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Craniofacial morphology, dental occlusion, tooth eruption, and dental maturity in boys of short stature with or without growth hormone deficiency.

The aim of this project was to study the craniofacial morphology, dental occlusion, dental maturation and tooth eruption in short-statured boys with growth hormone secretion ranging from low to high. The measurements from lateral and posteroanterior cephalograms, orthopantomograms and plaster models were used. Almost all linear measurements of the facial structures were significantly smaller. A disproportionate growth in the cranial base structures as well as in the jaws resulted in facial retrognathia, a proportionately smaller posterior than anterior facial height, and a steep vertical inclination of the mandible. Dental crowding was more common and the overbite was small. Dental maturity and tooth eruption were delayed 1.2 and 1.3 yr, respectively. No significant differences between the idiopathic short-statured and the growth hormone-deficient group in any of the above-mentioned variables were found. It can be concluded that although most of the cephalometric variables measured differed significantly from the average, the facial appearance of the boys is not conspicuous and is of minor clinical importance. However, the short-statured boys might be in greater need of orthodontic treatment due to the higher percentage of dental crowding.

Adolescent↗

A comparison of the effects of the Latham-Millard procedure with those of a conservative treatment approach for dental occlusion and facial aesthetics in unilateral and bilateral complete cleft lip and palate: part I. Dental occlusion.

The purpose of this study was to compare the effect of the Latham-Millard presurgical orthopedics, gingivoperiosteoplasty, and lip adhesion protocol with conservative treatment (nonpresurgical orthopedics without gingivoperiosteoplasty) for palatal and dental occlusion in complete bilateral and complete unilateral cleft lip and palate. All patients were from the South Florida Cleft Palate Clinic. A retrospective dental occlusal study was conducted using serial dental casts that had been taken of patients from birth to 12 years of age. All surgical procedures, except for the secondary alveolar bone grafts in the conservative, nonpresurgical orthopedics group, were performed by D. Ralph Millard, Jr. Ralph Latham supervised the presurgical orthopedics cases. Samuel Berkowitz collected and analyzed all the serial records from 1960 to 1996. Among the patients with complete unilateral cleft lip and palate, 30 patients were treated with presurgical orthopedics, gingivoperiosteoplasty, and lip adhesion (the Latham-Millard protocol) and 51 patients were treated conservatively (i.e., nonpresurgical orthopedics without gingivoperiosteoplasty). Among the patients with complete bilateral cleft lip and palate, 21 patients were treated with the Latham-Millard protocol and 49 patients were treated conservatively. Conservative treatment was performed between 1960 and 1980. In patients with bilateral cleft lip and palate, a head bonnet with an elastic strip was used to ventroflex the protruding premaxilla. In all patients (unilateral and bilateral cleft), lip adhesion was performed at 3 months followed by definitive lip surgery at 6 to 8 months and palatal cleft closure between 18 and 24 months of age, in most cases. The Latham-Millard procedure was performed from 1980 to 1996; in bilateral cleft patients, it involved the use of a fixed palatal orthopedic appliance to bodily retract the protruding premaxilla and align it within the alveolar segments soon after birth. In all patients (unilateral and bilateral cleft), palatal alignment was also followed by gingivoperiosteoplasty and lip adhesion. Definitive lip surgery was performed between 6 and 8 months of age, and palatal closure was performed between 8 and 24 months of age using the von Langenbeck procedure with a modified vomer flap. All of the study participants had cleft lips and palates of either the unilateral or bilateral type; the unilateral and bilateral groups were further subdivided based on whether they had received the Latham-Millard protocol or the conservative treatment. It was then determined how many in each of these four basic groups had either anterior or buccal crossbites at four different age levels, when they were approximately 3, 6, 9, and 12 years of age. Although several children entered the study at or just before age 6, every patient in the 9-year-old and 12-year-old sample groups had been in the 6-year-old group and all of the 12-year-olds had been included in the immediate preceding age sample. Two-by-two chi-square tests were carried out within each cleft type (unilateral or bilateral) at each of the four age levels separately, to test whether the treatment groups (protocol versus conservative) differed in the frequency of cases with a given kind of crossbite (rather than not having that kind of crossbite). At every age level, a greater percentage of patients treated with the Latham-Millard protocol developed crossbites than did those treated more conservatively. This difference existed for both the anterior and buccal crossbites and for both unilateral and bilateral clefts. Chi-square tests of the treatment differences in crossbite frequency showed that in three quarters of the Latham-Millard protocol versus conservative treatment comparisons (12 out of 16), a significantly greater frequency of crossbite cases occurred after the Latham-Millard protocol treatment as compared with after the conservative procedure. The chi-square values for the differences in outcome between the two kinds of treatment procedures were greater for the anterior crossbites than for the buccal crossbites, suggesting that the Latham-Millard protocol, relative to the conservative method, was more likely to have an adverse effect on the anterior crossbites than on the buccal crossbites. For those patients born with a bilateral cleft, the differences in crossbite frequency between the protocol and the conservative treatment were statistically significant for patients with an anterior crossbite but not for patients with a buccal crossbite. The analysis shows that in complete bilateral and unilateral cleft lip and palate, the frequency of the anterior crossbite and (except for ages 3 and 12) the buccal crossbite is significantly higher with the Latham-Millard presurgical orthopedics, gingivoperiosteoplasty, and lip adhesion protocol compared with the conservative, nonpresurgical orthopedics without gingivoperiosteoplasty treatment. The exception in the bilateral buccal case may be attributed to the small experimental sample size, which brings down the confidence level.

Alveolar Process↗

Early bone grafting in complete cleft lip and palate cases following maxillofacial orthopedics. III. A study of the dental occlusion.

The dental occlusion of children born with complete cleft lip and palate was studied in deciduous and mixed dentition. The children were divided in two unilateral groups: one group of 39 children operated on between 1960-1965 without preoperative orthopedics and another group of 46 children operated on between 1965-1972 after preoperative orthopedics ("T-traction"). One group of 19 children with bilateral clefts operated on 1960-1972 after premaxillary retropositioning pressure, if necessary combined with outward rotation of the lateral maxillary segments was also studied. All children were bone grafted with the "four flap" technique. Comparisons were made with cleft children bone grafted with a different surgical method, with non-grafted U.S. cleft children, with cleft children operated on with infant periosteoplasty and with nonclefts. Crossbites were more frequent in clefts bone grafted with a different surgical method. The results of this study corresponded more to those operated on with infant periosteoplasty or to the non-grafted cases. However, all cleft groups differed significantly from nonclefts with a reduced overjet and overbite and narrower and shorter upper dental arches.

Bone Transplantation↗

A preliminary study of manducatory behaviour influenced by stress and dental occlusion.

Stress and dental occlusion often are incriminated as causes of dysfunction of the manducatory system. How and in what degree these two factors came through has not yet been clearly worked out. Our study is carried out on a group of rats presenting one or both of these two factors and we proposed to examine the duration and frequency of some components of their behaviour--intake of solid food and grooming, to detect some possible perturbations on manducatory behaviour caused by stress and/or occlusal interference. Our study shows that stress induced by emotion or occlusal interference will change the microstructure of behaviour rather than the global component in itself. This implies that we must find a clear definition of the different types of microstructure to find out which ones are changed by the two incriminating factors and which part of the behaviour component will remain stable.

Animals↗

[Lisping and dental occlusion alterations in 03 to 06 year old children].

BACKGROUND: lisping and dental occlusion alterations. AIM: to verify the relationship between lisping and alterations in the anterior vertical plane of the dental occlusion in children with ages ranging from 03 to 06 years. METHOD: 132 children were submitted to an evaluation of the dental occlusion and of speech. RESULTS: lisping occurred in 51.5% of the participants and was associated to dental occlusion alterations in 50% of the individuals, while for the other 50% lisping was not associated to any dental occlusion alterations. CONCLUSION: lisping did not demonstrate to have any association with alterations in the anterior vertical plane of the dental occlusion. The presence of alterations in the dental occlusion can be a risk factor for the development of lisping in speech, but is not decisive for its occurrence.

Age Distribution↗

The role of occlusal auscultation in assessing dental occlusions.

Little attention is paid to the noises made when the teeth occlude, yet there is a wealth of information stored in these sounds. It is remarkable how quickly the ear can learn to discern the difference between a good occlusion and one which is disrupted, by using a stethoscope. With the addition of relatively inexpensive instrumentation, occlusal sounds may also be recorded for later reference, analysis, comparison or audit.

Auscultation↗

Development and evolution of the helicoidal plane of dental occlusion.

The helicoidal plane of dental occlusion is a composite feature involving axial inclination of teeth and effects of dental attrition. Recent studies disagree on its distribution and significance in hominoid primates. The distribution, development, and functional basis of the helicoidal plane are investigated here, based on quantitative analysis of dental morphology and attrition in 667 human and 60 chimpanzee dentitions. Helicoidal planes are nearly universal in the human and chimpanzee dentitions studied. Increasing axial inclination of molars from M1 to M3 is primarily responsible for the helicoidal plane, although attrition acts to increase its expression. In hominoids, increased molar axial tilt appears to be associated with facial shortening and dental reduction. Population and species comparisons suggest a functional relationship with cranial structure. Progressive axial tilt of molars producing a helicoidal plane is found consistently in mammals with cheek teeth positioned partly under the cranium, as in hominids, pongids, some cebids, macropodids, ursids, and sciurids. Facial shortening is an important trend in hominid evolution and axial inclination of molars might be expected to show progressive change from Australopithecus afarensis to recent Homo sapiens.

Animals↗

The effectiveness of orofacial myofunctional therapy in improving dental occlusion.

The most significant findings of this study definitively establish the beneficial effects of orofacial myofunctional therapy on improving dental occlusion, decreasing dental open bite, and decreasing dental overjet. The results reported are actually quite conservative because of the method of measuring. Measuring and recording every tooth unquestionably dilutes the results which would have been achieved if only the anterior teeth had been used in the calculations. Some may question the small millimeter change as being significant. The change is reflective of the overall relative value change of incorporating all teeth within the dental arches and not limiting the analysis to only the anterior teeth. The secondary findings of the study confirm that age is not necessarily a factor in predicting success of a therapy program. Further, this study indicates that improvement of open bite and overjet can result from OMT without prior or concurrent orthodontic intervention. Orofacial myofunctional therapy, from a public health standpoint, is a classic form of primary prevention to improve the overall health and well-being of the individual. The end result of OMT therapeutic programs is the establishment of new neuromuscular patterns, correction of functional and resting postures, correction of chewing/swallowing/feeding patterns and elimination of deleterious behaviors. Stabilization and maintenance of therapeutic goals become part of the lifelong learning and change process. Orofacial myofunctional therapy utilizes knowledge and skills acquired through multidisciplinary education and training. Licensed professionals, from dental hygiene, dentistry, speech pathology, medicine, nursing, and other allied health professions with advanced education and training in orofacial myofunctional therapy have demonstrated expertise in providing collaborative, integrated, and interdisciplinary primary care. Reference to earlier research works and anecdotal reports of ineffectiveness unfortunately perpetuate and reinforce the dichotomous quandary of form and function. Instead, recognition of the interrelationship of form and function, as conjoint fundamental processes, would encourage more pro-active patient referrals for orofacial myofunctional therapy services. This would allow the specialty area of orofacial myology to further validate the effectiveness of OMT on tooth movement in a positive, collaborative, and beneficial manner. Acknowledging the small sample size in this study may encourage other clinicians to conduct future research in this area. Additional research is needed on the physiologic adaptive capacity of the orofacial environment. Developmental aspects of orofacial and jaw neurophysiology, especially in children, are scant in the literature. Treatment recommendations for specific dental malocclusions are based on many factors. Each malocclusion classification presents opportunity for OMT research. A major research dilemma for the practicing clinician is the moral and ethical responsibility of providing treatment when dysfunction is diagnosed. Designing a study and identifying a "control group" is difficult due to the unethical aspect of knowingly withholding therapy when the benefits are statistically proven and available. A study design using the sample as its own control can infer and demonstrate validity. The next logical test is replication of this study to determine the level of reliability. This issue of the I.J.O.M. addresses the effectiveness of orofacial myology treatment in improving speech articulation, eliminating digit sucking, and improving dental occlusion. It is time the professions of dental hygiene, dentistry, medicine, and speech pathology move forward and acknowledge current substantive research and literature that supports the philosophies of prevention, early interception (intervention), and corrective treatment. The dark ages of disbelief only remain dark as long as we forget to turn on the light. (ABSTRACT TRU

Adolescent↗

Associations between dental occlusion and misarticulations of Finnish dental consonants in cleft lip/palate children.

The purpose of this study was to examine whether malocclusions in terms of crossbites, large maxillary overjet, and deep bite are related to the articulatory problems with the Finnish dental consonants /r/, /s/ and /l/ in different cleft types and gender. The subjects were 260 (108 girls, 152 boys) 6-yr-old Finnish-speaking non-syndromic children with isolated cleft palate (CP, n = 79), cleft lip/alveolus (CL(A), n = 76), unilateral (UCLP, n = 78), and bilateral (BCLP, n = 27) cleft lip and palate. Occlusal anomalies were evaluated from dental plaster casts, and speech was analyzed by two speech pathologists with a high reliability. Altogether, 43% of patients misarticulated at least one of the studied sounds, and had crossbites significantly more often (73%) than subjects with correct /r/, /s/ and /l/ production (45%). Posterior crossbites were significantly associated with defective articulation, whereas anterior crossbite alone, large maxillary overjet, or deep bite were not. It was concluded that occlusal abnormalities in terms of posterior crossbites should be considered as a risk factor for correct dental consonant articulation in cleft-affected subjects.

Articulation Disorders↗

Research on variation in dental occlusion. A "state of the art" workshop conducted by the Craniofacial Anomalies Program, the National Institute of Dental Research.

The following report on assessing research on variation in dental occlusion was based in part on a workshop conducted by the National Institute of Dental Research at the initiative of Richard L. Christiansen, Chief, Craniofacial Anomalies Program. The meeting was planned and developed by Robert J. Isaacson, Chairman, Touro M. Graber, Richard A. Riedel, and Richard L. Christiansen. This report is designed to provide a review of the achievements, directions, and needs of research concerning variations in dental occlusion. The workshop was held at the National Institutes of Health, Bethesda, Maryland, on Nov 22 and 23, 1972. The material presented by the workshop participants has been summarized and incorporated in this report. The subject of research related to the field of malocclusion was discussed in an article published in the American Journal of Orthodontics in January, 1971.

Dental Occlusion↗

Dental occlusion modifies gaze and posture stabilization in human subjects.

Repercussion of dental occlusion was tested upon postural and gaze stabilization, the latter with a visuo-motor task evaluated by shooting performances. Eighteen permit holders shooters and 18 controls were enrolled in this study. Postural control was evaluated in both groups according to four mandibular positions imposed by interocclusal splints: (i) intercuspal occlusion (IO), (ii) centric relation (CR), (iii) physiological side lateral occlusion and (iv) controlateral occlusion, in order to appreciate the impact of the splints upon orthostatism. Postural control and gaze stabilization quality decreased, from the best to the worst, with splints in CR, IO and lateral occlusion. In shooters, the improvement in postural control was parallel to superior shooting performance. A repercussion of dental occlusion upon proprioception and visual stabilization is suggested by these data.

Dental Occlusion↗

Skeletal and dental arch asymmetries in individuals with normal dental occlusions.

The aim of this study was to determine whether skeletal and/or dental asymmetries are presented in individuals with normal dental occlusions. Frontal cephalometric radiographs and dental arch casts were obtained from 20 Brazilians from Rio de Janeiro whose mean age was 22.4 years. Normal dental occlusions were present in all individuals. Nine bilateral triangles were established on the radiographs for the craniodentofacial complex. The area for each triangle was calculated, and the frequency of asymmetries on the dental casts was investigated. When comparing right and left sides on the radiographs, Student's tests did not show statistically significant differences in triangle areas, although the areas were not symmetrical. Males and females showed similar results when the areas of the radiographic triangles were compared between sexes. Maxillary and mandibular dental midlines, palatal raphe on the casts, and median sagittal plane on the radiographs were almost coincident. Additionally, the frequency of molar asymmetries on the dental casts was not statistically different, but molar asymmetries greater than 1 mm were present in 50% of the sample.

Adolescent↗