Transalveolar transplantation of maxillary canines. An alternative to orthodontic treatment in adult patients

Transalveolar transplantation of 31 maxillary canines in 26 patients was performed. Fixed orthodontic appliances were used for fixation for 6 to 8 weeks. All the transplanted teeth were firmly affixed in the new positions 3 to 6 months postoperatively. Complete bone regeneration and an attached gingiva with a stippled surface buccally and a normal pocket depth were observed 1 to 2 years postoperatively. These positive treatment results indicate that transalveolar transplantation is a useful alternative in the treatment of impacted maxillary canines in selected patients.     

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提要：正畸学作为颌面美学的一个重要组成部分,给许多牙颌畸形患者带来了福音。随着口腔正畸技术和人民生活水平的提高,接受正畸治疗的患者愈来愈多。其中成人患者比例不断增加。本文就成年人接受正畸治疗的相关因素进行综述     

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目的研究影响成人患者接受正畸治疗的相关因素。方法随机选择2009年11—12月大连大学附属口腔医院正畸科接受治疗的成人患者400例,进行问卷调查。问卷内容包括患者的一般情况、治疗前及治疗过程中的感受、治疗对日常生活的影响及患者对医生和医院的要求与期望。将问卷数据分类并进行统计分析。结果与男性患者比较,女性患者认为颜面外观对结婚、职业、人际关系的影响更显著(P<0.05);女性在正畸治疗中对矫治器的颜色和外观以及医生的专业水平方面的要求更高(P<0.05)。对正畸治疗标准的评价中,女性更关注外观的改善和牙周的健康(P<0.05)。对日常生活的影响方面,女性患者认为对口腔卫生的影响较大(P<0.05),而男性则认为对社会交往的影响更为明显(P<0.05)。与≥25岁患者比较,<25岁患者认为戴用矫治器对日常生活中微笑的影响更显著(P<0.05)。结论不同性别和年龄的成人患者接受正畸治疗对相关因素的要求各有不同。     

Digital images as an alternative to orthodontic casts in assessing malocclusion and orthodontic treatment need

Objective. To investigate the potential use of two-dimensional digital images as an alternative to orthodontic casts in the assessment of malocclusion and orthodoantic treatment need. Material and Methods. Assessment of malocclusion (Angle's classification of molars, overjet, and overbite) and orthodontic treatment need (Index of Orthodontic Treatment Need (IOTN): Dental Health Component (DHC) and Aesthetic Component (AC)) was conducted on 313 study casts and their images by two trained and calibrated examiners. Agreement of orthodontic treatment need and Angle's molar classification was assessed employing Kappa statistics (κ). Agreement of overjet and overbite (measured in mm) was assessed in comparison and correlation analyses. Inter- and intra-examiner reliability of assessment was investigated. Results. There was substantial agreement of the molar relationship classifications (κ >0.70), orthodontic treatment need as assessed by IOTN-DHC (κ =0.79) and IOTN-AC (κ =0.56) between measurements obtained from orthodontic casts and their images. There was also substantial agreement of measurements of overjet and overbite as obtained from orthodontic casts and their images. The standardized directional differences of overjet and overbite were ≤0.2. The intra-class correlation coefficients of assessments of overjet and overbite obtained from orthodontic casts and their images were >0.90. Inter- and intra-examiner reliability for the assessment of malocclusion and orthodontic treatment need was acceptable. Conclusion. Two-dimensional digital images can be used as an alternative to casts in assessment of malocclusion and orthodontic treatment need.     

A study of adult orthodontic patients and their treatment

This retrospective epidemiological study was undertaken to assess factors related to adult orthodontic treatment and to identify any associated trends. Case records of all patients (676) aged 18 years or over at the start of active orthodontic treatment at the Eastman Dental Hospital, London were examined. Variables associated with patients and their treatment (age, sex, source of referral, malocclusion, type of appliance, and interdisciplinary treatment including orthognathic surgery) were studied and the data analysed statistically. Findings revealed that the number of adult patients undergoing orthodontic treatment has increased significantly, especially since 1985. The age of the patients treated was also found to increase in recent years. The percentage of female patients (72 per cent) Class III malocclusions (21.6 per cent) and Class III skeletal bases (26.2 per cent) was higher than found in studies on children. Most of the treatments required fixed appliances and over half involved interdisciplinary treatment, with an increase in the percentage of orthognathic surgical cases. Surgery was significantly more common in males (P less than 0.01) and highly significantly associated with Class III malocclusions and skeletal III bases (P less than 0.001). Twenty-five per cent of adult patients were found to have had a previous course of orthodontic treatment though these patients were not significantly different from adult patients presenting for the first course of treatment.     

Accelerated orthodontic treatment with piezocision: a mini-invasive alternative to conventional corticotomies

An increasing number of adult patients are seeking orthodontic treatment and a short treatment time has become a recurring request. To meet their expectations, a number of surgical techniques have been developed to accelerate orthodontic tooth movement. However, these have been found to be quite invasive. We are introducing here a new, minimally invasive flapless procedure, combining micro incisions, piezoelectric incisions and selective tunneling that allows for hard- or soft-tissue grafting. Combined with a proper treatment planning and a good understanding of the biological events involved, this novel technique can locally manipulate alveolar bone metabolism in order to obtain rapid and stable orthodontic results. Piezocision allows for rapid correction of severe malocclusions without the drawbacks of traumatic conventional corticotomy procedures.     

成人牙周病正畸治疗的疗效分析

目的通过对牙周病患者施行牙周和正畸联合治疗,探讨正畸治疗对牙根长度和牙槽骨高度的影响。方法选择30例牙周病患者,采取牙周治疗和直丝弓固定矫治器正畸的联合方法,拍摄正畸治疗前后的曲面断层片,借鉴Sche i提出测量牙槽骨吸收程度的方法,测量正畸治疗前后牙根长度和牙槽骨高度,用计算机进行统计分析。结果 30例牙周病患者,经过牙周和正畸联合治疗,治疗前后牙根长度和牙槽骨高度的变化差异无统计学意义（P〉0.05）。结论牙周病患者严格控制炎症、采取轻力,通过牙周和正畸联合治疗,不会对牙根长度和牙槽骨高度产生影响。     

Multidisciplinary orthodontic treatment in adult patients: the future of orthodontics

There is currently great demand among adult patients for aesthetic solutions. In the great majority of cases, patients present with serious oral problems in their mouths, such as over-crowding, ageneses, edentulous spaces from old extractions, periodontal problems, etc. In the face of all these problems we need interdisciplinary strategies that will help us carry out the complex and imaginative treatments that these cases require. In this article we are going to describe the interdisciplinary treatment that we provided to two adult patients. 1--On a 25 year old male patient with significant upper maxillary crowding with transversal constriction and absence of the upper right lateral incisor; through correction of the over-crowding, the maxillary constriction and rehabilitation with an implant-supported fixed prosthesis in the edentulous space, we will treat and correct this case. 2--A 29 year old male patient with agenesis of the superior canines and edentulous gap in the inferior dental arch.     

成人正畸治疗Ⅳ.成人修复前正畸治疗和小范围牙移动治疗

在正畸门诊中,很多成年患者并非以矫治错(牙合)畸形为主诉,大部分是会诊中需做正畸辅助处置,如牙周病、颞下颌关节紊乱病(TMD)、正颌手术、外伤治疗,以及缺失牙修复、美齿治疗等.     

成人正畸治疗与颞下颌关节紊乱病的MRI研究

目的 探讨成人正畸治疗与颞下颌关节紊乱病(temporomandibular disorder TMD)的关系,为预防和治疗TMD提供参考.方法 选择60例20 ～ 29岁成年正畸患者,用Helkimo指数将患者分为TMJ无症状组(44例)、TMJ有症状组(16例),分别于治疗前(t1)、治疗中(t2)、治疗后(t3),用MRI检查TMJ关节盘的位置,并用电子测量尺测量TMJ前、后间隙,观察颞下颌关节在治疗前后的变化情况与TMD间的关系.结果 治疗中TMJ无症状组、TMJ有症状组分别有8、9例患者发生TMD,两组TMD发生比例差异有统计学意义(P＜0.05);治疗前后两组均发现关节盘移位;两组治疗前后TMJ各间隙线距发生改变,但两组差异无统计学意义(P＞0.05).结论 成人正畸治疗不会导致TMD,但治疗过程中可诱发TMD症状,并有出现TMD重度症状的风险.在成人正畸治疗前对TMJ进行评估有重要意义.     

Use of osseointegrated implants in adult orthodontic treatment: a clinical report

This article describes the complex dental treatment of an adult patient with multiple missing teeth, mild periodontitis, and a malocclusion. Titanium implants were placed in the posterior mandibular edentulous segments and became osseointegrated. The placement of the mandibular implants was originally designed for orthodontic anchorage. The mandibular implants would subsequently be used for implant-retained crowns on completion of orthodontic treatment. After a 4-month healing period, an impression was made of the implant hexes and a master cast was formed. Two-piece temporary healing abutments were placed on the implants and used to retain orthodontic brackets. The orthodontist retracted the mandibular anterior teeth using the posterior implants for anchorage. The abutment screws of the 2-piece temporary healing abutments were tightened to 20 N-cm at the insertion appointment and did not need to be tightened again during the course of orthodontic therapy. Standard orthodontic brackets were cemented to the 2-piece temporary healing abutments. Orthodontic treatment was accomplished uneventfully. Prosthodontic treatment was completed using the osseointegrated implants to replace the missing teeth. The methods described in this clinical report present clinicians with additional choices in the treatment of complex dental disease using osseointegrated dental implants.