Effects of eruption guidance appliance in the early treatment of Class III malocclusion.

OBJECTIVES: To evaluate the dentoskeletal effects and effectiveness of the eruption guidance appliance in Class III patients in the mixed dentition. MATERIALS AND METHODS: The experimental group comprised 22 patients with Class III malocclusion and anterior cross-bite (12 males, 10 females, mean age 7.63 ± 0.96 years) treated with the eruption guidance appliance over a mean period of 1.72 ± 0.48 years. The control group comprised 22 untreated subjects (12 males, 10 females, mean age 7.21 ± 0.60 years) with Class III malocclusion. Lateral cephalometric radiographs were obtained at pretreatment (T1) and posttreatment (T2). Intergroup comparisons were performed with Mann-Whitney and t-tests (P < .05). RESULTS: In the experimental and control groups, the anteroposterior relationship between the maxilla and mandible (ANB angle) remained stable during the treatment period (T1 to T2). The mandibular plane angle decreased in the experimental group and increased in the control group. In the experimental group, the lower anterior face height increase and maxillary molar vertical development were significantly smaller compared to controls. Positive overjet was achieved in 54% of the experimental group. CONCLUSIONS: The eruption guidance appliance produced no change in the skeletal anteroposterior relationship. The anterior cross-bite/edge-to-edge relationship was corrected in only about half of the treated subjects.

Clinical Insights Into Addressing Constricted Maxillary Arch in Angle's Class II Malocclusion: A Case Report.

The transverse dimension, often overlooked in orthodontics, plays a crucial role in malocclusions, affecting not only occlusion in that dimension but also sagittal and vertical dimensions. Posterior crossbites, indicative of transverse maxillary issues, are commonly addressed through palatal expansion. This case report explores the clinical insights into addressing a constricted maxillary arch in Angle's Class II malocclusion using a nickel-titanium (NiTi) expander. The NiTi expander provides constant and optimal expansion forces by incorporating a temperature-activated NiTi alloy. A 16-year-old male with irregularly placed teeth, high palatal vault, and posterior crossbite underwent treatment involving NiTi expander usage for maxillary expansion. The case presentation details the patient's journey, starting with upper arch bonding and expansion, then lower arch bonding, and concluding with complete leveling and alignment without extractions. The presented case demonstrates successful correction of a constricted maxillary arch, specifically in the canine and molar regions, utilizing the NiTi expander. The observed increase in intermolar width aligns with previous studies, showcasing the effectiveness of slow maxillary expansion. This article contributes valuable clinical insights into addressing transverse maxillary issues, emphasizing the importance of careful consideration in choosing the appropriate expansion method for optimal results.

Early Interceptive Correction for Anterior Crossbite Using a Removable Appliance: A Pediatric Case Study.

Anterior crossbite is a malocclusion that occurs for a variety of reasons, causes significant issues, and may be corrected in a variety of ways. Early recognition and timely intervention are crucial in managing anterior dental crossbites during the mixed dentition stage. The purpose of this report is to assist general dentists and pediatric dentists in distinguishing between cases within their scope of practice and those requiring referral to orthodontists and treating this condition immediately to prevent future complex treatment and improve patient aesthetics and function. This case report highlights the treatment of an eight-year-old patient with class III incisors on a skeletal class I base, presenting with an anterior crossbite. The patient was treated successfully using an upper removable appliance, showcasing a non-invasive and effective approach to correcting dental malocclusions early. The rapid correction of the crossbite within six weeks underscores the importance of early intervention and the potential for general dentists and pediatric dentists to manage such conditions efficiently, improving patient outcomes in aesthetics and function.

Functional treatment of bilateral posterior crossbite improves mandibular kinematics during chewing.

OBJECTIVES: To evaluate the effects of treatment of bilateral posterior crossbite (BPXB) on mandibular kinematics by the percentage of reverse chewing cycles (RCCs) during soft and hard bolus chewing before and after the correction of the malocclusion with function-generating bite (FGB). MATERIALS AND METHODS: This prospective study included 71 subjects: 19 patients with occlusally symmetric BPXB (M = 9; F = 10; mean age 9.3 ± 2.2[yr.mo]), 32 patients with occlusally asymmetric BPXB (19 with more teeth in crossbite on the right side (right prevalent side), M = 7; F = 12; mean age 8.2 ± 1.6 [yr.mo] and 13 on the left side, M = 7; F = 6; mean age 9.6 ± 1.9 [yr.mo]) and 20 controls without malocclusion (M = 8; F = 12; mean age 10.2 ± 1.7 [yr.mo]). Masticatory patterns were recorded before (T0) and after (T1) the correction of the malocclusion with FGB, with the K7-I® kinesiograph using standardized soft and hard boluses. RESULTS: BPXB was corrected in all included patients. At T0, the percentage of RCCs in BPXB was significantly increased compared to controls (P < .0001); symmetric BPXB showed no difference in RCCs between the sides, whereas asymmetric BPXB showed significantly more RCCs on the side with more teeth in crossbite (prevalent side). After treatment with FGB (T1), the percentage of RCCs was significantly reduced in both symmetric BPXB patients (soft bolus, P = .003; hard bolus, P < .001) and asymmetric BPXB patients (prevalent side: soft and hard bolus, P < .00001; non-prevalent side: soft bolus, P = .01 and hard bolus, P = .0002). CONCLUSION: Functional correction of BPXB with FGB significantly improved mandibular kinematics during chewing.

Analysis of the Influence of Breastfeeding and Bottle-Feeding upon the Origin of Posterior Crossbites.

(1) Introduction. An analysis was made of posterior crossbites in deciduous dentition and their relation to the type of feeding received by the child, with the objective of determining the influence of the way in which the child is fed in the early stages of life on the development of posterior crossbites. (2) Material and methods. A total of 1401 preschool children between 3 and 6 years of age from Seville (Spain) were included in the study. An intraoral exploration was carried out to assess the presence of crossbites (uni- or bilateral, and functional or not). The study was completed with a parent or legal guardian questionnaire exploring the type of feeding received by the child in the first stages of life, as well as the presence of bad oral habits and their duration. (3) Results. A total of 276 children (19.7%) presented posterior crossbite in occlusion. Uponn centering the midlines, 197 were maintained, indicating that 79 were due to premature contacts (functional crossbites). There were no significant differences in crossbites among the children who had received breastfeeding, though bottle-feeding was seen to favor crossbite. (4) Conclusions. No statistically significant relationship was found between posterior crossbites and breastfeeding, though an association between posterior crossbites and bottle-feeding was observed, with the number of crossbites increasing with the duration of bottle-feeding.

Long-term stability of posterior crossbite correction, treated in the mixed or permanent dentition of growing children: A systematic review and meta-analysis.

When treating posterior crossbite, the primary goal is to achieve long-term crossbite correction. The majority of studies however focus on relapse of the increase in the transverse dimension, but not relapse of the crossbite itself, which is an essential outcome. The aim of the present study was to determine long-term stability (2 years minimum post-treatment) of posterior crossbite correction, treated in mixed or early permanent dentitions of growing children. Following registration in PROSPERO (CRD42022348858), an electronic literature search including PubMed, Embase, Web of Science, the Cochrane Library, and a manual search were conducted up to January 2023, to identify longitudinal studies looking into the long-term stability of crossbite correction in growing children. Data extraction and risk of bias assessment were carried out, and subsequently, a random-effects meta-analyses models were used to calculate estimates for relapse of the crossbite and relapse at the transverse level. Twenty-two studies were included, of varying designs and quality, representing 1076 treated patients, with different expansion appliances and protocols. Meta-analysis results showed that 19.5% (95% CI: 15%; 25%) of patients present with relapse of posterior crossbite at long-term follow-up. At the transverse level, 19.3% of the total expansion (including overexpansion) relapsed (95% CI: 13%; 27%) regardless of whether there a was relapse of the crossbite itself. Data from existing studies, with a moderate level of evidence, indicate that the long-term stability of posterior crossbite correction in growing children is unfavourable in roughly 1 in 5 growing children, with crossbite relapse long-term. On average, 19% of the maxillary expansion performed (including overexpansion) relapses long-term, which may occur in cases with or without relapse of the crossbite.

Analysis of maxillary asymmetry before and after treatment of functional posterior cross-bite: a retrospective study using 3D imaging system and deviation analysis.

BACKGROUND: Previous evidence would suggest that subjects affected by functional posterior cross-bite (FPXB) present an asymmetric morphology of the maxilla. However, no evidence is available concerning the morphology (symmetry/asymmetry) of the maxilla after treatment of FPXB. This study aimed to investigate the volumetric and morphological changes of the palate in FPXB subjects treated with maxillary expansion and to compare these data with an untreated control group. The study sample included 20 FPXB subjects (mean age 8.1 ± 0.9 years) who underwent maxillary expansion (MEG group) and 21 FPXB subjects (mean age 7.7 ± 1.2 years) as controls (CG group). Digital models were recorded at T0 (first observation) and T1 (12-18 months after first observation) and analyzed to assess palatal volume and symmetry. Deviation analysis and percentage matching calculation were also performed between original and mirrored palatal models for each patient. All data were statistically analyzed for intra-timing, inter-timing and inter-groups assessments. RESULTS: At T0, the cross-bite side (CBS) was significantly smaller than non-cross-bite side (non-CBS) in both groups (p < 0.05). At T1, the CBS/non-CBS difference reduced significantly in the MEG group (p < 0.05) while slightly worsened in the CG, however without statistical significance (p > 0.05). The matching percentage of the palatal models improved significantly at T1 in the MEG group (T0 = 74.02% ± 9.8; T1 = 89.95% ± 7.12) (p < 0.05) while no significant differences were recorded in the CG (T0 = 76.36 ± 8.64; 72.18% ± 9.65) (p > 0.05). LIMITATIONS: The small sample size and the retrospective design of the study represent two limitations that should be overcome with further clinical trials. CONCLUSIONS: Subjects with FPXB present an asymmetric development of the maxillary vault that improves after reestablishment of normal occlusion following maxillary expansion.

Clinical and CT Scan Evaluation of Outcomes of Modified SARPE Using a Bone-Borne Hyrax Appliance in Unilateral Posterior Crossbite.

Objective: The objective of this study was to evaluate, using clinical and computed tomography, outcomes of unilateral SARPE with a bone-borne hyrax appliance in case of unilateral crossbite and to assess the correlations between hyrax appliance opening and post-SARPE skeletal changes. Materials and Methods: Two patients of unilateral crossbite underwent Unilateral SARPE and post-surgical expansion of maxilla using a bone-borne hyrax appliance. Computed tomography was used to make comparative linear and angular measurements of the anterior, intermediate, and posterior portions of the maxilla. The correlation between maxillary expansion and appliance opening was also investigated. Results: Significant overall expansion was observed with maximum expansion in the anterior and inferior portions of the maxilla. The degree of appliance opening was significantly greater than that of the skeletal expansion. Comparative CAD measurements showed maximum increase in interdental width at the second premolar level. Conclusion: The transverse expansion of the maxilla obtained with a bone-borne hyrax is less than uniform. The lack of linear correlation between appliance opening and skeletal expansion is attributable to multiple factors, including those related to the device, the surgical technique, and the craniofacial deformity itself.

Influence of bad oral habits upon the development of posterior crossbite in a preschool population.

BACKGROUND: A study is made of posterior crossbite in deciduous dentition and its possible association to extrinsic factors (bad oral habits). METHODS: A total of 1168 Spanish children between 3 and 6 years of age were included in the study. Exploration of the oral cavity was performed to assess the presence of crossbite (uni- or bilateral and/or functional), and a questionnaire was administered to the parents or caregivers to determine the presence of bad oral habits and their duration. RESULTS: In occlusion, 19.7% of the cases (n = 230) presented uni- or bilateral posterior crossbite. On adopting centric relation confronting the midlines, crossbite persisted in 165 children, indicating that 65 cases were due to premature contacts (functional crossbite). The identified favoring factors were pacifier use, thumb sucking, oral breathing and tongue thrusting or immature swallowing. DISCUSSION: Most studies in the literature report a relationship between posterior crossbite and bad oral habits. The proportion of posterior crossbites identified in our study (16.6%) is consistent with the data published by authors such as Kobayashi, Limeira or Paolantonio, among others, but differs from the results of Zhifei Zhou, Peres or Germa. In coincidence with most studies, we recorded a statistically significant association between posterior crossbite and bad oral habits. CONCLUSIONS: Bad oral habits favor the appearance of posterior crossbite, and the duration of the habit, its intensity (in the case of thumb sucking) and type (in the case of pacifier use) act as influencing factors. Functional study characterized the types of posterior crossbites and identified those attributable to premature contacts. This aspect has not been addressed by previous studies, and we consider the findings to be very interesting for analyzing and identifying the features of true crossbites.

Evaluation of First Molar Buccolingual Angulations and Dental Arch Parameters in Adolescents with Bilateral Posterior Crossbite.

Objective: This study aimed to compare the maxillary and mandibular transverse dental arch widths and buccolingual inclinations of the molar teeth in patients with and without bilateral posterior crossbite (BPC) divided into different age groups. Methods: The study included dental models from 120 patients (age: 12-18 years), including 60 with BPC (32 boys and 28 girls) and 60 without BPC (controls; 30 boys and 30 girls), who were divided into three age groups (12-14, 14-16, and 16-18 years). The centroid and lingual transverse arch widths, dental arch perimeters, dental arch depths, and buccolingual angulation of the molar teeth in the maxillary and mandibular regions were evaluated using scanned three-dimensional dental models. Results: Dental arch parameters and buccolingual molar angulation did not significantly differ between the different age groups in either the patients with BPC or the controls (p>0.05). However, several dental arch width parameters differed significantly between sexes in both groups, with higher values in boys than in girls (p<0.05). The difference in the upper and lower molar buccolingual angulation between patients with BPC and controls was greater at the age of 16-18 years than the age of 12-14 years (p<0.05). Conclusion: Patients with BPC have smaller maxillary dental arch widths and larger mandibular intermolar widths than those without BPC. The difference in the molar buccolingual angulation between them increases with advancing age.

Effect of rapid maxillary expansion on masticatory and swallowing functions in children with posterior crossbite

Abstract Objective: Investigate the influence of posterior crossbite on masticatory and swallowing functions by videofluoroscopy examination and to analyze the effects of Rapid Maxillary Expansion (RME) on the same functions. Methods: A prospective longitudinal study was conducted on 32 children, 21 of them with posterior crossbite (10 girls and 11 boys, mean age 9.2 years, study group) and 11 children with no occlusal changes (6 girls and 5 boys, mean age 9.3 years, control group). The children were evaluated by an orthodontist for diagnosis, group characterization and occlusal treatment, by the otorhinolaryngology team for the assessment of respiratory symptoms, and by a speech therapist for videofluoroscopic evaluation of masticatory and swallowing parameters. The children with posterior crossbite were treated orthodontic ally using the Haas disjunctor for approximately six months and re-evaluated 5-months after removal of the appliance. Data were analyzed statistically by the Studentt-test for independent samples for comparison of the crossbite and control groups before and after treatment. Results: There was no significant difference in oral preparatory and oral transit times, nor in cycles and masticatory frequency, between the pre and post orthodontic treatment groups and the control group. Conclusion: Rapid maxillary expansion did not influence the masticatory and swallowing variables studied by videofluoroscopy. However, the data require caution in interpretation.

Cross-Bite and Oral-Health-Related Quality of Life (OHRQoL) in Preadolescents Aged 11 to 14 Years Old: A Pilot Case-Control Study.

INTRODUCTION: Malocclusions have a negative impact on oral-health-related quality of life (OHRQoL). Posterior cross-bite is one of the most prevalent malocclusions in the preadolescent population. This study investigated the influence of posterior cross-bites (unilateral or bilateral) on OHRQoL in an 11- to 14-year-old population. MATERIALS AND METHODS: A pilot case-control study was carried out at the Dental Clinic of the University of Salamanca between 2021 and 2023. A consecutive sample of 120 preadolescent patients aged 11 to 14 years old was recruited. Three groups were analyzed: a control group (no posterior cross-bite) (n = 40), a group with unilateral posterior cross-bite (n = 40), and a group with bilateral posterior cross-bite (n = 40). To analyze the OHRQoL, the Spanish version of the Child Perception Questionnaire (CPQ-Esp11-14) was used. RESULTS: The mean age of the sample was 12.2 years old (±0.96 years). The group of patients with a bilateral posterior cross-bite was shown to have higher scores in all dimensions of the CPQ-Esp11-14, as well as a higher total score. Sex only influenced the oral symptom dimension of the CPQ-Esp11-14 questionnaire; in this dimension, the girls described a greater impact. Age did not influence OHRQoL. CONCLUSION: The presence of a posterior cross-bite had a negative impact on OHRQoL in the preadolescent population that was studied.

Comparison of nasal cavity changes between the expander with differential opening and the fan-type expander: a secondary data analysis from an RCT.

INTRODUCTION: The aim of this study was to compare the nasal cavity skeletal changes between the expander with differential opening (EDO) and the fan-type expander (FE). METHODS: This study was a secondary analysis of a previous randomized clinical trial. Forty-eight patients with posterior crossbite were randomly allocated into two study groups. Twenty-four patients (11 male, 13 female) with a mean initial age of 7.6 ± 0.9 years were treated with rapid maxillary expansion (RME) using the EDO. Twenty-four patients (10 male, 14 female) with a mean initial age of 7.8 ± 0.9 years were treated with the FE. Cone-beam computed tomography (CBCT) was performed before treatment and 1 to 6 months after the active phase of RME. Using frontal CBCT slices passing at the level of maxillary permanent first molars and maxillary deciduous canines, the width of the nasal cavity was measured in the lower, middle and upper thirds. Nasal cavity height was also evaluated in both slices. Intergroup comparisons of interphase changes were performed using t or Mann-Whitney tests (P < 0.05). RESULTS: The two groups were similar regarding baseline data. EDO showed a greater transverse increase in the lower third of the nasal cavity in both canine (P = 0.007) and molar regions (P < 0.001). No intergroup difference was observed for changes in middle and upper widths and height of the nasal cavity. CONCLUSIONS: Both expanders are effective in promoting an increase of the nasal cavity skeletal dimensions. The expander with differential opening produced a greater transverse increase in the lower third of the nasal cavity compared to the fan-type expander, both at the anterior and posterior regions of the maxilla. CLINICAL RELEVANCE: EDO might be more beneficial to pediatric patients with oral breathing and obstructive sleep apnea compared to FE.

Three-Dimensional Evaluation of Alveolar Cleft Volume and Nasomaxillary Form in Patients with Unilateral Cleft Lip and Palate.

OBJECTIVE: To evaluate the alveolar cleft volume (ACV) and to study its correlation with the nasomaxillary form in patients with unilateral cleft lip and palate (UCLP). DESIGN: Retrospective study. SETTING: University Academic Hospital. PATIENTS/PARTICIPANTS: 30 patients with UCLP and 30 non-cleft patients. INTERVENTIONS: Cone beam computed tomography (CBCT) scans. RESULTS: The Maxillary sinus volume (MSV) and Nasal cavity volume (NCV) were significantly reduced on the affected side in patients with UCLP (P < .001) and also in the cleft group when compared to the noncleft group (P < .01). The septal deviation measured at anterior, mid and posterior nasal spine were increased in the UCLP group significantly when compared to the non-cleft group (P < .01) and maximum deviation was seen at the mid-level. The mean ACV was found to be 0.587 + 0.396 cm3.The nasomaxillary complex was affected in UCLP patients irrespective of cleft size and a statistically significant correlation of ACV was found with septal height only (r value = -0.508). Parameters like septal height, anterior and middle maxillary width were significantly reduced (P < .01) in the cleft group when compared to the non-cleft group. CONCLUSION: The patients with UCLP showed significant differences among various parameters within the nasomaxillary complex when compared to the control group. Within the cleft group, the MSV and NCV were significantly decreased on the cleft side and also a significant negative correlation of ACV was found with septal height only.

Effect of rapid maxillary expansion on masticatory and swallowing functions in children with posterior crossbite.

OBJECTIVE: Investigate the influence of posterior crossbite on masticatory and swallowing functions by videofluoroscopy examination and to analyze the effects of Rapid Maxillary Expansion (RME) on the same functions. METHODS: A prospective longitudinal study was conducted on 32 children, 21 of them with posterior crossbite (10 girls and 11 boys, mean age 9.2 years, study group) and 11 children with no occlusal changes (6 girls and 5 boys, mean age 9.3 years, control group). The children were evaluated by an orthodontist for diagnosis, group characterization and occlusal treatment, by the otorhinolaryngology team for the assessment of respiratory symptoms, and by a speech therapist for videofluoroscopic evaluation of masticatory and swallowing parameters. The children with posterior crossbite were treated orthodontic ally using the Haas disjunctor for approximately six months and re-evaluated 5-months after removal of the appliance. Data were analyzed statistically by the Studentt-test for independent samples for comparison of the crossbite and control groups before and after treatment. RESULTS: There was no significant difference in oral preparatory and oral transit times, nor in cycles and masticatory frequency, between the pre and post orthodontic treatment groups and the control group. CONCLUSION: Rapid maxillary expansion did not influence the masticatory and swallowing variables studied by videofluoroscopy. However, the data require caution in interpretation.

Influencia de la masticación unilateral no alternante en el desarrollo maxilofacial y tratamiento precoz / Influence of non-alternating unilateral chewing on the maxillofacial development and early treatment

Introducción: La masticación unilateral no alternante es un hábito nocivo consis tente en realizar la masticación de forma exclusiva o predominante por uno de los dos lados de la dentición que, manteni do en el tiempo durante el crecimiento, origina un desarrollo asimétrico del com plejo craneofacial afectando a las estruc turas óseas, musculares, articulares y dentarias. Objetivo: Describir cómo influye la masticación unilateral en el crecimiento maxilofacial y en la oclusión, así como el abordaje precoz para evitar las conse cuencias de este hábito. Material y método: Se realizó una bús queda bibliográfica en el metabuscador EBSCO-Dentistry Oral Science Source y en PubMed, seleccionando artículos a texto completo en inglés y español rela cionados con el tema, de lo que se extra jeron 45 para realizar esta revisión. Resultados: La masticación unilateral no alternante genera que la rama mandi bular del lado no masticatorio sufra ma yor crecimiento debido a que el cóndilo de este lado sólo realiza movimientos de traslación con un enorme estímulo de crecimiento. Además, la mayor carga en el cóndilo del lado de masticación gene ra cambios anatómicos, encontrándose el cuello engrosado y el área de la ca beza aumentada. Estos cambios a nivel mandibular producen mordida cruzada posterior unilateral en el lado de la mas ticación con una clase II subdivision (AU)

Introduction: Non-alternating unilateral chewing is a harmful habit consisting of chewing exclusively or predominantly on one of the two sides of the dentition which, maintained over time during growth, causes an asymmetric development of the craniofacial complex, affecting bone structures, muscular, articular and dental. Aim: Describe how unilateral chewing influences maxillofacial growth and occlusion, as well as the early approach to avoid the consequences of this habit. Material and method: A bibliographic search was carried out in the EBSCO Dentistry oral Science Source metasearch engine and in PubMed, selecting full-text articles in English and Spanish related to the subject, of which 45 were extracted to carry out this review. Results: Non-alternating unilateral mastication causes the mandibular ramus on the non-masticatory side to undergo greater growth because the condyle on this side only performs translational movements with enormous growth stimulus. In addition, the greater load on the condyle on the masticatory side generates anatomical changes, with a thickened neck and an increased head area. These changes at the mandibular level produce a unilateral posterior crossbite on the chewing side with a class II subdivision. Conclusions: The hyperfunction of the masticatory muscles and the vertical mandibular movement on the chewing side as well as the eminently translational tra jectory on the rocking side generates asymmetric grow th of the jaw and TMJ, deviation of the chin and midline lower teeth towards the working side, unilateral posterior crossbite and class II subdivision on the masticatory side, among other alterations. Early-stage therapy consists of rehabilitating function, application of composite tracks on the cruciate side, and maxillary expansion (AU)

Activated omega loops for anterior crossbite correction in transitional dentition.

Key Clinical Message: Several approaches can correct pseudo-Class III anterior crossbite. 2 × 4 appliance, compressed open-coil springs, Class III elastics, etc. All cause either soft tissue lacerations, smile line flattening, or upper incisor overproclination. This paper describes a novel method to tip lower incisors into a normal overjet without compromising the upper dentition. Abstract: In pseudo-class III cases, a "two by four" multibracketed appliance has been utilized to put the incisors into a typical overjet during transitional dentition. Compressing a rectangular super elastic archwire creates continuous force, but its length restricts activation and risks cheek impingement. Open-coil springs on rigid archwires advance incisors labially, although a 4-5 mm of wire distal to the molar tube may injure soft tissue. Reciprocally anchored Class III intermaxillary elastics restore anterior overjet through lower incisor lingual tipping and upper incisor proclination. Class III elastics extrude maxillary molars and mandibular incisors, rotating the dental occlusal plane counterclockwise and reducing maxillary incisor exposure and aesthetics. A unique method is reported in this report to tip the lower incisors back into normal overjet without affecting the upper dentition.

The Facial Characteristics of Individuals with Posterior Crossbite: A Cross-Sectional Study.

Facial morphology is known to be influenced by genetic and environmental factors. Scientific evidence regarding facial parameters in patients with posterior crossbite is lacking. This study aimed to investigate the association between posterior crossbite and facial parameters. This cross-sectional study included 34 adolescents with and 34 adolescents without posterior crossbite in the age range from 13 to 15 years. Facial surface scans were acquired with a 3dMD imaging system, and landmark-based analysis was performed. Data were analyzed using the Mann-Whitney U test and Spearman's correlations. Individuals in the control group had lower face heights (females: p = 0.003, r = 0.45; males: p = 0.005, r = 0.57). The control group females presented with smaller intercanthal width (p = 0.04; r = 0.31) and anatomical nose width (p = 0.004; r = 0.43) compared with the crossbite group females. The males in the control group had wider nostrils. In the control group, significant correlations among different facial parameters were more common, including the correlations between eye width and other transversal face measurements. On the contrary, the facial width was correlated with nasal protrusion (r = 0.657; p < 0.01) and the morphological width of the nose (r = 0.505; p < 0.05) in the crossbite group alone. In both groups, the philtrum width was linked with the anatomical and morphological widths of the nose. Conclusions: Patients with posterior crossbites have increased face height and different patterns of facial proportions compared with individuals without crossbites.

Relation between Maximum Oral Muscle Pressure and Dentoalveolar Characteristics in Patients with Cleft Lip and/or Palate: A Prospective Comparative Study.

BACKGROUND: Perioral muscle function, which influences maxillofacial growth and tooth position, can be affected in patients with oral clefts due to their inherent anatomical characteristics and the multiple surgical corrections performed. This research aims to (1) compare the maximum oral muscle pressure of subjects with and without isolated cleft palate (CP) or unilateral cleft lip and palate (UCLP), (2) investigate its influence on their dentoalveolar characteristics, and (3) investigate the influence of functional habits on the maximum oral muscle pressure in patients with and without cleft. MATERIAL AND METHODS: Subjects with and without CP and UCLP seeking treatment at the Department of Orthodontics of University Hospitals Leuven between January 2021 and August 2022 were invited to participate. The Iowa Oral Performance Instrument (IOPI) was used to measure their maximum tongue, lip, and cheek pressure. An imbalance score was calculated to express the relationship between tongue and lip pressure. Upper and lower intercanine (ICD) and intermolar distance (IMD) were measured on 3D digital dental casts, and the presence of functional habits was reported by the patients. The data were analyzed with multivariable linear models, correcting for age and gender. RESULTS: 44 subjects with CP or UCLP (mean age: 12.00 years) and 104 non-affected patients (mean age: 11.13 years) were included. No significant differences in maximum oral muscle pressure or imbalance score were detected between controls and clefts or between cleft types. Significantly smaller upper ICDs and larger upper and lower IMDs were found in patients with clefts. A significant difference between controls and clefts was found in the relationship between oral muscle pressure and transversal jaw width. In cleft patients, the higher the maximum tongue pressure, the wider the upper and lower IMD, the higher the lip pressure, the smaller the upper and lower ICD and IMD, and the higher the imbalance score, the larger the upper and lower IMD and lower ICD. An imbalance favoring the tongue was found in cleft patients. The influence of functional habits on the maximum oral muscle pressure was not statistically different between clefts and controls. CONCLUSION: Patients with CP or UCLP did not present reduced maximum oral muscle pressure compared with patients without a cleft. In cleft patients, tongue pressure was consistently greater than lip pressure, and those who presented a larger maxillary width presented systematically higher imbalance scores (favoring the tongue) than those with narrow maxillae. Therefore, the influence of slow maxillary expansion on maximum oral muscle pressure in cleft patients should not be underestimated.