Dilemmas in Treatment of Recurrent Recalcitrant Dental Anterior Open Bite.

An anterior open bite is one of the most difficult occlusal abnormalities to treat. Quite often this aberration entails dental component and/or skeletal component. The skeletal open bite will require intrusion of the posterior sextants with the assistance of bite blocks, temporary anchorage devices, high pull headgear, and as a last resort - orthognathic surgery. The orthodontic treatment should be augmented with the orofacial myofunctional therapy. In this article, the author describes 3 different variations of treatment of the dental anterior open bite, first on acrylic models, and then on the actual patients. Consideration should be given to patients with a 'short upper lip," and in this case, surgical correction should be entertained.

A multidisciplinary approach to the treatment of oral manifestations associated with Beckwith-Wiedemann syndrome: a long-term case report.

BACKGROUND: Beckwith-Wiedemann syndrome (BWS) is a congenital disorder that involves a somatic overgrowth during the patient's first years of life. Exomphalos, macroglossia and gigantism are the main clinical symptoms. CASE DESCRIPTION: The authors describe a 15-year follow-up in a patient with BWS. They focus on a multidisciplinary approach to treating the patient's oral manifestations from age 9 months. The approach included an initial physiotherapy treatment, a partial glossectomy, a first phase of orthopedic treatment with a tongue crib and chin cap, and a second phase of orthodontic treatment with an edgewise appliance. CLINICAL IMPLICATIONS: To obtain long-term positive and stable results, an appropriate treatment plan for patients with BWS and dentoskeletal alterations, including macroglossia, requires surgical tongue reduction when the patient is young, combined with physiotherapeutic phases and orthopedic and orthodontic treatment.

Timing of myofunctional appliance therapy.

OBJECTIVE: To identify the stage of skeletal maturity, as depicted by the Cervical Vertebrae Maturity Index at which the maximal response to myofunctional therapy could be expected. DESIGN: The soft copies of pre and post treatment lateral cephalometric radiographs of the sample comprising of 48 subjects, on myofunctional therapy, were traced on 'Nemotec Dental Studio NX'software. Three groups were formed based on the stages of skeletal maturity and comparison was done. RESULTS: The treated samples were compared with control samples consisting of subjects with untreated Class II malocclusions, also selected on the basis of stages in cervical vertebrae maturation. Inter-group comparison of the treated samples revealed statistically significant changes in Group II (Stages 3 to 4 of Cervical Vertebrae Maturity Index). CONCLUSION: Maximum response to myofunctional therapy can be expected in patients during the stages 3 to 4 of cervical vertebrae maturation index, i.e., during or slightly after the pubertal peak.

Influence of the temporomandibular joint on range of motion of the hip joint in patients with complex regional pain syndrome.

OBJECTIVE: This study evaluated if patients with complex regional pain syndrome (CRPS) would have an increase in range of motion (ROM) after myofascial release and a similar ROM decrease after jaw clenching, whereas in healthy subjects these effects would be minimal or nonexistent. METHODS: Documentation of patients with CRPS (n = 20) was established using the research diagnostic criteria for CRPS, questionnaires, average pain intensity for the past 4 weeks, and the temporomandibular index (TMI). Healthy subjects (n = 20, controls) also underwent the same testing. Hip ROM (alpha angle) was measured at 3 time points as follows: baseline (t1), after myofascial release of the temporomandibular joint (t2), and after jaw clenching for 90 seconds (t3). Comparison of the CRPS and control groups was made using t tests. RESULTS: Mean TMI total score and mean pain reported for the last 4 weeks were significantly different between the 2 groups (P < .0005). Hip ROM at t1 was always slightly higher compared to t3, but t2 was always lower in value compared to t1 or t3 for both groups. The differences of all hip ROM values between the groups were significant (P < .0005). Moreover, the difference between t1 or t3 and t2 was significantly different within the CRPS group (t1 = 48.7 degrees ; t2 = 35.8 degrees ; P < .0005). CONCLUSIONS: The results suggest that temporomandibular joint dysfunction plays an important role in the restriction of hip motion experienced by patients with CRPS, which indicated a connectedness between these 2 regions of the body.

Conscious hypnosis as a method for patient motivation in cervical headgear wear--a pilot study.

The aim of the present study was to assess the efficiency of conscious hypnosis on patient cooperation. The subjects were 30 patients (14 females and 16 males) with a skeletal Class II division 1 malocclusion, divided into two equal groups, a control and a study group. The mean age was 10.78 +/- 1.06 years for the hypnosis, and 10.07 +/- 1.09 years for the control group. Both groups were treated with cervical headgear containing a timer module. The patients were also asked to record their actual wear time on timetables. The hypnosis group patients were motivated with conscious hypnosis while the control group were given verbal motivation by their orthodontist. The timer modules were read at every visit and compared with the timetables. Analysis of variance was used to determine the differences in measurements at each time point. For comparison of the groups, an independent t-test was used. A statistically significant decrease (P < 0.05) in headgear wear was observed in the control group from the first to the sixth month; however, the difference in the hypnosis group was not significant. This result indicates that conscious hypnosis is an effective method for improving orthodontic patient cooperation. There was a low correlation between actual headgear wear indicated by the patient and that recorded by the timing modules, which showed that, timetables are not consistent tools for measuring patient cooperation.

Long-term outcome in a patient with a dentoskeletal open-bite malocclusion treated without extraction.

This case report describes the treatment of a patient with a Class II malocclusion with an anterior open bite. The patient, a girl 16 years of age, had a significant anteroposterior discrepancy and a high-angle tendency. Her face was convex, with competent lips. Intraorally she had an anterior open bite of 3 mm, space in the mandibular arch, and an overjet of 2 mm. High-pull headgear, anterior intermaxillary elastics, and appropriate wire bending were used to close the bite and to correct the anteroposterior dental relationship. Modification of a tongue thrust habit helped to correct this significant malocclusion and provided stability at 11 years posttreatment.

Resistencia a la tracción de brackets cementados con distintos tipos de resinas sobre amalgama tratada / Shear-bond strength of brackets bonded with different types of resins on treated silver amalgam

Se prepararon 450 muestras de amalgama de plata, sobre las cuales se efectuó un pulido de la superficie, un rayado con una fresa de diamante o un microarenado con óxido de aluminio. Se cementaron brackets metálicos con diferentes adhesivos: System 1+, Concise, Concise sistema ortodóncico, Panavia 21 EX y All Bond . Se realizó la tracción de las muestras y los valores de fuerzas más elevados se observaron en las muestras rayadas o microarenadas, sin encontrarse diferencias significativas entre ambos grupos, mientras que sí había diferencia significativa con aquellas en las que se realizó el pulido de la amalgama. Entre las resinas utilizadas el Panavia mostró los valores más altos de fuerza de rotura (8,70 Mpa) (AU)

Intraoral aging of the inner headgear component: a potential biocompatibility concern?

The effect of intraoral aging of biomaterials on the modification of their surface properties has mostly been unknown. The purpose of this study was to investigate and characterize surface alterations of retrieved inner face-bow headgear components. Specimens were prepared from 3 areas of retrieved headgear wires: inner-outer face-bow soldered junction, buccal segment, and projection entering the buccal tube. Specimens from as-received headgear wires that matched the brand and size of the retrieved wires were also fabricated; all specimens were then subjected to multitechnique characterization. Optical microscopy revealed extensive biofilm islands of amorphous precipitants and accumulated microcrystalline particles. Micro-multiple internal reflectance Fourier transform infrared spectroscopy investigation of the retrieved wire samples demonstrated the presence of a proteinaceous biofilm, the organic constituents of which were mainly amide, alcohol, and carbonate. Scanning electron microscopy and radiographic microanalysis showed that the elemental species precipitated on the material surface were mainly calcium and phosphorus, forming calcium-phosphorus precipitates with thicknesses reaching 300 microm, whereas radiograph fluorescence spectrometry provided evidence of integument calcification through identification of calcium and phosphorus peaks. The clinical implication of the aging pattern that was identified relates to the potential protective role or induction of disintegration by the biofilm adsorbed on the wire that affected the biocompatibility of the alloy. Whereas further investigation is suggested for the clarification of the effect of intraoral aging on ionic release, the results of this study emphasize the necessity for the incorporation of in vivo approaches, including retrieval analyses, in the study of the biologic performance of orthodontic materials.