The effect of anterior inclined plane treatment on the dentoskeletal of Class II division 1 patients.

J Indian Soc Pedod Prev Dent. 2007 Jul-Sep;25(3):130-2

Authors: Emami MS, Jamilian A, Showkatbakhsh A

Most of Class II malocclusions are due to underdeveloped mandible with increased overjet and overbite. Lack of incisal contact results in the extrusion of the upper and lower anterior dentoalveolar complex, which helps to lock the mandible and prevent its normal growth and development, and this abnormality is exaggerated by soft tissue imbalance. The purpose of this study was to evaluate the skeletal and dental changes in patients treated with anterior inclined plane appliance in growing patients with moderate Class II Division 1 having deep overbite. In this study, 25 patients, including 15 girls and 10 boys, with a mean age of 9 +/-1.2 years were selected; all of them presented with moderate Class II deep bite with increased overjet and normal or horizontal growth pattern. Pre- and post-treatment X-rays and photos for an average of 8 months were taken. The statistical assessment of the data suggested that there were no significant changes in the vertical skeletal parameters. The mandibular incisors were protruded, whereas the maxillary incisors were retruded. Overbite and overjet were also reduced. There was significant increase in the mandibular length. The results revealed that in mixed dentition patients, the inclined plane corrected Class II discrepancies mostly through dentoskeletal changes.

PMID: 17951929 [PubMed - in process]

Maxillary canine impactions related to impacted central incisors: two case reports.

J Contemp Dent Pract. 2007;8(6):72-81

Authors: Bayram M, Ozer M, Sener I

AIM: The purpose of this case report is to describe the combined surgical and orthodontic treatment of two cases with an impacted maxillary central incisor and canine in the same quadrant and to discuss the causal relationship between them. BACKGROUND: The most common causes of canine impactions are usually the result of one or more factors such as a long path of eruption, tooth size-arch length discrepancies, abnormal position of the tooth bud, prolonged retention or early loss of the deciduous canine, trauma, the presence of an alveolar cleft, ankylosis, cystic or neoplastic formation, dilaceration of the root, supernumerary teeth, and odontomas. Although impaction of the maxillary central incisor is almost as prevalent as impacted canines its etiology is different. The principal factors involved in causing the anomaly are supernumerary teeth, odontomas, and trauma. REPORTS: Case #1: A 10.5-year-old girl in the early mixed dentition stage presented with a chief complaint of the appearance of her anterior teeth. She had a Class I skeletal pattern and a history of trauma to the maxillary central incisors at age five with premature exfoliation. Radiographs revealed an impacted upper right central incisor in the region of the nasal floor, delayed eruption of the maxillary permanent central incisor, and the adjacent lateral incisor was inclined toward the edentulous space. Treatment was done in two stages consisting of surgical exposure and traction of the impacted central incisor and fixed orthodontic treatment. Case #2: An 11.5-year-old girl presented for orthodontic treatment with the chief complaint of an unerupted tooth and the appearance of her upper anterior teeth. She was in the late mixed dentition period with a Class III skeletal pattern along with an anterior cross-bite with some maxillary transverse deficiency. The maxillary right canine and central incisor were absent, but the maxillary right deciduous canine was still present. Treatment included arch expansion followed by surgical exposure and traction of the impacted teeth and fixed orthodontic treatment. SUMMARY: This case report provides some evidence of a significant environmental influence of an impacted maxillary central incisor on the path of eruption of the ipsilateral maxillary canine. When an impacted maxillary central incisor exists, the maxillary lateral incisor's root might be positioned distally into the path of eruption of the maxillary canine preventing its normal eruption. Ongoing assessment and early intervention might help to prevent such adverse situations from occurring.

PMID: 17846674 [PubMed - indexed for MEDLINE]

[Remarks on drawing up a community health orthodontic assistance protocol]

Cien Saude Colet. 2007 Jul-Aug;12(4):1067-78

Authors: Hebling SR, Pereira AC, Hebling E, Meneghim Mde C

This study offers help for drawing up a community health orthodontic assistance protocol, especially for the public health system. A preventive and interceptive orthodontic program is suggested through the inclusion of approaches in existing healthcare programs that may help prevent malocclusions, extending the services offered by Basic Healthcare Units to include fitting space retainer appliances and interceptive procedures. Possible occlusion problems are discussed and rated as high or low priority for treatment, stressing occlusal deviations that should not be treated precociously. Preventive and interceptive orthodontic treatment should primarily be offered to children with deciduous and mixed dentition. The management and inclusion of orthodontic procedures can be deployed through the management of physical, human and financial resources, establishing access criteria for these services. The use of an appropriate orthodontic assistance protocol and correct planning of orthodontic actions could pave the way for preventive and interceptive procedures at the Basic Healthcare Units, while more resources could be allocated to setting up Specialty Reference Centers offering more complex corrective orthodontic procedures.

PMID: 17680165 [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]

Oral health comparisons between children attending an Aboriginal health service and a Government school dental service in a regional location.

Rural Remote Health. 2007 Apr-Jun;7(2):625

Authors: Parker EJ, Jamieson LM

INTRODUCTION: Indigenous children in Australia have higher dental caries levels than their non-Indigenous counterparts. Indigenous communities in South Australia's mid-north region have identified dental health as one of their top health priorities. In response to this, an oral health program based at the Pika Wiya Health Service in Port Augusta was established, with a dentist providing care for adults, and a dental therapist providing care for children, 2 days per week each. The purpose of this article is to compare the socio-demographic and oral health characteristics of children attending for care at the Pika Wiya Health Service Dental Clinic with those of their counterparts attending the general Port Augusta School Dental Service (SDS). Both Indigenous and non-Indigenous children were included. METHODS: Data were obtained from the South Australian Dental Service (SADS), which routinely collects socio-demographic and dental information from patients seen through their system. Examinations were conducted by SADS-employed dental professionals. A full enumeration of children attending for care at Pika Wiya and the Port Augusta SDS from March 2001 to March 2006 was included. Surface level tooth data was captured using the EXACT treatment charting and management information system. The Socio-Economic Indices For Areas (SEIFA) were used to determine socio-economic status, and the dmft (sum of decayed, missing and filled teeth in the deciduous dentition) and DMFT (sum of decayed, missing and filled teeth in the permanent dentition) indices were used to assess oral health outcomes. Both measures were used for children aged 6-10 years because in such age groups children have a mixed dentition (both primary and permanent teeth are present). Caries prevalence (dmft/DMFT>0) and severity (mean dmft/DMFT) were calculated, as well as the Significant Caries Index (SiC) and Significant Caries Index 10 (SiC 10). The SiC is the mean dmft/DMFT of the one-third of the sample with the highest caries score; while the SiC 10 is the mean dmft/DMFT of the one-tenth of the sample with the highest caries score. RESULTS: In the 5 year observation period, 760 children were seen at the Pika Wiya Dental Service while over 6800 were seen at the Port Augusta SDS. A higher proportion of pre-school children attended for care at Pika Wiya, while proportionally more children aged > or = 11 years attended for care at the Port Augusta SDS. More females attended for care at Pika Wiya. Almost all children (99%) attending for care at Pika Wiya lived in the most disadvantaged areas according to the SEIFA scale. Children attending for care at Pika Wiya had three-times the mean number of decayed deciduous and permanent teeth than their counterparts attending the Port Augusta SDS. Over 75% of children attending for care at Pika Wiya aged 10 years or less had dental caries experience in the primary dentition compared with just over 50% of children attending for care at the Port Augusta SDS. Children attending for dental care at Pika Wiya aged 10 years or less had 1.8 times the mean dmft, 1.4 times the SiC and 1.4 times the Sic 10 of their counterparts attending for care at Port Augusta SDS. Over half the children aged > or = 6 years who attended Pika Wiya for dental care had caries experience in the permanent dentition compared with 38% of their Port Augusta SDS-attending counterparts. Children aged > or = 6 years who attended Pika Wiya for dental care had 1.9 times the mean DMFT, 1.8 times the SiC and 1.6 times the SiC 10 of their similarly-aged Port Augusta SDS-attending counterparts. CONCLUSIONS: Children attending for care at the Pika Wiya Dental Service were more likely to be pre-school-aged, female, Indigenous and living in a socially disadvantaged area, in comparison with children attending the Port Augusta SDS. Pika Wiya-attending children had 1.5-3 times the dental caries prevalence and severity in both the primary and permanent dentition of children attending for care at the Port Augusta SDS. The higher levels of dental caries experience, untreated disease and social disadvantage of children attending Pika Wiya provides further evidence for the need to address the health inequalities for Aboriginal children living in South Australia's mid-north region. While the Pika Wiya Oral Health Program is attempting to address some of these needs, a much broader focus to address the social and health inequalities will be required to improve the oral health characteristics of this population. It is hoped that through the Pika Wiya Dental Service's dedication to increasing Aboriginal child dental service participation rates, the proportion of untreated decay will diminish.

PMID: 17474830 [PubMed - indexed for MEDLINE]

Anterior open bite treated with a palatal crib and high-pull chin cup therapy. A prospective randomized study.

Eur J Orthod. 2006 Dec;28(6):610-7

Authors: Torres F, Almeida RR, de Almeida MR, Almeida-Pedrin RR, Pedrin F, Henriques JF

The aim of this prospective randomized clinical study was to cephalometrically investigate the dentoalveolar and soft tissue changes produced by a removable appliance with a palatal crib associated with high-pull chin cup therapy in children with an Angle Class I anterior open bite (AOB) malocclusion. Thirty children (8 males and 22 females) with an initial mean age of 8.3 years and a mean AOB of 4.1 mm were treated with a removable appliance composed of a palatal crib associated with chin cup therapy for 12 months. A control group of 30 individuals (7 males and 23 females) closely matched for age, initial mean age 8.6 years, gender, and ethnicity with a mean AOB of 4.6 mm was followed without treatment. The measurements (means and standard deviations) were statistically analysed using a paired t-test. The results showed no significant differences in the level of molar eruption or in lower anterior face height, suggesting that the vertical control expected from the chin cup therapy did not occur. Dentoalveolar changes at the anterior region were evident, with statistically significant extrusion, retrusion, and lingual tipping of the maxillary and mandibular incisors (P < or = 0.05). However, these hard tissue changes did not imply soft tissue changes and the variables related to the soft profile were not statistically significantly different between the groups. The dentoalveolar changes at the anterior region of the dental arches were mainly responsible for closure of the AOB in patients treated in the mixed dentition.

PMID: 17101701 [PubMed - indexed for MEDLINE]

Surgical and orthodontic treatment of an impacted permanent central incisor: a case report.

J Indian Soc Pedod Prev Dent. 2006 Jun;24(2):100-3

Authors: Thosar NR, Vibhute P

Although impaction of a permanent tooth is rarely diagnosed during the mixed dentition period, an impacted central incisor is usually diagnosed accurately when there is delay in the eruption of tooth. In this article, the impacted incisor was moved into it's proper position with surgical exposure and orthodontic traction, after which it showed good stability.

PMID: 16823236 [PubMed - indexed for MEDLINE]

Loss of space and changes in the dental arch after premature loss of the lower primary molar: a longitudinal study.

J Indian Soc Pedod Prev Dent. 2006 Jun;24(2):90-6

Authors: Padma Kumari B, Retnakumari N

The purpose of the study was to evaluate the space changes, dental arch width, arch length and arch perimeter, after the unilateral extraction of lower first primary molar in the mixed dentition period. A longitudinal study was conducted among forty children in the age group of 6-9 years, who reported for extraction of lower first primary molar in the department of Pedodontics, Govt. Dental College, Trivandrum. Study models were made from alginate impression taken before extraction and after extraction at the periodical intervals of two months, four months, six months and eight months. The mesiodistal width of lower first primary molar of the non-extracted side was taken as the control. The results of the study showed statistically significant space loss in the extraction side ( P value < 0.01) and no significant space loss in the control side (P value > 0.05). The rate of loss was greatest in the first four months. The arch width, arch length and arch perimeter had no significant change from initial to eight months follow up. The present study challenges the use of a space maintenance under the circumstances of premature loss of mandibular primary molar for preventing space loss.

PMID: 16823234 [PubMed - indexed for MEDLINE]

Correlation between transverse expansion and increase in the upper arch perimeter after rapid maxillary expansion.

Braz Oral Res. 2006 Jan-Mar;20(1):76-81

Authors: Claro CA, Abr&#xE3;o J, Reis SA, de Fantini SM

The purpose of the present study was to assess the correlation between transverse expansion and the increase in upper arch perimeter, after maxillary expansion. Dental casts of eighteen patients were obtained before treatment and again five months after maxillary expansion. Measurements of intermolar width, intercanine width, arch length and arch perimeter were made with a digital caliper on photocopies taken from the dental casts. After assessment of the method error, a multiple regression model was developed following the identification of the best subset of variables. The resulting equation led to the conclusion that the increase in arch perimeter is approximately given by the addition of 0.54 times the intercanine expansion, and 0.87 times the arch length alteration.

PMID: 16729179 [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]

Palatal development of preterm and low birthweight infants compared to term infants - What do we know? Part 3: Discussion and Conclusion.

Head Face Med. 2005 Nov 2;1:10

Authors: Hohoff A, Rabe H, Ehmer U, Harms E

BACKGROUND: It has been hypothesized that prematurity and adjunctive neonatal care is 'a priori' a risk for disturbances of palatal and orofacial development which increases the need for later orthodontic or orthognathic treatment. As results on late consequences of prematurity are consistently contradictory, the necessity exists for a fundamental analysis of existing methodologies, confounding factors, and outcomes of studies on palatal development in preterm and low birthweight infants. METHOD: A search of the literature was conducted based on Cochrane search strategies including sources in English, German, and French. Original data were recalculated from studies which primarily dealt with both preterm and term infants. The extracted data, especially those from non-English paper sources, were provided unfiltered in tables for comparison (Parts 1 and 2). RESULTS: Morphology assessment of the infant palate is subject to non-standardized visual and metrical measurements. Most methodologies are inadequate for measuring a three-dimensional shape. Several confounding factors were identified as causes contributing to disturbances of palatal and orofacial development. CONCLUSION: Taking into account the abovementioned shortcomings, the following conclusions may be drawn for practitioners and prospective investigators of clinical studies. 1) The lack of uniformity in the anatomical nomenclature of the infant's palate underlines the need for a uniform definition. 2) Metrically, non-intubated preterm infants do not exhibit different palatal width or height compared to matched term infants up to the corrected age of three months. Beyond that age, no data on the subject are currently available. 3) Oral intubation does not invariably alter palatal morphology of preterm and low birthweight infants. 4) The findings on palatal grooving, height, and asymmetry as a consequence of orotracheal intubation up to the age of 11 years are inconsistent. 5) Metrically, the palates of orally intubated infants remain narrower posteriorly, beginning at the second deciduous molar, until the age of 11 years. Beyond that age, no data on the subject are currently available. 6) There is a definite need for further, especially metrical, longitudinal and controlled trials on palatal morphology of preterm and low birthweight infants with reliable measuring techniques. 7) None of the raised confounding factors for developmental disturbances may be excluded until evident results are presented. Thus, early orthodontic and logopedic control of formerly premature infants is recommended up to the late mixed dentition stage.

PMID: 16270912 [PubMed - in process]

Cephalometric standards for Slovenians in the mixed dentition period.

Eur J Orthod. 2006 Feb;28(1):51-7

Authors: Drevensek M, Farcnik F, Vidmar G

The aim of this study was to develop standard cephalometric values for Slovenians in the period of the mixed dentition. Eighty-eight children were included in the study (46 girls and 42 boys, mean age 9.31 +/- 1.52 years). The selection criteria were: in the mixed dentition, a score of the modified Eismann method for an objective assessment of malocclusion of less than 15 points, the absence of aplasia and supernumerary teeth, no congential anomalies and no previous orthodontic treatment. Twenty-five cephalometric measurements were performed twice to analyse the size and shape of the craniofacial complex. The reliability of the measurements was assessed by correlation coefficients, regression, and analysis of inter-subject differences; satisfactory results were obtained. The differences between boys and girls and between those in the early and late mixed dentition period were tested with a two-way analysis of variance. The most pronounced changes between the early and late mixed dentition were observed in the vertical skeletal relationships: a decrease in mandibular inclination, interbasal angle and gonial angle, and an increase in anterior and posterior face height. Sagittal skeletal relationships remained constant from the early to the late mixed dentition. No significant differences were found between the observed developmental stages. Significant differences between genders were found only for anterior and posterior face height, with boys showing larger values (P </= 0.001). As there were no significant differences between the early and late mixed dentition, the mean measurement values of the total sample can be used as cephalometric standards for Slovenians in the mixed dentition period.

PMID: 16230328 [PubMed - indexed for MEDLINE]

Inflammatory dentigerous cysts of children treated by tooth extraction and decompression--report of four cases.

Br Dent J. 1999 Dec 11;187(11):587-90

Authors: Kozelj V, Sotosek B

Inflammatory dentigerous cysts are only found in the mixed dentition. The four cases presented here illustrate the uncomplicated behavior of these cysts when properly treated. By extracting the infected primary teeth, opening the cyst and ensuring continuous drainage, it is possible to achieve spontaneous eruption of the involved permanent teeth into the dental arch even if they are badly dislocated. Simultaneous with the eruption of the permanent teeth, ossification of the bony defect can take place. The reparatory process is completed in one to two years.

PMID: 16163275 [PubMed - indexed for MEDLINE]

[The effect of maxillary and mandibular lip bumper on teeth and dental arch in late mixed dentition]

Shanghai Kou Qiang Yi Xue. 2005 Aug;14(4):348-51

Authors: Teng M, Sun F

PURPOSE: To study the effect of maxillary and mandibular lip bumper on tooth and dental arch in late mixed dentition. METHODS: Twelve subjects with mild or moderate crowding were selected. They were treated with maxillary and mandibular lip bumper for eight months. Analysis of cephalometrics and model measurements were done before and after treatment and paired t test were performed respectively for their changes. RESULTS: After treatment, SNA and SNB increased by 1.02 degrees and 0.97 degrees (P<0.05). Upper and lower incisor both had controlled tipping movement. The crown of incisor moved mesially and had root apex were fixed relatively. The center of rotation was close to root apex. The upper and lower molar moved differently. Upper molar was upright distally and the center of rotation was close to the crown. However, the lower molar tipped distally and the center of rotation was close to the center of resistance.The width between the first molars and length of maxillary dental arch increased by 4.12 mm and 5.09 mm (P<0.01). The width between the first molars and length of mandibular dental arch increased by 4.07 mm and 6.86 mm (P<0.01) CONCLUSION: Clinical application of lip bumper could cause transverse and vertical changes in dental arch ,which help to decrease or remove crowding.

PMID: 16155695 [PubMed - in process]

[A study on the extraoral cervical traction in the treatment of skeletal Class II division 1 malocclusion in mixed dentition]

Shanghai Kou Qiang Yi Xue. 2005 Jun;14(3):243-6

Authors: Sun Y, Liu HH, Cao HJ

PURPOSE: To evaluate the effects of extraoral cervical traction on skeletal Class II division 1 malocclusion of early or late mixed dentition and discuss the optimal treatment timing. METHODS: The sample consisted of two groups of skeletal Class II division 1 malocclusion. One group with 11 cases was treated started in early mixed dentition while the other with 15 cases in late mixed dentition. All cases were treated with extraoral cervical traction headgear. Cephalometric analysis was conducted to evaluate the treatment effects. Student's t test was applied for statistical analysis. RESULTS: SNA, ANB and the length of maxilla (A-Ptm) were reduced and the inclination of maxillary incisor was decreased in both two groups. When comparing the two groups, it was found that the reduction of SNA was more notable, which means the inhibition of the maxilla was more evident in late mixed dentition. The difference was statistically significant (P<0.01). There was no significant difference on the distalization of the first upper molar between two groups (P<0.01). CONCLUSIONS: The extraoral cervical traction might be more effective in late mixed dentition to restrain maxillary growth in the treatment of skeletal Class II division 1 malocclusion.

PMID: 15995768 [PubMed - in process]

[Treatment effects of the maxillary protraction in correction of maxillary deficiency: a comparative study between RPE group and no RPE group.]

Shanghai Kou Qiang Yi Xue. 2004 Oct;13(5):437-40

Authors: Li YM, Zhang MP, Zha NB

PURPOSE: To compare the clinical effects of rapid palatal expansions combined with maxillary protractions to that of maxillary protractions of the maxillary deficiency alone. METHODS: Twenty patients aging from 9 to 11 years were divided into two groups , each group had 10 patients. All patients were diagnosed as having deficient maxillas with anterior crossbite. Group A were treated with rapid palatal expansion before maxillary protraction.Group B were treated with maxillary protraction alone. Lateral cephalometric films were taken at the beginning and the end of the treatment, and analyzed with McNamara analysis (Co-A,Co-Gn,ANS-Me) and traditional analysis. RESULTS: (1) After maxillary protraction,the maxilla and upper dentitions were protracted in both groups,the anterior crossbite had been corrected and obvious profile changes can be observed. (2) The mandible moved backward and downward in the RPE group and more obvious profile changes can be achieved compared with no RPE group. CONCLUSION: (1) It's an effective method to manage the maxillary deficiency with maxillary protraction in the mixed dentition. (2) Applying maxillary protraction combined with RPE is more adaptable to low angle cases.

PMID: 15514875 [PubMed - in process]

How to effectively use a 2 x 4 appliance.

J Orthod. 2004 Sep;31(3):248-58

Authors: Dowsing P, Sandler PJ

A mixed dentition treatment can efficiently and effectively be provided using a 2 x 4 appliance. The indications for early treatment are discussed and advantages of fixed appliances over traditionally used removable appliances illustrated using four case reports.

PMID: 15489369 [PubMed - indexed for MEDLINE]

[Study on the characteristics and reasons for mistakes in some orthodontic cases]

Shanghai Kou Qiang Yi Xue. 2004 Aug;13(4):331-2

Authors: Qin K, Chang X, Zhao ZJ

PURPOSE: To evaluate the characteristics and reasons for mistakes in some orthodontic cases. METHODS: 37 cases after or during treatment in other hospitals with mis-treatment were chosen, their original records as well as the records when they came to our hospital were collected, their original and present malocclusions were classified and the characteristics and reason of mistakes were analysed. RESULTS: Among the 37 cases, 26 cases had class-III malocclusion which account for 70.27% of the group, especially for the malocclusions began in mixed dentition and the problems developed from anterior dental crossbite to severe skeletal crossbite with dentofacial asymmetry and openbite. The main reasons lie in the mistakes of diagnosis and treatment planning, preventive treatment,appliance fabrication,use of extraoral arch and elastics, treatment processes, et al. CONCLUSIONS: There are various characteristics and reasons of treatment mistakes, but the problems lie mainly in class-III malocclusion especially during mixed dentition which indicates that we should pay more attention to the treatment of class-III malocclusion.

PMID: 15349681 [PubMed - indexed for MEDLINE]

The prevalence of temporomandibular joint dysfunction in the mixed dentition.

Eur J Orthod. 2004 Jun;26(3):311-20

Authors: Tuerlings V, Limme M

A functional and articular examination was carried out of 136 children (70 boys, 66 girls) aged from 6 to 12 years (6 years 1 month to 12 years 9 months), all presenting with a malocclusion in the mixed dentition and who had not yet received orthodontic treatment. The aim of the study was to examine the prevalence of signs of temporomandibular joint dysfunction (TMD) in this population and to evaluate the possible relationship between certain 'individual' parameters and TMD signs. The results showed an elevated prevalence of muscle tenderness, particularly in the lateral pterygoid muscle, which was found to be sensitive in 80.9 per cent of patients. Muscle tenderness had a tendency to increase with age and was greater on the right side. Temporomandibular joint sounds were present in 35.3 per cent of the subjects and more frequent in girls and in older children. Of the children who presented a mandibular deviation on maximal opening (19.8 per cent), 13.2 per cent had a predominance of opening deviation towards the left. Retruded contact position interferences were present in 57.4 per cent of the children and 72.1 per cent presented lateral and protrusive interferences. Assessment of the maximal amplitudes of mandibular movements did not reveal any limitations. These results indicate that few relationships exist between individual parameters and TMD signs.

PMID: 15222717 [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]

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

Eur J Orthod. 2004 Jun;26(3):237-44

Authors: Tausche E, Luck O, Harzer W

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.

PMID: 15222706 [PubMed - indexed for MEDLINE]

An orthopaedic approach to the treatment of Class III malocclusions in the early mixed dentition.

Eur J Orthod. 2004 Apr;26(2):191-9

Authors: Cozza P, Marino A, Mucedero M

The aim of this investigation was to study cephalometrically the skeletal, dental and soft tissue modifications induced by a Delaire facemask and Bionator III appliance in a sample of 30 patients (17 boys and 13 girls), aged 4.1-9 years [mean 5.85 years, confidence interval (CI) 5.41-6.29], in the early mixed dentition with a skeletal Class III malocclusion caused by maxillary retrognathism (group 1) and compared with a control sample of 24 subjects (14 boys and 10 girls), aged 4-9 years (mean 5.97 years, CI 5.35-6.58) with untreated Class III malocclusions (group 2). For each patient a lateral cephalogram was taken before treatment (T0), after facemask removal (T1), and at the end of the retention period with a Bionator III (T2). Cephalometric analysis was carried out. The post-treatment cephalometric values in the treated group showed a forward displacement of the maxilla resulting in a statistically significant increase (P < 0.001) in the SNA angle, A-NPg (mm) and PNS-A (mm) linear values. There was a clockwise rotation of the mandible, with a decrease in the SNB angle and a satisfactory correction of the Class III relationship. The beneficial effects on the facial profile were confirmed by an increase in UL-EL distance and in NB--HL and NsPgs--HL angles, and by a decrease in the facial convexity angle. These findings indicate that the Delaire facemask and Bionator III treatment is effective for correcting skeletal Class III malocclusions caused by maxillary retrognathism in the early mixed dentition.

PMID: 15130043 [PubMed - indexed for MEDLINE]

[Early face mask treatment for maxillary hyperplasia in patients with cleft lip and Palate]

Shanghai Kou Qiang Yi Xue. 1999 Dec;8(4):206-9

Authors: Fang B, Qiu WL, Yuan WH, Tang YS, Shen GF, Zhang H

OBJECTIVE: Early interfering orthodontics were used to treat maxillary hyperplasia by face mask and extra-oral bow technique in teenages.The position changes of maxilla after orthodontic treatment were evaluated.METHODS:The cephlometric variables before and after treatment were measured.Variables after treatment were compared with normal values in children with same ages,and changes of the maxillary position was determind.RESULTS:The position of the maxilla after orthopedics was significantly advanced (P<0.001),but there was still difference from normal values.CONCLUSION:In the peroid of mixed dentition of patients with cleft lip and palate,early orthodontics on maxillary hyperplasia could stimulate maxillary development and growth,remove or improve crossbite,extra-oral bow and face mask were efficient tools for this kind of patients.

PMID: 15048211 [PubMed - as supplied by publisher]

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

Eur J Orthod. 2004 Feb;26(1):59-64

Authors: M&#xE4;ntysaari R, Kantomaa T, Pirttiniemi P, Pykäläinen A

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.

PMID: 14994883 [PubMed - indexed for MEDLINE]

The effect of a modified reverse headgear force applied with a facebow on the dentofacial structures.

Eur J Orthod. 2004 Feb;26(1):51-7

Authors: Göyenç Y, Ersoy S

The purpose of this study was to evaluate the effects of a modified reverse headgear force applied with a facebow on the dentofacial structures of patients with skeletal Class III malocclusions characterized by maxillary retrognathism. Thirty individuals before the pubertal peak and in the mixed dentition were selected. Fifteen subjects (seven males, eight females, mean age 9.2 years) who formed the treatment group were compared with a control group comprising seven males and eight females (mean age 8.6 years). Maxillary deficiency and negative overjet were noted in all individuals included in the treatment and control groups. The combination of a full coverage maxillary removable appliance and an embedded facebow was used for treatment. The outer arms of the facebow were bent to deliver the force through the approximate centre of resistance of the maxilla. Extra-oral elastics extended from the reverse headgear to the outer arms of the facebow. Statistical analysis indicated significant changes in angles SNA, NV-A, SV-ANS, SV-PNS and PP measurements, suggesting that the maxilla moved anteriorly. There was, however, no statistically significant difference in SN-MP, SN-PP and MP-PP measurements between the treatment and control groups. These results suggest that there was no maxillary or mandibular rotation, but that the molars moved mesially in the protraction group. The U6-PP(V) dimension did not display significant differences between the pre- and post-treatment measurements in the treated group. Anterior movement of the maxilla was obtained without rotation of the jaws and upper and lower maxillary heights were unaffected.

PMID: 14994882 [PubMed - indexed for MEDLINE]

[Periodontal status of mandibular incisors after pronounced orthodontic advancement during adolescence]

Shanghai Kou Qiang Yi Xue. 2002 Dec;11(4):297-9

Authors: Zhang XY, Liu DX, Gao X, Wang XY, Xi R

OBJECTIVE: To analyze whether pronounced orthodontic advancement of the mandibular incisors during Class II correction in the mixed dentition results in gingival recession. METHODS: Through mandibular superimposition of the pretreatment and posttreatment cephalograms of 67 Class II patients who were treated, 45 patients with a minimum of a 1-mm advancement of the CEJ and a minimum of a 2-mm advancement of the IE were identified.Using the same protocol in Class II patients,30 individuals who finished treatment at a similar time and age,but with no advancement of the CEJ and a maximum of 1-mm advancement of the IE were identified. A total of 30 patients with pronounced advancement and 21 patients with no advancement could meet for a follow-up examination with a mean period of 7.83 years and 9.38 years after treatment, respectively. Through measuring cephalograms,study models,as well as clinical examinations to analyze the periodontal status of mandibular incisors. RESULTS: Clinical examinations at the time of follow-up revealed no differences in the amount of recession,the width of attached gingiva,the length of supracrestal connective tissue attachment,the probing pocket depth, gingival bleeding index or visible plaque index of the mandibular incisors between the patients in the 2 groups. No differences in the number of mandibular incisors that developed recession from T1 to T2 and from T2 to T3.The increase of mandibular incisor crown height demonstrated no difference from T2 to T3 between the patients in the 2 groups. CONCLUSION: Pronounced advancement of the mandibular incisors may be performed in adolescent patients with dentoalveolar retrusion without increasing the risk of recession.

PMID: 14983361 [PubMed]

[Clinical results of skeletal class III malocclusion in 11 children aged from 10 to 14 years]

Shanghai Kou Qiang Yi Xue. 2002 Mar;11(1):2-4

Authors: Wang CL, Wang YL, Liu DX, Kong FZ, Guo J

OBJECTIVE: The aim of this study is to investigate the clinical effects of combined protraction facemask and rapid maxillary expansion in the treatment of Class III malocclusion in 11 children aged from 10 to 14 years. METHODS: The observation group included 11 subjects in late mixed dentition or early permanent dentition, and the control group included 32 subjects in early mixed dentition. Protraction facemask and rapid maxillary expansion device was used and the mean treatment time was 6 months. Cephalometric radiographs were taken at the initiation of treatment (T1) and after 6 months of treatment (T2). In this way,(T2-T1) represented cephalometric changes after the treatment and cephalometric analysis based on a new basecranical reference system was used to compare the changes. RESULTS: All the subjects had the following changes: the maxilla moved forward,the mandible exhibited a downward and backward rotation and the forward growth was restricted. The overjet correction of the observation group was 5.3mm, 51% of the overjet correction was due to skeletal changes and 49% due to dental changes.9 cases obtained normal overjet and overbite and molar relationship. CONCLUSION: The combination of protraction facemask and rapid maxillary expansion is helpful to the correction of Class III malocclusion in children aged from 10 to 14 years. It can alleviate the degree of deformation,avoid surgery, and improve the relationship between hard and soft tissue.

PMID: 14983320 [PubMed]

[Application of III-type bio-modulator in the reversed horizontal overbite of the deciduous dentition and mixed dentition]

Shanghai Kou Qiang Yi Xue. 2003 Oct;12(5):398-400

Authors: Qian L

PMID: 14966629 [PubMed - indexed for MEDLINE]

[The study on treatment of anterior crossbite cases in mixed dentition applying FR-III combind with maxillary removable appliance]

Shanghai Kou Qiang Yi Xue. 2003 Oct;12(5):383-5

Authors: Wang SX, Zhou ZG

PMID: 14966620 [PubMed - indexed for MEDLINE]

[Cephalometry study of craniofacial and upper airway in boys with OSAS]

Shanghai Kou Qiang Yi Xue. 2003 Feb;12(1):3-6

Authors: Wei YH, Cai Z, Qian YF

OBJECTIVE: The purpose of the study was to find out craniofacial and upper airway characteristics of boys with OSAS. METHODS: Craniofacial and upper airway morphology was studied by computerized cephalometric analysis in 7 mixed dentition boys with OSAS and 29 healthy boys. RESULTS: The main differences of OSAS patients were shown as follows: longer dimension of cranial base with clockwise rotation of palate plane and mandibular plane, increased height of the tongue, inferiorly displaced hyoid bone, decreased sagittal dimension of upper airway in soft palate level and tongue base level. In addition, the tongue and soft palate occupied a larger portion of the oropharyngeal area. CONCLUSION: Patients with OSAS presented multiple abnormalities in craniofacial and upper airway. Cephalometry can be useful in diagnosis and determining the appropriate treatment for OSAS patients.

PMID: 14661449 [PubMed - indexed for MEDLINE]

Pseudo-Class III malocclusion treatment with Balters' Bionator.

J Orthod. 2003 Sep;30(3):203-15

Authors: Giancotti A, Maselli A, Mampieri G, Span&#xF2; E

The aim of this article is to show the use of the Balters' Bionator in pseudo-Class III treatment. The importance of differentiating between true Class III and pseudo-Class III is emphasized. The therapeutic results of a Balters' Bionator appliance are presented in three case reports of subjects in the mixed dentition. In this stage of development it is possible to correct an isolated problem. The use of the Bionator III in this kind of malocclusion enabled the correction of a dental malocclusion in a few months and therapeutic stability of a mesially-positioned mandible encouraging favourable skeletal growth.

PMID: 14530417 [PubMed - indexed for MEDLINE]

Quantitative effects of a nickel-titanium palatal expander on skeletal and dental structures in the primary and mixed dentition: a preliminary study.

Eur J Orthod. 2003 Aug;25(4):401-10

Authors: Ferrario VF, Garattini G, Colombo A, Filippi V, Pozzoli S, Sforza C

The present study analysed the six-month effects of a nickel-titanium (NiTi) palatal expander on the dental and palatal structures of four primary (mean age 5.8 years) and nine mixed dentition children (mean age 8.7 years), with a posterior unilateral crossbite. Standardized dental and palatal landmarks were digitized using a three-dimensional (3D) electromagnetic instrument. Collected data were analysed with geometric-mathematical models. During a six-month interval, the natural growth and development of the dental arches and hard tissue palate was negligible, as assessed in seven control children (two in the primary dentition, mean age 4.4 years; five in the mixed dentition, mean age 7.7 years). In all children the crossbite was completely corrected. Indeed, dental expansion was always more than or corresponded to the palatal expansion. A smoothing of the size-independent (shape) palatal curvature in the transverse plane was observed. No differences in maximum palatal height were noted. Symmetrical derotation of the anchorage teeth in a distal direction occurred in almost all children. The inclination of the facial axis of the clinical crown (FACC) in the anatomical transverse plane of those teeth with differences between dental and palatal expansion always showed significant modifications (vestibular inclination up to 16.7 degrees). The clinical crown height of anchorage teeth remained nearly the same in all patients. No significant modifications in mandibular arch size were observed. The increase in maxillary arch width, especially in younger children, was probably due to a combination of different effects: opening of the midpalatal suture, tipping of the alveolar process, and molar tipping.

PMID: 12938847 [PubMed - indexed for MEDLINE]

Orthopedic cervical headgear in class II treatment: case report.

Braz Dent J. 2003;14(1):63-6

Authors: Enoki C, Matsumoto MA, Ferreira JT

Early treatment for Class II malocclusion was undertaken with the objective of correcting skeletal disproportion by altering the growth pattern. A case of Class II, Division 1 malocclusion in the mixed dentition was corrected to Class I molar relationship using orthopedic cervical headgear, with nonextraction edgewise therapy. Cephalometric analysis indicated a reduction in the maxillomandibular discrepancy (ANB) correcting the Class II malocclusion to Class I malocclusion. The treatment showed that this was achieved by downward displacement and inhibition of the forward growth of the maxilla and growth of the mandible. There was no downward rotation of the mandible nor maxillary first molar extrusion. There was improvement in the jaw relationship.

PMID: 12656468 [PubMed - indexed for MEDLINE]

Comparative reproducibility of three methods of radiographic assessment of alveolar bone grafting.

Eur J Orthod. 2003 Feb;25(1):35-41

Authors: Nightingale C, Witherow H, Reid FD, Edler R

The aims of this study were to compare the reproducibility of three radiographic methods of assessing the quality of alveolar bone grafts, namely the Bergland, Kindelan and Chelsea Scales, and evaluate their application in the mixed and permanent dentitions. Additionally the use of occlusal versus periapical radiographs was assessed. Three examiners applied each scale on two occasions to the radiographs of 48 cleft lip and palate patients who had received alveolar bone grafts in 59 sites (11 had bilateral clefts). The agreement between repeated assessments by the same observer at different time points was measured by the kappa statistic, for each of the three assessors and each of the types of radiographic scale in turn. None of the three scales was found to be more reproducible than the others (kappa statistics for intraobserver variation ranged from 0.61 to 0.70). The agreement between observers was also similar across the three radiographic scales (multiple kappa statistics for inter-observer variation ranged from 0.45 to 0.51). Likewise, neither occlusal nor periapical radiographs were found to enable greater reproducibility of assessment. Surprisingly there was a tendency to greater reproducibility in the mixed than in the permanent dentition, which suggests the outcome of alveolar bone grafting may be assessed at an earlier stage than currently adopted. The outcome of alveolar bone grafting in this group of patients was generally successful.

PMID: 12608721 [PubMed - indexed for MEDLINE]

Unilateral distalization of a maxillary molar with sliding mechanics: a case report.

J Orthod. 2002 Jun;29(2):97-100

Authors: Keles A

INTRODUCTION: A unilateral Class II relationship could arise due to early loss of an upper second deciduous molar on one side during the mixed dentition period. This would allow the mesial drift of the molars, which may block the eruption of the second premolar. METHODS AND RESULTS: A 15-year 8-month-old male patient presented with a Class II molar relationship on the right, and Class I canine and molar relationship on the left side. His E was extracted when he was 5 years old. The 54 were impacted and the 3 was ectopically positioned due to the space loss from the mesial migration of the 76. In addition 21 1 were in cross-bite. Skeletally he had Class III tendency with low MMPA. He presented with a straight profile and retruded upper lip. For maxillary molar distalization, a newly developed 'Keles Slider' was used. The appliance was composed of one premolar and two molar bands, and the anchorage unit was composed of a wide Nance button. 46 were connected to the Nance button and, therefore, included into the anchorage unit. The point of distal force application was close to the centre of resistance of the 6 and parallel to the occlusal plane. Ni-Ti coil springs were used and 200 g of distal force was applied. Seven months later the space required for eruption of the permanent premolars and canine was regained, and the anterior cross-bite corrected. The appliance was removed and final alignment of the teeth was achieved with fixed appliances. CONCLUSION: At the end of the second phase treatment Class I molar and canine relationship was achieved on the both sides, the anterior cross-bite was corrected, inter-incisal angle was improved, and ideal overbite and overjet relationship was achieved. The active treatment time was 27 months.

PMID: 12114457 [PubMed - indexed for MEDLINE]

Orthodontics and the general practitioner.

J Am Dent Assoc. 2002 Mar;133(3):369-71

Authors: Christensen GJ

Until now, general dentists have not had significant involvement with orthodontic procedures. With this article, I encourage general dentists and other nonorthodontists interested in orthodontic therapy to acquire adequate education to allow them to participate in this area of clinical activity. The Invisalign concept can enhance the desirability of nonorthodontists' becoming involved with orthodontic procedures.

PMID: 11934193 [PubMed - indexed for MEDLINE]

Surgical repositioning of an impacted dilacerated incisor in mixed dentition.

J Am Dent Assoc. 2002 Jan;133(1):61-6

Authors: Tsai TP

BACKGROUND: Treatment options for a dilacerated incisor are either extraction or surgery and orthodontic traction. Because patients with such incisors usually are young, and because of the root angulation of the impacted incisor, treatment usually is lengthy and complicated. Surgical repositioning provides another option for treatment of this unique problem. CASE DESCRIPTION: The author presents the case of a 9-year-old girl with an impacted dilacerated maxillary central incisor to demonstrate the timing, technique and results of the surgical repositioning treatment approach. The advantages of this approach include immediate esthetic improvement, use of a single and simplified surgical procedure, simple and short orthodontic therapy, a normal gingival margin and the possibility of the developing root's adapting to the new position. CLINICAL IMPLICATIONS: Surgical repositioning is a simplified treatment for dilacerated incisors. It is especially valuable in cases of difficult-to-treat impaction. Timing of surgical repositioning depends on the incisor's root development and the space available for the transplant.

PMID: 11811744 [PubMed - indexed for MEDLINE]

The role of removable appliances in contemporary orthodontics.

Br Dent J. 2001 Sep 22;191(6):304-6, 309-10

Authors: Littlewood SJ, Tait AG, Mandall NA, Lewis DH

The contemporary uses of removable appliances are considerably more limited than in the past. This article discusses possible reasons for their declining use, including recognition of their limitations. It is possible to achieve adequate occlusal improvement with these appliances providing that suitable cases are chosen. Specific indications for their appropriate use on their own in the mixed dentition are presented. Removables can also be used as an adjunct to more complex treatments, to enhance the effect of fixed appliances, headgear or in preparation for functional appliances. Further research is required to confirm whether their use in conjunction with more complex treatments enhances the quality and efficiency of treatment or not.

PMID: 11587502 [PubMed - indexed for MEDLINE]

Pediatric mandibular fractures: a free hand technique.

Arch Facial Plast Surg. 2001 Jul-Sep;3(3):185-89; discussion 190

Authors: Davison SP, Clifton MS, Davison MN, Hedrick M, Sotereanos G

BACKGROUND: The treatment of pediatric mandibular fractures is rare, controversial, and complicated by mixed dentition. OBJECTIVES: To determine if open mandibular fracture repair with intraoral and extraoral rigid plate placement, after free hand occlusal and bone reduction, without intermaxillary fixation (IMF), is appropriate and to discuss postoperative advantages, namely, maximal early return of function and minimal oral hygiene issues. PATIENTS: A group of 29 pediatric patients with a mandibular fracture were examined. Twenty pediatric patients (13 males and 7 females) with a mean age of 9 years (age range, 1-17 years) were treated using IMF. All patients were treated by the same surgeon (G.S.). RESULTS: Surgical time for plating was reduced by 1 hour, the average time to place patients in IMF. The patients who underwent open reduction internal fixation without IMF ate a soft mechanical diet by postoperative day 3 compared with postoperative day 16 for those who underwent IMF. Complication rates related to fixation technique were comparable at 20% for those who did not undergo IMF and 33% for those who did. CONCLUSIONS: We believe that free hand reduction is a valuable technique to reduce operative time for pediatric mandibular fractures. It maximizes return to function while minimizing the oral hygiene issues and hardware removal of intermaxillary function.

PMID: 11497503 [PubMed - indexed for MEDLINE]

Rapid palatal expansion in mixed dentition using a modified expander: a cephalometric investigation.

J Orthod. 2001 Jun;28(2):129-34

Authors: Cozza P, Giancotti A, Petrosino A

The aims of this investigation were to cephalometrically study the short-term skeletal and dental modifications induced by rapid palatal expansion in a sample of 20 patients (10 male, 10 female), aged 6-10 years (mean age 8 years) in mixed dentition with a uni- or bilateral posterior crossbite, a mild skeletal Class II malocclusion, and an increased vertical dimension (FMA, SN/\GoGn), and to compare them with an untreated matched control group of 20 subjects (10 male and 10 female), mean age 8 years. Cephalometric analysis showed that the maxilla displayed a tendency to rotate downwards and backward, resulting in a statistically significant increase of the SN/\PP angle (T0 = 9*95 degrees, T1 = 11*60 degrees, P < 0*01) and the SN-ANS linear value (T0 = 49*50 mm, T1 = 51*10 mm, P < 0*05). In addition, there was a statistically significant alteration of the anterior total facial height N-Me (T0 = 113*15mm, T1 = 114*15 mm, P < 0*05) and for the dental upper molar measurement U6-PP (T0 = 19*70 mm, T1 = 20*30 mm, P < 0*05). The small alterations found in the anterior total facial height and in the sagittal angles agree with previous studies, and suggest that RPE can be also used in subjects with a tendency to vertical growth and a skeletal Class II malocclusion.

PMID: 11395527 [PubMed - indexed for MEDLINE]

Survey of dental treatments for pediatric patients referred to the pediatric dental clinic of a dental school hospital.

Bull Tokyo Dent Coll. 2000 Aug;41(3):127-33

Authors: Sekiguchi H, Ishiuchi C, Yakushiji M

This survey was conducted to clarify which dental treatments in children are regarded as difficult by general dentistry practitioners. The subjects were 615 children who first visited Tokyo Dental College Chiba Hospital from January 1995 to August 1999 with reference letters. There were 615 children in the study; 571 (92.8%) came from Chiba City where our hospital is located and the 11 regions surrounding Chiba City. The prime reasons for referral in the order of frequency were treatments of dental caries, malalignment/malocclusion, traumatized teeth, supernumerary teeth, retarded eruption/impacted teeth, abnormal direction of erupted teeth, congenitally missing teeth, prolonged retention of deciduous teeth, and abnormal frenulum. Patients with dental caries or traumatized teeth in the deciduous dentition period and those with malalignment/malocclusion, supernumerary teeth, or retarded eruption/impacted teeth in the mixed dentition period were often referred to medical organizations specializing in pediatric dentistry because of the difficulties in controlling the patients' behavior and in providing adequate treatment. The information about pediatric dental treatments considered difficult by general dentists revealed by this survey appears to be useful and needs to be incorporated in the programs for clinical training of undergraduate students and education of postgraduate students.

PMID: 11212585 [PubMed - indexed for MEDLINE]

Early vs. late orthodontic treatment.

J Am Dent Assoc. 2000 Oct;131(10):1406, 1408, 1410 passim

Authors: Solomon F

PMID: 11042978 [PubMed - indexed for MEDLINE]

Early orthodontic treatment: what are the imperatives?

J Am Dent Assoc. 2000 May;131(5):613-20

Authors: Kluemper GT, Beeman CS, Hicks EP

BACKGROUND: Then authors provide a critical review of the issues involved in determining the appropriate timing of orthodontic treatment. Both single- and two-phase treatments are discussed and guidelines are offered to assist in formulating treatment plans. OVERVIEW: In providing orthodontic care for pediatric patients, clinicians often question whether to begin treatment early--during the primary or early-transitional dentition--or wait until all or most of the permanent teeth are present. The authors review the most current literature (from 1991 to 1999), including several recently completed and ongoing randomized clinical trials, to critically evaluate the effectiveness of each approach. PRACTICAL IMPLICATIONS: The controversy surrounding early vs. late orthodontic treatment is often confusing to the dental community. This article reviews both sides of the issue for orthodontic treatment of Class II and III malocclusions, as well as for the management of Class I crowding and problems in the transverse dimension. Early orthodontic treatment is effective and desirable in specific situations. However, the evidence is equally compelling that such an approach is not indicated in many cases for which later, single-phase treatment is more effective. Therefore, clinicians must decide, on a case-by-case basis, when to provide orthodontic treatment. For many patients, delaying treatment until later in their dental and skeletal development may be advisable.

PMID: 10832255 [PubMed - indexed for MEDLINE]

Treating bruxism and clenching.

J Am Dent Assoc. 2000 Apr;131(4):436

Authors: Harnick DJ

PMID: 10770004 [PubMed - indexed for MEDLINE]

Treating bruxism and clenching.

J Am Dent Assoc. 2000 Feb;131(2):233-5

Authors: Christensen GJ

PMID: 10680392 [PubMed - indexed for MEDLINE]

Orthodontists' perceptions of the impact of phase 1 treatment for Class II malocclusion on phase 2 needs.

J Dent Res. 1999 Nov;78(11):1745-53

Authors: King GJ, Wheeler TT, McGorray SP, Aiosa LS, Bloom RM, Taylor MG

The most appropriate timing for the treatment of Class II malocclusions is controversial. Some clinicians advocate starting a first phase in the mixed dentition, followed by a phase 2 in the permanent dentition. Others see no clear advantage to that approach and recommend that the entire treatment be done in the late mixed or early permanent dentition. This study examines how orthodontists, blinded to treatment approach, perceive the impact of phase 1 treatment on phase 2 needs. The sample consisted of 242 Class II subjects, aged 10 to 15, who had completed phase 1 or observation in a randomized clinical trial (RCT). For each subject, video orthodontic records, a questionnaire, a fact sheet, and a cephalometric tracing were sent to five randomly selected reviewing orthodontists blinded to subject group and study purpose. Reviewing orthodontists were asked to assess treatment need, general approach, need for extractions, priority, difficulty, and determinants. Orthodontists agreed highly on treatment need (95%) and moderately on treatment approach (84%) and extraction need (80%). They did not perceive differences in need, approach, or extractions between treated and control groups. Treated subjects were judged as less difficult (p = 0.0001) and to have a lower treatment priority (p = 0.0001) than controls. In ranking problems that affect treatment decisions, the orthodontists ranked dental Class II (p = 0.005) and skeletal relationships (p = 0.004) more highly in control than in treated patients. These data indicate that orthodontists do not perceive phase 1 treatment for Class II as preventing the need for a second phase or as offering any particular advantage with respect to preventing the need for extractions or other skeletal treatments in that second phase. They do view early Class II treatment as an effective means of reducing the difficulty of and priority for phase 2.

PMID: 10576171 [PubMed - indexed for MEDLINE]

Management of space problems in the primary and mixed dentitions.

J Am Dent Assoc. 1999 Sep;130(9):1330-9

Authors: Ngan P, Alkire RG, Fields H

BACKGROUND: According to the Third National Health and Nutrition Examination Survey, crowding and irregularity remain a consistent problem for children. Management of space problems continues to play an important role in a dental practice. It also represents an area of major interaction between the primary provider and the specialists. This article attempts to update clinicians on the current knowledge of space management. DESCRIPTION OF CONDITION: Proper management of space in the primary and mixed dentitions can prevent unnecessary loss in arch length. Diagnosing and treating space problems requires an understanding of the etiology of crowding and the development of the dentition to render treatment for the mild, moderate and severe crowding cases. Most crowding problems with less than 4.5 millimeters can be resolved through preservation of the leeway space, regaining space or limited expansion in the late mixed dentition. In cases with 5 to 9 mm of crowding, some can be approached with expansion after thorough diagnosis and treatment planning. Most of these cases will require extraction of permanent teeth to preserve facial esthetics and the integrity of the supporting soft tissue. Serial extraction or guidance of eruption is reserved for treatment of severe tooth-size/arch-size discrepancies. Due to variations in the timing and extraction sequence depending on the diagnosis, serial extraction should be reserved for those who can complete the treatment successfully. CLINICAL IMPLICATIONS: The recommended timing of referring patients with moderate crowding to specialists for treatment is in the late mixed-dentition stage of development. Patients with severe crowding will require earlier evaluation for serial extraction.

PMID: 10492540 [PubMed - indexed for MEDLINE]

Elastic activator for treatment of open bite.

Br J Orthod. 1999 Jun;26(2):89-92

Authors: Stellzig A, Steegmayer-Gilde G, Basdra EK

This article presents a modified activator for treatment of open bite cases. The intermaxillary acrylic of the lateral occlusal zones is replaced by elastic rubber tubes. By stimulating orthopaedic gymnastics (chewing gum effect), the elastic activator intrudes upper and lower posterior teeth. A noticeable counterclockwise rotation of the mandible was accomplished by a decrease of the gonial angle. Besides the simple fabrication of the device and uncomplicated replacement of the elastic rubber tubes, treatment can be started even in mixed dentition when affixing plates may be difficult.

PMID: 10420241 [PubMed - indexed for MEDLINE]

Thin-plate spline analysis of treatment effects of rapid maxillary expansion and face mask therapy in early Class III malocclusions.

Eur J Orthod. 1999 Jun;21(3):275-81

Authors: Baccetti T, Franchi L, McNamara JA

An effective morphometric method (thin-plate spline analysis) was applied to evaluate shape changes in the craniofacial configuration of a sample of 23 children with Class III malocclusions in the early mixed dentition treated with rapid maxillary expansion and face mask therapy, and compared with a sample of 17 children with untreated Class III malocclusions. Significant treatment-induced changes involved both the maxilla and the mandible. Major deformations consisted of forward displacement of the maxillary complex from the pterygoid region and of anterior morphogenetic rotation of the mandible, due to a significant upward and forward direction of growth of the mandibular condyle. Significant differences in size changes due to reduced increments in mandibular dimensions were associated with significant shape changes in the treated group.

PMID: 10407536 [PubMed - indexed for MEDLINE]

A retrospective comparison of functional appliance treatment of Class III malocclusions in the deciduous and mixed dentitions.

Eur J Orthod. 1998 Jun;20(3):309-17

Authors: Baccetti T, Tollaro I

This retrospective study compared the effectiveness of treatment of Class III malocclusions with the removable mandibular retractor in the deciduous and mixed dentitions. A group of 20 children with Class III malocclusions started treatment at a mean age of 5 years 1 month +/- 7 months (deciduous dentition), while a group of 18 children with Class III malocclusions started treatment at a mean age of 8 years 2 months +/- 9 months (mixed dentition). The mean observation period was 2 years 3 months +/- 6 months for the first group, and 2 years 4 months +/- 7 months for the second group. Matched control groups of children with untreated Class III malocclusions in the deciduous and in the mixed dentition (16 subjects and 15 subjects, respectively) were used. The cephalometric analysis was based on a stable basicranial reference system appropriate for longitudinal studies that begin at early developmental ages. The results showed that treatment of Class III malocclusions in the deciduous dentition produced a more significant anterior morphogenetic rotation of the mandible, due to a more upward and forward direction of condylar growth (P < 0.01). This leads to significantly smaller increments in mandibular total length (Co-Pg) in children with Class III malocclusions under-going very early treatment (P < 0.01). On the contrary, maxillary dento-alveolar protrusion induced by therapy was greater in Class III subjects treated in the mixed dentition (P < 0.01). The optimum timing to improve skeletal relationships in Class III malocclusions by means of a functional appliance appears to be in the deciduous dentition.

PMID: 9699409 [PubMed - indexed for MEDLINE]