The short-term effects of face mask and fixed tongue appliance on maxillary deficiency in growing patients--a randomized clinical trial.

BACKGROUND: The purpose of this single blind, prospective, parallel randomized trial study was to compare the effects of face mask and fixed tongue appliance in treatment of Class III malocclusion with maxillary deficiency in growing patients. METHODS: 88 patients with maxillary deficiency were selected. 60 fulfilled the study requirements. The patients were randomly assigned to 2 groups by computer generated tables. One group was treated with removable face mask and the other group was treated by fixed tongue appliance. 4 of the patients dropped out of study leaving a final number of 56 patients. Thus, the face mask group included 30 patients (13 males, 17 females) with the mean age of 8.5 (SD 1.4) years and the fixed tongue appliance group included 26 patients (13 males, 13 females) with the mean age of 8.9 (SD 1.7) years. The patients Lateral cephalograms obtained at the beginning and end of the study were analyzed. RESULTS: Paired t-tests showed that SNA increased by 1.3° (SD 1.1°) in face mask group (P<0.001) and it increased by 1.8° (SD 0.9°) in fixed tongue appliance group (P<0.001). T-test showed that there were no statistically significant differences between the two groups except for SNB. IMPA decreased significantly in both groups. CONCLUSIONS: Both treatment modalities were successful in moving the maxilla forward and improving the profile of the patients; however, the bulky size of face masks might reduce patients' compliance and make them less favorite choice of treatment.

The effects of face mask and tongue plate on maxillary deficiency in growing patients: a randomized clinical trial.

OBJECTIVE: The purpose of this randomized clinical trial was to compare the effects of facemask and tongue plate therapy in the treatment of class III malocclusion associated with maxillary deficiency in growing patients. DESIGN: Prospective, randomized clinical trial. SETTING: Department of Orthodontics, SB University of Medical Sciences Dental School, Tehran, Iran. METHODS: Fifty patients with maxillary deficiency were randomly allocated to two groups. One group was treated with a removable facemask and the other with a tongue plate. Three patients dropped out of the study leaving a final number of 47 that were analysed. The face mask group included 24 patients (12 males, 12 females) with a mean age of 9 (SD 1·2) years; while the tongue plate group included 23 patients (10 males, 13 females) with a mean age of 9·1 (SD 0·9) years. The patients lateral cephalograms obtained at the beginning and end of the study were analysed. RESULTS: Paired t-tests showed that SNA increased by 1° (SD 1·5°) in the facemask group (P<0·001) and by 2·2° (SD 1·5°) in the tongue plate group (P<0·001). With the exception of SNA and GoGn, Mann-Whitney testing showed that there were no statistically significant differences between the two groups. IMPA was found to decrease significantly in both groups. CONCLUSION: Both treatment modalities were successful in moving the maxilla forward, proclining the maxillary incisors and retroclining the mandibular incisors. The more simple design of the tongue plate might therefore confer some advantages to this system in comparison with a facemask.

A novel approach in treatment of open bite: a case report.

This case illustrates the treatment of a 12-year-old boy with an open bite, a slight Class II jaw relationship, Class I molar relationship, and a steep lower occlusal plane. The patient needed a surgical procedure due to the severity of openbite; however the surgery option was rejected. Therefore, he was treated by a Hyrax, fixed tongue appliance, posterior bite plate, reverse chin cup and fixed orthodontics. His second premolars and lower second molars were extracted during treatment. The active treatment lasted for 34 months after which favorable correction of the malocclusion was observed. The SNA angle increased by 4 degrees and the GoGn-Sn decreased by 6 degrees. This patient was treated nonsurgically and favorable profile and occlusion were obtained.

Lefort 1 osteotomy in a beta-thalassemia major patient--a case report.

Maxillary setback of patients with protruded maxilla is a complex procedure. This complexity is aggravated when combined with thalassemia. The Aim of this case report was to treat a beta-thalassemia major girl with severe maxillary protrusion. A 16 year-old beta-thalassemia major girl presented with excessive maxilla, incompetent lips and an everted upper lip was referred for treatment. She had her spleen removed at the age of 9 and her blood transfusion was stopped 3 month before referral. After leveling and aligning with 018 standard edgewise system the patient was sent for Lefort 1 osteotomy. Segmental osteotomy was denied due to excessive bleeding in the procedure. The results showed that the thalassemic patient was effectively treated with presurgical orthodontics, Lefort 1 osteotomy followed by post surgical orthodontics. Very satisfactory esthetic results were obtained in the patient after 4.5 years of active treatment.

Maxillary deficiency treatment by fixed tongue appliance--a case report.

This case illustrates orthopaedic treatment of a 12.1-year-old girl with class III malocclusion and maxillary deficiency. The patient was treated by a fixed tongue appliance in the upper jaw. First maxillary molars and premolars were banded and a hyrax was mounted on them in order to achieve lateral expansion. A fixed tongue appliance comprising of a few cribs was soldered to the anterior side of the hyrax with the purpose of pushing the maxilla in forward position. The orthopaedic stage of treatment lasted for 5 months after which favourable correction of the malocclusion was observed. The SNA angle increased by 2 degrees, the IMPA decreased by 10 degrees and mandibular plane angle (GoGn-SN) increased by 20. After this time, the fixed tongue appliance and Hyrax remained in the mouth for 3 more months as retention. This case demonstrates that fixed tongue appliance might be an alternative method to extra oral appliances in class III and maxillary deficient cases.

The effects of facemask and reverse chin cup on maxillary deficient patients.

INTRODUCTION: The aim of this randomized clinical trial was to assess differences in the effects of face mask and reverse chin cup therapy on maxillary deficient growing patients. METHODS: The sample consisted of 42 class III patients with maxillary deficiency randomly divided into two equal groups. Twenty-one patients (10 males and 11 females) with a mean age of 8.9 (SD: 1.4) years were treated with a face mask for 18 (SD: 2) months. Twenty-one patients (9 males and 12 females) with the mean age of 9.2 (SD: 1.1) years were treated with a reverse chin cup for 19 (SD: 4) months. Cephalometric radiographs were taken at the beginning and end of treatment and the cephalometric measurements were analysed. Paired t-tests and a Wilcoxon test were used for intra-group evaluations. Mann-Whitney test was used for inter-group evaluations. RESULTS: Sella-Nasion-A point (SNA) was increased by 1° (SD: 1.7°) (P<0.003) and 1.8° (SD: 1.7°) (P<0.001) in the face mask and reverse chin cup groups, respectively. The IMPA decreased by 4.1° (SD: 6.5°) in face mask group (P<0.009) and 3.1° (SD: 4.7°) in the reverse chin cup group (P<0.008). However, no statistically significant differences were seen in changes between the two groups. CONCLUSION: Both face mask and reverse chin cup appliances are successful at moving the maxilla forward.

A novel approach for treatment of mandibular deficiency with vertical growth pattern.

This case illustrates the treatment of a 10.5-year-old girl with Class II Division I malocclusion and mandibular deficiency combined with vertical growth pattern. The patient was treated by a modified R-Appliance and extraction of upper and lower first bicuspids. Modified R-Appliance was used for 18 months followed by 17 months of Posterior bite plate, after which favorable correction of the malocclusion was observed. The SNB angle increased by 5 degrees and the IMPA decreased by 11 degrees. This case demonstrates that modified R-Appliance can be a suitable method for treatment of mandibular deficient cases with verticalgrowth pattern.

Hyrax application as a tooth-borne distractor for maxillary advancement.

Distraction osteogenesis (DO) has become a mainstream surgical technique for patients with jaw deformities. The aim of this study was to report the use of internal DO in the treatment of maxillary hypoplasia in a patient with cleft lip and palate. The case illustrates a 17-year-old boy with class III malocclusion, maxillary deficiency, and cleft lip and palate. Because the patient was experiencing severe hypernasality, it was decided to treat him by DO. The treatment process began by mounting a hyrax in the upper jaw for lateral expansion. A second hyrax was mounted in a way to create anteroposterior expansion. One day after the second hyrax application, the patient underwent a modified Le Fort I osteotomy. He was instructed to turn the screws twice per day for 12 days. The treatment was continued by means of a conventional face mask for 2 months. After 16 months of active treatment, favorable correction of the skeletal problem was observed. The S-N-A angle increased by 5 degrees, and patient's hypernasality was comprehensively improved.

Treatment effects of the R-appliance and twin block in Class II division 1 malocclusion.

The purpose of this study was to compare the effects of a differently designed functional appliance (the R-appliance) with a twin-block (TB)-treated group. Thirty patients (18 girls and 12 boys) with a mean age of 10.5±0.7 years were treated with the R-appliance for 16.2±0.3 months and 25 (11 boys and 14 girls) with a mean age of 11.2±1.3 years with a TB for 16.1±1.4 months (control). All had a Class II division 1 malocclusion due to mandibular deficiency. Lateral cephalograms obtained at the beginning (T1) and end (T2) of the study were analysed. Paired t-tests showed that SNB significantly increased in both groups. The incisor mandibular plane angle (IMPA) was reduced in the R-appliance group by 1.9±4.9 degrees (P<0.04) but increased by 0.5±5.1 degrees (P<0.6) in the TB group. SNA in the R-appliance group showed an increase of 0.2±1.8 degrees (P<0.5), while it was decreased by 0.2±1.3 degrees (P<0.3) in the TB group. Both treatment modalities were successful in moving the mandible forward. However, with the R-appliance, this was achieved without retroclination of the lower incisors.

Treatment of a Class III patient: a case report.

BACKGROUND: The skeletal Class III malocclusion may be characterised by mandibular prognathism, maxillary deficiency or both. AIM: To describe the early treatment of a skeletal Class Ill patient. METHODS: This case report presents a 10 year-old boy with a Class III malocclusion comprising a combination of maxillary deficiency and mandibular prognathism. Two treatment plans were considered. The first was to correct maxillary deficiency at an early age, while the second aimed to postpone treatment until after skeletal growth completion and then offer bimaxillary surgery. The case was treated early and a tongue appliance was used for maxillary protraction. RESULTS: The post-treatment SNA angle showed a 5 degree increase and a positive overbite and overjet were achieved after 23 months of active treatment. However, mandibular prognathism was still evident. CONCLUSION: Both treatment options have advantages and disadvantages which require informed clinical consideration.

A novel method of maxillary deficiency treatment by tongue plate--a case report.

This case illustrates the treatment of a 6-year-old girl with Class III malocclusion and maxillary deficiency. The patient was treated by a tongue plate in the upper jaw. The tongue plate had two Adams clasps on the first maxillary molars, two C clasps on the deciduous maxillary canines and an acrylic plate posterior to the maxillary incisors. The active treatment lasted for 24 months after which favorable correction of the malocclusion was observed. The SNA angle increased by 4 degrees and the IMPA decreased by 11 degrees. This case demonstrates that tongue plate might be an alternative method to extraoral appliances in Class III and maxillary deficient cases.

The effects of miniscrew with Class III traction in growing patients with maxillary deficiency.

The aim of this study was to compare the effects of face mask and miniscrew combined with Class III traction on Class III malocclusion maxillary deficiency in growing patients. 10 patients were treated with facemask and 10 other patients were treated by means of miniscrew and Class III traction. Pre- and post-treatment cephalometric data were analyzed and compared between the two groups. Both groups were successfully treated; however, IMPA increased in miniscrew group while it decreased in facemask group.

Treatment of maxillary deficiency by miniscrew implants--a case report.

This case report illustrates the treatment of a 12-year-old boy with maxillary deficiency using miniscrew implants. The patient rejected the use of extraoral appliances and future surgical correction; therefore the patient was treated using Class III elastics connected from two mandibular miniscrew implants to an upper removable appliance. The miniscrews were inserted between the permanent canines and first premolars under local anaesthesia. The treatment lasted for 8 months after which favourable correction of the malocclusion was observed. The SNA and ANB angles increased by 3 degrees and the IMPA increased by 4 degrees . This case demonstrates that miniscrews can be a suitable alternative method to extraoral appliances and possibly surgery in mild Class III cases.

Non-surgical treatment of mandibular deviation: a case report.

BACKGROUND: Mandibular deviation due to premature contact of teeth in crossbite may be associated with facial asymmetry. AIM: To describe the non-surgical treatment of mandibular deviation associated with a marked facial asymmetry. METHODS: A 13.5 year-old girl presented with a unilateral posterior crossbite, noticeable facial asymmetry, anterior crossbite and displacement of the mandible on closure. She had no history of head injury or significant medical problems and her parents rejected surgical correction. A removable appliance was used to correct the crossbite followed by fixed appliances to complete treatment. RESULTS: Treatment resulted in a marked improvement in facial symmetry and elimination of the mandibular displacement. CONCLUSIONS: Early correction of a functional deviation associated with a unilateral facial asymmetry may avoid the need for surgery.

A novel approach in treatment of maxillary deficiency by reverse chin cup.

The aim of this study was to evaluate the effectiveness of a newly designed small-sized extraoral appliance on Class III malocclusion and maxillary deficiency in growing patients. The case series included 10 patients (4 males, 6 females) with a mean age of 8.9 +/- 1.72 years who suffered from maxillary deficiency. All the patients were treated with an extra oral appliance which was named as reverse chin cup. This appliance consisted of a high pull cap, a chin cup with two vertical hooks, a removable appliance on the upper jaw, and two elastics which connected the hooks of the cup to the hooks of the removable appliance. The mean treatment time was 24 +/- 9 months. Mean SNA and ANB were significantly increased by 3.1 degrees +/- 1.6 degrees and 3.5 degrees +/- 1.7 degrees, respectively (p<0.001). The level of significance was set at P<0.05. The increase of SNA angle and ANS-PNS distance (p<0.001) and the decrease of nasolabial angle (P<0.004) indicated that the reverse chin cup was effective in moving the maxilla in a forward position. Moreover, the smaller size of this appliance makes it more favorable for patients.

The effect of tongue appliance on the maxilla in Class III malocclusion due to maxillary deficiency.

Various treatment approaches are applied for correction of CL III malocclusion due to maxillary deficiency. However, the benefits of a simple intraoral appliance that can move the maxilla in forward position have not been reported. 25 Cl III patients with SNA < 78 degrees, SNB < or = 80 degrees and ANB < or = 0 were selected for this study. All the patients received a tongue appliance, which originally was a habit breaker. Pre- and post-treatment cephalometric images were obtained and paired t-test revealed significant increase in SNA and significant decrease in IMPA. The tongue appliance can move the Maxilla in forward position. Therefore, this simple appliance can be an alternative method for protraction of Maxilla.

R-appliance: a different design in functional therapy in Class II Division I malocclusion.

UNLABELLED: The aim of this study was to compare the effects of a differently designed functional appliance (R-appliance) with control group in Class II Division I (Cl II Div I) cases. METHODS: 18 girls treated with R-Appliance were selected as the experimental group. The control group consisted of 20 untreated girls. All of the patients had Cl II Div I malocclusion due to mandibular deficiency. Lateral cephalograms were analyzed at the beginning (T'1, T'2) and end of the study (T'1, T2). RESULTS AND CONCLUSIONS: Increase of IMPA and reduction of SNA are two prevalent side effects of most functional appliances; however, results of this study showed SNA and IMPA had no significant changes in experimental group in comparison with the control group.

Cephalometric changes in nasopharyngeal area after anterior maxillary segmental distraction versus Le Fort I osteotomy in patients with cleft lip and palate.

OBJECTIVE: The present study was designed to compare the effects of two surgical methods, anterior maxillary segmental distraction (AMSD) versus conventional Le Fort I osteotomy, on cephalometric changes of velopharyngeal area of patients with cleft lip and palate. MATERIALS AND METHODS: This study was conducted on 20 CLP in two groups. The first group had classic Le Fort I maxillary advancement and the second group had AMSD with a modified hyrax as an intraoral tooth-borne distractor. In the second group, 1 week after the surgery, activation of hyrax screw was started with the rate of 2 times a day for about 10 days. Initial and final lateral cephalograms were traced and analyzed by OrthoSurgerX software. RESULTS: The changes in variables evaluating velopharyngeal status showed a significant difference between the two groups. In Group A (conventional), the mean of nasopharyngeal area and Nasopharynx floor length showed a significant increase (P < 0.05) after the surgery, while in Group B (DO), the trend of changes was vice-versa. The changes in SNA, overjet, and soft-tissue convexity were similar in both groups. CONCLUSION: AMSD can improve facial profile, almost similar to the conventional Le Fort I advancement, while there is a significant decrease in nasopharyngeal; hereby there is no increase in the velopharyngeal sphincter.

Tooth-borne distraction osteogenesis versus conventional Le Fort I in maxillary advancement of cleft lip and palate patients.

BACKGROUND: Distraction osteogenesis (DO) is rapidly becoming a mainstream surgical technique for correction of maxillary deficiency. The aim of this study was to compare the effectiveness of a newly designed tooth-borne osteogenic distraction device with conventional Le Fort 1 osteotomy in maxillary advancement of cleft lip and palate patients. METHODS: The DO group consisted of 10 subjects (7 males, 3 females) with a mean age of 21.2 (SD 4.2) years. In these patients, the newly designed distraction device which exerted force anteroposteriorly was cemented after mobilization of the maxilla. After a latency period of 7 days, the distractor was activated twice daily by a total amount of 0.5 mm per day. The activation was continued for 3 weeks. After an 8-week consolidation period, the distraction appliance was removed. Cephalograms of DO patients were obtained at the start of distraction and at the end of consolidation. The Le Fort 1 group consisted of 11 subjects (6 males, 5 females) with a mean age of 22.3 (SD 3.7) years. Pre and postsurgery lateral cephalograms were obtained. t-test and paired t-test were used to evaluate the data. RESULTS: At the end of treatment, the SNA angle of Le Fort 1 patients increased by 5.5° (SD 2.3) (P<0.001) and the SNA angle of DO patients increased by 3.4° (SD 2) (P<0.001). CONCLUSIONS: Current evidence suggests that both conventional Le Fort 1 and tooth-borne osteogenic distraction device can effectively advance the maxilla forward in patients with cleft lip.

Use of anterior maxillary distraction osteogenesis in two cleft lip and palate patients.

Distraction osteogenesis (DO) has become a mainstream surgical technique for patients with jaw deformities. The aim of this study was to report the effect of DO done by a hyrax screw incorporated in an acrylic plate in the treatment of two maxillary deficient cases with cleft lip and palate. Two patients, a 24-year-old female and a 29-year-old male who suffered from maxillary deficiency and cleft lip and palate, were treated by DO. After making vertical cuts between the premolars on both sides and horizontal cuts similar to Le Fort 1, a hyrax screw was mounted on an acrylic plate for the slow anteroposterior expansion of maxillary arch. The expansion was achieved by turning the hyrax screw 0.8 mm per day after the latency period. Treatment was discontinued after achieving satisfactory over jet and occlusion. This study showed that anterior maxillary distraction is a reliable technique for correction of midfacial deformity arising out of cleft lip and palate. Incidences of complications are negligible compared to total maxillary distraction.