Evaluating the efficiency of mandibular molar protraction using Herbst appliances versus temporary anchorage devices: a retrospective case-controlled study.

BACKGROUND: Mandibular second premolar agenesis is a common problem in orthodontics and is often treated in conjunction with maxillary counterbalancing extractions. However, in cases without maxillary crowding or dental protrusion, space closure may pose challenges leading to compromised occlusal results or patient profile. Multiple techniques have been described to treat these patients; nevertheless, there is a paucity of data comparing effectiveness of space closure utilizing various anchorage techniques. The goal of this study is to assess the effectiveness of the Herbst device during mandibular molar protraction and compare it to the use of temporary anchorage device (TADs) in patients with mandibular second premolar agenesis. MATERIALS AND METHODS: This retrospective study included 33 patients with mandibular premolar agenesis treated without maxillary extractions. Of these patients, 21 were treated with protraction Herbst devices and 12 with TADs. Changes in molar and incisor positions, skeletal base positions and occlusal plane angulations were assessed on pretreatment (T0) and post-treatment (T1) lateral cephalograms. Scans/photographs at T0 and T1 were used to evaluate canine relationship changes representing anchorage control. Space closure and breakage/failure rates were also compared. Data was analyzed with paired and unpaired t-tests at the significance level of 0.05. RESULTS: Within the Herbst group, changes in mandibular central incisor uprighting and mandibular molar crown angulations were statistically significant. However, no significant differences were noted between the Herbst and TAD groups. Protraction rates as well as overall treatment times were comparable (0.77 mm/month vs. 0.55 mm/month and 3.02 years vs. 2.67 years, respectively). Canine relationships were maintained or improved toward a class I in 82.85% of the Herbst sample, compared to in 66.7% of the TAD sample. Emergency visits occurred in 80.1% of the Herbst group, with cementation failures or appliance breakages as the most common reasons. CONCLUSION: The Herbst device could be a viable modality in cases with missing mandibular premolars where maximum anterior anchorage is desired, or if patients/parents are resistant to TADs. Furthermore, they could be beneficial in skeletal class II patients with mandibular deficiency who also need molar protraction. However, the increased incidence of emergency visits must be considered when treatment is planned.

Treatment of absent maxillary lateral incisors: orthodontic space closure and associated procedures.

Missing maxillary lateral incisors can be treated either with orthodontic space closure or preservation of the edentulous space for tooth replacement. Orthodontic space closure coupled with non-invasive post-orthodontic cosmetic dentistry is a compelling option compatible with optimal function, favourable aesthetics, and periodontal health in the long-term. We present the rationale for space closure and detail contemporary clinical strategies underpinning interdisciplinary treatment planning and excellence in finishing.

Orthodontic bonding in special circumstances.

This clinical paper provides an in-depth exploration of advanced techniques for bonding orthodontic attachments under special circumstances. Challenges arise when bonding brackets to non-enamel surfaces, such as dental restorations, and in conditions such as amelogenesis imperfecta, which affect enamel integrity. Distinct approaches required for bonding to different restorative materials, including glassy ceramics, zirconia, resin composites and metals, are outlined. Moreover, we describe strategies to manage bonding in conditions including amelogenesis imperfecta, hypodontia and microdontia in a multidisciplinary context.

Control of anterior anchorage with miniscrews and sliding mechanics in an adolescent with missing second premolars: A clinical report with biomechanical validation.

Congenital missing second premolars in growing patients should be accurately evaluated in order to establish a suitable treatment plan. Concerning the decision of whether to close or maintain spaces in the dental arches, it shall also be based on biomechanical aspects and the aesthetic traits of individual patients. Accordingly, the option of closing tooth spaces requires an adequate application of biomechanical principles aimed at avoiding detrimental effects on dental arches and facial profile. An effective use of titanium miniscrews for immediate loading, associated with efficient sliding mechanics, can represent an elective way to successfully treat such cases. Herein, the objective is to describe the procedure and underscore the advantages of the mentioned approach by presenting a clinical case along with long-term follow-up.

Treatment strategy for patient with non-syndromic tooth agenesis: a case report and literature review.

BACKGROUND: Non-syndromic tooth agenesis (NSTA) is a type of ectodermal dysplasia (ED) in which patients with non-syndromic oligodontia may only affect teeth. No pathological findings were found in other tissues of the ectodermal. Herein, we report a case of a NSTA patient with severe dental anxiety and poor oral health. CASE PRESENTATION: A 5-year-old boy without systemic diseases presented as a patient with oligodontia, extensive caries, and periapical periodontitis. Molecular genetic analysis found a mutation in the Ectodysplasin A (EDA) gene, confirming the diagnosis of NSTA. CONCLUSION: Tooth agenesis (TA) is the most common ectodermal developmental abnormality in humans. Non-syndromic oligodontia patients often seek treatment in the department of stomatology. Because of their complex oral conditions, these patients should be provided with a systematic and personalized treatment plan.

[Etiology and clinical treatment strategies for second primary molars without permanent tooth germs].

Congenital tooth agenesis is a type of craniofacial developmental anomaly with reduced number of teeth, which is caused by disturbances in tooth germ development. If the number of missing teeth is less than six (excluding the third molars), it is termed as hypodontia. The second premolars are most commonly affected. When the second premolars are missing, the second primary molars are more prone to suffer from retention, infraocclusion, caries, pulpitis, or periapical periodontitis. Without timely prevention and appropriate treatment, congenital loss of second premolars may cause adverse effects on the patients' tooth arrangement, occlusal function, craniofacial development, and even future prosthetic treatment. This review summarises the aetiological and diagnostic features of the agenesis of second premolars, and discusses the clinical considerations of retaining or extracting the second primary molars without permanent tooth germs, when the absence of permanent tooth germs is fully established or not, so as to provide references for dentists.

Double crown removable partial denture for a patient with ectodermal dysplasia: A clinical report after 31 years.

This clinical report describes the prosthodontic management of a 5-year-old boy with ectodermal dysplasia who had been followed for 31 years. During the first 15 years, several interim removable overdentures were fabricated and modified according to his skeletal growth. At age 20, after the completion of jaw development, 4 endosseous dental implants were inserted in the mandible with a nerve repositioning procedure. After a 6-month healing period, maxillary and mandibular double crown removable partial dentures (RPDs) using a gold electroforming system were delivered. In the 16 years since delivery, the implants and abutment teeth have shown no pathologic signs. The double crown RPDs supported by implants and natural teeth were found to be an effective, long-term stable treatment option for this patient with hypodontia. The authors are unaware of a longer follow-up period of dental rehabilitation in a patient with ectodermal dysplasia providing satisfactory functional and esthetic results.

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.

Cleft lip and palate outcomes: Multidisciplinary approach for comprehensive management.

In patients with cleft lip and palate the most common associated dental problem is lateral incisor agenesis, often associated with lack of support and definition of the nasal tip. In many cases, adhesions deriving from surgical procedures and skeletal discrepancy make orthognathic surgery and rhinoseptoplasty unavoidable. In the present case report a dental rehabilitation with canine substitution and prosthetic-implant treatment in a posterior area is described. The use, during rhinoseptoplasty, of a customized titanium prosthesis, which provides projection for the tip of the nose, is also introduced. The patient was administered two questionnaires in order to assess the psychological aspects related to the cleft outcomes and the influence that the treatment conveyed.

A Case Against the Implant.

It is incumbent upon our profession to reevaluate our preference for routinely replacing a missing single maxillary incisor, especially a maxillary lateral incisor, with a dental implant in a young adult. The dental literature is replete with beautiful restorative results using implants in this area, but there is minimal discussion regarding the long-term consequences of this treatment. The maxillary lateral incisor is one of the most commonly missing teeth due to agenesis, and it is also one of the most common teeth to be lost due to trauma in the developing child.1 Therefore, the decision for replacement must be made with the long-term in mind, as these restorations are commonly placed between ages 18 and 21 and must serve the patient for many decades. There are several reasons that implants can be associated with complications or even fail, including the following: (1) Continued craniofacial growth, which has a predominant anterior and vertical component and has been shown to occur in the maxilla, resulting in the apparent submersion of the implant crown as the natural teeth move incisally in relation to the implant2,3-there is no evidence that this can be predicted, let alone how far into the future it may happen; (2) peri-implantitis, which has a patient-level prevalence estimate of nearly 25% according to the findings of a recent systematic review;4 (3) thinning and recession of the peri-implant mucosa due to poor implant placement, inadequate prosthetic management, and/or poor case selection, often resulting in compromised esthetics and a predisposition for the onset and progression of peri-implant diseases; and (4) mechanical failure of the implant, abutment screw, transmucosal abutment, and/or crown. Clinicians should also keep in mind that, once an implant is placed in the anterior maxilla, it precludes the possibility for palatal expansion in the adult patient because the space created by the expansion cannot be redistributed orthodontically. Canine substitution is one traditional method for replacement of the missing maxillary lateral incisor. It is still a viable option when the canine tooth has an acceptable shape and color, and the occlusion will not be compromised by the substitution.5 Additionally, the bonded single-wing zirconia bridge has become a primary treatment option.6 Zirconia has the strength of metal and beauty of porcelain, which makes it an ideal substrate for a bonded bridge. The literature has demonstrated the long-term success of this replacement option for the missing maxillary incisor.7 There are clearly many potential long-term disadvantages associated with replacing a single missing maxillary incisor with an implant in young adults. We should be prescribing the least-invasive treatment option for the replacement of these teeth. Therefore, when treatment-planning for a missing maxillary incisor in a young adult, alternatives to implant therapy-such as the bonded single-wing zirconia bridge and canine substitution-should be the primary treatment options. The implant should only be considered as a secondary treatment when the other options are not viable or have previously failed.

Evaluation of the aesthetics and clinical findings in patients with missing maxillary lateral incisors treated with a 10-year interval.

INTRODUCTION: The most common treatment approaches for patients missing maxillary lateral incisors are implant replacement (IT) and orthodontic space closure (SC). Treatment techniques change and improve over time, and it is of interest to know if improvements differ between the methods. AIM: To compare the aesthetic outcome and other clinical findings in patients with one or two missing maxillary lateral incisors who were treated with a 10-year difference in time, with either orthodontic space closure or implant replacement. MATERIAL AND METHODS: A total of 88 patients were included in the study. Forty-four patients treated between 2011 and 2018 were included as the latter cohort (LC). The LC was compared to the early cohort (EC; n = 44), treated between 2001 and 2008. A total of 132 teeth was analysed: 62 teeth in the EC (28 teeth in IT cases and 34 teeth in SC cases) and 70 teeth in the LC (34 teeth in IT cases and 36 teeth in SC cases). Long-term clinical and aesthetic outcomes were evaluated. RESULTS: An improvement over time was found in crown length, BoP, papilla, the inclination of incisors, and overall appearance in IT cases and in crown colour and overbite in SC cases. A deterioration over time was found in crown length and BoP among the SC cases. CONCLUSION: Among the IT cases, an improvement in outcomes was noted over time. When comparing SC cases the colour of the crown and overbite had improved, while crown length and BoP had deteriorated over time.

Agenesis of the maxillary permanent lateral incisors with the deciduous retained: Conservative and biomimetic approach using the BAIR technique.

OBJECTIVE: Agenesis of the maxillary permanent lateral incisors is a condition that requires treatment aimed at improving the esthetics, even at an early age. However, traditional therapeutic protocols are long, invasive and have limitations and contraindications imposed by the age of the patient. CLINICAL CONSIDERATIONS: Recent developments in restorative dentistry have provided a new approach to this clinical situation, in particular when the deciduous laterals are retained. We report two cases regarding the management of missing lateral incisors using Biologically Active Intrasulcular Restoration (BAIR) technique. The BAIR technique allows us to transform the shape of the deciduous lateral incisor into the permanent, acting both on the dental morphology and proportions, and on the appearance of the soft tissues and the gingival parables. CONCLUSIONS: The BAIR technique is a valid approach to cases of agenesis of the maxillary permanent lateral incisors, when the deciduous are retained. It does not require any preparation of the dental tissues, is reversible and minimally invasive. It is applicable to patients of all ages, and results are obtained in a single appointment. CLINICAL SIGNIFICANCE: The BAIR technique allows a biomimetic conservative approach for the rehabilitation of congenitally missing permanent lateral incisors, when the deciduous are retained. It is a non-invasive protocol and effective in successfully restoring esthetics.

Retratamiento multidisciplinar de una agenesia de un incisivo lateral superior con un implante cerámico monobloque. A propósito de un caso clínico / Multidisciplinary re-treatment of an agenesis of an upper lateral incisor with an one-piece ceramic implant. A clinical report

Introducción: Los implantes dentales de circona son una buena opción terapéutica que surge como alternativa a los implantes dentales convencionales de titanio, dadas sus excelentes propiedades de biocompatibilidad, baja acumulación de placa bacteriana y escaso infiltrado inflamatorio. El objetivo del presente caso clínico es describir la colocación de un implante monobloque de circona para reponer un incisivo lateral superior izquierdo en un paciente de 34 años de edad, para la posterior realización de una corona implantosoportada monolítica de circona. Descripción del caso: Se presenta un paciente varón de 34 años de edad, no fumador y sin antecedentes médico-quirúrgicos de interés (ASA I), que acudió a la consulta demandando una mejora en la estética de su sonrisa. El paciente presentaba una agenesia congénita en el incisivo lateral superior izquierdo que había sido tratada previamente con ortodoncia para cerrar dicho espacio. Tras el examen intraoral del paciente y el estudio radiográfico, se plantea la opción de tratamiento de abrir nuevamente el espacio mediante ortodoncia para rehabilitar la ausencia con un implante de circona, asegurando la estética que demandaba el paciente. Conclusiones: La rehabilitación mediante implantes de circona para el tratamiento de agenesias congénitas en incisivos laterales superiores, es una opción válida y efectiva, obteniendo resultados óptimos a nivel estético y funcional. Sin embargo, se necesitan más estudios clínicos con tamaños muestrales suficientes que comparen implantes de titanio y cerámicos con el fin de tener datos más concluyentes. (AU)

Introduction: Zirconia dental implants are a good therapeutic option emerging as an alternative to conventional titanium dental implants, given their excellent properties of biocompatibility, low bacterial plaque accumulation and low inflammatory infiltrate. The aim of the present clinical case is to describe the placement of a zirconia implant to replace an upper left lateral incisor in a 34-year-old patient, for the subsequent restoration of a monolithic implant-supported zirconia crown. Case description: A clinical case of a 34-year-old man is presented, nonsmoker and with no previous registered medical records (ASA I) who came to the dental clinic demanding an improvement in the aesthetics of his smile. The patient had a congenital agenesis of the left lateral incisor that had previously been treated with orthodontics to close the space. After the radiographic study and intraoral examination of the patient, the treatment option of reopening the space with a new phase of corrective orthodontics to rehabilitate the absence with a zirconia implant was proposed, ensuring the aesthetics demanded by the patient. Conclusions: Restoration using zirconia implants for the treatment of congenital agenesis in upper lateral incisors is a valid and effective option, obtaining optimal aesthetic and functional results. However, more clinical studies with sufficient sample sizes comparing titanium and ceramic implants are needed in order to have more conclusive data. (AU)

Retratamiento multidisciplinar de una agenesia de un incisivo lateral superior con un implante cerámico monobloque. A propósito de un caso clínico / Multidisciplinary re-treatment of an agenesis of an upper lateral incisor with an one-piece ceramic implant. A clinical report

Introducción: Los implantes dentales de circona son una buena opción terapéutica que surge como alternativa a los implantes dentales convencionales de titanio, dadas sus excelentes propiedades de biocompatibilidad, baja acumulación de placa bacteriana y escaso infiltrado inflamatorio. El objetivo del presente caso clínico es describir la colocación de un implante monobloque de circona para reponer un incisivo lateral superior izquierdo en un paciente de 34 años de edad, para la posterior realización de una corona implantosoportada monolítica de circona. Descripción del caso: Se presenta un paciente varón de 34 años de edad, no fumador y sin antecedentes médico-quirúrgicos de interés (ASA I), que acudió a la consulta demandando una mejora en la estética de su sonrisa. El paciente presentaba una agenesia congénita en el incisivo lateral superior izquierdo que había sido tratada previamente con ortodoncia para cerrar dicho espacio. Tras el examen intraoral del paciente y el estudio radiográfico, se plantea la opción de tratamiento de abrir nuevamente el espacio mediante ortodoncia para rehabilitar la ausencia con un implante de circona, asegurando la estética que demandaba el paciente. Conclusiones: La rehabilitación mediante implantes de circona para el tratamiento de agenesias congénitas en incisivos laterales superiores, es una opción válida y efectiva, obteniendo resultados óptimos a nivel estético y funcional. Sin embargo, se necesitan más estudios clínicos con tamaños muestrales suficientes que comparen implantes de titanio y cerámicos con el fin de tener datos más concluyentes. (AU)

Introduction: Zirconia dental implants are a good therapeutic option emerging as an alternative to conventional titanium dental implants, given their excellent properties of biocompatibility, low bacterial plaque accumulation and low inflammatory infiltrate. The aim of the present clinical case is to describe the placement of a zirconia implant to replace an upper left lateral incisor in a 34-year-old patient, for the subsequent restoration of a monolithic implant-supported zirconia crown. Case description: A clinical case of a 34-year-old man is presented, nonsmoker and with no previous registered medical records (ASA I) who came to the dental clinic demanding an improvement in the aesthetics of his smile. The patient had a congenital agenesis of the left lateral incisor that had previously been treated with orthodontics to close the space. After the radiographic study and intraoral examination of the patient, the treatment option of reopening the space with a new phase of corrective orthodontics to rehabilitate the absence with a zirconia implant was proposed, ensuring the aesthetics demanded by the patient. Conclusions: Restoration using zirconia implants for the treatment of congenital agenesis in upper lateral incisors is a valid and effective option, obtaining optimal aesthetic and functional results. However, more clinical studies with sufficient sample sizes comparing titanium and ceramic implants are needed in order to have more conclusive data. (AU)