[New orthodontic therapy: treatment of an open sucking bite with Tegtmeier's impulsator].
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Humans↗
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Magnetic resonance imaging characteristics of temporomandibular joint pain during opening and biting in patients with disc displacement.
OBJECTIVE: The purpose of this study was to evaluate the magnetic resonance (MR) imaging characteristic of temporomandibular joint (TMJ) pain during opening and biting in patients with disk displacement. STUDY DESIGN: MR images of 1252 TMJs in 640 patients with disk displacement were studied retrospectively. The relationship between TMJ pain and age, sex, and MR imaging findings, such as disk displacement with or without reduction, TMJ fluid, and osteoarthrosis, was analyzed using logistic regression analysis. RESULTS: The resultant data showed a significant relationship between TMJ pain during maximum jaw opening and disk displacement without reduction (OR = 2.36). The resultant data also showed a significant relationship between TMJ pain during maximum biting and TMJ fluid (OR = 1.85). CONCLUSION: The results suggest that TMJ pain during opening and biting is related to disk displacement without reduction and TMJ fluid on MR images.
Adolescent↗
[Discriminating factors of mandibular divergence].
The aim of this work is to identify the discriminating factors of mandibular divergence. 90 patient records taken from the 98--99. 99--2000 files in the orthopedic dentistry service of the Department of Odontology at Dakar University were examined. The patients selected were all of Black African descent and aged from 11 to 13. This work consists in the cephalometric examination of X-ray profiles radiographis in order to compare various elements between normodivergent and open-bite subjects. The statistical analysis of data along with various tests carried out led to the following conclusions: - Measuring FMA. GOI-Me/Oli, GOI-Me/Pocc, Ans-Pns/GOI-Me and chin angle can be used to discriminate between open-bite and normodivergent patients. - SN/GOI-Me has a positive correlation with GOI-Me/Oli, GOI-Me/ Pocc, Ans-Pns/Pocc, Ans-Pns/GOI-Me and FMA. - The chin angle has a negative correlation with the previous forms of measurements. - The correlation between Ans-Pns/Pocc and the other measures is weak. - The average difference between the measures of both groups is important, which means that these variables discriminate between normodivergent et open-bite patients. BIased on the most discriminating variables, we produced the following function of classification: F= - 1,542 -0,095(Angle) + 0.098(Ans-Pns/GOI-Me) + 0,145(FMA) We have also established an equation of probability for a patient to be normodivergent or open-bite, which is as follows: Pr (Normal) -----------=e(-0.273 FMA -0.267 ANS-NS/MEGOI +0.272 ANGLE) Pr (hyper)
Adolescent↗
Association between allergic rhinitis, bottle feeding, non-nutritive sucking habits, and malocclusion in the primary dentition.
AIM: To determine the association between allergic rhinitis, bottle feeding, non-nutritive sucking habits, and malocclusion in the primary dentition. METHODS: Data were collected on 1160 children aged 4-5 years, who had been longitudinally followed since the age of 4 months, when they were admitted to nurseries in a suburban area of Tampico-Madero, Mexico. Periodically, physical examinations were conducted and a questionnaire was given to their parents or tutors. RESULTS: Malocclusion was detected in 640 of the children (51.03% had anterior open bite and 7.5% had posterior cross-bite). Allergic rhinitis alone (adjusted odds ratio = 2.87; 95% CI 1.57 to 5.25) or together with non-nutritive sucking habits (adjusted odds ratio = 3.31; 95% CI 1.55 to 7.09) had an effect on anterior open bite. Bottle feeding alone (adjusted odds ratio = 1.95; 95% CI 1.07 to 3.54) or together with allergic rhinitis (adjusted odds ratio = 3.96; 95% CI 1.80 to 8.74) had an effect on posterior cross-bite. Posterior cross-bite was more frequent in children with allergic rhinitis and non-nutritive sucking habits (10.4%). CONCLUSIONS: Allergic rhinitis alone or together with non-nutritive sucking habits is related to anterior open bite. Non-nutritive sucking habits together with allergic rhinitis seem to be the most important factor for development of posterior open bite in children under the age of 5 years.
Bottle Feeding↗
[Early recognition of orthodontic problems by the general dentist during oral examination: signs which should attract attention].
The last decennia more and more patients are aware of the advantages of a good dental health. Dental minded parents in their children visit the dentist (general practitioner, GP) on a regular basis for a routine check up. During this check up, signs of possible future orthodontic problems can be encountered by the GP. In this article guidelines are handed to the GP by means of a flow chart which can be used at the end of the dental examination. Anterior/posterior relation, cross-bites, deep and open bite, habits and crowding shall be briefly discussed. Heaving knowledge of these, the GP can decide referring the patient to the orthodontist for further orthodontic evaluation.
Anodontia↗
Comparison of the effects of passive posterior bite-blocks with different construction bites on the craniofacial and dentoalveolar structures.
Posterior bite-blocks that are used in the early treatment of skeletal open bite, produce a forward and upward mandibular rotation by transmitting the masticatory muscle forces to the buccal dentoalveolar regions and preventing their vertical growth. Increasing the vertical dimension of the face artificially causes skeletal adaptations to occur not only in the dentoalveolar region but also in the other regions of the craniofacial complex. The affects of passive posterior bite-blocks, constructed in two different heights, were investigated for two treatment groups, in comparison to an untreated control group. Two treatment groups comprised of 25 growing patients, who had skeletal open bite and skeletal/dental Class I or Class II malocclusions, and one control group consisting of 14 growing patients were used. These groups were matched concerning their age, sex, and vertical and sagittal skeletal cephalometric and dental characteristics. Passive posterior bite-blocks of 5 and 10 mm heights were applied to the subjects of the treatment groups respectively for 18 hours per day. Untreated control subjects were observed for 7 to 9 months. The findings of this study revealed that the downward and backward mandibular rotation continued in the control group, increasing the lower facial height significantly, whereas in the treatment groups, the skeletal open bite was treated and the mandible rotated upward and forward. The increase of the height of the posterior bite-blocks had a significant effect on the anterior mandibular rotation and in the increase of the gonial angle.
Adolescent↗
Indication for and frequency of early orthodontic therapy or interceptive measures.
The early treatment of nonskeletal and skeletal orthodontic anomalies in the deciduous and early mixed dentition is intended to prevent the development of pronounced anomalies in the late mixed and permanent dentition with the ultimate aim of reducing or even eliminating the need for later orthodontic treatment. There is a general consensus in the international literature that early therapy is indicated in cases of anterior and lateral crossbite and Class III malocclusion, and possibly for extreme forms of mandibular retrognathism (overjet > or =10 mm) and of open bite. However, evidence of the efficiency of early orthodontic measures is just as rare as studies providing serviceable information on the incidence of tooth malalignments and malocclusions in the deciduous and early mixed dentition, some of whose findings are in any case highly divergent. This makes it substantially more difficult to draw conclusions on the extent to which early orthodontic therapy may be indicated. In order to obtain information on the incidence of nonskeletal and skeletal orthodontic problems constituting a treatment need, 2326 first-year schoolchildren aged between 6 and 7 years were examined in Frankfurt am Main and in the Rural District of Offenbach. In only 14.7% of the children were no relevant orthodontic findings recorded. 77.2% displayed mild to severe dysgnathic symptoms, though without early orthodontic therapy being considered indicated. Treatment with orthodontic appliances was considered urgent for 187 of the children (8.04%). With 8.3% and 7.9% respectively, lateral and anterior crossbite were top of the list of anomalies with an urgent treatment need. Among the patients with lateral crossbite, the prognostically less favorable unilateral form was recorded approximately four times more often than the bilateral form. Markedly increased sagittal overjet > or =10 mm) was registered in only 1.4% of the children, and negative overjet (Class III) (with the exception of edge-to-edge bite) in 1.9%. Extreme anterior open bite > or =6 mm) was recorded in only two children (0.09%). In 19.6% of the children, a supporting zone was reduced in at least one quadrant, necessitating interceptive measures such as the insertion of a space maintainer or later orthodontic treatment (space opening or extraction therapy).
Child↗
Malocclusion traits and articulatory components of speech.
The aim here was to determine the effects of particular types of malocclusion including the effects of combinations of different occlusal anomalies on speech articulation. Occlusal anomalies and articulatory speech disorders, a diagnosis based on errors in place of articulation, were determined for 451 students, mean age 23 years. The present results showed that risk ratios for producing consonants too far anteriorly was greater by 4.5 times for subjects with mesial occlusion, 3.7 times for those with mandibular overjet, 3.4 times for subjects with incisal open bite and 1.7 for those with lateral cross-bite compared to individuals without those occlusal anomalies. This study suggests that incisal open bite alone is rarely associated with articulatory speech disorders, but if present they tend to be mild. Incisal open bite combined with other occlusal anomalies, especially with mesial occlusion, is related to more severe misarticulations of consonants.
Adult↗
Fiber-type differences in masseter muscle associated with different facial morphologies.
BACKGROUND: The influence of muscle forces and associated physiologic behaviors on dental and skeletal development is well recognized but difficult to quantify because of the limited understanding of the interrelationships between physiologic and other mechanisms during growth. METHODS: The purpose of this study was to characterize fiber-type composition of masseter muscle in 44 subjects during surgical correction of malocclusion. Four fiber types were identified after immunostaining of biopsy sections with myosin heavy chain-specific antibodies, and the average fiber diameter and percentage of muscle occupancy of the fiber types were determined in each of 6 subject groups (Class II or Class III and open bite, normal bite, or deepbite). A 2 x 3 x 4 analysis of variance was used to determine significant differences between mean areas for fiber types, vertical relationships, and sagittal relationships. RESULTS: There were significant differences in percentage of occupancy of fiber types in masseter muscle in bite groups with different vertical dimensions. Type I fiber occupancy increased in open bites, and conversely, type II fiber occupancy increased in deepbites. The association between sagittal jaw relationships and mean fiber area was less strong, but, in the Class III group, the average fiber area was significantly different between the open bite, normal bite, and deepbite subjects. In the Class III subjects, type I and I/II hybrid fiber areas were greatly increased in subjects with deepbite. CONCLUSIONS: Given the variation between subjects in fiber areas and fiber numbers, larger subject populations will be needed to demonstrate more significant associations between sagittal relationships and muscle composition. However, the robust influence of jaw-closing muscles on vertical dimension allowed us to conclude that vertical bite characteristics vary according to the fiber type composition of masseter muscle.
Adult↗
Cerec 3 for orthodontics: a tool for treating deep bite.
Bite-opening procedures are used in the early stages of orthodontic fixed treatment in order to: ease antero-posterior tooth movements; bracket the mandibular arch and level the Curve of Spee; prevent mandibular brackets from debonding; use regular straight archwires to proceed with treatment. For these purposes, removable or bonded biteplanes are universally recognized as very effective when the bite-opening is needed. Conventional orthodontic procedures include clinical solutions which effectively open the bite, but they all lack sufficient hygiene, comfort, and esthetics. The authors propose the use of the CAD-CAM technology with the Cerec 3 system (Sirona, Bensheim, Germany) to create an overcrown able to open the bite through clinical crown lengthening of the mandibular second premolars. The laboratory steps are described and the clinical efficacy is demonstrated with an orthodontic case report.
Adolescent↗
Occlusal features are not a reliable predictor of bruxism.
AIM: The aim of this investigation was to estimate the contribution of occlusion to differentiate bruxers from non-bruxers. METHODS: Participants in the study were 160 patients consecutively selected among 20-30 year old patients attending the Section of Prosthetic Dentistry for conservative care. The presence of bruxism was clinically and anamnestically investigated. In each patient the following occlusal features were recorded: retruded contact position-intercuspal position slide length, vertical overlap, horizontal overlap, unilateral posterior crossbite, incisor dental midline discrepancy, mediotrusive interferences, laterotrusive interferences. A stepwise logistic regression model was used to identify the significant associations between occlusal features and bruxism. RESULTS: Diagnosis of bruxism was made in 67/160 subjects (41.8%). Differences between sex were not significant (p=0.814). Among the 8 occlusal variables included in the logistic regression analysis, those remaining in the final model were laterotrusive interferences (OR 2.47) and anterior open-bite (OR 0.88). This model showed good specificity (87%) but an unacceptable sensitivity (26.9%) to predict bruxism (accuracy=61.6%). Therefore, multivariate analysis did not lead to an improvement in bruxism predictability with respect to univariate analysis, which revealed that the presence of bruxism was significantly associated with laterotrusive interferences alone (p=0.040), and not with unilateral cross-bite (p=0.208), anterior open-bite (p=0.202), deep-bite (p=0.572), large horizontal overlap (p=0.261), dental midline discrepancy (p=0.519), mediotrusive interferences (p=0.119), slide >or=2 mm (p=0.857). CONCLUSION: According to our findings the contribution of occlusion to differentiate bruxers from non-bruxers is very poor. Infact, only laterotrusive interferences seem to be significantly associated with bruxism.
Adult↗
A cephalometric study of Class II malocclusions treated with mandibular surgery.
INTRODUCTION: Class II malocclusion is often associated with retrognathic mandible. Some of these problems require surgical correction. The purposes of this study were to investigate treatment outcomes in patients with Class II malocclusions whose treatment included mandibular advancement surgery and to identify predictors of good outcomes. METHODS: Pretreatment and posttreatment cephalometric radiographs of 90 patients treated with mandibular advancement surgery by 57 consultant orthodontists in the United Kingdom before September 1998 were digitized, and cephalometric landmarks were identified. Paired samples t tests were used to compare the pretreatment and posttreatment cephalometric values for each patient. For each cephalometric variable, the proportion of patients falling within the ideal range was identified. Multiple logistic regression analysis was performed to identify predictors of achieving ideal range outcomes for the key skeletal (ANB and SNB angles), dental (overjet and overbite), and soft-tissue (Holdaway angle) measurements. RESULTS: An overjet within the ideal range of 1 to 4 mm was achieved in 72% of patients and was more likely with larger initial ANB angles. Horizontal correction of the incisor relationship was achieved by a combination of 75% skeletal movement and 25% dentoalveolar change. An ideal posttreatment ANB angle was achieved in 42% of patients and was more likely in females and those with larger pretreatment ANB angles. Ideal soft-tissue Holdaway angles (7 degrees to 14 degrees ) were achieved in 49% of patients and were more likely in females and those with smaller initial SNA angles. Mandibular incisor decompensation was incomplete in 28% of patients and was more likely in females and patients with greater pretreatment mandibular incisor proclination. Correction of increased overbite was generally successful, although anterior open bites were found in 16% of patients at the end of treatment. These patients were more likely to have had initial open bites. CONCLUSIONS: Mandibular surgery had a good success rate in normalizing the main dental and skeletal relationships. Less ideal soft-tissue profile outcomes were associated with larger pretreatment SNA-angle values, larger final mandibular incisor inclinations, and smaller final maxillary incisor inclinations. The use of mandibular surgery to correct anterior open bite was associated with poor outcomes.
Adolescent↗
Molding of the regenerate in mandibular distraction: Part 1: Laboratory study.
Distraction osteogenesis has evolved as a mainstream surgical technique for lengthening and augmentation of the hypoplastic mandible. As clinical experience accumulated, there developed the need to "mold" the bony regenerate to avoid the development of postdistraction malocclusion and to achieve the desired craniofacial form. Although the potential to mold the regenerate has important clinical implications, the safety and efficacy of such an acute manipulation of the bony regenerate form have not yet been investigated in the laboratory. The purpose of this study was to determine if the distraction regenerate could be molded and result in a bony union. Four adult female dogs underwent bilateral mandibular distraction with an external multiplanar device (Stryker, Osteonics). After a latency period of 5 days, the mandibles underwent linear (anteroposterior) and angular (superoinferior) distraction to produce an anterior open bite of approximately 30 degrees. At the conclusion of the distraction procedure, the distraction sites were molded to close the open bite. In two dogs, the maneuver was performed over 3 days by changing the angulation of the devices (gradual molding), and in the other two dogs, molding was achieved with a single movement (acute molding). In the latter, the distraction devices were adjusted and reapplied to allow for anatomical fixation during the consolidation period of 49 days. According to the research protocol, the mandibles were assessed serially by cephalograms and computed tomography (CT) scans. All dogs survived the study without complications. The bony regenerate was easily molded in both groups to close the surgically created open bite. After molding, all the regenerates showed CT scan evidence of solid bone (consolidation), which was classified as "extended" on the Hamanishi scale. After the dogs were killed and soft tissue was removed, the regenerate seemed to be robust on gross examination without any evidence of fibrous nonunion. In addition, histological study of the regenerate confirmed the bony union. The study demonstrates that the mandible can be successfully molded into a desired anatomical position immediately after distraction without producing a fibrous union. Furthermore, it has been demonstrated that the bony regenerate is sufficiently malleable before consolidation to undergo either acute or gradual angular molding without disturbing osteogenic potential. The ability to mold the regenerate without the fear of creating a fibrous union or destroying bony potential provides the surgeon the capability to optimize the dental occlusion and mandibular form as part of the distraction treatment process.
Animals↗
Case report: orofacial characteristics of Hallermann-Streiff Syndrome.
BACKGROUND: Hallermann in 1948 and Streiff in 1950 described patients characterised by "bird face", congenital cataract, mandibular hypoplasia, and dental abnormalities. The new syndrome was later defined as Hallermann-Streiff Syndrome (HSS), underlining the differences with regard to Franceschetti's mandibulofacial dysostosis. CASE REPORT: Examination of a white male affected by Hallermann-Streiff Syndrome revealed facial characteristics typical of the "bird face" in HSS. The nose appeared thin, sharp and hooked; the prominence of the chin was absent in the lateral view; a marked microstomia was evident as well. Radiographic records showed aplasia of teeth 14, 13, 12, 22, 24, 35, 34, 33, 32, 31, 41, 42, and 43. As for orthodontic diagnosis, the following dentoskeletal features were assessed: skeletal Class II malocclusion, narrow upper arch, bilateral posterior crossbite, and anterior open bite. Lateral cephalogram showed hypoplasia of the mandible, a typical sign of HSS. The mandible revealed a clockwise rotation growth pattern with an opening of the gonial angle, skeletal anterior open bite, and an excessive vertical dimension of the lower third of the face. Radiographs at the age of 13 years showed an anomaly in shape of the lower right first bicuspid, which appeared with a double crown. TREATMENT: Orthodontic treatment started at 10 years of age with rapid maxillary expansion in the early stages of the mixed dentition, in order to correct the posterior crossbite due to the narrow maxillary arch. A subsequent phase of the orthodontic therapy consisted of a functional appliance with the goal of maintaining the transverse dimension of the dental arches and of controlling the tongue thrust in the anterior open bite. Surgical and prosthetic interventions were scheduled at completion of growth to solve the skeletal discrepancy and for occlusal rehabilitation. FOLLOW-UP: The therapeutic protocol used in the patient presented here was able to reach the orthodontic goals during the developmental ages. Further treatment is planned as there are multiple missing permanent teeth and prosthetic/restorative care is needed until the patient reaches full adulthood.
Child↗
Clinical crown length in 9-, 11- and 13-year-old children with and without finger-sucking habit.
Continuing finger-sucking often leads to an anterior open bite. The object of the present study was to attempt to illustrate whether this open bite is caused by an arrested eruption of incisors or primarily by inhibited growth of the alveolar processes. A comparison is made between 9-, 11- and 13-year-old children with continuing finger-sucking habits or who ceased finger-sucking only after 8 years of age, and children of the same ages without sucking habits in respect of the clinical crown length of central and lateral incisors in the upper and lower jaws. In all measurements the clinical crown length among children in the finger-sucking groups was greater than among children in the control groups (Table 1). The anterior open bite of the finger-suckers was therefore probably not caused by arrested eruption of incisors but rather by inhibited vertical growth of the anterior part of the alveolar processes.
Adolescent↗
A longitudinal study of skeletal side effects induced by rapid maxillary expansion.
Orthopedic expansion of the maxillary arch--rapid maxillary expansion (RME)--is a commonly used treatment technique that has become increasingly popular during the last 25 years. During this time, however, clinicians routinely have imputed a variety of undesirable side effects to RME, particularly bite opening. Whereas there have been many explanations as to the mechanisms underlying such RME-related effects as bite opening, few studies have considered the long-term effects of RME in the vertical and sagittal dimensions of the face. The purpose of this investigation was to examine cephalometrically the long-term effect that the Haas-type rapid maxillary expansion may have on bite opening and on the anteroposterior position of the maxilla. The sample consisted of 25 patients who had undergone RME with the Haas-type expander, followed by standard edgewise therapy. This RME sample was compared with a group of 25 patients who had standard edgewise treatment (SET) only and with a control (CTRL) group of 23 subjects. Mean initial form and mean age at start of treatment for the RME, SET, and CTRL groups were similar. Statistically significant among-group differences were documented for only 2 of 10 cephalometric variables sensitive to anteroposterior and vertical skeletal changes. These differences, however, were not clinically significant. The current investigation implies therefore that RME therapy with the Haas-type expander has little long-term (more than 6 years after treatment) effect on either the vertical dimensions or the anteroposterior dimensions of the face.
Adolescent↗
Vector control in lower jaw distraction osteogenesis using an extra-oral multidirectional device.
PURPOSE: This cephalometric study describes structural changes in facial features and occlusion during distraction of the mandible. PATIENTS: Seven patients aged 7-16 years with severely retrognathic lower jaws were treated by bilateral extra-oral distraction. The direction of the distraction was changed during the distraction period (mean 30 days) using the adjustable hinge in the distractor. Cephalometric follow-up documents were analysed for changes in facial and occlusal structures. The distraction therapy proceeded in two phases. First, horizontal distraction was undertaken to achieve a good incisor relationship. After this, the direction was changed to a more vertical plane with the use of a hinge axis, and the tips of the lower incisors were used as the axis of rotation. RESULTS: The most remarkable changes were in the more anterior position of the lower jaw, the increase in ramus height and good dental overjet. The mandibular occlusal plane became more horizontal, creating a posterior open bite. By guiding the vector of distraction, no anterior open bite or lateral crossbite appeared. CONCLUSION: This study points out the advantages of using extra-oral multidimensional distractors. Severe lower jaw deficiency requires not only a long working length of the device but also precise control of the vector during the active phase of distraction.
Adolescent↗
The prediction of facial growth.
In the two contrasting malocclusions, the open bite and the deep overbite, statistically significant differences are shown in the anterior, middle and posterior endocranial regions. In open bite there is an association between the lower face height and the size of the anterior, middle and posterior cranial regions, but in deep overbite the associations between face height and the endocranial size are less strong. These and other associations if brougth together in a multiple regression analysis may prove useful in prognosticating the final face height in the growing child, particularly in the open-bite case.
Adolescent↗