Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
L. Favero1, C. Pizzo2, D. Farronato3, A. Balercia4, V. Favero5 Professor and Chair, Department of Neuroscience, Institute of Clinical Dentistry, University of Padua, Italy 2 Department of Neuroscience, Institute of Clinical Dentistry, University of Padua, Italy. 3 Private Practice in Milan, Italy. 4 Department of Surgical, Reconstructive and Diagnostic Sciences, Fondazione IRCSS Cà Granda, University of Milan, Italy 5 Department of Surgery and Dentistry, Oral and Maxillofacial Surgery Unit Resident, University of Verona, Italy Keywords Canine camouflage; Endosseous implants; Miniscrews; Space-closure; Tooth agenesis. 1 e-mail: [email protected] A new methodological and clinical approach for the treatment of upper lateral incisors agenesis: the posterior space opening Introduction Excluding the third molars, the agenesis of the upper lateral incisors is unfortunately second only to the agenesis of the second bicuspids, with a prevalence of about 1-1.5% [Mattheeuws et al., 2004; Polder, 2004; Celikoglu, 2011]. The development of permanent teeth in children with dental agenesis is delayed when compared with normal patients. The current treatments found in the scientific literature, such as anterior space closure with canine replacement [Kokich Jr, 2005; Brough, 2010; Rosa, 2010] or anterior space opening with implant placement [Krassnig, 2011], have their own peculiar advantages and disadvantages [Kavadia, 2011; Uribe, 2011; Park, 2011]. The purpose of this study is to apply a new methodological and clinical approach for the treatment of upper lateral incisors agenesis, a new “Third Way” able to safaguarding the occlusal integrity and the dental and periodontal aesthetics of the front teeth, with the advantages [Mirabella, 2011] of previous techniques and without their drawbacks. Material and methods abstract Aim The purpose of this study is to present a new clinical approach for the treatment of upper lateral incisor agenesis. Materials and methods A new treatment option was conceived and applied: posterior space opening as a safeguard of occlusal integrity and dental and periodontal aesthetics of the front teeth. This is acheved by means of the anterior space closure, with the mesialisation of the canines and the bicuspids, combined with a posterior space opening to create adequate room for the placement of an implant in the second premolar area. The obtained space should be maintained with a space retainer or a provisional Maryland bridge until the patient is old enough to undergo implant rehabilitation and the canines must be reshaped into a lateral incisor. Conclusion The results of this treatment are a correct teeth alignment, without diastema, Class I occlusion, and occlusal integrity with all natural teeth in the anterior area. In this way there are many advantages for the patient; so it is an effective approach. European Journal of Paediatric Dentistry vol. 13/2-2012 This new approach was conceived by means of the anterior space closure, with mesialisation of the canine and the bicuspids, if necessary aided by mini-implants, combined with posterior space opening to create adequate room for the placement of an implant in the second premolar area. Usually the patient presents the following conditions at baseline (Fig. 1, 2, 3). Mono- or bilateral agenesis of maxillary lateral incisors. Class I molar relationship with tendency toward Class II. Skeletal Class I, normodivergent. Normal overjet. Increased overbite. › › › › › Treatment The first phase of the treatment consists in applying a fixed orthodontic appliance in order to obtain the mesialisation of the canines and the bicuspids, along with the distalisation of the molars if necessary. This objective can be obtained by means of an elastic chain, compressed springs between molars and premolars, and springs between miniscrews and Power Arm 151 FAVERO L. et al. fig. 1 Starting point of the treatment: radiographic and clinical frontal view. fig. 2 Starting point: lateral clinical view. fig. 3 Starting point: face of the patient. fig. 4 Mesialization of canines and bicuspids. fig. 5 Derotation and mesialization of the second premolar. fig. 6 Final result of the orthodontic phase: frontal intraoral view. [Kravitz ND, 2007; Wehrbein H, 2008 ] [Fig. 4]. In case of upper lateral incisors agenesis, second bicuspids are often rotated [Arte, 2001]: this condition can be corrected using an elastic chain between a palatal button on the second premolar and the bracket on the first premolar, or between the bracket on the second premolar and a miniscrew placed buccally [Favero, 2010; Favero, 2009; Favero, 2002; Antoszewska, 2010] (Fig. 5). At the end of the orthodontic phase [Garino, 2003], anterior space closure and posterior space opening are obtained. The space is opened in the second premolar 152 European Journal of Paediatric Dentistry vol. 13/2-2012 lateral incisor agenesis: a new treatment option fig. 7 Final result of the orthodontic phase: occlusal view. figg. 8 Final result: occlusal view for the patient: Preservation of all natural teeth in the aesthetically relevant anterior area: implant rehabilitation is not performed at the lateral incisor area, since canines and premolars are mesialised and reshaped. Highly aesthetic and stable dental and periodontal results, which are obtained at the right moment of the orthodontic treatment, with: presence of natural teeth in the front area, orthodontic correction of the gingival pattern and reshaping of canines and bicuspids warrant a very good aesthetic result. The implant and crown are placed in the posterior area, which is less aesthetically relevant, therefore the possible consequences of the implant therapy (bone resorption, gingival recession, perimplantitis, implant loss) have a lower impact. Occlusal integrity and simmetry are maintained, which cannot be achieved with the sole anterior space closure technique. In the posterior area the interradicular space is usually sufficient for implant surgery. Instead with the anterior space-opening techniques, the proinclination of the frontal teeth to open the space for the implant and the crown causes loss of the interradicular space. As a consequence, if the maxillary basal bone is not sufficient, it is sometime impossible to place an implant in such position. Bone volume is maintained by the presence of natural teeth and implant all around the arch perimeter. Low biological costs: permanent damage to the hard structures of the teeth are limited to minor reshaping of the canine and the first premolar. This new method can be considered an effective approach [Favero, 2009] for the treatment of congenitally missing upper lateral incisors. › › figg. 9 Final result: face view of the patient area and it is sufficient for implant rehabilitation (Fig. 6, 7). After this, the space obtained must be maintained with a space retainer or a provisional Maryland bridge, until the patient is old enough to undergo implant therapy, and the canines must be reshaped into lateral incisors. Finally, when the patient is old enough, an implant can be placed in the second premolar area and the final prosthetic crown can be made. Results The results of this new approach are a correct teeth alignment without diastema, Class I occlusion, and occlusal integrity with all natural teeth in the anterior area, with lower risk of aesthetic periodontal consequences compared to implant therapy in the maxillary lateral incisor area [Furze, 2012; Belser, 2004] (Fig. 8, 9, 10), with better long-term outcomes and stability. Conclusion The advantages of this new methodological and clinical approach can be found in the synergic use of the two main treatments for congenitally missing upper lateral incisors, that have always been used antithetically. The new approach has many advantages European Journal of Paediatric Dentistry vol. 13/2-2012 › › › › › References › Antoszewska J, Raftowicz-Wójcik K, Kawala B, Matthews-Brzozowska T. Biological factors involved in implant-anchored orthodontics and in prosthetic-implant therapy: a literature review. Arch Immunol Ther Exp (Warsz). 2010 Oct;58(5):379-83. › Arte S, Nieminen P, Apajalahti S, Haavikko K, Thesleff I, Pirinen S. Characteristics of incisor-premolar hypodontia in families. J Dent Res. 153 FAVERO L. et al. 2001 May; 80:1445-50. › Belser UC, Schmid B, Higginbottom F, Buser D. Outcome analysis of implant restorations located in the anterior maxilla: a review of the recent literature. Int J Oral Maxillofac Implants. 2004;19 Suppl:30-42. › Brough E, Donaldson AN, Naini FB. Canine substitution for missing maxillary lateral incisors: the influence of canine morphology, size, and › Celikoglu M, Bayram M, Nur M. Patterns of third-molar agenesis and associated dental anomalies in an orthodontic population.Am J Orthod Dentofacial Orthop. 2011 Dec;140(6):856-60. Eur J Orthod. 2011 › Favero L, Brollo P, Bressan E. Orthodontic anchorage with specific fixtures: related study analysis. Am J Orthod Dentofacial Orthop. 2002 Jul;122(1):84-94. › Favero L, Giagnorio C, Cocilovo F. Comparative analysis of anchorage systems for micro implant orthodontics. Prog Orthod. 2010;11(2):10517. Epub 2010 Oct 8. › Favero L, Pavan L, Arreghini A. Communication through telemedicine: home teleassistance in orthodontics. Eur J Paediatr Dent. 2009 Dec;10(4):163-7. › Favero L, Terrazzani C, Favero V, Stellini E, Cocilovo F. Virtual study models: a comparison of modular application systems. Prog Orthod. 2009;10(2):16-25. › Furze D, Byrne A, Donos N, Mardas N. Clinical and esthetic outcomes of single-tooth implants in the anterior maxilla. Quintessence Int. 2012 Feb;43(2):127-34. › Garino F, Favero L. Control of tooth movements with the Speed system. Prog Orthod. 2003;4:23-30. › Kavadia S, Papadiochou S, Papadiochos I, Zafiriadis L. Agenesis of maxillary lateral incisors: a global overview of the clinical problem. 154 Orthodontics (Chic.). 2011 Winter;12(4):296-317. › Kokich VO Jr, Kinzer GA. Managing congenitally missing lateral incisors. Part I: Canine substitution. J Esthet Restor Dent. 2005;17(1):5-10. › Krassnig M, Fickl S Congenitally missing lateral incisors--a comparison between restorative, implant, and orthodontic approaches. Dent Clin North Am. 2011 Apr;55(2):283-99, viii. Epub 2011 Mar 9. › Kravitz ND, Kusnoto B Risks and complications of orthodontic miniscrews. Am J Orthod Dentofacial Orthop. 2007 Apr;131(4 Suppl):S43-51. › Mattheeuws N, Dermaut L, Martens G. Has hypodontia increased in Caucasians during the 20th century? A meta-analysis. Eur J Orthod 2004; 26: 99–103. › Mirabella AD, Kokich VG, Rosa M. Analysis of crown widths in subjects with congenitally missing maxillary lateral incisors. › Park JH, Kim DA, Tai K. Congenitally missing maxillary lateral incisors: treatment. Dent Today. 2011 May;30(5):81-2, 84-6. › Polder BJ, Van’t Hof MA, Van der Linden FP, Kuijpers- Jagtman AM. A meta-analysis of the prevalence of dental agenesis of permanent teeth. Community Dent Oral Epidemiol 2004; 32: 217–26. › Rosa M, Zachrisson BU. The space-closure alternative for missing maxillary lateral incisors: an update. J Clin Orthod. 2010 Sep;44(9):5409 shade on perceptions of smile attractiveness. Am J Orthod Dentofacial Orthop. 2010 Dec;138(6):705. › Uribe F, Chau V, Padala S, Neace WP, Cutrera A, Nanda R. Alveolar ridge width and height changes after orthodontic space opening in patients congenitally missing maxillary lateral incisors. Eur J Orthod. 2011 › Wehrbein H, Göllner P. Miniscrews or palatal implants for skeletal anchorage in the maxilla: comparative aspects for decision making. World J Orthod. 2008 Spring;9(1):63-73. European Journal of Paediatric Dentistry vol. 13/2-2012