Matthias Kalwitzki

Transplantation of a Lower Bicuspid after Traumatic Loss of Three Upper Incisors

Abstract.Background: Prosthodontic and orthodontic procedures have been described for the treatment of patients with traumatic loss of teeth. Patient and Methods: Both upper central incisors and the upper right lateral incisor had to be extracted in an 8-year-old patient after failure of conservative procedures following a sports accident. The patient was treated on a temporary basis with a space retainer as a substitute for the teeth. Definitive therapy was carried out by transplanting a lower bicuspid germ into the upper arch with subsequent orthodontic gap closure. Results: 8 years after the intervention, the transplanted tooth is still in place. The patient is fully rehabilitated both functionally and esthetically with no discomfort. Conclusions: The transplantation of bicuspid germs in conjunction with orthodontic gap closure is a valuable alternative to prosthodontic treatment, particularly in the case of loss or aplasia of several teeth.Zusammenfassung.Hintergrund: Für das therapeutische Procedere nach dentalen Traumata mit Verlust von Zähnen sind prothetische und kieferorthopädische Vorgehensweisen beschrieben. Patient und Methoden: Bei einem 8-jährigen Patienten waren nach einem Sportunfall die Zähne 12, 11 und 21 trotz konservierender Maßnahmen nicht zu erhalten und mussten extrahiert werden. Der Patient wurde zunächst mit einem Lückenhalter zum Ersatz der fehlenden Zähne temporär versorgt. Die definitive Therapie erfolgte durch die Transplantation eines unteren Zahnkeimes in den oberen Zahnbogen und einen sich anschließenden kieferorthopädischen Lückenschluss. Ergebnisse: 8 Jahre nach Durchführung ist der transplantierte Zahnkeim in situ, der Patient bei Beschwerdefreiheit ästhetisch und funktionell rehabilitiert. Schlussfolgerungen: Die Transplantation von Prämolarenzahnkeimen in Verbindung mit einem kieferorthopädischen Lückenschluss stellt insbesondere bei traumatischem Verlust oder Aplasie mehrerer Zähne eine wertvolle Alternative zur prothetischen Versorgung dar.

Effects of extraction treatment on maxillary and mandibular sagittal development in growing patients

This retrospective investigation was designed to assess the effects of extraction treatment on the sagittal dimensions of the maxillary and mandibular skeletal structures of growing patients. The records of 40 patients (17 girls, 23 boys; median age 10 years 11 months) whose orthodontic treatment involved extraction of four premolars were evaluated and compared with a control group of 100 patients (54 girls, 46 boys; median age 10 years 7 months) treated non-extraction. Two lateral cephalograms were obtained of each patient, the first before the extractions, T1, and the second at a later point, T2 (mean difference 59 months). Linear parameters, including S-N, the maxillary/mandibular alveolar process, and maxillary/mandibular base, were measured. The same parameters were determined in the control group at corresponding time points (mean difference 63 months). For analysis, the sagittal dimensions of the alveolar processes and jaw bases were compared with each other. The relationships were also established to a reference line known to be unaffected by extraction treatment (S-N). This procedure was performed for the whole sample and for three subgroups formed according to the Wits appraisal. Statistical analysis was carried out using a Students t-test. Comparisons of the total sample showed differences between the groups, which were statistically significant for the maxillary alveolar process, the mandibular alveolar process, and the mandibular base. They varied however in the different subgroups. Whenever extraction treatment is considered, it should be borne in mind that the effects on the sagittal dimension of different bony structures may vary.

Differences in the perception of seven behaviour-modifying techniques in paediatric dentistry by undergraduate students using lecturing and video sequences for teaching

Whilst preparing undergraduate students for a clinical course in paediatric dentistry, four consecutive classes (n = 107) were divided into two groups. Seven behaviour-modifying techniques were introduced: systematic desensitization, operant conditioning, modelling, Tell, Show, Do-principle, substitution, change of roles and the active involvement of the patient. The behaviour-modifying techniques that had been taught to group one (n = 57) through lecturing were taught to group two (n = 50) through video sequences and vice versa in the following semester. Immediately after the presentations, students were asked by means of a questionnaire about their perceptions of ease of using the different techniques and their intention for clinical application of each technique. After completion of the clinical course, they were asked about which behaviour-modifying techniques they had actually used when dealing with patients. Concerning the perception of ease of using the different techniques, there were considerable differences for six of the seven techniques (P < 0.05). Whilst some techniques seemed more difficult to apply clinically after lecturing, others seemed more difficult after video-based teaching. Concerning the intention for clinical application and the actual clinical application, there were higher percentages for all techniques taught after video-based teaching. However, the differences were significant only for two techniques in each case (P < 0.05). It is concluded that the use of video based teaching enhances the intention for application and the actual clinical application only for a limited number of behaviour-modifying techniques.

Dislocation of an upper third molar by an ossifying fibroma--case report.

BACKGROUND The occurrence of ossifying fibromas (OFs) in childhood and adolescence has been described in the literature, along with different courses of the disease due to different growth rates. CASE REPORT In the case of the 15-year-old female patient presented here, an OF resulted in displacement of a maxillary third molar far into the maxillary sinus. It is assumed that the tumour originated coronal to the affected tooth 18. Radiographs document an initial rapid growth of this tumour over a period of 2 years, while its growth almost completely ceased in the next 2 years immediately prior to diagnosis and surgical treatment. The operation was complicated by unexpected profuse bleeding from the tumour tissue. CONCLUSION The peculiarity of the OF in the case presented here is its similarity, in terms of clinical and radiological appearances, with a follicular cyst, its unusual place of origin that resulted in the migration of the tooth 18 into the maxillary sinus, its different growth dynamics, and the pronounced haemorrhage encountered as the tumour was surgically removed.

Cervical Headgear Treatment and Growth Patterns: Analysis by Lateral Cephalometry

Objective:Retrospective cephalometric study of changes in vertical and sagittal relations after headgear treatment depending on preexisting growth patterns.Materials and Methods:Lateral cephalograms obtained from 119 patients before and after headgear treatment were analyzed. All patients were treated with headgears exclusively. Only cases were included that showed bilateral improvement of least 4 mm in Class II occlusion after headgear treatment lasting at least 6 months. Patients were assigned to six groups based on y-axis values obtained at baseline.Results:Almost all groups revealed substantial improvements in skeletal Class II relations, including 1.38°–1.72° reductions in ANB angles and 0.62–0.81 mm reductions in Wits values. SNA values fell by 0.51–1.25°. SNB angle values increased by 0.21°– 0.95°. SN-MeGo angles and mandibular angles were reduced, while y-axis values remained essentially unchanged during headgear treatment. Different results were only obtained in the group with the most pronounced horizontal growth pattern. Those patients revealed lower SNB angle values (–0.93°) and increased vertical relations (y-axis: +1.39°; SN-MeGo angle: +1.22°; mandibular angle: +0.01°) after headgear treatment. All groups showed a reduction in basal plane angles and maxillary retroinclination after treatment.Conclusion:Our results do not support the conventional recommendation that cervical headgears should not be used in the presence of vertical growth patterns.ZusammenfassungZiel:Retrospektive fernröntgenkephalometrische Untersuchung der Veränderungen vertikaler und sagittaler Beziehungen nach Headgearbehandlung in Abhängigkeit vom Wachstumsmuster zu Behandlungsbeginn.Material und Methodik:Die Fernröntgenseitenbilder zu Beginn und nach Beendigung einer ausschließlichen Headgearbehandlung von 119 Patienten wurden ausgewertet. Einschlusskriterien waren eine Verbesserung der Distalokklusion um mindestens 1/2 Pb beidseits und eine mindestens 6-monatige Behandlungsdauer. Anhand der y-Achse zu Behandlungsbeginn erfolgte die Einteilung der Patienten in sechs Gruppen.Ergebnisse:In fast allen Gruppen zeigte sich eine deutliche Verbesserung der skelettalen Klasse II (Veränderung des ANB-Winkels zwischen –1,38° und –1,72°, Veränderung des Wits-Wertes zwischen –0,62 mm und –0,81 mm), eine Reduktion des SNA-Wertes (zwischen –0,51° und –1,25°) und eine Vergrößerung des SNB-Wertes (zwischen 0,21° und 0,95°). Darüber hinaus kam es zu einer Verkleinerung des SN-MeGo- und des Kieferwinkels, während der Wert für die y-Achse weitgehend stabil blieb. Eine Ausnahme bildete die Gruppe mit ausgeprägt horizontalem Wachstumsmuster, in der sich eine Verkleinerung des SNB-Wertes (–0,93°) und eine Vergrößerung der vertikalen Relationen (y- Achse +1,39°, SN-MeGo +1,22°, Kieferwinkel +0,01°) zeigte. In allen Gruppen kam es zu einer Reduktion des Basiswinkels und zu einer Veränderung der Oberkieferinklination im Sinne einer Retroinklination.Schlussfolgerung:Anhand dieser Ergebnisse kann die übliche Empfehlung zum Verzicht des zervikalen Headgears bei vertikalem Wachstumsmuster nicht unterstützt werden.

Retrospective Analysis of Casts to Assess Cervical Headgear Treatment in the Presence of Vertical Growth Pattern

Objective:Does molar distalization as effected by cervical headgear increase the vertical dimension of occlusion in patients with vertical growth pattern?Materials and Methods:A sample of 86 patients with neutral and vertical growth pattern in the late mixed dentition stage underwent headgear treatment. Their initial and intermediary casts were retrospectively analyzed for occlusal relationships at the maxillary first molars and degrees of overjet and overbite. The only cases included were those in which headgear treatment was carried on for at least 6 months, achieving a minimum distalization of 4 mm. The intermediary casts were fabricated after headgear treatment had been completed and prior to the initiation of multiband treatment.Patients were divided into three groups (N, V1 and V2) according to the degrees of vertical growth pattern, which were determined based on y-axis angle values.Results:Grouped by degrees of vertical growth, the data revealed occlusal relationship changes of 6–8 mm and overjet reductions of 0.6–1.2 mm. The overbite changes were unexpectedly small (0–0.04 mm).Grouped by degrees of overbite, the data revealed that headgear treatment increased the vertical dimension of occlusion in deep-bite patients (> 4 mm), while giving rise to decreases in patients with overbites of < 3 mm.ZusammenfassungFragestellung:Führt die Molarendistalisation mit Hilfe eines zervikalen Headgear bei Patienten mit vertikalem Wachstumsmuster zur Bisshebung?Material und Methode:In einem Patientenkollektiv von 86 Patienten mit neutralem und vertikalem Wachstumsmuster wurden nach abgeschlossener Headgear-Behandlung in der zweiten Wechselgebissphase die Anfangs- und Zwischenmodelle im Hinblick auf die Verzahnung im Bereich der Sechsjahrmolaren sowie auf die sagittale Frontzahnstufe und den vertikalen Überbiss nachuntersucht. Einschlusskriterium war eine Behandlungsdauer von mindestens 1/2 Jahr und eine Distalisation von mindestens 4 mm beidseits. Die Zwischenmodelle waren nach abgeschlossener Headgear-Behandlung und vor der anschließenden Multiband-Behandlung angefertigt worden.Die Einteilung der Ausprägung des vertikalen Wachstumsmusters wurde anhand der Werte des Winkels der y-Achse vorgenommen. Daraus wurden drei Gruppen (N, V1 und V2) gebildet.Ergebnisse:Bei der Auswertung der Daten nach der Ausprägung des vertikalen Wachstumsmusters zeigten sich bei einer Veränderung der Okklusionsbeziehung von 6–8mm und einer Reduzierung der sagittalen Stufe um 0,6–1,2 mm nur geringe Veränderungen des vertikalen Überbisses (0–0,4 mm).Bei einer weiteren Auswertung der Daten nach der Ausprägung des vertikalen Überbisses zum Behandlungsanfang ergab sich bei Tiefbisspatienten (> 4 mm) eine Bisshebung, bei Patienten mit einem vertikalem Überbiss von weniger als 3 mm hingegen eine Bissvertiefung.

Molar and canine occlusal changes in study casts before and after treatment with cervical headgears.

Aim:We carried out a retrospective study on 246 pairs of casts to compare the extent of changes in occlusal relationship and overjet reduction induced by cervical headgears.Material amd Methods:Molar-canine occlusal relationships and overjet were determined from study casts made immediately before headgear treatment. Those findings were then compared to another cast made immediately after headgear monotherapy and before multiband-appliance administration. Headgear treatment lasted at least 6 months. Only patients whose upper first molars were distalized by at least 4 mm were included.Results:Strikingly, the distalization and overjet reduction induced by headgear treatment were most pronounced in posterior positions and decreased progressively toward more anterior positions along the arch. The mean amount of distalization was 6.87 mm at molar, and 1.87 mm at canine positions. The mean reduction of initial overjet was 0.78 mm. No significant differences resulted by grouping the data based on upper anterior tooth inclinations before treatment. Significant differences, however, were obtained by grouping the data based on initial overjet. Significantly greater changes in molar-canine occlusal relationships and overjet reductions were observed in patients with a major initial overjet of > 6 mm than in those with a relatively minor overjet of < 4 mm.ZusammenfassungZiel:In einer retrospektiven Studie wurde anhand von 246 Modellpaaren das Ausmaß der Veränderung der Okklusion im Molaren- und im Eckzahnbereich sowie der sagittalen Stufe nach Behandlung mit einem zervikalen Headgear untersucht.Material und Methodik:Zunächst wurden am Ausgangsmodell, welches den Zustand direkt vor der Headgear-Behandlung wiedergab, die Verzahnung im Molaren- und im Eckzahnbereich sowie die sagittale Stufe bestimmt. Diese Ergebnisse wurden mit den Ergebnissen eines weiteren Modells verglichen, das direkt nach der ausschließlichen Headgear- und vor der anschließenden Multibandbehandlung angefertigt wurde. Die Headgear-Behandlung umfasste einen Zeitraum von mindestens 6 Monaten. Einschlusskriterium war eine Distalisierung des ersten oberen Molaren von mindestens 4 mm (entsprechend etwa einer halben Prämolarenbreite).Ergebnisse:Auffällig war die abnehmende Headgear-Wirkung im Sinne der durchschnittlich erreichten Distalisierung bzw. Reduktion der sagittalen Stufe von dorsal nach ventral. So betrug die durchschnittliche Distalisierung im Molarenbereich 6,87 mm, im Eckzahnbereich 1,87 mm und die durchschnittliche Reduktion der sagittalen Stufe 0,78 mm. Eine Unterteilung der Daten nach der Frontzahninklination zu Behandlungsanfang ergab keine signifikanten Unterschiede. Dies war jedoch der Fall bei der Unterteilung nach der sagittalen Stufe zu Behandlungsanfang. Bei großer sagittaler Stufe (> 6 mm) zu Behandlungsanfang war die distalisierende Wirkung des Headgears auf die Molaren- und Eckzahnrelation sowie auf die sagittale Stufe statistisch signifikant größer als bei kleiner sagittaler Stufe (< 4 mm).