Teresa Pinho

Impacted maxillary central incisor: Surgical exposure and orthodontic treatment

This case report describes the treatment of a patient with a horizontally impacted maxillary central incisor, a canine in the same quadrant, and an inclusion tendency. Due to severe crowing in the maxilla and the Class II molar relationship on the impaction side, a 2-stage treatment plan was developed. In the first stage, the right first premolar and deciduous canine were extracted; this allowed enough space for the eruption of the maxillary right permanent canine. The second stage included surgical exposure and traction of the impacted central incisor with a fixed orthodontic appliance. An excisional uncovering technique was needed to expose the impacted incisor. After it erupted, an apically positioned partial-thickness flap was used to add keratinized attached gingiva in the area surrounding the crown, initially located in an area of unattached gingiva. The patient finished treatment with a normal and stable occlusion between the maxillary and mandibular arches and an adequate width of attached gingiva.

Familial Aggregation of Maxillary Lateral Incisor Agenesis

In spite of recent developments, data regarding the genes responsible for the less severe forms of hypodontia are still scarce and controversial. This study addressed the hypothesis that agenesis of maxillary lateral incisors (MLIA) is a distinct type of hypodontia, by evaluating its familial aggregation and the occurrence of other types of ageneses or microdontia in probands’ relatives. Sixty-two probands with MLIA were identified, and information was collected on 142 first-degree relatives. Relative risk (RR) was calculated and compared by re-assessment of data previously published for the Swedish, Utah, and Israeli populations, for the same trait. A RR of 15 was obtained in the Portuguese, 16 in the Swedish, 12 in Utah, and 5 in the Israeli population. Our results support a significant familial aggregation of MLIA, show that MLIA almost never segregates with other forms of agenesis, and suggest that microdontia of maxillary lateral incisors is part of the same phenotype.

Developmental disturbances associated with agenesis of the permanent maxillary lateral incisor

The aim of this study was to characterise the intra and extra-oral phenotype associated with agenesis of the permanent maxillary lateral incisor. We compared three groups: (1) subjects with agenesis of one or both permanent maxillary lateral incisors (n = 80); (2) first and second degree relatives of group 1 with no agenesis of the permanent maxillary lateral incisor and (3) subjects with no agenesis of the maxillary lateral incisor or family history of it (n = 49). For each of the 201 subjects detailed clinical information was reviewed and panoramic radiographs were analysed. Considering only the sample with unilateral agenesis, microdontia of the contralateral permanent maxillary lateral incisor was significantly more frequent in group 1 (82.4%) than in group 2 (25%) and the control group (2%). This supports the theory that microdontia is a variable expression of the same developmental disturbance that causes tooth agenesis. The absence of third molars occurred more often in group 1 (36.2%) than in groups 2 and 3 (18.6% and 18.9% respectively), confirming that agenesis of third molars was markedly associated with the agenesis of the permanent maxillary lateral incisor. Agenesis of teeth other than third molars was not significantly different among subjects with agenesis of the permanent maxillary lateral incisor and their relatives. The frequencies of supernumerary teeth, permanent maxillary canine impaction, general health condition and minor anomalies were not significantly different between the three groups.

Multidisciplinary management including periodontics, orthodontics, implants, and prosthetics for an adult

This article describes the complex dental treatment of an adult patient with multiple missing teeth, mild chronic periodontitis, and a malocclusion with a cant of the occlusal plane. After periodontal treatment, titanium implants and a miniscrew were placed to correct the occlusal plane canting with orthodontic treatment. Prosthodontic treatment was completed by using osseointegrated implants to replace the missing teeth.

Mutational analysis of MSX1 and PAX9 genes in Portuguese families with maxillary lateral incisor agenesis

The observation that certain patterns of tooth agenesis occur more frequently in individuals of the same family may suggest the existence of predisposing genetic factors. The aim of this study was to search for mutations in the PAX9 and MSX1 genes and to investigate their potential association with the maxillary lateral incisor agenesis (MLIA) phenotype in 12 Portuguese families, a total of 52 individuals, 12 probands and 40 relatives (eight of which had MLIA). Twenty-three of the subjects were male and 29 female with an age range of 10-75 years. The control group comprised random DNA samples of 91 Portuguese individuals. Nucleotide alterations were not detected in the coding regions of the MSX1 gene, analysed by single-strand conformation polymorphism and sequencing; in the PAX9 gene, a polymorphism was found that led to transition of G718 to C, implying a change of alanine 240 for proline. However, the differences in the frequencies of the PAX9 gene polymorphism between the probands (67 per cent) and the control population (56 per cent carrying the c allele) were not statistically significant as determined by chi-square test, and the polymorphism did not clearly segregate with the trait in the families. Aggregating the available data, there does not seem to exist a clear association between the alanine 240 for proline variant in the PAX9 gene and the MLIA phenotype. Further studies are required to clarify the basic genetics of MLIA.

Effects of mandibular setback surgery on upper airway dimensions and their influence on obstructive sleep apnoea – A systematic review

BACKGROUND Mandibular setback used to be the traditional treatment of choice for correcting mandibular prognathism. Nowadays, bimaxillary surgery is preferred. Several authors have asserted that mandibular setback causes a relative narrowing of the upper airway (UA) that could trigger obstructive sleep apnoea (OSA); however, its potential role in OSA development is still much debated. Another controversial subject is whether changes in airway space caused by the procedure are permanent. OBJECTIVES To ascertain the consequences for UA size and shape of mandibular setback surgery in comparison with bimaxillary surgery (maxillary advancement with Le Fort I and mandibular setback), and to analyse the changes in oximetric indices and their relationship with OSA. SEARCH METHODS A systematic review was made of the bibliography in 4 databases: Medline, Scopus, Embase and Cochrane. SELECTION CRITERIA Systematic reviews, meta-analyses, clinical trials and cohort and case-control studies of adults published in the past 15 years were included. DATA COLLECTION AND ANALYSIS The initial search yielded 668 articles, of which 498 were eliminated because of duplication and 123 on the basis of their titles and abstracts or summaries. The remaining 47 papers were read in their entirety, and 14 were included in the final selection. RESULTS According to our observations, the nasopharyngeal space does not undergo significant changes after either of the two surgical procedures. In the oropharynx and hypopharynx, none of the measurements changed significantly with maxillary advancement; however, persistent and significant decreases in the area, horizontal linear dimensions, and volume of these spaces are encountered after mandibular setback alone. No long-term changes in oximetric indices were found. CONCLUSIONS Morphological changes are more pronounced following exclusively mandibular surgery. A decrease in the UA does take place but appears not to affect the patients sleep quality. This study found no evidence to confirm that bimaxillary or mandibular orthognathic surgery predisposes to obstructive sleep apnoea development.

Identification of Genetic Risk Factors for Maxillary Lateral Incisor Agenesis

Tooth agenesis affects 20% of the world population, and maxillary lateral incisors agenesis (MLIA) is one of the most frequent subtypes, characterized by the absence of formation of deciduous or permanent lateral incisors. Odontogenesis is a complex mechanism regulated by sequential and reciprocal epithelial-mesenchymal interactions, controlled by activators and inhibitors involved in several pathways. Disturbances in these signaling cascades can lead to abnormalities in odontogenesis, resulting in alterations in the formation of the normal teeth number. Our aim was to study a large number of genes encoding either transcription factors or key components in signaling pathways shown to be involved in tooth odontogenesis. We selected 8 genes—MSX1, PAX9, AXIN2, EDA, SPRY2, TGFA, SPRY4, and WNT10A—and performed one of the largest case-control studies taking into account the number of genes and variants assessed, aiming at the identification of MLIA susceptibility factors. We show the involvement of PAX9, EDA, SPRY2, SPRY4, and WNT10A as risk factors for MLIA. Additionally, we uncovered 3 strong synergistic interactions between MLIA liability and MSX1-TGFA, AXIN2-TGFA, and SPRY2-SPRY4 gene pairs. We report the first evidence of the involvement of sprouty genes in MLIA susceptibility. This large study results in a better understanding of the genetic components and mechanisms underlying this trait.

Orthodontic-orthognathic surgical treatment in a patient with Class II subdivision malocclusion: Occlusal plane alteration

Despite the different orthodontic treatment options for patients with Class II subdivision malocclusions, the involvement of the skeletal structures is significant. It is desirable to combine orthodontic and surgical treatment to achieve a stable and better esthetic result, as illustrated in this case report. The occlusal plane was canted to the right as a part of the patients facial asymmetry. Consequently, a 3-mm differential impaction of the maxilla on the left side allowed occlusal plane leveling. Mandibular rotation with advancement on the right side corrected the right Class II malocclusion. The successful attainment of the treatment goals was accomplished through teamwork and integration between the orthodontist and the maxillofacial surgeon.

Tooth agenesis in a Portuguese population

OBJECTIVE The aim of this retrospective study was to evaluate the prevalence and pattern of hypodontia in the permanent dentition, including and excluding third molars, in a Portuguese sample. PATIENTS AND METHODS The study group comprised 2888 patients, observed between 2005 and 2009 at the Dentistry Clinic of the Instituto Superior de Ciências de Saúde-Norte (ISCSN, Portugal). The patients were examined for evidence of hypodontia and presence or absence of deciduous teeth in those presenting agenesis. The age range varied from 7 to 21 years. In order to study the absence of the third molar, subjects under 14 years were excluded. Statistical analysis was performed using SPSS(®). RESULTS Excluding third molars, the prevalence of tooth agenesis was 6.1% for the Portuguese population. Tooth agenesis was found more frequently in females than in males, although this difference was not statistically significant (P>.05). The most commonly missing tooth was the mandibular second premolar, followed by maxillary lateral incisor, and maxillary second premolar. There was a significantly higher prevalence of missing third molars in the agenesis group than in the non-agenesis group. There was a correlation between second premolar and upper lateral agenesis with presence of their corresponding deciduous teeth. CONCLUSIONS The prevalence of tooth agenesis was found to be 6.1% for this Portuguese population and there was a correlation between agenesis and presence of deciduous teeth and between agenesis and missing third molars.

Impaction of both maxillary central incisors and a canine

This case report describes the treatment of a 14-year-old adolescent patient who had 2 impacted maxillary central incisors with distoangular root dilacerations. He also had an impacted maxillary left canine, with the crown completely overlapping the root of the lateral incisor, and insufficient space. The general dentist referred this patient because the maxillary central incisors had still not erupted 2 years after extraction of the retained deciduous incisors. A unilateral expander with a modified vestibular arch and an attachment spring on the right side was used to correct the posterior crossbite on the right side and improve the positions of the teeth. The expansion appliance was also applied as a high anchorage device to move the central incisors and the left canine into position during the initial stages. After this phase, fixed appliances were used to redistribute the space in the anterior maxillary region to create enough space for repositioning the impacted teeth. This procedure restored the normal appearance of the maxillary arch, with good periodontal health and without evidence of root resorption, apart from the distoangular root dilacerations of the 2 maxillary central incisors.