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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↗
PubMed1990

Surgical correction of temporomandibular joint ankylosis.

The correction of temporomandibular joint ankylosis is frequently followed by re-ankylosis, occlusal disturbance and alteration of functional masticatory movements. A multitude of surgical procedures have been devised in an attempt to overcome the complication of re-ankylosis in particular, and to create a functioning pseudoarthrosis where distance between resected bone surfaces and/or interpositional autogenous, homologous or alloplastic material is relied upon to prevent re-ankylosis and facilitate functional joint activity. Success in preventing re-ankylosis is said also to depend on long-term patient compliance in undertaking frequent and usually painful mandibular movement exercises. Achieving a functioning joint often precludes the maintenance of the occlusion and depends on resection of large amounts of bone and the use of alloplastic implants. A surgical technique is presented whereby a minimal gap arthroplasty in the region of the obliterated temporomandibular joint is completed. This minimizes deviation of the mandible to the operated side with the formation of an anterior open bite. Separation of the resected bone surfaces is accomplished using a composite free auricular skin and cartilage graft in order to prevent re-ankylosis as efficaciously as possible, while allowing for the promotion of immediate postoperative mandibular function, continued growth and the construction of a joint similar in broad terms to the pre-existing joint. A two-stage correction of temporomandibular joint ankylosis and concomitant secondary maxillofacial deformity is recommended. The results in 13 patients (17 joints) with a follow-up range of 1.5 to 5.5 years show that in all but one instance (of fibrous re-ankylosis following postoperative joint infection), satisfactory postoperative mandibular function and mouth opening was achieved.

Adolescent↗
PubMed1998

Malocclusion traits and symptoms and signs of temporomandibular disorders in children with severe malocclusion.

The present study reports the prevalence of the various traits of malocclusion, as well as the occurrence of associations between malocclusion, and symptoms and signs of temporomandibular disorders (TMD) in children selected for orthodontic treatment by the new Danish procedure for screening the child population for severe malocclusions entailing health risks. The sample comprised 104 children (56 F, 48 M) aged 7-13. Malocclusion traits were recorded at the time of selection, symptoms and signs of TMD were recorded at recall. The most prevalent malocclusion traits were distal molar occlusion (Angle Class II; 72 per cent), crowding (57 per cent), extreme maxillary overjet (37 per cent) and deep bite (31 per cent). Agenesis or peg-shaped lateral teeth were observed in 14 per cent of the children. The most prevalent symptom of TMD was weekly headache (27 per cent); the most prevalent signs of TMD were tenderness in the anterior temporal, occipital, trapezius, and superficial and profound masseter muscles (39-34 per cent). Seven per cent of the children were referred for TMD treatment. The Danish TMD screening procedure was positive in 26 per cent, while 20 per cent had severe symptoms (Aill), and 30 per cent had moderate signs (Dill) according to Helkimo (1974). Symptoms and signs of TMD were significantly associated with distal molar occlusion, extreme maxillary overjet, open bite, unilateral crossbite, midline displacement, and errors of tooth formation. The analysis suggests that there is a higher risk of children with severe malocclusions developing TMD. Errors of tooth formation in the form of agenesis or peg-shaped lateral teeth showed the largest number of associations with symptoms and signs of TMD; these associations have not previously been reported in the literature.

Adolescent↗
PubMed2004

Morphometric analysis of the mandible in growing rats with different masticatory functional demands: adaptation to an upper posterior bite block.

Functional appliances displace the mandible forward and/or downward, causing a stretching of the orofacial soft tissues, muscles included. The resulting forces are directly or indirectly transmitted to the underlying dento-skeletal tissues. The hypothesis underlying the present investigation was that the insertion of a bite-opening appliance influences the lateral morphology of the rat mandible during growth, and that, moreover, this influence depends on the masticatory functional demands. One-hundred and four 4-wk-old male albino rats were divided into two groups, fed a hard and soft diet, respectively. After 2 wk, half of the animals in each experimental group were fitted with upper posterior blocks, and 4 wk later they were killed. Their left hemi-mandibles were transilluminated, photographed under magnification, and digitized on screen. A total of 170 points were used to draw the lateral outline of the mandible. In addition to the inhibitory effect on the height of the dento-alveolar process, the upper bite block resulted in significant changes in the condyle inclination, the length of the coronoid process, and the occlusal plane inclination. Masticatory functional demands influenced this adaptation in an additive way. The results raise the question of whether orthodontic treatment with posterior bite blocks might have different effects on the mandible, depending on the characteristics of the orofacial soft tissues.

Adaptation, Physiological↗
PubMed2005

Anchorage provided during intra-arch distal molar movement: a comparison between the Nance appliance and a fixed frontal bite plane.

The aim of this retrospective study was to evaluate and compare the anchorage provided with the Nance appliance (NA) and the fixed frontal bite plane (FBP) during intra-arch distal molar movement. After a sample size calculation, 20 patients were recruited and randomly selected for each group from patients who fulfilled the following criteria: use of an intra-arch Ni-Ti coil appliance with either NA or FBP to provide anchorage during a six-month molar distalization period, no orthodontic treatment before molar distalization, and first and second maxillary molars in occlusion. The outcome measures assessed were anchorage loss, ie, anterior movement of maxillary central incisors, distal movement of maxillary molars, and bite opening effect. The mean age in the NA group was 14.7 years (SD 1.09) and in the FBP group 15.0 years (SD 0.99). The data revealed that the maxillary central incisors moved anteriorly 1.4 mm in the NA group and 1.9 mm in the FBP group. The difference in anchorage loss was not significant. The mean amount of molar distalization within the maxilla was 1.7 mm in the NA group and 1.8 mm in the FBP group. In both groups, the overbite was significantly reduced and the overbite was decreased significantly more in the FBP group. Because neither the NA nor FBP provided stable anchorage, a second treatment phase is recommended to reverse the anchorage loss after distal molar movement. If molar distalization is planned in deep bite cases, the FBP is the anchorage system of choice.

Adolescent↗
PubMed2001

Bite forces after open or closed treatment of mandibular condylar process fractures.

PURPOSE: This study compared maximum voluntary bite forces in patients who received either open or closed treatment for fractures of the mandibular condylar process. PATIENTS AND METHODS: One hundred fifty-five patients (127 male, 28 female) with unilateral fractures of the mandibular condylar process (91 treated closed and 64 treated open) were included in this study. Maximum voluntary bite forces were measured at 6 weeks, 6 months, and 1, 2, and 3 years after fracture. At each trial, unilateral maximum voluntary bite force was measured at 4 different tooth positions bilaterally using a standard transducer. Electromyography (EMG) of the masseter muscles was also recorded during the bite force measurements, and ratios of the working/balancing side EMG were calculated. Analysis of the data was performed using standard statistical methods. RESULTS: The only significant difference between the 2 samples was in the level of fractures on the condylar process. No patients treated open had fractures of the "head" of the condylar process, whereas there were 11 in the group treated closed. No differences were observed in maximum voluntary bite forces between the 2 treatment groups at any time period, or were there correlations between bite force magnitude and location of the fracture, displacement of the fracture, or any other variable studied. Both groups showed a significant recovery of maximum bite force from the 6-week to the 6-month testing session. For both groups, working/balancing EMG ratios were significantly greater when subjects were biting on the side opposite the fracture. When biting on that side, the working/balancing EMG ratios were higher in the closed treatment group, but the difference did not reach significance. CONCLUSIONS: Maximum voluntary bite forces in patients treated for mandibular condylar process fractures do not differ significantly when treatment is open or closed. Neuromuscular adaptations to the fractured mandibular condylar process occur in both groups.

Adolescent↗
PubMedDate not supplied

Mandibular angle fractures: two-miniplate fixation and complications.

BACKGROUND: Noncompression monocortical miniplate fixation of the mandibular angle is an accepted and reliable method for providing rigid internal fixation. High complication rates have been reported for internal fixation of angle fractures. OBJECTIVE: To analyze the outcome and complications in cases in which patients were treated with 2-miniplate fixation at the mandibular angle. DESIGN: A retrospective analysis of outcomes for a case series. SETTING: Treatment performed at a level 1 trauma-rated teaching hospital. METHODS: From May 1992 to September 2001, a total of 88 patients with angle fractures of the mandible were treated with 2-miniplate fixation. Sixty-eight of the 88 patients, with 70 angle fractures, were included in the study; 13 were unavailable for follow-up and 7 had less than the minimum follow-up of 6 weeks. The time of trauma to treatment, cause of injury, and associated fractures were recorded. Postoperative complications, including infection, malunion, nonunion, dehiscence, osteomyelitis, and nerve injury due to surgical manipulation, were tabulated. Follow-up examinations were performed up to 12 weeks after surgery, with additional examinations if necessary. Postreduction panoramic radiographs were obtained in most cases. RESULTS: No patients treated with monocortical 2-miniplate fixation had malunion, nonunion, or osteomyelitis. Twelve (17.6%) of the 68 patients were identified as having at least 1 postoperative complication. Postoperative infection occurred in 2 patients (2.9%). Infection was controlled with oral antibiotic therapy. One patient required removal of miniplates after the acute phase resolved. Occlusal disturbances were noted in 4 patients (5.9%) (2 with a slight anterior open bite, 1 with a crossbite, and 1 with premature contact of a molar) after surgery. Three of the 4 patients had associated midfacial or multiple mandibular fractures. None required further surgery. Wound dehiscence, with exposure of an underlying plate, occurred in 4 patients (5.9%); the wounds were treated conservatively and subsequently resolved. Nerve injury due to surgical manipulation occurred in 3 patients (4.4%). CONCLUSIONS: Monocortical 2-miniplate fixation of the mandibular angle is a reliable and effective technique for providing rigid fixation. The complications were minimal in our study, and the infection rate was 2.9%, which is comparable to or better than the infection rate reported with the use of a single miniplate fixation technique in other studies. Disturbances of occlusion were associated with midfacial or additional mandibular fractures. In view of the contradictory published results, further studies are needed to determine the ideal approach for noncompression monocortical plate fixation of angle fractures.

Bone Plates↗
PubMed2004

The natural history, including orofacial features of three patients with Ehlers-Danlos syndrome, dermatosparaxis type (EDS type VIIC).

Ehlers-Danlos syndrome (EDS) dermatosparaxis type (type VIIC) and the related disease of cattle dermatosparaxis, are recessively inherited connective tissue disorders, caused by a deficient activity of procollagen I N-proteinase, the enzyme that excises the N-terminal propeptide in procollagen type I, type II, and type III. Although well documented in cattle, to date only seven human cases have been recorded, most of them aged under 2 years. We document the natural history of three patients with EDS dermatosparaxis type, two of whom have been reported before the age of 2 years, and one new patient. The phenotype of the patients, and especially the facial resemblance, is striking, making this a clinically recognizable condition. The most consistent anomalies during the first years of life are premature rupture of the membranes, extreme skin fragility and easy bruising, large fontanels, blue sclerae, puffy eyelids, micrognathia, umbilical hernia, and short fingers. Joint hypermobility becomes more important with age. The children are at risk for rupture of internal organs due to soft tissue fragility, as is illustrated by different internal events in two of the three patients described here. Orofacial features include micrognathia, a frontal open bite, and gingival hyperplasia with varying degrees of hyperkeratosis. The deciduous dentition shows abnormal morphology of the molars, obliteration of the tooth pulp, and severe enamel attrition. The permanent dentition shows agenesis and microdontia of several teeth. Tooth discoloration, dysplastic roots, and tooth pulp obliteration are present in a restricted number of permanent teeth.

Child↗
PubMed1992

Occlusion in 47,XXY (Klinefelter syndrome) men.

Occlusal morphology of permanent dentitions in 29 men with a 47,XXY chromosome complement (Klinefelter syndrome) was determined from dental casts. The results showed that a relatively frequent occlusal anomaly was mesial molar occlusion. Incisal open bite was also more common than in controls. Based on the present and previous observations of occlusal anomalies in various sex chromosome anomaly groups and normal controls, it is suggested that the presence of the Y chromosome in the genome is at least as important as the X chromosome for the development of harmonious occlusal morphology. The tendency towards sexual dimorphism in occlusal phenotype might result from a differential effect of the X and Y chromosomes on cellular activity which leads to different growth patterns.

Adolescent↗
PubMed2002

Morphologic changes in the TMJ following splint wear.

Intraoral splints are a commonly used dental treatment for a variety of conditions. Because such splints alter the condyle-disc-fossa relationship, they probably change the loading status of the temporomandibular joint (TMJ), including the TMJ disc. Collagen, a major constituent of the disc, acts to resist tensile loading, and it is presumed that the fiber orientations of the individual disc bands reflect their functional loading. Therefore, the purpose of this study was to examine effects of intraoral splint wear on TMJ morphology in general, and collagen orientation of the intra-articular disc in particular. Young adult, female miniature pigs were divided into three groups: open-bite splint, protrusive-bite splint, and unsplinted control. Splints were worn for 2 months, after which the TMJ discs were harvested for histological examination and stereological analysis, and the skulls were cleaned. Although the splints had no effect on skull dimensions, changes were seen in the TMJs. The discs of the protrusively-splinted group showed an increased thickness of the posterior band (P < 0.015) and minor changes in collagen orientation of the anterior band. The most striking change was the presence of a degenerative osseous defect on the medial side of the mandibular condyle in half of the splinted animals. These results indicate that prolonged splint wear can induce remodeling and even injury of TMJ tissues.

Animals↗
PubMed1999

Cephalometric differentiation between vertical and horizontal malocclusions in 122 Europeans using the Denture Frame Analysis and standard measurements. Differentiation between vertical and horizontal malocclusion.

This study evaluated the ability of some cephalometric measurements to differentiate between horizontal and vertical malocclusions and normal occlusion. Based upon the Angle classification and the vertical incisor overbite, 122 randomly selected subjects were assigned to 3 horizontal and 3 vertical groups: neutrocclusion, distocclusion, mesiocclusion as well as open bite, normal overbite, and deep bite. Evaluation of the lateral cephalograms was based on Denture Frame Analysis and cephalometric standard measurements (SNA, SNB, ANB, Wits appraisal, Björk polygon, overbite depth indicator, incisor inclination, incisor protrusion, facial height ratio). The statistical evaluation assessed the ability of the measurements to show significant differences between the individual horizontal and vertical groups. Using Denture Frame Analysis, all vertical groups could be differentiated by the occlusomandibular angle (OP-MP) and all horizontal groups by the angle between the A-B plane and the mandibular plane as well as by the inclination of the upper incisors to the A-B plane with statistical significance (p < 0.05). Among the standard measurements, the Wits appraisal was the only one to show differences between all horizontal groups with statistical significance. None of the standard measurements could fully differentiate the vertical groups. The above measurements from the Denture Frame Analysis distinguished the types of malocclusion in anteroposterior and vertical direction including significant distinction between the neutrocclusion group and the malocclusion groups. Therefore a cephalometric classification was feasible in terms of hyper- and hypodivergence as well as of a mesial or distal dentofacial relationship.

Adolescent↗
PubMed1998

Influence of orthodontic treatment in the primary dentition upon development of the dentition and craniofacial growth.

UNLABELLED: Thirty patients who underwent orthodontic treatment of the primary dentition were examined in this retrospective follow-up study. The mean age at the beginning of treatment was 4.4 (+/= 1.1) years, and at follow-up 15.4 (+/- 1.7) years. Different kinds of malocclusion were present. RESULTS: The early treatment lasted on average 12.3 (+/- 7.2) months. Treatment time of Class III malocclusion and lateral crossbite was significantly shorter than that of Class II, 1 malocclusion, functional Class II, 2 malocclusion or anterior open bite (p < 0.05). A Class I occlusion was achieved in 90% of the patients during treatment of the primary dentition. No patient treated successfully in the primary dentition showed any relapse to initial malocclusion. CONCLUSION: These results suggest that changes in occlusion and mandibular position during treatment in the primary dentition are maintained in the mixed and permanent dentition. It can be concluded that a Class I occlusion following orthodontic treatment in the primary dentition serves as a basis for physiological development of the dentition and craniofacial growth.

Child, Preschool↗
PubMed1992

[The importance of electromagnetic articulography in studying tongue motor function in the framework of an orthodontic diagnosis].

Objective data are required for assessing the influence of movements of the tongue on the position of the teeth. Electromagnetic articulography (EMA) makes it possible to track movements of the tongue using the principle of inductive distance measurement. A helmet made of light but robust acrylic material serves as a carrier for three transmitter coils; these latter are located in front of the forehead, in front of the chin, and at the back of the neck. Receiver coils are fixed to the tip of the tongue and at various points on the dorsum of the tongue. The distance between the receiver coils and the transmitter coils is calculated in real time by means of a personal computer. The movement trajectories are displayed on the computer screen in different colors in X-Y coordinates. The movements of the tongue are recorded in patients with correctly positioned front teeth and compared with those in patients with a frontal open bite. The significance of electromagnetic articulography for dental research and functional treatment is demonstrated.

Adolescent↗
PubMed1989

[Early orthodontic treatment measures in infants with the EMG syndrome].

In 1963 Beckwith and Wiedemann reported a syndrome, which was characterized by umbilical hernia, macroglossia and somatic gigantism. In the literature, early intervention by tongue reduction is recommended in order to prevent both mandibular prognathism and open bite. In this paper seven cases were presented showing that early functional treatment of the stomatognatic system leads to pleasing results, both functionally and aesthetically. Therefore it is suggested, that functional treatment should replace surgical management of macroglossia in the Beckwith-Wiedemann-syndrome.

Beckwith-Wiedemann Syndrome↗
PubMed1993

[Early orthodontic treatment of the deciduous dentition. The therapeutic potentials and indications].

The purpose of orthodontic treatment of the deciduous dentition is to prevent the skeletal manifestation of anomalies. Anterior open bites, abnormal posterior occlusions, lateral cross-bites and negative (reverse) overjets, may be preserved in the permanent dentition. Early recognition of the anomalies and their aetiology makes it possible, by eliminating bad habits and through the use of simple appliances, to normalise occlusion and ensure physiological development of the permanent dentition.

Child↗
PubMed1995

[Findings in the panoramic tomogram in orthodontic patients with functional disorders].

In our study of 107 patients, for whom data derived from clinical functional analysis, axiography and, in part magnet resonance imaging, were present, we were able to show that in routine orthodontic diagnosis the use of panoramic X-ray in the normal course of a general examination of the mandibular joint can also provide important indications of the presence of cranio-mandibular disorders. The panoramic X-ray revealed that in patients with Angle class II and front deep and open bite there were significantly mor changes in the form of the condyles. A definite morphologic finding of a retracted fovea pterygoidea was found frequently in patients with anterior disk replacement with or without reduction. Lastly, the panoramic X-ray showed that a change in form of the condyles, with in some cases a serious arthrosis, occurs significantly most frequent in patients with anterior displacement without reduction.

Adolescent↗
PubMed1995

[The importance of hand x-rays for the treatment of skeletal dysgnathias].

This study demonstrates the importance of X-rays of the hand in assessing skeletal changes in jaw relationships. The study is based on a follow-up examination of 53 patients with skeletal class II,1-, skeletal class II,2-, class III and skeletal open bite malocclusions who had been treated orthodontically. Statistical analysis of the growth parameters found a significant correlation between chronological age and skeletal age with considerable deviations depending on sex. At the end of the treatment period it was observed that 34% of all patients had not reached the end of puberty and had not achieved a mature level of growth. During the post-therapeutical period, growth was found on average to be 2.4% in the girls and up to 4.7% in the boys. When looking at the influence of growth and therapy, the patient group with skeletal class II,1 malocclusion exhibited at both therapeutical and post-therapeutical examinations a very positive development both in the horizontal and vertical basal relation of the jaw with a significant increase in mandibular length and in anterior lower facial height. On the other hand the class II,2 cases exhibited significantly reduced lower facial height, which can probably be considered to be a causal factor in the 70% relapse rate after completion of orthodontic treatment. In class III malocclusions the horizontal jaw relationship was stabilized throughout the orthodontic treatment period, however, following treatment a progressive alteration became apparent. The results achieved in this study add weight to the importance of taking skeletal maturation factors into consideration in patients with skeletal jaw discrepancies. These factors are useful in prognosticating the therapeutical goal to be achieved, the degree of stability during treatment, and the chances of relapse following treatment.

Adolescent↗