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Klippel-Trenaunay-Weber syndrome is characterized by limb hypertrophy, varicose veins, and vascular nevus. The orofacial manifestations include early eruption of permanent teeth and hemifacial hypertrophy. This 5-year-old male patient had facial asymmetry, limb abnormalities, and a thumb-sucking habit. Cephalometric analysis revealed a Class II open bite occlusion.
Forty-one patients who underwent bilateral sagittal ramus osteotomy for large mandibular advancements were evaluated by retrospective cephalometric analysis for rotational and linear stability of the proximal and distal segments of the mandible. The patients were grouped by the number of screws used in fixation (three versus four 2-mm bicortical screws) and matched for the amount of advancement measured from changes in mandibular body length. The group with four fixation screws did receive significantly larger advancements relative to the cranial base than did the group with three screws. However, the pattern of postoperative change was similar for the two groups. There was no higher rate of relapse seen in those patients with high mandibular plane angles, genioplasties, mandibular constriction with a symphyseal osteotomy, or open bites preoperatively, nor did the number of screws used in fixation affect changes seen in those patients. Factors associated with both relapse and continued postoperative movement in the direction of advancement independent of the screw fixation group were identified.
Fifty-four homozygous beta-thalassemic patients (26 men and 28 women) aged 7 to 24 years, who had been treated with high transfusion regimen (Hb levels = 9-10 g/dl) and chelation therapy (desferrioxamine, 35-50 mg/kg), underwent clinical and radiographic investigations. This study was aimed at assessing the clinical and radiographic changes in the stomatognathic system (teeth, mandible and maxilla, occlusion relationship and dental bases). All patients underwent orthopantomography and teleradiography of the skull, in the lateral view. Twenty thalassemic patients (13 men and 7 women) of the same age but treated with low transfusion regimes (Hb levels = 5-6 g/dl) were examined as a control group. Our results indicate that: 1) in the control group, osteopenia is the specific lesion of anemia, in both the alveolar process and the mandible, following marrow expansion. Consequently, diastema of incisors and several types of malocclusion follow--i.e., overjet, anterior open-bite and crossbite, nearly all of them associated with II dental and skeletal patterns of Angle's classification. 2) In adequately transfused patients, no lesions are observed in 55% of cases, in both the teeth and the facial skeleton. This means that current treatment methods can prevent bone abnormalities, especially if transfusions begin at birth. Nevertheless, osteopenia of the mandible (31.4%) and dental and/or skeletal malocclusions (40.7%) remain in many cases, because of persistent marrow expansion, which usually follows incorrect treatment. 3) General dental diseases--e.g., caries, paradentosis, gingivitis, etc.--affect both populations with the same incidence.
The association between malocclusion and the prevalence of temporomandibular disorders (TMD) was studied in an orthodontic patient population before orthodontic treatment was started. A total of 305 patients, 232 with general malocclusion and 73 who also had cleft lip or palate, were given a questionnaire about the subjective symptoms of TMD. Clinical examinations for type of malocclusion and TMD signs were also conducted. No significant differences in the prevalence of TMD were observed between the sexes or between the two patient groups. Temporomandibular joint sounds and difficulty of jaw movement were the most common of the TMD signs and symptoms. Open bite, posterior crossbite, and deep bite were the most prevalent types of malocclusion in both groups. Thus, some specific types of malocclusion were significantly associated with the occurrence of TMD.
The pathognomonic open mouth of centronuclear and other myopathies can also have implications for oral health. These patients are at greater risk for gingivitis, dental caries as a result of the mouth breathing and loss of lip seal. Low tongue posture may impede the lateral expansion of the maxilla resulting in a constricted maxillary arch with resultant posterior crossbites and functional shifts. Excessive molar eruption may also occur, resulting in anterior open bites and increases in the anterior lower vertical height.
On several occasions, the suprahyoid muscles have been detached from the lingual surface of the mandible at the same time as sagittal split advancement procedures in treatment of class II malocclusion and/or open bite patients. We usually perform suprahyoid myotomy through a degloving type incision (the Steinhauser technique) when genioplasty is planned. However, sometimes genioplasty is not necessary. In such cases, we perform the myotomy through a small submental skin incision. This method has some advantages: 1. Surgical stress is less and operating time is shorter than the Steinhauser method. 2. The risk of detachment of the major portion of the genioglossus muscles is lower than in the Allison method. We present this procedure of suprahyoid myotomy carried out from an external approach.
Diastrophic dysplasia (DTD) is a well-characterized, recessively inherited osteochondrodysplasia. The gene, DTDST, in which mutations are responsible for the disease, codes for a sulphate transporter protein. We studied 53 patients with earlier diagnosed DTD for special characteristics in the oral region. Clinical examination included impressions of dental arches, oral photographs, and panoramic radiographs. Palatal clefting was recorded. Congenitally missing teeth were evaluated and dental maturity calculated from the panoramic radiographs. Tooth crown size and length and breadth of dental arches were measured from the casts. Dental anomalies and orthodontical status were evaluated from the casts and oral photographs. The level of oral hygiene was evaluated with caries (DMF) and periodontal (GBI) indices. Cleft palate was recorded in 56% and hypodontia (excluding third molars) in 31% of the patients. Dental age was retarded. Dental arches were narrow and tooth crown size was reduced. The observed crown size reduction could result from the same factors that cause cleft palate and/or hypodontia, or from a lack of sulfation in the developing dental papilla. The typical malocclusion traits were crowding, lateral crossbite, and open bite, which we assumed to result from reduced growth potential of the dental arches. Despite crowding and limited flexion of the finger joints leading to a severe handicap, the level of oral hygiene was high and no need for auxiliary equipment for cleaning the teeth was noted.
The molar relations, overjet and overbite of 201 Hong Kong Chinese adults of mean age 20 years were studied. It was found that 63.7 per cent had Angle Class I, 16.4 per cent had Class II and 19.9 per cent had Class III molar relations. Of the sample studied, 69.7 per cent had normal overjets of two to four mm, 14.9 per cent had increased overjets and 15.4 per cent had reduced or reversed overjets. The most prevalent overbite was zero to one-third of the mandibular central incisor crown length (63.2 per cent of the sample); 31.3 per cent had overbites of one to two thirds of mandibular central incisor crown length; four per cent had overbites of more than two thirds of mandibular incisor crown length; and 1.5 per cent only had open bites.
The contribution of the nervous system to the pathophysiology of rheumatoid arthritis has been proposed to be mediated by certain neuropeptides. Neuropeptide Y, calcitonin gene-related peptide, substance P, and neurokinin A are considered modulators of inflammatory joint disease. Parameters of pain, as well as occlusal signs of tissue destruction from the arthritic TMJ and the corresponding neuropeptide concentrations in TMJ synovial fluid, were investigated in patients with various inflammatory joint diseases. The patients with rheumatoid arthritis were also examined in a separate diagnostic group. Visual analog scale, palpatory tenderness, maximal voluntary mouth opening, and anterior open bite were correlated to neuropeptide-like immunoreactivities of the above four neuropeptides. It was found that high concentrations of calcitonin gene-related peptide and neuropeptide Y in TMJ fluid are associated with pain, impairment of mandibular mobility, and occlusal signs of TMJ destruction in patients with rheumatoid arthritis. The results indicated neuropeptide involvement in rheumatoid arthritis, proposing a potentiation of the symptoms and signs by the inflammatory action of calcitonin gene-related peptide and neuropeptide Y.
The simultaneous contribution of 11 occlusal factors, dental attrition severity, orthodontic history, trauma (motor vehicle accident [MVA] and non-MVA), and age in defining two independent large populations of females diagnosed with five mutually exclusive temporomandibular disorders was tested through multiple stepwise logistic regression analysis. Non-MVA trauma was significant in both groups in defining disc displacement (DD) with and without reduction, and osteoarthrosis (OA) (both primary and following DD). Anterior open bite was also a significant factor in defining OA in both groups. Much smaller contributions were also made by missing teeth in one of the populations with OA following DD, and by retruded contact position-intercuspal position slide lengths and overjet in one of the primary OA populations. Motor vehicle accident trauma was significant in defining myofascial pain (MP) in both populations, and laterotrusive attrition mildly defined MP in one population. Only a minority of total variance was explained: 6% to 8% of DD with reduction; 10% to 14% of DD without reduction; 11% to 20% of OA following DD; 17% to 38% of primary OA; and 4% to 10% of MP. Non-MVA trauma was the major defining feature of the temporomandibular joint intracapsular disorders, and MVA trauma explained a very small percentage of the MP patients. Implications are discussed and recommendations are made for future research.
Turner syndrome is a disease belonging to the group of chromosome disorders, which affect sexual chromosomes. The present study aims at analysing and describing orthodontic and TMI joint disorders in patients with Turner's syndrome, and comparing the results with those healthy controls. Data of 24 patients with Turner's syndrome as well as 24 healthy controls were collected and analysed. No significant alteration in TMI was found in any of the two groups. Both groups presented orthodontic anomalies, however, crowding was the most common anomaly in the control group, whereas in the case of patients with Turner's syndrome, other anomalies (protrusion, open bite, cross bite) could also be found more frequently.
Aspartylglucosaminuria (AGU) is a lysosomal storage disorder with progressive mental retardation as a presenting manifestation. The disorder is caused by a single nucleotide change in the gene encoding aspartylglucosaminidase (AGA). This rare disease is relatively common in Finland: we were able to examine 81 Finnish AGU-patients for dental and oral changes. Tooth crown size and crown shape were normal, but dental malocclusions were common, and prevalences of spacing, large overjet, anterior open bite, and lateral crossbite exceeded Finnish population prevalences (P < 0.0001). Dental arches were already large in childhood, and in adult patients, when compared to Finnish population standards, the lower dental arch was larger in all dimensions (P < 0.001). Almost all patients had abnormally large tongues, which we assumed to be the reason for the structural abnormalities observed.
Congenital Fiber-Type Disproportion myopathy (CFTD) is a relatively rare muscular disorder due to predominance and reduction in size of type 1 fibers, with large type 2 fibers. After a review of the clinical and histopathological aspects of the disease, the present work described craniofacial skeletal and EMG features of a 9-year-old child affected by CFTD. Narrow maxillary arch, incompetent lips, severe skeletal open bite, and EMG evidence of weakness of masticatory muscles, were found in the examined patient. All these findings are fully consistent with previously-reported craniofacial features of patients affected by myotonic disorders (muscular dystrophy), and they may represent important diagnostic signs of a congenital muscular disease.
Twenty schoolchildren between the age groups of 12-14 years with permanent dentition were the subjects of this study. Group A comprised of ten subjects with Angle's Class I occlusion. Group B consisted of ten subjects having Angle's Class I occlusion with anterior open bite and simple tongue thrust swallow pattern. Evaluation of electrical activity of genioglossus muscle and associated arch dimensional changes were performed in both groups A and B. Frequency of electrical activity of the genioglossus muscle and duration of swallow was found to be significantly higher in tongue thrusters than in the normal subjects. No statistically significant changes were observed in both upper and lower arches of Groups A and B in terms of bimolar and bipremolar width and palatal depth. A significant increase in the extent of anterior teeth proclination in the upper arch in the tongue thrust individuals was attributed to the effect of the increased frequency of electrical activity of the genioglossus muscle and prolonged duration of swallow.
Each patient (and parents or guardian) should be clearly informed that there is a real possibility of one or more teeth undergoing root resorption during orthodontic procedures. They should sign an Information and Consent Form arranged by the dentist that they understand these risks before treatment is begun. Open bite cases possess significantly great degrees of resorption. Since trauma is closely associated with root resorption, the patient (and parents or guardian) should be questioned concerning previous traumatic occurrences that involved blows or accidents involving the teeth. Periapical radiographs are an important part of orthodontic records. They are useful to compare pretreatment and posttreatment root resorption. Maxillary incisors are affected more frequently and to a greater degree than the rest of the teeth during active treatment. Also, root resorption of the upper incisors during the initial 6-9 months of treatment with fixed appliances gives a high risk for continued resorption during the subsequent treatment. Therefore, it would be prudent to take periapical radiographs periodically during treatment. When root resorption is detected during active treatment, a decision must be made as to whether to continue, modify or discontinue the treatment. Extremely heavy forces should be avoided, since they have been shown to produce greater resorption activity. The ectopic eruption of canines causes a significant number of resorptions in lateral incisors. Habits adversely affect root resorption and should be eliminated if possible. Pathological lesions increase the risk of resorption. Periodontal disease increases the risk of resorption. The practitioner contemplating doing orthodontics should be cognizant of the above factors in evaluating the risk of root resorption. Patients (and parents or guardians) should be made clearly aware that any type of orthodontic treatment carries with it the risk of root tip blunting or resorption during orthodontic therapy.
The study is based on evaluation of X-ray films of the head of 29 boys aged 5 years and 34 males aged about 20 years with complete unilateral cleft of the lip and palate. Deviations in the craniofacial morphology were assessed using the Jarabak's analysis. Most linear dimensions were smaller in both children and adult patients. The exception was the posterior part of the cranial base the length of which was the same as in controls. The anterior part of the cranial base and the mandibular body were significantly shortened only in 5-year-old individuals while the maxillary body was shortened only in adult patients. The anterior facial height was elongated in adult patients. The mandible showed a posterior rotation, the gonial angle was increased in its lower part. The maxilla and mandible were retrusive with impaired vertical--and in adults also sagittal--jaw relations. Both upper and lower incisors showed retroinclination. In 5-year-old patients an anterior crossbite developed, a trend to open bite was evident in adult patients. The upper lip was retrusive while the lower lip was protrusive. Jarabak's method is not sufficient for an accurate analysis of the soft profile in patients with clefts.
The goals of mandibular distraction are to restore a normal length but also a normal shape to the hypoplastic mandible. These two goals are related to the elongation vector which is itself related to the location of the cortictomy and of the device. Other factors influence this elongation vector. So it is impossible to precisely predict the elongation vector. With the monodirectional distraction device no modification can be made during the distraction time. With a bidirectional distraction device offering the possibility to modulate the angulation between the two elongation rods it is possible to adjust the elongation vector during distraction. Precise distraction gap modeling is possible. This is particularly important to correct anterior open-bite. This device was tested on animals (pigs).
PURPOSE: The purpose of this study was to examine the occlusion of children younger than 6 years with a diagnosis of otitis media. METHODS: The study consisted of 112 children diagnosed with otitis media by their pediatrician. Parents were surveyed regarding their child's history of pacifier use, thumb/finger-sucking habit, mouthbreathing habit, method of feeding, day care attendance, snoring, allergies, asthma, upper respiratory infections, otitis media in the family, and the number of people who smoke in the home. The children's occlusions were examined. RESULTS: In this study, 52% of the population presented with some type of malocclusion, with anterior open bite (17%) and an overbite measuring greater than 70% (17%) being the most prominent. This study showed that the following factors were common in children with otitis media: bottle feeding, smoking in the home, day care attendance, upper respiratory infection, history of otitis media with a sibling, pacifier habit, snoring, and mouthbreathing habit. CONCLUSION: A logistic regression analysis showed no significant association between malocclusion and factors related to otitis media.