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At least 613 records · Page 34Linked to original sources
PubMed1997

Predicting functional appliance treatment outcome in Class II malocclusions--a review.

Selecting cases suitable for treatment with a functional appliance remains a problem as much of the relevant literature is anecdotal. There are also design and methodologic differences between the available studies, and most studies are limited to the Andresen type of appliance. The literature suggests that functional appliances are most successful in cases with an overjet of up to 11 mm, an increased overbite, active facial growth, and good cooperation.

Adolescent↗
PubMed1997

Initial effects of treatment of Class II malocclusion with the Herren activator, activator-headgear combination, and Jasper Jumper.

The initial effects of treatment of Class II, Division 1 malocclusion with an activator, according to Herren (27 patients), with an activator-headgear combination (20 patients), or with the Jasper Jumper appliance (25 patients) were studied on lateral cephalograms from before and after 6 to 8 months of treatment. The patients' ages ranged from 9 to 12 years. At the end of the period of observation, the correction in overjet and molar relationship was more complete in the patients with the Jasper Jumper than in the patients with the activator. Whereas all the patients with the Jasper Jumper showed neutral occlusion, this was the case in only 20 of the 47 patients with the activator. The correction of the distal occlusion occurred through a combination of skeletal and dentoalveolar adaptations. Skeletal changes accounted for 42%, 35%, and 48% of the overjet correction by the Herren-type activator, the headgear-activator, and the Jasper Jumper, respectively. The correction of the molar relationship occurred to 55%, 46%, and 38% by skeletal changes in the respective groups. Dentoalveolar compensation (distal movement of the upper molars, mesial movement of the lower molars) appeared to be inversely related to skeletal adaptation. The patients with the Jasper Jumper showed a marked intrusion of the lower incisors with a consequent reduction in overbite.

Activator Appliances↗
PubMed1997

Early dentofacial features of Class II malocclusion: a longitudinal study from the deciduous through the mixed dentition.

A group of 25 untreated subjects with Class II malocclusion in the deciduous dentition (featuring the concomitant presence of distal step, Class II deciduous canine relationship, and excessive overjet) was compared with a control group of 22 untreated subjects with ideal occlusion (flush terminal plane, Class I deciduous canine relationship, minimal overbite, and overjet) at the same dentitional stage. The subjects were monitored during a 2 1/2-year period in the transition from the deciduous to the mixed dentition, during which time no orthodontic treatment was provided. Occlusal analysis of the Class II group in the deciduous dentition revealed an average interarch transverse discrepancy due to a narrow maxillary arch relative to the mandible. All occlusal Class II features were maintained or became exaggerated during the transition to the mixed dentition. The skeletal pattern of Class II malocclusion in the deciduous dentition typically was characterized by significant mandibular skeletal retrusion and mandibular size deficiency. During the period examined, cephalometric changes consisted of significantly greater maxillary growth increments and smaller increments in mandibular dimensions in the Class II sample. Moreover, a greater downward and backward inclination of the condylar axis relative to the mandibular line, with consequent smaller decrements in the gonial angle, were found in the Class II group, an indication of posterior morphogenetic rotation of the mandible in patients with Class II malocclusion occurring during the period examined. The results of this study indicate that the clinical signs of Class II malocclusion are evident in the deciduous dentition and persist into the mixed dentition. Whereas treatment to correct the Class II problem can be initiated in all three planes of space (e.g., RME, extraoral traction, functional jaw orthopedics), other factors such as patient cooperation and management must also be taken into consideration before early treatment is started.

Cephalometry↗
PubMed1997

A longitudinal study of arch size and form in untreated adults.

Adulthood-the lengthy phase following attainment of biologic maturity-often is perceived as a period of "no change" or one of slow deterioration. Recent skeletodental studies discount this stereotype. Changes in arch size and shape were studied here in a longitudinal series of 60 adults with intact dentitions. Full-mouth study models were taken at about 20 years of age and again at about 55 years. Some variables-particularly those between arches (incisor overbite and overjet, molar relationship) and mandibular intercanine width-remained age-invariant. In contrast, all other measures of arch width and length changed significantly (P < 0.01): Arch widths increased over time, especially in the distal segments, whereas arch lengths decreased. These changes significantly altered arch shape toward shorter-broader arches. The data suggest that changes during adulthood occur most rapidly during the second and third decades of life, but do not stop thereafter. Possible mechanisms driving these changes in tooth position are discussed.

Adult↗
PubMed1998

Assessment of skeletal and dental changes by maxillary protraction.

To further evaluate the effect of maxillary protraction on facial growth, cephalometric changes in 129 subjects with conditions diagnosed as skeletal Class III malocclusion and who had been treated with maxillary protraction were compared to 9 male and 12 female subjects with annual cephalometric records from the Yonsei growth study sample. The control subjects had Angle Class I malocclusions with normal overjet and overbite. More maxillary forward displacement and mandibular growth inhibition were observed in the protraction group during treatment, and the difference from the untreated controls was statistically significant. When changes due to treatment according to ages were compared, there was no statistical difference. The direction of maxillary growth was similar in the untreated and protraction groups. Maxillary protraction had a growth-stimulating effect on the maxilla during the treatment period.

Adolescent↗
PubMed1998

Occlusal stability after extraction orthodontic therapy in adult and adolescent patients.

In this study we compared the posttreatment stability of occlusion in adults and adolescents treated for crowding or maxillary protrusion with four-premolar extractions and edgewise mechanics at an average of more than 4 years out of treatment. The adolescent sample showed a significantly greater posttreatment increase in mandibular anterior crowding than the adult sample. Posttreatment overjet and overbite remained more stable in the adolescents. We noted a correlation between in-treatment expansion and posttreatment narrowing of mandibular intercanine width in the adults. Differences in postorthodontic occlusal changes were noted between the adult and adolescent samples.

Adolescent↗
PubMed1998

Occlusal stability in Class II, Division 1, deep bite cases followed up for many years after orthodontic treatment.

This case report analyzes long-term occlusal stability that can be achieved in Class II, Division 1, deep bite cases with active treatment finished during the period of maxillomandibular growth. The analysis was designed to identify occlusal features common to two cases at the end of active treatment and to study how the occlusion changed with growth and jaw movement to achieve stability. The following occlusal features were shared by the two cases at the end of active treatment: (1) AB plane and axes of the maxillary and mandibular posterior teeth were perpendicular to functional occlusal plane; (2) the axis of the lower incisor was almost perpendicular to DC-L1i line; (3) the anterior occlusion was overcorrected to or near an edge-to-edge relationship. Items 1 and 2 remained unchanged throughout the follow-up periods, regardless of growth status, and the overjet and overbite increased during maxillomandibular growth after treatment. During the period of mandibular growth alone, after the end of retention, the axes of maxillary incisors tipped labially; as a result, F line became parallel to CDM line by the end of growth. The labial tipping of maxillary incisors brought the lower incisal edge into contact with or extremely near the inflection point (Bp).1 By the end of growth, the tangent of Bp became parallel to or coincident with DC-L1i line and perpendicular to the axis of the lower incisor, and the DC-L1i lines at various times posttreatment were almost parallel to each other in the two cases. Overjet increased as the maxillary incisors tipped labially, providing proper protrusive and retrusive paths for mandibular guidance. The angle between the functional occlusal plane and CDM line stayed almost the same as at the end of active treatment in the two cases, suggesting a possible change in the angle of eminence in harmony with the functional occlusal plane. These factors apparently contributed to the long-term occlusal stability in the two cases.

Cephalometry↗
PubMed1998

Unexpected temporomandibular joint findings during fixed appliance therapy.

Six hundred consecutively debonded patients were retrospectively examined for the development of any temporomandibular joint signs or symptoms that developed during orthopedic/orthodontic treatment. Sixteen (2.6%) patients were found to have developed unexpected temporomandibular joint findings during treatment. Considering such a small sample, no conclusive results could be found, but several tendencies seemed to be apparent. Those types of patients who seemed to be most predisposed to developing temporomandibular joint problems included female Class II patients with excessive overjet and overbite and moderate to severe crowding of the lower arch. Ninety-three percent of the patients experienced posterior net condylar change in spite of using several different treatment mechanics. The types of treatments used included FJO appliances, headgear, Class II and Class III elastics, no elastics of any kind, extraction and nonextraction. This small study seems to suggest that temporomandibular joint signs and symptoms are changing, inconsistent, and ephemeral in many orthodontic patients regardless of the treatment mechanics.

Child↗
PubMed1998

Mandibular changes in persons with untreated and treated Class II division 1 malocclusion.

The growth potential of individuals with Class II malocclusions is of interest to the practicing orthodontist because such malocclusions constitute a significant percentage of cases. The purpose of this study was to evaluate on cross-sectional and longitudinal bases the changes in mandibular length and relationship and maxillary-mandibular relationships in untreated Class II subjects from deciduous to permanent dentition and also to evaluate the effects of orthodontic treatment, with and without the extraction of first premolars, on these relationships. Class II samples were compared with matched normal, untreated individuals. The Class II division 1 (Class II/1) untreated sample comprised 30 subjects, 15 males and 15 females. Each subject had a complete set of data at three stages of dental development-namely, Stage I, after the completion of eruption of the deciduous dentition; Stage II, at the time when the permanent first molars and most of the incisors have erupted (i.e., in mixed dentition); and Stage III, at the completion of eruption of the permanent dentition, excluding third molars. The Class II treated sample comprised 44 subjects (21 males, 23 females) treated with four first-premolar extractions and 47 subjects (20 males, 27 females) treated without extraction. Treatment was accomplished with the use of an edgewise appliance, appropriate extraoral traction, and Class II elastics. The extraction decision was based mainly on the presence of crowding and profile consideration. Records on 35 normal subjects (20 males, 15 females) were available from the Iowa Longitudinal Facial Growth Study. Cephalograms for the normal individuals were matched to the corresponding ages of the Class II cases. With regard to these findings, few consistent differences were noted between the untreated Class II/1 and normal subjects on cross-sectional comparisons. The differences in mandibular length and position were more evident in the early stages of development than at later stages. Longitudinal comparisons of growth profiles indicated that the growth trends were essentially similar between the untreated Class II/1 and normal subjects in the various parameters compared. The comparisons of growth magnitude indicated the presence of greater skeletal facial convexity in the untreated Class II/1 subjects, accompanied by a tendency for a more retruded mandible. Initial comparisons between the Class II/1 treated groups and normal subjects indicated that the Class II/1 malocclusions were associated with a larger overjet, deeper overbite, and greater ANB angle. After a 5-year treatment and observation period, an overall "normalization" in the mandibular and maxillary-mandibular skeletal relationships was noted in the treated Class II/1 subjects in both the extraction and the nonextraction groups compared with normal subjects. The changes were more pronounced in the extraction group.

Adolescent↗
PubMed1998

Alveolar and skeletal dimensions associated with lower face height.

In this study, the relationships between the lower face height and the structure of the frontal alveolar and basal bone were investigated. The areas and the dimensions of the anterior alveolar and basal midsagittal cross-sectional bone from the maxilla and the mandible were recorded on lateral cephalograms from 460 untreated adults. An index was calculated dividing the sagittal by the vertical dimension of the midsagittal cross-sectional area. The subjects with a normal overbite between 0.5 and 4 mm (N=165) were divided into three groups according to the lower face height. A larger lower face height coincided with a larger maxillary alveolar and basal area and with a smaller mandibular alveolar index. Correlations between the lower face height and the maxillary alveolar index and the mandibular alveolar and basal area were low. It is concluded that long-faced subjects have a large mandibular alveolar height, which is more associated with a narrowed shape than with a large volume of the symphysis.

Adolescent↗
PubMed1998

International comparisons of professional assessments in orthodontics: Part 1--Treatment need.

An international survey has been undertaken to assess variation in professional assessment of orthodontic treatment need. Ninety-seven orthodontists from nine countries examined a standard sample of 240 dental study casts to judge the need for orthodontic treatment in terms of dental health, dental esthetics, and deviation from normal. Participants also indicated their assessment of treatment complexity and whether they would recommend treatment. Practitioners' subjective assessments were found to be only moderately reliable overall. Of the cases examined, 76% [corrected] obtained a consensus of 80% or greater on the need for treatment. Logistic regression equations were derived to explain the observed variation in treatment decisions. It was found that occlusal traits from the dental casts were highly predictive of the treatment decision, and that the practitioners' country of origin and payment methods are important influences on prescribing behavior. The treatment decisions were predicted with an accuracy of 84% by using occlusal score values for the dental esthetics, the degree of upper arch crowding, the presence of crossbite, the anterior overbite, and the buccal segment sagittal relationship. It is suggested that these traits may form the basis for an internationally validated index of treatment need for use in clinical audit and orthodontic research.

Adult↗
PubMed1998

Associations between initial, posttreatment, and postretention alignment of maxillary anterior teeth.

Contradictory findings from studies on pretreatment malalignment as a risk factor for relapse of maxillary incisor alignment may be due to inappropriate sample selection and measurement technique. In an attempt to clarify the issue, 745 sets of study models made before (T1) and after (T2) orthodontic treatment and at long-term out of retention (T3) were screened. On the basis of the configuration of the maxillary anterior teeth on the T3 study models, three groups were established: one with significant spacing (group 1, n = 30); one with significant irregularity (group 2, n = 49); and one with perfect alignment (group 3, n = 28). The occlusal surfaces of the 321 maxillary study models at T1, T2, and T3 were photocopied and the tooth anatomic contact points digitized. An algorithm was used to fit the dental arch to the digitized points. Amount of incisor rotation and anatomic contact point displacement of the maxillary anterior teeth relative to the dental arch were computer generated. Interdental spaces in the maxillary anterior segment, as well as overjet and overbite, were measured manually. Nonstructural data were collected from the charts. Logistic regression analyses revealed that irregularity was associated with greater anatomic contact displacement and with greater incisor rotation both at T1 and T2 (P < 0.01). Similar analyses also revealed that spacing was associated with greater interdental spaces at T1 and T2 (P < 0.01). Correlation analyses revealed that the pattern of pretreatment rotational displacement has a strong tendency to repeat itself after retention (P < 0.001), as opposed to the pattern of contact point displacement and interdental spacing.

Adolescent↗
PubMed1999

A comparison of the effects of rectangular and round arch wires in leveling the curve of Spee.

A prospective randomized clinical study was designed to evaluate the effects of full continuous arch wires, rectangular in cross section, on the axial inclination of lower incisors. The intention of rectangular arch wires is to counteract the labial crown moment usually produced during leveling the curve of Spee with full arch mechanics. Patients were randomly assigned to 2 groups. Group 1 (N = 12) received round arch wires throughout the leveling stage. Group 2 (N = 16) started with flat 0.016 x 0.022 nickel titanium arch wires progressing to 0.016 x 0.022 stainless steel. The preadjusted 0.018 x 0.025 edgewise appliance was used in all cases. Lateral cephalometric radiographs and mandibular study models were taken before treatment and when the curve of Spee was leveled (or in some cases when the overbite was considered clinically acceptable). In group 1, the lower incisor proclined a mean of 6.75 degrees +/- 4.85 degrees (P <.01) and in group 2 it proclined a mean of 6.10 degrees +/- 3.95 degrees (P <.01). However, no significant difference in proclination was detected between the 2 groups. Statistically significant, but low, correlations were demonstrated between change in lower incisor axial inclination and relief of crowding r = 0.45) and change in mandibular arch depth r = 0.54), which was in turn inversely correlated with change in intercanine width r = -0.45). In both groups, the lower incisors proclined with uncontrolled tipping that can probably be attributed to the intrusive force introduced by the arch wire being labial to the center of resistance of the lower incisors. The ability of the rectangular arch wires to control labial proclination following leveling of the curve of Spee, as used in this study, was not supported.

Adolescent↗
PubMed1999

External apical root resorption of posterior teeth in asthmatics after orthodontic treatment.

External apical root resorption is an undesirable sequela of orthodontic treatment, resulting in loss of tooth structure from the root apex. It has been proposed that systemic factors, such as the inflammatory mediators produced in asthma, may enter the periodontal ligament and act synergistically to enhance root resorption. The aim of this study was to determine if asthmatic patients exhibited a higher incidence or severity of external apical root resorption compared with healthy (no medical conditions) patients after fixed orthodontic treatment. Records were obtained from patients treated with fixed appliances; 99 were healthy and 44 had asthma. Using OPGs (panoral films), posterior external apical root resorption was measured on all first and second premolars, mesiobuccal and distobuccal roots of the upper first molars, and mesial and distal roots of the lower first molars, giving 4 measurements per quadrant. A 4-grade ordinal scale was used to determine the degree of external apical root resorption. Combined tooth analysis (adjusted for treatment time, appliance, and extractions) showed that asthmatics had significantly more external apical root resorption of posterior teeth after treatment compared with the healthy group (P =.0194). Tooth-by-tooth analysis (adjusted for treatment time, appliance, extractions, headgear, overbite, overjet, sex, and age at start of treatment) found the upper first molars were most susceptible to external apical root resorption. Although the incidence of external apical root resorption was elevated in the asthma group, both asthmatics and healthy patients exhibited similar amounts of grade 2 (moderate) and grade 3 (severe) resorption.

Adult↗
PubMed1999

Cephalometric evaluation of open bite treatment with NiTi arch wires and anterior elastics.

The aim of this study was to evaluate cephalometrically the effects of open bite treatment with NiTi arch wires and anterior elastics. The study group comprised of 17 patients who displayed a high angle skeletal pattern, along with an anterior open bite. After initial leveling, 0.016 x 0.022 inch upper accentuated-curve and lower reverse-curve arch wires were placed, with anterior elastics applied in the canine regions. Cephalometric assessment was carried out on lateral head films taken at the beginning of treatment and on average 2.8 months after open bite closure was obtained. The results of this study indicated that open bite closure had been achieved mainly by extrusion of the lower incisors and uprighting of the upper incisors. The functional occlusal plane was leveled by extrusion of lower premolars and uprighting of lower molars. Lateral cephalograms obtained from 10 patients who had been available after 1 year postretention were used to evaluate relapse changes. During the follow-up period, position of the upper and lower incisors and the inclination of the occlusal plane were maintained. However, extrusion of upper and lower molar teeth resulted in a reduction in overbite.

Adolescent↗
PubMed1999

Treatment effects produced by the twin-block appliance and the FR-2 appliance of Fränkel compared with an untreated Class II sample.

This retrospective cephalometric study compares the treatment effects produced in 40 patients treated with the Twin-block appliance to those seen in a matched sample of 40 children treated with the FR-2 appliance of Fränkel and to changes undergone in 40 untreated Class II controls from The University of Michigan Elementary and Secondary School Growth Study. The average starting ages for the Twin-block, Fränkel, and control groups were 10 years 5 months, 10 years 2 months, and 9 years 11 months, respectively. The T(2) to T(1) observation period was adjusted to an average of 16 months for all groups. Significant decreases in overbite and overjet were observed at the end of treatment in the Twin-block and Fränkel groups. Compared with the untreated subjects, statistically significant increases in mandibular length were observed in both treated groups. The Twin-block patients achieved an additional 3.0 mm of mandibular length, whereas the Fränkel group increased 1.9 mm more than did the controls. No significant restriction of midfacial growth was observed in either functional appliance group relative to controls. A significant increase in lower anterior facial height was evident in both treatment groups. Vertical increase in the Twin-block patients was significantly greater than in the FR-2 group. In general, more extensive dentoalveolar adaptation was observed with the tooth-borne Twin-block appliance than with the more tissue-borne FR-2 of Fränkel. The Twin-block and FR-2 samples both showed significant retroclination and extrusion (eruption) of the maxillary incisors. The Twin-block patients also exhibited distal movement of the upper molars; however, there was no extrusion. Slight lower incisor proclination was noted in both treatment groups, and lower molar extrusion was found to be significantly greater in the Twin-block group compared with the other 2 samples. No horizontal differences were detected in the lower molars among groups. The present study suggests, therefore, that Class II correction with the Twin-block appliance is achieved through normal growth in addition to mandibular skeletal and dentoalveolar changes. Class II correction with the FR-2 is more skeletal in nature, with less dentoalveolar changes noted.

Analysis of Variance↗
PubMed1999

Does 2 years' nocturnal treatment with a mandibular advancement splint in adult patients with snoring and OSAS cause a change in the posture of the mandible?

The aim of this pilot study was to investigate the effects of 2 years' nocturnal treatment with a mandibular advancement splint in adult patients with snoring and obstructive sleep apnea syndrome with respect to possible development of a forward position of the mandible or other dentofacial changes. Thirty snoring and sleep apnea patients, mean age 55.3 years (SD, 8.61; range, 46.5 to 79.8 years), referred from the Ear, Nose, and Throat Department, were treated with an acrylic splint with full tooth coverage that advanced the mandible 5 to 8 mm (70% of maximal protrusion) and used 5 mm opening vertically. The splint was used 6 to 8 hours per night and 5 to 7 nights per week. Two lateral head radiographs were taken in centric occlusion, 1 before and 1 after 2 years of treatment. A small but statistically significant forward and downward change in mandibular position was found after treatment; mean was 0.4 mm (SD, 0.53; range, 0.0 to 2.0 mm; P <.001) and 0.3 mm (SD, 0.43; range, 0. 0 to 1.5 mm; P <.001), respectively. The forward and downward movement of the mandible was accomplished by a statistically significant increase in mandibular length-mean was 0.4 mm (SD, 0.62; range, 0.0 to 2.5 mm; P <.01)-and a significant decrease in overjet (P <.001) and overbite (P <.05). However, none of the patients reported any permanent sense of altered occlusion, and the anteroposterior distance between habitual occlusion (intercuspal position) and centric relation (retruded position) did not exceed 1. 0 mm in any of the patients either before or after the treatment. The change in mandibular position might be a result of a condylar and/or glenoid fossa remodeling or condylar position changes within the fossa as a compensatory reaction to the advancement of the mandible (bite jumping). However, to visualize and analyze such possible changes in detail, additional studies using lateral tomography of the temporomandibular joints or magnetic resonance imaging are required. Furthermore, because the treatment of snoring and OSAS patients is considered to be lifelong, long-term studies are needed to analyze if the small change in mandibular position will continue with further treatment.

Adaptation, Physiological↗
PubMed1999

Are dental anomalies risk factors for apical root resorption in orthodontic patients?

Regression analyses suggest a weak prediction power of identified risk factors for apical root resorption in orthodontic patients, indicating the presence of etiologic or causative factors that have not yet been disclosed. To investigate the possible significance of dental anomalies as risk factors, pretreatment and posttreatment periapical radiographs of 84 patients with presence of at least one dental anomaly and of 84 patients without such anomalies were compared. The patients in the two groups were matched according to age, gender, Angle Class, extraction therapy, overbite, and treatment time. Apical root resorption was calculated by subtracting posttreatment tooth length measurements from the corresponding pretreatment measurements. Two sample t tests revealed no differences in mean root resorption between the patients in the two groups (P = .88). Stepwise regression analyses did not identify any of the individual anomalies as risk factors. In addition, patients with more than one anomaly did not appear to be at increased risk.

Adolescent↗