Evaluating the Effects of Carriere Motion Appliance and Twin Block Appliances in Class II Correction-A Retrospective Study.

This retrospective study compared Class II orthodontic non-extraction treatment using Carriere Motion Appliance (CMA) and Twin Block (TB) appliances. METHODS: The treatment of 38 patients was assessed. Pre- and post-treatment cephalometric radiographs were analyzed to evaluate skeletal, dental, and soft tissue treatment outcomes and efficacy. RESULTS: Both appliances effectively corrected the Class II molar relationship. When measured at the distal aspect of the first molar, TB achieved 4.22 mm, while CMA had a 2.55 mm correction. When measured in the mesial aspect, the CMA achieved a 3.9 mm correction. The changes in SNB and ANB were statistically significant only in the TB group. The CMA appliance demonstrated statistically significantly less protrusion of the mandibular incisors and less upper incisor retrusion without vertical changes compared to the TB appliance. The TB demonstrated statistically significant lower lip protrusion compared to the CMA. CONCLUSION: The CMA corrects Class II malocclusions only by exerting a dentoalveolar influence and does not demonstrate the added effects associated with TB, such as elongation of lower facial height (LFH) and less loss of lower anchorage. Nonetheless, the correction in the TB group comprised both dentoalveolar and skeletal components. The CMA promotes a multidirectional upper and lower molar movement, and despite our 2D cephalometric analysis, we were able to estimate the extent of upper molar derotation.

Orthodontists and lay people rate masculine soft tissue profiles similarly but feminine soft tissue profiles differently.

Objective: An esthetic facial soft tissue profile is an important objective of contemporary orthodontics. The extent to which clinicians and the public agree on profiles that are esthetically acceptable versus profiles recommended for treatment is unclear. Thus, this work examined the profile considered esthetic by laypeople and general dental practitioners compared to orthodontists.
Method and materials: An Israeli balanced male-female group comprising 284 participants (orthodontists [n = 86], general dental practitioners [n = 64], laypeople [n = 134]) rated the attractiveness of five standardized masculine and feminine profiles presented in standardized silhouettes ranging from concave to convex.
Results: Laypeople see no esthetic difference between masculine and feminine profiles, and prefer moderately concave over moderately convex and severely concave over severely convex profiles. While all raters preferred the straight silhouettes, orthodontists rated them significantly higher than general dental practitioners (P < .0001) or laypeople (P < .020). Similar to the general population, orthodontists gave higher ratings to concave profiles for masculine profiles, but significantly lower ratings for feminine profiles. The severely convex male profile was the least attractive to clinicians and laypeople. There was a significant difference in the attractiveness of the female profile between practitioners (P < .001 and P < .02 for general dental practitioners and orthodontists, respectively) and laypeople.
Conclusions: The findings suggest that orthodontic training and clinical adherence to strict beauty norms results in more critical judgment of female attractiveness, which may affect orthodontic treatment. They indicate trends that reflect changes in recent decades in the public perception of facial beauty, which may affect patient expectations of treatment outcomes.

Maxillofacial trauma following road accidents-An 11-year multi-center study in Israel.

BACKGROUND/AIM: Road traffic collisions (RTC) are known to be one of the major causes of maxillofacial trauma (MFT). The road user factor is of crucial importance in the prevalence, severity, and treatment of maxillofacial injuries. The aims of the study were to determine the prevalence of maxillofacial trauma among road users, to illustrate injury patterns and to identify road users at high risk. METHODS: This historical prospective multi-center study was based on Israel's Trauma Registry between 2008-2018, which included 4829 hospitalized patients following RTC with MFT. Data were analyzed according to six road user types (vehicle driver, passenger, bicyclist, motorcyclist, pedestrian, and e-bike/scooter), maxillofacial injury location, and maxillofacial treatment. RESULTS: MFT, which accounted for 5% of the hospitalized RTC injuries, was not equally distributed among road users, as bicyclists and e-bike/scooters were more prone to maxillofacial trauma (7.2% and 10.1%, respectively) than vehicle drivers (3.2%). Children (age 0-14 years) comprised almost half of the cyclists, 25% of the pedestrians and 20% of the passengers. Some MFT patients experienced multiple injuries, with the majority involving jaw and facial bones and to a lesser extent the mouth, teeth, gingivae, and alveolar bone (mouth and dento-alveolar (DA) trauma). Approximately 30% of hospitalized road casualties with MFT underwent MF surgery, with the need for surgery lowest among pedestrians. CONCLUSION: Hospitalized road casualties had different types of MFT in terms of prevalence, location, severity, and treatment, depending on the road user type.

Immediate post-operative rehabilitation after decoronation. A systematic review.

BACKGROUND/AIMS: Decoronation is currently considered the best treatment option for ankylosed teeth and discrepancies in the alveolar bone, particularly in childhood and adolescence. The loss of a front tooth creates aesthetic, functional, and psychological distress in patients and their parents. The aim of this study was to analyze the types of restorations provided after decoronation, their suitability, durability, and follow up until insertion of the final restoration. MATERIALS AND METHODS: A literature review was conducted using Ovid MEDLINE, Embase, and Web of Science to identify eligible articles. English language publications until August 9, 2018, were searched independently and cross-checked by two researchers online, in print, and in press. RESULTS: Of 618 articles screened, 10 included reports on 11 patients with detailed descriptions of 13 provisional restorations. Patients' ages at the time of decoronation were 8-15 years. Seven underwent avulsion and four intrusion. Removable partial denture (nine cases) was the most common restoration. In two cases, the restoration was provisional with a lingual bar with prosthetic crown and in two other cases with an adhesive bridge. Follow up ranged from 3 months to 5 years in nine patients. Two cases were followed until the permanent restoration was placed. CONCLUSIONS: The importance of long-term provisional restorations was disregarded by most authors. A multidisciplinary approach should take into consideration immediate-, mid-, and long-term rehabilitation of the decoronated tooth.

Regenerative Endodontics: A Potential Solution for External Root Resorption (Case Series).

INTRODUCTION: Regenerative endodontic procedures (REPs) are aimed to treat apical periodontitis and promote root maturation of immature necrotic teeth. However, REPs are not intended to be a primary indication for treating or arresting external root resorption (ERR). The purpose of this study was to describe REP treatment in the cessation of ERR. METHODS: Four cases (5 teeth) of posttraumatic immature teeth diagnosed with necrotic pulp and apical periodontitis or chronic apical abscess were treated with REPs using plasma-rich fibrin as a scaffold. All the teeth showed ERR and have been followed up to 3 years. RESULTS: This case series shows how REPs arrested ERR. In 3 of the cases, replacement resorption was arrested, thus avoiding complications of ankylosis and the need for decoronation. CONCLUSIONS: In addition to the known advantages of REPs, we show that REPs are a promising treatment modality for arresting ERR, warranting further clinical trials.

Craniofacial Deformities in Patients With Beta-Thalassemia: Orthodontic Versus Surgical Correction-A Systematic Review.

Rapid blood cell turnover and bone marrow expansion caused by beta-thalassemia (ßT) result in craniofacial and dentoalveolar anomalies. This report presents a systematic review of the literature over the past 50 years on orthodontic and surgical considerations in the management of ßT-affected patients. Seventeen publications encompassed 24 patients, 11 male individuals and 13 female individuals, 7 to 43 years of age. Eleven patients underwent only surgical treatment, eleven combined orthodontic-surgical treatment, and 2 orthodontic treatment. Surgical treatment primarily addressed typical maxillary overgrowth by maxillary reshaping, premaxillary segmental repositioning, or complete Le Fort I impaction and set back osteotomy. In severe maxilla-mandibular discrepancy and/or increased lower facial height, a bilateral sagittal split mandibular osteotomy is the treatment of choice. Although surgery involves risks of excessive bleeding, morbidity, and impaired nasal esthetics, little attention is given to the orthodontic modality. In conclusion, the current literature recommends early interceptive orthodontics aimed to decrease dentoskeletal deformities, severe malocclusion, and soft tissue imbalance. Treatment includes maxillo-mandibular orthopedic and functional manipulation with dentoalveolar treatment, which might either prevent orthosurgical procedures later or reduce its extent. This suggested a multidisciplinary approach comprising a hematologist, a pediatrician, a pediatric dentist, and an orthodontist, which might also significantly improve the patient's quality of life.

Orthodontic extraction space closure with and without socket preservation: a comparative case analysis.

Preorthodontic socket preservation after tooth extraction is intended to enhance favorable dentoalveolar ridge morphology and architecture, and facilitate orthodontic tooth movement (OTM) and extraction space closure. This 13-year-old skeletal Class II case presents a unique opportunity to evaluate and compare the OTM extraction space closure by means of a split-mouth analysis in a single patient. The comprehensive orthodontic-periodontal treatment included nonsimultaneous extraction of the bilateral periodontally compromised mandibular first molars and the eruption of bilateral impacted mandibular canines. While the right post-extraction space underwent a natural healing process, the left one was grafted using 4BONE BCH (hydroxyapatite ß-tricalcium phosphate [HA-ß-TCP], HA 60%, and ß-TCP 40%). The 3-year multidisciplinary treatment approach resulted in Class I relationships on the right side and Class II on the left side, improved facial appearance, and dento-skeletal jaw relationships. However, a 3-mm residual alveolar space remained unclosed on the grafted left-site, along with an unerupted left third molar. This split-mouth comparative analysis of the orthodontic space closure demonstrated a significant clinical difference in the outcome. Preorthodontic placement of HA-ß-TCP grafting material on the left segment, proved to be an obstacle for OTM extraction space closure, hindering the establishment of good occlusion.

Decoronation of an ankylosed tooth: Postoperative restoration by means of an intermediate fixed orthodontic laboratory device.

Rehabilitation of missing decoronated permanent incisors in growing children and adolescents is a major challenge. The psychologic impact of the loss of an incisor is significant due to its immediate influence on facial appearance. Final restoration is planned only after skeletal growth cessation. Consequently, the fabrication and installation of an immediate temporary restoration, which is expected to remain in place for a long period, must meet the patient's esthetic demands and be durable in the oral environment. Several proposed removable and fixed restorations have presented significant shortcomings. The purpose of this report is to suggest a comfortable dental device for restoring the missing permanent tooth with improved esthetic, functional, and psychologic benefits. An alternative fixed orthodontic laboratory fabricated appliance for permanent tooth restoration is described among children with posttraumatic tooth decoronation. Unlike removable restorative appliances, this fixed device is not dependent on the child's compliance. Esthetically, no metal part is exposed in the anterior region and the architecture is more sturdy and stable, with minimum interruption to the alveolar ridge's vertical development. CASE REPORT: An alternative fixed orthodontic laboratory appliance is described for intermediate restoration of a missing permanent tooth. CLINICAL RELEVANCE: A posttrauma intermediate fixed orthodontic appliance is a beneficial solution from esthetic, psychologic, functional, and economic perspectives for replacing missing anterior maxillary teeth. This device may be worn by patients for a long period until final restoration is indicated.

Invasive cervical resorption following orthodontic treatment: Two cases involving the same patient.

Invasive cervical resorption (ICR), a destructive form of external root resorption, is characterized by invasion of the fibrovascular tissue. This phenomenon is very rare and appears in 0.02% of the general population where the leading factors are orthodontics in addition to trauma, restorations, and bleaching. Heavy orthodontic force may increase the incidence to 1%. One of the main concerns regarding ICR is that it is often misdiagnosed with conventional diagnostic tools. In recent decades, a cone beam computed tomography (CBCT) imaging technique has become more common and can lead to a more accurate diagnosis and treatment plan. This case report describes a possible association between orthodontic treatment and ICR of a 14-year-old male, 18 months post orthodontic treatment. ICR in the mandibular right canine was diagnosed and verified by CBCT, and underwent combined endodontic-periodontal treatment. However, after orthodontic forced eruption was performed on this tooth to improve the bone defect, ICR was diagnosed on the mandibular right second premolar. The possible association between orthodontic treatment and ICR is discussed, as ICR was noted following orthodontic treatment on both occasions. This case report stresses the importance of ICR early detection by close attention to periodic radiographic checkups during orthodontic treatment. The use of modern diagnostic tools is highly recommended in suspicious cases. CONCLUSION: A case is described in which the patient underwent two types of orthodontic treatment in the mandible at different time periods and developed ICR in two different teeth.

Orthodontic Consideration in Patients with Beta-Thalassemia Major: Case Report and Literature Review.

OBJECTIVE: Beta Thalassemia (ßT) patients present a unique facial appearance and specific craniofacial, jaw and dental patterns. Although this anomaly often requires orthodontic management, ßT patients have received scant attention in the orthodontic and dental literature over the past 50 years. The aim of this article is to review the characteristic craniofacial and dental manifestation pattern of ßT patients and to emphasize their preferred orthodontic management protocol by presenting a ßT orthodontic treated patient. CASE REPORT: A 10 year old patient presented with a complaint of severe esthetic and functional disorders due to her diagnosis of ßT. We initiated orthodontic treatment including a combined orthopedic and functional treatment modality to improve facial appearance. RESULTS: Maxillary restraint and increased mandibular size during treatment along with an increase in the vertical dimension were achieved. The patient presented with Angle class I molar relationship, with reduction of the excessive overjet and deep overbite. CONCLUSION: Orthodontic treatment comprised of maxillary orthopedic treatment directed especially toward premaxilla with light forces, and mandibular modification by functional appliance along with fixed orthodontic treatment is recommended in ßT patients.

Maxillofacial Trauma Following Road Accidents and Falls.

INTRODUCTION: Motor vehicle accidents (MVA) and falls are major causes of maxillofacial injuries posing real challenges for the medical staff. PURPOSE: To describe the demographic and injury characteristics, as well as the treatment procedures of casualties diagnosed with maxillofacial injuries. METHODS: The investigators implemented a multicenter retrospective study composed of hospitalized maxillofacial trauma patients recorded in the Israel Trauma Registry for 2000 to 2011. The predictor variable was mechanism of injury and the outcome variable was type of injury, severity, and hospital resources utilization. Descriptive and bivariate statistics with P values was set at 0.05. RESULTS: The study included 11,592 reported hospitalized maxillofacial trauma patients (39.4% of them were MVA, 33.5% were falls), with a male predominance of a 3:1 ratio. The high-risk age groups were the first 3 decades of life in both etiologies, while age groups above 75 years were also frequent in falls. Severity of maxillofacial injuries, multiple injuries, admission to intensive care units, hospitalization for more than 15 days, inpatient mortality, and rehabilitation after discharge was significantly higher in MVA compared with falls. Conversely, maxillofacial surgeries were performed slightly more among patients injured in falls (34.1% and 31.1% respectively), as tongue and mouth are more prone targets in falls, compared with zygoma, maxilla, mandible, and teeth in MVA. CONCLUSION: The results of this study suggest that the etiologies present an entire separate pattern of trauma. A better understanding and proper identification of their high-risk groups should lead to appropriate prevention programs and treatment protocols.

The diagnostic and treatment challenges associated with traumatized intruded permanent incisors: a case report.

Intrusions are considered among the most severe forms of dental trauma and are associated with severe late complications. Usually general dental practitioners are the first to see and treat these children. The present case describes the challenges associated with the diagnosis and treatment of late complications of complete intruded maxillary incisors accompanied by profound buccal displacement in an 8-year-old patient. The treatments performed included root-canal treatment of right central incisor using mineral trioxide aggregate (MTA) and a combination of surgical and orthodontic repositioning of the intruded left incisor. Clinical and radiographic examinations at 2 years' follow-up revealed intact lamina dura and no sign of ankylosis in both incisors, apexogenesis of the right central incisor, and positive response to pulp testing of the left central incisor. The present report emphasizes the need to follow a child with severe dental injury and to consult with trained specialists when needed.

Aggressive periodontitis diagnosed during or before orthodontic treatment.

OBJECTIVE: The aim was to review the literature on aggressive periodontitis diagnosed during or before the initiation of orthodontic treatment and to propose preventive recommendations before, during and after orthodontic treatment. MATERIALS AND METHODS: Literature searches of free text and MeSH terms were performed by using PubMed, Embase and the Cochrane Library and the appropriate studies were selected. The retrieved articles were analyzed and the relevant data was tabulated according to different parameters. RESULTS: A total of 220 articles were found in the preliminary search. Eighteen studies, all case reports, describing 21 cases from this search met all the criteria. The mean age of the reported cases was 21.12 years, all treated with combined periodontal and orthodontic modalities. Most of the reported cases were female. CONCLUSION: An interdisciplinary dental team must approve the periodontal health prior to and during the course of the orthodontic therapy. In subjects with periodontal pathology, a periodontal consultation and interceptive/corrective therapy should be performed prior to commencing with orthodontic treatment. Orthodontic treatment should be postponed or replanned in order to shorten treatment duration and reduce the orthodontic forces exerted on the aggressive periodontitis involved dentition.

Craniofacial magnetic resonance imaging with a gold solder-filled chain-like wire fixed orthodontic retainer.

Magnetic resonance imaging (MRI) is one of the most powerful tools in diagnostic imaging. With the growing rates of orthodontic treatment, there are increasing chances of post-orthodontic treatment patients permanently wearing fixed retainers who shall undergo MRI examination.Three adolescent patients were referred for craniofacial MRI examination. All the patients had completed full orthodontic treatment with a retention protocol of permanently wearing bonded gold solder-filled wire fixed retainers. In the first 2 cases, the MRI examination was performed on a 1.5-T system and in the last case on a 3-T system.All the images achieved were of good quality and high resolution. No adverse effects were reported by the first 2 patients including no complaint of heat sensation or any other discomfort in the anterior teeth area. The third patient complained of a headache during the MRI examination.Radiologists and technicians may consider allowing performance of MRI examination using 1.5-T systems when a gold solder-filled wire fixed retainer is involved with no concern regarding the patient's health or the accuracy of the MRI scans.

Guidelines for periodontal care and follow-up during orthodontic treatment in adolescents and young adults.

Aggressive periodontitis is characterized by non-contributory medical history, rapid attachment loss and bone destruction and familial aggregation of cases. Aggressive periodontitis (both localized and generalized) is usually diagnosed in a young population. This is frequently the age that an orthodontic care is provided to this population. The aim of the present paper is to draw guidelines for periodontal evaluation and monitoring prior to and during active orthodontic treatment. Strict adherence to these guidelines as a routine protocol for periodontal examination prior, during and following orthodontic treatment may dramatically decrease the severity and improve the prognosis of patients with aggressive periodontitis in orthodontic clinics.

Guidelines for periodontal care and follow-up during orthodontic treatment in adolescents and young adults

Aggressive periodontitis is characterized by non-contributory medical history, rapid attachment loss and bone destruction and familial aggregation of cases. Aggressive periodontitis (both localized and generalized) is usually diagnosed in a young population. This is frequently the age that an orthodontic care is provided to this population. The aim of the present paper is to draw guidelines for periodontal evaluation and monitoring prior to and during active orthodontic treatment. Strict adherence to these guidelines as a routine protocol for periodontal examination prior, during and following orthodontic treatment may dramatically decrease the severity and improve the prognosis of patients with aggressive periodontitis in orthodontic clinics.

Periodontal and space maintenance considerations for primary teeth presenting with aggressive periodontitis: a case report.

Aggressive periodontitis is diagnosed mainly by clinical and radiographic examination. Diagnosis in the primary dentition indicates a choice between conservative and radical treatment that involves extractions, depending on the severity of the case. The purpose of this report was to present a case of aggressive periodontitis in a systemically healthy child and to discuss the periodontal and orthodontic aspects. A 7-year-old girl presented with bleeding on probing of approximately half of the dentition, deep periodontal pockets around all primary molars, and increased tooth mobility. An individual oral hygiene program was initiated. The primary maxillary right molar and all primary mandibular molars were extracted, and clear vacuum-formed removable retainers were fabricated and used as space maintainers. The patient was followed longitudinally for 2 years, and no space loss was recorded. Clear vacuum-formed removable retainers mainly involve occlusal crown attachment and, therefore, decrease the risk of plaque accumulation, gingival irritation, and aggressive periodontitis in the permanent dentition.

Wilckodontics--an alternative adult orthodontic treatment method: rational and application.

Adult orthodontics poses a challenge for practitioners as it involves unique biomechanical considerations due to biologic age related changes and lack of skeletal growth potential. Dental risks in adult orthodontics include, amongst others, root resorption and periodontal complications. As modern life calls for quick and efficient orthodontic treatments, a novel orthodontic modality was developed utilizing adjunctive periodontal surgery that includes bone corticotomy combined with bone augmentation. This multidisciplinary team approach: Periodontally Accelerated Osteogenic Orthodontics (PAOO) or Wilckodontics seems to be promising not only for reducing orthodontic treatment duration, but also for biological aspects during and after orthodontic treatment. PAOO enhances bone remodeling and augmentation, accelerates tooth movement and significantly reduces the duration of treatment. The presented cases manifest the biologic benefit of profound enlargement in the envelope of motion reducing the need for extraction and eliminating the need for aggressive intervention of surgically-assisted rapid maxillary expansion. PAOO serves as a reasonable and safe option for the growing demand of shortened treatment duration of adult teeth movement in three dimensions. Further research is recommended for an in depth evaluation of the long-term stability claimed to be advantageous in this modality.

How much does the DMFT index underestimate the need for restorative care?

The DMFT index, which represents caries experience as recommended by the World Health Organization (clinical examination without radiographs), was compared with a modified DMFT index with radiographs. The purpose was to evaluate how much the DMFT index underestimates the need for restorative care. A cohort of 376 young adults (eighteen to twenty years old) was examined from March 2003 to December 2004. Dental screening was based on clinical examination and bilateral bitewing radiographs. DMFT index was calculated with and without radiographs to compare DMFT scores. The average DMFT was 1.42 higher with radiographs than without (6.35 vs. 4.93, respectively), and the D component was 1.75 higher. The Pearson correlation between DMFT indices was 0.899 (p<0.0001) and 0.759 between the D components (p<0.0001). A correlation was found between D with radiographs and smoking more than ten cigarettes per day (p=0.0069). Without radiographs, there is a 44 percent probability that the caries decay value will be lower than the actual value, thus causing a greater possibility of diagnostic errors. The findings indicate that assessing treatment needs for a population based only on DMFT screening is inadequate and incomplete without radiographs.

Bruxism in military pilots and non-pilots: tooth wear and psychological stress.

BACKGROUND: Bruxism is the diurnal or nocturnal para-functional habit of clenching or grinding the teeth and affects 5-10% of the general western population. Bruxism can cause pain and irreversible damage to the teeth, periodontium, masticatory muscles, and temporo-mandibular joint. Variables such as general stress, work-related stress, and personality traits have been increasingly considered as initiating, predisposing, and perpetuating factors for bruxism. We sought to evaluate the potential of work-related stress and personality factors to induce bruxism among military pilots and non-pilot officers. METHODS: Subjects were 57 healthy male Israel Air Force officers (mean age 25.8+/-4.3 yr). Of these, 17 were jet-pilots, 18 helicopter-pilots, and 22 non-pilot officers. Tooth-wear was classified according to a six-point scale. In addition, the subjects responded to a battery of psychological questionnaires for self-assessment of stress at the workplace and their coping behavior. RESULTS: Bruxism of clinical importance (i.e., with dentin exposure) was found in 69% of the aircrew members but only 27% of the non-pilot group. No difference was found between groups regarding stress levels. DISCUSSION: Military aircrews may be relatively vulnerable to deleterious bruxism as well as other signs of chronic stress. Among bruxers, pilots tended to show coping strategies that were significantly more emotional and less task-oriented than non-pilots, whereas non-bruxers showed no significant differences in coping behavior. This study suggest that integrating dental and psychological preventive intervention may be helpful.