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PubMed1990

[Two cases of crowding with disharmony between the upper and lower jaws].

Since the malocclusion involved with a disharmony between the upper and lower jaws is generally treated with growth stimulation and inhibition to correct the disharmony, orthodontic treatment for this type of malocclusion is usually started at an early age. On the other hand, the case of crowding which has no such problem is caused by so called arch length discrepancy; discrepancy between teeth and jaw sizes. This type of maloccusion, therefore, is usually treated with extraction of teeth and in most of these cases treatment is started after the permanent dentition is established and growth and development of the maxilla is fairly well completed. Actually, however, case of crowding often have skeletal disharmony as a potential problem, in which cases the orthopedic approach is thought to be better if started rather early. This is because the orthodontic approach alone is not enough to solve skeletal problems, which problems are better handled before the teeth are moved. This procedure can prevent excessive tooth movement. The two cases reported here with crowding as the chief complaint were treated by the early orthopedic approach for potential skeletal problems prior to orthodontic correction. The results indicate the effectiveness of this procedure.

Child↗
PubMedDate not supplied

Anterior dental crossbite: relationship between incisor crown length and incisor irregularity before and after orthodontic treatment.

The purpose of this study involving a sample of children with single central incisor crossbite was to determine the relationship between clinical crown lengths of the crossbite and noncrossbite mandibular incisors, incisor irregularity, and orthodontic correction of the crossbite. In addition, for comparison, the normal maturational change in position of the labial gingival margin of mandibular incisors not undergoing orthodontic correction was examined. Twenty-one children treated for single central incisor crossbite were matched individually by gender and age to a comparison group. Pre- and post-treatment mandibular central incisor crown lengths and incisor irregularity were measured. In 10 of the 21 anterior crossbite cases, the crown length of the crossbite incisor was more than 1.5 mm greater than that of the noncrossbite incisor. This difference improved with orthodontic treatment by a combination of apical movement of the gingival margin of the noncrossbite incisor (0.9 +/- 0.8 mm) and coronal movement (0.2 +/- 0.6 mm) of the gingival margin of the crossbite incisor. In contrast, for the remaining 11 anterior crossbites without such a crown length difference, and for the comparison cases, the gingival margins of both mandibular central incisors moved equally from pre- to post-treatment by 0.5 +/- 0.5 mm in an apical direction. Pretreatment crown length difference between crossbite and noncrossbite incisor was associated strongly to incisor irregularity (P < or = 0.005, r = 0.65). Orthodontic correction of the crossbite produced an improvement in irregularity index (IR) that was greatest in those anterior crossbite cases with a pretreatment crown length difference.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1996

Orthodontic-surgical correction of a Class II, Division 2 malocclusion.

The incorporation of the total subapical osteotomy as an alternative surgical technique to augment standard bilateral sagittal split osteotomy in facilitating establishment of the profile objectives in the surgical-orthodontic treatment of a patient with skeletal sagittal discrepancy, is presented in this case report. Esthetic considerations, as well as risks involved in this type of a combined surgical approach, are also discussed.

Adult↗
PubMed1998

Stability of transverse maxillary dental arch dimensions following orthodontic-surgical correction of anterior open bites.

A sample of 130 patients with vertical maxillary hyperplasia; mandibular hypoplasia with a high mandibular plane angle; narrow, tapered maxillary dental arch form; and anterior vertical open bite were collected from three different institutions to evaluate the stability of transverse maxillary arch dimensions after correction of the open bite. Surgical treatment consisted of Le Fort I or bimaxillary osteotomies. Intermolar, interpremolar, and anterior arch widths were measured three-dimensionally on dental casts using a Reflex microscope, and transverse stability after orthodontic or surgical maxillary expansion was analyzed. Orthodontic expansion followed by a one-piece Le Fort I intrusion osteotomy was performed in 77 patients, and surgical maxillary expansion by a multisegment Le Fort I intrusion osteotomy was performed in 53 patients. The increase of transverse arch width and the relapse after orthodontic or surgical expansion were not significantly different. The transverse arch width in these two groups did not relapse in 20% of the patients after a mean follow-up of 69 months. An additional bilateral sagittal split osteotomy had no detectable effect on stability. Patients who underwent a multisegment Le Fort I osteotomy stabilized with rigid internal fixation showed better transverse stability than those with intraosseous wire fixation and maxillomandibular fixation. Maxillary intermolar and interpremolar arch width relapses were not correlated with tongue interposition or loss of interdigitation. The relapse of these arch widths showed significant correlations with clockwise rotation of the mandible but not with changes of overbite or overjet.

Adolescent↗
PubMed1996

An American Board of Orthodontics case report: the orthodontic-surgical correction of a Class II malocclusion with anterior open bite.

This is the case report of a 39-year-old woman who presented with a skeletal Class II malocclusion, anterior open bite, and chronic temporomandibular disorder. Small maxillary lateral incisors and moderate mandibular anterior crowding led to the treatment plan, which involved extraction of a mandibular incisor. A combined orthodontic-surgical treatment plan resulted in greatly improved occlusal function and in a reduction of the patient's temporomandibular disorder symptoms.

Adult↗
PubMed1979

Combined orthodontic-surgical correction of moderate mandibular deficiency.

Carefully planned, coordinated, and executed orthodontic and surgical treatment is a viable alternative to traditional orthodontic treatment of patients with moderate mandibular deficiency. Recognition of their clinical manifestations is essential to distinguish between relative and absolute mandibular deficiency. If after clinical analysis of the Class II patient, esthetic priorities are established to maintain a balanced relationship between the upper lip and nose and not reduce the prominence of the upper lip, mandibular deficiency must be treated by surgical advancement of the mandible, superior repositioning of the maxilla, and consequent autorotational movement of the mandible forward and upward, or a combination of these procedures. The common denominator of successful therapy of absolute mandibular deficiency involves surgery to advance the mandible; relative mandibular deficiency, on the other hand, is treated by maxillary surgery to reposition the maxilla superiorly to allow forward and upward movement of the retropositioned mandible (autorotation). In actual clinical practice many patients manifest a combination of absolute and relative mandibular deficiency and are treated by maxillary and mandibular surgery. Lateral maxillary osteotomies, in concert with rapid maxillary expansion and genioplasty to alter the dimensions of the chin, are essential adjunctive surgical procedures to achieve three-dimensional esthetic and occlusal balance.

Adult↗
PubMed1993

An American Board of Orthodontics case report: the orthodontic-surgical correction of a Class I malocclusion with high mandibular plane angle, bimaxillary protrusion, and vertical maxillary excess.

This is the case report of a 26-year-old black woman with a Class I malocclusion and a skeletal Class II profile and vertical maxillary excess. Extraction spaces were closed, creating a Class II malocclusion to augment anticipated surgery (LeFort I osteotomy and genioplasty). The treatment result provided outstanding occlusal function and optimal facial esthetics. Attention to detail was mandatory, i.e., identify the patient's chief complaint, provide treatment options to resolve the complaint, and treat and maintain the dentition as ideally as possible. [This case was presented to the American Board of Orthodontics in partial fulfillment of the requirements for the certification process conducted by the Board.]

Adult↗
PubMed2001

Concerns and motivations of skeletal Class III patients receiving orthodontic-surgical correction.

The objective of this research was to study the impact of skeletal Class III malocclusion on patients' emotional status, as well as patients' motivations for seeking surgical correction of Class III malocclusion. The sample comprised 140 consecutive Chinese patients with skeletal Class III malocclusion who had been treated with a combined orthodontic-surgical approach. A retrospective analysis was performed, based on questionnaires with answers ranked on a numeric scale (O = not at all; 1 = a little; 2 = moderately; 3 = quite a bit; 4 = extremely). Sixty-seven percent of subjects (40 males and 54 females) returned completed questionnaires. Fifty-four percent had bimaxillary deformities, 32% had mandibular hyperplasia, and 14% had maxillary hypoplasia. Seventy-seven percent received bimaxillary surgery, 15% received maxillary advancement, and 8% received mandibular setback. The results showed that nearly half of the patients had a nickname related to their dentofacial problems, and 8 of 10 of these felt embarrassed or angry about their nickname. Ninety-three percent sought improvement of their facial appearance, 85% wanted an improvement in their dental appearance, and 73% desired an improvement in chewing ability. Seventy-six percent were concerned about surgical risks and 63% about possible pain. The vast majority of Class III patients undergoing orthognathic surgery suffered psychologic and functional problems related to their appearance prior to treatment. Esthetic improvement was the driving force behind seeking treatment.

Adolescent↗
PubMed2005

Bilaterally impacted maxillary canines and multiple missing teeth: a challenging adult case.

UNLABELLED: AUTHORS: Mesotten K, Naert I, van Steenberghe D, Willems G. OBJECTIVES: Orthodontic correction of bilateral maxillary canine impaction with agenesis of the lower second premolars and extraction of the lower first molars in an adult patient. METHODS: After surgical exposure, the canines were relocated in the arch by means of immediate orthodontic traction. Endosseous Branemark system implants were inserted in the lower jaw with a double purpose: stabilization of orthodontic anchorage and prosthetic tooth replacement. RESULTS: Closure of the edentulous space in the lower arch was accomplished by a multidisciplinary approach while orthodontic correction of the initial malocclusion was achieved. CONCLUSION: Implants provided anchorage control for tooth movement and created the possibility of prosthetic rehabilitation through a multidisciplinary treatment approach.

Adult↗
PubMed1994

Cephalometric alterations following facial advancement surgery. 2. Clinical and computerised evaluation.

Part 1 of this investigation identified an established patient cohort whose treatment is best suited to combined surgical-orthodontic correction of dento-facial deformity. This is as opposed to the attempted correction of the problem by an orthodontics-only or a surgery-only approach. Experienced surgeons will subjectively assess facial aesthetics and devise surgical treatment objectives in terms of the beneficial soft tissue improvements derived from dento-skeletal manipulation. None the less, traditional and soft tissue cephalometric parameters remain a guideline in the diagnostic phase of treatment. Part 2 of this investigation compared pre and postoperative clinical and computerised evaluations of patients diagnosed as having combined mid and lower dento-facial deficiency with Class 1 dento-skeletal parameters.

Cephalometry↗
PubMed1994

Effects of patient age on postorthodontic stability in Class II, division 1 malocclusions.

The increase in the proportion of adults in the typical orthodontic practice merits closer scrutiny of the treatment differences involved in adult vis-à-vis adolescent patients. Orthodontic treatment in the adolescent relies heavily on growth; in the adult, the practitioner must reposition teeth within the nongrowing arches. This difference may create the potential for greater postretention relapse in the adult; alternatively, continued growth in the subadult might detract from stability of the case. Two samples of Class II, Division 1 cases, all treated by one specialist, were examined an average of 5 years out of treatment. One group had been treated during adolescence (approximately 12 years of age), the other in adulthood (approximately 28 years). The orthodontic corrections were stable in both groups, but for different reasons: Posttreatment changes in the bony and dental structures of the adults were minimal. Bony changes (i.e., continued midface and mandibular growth) were appreciable in adolescents, and this growth--notably growth of the mandible--compensated for unfavorable drift of the dental elements (primarily mesial shift of the maxillary molar) after treatment. In sum, orthodontic corrections in adults were found to be at least as stable as those in the conventional adolescent patient.

Adolescent↗
PubMed2006

Lip-to-incisor relationship and postorthodontic long-term stability of cover-bite treatment.

OBJECTIVE: To investigate the impact of a persisting high lip line and other potential relapse-inducing factors on long-term stability of orthodontic correction of retroinclined maxillary central incisors. MATERIALS AND METHODS: Thirty-one cover-bite ("Deckbiss") patients with retroinclined maxillary central incisors and a deep frontal overbite were evaluated. The maxillary central incisor inclination was determined odontometrically with study models made pretreatment, posttreatment, and at a follow-up examination (mean posttherapeutic interval: 9.0 years). The lip-to-incisor relationship, the interincisal angle, and the anteroposterior maxillary central incisor position were measured on lateral cephalograms taken after active treatment. RESULTS: The relapse tendency of the orthodontic correction of the retroinclined maxillary central incisors displayed great interindividual variability with a range of posttherapeutic inclination change of -6.75 degrees to +8.00 degrees. Multiple regression analysis revealed an increased tendency for relapse in patients with (1) a high posttherapeutic (dorsal) lip line level combined with the maxillary central incisor and lower lip contact only in the incisal crown area (P < .01) and (2) a marked therapeutically induced inclination change of the maxillary central incisors (P < .05). Interrelations between the relapse of the corrected maxillary central incisors and other evaluated parameters were not statistically significant. CONCLUSIONS: For maximum treatment stability, the elimination of an excessive overlap of the upper incisors by the lower lip should be regarded as one of the most important therapeutic objectives when treating this malocclusion.

Adolescent↗
PubMed1981

The level anchorage system for correction of orthodontic malocclusions.

A new method of treating orthodontic malocclusion has evolved over 27 years of clinical effort to formulate anchorage requirements, treatment timing sequences, and treatment control. I have used a punch-card system to evaluate approximately 80 percent of my posttreatment results. Data from 20 patients were selected for presentation. The subjects all responded well with excellent posttreatment occlusion. Preorthodontic treatment goals such as cephalometric values, arch form, and function were achieved to my satisfaction. Average treatment time was longer than that estimated by only 6.5 percent. The subjects represent a wide variety of orthodontic problems with extraction and nonextraction choices and provide corroboration for the proposed efficiency of this method.

Adolescent↗