21/92. Indications and procedures for segmental dentoalveolar osteotomy: a review of 13 patients. The authors evaluated the surgical area, indications, and procedures for segmental dentoalveolar osteotomy carried out on 16 jaws in 13 patients treated at the Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of medicine, between 1990 and 2001. osteotomy was indicated mainly in cases where tooth repositioning by orthodontic treatment was limited, where social conditions (e.g., age, time, finances) precluded orthodontic treatment, or where revision of orthodontic or surgical treatment was required. In cases of maxillary anterior segmental dentoalveolar osteotomy, the modified Wunderer method was used, where after an incision was made in the palatal mucosa, a mucoperiosteal flap was abraded as much as possible until the area of the osteotomy on the palatal side could be visualized. In maxillary posterior segmental dentoalveolar osteotomy, the operation was carried out in 2 stages because of the risk of necrosis of the bone fragments. In the first stage, an osteotomy was carried out on the vestibular side, since the vestibular gingival pedicle was intact. In the second stage, 3 weeks later, another osteotomy was performed after the palatal mucoperiosteal flap was abraded to visualize the area of the osteotomy as well as that of the maxillary anterior segmental dentoalveolar osteotomy. ( info) |
22/92. Combined aplasia of maxillary first molars and lateral incisors: a case report and management. Congenital absence of teeth, as the most commonly known developmental dental anomaly in man, has a multitude of adverse affects that could be detrimental to normal function and esthetics. This report presents a rare case of combined agenecies of maxillary permanent first molars and lateral incisors. The management plans are highlighted, and phase I orthodontic-restorative treatment mechanics and its result are described. The benefits for early orthodontic treatment intervention for this case presented here are discussed. ( info) |
23/92. Mandibular symphyseal distraction and its geometrical evaluation: report of a case. In this report, the case of a patient who has been treated with a different use of a tooth-borne custom-made mandibular symphyseal distraction device is presented. The difference in the application is that the distal arm of the device was sectioned during the retention phase to allow the possible relapse of displaced condyles to their original positions while the labial segment expansion is being maintained. The effect of this procedure was also evaluated on a geometrical model using measurements from the patient's cast. We conclude that symphyseal distraction is an effective and fast method of correcting orthodontic anomalies. The effect of the procedure on the condyle was only 3 degrees of distolateral rotation as calculated using the geometrical model. ( info) |
24/92. Severe anterior open bite malocclusion with multiple odontoma treated by C-lingual retractor and horseshoe mechanics. A fixed lever arm appliance called C-lingual retractor was placed on the lingual aspects of the maxillary anterior teeth in a 16-year-old male patient with a Class II anterior open bite malocclusion. The treatment plan consisted of extracting both upper first premolars and retracting the upper six anterior teeth. A multiple odontoma between the lower left lateral incisor and canine was surgically removed before orthodontic treatment, and a horseshoe appliance was used in the lower dentition for intermaxillary anchorage during the bone-healing period. The transpalatal arches soldered to the upper first and second molar bands were used as an intra-arch anchor unit for upper-space closure. Class II elastics were used buccally between the upper six anterior teeth and the lower horseshoe appliance. We took 13 months to treat the open bite malocclusion. There was a decrease in lip fullness as the upper anterior teeth were retracted, which contributed to a decrease in facial convexity. The treatment result was maintained six months after debonding. Details of the new appliance, clinical procedures, and treatment changes are presented. ( info) |
25/92. Permanent incisors traumatized through predecessors: sequelae and possible management. This report describes the sequence of events following a traumatic dental injury to primary maxillary anterior teeth of a five-year old male during a bicycle accident. The development of the affected teeth during the subsequent ten years was studied from the radiographic records. A detailed account of the clinical and radiographic findings as well as the physio-pathologic changes that have taken place is discussed. In view of the inevitable prognosis of dentitions that sustain traumatic injury during the formative years preventive measures and feasible dental management are proposed. These precautionary measures are aimed to circumvent the sequelae that were experienced in the present case, and avoid predictable complications. ( info) |
| smith-lemli-opitz syndrome (SLOS) is an autosomal recessive developmental disorder characterized by multiple congenital malformations, dysmorphic craniofacial features, and mental impairment. SLOS is caused by a deficiency of the enzyme 7-dehydrocholesterol delta7 reductase which converts 7-dehyrocholesterol to cholesterol. This error results in elevated serum levels of 7-dehydrocholesterol and decreased levels of serum cholesterol. This article describes the clinical features and medical treatment of SLOS. A case report is included, with recommended guidelines for providing safe and comprehensive dental care for individuals with SLOS. ( info) |
27/92. Clinical treatment of oral manifestations of Beckwith-Wiedeman syndrome in a child. Orthodontic treatment in a young patient with Beckwith-Wiedeman Syndrome (BWS) is reported and a multidisciplinary approach to the management of this syndrome is reviewed. The patient presented with a tendency to Class III malocclusion, an open-bite and a slight macroglossia, which was treated at an early age by glossotomy. It was decided to monitor growth without treatment and to wait for the best time to begin therapy. It was based only on functional rehabilitation, without any fixed appliances, in which optimum intercuspation of the teeth and the skeletal Class I relationship was achieved and maintained after the retention period of three years. In conclusion the treatment of BWS patients requires a multidisciplinary approach that includes orthodontics, orthopaedics and surgical intervention. It is also necessary to underline the significance of diagnosis at an early age and timely treatment to reduce the development of dento-skeletal alterations. ( info) |
28/92. Oral findings in noonan syndrome: report of a case. Oral findings in a case of noonan syndrome in an 8-year-old Japanese male are reported. Examination of the patient revealed a narrow, high-arched palate and an anterior open bite. Cephalometric measurements showed a wide gonial angle, a large mandibular plane angle, a large Y-axis and long facial height. It is suggested that the patient had a skeletal open-bite malocclusion, which included an abnormal swallowing habit. ( info) |
29/92. A case of Zimmermann-Laband syndrome with supernumerary teeth. BACKGROUND: Zimmermann-Laband syndrome is a rare autosomal dominant disorder that is characterized by gingival fibromatosis, ear, nose, bone, and nail defects, and hepatosplenomegaly. methods: This case report describes the clinical presentation and periodontal findings in a 13-year-old female patient with previously undiagnosed Zimmermann-Laband syndrome. RESULTS: Clinical and radiographic findings and genetic counseling confirmed the diagnosis of Zimmermann-Laband syndrome. The most striking oral findings were the presence of gingival enlargement involving both the maxillary and mandibular arches, anterior open bite, non-erupted teeth, and two supernumerary teeth. Periodontal treatment consisted of gingivectomy in four quadrants. Histopathologic evaluation of excised tissue supported the diagnosis of gingival fibromatosis. The patient was referred for appropriate orthodontic treatment and genetic counseling, and has been closely followed for the earliest signs of hepatosplenomegaly. CONCLUSIONS: Dental practitioners should be alert for developmental abnormalities that may occur in patients with gingival fibromatosis as this may indicate the presence of a rare disorder like Zimmermann-Laband syndrome. A comprehensive medical history and physical systemic evaluation are essential for correct diagnosis and treatment of these cases. ( info) |
30/92. Case report: orofacial characteristics of Hallermann-Streiff Syndrome. BACKGROUND: Hallermann in 1948 and Streiff in 1950 described patients characterised by "bird face", congenital cataract, mandibular hypoplasia, and dental abnormalities. The new syndrome was later defined as Hallermann-Streiff Syndrome (HSS), underlining the differences with regard to Franceschetti's mandibulofacial dysostosis. CASE REPORT: Examination of a white male affected by Hallermann-Streiff Syndrome revealed facial characteristics typical of the "bird face" in HSS. The nose appeared thin, sharp and hooked; the prominence of the chin was absent in the lateral view; a marked microstomia was evident as well. Radiographic records showed aplasia of teeth 14, 13, 12, 22, 24, 35, 34, 33, 32, 31, 41, 42, and 43. As for orthodontic diagnosis, the following dentoskeletal features were assessed: skeletal Class II malocclusion, narrow upper arch, bilateral posterior crossbite, and anterior open bite. Lateral cephalogram showed hypoplasia of the mandible, a typical sign of HSS. The mandible revealed a clockwise rotation growth pattern with an opening of the gonial angle, skeletal anterior open bite, and an excessive vertical dimension of the lower third of the face. Radiographs at the age of 13 years showed an anomaly in shape of the lower right first bicuspid, which appeared with a double crown. TREATMENT: Orthodontic treatment started at 10 years of age with rapid maxillary expansion in the early stages of the mixed dentition, in order to correct the posterior crossbite due to the narrow maxillary arch. A subsequent phase of the orthodontic therapy consisted of a functional appliance with the goal of maintaining the transverse dimension of the dental arches and of controlling the tongue thrust in the anterior open bite. Surgical and prosthetic interventions were scheduled at completion of growth to solve the skeletal discrepancy and for occlusal rehabilitation. FOLLOW-UP: The therapeutic protocol used in the patient presented here was able to reach the orthodontic goals during the developmental ages. Further treatment is planned as there are multiple missing permanent teeth and prosthetic/restorative care is needed until the patient reaches full adulthood. ( info) |