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PubMed2005

C-orthodontic microimplant for distalization of mandibular dentition in Class III correction.

A 16-year-old male patient with a Class III malocclusion and 2 lower missing central incisors presented for treatment. The treatment plan consisted of asymmetrically distalizing the lower dentition and regaining space for lower anterior prosthetic work. C-implants were to be used as anchorage for Class III intermaxillary elastics, and two C-orthodontic microimplants (C-implants) were placed in the interdental spaces between the upper second premolars and first molars. The particular design of the C-implant head minimized gingival irritation during the orthodontic treatment. Sliding jigs were applied on the buccal for distalization of the lower posterior teeth. The correct overbite and overjet were obtained by distalizing the entire lower dentition into its proper position with C-implant anchorage, which contributed to an improvement in facial balance. It took 15 months to treat this case. The application of this new microimplant, considerations for case selection, and the sequence of treatment are presented.

Adolescent↗
PubMed2005

Skeletal, dental and soft-tissue changes induced by the Jasper Jumper appliance in late adolescence.

The purpose of this study was to evaluate the skeletal, dental, and soft-tissue changes in late-adolescent patients treated with Jasper Jumpers applied with sectional arches. The study sample consisted of 30 subjects (15 treated, 15 untreated) with skeletal and dental Class II malocclusion. Our study was carried out on 75 lateral cephalometric films. Among these radiograms, 15 were taken before the leveling stage in the treatment group. Half of the remaining 60 were taken before placement and after removal of the Jasper Jumper appliance in the treatment group and the other half at the beginning and six months after in the control group. The patient selection criteria were Class II malocclusion caused by retrognathic mandible, normal or low-angle growth pattern, and postpeak growth period. The statistical assessment of the data suggests that the sagittal growth potential of the maxilla was inhibited. There were no significant changes in the vertical skeletal parameters. The mandibular incisors were protruded and intruded, whereas the maxillary incisors were retruded and extruded. The upper molars tipped distally as the lower molars tipped mesially. Because of these changes, the occlusal plane rotated in the clockwise direction. Overbite and overjet were reduced, and the soft-tissue profile improved significantly. The results revealed that, in late-adolescent patients, the Jasper Jumper corrected Class II discrepancies mostly through dentoalveolar changes. It is suggested that this treatment method could be an alternative to orthognathic surgery in borderline Class II cases.

Activator Appliances↗
PubMed2005

An adult case of skeletal open bite with a large lower anterior facial height.

Control of the height of posterior dentoalveolar regions is of great importance for the correction of skeletal open bite. Traditionally, second premolar extraction facilitates the closure of open bite by inducing a counterclockwise mandibular rotation without molar intrusion. This article reports treatment for a 24-year six-month-old female patient with an open bite and large anterior facial height. She complained of occlusal disturbances and difficulty of lip closure because of the open bite. Overjet and overbite were +3.0 mm and -3.0 mm, respectively. To correct open bite and crowding, the bilateral extraction of the maxillary and mandibular second premolars plus multibracket appliances for mesial movement of the molars was selected as the treatment plan. After a two-year treatment, an acceptable occlusion was achieved, the lower anterior facial height was decreased, and the lips showed less tension in a lip closure. An acceptable occlusion was maintained without recurrence of the open bite during a three-year retention period, indicating a long-term stability of the occlusion. The results of this treatment indicated that the correction of open bite with no or less molar intrusion or incisor extrusion is of great importance for achieving stable occlusion and avoiding the relapse of open bite.

Adult↗
PubMed2005

Effects of a magnetic appliance in functional Class III patients.

The aim of this study was to determine the effects of a magnetic appliance in functional Class III patients. Standardized lateral head cephalograms and hand-wrist films of 10 subjects (mean age nine years seven months) were taken. These records were repeated after a period of one year, and the serial films were compared to determine the direction of facial growth as the control group. After this observation period, the magnetic appliance was placed in the 10 patients for approximately 9.4 months. The significant findings showed a posterior rotation of the mandible (x = 2.1 +/- 0.7 degrees), increased overjet (x = 4.8 +/- 0.3 mm), decreased overbite (x = -3.7 +/- 0.7 mm), protrusion of the upper incisors (x = 6.2 +/- 1.2 degrees), retrusion in the lower incisors (x = -0.6 +/- 0.3 degrees), reduced SNB angle (x = -1.8 +/- 0.8 degrees), increased ANB angle (x = 1.9 +/- 0.3 degrees), and an increased mandibular plane angle (x = 2.1 +/- 0.7 degrees). The results of this study indicate that the primary effect of magnetic appliance was the increase in the posterior rotation of the mandible.

Age Factors↗
PubMed2005

Standardizing interarch tooth-size harmony in a Syrian population.

The Bolton analysis is considered to be a good indicator for evaluating the degree of intermaxillary tooth-size harmony, but the possibility of ethnic variation of these values should be examined. Thus, the aim of this study was to calculate both the anterior and overall ratios of mandibular and maxillary tooth sizes for a Syrian sample of harmonious permanent dentitions and to compare these ratios with the data from the Bolton and the Michigan studies. In plaster models of 55 Syrian patients (11-22 years) with neutral occlusion (Angle Class I), harmonious overjet and overbite, no reduction of mesiodistal tooth width or missing teeth, the mesiodistal widths of each tooth from the incisors to the first permanent molars were measured in both arches. In the statistical data analysis, the anterior and overall ratios were calculated according to Bolton. The results for the anterior ratio (78.99 +/- 2.18) and the overall ratio (92.26 +/- 2.06) showed no statistically significant differences by sex (P > .48). These values and the degree of variation were similar to the original data by Bolton. Both studies differed considerably from the values of the anterior ratio found in the Michigan University study, which also shows a higher degree of variability. Nevertheless, the overall ratios of all three studies were very similar. Therefore, the interarch tooth-size analysis and values for a harmonious dentition developed by Bolton can also be transferred to an Arabian or at least a Syrian population.

Adolescent↗
PubMed2006

Skeletal anchorage for orthodontic correction of maxillary protrusion with adult periodontitis.

Because the number of adult patients seeking orthodontic treatment is increasing, orthodontists are becoming more likely to encounter patients with adult periodontitis. However, it is sometimes difficult to establish anchorage because of poor periodontal tissues in patients with adult periodontitis. This article reports the successful use of skeletal anchorage to treat a maxillary protrusion case complicated by severe adult periodontitis. A female patient aged 50 years seven months showed a skeletal Class II jaw base relationship. A spacing of five mm in the upper anterior teeth with an overjet of 7.5 mm and overbite of four mm was observed. She had generalized horizontal bone loss in both arches, with vertical bone loss in the posterior segment. After periodontal treatment, miniplates were placed in the zygomatic process, and retraction and intrusion of the maxillary incisors were performed. After active treatment for 21 months, the upper incisors had been inclined 9.5 degrees lingually, intruded two mm at the apex, and good anterior occlusion was achieved. Acceptable occlusion and periodontal tissue were maintained after a retention period of two years. Our results suggest that skeletal anchorage is useful for retraction and intrusion of upper incisors in cases of maxillary protrusion with severe adult periodontitis.

Female↗
PubMed2006

Vertical control by combining a monoblock appliance in adult class III overclosure treatment.

Monoblock appliances were used in combination with intermaxillary elastics for treatment of adult skeletal Class III patients. The patients showed predisposing upper incisors problems, significant mobility in patient 1 and root resorption in patient 2, which contraindicated direct intrusion of the incisors. Using the monoblock with selective extrusion of the molars, a clockwise rotation was induced to reduce overbite and to achieve a better profile. It was also possible to reduce the excessive force to the upper incisors during and after treatment, which improved incisor mobility to a physiologic extent (patient 1) and prevented further progression of root resorption (patient 2). Stability was high after the 2-year follow-up, which suggests a stable vertical control approach by using the monoblock appliance in combination with a fixed appliance in adults.

Adult↗
PubMed2006

Intraarch and interarch relationships of the anterior teeth and periodontal conditions.

This study was undertaken to investigate the association between orthodontic anomalies and periodontal conditions. Three parameters of the intraarch relationship on both dental arches (displacement of contact point, crowding, and spacing) and four parameters of interarch relationship (overjet, open bite, crossbite, and overbite) assessed with either Index of Orthodontic Treatment Need or Index of Complexity, Outcome and Need were correlated with parameters of periodontal condition, ie, hygiene (Plaque Index and Retention Index), inflammation (gingival inflammation and Gingival Bleeding Index), and periodontal disease severity (pocket depth, clinical attachment loss, and gingival recession). In the main, weak but significant correlations were found between certain parameters of intraarch and interarch relationship and some indices of periodontal conditions. Within the limitations of this study, it was concluded that providing orthodontic treatment on the ground of deleterious effect of malocclusion and malpositioned teeth on periodontal condition is justified.

Adult↗
PubMed2006

Bolton tooth size discrepancies in skeletal Class I individuals presenting with different dental angle classifications.

The objective of this study was to investigate the frequency and association of Bolton tooth size discrepancies with dental discrepancies. Forty-eight skeletal Class I, 60 Class II, and 44 Class III subjects with similar skeletal characteristics were included in this study. Analysis of variance was performed to compare the mean ratios of Bolton analysis as a function of the Angle classification and sex. To determine the prevalence of tooth size imbalances among the three groups of occlusions and the two sexes, chi-square tests were performed. To determine the correlation of tooth size imbalances with certain dental characteristics, Pearson's correlation coefficients were calculated. No statistically significant differences were determined for the prevalence of tooth size discrepancies and the mean values of Bolton's anterior and overall ratios among the occlusal groups and sexes. Bolton's anterior ratio discrepancies had significant correlations with midline shifts (P < .05) in Angle Class I cases, with U1-SN angle (P < .01) in Angle Class II cases, and with L1-APog distance (P < .05) in Angle Class III cases. Bolton discrepancies related to overall ratio had significant correlations with overjet (P < .05) in Class I cases, with overbite (P < .05) and U1-SN angle (P < .01) in Class II cases, and with IMPA (P < .01) in Class III cases. A high prevalence of tooth size discrepancies in an orthodontic patient population and the statistically significant correlation of some of these with some dental characteristics suggest that the measurement of interarch tooth size ratios might be clinically beneficial for treatment outcomes.

Adolescent↗
PubMed2006

Forsus Nitinol Flat Spring and Jasper Jumper corrections of Class II division 1 malocclusions.

OBJECTIVE: To compare the effects of Forsus Nitinol Flat Spring (FNFS) and Jasper Jumper (JJ) in the correction of Class II division I malocclusions. MATERIALS AND METHODS: Our research was conducted on 48 adolescents, who had a normal or horizontal growth pattern and retrognathic mandible. The patients were divided into three equal groups randomly. First group was treated with FNFS, and the second group was treated with JJ appliances, whereas the third group was the control group. Lateral cephalograms and study models were obtained after the leveling phase and at time of the removal of the appliances. RESULTS: Cephalometric analysis revealed that both the appliances stimulated mandibular growth, increased the anterior face height because of the lower face, and elongated the posterior face height because of the growth of temporomandibular joint. Maxillary central incisors were extruded, retruded, and distally tipped. Contrarily, intrusion, protrusion, and labial tipping were observed in the mandibular central incisors. Distal movement and intrusion of the maxillary first molars and mesial movement and extrusion of the mandibular first molars were the other dental alterations. Overjet and overbite were decreased, and a Class I molar relationship and improvement in the profile were attained in both treatment groups. Cast model analysis showed expansion in the maxillary and mandibular dental arches. CONCLUSIONS: Both the appliances were effective in the treatment of Class II malocclusion and revealed nearly same alterations in the skeletal, dental, and soft tissue parameters.

Activator Appliances↗
PubMed2001

Correction of anterior dental crossbite with composite as an inclined plane.

OBJECTIVE: The purpose of this study was to evaluate a passive method to correct anterior crossbite of only one incisor by constructing a composite inclined plane. SAMPLE AND METHOD: A total of 35 children aged 7-11 with a crossbite of only one incisor tooth were selected for this study. An inclined composite block 3-4 mm in size and 45 degrees to the longitudinal axis of the tooth, was constructed on the incisal edges of the related mandibular incisors. The occlusion was checked so that the only contact between both arches was at the level of these incisors. RESULTS: At the end of one week, 33 cases of crossbite were corrected by this method. Of the two cases which were not corrected one had a deep overbite and the second had a rotated incisor together with crossbite. CONCLUSION: The present results show that, a composite inclined plane is a useful technique to correct anterior crossbite of only one incisor tooth.

Child↗
PubMed1999

The influence of crossbite on the coordinated electromyographic activity of human masticatory muscles during mastication.

The analysis of the masticatory muscle activity in subjects with altered occlusal relationships could provide useful data of the functional impact of morphological discrepancies. Thirty subjects aged 16-18 years, with a sound, full permanent dentition, bilateral angle class I, and an overjet and overbite between 2 and 5 mm, were examined. The control group (10 male, 10 female) had no crossbite, while the crossbite group (four male, six female) had a posterior unilateral crossbite (five on the left side, five on the right side). The electromyographic activity of the left and right masseter and temporalis anterior muscles was recorded during 15 s of unilateral (left and right) chewing of gum, and expressed as a percentage of the maximum voluntary clench on cotton rolls. For each subject, the masticatory frequency, the confidence ellipse of the simultaneous differential left-right masseter and temporal activity (Lissajous figure), and an index of muscular symmetry, were computed to assess muscular coordination. In the crossbite subjects, the four analysed muscles appeared to contract with altered and asymmetric patterns. A large variability was found, and the confidence ellipses calculated for the chewing tests performed on the crossed sides were not significant, while the confidence ellipses of the uncrossed side chewing were different from the ellipses computed in the normal occlusion group. The altered occlusal relationship influenced the coordination of the masticatory muscles during chewing on both sides. The functional alteration was more apparent when the side with the altered morphology was directly involved, i.e. when chewing was performed on the crossbite side.

Adolescent↗
PubMed2000

The post-orthodontic prevalence of temporomandibular disorder and functional occlusion contacts in surgical and non-surgical cases.

This study aimed to assess mandibular mobility and the prevalence of functional occlusal contacts in subjects treated to a Class 1 incisor relationship by fixed orthodontic appliance therapy. Two hundred and thirty subjects participated (mean age=18 years) of whom 42 underwent orthognathic surgery. All subjects were in retention with a mean time of 7 months between debond and examination. Maximal mandibular opening, lateral and protrusive excursions were all significantly reduced in the surgical cases compared to the non-surgical group. Centric and eccentric non-ideal occlusal contacts were not different between surgical and non-surgical groups. Non-working side contacts occurred in 30% of subjects, posterior contacts on protrusion in 20% and RCP-ICP prematurities in 18% of subjects. Non-working side contacts were significantly more frequent in post-graduate cases compared to staff cases (P<0.05). An overbite less than the mean of 2.4 mm resulted in a reduced likelihood of canine guidance on the working side (P<0.001) and an increased frequency of non-working side contacts and posterior contacts on protrusion (P<0.001).

Adolescent↗
PubMed2000

Morphological differences in individuals with lip competence and incompetence based on electromyographic diagnosis.

The study group consisted of 19 subjects with positive overjet and overbite, and 17 subjects with skeletal open bite. Two bipolar surface electrodes were attached to the skin of the upper and lower lips. The mean integrated amplitude of the electromyographic (EMG) activity was obtained at the mandibular rest position with the lips in contact and with the lips apart. Subjects were divided into two groups based on positive or negative values of the difference in integrated EMG activity of the mentalis muscle between the two lip positions. Subjects displaying a negative value were classified as having competent lips and those displaying a positive value were classified as having incompetent lips. The EMG activity of the mentalis muscle was found to be more indicative of lip sealing as compared with the EMG activity of the depressor of the lower and the upper lips. The activities of the mentalis muscle at the mandibular rest position with the lips in contact and with the lips apart appear to offer an objective criterion for the evaluation of lip incompetence. In addition, the vertical dimension of the face, as well as the proclination of the incisors, appear to affect lower lip function.

Adult↗
PubMed2001

Activity of jaw-opening and jaw-closing muscles and their influence on dentofacial morphological features in normal adults.

The purpose of this study was to determine the relationship between the dentofacial morphology and the function of masticatory muscles estimated by kinesiological measurements during isotonic jaw-opening (O) and closing (C) muscle contractions. We examined 26 male adult subjects who had no history of masticatory dysfunction. Three kinesiological parameters, the maximum force (F(max)), maximum velocity (V(max)) and maximum power (P(max)) were measured in both O and C muscles. Correlation analysis was performed between these parameters and dentofacial morphological features determined on lateral roentgenographic cephalograms. The F(max) (C), V(max) (O), log O/C of V(max), and P(max) (O) significantly correlated with anterior overbite. P(max) (C) significantly and negatively correlated with SN-ArG. Furthermore, log O/C of P(max) significantly and negatively correlated with SNA, SNB and ArG/GMe, and positively with SN-ArG. These results, combined with our previous findings that electromyographic muscle activity during isometric contraction correlated significantly with mandibular morphology, indicate that the dentofacial morphology is influenced by the function of both O and C muscles.

Adult↗
PubMed2003

Vertical jaw separation and masseter muscle electromyographic activity: a comparative study between asymptomatic controls & patients with temporomandibular pain & dysfunction.

The aims of the present study were to assess the relationship pattern between bilateral masseter muscle electromyographic (MEMG) activity recordings and vertical jaw separation (VJS). Asymptomatic subjects (n = 15) were compared with age and gender-matched patients (n = 18) with temporomandibular pain and dysfunction (TMPD); before and after undergoing interocclusal appliance (IOA) therapy for 4 months. In asymptomatic subjects a bilateral minimum MEMG activity was found in a 'resting zone' at approximately a quarter of maximum mandibular opening (mean, 15.4 mm of VJS; range, 5.5-22.5 mm including overbite). No overall relationship between MEMG and VJS was shown for patients with TMPD. After successful IOA therapy, the majority of TMPD patients (14 of 18) showed normalization of the relationship between MEMG and VJS, but electromyographic assessment was not found to be of value as a single objective assessment parameter in evaluating the resolution of TMPD or the effectiveness of IOA therapy.

Adolescent↗
PubMed2004

Temporomandibular joint problems and self-registration of mandibular opening capacity among adults with Ehlers-Danlos syndrome. A questionnaire study.

OBJECTIVES: To study maximal mandibular opening capacity and the prevalence of temporomandibular joint (TMJ) problems reported among a larger group of adults with Ehlers-Danlos syndrome (EDS). Furthermore, to compare proportions of disorders with those in a cohort of randomized population- based controls. DESIGN: A questionnaire study with self-registration of maximal mandibular opening capacity. SETTING AND SAMPLE POPULATION: One hundred and fourteen persons with EDS and 114 controls in a randomized population-based cohort. Experimental variables - Self-registered maximal mandibular opening capacity values that were calculated from the markings of maximal interincisal distance on spatulas and the assessments of overbite with the aid of photos. Questions concerning EDS, TMJ problems and other related questions. OUTCOME MEASURE: Mean values of maximal mandibular opening capacity compared between groups. Proportions of affirmative answers about TMJ problems compared between persons with EDS and controls who did not have the syndrome. RESULTS: The EDS persons who reported problems with poor mouth opening capacity when biting into thick pieces of food had a lower mean maximal mandibular opening value compared with the other EDS persons (p < 0.05). The proportions of affirmative answers concerning mobile joints during mouth opening, present TMJ problems, poor mouth opening capacity when biting into thick food, clicking, crepitations and permanent locking were greater compared with the controls (p < 0.05). CONCLUSION: These data corroborate the reports in literature that persons with EDS are naturally predisposed to TMJ problems. The self-registration of maximal mandibular opening capacity was a useful diagnostic tool to provide an objective clinical measure of movement capacity of the TMJ. The clinical measure was in line with the affirmative answers on having problems with poor mouth opening capacity among the EDS persons.

Adult↗
PubMed2005

[Computed tomographic examination of muscle volume, cross-section and density in patients with dysgnathia].

PURPOSE: The individual jaw position is determined by the masticatory muscle among other factors. Before surgical treatment of malocclusions, thorough evaluation of the muscles is required to estimate the relapse risk. MATERIALS AND METHODS: By means of computer tomography, lateral radiographs of the skull and denture models, the relationships between morphological parameters of the masticatory muscles and the jaw bone were analyzed. Furthermore, possible causes for the extent of the malocclusion are described. RESULTS: A patient group with deep overbite was found to have significantly higher muscle densities (measured in Hounsfield units [HU]) in the medial pterygoideus muscle (59.89 +/- 3.91 HU to 48.94 +/- 4.14 HU, p < 0.01), masseter muscle, and genioglossus muscle (p < 0.05) in comparison to open bite patients. Significant differences of the muscle cross-section were measured in the masseter muscle between patients with retroclined maxillary incisors and with an open bite (5.4 +/- 0.7 cm (2) to 3.8 +/- 0.4 cm (2), p < 0.05). CONCLUSION: The results show a correlation between different jaw positions and masticatory muscles. They also suggest that the function of each muscle may be different. Additional examinations of the muscle structures are required for verification of the influence of the masticatory muscles on facial morphology.

Bone Density↗