Comparisons of two protocols for early treatment of anterior open bite.

Aim: The purpose of this study was to compare the outcomes of the treatment with the quad-helix/crib (Q-H/C) appliance with those of a combination of transpalatal arch, high-pull headgear, and lip bumper (TPA/HG/LB) in growing patients with anterior open bite malocclusion. Methods: The TPA/HG/LB sample consisted of 22 subjects, 16 girls and 6 boys (mean age 7.5±1.4 years at the start of treatment, T1, and 8.7±1.5 years at the end of active treatment, T2). The Q-H/C sample consisted of 28 subjects, 17 girls and 11 boys (mean age 8.2±1.3 years at T1, and 8.7±1.6 years at T2). Both treated groups were compared with a control group of 20 untreated subjects matched for dentoskeletal disharmony and observation interval. The changes from T2 to T1 between the three groups were compared with the analysis of variance. Results: Both TPA/HG/LB and Q-H/C groups exhibited greater reduction of the palatal plane to mandibular plane angle (-1.7° and -1.9°, respectively) and a significantly greater increase in overbite (2.2 and 2.3mm, respectively) with respect to controls. Conclusions: Q-H/C and TPA/HG/LB protocols were equally effective in correcting the anterior open bite.

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.

Posterior tooth angulations in patients with anterior open bite and normal occlusion.

INTRODUCTION: The aim of this study was to compare the posterior tooth angulations in patients with open-bite malocclusion and normal occlusion. METHODS: Lateral cephalometric headfilms of 45 untreated open-bite subjects were compared with the lateral headfilms of 45 subjects with normal occlusion in the permanent dentition. The groups were matched for age and sex distribution and compared with t tests. RESULTS: The maxillary and mandibular premolars were more mesially angulated in relation to the bisected occlusal plane, and the first and second molars were significantly more distally angulated in the open-bite group in relation to the palatal and mandibular planes. CONCLUSIONS: The maxillary and mandibular premolars were more mesially angulated in relation to the bisected occlusal plane and therefore do not compensate for the divergence of the palatal and mandibular planes as the molars do.

Retrospective study of maxillary sinus dimensions and pneumatization in adult patients with an anterior open bite.

INTRODUCTION: The aim of this study was to evaluate differences in the maxillary sinus floor levels between adults with an anterior open bite and those without. METHODS: This retrospective study included 30 subjects: 15 adults with an anterior open bite (mean age, 21.5 ± 4.3 years) and 15 control subjects with normal occlusion (mean age, 21.7 ± 3.1 years). Cone-beam computed tomography and lateral cephalograms were analyzed before treatment. RESULTS: The open-bite group exhibited a significantly greater maxillary posterior alveolar height (P <0.05). The craniocaudal heights of the maxillary sinus in the region between the first and second molars and between the second premolar and first molar were significantly greater in the open bite group (40.5 and 39.0 mm, respectively) than in the control group (36.7 and 34.7 mm, respectively; P <0.05 for both). The basal bone heights in the regions between the first and second molars, the second premolar and first molar, and the first and second premolars were significantly smaller in the open-bite group than in the control group (P <0.001 for all). CONCLUSIONS: Vertical pneumatization of the maxillary sinus floor in the region between the first and second molars and between the second premolar and first molar is greater in adults with an anterior open bite than in those without, whereas basal bone height in the maxillary posterior region is lower in the open-bite patients.

Defining the location of the dental midline is critical for oral esthetics in camouflage orthodontic treatment of facial asymmetry.

When considering camouflage orthodontic treatment of a malocclusion associated with significant facial asymmetry, it is important to define the location of the dental midline. The patient, a 19-year-old Japanese woman, had an anterior open bite and a dental midline discrepancy associated with facial asymmetry. A nonsurgical treatment plan was considered. The main treatment objective was to correct the anterior open bite and the dental midlines in both arches. The dental midline discrepancy was eliminated, and proper overjet and overbite were achieved. Although the facial asymmetry remained, oral esthetics dramatically improved and a favorable occlusion was obtained. The results suggest that appropriately defining the location of the dental midline is critical for successful camouflage treatment of facial asymmetry.

Cephalometric configuration of the occlusal plane in patients with anterior open bite.

INTRODUCTION: This study was performed to investigate the cephalometric configuration of the occlusal plane in patients with anterior open bite. METHODS: Of 61 subjects with open bite (overbite ≥3.75 mm) who had been recruited consecutively from January 2006 to November 2013 and had no history of orthodontic treatment, 14 cephalometric landmarks indicating the incisal edge or the buccal or mesiobuccal cusp tips of each tooth were used for K-means clustering to classify the occlusal plane configuration. For the open-bite group and a control group with normal occlusion (n = 38), dentoalveolar height, which is the perpendicular distance of each tooth to the palatal or mandibular plane, was compared among the clusters and between the 2 groups. RESULTS: The open-bite subjects were divided into 2 clusters according to occlusal contact of the premolars: Y-form and V-form (with and without premolar contact, respectively). The normalized dentoalveolar heights of the 4 mandibular teeth (lateral incisor to second premolar) were significantly greater in the Y-form class than in the V-form class. The dentoalveolar heights of the 5 maxillary teeth (lateral incisor to first molar) were significantly greater in the open-bite group than in the control group. CONCLUSIONS: For anterior open-bite treatment, the cephalometric configuration of the occlusal plane should be considered based on the occlusal contacts of the premolars.

Influence of maxillary posterior discrepancy on upper molar vertical position and facial vertical dimensions in subjects with or without skeletal open bite.

OBJECTIVES: To determine the influence of maxillary posterior discrepancy on upper molar vertical position and dentofacial vertical dimensions in individuals with or without skeletal open bite (SOB). MATERIALS AND METHODS: Pre-treatment lateral cephalograms of 139 young adults were examined. The sample was divided into eight groups categorized according to their sagittal and vertical skeletal facial growth pattern and maxillary posterior discrepancy (present or absent). Upper molar vertical position, overbite, lower anterior facial height and facial height ratio were measured. Independent t-test was performed to determine differences between the groups considering maxillary posterior discrepancy. Principal component analysis and MANCOVA test were also used. RESULTS: No statistically significant differences were found comparing the molar vertical position according to maxillary posterior discrepancy for the SOB Class I group or the group with adequate overbite. Significant differences were found in SOB Class II and Class III groups. In addition, an increased molar vertical position was found in the group without posterior discrepancy. LIMITATIONS: Some variables closely related with the individual's intrinsic craniofacial development that could influence the evaluated vertical measurements were not considered. CONCLUSIONS AND IMPLICATIONS: Overall maxillary posterior discrepancy does not appear to have a clear impact on upper molar vertical position or facial vertical dimensions. Only the SOB Class III group without posterior discrepancy had a significant increased upper molar vertical position.

Influence of tonsillar grade on the dental arch measurements.

INTRODUCTION: The role of the palatine tonsils in the development of dental intra-arch and interarch abnormalities is often brought up in the literature, but it remains controversial. Data on the probable relationship between enlarged tonsils and the occurrence of orthodontic abnormalities are subjective. The purpose of this study was to seek an association between the space occupied by the palatine tonsils and the dental arch measurements. METHODS: A cross-sectional study was performed on a group of children subdivided into 5 groups according to the standardized tonsillar hypertrophy grading scale. Dental arch measurements were recorded for each child. Data were analyzed with software. Comparisons of qualitative variables according to tonsillar grade were made using the chi-square test. The strength of the association between tonsillar grade and qualitative variables was evaluated with a phi coefficient (φ). The strength of the association between tonsillar grade and quantitative variables was assessed by the Spearman' rank correlation coefficient (rho). The significance threshold was set at P = 0.05. RESULTS: The maxillary dental arch depth was significantly and positively correlated to grade. The maxillary intercanine, interpremolar, and intermolar widths were significantly and negatively correlated to grade. Grade 4 was strongly associated with molar Class II malocclusions, and posterior crossbite with functional lateral deviation of the mandible. CONCLUSIONS: Early evaluation of the size of the palatine tonsils would help to prevent orthodontic abnormalities caused by upper airway obstruction. Thus, patients could be spared late, more aggressive treatments that are less efficient than treatments during childhood.

Association of breastfeeding and three-dimensional dental arch relationships in primary dentition.

BACKGROUND: The benefits of breastfeeding on oral health are still inconclusive, especially the association on occlusion. This study aimed to investigate the association of breastfeeding and the development of primary dentition. METHODS: A cross-sectional study was conducted with 851 Asian children aged 2-5 years old in Hong Kong. Questionnaires were completed by the parents to collect information on breastfeeding and the non-nutritive sucking habits. The children's dental arch relationships were examined in the sagittal, vertical, and transverse dimensions by an experienced examiner. RESULTS: Children who experienced pure breastfeeding for more than 6 months had a lower chance of developing a class II incisal relationship (P < 0.05) or an increased overjet (P < 0.05), and had wider intercanine (P < 0.05) and intermolar widths (P < 0.05). Vertically, no association on the extent of overbite or openbite was found (P > 0.05). CONCLUSIONS: Pure breastfeeding for more than 6 months is positively associated with primary dental arch development in the anterior sagittal dental segment and on the horizontal arch width in primary dentition. Therefore, pure breastfeeding for more than 6 months is recommended, as it is associated with lower chance of the development of abnormal dental relationships. The results will be valuable for education and promotion of maternal breastfeeding.

[Frequency of signs and symptoms of temporomandibular joint disorders, vertical orthodontic anomalies and their relationships based on screening of a large population]. / Temporomandibuláris ízületi és vertikális ortodonciai rendellenességek elofordulási gyakorisága, valamint azok összefüggései nagyszámú populáció szurovizsgálata alapján.

Altogether 4606 volunteers (2923 vomen, 1683 men) participated in the representative national epidemiological study to screen the alterations of temporomandibular joint (TMJ). The characteristic clinical signs and subjective complaints according to TMJ were evaluated by medical history taking and physical examination. Regarding the orthodontic anomalies, the vertical abnormalities (deep bite and open bite) were specifically noted. Clinical signs showing functional problems of TMJ were found in 45.19% of the screened population, mainly in the group of 35-44 year olds. The frequency of clicking and crepitation of TMJ was significantly higher in women compared to men (p < 0.05). The highest rate of clinical signs of TMJ disorders was found in the South-Transdanubian region, the lowest rate in the Middle-Transdanubian region, between these regions it was a significant difference regarding the frequency of deviation/deflexion (p < 0.05). Of the vertical abnormalities, deep bite occured most frequently in the 35-44 ys old age group. The prevalence of deep bite was higher among males than females in the whole screened population, but the difference was not statistically significant. Significant relationship was detected between deep bite and TMJ pain, deep bite and noises in the joint in the majority of the population. The most frequent anomaly in the South-Transdanubian region was deep bite, while the open bite occured most frequently in south middle part of Hungary. Conclusion: the Hungarian population needs well organized specific programs to improve the oral health including TMJ and orthodontic aspects.

Molar heights and incisor inclinations in adults with Class II and Class III skeletal open-bite malocclusions.

INTRODUCTION: The aim of this research was to compare maxillary and mandibular molar heights and incisor inclinations in patients with skeletal open-bite Class II, patients with skeletal open-bite Class III, and an untreated control group. METHODS: Pretreatment lateral cephalograms of 70 orthodontic patients (34 men, 36 women) between 16 and 40 years of age were examined. The sample was divided into 3 groups according to facial growth pattern and overbite. The control group (n = 25) included normodivergent Class I subjects with adequate overbite; the skeletal open-bite Class II group (n = 25) and the skeletal open-bite Class III group (n = 20) included hyperdivergent Class II or Class III subjects with negative overbite. Measurements considered were ANB angle, palatal and mandibular plane angles, maxillary incisor palatal plane angulation, and mandibular incisor mandibular plane angulation, as well as the distance from the palatal or the mandibular plane to the mesial cusp of the molars. Multivariate analysis of covariance and multivariate analysis of variance tests were used to determine the differences between the groups, followed by the Tukey post-hoc test. Additionally, the Mann-Whitney U test and Kruskall-Wallis test were performed. RESULTS: Significant differences in molar height were found (P <0.001). A 4-mm difference in maxillary molar height between the skeletal open-bite and control groups was found. Mandibular molar height was greater in the skeletal open-bite Class II group (P <0.001). Maxillary incisor palatal plane angulation was greater in the skeletal open-bite Class III group by approximately 6°. Mandibular incisor to mandibular plane angulation was 10° more lingual in the skeletal open-bite Class III group (P <0.001). CONCLUSIONS: The skeletal open-bite groups had greater molar heights than did the control group. The skeletal open-bite Class II group had more eruption of the mandibular molars. The maxillary incisors were more proclined and the mandibular incisors were more lingual in the skeletal open-bite Class III group.

Cervical vertebral column morphology and head posture in preorthodontic patients with anterior open bite.

INTRODUCTION: Cervical vertebral column morphology and head posture were examined and related to craniofacial morphology in preorthodontic children and adolescents with anterior open bite. METHODS: One hundred eleven patients (ages, 6-18 years) with an anterior open bite of more than 0 mm were divided into 2 groups of skeletal or dentoalveolar open bite. The skeletal open-bite group comprised 38 subjects (19 girls, 19 boys). The dentoalveolar open-bite group comprised 73 subjects (43 girls, 30 boys). Visual assessment of the cervical column and measurements of craniofacial morphology and head posture were made on profile radiographs. RESULTS: Deviations in the cervical vertebral column morphology occurred in 23.7% of the subjects in the skeletal open-bite group and in 19.2% in the dentoalveolar open-bite group, but the difference was not significant. Head posture was significantly more extended in the skeletal open-bite group compared with the dentoalveolar open-bite group (craniovertical angle [Mx/VER], P <0.05; craniocervical angles [Mx/OPT, Mx/CVT], P <0.01. Only head posture was associated with craniofacial morphology: extended posture was associated with a large cranial base angle (P <0.01, P <0.001), large vertical craniofacial dimensions (P <0.05; P <0.01; P <0.001), and retrognathia of the jaws (P <0.001). CONCLUSIONS: Cervical column morphology is described for the first time in children and adolescents with open bite. No significant differences in the cervical vertebral column's morphologic deviations were found between the skeletal and the dentoalveolar open-bite groups. Significant differences were found in head posture between the groups and with regard to associations with craniofacial dimensions. This might indicate a respiratory etiologic component in children with anterior open bite.

Dental arch dimensional changes after adenotonsillectomy in prepubertal children.

INTRODUCTION: The purposes of this study were to investigate the dental arch changes after adenotonsillectomies in prepubertal children and to compare the dental arch dimensions of mouth-breathing and nasal-breathing children. METHODS: The sample included 49 prepubertal severely obstructed mouth-breathing children and 46 prepubertal nasal-breathing children. Twenty-four of the 49 mouth-breathing children had an adenotonsillectomy and composed the adenotonsillectomy subgroup. The 25 children in whom the mouth-breathing pattern was unchanged during the 1-year study period composed the control subgroup. RESULTS: The mouth-breathing children showed a deeper palatal vault, a larger mandibular width, and a larger mandibular arch length in comparison with the nasal-breathing children. After airway clearance, the adenotonsillectomy group showed a significant maxillary transverse width gain compared with the control subgroup. The control subgroup showed a significant deepening of the palatal height when compared with the adenotonsillectomy subgroup after 1 year. CONCLUSIONS: The adenotonsillectomy subgroup had a significantly different pattern of arch development compared with the untreated controls. After adenotonsillectomy, the mouth-breathing children showed greater maxillary transverse development than did the controls. The palatal vault deepened in the untreated children. The mouth-breathing children showed a deeper palatal vault, a larger mandibular width, and a larger mandibular arch length in comparison with the nasal-breathing children.

Gender differences in dentofacial characteristics of adult patients with temporomandibular disc displacement.

PURPOSE: The purpose of this study was to assess gender differences in dentofacial characteristics of adult patients according to temporomandibular joint (TMJ) disc displacement (DD) status. MATERIALS AND METHODS: The sample consisted of 293 adult patients (80 male and 213 female). Male and female patients were divided into 3 groups based on magnetic resonance images of bilateral TMJs: bilateral normal disc position (BN), bilateral DD with reduction (DDR), and bilateral DD without reduction (DDNR). Seventeen variables from lateral cephalograms were analyzed by 2-way analysis of variance to identify differences in dentofacial morphologies with respect to gender and TMJ DD status. RESULTS: Patients with TMJ DD had short ramus height, short mandibular body length, and backward positioning of the ramus and mandible. These dentofacial characteristics became more severe as TMJ DD progressed to DDNR. In addition, dentofacial characteristics associated with TMJ DD were not significantly different between men and women except for effective mandibular length (Articulare to pogonion). Effective mandibular length even tended to decrease as TMJ DD progressed, but male patients showed a larger difference in effective mandibular length between BN and DDR than female patients. CONCLUSIONS: This study's findings suggest that dentofacial morphology is strongly associated with TMJ DD status and that skeletal Class II hyperdivergent pattern with a short ramus and mandible may be a potential indicator of TMJ DD regardless of gender.

Evaluation of the severity of malocclusions in children affected by osteogenesis imperfecta with the peer assessment rating and discrepancy indexes.

INTRODUCTION: Osteogenesis imperfecta is a heritable disorder affecting bone and tooth development. Malocclusion is frequent in those affected by osteogenesis imperfecta, but this has not been studied in detail. The purpose of this study was to describe and quantify the severity of malocclusions in patients with osteogenesis imperfecta. METHODS: Articulated dental casts were obtained from 49 patients diagnosed with osteogenesis imperfecta (ages 5-19 years; 28 female) and 49 age- and sex-matched control subjects who did not have osteogenesis imperfecta. Both groups were seeking orthodontic treatment. Malocclusions were scored by using the peer assessment rating (PAR) and the discrepancy index (DI). RESULTS: The average United Kingdom weighted PAR scores were 31.1 (SD, 14.5) for the osteogenesis imperfecta group and 22.7 (SD, 10.7) for the control group (P <0.05). The mean United States weighted PAR scores were 32.2 (SD, 15.0) for patients with osteogenesis imperfecta and 21.6 (SD, 9.6) for the controls (P <0.05). The average modified DI scores were 29.8 (SD, 20.2) for the osteogenesis imperfecta group and 12.4 (SD, 6.8) for the control group (P <0.05). Group differences were greatest for lateral open bite (osteogenesis imperfecta group, 7.1; control group, 0.3) for the DI parameters and anterior crossbite (osteogenesis imperfecta group, 13.0; control group, 3.8 [United Kingdom]) for the PAR. CONCLUSIONS: Both the PAR and the DI showed that malocclusions were significantly more severe in patients with osteogenesis imperfecta than in the control group. There was a higher incidence of Class III malocclusion associated with anterior and lateral open bites in patients affected by osteogenesis imperfecta.

Human masseter muscle fiber type properties, skeletal malocclusions, and muscle growth factor expression.

PURPOSE: We identified masseter muscle fiber type property differences in subjects with dentofacial deformities. PATIENTS AND METHODS: Samples of masseter muscle were collected from 139 young adults during mandibular osteotomy procedures to assess mean fiber areas and percent tissue occupancies for the 4 fiber types that comprise the muscle. Subjects were classified into 1 of 6 malocclusion groups based on the presence of a skeletal Class II or III sagittal dimension malocclusion and either a skeletal open, deep, or normal bite vertical dimension malocclusion. In a subpopulation, relative quantities of the muscle growth factors IGF-I and GDF-8 gene expression were quantified by real-time polymerase chain reaction. RESULTS: Fiber properties were not different in the sagittal malocclusion groups, but were very different in the vertical malocclusion groups (P ≤ .0004). There were significant mean fiber area differences for type II (P ≤ .0004) and type neonatal-atrial (P = .001) fiber types and for fiber percent occupancy differences for both type I-II hybrid fibers and type II fibers (P ≤ .0004). Growth factor expression differed by gender for IGF-I (P = .02) and GDF-8 (P < .01). The ratio of IGF-I:GDF-8 expression associates with type I and II mean fiber areas. CONCLUSION: Fiber type properties are very closely associated with variations in vertical growth of the face, with statistical significance for overall comparisons at P ≤ .0004. An increase in masseter muscle type II fiber mean fiber areas and percent tissue occupancies is inversely related to increases in vertical facial dimension.

Basic dental information needed for the OFM initial occlusal evaluation.

It is incumbent upon the orofacial myologist to evaluate the presenting client's occlusion and detect any behaviors which may be influencing the alignment of the dentition or interfering with the treatment plan of the referral source. In order to accomplish these tasks, it is necessary to share some common terminology and to effectively communicate between all the participants involved in the treatment plan. The purpose of this article is to assist in accomplishing these goals.

Treatment of skeletal open-bite malocclusion with lymphangioma of the tongue.

Lymphangioma of the tongue causes massive tongue enlargement, leading to difficulties in swallowing and mastication, speech disturbances, airway obstruction, and skeletal deformities such as open-bite malocclusion. Early reduction of tongue volume improved the excessive open bite in a young girl, but it was not sufficient to redirect the original hyperdivergent growth pattern. Orthodontic camouflage treatment was therefore rendered. Long-term evaluation after tongue-reduction surgery and orthodontic treatment is presented.

Treatment effects of bonded spurs associated with high-pull chincup therapy in the treatment of patients with anterior open bite.

INTRODUCTION: The aim of this prospective clinical study was to investigate the cephalometric changes produced by bonded spurs associated with high-pull chincup therapy in children with Angle Class I malocclusion and anterior open bite. METHODS: Thirty patients with an initial mean age of 8.14 years and a mean anterior open bite of -3.93 mm were treated with bonded spurs associated with chincup therapy for 12 months. An untreated control group of 30 subjects with an initial mean age of 8.36 years and a mean anterior open bite of -3.93 mm and the same malocclusion was followed for 12 months for comparison. Student t tests were used for intergroup comparisons. RESULTS: The treated group demonstrated a significantly greater decrease of the gonial angle, and increase in overbite, palatal tipping of the maxillary incisors, and vertical dentoalveolar development of the maxillary and mandibular incisors compared with the control group. CONCLUSIONS: The association of bonded spurs with high-pull chincup therapy was efficient for the correction of the open bite in 86.7% of the patients, with a 5.23-mm (SD, ±1.69) overbite increase.

Comparison of Japanese and European overbite depth indicator and antero-posterior dysplasia indicator values.

This study evaluated cephalometric differences between 113 Japanese (43 males and 70 females, aged 14.1 ± 5 years) and 106 European subjects (36 males and 70 females, aged 13.5 ± 7.3 years) using two compound angular measurements and their single components: the overbite depth indicator (ODI) for the assessment of vertical skeletal relationships and the antero-posterior dysplasia indicator (APDI) for an evaluation of sagittal dysgnathia. Both populations were assigned to groups representing Angle Classes I, II, and III, and an anterior open bite (AOB) group. Two sample t- and Wilcoxon signed-ranks tests were performed (P < 0.05). The ODI values showed no statistically significant differences between the Japanese and European samples. The Japanese sample showed a significantly smaller APDI but only in the Class II group. In the Japanese Class II and III subjects, the malocclusion patterns were more pronounced than those in the Caucasian sample (overbite, overjet, and APDI).