Comparison of Class II open bite correction by temporomandibular joint prostheses or bimaxillary orthognathic surgery.

INTRODUCTION: The aim of this study was to evaluate the outcome of skeletal Class II and anterior open bite patients who received simultaneous Le fort I osteotomies with temporomandibular joint (TMJ) prostheses or bimaxillary orthognathic surgery. MATERIALS AND METHODS: Patients with condylar resorption (CR) were treated by TMJ prostheses and orthognathic surgery and divided into two groups. Cephalometric radiographs were obtained before and after operation to find out the surgical alteration by comparing measures at different time points. RESULTS: 23 patients were included. Mean overbite of the patients was increased by 3.39 mm in TMJ prostheses group and 3.24 mm in orthognathic group. Occlusal plane angle was averagely rotated -6.06° and 1.31°; mandibular plane counterclockwise rotated 12.23° and 5.81°, respectively. The increase of ramus height in TMJ prostheses group were significantly greater than orthognathic surgery group (8.02 ± 1.96 mm vs. -0.09 ± 1.29 mm). The overall treatment effect was stable in both groups during the 1-year follow up. DISCUSSION: Two surgical plans seem to be reliable treatments of anterior open bite and mandibular retrognathism caused by temporomandibular disease. TMJ prostheses with simultaneous Le fort I osteotomies close open bite by lengthening the height of ramus and rotating maxillo-mandibular complex counterclockwise, while bimaxillary orthognathic surgery by rotating maxilla clockwise and mandible counterclockwise without rebuilding ramus.

Digitization and validation of the open bite checklist manifesto: a step toward artificial intelligence.

OBJECTIVES: To introduce and validate newly designed computer software to aid in the diagnosis of anterior open bite (AOB). MATERIALS AND METHODS: The software was constructed based on the algorithm of a standardized open bite checklist, which considered skeletal, dental, and soft tissue components, as well as smile characteristics. Feeding the software with this input yielded a digital form output (DFO) in the guise of a diagnostic report characterizing the AOB phenotype, contributing components, severity, associated problems, and functional factors. For validation, DFO was compared to a conventional form output (CFO), created in a standardized manner according to expert opinions. Agreement between the DFO and CFO in terms of AOB phenotype was the primary outcome, while the secondary outcome was the number of missing diagnostic components in either method. RESULTS: Percentage of agreement between CFO and DFO was 82.2%, with a kappa coefficient of 0.78, which is considered a good level of agreement. There was a statistically significant relationship between the number of missing diagnostic components in CFO and level of disagreement, which rendered the DFO more reliable. CONCLUSIONS: Newly constructed software represents an efficient and valid diagnostic tool for AOB and its contributing components. There was good agreement between CFO and DFO, with the latter being more comprehensive and reliable. The algorithm built in the software can be used as the basis for a future artificial intelligence model to aid in the diagnosis of AOB.

Tratamiento integral de la clase III esquelética severa, mordida abierta y asimetría facial / Comprehensive treatment of severe skeletal class III, open bite and facial asymmetry

Introducción: La cirugía ortognática está especialmente indicada en casos complejos, donde los procedimientos conservadores fracasan o son insuficientes. El diagnóstico, planificación y tratamiento deben estar a cargo de un equipo multidisciplinario que trabaje en estrecha relación. Objetivo: Reportar el trabajo multidisciplinario en el tratamiento ortodóncico quirúrgico de una desarmonía dentomaxilofacial compleja. Presentación de caso: Paciente masculino, 19 años de edad, mestizo, clase III esquelética grave, hiperdivergente con mordida abierta y asimetría del tercio inferior, que recibió tratamiento prequirúrgico descompensador de ortodoncia. Se realizó cirugía ortognática bimaxilar con genioplastia de ascenso. Conclusiones: El tratamiento de las desarmonías dentomaxilofaciales es complejo y necesita la concurrencia de varias especialidades. Para la resolución del presente caso fue necesario el trabajo coordinado y simultáneo de especialistas de ortodoncia, prótesis dental, cirugía maxilofacial, periodoncia, psicología y otorrinolaringología. Se alcanzaron resultados estéticos y funcionales acorde a los objetivos del tratamiento propuestos y hubo estabilidad un año después de la cirugía(AU)

Introduction: Orthognathic surgery is especially indicated in complex cases, where conservative procedures fail or are insufficient. Diagnosis, planning and treatment should be carried out by a multidisciplinary team that works closely together. Objective: Report the multidisciplinary work in the surgical orthodontic treatment of a complex dentomaxillofacial disharmony. Case presentation: Male patient, 19 years old, mestizo, severe skeletal class III, hyperdivergent with open bite and asymmetry of the lower third, who received presurgical treatment decompensating orthodontics. Bimaxillary orthognathic surgery was performed with ascent genioplasty. Conclusions: The treatment of dentomaxillofacial disharmonies is complex and requires the concurrence of several specialties. For the resolution of this case, the coordinated and simultaneous work of specialists in orthodontics, dental prostheses, maxillofacial surgery, periodontics, psychology and otolaryngology was necessary. Aesthetic and functional results were achieved according to the proposed treatment objectives and there was stability one year after surgery(AU)

Anterior open bite - diagnostics and therapy.

An anterior open bite (AOB) is an occlusal disorder that causes the patient both an aesthetic and functional handicap. The lower third of the face is disproportionately larger. Patients are unable to properly occlude with the anterior part of dental arch and occlusion only happens in the premolar and/or molar regions. An anterior open bite may be the result of anatomical anomalies. Long term stability as well as an immediate outcome of the surgery depends on the choice of a suitable treatment strategy. In this article, we review options of AOB treatment, from classical orthodontic treatment to current combined orthodontic and surgical approach with a benefit of an anchor system.

Are pediatricians and otolaryngologists well prepared to identify early signs of vertical facial growth?

BACKGROUND: The prevalence of vertical facial growth is very high in the developed world. Most authors agree that mouth breathing is its main cause. Even though care is mainly conducted by odontologists, the professionals who first see these patients are pediatricians and otolaryngologists. The objective of this study is to analyze the ability of pediatricians and otolaryngologists to identify early signs of vertical facial growth among children. METHODS: 60 participant aged 4.1-13.7 years were analyzed subjectively by 9 otolaryngologists, 9 pediatricians and two specialists in dentofacial orthopedics. They were also assessed objectively with cephalometric analysis. RESULTS: Otolaryngologists showed 34.78% sensitivity, 92.86% specificity and 48.33% efficiency. Pediatricians showed 13.04% sensitivity, 100% specificity and 33.33% efficiency. Using a linear regression model compared against the objective measurements we found a weak positive correlation both for otolaryngologists and pediatricians. CONCLUSION: The sensitivity was very low for both groups. We believe it is of paramount importance to increase the awareness and the ability of otolaryngologists and pediatricians to recognize signs of disrupt facial growth.

Comportamento mecânico de diferentes tipos de miniplacas para ancoragem esquelética no tratamento da mordida aberta anterior / Mechanical behavior of different miniplate designs for skeletal anchorage in the previus open bite

Situações clínicas que envolvam discrepâncias moderadas e que teriam como opção terapêutica o tratamento orto-cirúrgico, por meio da cirurgia ortognática, podem beneficiar-se da utilização da ancoragem esquelética buscando resultados satisfatórios e com menor morbidade ao paciente. O tratamento da mordida aberta anterior no paciente adulto é uma das situações em que as miniplacas podem oferecer uma ancoragem esquelética capaz de permitir o seu tratamento sem a realização da cirurgia ortognática. O objetivo deste trabalho foi verificar, por meio de análise por elementos finitos, distribuição de tensão e o comportamento de diferentes desenhos de miniplacas, por meio dastensões recebidas e deslocamento sofrido, simulando uma situação clínica de ancoragem esquelética para o tratamento de mordida aberta anterior no adulto. Em um modelo virtual foram aplicadas forças intrusivas de 2, 4 e 6N em molares superiores, tendo como ancoragem miniplacas com formatos T, Y, e I instaladas na região da crista zigomática alveolar. Verificou-se o deslocamento, tensão máxima principal e tensão de Von Mises, de acordo com o formato do dispositivo de ancoragem. As configurações das placas resultaram em diferentes intensidades de stress no osso, na placa e no deslocamento, porém essas tensões se localizaram sempre nas mesmas regiões dentro do limite fisiológico. A placa T obteve comportamento mais indesejado e a placa Y se mostrou mais próxima do ideal(AU)

Clinical situations that involve moderate discrepancies and that would have as a therapeutic option the ortho-surgical treatment, through orthognathic surgery, can benefit from the use of skeletal anchorage seeking satisfactory results and lower morbidity to the patient. The treatment of anterior open bite in the adult patient is one of the situations in which the miniplates can offer a skeletal anchorage capable of allowing its treatment without performing orthognathic surgery. The objective of this work was to verify, through finite element analysis, the bone stress and the behavior of different miniplate designs, through the tensions received and displacement suffered, simulating a clinical situation of skeletal anchorage for the treatment of anterior open bite in the adult. In a virtual model, intrusive forces of 2, 4 and 6N were applied in upper molars, and miniplates with T, Y, and I formats were anchored in the region of the zygomatic abutment. The displacement, main maximum voltage and voltage of Von Mises were checked according to the shape of the anchoring device. The plaque configurations resulted in different stresses in bone, plaque and displacement, but these stresses were always located in the same regions within the physiological limit. The T plate obtained more unwanted behavior and the Y plate showed to be closer to the ideal(AU)

THE ORTHODONTIC APPLIANCES FOR TREATMENT OF OPEN BITE PROPRIETARY CONSTRUCTION.

In orthodontic practice, removable orthodontic devices are used to treat anomalies and deformations of the dentoalveolar apparatus during the period of the transition occlusion. The creation of new orthodontic appliances or the modification of existing appliances is actual today. The aim is to create easy-to-use therapeutical-prophilaxis orthodontic appliances that can be used to treat open bite and anomalies of the individual teeth position. The mechanism of action of the proposed appliance by P. Flis - V. Filonenko for the treatment of open bite (Ukraine's declarative patent No. 69548 for the utility model A61C7 / 00) is to expand the dentition; stimulation of growth of the apical bases of the jaws by moving the upper frontal teeth orally; correction of the tooth-alveolar height; normalization of the position of tongue. The clinical experience of the use of the orthodontic apparatus by P. Flis - V. Filonenko pointed to the drawbacks of its use in the case of retrusion or normal torque of upper frontal teeth. This goal is achieved by introducing into the design a lingual arc and lip bumper (Ukraine's declarative patent No. 115089 for the utility model A61C7 / 00). Orthodontic appliances of P. Flis - V. Filonenko and P. Flis - O.Tsyzh - V. Filonenko are advisable to use for the treatment and prevention of dentoalveolar anomalies and deformations, in particular, open bite and anomalies of individual teeth position. Conducted clinical studies indicate the feasibility of widespread introduction of appliances in orthodontic practice.

Masticatory evaluation of anterior open bite malocclusion using the colorimetric capsule method.

This pediatric study aimed to assess the masticatory function of patients with anterior open bite through a method that utilizes colorimetric capsules. The sample consisted of 106 patients aged 7-11 years, of whom 51 presented with anterior open bite (experimental group) and 55 presented with normal overbite (control group). The colorimetric capsules used in this evaluation contained basic fuchsin granules, which were used to produce a solution after they were ground during chewing. Each patient was asked to chew 1 capsule for 20 seconds. The absorbance of the obtained solutions was analyzed with a spectrophotometer. Greater masticatory efficiency is directly related to the greater light absorbance of a solution, since light absorbance increases with solution concentration. A nonparametric Wilcoxon test indicated that the solutions obtained from the control group presented significantly greater light absorbance than did those from the experimental group (P < 0.05). Therefore, children with an anterior open bite exhibited less masticatory efficiency than those with a normal overbite.

Therapeutic Protocol for Orthosurgical Management of Class III Malocclusion in Patients With Cleidocranial Dysostosis.

Cleidocranial dysostosis (CCD) is a congenital skeletal disorder with significant manifestations in facial and dental development. Patients are affected with CCD present maxillary deficiency, late dental eruption, and supernumerary teeth. Early and multidisciplinary approach is necessary to treat CCD patients, especially to manage dental eruption and Class III malocclusion with maxillary deficiency. Several orthodontic and surgical interventions are performed to enable traction and extraction of teeth. Yet the maxillary deficiency may be protracted followed by orthodontic dental compensation. On the other hand, it is important to note that CCD patients' treatment is closely related to the severity of transversal and sagittal deformities, as well as the discrepancies in the lower third of the face. In this context, patients with facial impairment highly affected by CCD may need ortho-surgical decompensation to reach more aesthetic outcomes. The present study reports a case of a 14-year-old young patient affected by CCD. Clinically, the patient presented Class III malocclusion, maxillary deficiency, short lower facial third, posterior crossbite, and anterior open bite leading to facial disharmony. The patient underwent treatment in 2 stages: the interceptive approach aimed to transversally expand the maxilla and promote its protraction; and the corrective phase combined with the orthognathic surgery treated the patients' main complains; the anterior open bite, unerupted teeth, and chin prominence. The treatment approach applied in the clinical report allowed the correction of the malocclusion and facial profile satisfying completely the patient's expectations.

Miniplate With a Bendable C-Tube Head Allows the Clinician to Alter Biomechanical Advantage in Extremely Complicated Anatomic Structure.

BACKGROUNDS: This article reports C-tube miniplates as a practical temporary anchorage device choice to treat open bite patients with maxillary sinus pneumatization. METHODS: The C-tube components are titanium anchor plates and monocortical screws that are basically similar to any other miniplate systems, but it has the unique characteristic of the tube head to be malleable. The manipulation of the head part is easy due to the composition of pure titanium. The I-shaped C-tube with 3 holes and T-shaped C-tube miniplates were placed above the apices of maxillary molars as an absolute anchorage system to intrude the posterior maxilla. The bending of the tube heads assisted in reduction of severe open bite patient with maxillary sinus pneumatization. RESULTS: Sinus perforation during placement of skeletal anchorage system weakens stability of the anchorage and further cause complications. Placement of titanium C-tube miniplates allowed reliable skeletal anchorage and avoided maxillary sinus perforation in patients with extreme pneumatizations. Simple bending of C-tube miniplates ensured increased orthodontic intrusion force without having to replace them, and eliminated consequences such as perforation of maxillary sinus, sinusitis, soft tissue irritation, or infection. CONCLUSIONS: Anatomic difficulties in the placement of temporary anchorage device can be easily managed by using the bendable C-tube miniplate. It can serve as a great alternative over miniscrews or regular miniplates with reduced risk of sinus perforation and ability to bend the head portion to control orthodontic vectors and forces.

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.

Bimaxillary Osteotomy for Jaw Deformity With Facioscapulohumeral Muscular Dystrophy.

Facioscapulohumeral muscular dystrophy (FSHD) is a subtype of muscular dystrophies which reduces the muscle strength, especially the regions of scapular, shoulder, and upper arms, progressively. According to progressive muscle weakness in FSHD, postoperative stability of patient with FSHD after orthognathic surgery is not reliably acquired same as healthy subjects. A 32-year-old woman with FSHD underwent orthodontic and orthognathic surgical treatment due to jaw deformity. She has been followed up more than 3 years after surgery and acquired skeletal stability. This patient is the first report that showed long-term skeletal stability after orthognathic surgery in patient with FSHD. This patient report suggests that it is possible to apply orthognathic surgical treatment to patients with FSHD.

Etiology of anterior open bite: a review.

OBJECTIVES: Presentation of different causes described in the literature for development of anterior apertognathia. METHODS: A review about data referring to patients limited in their anterior tooth function through the positioning of their teeth has been performed. Electronic data bases, two libraries have been searched for information. Of the identified titles 357 articles and chapters were selected. 43 of these were considered. RESULTS: Aetiology classifications are inconstant and author dependent, but mostly differentiated into genetic and environmental causes. Specifically named are: habit, tongue, airway obstruction, neuromuscular deficiency, trauma, rheumatoid disease, posture and posterior discrepancy. CONCLUSIONS: Many different factors can be relevant for the development of apertognathia and have to be considered. Further research could help differentiating which of the partially contradictory statements are true.

Abordagem multidisciplinar de mordida aberta anterior associada à sucção digital: caso clínico / Multidisciplinary performance to anterior open bite associated with finger sucking: case report

Este estudo tem como objetivo relatar o caso clínico de uma paciente com mordida aberta anterior(MAA) associada ao hábito bucal deletério (HBD) de sucção digital e a importância da interação entre profissionais no tratamento integral. Paciente (9 anos) e sua responsável procuraram atendimento com queixa de hábito de sucção digital prolongado, MAA, ausência de alguns dentes e mal posicionamento dentário, o que comprometia negativamente a estética e autoestima da paciente. Diagnosticou-se crescimento facial equilibrado, MAA, atresia dento alveolar superior, discrepância negativa e dentes 11 e 12 com atraso na irrupção. O tratamento consistiu na instalação do disjuntor de Haas associado à grade palatina para obter a expansão rápida da maxila e corrigir a atresia do arco superior, a fim de anular a discrepância negativa. Concomitantemente realizou-se o acompanhamento e tratamento psicológico e fonoaudiológico.A grade palatina, adaptada com barreira de acrílico, evitou que a língua interpusesse entre os incisivos,o que propiciou a irrupção dos mesmos. Entretanto a paciente ausentou-se por dois meses e retornou ao hábito de sucção digital. Diante disto, indicou-se um bihélice com grade para expansão dento alveolare a paciente manteve o tratamento fonoaudiológico e psicológico. Foi realizado também o acompanhamento para monitoramento da irrupção dentária e desenvolvimento da oclusão. Por meio deste estudo,conclui-se que a intervenção na MAA requer abordagem multidisciplinar a fim de restabelecer a oclusão,propiciar melhora na autoestima e consequentemente na qualidade de vida da criança.

The purpose of this study is to report to the clinical case of a patient with anterior open bite (AOB)associated to the oral deleterious habit of digital suction and the importance of interaction between professionals in the comprehensive treatment. Patient (9 years of age) and its guardian searched dental carewith main complaint of prolonged digital suction, AOB, absence of some teeth and bad dental positioning, which compromised negatively the aesthetic and self es teem of the patient. Balanced facial growth, AOB,upper alveolar dental atresia, negative discrepancy and teeth 11 and 12 with delayed eruption were diagnosed.The treatment consisted in installation of Hass expander associated to palatine grating in order toobtain a fast maxilla expansion and to correct the upper arch atresia that so neutralize the negative discrepancy. Concurrently, held the monitoring and psychological and speech treatment were performed. The palatine grating, adapted with acrylic barrier, prevented the tongue to be positioned between the incisors,which favored their eruption. However, the patient was absent for 2-month and the habit of digital suction was reestablished. In view of this, bi-helix with grating for expansion of the alveolar dental region was indicated and the patient continued speech therapy and psychological treatment. The follow-up to monitoring of the dental eruption and developing of the occlusion were conducted. By means of this study, it was concluded that the OPB intervention require multidisciplinary approach with the purpose of reestablishing the occlusion, propitiating improvement in the selfesteem and consequently in the child quality of life.

Exploring the association between feeding habits, non-nutritive sucking habits, and malocclusions in the deciduous dentition.

BACKGROUND: This study aimed to explore the association between feeding habits, non-nutritive sucking habits, and malocclusions in deciduous dentition. METHODS: A cross-sectional observational survey was carried out in 275 children aged 3 to 6 years and included clinical evaluations of malocclusions and structured interviews. Statistical significance for the association between feeding habits and the development of malocclusion was determined using chi-square and Fisher's exact tests. In addition, odds ratio (OR) calculations were used for intergroup comparisons. Controlling for confounders was adjusted by excluding children with non-nutritive sucking habits. RESULTS: The results indicated that there were no significant relationships between exclusive breastfeeding or bottlefeeding and the presence of any type of malocclusion (p > 0.05). There was also no significant association between breastfeeding or bottlefeeding duration and malocclusion (p > 0.05). In addition, it was observed that exclusive breastfeeding had a protective effect and diminished the risk of acquiring non-nutritive sucking habits (p = 0.001). CONCLUSIONS: There was no association between feeding habits and malocclusions in the deciduous dentition in this sample of children. Exclusive breastfeeding reduced the risk of acquiring non-nutritive sucking habits.

Guidelines proposal for clinical recognition of mouth breathing children.

INTRODUCTION: Mouth breathing (MB) is an etiological factor for sleep-disordered breathing (SDB) during childhood. The habit of breathing through the mouth may be perpetuated even after airway clearance. Both habit and obstruction may cause facial muscle imbalance and craniofacial changes. OBJECTIVE: The aim of this paper is to propose and test guidelines for clinical recognition of MB and some predisposing factors for SDB in children. METHODS: Semi-structured interviews were conducted with 110 orthodontists regarding their procedures for clinical evaluation of MB and their knowledge about SDB during childhood. Thereafter, based on their answers, guidelines were developed and tested in 687 children aged between 6 and 12 years old and attending elementary schools. RESULTS: There was no standardization for clinical recognition of MB among orthodontists. The most common procedures performed were inefficient to recognize differences between MB by habit or obstruction. CONCLUSIONS: The guidelines proposed herein facilitate clinical recognition of MB, help clinicians to differentiate between habit and obstruction, suggest the most appropriate treatment for each case, and avoid maintenance of mouth breathing patterns during adulthood.

Guidelines proposal for clinical recognition of mouth breathing children

INTRODUCTION: Mouth breathing (MB) is an etiological factor for sleep-disordered breathing (SDB) during childhood. The habit of breathing through the mouth may be perpetuated even after airway clearance. Both habit and obstruction may cause facial muscle imbalance and craniofacial changes.OBJECTIVE: The aim of this paper is to propose and test guidelines for clinical recognition of MB and some predisposing factors for SDB in children.METHODS: Semi-structured interviews were conducted with 110 orthodontists regarding their procedures for clinical evaluation of MB and their knowledge about SDB during childhood. Thereafter, based on their answers, guidelines were developed and tested in 687 children aged between 6 and 12 years old and attending elementary schools.RESULTS: There was no standardization for clinical recognition of MB among orthodontists. The most common procedures performed were inefficient to recognize differences between MB by habit or obstruction.CONCLUSIONS: The guidelines proposed herein facilitate clinical recognition of MB, help clinicians to differentiate between habit and obstruction, suggest the most appropriate treatment for each case, and avoid maintenance of mouth breathing patterns during adulthood.

INTRODUÇÃO: a respiração bucal (RB) é um fator etiológico para os distúrbios respiratórios do sono (DRS) na infância. O hábito de respirar pela boca pode ser perpetuado mesmo depois da desobstrução das vias aéreas. Tanto o hábito quanto a obstrução podem causar desequilíbrios da musculatura facial e alterações craniofaciais. O objetivo deste trabalho é propor e testar uma diretriz para o reconhecimento clínico da RB e de alguns fatores predisponentes aos DRS em crianças.MÉTODOS: entrevistas semiestruturadas foram realizadas com 110 ortodontistas, com relação aos seus procedimentos para avaliação clínica da RB e aos seus conhecimentos sobre DRS na infância. A partir daí, com base nas respostas obtidas, uma diretriz foi desenvolvida e testada em 687 crianças, com 6 a 12 anos, oriundas de escolas de ensino fundamental.RESULTADOS: não existe padronização para o reconhecimento clínico da RB pelos ortodontistas. Os procedimentos mais comumente realizados foram ineficientes para reconhecer a diferença entre a RB por hábito e a por obstrução.CONCLUSÕES: a diretriz proposta facilita o reconhecimento clínico da RB, diferencia entre RB por hábito e por obstrução, sugere o tratamento mais adequado para cada caso, e evita a manutenção do padrão de respiração bucal na idade adulta.

Unilateral condylar hyperplasia: diagnosis, clinical aspects and operative treatment. A case report.

BACKGROUND: Condylar hyperplasia of the mandible is an uncommon idiopathic disorder of the jaw characterised by increased volume of the condyle, unilaterally or bilaterally, leading to facial asymmetry, mandibular deviation, malocclusion and articular dysfunction. CASE REPORT: The authors present one case of unilateral condylar hyperplasia of a 16-year-old patient affected by severe facial asymmetry. Conventional X-rays examinations, multislice spiral CT and bone SPECT were used for the final diagnosis of primary condyle hyperplasia. The patient was treated with a combined orthodontic and surgical approach. CONCLUSION: Treatment of condylar hyperplasia with a combined orthodontic and surgical approach including condylectomy yield good aesthetic and functional outcomes.

Geometry of anterior open bite correction.

Correction of anterior open bite is a frequently encountered and challenging problem for the craniomaxillofacial surgeon and orthodontist. Accurate clinical evaluation, including cephalometric assessment, is paramount for establishing the diagnosis and appropriate treatment plan. The purposes of this technical note were to discuss the basic geometric principles involved in the surgical correction of skeletal anterior open bites and to offer a simple mathematical model for predicting the amount of posterior maxillary impaction with concomitant mandibular rotation required to establish an adequate overbite. Using standard geometric principles, a mathematical model was created to demonstrate the relationship between the magnitude of the open bite and the magnitude of the rotational movements required for correction. This model was then validated using a clinical case. In summary, the amount of open bite closure for a given amount of posterior maxillary impaction depends on anatomic variables, which can be obtained from a lateral cephalogram. The clinical implication of this relationship is as follows: patients with small mandibles and steep mandibular occlusal planes will require greater amounts of posterior impaction.

Lateral or oblique facial clefts associated with accessory maxillae: Review of the literature and report of a case.

INTRODUCTION: Lateral or oblique facial clefts associated with accessory alveolar processes are very rare congenital anomalies; only a few clinical cases have been reported in published literature. CASE REPORT AND LITERATURE REVIEW: Here, we present a retrospective review of 22 cases of lateral facial clefts and six cases of oblique facial clefts associated with accessory alveolar processes, and a case report of 23-year-old woman from China with bilateral transverse facial clefts and accessory alveolar processes. We present a summary of their clinical features, along with bone and teeth abnormalities. DISCUSSION: We identified 24 cases from published English literature and four cases from Chinese literature. Accessory alveolar processes in lateral or oblique facial clefts occurred most frequently in the molar region, with pterygoid processes and maxillary tuberosities as the most common site. The maxilla displayed a full complement of deciduous and permanent teeth appropriate to his age. Supernumerary teeth resembled deciduous and permanent molars developed in accessory alveolar processes. There was no cleft in the posterior maxillary alveolus. Some were cases of orbital and mandibular deformation. CONCLUSION: The maxillary prominence was the main area of the lesion. Accessory alveolar processes may be an isolated pathology in lateral or oblique facial cleft.