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PubMed2006

Examiner differences in the assessment of different malocclusions.

BACKGROUND: In the current discussion about ensuring treatment quality and reducing costs in the health sector, indication systems with which to determine the need for a treatment and the success of therapy are increasingly being used in orthodontics. These indication systems require the objective evaluation of malocclusions. Our objective was to determine the examiner reliability in the assessment of various malocclusions. MATERIALS AND METHODS: In 180 adults (64 male, 116 female, aged 20-49) from the population-based Study of Health in Pomerania (SHIP), malocclusions were recorded clinically and on models by calibrated examiners. An experienced orthodontist conducted the clinical examination. Another orthodontically-experienced examiner analyzed the models. To compare the model examiners, two examiners with varying degrees of orthodontic experience evaluated 60 of the 180 models as well (29 male, 31 female). One of the model examiners repeated the assessment of 60 models at a later time (intra-individual comparison). RESULTS AND CONCLUSIONS: Reliability amongst the examiners depended on which malocclusions were judged: crowding and contact point displacement showed little agreement, while cross bite, edge-to-edge bite, deep bite and enlarged overjet revealed greater agreement. Comparison between the clinical examination and model analysis (kappa median 0.57) revealed the greatest differences between the examiners. Comparison of the three model examiners also showed differences. The contrast to the orthodontically least experienced examiner was greater (kappa median 0.61 and 0.62) than the divergence between the two orthodontically more experienced examiners (kappa median 0.70). The intra-individual examiner comparison revealed the smallest differences (kappa median 0.82).

Adult↗

PubMed1983

The dependence of mandibular dysfunction in children on functional and morphologic malocclusion.

The influence of dental status, occlusal interference, occlusal anomalies, and general background variables on bruxism and subjective symptoms and clinical signs of mandibular dysfunction has been studied in children. Three samples of children, aged 7, 11, and 15 years, were included. The interrelations were analyzed by rank-correlation and stepwise multiple regression. In the rank-correlation analyses, dental wear and age were significantly correlated to all of the dysfunction variables. Bruxism (reported by the subjects) was not found to be significantly correlated to any of the independent variables in the regression analysis. Subjective symptoms of dysfunction could be explained to a small extent by the independent variables, of which dental wear and sucking habits were found to be the most important. Recurrent headache was, to a certain extent, dependent upon age and sex. TMJ clicking was positively correlated with dental wear and unilateral contact in the retruded contact position but was most influenced by age and sex; TMJ clicking increased with age and was more common in girls than in boys. The clinical dysfunction index of Helkimo and tenderness of the masticatory muscles on palpation were explainable, although to a minor degree, by the influence of a combination of age, occlusal interference, motor activity, and psychological factors. Functional malocclusion (occlusal interference) is more important than morphologic malocclusion in explaining the existence of mandibular dysfunction. Nevertheless, morphologic malocclusion such as Class II and Class III occlusion, frontal open-bite, and cross-bite, when associated with functional malocclusion, may create a predisposition to mandibular dysfunction. The study confirms the multifactorial etiology of mandibular dysfunction.

Adolescent↗

PubMed1989

The occurrence of tooth size discrepancies among different malocclusion groups.

This study consisted of 109 patients with varying malocclusions (Class I; Class II, Division 1; Division 2; and Class II surgery) who were treated orthodontically. Tooth size analyses were performed on the pretreatment models of these patients and mesial-distal tooth size ratios were measured as described by Bolton. The incidence of mesial-distal tooth size discrepancies in the malocclusion groups was analyzed and compared with Bolton's means and standard deviations. The results showed no difference in the incidence of tooth size discrepancies from one malocclusion group to another. When the sample was taken as a whole, there was no significant difference in the mean of the mesial-distal tooth size ratios as computed in the present study and compared to Bolton's mean. There were, however, higher standard deviations seen in the present study compared with Bolton's study. Even though there was no significant difference in the incidence of tooth size discrepancies among malocclusion groups, there was a large number of tooth size discrepancies in each group. Therefore it is suggested that Bolton's tooth size analysis be performed before initiation of orthodontic treatment.

Humans↗

PubMed2006

Skeletal and dentoalveolar effects of Twin-block and bionator appliances in the treatment of Class II malocclusion: a comparative study.

INTRODUCTION: The purpose of this study was to evaluate the skeletal and dentoalveolar effects of the Twin-block and bionator appliances in the treatment of Class II Division 1 malocclusions. METHODS: Fifty-five girls from North India with Class II Division 1 malocclusion and the same physical growth maturation status were selected for the study. The subjects were divided among a Twin-block group (n = 25), a bionator group (n = 20), and a control group (n = 10). Pretreatment and posttreatment lateral cephalometric radiographs of the treatment group subjects, and prefollow-up and postfollow-up radiographs of the control group subjects, were traced manually and subjected to the pitchfork analysis. RESULTS: Statistical software was used for 1-way analysis of variance and multiple comparisons (post-hoc test, Bonferroni). A P value of .05 was considered statistically significant. Neither the Twin-block nor the bionator appliance significantly restricted forward growth of the maxilla (P = .476). Mandibular growth in the Twin-block subjects was significantly greater than in controls (P = .005). Mandibular growth was comparable in the control and the bionator subjects. Molar correction, overjet reduction, and proclination of the mandibular incisors were significantly greater (P = .000) in the treated subjects compared with the controls. CONCLUSIONS: Both the Twin-block and bionator appliances were effective in correcting molar relationships and reducing overjets in Class II Division 1 malocclusion subjects. However, the Twin-block was more efficient than the bionator in the treatment of Class II Division 1 malocclusion.

Age Factors↗

PubMed2006

Malocclusion: esthetic impact and quality of life among Brazilian schoolchildren.

INTRODUCTION: The objectives of this study were to assess the esthetic impact of malocclusion on the daily life of Brazilian schoolchildren and to test the association between esthetic impact due to malocclusion and biopsychosocial variables. METHODS: The sample comprised 333 randomly selected subjects aged 10 to 14 years. The oral impact on daily performance (OIDP) instrument was used to assess the esthetic impact, and the dental aesthetic index (DAI) was used for clinical assessment. The subjects were further evaluated as to their self-esteem (global self-evaluation) and self-perception of oral esthetics (oral aesthetic subjective impact scale). Other variables were assessed through questionnaires. Multiple logistic regression was used in the data analysis. RESULTS: Twenty-seven percent of the children reported an esthetic impact on their daily lives due to malocclusion. The following variables were independent risk factors for an esthetic impact: female sex, maxillary anterior crowding of 2 mm or more, normative need for treatment considered elective and highly desirable, negative self-perception of oral esthetics, low self-esteem, and intermediate economic level. CONCLUSIONS: The esthetic impact of malocclusion significantly affects the quality of life of schoolchildren in Belo Horizonte.

Activities of Daily Living↗

PubMed1998

Procrustes, Euclidean and cephalometric analyses of the morphology of the mandible in human Class III malocclusions.

The role of mandibular phenotype in the development of Class III malocclusion remains unclear. The purpose of this study was to determine whether the form of the mandible differed between prepubertal individuals with Class I and Class III malocclusions. Lateral cephalographs of 73 children of European-American descent aged between 5-11 years with Class III malocclusion were compared to those of 60 counterparts with a normal, Class I molar occlusion. The cephalographs were traced and checked, and eight homologous mandibular landmarks were digitized. Average mandibular geometries, scaled to an equivalent size, were generated using Procrustes superimposition. Euclidean distance matrix analysis (EDMA) was undertaken to corroborate the Procrustes analysis, and bivariate analysis utilizing eight linear and five angular measurements was also performed. Residuals and F-values from Procrustes analysis indicated that mandibular configurations differed statistically for Class I and Class III types. EDMA confirmed that the Class I and Class III geometries were significantly different, revealing that the greatest differences in morphology arose in the anterior-most mandibular regions. As well, most variables showed statistically significant differences when the Class I and Class III mandibular types were compared. When the sample was subdivided into seven age- and sex-matched groups, nearly all age-based comparisons were significantly different. It is concluded that the morphology of the mandible differs in individuals with Class III malocclusions when compared to the normal Class I configuration, and that these alterations may indicate dichotomous postnatal mandibular ontogeny.

Cephalometry↗

PubMed2000

Eruption Guidance Appliance effects in the treatment of Class II, Division 1 malocclusions.

The objective of this research was to cephalometrically evaluate the possible effects of the Eruption Guidance Appliance on the craniofacial complex in a sample of 30 patients, over a treatment period of 26 months. The experimental sample consisted of 30 patients (13 females and 17 males), 27 of which presented with a Class II, Division 1 malocclusion and 3 with a Class I malocclusion. The mean initial chronologic age was 9 years; the treatment period lasted 26 months. A control group was used for comparison and consisted of 30 subjects (13 females and 17 males) of similar ages and spanned a similar observation period. Twenty-six subjects of this control group had Class II, Division 1 malocclusions, and 4 had Class I malocclusions. Lateral cephalometric headplates were obtained for the experimental group initially and after 26 months of treatment. The subjects in the control group were randomly selected from a serial growth study sample from the Orthodontic Department at Bauru Dental School, University of São Paulo, for whom cephalometric headplates were obtained annually from 4 to 18 years of age. Comparative statistics were used to assess possible differences between the experimental and control groups during the 26-month period of observation. Results demonstrated statistically significant increases in mandibular growth, degree of mandibular protrusion, lower anterior and total anterior face height, mesial migration of the lower molars, and mandibular posterior dentoalveolar height. There was also lingual tipping and retrusion of the upper incisors, linear protrusion of the lower incisors, improvement in the maxillomandibular relationship and in molar relationship, as well as a significant decrease in the overjet and overbite and an inhibition of the vertical development of the upper incisors. The study demonstrated no significant changes in maxillary growth during the evaluation period. It was concluded from these results that the effects of the Eruption Guidance Appliance during this time period were mostly dentoalveolar, with a smaller, but significant, skeletal effect.

Cephalometry↗

PubMed1995

The validation of the Peer Assessment Rating index for malocclusion severity and treatment difficulty.

The Peer Assessment Rating (PAR) index is a British occlusal index that measures the severity of dental malocclusion and has been used in several investigations that have evaluated the effectiveness of orthodontic treatment provision in Europe. As part of its development, the PAR index was validated for malocclusion severity, by using the opinions of a panel of 74 dentists and orthodontists. The present investigation was carried out to validate the PAR index, by using the opinion of an American panel of orthodontists. Eleven orthodontists examined a sample of 200 sets of study casts and rated them for malocclusion severity and perceived treatment difficulty. Multiple regression techniques were used to evaluate the predictive power of the components of malocclusion on the panel's scores. Weightings were calculated from the partial regression coefficients and, when these weightings were applied to the PAR index, the association between the panel's opinion and the PAR index scores was increased.

Analysis of Variance↗

PubMed1996

Ossification of the distal phalanx of the first digit as a maturity indicator for initiation of orthodontic treatment of Class III malocclusion in Japanese women.

The influence of mandibular growth on the stability of orthodontic treatment has been well established. A particular problem is late mandibular growth in patients with Class III malocclusions, because of skeletal jaw discrepancies that may influence the timing and course of treatment, as well as the stability of posttreatment. We have used the ossification of the distal phalanx of the first digit as an indicator of the skeletal maturity of the patient and of their potential for further growth. Our previous studies have shown that fusion of the epiphysis and the diaphysis of the distal phalanx of the first digit occurs from 1 to 3 years after the pubertal growth maximum in Japanese women. In these case reports, the orthodontic treatment of two female patients with mild Class III skeletal malocclusions is presented to show the possible clinical application of the ossification of the first digit as an indicator of the completion or near cessation of mandibular growth in the timing of treatment of Class III malocclusions. The case reports show that, although both patients experienced some mild degree of mandibular growth after treatment, this method can be helpful in determining residual mandibular growth potential in Japanese female patients with Class III malocclusions and mild skeletal discrepancies.

Age Determination by Skeleton↗

PubMed1997

Early dentofacial features of Class II malocclusion: a longitudinal study from the deciduous through the mixed dentition.

A group of 25 untreated subjects with Class II malocclusion in the deciduous dentition (featuring the concomitant presence of distal step, Class II deciduous canine relationship, and excessive overjet) was compared with a control group of 22 untreated subjects with ideal occlusion (flush terminal plane, Class I deciduous canine relationship, minimal overbite, and overjet) at the same dentitional stage. The subjects were monitored during a 2 1/2-year period in the transition from the deciduous to the mixed dentition, during which time no orthodontic treatment was provided. Occlusal analysis of the Class II group in the deciduous dentition revealed an average interarch transverse discrepancy due to a narrow maxillary arch relative to the mandible. All occlusal Class II features were maintained or became exaggerated during the transition to the mixed dentition. The skeletal pattern of Class II malocclusion in the deciduous dentition typically was characterized by significant mandibular skeletal retrusion and mandibular size deficiency. During the period examined, cephalometric changes consisted of significantly greater maxillary growth increments and smaller increments in mandibular dimensions in the Class II sample. Moreover, a greater downward and backward inclination of the condylar axis relative to the mandibular line, with consequent smaller decrements in the gonial angle, were found in the Class II group, an indication of posterior morphogenetic rotation of the mandible in patients with Class II malocclusion occurring during the period examined. The results of this study indicate that the clinical signs of Class II malocclusion are evident in the deciduous dentition and persist into the mixed dentition. Whereas treatment to correct the Class II problem can be initiated in all three planes of space (e.g., RME, extraoral traction, functional jaw orthopedics), other factors such as patient cooperation and management must also be taken into consideration before early treatment is started.

Cephalometry↗

PubMed2004

Dentoskeletal treatment changes in Class II subdivision malocclusions in submentovertex and posteroanterior radiographs.

The objective of this study was to evaluate the dentoskeletal changes consequent to orthodontic treatment in subjects with Class II subdivision malocclusions, treated with asymmetric extractions, compared with a normal-occlusion control group. The sample consisted of 3 groups, with 30 subjects in each: normal-occlusion subjects (group 1), untreated Class II subdivision subjects (group 2), and Class II subdivision patients treated with asymmetric extractions (group 3). All subjects had a full complement of permanent teeth at the beginning of treatment. The average ages of the subjects were 22.42, 15.76, and 18.57 years, respectively, in groups 1, 2, and 3. Measurements of relative differences in the spatial position of dental and skeletal bilateral landmarks were obtained from the submentovertex and posteroanterior cephalometric (PA) radiographs. The t test for independent samples was used to compare group 1 with groups 2 and 3 at different times. Results from the submentovertex radiograph showed that asymmetric extractions in Class II subdivision malocclusions will maintain the differences in the anteroposterior positions of right and left, maxillary and mandibular first molars, as would be expected with the treatment protocols used. There were no significant skeletal changes that could be attributed to the treatment approaches investigated or transverse collateral effects with the asymmetric mechanics used. It was also demonstrated that treatment of Class II subdivision malocclusions with asymmetric extractions produced corrections of maxillary and mandibular dental midline deviations with the midsagittal plane, without canting the occlusal plane or any other investigated horizontal plane, as seen in the PA radiograph. Treatment of Class II subdivision malocclusions with asymmetric extractions constitutes a beneficial approach to this problem.

Adolescent↗

PubMed1994

Case report: developmental characterization of skeletal Class III malocclusion.

Skeletal Class III malocclusion is usually characterized by a steep mandibular plane angle, obtuse gonial angle, overdeveloped mandible, underdeveloped maxilla, and a small cranial base angle which may displace the glenoid fossa anteriorly to cause a forward positioning of the mandible. These factors are generally thought to contribute to the development of skeletal malocclusion as well as facial deformities, and are believed to originate from genetic and/or environmental factors. The posterior discrepancy is an important etiological factor in the development of a skeletal Class III malocclusion because it affects the occlusal plane. This idea must be amended for an appropriate clinical approach to the treatment of Class III malocclusion.

Adolescent↗

PubMed1995

Self-concept, Class II malocclusion, and early treatment.

Increased overjet has been associated with teasing, negative stereotyping, and low self-concept. Early treatment for children with Class II malocclusion is often recommended under the assumption that an improved dental appearance may benefit a child by increasing his or her social acceptance and hence self-concept. The self-concept of 208 patients, age 7 to 15 years and with increased overjet, was measured before treatment using the Piers-Harris self-concept scale; a subset of 87 of these children were measured again after 15 months of early growth modification. The mean self-concept score for these children was above the population norm, and there was no association between the child's score and the magnitude of his or her overjet or age. Although some significant associations were found between Class II malocclusion features and self-concept scores, the explained variation in self-concept scores was low (R2 from 5% to 8%). There was no change in the mean self-concept score of these children during early treatment, nor was there any association between reduction of Class II malocclusion features and improved self-concept. These findings suggest that children with Class II malocclusion do not generally present for treatment with low self-concept and, on average, self-concept does not improve during the brief period of early orthodontic treatment.

Adolescent↗

PubMed2003

A 20-year follow-up of signs and symptoms of temporomandibular disorders and malocclusions in subjects with and without orthodontic treatment in childhood.

This investigation analyzes the influence of orthodontic treatment on signs and symptoms of temporomandibular disorders (TMDs) and different malocclusions during a 20-year period. Originally, 402 randomly selected 7-, 11-, and 15-year-old subjects were examined clinically and by means of a questionnaire for signs and symptoms of TMDs. The examination was repeated after five and ten years. After 20 years, 320 subjects (85% of the traced subjects) completed the questionnaire. The oldest age group,now 35 years of age, was invited to a clinical examination, and 100 subjects (81% of the traced subjects) were examined. The correlations between signs and symptoms of TMD and different malocclusions were mainly weak, although sometimes statistically significant. Lateral forced bite and unilateral crossbite were correlated with TMD signs and symptoms at the 10- and 20-year follow-ups (r = 0.38, P < .05 and r = 0.34, P < .01, respectively). Subjects with malocclusion over a long period of time tended to report more symptoms of TMD and to show a higher dysfunction index, compared with subjects with no malocclusion at all. There were no statistically significant differences in the prevalence of TMD signs and symptoms between subjects with or without previous experience of orthodontic treatment. This 20-year follow-up supports the opinion that no single occlusal factor is of major importance for the development of TMD, but a lateral forced bite between retruded contact position (RCP) and intercuspal position (ICP), as well as unilateral crossbite, may be a potential risk factor in this respect. Furthermore, subjects with a history of orthodontic treatment do not run a higher risk of developing TMD later in life, compared with subjects with no such experience.

Adolescent↗

PubMed2004

Association of malocclusion and functional occlusion with signs of temporomandibular disorders in adults: results of the population-based study of health in Pomerania.

The objective of this study was to determine whether associations exist between occlusal factors and signs of temporomandibular disorders (TMD) in adults using the population-based Study of Health in Pomerania (SHIP), Germany. A representative sample of 4310 men and women aged 20 to 81 years (response 68.8%) was investigated for TMD signs, malocclusions, functional occlusion factors, and sociodemographic parameters. Multiple logistic regression analysis, adjusted for sex, age, and socioeconomic status, was used. The results were compared with other population-based studies identified by a systematic review. Few malocclusions and no factors of functional occlusion except socioeconomic parameters were associated with TMD signs, and these associations were mostly weak. Only bilateral open bite up to three mm appeared to be clinically relevant and was associated with TMD signs (odds ratio [OR] = 4.0). This malocclusion, however, was of rare occurrence, with a prevalence of 0.3% (n = 9), and this finding was not confirmed by other representative studies. Occlusal factors examined in this study explained only a small part of the differences between normal subjects and those with TMD signs. This and other population-based studies indicate that malocclusions and factors of functional occlusion surveyed should be seen as merely cofactors in the sense of one piece of the mosaic in the multifactorial problem of temporomandibular dysfunction. Single occlusal factors that showed significant effects throughout several studies could not be detected. In view of the large number of occlusal variables already investigated, other variables including nonocclusal ones probably also play a role and should be looked at more intensely.

Adult↗

PubMed2005

Cephalometric predictors of long-term stability in the early treatment of Class III malocclusion.

The aim of this study was to examine the differences in the early craniofacial morphology of Class Ill malocclusions. Lateral cephalograms of 45 subjects with a Class III malocclusion and an anterior crossbite in the deciduous or mixed dentition were examined before treatment, after treatment, and during the long-term retention stage. The anterior crossbites of all patients were corrected after a series of orthodontic treatments. After a mean follow-up period of 5.7 years, all the subjects were reevaluated and divided into three groups according to the final occlusal status: good, fair, and poor occlusal stability. Twenty cephalometric variables on the pretreatment lateral cephalograms were analyzed by one-way analysis of variance and discriminant analysis to identify the key determinants for discriminating among the three groups. Among the 20 variables, 11 showed statistical significance. Generally, the subjects with a smaller gonial angle and a more hypodivergent skeletal pattern had good prognosis after the early treatment of Class III malocclusion. When the AB to mandibular plane angle and N-perpendicular to point A were selected in discriminant analysis, the AB to mandibular plane angle was the most significant variable. Discriminant analysis showed a relatively high degree of correct classifications of the patients with early Class III malocclusion. In particular, discriminant analysis showed the highest accuracy (93.3%) when predicting a poor prognosis.

Adolescent↗

PubMed2005

Dental and alveolar arch widths in normal occlusion and Class III malocclusion.

The aim of this study was to compare the transverse dimensions of the dental arches and alveolar widths of Class III malocclusion group with a group of untreated normal occlusion subjects. This study was performed using measurements on dental casts of 150 normal occlusion (mean age, 21.6 +/- 2.6 years) and 100 Class III malocclusion (mean age, 15.4 +/- 2.2 years) subjects. Independent samples t-test was applied for comparing the groups. The findings of this study indicated that the mandibular intercanine and intermolar alveolar widths were significantly larger in the Class Ill group when compared with the normal occlusion sample (P < .001). Maxillary interpremolar, intermolar widths and all maxillary alveolar width measurements were significantly narrower in the Class III group (P < .001). In addition, the lower canine and premolar alveolar width measurements were also statistically significantly larger in the normal occlusion group when compared with the Class III malocclusion group (P < .001). Subjects with Class III malocclusion tend to have the maxillary teeth inclined to the lingual and mandibular teeth inclined to the buccal direction because of the restriction of maxillary growth and development according to dental arch width measurements. Therefore, rapid maxillary expansion should be considered before or during the treatment of a Class III patient with or without face-mask therapy.

Adult↗

PubMed2006

Intermaxillary Bolton tooth size discrepancies among different malocclusion groups.

The orthodontic "finishing" phase is recognized for the many details necessary to accomplish an excellent result. A high percentage of finishing-phase difficulties arise because of tooth size imbalances that could have been discovered and considered during the initial diagnosis and treatment planning. The aim of our study was to determine whether there is a prevalent tendency for intermaxillary tooth size discrepancies among different malocclusion groups. This study involved 60 subjects who served as the normal occlusion group and 300 patients divided into five malocclusion groups (ie, Class I, Class II, Class II division 1, Class II division 2, and Class III). Tooth size measurements were performed on the models of the normal occlusion group and the pretreatment models of the patients. The tooth size ratios and the one-way analysis of variance test showed no sexual dimorphism for these ratios in each of five groups, so the sexes were combined for each group. Then, these ratios were compared among different malocclusion groups. The results showed no significant difference between subcategories of malocclusion, so these groups were combined as Class I, Class II, and Class III. No significant difference was found for all the ratios between the groups.

Adolescent↗