Treatment effects and short-term relapse of maxillomandibular expansion during the early to mid mixed dentition.

INTRODUCTION: The treatment effects and the short-term (0.9 +/- 0.45 years) relapse potential of phase I slow maxillary expansion, with a bonded palatal expander or a quad-helix appliance combined with a mandibular banded Crozat/lip bumper and followed by 12 to 15 months of retention, were examined. METHODS: Pretreatment (8.8 +/- 1.7 years) and posttreatment (11.1 +/- 1.7 years) models of 54 patients were used to evaluate treatment effects. Posttreatment (11.0 +/- 1.3 years) and follow-up (11.9 +/- 1.4 years) models of 23 patients who returned for phase II treatment were used to evaluate relapse over the 11 months, during which no retention was used. The models were digitized, and 15 measures were computed. RESULTS: Significant treatment increases were observed for all measurements in both arches. Treatment gains in arch perimeter (6%-8%) were due more to increases in intermolar width (11%-15%) than to increases in arch depth (5%). Posttreatment relapse was significant (P <.05) for all measures except mandibular intercanine width and maxillary molar arch depth. After accounting for normal growth, net changes (pretreatment to follow-up) indicated significant increases for all measures except maxillary molar arch depth. In addition to maintaining leeway space, the maxilla and the mandible showed net perimeter gains of 2.9 and 1.0 mm, respectively. CONCLUSIONS: Slow maxillary expansion combined with a mandibular banded Crozat/lip bumper during the early mixed dentition produced clinically useful increases in arch dimensions that subsequently underwent mild-to-moderate amounts of relapse after removal of all retention appliances.

The impact of buccal corridors on smile attractiveness.

The aim of this study was to assess the impact of various sized buccal corridors (BCs) on smile attractiveness. One female smiling photograph, displaying first molar to first molar (M1-M1), was digitally altered to produce (1) smiles that filled 84, 88, 92, 96, and 100 per cent of the oral aperture; (2) second premolar to second premolar smiles (PM2-PM2) that filled 84, 88, 92, and 96 per cent of the oral aperture; and (3) smiles with asymmetrical BC that filled 88, 90, 94, and 96 per cent of the oral aperture. The 18 smiles produced were evaluated by 82 orthodontists (70 males and 12 females) and 94 laypeople (40 males and 54 females). Paired t-tests were used to evaluate differences within the orthodontist and laypeople groups: independent t-tests were used to compare the two groups. The effect of age and gender on the ratings was evaluated by two-way analysis of variance. Orthodontists and laypeople rated smiles with small BCs as significantly (P < 0.05) more attractive than those with large BCs. Orthodontists rated M1-M1 smiles as more attractive than PM2-PM2 smiles, whereas laypeople preferred PM2-PM2 smiles. Orthodontists rated only two of eight asymmetrical smiles as less attractive than would be expected for symmetrical smiles with similar arch widths; laypeople did not rate any asymmetrical smiles as less attractive than would be expected. Rater age and gender did not significantly influence the impact of BCs on smile attractiveness.

Long-term profile changes in extraction and nonextraction patients.

INTRODUCTION: The purpose of this investigation was to determine the long-term differences in soft tissue profile changes between extraction and nonextraction patients who had been treated to the same incisor position and lip line. METHODS: Twenty extraction and 20 matched nonextraction patients, with posttreatment and long-term follow-up (average 15 years) records, were selected from a single private orthodontic practice. Posttreatment and long-term follow-up profile photos of the patients' nose, lip, and chin areas were evaluated by 105 orthodontists and 225 laypeople, who indicated their preferences and the amount of change they perceived among the 40 profiles. The patients had similar dental protrusion, soft tissue profile measurements, and ages at the posttreatment observation. RESULTS: No significant cephalometric differences between the extraction and nonextraction groups were found at long-term follow-up; both groups showed similar long-term changes. Significant (P < .05) differences were found between males and females at long-term follow-up; male lips became relatively more retrusive, and their profiles became flatter. Significant (P < .05) changes in the profiles were also perceived over time, but there was no relationship between the amount of change perceived and profile changes measured cephalometrically. There were also no significant (P < .05) differences in preferences between orthodontists and laypeople, between extraction and nonextraction patients, or between males and females. CONCLUSIONS: If extraction and nonextraction patients are treated to the same incisor position and lip line, the treatment modality does not affect long-term soft tissue profile changes. Furthermore, the amounts of change perceived by either orthodontists or laypeople were not related to the amount of change measured cephalometrically.

Long-term stability of Class I premolar extraction treatment.

This study evaluates Class I, 4-premolar-extraction patients who were treated with the edgewise appliance by 1 practitioner, according to the philosophy of Tweed, and who had been out of retention a minimum of 5 years. The sample includes 32 patients, who started treatment at an average age of 12.8 years and who were examined a mean of 15 years posttreatment (11.7 years postretention). Cephalometric and model analyses were conducted to evaluate treatment and posttreatment tooth movements. The results showed that irregularity, as measured by the irregularity index, decreased 5.3 mm during treatment and increased 0.7 mm (SD 1.1 mm) during the posttreatment period. Eighty percent of the patients had satisfactory (<3.5 mm) mandibular incisor alignment over 10 years postretention, and none was in the severe category (>6.5 mm). Mandibular intercanine width increased (1.7 mm) during treatment, whereas intermolar width decreased (-2.1 mm). Maxillary molar widths remained unchanged posttreatment, and mandibular intercanine width decreased 1.4 mm from immediately posttreatment to postretention. Arch lengths decreased during treatment because of molar protraction and incisor retraction. Mandibular arch length continued to decrease posttreatment (-1.4 mm) because of mesial molar movement rather than distal incisor movement. Satisfactory long-term results can be achieved for most Class I, 4-premolar-extraction patients for whom evidence-based treatment objectives-including minimal alteration of the mandibular arch form and the retraction and uprighting or maintenance of mandibular incisors in their original position-have been met.