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Management of dental, oral and maxillofacial developmental disorders

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Abstract

This chapter looks at the management of developmental abnormalities of the hard and soft tissues of the head, including occlusion and malocclusion, abnormalities of teeth, lip and palate defects. : Obtaining a full-mouth impression, bite registration and creating stone models; Fabrication of a direct inclined plane; Active orthodontic appliance with brackets, buttons or ligature wires and elastic chain.

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Figures

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10.1 (a) Front and (b) lateral view of a dog with normal occlusion. Note the position of the mandibular canine tooth (*) and the interdigitation of the cusps of the maxillary and mandibular premolar teeth (white zig-zag pattern). The maxillary fourth premolar tooth (P4) conceals the mandibular first molar tooth when the mouth is closed. (a, © AVDC used with permission; b, © Dr Margherita Gracis)
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10.2 (a) Front and (b) lateral view of a cat with normal occlusion. (a) Note the position of the mandibular canine tooth (*). (b) Note the position of the maxillary canine tooth (*) and the interdigitation of the cusps of the maxillary and mandibular premolar teeth (white zig-zag pattern). The maxillary fourth premolar tooth (P4) conceals the mandibular first molar tooth when the mouth is closed. (© Dr Alexander M. Reiter)
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10.4 (a) Front and (b) lateral view of a dog with a class 2 malocclusion. Note that the lower jaw is too short with the mandibular canine tooth (*) and the incisor teeth impinging on the hard palate mucosa. (© AVDC used with permission)
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10.5 (a) Front and (b) lateral view of a dog with class 3 malocclusion. Note the upper jaw is too short with the mandibular canine tooth (*) hitting the distal aspect of the maxillary third incisor tooth upon closure of the mouth. Several maxillary incisor teeth bite into the gingiva lingual to the mandibular incisor teeth. (© AVDC used with permission)
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10.6 Maxillomandibular asymmetry in a rostrocaudal direction in a dog. Front views with the mouth (a) nearly closed and (b) moderately open. Note that the right upper jaw appears shorter compared with the left, and that there is no longer midline alignment between the upper and lower jaws. (© Dr Alexander M. Reiter)
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10.7 Maxillomandibular asymmetry in a side-to-side direction in a dog with mixed dentition. Front views with (a) the mouth closed and (b) the lips retracted. Note the loss of the midline alignment of the upper and lower jaws due to severe deviation. (© Dr Alexander M. Reiter)
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10.8 Maxillomandibular asymmetry in a dorsoventral direction resulting in an open bite in a 7-month-old dog. Note that all four deciduous canine teeth are still present, and there appears delayed eruption of the permanent canine teeth. (© Dr Alexander M. Reiter)
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10.9 A small selection of orthodontic instruments. (a) Multiple purpose pliers. (b) Three-prong pliers. (c) Posterior bracket holders. (d) Mathieu needle holder. (e) Mixing spatulas. (f) Rubber mixing bowls. (g) Two versions of impression trays. (h) Dental vibrator. (i) Acrylic contouring bur mounted on a straight cone on a low-speed handpiece.
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10.10 Interceptive orthodontics performed in a 2.5-month-old puppy. (a) Note the discrepancy in length between the upper and lower jaws. (b) Impressions left in the hard palate mucosa by the deciduous mandibular canine and incisor teeth. (c) Sutured extraction sites. (d) Note the crown-root relationships of extracted deciduous teeth. (© Dr Alexander M. Reiter)
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10.11 (a) Lateral view of the closed mouth and (b) occlusal view of the rostral upper jaw in a 7-month-old dog. Note the presence of persistent deciduous canine teeth (*), accompanied by a displaced permanent left mandibular canine tooth leaving an impression in the gingiva immediately distal to the third incisor tooth (arrowed).
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10.12 Linguoversion of the left mandibular canine tooth in a dog, causing a soft tissue lesion mesial to the left maxillary canine tooth.
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10.13 (a) Linguoversion of mandibular canine teeth (*) in a dog with class 2 malocclusion. (b) Impressions are left in the hard palate mucosa (arrowed) by the displaced mandibular canine teeth. Note the presence of four persistent deciduous canine teeth. (c) The deciduous canine teeth were extracted and the crowns of the permanent canine teeth were reduced to the level of the mandibular incisor teeth, followed by vital pulp therapy. (© Dr Alexander M. Reiter)
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10.14 Two different designs of direct inclined planes: (a) one design moves the mandibular canine teeth mesiolabially and (b) the other design moves the mandibular canine teeth distolabially. (© Dr Alexander M. Reiter)
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10.15 (a) Linguoversion of the right mandibular canine tooth (*) in a dog. (b) Composite resin extension has been bonded to the displaced tooth in order to tip it labially upon occluding into the space between the ipsilateral maxillary third incisor and canine tooth. The appliance should be built bilaterally to avoid mandibular deviation and allow for proper tooth tipping. (© Dr Sigbjorn Storli)
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10.16 (a) The lingually displaced left mandibular tooth has left an impression in the gingiva between the left maxillary third incisor and canine teeth. (b) A natural inclined plane is created with a 12-fluted bur (bullet- or egg-shaped) on a water-cooled high-speed handpiece to create space for and allow the lingually displaced left mandibular canine tooth to move labially. (c) The cut gingiva is coated with a layer of tissue protectant (such as tincture of myrrh and benzoin). (© Dr Alexander M. Reiter)
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10.17 (a) Dog with a ‘lance canine’, an extreme form of mesioversion, of the right maxillary canine tooth (*). (b) Mesioversion of the right maxillary canine tooth (*) in a cat.
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10.18 (a) Mesioversion of the maxillary canine teeth in a 6-month-old Siamese cat. (b) Active orthodontic movement is performed. Note the elastic chain spanning from a transparent plastic button on the left maxillary canine tooth to a wire hook attached to an anchorage unit built on the maxillary third and fourth premolar teeth. (c) Front view 1 week after the start of treatment. (© Dr Alexander M. Reiter)
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10.19 Rostral crossbite in a dog involving the right mandibular second incisor tooth (*). (© Dr Alexander M. Reiter)
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10.20 Caudal crossbite in a dog with the left mandibular first molar tooth (*) occluding buccal to the left maxillary fourth premolar tooth. (© Dr Alexander M. Reiter)
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10.21 (a) Front and (b) side views of severely worn teeth resulting in pulp exposure in a dog with ‘level bite’ malocclusion. (© Dr Alexander M. Reiter)
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10.22 Enamel hypoplasia of (a) maxillary and (b) mandibular teeth in a dog. The banded enamel defects affecting multiple teeth indicate that some systemic disturbance occurred for a finite amount of time during amelogenesis.
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10.23 Enamel hypomineralization in a dog. (a) Note the scratches made in the crown surface of the left maxillary fourth premolar tooth upon scaling. (b) Note the lack of a dense enamel layer on the radiograph showing the left mandibular cheek teeth. (© Dr Alexander M. Reiter)
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10.24 (a) Clinical and (b) radiographic appearance of some of the teeth of a 6-month-old crossbreed dog affected by dentinogenesis imperfecta. All teeth showed similar radiographic features, with a thinner than normal layer of dentine. Histologically, the presence of cementum on an extracted tooth was inconsistent, and the presence of dentine was unremarkable with a poor or absent tubular architecture. (© Dr Margherita Gracis)
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10.25 Developmentally missing mandibular third incisor and first premolar teeth in a dog. (© Dr Alexander M. Reiter)
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10.26 Hyperdontia in a dog. There are five right maxillary incisor and four left maxillary incisor teeth; the left maxillary second incisor tooth (*) shows gemination.
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10.27 (a) Front view, (b) ventral view and (c) dental radiograph of a dog showing gemination of the right maxillary second incisor tooth (arrowed) and a supernumerary left maxillary first (or second) incisor tooth (*). (© Dr Alexander M. Reiter)
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10.28 (a) Front view and (b) dental radiograph showing fusion of the left maxillary first and second incisor teeth in a dog. (© Dr Alexander M. Reiter)
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10.29 Radiograph of a right mandibular first molar tooth in a dog, showing dilacerated root ends (arrowed). (© Dr Alexander M. Reiter)
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10.30 Dens invaginatus of a left mandibular first molar tooth in a dog. (a) There is a sinus tract (arrowed) at the mucogingival junction. (b) There is evidence of coronal invagination (*) and periapical disease (arrowed) on the dental radiograph of this tooth. (© Dr Alexander M. Reiter)
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10.31 Ectodermal dysplasia in the jaws of a puppy. (a) Left side view. (b) Dental radiograph of the left upper jaw. (c) Dental radiograph of the left lower jaw. Note the presence of oligodontia, reduced number of cusps, and conical shape of the cusps of both the deciduous and permanent teeth. (© Dr Alexander M. Reiter)
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10.32 Embedded tooth in a cat. (a) The right maxillary canine tooth is clinically missing. (b) Dental radiography shows the tooth (*) to be present with an abnormally shaped root. Note also the displaced right maxillary third incisor tooth (arrowed), consistent with a previous history of trauma. (c) A small flap was raised, and (d) the malformed canine and incisor teeth were extracted. (© Dr Alexander M. Reiter)
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10.33 Impacted tooth in a dog. (a) The right mandibular canine tooth is clinically missing. (b) Dental radiography shows the tooth (*) to be present. (c) A lingual approach was undertaken and (d) the malformed tooth (together with the second incisor and first, second and third premolar teeth) was extracted. (e) The wound was then sutured closed. (© Dr Alexander M. Reiter)
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10.34 Dentigerous cyst in a dog. (a) Lateral view of the left rostral mandible. Note the swelling in the area of a missing first premolar tooth and the distally displaced second premolar tooth. (b) Dental radiography shows an unerupted left mandibular first premolar tooth (*) to be surrounded by a cyst-like lesion (arrowed), causing pressure resorption of the roots of the caudally displaced second premolar tooth (306). (© Dr Alexander M. Reiter)
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10.35 Defect of the primary palate, manifesting as a left-sided cleft lip and a cleft of the most rostral hard palate in an 8-month-old Boston Terrier. (a) Front view and (b) with the upper lips retracted. (© Dr Alexander M. Reiter)
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10.36 Complete defect of the secondary palate, manifesting as a midline cleft of the hard and soft palate in a 5-month-old Bulldog. (a) View towards the hard palate cleft. (b) The defect is repaired with an overlapping flap technique. (c) View towards the soft palate cleft. (d) The defect is repaired with a medially positioned flap technique. (© Dr Alexander M. Reiter)
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10.37 For narrow congenital hard palate clefts, the medially positioned flap technique may be utilized. (a) Incisions are made at the medial edges of the hard palate defect. Releasing incisions 1–2 mm away from the teeth are often necessary for accommodation of flaps. (b) The periosteum is undermined without injuring the major palatine arteries. (c) The flaps are slid together and sutured over the defect. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. (Reproduced from the )
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10.38 For wider congenital hard palate clefts, the overlapping flap technique is utilized. (a) Incisions are made in the mucoperiosteum of the hard palate. (b) Flap A is elevated and flap B is undermined. (c) Flap A is turned on itself and sutured under flap B so that the connective tissue surfaces are in contact. Care should be taken to not injure the major palatine arteries during elevation of flap A and undermining flap B. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. (Reproduced from the )
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10.39 For soft palate clefts, the medially positioned flap technique is utilized. (a) Incisions are made at the margins of the soft palate defect. (b) Dorsal and ventral flaps are sutured separately. (c) Both hard (overlapping flap technique) and soft palate defects closed. T = palatine tonsil. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. (Reproduced from the )
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10.40 Repair of unilateral clefts of the soft palate. (a) First remove the ipsilateral palatine tonsil (*) and then (b) extend the tonsillectomy incision rostrally to the most rostral location of the soft palate defect and continue along the medial edge of the soft palate defect. The pharyngeal and palatal tissues are separated, and two dorsal (1) and two ventral (2) flaps are created. (c) These flaps are sutured separately in a simple interrupted pattern to the level of the midpoint or caudal end of the contralateral tonsil. (d) The 2-month re-examination shows slight dehiscence at the caudal margin of the sutured site. However, the caudal edge of the soft palate (arrowed) still correctly lines up with the caudal end of the contralateral tonsil. (© Dr Alexander M. Reiter)
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10.41 Temporomandibular joint dysplasia in a dog shown on a lateral oblique radiographic view. Note the lack of congruence of the mandibular condyle (MC), the flattened mandibular fossa (MF), and the short retroarticular process (RP). B = tympanic bulla.
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10.42 Dalmatian dog with open-mouth jaw locking. The mouth is locked open with no contact between the upper and lower teeth, the lower jaw is rotated ventrolaterally towards the right side, and the tip of the coronoid process (*) of the displaced right mandible is locked ventrolateral to the zygomatic arch. (© Dr Margherita Gracis)
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10.43 Dorsoventral radiographic views of a dog with open-mouth jaw locking. (a) Before partial zygomectomy. (b) Following surgery. Note the position of the coronoid process (*), the zygomatic arch (Zyg) and the area where the surgery was performed (arrowed).
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10.44 (a) Craniomandibular osteopathy in a dog, manifesting as thickened mandibles and calvarial bones. (b) The patient 1 year later, showing resolution of clinical signs but continued thickening of the ventral mandibular borders.
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10.45 A 4.5-month-old male Labrador Retriever with periostitis ossificans. (a) Note the fluid-filled swelling (*) in the area of the left mandibular deciduous fourth premolar (708) and permanent first molar (309) teeth and the clinical signs of pericoronitis (arrowed) at the incompletely erupted left mandibular second molar (310) tooth. (b) The occlusal radiograph of the left mandibular body shows the double-cortex formation lingually and buccally (arrowed) with a space between the two cortices (*). (From , , with permission; © Dr Alexander M. Reiter)
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10.46 Dental radiographs of the (a) rostral upper jaw and (b) rostral lower jaw in a 10-year-old dog with renal secondary hyperparathyroidism and fibrous osteodystrophy clinically manifesting as ‘rubber jaw’. (© Dr Alexander M. Reiter)
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10.47 (a) Severely stenotic nares in a young French Bulldog. (b, c) Bilateral naroplasty has been performed.
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10.48 (a) The elongated soft palate of a dog is grasped with a pair of tissue forceps and gently pulled rostroventrally. Wet gauzes are used to protect the other soft tissues and the endotracheal tube while using the CO laser scalpel. (b) The soft palate is resected from the caudal edge of one tonsil to the caudal edge of the other (*). Use of the laser scalpel eliminates the need to suture the incised margin. (c) The piece resected with the laser shows a non-bleeding cutting edge.
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10.49 Mastiff dog with tight lower lip. (a) The lower lip rolls caudally over the mandibular incisors. (b) A partial-thickness incision is made into alveolar mucosa near the mucogingival junction. The lip is dissected free and allowed to hang down. (c) The edges of the labial mucosa of the freed lip are sutured down to the periosteum to prevent them from re-attaching to the alveolar mucosa. The defect is left to granulate in by second intention. This creates a new band of epithelialized tissue that releases the tension on the lip. When the surgery is complete, the lower lip should rest in a lower position than before, and the incisor teeth should be visible. (d) At the 3-week recheck visit, the lower lip is still below the incisor teeth.
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10.50 Puppy with macroglossia. Note the erosions at the rostral aspect of the dorsum of the tongue. (© Dr Alexander M. Reiter)
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