Very early orthodontic treatment: when, why and how?

INTRODUCTION: Several orthodontic problems should already be treated at an early age to prevent the necessity of future complex and expensive procedures. Scientific evidence suggests that posterior crossbites, mild to moderate Class III, as well as certain Class II malocclusions, open bites and arch length discrepancies can benefit from simple, but efficient interceptive therapy. OBJECTIVE: To summarize the existing evidence-based literature on early orthodontic treatment, and to illustrate its application and effectiveness by showcasing multiple clinical examples. CONCLUSION: Early short-term interceptive orthodontic treatment with simple appliances, in the deciduous or early mixed dentition phase, can efficiently correct certain malocclusions and help to either reduce the complexity or even avoid the necessity of complex and expensive procedures during puberty. For certain patients with significant arch length discrepancy the concept of serial extractions should be part of the orthodontic armamentarium.

Very early orthodontic treatment: when, why and how?

ABSTRACT Introduction: Several orthodontic problems should already be treated at an early age to prevent the necessity of future complex and expensive procedures. Scientific evidence suggests that posterior crossbites, mild to moderate Class III, as well as certain Class II malocclusions, open bites and arch length discrepancies can benefit from simple, but efficient interceptive therapy. Objective: To summarize the existing evidence-based literature on early orthodontic treatment, and to illustrate its application and effectiveness by showcasing multiple clinical examples. Conclusion: Early short-term interceptive orthodontic treatment with simple appliances, in the deciduous or early mixed dentition phase, can efficiently correct certain malocclusions and help to either reduce the complexity or even avoid the necessity of complex and expensive procedures during puberty. For certain patients with significant arch length discrepancy the concept of serial extractions should be part of the orthodontic armamentarium.

RESUMO Introdução: Vários problemas ortodônticos devem ser tratados já em idade precoce, para evitar a necessidade de procedimentos futuros de maior complexidade e custo. A evidência científica sugere que as seguintes más oclusões podem se beneficiar de terapias interceptivas simples mas eficientes: mordidas cruzadas posteriores, Classe III leve a moderada, certas más oclusões de Classe II, mordidas abertas e discrepâncias no tamanho das arcadas. Objetivo: Resumir a evidência científica existente sobre o tratamento ortodôntico precoce e ilustrar sua aplicação e efetividade, por meio da exposição de múltiplos casos clínicos. Conclusão: O tratamento ortodôntico interceptivo precoce de curto prazo com aparelhos simples na fase da dentição decídua ou início da dentição mista pode corrigir eficientemente certas más oclusões e ajudar a reduzir a complexidade ou, até mesmo, evitar a necessidade de procedimentos complexos e onerosos durante a puberdade. Para certos pacientes com discrepância significativa no comprimento das arcadas, o conceito de extrações seriadas deve fazer parte do arsenal de recursos ortodônticos.

Orthodontic space closure in a young female patient with solitary median maxillary central incisor syndrome.

A solitary median maxillary incisor can occur as a rare single dental anomaly or a symptom of the early-intrauterine developmental brain disorder of holoprosencephaly. The few published case reports about orthodontic treatment for this disorder have only described space opening for prosthodontic replacement of a central incisor. In contrast, the present patient was treated with extraction of the solitary median maxillary central incisor and orthodontic space closure with subsequent minimally invasive restorations in order to avoid looming esthetic or periodontal sequelae associated with any type of fixed bridgework or implant-borne crowns in the sensitive maxillary anterior area-which is especially indicated in young girls with a hyperdivergent growth pattern.

Prospective Evaluation of Changes in Pain Levels, Quality of Life and Functionality After Low Dose Radiotherapy for Epicondylitis, Plantar Fasciitis, and Finger Osteoarthritis.

Background: The objective benefits of low dose radiotherapy (LDRT) for non-malignant joint disorders are controversial. This study evaluated changes in pain, quality of life (QoL) and function after LDRT for epicondylitis, plantar fasciitis, and finger osteoarthritis. Materials and Methods: Patients over 40 years old with epicondylitis, plantar fasciitis, and finger osteoarthritis were had pain following at least 6 months of conservative therapy. Patients received 0.5 Gy LDRT twice weekly for 4 weeks repeated once after 8 weeks in patients who failed to achieve complete pain relief. Patients assessed their pain according to the visual analog scale. Handgrip strength was measured with an isometric dynamometer and the fast self-paced walking test was used in patients with plantar fasciitis. QoL was evaluated according to the EQ-5D and HAQ-DI questionnaires. Results: Outcomes for 157 patients (204 sites) were documented at 2, 6, and 12 months after last LDRT. Pain reduction at rest (p < 0.001), during activity (p < 0.001) and increase in handgrip strength (extension p < 0.001, flexion p = 0.002) were highly significant for patients with lateral epicondylitis. Patients with medial epicondylitis reported pain relief at rest (p = 0.041) and during activity (p = 0.041) and significant increase in handgrip strength (p = 0.022). Patients with plantar fasciitis reported pain reduction at rest (p < 0.001), during activity (p < 0.001) and faster walking times (p < 0.001). A trend toward improved QoL was observed. Patients with finger osteoarthritis reported significant pain relief during activity (p < 0.001) and a gain in handgrip strength (p = 0.004), with a trend to both pain relief at rest (p = 0.056) and stronger pinch grip (p = 0.099). Conclusions: LDRT achieved significant pain relief at rest and during activity and a corresponding objective improvement in handgrip strength in patients with epicondylitis. Pain relief at rest, during activity and improvement in walking time were demonstrated in patients with plantar fasciitis. LDRT achieved pain relief during activity, and handgrip strength was improved in patients with finger osteoarthritis. No significant effect was seen on quality of life measures for these conditions. The observed benefits were maintained 12 months after LDRT for all 3 indications and we recommend this low cost, safe intervention for patients over 40 who have failed prior conservative therapy.

Atypical extraction treatment for failing replanted maxillary and mandibular incisors with space closure of 2 mandibular incisors in the same quadrant.

We report the successful orthodontic treatment of a 13-year-old girl who had been involved in an accident with avulsion of her maxillary right central incisor and both mandibular left incisors. Fifteen months after replantation of the teeth, all showed severe root resorption with apical inflammation and had to be extracted. After compensatory removal of the maxillary left central incisor, all 4 extraction sites were closed within 20 months of active orthodontic treatment to avoid implant-prosthodontic replacement. By sequential extraction of the 2 hopeless replanted equilateral mandibular left incisors and common-sense management of straightwire mechanics, it was possible to move the right central incisor across the mandibular midline and close the large space completely. To our knowledge, no case report about orthodontic closure of 2 adjacent extraction spaces in the same quadrant has been published.

Esthetic evaluation of implants vs canine substitution in patients with congenitally missing maxillary lateral incisors: Are there any new insights?

INTRODUCTION: The aims of the study were to determine how a panel of orthodontists, dentists, and laypersons rated the esthetic appeal of dentitions after orthodontic space closure by canine substitution compared with space opening and replacement of missing maxillary lateral incisors by implant-borne crowns and to compare the outcome with the results of a study in the United States in 2005. METHODS: A series of 9 posttreatment intraoral frontal photographs was presented to 87 orthodontists, 100 general dentists, and 100 laypersons. The photographs represented dentitions with either single-tooth implants or canine substitutions for missing maxillary lateral incisors and dentitions with no missing teeth. Each photograph was rated independently by assigning a number between 1 (best) and 5 (worst) for a series of 7 bipolar adjectives. Two-way analysis of variance and Tukey post hoc tests were performed to assess differences in intragroup and intergroup preferences for the various treatment options. Subsequently, the mean scores were compared with the mean scores in the study from 2005. RESULTS: Highly significant improvements (P <0.0001) in the esthetic outcome for implants were found in all respondent groups when compared with the study from 2005. To date, orthodontists and dentists rank implants and canine substitution as equally pleasing, but laypersons prefer space closure. CONCLUSIONS: Perceptions of dental esthetics can vary between dental professionals and laypersons. Investigating each patient's esthetic expectations is thus important, but in the patient's best interest, esthetic and functional aspects should be carefully weighed during comprehensive treatment planning.

Comparison of the anterior limit of the dentition in patients treated with self-ligating straight-wire, conventional straight-wire and standard edgewise appliances.

THE AIM OF THIS STUDY WAS TO IDENTIFY AND COMPARE ANY DIFFERENCES IN THE POSITION OF THE ANTERIOR LIMIT OF THE DENTITION PROVOKED BY THREE DIFFERENT TYPES OF ORTHODONTIC MECHANICS: traditional edgewise, straightwire and self-ligating. A sample of 54 patients (selected from a group of 289 patients) possessed a range of Little's Irregularity Index values for the upper and lower dental arches between a minimum of 6.5 and a maximum of 13.5 at T0, and corresponding final values no greater than 2 and hence of minimal irregularity. The 54 patients were subdivided into three groups according to the type of brackets used in their treatment: Group 1 was composed of 24 patients treated using the self-ligating technique, Group 2 of 15 patients treated using a conventional straight-wire technique (Roth) and Group 3 of 15 patients treated using the standard edgewise technique. Cephalometric tracings were performed on laterolateral teleradiography. Group 1 value was found to be nonsignificant, whereas significant labial inclination was noted in Groups 2 and 3 (P < 0.05). A significant labial inclination of the upper incisors was also evidenced in all three sample groups.

Atypical treatment of Class II malocclusion with space closure only in the lower arch.

Two patients with Class II malocclusions and missing or previously extracted teeth in the lower arch were treated without compensatory upper extractions to a Class I canine and a Class III molar result. Indications and contra-indications are discussed and the case reports are shown, including long-term retention records.