Dror Aizenbud

The optimal timing for commencement of orthodontic treatment has been controversial. Initial early orthodontic treatment usually begins at the deciduous dentition or early mixed dentition stage and continues for 12-18 months. In most cases, a second treatment phase will be required in the permanent dentition stage to achieve the treatment goals and a stable occlusion. One of the main purposes of the early treatment phase is to affect the growth pattern of the jaw and consequently correct skeletal imbalance and prevent future severe malocclusion by means of growth modification. Some clinicians strongly believe that early intervention with functional appliances improves facial harmony and simplifies as well as shortens the second orthodontic treatment phase. In contrast others advocate that it is unnecessary as the early treatment results will be eliminated by future growth and a recurrent treatment phase is essential in the permanent dentition stage in any case. Thus it is merely a waste of time and resources, and all treatment goals could be reached by a comprehensive single continued treatment phase in the late mixed dentition stage. This article summarizes the scientific literature on the different concepts of early functional orthodontic treatment of Skeletal Class II malocclusion correction vs. a single comprehensive orthodontic treatment process in the late mixed dentition stage. The indications and benefits of each of the approaches are discussed in detail. In conclusion, most of the researchers recommend early orthodontic intervention in children suffering psychological and social problems associated with their malocclusion. Prevention of traumatic injury in cases of maxillary incisor protrusive inclination is also considered an indication for early orthodontic treatment.

La preservacion preortodontica del alveolo tras la extraccion dental para mejorar la morfologia y arquitectura favorables de la cresta dentoalveolar y facilitar el movimiento dental ortodontico (MOD) y el cierre del espacio de extraccion. Este caso clinico de clase esqueletica II de un chico de 13 anos presenta una oportunidad unica para evaluar y comparar el cierre del espacio de extraccion con MOD mediante un analisis de boca partida en un unico paciente. El tratamiento ortodontico periodontal completo incluyo la extraccion no simultanea de los primeros molares mandibulares bilaterales periodontalmente comprometidos y la erupcion de los caninos impactados bilaterales. Mientras que el espacio posextraccion derecho desarrollo un proceso de cicatrizacion natural, el izquierdo fue injertado utilizando 4BONE BCH (hidroxiapatita β- fosfato tricalcico [HA-β-TCP], HA 60% y β-TCP 40%). El tratamiento multidisciplinario de 3 anos dio lugar a relaciones de clase I en el lado derecho y de clase II en el lado izquierdo, asi como a la mejora de la apariencia facial y la relacion dento-esqueletica maxilar. Sin embargo, un espacio alveolar residual de 3 mm no se cerro en el lado izquierdo injertado a lo largo de un tercer molar izquierdo no erupcionado. Este analisis comparativo de boca partida del cierre de espacio ortodontico mostro una diferencia clinica significativa en el resultado. La colocacion preortodontica del material de injerto de HA-β-TCP en el segmento izquierdo, demostro ser un obstaculo para el cierre del espacio de extraccion con MOD, impidiendo el establecimiento de una buena oclusion.

Orthodontic treatment poses a significant challenge in patients suffering from periodontal disease. Providing orthodontic treatment to periodontal patients should be carefully planned and performed in a tight collaboration between the orthodontist and periodontist. Resolution and stabilization of the periodontal condition is a pre-requisite for orthodontic treatment initiation. Careful oral hygiene performance and highly frequent recall periodontal visits are also crucial. Pre- or post- orthodontic periodontal surgery might help providing better treatment outcomes.

In cases of an avulsed or luxated tooth, splinting of the injured tooth is recommended. Splint is defined as a fixation of the injured tooth to adjacent teeth in the dental arch. The preferred splint type is semi-rigid, which should be placed for 10 to 14 days and enable proper oral hygiene and will not cause any kind of impingement to the gingiva. It is effective in reducing the replacement resorption process, which affects the periodontal tissue surrounding roots exposed to dental trauma.

Implant supported rehabilitation has become very common in treatment plans nowadays, yet many patients lack the vertical and horizontal bone dimensions required for endosseous implant insertion. Distraction osteogenesis is a technique in which bone is generated by progressive elongation of two bone fragments following an osteotomy or corticotomy. Distraction osteogenesis of the alveolar ridge as a treatment modality in implant dentistry is a very useful technique that allows for adequate bone formation suitable for implant insertion. Alveolar distraction can be unidirectional, bidirectional, multidirectional or horizontal. Alveolar distraction osteogenesis can be performed by using intraosseous distraction devices, intraosseous distraction implants or by extraosseous devices which are the most prevalent today. Distraction osteogenesis has many advantages such as gradual lengthening of the bone with no need for an autogenous bone graft and lack of the associated donor site morbidity as well as distraction of the surrounding soft tissue together with the transported bone. One of the major challenges when using alveolar distraction osteogenesis is controlling the vector of distraction, this problem should be further addressed in future researches. We describe different methods for alveolar distraction osteogenesis, including the surgical procedure, latency period, lengthening and consolidation period. We also discuss the advantages, disadvantages and complications of the method. In this manuscript a case of mandibular alveolar deficiency following mandibular fracture and loss of teeth and the alveolar bone is presented. This patient was treated by alveolar distraction osteogenesis with excellent results. This patient was later rehabilitated . using endosseous implants as demonstrated by radiographs. Alveolar distraction osteogenesis provides a method to regain both hard tissue and soft tissue without additional grafting and is an efficient modality in cases of medium to severe bone loss.

Aspiration and ingestion of foreign bodies of dental origin during treatment may cause a gastrointestinal and airway obstruction or perforation, and may constitute a life threatening situation. Ingestion occurs more often than aspiration and usually does not cause any clinical signs or symptoms. Most often it will spontaneously rejected from the gastrointestinal tract by peristaltic movement without any coimplication. However aspiration always requires treatment since foreign bodies there may cause inflammatory reaction and even severe obstruction and death. This article describes one case of aspiration and 3 cases of ingestion of dental instruments and materials. We discuss the diagnostic procedure: evidence of clinical signs and plain radiography, CT and the use of contrast material in case of radiolucent foreign bodies. The modern technique of endoscopy is successfully performed for diagnosis and treatment of foreign bodies in case of aspiration with minimal complications. We suggest a step by step protocol of treatment at the dental clinic in the case of ingestion/aspiration of foreign body and discuss several prevention techniques.

Extracorporeal generated shock waves were introduced in medical therapy approximately 20 years ago in order to disintegrate kidney stones. Over the last 10 years, extracorporeal generated shock waves have been used to stimulate healing processes. No report to date has examined its influence on different inflammation mediators and growth factors in the periodontium. Orthodontic tooth movement is a model including the induction of an aseptic inflammation and its resolution. We conducted a preliminary study to investigate the periodontium cytokine concentration fluctuations after induction of orthodontic force with and without extracorporeal shock wave therapy (ESWT) in a rat model. An orthodontic appliance was fabricated and applied between the molars and the incisors of rats. The rats were treated by a single episode of 1000 shock waves and gingival crevicular fluid was collected for 3 days. The concentration of typical acute phase cytokines was evaluated by ELISA assay. Of the three tested cytokines, IL-1beta was the only detected cytokine along the study timeframe. IL-1beta concentration rose in both the treated and non treated shockwave groups on the first day, however it was statistically significantly higher in the treated group on day 2. On day 3, IL-1beta concentrations in both groups decreased and reached a lower level in the treated group, revealing a statistically significant difference than its level on the previous day. The application of ESWT during orthodontic force induction enhances IL-1beta production as part of mechanical forces transduction triggering a biologic response, which may contribute to accelerated periodontal remodeling and therefore foreshortening the orthodontic tooth movement period.

Shockwave therapy is used in medicine due to its ability to stimulate healing processes. The application of orthodontic force evokes an inflammatory reaction resulting in tooth movement. Shockwave therapy might have an effect on both inflammatory and periodonal ligament cytokine profiles. Our aim was to evaluate the fluctuations of different inflammatory cytokines after orthodontic force induction with and without shockwave therapy. An orthodontic appliance was applied between the rats' molars and incisors. In conjunction with the commencement of orthodontic force, the rats were treated with a single episode of 1000 shock waves and the gingival crevicular fluid was collected for 3 days. The expression and concentration of different cytokines was evaluated by a commercial 4-multiplex fluorescent bead-based immunoassay. The level of all cytokines displayed a similar trend in both shockwave-treated and untreated groups; the concentration peaked on the first day and declined thereafter. In all cases, however, the cytokine levels were smaller in the shockwave-treated than in untreated animals; a significant difference was found for sRANKL and borderline difference for IL-6 on Day 1. We conclude that shockwave therapy during the induction of orthodontic tooth movement influences the expression of inflammatory cytokines.

Extracorporeal shock wave therapy has been used in various clinical conditions as a result of its ability to stimulate healing processes in acute and chronic inflammatory states. Orthodontic force application triggers an inflammatory reaction in the periodontal tissue surrounding the involved teeth, resulting in tooth movement. Preliminary work revealed that extracorporeal shock wave therapy increased the expression of the inflammatory cytokines involved. Our aim was to investigate the expression of inflammatory cytokines in the periodontal tissues following orthodontic force induction, with and without shock wave therapy, in experimental rats. An orthodontic appliance was fabricated and applied between the molars and the incisors of adult Wistar rats. In conjunction with orthodontic force commencement, the rats were treated with a single episode of 1000 shock waves. Every day, during the 3 d of the study, rats were killed and the immunolocalization of RANKL, interleukin (IL)-1β, IL-6 and tumor necrosis factor-alpha was evaluated. The percentage of the area staining positively for all inflammatory cytokines during the first 2 d decreased statistically significantly more in the shock wave-treated group compared with the nontreated control group. On the first day, the percentage of the area staining positively for IL-1β and RANKL on the compression side peaked in both groups, with a sequential rise in the number of TRAP-positive cells. The induction of shock wave therapy during orthodontic tooth movement influences the expression of different inflammatory cytokines in the tissue and might alter the expected periodontal remodeling rate.

OBJECTIVE The objective was to investigate the effect of extracorporeal shock wave therapy (ESWT) on the magnitude of orthodontic tooth movement, in a rat model, based on a previously established treatment protocol. DESIGN In conjunction with orthodontic force commencement, rats underwent ESWT. The amount of tooth movement along with different microarchitectural parameters were measured after three weeks by means of microcomputed tomography. In addition, the percentage of cells expressing vascular endothelial growth factor, the number of tartrate-resistant acid phosphatase (TRAP) positive cells/area and blood vessel density were evaluated both for the pressure and tension sides. RESULTS The addition of ESWT to the orthodontic force after three weeks more than doubled the average tooth movement. The addition of ESWT on the pressure side induced a significant decrease in volumetric bone mineral density. Blood vessel density and the number of TRAP positive cells were higher after the application of ESWT. CONCLUSION The induction of ESWT during orthodontic tooth movement in a rat model increases the rate of tooth movement by accelerating bone resorption on the pressure side and possibly enhances bone formation on the tension side.

Background: Distraction osteogenesis has widespread clinical use in the treatment of congenital and acquired craniofacial deformities. Nonetheless, during the prolonged consolidation period, the newly regenerated bone carries the risk of complications. A known method for enhancing bone healing is extracorporeal shock wave therapy, which has been shown to induce neovascularization and promote tissue regeneration. The authors investigated whether extracorporeal shock wave therapy can accelerate bony consolidation and regeneration in distraction osteogenesis of the rat mandible and at which stage of distraction osteogenesis it should be applied. Methods: Twenty-four male Sprague-Dawley rats were subjected to distraction osteogenesis of the right mandible (latency period, 3 days; distraction period, 10 days; 0.5 mm/day). Experimental groups consisted of the following: group I (control), no extracorporeal shock wave therapy; group II, extracorporeal shock wave therapy (0.18 mJ/mm2) at the latency period; and group III, extracorporeal shock wave therapy (0.18 mJ/mm2) at the consolidation period. Explants were removed for evaluation after 4 weeks of consolidation. Results: Histologic evaluation showed well-developed cortical cortex and a higher degree of bone formation and mature bone in group III; micro–computed tomography showed significantly increased bone mineral density, bone volume fraction, and trabecular thickness; immunohistochemistry demonstrated significantly increased expression of bone morphogenetic protein-2, vascular endothelial growth factor, and proliferating cell nuclear antigen. Conclusion: Extracorporeal shock wave therapy application at the consolidation period during distraction osteogenesis in the rat mandible enhances bone formation and osteogenic and angiogenic growth factors, improves bone mechanical properties, and accelerates bone mineralization.

Background: In craniofacial microsomia (CFM) Type III patients, autogenous costochondral grafts (CCG) are conventionally used for the reconstruction of the ramus and condyle. The aim of this study was to describe the use of CCG in children with CFM in terms of outcomes, growth patterns, and complications. Materials and methods: This is a retrospective study of nine, aged 4-12 years, patients with CFM Type III, who underwent reconstruction of the mandibular ramus condyle unit by CCG. Seven patients had right-sided CFM and two had left-sided CFM. The rationale for this choice was to utilize the potential growth of the CCG, providing length to the ramus, and the joint by acting as a growth center; to control the repositioning of the chin center; and to improve child compliance by undergoing only one operation. The surgical treatment plan was determined preoperatively, based on measurements of mandibular vertical and horizontal deficiency and analysis of the mandibular posterior and anterior angulation. The mandibular planes and axis were defined by a three-dimensional simulation software program to perform a "mock surgery", by creating a prototype model. Clinical follow-up included measurements of the maximal opening, observation of the facial symmetry, and recording of complications, such as reankylosis. Results: There were no serious postoperative complications, infections, or graft rejections. Successful postoperative occlusal cants were noted and measured in five patients and acceptable results were obtained in three patients. In one case, the CCG underwent distraction osteogenesis to improve the facial symmetry. In one patient, the graft continued to grow and the chin started to deviate into the opposite side. Measuring and calculating the ratio of the ramus height on the panoramic X-ray revealed a good relation between the healthy contralateral and the reconstructed ipsilateral ramus. Postoperative mean mouth opening was 34.3 mm, with minimal midline deviation of 2.6 mm in occlusion. Mean follow-up was 51.7 months. The mean postoperative occlusal cant analysis for eight patients was 3.66°. Conclusion: CCG is useful in treating CFM Type III. The growth potential of the CCG makes it the ideal choice for children. The advantages of this graft are its biological compatibility, workability, functional adaptability, and minimal additional detriment to the patient. The use of a stereolithographic model preoperatively improved intraoperative precision by clearly displaying detailed anatomy of the patient undergoing craniofacial surgery. The surgeon can plan the length of the CCG before surgery and use the printed template while harvesting without waiting for the exact measurements to be provided by the facial surgical team.

Individuals with moderate-to-profound intellectual and developmental disabilities (IDD) are characterized by significant cognitive deficits, abnormal muscle tone, poor posture and balance, and inactive lifestyle. Increased oxidative stress (OS) has been implicated in a variety of chronic diseases, inflammatory conditions, aging, and even following intense physical exercise. Nitric oxide (NO) is a highly reactive mediator that has been shown to play different roles in a variety of different biological process and in aging. The aim of the study was to investigate the serum levels of global OS and NO metabolites (NOx) in sedentary and non-sedentary older adults with IDD. Global OS was measured by CR 3000 instrument, FORM system, and NOx were measured by determination of serum nitrite levels. OS and NOx levels were significantly higher in sedentary IDD comparing non-sedentary controls. The increased of OS and NOx levels suggest their possible involvement in the phenomenon of 'accelerated aging' in IDD. Our findings can provide another aspect indicating both OS and NOx as possible biochemical markers and their potential application in minimizing their negative influence through future therapeutic strategies.

Preorthodontic socket preservation after tooth extraction is intended to enhance favorable dentoalveolar ridge morphology and architecture, and facilitate orthodontic tooth movement (OTM) and extraction space closure. This 13-year-old skeletal Class II case presents a unique opportunity to evaluate and compare the OTM extraction space closure by means of a split-mouth analysis in a single patient. The comprehensive orthodontic-periodontal treatment included nonsimultaneous extraction of the bilateral periodontally compromised mandibular first molars and the eruption of bilateral impacted mandibular canines. While the right post-extraction space underwent a natural healing process, the left one was grafted using 4BONE BCH (hydroxyapatite β-tricalcium phosphate [HA-β-TCP], HA 60%, and β-TCP 40%). The 3-year multidisciplinary treatment approach resulted in Class I relationships on the right side and Class II on the left side, improved facial appearance, and dento-skeletal jaw relations...

Sustained mechanical forces applied to tissue are known to shape local immunity. In the oral mucosa, mechanical stress, either naturally induced by masticatory forces or externally via mechanical loading during orthodontic tooth movement (OTM), is translated, in part, by T cells to alveolar bone resorption. Nevertheless, despite being considered critical for OTM, depletion of CD4+ and CD8+ T cells is reported to have no impact on tooth movement, thus questioning the function of αβT cells in OTM-associated bone resorption. To further address the role of T cells in OTM, we first characterized the leukocytes residing in the periodontal ligament (PDL), the tissue of interest during OTM, and compared it to the neighboring gingiva. Unlike the gingiva, monocytes and neutrophils represent the major leukocytes of the PDL. These myeloid cells were also the main leukocytes in the PDL of germ-free mice, although at lower levels than SPF mice. T lymphocytes were more enriched in the gingiva than...

Maxillary hypoplasia is a common outcome in patients with cleft lip and palate after surgical and orthodontic interventions, and maxillary distraction osteogenesis has become a useful procedure for patients with extensive maxillary deformities. The aim of this study was to evaluate long term (two years) stability after maxillary advancement of more than 10mm by distraction osteogenesis in cleft patients using internal devices. We organised a retrospective study on 42 patients with cleft lip and palate using cephalometric analysis before and after maxillary distraction osteogenesis and evaluated them for 24 months. Postoperative measurements showed a marked advancement with an increase of 13.3mm and 10.8° in the length of the maxilla (Co-A) and SNA, respectively, including a shift from Angle class III to class I in dental relations. Follow-up observations showed preservation of maxillary length with a relapse of only 6.0 % (mean (SD) 0.8 (0.7) mm) and 10% relapse in SNA angle (mean (SD)1.1 (1.4) °) one year postoperatively and a negligible regression at the two years' follow up. This large-scale study shows stable results of skeletal advancement using distraction osteogenesis, indicating safe and reliable outcomes among patients with cleft lip and palate.

Background: Transverse maxillomandibular discrepancies are widespread. Treatment is comprised of orthodontic expansion in patients younger than 15 years or by surgically assisted rapid palatal expansion (SARPE) in skeletally mature patients where the possibility of successful orthodontic maxillary expansion decreases as sutures close and resistance to mechanical forces increases. Aim: To present our experience of treating transverse maxillary deficiency using a unique L-shaped osteotomy and to demonstrate stable results. Patients and Methods: 32 patients aged between 19 and 54 years exhibiting transverse maxillary deficiency. L-shaped osteotomy was performed laterally from the pterygoid plate posteriorly to above the roots of the second incisive anteriorly continuing with a vertical osteotomy between the lateral incisive and canine teeth toward the horizontal osteotomy. In 18 patients with dysgnathia, bimaxillary surgery was performed one year following the SARPE procedure. Results: Mean transverse maxillary expansion of 6.2mm at the canine incisal and 6.4mm at the first molar occlusal regions were obtained. One year postoperatively results were relatively stable, 5.8mm and 6.2mm respectively. The SARPE procedure resulted in overcoming the maxillary buttress resistance, expansion of the anterior dental arch and bilateral distraction creating bone on both sides of the premaxilla contributing to better alignment of the anterior teeth and superior stability. Conclusions: We conclude that SARPE is an effective and stable method for addressing severe maxillary transverse discrepancy in adults while the unique osteotomy performed allowed for maintaining proper position of the premaxilla and maxillary midline and allowing for division of the newly created bone bilaterally thus resulting in a more stable outcome.

Objectives: The aim of this investigation was to evaluate the epidemiological data on dental injuries in permanent teeth among seventh and tenth grade schoolchildren in the Republic of Moldova. Study design:The pathfinder study model was chosen to evaluate the prevalence of Traumatic Dental Injuries (TDI). Schoolchildren ages 12 and 15 years old were examined: In the capital city (four schools), in two other major cities–(two schools each city), and in four villages (one per each village) in accordance with the WHO's recommendations. Results: A total of 720 seventh and tenth grade schoolchildren were examined. The overall prevalence of TDI was found to be 16.4% (total of 118 children). The prevalence of TDI was greater in the older age cohort (p<0.05). Children from rural areas presented with greater prevalence of TDI compared to children who live in urban region (p<0.03). The maxillary central incisors were found to be the most common teeth affected by trauma constituting...

Intravenous sedation is an efficient method to facilitate dental treatment delivery to uncooperative children. Entropy is used for monitoring anesthetic depth. Nonetheless, scarce data is found on entropy monitoring in intellectually-disabled patients during sedation. This comparative study set out to evaluate entropy values of normal and intellectually-disabled patients during the steady state period of deep sedation and awakening. Additionally, the study aimed to establish whether normal and intellectually-disabled patients reached a comparable clinically assessed state of sedation and the doses of total anesthetic drugs administered. 30 patients were included in the study and divided into two groups: 16 normal and 14 intellectually-disabled children. Ages ranged between 2 to 16 years. All patients were assigned to receive dental treatment under intravenous sedation. Entropy tracings were recorded for all patients. Clinical sedation level was assessed every 5 minutes. Drug adminis...

Tooth gemination is often presented clinically and radiologically as merged crowns or “megadonts” with or without a longitudinal fissure, single root, and a single pulp chamber. The increased mesiodistal width of these teeth results in poor anterior aesthetics, anterior crowding, and incisor rotation. Our aim is to present a conservative non-extraction orthodontic approach that provides both good aesthetics and long-term stability. It aims to achieve extra space to incorporate the megadonts into the dental arch and to exceed “super” class I dental relationships. Accordingly, this study shows that geminated teeth were successfully retained by means of conservative non-extraction orthodontic mechanotherapy and without premolar extractions or enamel reduction. It demonstrated stability during a long-term 15-year follow-up, in addition to high patient satisfaction, good aesthetics, and periodontal health. The solution protocol is definitive and achieved the aesthetic, psychological, and...

BACKGROUND The effect of improvement in prenatal identification of cleft lip or palate (CL/P) on termination of pregnancy (TOP) worldwide is scarcely reported. Our aim was to assess changes in the prevalence of cleft palate attributed to the high access and availability of prenatal advanced screening and pregnancy termination in Israel. METHODS A retrospective study was conducted on CL/P patients which were treated in our institute and born between January 2000 and December 2018. Clinical and demographic data were extracted from medical records. Data on TOP were collected based on accessible information from the Ministry of Health. Cleft palate severity was evaluated using the Veau Classification. RESULTS The study was conducted on 258 patients. Higher incidence of Veau II and III was evident throughout the examined period (2000-2018). However, when evaluating the incidence per year, we found that the incidence of severe cases (Veau III and IV) decreased every year showing a major decline of 60% in the last decade, whereas mild cases (Veau type I and II) demonstrated a marked increase of 90%. Regarding the incidence of abortions in Israel, a decrease of 30% was observed in the last two decades, meanwhile a substantial increase was detected in the rate of abortions related to physical malformations of the fetus. Additionally, the number of late terminations due to physical malformations significantly increased in the last decade. CONCLUSIONS Significant decrease was observed in the incidence of severe cleft palate cases in the last decade. Concurrently, we found a substantial increase in percentage of abortions performed due to physical malformations. We suggest that these changes might be attributed to the accessibility of advanced prenatal screening and pregnancy termination in Israel under the social healthcare system.

Extracorporeal shockwaves are noninvasive mechanical forms of sound wave treatment. They were introduced in medical therapy approximately 30 years ago in order to disintegrate kidney stones. Over the last 15 years, extracorporeal generated shockwaves have been used in many fields of medicine due to their versatility and ability to stimulate healing processes by inducing neovascularization and differentiate stem cells into cells of the injured tissue to allow proper healing and regeneration.

OBJECTIVE An esthetic facial soft tissue profile is an important objective of contemporary orthodontics. The extent to which clinicians and the public agree on profiles that are esthetically acceptable versus profiles recommended for treatment is unclear. Thus, this work examined the profile considered esthetic by laypeople and general dental practitioners compared to orthodontists. METHOD AND MATERIALS An Israeli balanced male-female group comprising 284 participants (orthodontists [n = 86], general dental practitioners [n = 64], laypeople [n = 134]) rated the attractiveness of five standardized masculine and feminine profiles presented in standardized silhouettes ranging from concave to convex. RESULTS Laypeople see no esthetic difference between masculine and feminine profiles, and prefer moderately concave over moderately convex and severely concave over severely convex profiles. While all raters preferred the straight silhouettes, orthodontists rated them significantly higher t...

Beta Thalassemia (βT) patients present a unique facial appearance and specific craniofacial, jaw and dental patterns. Although this anomaly often requires orthodontic management, βT patients have received scant attention in the orthodontic and dental literature over the past 50 years. The aim of this article is to review the characteristic craniofacial and dental manifestation pattern of βT patients and to emphasize their preferred orthodontic management protocol by presenting a βT orthodontic treated patient. A 10 year old patient presented with a complaint of severe esthetic and functional disorders due to her diagnosis of βT. We initiated orthodontic treatment including a combined orthopedic and functional treatment modality to improve facial appearance. Maxillary restraint and increased mandibular size during treatment along with an increase in the vertical dimension were achieved. The patient presented with Angle class I molar relationship, with reduction of the excessive overj...

Motor vehicle accidents (MVA) and falls are major causes of maxillofacial injuries posing real challenges for the medical staff. To describe the demographic and injury characteristics, as well as the treatment procedures of casualties diagnosed with maxillofacial injuries. The investigators implemented a multicenter retrospective study composed of hospitalized maxillofacial trauma patients recorded in the Israel Trauma Registry for 2000 to 2011. The predictor variable was mechanism of injury and the outcome variable was type of injury, severity, and hospital resources utilization. Descriptive and bivariate statistics with P values was set at 0.05. The study included 11,592 reported hospitalized maxillofacial trauma patients (39.4% of them were MVA, 33.5% were falls), with a male predominance of a 3:1 ratio. The high-risk age groups were the first 3 decades of life in both etiologies, while age groups above 75 years were also frequent in falls. Severity of maxillofacial injuries, mul...

TO THE EDITOR: Kita H, Kochi S, Kamiya N, et al. Alveolar ridge notching as a predictor for secondary bone grafting in incomplete alveolar clefts. Cleft Palate Craniofac J. 2004;41:36–41. I read with interest the paper by Dr. Kita et al. (2004) dealing with the importance of predicting the need for alveolar bone grafting (ABG) in the edentulous stage of incomplete alveolar clefts. Dental development in cases of incomplete clefts has been described by a number of authors. The cases all can be related to initial disturbance and disruption of the embryonic process of dental lamina formation, most notably in the area of failed merging and fusion of the medial nasal, lateral nasal, and maxillary processes (Bøhn, 1950, 1963; Ross and Johnston, 1972; Ranta, 1986; Long, 1998). The clinical effects of these embryonic failures include missing teeth, supernumerary teeth, hypoplastic teeth, dysmorphic teeth, and impacted teeth (Bøhn, 1950, 1963; Jordan et al., 1966; Kraus et al., 1966; Ranta, 1986; Semb and Schwartz, 1997). The tooth most commonly affected is the lateral incisor. When the lateral incisor is present, it can appear on either side of the cleft in near-normal form, rudimentary form, or malformation, especially in cases in which there are supernumeraries on both sides of the cleft (Bøhn, 1950, 1963; Ross and Johnston, 1972). In recent research conducted at our institute, we found that hyperdontia of the lateral incisor is more prevalent in individuals with an isolated cleft lip (incomplete cleft with or without alveolar ridge notching) than in individuals with a complete cleft lip. This phenomenon greatly corresponds with the trend reported by Nagai et al. (1965), Berkowitz (1978), and Hansen and Mehdinia (2002), who also found the highest prevalence of supernumerary maxillary lateral incisors in isolated cleft lip cases. Hansen and Mehdinia (2002) found supernumerary lateral incisors on the cleft side in 73% of subjects with isolated cleft lip. We have found microdontia of the lateral incisors of the isolated cleft lip also, with a prevalence of 31.25%. These dental anomalies all have an impact on orthodontic and prosthetic treatment planning decisions from a functional, as well as an esthetic, point of view. These decisions include extracting the rudimentary lateral incisors of both cleft sides, preparing the lateral incisor area for dental implants or other prosthetic replacements versus closing the residual extraction space using the canine eruption process, and using conventional orthodontic treatments (Nordquist and McNeill, 1975; Verdi et al., 1991; Takahashi et al., 1997; Ramstad, 1998; Long et al., 2000). We agree with the finding of Dr. Kita et al. (2004) that most patients with alveolar ridge notching require ABG. Our criteria for ABG in such cases concur with the criteria mentioned in the article: inadequate bone width, height, and thickness to permit the eruption and maintenance of the permanent dentition. From our experience, any alveolar bone defect, even minor in incomplete cleft lip and palate, is sufficient to restrict orthodontic closure of the defect and to exclude prosthetic replacement. Therefore, the main and most important role of the ABG in incomplete clefts cases (with or without alveolar cleft notching) is related to orthodontic-prosthetic considerations. These considerations require a precise clinical, as well as a radiological, examination during adolescence, the ideal time for dental implantation and orthodontic treatment. Kearns et al. (1997) published the longest follow-up (3 years) case series of 14 dental implants to grafted cleft sites. These authors reported a 90% success rate of implants in grafted cleft alveolar ridges. Interestingly, all were late secondary grafts in the permanent dentition, and 6 of the 14 patients required augmentation grafts to provide adequate bone in the cleft site. Also noteworthy is the fact that the longer the time span between graft and implant placement, the more likely the need for augmentation. We believe that a computed tomography (CT) examination is sufficient to precisely locate the bone defect form, as mentioned by Santiago et al. (1998), particularly in incomplete alveolar clefts clinically identified by appearance. CT offers demonstrable benefits given the increased financial burden and x-ray dosage, compared with simple radiography. However, a CT examination in instances of incomplete cleft should be administered during late childhood when reevaluation of the grafted bone width, height, and thickness, as well as identification of an orthodontic-prosthetic treatment plan, is being contemplated, rather than during the edentulous stage of the newborn according to Kita et al. (2004). Under the present circumstances, the benefits can be considered as exceeding the costs and risks of CT examinations during late childhood, and most probably, this late CT examination will prevent recurrence at a later age. In conclusion, ABG for orthodontic…

The purpose of this study was to evaluate the developmental stage of teeth adjacent to the agenesis site in comparison to their antimeres. Panoramic views of 39 patients with unilateral dental agenesis and 42 normal controls were evaluated. The dental developmental stage (normal or delayed) of the teeth adjacent to the agenesis site was determined for each patient using the Haavikko's method, while the overall dental age was determined by Becker's method. No statistically significant difference was found in the developmental stage of teeth adjacent to the agenesis, compared to their antimere and to the same teeth in the normal control group. However, the prevalence of cases with no difference in development was almost double for the tooth distal to the agenesis site compared to the tooth mesial to the agenesis site in the hypodontia group (84.6% distal and 43.6% mesial; p < 0.001) and in the control group (83.3% distal and 52.4% mesial; p < 0.002). In most of the cases...

Objectives: Goldenhar syndrome (GS) includes several craniofacial anomalies of structures derived from first and second pharyngeal-arches, as well as additional vertebral, cardiac and renal system abnormalities. However, the involvement of oncologists with craniofacial patients is uncommon.The aim of this study is to present the first reported medulloblastoma in a patient with GS, to explore a possible general association between craniofacial disorders and cancer and to suggest possible clinical implications. Methods: A PubMed search was conducted from 1966 to 2013. Inclusive criteria were clinical studies, case-reports and reviews on the development of primary malignancies in GS. In addition, we performed a thorough investigation of the first reported case of medulloblastoma in a patient with GS. Results: Six cases of cancer associated with GS were reported in the literature (all males, ages: 1 month to 19 years old). No cases of meduloblastoma associated with GS were reported. We ...

Objective The purpose of the study was to determine the prevalence of congenitally missing teeth in a group of Israeli children with various types of clefts. Design Prevalence of congenitally missing teeth was determined for 179 children with cleft lip, cleft lip and alveolar ridge, cleft lip and palate, and cleft palate. Subgroupings were assessed according to patient sex, origin, cleft type, tooth type, and the side of hypodontia. The diagnosis of congenitally missing teeth (CMT) was based on initial and follow-up panoramic roentgenograms. In case of doubt, occlusal or periapical roentgenograms as well as clinical dental photographs were also used. Setting Data collection was conducted at the Rambam Medical Center, Orthodontic and Craniofacial Unit, Haifa, Israel. Results In the total cleft group, 67.6% of the patients presented with hypodontia, totaling 246 missing teeth. A statistically significant difference was found in the distribution of patients with CMT of Jewish and minor...