Facial esthetic outcome of functional followed by fixed orthodontic treatment of class II division 1 patients.

OBJECTIVES: To assess the perceived facial changes in class II division 1, convex profile patients treated with functional followed by fixed orthodontic appliances. SUBJECTS AND METHODS: The study sample consisted of 36 pairs of pre- and post-treatment photographs (frontal and profile, at rest) of 12 patients treated with activator, 12 with twin-block, and 12 controls with normal profiles, treated without functional appliances. All photographs were presented in pairs to 10 orthodontists, 10 patients, 10 parents, and 10 laypersons. Visual analog scale (VAS) ratings of changes in facial appearance were assessed. RESULTS: The patient groups were similar in sex distributions, age, and treatment duration. The different rater groups showed strong to excellent agreement. There were no significant differences among treatment groups (F = 0.91; P = 0.526; Wilks lambda = 0.93), raters (F = 1.68; P = 0.054; Wilks lambda = 0.83), and when testing the combined effect of treatment and rater on the results (F = 0.72; P = 0.866; Wilks lambda = 0.85). The raters detected slightly more positive changes in the activator and twin-block groups, compared to the control group, regarding the lower face and the lips, but these findings did not reach significance. Furthermore, their magnitude hardly exceeded 1/20th of the total VAS length. LIMITATIONS: Retrospective study design. CONCLUSIONS: The perceived facial changes of convex profile patients treated with functional, followed by fixed orthodontic appliances, did not differ from those observed in normal profile patients, when full-face frontal and profile photos were simultaneously assessed. Consequently, professionals should be skeptical regarding the improvement of a patient's facial appearance when this treatment option is used.

Perceived facial changes of Class II Division 1 patients with convex profiles after functional orthopedic treatment followed by fixed orthodontic appliances.

INTRODUCTION: The aim of this research was to investigate the perceived facial changes in Class II Division 1 patients with convex profiles after functional orthopedic treatment followed by fixed orthodontic appliances. METHODS: Pretreatment and posttreatment profile photographs of 12 Class II Division 1 patients treated with activators, 12 Class II Division 1 patients treated with Twin-block appliances, and 12 controls with normal profiles treated without functional appliances were presented in pairs to 10 orthodontists, 10 patients, 10 parents, and 10 laypersons. The raters assessed changes in facial appearance on a visual analog scale. Two-way multivariate analysis of variance was used to evaluate differences among group ratings. RESULTS: Intrarater reliability was strong in most cases (intraclass correlation coefficients, >0.7). The internal consistency of the assessments was high (alpha, >0.87), both within and between groups. The raters consistently perceived more positive changes in the Class II Division 1 groups compared with the control group. However, this difference hardly exceeded 1/10th of the total visual analog scale length in its highest value and was mostly evident in the lower face and chin. No significant differences were found between the activator and the Twin-block groups. CONCLUSIONS: Although the raters perceived improvements of the facial profiles after functional orthopedic treatment followed by fixed orthodontic appliances, these were quite limited. Thus, orthodontists should be tentative when predicting significant improvement of a patient's profile with this treatment option.

Patterns of non-syndromic permanent tooth agenesis in a large orthodontic population.

OBJECTIVE: The aim of this study is to explore patterns of non-syndromic permanent tooth agenesis in a large orthodontic patient group. DESIGN: A record review was performed in various orthodontic clinics to identify white patients with non-syndromic permanent tooth agenesis, excluding 3rd molars. Four hundred and fourteen subjects fulfilled the inclusion criteria. RESULTS: In the 414 subjects with tooth agenesis, approximately 70% presented 1-2 missing teeth. Symmetric agenesis patterns were often observed in the sample (by jaw, by side, or crossed quadrants), with prevalence approaching 30% for cases with contralateral tooth agenesis within a jaw. In cases with 1 or 2 missing teeth, from the total number of potential tooth agenesis patterns in the sample, a certain part was evident, limiting the variation to 27.8% (44/158). In the entire sample, both in the maxilla and the mandible a certain incisor/premolar agenesis phenotype was observed in 59.0% of cases in isolated form. CONCLUSIONS: Although there was variation in the tooth agenesis patterns, our findings suggest the involvement of particular genetic, epigenetic, and/or environmental factors in the formation of the entire dentition, which often lead to specific tooth agenesis phenotypes in cases where this process is disrupted. The present study provides a comprehensive categorization of orthodontic cases with tooth agenesis and can assist in planning future epidemiological and genetic studies.

Diagnosis and treatment of ankyloglossia: A narrative review and a report of three cases.

BACKGROUND: Ankyloglossia or tongue-tie is a congenital oral anomaly with short, tight, and thick lingual frenulum. It may be asymptomatic or can cause movement limitations of the tongue, speech and articulation difficulties, breastfeeding difficulties in neonates, as well as periodontal and malocclusion problems. The etiopathogenesis of ankyloglossia is unknown; it can occur either as a sole anomaly in the vast majority or in association with other craniofacial anomalies. OBJECTIVES: The aims of this paper were (1) to provide a comprehensive review on the criteria for clinical assessment and diagnosis, etiology and inheritance, and the therapeutic options of ankyloglossia; and (2) to demonstrate the treatment of ankyloglossia by means of frenuloplasty in three cases. REVIEW: The available evidence from the literature indicates that among neonates, children, and adults the prevalence of ankyloglossia is low and in some cases remains undiagnosed. The early clinical assessment, diagnosis, and treatment are beneficial for the patients and their mothers. CONCLUSIONS: Frenuloplasty is a safe, quick, effective, and economical method and for this reason the parents should not hesitate towards frenulum release. More clinical studies are needed to confirm the benefits of the surgical interventions and to compare the results with those obtained using nonsurgical therapy or with untreated cases.

Aesthetic outcome of cleft lip and palate treatment. Perceptions of patients, families, and health professionals compared to the general public.

The aesthetic outcome of cleft treatment is of great importance due to its complex management and the psychosocial consequences of this defect. The aim of the study was to assess the aesthetic evaluations of patients following cleft surgery by various groups and investigate potential associations of the assessments with life quality parameters. Head photos of 12 adult patients with treated unilateral cleft lip and palate were evaluated by laypeople and professionals. A questionnaire was distributed and answered by the patients and their parents. Intra-panel agreement was high (α > 0.8) for laypeople and professionals. Between-groups agreement was high for both laypeople and professionals, but not when patients and/or parents were tested. Professionals, parents, and patients were more satisfied with patients' appearance than laypeople, although in general all groups were not highly satisfied. Low satisfaction with aesthetics correlated with increased self-reported influence of the cleft in the patients' social activity and professional life (0.56 < rho < 0.74, p < 0.05). These findings highlight the observed negative influence of the cleft on the patient's social activity and professional life and underline the need for the highest quality of surgical outcome for this group of patients.

A severe open bite case treated with orthodontics and tongue reduction surgery: 13-year followup. A case report.

BACKGROUND: The management of open bite malocclusions creates controversy when treatment approach and long-term stability are considered. Tongue size, posture and habits have been associated as aetiologic and compounding factors. Reduction tongue surgery has therefore been advocated as an aid in treatment, especially when the open bite is accompanied by perceived macroglossia. AIM: The present article describes a clinical case of a 10-year-old girl who started treatment in the mixed dentition with an excessive open bite and speech defects. METHODS: A combination of orthodontics and a partial glossectomy was necessary to successfully address the open bite associated with an enlarged tongue. RESULTS: The need for orthognathic surgery treatment was eliminated and the patient was satisfied with the post-treatment aesthetics, function and speech. CONCLUSION: After 13 years of follow-up, a stable occlusion was maintained with only minor relapse.

Clinical factors correlated with the success rate of miniscrews in orthodontic treatment.

Miniscrews offer a reliable alternative for anchorage during orthodontic treatment, particularly for non-cooperative patients or periodontal patients with alveolar bone loss. The study aims at assessing the correlation of various clinical indicators with the success or failure of miniscrews used for anchorage during orthodontic treatment. Thirty-four consecutive patients with a cumulative total of 82 miniscrews implanted participated in the study. Generalized Estimating Equations were used to assess the correlation of various factors with success rates. The miniscrew was considered the unit of analysis clustered within site and within patient. The overall success rate of miniscrews was 90.2%. For every additional miniscrew used in a patient's oral cavity, the success rate was reduced by 67%. Retromandibular triangle and palatal placement and in movable mucosa resulted in lower success rate. The miniscrew length and diameter were found to correlate with success rates. Orthodontic force applied on miniscrews for uprighting purposes showed a lower success rate than that used for retraction. This study revealed that miniscrews present high success rates. The number of miniscrews used per patient, the miniscrew site placement, the soft tissue type of placement, the miniscrew length and diameter as well as the orthodontic force applied on the miniscrew showed significant correlation with success rates.

Comparative assessment of clinical performance of esthetic bracket materials.

OBJECTIVES: To compare the alterations in esthetic appearance and slot morphology/integrity of two main types of esthetic brackets caused after clinical use. MATERIALS AND METHODS: Sixteen ceramic (CR) and 16 plastic (PR) central incisor brackets were obtained from 16 young adult patients at the end of treatment in a prospective randomized manner. As controls, 12 ceramic (CC) and 12 plastic (PC) nonused brackets were also examined. Three representative slot width measurements were obtained through micrometric microscopy. Visual inspection of optical microscopy images, surface electron microscopy (SEM), and energy-dispersive x-ray spectroscopy (EDS) were also performed. RESULTS: Intraoral exposure time varied from 5 to 20 months (mean, 12.4; P  =  .73). Two-way analysis of variance revealed significant differences in slot width among the different materials and a significant interaction between the material effect and its status (P < .001). Bonferroni post hoc tests on material × status effect showed significant differences between CC (95% confidence interval [CI]: 434.5, 447.0) vs PC (95% CI: 460.2, 472.8), CC vs CR (95% CI: 453.2, 464.4), and PC vs PR (95% CI: 448.8, 458.9). Interestingly, a significant difference was not detected for CR vs PR. Slot width was correlated with the time under clinical use only for plastic brackets (PR: r  =  -.64, P < .01). Visual inspection of the optical microscopy images did not reveal any major macroscopic morphological disfigurements or significant discolorations. However, a rough and irregular slot wall surface was evident after clinical use (also with SEM), especially in the bottom of the slot. CONCLUSIONS: Both bracket types presented adequate clinical performance at least for the time period studied and in terms of esthetic appearance and morphologic integrity.

Appreciation of cleft lip and palate treatment outcome by professionals and laypeople.

The aim of the study was to analyse the aesthetic evaluation of head photographs of treated individuals with clefts by laypeople and professionals and to investigate how certain cephalometric variables could be related to their rating. A set of five standardized head photos (frontal, both laterals, three-quater right and left) of 12 Caucasian patients with treated unilateral cleft lip and palate were presented to 12 adult laypeople, 12 orthodontists, and 12 maxillofacial surgeons. For each set of photos the judges had to answer four questions on a visual analogue scale (VAS). The answers were analysed for intra- and inter-panel level of agreement and correlations of assessments with certain cephalometric parameters were determined. There was a high level of agreement for all assessments of each panel of raters. However, laypeople were less satisfied with lip and nose aesthetics compared to professionals. The three groups were similarly satisfied with the aesthetics of the jaws and the face. The anterior position of the maxilla (SNA) influenced positively professionals' ratings of facial aesthetics. Orthodontists were negatively influenced when the vertical dimension of the face or the distance of the lower lip to E-plane were relatively increased. The latter was the only cephalometric parameter correlated with lower aesthetic scores obtained from laypeople. Professionals report greater satisfaction from the treatment outcome and evaluate cleft consequences with less severity than laypeople. According to cephalometric findings, the relative positions of the lips seem to dominate facial aesthetics' appreciation by laypeople, while specialists appear to focus on different features of the face.

Variation with age of dental cephalometric variables in Class II, division 2 patients.

The treatment of Angle Class II/2 malocclusion requires an understanding not only of the dental and maxillofacial features but also of the changes occurring with age in the dental relationships. This paper attempts to determine certain dental relationships in patients with Angle II/2 malocclusion and any changes that might occur with age. The study material included 96 lateral cephalometric X-rays of patients with Angle II/2 malocclusion, the youngest of whom was 7 years old and the eldest 35. Six cephalometric measurements were performed on every cephalometric X-ray. Statistical processing of data included one-variable analyses and correlations of two variables. Statistical one-variable analysis used methods from descriptive statistics. Methods of inferential statistics have been applied in order to revel statistical significance. The evaluation of the findings of this research study concluded that, in patients with Angle II/2 malocclusion, maxillary central incisors presented pronounced palatal tipping, which exacerbated significantly with age, while mandibular incisors displayed reduced labial tipping and projection, which significantly reduced with age. Furthermore, it was found that there was pronounced incisor overjet, which increased with age, due to increased protrusion of mandibular incisors.

Macroglossia.

Macroglossia is defined as an enlarged tongue and it is usually clinically diagnosed. Pseudomacryglossia concerns a tongue that is of normal size but gives a false impression of being too large in relation to adjacent anatomical structures. The causes of macroglossia are numerous and this is why various classifications have been proposed for this condition. The consequences of macroglossia usually include a possible malfunction of the stomatognathic system, breathing and speech problems, increased mandible size, tooth spacing, diastema and other orthodontic abnormalities. The treatment of macroglossia depends on its aetiology and generally includes correcting the systemic disease underlying the increase in lingual mass, surgical treatment, radiotherapy and treatment of orthodontic abnormalities that might have been caused by the condition.

Cephalometric methods of prediction in orthognathic surgery.

Over the past decade the growing number of adult patients seeking for orthodontic treatment made orthognathic surgery popular. Surgical and orthodontic techniques have developed to the point where combined orthodontic and surgical treatment is now feasible to manage dentofacial deformity problems very satisfactorily. The prediction of orthognathic treatment outcome is an important part of orthognathic planning and the process of patient' inform consent. The predicted results must be presented to the patients prior to treatment in order to assess the treatment's feasibility, optimize case management and increase patient understanding and acceptance of the recommended treatment. Cephalometrics is a routine part of the diagnosis and treatment planning process and also allows the clinician to evaluate changes following orthognathic surgery. Traditionally cephalometry has been employed manually; nowadays computerized cephalometric systems are very popular. Cephalometric prediction in orthognathic surgery can be done manually or by computers, using several currently available software programs, alone or in combination with video images. Both manual and computerized cephalometric prediction methods are two-dimensional and cannot fully describe three-dimensional phenomena. Today, three-dimensional prediction methods are available, such as three-dimensional computerized tomography (3DCT), 3D magnetic resonance imaging (3DMRI) and surface scan/cone-beam CT. The aim of this article is to present and discuss the different methods of cephalometric prediction of the orthognathic surgery outcome.

Effective treatment of self-injurious oral trauma in Lesch-Nyhan syndrome: a case report.

Lesch-Nyhan syndrome (LNS) is an X-linked disorder originating from deficiency of the enzyme hypoxanthine guanine phosphoribosyl transferase. It is characterized by neurological manifestations, including the dramatic symptom of compulsive self-mutilation, which results in destruction of oral and perioral tissues. Several drug trials have been administered to improve the severe self-destructive behaviour, with questionable effectiveness. Invasive treatment approaches, such as extraction of teeth and orthognathic surgery, have been suggested with variable success. A conservative treatment with an intraoral appliance serving to prevent oral and peri-oral self-injury is presented in this report. The patient was a 14-year-old boy demonstrating the typical LNS behaviour, including compulsive self-biting, significant loss of lip and tongue tissue, spasticity and involuntary movements. An acrylic maxillary appliance was designed and constructed with an occlusal plate raising the bite. The appliance was retained by two Adams' clasps on the first premolars, along with three ball clasps between the incisors. Fabrication, insertion, and maintenance were uncomplicated and non-stressful to the patient. Periodic recall over 3-year period has confirmed the effective healing of the oral lesions and a high level of tolerance of the appliance.

Management of root dilaceration of an impacted maxillary central incisor following orthodontic treatment: an unusual therapeutic outcome.

There are rare cases of impacted permanent central incisors with dilaceration, a dental deformity characterized by pronounced angulation of the longitudinal tooth axis. This paper presents the orthodontic alignment of a permanent maxillary left central incisor in a 7.5-year-old boy, which appeared impacted radiologically and displayed root dilaceration. Following surgical exposure with the closed-eruption technique and appropriate orthodontic traction, the tooth was successfully aligned into the dental arch and the root was radiologically shown to be straightened and relatively well developed.

An alternative impression technique for individuals with special care needs.

Impression making may be complicated in individuals with limited ability to cooperate with caregivers. An alternative technique for obtaining full-arch casts from sectional preliminary impressions is described. The technique is a modification of the procedure advocated for impression making in subjects with limited mouth opening. A pair of partial stock trays is selected to fit the right and left side of the arch. Two sectional irreversible hydrocolloid impressions are made separately. The first cast is placed into the second impression prior to pouring, to obtain a cast of the complete arch. The procedure was used during the treatment of an uncooperative young patient with Lesch-Nyhan Syndrome and provided a simple and reliable means to obtain the diagnostic cast of the mandibular teeth. It is recommended not only for uncooperative patients, but also for patients with special needs; such as those with anatomical restrictions, functional impairment, and movement disorders.

Dilaceration of maxillary central incisor: a literature review.

The main purpose of this review is to present the aetiological factors and the mechanism that cause dilaceration of the maxillary central incisors. In early developmental stages, the permanent tooth germ of the maxillary incisor is situated palatally and superiorly to the apex of the primary incisor and gradually changes direction in a labial direction with its crown coming closer to the resorbing primary root. For reasons of this close relationship between the permanent tooth germ and the apex of the primary incisor, it is believed that an acute trauma to the primary predecessor can cause dilaceration of the long axis of the permanent successor. Clinically, dilaceration can be revealed by palpation high in the labial sulcus or in the hard palate, while its radiographic view is characteristic. The therapeutic approach to the dilacerated maxillary central incisors has to be carefully planned and needs the cooperation of several specialities to attain the final objective.

A review of the clinical applications of elastic tractions in orthodontics.

Intermaxillary elastic traction to correct various malocclusions was first introduced in 1892 by Calvin Case. The types of elastics are distinguished according to their material, force production, and mode of application. All elastics vary in their characteristics presenting both advantages and disadvantages. Their composition plays an important role in their behavior when worn. The biomechanics of intermaxillary elastics determine their indications and contraindications.

Management of maxillary midline diastema with emphasis on etiology.

The importance of the presence of a maxillary midline diastema resides in its position and the concern it causes to patients. This specific diastema has been attributed to genetic and environmental factors, even though it is often a normal feature of growth, especially in primary and mixed dentition. The need for treatment is mainly attributed to esthetic and psychological reasons, rather than functional ones. Although it is often the case, treatment plans should not be selected empirically but rather should be based on adequate scientific documentation. Possible therapeutic approaches include orthodontics, restorative dentistry, surgery and various combinations of the above. The ideal treatment should seek to manage not only the diastema in question but also the cause behind it. Irrespective of the treatment alternative selected, permanent retention of stable results should be considered as a treatment objective. The aim of this paper is to underscore the main etiological factors for the presence of a maxillary midline diastema and to illustrate the clinical and laboratory examinations required to recognize these factors. Furthermore, alternative treatment options are discussed depending on the etiology of the problem.

An alternative for postorthodontic labial retention in an unusual case.

An integral part of sustaining long-term orthodontic results is a lingually bonded retainer. These retainers have been established as a standard retention protocol, as they combine efficiency and esthetics. Increasing patient demands for improved esthetics and maintenance of good health of dental and periodontal tissues have led to the development of new techniques and materials involving reinforced polyethylene fibers. In this case report, retention featuring the use of a reinforced polyethylene fiber retainer, placed labially to avoid irritating the tongue, is presented. Three-year posttreatment records indicated no relapse and that the integrity of soft and hard tissues had remained intact.