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Orthodontic diagnosis and treatment analysis--concepts and values: Part II.

Orthodontic treatment must be harmonious with normal growth and developmental patterns. Also, force systems used during malocclusion correction should attempt to improve or compensate the less normal patterns. Because orthodontic treatment is generally undertaken during the time when the patient is experiencing growth and development, to treat harmoniously with growth is a serious responsibility for the clinical orthodontist. By using control, successfully treated, and unsuccessfully treated samples, this article identifies some areas that must be controlled if orthodontic mechanotherapy is to be successful. Some suggestions for diagnosis and treatment management are made after a careful analysis of the three samples.

Adolescent↗

Long-term effects of palate repair on craniofacial morphology in patients with unilateral cleft lip and palate.

OBJECTIVE: To identify the long-term effects of palate repair on craniofacial growth in patients with unilateral cleft lip and palate (UCLP). DESIGN: Retrospective cross-sectional study. SETTING: Sri Lankan Cleft Lip and Palate Project. SUBJECTS: Forty-eight adults with nonsyndromic unilateral cleft lip and palate, 29 men and 19 women, had lip repair only (LRO group). Fifty-eight adults with nonsyndromic unilateral cleft lip and palate, 35 men and 23 women, had lip and palate repairs by the age of 9 (LPR group). MAIN OUTCOME MEASURES: Clinical notes were used to record surgical treatment histories. Cephalometry was used to determine craniofacial morphology. RESULTS: In the lip and palate repair group, the depth of the bony pharynx (Ba-PMP), the maxillary length at the alveolar level (PMP-A), the effective length of the maxilla (Ar-IZ, Ar-ANS, Ar-A), the maxillary protrusion (S-N-ANS, SNA), the anteroposterior jaw relation (ANS-N-Pog, ANB), and the overjet were smaller than in the lip repair only group. There were no significant differences in the maxillary length at the basal level (PMP-IZ, PMP-ANS) and the anterior and posterior maxillary heights (N-ANS and R-PMP, respectively) in the two groups. CONCLUSION: Palate repair inhibits the forward displacement of the basal maxilla and anteroposterior development of the maxillary dentoalveolus in patients with unilateral cleft lip and palate. Palate repair has no detrimental effects on the downward displacement of the basal maxilla or on palatal remodeling in patients with unilateral cleft lip and palate.

Adolescent↗

Breastfeeding is early functional jaw orthopedics (an introduction).

Breastfeeding places beneficial orthopedic forces on the jaws, similar to the forces of Functional Jaw Orthopedics--the newest form of orthodontics. To date most breastfeeding benefits have been attributed to the content of mother's milk. The true orthopedic benefits of breastfeeding, suckling, deserve more definitive attention and research. Breastfeeding is early preventive Functional Jaw Orthopedics because breastfeeding forces impact the jaws during a very rapid period of infant jaw growth. Breast suckling aids proper development of the jaws which form the gateway to the human airway. Bottle, pacifier and digit sucking deform jaws and airways. Forward forces of suckling clearly oppose the backward forces of sucking. Dentists who understand the positive impact of forward orthopedic forces on the jaws should support and advocate exclusive breastfeeding for about 6 months.

Biomechanical Phenomena↗

[Effects of activator and activator + anterior high-pull headgear on the growth direction of Class 2 cases].

In this study which the effects of activator and activator + anterior high-pull headgear on the growth direction of skeletal class 2 cases for a period of approximately 9 months; 33 cases having a mean age of 10.59 years; ANB angles 4.5 degrees and over were studied. Activator treatment has been applied to the 11 of the 22 treatment cases, the others have had the activator + anterior high-pull headgear treatment. The control group, 11 patients, has only been observed in terms of the growth and development without having any treatment. At the end of the study; it was found that the decrease in ANB angle and the increase in SL dimension in the treatment groups; the increase in anterior lower face height in the activator group and the increase in the ratio of posterior to anterior face height were statistically significant.

Activator Appliances↗

Age and race as factors in craniofacial growth and development.

Large samples of adult American black and white males are being studied to determine the extent to which age and race are important factors in craniofacial mophology and growth. It is shown that a number of dentofaical dimensions continue to change throughout adulthood and that the amount and direction of these changes may be race-specific. Applications in orthodontics and prosthetic dentistry are indicated.

Adult↗

Class II treatment effects of the Fränkel appliance.

The objective of this work was to evaluate prospectively and cephalometrically the effects of the function regulator (FR) on dentoskeletal components during a treatment period of 28 months. The subjects consisted of 18 patients presenting with a Class II division 1 malocclusion, with a mean chronological age of 9 years 3 months at the beginning of treatment. The treated group was compared with a compatible control group of 23 untreated subjects observed during the same time period. Lateral cephalometric head films were obtained for the treated group at the beginning and after 28 months of treatment. The subjects in the control group belonged to a serial growth study sample from the Orthodontic Department at Bauru Dental School, University of São Paulo, for whom cephalometric head films were obtained annually from 4 to 18 years of age. The data for the control group were calculated from these head films. A student's t-test was used to compare the changes observed in the treated group with those in the control group. Differences were considered statistically significant at P < 0.05. The results demonstrated that the FR produced a statistically significant increase in the mandibular body, in the proportional size of the mandible to the maxilla and in lower anterior face height (LAFH); induced greater vertical development of the mandibular molars; reduced the overjet and overbite and produced an improvement in the molar relationship. Retrusion and palatal tipping of the maxillary incisors was also observed. However, the appliance did not produce any changes in maxillary development, in the growth pattern, or any improvement in the basal relationship. Therefore it was concluded that the effects of the FR in the correction of Class II malocclusions are primarily dento-alveolar, with a smaller participation of skeletal changes.

Adolescent↗

Effect of rigid microfixation on the craniomaxillofacial skeleton.

Rigid microfixation has enhanced the immediate results in pediatric craniomaxillofacial surgery. The effects of rigid fixation on the development of the craniofacial skeleton, however, remain uncertain. The long-term effects of rigid microfixation on the growing craniofacial skeleton in the rabbit model were evaluated in this study. Bifrontal craniectomies were preformed in 9-day-old rabbits. The frontal bones were replaced orthotopically and fixed both anteriorly and posteriorly with either wire osteosynthesis or titanium microplates and screws. The animals were allowed to grow to craniofacial maturity, and craniofacial development was evaluated with both cephalometric and craniometric analyses. All data were statistically analyzed through analysis of variance. Regional adverse growth effects on the craniofacial skeleton with the use of both wire and rigid fixation were observed. The adverse effects were greatest with the use of rigid fixation.

Analysis of Variance↗

Changes in craniofacial development due to modifications of the treatment of unilateral cleft lip and palate.

OBJECTIVE: The objective of this study was to evaluate the craniofacial morphology of children with unilateral cleft lip and palate (UCLP) resulting from differing management protocols practiced in Prague from 1945 to 1976. DESIGN: The craniofacial morphologies of four groups of patients were compared. Two groups were assessed retrospectively (individuals born from 1945 to 1963), and two groups were followed on a longitudinal basis (individuals born from 1966 to 1976). SETTING: The study was conducted at the Cleft Lip and Palate Center at the Department of Plastic Surgery, Prague, which has a catchment area population of 6 million. PATIENTS: The subjects were a consecutive series of adult males (n = 84) who had complete UCLP without associated malformations. INTERVENTIONS: Patients born from 1945 to 1955 did not receive centralized orthodontic therapy. From 1945 to 1965, the alveolar process in the area of the cleft was not surgically repaired. Primary bone grafting was used for the group born from 1965 to 1972, and primary periosteoplasty was used in the subsequent period. Throughout the period covered by the study, the palate was operated on by pushback and pharyngeal flap surgery. From 1945 to 1965, the lip was repaired initially according to Veau, and later according to Tennison and Randall, and during this time, fixed appliances were used for orthodontic treatment. RESULTS: The results for the period from 1945 to 1955 are characterized by mandibular overclosure with anterior crossbite. Centralized orthodontic treatment in the later period improved sagittal jaw relations due to the posterior displacement of the mandible and an edge-to-edge bite was attained, but maxillary retrusion was unchanged. Primary bone grafting increased retrusion of the maxilla, which was compensated by further posterior displacement of the mandible. An edge-to-edge bite was also obtained. Primary periosteoplasty reduced maxillary retrusion, and the marked proclination of the upper dentoalveolar component with fixed appliances resulted in a positive overjet. It was no longer necessary to push the mandible back to the extent required in bone grafting. CONCLUSION: Effective orthodontic treatment made the greatest contribution to improved facial development. It allowed compensation of maxillary retrusion by changes in the position of the mandible or by proclination of the upper dentoalveolar component with fixed appliances. The applied surgical methods using primary bone grafting caused deterioration of the anterior growth of the maxilla.

Adult↗

The influence of simultaneous cleft lip and palate repair on facial growth in rabbits.

This study was designed to test the influence of simultaneous cleft lip and palate repair on facial growth in rabbits. Three groups of rabbits were used. Group I consisted of control rabbits who had no surgery; Group II had surgically created, but unrepaired, clefts of the lip, alveolus, and palate; and Group III had surgically created clefts of the lip, alveolus, and palate followed by immediate simultaneous lip and palate repair. In Group III, the lip was repaired using the Millare technique and the palate using two-flap palatoplasty, leaving no bare bone exposed. All animals were sacrificed after twenty weeks. Results of the direct cephalometry of the skulls confirmed that simultaneous lip and palate repair results in inhibition of anterior-posterior and transverse maxillary growth. Some significant changes were also found in mandibular length and nasal deflection. All 15 rabbits with simultaneous cleft lip and palate repair developed anterior crossbites and functional shifts to the left or cleft side. Further analysis comparing the results of facial growth inhibition in this study with inhibition following lip repair only or palate repair only will be necessary to assess the severity of secondary maxillo-facial deformities resulting from lip and palate repair.

Animals↗

[Delaire's architectural and structural cranio-facial analysis in cephalometric evaluation].

In this study, the main rules of architectural and Structural cranio-facial analysis developed by Delaire is explained. This architectural and structural cranio-facial analysis of the lateral cephalometric radiograph clarifies the mutual balance of the various bony structures of the cranium and face, individualizes certain of the structures, and specifies their normal of pathologic relationships. Five cephalometric, films were evaluated according to Delaire's architectural and structural analysis and according to classic cephalometric analysis. The results we obtained are presented.

Cephalometry↗

[Skeletal changes induced by radiotherapy. A study of subjects with retinoblastoma. II].

The authors examine the dental and skeletal alterations consequent to the use of radiotherapy as the elective method of treating retinoblastoma, an endobulbar neuroectodermal tumour typical of early infancy. The authors revise the basic concepts of radiobiology and the modifications induced by radiation in developing tissues with reference to both alterations at a microscopic (histological) level and those at a macroscopic level, namely of a morphological and structural nature. In the first part of the study the authors examine the damage to dental structures relating to both developing tissues and damage to mature tissue. The second part of the paper analyses radiation damage on cartilage and bone tissues in the process of formation and the authors present their documentation in the form of iconographic and radiographic material together with an esthetic face analysis performed using Rickettz's method in three cases referred to their attention.

Bone and Bones↗

[Hemifacial microsomia: development, diagnosis and surgical correction].

Hemifacial microsomia is the second most common congenital facial anomaly. It occurs as a spontaneous event during embryogenesis and involves structures derived from the first and second branchial arch. In the past treatment of the skeletal defect was delayed until the child ceased growing and end-stage of the deformity was reached. More recent approach to analysis and treatment of this anomaly, emphasizing early treatment, to give the patient the maximum benefit of a combined surgical and orthodontic therapy, is described.

Branchial Region↗

The mandibular muscles and their importance in orthodontics: a contemporary review.

It is widely accepted that the orthodontist should have a thorough understanding of the craniofacial musculature and its association with the growth and development of the dentofacial complex. There is still much controversy regarding the influence of the mandibular muscles on normal growth and development, and on orthodontic treatment and stability. This review presents an outline of the mandibular muscles and the vertical facial pattern. The different methods by which the mandibular muscles have been investigated are discussed. The potential influence of these muscles on normal morphologic variation in different people is also discussed, along with the implications for contemporary orthodontic treatment and stability.

Bite Force↗

Morphologic study of the mandibular fossa and the eminence of the temporomandibular joint in relation to the facial structures.

To clarify the relationship between the temporal component of the temporomandibular joint and facial bone structure, we measured anthropologic craniometric points and the structure of the mandibular fossa, including the eminence in 33 Japanese male dry skulls, with a three-dimensional apparatus. The length from the articular tubercle to the medial glenoid tubercle is correlated with skeletal variables such as the length of the fossae, the width of the masseter origin, and the mandibular length. Therefore it appears that the frontal dimension is related to the facial development, which is attributable to bite force. Goniometrically, the angle between the line deepest point of the fossa--the midpoint of the eminence and the Frankfort horizontal plane (middle angle)--was negatively correlated only with the ANB angle, suggesting that a steeper middle angle of the eminence is related to a retrusive maxilla or protrusive mandible.

Adolescent↗

Class III malocclusion: the post-retention findings following a non-extraction treatment approach.

A retrospective, cephalometric study was made of a group of 28 successfully treated, Class III, Skeletal III children, who were considered suitable for orthodontic correction of their malocclusions. All had undergone non-extraction therapy, involving a combination of upper incisor proclination and headgear to an intact mandibular dentition and were available for review at least 2 years after all treatment and retention had ceased. Only girls over the age of 16 years and boys above 18 years of age at the post-retention recall were included. Data were examined at the beginning and end of active treatment, and at least two years out of retention. Where differences between the sexes were apparent, data for each sex were given separately. Where no significant differences were seen, data were pooled. Overjet correction was achieved by a combination of upper and lower incisor movement with no alteration in overbite. This was accompanied by a downward and backward repositioning of the mandible, redirecting, rather than restricting mandibular growth. Post-retention, demonstrable skeletal development occurred in both male and female faces. Normal patterns of facial growth reasserted themselves, reversing many treatment effects. The mandible reverted to a more horizontal direction of development, but because no growth restriction had occurred during treatment, no 'catch-up' growth of the lower jaw could be shown. Mandibular growth exceeded that of the maxilla, and since upper and lower incisor inclinations remained unaltered, both overbite and overjet reduced. Reflecting the underlying growth pattern, the lips became more retrusive.

Adolescent↗

Morphogenetic classification of malocclusion as a basis for growth prediction and treatment planning.

This study has shown that the different groups, defined as morphogenetically homogeneous show homogeneity in several aspects. The individuals constituting a given group exhibit a peculiar pattern of craniofacial morphology, they grow alike and they seem to respond alike to a given type of treatment. Within the general frame defined by the group the occlusion seems to play an important role in the future development of the face. In this way the classification presented here is the first in the procedure leading to growth prediction and treatment planning. This classification also permits an analysis of the rotational pattern of the face and consequently allows one to pinpoint the 'failure' in facial growth more accurately. This should allow treatment to be more reliably matched to the growth pattern of the individual.

Adolescent↗

Moz-dependent Hox expression controls segment-specific fate maps of skeletal precursors in the face.

Development of the facial skeleton depends on interactions between intrinsic factors in the skeletal precursors and extrinsic signals in the facial environment. Hox genes have been proposed to act cell-intrinsically in skeletogenic cranial neural crest cells (CNC) for skeletal pattern. However, Hox genes are also expressed in other facial tissues, such as the ectoderm and endoderm, suggesting that Hox genes could also regulate extrinsic signalling from non-CNC tissues. Here we study moz mutant zebrafish in which hoxa2b and hoxb2a expression is lost and the support skeleton of the second pharyngeal segment is transformed into a duplicate of the first-segment-derived jaw skeleton. By performing tissue mosaic experiments between moz(-) and wild-type embryos, we show that Moz and Hox genes function in CNC, but not in the ectoderm or endoderm, to specify the support skeleton. How then does Hox expression within CNC specify a support skeleton at the cellular level? Our fate map analysis of skeletal precursors reveals that Moz specifies a second-segment fate map in part by regulating the interaction of CNC with the first endodermal pouch (p1). Removal of p1, either by laser ablation or in the itga5(b926) mutant, reveals that p1 epithelium is required for development of the wild-type support but not the moz(-) duplicate jaw-like skeleton. We present a model in which Moz-dependent Hox expression in CNC shapes the normal support skeleton by instructing second-segment CNC to undergo skeletogenesis in response to local extrinsic signals.

Animals↗