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PubMed2002

Gingival enlargement in acromegaly.

In this study, we investigated gingival enlargement in patients with acromegaly as a component of the disease. Eleven patients (5 males, 6 females) were evaluated. Diagnosis was confirmed with typical clinical features and laboratory. Oral examinations were carried out by the same periodontist. During the examination, plaque index, gingival index, probing pocket depths, and gingival enlargement values were evaluated. Duration of the disease was between 0.2 and 13 yr. Seven patients had pituitary macroadenomas and four had microadenomas during their initial diagnosis. Only one patient was newly diagnosed. The other patients had previously undergone surgery. Gingival enlargement was found in eight patients. Seven patients with gingival enlargement also had prognathism, and one patient had prognathism associated with gingival enlargement. These findings demonstrate that acromegaly that results in overgrowth in various organs should be considered one of the causes of gingival enlargement.

Acromegaly↗

PubMed2005

Cleft palate and Beckwith-Wiedemann syndrome.

OBJECTIVE: Patients with Beckwith-Wiedemann syndrome suffer numerous anomalies, which vary somewhat from case to case. Cleft palate in combination with this syndrome has rarely been reported in the literature. Through two cases, this report examines the staging of the surgical repairs and the role of macroglossia in cleft palate and the consequences of the scarred palate on mandibular development. RESULTS: Of four patients with Beckwith-Wiedemann syndrome, only two had a cleft palate. The timing of the repair in these two children was different. Speech development was satisfactory in the first case but mediocre in the second. This result seemed to be related to a poor social environment. Mandibular prognathism persisted in both cases. CONCLUSION: The treatment of patients with cleft palate and Beckwith-Wiedemann syndrome remains complex. It is preferable not to operate on a cleft palate before performing a tongue reduction plasty, but rather to combine these two surgical interventions. This would reduce the risks of anesthesia and enable the palate to heal more efficiently. Surgical treatment should be performed after the age of 6 months and before problems in speech development occur. An orthognathic surgery at adolescence could be performed if prognathism persists. While the origin of the cleft palate is still being discussed, we cannot claim that macroglossia is related to the development of cleft palate, nor that the scarred palate has an impact on the mandibular development.

Adult↗

PubMed1990

[Relation between dentofacial skeletal patterns and the deflection of the roots of mandibular canine and premolars].

We conducted an investigation of the relation between dentofacial skeletal patterns and the deflection of the roots of mandibular canines and premolars. Data on root deflection, rated as mesial, distal, or undeflected, were obtained from orthopantomographs taken of 130 patients who were judged to meet certain criteria on their initial orthodontic examinations. The significance of the relation between these data and the dentofacial patterns, determined by radiographic cephalometric analysis, was then examined statistically. This determined that in cases of severe mandibular prognathism (ANB less than -2 degrees), the roots of 1st and 2nd premolars exhibited significantly more mesial deflection. This result suggests that the mesial deflection of these roots is caused by the differential growth rates of basal and alveolar bone in cases of severe mandibular prognathism.

Alveolar Process↗

PubMedDate not supplied

[Pseudo Class III: diagnosis and therapeutic planning].

In this study clinical diagnostic elements essential in pseudo-Class III malocclusion have been taken under consideration. First of all have been analysed the main etiopathogenetic factors which are the causes of an anomalous development of the Maxillo Facial Complex and peculiarly of mandibular pseudo prognathism. The clinical variants of the malocclusion have been pointed out and they are: the true prognathism, the occlusal or dental one, and the pseudo Class III malocclusion. The Authors therefore, describe principal procedures to treat the malocclusion with orthodontic and functional appliances. Two cases are presented for this kind of malocclusion treated with the various orthodontic techniques on the ground of the different kinds of clinical variants.

Activator Appliances↗

PubMed1990

[Dynamics of changes of anteroposterior jaw positions relative to the cranial base during the second trimester of normal intrauterine growth].

The aim of this investigation was to estimate dynamics of changes of maxillary (SNAns) and mandibular (SNMe) prognathism relative of the cranial base from 14th to 24th week of normal intrauterine growth. Investigation was performed on lateral cephalometric radiographs of 50 fetuses, both sexes, derived from artificial abortions in advanced uncomplicated pregnancies, due to social indication. Estimation of gestational ages was made according to contemporary ultrasonic standards of the normal fetal growth. The results obtained from this study showed that enlargement of the SNAns angle was relatively more rapid and regular (2.806 degrees +/- 0.483 degrees per week). The average change of this angle was from 61.047 degrees (in 14th week) to 89.107 degrees (in 24th week), with total change of 28.060 degrees during the period investigated. On the other hand, enlargement of the SNMe angle was, relatively, moderate an variably of 1.678 degrees +/- 0.597 degrees per week. Changes of this angle were ranged, in average from 46.295 degrees (in 14th week) to 63.074 degrees (in 24th week), with the total change of the 16.780 degrees during the same period. Rhythm of enlargement of SNAns angle was 76.222% more rapid than in SNMe angle (p less than 0.05). However, individual variability of SNMe angle enlargement was 23.602% higher compared with SNAns angle (p greater than 0.05). The author concluded that changes of anteroposterior position of the upper jaw relative to the cranial base ranged from marked retrognathism to mild prognathism. During the period investigated, changes of anteroposterior position of the lower jaw relative to the cranial base ranged from marked to moderate retrognathism.

Cephalometry↗

PubMed1989

[A cephalometric planning in team treatment of different types of Class III malocclusion].

The technique of cephalometric reconstruction, used by Henderson, is described. The method of reconstruction is illustrated in three cases with the following types of Class III malocclusion: maxillary orthognathism and mandibular prognathism; maxillary retrognathism and mandibular orthognathism; and maxillary retrognathism; and mandibular prognathism.

Cephalometry↗

PubMed1986

[Facial profile--psychological profile].

The morphological organisation of the face reflects the individual's social context and heredity and also reveal certain personality traits. Emotional facial expression is a very special form of communication. This functional and behavioural dynamic leads to the formation of a certain anatomical structure as a result of repetitive functions. The psychological examination of nineteen retrognathic patients and seven prognathic patients revealed the timid, inhibited of even anxious personality of the first group of patients in contrast with the extraverted and frequently aggressive personality of prognathic patients.

Facial Expression↗

PubMedDate not supplied

[Lateral mandibular deviations].

The mandibular laterodeviation is one of the most evident malformations of the face, because it alters the lower third of the face. Etiologically it can be classified into: Static laterodeviations caused by teeth; Static laterodeviations caused by skeleton change: by monolateral hypertrophy (condyle, condyle and neck of the condyle, half mandible hypertrophy); by monolateral hypertrophy (congenital pathological); Dinamic laterodeviations functional. The midline displacement with posterior monolateral cross bite is caused by width discrepancy between the upper and lower dental arch resulting in a lateral shifting of the mandible. This laterodeviation is also called "laterale forced bite" or "articular cross bite". Articular cross bite is generally corrected by orthodontics during the interceptive period when the growth of the jaws is still present. In the author's opinion the orthognathic surgery is absolutely necessary for adult dental laterodeviation already stabilized. The skeletal laterodeviation must always be treated by orthognathic surgery. It is the author's practice to use the sagittal bilateral osteotomy at the angle and ramus level whose lines of osteotomy at the angle are different from one another depending on the displacement and rotation which one must do to the mandible to get contact surfaces which are larger enough to ensure proper union because the two mandibular halves have different lengths and different angles. This kind of operation normalizes the occlusion and is sometime sufficient to harmonize the oval of the lower third of the face. In the anterior part of the chin is still laterodeviated one continues with a wedge shaped osteotomy at the tip of the chin in order to reposition the tip to the midline and with an additional osteotomy at the hypertrophied angle level. If laterodeviation is joined by other bone malformations in can be considered a symptom which is more or less marked. In this case, therefore, laterodeviation is a part of a complex malformatin of the jaws: mandibular prognathism and/or maxillary retrognathism and/or maxillary prognathism. Consequently the operation must be single or combined. In these cases, one uses combined operations on the lower and upper jaws, so as to correct the various jaw malformations at the same time. The surgical methods used to correct laterodeviations of pathological origin are only directed to harmonize the edge of the mandible because only people with occlusion within the norm were seen by the author. The surgical methods are different depending on the complexity of the malformation. At the end laterodeviation on a functional basis are treated by the operation established by Köle which consists of a dermofibrotic flap, cut in front of the tragus, and then passed in front of the condyle in the space of the sigmoidal incisure and fixed to the mucous membrane of the internal wall of the cheek. Many well recorded cases have been presented.

Adult↗

PubMedDate not supplied

[The orthodontic treatment of traumatic occlusion in sagittal bite anomalies].

A total of 288 patients (100 females and 188 males) aged 25 to 60 with prognathic and progenic occlusion were examined and treated. Dentition deformations were revealed in 182 (63.1%) patients. Clinical and x-ray signs of traumatic occlusion were observed in 219 (76.04%) cases. Abnormal mobility of teeth was detected in 181 (79%) subjects with prognathic occlusion, dentogingival and osseous pouches in 164 (71.6%) subjects. Reduced height of occlusion was found in 68 (25.3%), dysfunction of the temporomandibular joint in 19 (8.2%) cases. Traumatic occlusion was observed in 38 of the 59 patients with progenic occlusion. In sagittal abnormalities of occlusion, traumatic occlusion was associated with dysfunctions of the masticatory muscles and of local circulation in the periodontium, which were recorded by electromyography and rheoparodontography. The treatment was carried out by therapists, surgeons, and orthodontists. Orthodontic treatment consisted in levelling of the occlusion surface of dentitions, orthodontic preparation of the maxillodental system, fitting with splints and prostheses. Remote results in periods from 1 to 3 years were good in 94.8% of patients.

Adult↗

PubMed1993

Diagnosis and treatment planning of hypodivergent skeletal pattern with clockwise occlusal plane rotation.

Diagnostic treatment planning of Class III malocclusion is complicated due to the interaction of development, timing, dental pattern, and skeletal relationships. Historically, the treatment of adult Class III malocclusions has tended to be seen primarily as cases of mandibular prognathism. As diagnostic acumen and surgical skills improve and merge, orthodontic and surgical treatment plans for Class III malocclusions have become more common. Class III malocclusions now tend to be described in terms of mandibular prognathism, horizontal maxillary hypoplasia, maxillary vertical hypoplasia, and mandibular dentoalveolar retrusion. The purpose of this paper is to present a combined surgical-orthodontic treatment approach involving clockwise rotation of the occlusal plane for treatment of hypodivergent Class III skeletal pattern and dental malocclusion.

Adult↗

PubMed1995

Facial anthropometrics versus cephalometry as predictors for surgical treatment in patients with Class III dentofacial deformities.

The purpose of this study was to determine statistically the relative importance of facial anthropometrics and cephalometry in diagnosing the specific jaw deformity in patients with Class III relationships, ie, the contribution that maxillary deficiency and/or mandibular prognathism made to the Class III deformity. Frontal and right profile photographic views and pretreatment lateral cephalometric radiographs of 20 randomly selected Class III patients were analyzed. Correlation and multiple-regression analyses were utilized to determine the relative importance of clinical diagnosis and cephalometric diagnosis in determining the actual surgery performed. In addition, these analyses determined the relative importance of the various facial anthropometrics and cephalometric parameters critical to making the specific diagnosis of maxillary deficiency and/ or mandibular prognathism. It was concluded that a jaw-specific diagnosis of the Class III population studied was best made with facial anthropometrics rather than cephalometry, and the most important predictive facial features on which to based this diagnosis were paranasal configuration and chin projection. Although the overall cephalometric diagnosis had no statistically significant correlation to the actual surgery preformed, two individual cephalometric parameters, maxillary first molar to pterygoid vertical and mandibular plane angle, were found to statistically correlate to the actual surgery performed. These cephalometric parameters should be scrutinized along with the facial anthropometric data when the jaw-specific surgery is selected.

Anthropometry↗

PubMedDate not supplied

[Dento-skeletal recurrence in cases of surgical treatment of dysmorphism].

The purpose of the present study is to investigate the factors contributing to skeletal relapse after surgical correction of mandibular prognathism. Postoperative follow-up after mandibular setback is carried out to clarify the timing and causes of the relapse. The subjects are mandibular prognathism patients. The etiology of relapse is discussed.

Adult↗

PubMedDate not supplied

Geometric morphometric study of population variation in indigenous southern African crania.

Much of our understanding of population variation in southern Africa is derived from traditional morphometric research. In the search for new perspectives, this paper reports on new geometric morphometric data examining cranial variation in 12 modern human populations from southern Africa. In total, 298 male Bantu-speaking individuals were studied. In addition, a small Khoisan (Khoikhoi and San) series was also examined. The purpose of this study was to investigate Khoisan-Bantu morphological similarities and differences, and to examine variation within both the Bantu-speaking and Khoisan populations. The three-dimensional coordinates of 96 landmarks were analyzed, using the shape-analysis software morphologika. Interpopulation variation was examined by calculating Procrustes distances between groups; a cluster analysis was then used to summarize phenetic relationships. A principal components analysis explored the relationships between populations; shape differences were visualized and explored using three-dimensional rendered models, and further interpreted using thin-plate splines. Morphological differences are present within and between the crania of Bantu-speaking and Khoisan individuals. The Khoisan demonstrate features (e.g., a pentagonoid vault, more rounded forehead contour, and a small and less prognathic face) that clearly distinguish them from Bantu-speaking populations. Although southern African Bantu-speaking populations are clearly closely related, they show population-specific features (e.g., the crania of more southerly populations (Xhosa, Southern Sotho, and Zulu) are characteristically more brachycephalic and less prognathic). This study suggests that differential admixture with adjacent Khoisan peoples has contributed to diversity within southern African Bantu-speaking populations.

Africa, Southern↗

PubMed2006

Craniofacial and dental phenotype of Smith-Magenis syndrome.

The aim of this study was to assess and characterize dental and craniofacial findings in individuals with a confirmed diagnosis of Smith-Magenis syndrome (SMS). Extraoral and intraoral examination including dental and craniofacial radiographs and three-dimensional facial photoimaging were performed for 15 cases between ages 4 and 19 years old. Tooth agenesis (13/15 cases) affecting primarily the mandibular second premolars and taurodontism (13/15 cases) were common findings. Dilaceration of the tooth roots was present in one-third of the cases. At least one dental anomaly was present in each case. These findings occur with greater frequency than in the general population (P < 0.001). An age-related increase in decayed and restored teeth was found. Poorer oral hygiene, increased dental plaque, and increased gingival inflammation progressed from childhood to teenage years. Radiographic findings suggest the prognathic appearance is not caused by excessive mandibular growth. Other findings including protrusion of the mandibular anterior teeth, increased bony chin size, and macroglossia were noted, which may contribute to the prognathic appearance. The high prevalence of dental anomalies (>90%) further expands the phenotype and indicates that dental evaluation may aid in the diagnosis of SMS.

Abnormalities, Multiple↗

PubMed2001

Canine reduction in the miocene hominoid Oreopithecus bambolii: behavioural and evolutionary implications.

The degree of canine size sexual dimorphism and relative canine size, which have been related to levels of agonistic behaviour amongst living anthropoid primates, together with relative molar size, are evaluated in the fossil hominoid Oreopithecus bambolii from the Late Miocene of Italy. Although Oreopithecus displays a significant degree of canine height sexual dimorphism, using allometric techniques and body mass estimates for fossil species, it is shown that Oreopithecus males are microdont (smaller postcanine as well as canine teeth than expected) when compared to most living hominoids and its putative ancestor Dryopithecus. Canine reduction in Oreopithecus includes both crown height and, especially, basal area, and most closely resembles the condition found in the pygmy chimpanzee Pan paniscus. Interestingly, it had been previously proposed that Oreopithecus displays, like pygmy chimpanzees, a paedomorphic cranial morphology resulting in a reduction of facial prognathism, which could be related to microdontia in both taxa. Independent canine reduction in several anthropoid lineages (including hominids and P. paniscus) has been related to a relaxation of the selection pressure favouring canine use as a weapon. Although changes in socio-sexual behaviour, as documented in P. paniscus, cannot be currently discarded in Oreopithecus, canine reduction could be also alternatively (although not exclusively) interpreted as an aspect of generalized microdontia. The latter is best considered an adaptive readjustment required by the paedomorphic reduction of prognathism and the resulting lack of space to accommodate the adult dentition. This mechanism of canine reduction highlights the significance of developmental constraints in evolution and had not been previously suggested for any anthropoid primate.

Animals↗

PubMed1983

Primate models in surgical orthodontics.

Between 1969 and 1980, 22 studies using nonhuman primates for experimental research in surgical orthodontics were published in the American Journal of Orthodontics, Angle Orthodontist, Journal of Oral Surgery, or International Journal of Oral Surgery. The most common species used was the rhesus monkey, Macaca mulatta. As laboratory animals, monkeys are relatively expensive and difficult to obtain. These problems have limited the design of experimental studies. Sample sizes are often too small for statistical analysis, control groups are small or omitted, and it has frequently been necessary to pool animals of different ages and sexes. These compromises might be appropriate if monkeys are the best available experimental model for humans, but there is little evidence that this is the case. Monkeys do not fill the usual role of good experimental models, which is to simplify a complex system. The monkeys used for craniofacial surgery have normal craniofacial function and morphology for their species, unlike human clinical patients. Cephalometric radiographs and skull measurements taken on monkeys of the five most common experimental species indicate that all experimental animals are much more prognathic than humans, and sex differences in prognathism are small. However, because many species have a large sex difference in canine size, females are a better experimental model than males for some questions. Considering recent federal legislative interest in animal research and the decreasing financial support for research, it is essential that the choice of experimental animals be justifiable and cost-effective. It would be worthwhile to consider alternatives to primates as the species of choice for experimental research in surgical orthodontics.

Animals↗

PubMed1986

The morphology of the potential Class III skeletal pattern in the growing child.

The aim of the present article was to identify morphologic characteristics in the craniofacial skeleton of the 11-year-old child that could indicate potential development of a Class III skeletal pattern. A radiographic material consisting of 24 children (13 girls, 11 boys) at an average age of 11 years 0 months, who in adulthood demonstrated a Class III skeletal pattern, was compared with a control group of 33 children (16 boys, 17 girls, average age 11 years 6 months) chosen retrospectively on the basis of Class I occlusion. The analysis was performed by means of both linear and angular variables and results are reported both as group means and individual analyses. No one morphologic trait indicative of potential Class III development could be isolated because the study clearly demonstrated the existence of different skeletal combinations. The development of the maxilla, both in size and position, was clearly demonstrated by the linear analysis to be an etiologic factor in Class III development. However, maxillary retrognathism was usually masked in the angular analysis because a reduction in length of the anterior base with subsequent effect on the position of point nasion was often seen in these cases. Mandibular prognathism was a frequent observation, although a true macrognathia was uncommon. In the majority of cases, mandibular prognathism was the result of an increase in the ratio between mandibular length and dorsal position of the glenoid fossa (articulare). The relative merits of angular and linear analyses are discussed in relation to the results presented.

Cephalometry↗

PubMed1989

Changes in facial morphology in Macaca mulatta: a cephalometric study from 1.5 to 5 years of age.

A cross-sectional and longitudinal (3.5 years) study on the craniofacial growth of 10 male rhesus monkeys, using metallic implants and a radiographic cephalometric technique based mainly on angular measurements, led to the following observations. (1) Maxilla and mandible were displaced in a forward and downward direction during growth, the sagittal changes being predominant over the vertical changes. (2) Maxillary and mandibular prognathism increased continuously during the whole time span. This increase was twice as great for the maxilla as for the mandible. (3) The inclination of the palatal plane and the mandibular plane changed very little over time. (4) Mandibular form remained constant, but the cranial base showed a significant flattening between approximately 1.5 and approximately 3 years of age. (5) Upper and lower occlusal plane angles changed little over time. (6) The interincisal angle decreased significantly until approximately 3 years of age in relation to the increase in proclination of the permanent incisors in the maxilla and mandible. The intermolar angle remained fairly constant. Changes in some of the variables reported (maxillary and mandibular prognathism, sagittal jaw relationship, mandibular length, interincisal angle, proclination of the upper and lower incisors, and opening of the cranial base angle) occurred as a function of age. The use of angular measurements allowed us to develop a series of templates that will provide a useful tool for a quick check of normal craniofacial morphology at three representative time points.

Aging↗