Management of skeletal Class III malocclusion with reverse pull headgear in a growing individual

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Ambreen Afzal; Hasnain Sakrani; Norisha Ehsan Mahmood; Kamellia Mehershahi; Fatima Burney

2016-01-01

Skeletal Class III malocclusion is considered to be one of the most difficult orthodontic problems to treat. This malocclusion is associated with the retrognathic maxilla or prognathic mandible or sometimes a combination of both. The treatment of such cases requires an integrated approach and a comprehensive treatment plan including growth modification, dental camouflage, or orthognathic surgery. In a growing patient, orthopedic correction of skeletal Class III malocclusion with the help of a...

Craniofacial morphology in Turner syndrome patients treated with growth hormone

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Jovana Julsoki

2015-05-01

Full Text Available ABSTRACT Introduction: In addition to well-established physical characteristics, Turner syndrome patients have distinct craniofacial morphology. Since short stature is the most typical characteristic, Turner syndrome patients are commonly treated with growth hormone in order to increase final height. At the same time, growth hormone treatment was found to influence craniofacial growth and morphology in various groups of treated patients. Whereas craniofacial characteristics of Turner syndrome patients are well documented, comparatively little is known of craniofacial morphology of those who are treated with growth hormone. Aim: The aim of this study was to investigate craniofacial morphology in Turner syndrome patients treated with growth hormone in comparison to healthy females. Materials and methods: The cephalometric evaluation was conducted on twenty lateral cephalograms of Turner syndrome patients (13.53 ± 4.04 years treated with growth hormone for at least one year (4.94 ± 1.92 years in average. As a control group, forty lateral cephalograms of healthy female controls, who matched Turner syndrome patients by chronological (11.80 ± 2.37 years and skeletal age, were used. Eleven angular, seven linear measurements and six dimensional ratios were measured to describe craniofacial morphology. Results: The results obtained for angular measurements, in cephalometric analyses for Turner syndrome patients treated with growth hormone, revealed bimaxillary retrognathism. The linear measurements indicated longer mandibular ramus, anterior cranial base and both anterior and posterior facial heights. However, posterior cranial base and maxilla were in proportion to the anterior cranial base, when comparing dimensional ratios. Anterior cranial base, maxilla and mandibular ramus were larger in proportion to mandibular body; as well as posterior facial height was when compared to anterior facial height. Turner syndrome patients treated with growth

Changes in oro-pharyngeal airway dimension after treatment with function appliance in class II skeletal pattern

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Ali, B.; Shaikh, A.; Fida, M.

2015-01-01

Background: Functional appliances have been used since many decades for the correction of mandibular retrognathism. Similar oral appliances are a treatment modality for patients with Obstructive sleep apnea. Hence, interception at the right age with these growth modification appliances might benefit a child from developing long term respiratory insufficiency. Therefore, the purpose of our study was to assess the short term effects of Twin block appliance (CTB) on pharyngeal airway size in subjects with skeletal Class II pattern in a sample of Pakistani population. Methods: A retrospective study was conducted from orthodontic records of 62 children (31 males, 31 females) with retrognathic mandibles using lateral cephalograms obtained at initial visit and after CTB treatment. Paired t-test was used to compare the pre-functional and post-functional treatment airway size. Independent sample t-test was used for comparison between the genders and statistical significance was kept at =0.05. Results: The upper airway width (p<0.001), nasopharyngeal depth (p=0.03) and upper airway thickness (p=0.008) was substantially improved after CTB treatment. Males showed a greater increase in upper airway width (p= 0.03) and nasopharyngeal depth (p=0.01) in comparison to the females. Conclusion: Functional appliance therapy can improve the narrow pharyngeal airway of growing children presenting with deficient mandibles having Class II skeletal pattern. (author)

Treatment of Bilateral Buccal Nonocclusion and Distalization

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Nagarajan Sadhasivam

2014-01-01

Full Text Available Orthodontic treatment aims to improve esthetics, function and structural balance. In some rare circumstances, the clinician may not be able to achieve the ideal treatment goals because of complex multiple orthodontic problems, which may include significant mutilation of the dentition. Brodie bite, a complete buccal posterior crossbite is a problem, which confronts clinicians with often complex variable etiology. The following case report demonstrates treatment of bilateral buccal nonocclusion that is mainly due to a maxillary dental arch issue rather than mandibular retrognathism.

Orthodontic treatment for a mandibular prognathic girl of short stature under growth hormone therapy

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Chin-Yun Pan

2013-12-01

Full Text Available This report presents a case of a 12-year-old girl with maxillary deficiency, mandibular prognathism, and facial asymmetry, undergoing growth hormone (GH therapy due to idiopathic short stature. Children of short stature with or without GH deficiency have a deviating craniofacial morphology with overall smaller dimensions; facial retrognathism, especially mandibular retrognathism; and increased facial convexity. However, a complete opposite craniofacial pattern was presented in our case of a skeletal Class III girl with idiopathic short stature. The orthodontic treatment goal was to inhibit or change the direction of mandibular growth and stimulate the maxillary growth of the girl during a course of GH therapy. Maxillary protraction and mandibular retraction were achieved using occipitomental anchorage (OMA orthopedic appliance in the first stage of treatment. In the second stage, the patient was treated with a fixed orthodontic appliance using a modified multiple-loop edgewise archwire technique of asymmetric mechanics and an active retainer of vertical chin-cup. The treatment led to an acceptable facial profile and obvious facial asymmetry improvement. Class I dental occlusion and coincident dental midline were also achieved. A 3½-year follow-up of the girl at age 18 showed a stable result of the orthodontic and dentofacial orthopedic treatment. Our case shows that the OMA orthopedic appliance of maxillary protraction combined with mandibular retraction is effective for correcting skeletal Class III malocclusion with midface deficiency and mandibular prognathism in growing children with idiopathic short stature undergoing GH therapy.

Orthodontic camouflage via total arch movement in a Class II with idiopathic condylar resorption

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Ji-Sung Jang

2014-01-01

Full Text Available Idiopathic condylar resorption (ICR, also known as idiopathic condylysis or condylar atrophy, is multifactorial pathology leading to severe mandibular retrognathism. The etiology has been shown to be multifactorial, such as avascular necrosis, traumatic injuries, hormone and autoimmune disease and it is largely difficult to distinguish the exact cause in each individual. In spite of the remarkable morphological alteration, surgical intervention is not readily recruited due to the possibility of recurrence of resorption. In order to restore balanced facial profile and occlusion. In this report, we present a camouflage treatment for skeletal Class II with ICR and facial asymmetry involving total arch movement, for the improvement facial profile and reconstruction of occlusion.

Correction of anterior open bite in a case of achondroplasia

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Karpagam S

2005-01-01

Full Text Available Treatment planning for patients with skeletal deformities is often considered challenging. This article reports a female patient with achondroplasia who presented with severe maxillary retrognathism and vertical excess along with anterior open bite. The clinical and cephalometric findings of the patient are detailed here. The treatment plan consisted of modified anterior maxillary osteotomy for simultaneous vertical and sagittal augmentation along with orthodontic intervention. The course of surgical-orthodontic treatment and the results are presented. This treatment is to be followed by correction of vertical maxillary excess after completion of growth. This paper concludes that the dentoalveolar component of a skeletal deformity can be handled independent of the craniofacial management.

Customized lingual bracket system and skeletal anchorage system for open bite correction

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Toru Inami

2016-01-01

Full Text Available We treated a female patient with open bite and high-angle Class II Division 2 malocclusion using fully customized lingual appliances, orthodontic anchor screws (OAS, and a skeletal anchorage system (SAS. By carefully controlling torque, anchorage, and vertical skeletal and dental factors, we were able to obtain proper anterior coupling. Even after the retention phase of treatment, the occlusion was maintained, indicating that we provided proper treatment according to the properly designed treatment plan. This also indicates that cases with an extremely high level of difficulty, as in the present case with high-angle retrognathic mandible and open bite, can be treated by combining the Incognito appliance (a fully customized lingual bracket appliance with a SAS and OAS.

Bilateral sagittal split osteotomy: Surgery first approach for correction of skeletal Class II

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Revathi Peddu

2018-01-01

Full Text Available Most of the skeletal malocclusions which require orthognathic surgeries are treated by traditional approach which requires time-consuming and unesthetic presurgical orthodontic phase. Surgery first approach (SFA avoids these disadvantages of the traditional approach. A 24-year-old female patient with skeletal and dental class II malocclusion due to retrognathic mandible was treated with SFA. Bilateral sagittal split osteotomy with mandibular advancement was done immediately after initial alignment and closure of the existing spaces in the maxillary arch. Angle's class I molar and canine relation was achieved after surgery. Bonding of the mandibular arch was done after 1 month of orthognathic surgery and treatment was completed within 13 months. A wrap-around retainer was placed in upper arch, and bonded lingual retainer was given in the lower arch.

Fixed-functional appliance treatment combined with growth hormone therapy.

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Jung, Min-Ho

2017-09-01

The purpose of this study was to illustrate the effects of growth hormone (GH) therapy and fixed functional appliance treatment in a 13-year-old Class II malocclusion patient without GH deficiency. GH has been shown to effectively increase endochondral growth and induce a more prognathic skeletal pattern. Although a major concern in Class II retrognathic patients is chin deficiency, long-term studies have shown that the mandibular growth enhancement effects of functional appliances are clinically insignificant. This case report demonstrates that the mandible grew significantly during fixed functional appliance treatment combined with GH therapy, with stable results during 2 years 11 months of retention. More studies are needed to evaluate GH therapy as a supplement in Class II treatment. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Changes in soft tissue profile using functional appliances in the treatment of skeletal class II malocclusion

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Stamenković Zorana

2015-01-01

Full Text Available Introduction. The effects of orthodontic treatment are considered to be successful if the facial harmony is achieved, while the structures of soft tissue profile are in harmony with skeletal structures of neurocranium and viscerocranium. In patients with skeletal distal bite caused by mandibular retrognathism, facial esthetics is disturbed often, in terms of pronounced convexity of the profile and change in the position and relationship of the lips. Objective. The aim of this study was to determine the extent of soft tissue profile changes in patients with skeletal Class II malocclusion treated with three different orthodontic appliances: Fränkel functional regulator type I (FR-I, Balters’ Bionator type I and Hotz appliance. Methods. The study included 60 patients diagnosed with skeletal Class II malocclusion caused by mandibular retrognathism, in the period of early mixed dentition. Each subgroup of 20 patients was treated with a variety of orthodontic appliances. On the lateral cephalogram, before and after treatment, the following parameters were analyzed: T angle, H angle, the height of the upper lip, the position of the upper and lower lip in relation to the esthetic line. Within the statistical analysis the mean, maximum, minimum, standard deviation, coefficient of variation, two-factor analysis of variance with repeated measures and the factor analysis of variance were calculated using ANOVA, Bonferroni test and Student’s t-test. Results. A significant decrease of angles T and H was noticed in the application of FR-I, from 21.60° to 17.15°, and from 16.45° to 13.40° (p<0.001. FR-I decreased the height of the upper lip from 26.15 mm to 25.85 mm, while Hotz appliance and Balters’ Bionator type I increased the height of the upper lip, thereby deteriorating esthetics of the patient. Conclusion. All used orthodontic appliances lead to changes in soft tissue profile in terms of improving facial esthetics, with the most distinctive

Growth-related changes of skeletal and upper-airway features in bilateral cleft lip and palate patients.

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Akarsu-Guven, Bengisu; Karakaya, Jale; Ozgur, Figen; Aksu, Muge

2015-10-01

The craniofacial morphology of subjects with cleft lip and palate differs from that of subjects without clefts. Subjects with bilateral cleft lip and palate tend to have maxillary retrognathism, a smaller mandible with an obtuse gonial angle, greater anterior upper and lower facial heights, and retroclined maxillary incisors. The purposes of this research were to compare the skeletal and upper-airway features of subjects with bilateral cleft lip and palate with the same features in control subjects without clefts and to determine the growth-related changes at different growth stages. The sample comprised 212 subjects divided into 2 groups: 68 with bilateral cleft lip and palate, and 144 controls without clefts; each group was further divided into 4 subgroups according to growth stage using the cervical vertebral maturation stage method. The subgroups were defined as early childhood (stage 1), prepubertal (stage 2), pubertal (stage 3), and postpubertal (stage 4). The cephalometric variables were evaluated with 2-way analysis of variance and the Bonferroni test. Maxillary position showed no significant differences between the male groups. The maxilla was more prognathic at stage 2 and became more retrognathic at stages 3 and 4 in the females. The mandible was more retrusive in the bilateral cleft lip and palate subjects at stage 1 in males and at stages 3 and 4 in females. ANB was larger at stages 1 and 2, and it became similar to the controls at stages 3 and 4 in male and female bilateral cleft lip and palate subjects. Vertical growth was seen in the bilateral cleft lip and palate subjects regardless of sex, and no change was observed with age. Posterior airway space was narrower in all stages (except for stage 1 in females). Middle airway space was wider after stage 1 in the male and female bilateral cleft lip and palate subjects. Inferior airway space was narrower in the male bilateral cleft lip and palate patients at the early childhood and pubertal stages. Age

PENGGUNAAN FACE-MASK & EKSPANSI PALATAL PADA PERAWATAN MALOKLUSI KLAS III (Studi Pustaka

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Krisnawati Krisnawati

2015-08-01

Full Text Available Class III skeletal anomaly is one of the most difficult malocclusions to correct in orthodontics. Orthodontist usually involved chincup appliances to restrain mandibular growth, camouflage techniques to advances maxillary incisors and retract mandibular incisors or waiting untul growth ceased to pursue orthognathic surgery. Many studies found that most of Class III malocclusions were characterized by maxillary retrognathism. In the late 1960s, the Delaire mask was popularized to protract the maxilla. The development of maxillary protraction with facemask and palatal expansion have provided a predictable and effective approach to managing treatment that was once considered difficult. Although no significant difference was found between early or late treatment group, the effect of improvement in facial aesthetics on psychosocial development resulted in a significant advantage for early treatment. However, the effects of face mask therapy should be evaluated over the long term in order to determine the relaps tendency.

Open reduction and internal fixation of dislocated condylar fractures in children: long-term clinical and radiologic outcomes.

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Deleyiannis, Frederic W-B; Vecchione, Lisa; Martin, Brian; Jiang, Shao; Sotereanos, George

2006-11-01

The purpose of this study was to investigate the long-term clinical and radiologic outcomes of treating dislocated condylar fractures sustained in childhood with open reduction and internal fixation (ORIF). Six children 14 years or younger with a condylar neck or subcondylar fracture with dislocation of the condyle from the glenoid fossa were treated with ORIF. Patients were followed for 27 to 92 months post-ORIF (mean: 67.6 months) with routine clinical and radiologic examinations. On the dislocated side, all patients radiographically showed signs of remodeling of the condylar process and shortening of the ramus. Subsequent to their fractures, 3 patients were classified with Angle class II malocclusion, retrognathism, and deviation of the mandibular symphysis. Four patients had objective and/or subjective signs of temporomandibular (TMJ) dysfunction. Until open surgery demonstrates a consistent functional advantage, nonsurgical management should be considered the first treatment option for the dislocated pediatric condylar fracture.

Obstructive sleep apnea syndrome in a pubescent boy of short stature was improved with an orthodontic mandibular advancement oral appliance: a case report.

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Ito, Shin; Otake, Hironao; Tsuiki, Satoru; Miyao, Etsuko; Noda, Akiko

2015-01-15

We report a 16-year-old pubescent pediatric patient with obstructive sleep apnea syndrome (OSAS) and short stature whose apnea hypopnea index (AHI) was significantly reduced following the use of an orthodontic oral appliance that advances the mandible ventrally. The mandible was advanced 64% of the maximal mandibular protrusive position with use of the appliance over a 3-year period. The patient's AHI without the appliance in place decreased from 101.6/h at baseline to 11/h after treatment. Moreover, the patient's height increased 14 cm during treatment, resulting in height close to the average height for his age. Cephalometric analysis revealed an improvement in his retrognathic mandible and proclination of the upper front teeth. In conclusion, an orthodontic mandibular advancement oral appliance played an important role not only in improving the patient's OSAS but also in normalizing his physical growth during puberty. © 2015 American Academy of Sleep Medicine.

A new modified tandem appliance for management of developing Class III malocclusion

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Ram Sukh

2013-01-01

Full Text Available Most developing Class III patients display a retruded maxilla. Early intervention in mixed dentition is associated with better patient compliance and possibly a better orthopedic response, which can produce favorable results. The aim of this article is to present the fabrication of the new modified tandem appliance and its use in management of developing Class III malocclusion. The therapeutic results of a new modified tandem appliance are presented in an 8 year-old male patient with anterior cross bite and retrognathic maxilla at the mixed dentition stage. Anterior cross bite was corrected in 3 months and the positive overjet of 4 mm after continued use of the appliance for 1 year. There was a significant improvement in profile of the patient. The use of this appliance in this type of malocclusion enabled the correction of malocclusion in a few months and encouraging favorable skeletal growth in the future.

A new modified tandem appliance for management of developing Class III malocclusion.

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Sukh, Ram; Singh, Gyan P; Tandon, Pradeep

2013-10-01

Most developing Class III patients display a retruded maxilla. Early intervention in mixed dentition is associated with better patient compliance and possibly a better orthopedic response, which can produce favorable results. The aim of this article is to present the fabrication of the new modified tandem appliance and its use in management of developing Class III malocclusion. The therapeutic results of a new modified tandem appliance are presented in an 8 year-old male patient with anterior cross bite and retrognathic maxilla at the mixed dentition stage. Anterior cross bite was corrected in 3 months and the positive overjet of 4 mm after continued use of the appliance for 1 year. There was a significant improvement in profile of the patient. The use of this appliance in this type of malocclusion enabled the correction of malocclusion in a few months and encouraging favorable skeletal growth in the future.

Camouflage of Severe Skeletal Class II Gummy Smile Patient Treated Nonsurgically with Mini Implants

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Irfan Qamruddin

2014-01-01

Full Text Available Skeletal class II has always been a challenge in orthodontics and often needs assistance of surgical orthodontics in nongrowing patients when it presents with severe discrepancy. Difficulty increases more when vertical dysplasia is also associated with sagittal discrepancy. The advent of mini implants in orthodontics has broadened the spectrum of camouflage treatment. This case report presents a 16-year-old nongrowing girl with severe class II because of retrognathic mandible, and anterior dentoalveolar protrusion sagittally and vertically resulted in severe overjet of 13 mm and excessive display of incisors and gums. Both maxillary central incisors were trimmed by general practitioner few years back to reduce visibility. Treatment involved use of micro implant for retraction and intrusion of anterior maxillary dentoalveolar segment while lower incisors were proclined to obtain normal overjet, and overbite and pleasing soft tissue profile. Smile esthetics was further improved with composite restoration of incisal edges of both central incisors.

Multidisciplinary treatment approach in Treacher Collins syndrome.

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Hylton, Joseph B; Leon-Salazar, Vladimir; Anderson, Gary C; De Felippe, Nanci L O

2012-01-01

Treacher Collins syndrome (TCS) is a common genetic disorder with high penetrance and phenotypic variability. First and second branchial arches are affected in TCS, resulting in craniofacial and intraoral anomalies such as: severe convex facial profile; mid-face hypoplasia; microtia; eyelid colobomas; mandibular retrognathism; cleft palate; dental hypoplasia; heterotopic teeth; maxillary transverse hypoplasia; anterior open bite; and Angle Class II molar relationship. A high incidence of caries is also a typical finding in TCS patients. Nonetheless, even simple dental restorative procedures can be challenging in this patient population due to other associated medical conditions, such as: congenital heart defects; decreased oropharyngeal airways; hearing loss; and anxiety toward treatment. These patients often require a multidisciplinary treatment approach, including: audiology; speech and language pathology; otorhinolaryngology; general dentistry; orthodontics; oral and maxillofacial surgery; and plastic and reconstructive surgeries to improve facial appearance. This paper's purpose was to present a current understanding of Treacher Collins syndrome etiology, phenotype, and current treatment approaches.

Successful treatment of Class II malocclusion with bidental protrusion using standard edgewise prescription

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Mohd Ayaz

2016-01-01

Full Text Available This case report deals with the successful orthodontic treatment of a 14-year-old female patient having Class II malocclusion with bidental protrusion using standard edgewise prescription. She reported with forwardly placed upper front teeth and difficulty in closing lips. She had prognathic maxilla, retrognathic mandible, and full cusp Class II molar and canine relation bilaterally with overjet of 7 mm. She was in cervical vertebrae maturation indicator Stage IV. The case was treated by fixed extraction mechanotherapy. Interarch Class II mechanics was used to retract the upper incisor and to mesialize the lower molars. Simultaneously, Class I mechanics was used to upright lower incisors. Tip back bend, curve of Spee, and extra palatal root torque were incorporated in upper archwire to maintain molars in upright position and prevent extrusion and deepening of bite, respectively. There was satisfactory improvement in facial profile at the end of 24 months. After a follow-up of 6 months, occlusion was stable.

Early treatment of Class III malocclusion with a tandem traction bow appliance

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Sneha Basaveshwar Valgadde

2016-01-01

Full Text Available Since Class III malocclusion is progressive in nature, the facial growth of Class III malocclusion worsens with age. Class III malocclusion is associated with a deviation in the sagittal relationship of the maxilla and the mandible, characterized by a deficient maxilla, retrognathic mandible, or a combination of both. The early orthopedic treatment of Class III malocclusions, at the end of primary dentition or the beginning of mixed dentition, prior to growth spurt, allows the accomplishment of successful results, providing facial balance, modifying the maxillofacial growth and development, and in many instances, preventing a future surgical treatment by increasing the stability. Many treatment approaches can be found in the literature regarding orthopedic and orthodontic treatment of Class III malocclusion, including intra- and extra-oral appliances. The major problem with extraoral anchorage has been of patient compliance due to its physical appearance. The case report presents an intraoral modified tandem appliance for maxillary protraction that has been used clinically to achieve successful results without relying much on patient co-operation.

Cephalometric aspects of thalassemic children in the Indian subcontinent: A cross-sectional study

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Amit Anand Samba

2018-01-01

Full Text Available Objectives: To compare the cephalometric characteristics of thalassemic children in the Indian subcontinent with the controls, matched for sex and dental age. Methodology: A total of 31 thalassemic children were a part of the study. Cephalometric readings were recorded for the study and the control group. Results: Within the Group I stage, the anterior cranial base length was 68.40±2.93 mm, shorter when compared to the control group. In the Group II stage, the maxillary/mandibular angle was 31.58° for the case group and the mandibular length was shorter in comparison to the controls. In the Group III stage, the SNB angle was 76.42°, lesser than the control group. A relative maxillary prognathism of 9.88 mm and 12.85 mm was observed in thalassemic males and females respectively through the Wiley's analysis. Conclusion: The overall picture depicted a retruded position of the maxilla and a retrognathic mandible within the study group. A class II profile has also been observed among the study subjects.

Maxillary molar distalization with first class appliance.

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Ramesh, Namitha; Palukunnu, Biswas; Ravindran, Nidhi; Nair, Preeti P

2014-02-27

Non-extraction treatment has gained popularity for corrections of mild-to-moderate class II malocclusion over the past few decades. The distalization of maxillary molars is of significant value for treatment of cases with minimal arch discrepancy and mild class II molar relation associated with a normal mandibular arch and acceptable profile. This paper describes our experience with a 16-year-old female patient who reported with irregularly placed upper front teeth and unpleasant smile. The patient was diagnosed to have angles class II malocclusion with moderate maxillary anterior crowding, deep bite of 4 mm on a skeletal class II base with an orthognathic maxilla and retrognathic mandible and normal growth pattern. She presented an ideal profile and so molar distalization was planned with the first-class appliance. Molars were distalised by 8 mm on the right and left quadrants and class I molar relation achieved within 4 months. The space gained was utilised effectively to align the arch and establish a class I molar and canine relation.

Orthodontic and surgical management of a patient with severe skeletal Class II deformity and facial asymmetry: A case report with a 5-year follow-up.

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Gao, Xiang; Wang, Tao; Song, Jinlin

2017-04-01

In this case report, we present the orthodontic and surgical management of an 18-year-old girl who had a severe craniofacial deformity, including maxillary prognathism, vertical maxillary excess (gummy smile), mandibular retrognathism, receding chin, and facial asymmetry caused by unilateral temporomandibular joint ankylosis. For correction of the facial asymmetry, the patient's right mandibular ramus and body were lengthened via distraction osteogenesis after 5 months of preoperative orthodontic therapy. Subsequently, extraction of 4 first premolars, bimaxillary anterior segmental osteotomy, and genioplasty were simultaneously performed in the second-stage operation to correct the skeletal deformities in the sagittal and vertical planes. Postoperative orthodontic treatment completed the final occlusal adjustment. The total active treatment period lasted approximately 30 months. The clinical results show that the patient's facial esthetics were significantly improved with minimal surgical invasion and distress, and a desirable occlusion was achieved. These pleasing results were maintained during the 5-year follow-up. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Long-term results of surgically-assisted maxillary protraction.

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Nevzatoğlu, Sirin; Küçükkeleş, Nazan

2014-05-01

The long-term treatment results of surgically-assisted facemask therapy were assessed by a comparison of the immediate protraction effects with those seen at five years review. Nine patients treated with a corticotomy-assisted maxillary protraction protocol were recalled five years following protraction. Cephalometric films taken before treatment (T0), immediately after maxillary protraction (T1) and five years after treatment (T2) were compared. The short-term results of surgically-assisted facemask therapy showed significant skeletal and soft tissue changes. After five years, the profile and dental relationships were well maintained and a cephalometric analysis revealed a stable vertical increase but only partially maintained soft tissue changes with loss of sagittal advancement. There was significant upper incisor proclination providing dental camouflage. Patients who are treated with corticotomy-assisted maxillary advancement should be very carefully selected. Assessment criteria include a low mandibular plane angle Class III patients who have severe maxillary retrognathism unable to be treated by conventional orthopaedic correction alone; patients who have almost completed growth and missed the chance of earlier orthopaedic correction, as well as patients who are not willing to accept bimaxillary orthognathic surgery, may be successfully treated.

Prenatal evaluation of the middle ear and diagnosis of middle ear hypoplasia using MRI

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Katorza, Eldad; Nahama-Allouche, Catherine; Ducou le Pointe, Hubert; Garel, Catherine [Hopital d' Enfants Armand-Trousseau, Service de Radiologie, Paris (France); Castaigne, Vanina [Hopital Saint-Antoine, Service de Gynecologie-Obstetrique, Paris (France); Gonzales, Marie; Marlin, Sandrine [Hopital d' Enfants Armand-Trousseau, Service de Genetique et Embryologie medicales, Paris (France); Galliani, Eva [Hopital d' Enfants Armand-Trousseau, Service de Chirurgie maxillo-faciale, Paris (France); Jouannic, Jean-Marie; Rosenblatt, Jonathan [Hopital d' Enfants Armand-Trousseau, Service de Gynecologie-Obstetrique, Centre pluridisciplinaire de diagnostic prenatal, Paris (France)

2011-05-15

Analysis of the middle ear with fetal MRI has not been previously reported. To show the contribution of fetal MRI to middle ear imaging. The tympanic cavity was evaluated in 108 fetal cerebral MRI examinations (facial and/or cerebral malformation excluded) and in two cases, one of Treacher Collins syndrome (case 1) and the other of oculo-auriculo-vertebral (OUV) spectrum (case 2) with middle ear hypoplasia identified by MRI at 27 and 36 weeks' gestation, respectively. In all 108 fetuses (mean gestational age 32.5 weeks), the tympanic cavity and T2 hypointensity related to the ossicles were well visualised on both sides. Case 1 had micro/retrognathia and bilateral external ear deformity and case 2 had retrognathism with a left low-set and deformed ear. MRI made it possible to recognize the marked hypoplasia of the tympanic cavity, which was bilateral in case 1 and unilateral in case 2. Both syndromes are characterized by craniofacial abnormalities including middle ear hypoplasia, which cannot be diagnosed with US. The middle ear cavity can be visualized with fetal MRI. We emphasize the use of this imaging modality in the diagnosis of middle ear hypoplasia. (orig.)

Morphological caracteristics of malocclusion class II

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Pavlović J.

2015-01-01

Full Text Available Class II malocclusion are complex anomalies of the skeletal and dental systems. The aim of this study is that the rengenkefalometrics analysis closer determine the morphological characteristics of this malocclusion. For this study were used 30 patients aged 18-30, previously clinically diagnosed class II, before the planned orthodontic treatment. The results analisis lateral cephalometric radiographs were compared with the 30 patients with class I malocclusion. Analyzed three linear and two angular cranial base dimensions and nine angular and four linear measures from the facial skeleton. The Results show: No statistically significant differensis in cranial base angle (SNBa and anterior cranial base length (S-N between class II and control Class I. Angle maxillar prognathism ( SNA is no signifikant different between class I and Class II but SNB angle were signifikant smaller. The length of maxillary base (A'-SnP is longer and the length of mandibule (Pg'-MT1/MT is signifficantly smaller. The gonial angle (ArGo-Me was smaller with open articular angle (GoArSN. Morphological characteristics of class II malocclusion are , retrognathic and smaller mandibular ligth, normognathic and longer maxilla, open articular angle with vertical tendency of the craniofacial growth pattern.

Multimodality Treatment for Rehabilitation of Adult Orthodontic Patient with Complicated Dental Condition and Jaw Relation

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Yu-Cheng Liaw

2008-11-01

Full Text Available A 50-year-old man with severe malocclusion requested comprehensive oral rehabilitation. He presented with retrognathic mandible, anterior deep bite and a gummy smile in the premaxilla, and tenting occlusal plane with severe buccal crossbite of the left maxillary posterior teeth. Inappropriate fixed prostheses spanned the maxilla and the mandible with a class II jaw relationship. A detailed analysis indicated the need for orthodontic treatment, orthognathic surgery, bone graft at the deficient alveolar ridge for implant surgery and a revision of all prostheses. Over a 2-year-period of management, the patient received anterior osteotomy for intrusion of lower anterior teeth, bilateral sagittal splitting osteotomy for mandible advancement and posterior osteotomy for inward upward repositioning of posterior teeth of the left maxilla to correct major jaw deformities. The deficient alveolar ridge in the premaxilla was augmented by autogenous bone graft harvested during the orthognathic surgery. He sequentially had mini-plate and dental implant as anchorage assisting teeth alignment in the mandible. Two 3-fixture-supported implant prostheses were delivered in the premaxilla and the mandible. The improvement in cosmesis, stability and function through treatment and a 2-year clinical follow-up were considered satisfactory.

Clinical and molecular analysis of the enamelin gene ENAM in Colombian families with autosomal dominant amelogenesis imperfecta

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Sandra Gutiérrez

2012-01-01

Full Text Available In this study, we analyzed the phenotype, clinical characteristics and presence of mutations in the enamelin gene ENAM in five Colombian families with autosomal dominant amelogenesis imperfecta (ADAI. 22 individuals (15 affected and seven unaffected belonging to five Colombian families with ADAI and eight individuals (three affected and five unaffected belonging to three Colombian families with autosomal recessive amelogenesis imperfecta (ARAI that served as controls for molecular alterations and inheritance patterns were studied. Clinical, radiographic and genetic evaluations were done in all individuals. Eight exons and three intron-exon boundaries were sequenced for mutation analysis. Two of the five families with ADAI had the hypoplasic phenotype, two had the hypocalcified phenotype and one had the hypomaturative phenotype. Anterior open bite and mandibular retrognathism were the most frequent skeletal abnormalities in the families with ADAI. No mutations were found. These findings suggest that ADAI in these Colombian families was unrelated to previously described mutations in the ENAM gene. These results also indicate that other regions not included in this investigation, such as the promoter region, introns and other genes should be considered as potential ADAI candidates.

Adaptações do sistema estomatognático em indivíduos com desproporções maxilo-mandibulares: revisão da literatura Adaptations on the stomatognathic system of individuals with maxillomandibular disproportion: literature review

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Tatiana Albuquerque Coutinho

2009-01-01

Full Text Available Esta pesquisa procurou identificar as adaptações do sistema estomatognático em indivíduos com desproporções maxilomandibulares. A revisão bibliográfica se fez por meio das bases de dados nacionais e internacionais, abordando as adaptações do sistema estomatognático em indivíduos com desproporção maxilo-mandibular submetidos a tratamento ortodôntico-cirúrgico (cirurgia ortognática associado à intervenção fonoaudiológica. Observou-se que sujeitos com prognatismo e retrognatismo apresentam adaptações em todas as funções realizadas pelo sistema motor oral, no período pré-cirurgia ortognática. No prognatismo mandibular, a função mais adaptada é a mastigação, caracterizando-se em movimentos verticalizados com utilização do dorso da língua para amassamento do alimento e pouca utilização dos músculos mastigatórios. No retrognatismo mandibular, estudos mostram que a deglutição apresenta-se bastante adaptada, com presença de deslize mandibular anterior somado ao movimento póstero-anterior de língua e com participação da musculatura perioral. Após a cirurgia ortognática, alguns casos podem apresentar adequação das funções do sistema estomatognático, porém em outros persistem as alterações, sendo necessário o conhecimento do fonoaudiólogo sobre as adaptações pré-existentes para traçar o melhor plano de reabilitação.This research had the aim to identify adaptations on the stomatognathic system of individuals with maxillomandibular disproportions. The literature review was carried out using national and international databases, addressing adaptations on the stomatognathic system of subjects with maxillomandibular disproportions submitted to orthognathic surgery associated to speech-language intervention. It was found that subjects with prognathism and retrognathism present adaptations in all oral-motor functions during the presurgical period. In mandibular prognathism, the most adapted function

Generalized epilepsy in a patient with mosaic Turner syndrome: a case report.

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Jhang, Kai-Ming; Chang, Tung-Ming; Chen, Ming; Liu, Chin-San

2014-04-02

Reports on cases of epilepsy in Turner syndrome are rare and most of them have cortical developmental malformations. We report the case of a Taiwanese patient with mosaic Turner syndrome with generalized tonic-clonic epilepsy and asymmetrical lateral ventricles but no apparent cortical anomaly. A 49-year-old Taiwanese woman without family history presented with infrequent generalized tonic-clonic epilepsy since she was 11 years old. On examination, her short stature, webbed neck, swelling of hands and feet, retrognathic face, and mild intellectual disability were noted. She had spontaneous menarche and regular menses. Brain magnetic resonance imaging showed asymmetrical lateral ventricles and diffuse subcortical white matter T2-weighted hyperintensities. Chromosome studies disclosed low aneuploid (10%) 45,X/46,XX/47,XXX mosaic Turner syndrome. There is increasing evidence that epilepsy can be an uncommon presentation of Turner syndrome. Mosaic Turner syndrome with 47, XXX probably increases the risk of epilepsy but more research is needed to reach a conclusion. This case also strengthens our knowledge that Turner syndrome can be one of the pathologic bases of asymmetrical lateral ventricles. When a patient has idiopathic/cryptogenic epilepsy or asymmetrical lateral ventricles on brain images, the presence of a mild Turner phenotype warrants further chromosome studies.

Thin-plate spline analysis of craniofacial morphology in subjects with adenoid or tonsillar hypertrophy.

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Baroni, Michela; Ballanti, Fabiana; Polimeni, Antonella; Franchi, Lorenzo; Cozza, Paola

2011-04-01

To compare the skeletal features of subjects with adenoid hypertrophy with those of children with tonsillar hypertrophy using thin-plate spline (TPS) analysis. A group of 20 subjects (9 girls and 11 boys; mean age 8.4 ± 0.9 years) with adenoid hypertrophy (AG) was compared with a group of 20 subjects (10 girls and 10 boys; mean age 8.2 ± 1.1 years) with tonsillar hypertrophy (TG). Craniofacial morphology was analyzed on the lateral cephalograms of the subjects in both groups by means of TPS analysis. A cross-sectional comparison was performed on both size and shape differences between the two groups. AG exhibited statistically significant shape and size differences in craniofacial configuration with respect to TG. Subjects with adenoid hypertrophy showed an upward dislocation of the anterior region of the maxilla, a more downward/backward position of the anterior region of the mandibular body and an upward/backward displacement of the condylar region. Conversely, subjects with tonsillar hypertrophy showed a downward dislocation of the anterior region of the maxilla, a more upward/forward position of the anterior region of the mandibular body and a downward/forward displacement of the condylar region. Subjects with adenoid hypertrophy exhibited features suggesting a more retrognathic mandible while subjects with tonsillar hypertrophy showed features suggesting a more prognathic mandible. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Long-term follow-up of a patient with achondroplasia treated with an orthodontic approach.

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Mori, Hiroyo; Matsumoto, Kazuma; Kawai, Nobuhiko; Izawa, Takashi; Horiuchi, Shinya; Tanaka, Eiji

2017-04-01

We successfully treated a patient with achondroplasia with conventional orthodontic techniques. It was followed by long-term retention. The patient, a 12-year-old boy, had chief complaints of occlusal disturbance and mandibular protrusion. He had been diagnosed with achondroplasia and had growth hormone treatment in his early teenage years. His facial profile was concave with a bulging forehead and a retrognathic maxilla. It was characterized by a skeletal Class III jaw-base relationship with a retropositioned maxilla. At the age of 12 years 9 months, maxillary protraction was initiated with a reverse headgear; for 2 years 6 months, the maxillomandibular growth was controlled. After the growth spurt, at the age of 15 years 6 months, leveling and alignment of both dental arches were started with preadjusted edgewise appliances. After 83 months of multibracket treatment, an acceptable occlusion with a Class I molar relationship and an adequate interincisal relationship was achieved, despite the simultaneous marked vertical growth of the mandible. The resultant occlusion was stable during a 6-year retention period, although considerable forward-downward mandibular growth was observed. Conclusively, our results indicated the necessity of long-term observation in this patient with achondroplasia, especially because of the persistent mandibular growth. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class II malocclusion: a systematic review and meta-analysis.

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Raposo, R; Peleteiro, B; Paço, M; Pinho, T

2018-04-01

This systematic review was performed to compare dental, skeletal, and aesthetic outcomes between orthodontic camouflage and surgical-orthodontic treatment, in patients with a skeletal class II malocclusion and a retrognathic mandible who have already finished their growth period. A literature search was conducted, and a modified Downs and Black checklist was used to assess methodological quality. The meta-analysis was conducted using the DerSimonian-Laird random-effects method to obtain summary estimates of the standardized mean differences and corresponding 95% confidence intervals. Nine articles were included in the qualitative synthesis and seven in the meta-analysis. The difference between treatments was not statistically significant regarding SNA angle, linear measurement of the lower lip to Ricketts' aesthetic line, convexity of the skeletal profile, or the soft tissue profile excluding the nose. In contrast, surgical-orthodontic treatment was more effective with regard to ANB, SNB, and ML/NSL angles and the soft tissue profile including the nose. Different treatment effects on overjet and overbite were found according to the severity of the initial values. These results should be interpreted with caution, due to the limited number of studies included and because they were non-randomized clinical trials. Further studies with larger sample sizes and similar pre-treatment conditions are needed. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Assessment of pterygomaxillary separation in Le Fort I Osteotomy in class III patients.

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Ueki, Koichiro; Hashiba, Yukari; Marukawa, Kohei; Okabe, Katsuhiko; Alam, Shamiul; Nakagawa, Kiyomasa; Yamamoto, Etsuhide

2009-04-01

To examine the separation of the pterygomaxillary region at the posterior nasal spine level after Le Fort I osteotomy in Class III patients. The study group consisted of 37 Japanese patients with mandibular prognathism and asymmetry, with maxillary retrognathism or asymmetry. A total of 74 sides were examined. Le Fort I osteotomy was performed without a pterygoid osteotome, with an ultrasonic curette used to remove interference at the pterygomaxillary region. Postoperative computed tomography (CT) was analyzed for all patients. The separation of the pterygomaxillary region and the location of the descending palatine artery were assessed. Although acceptable separation between the maxilla and pterygoid plates was achieved in all patients, an exact separation of the pterygomaxillary junction at the posterior nasal spine level was found in only 18 of 74 sides (24%). In 29 of 74 sides (39.2%), the separation occurred anterior to the descending palatine artery. In 29 of 74 sides (39.2%), complete separation between the maxilla and lateral and/or medial pterygoid plate was not achieved, but lower level separation of the maxilla and pterygoid plate was always complete. The maxillary segments could be moved to the postoperative ideal position in all cases. Le Fort I osteotomy without an osteotome does not always induce an exact separation at the pterygomaxillary junction at the posterior nasal spine level, but the ultrasonic bone curette can remove the interference between maxillary segment and pterygoid plates more safely.

Determining the anatomy of the descending palatine artery and pterygoid plates with computed tomography in Class III patients.

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Ueki, Koichiro; Hashiba, Yukari; Marukawa, Kohei; Nakagawa, Kiyomasa; Okabe, Katsuhiko; Yamamoto, Etsuhide

2009-12-01

Understanding the anatomy of the pterygomaxillary junction region helps prevent blood loss in Le Fort I osteotomy. Here, we determined the location of the descending palatine artery and the structure of the pterygomaxillary region. The study group consisted of 82 Japanese patients with mandibular prognathism and asymmetry, with and without maxillary retrognathism or asymmetry. A total of 164 sides were measured and divided into right versus left, men versus women, and bimaxillary osteotomy (B) versus mandibular osteotomy (S). Lateral and frontal cephalograms and computed tomography (CT) were analysed for all patients. The relationship between the cephalometric measurements and the measurements of the descending palatine artery and pterygoid plate (PP) were assessed. There were no significant correlations between measurements of cephalograms and those of the descending palatine artery and PPs. There were significant differences between right and left in lateral plate length (p=0.0014) and thickness of PP (p=0.0047). There were significant differences between men and women in right width of PP (p=0.0034), right thickness of PP (p=0.0063), left posterior length (p=0.0196), and left thickness of PP (p=0.0279). The B group had a shorter anterior length than the S group (right: ppalatine artery and the morphology of the PPs were not significantly associated with any cephalometric measurements. CT examination is necessary to recognize the anatomy of pterygomaxillary region and the exact positions of descending palatine artery before Le Fort I osteotomy.

TMJ response to mandibular advancement surgery: an overview of risk factors

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VALLADARES-NETO, José; CEVIDANES, Lucia Helena; ROCHA, Wesley Cabral; ALMEIDA, Guilherme de Araújo; de PAIVA, João Batista; RINO-NETO, José

2014-01-01

Objective In order to understand the conflicting information on temporomandibular joint (TMJ) pathophysiologic responses after mandibular advancement surgery, an overview of the literature was proposed with a focus on certain risk factors. Methods A literature search was carried out in the Cochrane, PubMed, Scopus and Web of Science databases in the period from January 1980 through March 2013. Various combinations of keywords related to TMJ changes [disc displacement, arthralgia, condylar resorption (CR)] and aspects of surgical intervention (fixation technique, amount of advancement) were used. A hand search of these papers was also carried out to identify additional articles. Results A total of 148 articles were considered for this overview and, although methodological troubles were common, this review identified relevant findings which the practitioner can take into consideration during treatment planning: 1- Surgery was unable to influence TMJ with preexisting displaced disc and crepitus; 2- Clicking and arthralgia were not predictable after surgery, although there was greater likelihood of improvement rather than deterioration; 3- The amount of mandibular advancement and counterclockwise rotation, and the rigidity of the fixation technique seemed to influence TMJ position and health; 4- The risk of CR increased, especially in identified high-risk cases. Conclusions Young adult females with mandibular retrognathism and increased mandibular plane angle are susceptible to painful TMJ, and are subject to less improvement after surgery and prone to CR. Furthermore, thorough evidenced-based studies are required to understand the response of the TMJ after mandibular advancement surgery. PMID:24626243

Radiological evaluation of the fetal face using three-dimensional ultrasound imaging

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Bäumler M

2012-12-01

Full Text Available Marcel Bäumler,1–3 Michèle Bigorre,1,4 Jean-Michel Faure1,51CHU Montpellier, Centre de Compétence des Fentes Faciales, Hôpital Lapeyronie, Montpellier, 2Clinique du Parc, Imagerie de la Femme, Castelnau-le-Lez, 3Cabinet de Radiologie du Trident, Lunel, 4CHU Service de Chirurgie Plastique Pédiatrique, Hôpital Lapeyronie, Montpellier, 5CHU Montpellier, Service de Gynécologie-Obstétrique, Hôpital Arnaud de Villeneuve, Montpellier, FranceAbstract: This paper reviews screening and three-dimensional diagnostic ultrasound imaging of the fetal face. The different techniques available for analyzing biometric and morphological items of the profile, eyes, ears, lips, and hard and soft palate are commented on and briefly compared with the respective bi-dimensional techniques. The available literature supports the use of three-dimensional ultrasound in difficult prenatal diagnostic conditions because of its diagnostic accuracy, enabling improved safety of perinatal care. Globally, a marked increase has been observed in the accuracy of three-dimensional ultrasound in comparison with the bi-dimensional approach. Because there is no consensus about the performance of the different three-dimensional techniques, future studies are needed in order to compare them and to find the best technique for analysis of each of the respective facial elements. Universal prenatal standards may integrate these potential new findings in the future. At this time, the existing guidelines for prenatal facial screening should not be changed.Keywords: prenatal three-dimensional ultrasound, prenatal screening, prenatal diagnosis, cleft lip and palate, fetal profile, retrognathism

[Cephalometric analysis in individuals with Class II/2 malocclusions].

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Rak, D

1990-06-01

Various orthodontic anomalies class II/2, classified into several experimental groups, and eugnathic occlusion serving as controls, were studied by roentgencephalometry. The objective of the study was to detect possible distinctions in the quantitative values of the chosen variables and to select those which discriminate the group of class II/2 orthodontic anomalies most significantly. Attempts were made to ascertain whether or not there were sex-related differences. The teleroentgenograma of 241 examines, aged 10 to 18 years, of both sexes, were analyzed. The experimental group consisted of 61 examinees class II/2 orthodontic anomalies. The control group consisted of 180 examinees with eugnathic occlusion. Latero-lateral skull roentgenograms were taken according to the rules of roentgencephalometry. Using acetate paper, the drawings of profile teleroentgenograms were elaborated and the reference points and lineas were entered. A total of 38 variables were analyzed, of which 10 were linear, 19 angular, 8 variables were obtained by mathematical calculations, and the age variable was also analyzed. For statistical analyses and electronic computer was used. The results are presented in tables and graphs. The results obtained have shown: that, when compared to the findings in the control group, the subjects in the experimental groups manifested significant changes in the following craniofacial characteristics: retroposition and retroinclination of the upper incisors; increased difference of the position of the apical basis of the jaw; marked convexity of the osseous profile; mandibular retrognathism and increased proportion of the maxillary compared to mandibular base; that, with regard to the sex of the examines, only linear variables of significantly discriminating character were selected. Thus it could be concluded that there were no significant sex differences among the morphological characteristics of the viscerocranium.

Three-Dimensional Reconstruction of Post-Traumatic Deficient Anterior Maxilla.

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Rachmiel, Adi; Shilo, Dekel; Aizenbud, Dror; Pen, Mark; Rachmiel, Dana; Emodi, Omri

2017-12-01

Maxillary retrognathism appears in 14.3% of patients exhibiting malocclusion after trauma treatment. This report describes the application of alveolar distraction osteogenesis (ADO) for treating the severely deficient anterior maxilla after trauma injuries in the vertical and anteroposterior planes. This is a retrospective study of patients exhibiting severe vertical and anteroposterior maxillary bone deficiency after trauma injuries and treated by ADO as a first stage with additional Le Fort I advancement when required. Predictor variables included ADO for alveolar augmentation and Le Fort I advancement for anteroposterior discrepancy after ADO. Outcome variables included dental implant failure and anteroposterior maxillary relations. Twelve patients with severe atrophic anterior maxilla secondary to trauma injuries were included and treated using ADO. In accordance to the size of the horizontal deficiency, 1 or 2 distractors were used. Vertical alveolar distraction was performed and the transported segments were elongated at a rate of 0.5 mm/day to a mean total of 13.9 mm (12 to 15 mm). In 4 of 12 cases, there was a severe anteroposterior discrepancy larger than 8 mm that could not be fully corrected using an anterior inclination during the vertical elongation. Therefore, a second stage of conventional Le Fort I advancement was performed. Thirty-eight dental implants were inserted, with a survival rate of 97.37% (median follow-up, 6.2 yr). This report describes treatment of the deficient anterior maxilla after trauma injuries in the vertical and anteroposterior planes, including implant-based dental rehabilitation. The main advantages include simultaneous bone and mucosa augmentation, no donor site morbidity, considerably higher vertical augmentation compared with other methods, and minimal relapse. Using an additional Le Fort I advancement in severe cases permits a useful method for proper repositioning of the maxilla, thus resulting in superior

Does Orthognathic Surgery Cause or Cure Temporomandibular Disorders? A Systematic Review and Meta-Analysis.

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Al-Moraissi, Essam Ahmed; Wolford, Larry M; Perez, Daniel; Laskin, Daniel M; Ellis, Edward

2017-09-01

There is still controversy about whether orthognathic surgery negatively or positively affects temporomandibular disorders (TMDs). The purpose of this study was to determine whether orthognathic surgery has a beneficial or deleterious effect on pre-existing TMDs. A systematic review and meta-analysis were conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched 3 major databases to locate all pertinent articles published from 1980 to March 2016. All subjects in the various studies were stratified a priori into 9 categories based on subdiagnoses of TMDs. The predictor variables were those patients with pre-existing TMDs who underwent orthognathic surgery in various subgroups. The outcome variables were maximal mouth opening and signs and symptoms of a TMD before and after orthognathic surgery based on the type of osteotomy. The meta-analysis was performed using Comprehensive Meta-Analysis software (Biostat, Englewood, NJ). A total of 5,029 patients enrolled in 29 studies were included in this meta-analysis. There was a significant reduction in TMDs in patients with a retrognathic mandible after bilateral sagittal split osteotomy (BSSO) (P = .014), but no significant difference after bimaxillary surgery (BSSO and Le Fort I osteotomy) (P = .336). There was a significant difference in patients with prognathism after isolated BSSO or intraoral vertical ramus osteotomy and after combined BSSO and Le Fort I osteotomy (P = .001), but no significant difference after BSSO (P = .424) or bimaxillary surgery (intraoral vertical ramus osteotomy and Le Fort I osteotomy) (P = .728). Orthognathic surgery caused a decrease in TMD symptoms for many patients who had symptoms before surgery, but it created symptoms in a smaller group of patients who were asymptomatic before surgery. The presence of presurgical TMD symptoms or the type of jaw deformity did not identify which patients' TMDs would improve, remain the

Indication for and frequency of early orthodontic therapy or interceptive measures.

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Schopf, Peter

2003-05-01

The early treatment of nonskeletal and skeletal orthodontic anomalies in the deciduous and early mixed dentition is intended to prevent the development of pronounced anomalies in the late mixed and permanent dentition with the ultimate aim of reducing or even eliminating the need for later orthodontic treatment. There is a general consensus in the international literature that early therapy is indicated in cases of anterior and lateral crossbite and Class III malocclusion, and possibly for extreme forms of mandibular retrognathism (overjet > or =10 mm) and of open bite. However, evidence of the efficiency of early orthodontic measures is just as rare as studies providing serviceable information on the incidence of tooth malalignments and malocclusions in the deciduous and early mixed dentition, some of whose findings are in any case highly divergent. This makes it substantially more difficult to draw conclusions on the extent to which early orthodontic therapy may be indicated. In order to obtain information on the incidence of nonskeletal and skeletal orthodontic problems constituting a treatment need, 2326 first-year schoolchildren aged between 6 and 7 years were examined in Frankfurt am Main and in the Rural District of Offenbach. In only 14.7% of the children were no relevant orthodontic findings recorded. 77.2% displayed mild to severe dysgnathic symptoms, though without early orthodontic therapy being considered indicated. Treatment with orthodontic appliances was considered urgent for 187 of the children (8.04%). With 8.3% and 7.9% respectively, lateral and anterior crossbite were top of the list of anomalies with an urgent treatment need. Among the patients with lateral crossbite, the prognostically less favorable unilateral form was recorded approximately four times more often than the bilateral form. Markedly increased sagittal overjet > or =10 mm) was registered in only 1.4% of the children, and negative overjet (Class III) (with the exception of edge

Cephalometric analysis of the middle part of the face in patients with mandibular prognathism.

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Cutović Tatjana; Jović, Nebojsa; Kozomara, Ruzica; Radojicić, Julija; Janosević, Mirjana; Mladenović, Irena; Matijević, Stevo

2014-11-01

compared to the control group, whereas SnaSnp was significantly smaller in patients with convergent facial type of mandibular prognathism compared to the control group. Additionally, there was a pronounced incisor dentoalveolar compensation of skeletal discrepancy in both groups of patients with mandibular prognathism manifested in the form of a significant upper front teeth protrusion, but without significant differences among the groups, while the maxillary retrognathism was present in most patients of both experimental groups. A pronounced UGPP was found only in the patients with divergent type of mandibular prognathism. The maxilla is certainly one of the key factors which contributes to making the diagnosis, but primarily to making a plan for mandibular prognathism treatment Accurate assessment of the manifestation of abnormality, localization of skeletal problems and understanding of the biological potential are key factors of the stability of/the results of surgical-orthodontic treatment of this abnormality.

Cephalometric analysis of the middle part of the face in patients with mandibular prognathism

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Čutović Tatjana

2014-01-01

patients with divergent facial type of mandibular prognathism compared to the control group, whereas SnaSnp was significantly smaller in patients with convergent facial type of mandibular prognathism compared to the control group. Additionally, there was a pronounced incisor dentoalveolar compensation of skeletal discrepancy in both groups of patients with mandibular prognathism manifested in the form of a significant upper front teeth protrusion, but without significant differences among the groups, while the maxillary retrognathism was present in most patients of both experimental groups. A pronounced UGPP was found only in the patients with divergent type of mandibular prognathism. Conclusion. The maxilla is certainly one of the key factors which contributes to making the diagnosis, but primarily to making a plan for mandibular prognathism treatment. Accurate assessment of the manifestation of abnormality, localization of skeletal problems and understanding of the biological potential are key factors of the stability of the results of surgical-orthodontic treatment of this abnormality.

Avaliação das alterações do plano oclusal em telerradiografias em norma lateral no tratamento de más oclusões de Classe II, 1ª divisão, com Bionator de Balters, em pacientes retrovertidos, neutrovertidos e provertidos Evaluation of occlusal plane changes in retroverted, neutroverted and proverted patients, with Class II, division 1, malocclusion treated with Balters' Bionator

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Ingrid Madeira de Barros Nunes

2007-01-01

Full Text Available OBJETIVO: este trabalho objetiva verificar as alterações do plano oclusal funcional de Ricketts, utilizando as variáveis que orientam este plano nas análises cefalométricas de Ricketts e Schawrz-Faltin, em pacientes portadores de má oclusão de Classe II de Angle, 1ª divisão, associada ao retrognatismo mandibular, cuja terapêutica indicada tenha sido a Bionatorterapia. METODOLOGIA: a amostra coletada neste estudo retrospectivo consta de 128 telerradiografias em norma lateral de 64 indivíduos retrovertidos, neutrovertidos e provertidos, de ambos os gêneros, no estágio de desenvolvimento da oclusão em fase mista ou permanente jovem. A faixa etária dos indivíduos selecionados para o estudo variou entre 7 anos e 1 mês a 13 anos e 2 meses no momento T1, sendo a média inicial de 10 anos de idade. A média de duração do tratamento foi de 19,7 meses. RESULTADOS E CONCLUSÃO: os resultados mostraram comportamentos distintos do plano oclusal, conforme o tipo facial retrovertido, neutrovertido ou provertido. O controle do plano oclusal na Bionatorterapia, pelo manejo do Bionator conforme o tipo facial de cada paciente, por meio de desgastes seletivos no acrílico e conseqüente erupção diferenciada dos dentes, pode influenciar favoravelmente o crescimento geral da face em cada tipo facial.AIM: This work aims to verify the changes of Ricketts functional occlusal plane making use of variables which guide this same plane in the cephalometric analysis of Ricketts and Schwarz-Faltin among patients with Class II, division 1 malocclusion, associated to mandible retrognathism, whose therapy indicated has been Bionatortherapy. METHODS: The sample collected in this retrospective survey has 128 lateral cephalograms of 64 retroverted, neutroverted and proverted individuals, of both genders, at the stage of developing occlusion, either in mixed phase or permanent young. The age scale of individuals selected by the survey goes from 7 years and 1

Características cefalométricas do padrão face longa Cephalometric characteristics assessment of long face pattern

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Mauricio de Almeida Cardoso

2005-04-01

and posterior facial heights, maxillary-mandibular relationship, as well as apical bases relationship and dental characteristics. In short, long face pattern individuals presented a large number of deviations compared to Class I pattern individuals, dysplasia being due to a disproportion among vertical components. It was observed that the values of variables TAFH, LAFH, TAFHperp, LAFHperp, 1-PP, 6-PP, 1-MP, SNB, ANB, goniac angle, mandibular plane angle, and the proportions among the facial heights were significantly altered in long face pattern individuals. Based on the results obtained from the present study, it has been verified that those individuals were characterized by the vertical growth pattern and by an increase of anterior and inferior facial height, the deformity being located below the palatal plane. It was also possible to verify a maxillary and mandibular retrognathism, as well as the presence of anterior (upper and lower and posterosuperior dental extrusion, with apical incisors in apical base, and linguoclinated lower incisors.