Post-treatment stability after 5 years of retention with vacuum-formed and bonded retainers-a randomized controlled trial.

BACKGROUND: Retention after orthodontic treatment is still a challenge and more evidence about post-treatment stability and patients' perceptions of different retention strategies is needed. OBJECTIVES: This trial compares removable vacuum-formed retainers (VFR) with bonded cuspid-to-cuspid retainers (CTC) after 5 years of retention. TRIAL DESIGN: A single centre two-arm parallel-group randomized controlled trial. METHODS: This trial included 104 adolescent patients, randomized into two groups (computer-generated), using sequentially numbered, opaque, and sealed envelopes. All patients were treated with fixed appliances in both jaws with and without tooth extractions. Patients in the intervention group received a VFR in the mandible (n = 52), and patients in the active comparator group received a CTC (n = 52). Both groups had a VFR in the maxilla. Dental casts at debond (T1), after 6 months (T2), after 18 months (T3), and after 5 years (T4) were digitized and analysed regarding Little's Irregularity Index (LII), overbite, overjet, arch length, and intercanine and intermolar width. The patients completed questionnaires at T1, T2, T3, and T4. RESULTS: Post-treatment changes between T1 and T4 in both jaws were overall small. In the maxilla, LII increased significantly (median difference: 0.3 mm), equally in both groups. In the mandible, LII increased significantly in the group VFR/VFR (median difference: 0.6 mm) compared to group VFR/CTC (median difference: 0.1 mm). In both groups, overjet was stable, overbite increased, and arch lengths decreased continuously. Intercanine widths and intermolar width in the mandible remained stable, but intermolar width in the maxilla decreased significantly. No differences were found between groups. Regardless of retention strategy, patients were very satisfied with the treatment outcome and their retention appliances after 5 years. LIMITATIONS: It was not possible to perform blinded assessments of digital models at follow-up. CONCLUSIONS: Post-treatment changes in both jaws were small. Anterior alignment in the mandible was more stable with a bonded CTC retainer compared to a removable VFR after 5 years of retention. Patients were equally satisfied with fixed and removable retention appliances. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03070444).

Comparison of dental arch measurements according to the grade and the obstructive character of adenoids.

INTRODUCTION: Obstructive adenoid hypertrophy is cited as one of the causes of mouth breathing and leads to disharmony in the development of orofacial structures. The objective of this study was to compare the measurements of dental arches according to the grade and the obstructive character of adenoids. MATERIALS AND METHODS: A cross-sectional study was carried out with 86 children. The grade and the obstructive character of adenoids were determined from Holmberg and Cohen's radiographic methods respectively. Dental arch measurements were taken on dental casts. A t-test and a Chi2 test were performed respectively to compare the quantitative and qualitative variables of dental arches according to the obstructive character. An Anova test made it possible to compare the quantitative variables according to the grade as Holmberg defined it. For variables that showed significant differences, a Post Hoc test was used. The significance level was set at P=0.05. RESULTS: Subjects with obstructive adenoids had a shorter posterior mandibular length (P=0.04) and a greater overbite (P=0.04) than those with non-obstructive adenoids. Those with grade 4 had a greater arch depth (P=0.02) and were more prone to open bite(P=0.03). CONCLUSION: A prevention program involving the otorhinolaryngologist and the orthodontist for subjects with obstructive adenoids or grade 4 is necessary to minimize their influence on dental arch relationships.

Relación entre el Síndrome de clase II división 2 y la disfunción temporomandibular. Artículo de revisión / Relation between the Syndrome type II division 2 malocclusions and the temporomandibular joint dysfunction. Review article

Introducción: Los pacientes con el Síndrome de clase II división 2, además de presentar clínicamente una relación de molares y caninos en disto-oclusión, muestran una retroinclinación de los incisivos centrales superiores con proinclinación de los laterales y sobremordida profunda, lo cual puede llegar a convertirse en un factor de riesgo que provoca disfunción temporomandibular. Objetivo: Identificar la relación entre el Síndrome de clase II división 2 y la disfunción temporomandibular. Material y Métodos: Se realizó una revisión bibliográfica automatizada en las bases de datos de los sistemas MEDLINE, PubMed, Hinari y Google; se utilizó un total de 17 artículos. Desarrollo: Por las características clínicas de la oclusión en los pacientes con este síndrome, el rango de movimiento mandibular está limitado, y produce un efecto traumático que se relaciona con una posición de los cóndilos desplazados hacia atrás e intruidos en la fosa glenoidea. Este desplazamiento más distal produce la presión del espacio retrodiscal ricamente inervado y sería causa de inflamación de los tejidos circundantes y afectación de la función de la articulación por elongación de los ligamentos discales o adelgazamiento del disco que afecta el complejo cóndilo-disco. Conclusiones: Los estudios consultados muestran la relación entre el Síndrome de clase II división 2 y la disfunción temporomandibular, dada las características clínicas presentes en este síndrome, que afectan el funcionamiento de la articulación temporomandibular y que al sobrepasar las capacidades adaptativas del paciente producen la disfunción en la misma(AU)

Introduction: Patients with Syndrome type II division 2 malocclusions, besides presenting a clinically established relationship between molars and canines in a distal occlusion, show a retro-inclination of the upper front teeth with pro-inclination of the lateral incisors and a deep overbite, which can result in a risk factor of temporomandibular dysfunction. Objective: To identify the relationship between Syndrome type II division 2 malocclusions and the temporomandibular dysfunction. Material and Methods: A bibliographic review was carried out through a search of databases such as MEDLINE, PubMed, Hinari, and Scholar Google. A total of 17 articles were used. Development: Because of the clinical characteristics of the occlusion in the patients with this syndrome, the range of jaw movement is limited, producing a traumatic effect that is related with a position of the condyles displaced backward and with glenoid fossa intrusion. This more distal displacement produces the pressure of the richly innervated retrodiscal tissue, which could be the cause of inflammation of the surrounding tissues and the affectation of the joint function due to an elongation of the discal ligaments or a thinning of the disc affecting the disc-condyle complex. Conclusions: The studies conducted demonstrate the relationship between the Syndrome type II division 2 and the temporomandibular joint dysfunction, given the clinical characteristics that are present in this syndrome, which affect the functioning of the temporomandibular joint, and produce its dysfunction when exceeding the adaptive capacities of the patient(AU)

Association Between Maxillary Posterior Segment Discrepancy And The Angulation Of Maxillary Molars In Patients With Different Vertical Growth Patterns.

BACKGROUND: The impaction of maxillary third molars causes the crowns of maxillary first and second molars to tip distally in patients with maxillary posterior segment discrepancy. The aim of this study was to compare the maxillary first and second molar angulations in patients with maxillary posterior segment discrepancy (MPSD) with non-maxillary posterior segment discrepancy (N-MPSD) and evaluate the effect of their angulations on various divergence patterns. METHODS: A cross-sectional study was conducted using the pre-treatment lateral cephalograms of 180 subjects which were divided into two groups, i.e., MPSD and N-MPSD. The Mann-Whitney U test was applied to compare various skeletal and dental parameters between the two groups and a pairwise comparison was made among the vertical growth patterns. The Kruskal Wallis test was used to compare the mean molar angulations and overbite among the three divergence patterns. RESULTS: The ratio of anterior to total palatal plane (p≤0.001) and the molar angulation (p≤0.001) showed significant differences between the MPSD and N-MPSD groups. In the MPSD group, significant differences were found between the overbite in the normo-divergent versus hyperdivergent (p≤0.001) and hypodivergent versus hyperdivergent groups (p≤0.001), and in the angulation of the first maxillary molars in the normo-divergent versus hyperdivergent groups (p≤0.001). CONCLUSIONS: MPSD causes reduced maxillary first and second molar angulations. A ratio of the anterior palatal plane to total palatal plane length of ≥0.51 was seen in patients with impacted maxillary third molars.

Side effects of intraoral devices for OSAS treatment / Side effects of intraoral devices for OSAS treatment

Abstract Introduction: Intraoral devices have increasingly assumed a key role in the treatment of obstructive sleep apnea syndrome, but there are limitations to their indication and side effects that result from their continuous use, as well as the use of the continuous positive airway pressure device. Objectives: To evaluate the changes in dental positioning caused by the continuous use of mandibular advancement devices. Methods: A prospective longitudinal study with a sample of 15 patients, with evaluation of complete documentation after a mean time of 6.47 months, assessed changes in dental positioning due to the use of the Twin Block oral device for the treatment of patients with apnea. The following variables were evaluated: overjet, overbite, upper and lower intermolar distances, upper and lower intercanine distances, Little's irregularity index and the incisor mandibular plane angle. An intraclass correlation test was performed and a correlation index > 0.08 was accepted. After verifying the normal sample distribution (Shapiro-Wilks), a parametric test was used (t test), with a significance level set at 5%. Results: There was a decrease in the values of overjet, overbite and Little's irregularity index, whereas there was an increase in the lower intercanine distance and IMPA values. All these variables are influenced, at different levels, by the forward inclination of the lower incisors, an action that can be expected due to the force applied by the device on the dentition. The other variables did not show statistically significant differences. Conclusion: After a mean time of 6.47 months of use of the mandibular advancement device, there were statistically significant changes in the dental positioning, but they were not clinically relevant. However, it is relevant that this device is commonly in use over long periods of time, making the monitoring of these patients of the utmost importance for the duration of their therapy.

Resumo: Introdução: Os aparelhos intraorais têm assumido cada vez mais um papel importante no tratamento da síndrome da apneia obstrutiva do sono, mas existem limitações a sua indicação e efeitos colaterais com o seu uso contínuo, assim como com o uso do aparelho de pressão aérea positiva contínua. Objetivos: Avaliar as alterações no posicionamento dentário produzido pelo uso contínuo do aparelho de projeção mandibular. Método: Através de estudo longitudinal prospectivo com amostra de 15 pacientes, com avaliação de documentações completas após um tempo médio de 6,47 meses do uso do aparelho oral de Twin Block para tratamento de pacientes com apneia, foram avaliadas as alterações do posicionamento dos dentes decorrentes do seu uso. As seguintes variáveis foram avaliadas: overjet, overbite, distâncias intermolares superior e inferior, distâncias intercaninos superior e inferior, índice de irregularidade de Little e ângulo do plano incisivo mandibular. Foi feito teste de correlação intraclasse e foram aceitos índices de correlação acima de 0,08. Após atestada a distribuição normal da amostra (Shapiro-Wilks), foi usado um teste paramétrico (teste t), com nível de significância de 5%. Resultados: Houve diminuição nos valores de overjet, overbite e irregularidade de Little e aumento nos valores da distância intercanino inferior e do ângulo do plano incisivo mandibular. Todas essas variáveis sofrem influência, com diferentes expressividades, da inclinação para frente dos incisivos inferiores, uma ação que pode ser esperada devido à força aplicada pelo aparelho sobre a dentição. As demais variáveis não demostraram diferenças estatisticamente significativas. Conclusão: Houve mudanças estatisticamente significativas no posicionamento dos dentes, porém clinicamente sem relevância, com um tempo médio de uso de 6,47 meses do aparelho de avanço mandibular. Contudo, deve-se considerar que o uso dessa aparelhagem é comum durante longos períodos, fazendo com que seja de suma importância o acompanhamento desses pacientes a longo prazo.

Orthodontic correction of severe Class II malocclusion in a patient with Prader-Willi syndrome.

Prader-Willi syndrome (PWS) is a complex disorder that affects multiple systems and may cause craniofacial and dentofacial abnormalities. However, there is still a lack of evidence in the literature regarding the progress of orthodontic treatment in patients with PWS. This case report describes the successful orthodontic treatment of a patient with PWS. A girl, 9 years 0 months of age, who had been diagnosed with PWS had protruding maxillary incisors and a convex profile. Her malocclusion was due to the posteriorly positioned mandible. Screening tests for sleep apnea syndrome showed that she had sleep-disordered breathing, including obstructive sleep apnea and bruxism. We also observed an excessive overjet of 10.0 mm, a deep overbite of 6.8 mm, and the congenital absence of the mandibular second premolars. The patient was diagnosed with an Angle Class II malocclusion and a skeletal Class II jaw-base relationship with a deep overbite. Functional appliance therapy with mandibular advancement, which can enlarge the upper airway and increase the upper airspace, was performed to prevent further deterioration of the patient's obstructive sleep apnea. An acceptable occlusion with a proper facial profile and functional excursion were achieved without interference after comprehensive 2-stage treatment that incorporated orthodontic therapy for the patient's excessive overjet and deep overbite. The resulting occlusion was stable, and the occlusal force and the contact area gradually increased over a 2-year retention period. These results suggest that orthodontic treatment offers the opportunity to greatly improve the health and quality of life of people with PWS.

Side effects of intraoral devices for OSAS treatment.

INTRODUCTION: Intraoral devices have increasingly assumed a key role in the treatment of obstructive sleep apnea syndrome, but there are limitations to their indication and side effects that result from their continuous use, as well as the use of the continuous positive airway pressure device. OBJECTIVES: To evaluate the changes in dental positioning caused by the continuous use of mandibular advancement devices. METHODS: A prospective longitudinal study with a sample of 15 patients, with evaluation of complete documentation after a mean time of 6.47 months, assessed changes in dental positioning due to the use of the Twin Block oral device for the treatment of patients with apnea. The following variables were evaluated: overjet, overbite, upper and lower intermolar distances, upper and lower intercanine distances, Little's irregularity index and the incisor mandibular plane angle. An intraclass correlation test was performed and a correlation index>0.08 was accepted. After verifying the normal sample distribution (Shapiro-Wilks), a parametric test was used (t test), with a significance level set at 5%. RESULTS: There was a decrease in the values of overjet, overbite and Little's irregularity index, whereas there was an increase in the lower intercanine distance and IMPA values. All these variables are influenced, at different levels, by the forward inclination of the lower incisors, an action that can be expected due to the force applied by the device on the dentition. The other variables did not show statistically significant differences. CONCLUSION: After a mean time of 6.47 months of use of the mandibular advancement device, there were statistically significant changes in the dental positioning, but they were not clinically relevant. However, it is relevant that this device is commonly in use over long periods of time, making the monitoring of these patients of the utmost importance for the duration of their therapy.

Relationship Between Occlusal Features and Enzyme Replacement Therapy in Patients With Mucopolysaccharidoses.

PURPOSE: The aim of this study was to describe the relation between occlusal features and enzyme replacement therapy in patients with mucopolysaccharidoses. MATERIALS AND METHODS: A cross-sectional study was conducted. The sample consisted of 20 patients with mucopolysaccharidoses, 10 of whom were undergoing treatment at a hospital in northeast Brazil. Occlusal features were evaluated by clinical examination and panoramic radiography. A structured questionnaire was administered to evaluate the dental care of each patient. Pearson χ2, Fisher exact, and Mann-Whitney tests were used for data analysis, with a level of significance of 5%. RESULTS: Marked overjet (75%) and anterior open bite (70%) were the most frequent occlusal alterations, and 15% had Class III disorders. Radiography visualized the presence of impacted teeth (75%) and prolonged retention of deciduous teeth (65%). Patients with enzyme replacement therapy had a lower average maximum protrusion (P = .033). A total of 75% of mothers said they had not been advised to take their children to the dentist and 10% of children had never been to the dentist. CONCLUSION: Patients with mucopolysaccharidoses exhibited notable occlusal alterations, especially marked overjet and anterior open bite. Enzyme replacement therapy seems to influence the maximum protrusion of patients.

Characteristic of Malocclusion among Saudi Special Need Group Children.

INTRODUCTION: The present study analyzed the characteristics of malocclusions, occlusal traits among Special Health care Needs (SHCN) children with Down syndrome (DS) and autism disorder (AD) in Riyadh City, Kingdom of Saudi Arabia. MATERIALS AND METHODS: A total of 100 DS and 100 AD children from five rehabilitation centers in and around Riyadh, Kingdom of Saudi Arabia, were included in the study. Any children with history of ongoing medical treatment, extraction, or orthodontic treatment were excluded from the study. Out of the 200 patients examined, 131 were males and 69 were females and the age of the children ranged from 6 to 14 years. The children were examined for malocclusion characteristics using the Angle's classification of malocclusion, and also other occlusal traits, such as overjet, overbite, cross bite, and open bite were also determined. The data obtained were analyzed using Statistical Package for the Social Sciences, version 16 to generate descriptive statistics for each variable. RESULTS: The analyzed data of the right and left permanent molar relation showed higher incidence of class III malocclusion (66%) in DS children as compared with (3-4%) AD children. The AD children presented with higher percentage of class I malocclu-sion (40-41%) as compared with (10-14%) DS children. During examination of the primary molars, the analyzed data showed that left primary molar had more mesial shift in AD children as compared with DS children. CONCLUSION: Down syndrome children had high incidence of class III malocclusion and autistic children had high incidence of class I malocclusion. Overall, the DS children were more prone to malocclusion. CLINICAL SIGNIFICANCE: This study provides database for health professionals in Saudi Arabia in regard to malocclusion of autis-tics and DS patients.

Dentoskeletal effects of oral appliance wear in obstructive sleep apnoea and snoring patients.

OBJECTIVES: To evaluate the dentoskeletal changes associated with long-term and continuous mandibular advancement device (MAD) use in sleep-related breathing disorder patients. METHODS: Cephalometric measurements and three-dimensional model analysis were performed at baseline and after 3.5 ± 1.1 years in 20 snoring and obstructive sleep apnoea patients treated with the Silensor® appliance. Intra-group differences were compared using paired t-test or Wilcoxon signed-rank test. A regression analysis was performed for variables that showed a statistically significant difference between time points to evaluate the influence of treatment time and patient's initial characteristics on their variations. The statistical significance was set at P < 0.05. RESULTS: At cephalometric assessment, the maxilla revealed a significant decrease in horizontal position (SNA: -0.4 ± 0.72 degree, P = 0.021) and a significant retroclination of the upper incisor (-1.59 ± 1.07 degree, P < 0.001), while the mandible displayed a significant downward rotation (0.88 ± 1.28 degree, P = 0.006) and a proclination of the lower incisor (2.27 ± 1.38 degree, P < 0.001). Model analysis showed a decrease in upper total space discrepancy (-0.66 ± 0.72 mm, P < 0.002), overjet (OJ; -0.34 ± 0.47 mm, P < 0.011), and overbite (-0.4 ± 0.52 mm, P < 0.004). In the regression analysis, treatment time influenced the lower incisor inclination (Beta = -0.713, P = 0.018) and OJ (Beta = -0.218, P = 0.018); patients' initial characteristics had an effect on OJ (Beta = -0.195, P = 0.011). LIMITATIONS: A larger sample size could increase the generalizability of the findings. CONCLUSION: MAD wear after a mean of 3.5 years determines statistically significant but clinically irrelevant dentoskeletal changes. Their potential occurrence should be thoroughly discussed with patients; regular follow-up visits by a specialist experienced in dental sleep medicine are also mandatory during treatment in addition to polysomnographic examinations.

[Skeletal Class â ¢ patients treated with Fränkel function regulator type â ¢ in the early and late mixed dentition].

OBJECTIVE: To investigate the outcome of skeletal Class Ⅲ patients treated with Fränkel function regulator type Ⅲ (FR Ⅲ)in the early mixed and late mixed dentition. METHODS: The samples consisted of 45 mild and moderate skeletal Class Ⅲ patients(26 males, 19 females; meanage, [7.9±1.3] years) treated with FR Ⅲ. According to Hellman's dental developmental stages, these samples were divided into early-treated group(n=24) and late-treated group(n=21). Lateral cephalograms were taken at the beginning and the end of treatment. Twenty-one measurements on hard and soft tissue were included. RESULTS: After treatment, SNA, ANB, NA-Apo, Wits, U1-SN, U1-NA, Overjet, UL-EP were significantly increased (1.0±1.9)°, (1.2±1.6)°, (2.6±4.2)°, (1.8±2.7) mm, (4.2±7.6)°, (2.6±7.5)°, (3.6±2.3) mm and (0.8±2.2) mm(P<0.05). OP-SN and IMPA were significantly decreased (1.5±3.7)°and (1.4±4.2)°(P<0.05). There were significant differences in SNA, ANB, UL-EP, IMPA, L1-NB between early-treated group and late-treated group(P<0.05). CONCLUSIONS: FR Ⅲ was suitable for the treatment of mild and moderate skeletal Class Ⅲ patients. The result was better in the early-treated patients than in late-treated ones.

Orthodontic Treatment of Maxillary Incisors with Severe Root Resorption Caused by Bilateral Canine Impaction in a Class II Division 1 Patient.

This case report shows the successful alignment of bilateral impacted maxillary canines. A 12-year-old male with the chief complaint of the protrusion of his maxillary anterior teeth happened to have bilateral maxillary canine impaction on the labial side of his maxillary incisors. Four maxillary incisors showed severe root resorption because of the impacted canines. The patient was diagnosed as skeletal Class II malocclusion with proclined maxillary incisors. The impacted canine was carefully retracted using sectional buccal arch wires to avoid further root resorption of the maxillary incisors. To distalize the maxillary dentition, two palatal miniscrews were used. After 25 months of treatment, the maxillary canines were well aligned without any additional root resorption of the maxillary incisors.

The relationship between craniofacial development and hypodontia in patients with Down syndrome.

BACKGROUND/OBJECTIVE: Hypodontia is often seen in people with Down syndrome (DS). In the normal population, persons with hypodontia have a shorter cranial base and a hypoplastic maxilla, leading to a skeletal Class III tendency and a reduced face height. The purpose of this study was to examine craniofacial morphology in patients with DS at different ages and the influence of hypodontia on their craniofacial morphology. MATERIALS AND METHODS: A comparative cross-sectional study was conducted in 63 children with DS (6-19 years old; 28 males and 35 females) at a Centre for Special Care Dentistry in Rotterdam, the Netherlands (CBT Rijnmond). Digital lateral cephalograms were obtained from all subjects and a cephalometric analysis was performed. The subjects were divided into a group with hypodontia (13 males and 25 females) and a group without hypodontia (15 males and 10 females). RESULTS: Significant results included a decrease in antero-posterior relationship of upper and lower jaw (ANB angle -0.331° per year, P = 0.044) and a decrease in vertical dimension (S-N_Go-Gn angle -0.72° per year, P = 0.039) over the years in subjects with hypodontia compared to subjects without hypodontia. CONCLUSION: The process of growth in DS patients is towards a reversed overjet. Hypodontia seems to have an additional effect on this development. The management of hypodontia as part of the complete treatment of dental development in DS children is important because it strongly influences the jaw relationship.

Frequência, razão de prevalência e associação do transpasse vertical dentário anterior em diferentes padrões faciais / Frequency, prevalence ratio and association of anterior overbite in different facial patterns

Determinados padrões faciais são citados na literatura como responsáveis diretos pelo acometimento de más oclusões de transpasse vertical anterior. Apesar disso, ainda não está elucidado de que forma as diferenças dos padrões faciais estão associadas aos problemas dentários. Os objetivos deste estudo são: verificar a correlação do grau de transpasse vertical com os padrões faciais e com fatores esqueléticos e dentários; investigar a frequência dos hábitos deletérios de acordo com os tipos de overbite; e investigar a frequência e as razões de prevalência dos tipos de transpasse vertical dentário anterior de pacientes com diferentes padrões faciais. A amostra consistiu de telerradiografias de perfil de adultos, com registro de ausência ou presença de hábitos deletérios e a coleta foi realizada em diferentes centros de ensino de ortodontia do território brasileiro. Os filmes radiográficos foram digitalizados e analisados através do software Dolphin Imaging 11.0 e os resultados foram obtidos através de uma análise estatística descritiva, utilizando o software SPSS 17.0. Quanto às correlações, o overbite apresentou fraca correlação com fatores esqueléticos e dentários, inclusive com a variável AFPI/AFAI, determinante do padrão facial. A presença ou a ausência de hábitos deletérios não apresentou diferença estatística quando comparadas aos tipos de problemas verticais. Todos os padrões faciais apresentaram todos os tipos de transpasse vertical anterior, porém pacientes hiperdivergentes apresentaram uma frequência estatisticamente significativa de casos com mordida aberta anterior, assim como uma razão de prevalência indicativa de situação de risco, quando comparados aos pacientes normodivergentes e hipodivergentes. Presume-se que exista a predisposição de outros fatores associados aos problemas verticais, seja a presença de hábitos deletérios, sejam os desequilíbrios de forças musculares em pacientes hiperdivergentes para que a presença da mordida aberta anterior seja mais frequente neste padrão facial.

Certain facial patterns are described in the literature as directly responsible for the involvement in vertical anterior malocclusions. However, how differences in facial patterns are associated with dental problems it is not yet elucidated. The aims of this study were to verify the correlation between the degree of overbite with the facial pattern, and with skeletal and dental factors; to investigate the frequency of deleterious habits according to the overbite; and to investigate the frequency and odds ratio of the types of overbite of patients with different facial patterns. The sample consisted of cephalometric radiographs of adults, with records on the presence or absence of deleterious habits. The sample was collected in different centers of orthodontic education in Brazil. The radiographic films were scanned and analyzed using the Dolphin Imaging 11.0 software and the results were obtained through a descriptive statistical analysis using SPSS 17.0 software. The overbite showed a weak correlation with the skeletal and dental factors, including the variable LPFH/LAFH, which determines facial pattern. The presence or absence of habits showed no statistical difference when compared to the overbite types. All facial patterns presented all sorts of overbite, but hyperdivergent patients showed a statistically significant higher frequency of cases with anterior open bite, compared to normodivergents and hypodivergent patients, as well as the odds ratio indicated a risk situation. It is assumed that there is a predisposition of other factors associated to anterior vertical problems, such as the presence of deleterious habits or imbalanced muscle forces in hyperdivergent patients, for a greater frequency of anterior open bite to be found in this facial pattern.

Longitudinal study of habits leading to malocclusion development in childhood.

BACKGROUND: The increased prevalence of malocclusions represents a secular trend attributed to the interaction of genetic and environmental factors. The analysis of factors related to the causes of these changes is essential for planning public health policies aimed at preventing and clinically intercepting malocclusion. This study investigated the sucking habits, nocturnal mouth breathing, as well as the relation of these factors with malocclusion. METHODS: This is a longitudinal study in which 80 mother-child pairs were monitored from the beginning of pregnancy to the 30th month after childbirth. Home visits for interviews with the mothers were made on the 12th, 18th and 30th months of age. Finger sucking, pacifier sucking, bottle feeding, breastfeeding and nocturnal mouth breathing, were the variables studies. On the 30th month, clinical examinations were performed for overjet, overbite and posterior crossbite. A previously calibrated single examiner (Kappa coefficient = 0.92) was responsible for all examinations. Data were analyzed using the chi-squared or Fisher's exact tests, at a significance level of 5%. RESULTS: Bottle feeding was the most prevalent habit at 12, 18 and 30 months (87.5%; 90% and 96.25%, respectively). Breastfeeding was 40%, 25% and 12.50% at 12, 18 and 30 months, respectively. Nearly 70% of the children in this study had some sort of malocclusion. Pacifier sucking habit at 12, 18 and 30 months of age was associated with overjet and open bite; and at 30 months, an association with overbite was also observed. Finger sucking habit and breastfeeding at 12, 18 and 30 months were also associated with overjet and open bite. The posterior crossbite was associated with bottle feeding at 12 and 30 months, and nocturnal mouth breathers at 12 and 18 months. CONCLUSIONS: Sucking habits, low rates of breastfeeding, and nocturnal mouth breathing were risk factors for malocclusion.

Craniofacial characteristics in unilateral complete cleft lip and palate patients with congenitally missing teeth.

INTRODUCTION: Congenitally missing permanent teeth are common in patients with clefts. This retrospective study was conducted to evaluate the craniofacial characteristics in patients with unilateral complete cleft lip and palate with congenitally missing permanent teeth. METHODS: A series of 73 consecutive patients with nonsyndromic unilateral complete cleft lip and palate were enrolled. Evaluation of congenitally missing permanent teeth was based on the panoramic films taken from 7 to 11 years of age. The cephalometric films taken around 9 years of age were used to compare the craniofacial morphology in patients with no congenitally missing permanent teeth (n = 20) and 1 (n = 25), 2 (n = 18), and 3 (n = 10) congenitally missing permanent teeth. The Spearman correlation coefficient was used to assess the association of increased numbers of congenitally missing permanent teeth with each cephalometric parameter. RESULTS: Anterior facial height, distance from the maxillary incisor and first molar to the palatal plane, and overjet decreased as the number of congenitally missing permanent teeth increased in patients with unilateral cleft lip and palate. CONCLUSIONS: Unilateral cleft lip and palate patients with congenitally missing permanent teeth have a unique craniofacial morphology with a reduced vertical dimension.

Allergic rhinitis as a possible risk factor for malocclusion: a case-control study in children.

BACKGROUND: Prolonged oral respiration is known to cause postural alterations, which can lead to dental malocclusions. Allergic rhinitis, a common cause of upper airway obstruction in children, must therefore be seen as a possible risk factor in the development of malocclusions. AIM: Aim of this study was to investigate the association between allergic rhinitis and malocclusions in primary and early-mixed dentition. DESIGN: A case-control study was carried out involving 275 Italian children aged 5-9. The case group and the control group were composed of 125 individuals affected by malocclusions and by 150 healthy patients, respectively. Through a questionnaire, we assessed the presence of professionally diagnosed allergic rhinitis. Data were analysed to identify associations between these variables and the presence of malocclusions. RESULTS: Children with a history of allergic rhinitis had a threefold increased risk to develop one or more dento-skeletal alterations [OR = 3.16; 95% CI (1.79-5.58), P < 0.001]. Statistically significant associations were found between allergic rhinitis and the development of posterior crossbite and increased overjet. No significant association was found for anterior openbite. CONCLUSIONS: Allergic rhinitis is a significant risk factor for the development of malocclusions in general and is associated with the development of posterior crossbite and increased overjet.

Ideal treatment protocol for cleft lip and palate patient from mixed to permanent dentition.

A girl with an Angle Class III malocclusion, anterior and posterior crossbites, a concave profile, and cleft lip and palate sought orthodontic treatment. She was treated with a multidisciplinary therapeutic protocol including orthodontic and surgical procedures. The proposed objectives of occlusion, normal function, and balanced profile were achieved, and these results remained stable 4 years after the treatment.

Prevalence of malocclusion and related oral habits in 5- to 6-year-old children.

PURPOSE: To verify the prevalence of malocclusion and the influence of harmful oral habits on deciduous dentition in 5- and 6-year-old children enrolled in Brazilian public elementary schools during 2010. MATERIALS AND METHODS: Exams were conducted in 1385 children from 56 Brazilian elementary schools using the method recommended by the World Health Organization (WHO) for epidemiological surveys on oral health. Information about the type of arch, social and economic data and harmful oral habits of the children were collected through a structured questionnaire. RESULTS: In relation to canine occlusion, a high prevalence of Class I (74.5%), followed by Class II (19.4%), was found. Among all participants, 22% showed high overjet, 7.8% showed edge-to-edge occlusion and 2.3% showed anterior crossbite. In relation to overbite, 13.2% had short overbite, 14.3% open bite and 16.8% high overbite. The presence of posterior crossbite occurred in 14.6% of children. Maxillae predominantly exhibited the type I arch (67.9%) and mandibles predominantly exhibited type II (51.7%). In relation to harmful oral habits, 43.4% used a pacifier, 84.8% used a bottle and finger sucking was reported by 17.2%. CONCLUSION: There was a high prevalence of malocclusion associated with oral habits harmful to deciduous dentition.

Malocclusions and non-nutritive sucking habits: a preliminary study.

OBJECTIVE: This study investigated the non-nutritive sucking habits in a sample of patients with malocclusions at the Unit of Pediatric Dentistry of the "Sapienza", University of Rome. MATERIALS AND METHODS: 81 children (average age 5.9 years) were examined from January to December 2008. All children showed typical malocclusions that could be associated with non-nutritive sucking habits (pacifier or finger). Increased overjet (OVJ), anterior openbite (OPB), and posterior crossbite (CRB) were recorded in this survey. A questionnaire was directed to parents. RESULTS: At the first examination 40.4% of pacifier users over 24 months were affected by an anterior OPB, 50% by a posterior CRB and 39.4% by an increased OVJ. Moreover, 40.4% of the children with finger or thumb sucking behavior were affected by an anterior OPB, 29.2% by a posterior CRB, and 42.4% by an increased OVJ. CONCLUSIONS: No statistically significant associations could be detected between the non-nutritive sucking habits and the malocclusions. There was no difference in type of habit in children who presented an anterior OPB, while there was a higher prevalence rate of children with a posterior CRB who had sucked the pacifier and of children with increased OVJ who had sucked their finger.