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Oral findings in a case of Noonan syndrome in an 8-year-old Japanese male are reported. Examination of the patient revealed a narrow, high-arched palate and an anterior open bite. Cephalometric measurements showed a wide gonial angle, a large mandibular plane angle, a large Y-axis and long facial height. It is suggested that the patient had a skeletal open-bite malocclusion, which included an abnormal swallowing habit.
OBJECTIVE: To assess the prevalence of oral habits among 7-10 year-old children in Ibadan, Nigeria. DESIGN: An epidemiological survey of randomly selected school children. Criteria for social class was based on registrar general's social class. SETTING: Primary schools from different parts of Ibadan city, Nigeria. SUBJECTS: 493 school children aged 7-10 years consisting of 237(48.1%) boys and 256(51.9%) girls. MAIN OUTCOME MEASURES: Only children still actively involved in oral habits were coded positive. RESULTS: In all, 49(9.9%) of the children were involved in one type of oral habit or the other with digit sucking being most prevalent 40(8.1%). Lip sucking was observed in 6(1.2%) while 1(0.2%) had an unusual sucking habit--sucking of left forearm with resultant severe anterior open bite (10 mm). The relationship between the oral habits anterior open-bite and increased overjets were very significant statistically (p<0.01). No significant associations were noted between the habits and social class as well as Angle's classification of molar relations. None of the children examined had gone for routine dental check-ups before except for the 62(12.6%) who had previous dental consultations due to toothaches. CONCLUSION: Oral habits especially digit sucking needing management was revealed by this study and none of them had been to a dentist for help. This suggests that there is need to intensify oral health education in our environment, targeted at both parents and school children to enable them benefit from interceptive orthodontic care which has numerous advantages.
AIM AND METHOD: The aim of the present epidemiologic study was to obtain representative basic data on the frequency, extent and age-dependence of malocclusions in the deciduous and early mixed dentition. The developmental tendencies of specific malocclusions were investigated from the aspect of orthodontic prevention. The collective comprised 8,864 preschool and school-aged children, of whom 1,225 were in the deciduous dentition (mean age 4.5 years) and 7,639 in the mixed dentition (mean age 8.9 years). The orthodontic data were clinically assessed as sagittal, transversal, or vertical single-arch and occlusal findings. In addition, the malocclusions were classified according to their primary symptoms. Early infantile habits, tongue dysfunctions, speech defects and incompetent lip closure were registered separately. RESULTS: 57% of the children were found to have malocclusions, with the frequency rising statistically significantly in dependence on age from the deciduous to the mixed dentition (p < or = 0.001). The mean extent of excessive overjet increased significantly from the deciduous to the mixed dentition. Crossbite with mandibular midline discrepancies were observed significantly more frequently in the deciduous dentition. Although the frequency of anterior open bite underwent a significant decline from the deciduous to the mixed dentition, open bite was the malocclusion most frequently associated with dysfunction in both groups. The significant increase in traumatic deep bite in the mixed dentition indicates an unfavorable developmental tendency in this anomaly until after the eruption of the permanent incisors. CONCLUSION: The need for preventive orthodontic therapy and for the intensified application of interceptive and early treatment measures is stressed in view of the high number of malalignments and malocclusions in the deciduous and mixed dentition and the tendency for some forms of malocclusion to deteriorate as the dentition develops.
In orthognathic surgery cases the treatment objectives, extraction patterns, and types of mechanics used are frequently the reverse of those used in conventional orthodontics. Thus, starting cases orthodontically and then, if unsuccessful, referring them for surgery often produces compromised results. Presurgical intra-arch objectives include positioning of the incisors in "ideal" positions, establishment of correct torque, and elimination of tooth-size discrepancies so as to permit the establishment of Class I canine and molar relationships after surgery. Presurgical objectives in the sagittal plane focus on removal of dental compensations. This may require the use of Class III elastics in Class II cases (and vice versa), thus allowing for maximal surgical correction of the underlying skeletal deformity. In the transverse plane, differentiation of skeletal from dental problems as well as identification of relative and absolute discrepancies should be carried out presurgically. Lateral corticotomies or segmental maxillary procedures should be used, depending on individual circumstances. Presurgical objectives in the vertical plane include maximizing the amount of presurgical orthodontic treatment carried out in open bites and minimizing the presurgical mechanics in deep bites. Encouragement of opening mandibular rotation at surgery while avoiding an increase in posterior face height contributes to stability. Orthodontic mechanics should not always include presurgical leveling of the curve of Spee and should actively avoid movements that may cause relapse tendencies. Careful attention to the use of surgical arch wires and splints during surgery and fixation, along with controlled elastic therapy and exercise programs after fixation, can greatly facilitate treatment.
BACKGROUND: This research aims to analized the clinical and diagnostic aspects of OSA in the orthodontic research field. METHODS: Through a case control study, the presence of early craniofacial modifications in a study group constituted of 13 children with long history of habitual snoring and obstructive sleep apnea syndrome (mean age 54 months, range 36-103) and in a control group constituted of 13 children with no history of snoring (mean age 60 months, range 55-67), is analyzed. Clinical neurological and orthodontic examination, cefalometrics analysis and MESAM 4 has been performed to each single child. RESULTS: Neurological clinical examination and diurnal polysomnography or nocturnal ambulatory monitoring of snoring (MESAM 4) showed that this pathology started very early in the childhood: snoring onset was 22.7 months, the apnea onset was 34.7 months. Moreover 23% of the children showed a failure to thrive. The cephalometric results revealed that OSA children showed different cranio-facial features: a maxillo-mandibular micrognathia and or retrognathia, an increment of divergency associated with an increase in the vertical development of the face and a reduced perviety of the upper airway space caused by a mechanical obstruction due to enlarged adenoids. The orthodontic clinical examination revealed that OSA patients showed posterior cross-bite, anterior open-bite and lip-incompetence. CONCLUSIONS: These results suggest that oral breathing, that is present in sleep apnea patients, is responsible of different cranio-facial anomalies. For this reason these features must be recognized, as soon as possible, in order to start an early treatment of this pathology.
The purpose of this study conducted at Tufts University School of Dental Medicine is to investigate the possibility of limiting the development of an excessive vertical overbite and horizontal overjet during sleeping hours in young children prior to and during the eruption of the permanent incisors. A sample of 43 individuals, whose mean age was 6.17 years, wore a Preventive Eruption Guidance Appliance passively only while sleeping at night for 13 months (mean) to control the development of the overbite as the permanent incisors erupted and to correct the excessive overjet. The mean initial overbite of the sample was 3.4 mm and was reduced to 1.4 mm. The mean initial overjet was 3.0 mm and was reduced to 1.4 mm. Fourteen percent (6 cases) of the sample had an open bite of 1.84 mm (mean), which was reduced to a mean open-bite of 0.81 mm. As a result of the statistical comparison between the treatment sample to the control sample of 50 non-treated individuals, it was shown that the reduction of the overbite and overjet was accomplished solely by altering the problematic dentition without affecting the normal growth pattern or facial morphology as measured from nine lineal dimensions. It was also shown that the change in overbite and overjet was a significant improvement over what would have occurred if no intervention had been instituted, and that the overbite was corrected by restricting continued excessive eruption of the maxillary incisors with only nighttime passive use of the appliance.
A cross-sectional study of one thousand and sixty-five children (508 boys and 557 girls) from the Watertown School System was done in order to determine whether there is a relationship between airway obstruction, palatal vault formation and malocclusion. The age range was 5 to 12 years old with a mean age of 8.5 years. Breathing pattern was based on the lip competency (seal) of each individual. The height of the palatal vault, the Angle's molar classification, cuspid relationship, the anterior and posterior cross-bites, the deep-bites or open-bites were also recorded. Enlarged tonsils were observed and the presence of allergies was noted. High palatal vaults were observed in children with lip incompetency (85.8%), and in children with Class II (73.6%) and Class III (65.3%). Anterior and/or posterior cross-bites accompanied high palatal vaults. From the examined children in this study, 20% presented known allergies. Eighty (80%) percent of the allergic children had high palatal vaults. Enlarged tonsils were also found in children with high palatal vaults.
This investigation was undertaken to study the skeletal and muscular adaptations in the mandible after lengthening, detachment, and reattachment of the masseter. Placing the bite-opening appliance and altering the length of the masseter, with and without surgical detachment and reattachment, resulted in a number of mascular and skeletal adaptations: First, a posterior and inferior rotation of the mandible was produced. In the experimental period, forward repositioning of the gonial angle and upward repositioning of the symphyseal region occurred. The amount of skeletal repositioning was greater in those animals in which the associated musculature was not detached. Second, if the masseter muscle was lengthened and not detached from the mandible, a gradual return of the muscle to its original length was observed. After 48 weeks, a 50% return occurred. Third, if a muscle was lengthened and then surgically detached, immediate shortening of the muscle occurred in an anterior and superior direction, with ultimate reattachment often at a length shorter than the original. Fourth, if a muscle was surgically detached and then surgically reattached without placement of a bite-opening appliance, a slight shortening of the muscle occurred. Fifth, if the bite was opened and the masseter was surgically detached and then surgically reattached, the muscle returned to its approximate original length and had a more predictable postsurgical positioning. It may be concluded that, in surgical procedures where lengthening of the masticatory muscles is mandatory, it is beneficial, if possible, to surgically detach these muscles from their insertions. In doing so, one would maintain the original orientation of the muscle and at the same time presumably impose less stress on the newly placed, surgically repositioned skeletal elements.
To determine the distribution of costs and various influencing factors in the entire process of surgical-orthodontic treatment in community hospital care, a retrospective study was carried out. The records and radiographs of 99 community hospital patients operated on between 1994 and 2001 were included. Cost analysis data were gathered from 4 phases of treatment: the orthodontics, the surgical outpatient assessments, the surgery/surgeries, and the inpatient period. The results showed that the surgical phases together are responsible for roughly 61% of the costs, 28% of which were attributed to the surgical operation itself. Orthodontics made up approximately 39% of the total costs, with an average of 26 visits. The average total costs of all treatments were US $6,206 +/- 912. Patients that could be operated on with bilateral sagittal split ramus osteotomy of the mandible only had the lowest costs, and those who required bimaxillary osteotomies had the highest costs. Of the several clinical and cephalometric measurements made in this study, only skeletal open bite and orthodontic space closure after tooth extraction were found to affect the costs. It can be concluded that surgical-orthodontic treatment is a rather expensive way to correct dentofacial malocclusions due to the high costs of the surgical phase. Skeletal open bite constituted the most costly entity, while malocclusion resulting from mandibular deformity was the cheapest.
Children, who were tonsillectomized because of sleep apnea were examined with respect to facial growth and dental arch morphology. Dental casts and lateral roentgencephalograms were analysed before surgery and two years after tonsillectomy. The findings were compared to data from children without tonsillary obstruction. A higher proportion of malocclusion than normal, especially open bite and crossbite, was noticed before surgery. Two years after surgery, 77% of the open bites were normalised and 50-65% of the buccal and anterior crossbites. The best results were seen in children operated before the age of 6.
Despite impressive results, distraction osteogenesis of the mandible is still compromised by difficulties with vector control. Because of the action of the masticatory muscles, the gonion angle has the tendency to open, resulting in an open bite. We report two patients, aged 10 and 12 years, who developed a severe open bite during mandibular distraction. As a salvage procedure, manual shaping of the soft regenerate was done immediately after distraction. Uneventful bony consolidation was observed, which resulted in anatomically shaped gonion angles. The fact that a regenerate created by distraction osteogenesis can be molded to virtually any shape offers interesting perspectives for the correction of complex mandibular deformities.
PURPOSE: The aim of this study was to evaluate masticatory efficiency in children with normal primary occlusion and malocclusion and to correlate efficiency with body variables. METHODS: Thirty children were divided into three groups: Group I with normal occlusion (n = 10), Group II with posterior crossbite (n = 10) and Group III with anterior open bite (n = 10). They chewed standardized silicone tablets for 20 strokes and the optical scanning system was used to calculate the particle size (area and perimeter). Results were compared among the groups. Body weight and height were correlated with masticatory efficiency. RESULTS: Group I fragmented the tablets into a greater number of particles with smaller sizes than Groups II and III, and the differences were statistically significant (p<0.05). There was no difference between the children with crossbite and children with open bite. Correlation coefficients between body variables and masticatory efficiency were weak (p>0.05). CONCLUSIONS: Occlusion is a factor of influence on masticatory process.
PURPOSE: The aim of this study was to investigate whether interleukin-1beta (IL-1beta), interleukin-1 receptor antagonist (IL-1ra), or soluble IL-1 receptor II (sIL-1RII) in synovial fluid or plasma is associated with joint pain or signs of tissue destruction in patients with temporomandibular joint (TMJ) involvement of polyarthritides. PATIENTS AND METHODS: Forty-three patients with TMJ involvement of polyarthritides were included. TMJ resting pain, tenderness to palpation, pressure pain threshold, pain on mandibular movement, and anterior open bite were assessed. TMJ synovial fluid samples and plasma were obtained for analysis of IL-1beta, IL-1ra, and sIL-1RII. RESULTS: IL-1beta was detected in 18% of the synovial fluid samples and in 44% of the plasma samples. The concentrations of IL-1ra in plasma were lower than in the synovial fluid, whereas the opposite condition was found for sIL-1-RII. IL-1ra in synovial fluid and plasma was associated with low intensity of TMJ pain. sIL-1RII in synovial fluid was associated with low degree of anterior open bite, whereas sIL-1RII in plasma was associated with widespread musculoskeletal pain, TMJ pain and tenderness, and decreased pressure pain threshold over the TMJ. CONCLUSION: IL-1ra and sIL-1RII are present in different proportions in TMJ synovial fluid and blood plasma from patients with TMJ involvement of polyarthritis. Both of these molecules seem to influence the clinical features of these forms of TMJ inflammation.
In recent years there have been many reports on studies related to the temporomandibular joint (TMJ) in orthodontic treatment, but an adequate system of diagnosis and treatment has yet to be established, and they often cause considerable difficulty clinically. The patient in this case report sustained generalized contusions, a cerebral concussion, a midline fracture of the mandibular corpus, and bilateral fractures of the condylar process of the mandible when he fell asleep while driving a car and collided with a truck. Because non-surgical reduction was impossible, mandibular condylectomy was performed, and when orthodontic treatment was attempted to improve the open bite that persisted as a sequela of the accident, the favorable results were obtained, as described below. 1. The open bite was corrected by the orthodontic treatment, and the impairment that remained as a sequela resolved. 2. The mandibular condyles were removed during surgical reduction, and the mouth opening disturbance, the TMJ pain, and the TMJ noise resolved. The patient was able to go about his everyday life unimpaired, with hardly any awareness of limitation of jaw movement, and this situation remained unchanged even after the orthodontic treatment was performed.
In this epidemiologic survey 510 children aged 3-6 yr were investigated. Several occlusal and functional parameters were measured: the maximal interincisal distance, the frequency of lateral and frontal crossbite, open bite, the number of tooth contacts on lateral excursions of 3 mm, the wear facets, deviations in opening, pain in muscles and in the TM-joints, TMJ sounds, parafunctional habits. The interincisal distance varied between 25 and 55 mm. This distance increased with age. Only five children had a hypermobility of the mandible (opening more than 55 mm) and 11 a restricted opening movement (less than 30 mm). 7.2% showed a lateral crossbite on the right, and 8.9% on the left, side. The percentage of an open bite decreased with age from 66.7% in the 3-yr-olds to 20.0% in the 6-yr-olds. 33% of the children had only one contact on the working side. As reported by the parents 7.7% had regularly bruxism but 21.8% showed wear facets on the molars and 40.7% on the front teeth. Only in three girls were the TMJ painful to palpation. Dysfunction only occurred in 3.5% of the sample.
Neural factors influence post-natal growth, development, and aging throughout the body. This influence may be mediated through sensory or motor effects interacting with endocrine and immunological factors. Growth effects may be expressed directly by sensory or motor nerves on the tissue or indirectly by motor function. Direct neutrotrophic effects have been well-documented in the development of striated muscle, the taste bud, and the amphibian limb. Evidence for a trigeminal neurotrophic effect on tooth development and facial development is lacking. Growth disturbances of the jaws consequent to lesioning of the trigeminal nerve are due most likely to functional disturbances rather than neutrotrophism. Examples of function impact on orofacial growth are abundant. Oral and facial target tissues, like those elsewhere in the body, determine the nature of the target tissue innervation and its central organization. Central effects consequent to tooth loss or dental pulp entirpation are well-documented. Inflammation and pain may exert growth effects through release of "wound hormones" or secondarily to somatic and autonomic effects. There is evidence that vasoactive intestinal peptide (VIP) and calcitonin gene-related peptide (CGRP) elaborated from sympathetic and parasympathetic neurons may have a modulatory role in growth. While the effects of longstanding motor pathologies on skeletal growth are well-known, concomitant sensory deficits and soft tissue disturbances have not been examined. However, the pathological models beg the question of normal regulation. While muscle develops in the absence of innervation, neurotrophic effects are clearly identified. Little is known about the interaction of simple and complex motor behavior on growth. Regulation of growth is frequently visualized within a form-function paradigm. For example, anterior open bites have been seen as the consequence of tongue thrusting or tongue thrusting as a consequence of open bites. Low tonic forces in posture are thought to be more important in the development of both the face and the dental alveolar complex than the higher intermittent forces in mastication and swallowing. The need for an active (reflex) contribution to growth at the TMJ is in dispute.(ABSTRACT TRUNCATED AT 400 WORDS)
The purpose of this review is to highlight consensus in past research on the role of intercuspal occlusal factors in the pathophysiology of temporomandibular disorders. The occlusal intercuspal relationships considered are skeletal anterior open bite, overbite, overjet, symmetry of contacts in the retruded contact position (RCP), crossbite, and posterior occlusal support. Skeletal anterior open bite, reduced overbite, and increased overjet are associated with osteoarthritic TMJ patients, but lack specificity for defining patient populations per se. There is no evidence that overbite or overjet plays a role in the pathophysiology of nonarthritic disorders. A combination of unilateral RCP with an absence of a clinically apparent RCP-ICP (intercuspal position) slide may encourage TMJ disc displacement, but unilateral RCP per se was not associated with TMJ diagnoses. Crossbite does not seem to provoke TMJ symptoms or disease. Lost molar support may be associated with osteoarthrosis presence and severity, but studies have not yet been distinguished for age effects. Where appropriate, implications for clinical practice are drawn.
The purpose of this study was to determine the effects of the spring-loaded bilateral posterior occlusal bite-block on the maxillo-facial morphology, with emphasis on the response of the facial structures to the progressively increased vertical dimension. Our sample consisted of two groups: eleven open-bite subjects having a mean age of 10.30 years, treated with spring-loaded posterior bite-blocks over a mean period of 0.49 +/- 0.08 years (6 months); and twelve open bite subjects with a mean age of 9.84 years, treated by means of passive posterior bite-block and vertical chin-cap for a mean period of 0.67 +/- 0.03 years (8 months). The average daily use of the appliances was 16 hours. The study was carried out on lateral head films taken prior to and after treatment, which was concluded when an overbite of 1-1.5 mm was achieved. The results did not reflect any statistically significant difference between the groups when considering the changes in the horizontal growth pattern of the mandible, the decrease of the lower and the total anterior facial heights, or the overbite achieved by the two types of posterior bite-blocks. The artificial increase of the vertical dimension contributed to a statistically significant increase in the ramal inclination in both groups, though greater in the spring-loaded posterior bite-block group.