Maxillary segmental distraction for the treatment of primary failure of tooth eruption
Shirota T, Hishida M, Yamaguchi T, Kurabayashi H, Maki K, Shintani S. Posterior maxillary segmental distraction for the treatment of severe lateral open bite caused by primary failure of tooth eruption: a case report. J Oral Maxillofac Surg Med Pathol 2013;25:39-42
Primary failure of eruption (PFE) is a rare disorder that is described as cessation of eruption of the teeth. PFE is not caused by physical barriers, abnormal position of teeth, or a systemic condition. PFE often results in ankylosis of the affected teeth and open bite. This case report describes the treatment of an open bite caused by PFE and treatment with maxillary segmental distraction osteogenesis to improve occlusion and masticatory function. The 24-year old male patient presented with a Class III skeletal relationship and severe unilateral open bite caused by PFE. After 18 months of presurgical orthodontic therapy, mandibular setback surgery was completed to correct the mandibular prognathism. After 6 months, a 2–staged segmental osteotomy technique (palatal then buccal cuts) was applied, and an alveolar distractor was placed to achieve a gradual downward movement of the maxillary left segment. Four weeks of distraction were completed, and the distractor was removed. Subsequently, the authors used a “floating bone concept” to control the position of the alveolar segment after callus distraction, but before bone consolidation. This was accomplished via the use of intermaxillary elastics to move the dental segment into the desired position. Twenty-four months after treatment, panoramic radiographs showed successful vertical distraction osteogenesis of the alveolar bone and 8 mm closure of the open bite. The authors concluded that the “floating bone concept” is effective in improving a unilateral open bite caused by multiple ankylosed teeth.
Reviewed by Shireen Irani and Azadeh Amin
Third molar extractions: Evidence-based informed consent
Kandasamy S, Jerrold L, Friedman JW. Asymptomatic third molar extractions: evidence-based informed consent. J World Fed Orthod 2012;1:e135-8
The goal of this review article was to evaluate the issues regarding the extraction of asymptomatic third molars. To date, health profession conferences have failed to reach a consensus for defined guidelines regarding the treatment of third molars. The American Association of Oral Maxillofacial Surgeons advocates the removal of asymptomatic third molars on the assumption that these sites are prone to future periodontal disease and a potential source of chronic inflammation. However, the evidence-based literature advocates monitoring asymptomatic third molars and does not support their extraction. First, there is no supporting evidence that mandibular third molars contribute to mandibular incisor crowding. In addition, there is little justification for the removal of asymptomatic third molars to prevent future complications such as odontogenic tumors, cysts, and mandibular fractures. Finally, periodontal pockets of 4 mm or greater involving the third molars do not necessarily initiate systemic health concerns involving a link between periodontal and cardiovascular diseases. Cardiovascular disease has been shown to have a stronger correlation with obesity, diet, age, sex, smoking, and family history. Extraction of unerupted, pathology-free, asymptomatic third molars is an elective procedure that should be performed based on the patient’s ability to maintain good oral hygiene while considering the risks of nerve injury, infection, bleeding, and trismus associated with the procedure. The patient must be involved in the decision-making process and should be aware of these potential complications before consenting to the procedure. The authors believe that orthodontists should only recommend extractions if they are pertinent to orthodontic treatment. If the general dentist advises that a patient have extractions, then the orthodontist is safe from liability as long as no nonevidence-based referrals are made.
Reviewed by Christopher Ruth and Kyle Jamison
Third molar extractions: Evidence-based informed consent
Kandasamy S, Jerrold L, Friedman JW. Asymptomatic third molar extractions: evidence-based informed consent. J World Fed Orthod 2012;1:e135-8
The goal of this review article was to evaluate the issues regarding the extraction of asymptomatic third molars. To date, health profession conferences have failed to reach a consensus for defined guidelines regarding the treatment of third molars. The American Association of Oral Maxillofacial Surgeons advocates the removal of asymptomatic third molars on the assumption that these sites are prone to future periodontal disease and a potential source of chronic inflammation. However, the evidence-based literature advocates monitoring asymptomatic third molars and does not support their extraction. First, there is no supporting evidence that mandibular third molars contribute to mandibular incisor crowding. In addition, there is little justification for the removal of asymptomatic third molars to prevent future complications such as odontogenic tumors, cysts, and mandibular fractures. Finally, periodontal pockets of 4 mm or greater involving the third molars do not necessarily initiate systemic health concerns involving a link between periodontal and cardiovascular diseases. Cardiovascular disease has been shown to have a stronger correlation with obesity, diet, age, sex, smoking, and family history. Extraction of unerupted, pathology-free, asymptomatic third molars is an elective procedure that should be performed based on the patient’s ability to maintain good oral hygiene while considering the risks of nerve injury, infection, bleeding, and trismus associated with the procedure. The patient must be involved in the decision-making process and should be aware of these potential complications before consenting to the procedure. The authors believe that orthodontists should only recommend extractions if they are pertinent to orthodontic treatment. If the general dentist advises that a patient have extractions, then the orthodontist is safe from liability as long as no nonevidence-based referrals are made.
Reviewed by Christopher Ruth and Kyle Jamison
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