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PubMed1999

Molarization of the lower second premolars.

This paper presents a case of extreme tooth variation. The patient was first observed during the mixed dentition period, when she presented a mild Class II malocclusion with increased overjet and acceptable overbite. In a panoramic radiograph, the presence of lower second premolars of disproportionate dimensions was discovered. When these oversized premolars erupted, the Class I malocclusion tended toward Class III, with an edge-to-edge bite. This created an unstable occlusion and the possible need for extractions.

Bicuspid↗
PubMed1999

Cephalometric characteristics of nonobese patients with severe OSA.

The purpose of this study was to determine the facial characteristics of nonobese patients with obstructive sleep apnea (OSA). Observational data on a cohort of patients was analyzed retrospectively. The subjects were classified into four groups: nonobese mild, obese mild, nonobese severe, and obese severe. The nonobese mild group included patients with a body mass index (BMI = kilogram/meter2) <25 and an apnea-hypopnea index (AHI) >5 and <15; the obese mild patients had a BMI >35 and an AHI >5 and <15; the nonobese severe patients had a BMI <25 and an AHI >40; the obese severe group had a BMI >35 and AHI >40. Thirty-three male patients referred for overnight polysomnography and lateral cephalometry who met the selection criteria were included. Between-group differences were examined pairwise by analysis of variance (ANOVA) with Bonferroni correction. Only two variables--lower facial height and overbite--were significantly different at p<0.05 between the nonobese severe group and the obese mild group. A discriminant analysis on the cephalometric measurements revealed that patients in the nonobese severe group could be distinguished from patients in other groups by their facial characteristics. OSA patients do not have a homogenous bony structure of the face. In particular, OSA severity in nonobese severe patients may be associated with a vertical skeletal disharmony.

Adult↗
PubMed2000

External apical root resorption following orthodontic treatment.

This study investigated the association of appliance type and tooth extraction with the incidence of external apical root resorption (EARR) of posterior teeth following orthodontic treatment. Pre- and posttreatment orthopantomograms were compared for 97 patients and a 4-grade ordinal scale used to measure EARR. The incidence of EARR was positively associated with tooth position (P < .001), appliance type (P = .038), and extractions (P = .001). This was observed in an overall analysis mutually adjusted for the effects of age at start of treatment, pretreatment overbite and overjet, use of headgear, tooth extraction, and type of appliance. The incidence of EARR was 2.30 times higher for Begg appliances compared with edgewise, and it was 3.72 times higher where extractions were performed.

Adolescent↗
PubMed2000

A cineradiographic study of deglutitive tongue movement and nasopharyngeal closure in patients with anterior open bite.

The purpose of this study was to investigate the movement of the tip and the dorsal surface of the tongue during deglutition in patients with anterior open bite using cineradiography. The subjects were 10 female patients with anterior open bites and 10 female controls with normal overbites. By cineradiography we established 7 stages of tongue movement and bolus position during deglutition and analyzed the tongue position, tongue movement and the time. The tongue-tip position was more protrusive during deglutition in anterior open bite than in the controls. After the head of the bolus arrived at the opening of the esophagus, the rear part of the dorsal surface of the tongue demonstrated slower movement in patients with anterior open bite than in controls. The nasopharynx closed earlier in patients with anterior open bite than in controls. It is suggested that anterior open bite patients had compensatory coordination of tongue movement, soft palate movement and pharyngeal constrictor muscle activity during deglutition.

Adolescent↗
PubMed2001

A 2-center comparison of orthodontist's perceptions of orthodontic treatment difficulty.

The aim of this study was to determine which factors correlate with easy and difficult treatments and to assess the use of the Index of Complexity, Outcome & Need (ICON) as an indicator for treatment difficulty. The study was conducted at 2 centers using a retrospective cross-sectional questionnaire-based design. The participants were specialist orthodontic practitioners in Dresden, Germany and Cardiff, UK. Sixteen specialist orthodontists participated. Each supplied 10 completed cases--5 they regarded as being easy and 5 as being difficult. The specialist orthodontists completed a questionnaire and stated up to 5 reasons why they considered the case easy or difficult. Two examiners were calibrated in the use of the ICON. Logistic regression analysis using a forward conditional systematic model with complexity of case (ie, easy or difficult) as the dependent variable demonstrated statistical significance of the following patient-related factors: pretreatment ICON score, number of appointments, and age. Chi-squared testing demonstrated statistical significance of the following factors: cooperation, extent of overbite, presence of dysfunction, extent of overjet, anchorage, angulation of teeth, presence of crossbite, center-line shift, nonextraction treatment, age at start of treatment, compliance during the course of treatment, oral hygiene level. This study indicates that the main distinguishing factors between easy and difficult cases appear to be pretreatment age, number of appointments, and pretreatment ICON score. However, the odds ratios were not sufficiently high for these factors to be strong predictors of difficulty.

Age Factors↗
PubMed2002

Effects of a modified acrylic bonded rapid maxillary expansion appliance and vertical chin cap on dentofacial structures.

The aim of this study was to determine the sagittal, transverse, and vertical effects of a modified acrylic bonded rapid maxillary expansion (RME) device used with a vertical chin cap on dentofacial structures. The study group consisted of 34 patients (25 girls and 9 boys) who were selected without regard to their skeletal class and gender. All subjects had permanent dentition (mean age, 12.7 years) and needed maxillary expansion. Study Group I (RME only) was composed of 17 subjects, and study Group II (RME with vertical chin cap) was composed of 17 subjects. Twenty-nine measurements were made on the patients' cephalometric films and plaster models. The means and standard deviations for linear and angular cephalometric measurements were analyzed statistically, and intra-group and inter group changes were evaluated by paired and Student's t-tests using SPSS 10.1 for windows. We found that the maxilla moved anteriorly relative to the anterior cranial base. The nasal width, maxillary width, intercanine width, mandibular intermolar width, maxillary intermolar width, and overjet all increased, while the upper molars tipped buccally in both groups. In Group I, the mandible rotated posteriorly, the lower anterior facial height increased, and the overbite decreased. These effects were reduced in Group II. We conclude that the vertical chin cap is an effective appliance for preventing the adverse vertical effects of RME in patients with a crossbite and a vertical growth pattern.

Acrylic Resins↗
PubMed2002

Pathognomonic cephalometric characteristics of Angle Class II Division 2 malocclusion.

The Class II division 2 (Class II/2) malocclusion as originally defined by E.H. Angle is relatively rare. The orthodontic literature does not agree on the skeletal characteristics of this malocclusion. Several researchers claim that it is characterized by an orthognathic facial pattern and that the malocclusion is dentoalveolar per se. Others claim that the Class II/2 malocclusion has unique skeletal and dentoalveolar characteristics. The present study describes the skeletal and dentoalveolar cephalometric characteristics of 50 patients clinically diagnosed as having Class II/2 malocclusion according to Angle's original criteria. The study compares the findings with those of both a control group of 54 subjects with Class II division I (Class II/1) malocclusion and a second control group of 34 subjects with Class I (Class I) malocclusion. The findings demonstrate definite skeletal and dentoalveolar patterns with the following characteristics: (1) the maxilla is orthognathic, (2) the mandible has relatively short and retrognathic parameters, (3) the chin is relatively prominent, (4) the facial pattern is hypodivergent, (5) the upper central incisors are retroclined, and (6) the overbite is deep. The results demonstrate that, in a sagittal direction, the entity of Angle Class II/2 malocclusion might actually be located between the Angle Class I and the Angle Class II/1 malocclusions. with unique vertical skeletal characteristics.

Adolescent↗
PubMed2003

Effects of extraction and nonextraction treatment on class I and class II subjects.

This study aims to examine the profile as well as the dentoalveolar and skeletal effects of extraction or nonextraction treatment in a wide range of patients including Class I and Class II, division 1 cases. Results achieved with extraction and nonextraction modalities have also been compared. The study was performed on pretreatment and posttreatment lateral cephalograms of 87 orthodontic patients. There were no significant differences between the pretreatment values of extraction and nonextraction Class I groups, whereas SN-GoGn (degrees), maxillary incisor to A-Po (degrees), mandibular incisor to A-Po (mm), Co-Gn (mm), overjet (mm), and overbite (mm) measurements of extraction Class II group were significantly higher before the treatment. After treatment, these differences were eliminated in the Class II group; however, incisors were significantly protruded in both nonextraction groups. No other differences in profile or lip position were found between the extraction and nonextraction groups. The results of this study indicate that in successfully treated cases, whether by extraction or nonextraction, the same soft and hard tissue profile posttreatment end points were reached except for the incisor positioning, which is rather easier to anticipate than profile and soft tissue changes. The simple statement that extraction means a more retrusive or dished-in profile seems to be unacceptable. It seems that a more thorough assessment and investigation including pretreatment extent of crowding and factors related to anchorage, soft tissue thickness, and strain should be carried out.

Adolescent↗
PubMed2003

A cephalometric comparison of black open-bite subjects and black normals.

Orthodontic surveys of the adolescent and adult population of the United States have shown that the incidence of anterior open bite is three to four times higher in blacks than in whites. A cephalometric comparison of black subjects with and without an open bite was used to identify skeletal and dental differences between the two groups. Statistically significant differences were found in the vertical skeletal dimensions and incisor proclination. The open-bite group had a significantly longer anterior lower facial height and total facial height. The mandibular plane was rotated down relative to the cranial base and Frankfort plane and gonial angle was increased in the open-bite sample. There were small differences between the open bite and non-open-bite groups in the cranial base angle and the overbite depth indicator of Kim. No significant differences were found in the skeletal anteroposterior dimensions or dental vertical development. The vertical skeletal pattern and the greater degree of dental proclination differentiated black patients with an anterior open bite from those without.

Adolescent↗
PubMed2003

Bodily distalization of molars with absolute anchorage.

Palatal implants have been used over the last two decades to eliminate headgear wear and to establish stationary anchorage. In this case report, the stability of a palatal implant for distalization of molars bodily and for anchorage maintenance was assessed. The implant was a stepped screw titanium (4.5 mm diameter x 8 mm length), and it was placed in the palatal region for orthodontic purposes. A surgical template containing a metal drill housing was prepared. Angulation of the drill housing was controlled according to the radiologic tracing of the maxilla transferred to a plaster cast section in the paramedian plane. The implant was placed using a noninvasive technique (incision, flap, and suture elimination) and left transmucosally to facilitate the surgical procedure and to reduce the number of operations. The paramedian region was selected (1) to avoid the connective tissues of the palatine suture and (2) because it is considered to be a suitable host site for implant placement. After three months of healing, the implant was osseointegrated and orthodontic treatment was initiated. For molar distalization, the Keles Slider appliance was modified and, instead of a Nance button, a palatal implant was used for anchorage. The results showed that the molars were distalized bodily at five months, and no anchorage loss was observed. At the end of the treatment, the smile was improved, and an ideal Class I molar and canine relationship, an ideal overbite, and an ideal overjet were all achieved. In conclusion, palatal implants can be used effectively for anchorage maintenance and in space-gaining procedures. Use of a three-dimensional surgical template eliminated implant placement errors, reduced chair time, minimized trauma to the tissues, and enhanced osseointegration. This method can be used effectively to achieve distalization of molars bodily without anchorage loss.

Adolescent↗
PubMed2003

Crown-root shape of the permanent maxillary central incisor.

This study aimed to determine whether the lateral cephalometric crown-root shape differs among the permanent maxillary central incisor in Class I, Class II division 1, Class II division 2 and Class III malocclusions and to identify the nature of any differences. Of the 499 lateral cephalograms recorded at a university orthodontic clinic during 2001, 361 satisfied the inclusion criteria. Sixty cephalograms were selected from the four malocclusion groups and were digitized in random order. The configurations of the 10 landmarks characterizing the crown-root shape of the permanent maxillary central incisor were then optimally superimposed using Procrustes algorithms. Discriminant analysis of the principal components of shape determined the incisor shape differences between the malocclusion groups. The crown-root shape of the permanent maxillary central incisor did not differ significantly among the Class I, Class II division 1, and Class III groups (P > .05); however, the crown-root shape of the Class II division 2 permanent maxillary central incisor was significantly different (P < .001) from that of the Class 1, Class II division 1 and Class III. The shape discrimination involved axial bending of the Class II division 2 incisors. Principal components 1, 2, and 3 accounted for 63% of the Class II division 2 incisor shape variance, encompassing a shorter root, a longer crown, and axial bending of the incisor, in addition to a reduced labiopalatal thickness. These shape features could precipitate the development of a deep overbite in Class II division 2 malocclusion and may limit the amount of palatal root torque during fixed appliance therapy.

Algorithms↗
PubMed2004

Severe Class II anterior deep bite malocclusion treated with a C-lingual retractor.

A C-lingual retractor was placed on the lingual aspects of the six maxillary anterior teeth in a 24-year-old female patient with a Class II anterior deep-bite malocclusion. The treatment plan consisted of extracting both the upper first premolars and intruding and retracting the upper six anterior teeth. Transpalatal arches were soldered to the upper first and second molar bands and used as an intra-arch anchor unit for upper space closure. Double NiTi closed coil springs were used palatally between the hooks of the C-lingual retractor and the transplantar arches. A high-pull headgear was used for anchorage reinforcement during en masse retraction. It took 14 months to treat this patient. The correct overbite and overjet was obtained by simultaneously intruding and retracting the upper six anterior teeth into their proper positions by C-lingual retractor mechanics, which contributed to an improvement in facial balance. The treatment result was stable 6 months after debonding. The application of this new appliance, consideration in case selection, and sequence of treatment are presented.

Adult↗
PubMed2004

Initial intrusion of the molars in the treatment of anterior open bite malocclusions in growing patients.

The treatment of the hyperdivergent phenotype and/or anterior openbite is one of the common problems facing orthodontists. The purpose of this study is to present a new appliance (Molar Intruder) for molar intrusion and to determine its effects in the treatment of anterior openbite. The study group comprised 14 patients (eight girls and six boys), with a mean age of 10 years and 7 months. All presented anterior open bite malocclusions between the second premolars. The study was carried out on lateral head films taken before (T1) and after (T2) molar intrusion. Periapical radiographs, study models, and standard photographs of all the patients were also obtained before and after molar intrusion. The paired sample t-test was used to determine the differences between the parameters. The average treatment time with the Molar Intruder was five months. The mean intrusion of maxillary and mandibular molars was 1.86 mm and 1.04 mm, respectively. Maxillary incisors extruded 0.54 mm with a labial tipping of 1.46 degrees and overbite increased by 4.00 mm. The mandibular plane angle was decreased by 1.57 degrees, and the anterior face height was decreased by 1.86 mm on average. The mandible showed a counterclockwise rotation, the chin moved forward, and the posterior facial height/anterior facial height ratio was increased. Anterior openbites of the patients were significantly rehabilitated at the end of the intrusion period, simplifying further orthodontic treatment.

Cephalometry↗
PubMed2004

Stability of Class II, division 1 treatment with the headgear-activator combination followed by the edgewise appliance.

This study assessed the stability of the headgear-activator combination treatment, followed by edgewise mechanotherapy, 5.75 years after treatment. The experimental group consisted of 23 patients who were evaluated during treatment and after treatment. Two compatible control groups consisting of 15 Class II, division 1 patients and 24 normal occlusion individuals were used. This enabled us to evaluate the changes during treatment and after treatment, respectively. Results showed that the anteroposterior dentoalveolar changes and the maxillary and the mandibular positions remained stable in the long term. However, there was a slight relapse of the maxillomandibular relationship probably because the maxilla resumed its normal development and the mandibular growth rate was smaller than in the control group. The overbite demonstrated a statistically significant relapse that was directly proportional to the amount of its correction. There were low but significant inverse correlations between the changes in Go-Gn during and after treatment. These included the uprighting of the maxillary incisors, labial tipping of the mandibular incisors, and the amount of molar relationship correction during treatment and their stability. Active retention time, length of posttreatment period, initial Class II malocclusion severity (ANB and Wits), and initial molar relationship did not present any correlation with molar relationship and overjet relapse. However, the initial overjet presented a low but statistically significant correlation with molar relationship relapse and overjet relapse.

Activator Appliances↗
PubMed2004

Profile changes associated with different orthopedic treatment approaches in Class III malocclusions.

The aim of this study was to evaluate and compare the soft tissue effects of chincup (CC), chincup plus bite plate (CC+P), and reverse headgear (RHg) therapies with each other and with an untreated control group (C). The material consisted of lateral cephalometric and hand-wrist films of 59 Class III cases and 20 nontreated control subjects. Thirty-one cases were treated with CC, 14 with CC+P, and 14 with RHg, and Class I relation was achieved. The mean pretreatment ages were approximately 11 years and the observation period was one year. The cephalometric films were analyzed according to the structural superimposition method of Björk. All tracings were double digitized, and the measurements were calculated by a computer program (PORDIOS). Treatment and control changes within the groups and the differences between the groups were analyzed statistically. Forward positioning of the maxilla was significant in the RHg group, whereas the mandible was positioned backward significantly in all the treatment groups. Posterior rotation of the mandible was significant in the CC+P and RHg groups. The overjet increased and the overbite decreased significantly in all the treatment groups. Forward movement of soft tissue A and upper lip was significant in all groups, whereas more pronounced in the CC+P group. The soft tissue changes in the mandibular region were significant in the CC and CC+P groups, whereas in the maxillary region more significant and similar improvements were obtained by CC+P and RHg treatments. Longterm studies are required to confirm the stability of these changes.

Activator Appliances↗
PubMed2004

Intraosseous screw-supported upper molar distalization.

The aims of the present study were to investigate (1) the efficiency of intraosseous screws for anchorage in maxillary molar distalization and (2) the sagittal and vertical skeletal, dental, and soft tissue changes after maxillary molar distalization using intraosseous screw-supported anchorage. Twenty-five subjects (18 girls and seven boys; 11.3 to 16.5 years of age) with skeletal Class I, dental Class II malocclusion participated in the study. An anchorage unit was prepared for molar distalization by placing an intraosseous screw behind the incisive canal at a safe distance from the midpalatal suture following the palatal anatomy. The screws were placed and immediately loaded to distalize upper first molars or the second molars when they were present. The average distalization time to achieve an overcorrected Class I molar relationship was 4.6 months. The skeletal and dental changes were measured on cephalograms and dental casts obtained before and after the distalization. In the cephalograms, the upper first molars were tipped 8.8 degrees and moved 3.9 mm distally on average. On the dental casts, the mean distalization was five mm. The upper molars were rotated distopalatally. Mild protrusion (mean 0.5 mm) of the upper central incisors was also recorded. However, there was no change in overjet, overbite, or mandibular plane angle measurements. In conclusion, immediately loaded intraosseous screw-supported anchorage unit was successful in achieving sufficient molar distalization without major anchorage loss.

Adolescent↗
PubMed2005

Changes in dentoalveolar and facial heights during early and late growth periods: a longitudinal study.

This longitudinal study examined the dentoalveolar structures during early and late growth periods in 62 subjects (26 male, 36 female) with normal facial patterns and acceptable occlusions. Hand-wrist radiographs were assessed and subjects grouped accordingly as either early stage (group 1) or late stage (group 2). Group 1 comprised 30 subjects with skeletal development maturation stages between PP2= and MP3=, H or S. Group 2 comprised 32 subjects with skeletal development maturation stages between MP3u and Ru. Skeletal and dentoalveolar measurements and ratios were assessed at the beginning and end of the observation periods. Differences in measurements and ratios within each group were examined using paired t-tests. Differences between the 2 groups were evaluated using Student's t-tests. Increases in alveolar heights (except for upper posterior alveolar heights) differed between the groups. Vertical alveolar dimensions increased substantially in group 1 in comparison with group 2. With the exception of upper anterior alveolar heights, all increases in group 2 were statistically significant. As a result of differential growth in alveolar dimensions, lower facial ratio (Co-Go/ANS-Me) and overbite remained constant in both stages. Vertical alveolar growth exhibited regional differentiation according to the pubertal growth periods. Although this growth plays a role in the establishment of normal facial patterns and occlusion, it should also be considered with respect to the treatment and treatment stability of patients showing vertical facial discrepancies.

Adolescent↗