In August 23-25, 2007, the Scandinavian Society for Prosthetic Dentistry in collaboration with the Danish Society of Oral Implantology arranged a consensus conference on the topic 'Implants and/or teeth'. It was preceded by a workshop in which eight focused questions were raised and answered in eight review articles using a systematic approach. Twenty-eight academicians and clinicians discussed the eight review papers with the purpose to reach consensus on questions relevant for the topic. At the conference the consensus statements were presented as well as lectures based on the review articles. In this article the methods used at the consensus workshop are briefly described followed by the statements with comments.

This study was performed to establish age- and gender-specific cephalometric normative data for a Swedish population. The material comprised 469 lateral cephalograms from two groups of subjects of Swedish origin between 5 and 31 years of age. All subjects (males and females) were diagnosed as 'normal' according to specified criteria and with no history of orthodontic treatment. Lateral cephalograms and body height measurements were taken at 5, 7, 10 and 13 years of age in one group (group E) (longitudinal follow-up). The same registrations were made in the other group (group U) at 7, 10 and13 years of age (mixed longitudinal type). Those 13 year olds were re-examined at 16, 19 and 31 years of age (longitudinal follow-up). No significant differences between age groups in the two samples were found. Therefore, subjects of the same age were combined. The study is hence regarded as a longitudinal follow-up from 5 to 31 years of age. The subjects were also grouped into dental development stages to widen the applicability of the cephalometric data.The craniofacial distances were constantly larger in males than in females, while no statistical differences as regards angular measurements were seen between genders. Distances as well as angular measurements varied with the different developmental periods. The results clearly verify that facial pattern changes existed during the observation period, with a growth acceleration of most distances between the 13 and 16 year recordings.

The aim of the present study was to evaluate the long-term effect of implants installed in different dental areas in adolescents. The sample consisted of 18 subjects with missing teeth (congenital absence or trauma). The patients were of different chronological ages (between 13 and 17 years) and of different skeletal maturation. In all subjects, the existing permanent teeth were fully erupted. In 15 patients, 29 single implants (using the Brånemark technique) were installed to replace premolars, canines, and upper incisors. In three patients with extensive aplasia, 18 implants were placed in various regions. The patients were followed during a 10-year period, the first four years annually and then every second year. Photographs, study casts, peri-apical radiographs, lateral cephalograms, and body height measurements were recorded at each control. The results show that dental implants are a good treatment option for replacing missing teeth in adolescents, provided that the subject's dental and skeletal development is complete. However, different problems are related to the premolar and the incisor regions, which have to be considered in the total treatment planning. Disadvantages may be related to the upper incisor region, especially for lateral incisors, due to slight continuous eruption of adjacent teeth and craniofacial changes post-adolescence. Periodontal problems may arise, with marginal bone loss around the adjacent teeth and bone loss buccally to the implants. The shorter the distance between the implant and the adjacent teeth, the larger the reduction of marginal bone level. Before placement of the implant sufficient space must be gained in the implant area, and the adjacent teeth uprighted and paralleled, even in the apical area, using non-intrusive movements. In the premolar area, excess space is needed, not only in the mesio-distal, but above all in the bucco-lingual direction. Thus, an infraoccluded lower deciduous molar should be extracted shortly before placement of the implant to avoid reduction of the bucco-lingual bone volume. Oral rehabilitation with implant-supported prosthetic constructions seems to be a good alternative in adolescents with extensive aplasia, provided that craniofacial growth has ceased or is almost complete.

The aim of the study was to assess the prevalence of malocclusion in a population of Bogotanian children and adolescents in terms of different degrees of severity in relation to sex and specific stages of dental development, in order to evaluate the need for orthodontic treatment in this part of Colombia. A sample of 4724 children (5-17 years of age) was randomly selected from a population that attended the Dental Health Service; none had been orthodontically treated. Based on their dental stages the subjects were grouped into deciduous, early mixed, late mixed and permanent dentition. The registrations were performed according to a method by Björk et al. (1964). The need for orthodontic treatment was evaluated according to an index used by the Swedish National Board of Health. The results showed that 88 per cent of the subjects had some type of anomaly, from mild to severe, half of them recorded as occlusal anomalies, one-third as space discrepancies, and one-fifth as dental anomalies. No clear sex differences were noted, except for maxillary overjet, spacing, tooth size (all more frequent in boys), and crowding (more frequent in girls). Occlusal anomalies and space discrepancies varied in the different dental developmental periods, as did tipped and rotated teeth. Little need for orthodontic treatment was found in 35 per cent and moderate need in 30 per cent. A great need was estimated in 20 per cent, comprising children with prenormal occlusion, maxillary overjet, or overbite (> 6 mm), posterior unilateral crossbite with midline deviation (> 2 mm), severe crowding or spacing, congenitally missing maxillary incisors, impacted maxillary canines or anterior open bite (> 3 mm in the permanent dentition). Urgent need for treatment was estimated to be 3 per cent, comprising subjects with extreme post- and pre-normal occlusion, impacted maxillary incisors or extensive aplasia.

The aim of the present study was to describe some histopathologic features of tissues collected from root resorption areas of maxillary canines after transalveolar transplantation surgery. In 8 of 101 transplanted canines, complications including cervical root resorption occurred between 6 and 11 years after treatment. The resorptive processes were located at the supra-alveolar portions of the distal and/or mesial aspects of the teeth and were scheduled for treatment involving surgical exploration. The resorption cavities, which extended from the cementoenamel junction to a position immediately below the bone crest, were filled with a granulation tissue. In four of the diagnosed complication cases, this granulation tissue was carefully excised concomitant with the adjacent gingival tissue after flap elevation and placed in a buffered fixative. After proper soft-tissue healing, the cavities were filled with a glass-ionomer material. The collected biopsy specimens were, after fixation and, in one case, decalcification in ethylenediaminetetraacetic acid, dehydrated and embedded in Epon. Sections 3 microns thick were produced, stained in periodic acid-Schiff and toluidine blue, and used for histometric and morphometric analyses. The histologic analysis showed that the dissected tissue harbored well-encapsulated areas of inflammatory infiltrates. The lesions comprised a relatively low volume of collagen and a large number of inflammatory cells, predominantly lymphocytes.

Regular discussions between the Departments of Oral Surgery and Orthodontics at Göteborg University have resulted in a modified operative technique for impacted maxillary canines, called transalveolar transplantation. After exposure of the operation field, large amounts of bone are removed, avoiding damage to the surface of the cementum and the periodontal membrane. Throughout the surgical procedure the tooth is kept in the alveolar process and then finally gently moved to its desired position. Orthodontic fixation is used to stabilize, not to immobilize, the tooth. So far 101 maxillary canines have been autotransplanted in 85 patients (11-76 years old) with an observation period of 1-17 years. Transalveolar transplantation is considered a good alternative for impacted maxillary canines, provided that the treatment planning is discussed by an orthodontist and an oral surgeon together and the treatment is performed with meticulous surgical techniques and adequately functioning orthodontic fixation and used in patients with proper oral hygiene.

In 15 adolescents (age 13.2 to 19.4 years) in the late dental stage implants (n = 27) were chosen to replace missing teeth due to congenital absence or trauma. The patients were followed for at least 3 years. No fixture losses occurred. Only minor loss of bone support at the fixture was observed, while adjacent tooth surfaces showed some loss. Infra-occlusion of the implant restorations was noticed in patients with residual craniofacial growth. Thus, the dental and skeletal maturation, and not the chronological age, must be taken into account to avoid infra-occlusion. Furthermore it is important to gain enough space for the fixture in the mesio-distal direction in order to avoid the risk of marginal bone loss at teeth adjacent to the implants.

The changes in craniofacial growth and development of dental occlusion were studied in children with juvenile chronic arthritis (JCA), and treatment with functional orthodontic appliances (activators) was tested in both JCA and healthy children with distal occlusion. Fifteen JCA children with Angle Class I occlusion and 15 JCA children with Angle Class II malocclusion were followed longitudinally and compared with 23 healthy children with Angle Class II malocclusion. The facial growth of the JCA children without need of orthodontic treatment mainly followed the normal pattern while the JCA children with Angle Class II malocclusion had a deviating facial morphology, which became more abnormal during growth. During the orthodontic treatment period a slight improvement was seen in mandibular positions in the sagittal and vertical planes in both treated groups, but the changes were more marked in the healthy children. None of the treated groups attained completely normal facial morphology, but in most children the occlusion improved and could be classified as normal. The morphology achieved by treatment largely remained the same during the follow-up period and relapse was seen only in a few children. JCA children with minor skeletal discrepancies can be satisfactorily treated during growth with functional orthodontic appliances, possibly in combination with fixed appliances. Even if skeletal changes in response to orthodontic treatment are rather limited, these changes combined with the improvement in dental occlusion obtained through treatment may result in better dentofacial aesthetics. Furthermore, jaw functions are likely to improve which also might benefit the patient from a psychosocial point of view.

Bone growth is controlled by growth areas, not active growth centers as stated earlier. Conversion of cartilage, sutural deposition, and periosteal remodeling are the basic phenomena involved in growth mechanisms. The principles of bone growth will result in changes in the size and shape of the mandible and the nasomaxillary complex in the three dimensions. The growth rate varies at different times during the development of the child. The processes of facial growth and changes in the dental arches continue to a much later age than had previously been realized. Although our knowledge of craniofacial growth has increased during recent times, it is still incomplete with regard to the explanation for the regulation of craniofacial growth.

The aim of the present study was to evaluate the influence of condylar destruction on the craniofacial growth of children with juvenile chronic arthritis (JCA) and to compare their craniofacial structure with that of healthy children with ideal or postnormal occlusion. Thirty-five children (7 to 16 years) affected by JCA were compared with 136 children (7 to 16 years) with normal facial structure and occlusion (ideal group) and 62 children (7 to 12 years) with postnormal occlusion (postnormal group). Panoramic radiographs and lateral cephalograms were taken to detect condylar lesions and analyze facial structure. Multiple regression analysis was applied to test the possible relationships between the groups. The present study largely confirms earlier findings that the JCA group has a characteristic craniofacial structure. Their structure differed not only from the facial characteristics of children with ideal, but also to some extent, from children with postnormal occlusion. Furthermore, the craniofacial structure of children with JCA varied greatly, and radiographs showed that the most extreme craniofacial changes, particularly the mandibular structure, were associated with condylar lesions. In conclusion, the arthritic condylar lesions seem to be the main etiologic reason for the altered facial structure and changes in the occlusion in children with JCA. Influences of other factors, such as masticatory muscular function, are also discussed. (AM J ORTHOD DENTOFAC ORTHOP 1995;107:67-78.)

The aim of this study was to develop and apply a reliable method of measuring the effects of condylar lesions quantitatively on panoramic radiographs. Three different types of machines were tested. Two dry skulls were exposed in six positions in each machine, and the relative size of the condyle in relation to ramus height was calculated. The results showed good validity for the reference points used. The head position did not contribute to the variation in the measurements, but the type of panoramic machine had some influence. It was concluded that the method may be applied when calculating condylar ratios, provided that the same panoramic machine is used. The relative height of the condyle in relation to ramus height was measured bilaterally in three groups of children, with either normal or postnormal occlusion or with juvenile chronic arthritis (JCA), to detect possible asymmetries and define differences in the relative condylar height. The JCA group had a significantly shorter relative condylar height, and asymmetries were commoner than in the other two groups.

In this investigation, the tissue reactions towards titanium implants inserted in growing jaws of pigs were studied by means of histology. At the age of 12 weeks, 5 test pigs each received 4 Brånemark System titanium implants (fixtures). The fixtures were inserted immediately after extraction of the mesial root of the second deciduous premolar (P2) and the deciduous canine (C) on one side of the mandible and the mesial root of the first deciduous premolar (P1) on the other side. The fourth implant was placed after extraction of the deciduous lateral incisor (L) on one side in the upper jaw. Furthermore, 1 pig in which no extractions or fixture installations were performed served as a control. All pigs were followed for 165 days with clinical, radiographic and biometric examinations, the results of which have been previously presented. In this study, 10-microns-thick ground sections were produced for histology after the jaws had been fixed by immersion in formalin and further processed and embedded in plastic resin. Six of the fixtures originally inserted were lost during the experimental period, and the remaining implants were found to be involved with mineralized bone to varying degrees. Regarding the fixture-to-teeth relationship, it was found that, in the premolar region of the lower jaw, the teeth were positioned superior to and buccally angulated in relation to the fixtures. In the upper jaw, the implants were positioned below the adjacent teeth but centrally in the alveolar process. Tooth germs adjacent to the fixture had a displaced eruption path, buccally or lingually to the fixture. If the bud developed in close contact with the fixture, a changed morphology of the germ could be observed.

The aim was to study if osseointegrated implants behave like teeth in the growing jaw. Six young pigs were used, one of them randomly selected as a control. The test pigs received four fixtures each in regions with various dento-alveolar development. The biometric and radiographic findings, after an experimental period of 165 days, showed that the osseointegrated implants do not become secondarily displaced in sagittal and transversal dimensions and, thus, do not behave like normal teeth. Consequently, the osseointegration technique is not to be recommended in the lateral regions in young children.

The purpose of the present study was to reexamine a group of children and adolescents with respect to signs and symptoms of craniomandibular disorders (CMD) and to evaluate whether any differences could be found between persons who had received orthodontic treatment earlier and those who had not. A total of 402 children in three age groups (7, 11, and 15 years) had participated in a cross-sectional study on the relationship between malocclusion and signs and symptoms of CMD. Ten years later they were asked to answer a questionnaire. In the youngest age groups (now 17 and 21 years old) 190 (76%) subjects answered the questionnaire. In the oldest age group (now 25 years old) completed questionnaires were received from 103 (84%) subjects, and 83 (62%) of those subjects appeared for a clinical examination. Subjects with a history of orthodontic treatment had a lower prevalence of subjective symptoms of CMD (TMJ sounds included) than those without any experience of orthodontics. Although the differences were small, it was more evident for the oldest age group. The clinical examination has shown that persons who had undergone orthodontic treatment had a significantly lower clinical dysfunction index than those who had not.

Orthodontic tooth extrusion is used at crown lengthening procedures or in conjunction with periodontal therapy aimed at eliminating or reducing angular bone defects. A technique for orthodontic extrusion combined with resection of the supracrestal attachment fibers (fiberotomy) was recently proposed as an adjunct to certain restorative procedures. The aim of the present investigation was to analyze reactions of the periodontal tissues to orthodontic extrusion when combined with fiberotomy. In 5 beagle dogs, the mesial roots of the 2nd, 3rd and 4th hemisected mandibular premolar were used as target roots while the distal roots served as reference units. After a baseline examination, an orthodontic extrusion device (stent) was installed and reactivated at 2-week intervals during an 8-week period of active tooth movement. Immediately following the installation of the stent and once every 2nd week, the target roots were exposed to fiberotomy. After the active period, the teeth were retained in their new position for a period of 8 weeks. Clinical, radiographical and histological measurements were performed. The results from the investigation demonstrated that orthodontic extrusion combined with supracrestal fiberotomy resulted in a coronal displacement of the tooth and was associated with pronounced recession of the gingival margin and extensive loss of connective tissue attachment. The degree of gingival recession and the amount of loss of connective tissue attachment were, however, less extensive than the amount of tooth extrusion. Thus, repeated fiberotomy obviously failed to entirely prevent coronal migration of the attachment apparatus. It was also observed that undesired attachment loss had occurred at the reference roots.

In an attempt to study the effect of osseointegrated implants on vertical dento-alveolar development, six growing pigs of the Pigham strain were used, one of them randomly selected as a control. The test pigs received four fixtures each, three in the lower jaw and one in the upper. The fixtures were placed in areas where different patterns of the dento-alveolar development were expected. The clinical and radiographic findings have clearly shown that the implants do not behave like normal erupting teeth during the development of the dentition. Neither do the fixtures move together with the adjacent teeth, but behave more like ankylosed teeth.

During an excavation of the Carmelite monastery in New Varberg, 178 skeletons were found. Many of the skulls were in a bad condition. Thus, the material in the present study consists of 12 complete and 47 partial skulls (maxilla and/or mandible) of 22 monks and 37 ordinary inhabitants. The information collected involved direct inspection of the skulls, segments of the jaws and radiographic examination of the complete skulls. Malocclusion, attrition, temporomandibular joints and arch dimensions were analysed. From the results it is tempting to assume that lack of forceful masticatory function and consequent absence of evenly distributed attrition and observed differences in craniofacial morphology can be a major explanation to the high prevalence of severe malocclusion in modern man.

The aim of this study was to examine the effects of repelling magnets on the treatment of anterior open bite and compare them with the effects of acrylic posterior bite-blocks. Twenty patients, aged 9-16 years with skeletal anterior open bite, were randomly divided into two groups. In one group the patients wore posterior repelling magnet splints and in the other they wore acrylic posterior bite-blocks of the same thickness as the magnet splints. The patients were instructed to use their appliance as much as possible (the minimum accepted being 18 hours daily) during a 6-month period. Dental casts, intra-oral photos, and lateral cephalograms were taken before and after treatment, and the patients were also examined regularly to identify the development of any craniomandibular disorders. In the first group, the dental and skeletal vertical relation responded quickly to the magnet treatment. The open bite was generally closed in just under 4 months, especially in patients in early mixed dentition. Spacing in the labial segments decreased in some cases, while slight crowding was induced in others. Transverse problems, i.e. unilateral cross-bite, sometimes followed by scissor-bite on the opposite side, was observed in those patients who were in the early mixed dentition and had used the magnets intensively. The patients who wore acrylic posterior bite-blocks also showed improvement in the dental and skeletal vertical relationships, especially during the first months. This was followed by a 'plateau' period. No transverse problems were found in these patients.

Two-hundred-and-thirty-eight subjects in three different age-groups (7, 11, and 15 years) were followed over a period of 4-5 years in respect of morphological malocclusions, and signs and symptoms of functional disturbances. About half of the 7-year-olds had at least one of the morphological malocclusions registered while the corresponding figure was 38 per cent at the age of 20. Some subjects had received corrective orthodontic treatment. When compared with subjects without such treatment, there were no differences in prevalences of occlusal interferences, nor in signs or symptoms of craniomandibular disorders (CMD). The associations between CMD and different morphological malocclusions were low. Nevertheless, some malocclusions were found to be more important than others. In a long-term perspective cross-bite, both uni- and bilateral, anterior open bite, post-, and prenormal occlusion had some association with the development of CMD.

The occlusal traits and the craniofacial morphology were studied in patients with an altered muscle function caused by myotonic dystrophy. Twenty-four adult patients were examined and compared with a matched group of healthy individuals. The condition of the masticatory muscles was evaluated by measuring the maximal bite force. The dental arches and the occlusal traits were analysed on dental casts. Lateral cephalograms were taken in the patients with myotonic dystrophy to study the craniofacial morphology. It was found that the patients suffering from myotonic dystrophy had weak masticatory muscles, which might be caused by the disease. A high prevalence of malocclusions (postnormal occlusion, anterior open bite and lateral cross bite) was found among these patients. Their craniofacial morphology showed a vertical aberration, characterized by a large angle between the mandibular and palatal planes and a steep mandible. These findings seem to be most pronounced in patients with an early onset of the disease and support the hypothesis that reduced muscle function may cause changes in the craniofacial morphology.