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PubMed1996

Long-term stability of Class II, Division 1, nonextraction cervical face-bow therapy: I. Model analysis.

The long-term stability of Class II, Division 1 nonextraction therapy remains poorly described. This study evaluates the face-bow therapy, in conjunction with full-fixed appliance therapy, of 42 patients (34 females and 8 males) who were treated by the same practitioner. Treatment goals had been attained for all patients. The pretreatment, posttreatment, and postretention records were taken at 11.5, 14.5, and 23.1 years, respectively. The results showed that mandibular and maxillary arch widths were increased significantly during treatment. Mandibular intercanine width decreased 0.3 mm during the postretention period; the remaining width measures increased or remained stable. Arch length, which did not change during treatment, decreased 1.0 mm after treatment. Overjet and overbite decreased 4.4 mm and 2.5 mm, respectively, during treatment. Both overjet (0.5 mm) and overbite (0.4 mm) showed small increases after retention. Mandibular incisor irregularity was decreased 2.7 mm during treatment and increased only 0.4 mm after treatment. Within the limits of this study, it is concluded that, when the described techniques are used, nonextraction therapy for patients with Class II malocclusion is largely stable.

Adolescent↗
PubMed1998

Longitudinal dental arch changes in adults.

This study examined changes in the dental arches that occur in untreated persons between late adolescence and the fifth or sixth decade of life. Longitudinal dental casts from 82 subjects were obtained as part of a recall study of subjects from the University of Michigan Elementary and Secondary School Growth Study. From the parent sample, three groups were identified. The untreated sample comprised 53 subjects (27 males and 26 females). A midadult sample of 10 persons, who had an additional set of records taken on average during their fourth decade of life also was analyzed, as was a sample of 13 subjects who received orthodontic treatment as adolescents and were about 30 years posttreatment. Measures of dental arch width, arch depth, and arch perimeter were evaluated with the aid of digital-imaging hardware and software. Incisor irregularity, curve of Spee, overjet, and overbite were measured directly from the dental casts. Statistically significant decrements occurred in arch width, depth, and perimeter. The mean decrement in any one dimension was less than 3 mm. At all times, males displayed significantly more mandibular incisor irregularity than females. In addition, the increase in mandibular incisor irregularity that occurred in male and female subjects was the same. However, irregularity did not increase in all subjects; it decreased in 3% of the males and 7% of the females. In general, overbite, overjet, and curve of Spee were stable during adulthood. Statistically significant correlations between the changes in dental arch measures could not be established.

Adolescent↗
PubMed1998

Psychological influences on the timing of orthodontic treatment.

Debates about the "ideal" timing of orthodontic treatment have focused on issues of biologic development and readiness. In this article we examine psychologic issues that should be considered in the decision to initiate orthodontics in the younger child or to wait until adolescence or later. Psychologic development during the preadolescent and adolescent stages may influence the child's motive for, understanding of, and adherence to treatment regimens. Results of a study of some personality characteristics, motives, and aesthetic values of young phase I patients are presented. Questionnaires were completed by 75 children (mean age 10.85 years, 52.1% female, 84% white) and their parents. Children's perceived reasons for treatment were consistent with their parents' reports (chi 2 = 76.08, p < .001); most were referred for crowded teeth (56%) and overbite (17.3%). Although body image and self-concept scores were within the normal range, both children and their parents expected the most improvement in self-image and oral function, with greater expectations by parents on self-image (p < .0001), oral function (p < .0001), and social life (p < .03) than children themselves. Although white and minority children were similar in their self-ratings and expectations from orthodontics, the former were more critical in their aesthetic judgments. They rated faces with crowded teeth (p < .02), overbite (p < .02), and diastema (p < .01) more negatively than did ethnic minorities. These results suggest that younger children are good candidates for Phase I orthodontics, have high self-esteem and body-image, and expect orthodontics to improve their lives. White children who have been referred for Phase I orthodontics appear to have a narrower range of aesthetic acceptability than minority children.

Adolescent↗
PubMed1999

A retrospective study of Angle Class I malocclusions treated orthodontically without extractions using two palatal expansion methods.

The correction and relapse of mandibular anterior crowding was evaluated in a population of 58 patients with Angle Class I malocclusion who were treated orthodontically without extraction of permanent teeth. The subjects were retrospectively evaluated from records taken before treatment, posttreatment, and postretention. The postretention period averaged 8 years (minimum of 4 and maximum of 20 years). All cases in Groups A and B were given orthopedic treatment to develop the maxillary apical base in the transverse and anteroposterior planes. Group A was treated with expansion of the inner bow of the face bow appliance (Kloehn), and Group B was treated with the Haas palatal expansion appliance. Both groups were then treated orthodontically with tandem mechanics. The response variables measured were: overbite, overjet, intercanine distance, intermolar distance, and irregularity index. Study groups A and B were not significantly different for subject age, retention, or postretention time. Moreover, the groups did not show significant difference for any of the response variables before treatment. However, there was a statistically significant difference in the treatment times (P =.0133). A statistically significant treatment effect was observed for most response variables in the groups. Overbite, overjet, and irregularity index were significantly reduced, intermolar distance was significantly increased, and intercanine distance showed no significant change in Groups A and B. In the postretention period, there was a tendency for variables to change slightly toward their before treatment values but no compromise of orthodontic correction was noted. The irregularity index in Group A was corrected from 4.8 to 1.1 mm and remained at 1.1 mm in the postretention period. The irregularity index in Group B was corrected from 5.1 to 1.2 mm (P =.0001) and changed slightly from 1. 2 to 1.7 mm (P =.0540) in the postretention period. We concluded that mandibular incisors tended to become more crowded postretention. However, in contrast to previous reports, we calculate this relapse to be small. Neither before treatment nor posttreatment variables were predictive of relapse.

Adolescent↗
PubMed1997

Skeletal and dento-alveolar stability of Le Fort I intrusion osteotomies and bimaxillary osteotomies in anterior open bite deformities. A retrospective three-centre study.

A sample of 267 patients with maxillary hyperplasia, a Class I or Class II/I occlusion and anterior vertical open bites, collected from three different institutions, was analysed regarding stability after surgical corrections. Skeletal and dento-alveolar stability of the maxilla, and positional changes of the mandible and of the incisors were evaluated. All patients underwent Le Fort I intrusion osteotomies and in 92 patients segmentation of the maxillae was performed. An additional bilateral sagittal split advancement osteotomy was performed in 123 patients. Intraosseous wire fixation was used in 153 patients and rigid internal fixation in 114 patients. Cephalometric radiographs were collected before orthodontic treatment, before surgery, immediately after surgery, one year postoperatively and at the latest follow up. The mean follow up was 69 months (range 20-210 months). It can be concluded that patients with anterior open bites, treated with a Le Fort I osteotomy in one-piece or in multi-segments, with or without bilateral sagittal split osteotomy, exhibited good skeletal stability of the maxilla. Rigid internal fixation produced the best maxillary and mandibular stability. The mean overbite at the longest follow up was 1.24 mm and a lack of overlap between opposing incisors was present in 19%. The overbite did not differ significantly between the different treatment procedures, probably due to compensatory movements of the mandibular and maxillary incisors.

Adolescent↗
PubMed2001

Extraction as a treatment alternative follows repeated trauma in a severely handicapped patient.

Handicapped patients with protruding maxillary incisors are prone to repeated dental trauma. A 13-year-old girl with cerebral palsy, severe mental retardation and seizure disorder was referred to our department for restoring the traumatized anterior teeth. Despite drug combination, the frequency of seizure attack was around 10 times a month. The oral examination showed multiple caries, gingival hyperplasia, class II malocclusion with 14 mm overjet and deep overbite. During the first 3 years of a 7-year follow-up period, six episodes of anterior tooth trauma due to seizure attack occurred. The trauma-related treatment performed included endodontic therapy, multiple composite restorations, apical repositional flap, and finally extraction of all four upper incisors with fabrication of a semi-fixed band-retained denture. The denture restored normal overbite and overjet with improved esthetics. For 4 years following the fabrication of denture, no trauma occurred to the anterior teeth in later seizure attacks. Considering inadequate control of seizure disorder, little ability of the patient to receive comprehensive orthodontic treatment, poor prognosis of restorations, and possible future injuries, the removal of non-functional, nonesthetic, trauma-susceptible incisor teeth can be justified as an alternative to tooth preservation.

Adolescent↗
PubMed1980

The prediction of facial growth.

In the two contrasting malocclusions, the open bite and the deep overbite, statistically significant differences are shown in the anterior, middle and posterior endocranial regions. In open bite there is an association between the lower face height and the size of the anterior, middle and posterior cranial regions, but in deep overbite the associations between face height and the endocranial size are less strong. These and other associations if brougth together in a multiple regression analysis may prove useful in prognosticating the final face height in the growing child, particularly in the open-bite case.

Adolescent↗
PubMed1993

Evaluation of the vertical forces generated by the cervical biteplate facebow.

The biteplate facebow has been recommended for use in the correction of Class II malocclusions with deep overbites. This facebow is similar in design to the conventional cervical facebow with the addition of an inner bow metal plate. The plate presses against the maxillary incisors and prevents the patient from fully closing, thus acting as a biteplate. A test apparatus was constructed to simulate the force system present during application of the facebow. In this study, high resolution force transducers were used to measure the intrusive forces on the maxillary and mandibular incisors. Static force analysis techniques were then used to calculate the vertical force component of the first molars. Analyses were performed using a wide range of relative bow angles, neck strap tensions of 200 grams and 400 grams, and various mandibular incisor occluding forces. The molar eruptive forces of the biteplate facebow are found to exceed those of the standard cervical facebow by a low of 158% to a high of 537%, depending on the neck strap tension and the inner bow/outer bow angle. While the intrusive forces on the maxillary incisors were excessive, no intrusion is anticipated because the biteplate disarticulates the posterior teeth and the eruption of the unopposed maxillary molars would likely cause the occlusal plane to tip in a counter-clockwise direction. Consequently, the overbite correction would be obtained through maxillary molar eruption accompanied by occlusal plane tipping. Before considering use of the biteplate facebow, a patient's anticipated growth pattern, the magnitude of the intrusive forces and the treatment objectives should be evaluated.

Activator Appliances↗
PubMed1994

Repelling magnets versus superelastic nickel-titanium coils in simultaneous distal movement of maxillary first and second molars.

Eighteen subjects, aged 12.5 to 18.3 years, with Class II malocclusion, deep overbite and moderate space deficiency in the maxilla were treated orthodontically using repelling rare earth magnets on one side and superelastic nickel-titanium coils on the contralateral side for simultaneous distalization of maxillary first and second molars. The force values of the magnets and the coils were calibrated to 225g at the start of treatment and when reactivation was performed every fourth week. Tooth movement was analyzed by measuring dental casts, lateral photographs of dental casts, and lateral skull radiographs before and after 6 months of treatment. Mean distal molar movement was 3.2 mm for the supercoils and 2.2 mm for the magnets. Mean reduction of the overbite was 3.6 mm. Complaints of discomfort were more frequent for the magnet sides. The results indicate that superelastic coils are more effective than repelling rare earth magnets in molar distalization.

Adolescent↗
PubMed1997

Simultaneous intrusion and retraction using a three-piece base arch.

Flared incisors and deep overbite are challenging to treat orthodontically. This paper describes the use of a three-piece base arch and Class I elastics to correct deep overbite while simultaneously closing spaces. An analysis of the biomechanics and a discussion of the appliance design are presented to help understand how the incisor axial inclination can be corrected and controlled during orthodontic therapy. A clinical example illustrates the treatment sequence.

Adult↗
PubMed1999

Occlusal changes from adolescence to adulthood in untreated patients with Class II Division 1 deepbite malocclusion.

A sample of 47 untreated children (M 32:F 15) with Class II Division 1 (II/1) deep-overbite malocclusion was collected from a group of patients who declined orthodontic therapy. Longitudinal records consisted of plaster dental casts and lateral cephalograms at original diagnosis and plaster dental casts at a follow-up observation in adulthood, an average of 11.5 years later. To study retrospectively natural changes in dental occlusion during this interval, plaster-cast millimetric measurements were recorded of sagittal dental relationships (first molar and canine), overjet, overbite, and crowding/spacing at the two registrations. Results showed statistically significant improvements in untreated II/1 deepbite malocclusion from adolescence to adulthood for all measured occlusal variables except development of mild crowding. Therefore, assumptions that untreated II/1 distoclusion will worsen with age appear to be unfounded. The evidence indicates that the absence of orthodontic correction for adolescent patients with Class II Division 1 deepbite malocclusion will not usually lead to measurable occlusal deterioration in young adulthood.

Adolescent↗
PubMed1999

The use of a deprogramming appliance to obtain centric relation records.

The purpose of this study was to investigate the effect of an anterior flat plane deprogramming appliance (Jig) in 40 subjects for whom centric relation (CR) records were obtained before and after the use of the appliance. Incisal overbite and overjet dimensions and three-dimensional instrument condylar representation using the Panadent condylar path indicator (CPI) were recorded from maximum intercuspation and centric relation. Subjects were assessed subjectively to determine the degree of difficulty manipulating the mandible to obtain the centric relation record. The mean overbite difference from maximum intercuspation (MI) to centric relation without (CR) and with (CRJ) the appliance were statistically significant and decreased 1.58 mm and 2.23 mm, respectively. The mean overjet values from MI to CR and CRJ were statistically significant and increased .44 mm and .57 mm, respectively. Significant differences were determined on the Panadent articulator for the absolute vertical (Z) and absolute horizontal (X) values for centric relation with and without the appliance. The number of subjects who exceeded the threshold values of 2 mm for CPI recordings in either the horizontal or vertical direction was 7 (18%,) from MI to CR and 16 (40%) from MI to CRJ. The Lucia-type jig deprogramming appliance provides a centric relation record with greater displacement from MI than a centric relation record alone. This appliance may be a useful adjunct in a patient where mandibular manipulation in taking a centric relation bite registration is deemed not easy.

Adult↗
PubMed2000

Long-term stability of surgical open-bite correction by Le Fort I osteotomy.

Skeletal changes greater than those observed in untreated adults have been noted beyond 1 year post-surgery in adult patients who had surgical correction of a long face deformity. The stability of skeletal landmarks and dental relationships from 1 to >3 years post-surgery was examined in 28 patients who had undergone surgery of the maxilla only, and in 26 patients who had undergone 2-jaw surgery to correct >2 mm anterior open bite. Although the average changes in almost all landmark positions and skeletal dimensions were less than 1 mm, point B moved down >2 mm and face height increased >2 mm in one-third of the maxilla-only group and in 40% of the 2-jaw group (>4 mm in 10% and 22% respectively). Overbite decreased 2-4 mm in only 7% of the maxilla-only and 12% of the 2 groups, with no changes >4 mm, because in three-fourths of the patients with an increase in anterior face height, further eruption of the incisors maintained the overbite relationship. In the maxilla-only group, mandibular length (Co-Pg) showed >2 mm long-term change in 45% of the patients, two-thirds of whom showed an increase rather than a decrease in length. In the 2-jaw group, no patients showed a decrease in Co-Pg length and one-third had an increase. For both groups, changes in overjet were smaller and less frequent than changes in mandibular length.

Adaptation, Physiological↗
PubMed2001

The incisor-lip relationship in Herbst/multibracket appliance treatment of Class II, Division 2 malocclusions.

The purpose of this investigation was to examine the effect of Herbst/multibracket appliance treatment on the upper incisor-lower lip relationship in the management of Class II, division 2 malocclusions. The study evaluated 19 successfully treated subjects using lateral head films analyzed at 3 occasions: before (T1) and after (T2) Herbst/multibracket appliance treatment and 1-year posttreatment (T3). The average treatment (T1-T2) changes showed (1) the lower lip overlap on the upper incisors was reduced from 6.0 mm to 4.2 mm (P < .001), (2) the upper incisors were proclined 15.3 degrees (P < .001) and the lower incisors were proclined 9.6 degrees (P < .001), (3) the overbite was reduced from 7.3 mm to 1.7 mm (P < .001), and (4) the sagittal jaw base relationship (Wits) improved from +3.5 to +0.5 mm (P < .001). The average posttreatment (T2-T3) changes showed (1) the upper incisor-lower lip relationship remained stable, (2) the upper (0.6 degrees; P < .001) and lower (2.3 degrees; P < .001) incisors retroclined, (3) the overbite increased (1.2 mm; P < .001), and (4) the sagittal jaw base relationship remained unchanged. In conclusion, it was found that the upper incisor-lower lip relationship was improved by Herbst/multibracket appliance treatment and remained stable during a 1-year posttreatment period in spite of minor relapses of incisor tooth positions and relationships.

Cephalometry↗
PubMed2002

Reproducibility of characteristics assessing the occlusion of young adults.

The aim of the present investigation was to analyze the reproducibility in the assessment of six morphological and three functional characteristics included in a new method evaluating the occlusion in young adults. These characteristics comprised coincidence of midlines, overjet, overbite, canine relationship, crossbite, scissors bite, recurrent deviation on opening, guided lateral excursions, and discrepancy between the centric relation and the intercuspal position. The study was conducted in three stages: (1) five observers assessed the occlusions of five volunteers, (2) seven observers assessed nine volunteers, and (3) five observers assessed nine volunteers. Two calibrated orthodontists were used as references. For numerical variables, the nonparametric method for repeated measurements (Friedman's test) was used to test the significance of differences, while the proportion of agreement was calculated for categorical assessments. The results were analyzed using two precision levels: within a measurement unit/the same category and an acceptable/nonacceptable dichotomy. The magnitude of systematic differences was small and of minor clinical importance except in measurements of recurrent deviation on opening. The proportional agreement for acceptance was good in the assessment of overjet, coincidence of midlines, crossbite, scissors bite, open bite, and discrepancy between the centric relation and the intercuspal position. Moderate agreement was achieved in the assessment of overbite, canine relationship, recurrent deviation on opening, and guided lateral excursions. Among the nonacceptable cases, the agreement ranged from poor to good. The results indicated that noncalibrated observers assess categorical characteristics inconsistently.

Adolescent↗
PubMed2004

Comparison between the opinions of Tanzanian parents and their children on dental attractiveness.

The objective was to investigate the opinion of Tanzanian parents on dental attractiveness and to compare their opinion with that of their children. A prestructured questionnaire with 18 intraoral frontal photographs was given to 286 parents and their children aged 9-18 years. The photographs represented various types of occlusion traits, with the first 10 intraoral photographs representing grade 1-10 of the aesthetic component (AC) of the index of orthodontic treatment need, and the remaining eight photographs were added to represent malocclusions that are often seen in Tanzania. Basic statistical techniques were used to analyze the data. Photographs showing severe deviations were perceived by both children and parents as the most unattractive. The opinion was significantly correlated with children's age (P = .02) and sex (P < .0005), with older girls tending to dislike photographs showing severe deviations the most. The mean of the opinion for the photographs showing some spacing with overbite < or = 2 mm or open bite and overbite > 2 mm fell in the middle of the scale, with a tendency toward unattractiveness. Photographs matching 8-10 on the AC scale were perceived as the most unattractive, indicating what could be a lay person's priority when considering an orthodontic treatment policy in Tanzania.

Adolescent↗
PubMed2004

The role of a high pull headgear in counteracting side effects from intrusion of the maxillary anterior segment.

Intrusion of incisors is often the preferred treatment of a deep overbite. This study focuses on deep overbite correction by intrusion of maxillary incisors. The purpose of this study is to determine whether high-pull headgear wear can prevent steepening of the buccal segment, extrusion of the buccal segment, maintain arch width, and increase the rate of incisor intrusion. The number of patients needed for this study was calculated to be 20. Patients were between nine and 14 years of age and assigned to one of two groups. In each group, intrusion of maxillary incisors was performed. Patients in one group wore a high-pull headgear at night, and patients in the other group did not. For each patient, a lateral head film, impressions with a wax bite in centric occlusion, and intraoral photographs were taken at the beginning and end of intrusion. This study demonstrated that high-pull headgear had no effect on steepening and extrusion of the buccal segments or on the rate of intrusion but did have an effect on narrowing of the buccal segments. By performing intrusion as described in this study, no statistically significant side effects were observed in the buccal segments, whereas a statistically significant amount of incisor intrusion of 2.24 mm in the no-headgear group and 2.37 mm in the headgear group was observed.

Adolescent↗
PubMed2004

Relationship between mandibular anterior crowding and lateral dentofacial morphology in the early mixed dentition.

Mandibular anterior crowding is identified as the discrepancy between mesiodistal tooth widths of four permanent incisors and available space in the alveolar process. However, incisor crowding is not merely a tooth-arch size discrepancy. Many variables such as direction of mandibular growth, early loss of deciduous molars, the oral and perioral musculature and incisor and molar inclination can be associated with crowding. Only few studies evaluated the relationship between mandibular anterior crowding and cephalometric measurements in the early mixed dentition. It was the aim of this study to search for dentofacial factors that might be associated with mandibular crowding in the early mixed dentition. Lateral cephalograms and dental casts of 60 children (33 girls, 27 boys) were evaluated. It was determined that patients with crowding had smaller lower incisor to NB angles, maxillary skeletal lengths, mandibular skeletal length, and mandibular dental measurements. They also had greater interincisal angles, overjet, overbite, and Wits appraisal measurements. Significant inverse correlations were found between crowding and SNB, lower incisor to NB angle, anterior cranial length, mandibular length, maxillary length, mandibular dental measurement and direct correlations between crowding and interincisal angle, overjet, overbite, and FMIA. According to these results, we conclude that crowding of the mandibular incisors is not only a tooth-arch size discrepancy. Dentofacial characteristics also contribute to this misalignment.

Alveolar Process↗