Seminars in Orthodontics最新文献

Altered passive eruption (APE) is a condition better known as ‘gummy smile’, patients affected by APE display short and square clinical crowns and an excessive display of gingiva when smiling.

APE was classified as type 1 or 2 depending on its features, in type 1 the gingival margin is coronal to the CEJ, the teeth look short and squared, in type 2 the gingival margin seems to be at the right position, it is the bone crest that is not. The position of the bone crest is defined by sub types A and B. In subtype A the bone crest is located 1.5 to 2 mm apical to the CEJ while in subtype B the alveolar bone crest is located near the CEJ and in some cases even above the CEJ.

Nowadays a case of APE can be studied and 3D planned with a full support of digital dentistry. Once the process of planning is completed, the surgical stent is produced by a 3D printer, the patient is recalled for fitting the surgical stent and final check -up and the surgical procedure is performed.

A case where Vertical Maxillary Excess (VME) and APE were present together is showed and the diagnosis and interdisciplinary treatment demonstrated.

Orthodontic treatment can preserve, harm or benefit the periodontal condition.

During orthodontic treatment, patients may be at a greater risk of developing periodontal disease or conditions. Thus, the treating clinicians should carefully evaluate their patients’ periodontal conditions prior to, during, and after the completion of orthodontic treatment. This literature review describes the damage situations and the methods of preventing and repairing them as well as situations in which the orthodontic intervention contributes to the periodontal status. Recommended protocols for periodontal screening, maintenance and follow-up are presented as well.

Clinicians should conduct a complete periodontal evaluation prior to initiating orthodontic treatment, help patients develop an effective home care therapy regimen, ensure the absence of periodontal disease and or mucogingival deformities and conditions that may worsen during orthodontic treatment, and determine the appropriate recall maintenance program for the patient. During the active orthodontic phase, patients’ periodontal conditions should be carefully monitored, compared to their baseline clinical and radiographic measurements, and treated if necessary. Patients’ compliance with the suggested home oral care should be carefully evaluated and reinforced. If necessary, the orthodontic treatment may need to be stopped temporarily until patients’ home oral care improves.

Stage IV periodontitis is characterized, apart from high severity/complexity (attachment loss, radiographic bone loss, and deep probing depths), from loss of multiple teeth and/or alterations of the masticatory function. Periodontitis stage IV patients are often characterized by pathologic tooth migration, drifting, flaring, posterior bite collapse, and secondary occlusal trauma. These act as complexity factors not only for the management of periodontitis, but also for the prognosis of the whole dentition, and the majority of these patients present secondary malocclusions that require interdisciplinary treatment with orthodontics. However, the management of stage IV patients is complex and requires coordination between the periodontal and orthodontic specialist, while orthodontic treatment needs to be appropriately adjusted to the specificities of adult periodontally-stable patients with severely reduced periodontium. The aim of the paper is to discuss the orthodontic management of these patients, including conditions that need to be met for orthodontic treatment to start, treatment-related considerations pertaining to appliance choice and mechanotherapy, as well as post-treatment maintenance protocols to ensure long-term stability of the treatment results. Finally, an updated systematic review with meta-analysis is presented that summarizes clinical evidence on the effect of combined periodontal-orthodontic treatment for stage IV periodontitis patients with pathological tooth migration.

Piezocision™ assisted orthodontics as a technique was first published 14 years ago. This technique has evolved into a treatment concept that allows the orthodontist to treat successfully challenging cases by creating differential anchorage in three planes while maintaining or enhancing the patients’ periodontal phenotype. Technical advances in digital dentistry over the past 10 years have brought some important innovations to Piezocision™ assisted orthodontic surgery. Dynamic Navigated Piezocision™ allows the surgeon to see the corticotomies in REAL TIME on the monitor screen, thus avoiding roots, anatomical structures and getting to proper depth. Piezocision™ allows for Precision orthodontics. In the past 10 years it has helped in distalization mechanics, bite opening, severe torque issues, treatment of posterior crossbites in adults, posterior open bites, anterior open bites, alveolar insufficiencies and impacted teeth eruption.

Diagnosis is the cornerstone of care for temporomandibular disorders (TMD) in order to provide crucial forward momentum in terms of patient engagement and education alongside provision of appropriate management. Despite its importance diagnostic confidence for TMD is reported as low in the primary care settings. This article will consider potential reasons for this and outline the importance of diagnosis for both individuals living with the condition and clinicians. We will suggest utilisation of a pragmatic, evidence based, broad group diagnosis using simplified examination procedures and diagnostic aids to support the TMD diagnostic process for clinicians.

There is limited and conflicting evidence regarding the impact of orthodontic appliances on masticatory muscle activity (MMA), jaw function, and oral parafunctional behaviours. Investigations in this field frequently utilise surface electromyography (sEMG) to analyse changes in muscle contractile activity. Fixed orthodontics appliances have been associated with significant reductions in MMA post archwire activation. Conversely, elevations in masseter and digastric muscle activity have been reported in response to removable functional appliances. Research into the effect of clear aligner therapy (CAT) on MMA is still in its infancy with few studies published. There is a lack of agreement on whether MMA increases or diminishes in response to CAT though there is evidence this relationship may change over time due to muscle adaptation. The impact of CAT on temporomandibular disorder (TMD) symptoms is unclear, particularly how pre-existing risk factors for TMD may alter and individual's response.

In 1976, Marbach first described in the literature a clinical entity that he called “the phantom bite,” now known as “occlusal dysesthesia” (OD). Most patients suffering from OD are going through an unusually stressful period in their lives and have undergone dental therapy at the same time, resulting in a mental fixation on their teeth. They perceive clinically unremarkable occlusal contacts as bothersome or uncomfortable and TMD is a common comorbidity. Although there is no apparent relationship between the clinical findings and the nature and severity of the reported occlusal complaints, patients search for their “ideal” occlusion or to regain their “lost bite.” As a result, they suffer from persistent and severe emotional distress. The co-occurrence of depression, anxiety and/or personality disorders is common. The primary therapeutic goal is to improve oral health-related quality of life. Occlusal adjustments are contraindicated. Instead, professional counseling and education as information therapy, psychological therapy, oral splints as a form of occlusal therapy with the goal of defocusing effects and medication are recommended forms of therapy. Unfortunately, the acceptance of the diagnosis of OD and the therapeutic recommendations is usually low among these patients and a large proportion reject therapeutic efforts out of conviction and continue their journey in search of “healing” invasive therapy.