Orthodontic and orthopedic management of dentofacial deformity from juvenile idiopathic arthritis: a systematic literature review.

BACKGROUND: An update on the knowledge regarding the orthopedic/orthodontic role in treating JIA-related dentofacial deformities is relevant. OBJECTIVES: This systematic review aimed to assess the level of evidence regarding the management of dentofacial deformity from juvenile idiopathic arthritis (JIA) with orthodontics and/or dentofacial orthopedics. SEARCH METHODS: The following databases were searched without time or language restrictions up to 31 January 2024 (Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Latin American and Caribbean Health Sciences Literature). SELECTION CRITERIA: Inclusion criteria were studies dealing with JIA subjects receiving treatment with orthodontic and/or dentofacial orthopedic functional appliances. DATA COLLECTION AND ANALYSIS: After the removal of duplicate studies, data extraction, and risk of bias assessment according to ROBINS-I guidelines were conducted. Data extraction was conducted by two independent authors. RESULTS: The electronic database search identified 397 eligible articles after the removal of duplicates. Following the application of the pre-defined inclusion and exclusion criteria, 11 articles were left for inclusion. Two trials were associated with a severe risk of bias, four trials were at moderate risk of bias, and the other five presented a low risk of bias. Various research groups employed and documented the effects of different types of appliances and methodologies. The study heterogeneity did not allow for meta-analyses. In addition, a lack of uniformity in treatment objectives was observed across the included studies. After treatment with dentofacial orthopedics skeletal improvement was demonstrated in 10 studies, and a decrease in orofacial signs and symptoms was reported in 7 studies. CONCLUSIONS: Across the available literature, there is minor evidence to suggest that dentofacial orthopedics may be beneficial in the management of dentofacial deformities from JIA. There is little evidence to suggest that it can reduce orofacial signs and symptoms in patients with JIA. Based on current evidence, it is not possible to outline clinical recommendations for specific aspects of orthopedic management in growing subjects with JIA-related dentofacial deformity. REGISTRATION: PROSPERO (CRD42023390746).

Effects of orthopedic treatment (distraction splint) on dentofacial deformities in patients with juvenile idiopathic arthritis.

BACKGROUND: Juvenile idiopathic arthritis (JIA) frequently affects the temporomandibular joint (TMJ), which can alter mandibular growth and development and result in dentofacial deformities. OBJECTIVE: To assess the outcomes of orthopedic treatment with distraction splint (DS) in patients with JIA-related dentofacial deformity. METHODS: The retrospective study involved 30 patients with JIA and unilateral TMJ involvement, another study group of 20 patients with JIA and bilateral TMJ involvement, and a control group of 18 non-JIA orthodontic patients with Class II and III malocclusions. The inclusion criteria were DS treatment and cone-beam computed tomography (CBCT) scans before (T0) and 2 years after treatment (T1). Dentofacial morphology and deformity were evaluated based on a validated three-dimensional CBCT-based morphometric analysis. Intergroup differences in outcome measures were compared at T0 and T1, and intragroup changes between T0 and T1 were assessed using the Kruskal-Wallis test. RESULTS: Initial evaluations at T0 revealed significant differences between the unilateral and bilateral JIA groups and the control group for three out of eight dentofacial deformity variables: inter-side difference in total posterior mandibular height, mandibular axial angle, and posterior/anterior face height (ratio). At follow-up (T1), significant inter-group differences were only observed in total posterior mandibular height indicating that intergroup differences were less pronounced after splint treatment. Assessing inter-group changes between T0 and T1 showed that all parameters remained constant except posterior/anterior face height ratio, which significantly decreased between T0 and T1. CONCLUSIONS: The findings demonstrate the potential of DS treatment for patients with JIA and unilateral or bilateral TMJ involvement to generally support normal dentofacial growth or at least limit further deterioration of dentofacial deformities.

Knowledge and attitudes of emergency medicine physicians and nurses regarding emergency management of dentofacial trauma in pediatric patients.

OBJECTIVES: Considering that the first visit for dentofacial trauma is generally in emergency departments, the awareness and knowledge of the emergency medicine staff regarding the treatment of dentofacial injuries is very important for the prognosis. The aim of this study was to investigate the knowledge, education, and self-confidence levels of emergency medicine physicians and nurses concerning the diagnosis and treatment of dentofacial traumatic injuries in pediatric patients. METHODS: This questionnaire-based, cross-sectional study included emergency medicine physicians and emergency medicine nurses. The survey contained questions and three sections on participants' general data, attitudes, basic knowledge, and confidence levels in managing dentofacial trauma. RESULTS: A total of 407 participants (250 emergency medicine physicians and 157 emergency medicine nurses) were included in this study. There was a significant difference between the groups regarding the correct answers to the questions about trauma management and emergency management of crown fractures and avulsed permanent teeth (p <0.05). CONCLUSION: Our findings show that there is a lack of information on dentofacial trauma for emergency medicine physicians and nurses. In order to increase knowledge in this area and to improve the diagnosis and management of dentofacial trauma, interdisciplinary seminars, case discussions, and continuing education programs should be held for emergency medicine staff.

Facial asymmetry: virtual planning to optimize treatment predictability and aesthetic results

Abstract Facial asymmetry is a condition that compromises function and social interactions and, consequently, the quality of life. Orthodontic-surgical treatment may be indicated to achieve a stable occlusion and significant improvement in facial aesthetics. The virtual planning of the maxillary, mandibular and chin movements can be done prior to surgery. These movements can be successfully performed with the use of prototyped guides obtained from virtual planning. The aim of this article is to show the state of the art of treatments of facial asymmetries, and emphasize how important is the multi-disciplinary approach to achieve predictable aesthetic and functionally stable results in a patient with facial asymmetry and chin protrusion.

Resumo A assimetria facial é uma condição capaz de comprometer a função oclusal e as interações sociais e, consequentemente, a qualidade de vida dos indivíduos. Nessas condições, para se obter oclusão estável e melhora significativa na estética facial, o tratamento ortodôntico-cirúrgico pode estar indicado. A simulação virtual da cirurgia permite planejar de forma adequada, e antecipada, os movimentos cirúrgicos a serem efetuados na maxila, mandíbula e mento. Esses movimentos são, então, realizados com sucesso graças ao uso de guias prototipados obtidos a partir do planejamento virtual. Assim, os objetivos do presente artigo consistem em relatar o estado da arte no planejamento virtual do tratamento de um paciente com assimetria facial e protrusão do mento, e enfatizar a importância da abordagem multidisciplinar para se atingir resultados estéticos previsíveis e funcionalmente estáveis.

Facial asymmetry: virtual planning to optimize treatment predictability and aesthetic results.

Facial asymmetry is a condition that compromises function and social interactions and, consequently, the quality of life. Orthodontic-surgical treatment may be indicated to achieve a stable occlusion and significant improvement in facial aesthetics. The virtual planning of the maxillary, mandibular and chin movements can be done prior to surgery. These movements can be successfully performed with the use of prototyped guides obtained from virtual planning. The aim of this article is to show the state of the art of treatments of facial asymmetries, and emphasize how important is the multi-disciplinary approach to achieve predictable aesthetic and functionally stable results in a patient with facial asymmetry and chin protrusion.

Large-Scale Study of Long-Term Anteroposterior Stability in a Surgery-First Orthognathic Approach Without Presurgical Orthodontic Treatment.

Presurgical orthodontic treatment has long been known as a prerequisite in the traditional orthognathic approach. However, achieving ideal decompensation is very difficult even in the presurgical orthodontic period. For minimization of this problem, the surgery-first orthognathic concept has been introduced. The authors hypothesized that this treatment modality will be feasible for skeletal class III dentofacial deformity patients. In this study, the authors tried to compare the traditional and surgery-first approaches regarding long-term outcomes in terms of stability, based on large-scale data. The patients included in this study had skeletal class III dentofacial deformities, and all underwent, and completed, orthognathic surgery between December 2007 and December 2015. The inclusion criteria were based on presurgical simulation on the dental model, and the authors predicted the potential of the surgery-first approach by this preoperative simulation model. Patients with cleft-related syndromes, those who underwent orthognathic surgeries due to facial asymmetry or class II deformity were excluded from the study. In total, 104 class III patients were enrolled in the surgery-first group and 51 class III patients in the traditional orthodontic-first group. Satisfactory results were achieved in all 155 patients with dentofacial deformity in this study. Overall, the analysis revealed that anteroposterior skeletal long-term stability in the surgery-first approach was not different, statistically or otherwise, from that in the orthodontic-first approach. Anteroposterior skeletal stability was maintained well in the surgery-first approach. In conclusion, surgery-first approach without presurgical orthodontic treatment can achieve similar results of long-term anteroposterior stability in correcting dentofacial deformities as the orthodontic treatment-first approach.

Introduction and assessment of orthognathic information clinic.

BACKGROUND/OBJECTIVES: Orthognathic treatment is routine practice to rehabilitate severe malocclusions and dentofacial deformities. Because orthognathic treatment is elective, patient's involvement in deciding whether to proceed with treatment is vital. Interaction and communication between patient and treating team plays a key role in achieving post-treatment satisfaction. To achieve satisfaction, an orthognathic 'information clinic' for prospective orthognathic patients was established at Oral and Maxillofacial Unit, Tampere University Hospital, Finland. 'Information clinic' includes short talks with power-point presentation given by orthodontist, oral hygienist, oral and maxillofacial surgeon, psychologist, and previous patient. Aim of the study was to set up an 'information clinic' and, more specifically, 1. to assess patients' opinions on the 'clinic' during pilot phase (2013-14) and 2. to analyse general statistics during the first 3 years (2013-16). METHODS: During the pilot phase, patient opinions, based on voluntary questionnaire, were obtained from 85 people. General data were collected for the clinics run in 2013-16. RESULTS: Seventy-two per cent of respondents reported the information provided to help in their decision-making to proceed/not proceed with treatment. Majority considered the information about the surgical aspects and meeting patient who had undergone orthognathic treatment to be the most important part of the clinic. Between March 2013 and 2016, 290 prospective orthognathic patients were invited to 29 'information clinics'. One hundred and ninety-four patients attended, of whom 137 were female and 57 male (age range 15-67 years). CONCLUSIONS: The questionnaire and verbal feedback from the patients was positive; hence, the 'information clinic' is now offered as a routine process to all prospective orthognathic patients in our clinic.

Orthognathic treatment of dentofacial disharmonies: its impact on temporomandibular disorders, quality of life, and psychosocial wellness.

AIM: The objective of this literature review was to assess the effect of orthognathic surgical treatment on temporomandibular disorders (TMD), quality of life (QoL), and psychosocial wellness. METHODS: Journal articles and systematic reviews published in English between 1982 and 2015 were searched using PubMed, MEDLINE, and Cochrane database using the search terms "orthognathic," "temporomandibular disorders," "quality of life," and "psychosocial." The articles were then reviewed and discussed. RESULTS: Both objective and subjective parameters play a role in orthognathic treatment outcome satisfaction and QoL. Psychological factors and TMD exerted a stronger influence on patients' QoL more than objective treatment outcome measures. CONCLUSION: A paradigm shift in clinical mindset from solely objective measures to a more holistic, patient-centric approach of addressing patients' expectations and improving QoL is warranted when treating patients with dentofacial disharmonies.

Tratamento ortodôntico-cirúrgico do Padrão Face Longa e suas complexidades / Complexity of surgical orthodontic treatment in long face patient

Caso Clínico: paciente Padrão Face Longa, Classe II, divisão 1, procurou retratamento ortodôntico apresentando queixa relacionada à estética facial. Em tratamento prévio, havia extraído os quatro primeiros pré-molares. Apresentava, ainda, acentuada atresia das arcadas superior e inferior, perda óssea, reabsorção radicular e inflamação gengival. Foi realizado tratamento ortodôntico associado à cirurgia ortognática, com controle periodontal associado. A reabsorção e a perda óssea não se agravaram durante o tratamento, provavelmente devido ao controle periodontal, às forças leves e o maior intervalo de troca de fios. Houve grande melhora na estética e função. Conclusão: o tratamento ortodôntico-cirúrgico em pacientes periodontais e com reabsorções radiculares, que apresentem queixa importante relacionada à estética facial, pode ser realizado, trazendo acentuado benefício para a qualidade de vida dos pacientes

Planejamento virtual: uma realidade no tratamento das deformidades dentofaciais / Virtual planning: a reality in dentofacial deformities treatment

Introdução: O objetivo deste trabalho é apresentar, por meio da análise de um caso clínico, um protocolo para diagnóstico e tratamento de pacientes portadores de deformidade dentofacial, candidatos ao tratamento ortodôntico-cirúrgico. Esse tratamento exige cautelosa análise da estética facial, da oclusão e do padrão respiratório do paciente. Um diagnóstico preciso é fundamental para a construção de um plano de tratamento adequado, elaborado conjuntamente por cirurgiões e ortodontistas. Os avanços nos exames de imagens 3D na última década permitiram um aumento sem precedentes da precisão no diagnóstico e na execução do planejamento cirúrgico. Atualmente, o planejamento virtual constitui uma importante ferramenta para a realização do tratamento orto-cirúrgico. A cirurgia virtual possui maior precisão, melhorando a capacidade de reprodução do plano de tratamento na sala de cirurgia. Entretanto, é importante que protocolos para o tratamento virtual sejam estabelecidos e aprimorados

Tratamento ortodôntico-cirúrgico das más oclusões do Padrão Face Longa: um benefício muito além da relação molar / Orthodontic-surgical treatment of long face pattern malocclusions: a benefit beyond the molar relationship

A cirurgia ortognática é uma abordagem de tratamento bem estabelecida e indicada em casos de deformidades dentofaciais graves que extrapolam o tratamento ortodôntico convencional. Os pacientes do Padrão Face Longa do tipo grave são usualmente candidatos ao tratamento ortodôntico-cirúrgico, devido ao comprometimento da estética facial e pelas anormalidades oclusais e funcionais que podem afetar a sua aparência e, consequentemente, seu convívio social. No presente artigo, foi abordado um caso clínico de uma paciente do sexo feminino, Padrão Face Longa com deformidade facial grave associada a um desequilibro funcional, submetida ao tratamento ortodôntico-cirúrgico

Surgery first in orthognathic surgery: A systematic review of the literature.

INTRODUCTION: Compared to the conventional approach to orthognathic surgery, "surgery first" protocols could be advantageous in terms of shortened treatment times and immediate esthetic improvement. However, consensus regarding patient selection, technical protocol, and stability is still lacking. METHODS: A systematic review of the scientific literature on surgery-first treatment (January 2000 to January 2015) was performed. The PubMED and Cochrane Library databases were accessed. Patient selection criteria, specific surgical-orthodontic protocol, treatment duration, patient and orthodontist satisfaction, and stability of results were compared with a similar population treated conventionally. RESULTS: The search yielded 179 publications. The application of strict selection criteria gave the final group of 11 articles. In total, 295 patients were managed with a surgery-first approach. A Class III malocclusion was the most prevalent underlying malocclusion (84.7%). Total treatment duration was shorter in surgery-first patients than in those treated conventionally. There was substantial heterogeneity among articles and high reporting bias regarding the inclusion and exclusion criteria, the orthodontic and surgical protocols, and the stability of results. A meta-analysis of combined data was not possible. CONCLUSIONS: The surgery-first approach is a new treatment paradigm for the management of dentomaxillofacial deformity. Studies have reported satisfactory outcomes and high acceptance. However, the results should be interpreted with caution because of the wide varieties of study designs and outcome variables, reporting biases, and lack of prospective long-term follow-ups.

Test-Enhanced Learning in Competence-Based Predoctoral Orthodontics: A Four-Year Study.

Dental educators intend to promote integration of knowledge, skills, and values toward professional competence. Studies report that retrieval, in the form of testing, results in better learning with retention than traditional studying. The aim of this study was to evaluate test-enhanced experiences on demonstrations of competence in diagnosis and management of malocclusion and skeletal problems. The study participants were all third-year dental students (2011 N=88, 2012 N=74, 2013 N=91, 2014 N=85) at New York University College of Dentistry. The 2013 and 2014 groups received the test-enhanced method emphasizing formative assessments with written and dialogic delayed feedback, while the 2011 and 2012 groups received the traditional approach emphasizing lectures and classroom exercises. The students received six two-hour sessions, spaced one week apart. At the final session, a summative assessment consisting of the same four cases was administered. Students constructed a problem list, treatment objectives, and a treatment plan for each case, scored according to the same criteria. Grades were based on the number of cases without critical errors: A=0 critical errors on four cases, A-=0 critical errors on three cases, B+=0 critical errors on two cases, B=0 critical errors on one case, F=critical errors on four cases. Performance grades were categorized as high quality (B+, A-, A) and low quality (F, B). The results showed that the test-enhanced groups demonstrated statistically significant benefits at 95% confidence intervals compared to the traditional groups when comparing low- and high-quality grades. These performance trends support the continued use of the test-enhanced approach.

Evolving concepts of heredity and genetics in orthodontics.

The field of genetics emerged from the study of heredity early in the 20th century. Since that time, genetics has progressed through a series of defined eras based on a number of major conceptual and technical advances. Orthodontics also progressed through a series of conceptual stages over the past 100 years based in part on the ongoing and often circular debate about the relative importance of heredity (nature) and the local environment (nurture) in the etiology and treatment of malocclusion and dentofacial deformities. During the past 20 years, significant advancements in understanding the genomic basis of craniofacial development and the gene variants associated with dentofacial deformities have resulted in a convergence of the principles and concepts in genetics and in orthodontics that will lead to significant advancement of orthodontic treatments. Fundamental concepts from genetics and applied translational research in orthodontics provide a foundation for a new emphasis on precision orthodontics, which will establish a modern genomic basis for major improvements in the treatment of malocclusion and dentofacial deformities as well as many other areas of concern to orthodontists through the assessment of gene variants on a patient-by-patient basis.

[Orthodontic treatment in children suffering from obstructive sleep apnea]. / Traitement orthodontique chez l'enfant porteur d'un syndrome d'apnées obstructives du sommeil.

The obstructive sleep apnea syndrome (OSAS) may affect children, especially those with dentofacial disharmonies. Dentofacial orthopedic (DFO) treatments carried out in those patients must take this condition into account and can, in selected cases, improve or even treat the OSAS. The goal of our work was to report our experience about DFO treatments of children affected by OSAS in the department of maxillofacial surgery of Femme-Mère-Enfant hospital of university hospitals of Lyon, France.

Combined surgical-orthodontic treatment: how did it evolve and what are the best practices now?

It has been 50 years since the landmark presentation by Hugo Obwegeser at Walter Reed Army Hospital. At that conference, Professor Obwegeser offered American surgeons techniques to correct facial skeletal deformities with access through intraoral incisions. As important advances in surgical technique and anesthesia evolved for the surgical procedures, a major contribution by American orthodontists in collaboration with surgeons was the creation of a common diagnostic, planning, and treatment scheme for use by both clinician groups in the treatment of dentofacial deformities, the skeletal and dental problems of the most severely affected 5% of the population. This article summarizes what American orthodontists and surgeons have learned in the late 20th and early 21st centuries, and forecasts what might be the future of treatment for patients with dentofacial deformities.

Extracciones en ortodoncia: puesta al día / Extractions in orthodontics: update

El objetivo de este artículo es revisar los principales criterios actuales sobre las extracciones dentarias en la profilaxis y el tratamiento de las maloclusiones y las deformidades dentofaciales. Las extracciones dentarias constituyen un arma terapéutica imprescindible para el manejo de ciertas maloclusiones. Sus indicaciones responden entre otras razones a la obtención de espacio en la arcada, la mejoría de la estética facial y la consecución de una oclusión equilibrada. Los patrones 'convencionales' de extracciones terapéuticas se corresponden con distintas combinaciones de extracción simétrica de premolares, pero cada vez son más frecuentes las extracciones atípicas, que no siguen un patrón definido. Éstas son más comunes en los pacientes adultos y se realizan por causas vinculadas a patología del propio diente que se extrae, o por exigencias del tratamiento no convencional de la maloclusión. Entre las extracciones atípicas hay que destacar la extracción de un incisivo inferior con indicaciones, contraindicaciones y efectos indeseables bien definidos. Las extracciones de dientes temporales pueden realizarse en el marco de un programa de guía de la erupción, que debe adaptarse a la situación de cada paciente y nunca considerarse como un esquema rígido de aplicación general (AU)

The aim of this paper is to update the most widely accepted criteria on dental extractions in the prevention and treatment of malocclusions and dentofacial deformities. Dental extractions constitute an undeniable tool for the management of some malocclusions. Their purpose is to obtain space in the dental arches, to improve face esthetics and to achieve an adequate occlusion. The traditional patterns of therapeutic extractions consist of different combinations of symmetric extraction of premolars, although atypical extractions without an established pattern are becoming increasingly more common. These are more frequent among adult patients, and are performed because of intrinsic pathology of the tooth to be extracted or due to the unconventional nature of the malocclusion treatment. The atypical extractions include the extraction of a lower incisor, whose indications, contraindications and side effects are well known. The extraction of temporary teeth can be performed as a part of a guide of eruption program. These programs must not be designed to be prescriptive, but rather adapted to the specific patient (AU)

[Skeletal discrepancies: could we avoid surgical procedures?]. / Dysmorphoses dento-squelettiques : peut-on éviter à tout prix la chirurgie ?

Orthodontic-surgical protocols are nowadays considered as the state-of-the-art in cases of skeletal dentomaxillary dysmorphosis. However, for some reasons, it may happen that unquestionable indications for orthodontic-surgical procedures are not respected, patients being treated by orthodontics alone. This kind of mistake in the treatment planning lay the patient open to various potential complications such as: abnormal duration of the orthodontic treatment, dental root resorptions, questionable tooth extraction, unfavorable facial aesthetics, treatment instability... The authors discuss these points illustrated by clinical cases. Although orthognathic surgery protocols became considerably simplified these last two decades, orthodontic-surgical protocols are still relevantly considered as heavy both by patients and practitioners. As a consequence, their indication must be carefully weighed by a multidisciplinary team, keeping in mind that these protocols represent the ultimate functional and aesthetic treatment for dento-skeletal dysmorphoses.

Orthodontic-surgical management of a case of severe mandibular deficiency due to condylar ankylosis.

Dentofacial deformities involve deviations from the normal facial proportions and dental relationships and can range from mild to being severe enough to be severely handicapping.The term handicapping malocclusions though not a term commonly used, involves a fortunately small section (2-4%) of patients who can suffer from esthetic,psychological and functional problems. Craniofacial Orthodontics is the area of orthodontics that treats patients with congenital and acquired deformities of the integument and it's underlying musculoskeletal system within the craniofacial area and associated structures.This case report of a young woman with severe mandibular deficiency and facial asymmetry due to condylar ankylosis highlights the importance of team work in rehabilitation of such severe craniofacial deformities.

Assessing change in quality of life using the Oral Health Impact Profile (OHIP) in patients with different dentofacial deformities undergoing orthognathic surgery: a before and after comparison.

Dentofacial deformities and their treatment have physical and psychological repercussions on quality of life (QOL). Seventy-four patients were evaluated preoperatively (T0) and at 4-6 months postoperatively (T1). Oral health-related QOL was assessed using the short form of the Oral Health Impact Profile (OHIP-14). There was a statistically significant reduction in the average overall OHIP-14 score between T0 (13.23±6.45) and T1 (3.26±4.19). In addition, there were significant decreases in all seven OHIP-14 domains. Class III patients benefited in all domains evaluated, while a significant improvement was seen only in the psychological disability domain for class I patients. Class II patients showed a significant benefit in all domains except the domain of functional limitation. With regard to the total sample (n=74) and class III patients (n=58), correlations between domains were identified for all domains. The same correlation was not identified for class I (n=5) and II (n=11) patients. The entire sample and class III patients showed significant improvements in OHIP-14 scores for all degrees of postoperative sensory disturbance in the upper and lower lips, except for patients with degree 5 (extreme) disturbance of the upper lip. Orthognathic surgical treatment had a positive impact on oral health-related QOL in the patients evaluated.