Mandibular asymmetry after lesion of the trigeminal motor nucleus: a case report.
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Adult↗
Biomedical subjects
Gernot Göz
Publications and source records attributed to Gernot Göz.
Effects of cervical headgear on overbite against the background of existing growth patterns. A retrospective analysis of study casts.
OBJECTIVE: To test the questions "Does cervical headgear treatment necessarily lead to a reduction of overbite?" and "Are there differences in treatment results due to different growth patterns or the initial overbite?" MATERIALS AND METHODS: Initial and intermediary casts of 247 patients who had been treated exclusively with headgear were analyzed for changes in the occlusal relationship of the first molars and overbite. Orthodontic treatment consisted of the application of cervical headgear with nonangulated external arms applied at a force of 3.5-4.0 N. Only patients showing dental changes of occlusal relationship > or = 4 mm during at least a 6-month treatment duration were selected. Growth patterns were identified by the y-axis values measured on lateral cephalograms obtained at study entry. Six groups were formed on the basis of these growth patterns. RESULTS: Headgear treatment induced bite deepening in patients with vertical growth patterns and bite opening in patients with horizontal growth patterns. Further subdivision based on initial overbite revealed bite deepening in patients with small initial overbite and bite opening in patients with large initial overbite. These differences were statistically significant (P < .05). Only minor changes were observed in patients with an initial overbite of 3-4 mm. CONCLUSIONS: Overbite reductions were not dependent on the growth pattern. Orthodontists should expect bite opening in deep-bite situations and bite deepening in open-bite situations. However, initial overbite situations of 3-4 mm should not be expected to change in a significant way.
Cephalometry↗
Molar and canine occlusal changes in study casts before and after treatment with cervical headgears.
AIM: We carried out a retrospective study on 246 pairs of casts to compare the extent of changes in occlusal relationship and overjet reduction induced by cervical headgears. MATERIAL AMD METHODS: Molar-canine occlusal relationships and overjet were determined from study casts made immediately before headgear treatment. Those findings were then compared to another cast made immediately after headgear monotherapy and before multiband-appliance administration. Headgear treatment lasted at least 6 months. Only patients whose upper first molars were distalized by at least 4 mm were included. RESULTS: Strikingly, the distalization and overjet reduction induced by headgear treatment were most pronounced in posterior positions and decreased progressively toward more anterior positions along the arch. The mean amount of distalization was 6.87 mm at molar, and 1.87 mm at canine positions. The mean reduction of initial overjet was 0.78 mm. No significant differences resulted by grouping the data based on upper anterior tooth inclinations before treatment. Significant differences, however, were obtained by grouping the data based on initial overjet. Significantly greater changes in molar-canine occlusal relationships and overjet reductions were observed in patients with a major initial overjet of > 6 mm than in those with a relatively minor overjet of < 4 mm.
Child↗
Treating Class II patients with removable plates and functional orthopedic appliances-the importance of anterior tooth inclination and direction of growth on treatment outcome.
OBJECTIVE: To determine the influence of physiological growth pattern and anterior tooth inclination on the outcome in Class II patients treated with removable orthodontic plates and functional orthodontic appliances. PATIENTS AND METHODS: After recruiting 50 patients with an upper anterior proclination of 1-SN >or= 107 degrees for this retrospective study, another 50 patients with a retroclination of 1-SN <or= 95 degrees were also included. All patients initially presented a skeletal Class II relationship with a distoclusion of at least one premolar width in the region of the first molars. All patients were evaluated separately by gender and additionally subdivided into three subgroups with a horizontal, neutral, or vertical craniofacial configuration. Treatment with removable orthodontic plates (pretreatment) and functional orthodontic appliances was initiated in mixed dentition. Pre- and post-treatment lateral cephalograms were evaluated for each patient. RESULTS: Dento-alveolar analysis showed that the inclination of the upper incisors changed in the direction of the clinical standard value independent of the craniofacial configuration, although full correction using removable orthodontic plates and functional orthodontic appliances was not always achieved. Similarly good treatment outcomes were achieved with regard to overjet and overbite. The lower incisors of all patients were in proclination after treatment. The ANB angle was reduced in both groups. Nevertheless, on average a skeletal Class II persisted in the Class II, Division 2 patients, while Class II, Division 1 patients with horizontal craniofacial configurations attained skeletal Class I. CONCLUSIONS: Treatment of Class II patients with removable appliances resulted in differences depending on anterior tooth inclination (Class II, Division 1 and II, Division 2) and craniofacial configuration. These differences must be taken into account during treatment planning. Complete treatment success with regard to sagittal jaw balance is very difficult to achieve with removable orthodontic plates (pre-treatment) and functional orthodontic appliances alone in Class II, Division 1 cases with a vertical craniofacial configuration and generally in Class II, Division 2 cases. A particularly favorable constellation for removable treatment is a Class II, Division 1 situation with a horizontal craniofacial configuration and retroclined or orthognathic mandibular anteriors.
Bone Development↗
A premolar extraction case using the Invisalign system.
INTRODUCTION: Invisalign therapy is an orthodontic treatment method using removable transparent polyurethane splints. Its applicability in extraction cases is limited. This case report documents the treatment with Invisalign of a patient in whom four premolars had to be extracted due to dental crowding. FINDINGS AND DIAGNOSIS: The patient's primary objective was to undergo treatment to resolve her anterior crowding as esthetically inconspicuously as possible. Diagnostic findings were: constriction of the maxillary and mandibular arch with anterior dental crowding; proclination and anteposition of the anteriors; neutroclusion with an overjet of 6 mm and an overbite of 1 mm. The radiographs showed a mesial tilt of the lower canines and premolars and a mild skeletal Class II relationship with a vertical craniofacial configuration. TREATMENT PROGRESS AND RESULTS: Treatment was initiated by extracting the four first premolars and placing the attachments (Tetric Ceram composite). After the Invisalign aligners had been worn, the anterior segment was uprighted and retracted, the crowding resolved, and the arches well-aligned. The patient's neutroclusion was maintained, physiological anterior relations in the sagittal and vertical planes were achieved, and the lower canines and premolars were uprighted. Active treatment lasted 1 year and 8 1/2 months and involved 43 maxillary and 28 mandibular aligners. CONCLUSION: Particularly in cases with an extended indication for this new treatment modality, due consideration must be given to the importance of comprehensive and meticulous diagnostics and treatment planning, and a solid grasp of the biological and mechanical fundamentals.
Adult↗
Retrospective analysis of casts to assess cervical headgear treatment in the presence of vertical growth pattern.
OBJECTIVE: Does molar distalization as effected by cervical headgear increase the vertical dimension of occlusion in patients with vertical growth pattern? MATERIALS AND METHODS: A sample of 86 patients with neutral and vertical growth pattern in the late mixed dentition stage underwent headgear treatment. Their initial and intermediary casts were retrospectively analyzed for occlusal relationships at the maxillary first molars and degrees of overjet and overbite. The only cases included were those in which headgear treatment was carried on for at least 6 months, achieving a minimum distalization of 4 mm. The intermediary casts were fabricated after headgear treatment had been completed and prior to the initiation of multiband treatment. Patients were divided into three groups (N, V1 and V2) according to the degrees of vertical growth pattern, which were determined based on y-axis angle values. RESULTS: Grouped by degrees of vertical growth, the data revealed occlusal relationship changes of 6-8 mm and overjet reductions of 0.6-1.2 mm. The overbite changes were unexpectedly small (0-0.04 mm). Grouped by degrees of overbite, the data revealed that headgear treatment increased the vertical dimension of occlusion in deep-bite patients (>4 mm), while giving rise to decreases in patients with overbites of <3 mm.
Adolescent↗
Perceived relative attractiveness of facial profiles with varying degrees of skeletal anomalies.
OBJECTIVE: The objective of this study was to answer the following questions: Are profiles of Class I patients perceived as more attractive than profiles of Class II or Class III patients in Germany today? How pronounced must a skeletal malocclusion be to be perceived as less attractive? Are there differences in perception between dentists and laypersons? MATERIAL AND METHOD: For the present study we examined seven patients with skeletal Class I, orthognathic maxillae and mandibles, and straight average faces (ideal biometric face as defined by A. M. Schwarz). Using the Onyx Ceph software, their profile lines were modified to reflect three different Class II profile variants and three different Class III profile variants. The 49 profiles thus obtained were assigned to two groups. Group 1 comprised the seven straight average faces and the first part of the retrognathic and prognathic profile variants. Group 2 comprised the same seven straight average faces and the remaining retrognathic and prognathic profile variants. Both groups of faces were scored by 130 laypersons and 126 dentists. RESULTS: Both groups of observers perceived the seven straight average faces similarly both in the first and second (subsequent) scoring rounds. The straight average face was perceived as most attractive by laypersons (mean, 5.48; 95% confidence interval (CI:) 5.33-5.60) and dentists (mean, 5.44; 95% CI, 5.28-5.50) alike, followed by the mildest variant of the retrognathic face (laypersons, mean, 4.85; 95% CI, 4.68-5.01; dentists, mean, 4.98; 95% CI, 4.81-5.10). Dentists differentiated more clearly by degree of skeletal malocclusion than did laypersons. Both groups alike perceived the extreme variant of the prognathic and retrognathic profile lines as the least attractive. Grouping the subjects by gender yielded only minor differences in perception. CONCLUSION: The straight average face is perceived as most attractive by representative German populations today. Dentists make clearer gradual distinctions in their perceptions than do laypersons.
Adult↗
Influence of orofacial dysfunctions on spatial and temporal dimensions of swallowing movements.
BACKGROUND AND AIM: Tongue dysfunctions are of etiologic significance for the development of malocclusions and speech disorders. Electromagnetic articulography is a means of recording orofacial movements. The aim of this study was therefore to analyze differences in the spatial and temporal sequence of swallowing movements under the influence of lip and tongue dysfunctions in order to develop new means of objectifying the diagnosis of such a dysfunction. PATIENTS AND METHOD: Thirty-one subjects were monitored during reflex swallowing and while swallowing 20 ml of water. All probands also underwent evaluation by a speech pathologist as well as palatography. The entire cohort was then divided into a viscerally and a somatically swallowing group, and the movement sequences were analyzed with reference to spatial and temporal parameters. RESULTS: The temporal parameters revealed fewer significant differences than the spatial parameters. Most differences were recorded for the section between palate separation point and end of swallowing. Specific spatial or temporal variables revealing a maximum number of differences between the two groups were found for each tongue region. Swallowing water revealed notably more significant intergroup differences. The most suitable variables during the swallowing of water were the maximum distance of tongue-palate contact and the distance or time interval between palate separation point and end of swallowing. CONCLUSION: The analysis of swallowing movements by electromagnetic articulography offers opportunities to evaluate tongue dysfunctions. The most suitable combination of variables was found for each of the regions investigated. Spatial analysis of the movement pattern seems to be the most reliable method.
Adolescent↗
Transplantation of a lower bicuspid after traumatic loss of three upper incisors.
BACKGROUND: Prosthodontic and orthodontic procedures have been described for the treatment of patients with traumatic loss of teeth. PATIENT AND METHODS: Both upper central incisors and the upper right lateral incisor had to be extracted in an 8-year-old patient after failure of conservative procedures following a sports accident. The patient was treated on a temporary basis with a space retainer as a substitute for the teeth. Definitive therapy was carried out by transplanting a lower bicuspid germ into the upper arch with subsequent orthodontic gap closure. RESULTS: 8 years after the intervention, the transplanted tooth is still in place. The patient is fully rehabilitated both functionally and esthetically with no discomfort. CONCLUSIONS: The transplantation of bicuspid germs in conjunction with orthodontic gap closure is a valuable alternative to prosthodontic treatment, particularly in the case of loss or aplasia of several teeth.
Adolescent↗
Retention and stability--taking various treatment parameters into account.
PATIENTS AND METHOD: In order to assess stability after orthodontic treatment, 132 patients who had been treated by one orthodontist in private practice were examined 6 years on average after completion of their treatment. Therapeutically induced movements and post-therapeutic changes were measured using dental casts, and the number of cases which had relapsed was calculated as a percentage of the individual measurements. The extent of post-therapeutic changes in patients with and without long-term retention was analyzed together with possible correlations with retention time and retainer type. Furthermore, the influence of gender, Angle classification, treatment-induced changes, initiation, type and duration of therapy, and extraction of premolars on the development of relapse was also investigated. RESULTS AND CONCLUSIONS: Some degree of relapse was recorded in 13% of the measurements on average, even in patients with some form of long-term retention. However, it may be possible to reduce the relapse rate by taking account of the following criteria: Retention time should be increased in cases of short-term therapy, since relapse was found to occur more often on average (19%) when the treatment time was less than 3 years than when it was longer than 4 years (13%). As the highest relapse rate registered was 24% when therapy was started between the ages of 9 and 12 years, but was up to 42% in younger and older patients, there should be more extensive retention in these latter cases. Where there is a risk of relapse in the anterior arch, fixed lingual retainers should be given preference over removable ones. This is especially applicable to male patients and to non-extraction patients, as relapses in the anterior segment occurred more often or were more marked in these cases. The use of removable retainers is necessary when the transverse stability of the buccal segment is at risk. When only fixed retainers were used in the anterior area, relapses were recorded 6-31% more frequently in the interpremolar distance in the maxilla (21%) and the mandible (35%), and in the lower intermolar distance (27%). In particular, the use of a removable mandibular retainer should not be dispensed with after bicuspid extractions, transverse expansion and, in female patients, in the lower jaw, as relapse in the buccal segment was more marked or more common in such cases. On the basis of our clinical findings and of earlier studies, the retention time should be at least 2 years. The retainer type used has been found to be just as important as the retention time. If optimum relapse prevention is aimed at, fixed maxillary and mandibular retainers in the anterior region should be combined with a removable retainer and worn until the patients reach their late twenties.
Adolescent↗
TMJ remodeling after condylar fracture and functional jaw orthopedics a case report.
BACKGROUND: Condylar fractures in childhood are generally treated in a conservative-functional manner. As a rule, very good healing results are achieved by functional orthodontic treatment alone or, after immobilization, by splinting. HISTORY AND TREATMENT: Here we report on a patient who suffered a deep condylar dislocation fracture as a result of trauma at the age of 5. After initial immobilization with Schuchardt splints she underwent functional jaw orthopedics with activators. Subsequent orthodontic treatment with removable and fixed appliances enabled her to be followed up form functional and radiographic aspects over a period of 13 years. The remodeling process of the condylar head and neck could be clearly seen in the panoramic control radiographs. RESULT: Although the traumatized right TMJ was completely pain-free and fully functional after only a short time, the remodeling of the head and neck of the originally traumatized TMJ took 13 years to correspond fully to the healthy TMJ on the opposing side.
Activator Appliances↗