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PubMed2004

Self-perceived orthodontic treatment need evaluated through 3 scales in a university population.

OBJECTIVE: To evaluate the self-perceived orthodontic treatment need in a university population evaluated through 3 scales that used different approaches. DESIGN: Cross-sectional survey. SETTING: University dental clinic, Lima, Peru, 2001. MATERIALS AND METHODS: Questionnaires that gathered perceptions on dentofacial aesthetic perception and orthodontic treatment need were applied to a randomly selected sample (329) of first year university students (729). Subjects undergoing orthodontic treatment at the time of examination were excluded. MAIN OUTCOME MEASURES: Aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN), Oral Aesthetics Subjective Index Scale (OASIS) and a visual analogue scale (VAS) were used. STATISTICAL ANALYSIS: Descriptive statistics, Spearman correlation test, Kruskall-Wallis test and Mann-Whitney U-test were used. RESULTS: For the AC, 87.5% were in the "without treatment need" category, 10.6% in the "borderline need" category and 1.8% in the "treatment need" category. The mean AC score was 3.02 (+/-1.49). The mean OASIS score was 11.81 (+/-4.84), and the VAS score was 40.16 (+/-18.16). Correlations between the 3 self-assessment scales were moderate (AC-OASIS 0.416, AC-VAS 0.541 and OASIS-VAS 0.457). Gender or previous orthodontic treatment had no influence (p<0.05) on the scales. CONCLUSIONS: Differences in the approaches used by each scale to evaluate the self-perception of the aesthetical arrangement of the front teeth may explain the moderate correlation values.

Adolescent↗
PubMed1996

Orthodontic treatment of a cleft palate patient with surgically assisted rapid maxillary expansion.

Some adult cleft palate patients show severe maxillary transverse contraction and posterior crossbite. This case report demonstrates successful surgical-orthodontic treatment of such a patient. Surgically assisted rapid maxillary expansion (SA-RME) was completed prior to comprehensive orthodontic treatment. The osteotomy was performed on both the buccal and lingual aspects of the posterior maxillary alveolus. A Hyrax-type maxillary-expansion appliance was used, and the screw (0.2 mm, one quarter turn) was turned two or three times per day. Comprehensive orthodontic treatment was initiated after extraction of the mandibular first premolars and four third molars. The maxillary lateral incisors were also extracted after active orthodontic treatment. The amount of expansion achieved using SA-RME was greater at the posterior than at the anterior maxilla. Midpalatal suture opening occurred. After orthodontic treatment, occlusal stability was satisfactory. This case demonstrates the effectiveness of SA-RME in adult cleft palate patients with severe posterior crossbite.

Adult↗
PubMed1977

Occurrence and distribution of interdental gingival clefts following orthodontic movement into bicuspid extraction sites.

Forty patients in active retention following orthodontic tooth movement into premolar extraction sites were examined for the occurrence and distribution of interdental gingival clefts, defined as an invagination of interproximal tissue with definite mesial and distal peaks having a depth of at least 1 mm. Fourteen of the forty orthodontic patients demonstrated clefts in one or more of the premolar extraction sites. No clefts were observed in premolar areas of orthodontic patients who did not require premolar extraction or in patients without previous orthodontic treatment. Interdental clefts occurred most frequently at the buccal aspect of mandibular first premolar extraction sites. The presence of the cleft appears to have clinical implications, both in terms of orthodontic relapse, and maintenance of gingival health.

Adolescent↗
PubMed2003

Orthodontic movement into infrabony defects in patients with advanced periodontal disease: a clinical and radiological study.

BACKGROUND: In cases of advanced periodontal disease with a pathologic flaring of frontal teeth, a combined periodontic-orthodontic therapy may be a reliable approach in order to solve both functional and esthetic problems. The aim of the present study was to evaluate the periodontal tissue alterations following periodontal surgery and orthodontic intrusion in migrated upper central incisors with intrabony defects. METHODS: Ten patients with advanced periodontal disease and an extruded maxillary central incisor infrabony defect at its mesial aspect and probing depth (PD) > or = 6 mm were included in the present study. At baseline, PD and clinical attachment level (CAL) were measured. The vertical and horizontal dimensions of the defects were assessed on standardized radiographs. Seven to 10 days after surgery the active orthodontic treatment started using the segmented arch technique, in order to intrude and move the teeth into the defects. Maintenance therapy was performed every 2 to 3 months until the orthodontic treatment was completed. RESULTS: At the end of treatment, mean PD reduction was 4.35 mm, with a residual mean PD of 2.80 mm. Mean CAL gain was 5.50 mm. The mean radiological vertical and horizontal bone fills were, respectively, 1.35 mm and 1.40 mm. All differences were of statistical significance (P<0.001). CONCLUSION: The present study showed that the combined orthodontic and periodontic therapy performed resulted in the realignment of extruded teeth with infrabony defects, obtaining a significant probing depth reduction, clinical attachment gain, and radiological bone fill.

Adult↗
PubMed2000

Orthodontically stressed periodontium of transgenic mouse as a model for studying mechanical response in bone: The effect on the number of osteoblasts.

A better understanding of cellular and molecular mechanisms involved in response to mechanical stress is a prerequisite for future improvements in orthodontic treatment. To expand the application of molecular biology techniques in this area of research, we developed and characterized a mouse tooth movement model. The aim of this study was to biomechanically characterize this model and to evaluate the effect of orthodontic stress on the proliferation of periodontal osteoblasts. We used an orthodontic coil spring appliance with a low force/deflection rate, which produced an average force of 10-12 g. This design provided a predictable tipping movement of the molar with the center of rotation at the level of root apices. Histological observations of paradental tissues revealed a response favoring a fast onset of tooth movement and deposition of new osteoid starting after 3 days of treatment. The effect of treatment on the histomorpometric parameter of the number of osteoclasts per unit bone perimeter was determined after 1, 2, 3, 4, 6, and 12 days of treatment. Starting with day 2, the osteoblast number showed a modest but consistent increase in treated periodontal sites at all time-points, ranging from 14 to 39% and becoming significant only at day 6. Only a moderate increase in the number of osteoblasts in the areas of otherwise intense bone matrix synthesis suggests that, during bone formation, proliferation of cells has a smaller role compared to a marked increase in differentiation of individual cells. The mouse model, which allows for a controlled, reproducible, orthodontic mechanical loading, can be applied to both wild-type and transgenic animals and should enhance the research of the transduction of mechanical orthodontic signal into a biological response.

Journal Article↗
PubMed2000

Orthodontically stressed periodontium of transgenic mouse as a model for studying mechanical response in bone: The effect on the number of osteoblasts.

A better understanding of cellular and molecular mechanisms involved in response to mechanical stress is a prerequisite for future improvements in orthodontic treatment. To expand the application of molecular biology techniques in this area of research, we developed and characterized a mouse tooth movement model. The aim of this study was to biomechanically characterize this model and to evaluate the effect of orthodontic stress on the proliferation of periodontal osteoblasts. We used an orthodontic coil spring appliance with a low force/deflection rate, which produced an average force of 10-12 g. This design provided a predictable tipping movement of the molar with the center of rotation at the level of root apices. Histological observations of paradental tissues revealed a response favoring a fast onset of tooth movement and deposition of new osteoid starting after 3 days of treatment. The effect of treatment on the histomorpometric parameter of the number of osteoclasts per unit bone perimeter was determined after 1, 2, 3, 4, 6, and 12 days of treatment. Starting with day 2, the osteoblast number showed a modest but consistent increase in treated periodontal sites at all time-points, ranging from 14 to 39% and becoming significant only at day 6. Only a moderate increase in the number of osteoblasts in the areas of otherwise intense bone matrix synthesis suggests that, during bone formation, proliferation of cells has a smaller role compared to a marked increase in differentiation of individual cells. The mouse model, which allows for a controlled, reproducible, orthodontic mechanical loading, can be applied to both wild-type and transgenic animals and should enhance the research of the transduction of mechanical orthodontic signal into a biological response.

Journal Article↗
PubMed2003

Influence of orthodontic forces on the distribution of proteoglycans in rat hypofunctional periodontal ligament.

During orthodontic treatment, it is often necessary to move the hypofunctional teeth. In this study, we revealed an influence of orthodontic forces in the hypofunctional periodontal ligament, and focused on the distribution of proteoglycans, major extracellular matrix molecules. Five-week-old rats were divided into normal group and hypofunctional group. To induce occlusal hypofunction, occluding teeth of the mandibular first molar were extracted. At 8-week-old, orthodontic force by 15 or 2 gf titanium-nickel alloy closed coil spring was applied to the mandibular first molar toward the mesial direction. Immunohistochemical analysis was performed using antibodies for chondroitin sulfate (CS) and heparan sulfate (HS). In normal group, CS was observed throughout the extracellular matrix, while HS was observed on the endothelial cells and the osteoclastic cells on compressive side. In hypofunctional group without orthodontic appliance, CS and HS were detected in less amounts. With 15 gf, CS was observed at the compressive area where no cells and fibers were present, and HS was observed at the periphery of this area. With 2 gf, however, the distribution of CS and HS was similar to the normal control. These findings indicate that CS and HS were affected by orthodontic forces, and suggest their distinct functions in tissue remodeling.

Animals↗
PubMed2005

Craniofacial morphology of skeletal class III patients before treatment and growth-related changes during treatment with a maxillary protraction appliance: a comparison of orthodontic and surgical cases.

AIMS: To examine differences in the craniofacial morphology of skeletal Class III patients before treatment and growth-related changes during treatment with a maxillary protraction appliance (MPA) between patients who were treated only orthodontically (orthodontic group) and those who eventually received orthognathic surgery (surgical group). METHODS: The orthodontic and surgical groups consisted of 6 boys and 9 girls and 4 boys and 6 girls, respectively. Lateral cephalograms taken at the first visit and at the end of treatment with the MPA were measured. The Mann-Whitney U test and Wilcoxon signed-rank test were used. RESULTS: Before treatment, the Wits appraisal was significantly smaller and the gonial angle was significantly larger in the surgical group. During treatment, both the SNA and ANB angles were significantly increased in the orthodontic group, whereas only the SNB angle was significantly increased in the surgical group. Moreover, significant lingual inclination of the mandibular incisors was found in the orthodontic group. CONCLUSION: The Wits appraisal and gonial angle were useful for distinguishing between the two groups at the first visit. Facilitation of forward maxillary growth, modification of the direction of mandibular growth, and lingual tipping of the mandibular incisors may be important ways to avoid orthognathic surgery.

Cephalometry↗
PubMed2005

[Effect of high pull J hook headgear on root resorption during orthodontic treatment].

PURPOSE: The purpose of this study was to evaluate the effect of high pull J hook headgear(HPHG) on root resorption of maxillary incisors during orthodontic treatment. METHODS: Sixty female adolescent subjects who had finished orthodontic treatment were selected. They were either Class I or Class II division I cases treated with standard edgewise appliances. Half of the patients(30 cases) had an additional HPHG to assist upper anterior teeth retraction. They were matched to the other 30 cases with age and type of malocclusion. Panoramic radiographs taken before and after the orthodontic treatment were used to evaluate the degree of root resorption on upper incisors. Chi(2) test was used for statistical analysis. RESULTS: The incidence of root resorption on upper incisors was significantly increased after orthodontic treatment in both HPHG and non-HPHG groups (P<0.01). Compared to the non-HPHG group, more teeth in HPHG group showed moderate or severe root resorption (P<0.01). Some cases even encountered extremely severe root resorption. CONCLUSION: A combination of HPHG might lead to more severe root resorption on maxillary incisors during orthodontic treatment.

Adolescent↗
PubMed1990

[Growth dynamics of the four main craniofacial dimensions in relation to orthodontic finding--a longitudinal study].

Analysis of growth dynamics of the four main craniofacial dimensions at the transition point from primary into mixed dentition was performed in order to better determine the effect of individual orthodontic anomalies starting to manifest at that time, on the direction and extent of the alterations observed. A sample consisting of 73 children aged 3.5-5.5 years, free of any overt symptoms of orthodontic anomalies, were re-examined at the age of 6.5-8.5 years and divided into groups according to orthodontic findings then obtained. Mean values (and their differences) of the defined parameters obtained on the first and second measurement were analyzed, both for the sample in total and separately, according to the orthodontic findings in mixed dentition. Based on this data, specific relationships between alterations in each craniofacial dimension and maxillary morphology, specific for particular anomaly, were determined. In the group free of growth dynamics anomalies, both facial and both cranial parameters were almost identical. More or less expressed alterations of a single facial or cranial parameter in dysgnathic subjects may have been related to oral symptoms of the respective anomaly. At the same time, results obtained in the study suggested the size of the four main craniofacial dimensions to differ as early as in primary dentition, and become grouped, depending on the development of future orthodontic anomaly.

Cephalometry↗
PubMed1990

[The clinical study on occurrence of TMJ dysfunction in orthodontic patients].

Occlusal disharmony is considered to be the most significant factor of temporomandibular joint (TMJ) dysfunction, but the relationship between malocclusion and TMJ dysfunction has been unknown yet. The purpose of present study was to investigate the relationship between TMJ dysfunction and occlusal disharmony (eccentric occlusal contacts and functional shift of the mandible) in orthodontic patients. The subjects were 533 orthodontic patients, 209 males and 324 females, who were received at the Department of Orthodontics, School of Dentistry, Hokkaido University from April 1985 to March 1988. Their ages ranged from 8 to 38 years old. All were prior to orthodontic treatment. The results were as follows 1. The prevalence of TMJ dysfunction was 27.6%, 24.9% in males and 29.3% in females. The difference was insignificant between males and females. 2. The patients with TMJ dysfunction increased after 13-15 years old, corresponding to dental age IV A (Hellman's classification). 3. In patients with TMJ dysfunction, the highest frequency of symptom of TMJ dysfunction was joint sounds (77.6%), the second was pain (22.4%), the third was disturbance of mandibular movement (4.8%). The complication of those symptoms were compounded in 26.3% of the total patients. 4. The prevalence of TMJ dysfunction had no relation to specific malocclusion and maxillofacial morphologic characteristic. 5. Most patients with TMJ dysfunction had occlusal disharmony (95.9%). 6. Eccentric occlusal contacts were found most frequently in patients with open bite and functional shift of the mandible was found most frequently in patients with deep bite. From these findings, the prevalence of TMJ dysfunction was frequent in orthodontic patients, however the symptoms were objective and the patients were not aware of TMJ dysfunction. TMJ dysfunction had no relation to specific malocclusion but some kinds of occlusal disharmony were easy to occur in specific malocclusion and TMJ dysfunction was induced by those etiological factors.

Adolescent↗
PubMed1990

Diagnosis and treatment planning for the surgical-orthodontic patient.

Contemporary orthognathic surgery has made it possible to reposition either or both jaws in one piece or as segmental osteotomies. This has provided the patient, who has a severe dentofacial problem, with the option of having all components of their malocclusion and facial aesthetic concerns addressed. The close collaboration between the orthodontist and the surgeon provides a comprehensive diagnosis and treatment plan to be generated. The goal of the presurgical phase of orthodontics is to remove the dental compensations and allow optimum surgical correction of the jaw discrepancy. A short phase of orthodontic treatment postoperatively is usually necessary to detail the final occlusion. A systematic approach to diagnosis and treatment planning is discussed in the context of the problem-oriented approach. The application of this approach is illustrated in a case report of the combined orthodontic-surgical treatment of a patient who benefited from a two-jaw surgical procedure with pre- and postoperative orthodontic treatment. The principles of presurgical orthodontic treatment are discussed and should avoid any counterproductive tooth movements that can be part of the surgical correction. Tooth movements done as part of the postoperative treatment should avoid compromising the surgical outcome. Illustrations of the cephalometric prediction tracing and its application to the diagnosis and treatment plan of the patient discussed in the case report is an important aspect in providing the dentofacial patient with a representation of the expected treatment outcome.

Clinical Protocols↗
PubMed1990

[Physical growth and adult height of orthodontic cleft lip and palate patients].

No unusual variations were found in the skeletal age of 38 female and 78 male patients with clefts of the lip and palate at the time of orthodontic treatment. The patients were divided in groups according to gender and severity of the cleft. In all groups a tendency towards over-average growth was found, which manifested itself rather in adulthood than at the time of orthodontic treatment. The mean height of adult women was 165 cm, 3 cm more than the average values found by Tanner. The mean height of men was 180 cm, i.e. 6 cm more than the corresponding values of Tanner. Only one man showed a body height of less than the third percentile, although he had been within the normal range during orthodontic treatment. Two girls rated below the third percentile during orthodontic treatment, but later grew up to the normal range of height. Hence it may be concluded that dwarfism is not among the factors that must be expected in the orthodontic treatment of cleft lip and palate patients.

Body Height↗
PubMed1994

[Orthodontic movements and the periodontium: how far to go? A review of the literature].

The aim of this paper was to describe, with the help of recent research informations, the possible interactions between orthodontics and periodontics. It is well-known that the periodontal structures of a tooth play an important role during its orthodontic movement; this should therefore be considered before, during and after any orthodontic treatment. The theoretical basis of the usual difficulties are explained, as well as their clinical consequences. The particular problem of orthodontic movements in dentitions with reduced periodontal support has been stressed. A synoptic table summarizes the diagnostic steps and the clinical approach with the recommendations which seem, at the present time, to allow the preservation of the periodontal structures during orthodontic movement. Finally, the problem of apical root resorption is addressed in a specific chapter.

Adult↗
PubMed1996

Orthodontic procedures improving periodontal prognosis.

The wide range of interrelations between orthodontics and periodontology shows that besides the preventive significance in the mixed dentition, another focal point is the comprehensive rehabilitation of periodontally affected patients. With increasing experience in the field of adult orthodontics, setting therapeutic limits becomes increasingly difficult. It is impossible in principle to define in exact metric terms the probing depth or attachment loss up to which orthodontic tooth movement is feasible. The fact is rather that the orthodontic-periodontal treatment goal can be defined only after evaluation in each individual finding a number of different factors: esthetics, function, risks of orthodontic tooth movement, biomechanical considerations, and periodontal prognosis.

Adolescent↗
PubMed1999

Adult patients' view of orthodontic treatment outcome compared to professional assessments.

One important aspect in evaluating the outcome and quality of orthodontic treatment is the patient's own assessment. The objective of this study was to evaluate the course and outcome of orthodontic treatment in adults from the patient's vs the operator's point of view. In a previous study, the orthodontic treatment of 88 adults was evaluated using the IOTN and PAR Index before and after treatment. Fifty-nine patients answered treatment questionnaires on 1. the reason for seeking treatment, 2. dentofacial aesthetics, 3. treatment outcome, 4. course of treatment, 5. attitude, 6. social well-being. Depending on the original treatment goal, the patient population was divided into an Ideal Group and a Compromise Group. In 75% of the patients, dissatisfaction with dental aesthetics was the prime motive for seeking treatment; correlations with PAR parameters (overjet and maxillary anterior teeth) were weak. In general, a high degree of patient satisfaction with orthodontic treatment was registered. As regards satisfaction with post-treatment dental aesthetics there were no significant differences between the groups. Comparison of professional assessment with the subjective rating by patients revealed discrepancies in that the patients' rating of outcome tended to be more positive. The differentiation between ideal and compromise treatment goals proved useful. In the Compromise Group, a high level of patient satisfaction was attained with a shorter treatment duration and lower appliance involvement. 92% considered their major pre-treatment need to have been met, and 95% would have had the treatment performed again.

Adult↗
PubMed1994

[A computer-controlled flexing test for determining the elastic parameters of highly flexible orthodontic wires].

Metals are the most commonly used materials in the construction of orthodontic appliances designed for the correction of malocclusions. Knowledge of the force systems at work is a prerequisite for judging the functionality of these appliances. The elasticity parameters (Young's E-moduli, strain limits) of the alloys employed can be drawn upon to calculate numerically forces and torsional moments. Both tensile tests and bending experiments are used to determine the E-moduli and strain limits of standard steel and highly flexible NiTi wires frequently used in orthodontics. However, parameters obtained by tensile tests are less suited for studying the mechanical properties of orthodontic appliances. Since bending deformation prevails, bending experiments should be preferred method for ascertaining the relevant parameters. This study, therefore, presents a new experimental method for testing the bend ability of highly flexible materials and the determination of the underlying material parameters. A comparison of calculated force systems with direct measurements revealed that bending parameters lead to an appropriate description of forces and moments generated during clinical treatment, whereas calculations based on tensile test parameters differ substantially. The bending test proposed here is, thus, a suitable means for dependably predicting the force systems produced by an orthodontic appliance and the test therefore can contribute to an accurate design of new types of therapeutic devices.

Computer-Aided Design↗
PubMed1996

Three-dimensional interpretation of periodontal lesions and remodeling during orthodontic treatment. Part III.

In a clinical study of 11 adult patients, HR-CT-examinations were performed before or during and after orthodontic treatment with fixed appliances. The treatment period between the first and second CT-scanning varied from 12 to 24 months. Comparison of the first and second CT-examination permits three-dimensional evaluation of osteoclastic and osteoblastic alveolar remodeling. The incidence of periodontal lesions such as bone dehiscences, fenestrations and root resorptions was assessed in relation to the initial periodontal situation and the orthodontic treatment concept. Anatomical risks were a small alveolar process, thin buccal or lingual bone plates, eccentric position of teeth, basally extended maxillary sinus and progressive alveolar bone loss. Therapeutic risks were uncontrolled sagittal or vertical movements of incisors and cortical or intermaxillary anchorage preparation. CT-scanning of the alveolar process during orthodontic treatment with HR-CT allows three-dimensional interpretation of the alveolar osteodynamics, especially the development and repair of orthodontically induced bone dehiscences in relation to tooth movement.

Adolescent↗