Conservative reconstruction of the smile by orthodontic, bleaching, and restorative procedures

The following is a clinical case report of a patient whose chief complaint was the presence of generalized spacing in the maxillary anterior segment following orthodontic treatment. After meticulous clinical analyses and discussions of the clinical procedures to be adopted, dental bleaching was performed in both arches with 10% hydrogen peroxide (Opalescence Trèswhite Supreme 10% Hydrogen Peroxide - Ultradent Products, Inc., South Jordan, USA) after the conclusion and stabilization of orthodontic treatment. Then, the orthodontic appliance was removed and the diastemas in the maxillary anterior teeth were closed with Amelogen Plus (Ultradent Products, Inc., South Jordan, USA) resin composite. It was observed that the association of orthodontic, bleaching, and restorative procedures was capable of restoring dental shape, function, and esthetics, allowing the patient to smile without hesitation.     

Orthodontic intervention to a patient injured in a traffic accident

This case report describes the orthodontic treatment of a 29-year-old male who lost the maxillary bilateral central incisors as a result of a traffic accident. After emergency treatment for facial fracture by a plastic surgeon, the patient visited our orthodontic clinic. He had a concave profile, Class I molar relationship with slight maxillary retrusion, and crossbite of the maxillary bilateral lateral incisors. The interdental space was insufficient for prosthetic treatment of the missing maxillary incisors. Therefore, we planned to distalize the maxillary and mandibular molars to obtain appropriate interdental space for the prosthetic treatment of the missing teeth and to correct the crowding of the mandibular anterior teeth. The anterior crossbite was corrected, and appropriate overjet and overbite were obtained with functional occlusion after prosthetic treatment. This case report shows that the favorable occlusion and facial profile are obtained by the interdisciplinary treatment and discusses the specific problems which seen after the traffic accident.     

Smile design for the adolescent patient--interdisciplinary management of anterior tooth size discrepancies

Adolescent patients often seek orthodontic treatment to correct spacing of the maxillary anterior teeth. If the spacing is caused by a tooth size discrepancy that affects one or more anterior teeth, an interdisciplinary treatment plan involving orthodontic, restorative, and periodontal treatment is recommended to achieve a harmonious esthetic result. This article describes a clinical approach for treatment of these complex cases, focusing on the importance of tooth form, gingival esthetics, and treatment sequencing.     

Ribbon-wise customized lingual appliance and orthodontic anchor screw for the treatment of skeletal high-angle maxillary protrusion without bowing effect

This case report demonstrates the treatment of a skeletal Class II high-angle adult patient with bimaxillary protrusion, angle Class I occlusion, and crowded anterior teeth. A ribbon-wise arch wire and a customized lingual appliance with anterior vertical slots were used to achieve proper torque control of the maxillary anterior teeth. An orthodontic anchor screw and a palatal bar were used for vertical control to avoid increasing the Frankfort-mandibular plane angle (FMA) by maxillary molar extrusion. Through the combined use of the ribbon-wise customized lingual appliance, palatal bar, and orthodontic anchor screw, vertical control and an excellent treatment result were achieved without the vertical and horizontal bowing effects peculiar to conventional lingual treatment.     

An interdisciplinary approach for improved esthetic results in the anterior maxilla

This clinical report describes an interdisciplinary (orthodontic, periodontic, and prosthodontic) approach for the coordinated treatment of a patient diagnosed with peg-shaped maxillary lateral incisors, diastemata, short clinical crowns, excessive gingival display, and orthodontic malocclusion. The patient's specific esthetic expectations for the anterior maxilla were successfully met through phased treatment, including orthodontic tooth movement, provisional restorations, periodontal surgery for lengthening of the clinical crown, porcelain laminate veneers, and direct composite restorations. Such coordinated interdisciplinary evaluation and treatment are necessary for improved esthetic results in maxillary anterior areas esthetically compromised in several aspects.     

Polyethylene Ribbon and Fixed Orthodontic Retention and Porcelain Veneers: Solving an Esthetic Dilemma

Abstract: The patient, a 58-year-old woman, had started orthodontic treatment to correct spacing between the maxillary anterior teeth 6 year prior to presentation with a chief complaint of tooth discoloration and spacing. The treatment had consisted of the use of a removable appliance to retract the maxillary anterior teeth. The patient continued to wear the appliance sporadically. When she presented, the maxillary incisors were in primary occlusal trauma with Grade 2 mobility. The patient discontinued wearing the appliance. The periodontal condition was addressed with initial therapy. As part of the treatment plan to stabilize the maxillary anterior teeth and provide the patient with an esthetic result, it was decided to do a limited occlusal adjustment of the maxillary anterior teeth to control fremitus, and to place a fixed, composite resin, polyethylene ribbon-reinforced splint, using a facial approach. The esthetic restoration of these teeth was accomplished with bonded porcelain veneers.     

Anterior interocclusal relations. Part I

It is not uncommon for discrepancies in anterior interocclusal arch length to exist in the orthodontic patient. A frequent cause of this problem is a decrease in upper anterior dental arch length. This discrepancy, if left uncorrected, may result in an end-to-end incisal relation whereby the anterior teeth are unable to perform their function in the mutually protected dentition. This article will discuss the following procedures which may be useful in the correction of discrepancies in anterior interocclusal arch length: (1) repositioning of upright maxillary incisors to increase upper dental arch length, (2) mesiodistal enamel reduction to reduce mandibular dental arch length, promote stability, and improve gingival conditions, and (3) treatment of three-mandibular-incisor cases to decrease mandibular dental arch length, allow correction of crowded mandibular anterior teeth, and reduce protrusion of the lower anterior teeth.     

Unilaterally impacted maxillary central incisor and canine with ipsilateral transposed canine-lateral incisor

Concurrent impaction and transposition of maxillary anterior teeth is uncommon and poses a challenge for dentists. Early diagnosis and management of eruption disturbances benefits esthetic and functional outcomes. This article describes the treatment of a teenager who had impactions of the left maxillary central incisor and canine as well as ipsilateral canine-lateral incisor transposition. Treatment alternatives and effective orthodontic techniques are delineated. To optimize the treatment results, the impacted maxillary canine was surgically exposed and orthodontically distalized with an innovative cantilever. Subsequently, the deeply impacted maxillary central incisor was uncovered and orthodontically mesialized into the arch. Finally, the displaced maxillary lateral incisor was brought into its normal position. The combined surgical-orthodontic approach resolved a difficult clinical issue and avoided additional restorations. An esthetic, functional outcome was achieved and satisfied the patient.     

Management of anterior spacing with orthodontics and prosthodontics

Closing maxillary and mandibular diastemas is facilitated by a multidisciplinary approach involving orthodontics and prosthodontics. This case study demonstrates the management of a discrepancy in maxillary and mandibular anterior tooth widths. The problem is resolved by limited orthodontic treatment followed by porcelain laminate veneers. Anterior spacing is one of the major reasons adults seek esthetic treatment. Multidisciplinary treatment (periodontics, orthodontics and/or prosthodontics) is often indicated for an optimal result.     

Incidence and etiology of midline diastema in a population in south India (Madras)

In a cross-sectional study of midline diastemas in a South Indian (Madras) population, 9,774 patients aged 13-35 years were screened. True midline diastema was defined as one without periodontal/periapical involvement and with the presence of all anterior teeth in the arch. Sample purification resulted in a research sample of 166 patients with true midline diastemas. The incidence of true maxillary midline diastema (160/9774-1.6%) was greater than that of true mandibular midline diastemas (31/9774-0.3%). No direct etiologic factor for the midline diastemas was noted. Spacing in the anterior region was the most significant factor associated with the midline diastema.     

Multidisciplinary treatment of "twinned" permanent teeth: two case reports

Twinned teeth usually appear in the anterior region of the dental arch. Besides orthodontic malocclusions, such as protrusion, crowding, or diastema, they also cause esthetic problems. Different treatment methods can be used according to the requirements of the situation. This article reports multidisciplinary treatment of 2 patients whose maxillary central teeth were twinned with supernumerary incisors. The twinned tooth was reshaped following endodontic treatment in 1 of the patients and orthodontic treatment was performed with edgewise mechanics. In the second case, however, it was determined that the twinned tooth had 2 separate roots. There was also another supernumerary lateral incisor in the dental arch that increased the severity of the crowding. The twinned tooth was hemisected and the other supernumerary tooth was extracted. The patient wore a removable appliance for initial tooth movements and treatment was finished with fixed appliances.     

Endodontic and orthodontic treatment of fused maxillary central incisors: a case report

Abstract – The purpose of this case report was to describe combined endodontic and orthodontic treatment of a patient who had permanent maxillary central incisors fused with supernumerary teeth. A severe esthetic problem and crowding in the maxillary arch were present clinically. Radiographic examination demonstrated two separate crowns, roots and pulpal canals on each side. The therapy was initiated with endodontic treatment. Six months after the completion of endodontic therapy, mesio‐distal trimming was performed and the defects were restored with anterior resin composites in order to re‐establish the esthetics. Orthodontic treatment was performed for the alignment of the upper arch. Follow‐up at 4 years demonstrated that the teeth were asymptomatic and neither root nor alveolar bone resorption was found. In conclusion, instead of extracting the supernumerary teeth, the anomaly was treated successfully in a conservative way.     

Correction of severe vertical maxillary excess with anterior open bite and transverse maxillary deficiency

Patients requiring correction of large anterior open bites have historically been among the most challenging treatments for orthodontists. Adding to that fundamental challenge for the adult patient in this case was vertical maxillary excess, a severe transverse maxillary deficiency as well as an arch length inadequacy, even though the patient had prior orthodontic treatment. The prior orthodontist had included arch expansion and extracted four first bicuspids, which limited current treatment options. Various treatment modalities that have traditionally been used to correct transverse maxillary deficiency and the accompanying arch length inadequacy include extractions, labial and buccal dental tipping, segmental maxillary osteotomies, and rapid maxillary expansion with or without surgical assistance. Transverse maxillary distraction osteogenesis is a modification (ie, using a latency period and specific rate and rhythm of distraction) of the surgically assisted rapid maxillary expansion technique developed 25 years ago. This case demonstrates the relationship of transverse maxillary deficiency as well as vertical maxillary excess to apertognathia. Considerations regarding the use of segmental maxillary osteotomy vs transverse distraction osteogenesis are discussed. This case report illustrates the benefit of a team approach using transverse maxillary distraction osteogenesis, effective orthodontic mechanics, and orthognathic surgery to correct a severe dentofacial deformity.     

The distribution of diastemas in different human population samples

Abstract— A study was undertaken to determine the number and distribution of diastemas within the dentitions of three racial groups of man, (a diastema being defined as a space greater than 0.5 mm between the proximal surfaces of adjacent teeth). From examination of the dentitions of 656 subjects, the mean number of diastemas was found to be 2.07 for Caucasoids, 2.09 for mongoloids, and 2.02 for negroids. In all three population samples, 75 % of the diastemas occurred in the maxillary dentition and 25 % in the mandibular dentition, the diastemas being mainly confined to the region of the dental arch anterior to the first premolar.     

正畸治疗诱导阻生上颌尖牙的自发萌出

目的 探讨阻生上颌尖牙正畸治疗诱导自发萌出的方法,总结合适的临床处理策略,为阻生尖牙的合理治疗提供依据.方法 选择13例恒牙列患者(男6例,女7例)的17颗阻生上颌尖牙,通过正畸治疗在相应牙弓位置为尖牙预留充足的间隙,待其自发萌出后直接粘结矫正装置排入牙列正常位置.结果 预留间隙2～24个月后阻生尖牙自发萌出,治疗后尖牙及邻牙牙周状况良好.结论 当阻生尖牙错位不严重,扩弓或减数拔牙即能为阻生尖牙提供足够萌出间隙,判断其能自行萌出时,可采取正畸诱导自萌的方法进行治疗.     

Esthetic restorations of maxillary anterior teeth with orthodontic treatment and porcelain laminate veneers: a case report

If orthodontists and restorative dentists establish the interdisciplinary approach to esthetic dentistry, the esthetic and functional outcome of their combined efforts will be greatly enhanced. This article describes satisfying esthetic results obtained by the distribution of space for restoration by orthodontic treatment and porcelain laminate veneers in uneven space between maxillary anterior teeth. It is proposed that the use of orthodontic treatment for re-distribution of the space and the use of porcelain laminate veneers to alter crown anatomy provide maximum esthetic and functional correction for patients with irregular interdental spacing.     

Interdental papilla reconstruction combining periodontal and orthodontic therapy in adult periodontal patients: a case report

Migration of maxillary anterior teeth because of the loss of periodontal support can alter the appearance of the esthetic zone. The loss of contacts between adjacent teeth results in the recession of interdental papillae. To restore sustainable periodontal health and the normal, esthetic appearance of a healthy 37-year-old woman with generalized advanced chronic periodontitis in the maxillary arch, a combined periodontal and orthodontic technique was used. This approach resulted in stable periodontium and an esthetically pleasing appearance of the maxillary anterior area.     

Interdisciplinary treatment planning for single-tooth restorations in the esthetic zone

This article presents a conservative approach for restoring single anterior teeth in patients with congenitally missing maxillary lateral incisors, emphasizing the importance of interdisciplinary treatment planning. Minor orthodontic treatment was necessary to create the space for implant placement. Once the fixtures were inserted and the temporary abutments connected to the implants, the provisionals were relined with the use of a repositioning stone key. From the diagnostic wax-up, it was decided that in order to attain a satisfying final esthetic outcome, it was necessary to also restore the distal aspect of the central incisors and the right first premolar for anatomical and functional reasons. Finally, after having screwed the abutments on the implants, inducing a torque of 20 Ncm, the metal-ceramic restorations were cemented with temporary cement. CLINICAL SIGNIFICANCE: This article presents a systematic approach for restoring anterior teeth in the esthetic zone using a diagnostic additive wax-up and an interdisciplinary approach to optimize the final esthetic outcome.     

An interdisciplinary approach for improved functional and esthetic results in a periodontally compromised adult patient

In contemporary dental care, an increasing number of adult patients are seeking orthodontic treatment. In such adult patients, a combined orthodontic and other specialized therapy often offers the best option for achieving a predictable outcome to solve complex clinical problems. This case report demonstrates a combined therapy with orthodontic, periodontic, and implant-prosthodontic treatments in a 56-year six-month-old female patient with mild diastemata in the maxillary anterior region and a missing left maxillary second premolar caused by a periodontal disease with medium bone loss. The patient had improved her oral hygiene condition through periodontal treatment before orthodontic treatment. The patient was orthodontically treated with a maxillary lingual arch and a maxillary edgewise orthodontic appliance. Active orthodontic treatment was completed in 18 months, and an implant-supported prosthesis was placed with a single crown in the region of the left maxillary second premolar. The treatment outcomes, including the periodontal condition and the dental implant treatment, were stable at two years after the active orthodontic treatment. We demonstrate that combined orthodontic-periodontic-implant-prosthodontic treatment can achieve an improved masticatory function, esthetics, occlusion, and periodontal condition.