Principles of retention and avoidance of posttreatment relapse.
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Our findings indicate a cellular basis for the connective tissue remodeling which takes place during physiologic tooth movement. This cell is the fibroblast which is capable of synthesizing and degrading collagen simultaneously and, utilizing this ability, the orderly control of collagen remodeling within the periodontal ligament is possible. It is suggested that this cellular basis of connective remodeling will have a direct significance for orthodontic tooth movement once control mechanisms have been established.
Transseptal fibers are a part of the gingival group of fibers of the periodontal membrane, and they are very tough and resistant. They form a chain from tooth to tooth which, provided that it remains intact and is sufficiently strong to resist displacing muscular pressures, will preserve the contacts between the teeth throughout the arch. If the continuity of the chain is interrupted, the balance of the forces acting upon the teeth on either side of the break is upset and considerable displacements can occur. Maxillary median diastemas are classified as "simple" or "persistent" according to their etiology, and an operation to clear the upper midline suture of transeptal fibers is described as an essential part of the treatment of persistent upper median diastema.
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A 2-year longitudinal investigation was conducted at five New York City junior high schools on 11- to 13-year-old children starting instrumental music education to determine what tooth movement, if any, resulted from the playing of certain musical instruments. Questionnaires, interviews, oral examinations, and dental casts were used at the start of instrumental study, after one year, and then after a second year. Statistically significant anterior tooth movements occurred in an overwhelming majority of the instrumentalists, while negligible movements were recorded for the controls over this period. As a result of this study, certain recommendations can be made by dentists when they are asked to suggest instruments which are dentally suited for children. In most cases they can suggest more than one instrument which would be of benefit dentally to the individual child, especially in the increase or reduction of overjet and overbite. The playing of the correct musical instrument can serve as an adjunct to the dentist or orthodontist in trying to accomplish certain tooth movements.
A method is presented for the accurate application of the modified 3-3 retainer of multistrand wire described by Zachrisson . This lingual retainer or splint is noninvasive of dental tissue and is reversible. Wire breakage does not appear to occur, and the slightly elastic properties of the wire allow a physiologic mobility of the teeth, which is of advantage in the periodontal patient. The only breakage that may occur is of the composite bond, although this appears to be less than with bonded brackets, but repair is quick and simple. The present method is now offered to add simplicity, speed, and accuracy to the important advantages already enjoyed, widening the scope for employment of this type of retainer to as many as eight or ten teeth in a series and, perhaps more significantly, to the maxillary anterior teeth, even where a deep bite exists. The value of the method is also seen when an active orthodontic appliance is removed and retention or splinting is required within an hour or two, as for the patient who is concurrently undergoing periodontal treatment.
Increasing numbers of adult patients are seeking orthodontic care and some, despite significant skeletal malocclusions, elect not to have combined orthodontic-surgical treatment. The purpose of this article is to outline some of the diagnostic and therapeutic principles that can be used in the adult nonsurgical orthodontic patient. The importance of realistic goal setting in the face of compromised occlusions is emphasized. Diagnosis should include evaluation of all three dimensions and recognize the limitations of therapy in each dimension for the nongrowing patient. Periodontal considerations, extraction decisions, and retention regimens are of vital importance to the achievement and maintenance of an optimum result. Clinical records will demonstrate four commonly seen problems and their resolution.
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The study was designed to elucidate the effect of physiological tooth movement on cellular cementum, using the upper molar roots of 10-week-old rats. Paraffin sections stained with haematoxylin and eosin displayed two types of cellular cementum, lightly and darkly staining. The lightly stained was present on the distal half of all molar roots except the mesial root of the first molar. The alveolar bone facing the lightly stained cementum showed resorption lacunae and multinucleated osteoclasts, while the opposite bone surface was lined with osteoblasts. In contact microradiographs of undemineralized ground sections, the X-ray density of the lightly stained cementum was similar to that of the periodontal ligament and pulp, while the X-ray density of the darkly stained cementum was similar to that of alveolar bone. Tetracycline labelling lines were seen at the interface between the two types of cellular cementum as well as on surfaces of bone and cementum located mesially to the root dentine. The results suggest that the mechanical stress of tooth movement differently affects the alveolar bone and cellular cementum; the bone is resorbed whereas the cementum resists resorption and its calcification is inhibited under the compressive force of tooth movement.
The integration of interspecialty treatment before the restorative and prosthodontic efforts of the dentist can eliminate conditions that have the potential to jeopardize successful completion of the proposed treatment. Adult dentitions that have deteriorated because of neglect, fear, caries, extractions, or trauma can be restored to stability, health, function, and esthetics. In "Part I, The biomechanic aspects," the orthodontic paralleling of proposed abutment teeth displays premolar (buccolingual) and molar (mesiodistal) uprighting procedures that achieve improved force distribution to these teeth. Molar intrusion (occlusoapical) to improve an occlusal plane distribution of adverse forces to the proposed opposing fixed partial denture is discussed. These vexing problems facing successful reintegration of the altered states of occlusal relationships frequently can be answered by the incorporation of preprosthodontic corrections.
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Surgical exposure may be an integral part of orthodontic treatment of impacted teeth. In some cases the surgical procedure alone results in eruption and alignment of such teeth. The nature of the mechanism that starts concomitantly with the removal of covering tissues is not known. The aim of this investigation was to study factors associated with eruption as well as the eruption route of impacted and unerupted teeth following surgical exposure. The material consisted of 542 impacted teeth in 389 patients. The findings given strong support to the hypothesis that forces within surrounding tissues act upon the exposed crown in such a way as to direct it toward the area where the tissues were removed.
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