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Comparison of two orthodontical techniques for the correction of lingual deviation of upper incisors in the dog.

Two different orthodontic treatments were applied to dogs exhibiting lingual deviation of maxillary incisors. Two dogs were treated by means of an orthodontic device consisting of an acrylic plate fitted with a counteracting spring. The results were disappointing. These animals and two other dogs were treated with Schwarz's orthodontic device. After 3 to 4 months of treatment, lingual malposition of incisors was successfully corrected. Orthodontic therapy induced problems were unimportant and with collaborating owners could be easily overcome.

Animals↗

Abnormal function of the temporomandibular joints and related musculature. Orthodontic implications. Part II.

Timing of mandibular growth and orthodontic treatment are coincidental, not cause-and-effect. Comparison of cephalometric radiographic tracings made before, during, and after treatment has shown no evidence that orthodontic forces can either arrest or stimulate growth of the condyle. Conversely, the growth behavior of the condyles can have a profound effect on the time required to achieve an orthodontic correction and on the anatomic and functional relationships at the end of treatment and later. Mandibular growth at the moment of orthodontic force application can have important effects on facial growth and function. If there is no growth, the mandible may rotate downward and backward, and condyle displacement and clicking can occur. Future growth rarely leads to recovery of such alterations. With adequate growth at the moment of orthodontic force application, the freeway space is maintained and horizontal tooth movement does not alter mandibular position. The position of the maxillary incisors in the face must be based on many considerations going far beyond arbitrary conformity to some "standard" values based on averages. Functional relationships and their effects on the joints are one of those considerations, along with esthetics. Dynamic thinking requires that maxillary incisors not be over-retracted, anticipating continued growth of the condyle that can reposition the body of the mandible and lower incisors downward and forward. This can occur before, during, or many years after treatment. If a tight incisor relationship is established, or develops naturally, in the early or midteens, and the condyles later outgrow the maxilla, clicking may well develop. Anterior translation of the mandible with the new growth is impeded by the incisors, so posterior displacement of the condyles occurs instead. This is most likely to occur in straight ("good") faces. Facial morphology, or pattern, has an impact on function. In the straight facial pattern, these problems usually involve incisor interference. In convex faces, the problems more often involve vertical molar interferences. Each of these presents its own unique problems and treatment requirements.

Adolescent↗

Orthodontic analysis and treatment planning: a suite of programs for performing centroid cephalometrics.

The lateral skull radiograph is essential in the diagnosis of facial dysharmony and the planning and evaluation of corrective orthodontic treatment. The classical cephalometric analysis of the lateral radiograph involves the construction of lines and planes based on anatomical landmarks to form a reference system. A new approach to cephalometric measurement based on centres of area (i.e. centroids) has recently been developed. A suite of programs is described here for performing various types of centroid analysis ranging from a simple analysis of facial and cranial segments to template matching of cyclical curves. Sample runs are presented. Many of the programs are data-driven which means that they can be readily adapted to new situations. The system is currently being re-written to run in a more standardized environment.

Cephalometry↗

Guiding occlusal development with functional appliances.

Functional appliances have been used in orthodontics since their introduction by Pierre Robin almost one hundred years ago, however, our understanding of how they bring about orthodontic correction is still limited. This article is a brief overview of their history, mode of action, advantages and disadvantages, and includes the results of a study of attempts to control and minimise their side-effects using a recent development in functional appliances: the 'Teuscher Appliance'. This appliance combines a high-pull headgear with the activator, and is designed to reduce the often reported side-effects of functional appliances. The skeletal and dentoalveolar effects of treatment with the Teuscher Appliance on 40 consecutively-treated patients are reported and illustrated with four individual case reports. The results showed that the skeletal effect on the maxilla was a retardation of the normal forward and downward growth in 80 per cent of the cases, and that mandibular growth in 70 per cent of cases was forward. In patients whose mandibular growth was primarily in a vertical direction, such growth could be ascribed mainly to posterior rotation of the maxilla and/or the fact that the acrylic covering the lower posterior teeth to correct a deep bite was removed, promoting the eruption of these teeth and increasing the anterior vertical development. The dentoalveolar changes were characterised by retroclination of the maxillary incisors in 90 per cent of the patients, and were due to insufficient torque control by the built-in torque springs, which need further development. The mandibular incisors were well controlled by capping. The statistical analysis showed an inverse correlation between the initial incisor inclination and the change during treatment. This suggests that proclination of the lower incisors, as previously reported, is not a contra-indication to functional appliance treatment, provided the appliance is correctly designed. Overall, this study showed considerable individual response to treatment, and that the occlusal correction occurred through a combination of skeletal and dentoalveolar changes.

Adolescent↗

Dental malocclusion and upper airway obstruction, an otolaryngologist's perspective.

INTRODUCTION: This paper, through the presentation of eight case reports and a limited literature review, attempts to illustrate the negative effect that upper airway obstruction can have on developing dental occlusion and the positive effect that upper airway relief can have on the 'normalization' of various malocclusion patterns believed to be related to chronic obligate mouth breathing. OBJECTIVE: To study the effect of airway relief (usually through tonsillectomy and/or adenoidectomy) on various patterns of dental malocclusion. METHODS: Children coming to the office of the lead author (D.J.W.) found to be obligate mouth breathers and who also had dental malocclusion had Polaroid 'bite' pictures taken at the time of their initial visit. One year or more after their surgery for upper airway relief (tonsillectomy and adenoidectomy in these cases) a second 'bite' photograph was taken and compared to the first. RESULTS: In all cases selected in this study there was observed improvement in their dental occlusion within a year following surgery to improve their breathing. CONCLUSION: It is the opinion of the authors of this paper that upper airway obstruction may have a negative effect on the developing transitional dental occlusion and that eliminating the cause of upper airway obstruction can lead to 'normalization' of occlusion in such children. Further orthodontic corrective modalities may be required for optimal occlusal results.

Adenoidectomy↗

Dynamic cleft maxillary orthopedics and periosteoplasty: benefit or detriment?

In 1990, Drs Millard and Latham published their initial experience with dynamic maxillary appliances (DMAs) and periosteoplasty for children with cleft lip and palate. The technique provided for alveolar alignment and consolidation, with elimination of oronasal fistulas. Opponents to this approach speculated about impairments to facial growth. To date no longitudinal studies have been published. Over the last 10 years, 35 unilateral and 10 bilateral complete clefts have been treated with this technique. All patients have been followed and documented clinically, orthodontically, and radiographically. Cephalometric analyses were performed on children after the age of 6 years. The children have excellent facial aesthetics with well-balanced lips and noses. Radiographs demonstrate bone within the repaired alveolar clefts. Articulated impressions show anterior and lateral crossbites in the unilateral patients that improve over time and appear to be correctable orthodontically. The bilateral patients have satisfactory occlusions and arch forms. Cephalometric analyses confirmed no evidence of skeletal crossbites or midfacial growth retardation. This is a work in progress that will continue as the children grow. Although definite and final conclusions would be premature, it can be stated that to date all patients are following consistent and favorable growth patterns. Our team is confident in proceeding with this technique.

Alveoloplasty↗

An adolescent case of anterior open bite with masticatory muscle dysfunction.

In adolescence an open bite is likely to be induced by various causes, and most patients with open bite show masticatory muscle dysfunction. The orthodontic correction of an open bite may lead to the recovery of harmonious stomatognathic function. This article reports treatment for a 12-year and 10-month-old female patient with an anterior open bite. She complained of occlusal disturbances due to an anterior open bite. Before the eruption of the upper second molars, she recognized the presence of occlusal contacts between the upper and lower anterior teeth. Before treatment, the activity of the masticatory muscles was relatively low during clenching. An upper lingual arch with an accessory spring to eliminate the premature contact and to improve the anterior open bite plus conventional fixed appliances for tooth alignment was selected as the treatment plan. Immediately after improvement of the open bite, the muscle activity became slightly greater than that at the initial stage. The total treatment time was 13 months. After treatment, an acceptable occlusion was achieved, the masticatory muscles were working harmoniously, and their activity was much higher than that at the initial stage. After a 2-year retention period, an acceptable occlusion was maintained without recurrence of the open bite, indicating a long-term stability of occlusion. The result of this treatment indicated that correction of open bite is of great importance for prevention of skeletal impairment and recovery of harmonious stomatognathic function lost by an unstable occlusion.

Adolescent↗

Discriminant analysis: a model for the prediction of relapse in Class III children treated orthodontically by a non-extraction technique.

Discriminant analysis has been used to predict the long-term outcome of treatment in children with Class III malocclusions considered suitable for orthodontic correction by a non-extraction technique. Thirty-four children, whose treatment included the application of headgear to the mandibular dentition, formed the basis of this study. Records were examined at the start of treatment and at least 2 years out of all retention. For 25 of these patients, the treatment outcome was unambiguous and from these data a four-variable discriminant model was generated using a step-wise selection procedure, run under SPSS. This afforded 100 per cent correct prediction of the relapse status of all 25 children. The model provided realistic predictions for the remaining nine cases and for seven out of eight other children considered suitable for treatment without extractions, but by a variety of different techniques. The model was not suitable for the prediction of treatment outcome in children who required extractions: these represented a distinctly different sub-group of Class III individuals. Thus, using four measurements taken from the start of treatment records, the eventual outcome of orthodontic treatment can reliably be estimated, provided that the model is restricted to the sub-group of Class III children for whom it was designed. If the discriminant model predicts that this form of therapy will relapse, an alternative approach may be chosen.

Cephalometry↗

Transmaxillary osteogenesis distraction combined with orthopedics and orthodontics in the correction of a severe retrusion of the upper maxilla.

A patient having adequate records and diagnosed as having Binder syndrome is presented. Nasomaxillary hypoplasia requires a definitive treatment, use of bone grafts, upper maxillary osteotomies, and advancement or a combination of both. Bone grafts can be reabsorbed, and complete maxillary advance modifies normal occlusion in a certain way, because the posterior sector is not compromised. The aim of this case treatment is to create a new osseous surface that makes the eruption of the permanent dental pieces easier and gives the correct skeletal position to the upper maxilla with distraction osteogenesis combined with an orthopedic appliance, transmaxillary segment osteotomy, and subsequent orthodontics. The absence of the osseous surface in the upper maxilla and the presence of supernumeraries in the anterior region determined the permanence of most of the temporary dental pieces, resulting in the impossibility of making the exchange to permanent dental pieces. The technique and the devices are simple and easy to manipulate. After the treatment, an adequate dental relation is restored as well as effective advance of the upper maxillary bone; thus, an excellent functional and stable esthetic result is achieved, avoiding any complication of velopharingeal incompetence.

Child, Preschool↗

Aspartate aminotransferase activity in gingival crevicular fluid during orthodontic treatment. A controlled short-term longitudinal study.

BACKGROUND: During orthodontic tooth movement, the early response of periodontal tissues to mechanical stress involves an acute inflammatory response, with a sequence characterized by periods of activation, resorption, reversal, and formation in both tension and compression sites. This study used a longitudinal design to examine aspartate aminotransferase (AST) activity in gingival crevicular fluid (GCF) in order to assess whether AST in GCF has potential as a possible diagnostic aid to monitor tooth movement and tissue response during orthodontic treatment. METHODS: Eighteen patients (mean age, 16.1 years) participated in the study. An upper first molar from each patient undergoing treatment for distal movement served as the test tooth (TT), with its contralateral (CC) and antagonist (AC) first molars used as controls. The CC was included in the orthodontic appliance, but was not subjected to the orthodontic force; the AC was free from any orthodontic appliance. The GCF around the experimental teeth was collected from both mesial and distal tooth sites immediately before appliance activation, 1 hour after, and weekly over the following 4 weeks. Clinical gingival condition was evaluated at baseline and at the end of the experimental period. AST activity was determined spectrophotometrically at 30 degrees C, and the results were expressed as total AST activity (mU/sample). RESULTS: Throughout the experiment, AST levels were significantly elevated in all sites from the TT and CC groups compared to the AC group where, conversely, AST activity remained at the baseline level. However, enzyme levels in the TT group were significantly greater than in the CCs at tension sites on day 14, and in compression sites on days 7 and 14. Moreover, AST activity from the TT group was significantly greater in compression sites than in tension sites on day 7; this was not observed for the CCs. CONCLUSIONS: Our results suggest that AST levels in GCF reflect the biological activity which occurs in the periodontium during controlled occlusal trauma and, therefore, should be further evaluated as a diagnostic tool for monitoring correct orthodontic tooth movement in clinical practice.

Adolescent↗

Managing the cleft lip and palate patient.

We have attempted to elucidate, first through an examination of the basic science of clefting and then through a description of the roles of the various members of the cleft palate team, an understanding of the multiplicity of problems faced by this heterogeneous group of children with cleft lip or palate. With an incidence of cleft of 1 in 700 births, all practicing pediatricians will at some time be faced with a patient with a cleft. Pediatric management begins in the hospital nursery by ruling out possible associated anomalies (e.g., congenital heart disease or urinary tract) or syndromes. At the same time, cleft palate nursers may be needed to overcome feeding problems. Simultaneously, counseling for the family begins with a positive attitude toward outcome and an initial explanation of the schedule of corrective procedures, i.e., lip repair at 3 months of age and palate repair at about 1 year. The counseling should incorporate an understanding of the cause of clefting, both its genetics and teratogenetics, and then proceed to noting the actual recurrence risks of 1% for a new cleft and 16% if there is a positive family history in a first-degree relative. The recurrence risks in recognized syndromes may follow mendelian patterns. Later, the pediatrician can help the family deal with multiple ear infections and the likely need for tympanostomy tubes, anticipating the need for tubes in a way that might facilitate placement at the time of anesthesia for the lip or the palate repairs. An understanding of the speech and language difficulties that may be encountered in later infancy may relieve parental anxiety. Later, after palate repair, knowledge of velopharyngeal incompetence may avert premature hypernasal speech problems caused by adenoidectomy, which should be avoided if at all possible. The pediatrician needs to be aware of the tooth malformations that accompany clefting of the alveolus as well as the increased susceptibility to caries, so that the family may be directed to early intervention by the pediatric dentist. With support by pediatrics of the efforts of pediatric dentistry, the child is then in optimal condition for orthodontics. Continually keeping the child's emotional adjustment in mind, the pediatrician can encourage the child and family, knowing that with palatal expansion techniques plus possible bone graft surgery to the cleft alveolus at about 9 years of age, the child may be orthodontically corrected to very near normal.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗

C-fos expression in rat brain nuclei following incisor tooth movement.

In the rat experimental model, molar tooth movement induced by Waldo's method is known to cause a temporally and spatially defined pattern of brain neuronal activation. Since orthodontic correction usually involves the entire dental arch, we used a spring-activated appliance to extend the investigation to incisors, and we included brain regions related to antinociception. Adjustment of the non-activated appliance on incisors resulted in c-fos expression in the dorsal raphe, peri-aqueductal gray matter, and the locus coeruleus, in addition to trigeminal sensory subnuclei and the parabrachial nucleus, where neuronal activation has already been detected in previous studies on molar tooth movement. Appliance activation with a 70-g force resulted in a further increase in Fos-immunoreactive neurons in the trigeminal sensory subnucleus caudalis and in the dorsal raphe. This result suggests that there is a recruitment of neurons related to nociception and to antinociception when tooth movement is increased.

Analgesics↗

A comparative study of the effects of customized facemask therapy or headgear to the lower arch on the developing Class III face.

This retrospective, cephalometric study examined the effects of treatment in a group of 83 Class III, Skeletal III children, who were considered suitable for orthodontic correction of their malocclusions. All children completed therapy successfully: 44 individuals were treated with headgear to the mandibular dentition and for 39 a customized facemask was prescribed. These two groups were compared with 30 untreated Class III controls. Data were examined at the beginning and end of active treatment for the treated groups, and over a similar time interval for the controls. Where differences between the sexes were apparent, data for each sex are given separately. Where no significant differences were seen, data are pooled. In order to standardize the results, treatment (or observation) effects are presented as average changes per year. Surprisingly, despite the very different methods of applying the extra-oral force, the two treated groups showed strikingly similar therapeutic effects. The reverse overjet was corrected with little alteration in overbite. Upper incisors proclined whilst the lowers retroclined, becoming less prominent in relation to APo. The mandible hinged downwards and backwards, whilst the maxillary complex advanced. Lower face height increased more than would be expected by growth alone. Mirroring the hard tissue changes, the soft tissue profile improved and the relationship between the upper and lower lips became more harmonious. For only three parameters did the facemask children demonstrate a significantly better performance than their headgear peers: the overjet and the antero-posterior position of the lower lip and chin in females. It was concluded that, despite their differing approaches, the customized facemask and headgear to the mandibular dentition have very similar treatment effects. Both are clinically effective. However, treatment can begin earlier, and both the skeletal and profile changes are marginally superior when a facemask is worn.

Adolescent↗