Detailed three-dimensional orthodontic tooth repositioning to improve restorative outcome: A case report
Reference
Davide Mirabella
Ugo Macca
Carolina Pancari
Gabriella Giunta
Luca Lombardo
In breve
The case describes the interdisciplinary treatment of a 23-year-old woman with a Class III malocclusion, missing an upper right lateral incisor, abrasion of the maxillary incisal edges, anterior gingival margin discrepancies, and gingival recession. Initially, the patient was treated with fixed appliances combined with orthognathic surgery. The extraction of the upper left lateral incisor and bilateral canine substitution plan was chosen. At the end of the surgical and orthodontic treatment, the restorative treatment with six veneers was accomplished to improve smile esthetics. Despite the missing lateral incisors, the patient showed a natural, good-looking final result. A symmetric incisal plane was established, a functional occlusion with average vertical and horizontal overlap was set, and the bone scallop and consequently the gingival margins were leveled. The interdisciplinary approach hid all of the initial esthetic defects of the case. The result highlights how to obtain a remarkable improvement of the smile outcome with a well-functioning masticatory system.
Immediate Loading of Implants Inserted Through Impacted Teeth in the Esthetic Area: A Series of 10 Cases with up to 7 Years of Follow-up
Reference
Francesco Amato, MD, DDS, PhD1
Ugo Macca, DDS2
Giulia Amato, DDS3
Davide Mirabella, DDS, MSD4
In breve
The purpose of this case series was to evaluate the survival rate and the incidence of complications of implants inserted and immediately loaded in sites where
an impacted tooth was present in the anterior maxillary or mandibular arches (incisor to premolar). The implants were immediately inserted, drilling through the impacted teeth. Site preparation started in the crestal bone and continued into the impacted tooth’s enamel and dentin. Seven patients were treated and 11 implants were inserted, 3 in the mandibular arch and 8 in the maxillary arch. All implants healed uneventfully without any adverse clinical or radiographic signs or symptoms, resulting in a success rate of 100%. Once loaded, the implants were in function and monitored for 5 to 7 years. Although more studies and a larger sample size are needed to validate this unconventional procedure,
it may be considered as a possible clinical option to overcome invasive procedures and surgical complications related to the extraction of impacted teeth. Int J Periodontics Restorative 2019;39:325–332. doi: 10.11607/prd.397
Risk factors for apical root resorption of maxillary anterior teeth in adult orthodontic patients
Reference
A. Davide Mirabella & Jon Ãrtun
In breve
The purpose of this study was to identify risk factors for apical root resorption in adult orthodontic patients. Standardized periapical radiographs of maxillary anterior teeth and cephalograms made before and after treatment and treatment charts of 343 adults, representing groups of consecutively treated patients from four orthodontic practices, were examined. Apical root resorption was calculated by subtracting posttreatment tooth length measurements from the corresponding pretreatment measurements. Root width was measured from the mesial to the distal outline of the roots 4 mm from the apex. Root form was scored subjectively as normal, pointed, eroded, blunt, bent, and bottle shaped. Root movement was calculated from measurements of superimposed tracings of pretreatment and posttreatment cephalograms. Proximity of the central incisor roots to the palatal cortical bone was scored subjectively as present or absent. Severity of initial malocclusion and treatment variables were collected from the charts. Multiple linear regression analyses revealed that amount of root movement, long roots, narrow roots, abnormal root shape, and use of Class II elastics were significant risk factors. However, the statistical model had a low explained variance, strongly suggesting a weak prediction power. No association was found between type of initial malocclusion, treatment time, use of rectangular arch wires, proximity of the root to the palate or treatment with maxillary osteotomy, and root resorption. Endodontic treatment was a preventive factor. (AMJ ORTHODDENTOFACORTHOP1995;108:48-55.) American Journal of Orthodontics and Dentofacial Orthopedics Volume 108, No. 1
Impianti e magneti nel ripristino della continuità occlusale
Reference
Ugo Macca, A. Davide Mirabella Implantologia orale n° 3 Maggio 2000
In breve
L’utilizzo degli impianti osteointegrati nella pratica odontoiatrica ha assunto un ruolo molto importante per la risoluzione di numerosi casi clinici. Recentemente il loro utilizzo come ancoraggio in ortodonzia ha permesso soluzioni terapeutiche altemative. Quando un dente viene mosso ortodonticamente, la forza di reazione si scarica sui denti di ancoraggio che, inevitabilmente, tendono a muoversi. L’ ancoraggio è quindi sempre relativo, ma non nel caso di un dente in anchilosi o di un impianto osteointegrato. Il movimento di intrusione dei molari è di difficile attuazione clinica, perché è seguito dall`estrusione dei denti adiacenti usati come ancoraggio.
Analisi cefalometrica in norma lateralis di un campione di soggetti affetti da morbo di Cooley in terapia trasfusionale intensiva
Reference
Jon Ãrtun, Dr Odont A. Davide Mirabella
In breve
The patient presented as a healthy 35-year-old male with a history of no significant medical problems. His oral hygiene was fair and he had several heavily restored molars. The mandibular right second molar was severely decayed and he had not received regular dental treatment. His chief concern was for the irregularity of his anterior teeth. Diagnostic summary Extraoral evaluation revealed a well-balanced face with a straight profile and a slightly prominent nose. The lips were retrusive relative to Ricketts’ E-line, but nicely curved and well-related to each other. Model analysis showed a tendency toward Class III molar and Class II canine relationships on the right side with Class I relationships on the left side. Overjet and overbite were normal. A severe arch length deficiency was observed, with a blocked out mandibular right first premolar as well as maxillary and mandibular left canines Cephalometric evaluation indicated a slightly retrognathic maxilla and a Class III skeletal relationship. Compensatory proclination of the maxillary incisors and retroclination of the mandibular incisors were observed. The vertical relationships were normal. Radiographic evaluation showed coronal pulpectomy and periapical lesions on both maxillary and mandibular left first molars. A periapical lesion was also observed on the mandibular right second molar due to severe caries. The maxillary right third molar was missing and the maxillary left third molar was peg shaped The patient was embarrassed about his smile and very motivated for treatment. The Angle Orthodontist Vol. 64 No. 5 1994
Treatment of arch length deficiency in an adult male: the extraction of compromised molars rather than healthy premolars
Reference
M. CALTABIANO, F. DI GREGORIO, P. VERZI, M.A. ROMEO e A.D. MIRABELLA XXIII Congresso Nazionale della Società Italiana di Odontostomatologia e Chirurgia Maxillo-Facciale
In breve
La diaqnosi precoce e il trattamento trasfusionale intensivo e precoce del Morbo di Cooley stanno riducendo ia gravità delle alterazioni maxillo-facciali che in passato caratterizzavano tale malattia. In questo studio sono stati eseguiti esami teleradiografici in norma lateralis ed ortopantorriografici di 50 soggetti di età compresa tra i 4.3 e i 13.4 anni affetti da M. di Cooley e sottoposti a terapia trasfusionale intensiva (Hh pretrasfusionale) 11 _qr.%) sin dall’età di 6 mesi. I tracciati cefalometrici eseguiti secondo Rícketts hanno evidenziato una distribuzione dei biotipi facciali sovrapponibile a quella dei pazienti sani ed un aumento della convessità scheletrica nel 50% dei casi
Substitution of impacted canines by maxillary first premolars: A valid alternative to traditional orthodontic treatment
Reference
Davide Mirabella, Gabriella Giunta and Luca Lombardo
American Journal of Orthodontics and Dentofacial Orthopedics, January 2013 Vol 143 Issue 1
In breve
Her maxillary canines were bilaterally impacted. Treatment included extraction of the maxillary canines and the mandibular second premo- lars. The maxillary first premolars were substituted for the canines. After 26 months of active treatment, the pa- tient had a Class I molar relationship and ideal overbite and overjet. Her profile was improved, lips were competent, and gingival levels were acceptable. Cephalometric evaluation showed acceptable maxillary and mandibular incisor inclinations. Intraoral pictures taken 3 years 7 months after the end of treatment demonstrated that the extraction of impacted canines and their substitution by first premolars can be a valid alternative to tra- ditional orthodontic treatment when maxillary premolar extraction is a treatment option. (Am J Orthod Dentofacial Orthop 2013;143:125-33)
Prevalence and severity of apical root resorption of maxillary anterior teeth in adult orthodontic patients
Reference
A. Davide Mirabella & Jon Ãrtun
In breve
The purpose of this study was to evaluate prevalence and severity of apical root resorption of maxillary anterior teeth in a large sample of adult orthodontic patients, to analyse any difference between subgroups of patients with and without a history of earlier orthodontic treatment, and to test the hypothesis that endodontically treated teeth are less likely to experience apical root resorption. Differences in tooth length measurements of standardized períapical radiographs made before and after treatment of 343 adults, representing groups of consecutively treated patients from four orthodontic practices, were calculated. Sample means of averaged root resorption of all six anterior teeth and of the most severely resorbed tooth per patient were 0.94 mm (SD 0.88) and 2.39 mm (SD 1.43), respectively. Forty per cent of the adults had one or more teeth with 2.5 mm resorption or greater. The subsample of 31 patients with a history of earlier orthodontic treatment had less root resorption than the remaining patients (P<0.001). Evaluation of the 39 contralateral pairs of teeth with and without endodontic treatment in 36 of the patients revealed less resorption of the endodontically treated teeth (P< 0.05). European Journal of Orthodontics 17 (1995)
LED vs Halogen Light-Curing of Adhesive-Precoated Bracket
Reference
Davide Mirabella; Raffaele Spena; Giovanni Scognamiglio; Luca Lombardo; Antonio Gracco; Giuseppe Siciliani
Angle Orthodontist, Vol 78, No 5, 2008
In breve
Objective: To test the hypothesis that bonding with a blue light-emitting diode (LED) curing unit produces no more failures in adhesive-precoated (APC) orthodontic brackets than bonding carried out by a conventional halogen lamp. Materials and Methods: Sixty-five patients were selected for this randomized clinical trial, in which a total of 1152 stainless steel APC brackets were employed. In order to carry out a valid comparison of the bracket failure rate following use of each type of curing unit, each patient’s mouth was divided into four quadrants. In 34 of the randomly selected patients, designated group A, the APC brackets of the right maxillary and left mandibular quadrants were bonded using a halogen light, while the remaining quadrants were treated with an LED curing unit. In the other 31 patients, designated group B, halogen light was used to cure the left maxillary and right man- dibular quadrants, whereas the APC brackets in the remaining quadrants were bonded using an LED dental curing light. The bonding date, the type of light used for curing, and the date of any bracket failures over a mean period of 8.9 months were recorded for each bracket and, subsequently, the chi-square test, the Yates-corrected chi-square test, the Fisher exact test, Kaplan- Meier survival estimates, and the log-rank test were employed in statistical analyses of the results. Results: No statistically significant difference in bond failure rate was found between APC brack- ets bonded with the halogen light-curing unit and those cured with LED light. However, significantly fewer bonding failures were noted in the maxillary arch (1.67%) than in the mandibular arch (4.35%) after each light-curing technique. Conclusions: The hypothesis cannot be rejected since use of an LED curing unit produces similar APC bracket failure rates to use of conventional halogen light, with the advantage of a far shorter curing time (10 seconds).
Upper lip changes correlated with maxillary incisor movement in 65 orthodontically treated adult patients
Reference
Davide Mirabella, Stefano Bacconi, Antonio Gracco, Luca Lombardo, Giuseppe Siciliani
In breve
Aim: To describe the behavior of the upper lip components following orthodontically induced movement of the maxillary incisor in a sample of 65 adults. Methods: The study sample was divided into 2 groups: the retraction group, made up of 35 patients in whom the incisor had been moved in a palatal direction (tipping), and the protraction group, consisting of 30 patients who had undergone labial movement of the incisor (tipping). To evaluate the mean changes in lip position and quality of the patients’ profiles between T1 (before movement of the incisor) and T2 (after movement of the incisor), we measured the following parameters: variation in upper lip thickness (DUVT), variation in the depth of the labial sulcus (DULSD), variation in vermillion height (DUVH), variation in upper lip length (DULL), vari- ation in maxillary incisor exposure (DIs-STOs), and DSTOs and STOi, which indicate a variation in the gap between the lips. Results: In the retraction group, all soft tissue parameters showed significant changes at T2, except for DUVT and DULL, while in the protraction group, the significance of the mean changes was decidedly lower and resulted higher for only DULSD and DUVT. Nevertheless, multiple lin- ear regression analysis highlighted the unfeasibility of predicting the behavior of the dependent (cutaneous) variables except for DUVH and DULSD in the protraction group. Conclusion: The results obtained highlight a pronounced variability among the patients studied and the impossibility of accurately predicting the behavior of the soft tissues following movement of maxillary incisors. World J Orthod 2008;9:337–348. WORLD JOURNAL OF ORTHODONTICS VOLUME 9, NUMBER 4, 2008
Estrusione pre-protesica con miniviti per ancoraggio scheletrico: due casi clinici eseguiti con metodiche differenti
Reference
Nicola Derton, Roberto Derton, Davide Mirabella e Alessandro Perini
Ortodonzia Clinica 2009;3:11-16
In breve
La preparazione ortodontica preprotesica del paziente adulto è un aspetto in continua evoluzione nell’ambito del trattamento interdisciplinare. In riferimento alla parodontologia e all’odontoiatria protesica ricostruttiva, il movimento estrusivo può essere di grande ausilio per ottimizzare i risultati. In Letteratura sono state descritte varie metodiche per ottenere l’eruzione forzata di elementi dentali, ma spesso si ha un movimento indesiderato dell’unità dentale di ancoraggio ed è richiesto l’uso di una apparecchiatura estesa, a volte in abbinamento anche a elastici interarcata. L’introduzione delle miniviti nella pratica ortodontica quotidiana per ottenere l’ancoraggio scheletrico ha rappresentato un notevole passo in avanti per risolvere il problema dell’ancoraggio. L’intento di questo case report è descrivere 2 casi clinici di estrusione ortodontica allo scopo di una finalizzazione protesica condotta con utilizzo di miniviti per ancoraggio scheletrico. Indicazioni, descrizione della metodica e i vantaggi clinici verranno discussi. Materiali e metodi. Nel caso 837, un secondo molare superiore con lesione cariosa radicolare distale è stato estruso con uso di miniviti e impiego della metodica interarcata (ancoraggio scheletrico diretto), che prevede collaborazione del paziente con elastici. Nel caso 1016, un primo premolare superiore con frattura corono radicolare complessa “a becco di flauto” è stato sottoposto a eruzione forzata con uso di miniviti e metodica intra arcata (ancoraggio scheletrico indiretto con tecnica Derton-Perini), senza collaborazione del paziente. Risultati. Un’adeguata estrusione del dente interessato è stata ottenuta, permettendo in tal modo un soddisfaciente restauro protesico; senza l’effetto indesiderato dello spostamento di altri elementi dentali. Usando la metodica intra-ar- cata è stato possibile raggiungere l’obiettivo evitando la collaborazione del paziente. Conclusioni. Le miniviti per ancoraggio scheletrico si sono dimostrate un efficace mezzo per ottenere estrusione preprotesica di elementi dentari senza movimenti indesiderati del resto della dentatura. L’uso della metodica intra-arcata ha inoltre reso non necessaria la collaborazione del paziente
Analysis of crown widths in subjects with congenitally missing maxillary lateral incisors
Reference
A. Davide Mirabella, Vincent G. Kokich and Marco Rosa
In breve
The aim of the study was to test the hypothesis that the gene defect causing congenital absence of maxillary lateral incisors also causes narrowing of the dentition. A total of 81 patients with one or two congenitally missing lateral incisors were retrieved; 52 (64.2 per cent) patients presented bilateral agenesis, whereas 29 (35.8 per cent) had unilateral agenesis. The control group consisted of 90 consecutively treated patients. The largest mesiodistal crown dimension for all teeth, except for the maxillary second and third molars, was measured on plaster casts using a digital caliper to the nearest 10th of a millimetre. Statistical testing was performed using the analysis of variance model (P < 0.05) to test for differences in the mesiodistal dimension between the sample and the control group. Significance has been assessed using a P-value threshold level of 5 per cent. Agenesis of maxillary lateral incisors was found to be a significant predictor of tooth size. Patients who were missing maxillary lateral incisors had smaller teeth compared to control subjects, except for the maxillary right and left first molars. This finding was true for both unilateral and bilateral lateral incisor agenesis. Interaction between maxillary lateral incisor agenesis and gender was not significant. Patients with congenitally missing lateral incisors have narrower teeth than patients without any dental anomalies, except for maxillary first molars. A higher prevalence of microdontic contralateral incisors was found in patients with unilateral agenesis with respect to the control group. The European Journal of Orthodontics Advance Access published September 12, 2011
Implant Site Development by Orthodontic Forced Extraction: A Preliminary Study
Reference
Francesco Amato, A. Davide Mirabella, Ugo Macca, Dennis P. Tarnow
The International Journal of Oral & Maxillofacial Implants Volume 27, Number 2, 2012
In breve
Purpose: To evaluate the soft and hard tissue response to orthodontic implant site development (OISD) (ie, forced extraction), to measure the amount of tissue that was regenerated and its relationship to the amount of orthodontic vertical tooth movement, to evaluate the tissue response in teeth with different degrees of periodontal attachment loss, to understand the limits of OISD, and to evaluate the implant survival rate. Materials and Methods: A total of 32 hopeless teeth were treated with OISD, and 27 implants were placed in 13 patients consecutively. The level of periodontal attachment on the teeth to be extracted, amount of augmented alveolar bone, changes in soft tissue volume, and the rate of orthodontic tooth movement were recorded. Results: Mean values after OISD were as follows: orthodontic extrusive movement, 6.2 ± 1.4 mm; bone augmentation, 4 ± 1.4 mm; coronal movement of the gingival margin, 3.9 ± 1.5 mm; coronal movement of the mucogingival junction, 2.1 ± 1.3 mm; keratinized gingival augmentation, 1.8 ± 1.1 mm; gingival thickness (buccolingual dimension) augmentation, 0.7 ± 0.4 mm; recession, 1.8 ± 1.2 mm; bone augmentation/orthodontic movement ratio (efficacy), 68.9% ± 17.3%; gingival augmentation/orthodontic movement ratio (efficacy), 65.2% ± 19.9%; and pocket depth reduction, 1.8 ± 0.9 mm. The implant survival rate was 96.3%. Conclusions: OISD was a viable treatment for these hopeless teeth to regenerate hard and soft tissues. Its efficacy was about 70% for bone regeneration and 60% for gingival augmentation. The residual attachment level on the tooth was not a limitation. OISD might be a valuable treatment option to regenerate tissues for implant site development in patients in need of conventional orthodontic therapy. Int J Oral MaxIllOfac IMplants 2012;27:411–420 Key words: bone augmentation, forced eruption, gingiva augmentation, implant site development, orthodontic forced extrusion, orthodontic implant site development
Assessment of lower lip changes following incisor displacement in 92 orthodontically- treated adults
Reference
A. Davide Mirabella, Luigi Quartarone, Luca Lombardo, Antonio Guarnieri, Maria Paola Guarnieri and Giuseppe Siciliani
In breve
Aim: A retrospective assessment of the lower lip changes conse- quent to incisor displacement in correction of malocclusion in a sample of 92 post-adolescent subjects. Methods: The study sample comprised two groups, subdivided according to the direction of incisor movement achieved during orthodontic treatment: the retraction group (Group 1), made up of 41 patients in which the maxillary incisor had been moved in a palatal direction (palatal tipping); and the protraction group (Group 2), composed of 51 patients who had undergone labial movement of the upper incisors (labial tipping). In order to evaluate the mean changes in lower lip position, and consequent alterations in the quality of the patients’ profiles, between T1 (prior to orthodontic displacement of the incisors) and T2 (fol- lowing treatment), the following parameters were measured on lateral head film X rays: variation in lower lip vermilion thick- ness (dLVT); variation in lower lip sulcus depth (dLLSD); variation in lower vermilion height (dLVH); variation in expo- sure of the upper and lower incisors in relation to the lower stomion (dIs-STOi and dIi-STOi, respectively); variation in upper and lower incisor tipping with respect to the palatal plane (d1/PP and dinf1/PP); and variation in lower facial height (dLFH). International Orthodontics 2012 ; 10
Rapid Orthodontic Treatment After the Ridge-Splitting Technique—A Combined Surgical-Orthodontic Approach for Implant Site Development: Case Report
Reference
Francesco Amato, A. Davide Mirabella, Diego Borlizzi
In breve
This article presents a clinical case of bilateral partial edentulism in the posterior mandible with severe horizontal and moderate vertical bone atrophy. A new technique using rapid orthodontics after ridge splitting is presented. The split- crest technique was carried out using piezosurgical instruments in the first molar and second premolar areas to widen the bone crest and open a channel for tooth movement. Immediately after, orthodontic appliances were used to move the first premolars distally and the second molars mesially into the surgical site. The rationale was to facilitate and accelerate orthodontic movement of the teeth, which is otherwise difficult in a cortical knife-edged ridge. The bone defect was filled with the alveolar bone of the adjacent teeth that were moved into the surgically opened path. Adequate bone volume for implant placement was generated in the first premolar area. Implants were then inserted, and the patient was rehabilitated. (Int J Periodontics Restorative Dent 2012;32:395–402.) The International Journal of Periodontics & Restorative Dentistry Volume 32, Number 4, 2012
Multidisciplinary treatment of severely resorbed maxillary anterior region
Reference
A. Davide Mirabella, Francesco Amato, Luca Lombardo, Antonio Gracco, Giuseppe Siciliani
In breve
Treatment of severe periodontal breakdown in the maxillary anterior region by means of multibanded orthodontic treatment, miniscrews and implant rehabilitation: a case report. European Orthodontics Society 2007
Cone-beam computed tomographyevaluation of periodontal and bone support loss in extraction cases
Reference
Luca Lombardo, Romina Bragazzi, Carlo Perissinotto, Davide Mirabella and Giuseppe Siciliani
Comparison of adhesion forces developed by foil mesh of various dimensions applied in combination with composites of different viscosity
Reference
Luca Lombardo, Claudia Bulli, A. Davide Mirabella, Alessandri Giulio Bonetti, Giuseppe Siciliani International Orthodontics 2013 ; 11 : 290-302
Implant site development by orthodontic forced extraction
Reference
F. Amato, D. Mirabella, U. Macca, D. P. Tarnow
In breve
OISD was a viable treatment for these hopeless teeth to regenerate hard and soft tissues. Its effi cacy was about 70 % for bone regeneration and 60 % for gingival augmentation. The residual attachment level on the tooth was not a limitation. OISD might be a valuable treatment option to regenerate tissues for implant site development in patients in need of conventional orthodontic therapy.
Dental and alveolar arch forms in a Caucasian population compared with commercially available archwires
Reference
Luca LOMBARDO, Lorenzo FATTORI, Camilla MOLINARI, Davide MIRABELLA, Giuseppe SICILIANI