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PubMed1991

[The impacted upper cuspid].

Impacted upper cuspids may give rise to problems, such as the formation of cysts and the resorption of adjacent teeth. Early diagnosis (before the age of 12) is important. Proper timing of extraction of the deciduous cuspid may lead to spontaneous correction. When the position of the cuspid is unclear, orthopantomography and a lateral skull film may be helpful. Palatally impacted cuspids should be exposed surgically and moved into position by orthodontic treatment. Labially impacted cuspids are exposed by relocation of an attached gingival flap. The experience of the authors with the treatment of 81 patients are reported.

Adolescent↗
PubMed1991

When osteotomies should be considered.

Osteotomy at various levels of the facial skeleton is entirely justified in selected aesthetic surgical patients. By the very nature of aesthetic surgery, the morbidity potential associated with such osteotomies must be extremely low. Accordingly, osteotomy at the symphyseal level and the LeFort I level are the most commonly performed procedures in the aesthetic surgical patient. Aesthetic changes required in the vertical plane of space will require osteotomy, because these cannot be reliably and consistently achieved through changes in skeletal surface contour. Lastly, when the extent of change required is greater than what can be naturally achieved with surface augmentation, osteotomy must be considered. This last indication is frequently found in the aesthetic surgical patient presenting with a facial skeletal imbalance that has been previously treated with orthodontics to correct a skeletally based malocclusion. Recent technical advances have markedly reduced the associated morbidity of facial osteotomies and, therefore, have made this treatment option more acceptable to aesthetic surgical patients. Ceramic orthodontic brackets and surgical hooks and lingual orthodontic appliances have made presurgical orthodontic preparation more aesthetic and socially acceptable for LeFort I osteotomy patients. The use of rigid fixation, obviating the need for any postoperative intermaxillary fixation, has also made this treatment approach more appealing to aesthetic patients. Lastly, the efficacy of nonresorbable bone substitutes--in particular, porous, block hydroxyapatite--has, to a significant extent, obviated the need for harvesting autogenous bone grafts, further reducing surgical morbidity.

Face↗
PubMed1989

[Posterior hypsomaxilla: diagnostic and therapeutic considerations].

Posterior maxillary excess is a well individualized dento-alveolar anomaly which distorts the maxillary occlusal plane and induces clockwise rotation of the mandible. The dysmorphosis issued from is a skeletal open bite syndrome without dento-labial dysharmony. Surgico-orthodontic combined management is the adequate therapeutic procedure, on the following stages: during youth, a dento-facial orthopedic treatment is attempted to control posterior alveolar growth; pre-surgical alignment of teeth by orthodontic means correcting sagittal and transversal dental dystopies; surgical correction of the sole posterior hypsomaxilly is carried out by SCHUCHARDT osteotomy. In case of associated maxillary anomalies, LEFORT I osteotomy is indicated, mobilising the hole maxillary plate; post-surgical orthodontic affinement of final occlusion. When no orthodontic treatment had been effectuated, the prosthodontist will act for obtaining maximal dental intercuspidation; the plastic surgeon will harmonize facial profile, if needed.

Adolescent↗