A case report of multidisciplinary treatment of an adult patient with bilateral cleft lip and palate.

This is a case report about the successful orthodontic treatment of a bilateral cleft lip and palate patient by using a combination of bone grafting and subsequent prosthodontic rehabilitation. An adult patient with a bilateral cleft lip and palate presented with a concave profile, anterior and lateral crossbite, a markedly deep overbite, and residual bilateral alveolar clefts. His jaw movement patterns were unstable and irregular due to his collapsed bite. Orthodontic treatment with bilateral bone grafting improved his concave profile by downward and backward rotation of the mandible within the freeway space, and optimum occlusion and functionally stable and smooth jaw movements were obtained. After a 6-year retention period, no skeletal relapse could be detected, and his occlusal stability was satisfactory.

Delayed tooth movement in Runx2+/- mice associated with mTORC2 in stretch-induced bone formation.

Runt-related transcription factor 2 (Runx2) is an essential transcription factor for osteoblast differentiation, and is activated by mechanical stress to promote osteoblast function. Cleidocranial dysplasia (CCD) is caused by mutations of RUNX2, and CCD patients exhibit malocclusion and often need orthodontic treatment. However, treatment is difficult because of impaired tooth movement, the reason of which has not been clarified. We examined the amount of experimental tooth movement in Runx2+/- mice, the animal model of CCD, and investigated bone formation on the tension side of experimental tooth movement in vivo. Continuous stretch was conducted to bone marrow stromal cells (BMSCs) as an in vitro model of the tension side of tooth movement. Compared to wild-type littermates the Runx2+/- mice exhibited delayed experimental tooth movement, and osteoid formation and osteocalcin (OSC) mRNA expression were impaired in osteoblasts on the tension side of tooth movement. Runx2 heterozygous deficiency delayed stretch-induced increase of DNA content in BMSCs, and also delayed and reduced stretch-induced alkaline phosphatase (ALP) activity, OSC mRNA expression, and calcium content of BMSCs in osteogenic medium. Furthermore Runx2+/- mice exhibited delayed and suppressed expression of mammalian target of rapamycin (mTOR) and rapamycin-insensitive companion of mTOR (Rictor), essential factors of mTORC2, which is regulated by Runx2 to phosphorylate Akt to regulate cell proliferation and differentiation, in osteoblasts on the tension side of tooth movement in vivo and in vitro. Loss of half Runx2 gene dosage inhibited stretch-induced PI3K dependent mTORC2/Akt activity to promote BMSCs proliferation. Furthermore, Runx2+/- BMSCs in osteogenic medium exhibited delayed and suppressed stretch-induced expression of mTOR and Rictor. mTORC2 regulated stretch-elevated Runx2 and ALP mRNA expression in BMSCs in osteogenic medium. We conclude that Runx2+/- mice present a useful model of CCD patients for elucidation of the molecular mechanisms in bone remodeling during tooth movement, and that Runx2 plays a role in stretch-induced proliferation and osteogenesis in BMSCs via mTORC2 activation.

Mandibular deviation and canted maxillary occlusal plane treated with miniscrews and intraoral vertical ramus osteotomy: functional and morphologic changes.

Conventionally, the combination of mandibular and maxillary osteotomy is used to correct both mandibular deviation and maxillary canted occlusal plane. This case report describes functional and morphologic changes after an alternative treatment with miniscrew anchorage instead of maxillary osteotomy. A boy, aged 16 years 5 months, had temporomandibular joint disease symptoms, facial asymmetry with mandibular deviation, and a maxillary canted occlusal plane. The maxillary molars on the right side were extruded 3 mm compared with those on the left side. In addition, there were functional problems: lopsided chewing and asymmetric motion range of the bilateral condyles. After correction of the maxillary canted occlusal plane by intrusion of the maxillary right molars with miniscrew anchorage, the mandibular deviation was corrected with mandibular osteotomy. As the therapeutic result, functional symmetry was achieved in addition to symmetric morphologic changes, suggesting that combination treatment of miniscrew anchorage and mandibular osteotomy is effective for treating patients with mandibular deviation and maxillary canted occlusal plane.

Skeletal Class lll severe openbite treatment using implant anchorage.

A female patient with a skeletal Class III severe anterior openbite was treated using miniplates as the anchorage. The patient was 15 years and 10 months of age when she reported to our university hospital with a chief complaint of anterior openbite and reversed occlusion. The patient had an anterior openbite with an overjet of -3.0 mm and overbite of -5.0 mm and a Class III molar relationship. The cephalometric analysis showed a skeletal Class III relationship (ANB 0 degrees ). After the extraction of the bilateral mandibular third molars, miniplates were placed in the mandibular external oblique line. The mandibular dentition was retracted using elastic chain and miniplates. After treatment, an Angle Class I molar relationship was achieved and overjet and overbite had become 2.0 mm and 1.5 mm. A good facial appearance and occlusal relationship were obtained. The total active orthodontic treatment period was 23 months. Wrap-around type retainers were placed on both jaws and a lingual bonded retainer was also attached in the mandibular incisors. After 1 year of retention, the occlusion was stable, and a good facial profile was also retained. The mandibular deviation to the left was improved and the strain in the circumoral musculature during lip closure disappeared. An appropriate interincisal relationship was achieved by the uprighting of mandibular dentition without changing the vertical intermaxillary relationship. A panoramic radiograph showed no marked root resorption. Our results suggest that implant anchorage is useful for correction of skeletal Class III severe anterior openbite cases.

Treatment of severe anterior open bite with skeletal anchorage in adults: comparison with orthognathic surgery outcomes.

INTRODUCTION: Skeletal anterior open bite is a difficult problem to correct in orthodontic treatment. In adults, treatment of severe skeletal anterior open bite consists mainly of surgically repositioning the maxilla or the mandible. Recently, molar intrusion by using skeletal anchorage has been developed as a new strategy for open-bite treatment. In this study, we compared treatment outcomes in patients with severe anterior open bite treated with molar intrusion by using skeletal anchorage and with orthognathic surgery. METHODS: Twenty-three subjects with overbite less than -3.0 mm were treated with skeletal anchorage (n = 10) or with LeFort I osteotomy combined with mandibular osteotomy (n = 13). Pretreatment and posttreatment lateral cephalograms were compared. RESULTS: Incisors were significantly elongated in the surgically treated subjects (4.6 mm, P <.01). There were no significant differences in the treatment results between skeletal anchorage and surgery, with reduced facial heights of 4.0 and 3.8 mm, and increased overbites of 6.8 and 7.0 mm, respectively. CONCLUSIONS: These results suggest that molar intrusion with skeletal anchorage is simpler and more useful than 2-jaw surgery in the treatment of patients with severe anterior open bite.