A clinical technique for the management of a Class II skeletal relationship with an anterior open bite as a result of long face syndrome in the adult patient.
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Adult↗
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Bending of the distraction site during mandibular distraction osteogenesis in the rabbit: a model for studying segment control and side effects.
PURPOSE: The purpose of this investigation was to develop an animal model for studying and correcting mandibular distraction side effects. MATERIALS AND METHODS: Twenty-nine rabbits underwent bilateral mandibular distraction. Bending of the mandible was accomplished by offsetting a linear distraction by 35 degrees from the occlusal plane (4 screws per distractor), rotating the anterior segment inferiorly (2 screws per distractor), and removing a 3- or 6-mm wedge of the distraction site. The amount of bite opening varied according to the surgical design. Direct measurements, radiographs, and histology samples were compared. RESULTS: Linear distraction produced a 4-mm anterior open bite and a Class III malocclusion after 2 weeks of distraction. Segmental rotation produced an 8-mm anterior open bite without complications. Removal of a wedge initiated rotation of the anterior segment. A large wedge (6 mm) produced fibrous union in the distraction site. The amount of bite opening or closure depended on the number of surgical screws and position of the distractor. Serial histologic sections showed bone formation at the rotated, triangular distraction site. CONCLUSION: Bite opening or closure can occur from loss of segment control or by altering surgical design. This information is needed to counter unwanted side effects or to plan segment rotations.
Analysis of Variance↗
Deep bite treatment in relation to mandibular growth rotation.
This paper illustrates some of the changes which occur during the treatment of Class II division 1 malocclusions complicated by a deep bite, and reviews the significance of these changes in relation to concepts of deep bite treatment. Particular reference is made to mandibular growth rotation and consequent differential tooth eruption in assessing factors involved in initial bite opening and consolidation of the opened bite. The cases shown illustrate that although an initial bite opening may occur by incisor intrusion and molar eruption, when viewed over a longer period of time rotational mandibular growth and associated differential eruption of teeth in which molars erupt more than incisors may be a more significant factor. Differential eruption which takes place in response to vertical condylar growth under guidance of the appliance would appear to be a significant factor in treatment of deep bite.
Activator Appliances↗
Vertical and horizontal components of functional appliance therapy.
Disocclusion of the teeth has been postulated to have a deregulating or promoting influence on mandibular growth. The clinical effects of disocclusion were evaluated with a prospective pilot study of 16 children with mixed dentition who wore either a maxillary Hawley biteplane or the functional regulator of Fränkel. The pilot study was used to assess individual variations to establish the feasibility of a larger, more statistically valid investigation. The biteplane was used to evaluate the effects of vertical mandibular displacement on craniofacial growth. The Fränkel regulator was used to evaluate the effects of both vertical and horizontal mandibular displacement. The relationships between patient cooperation, personality characteristic, and treatment effects were also evaluated. After 9 months of treatment, the biteplane group had an increase in the mandibular plane angle with little or no horizontal mandibular growth and tendency toward an interior open bite. This was deemed to be clinically detrimental and the biteplane therapy was discontinued. The results of this study are presented to aid the clinician in his or her decision to use biteplane therapy. In the biteplane group, the bite opening was associated with molar, and not incisor, extrusion. Though the biteplane group had primarily a vertical increase in the length of the lower third of the face, the Fränkel group had a combination of anterior and inferior mandibular growth. In both groups, the mandibular incisor usually moved anteriorly. The maxially incisor usually moved labially in the biteplane group and lingually in the Fränkel group, although exceptions were in both groups. Correlation coefficients between self-esteem, compliance, and cognitive level were not statistically significant. These findings suggest that a constant protracting force on the mandible, rather than bite opening only, may be necessary for increasing mandibular length. Thus the biteplane should only be used to increase the vertical dentoalveolar and facial heights in patients with normal anteroposterior maxillary-mandibular relationships.
Activator Appliances↗
Assessment of open and incomplete bite correction by incisor overlap and optical density of polyvinyl siloxane bite registration.
Open bite (OB) is a generalized term, which could incorporate subgroups that react differently to vertical correction. The objectives of the present study were to detect vertical treatment changes in incomplete bite (IB: inter-incisor overlap with no lower incisor contact with teeth or palate) and OB (no inter-incisor overlap) groups compared with a complete bite (CB: inter-incisor overlap with full lower incisor contact with teeth or palate) control group, to evaluate treatment response of the central and lateral incisors, and to study the vertico-sagittal interaction. Dental casts were taken at three time points, pre-treatment, post-treatment, and after one year of retention, from 54 Class II patients (22 males and 32 females with a mean age of 11 years 6 months) divided into three groups: CB (n = 21), IB (n = 18) and OB (n = 15). Measurements included incisor overlap (mm) and optical density (OD/mm2) of occlusal bite registration made of polyvinl siloxane. Both CB and IB groups demonstrated post-retention bite opening. However, bite opening in the CB group was three times greater than that in the IB group (e.g. lower lateral = -1.42 mm, 118 OD/mm2 versus -0.40 mm, 107 OD/mm2). Conversely, the OB group showed a significant (P < 0.001) bite closure (e.g. lower lateral = 1.30 mm, -377 OD/mm2). Overjet changes affected OD measurements, causing diversity in OD and millimetric measurements of the lateral incisors in the IB group. In conclusion, the OB group demonstrated a significant stable vertical correction; a post-treatment non-contact inter-incisor relationship was determined by a vertico-sagittal relapse; and full compensation of an IB was not possible.
Child↗
The effects of overbite on the maxillary and mandibular morphology.
The aim of this study was to investigate the differences in the maxillary and mandibular morphology related to the overbite. A total of 80 untreated subjects were divided into 4 groups with normal overbite, edge-to-edge bite, open bite, or deep bite and were compared with one another. Differences between the overbite groups and between genders were assessed by means of variance analysis and the least significant difference test. In addition, correlation coefficients between the overbite and other variables were calculated. The results showed that there are statistically significant differences in the maxillary and mandibular morphology among the overbite groups.
Adolescent↗
A comparative study on the intercuspal occlusion among TMD patients, malocclusion patients and university students.
OBJECTIVE: The relationship between occlusion and temporomandibular disorders (TMD) remains disputed. The related epidemiological studies have been carried out focused on the occlusal characteristics in motion, for example in protrusion, retrusion or laterally extension and on some of malocclusion features. Very few studies were carried out on the intercuspal occlusion which is the most important occlusal relationship. Angle's classification of occlusion and the relationship of over-jet and over-bite are two prominent features now generally used in clinical practice for occlusal evaluation. In present study two kinds of features of occlusion were compared among TMD patients, malocclusion patients and university student volunteers, who of the laters represented nature population. METHODS: 100 continued cases visiting our TMD Clinic during the year of 2 000 with complain of TMD problem, 100 malocclusion patients in continued orthodontic department records, and 268 university student volunteers were included. All subjects were with complete dentitions, except of age-related third or second molar tooth eruption difference. Study cast were obtained for all 468 subjects involved and following characters were studied. 1. Angle's classification; 2. Over-jet and over-bite relationship. Anteriorly it included cross-bite, cusp-to cusp bite, deep over-bite (without deep over-jet), deep over-jet (with or without deep-bite), open bite, and others. Posteriorly it included cross-bite, reverse cross-bite and others. 3. Abnormal occlusal index: For the purpose of quantitatively comparing the abnormal occlusal relationship of over-bite and over-jet, the occlusal index was introduced. The anterior continued abnormal was scored as 3 while posterior continued oclcusal abnormal scored as 5. The sum of the scores in the same subject was taken as his abnormal occlusion index. RESULTS: 1. Ratio of Angle's I patients in malocclusion group was significantly lower than those in TMD group and US group (P < 0.05), while the later two groups had no difference (P > 0.05). 2. The ratios of anterior cross-bite and deep over-jet were higher in malocclusion group than those in other two groups. No significant difference for the other kinds of abnormal over-jet and over-bite relationship were found among the three groups. 3. The abnormal occlusion index of malocclusion group was higher than that of US group, but not than that of TMD group which had no difference with US group either. CONCLUSIONS: 1. Aesthetic related anterior abnormal occlusion such as anterior cross-bite and deep-over-jet attract more attention of popular. But they had no relationship with TMD. 2. TMD patients had not significant occlusal features on Angle's classification and over-jet and over-bite relationship compared to malocclusion and nature population subjects.
Dental Occlusion↗
[Oromaxillofacial changes in thalassemia major].
Sixty patients (31 male and 29 female) with thalassemia major, aged between 6 and 26 years, 18 of which were splenectomized, were observed in this study evaluating the oro-maxillo-facial alterations and correlating them to transfusion indexes, serum ferritin levels, splenectomy and age. For each patient a haematologic and odontostomatologic card was filed with a view to report the medical and clinical history regarding: the haematologic picture, the prevention of caries and parodontal disease, the facies characteristics, the odonto-stomatologic examination, the orthodontic diagnosis, the skull X-rays and the orthopantomography. Poor oral hygiene as well as misknowledge of prevention were generally observed. All the patients showed carious lesions but most of them had never seen a dentist for therapy. The disharmonious growth of splanchnocranium, with the enlargement of the jaw and of its alveolar process, induced by the bone marrow hyperplasia, produced various and serious malocclusion stages (Angle's II class, deep bite, open bite), gnathologic alterations, hypodiaphanous paranasal sinuses and orbital hypertelorism, with a typical oriental-like facies. Malocclusion and the poor oral hygienic conditions determined the occurrence of marginal gingivitis, mainly localized at the level of the lower frontal teeth. In only 3 patients the oral mucous membrane was pale and atrophic. During this investigation agenesia and dental retention were reported in 30% and in 26% of the examined cases respectively, while no patients had supernumerary teeth. Tooth volume, position and shape abnormalities rarely occurred. Only in two patients was enamel hypoplasia described. The caries frequency greatly varied in number and in degree. Only five patients did not show any carious lesions. The caries index (DMF) for the permanent teeth calculated in all the 60 subjects was 5, 12 +/- 4.76. By utilizing Spearman's rank test the number of teeth with caries in the permanent dentition (DFM) and in the mixed dentition (DFM + dmf) was correlated to the average value of ferritin, with the ferritin peak, with transfusion requirements and with the age of the patient at the date of the clinical examination. A significant inverse correlation was therefore demonstrated between transfusion requirements and caries in the mixed dentition. The chi 2 test was used to assess the different frequency of the caries index (above 5) between splenectomized and non-splenectomized patients. Splenectomy proved to be associated only apparently to the total number of patients with more than 5 caries. Conversely, in the non-splenectomized group the frequency of patients with more than 5 caries was definitely lower. Indeed the overall number of caries in both groups of splenectomized and non-splenectomized subjects, of the same average age, was almost identical. Consequently, splenectomy and the higher number of caries are statistically more probable in individuals affected by thalassemia, of increasing age, without however being mutually correlated.
Adolescent↗
The ABO discrepancy index: a measure of case complexity.
A criterion for determining the acceptability of a case presented for the American Board of Orthodontics (ABO) Phase III clinical examination is case difficulty. Case difficulty can often be subjective; however, it is related to case complexity, which can be quantifiable. Over the past 5 years, the ABO has developed and field-tested a discrepancy index, made up of various clinical entities that are measurable and have generally accepted norms. These entities summarize the clinical features of a patient's condition with a quantifiable, objective list of target disorders that represent the common elements of an orthodontic diagnosis: overjet, overbite, anterior open bite, lateral open bite, crowding, occlusion, lingual posterior crossbite, buccal posterior crossbite, ANB angle, IMPA, and SN-GoGn angle. The greater the number of these conditions in a patient, the greater the complexity and the greater the challenge to the orthodontist. The ABO is considering several options for applying the discrepancy index to the Phase III clinical examination.
Cephalometry↗
Long-term evaluation of patients with progressive condylar resorption following orthognathic surgery.
The aim of this retrospective study was to evaluate the long-term treatment results of 26 patients who developed progressive condylar resorption (PCR) following a bilateral sagittal split advancement osteotomy (n= 19) or a bimaxillary osteotomy (n=7). PCR was diagnosed clinically and from a comparison of pre- and postoperative cephalometric and orthopantomographic radiographs. The preoperative condylar configuration and resorption pattern were assessed distinguishing between 'deep bite' and 'open bite'. Patients with 'deep bites' tended to have more resorption on the superior site of the condyle, while 'anterior open bites' often had resorption on the superior and anterior sites of the condyle. The patients were divided into 2 groups, one receiving non-surgical treatment that included splints, orthodontics with or without extractions and restorative dentistry. The second group underwent repeated surgery to treat skeletal relapse. Thirteen patients who underwent non-surgical treatment after orthognathic surgery had satisfactory results from orthodontic dental compensation, although only 3/13 had Class I occlusion. Another 13 patients had unacceptable occlusal and/or esthetic results and, therefore, underwent a second surgery. Following surgery, 7 patients had satisfactory occlusal and esthetic results and were skeletally stable. Four patients had 40-80% relapse, but with a stable occlusion. Two patients had 120% and 100% relapse, respectively, and needed a third surgical intervention. The first patient had a stable occlusal and esthetic result with approximately 30% relapse at pogonion, but the second patient still had an unstable malocclusion with again 100% relapse. It appeared that, without surgical intervention after PCR, further resorption ceased after approximately two years. Second surgery appeared to produce variable results, but, in this series, the majority had significant improvement.
Adolescent↗
Alveolar and skeletal dimensions associated with overbite.
The aim of this study was to investigate whether in the maxilla and in the mandible the structure of the anterior medial sagittal alveolar and basal bone is related to the overbite. A total of 460 untreated adult subjects were divided into four groups with either deep bite, normal overbite, end-to-end bite, or open bite and were compared. The overbite, lower face height, and anterior alveolar and basal midsagittal cross-sectional areas from the maxilla and the mandible were assessed on lateral cephalometric radiographs. An index was calculated, dividing the sagittal by the vertical dimension of the midsagittal cross-sectional area. A deeper bite coincided with smaller lower face height, larger alveolar and basal areas, and a more widened shape of the symphysis. If the lower face height was introduced as a covariable, the open bite group showed significantly smaller maxillary and mandibular alveolar and basal cross-sectional areas compared with the end-to-end group, the normal overbite group, or the deep bite group. Vertical variation of the overbite probably coincides with a relative hyperdevelopment or hypodevelopment of the symphysis.
Adolescent↗
[The growth of the skull and its importance for the occlusal conditions in Down's disease].
The teleradiographs and study casts of 68 patients with Down's disease were compared with those of 102 students. Pseudoprognathism, cross-bite and open bite were strikingly more frequent in the patients with Down's disease than in the students. The success of orthodontic treatment is very uncertain in patients with Down's disease. Mandibular prognathism needs in most cases surgical treatment. An open bite will be improved only if the position of the tongue is changed. Improvement of a cross-bite may be achieved by early expansion of the maxillae. In certain cases, normalization is accomplished. It is possible to reach considerable inprovements in patients showing a few or no occlusal surfaces though normal conditions cannot be established.
Adolescent↗
Influences of occlusal and skeletal discrepancies on biomechanical environment in the TMJ during maximum clenching: an analytic approach with the finite element method.
The purpose of this study was to investigate the influences of occlusal and skeletal discrepancies on temporomandibular joint (TMJ) stresses during maximum clenching. A three-dimensional (3-D) finite element model of the mandible including the TMJ was developed as a standard model. Furthermore, nine modified models were established; one dentoalveolar open bite model and eight skeletal open bite models with varying gonial angles or mandibular plane angles (FMAs). For the dentoalveolar open bite model, the TMJ stresses were larger than those for the standard model, although the distribution pattern was not essentially varied. In the skeletal open bite model with greater gonial angle or FMA, the TMJ stresses were significantly larger than those in the dentoalveolar open bite model. In conclusion, the TMJ stress was affected by occlusal and/or skeletal discrepancies, if coexisted in particular, indicating the association with degenerative changes of the TMJ components.
Biomechanical Phenomena↗
Role of pharyngeal length in patients with a lack of overbite.
Anterior open bites may be localized dental manifestations, which are caused by habits or skeletal disharmony, with or without functional aberration. Previous studies suggest various associations between open bites and underlying etiologic factors. We hypothesize that respiratory efficiency may be associated with anterior open bites. Under the assumption that breathing efficiency of the oropharynx and hypopharynx may be related to pharyngeal airway length, a cephalometric variable, vertical airway length (VAL), was measured on lateral cephalograms obtained from a total of 58 subjects with, so called, "open bite tendencies" (hereafter, open bite tendency). By means of the variable VAL, the association between pharyngeal length and open bite was investigated. In addition, the difference between actual open bite and open bite tendencies was also examined. The samples were randomly collected under stringent selection criteria from an existing database. A series of statistical analyses, such as unpaired t test, multiple regression, and discriminant analysis, was used to test the proposed hypothesis. The study found that none of the open bite tendency indicators used can segregate open bite subjects from nonopen bite subjects. The obtained discriminant function clearly divides the samples into two groups, i.e., open bite group and nonopen bite group, which were based on VAL and lower facial height. The study concludes that, first, an open bite tendency may be a different entity from an actual open bite or may be a misconceptualized term. Second, pharyngeal length may be a convenient indicator to diagnose open bite. We speculate that open bite may be different from an open bite tendency in pharyngeal length.
Adolescent↗
[Effects of unilateral mandibular distraction osteogenesis on temporomandibular joint].
OBJECTIVE: To study the effects of unilateral mandibular distraction osteogenesis(MDO) on the temporomandibular joint(TMJ). METHODS: Ten rhesus monkeys were used to perform right MDO. After 5 days, latency period, the distractor was initiated at the rate of 0.5 mmx2/day, totally 15 days. When MDO completed, and 2,4,6,and 12 weeks after MDO, X-ray films of bilateral TMJ were taken and one group of animals was sacrificed. Bilateral TMJ were obtained and paraffin slices were made HE and immunohistochemistry stains of TGF-beta1 were done on the slices. RESULTS: After MDO, the monkeys' mandible midline obviously deflected to the left side. The front teeth had open bite and reverse bite. The right molars were severely open bite and the left molars were reverse bite. From the X-ray film, we can see that the right condylar process moved backward and upward in the acetabulum, while the left condylar process moved forward and downward. On the slices, both sides of the TMJ showed different degrees of degeneration and proliferation, but the changes on the right side were more severe and obvious than the left side, and had involved all the cartilage's layers and the bone tissues under the cartilage. In some animals, there even appeared cartilage erosion and light histological changes of acetabulum. During the consolidation period, the open bite gradually closed, and the condylar process gradually moved to normal position. Twelve weeks after MDO, the open bite at the right side disappeared, but the front teeth open bite and reverse bite still existed. The right condylar process still lay a little backward and had some degree of degeneration. The left TMJ had the normal position and histology except for cartilage hypertrophy layer thickness. At different times during consolidation period, the positive stains of TGF-beta1 in condylar process on both sides were all more obvious than that of the control group. CONCLUSION: MDO can cause TMJ position change and light histological degeneration, but these changes can gradually rehabilitate in the future. TGF-beta1 may play a role in the reconstructive process of TMJ degeneration.
Animals↗
[The Procuste superimpositions: its value in the study of typology and its development during Edgewise Tweed-Merrifield treatment].
By transforming all figures into the same size, the Procruste mathematical superimpositions system allows orthodontists to analyze and compare geometric shapes whose different areas and forms would otherwise have made comparison impossible. Procruste is, accordingly, particularly useful in the study of facial types. In this retrospective study we analyzed the effects exerted by both growth and Edgewise Tweed Merrifield treatment upon changes in patients' typology of three different facial types. One hundred patients with Class II dental malocclusions were divided into three groups of deep bite, normal bite, and open bite. We found no significant statistical difference in the effects of treatment and of growth on modification of "form" of the facial skeleton as seen on profile cephalograms of the three categories. Patients in all the groups showed an average anterior rotation of the mandible.
Adolescent↗
Psychic and occlusal factors in bruxers.
BACKGROUND: The aim of this study was to investigate the existence of associations between bruxism and psychic and occlusal factors. METHODS: Participants in this study (n=85) were recruited from the Section of Odontostomatology, Deparent of Neuroscience, University of Pisa, Italy. They were split into two groups, bruxers (n=34) and non-bruxers (n=51), on the basis of the presence of both clinical and anamnestical indicators of bruxim. All participants were administered two self-reported validated questionnaires to evaluate (MOODS-SR) and panic-agoraphobic (PAS-SR) spetra. A number of occlusal variables (deep-bite: cross-bite, open-bite, mediotrusive and laterotrusive interferences, slide RCP-ICP, laterotrutsive guides, canine and molar classes) were also recorded. RESULTS: With regards to occlusal factors, the only association was revealed between bruxism mediotrusive interferences (p < 0.05). As for psychiatric investigation, significant differences between bruxers and controls emerged for the presence of both depressive (p < 0.01) and manic symptoms (p < 0.01) in MOODS-SR, and for stress sensitivity (p < 0.01), anxious expectation (p < 0.05), and reassurance sensitivity symptoms (p < 0.05) in PAS-SR. In particular, both mood (p < 0.01) and panic-agoraphobic (p < 0.05) spectra symptoms seem to differentiate bruxers from controls in males, while in females strong differences emerged for stress sensitivity symptoms (p < 0.05). CONCLUSIONS: It can be confirmed that certain psychic traits are present in bruxers, while occlusal factors are not useful parameters to discern bruxers from non-bruxers.
Adult↗
Prevalence of malocclusion in 4-6 year old Brazilian children.
The prevalence of malocclusion and the relationship with oral habits in Brazilian children from two public primary schools was evaluated. The sample was composed of 112 children with mean age of 61 +/- 6.67 months. The results demonstrated the presence of malocclusions in 75.8% (n = 85). The oral habits was related by 34.8% (n = 39). The open bite was the most prevalent malocclusion in the studied population and the oral habits was the decisive etiological factor.
Brazil↗