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PubMed2004

The biomechanical relationship between incisor and condylar guidances in deep bite and normal cases.

The purpose of this study was to investigate the biomechanical relationship between the condylar and anterior guidances in deep bite malocclusion and control groups. The subjects consisted of 18 deep bite patients and 14 normal occlusions. A four-bar mechanism was described on the lateral cephalogram films and a computer program, for which the lengths of the links measured on the films were the inputs, was developed. The computer program was used to calculate the angles of rotation of the mandible and the condyle during contact of the mandibular anterior teeth with the lingual surface of the maxillary anterior teeth as the mandible moves forward. Comparison of the mean values of the angles of rotation of the mandible and condyle in the two groups has shown that the change in the angle of rotation of the condyle is statistically significant (P < 0.05). The angles of rotation of condyle in deep bite group were found larger than the angles of normal group. Correlation between the angles of rotation of the condyle and mandible has shown that they were significantly related. The cause of temporomandibular disorders may be attributed to the large angle of rotation of the condyle in deep incisal overbite.

Adolescent↗
PubMed2006

Real time balanced turbo field echo Cine-MRI in the analysis of deglutition events and transit times.

Investigation of swallowing is an important part of oral diagnosis. It usually plays a role in the aetiology of some orofacial deformities and open-bite as well as in the relapse of treated open-bite patients. In recent years, the movements of the anatomical structures that participate in deglutition have been investigated by several methods such as cineradiography, electromyography, electropalatography, electromagnetic articulography and ultrasonography. However, all these techniques have various disadvantages. Recently, dynamic magnetic resonance imaging has become available in the evaluation of swallowing function. In this study we intended to present this new technique to the dental literature and aimed to obtain dynamic images of the deglutition process. We also compared the timing of events in subjects with anterior open-bite and normal overbite during swallowing 10 mL water.

Adolescent↗
PubMed1980

Dental and social effects of malocclusion and effectivenessof orthodontic treatment: a review.

The relationship between malocclusion and the health of the masticatory apparatus is reviewed. While there is evidence that certain features such as traumatic deep overbite, unprotected incisors and impacted teeth may adversely affect the longevity of the dentition, the relationship of dental irregularity to periodontal disease, caries and mandibular dysfunction is less certain. Studies in the field of social psychology indicate that an unattractive physical appearance may evoke an unfavourable social response in many facets of social interaction but the place of dentofacial anomalies in this context has not been satisfactorily assessed. The individual's adjustment to his own imperfections in dental alignment is variable and there is no evidence that children with visible irregulaities will in general be emotionally handicapped. Effectiveness studies have yet to be undertaken but the factors which will have to be taken into account in assessing the benefits of orthodontic treatment are the definition of treatment need, treatment standards, the disadvantages of treatment and the influence of other determinants of dental health. The need for further research is underlined.

Dental Caries↗
PubMed1986

Epidemiology of malocclusion in Argentine children.

As part of a nationwide oral health survey in Argentina, malocclusion traits and need of orthodontic treatment was assessed in 1554 schoolchildren aged 12-13 using the WHO-FDI basic method for recording occlusal traits. A frequency of 1.38% extracted permanent teeth was found, being higher in Amerindian than Caucasian children. Incisor diastema and crowding was significantly lower in Amerindians. Both maxillary overjet and overbite were significantly lower in Amerindian (2.9% and 3.8%) than in Caucasian children (9.9% and 8.1%) respectively (P less than 0.001). The frequency of distal molar relation was 10% and the mesial molar relation 5%. Of the children examined 76% had no need of orthodontic treatment. Treatment need in Amerindian group (18%) was significantly lower than in the Caucasian group (28%). Since there is an increasing public demand for the provision of orthodontic treatment in public dental services, careful planning based on feasibility studies is essential for the creation of appropriate solutions.

Adolescent↗
PubMed1989

Relation between sucking habits and dental characteristics in preschoolchildren with unilateral cross-bite.

The relationship between sucking habits and dental characteristics of unilateral cross-bite in 4-yr-old children (n = 76) was studied. The cross-bites were classified on the variables "number of teeth involved", incisor "overjet" and "overbite", "terminal plane shift", "midline shift", "asymmetric maxillary dental arch" and "max./mand. arch width difference". Type of sucking habit (dummy, finger) and its duration and intensity were analyzed from a questionnaire answered by the parents. The "max./mand. arch width difference" in the canine region was found to be negatively related to the intensity and duration of the sucking habit, and also negatively related to sucking a dummy compared to finger sucking. The study indicates that the "duration" and "intensity" of the sucking habit have a negative influence by reducing the transverse width of the maxillary arch in children with a unilateral cross-bite. Dummy sucking was more detrimental to the transverse dimension in the canine region than finger sucking.

Child, Preschool↗
PubMed1990

Mandibular condyle lesions, jaw movements, and occlusal status in 15-year-old children with juvenile rheumatoid arthritis.

The purpose was to determine the number and severity of lesions in the temporomandibular area and their association with occlusal status and mandibular movements in 15-yr-old children afflicted with juvenile rheumatoid arthritis (JRA). The series comprised 121 JRA children, 78 girls and 43 boys, and a control group of 104 schoolchildren, 70 girls and 34 boys, taken for clinical examination. Of the JRA children, 55% had roentgenologically detectable lesions in the TMJ area. Lesions were found in 60% of the girls and in 42% of the boys, the ratio thus being 3:2. The largest group had grave lesions (48%), the second largest displayed flattening of the condyle (43%) and the smallest a flattened condyle with a minor lesion (9%). There were more bilateral lesions in the children with the severest lesions. Tendencies for Class II malocclusion, small vertical overbite and open bite were visible in the JRA children. Reduced maximal opening capacity, maximal protrusion, lateral movements of the mandible and pain in the TMJ area proved to be reliable signs predicting temporomandibular joint involvement in JRA children. Maximal mouth opening capacity was significantly restricted in the patients showing condylar lesions as compared with patients having no lesions or with controls. JRA children should be divided according to sex and the severity of the lesions. The JRA children without TMJ lesions had normal values for mandibular movements and were thus comparable to healthy children.

Adolescent↗
PubMed1990

Occurrence of malocclusion in attritive environment: a study of a skull sample from southwest Finland.

Occlusal variation and occurrence of malocclusion were examined in a Finnish skull sample derived from the 15th and 16th centuries. The material consisted of 207 adult individuals; 141 maxillas and 159 mandibles, including 93 pairs, were in observable condition. In the skull sample, only dental anomalies were observed; no skeletal malocclusions were found. The frequency of an Angle Class I lateral relationship was 97.7%. The mean values for overjet and overbite were 1.6 and 1.4 mm, respectively. A comparison with present-day Finns revealed that the skull sample showed less variation in all occlusal variables studied. An Angle Class II type occlusion, deep bite, crowding, spacing, and lateral crossbite occurred with significantly lower frequencies in the skull sample than in the present-day Finns. Advanced dental wear in the skull sample shows that a hard and attritive diet was eaten at that time. It is suggested that a dietary transition from hard to soft food is the most probable cause of the increased occlusal variation and high frequency of malocclusion in present-day Finns.

Diet↗
PubMed1997

Impact of nocturnal bruxism on mercury uptake from dental amalgams.

The mercury (Hg) release from dental amalgam fillings increases by mechanical stimulation. The aim of this study was to investigate the possible impact of nocturnal bruxism on Hg exposure from dental amalgams and to evaluate the effect of an occlusal appliance. 88 female patients from an orofacial pain clinic with a complete maxillary and mandibular dentition, a normal frontal vertical overbite with cuspid guidance, and at least 4 occlusal amalgam fillings in contact with antagonists in intercuspidal position, were examined with the Bruxcore bruxism monitoring device to measure the level of on-going nocturnal bruxism. Based on the degree of abrasion recorded, the subjects were divided into a group defined as bruxists, (n = 29), another group defined as non-bruxists, (n = 32), serving as controls, the intermediate group being discarded. The Hg exposure was assessed from the Hg concentration in plasma and urine, corrected for the creatinine content. In a regression model with bruxism as the only explanatory variable, no significant effect of bruxism was found, but when the number of amalgam fillings, chewing gum use, and other background variables were taken into account, there was a limited impact of bruxism on Hg in plasma. The nocturnal use of an occlusal appliance did not, however, significantly change the Hg levels. This study indicates that mechanical wear on amalgams from nocturnal bruxism may increase the Hg uptake, but the magnitude of this effect seems to be less than from the use of chewing gum.

Absorption↗
PubMed2004

Characteristics of patients with severe root resorption.

OBJECTIVES: The purpose of this study was to compare a group of patients in whom all four maxillary incisors were resorbed at least 20% with a matched group. MATERIALS AND METHODS: Retrospective, case-control. Root resorption was measured on pre- and post-treatment periapical radiographs collected from 868 patients treated in private practices in southern California. Diagnostic and treatment factors were recorded, and vertical and horizontal apical movement calculated from cephalometric films. Root shape was assessed with a six-object non-parametric rating system. From this patient population, 25 patients were found who had >20% root resorption on all four maxillary incisors. A case control group without severe root resorption matched by sex, treating office, age at start, ethnicity, and duration of treatment was created with two controls for each severe case. RESULTS: There were no statistically significant differences found for extractions, use of Class II and finishing elastics, transverse treatments, overjet, overbite, vertical, tooth length, habits, and root shape. Higher estimated risk was found for abnormal root shape for both maxillary incisors, and tongue thrust. Horizontal apical displacement was not significantly different (p = 0.07) but severely resorbed incisors were retracted an average of one millimeter further. CONCLUSIONS: Twenty-five of 868 patients were found to have over 20% of all four of their maxillary incisors resorbed. This is <3% of the total patients. Matching this group by sex, ethnicity, office, treatment time, and age greatly reduced the number of factors that would differentiate these patients from 50 who did not get severe root resorption. We conclude that horizontal root displacement, tongue thrust, and abnormal root shape may have higher estimated risk but interoffice variability and treatment time cannot be underestimated.

Adolescent↗
PubMed2005

A study of occlusion in elderly Japanese over 80 years with at least 20 teeth.

OBJECTIVES: The purpose of this study was to identify the occlusal status of elderly Japanese over 80 years with at least 20 teeth. MATERIALS AND METHODS: The study enrolled 76 elderly Japanese (44 male, 32 female) with a mean age of 82 years and an average of 25.7 remaining teeth. The study consisted of intra-oral examination, intra-oral and facial photographs, radiographs and impressions for study casts. RESULTS: No gender difference was observed in age or number of remaining teeth. Anteroposterior occlusal relationship was characterised by maxillary protrusion in 67.6%, acceptable overjet in 31.0%, and anterior crossbite in 1.4%. Vertically, deep bite was noted in 33.8%, acceptable overbite in 64.8%, and open bite in 1.4%. Most of the subjects had either Angle class I (68.4%) or class II (25.7%) canine relationship. Only 3.9% of the subjects had upper anterior crowding. Lower anterior crowding was observed in 23.7%, but tended not to be severe. CONCLUSION: These results indicate that Japanese who attained the goal of '8020' have a relatively good occlusion.

Age Factors↗
PubMedDate not supplied

Sickle cell anemia: a review of the dental concerns and a retrospective study of dental and bony changes.

This paper is a review of the medical concerns pertinent to dental care and a preliminary study of dental findings of the sickle cell anemia (SS) patient. The dental characteristics observed in 21 dental patients with SS are described. Radiographic findings included "stepladder" trabeculae pattern (70%), enamel hypomineralization (24%), calcified canals (5%), increased overbite (30-80%), and increased overjet (56%). Comparisons are made with other studies of the sickle cell patient, and the need for further study is suggested.

Adolescent↗
PubMed1993

Malocclusion prevalence in an ethnic Chinese population.

Population norms derived from one ethnic group may not necessarily be valid and accurate for other ethnic groups. With the increasing number of ethnic Chinese immigrants in Australia, Europe, and America, it would be useful for dental practitioners to be informed about malocclusion prevalence among Chinese. This study was carried out on 1050 Chinese school children (aged 12-14 years) to assess both qualitatively and quantitatively certain occlusal features. The population was found to have a high incidence of Class III malocclusions compared with caucasians. However, the incidence of Class II malocclusions was quite similar to those reported in caucasians. Normal occlusions occurred in about 7 per cent of this population. Although this percentage was much lower than those reported in blacks, it was similar to those reported in caucasians. Crowding occurred in about 50 per cent of cases, which was slightly less than for those reported for caucasians. Increased overbites were also less common in this Chinese population compared with caucasians. Compared with caucasians, crossbites were also less frequent in this Chinese population.

Adolescent↗
PubMed1998

Mandibular stability after sagittal split ramus osteotomy without post-operative maxillomandibular fixation in the treatment of prognathic patients with symmetric mandibles.

This study was designed to examine post-operative stability in prognathic patients with symmetric lower jaws who underwent sagittal split ramus osteotomy (SSRO) of the mandible without post-operative maxillomandibular fixation (MMF). Twenty prognathic patients with symmetric mandibles were investigated. An appliance for repositioning the proximal segment and titanium screw fixation was applied in all patients. Ten patients underwent post-operative MMF with stainless steel wire (mean duration, 9.6 days) and intermaxillary rubber traction after removal of the MMF (Group I), and the remaining ten underwent intermaxillary rubber traction only (Group II) post-operatively. Cephalograms were obtained 2-3 days post-operatively, and 3, 6, and 12 months after surgery. Changes in the positions of upper incisors (U-1), lower incisors (L-1), B-point, and pogonion were examined on lateral cephalograms. In the early stages of follow-up, decreases in the overbite tended to be more marked in Group I than in Group II, and the forward movement of each standard point was significantly larger in Group I than in Group II. No significant differences, however, were revealed between the two groups at 12 months after surgery. Forward movement of anterior cephalometric landmarks, post-operatively, in Group II were significant, however, this pattern differed from Group I, in which big changes occurred in the early stages after surgery. Although the patterns of post-operative changes in the two groups are different, there are no significant differences in their post-operative stability in long-term follow-up. Therefore, post-operative MMF may be avoided when prognathic patients with symmetric mandibles undergo SSRO with an appliance for repositioning the proximal segment and titanium screw fixation.

Adult↗
PubMed1979

Night blindness, characteristic facies, and skeletal abnormalities in two brothers.

Two brothers are described with a similar physical appearance characterised by minor periorbital anomalies, malar flatness, a maxillary overbite, retrognathia, sloping shoulders, joint hyperextensibility, and minor radiological anomalies. In addition, they had a slowly progressing night blindness, myopia, and extinguished electroretinograms. The mother had mild expression of some of the physical anomalies and a decreased electroretinogram response to red light. We have been unable to find any report of similarly affected children. The possible modes of inheritance are discussed.

Abnormalities, Multiple↗
PubMedDate not supplied

Maxillo-nasal dysplasia (binder syndrome): antenatal discovery and implications.

Binder syndrome (BS) or maxillo-nasal dysplasia is an uncommon developmental anomaly affecting primarily the anterior part of the maxilla and nasal complex. The characteristic findings are a failure of development in the premaxillary area with associated deformities of the nasal skeleton and the overlying soft tissues. Affected individuals typically have an unusually flat, underdeveloped midface (midfacial hypoplasia), with an abnormally short nose and flat nasal bridge, underdeveloped upper jaw, relatively protruding lower jaw and/or a 'reverse overbite' (or class III malocclusion). A case of BS was diagnosed at 24 weeks of gestation using two- and three-dimensional ultrasound. The first sign was an isolated flattened fetal nose in the mid-sagittal plane. Further ultrasound imaging showed the absence of the naso-frontal angle, giving impression of flat forehead and small fetal nose. We discuss about this entity.

Adult↗
PubMedDate not supplied

Prevalence and severity of malocclusion in adolescent Kuwaitis.

OBJECTIVES: Our aim was to evaluate prevalence and severity of malocclusion in an adolescent Kuwaiti population. SUBJECTS AND METHODS: Using a stratified cluster sampling method and excluding non-Kuwaitis, subjects with mesial migration and/or loss of first molars, and subjects with orthodontic treatment experience without availability of initial study models, we examined 1,299 Kuwaitis (674 boys and 625 girls) of mean age 13.2 +/- 0.4 years in a regular well lit classroom. We scored molar and canine relationship, overjet, overbite, anterior and posterior cross bite as well as spacing and irregularity of the incisors using gloves, mirrors, rulers, and spatulas. RESULTS: Fourteen, 15, and 71% met the criteria for almost ideal, mild, and moderate to severe malocclusion, respectively. Of the 86% with malocclusion, occurrence of class 1, half step class 2, full step class 2, half step class 3, and full step class 3 was 57.8, 24.9, 6.3, 8.8, and 2.2% for the first molars, and 36.1, 50.0, 6.2, 5.4, and 2.3% for the canines, respectively. Incisor malalignment was the most prevalent malocclusion trait (73.2%). Overjet > or = 9.5 mm occurred in less than 1.5%, open bite in less than 3.5%, deep bite with gingival contact in less than 2.0%, complete posterior cross bite in less than 1.5%, and complete anterior crossbite in less than 2.0%. Median diastema was present in about 2/3 of the cases with maxillary anterior spacing as opposed to only about 1/3 of those with mandibular spacing. CONCLUSION: Our findings suggest that more than 70% of young adolescent Kuwaitis have moderate to severe malocclusion, with incisor malalignment as the most prevalent malocclusion trait.

Adolescent↗
PubMed2001

Side effects of mandibular advancement devices for sleep apnea treatment.

Our purpose was to investigate side effects of sleep apnea treatment by removable oral appliances (OA) that advance the mandible. In 22 patients suffering from obstructive sleep apnea (OSA), questionnaire evaluations, polysomnographies, cephalographies, and dental plaster casts were obtained before initiation of treatment with OA that fully covered both dental arches. Patients were reevaluated after 3 to 12 mo (questionnaires, polysomnographies) and 12 to 30 mo (questionnaires, cephalographies, plaster casts) during continuous treatment. Polysomnographies confirmed improved breathing by OA. All patients experienced persistent alleviation of symptoms after 12 to 30 mo and wished to continue treatment. Side effects were common but only mildly disturbing: mucosal dryness (86% of patients), tooth discomfort (59%), and hypersalivation (55%). Cephalographies revealed a decrease in the mean (+/- SE) upper incisors to maxillary plane angle from 102 +/- 2 degrees at baseline, to 101 +/- 2 degrees after 12 to 30 mo (p < 0.05). Overbite and overjet were also slightly (mean reduction < 1 mm) but significantly reduced. None of these side effects required discontinuation of treatment. OA are an effective therapy of obstructive sleep apnea. Mild side effects are common but rarely require intervention. Nevertheless, close follow-up during long-term therapy by OA is advisable in order to timely detect potentially relevant orthodontic changes.

Humans↗
PubMed2003

A decision rule for diagnostic testing in obstructive sleep apnea.

Obstructive sleep apnea (OSA) is traditionally diagnosed using overnight polysomnography. Decision rules may provide an alternative to polysomnography. A consecutive series of patients referred to a tertiary sleep center underwent prospective evaluation with the upper airway physical examination protocol, followed by determination of the respiratory disturbance index using a portable monitor. Seventy-five patients were evaluated with the upper airway physical examination protocol. Historic predictors included age, snoring, witnessed apneas, and hypertension. Physical examination-based predictors included body mass index, neck circumference, mandibular protrusion, thyro-rami distance, sterno-mental distance, sterno-mental displacement, thyro-mental displacement, cricomental space, pharyngeal grade, Sampsoon-Young classification, and over-bite. A decision rule was developed using three predictors: a cricomental space of 1.5 cm or less, a pharyngeal grade of more than II, and the presence of overbite. In patients with all three predictors (17%), the decision rule had a positive predictive value of 95% (95% confidence interval [CI], 75-100%) and a negative predictive value of 49% (95% CI, 35-63%). A cricomental space of more than 1.5 cm (27% of patients) excluded OSA (negative predictive value of 100%, 95% CI, 75-100%). Comparable performance was obtained in a validation sample of 50 patients referred for diagnostic testing. This decision rule provides a simple, reliable, and accurate method of identifying a subset patients with, and perhaps more importantly, without OSA.

Adult↗