Nikolaos Topouzelis

The orthodontic–periodontic interrelationship in integrated treatment challenges: a systematic review

Orthodontic treatment aims at providing an acceptable functional and aesthetic occlusion with appropriate tooth movements. These movements are strongly related to interactions of teeth with their supportive periodontal tissues. In recent years, because of the increased number of adult patients seeking orthodontic treatment, orthodontists frequently face patients with periodontal problems. Aesthetic considerations, like uneven gingival margins or functional problems resulting from inflammatory periodontal diseases should be considered in orthodontic treatment planning. Furthermore, in cases with severe periodontitis, orthodontics may improve the possibilities of saving and restoring a deteriorated dentition. In modern clinical practice, the contribution of the orthodontist, the periodontist and the general dentist is essential for optimized treatment outcomes. The purpose of this systematic review is to highlight the relationship between orthodontics and periodontics in clinical practice and to improve the level of cooperation between dental practitioners. Potentials and limitations that derive from the interdisciplinary approach of complex orthodontic-periodontal clinical problems are discussed.

Dilaceration of maxillary central incisor: a literature review

The main purpose of this review is to present the aetiological factors and the mechanism that cause dilaceration of the maxillary central incisors. In early developmental stages, the permanent tooth germ of the maxillary incisor is situated palatally and superiorly to the apex of the primary incisor and gradually changes direction in a labial direction with its crown coming closer to the resorbing primary root. For reasons of this close relationship between the permanent tooth germ and the apex of the primary incisor, it is believed that an acute trauma to the primary predecessor can cause dilaceration of the long axis of the permanent successor. Clinically, dilaceration can be revealed by palpation high in the labial sulcus or in the hard palate, while its radiographic view is characteristic. The therapeutic approach to the dilacerated maxillary central incisors has to be carefully planned and needs the cooperation of several specialities to attain the final objective.

Clinical factors correlated with the success rate of miniscrews in orthodontic treatment

Miniscrews offer a reliable alternative for anchorage during orthodontic treatment, particularly for non-cooperative patients or periodontal patients with alveolar bone loss. The study aims at assessing the correlation of various clinical indicators with the success or failure of miniscrews used for anchorage during orthodontic treatment. Thirty-four consecutive patients with a cumulative total of 82 miniscrews implanted participated in the study. Generalized Estimating Equations were used to assess the correlation of various factors with success rates. The miniscrew was considered the unit of analysis clustered within site and within patient. The overall success rate of miniscrews was 90.2%. For every additional miniscrew used in a patients oral cavity, the success rate was reduced by 67%. Retromandibular triangle and palatal placement and in movable mucosa resulted in lower success rate. The miniscrew length and diameter were found to correlate with success rates. Orthodontic force applied on miniscrews for uprighting purposes showed a lower success rate than that used for retraction. This study revealed that miniscrews present high success rates. The number of miniscrews used per patient, the miniscrew site placement, the soft tissue type of placement, the miniscrew length and diameter as well as the orthodontic force applied on the miniscrew showed significant correlation with success rates.

Cephalometric Methods of Prediction in Orthognathic Surgery

Over the past decade the growing number of adult patients seeking for orthodontic treatment made orthognathic surgery popular. Surgical and orthodontic techniques have developed to the point where combined orthodontic and surgical treatment is now feasible to manage dentofacial deformity problems very satisfactorily. The prediction of orthognathic treatment outcome is an important part of orthognathic planning and the process of patient’ inform consent. The predicted results must be presented to the patients prior to treatment in order to assess the treatment’s feasibility, optimize case management and increase patient understanding and acceptance of the recommended treatment. Cephalometrics is a routine part of the diagnosis and treatment planning process and also allows the clinician to evaluate changes following orthognathic surgery. Traditionally cephalometry has been employed manually; nowadays computerized cephalometric systems are very popular. Cephalometric prediction in orthognathic surgery can be done manually or by computers, using several currently available software programs, alone or in combination with video images. Both manual and computerized cephalometric prediction methods are two-dimensional and cannot fully describe three-dimensional phenomena. Today, three-dimensional prediction methods are available, such as three-dimensional computerized tomography (3DCT), 3D magnetic resonance imaging (3DMRI) and surface scan/cone-beam CT. The aim of this article is to present and discuss the different methods of cephalometric prediction of the orthognathic surgery outcome.

Comparative assessment of clinical performance of esthetic bracket materials

OBJECTIVES To compare the alterations in esthetic appearance and slot morphology/integrity of two main types of esthetic brackets caused after clinical use. MATERIALS AND METHODS Sixteen ceramic (CR) and 16 plastic (PR) central incisor brackets were obtained from 16 young adult patients at the end of treatment in a prospective randomized manner. As controls, 12 ceramic (CC) and 12 plastic (PC) nonused brackets were also examined. Three representative slot width measurements were obtained through micrometric microscopy. Visual inspection of optical microscopy images, surface electron microscopy (SEM), and energy-dispersive x-ray spectroscopy (EDS) were also performed. RESULTS Intraoral exposure time varied from 5 to 20 months (mean, 12.4; P  =  .73). Two-way analysis of variance revealed significant differences in slot width among the different materials and a significant interaction between the material effect and its status (P < .001). Bonferroni post hoc tests on material × status effect showed significant differences between CC (95% confidence interval [CI]: 434.5, 447.0) vs PC (95% CI: 460.2, 472.8), CC vs CR (95% CI: 453.2, 464.4), and PC vs PR (95% CI: 448.8, 458.9). Interestingly, a significant difference was not detected for CR vs PR. Slot width was correlated with the time under clinical use only for plastic brackets (PR: r  =  -.64, P < .01). Visual inspection of the optical microscopy images did not reveal any major macroscopic morphological disfigurements or significant discolorations. However, a rough and irregular slot wall surface was evident after clinical use (also with SEM), especially in the bottom of the slot. CONCLUSIONS Both bracket types presented adequate clinical performance at least for the time period studied and in terms of esthetic appearance and morphologic integrity.

Management of root dilaceration of an impacted maxillary central incisor following orthodontic treatment: an unusual therapeutic outcome.

There are rare cases of impacted permanent central incisors with dilaceration, a dental deformity characterized by pronounced angulation of the longitudinal tooth axis. This paper presents the orthodontic alignment of a permanent maxillary left central incisor in a 7.5-year-old boy, which appeared impacted radiologically and displayed root dilaceration. Following surgical exposure with the closed-eruption technique and appropriate orthodontic traction, the tooth was successfully aligned into the dental arch and the root was radiologically shown to be straightened and relatively well developed.

Variation with age of dental cephalometric variables in Class II, division 2 patients

The treatment of Angle Class II/2 malocclusion requires an understanding not only of the dental and maxillofacial features but also of the changes occurring with age in the dental relationships. This paper attempts to determine certain dental relationships in patients with Angle II/2 malocclusion and any changes that might occur with age. The study material included 96 lateral cephalometric X-rays of patients with Angle II/2 malocclusion, the youngest of whom was 7 years old and the eldest 35. Six cephalometric measurements were performed on every cephalometric X-ray. Statistical processing of data included one-variable analyses and correlations of two variables. Statistical one-variable analysis used methods from descriptive statistics. Methods of inferential statistics have been applied in order to revel statistical significance. The evaluation of the findings of this research study concluded that, in patients with Angle II/2 malocclusion, maxillary central incisors presented pronounced palatal tipping, which exacerbated significantly with age, while mandibular incisors displayed reduced labial tipping and projection, which significantly reduced with age. Furthermore, it was found that there was pronounced incisor overjet, which increased with age, due to increased protrusion of mandibular incisors.

Patterns of non-syndromic permanent tooth agenesis in a large orthodontic population.

OBJECTIVE The aim of this study is to explore patterns of non-syndromic permanent tooth agenesis in a large orthodontic patient group. DESIGN A record review was performed in various orthodontic clinics to identify white patients with non-syndromic permanent tooth agenesis, excluding 3rd molars. Four hundred and fourteen subjects fulfilled the inclusion criteria. RESULTS In the 414 subjects with tooth agenesis, approximately 70% presented 1-2 missing teeth. Symmetric agenesis patterns were often observed in the sample (by jaw, by side, or crossed quadrants), with prevalence approaching 30% for cases with contralateral tooth agenesis within a jaw. In cases with 1 or 2 missing teeth, from the total number of potential tooth agenesis patterns in the sample, a certain part was evident, limiting the variation to 27.8% (44/158). In the entire sample, both in the maxilla and the mandible a certain incisor/premolar agenesis phenotype was observed in 59.0% of cases in isolated form. CONCLUSIONS Although there was variation in the tooth agenesis patterns, our findings suggest the involvement of particular genetic, epigenetic, and/or environmental factors in the formation of the entire dentition, which often lead to specific tooth agenesis phenotypes in cases where this process is disrupted. The present study provides a comprehensive categorization of orthodontic cases with tooth agenesis and can assist in planning future epidemiological and genetic studies.

Diagnosis and treatment of ankyloglossia: A narrative review and a report of three cases

BACKGROUND Ankyloglossia or tongue-tie is a congenital oral anomaly with short, tight, and thick lingual frenulum. It may be asymptomatic or can cause movement limitations of the tongue, speech and articulation difficulties, breastfeeding difficulties in neonates, as well as periodontal and malocclusion problems. The etiopathogenesis of ankyloglossia is unknown; it can occur either as a sole anomaly in the vast majority or in association with other craniofacial anomalies. OBJECTIVES The aims of this paper were (1) to provide a comprehensive review on the criteria for clinical assessment and diagnosis, etiology and inheritance, and the therapeutic options of ankyloglossia; and (2) to demonstrate the treatment of ankyloglossia by means of frenuloplasty in three cases. REVIEW The available evidence from the literature indicates that among neonates, children, and adults the prevalence of ankyloglossia is low and in some cases remains undiagnosed. The early clinical assessment, diagnosis, and treatment are beneficial for the patients and their mothers. CONCLUSIONS Frenuloplasty is a safe, quick, effective, and economical method and for this reason the parents should not hesitate towards frenulum release. More clinical studies are needed to confirm the benefits of the surgical interventions and to compare the results with those obtained using nonsurgical therapy or with untreated cases.

An alternative impression technique for individuals with special care needs

Impression making may be complicated in individuals with limited ability to cooperate with caregivers. An alternative technique for obtaining full-arch casts from sectional preliminary impressions is described. The technique is a modification of the procedure advocated for impression making in subjects with limited mouth opening. A pair of partial stock trays is selected to fit the right and left side of the arch. Two sectional irreversible hydrocolloid impressions are made separately. The first cast is placed into the second impression prior to pouring, to obtain a cast of the complete arch. The procedure was used during the treatment of an uncooperative young patient with Lesch-Nyhan Syndrome and provided a simple and reliable means to obtain the diagnostic cast of the mandibular teeth. It is recommended not only for uncooperative patients, but also for patients with special needs; such as those with anatomical restrictions, functional impairment, and movement disorders.