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PubMed2002

The effect of occlusal relationships on the occurrence of sounds in the temporomandibular joint.

The aim of this investigation was to determine the influence of occlusal relationships on the occurrence of sounds in the temporomandibular joint. A group of 100 male subjects aged 24-52 years (X = 35.03+/-6.92) was examined. Analysis of occlusion included determination of the number of existing teeth, number of teeth in occlusion, overbite and overjet, type of occlusion, mediotrusion interferences, relationship of the retruded contact position (RCP) to intercuspal position (ICP), and the amount and direction of sliding from RCP to ICP. Sound was registered by means of a stethoscope and classified according to its character in click or crepitation. Sound was present in 29% of subjects. In 28% of cases it was registered as click and in 2% of cases as crepitation. One subject had simultaneous click and crepitation. The results of the statistical analysis indicate that overbite, type of occlusion, existence of mediotrusion interferences, the relationship of RCP to ICP, and the amount and direction of sliding from RCP to ICP do not have an influence on the occurrence of sounds. The risk of the occurrence of crepitation is significantly increased in the case of the loss of more than 5 teeth, and in the case of horizontal overbite larger than 7.5 mm (p<0.05).

Adult↗
PubMed1991

The role of intercuspal occlusal relationships in temporomandibular disorders: a review.

The purpose of this review is to highlight consensus in past research on the role of intercuspal occlusal factors in the pathophysiology of temporomandibular disorders. The occlusal intercuspal relationships considered are skeletal anterior open bite, overbite, overjet, symmetry of contacts in the retruded contact position (RCP), crossbite, and posterior occlusal support. Skeletal anterior open bite, reduced overbite, and increased overjet are associated with osteoarthritic TMJ patients, but lack specificity for defining patient populations per se. There is no evidence that overbite or overjet plays a role in the pathophysiology of nonarthritic disorders. A combination of unilateral RCP with an absence of a clinically apparent RCP-ICP (intercuspal position) slide may encourage TMJ disc displacement, but unilateral RCP per se was not associated with TMJ diagnoses. Crossbite does not seem to provoke TMJ symptoms or disease. Lost molar support may be associated with osteoarthrosis presence and severity, but studies have not yet been distinguished for age effects. Where appropriate, implications for clinical practice are drawn.

Humans↗
PubMed1982

Vertical dentofacial changes during Herbst appliance treatment. A cephalometric investigation.

The effect of bite jumping with the Herbst appliance on the vertical dimensions of the dentofacial complex was analysed on profile roentgenograms. The material consisted of 42 Class II, Division 1 malocclusion cases with a deep anterior overbite. Twenty-two of the cases were successfully treated with the Herbst appliance for six months. The other 20 cases served as a control group. The Herbst appliance had a pronounced effect on vertical tooth position. The mandibular incisors and maxillary molars were intruded during treatment while the mandibular molars were allowed to erupt freely. As a result of the dental changes the overbite was reduced, lower facial height was increased as well as the angulation of the maxillary and mandibular occlusal planes. A small positive correlation existed between vertical bite opening at the start of treatment and the treatment changes of overbite, lower facial height and mandibular vertical tooth position. The appliance had a limited effect on vertical mandibular and maxillary jaw position, expressed by the angles ML/NSL and NL/NSL. In four patients, however, a marked posterior rotation of the entire maxillary complex was noted. The clinician should be aware of the vertical dentofacial changes occurring during Herbst appliance treatment and consider these changes when designing his treatment strategy and planning post-treatment retention.

Activator Appliances↗
PubMed1995

Cleft-orthognathic surgery: complications and long-term results.

We reviewed the complications and long-term results of a consecutive series of adolescents (67 males, 49 females; age range 15 to 25 years; mean 18 years) born with a cleft who underwent primary repair in childhood and later developed a jaw deformity and malocclusion that required orthognathic surgery. Between 1986 and 1992, 116 adolescents with either unilateral cleft lip and palate (n = 66), bilateral cleft lip and palate (n = 33), or isolated cleft palate (n = 17) underwent an orthognathic procedure that included a Le Fort I osteotomy; 32 also underwent simultaneous sagittal split osteotomies of the mandible; and 87 underwent osteoplastic genioplasty. Clinical follow-up ranged from 1 to 7 years (mean 40 months) at the close of the study. The preoperative clinical examination varied according to cleft type and individual variation, but all patients had maxillary hypoplasia. Additional cleft-related deformities included residual oronasal fistula and bony defects, clefted alveolar ridges that retained dental gaps, and mobile premaxilla that lacked union to the lateral segments. Overall, 89 percent of residual fistulas underwent successful closure as part of the orthognathic procedure. Surgical cleft dental gap closure was achieved and maintained to the extent planned at 92 percent of the cleft sites. A fixed (prosthetic) bridge was used successfully for dental rehabilitation to close the gap in all other patients at each cleft site (n = 9). All patients with alveolar clefts (n = 99) maintained keratinized mucosa along the labial surface of the cleft-adjacent teeth (n = 264 teeth). Complications were few and generally not serious. There was no segmental bone loss of teeth because of aseptic necrosis or infection. Only 5 percent of cleft adjacent teeth underwent a degree of gingival recession and root exposure as a result of the maxillary osteotomy procedure; all were retained long term. The long-term maintenance of overjet and overbite measured directly from the late (> 1 year) postoperative lateral cephalometric radiograph indicated that 97 percent of patients maintained a positive overjet and 89 percent maintained a positive overbite; 5 percent shifted to a neutral overbite. The methods used to manage jaw deformity, malocclusion, residual oronasal fistula, and bony defects in adolescents born with a cleft are safe and reliable and offer the patient an enhanced quality of life. They also provide a stable foundation in which final soft-tissue lip and nose revisions may be carried out.

Adolescent↗
PubMed1989

[The effect on chewing of treating distal bite with an activator].

The aim of this study was to analyse the influence of activator treatment on chewing efficiency. The subject material consisted of 60 children, adolescents and adults: Twelve children (ten years of age) with a Class II, Division 1 malocclusion were treated successfully with activators to a normal occlusion (16 years of age). Three normal occlusion samples, ten years (n = 12), 16 years (n = 12) and 29 years (n = 12) of age as well as an untreated Class II sample (n = 12), 16 years of age, served as control groups to the activator patients. The chewing ability was evaluated with the aid of a chewing efficiency test. The dental occlusion was appraised on dental casts. Recordings were made of number of erupted teeth, number of intermaxillary occlusal tooth contacts, overjet and overbite. The results revealed that chewing efficiency in activator patients was doubled from ten to 16 years of age. When comparing untreated subjects 16 years and ten years of age a greater chewing efficiency was seen in the older subjects. This was true for both Class II malocclusion and normal occlusion cases. Furthermore, in 16 year old subjects the chewing efficiency was comparable in treated and untreated normal occlusions as well as untreated Class II malocclusions. Thus, the investigation did not ascertain whether activator treatment per se resulted in an improved chewing efficiency. Furthermore, in the activator group no direct association existed between improvement in chewing efficiency and increased number of erupted teeth on one hand and increased number of intermaxillary occlusal tooth contacts, reduced overjet and overbite on the other. It is suggested that chewing efficiency is partly age related. The sagittal intermaxillary dental arch relationship doesn't seem to play an important role in determining chewing ability. However, harmonious interplay between the occluding teeth and the muscles influencing them (the muscles of mastication, the tongue-, lip- and cheek-musculature) is certainly of importance.

Activator Appliances↗
PubMed2003

Prevalence of defined symptoms of malocclusion among probands enrolled in the Study of Health in Pomerania (SHIP) in the age group from 20 to 49 years.

SUBJECTS AND METHODS: SHIP is a complexly structured, population-based cross-sectional study of adults in the German region of Pomerania (age group covered: 20-79 years). Findings in a population subgroup (age group 20-49 years; n = 1777; 53.1% women; 46.9% men) were subjected to orthodontic evaluation. Graduated registration of anterior crowding, overjet, frontal overbite and sagittal intermaxillary relationship of the posterior teeth; registration of ectopic canines, posterior crowding, anterior and posterior crossbite, negative overjet, retroclination of the upper incisors, buccal nonocclusion, and lateral open bite. The prevalence of almost regular dentition and of symptoms of malocclusion as well as the frequency of orthodontic treatment (subjective patient data) undergone by men and women were recorded. The correlation between the registered symptoms of malocclusion was calculated. RESULTS: 92.2% of the subjects had symptoms of malocclusion varying in number and severity. An anatomically correct dentition was found in only 7.8% of cases, and an "almost regular dentition" (inclusion criteria defined) in 14.2%. 32.8% of the subjects had severe malocclusion (inclusion criteria defined). The most frequent symptoms were anterior crowding, increased overjet, and distoclusion. These symptoms were significantly more frequent in women, while spacing and edge-to-edge bite, excessive overbite and mesioclusion were more frequent in men. 26.7% of the probands (28.0% women, 25.3% men) reported having received orthodontic treatment. The prevalence of craniofacial malformations (cleft lip and palate, syndromes) was 0.09% in women and 0.2% in men. Increased overjet was most frequently correlated with other symptoms of malocclusion.

Adult↗
PubMed1980

Variation in morphology of the maxillary central incisors found in class II, division 2 malocclusions.

Class II, Division 2 malocclusions show several common characteristics. One of the features is the presence of a deep overbite ("deckbiss"), which can be the result of an excessive eruption of the maxillary central incisors. This study tested the theory that the deep overbite, together with the apparent entrapment of the mandible, may be partly due to the bending of the maxillary central incisors or the presence of the Collum angle. In a comparison between the group of patients with Class II. Division 2 malocclusions and the control group, it was determined that the former group exhibited significantly larger Collum angles than the latter group (p < 0.005). It is suggested that in describing the maxillary incisor angulation in this type of malocclusion, the long axis of the crown, rather than the long axis of the tooth connecting the incisal edge to the apex, be used as a measure of their position.

Adolescent↗
PubMed1980

Correlations between orofacial muscle activity and craniofacial morphology in a sample of control and anterior open-bite subjects.

In order to investigate the correlations between genioglossus, masseter, and orbicularis oris muscle activity and craniofacial morphology, an electromyographic and cephalometric analysis was undertaken on a series of twenty-four human subjects. The activity from the muscles was recorded during voluntary opening movements of the mandible monitored by an electronic transducer. A computer-based method was devised to calculate the threshold incisor-separation position corresponding to a 20 percent increase in base line muscle activity for each of the muscles. In addition, twenty-seven anatmoic points were digitized from lateral head films, and a computer-based cephalometric analysis was completed for each subject. A number of significant correlations were found between the threshold muscle values and the thirty-one linear and angular morphologic variables. Low threshold values for the genioglossus muscle were correlated with negative overbites, undererupted maxillary and mandibular incisors, and low total face heights. Low threshold values for the masseter muscle were also associated with low overbite measurements. In contrast, orbicularis oris muscle thresholds did not appear to be correlated with any of the craniofacial variables measured. This interdependence of tongue and jaw muscle activity and facial morphology suggests a contribution of the musculature to the development and/or maintenance of the dentition.

Adult↗
PubMed1982

Long-term assessment of orthodontic relapse.

The long-term stability of orthodontic treatment was evaluated in a group of ninety-six former patients who were treated between 12 and 35 years previously. Dental relationships were recorded on study models taken prior to orthodontic treatment, at the end of active treatment, and at long-term follow-up. A malocclusion score was developed for this study, and the over-all static occlusal relationships were categorized by defining an ideal range for eleven variables. Ninety of the ninety-six cases were within the ideal range at the end of treatment. Most of the cases showed an improvement of their malocclusions in the long-term stage. However, of the ninety-six subjects, sixty-nine (72 percent) had at least one variable outside our ideal range in the long-term follow-up. A moderately increased overjet and overbite was responsible in most instances for the result being outside the ideal range in the long term. The long-term result as compared to the original malocclusion exhibited increased overbite in 16 percent of the cases, increased mandibular anterior crowding in 9 percent of the cases, and increased overjet in 5 percent of the cases. The range of ideal, considering only the variables used in this study, will to some extent vary with the eye of the beholder. Therefore, the results of this study need to be interpreted accordingly. It is suggested that orthodontists be well aware of long-term changes in dental relationships many years after treatment and take this into account when advising patients as to the potential benefits of orthodontic treatment.

Dental Occlusion↗
PubMed1984

Comparison study between three tooth positioners.

Maintenance of arch dimensions during treatment and retention is essential for the stability of orthodontic results. This study compared ten essential measurements between posttreatment models and three different tooth positioners. Two custom-made positioners and one prefabricated positioner were evaluated. The material for this study consisted of models of twelve patients who were treated orthodontically to a Class I occlusion. Three sets of models were made at the debanding appointment. One set was kept as the original control model. The other two sets were sent to two different laboratories for construction of custom-made positioners. Identical instructions were included. A fourth set of models was made from the prefinisher positioner that was selected for each patient. The original control model, the returned individualized setups, and the prefinisher models were compared. Changes in maxillary and mandibular intercanine and intermolar widths were recorded, along with arch length, molar classification, rotations, spaces, curve of Spee, overjet, overbite, midline discrepancies, and teeth positioned out of arch symmetry. This study showed that there was a significant difference in the mandibular intercanine and maxillary intermolar width between the control model and the prefinisher model. No significant difference in arch length, maxillary intercanine width, and mandibular intermolar width was found between the control model and the other three models. All studied models had a Class I molar relationship. Open contact points and a slight curve of Spee were found in a high percentage of cases. Rotations, midline discrepancies, overjet, and overbite were within normal limits. Arch symmetry was acceptable in all but one case. Positioners, although they appear in most cases to respect individual arch dimensions, should be checked carefully before delivery to the patient.

Adolescent↗
PubMed1984

New technique for semipermanent replacement of missing incisors.

An investigation was carried out to study the efficiency of a new technique for semipermanent replacement of missing incisors. A flexible system allowing slight physiologic movement of the bridge units was created by bonding an acrylic tooth to the abutments by means of three orthodontic wires, as shown in Figs. 9 to 11. Between June, 1981, and December, 1982, fifty-three bridges of this type were inserted in a sample that was nonselected relative to overbite and overjet. It comprised fifty-one persons 10 to 22 years of age (mean, 16; SD, 3.9). During an observation period of 5 to 22 months (mean, 15; SD, 4.8) ten bridges came loose, giving a failure rate of 18.9% for the whole sample. All the loosened bridges were replacements for missing maxillary central incisors. The thirteen bridges replacing missing maxillary lateral incisors and two bridges inserted in the mandible functioned without problems. There was no correlation between failure rate and overjet and overbite. However, the functional occlusion was of importance. If there was antagonistic contact with the pontic during functional movements, the failure rate was 57.1%. If there was no such contact, however, the failure rate was only 5.4%. This difference was statistically significant. Accumulation of plaque was significantly higher around the abutments than on contralateral surfaces. However, no significant differences in gingival health were recorded. In two persons, dental caries was recorded on the abutment surface facing the pontic.(ABSTRACT TRUNCATED AT 250 WORDS)

Acrylic Resins↗
PubMed1985

Stability and relapse of mandibular anterior alignment: a cephalometric appraisal of first-premolar-extraction cases treated by traditional edgewise orthodontics.

Assessment at least 10 years postretention of fifty-four cases previously treated in the permanent-dentition stage with first-premolar extractions, traditional edgewise mechanotherapy, and retention revealed considerable variation among patients. The long-term response to mandibular anterior alignment was unpredictable; no cephalometric parameters, such as maxillary and mandibular incisor proclination, horizontal and vertical growth amounts, mandibular plane angle, etc., were useful in establishing a prognosis. Few associations of value were found between cephalometric parameters and dental-cast measurements, such as overbite, arch length, intercanine width, and overjet. Only a slight tendency was found for incisor inclination to return toward the pretreatment value during the postretention period. It was possible to predict, on the basis of an analysis of pre- and posttreatment cephalometric records, those cases which had greater than 4 mm deepening of overbite postretention as well as those cases which had decreases of 3 mm or more in arch-length postretention. The practical use of these predictions were of limited clinical value, however.

Adolescent↗
PubMed1989

Postural kinematics of trumpet playing.

This paper examines the effects of anthropometry on body posture of trumpeters playing in standing position. Sixteen virtuosi trumpeters were photographed while hitting three notes (low C, high F and high F sustained) during performance of musical tasks. Initial standing posture and anthropometric data were recorded. Six body segment angles were computed and a vectorial sum was obtained to describe whole body posture in neutral and playing conditions. Horn angle and dental overbite were also computed. Earlier results showed that the musical task has no effect on playing posture. One-way ANOVA showed notable differences between the neutral posture and the note-related playing postures. A multiple regression model showed that in addition to the note effect, anthropometric variables, mainly neck length, explain the changes in playing posture. Horn angle is determined by the dental overbite. The importance of the anthropometric variables in playing the more demanding notes indicate that anthropometry may act to constrain trumpeters' performance.

Adult↗
PubMed1988

Temporomandibular disorders. Part II: Occlusal factors associated with temporomandibular joint tenderness and dysfunction.

Two complete classes of freshman dental and dental hygiene students, 120 men and 102 women (mean age 23.9 years) were assessed for the presence of masticatory pain or dysfunction by questionnaire, clinical examination, and evaluation of dental casts according to strict criteria. The purpose was to identify the degree of association between observable signs of TMJ disorders and selected combinations of occlusal variables. TMJ tenderness was more frequent in class II, division 2 than in class I (p less than .05), but overall was not associated with occlusal factors such as deep overbites, length of a symmetric RCP-ICP slide, and unilateral contact in RCP. Overall, clicking was not associated with Angle class, deep overbite, length of symmetric RCP-ICP slide, or unilateral RCP contact. Among subjects with unilateral RCP contact, those with no clinically obvious RCP-ICP slide (p less than .005) and those with asymmetric slides (p less than .05) had more TMJ clicking than subjects with symmetric slides. Luxation clicking of the condyle over the articular eminence on wide opening was absent in class II, division 2 subjects, but was most frequent in subjects with some teeth in unilateral posterior crossbite, particularly when this was a unilateral condition (p less than .001). Certain occlusomorphologic conditions may require less adaptation in the TMJs. This article indicates that an ICP anterior to the RCP in association with bilateral occlusal stability may be protective.

Adult↗
PubMed1988

The stability of the lower labial segment following surgical correction of Class III skeletal discrepancy.

There has been some controversy over the post-operative changes that may take place in tooth position following orthognathic surgery. The present study was designed to observe the changes that take place in the position of the incisors following surgery to correct class III skeletal discrepancies. It was found that the postoperative changes that occur in the axial inclination of the lower incisors are small enough to be clinically insignificant, provided an adequate overbite has been established. Any changes that do occur will probably be associated with a small increase in the mandibular maxillary planes angle, with possibly some upper incisor proclination and reduction of overbite.

Adult↗
PubMed1985

The nature of vertical maxillary deformities: implications for surgical intervention.

A study was performed to identify the area within the maxilla where vertical maxillary deformities are expressed. Analysis of the maxillas of individuals who displayed 4 mm or more of the central incisors at rest were compared with those who displayed less than 1 mm. Similarly, individuals who had greater than or equal to 2 mm negative incisor overbite (open-bite) were compared with those who had greater than or equal to 2 mm positive overbite. The results showed that the vertical position of the maxillary skeleton (palate) was similar in all groups. The vertical excess was found to lie within the dentoalveolus. The clinical implications of these results are discussed.

Adolescent↗
PubMed1992

Modification of the maxillary Le Fort I osteotomy in cleft-orthognathic surgery: the unilateral cleft lip and palate deformity.

Modifications of the Le Fort I osteotomy are described that allow for the simultaneous routine and safe management of maxillary hypoplasia, residual oronasal fistula, bony defects, soft-tissue scarring, and cleft-dental gap in adolescents with unilateral cleft lip and palate (UCLP). The results of this operation with 40 consecutive patients are presented, together with follow-up findings ranging from 15 months to 4 years 5 months. Parameters reviewed include cleft-dental gap closure, maintenance of attached gingiva at the cleft site, maintenance of a positive overjet and overbite, closure of residual oronasal fistula, the need for prosthetics to complete dental rehabilitation, and surgical morbidity. Thirteen of the patients also underwent simultaneous sagittal split osteotomies of the mandible, and 29 had a genioplasty performed. In 32 of the patients surgical cleft-dental gap closure was planned, and was successfully executed in all but one. Thirty-seven patients underwent successful simultaneous oronasal fistula closure, but in three cases, small residual fistulas remained. In all cases, attached gingiva was maintained in the region of the cleft site and along the tooth-bearing surfaces. Almost all of the patients maintained a positive overjet (39 of 40) and 85% maintained a positive (34 of 40) or at least neutral (4 of 10) overbite. Complications were few and generally not serious.

Adolescent↗
PubMed1987

Nonextraction orthodontic therapy: posttreatment dental and skeletal stability.

To assess the long-term stability of nonextraction orthodontic treatment, the dental cast and cephalometric records of 28 cases were evaluated. Thirty cephalometric and seven cast parameters were examined before treatment, posttreatment, and an average of almost 8 years postretention. Results showed overall long-term stability to be relatively good. Relapse patterns seen were similar in nature, but intermediate in extent, between untreated normals and four first premolar extraction cases. Significant decreases were seen in arch length and intercanine width during the postretention period despite minimal changes during treatment. Incisor irregularly increased slightly postretention; intermolar width, overjet, and overbite displayed considerable long-term stability. Mandibular incisor mesiodistal and faciolingual dimensions were not associated with either pretreatment or posttreatment incisor crowding. Class II malocclusions with large ANB values and shorter mandibular lengths showed increased incisor irregularity, shorter arch lengths, and deeper overbites at the postretention stage, suggesting that the amount and direction of facial growth may have been partially responsible for maturational changes seen during the postretention period.

Adolescent↗