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PubMed1988

[Tight calcified aortic valve stenosis in adults aged from 50 to 69. Anatomical study of 50 cases].

The results of anatomical examination in fifty patients aged from 50 to 69 years presenting with calcified and tight aortic stenosis are reported. The calcifications were located mostly on the aortic side of the valves, and the aortic orifice area was less than 1 cm2. The macroscopic features of the aortic valve system fell into three categories: bicuspid valve in 28 patients (21 men, 7 women), trivalve orifice with commissural adhesion (calcified in every case) in 21 patients (18 men, 3 women), and trivalve orifice without commissural adhesion in 1 patient (a 68-year old man). Male predominance was obvious (40/50; 80 p. cent). From an analysis of the various anatomical data recorded three differences emerged: the aortic annulus was wider in cases with bicuspid valve (P less than 0.01); the calcifications did not involve the free border of the valves in cases with bicuspid valve or trivalve orifice without commissural adhesion, but they involved this free border in 1 out of 2 cases with trivalve orifice and commissural adhesion; the aortic stenosis was minimal to moderate in all cases with trivalve orifice and commissural adhesion. In patients of that age group, the main cause of stenosis was bicuspid valve which seemed to be congenital in all cases. Dilatation with the finger through the left ventricle - which cannot by any means be assimilated to inflation of a balloon passed into the aortic orifice - resulted in significant opening of the aortic orifice by compression and/or disruption of the calcareous formations in patients with bicuspid valve.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1996

[Correlation between aortic transvalvular gradient obtained with Doppler ultrasonography and with hemodynamics study. Role of the underlying etiology].

In aortic stenosis, a good correlation was found between the gradients obtained by catheterization and Echo-Doppler. However, the correlation of these two methods in subgroups of patients with different etiologies of aortic stenosis is unknown. The aim of this study was to evaluate, whether the correlation between catheterization and Echo-Doppler was similar in patients with different etiologies of aortic stenosis. Patients with concomitant valvular disease were excluded. Only patients with a clearly defined etiology (based on clinical history, echocardiography, angiography and/or pathology) were included in this study. We evaluated 106 patients with aortic stenosis. Forty-nine patients had degenerative aortic stenosis, 32 bicuspid aortic stenosis and 25 rheumatic aortic stenosis. The percentage of male patients in each group were as follows: 57.1% in the denerative aortic group; 62.5% in the bicuspid aortic stenosis group; and 76% in the rheumatic aortic stenosis group. Mean age (years) was 69 +/- 6.7 in the degenerative aortic stenosis group, 58.1 +/- 7.5 in the bicuspid aortic stenosis group, and 64 +/- 7.1 in the rheumatic aortic stenosis group. In our study we found different correlations between the gradients obtained by the two methods-catheterization and Eco-Doppler-among the patients with different etiologies of aortic stenosis. The correlation coefficient (r2) was 0.54 (p < 0.001) in the rheumatic aortic stenosis group, 0.37 (p < 0.001) in the bicuspid aortic stenosis group and 0.21 (p = 0.001) in the degenerative aortic stenosis group. In conclusion, a good overall correlation was found between the two methods in aortic stenosis, however, this correlation is different in the three etiologies of aortic stenosis. The correlation is better in rheumatic valves, intermediate in bicuspid valves, and worse in degenerative valves. Changes in aortic valve morphology in these subgroups of patients are probably responsible for these different results.

Aged↗
PubMed2006

Novel MSX1 frameshift causes autosomal-dominant oligodontia.

Can kindreds with tooth agenesis caused by MSX1 or PAX9 mutations be distinguished by their phenotypes? We have identified an MSX1second bicuspids and mandibular central incisors. The dominant phenotype is apparently due to haploinsufficiency. We analyzed patterns of partial tooth agenesis in seven kindreds with defined MSX1 mutations and ten kindreds with defined PAX9 mutations. The probability of missing a particular type of tooth is always bilaterally symmetrical, but differences exist between the maxilla and mandible. MSX1-associated oligodontia typically includes missing maxillary and mandibular second bicuspids and maxillary first bicuspids. The most distinguishing feature of MSX1-associated oligodontia is the frequent (75%) absence of maxillary first bicuspids, while the most distinguishing feature of PAX9-associated oligodontia is the frequent (> 80%) absence of the maxillary and mandibular second molars.

Anodontia↗
PubMed2001

Root trunk concavities as a risk factor for regenerative procedures of class II furcation lesions in dogs.

BACKGROUND: The purpose of this study was to evaluate the influence of root trunk concavities on guided tissue regeneration. METHODS: The second, third, and fourth mandibular bicuspids of 4 healthy mongrel dogs were used. Full flaps were elevated and furcation lesions (5 mm in height and 2 mm in depth) were surgically created. One mm deep concavities were prepared on the root trunks and part of the crown of all teeth. The second bicuspids remained as controls (C); the left third and fourth bicuspids received normal expanded polytetrafluoroethylene (ePTFE) membranes (NM) and the right bicuspids received modified ePTFE membranes (MM). The MM were made by removing the collar from an NM, cutting it into 2 mm segments, and suturing each of the segments to the collar of each MM. Normal and modified membranes were sutured to their corresponding teeth and the flaps sutured. After the healing period, the mandibles were removed and the teeth processed for histomorphometry. RESULTS: The results showed that the junctional epithelium measured a mean of 0.71 mm for C, 0.64 mm for NM, and 0.14 mm for MM. The differences between C and MM and between NM and MM were both statistically significant at the 5% level (Kruskal-Wallis test). Mean bone height measurements for the buccal surfaces from the furcation roofs were 2.79 mm for C, 2.60 mm for NM, and 1.06 mm for MM and for the mid-portion 1.10 mm for C, 1.23 mm for NM, and 0.30 mm for MM. Differences were statistically significant at the 1% level between C and MM and between NM and MM for the buccal measurements, and at the 5% level between NM and MM for the mid-portion measurements. CONCLUSIONS: Root trunk concavities are important risk factors for regenerative procedures. The collars of the membranes should be modified to improve results when concavities are present.

Alveolar Process↗
PubMed1991

Marginal ridge strength in Class II tunnel restorations.

This in vitro study evaluated the compressive fracture resistance of marginal ridges of teeth with Class II tunnel preparations. Tunnel preparations were completed in extracted human bicuspid and molar teeth (bicuspids, bur size: #2, #4, #6; molars, bur size: #4, #6, #8). Control teeth in both the molar and bicuspid groups remained unprepared. Half the preparations in each group were restored with a glass ionomer cermet. After thermocycling, each marginal ridge was loaded in compression in an Instron Universal testing machine. Fracture values were compared with a two-factor ANOVA. A Dunnet post hoc test was used to compare the strength of each group to its control. Results indicated that up to a certain size, tunnel preparations could be completed without diminishing the strength of the undermined marginal ridges. Placement of a glass-ionomer cermet in the tunnel preparations restored the strength of all but the largest preparations (#6 bur in the bicuspid group) to a level which was not statistically significantly different from the controls.

Bicuspid↗
PubMed2006

Echocardiographic anatomy of ascending aorta dilatation: correlations with aortic valve morphology and function.

BACKGROUND: Different anatomical forms of proximal aortic dilations associated with aortic valve disease can be distinguished by echocardiography. Differences in the anatomy could reflect different pathogeneses and need for different therapeutic approaches. The present study assessed the clinical features associated to each anatomical form, particularly focusing on the relations with valve morphology and function. METHODS: Trans-thoracic and trans-esophageal echocardiography reports of 552 adult patients (mean age 60.4+/-12.8 years; 379 male) with mild to severe proximal aorta dilation were reviewed. The relationships between the anatomy of aorta dilatation (distinguished into "root type" dilatation, with maximal enlargement at the sinuses, and "mid-ascending type", with maximal diameter at the mid-ascending tract) and aortic valve morphology (tricuspid/bicuspid) and function (normal/stenosis/regurgitation) were assessed. The relations with other clinico-echocardiographic variables were also tested in univariate and multivariate analysis. RESULTS: A "root type" dilatation was found in 4.9% tricuspid patients with stenosis, 32.3% with regurgitation, 22.5% with normal valve function (p=0.018). Dilatation prevailed at the mid-ascending tract in patients with bicuspid aortic valve, irrespective of valve function (stenotic: 92.9%, regurgitant: 87.9%, normal: 94.3%; p=0.23). Predominant root involvement was significantly more prevalent in male patients (24.8% versus 5.2% in females; p<0.001). In multivariate analysis, predominant aortic valve regurgitation (OR=1.83; p=0.028) independently predicted root site, while predominant aortic valve stenosis (OR=3.70; p=0.001), bicuspidity (OR=2.90; p=0.005) and female sex (OR=6.10; p<0.001) predicted mid-ascending site. CONCLUSIONS: Pathogenetical considerations arise from the evidence of preferential mid-ascending localization of bicuspid-associated aortic dilatations. This finding is consistent with previous studies on bicuspid valve models revealing a wall stress overload beyond the sino-tubular ridge.

Aorta↗
PubMed2000

Teeth and their sex-dependent dimorphic shape in three species of Costa Rican plethodontid salamanders (Amphibia: Urodela).

The shape of the teeth and their sex-dependent dimorphic expression in three species of Costa Rican plethodontids (Bolitoglossa subpalmata, Oedipina uniformis and Nototriton abscondens) were studied using light microscopy and scanning electron microscopy. The teeth of the vomerine tooth patches are about one third larger than the teeth of the jaws in B. subpalmata and O. uniformis, whereas all teeth of N. abscondens are of about uniform size. The occurrence of bicuspid tooth germs in the fetus proves that primary teeth are bicuspid in these directly developing plethodontids. Females possess only bicuspid teeth consisting of a pedicel and a crown, as is considered characteristic for urodeles after metamorphosis. Adult males possess conical monocuspid teeth on the premaxillary. These teeth--which are similar to the typical late larval tooth of salamanders presenting a larval stage--are about twice as big as the neighbouring bicuspid maxillary teeth. N. abscondens males possess some monocuspid teeth and teeth of aberrant shapes on the premaxillary and the maxillaries. A tendency to build more monocuspid teeth in the premaxillary region than in the maxillary region can be observed in this species. We suppose that different degrees of sensitivity to androgens in each section of the dental lamina of the upper jaw cause the secondary occurrence of conical monocuspid teeth predominantly on the premaxillary section.

Animals↗
PubMedDate not supplied

Risk factors for requirement of permanent pacemaker implantation after aortic valve replacement.

BACKGROUND: The aim of this study was to evaluate the frequency of requirement for permanent pacing and related risk factors after aortic valve replacement. METHODS: Among 465 patients operated between 1994 and 2004, 19(4.1%) patients with a mean age 49.9 +/- 17.2 years required the implantation of a permanent pacemaker. Eleven of them were female (57.9%). The main indication was aortic stenosis (89.5%). Severe annular calcification was documented in 78.9% of them, and the aortic valve was bicuspid in 57.9%. RESULTS: Risk factors for permanent pacing after aortic valve replacement (AVR) identified by univariate analysis were female sex, hypertension, preoperative ejection fraction, aortic stenosis, annular calcification, bicuspid aorta, presence of right bundle branch block (RBBB) or left bundle branch block (LBBB), prolonged aortic cross-clamp and perfusion times, and preoperative use of calcium channel blockers. Multivariate analysis showed that female sex (p = 0.01, OR; 5.21, 95% CI: 1.48-18.34), annular calcification (p < 0.001, OR; 0.05, 95% CI: 0.01-0.24), bicuspid aortic valve (p = 0.02, OR; 0.24, 95% CI: 0.07-0.84), presence of RBBB (p = 0.009, OR; 0.03, 95% CI: 0.003-0.44) or LBBB (p = 0.01, OR; 0.13, 95% CI: 0.02-0.69), hypertension (p = 0.03, OR; 0.22, 95%CI: 0.05-0.89), and total perfusion time (p = 0.002, OR; 1.05, 95% CI: 1.01-1.08) were associated risk factors. CONCLUSION: Irreversible atrioventricular block requiring a permanent pacemaker implantation is an uncommon complication after AVR. Risk factors are annular calcification, bicuspid aorta, female sex, presence of RBBB or LBBB, prolonged total perfusion time, and hypertension.

Adult↗
PubMed2004

Long term results of percutaneous balloon valvoplasty of congenital aortic stenosis: independent predictors of outcome.

OBJECTIVE: To evaluate long term results and independent predictors of outcome of aortic valvoplasty. DESIGN: Retrospective follow up study. Independent predictors of outcome identified by multiple logistic regression. SETTING: Tertiary referral centre. PATIENTS: 269 consecutive patients treated at the median age of 8 months (0-23 years): 80 (30%) under 4 weeks, 59 (22%) between 4 weeks and 1 year, and 130 (48%) over 1 year. The follow up period was up to 14.8 years (median 5.3, in survivors 6.4 years). INTERVENTIONS: Percutaneous balloon valvoplasty with mean (SD) balloon to annulus ratio 0.97 (0.08). MAIN OUTCOME MEASURES: Restenosis > or = 70 mm Hg, grade 3 aortic insufficiency, cusps disruption, surgery, death, and valvoplasty failure (significant restenosis or insufficiency or surgery or death). RESULTS: The mortality rate was 10.4% (n = 28), the restenosis rate was 16.7% (n = 45), significant insufficiency developed in 22.3% (n = 60), surgery was needed in 20.1% (n = 54), and "valvoplasty failure" occurred in 41.6% (n = 112) patients. Mean (SEM) survival probability 14.4 years after the procedure was 0.89 (0.02) and mean (SEM) probability of surgery-free survival was 0.50 (0.08). The independent predictors were as follows. For restenosis: small aortic annulus; for cusp disruption: large aortic annulus; for insufficiency: bicuspid aortic valve; for need for surgery: bicuspid aortic valve; for death: small aortic annulus, low left ventricular shortening fraction, and low sequential number of the valvoplasty; and for valvoplasty failure: small aortic annulus, bicuspid aortic valve, and high grade of mitral insufficiency. CONCLUSION: Independent predictors of unfavourable outcome are small aortic annulus, bicuspid aortic valve, poor function of left ventricle or mitral valve, and limited operator experience.

Adolescent↗
PubMed2000

[Clinicopathologic study of calcified aortic valve stenosis in the aged, and evaluation of the indications for percutaneous aortic balloon valvuloplasty].

OBJECTIVES: We performed clinicopathologic study of 56 aged patients with calcified aortic valve stenosis and investigated the indications for percutaneous aortic balloon valvuloplasty. METHODS: The patients were 24 men and 32 women with a mean age of 81.9 years, who were classified into the following 3 types by etiology: 33 patients (58.9%) had senile aortic stenosis, 10 patients (17.9%) had bicuspid aortic stenosis, and 13 patients (23.2%) had rheumatic aortic stenosis. The sites of calcification were divided into the following 3 categories: cusp bases (base type), free edges (edge type), and both bases and edges (mixed type). RESULTS: Among the 33 patients with senile aortic stenosis, 10 (30.3%) had calcification of base type, 2 (6.1%) of edge type and 21 (63.6%) of mixed type. Among the 10 patients with bicuspid aortic stenosis, one (10%) had calcification of base type and 9 (90%) of mixed type. Among the 13 patients with rheumatic aortic stenosis, 3 (23.1%) had calcification of edge type and 10 (76.9%) of mixed type. In addition, 2 or 3 commissures were fused in patients with rheumatic aortic stenosis. The cusps of the aortic valves in the bicuspid type were the most severely thickened among the 3 groups. Soft X-ray imaging showed the aortic valves of rheumatic aortic stenosis were the most severely calcified (calcification score: 2.4), followed by those of bicuspid aortic stenosis (1.9) and senile aortic stenosis (1.6). CONCLUSIONS: Percutaneous aortic balloon valvuloplasty is most suitable in patients with calcified senile aortic stenosis because of the milder calcification, compared with those of the other 2 types.

Aged↗
PubMed1976

Cronic non-rheumatic valvular heart disease. An autopsy study.

The frequency of chronic non-rheumatic valvular heart disease in Iceland was investigated via autoposies performed from November 1965 through December 1974. During this period, about 12.400 Icelanders died at the age of 16 years and older and 28.8 per cent of these were included in the study. At autopsy, males outnumbered females by 2:1. The frequency of calcific aortic stenosis was found to be 3.63 per cent and the prevalence was calculated to be 3.17 per cent among males and 4.50 per cent among females. Calcific aortic stenosis in tricuspid valves was more frequent in females and calcific aortic stenosis in bicuspid valves was more frequent in males. Among the hearts with calcific aortic stenosis, 70.8 per cent were found to have normally tricuspid valves, 25.4 per cent bicuspid valves and 3.8 per cent tricuspid valves with an unicommissural fusion. In 0.59 per cent of the hearts the aortic valve was either bicuspid or had an uncommissural fusion without the features of calcific stenosis. However, a functional stenosis was suggested by the increased weight of most of these hearts. The frequency of bicuspid aortic valves was 1.2 per cent with a prevalence in males of 1.54 per cent and in females 0.50 per cent. A calcified mitral annulus was found in 1.98 per cent of the hearts and in most, it was either associated with calcific aortic stenosis in a tricuspid valve, or it was a single valvular disease. Rheumatic valvular disease was found in 1.08 per cent of the heart examined.

Adolescent↗
PubMed2006

Coexistent congenital aortic defects, aneurysm of sinus of valsalva, atrial septal defect and infective endocarditis: a case report.

Coarctation of the Aorta is frequently associated with bicuspid aortic valve. This is a risk factor for infective endocarditis. Aneurysm of a sinus of Valsalva is a rare defect with a prevalence of 0.09%. They are associated in 10% of cases with a bicuspid aortic valve and less frequently with coarctation of the aorta and atrial septal defect. It is extremely rare the association of coarctation of the aorta with an atrial septal defect. This is one of the first cases reported in Puerto Rico of an adult patient with coarctation of the aorta in association with a bicuspid aortic valve, a ruptured aneurysm of a sinus of Valsalva and an atrial septal defect. The patient is a 22 year old male with coarctation of the aorta diagnosed since childhood who was admitted at the Cardiovascular Center of Puerto Rico with signs of heart failure due to infective endocarditis secondary to a teeth infection. Upon evaluation with transthoracic and transesophageal echos, he was found to have a coarctation at the aortic isthmus, aortic root dilatation, bicuspid aortic valve with vegetation, severe aortic and tricuspid regurgitation, aneurysm of the non coronary sinus of Valsalva with perforation to the right atrium, biatrial enlargement and a dilated right ventricle. Successful antibiotic treatment of endocarditis was achieved followed by surgical replacement of the aortic valve and ascending aorta with closure of the non coronary sinus of Valsalva was done. An secundum atrial septal defect was found and was also closed. Surgical correction of the coarctation of the aorta was postponed for a future time. The patient had a successful postsurgical recovery and was discharged home with anticoagulation treatment.

Abnormalities, Multiple↗
PubMed1988

[Narrow and calcified aortic valve stenosis in subjects in their 8th and 9th decades. An anatomic study of 64 cases].

Anatomical data obtained from 64 patients aged from 70 to 86 years with calcified and tight aortic orifice stenosis (functional area less than 1 cm2) were divided into three types according to the macroscopic appearance of the aortic valve: (1) tricuspid valve without commissural fusion: 44 cases (18 men, 26 women, mean age 76 years); (2) tricuspid valve with commissural fusion: 12 cases (8 men, 4 women, mean age 72 years); (3) calcified congenital bicuspid valve: 8 cases (6 men, 2 women, mean age 73 years). Thus, the distribution of patients by sex became the same starting from the eighth decade of life. Calcified aortic orifice stenosis (CAOS) of degenerative origin was the most common lesion (69 p. 100), with a strong female predominance. There were several differences between degenerative CAOS and bicuspid valve stenosis on the one hand and aortic orifice stenosis with commissural fusion on the other hand. In the first group, calcification did not involve the free edge of the aortic cusps, large calcifications of the mitral ring were extremely frequent, and there was little or no aortic regurgitation. Moreover, the aortic ring clearly was wider in cases with bicuspid valve. In patients with degenerative CAOS and bicuspid valve, attempts at digital dilatation by the left ventricular route succeeded in most cases in obtaining a fairly important widening of the aortic orifice by compression and/or disruption of the valvular calcium deposits, without causing significant regurgitation of injuring the valve; the cusps recovered some mobility.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1997

Measurement of the radiation doses absorbed by jaw bones during irradiation of nasopharyngeal cancers.

BACKGROUND: Nasopharyngeal carcinoma (NPC) occurs more frequently for Chinese than for other ethnic groups. The most common treatment for NPC is radiotherapy, but there is no report of the doses of radiation absorbed by the mandibular and maxillary bones, although exposure to radiation is one of the most important references for those patients who need to have oral surgical treatments. METHODS: Thermoluminescent dosimeter (TLD) was used to measure radiation absorbed by a rando phantom and cancer patients. RESULTS: The results showed that the doses absorbed by the mandible and maxilla depend on the dose applied, field size, and field shape. In the rando phantom, the range of absorption in the mandible was, for the central incisor 1.89-3.36 Gy, canine 1.96-3.78 Gy, bicuspid 2.24-14.14 Gy, second molar 4.34-31.92 Gy, internal pterygoid muscle region 70 Gy. In the maxilla the range was, for the central incisor 2.17-2.94 Gy, canine 2.24-3.36 Gy, bicuspid 3.15-4.41 Gy, second molar 7.00-7.42 Gy. In nasopharyngeal carcinoma patients, the mean radiation absorbed by the bicuspid vestibular region of the mandible was 3.09 Gy, by the bicuspid vestibule of the maxilla 3.35 Gy and by the midline vestibule 2.31 Gy. The radiation doses absorbed by maxilla and mandible from the incisor to the second premolars were less than 20% of the dose to the primary tumor. CONCLUSIONS: The doses absorbed by the mandible and maxilla are relatively low in NPC patients receiving radiation therapy.

Adult↗
PubMed1989

[The effects of premature deciduous molar loss on the succeeding premolars].

By means of panoramic radiographs of 76 patients we investigated the development and eruption of lower premolars following premature loss of their deciduous predecessor. Following extraction of deciduous molars the mineralization of the bicuspids was accelerated. The eruption of the respective bicuspids took place earlier than expected. During eruption root length was shorter than usual for that stage of development. Although the bicuspids reached occlusion earlier than normal, root mineralization continued to normal length.

Bicuspid↗
PubMedDate not supplied

Proximal wear rates by tooth position of resin composite restorations.

OBJECTIVE: The purpose of this study was to evaluate restorations, previously placed in clinical trials, for the rate of wear of the proximal surfaces, by tooth position. MATERIALS AND METHODS: Seventy resin composite restorations were evaluated in bicuspids and molars. Fifty restorations were direct placement restorations and 20 were indirect placement restorations. Thirty-five bicuspids and 35 molars were evaluated for proximal wear rate. All restorations were opposing unrestored enamel proximal surfaces. Ten enamel to enamel proximal surfaces were chosen as controls. At baseline, contacts were judged to be closed visually and with thin, unwaxed dental floss. Impressions were taken at baseline and after 6, 12 and 24 months for the fabrication of models. Measurements for proximal wear, as determined by a loss of space between indexed transfer copings, were made under a zoom stereomicroscope by two independent evaluators. A parametric ANOVA, Student-Newman-Keuls, and log curve fit were applied to the data. RESULTS: When all data were pooled regardless of material, there were no significant differences (P < 0.05) in wear values for 1st and 2nd bicuspids and 1st and 2nd molars. Wear rates showed a high correlation (log curve fit R2 > 0.950) regardless of actual amount of wear. CONCLUSIONS: Regardless of composites examined, there were no differences in the amount of proximal wear with regard to tooth position in the arch.

Acrylic Resins↗
PubMed2003

[A second generation of premolars in the mandible].

Two developing supernumerary bicuspids were noticed accidentally in the mandible of a 12 years old girl when evaluating an impacted 35 on a radiograph. The development of these teeth was followed, but at a later stage they were removed. In a 17 years old man multiple complete developed bicuspids were seen on a radiograph. The backgrounds and treatment concerning supernumerary bicuspids in the mandible are discussed.

Adolescent↗
PubMed2002

Bilateral open bite in dicygotic twins. A combined orthodontic-prosthetic approach.

CASE REPORT: Dizygotic twins, male, 25 years of age, required treatment for an identical orthodontic diagnosis. DIAGNOSIS: Class III malocclusion with mesial molar relation and frontal edge-to-edge bite, lyrate upper dental arch, grouped cross-bite and bilateral open bite in the molar and bicuspid region, retention and lingual inclination respectively of the lower left second bicuspid, mesial inclination of both lower first molars. The severity of the malocclusion differed in the two brothers. THERAPY: Orthodontic treatment was successful concerning the transversal expansion and alignment of the maxillary dental arch, the functional relation of the anterior teeth, the transversally correct relation of the upper and lower dental arches and, following surgical removal of the lower second bicuspids, the reduction of crowding in the lower arch. An attempt was made to upright the molars in the mandibular arch and to close the lateral open bite by means of vertical elastics. However, the 10-month period of resistance to the therapy suggested, after a tongue protrusion habit had been ruled out, a diagnosis of ankylosis. Further orthodontic treatment was renounced and a prosthetic solution was pursued instead: the teeth in infraocclusion were treated with full ceramic overlays and, in the regions with residual gaps, with pontics (Empress II, Ivoclar, Schaan, Liechtenstein), after minimally invasive preparation (confined to removal of existing fillings). CONCLUSION: This case is particularly interesting because the infrapositioned molars in both brothers were very likely due to ankylosis, suggesting a genetic cause.

Adult↗