Survey on Condition and Orthodontic Treatment of Maxillary Lateral Incisors in Patients with Cleft Lip and Palate.

The aim of this study was to investigate the condition of the maxillary lateral incisors and evaluate the methods used for cleft closure in patients with cleft lip and palate, including the treatment of the maxillary lateral incisors. A total of 214 patients (260 clefts) with alveolar clefts who had started Phase II treatment and entered the maintenance period at the Department of Orthodontics at Tokyo Dental College, Chiba Hospital, between 1975 and 2014 were included. Panoramic, intraoral, and occlusal radiographs, as well as intraoral photographs and medical records, were used to investigate cleft classification, the presence or absence and location of maxillary lateral incisors, and frequency and treatment method for peg lateral incisors in the cleft region. There were more unilateral cleft cases (78.5%) than bilateral cleft cases. The prevalence of congenital absence of the maxillary lateral incisors was similar between unilateral (53.0%) and bilateral cases (53.3%). Peg laterals occurred frequently, with 89.9% occurring in unilateral cases. The maxillary lateral incisors were more commonly found in the secondary than in the primary palate. The number of non-extraction cases was larger than that of extraction cases, regardless of cleft type or the location of the peg laterals. In many cases, the peg laterals were treated with non-extraction and space closure or crown modification. These results suggest that, depending on their condition, the peg laterals should be preserved as much as possible in devising a treatment plan.

Demographics of Postgraduate Training Course at Tokyo Dental College Department of Orthodontics and Alumni Working Trends.

The postgraduate training course at the Department of Orthodontics of Tokyo Dental College, which started in April 1975, comprises a 3-year curriculum aimed at fostering orthodontic specialists. A system of Accreditation for Orthodontists was introduced by the Japan Orthodontic Society in 1990, since which time, this postgraduate training course has also sought to provide the basic training required to obtain such certification. The purpose of this study was to investigate the demographics of the students on this course and the current work status of its graduates by means of a questionnaire-based survey. The results revealed that, when the fortieth intake of students graduated in March 2017, the total number completing the course had reached 326. The annual mean number of students on this course was 8.2, and recent years have seen a marked increase in the number of women enrolling. In total, 37.5% of the questionnaire respondents had opened orthodontic clinics; 14.8% had opened general dentistry clinics; and 42.6% were working as employees. In addition, 46.2% had an additional place of employment other than their principal place of employment, mainly at a general dentistry clinic. Regarding the field of treatment, 82.4% provided solely orthodontic treatment. We believe that this may because all the responders had completed the postgraduate orthodontics course. The rate of earning accreditation as an orthodontist was high (82.4%), with no difference in the rate of acquisition between men and women. The rate of qualification as a Board-certified orthodontist was 17.9%, with the rate of acquisition by women approximately half of that by men. The number of female orthodontists is rising, and no difference was observed between sexes in the rate of acquiring accreditation as an orthodontist. Women were found to be lagging behind men, however, in regard to the rate of advancement to masters/PHD programs; qualifying as a Board-certified orthodontist; opening an orthodontic practice; and number of days worked. These findings suggest that there are differences in regard to the actual working conditions among the alumni of our postgraduate orthodontic training course, and that these differences are sex-based.

A Survey of Orthodontic Treatment in Team Care for Patients With Syndromic Craniosynostosis in Japan.

OBJECTIVE: To understand the actual condition of orthodontic treatment in team care for patients with syndromic craniosynostosis (SCS) in Japan. DESIGN: A nationwide collaborative survey. SETTING: Twenty-four orthodontic clinics in Japan. PATIENTS: A total of 246 patients with SCS. MAIN OUTCOME MEASURE: Treatment history was examined based on orthodontic records using common survey sheets. RESULTS: Most patients first visited the orthodontic clinic in the deciduous or mixed dentition phase. Midface advancement was performed without visiting the orthodontic clinic in about a quarter of the patients, and more than a half of the patients underwent "surgery-first" midface advancement. First-phase orthodontic treatment was carried out in about a half of the patients, and maxillary expansion and protraction were performed. Tooth extraction was required in about two-thirds of patients, and the extraction of maxillary teeth was required in most patients. Tooth abnormalities were found in 37.8% of patients, and abnormalities of maxillary molars were frequently (58.3%) found in patients who had undergone midface surgery below the age of 6 years. CONCLUSIONS: Many patients underwent "surgery-first" midface advancement, and visiting the orthodontic clinic at least before advancement was considered desirable. First-phase orthodontic treatment should be performed considering the burden of care. Midface advancement below the age of 6 years had a high risk of injury to the maxillary molars. This survey is considered useful for improving orthodontic treatment in team care of patients with SCS.

Relationship between Orthodontic Treatment Plan and Goslon Yardstick Assessment in Japanese Patients with Unilateral Cleft Lip and Palate: One-stage vs. Two-stage Palatoplasty.

The present study targeted patients with unilateral cleft lip and palate (UCLP) undergoing either one - (Wardill technique) or two-stage palatoplasty (Perko technique). Correlations between Goslon Yardstick scores and orthodontic appliances used and whether an osteotomy was performed were investigated. No differences were observed between the two types of palatoplasty in terms of Goslon Yardstick scores. A palatal expander and protraction facemask were used in Phase I of orthodontic treatment. The palatal expander was selected for most patients with UCLP in Phase I, regardless of the surgical technique used. A protraction facemask was used in patients undergoing the Wardill procedure who had a Goslon Yardstick score placing them in Group 3 or 4. In contrast, a protraction facemask was used in patients undergoing the Perko procedure who had a Goslon Yardstick score placing them in Group 4. No significant differences were observed in the Goslon Yardstick scores yielded by either type of procedure. The Goslon Yardstick score in relation to whether an osteotomy was performed in Phase II as part of orthodontic treatment was determined, focusing on the relationship between that score and the palatoplasty method used. A protraction facemask was used in patients undergoing the Perko procedure, which eliminated the need for an osteotomy at a future date. However, a protraction facemask was also used in patients undergoing the Wardill option, and those patients were likely to require an osteotomy. In other words, the results suggest that the type of palatoplasty selected will determine the effectiveness of any orthodontic appliances used.

Orthodontic treatment in Down's syndrome patient with unilateral cleft lip and alveolus.

In this paper, we describe orthodontic treatment in a patient with Down's syndrome accompanied by reverse occlusion due to skeletal deformity with unilateral cleft lip and alveolus. Orthodontic treatment was not initially indicated due to the potential need for surgical intervention and the presence of mental retardation. The further mental and physical growth of the patient together with the help of their guardians, however, allowed placement of a multi-bracket. Although no skeletal correction occurred as a result, reverse occlusion was corrected by labial inclination of the incisors. The patient and her guardians were satisfied with the correction of the overlap by orthodontic treatment alone.

Orthodontic treatment in combination with Le Fort II bone distraction in patient with Apert syndrome.

We report a case of an 11-year-old girl presenting with Apert syndrome characterized by midface concavity, protrusion of the eyeballs, and ocular hypertelorism. She had class III anterior crossbite, narrow upper and lower arches, and marked crowding. Based on cephalometric analysis, anterior crossbite associated with marked midfacial hypoplasia was diagnosed. Orthodontic treatment in combination with Le Fort II maxillary distraction was scheduled. The dentition was laterally extended using a Rapid palatal expander in the upper jaw and a Bihelix in the lower jaw. Multi-bracket appliances were simultaneously applied for leveling. Next, Le Fort II maxillary osteotomy was performed to distract the midface bone 16 mm anteroinferiorly using a rigid external distraction system. Orthodontic treatment was completed at 3.8 years after initiation. Bone distraction moved the upper jaw anteriorly downward, and the lower jaw subsequently rotated posteriorly downward, leading to a marked improvement in facial appearance and occlusion. Elongation of the dorsum of the nose, in particular, allowed esthetic improvement of the saddle nose. These improvements remain stable at 2 years after orthodontic treatment.

Dental implant treatment after improvement of oral environment by orthodontic therapy.

A 57-year-old man presented with mesial inclination of the lower right first molar caused by untreated loss of the second premolar. The occlusal relationship was restored by dental implant treatment following improvement of the intraoral environment by orthodontic therapy. At his initial visit, the interdental spacing in the molar-premolar region was inadequate, as the first molar had mesially inclined into the extraction space of the second premolar. The patient had also lost the second molar and complained of masticatory problems on the right side. It was considered necessary to restore the second molar and improve the occlusal relationship with the first molar to recover occlusal function on the right side. After orthodontic therapy to correct the position of the mesially inclined tooth, occlusal restoration was carried out by dental implant treatment. The patient's clinical condition has remained excellent at over 5 years 2 months post-surgically and the patient is satisfied with the treatment outcome. The combination of dental implant treatment and orthodontic therapy were effective in improving the intraoral environment in this patient, indicating the efficacy of interdisciplinary treatment planning and practice.

Occlusal force in people in their sixties attending college for elderly.

The "8020" goal of retaining 20 or more teeth after the age of 80 necessitates investigating oral health status in people below the age of 80. The purpose of this study was to determine similarities and differences between people in their sixties attending college and achievers of the 8020 goal. The results of oral examination and occlusal force measurement in 46 students enrolled at a college for the elderly in Chiba City with an average age of 66.9 years (22 men, 24 women) were compared with data from previous surveys of fifty-two 8020 achievers (28 men, 24 women). Occlusal force was measured and evaluated using Dental Prescale (Fuji Photo Film Co., Tokyo). The average number of present teeth was 25.8, and no subjects showed anterior crossbite, comparable with findings in 8020 achievers. Average occlusal force was 942.9 + or - 440.1 N (1,029.6 + or - 545.9 N for men, 863.4 + or - 305.1 N for women), not significantly different from that in 8020 achievers. The results of multiple regression analysis suggest that occlusal force is unaffected by aging if many teeth are present.

Patient in whom surgery was selected to improve mandible position after changing doctors.

A patient who visited our department after job relocation was reexamined, and a marked discrepancy was found in mandibular position between centric occlusion and centric relation. Although the patient was originally scheduled to undergo orthodontic treatment only, the results of comprehensive tests indicated that surgery would be needed to resolve this discrepancy. Surgery was performed with the patient's consent, yielding favorable results. Although the entire orthodontic treatment lasted 3 years and 11 months, including treatment prior to transfer, it was clear that long-term use of intermaxillary elastics would not have corrected the discrepancy and that surgery was the right decision.

Clinical statistical investigation of cleft lip and palate patients aged over 18 years at Department of Orthodontics, Suidobashi Hospital, Tokyo Dental College.

Since the fee for orthodontic treatment of malocclusion caused by cleft lip and palate (CLP) became covered by national health insurance in 1982, orthodontic treatment from school age has become the norm. However, in some CLP patients, orthodontic treatment is commenced in adulthood. A number of studies have reported on orthodontic treatment in adult CLP patients. The purpose of this study was to clarify the number and age of new patients, chief complaint, referral status, cleft type, malocclusion, history of orthodontic treatment, and acceptance and planning of orthodontic treatment. The study investigated new CLP patients aged over 18 years who visited the Department of Orthodontics, Suidobashi Hospital of Tokyo Dental College, between April 1, 2001 and March 31, 2006. During the investigation period mentioned above, 235 new CLP patients visited our department. Among them, 23 were aged over 18 years, accounting for 9.8% of the 235 CLP patients. In terms of chief complaint, occlusion-related complaints and occlusal dysfunction accompanying malocclusion were noted in 14 cases (61%). Eighteen patients were referrals. Unilateral CLP was the most prevalent cleft type. In terms of malocclusion type, reversed occlusion was noted in 13 cases (57%), accounting for over half of all cases. Patients with a previous history of orthodontic treatment accounted for half of all cases. Ten patients accepted orthodontic treatment. In terms of treatment plan, surgical orthodontic treatment was planned in 10 cases.

Oral flora in independent over 80-year-olds with more than 20 teeth.

The purpose of this study was to investigate oral flora in independent persons aged over 80 years with more than 20 remaining teeth. The subjects were 22 participants of the 8020 campaign (6 males and 16 females) with a mean age of 81.3+/-1.6 years and an average of 24.7 teeth (Independent 8020 group). This group was compared with a group of 38 elderly people residing in nursing homes (10 males and 28 females) who had a mean age of 81.3+/-8.5 years and an average of 4.2 teeth (Nursing group with fewer teeth). Saliva samples were collected from the vestibular areas of the maxilla and mandible using cotton swabs. Cell numbers of microorganisms were expressed as colony forming units/ml (CFUs/ml) and compared between the two groups. The average number of Staphylococcus species was 65.2+/-74.4 CFUs/ml in the Independent 8020 group and 400.3+/-352.1 CFUs/ml in the group with fewer teeth (p<0.01); that of Candida albicans was 18.0+/-37.7 CFUs/ml in the Independent 8020 group and 152.9+/-211.9 CFUs/ml in the Nursing group with fewer teeth (p<0.05). Both species showed statistically significant differences between the two groups. This suggests that the Independent 8020 achiever group had better oral hygiene and that the presence of many teeth may be associated with an increased awareness of dental health.

Evaluation of psychological factors in orthodontic patients with TMD as applied to the "TMJ Scale".

Physical and psychological evaluation have been required for TMD patients whose problems are multi dimensional. The questionnaire named the "TMJ Scale" was created to differentiate subjective TMD symptoms of patients. The purpose of this study was to clarify the reliability of the TMJ Scale for Japanese orthodontic patients with TMD and to differentiate the symptoms. Fifty orthodontic patients (average age 21y4m) with a chief complaint of TMD symptoms were compared with thirty patients (average age 21y1m) without TMD symptoms. The results were as follows: female patients in the symptom group in particular showed a higher degree of stress due to the chronic pain and abnormalities than those in the non-symptom group. Significant differences were observed in Pain Report, Joint Dysfunction and Global Scale at the 0.1% significant level, in Non-TM Disorder, Psychological Factor and Chronicity at the 1% level, and in Palpation Pain and Perceived Malocclusion at the 5% level in females. Few psychological problems were observed in male patients in the symptom group. Significant differences were observed in Range of Motion limitation at the 5% level in males. The differences in the psychological factors between male and female patients were clarified by using the TMJ Scale. These findings suggested that it was useful to differentiate the multiple symptoms, especially the psychological factors, by using the TMJ Scale for orthodontic patients with TMD.

Cephalometric study of elderly with nearly intact dental arches.

OBJECTIVE: The purpose of this study was to investigate the craniofacial morphology of elderly people with many remaining teeth using cephalometric analysis. SUBJECTS AND METHODS: The subjects were 30 Japanese elderly who participated in the '8020 campaign 2001' in Bunkyo Ward, Tokyo, organised by The Dental Association of Tokyo, as well as 30 Japanese young adults with normal occlusion. Lateral cephalograms of all subjects were analysed using the Coben method. RESULTS: In the female elderly group, the lower face depth was smaller than in the younger adults. In the male elderly group, the height and depth of both the total face and the lower face were longer than in the younger group. In comparing the 8020 achievers with the younger group, the proportion of the lower facial height was greater than the upper facial height, and this finding was more pronounced in women than in men. CONCLUSION: For the lateral facial pattern of the elderly, a reduction of lower facial height because of tooth occlusal reduction was not apparent. It was clear that there are age differences for males and females; in addition, differences in the total face and lower face area of the elderly group were due to their having many remaining teeth over a long time period. Also, these changes were more apparent in women than in men, and it is clear that there is a male-female difference in ageing.

A study of occlusion in elderly Japanese over 80 years with at least 20 teeth.

OBJECTIVES: The purpose of this study was to identify the occlusal status of elderly Japanese over 80 years with at least 20 teeth. MATERIALS AND METHODS: The study enrolled 76 elderly Japanese (44 male, 32 female) with a mean age of 82 years and an average of 25.7 remaining teeth. The study consisted of intra-oral examination, intra-oral and facial photographs, radiographs and impressions for study casts. RESULTS: No gender difference was observed in age or number of remaining teeth. Anteroposterior occlusal relationship was characterised by maxillary protrusion in 67.6%, acceptable overjet in 31.0%, and anterior crossbite in 1.4%. Vertically, deep bite was noted in 33.8%, acceptable overbite in 64.8%, and open bite in 1.4%. Most of the subjects had either Angle class I (68.4%) or class II (25.7%) canine relationship. Only 3.9% of the subjects had upper anterior crowding. Lower anterior crowding was observed in 23.7%, but tended not to be severe. CONCLUSION: These results indicate that Japanese who attained the goal of '8020' have a relatively good occlusion.