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PubMed1993

Trigeminal foraminal patterns in "skeletal" Class II and Class III adults--a radiocephalometric study.

Radiocephalometric analysis, based mainly on the foramina of the trigeminal nerve branches, was applied to three samples of adults, two representing fairly extreme profile types, the third representing "normal" dentofacial build. The aim of the study was to find out whether the analytical method could be used to differentiate between facial types. It appeared that some elements of the method had diagnostic powers, and could substitute for traditional methods. Many dimensions inspected, however, were fairly similar in all facial types, thus suggesting a general basic role of the trigeminal nerve in relation to craniofacial structure. Generally speaking, the foraminal pattern was relatively stable in "normal" faces, but more variable in deviant faces.

Adult↗
PubMedDate not supplied

[Graphical registration of tongue in evaluation of the maxillo-mandibular relationship].

OBJECTIVE: The evaluation of the tongue-maxilla relationship, in interrelation with the maxilla-mandibular relationship, determined by the skeletal pattern or modified by the total dentures. MATERIAL AND METHOD: Clinical observations and verification of the tongue-maxilla relationship by a tongue-graphical registration, in edentulous patients, with Class II and Class III skeletal relationships, which had inappropriate dentures, both in vertical dimension of occlusion and maximal intercuspidation/centric relation. RESULTS: According to clinical observations and tongue-graphical registrations, there are obvious differences in the tongue-maxilla relationship, depending on the vertical and antero-posterior relations from every skeletal class and on the incorrect prosthesis; this leads to changes in denture's equilibrium, functionality, comfort and tolerance. CONCLUSIONS: The tongue-graphical registration can be used as a simple method of evaluation of the maxillo mandibular relationship, determined by the skeletal pattern or modified by dentures.

Dental Impression Technique↗
PubMed2001

Segmental distraction osteogenesis of the anterior alveolar process.

PURPOSE: This article describes a nonextraction therapy for patients with anterior tooth crowding in the mandible or with an unfavorable relation between the anterior dentoalveolar area and the skeletal base. The method involves the gradual repositioning of the dentate segment by use of distraction osteogenesis. PATIENTS AND METHODS: The method was applied in 25 patients. Indications comprised skeletal Class II patients with crowding, Class I patients with crowding, and Class III patients requiring decompensation before orthognathic surgery. A special hinge-joint bone plate was developed to allow the rotation of the anterior bone segment into the desired position. The gradual repositioning was achieved with orthodontic appliances. RESULTS: The procedure was successful in all patients. The typical advancement at the incisal edge was 2 to 5 mm. CONCLUSION: This method represents a new approach for nonextraction therapy in the mandible. It requires no soft or hard tissue grafting and results in favorable tissue conditions at the distraction site.

Alveolar Process↗
PubMed2003

Mandibular instantaneous centers of rotation in patients with and without temporomandibular dysfunction.

PATIENTS AND METHODS: The free opening movement of the mandible was examined in 30 patients with and without dysfunctions, using the CADIAX electronic axiography system. All patients in the diseased group showed dysfunctions in the left temporomandibular joint. Half of the 20 asymptomatic patients were skeletal Class II, the other half skeletal Class III. Based on the data collected for the left temporomandibular joint, the movement of the mandible during the mouth-opening movement in the sagittal and vertical planes was described as the pathway over time of the various instantaneous centers of rotation (ICR), using physico-biomechanical factors. RESULTS AND CONCLUSION: It emerged that the ICR path in the patients with dysfunctions was irregular with erratic changes of direction. A harmonious ICR path beginning near the condyle was typical of the healthy group; as the mouth opened, the path moved toward downward backward and finally shifted toward forward and forward upward. Therefore, such an ICR path pattern can be used as an indicator in detecting dysfunctions.

Adolescent↗
PubMed1996

Dental malocclusion in native children of British Columbia, Canada.

Since 1972, the Medical Services Branch (MSB), Pacific Region of Health Canada, has conducted quadrennial surveys of the dental health status of Native children in British Columbia (B.C.), Canada. This paper will analyze the findings related to dental malocclusion. Data from the most recent survey in 1988 are compared to data from 1980, and also to similar data from the most recent B.C. Children's Dental Health Survey. Prevalences of abnormal and severe malocclusion are also compared to the original 1972 data. Methods used in the surveys were detailed in a previous paper (I). Significant decreases in the percentage of children with drifting due to premature space loss (P < 0.05), as well as a slight decrease in the percentage of children with crowding were observed. A trend towards an increase in Class II molar relationship was demonstrated, but was not consistent for all age groups. In contrast, there was a slight, but consistent, trend towards a decrease in the percentage of children with an anterior openbite. Comparisons between the age groups demonstrated an increased prevalence of abnormal molar relationship, drifting due to space loss, crowding, crossbite, and overjet greater than 4 mm in children older than 7 years. Native children had a significantly greater prevalence of Class III molar relationship, crossbite, crowding, negative overjet, and anterior openbite than other schoolchildren in B.C. (P < 0.05). However, percentage of Native children with a severe malocclusion decreased significantly from 1972 to 1988 for 7, 9, and 11 year old children (P < 0.05), but for 13 and 15-yr-olds. Improvement has occurred over time in some aspects of dental malocclusion in these Native Canadian children, but malocclusion continues to be a frequent problem, especially amongst adolescents.

Adolescent↗
PubMed2006

Development of cephalometric norms using a unified facial and dental approach.

OBJECTIVE: To develop a cephalometric determination of anteroposterior skeletal occlusion on the basis of a clinically rational "gold standard" and objectively determined cut points. MATERIALS AND METHODS: Pretreatment cephalograms from 10- to 18-year-old Caucasian patients with a normal vertical face dimension were digitized. Facial profile line drawings were judged by orthodontist raters as Class I, II, or III. Subjects who met all inclusion criteria were divided into Class I, Class II, and Class III on the basis of the matched skeletal (facial) and dental occlusion and comprised our gold standard for anteroposterior skeletal occlusions. Cephalometric variables included ANB angle, McNamara analysis, Harvold unit differential, anteroposterior dysplasia index (APDI), and Wits analysis. Half the sample was used to derive skeletal classification norms using receiver operator characteristic (ROC) curves, and half the sample was used to test for diagnostic ability and to compare the diagnoses based on traditional cephalometric norms with the new norms. RESULTS: Results of the study showed that ANB and McNamara analysis performed well with traditional and ROC-derived norms, whereas Wits, Harvold unit differential, and APDI showed fewer errors in diagnosis with ROC norms compared with traditional norms. CONCLUSIONS: The use of a single set of diagnostic norms for each analysis to distinguish between the skeletal classifications for the 10- to 18-year-age group proved to be highly successful for each of the analyses and performed as well or better than when using traditional norms based on age and sex.

Adolescent↗
PubMedDate not supplied

[Brodie's syndrome. A report of 2 atypical cases].

The aim of the authors is to show the treatment of Brodie's syndrome even in atypical cases where this pathology can not offer typical signs but can be associated to other skeletal deformities of the face. There are two atypical cases of Brodie's syndrome both of them came to our out patient's department. They were grown-up (one 20 one 22 years old), one of them with an extreme vertical expansion of lower third of the face and with a big transverse expansion of the upper maxillary bone, all typical signs of Brodie's syndrome; the other patient was with an extreme transverse expansion of the upper maxilla associated to a II class and a defect of 11, 12, 21, 22. The first patient was treated with orthodontic Tweed technique continued with surgical operation setting out to the contraction of the transverse diameter of the upper maxilla, associated to a Le Fort I osteotomy and an Epker osteotomy of the jaw. This orthodontic-surgical correction, allowed us to achieve a good aesthetic and functional result. The second patient was treated with orthodontics followed by surgical correction of the excessive transverse expansion of the upper maxilla after a Le Fort I osteotomy; a sagittal split of the jaw on Gotte technique was performed to correct the III class. We gave the patient a good aesthetic result with the restoration of the lost teeth in the upper maxilla, reaching in this way a good aesthetic and a well functioning result. We think it's possible to treat patients with atypical Brodie's syndrome with orthodontics or surgery in the same way we treat Brodie's syndrome and other deformities of the face reaching good aesthetic-functional results.

Adult↗
PubMed1998

Roentgencephalometric analysis of the skulls of the Luxemburgs, the second Bohemian Royal Dynasty.

X-ray films of the skull of the king and emperor Charles IV and his four wives and two sons were made under standard conditions with the mandibles fixed in a centric occlusion. The results of roentgenocephalometric analysis were compared with norms valid for the contemporary Czech population. Consistent with the somatic condition of Charles IV, the findings indicate an above-average large face with the usual anteriorotational developmental type. The facial skeleton is structurally harmonious, but the sagittal intermaxillary relations belong into skeletal class II with a relatively retruded lower jaw in relation to the upper one. This is associated with a greater maxillary overjet of the upper incisors. The disharmony was caused by a fracture of the mandibular condyles. Reconstruction of the condition before the injury revealed an originally normal anteroposterior relationship of the jaws (skeletal class I) and occlusion of the incisors. As to the shape of the cranium, Charles IV's wives differ in basic features. In two, for different reasons, we find skeletal class II (retrogenia), in one skeletal class III (progenia) and only in Elizabeth of Pomerania, with marked flattening of the cranial base and posteriorotation of the face are the anteroposterior relations of the two jaws normal (skeletal class I). Wenceslas IV differs from his parents Charles IV and Anne of Svidnic by a flat cranial base which pushes the lower jaw backwards, however, it does not cause its posteriorotation; we find, similarly as in the father and mother, an anteriorotational growth type of the face. In the other basic parameters of the cranium there are no marked differences between son and parents. In evaluating the similarity of the facial structure of John of Görlitz to that of his parents, disagreement is caused by the flat cranial base of the mother Elizabeth of Pomerania associated with posteriorotation of the face. In the son we find, conversely, an even more marked anteriorotation than in the father and also other parameters of the facial configuration indicating plausible agreement with the findings in Charles IV. The curving of the cranial base has an impact on the shape of the whole cranium, but the results indicate that the heritability of the rotational growth type of face and the degree of cranial base curvature probably is not very marked.

Cephalometry↗
PubMed2004

Modeling facial movement: II. A dynamic analysis of differences caused by orthognathic surgery.

PURPOSE: The purpose of this study was to determine the facial movement characteristics of patients who underwent orthognathic surgery. The specific aims were to determine the presurgery versus postsurgery differences in facial movements; to determine whether the presurgery facial movements were similar among patients with different dentofacial deformities; and to determine whether patients have a more similar post- than presurgery dentofacial morphology and soft tissue movement. The hypothesis was that there are differences between the pre- and postsurgery facial movements. PATIENTS AND METHODS: The sample consisted of 19 patients (11 women, 8 men) with a mean age of 20.6 years (SD +/- 8.34). Facial movement and lateral cephalometric data were collected at presurgery, and at 6 and 12 months postsurgery. Measures of the facial skeletal differences were made from lateral cephalometric radiographs and facial movements were recorded by a video-based tracking system. Descriptive and inferential statistics were performed on principal component scores generated from the movement data. A linear mixed-effects model was used to test for significant differences in movement. RESULTS: Differences were found between the presurgery and 12-month postsurgery visits for the instructed smile, lip purse, eye closure, grimace, and mouth opening movements as well as the natural smile. Also, there were significant differences at presurgery among the dentofacial groups for the lip purse movement but no differences were found at postsurgery for any of the movements. CONCLUSION: These findings suggest that facial movements are effected by skeletal malocclusion and orthognathic surgical procedures.

Adult↗
PubMed2001

Realities of craniofacial growth modification.

Facial growth modification can be an effective method of resolving skeletal discrepancies. There still is much controversy regarding our understanding of the nature and extent of skeletal orthopedic change possible in individual patients and the most effective appliances and timing of such treatment. In the treatment of class II patients, growth modification can lead to an improvement, if not complete correction of the class II malocclusion. Although two-phase treatment with an early first prepubertal phase can be effective, a later single-phase approach during early puberty seems to be equally effective. Certainly, before surgical correction of the mild to moderate skeletal class II problem in a growing patient is considered, an orthopedic phase of treatment prior to the pubertal growth spurt is an appropriate first step. Skeletal class III patients with a maxillary deficiency stand to gain significant benefits from early orthopedic treatment. However, such therapy may produce more favorable changes for older children and adolescents than previously thought. Nevertheless, orthopedic correction of the mild to moderate skeletal class III should be accompanied by regular progress evaluations to avoid creating significant dental compensations in the face with little skeletal change that ultimately requires surgery anyway. Skeletal class III patients with mandibular excess and/or vertical excess are poor candidates for growth modification. Orthopedic palatal expansion appears to be effective and stable at any time prior to late puberty, a stage of development when ossification of the maxillary sutures is more advanced. Consequently, the timing for expansion may be better determined by the specific needs of each patient. A functional shift resulting from a crossbite is optimally corrected early, so that asymmetric growth of the mandible can be reduced or even prevented. Postpubertal orthopedic expansion is likely to result in bone bending, which will reverse itself over time, potentially leaving periodontal compromise of the maxillary posterior teeth. Therefore, surgically assisted expansion should be considered in such cases. Vertical maxillary excess is challenging to treat with growth modification. The combination of interocclusal acrylic bite blocks combined with a high-pull headgear presently appears to be the best means available. Unfortunately, this treatment has limited success, it must be continued over many years owing to the long-term nature of vertical growth, and it is counterproductive in achieving a balanced sagittal jaw relationship in class I or class III patients with vertical excess. Future research will permit us to have a greater understanding of the nature and extent of facial growth modification possible in individual patients and the optimal appliances and timing of treatment to achieve the best outcome. The development of intraoral osseointegrated attachments such as implants and onplants hold promise for a future means of dissipating orthopedic forces to prevent unwanted dentoalveolar changes that presently occur with our tooth-borne appliances. Analogous attachments presently are undergoing clinical testing for surgically assisted orthopedic movements associated with distraction osteogenesis.

Adolescent↗
PubMed1982

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↗
PubMed1992

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↗
PubMed1992

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↗
PubMed1994

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↗