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Cleft lip and palate affects roughly 1 in 600 children and predisposes patients to a lifetime of functional and esthetic discrepancies. Disparities in access as well as quality of care exist worldwide, with many children in developing countries unable to receive treatment. In the late 20th century, humanitarian medical missions emerged as a means of delivering surgical expertise to patients in resource-limited settings. These early missions took on a patient-centered approach focused solely on cleft repair, with little emphasis on treating the dental abnormalities that arose after the initial surgery. However, modern cleft care is characterized by a multidisciplinary, team-based approach with significant dental involvement. Recent cleft lip and palate endeavors have shifted from a mission-based approach to a developmental approach facilitating growth of an independent care center. This strategy focuses on creating an institution with expanded access to dental services, thus facilitating the long-term treatment inherent in modern cleft care. One clinic in a developing country that has experienced successful transitioning from a mission site to an independent craniofacial clinic is Operation Smile's Cleft Comprehensive Care Clinic in Guwahati, India. This article will summarize the rationale and planning of the clinic, underscore the team-based approach required in longitudinal treatment of cleft lip and palate, and demonstrate how treatment methodology may differ in resource-limited settings by outlining the therapeutic considerations of each provider in the Guwahati Clinic.

This second part follows on from part 1 published in the previous issue of this journal. The aim of this publication is to offer teams specializing in the primary and secondary treatment of labio-alveolar-palatal clefts a prosthetic evaluation for more rational management of the dental sequellae of clefts for patients who, when they reach adulthood, often wish to improve their facial esthetics, in which the dental element plays an important part. The reorganization and restoration of the maxillary anterior teeth and their esthetic integration with respect to the face and lips would then be less of a problem for plastic surgeons and orthodontists. In this regard, the installation in this sector of implants, following ambitious bone surgery involving the sacrifice of the teeth of the medial nasal process in bilateral forms, is a protocol that could usefully be taken into account., (Copyright © 2014 CEO. All rights reserved.)

Background: Apert syndrome is a severe developmental malformation, clinically characterised by craniosynostosis, midface hypoplasia, a cone-shaped calvarium, ocular manifestations, typical dental findings and syndactyly of the hands and feet. Early craniosynostosis of the coronal suture, the cranial base and agenesis of the sagittal suture are prodromal characteristics for the typical craniofacial appearance in patients with Apert syndrome., Case Reports: The aim of this report was to describe the maxillofacial and orthodontic management of three patients with Apert syndrome who attended the Craniofacial, Maxillofacial and Orthodontic clinics of the University Hospitals of the KU Leuven (Belgium). The typical clinical features, the general orthognathic treatment approach as well as individual approaches of three patients with Apert syndrome are being highlighted., Follow-Up: The three patients with Apert syndrome have been followed up very closely by all involved specialised departments as well as by multidisciplinary teams from birth., Conclusion: This report demonstrated that a combined orthodontic and orthognathic surgical treatment plan could significantly improve the occlusal function as well as the facial and occlusal aesthetics in patients with Apert syndrome.

A molar-incisor malformation (MIM) is a newly discovered type of dental anomaly of the permanent first molars, deciduous second molars, and permanent maxillary central incisors. MIM anomalies of the permanent first molars and deciduous second molars may include normal crowns with a constricted cervical region and thin, narrow, and short roots, whereas the affected maxillary central incisors may exhibit a hypoplastic enamel notch near the cervical third of the clinical crown. Although the etiology of MIM remains to be determined, it is thought to be attributable to an epigenetic factor linked to brain- and central nervous system-related systemic diseases at around age 1 to 2 years. MIM teeth are associated with clinical problems such as impaction, early exfoliation, space loss, spontaneous pain, periapical abscess, and poor incisor esthetics. Children with MIM teeth should be observed closely with respect to their medical history, and dentists should formulate a wider-ranging treatment plan., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The aim of this publication is to offer teams specializing in the primary and secondary treatment of labio-alveolar-palatal clefts a prosthetic evaluation for more rational management of the dental sequellae of clefts for patients who, when they reach adulthood, often wish to improve their facial esthetics, in which the dental element plays a significant part. The reorganization and restoration of the upper anterior teeth, and their esthetic integration with respect to the face and lips, would then be less of a problem for plastic surgeons or orthodontists. In this respect, the installation in this sector of implants, following ambitious bone surgery involving the sacrifice, in bilateral forms, of the teeth of the medial process is a protocol that could usefully be taken into account., (Copyright © 2014 CEO. Published by Elsevier Masson SAS. All rights reserved.)

100 patient, aged between 4 and 42, with various dentition anomalies exacerbated by crowding of lower and upper teeth, have been examined and given orthodontic treatment. The orthodontic treatment involved a combination method in conjunction with functional (biological), machine, surgical and prothetic methods. The analysis of the results of this study shows that the treatment algorithms used in this study could be recommended for clinical application.

The purpose of this meta-analysis was to determine whether genetic variants of the interleukin-1β[+3954 C>T (rs1143634)] (IL-1β +3954 C>T) gene polymorphisms were associated with orthodontic external apical root resorption (EARR). A meta-analysis was carried out using data entered into the PubMed and Embase electronic databases before October 5, 2012. A total of 7 studies were identified for meta-analysis. The strength of the relationship between IL-1β +3954 C>T polymorphism and the risk of EARR was assessed using odds ratio (OR). The studies provided overall OR estimates for EARR. Overall, the variant genotypes (CC and CT) of the IL-1β +3954 C>T polymorphism were unassociated with EARR risk compared with the TT homozygote [CC vs TT, OR = 1.28, 95% confidence interval (95%CI) = 0.27-6.08; CT vs TT, OR = 0.74, 95%CI = 0.11-5.02]. Similarly, no associations were found in the dominant and recessive models (dominant model, OR = 1.08, 95%CI = 0.24-4.86; recessive model, OR = 1.85, 95%CI = 0.87-3.93). No publication bias was found, and no association was apparent between the IL-1β +3954 C>T polymorphism and risk of EARR in orthodontic treatment patients. Further multicenter and better-controlled studies are required to confirm these findings.

Dental transposition is the positional interchange of two adjacent teeth. Canine transpositions are usually accompanied by other dental anomalies, such as: impaction of the incisors; missing teeth; peg-shaped lateral incisors; severe rotation or malposition of adjacent teeth; dilacerations; and malformations. Local pathologic processes, such as tumors, cysts, retained primary canines, and supernumerary teeth, might be responsible for canine transposition. The purpose of this paper was to present a rare case of maxillary canine-to-maxillary incisor transposition in an 8-year-old girl. The patient presented with noneruption of the permanent maxillary left central incisor, and a radiographic examination revealed an impacted dilacerated incisor. The central incisor was extracted because the root was severely dilacerated. At the 3-year follow-up, an oral examination revealed that the canine had transposed to the extraction site. Through orthodontic traction, combined with reshaping of the tooth, the transposed canine was successfully positioned into the incisor position.

Items in clusters, such as patients of the same clinician or teeth within the same patient, tend to be more similar than items from different groups. This within-group similarity, represented by the intraclass correlation coefficient (ICC), reduces precision, yielding less statistical power and wider confidence intervals, compared with non-clustered samples of the same size. This must be considered in the design of studies including clusters. We present ICC estimates from a study of 7,826 restorations placed in previously unrestored tooth surfaces of 4,672 patients by 222 clinicians in the National Dental Practice-Based Research Network, as a resource for sample size planning in restorative studies. Our findings suggest that magnitudes of ICCs in practice-based research can be substantial. These can have large effects on precision and the power to detect treatment effects. Generally, we found relatively large ICCs for characteristics that are influenced by clinician choice (e.g., 0.36 for rubber dam use). ICCs for outcomes within individual patients, such as tooth surfaces affected by a caries lesion, tended to be smaller (from 0.03 to 0.15), but were still sufficiently large to substantially affect statistical power. Clustering should be taken into account in the design of oral health studies and derivation of statistical power estimates for these studies (ClinicalTrials.gov, NCT00847470).

The retinoblastoma is one of the most common tumors of the eye diagnosed in childhood. The treatment for patients with retinoblastoma includes surgical removal of the lesion along with adjunctive chemotherapy and radiotherapy. If the tumor is controlled, these treatments can have secondary adverse effects pertaining to the growth and development of orofacial structures in young patients. This clinical report describes the prosthetic rehabilitation of a patient who underwent enucleation followed by radiation therapy and adjunctive chemotherapy to treat the primary diagnosis of retinoblastoma. This therapy resulted in a combination of dental and facial growth and developmental abnormalities., (Copyright © 2013 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Unlabelled: Macrodontia is an uncommon dental anomaly that can present in both primary and permanent dentition. It has often been reported to occur concomitantly with other dental anomalies and has also been an established clinical characteristic of numerous systemic conditions and syndromes. The following case reports illustrate the challenges of managing macrodont teeth in view of the various treatment options available, as well as the multiple factors that tend to influence each case individually., Clinical Relevance: This article highlights the importance of early referral and a multidisciplinary approach to treating patients with dental anomalies.

Background: Abnormally, large teeth are often referred to as 'double teeth'. These can pose numerous challenges for the clinician. There is no published protocol on the management of double teeth., Aim: To review the published literature and also patients managed at the Eastman Dental Hospital (EDH) and to develop a clinical protocol for the management of double teeth in children and adolescents., Design: Literature was searched (Medline and Embase) and data collated. Patient notes of cases managed at the EDH were reviewed., Results: Eighty-one teeth from 53 papers and 22 patients were included in the review. Success criteria were only reported in 32 papers and were variable. Twenty-three papers had no follow-up period. The main factor in determining the management of a double tooth was root and root canal system morphology. The treatment of choice in teeth with separate roots was hemisection and in those with a single root was crown modification or extraction., Conclusion: It was not possible to determine the best management strategies because of the variable reporting in the literature. The authors have proposed a protocol for management and a data collection sheet for essential information needed when reporting on double teeth cases., (© 2012 The Authors. International Journal of Paediatric Dentistry © 2012 BSPD, IAPD and Blackwell Publishing Ltd.)

In addition to providing functionality to patients, contemporary dentistry strives for esthetic excellence. Patients with anterior impairments, such as shape, size, and position alterations, have compromised smile harmony. A multidisciplinary orthodontic-operative dentistry approach has improved the treatment of these patients, since the use of orthodontic appliances in association with direct composite restorations can solve many esthetic problems. Although this treatment strategy is rather widespread, professional skills are necessary for the correct reproduction of the main features of teeth. Moreover, treatment success is directly related to its longevity. With the aid of a 9-year follow-up case report, a simple direct technique associated with an orthodontic treatment for restoring the esthetic appearance of an impaired smile, with good short- and long-term outcomes, based on minimal but essential esthetic repair interventions is discussed. Such coordinated treatment proved to be effective for the establishment and maintenance of an esthetic and pleasant smile.

Objective: To evaluate the clinical application value of minimal prepared ceramic veneer in anterior teeth, by analyzing the esthetic effects and success rates., Methods: Forty-four anterior teeth in 30 patients with minor esthetic defect were included in this study. Less than 0.5 mm preparation or no preparaion technique was used in the clinical procedure. Glass ceramics veneers were delivered and 3M Relyx Veneer were used as the adhesive. The final appearance of each restoration was evaluated by patients on visual analogue scales (VAS) and by professional prosthodontists. Evaluation criteria included margin effects, color, shape and translucency. The success rate of all the restoration were analyzed in 6, 12 and 24 month after the treatment., Results: The patients' degree of satisfaction was 9.2 ± 0.4, while the excellent rate of esthetic effect of margin effect, color, shape and translucency was 89% (39/44), 91% (40/44), 98% (43/44) and 93% (41/44) by professional prosthodontist. The success rate of 6, 12 and 24 month were 100% (44/44), 98% (43/44) and 91% (40/44)., Conclusions: The minimal prepared venneers have a good esthetic effect and a satisfactory success rate, and is a suitable technique in esthetic treatment under the critical indications.

This case report describes the treatment of a 14-year-old adolescent patient who had 2 impacted maxillary central incisors with distoangular root dilacerations. He also had an impacted maxillary left canine, with the crown completely overlapping the root of the lateral incisor, and insufficient space. The general dentist referred this patient because the maxillary central incisors had still not erupted 2 years after extraction of the retained deciduous incisors. A unilateral expander with a modified vestibular arch and an attachment spring on the right side was used to correct the posterior crossbite on the right side and improve the positions of the teeth. The expansion appliance was also applied as a high anchorage device to move the central incisors and the left canine into position during the initial stages. After this phase, fixed appliances were used to redistribute the space in the anterior maxillary region to create enough space for repositioning the impacted teeth. This procedure restored the normal appearance of the maxillary arch, with good periodontal health and without evidence of root resorption, apart from the distoangular root dilacerations of the 2 maxillary central incisors., (Copyright © 2012 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

The purpose of this paper was to report the case of a 6-year-old male patient who was clinically diagnosed as having Rapp-Hodgkin syndrome-a variant of ectodermal dysplasia characterized by dysplastic disorders of the skin, hair, and nails associated with cleft lip and/or palate. The patient exhibited only the primary maxillary and mandibular canines bilaterally. Restorative treatment was performed on all primary canines, followed by aquisition of maxillary and mandibular impressions for fabrication of acrylic removable partial dentures with circumferential clasps on the primary canines. The dentures allowed recovery of the vertical dimension and excellent esthetics. Hypodontia of several teeth associated with ectodermal dysplasia, as in this case involving Rapp-Hodgkin syndrome, causes several functional and esthetic alterations. These disorders should be diagnosed and treated as early as possible to restore the normal function, allow adequate mastication and speech, enhance esthetics, and, consequently, promote the patient's self-esteem and social integration.

A 7-year-old girl with hyperimmunoglobulin E syndrome (HIES) presented to our clinic with tooth agenesis in both primary and permanent dentitions. The patient's serum immunoglobulin E level was elevated at 17,091 IU/ml, and her medical history indicated the occurrence of HIES, numerous skin abscesses, and recurrent infection by bacteria and/or fungi such as Candida from birth. She also suffered from heart disease. Dental manifestations included extensive caries, impaired root resorption of primary mandibular central incisors and absence of primary mandibular canines and permanent mandibular lateral incisors. Intraoral phenotypes in HIES patients have already been reported in detail, but no previous report has described abnormalities in the number of primary teeth in HIES patients. The purpose of this report was to describe the dental manifestations in the primary dentition of a hyperimmunoglobulin E syndrome patient and to emphasize the importance of preventive dental management from early childhood in compromised children, such as those with HIES.

Taurodontism is a morpho-anatomical developmental anomaly rarely seen in teeth. It is characterised by lack of constriction at the level of cementoenamel junction with elongated pulp chambers and apical displacement of bifurcation or trifurcation of roots. This gives the tooth a rectangular or cylindrical appearance. This paper reports successful endodontic therapy of cases with hypo-, meso- and hypertaurodontism in healthy individuals with no associated syndrome or anomaly., (© 2011 The Authors. Australian Endodontic Journal © 2011 Australian Society of Endodontology.)

Aim: To examine the reasons for referral to the Paediatric Dental Department, Cork University Dental School and Hospital, Ireland and to study the profile of these reasons in terms of the various sources of referral., Study Design: Clinical review., Methods: Consecutive clinical records for children attending the service were reviewed with regard to a child's age at initial attendance, the reason for referral and the source of referral. Reasons for referral were recorded based on a defined list of acceptance criteria and were categorised by their different sources of referral., Results: Records were available for 612 children with a mean age at time of initial consultation was 9.13 (SD+/- 3.94) years. Reason for referral; children who had difficulty co-operating for dental treatment made up the largest group (36.1%). Children who only required treatment planning comprised 25.0% of the total. Source of referral: 56.0% of consultations were from the salaried public dental service and 31.2% from private dental practitioners. Forty seven patients (7.7%) were from emergency department, while 31 (5.1%) were from medical practitioners. From the public dental service, 51.0% of referrals were for children who had difficulty co-operating for dental treatment and 22.7% were for treatment planning only. Referrals from private dental practitioners were most commonly for treatment planning only (38.2%). The proportion of referrals from the public dental service for children who had difficulty cooperating for dental treatment was twice as high as from private dentists. The proportion of referrals for trauma and for extensive dental disease from private dental practitioners was twice as high as from the public dental service. Almost all attendances from an emergency hospital department were for dental trauma. The majority of attendances from medical doctors were for medically at risk patients., Conclusions: Children with difficulty cooperating for dental treatment made up the largest single group of children attending the service. The majority of children attending were referred from the salaried public dental service.

We present the case of an 8-year-old boy with a talon cusp associated with a permanent maxillary central incisor that was mistaken for a supernumerary tooth. The importance of early and correct diagnosis of a talon cusp is stressed. Diagnosis and treatment planning strategies are discussed.

Palatal radicular groove is a discreet alteration in tooth morphology, characterized by an invagination that begins near the cingulum of the tooth and moves in an apical direction. Clinically, palatal radicular groove may be associated with periodontal and/or endodontic problems. This paper describes a clinical case of a young patient with palatal radicular groove with no signs of periodontal disease or endodontic impairment. An early diagnosis was made and treatment consisted of surgical sealing of the defect. After a 2-year period, reexaminations demonstrated adequate hygiene, maintenance of tooth vitality and periodontal health. The early diagnosis and sealing of the groove observed surgically made the root surface smooth, avoiding subgingival bacterial plaque buildup, and preventing possible periodontal and/or pulp impairment stemming from the defect.

Background: The authors conducted a study to quantify the reasons for restoring noncarious tooth defects (NCTDs) by dentists in The Dental Practice-Based Research Network (DPBRN) and to assess the tooth, patient and dentist characteristics associated with those reasons., Methods: Data were collected by 178 DPBRN dentists regarding the placement of 1,301 consecutive restorations owing to NCTDs. Information gathered included the main clinical reason, other than dental caries, for restoration of previously unrestored permanent tooth surfaces; characteristics of patients who received treatment; dentists' and dental practices' characteristics; teeth and surfaces restored; and restorative materials used., Results: Dentists most often placed restorations to treat lesions caused by abrasion, abfraction or erosion (AAE) (46 percent) and tooth fracture (31 percent). Patients 41 years or older received restorations mainly because of AAE (P < .001). Premolars and anterior teeth were restored mostly owing to AAE; molars were restored mostly owing to tooth fracture (P < .001). Dentists used directly placed resin-based composite (RBC) largely to restore AAE lesions and fractured teeth (P < .001)., Conclusions: Among DPBRN practices, AAE and tooth fracture were the main reasons for restoring noncarious tooth surfaces. Pre-molars and anterior teeth of patients 41 years and older are most likely to receive restorations owing to AAE; molars are most likely to receive restorations owing to tooth fracture. Dentists restored both types of NCTDs most often with RBC.

Aim: To report on the successful conservative management of three patients having a talon cusp with pulpal involvement using mineral trioxide aggregate (MTA)., Summary: Mineral trioxide aggregate was used to induce hard-tissue formation following the direct pulp capping of a resected talon cusp in three cases., Key Learning Points: • Talon cusp is an odontogenic anomaly which can cause occlusal interferences, displacement of the affected tooth, caries-susceptible developmental grooves and speech difficulties • Direct pulp capping using MTA following the resection of a talon cusp is a suitable treatment option., (© 2011 International Endodontic Journal.)

Abnormalities in size of teeth and number of teeth are occasionally recorded in clinical cases. True generalized microdontia is rare case in which all the teeth are smaller than normal. Mesiodens is commonly located in maxilary central incisor region and uncommon in the mandible. In the present case a 12 year-old boy was healthy; normal in appearance and the medical history was noncontributory. The patient was examined and found to have permanent teeth that were smaller than those of the average adult teeth. The true generalized microdontia was accompanied by mandibular mesiodens. This is a unique case report of non-syndromic association of mandibular hyperdontia with true generalized microdontia.

Hallermann-Streiff syndrome is a rare congenital disorder characterized by bird-like facies and dental anomalies. A description of a 21-year-old Hispanic woman with Hallermann-Streiff syndrome, whose anterior open occlusal relationship and smile were improved with overdentures is presented. The treatment was satisfactory in terms of both esthetics and phonetics, excluding the need for aggressive surgical treatment., (Copyright © 2011 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Talons cusp is an uncommon developmental dental anomaly characterized by presence of an accessory cusp like structure projecting from tooth neck towards incisal edge. This anomaly commonly affects permanent dentition than primary dentition. This article describes early diagnosis and management of two patients with talons cusp. Conservative treatment by selective grinding, followed by fluoride varnish application was done. The patients were followed up for one year without any complications. This indicates conservative means of management to be the most desirable way of managing such anomalies.

Ectodermal dysplasia is a hereditary disorder of ectodermal origin. A 12-year-old boy was referred for management of the oral manifestations of his ectodermal dysplasia. An overdenture retained by natural teeth for the maxilla and a double-crown-retained denture for the mandible were made. Double-crown-retained dentures may be modified into complete dentures if the abutment teeth are lost. The patient was instructed to maintain oral hygiene and return periodically for follow-up visits. This report describes a potential routine approach to restoring the appearance, function, and psyche of a growing boy with ectodermal dysplasia.

Introduction: Dilaceration of the permanent teeth usually occurs because of trauma to their deciduous predecessors. Dilaceration in the crown is rare compared with that in the root and is more common in the maxillary and mandibular incisors. Generally, surgical exposure of the tooth followed by orthodontic traction or extraction of the tooth is the the choice of treatment., Methods: This article highlights a surgical-endodontic approach to the management of the left permanent maxillary central incisor with dilaceration of the crown., Results: The 1-year follow-up showed good stability of the prosthesis and good periodontal health., Conclusions: Surgical resection of the crown followed by endodontic treatment and restoration is a viable and rapid option for the management of crown dilaceration., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

The description of an original design of appliance for distalization of maxillary molars; it's principle of work; comparison with the available conventional appliances for similar purpose, were presented.

Dens evaginatus is a developmental anomaly that can be defined as a tubercle from the surface of an affected tooth. It is composed of enamel and dentin usually enclosing pulp tissue. It is a rare dental anomaly commonly seen on premolars. A 12-year-old boy reported for the management of dental caries. He had bilateral occurrence of dens evaginatus on maxillary second premolars. The tubercle on the right side was unusually long without occlusal interference with the opposing primary mandibular second molar. Carious teeth were restored and the tubercle was left untreated. Management of dens evaginatus is determined by various factors which are discussed in decision-support system. Pulpal complication due to caries or fracture of tubercle can occur; hence it should be periodically monitored.

This article describe a rare case of multiple taurodontism involving all molars in a 17-year-old male. Volumetric cone-beam computed tomography was used to investigate internal and external root morphology, including that of a maxillary first molar which required endodontic treatment and retreatment. Medical history was not contributory; however, Klinefelter syndrome was the diagnostic hypothesis in this case.

Aim: The aim of this report is to present the management of three cases of different magnitude affecting the periodontal attachment apparatus due to the presence of a palato-radicular groove (PRG)., Background: The palato-radicular groove is a developmental anomaly often associated with localized periodontitis and pulpal necrosis., Case Description: The authors present three cases involving the management of teeth with a palato-radicular groove. In the first case, a 20-year-old woman presented with a 5mm periodontal pocket associated with the maxillary right central incisor but no evidence of pulpal involvement. In the second case, there was extensive bone loss and pulpal necrosis of the maxillary right lateral incisor in a 35-year-old man. The third case involved severe localized periodontitis of the right and left maxillary lateral incisors of a 47-year-old man. This report describes the diagnosis and periodontal management of these three clinical situations., Summary: Periodontal complications due to a palatal-radicular groove are relatively rare. However, when they do occur, the diagnosis of a pulpal or localized periodontal lesion can sometimes present a dilemma for the general dentist, particularly if a palato-radicular groove is the etiologic factor. This is because a radicular groove can act like a "funnel," aiding microbial plaque accumulation, and lead to gingivitis, localized periodontitis, and even pulpal necrosis. But with a timely diagnosis and proper clinical management, the tooth or teeth involved can be treated and often retained., Clinical Significance: Thorough examination of the morphological anomalies associated with the lateral and central incisors, in particular, aided by appropriate diagnostic aids, can lead to accurate diagnosis and management of a tooth or teeth with a palato-radicular groove.

The main purpose of this review is to present the aetiological factors and the mechanism that cause dilaceration of the maxillary central incisors. In early developmental stages, the permanent tooth germ of the maxillary incisor is situated palatally and superiorly to the apex of the primary incisor and gradually changes direction in a labial direction with its crown coming closer to the resorbing primary root. For reasons of this close relationship between the permanent tooth germ and the apex of the primary incisor, it is believed that an acute trauma to the primary predecessor can cause dilaceration of the long axis of the permanent successor. Clinically, dilaceration can be revealed by palpation high in the labial sulcus or in the hard palate, while its radiographic view is characteristic. The therapeutic approach to the dilacerated maxillary central incisors has to be carefully planned and needs the cooperation of several specialities to attain the final objective., (© 2010 John Wiley & Sons A/S.)

Oculodentodigital dysplasia is an extremely rare autosomal dominant pleiotropic disorder. The syndrome is characterized by abnormal facial features, central nervous system involvement, syndactyly and clinodactyly of fourth and fifth fingers, dry and lusterless hair, generalized enamel hypoplasia and odontodysplasia. Combination of odontodysplasia, poor oral hygiene, and parental neglect can lead to extensive destruction of tooth structure and the treatment options become limited. Early diagnosis with a proper treatment plan and meticulous oral hygiene program helps eliminate the necessity of multiple tooth extractions. This case report describes the comprehensive dental treatment aimed at rehabilitation of function and aesthetics of the dentition in an 8-year-old boy with oculodentodigital dysplasia.

Unlabelled: The aim of this second article in this series of two is to outline a variety of methods which may be used to compensate for variations in tooth shape and number using a combination of orthodontic and restorative approaches. It will also provide an overview of other areas of patient care which necessitate a multi-disciplinary orthodontic/restorative approach. The article will highlight the importance of combined planning from the outset and the close relationship between the different specialties, which must be maintained throughout treatment. The methods of compensating for variations in tooth number and shape will often require contributions from both orthodontist and restorative dentist. It is important that both disciplines are involved in the assessment and treatment planning process so that they know what will be expected of them during the patient's care. Treatment planning in isolation may lead to care being delivered which is below the optimum standard which can be achieved. The orthodontist and restorative dentist are likely to liaise with the patient's general dental practitioner so that he/she can provide the restorative treatment in some cases., Clinical Relevance: Great improvements in aesthetics and function may be obtained using an interdisciplinary approach for patients who have variations in tooth number and shape.

Ectodermal dysplasia are rare genetic diseases characterized by the absence or dysplasia of some tissues of ectodermal origin. We present a case of a young boy seen at the age of seven and a half years for late eruption of teeth, morphologic abnormalities of the teeth and a feeling of exaggerated heat. The diagnosis of anhidrotic ectodermal dysplasia was discussed. The absence of sweat glands on the skin biopsy slides was in favor of the diagnosis. Dental prostheses were put in place which the aim of permitting the child to eat normally and have a better self image.

Aim: Cleidocranial dysplasia (CCD) is a rare disorder that is inherited as an autosomal genetic trait. It is characterised by defective ossification, delayed bone and tooth development, stomatognathic and craniofacial abnormalities and it is caused by mutations in the RUNX2 gene that is responsible for osteoblast differentiation. CCD is a dental disease that needs complex rehabilitation and the assistance of several specialists. In most cases, this disease precipitates towards the end of childhood with the progressive morbidity of the deciduous dentition, thus leading to edentulism at a young age and giving patients an older appearance. Several therapeutic approaches have been proposed within literature. The aim of this paper is to revise the literature on the proposed therapeutic approaches for the functional and aesthetical rehabilitation of the typical defects caused by CCD in the cephalic region, and to identify the most effective therapy currently available., Conclusions: The most effective therapeutic approach for the early treatment of the orthodontic and orthopaedic diseases in CCD patients would start with an orthopaedic treatment of the upper jaw followed by orthodontic and surgical treatments. When growth is completed a reintervention for maxillofacial surgery and the orthodontic treatment may be required. Finally, if some teeth are missing. function and aesthetics can be achieved replacing them with prosthesis.

Objective: The aim of this study was to report the case of a Japanese subject with ring chromosome 18 syndrome. A cephalometric analysis was performed, and the treatment procedure is described., Design: Lateral and posteroanterior cephalograms were compared with Japanese norms. Dental anomalies were evaluated by a model analysis. The outcome of orthodontic-prosthodontic treatment was evaluated by comparing cephalograms during the course of treatment., Results: The cephalometric analysis showed a reduction in the cranial base length and cranial width, midfacial depth, and height and width. Comparison of lateral cephalograms at age 16 years 6 months and 22 years 4 months showed late growth of the mandible. The model analysis showed that all of the teeth, except for the mandibular canine, were small., Conclusions: Characteristic craniofacial and dental anomalies were clarified. Successful oral rehabilitation was achieved by combined orthodontic-prosthodontic treatment.

Dens evaginatus is a rare dental anomaly characterized by the development of a tubercle on the occlusal surface of the tooth and can cause pulpitis, pulp necrosis, and periapical periodontitis due to tubercular fracture or attrition. Unlike with caries, pain caused by dens evaginatus may manifest itself in a distant location. Therefore, diagnosing the cause of that pain may prove problematic. Dens evaginatus usually occurs in the mandibular premolars. We report a successfully treated case in which dens evaginatus was difficult to diagnose due to distant radiation of pulpitis-induced pain. This pain occurred as a result of fracture of a tubercle located on the occlusal surface of the maxillary second molar, which is very rare.

Growth hormone insensitivity syndrome, also known as Laron syndrome, is an autosomal recessive disorder caused by defects the of growth hormone receptor gene and may lead to increased growth hormone levels. This syndrome's main clinical features are: dwarfism; acromicria; organomicria; cervical spinal stenosis; early osteoarthritic changes of the atlantoaxial joint; small oropharynx; decreased growth velocity; insulin resistance; hypoglycemia; delayed skeletal maturation and osteoporosis; and muscular and central nervous tissue underdevelopment. The facial bones, especially sphenoid and mandibular, are also underdeveloped. No reports of the incidence of growth hormone insensitivity syndrome in the population are available in the literature. The purpose this case report was to describe oral findings and particularities of dental treatment in a child with growth hormone insensitivity syndrome.

Aims: To describe our treatment considerations obtained from the dental care of several boys affected with X-linked hypohidrotic ectodermal dysplasia (HED) and to discuss the different problems that may arise in connection with these kinds of treatments., Study Design: The subject group included 10 males affected with X-linked HED, treated at the department of Paediatric Dentistry and Clinical Genetics, Copenhagen School of Dentistry. All patients were treated, after a period of adaptation, with removable prostheses and whenever necessary, composite restoration of the conical crown morphology of the maxillary incisors. Furthermore, some of the patients received an orthodontic treatment for closure/reduction of the medial diastema., Results: The mean number of appointments at the department was 32 with a range from 7 to 59 appointments. In 7 out of 10 patients, the treatment was a success according to the patient, parents and dentist. In 3 out of 10 patients the treatment was not a success from the dentist's point of view: primarily due to lack of cooperation between the patient, parents and dentist. In half of the patients the deviated maxillary incisors morphology was restored and 5 out of 10 patients received orthodontic treatment for closure of the medial diastema in the maxilla., Conclusion: It is of utmost importance to take the motivation of the patient and parents as well as the patient's acceptance for dental treatment into consideration. Furthermore, the treatment is rather time-consuming and should involve different areas of specialisation. Finally it is vital to remember that the parents may also have undergone a prolonged dental treatment, which might reduce their patience regarding their children's treatments.

Taurodontism can be defined as a change in tooth shape caused by the failure of the Hertwig's epithelial sheath diaphragm to invaginate at the proper horizontal level. An enlarged pulp chamber, apical displacement of the pulpal floor, and no constriction at the level of the cementoenamel junction are the characteristic features. Permanent molars are most commonly affected. Endodontic treatment of a taurodont tooth is challenging and requires special handling because of the proximity and apical displacement of the roots. Here, we report a case in which endodontic treatment of the maxillary right first molar with taurodontism was performed. In this case, the maxillary right second molar and maxillary left first and second molars were also taurodont teeth.

Objectives: To assess retrospectively, over at least 5 years, the incidences of technical and biological complications and failures in young adult patients with birth defects affecting the formation of teeth., Material and Methods: All insurance cases with a birth defect that had crowns and fixed dental prostheses (FDPs) inserted more than 5 years ago were contacted and asked to participate in a reexamination., Results: The median age of the patients was 19.3 years (range 16.6-24.7 years) when prosthetic treatment was initiated. Over the median observation period of 15.7 years (range 7.4-24.9 years) and considering the treatment needs at the reexamination, 19 out of 33 patients (58%) with reconstructions on teeth remained free from all failures or complications. From the patients with FDPs and single unit crowns (SCs) on implants followed over a median observation period of 8 years (range 4.6-15.3 years), eight out of 17% or 47% needed a retreatment or repair at some point due to a failure or a complication. From the three groups of patients, the cases with amelogenesis/dentinogenesis imperfecta demonstrated the highest failure and complication rates. In the cases with cleft lip, alveolus and palate (CLAP) or hypodontia/oligodontia, 71% of the SCs and 73% of the FDPs on teeth (FDP T) remained complication free over a median observation period of about 16 years. Sixty-two percent of the SCs and 64% of the FDPs on implants remained complication free over 8 years. Complications occurred earlier with implant-supported reconstructions., Conclusions: Because healthy, pristine teeth can be left unprepared, implant-supported SCs and FDPs are the treatment choice in young adults with birth defects resulting in tooth agenesis and in whom the edentulous spaces cannot be closed by means of orthodontic therapy. However, the trend for earlier and more frequent complications with implant-supported reconstructions in young adults, expecting many years of function with the reconstructions, has to be weighed against the benefits of keeping teeth unprepared. In cases with CLAP in which anatomical conditions render implant placement difficult and in which teeth adjacent to the cleft require esthetic corrections, the conventional FDP T still remains the treatment of choice.

Background and Objective: The transfer of forces and moments between the bracket and archwire is decisive in the multi-band/bracket technique. New developments in bracket design and ligation method aim to optimize the transfer of forces and moments and improve leveling effectiveness. We thus aimed in this study to investigate whether leveling behavior is influenced by different bracket systems, or by the ligation method. The baseline situation for this examination was a complex tooth malalignment., Material and Methods: Using the orthodontic measurement and simulation system (OMSS), we tested the leveling effectiveness of nine self-ligating bracket systems made by various manufacturers (Forestadent-Quick, in active and passive variants, Dentsply GAC In-Ovation, adenta TIME, Ormco Damon 2 and Damon 3MX, UP-Dental Opal-M and Opal-2, Strite SPEED) in the 0.022 inch slot system. A conventional bracket system (Dentaurum discovery) was used for reference purposes. We also used a multistranded steel archwire (Ormco Tripleflex, 0.44 mm round) and four nickel-titanium archwires of various diameters (Forestadent BioStarter 0.30 mm round, BioStarter 0.40 mm round, Titanol Low Force 0.40 x 0.40 mm(2) and Titanol Low Force 0.40 x 0.56 mm(2)). The leveling task consisted of correcting a complex malalignment (infraocclusion and vestibular displacement, each of 2 mm) of tooth 21. We analyzed the forces and torque movements that arose during the leveling phase., Results: The test of the ten bracket systems revealed no significant difference in terms of their leveling effectiveness. Both selfligating brackets and conventional brackets behaved similarly, and we observed roughly 80% of the infraocclusions to have been corrected. Vestibular displacement was corrected with all the bracket systems by as much as 100% or even more due to a developing torque movement. The influence of wire material and wire diameter became apparent in relation to existing forces durconvening the leveling stage; those factors' influence was clearly greater than that of the ligation method., Conclusions: This study's results demonstrate that bracket selection has a negligible influence on leveling effectiveness. Although self-ligating brackets are easier for the orthodontist to manipulate and provide patients with esthetic and wearing comfort advantages, they are not superior to conventional brackets in terms of their biomechanical characteristics.