Creation of a nonsurgical papilla in orthodontic treatment with severe periodontal disease: a case report.

This case report describes the nonsurgical creation of an interdental papilla in orthodontic therapy of a patient with severe periodontal disease. A large diastema between the maxillary incisors was closed completely, and the lost interdental papilla was re-created by orthodontic therapy after nonsurgical periodontal therapy. Radiographs showed improvement of the bone defect. Periodontal/orthodontic soft tissue manipulation is a nonsurgical technique that can lead to reformation of the interdental papilla, provided that periodontal health is maintained.     

正中多生牙与中切牙间隙的关系

目的:探讨早期摘除正中多生牙对纠正儿童上颌中切牙间隙过大的临床意义。方法:对76例上颌中切牙间隙过大的6~12岁儿童作X线摄片检查及病因分类,对存在有正中多生牙的46例患儿予以手术摘除,随访3年观察间隙关闭效果。结果:儿童上颌中切牙间隙过大多与正中多生牙有关(46P76),与其它原因造成的中切牙间隙过大相比有显著性差异(P<0105);在侧切牙萌出前摘除埋伏正中多生牙的病例,中切牙间隙常可自行关闭,良好率达8814%。结论:宽大的上颌中切牙间隙(4 mm以上)绝大多数由正中多生牙引起,早期摘除有碍的正中多生牙对儿童中切牙间隙过大的自行调整有重要意义。     

Case report: an unorthodox orthodontic retainer

This case report describes the management of a patient who presented with an interdental eyelet-style retainer placed around maxillary central incisors ten years ago. At that time, the patient underwent orthodontic treatment to close a large maxillary midline diastema. The maxillary central incisors were then crowned to close the small residual midline diastema remaining after the orthodontic treatment. The wire retainer was apparently placed to prevent the diastema from reopening. The patient sought treatment ten years later when pain from necrotic pulps in these central incisors became unbearable.     

早期拔除上颌正中多生牙与中切牙间隙之间关系的临床研究

目的探讨上颌正中多生牙与中切牙间隙的关系及早期拔除正中多生牙对于过大的中切牙间隙的意义。方法对120例上颌正中多生牙患者进行X线检查,是否造成中切牙间隙进行统计。并对105例有中切牙间隙患者拔除多生牙后进行2年的随访,观察间隙关闭效果。结果上颌正中多生牙可造成儿童中切牙间隙占87.50%;在侧切牙萌出前拔除多生牙间隙自行关闭程度明显优于侧切牙萌出后拔除,差异有统计学意义(P<0.01)。结论上颌正中多生牙(已萌出及埋伏)可造成宽大的中切牙间隙,早期拔除上颌正中多生牙对儿童中切牙宽大的间隙的调整有重要意义。     

Combined periodontal, orthodontic, and restorative treatment of pathologic migration of anterior teeth: a case report

Pathologic tooth migration related to periodontal disease is a common chief complaint of periodontal patients. This paper describes the treatment of a case of severe periodontal disease and disfiguring pathologic migration of maxillary central incisors, which required a multidisciplinary approach. After conventional periodontal treatment was performed, the anterior diastema was closed using a combination of orthodontic therapy and restorative treatment. A 6-month follow-up examination of this case revealed resolution of the anterior pathologic migration, with gains in clinical attachment levels and a successful esthetic and functional final result.     

Relapse of a maxillary median diastema: Closure and permanent retention

The purpose of this article was to describe the closure of a maxillary median diastema of a 26-year-old woman that had been corrected before during orthodontic treatment but reopened after dental trauma in a car accident. A clear esthetic device made from a tray like those used for home bleaching was used, providing a comfortable, nearly undetectable, and efficient solution. A permanent fixed retainer was bonded again to the maxillary central incisors to prevent relapse.     

Spontaneous correction of pathologic tooth migration and reduced infrabony pockets following nonsurgical periodontal therapy: a case report

This case report describes the spontaneous correction of pathologic tooth migration and reduced infrabony pockets after nonsurgical periodontal therapy. A 3-mm diastema between the maxillary incisors was closed completely, and the mandibular teeth, which had migrated pathologically, returned to the optimal position. Clinical evaluation showed a significant reduction in probing depth, with increased clinical attachment and bone deposition demonstrated radiologically.     

Healing following surgical treatment and root demineralization in monkeys with periodontal disease

Abstract The aim of the present investigation was to study the potential for new attachment to root surfaces which 1) had become devoid of attachment either by mechanical removal or in conjunction with experimental periodontal tissue breakdown and 2) subsequently had been conditioned with citric acid. Three adult monkeys (Macaca cynomolgus) were used. Periodontal pockets were produced during a 2–6-month period around the maxillary central incisors and first and second premolars and around the mandibular central incisors by the placement of orthodontic elastics. Surgical treatment of the pockets was carried out with the use of a flap procedure. During surgery, the roots of the premolars on the right side of the jaws were first scaled and planed and subsequently treated with citric acid. Citric acid conditioning was not performed on the premolars of the left side. In the front tooth regions the surgical treatment included citric acid conditioning of the mandibular central incisors in two animals and of the maxillary central incisors in one animal. Surgical procedures were also carried out around the mandibular second premolars and first molars which had not been exposed to periodontal tissue breakdown. Folio wing flap elevation, the buccal bone plate was mechanically removed within an area corresponding to that of bone loss produced by the experimental periodontitis model in the maxillary premolars. The cementum layer of the surgically denuded portion of the roots was removed by root planing. In all treated teeth, a notch was prepared in the buccal root surfaces at the level of the alveolar bone crest. Six months following treatment the animals were sacrificed and histologic sections prepared. Linear measurements were made along the root surface from the apical border of the prepared notch to the apical termination of the junctional epithelium and to the crest of the alveolar bone. The results demonstrated that cementum formation and new connective tissue attachment did not occur on root surfaces previously exposed to periodontal pockets and subsequently subjected to scaling and root planing or on root surfaces surgically deprived of their supporting bone and previously “non-exposed” cementum layer. Cementum formation and new connective tissue attachment also failed to occur following citric acid conditioning of root dentin surfaces. In all sections representing all three treatment groups, the attachment between the gingiva and the root was established by epithelium.     

Severe localized destruction of the periodontium secondary to subgingival displacement of an elastic band. Report of a case

A seven-year-old male with localized severe periodontal destruction at the maxillary central incisior region presented for treatment. There was a history of acute trauma, but local factors were inconsistent with the clinical picture. Initial treatment consisting of palliative nonsurgical debridement coupled with systemic tetracycline resulted in a more chronic lesion with progressive bone loss. Surgical entry revealed an elastic band close to the apices of the central incisors. Removal of the etiologic agent has resulted in increased radiographic bone density and decreased probing depths. Periodontal lesions induced by elastic bands are difficult to diagnose but have several features in common that may aid in rapid diagnosis and treatment.     

正畸牵引术后上颌唇侧阻生中切牙牙周及美观效果评价

目的    评价上颌唇侧阻生中切牙行外科开窗及正畸闭合式牵引术后的牙周及美观效果。方法    选择烟台市口腔医院2011—2015年18例单侧上颌唇侧阻生中切牙患者,行外科开窗及正畸闭合式牵引术,拆除矫治器后3个月,分别对阻生牙及对照中切牙进行牙周指数、临床指数及X线指数的测量评价,采用SPSS17.0软件对数据进行分析。结果    与对照牙相比,受试牙的牙龈指数、菌斑指数、附着龈宽度、牙周袋深度无明显差异;但受试牙的临床冠长度增加,远中面骨支持量降低,差异有统计学意义（P＜0.05）;对照牙中4例出现牙龈炎症（或）牙龈增生堆积现象。结论    上颌唇侧阻生中切牙经过外科开窗及正畸闭合式牵引治疗后,获得的美观及牙周状况结果令人满意,但远期效果尚须进行长期追踪和评价。     

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??Objective    To evaluate the clinical appearance and periodontal status of impacted maxillary central incisors that had been exposed and aligned after a closed-eruption orthodontic surgical technique. Methods    The subjects consisted of 18 patients who were treated in  Stomatology Hospital of Yantai from 2011 to 2015. Examinations were done after orthodontic treatment for the unilateral labially impacted maxillary central incisors 3 months after retention. The clinical and radiographic variables were compared by SPSS 17.0 software package. Results    The treated central incisors showed no significant difference in plaque and gingival indexes??width of attach gingival or pocket depth??whereas a small but statistically significant increase was found in the clinical crown lengths. The bone support was reduced in the treated incisors??whereas in 4 of the control central incisors??abnormal gingival contour was recorded. Conclusion    This study demonstrates that the overall esthetic and periodontal results can be achieved by treating impacted maxillary central incisors with a closed-eruption orthodontic surgical technique. However??a long term follow-up study on the esthetic outcome is recommended.     

Trattamento chirurgico-ortodontico degli incisivi in malposizione: protocollo terapeutico

Objectives

The aim of this report is to provide clinicians with useful information for immediate management of impacted maxillary incisors due to obstacles to eruption.

Materials and methods

A 8-year-old boy was seen in the Operative Unit of Orthodontics of Policlinico Tor Vergata in Rome. Radiographic images showed intraosseus impaction of the maxillary left central incisor due to a compound odontoma. The treatment plan consisted of three stages: (1) removal of the odontoma and extraction of the deciduous incisors; (2) rapid maxillary expansion in order to improve the intraosseus tooth position; (3) surgical exposure and orthodontic traction of the impacted central incisor to its right position.

Results

The impacted maxillary left central incisor was brought into proper alignment with the adjacent teeth and produced a nice smile. Two years after the treatment, the patient presented good occlusal stability, adequate width of attached gingiva, no periodontal bone loss, symmetric gingival margins for both maxillary central incisors.

Conclusions

The improvement of the intraosseus position of the unerupted incisor, obtained by removal of the odontoma and rapid maxillary expansion, has enabled a conservative surgery and the achievement of an excellent esthetics and periodontal result.     

美学区牙冠延长术联合树脂修复改善露龈笑并关闭牙间隙的初步探索

上颌前牙美学区作为微笑过程关注的重点，区域内任何粉白美学的缺陷都可能损害整体的微笑美学，对于高位笑线伴有被动萌出不足的患者，微笑时显露牙龈过多是常见的美学问题之一。而美学区牙冠延长术通过对牙周软硬组织的切除和成形，可有效重建协调、美观的龈缘位置和曲线，增加被动萌出不足的临床冠高度，同时改善牙冠宽长比等相关白色美学缺陷。文章完整展示了1例针对因被动萌出不足所致露龈笑且存在上中切牙牙间隙的美学治疗过程，包括美学分析、治疗计划的制定、临床实施过程和随访效果观察，详细介绍了美学区牙冠延长术的手术过程，并采用美学树脂直接修复关闭窄牙间隙，为此类患者的临床诊治积累经验。     

Combined bone grafting and orthodontic treatment of an iatrogenic periodontal defect: a case report with clinical reentry

BACKGROUND: This case report discusses the treatment of an iatrogenic periodontal defect caused by an inadequate orthodontic appliance in a 9-year-old girl. METHODS: The multidisciplinary approach to this case consisted of periodontal treatment using a bone grafting technique to restore the 10 mm bone dehiscence. Three months later orthodontic treatment was initiated to straighten and level the central incisors. Six months later mucogingival surgery was performed to cover 2 to 3 mm gingival recession. RESULTS: The bony defects were completely filled and the 10 mm dehiscence was reduced to 4 mm. The connective tissue graft resulted in a complete coverage of the recessions and a thickening of the keratinized gingiva. The patient is still undergoing orthodontic treatment. So far, straightening of the upper central incisors and closure of the diastema are satisfactory. CONCLUSIONS: Inadequate orthodontic appliances can cause iatrogenic periodontal defects. A multidisciplinary approach in a well-defined sequence can restore lost periodontal tissue, thus achieving comfort, function, and esthetics.     

Management of a hyperdivergent class III malocclusion, maxillary midline diastema, and infected mandibular incisors in a young adult

This is a case report of a 20-year-old woman with a hyperdivergent Class III malocclusion, infected mandibular incisors, maxillary midline diastema, and a mild tongue thrust. Extraction of the infected incisors and orthodontic treatment involving partial mesial movement of the remaining mandibular teeth produced a well-intercuspated Class III occlusion. After successful orthodontic treatment, a 4-unit bridge with pontics for the mandibular central incisors completed the rehabilitation and met the functional, esthetic, and occlusal treatment goals. Occlusal stability of the treatment result has been excellent in the 3-year follow-up.     

Conservative surgical orthodontic adult rapid palatal expansion: sixteen cases

A conservative surgical orthodontic technique that facilitates the widening of the adult maxilla at the midpalatal suture is presented. This procedure uses only lateral maxillary corticotomies and a maxillary Hyrax split-palate appliance. In all sixteen cases attempted, separation of the midpalatal suture was confirmed by occlusal radiographs and a diastema between the maxillary central incisors.     

上颌切牙扇形移位的牙周-正畸联合治疗效果研究

目的    探讨伴上颌切牙病理性扇形移位错牙合畸形的牙周-正畸联合治疗效果。方法    选择2016年1月至2021年12月于南京大学医学院附属口腔医院正畸科就诊的经牙周-正畸联合治疗的伴有上颌切牙扇形移位的Ⅳ期/C级牙周炎患者18例，其中扇形移位的切牙31颗。回顾性分析患者正畸治疗前及正畸治疗后的出血指数（bleeding index，BI）、探诊深度（probing depth，PD）、探诊出血（bleeding on probing，BOP）位点百分比；采用锥形束CT评价扇形移位切牙的剩余牙槽骨高度（residual alveolar bone height，RBH）、切牙倾斜度及牙根吸收比的变化情况。结果    与正畸治疗前相比，正畸治疗后PD显著降低（P < 0.05）；正畸治疗后，扇形移位的切牙腭侧及近中RBH显著增加（均P < 0.05），切牙倾斜度显著减少（P < 0.001）；正畸治疗后唇侧、腭侧及远中上颌中切牙RBH的变化程度大于上颌侧切牙（均P < 0.05），上颌切牙总体牙根吸收比为0.08 ± 0.01。结论    在完善的牙周治疗基础上，正畸治疗有助于扇形移位切牙的牙周组织健康。     

Postretention stability after orthodontic closure of maxillary interincisor diastemas

Anterior spaces may interfere with smile attractiveness and compromise dentofacial harmony. They are among the most frequent reasons why patients seek orthodontic treatment. However, midline diastema is commonly cited as a malocclusion with high relapse incidence by orthodontists.

Objectives

This study aimed to evaluate the stability of maxillary interincisor diastemas closure and the association of their relapse and interincisor width, overjet, overbite and root parallelism.

Material and Methods

Sample comprised 30 patients with at least a pretreatment midline diastema of 0.5 mm or greater after eruption of the maxillary permanent canines. Dental casts and panoramic radiographs were taken at pretreatment, posttreatment and postretention.

Results

Before treatment, midline diastema width was 1.52 mm (SD=0.88) and right and left lateral diastema widths were 0.55 mm (SD=0.56) and 0.57 mm (SD=0.53), respectively. According to repeated measures analysis of variance, only midline diastema demonstrated significant relapse. In the overall sample the average relapse of midline diastema was 0.49 mm (SD=0.66), whilst the unstable patients showed a mean space reopening of 0.78 mm (SD=0.66). Diastema closure in the area between central and lateral incisors showed great stability. Multivariate correlation tests showed that only initial diastema width (β=0.60) and relapse of overjet (β=0.39) presented association with relapse of midline diastema.

Conclusions

Midline diastema relapse was statistically significant and occurred in 60% of the sample, while lateral diastemas closure remained stable after treatment. Only initial diastema width and overjet relapse showed association with relapse of midline diastema. There was no association between relapse of interincisor diastema and root parallelism.     

Spontaneous closure of midline diastema following frenectomy

Maxillary midline diastema is a common aesthetic problem in mixed and early permanent dentitions. The space can occur either as a transient malocclusion or created by developmental, pathological or iatrogenical factors. Many innovative therapies varying from restorative procedures such as composite build-up to surgery (frenectomies) and orthodontics are available. Although literature says every frenectomy procedure should be preceded by orthodontic treatment, we opted for frenectomy technique without any orthodontic intervention. Presented herewith is a case report of a 9-year-old girl with a high frenal attachment that had caused spacing of the maxillary central incisors. A spontaneous closure of the midline diastema was noted within 2 months following frenectomy. The patient was followed up for 4 months after which the space remained closed and there was no necessity for an orthodontic treatment at a later stage.     

The multidisciplinary management of a fused maxillary central incisor with a talon cusp

Background: A fused maxillary incisor required complex multidisciplinary treatment to preserve health and restore aesthetics. This report presents a rare case of a dental fusion between the maxillary right central incisor and a supernumerary tooth of a 9‐year‐old male patient with the chief complaint of the presence of a large anterior tooth. Methods: Radiographic investigation and computerized tomography indicated there was no connection between pulp chambers. After dividing the crown with a diamond bur, the supernumerary tooth was removed and the diastema between the maxillary central incisors was closed by orthodontic treatment. The tooth was then restored with composite resin. Results: The maxillary right central incisor was still healthy after a follow‐up examination period of 24 months. Conclusions: A multidisciplinary approach with the cooperation of different practitioners can contribute to the success of a treatment plan.