Orthodontic management of a dental anomaly pattern (DAP) including mandibular canine transmigration: A case report: A challenging treatment but worth it!

Orthodontic technology has advanced to the point where management of cases with multiple dental anomalies should be within an orthodontist's daily armamentarium. A patient with bilateral agenesis of lower second premolars, delayed development, and transmigration of a mandibular canine was treated with the aid of hemisection, indirect/closed exposure, application of continuous force, targeted delivery, and strict attention to keeping the roots as much in bone as possible. This was accomplished without implants or flattening the facial profile, yet with excellent periodontal status and a fully functioning occlusion.

Gingival recession--can orthodontics be a cure?

Does orthodontic treatment help or hinder a patient's periodontal status? What factors affect the periodontium? Can those factors be managed in a way that remedies existing periodontal issues? A 35-year-old woman presented with severe gingival recession and a unilateral Class II malocclusion. The treatment plan was to correct the malocclusion in a way that torques the roots more onto bone and to change her dental hygiene methods. With an extensive review of the literature, this case review attempts to make sense of the enigma of gingival recession and demonstrates an excellent treatment solution to concomitant orthodontic and periodontal problems.

The nuts and bolts of hemisection treatment: managing congenitally missing mandibular second premolars.

When you treat the congenital absence of mandibular second premolars by extracting the residual deciduous second molar and closing the space, you run the risk of flattening facial fullness, especially in patients with nonextraction features--diminished facial fullness, absence of crowding, and reduced tooth size. This challenge is heightened by the increased likelihood that these features will occur in patients who have agenesis. This article describes a new approach that has been shown to minimize such a loss of anchorage. The technique is called hemisection and involves buccolingual sectioning of the second deciduous molar, followed by removal of its distal half. As necessary, the mesial half is also removed, and space closure can be completed. The advantages, philosophy, and technique are discussed in detail.

Hemisection: one large step toward management of congenitally missing lower second premolars.

When the primary molar cannot be retained in cases of agenesis of the lower second premolar (CML5), there is the possibility of alveolar atrophy, and space closure might have a negative impact on facial fullness. Bearing these in mind, the removal of the distal half of the second primary molar might allow closure in stages. Subsequent removal of the mesial half can be followed by space closure. Using this hemisection approach, space closure can be continued with ease improving treatment results. In order to test the amount of anchorage loss resulting from this approach, the pitchfork analysis was used to compare a group of 23 consecutively treated patients, each treated by hemisection, with two groups of 30 patients, each of whom was treated with the extraction of four premolars. One group had four first premolars removed and the second group had second premolars removed. In order to obtain an untreated "control," these were further compared with the difference between the Bolton templates at ages nine and twelve. The CML5 group was divided into those which had upper teeth extracted in order to facilitate the correction and those who were treated without extraction in the upper. The hemisection groups showed statistically significant diminished distal movement of the upper incisor as well as the upper and lower lip. Lower molar protraction and molar relation was significantly increased. The process facilitates the keeping of upper premolars, which further enhances the facial fullness.

Composite spirometric-computed tomography outcome measure in early cystic fibrosis lung disease.

With the advent of therapies aimed at young patients with cystic fibrosis, who have mildly reduced pulmonary function, the need for improved outcome measures that discriminate treatment effects has become important. Pulmonary function measurements or chest high-resolution computed tomography (HRCT) scores have been separately used to assess interventions. We evaluated these modalities separately and together during a treatment study to develop a more sensitive outcome measure. In a 1-year trial, 25 children randomized either to daily Pulmozyme or to normal saline aerosol were evaluated at randomization and at 3 and 12 months. Outcome variables were pulmonary function test (PFT) results, a global HRCT score, and a composite score incorporating PFTs and HRCT scoring. Regression analyses with generalized estimating equations permitted estimation of the difference in treatment effect between groups over time for each outcome. The largest difference in treatment effects observed at 12 months, measured by the percentage change from baseline, were with the composite total and maximal CT/PFT scores (35.4 and 30.4%), compared with mean forced expiratory flow during the middle half of the FVC (FEF25-75%) (13.0%) and total and maximal global HRCT scores (6.2%, 7.2%). The composite total and maximal CT/PFT scores were the most sensitive outcome measures for discriminating a treatment effect in children with cystic fibrosis with normal or mildly reduced pulmonary function during a 1-year trial of Pulmozyme.