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PubMed1980

[Preoperative planning and function-stable fixation by osteosynthesis and external cranial clamp in the treatment of progenia, open bite and distal bite].

Close collaboration between the orthodontist and the surgeon is essential to the success of any corrective maxillofacial procedure. The operative part combines the surgical principles of orthopedics with those of dentistry. However, until recently little emphasis was placed on truly stable fixation of the maxillofacial segments following osteotomy; they were simply wired together and then immobilized by intermaxillary fixation and traction. The stabilization of osteotomies of the long bones by internal fixation with plates and screws or by the application of external fixation clamps has been accepted orthopedic surgical practice for a number of years. The Association for the Study of Internal Fixation (ASIF) has played an important part in the development of these techniques. The principles involved are now being applied to the fixation of maxillofacial osteotomies. Devices such as lag screws, the EDCP, mandibular reconstruction plate, and the "craniofixature externe" are being used to obtain functionally stable fixation, thus eliminating the need for traction. If the upper and lower jaws are to be operated on simultaneously then functionally stable fixation is an essntial prerequisite for accurate displacement by the amount, and in the direction, planned. The introduction of rigid stabilisation techniques into the field of maxillofacial surgery has led to an increased emphasis on accurate preoperative planning. It is important that the surgeon performs the key steps of the preoperative planning, such as simulography, himself. This involves little extra work, since the computational and graphic chores are nowadays performed by the computer.

Adult↗
PubMed1989

[Morphological study on open bite patients].

The purpose of the present study is to investigate the morphological features of open bite patients who have also disharmony of anteroposterior relations between maxilla and mandible. Lateral head films of 40 adult females with open bite were used. The samples were classified into three groups by ANB angle. Three groups were as follows. 1. Type I open bite (12 subjects, 1 degree less than or equal to ANB less than or equal to 4.5 degrees). 2. Type II open bite (13 subjects, ANB less than 4.5 degrees). 3. Type III open bite (15 subjects, ANB less than 1 degree) The normal samples was the longitudinal data of females in our department. Skeletal and dental variables were calculated and compared norm versus type I open bite, type I open bite versus type II open bite and type I open bite versus type III open bite, respectively. The following results were obtained. 1. Disharmony of the vertical dimensions in type I open bite was mainly due to long anterior lower facial height which was accompanied by large gonial angle as compared with norm. 2. There were no difference in anteroposterior position of the maxilla and nasal floor in all three open bite groups. 3. There were no difference in anterior and posterior facial height between type I and type II open bite. However, type II open bite showed the backward rotation of the mandible accompanied by over eruption of upper first molars. 4. Type III open bite showed longer anterior lower facial height which was caused by excessive mandibular growth than type I open bite. 5. Upper incisors showed labial inclination as compared with norm in all three open bite groups. However, lower incisors showed labial inclination in type II open bite and lingual inclination in type III open bite as compared with type I open bite. As a result, the inter-incisal angle was small in type II open bite and large in type III open bite as compared with type I open bite. These results suggested that the dentoalveolar factors were large in type II open bite and the skeletal factors were large in type III open bite as compared with type I open bite.

Cephalometry↗
PubMed1997

Treating the open bite.

Tongue thrust is involved in nearly all open bites. An open bite can be created by tongue thrust, tongue posture or mandibular posture. Tongue is an unusual muscle in that its contraction allows it to assume many shapes; its influence in the swallow can create an open bite in the area dictated by the contraction, thrust or rest position. Once space has been created between the upper and lower teeth by the tongue it continues to enter the space created, consequently enlarging the space. Skeletal open bites do not occur in patients whose masseter muscles are active during the swallow (an open bite can develop in these individuals due to habit or during orthodontic therapy). In these individuals the masseters fully contract during the swallow. The weaker the masseter muscles, the more likely an open bite will either be present or may develop during orthodontic treatment. Orthodontic movement will always result in occlusal interferences at some point in treatment. Occlusal interferences during orthodontic treatment make it difficult for patients to find a comfortable biting position. At this point they do not fully contract--"squeeze"--the masseters during the swallow to avoid traumatizing the teeth. Once the masseter squeeze is reduced, the tongue must contribute more to the swallow than when the masseters were more actively involved. The tongue becomes the cushion for the dentition during the swallow. The tongue now positions itself between the teeth during the swallow and the open bite during orthodontic treatment is born. Once the open bite occurs it is best to treat it immediately as the open bite thus created will only worsen with time. If the patient was originally a counterclockwise grower (brachycephalic), it is easier to correct. A clockwise grower (dolichocephalic) is hardest to correct, but can be corrected with patience, perseverance, exercise and a properly constructed tongue thrust appliance. While it is true that some skeletal configurations (i.e. clockwise growers, dolichocephalic facial types) lend themselves to the development of an open bite, the skeletal configuration itself seldom produces an open bite. The tongue is the main progenitor of open bites and it is also responsible for perpetuating the open bite. Dolichocephalic facial types lend themselves to open bite development as any orthodontic treatment which either distalizes molars or allows molars to extrude will tend to wedge the mandible and dentition open. (In this type of patient the masseter muscles develop insufficient force on closure to intrude the molars.) Once the bite opens, the tongue now enters the picture in order to complete the swallow. The open bite immediately worsens. The open bite thus created may require several months to correct. In the clockwise growth patient it is imperative that all precautions be taken during treatment to counteract open bite development. It is also imperative that an open bite, once detected, be treated immediately as the longer it persists the more difficult it becomes to treat. If left untreated, it becomes a habit and the more engrained a habit the more effort needed to change it.

Adolescent↗
PubMed1991

Three-dimensional analyses of human bite-force magnitude and moment.

The effect of the three-dimensional orientation of occlusal force on maximal bite-force magnitude was examined in seven human subjects at three different unilateral anteroposterior bite positions (canine, second premolar and second molar). At each position, bite-force magnitude was registered in 17 precisely defined directions using a three-component force transducer and a feedback method. In addition, to assess the efficiency of transfer of muscle to bite force, for bites produced in the sagittal plane, moment-arm length was determined and the produced bite-force moment calculated. The results showed that the largest possible bite force was not always produced in a direction perpendicular to the occlusal plane. Generally, maximal bite force in medial and posterior directions was larger than that in, respectively, corresponding lateral and anterior directions. In each direction the produced force was larger at the posterior bite point than at the anterior bite point. The combined moment produced by the jaw muscles was largest for vertical bites, smallest for posteriorly directed bites and intermediate for anteriorly directed bites. In the case of vertically and anteriorly directed bites the produced moment did not vary significantly with the bite position. Hence, for these bite positions the jaw closing moment of the muscles must have kept constant. In the case of posteriorly directed bites the produced moment decreased when bite position changed from the anterior to the posterior side of the dentition. This indicated that jaw muscle activity had declined.

Adult↗
PubMed2005

Comparison of the epidemiology of human bites evaluated at three US pediatric emergency departments.

OBJECTIVES: (1) Using clearly defined methods, provide a current assessment of the epidemiology of human bites sustained by pediatric patients evaluated at a pediatric ED; (2) Compare the frequency, demography, locations, and management of these injuries from the results of the current study to the 2 prior ED studies on pediatric human bites; and (3) Determine if the frequency of these injuries varies by year, gender, or body location. METHODS: The current study involved a retrospective analysis of all visits to an urban, northeastern, United States pediatric ED from 1995 to 2001. Visits for human bites were identified by International Classification of Disease, Ninth Revision, Clinical Modification codes using 2 separate computerized billing databases. Data were extracted from 2 prior published studies for the comparative portion of the study. Frequency estimates and 95% confidence intervals were created using STATA7. RESULTS: For the current study, there were 115 visits for human bites, which comprised 0.04% [0.03-0.05] of total visits to this pediatric ED. Bite visits as a percentage of pediatric ED visits remained the same during the 7 years of the current study. For all 3 pediatric EDs, human bites consisted of much less than 1% of the overall patient volume. The majority (65% [55.8-73.9]) of the patients in the current study were male. When adjusted for the frequency of all patient visits by gender, there was no statistically significant difference in percentage of visits for human bites between males and females (0.05% [0.039-0.063] vs. 0.03% [0.023-0.044]) in the current study. Prior studies did not reveal a statistically significant predominance of males presenting for human bites. As a percentage of visits by age group, human bites were more frequent among adolescents in the current study. Altercations and child play were reported approximately equally as the circumstances contributing to the bites in the current study, although altercations were reported more often in older age groups. In all 3 studies, fewer than 14% of patients were admitted and over 80% presented within 12 or 24 hours after the bite. CONCLUSIONS: Pediatric ED visits for human bites are infrequent and from the current study data, the frequency of visits for these injuries appears to be currently stable. Altercations may not be the main circumstances surrounding all pediatric human bites, yet altercations and human bites might be jointly associated with adolescence. The current study results suggest that most pediatric ED human bite patients are male, although males may not necessarily sustain human bites more frequently than females. Visits for human bite injuries may increase in frequency with age, in comparison to visits for other medical conditions.

Adolescent↗
PubMed1979

Epidemiologic and clinical aspects of animal bite injuries.

During 1975, 332 animal bite injuries accounted for 1.2% of all surgical problems treated at the UCLA Hospital Emergency Department. Data on 307 bite injuries were available and analyzed for environmental, animal, human, interaction, and clinical factors. More than half of the dog bites and almost three fourths of the cat bites-scratches happened at or near the victims' homes. Dog bites were almost twice as common among men, while cat bites-scratches were twice as common among women. Of the incidents in which ownership information was available, 85% of dog bites and 80% of cat bites-scratches were from an animal belonging to the victim, his family or friends, or another known person. Forty-three percent of dog bites, and 52% of cat bites-scratches were provoked, that is, happened while the victim was interacting with the animal. Of bites of the head and/or neck, 38% injured the upper lip; 17% of dog bites injured the eye or adjacent tissues; 48% were in children less than ten-years-old. On fifth of cat bites-scratches involved the head and/or neck, 60% of these injured orbital or periorbital tissues. Over 2% of patients were hospitalized. Five percent of dog bite victims and 29% of cat bite-scratch victims returned with complications, mostly cellulitis or lymphangitis. Pasteurella multocida was the most common pathogen cultured, as evidenced by the 50% and 80% culture-positive rates for dog and cat bite-scratches respectively in this series.

Adolescent↗
PubMed2006

Interactive relationship between the mechanical properties of food and the human response during the first bite.

Biting is an action that results from interplay between food properties and the masticatory system. The mechanical factors of food that cause biting adaptation and the recursive effects of modified biting on the mechanical phenomena of food are largely unknown. We examined the complex interaction between the bite system and the mechanical properties. Nine subjects were each given a cheese sample and instructed to bite it once with their molar teeth. An intra-oral bite force-time profile was measured using a tactile pressure-measurement system with a sheet sensor inserted between the molars. Time, force, and impulse for the first peak were specified as intra-oral parameters of the sample fracture. Mechanical properties of the samples were also examined using a universal testing machine at various test speeds. Besides fracture parameters, initial slope was also determined as a mechanical property possibly sensed shortly after bite onset. The bite profile was then examined based on the mechanical parameters. Sample-specific bite velocities were identified as characteristic responses of a human bite. A negative correlation was found between bite velocity and initial slope of the sample, suggesting that the initial slope is the mechanical factor that modifies the consequent bite velocity. The sample-specific bite velocity had recursive effects on the following fracture event, such that a slow velocity induced a low bite force and high impulse for the intra-oral fracture event. We demonstrated that examination of the physiological and mechanical factors during the first bite can provide valuable information about the food-oral interaction.

Adaptation, Physiological↗
PubMed2005

Seven hundred seventy eight bite marks: analysis by anatomic location, victim and biter demographics, type of crime, and legal disposition.

A study of the etiology, anatomic location, victim demographics and legal disposition of bite mark cases was made with the purpose of updating and augmenting previous research in the field. The information may be of interest to a myriad of professional disciplines including Forensic Odontologists, Medical Examiners, Detectives, Profilers, Emergency Room Personnel, Coroners, Psychologists, and Family Service Counselors, as bite marks provide both physical and biological data. While bite marks were found on all anatomic regions of the body some sites are significantly more likely to receive bites, and the frequency that an area is bitten may vary with the type of crime. Sex and age of the victim may also impact the resulting location and frequency of bites. A survey form for bite mark cases was created and mailed to all Diplomates of the American Board of Forensic Odontology. The survey form was also included in the American Society of Forensic Odontology newsletter. The survey requested that the recipient fill out a separate form for each case for which the recipient was the primary investigator of a patterned injury. The data from the resulting surveys were entered into a Microsoft Excel spreadsheet. The responses detailed two hundred thirty two (259) bite mark cases that included seven hundred (778) individual bite marks. Harvey (1976) and Sweet and Pretty (2000) published studies finding the highest percentage of bites to the breasts. In 1983 Vale and Noguchi published the paper indicating that the most frequently bitten area was the upper extremities. The survey forms were sent to approximately 1100 forensic dentist in 26 countries. The forensic experience level of the dentists varied from neophyte to very experienced. The data were analyzed and the results reported and organized in the following categories; Victim Distribution by Gender, Victim Distribution by Age, Child Abuse Distribution by Age and Gender, Sexual Assault Distribution by age and Gender, Homicide Distribution by Age and Gender, Bite Mark Distribution by Gender and Location, Number of Bite Marks per Victim, Bite mark Distribution Comparison to Previous Research, Child Abuse Suspect Age Distribution by Age and Sex, Homicide Suspect Age Distribution by Age and Sex, Sexual Crimes Suspect Age Distribution by Age and Sex, and Bite Mark Incidence by Anatomical Area and Type of Crime. Fifty-two forensic odontologists from seven countries responded. Nineteen responders were Diplomates of the American Board of Forensic Odontology. The number of cases reported by each responder ranged from one to thirty-three and the average number of cases reported was 4.5. In this broad based study, females were bitten more often than males. The average male victim was younger than the average female victim. Males that were victims tended to be either very young or very old. The youngest victim was a two-month-old boy and the oldest victim a 95-year-old woman. Perpetrators were male more often than female and there was an average of 1.4 suspects per case. The results show that most bites occurred on the arm, followed by the breast. If broken down by gender, males were bitten on the arm more than females, and females were bitten on the breast more often than males. The data show patterns in location and number of bites that seem related to both the type of crime and the age of the victim.

Adolescent↗
PubMed1990

[Influences of changing vertical dimension, occlusal contacts of bite plane and body position on masticatory muscle activities].

The Bite plane therapy has been accepted to be useful for treatment of the patients with the stomatognathic dysfunction. The purpose of this study is to make clear the influences of changing the vertical dimension and occlusal contacts of the bite plane on masticatory muscle activities in order to improve the bite plane therapy. The full arch bite plane with an interincisal distance of 5 mm was fabricated for each one of 30 subjects without stomatognathic dysfunction. The EMG activities were recorded from the anterior part of the temporal muscles, the masseter muscles and the anterior belly of the digastric muscles bilaterally while the subject exerted tapping and maximal voluntary clenching in a postural position. Four kinds of experiments were performed as follows. In Exp. 1, integrated EMG activities of each muscle were compared with and without the bite plane. In Exp. 2, the influences of changing the vertical dimension of the bite plane (2.5 mm, 5 mm and 7.5 mm) were tested in 17 subjects. In Exp. 3, the influences of changing the location of occlusal contacts of the bite plane were studied in 12 subjects. In Exp. 4, the influence of changing the body positions on EMG activities and mandibular positions was compared in 30 subjects between the sitting and supine positions. Furthermore, the influence of the same factor was compared with and without the bite plane which was adjusted in each position. The results were summarized as follows: 1. Wearing the bite plane mainly reduced activities of the temporal muscles. 2. The bite plane with an interincisal distance of 5 mm was most effective in reducing activities of the temporal muscles. 3. Wearing the bite plane with anterior occlusal contacts reduced activities of the elevator muscles significantly. 4. Significant differences in activities of the temporal and digastric muscles were recognized between the two body positions when the bite plane was not applied. However, no significant difference was recognized when the bite plane was inserted. Furthermore, those differences were correlated with the difference in the antero-posterior mandibular displacement between the two body positions while the subject tapped the teeth. These results suggest the possibility to control masticatory muscle activities by applying the bite plane with the proper vertical dimension and occlusal contacts. In addition, it is necessary to take a suitable body position for the patient who has a difference in the mandibular displacement between the sitting and supine positions when applying the bite plane.

Dental Occlusion↗
PubMedDate not supplied

An epidemiologic study of the human bite.

The 892 human bites reported to the New York City Department of Health in 1977 were analyzed by time, place, and the victim's characteristics. The bites appeared to have a seasonality, increasing in March and exceeding the mean monthly average through August. The bite rate for the entire city, 10.7 per 100,000 population, was exceeded in 5 of the 10 Brooklyn health districts; one of these districts reported a rate of 60.9 human bites per 100,000 population. Most of the bites with identifiable locations occurred indoors (63.2 percent). In 72.8 percent of the bite episodes in which the activities surrounding them were known, these activities were aggressive in nature. Males exceeded females as bite victims in all age groups except those 10-20 and 55-60 years. Bites of the upper extremity accounted for 61.2 percent of the total bites. Left-sided bites exceeded right-sided, except for the hand. In frequency of reported occurrence, the human bite ranks third, after the dog bite and the cat bite. Human bites may be a useful indicator of antisocial behavior.

Adolescent↗