Accelerated Osteogenic Orthodontics? for retreatment of a patient with diminished root length and absence of the maxillary central incisor

An 18-year-old female patient visited a university orthodontics department with a chief complaint of an unesthetic appearance of her teeth, including a protruded upper central incisor and unsatisfactory results from previous orthodontic treatment. Pretreatment records showed a Class II skeletal and dental relation with proclined upper and lower incisors, replacement of an absent upper left central incisor with the left upper cuspid, presence of the upper left deciduous cuspid, mild crowding, and 4 mm of overbite and overjet. The panoramic radiograph showed shortened roots of multiple teeth. Accelerated Osteogenic Orthodontics™ (AOO™) was recommended as an approach to reduce the treatment time and the risk of further root shortening. Despite being more expensive and requiring a surgical procedure, this treatment option was very attractive to the patient. The overall treatment time was 14 months. Facial balance was improved, and good occlusal relationships were achieved from the functional and esthetic perspectives. In conclusion, surgically facilitated orthodontics (specifically, AOO™) is an efficient and safe therapeutic tool for treating or retreating orthodontic patients with diminished root length.     

Are intrauterine growth restriction and preterm birth associated with dental caries?

OBJECTIVES: To assess the association between two intrauterine growth restriction (IUGR) surrogates - IUGR [small for gestational age birth (SGA) and fetal growth restriction (FGR)] and preterm birth with dental caries. METHODS: Data from the Third National Health and Nutritional Examination Survey (1988-1994) were used, including 2- to 5.9-year-old singletons (n = 3189). Dental caries was defined as presence of any teeth with dental caries (treated or untreated) and also as presence of at least two teeth with dental caries. Exposure variables were preterm birth (<37 gestational weeks), FGR, and SGA. Covariates included were poverty, race/ethnicity, age, sex, sucrose intake, environmental tobacco smoking, dental visits, education of head of household, breastfeeding, and use of baby bottle. Separate statistical analyses were conducted for IUGR and for preterm birth through the estimation of prevalence ratio (PR), taking complex sampling design into consideration and adjusting for confounders. Sensitivity analysis was conducted including and excluding 2-year-old children and also with the two definitions of dental caries. RESULTS: In general, the inclusion of 2-year-old children and the case definition of presence of any teeth with dental caries biased the results toward the null, but with no major changes in the results. In bivariate analysis, SGA and FGR birth were both negatively but not significantly associated with dental caries while a significant positive association was found for preterm birth. Sensitivity analysis showed that the PR for preterm in bivariate analysis varied from 1.65 (95% CI 1.14-2.40) to 1.84 (95% CI 1.19-2.83). After adjusting for confounders, the PR for preterm birth varied from 1.38 (95% CI 1.00-1.89) to 1.64 (95% CI 1.22-2.20). After adjustment, the PR for SGA varied from 0.79 (95% CI 0.56-101) to 0.66 (95% CI 0.33-0.96). For children from 3 to 5.9 years old, the adjusted PR for FGR using the category 'none' as reference were mild (PR 1.10; 95% CI 0.76-1.58), moderate (PR 0.66; 95% CI 0.26-167), and severe (PR 0.59; 95% CI 0.36-0.99). These values for FGR were very similar for the other models using other classifications of case definition or inclusion of 2-year-old children. CONCLUSIONS: Preterm birth was found to be positively associated with dental caries while there is an indication that SGA and FGR are negatively associated with dental caries. Although the negative association is counterintuitive, it is possible that increased antibiotic use and delayed tooth eruption may explain the negative association between IUGR and dental caries.     

Association between facial measurements and polymorphisms in human epidermal growth factor and transforming growth factor β1

The aim of the study was to evaluate the association between genetic polymorphisms in human epidermal growth factor (EGF) (rs4444903) and transforming growth factor β1 – (TGF-β1) (rs1800470) with facial measurements in patients with dentofacial deformities. A total of 144 adult patients with dentofacial deformities were included. Facial linear and angular measurements were traced in lateral cephalometric radiographs used Dolphin 2D software. Cells from oral mucosa were collected for DNA to be extracted. The polymorphisms were genotyped using real-time polymerase chain reaction (PCR). Probabilites of less than 0.05 were accepted as significant. The rs4444903 heterozygous patients had a decrease in the mandibular length (p = 0.043) and the length of the mandibular base (p = 0.008), and homozygous A patients also had a reduction in the length of the mandibular base (p = 0.013) compared with homozygous G patients. Patients AG had an increase in measurement of the anterior facial height (p = 0.032) and in ANS-Me distance (p = 0.022) when compared with homozygous A. To the rs1800470, heterozygous patients had an increase in the length of the mandibular base (p = 0.043) when compared with homozygous A. Heterozygous AG patients had an increase in angular measurements in TGF-β1 polymorphism for the upper gonial angle, when compared with the homozygous AA (p = 0.032). Genetic polymorphisms in EGF and TGF-β1 are associated with facial measurements in a Brazilian population of patients with dentofacial deformities.     

Considerations of dentofacial growth in long-term retention and stability: is active retention needed?

It is extremely important to pay attention to the person's growth pattern, and a distinction must be made in the selection of retention devices on the basis of the nature and the extent of dentofacial dysplasia (growth pattern). The nature and duration of retention should depend on the maturation status of the patient and on anticipated future growth. Retention guidance is necessary for adjustment of the dentition to late growth changes and maturation of neuromuscular balance. "Active retention" is a concept we accept as readily as the orthopedic surgeon does for his scoliosis patients. There is some merit in the philosophy of those clinicians who advocate permanent retention guidance. Without always being aware of the biomechanics of growth change, they are in fact carrying the patient through the active stages of growth with their retention appliances. Finally, one may philosophize that nothing about the human morphology is stationary. Aging is a well-documented process of change. Lifetime dentitional adjustment and changing dental relationships are known to all, even in otherwise healthy persons. Then why do we expect long-term stability in every case? The answer to the question of long-term stability is long-term retention--dynamic, not static.     

Cervical vertebrae: Mandibular growth dynamism indicators?

A study of mandibular growth maturation was performed on a population of 103 patients during orthodontic treatment (69 girls and 34 boys) from 11 to 16 years, having initially a Class II skeletal discrepancy. The relationship between wrist maturation indices and the cervical vertebrae maturation was studied by Lamparski classification. Significant correlations were found between Bj?rk stages, MP3=, MP3 cap and MP3 U and respectively Lamparski stages as CVS 2, CVS 3-4 and CVS 5-6. This retrospective longitudinal study identified three mandibular variables at three different maturation stages according to Bj?rk classification and to the six stages of Lamparski classification. The relationships between these different maturation stages and a quantitative mandibular response permit to estimate optimal time for our orthodontic therapy. The results indicate a significant increase in mandibular length between CVS 4 and CVS 5, suggesting the persistence of a condylar response to a stimulation therapy after CVS3 or CVS 4 stages (MP3 cap). Mandibular growth seems to continue after MP3 U stage or CVS 5 stage.