The effects of adenoid hypertrophy and oral breathing on maxillofacial development: a review of the literature.

According to modern epidemiological surveys, the prevalence of adenoid hypertrophy in children and adolescents ranges from 42% to 70%. Adenoid hypertrophy can lead to airway obstruction; thus forces a child to breathe through their mouth, thus affecting the normal development of the dental and maxillofacial area, and can lead to malocclusion. Long-term mouth breathing can cause sagittal, vertical and lateral changes in the maxillofacial area. In this article, we review the current research status relating to the association between adenoid hypertrophy, oral breathing and maxillofacial growth and development in children and adolescents. We also discuss the personalized formulation of treatment plans.

Complications in patients with facial bone fractures before and after conservative and surgical treatment, their comparison and correlation with different factors.

OBJECTIVE: This study aims to determine the occurrence of complications before and after the treatment of facial fractures, as well as the impact of the factors on the treatment results and evaluation of their relationships. PATIENTS AND METHODS: This is a prospective case-control study comprising 90 patients aged between 18 and 65 with facial fractures. Depending on the treatment method, patients were divided into three groups: those treated surgically using a transcutaneous approach, those treated surgically using a transmucosal approach, and those treated conservatively (control group). Following complications before and after treatment were compared: malocclusions, paresthesias, facial asymmetry, diplopia, and limited mouth opening. The follow-up period after the treatment of choice was six months. RESULTS: There was a significant reduction in complications after treatment: malocclusion, paresthesia, facial asymmetry, and limited mouth opening. Regarding the transcutaneous approach, there is a substantial reduction in the number of complications after treatment, such as malocclusions (p=0.008), paresthesias (p=0.004), and facial asymmetries (p<0.001). Similar results were obtained for the transmucosal approach. Pain intensity positively correlated with preoperative complications: malocclusion, paresthesias, and facial asymmetry. The range of mouth opening had a negative interdependence with malocclusion before and after treatment with infection, fractura male sanata, malocclusion, paresthesias, postoperative level of mouth opening, and damage to the facial nerve. CONCLUSIONS: There is no difference in the reduction of preoperative and postoperative complications related to surgery when an incision is made through the skin or mucosa. Malocclusions, paresthesias, and facial asymmetry are reduced through surgical methods.

Association between malocclusions and amelogenesis imperfecta genotype and phenotype: A systematic review.

INTRODUCTION: The aim of this systematic review (Prospero CRD42022323188) is to investigate whether an association exists in patients with amelogenesis imperfecta (AI) between occlusal characteristics and genotype on the one hand and enamel structural phenotype on the other. MATERIAL AND METHODS: Reports up to May 2023 assessing occlusion of individuals with AI were browsed in a systematic search using Medline, Embase, ISI Web of Science, and the grey literature. Randomised control trials, case control studies, and case series specifying both occlusion, assessed by cephalometric or clinical analysis, and genotype or dental phenotype in patients with AI were included without any age limitation. Two authors independently selected the publications and extracted the data in accordance with the PRISMA statement. The risk of bias was assessed with the Critical Appraisal Checklists from the Johanna Briggs Institute. RESULTS: Twenty-five articles were chosen from the 261 results. Most of the included publications were case series (n=22) and case control studies (n=3). Thirteen studies reported both a genotype (ENAM, FAM83H, FAM20A, DLX3, CNMM4, WDR72) and occlusal diagnostic. The methodological quality of the studies was moderate. All AI phenotypes showed an open bite (OB) rate around 35%, except mixed form. The other malocclusions were not often mentioned. No correlation between occlusal phenotype and genotype or AI phenotype could be identified in patients with AI, as most studies had short occlusal descriptions and small sample sizes. CONCLUSION: OB malocclusions were more frequently reported in AI. This review highlighted the need for a more accurate description of orofacial features associated with AI, to better clarify the role of amelogenesis genes in the regulation of craniofacial morphogenesis and identify patients requiring orthognathic surgery at an early stage.

Treatment of extracapsular fractures of the mandibular condylar process: A retrospective evaluation of 377 cases.

BACKGROUND/AIM: Mandibular condylar fractures represent 25%-35% of all mandibular fractures. Despite profound research, there is still a controverse debate about treating these fractures conservatively or by open reduction and internal fixation (ORIF). The aim of this study is to analyse the outcome after open and closed treatment of extracapsular mandibular condyle fractures regarding general characteristics, post-treatment malocclusion, facial nerve palsy (FNP), maximum mouth opening (MMO) and parotid complications. METHODS: A retrospective cohort of 377 fractures (350 open, 27 closed treatment) was reviewed by reference to clinical and radiological pre- and postoperative documentation. Follow-up period was 12 months. Pearsons' chi-square-test, correlations, Kruskal-Wallis test and t-test were carried out for statistical analysis. RESULTS: The dominant type of fracture was type II in Spiessl and Schroll classification (50.1%). In the open treated fractures, the most common approach was retromandibular transparotid (91.7%). Post-treatment malocclusion occurred in 18.0% and was significantly increased in bilateral fractures (p = .039), in luxation fractures (p = .016) and in patients with full dentition (p = .004). After open reduction and internal fixation (ORIF), temporary FNP was documented in 7.1% whereas a permanent paresis occurred in 1.7%. FNP was significantly associated with high fractures (p = .001), comminution (p = .028) and increased duration of surgery (p = .040). Parotid complications were significantly associated with revision surgery (p = .009). Post-treatment reduction of MMO mainly occurred in female patients (p < .001) as well as in patients with bilateral fractures (p < .001), high fractures (p = .030) and concomitant mandibular (p = .001) and midfacial fractures (p = .009). CONCLUSION: Malocclusion seems to be the most frequent long-term complication after open reduction and osteosynthesis of extracapsular mandibular condyle fractures. We suggest ORIF by a transparotid approach to be an appropriate treatment with a low complication rate regarding especially FNP for extracapsular fractures of the mandibular condyle.

Orofacial myofunctional reeducation assisted by a prefabricated reeducation appliance: a systematic review of the literature / Rééducation myofonctionnelle orofaciale assistée par gouttière de rééducation préfabriquée : une revue systématique de la littérature

Introduction: Several cross-sectional studies have shown the association of a dysfunctional orofacial environment with a greater prevalence of malocclusions. Orofacial myofunctional reeducation (OFMR) is the rehabilitation of the muscles, functions and resting postures of the orofacial complex. It is used in the therapeutic management of orofacial dysfunction in patients of all ages and with a wide range of disorders and comorbidities. RMOF mainly uses isotonic and isometric exercises targeting the oral and oropharyngeal structures, combined with specific exercises for ventilation, swallowing and mastication. It may involve the use of prefabricated reeducation appliances (PRAs), which may also be prescribed to modify the shape and relationship of the dental arches. Objectives: The primary objective of this systematic review of the literature was to describe and evaluate the efficacy of prefabricated reeducation appliance-assisted OFMR in orthodontics, occlusodontics and dental sleep medicine. Its secondary objective was to assess whether the use of currently available PRAs is associated with adverse effects. Materials and Methods: The systematic literature review was undertaken using five electronic databases: Medline (via PubMed), Web of Science, Cochrane Library, Embase, and Google Scholar, to identify studies evaluating the efficacy of PRA-assisted OFMR in the treatment of orofacial dysfunctions and parafunctions, temporo-mandibular dysfunction (TMD) or obstructive sleep apnea (OSA) in children, adolescents and adults, published until 20 March 2023. The primary outcome of interest was the therapeutic efficacy of PRA-assisted OFMR. In patients with obstructive sleep apnoea (OSA), efficacy was assessed primarily by a decrease in the apnoea/hypopnoea index (AHI) of at least five episodes per hour from baseline, improvement in subjective sleep quality, sleep quality measured by nocturnal polysomnography and subjectively measured quality of life. In patients with orofacial dysfunctions, parafunctions or TMD, efficacy was assessed mainly by electromyography (EMG), history and clinical examination. Secondary outcomes were dentoalveolar or skeletal improvements, and possible adverse effects of the PRAs used, including adverse effects on occlusion. Results: Only fourteen studies met all inclusion criteria: two randomised controlled trials, one non-randomised controlled trial, five prospective case-control studies, two retrospective case-control studies, two prospective case series and two retrospective case series. The two randomised controlled trials were assessed as "low risk of bias" according to the Cochrane Back Review Group's 12 risk of bias criteria. The methodological quality of the remaining 12 included studies was assessed using the ROBINS-I tool, according to the recommendations of the Cochrane Handbook. One was judged to have a measured risk of bias, eight a significant risk of bias and three a critical risk of bias. Based on the available evidence, PRA-assisted OFMR results in a statistically significant (p=0.0425) reduction in AHI in children with mild to moderate obstructive sleep apnea. In children with obstructive sleep apnoea undergoing adenoid and/or tonsil surgery, postoperative OFMR combined with a flexible PRA leads to a greater reduction in AHI compared to a control group and an improvement in SaO2 at 6 months and 12 months after surgery (p<0.01). It also contributes to greater improvement in sleep disturbance, physical fitness, daytime lethargy in the treated group than in the control group 6 months and 12 months after surgery (p<0.05). PRA-assisted OFMR provides correction of atypical swallowing and improvement in orofacial muscle balance. GRPs are generally less effective than activators for the treatment of Class II Division 1 malocclusions and appear to cause more adverse effects, mainly vestibuloversion of the mandibular incisors. The use of PRA-assisted OFMR for the management of TMD is not validated by current evidence. Conclusions: Published data, albeit of uneven methodological quality, appear to show the superiority of OFMR combined with the use of a PRA, compared with the implementation of OFMR without PRA. Prospective studies with large sample sizes would be useful to better evaluate the new therapeutic possibilities brought by the combination of OFMR with a PRA. Continued attention should be paid to the monitoring of possible adverse effects of PRA-assisted OFMR on the dental arches, especially the vestibuloversion of the mandibular incisors. It might be useful to reflect on the relevance of the arguments put forward by manufacturers about the particularities of their devices and their supposed effects. PRA-assisted OFMR appears to be a necessary paradigm shift , which it seems useful to bring to our patients. Protocol registration: This protocol was registered on March 02, 2023 in the International Prospective Register of Systematic Review (PROSPERO) and received the CRD number: CRD42023400421.

Introduction: Plusieurs études transversales ont montré l'association d'un environnement orofacial dysfonctionnel avec une plus grande prévalence de malocclusions. La rééducation myofonctionnelle orofaciale (RMOF) est la rééducation des muscles, des fonctions et des postures de repos du complexe orofacial. Elle est utilisée dans la prise en charge thérapeutique des dysfonctionnements orofaciaux chez des patients de tous âges et présentant un large éventail de troubles et de comorbidités. La RMOF met principalement en œuvre des exercices isotoniques et isométriques ciblant les structures buccales et oropharyngées, associés à des exercices spécifiques pour optimiser la ventilation, la déglutition et la mastication. Elle peut faire appel à des gouttières de rééducation préfabriquées (GRP) dont la prescription peut également viser l'objectif d'une modification des formes et des rapports d'arcades dentaires. Objectif: L'objectif principal de cette revue systématique de la littérature était de décrire et d'évaluer l'efficacité de la RMOF assistée par gouttières de rééducation préfabriquées en orthodontie, en occlusodontie et en médecine dentaire du sommeil. Son objectif secondaire était d'évaluer si l'emploi des GRP, actuellement disponibles, s'accompagne d'effets indésirables. Matériels et méthodes: La revue systématique de la littérature fut entreprise à partir de cinq bases de données électroniques : Medline (via PubMed), Web of Science, Cochrane Library, Embase et Google Scholar, afin d'identifier les études évaluant l'efficacité de la RMOF assistée par GRP dans le traitement des dysfonctions orofaciales et des parafonctions, des dysfonctionnements temporaux-mandibulaires (DTM) ou des syndromes d'apnées obstructives du sommeil (SAOS) de l'enfant, de l'adolescent et de l'adulte, publiées jusqu'au 20 mars 2023. Le critère de jugement principal de cette revue systématique était l'efficacité thérapeutique de la RMOF assistée par GRP. Chez les patients souffrant d'apnée obstructive du sommeil (AOS), l'évaluation de l'efficacité s'appuyait principalement sur une diminution statistiquement significative de l'indice d'apnée/hypopnée (IHA) et sur une amélioration de la qualité subjective du sommeil, de la qualité du sommeil mesurée par polysomnographie nocturne et de la qualité de vie mesurée subjectivement. Chez les patients présentant des dysfonctions orofaciales, des parafonctions ou des DTM, l'évaluation de l'efficacité l'était principalement par l'électromyographie (EMG), l'anamnèse et l'examen clinique. Les critères de jugement secondaires étaient les améliorations dentoalvéolaires ou squelettiques, et les éventuels effets indésirables des GRP employées, dont des effets indésirables sur l'occlusion. Résultats: Seulement quatorze études répondaient à tous les critères d'inclusion : deux essais contrôlés randomisés, un essai contrôlé non randomisé, cinq études cas témoins prospectives, deux études cas-témoins rétrospectives, deux séries de cas prospectives et deux séries de cas rétrospectives. Les deux essais cliniques contrôlés randomisés ont été évalués à « faible risque de biais ¼ d'après les douze critères de risque de biais du Cochrane Back Review Group. La qualité méthodologique des 12 autres études incluses a été évaluée à l'aide de l'outil ROBINS-I, conformément aux recommandations du Cochrane Handbook. L'une a été jugée comme présentant un risque de biais mesuré, huit un risque de biais important et trois un risque de biais critique. D'après les données probantes disponibles, la RMOF assistée par GRP permet une réduction statistiquement significative (p = 0,0425) de l'IAH d'enfants souffrant d'apnée obstructive du sommeil légère à modérée. Chez des enfants souffrant d'apnée obstructive du sommeil et opérés des adénoïdes et/ou des amygdales, une RMOF postopératoire associée au port d'une GRP souple conduit à une plus grande réduction de l'IAH, comparativement à un groupe témoin, et une amélioration de la saturation en oxygène (SaO2), 6 mois et 12 mois après l'opération (p < 0,01). Elle contribue également à une amélioration des troubles du sommeil, de la condition physique, de la léthargie diurne plus importante dans le groupe traité que dans le groupe témoin, 6 mois et 12 mois après l'opération (p < 0,05). La RMOF assistée par GRP permet une correction jusqu'à 100 % de la déglutition atypique et une amélioration de l'équilibre musculaire orofacial. Les GRP sont généralement moins efficaces que les activateurs pour le traitement des malocclusions de classe II, division 1 et semblent entraîner davantage d'effets indésirables, principalement une vestibuloversion des incisives mandibulaires. L'utilisation de la RMOF assistée par GRP pour la prise en charge des DTM n'est pas validée par les preuves actuelles. Conclusions: Les données publiées, même de qualité méthodologique inégale, semblent montrer la supériorité d'une RMOF associée au port d'une GRP comparée à la mise en œuvre d'une RMOF sans GRP. La mise en œuvre d'études prospectives avec de grands échantillons serait utile pour mieux évaluer les nouvelles possibilités thérapeutiques apportées par l'association de la RMOF avec une GRP. Une attention constante devra être portée à la surveillance des éventuels effets indésirables sur les arcades dentaires des GRP associées à la RMOF, notamment la vestibuloversion des incisives mandibulaires. Il pourrait être utile de conduire une réflexion quant à la pertinence des arguments avancés par les fabricants sur les particularités de leurs dispositifs et leurs effets supposés. La RMOF assistée par GRP apparaît comme un nécessaire changement de paradigme, dont il semble utile de faire bénéficier nos patients. Enregistrement du protocole: Ce protocole a été enregistré le 2 mars 2023 dans l'International Prospective Register of Systematic Review (PROSPERO) et a reçu le numéro CRD : CRD42023400421.

Malocclusions, pathologic tooth migration, and the need for orthodontic treatment in subjects with stage III-IV periodontitis. A cross-sectional study.

BACKGROUND: Literature is scarce on malocclusion prevalence and orthodontic treatment need (OTN) in subjects with stage III-IV periodontitis. Study aims were to assess prevalence of primary and secondary malocclusions in subjects with stage III-IV periodontitis and OTN based on pathologic tooth migration (PTM) and occlusal trauma of anterior teeth (AT). SUBJECTS AND METHODS: One hundred and twenty-one subjects with stage III-IV periodontitis were examined. A comprehensive periodontal-orthodontic examination was performed. Exclusion criteria: age <30 years, removable prosthetics, uncontrolled diabetes, pregnancy/lactation, and oncologic disease. RESULTS: Class II malocclusion was found in 49.6% (Class II div 1-20.7%, Class II div 2-9.9%, subdivision Class II-19.0%), Class I-31.4%, Class III-10.7%, no malocclusion-8.3% of subjects. PTM was observed in 74.4% of maxillary and 60.3% of mandibular AT. Spacing and extrusion were the main types of PTM of AT. Odds ratio for PTM of maxillary AT was 9.3 in cases with >30% of sites with clinical attachment loss ≥5 mm (P = 0.001). Spacing of maxillary AT was influenced by periodontitis, Class III malocclusion, and lost teeth. Tongue habit had impact on spacing of mandibular AT. Dental Health Component of Index of Orthodontic Treatment Need yielded that OTN was found in >50% and OTN due PTM, occlusal trauma and impaired function in 66.1% of subjects. CONCLUSIONS: The most prevalent malocclusion was Class II. Spacing and extrusion were prevalent types of PTM of AT. OTN was found in more than half of the subjects. The study highlights the need for preventive measures for PTM in subjects with stage III-IV periodontitis.

Pediatric sleep-disordered breathing in Shanghai: characteristics, independent risk factors and its association with malocclusion.

OBJECTIVES: This study aimed to determine the prevalence and independent risk factors of SDB, and explore its association with malocclusion among 6-11-year-old children in Shanghai, China. METHODS: A cluster sampling procedure was adopted in this cross-sectional study. Pediatric Sleep Questionnaire (PSQ) was applied to evaluate the presence of SDB. Questionnaires including PSQ, medical history, family history, and daily habits/environment were completed by parents under instruction, and oral examinations were implemented by well-trained orthodontists. Multivariable logistic regression was applied to identify independent risk factors for SDB. Chi-square tests and Spearman's Rank Correlation were used to estimate the relationship between SDB and malocclusion. RESULTS: A total of 3433 subjects (1788 males and 1645 females) were included in the study. The SDB prevalence was about 17.7%. Allergic rhinitis (OR 1.39, 95% CI 1.09-1.79), adenotonsillar hypertrophy (OR 2.39, 95% CI 1.82-3.19), paternal snoring (OR 1.97, 95% CI 1.53-2.53), and maternal snoring (OR 1.35, 95% CI 1.05-1.73) were independent risk factors for SDB. The SDB prevalence was higher in children with retrusive mandibles than in proper or excessive ones. No significant difference was observed in the correlation between SDB and lateral facial profile, mandible plane angle, constricted dental arch form, the severity of anterior overjet and overbite, degree of crowding and spacing, and the presence of crossbite and open bite. CONCLUSIONS: The prevalence of SDB in primary students in the Chinese urban population was high and highly associated with mandible retrusion. The independent risk factors included Allergic rhinitis, adenotonsillar hypertrophy, paternal snoring, and maternal snoring. More efforts should be made to enhance public education about SDB and related dental-maxillofacial abnormalities.

Determinants of awake oropharyngeal volume reduction between sitting and supine positions in children evaluated for snoring.

Pharyngeal collapsibility is a major determinant of obstructive sleep apnea (OSA) pathophysiology, but its anatomical predictors in children are largely unknown. We hypothesised that anatomical (tonsillar hypertrophy, narrow palate, nasal obstruction, dental/skeletal malocclusion, obesity) and OSA-related (apnea-hypopnea index, AHI) parameters could be related to a measure of awake pharyngeal collapsibility. We performed acoustic pharyngometry in children evaluated for suspected OSA, allowing us to measure the reduction of oropharyngeal volume in supine versus sitting position normalised for the volume in supine position (ΔV%), a measure of pharyngeal collapsibility. In addition to polysomnography and a clinical examination (anatomical parameters), acoustic rhinometry was used to assess nasal obstruction. A total of 188 snoring children were included, 118 (63%) of whom were obese and 74 (39%) of whom had moderate to severe OSA (AHI ≥5/h). The median (25th-75th percentiles) ΔV% in the whole population was 20.1% (4.7; 43.3). ΔV% was independently and positively associated with AHI (p = 0.023), z-score of BMI (p = 0.001), tonsillar hypertrophy (p = 0.007), narrow palate (p = 0.035), and African (p < 0.001) ancestry. By contrast, ΔV% was not modified by dental or skeletal malocclusion, Friedman palate position class or nasopharyngeal obstruction. Tonsillar hypertrophy, obesity, narrow palate and African ancestry are independently associated with an increase in pharyngeal collapsibility in snoring children, thus increasing the risk of OSA. Increased pharyngeal compliance in African children may explain the increased risk of residual OSA after adenotonsillectomy observed in this population.

Determination of the range of intervention timing for supernumerary teeth using the Korean health insurance review and assessment service database.

This study aimed to identify the frequency of complications during the diagnosis, observation, and treatment of supernumerary teeth or odontomas and evaluate the relationship between complications and the timing of surgical intervention. This study was conducted based on data from the Korea Health Insurance Review and Assessment Service between January 2008 and December 2019. A 2-year washout period was applied, and a follow-up period of at least 2 years was also included. During the observation period, the age at diagnosis of supernumerary teeth and odontomas was analyzed using major diagnostic codes, and the treatment codes were used to determine the interval between diagnosis and surgical intervention. The incidence rates of supernumerary teeth (1.21%) and odontomas (0.36%) were comparable to that reported in previous studies. The frequency of supernumerary teeth was the highest in the anterior region, followed by the premolar and molar regions. The average ages at diagnosis according to the location of the supernumerary teeth were 7.25, 13.98, and 16.11 years in the anterior, premolar, and molar regions, respectively. The age at diagnosis correlated with the maturity period of the teeth at the corresponding location. For the supernumerary tooth group, surgical intervention was more likely to occur when malocclusion (p < 0.0001) or tooth eruption disturbances (p < 0.0001) were present or dentigerous cysts were absent (p = 0.006). For the odontoma group, malocclusion (p = 0.251) was not correlated with surgical intervention. When tooth eruption disturbances (p = 0.002) and dentigerous cysts (p < 0.0001) were present, surgical intervention was more likely to occur. Pediatric dentists should conduct timely clinical checks and periodic follow-ups to prevent complications and unnecessary orthodontic treatments in patients with supernumerary teeth or odontomas.

Genetic architecture of non-syndromic skeletal class III malocclusion.

Non-syndromic skeletal Class III malocclusion is a major craniofacial disorder characterized by genetic and environmental factors. Patients with severe skeletal Class III malocclusion require orthognathic surgery to obtain aesthetic facial appearance and functional occlusion. Recent studies have demonstrated that susceptible chromosomal regions and genetic variants of candidate genes play important roles in the etiology of skeletal Class III malocclusion. Here, we provide a comprehensive review of our current understanding of the genetic factors that affect non-syndromic skeletal Class III malocclusion, including the patterns of inheritance and multiple genetic approaches. We then summarize the functional studies on related loci and genes using cell biology and animal models, which will help to implement individualized therapeutic interventions.

The Stability Guided Multidisciplinary Treatment of Skeletal Class III Malocclusion Involving Impacted Canines and Thin Periodontal Biotype: A Case Report with Eight-Year Follow-Up.

Skeletal class III malocclusion with severe skeletal disharmonies and arch discrepancies is usually treated via the conventional orthodontic-surgical approach. However, when associated with tooth impaction and periodontal risks, the treatment is more challenging and complex. The esthetic, occlusal, and periodontal stability of the treatment outcome is more difficult to obtain. The 16-year-old female patient in this case was diagnosed with dental and skeletal Class III malocclusion, bilateral impacted maxillary canines, and scalloped thin gingiva. The multidisciplinary management included a segmental arch technique, extracting two premolars, a subepithelial connective tissue graft surgery, and orthognathic surgery. The esthetic facial profile, pleasant smile, appropriate occlusion, and functional treatment results were obtained and maintained in 8-year follow-up.

The impact of mouth breathing on dentofacial development: A concise review.

Mouth breathing is one of the most common deleterious oral habits in children. It often results from upper airway obstruction, making the air enter completely or partially through oral cavity. In addition to nasal obstruction caused by various kinds of nasal diseases, the pathological hypertrophy of adenoids and/or tonsils is often the main etiologic factor of mouth breathing in children. Uncorrected mouth breathing can result in abnormal dental and maxillofacial development and affect the health of dentofacial system. Mouth breathers may present various types of growth patterns and malocclusion, depending on the exact etiology of mouth breathing. Furthermore, breathing through the oral cavity can negatively affect oral health, increasing the risk of caries and periodontal diseases. This review aims to provide a summary of recent publications with regard to the impact of mouth breathing on dentofacial development, describe their consistencies and differences, and briefly discuss potential reasons behind inconsistent findings.

A surgeon's perspective on the uncorrected skeletal deformity. Part I: Unintended consequences on facial structures and esthetic harmony.

It is not uncommon for orthodontists to encounter patients whose malocclusion results, at least in part, from an underlying skeletal discrepancy. In many patients, these discrepancies can be fully corrected with growth modification with or without dental compensation to achieve a Class I occlusal relationship. A subset of patients with moderate skeletal deformities in whom surgery is ideally indicated but who choose to defer surgical treatment may be at risk for long-term adverse consequences on facial esthetics. As a surgeon who performs both orthognathic and facial esthetic surgery, the senior author has had the opportunity to appreciate the contributions of underlying skeletal deformities to his patients' esthetic concerns. These patients often present years after orthodontic treatment with complaints of early facial soft tissue laxity, facial disproportion, and overall dissatisfaction with facial appearance. The authors hope to illustrate to the orthodontic community the clinical picture of adult patients who present to the offices of surgeons dissatisfied with their appearance secondary to the uncorrected skeletal deformity. This paper aims to increase orthodontists' awareness of the long-term effects of uncorrected skeletal dysplasia on facial appearance. The ultimate goal is to allow the informed consent process to incorporate these esthetic consequences and to facilitate patient decision making. This article serves as Part I of a 2-part series reviewing a surgeon's approach to patients who present with facial skeletal disharmony after orthodontic treatment with dental compensation.

Specific dento-craniofacial characteristics in non-syndromic children can predispose to sleep-disordered breathing.

AIM: To ascertain and illustrate specific clinical dento-craniofacial characteristics associated with sleep-disordered breathing (SDB) in non-syndromic children. METHODS: Narrative review of literature on SDB, dental occlusion and craniofacial morphology retrieved through online literature database search for these terms. The review focused on clinical examples and graphical illustrations in order to ascertain the association between dento-craniofacial characteristics and SDB. Only publications concerning healthy non-syndromic children without any somatic or psychological diagnosis were included. RESULTS: Dento-craniofacial characteristics such as anterior open bite, large overjet, cross bite and facial appearance such as convex profile due to mandibular retrognathia and inclination, narrow and high palate can predispose to SDB in non-syndromic children. Furthermore, extended head posture, mouth breathing and general adenoidal face may be symptoms or predisposing factors to SDB in non-syndromic children. CONCLUSION: Dento-craniofacial characteristics as anterior open bite, large overjet due to mandibular retrognathia, cross bite, and narrow and high palate can predispose to SDB in non-syndromic children. Facial characteristics predisposing to SDB can be a convex facial profile, extended head posture, mouth breathing and general adenoidal face. Interdisciplinary collaboration between medical doctors and dentists can prove valuable in diagnostics, prevention and treatment of SDB in non-syndromic children.

Malocclusion in individuals with osteogenesis imperfecta: A systematic review and meta-analysis.

OBJECTIVE: To evaluate whether individuals with osteogenesis imperfecta (OI) are more affected by malocclusion than individuals without OI. MATERIALS AND METHODS: Searches in PubMed, Ovid, Web of Science, Scopus, Lilacs and gray literature were performed. Data extraction was conducted by two researchers. Risk of bias assessment employing the Newcastle-Ottawa Scale and meta-analysis were conducted. Results were provided with mean difference (MD), odds ratio (OR) and 95% confidence interval (CI). Strength of evidence was determined. RESULTS: Six cross-sectional studies were included. In comparison with individuals without OI, the group with OI had 19.69-fold greater chance of exhibiting Angle Class III malocclusion (OR = 19.69, CI: 9.00-43.09) and presenting anterior crossbite greater (MD = 6.08, CI: 2.40-9.77). Individuals without OI had a significantly greater ANB angle (MD = 3.88, CI: 1.15-6.61) and SNA angle (MD = 2.11, CI: 0.24-3.98) in comparison with those with OI. No difference between groups was found for SNB (MD = -0.50, CI: -2.21 to 1.21) and open bite (MD = 0.98, CI: -0.29 to 2.25). Most studies included had moderate methodological quality. Strength of evidence was low or very low. CONCLUSIONS: The occurrence of Angle Class III malocclusion and anterior crossbite was greater among individuals with OI compared to those without OI. These findings can assist stakeholders about the occlusal abnormalities affecting OI individuals.

The consequences of living with a severe malocclusion: A review of the literature.

AIM: To facilitate the orthognathic shared decision-making process by identifying and applying existing research evidence to establish the potential consequences of living with a severe malocclusion. METHODS: A comprehensive narrative literature review was conducted to explore the potential complications of severe malocclusion. A systematic electronic literature search of four databases combined with supplementary hand searching identified 1024 articles of interest. A total of 799 articles were included in the narrative literature review, which was divided into 10 themes: Oral Health Related Quality Of Life; Temporomandibular Joint Dysfunction; Masticatory Limitation; Sleep Apnoea; Traumatic Dental Injury; Tooth Surface Loss; Change Over Time; Periodontal Injury; Restorative Difficulty; and Functional Shift and Dual Bite. A deductive approach was used to draw conclusions from the evidence available within each theme. RESULTS: The narrative literature review established 27 conclusions, indicating that those living with a severe malocclusion may be predisposed to a range of potential consequences. With the exception of Oral Health Related Quality Of Life, which is poorer in adults with severe malocclusion than those with normal occlusions, and the risk of Traumatic Dental Injury, which increases when the overjet is >5 mm in the permanent and 3 mm in the primary dentition, the evidence supporting the remaining conclusions was found to be of low to moderate quality and at high risk of bias. CONCLUSION: This article summarises the findings of a comprehensive narrative literature review in which all of the relevant research evidence within a substantive investigative area is established and evaluated. Notwithstanding limitations regarding the quality of the available evidence; when combined with clinical expertise and an awareness of individual patient preferences, the conclusions presented may facilitate the orthognathic shared decision-making process and furthermore, may guide the development of the high-quality longitudinal research required to validate them.

Association between upper airway obstruction and malocclusion in mouth-breathing children.

OBJECTIVES: To evaluate the association between upper airway obstruction and occlusal anomalies in mouth-breathing children. METHODS: 356 mouth-breathing children were evaluated by ENT physicians and specialists in orthodontics. ENT examination included nasal endoscopy to assess the adenoidal hypertrophy, tonsillar grading and presence of nasal septum deviation. Clinical orthodontic examination was performed to record occlusal variables. Univariate and multivariable logistic regression were performed to study the association between registered variables. RESULTS: 221 patients (mean age ± sd = 6.2 ± 2.5 years) met inclusion criteria. 81.4% of children presented malocclusion. A significant association between tonsillar grade 2 and the presence of malocclusion, Class II relation and increased overjet was shown. Tonsillar grade 4 showed a significant association with the presence of malocclusion and increased overjet. Adenoidal hypertrophy and nasal septum deviation did not show any association with occlusal findings. CONCLUSIONS: A high frequency of orthodontic problems was seen in mouth-breathing children. Our results suggested that severe tonsillar hypertrophy may determine presence of malocclusion and increased overjet. On the other hand, the association between mild tonsillar hypertrophy and many occlusal anomalies in mouth-breathers suggest an important role of malocclusion in the onset of oral breathing in children.

Clave I de la oclusión según los criterios de Andrews y los trastornos temporomandibulares / Key I of occlusion according to the Andrews criteria and temporomandibular disorders / Chave I da oclusão de acordo com os critérios de Andrews e distúrbios temporomandibulares

RESUMEN Introducción: El estudio de la oclusión y su papel en la etiología de los trastornos temporomandibulares ha sido un tema controvertido y de interés en el campo estomatológico. Objetivo: Determinar la relación entre la oclusión, según clave I de los criterios de Andrews y los trastornos temporomandibulares. Método: Se realizó un estudio observacional, descriptivo, de corte transversal a estudiantes de la carrera de Estomatología en la Clínica Estomatológica Docente Provincial de la ciudad de Sancti-Spíritus, en el periodo comprendido de septiembre de 2018 a septiembre de 2019. El universo fue de 42, la muestra aleatoria simple fue conformada por 40 estudiantes, los que respondían a los criterios de inclusión. Las variables de estudio fueron: presencia de trastorno temporomandibular, relación de molares, de caninos y coincidencia de las líneas media. Se utilizaron métodos del nivel teórico, empírico, estadísticos y matemáticos. Resultados: El 52,5 % de los pacientes presentó trastornos temporomandibulares, de los cuales, la relación de molares era bilateral en el 80 %. Con respecto a la relación de caninos, todos los afectados presentaron relación de mesio, disto o combinación de ellas. La mayoría de los no afectados (89,5 %) tenía coincidencia de las líneas media. Conclusiones: Se constata que cualquier alteración en la oclusión dentaria según los criterios de Andrews tendrán consecuencias en el sistema estomatognático y, por tanto, en la aparición de los trastornos temporomandibulares.

ABSTRACT Introduction: The study of occlusion and its role in the etiology of temporomandibular disorders has been a controversial topic of interest in the stomatological field. Objective: To determine the relationship between occlusion, according to key I of the Andrews criteria, and temporomandibular disorders. Method: An observational, descriptive, cross-sectional study was carried out on students of dentistry at the Clínica Estomatológica Docente Provincial of the city of Sancti-Spíritus, in the period from September 2018 to September 2019. The population was of 42 students, the simple random sample consisted of 40 of them, those who responded to the inclusion criteria. The study variables were: presence of temporomandibular disorder, canines and molars ratio and coincidence of dental midlines. Methods of the theoretical, empirical, statistical and mathematical levels were used. Results: 52.5% of the patients presented temporomandibular disorders, of which the molar relationship was bilateral in 80%. Regarding the relationship of canines, all those affected presented a relationship of mesio, disto or a combination of them. Most of the unaffected (89.5%) had midline coincidence. Conclusions: It is found that any alteration in dental occlusion according to the Andrews criteria will have consequences on the stomatognathic system and, therefore, on the appearance of temporomandibular disorders.

RESUMO Introdução: O estudo da oclusão e seu papel na etiologia dos distúrbios temporomandibulares tem sido um tema controverso e de interesse no campo estomatológico. Objetivo: Determinar a relação entre oclusão, de acordo com a chave I dos critérios de Andrews, e distúrbios temporomandibulares. Método: Foi realizado um estudo observacional, descritivo e transversal com alunos da carreira de Estomatologia da Clínica Estomatológica Docente Provincial da cidade de Sancti Spíritus, no período de setembro de 2018 a setembro de 2019. O universo foi de 42, a amostra aleatória simples foi composta por 40 alunos, aqueles que responderam aos critérios de inclusão. As variáveis de estudo foram: presença de disfunção temporomandibular, relação de molares, caninos e coincidência das linhas médias. Foram utilizados métodos dos níveis teórico, empírico, estatístico e matemático. Resultados: 52,5% dos pacientes apresentavam disfunção temporomandibular, sendo a relação molar bilateral em 80%. Sobre a relação dos caninos, todos os afetados apresentaram relação de mesio, disto ou uma combinação dos dois. A maioria dos não afetados (89,5%) teve uma coincidência das linhas médias. Conclusões: Verifica-se que qualquer alteração da oclusão dentária de acordo com os critérios de Andrews terá consequências no sistema estomatognático e, portanto, no aparecimento dos distúrbios temporomandibulares.

Correlation between the cephalometric measurements and acoustic properties of /s/ sound in Turkish

Abstract Objectives To evaluate the acoustic properties of the /s/ sound in individuals with different occlusion types and to investigate relationships between these properties and cephalometric measurements. Methodology Sixty patients were divided into three groups based on malocclusion. Group 1 included 20 patients (mean age: 14.85±2.01 years) with Class I skeletal and dental relationships. Group 2 included 20 patients (mean age: 13.49±1.78 years) with Class II skeletal and dental relationships. Group 3 included 20 patients (mean age: 12.46±2.62 years) with Class III skeletal and dental relationships. Cephalometric tracings were obtained from cephalometric radiographs. All included patients were native speakers of Turkish. The /s/ sound was selected for center of gravity analysis. Correlations between cephalometric values and acoustic parameters were also investigated. Results The center of gravity of the /s/ sound had the lowest value in Group 2 (p<0.05). For the /s/ sound in Group 3, moderate positive correlations were found between center of gravity and Sella-Nasion to Gonion-Gnathion angle (p<0.05, r=0.444) Lower incisor to Nasion-B point (p<0.023, r=0.505), and Lower incisor to Nasion-B point angle (p<0.034; r=0.476). No correlation was found in other cephalometric measurements. Conclusions The /s/ sound was affected by malocclusion due to the changing place of articulation. Therefore, referral to an orthodontist for malocclusion treatment especially patients with class III in the early period is suggested for producing acoustically ideal sound.

Prevalencia de apiñamiento dental en la población costarricense que consulta los servicios de odontología de la CCSS, 2017 / Prevalence of dental crowding in the costarican population consulting the dental services of the CCSS, 2017

Resumen El objetivo del presente estudio es determinar la prevalencia del apiñamiento dental determinando el comportamiento y la prevalencia de esta anomalía en el ciclo de vida de las personas y el grupo dentario más afectado en la población que consulta los servicios de odontología de la CCSS. Se realizó un estudio descriptivo del 1 de enero al 30 de abril del 2017 en las áreas de salud del país donde se valoró la cantidad de pacientes sugeridos; para el examen clínico se usó como soporte la ficha de encuesta para la evaluación del estado de salud bucodental, elaborada con variables con base en las necesidades de esta investigación. Se recolecta una muestra de 104.691 datos de personas, en el que el muestreo estratificado por grupos de edad prefijados, es el siguiente: 9.652 niños de 0 a 5 años; 4.270 niños de 6 años; 10.477 niños de 7 a 9 años; 9.495 adolescentes de 10 a 12 años; 13.096 jóvenes de 13 a 19 años; 14.532 mujeres de 20 a 35 años; 7.586 mujeres de 36 a 45 años; 13.435 adultos de 20 a 45 años; 13.504 adultos de 46 a 59 años y 8.644 adultos mayores de 60 y más años, y esta información es procedente de las áreas de salud de las diferentes regiones del país. La prevalencia nacional del apiñamiento dental se estimó en 10% (0,0981 - 0,1018) IC95%, y la prevalencia de apiñamiento dental es menor del 1% en el grupo de 0-5 años, y empieza un aumento acelerado hasta 17% a la edad de 13-19 años, para luego disminuir hasta el 3% en el adulto mayor; que disminuye a partir del grupo de los 13 a 19, debido a que en estas edades comienza a incrementarse la pérdida de piezas dentales producto de la caries dental en que la prevalencia de pieza perdida dental de 5% en el grupo de 13 a 19 se incrementa hasta llegar al 75% en el adulto mayor y la pérdida de dientes por enfermedad periodontal de 0,08 en los adolescentes de 13 a 19 años para luego incrementarse paulatinamente hasta llegar al 18% en el adulto y luego aumentar abruptamente al 39% en el adulto mayor. El apiñamiento promueve dificultades para comer, hablar e incluso problemas bucodentales como consecuencia de la acumulación de placa, caries, enfermedad periodontal, disfunción de la articulación temporomandibular (ATM), además de repercutir en la estética del paciente, disminuyendo su autoestima, por lo que, realizar este tipo de investigaciones nos ayuda a conocer el impacto que tienen este tipo de patologías en la población y que por ser un problema de salud pública, es de especial interés para los tomadores de decisiones en salud, conocer a fondo dicha problemática.

Abstract The aim of this study is to estimate the prevalence of dental crowding, determining its behavior and presence of this anomaly through life, also the most affected population group that uses the dentistry services of CCSS. A descriptive study was made from January 1st through April 30, 2017, in different Costa Rican health services, the number of necessary patients was calculated; for the clinical exam a dental survey record chart was used to evaluate oral health conditions, this chart was specifically designed for the needs of this investigation A sample of 104.691 patients was documented, in which stratified sampling of previously selected age groups was designated as follows: 9.652 children from 0 to 5 years old; 4.270 children under 6 years, 10.477 children from 7 to 9 years old; 9.495 teenagers from 10 to 12 years old; 13.096 teenagers from 13 to 19 years of age; 14.532 women from 20 to 35 years old; 7.586 women from 36 to 45 years old; 13.435 adults from 20 to 45 years of age; 13.504 adults from 46 to 59 years old and 8.644 adults at age 60 or older, and this information proceeded from different regions of the country. The Crowding National Prevalence was estimated at 10% (0.0981 - 0.1018) IC95%, in the group from 0 to 5 years old crowding was lower than 1%, and started increasing quickly up to 17% at 13-19 years of age, after that it lowered down to 3% in the elderly group; crowding decreased in group 13 to 19 years old, possibly because at these ages tooth loss starts increasing due to dental cavities. Tooth loss at ages 13 to 19 had a prevalence of 5% and increased up to 75% in the elderly group. Tooth loss caused by periodontal disease in the age group 13 to 19 had a prevalence of 0.08 and gradually increased to 18% in adults and 39% in the elderly group. Crowding promotes difficulties for eating, speaking, increases oral problems as a consequence of biofilmbaccumulation, dental cavities, periodontal disease, TMD, as well as affecting the patient's esthetics lowering self-esteem, for these reasons this type of investigations helps to understand the impact of this pathology over the population, and since it is viewed as a public health issue, it is of special interest in the health program's decisión making process to comprehend such problematic.