Post-treatment stability after 5 years of retention with vacuum-formed and bonded retainers-a randomized controlled trial.

BACKGROUND: Retention after orthodontic treatment is still a challenge and more evidence about post-treatment stability and patients' perceptions of different retention strategies is needed. OBJECTIVES: This trial compares removable vacuum-formed retainers (VFR) with bonded cuspid-to-cuspid retainers (CTC) after 5 years of retention. TRIAL DESIGN: A single centre two-arm parallel-group randomized controlled trial. METHODS: This trial included 104 adolescent patients, randomized into two groups (computer-generated), using sequentially numbered, opaque, and sealed envelopes. All patients were treated with fixed appliances in both jaws with and without tooth extractions. Patients in the intervention group received a VFR in the mandible (n = 52), and patients in the active comparator group received a CTC (n = 52). Both groups had a VFR in the maxilla. Dental casts at debond (T1), after 6 months (T2), after 18 months (T3), and after 5 years (T4) were digitized and analysed regarding Little's Irregularity Index (LII), overbite, overjet, arch length, and intercanine and intermolar width. The patients completed questionnaires at T1, T2, T3, and T4. RESULTS: Post-treatment changes between T1 and T4 in both jaws were overall small. In the maxilla, LII increased significantly (median difference: 0.3 mm), equally in both groups. In the mandible, LII increased significantly in the group VFR/VFR (median difference: 0.6 mm) compared to group VFR/CTC (median difference: 0.1 mm). In both groups, overjet was stable, overbite increased, and arch lengths decreased continuously. Intercanine widths and intermolar width in the mandible remained stable, but intermolar width in the maxilla decreased significantly. No differences were found between groups. Regardless of retention strategy, patients were very satisfied with the treatment outcome and their retention appliances after 5 years. LIMITATIONS: It was not possible to perform blinded assessments of digital models at follow-up. CONCLUSIONS: Post-treatment changes in both jaws were small. Anterior alignment in the mandible was more stable with a bonded CTC retainer compared to a removable VFR after 5 years of retention. Patients were equally satisfied with fixed and removable retention appliances. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03070444).

Relationship Between Occlusal Features and Enzyme Replacement Therapy in Patients With Mucopolysaccharidoses.

PURPOSE: The aim of this study was to describe the relation between occlusal features and enzyme replacement therapy in patients with mucopolysaccharidoses. MATERIALS AND METHODS: A cross-sectional study was conducted. The sample consisted of 20 patients with mucopolysaccharidoses, 10 of whom were undergoing treatment at a hospital in northeast Brazil. Occlusal features were evaluated by clinical examination and panoramic radiography. A structured questionnaire was administered to evaluate the dental care of each patient. Pearson χ2, Fisher exact, and Mann-Whitney tests were used for data analysis, with a level of significance of 5%. RESULTS: Marked overjet (75%) and anterior open bite (70%) were the most frequent occlusal alterations, and 15% had Class III disorders. Radiography visualized the presence of impacted teeth (75%) and prolonged retention of deciduous teeth (65%). Patients with enzyme replacement therapy had a lower average maximum protrusion (P = .033). A total of 75% of mothers said they had not been advised to take their children to the dentist and 10% of children had never been to the dentist. CONCLUSION: Patients with mucopolysaccharidoses exhibited notable occlusal alterations, especially marked overjet and anterior open bite. Enzyme replacement therapy seems to influence the maximum protrusion of patients.

Orthodontic correction of severe Class II malocclusion in a patient with Prader-Willi syndrome.

Prader-Willi syndrome (PWS) is a complex disorder that affects multiple systems and may cause craniofacial and dentofacial abnormalities. However, there is still a lack of evidence in the literature regarding the progress of orthodontic treatment in patients with PWS. This case report describes the successful orthodontic treatment of a patient with PWS. A girl, 9 years 0 months of age, who had been diagnosed with PWS had protruding maxillary incisors and a convex profile. Her malocclusion was due to the posteriorly positioned mandible. Screening tests for sleep apnea syndrome showed that she had sleep-disordered breathing, including obstructive sleep apnea and bruxism. We also observed an excessive overjet of 10.0 mm, a deep overbite of 6.8 mm, and the congenital absence of the mandibular second premolars. The patient was diagnosed with an Angle Class II malocclusion and a skeletal Class II jaw-base relationship with a deep overbite. Functional appliance therapy with mandibular advancement, which can enlarge the upper airway and increase the upper airspace, was performed to prevent further deterioration of the patient's obstructive sleep apnea. An acceptable occlusion with a proper facial profile and functional excursion were achieved without interference after comprehensive 2-stage treatment that incorporated orthodontic therapy for the patient's excessive overjet and deep overbite. The resulting occlusion was stable, and the occlusal force and the contact area gradually increased over a 2-year retention period. These results suggest that orthodontic treatment offers the opportunity to greatly improve the health and quality of life of people with PWS.

Dentoskeletal effects of oral appliance wear in obstructive sleep apnoea and snoring patients.

OBJECTIVES: To evaluate the dentoskeletal changes associated with long-term and continuous mandibular advancement device (MAD) use in sleep-related breathing disorder patients. METHODS: Cephalometric measurements and three-dimensional model analysis were performed at baseline and after 3.5 ± 1.1 years in 20 snoring and obstructive sleep apnoea patients treated with the Silensor® appliance. Intra-group differences were compared using paired t-test or Wilcoxon signed-rank test. A regression analysis was performed for variables that showed a statistically significant difference between time points to evaluate the influence of treatment time and patient's initial characteristics on their variations. The statistical significance was set at P < 0.05. RESULTS: At cephalometric assessment, the maxilla revealed a significant decrease in horizontal position (SNA: -0.4 ± 0.72 degree, P = 0.021) and a significant retroclination of the upper incisor (-1.59 ± 1.07 degree, P < 0.001), while the mandible displayed a significant downward rotation (0.88 ± 1.28 degree, P = 0.006) and a proclination of the lower incisor (2.27 ± 1.38 degree, P < 0.001). Model analysis showed a decrease in upper total space discrepancy (-0.66 ± 0.72 mm, P < 0.002), overjet (OJ; -0.34 ± 0.47 mm, P < 0.011), and overbite (-0.4 ± 0.52 mm, P < 0.004). In the regression analysis, treatment time influenced the lower incisor inclination (Beta = -0.713, P = 0.018) and OJ (Beta = -0.218, P = 0.018); patients' initial characteristics had an effect on OJ (Beta = -0.195, P = 0.011). LIMITATIONS: A larger sample size could increase the generalizability of the findings. CONCLUSION: MAD wear after a mean of 3.5 years determines statistically significant but clinically irrelevant dentoskeletal changes. Their potential occurrence should be thoroughly discussed with patients; regular follow-up visits by a specialist experienced in dental sleep medicine are also mandatory during treatment in addition to polysomnographic examinations.

Characteristic of Malocclusion among Saudi Special Need Group Children.

INTRODUCTION: The present study analyzed the characteristics of malocclusions, occlusal traits among Special Health care Needs (SHCN) children with Down syndrome (DS) and autism disorder (AD) in Riyadh City, Kingdom of Saudi Arabia. MATERIALS AND METHODS: A total of 100 DS and 100 AD children from five rehabilitation centers in and around Riyadh, Kingdom of Saudi Arabia, were included in the study. Any children with history of ongoing medical treatment, extraction, or orthodontic treatment were excluded from the study. Out of the 200 patients examined, 131 were males and 69 were females and the age of the children ranged from 6 to 14 years. The children were examined for malocclusion characteristics using the Angle's classification of malocclusion, and also other occlusal traits, such as overjet, overbite, cross bite, and open bite were also determined. The data obtained were analyzed using Statistical Package for the Social Sciences, version 16 to generate descriptive statistics for each variable. RESULTS: The analyzed data of the right and left permanent molar relation showed higher incidence of class III malocclusion (66%) in DS children as compared with (3-4%) AD children. The AD children presented with higher percentage of class I malocclu-sion (40-41%) as compared with (10-14%) DS children. During examination of the primary molars, the analyzed data showed that left primary molar had more mesial shift in AD children as compared with DS children. CONCLUSION: Down syndrome children had high incidence of class III malocclusion and autistic children had high incidence of class I malocclusion. Overall, the DS children were more prone to malocclusion. CLINICAL SIGNIFICANCE: This study provides database for health professionals in Saudi Arabia in regard to malocclusion of autis-tics and DS patients.

The relationship between craniofacial development and hypodontia in patients with Down syndrome.

BACKGROUND/OBJECTIVE: Hypodontia is often seen in people with Down syndrome (DS). In the normal population, persons with hypodontia have a shorter cranial base and a hypoplastic maxilla, leading to a skeletal Class III tendency and a reduced face height. The purpose of this study was to examine craniofacial morphology in patients with DS at different ages and the influence of hypodontia on their craniofacial morphology. MATERIALS AND METHODS: A comparative cross-sectional study was conducted in 63 children with DS (6-19 years old; 28 males and 35 females) at a Centre for Special Care Dentistry in Rotterdam, the Netherlands (CBT Rijnmond). Digital lateral cephalograms were obtained from all subjects and a cephalometric analysis was performed. The subjects were divided into a group with hypodontia (13 males and 25 females) and a group without hypodontia (15 males and 10 females). RESULTS: Significant results included a decrease in antero-posterior relationship of upper and lower jaw (ANB angle -0.331° per year, P = 0.044) and a decrease in vertical dimension (S-N_Go-Gn angle -0.72° per year, P = 0.039) over the years in subjects with hypodontia compared to subjects without hypodontia. CONCLUSION: The process of growth in DS patients is towards a reversed overjet. Hypodontia seems to have an additional effect on this development. The management of hypodontia as part of the complete treatment of dental development in DS children is important because it strongly influences the jaw relationship.

Orthodontic Treatment of Maxillary Incisors with Severe Root Resorption Caused by Bilateral Canine Impaction in a Class II Division 1 Patient.

This case report shows the successful alignment of bilateral impacted maxillary canines. A 12-year-old male with the chief complaint of the protrusion of his maxillary anterior teeth happened to have bilateral maxillary canine impaction on the labial side of his maxillary incisors. Four maxillary incisors showed severe root resorption because of the impacted canines. The patient was diagnosed as skeletal Class II malocclusion with proclined maxillary incisors. The impacted canine was carefully retracted using sectional buccal arch wires to avoid further root resorption of the maxillary incisors. To distalize the maxillary dentition, two palatal miniscrews were used. After 25 months of treatment, the maxillary canines were well aligned without any additional root resorption of the maxillary incisors.

Longitudinal study of habits leading to malocclusion development in childhood.

BACKGROUND: The increased prevalence of malocclusions represents a secular trend attributed to the interaction of genetic and environmental factors. The analysis of factors related to the causes of these changes is essential for planning public health policies aimed at preventing and clinically intercepting malocclusion. This study investigated the sucking habits, nocturnal mouth breathing, as well as the relation of these factors with malocclusion. METHODS: This is a longitudinal study in which 80 mother-child pairs were monitored from the beginning of pregnancy to the 30th month after childbirth. Home visits for interviews with the mothers were made on the 12th, 18th and 30th months of age. Finger sucking, pacifier sucking, bottle feeding, breastfeeding and nocturnal mouth breathing, were the variables studies. On the 30th month, clinical examinations were performed for overjet, overbite and posterior crossbite. A previously calibrated single examiner (Kappa coefficient = 0.92) was responsible for all examinations. Data were analyzed using the chi-squared or Fisher's exact tests, at a significance level of 5%. RESULTS: Bottle feeding was the most prevalent habit at 12, 18 and 30 months (87.5%; 90% and 96.25%, respectively). Breastfeeding was 40%, 25% and 12.50% at 12, 18 and 30 months, respectively. Nearly 70% of the children in this study had some sort of malocclusion. Pacifier sucking habit at 12, 18 and 30 months of age was associated with overjet and open bite; and at 30 months, an association with overbite was also observed. Finger sucking habit and breastfeeding at 12, 18 and 30 months were also associated with overjet and open bite. The posterior crossbite was associated with bottle feeding at 12 and 30 months, and nocturnal mouth breathers at 12 and 18 months. CONCLUSIONS: Sucking habits, low rates of breastfeeding, and nocturnal mouth breathing were risk factors for malocclusion.

Allergic rhinitis as a possible risk factor for malocclusion: a case-control study in children.

BACKGROUND: Prolonged oral respiration is known to cause postural alterations, which can lead to dental malocclusions. Allergic rhinitis, a common cause of upper airway obstruction in children, must therefore be seen as a possible risk factor in the development of malocclusions. AIM: Aim of this study was to investigate the association between allergic rhinitis and malocclusions in primary and early-mixed dentition. DESIGN: A case-control study was carried out involving 275 Italian children aged 5-9. The case group and the control group were composed of 125 individuals affected by malocclusions and by 150 healthy patients, respectively. Through a questionnaire, we assessed the presence of professionally diagnosed allergic rhinitis. Data were analysed to identify associations between these variables and the presence of malocclusions. RESULTS: Children with a history of allergic rhinitis had a threefold increased risk to develop one or more dento-skeletal alterations [OR = 3.16; 95% CI (1.79-5.58), P < 0.001]. Statistically significant associations were found between allergic rhinitis and the development of posterior crossbite and increased overjet. No significant association was found for anterior openbite. CONCLUSIONS: Allergic rhinitis is a significant risk factor for the development of malocclusions in general and is associated with the development of posterior crossbite and increased overjet.

Craniofacial characteristics in unilateral complete cleft lip and palate patients with congenitally missing teeth.

INTRODUCTION: Congenitally missing permanent teeth are common in patients with clefts. This retrospective study was conducted to evaluate the craniofacial characteristics in patients with unilateral complete cleft lip and palate with congenitally missing permanent teeth. METHODS: A series of 73 consecutive patients with nonsyndromic unilateral complete cleft lip and palate were enrolled. Evaluation of congenitally missing permanent teeth was based on the panoramic films taken from 7 to 11 years of age. The cephalometric films taken around 9 years of age were used to compare the craniofacial morphology in patients with no congenitally missing permanent teeth (n = 20) and 1 (n = 25), 2 (n = 18), and 3 (n = 10) congenitally missing permanent teeth. The Spearman correlation coefficient was used to assess the association of increased numbers of congenitally missing permanent teeth with each cephalometric parameter. RESULTS: Anterior facial height, distance from the maxillary incisor and first molar to the palatal plane, and overjet decreased as the number of congenitally missing permanent teeth increased in patients with unilateral cleft lip and palate. CONCLUSIONS: Unilateral cleft lip and palate patients with congenitally missing permanent teeth have a unique craniofacial morphology with a reduced vertical dimension.

Prevalence of malocclusion and related oral habits in 5- to 6-year-old children.

PURPOSE: To verify the prevalence of malocclusion and the influence of harmful oral habits on deciduous dentition in 5- and 6-year-old children enrolled in Brazilian public elementary schools during 2010. MATERIALS AND METHODS: Exams were conducted in 1385 children from 56 Brazilian elementary schools using the method recommended by the World Health Organization (WHO) for epidemiological surveys on oral health. Information about the type of arch, social and economic data and harmful oral habits of the children were collected through a structured questionnaire. RESULTS: In relation to canine occlusion, a high prevalence of Class I (74.5%), followed by Class II (19.4%), was found. Among all participants, 22% showed high overjet, 7.8% showed edge-to-edge occlusion and 2.3% showed anterior crossbite. In relation to overbite, 13.2% had short overbite, 14.3% open bite and 16.8% high overbite. The presence of posterior crossbite occurred in 14.6% of children. Maxillae predominantly exhibited the type I arch (67.9%) and mandibles predominantly exhibited type II (51.7%). In relation to harmful oral habits, 43.4% used a pacifier, 84.8% used a bottle and finger sucking was reported by 17.2%. CONCLUSION: There was a high prevalence of malocclusion associated with oral habits harmful to deciduous dentition.

Ideal treatment protocol for cleft lip and palate patient from mixed to permanent dentition.

A girl with an Angle Class III malocclusion, anterior and posterior crossbites, a concave profile, and cleft lip and palate sought orthodontic treatment. She was treated with a multidisciplinary therapeutic protocol including orthodontic and surgical procedures. The proposed objectives of occlusion, normal function, and balanced profile were achieved, and these results remained stable 4 years after the treatment.

Enameloplasty and esthetic finishing in orthodontics-differential diagnosis of incisor proclination-the importance of appropriate visualization and records part 2.

The purpose of this paper is to briefly review some of the principals of ideal tooth shape and morphology and demonstrate how to use tooth reshaping through enameloplasty to treat and finish orthodontic cases to much more esthetic conclusions. This paper demonstrates the significant improvement to a smile orthodontists can achieve if they understand the principles of dental esthetics. In assessing smile design, the patient must be evaluated in three dimensions, and both dental and skeletal components must be considered. Expanded documentation in the form of frontal, profile, and oblique images taken both at rest and on dynamic smile permits the dentist to evaluate these elements without cephalometric radiography.

Myths that persist about orofacial myology.

This article addresses many myths that have persisted over the years in dentistry and orofacial myology regarding the nature of orofacial myofunctional disorders (OMD's). Myths include 1) the concept that the term "tongue thrusting" includes the rest posture; 2) that there is an excessive amount of pressure exerted against the anterior teeth in swallows, that swallowing pressures add up, and the frequency of swallowing has an impact on the dentition; 3) the idea that the tongue is the strongest muscle in the body; 4) the view that a muscle will be the winner in any tug of war between muscle and bone; 5) the claim that a tongue thrust can cause an open bite malocclusion; 6) the claim that a tongue thrust can cause a Class II malocclusion; 7) the claim that the tongue molds the palatal vault; 8) the notion that a low tongue tip posture at rest presents a problem; and 9) the claim that OMD's represent a muscle imbalance that can be brought into balance with therapy. Each of these false claims or "myths" is discussed and corrected, with the positive acknowledgement that clinicians are abandoning the incorrect notion of muscle balance and imbalance as had been claimed previously.

Controlled tooth movement to correct an iatrogenic problem.

This case report describes the treatment of a 9-year old boy, who had his maxillary central incisors extruded by noncontrolled elastic mechanics to close a diastema. The article describes the consequences of this movement and how the problem was solved with controlled intrusion.

Craniofacial characteristics and genotypes of amelogenesis imperfecta patients.

The aims of the study were to identify craniofacial characteristics in patients with the rough hypoplastic amelogenesis imperfecta (AI) phenotype and to evaluate whether craniofacial variables are related to a mutation in either of the two genes associated with AI, enamelin (ENAM) and amelogenin (AMGX). Eight children (five males and three females) with rough hypoplastic AI phenotype, aged 6.5-15 years, from three families and their parents (three males and three females) were examined clinically, radiographically, and genetically. Seventeen variables were measured on lateral cephalometric radiographs in AI affected (n = 11) and AI unaffected (n = 3) members. Craniofacial measurements were statistically analysed using a Student's t-test. In all 14 individuals, mutation analysis of the ENAM and AMGX genes was performed by direct sequencing of the coding region. All AI affected patients had hypoplastic enamel with a rough surface and malocclusions. In the vertical plane, all AI children presented an anterior and/or posterior open bite (OB). Craniofacial analysis confirmed increased vertical relationships, with increased vertical jaw relationships and higher values for gonial angle. In two AI affected families, A and B, the same heterozygous ENAM g.8344delG mutation was confirmed, while in the third family, neither ENAM nor AMGX mutation was found. All patients with rough hypoplastic AI had a moderate to severe malocclusion with increased vertical dimensions regardless of the presence or absence of the ENAM g.8344delG mutation. As an OB requires appropriate timing of therapy, it is important to diagnose these patients as early as possible.

Effectiveness of appliance therapy in reducing overjet and open bite associated with thumb sucking habit.

AIM: The aim of this paper was to compare the effectiveness of appliance therapy and reward therapy in reducing overjet and open bite associated with thumb sucking habit. METHODS: Thirty nine subjects (17 males and 22 females) with chronic thumb sucking habit were allocated to three groups: group A (positive reinforcement), group B (modified triple loop corrector), and group C (control). Pre-treatment and post-treatment study casts were evaluated for changes in overjet and open bite. Data from measurements of the three groups were statistically analyzed using a non-parametric Kruskal-Wallis test and Mann-Whitney U tests. All statistical computation was performed with SPSS 15.0 software. Significance was set at 0.05 level. RESULTS: Statistically significant reductions in mean overjet and open bite were seen for the group treated with appliance therapy when compared to other two groups (P<0.05). CONCLUSION: Appliance therapy was significantly more superior in reducing the overjet and open bite associated with thumb sucking habit. Early interception of these habits is recommended to reduce the incidence of malocclusion in children.

Oral manifestation associated with multiple pituitary hormone deficiency and ectopic neurohypophysis.

Multiple pituitary hormone deficiency (MPHD) is the diminished secretion of all the hormones produced in the anterior lobe of the pituitary gland. The oral manifestation of this condition includes delayed eruption and prolonged retention of primary teeth, delayed formation and eruption of permanent teeth, delay in development and growth of the jaws, tendency towards development of deep bite and enamel disturbances. This paper reports the case of an adolescent patient with MPHD. Clinical examination revealed partial ankylosis and prolonged retention ofprimary second molars, primary maxillary canines and deep bite. Dental treatment included extraction of all molars with prolonged retention preceded by the necessary medical care with clinical and radiographic follow-up afterwards. The patient was also referred to an orthodontist for orthodontic treatment. Patients' medical condition should always be investigated by clinicians when faced with cases of delayed tooth eruption and bone development.

Midfacial trauma and facial growth: a longitudinal case study of monozygotic twins.

The purpose of this article is to present a long-term follow-up of the growth of the face and the nasomaxillary complex in a pair of identical twins, one of whom had suffered severe midfacial trauma at age 2 years. Growth of the face and the nasomaxillary complex was longitudinally assessed and compared by means of facial photographs and cephalometric x-rays. Twin A suffered Le Fort II and III fractures with an associated frontal bone injury in early childhood and subsequently developed significant midface hypoplasia; twin B had no trauma and normal facial growth and development. Facial profile difference between the twins gradually became more pronounced until age 19. Twin A had obvious retrusion of the midfacial region, including the nasal bones on visual examination and radiographic study. At age 20, she underwent orthognathic surgical correction of the traumatic deformity. Her unaffected sibling, twin B, provided the genetic facial phenotype for the surgical orthognathic reconstruction.

Association Between Maxillary Posterior Segment Discrepancy And The Angulation Of Maxillary Molars In Patients With Different Vertical Growth Patterns.

BACKGROUND: The impaction of maxillary third molars causes the crowns of maxillary first and second molars to tip distally in patients with maxillary posterior segment discrepancy. The aim of this study was to compare the maxillary first and second molar angulations in patients with maxillary posterior segment discrepancy (MPSD) with non-maxillary posterior segment discrepancy (N-MPSD) and evaluate the effect of their angulations on various divergence patterns. METHODS: A cross-sectional study was conducted using the pre-treatment lateral cephalograms of 180 subjects which were divided into two groups, i.e., MPSD and N-MPSD. The Mann-Whitney U test was applied to compare various skeletal and dental parameters between the two groups and a pairwise comparison was made among the vertical growth patterns. The Kruskal Wallis test was used to compare the mean molar angulations and overbite among the three divergence patterns. RESULTS: The ratio of anterior to total palatal plane (p≤0.001) and the molar angulation (p≤0.001) showed significant differences between the MPSD and N-MPSD groups. In the MPSD group, significant differences were found between the overbite in the normo-divergent versus hyperdivergent (p≤0.001) and hypodivergent versus hyperdivergent groups (p≤0.001), and in the angulation of the first maxillary molars in the normo-divergent versus hyperdivergent groups (p≤0.001). CONCLUSIONS: MPSD causes reduced maxillary first and second molar angulations. A ratio of the anterior palatal plane to total palatal plane length of ≥0.51 was seen in patients with impacted maxillary third molars.