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PubMed2004

Utilization of third molars in the orthodontic treatment of skeletal class III subjects with severe lateral deviation: case report.

AIM: This clinical report discusses the importance and use of third molars in the adult patient by presenting a case in which their use during orthodontic treatment allowed occlusal improvement. SUBJECT AND TREATMENT PLAN: The patient was a Japanese adolescent boy who had a skeletal Class III malocclusion with severe lateral deviation of the mandible, significant loss of posterior occlusal vertical dimension, due to premature loss of the maxillary and mandibular left first molars, and furthermore, both first molars had advanced carious lesions that had resulted in reduced crown heights and bilateral chewing surfaces. The mandible had shifted to the left, with a bilateral chewing pattern and a lack of posterior vertical alveolar height, which in turn had produced an abnormal occlusal plane and curve of Spee. The maxillary arch was expanded, the maxilla was moved downward and forward, and the mandible was moved slightly backward and rotated open to increase posterior vertical alveolar and crown height. The reconstruction of a functional occlusal plane was achieved by uprighting the posterior teeth to correct asymmetric posterior vertical alveolar and crown height, using a full multibracket system incorporating four third molars and closing the space from the missing first molars and extraction of the questionable first molars. RESULTS: A normal overbite and overjet and adequate posterior support and anterior guidance were established, achieving a better intercuspation of the posterior teeth. A favorable perioral environment was created, with widened tongue space to produce an adequate airway. A well-balanced lip profile and almost symmetric face were achieved using the four wisdom teeth without extraction of the four premolars. Subsequent mandibular growth, with development of posterior vertical alveolar height and temporomandibular joint adaptation, has resulted in an almost symmetric posterior vertical height and joint structure between right and left sides. These factors have contributed to the occlusal stability maintained for more than 5 years. CONCLUSION: In the growing patient, with missing and/or early advanced caries of the first molars, it may be more beneficial to plan occlusal improvement through extraction of the questionable first molar rather than premolar extraction. This method of treatment can equalize posterior vertical dimension and does not restrict tongue space. In addition, this treatment method addresses the clinician's concern about postorthopedic relapse due to tongue habits and eruption of the third molars.

Adaptation, Physiological↗
PubMed1992

[Orthodontic treatment as prevention of periodontal changes].

Even the general dental practitioners consider the orthodontic therapeutical interventions carried out with removable appliances as a harmful procedure. It is much less known how the lack of adequate orthodontic treatment endangers the peridontium. Clinical data show a cause related correlation between the maxillary incisor protrusion, mandibular frontal jammed dentition, deep vertical overbite, openbite, crossbite early deciduous tooth extractions and the periodontal pathological happenings. So it is very important to start an early orthodontic treatment to avoid the periodontal consequences of malocclusion before it has become irreversible.

Child↗
PubMed2005

Nonsurgical and nonextraction treatment of a skeletal class III adult patient with severe prognathic mandible.

AIM: A patient with a skeletal Class III malocclusion, prognathic mandible, anterior open bite, large tongue, and temporomandibular disorders is presented. Treatment objectives included establishing a stable occlusion with normal respiration, eliminating temporomandibular disorder symptoms, and improving facial esthetics through nonextraction and nonsurgical treatment by creating a favorable perioral environment, restoring the harmony to the tongue and perioral environment, improving masticatory muscle function, and creating adequate tongue space for establishment of normal respiration. SUBJECT AND METHODS: The patient was a Japanese adult male, who had previously been advised to have orthognathic surgery, with tongue-size reduction. An expansion plate was used to expand the maxillary dentoalveolar arch. Distalization of the mandibular arch was achieved by reduced excessive posterior vertical dimension, through uprighting and intruding the mandibular posterior teeth and rotating the mandible slightly counter-clockwise. The height of the maxillary alveolar process and the vertical height of symphysis were increased slightly. The functional occlusal plane was reconstructed by uprighting and intruding the posterior teeth with a full-bracket appliance, combined with a maxillary expansion plate, with short Class III and vertical elastics in the anterior area. Myofunctional therapy involved sugarless chewing gum exercises. RESULTS: The excessive posterior vertical occlusal dimension was reduced slightly, creating a small clearance between the posterior maxilla and mandible. At the same time, the interferences in the posterior area were eliminated by the expansion of the maxillary dentoalveolar arch. As a result, the laterally displaced mandible moved to a more favorable jaw relationship, with distalization of the mandibular arch. The functional occlusal plane was reconstructed and an almost-normal overjet and overbite were created. Adequate tongue space for normal respiration was established during the early stage of treatment, by 7 months. A stable occlusion, with adequate posterior support and anterior guidance, was established and maintained at more than 4 years posttreatment.

Adolescent↗
PubMed2005

Light-force technique for the early treatment of an ectopic tooth.

Free crown tipping can be useful when teeth do not erupt in their physiologic sequence and a real intraosseous migration and eruption of a single tooth into a distant ectopic position can be observed. This article presents a case of an ectopic mandibular lateral incisor treated early, with the light-force technique and uncontrolled forces, and finished with the bidimensional edgewise appliance. A Caucasian female patient, 10 years 10 months of age, had a mandibular left lateral incisor displacement, with the lateral incisor crown positioned mesial to left second primary molar. An early treatment was planned to correct the mandibular left lateral incisor displacement and to allow proper eruption of the mandibular left canine and first premolar. A second phase of treatment, in permanent dentition, was planned for the dental Class II subdivision on the right and deep bite correction. Phase 1 treatment was completed after 10 months; phase 2 treatment was initiated in the permanent dentition and lasted 18 months. Treatment achieved the following outcomes: (1) mandibular lateral incisor in corrected position; (2) full canine and molar Class I relationship; (3) overjet and overbite within the normal limits; (4) symmetric arches; and (5) a balanced profile. The radiograph evaluation revealed good root parallelism and mandibular left lateral incisor light root resorption. The light-force technique is not only a possible alternative but the ideal appliance for treatment in the mixed dentition, when the permanent teeth should be controlled.

Child↗
PubMed1992

Assessment of orthodontic treatment needs by teenagers in an Asian community in Singapore.

The purpose of this study was to determine (1) the preference of dental occlusion types among teenagers, and (2) their assessment of the necessity for orthodontic treatment. A total of 1189 teenagers (mean age 15.3 +/- 3.2 years) were asked to rank a series of colour photographs of seven occlusion types. Their ranking, in descending order of attractiveness, were as follows: Class I occlusion, anterior open bite, Class III occlusion, Class II occlusion, anterior spacing, anterior crowding and deep bite occlusion. The perceived need for treatment was found to be inversely correlated with the rank order of attractiveness. There appeared to be no statistical difference (P less than 0.05) in the perception for treatment among different racial and income groups. However, with the exception of anterior open bite and deep overbite occlusions, a statistically significant (P less than 0.05) greater number of females than males perceived a need for treatment. Assessment of occlusal disharmonies among teenagers could provide clinicians and health care personnel with an indication of the relative attractiveness among occlusion types and hence the establishment of treatment priorities.

Adolescent↗
PubMed2005

Electromyographic evaluation of neuromuscular co-ordination during chewing in a subject with organic occlusion.

The neuromuscular co-ordination of the anterior masseter and temporal muscles during chewing has been studied. The subject analysed was 24 years old female with organic occlusion, molar and canine class 1, with 2 mm overbite and overjet, frontal disocclusion and canine protection, with no cranio-mandibular disorders. Masticatory cycles and electromyographic activity were recorded with a K6 I kinesiograph (Myotronics Inc., Seattle, WA, USA). The chewing cycles were recorded with a soft bolus and a hard bolus, on 3 consecutive days. Electromyographic analysis during masticatory cycles showed that electromyographic activity was higher in the masseter muscle homolateral to the chewing side than in the contralateral muscle, whereas the anterior temporal muscles achieved similar voltages. When chewing the hard bolus, versus the soft bolus, activity in the contralateral masseter muscle increased to a greater extent than in the homolateral masseter muscle. The results were analogous at all 3 recordings. When chewing, the subject showed good muscle co-ordination, which was constant over the 3 recordings made on 3 consecutive days. Increased activity of the contralateral masseter muscle when chewing the hard versus the soft bolus indicates the stomatognathic system's capability to adapt to load and its neuromuscular equilibrium.

Adult↗
PubMed2005

Cephalometric craniofacial characteristics in patients with temporomandibular joint ankylosis.

BACKGROUND: The sequelae of temporomanibular joint (TMJ) ankylosis include limitation of jaw movement, interference of oral function and affects on the craniofacial growth. Analysis of the craniofacial form of TMJ ankylosis offers guidelines for managing this disease. METHODS: Forty-five patients with intraarticular TMJ ankylosis were collected from the files at the Chang Gung Craniofacial Center. There were 21 male and 24 female patients, aged 3 to 47 years. Thirty-seven patients were unilaterally affected and eight had bilateral involvement. Patients were grouped according to gender and age. Both the medical history and onset of the disease were investigated in all patients. The pretreatment lateral cephalograms were used for analysis. The variables were compared with the Chinese norms with corresponding sex and age groups. RESULTS: The etiology included 48.9% facial trauma history, 17.8% traumatic delivery or birth injury, 15.6% middle ear or dental infection, 2.2% chronic arthritis and 15.6% unknown causes. The onset of mouth opening limitation was under 16 years of age. The average total mandibular length was less than the norm by 30 mm. Each patient presented with a mandible that had backward rotation with chin recession. Accentuated antegonial notch and inferiorly located condyle were observed on the affected side. The maxilla was shorter and the ANB was larger than the norm by 10 degrees but the overbite and overjet were within normal ranges. CONCLUSIONS: The facial growth was severely disturbed in terms of dimension, morphology and direction of growth in patients with TMJ ankylosis. Better management of mandibular fractures, good infection control and early treatment intervention are ways to reduce the influence on craniofacial growth.

Adolescent↗
PubMed2005

Preventive and interceptive orthodontic treatment needs of an inner-city group of 6- and 9-year-old Canadian children.

OBJECTIVE: Early recognition of developing malocclusions and the potential for uncomplicated orthodontic treatment procedures can minimize or eliminate future costly treatment. This study was designed to assess the potential for this approach in children living in a limited-income environment. A modified index for preventive and interceptive orthodontic needs (IPION) was used to determine the need for such treatment in schoolchildren aged 6 and 9 years. METHODS: Two calibrated examiners examined each child independently and assessed several components of his or her occlusion, including molar relationship, crossbite, open bite, overbite and overjet. Dental variables such as presence of caries and early loss of teeth were also noted. Informed consent was obtained and all children present at school on the day of the field study were included. A total of 395 children were divided into 2 groups, aged 6 and 9 years. RESULTS: A high prevalence of caries in the deciduous dentition (30.4% for 6 year olds; 20.6% for 9 year olds) and early loss of primary teeth (11.9% for 6 year olds; 29.4% for 9 year olds) was observed. A large percentage of children had crossbite in the anterior or posterior segments, or both. Open bites were also a common finding. Future orthodontic problems were identified in 28% of this population by using the modified IPION. No statistically significant differences (p > 0.05) were found between sexes or age groups using the chi2 test. CONCLUSIONS: Most of the developing malocclusions identified in this study would be amenable to interceptive orthodontics, consisting of space maintenance, crossbite correction and arch expansion.

Child↗
PubMed2005

Severe Class II division 1 malocclusion treated by orthodontic miniplate with tube.

A miniplate with tube (C-tube) was placed in the interdental spaces between both left and right upper second premolars and first molars in a 15-year-8 month-old male patient with a Class II malocclusion who with severe anterior protrusion and lower anterior crowding. The treatment plan consisted of extracting both upper first premolars, en masse retraction of the upper six anterior teeth and lower anterior decrowding. C-tubes were used as substitutes for posterior dental anchorage during upper anterior retraction. The particular design of the C-tubes made it possible to retract fully with minimal gingival irritation. The correct overbite and overjet were obtained by intruding and retracting the maxillary incisors to their proper positions and this correction remained stable for at least 27 months after debonding. Also, facial balance was improved. The active treatment period was 14 months. The application of this new appliance, consideration of case selection, and sequence of treatment are presented.

Adolescent↗
PubMed2006

The Dahl principle: creating space and improving the biomechanical prognosis of anterior crowns.

There is an increased demand for restoration of anterior teeth based on esthetic requirements. Oftentimes, the teeth restored are compromised and have minimal remaining dentin after undergoing root canal treatment. Reduction of nonaxial forces by controlling incisal guidance is essential in improving the long-term prognosis of such situations. Another common complication when crowning anterior teeth is the lack of palatal space for restorative material. This is often evident in patients with anterior tooth wear and deep overbite. This article describes the Dahl principle, a conservative method for controlling incisal guidance and gaining palatal space for restorative material. A case presentation is used to illustrate the concepts discussed.

Aluminum Oxide↗
PubMed2006

[First molar extraction in patients with crowding: cases analysis].

OBJECTIVE: To evaluate the outcome of first molar extraction in patients with crowding. METHODS: Totally 22 patients (8 males and 14 females) from Clinic of Orthodontics, SUN Yat-sen University School of Stomatology with crowding were collected. The patients were aged 11 years 3 months to 26 years 8 months (mean age 16 years 6 months). All of them treated with 1 to 4 first molar extractions. RESULTS: The average duration of orthodontic treatment was 18.5 months. Normal overjet and overbite was achieved. Good functional occlusion was established. CONCLUSIONS: Patients with severe crowding could be successfully treated with first molar extraction.

Adolescent↗
PubMed2006

Functional appliance treatment outcome and need for additional orthodontic treatment with fixed appliance.

The objectives of this study were to investigate (1) the results of treatment with functional appliances in mixed dentition run by general practitioners, (2) factors associated with a final treatment result of overjet of > or = 5 mm and (3) the need of additional treatment with fixed appliances. The study was designed as a retrospective, cross sectional survey and conducted in one of the Public Dental Clinics and the Orthodontic Clinic in Lidköping, Sweden. 122 patients (aged 7.6 -13.2 years) with an overjet of > or = 7 mm and consecutively collected for treatment with functional appliance therapy. Patient files were analysed with regard to gender, age, initial class II severity, type of functional appliance, co-operation, overall growth, number of missed appointments and treatment time. The treatment results were studied and correlated with the above-mentioned variables. The need for additional treatment with fixed appliances was evaluated. A final overjet of < or = 5 mm was observed in 61.5% of the patients, 48.4% interrupted treatment prematurely and 33.6% received additional treatment with fixed appliances. Good co-operation and extended treatment time was found to be correlated with a final overjet of < or = 5 mm. Other factors not associated with treatment outcome were age, gender, overjet, overbite, molar relation, type of functional appliance, overall growth and number of missed appointments. Activator treatment was successful in reducing overjet to 5 mm or less in almost two thirds of the treated patients. Mainly because of poor functional appliance treatment results or relapse, one third of the patients were retreated with fixed appliance. Since good co-operation is one of the main factors for successful treatment outcome, evaluation of the motivational level of both the parents and the patient before treatment start is crucial.

Activator Appliances↗
PubMed2006

[Correlation analysis on the malocclusion and articulation of skeletal angle III malocclusion in mixed dentition].

OBJECTIVE: To investigate the effects of skeletal Class III malocclusion in mixed dentition on speech articulation and to look for which factors lead to the speech errors. METHODS: Thirty-eight children with skeletal Angle Ill malocclusion in mixed dentition were selected as a sample group and 40 children with normal occlusion in mixed dentition as a control group. Two phoneticians evaluated their articulations and wrote down error phonemes respectively. The correlation analysis was undertaken between the number of errors and the measurements of patients' cephalometry. RESULTS: The number of errors were correlated significantly with overbite, UI-LI, OBJ (OB+OJ) and TD-PW. CONCLUSION: There is articulatory malfunction in the majority of skeletal Angle III malocclusion patients in mixed dentition. Articulatory malfunction is related to the position of incisors and the tongue.

Cephalometry↗
PubMed2006

An update on present and future considerations of aligners.

This report reviews the orthodontic treatment of six different patients who received removable aligners. These cases include correction of deep overbite, open bite, mild-to-moderate crowding, large overjet, cases requiring premolar extractions, the presence of multiple restorations, and cases requiring periodontal-restorative treatments, the improved periodontal status with aligners compared to fixed appliances and the use in teenagers. This report demonstrates that a wide range of cases can be effectively treated, provided the cases are thoroughly reviewed at an early stage process using Invisalgn's ClinCheck software, which will show the specific details of all consecutive appliances prior to any treatment being started so as to determine the biologic and biochemical feasibility of treatment.

Adolescent↗
PubMed2006

Occlusion in the primary dentition. Part 2: a comparison of some occlusal traits among pre-school children of the 3 major ethnic groups in Nigeria.

This paper attempted to compare some of the other occlusal variations in the primary dentition of the children from the 3 major ethnic groups in Nigeria. Cross-sectional epidemiological study involving two major cities in Nigeria. 269, 3-5 year-old children from the 3 major ethnic groups in Nigeria consisting of 125 (46.5%) males and 144 (53.6%) females selected from pre-primary schools/centres. Only children with confirmed ages were included in the study and the criteria of Foster and Hamilton were used in assessing the occlusal features. Although some ethnic differences were observed in relation to the assessed occlusal features, overjet, overbite, cross bite, scissors bite and midline relationship, none was found to be statistically significant (P > 0.05). The occlusal features among the children from the ethnic groups do not differ significantly. Prospective longitudinal study could be worthwhile in further understanding their occlusal developments.

Black People↗
PubMed2006

Factors related to apical root resorption of maxillary incisors in orthodontic patients.

UNLABELLED: THE MAIN OBJECTIVE of the study was to determine the extent of external apical root resorption at the end of orthodontic treatment and to identify the possible pre-treatment and treatment factors that would allow to predict the possible incidence of root resorption before the start of treatment. PATIENTS AND METHODS: Panoramic radiographs of 75 patients that had been treated with full fixed appliances were used to assess apical root resorption in maxillary incisors. The degree of root resorption was measured in millimetres and the scale of Shape was used. RESULTS: The results showed that the resorption in the maxillary incisors is on the average 1.5 mm, the severe resorption was seen in 2.6% of patients. The worst resorption was seen in teeth with abnormal root shape. There were no differences in the severity of root resorption when comparing males and females as well as children and adults. Increased overjet, overbite and extraction therapy were not associated with greater root resorption. Duration of treatment and length of treatment time with rectangular wires were associated with greater root resorption. Patients wearing composite brackets with a metal slot had more resorption than patients wearing metal brackets. CONCLUSION: Pre-treatment risk indicator for root resorption was abnormal root shape. Risk indicators for root resorption that were related to treatment procedures included length of treatment time with rectangular wires, duration of treatment and treatment with composite brackets with a metal slot.

Adolescent↗
PubMed1991

[Indication and application of the cervical traction headgear].

Two types of cervical headgear were presented, the cervical traction with caudal tip and with cranial tip of the long outer bow. The results of an actual long-term follow-up study show long-term stability after distalization with both appliances. The indication and application of the cervical traction are described as a two-term movement. Type I, the cervical headgear with long outer bow tipped 10 to 15 degrees caudal to the inner bow allows to move the crown of the molar distally and to upright mesially tipped molars; the classic indication is the dentoalveolar class II division 1. Type II with long outer bow and tip of 10 to 15 degrees cranial is indicated to upright the roots distally in cases of dentoalveolar and/or skeletal class II with deep overbite. As a concluding remark the recommendation is made that the indications for extraction therapy are understood and that cervical headgears are not seen as a substitute for extractions.

Adolescent↗
PubMed1991

[Protraction--it's use and abuse].

1. Protraction devices can be used to close excess spaces by moving posterior teeth forward, to protract maxillas, to rotate arch segments in cleft palate patients and to remove hyper anterior contacts in patients with TMJ derangements. 2. There are three types of protraction headgears: Chin support with cranial straps (Hickham), chin support with a forehead pad (Face mask) and zygoma support with a headband (Suborbital). They all have specific advantages and disadvantages. 3. The force magnitude from a protraction gear varies according to the desired effect from between app. 400 grams/side to move the maxillary anterior teeth forward and 800 grams/side to encourage maxillary sutural expansion. 4. The centers of rotation of the jaws and the dentition are located apically to the attachment of the protraction device. Therefore not only the intended mesially oriented force is produced but also the undesired side effect of both jaws moving around their centers of rotation. To avoid these negative effects the protraction elastics should always leave the arch in the canine area. 5. Basically Class III cases are due to either a short maxilla and/or a long mandible with variations in the vertical. App. 60% of all Class III cases have a short maxilla indicating the need for protraction. About 50% of the total Class III patient population would need surgery to finish with an ideal occlusion. However, many types of compromise treatments can be acceptable. 6. A good occlusion can only be accomplished in the presence of normal function. In Class III patients special attention should be given to possible nasal obstruction as well as to tongue posture and function. ENT cooperation and tongue spikes are often necessary to resolve these problems. 7. Class III elastics tend to rotate the maxilla and mandible counterclockwise. The resulting change in molar relationship is only due to the rotation of the occlusal plane which is unstable. Also because of the extrusional side effect there is an increase in vertical dimension which usually is undesirable. 8. Intraorally the protraction device can either be attached to a bonded acrylic expansion appliance or to a cemented Hyrax depending on the developmental stage of the dentition. To avoid traumatic occlusion conditions a modified splint should be used with the protraction gear in adults. 9. In all growing Class III patients overcorrection of overjet and overbite is very important. This way not only possible relapse is prevented but also the change of a posteriorly displaced mandible is avoided which could be a later cause for TMJ derangement. 10. When deciding whether the deformity is in the maxilla or in the mandible--the individualized Jacobson templates are very helpful.

Adolescent↗