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At least 271 records · Page 15Linked to original sources
PubMed2003

Morphometric analysis of the transverse dentoskeletal features of class II malocclusion in the mixed dentition.

The aim of the present study was to evaluate the dentoskeletal features of Class II malocclusion in the transverse plane by means of a morphometric analysis (thin-plate spline analysis [TPS]) applied to posteroanterior cephalograms. A sample of 49 subjects (24 males, 25 females; mean age 7 years, 9 +/- 5 months) with Class II Division 1 malocclusion was compared with a control group of 50 subjects (17 males, 33 females; mean age 8 years, 4 +/- 3 months) with Class I occlusion. Subjects of both groups were in the mixed dentition and had no history of orthodontic treatment. Average craniofacial configurations were subjected to TPS analysis to compare the differences in shape between the two groups. The results of the present study showed that subjects with Class II malocclusion exhibited significant shape differences in craniofacial configuration in the frontal plane when compared with subjects with normal occlusion; these differences mainly consisted of a contraction of the maxilla at both the skeletal and the dentoalveolar levels and a narrowing of the base of the nose. The reduction in maxillary dentoskeletal width was associated with an increase in the vertical height of the maxilla.

Alveolar Process↗
PubMed2003

Children with class III malocclusion: development of multivariate statistical models to predict future need for orthognathic surgery.

Until now, the literature does not provide an accurate model to predict the future need for orthognathic surgery in prepubertal patients with class III malocclusion. Because not all of these patients are candidates for later surgical correction, patient assessment and selection remain arbitrary with respect to diagnosis and treatment planning. The purpose of the present investigation was to analyze the value of classifying class III children before puberty into patients who can be effectively treated by orthopedic/orthodontic therapy alone and those who require orthognathic surgery. To obtain a robust model, the study design was multicentric (University Orthodontic Departments of Frankfurt, Heidelberg, and Würzburg). A total of 88 patients with class III malocclusion were grouped into orthopedic/orthodontic (n = 65) and surgery patients (n = 23), according to their records after puberty (mean age, 17 years three months). Discriminant analysis (DA) and logistic regression (LogR) were applied to 20 landmarks of the patients' cephalograms before puberty (mean age, nine years eight months) to identify the dentoskeletal variables that provide the best group separation and the best predictability of group membership, respectively. Both models were highly significant (P < .001), classifying 93.3% (DA) and 94.3% (LogR) of the patients correctly. The extracted variables were identical for both procedures: Wits appraisal, palatal plane angle, and individualized inclination of the lower incisors. The resulting equation of LogR was individual score = -7.968 - 1.323Wits - 0.363NL-NSL + 0.153[180 - (LI-ML) - (L1-ML(ind))]. We concluded that by means of multivariate statistics, prepubertal children with class III malocclusions may be classified into nonsurgery and surgery patients with high accuracy.

Adolescent↗
PubMed2004

Effects of orthodontic treatment on mandibular rotation and displacement in Angle Class II division 1 malocclusions.

The aim of this retrospective cephalometric study was to investigate the effects of orthodontic treatment on rotation and displacement of the mandible in Angle Class II, division 1 malocclusions. Thirty patients in the treated group (15 boys and 15 girls; mean age at pretreatment, 12.27 +/- 1.36 years) were compared with 28 subjects who had untreated Class II, division 1 malocclusions (15 boys and 13 girls; mean age at T1, 12.01 +/- 0.07 years). The patients in the first group were treated nonsurgically, without extraction, and without the use of functional appliances. Cephalometric data were obtained from three lateral cephalograms per case representing pretreatment (T1), posttreatment (T2), and at least 2-years postretention (T3). Thirty-seven variables were measured representing craniofacial morphology, tooth measurements, and mandibular displacement. Some variables were obtained from cranial base, maxillary, or mandibular superimposition. Statistical significance was established at P < .05, P < .01, and P < .001. The findings indicated that orthodontic treatment of Class II, division 1 malocclusions induced a more vertical mandibular growth direction associated with an increased vertical displacement of pogonion. Occlusal or vertical movement of maxillary and mandibular molars was not correlated to mandibular rotation or horizontal displacement of pogonion. When compared with controls, the treated group did not exhibit a significant difference in mandibular rotation or occlusal movement of maxillary molars; however, it did show a greater occlusal movement of mandibular molars during treatment.

Case-Control Studies↗
PubMed2005

Gender differences in Class III malocclusion.

This study evaluated gender differences in the cephalometric records of a large-scale cross-sectional sample of Caucasian subjects with Class III malocclusion at different developmental ages. The purpose also was to provide average age-related and sex-related data for craniofacial measures in untreated Class III subjects that are used as reference in the diagnostic appraisal of the patient with Class III disharmony. The sample examined consisted of 1094 pretreatment lateral cephalometric records (557 female subjects and 537 male subjects) of Caucasian Class III individuals. The age range for female subjects was between three years six months and 57 years seven months. The male subject group ranged from three years three months to 48 years five months. Twelve age groups were identified. Skeletal maturity at different age periods also was determined using the stage of cervical vertebral maturation. Gender differences for all cephalometric variables were analyzed using parametric statistics. The findings of the study indicated that Class III malocclusion is associated with a significant degree of sexual dimorphism in craniofacial parameters, especially from the age of 13 onward. Male subjects with Class III malocclusion present with significantly larger linear dimensions of the maxilla, mandible, and anterior facial heights when compared with female subjects during the circumpubertal and postpubertal periods.

Adolescent↗
PubMed2001

Cephalometric comparison of maxillary second molar extraction and nonextraction treatments in patients with Class II malocclusions.

This retrospective cephalometric study compared the nature of the skeletodental correction of maxillary second-molar extraction and nonextraction treatments in correcting Class II malocclusions. The sample comprised 50 Class II, deep-bite, low-angle adolescents; half were treated with maxillary second-molar extraction and half were treated without extraction. Pretreatment and posttreatment lateral cephalograms were analyzed. Analysis relied primarily on the method of Lysle Johnston that evaluates sagittal changes in the teeth and supporting bones relative to the functional occlusal plane. All 18 cephalometric variables examined were statistically equivalent between the 2 groups at the start of treatment. In contrast, several skeletodental treatment changes differed significantly. The maxillary second-molar extraction group exhibited distal movement of the maxillary first molar (1.2 mm vs 0.0 mm), and there was greater flaring of the mandibular incisors in the nonextraction group (9.1 degrees vs 3.5 degrees ). The upper incisor root was torqued lingually in both groups, but there was more anterior crown movement in the nonextraction group (2.0 mm vs 0.0 mm). Also, the extraction group finished active treatment 7 months sooner on average. Sagittal molar correction in the maxillary second-molar group was a result of distalizing in the maxillary arch, whereas anchorage was expended in the mandibular arch to correct the malocclusion in the nonextraction group. In properly selected Class II malocclusions, maxillary second-molar extraction is a viable alternative treatment choice.

Adolescent↗
PubMed2002

Treatment decision in adult patients with Class III malocclusion: orthodontic therapy or orthognathic surgery?

Class III malocclusion is one of the most difficult anomalies to understand. Because not all Class III patients are candidates for surgical correction, patient assessment and selection remain main issues in diagnosis and treatment planning. The purpose of this study was to separate Class III patients who can be properly treated orthodontically from those who require orthognathic surgery. A large sample size was a necessary to obtain a sufficiently robust model. Thus, a multicentric study design was chosen (Orthodontic Departments of the Universities of Frankfurt, Heidelberg, and Würzburg, Germany). The cephalograms of 175 adult patients with Class III malocclusions were analyzed. The orthodontic group comprised 87 patients, and the surgery group, 88 patients. Twenty linear, proportional, and angular measurements were made. Stepwise discriminant analysis was applied to identify the dentoskeletal variables that best separate the groups. The discriminant function model was highly significant (P <.0001); 92% of the patients were correctly classified. The following variables were extracted: Wits appraisal, length of the anterior cranial base, maxillary/mandibular (M/M) ratio, and lower gonial angle. The resulting equation was: Individual score = -1.805 + 0.209. Wits + 0.044. S-N + 5.689. M/M ratio - 0.056. Go(lower). By means of discriminant analysis, correct classification of adult Class III malocclusion patients succeeded to a very high degree. Of all the variables, the Wits appraisal was the most decisive parameter.

Adult↗
PubMed2002

Dental arch width in Class II Division 2 deep-bite malocclusion.

A severe phenotype of Angle's Class II Division 2 (II/2) malocclusion with extremely deep overbite has been called cover-bite, or "Deckbiss" in its early German descriptions. This distinctive occlusal variation is characterized by skeletofacial hypodivergence, mandibular dentoalveolar retrusion, excessive bony chin projection, reduced mesiodistal tooth size, maxillary incisor retroclination, and at least 100% overbite, covering at least 1 mandibular incisor in occlusion. In this study, maxillary and mandibular dental arch widths measured at the first molars and the canines were recorded from dental casts of 23 subjects with II/2 cover-bite malocclusions. The data were compared with a control-reference sample of 46 orthodontic patients matched for age and gender. In the cover-bite group, the intermolar widths in both arches and the intercanine width in the maxilla were comparable with those in the control sample. However, mandibular intercanine width in the II/2 cover-bite group was significantly less than that of the controls (P =.01). These findings suggest that II/2 deep overbite malocclusion is characterized by normalized and relatively compatible transverse dimensions in the maxilla and in the mandibular posterior segments. The transverse underdevelopment that this study identified in the mandible from canine to canine is probably responsible for mandibular incisor compression and crowding--natural sequelae of the deep overbite in II/2 cover-bite. Thus, a reasonable orthodontic treatment plan for the mandibular dentoalveolar compensation often seen in II/2 deep-bite patients would be anterior expansion of the mandibular arch width, usually reducing the need for orthodontic tooth extractions and increasing the desirability of fixed retention.

Adolescent↗
PubMed2003

Predictive value of morphologic parameters for successful correction of Class II Division 2 malocclusion.

The aim of this study was to assess the predictive value of pretreatment cephalometric parameters and apical base size for successful correction of Angle Class II Division 2 malocclusion. Pretreatment lateral cephalograms and pretreatment and posttreatment study casts of 96 subjects with Class II Division 2 malocclusions were examined to obtain 23 cephalometric parameters and to measure the size of the apical bases. Success of occlusal correction was evaluated as the percentage of change of peer assessment rating scores during treatment; percentage of change was the dependent variable in multivariate statistical analyses used to test the predictive value of the assessed parameters. Cephalometric parameters of pretreatment craniofacial morphology were insignificant as predictors of successful orthodontic correction of the malocclusions. Maxillary apical base size was the strongest predictor of occlusal correction and might serve as a valuable diagnostic predictor of successful treatment outcome.

Cephalometry↗
PubMed2003

Comparison of peer assessment ratings (PAR) from 1-phase and 2-phase treatment protocols for Class II malocclusions.

The purpose of this study was to compare the dentoalveolar outcomes after 1-phase and 2-phase orthodontic treatment of Class II malocclusions. Class II subjects (n = 208) were randomized to 1-phase or 2-phase treatment with either bionator or headgear/biteplate. The peer assessment rating (PAR) was calculated from pretreatment, prephase 2, and final study models. Chi-square, Kruskal-Wallis, and Wilcoxon rank sum tests were used to evaluate the differences among treatment groups, sexes, races, pretreatment, mandibular plane angle, severity, and compliance. Spearman rank correlation coefficients were used to examine relationships between PAR at different times. The dropout rate of 24.6% did not adversely affect the ability to detect differences of clinical importance or impact treatment groups disproportionately. There were no significant differences with respect to initial PAR or final PAR among the 3 treatment protocols. The 2 early treatment groups had lower PAR scores than the 1-phase group before phase 2 (P =.0001). Lower PAR scores were achieved at both the beginning and end of phase 2 in girls (P =.03; P =.02, respectively). There were differences in the pre-phase-2 and post-phase-2 PAR scores based on initial severity (P =.0006; P =.02, respectively), with greater improvement in the patients whose malocclusions were less severe initially. Mandibular plane angle had no effect on pre-phase-2 or post-phase-2 PAR scores. These results do not support the hypothesis that different dentoalveolar outcomes are obtained between 2-phase and 1-phase treatment of Class II malocclusions.

Activator Appliances↗
PubMed2002

Study of the signs and symptoms of temporomandibular dysfunction in individuals with normal occlusion and malocclusion.

The signs and symptoms of temporomandibular dysfunctions were studied in a well-defined sample, divided into one group with normal occlusion and a second group with malocclusion, where the primary characteristic was Angle Class II a malocclusion with moderate to deep overbite. Each group comprised 30 individuals with a mean overall age of 22.6 years. The following were evaluated in both groups: tenderness to palpation of the muscles involved in the joint; presence of articular noises; subjective symptoms obtained via a questionnaire; and mandibular movements. The data gathered was subjected to statistical analysis and no significant differences were detected between the groups in the majority of variables studied. However, it was found that those individuals with malocclusion had a wider range of lateral movement and also complained of greater discomfort in the TMJ when compared to individuals in the normal occlusion group. The lack of uniformity between the results of this work and those of other authors may be attributed in particular to variations in age of the sample populations studied.

Adult↗
PubMed1992

No posterior mandibular displacement in Angle Class II, division 2 malocclusion as revealed with electromyography and sirognathography.

The activity of the anterior and posterior temporal, and of the masseter muscles was studied by electromyography and the position of the mandible by sirognathography. The recordings were made in 22 children, aged 8-13 years, with Angle Class II, division 2 malocclusion before and during treatment of their malocclusion. The treatment comprised two phases: proclination of the upper incisors and bite raising with a removable plate, and the subsequent correction of the distal occlusion with an activator. The aim of the study was to reveal signs of anterior mandibular positioning during the treatment. The electromyographic recordings were made in the rest position of the mandible, and during maximal biting, chewing, and swallowing. The sirognathographic recordings comprised the positions of the mandible at rest, at intercuspation, and during tooth contact during chewing and maximal mandibular movements. The muscle activity at rest was unchanged during the period of observation. The activity during maximal biting, chewing, and swallowing decreased during the phase of proclination, which was interpreted as a result of occlusal instability. The positions of the mandible at rest, at intercuspation, and during chewing were stable during the treatment. Neither the electromyographic recordings nor the recordings of mandibular positions revealed any signs of anterior mandibular positioning during the treatment of the Class II, division 2 malocclusion.

Child↗
PubMed1996

Significance of the cant of the posterior occlusal plane in class II division 1 malocclusions.

In studying a group of fifty adult females with Class II division 1 malocclusion, it was evident that the skeletal problems of this malocclusion involved small, retruded mandibles accompanied by backward rotation. This skeletal pattern was considered to be influenced by the vertical dimension of the upper dentition in the buccal segment for mandibular function. The anterior and the posterior occlusal planes were examined to gain a detailed assessment of the relationship between the dental and the skeletal patterns. The findings indicated that the steep cant of the posterior occlusal plane was strongly correlated with the following: 1. Small, retruded mandible with backward rotation as the skeletal pattern. 2. Short vertical height of the upper second molars and distal inclination of the upper molars as the dental pattern. The increased vertical height of the lower second premolars was found to be related to backward rotation of mandible. In treating skeletal Class II malocclusions, this study indicated that control of the vertical dimension of the posterior teeth is extremely important.

Adolescent↗
PubMed1997

Thin-plate spline analysis of the cranial base in subjects with Class III malocclusion.

The role of the cranial base in the emergence of Class III malocclusion is not fully understood. This study determines deformations that contribute to a Class III cranial base morphology, employing thin-plate spline analysis on lateral cephalographs. A total of 73 children of European-American descent aged between 5 and 11 years of age with Class III malocclusion were compared with an equivalent group of subjects with a normal, untreated, Class I molar occlusion. The cephalographs were traced, checked and subdivided into seven age- and sex-matched groups. Thirteen points on the cranial base were identified and digitized. The datasets were scaled to an equivalent size, and statistical analysis indicated significant differences between average Class I and Class III cranial base morphologies for each group. Thin-plate spline analysis indicated that both affine (uniform) and non-affine transformations contribute toward the total spline for each average cranial base morphology at each age group analysed. For non-affine transformations, Partial warps 10, 8 and 7 had high magnitudes, indicating large-scale deformations affecting Bolton point, basion, pterygo-maxillare, Ricketts' point and articulare. In contrast, high eigenvalues associated with Partial warps 1-3, indicating localized shape changes, were found at tuberculum sellae, sella, and the frontonasomaxillary suture. It is concluded that large spatial-scale deformations affect the occipital complex of the cranial base and sphenoidal region, in combination with localized distortions at the frontonasal suture. These deformations may contribute to reduced orthocephalization or deficient flattening of the cranial base antero-posteriorly that, in turn, leads to the formation of a Class III malocclusion.

Case-Control Studies↗
PubMed1998

Head posture and malocclusions.

The present study aimed to examine whether any pattern of associations could be found between the posture of the head and neck, and the occurrence of malocclusions. The sample comprised 96 children (45 M, 51 F) aged 7-13 years, sequentially admitted for orthodontic treatment of severe malocclusions. Malocclusions were diagnosed clinically and classified into occlusal, spacing, and dentitional anomalies and their subdivisions. Craniovertical, craniocervical, and cervicohorizontal postural variables were recorded from lateral cephalometric radiographs taken with the subject standing with the head in the natural head position (mirror position). A clear pattern of associations between crowding and craniocervical posture was found. Subjects with anterior crowding, i.e. more than 2 mm lack of space in the upper or lower anterior segments of the dental arch, had craniocervical angles that were on average 3-5 degrees larger than subjects without crowding (P < 0.05, P < 0.01). The findings were in agreement with the soft tissue stretching hypothesis, according to which the sagittal development of the dentoalveolar arches is impeded by the increased dorsally-directed soft tissue pressure in subjects with extended craniocervical posture.

Adolescent↗
PubMed2000

Perceived aesthetic impact of malocclusion and oral self-perceptions in 14-15-year-old Asian and Caucasian children in greater Manchester.

The aims of this study were to evaluate (i) the effect of ethnicity, social deprivation, and normative orthodontic treatment need on orthodontic aesthetic self-perception, self-perceived need for orthodontic treatment, and oral aesthetic impact of malocclusion; (ii) the effect of ethnicity, social deprivation, and gender on perceived orthodontic treatment need and use of orthodontic services; (iii) the influence of perceived oral aesthetic impact of malocclusion on perceived need and wish for orthodontic treatment; and (iv) whether orthodontic treatment experience influences perceived oral aesthetic impact of malocclusion. A stratified, random sample of 434 14-15-year-old children from schools in Manchester, UK, was obtained. Information was collected on orthodontic aesthetic self-perception and orthodontic treatment experience using a questionnaire. The former data were combined to form an Oral Aesthetic Subjective Impact Scale (OASIS). Normative orthodontic treatment need was measured with the Index of Orthodontic Treatment Need (IOTN). Children with higher clinical need for orthodontic treatment perceived themselves as worse off than their peers with lower need. More socially deprived children or those with high IOTN aesthetic component (AC) scores had a higher (i.e. more negative) aesthetic impact (OASIS) score. Asians and females had higher IOTN dental health component (DHC) scores, but a better aesthetic appearance than Caucasians and males. More deprived children were less likely to have received orthodontic treatment. Despite this, OASIS scores were similar between treated and untreated children. Untreated children who wished for orthodontic treatment had higher IOTN AC and OASIS scores.

Adolescent↗
PubMed2000

Signs of temporomandibular disorders in girls receiving orthodontic treatment. A prospective and longitudinal comparison with untreated Class II malocclusions and normal occlusion subjects.

The aim of this investigation was to prospectively and longitudinally study signs of temporomandibular disorders (TMD) and occlusal changes in girls with Class II malocclusion receiving orthodontic treatment and to compare them with subjects with untreated Class II malocclusions and with normal occlusion subjects. Three groups of age-matched adolescent girls were examined for clinical signs of TMD and re-examined 2 years later. Sixty-five Class II subjects received orthodontic fixed straight-wire appliance treatment (Orthodontic group), 58 subjects were orthodontically untreated (Class II group), and 60 subjects had a normal occlusion (Normal group). In the Orthodontic group, the prevalence of muscular signs of TMD was significantly less common post-treatment. The Class II and the Normal groups showed minor changes during the 2-year period. Temporomandibular joint clicking increased in all three groups over the 2 years, but was less common in the Normal group. The Normal group also had a lower overall prevalence of signs of TMD than the Orthodontic and the Class II groups at both registrations. Functional occlusal interferences decreased in the Orthodontic group, but remained the same in the other groups over the 2 years. In conclusion, orthodontic treatment did not increase the risk for or worsen pretreatment signs of TMD. On the contrary, subjects with Class II malocclusions and signs of TMD of muscular origin seemed to benefit functionally from orthodontic treatment in a 2-year perspective. The Normal group had a lower prevalence of signs of TMD than the Orthodontic and the untreated Class II groups.

Adolescent↗
PubMed2004

An orthopaedic approach to the treatment of Class III malocclusions in the early mixed dentition.

The aim of this investigation was to study cephalometrically the skeletal, dental and soft tissue modifications induced by a Delaire facemask and Bionator III appliance in a sample of 30 patients (17 boys and 13 girls), aged 4.1-9 years [mean 5.85 years, confidence interval (CI) 5.41-6.29], in the early mixed dentition with a skeletal Class III malocclusion caused by maxillary retrognathism (group 1) and compared with a control sample of 24 subjects (14 boys and 10 girls), aged 4-9 years (mean 5.97 years, CI 5.35-6.58) with untreated Class III malocclusions (group 2). For each patient a lateral cephalogram was taken before treatment (T0), after facemask removal (T1), and at the end of the retention period with a Bionator III (T2). Cephalometric analysis was carried out. The post-treatment cephalometric values in the treated group showed a forward displacement of the maxilla resulting in a statistically significant increase (P < 0.001) in the SNA angle, A-NPg (mm) and PNS-A (mm) linear values. There was a clockwise rotation of the mandible, with a decrease in the SNB angle and a satisfactory correction of the Class III relationship. The beneficial effects on the facial profile were confirmed by an increase in UL-EL distance and in NB--HL and NsPgs--HL angles, and by a decrease in the facial convexity angle. These findings indicate that the Delaire facemask and Bionator III treatment is effective for correcting skeletal Class III malocclusions caused by maxillary retrognathism in the early mixed dentition.

Activator Appliances↗
PubMed2006

Orthodontic and orthopaedic changes associated with treatment in subjects with Class III malocclusions.

The aim of this study was to determine the cephalometric changes in subjects with Class III malocclusions after rapid palatal expansion (RPE) and facemask treatment. The 30 subjects presented with developing Class III malocclusions. The treatment group comprised 15 patients (eight girls and seven boys, mean age 11 years 6 months) who had undergone RPE and facemask therapy. The control group consisted of nine girls and six boys with a mean age of 11 years 8 months. Radiographs were take at the same time intervals for both groups, and the average treatment time was 15 months. A Wilcoxon test was used to determine significant differences before and after treatment, and a Mann-Whitney U-test to analyse differences between the treatment and control groups. In the sagittal plane, significant changes were observed in both groups. In the treatment group, the following dimensions increased significantly: A perpendicular to FHp (P < 0.001), ANS-PNS (P < 0.01), 6 perpendicular to FHp (P < 0.05); in the control group Go-Gn (P < 0.05) increased significantly. In the treatment group, SN/Go-Gn and SN/ANS-PNS had higher values and this finding was significant (P < 0.05). Managing developing Class III malocclusions with RPE and maxillary protraction presents favourable results, such as vertical and sagittal displacement of point A.

Case-Control Studies↗