Surgically-assisted maxillary expansion

A combined surgical and orthodontic technique for management of transverse maxillary deficiencies in mature patients is described and discussed. Special references are made to the surgical release of several circummaxillary articulations to facilitate the use of a fixed expansion device, and to the authors' addition of an osteotomy below the nasal spine, to ensure that the nasal septum remains independent of the maxillary segments. Indications for the use of this surgically-assisted maxillary expansion technique, and its advantages when compared with segmented surgical expansion, are also presented.     

The use of a simple functional appliance as an adjunct to fixed appliance orthodontic treatment

Three clinical case studies are presented to demonstrate the use of a simple functional appliance in orthodontic situations not covered by traditionally-accepted dental and skeletal indications. In each case, the appliance was used to reduce the severity of the malocclusion, before a routine fixed-appliance detailing phase.     

Reducing the incidence of unerupted palatally displaced canines by extraction of deciduous canines. The history and application of this procedure with some case reports

The procedure of extracting the deciduous canine to reduce the incidence of the unerupted palatally displaced canine was first described in 1951, and an article solely devoted to the technique appeared in 1959. The procedure then virtually vanished until 1981. A prospective study published in 1988 created the first widespread interest in the method which now appears in major texts. Why the procedure succeeds is uncertain. In the 1950s nonresorption of the deciduous canine was thought to cause palatal deflection of its successor and therefore it appeared appropriate to extract the obstructing deciduous tooth. It has been estimated that the technique should be successful in approximately one in three of all cases in the population aged 10 to 13 years. The earlier the detection the better the prognosis, because the unerupted canine frequently moves more mesially with time. Before the procedure is attempted it is important to discuss possible outcomes with the patient. Three successfully treated cases are illustrated. The first conformed with the guidelines of having an uncrowded maxillary arch and being aged between 10 and 13 years. The second was aged 15 years 2 months at commencement. An unsuccessful surgical exposure of the permanent canines followed by extraction of the deciduous canines was carried out in the third case.     

A maxillary buccal tip

A method for the delivery of the average fractured upper buccal root apex, for which no reference can be found in the exodontic literature, is presented.     

Reducing the incidence of palatally impacted maxillary canines by extraction of deciduous canines: a useful preventive/interceptive orthodontic procedure. Case reports

The early detection of palatally impacted permanent maxillary canines is stressed. Appropriate radiographs to determine impactions are suggested and removal of deciduous canines to eliminate impactions in patients who have good dental arches with no space deficiency is recommended. Two case histories are presented to illustrate the method.     

A laboratory for teaching oral-surgical technique

A special-purpose laboratory designed to improve the efficiency of simulated teaching of oral-surgical techniques at both undergraduate and graduate levels is described The laboratory is recommended because it has simplified further the staging of oral-surgical-technique teaching. The possible risk of infections from the use of animal tissue in this type of laboratory is also discussed.     

Palatally impacted canines: aetiology of impaction and the scope for interception. Report of cases outside the guidelines for interception

Patients with palatally impacted canines have an increased incidence of missing or anomalous lateral incisors adjacent to the impacted canines. Their arches are often uncrowded and this, in part, is linked to the increased incidence of missing or anomalous lateral incisors. Other teeth are also more frequently missing. The present guidelines for the relief of palatally impacted canines by extraction of the deciduous canine require that the patient is aged between 10–13 years and that normal space conditions are present. Two successful case reports are presented which were outside the recommended guidelines. The technique of relieving a palatal impaction by extraction of the deciduous canine has wide application.     

Treatment planning in orthodontics and orthognathic surgery: the significance of tooth inclination and dental compensations

The scope of orthodontic treatment is examined and the importance of the initial tooth inclinations and skeletal base relationships is explained. Dental compensations which occur in all three planes of space are discussed. Special attention is given to the importance of dental compensations in the antero-posterior plane in orthognathic surgery treatment planning. There is a necessity for early definitive decision-making in the borderline orthognathic surgery patient and the role of orthodontic camouflage is pointed out. Case selection for treatment with removable appliances is explored.     

Teeth in cross-bite: the role of removable appliances

The role of removable appliances with springs for the treatment of teeth in anterior and posterior cross-bite is discussed. The indications for their use (that is, case selection), and their manipulation are examined. Cases are presented where removable appliances are the appliances of choice in the first stage of the correction of a posterior cross-bite, the final treatment being completed with fixed appliances. The ease of correcting and retaining various maxillary teeth which may be in cross-bite is discussed.     

The impacted maxillary canine. Further observations on aetiology, radiographic localization, prevention/interception of impaction, and when to suspect impaction

A bstract — Adjacent anomalous or missing maxillary lateral incisors have been implicated in the aetiology of palatally displaced canines by not providing proper guidance to the canine during its eruption. However, a recent review of the literature suggests that the aetiology of palatally displaced canines is genetic in origin. The aetiology of labially impacted canines differs, being due to inadequate arch space. Vertex occlusal radiographs have been recommended for localization but have limitations, and a case is illustrated where this radiograph is deceptive. The prevention/interception of a palatally displaced canine by the extraction of the deciduous canine is best carried out as early as the displacement is detected, mostly soon after 10 years of age. Usually, prevention/interception will avoid the surgical and orthodontic treatment needed to align a palatally impacted canine and may help prevent resorption of the adjacent incisor root. Suspicions that an impaction could occur or has occurred arise a) before the age of 10 years if there is a familial history and/or the maxillary lateral incisors are anomalous or missing; b) after the age of 10 years if there is asymmetry in palpation or a pronounced difference in eruption of canines between the left and right side; or, the canines cannot be palpated and occlusal development is advanced; or, the lateral incisor is proclined and tipped distally; and, on a panoramic radiograph of the late mixed dentition if the incisal tip of the canine overlaps the root of the lateral incisor.