Hagai Hazan-Molina

Revascularization: A Treatment for Permanent Teeth with Necrotic Pulp and Incomplete Root Development

INTRODUCTION Endodontic treatment of immature permanent teeth with necrotic pulp, with or without apical pathosis, poses several clinical challenges. There is a risk of inducing a dentin wall fracture or extending gutta-percha into the periapical tissue during compaction of the root canal filling. Although the use of calcium hydroxide apexification techniques or the placement of mineral trioxide aggregate as an apical stop has the potential to minimize apical extrusion of filling material, they do little in adding strength to the dentin walls. It is a well-established fact that in reimplanted avulsed immature teeth, revascularization of the pulp followed by continued root development can occur under ideal circumstances. At one time it was believed that revascularization was not possible in immature permanent teeth that were infected. METHODS An in-depth search of the literature was undertaken to review articles concerned with regenerative procedures and revascularization and to glean recommendations regarding the indications, preferred medications, and methods of treatment currently practiced. RESULTS Disinfection of the root canal and stimulation of residual stem cells can induce formation of new hard tissue on the existing dentin wall and continued root development. CONCLUSIONS Although the outcome of revascularization procedures remains somewhat unpredictable and the clinical management of these teeth is challenging, when successful, they are an improvement to treatment protocols that leave the roots short and the walls of the root canal thin and prone to fracture. They also leave the door open to other methods of treatment in addition to extraction, when they fail to achieve the desired result.

The management of mandibular body fractures in young children

This article reviews the management of mandibular body fractures in young children. Treatment principles of this fracture type differ from that of adults due to concerns regarding mandibular growth processes and dentition development. The goal of this fracture treatment is to restore the underlying bony architecture to its preinjury position in a stable fashion as non-invasively as possible and with minimal residual esthetic and functional impairment. The management of mandibular body fractures in children depends on the fracture type and the stage of skeletal and dental development; treatment modalities range from conservative non-invasive, through closed reduction and immobilization methods to open reduction with internal fixation. Disruption of the periosteal envelope of the mandibular body may have an unpredictable effect on growth. Thus, if intervention is required closed reduction is favored.

Aggressive periodontitis diagnosed during or before orthodontic treatment

Abstract Objective. The aim was to review the literature on aggressive periodontitis diagnosed during or before the initiation of orthodontic treatment and to propose preventive recommendations before, during and after orthodontic treatment. Materials and methods. Literature searches of free text and MeSH terms were performed by using PubMed, Embase and the Cochrane Library and the appropriate studies were selected. The retrieved articles were analyzed and the relevant data was tabulated according to different parameters. Results. A total of 220 articles were found in the preliminary search. Eighteen studies, all case reports, describing 21 cases from this search met all the criteria. The mean age of the reported cases was 21.12 years, all treated with combined periodontal and orthodontic modalities. Most of the reported cases were female. Conclusion. An interdisciplinary dental team must approve the periodontal health prior to and during the course of the orthodontic therapy. In subjects with periodontal pathology, a periodontal consultation and interceptive/corrective therapy should be performed prior to commencing with orthodontic treatment. Orthodontic treatment should be postponed or replanned in order to shorten treatment duration and reduce the orthodontic forces exerted on the aggressive periodontitis involved dentition.

The Future in Craniofacial Surgery: Computer-Assisted Planning

Advancements in computers, prototyping, and imaging, especially over the last 10 years, have permitted the adoption of three-dimensional imaging protocols in the health care field. In this article, the authors present an integrated simulation system for craniofacial surgical planning and treatment. Image fusion technology, which involves combining different imaging modalities, was utilized to create a realistic prototype and virtual image that can be manipulated in real time. The resultant data can then be shared over the Internet with distantly located practitioners.

Reverse quad helix appliance: differential anterior maxillary expansion of the cleft area before bone grafting.

Abstract Cleft-affected cases present a variable degree of transversal constriction of the maxilla. Our aim is to present a new method for differential expansion of the premaxillary area in unilateral cleft lip and palate–affected patients. The reverse quad helix appliance is made of a 0.036-in stainless-steel wire soldered to 2 bands placed on maxillary deciduous canines or first primary molars (or first permanent premolars). It incorporates 4 helical loops forming an inverse W–arch design. The spring is positioned posterior to the banded teeth; thus, the expansion effect is focused in the anterior maxillary region. A reverse quad helix appliance was activated and cemented in 20 patients for premaxillary expansion. Upper arch width was assessed by means of plaster study models in the anterior and posterior maxillary regions. The mean anterior occlusal expansion achieved by the reverse quad helix (9.60 [±5.24] mm) is statistically significantly larger than that achieved in the posterior region (5.50 [±3.07] mm) (P < 0.0001). The reverse quad helix is an efficient appliance for differential expansion of the anterior maxillary region as a preparatory stage for secondary bone graft procedures in unilateral cleft lip and palate–affected patients.

Combined orthognathic distraction procedure: Le Fort I maxillary osteotomy and mandibular curvilinear distraction osteogenesis. A new technique for craniofacial management.

Dentofacial deformities are traditionally treated by maxillary and mandibular osteotomies conducted separately or simultaneously. Recently, distraction osteogenesis has become an irreplaceable part of the surgical armamentarium, for its ability to induce new bone formation between the surfaces of bone segments that are gradually separated by incremental traction, along with a simultaneous expansion of the surrounding soft-tissue envelope. The aim of this article is to describe a combined surgical technique consisting of simultaneous maxillary Le Fort I advancement and mandibular surgical repositioning by means of bilateral sagittal split osteotomy with a curvilinear distractor based on a preliminary computerized presurgical prediction.

Orthodontic Consideration in Patients with Beta-Thalassemia Major: Case Report and Literature Review.

OBJECTIVE Beta Thalassemia (βT) patients present a unique facial appearance and specific craniofacial, jaw and dental patterns. Although this anomaly often requires orthodontic management, βT patients have received scant attention in the orthodontic and dental literature over the past 50 years. The aim of this article is to review the characteristic craniofacial and dental manifestation pattern of βT patients and to emphasize their preferred orthodontic management protocol by presenting a βT orthodontic treated patient. CASE REPORT A 10 year old patient presented with a complaint of severe esthetic and functional disorders due to her diagnosis of βT. We initiated orthodontic treatment including a combined orthopedic and functional treatment modality to improve facial appearance. RESULTS Maxillary restraint and increased mandibular size during treatment along with an increase in the vertical dimension were achieved. The patient presented with Angle class I molar relationship, with reduction of the excessive overjet and deep overbite. CONCLUSION Orthodontic treatment comprised of maxillary orthopedic treatment directed especially toward premaxilla with light forces, and mandibular modification by functional appliance along with fixed orthodontic treatment is recommended in βT patients.

Craniofacial magnetic resonance imaging with a gold solder-filled chain-like wire fixed orthodontic retainer.

Abstract Magnetic resonance imaging (MRI) is one of the most powerful tools in diagnostic imaging. With the growing rates of orthodontic treatment, there are increasing chances of post–orthodontic treatment patients permanently wearing fixed retainers who shall undergo MRI examination. Three adolescent patients were referred for craniofacial MRI examination. All the patients had completed full orthodontic treatment with a retention protocol of permanently wearing bonded gold solder–filled wire fixed retainers. In the first 2 cases, the MRI examination was performed on a 1.5-T system and in the last case on a 3-T system. All the images achieved were of good quality and high resolution. No adverse effects were reported by the first 2 patients including no complaint of heat sensation or any other discomfort in the anterior teeth area. The third patient complained of a headache during the MRI examination. Radiologists and technicians may consider allowing performance of MRI examination using 1.5-T systems when a gold solder–filled wire fixed retainer is involved with no concern regarding the patient’s health or the accuracy of the MRI scans.

Clinical Application of Shockwave Therapy in Orthodontics

Extracorporeal shockwaves are noninvasive mechanical forms of sound wave treatment. They were introduced in medical therapy approximately 30 years ago in order to disintegrate kidney stones. Over the last 15 years, extracorporeal generated shockwaves have been used in many fields of medicine due to their versatility and ability to stimulate healing processes by inducing neovascularization and differentiate stem cells into cells of the injured tissue to allow proper healing and regeneration.