Introduction: Impaction of maxillary canines is a frequently encountered clinical problem in orthodontic therapy. When a preventive approach fails, treatment involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the dental arch. The aim of the present report was to demonstrate by case reports of an adult patient with bilateral impacted maxillary canines treated with surgical exposure and orthodontic treatment
Clinical Management of Bilateral Impacted Maxillary CaninesAbu-Hussein Muhamad
Introduction: Impaction of maxillary canines is a frequently encountered clinical problem in orthodontic therapy. When a preventive
approach fails, treatment involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the
dental arch. The aim of the present report was to demonstrate by case reports of an adult patient with bilateral impacted maxillary canines
treated with surgical exposure and orthodontic treatment.
Material and Methods: A 15year-old female with various degrees of bilateral palatal impaction of maxillary canines were managed
by the described technique.
Results and Discussion: Autonomous eruption of the impacted canines after surgical uncovering was witnessed in all patients
without the need for application of a vertical orthodontic force for their extrusion.
Conclusion: The described method of surgical uncovering and autonomous eruption created conditions for biological eruption of the
palatally impacted canines into the oral cavity and facilitated considerably the subsequent orthodontic treatment for their proper alignment
in the dental arch.
Keywords: Impacted canines; Surgical; Tooth exposure; Orthodontic treatment
Titanium Button With Chain by Watted For Orthodontic Traction of Impacted Ma...Abu-Hussein Muhamad
Abstract: Advances in bonding techniques and materials allow for reliable bracket placement on ectopically positioned teeth. This prospective study evaluates the outcome of forced orthodontic eruption of impacted canine teeth in both palatal and labial positions. Eighty-two impacted maxillary canines in 2200patients were included in the study and were observed for 2006 to 2013 ,in Center for Dentistry research and Aesthetics, Jatt/Israel after exposure. Following exposure by means of a palatal flap or an apically repositioned buccal flap, an orthodontic traction hook, with a Titanium Button with chain by Watted (Dentaurum) attached, was bonded to each impacted tooth using a light cured orthodontic resin cement. A periodontal dressing was placed over the surgical site for a period of time. All teeth were successfully erupted. Complications consisted of: failure of initial bond, at the time of surgery, which required rebonding; premature debonding at the time of pack removal and; debonding of brackets during orthodontic eruption. There was no infection, eruption failure, ankylosis, resorption or periodontal defect (pocket greater than 3 mm) associated with any of the exposed teeth. Forced orthodontic eruption of impacted maxillary canines with a well bonded orthodontic traction hook and ligation chain, used in conjunction with a palatal flap or an apically repositioned labial flap, results in predictable orthodontic eruption with few complications. Key Words: cuspid/surgery; orthodontics, corrective; tooth, impacted/therapy
Titanium Button With Chain by Watted For Orthodontic Traction of Impacted Max...Abu-Hussein Muhamad
This document summarizes a study that evaluated the outcome of using a titanium button with chain by Watted for orthodontic traction of 82 impacted maxillary canines in patients between 2006-2013. Following surgical exposure of the impacted teeth, an orthodontic traction hook with a titanium button and chain was bonded to each tooth. All teeth were successfully erupted with few complications. Forced orthodontic eruption using a well-bonded orthodontic traction hook and ligation chain in conjunction with surgery resulted in predictable orthodontic eruption of impacted maxillary canines.
Maxillary lateral incisors are the second most commonly congenitally missing teeth. When they are missing, orthodontic treatment can either open space to replace the tooth with an implant later, or close the space and substitute the canine. Selecting the best option depends on factors like malocclusion and tooth sizes. For opening space, implants are usually placed after growth is complete, so it is important to monitor eruption and implant site development early. Ankylosed primary molars can also affect future implant placement if not addressed. The orthodontist must consider various factors like age, gender, and tooth development when deciding how to manage congenitally missing teeth and ankylosed primary molars in adolescent patients.
1. Early treatment for impacted maxillary incisors is important to encourage natural eruption through presurgical space opening and orthodontic intervention after surgery.
2. Spontaneous eruption of impacted teeth is unlikely without presurgical orthodontic space opening and postsurgical orthodontic forces to guide eruption.
3. The optimal treatment approach involves presurgical orthodontic space opening, closed eruption surgical exposure with attachment placement, and postsurgical orthodontic forces to accelerate eruption and alignment of the tooth.
This document summarizes key points about early treatment of tooth eruption disturbances from a presentation by Dr. Juri Kurol. It discusses that early treatment is purportedly easier and less expensive but should not be prescribed automatically without evaluating need and prognosis. Early treatment is recommended to avoid further disturbances during eruption and prevent complications like tooth resorption. Common disturbances requiring early treatment include ectopic maxillary first molars, mesiodens, ankylosed deciduous molars, and palatally erupting canines to prevent root resorption of incisors. Early extraction of palatally erupting canines in ages 10-13 normalized 78% of cases. More evidence is needed to demonstrate benefits of early treatment versus
The purpose of this article is to review the principles of case management of soft tissue impacted second premolars mandibular and to illustrate their potential to respond well to the treatment. Although the scope of treatment may depend on a varying range of factors, this case report demonstrates the inherent potential for good treatment outcome in cases of soft tissue impactions
This document describes the case of a 16-year-old girl with an impacted mandibular second premolar. The tooth was impacted horizontally near the lingual sulcus and covered by gingiva. Orthodontic treatment using aligners and open coil springs created space. The impacted tooth was then surgically exposed using a closed exposure technique and attached to the archwire using a button and chain. Over months of orthodontic forces, the tooth was moved into position in the dental arch. The document reviews principles of managing impacted second premolars and concludes that with adequate treatment, even severely impacted teeth can erupt into functional occlusion.
Clinical Management of Bilateral Impacted Maxillary CaninesAbu-Hussein Muhamad
Introduction: Impaction of maxillary canines is a frequently encountered clinical problem in orthodontic therapy. When a preventive
approach fails, treatment involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the
dental arch. The aim of the present report was to demonstrate by case reports of an adult patient with bilateral impacted maxillary canines
treated with surgical exposure and orthodontic treatment.
Material and Methods: A 15year-old female with various degrees of bilateral palatal impaction of maxillary canines were managed
by the described technique.
Results and Discussion: Autonomous eruption of the impacted canines after surgical uncovering was witnessed in all patients
without the need for application of a vertical orthodontic force for their extrusion.
Conclusion: The described method of surgical uncovering and autonomous eruption created conditions for biological eruption of the
palatally impacted canines into the oral cavity and facilitated considerably the subsequent orthodontic treatment for their proper alignment
in the dental arch.
Keywords: Impacted canines; Surgical; Tooth exposure; Orthodontic treatment
Titanium Button With Chain by Watted For Orthodontic Traction of Impacted Ma...Abu-Hussein Muhamad
Abstract: Advances in bonding techniques and materials allow for reliable bracket placement on ectopically positioned teeth. This prospective study evaluates the outcome of forced orthodontic eruption of impacted canine teeth in both palatal and labial positions. Eighty-two impacted maxillary canines in 2200patients were included in the study and were observed for 2006 to 2013 ,in Center for Dentistry research and Aesthetics, Jatt/Israel after exposure. Following exposure by means of a palatal flap or an apically repositioned buccal flap, an orthodontic traction hook, with a Titanium Button with chain by Watted (Dentaurum) attached, was bonded to each impacted tooth using a light cured orthodontic resin cement. A periodontal dressing was placed over the surgical site for a period of time. All teeth were successfully erupted. Complications consisted of: failure of initial bond, at the time of surgery, which required rebonding; premature debonding at the time of pack removal and; debonding of brackets during orthodontic eruption. There was no infection, eruption failure, ankylosis, resorption or periodontal defect (pocket greater than 3 mm) associated with any of the exposed teeth. Forced orthodontic eruption of impacted maxillary canines with a well bonded orthodontic traction hook and ligation chain, used in conjunction with a palatal flap or an apically repositioned labial flap, results in predictable orthodontic eruption with few complications. Key Words: cuspid/surgery; orthodontics, corrective; tooth, impacted/therapy
Titanium Button With Chain by Watted For Orthodontic Traction of Impacted Max...Abu-Hussein Muhamad
This document summarizes a study that evaluated the outcome of using a titanium button with chain by Watted for orthodontic traction of 82 impacted maxillary canines in patients between 2006-2013. Following surgical exposure of the impacted teeth, an orthodontic traction hook with a titanium button and chain was bonded to each tooth. All teeth were successfully erupted with few complications. Forced orthodontic eruption using a well-bonded orthodontic traction hook and ligation chain in conjunction with surgery resulted in predictable orthodontic eruption of impacted maxillary canines.
Maxillary lateral incisors are the second most commonly congenitally missing teeth. When they are missing, orthodontic treatment can either open space to replace the tooth with an implant later, or close the space and substitute the canine. Selecting the best option depends on factors like malocclusion and tooth sizes. For opening space, implants are usually placed after growth is complete, so it is important to monitor eruption and implant site development early. Ankylosed primary molars can also affect future implant placement if not addressed. The orthodontist must consider various factors like age, gender, and tooth development when deciding how to manage congenitally missing teeth and ankylosed primary molars in adolescent patients.
1. Early treatment for impacted maxillary incisors is important to encourage natural eruption through presurgical space opening and orthodontic intervention after surgery.
2. Spontaneous eruption of impacted teeth is unlikely without presurgical orthodontic space opening and postsurgical orthodontic forces to guide eruption.
3. The optimal treatment approach involves presurgical orthodontic space opening, closed eruption surgical exposure with attachment placement, and postsurgical orthodontic forces to accelerate eruption and alignment of the tooth.
This document summarizes key points about early treatment of tooth eruption disturbances from a presentation by Dr. Juri Kurol. It discusses that early treatment is purportedly easier and less expensive but should not be prescribed automatically without evaluating need and prognosis. Early treatment is recommended to avoid further disturbances during eruption and prevent complications like tooth resorption. Common disturbances requiring early treatment include ectopic maxillary first molars, mesiodens, ankylosed deciduous molars, and palatally erupting canines to prevent root resorption of incisors. Early extraction of palatally erupting canines in ages 10-13 normalized 78% of cases. More evidence is needed to demonstrate benefits of early treatment versus
The purpose of this article is to review the principles of case management of soft tissue impacted second premolars mandibular and to illustrate their potential to respond well to the treatment. Although the scope of treatment may depend on a varying range of factors, this case report demonstrates the inherent potential for good treatment outcome in cases of soft tissue impactions
This document describes the case of a 16-year-old girl with an impacted mandibular second premolar. The tooth was impacted horizontally near the lingual sulcus and covered by gingiva. Orthodontic treatment using aligners and open coil springs created space. The impacted tooth was then surgically exposed using a closed exposure technique and attached to the archwire using a button and chain. Over months of orthodontic forces, the tooth was moved into position in the dental arch. The document reviews principles of managing impacted second premolars and concludes that with adequate treatment, even severely impacted teeth can erupt into functional occlusion.
- There is no good evidence that orthodontics causes or cures temporomandibular joint dysfunction. Extracting teeth for orthodontic reasons does not inevitably alter a patient's facial profile. Better quality research is still needed in many controversial areas of orthodontics.
Salvation of severely fractured anterior tooth: An orthodontic approachAshok Ayer
Restoration of severely fractured teeth presents a challenge to the endodontist and may require an interdisciplinary approach for proper management. When the available crown structure is less, orthodontic forced extrusion is the option where the coronal root structure is exposed for proper restoration. This report describes the management of severely fractured maxillary right lateral incisor with extensive loss of coronal structure and fracture line extending below gingival margin. Endodontic treatment of the fractured tooth was followed by controlled orthodontic extrusion to expose fracture margin and providing sufficient coronal tooth structure to support the prosthesis. Orthodontic extrusion may be considered as a viable option for the salvation of fractured anterior teeth.
Modern Treatment for Congenitally Missing Teeth : A Multidisciplinary Appro...Abu-Hussein Muhamad
The maxillary lateral incisor is the second most common congenitally absent tooth. There are several treatment options for replacing the missing maxillary lateral incisor, including canine substitution, tooth-supported restoration, or single-tooth implant. Dental implants are an appropriate treatment option for replacing missing maxillary lateral incisor teeth in adolescents when their dental and skeletal development is complete. This case report presents the treatment of a patient with congenitally missing maxillary lateral incisors using dental implants. Finally, the importance of interdisciplinary team treatment planning is emphasized as a requirement for achieving optimal final esthetics
- The intra-oral examination assesses oral health, individual tooth positions, and inter-occlusal relationships. This, along with the extra-oral examination, allows for formulation of a treatment plan.
- Careful examination of the lower arch first is important, followed by the upper arch, as the lower arch often determines treatment for the upper. Tooth positions, crowding, rotations, and occlusal relationships are evaluated.
- Dental health is the most important factor, as active dental disease precludes orthodontic treatment due to risks of decalcification and accelerated bone loss during tooth movement. Treatment options depend on the degree of occlusal discrepancy and patient motivation/dental health.
This document discusses dental trauma classifications and management. It provides classifications for types of injuries like fractures and luxations. It also describes approaches for different traumatic injuries like pulp capping for exposed pulps, apexification for open apices, splinting for luxated teeth and observation for intruded primary teeth. Proper examination, history taking, cleaning and temporary restorations are emphasized along with follow up appointments to monitor healing.
This document presents the case of a patient seeking full mouth rehabilitation due to severe deterioration of his oral health from poor hygiene. The patient had previously refused treatment plans involving fixed partial dentures and crowns. Examination found missing teeth #46 and #45 and dental attrition. The treatment plan will take into account factors like tooth eruption after attrition, compensating for lost vertical dimension, and ensuring ferrule effect for shortened clinical crowns. Temporary restorations may be used to achieve satisfactory esthetics and function for the permanent restoration. A multidisciplinary approach involving different dental specialties will be needed for complicated cases.
This case report discusses the treatment of a patient with congenitally missing upper lateral incisors. There were two treatment options considered: opening the spaces for prosthetic replacement or closing the spaces via canine substitution. The parents chose to close the spaces orthodontically. Fixed appliances were used to retract the canines into the lateral incisor spaces and extract mandibular premolars to relieve crowding. After treatment, the canines were reshaped to resemble lateral incisors. The final result had a Class I occlusion and improved esthetics. The report evaluates considerations for treating missing lateral incisors cases.
This case report describes the replacement of congenitally missing bilateral maxillary lateral incisors and a right mandibular premolar with dental implants in a 22-year old female patient. The treatment involved first extracting retained primary canines and using orthodontics to gain space between teeth for implant placement. Implants were then surgically placed and allowed to heal, followed by the placement of abutments and final prosthesis. The treatment achieved excellent esthetic and functional results through an interdisciplinary approach between orthodontics, periodontics, and prosthodontics.
Treatment of Patients With Congenitally Missing Lateral Incisors: Is an Inter...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. The available treatment modalities to replace congenitally missing teeth include prosthodontic fixed and removable prostheses, resin bonded retainers, orthodontic movement of maxillary canine to the lateral incisor site and single tooth implants. Dental implants offer a promising treatment option for placement of congenitally missing teeth. Interdisciplinary approach may be needed in these cases. This article aims to present a case report of replacement of bilaterally congenitally missing maxillary lateral incisors with dental implants.
Autotransplantation of Tooth in Children with Mixed DentitionAbu-Hussein Muhamad
Autotransplantation of tooth in children is the surgical movement of a tooth from one place in the mouth to another
in the similar individual. Once thought to be uncertain, autotransplantation has achieved high success rates and is an
outstanding option for tooth replacement in children. Although the indications for autotransplantation are narrow, careful
patient assortment coupled with a suitable method can lead to exceptional esthetic and useful results. One benefit of
this procedure is that placement of an implant-supported prosthesis or other form of prosthetic tooth replacement is
not needed. A review of the recommended surgical technique as well as success rates is also discussed.
This document discusses who needs orthodontic treatment. It provides three main reasons for orthodontic treatment: 1) To improve dental aesthetics, 2) To correct occlusal function, and 3) To eliminate malocclusions that could damage long-term dental health. It examines various types of malocclusions that may benefit from treatment, such as large overjets which increase risk of dental trauma. Indices like IOTN are used to assess orthodontic treatment need based on aesthetics and dental health. Not all irregularities need treatment, and treatment should only be carried out if it provides clear benefit to the patient.
This document discusses autotransplantation of teeth in children with mixed dentition. It provides background on the timing of primary and permanent tooth eruption. Autotransplantation involves surgically moving a tooth from one site to another in the same person and can be useful for replacing teeth lost to decay or other issues. Success requires careful patient selection based on oral health, a suitable donor tooth with partially formed roots, and adequate bone support at the recipient site. The procedure aims to provide esthetic and functional tooth replacement without the need for dental implants.
This article discusses guidelines for assessing patients who wear complete dentures and their existing dentures. It covers general assessment of the patient, including their soft tissues, hard tissues, medical history and expectations. Assessment of the dentures includes examining retention, stability, occlusion and comfort. The goal is to determine patients' complaints, identify any problems, and establish appropriate treatment options such as relining, rebasing or new dentures. A simple assessment form is suggested to record the initial visit. The guidelines aim to help practitioners thoroughly evaluate patients' needs and develop suitable treatment plans for complete denture wearers.
This document summarizes the key aspects and considerations for autogenic dental transplants. It discusses the technique, which involves carefully dissecting rather than extracting the donor tooth and immediately placing it in the prepared recipient site while avoiding damage to the periodontal ligament. Success rates from previous studies ranging from 72-100% are reported. Factors like patient age, root development stage, fixation method, and avoidance of forces for 3-6 months are discussed as important to transplant success and outcomes like revascularization and root growth. Premolars and third molars are considered good candidates due to their dispensability and timing of development. While more common in Scandinavia, the document argues autogenic transplants can be a viable treatment option
The management of impacted canines is important in terms of esthetics and function. Clinicians must formulate treatment plans that are in the best interest of the patient and they must be knowledgeable about the variety of treatment options. When patients are evaluated and treated properly, clinicians can reduce the frequency of ectopic eruption and subsequent impaction of the maxillary canine. The simplest interceptive procedure that can be used to prevent impaction of permanent canines is the timely extraction of the primary canines. This procedure usually allows the permanent canines to become upright and erupt properly into the dental arch, provided sufficient space is available to accommodate them. In the present article, an overview of the incidence and sequelae, as well as the surgical, periodontal, and orthodontic considerations in the management of impacted canines is presented.
DIAGNOSTIC SETUP FOR REMOVABLE PARTIAL DENTURE /prosthodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
- Avulsion of permanent teeth most commonly involves maxillary central incisors in children ages 7-9 years old when they are erupting. Boys experience avulsion more than girls.
- If a tooth is avulsed, it should be replanted immediately if clean or cleaned and replanted. It is important to replant the tooth within 10 minutes for the best prognosis.
- After replantation, the tooth should be splinted for 10-14 days and the patient should receive antibiotics and follow up dental treatment which may include root canals or monitoring depending on the maturity of the root.
Aim: Dental impaction is a very frequent problem and the canine tooth is one of the most affected. Impacted canines result
in many complications and their early diagnosis by radiographic evaluation is imperative. The aim of the present study was
to determine the prevalence of impacted canines in the Arab population in Israel(48Arabs). Materials and Methods: The
panoramic radiographic records of 2200patients attending the Center for Dentistry Research and Aesthetics, Jatt/Israel ,
between June 2006 and December 2013 were examined for the study. The age of the patients ranged from 10.5 to
39,5years, with a mean of 16,2years. Results: The prevalence of canine impaction in males was 1,6% and 2,1% in
females.in maxillary,and 0,6%mandibular The overall prevalence was 4,3 %. Maxillary left canines were the most
frequently impacted Only 13 cases showed impaction of the mandibular canine. Unilateral impaction was seen in 0,5% of
the patients. Conclusion: Canines play a vital role in facial appearance, dental esthetics, arch development, and functional
occlusion. If signs of ectopic eruption are detected early, every effort should be made to prevent impaction and its
consequences. Early intervention eliminates the need for surgical intervention and complex treatment.
Autogenous tooth fragment reattachment ; a 12 years follow-upAbu-Hussein Muhamad
The fractures of the anterior teeth are a common form of dental trauma that mainly affects children and adolescents. One of the therapeutic options for managing coronal tooth fractures when the tooth fragment is available and there is no or minimal violation of the biological width is the Autogenous reattachment of the dental fragment.. Reattachment of fractured fragment can provide good and long lasting esthetics. This is a report of a 12 -year follow-up of a coronal fracture case successfully treated using tooth fragment reattachment.
Keywords: Composite resins, coronal fracture, fragment reattachment
Surgery of Labially Impacted Canine & Orthodontic Management – A Case ReportAbu-Hussein Muhamad
Maxillary canines are one of the most common teeth that are impacted among patients seeking orthodontic treatment. Depending on the position of these impacted teeth, various surgical techniques have been employed for their exposure. His primary goal of surgical phase is to provide the means for correct position of orthodontic anchorage. Additionally, the technique used must ensure favorable tissue anatomy that will permit long-term maintenance of periodontal health. In the present case, a labially impacted maxillary left canine was surgically exposed using an apically po
Treatment concept by Watted for a controlled alignment of palatally impacted ...Abu-Hussein Muhamad
It is known that maxillary canines remain impacted more often than the mandibular canines, and the inclusion can be
buccal or palatal. The treatment focuses mainly on the exposure and on the orthodontic realignment of the impacted
tooth. There are situations when canines erupt spontaneously after their surgical discovery. The present paper has the
purpose of approaching aspects related to impacted upper permanent canines by a literature review, including
localization and treatment conducts.
Key words: Impacted canine, periodontal, surgical-orthodontic treatment.
- There is no good evidence that orthodontics causes or cures temporomandibular joint dysfunction. Extracting teeth for orthodontic reasons does not inevitably alter a patient's facial profile. Better quality research is still needed in many controversial areas of orthodontics.
Salvation of severely fractured anterior tooth: An orthodontic approachAshok Ayer
Restoration of severely fractured teeth presents a challenge to the endodontist and may require an interdisciplinary approach for proper management. When the available crown structure is less, orthodontic forced extrusion is the option where the coronal root structure is exposed for proper restoration. This report describes the management of severely fractured maxillary right lateral incisor with extensive loss of coronal structure and fracture line extending below gingival margin. Endodontic treatment of the fractured tooth was followed by controlled orthodontic extrusion to expose fracture margin and providing sufficient coronal tooth structure to support the prosthesis. Orthodontic extrusion may be considered as a viable option for the salvation of fractured anterior teeth.
Modern Treatment for Congenitally Missing Teeth : A Multidisciplinary Appro...Abu-Hussein Muhamad
The maxillary lateral incisor is the second most common congenitally absent tooth. There are several treatment options for replacing the missing maxillary lateral incisor, including canine substitution, tooth-supported restoration, or single-tooth implant. Dental implants are an appropriate treatment option for replacing missing maxillary lateral incisor teeth in adolescents when their dental and skeletal development is complete. This case report presents the treatment of a patient with congenitally missing maxillary lateral incisors using dental implants. Finally, the importance of interdisciplinary team treatment planning is emphasized as a requirement for achieving optimal final esthetics
- The intra-oral examination assesses oral health, individual tooth positions, and inter-occlusal relationships. This, along with the extra-oral examination, allows for formulation of a treatment plan.
- Careful examination of the lower arch first is important, followed by the upper arch, as the lower arch often determines treatment for the upper. Tooth positions, crowding, rotations, and occlusal relationships are evaluated.
- Dental health is the most important factor, as active dental disease precludes orthodontic treatment due to risks of decalcification and accelerated bone loss during tooth movement. Treatment options depend on the degree of occlusal discrepancy and patient motivation/dental health.
This document discusses dental trauma classifications and management. It provides classifications for types of injuries like fractures and luxations. It also describes approaches for different traumatic injuries like pulp capping for exposed pulps, apexification for open apices, splinting for luxated teeth and observation for intruded primary teeth. Proper examination, history taking, cleaning and temporary restorations are emphasized along with follow up appointments to monitor healing.
This document presents the case of a patient seeking full mouth rehabilitation due to severe deterioration of his oral health from poor hygiene. The patient had previously refused treatment plans involving fixed partial dentures and crowns. Examination found missing teeth #46 and #45 and dental attrition. The treatment plan will take into account factors like tooth eruption after attrition, compensating for lost vertical dimension, and ensuring ferrule effect for shortened clinical crowns. Temporary restorations may be used to achieve satisfactory esthetics and function for the permanent restoration. A multidisciplinary approach involving different dental specialties will be needed for complicated cases.
This case report discusses the treatment of a patient with congenitally missing upper lateral incisors. There were two treatment options considered: opening the spaces for prosthetic replacement or closing the spaces via canine substitution. The parents chose to close the spaces orthodontically. Fixed appliances were used to retract the canines into the lateral incisor spaces and extract mandibular premolars to relieve crowding. After treatment, the canines were reshaped to resemble lateral incisors. The final result had a Class I occlusion and improved esthetics. The report evaluates considerations for treating missing lateral incisors cases.
This case report describes the replacement of congenitally missing bilateral maxillary lateral incisors and a right mandibular premolar with dental implants in a 22-year old female patient. The treatment involved first extracting retained primary canines and using orthodontics to gain space between teeth for implant placement. Implants were then surgically placed and allowed to heal, followed by the placement of abutments and final prosthesis. The treatment achieved excellent esthetic and functional results through an interdisciplinary approach between orthodontics, periodontics, and prosthodontics.
Treatment of Patients With Congenitally Missing Lateral Incisors: Is an Inter...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. The available treatment modalities to replace congenitally missing teeth include prosthodontic fixed and removable prostheses, resin bonded retainers, orthodontic movement of maxillary canine to the lateral incisor site and single tooth implants. Dental implants offer a promising treatment option for placement of congenitally missing teeth. Interdisciplinary approach may be needed in these cases. This article aims to present a case report of replacement of bilaterally congenitally missing maxillary lateral incisors with dental implants.
Autotransplantation of Tooth in Children with Mixed DentitionAbu-Hussein Muhamad
Autotransplantation of tooth in children is the surgical movement of a tooth from one place in the mouth to another
in the similar individual. Once thought to be uncertain, autotransplantation has achieved high success rates and is an
outstanding option for tooth replacement in children. Although the indications for autotransplantation are narrow, careful
patient assortment coupled with a suitable method can lead to exceptional esthetic and useful results. One benefit of
this procedure is that placement of an implant-supported prosthesis or other form of prosthetic tooth replacement is
not needed. A review of the recommended surgical technique as well as success rates is also discussed.
This document discusses who needs orthodontic treatment. It provides three main reasons for orthodontic treatment: 1) To improve dental aesthetics, 2) To correct occlusal function, and 3) To eliminate malocclusions that could damage long-term dental health. It examines various types of malocclusions that may benefit from treatment, such as large overjets which increase risk of dental trauma. Indices like IOTN are used to assess orthodontic treatment need based on aesthetics and dental health. Not all irregularities need treatment, and treatment should only be carried out if it provides clear benefit to the patient.
This document discusses autotransplantation of teeth in children with mixed dentition. It provides background on the timing of primary and permanent tooth eruption. Autotransplantation involves surgically moving a tooth from one site to another in the same person and can be useful for replacing teeth lost to decay or other issues. Success requires careful patient selection based on oral health, a suitable donor tooth with partially formed roots, and adequate bone support at the recipient site. The procedure aims to provide esthetic and functional tooth replacement without the need for dental implants.
This article discusses guidelines for assessing patients who wear complete dentures and their existing dentures. It covers general assessment of the patient, including their soft tissues, hard tissues, medical history and expectations. Assessment of the dentures includes examining retention, stability, occlusion and comfort. The goal is to determine patients' complaints, identify any problems, and establish appropriate treatment options such as relining, rebasing or new dentures. A simple assessment form is suggested to record the initial visit. The guidelines aim to help practitioners thoroughly evaluate patients' needs and develop suitable treatment plans for complete denture wearers.
This document summarizes the key aspects and considerations for autogenic dental transplants. It discusses the technique, which involves carefully dissecting rather than extracting the donor tooth and immediately placing it in the prepared recipient site while avoiding damage to the periodontal ligament. Success rates from previous studies ranging from 72-100% are reported. Factors like patient age, root development stage, fixation method, and avoidance of forces for 3-6 months are discussed as important to transplant success and outcomes like revascularization and root growth. Premolars and third molars are considered good candidates due to their dispensability and timing of development. While more common in Scandinavia, the document argues autogenic transplants can be a viable treatment option
The management of impacted canines is important in terms of esthetics and function. Clinicians must formulate treatment plans that are in the best interest of the patient and they must be knowledgeable about the variety of treatment options. When patients are evaluated and treated properly, clinicians can reduce the frequency of ectopic eruption and subsequent impaction of the maxillary canine. The simplest interceptive procedure that can be used to prevent impaction of permanent canines is the timely extraction of the primary canines. This procedure usually allows the permanent canines to become upright and erupt properly into the dental arch, provided sufficient space is available to accommodate them. In the present article, an overview of the incidence and sequelae, as well as the surgical, periodontal, and orthodontic considerations in the management of impacted canines is presented.
DIAGNOSTIC SETUP FOR REMOVABLE PARTIAL DENTURE /prosthodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
- Avulsion of permanent teeth most commonly involves maxillary central incisors in children ages 7-9 years old when they are erupting. Boys experience avulsion more than girls.
- If a tooth is avulsed, it should be replanted immediately if clean or cleaned and replanted. It is important to replant the tooth within 10 minutes for the best prognosis.
- After replantation, the tooth should be splinted for 10-14 days and the patient should receive antibiotics and follow up dental treatment which may include root canals or monitoring depending on the maturity of the root.
Aim: Dental impaction is a very frequent problem and the canine tooth is one of the most affected. Impacted canines result
in many complications and their early diagnosis by radiographic evaluation is imperative. The aim of the present study was
to determine the prevalence of impacted canines in the Arab population in Israel(48Arabs). Materials and Methods: The
panoramic radiographic records of 2200patients attending the Center for Dentistry Research and Aesthetics, Jatt/Israel ,
between June 2006 and December 2013 were examined for the study. The age of the patients ranged from 10.5 to
39,5years, with a mean of 16,2years. Results: The prevalence of canine impaction in males was 1,6% and 2,1% in
females.in maxillary,and 0,6%mandibular The overall prevalence was 4,3 %. Maxillary left canines were the most
frequently impacted Only 13 cases showed impaction of the mandibular canine. Unilateral impaction was seen in 0,5% of
the patients. Conclusion: Canines play a vital role in facial appearance, dental esthetics, arch development, and functional
occlusion. If signs of ectopic eruption are detected early, every effort should be made to prevent impaction and its
consequences. Early intervention eliminates the need for surgical intervention and complex treatment.
Autogenous tooth fragment reattachment ; a 12 years follow-upAbu-Hussein Muhamad
The fractures of the anterior teeth are a common form of dental trauma that mainly affects children and adolescents. One of the therapeutic options for managing coronal tooth fractures when the tooth fragment is available and there is no or minimal violation of the biological width is the Autogenous reattachment of the dental fragment.. Reattachment of fractured fragment can provide good and long lasting esthetics. This is a report of a 12 -year follow-up of a coronal fracture case successfully treated using tooth fragment reattachment.
Keywords: Composite resins, coronal fracture, fragment reattachment
Surgery of Labially Impacted Canine & Orthodontic Management – A Case ReportAbu-Hussein Muhamad
Maxillary canines are one of the most common teeth that are impacted among patients seeking orthodontic treatment. Depending on the position of these impacted teeth, various surgical techniques have been employed for their exposure. His primary goal of surgical phase is to provide the means for correct position of orthodontic anchorage. Additionally, the technique used must ensure favorable tissue anatomy that will permit long-term maintenance of periodontal health. In the present case, a labially impacted maxillary left canine was surgically exposed using an apically po
Treatment concept by Watted for a controlled alignment of palatally impacted ...Abu-Hussein Muhamad
It is known that maxillary canines remain impacted more often than the mandibular canines, and the inclusion can be
buccal or palatal. The treatment focuses mainly on the exposure and on the orthodontic realignment of the impacted
tooth. There are situations when canines erupt spontaneously after their surgical discovery. The present paper has the
purpose of approaching aspects related to impacted upper permanent canines by a literature review, including
localization and treatment conducts.
Key words: Impacted canine, periodontal, surgical-orthodontic treatment.
The management of impacted canines is important in terms of esthetics and function. Clinicians must formulate treatment plans that are in the best interest of the patient and they must be knowledgeable about the variety of treatment options. When patients are evaluated and treated properly, clinicians can reduce the frequency of ectopic eruption and subsequent impaction of the maxillary canine. The simplest interceptive procedure that can be used to prevent impaction of permanent canines is the timely extraction of the primary canines. This procedure usually allows the permanent canines to become upright and erupt properly into the dental arch, provided sufficient space is available to accommodate them. In the present article, an overview of the incidence and sequelae, as well as the surgical, periodontal, and orthodontic considerations in the management of impacted canines is presented.
Multidisciplinary Approach in the Rehabilitation of Congenitally Maxillary C...Abu-Hussein Muhamad
Objective: This case report describes the multidisciplinary
approach to treat a congenitally missed maxillary canine, how to
improve patient’s smile using orthodontic fixed appliance, endosseous
dental implant, and porcelain veneer to achieve the treatment results of
function and esthetic.
Materials and procedures: Unilateral agenesis of the permanent
maxillary canines in healthy individuals is extremely rare. This
paper presents the case of a female patient diagnosed with congenital
unilateral agenesis of the permanent maxillary canines as well as
occlusal abnormalities in the form of left-side crossbite. To restore the
proper aesthetics and function, interdisciplinary therapeutic treatment
was implemented. In the case presented in this paper, the aim of
oral rehabilitation was to restore a functional balance by obtaining
proper skeletal relationships, creating optimal occlusal conditions and
obtaining arch continuity.
Conclusion: Interdisciplinary treatment combined of orthodontics,
implant surgery, and prosthodontics was useful to treat a nonsyndromic
oligodontia patient. Especially, with the new strategy, implantanchored
orthodontics, which can facilitate the treatmentand make it
more simply with greater predictability.
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs
Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel,
4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec
2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental
records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6
(N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of
impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for
maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies.
The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample
selection, method of the study and area of patient selection, which suggest racial and genetic differences.
This document discusses impacted and unerupted maxillary incisors. It provides information on prevalence, causes such as supernumerary teeth or odontomes, and classifications of delayed eruption. For management, it recommends examining patient history, radiographs, and surgical exposure techniques. Surgical exposure can be open, involve an apically repositioned flap, or use a closed eruption procedure. Factors like position, angulation, and amount of attached gingiva determine the best exposure technique. Orthodontic treatment may involve space creation, surgical exposure with orthodontic alignment, or tooth removal and space management. Complications of orthodontic treatment include relapse, non-compliance, root resorption,
Treatment of Extremely Displaced and Impacted Second Premolar in the MandibleAbu-Hussein Muhamad
The mandibular second premolar is one of the most frequently impacted teeth. The recommended treatment is to extract the second primary molar with or without removing the bone along the eruption path, to uncover the tooth surgically and move it into the arch by orthodontic treatment. The purpose of this article is to review the principles of case management of soft tissue impacted second premolars mandibular and to illustrate their potential to respond well to the treatment. Although the scope of treatment may depend on a varying range of factors, this case report demonstrates the inherent potential for good treatment outcome in cases of soft tissue impactions.
The mandibular second premolar is one of the most frequently impacted teeth. The recommended treatment is to extract the second primary molar with or without removing the bone along the eruption path, to uncover the tooth surgically and move it into the arch by orthodontic treatment.
The purpose of this article is to review the principles of case management of soft tissue impacted second premolars mandibular and to illustrate their potential to respond well to the treatment. Although the scope of treatment may depend on a varying range of factors, this case report demonstrates the inherent potential for good treatment outcome in cases of soft tissue impactions
ORTHODONTIC TREATMENT OF AN IMPACTED MAXILLARY CENTRAL INCISOR COMBINED WI...Abu-Hussein Muhamad
Impaction of maxillary permanent incisors is not a frequent case in dental practice, but its treatment is challenging because of these teeth importance to facial esthetics Management by a combination of orthodontics and surgery produces a satisfactory result. The surgical exposure and orthodontic traction of impacted central incisor after surgical exposure of impacted maxillary central incisor teeth is presented in this case report.
Key words: Impacted tooth, Maxillary incisors orthodontics, tooth movement
Prosthodontic-Orthodontic Treatment Plan with Two-Unit Cantilevered Resin-Bon...Abu-Hussein Muhamad
Abstract: Congenitally missing lateral incisors create an esthetic problem with specific orthodontic and prosthetic considerations. Selecting the appropriate treatment option depends on many factors, such us the malocclusion, the anterior relationship, specific space requirements, bone volume, root proximity, the condition of the adjacent teeth, and esthetic prediction mainly when the canine must be reshaped.Resin bonded bridges were considered to be doomed owing to their very high decementation rate, have come alive once again because of newer resin based cements. This article will discuss the variety of treatment managements in case of space opening and treated with two 2-unit cantilevered resin-bonded fixed partial dentures supported by the cuspids. This conservative treatment plan was cost-effective without having any significant biological cost. Keywords: Agenesis, Resin- bonded fixed partial denture, interim prosthesis.
Surgery of Labially Impacted Canine & Orthodontic Management – A Case ReportAbu-Hussein Muhamad
Maxillary canines are one of the most common teeth that are impacted among patients seeking orthodontic treatment. Depending on the position of these impacted teeth, various surgical techniques have been employed for their exposure. His primary goal of surgical phase is to provide the means for correct position of orthodontic anchorage. Additionally, the technique used must ensure favorable tissue anatomy that will permit long-term maintenance of periodontal health. In the present case, a labially impacted maxillary left canine was surgically exposed using an apically positioned flap. Orthodontic extrusion was carried out further.
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel, 4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec 2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6 (N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies. The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample selection, method of the study and area of patient selection, which suggest racial and genetic differences.
Multidisciplinary approach in the rehabilitation of congenitally missing late...Abu-Hussein Muhamad
Agenesis, the absence of permanent teeth, is a common occurrence among dental patients. The total incidence of tooth agenesis is about 4.2% among patients that are seeking orthodontic treatment and with the exception of third molars, the maxillary lateral incisors are the most common congenitally missing teeth with about a 2% incidence. The maxillary lateral incisor is the second most common congenitally absent tooth. There are several treatment options for replacing the missing maxillary lateral incisor, including canine substitution, tooth-supported restoration, or single-tooth implant. Dental implants are an appropriate treatment option for replacing missing maxillary lateral incisor teeth in adolescents when their dental and skeletal development is complete. This case report presents the treatment of a patient with congenitally missing maxillary lateral incisor using dental implants. The paper discusses the aspects of pre-prosthetic orthodontic diagnosis and the treatment that needs to be considered with conservative and fixed prosthetic replacement.
Pre-Prosthetic Orthodontic Implant for Management of Congenitally Unerupted L...Abu-Hussein Muhamad
The maxillary lateral incisor is one of the most common congenitally missing teeth of the permanent
dentition. With the advent of implants in the field of restorative dentistry, a stable and predictable fixed
prosthetic replacement has become a reality, especially for young adult patients who suffer from congenital
absence of teeth. The dual goals of establishment of functional stability as well as enhancement of esthetic
outcomes are made achievable by the placement of implants. A multidisciplinary team approach involving the
triad of orthodontist, periodontist and restorative dentist will ensure the successful completion of the integrated
treatment approach in these patients. The present case report achieved successful implant based oral
rehabilitation in a patient diagnosed with congenital absence of bilateral maxillary lateral incisors utilizing a
preprosthetic orthodontic implant site preparation for the purpose of space gain.
Keywords: Preprosthetic, interdisciplinary treatment, implant placement
The main purpose of our study is to present the corrective movement of impacted canines using various surgical-orthodontic techniques Materials and method: Eighty-two impacted maxillary canines in 2200patients were included in the study and were observed for 2006 to 2013 ,in Center for Dentistry research and Aesthetics, Jatt/Israel after exposure. Following exposure by means of a palatal flap or an apically repositioned buccal flap, an orthodontic traction hook, with a Titanium Button with chain by Watted (Dentaurum) attached, was bonded to each impacted tooth using a light cured orthodontic resin cement. For this study we used only the batch of patients who presented upper impacted canine. Depending on the clinical status, we used the following surgical techniques: repositioned flap, gingival translation flap, window flap method and local mesh application. After surgery for 39 patients we considered that canine traction with an orthodontic device was necessary in order to obtain a vertical position of the teeth. The orthodontic systems used were: fixed orthodontics, with a Titanium Button with chain by Watted (Dentaurum). Results and discussion: We used the repositioned flap for 39patients with deep impacted canines in order to uncover the teeth and to bond an auxiliary orthodontic device, the gingival translation flap for 27 patients with superficial impacted canines: 10cases with apical translation and 2 with lateral and apical translation. The window flap was used for 22 patients with palatal impaction. After surgery all patients continued orthodontic treatment in order to correct every dental malposition and to obtain a neutral occlusion with esthetical, functional and stabile results.
Esthetic Management of Congenitally Missing Lateral Incisors With Single Toot...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. Several treatment options exist for the replacement of congenitally missing lateral incisors.This case report addresses the fundamental considerations related to replacement of a congenitally missing lateral incisor by a team approach.
Esthetic Management of Congenitally Missing Lateral Incisors With Single Toot...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the proper treatment plan. Several treatment options exist for the replacement of congenitally missing lateral incisors.This case report addresses the fundamental considerations related to replacement of a congenitally missing lateral incisor by a team approach.
Pre prosthetic orthodontic implant for management of congenitally unerupted l...Abu-Hussein Muhamad
The maxillary lateral incisor is one of the most common congenitally missing teeth of the permanent dentition. With the advent of implants in the field of restorative dentistry, a stable and predictable fixed prosthetic replacement has become a reality, especially for young adult patients who suffer from congenital absence of teeth. The dual goals of establishment of functional stability as well as enhancement of esthetic outcomes are made achievable by the placement of implants. A multidisciplinary team approach involving the triad of orthodontist, periodontist and restorative dentist will ensure the successful completion of the integrated treatment approach in these patients. The present case report achieved successful implant based oral rehabilitation in a patient diagnosed with congenital absence of bilateral maxillary lateral incisors utilizing a preprosthetic orthodontic implant site preparation for the purpose of space gain.
Dentigerous cyst in maxilla in a young girlMausumi Iqbal
This document describes a case report of a rare dentigerous cyst in an 8-year-old girl arising from an unerupted maxillary premolar that had invaded the right maxillary sinus. Clinically, the patient presented with swelling in the right upper jaw. Radiographs revealed a partially formed tooth surrounded by a radiolucent area. The cyst was surgically removed via enucleation along with the displaced tooth. Histopathological examination confirmed the diagnosis of a dentigerous cyst.
Prosthodontic-Orthodontic Treatment Plan with Two-Unit Cantilevered Resin-Bon...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Similar to Scientifi c Journal of Research in Dentistry (20)
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Introduction: Laparoscopic surgery has been performed in Mexico since 1989, but no reports about training tendencies exist. We conducted a national survey in 2015, and here we report the results concerning training characteristics during the surgical residence of the respondents. Materials and Methods: A prospective study was conducted through a survey questioning demographic data, laparoscopic training during pre and post surgical residency and other of areas of laparoscopic practice. The sample was calculated and survey piloted before
application. Special interest in this report was placed on type and quality of training received. Data are reported in percentages.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.
Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using Epi Data 3.1 and finally, it was analyzed using SPSS VERSION 20.
A Division I football player experienced acute posterior leg pain while playing. An ultrasound examination revealed an unusual injury - a complete rupture of the plantaris tendon mid-substance. This type of isolated plantaris tendon injury has rarely been reported. Ultrasound was useful for diagnosis and guided rehabilitation by monitoring healing over time. The athlete was able to return to full competition within 3 weeks through a progressive rehabilitation program focused on restoring range of motion and strength. This case suggests isolated plantaris tendon injuries may allow for faster return to play than other potential causes of posterior leg pain.
Type 1 Diabetes (T1D), is a severe disease, representing 5-10% of all reported cases of diabetes worldwide. Fulminant Type 1 Diabetes Mellitus (FT1D) is a subtype of type 1 diabetes mellitus that is largely characterized by the abrupt onset of Diabetic Ketoacidosis (DKA) and severe hyperglycemia without insulin defi ciency. Viral infections have been hypothesized to play a major role in the pathogenesis of Fulminant Type 1 Diabetes Mellitus (FT1D) through the complete and rapid destruction of pancreatic beta cells. Coxsackie viral infection has been detected in islets of 50% of the pancreatic tissue recovered from recent-onset Type 1 Diabetes (T1D) patients. In this report we have highlighted a case where the patient developed a Group B Coxsackie virus infection culminating in the development of Fulminant Type 1 Diabetes Mellitus (FT1D).
Methods: Cercariae are released by infected water snails. To determine the occurrence of cercariae-emitting snails in SchleswigHolstein, 155 public bathing places were visited and searched for fresh water snails. Family and genus of the collected snails were determined and the snails were examined for the shedding of cercariae, using a standard method and a newly developed method.
Objective: To generate preliminary information about of enteroviruses and Enterovirus 71 (EV71) in patients with aseptic meningitis in Khartoum State, Sudan.
Method: Cerebrospinal fluid specimens were collected from 89 aseptic meningitis patients from different Khartoum Hospitals
(Mohammed Alamin Hamid Hospital, Soba Teaching Hospital, Omdurman Military Hospital, Alban Gadeed Teaching Hospital and Police Hospital) within February to May 2015. Among these 89 patients, 43 (48%) were males and 46 (52%) were females. The patient’s age ranged between 1 day and 30 years old. The collected specimens were assayed to detect enteroviruses and EV71 RNA using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) technique
Femoral hernias, comprise 2% to 4% of all hernias in the inguinal region, and occur most commonly in women. Th ey present typically with a mass below the level of the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures and have a high rate of incarceration and strangulation due to the small size of the hernia neck orifice, requiring emergency surgery. We present the case of a 54-year-old female patient with intestinal occlusion due to incarcerated femoral hernia, repaired by laparoscopic approach, that gave the patient the opportunity to attend her daughter’s wedding the same day.
Small Supernumerary Marker Chromosome (sSMC) is a rare genetic condition marked by the presence of an extra chromosome to the 46 human chromosomes. This case report describes a 4 year old child with SSMC on the 46th chromosome. The child presented with delayed speech and language development, seizures and mild developmental delay. Speech and Language evaluation was carried out and management options are discussed.
A catheter is a thin tube made from medical grade materials that serve a broad range of functions, but mainly catheters are medical devices that can be inserted in the body to treat disease or perform surgical procedures. Catheters have been inserted into body cavities, ducts, or vessels to allow for drainage, administration of therapeutic fluids or gases, operational access for surgery. Catheters help perform tasks in various systems such as cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic systems. A dataset of 12 patients with varying “weights” and “heights” was recorded along with the lengths of their catheter tubes. This data set was found from two revered statistical textbooks on linear regression and the Department of Scientific Computing at Florida State University. This data set was not able to be linked to any particular clinical or experimental research studies, but the data set can be used to help catheter manufacturers and medical professionals better decide on what particular catheter lengths to use for patients knowing only their height & weight. These research insights could be helpful to healthcare professionals that have patients with incomplete or no healthcare records
to decide what catheter length to use. The main investigative inquiry that needed to be answered was how does patient weight & height influence catheter length together and separately? We conducted linear regression and other statistical analysis procedures in R program & Microsoft Excel and discovered that this data exhibited a quality called multi collinearity. With multi collinearity, all predictors (2 or more
independent variables) are not significant in an all encompassing linear aggression, but the predictors might be significant in their own individual linear regressions. Individual linear regression analyses were conducted for both patient height & weight to see how much they both contribute to varying catheter length. Patient weight was found to be more impatful than patient height in relationship to catheter length, even though height and weight are a classical example of multi collinearity predictors.
Bovine mastitis has a negative impact through economic losses in the dairy sector across the globe. A cross sectional study was carried out from September 2015 to July 2016 to determine the prevalence of bovine mastitis, associated risk factors and isolation of major causative bacteria in lactating dairy cows in selected districts of central highland of Ethiopia. A total of 304 lactating cows selected randomly from five districts were screened by California Mastitis Test (CMT) for subclinical mastitis. Based on CMT result and clinical examination, over all prevalence of mastitis at cow level was 70.62% (214/304).
Two hundred fourteen milk samples collected from CMT positive cows were cultured for isolation of major causative bacteria. From 214 milk samples,187 were culture positive and the most prevalent isolates were Staphylococcus aureus 42.25% (79/187) followed by Streptococcus agalactiae 14.43%
(27/187). Other bacterial isolates were included Coagulase Negative Staphylococcus species 12.83% (24/187), Streptococcus dysgalactiae 5.88% (11/187), Escherichia coli 13.38% (25/187) and Entrococcus feacalis 11.23% (21/187) were also isolated. Moreover, age, parity number, visible teat abnormalities,husbandry practice, barn fl oor status and milking hygiene were considered as risk factors for the occurrence of bovine mastitis and they were found significantly associated with the occurrence of mastitis (p < 0.05). The findings of this study warrants the need for strategic approach including dairy extension that focus on enhancing dairy farmers’ awareness and practice of hygienic milking, regular screening for subclinical mastitis, dry cow therapy and culling of chronically infected cows.
A 36-year-old female developed right upper quadrant pain and nausea after taking the herbal supplement kratom for two weeks to manage back pain. Laboratory tests showed elevated liver enzymes. A liver biopsy ruled out other causes and determined she had drug-induced liver injury from kratom use. Her symptoms and liver enzymes gradually returned to normal over six weeks after stopping kratom. The case report discusses kratom's potential for hepatotoxicity and advises clinicians to consider its effects on patient health.
The assessment, diagnosis and treatment of critically ill patients is extremely challenging. Patients often deteriorate whilst being
reviewed and their rapidly changing pathophysiology barrages healthcare professionals with new data. Furthermore, comprehensive assessments must be postponed until the patient has been stabilised. So, important data and interventions are often missed in the heat of the moment. In emergency situations, suboptimal management decisions may cause signifi cant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. So, I have developed a series of checklist proformas to guide the assessment of critically ill patients. These proformas also promote the systematic recording and presentation of information to facilitate the retrieval of the precise data required for the management for critically ill patients. The proformas have been modifi ed extensively over the last twenty years based on my personal experience and extensive consultation with colleagues in several world-renowned centres of excellence. The proformas were originally developed for use in the intensive therapy unit
or high dependency unit. However, they have been adapted for use by outreach teams reviewing patients admitted outside of critical care areas. The use of these tools can direct eff orts to provide appropriate organ support and provides a framework for diagnostic reasoning.
This review article discusses microvascular and macrovascular disease in systemic hypertension. It summarizes that:
1) Cardiac imaging plays a crucial role in risk stratifying hypertensive patients and identifying management strategies by properly diagnosing microvascular and coronary artery disease.
2) The nitric oxide synthase (eNOS) G298 gene allele may be a marker for microvascular angina in hypertensive patients, as studies have found it to be more prevalent in hypertensive patients with chest pain and reversible myocardial defects but normal coronary arteries.
3) Both structural changes like capillary rarefaction and functional changes like endothelial dysfunction can cause microvascular dysfunction and angina in hypertensive individuals in the absence of
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
Researchers from Utrecht recently published yet another paper on the use of Magnetic Resonance Imaging (MRI)demonstrating an additional failed attempt to understand the importance of qualitative versus quantitative imaging, and anatomic versus physiologic imaging. Th e implications of this failure here cannot be overstated.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
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Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
2. SRL Dentistry
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INTRODUCTION
Impaction is a pathological condition defined by the lack
of eruption of a tooth in to the oral cavity within the time and
physiologicallimitsofthenormaleruptionprocess[1].Impactedteeth
are those with a delayed eruption time or that are not expected to erupt
completely based on clinical and radiographic assessment. Permanent
maxillary canines are the second most frequently impacted teeth;
the prevalence of their impaction is 1-2% in the general population.
This is most likely due to an extended development period and the
long, tortuous path of eruption before the canine emerges into full
occlusion [1-4].
The maxillary permanent canines are the most commonly
impacted teeth with a reported prevalence of 0.9% to 3.3% [4,5].
About two thirds of these impacted maxillary canines are located
palatally whereas the rest are located labially or within the alveolus
[2]. Less frequently observed is the impaction of the maxillary central
incisors with an estimated prevalence ranking from 0.06% to 0.2%
[1] and it is usually diagnosed in the early mixed dentition stage [6-
7]. The other teeth can eventually be impacted but with a very lower
prevalence.
The etiology of tooth impaction is usually related to either a lack
of space for a natural eruption, a retained deciduous tooth, a diversion
of the tooth bud, or an idiopathic failure of eruption for unknown
origin [6]. Other known factors are also an obstacle hindering
eruption, cysts, or a trauma on the temporary dentition [8].
The diagnosis of impacted maxillary canine has to be based
on both clinical examinations – disease history and status (clinical
examination and palpation) and paraclinical examination –
biometrical analysis and radiographic investigations [9].
According to Bishara there are a number of clinical signs that
indicate the impaction of the upper canine: delayed eruption of the
permanent canine, over retained deciduous canine (after the age
of 14-15 years), absence of a normal labial canine bulge along the
alveolar ridge; presence of a bulge on the palatal side of the alveolus
or distal tipping of the lateral incisor [10].
The different methods of diagnosis that may allow for early
detection and prevention should include a family history, visual and
tactile clinical examinations by the age of 9-10 years and a thorough
radiographic assessment. Clinical signs that may indicate ectopic or
impacted cuspids include lack of a canine bulge in the buccal sulcus by
the age of 10 years, over retained primary cuspids, delayed eruption
of their permanent successor and asymmetry in the exfoliation and
eruption of the right and left canines. Eruption time of a maxillary
canine varies from 9.3 to 13.1 years.
Because canines are palpable from 1 to 1.5 years before they
emerge, the absence of the canine bulge after the age of 10 years is a
good indication that the tooth is displaced from its normal position,
and ectopic eruption or impaction of the maxillary cuspids is
possible. In patients older than 10 years, an obvious palpable bilateral
asymmetry could indicate that one of the permanent cuspids is
impacted or erupting ectopically [11,12].
According to Ericson and Kurol, for an accurate diagnosis the
clinical examination should be supplemented with a radiographic
evaluation. Panoramic films are used to localize impacted teeth .Labial
impaction of a maxillary canine is due either to ectopic migration of
the canine crown over the root of the lateral incisor or shifting of the
maxillary dental midline, causing insufficient space for the canine to
erupt [13,14].
Extraction of the maxillary deciduous canine as early as 8 or
9 years of age will enhance the eruption and self correction of a
labial or intra-alveolar maxillary canine impaction. Olive suggested
that opening space for the canine crown with routine orthodontic
mechanics might allow for spontaneous eruption of an impacted
canine. However, in some situations, even these techniques do not
work, and the orthodontist must refer the patient to have the labial
impactionuncoveredsurgically.Thereare3techniquesforuncovering
a labially impacted maxillary canine: excisional uncovering, apically
positioned flap, and closed eruption technique [1,2,9].
Before surgical intervention, it is necessary to consider the need
to create adequate space to facilitate movement of the impacted tooth
[15]. For management of the impacted maxillary canine, all of the
teeth in the maxillary arch should be bracketed to allow for proper
positioning of the canine and to avoid canting of the occlusal plane
[16]. Bracketing of all the teeth provides adequate anchorage for
extrusion of the impacted canine. The other option is to use a mini-
implant or micro mini-implant as anchorage to move the impacted
canine [17]. Pre-surgical orthodontic treatment should be performed
until adequate space is made for the canine. This usually takes between
2 and 4 months [15,17].
ABSTRACT
Introduction: Impaction of maxillary canines is a frequently encountered clinical problem in orthodontic therapy. When a preventive
approach fails, treatment involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the
dental arch. The aim of the present report was to demonstrate by case reports of an adult patient with bilateral impacted maxillary canines
treated with surgical exposure and orthodontic treatment.
Material and Methods: A 15year-old female with various degrees of bilateral palatal impaction of maxillary canines were managed
by the described technique.
Results and Discussion: Autonomous eruption of the impacted canines after surgical uncovering was witnessed in all patients
without the need for application of a vertical orthodontic force for their extrusion.
Conclusion: The described method of surgical uncovering and autonomous eruption created conditions for biological eruption of the
palatally impacted canines into the oral cavity and facilitated considerably the subsequent orthodontic treatment for their proper alignment
in the dental arch.
Keywords: Impacted canines; Surgical; Tooth exposure; Orthodontic treatment
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In principle, there are five treatment options for impacted
maxillary canines [17];
(i) No active treatment except monitoring,
(ii) Interceptive removal of the primary canine,
(iii) Surgical removal of the impacted canine,
(iv) Surgical exposure with orthodontic traction and alignment,
and;
(v) auto-transplantation of the impacted canine
This article presented a case of an adult patient with bilateral
impacted maxillary canines treated with surgical exposure and
orthodontic treatment.
CASE REPORT
A 15 year-old female, was referred to the orthodontist by his
family dentist. The clinical examination showed the presence of the
left deciduos canine, and distal migration of lateral and central incisor.
The absence of a canine bulge and the presence of a bilateral palatal
bulge were noted upon intraoral palpation. There were no symptoms.
The canines for this particular patient were rather horizontal in
angulation and the crowns of the canines were in close proximity to
the roots of the central incisors. This presented risk not only to the
roots of the lateral incisors but also to the central incisors. We elected
to address the canine with surgical exposure of the canines and
utilizing orthodontic treatment to guide the impacted teeth into their
proper position. The primary canines were extracted, the canines were
exposed, and buttons with micro-chains were placed on the impacted
teeth. Orthodontic treatment was used to create the space needed for
the canine in the maxillary arch and specific orthodontic mechanics
were applied to guide the teeth in a distal vector of force – away from
the adjacent roots and teeth; this careful approach helps minimize
potential root damage as well as other compromises (Figure 1a-c).
Panoramic radiographs showed the presence of two impacted
canines. Considering the good morphology of the teeth, the position
and the absence of ankylosis, in agreement with the oral surgeon the
surgical orthodontic disimpaction was decided (Figure 1d).
A fixed superior appliance was applied. The oral surgeon
performed the surgical exposure of the impacted teeth and the
orthodontist attached an auxilliary button directly to the crown’s
enamel on the palatal side. This one-step approach is preferable, and
to assure good bonding to the enamel the exposure should be the least
traumatic possible. A fibrine sponge is useful to reduce the bleeding
around the crown, and a periodontal curette can be used to remove
the primary cuticle from the enamel. An orthophosphoric acid (37 %)
was used for 40 second and the button was bonded. A ligature with
several holes was prepared and attached to the button before bonding
(Figure 2a).
The surgical exposure was very conservative. Only the bony
tissue over the crown was excised and the flap completely sutured.
We consider this light surgical exposure to be beneficial to the future
periodontal health.
After a week the suture and the surgical dressing were removed,
and light orthodontic force (no more 60 grams/2 ounces) with elastic
ligatures was started. Concurrently sufficient space was created in the
arch thus reducing the diastema. A preformed round arch wire 0.020
was used to provide sufficient stiffness (Figure 2b-c).
During the treatment two end oral radiographs were made on
each side to ensure that the movement of canine was not damaging
the roots of the neighboring teeth. When the crowns were erupted a
metallic canine bracket was bonded, and the remaining movements
were made with sectional, later repositioning the bracket twice. A
Flexiloy tm 0.021 X 0.025 was the finishing arch and an Essix retainer
was used for retention. The active treatment lasted 2 years long. Both
the canines at the end of treatment had good periodontal conditions
(Figure 2d, 3a-c).
A B C
Figure 1a-c: Pre-treatment intraoral views.
D
Figure 1d: Initial panoramic radiograph.
Figure 2a: Panoramic radiograph taken during Treatment after 3 months.
Figure 2b: Panoramic radiograph taken during Treatment after 9months.
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DISCUSSION
It is not unusual for maxillary canine impaction to occur
bilaterally, although unilateral ectopic eruptions are more frequent
[1,2]. Genetic factors have been reported to be the primary cause
of palatally impacted maxillary canines [2]. Pathological sequelae
like cysts, tumors, external/internal resorption of the impacted
teeth and/or adjacent teeth, transmigration, referred pain and
periodontitis have been associated with tooth impaction [2,9]. The
clinician can investigate the presence and position of the cuspid by
visual inspection, palpation and radiography. In the approach to
the orthodontic patients, the application of traditional radiographic
techniques is indispensable. However CBCT provides information
which is not revealed during traditional radiographic analysis and is
therefore indicated in case of impacted teeth or craniofacial structural
anomalies [8].
There are four treatment options for impacted teeth; observation,
intervention, relocation and extraction [17]. When the condition
is identified early, interceptive extraction of the primary canines
completely resolves permanent impaction in majority while
others show some improvement in terms of more favorable canine
positioning. However extraction of the primary cuspids does not
guarantee elimination or correction of the problem. As a general rule,
when the degree of overlap between the permanent maxillary cuspid
and m the neighboring lateral incisor exceeds half the width of the
incisor root, the chances of complete recovery are poor. An angle
exceeding 31° from the vertical significantly reduces the chance of
normal eruption following an extraction [9].
Upper canine inclusion is more frequent than lower impaction
(with a minimum ratio of 4 to 1), in 57% cases in women. The
aetiology of canine impaction is generally related to the upper
dental arch length deficiency or to the developmental position of
the tooth that could be more cranial than the norm. Mechanical
factors have also been proposed to be related to the impaction of a
canine [1-4]. For instance, the premature loss of deciduous canines
or their prolonged retention could be associated with mechanical
impingement of permanent canine. This can also be the consequence
of displacement of lateral incisors or of the presence of impacted
teeth or odontomas. Untreated impacted canines may determine
arch length discrepancies, loss of vitality of adjacent teeth, follicular
cysts, canine ankylosis, infections, and pain. As a consequence of this,
orthodontic treatment is strongly recommended [5-9].
Orthodontic movement of an impacted tooth depends on a
variety of factors, such as the position of the impacted tooth relative
to neighboring teeth, its angulation, the distance the tooth has to be
moved, and the possible presence of ankylosis. Surgical extraction is
indicated in the following situations. a) The existence of infection,
cyst, or tumor related to the impacted canine, b) impacted tooth
causes the periodontal disturbance of the adjacent teeth, c) presence
of neuralgic symptoms, d) crowding of arch requiring therapeutic
extractions to correct crowded incisor teeth (e) impacted canine is
enclosed and cannot be transplanted, f) root resorption affecting the
adjacent teeth, g) root of impacted canine is severely dilacerated, h)
severe impaction of canine tooth and i) patient’s unwillingness to
orthodontic treatment or transplantation [17].
When the permanent maxillary canine is impacted or erupting
buccally or palatally to the arch, the preventive treatment of choice
is extraction of the primary canine; when the patient is 10-13 years
old [14,18]. However, if any root resorption is evident before this
age and there is suspicion of impaction, the primary canine should
be extracted and appropriate treatment implemented, such as
monitoring of the eruption path or orthodontic alignment. When a
canine is impacted buccally, the retained primary canine should be
extracted to create a pathway and space for the permanent canine to
erupt into the arch. This is especially important if both the permanent
and primary canines are simultaneously visible in the arch [19].
Baccetti and co-workers evaluated the effectiveness of two
interceptive approaches to manage palatally displaced canines in a
randomized clinical trial. They compared the success of extraction
of primary canines alone and in association with the use of cervical-
pull headgear. They concluded that removal of primary canine as
an isolated measure to intercept palatal displacement of maxillary
canines showed a success rate of 65.2% which was significantly
greater than that in the untreated controls (36%). The additional use
of a headgear resulted in successful eruption in 87.5% of the subjects.
[20]
The success of early interceptive treatment for an impacted
maxillary canine is influenced by the degree of impaction and the age
of the patient at the time of diagnosis [18]. Ericson and Kurol in their
study, found that when the cusp of the canine was loc distal to the
midline of the root of the lateral incisor, 91% of the canines could be
Figure 2c: Panoramic radiograph taken during Treatment after 12months.
Figure 2d: Panoramic radiograph taken during Treatment after 18months
(final).
A B C
Figure 3a-c: Final intraoral views.
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corrected whilst when the crown had passed medial to the midline of
the root of the lateral incisor only 64% of the ectopically positioned
teeth could be corrected [14]. As a general rule, when the degree of
overlap between the permanent maxillary canine and the neighboring
lateral incisor exceeds half the width of the incisor root, the chances
of complete recovery are considered to be poor [21].
Other factors influencing the prognosis include angulation of
the canine and crowding [19]. The chance of successful eruption
of an impacted canine following extraction of the primary canine
becomes less favourable as the angle from the vertical increases [14].
However, the degree of horizontal overlap with the adjacent lateral
incisor has been found to have more influence on the prognosis
than the angulation [17]. Thus, extraction of the primary canine is
recommended if the patient is between 10 and 13 years old and the
maxillary canine cannot be palpated. If the canine position does not
improve over a 12-month period, alternative treatment is indicated.
Radiographic evaluation in these cases should be at intervals of 6
months [14].
Orton et al reported a principal of treating unrupted canines by
assessing the vertical axial eruptive path and suggested that labial
tipping of 45° is generally orthodontically untreatable. Horizontal
position, age of the patient, vertical height and bucco palatal position
in descending order of importance are the factors which determine
the difficulty of canine alignment [22].
Surgical exposure is the conventional treatment for impacted
canines. While, many surgical procedures have been advocated in the
past, the simplest and arguably the least traumatic that is still in use
today is the gingivectomy [21,23].
Historically, the employment of this technique gave little
consideration to the need for attached gingiva on the buccal surface
of the canine. The clinician simply exposed the tooth by excising the
overlying tissue regardless of the quality of the outcome. However,
it is now considered that a minimum of 3mm of keratinized gingiva
should be left following the gingivectomy [16]. This technique is
more applicable for palatal impactions where there is an abundance
of attached gingival [23]. The disadvantages of this technique are that
attached gingiva is lost and tissue may re-grow over the surgical site
if the gingivectomy is too conservative [24]. However, there are two
other surgical methods that are favoured; the closed flap technique
and the open surgical technique [1,2,8,9].
The closed flap technique is applicable when the tooth is in a
position that does not permit the repositioning of a flap after crown
exposure. This technique is frequently used for palatal impactions
that are not close to the ridge of the alveolar process. In addition,
when a canine is impacted high on the buccal aspect of the maxilla,
or low relative to the occlusal plane of the mandible, this technique
provides exposure without compromising the periodontal status of
the adjacent teeth [24].
A small portion of the cortical bone is removed as necessary and
the impacted tooth is exposed; some surgeons favour luxation of the
tooth. Removal of less bone is said to promote healing and reduce
post-operative bone loss [25]. An orthodontic bracket is then placed
on the impacted tooth, the attached ligature wire or a chain then
projects through the incision line. In cases where the tooth is distant
from the
arch, it may be necessary to penetrate the flap and bring the
ligature through the tissue to the arch wire [16]. The flap is then
sutured back into place and orthodontic traction is subsequently
applied [2].
The orthodontic management of these difficult cases requires the
use of specific orthodontic mechanics, which could allow a perfect
three dimensional control of tooth movement in order to reduce
possible side effects. Elastic chain were used to retract the impacted
canines, firstly activated in order to extrude the teeth, and to obtain
their distal movement. The activation of the elastic chain was
scheduled about once a month [17,26].
From a biomechanical perspective, it is desirable to deliver a light,
point force in the occlusal direction to erupt impacted canines when
sufficient space for the canine exists or has been created. When elastic
chains or threads are used to deliver the single erupting force to the
canine from a rigid base arch wire, the forces must be kept light due
to the high load deflection rate and rapid decay of the force delivered
by the elastic. Including many teeth helps to distribute the unwanted
intrusive side effects among a larger cumulative root surface area and
thus to minimize localized deleterious effects [9].
Ankylosis needs to be ruled out after surgical exposure by
determining tooth movement with reasonable digital force or
metallic sound on percussion. It is desirable to deliver a light force
in the occlusal direction, using elastics, elastic chain, NiTi spring,
or tie wire. Cole et al have described the use of magnets in the
management of teeth that fail to erupt. We used ligature wire as
traction attachment. Ligature wire were tied to the 0.016” NiTi wire
which would get deformed under the traction force [27]. The spring
back property of NiTi would bring the wire in its original shape thus
transmitting a continuous traction force to the tooth through ligature
wire. Ligature was adjusted every week to maintain traction force.
However it is felt that auxiliary NiTi wire for ligature tie in addition to
the base wire could have avoided the complication of mid treatment
open bite [9,17].
Complications and The Side Effects Associated With The
Treatment of The Impacted Maxillary are as Follows
Pain: As with any surgical procedure, patients experience some
pain; however, there is slightly more post-operative pain from
surgery on maxillary impacted canines than for the surgery related
to other impacted teeth. Post-operative management during the first
24 hours should include non-steroidal anti-inflammatory drugs and
long acting local anaesthetic agents [17].
Infection: Any surgical wound can lead to an infection even
with the best aseptic technique. With maxillary impacted canines,
infections can develop in the lip, canine space, or palate. Treatment
consists of antibiotic therapy and surgical drainage.
Ecchymosis of the lip: Post-operatively ecchymosis can occur
in the soft tissue if haemostasis is not achieved before closure [28].
It also can occur if the patient is taking salicylic acid or any herbal
preparation or medication that increases bleeding time.
Non-eruption: The most common reasons for non-eruption after
surgical exposure are ankylosis, inadequate space, gingival scarring,
improper bonding and inappropriate orthodontic mechanics [16].
Devitalization of the pulp: If symptoms of pulpitis develop when
an impacted canine is being moved orthodontically, the orthodontic
therapy should be stopped and the canine should be evaluated for
possible endodontic treatment. This complication is rare particularly
in young individuals [16,17].
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Damage to adjacent structures: If an impacted canine is in close
proximity to the roots of neighbouring teeth, the surgery may cause
damage to them. Rarely, displacement of a root into the maxillary
sinus, or nasal cavity can occur during surgical removal. Even more
rarely, an oro-antral or oro-nasal fistula can follow surgical removal
of an ectopic maxillary canine [17,28].
Paresthesia: When an impacted maxillary canine is located
near to the neurovascular bundle, paresthesia may be a sequela of
surgery. For instance, if the maxillary canine is impacted palatally,
the nasopalatine nerve may be affected, although it rarely presents a
problem for the patient [29].
Loss of soft tissue flap: Loss of the soft tissue flap is the result
of interruption of the blood supply during surgery or post-operative
infection.Whenaflapisthinitiseasytocompromisethebloodsupply,
so careful design and handling of the flap is important. Allowing
phosphoric acid etch to come into contact with the soft tissues has
been said to adversely affect the vitality of the flap [17,29,30].
Lack of attached gingival: Poor quality gingival mucosa may
occur following exposure of a labially impacted maxillary canine.
Therefore, the flap design should be cognisant of the need to preserve
keratinized tissue [29,30].
The results of this case treatment showed the bilateral impacted
maxillary canines were corrected. Acceptable occlusion achieved and
the over jet and overbite come to normal [31]. The molar and canine
relation were Class I on the both sides. Lateral cephalometric showed
overall facial balance was improved. The lip becomes less tension on
closure. No signs or symptoms of temporomandibular dysfunction
after treatment [32].
CONCLUSIONS
Impaction of a maxillary canine is a frequent occurrence and
requires a multi-disciplinary approach for proper management.
Awareness of the prevalence, aetiology, associated anomalies
and techniques for diagnosis allow for early recognition and
implementation of interceptive treatment. Planned extraction of
a primary canine and radiographic follow-up for 12 months can in
selected cases, avoid the need for surgery followed by orthodontic
therapy. The retraction of the bilateral impacted maxillary canine
occuredwithoutlossanchorageintheposteriorsegment.Patientmain
complaint about the appereance of her bilateral upper canines due to
impacted condition was improved by the treatment. It is concluded
that that surgical and orthodontic treatment can be considered as an
effective therapy for bilateral impacted canine correction.
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