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PubMed1998

Clinical aspects of orthodontic treatment for children with juvenile chronic arthritis.

Growth abnormalities as a consequence of temporomandibular joint arthritis in children with juvenile chronic arthritis are difficult and complicated problems to treat. The diagnosis of the inflammatory condition in the joint is difficult but important to the success of the interceptive treatment. The diagnostic problems, treatment objectives, and treatment suggestions are discussed in this article.

Activator Appliances↗
PubMed2004

The effects of early headgear treatment on dental arches and craniofacial morphology: a report of a 2 year randomized study.

The aim of the present study was to determine the effects of early headgear treatment on dental arches and craniofacial morphology in children in the early mixed dentition. The total study group comprised 68 children of both sexes (40 boys and 28 girls) aged 7.6 years [standard deviation (SD) 0.3]. The children, who had a Class II tendency in occlusion and moderate crowding of the dental arches, were randomly divided into two groups of equal size, matched according to gender. In the headgear (HG) group, treatment was initiated immediately. The mean treatment time was 16 months. In the second group, which served as the control, only interceptive procedures were performed during the follow-up period. The records, which included dental casts and lateral cephalograms, were obtained after follow-up periods of 1 and 2 years. The lengths and the widths of the maxillary and mandibular dental arches were significantly increased in the HG group after the 2 year follow-up period. The mean increase in lower arch length and width was 2.4 mm (SD 1.7) and 2.2 mm (SD 1.2), respectively. On average, the space gain in the lower arch was half that of the upper arch. No significant changes were found in the arch dimensions of the control group. Maxillary growth restraint and labial tilting of the incisors were the most significant cephalometric findings in the HG group when compared with the controls. The use of headgear in the early mixed dentition is effective in the treatment of moderate crowding. It is noteworthy that significant space gain in the dimensions of the lower arch can be achieved by headgear application to the upper first molars.

Case-Control Studies↗
PubMed2004

Prevalence of malocclusions in the early mixed dentition and orthodontic treatment need.

Early interceptive treatment for the elimination of factors inhibiting dental arch development and mandibular and maxillary growth is applied varyingly by orthodontists, possibly because there is little scientific evidence that such interventions are of actual benefit. The aim of this study was to determine specific factors for treatment need in the early mixed dentition period in order to obtain basic data to support early intervention. The study was part of a larger survey of 8768 children aged between 6 and 17 years. From this sample, 1975 children aged between 6 and 8 years were used to estimate the prevalence of malocclusions using the Index of Orthodontic Treatment Need (IOTN) during the early mixed dentition period. The results showed that deep overbite and overjet, both more than 3.5 mm, were the most frequent discrepancies, affecting 46.2 and 37.5 per cent of patients, respectively. An anterior open bite was registered in 17.7 per cent, crossbite in 8.2 per cent, and a reverse overjet in 3.2 per cent. A tooth width to arch length discrepancy was recorded in 12 per cent of teeth in the upper arch and in 14.3 per cent in the lower arch. The proportion of children estimated using the Dental Health Component of the IOTN to have a great or very great treatment need (grades 4 and 5) was 26.2 per cent. The higher values of treatment need during the mixed dentition period may account for temporary changes in the dentition and for the discrepancy in overjet and overbite. These discrepancies will be compensated in part during mandibular growth and development of the dental arch. Nevertheless, the findings indicate the early development of progressive malocclusion symptoms which are evidenced in the IOTN and concur with the acronym 'MOCDO' hierarchy (missing, overjet, crossbite, displacement, overbite). This early formation of progressive symptoms inhibiting or disturbing mandibular or maxillary growth or the development of the normal dental arch, i.e. crossbite, reverse overjet and increased overjet with myofunctional disorders, should be treated at an early stage.

Adolescent↗
PubMed2005

The effects of early headgear treatment on dental arches and craniofacial morphology: an 8 year report of a randomized study.

The aim of this study was to determine the long-term effects of early headgear (HG) treatment on craniofacial structures. The total study group comprised 68 children (40 males and 28 females) aged 7.6 years (standard deviation 0.3 years). The children, who had a Class II tendency in occlusion and moderate crowding, were randomly divided into two groups of equal size. In the first group, HG treatment was initiated immediately. In the second group, which served as a control group, only minor interceptive procedures were performed during the first follow-up period of 2 years. During the 8 year follow-up, orthodontic therapy, including fixed appliances and possible extractions, was carried out when necessary. The results showed that the most evident difference between the groups was the wider and longer dental arches in the HG group, which could only partly be explained by the higher rate of extractions in the control group. For the cephalometric measurements, the most significant difference was in the maxillary plane orientation. The peer assessment rating (PAR) score, showing the general outcome of treatment, was at the same level in both groups at follow-up. The deficit of the early HG treatment was the longer mean total treatment time, resulting from the two-phase treatment.

Age Factors↗
PubMed1995

The provision of orthodontic services by general dental practitioners. 1. Methods and descriptive results.

Information regarding orthodontic service provision by general dental practitioners in Australia is limited. The aim of this survey was to determine the amount and variety of orthodontic services provided by general dental practitioners in the Melbourne Statistical Division, Victoria, Australia. A random sample of 307 dentists drawn from the Victorian Dentists Register was surveyed by mailed questionnaire: 218 (71%) replied. Data were collected using a fortnight log. During this time 59 per cent of the dentists saw at least one orthodontic patient; one dentist saw 66 orthodontic patients. Removable orthodontic appliances were used by 35 per cent of the dentists and fixed orthodontic appliances by 18 per cent. Twenty-six per cent provided comprehensive orthodontic treatment, 22 per cent aligned incisors, and 21 per cent corrected anterior crossbites. The general dental practitioners surveyed provided a wide range of preventive and interceptive orthodontic services to generally a small percentage of their patients.

Adult↗
PubMed2006

Early orthodontic treatment as a means to increase access for children enrolled in Medicaid in Washington state.

BACKGROUND: The authors assessed the likelihood that interceptive orthodontic Medicaid programs would increase access to care for Washington children. METHODS: The authors surveyed 210 Washington state orthodontists, including questions on demographics, attitudes toward early treatment, use of innovations and perceptions of Medicaid. Respondents were either Medicaid participants or nonparticipants. RESULTS: Fifty of 159 respondents were Medicaid participants. Most respondents perceived early orthodontic treatment as beneficial. Medicaid participants were more willing to participate in Medicaid early-treatment programs, had slightly fewer patients in the "other insurance" category, provided more discounted fees, received more Medicaid inquiries, practiced in rural areas with lower household incomes, reported feeling overworked and experienced fewer Medicaid problems. The principal problem reported with the Medicaid system was low fee reimbursement. CONCLUSIONS: Programs offering early orthodontic treatment could increase access. Important barriers would be low fees and unfamiliarity with Medicaid. PRACTICE IMPLICATIONS: Medicaid should design programs aimed at early treatment with reasonable reimbursement and an educational component.

Attitude of Health Personnel↗
PubMed1993

Intercanine widening and sagittal effect of maxillary transverse expansion in patients with cleft lip and palate during the deciduous and mixed dentitions.

Since 1977 cleft lip and palate (CLP) patients with maxillary deficiency have received an interceptive orthopedic treatment consisting of (a) transverse expansion, (b) protraction, and (c) fixed retention. Ideally the treatment should be completed early enough to permit spontaneous eruption of the maxillary permanent incisors into normal occlusion without orthodontic intervention. The early transverse expansion considerably increases space so that unerupted malpositioned incisors spread out spontaneously, creating optimal conditions for eruption and root formation. Dental diagnosis in the cleft areas is made easier. Posterior crossbites in 112 CLP patients were expanded with a modified quad-helix appliance cemented with four bands in the deciduous or mixed dentition. Intercanine widening was about 3 mm per month regardless of cleft type. Several authors have claimed that transverse expansion of the upper jaw will increase sagittal overjet. Other authors have not found such an effect. The sagittal effect on the maxilla was studied in 68 CLP patients who had received transverse expansion. Analysis of the lateral cephalograms revealed no significant sagittal dentofacial maxillary treatment effects involving forward movement of maxilla, but a downward clockwise rotation of the mandible was found.

Adolescent↗
PubMed1993

Maxillary protraction: different effects on facial morphology in unilateral and bilateral cleft lip and palate patients.

Since 1977 patients with anterior/posterior crossbites in the care of the Bergen CLP team have undergone an interceptive orthopedic protraction phase during the deciduous and mixed dentition period. Eighty-seven cases with complete clefts (63 unilateral and 24 bilateral) displaying anterior crossbite (negative overjet) were treated to normal occlusion. A fixed quad-helix appliance was used in combination with a facial mask. In the unilateral complete cleft lip and palate (UCLP) group, mean age at start of treatment was 6 years 10 months and mean duration was 12 months. In the bilateral complete cleft lip and palate (BCLP) group, mean age at start of treatment was 7 years and mean duration 15 months. The protraction force was 700 g. The sagittal changes during protraction in the UCLP and BCLP groups were compared, and related to the growth changes in a group of noncleft children at the same age. Dentofacial treatment effect was different in the UCLP and BCLP groups. Significant increase of maxillary prognathism (angle s-n-ss) was found only in the UCLP group, whereas the treatment effect in the BCLP group was mainly dentoalveolar. However, after protraction there was no longer a significant difference in maxillary prognathism between the two CLP groups, and the sagittal position of the upper molars was normalized in both groups. The upper incisors remained retroclined in both groups, significantly more in the BCLP group. Increase of the upper facial height (n-sp") and clockwise rotation of the occlusal line were significantly greater in the BCLP group. The computerized occlusal line was unsuitable as a reference standard for the evaluation of sagittal dentofacial treatment changes when the occlusal line was rotated during treatment.

Cephalometry↗
PubMed1993

Soft-tissue profile changes during widening and protraction of the maxilla in patients with cleft lip and palate compared with normal growth and development.

During the last 15 years, cleft lip and palate (CLP) patients with maxillary deficiency in the care of the Bergen CLP team have undergone an interceptive orthopedic treatment phase during the deciduous and mixed dentition period. The present study includes 68 patients who received maxillary transverse expansion by use of a modified quad-helix appliance and 98 cases given maxillary protraction by a facial mask. All cases were treated until an acceptable normal occlusion was attained. Lateral cephalograms were taken immediately before and after the active treatment periods. Sagittal changes of the soft-tissue profile during transverse expansion and protraction were analyzed separately for unilateral complete cleft lip and palate (UCLP) patients and bilateral complete cleft lip and palate (BCLP) patients. The soft-tissue profiles of the groups were compared to growth changes of noncleft age-matched children (NORM group). During the short period of maxillary transverse expansion (mean period, 3.5 months) no significant change of the soft-tissue profile was found, except in the protrusion of the lower lip in the BCLP group. During the period of maxillary protraction (mean periods, 12 months in the UCLP group and 15 months in the BCLP group) the soft-tissue profile improved significantly by reducing the characteristic tendency towards a concave profile in CLP patients with maxillary deficiency. Significant increases of the sagittal maxillomandibular lip relation (angle SS-N-SM: mean increase, 2.5 degrees) and the Holdaway-angle (H-angle: mean increase, 3.0 degrees) were found to be similar in the UCLP and BCLP groups. However, the use of different reference lines for evaluation of treatment effects upon the soft-tissue profile resulted in conflicting findings suggesting that anteriorly situated reference lines are more suitable for the evaluation of CLP patients. Thus, the esthetic line (E.line) indicated a favorable position of the lips after treatment; the subspinale-pogonion line (ss.pg) revealed an improved soft-tissue profile; the soft-tissue-facial line (N.PG) showed a retruded nose and upper lip; whereas basal references such as the nasionsella line (NSL) and the occlusal-line perpendicular (OLP) mainly showed major differences between the CLP groups and the NORM groups.

Cephalometry↗
PubMed1994

Skeletal response to maxillary protraction in patients with cleft lip and palate before age 10 years.

Over the last 15 years, cleft lip and palate (CLP) patients with maxillary deficiency in the care of the Bergen CLP Team have received interceptive orthopedic treatment to correct anterior and posterior crossbites during the deciduous and mixed dentition periods. The present study comprises 72 subjects of various cleft types with anterior crossbite, treated to an acceptable positive overjet by maxillary protraction using a facial mask (Delaire). Lateral cephalograms were taken immediately before and after the active treatment periods. Individuals exhibiting a favorable (fair) skeletal response to the protraction were compared with those who revealed little, (poor) skeletal response. Two cephalometric variables were chosen for the evaluation of the sagittal skeletal treatment changes: (1) the sagittal maxillomandibular change (change of angle ss-n-sm [ANB]); and (2) the forward movement of the maxilla (change of distance NSP-maxp), where maxp (maxillary point) represents the anterior contour of maxilla and NSP is the perpendicular to the nasion-sella-line (NSL) through sella. A numerical change greater than or equal to the value 1.5 (degrees or mm, respectively) was classified as fair versus poor response revealing a change less than 1.5. Fair-response (favorable response) of sagittal maxillomandibular change was found in 63% of the cases (mean increase of angle ANB was 3.3 degrees), more often when protraction started early. The length of maxilla was increased, the skeletal maxilla was moved forward 1.8 mm, the upper dentition advanced 3.6 mm, the occlusal line was clockwise rotated, and the anterior face height was increased. Similarly, fair-response of forward movement of maxilla was found in 44% of the cases (mean increase of distance NSP-maxp was 2.4 mm), more often when protraction was started early and after long treatment duration. The maxillary prognathism increased 1.8 degrees, the angle ANB increased 3 degrees, the length of maxilla increased 1.5 mm, and the upper dentition was advanced 3.7 mm. The anterior face height increased with counterclockwise rotation of the nasal line, whereas the occlusal line was clockwise rotated. A paired fair-response of both skeletal maxillomandibular change and skeletal forward movement of maxilla was found in 35% of the cases. During protraction the mean increase of maxillary prognathism was 2.1 degrees, the maxilla moved forward 3.1 mm, the maxillary dentition advanced 4.3 mm, the maxillary length increased 1.9 mm, the ANB angle increased 3.7 degrees, and the lower anterior facial height increased 3.4 mm.

Cephalometry↗
PubMedDate not supplied

Orthodontic management of mandibular lateral incisor-canine transpositions: reports of cases.

This article presents different treatment aspects in three mandibular lateral incisor-canine transposition cases. The early identification of transposed teeth simplifies orthodontic correction. Incomplete transposition cases can be managed successfully by interceptive orthodontic treatment. If complete transposition occurs, two treatment alternatives may be possible: Extraction of the transposed tooth or keep the teeth in their transposed positions.

Child↗
PubMedDate not supplied

Early treatment mechanics of the Class II division 2 malocclusion.

A most common type of early malocclusion that the pediatric dentist comes in contact with daily is the developing Class II Division 2 malocclusion (Fig 1-a,b). It is the malocclusion that the parents of the children we serve bring to our attention. Parental concern is the early crowding that develops in the anterior of the lower arch with risk of periodontal involvement. This malocclusion is readily amenable to interception at age 7 or 8 and can proceed with a protocol of defined objectives and predictable outcomes (Fig 2). With efficient and effective utility arch wire (UAW) mechanics a state of normalcy can be achieved within six to eight months of treatment.

Child↗
PubMed2000

A review of impacted permanent maxillary cuspids--diagnosis and prevention.

As impacted permanent maxillary cuspids occur in 1-2% of the population, the general dentist should know the signs and symptoms of this condition and the interceptive treatment. Features of buccal or palatal cuspid impaction include lack of canine bulges in the buccal sulcus indicating a lingual eruption path and possible impaction; lack of symmetry between the exfoliation and eruption of cuspids that may indicate palatal or lingual impaction; and abnormal mesiodistal location and angulation of the developing maxillary permanent cuspids on radiographs. Diagnosis of impacted cuspid teeth at age 8-10 years can significantly reduce serious ramifications, including surgical exposure and orthodontic alignment as well as root resorption of the lateral incisors. In specific cases, extraction of the primary maxillary cuspids can prevent impaction of the permanent maxillary cuspids and additional sequelae.

Child↗
PubMed2000

[Early orthodontic treatment, a diagnostic challenge].

This article investigates which growth anomalies require early orthodontic interception, that is before the age of 9 years. The diagnosis should be established at three levels: the skeletal jaw relationship including the facial profile, dental space problems determined by the apical base area, and function. Rather than to advise on mechanotherapy emphasis is placed on improvement of diagnostic skills because, contrary to therapy, making a diagnosis cannot be delegated. The analysis at the three diagnostic levels shows that only a limited number of situations demand early treatment. Among these are a negative overjet, a cross-bite, open mouth posture, and sometimes a space maintainer after extraction of deciduous molars. Special precautions are required when front teeth become ankylosed at an early age after trauma. In case of doubt the general practitioner is advised to seek orthodontic counseling from a specialist.

Age Factors↗
PubMed2001

[Orthodontic treatment in children and adults].

Orthodontics is concerned with the study of dental-maxillofacial development, and the analysis and treatment of anomalies in this development. The orthodontic approach commences with the monitoring of oro-facial functions as of the early stages of childhood (3 to 4 years). This first stage is chiefly preventative. Interceptive orthopaedic treatment is performed, if necessary, on young patients who have reached the mixed dentition stage. This treatment involves the use of fixed or removable braces to correct any irregularity in the maxillofacial development and dental malposition. The treatment for most dental malpositions commences as of the setting in of the secondary dentition (11 to 13 years). The movements of the teeth in the three precise spatial directions are defined with the use of fixed braces. Residual maxillary deformities (prognathism, retrognathism, laterognathism, etc.) are corrected at the end of the growth process or in adulthood through fixed orthodontic treatment combined with maxillofacial osteotomies. Adult patients are treated with the same fixed orthodontic techniques and according to a therapeutic protocol adapted to their specific dental or periodontal mutilations.

Adolescent↗
PubMed2000

Early intervention: the mixed dentition.

The mixed dentition phase of tooth eruption can continue for up to six years from the eruption of the permanent molars to the complete replacement of all deciduous teeth. Early intervention is indicated to intercept developing problems in function. This paper will discuss the treatment of ectopic eruption of maxillary first permanent molars with removable appliances and the correction of molar crossbites with fixed appliances.

Dentition, Mixed↗
PubMed1994

[Preventive orthodontics].

In this article orthodontic preventive and interceptive measures are discussed. The number of environmental factors that can be influenced to prevent malocclusions is rather small.

Child↗