Relato de caso: Serão apresentados neste trabalho alguns aspectos relevantes sobre os alinhadores estéticos, além de um caso clínico tratado com o sistema Invisalign. Considerações finais: Este sistema é uma alternativa a ser usada com sucesso na ortodontia, por proporcionar ótima estética e conforto ao paciente, além de reduzir o tempo de cadeira e favorecer uma boa higiene bucal.