[Congenitally missing maxillary lateral incisors: long-term periodontal and functional evaluation after orthodontic space closure with first premolar intrusion and canine extrusion]. / Agénésie congénitale des incisives latérales maxillaires : évaluation parodontale et fonctionnelle à long terme après fermeture orthodontique de l'espace avec ingression de la première prémolaire et égression de la canine.

INTRODUCTION: The aims of this investigation were to evaluate associations between orthodontic space closure (including first premolar intrusion and canine extrusion for esthetic reasons) and periodontal tissue deterioration over a 10-year period in subjects with one or both missing maxillary lateral incisors and to investigate the occurrence of signs or symptoms of temporomandibular disorder (TMD). METHODS: This was a retrospective cohort study comprising patients treated by the same orthodontist. The agenesis group included 26 consecutive adolescent and young adult patients (9 male, 17 female) treated with space closure. The control group consisted of 32 orthodontic patients (12 male, 20 female) with no missing teeth and no need for extractions. In the agenesis group, full-mouth probing pocket depths and bleeding on probing were recorded at six locations for each of 657 teeth (3942 periodontal sites). In the control group, comparative data were collected for the maxillary first molars, premolars, canines, and lateral incisors, a total of 264 teeth (1584 periodontal sites). Mobility and gingival recession were also evaluated. Patients in both groups completed questionnaires concerning symptoms related to TMD. RESULTS: The full-mouth assessments in the agenesis group generally demonstrated periodontally healthy conditions, with probing depths below 4 mm and few bleeding sites. Some slight recessions were found, mostly on molars and second premolars, and there was normal mobility of first premolars that substituted for canines. Comparisons between the agenesis and control groups showed no statistically significant differences for the maxillary teeth regarding increased pocket depth (≥ 4 mm) or increased mobility. Interproximal sites in the agenesis group showed less bleeding on probing than in the control group; this was statistically significant. Anterior teeth in the agenesis group did not show any more recession than in the controls. In addition, we observed no difference in signs or symptoms between the two groups; this might be due to the limited sample size or the drawbacks of the surveys of TMD through subjects' recall. Thus, the long-term periodontal tissue health and the incidence of dysfunction or TMD signs were similar in the space-closure agenesis group and in the control group of nonextraction orthodontic patients. CONCLUSIONS: Orthodontic space closure including first premolar intrusion and canine extrusion in patients with missing lateral incisors does not incur risks for periodontal tissue deterioration or TMD in the long term.

Congenitally missing maxillary lateral incisors: Long-term periodontal and functional evaluation after orthodontic space closure with first premolar intrusion and canine extrusion.

INTRODUCTION: The aims of this investigation were to evaluate associations between orthodontic space closure (including first premolar intrusion and canine extrusion for esthetic reasons) and periodontal tissue deterioration over a 10-year period in subjects with one or both missing maxillary lateral incisors and to investigate the occurrence of signs or symptoms of temporomandibular disorder (TMD). METHODS: This was a retrospective cohort study comprising patients treated by the same orthodontist. The agenesis group included 26 consecutive adolescent and young adult patients (9 male, 17 female) treated with space closure. The control group consisted of 32 orthodontic patients (12 male, 20 female) with no missing teeth and no need for extractions. In the agenesis group, full-mouth probing pocket depths and bleeding on probing were recorded at 6 locations for each of 657 teeth (3942 periodontal sites). In the control group, comparative data were collected for the maxillary first molars, premolars, canines, and lateral incisors, a total of 264 teeth (1584 periodontal sites). Mobility and gingival recession were also evaluated. Patients in both groups completed questionnaires concerning symptoms related to TMD. RESULTS: The full-mouth assessments in the agenesis group generally demonstrated periodontally healthy conditions, with probing depths below 4 mm and few bleeding sites. Some slight recessions were found, mostly on molars and second premolars, and there was normal mobility of first premolars that substituted for canines. Comparisons between the agenesis and control groups showed no statistically significant differences for the maxillary teeth regarding increased pocket depth (≥4 mm) or increased mobility. Interproximal sites in the agenesis group showed less bleeding on probing than in the control group; this was statistically significant. Anterior teeth in the agenesis group did not show any more recession than in the controls. In addition, we observed no difference in signs or symptoms between the 2 groups; this might be due to the limited sample size or the drawbacks of the surveys of TMD through subjects' recall. Thus, the long-term periodontal tissue health and the incidence of dysfunction or TMD signs were similar in the space-closure agenesis group and in the control group of nonextraction orthodontic patients. CONCLUSIONS: Orthodontic space closure including first premolar intrusion and canine extrusion in patients with missing lateral incisors does not incur risks for periodontal tissue deterioration or TMD in the long term.

Multistranded wire bonded retainers: from start to success.

Fixed or bonded retainers are routinely placed at the end of orthodontic treatment. Wires of various types and sizes are available, and they can be bonded labially or lingually. This article presents the background for and evolution of multistranded fixed retainers and gives clinical recommendations for their use. Based on my over 20 years' experience, I recommend a 5-stranded 0.0215-in-diameter wire.

Dental health assessed after interproximal enamel reduction: caries risk in posterior teeth.

INTRODUCTION: We investigated whether careful interdental enamel reduction (using extrafine diamond disks with air cooling, followed by contouring with triangular diamond burs and polishing) leads to increased caries risk in premolars and first molars. METHODS: Our subjects were 43 consecutive patients from 19 to 71 years of age who had received mesiodistal enamel reduction of anterior and posterior teeth 4 to 6 years previously. Dental caries were assessed on standardized bite-wing radiographs according to a 5-grade scale and with a fine-tip explorer catch. The incidence of interproximal caries was compared between reproximated and unground contralateral surfaces in the same patient. Patients were asked about their toothbrushing habits, use of dental floss and toothpicks, and regular fluoride supplementation after the orthodontic appliances were removed. RESULTS: The overall clinical impression generally showed healthy dentitions with excellent occlusion. Only 7 (2.5%) new caries lesions (all grade 1) were found among 278 reproximated mesial or distal surfaces, in 3 patients. Among 84 contralateral unground reference tooth surfaces, 2 lesions (2.4%) were seen. On nonpaired premolars and molars that had not been ground, 23 surfaces had to be referred for caries treatment (grade 3 or occlusal caries). Eleven of these occurred in 1 patient. None of the 43 patients reported increased sensitivity to temperature variations. CONCLUSIONS: Interdental enamel reduction with this protocol did not result in increased caries risk in posterior teeth. We found no evidence that proper mesiodistal enamel reduction within recognized limits and in appropriate situations will cause harm to the teeth and supporting structures.

Planning esthetic treatment after avulsion of maxillary incisors.

BACKGROUND: When a young patient accidentally loses two neighboring maxillary incisors, the choice of treatment plan is difficult. Although implant restorations are a popular option, they cannot be placed until skeletal growth is finished. Furthermore, the use of two neighboring implant crowns represents a considerable challenge from an esthetic point of view. This case report describes an innovative solution that combined autotransplantation of a developing premolar and orthodontic space closure. CASE DESCRIPTION: An 11-year-old girl sought treatment for avulsion of both her maxillary right lateral incisor and her central incisor, which occurred as a result of a horseback-riding accident. Replantation by her general dentist was unsuccessful. An oral surgeon transplanted the mandibular right second premolar to the injury site, and the author moved the maxillary right quadrant mesially to close all spaces. The first premolar was intruded, and the canine extruded, to provide normal marginal gingival contours. A prosthodontist, working with his dental technician, restored the "abnormal" crowns with three porcelain veneers. The outcome was almost indistinguishable from a natural dentition. CONCLUSIONS: and CLINICAL IMPLICATIONS: When faced with treating severe traumatic injuries in growing patients, even after avulsion of incisors, clinicians working in cooperation can optimize the outcome. A combination of transplantation and space closure may represent the best treatment option, particularly when coupled with elements of esthetic dentistry. The advantage of this approach is that a concomitant malocclusion can be treated simultaneously, and that the treatment result is permanent. Interdisciplinary cooperation between orthodontists and other dentists, such as oral surgeons, prosthodontists and general practitioners, appears to be of increasing importance in achieving high-quality treatment results in such cases.

Contact damage to root surfaces of premolars touching miniscrews during orthodontic treatment.

INTRODUCTION: Our aim in this clinical study was to examine premolar root surfaces after intentional contact with miniscrews. METHODS: Ten patients (5 male, 5 female; mean age, 15.8 years; range, 13.5-23.2 years) with 2 maxillary first premolars to be extracted as part of their orthodontic treatment participated in the study. Two miniscrews were placed in each patient, and the first premolar roots were tipped into contact with the miniscrews by using tipping springs with a standardized force. Half of the experimental teeth were kept in contact with the screws for 4 weeks (mild resorption) and the other half for 8 weeks (severe resorption). In 5 patients, the screws were removed, and, in the remaining 5, the springs were removed to allow the roots to move back. The roots were allowed to recover for 4 or 8 weeks before extraction. Two premolars with accidental direct contact were used as controls. All teeth were prepared, coated, and examined with scanning electron microscopy. RESULTS: In the control group, the periodontal ligament was removed and the dentin surface denuded. The experimental groups showed signs of resorption with structural surface irregularities. However, no apparent denuded dentin surfaces were seen. Although some resorption lacunae were still discernible at 8 weeks, the collagen fibers fully covered the affected areas. The immature fiber organization in the deepest crater represented the ongoing process of fiber reorganization, compared with the fully matured surface areas surrounding the crater. CONCLUSIONS: The results indicate that root surfaces that touch miniscrews show swift repair and almost complete healing within a few weeks after removal of the screw or the orthodontic force. These findings are based on 10 patients only; verification in a larger study sample is needed.

Dental health assessed more than 10 years after interproximal enamel reduction of mandibular anterior teeth.

INTRODUCTION: We investigated whether interdental enamel reduction using fine diamond disks with air cooling, followed by polishing, leads to iatrogenic damage or reduced interradicular distances. METHODS: Our subjects were 61 consecutive patients who had received mesiodistal enamel reduction of all 6 mandibular anterior teeth more than 10 years previously. Dental caries, bleeding on probing, probing depths, and gingival recessions were assessed with standard techniques. Incisor irregularities and tooth width/thickness ratios were measured on models, and the patients were asked about any increased tooth sensitivity. The reference group comprised 16 students. RESULTS: No new caries lesions were detected. Three mature adults had some minor labial gingival recessions. There was no evidence of root pathology. The distance between the roots of the mandibular incisors was statistically significantly greater in the patients who had received stripping than in those who had not; 59 of 61 patients reported no increased sensitivity to temperature variations. The overall irregularity index at follow-up was only 0.67 (SD, 0.64). CONCLUSIONS: Interdental enamel reduction according to this protocol did not result in iatrogenic damage. Dental caries, gingival problems, or alveolar bone loss did not increase, and the distances between the roots of the teeth in the mandibular anterior region were not reduced. The overall incisor irregularity at the follow-up examination was small.