Seminars in Orthodontics最新文献

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.

This systematic review aimed to investigate the efficacy of orthodontic tooth movement (OTM) through bone regenerated with osteoconductive grafts, together with the risk of root resorption (RR), in relation to the material and the timing of force initiation. Following PRISMA-ScR guidelines, three major electronic databases were searched (PubMed, EMBASE, and Cochrane). Only studies which reported on the primary outcome (OTM rate) were included. Investigations with fewer than 3 participants/groups and an absence of controls were excluded. The final sample consisted of 16 randomized and controlled clinical trials. Among them, 9 reported on RR (the secondary outcome). The articles showed substantial heterogeneity and low-moderate quality. Most studied OTM through alloplasts (7) and xenografts (8), 3 addressed allografts, 3 autografts and 6 analyzed 2 grafts. Timing for force initiation varied from 0 to 13 weeks post-grafting. Based on limited evidence, it can be cautiously concluded that most graft materials have either no impact or slightly impair OTM, with no significant increase in RR. Xenografts might impede OTM and increase RR risk. The optimal timing for force application depends on the state of bone healing. Future studies are mandatory for deciding on the ideal graft and timing for optimal OTM in each clinical setup.

The closure of an edentulous space with the orthodontic movement of adjacent teeth even if affected by severe loss of periodontal support is a treatment option nowadays supplanted by the implant-born crown substitution and periodontal regenerative/reconstructive therapy. Nevertheless it is important not to forget some fundamentals of dental research that still justify, even more when combined with the most recent innovations in the field of mucogingival surgery and guided tissue regeneration, the alternative of orthodontic space closure. The latter indeed represents a valuable alternative in many malocclusions complicated by lost maxillary incisors, first of all in the growing patients and when the gingival margins are visible during speech and smile.

This article will outline crucial details about the orthodontic management of the reduced periodontal tissues in the pressure area.

Enamel interproximal reduction (IPR), also known as stripping, is an orthodontic procedure used by many clinicians, especially in non-extraction cases. It aims to reduce the mesiodistal diameter of teeth by removing interproximal enamel. This therapeutic option allows to obtain space in the dental arch to achieve tooth alignment, in case of mild or moderate crowding, and to preserve the papilla avoiding the onset of black triangles. IPR is an irreversible procedure, and it requires an accurate case examination to avoid damage, such as demineralization of the enamel or periodontal complications, that can compromise both aesthetics and oral health. When performing IPR, orthodontists can change the contact point between the teeth and move it closer to the alveolar crest, thus improving esthetics by reducing the black triangles. However, there is also a risk for worsening periodontal health due to root proximity although, according to the literature, periodontal indices, such as clinical attachment loss (CAL) and bleeding on probing (BOP), seem to be not significantly affected by IPR.

Temporomandibular disorders (TMDs) are a group of musculoskeletal conditions affecting the masticatory system and which are best defined based on symptoms and signs reflective of the underlying disease process. Etiology – the cause of disease – is best considered as risk determinants due to the complexity of TMDs in terms of the broad range of factors that place an individual at risk for initial development of a TMD and at risk for transition from an acute disorder to a chronic disorder. Identified risk determinants act together in unique patterns across individuals; notably, painful TMDs seldom occur in isolation of other risk determinants. While occlusal characteristics have been proposed as a primary etiology for TMDs, the evidence remains weak and unconvincing. In contrast, the evidence is strong for a wide range of intersecting factors to act as risk determinants for initial onset of a painful TMD, and which contribute further when pain becomes chronic due to bidirectional relationships between a primary pain condition and its risk determinants. These include overuse behaviors, pain sensitivity, psychological distress, injury, and the presence of other health and pain disorders. Overall, the evidence points to TMDs as system level disorders residing within a person at risk due to any of these identified risk determinants, and when more than one is present, the risk increases substantially. This complexity requires evolved standards of care for evaluation and treatment of the identified risk determinants based on available evidence.