The use of miniplates for nontraditional orthodontic treatment: clinical considerations for referring general dentists.

Distalization of mandibular molars comes with significant challenges, especially in adult and young adult patients. In selected cases, third molar extraction procedures offer the opportunity to place miniplates for anchorage to distalize mandibular molars, providing additional solutions to the traditional extraction of premolars or a single incisor. This approach can be of special interest to adult patients, who may have life commitments and time restraints that limit traditional orthodontic and surgical treatment options, and it can improve the efficiency of dental care. This case series describes 3 clinical scenarios in which miniplates were placed with minimal invasiveness during the removal of impacted third molars, offering the patients nontraditional orthodontic treatment options. Awareness of these options is essential for general dentists so that they can explain all treatment possibilities and provide appropriate referrals to patients with impacted third molars.

Comprehensive analysis of bone tissue in extraction sockets of third molars after leukocyte and platelet rich fibrin and photobiomodulation applications.

OBJECTIVES: The aim of this study was to compare leukocyte and platelet-rich fibrin (L-PRF) and photobiomodulation (PBM) applications, which have been repeatedly reported to be superior to control groups, in terms of pain, soft tissue and bone healing in tooth extraction sockets. MATERIALS AND METHODS: This double-blind, randomized clinical study was completed with 34 patients, who had an indication for extraction of their bilaterally impacted teeth. The right and left teeth of the patients were randomly divided into L-PRF and PBM groups. L-PRF group was treated with the blood product centrifuged for 12 min at 2700 rpm, and the PBM group was treated with a diode laser at different points for 60 s with a wavelength of 940 nm in repeated sessions. Postoperative pain was evaluated using Visual Analogue Scale (VAS), soft tissue healing with Landry Index (LI), tissue healing in the distal region of mandibular second molar by probing depth measurement, and bone healing via panoramic x-ray using the Image J program. RESULTS: No statistically significant difference was found for any variable compared between the groups. CONCLUSION: L-PRF and PBM applications provide similar support in the healing of extraction sockets. Nevertheless, the advantages and disadvantages of both methods determine their usage areas. CLINICAL RELEVANCE: While L-PRF is advantageous in the early healing of extraction sockets, PBM may be preferred in terms of bone trabeculation in the long term.

Effect of force direction and impaction angulation during dilaceration impacted central incisor traction: a finite element analysis.

BACKGROUND: The effects of traction forces at different angles on impacted central incisors(ICI)with varying inverted angles (IA) may be different. The objective of this study was to analyze the biomechanical effects of different force directions (FD) on developmentally inverted ICI with multi-angle variations and to offer insights and guidance for the treatment of inverted ICI. METHODS: Three-dimensional finite element method was employed to simulate clinical scenarios of inverted ICI traction. As such, 0.2 N of force (direction: antero-superior angles of 90°, 100°, 110°, 120°, and 130° relative to the long axis of the inverted ICI crown) was applied to the inverted ICI with inverse angles (IA) of 40°, 30°, 20°, 10° and 0°. Inverted ICI apical displacement and Von Mises stress on periodontal ligament (PDL) and alveolar bone were compared. RESULTS: IA and FD showed minimal influence on the stress distribution in the PDL, as higher stresses were concentrated in the apical region. The higher stresses in the alveolar bone are focused on the cervical and apical regions of the tooth. In particular, IA exerts a more significant impact on stress distribution in the alveolar bone than FD. The influence of IA on the apical displacement of inverted ICI is larger than that of FD. CONCLUSIONS: To promote the health of the root and periodontal tissues, it is recommended to use an angle of 100°-110° relative to the long axis of the ICI crown when dealing with a large IA (> 20°) developmentally inverted ICI. Conversely, an angle of 110°-120° can be used.

Impacted Mandibular "Double" Third Molar: Fusion or Gemination? A Case Report.

Dental fusion is defined as an abnormality in tooth shape caused by developmental tooth disturbances that produce an intimate union of dental tissues. This case report discusses treatment of a mandibular impacted "double" third molar in a 21-year-old patient that could have been related to either gemination or tooth fusion. Radiological examination allowed for careful analysis of the tooth's shape and root development, relation to the inferior alveolar nerve, and 3-dimensional position. After evaluation of therapeutic options and risks, and with the patient's consent, the authors opted to extract the tooth in question. Such favorable conditions as the incomplete development of the roots and the relatively young age of the patient, combined with the use of an antibiotic and antiseptic prophylaxis as well as a standard surgical approach, enabled a successful result to be achieved with no related complications.

Therapeutic reassessment of impacted or transposed teeth / Réévaluation thérapeutique des dents incluses ou transposées

Introduction: Impacted or transposed teeth present a common yet challenging issue in dentistry. These conditions occur when teeth fail to erupt properly or emerge in abnormal positions within the dental arch. Material and Method: This article explores the evolving landscape of therapeutic strategies for impacted or transposed teeth, emphasizing a multidisciplinary and patient-centered approach. Results: By adopting a multidisciplinary approach involving orthodontists, oral surgeons, and other dental specialists, clinicians can tailor treatment plans to address individual needs and optimize outcomes. Discussion: Therapeutic reassessment of impacted or transposed teeth represents a paradigm shift in modern dentistry, emphasizing personalized care, minimally invasive techniques, and interdisciplinary collaboration.

Introduction: Les dents incluses ou transposées présentent un problème courant, quoique difficile à gérer. Ces conditions surviennent lorsque les dents ne parviennent pas à faire leur éruption correctement ou émergent dans des positions anormales au sein de l'arcade dentaire. Matériel et méthode: Cet article explore le paysage évolutif des stratégies thérapeutiques proposées pour la prise en charge des dents incluses ou transposées, en mettant l'accent sur une approche multidisciplinaire centrée sur le patient. Résultats: En adoptant une approche multidisciplinaire réunissant des orthodontistes, des chirurgiens oraux et d'autres spécialistes dentaires, les cliniciens peuvent adapter les plans de traitement au mieux pour répondre aux besoins individuels de chaque patient et optimiser les résultats. Discussion: La réévaluation thérapeutique des dents incluses ou transposées représente un changement de paradigme en dentisterie moderne, mettant l'accent sur les soins personnalisés, les techniques mini-invasives et la collaboration interdisciplinaire.

Interdisciplinary management of an adolescent patient with a severely impacted mandibular canine.

Impacted mandibular canines often result in a variety of clinical dilemmas. Orthodontic disimpaction of severely displaced mandibular canines may be extremely challenging and associated with significant patient discomfort and a high risk of iatrogenic damage. This case report demonstrates the interdisciplinary management of a horizontally impacted permanent mandibular canine, utilising a combination of three-dimensional radiology, biomodel fabrication and subsequent endodontic treatment. © 2024 Australian Dental Association.

Treatment duration by morphology and location of impacted maxillary canines: A cone-beam computed tomography investigation.

INTRODUCTION: This study aimed to identify whether patients with impacted maxillary canines take longer to treat than orthodontic patients without an impacted canine. We also sought to identify factors that are predictive of increased treatment duration in patients with impacted maxillary canines and treated by surgical exposure. METHODS: A retrospective investigation of 37 patients with an impacted maxillary canine, treated by surgical exposure and fixed appliance therapy, was undertaken. In addition, an age- and sex-matched control group of 39 patients (without impacted canines) was also collected. Patient age, sex, and total treatment duration were recorded. For patients with an impacted canine, patient records and pretreatment cone-beam computed tomography datasets were assessed. Point coordinates identifying relevant landmarks were recorded, and a geometric method was used to calculate variables describing canine location, orientation, and apical morphology. RESULTS: Controlling for age and sex, linear regression identified a statistically significant increase in treatment duration of 46.7 and 41.5 weeks for palatal and labial/midalveolar impacted canines, respectively, vs controls (P <0.002). Age and sex of patients with impacted canines collectively affected treatment duration (P = 0.04), with females of increased age being treated faster than younger males. Rotation of the impacted canine crown had a highly significant effect on treatment duration, with every degree of rotation increasing treatment duration by 0.32 weeks (P <0.001). There was a significant degree of multicollinearity between the other radiographic variables. Collectively, radiographic variables describing canine displacement significantly prolonged treatment duration (P <0.001) and explained 29.8% of the variability in total treatment time. The apical morphology of impacted maxillary canines was significantly associated with increased treatment duration (P = 0.01) and explained 11.3% of the overall treatment variability (P = 0.01). CONCLUSIONS: Increased total treatment duration of surgically exposed impacted maxillary canines is associated with increasing mesiopalatal canine crown rotation, worsening displacement, and hooked apical morphology.

Autotransplantation of an inverse impacted dilacerated incisor: a case report with 11-year follow-up.

BACKGROUND: Dilaceration can lead to impaction of maxillary incisors, resulting in both aesthetic and functional problems. This case report presents the multidisciplinary approach to managing an inverse impacted dilacerated left lateral incisor in a 9-year-old male patient. CASE REPORT: The orthodontic alignment of the remaining three incisors was achieved within six months. After using the diode laser to remove the gingiva covering the right lateral incisor during alignment process, a lingual button was bonded. The primary left canine and the impacted permanent left lateral incisor were extracted by raising the full-thickness mucoperiosteal flap, followed by the transplantation of the dilacerated lateral incisor into its correct position, splinted to the adjacent central incisors using composite resin. Root canal treatment was performed after the apical plug was created with mineral trioxide aggregate. The composite splint was removed after three weeks, and a new bracket was bonded to the left lateral incisor. It was left passively for 18 months until the permanent canines started to erupt. Light orthodontic forces were then applied for six months, and a passive eruption was expected over three months to properly position the canines within the dental arch. After an 11-year follow-up, the incisor displayed no clinical symptoms, although radiographic examination revealed external resorption in the long-term. CONCLUSION: This case demonstrates the successful and fast autotransplantation of an immature inverse impacted dilacerated incisor, highlighting the long-term clinical success and favorable aesthetic outcomes.

Strategic treatment for a patient with missing lateral incisor and first molar accompanied by posterior scissor bite and an impacted premolar.

Managing orthodontic treatment for adults with missing permanent teeth can be intricate, especially when dealing with a posterior scissor bite and an impacted tooth. This case report presents successful treatment of a female patient with dental and skeletal Class II malocclusion, high mandibular plane angle, missing maxillary left lateral incisor and mandibular right first molar, as well as right posterior scissor bite, and a deeply impacted mandibular left second premolar. In the maxilla, the right second molar and right lateral incisor were strategically extracted to eliminate the scissor bite and enhance frontal esthetic balance. In the mandible, the edentulous space caused by early loss of the first molar was successfully closed and the impacted second premolar was guided into its proper position after surgical exposure. Finally, symmetric frontal esthetics, well-aligned dentition with ideal intercuspation and an improved profile were achieved, which remained stable in the 17 month follow-up.

Alveolar bone retention following treatment of dilacerated labial inversely impacted maxillary central incisors-a retrospective study.

The root of late-dental-age labial inversely impacted maxillary central incisors (LIIMCIs) typically develops to severe dilacerated morphology. Therefore, reliable posttreatment periodontal estimates of orthodontic treatment prognosis would be critical to the treatment value of impacted incisors. This study aims to analyze further changes in dimensions of the alveolar bone following the closed-eruption treatment of late-dental-age dilacerated LIIMCIs. Cone beam computed tomography (CBCT) scanning data of 16 patients with unilateral dilacerated late-dental-age LIIMCIs were collected, including the pretreatment (T1) and at the 2.23 ± 0.78 years follow-up stage (T2) respectively. Patients underwent closed-eruption treatments to bring the impacted incisor into the dental arch. Dolphin imaging software was used to measure alveolar bone height labially, palatally, and proximally to the site at T1 and T2, as well as alveolar bone thicknesses at 0, 2, 4, 6 and 8 mm below the initial measurement plane (IMP). The alveolar bone heights on the impacted and contralateral sides increased from T1 to T2 (p < 0.05). Alveolar bone growth on both sides had no significant difference. In T2, the mean values of labial and distal alveolar heights on the contralateral sides were greater than on the impacted sides (p < 0.05). The mean values of total alveolar bone thicknesses on the impacted sides in T1 were significantly smaller than those on the contralateral sides in IMP-0, 2, 4, 6, 8 (p < 0.05). The total thicknesses on the impacted sides in T2 increased and were significantly greater than on the contralateral sides (p < 0.05), except for the thickness in IMP-0. The closed-eruption treatment of dilacerated late-dental-age LIIMCIs results in no significant changes to alveolar bone height, except on the labial and distal sides, with increased alveolar bone thickness, suggesting that this approach may be viable first choice therapy for non-extraction orthodontic cases.

Uprighting a mesially impacted mandibular second molar with scissor bite using simple tubes.

Orthodontic uprighting or traction of an impacted mandibular second molar often necessitates invasive interventions. This report aims to illustrate the utilization of nickel-titanium wire segments inserted into small, simple tubes for uprighting mesially impacted mandibular second molars and also for scissor bite correction. The term "simple tube" refers to a tube without a bonding base attached to a tooth surface by covering it with flowable composite resin. Due to the absence of a bonding base, the simple tube is characterized by its diminutive size and minimal profile height, facilitating placement on partially exposed second molars and unconventional positioning to adjust the force geometry. In this case study, mesially-impacted mandibular second molars with scissor bite were uprighted in a 21-year-old male utilizing simple tubes. Simple tubes can be used for molar uprighting and scissor bite correction buccally and lingually.

Uprighting horizontally impacted third molars by super-elastic nickel-titanium wire in patients with an extracted first molar.

Protracting lower second molars and uprighting horizontally impacted third molars is a significant orthodontic challenge in patients who require the extraction of severely decayed first molars. Here, we describe the use of biomechanics to upright 90°-tilted lower third molars following second molar protraction. Herein, we introduce a technique for uprighting the lower third molars by (1) the placement of superelastic nickel titanium archwires, (2) bonding, and (3) repositioning of a buccal tube in a tilted position to compensate for the efficiency of Ni-Ti (nickel-titanium) wire. The treatment mechanics used for our two cases showed that even severely impacted third molars can be uprighted by routine continuous straight-wire techniques. This technique proved to be a simple, efficient and reliable treatment option for uprighting horizontally impacted third molars.

Quality analysis of the clinical practice guidelines for management of impacted maxillary central incisors: a systematic review.

PURPOSE: To assess the quality of clinical practice guidelines (CPG) for management of impacted central incisors. METHODS: Search was performed in PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane databases, and guideline-focused databases/repositories on 15-09-2022 without any limitations and was updated on 15-07-2023. Grey literature search was also performed. Two independent reviewers were involved in the study selection and data extraction. Quality assessment of the included CPG was performed by four independent appraisers using the AGREE-II instrument. The degree of agreement among the appraisers was calculated using the intraclass correlation coefficient (ICC). RESULTS: Five CPG were included in the review. The Ministry of Health, Malaysia (MHM) guideline obtained the highest scores in all six domains of AGREE-II and an overall score of 73% demonstrating the "highest" quality. The remaining four guidelines obtained overall "low-quality" scores ranging from 34.57-37.52%. The ICC scores ranged from 0.530 to 0.990 for various domains of AGREE-II. CONCLUSION: MHM guidelines demonstrated high-quality scores in domains of 'scope and purpose', 'clarity of presentation', 'applicability domain', and 'editorial independence', while others were found to have moderate or low quality. This review identified areas that can be addressed by future guideline developers to avoid these discrepancies.

Appropriate timing of treatment contributes to better root development of impacted anterior teeth in children.

INTRODUCTION: This study investigated the effects of different timings of orthodontic treatment on the root development of impacted anterior teeth in children. METHODS: The cone-beam computed tomography (CBCT) data of 45 children with impacted anterior teeth were divided into unformed root (UR) group or basically formed root (BFR) group to evaluate root length (RL) and root growth length (RGL) of impacted teeth and contralateral nonimpacted teeth pretreatment and posttreatment. In addition, 22 patients with impacted dilaceration were selected to assess the effects of the crown-root angle and root development stage on RL and RGL. The Student t test, Wilcoxon test, analysis of variance, and multiple linear regression analysis were used for statistical evaluations. RESULTS: The RL of treated impacted teeth pretreatment and posttreatment was significantly shorter than contralateral nonimpacted teeth values (P <0.05). Posttreatment, the RL and RGL of impacted teeth of the UR group were significantly greater than those of the BFR group (P <0.05). The RGL of the dilacerated root in the UR group was considerably higher than in the BFR group (P <0.05). The larger crown-root angle group had a longer posttreatment RL (P <0.05). Multiple linear regression analysis revealed that the Nolla stage of impacted teeth and RL of contralateral teeth pretreatment significantly influenced the RL of impacted teeth posttreatment. CONCLUSIONS: Prompt orthodontic treatment is necessary for children with impacted anterior teeth to release the impacted state and achieve better root development. The root length of a dilacerated tooth continued to develop under treatment, but the crown-root angle partly constrained it.

Will supplemental cone beam computed tomography change the treatment plan of impacted maxillary canines based on 2D radiography? A prospective clinical study.

AIM: To evaluate the impact of cone beam computed tomography (CBCT) on treatment planning for impacted maxillary canines; secondly, to identify CBCT factors influencing a change in the treatment plan; and thirdly, to assess 2D radiographic factors that can aid in selecting appropriate candidates for CBCT. MATERIAL AND METHODS: Patients with impacted maxillary canines and an overlap of a neighboring tooth in 2D radiographs and the suspicion of root resorption were referred for CBCT examination. An initial treatment plan was based on 2D radiographs, and the final treatment plan was established after the CBCT examination. Logistic regression analyses and t-tests were performed to evaluate differences in radiographic findings between the groups with and without a change in treatment plan. RESULTS: The study prospectively included 125 impacted canines, and 43 (34.4%) of them had a change in treatment plan after the CBCT examination. The most common change was a modification in the direction of cantilever traction (n = 28; 22.4%), while the least common was the change in decision to remove/keep the canine (n = 4; 3.2%). The size of the alpha and lateral angles had a significant impact on the decision to change the treatment plan. Other radiographic findings did not influence a change in treatment plan. CONCLUSIONS: One-third of the canines had a change in treatment plan after supplemental CBCT examination. Canines with large alpha and lateral angles measured in the panoramic image were found to be significantly more likely to undergo changes in the initial direction of cantilever traction or changes to the canine extraction strategy following CBCT examination.