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Recent surveys of children have shown the use of general anaesthesia for extractions by GDPs has declined while its use in hospitals may actually have increased. Shaw and Weatherill argue the aim should be to reduce its use.
Timing of treatment is one of the main themes. The development of orthodontics in the United Kingdom is described against the background of a state-funded system. The scope and limitations of extraction therapy and removable appliance therapy are discussed. The principles of functional appliances are also described, as is the need for flexibility in appliance systems, to bring about maximum effect.
Absolute distal movement of upper first molars together with distal tipping, but no significant extrusion, occurred with cervical traction. Distal movement of the maxillary first molars was more stable in the group where maxillary 2nd molars had been extracted. With Andresen treatment a restraining effect took place on the upper molars, while mesial movement of the lower first molars contributed to correction of the molar relationship.
Successful treatment of the adult patient with an open bite dental or skeletal pattern often presents a difficult challenge. While the causes of open bite may be multifactorial in nature, there are specific diagnostic criteria that may allow for an orthodontic treatment modality incorporating extraction therapy with retraction of incisors. Two case presentations illustrate treatment of adult patients with open bites due to proclined incisors. The diagnostic criteria and mechanics for appropriate and successful treatment are discussed. Although the selection of extraction therapy for correction of anterior open bite has a narrow range of application in the overall scheme of open bite treatment, this treatment method has certain areas of application in which success may be anticipated.
We aimed to evaluate the reproducibility of the skin prick test performed with serial 1:4 dilutions of commercial standardized extracts in comparison with serum-specific IgE and the undiluted commercial extract. Twenty-four subjects sensitized to one (17 cases) or two (seven cases) inhalant allergens were selected and submitted to duplicate skin prick tests with concentrated commercial allergenic extracts or with serial 1:4 dilutions of the same extracts in two different examinations 7 days apart. Blood samples were obtained from 17 of the 24 patients for specific IgE determination. No statistically significant within-patient variations in the area of the wheal in skin prick tests done 1 week apart were found up to the eighth dilution (1:256) of the commercial allergen. On a patient-by-patient basis, only some dilutions showed a statistically significant correlation between allergen-specific IgE and the wheal area elicited by the same allergen, and a significant correlation was found between the wheal elicited by 10 mg/ml histamine and both the concentrated and diluted allergens (up to the sixth dilution). In polysensitized patients, the allergen producing the largest wheal when used in concentrated form did not produce the same result when diluted. The skin prick test with low-potency allergens was reproducible in individual patients even after a 7-day interval up to a 1:256 dilution of the commercial extract, although there was no clear correlation with allergen-specific IgE concentration. In polysensitized patients, the use of high-potency or low-potency allergens for skin prick tests can lead to different conclusions regarding the relative importance of each allergen.
This is a case report of a 21-year-old female with a Class II Division 1 malocclusion. The maxillary arch was constricted with an associated anterior open bite. The lower facial height was excessive, and the mandibular plane angle was high. The treatment options were limited due to a previously extracted mandibular right lateral incisor. The patient was successfully treated by a surgical rapid palatal expansion procedure, extraction of the mandibular left lateral incisor, extraction of the maxillary first premolars at the time of a 3-piece Lefort 1 maxillary osteotomy procedure, and a bilateral sagittal split osteotomy advancement procedure.
The primary objective of this study was to determine whether there was a significant difference in the degree of improvement after orthodontic treatment between a sample of First Nations orthodontic patients and a control sample of non-First Nations orthodontic patients. The secondary objective was to determine whether there was a difference in the severity of malocclusions being treated in a sample of the First Nations patients compared with a control sample of the non-First Nations patients. Several factors that might affect treatment outcome, such as missed appointments, treatment duration, oral hygiene, extractions, dental classification, and geographic location, were also studied. A sample of 60 First Nations patients and a control group of 60 non-First Nations patients between the 11 and 18 years of age who had been treated with full fixed orthodontic appliances were evaluated. The weighted peer assessment rating (PAR) index was applied to pretreatment and posttreatment study models to address the study's main objectives. The results showed that the First Nations group had greater PAR scores pretreatment than did the controls, and their weighted PAR scores improved more with treatment. Posttreatment PAR scores were similar between the 2 groups. In addition to First Nations status, only extractions and geographic location affected PAR improvement scores.
A case report of a Class II, Division 1 malocclusion with a deep overbite and severe overjet. The case was treated with the extraction of four first premolars and differential force mechanics. No adjuncts such as functional appliances, headgear, or surgery, were used. [This case was presented to the American Board of Orthodontics in partial fulfillment of the requirement for the certification process conducted by the Board.]
Thirty-four children with lower premolar crowding were treated by extraction of second molars. Thirteen cases had mechanical lower arch treatment started not less than 6 months after extractions. The remainder had no treatment in the lower arch. The change in premolar crowding was measured, and the reasons why spontaneous alignment occurred in some cases and not in others were examined.
AIM: The aims of the study were to evaluate 1) the uptake of general anaesthesia 2) the dental factors influencing use of general anaesthesia for routine orthodontic extractions. RESEARCH DESIGN: Retrospective cross-sectional. PARTICIPANTS: All patients, aged 16 years and under (n=145), currently undergoing orthodontic treatment at the University Dental Hospital of Manchester, who had received extractions, for their current course of treatment. METHOD: Patients were asked to complete a questionnaire after appliance adjustment. MAIN OUTCOME MEASURES: 1) type of anaesthesia received for the most recent orthodontic extractions 2) whether a choice of anaesthesia was given 3) number of permanent teeth removed for the current course of orthodontic treatment 4) previous experience of general anaesthesia. RESULTS: The response was 87%. Twenty-two per cent of patients received general anaesthesia, 64% local anaesthesia and 14% inhalation sedation. Sixty-five per cent of patients were not given a choice of anaesthesia for extractions. Stepwise logistic regression analysis revealed that a patient was more likely to receive a general anaesthetic if: 1) they had received a GA in the past (for fillings or extractions) 2) more than four teeth were extracted. CONCLUSIONS: Local anaesthesia was predominantly used for orthodontic extractions although the use of general anaesthesia was still quite high. The majority of patients were not given a choice of anaesthesia for routine extractions. Previous exposure to general anaesthesia and removal of more than four teeth increased the likelihood of a patient receiving general anaesthesia.
First and second molar extraction, in combination with orthodontic treatment, is well represented in the literature. The following cases document situations in which first or second molars were removed without the introduction of orthodontic forces. The results show space gain and good eruption of the replacing second and third molars.
The patient was a 9-year-old girl with a skeletal Class II malocclusion characterized by maxillary protrusion, excessive overjet and deep overbite. The patient's maxillary left central incisor was deeply impacted. During the first stage, a lingual arch was employed after surgical exposure. During the secondary stage, all four first premolar teeth were extracted and then edgewise mechanotherapy was performed. The total treatment time was 6 years. The malocclusion was treated satisfactorily and resulted in correction of the esthetic and functional flaws after 1 year out of retention.
Hypophosphatemic vitamin D-resistant rickets, when developed later in life, is less severe and may not be characterized by rickets or other osseous deformities. A Japanese girl, age nine years and one month, was first seen in the Dental Hospital of Osaka University, complaining of the crowding of the maxillary teeth. At one year of age, the patient was admitted to Osaka University Hospital for her leg deformities. Although the patient has been administered 4 micrograms 1 alpha/-hydroxyvitamin D3 and 1.0 g phosphorous daily, the serum phosphate has been low and never reached normal level. This case was a Class II division 2 malocclusion with severe anterior crowding and retarded mandibular growth. We treated her with a functional appliance (elastic open activator), followed by the extraction of four premolars and the use of an edgewise appliance. No unfavorable root resorption or bone defect occurred. Good occlusion was achieved and the facial features were pleasing.
Three serial isolates of Candida albicans were obtained by direct swab or by oral saline rinses from each of five human immunodeficiency virus-infected patients with recurrent oropharyngeal candidiasis. Genotyping techniques confirmed the presence of a persistent strain in multiple episodes from the same patient, which was different from the strains isolated from other patients. Fluconazole susceptibility was determined by both an agar dilution method and the National Committee for Clinical Laboratory Standards macrobroth procedure. In four of these patients the strains developed fluconazole resistance, and in one patient the strain remained susceptible. The different isolates were propagated as yeast cells on a synthetic medium, and their cell wall proteinaceous components were extracted by treatment with beta-mercaptoethanol. Protein and mannoprotein components present in the extracts were analyzed by electrophoresis, immunoblotting, and lectin-blotting techniques. The analysis showed a similar composition, with only minor qualitative and quantitative differences in the polypeptidic and antigenic patterns associated with the cell wall extracts from serial isolates from the same patient, as well as those from different strains isolated from different patients. Use of monospecific antibodies generated against two immunodominant antigens during candidiasis (enolase and the 58-kDa fibrinogen-binding mannoprotein) demonstrated their expression in all isolates tested. Overall, the antigenic makeup of C. albicans strains remained constant during the course of infection and was not affected by development of fluconazole resistance. In contrast to previous reports, the low degree of antigenic variability observed in this study may be due to the fact that the isolates were obtained from a highly homogeneous population of patients and to the uniformity in techniques used for the isolation, storage, and culture of the different strains, as well as extraction methodologies.
The effect of deciduous tooth extraction in the late mixed dentition on the eruption of succedaneous teeth was studied in ten Macaca nemestrina. Nineteen deciduous teeth were extracted: nine maxillary and ten mandibular left deciduous first molars. Regardless of sex, arch, chronologic or dental age, all first premolars on the experimental side erupted before those on the control side and this pattern was statistically significant. Extraction of deciduous molars in the late mixed dentition is seen to accelerate eruption of first premolars in Macaca nemestrina. This could be the result of eliminating the need for deciduous tooth root resorption during the normal process of eruption.
Current trends in orthodontic care emphasise alternatives to the extraction of premolars, despite a lack of support from the refereed literature for many of the non-extraction treatments. Anecdotal reports published in non peer-reviewed journals have called into question the aesthetic effects of extraction treatment. As calls for evidence-based treatments increase throughout dentistry, reports on the effects--both positive and negative--of different orthodontic options have appeared in growing numbers. Given the results of a variety of reports in the peer-reviewed literature, it may be concluded that orthodontic treatment involving extractions can produce improved aesthetics for many patients who have some combination of crowding and protrusion. However, careful diagnosis followed by evidence-based treatment decisions should be the accepted clinical norm as the specialty of Orthodontics embarks on its second century.
A four-unit symmetrical premolar extraction case demands meticulous levelling, overjet reduction, space closure, rotating, paralleling and torqueing to justify the gambit of having extracted the teeth at the commencement of treatment. This involves the patient in complex therapy which may, for any of several reasons, be contra-indicated for that particular patient, though a decision based on the plaster casts alone may have upheld such an approach. The purpose of this article is to discourage automatic decisions to extract first premolars in orthodontic extraction cases. The clinician is offered a classification of special cases in which an alternative should be sought, based on careful consideration of the general dental, facial, physical, psychological and economic state of the patient.
Contemporary orthodontic practice is diverse, both in the variety of clinical problems treated and in the methods used. Practices differ with respect to their patient composition as well as in many variables relative to treatment protocols. Such heterogeneity makes it difficult to make valid generalizations concerning the characteristics of orthodontic treatment procedures or outcomes; yet data and methods are required for assessment of issues of efficacy and utility. The frequency of orthodontic extractions is an objective criterion that distinguishes practices and may also be related to differences in treatment outcome variables, such as duration. Following a telephone survey to estimate extraction rates in the practices of 238 Michigan orthodontists, five practices with very high or low reported rates were chosen for this pilot study. Our primary aim was to determine whether a systematic relationship existed between the relative frequency of extraction treatments and the duration of active appliance therapy. Records of 438 patients from these practices were examined. The extraction rates of the practices ranged from a low of 25% to a high of 84%. Treatment duration was affected by several variables, such as the number of arches treated, the number of treatment phases, and the practice selected. When the data for all five practices were pooled, and all of the extraction versus nonextraction treatments were compared, the mean durations of treatment were 31.2 and 31.3 months, respectively. Data from individual practices, however, indicated that extraction treatment in each of the practices was of longer duration than nonextraction therapy. These differences in duration were 3.0, 6.6, 2.4, 3.0, and 7.3 months in the five practices.(ABSTRACT TRUNCATED AT 250 WORDS)