Interdisciplinary management of a patient with a bilateral cleft lip and palate and 12 congenitally missing teeth.

This article reports the interdisciplinary treatment of a girl born with a complete bilateral cleft lip and palate. She had congenitally missing maxillary lateral incisors and canines and mandibular incisors, canines, and second premolars in addition to third molars. At age 11 years 2 months, she was treated with rapid maxillary expansion followed by bonding of the maxillary arch. Cranial harvested alveolar bone graft surgery was done at age 17 years 2 months. Mandibular arch treatment was started at age 19 years using single tooth implants initially as orthodontic anchorage devices and secondarily as prosthetic abutments. Teeth were placed in strategic positions for a 4 incisor fixed partial denture cemented on the 2 lateral incisor implants and screw-retained crowns on premolar implants. The maxillary arch was restored with screw-retained crowns on canine implants with lateral incisors in cantilever and pink ceramic. Two years posttreatment records at age 22 years 6 months showed long-term stability with good occlusion, facial balance, and smile esthetics.

[Adult orthodontics for a better prosthesis]. / L'orthodontie adulte pour une meilleure prothèse.

INTRODUCTION: Adult patients are seen more frequently in our orthodontic offices. Unlike the adolescent, the adult patient will often need a multidisciplinary approach due to tooth migrations secondary to extractions or periodontal disease. MATERIALS AND METHODS: This article will address the indications and orthodontic solutions to various restorative problems relative to the adult patient. Specific orthodontic mechanics aimed at facilitating and improving the prosthetic outcomes will be described and illustrated with clinical cases.

[Agenesis of the maxillary lateral incisors: orthodontic and implant approach]. / Agénésie des incisives latérales maxillaires: approche orthodontique et implantaire.

Missing maxillary lateral incisors create a major esthetic problem due to their strategic position in the smile. The two treatment approaches commonly taken are creating adequate space to prosthetically replace the missing lateral incisors or closing the spaces and replacing the missing lateral incisors by the canines. This article will discuss indications, advantages, disadvantages and problems encountered in cases of space opening and space closure for missing laterals. The amount of space to be created, the preparation and the timing for implant placement, the bone volume, the implant size and prosthetic considerations will also be discussed. The methods for reshaping canines and building them up to simulate lateral incisors in orthodontic space closure, and positioning the canines and first premolars - so that they resemble to the teeth they are replacing - will be described.

Influence of prosthetic parameters on the survival and complication rates of short implants.

PURPOSE: Implants shorter than 10 mm can be a long-term solution for sites with limited bone height. The purpose of this study was to determine the influence of some prosthetic factors on the survival and complication rates. MATERIALS AND METHODS: Two hundred sixty-two short machined-surface Brånemark System implants were consecutively placed in 109 patients and followed for a mean of 53 months. The prosthetic parameters were recorded, and the data were examined for relation to peri-implant bone loss and biologic or biomechanical complications. RESULTS: Relatively few crown-to-implant (C/I) ratios were < 1 or > 2 (16.2%). Occlusal table (OT) width ranged from 5.4 to 8.3 mm. Opposing dentition was most often natural teeth, a fixed prosthesis supported by natural teeth, or an implant-supported fixed restoration. Occlusion with a normal buccolingual maxillomandibular relationship was found in 72.7% of the cases. No significant difference in peri-implant bone loss was correlated with C/I ratio or OT. Neither cantilever length nor bruxism had a significant effect on peri-implant bone loss. Mean bone loss was 0.74 +/- .65 mm. The difference in the complication rate (15% overall) between the bruxer and the nonbruxer group was not statistically significant (P = .51). One implant was lost in a heavy bruxer after 7 years of function. DISCUSSION: Increased C/I and OT values do not seem to be a major risk factor in cases of favorable loading. In 67% of the cases, the mesiodistal length of the prosthesis was less than the corresponding natural tooth length, which may have contributed to better load distribution and more favorable results. CONCLUSIONS: Short implants appear to be a longterm viable solution in sites with reduced bone height, even when the prosthetic parameters exceed the normal values, provided that force orientation and load distribution are favorable and parafunction is controlled.