Combined orthodontic and surgical treatment supported by virtual planning in a severe mandibular asymmetry: A case report.

This article describes the complex dental treatment of a 17-year-old girl with skeletal Class I, severe mandibular asymmetry, maxillary retrusion, normodivergent pattern, left canine and molar Class II, canting of the occlusal plane, lateral left cross-bite, deep bite, upper and lower incisors retrusion and an increased curve of Spee. To achieve optimal results, a multidisciplinary approach to treatment was adopted involving orthodontics and maxillofacial surgery. The surgical phase was supported by virtual surgical planning with dedicated software. Thanks to the development of the three-dimensional radiological findings, a visualization and an accurate simulation of all the surgery-steps help to determine reproducibly and with high precision the best adjustments to do. Firstly, the excessive curve of Spee, the incisors retrusion and the deep bite were corrected with orthodontic treatment. The surgical treatment plan consisted of a palatal expansion, maxillary advancement, zygomatic grafts, bilateral sagittal osteotomy for mandibular correction and genioplasty. Orthodontic treatment was continued to finish with all the objectives achieved. After two years, the patient was satisfied with her facial and dental treatment results and with her oral function as well.

Middle phalanx maturation of the third finger (MPM) method in the evaluation of skeletal age in a growing orthodontic patient.

A 12-year-old boy consulted with a severe skeletal class II malocclusion, proclination of the upper incisors with diastemas in the upper arch, 11mm of overjet, a Bolton discrepancy, deep bite and a severe curve of Spee. Treatment included evaluation of the skeletal age using the middle phalanx maturation of the third finger (MPM) method in order to assess the pubertal growth spurt. When this period was reached, a Herbst was applied for 8 months; then fixed orthodontic treatment was delivered for 16 months. At the end of orthodontic treatment, restorative therapy was given to improve the shape of the upper incisors. Retention was provided with a Boston splint in the upper arch and a spring retainer in the lower arch. Precise evaluation of a patient's skeletal age can shorten orthodontic treatment and enhance compliance.

Maturation of the Middle Phalanx of the Third Finger: A Comparative Study between Right and Left Hand.

OBJECTIVES: Recently a classification of patient's skeletal age based on the phalanx maturation, The Middle Phalanx Maturation of the third finger (MPM) method, was suggested. The aim of this study is to evaluate if there is a difference in MPM between the right and left hand. STUDY DESIGN: Two hundred fifty-four patients were obtained from the Complex Operating Unit of Orthodontics of Padua University Hospital. The total sample size has been selected by appropriate statistical calculations resulting in 130 patients. It was decided to further double the sample size of a previous study to ensure a robust statistical analysis. Radiographs of the right and left were obtained using the MPM method. Stages were compared using the right hand as a reference. The statistical analysis (Fisher exact test) was performed for the entire sample and related to gender in order to compare the right and the left hand stages. RESULTS: In MPS2, 6 out 49 (12.2%) males and 7 out 27 females (25.9%) showed MPS3 in the left hand (p-value < 0.05). In all other stages, a total agreement (100%) was found. CONCLUSION: The authors confirm the use of the right hand as reference. In patients with MPS2 an additional radiograph on the left hand can be taken in order to increase the diagnostic accuracy. In all other stages other radiographs are not needed as a total agreement between the right and left hand was found.

The use of computer-assisted corticotomy to enhance surgical procedures.

In recent years, several surgical techniques have been proposed with the main goal of reducing the length of orthodontic treatment. Some of these techniques use a piezoelectric surgical instrument to perform alveolar bone cuts and promote localized bone turnover. One of the main limitations of these surgical techniques is that corticotomies may damage dental roots since traditional radiographic examinations do not allow the surgeon to precisely determine the length and three-dimensional position of the roots. In this case report, the authors aim to describe a method in which, starting from the patient's CBCT dicom files, they were able to plan the location and depth of the bone cuts and to build a surgical guide to be used during piezoelectric bone surgery. In addition, the technique and final results are described, as well as a two-year follow-up showing stable results.

Anterior open-bite orthodontic treatment in an adult patient: A clinical case report.

A 45-year-old woman presented with an anterior open-bite complaining chiefly of her unpleasant smile esthetics and masticatory and speech problems. Treatment included speech therapy initiated immediately after bonding. Lingual spurs were positioned on the mandibular incisors in order to help tongue rehabilitation. During the working phase, temporary anchorage devices (TADs) were used at the mandibular anterior segment to intrude the lower left premolars. A splint was used to ensure retention in the upper and lower arches; an enveloppe linguale nocturne (ELN) was provided. Non-surgical open-bite treatment could offer a valid alternative to orthognanthic surgery when cephalometric evaluation shows no vertical growth pattern; patient compliance is essential to prevent relapse.

Orthodontic treatment of a transposed maxillary canine and first premolar in a young patient with Class III malocclusion.

A 12-year-old girl was referred to our clinic for evaluation of an unaesthetic dental appearance. All permanent teeth were erupted, while the deciduous maxillary right canine was retained. Cone-beam computed tomography revealed a complete transposition of the maxillary left canine and first premolar involving both the crowns and the roots. Initial cephalometric analysis showed a skeletal Class III pattern, with a slight maxillary retrusion and a compensated proclination of the upper incisors. The patient's teeth were considered to be in the correct position; therefore, we decided to attempt treatment by correcting the transposition and using only orthodontic compensation of the skeletal Class III malocclusion. After 25 months of active orthodontic treatment, the patient had a Class I molar and canine relationship on both sides, with ideal overbite and overjet values. Her profile was improved, her lips were competent, and cephalometric evaluation showed acceptable maxillary and mandibular incisor inclinations. The final panoramic radiograph showed that good root parallelism was achieved. Two-year follow-up intraoral photography showed stable results.

Multidisciplinary correction of anterior open bite relapse and upper airway obstruction.

A 27-year-old man presented an anterior open bite relapse. He had low tongue posture positioned anteriorly at rest and during swallowing and reported chronic difficulty in nose breathing. Head cone-beam computed tomography revealed nasal septum deviation, right turbinate hypertrophy, and left maxillary sinus congestion, which were thought to contribute to the breathing problem, encourage the improper tongue posture, and thereby cause the relapse. Multidisciplinary treatment involving an otorhinolaryngologist, an orthodontist, and a periodontist resolved the upper airway obstruction and corrected the malocclusion. The follow-up examination after 3 years 5 months demonstrated stable results.

Customized orthodontics: The Insignia System.

Customized treatment systems offer both patient and clinician numerous advantages, first and foremost the possibility of viewing a computerized rendering of the dentition in three dimensions. This allows the orthodontist to perform accurate measurements, analyses and simulations, and for both to be able to view the end result on screen. Thus, computerized technology consents optimization of not only the diagnostic phase, by means of extremely accurate three-dimensional imaging systems, but also the operative phase, by supplying individualized appliances with little or no correction while the treatment is in progress. In this article we present a customized orthodontic system called Insignia and how it works through two different clinical cases.