Search Results (21)

Background: Supplemental teeth are a rare subtype of supernumerary elements that closely resemble the morphology of normal dentition. Their occurrence in the mandibular anterior region is extremely uncommon. Aim: To describe the clinical features, diagnosis, and phased orthodontic management of a rare case involving bilateral supplemental mandibular incisors in a pediatric patient. Case report: A 7-year-old female patient presented with early mixed dentition and significant lower anterior crowding due to the presence of two fully erupted supplemental mandibular incisors. Treatment phase I included extraction of the malpositioned supplemental teeth and rapid maxillary expansion to transversally coordinate the arches. By the end of phase I, spontaneous alignment of the remaining lower incisors was observed. Discussion: The presence of two supplemental mandibular incisors is extremely rare in Caucasian populations. Supernumerary teeth can cause crowding, impaction, or delayed eruption of adjacent permanent teeth. Timely extraction can prevent such complications and often allows spontaneous alignment. Conclusions: The prompt removal of supplemental mandibular incisors, when they have just erupted, might lead to the alignment of the other incisors, considering that they spontaneously occupy the extractive spaces often without the aid of fixed appliances first line. Full article

Objectives: This study aimed to compare the skeletal and dentoalveolar effects of a fully customized elastodontic appliance with those of the traditional Twin Block appliance in growing patients with Class II malocclusion during the mixed dentition phase. Methods: A total of 35 patients were included: 18 treated with a customized elastodontic appliance (C-Ela group) and 17 with a Twin Block appliance (TB group). Digital dental models and lateral cephalometric radiographs were obtained at baseline (T1) and after 12 months of treatment (T2). All patients were treated by experienced clinicians according to standardized appliance protocols. Data analysis was performed by a blinded operator using Ortho Analyzer and Dolphin Imaging software. The Shapiro–Wilk test was applied to verify the normal distribution of the data. Paired-sample t-tests were used to assess within-group changes between T1 and T2. For intergroup comparisons two-tail independent-sample t-tests were used, and chi-square tests were used for categorical variables. Statistical significance was set at p < 0.05. Results: Both groups showed significant intragroup improvements in overjet (C-Ela: −2.77 ± 2.07; TB: −2.30 ± 2.72 mm), overbite (C-Ela: −1.79 ± 1.95; TB: −1.40 ± 2.65 mm), and sagittal molar relationship (p < 0.05) after treatment. The C-Ela group exhibited a significantly greater reduction in anterior dental crowding (p < 0.05) and better control of upper (C-Ela: −4.93 ± 7.65°; TB: −1.80 ± 5.72°) and lower incisor inclination (C-Ela: +1.70 ± 4.80°; TB: +4.35 ± 6.22°). In intergroup comparisons, the TB group showed a significantly greater proclination of the lower incisors at T2 (L1/Go-Gn: +4.35°; L1/A-Pog: +1.44 mm), whereas the C-Ela more effectively limited these changes (L1/Go-Gn: +1.70°; L1/A-Pog: +1.18 mm). Skeletal analysis revealed an increase in ANB angle in both groups (C-Ela: −1.49 ± 2.62°; TB: −1.78 ± 2.78°), with no statistically significant intergroup differences, and no other skeletal parameters showed significant between-group changes. Conclusions: Both appliances effectively corrected Class II malocclusions. However, the customized elastodontic device provided better dentoalveolar control, particularly in managing anterior crowding and incisor inclination. Its individualized fit may enhance biomechanical precision and improve overall treatment outcomes in growing patients. Full article

Objectives: Anterior crowding in the lower jaw is a common orthodontic issue often managed through premolar extraction, which can affect facial profile development. This study aimed to evaluate skeletal and dental changes in moderate to severe crowding using a novel mandibular reference line—the Ramus Anterior Vertical (RaV)—to support treatment planning. Methods: A total of 140 patients (LII > 4 mm and < 9 mm; mean age ≈ 12.5 years) were divided into two groups (G1: extraction; G2: nonextraction; total n = 140; n = 70 per group). Skeletal and dental parameters were measured before (T0) and after (T1) orthodontic treatment using 280 lateral cephalograms. RaV was defined as a vertical line through the anterior ramus point, perpendicular to the occlusal plane. Results: Sagittal measurements relative to RaV were reproducible and unaffected by mandibular mobility. Significant vertical skeletal changes were observed in G2 females, with an increased anterior facial height (N–Sp′ and Sp′–Gn) but a stable Hasund Index. In G1, the dental arch length and distances from RaV to i5 and i6 were reduced, while second molars (i7) remained stable. Sagittal incisor axis changes (L1–NB°, SAi1°) and skeletal–dental correlations (ML–NSL, Gn–tGo–Ar) were present only in G1. Conclusions: RaV proved to be a stable mandibular reference for assessing treatment effects. In this study, premolar extraction vs. nonextraction was comparably effective, though some vertical skeletal adaptations, especially in G2 females, took place. Full article

Background/Objectives: Dental crowding and the premature loss of one or more deciduous teeth are common issues during the growth phase that accompanies the transition from mixed to permanent dentition. The aim of this systematic review is to examine the effectiveness of using a passive lingual arch in preserving the length of the lower arch and managing the leeway space, analyzing the effects on the linear and angular positions of the permanent teeth. Methods: A systematic review of the literature was conducted using the PubMed, Web of Science, Scopus, and Cochrane Library database. After an initial selection of 306 articles, seven studies that met the defined selection criteria were included. These articles were used to compile the PICO table. Results: The studies examined agree that the application of the passive lingual arch is useful in preserving the length of the lower arch during the transition from mixed to permanent dentition. The observed changes in the linear and angular positions of the permanent teeth, particularly the distoinclination of the permanent molars and the proclination of the incisors, were considered indicative of the effectiveness of this technique. However, one author did not observe these changes, noting only a prevention of mesioinclination and lingualization of the molars and incisors. Conclusions: The use of the passive lingual arch in the transition from mixed to permanent dentition proves to be advantageous for correcting mild anterior crowding, maintaining residual spaces after the premature loss of deciduous molars, and preventing the impaction of permanent premolars. This simple and effective orthodontic device can be applied in clinical practice, always based on an accurate diagnosis and a well-defined treatment plan. Full article

Background: Ankyloglossia is a congenital, abnormally short, thickened, or tight lingual frenulum that restricts tongue mobility, which may impair the development of the lower face morphology, namely the occlusion and skeleton. Objective: The aim of this study was to evaluate whether and how the lingual frenotomy benefits the occlusion and lower face skeleton development. Search methods and selection criteria: The authors, independently and in duplication, performed searches of PubMed, Cochrane Library, Medline, Web of Science, and Embase, introducing the following keywords: tongue tie, ankyloglossia, and short lingual frenum/frenulum, combined with malocclusion, lower face skeleton, and hyoid bone. Data collection and analysis: Relevant articles were assessed for quality according to the Cochrane guidelines and the data extracted for further analysis of the risk of bias and the evidence strength. Results: Seven articles including 1349 patients with ankyloglossia and 90 in the control group underwent the detailed analysis. The quality of the included studies was assessed as low. The strongest evidence of studies reporting the relationship of ankyloglossia with lower face abnormalities concerns the reduction in the intercanine and intermolar widths in either the maxilla or the mandible, as well as Class III occurrence. Limitations: The drawbacks of the analysed papers are mainly composition and number of participants. There is also a lack of good-quality prospective studies, particularly randomised clinical trials, in the literature. Conclusions: Although the lack of high-quality studies dictates that we must treat our results cautiously, the gathered evidence conditionally allow us to state the following: 1. ankyloglossia may be one of the factors contributing to maxillary constriction, Class III malocclusion, and mandibular incisor crowding; 2. the patient’s age is relevant when it comes to frenotomy timing. Possible indications for the procedure depend on the patient’s malocclusion. Full article

Background: This study evaluated the number of aligners that Invisalign ClinCheck™ Pro Software estimates for correcting different malocclusion traits. Methods: This retrospective study included 157 non-extraction patients over the age of 12 years old with easy to mild malocclusions who were treated with Invisalign aligners. The Index of Complexity, Outcome, and Need (ICON) was used to evaluate the malocclusion complexity level. The number of aligners (upper, lower, and total) required to correct the malocclusion was compared based on sex, ICON level, molar and canine class, occlusal asymmetry, overbite, overjet, crowding, incisor inclination, and Bolton discrepancy. A Mann–Whitney U test (for comparisons between two groups) or a Kruskal–Wallis test (for comparisons between three or more groups) (p < 0.05) was used to evaluate differences in the number of aligners across variable categories. Results: ICON, molar class, overbite, and overjet presented significant differences (p < 0.05) in the number of aligners (upper, lower, and total) required to correct a malocclusion. Canine class and lower dental crowding showed significant differences in the lower and total number of aligners (p < 0.05). Conclusions: The number of aligners increases when the malocclusion presents any of the following elements: the absence of molar or canine class I, an altered overjet or overbite, severe lower crowding, or a higher complexity level. The clinician should consider these malocclusion traits when estimating the number of aligners needed for correction. Full article

Background: Early mixed dentition represents a critical phase since crowding conditions can occur. The interceptive resolution of dental crowding allows favorable arch and occlusal development. The aim of the present investigation was to evaluate dentoalveolar changes of clear aligner treatment planned to manage lower incisor crowding, loss of arch length, and midline deviation in early mixed dentition. Methods: A total of 13 patients (7 females, 6 males, 9.4 ± 1.2 age) treated with clear aligners were selected. Arch dimensions and incisor inclinations were evaluated before (T0) and at the end of interceptive treatment (T1). A paired t-test was chosen to compare T1–T0 changes. The level of significance was set at 5%. Results: The greatest significant increase in mandibular width was observed at the level of the first deciduous molars (+2.44 ± 1.4 mm), followed by the second permanent molars (+2.16 ± 1.4 mm). Lower arch length and arch depth showed a statistically relevant increase (2 ± 0.6 mm and 4.5 ± 1.6 mm, respectively). The mean lower dental midline changes were statistically significant (1.42 ± 0.73 mm). Conclusions: Early treatment with clear aligners, including the combination of transversal arch development, maintenance of leeway space, and guidance of eruption, represents a valid treatment strategy in early mixed dentition to manage arch crowding and occlusion development. Full article

The present systematic review updates the evidence on wisdom teeth contributing to lower incisor crowding following orthodontic treatment. Relevant literature was searched on online databases, namely Pubmed, Scopus, and Web of Science, up to December 2022. Eligibility criteria were formulated using the PICOS approach and PRISMA guidelines. Eligible research included original clinical studies involving patients previously being treated orthodontically with permanent dentition at the end of treatment, regardless of sex or age. The initial search yielded 605 citations. After considering eligibility criteria and removing duplicates, only 10 articles met the criteria for inclusion. The risk of bias of eligible studies was evaluated using the Cochrane Handbook for Systematic Reviews and Interventions tool. The majority were highly biased, mainly regarding allocation concealment, group similarity, and assessment blinding. The vast majority did not report statistically significant associations between the presence of third molars and crowding relapse. However, a minor effect has been suggested. Seemingly, there is no clear connection between mandibular third molars and incisor crowding after orthodontic treatment. The present review did not find adequate evidence to advocate preventative removal of the third molars for reasons of occlusal stability. Full article

Background: Crowding is the most frequent malocclusion in orthodontics, with a strong hereditary tendency. It already occurs in pediatric age and is mainly hereditary. It is a sign of a lack of space in the arches, and is not self-correcting, but can worsen over time. The main cause of the worsening of this malocclusion is a progressive and physiological decrease in the arch perimeter. Methods: To identify relevant studies investigating the most common possible treatments for mandibular dental crowding, a comprehensive search of PubMed, Scopus and Web of Science was conducted encompassing the last 5 years (2018–2023) using the following MeSH: “mandibular crowding AND treatment” and “mandibular crowding AND therapy “. Results: A total of 12 studies were finally included. An orthodontic treatment cannot ignore the concept of “guide arch”, which concerns the lower arch, because of the objective difficulty in increasing its perimeter; the bone structure of the lower jaw is more compact than that of the upper one. Its expansion, in fact, is limited to a slight vestibularization of the incisors and lateral sectors that may be associated with a limited distalization of the molars. Conclusions: There are various therapeutic solutions available to the orthodontist, and a correct diagnosis through clinical examination, radiographs and model analysis are essential. The decision of how to deal with crowding cannot be separated from an overall assessment of the malocclusion to be treated. Full article

According to the literature, interproximal enamel reduction (IER) has become a consolidated technique used in orthodontic treatments to gain space in particular situations such as dental crowding, non-extractive therapies, tooth-size discrepancies, and prevention of dental relapse. There are different methods to realize stripping, and enamel surfaces resulting after this procedure can be analyzed with SEM. The aim of this study was to analyze how different devices of IER leave the surface of the teeth. One hundred and sixty freshly extracted, intact human lower incisors were included in the study, fixed in a plaster support, and then processed with four different techniques of enamel reduction and finishing. Then, they were divided randomly into eight groups (A1–A2, B1–B2, C1–C2, D, and E), each containing twenty teeth. The A, B, and C groups were divided into two subgroups and then all the teeth were observed at SEM. Each digital image acquired by SEM showed that there were streaks on the surfaces, due to the cutter used. The results of this study showed that only group C2 (tungsten carbide bur followed by twelve steps of medium–fine–ultrafine 3M Soft Lex disks) has a few line, which is very similar to group E (untreated group), while the other groups have a lot of lines and show a rougher final surface. Full article

Lip bumper (LB) therapy is used as a treatment approach for mild to moderate crowding without extraction of teeth. Previous studies demonstrated that LB increases arch length through molar uprighting and lateral expansion. However, the effects of LB on mandibular incisors are inconclusive. The controversial results from different studies may be due to limitations including absence of a control group and/or use of 2D radiography. To address this issue, the current retrospective longitudinal CBCT study compared a rapid maxillary expansion (RME) group with no lower treatment [16 patients (9 females, 7 males); median age 8.86 years at T1 and 11.82 years at T2] and an RME + LB group [18 patients (13 females, 5 males); median age 9.46 years at T1 and 12.10 years at T2]. The CBCTs taken before and after phase 1 treatment were 3D superimposed based on the mandibular structure and were measured to determine the angular and linear changes of the mandibular incisors over the course of LB treatment. For comparisons between different timepoints within a group, a Wilcoxon matched-pairs signed rank test was used. For intergroup comparisons, a Mann–Whitney U test was used. Both groups showed eruption and protrusion of the mandibular incisors during the observation period, while there was no significant change in proclination of the lower incisors. When comparing the discrepancy of change between groups, there was no statistically significant difference detected. In summary, by utilizing a longitudinal 3D database, the current study demonstrated that the effect of LB on the position of the mandibular incisors is limited. Full article

Background and Objectives: The long face type is associated with excessive vertical facial growth and most often with anterior open bite. In many cases of anterior open bite of high severity associated with bimaxillary dento-alveolar protrusion, lips are unable to form an adequate seal at rest. This leads to many issues, including facial dysmorphism. The aim of this study was to describe the case of a 15 year old girl who addressed the orthodontist in November 2015, having complaints related to the skeletal and dental open bite. Case Description: A 15.7 year old patient required a consultation with the orthodontic service for impaired dento-facial aesthetics at rest, smile and speech due to an exaggerated superior protrusion of the upper frontal teeth, labial incompetence with excessive gingival exposure at rest and smile associated with upper and lower anterior teeth crowding. The orthodontic diagnostic consisted of skeletal open bite with a hyperleptoprosop morphological facial type, high degree of hyperdivergence, bimaxillary dento-alveolar protrusion, 7 mm skeletal open-bite, 3 mm vertical inocclusion of the anterior teeth, skeletal class II relationships, bilateral half cusp class II molar and canine relationships, labial incompetence, highly increased interlabial gap, facial asymmetry, excessive gingival exposure of 7 mm at smiling and bimaxillary anterior crowding. Because the patient initially refused orthognathic surgery, prior to starting the orthodontic treatment, the patient was recommended to receive a bilateral extraction of the first upper premolars. Key objectives of pre-surgical orthodontic treatment were to achieve a retroclined position of the upper incisors under their normal inclination for the planned upward maxillary rotation, to maintain slightly lower incisor proclination. The orthognathic surgery consisted of Le Fort I impaction osteotomy with 8 mm anterior impactation, bilateral sagittal split osteotomy, and mandibular repositioning using occlusal splint. Conclusions: At the end of the orthodontic-surgical treatment, the patient presented significant improvement in dento-facial aesthetics, and optimal skeletal, muscular and dental balance. Full article

Molar distalization has been a validated method to correct dental sagittal relationships and create space to relieve mild to moderate crowding. In the current case report, an adult female patient had a mild skeletal Class III relationship and dental Class III molar relationship. Four premolars and one lower incisor were extracted during the previous two rounds of orthodontic treatments, and the maxillary anterior teeth were left with severe proclination and root resorption. Limited by the available teeth, extraction was not an option for her. Thus, molar distalization with TADs was the best option used in the treatment to address her chief complaint. In addition, a proper bite opening was performed to eliminate occlusion trauma. Utilizing the mid-palatal TADs, the maxillary central incisors were retracted 7.9 mm and retroclined 33 degrees, and the molar distalization was achieved as much as 8 mm. The cross-section slices of CBCT images confirmed the proper retraction of maxillary incisors and well-positioned roots in the alveolar bone. Moreover, the root resorption was not worsened from the treatment. Clinically, the maxillary anterior teeth were preserved esthetically and functionally. This case report illustrates that with proper diagnosis and treatment mechanics, significant tooth movement can be achieved even on extremely proclined maxillary incisors with severe root resorption. Full article

The present study was carried out to evaluate the benefits from one-phase Class II Early Treatment (ET) using extraoral forces and functional appliances but without intermaxillary forces and eventual lower leeway space preservation compared to two-phase Class II Late Treatment (LT) with the need for extractions and full fixed appliances as well as lower incisor proclination. The ET group (n = 239, 115 M, 124 F, mean age 10.6 ± 1.2 years), with first premolars not in contact and the second deciduous lower molars preserved, was compared to the LT group (n = 288, 137 M, 151 F, mean age 12.4 ± 1.5 years). The ET group was first treated with headgears, growth guide appliances, or Teuscher activators and, in borderline crowding cases, with lower space maintenance by a lingual arch, lip bumper, or fixed utility arch. The LT group and the second phase of ET were treated with full fixed appliances including intermaxillary forces such as Class II elastics or noncompliance devices; headgear and a growth guide appliance were also used. Cephalograms and plaster models were taken before (T1) and after treatment (T2) to calculate cephalometric changes and space balance discrepancies. The differences between T1 and T2 were analyzed by a t-test for normally distributed data and by the Mann–Whitney Test for nonnormally distributed data at a level of p < 0.05. The groups were defined as statistically homogeneous at T1. A statistical analysis showed that the ET group (mean treatment time 35.3 ± 13.3 months) was significantly associated with a 22.2% lower extraction rate, 15.9% less need for a full fixed appliance, and more than 5° less incisor proclination in the nonextraction cases compared to the LT group (mean treatment time 25.9 ± 8.1 months); treatment time significantly increased in the ET group compared to the LT group. Early Class II treatment resulted in a significant treatment effort reduction in more than one third of the patients and less lower incisor proclination, even if it clinically increased treatment time. Full article

The objectives of this study were to assess gingival recessions (GR) and periodontal status in patients previously treated with non-extraction orthodontic treatment and retention at a follow-up of a minimum of two years after the end of treatment. Data from patients aged between 16 and 35 years with a previous non-extraction orthodontic treatment and at least 2 years of retention and full records before and after treatment were collected. The casts were digitalized using the 3Shape TRIOS^® intraoral scanner and the Viewbox4 software was used for the measurements. The following parameters were scored: inclination of the lower and upper incisors (IMPA and I^SN) and anterior crowding (Little index). The included patients were recalled for a clinical periodontal follow-up examination and the following parameters were evaluated: buccal and lingual GR (mm) of incisors and canines, bleeding of probing score, plaque score, and gingival phenotype. The digital cast analysis showed a mean Little index of 7.78 (SD 5.83) and 1.39 (SD 0.79), respectively, before and after treatment. The initial and final cephalometric analyses showed an I^SN of 103.53° and 105.78° (SD 7.21) and IMPA of 91.3°and 95.1°, respectively. At the follow-up periodontal visits, the patients showed an overall low oral hygiene with bleeding at probing in 66.6% and plaque in the anterior area in 76.2% of patients. From the total examined 240 teeth of the frontal sextants, three patients had GR (from 1 to 6.5 mm): in the upper arch two at canines and one at central incisor, whereas in the lower arch two at central and one at lateral incisors. The gingival phenotype was thick in 55% of cases. The lingual-to-lingual retainers at follow-up were present in 61.9% of patients. A slight increased risk for buccal GR development was found only in correlation with the presence of fixed retainer and thin gingival phenotype mainly in patients with gingivitis. Thus, non-extraction orthodontic treatment performed with controlled forces and biomechanics seems to not affect the development of GR or the periodontal health after retention. Full article