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Malocclusion in Lagos, Nigeria.

617 schoolchildren 10-19 years of age were examined in order to assess the prevalence of malocclusion in a population sample in Lagos. Class I occlusion accounted for 76.8%, followed closely by Class II malocclusion, 14.7%, and Class III malocclusion, 8.4%. Crowding was recorded in 15.1% of the cases, most of which occurred anteriorly. The present study shows some interesting differences in the prevalences of malocclusions compared to studies on Caucasian subjects.

Adolescent↗

[Progression toward bimaxillary surgery].

The authors explain the different reflexions which drive maxillo-facial surgery to a bimaxillary surgery. They describe this surgery relatively to Class II and Class III malocclusions with facial diseases in the vertical dimension. Surgical procedures seem to be directed by aesthetic (better facial balance) and functional problems, in spite of the ideal is not yet reached on this last point.

Humans↗

A study of mandibular shape.

The technique of medial axis transformation of the outline form was used for the specific analysis of mandibular shape. When used to compare mandibular shape derived from lateral cephalographs between three equal samples of 30 female patients aged 12-15 years, marked overall similarity was noted between patients with Classes I, II and III occlusions. There were however subtle contrasts including the degree of coronoid and condylar separation and orientation of the ramus relative to the corpus. Such constancy of mandibular form derived from this technique of investigation was marked contrast to the data of traditional cephalometric studies which combine both size and shape parameters together. This study therefore demonstrated that shape appears less variable than size.

Adolescent↗

[Orthodontic approach to asymmetry].

From an orthodontic point of view, asymmetries can be gathered in three great clinical entities: mandibular lateral deviations, dental asymmetries without skeletal involvement, skeletal asymmetries. Once the therapeutic aims and the principles of the orthodontic approach of these dysmorphoses have been recalled, the authors present the various orthodontic means implemented in this type of treatment. Four cases treated illustrate those types of treatment. Vertical non-surgical asymmetry may have an obvious local origin, for instance, a unilateral damage to a nerve. but usually, there is no evident origin. Frequently the occlusal slippage of a severe sagittal or a vertical malformation, which may evolve as a borderline surgery case, is suspected to be the real cause. In these cases, the diagnosis is always late, with the ending growth. The treatment needs peculiar strong asymmetric mechanics and, sometimes, unilateral mixed extractions. The post-treatment occlusion can be unstable; for this reason, the finishing steps must be carefully conducted. Four clinical case reports develop these points ov view. Multidisciplinary treatments prove very useful to solve three types of clinical situations. In the adult patient, facial esthetics are indicated in severe dentofacial asymmetries. Esthetic improvements of dental nature are still required in deviated smiles, or frontal tippings of the occlusal plane. In addition, asymmetrical intermaxillary relationships will lead to functional anomalies: TMJ disorders, dental wear or lingual dysfunctions. Finally, multidisciplinary treatments in the adult concern the occlusal transverse anomalies, the lateral crossbites, the Class II subdivisions, the deviations of the inter-incisor midlines or unilateral edentulousness. The various plans of treatment, as well as the orthodontic mechanics used, are illustrated in the following development by clinical cases.

Adult↗

A method of measuring the apical base.

The maxillary and mandibular apical base areas were measured, using a gnathograph, on the study casts of 156 adults and children representing Class II division 1, Class II division 2 and Class III malocclusions. There were significant differences between the groups at each age. The maxillary apical base areas tended to be smaller for the adults than for the children in all three occlusal classes. By contrast, the mandibular apical base areas tended to be larger for the adults than for the children, except in Class II division 1 malocclusion. Following a logarithmic transformation to stabilize the variance, regression lines were fitted to relate the size of the maxillary and mandibular apical bases to one another, for the malocclusion groups within each age group. The method gives additional information regarding the degree of apical base discrepancy in a given case, but more work is required before it can be used as a diagnostic tool.

Adolescent↗

The cranial base in obstructive sleep apnea.

PURPOSE: The purpose of this investigation was to determine if there are cranial base differences in adults with obstructive sleep apnea (without identifiable craniofacial abnormalities) when compared with those of adults without airway problems. METHODS: Cephalometric analysis of the cranial base of 52 patients with documented sleep apnea were compared with 96 normal adult patients. Each of the groups was subdivided based on skeletal profiles (Class I, II, III). Cephalometric measurements included cranial base flexure angle and anterior and posterior cranial base lengths. Standard analysis of variance and Students' t test were used to determine level of significance. RESULTS: The cranial base flexure angle in patients with documented sleep apnea was significantly more acute than that found in the nonapnea group. Patients with a skeletal Class III profile had the most acute cranial base flexure whereas those with Class II profiles had the most obtuse angles. This pattern was true for apnea and nonapnea groups. No cranial base length differences could be found in either group. CONCLUSION: The results of this study demonstrate that there were abnormalities of the cranial base in patients with obstructive sleep apnea. Abnormalities of the cranial base seen in "nonsyndrome" obstructive sleep apnea patients are similar to those seen in patients with certain identifiable syndromes. This may suggest that sleep apnea is a reflection of a form of craniofacial syndrome.

Adult↗

Associations between severity of dentofacial deformity and motivation for orthodontic-orthognathic surgery treatment.

The successful outcome of orthognathic surgery is related to patient satisfaction and motivation. The aim of this retrospective study was to analyze the association between 1) severity of dentofacial deformity derived from cephalometric measures and 2) patient motivation for treatment. The initial cephalograms of 142 patients aged 16 years or older from the Dentofacial Program of the University of Michigan were traced and digitized. Inclusion criteria were established by assigning ANB 4 degrees to 15 degrees to define severe skeletal Class II (n = 65) and ANB - 15 degrees to -4 degrees to define severe skeletal Class III (n = 20). Motivation for orthodontics and surgery was derived from clinician administered forms scaled 1-10 with Low (1-5) and High (8-10). The cephalometric measure ANB was significant (p = 0.02) for high/low motivation for orthodontic treatment using Student's t test. No other cephalometric measures were significant for high/low motivation for orthodontics or surgery using Student's t test. Class II patients were significantly (p = 0.014) more motivated than Class III patients for orthodontic treatment. No significant difference was found for motivation for surgery between skeletal Class II and skeletal Class III patients. Patients with severe sagittal Class II deformities had higher motivation for orthodontics than surgery. The cephalometric measure, ANB, defining severe skeletal Class II and Class III patients did predict motivation level for orthodontics. None of the other 18 cephalometric measures were predictive of patient motivation for either orthodontics or surgery.

Adolescent↗

Electromyographic findings in Class II division 2 and Class III malocclusions.

Electromyography of masticatory muscles has proved useful for the functional study of occlusal dysfunctions. We employed this technique to study the activity of masseter and temporal muscles of 6 subjects with Class II division 2 malocclusion and 7 subjects with Class III malocclusion. Significant differences of masticatory muscles activity during mastication and swallowing were observed between the two groups. We hypothesize that the change of the activity of masticatory muscles might influence the clinical presentation of malocclusion.

Adult↗

Differential diagnosis of skeletal open bite based on sagittal components of the face.

AIMS: This study examined the morphology of skeletal open bite with respect to the sagittal components of the face. METHODS: The material consisted of cephalometric and hand-wrist films of 49 girls and 22 boys with skeletal open bite. The samples were grouped into Class I, II, and III facial types on the basis of ANB angle. In addition to conventional dentofacial variables, nasopharyngeal airway area was also measured on lateral headfilms. All measurements were examined by analysis of variance and Duncan test. Subsequently the factors leading to open bite were evaluated using multiple-regression analysis. RESULTS: Dentofacial morphology differed in the sagittal components of skeletal open bite, and the differences were most obvious between the Class II and Class III open bite groups. Posterior maxillary dentoalveolar height and mandibular incisor inclination were important factors in the development of open bite in the skeletal Class I and Class II open bite groups, while in the skeletal Class III open bite group, the nasopharyngeal airway and the gonial angle were involved. CONCLUSION: Sagittal components of skeletal open bite should be considered in the differential diagnosis and treatment planning of such cases.

Adolescent↗

Comparison of 'normal' TMJ-function in Class I, II, and III individuals.

Fifty-seven non-orthodontically treated young adults, judged as either clinically healthy or with only mild symptoms of TMJ-dysfunction, were divided into groups according to their sagittal molar relationship (Class I-, Class II-, and Class III-group). All underwent a standardized clinical and axiographic examination with an axiographic recording device (SAS-SYSTEM). The comparison of the lengths of the axiographical protrusive curves showed significantly higher values in the Class II group than in the Class I (P less than 0.01) and in the Class I group than in the Class III group (P less than 0.001). Analogous differences could be found in clinical protrusive measurements at the incisal point and in lateral excursions. It was concluded that the protrusive condylar movement capacity coincides with the dental sagittal relationship. In opening, significant differences were seen axiographically (Class I v. Class III: P less than 0.001; Class II v. Class III: P less than 0.01), but not clinically. Since axiographic measurements show only condyle translation, but not rotation in contrast to measurements at the incisal point, it can be concluded that the differences in opening are also translatory and not rotational. Measurements of the average change of curvature of axiographic tracings showed significantly less curved protrusive tracings in Class III than in Class I (P less than 0.001) and Class II individuals (P less than 0.01), supporting the concept that in the Class III group condyle movement is restricted to the straight posterior slope of the tubercle.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Postpharyngeal lymphoid tissue in Angle Class I and Class II malocclusions.

Opinions differ with regard to the relationship of adenoids and type of malocclusion. To study this possible relationship, xeroradiographic lateral cephalograms were made of eighty Class I (Angle) and sixty-four Class II, Division 1 (Angle) malocclusions to obtain reliable measures of the epipharyngeal lymphoid tissue, the nasopharyngeal airway, the nasopharynx, and certain cephalometric landmarks. Xeroradiographic cephalograms provide superior visualization with edge-enhancement effect for both soft and hard tissues. Electronic digitization and a comprehensive computer analysis were used to assess the head films. Significant differences were found for some of the linear and angular cephalometric criteria between the two malocclusion categories. A sexual dimorphism was observed. These skeletal and dental differences were anticipated in this mixed malocclusion sample, as prior cephalometric studies which compare different classes of malocclusion have shown. Airway space did not appear to vary with the type of malocclusion. Some low-level correlations were found between the size of the nasopharyngeal area and certain skeletal characteristics. These correlations depended on both the malocclusion type and the sex of the individual. The lateral, two-dimensional cephalogram does not seem to offer satisfactory information relating the nasopharyngeal area to Class I or to Class II, Division 1 malocclusions.

Cephalometry↗

The study of the maxillary sinus areas in different orthodontic malocclusions.

In the present study, the maxillary sinus areas have been investigated on orthopantomographs of 103 male and 86 female subjects either with ideal occlusions or with malocclusions. It has been found that malocclusions and sex factors have no effect on the size of the maxillary sinuses, and that sex is a significant factor only in Angle Class II malocclusions. The female subjects with Angle Class II malocclusions have larger maxillary sinuses than the male subjects and the other groups of female subjects.

Adolescent↗

Treatment of Class II high angle malocclusions with the Herbst appliance: a cephalometric investigation.

The purpose of this study was to examine the results of treatment of Class II malocclusions by using two different designs of the Herbst appliance. Cephalometric records from lateral headplates of 19 consecutively treated Class II cases were evaluated. The headplates were taken before and after the treatment stage in which the Herbst appliance was used. The patients were divided into two groups: the first group, normohypodivergent, was treated with the Herbst appliance attached to bands; the second group, hyperdivergent, was treated with the Herbst appliance attached to acrylic splints in which a high-pull headgear was also used. The results were compared between these groups and with a control group age-matched from Bolton standards to match the changes in the Herbst samples against what might be expected in case of normal growth during similar periods of time. The results of the investigation revealed the following: (1) 9 months of treatment resulted in Class I dental arch relationships in all 19 cases; (2) the Herbst appliance attached to bands did not significantly modify the vertical growth pattern of the normohypodivergent patients; and (3) in hyperdivergent patients, the use of a Herbst appliance attached to acrylic splints in conjunction with the use of a high-pull headgear allowed a better control of the vertical dimension, as assessed by the cephalometric parameters (FA, FMA, Go-Gn-SN). The clinician should be aware of the different dentofacial changes induced in the vertical plane by different designs of the Herbst appliance to better program treatment strategy.

Adolescent↗

Craniofacial morphology in children with Angle Class II-1 malocclusion with and without deepbite.

The craniofacial morphology of children with Class II-1 malocclusion with and without deepbite was studied and compared with that of a control group of children with normal occlusion. Common for the Class II-1 children was a short mandibular corpus, which was probably the main reason these children had a distal basal jaw relationship. The Class II children with deepbite differed from the control group in ways. They had: 1) a distal relationship between points A and B; 2) a distal relationship between points A and pogonion; and 3) a discrepancy in length between the corpora of the two jaws. These deviations discriminated nearly 95% correct between the deepbite group and the controls. The most characteristic deviations in the Class II children without deepbite, in relation to the controls, were: 1) a distal relationship between points A and B; 2) a small angle between the nasal plane and the anterior cranial base; and 3) a long mental process. These deviations discriminated about 95% correct between the experimental group and the controls. Many of the craniofacial differences between the Class II groups could, theoretically, be explained by the MP-SN angle being, on average, 9 degrees larger in the children without deepbite. Most typical was that this group has 1) a larger lower anterior face height, 2) larger maxillary and mandibular incisal heights, and 3) a more obvious distal relationship between points A and pogonion. In combination, these differences discriminated correctly between the Class II groups in 90% and 97% of the cases.

Adolescent↗