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Quintessence Publishing: Journals: ORTHODONTICS
The Art and Practice of Dentofacial Enhancement

Formerly World Journal of Orthodontics

Edited by
Rafi Romano, DMD, MSc (Editor-in-Chief)

ISSN 2160-2999 (print) / ISSN 2160-3006 (online)

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Winter 2008
Volume 9 , Issue 4

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EDITORIAL: Extraction at Any Cost?

Efthimia K. Basdra

PMID: 19146011

The treatment-planning pendulum that swings and follows constantly changing orthodontic treatment concepts now again seems to be on the extraction-at-any-cost side. After re-evaluating nonextraction treatment and stability results, clinicians today advocate total arch expansion to maintain complete dentitions. Low-friction self-ligating brackets can “magically” allow arches to expand (without the need for maxillary arch palatal suture expansion) or developed to accommodate severe tooth-sized arch length discrepancies. This total expansion and uprighting of the buccal teeth (primarily molars) will presumably allow for space gain and accommodation of teeth. Thus, the need for extraction is almost eliminated, apart from bimaxillary protrusive cases. How the surrounding functional anatomical elements will accommodate this expansion is not at all clear. Donald Rinchuse from the University of Pittsburgh’s School of Dental Medicine and Sanjivan Kandasamy from the University of Western Australia present their views and arguments. They argue that lingual molar inclination of about –30 degrees is the functional result of masticatory mandibular movements and has been described by many researchers. They challenge the “foregoing arguments for nonextraction treatment based on the facial/lingual uprighting of the mandibular first molars” by providing a number of justifiable reasons: anatomic evidence for the correct inclination of the mandibular molars, mandibular function, stability, and facial pattern. Finally, they suggest that with the use of advance imaging such as facial cone-beam CTs, one could compare the buccal teeth to buccal bone border inclinations and obtain data that will help justify treatment and treatment outcomes.

Congenital teeth anomalies such as transposition involve complex treatment mechanics to achieve functional occlusion and stable results. Drs Sabri from Lebanon and Zaher and Kassem from Egypt summarize statistical findings and present orthodontically treated cases of transposed teeth.

To evaluate the effects of orthodontic treatment in Class II Division 1 individuals with severe overbite, Drs Marques, Ramos-Jorge, de Souza Araujo, and Bolognese from Brazil examined 70 patients pretreatment and 3 years 3 months posttreatment and reported that overbite correction was primarily achieved by intrusion of the front teeth.

Drs Ioi, Matsumoto, Nishioka, Goto, Nakata, and Nakasima from Japan and Dr Counts from the USA, after examining 34 Japanese female patients with TMJ osteoarthritis, suggest that an association might exist among head, cervical posture, and dentofacial morphology.

Can we accurately predict the behavior of the soft tissues following movement of maxillary incisors in a labial or palatal direction? After examining 35 patients who had undergone palatal and 30 patients with labial incisor movement, Drs Mirabella, Bacconi, Gracco, Lombardo, and Siciliani from Italy seem to report on the individual variability and the unfeasibility in the accurate behavioral prediction of the lip.

Space maintenance after appliance removal in congenital missing lateral incisors seems to be no problem with the use of a chairside prefabricated fiber-reinforced composite bridge as a fixed space, as suggested by Drs Uribe, Meiers, and Nanda from Connecticut, USA.

Can we treat anterior crossbites without orthodontic appliances? In a most interesting paper, Drs Tzatzakis and Gidarakou from Greece present a way to treat these difficult cases: Instead of an appliance, they built mandibular deciduous second molars or permanent first molars with glass-ionomer cement to create an anterior open bite. As they show in 5 nicely presented cases, they succeeded in treating them with minimal intervention and cost and no TMJ side effects. It seems that disruption of the equilibrium between the lips and tongue, as well as masticatory muscle function, play a role in treatment’s success.

Drs Topouzelis and Gkantidis from Greece suggest the use of a reinforced polyethylene-fiber retainer placed labially in an unusual case.

A well-known group for mini-implants, Drs Kim, Kang, and Choi from South Korea and Dr Nelson from the USA describe a new surgical guide system for accurate placement of orthodontic mini-implants.

Dr Marsan of Turkey reports on head posture and hyoid bone position using lateral cephalograms of adult Class III Turkish female and male subjects. This article and other similar ones referring to craniofacial structure variabilities of ethnic groups can serve as reference basis for future studies within ethnic groups, and is featured in the World Orthodontics: Ethnic Variations section.

This issue’s Frontiers in Clinical Research article notes the clinical signs and treatment alternatives of allergic reactions to nickel-containing orthodontic appliances. Drs Kolokitha and Chatzistavrou from Greece provide clinicians with recent developments on the biologic mechanisms and diagnostic tools related to nickel hypersensitivity.

In Methods and Technical Advances, Dr Keles presents a new appliance design for palatal expansion employing a keyless mechanism that can greatly improve patient cooperation.

The online article by Drs Katz-Sagi, Redlich, Shapira, Peretz, and Steinberg from Israel reports on the effects of frequent oral hygiene instructions on microbial levels and salivary buffer capacity in orthodontic patients and their parents. Drs Okada and Kuroda from Japan present a very interesting orthodontically treated case of a patient with Treacher-Collins Syndrome. The final online article by Drs Kula, Trimmell, Lu, Briscoe, and Feng is a basic research article referring to a mutation of PAX9 gene causing tooth agenesis.

Efthimia K. Basdra

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