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PubMed1989

A cephalometric study of 32 North American black patients with anterior open bite.

The purpose of this research project was to investigate a group of 32 North American black patients with anterior open bite and compare them to the North American black norms established by Altemus and Drummond and to white population norms established by Steiner. In addition, values were established for black patients by use of the overbite depth indicator of Kim. The method involved the tracing of lateral cephalometric radiographs of 32 patients with anterior open bite using the analyses of Tweed, Steiner, and Kim. The resulting angles were added and the means and standard deviations calculated. On the basis of the criteria used for this study, the significant findings were as follows: (1) the maxilla was normally positioned to the cranial base; (2) the upper and lower incisors were procumbent with an acute interincisal relationship; (3) the mandibular position tended to be retrusive to the cranial base; (4) the lower facial height was greater and the mandibular plane angle (GoGn-SN) was smaller than white population standards; and (5) the overbite depth indicator of Kim was smaller for this group than for the white population studied.

Adolescent↗
PubMed2004

Long-term stability of anterior open bite extraction treatment in the permanent dentition.

The purpose of this study was to cephalometrically evaluate the long-term stability of anterior open bite extraction treatment in the permanent dentition after a mean period of 8.35 years. Cephalometric headfilms were obtained at pretreatment, posttreatment, and postretention stages from 31 patients who had undergone orthodontic treatment with fixed appliances. Two control groups were used. The first, with an age similar to that of the experimental group before treatment, was used only to characterize it. The second, with normal occlusion, was followed longitudinally for a period comparable with the posttreatment period and was used to compare changes during this period. The differences between the observation stages in the experimental group were analyzed with paired t tests, and the posttreatment changes were compared with the changes of the second control group with independent t tests. There was no statistically significant decrease of the obtained anterior overbite at the end of the posttreatment period. The primary factors that contributed to the nonsignificant decrease of the overbite were the normal vertical development of the maxillary and mandibular incisors, the smaller vertical development of the mandibular molars, and the consequent smaller increase in lower anterior face height, as compared with the control group in the long-term posttreatment period. Additionally, 74.2% of the sample had a "clinically stable" open bite correction.

Adolescent↗
PubMed2003

Occurrence of malocclusion and need of orthodontic treatment in early mixed dentition.

This study analyzed the occlusions of 489 children at the onset of the mixed dentition period (mean age 5.1 years, range 4.0-7.8 years). These children participate in an ongoing clinical trial that is investigating the effects of orthodontic intervention in the early mixed dentition. The aim was to report the occlusal findings at the baseline. The frequencies of mesial step, flush terminal plane, and distal step were 19.1%, 47.8%, and 33.1%, respectively. The canine relationship was Class I in 46.1%, Class II in 52.4%, and Class III in 1.5% of the sides examined. An asymmetrical canine relationship was found in 30.1% of the children, significantly more often on the right side than on the left (P <.001). Overjet ranged from -2 to +10 mm with a mean of 2.9 mm. Overbite ranged from -5 to +8 mm with a mean of 2.8 mm. Excessive (> or =4 mm) overjet was found in 26.7% and overbite in 33.8% of the children; in 15.5% of the children, both variables were 4 mm or more. Anterior crowding was detected in the maxillary arch in 11.6% and in the mandibular arch in 38.9% of the children. Girls showed mandibular crowding more often than boys (P <.01). A posterior crossbite was found in 7.5% of the children, unilaterally in 6.4% and bilaterally in 1.1%. Scissors-bite was detected in 1.1% and an anterior crossbite in 2.2% of the children. The mean maximal opening was 40.3 mm. Joint sounds were registered in 5.2% of the children. The prevalence of malocclusion was between 67.7% and 92.7%, depending on the values of unacceptable parameters used for each occlusal characteristic.

Child↗
PubMed2004

Prevalence of malocclusion among adolescents in Ibadan, Nigeria.

The objective of this study was to determine the prevalence of malocclusion among predominantly Yoruba adolescents in Ibadan, Nigeria, and to compare the results with those of other authors. The sample for this epidemiological survey comprised 636 secondary school students, (334 [52.5%] boys and 302 [47.5%] girls), aged 12-17 years (mean age, 14.72 +/- 1.16 SD). The subjects were randomly selected, and none had received previous orthodontic treatment. Occlusal anteroposterior relationships were assessed based on the Angle classification. Other variables examined were overjet, overbite, crowding, and midline diastema. The results showed that about 24% of the subjects had normal occlusions, 50% had Class I malocclusions, 14% had Class II malocclusions, and 12% had Class III malocclusions. Over 66% had normal overbites, and 14% and 9% had increased and reduced values, respectively. Overjet relationship was normal in 66%, increased in 16%, and decreased in 8%. Crowding was observed in 20% of the subjects and midline diastema in 37%. No statistically significant differences were observed for any occlusal variables (P > .05). Class I malocclusion is the most prevalent occlusal pattern among these Nigerian students. Different patterns of Class II and Class III might be present for the dominant ethnic groups in the country. Therefore, a survey of the occlusal pattern in southeastern Nigerians (Ibo ethnic group) would appear to be worthwhile.

Adolescent↗
PubMed2004

Changes in the curve of Spee with treatment and at 2 years posttreatment.

The purposes of this study were to determine pretreatment skeletal and dental patterns related to curve of Spee depth, evaluate changes in the curve of Spee with treatment and the effects on dentofacial structures, and determine factors associated with the stability of the curve of Spee after treatment. Lateral cephalograms and dental casts were evaluated for 24 white male and 26 white female patients at pretreatment, posttreatment, and at least 2 years postretention. All patients had mandibular permanent second molars and premolars erupted and in occlusion. The following variables were correlated with increased pretreatment curve of Spee depth: low Frankfort-mandibular plane angle, deep overbite, increased overjet, and Class II molar malocclusion. No significant differences were found in pretreatment curve depth between male and female patients or between right and left sides. Leveling the curve of Spee was accomplished by uprighting the molars, extruding the premolars, and intruding or flaring the incisors. Extraction and nonextraction cases demonstrated no significant differences in the amount of curve relapse. Increased curve relapse was correlated with postretention increases in overbite, irregularity index, and patients given removable retainers. Overall, the curve of Spee was relatively stable after treatment, with only a 16% relapse of the leveled curve.

Adolescent↗
PubMed2006

Stability of anterior open-bite extraction and nonextraction treatment in the permanent dentition.

INTRODUCTION: Although stability of anterior open-bite extraction and nonextraction treatment has been investigated, results suggesting that extraction treatment is more stable have not been confronted. Therefore, the purpose of this cephalometric study was to compare the long-term stability of anterior open-bite extraction and nonextraction treatment in the permanent dentition. METHODS: Group 1 consisted of 21 patients treated without extractions, and group 2 included 31 patients treated with extractions who had orthodontic treatment with fixed appliances. Cephalometric headplates were obtained at pretreatment, posttreatment, and postretention. The groups were compared at these 3 times and during the treatment and posttreatment periods with independent t tests. The number of patients with a clinically significant relapse of the open bite was compared between the groups with chi-square tests. RESULTS: During treatment, the maxillary incisors had greater retraction amounts, and the mandibular incisors had greater retraction and lingual tipping, and less extrusion in the extraction group. In the posttreatment period, the extraction group demonstrated statistically greater stability of the overbite. However, there was no statistically significant difference in the percentages of patients with clinically significant relapse of the open bite between the groups. CONCLUSION: Open-bite extraction treatment has greater stability of the overbite than open-bite nonextraction treatment.

Adolescent↗
PubMed2006

A new look at the treatment of Class II Division 2 malocclusions.

This case report illustrates a treatment option for managing a skeletal Class II relationship with a Class II Division 2 malocclusion and impinging overbite. The patient's maxillary first premolars were extracted during unsuccessful orthodontic treatment at age 15. These extractions and the retraction of the maxillary anterior teeth during space closure worsened the facial profile deficiency caused by the original facial skeletal Class II discrepancies. During the retreatment described here, the second premolars were moved into the place of the previously extracted first premolars. The opened spaces at the second premolars were then restored with implant-supported restorations. Lingual brackets were used to correct the severe overbite. This approach created sufficient overjet to correct the Class II skeletal relationship with bisagittal mandibular advancement osteotomy. Reconstruction of the skeletal and occlusal relationships resulted in a more desirable facial profile for this patient.

Adult↗
PubMed2006

Predictors of long-term orthodontic side effects from mandibular advancement devices in patients with snoring and obstructive sleep apnea.

INTRODUCTION: Orthodontic side effects can complicate the long-term use of mandibular advancement devices (MADs) in the treatment of patients with snoring and obstructive sleep apnea. The aim of this study was to find predictors of dental side effects from monoblock MADs. METHODS: Four hundred fifty patients, who consecutively received treatment with either soft elastomeric or hard acrylic devices, were followed up after 5.4 +/- 0.8 years (mean +/- SD). The continuing patients responded to questionnaires and had dental examinations and plaster casts made. RESULTS: Twenty-seven patients had moved or died during the follow-up period. Two hundred thirty-six of the remaining 423 patients (56%) continued treatment, and 187 of them reported compliance rates of > or = 50% at night. A small reduction in overjet of < 1 mm was associated with a deepbite with an overbite of > 3 mm and an overjet of < or = 3 mm (odds ratio [OR] = 7.5; P = .015), nasal congestion (OR = 2.9; P = .005), or the use of a soft elastomeric device (OR = 2.7; P = .014) controlled for age, sex, treatment time, and mandibular displacement. A small reduction in overbite of < 1 mm was related to a small opening of the mandible of < 11 mm (OR = 2.5; P = .008). CONCLUSIONS: Orthodontic side effects might be predictable on the basis of initial characteristics in dental occlusion and the design of MADs.

Adult↗
PubMed2006

Comparison of extraction versus nonextraction orthodontic treatment outcomes for borderline Chinese patients.

INTRODUCTION: The purpose of this study was to compare orthodontic treatment outcomes in Chinese patients with borderline problems treated with and without extractions. METHODS: Records of 39 borderline patients treated at the Faculty Clinic of the Peking University Orthodontic Department were evaluated retrospectively by 5 associate professors. Sixteen patients had been treated without extractions, and 23 had 4 first or second premolars extracted. Each judge evaluated the posttreatment records independently for tooth alignment, overbite, overjet, midline symmetry, lateral occlusion, and facial profile, and rated them on a scale from 1 to 5. RESULTS: The only statistically significant difference between the extraction and nonextraction groups was for facial profile, with the judges preferring the extraction profiles. Fifteen soft-tissue cephalometric variables were measured to determine the source of the difference, and 6 showed statistically significant differences. When profile changes from pretreatment to posttreatment were examined, significant differences in treatment-associated changes between extraction and nonextraction groups were all related to the lower lip and chin. CONCLUSIONS: In this sample of Chinese borderline orthodontic patients, Chinese clinicians had a statistically significant preference for the facial profiles of the extraction patients, but no statistically significant preferences for tooth alignment, overbite, overjet, midline symmetry, or posterior occlusion. Extraction treatment increases the inclination of the chin and reduces protrusion of the lower lip compared with nonextraction treatment, and this might explain the difference.

Asian People↗
PubMed2006

Treatment effects of a modified quad-helix in patients with dentoskeletal open bites.

INTRODUCTION: The aim of this study was to investigate the effectiveness of a quad-helix/crib (Q-H/C) appliance in a group of growing subjects with thumb-sucking habits and both dental and skeletal open bites. METHODS: The records of 23 subjects treated with Q-H/C appliances were compared with a control group of 23 untreated subjects with similar vertical relationships. Lateral cephalograms were analyzed before treatment (T1; mean age, 8.4 +/- 1.4 years) and immediately after treatment (T2; mean age, 9.9 +/- 1.5 years). Mean duration of treatment was 1.5 +/- 7 months. The T2-T1 changes in the 2 groups were compared with a nonparametric test for independent samples (Mann-Whitney U test). RESULTS: The average increase in overbite during Q-H/C therapy (3.6 mm more than the control group) overcorrected the amount of anterior open bite at T2. However, 4 of 23 subjects did not show positive overbites at T2. Both the maxillary and mandibular incisors had significantly greater lingual inclinations (about 4.0 degrees) associated with greater extrusion (1.4 and 1.0 mm, respectively) in the Q-H/C group than in the control group. In addition, the treated group showed a greater downward rotation (1.2 degrees) of the palatal plane than did the control group. This change was associated with a greater increase in upper anterior facial height (0.7 mm) and a clinically significant reduction in the palatal plane-mandibular plane angle (-1.7 degrees) in the Q-H/C group with respect to the controls. The upper and lower lips showed significant tendencies toward retraction relative to the E-plane in the treated group (2.6 and 2.9 mm, respectively) compared with the controls. CONCLUSIONS: The Q-H/C appliance was effective in correcting the dental open bite in 90% of growing subjects with thumb-sucking habits and dentoskeletal open bites. The Q-H/C protocol produced a clinically significant improvement in the vertical skeletal relationships because of downward rotation of the palatal plane.

Cephalometry↗
PubMed2007

A cephalometric study of Class II malocclusions treated with mandibular surgery.

INTRODUCTION: Class II malocclusion is often associated with retrognathic mandible. Some of these problems require surgical correction. The purposes of this study were to investigate treatment outcomes in patients with Class II malocclusions whose treatment included mandibular advancement surgery and to identify predictors of good outcomes. METHODS: Pretreatment and posttreatment cephalometric radiographs of 90 patients treated with mandibular advancement surgery by 57 consultant orthodontists in the United Kingdom before September 1998 were digitized, and cephalometric landmarks were identified. Paired samples t tests were used to compare the pretreatment and posttreatment cephalometric values for each patient. For each cephalometric variable, the proportion of patients falling within the ideal range was identified. Multiple logistic regression analysis was performed to identify predictors of achieving ideal range outcomes for the key skeletal (ANB and SNB angles), dental (overjet and overbite), and soft-tissue (Holdaway angle) measurements. RESULTS: An overjet within the ideal range of 1 to 4 mm was achieved in 72% of patients and was more likely with larger initial ANB angles. Horizontal correction of the incisor relationship was achieved by a combination of 75% skeletal movement and 25% dentoalveolar change. An ideal posttreatment ANB angle was achieved in 42% of patients and was more likely in females and those with larger pretreatment ANB angles. Ideal soft-tissue Holdaway angles (7 degrees to 14 degrees ) were achieved in 49% of patients and were more likely in females and those with smaller initial SNA angles. Mandibular incisor decompensation was incomplete in 28% of patients and was more likely in females and patients with greater pretreatment mandibular incisor proclination. Correction of increased overbite was generally successful, although anterior open bites were found in 16% of patients at the end of treatment. These patients were more likely to have had initial open bites. CONCLUSIONS: Mandibular surgery had a good success rate in normalizing the main dental and skeletal relationships. Less ideal soft-tissue profile outcomes were associated with larger pretreatment SNA-angle values, larger final mandibular incisor inclinations, and smaller final maxillary incisor inclinations. The use of mandibular surgery to correct anterior open bite was associated with poor outcomes.

Adolescent↗
PubMed2007

Orthodontic treatment experience and prevalence of malocclusion traits in an Icelandic adult population.

INTRODUCTION: The objectives of this study were to record the extent of orthodontic treatment and the prevalence of occlusal anomalies in an adult sample in Iceland. METHODS: The study was based on a random sample of 829 subjects, 342 men and 487 women, aged 31 to 44 years, who completed questionnaires about their orthodontic treatment experiences and were available for clinical examination. RESULTS: Complete dentitions in both jaws were present in 52.8% of the women and 45.3% of the men at the examinations. Significantly higher percentages of the women had received orthodontic treatment of some kind (24.3% compared with 16.9% for the men) and treatment with fixed appliances (16.0% compared with 9.5% for the men). Malocclusion traits were recorded with a standardized method, describing sagittal and vertical incisor relationships, sagittal and transverse molar relationships, and mandibular and maxillary space conditions. The results showed that 45.5% of the subjects had no malocclusions, 33.9% had 1 malocclusion trait, and 20.5% had 2 to 4 traits. The most frequent malocclusion traits were distal molar occlusion (27.7%), mandibular anterior crowding (13.4%), molar crossbite (11.9%), excessive overbite (11.8%), maxillary anterior crowding (7.1%), mesial molar occlusion (6.9%), and excessive overjet (5.3%). The prevalences of mandibular overjet, mesial occlusion, and scissors-bite were significantly higher in the men than in the women. CONCLUSIONS: The prevalences of malocclusion traits were similar in treated and untreated subjects, except for a significantly lower prevalence of overjet and a higher prevalence of molar crossbite in the treated group. Comparison with other studies showed low prevalences of overjet, overbite, open bite, and maxillary and mandibular spacing and crowding; other variables fell within the ranges of prevalence in previous surveys.

Adult↗
PubMed2000

Diagnostic criteria for pseudo-Class III malocclusion.

The aim of this study is to identify the diagnostic criteria for pseudo-Class III malocclusion and compare it with Class I malocclusion in the southern Chinese population. Sixty-seven patients (mean age, 10.9 +/- 1.8 years) were included in this study; 36 patients represented pseudo-Class III malocclusion. Selection criteria included the following: (1) anterior crossbite (at least 2 incisors with negative overjet and overbite); (2) mandibular displacement; (3) all patients were southern Chinese who had been followed after the growth spurt, none had developed a skeletal Class III malocclusion; (4) the patients were treated for an average of 7 months to procline upper incisors and retrocline lower incisors. None of the cases received any treatment that might affect skeletal growth. Thirty-one patients with Class I malocclusion were included in the Class I malocclusion group for the comparison of dentoskeletal characteristics with the pseudo-Class III malocclusion group. Selection criteria included the following: (1) skeletal Class I malocclusion with normal overjet and overbite, (2) mild to moderate crowding with Class I molar relationship, (3) straight facial profile. The following were included in the assessment of pseudo-Class III malocclusion cases: (1) family history, (2) molar and canine relationships at habitual occlusion and centric relation, and (3) dentoskeletal morphology. The results were that 72% of the examined cases in the pseudo-Class III malocclusion group showed no family history and 75% showed Class I molar relationship at habitual occlusion. Compared with the Class I malocclusion group, subjects in the pseudo-Class III malocclusion group showed a significantly decreased midface length, increased maxillary-mandibular difference, more retroclined upper incisors, and a retrusive upper lip. In conclusion, a pseudo-Class III malocclusion is characterized by retroclined upper incisors, retrusive upper lip, decreased midface length, and increased maxillary-mandibular difference. Findings of this study showed that patients with a pseudo-Class III malocclusion exhibit certain morphologic, dental, and skeletal characteristics that should be of aid in the diagnosis of pseudo-Class III malocclusion.

Centric Relation↗
PubMed2003

Comparison of measurements made on digital and plaster models.

Measuring plaster models by hand is the traditional method of assessing malocclusion. Recent technologic advances now allow the models to be digitized, measured with software tools, stored electronically, and retrieved with a computer. OrthoCAD (Cadent, Fairview, NJ) performs this service. The purpose of this study was to evaluate the reliability of the OrthoCAD system. Two independent examiners measured tooth size, overbite, and overjet on both digital and plaster models. The results were compared, and interexaminer reliability was assessed. The study sample consisted of 76 randomly selected pretreatment patients. The results showed a statistically significant difference between the 2 groups for tooth size and overbite, with the digital measurements smaller than the manual measurements. However, the magnitude of these differences ranged from 0.16 mm to 0.49 mm and can be considered clinically not relevant. No difference was found between the 2 groups in the measurement of overjet. Interexaminer reliability was consistent for both the plaster and the digital models.

Analysis of Variance↗
PubMed2003

Dental and skeletal changes after 4 years of obstructive sleep apnea treatment with a mandibular advancement device: a prospective, randomized study.

The aim of this prospective, randomized study was to analyze dental and skeletal side effects after 4 years of treating obstructive sleep apnea (OSA) patients with a mandibular advancement device (MAD) compared with uvulopalatopharyngoplasty (UPPP). With the appliance in position, the mandible was advanced 50% of maximum protrusion capacity (ie, 4-6 mm); the vertical opening between the incisal edges was, on average, 3 mm. Thirty patients in the MAD group and 37 in the UPPP group completed the 4-year follow-up. There were no differences between the MAD and the UPPP groups in any of the dental or skeletal variables measured after the 4-year treatment period. In the MAD group, small but statistically significant changes were found: there was a posterior rotation of the mandible (mandibular line [ML]/nasion-sella line [NSL]) (mean 0.5 degrees [95% confidence interval (CI) 0.1-0.8 degrees ]). Correlated to the posterior rotation of the mandible, the distances incision superius ML, incision superius-NSL, and incision inferius-NSL increased by means (95% CI) of 0.7 (0.5-1.2), 0.8 (0.4-1.1), and 1.3 (0.8-1.8) mm, respectively. Overjet and overbite did not change significantly, nor was there a significant change in the mandibular length. The observed changes were considered clinically insignificant because overbite and overjet stayed within normal limits. Only the vertical position of the maxillary incisors in relation to ML changed to the extent that the 95% CI of the mean for the change was outside that of the mean of the change in the UPPP group and measurement error. Treatment of OSA with a dental appliance is probably a lifelong process, and long-term follow-up studies should therefore be undertaken to control both the treatment effect on OSA and the side effects on the masticatory system.

Cephalometry↗
PubMed1990

A case of open bite with Turner's syndrome.

The treatment of a skeletal Class III open bite malocclusion with Turner's syndrome is described. Although the patient had a negative overbite of 9 mm, a positive overbite of 2 mm was obtained through treatment, without any tooth extractions; however, an excessive vertical growth of the anterior regions was noted.

Cephalometry↗
PubMed1995

Skeletal and dental changes associated with the treatment of deep bite malocclusion.

A retrospective study of 132 treated orthodontic cases presenting at least 70% overbite was conducted using dental casts and lateral cephalometric radiographs from before and after treatment. These were 61 Class I, 27 Class II, Division 1, and 44 Class II, Division 2 malocclusion patients. Six different treatment modalities for the correction of the deep bite were compared. On the basis of the analysis of cephalometric measurements, no statistically significant differences were observed between the various treatment mechanics in the correction of the deep bite. Only in the Class II, Division 2 sample, total anterior face height increased significantly (p < 0.01) with all treatment modalities. The data were then grouped according to Angle classification regardless of the type of mechanics used. Within each Angle class, the changes from before to after treatment were statistically significant for almost all of the cephalometric measurements. These significant changes were due to both anticipated growth and orthodontic treatment. The treatment of overbite primarily affected the proclination of incisors and the extrusion of molars. Within each Angle classification, the patients were also separated according to whether the permanent teeth had been extracted. The nonextraction group was compared with the extraction group for the changes in each cephalometric measurement. It was found that the extraction of teeth did have a significant effect on the changes observed with treatment in all the Angle classes but was more pronounced in the Class I sample. The proclination of incisors was less and the mesial movement of molars was more in patients who were treated with the extraction of premolar teeth than those who were treated with the nonextraction procedures.

Adolescent↗
PubMed1996

An evaluation of root resorption incident to orthodontic intrusion.

A new radiographic method was developed for measuring changes in root length. With this technique, orthodontic intrusion was investigated as a potential cause of apical root resorption of maxillary incisors. The experimental group consisted of 17 patients with excessive overbite who were treated with a Burstone-type intrusion arch, which delivered a low level of force (about 15 gm per tooth). A control group was made up of 17 patients in full-arch fixed appliances who were randomly selected. After a period of approximately 4 months, the intrusion group had only slightly more root resorption than the controls, 0.6 mm versus 0.2 mm (statistically significant difference). Intrusion measured at the center of resistance of the central incisor averaged 1.9 mm. The amount of resorption was not correlated with the amount of intrusion. A weak correlation, r = 0.45, was found between resorption and movement of the apex (i.e., in addition to intrusion, there was often palatal root movement). Results of this study seem to indicate that intrusion with low forces can be effective in reducing overbite while causing only a negligible amount of apical root resorption.

Adolescent↗