Dentofacial growth in patients with Sotos syndrome.

Bull Tokyo Dent Coll. 2007 May;48(2):73-85

Authors: Takei K, Sueishi K, Yamaguchi H, Ohtawa Y

Sotos syndrome is an overgrowth syndrome leading to peculiar facial characteristics, large hands and feet, and mental retardation. The maxillofacial characteristics are metopic protrusion, a high and narrow palate and a tapered mandible. In this study, we evaluated changes in maxillofacial growth in 2 patients with cerebral gigantism during the peripubertal period. Patient 1 was a boy aged 8 years at the first examination. The face showed midface retraction and a tapered mandible. Maxillary median diastema with an OJ of 2.5 mm and OB of 1.0 mm was observed, and the molar region showed mandibular mesial occlusion. Radiography revealed a lack of 15, 25, 37, 47, 14, 24, 34 and 44. Cephalometrics demonstrated maxillary and mandibular retrusion with an SNA of 68 degrees and an SNB of 70 degrees , and the patient had leptoprosopia with a mandibular plane of 38.0 degrees . This plane was 45 degrees at the time of re-examination when the patient was 14 years old, showing an increase in the lower facial height and decreases in facial axis and depth. Patient 2 was a boy aged 14 years at the first examination. The face showed mandibular retrusion and tapering. The occlusion was angle class II div. 1, OJ 14 mm, and OB -1 mm. Cephalometrics demonstrated maxillary and mandibular retrusion with an SNA of 74.5 degrees and an SNB of 69.5 degrees , and the patient had leptoprosopia with a mandibular plane of 37.0 degrees . At the time of re-examination, when the patient was 16 years old, the mandibular plane was 42.5 degrees , showing an increase in lower facial height and decreases in facial axis and depth. In this syndrome, excessive facial height without mandibular forward overgrowth is observed. Since the facial height tended to increase by growth during the peripubertal period, maxillofacial vertical growth is considered important in the treatment of this syndrome.

PMID: 17978548 [PubMed - indexed for MEDLINE]

Importance of occlusion aspects in the completion of orthodontic treatment.

Braz Dent J. 2007;18(1):78-82

Authors: Oltramari PV, Conti AC, Navarro Rde L, Almeida MR, Almeida-Pedrin RR, Ferreira FP

The purpose of this study was to address the therapeutic goals regarding the static and functional occlusion in the completion of orthodontic treatment. For such purpose, a study population comprising 20 female treated Class II malocclusion subjects with an initial mean age of 11 years underwent a two-phase treatment (orthopedics and orthodontics). The patients were diagnosed in centric relation and were treated according to the six keys for normal occlusion and functional occlusal parameters (centric relation, vertical dimension, lateral and anterior guidances, occlusal contacts and direction of forces applied on the teeth). After removal of fixed mechanics, retainers were installed and maintained for two years. Five years after orthodontic completion, the occlusal stability of the patients was evaluated regarding molar relationship and overjet, measured in dental casts. All subjects maintained the normal molar relationship and correct overjet achieved at the end of treatment, indicating a fair level of occlusal stability. The importance of the criteria of the ideal functional occlusion to ensure a better stability after completion orthodontic treatment will be discussed in detail in this paper. In addition, some clinical situations in which localized adjustments are indicated for occlusal refinement will be described.

PMID: 17639207 [PubMed - indexed for MEDLINE]

Effects of activator and high-pull headgear combination therapy: skeletal, dentoalveolar, and soft tissue profile changes.

Eur J Orthod. 2007 Apr;29(2):140-8

Authors: Marşan G

The aim of this study was to evaluate skeletal, dentoalveolar, and soft tissue profile changes with activator and high-pull headgear combination therapy in patients with Class II malocclusions caused by maxillary prognathism and mandibular retrognathism. The subjects, all in the mixed dentition, were selected from a single centre and were divided into two groups: 28 patients were treated with an incisor double capping activator and a high-pull headgear combination appliance (13 girls, 15 boys mean chronological age 11.7 +/- 1.2 years, skeletal age 12.1 +/- 1.4 years) and an untreated group of 28 subjects (14 girls, 14 boys mean chronological mean age 11.9 +/- 1.1 years, skeletal age 12.3 +/- 1.3 years). The skeletal, dentoalveolar, and soft tissue profile changes that occurred were compared on lateral cephalograms taken before treatment (T0) and after 1.1 +/- 0.3 years when the combination appliance was removed (T1). In the control group, the radiographs were obtained at the start (T0) and after an observation period 1.2 +/- 0.4 years (T1). Statistical analysis was undertaken with Wilcoxon's ranked-sum test for intra-group comparisons and differences between groups with t-test and Bonferroni's test at a level of significance of P < 0.05. Activator and high-pull headgear combination treatment in these growing patients resulted in a correction of the skeletal Class II relationship (ANB -3.4 degrees), a restriction of maxillary growth (SNA -2.0 degrees, OLp-A -2.3 mm), an advancement of the mandibular structures (SNB +2.6 degrees, FH-NPg +2.3 degrees, OLp-B +2.7 mm, OLp-Pg +2.2 mm), an increase in lower face height (ANS-Me +3.9 mm), a correction of the overjet (-5.4 mm), an improvement in overbite (-2.2 mm), uprighting of the maxillary incisors (U1-FH -5.3 degrees, OLp-U1 -2.5 mm), protrusion of the mandibular incisors (IMPA +2.0 degrees, OLp-L1 +2.7 mm), and a correction of the dental Class II malocclusion (OLp-L6 +3.5 mm). The soft tissue profile changes were a correction of facial convexity (G'-Sn-Pg' angle 2.3 degrees, Mlf-Li-x-axis angle 9.1 degrees), and an increase in lower antero-posterior (Mlf-y-axis 5.6 mm, Pg'-y-axis 5.3 mm), and lower vertical (Sls-x-axis 3.8 mm, Pg'-x-axis 3.8 mm, Me'-x-axis 5.1 mm) soft tissue dimensions. The mentolabial fold depth (Mlf-E line) also significantly decreased, -0.8 mm in the treated group. The activator and high-pull headgear combination appliance was effective in treating growing patients with maxillary prognathism, mandibular deficiency, and facial convexity by a combination of skeletal and dentoalveolar changes and improvement in the soft tissue facial profile.

PMID: 17488997 [PubMed - indexed for MEDLINE]

A controlled clinical trial of the effects of the Twin Block and Dynamax appliances on the hard and soft tissues.

Eur J Orthod. 2007 Jun;29(3):272-82

Authors: Lee RT, Kyi CS, Mack GJ

The aim of this controlled trial was to identify and quantify skeletal, soft tissue and dental changes during treatment, and immediately post-treatment with Twin Block (TB) or Dynamax appliance using the techniques of three-dimensional (3D)optical surface laser scanning, cephalometric, and clinical measurements. Sixty-two Caucasian subjects, 36 males aged 11-14 years and 26 females aged 10-13 years were enrolled in the study. The patients were placed in two groups, matched for gender and age and subsequently allocated randomly for treatment with either a TB or Dynamax appliance. Active treatment lasted 9 months followed by 3 months' post-treatment observation. Laser scanning and clinical measurements were taken at 3-monthly intervals and final cephalometric records after 12 months. Statistical analysis was performed using Wilcoxon's matched-pairs signed-rank tests. The non-compliance rates were the same for both groups (9 per cent), but a greater incidence of breakages was found in the Dynamax group. The TB was found to produce slightly more antero-posterior skeletal change, median ANB reduction, TB=2 degrees, Dynamax 1.1 degree (P=0.006), and similar forward movements of the chin and was associated with larger increases in the vertical facial dimension, median total anterior face height increase; TB=3.2 mm, Dynamax = 2.8 mm (P=0.03). The soft tissue vertical cephalometric increases were 3.6 mm with the TB, 2.0 mm with the Dynamax (P=0.036), and with laser scanning 5.05 and 2.6 mm, respectively, a difference which is likely to be more clinically relevant. The median post-treatment changes in soft tissue pogonion were -0.65 mm in the TB and +0.22 mm in the Dynamax group. The optical surface scanning mark and measure system is a valid method for quantifying soft tissue changes.

PMID: 17456506 [PubMed - indexed for MEDLINE]

[Study of facial soft tissue profile on angle Class II malocclusion with various vertical growth patterns]

Shanghai Kou Qiang Yi Xue. 2006 Oct;15(5):469-72

Authors: Zhao YH, Wang CL, Liu DX, Wei FL, Zhu K

PURPOSE: To investigate the difference of the facial soft tissue profile on Angle Class II malocclusion with various vertical growth pattern. METHODS: The samples (n = 84) were divided into three groups (low-angle, medial-angle, high-angle group) based on their SN-MP angle. Their cephalograms were measured and all data were analyzed by SPSS12.0 software. RESULTS: There were some regular changes in most facial profile variables while the mandibular plane angle increased: the facial profile convexity and the upper- and lower-lip convexity increased significantly; the depth of anterior lower face decreased from too large to small; the radian of upper- and lower- lip curve changed from too winding to upright. CONCLUSION: Vertical growth patterns make significant differences to soft tissue facial profile on Angle Class II malocclusion.

PMID: 17348216 [PubMed - in process]

Comparison of the headgear activator and Herbst appliance--effects and post-treatment changes.

Eur J Orthod. 2006 Dec;28(6):594-604

Authors: Phan KL, Bendeus M, H&#xE4;gg U, Hansen K, Rabie AB

The aim of this study was to evaluate the effects of the headgear activator (HGA) and Herbst appliance during active treatment and retention and at follow-up in children with a skeletal Class II malocclusion. The two groups comprised 16 consecutive male patients (mean age 11.6 +/- 1.42 years) treated with a HGA and 16 male patients (mean age 12.6 +/- 1.13 years) treated with a Herbst appliance and Andresen activator (HAA) sampled from a larger pool using similar selection criteria. Growth data were obtained for the two groups. Lateral cephalograms taken at the start, after 6 months of treatment, after 12 months of active treatment or 6 months of retention, and at the 24-month follow-up were analysed. The total changes over the whole observation period (T0-T3) did not differ significantly between the groups; there was, however, a statistically significant increase in jaw prognathism (P < 0.05) and improvement of the molar relationship (P < 0.05) in the HAA group as compared with the HGA group. During the initial treatment phase (T0-T1), the overall treatment effects were statistically more pronounced in the HAA group than in the HGA group. Despite significant differences in treatment effects and changes between the two devices, there were no significant overall changes at follow-up except for the prognathism, i.e. maxillary prognathism decreased with treatment with the HGA while mandibulars prognathism continued to increase with HAA treatment.

PMID: 17142260 [PubMed - indexed for MEDLINE]

The influence of functional orthodontics and mandibular sagittal split advancement osteotomy on dental and skeletal variables--a comparative cephalometric study.

Eur J Orthod. 2006 Dec;28(6):553-60

Authors: Lohrmann B, Schwestka-Polly R, N&#xE4;gerl H, Ihlow D, Kubein-Meesenburg D

Lateral head films of 200 Class II patients (106 females, 94 males) with a mean pre-treatment age range of 9.9-10.25 years successfully treated with functional orthodontics were analysed before (T1) and after (T2) treatment. The resulting data and findings were compared with lateral head films (T1, T2) of 20 patients (15 females, five males) with a mean pre-treatment age of 25.75 years whose Class II malocclusion and antero-posterior jaw discrepancy had been corrected by a mandibular sagittal split advancement osteotomy. The median and interquartile distances were calculated for every variable, at T1 and T2. The difference between the medians (T2-T1) was analysed using a signed rank test. The changes in scattering (T2-T1) were assessed by means of a F-test. Significant differences regarding the therapeutic influence on skeletal [ANB, Wits, Index, mandibular line-nasal line (ML-NL)], functional (beta', mu), and dental (1-NA degrees , 1-NB degrees ) variables were found. In the group initially treated with functional appliances in order to enhance mandibular prognathism, the antero-posterior (A-P) jaw discrepancy was reduced (ANB, Wits). The vertical skeletal pattern (Index) changed towards a more skeletal open relationship, whereas the ML-NL angle was reduced, which indicates a deepening of the bite. The comparison between biomechanical incisor position analysis (beta', mu) and dental variables (1-NA degrees , 1-NB degrees ) revealed different changes in incisor inclination depending on the type of analysis used. The findings for the dental variables (1-NA degrees , 1-NB degrees ) showed a protrusion of both upper and lower incisors after therapy. The results for the functional variables (beta', mu) showed a retrusion of the upper and a protrusion of the lower incisors. This change in incisor inclination is a dental compensation of the remaining sagittal jaw discrepancy. This effect is most clearly reflected by the functional analysis and the changes of the biomechanical variables beta' and mu. For the orthognathic surgery group, a clear improvement in the dental and skeletal relationship was observed: the skeletal discrepancies in the A-P plane were completely corrected (ANB, Wits) and the inclination of the incisors according to biomechanical and functional aspects was optimized (beta', mu).The alteration in both the Index and ML-NL angle in this group indicated an increase of the open bite components.

PMID: 17142259 [PubMed - indexed for MEDLINE]

A systematic review of cephalometric facial soft tissue changes with the Activator and Bionator appliances in Class II division 1 subjects.

Eur J Orthod. 2006 Dec;28(6):586-93

Authors: Flores-Mir C, Major PW

The objective of the present systematic review was to evaluate, through lateral cephalograms, facial soft tissue changes after the use of the Activator and Bionator appliances in Class II division 1 malocclusion subjects. Several electronic databases (PubMed, Medline, Medline In-Process and Other Non-Indexed Citations, Cochrane Database, Embase, Web of Sciences, and Lilacs) were searched with the assistance of a senior health sciences librarian. Abstracts, which appeared to fulfil the initial criteria, were selected by consensus. The original articles were then retrieved. Their references were also hand searched for possible missing articles. Clinical trials, which assessed facial soft tissue changes with the use of either an Activator or a Bionator appliance without any surgical intervention or syndromic characteristics, were considered. A comparable untreated control group was required to factor out normal growth changes. Five articles using the Activator and six using the Bionator fulfilled the selection criteria and quantified facial soft tissue changes. An individual analysis of these articles was undertaken and some methodological flaws were identified. Based on the available evidence, a significant amount of controversy regarding the soft tissue changes produced by the Activator and the Bionator exists. Soft tissue changes that were reported as being statistically significant were of questionable clinical significance. Long-term, double-blinded, prospective randomized clinical trials are needed to confirm the findings. Three-dimensional quantification is also required to overcome current limitations in our understanding of the soft tissue changes obtained with the use of removable functional appliances.

PMID: 17095741 [PubMed - indexed for MEDLINE]

Maxillary third molar position in Class II malocclusions: the effect of treatment with and without maxillary premolar extractions.

Eur J Orthod. 2006 Dec;28(6):573-9

Authors: Janson G, Putrick LM, Henriques JF, de Freitas MR, Henriques RP

The present study compared the number of erupted and functioning maxillary third molars and their mesio-distal angulation in patients with Class II malocclusions orthodontically treated with and without extraction of two maxillary premolars and fixed appliances. For that purpose, the records of 55 patients were selected, which were divided into two groups. Group 1 was treated without extractions and comprised 28 patient records (19 males and 9 females), with a mean age of 19.03 years [standard deviation (SD) = 2.33], treatment time of 2.59 years (SD = 1.08), and follow-up time of 6.48 years (SD = 2.42). Group 2 was treated with extractions and comprised 27 patient records (14 males and 13 females), with a mean age of 19.94 years (SD = 2.87), treatment time of 2.95 years (SD = 1.17), and follow-up time of 5.88 years (SD = 2.96). Analysis of the erupted and functioning maxillary third molars was conducted on the maxillary and mandibular dental casts. The mesio-distal angulations of the maxillary third molars were assessed on panoramic radiographs with the presence of both maxillary third molars. The results demonstrated that the number of erupted and functioning maxillary third molars was statistically greater (P = 0.01) in Class II subjects treated with extraction of maxillary premolars, when compared with those treated without extractions. The patients treated with two maxillary premolar extractions presented significantly smaller third molar mesio-distal angulations, that are more favourable to eruption, than those treated non-extraction.

PMID: 16957059 [PubMed - indexed for MEDLINE]

The benefits of aesthetic orthodontic brackets in patients requiring multiple MRI scanning.

J Orthod. 2006 Jun;33(2):90-4

Authors: Harris TM, Faridrad MR, Dickson JA

MRI scans are increasingly used diagnostically in medicine. Scans of the head and neck region can be distorted by metallic components in the vicinity. This paper discusses the consideration for aesthetic brackets (with no metal components) on all teeth including molars in patients requiring MRI scans and especially if those need to be repeated on a regular basis.

PMID: 16751430 [PubMed - indexed for MEDLINE]

The Dynamax system: a new orthopaedic appliance and case report.

J Orthod. 2006 Jun;33(2):78-89

Authors: Bass NM

The Dynamax appliance is a treatment modality for the correction of the Skeletal II malocclusion characterized by a mandibular retrusion. Progressive mandibular advancement, maxillary expansion, control of maxillary growth, incisor torque and control of vertical facial development are incorporated into a two-part appliance. The design facilitates laboratory construction, clinical handling and patient acceptability. A prefabricated spring module forms the basis of the appliance, allowing both maxillary expansion and mandibular advancement. An easily adjustable progressive forward position of the lower jaw makes a construction bite unnecessary. The spring module provides most of the structure of the appliance so that minimal acrylic is required and the appliance is fully contained within the freeway space. Contact between the upper and lower parts of the appliance occurs posteriorly in the lingual sulcus. Here the depth permits an extended vertical contact, to maintain a protrusive mandibular position throughout the range of mandibular opening, including during sleep. The lower portion of the appliance may be fixed or removable and multibracket treatment can be carried out in one or both arches at the same time as the orthopaedics.

PMID: 16751429 [PubMed - indexed for MEDLINE]

Unilateral molar distalization with a modified slider.

Eur J Orthod. 2006 Aug;28(4):361-5

Authors: Sayinsu K, Isik F, Allaf F, Arun T

Although there are numerous publications on bilateral non-compliance molar distalization appliances, there is limited information on problems such as asymmetrical unilateral Class II malocclusions. The aim of the present investigation was to examine the distalization of molars unilaterally in patients with a unilateral Class II molar relationship utilizing a Keles Slider, designed without a bite plane. Ten girls (mean age 13.94 +/- 2.13 years) and seven boys (mean age 13.12 +/- 1.51 years) comprised the study material. Following insertion of the appliance, the patients were seen monthly and the screw was reactivated every 2 months. After a super-Class I molar relationship was achieved, the appliance was removed and the molars were stabilized with a Nance appliance for 2 months before the second-phase of orthodontic treatment. The Nance appliance was maintained in the palate until the end of canine distalization. Lateral cephalometric radiographs were obtained before and immediately after insertion of the molar distalizer. The results showed that the maxillary first molars were distalized bodily on average by 2.85 mm. The maxillary first premolars moved forward bodily 2 mm and were extruded 2.03 mm. In all, 1.32 mm of protrusion, 1.12 mm of extrusion, and 1.79 degrees of proclination of the upper incisors were observed. The mandibular incisors and mandibular molars erupted 0.83 and 0.95 mm, respectively. The unilateral Keles Slider distalized molars successfully to a Class I molar relationship.

PMID: 16648210 [PubMed - indexed for MEDLINE]

Herbst/multibracket appliance treatment of Class II division 1 malocclusions in early and late adulthood. a prospective cephalometric study of consecutively treated subjects.

Eur J Orthod. 2006 Aug;28(4):352-60

Authors: Ruf S, Pancherz H

A prospective study of 23 consecutive adult Class II division 1 malocclusion subjects (19 female and 4 male) treated with the Herbst/multibracket (MB) appliance is presented. The skeletal, dental, and facial profile changes were evaluated in addition to the mechanism of Class II correction during the Herbst phase and the settling of the occlusion during the MB phase. The mean pre-treatment age of the subjects was 21.9 years (15.7-44.4 years). Lateral head films in habitual occlusion from before treatment (T1) and after the Herbst (T2) and MB (T3) phases were analysed using standard cephalometrics and the sagittal occlusion analysis. For the standard cephalometrics, normal growth standards were utilized as control parameters. All patients were treated successfully to a Class I occlusal relationship with a normal overjet and overbite. The mandibular variables (SNB and SNPg) showed an angular increase (1.22 and 0.93 degrees, respectively) during T2-T1 followed by an angular reduction (0.40 and 0.23 degrees, respectively) during T3-T2. Compared with normal growth standards, all mandibular parameters were affected favourably by Herbst/MB treatment. Both the skeletal and soft tissue profile convexities were significantly reduced. Over the entire observation period (T3-T1), the largest amount of profile convexity reduction was seen for the soft tissue profile excluding the nose (mean 3.14 degrees). Class II correction was achieved by both skeletal and dental changes: overjet correction by 13 per cent skeletal and 87 per cent dental changes, and molar correction by 22 per cent skeletal and 78 per cent dental changes. In conclusion, on a short-term basis, the Herbst/MB appliance combination was found to be a powerful tool for non-surgical, non-extraction, treatment of Class II division I subjects in early and late adulthood.

PMID: 16644850 [PubMed - indexed for MEDLINE]

Maxillary midline diastema: a case report involving a combined orthodontic/maxillofacial approach.

J Orthod. 2006 Mar;33(1):22-7

Authors: Campbell A, Kindelan J

This paper presents an orthodontic case of a large (14.5 mm) maxillary midline diastema that was related to the presence, and subsequent removal of 2 median maxillary supernumerary teeth and resulting bone loss. A combined orthodontic and maxillofacial approach involving bone grafting and fixed appliances was used to close the space. This episode of care was organized as interceptive treatment during development of the permanent dentition.

PMID: 16514130 [PubMed - indexed for MEDLINE]

BOS MOrth Cases Prize 2004.

J Orthod. 2006 Mar;33(1):7-21

Authors: U&#xFF;s JO

This paper describes the clinical orthodontic treatment of 2 cases that were successfully entered for the 2004 American Orthodontics MOrth Cases Prize. The first case is that of a patient presenting with a Class III malocclusion treated with rapid maxillary expansion and protraction headgear followed by fixed appliance therapy. The second case demonstrates the use of fixed appliances to correct a moderate Class II division I malocclusion.

PMID: 16514129 [PubMed - indexed for MEDLINE]

Twin-block re-activation.

J Orthod. 2006 Mar;33(1):3-6

Authors: Brennan JA, Littlewood SJ

This paper briefly reviews reasons for re-activating Twin-blocks, discussing different approaches and describing a new, simple, cost effective approach, which can be undertaken at the chairside.

PMID: 16514128 [PubMed - indexed for MEDLINE]

Effects of a segmented removable appliance in molar distalization.

Eur J Orthod. 2006 Feb;28(1):65-73

Authors: Akin E, Gurton AU, Sagdic D

The aim of the present investigation was to evaluate the skeletal and dentoalveolar treatment effects of a segmented removable appliance [removable molar distalizer (RMD)] for molar distalization. The study was conducted on 28 patients (12 females and 16 males), with a mean age of 11.8 years. All presented with a skeletal Class I malocclusion and a bilateral dental Class II molar relationship. The pre- and post-distalization records included lateral head films, study models and standard photographs. The findings were evaluated with a paired samples t-test. The average maxillary first molar distalization with the RMD was 3.98 mm, with 4.61 degrees of distal tipping. The maxillary second premolars drifted distally 2.13 mm on average with 1.54 degrees of distal tipping, while the maxillary first premolars showed 1.23 mm of mesial movement and 1.98 degrees of mesial tipping. The incisors protruded 1.09 mm with 1.27 degrees of labial tipping. The RMD was effective in distal molar movement and all patients attained a bilateral Class I molar relationship in an average period of 4.5 months. Hygiene problems and mucosal irritations, frequently found with fixed intraoral distalization techniques, were not observed during the distalization period.

PMID: 16436365 [PubMed - indexed for MEDLINE]

A comparative study of cephalometric and arch width characteristics of Class II division 1 and division 2 malocclusions.

Eur J Orthod. 2006 Apr;28(2):179-83

Authors: Isik F, Nalbantgil D, Sayinsu K, Arun T

The aim of this compound cephalometric and arch-width study was to determine any dental and/or skeletal differences between subjects with Class II division 1 and Class II division 2 malocclusions. The dento-skeletal characteristics of Class II subjects were evaluated using lateral cephalometric radiographs and dental casts of 90 untreated patients. The sample included 46 Class II division 1 patients (19 girls and 27 boys) with a mean age of 15.27 +/- 2.48 years, and 44 Class II division 2 patients (27 girls and 17 boys) with a mean age of 15.95 +/- 3.25 years. The intermolar, interpremolar and intercanine measurements were carried out on study models. The radiographs were digitized and processed using Dolphin Imaging software. In addition to standard descriptive statistical calculations, an independent samples t-test was carried out in order to compare the two groups. The non-parametric Mann-Whitney U test was utilized for the parameters for the data which were not normally distributed. The only statistically significant difference between the groups for the study model measurements was mandibular intercanine width. The cephalometric results revealed that SNB angle was responsible for the skeletal sagittal difference between the two groups. In addition, the Class II division 1 group had higher vertical proportions and the Class II division 2 group a more concave profile with a prominent chin. The sagittal skeletal pattern of Class II division 2 subjects was found to be very similar to the Class I skeletal relationship, with no evidence of any mandibular restriction.

PMID: 16431898 [PubMed - indexed for MEDLINE]

A computerized photographic assessment of the relationship between skeletal discrepancy and mandibular outline asymmetry.

Eur J Orthod. 2006 Apr;28(2):97-102

Authors: Good S, Edler R, Wertheim D, Greenhill D

The aim of this study was to investigate the relationship between mandibular outline asymmetry and skeletal discrepancy in a sample of orthodontic patients (33 females, 33 males) aged from 8 to 19 years. Skeletal discrepancy was assessed in both the anteroposterior and vertical planes, using standard cephalometric analyses. All were photographed under standardized conditions and the photographs were then digitized for analysis using a computerized system to assess differences in four variables (area, perimeter, compactness and moment-ratio) between the right and left sides of the mandibular outline. The results showed good repeatability of the photographic, cephalometric and digitization methods. A statistically significant relationship was found between mandibular outline asymmetry and both anteroposterior and vertical skeletal discrepancy in this sample, when compared with patients with an average skeletal pattern. There appeared to be a statistically significant relationship between a reduced ANB angle (< 3 degrees) and mandibular outline asymmetry (P = 0.051), as well as between an increase in lower face height and mandibular asymmetry (P = 0.023).

PMID: 16431897 [PubMed - indexed for MEDLINE]

Increase of condylar displacement between centric relation and maximal habitual intercuspation after occlusal splint therapy.

Braz Oral Res. 2005 Jul-Sep;19(3):176-82

Authors: Fantini SM, Paiva JB, Rino Neto J, Dominguez GC, Abr&#xE3;o J, Vigoritto JW

The present study assessed condylar displacement between initial maximal habitual intercuspation (MHI) and centric relation (CR), recorded after using a deprogramming occlusal splint for an average period of 7.8 +/- 2.1 months prior to any orthodontic treatment. The sample consisted of 22 subjects, 11 male and 11 female, with an average age of 14.2 +/- 1.4 years, with Class II malocclusion and with no apparent signs or symptoms of temporomandibular dysfunction (TMD). Condylar displacement was measured using a Panadent axis position indicator in decimal fractions of a millimeter. The original mean vertical displacements and the corresponding standard deviations were 4.24 +/- 2.53 mm and 3.86 +/- 2.72 mm, respectively, for the right and left sides. Because a significant negative correlation was observed between original condylar displacements and age factors, the displacement values were statistically adjusted to 2.74 +/- 2.00 mm and 2.44 +/- 1.93 mm. On the horizontal plane, the mean displacements measured were -0.72 +/- 1.53 mm on the right side and -0.51 +/- 1.98 mm on the left. The mean displacement on the transversal plane was 0.03 +/- 0.87 mm. A comparison between these values and those observed in non-deprogrammed groups, as well as those published in the related literature, indicates that use of occlusal splints results in greater mean condylar displacement values, especially vertically, between CR and MHI positions, which contributed to a more accurate orthodontic diagnosis.

PMID: 16308604 [PubMed - indexed for MEDLINE]

Masticatory performance in children and adolescents with Class I and II malocclusions.

Eur J Orthod. 2006 Apr;28(2):112-9

Authors: Toro A, Buschang PH, Throckmorton G, Rold&#xE1;n S

It is not fully understood whether masticatory performance is compromised in individuals with the more common forms of malocclusion (i.e. Class I and Class II). The aim of this prospective investigation was to establish the relationships between masticatory performance, malocclusion (type and severity), age, body size and gender, in children and adolescents. A total of 335 individuals were examined at the average ages of 6, 9, 12 and 15 years. Each subject's occlusal status was described by Angle classification and by the Peer Assessment Ratio (PAR) index. Masticatory performance was quantified by the median particle size (MPS) and the broadness of particle distribution using artificial food. Masticatory performance improved significantly with age. The 6-year-old children were less able to break down the food particles (MPS 4.20 mm2) than the 15 year olds (MPS 3.24 mm2). Analysis of covariance showed that age differences in performance are related to an increase in body size. There were statistically significant differences in masticatory performance between children with normal occlusion and those with a Class I malocclusion; no differences were found between normal occlusion and Class II malocclusion. Gender differences did not explain the variation in masticatory performance. It is concluded that occlusal indices are not reliable predictors of masticatory performance. Traditional descriptors of malocclusion type and severity apparently cannot explain most of the variation in masticatory performance in children and adolescents.

PMID: 16272209 [PubMed - indexed for MEDLINE]

Assessment of open and incomplete bite correction by incisor overlap and optical density of polyvinyl siloxane bite registration.

Eur J Orthod. 2006 Apr;28(2):166-72

Authors: Shpack N, Einy S, Beni L, Vardimon AD

Open bite (OB) is a generalized term, which could incorporate subgroups that react differently to vertical correction. The objectives of the present study were to detect vertical treatment changes in incomplete bite (IB: inter-incisor overlap with no lower incisor contact with teeth or palate) and OB (no inter-incisor overlap) groups compared with a complete bite (CB: inter-incisor overlap with full lower incisor contact with teeth or palate) control group, to evaluate treatment response of the central and lateral incisors, and to study the vertico-sagittal interaction. Dental casts were taken at three time points, pre-treatment, post-treatment, and after one year of retention, from 54 Class II patients (22 males and 32 females with a mean age of 11 years 6 months) divided into three groups: CB (n = 21), IB (n = 18) and OB (n = 15). Measurements included incisor overlap (mm) and optical density (OD/mm2) of occlusal bite registration made of polyvinl siloxane. Both CB and IB groups demonstrated post-retention bite opening. However, bite opening in the CB group was three times greater than that in the IB group (e.g. lower lateral = -1.42 mm, 118 OD/mm2 versus -0.40 mm, 107 OD/mm2). Conversely, the OB group showed a significant (P < 0.001) bite closure (e.g. lower lateral = 1.30 mm, -377 OD/mm2). Overjet changes affected OD measurements, causing diversity in OD and millimetric measurements of the lateral incisors in the IB group. In conclusion, the OB group demonstrated a significant stable vertical correction; a post-treatment non-contact inter-incisor relationship was determined by a vertico-sagittal relapse; and full compensation of an IB was not possible.

PMID: 16267127 [PubMed - indexed for MEDLINE]

The diary of an orthognathic patient aged 30 3/4.

J Orthod. 2005 Sep;32(3):169-74

Authors: Murphy TC

This article reports on the experiences of an orthodontist who has actually undergone combined orthodontic and orthognathic treatment. The aim is to give the reader an insight into not only what we, the orthodontists, fail to tell our orthognathic patients, but also what they fail to tell us.

PMID: 16170057 [PubMed - indexed for MEDLINE]

[Treatment of Angle Class II division I malocclusion cases with Twin-block appliance combined with face bow and intermaxillary elastic: report of 17 cases]

Shanghai Kou Qiang Yi Xue. 2005 Aug;14(4):365-9

Authors: Gong X, Qian YF

PURPOSE: The aim of this study was to evaluate the clinical value of the Twin-block appliance combined with face bow and intermaxillary elastic on Class II division I malocclusion in 17 cases. METHODS:17 cases with skeletal Class II(I) malocclusion were included, all cases were treated with Twin-block appliance combined with face bow and intermaxillary elastic. The methods of bite construction, fabrication of the application were introduced. Lateral cephalometric films were taken before and after treatment. Cephalometric analysis was conducted to evaluate the treatment effects. Student's t test was used to determine the effect on jaw growth before and after treatment. RESULTS: The treatment resulted in good outcomes: the neutral or mesial relations of the permanent first molars were reached, the deep overjet was reduced. The S-N-ss angle and the length of maxilla (ss/ref pl) were reduced (P<0.05, P<0.01). The pg/ref pl, co/ref pl+pg/ref pl and the S-N-sm angle had a significant increase (P<0.001). The convexity angle and s-N-sm angle had a significant change (P<0.001).The FMA angle had no change (P>0.05). CONCLUSION: The Twin-block appliance combined with face bow and intermaxillary elastic was very effective on improving mandible growth and inhibiting maxilla growth, the sagittal relationship between the upper and lower jaws was more compatible, the profile was improved.

PMID: 16155699 [PubMed - in process]

Soft tissue facial profile changes following functional appliance therapy.

Eur J Orthod. 2006 Feb;28(1):35-41

Authors: Quint&#xE3;o C, Helena I, Brunharo VP, Menezes RC, Almeida MA

The aim of this study was to evaluate changes in the facial profile resulting from the use of a twin block (TB) functional appliance. The sample comprised 38 patients (24 males and 14 females) with a Class II division 1 malocclusion. Nineteen subjects were treated with a functional appliance while the remaining 19, who did not undergo any intervention, served as the control. The mean age of the treated group was 9.5 years (SD 10 months) and of the control group 9.9 years (SD 13 months). Lateral cephalograms were obtained for all subjects at the initial consultation and again after one year. The changes in facial profile, resulting from treatment with the TB, were analysed after the influence of growth had been taken into account. The results showed a significant improvement in the facial profile, which closely followed the underlying dentoskeletal changes. Thus, the most significant effects were a total facial profile improvement, retraction of the upper lip and anterior movement of soft tissue pogonion (P < 0.05). Subjects treated with a TB appliance achieved improved facial harmony, but such changes were not observed in the control group.

PMID: 16113035 [PubMed - indexed for MEDLINE]

Effect of cervical headgear wear on dynamic measurement of head position.

Eur J Orthod. 2005 Oct;27(5):437-42

Authors: Usumez S, Orhan M, Uysal T

The aim of this study was to identify the effect of cervical headgear (CHG) wear on dynamic measurement of head posture during walking. Six male and 10 female patients (mean age, 11.9 +/- 1.9 years) who were receiving CHG therapy for correction of a Class II molar relationship as part of their orthodontic treatment were included in this study. Dynamic head posture measurements were recorded using an inclinometer and data logger apparatus during a walking session of 5 minutes. This procedure was repeated before (T1) and after (T2) insertion of CHG. The T1 and T2 measurements were repeated twice at 30-minute intervals. The mean dynamic head posture was calculated for each subject using the collected data. The means of these measurements were statistically compared using a paired t-test. Of the 16 subjects, 14 showed a cranial flexion with CHG wear in relation to T1 (1.4 to 8.9 degrees). The other two subjects showed a cranial extension of -1.6 and -3.8 degrees. The mean values at T1, T2 and T1-T2 were 1.4, -1.8, and 3.1 degrees, respectively, which indicated a mean cranial flexion at T2 in relation to T1. According to the paired sample t-test, there were statistically significant differences between the two measurements of dynamic head posture recorded before and after CHG insertion (P < 0.001). CHG wear causes a significant cranial flexion which may be responsible for its effects on the mandible.

PMID: 16093258 [PubMed - indexed for MEDLINE]

Age-related changes in sagittal relationship between the maxilla and mandible.

Eur J Orthod. 2005 Dec;27(6):568-78

Authors: Lux CJ, Burden D, Conradt C, Komposch G

The aim of the study was to assess age-related changes in sagittal jaw relationship during pre-pubertal and pubertal development on the basis of angular [ANB, anteroposterior dysplasia indicator (APDI) and A-B plane angle] and linear (Wits, AF-BF, App-Bpp, and App-Pgpp) measurements. Lateral cephalograms of orthodontically untreated subjects were evaluated at 7, 9, 11, 13 and 15 years of age. Cephalometric standards and age-related changes were determined on the basis of Class I subjects with a good occlusion (n = 18, 10 males and 8 females). With respect to changes related to growth, the main findings were, in both genders, a statistically significant age-related decrease in ANB angle, App-Bpp and App-Pgpp, a significant increase in APDI, but no age-related change in Wits. A reduction of sagittal jaw distance during pre-pubertal and pubertal development was observed arising from a relative dominance of sagittal mandibular growth. For an evaluation of differences concerning jaw relationship in Class II subjects, a group with Class II division 1 malocclusions (n = 17) and a group with Class II division 2 malocclusions (n = 12 were compared with two control groups, i.e. the good occlusion group and a Class I group (n = 37). Conclusions about the sagittal discrepancy in Class II division 1 and Class II division 2 subjects depended on the geometric reference used in the various parameters, and further research is called for with respect to the diagnostic performance of the various measurements. Differences between Class II subjects and controls present at 15 years of age were already established at 7 years of age, but were less pronounced.

PMID: 16093257 [PubMed - indexed for MEDLINE]

Effects of activator and activator headgear treatment: comparison with untreated Class II subjects.

Eur J Orthod. 2006 Feb;28(1):27-34

Authors: T&#xFC;rkkahraman H, Sayin MO

The aims of this study were to determine whether the activator and activator headgear encourage mandibular growth, and whether there is any superiority of one appliance over the other or if the resultant changes are due to normal growth. Forty-nine skeletal Class II division 1 patients were selected. Thirty-three (13 females, 20 males; mean age 12.52 +/- 1.42 years) were treated with an Andresen activator and the remaining 16 (7 females, 9 males; mean age 13.04 +/- 1.47 years) with an activator headgear combination. Twenty Class II subjects (9 females, 11 males; mean age 12.57 +/- 1.11 years) who had previously refused treatment served as a control group. Cephalometric landmarks were marked and digitized by one author to avoid inter-observer variability. Nine angular and 12 linear measurements were established and measured using Vistadent AT software. A paired-sample t-test and an ANOVA test were used to statistically evaluate the findings. The results revealed that both the activator and the activator headgear combination significantly (P < 0.001) encouraged mandibular growth, but had little restraining effect on the maxilla. The mandibular incisors were more controlled in the activator headgear combination group. The resultant skeletal, dentoalveolar and soft tissue changes differed significantly from those due to growth.

PMID: 16093256 [PubMed - indexed for MEDLINE]

Effects of camouflage treatment on dentofacial structures in Class II division 1 mandibular retrognathic patients.

Eur J Orthod. 2005 Oct;27(5):524-31

Authors: Demir A, Uysal T, Sari Z, Basciftci FA

The aims of this study were to determine the changes in the dentofacial structures of Class II division 1 mandibular retrognathic patients treated with bilateral extraction of the upper first premolars, and to compare pre- and post-treatment values with the cephalometric norms of Anatolian Turkish adults. The Class II division 1 subjects included 20 males and 33 females (mean age: 17.08 +/- 1.03 years). All received comprehensive orthodontic treatment using an edgewise appliance and appropriate headgear. Lateral cephalograms were taken at the beginning and end of treatment. Twenty-five (14 linear and 11 angular) measurements were analysed on each radiograph. Each cephalogram was traced and digitized. For statistical evaluation, paired and independent-samples t-tests were performed. When the pre- and post-treatment measurements were compared, statistically significant differences were found for nine of 25 measurements. During treatment the facial axis, U1-SN ( degrees ), U1-NA (mm), U1-NA ( degrees ), H angle and upper lip to E plane measurements decreased, while N-ANS, interincisal angle and upper lip to Steiner S line increased. No statistically significant gender differences were found. Significant improvements were determined in ANS-Me and L1-APo measurements compared with Turkish norms. However, statistically significant deterioration was found in values related to point A, upper incisor and lower lip measurements. The findings demonstrates that camouflage treatment in Class II, mandibular retrognathic subjects has characteristic skeletal, dental and soft tissue effects on the dentofacial complex.

PMID: 16049038 [PubMed - indexed for MEDLINE]

Third molar angulation during and after treatment of adolescent orthodontic patients.

Eur J Orthod. 2005 Dec;27(6):590-6

Authors: Artun J, Thalib L, Little RM

The purpose of this study was to analyse the effect of premolar extraction therapy on third molar angulation during active treatment, and to test the significance of such changes on subsequent impaction of the third molars. Lateral cephalograms made before (T1) and after (T2) treatment and at long-term follow-up (T3) of 157 patients treated non-extraction (non-ex) or with extraction of four premolars (ex), all accurately diagnosed for impaction versus eruption of at least one third molar at T3, were evaluated. Linear regression models demonstrated that the maxillary third molars uprighted more from T1 to T2 (P < 0.05) and were less distally angulated at T2 (P < 0.01) in the ex than in the non-ex patients. No such differences were detected in the mandible (P > 0.05). The regression models also showed similar uprighting of the maxillary and mandibular third molars from T1 to T2 and similar angulation of the maxillary third molars at T2 in those patients with subsequent eruption and impaction (P > 0.05), but more mesially angulated mandibular third molars at T2 in the impaction patients (P < 0.01). Chi square testing demonstrated a higher frequency of distal tipping of the maxillary third molars from T1 to T2 in the impaction patients (P < 0.01), while mesial tipping from T1 to T2 of the mandibular third molars occurred with similar frequency in the two patient groups (P > 0.05). Chi square analysis also showed a higher frequency of greater than 30 degree distal angulation as well as an amount mesial angulation of the maxillary third molars at T2 (P < 0.01), and a higher frequency of greater than 40 degree mesial angulation of the mandibular third molars at T2 (P < 0.01) in patients with impaction than in those with eruption.

PMID: 16009666 [PubMed - indexed for MEDLINE]

A measuring system for facial aesthetics in Caucasian adolescents: reproducibility and validity.

Eur J Orthod. 2005 Dec;27(6):579-84

Authors: Kiekens RM, Maltha JC, van 't Hof MA, Kuijpers-Jagtman AM

A new measuring system to judge facial aesthetics in young Caucasians is presented. The system uses sets of three photographs (one frontal, one three-quarter smiling, and one lateral) as a stimulus. Scores are performed on a visual analogue scale (VAS) with separate sets of reference photographs for girls and boys. The choice of the reference photographs was based on a panel evaluation of facial aesthetics of 40 boys and 40 girls from the archive of the orthodontic department. Reproducibility of the new measuring system was tested on a series of photographic sets (one frontal, one three-quarter smiling, and one lateral view) of 64 patients, using a panel of 78 adult laymen and 89 professionals. The panel members assessed these sets of photographs on a VAS, in relation to the reference sets. The system was shown to be reproducible. Although the intra-observer reproducibility was low, the reliability coefficient was excellent (Cronbach's alpha > or = 0.98). Validity was tested by comparing the scores on the new scales with those of the three-quarter smiling photographic views on an earlier published scale. The correlation between the ratings on the new measuring system and the earlier published scale was 0.82 for laymen and 0.77 for professionals. The new system is simple and flexible in its use, and reproducible and valid for assessing facial aesthetics in young Caucasians. The system can be used in further investigations on the evaluation of facial aesthetics.

PMID: 16009665 [PubMed - indexed for MEDLINE]

Three-part bi-maxillary osteotomy: a case report involving resorbable plates.

J Orthod. 2005 Jun;32(2):75-84

Authors: Waring D, Harrison J, Boyle M

This case report describes a patient who presented with a severe class 2 skeletal discrepancy together with a Class II malocclusion and a large anterior open bite. The malocclusion and skeletal discrepancy were managed with a combination of orthodontic and orthognathic treatment. The orthognathic surgery was undertaken following orthodontic decompensation using sectional mechanics to allow a segmental bimaxillary osteotomy and genioplasty to be performed. Although the discrepancy was severe using this combination of treatment, a successful outcome, both facially and occlusally, was achieved.

PMID: 15994980 [PubMed - indexed for MEDLINE]

Space conditions and dental and occlusal features in patients with palatally impacted maxillary canines: an aetiological study.

Eur J Orthod. 2005 Oct;27(5):461-5

Authors: Al-Nimri K, Gharaibeh T

The aetiology of palatal canine impaction is unclear. The aim of this research was to investigate the occlusal features that could contribute to the aetiology of palatal maxillary canine impaction. The material consisted of the pre-treatment dental casts of 34 patients (27 female and seven male) with unilateral palatal canine impaction (impaction group). The average age of this group was 17.7 years (+/- 4.6). These were matched according to age, gender and type of malocclusion with a comparison group of pre-treatment dental casts from unaffected orthodontic patients. From the dental casts the following parameters were obtained: (1) dentoalveolar arch relationship, (2) missing or anomalous teeth, (3) the mesiodistal width of each maxillary tooth, (4) the upper arch perimeter, (5) the maxillary inter-premolar and inter-molar widths. The arch length-tooth size discrepancy was only calculated for subjects with no missing teeth. Palatal canine impaction occurred most frequently in subjects with a Class II division 2 malocclusion. There was an association between palatal canine impaction and anomalous lateral incisors (P = 0.01). The transverse arch dimension was significantly wider in the impaction group than in the comparison group (P < 0.01). There was no statistically significant difference in the mesiodistal width of maxillary teeth or in the arch length-tooth size discrepancy between the palatal canine impaction group and their matched comparisons (P > 0.05). These results suggest that the presence of an 'excess palatal width' and anomalous lateral incisor may contribute to the aetiology of palatal canine impaction.

PMID: 15961570 [PubMed - indexed for MEDLINE]

The effects of the Twin-block appliance treatment on the skeletal and dentolaveolar changes in Class II Division 1 malocclusion.

Medicina (Kaunas). 2005;41(5):392-400

Authors: Sidlauskas A

Class II Division 1 malocclusion is the most frequent problem in the orthodontic practice. During the last ten years treatment with Twin-block functional appliance has gained popularity. The aim of the present study was to analyze the skeletal and dentoalveolar changes in Class II Division 1 malocclusions cases treated with Twin-block appliance. MATERIAL AND METHODS: Cephalometric analysis of skeletal and dentoalveolar facial structures of 34 Class II Division 1 patients treated with Twin-block appliance was performed using the same reference system before and after treatment. Longitudinal growth records of persons with excellent occlusion-Bolton standards have been used for the control in order to assess natural growth. RESULTS: Mandibular length as measured from point Articulare to point Pogonion increased by 4.6 mm in the Twin-block group compare with 2.2 mm in the control Bolton standards group. Skeletal and dentoalveolar relationship between maxillary and mandibular bases improved significantly: ANB angle reduced by 2.3 degrees, overjet reduction was 4.7 mm, postnormal molar position corrected by 3.6 mm. CONCLUSIONS: Twin-block appliance statistically significantly increases mandibular length by 2.4 mm during 12-month treatment period. With the Twin-block treatment about 40% overjet correction was achieved by skeletal and about 60% by dentoalveolar changes. Correction of postnormal buccal segments in Twin-block group was achieved by the combination of distal movement of the upper molars (0.7 mm dentoalveolar, 0.3 mm skeletal) and forward migration of lower molars (0.9 mm dentoalveolar and 1.7 mm skeletal).

PMID: 15947523 [PubMed - indexed for MEDLINE]

The role of psycho-social factors in headgear compliance.

Eur J Orthod. 2005 Jun;27(3):263-7

Authors: A&#x11F;ar U, Doruk C, Biçakçi AA, Büküsoğlu N

The aim of this study was to identify the role of psycho-social factors in headgear compliance. Fifty-one patients, with an Angle Class II division 1 malocclusion comprised the study sample. The treatment plan aimed to correct the malocclusion using cervical pull headgear. An electronic module timer was attached to the neckstrap to evaluate the number of hours the patients wore the headgear. One of their parents was asked to answer the Child Behaviour Checklist (CBCL), which defines a patient's behaviour. The patients were monitored for 6 months and the modules were measured at the end of each 2 month period. Mann-Whitney U and Chi square tests were used to analyse the data. The patients were separated into groups according to their compliance.The results showed that although there were significant differences in the use of headgear between the groups (P < or = 0.001), age, gender, and CBCL subgroup scores were not statistically significant (P > 0.05).

PMID: 15947226 [PubMed - indexed for MEDLINE]

The influence of mandibular prominence on facial attractiveness.

Eur J Orthod. 2005 Apr;27(2):129-33

Authors: Johnston C, Hunt O, Burden D, Stevenson M, Hepper P

This study examined the attractiveness of facial profiles. One hundred and two social science students (28 males and 74 females) rated the attractiveness of a series of silhouettes with normal, Class II or Class III profiles. A random sequence of 10 images included an image with the Eastman normal SNB value of 78 degrees, and images with SNB values of 2.5, 5, 7.5 and 10 degrees above and below normal. A duplicate image in each sequence was used to assess reproducibility. The participants scored the attractiveness of each image and also indicated whether they would seek treatment if each image was their own profile.The profile with the normal SNB angle of 78 degrees was rated as the most attractive. Attractiveness scores reduced as the mandibular profile diverged from the normal SNB value. The +5 degree profile (SNB = 83 degrees) was rated as significantly more attractive than the -5 degree profile (SNB = 73 degrees; P = 0.004). No other significant differences between the scores for Class II and Class III profile pairs of equal severity were found. At 10 degrees below the normal SNB (Class II), 74 per cent of the sample would elect to have treatment, while 78 per cent would elect to have treatment at 10 degrees above the normal SNB (Class III).

PMID: 15817618 [PubMed - indexed for MEDLINE]

Guest editorial: what do prospective randomized clinical trials tell us about the treatment of class II malocclusions? A personal viewpoint.

Eur J Orthod. 2005 Apr;27(2):105-14

Authors: Meikle MC

The prospective randomized clinical trial (RCT) is seen by many to be the 'gold standard' for analysing treatment outcome and the only valid source of clinical data. In orthodontics, most RCTs have been designed to resolve the controversy surrounding the ability of functional appliances to significantly modify dentofacial growth. Given the variability in the timing, magnitude and duration of pubertal dentofacial growth, differing levels of motivation and patient compliance, the inherent inaccuracy of cephalometry and the questionable validity of the measurements themselves used to quantitate change, it is not surprising that the conclusions have not been as clear-cut as anticipated. Unlike a laboratory experiment, in which it is possible to limit the differences between experimental and control groups to the single factor being investigated, in a clinical trial an orthodontic appliance is just one of several variables affecting the outcome. Furthermore, RCTs are expensive and time-consuming; by the time the end-point of the study has been reached, the appliance may no longer be in widespread use, the fate of more than one recent well-publicized RCT.What RCTs have shown is that functional appliances such as the Herbst and twin block, based on the principle of 'jumping the bite', are more effective at modifying dentofacial growth and reducing overjets than headgear and more passive appliances such as the Andresen activator and its variants. However, if one asks whether RCTs have achieved their objective, or provided knowledge not previously available from retrospective studies or animal experimentation, then the answer would have to be no; it is also hard to justify the cost. What is particularly interesting is that knowledge based on years of clinical experience has been disregarded and then announced as if it was something completely new.

PMID: 15817615 [PubMed - indexed for MEDLINE]

Maurice Berman Prize 2003.

J Orthod. 2004 Dec;31(4):279-87

Authors: McKeown HF

A crowded, high angle Class II case is presented and illustrated with stage clinical photographs. It was successfully treated with modified Twin Blocks and high pull headgear, extraction of all four first premolars, and upper and lower pre-adjusted edgewise appliances.

PMID: 15608342 [PubMed - indexed for MEDLINE]

Adaptive condylar growth and mandibular remodelling changes with bionator therapy--an implant study.

Eur J Orthod. 2004 Oct;26(5):515-22

Authors: Araujo AM, Buschang PH, Melo AC

The purpose of this study was to describe condylar growth and mandibular remodelling changes associated with bionator therapy. Twenty-five patients (15 males and 10 females) between 6.9 and 11.2 years of age with Class II division 1 malocclusions were randomly allocated to either control (n = 11) or treatment (n = 14; bionator only) groups and followed longitudinally for approximately 1 year. Treatment consisted of a bionator only, constructed to clear the buccal dentition by 2 mm and to position the mandible into an edge-to-edge incisor relationship. Using metallic implants for superimposition, mandibular growth, displacement, and true rotation were evaluated cephalometrically. The results showed significant changes in the direction (more posterior) but not in the overall amount of condylar growth. The bionator appliance produced greater than expected posterior drift of landmarks in the condylar and gonial regions. Cranial base superimposition showed greater than expected anterior mandibular displacement, but little or no true mandibular forward rotation with bionator therapy. The bionator appliance alone produced changes in condylar growth direction and remodelling changes associated with mandibular rotation and displacement.

PMID: 15536840 [PubMed - indexed for MEDLINE]

A paralleling device and ethylene vinyl acetate baffles for use with mandibular distraction osteogenesis: technical note.

J Orthod. 2004 Sep;31(3):181-9

Authors: Brown NL, House K, Leach A, Page K, Irvine GH, Sandy JR

A novel method for planning the placement of intra-oral lengthening devices using a paralleling device is described and illustrated with a case report. Simple radiographic measurements and study models are all that is required to construct a simple acrylic splint with guides, which allows accurate positioning of the distractors at surgery. The construction of ethylene vinyl acetate (EVA) baffles to prevent trauma to the labial mucosa from the intra-oral link arms is a technique that enhances patient comfort during distraction of the mandible. The case report demonstrates the application of the surgical planning technique and the use of EVA baffles for a patient with an overjet of 21.5 mm.

PMID: 15489362 [PubMed - indexed for MEDLINE]

The William Houston Medal of the MOrth of the Royal College of Surgeons of Edinburgh 2003 and the BOS MOrth Cases Prize 2003.

J Orthod. 2004 Sep;31(3):169-80

Authors: O'Dwyer JJ

This paper describes the orthodontic treatment of 2 cases that were presented by the winner of the William Houston Medal of the MOrth of the Royal College of Surgeons of Edinburgh at the June 2003 diet of the examination. The cases were also successful presented for the British Orthodontic Society MOrth Cases Prize 2003.

PMID: 15489361 [PubMed - indexed for MEDLINE]

[Combined orthodontic and orthognathic therapy on skeletal class II division 1 malocclusion in adults]

Shanghai Kou Qiang Yi Xue. 2004 Aug;13(4):325-7

Authors: Fang B, Qiu WL, Shen GF, Tang YS

PURPOSE: To Introduce a combined orthodontic and orthognathic method for treatment of skeletal class II division 1 malocclusion in adults. METHODS: In orthodontic-surgical treatment on skeletal class II division 1 malocclusion in adults, the goal of orthodontics was to remove the compensation of upper and lower anterior teeth, leveling Spee's curve, adjusting relationship of the upper and lower dentition arch for intercuspid bite after surgery. The goal of orthodontics before surgery was visual treatment objective (OTV), model surgery and making of bite-plate. To achieve these goals, a combined orthodontic and orthognathic method for treatment of skeletal class II division 1 malocclusion in adults was adopted in this study. RESULTS: Stable function of stomotognathicia and satisfactory facial aesthetics after treatment were obtained. CONCLUSION: Oral and maxillofacial deformity must be treated by combining orthodontic treatment and surgical osteotomy in order to restore oral function and aesthetic appearance.

PMID: 15349679 [PubMed - indexed for MEDLINE]

[The effects of combined reverse Nance and TPA on reinforcement of anchorage]

Shanghai Kou Qiang Yi Xue. 2004 Aug;13(4):262-5

Authors: Chen W, Chen RJ, Shen G

PURPOSE: To evaluate the effects of combined reverse Nance and TPA on anchorage control. METHODS: 16 female adults with Class II division 1 malocclusion were treated with the combined mechanism of reverse Nance and TPA in an attempt to reinforce molar anchorage. Cephalometric analysis and model measurements were conducted for the assessment of anchorage control. RESULTS: The mesial movement of the upper first molars were minimized within 1/5 extracted space, parameters such as UMVD, MP-FH, ANS-Me remained unchanged, indicating the molar anchorage was controlled effectively. CONCLUSION: The modified combination of reverse Nance and TPA might be effective in anchorage forcement.

PMID: 15349660 [PubMed - indexed for MEDLINE]

Drawing conclusions.

J Am Dent Assoc. 2004 Jun;135(6):719-20; author reply 720-1

Authors: Solomon F

PMID: 15270152 [PubMed - indexed for MEDLINE]

Three-dimensional finite element analysis in distal en masse movement of the maxillary dentition with the multiloop edgewise archwire.

Eur J Orthod. 2004 Jun;26(3):339-45

Authors: Chang YI, Shin SJ, Baek SH

The purpose of this study was to compare the effects of a multiloop edgewise archwire (MEAW) on distal en masse movement with a continuous plain ideal archwire (IA). Three-dimensional finite element models (FEM) of the maxillary dentition in which the second permanent molars had been extracted were constructed to include the periodontal membrane, alveolar bone, standard edgewise bracket (0.018 x 0.025 inch), stainless steel IA (0.016 x 0.022 inch), and MEAW (0.016 x 0.022 inch). The stress distribution and displacement of the maxillary dentition were analysed when Class II intermaxillary elastics (300 g/side) and 5 degree tip-back bends were applied to the IA and MEAW for distal en masse movement of the maxillary dentition. Compared with the IA, the MEAW showed that the discrepancy in the amount of tooth displacement was lower and individual tooth movement was more uniform and balanced. There was minimal vertical displacement or rotation of the teeth using the MEAW when compared with the IA. The MEAW seems to have advantages for distal en masse movement of the maxillary dentition.

PMID: 15222721 [PubMed - indexed for MEDLINE]

How predictable is orthognathic surgery?

Eur J Orthod. 2004 Jun;26(3):303-9

Authors: Eckhardt CE, Cunningham SJ

There are a number of increasingly sophisticated techniques available for orthognathic treatment planning. All are based on the determination of the skeletal pattern and the position of the dentition. However, they all suffer from difficulties associated with predicting the soft tissue profile. The aim of this retrospective cephalometric investigation was, therefore, to compare the ability to predict accurately the outcome of orthognathic treatment using the 'hand planning' technique and the orthognathic planning and analysis (OPAL) computer program, with an emphasis on the soft tissue profile. Seventy adult subjects were divided into two groups not specific for gender or age: the Class III patients had undergone bimaxillary surgery and the Class II patients sagittal split mandibular advancement. In each group, the pre-treatment and post-debond lateral cephalograms were utilized to calculate the actual orthodontic and surgical movements. These values were then used to produce a prediction using both the hand planning technique and the OPAL program. The resultant predictions were digitized using a customized computer program and compared with the actual outcome. The results show that there was marked individual variation when planning by hand and using the OPAL program. In the mandibular surgery group, hand planning and OPAL were of similar accuracy and few points differed significantly between prediction and outcome. However, for the bimaxillary group, a number of points showed bias and the hand planning technique appeared to be more accurate than the OPAL program, particularly in the region of the lips. Although the usefulness of predictions is acknowledged, these results suggest that they should be used with a certain amount of caution.

PMID: 15222716 [PubMed - indexed for MEDLINE]

Dentoskeletal effects and facial profile changes during activator therapy.

Eur J Orthod. 2004 Jun;26(3):293-302

Authors: Cozza P, De Toffol L, Colagrossi S

The aim of this retrospective study was to investigate cephalometrically the skeletal, dental, and soft tissue modifications induced by activator treatment in patients with Class II malocclusions caused by mandibular retrognathism. The subjects, all in the mixed dentition, were selected from a single centre and were divided into two groups: 40 patients treated with an incisor double capping activator (20 girls, 20 boys with a mean age of 10 years) and a control group of 30 subjects (15 girls, 15 boys with a mean age of 10 years). The dentoskeletal and aesthetic changes that occurred were compared on lateral cephalograms taken before treatment (T0) and after 18-24 months, when the activator was removed (T1). In the control group the radiographs were obtained before (T0) and after (T1) 21 months (standard deviation +/- 3 months). Activator treatment in these growing patients resulted in a correction of the Class II relationship (ANB -2.14 degrees), a restriction of maxillary growth (SNA -0.5 degrees), an advancement of the mandibular structures (SNB +1.64 degrees, FH--NPg +3.39 degrees; OLp-B +5.17 mm, OLp-Pg +5.14 mm, OLp-Go +2.44 mm), a correction of the overjet (-5.03 mm), an improvement in overbite (-1.17 mm) and uprighting of the maxillary incisors (1--FH -5.64 degrees). The activator appliance was effective in treating growing patients with mandibular deficiency: activator therapy corrected Class II malocclusions by a combination of skeletal and dental changes and improved the soft tissue facial profile.

PMID: 15222715 [PubMed - indexed for MEDLINE]

The William Houston Medal of the Royal College of Surgeons of Edinburgh 2002.

J Orthod. 2004 Jun;31(2):86-97

Authors: Teague AM

The William Houston medal is a prestigious prize awarded to the individual achieving the most outstanding examination performance at the Membership in Orthodontics examination for the Royal College of Surgeons of Edinburgh. Five clinical cases treated by the candidate are presented as part of the final examination; two of these cases are described below. The first a Class III malocclusion, and the second a Class II division 1 malocclusion, were both treated by orthodontic camouflage.

PMID: 15210923 [PubMed - indexed for MEDLINE]

Early versus late.

J Am Dent Assoc. 2004 May;135(5):552, 554; author reply 554

Authors: Carapezza LJ

PMID: 15202741 [PubMed - indexed for MEDLINE]

Effects of bilateral upper first premolar extraction on the mandible.

Eur J Orthod. 2004 Apr;26(2):223-31

Authors: Meral O, I&#x15F;can HN, Okay C, Gürsoy Y

The purpose of this study was to evaluate the effects of bilateral upper premolar extraction on mandibular growth. Twenty-six subjects (eight males, 18 females) in maximum pubertal growth with an Angle Class II molar relationship, normal to mild overjet increase, mild or no lower arch length discrepancy but severe upper arch discrepancy and no severe skeletal discrepancy were divided into two groups equal in number and gender, as extraction and control groups. The median chronological age was 11.2 years in the extraction group and 12.6 years in the controls. The subjects were observed for a median period of 1.1 years in the extraction group after bilateral extraction of the upper premolars and 1.2 years in the controls until termination of pubertal growth (DP3u) without any orthodontic treatment. Twenty-nine linear and angular measurements were made on 52 lateral cephalograms and hand-wrist radiographs taken before and after the study period. The increase in SNB measured on the total superimposition was significantly greater in the controls than in the extraction group (P < 0.05). In addition, anterior mandibular (counter-clockwise) rotation was only significant (P < 0.05) in the control group. Thus, it might be suggested that bilateral upper premolar extractions might affect the mandibular rotation tendency.

PMID: 15130047 [PubMed - indexed for MEDLINE]