1 Ankylosis2 Ectopic eruption3 Premature loss of deciduous teeth4 Delayed eruption5 Primary failure of eruption6 Single tooth in crossbite7 Gingival recession8 Midline diastema9 Molar Incisor hypomineralization10 Late lower incisor crowding

Anatomical fusion of alveolar bone with tooth cementum

It can occur at any time during eruption either before or after the tooth emerges into the oral cavity

Mild The entire occlusal surface is located at least 1 mm below the occlusal plane and above the contact point of the adjacent non-ankylosed teeth

Moderate The entire occlusal surface is located below the contact point level but above the CEJ of adjacent tooth

Severe The entire occlusal surface is level with or below the CEJ of the adjacent tooth

1 Syndromic

2 Non-Syndromica Geneticb Traumac Infectiond Radiation and chemicalse Congenital absence of the second premolarf Idiopathicg Iatrogenic

Any tooth that reached the occlusal plane and subsequently dropped out of occlusion should be considered ankylosed

Mobility test

Percussion sound

radiographic examination if the area of ankylosis is of sufficient size

Computerized tomography (CT)

Failure of the tooth to move following the application of orthodontic forces is believed to be the definitive diagnostic test

In the presence of permanent successor

1 Exfoliate naturally

2 Restore the vertical dimension or extract the affected tooth with lingual or palatal arch to maintain the space if the infraocclusionbecomes greater

In the absence of a permanent successor or if the permanent tooth is severely displaced

1 Retention of the second deciduous molar2 Early extraction to facilitate spontaneous space

closure3 Premolaizing the E 4 Extraction and prosthetic replacement

It depends on whether the patient is growing or not

If he is a growing patient then extract ankylosed tooth to prevent bone deficiency in the area of ankylosis

If he is a non growing patient maintain the tooth as previously mentioned

If they survive to twenty years of age continued long-term function can be anticipated

1 Extraction of the ankylosed tooth followed by prosthetic replacement

2 Surgical luxation followed by periodontal ligament distraction

3 Osteotomy of the dentoalveolar segment with immediate repositioning of the dentoalveolar structures

4 Osteotomy followed by intraoral distraction

5 Osteotomy followed by heavy orthodontic forces

6 Osteotomy followed by a combination of dentoalveolar distraction and light orthodontic forces

7 Osteotomy followed by conventional orthodontic forces

8 Osteotomy with partial repositioning followed by heavy orthodontic forces

9 Lingual corticotomy of the dentoalveolar segment followed by a labial corticotomy three weeks later and a conventional orthodontic force

A condition in which the permanent teeth because of deficiency of growth in the jaw or segment of jaw assume a path of eruption that intercepts a primary tooth causes its premature loss and produces a consequent malposition of the permanent tooth

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Anatomical fusion of alveolar bone with tooth cementum

It can occur at any time during eruption either before or after the tooth emerges into the oral cavity

Mild The entire occlusal surface is located at least 1 mm below the occlusal plane and above the contact point of the adjacent non-ankylosed teeth

Moderate The entire occlusal surface is located below the contact point level but above the CEJ of adjacent tooth

Severe The entire occlusal surface is level with or below the CEJ of the adjacent tooth

1 Syndromic

2 Non-Syndromica Geneticb Traumac Infectiond Radiation and chemicalse Congenital absence of the second premolarf Idiopathicg Iatrogenic

Any tooth that reached the occlusal plane and subsequently dropped out of occlusion should be considered ankylosed

Mobility test

Percussion sound

radiographic examination if the area of ankylosis is of sufficient size

Computerized tomography (CT)

Failure of the tooth to move following the application of orthodontic forces is believed to be the definitive diagnostic test

In the presence of permanent successor

1 Exfoliate naturally

2 Restore the vertical dimension or extract the affected tooth with lingual or palatal arch to maintain the space if the infraocclusionbecomes greater

In the absence of a permanent successor or if the permanent tooth is severely displaced

1 Retention of the second deciduous molar2 Early extraction to facilitate spontaneous space

closure3 Premolaizing the E 4 Extraction and prosthetic replacement

It depends on whether the patient is growing or not

If he is a growing patient then extract ankylosed tooth to prevent bone deficiency in the area of ankylosis

If he is a non growing patient maintain the tooth as previously mentioned

If they survive to twenty years of age continued long-term function can be anticipated

1 Extraction of the ankylosed tooth followed by prosthetic replacement

2 Surgical luxation followed by periodontal ligament distraction

3 Osteotomy of the dentoalveolar segment with immediate repositioning of the dentoalveolar structures

4 Osteotomy followed by intraoral distraction

5 Osteotomy followed by heavy orthodontic forces

6 Osteotomy followed by a combination of dentoalveolar distraction and light orthodontic forces

7 Osteotomy followed by conventional orthodontic forces

8 Osteotomy with partial repositioning followed by heavy orthodontic forces

9 Lingual corticotomy of the dentoalveolar segment followed by a labial corticotomy three weeks later and a conventional orthodontic force

A condition in which the permanent teeth because of deficiency of growth in the jaw or segment of jaw assume a path of eruption that intercepts a primary tooth causes its premature loss and produces a consequent malposition of the permanent tooth

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Mild The entire occlusal surface is located at least 1 mm below the occlusal plane and above the contact point of the adjacent non-ankylosed teeth

Moderate The entire occlusal surface is located below the contact point level but above the CEJ of adjacent tooth

Severe The entire occlusal surface is level with or below the CEJ of the adjacent tooth

1 Syndromic

2 Non-Syndromica Geneticb Traumac Infectiond Radiation and chemicalse Congenital absence of the second premolarf Idiopathicg Iatrogenic

Any tooth that reached the occlusal plane and subsequently dropped out of occlusion should be considered ankylosed

Mobility test

Percussion sound

radiographic examination if the area of ankylosis is of sufficient size

Computerized tomography (CT)

Failure of the tooth to move following the application of orthodontic forces is believed to be the definitive diagnostic test

In the presence of permanent successor

1 Exfoliate naturally

2 Restore the vertical dimension or extract the affected tooth with lingual or palatal arch to maintain the space if the infraocclusionbecomes greater

In the absence of a permanent successor or if the permanent tooth is severely displaced

1 Retention of the second deciduous molar2 Early extraction to facilitate spontaneous space

closure3 Premolaizing the E 4 Extraction and prosthetic replacement

It depends on whether the patient is growing or not

If he is a growing patient then extract ankylosed tooth to prevent bone deficiency in the area of ankylosis

If he is a non growing patient maintain the tooth as previously mentioned

If they survive to twenty years of age continued long-term function can be anticipated

1 Extraction of the ankylosed tooth followed by prosthetic replacement

2 Surgical luxation followed by periodontal ligament distraction

3 Osteotomy of the dentoalveolar segment with immediate repositioning of the dentoalveolar structures

4 Osteotomy followed by intraoral distraction

5 Osteotomy followed by heavy orthodontic forces

6 Osteotomy followed by a combination of dentoalveolar distraction and light orthodontic forces

7 Osteotomy followed by conventional orthodontic forces

8 Osteotomy with partial repositioning followed by heavy orthodontic forces

9 Lingual corticotomy of the dentoalveolar segment followed by a labial corticotomy three weeks later and a conventional orthodontic force

A condition in which the permanent teeth because of deficiency of growth in the jaw or segment of jaw assume a path of eruption that intercepts a primary tooth causes its premature loss and produces a consequent malposition of the permanent tooth

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

1 Syndromic

2 Non-Syndromica Geneticb Traumac Infectiond Radiation and chemicalse Congenital absence of the second premolarf Idiopathicg Iatrogenic

Any tooth that reached the occlusal plane and subsequently dropped out of occlusion should be considered ankylosed

Mobility test

Percussion sound

radiographic examination if the area of ankylosis is of sufficient size

Computerized tomography (CT)

Failure of the tooth to move following the application of orthodontic forces is believed to be the definitive diagnostic test

In the presence of permanent successor

1 Exfoliate naturally

2 Restore the vertical dimension or extract the affected tooth with lingual or palatal arch to maintain the space if the infraocclusionbecomes greater

In the absence of a permanent successor or if the permanent tooth is severely displaced

1 Retention of the second deciduous molar2 Early extraction to facilitate spontaneous space

closure3 Premolaizing the E 4 Extraction and prosthetic replacement

It depends on whether the patient is growing or not

If he is a growing patient then extract ankylosed tooth to prevent bone deficiency in the area of ankylosis

If he is a non growing patient maintain the tooth as previously mentioned

If they survive to twenty years of age continued long-term function can be anticipated

1 Extraction of the ankylosed tooth followed by prosthetic replacement

2 Surgical luxation followed by periodontal ligament distraction

3 Osteotomy of the dentoalveolar segment with immediate repositioning of the dentoalveolar structures

4 Osteotomy followed by intraoral distraction

5 Osteotomy followed by heavy orthodontic forces

6 Osteotomy followed by a combination of dentoalveolar distraction and light orthodontic forces

7 Osteotomy followed by conventional orthodontic forces

8 Osteotomy with partial repositioning followed by heavy orthodontic forces

9 Lingual corticotomy of the dentoalveolar segment followed by a labial corticotomy three weeks later and a conventional orthodontic force

A condition in which the permanent teeth because of deficiency of growth in the jaw or segment of jaw assume a path of eruption that intercepts a primary tooth causes its premature loss and produces a consequent malposition of the permanent tooth

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Any tooth that reached the occlusal plane and subsequently dropped out of occlusion should be considered ankylosed

Mobility test

Percussion sound

radiographic examination if the area of ankylosis is of sufficient size

Computerized tomography (CT)

Failure of the tooth to move following the application of orthodontic forces is believed to be the definitive diagnostic test

In the presence of permanent successor

1 Exfoliate naturally

2 Restore the vertical dimension or extract the affected tooth with lingual or palatal arch to maintain the space if the infraocclusionbecomes greater

In the absence of a permanent successor or if the permanent tooth is severely displaced

1 Retention of the second deciduous molar2 Early extraction to facilitate spontaneous space

closure3 Premolaizing the E 4 Extraction and prosthetic replacement

It depends on whether the patient is growing or not

If he is a growing patient then extract ankylosed tooth to prevent bone deficiency in the area of ankylosis

If he is a non growing patient maintain the tooth as previously mentioned

If they survive to twenty years of age continued long-term function can be anticipated

1 Extraction of the ankylosed tooth followed by prosthetic replacement

2 Surgical luxation followed by periodontal ligament distraction

3 Osteotomy of the dentoalveolar segment with immediate repositioning of the dentoalveolar structures

4 Osteotomy followed by intraoral distraction

5 Osteotomy followed by heavy orthodontic forces

6 Osteotomy followed by a combination of dentoalveolar distraction and light orthodontic forces

7 Osteotomy followed by conventional orthodontic forces

8 Osteotomy with partial repositioning followed by heavy orthodontic forces

9 Lingual corticotomy of the dentoalveolar segment followed by a labial corticotomy three weeks later and a conventional orthodontic force

A condition in which the permanent teeth because of deficiency of growth in the jaw or segment of jaw assume a path of eruption that intercepts a primary tooth causes its premature loss and produces a consequent malposition of the permanent tooth

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

radiographic examination if the area of ankylosis is of sufficient size

Computerized tomography (CT)

Failure of the tooth to move following the application of orthodontic forces is believed to be the definitive diagnostic test

In the presence of permanent successor

1 Exfoliate naturally

2 Restore the vertical dimension or extract the affected tooth with lingual or palatal arch to maintain the space if the infraocclusionbecomes greater

In the absence of a permanent successor or if the permanent tooth is severely displaced

1 Retention of the second deciduous molar2 Early extraction to facilitate spontaneous space

closure3 Premolaizing the E 4 Extraction and prosthetic replacement

It depends on whether the patient is growing or not

If he is a growing patient then extract ankylosed tooth to prevent bone deficiency in the area of ankylosis

If he is a non growing patient maintain the tooth as previously mentioned

If they survive to twenty years of age continued long-term function can be anticipated

1 Extraction of the ankylosed tooth followed by prosthetic replacement

2 Surgical luxation followed by periodontal ligament distraction

3 Osteotomy of the dentoalveolar segment with immediate repositioning of the dentoalveolar structures

4 Osteotomy followed by intraoral distraction

5 Osteotomy followed by heavy orthodontic forces

6 Osteotomy followed by a combination of dentoalveolar distraction and light orthodontic forces

7 Osteotomy followed by conventional orthodontic forces

8 Osteotomy with partial repositioning followed by heavy orthodontic forces

9 Lingual corticotomy of the dentoalveolar segment followed by a labial corticotomy three weeks later and a conventional orthodontic force

A condition in which the permanent teeth because of deficiency of growth in the jaw or segment of jaw assume a path of eruption that intercepts a primary tooth causes its premature loss and produces a consequent malposition of the permanent tooth

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Computerized tomography (CT)

Failure of the tooth to move following the application of orthodontic forces is believed to be the definitive diagnostic test

In the presence of permanent successor

1 Exfoliate naturally

2 Restore the vertical dimension or extract the affected tooth with lingual or palatal arch to maintain the space if the infraocclusionbecomes greater

In the absence of a permanent successor or if the permanent tooth is severely displaced

1 Retention of the second deciduous molar2 Early extraction to facilitate spontaneous space

closure3 Premolaizing the E 4 Extraction and prosthetic replacement

It depends on whether the patient is growing or not

If he is a growing patient then extract ankylosed tooth to prevent bone deficiency in the area of ankylosis

If he is a non growing patient maintain the tooth as previously mentioned

If they survive to twenty years of age continued long-term function can be anticipated

1 Extraction of the ankylosed tooth followed by prosthetic replacement

2 Surgical luxation followed by periodontal ligament distraction

3 Osteotomy of the dentoalveolar segment with immediate repositioning of the dentoalveolar structures

4 Osteotomy followed by intraoral distraction

5 Osteotomy followed by heavy orthodontic forces

6 Osteotomy followed by a combination of dentoalveolar distraction and light orthodontic forces

7 Osteotomy followed by conventional orthodontic forces

8 Osteotomy with partial repositioning followed by heavy orthodontic forces

9 Lingual corticotomy of the dentoalveolar segment followed by a labial corticotomy three weeks later and a conventional orthodontic force

A condition in which the permanent teeth because of deficiency of growth in the jaw or segment of jaw assume a path of eruption that intercepts a primary tooth causes its premature loss and produces a consequent malposition of the permanent tooth

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

In the presence of permanent successor

1 Exfoliate naturally

2 Restore the vertical dimension or extract the affected tooth with lingual or palatal arch to maintain the space if the infraocclusionbecomes greater

In the absence of a permanent successor or if the permanent tooth is severely displaced

1 Retention of the second deciduous molar2 Early extraction to facilitate spontaneous space

closure3 Premolaizing the E 4 Extraction and prosthetic replacement

It depends on whether the patient is growing or not

If he is a growing patient then extract ankylosed tooth to prevent bone deficiency in the area of ankylosis

If he is a non growing patient maintain the tooth as previously mentioned

If they survive to twenty years of age continued long-term function can be anticipated

1 Extraction of the ankylosed tooth followed by prosthetic replacement

2 Surgical luxation followed by periodontal ligament distraction

3 Osteotomy of the dentoalveolar segment with immediate repositioning of the dentoalveolar structures

4 Osteotomy followed by intraoral distraction

5 Osteotomy followed by heavy orthodontic forces

6 Osteotomy followed by a combination of dentoalveolar distraction and light orthodontic forces

7 Osteotomy followed by conventional orthodontic forces

8 Osteotomy with partial repositioning followed by heavy orthodontic forces

9 Lingual corticotomy of the dentoalveolar segment followed by a labial corticotomy three weeks later and a conventional orthodontic force

A condition in which the permanent teeth because of deficiency of growth in the jaw or segment of jaw assume a path of eruption that intercepts a primary tooth causes its premature loss and produces a consequent malposition of the permanent tooth

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

In the absence of a permanent successor or if the permanent tooth is severely displaced

1 Retention of the second deciduous molar2 Early extraction to facilitate spontaneous space

closure3 Premolaizing the E 4 Extraction and prosthetic replacement

It depends on whether the patient is growing or not

If he is a growing patient then extract ankylosed tooth to prevent bone deficiency in the area of ankylosis

If he is a non growing patient maintain the tooth as previously mentioned

If they survive to twenty years of age continued long-term function can be anticipated

1 Extraction of the ankylosed tooth followed by prosthetic replacement

2 Surgical luxation followed by periodontal ligament distraction

3 Osteotomy of the dentoalveolar segment with immediate repositioning of the dentoalveolar structures

4 Osteotomy followed by intraoral distraction

5 Osteotomy followed by heavy orthodontic forces

6 Osteotomy followed by a combination of dentoalveolar distraction and light orthodontic forces

7 Osteotomy followed by conventional orthodontic forces

8 Osteotomy with partial repositioning followed by heavy orthodontic forces

9 Lingual corticotomy of the dentoalveolar segment followed by a labial corticotomy three weeks later and a conventional orthodontic force

A condition in which the permanent teeth because of deficiency of growth in the jaw or segment of jaw assume a path of eruption that intercepts a primary tooth causes its premature loss and produces a consequent malposition of the permanent tooth

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

It depends on whether the patient is growing or not

If he is a growing patient then extract ankylosed tooth to prevent bone deficiency in the area of ankylosis

If he is a non growing patient maintain the tooth as previously mentioned

If they survive to twenty years of age continued long-term function can be anticipated

1 Extraction of the ankylosed tooth followed by prosthetic replacement

2 Surgical luxation followed by periodontal ligament distraction

3 Osteotomy of the dentoalveolar segment with immediate repositioning of the dentoalveolar structures

4 Osteotomy followed by intraoral distraction

5 Osteotomy followed by heavy orthodontic forces

6 Osteotomy followed by a combination of dentoalveolar distraction and light orthodontic forces

7 Osteotomy followed by conventional orthodontic forces

8 Osteotomy with partial repositioning followed by heavy orthodontic forces

9 Lingual corticotomy of the dentoalveolar segment followed by a labial corticotomy three weeks later and a conventional orthodontic force

A condition in which the permanent teeth because of deficiency of growth in the jaw or segment of jaw assume a path of eruption that intercepts a primary tooth causes its premature loss and produces a consequent malposition of the permanent tooth

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

If they survive to twenty years of age continued long-term function can be anticipated

1 Extraction of the ankylosed tooth followed by prosthetic replacement

2 Surgical luxation followed by periodontal ligament distraction

3 Osteotomy of the dentoalveolar segment with immediate repositioning of the dentoalveolar structures

4 Osteotomy followed by intraoral distraction

5 Osteotomy followed by heavy orthodontic forces

6 Osteotomy followed by a combination of dentoalveolar distraction and light orthodontic forces

7 Osteotomy followed by conventional orthodontic forces

8 Osteotomy with partial repositioning followed by heavy orthodontic forces

9 Lingual corticotomy of the dentoalveolar segment followed by a labial corticotomy three weeks later and a conventional orthodontic force

A condition in which the permanent teeth because of deficiency of growth in the jaw or segment of jaw assume a path of eruption that intercepts a primary tooth causes its premature loss and produces a consequent malposition of the permanent tooth

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

1 Extraction of the ankylosed tooth followed by prosthetic replacement

2 Surgical luxation followed by periodontal ligament distraction

3 Osteotomy of the dentoalveolar segment with immediate repositioning of the dentoalveolar structures

4 Osteotomy followed by intraoral distraction

5 Osteotomy followed by heavy orthodontic forces

6 Osteotomy followed by a combination of dentoalveolar distraction and light orthodontic forces

7 Osteotomy followed by conventional orthodontic forces

8 Osteotomy with partial repositioning followed by heavy orthodontic forces

9 Lingual corticotomy of the dentoalveolar segment followed by a labial corticotomy three weeks later and a conventional orthodontic force

A condition in which the permanent teeth because of deficiency of growth in the jaw or segment of jaw assume a path of eruption that intercepts a primary tooth causes its premature loss and produces a consequent malposition of the permanent tooth

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

5 Osteotomy followed by heavy orthodontic forces

6 Osteotomy followed by a combination of dentoalveolar distraction and light orthodontic forces

7 Osteotomy followed by conventional orthodontic forces

8 Osteotomy with partial repositioning followed by heavy orthodontic forces

9 Lingual corticotomy of the dentoalveolar segment followed by a labial corticotomy three weeks later and a conventional orthodontic force

A condition in which the permanent teeth because of deficiency of growth in the jaw or segment of jaw assume a path of eruption that intercepts a primary tooth causes its premature loss and produces a consequent malposition of the permanent tooth

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

A condition in which the permanent teeth because of deficiency of growth in the jaw or segment of jaw assume a path of eruption that intercepts a primary tooth causes its premature loss and produces a consequent malposition of the permanent tooth

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Grade I Mild ndash limited resorption to cementum or with minimum dentin penetration

Grade II Moderate ndash resorption of the dentin without pulp exposition

Grade III Severe ndash resorption of the distal root leading to pulp exposure

Grade IV Very severe ndash resorption that affects the mesial root of the primary second molar

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

If angle is from 15-30˚ of ectopic molar then good prognosis of eruption

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

1 Genetic2 Associated with developmental disorders (ectopic

canines)3 Increased mesial-distal width of 64 Increased mesial eruption angle of 65 Delayed calcification of the effected molars 6 Small maxilla

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Eruption path where distal cusps emerge before mesial cusps

Unilateral or bilateral delay in emergence of 6 Bulbos E and small jaw Mobility of E Neuralgia at area of 6 Diagnosis confirmed by dental radiographs

(superimposition and impaction against distobuccal root of deciduous tooth)

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

80 self-correct by age 7yrs while 10 self-correct at age 8 or 9yrs

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

If resorption of E lt15mm

observe 3-6months (to establish if reversible)

if no resorption and vertical position improved

monitor eruption

if no resorption and vertical position not improved

expose unerupted 6 and wait for 3 months

if still not improving treatment to move the impacted tooth distally

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

If resorption of E gt15mm

bull If E symptomatic or mobility gt1mm consider extraction and management of space problem once 6 erupts

If E asymptomatic and mobility lt1mm and 6 partially erupted

treatment to move the impacted tooth distally

If E asymptomatic and mobility lt1mm and 6 unerupted

expose 6 and commence treatment to move the impacted tooth distally

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

6 is partially erupted

Brass wire ligature

Elastomeric

Halterman appliance

Humphrey appliance

Steel spring clip separators

Orthodontic band on the E and a bonded bracket on the exposed cusp of 6 with an open coil spring

6 is unerupted Surgically expose and try above techniques or distal extension attached

to SS crown

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Orthodontic band on E with attached distal spring +- transpalatal arch when maximal anchorage required (Halterman appliance)

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

A bonded button is placed on the first permanent molar at the same time the appliance is cemented on the second primary molar The free arm engages on the mesial side of the button using reciprocal anchorage to distalize the permanent molar

Activation at 3 to 4-week intervals is made with three-prong pliers until overcorrection occurs

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Extent of it depends upon the degree of crowding the patientrsquos age and the site

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Local factors1 Trauma2 Periapical pathology3 Periodontal problem4 Caries

General factors1 Congenital disease fibrous dysplasia 2 Nutritional vitamin D deficiency3 Endocrine diabetes 4 Genetic disease hypophosphatemia or Ehler Danlos

syndrome5 Tumour6 Iatrogenic

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

1 Stage of eruption of successors 2 Which tooth space loss greater for E`s than D`s

by mesial drift of permanent teeth3 rate of space closure is greater in maxilla than

mandible4 Amount of crowding greater space loss in

crowded dentitions5 Occlusal interlocks

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Radiographic screening

To make sure permanent is present

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Loss of primary incisors ndash Early loss of primary incisors has little effect It is not necessary to balance or compensate the loss of a primary incisor

Loss of primary caninesndash In all but spaced dentitions is likely to have most effect on centre lines The more crowded the dentition the more the need for balance

Loss of primary first molars ndash Balancing extraction may be needed in a crowded arch but compensation is not needed

Loss of primary second molars ndash There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence However when a primary second molar has to be extracted consideration should be given to fitting a space maintainer

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Eruption time is defined either by chronological age (Expected tooth eruption time )or biological age (indicated by progression of root development)

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

When teeth do not erupt at the expected age (mean 2 SD)

A disruption in the normal sequence of eruption

An asymmetry in eruption pattern between contra lateral teeth If a tooth on one side of the arch has erupted and 6 months later there is still no sign of itrsquos equivalent on the other side (radiographic examination is indicated)

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Generalized Localized

Hereditary gingival fibromatosis Congenital absence

Downrsquos syndrome Crowding

Cleidocranial dysplasia Delayed exfoliation of primary predecessor

Cleft lip and palate Supernumerary

Rickets Dilaceration

Abnormal position of cyst

Primary failure of eruption

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

if root formation is not complete in permanent follow up of root development by periodic radiographic examination

If the tooth is lagging in its eruption status active treatment is recommended

Obstruction must be removed ( soft tissue or dental)

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

If self-correction is not observed over time active treatment should begin Exposureaccompanied by orthodontic traction has been shown to be successful when more than 23 of the root has developed

If ectopic teeth deviate more than 90deg from the normal eruptive path autotransplantationmight be an effective alternative

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

non syndromic eruption failure of permanent teeth in the absence of mechanical obstruction with no obvious localsystemic causative factor

Teeth distal to affected tooth also involved

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Complete failure of tooth eruption (primary retention)

Initial eruption prior to the eruption failure (secondary retention)

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Rare condition of unknown aetiology

Significant genetic influence suggested (PTH1 gene)

Commonly family history

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Effect on vertical facial growth the bite distal to the first affected tooth is usually open

Permanent teeth may become ankylosed

Diagnosis often made retrospectively and orthodontic extrusion is unsuccessful

May be associated with infra-occluded deciduous teeth in particular Es

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

No orthodontic solution will tend to intrude the rest of options dentition

Consider restorative options eg Crown build-ups

May consider segmental osteotomy

Extraction

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Dental malocclusion resulting from the abnormal axial inclination of one or more maxillary teeth

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Depends on

1 Adequate space to reposition the tooth in the arch

2 Sufficient overbite to hold the tooth in position following correction

3 An apical position of the tooth in cross bite that is the same as it would be if the tooth was in normal occlusion

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Tongue blade therapyInclined planes

Reverse stainless steel crown

Removable appliance

Fixed appliance

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

The ldquoreverserdquo stainless steel crown

Two disadvantages 1 Unsightly silver

appearance of the crown form

2 The limitations of working with an inclined slope that is already formed

Both problems can be avoided by using a bonded resin-based composite custom formed inclined slope

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Millerrsquos classification

Millerrsquos classification

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

1 Plaque 2 Position of the tooth3 Vigorous tooth brushing4 Traumatic occlusion5 Prominent frenum6 Thin marginal gingiva 7 Alveolar plate is thin8 Orthodontic movement (position the tooth labially)

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

1 Maintain good oral hygiene throughout orthodontic treatment

2 Eliminate potential causes of recession3 Avoid uncontrolled dento-alveolar expansion and maintain

arch form by extraction or IDS4 Modify tooth anatomy whenever indicated5 in lower incisor crowding consider segment arch mechanics

and create space before using it and use it wisely6 Consider atypical extractions of severly involved tooth7 Avoid jiggling because it may cause periodontal problems8 Treat early9 Gingival grafting before orthodontic treatment

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

1 Thorough instructions on plaque control should be provided

2 Free gingival graft before orthodontic treatment

3 Modified coronally advanced tunnel flap approach

4 envelope technique with connective tissue graft

5 The laterally positioned flap with or without connective tissue graft

6 A frenectomy can also be considered

7 The gingiva is attached to the supracrestal portion of the root so that lingual movement of the incisor will result in a labial increase in gingival height

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

1 Normal development in the deciduous dentition2 Ugly duckling stage before the eruption of the permanent canines3 Abnormal frenal attachments4 Microdontia (peg-lateral incisors)5 Presence of a supernumerary 6 Abnormal shape or crown-root angulation of the centrals7 Congenitally missing teeth8 Abnormal pressure habits (tongue thrust digit sucking9 Trauma leading to tooth loss in the incisor region10 Hereditary amp Racial predisposition Negros11 Pathological migration of the anterior maxilla teeth (rarely)12 during RME13 Iatrogenic

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Direct visualization

Blanching in the region of the frenum can occur when tension is applied by lifting the upper lip

A spade-shaped or notched intermaxillary segment can be visible on radiographic examination

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Depends primarily upon the removal of the underlying cause

In the deciduous dentition no treatment

In mixed dentition reassurance

In permanent dentition aesthetic build-up of the centrals

Active orthodontic treatment to close a diastema is usually carried out in the permanent dentition using fixed appliance

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Long-term retention is usually mandatory

Adjunctive procedure like frenectomy

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Hypomineralization of systemic origin that affects one to all of the first permanent molars and is often associated with affected permanent incisors

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

The etiology of MIH still remains unclear

Environmental conditions

Respiratory tract infections Perinatal complications Oxygen starvation and low birth weight Calcium and phosphate metabolic disorders Childhood diseases Antibiotics Prolonged breast feeding

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Primary teeth are not affected

The remaining permanent dentition is usually not affected

One two three or four permanent first molars affected

Whiteyellowbrown opacities well demarcated compared to normal enamel

The lesions on the incisors are usually not as extensive as those in the molars and present mainly a cosmetic problem

The risk of defects to the incisors appears to increase when more first permanent molars have been affected

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Behavioural avoidance of erosive diet

Preventive

Applying desensitizing agent in combination with fluoride varnish applications could be of some help in decreasing sensitivity

Fissure sealant

Restorative requirements

Extraction combined with orthodontic treatment should be considered as an alternative treatment especially if the molars have a poor longterm prospect The optimal time for extraction is indicated by the calcification of the bifurcation of the roots of the lower second permanent molar

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Begins between the ages of 17 and mid-twenties and progressing through into late adult life is common

Approximately 23 of adolescents with good alignment and ldquonormalrdquo occlusions will develop incisor irregularity be early adulthood

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

1 Lack of attrition2 Soft tissue maturation late mandibular growth changes

may bring the lower incisors into a different soft tissue 3 Late anterior growth and mandibular remodelling4 Anterior component of occlusal forces 5 Mesial vectors of muscular contraction6 Degenerative periodontal changes allowing teeth to drift

under light pressures7 Mesial drift of posterior teeth by trans-septal fibres8 Tooth size and shape which can result in contact point

displacement 9 The mandibular third molar Mandibular third molarsndash

presence and position

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Ades at al (1990) 4 study groups all a minimum of 10 years post retention (Washington group) ( Absent 8s Impacted 8s Erupted and functional Extracted at least 10 years before post retention records)

No significant differences in mandibular growth or LLS crowding between any of the subgroups

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

Accept

Prophylactic measurement IPS as prophylactic measure had been described by Peck and Peck

Permanent retainer

In the presence of significant malocclusion incisor crowding is best managed as part of a comprehensive orthodontic treatment plan either by IPS extraction or proclination with permanent retention

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

The work of Little and others has shown that although larger lower incisor changes in position are less stable lower incisor alignment tends to deteriorate after retention whether or not the lower incisor position has been maintained Rowland 2008 found PFR is more efficient in a maintaining the LLS position post orthodontic treatment

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol

1 Gingival recession State of the science on controversial topics orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting)Ama Johal Christos Katsaros Stavros Kiliardis Pedro Leito Marco Rosa Anton Sculean Frank Weiland and Bjoumlrn Zachrisson

2 Tooth ankylosis Orthodontic implications P PANOS Postgraduate Student Department of Orthodontics School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece

3 Ectopic eruption - A review and case report Syed Mohammed Yaseen Saraswati Naik1 and K S UloopiContemp Clin Dent 2011 Jan-Mar 2(1) 3ndash7 doi 1041030976-237X79289 PMCID PMC3220171

4 Single tooth in crossbite Bonded compomer slope for anterior tooth crossbite correction Theodore P Croll DDS William H Lieberman DDS Dr Croll is in private practice in Doylestown Pennsylvania and clinical professor Department of Pediatric Dentistry University of Pennsylvania School of Dental Medicine Dr Lieberman is in private practice in Redbank NJ and coordinator of continuing education at Monmouth Medical Center in Monmouth New Jersey

5 Rapid correction of a simple one-tooth anterior cross bite due to an over-retained primary incisor clinical report Susan A McEvoy DMD MS

6 Delayed tooth eruption Pathogenesis diagnosis and treatment A literature review Lokesh Suri BDS DMD MSa Eleni Gagari DDS DMScb and Heleni Vastardis DDS DMScc Boston Mass

7 Judgement criteria for Molar Incisor Hypomineralisation (MIH) in epidemiologic studies a summary of the European meeting on MIH held in Athens 2003 KL WEERHEIJM1 M DUGGAL2 I MEJAgraveRE3 L PAPAGIANNOULIS4 G KOCH5 LC MARTENS6 A-L HALLONSTEN

8 Primary eruption failure A review Vijesh Prashanth Kamath Arun Kumar BR Rajat Scindhia Raghuraj MB9 A long-term study of the relationship of third molars to changes in the mandibular dental arch10 Author links open overlay panelDDS MSDAmin GAdesa12DDS MSDonald RJoondephb12DDS MSD PhDRobert

MLittlec12PhDMichael KChapkod12

11 Contemporary Orthodontics 5th EditionBy William R Proffit DDS PhD Henry W Fields Jr DDS MS MSD and David M Sarver DMD MS

12 An Introduction to Orthodontics PDF by Laura Mitchell13 Postgraduate Notes in Orthodontics (7th Edition) for DDS and MOrth programmes from the University of Bristol