Optimal fit of chairside-fabricated distal shoe space maintainer

BACKGROUND

Premature loss of a primary second molar may lead to space loss in the dental arch. This space loss tends to be more severe in unfavourable malocclusions. The distal shoe space maintainer (DSSM) may be beneficial in controlling the path of eruption of an unerupted permanent first molar from the primary into the early mixed dentition.

TECHNIQUE

This article describes the technique for achieving optimal fit of a chairside-fabricated band and DSSM in a single visit by contouring the distal shoe blade, and by extending it to the mesial surface of the permanent first molar.

FOLLOW-UP CARE

Upon the eruption of the permanent first molar DSSM may be modified to a reverse band-and-loop, or replaced by a lingual holding arch.

Combined orthodontic and restorative care of early childhood caries and anterior crossbite: a case report

This case report describes management of a 3-year-old child with early childhood caries and anterior crossbite. Restorative care was postponed until after crossbite correction to eliminate occlusal interferences associated with premature contact and a functional shift of the mandible. Crossbite correction was performed with a fixed anterior bite plane appliance, and comprehensive restorative care was performed under general anesthesia.

Changes in condylar postition and occlusion associated with maxillary expansion for correction of functional unilateral posterior crossbite

The purpose of this study was to confirm that correction of functional posterior crossbite through maxillary expansion is associated with a change in condylar position and occlusal relationships, and to determine whether maxillary expansion is associated with autonomous increase in mandibular arch width. Pretreatment and posttreatment study models of 61 patients ages 4.1 to 12.0 years (mean 8.5 years, SD 1.5) were available after maxillary expansion with a Quad Helix or a Haas expander for correction of a functional posterior crossbite. Pretreatment and posttreatment tomograms were available for 22 of the patients. Tomographic evaluation revealed that the condyles moved posteriorly and superiorly on the noncrossbite side from before to after treatment (p < 0.05). No differences were observed on the crossbite side. Superior joint space was greatest on the noncrossbite side before treatment, whereas, conversely, it was greatest on the crossbite side after treatment (p < 0.05). Relative condylar position was more anterior on the noncrossbite side before treatment (p < 0.05), but similar on both sides after treatment. Molar and canine relationships were more Class II on the crossbite side before treatment (p < 0.01 and < 0.05, respectively) and similar on both sides after treatment. A significant reduction in midline deviation was seen from before to after treatment (p < 0.001). A small, but significant autonomous increase in mandibular intermolar width (p < 0.001) occurred concomitant with the maxillary expansion.

Use of occupational therapists in mental health settings in South Carolina

OBJECTIVES

Severe workforce shortages in occupational therapy require an examination of viable practice areas for occupational therapists. The mental health practice area has experienced greater shortages than have other areas of occupational therapy; in South Carolina, only 2% of occupational therapists work in mental health. This study was undertaken to examine the use of occupational therapists in mental health settings in South Carolina.

METHOD

A survey was sent to administrators at 52 South Carolina mental health facilities to collect information on the use of occupational therapists, the associated economic issues, and the perception of the roles of occupational therapists.

RESULTS

Among the 34 respondents, 39% hired occupational therapists on a part-time or contractual basis, and 17% had full-time occupational therapist positions; 33% hired certified occupational therapy assistants on a part-time or contractual basis, and 11% had full-time certified occupational therapy assistant positions. Occupational therapy positions decreased over a 5-year period, and respondents cited the cost of salaries and problematic recruitment as two of the major contributing factors. The need for occupational therapy services was ranked as the number one factor both for increased and decreased use of occupational therapists. Personnel factors were highly ranked for facilities with decreased use whereas patient-related factors were highly ranked for facilities with increased use.

CONCLUSION

The findings highlight factors that may contribute to recent trends of fewer occupational therapists in South Carolina choosing mental health as a primary practice area.

The association of simple anterior dental crossbite to gingival margin discrepancy

The purpose of this study was to determine the severity of gingival margin discrepancy affecting the mandibular incisors in children with a single-tooth anterior crossbite. The response of the position of the gingival margin to correction of the crossbite also was investigated. Twenty-two subjects with a single central crossbite and 16 subjects with a single lateral crossbite were identified from two orthodontic practices. Seventeen of the 22 central incisor patients had immediate posttreatment records available; six patients had long-term follow-up records. An insufficient number of posttreatment records were available for the patients with lateral crossbites. The mean clinical crown length of crossbite mandibular incisors, measured on the study models, was compared with mean crown length of contralateral control incisors and the difference in clinical crown length was determined. A gingival margin discrepancy was identified when the gingival margin of the crossbite incisor was at least 1.0 mm apical to the gingival margin of the control incisor. The proportion of subjects with gingival margin discrepancy was significantly higher in subjects with central incisor crossbite (12/22 = 54%) than in those with lateral incisor crossbite (4/16 = 25%), P less than 0.05. While a gingival margin discrepancy persisted for eight of the 17 central incisor crossbites after discontinuing the appliance, 8.9 +/- 4.7 months, the severity of the discrepancy showed a significant reduction from 2.2 +/- 0.5 mm to 1.3 +/- 0.8 mm, P less than 0.05. True recession with exposure of cementum was not observed in any subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

The clinical management of ectopically erupting first permanent molars

The literature on ectopically erupting first permanent molars is reviewed. The progression of the ectopic condition is discussed along with factors that will affect the practitioner's decision on a mode of treatment. The optimal treatment approach depends on the clinical eruption status of /6/, the change in position of /6/, the amount of enamel ledge of /E/ entrapping /6/, the mobility of /E/, and the presence of pain or infection. A variety of treatment approaches together with diagnostic rationale and clinical guidelines are presented. Overall aspects of the malocclusion must be considered when planning the management of ectopically erupting first permanent molars.

A test of the "hired gun" hypothesis in psychiatric testimony

A sample of 255 psychiatrists and psychologists responded to a questionnaire designed to elicit the extent of their experience as defense or prosecution witnesses in criminal determinations of insanity. Prior defense experience correlated .78 with prior prosecution experience, suggesting that experts cannot readily be classified as working exclusively for the defense or for the prosecution.

The effect of extraction and orthodontic treatment on dentoalveolar support

Full-mouth radiographs of ninety-six patients treated by extraction of four first premolars were taken at least 10 years postextraction. Three groups were established: one with extensive crowding in the full permanent dentition treated by extraction and fixed appliance therapy; one treated by serial extraction and fixed appliance therapy; and one treated by serial extraction only. Measurements of tooth length and alveolar bone height were made from the projected radiographs, and buccolingual socket areas were measured from direct tracings of the radiographs. Comparison between groups revealed reduced mean radiographic tooth lengths for incisors and mandibular molars in the orthodontically treated groups. The incidence of root resorption was similar for both treated groups. Reduced alveolar bone heights were noted in the extraction sites of the two orthodontically treated groups but not in the group treated by serial extraction only. Most reduction in long-term dentoalveolar support occurred as a result of root resorption except in the extraction sites, where it occurred largely as a result of bone loss. Root parallelism did not appear to influence proximal bone heights at the extraction site. In malocclusions involving arch length deficiency, maximally displaced canines had reduced long-term proximal bone compared to nondisplaced canines, supporting the concept of encouraging autonomous distal eruption through serial extraction.

Space control in the primary and mixed dentitions

Space control has been distinguished from space maintenance. The difference is not a semantic one. Space control calls upon the dentist to apply his knowledge of occlusal development to the patient's condition. It infers assessment and re-evaluation. Space maintenance, unfortunately, sometimes becomes a routine or mechanical placement of appliances. This article has reviewed some of the variables to be considered when effecting space control: the factors that dictate appliance selection and some of the more common appliances used for space control today. No formula has been recommended for the application of appliances. Rather, the dentist has been urged to review the variables and re-evaluate his decisions according to the dynamic development of the patient's dentition.

Pulpal and periodontal reactions to orthodontic alignment of palatally impacted canines

The purpose of this study was to evaluate differences in periodontal and pulpal status, root length, and tooth alignment between contralateral maxillary lateral incisors, canines, and premolars in patients treated for unilateral impaction of maxillary canines. Clinical examinations were performed on 32 patients, average age 22 years 11 months and average posttreatment observation period 3 years 7 months. Probing attachment level was lower at the mesial and distal aspect of the previously impacted canine and at the distal aspect of the adjacent lateral incisor. Crestal bone height was lower at the mesial aspect of the previously impacted canine and at the distal aspect of the adjacent lateral incisor. The roots of the lateral incisors and premolars adjacent to the previously impacted canines were shorter. Pulpal obliteration was observed in six previously impacted canines (21%), and pulp necrosis in one previously impacted canine. The pulps of the remaining teeth appeared normal radiographically. A negative response to electric pulp testing was observed in eight previously impacted canines. Approximately 40% of the previously impacted canines exhibited noticeable relapse and were judged to be intruded, lingually displaced, mesially rotated, as well as discolored. Of the contralateral canines, 91% were normal in appearance. The previously impacted canine could be identified on posttreatment color slides in approximately 75% of the cases.

Stability of anterior openbite treated with crib therapy

The records of 33 openbite patients treated with cribs were collected. The sample was divided into two groups with group one comprised of 26 growing patients and group two comprised of seven nongrowing patients. There was a significant increase in overbite for both groups during treatment. The nongrowing group also showed a significant increase in overbite during the posttreatment period. During the posttreatment time interval 17.4 percent of the growing sample and zero percent of the nongrowing sample exhibited relapse. However, all patients who achieved a positive overbite during treatment maintained a positive overbite posttreatment. These findings suggest that patients who achieve a positive overbite with crib therapy have a good chance of maintaining this correction after orthodontic treatment is completed. This statement appears to be true for both growing and nongrowing patients. The reason for this increased stability may be due to a modification of tongue position or posture.

Uncovering labially impacted teeth: apically positioned flap and closed-eruption techniques

The purpose of this study was to examine the esthetic and periodontal differences between two methods of uncovering labially impacted maxillary anterior teeth: the apically positioned flap and closed-eruption techniques. The sample consisted of 30 patients who were recalled a minimum of three months after orthodontic treatment of a unilateral labially impacted maxillary anterior tooth. Eighteen of the patients had undergone an apically positioned flap (APF) procedure, and the remaining twelve had undergone the closed-eruption (CE) technique. In the CE group, clinical examination showed less width of attached gingiva on the distal surface and increased probing bone level on the facial surface of the uncovered teeth relative to their contralateral controls. Uncovered teeth in the APF group showed more apical gingival margins on the mesial and facial surfaces; greater crown length on the midfacial surface; increased probing attachment level on the facial surface; increased width of attached gingiva on the facial surface; increased probing bone level on mesial, facial, and distal surfaces; and gingival scarring. Radiographic examination showed shorter roots on the uncovered teeth in both groups. Photographic examination revealed vertical relapse of the uncovered teeth in the APF group. We conclude that labially impacted maxillary anterior teeth uncovered with an apically positioned flap technique have more unesthetic sequalae than those uncovered with a closed-eruption technique.

Physiologic drift of the mandibular dentition following first premolar extractions

A retrospective study of two groups of patients was conducted to evaluate the physiologic drift, or "driftodontics", of the mandibular teeth following the extraction of four first premolars. Group 1 included 32 patients who underwent early extraction in the mixed dentition stage at a mean age of 10.4 years; they were followed for approximately 2.5 years postextraction. Group 2 included 20 patients whose premolars were extracted after the permanent dentition had fully erupted. Their mean age at the time of extraction was 14.2 years, followed by a 0.8 year observation period. Except for the extractions, no other mandibular therapy was rendered. The results show no differences in rates of molar movements between groups. The molar apex moved mesially approximately 0.6 mm/yr; the molar cusp moved mesially approximately 1.2 mm/yr. In contrast, there were marked group differences in movements of the mandibular incisors and canines; rates of change were significantly greater in Group 2 than in Group 1. The canines drifted laterally and distally into the extraction sites while the incisors became more upright over basal bone and less crowded. Incisor irregularity decreased 1.3 mm/yr in Group 1 and 5.5 mm/yr in Group 2. The group differences in amounts of tooth movement were accounted for by changes in incisor crowding.