Incidence of Orofacial Manifestations of Juvenile Idiopathic Arthritis From Diagnosis to Adult Care Transition: A Population-Based Cohort Study.

OBJECTIVE: To estimate the cumulative incidences of orofacial conditions related to temporomandibular joint (TMJ) juvenile idiopathic arthritis (JIA) between diagnosis in childhood to transition into adult care, and to identify features in JIA associated with TMJ involvement. METHODS: A population-based cohort analysis was conducted of patients with JIA involving longitudinal data on orofacial health from 2000 to 2018. Regardless of TMJ status, the patients were referred to the Regional Specialist Craniofacial Clinic of Western Denmark for routine orofacial examinations. Data collection included information about disease-specific background characteristics, TMJ involvement, JIA-induced dentofacial deformity, and orofacial symptoms and dysfunction. RESULTS: A total of 613 patients were followed up with a mean clinical TMJ observation time of 4.0 years. From JIA onset to transition into adult care, the cumulative incidence of patients with JIA involvement of the TMJ was 30.1%. Furthermore, 20.6% of the cohort had developed arthritis-induced dentofacial deformity. A substantial proportion of the cohort experienced several events with orofacial symptoms (23.5%) and dentofacial dysfunction (52%). Young age at diagnosis (<9 years), female gender, and antinuclear antibody positivity were significantly associated with TMJ involvement. CONCLUSION: Orofacial signs and symptoms were frequent findings in children and adolescents with JIA. TMJ involvement was seen in 30.1% of the cohort; and 20.6% of the total cohort developed JIA-related dentofacial deformity before transition into adult care. This is the first population-based study in the era of available biologic treatments to document these frequent orofacial complications in children with JIA.

Restricted upper airway dimensions in patients with dentofacial deformity from juvenile idiopathic arthritis.

BACKGROUND: This retrospective, cross-sectional study aimed to assess the pharyngeal airway dimensions of patients with juvenile idiopathic arthritis (JIA) and moderate/severe JIA-related dentofacial deformity (mandibular retrognathia/micrognathia), and compare the results with JIA patients with a normal mandibular appearance and a group of non-JIA patients. METHODS: Seventy-eight patients were retrospectively included in a 1:1:1 manner as specified below. All patients had previously been treated at the Section of Orthodontics, Aarhus University, Denmark. All had a pretreatment cone beam computed tomography (CBCT). Group 1 (JIA+); 26 JIA patients with severe arthritis-related dentofacial deformity and mandibular retrognathia/micrognathia. Group 2 (JIA-); 26 JIA patients with normal mandibular morphology/position. Group 3 (Controls); 26 non-JIA subjects. Dentofacial morphology and upper airway dimensions, excluding the nasal cavity, were assessed in a validated three-dimensional (3D) fashion. Assessment of dentofacial deformity comprised six morphometric measures. Assessment of airway dimensions comprised nine measures. RESULTS: Five morphometric measures of dentofacial deformity were significantly deviating in the JIA+ group compared with the JIA- and control groups: Posterior mandibular height, anterior facial height, mandibular inclination, mandibular occlusal inclination, and mandibular sagittal position. Five of the airway measurements showed significant inter-group differences: JIA+ had a significantly smaller nasopharyngeal airway dimension (ad2-PNS), a smaller velopharyngeal volume, a smaller minimal cross-sectional area and a smaller minimal hydraulic diameter than JIA- and controls. No significant differences in upper airway dimensions were seen between JIA- and controls. CONCLUSION: JIA patients with severe arthritis-related dentofacial deformity and mandibular micrognathia had significantly restricted upper airway dimensions compared with JIA patients without dentofacial deformity and controls. The restrictions of upper airway dimension seen in the JIA+ group herein were previously associated with sleep-disordered breathing in the non-JIA background population. Further studies are needed to elucidate the role of dentofacial deformity and restricted airways in the development of sleep-disordered breathing in JIA.

Treatment of Dentofacial Deformity Associated with Temporomandibular Joint Ankylosis Through Vertical and Sagittal Osteotomies of the Mandibular Ramus.

ABSTRACT: Ankylosis of the temporomandibular joint is a disorder resulting from fibrous, osseous, or fibro-osseous adhesion that directly affects the quality of life of the individual. The authors present a case of unilateral temporomandibular joint ankylosis treated by condilectomy and ipsilateral sliding vertical ramus osteotomy associated with contralateral sagittal osteotomy aiming to restore function and to correct dentofacial deformity class II. A 31-year-old female patient presented with a history of facial trauma and major complaint of oral opening limitation. Physical examination revealed hypoplasia of the lower third of the face, facial pattern type II, anterior open bite, and maximum mouth opening of 22.5 mm. Computed tomography showed an ankylotic mass in the right mandibular condyle with deformity of the condylar structure and fusion to the right zygomatic arch and a contralateral condylar fracture sequel. It was proposed to perform a condilectomy of the right mandibular condyle for the removal of the bone mass concomitant to the sliding vertical ramus osteotomy of the mandibular ramus for condylar reconstruction by rhytidectomy approach and the sagittal osteotomy of the left mandibular aiming the reestablishment of occlusion and the correction of dentofacial deformity. The condylar fracture was not operated because the condyle was remodeled. The patient is in her fourth year postoperative presenting satisfactory esthetic-functional re-stabilization, without clinical signs of recurrence. In conclusion, the authors believe that combined sliding vertical ramus osteotomy and sagittal osteotomy can bring satisfactory results in complex cases.

Associação de hábitos parafuncionais e DTM em pacientes classe II / Association of parafunctional habits and TMD class II patients

Introdução: A Disfunção Temporomandibular (DTM) é a dor orofacial crônica mais comum, encontrada por dentistas e outros profissionais de saúde. Sua etiologia tem caráter multifatorial, e pode envolver, desde fatores hereditários, hábitos parafuncionais, maloclusões, até ansiedade e estresse. Objetivo: Este estudo investigou a frequência da DTM e a sua relação entre hábitos parafuncionais em uma população de pacientes classe II esquelética. Método: Uma amostra composta por pacientes classe II esquelética foi selecionada de forma não probabilística. Setenta e três indivíduos concordaram em participar da pesquisa, se submetendo ao exame físico que consistia na aplicação do Eixo I do (RDC/TMD). Resultados: Quarenta e seis por cento dos pacientes examinados apresentaram diagnóstico positivo. A média de idade dos pacientes foi de 27 anos+ 8,73 anos, 82% do gênero feminino e 80% brancos. Trinta e quatro pacientes referiram alguma atividade parafuncional. Desses a onicofagia representou o grupo com maior frequência, seguido pelo bruxismo, interposição de objetos entre os dentes e por último o apertamento. As variáveis não apresentaram associação estatisticamente significante com o desfecho primário estudado. Conclusão: Na amostra estudada não se observou associação entre a ocorrência de DTM e hábitos parafuncionais em pacientes classe II esquelética... (AU)

Introduction: Temporomandibular disorder (TMD) is the most common chronic orofacial pain, found by dentists and other health professionals. Its etiology has a multifactorial character, and may involve, from hereditary factors, parafunctional habits, malocclusions, to anxiety and stress. Objective: This study investigated the TMD frequency and its relationship among parafunctional habits in a population of skeletal class II patients. Method: A sample composed by a class II patients was selected in a non probabilistic manner. Seventy-three members agreed to participate in the research, submitting themselves to a physical examination that consists in the application of Axis I (RDC/TMD). Results: Forty-six percent of patients diagnosed with a positive diagnosis. The average age of the patients was 27 years ± 8.73 years, 82% female and 80% white. Thirty-four patients reported some parafunctional activity. Of these, biting nail represented the group most frequently, followed by bruxism, interposition of objects between the teeth and lastly clenching. As variables did not present a statistically significant association with the primary outcome studied. Conclusion: In the sample studied, it is observed that there is no association between TMD occurrence and parafunctional habits in skeletal class II patients... (AU)

Changes of temporomandibular joint position after surgery first orthognathic treatment concept.

Orthognathic surgery treatment (OGS) after orthodontic treatment of dentofacial deformities is a widely performed procedure, often accompanied by a bilateral sagittal split osteotomy (BSSO). Positioning of the condyle during this procedure is a crucial step for achieving optimal functional and anatomical results. Intraoperatively poorly positioned condyles can have a negative effect on the postoperative result and the patient's well-being. Changes of the condylar position during OGS Procedures and its effects on the temporomandibular joint in orthognathic surgical interventions (OGS) are subject of scientific discussions. However, up to date, no study has investigated the role of condyle position in the surgery first treatment concept. The aim of this study was to investigate the influence of OGS on the three-dimensional position of the condyle in the joint in a surgery first treatment concept without positioning device and to record the change in position quantitatively and qualitatively. Analysis of our data indicated that OGS in surgery first treatment concept has no significant effect on the position of the condyle and the anatomy of the temporomandibular joint.

Management of Temporomandibular Joint Ankylosis With Dentofacial Deformities in Children.

This retrospective study described the authors' experience in the treatment of temporomandibular joint (TMJ) ankylosis with dentofacial deformities in 18 pediatric patients during a 4-year period. These patients underwent different types of arthroplasty with condylar reconstruction, simultaneously with treatment of dentofacial deformities. Re-ankylosis was confirmed if maximal incisal opening (MIO) was <20 mm. Clinical outcomes were evaluated in terms of oral function, radiography, and medical photography. Patients were followed up for a mean time of 24.8 months. No infections, re-ankylosis, or permanent facial nerve damage were found during the hospitalization or follow-up period. All patients achieved significant improvements in MIO and oral function. The dentofacial deformities in most patients were improved to varying degrees. The results provided more useful information for the management of the pediatric patients with TMJ ankylosis and secondary dentofacial deformities. Early treatment and close follow-up play an important role in the management of these patients.

ENPP1 and ESR1 genotypes associated with subclassifications of craniofacial asymmetry and severity of temporomandibular disorders.

INTRODUCTION: We investigated whether ACTN3, ENPP1, ESR1, PITX1, and PITX2 genes which contribute to sagittal and vertical malocclusions also contribute to facial asymmetries and temporomandibular disorders (TMD) before and after orthodontic and orthognathic surgery treatment. METHODS: One hundred seventy-four patients with a dentofacial deformity were diagnosed as symmetric or subdivided into 4 asymmetric groups according to posteroanterior cephalometric measurements. TMD examination diagnosis and jaw pain and function (JPF) questionnaires assessed the presence and severity of TMD. RESULTS: Fifty-two percent of the patients were symmetric, and 48% were asymmetric. The asymmetry classification demonstrated significant cephalometric differences between the symmetric and asymmetric groups, and across the 4 asymmetric subtypes: group 1, mandibular body asymmetry; group 2, ramus asymmetry; group 3, atypical asymmetry; and group 4, C-shaped asymmetry. ENPP1 SNP-rs6569759 was associated with group 1 (P = 0.004), and rs858339 was associated with group 3 (P = 0.002). ESR1 SNP-rs164321 was associated with group 4 (P = 0.019). These results were confirmed by principal component analysis that showed 3 principal components explaining almost 80% of the variations in the studied groups. Principal components 1 and 2 were associated with ESR1 SNP-rs3020318 (P <0.05). Diagnoses of disc displacement with reduction, masticatory muscle myalgia, and arthralgia were highly prevalent in the asymmetry groups, and all had strong statistical associations with ENPP1 rs858339. The average JPF scores for asymmetric subjects before surgery (JPF, 7) were significantly higher than for symmetric subjects (JPF, 2). Patients in group 3 had the highest preoperative JPF scores, and groups 2 and 3 were most likely to be cured of TMD 1 year after treatment. CONCLUSIONS: Posteroanterior cephalometrics can classify asymmetry into distinct groups and identify the probability of TMD and genotype associations. Orthodontic and orthognathic treatments of facial asymmetry are effective at eliminating TMD in most patients.

Exploring the impact of malocclusion and dentofacial anomalies on the occurrence of traumatic dental injuries in adolescents.

OBJECTIVE: To investigate the association between malocclusion/dentofacial anomalies and traumatic dental injuries (TDI) in adolescents. MATERIALS AND METHODS: The sample of this cross-sectional study comprised 509 adolescents aged 11 to 14 years enrolled at public schools in the city of Osório, southern Brazil. Parents answered a structured questionnaire addressing demographic and socioeconomic characteristics. An examiner who had undergone a training and calibration exercise recorded malocclusion/dentofacial anomalies (Dental Aesthetic Index, DAI), TDI (Andreasen), and dental caries (World Health Organisation). Statistical analyses (SPSS software) involved Poisson regression with robust variance. RESULTS: The prevalence of TDI was 11.6%, and the prevalence of defined, severe, and handicapping malocclusion was 24.0%, 21.6%, and 22.0%, respectively. The multivariate analysis demonstrated that the probability of TDI was approximately twofold higher among adolescents with severe malocclusion (prevalence ratio [PR] 2.22; 95% confidence interval [CI] 1.14-4.31) and handicapping malocclusion (PR 1.95; 95% CI 1.01-3.85) in comparison to those with normal occlusion or minor malocclusion. Defined malocclusion was not significantly associated with the outcome. Among the dentofacial anomalies evaluated, the probability of TDI was nearly twofold higher among adolescents with overjet greater than 3 mm (PR 1.96; 95% CI 1.14-3.37) and 2.2-fold higher among those with an abnormal molar relationship (PR 2.24; 95% CI 1.17-4.32), after controlling for confounding variables. CONCLUSIONS: Severe and handicapping malocclusion, accentuated overjet, and abnormal molar relationship were strongly associated with the occurrence of TDI. Future studies should investigate whether the treatment of these conditions can help reduce the occurrence of TDI in adolescents.

Change in Posterior Pharyngeal Space After Counterclockwise Rotational Orthognathic Surgery for Class II Dentofacial Deformity Diagnosed With Obstructive Sleep Apnea Based on Cephalometric Analysis.

Although maxillomandibular advancement (MMA) is an orthognathic surgical procedure used to manage obstructive sleep apnea (OSA) in individuals who are noncompliant with continuous positive airway pressure therapy, simple MMA encounters problems in terms of aesthetic outcomes in Asian populations with preexisting dentoalveolar protrusion. Our current prospective investigation describes changes in posterior pharyngeal space and aesthetic outcomes after counterclockwise rotational orthognathic surgery, which is known to be quite difficult in terms of the maintenance of the skeletal stability in skeletal class II patients with OSA. This prospective study investigated the surgical outcome of patients who suffered from OSA following counterclockwise rotational orthognathic surgery. The patients were skeletal class II patients who underwent orthognathic surgery between March 2013 and December 2014. Cephalometric posterior airway analysis and a questionnaire for facial perception were used to assess pharyngeal airway and patient perception of facial appearance. A total of 14 patients were included. Satisfactory results were achieved without complications in all OSA patients. The airway parameters for anteroposterior length significantly increased. Thirteen patients answered a questionnaire on their facial appearance, and the visual analog scale averaged 7.31 points, indicating a favorable facial appearance. Counterclockwise rotational orthognathic surgery without maxilla advancement for the correction of OSA can effectively increase the posterior pharyngeal space, with favorable aesthetic results. With thoughtful application, this novel approach may be an alternative to standard approaches for the correction of OSA using orthognathic surgery.

Progressive Atrial Conduction Defects Associated With Bone Malformation Caused by a Connexin-45 Mutation.

BACKGROUND: Inherited cardiac conduction disease is a rare bradyarrhythmia associated with mutations in various genes that affect action potential propagation. It is often characterized by isolated conduction disturbance of the His-Purkinje system, but it is rarely described as a syndromic form. OBJECTIVES: The authors sought to identify the genetic defect in families with a novel bradyarrhythmia syndrome associated with bone malformation. METHODS: The authors genetically screened 15 European cases with genotype-negative de novo atrioventricular (AV) block and their parents by trio whole-exome sequencing, plus 31 Japanese cases with genotype-negative familial AV block or sick sinus syndrome by targeted exon sequencing of 457 susceptibility genes. Functional consequences of the mutation were evaluated using an in vitro cell expression system and in vivo knockout mice. RESULTS: The authors identified a connexin-45 (Cx45) mutation (p.R75H) in 2 unrelated families (a de novo French case and a 3-generation Japanese family) who presented with progressive AV block, which resulted in atrial standstill without ventricular conduction abnormalities. Affected individuals shared a common extracardiac phenotype: a brachyfacial pattern, finger deformity, and dental dysplasia. Mutant Cx45 expressed in Neuro-2a cells showed normal hemichannel assembly and plaque formation. However, Lucifer yellow dye transfer and gap junction conductance between cell pairs were severely impaired, which suggested that mutant Cx45 impedes gap junction communication in a dominant-negative manner. Tamoxifen-induced, cardiac-specific Cx45 knockout mice showed sinus node dysfunction and atrial arrhythmia, recapitulating the intra-atrial disturbance. CONCLUSIONS: Altogether, the authors showed that Cx45 mutant p.R75H is responsible for a novel disease entity of progressive atrial conduction system defects associated with craniofacial and dentodigital malformation.

Comparative Evaluation of Condylar Volume Between Patients With Unilateral Condylar Hyperplasia and Class III Dentofacial Deformity.

PURPOSE: To compare the condylar volume of patients with unilateral condylar hyperplasia (UCH) with that of patients with a Class III skeletal relation. MATERIALS AND METHODS: Twenty cone-beam computed tomograms of patients were analyzed. Images were divided into 2 groups: 10 from patients with transverse asymmetry of the face and 10 from patients with a Class III facial deformity. Patients' ages ranged from 15 to 30 years. Volumetric data were reconstructed using Dolphin 3D software (Dolphin Imaging & Management Solutions, Chatsworth, CA). This software measured the condylar volume above the deepest point of the sigmoid notch, the lower arch midline deviation, and the overjet. RESULTS: The condyle with hyperplasia exhibited the largest volume (1.97 ± 0.52 cm3) and a statistically significant difference compared with the contralateral condyle (χ2 = 14.30; P < .01). The Class III condyle exhibited relative symmetry of volume between the left and right sides. These condyles exhibited a larger volume compared with the non-hyperplastic condyles in the UCH group, with a statistically significant difference (χ2 = 6.22; P = .013; χ2 = 5.50; P = .019). CONCLUSIONS: Hyperplastic condyles were similar in volume to the condyles of patients with mandibular prognathism, suggesting that patients with a Class III skeletal relation could exhibit bilateral condylar hyperplasia.

Evaluation of Nasal Obstruction in Various Sagittal Skeletal Deformity of Jaws.

Nasal obstruction (NO) is a common symptom present in 25% of the general population, which significantly interferes with the quality of life. The different facial profiles and malocclusion patterns could be associated with the degree of NO. In order to evaluate the nasal function in patients with different facial morphology patterns, the authors developed a prospective study in which 88 patients from a dentofacial deformities center were included. These patients were submitted to fibrorhinoscopy (Mashida, ENT PIII) with a 3.2-mm cannula under topical anesthesia to evaluate septal deviation, inferior and medium turbinates, and pharyngeal tonsils. The 88 patients included in the study were divided into 3 groups according to the classification of the facial profile, distributed as follows: 32 class I, 28 class II, and 28 class III; the data collected was statistically analyzed by analysis of variance and the results are shown. The patients included in this study presented similar prevalence of NO with the reduction of airway function efficiency. Although it was not a statistically different, the group II presented higher mean Nasal Obstruction Syndrome Evaluation scores.

Only severe malocclusion correlates with mastication deficiency.

OBJECTIVES: The relation between level of dentofacial deformity and extent of masticatory deficiency was studied. DESIGN: Three groups of human young adults were formed: (i) subjects needing orthodontics plus orthognathic surgery (SevDFD, n=18), (ii) subjects needing orthodontic treatment only (ModDFD, n=12), and (iii) subjects needing no treatment (NoDFD, n=12). For mastication tests, carrot boluses were collected at the deglutition time. Bolus particle size range was expressed as d50 value, which was compared with the Masticatory Normative Indicator (MNI). Index of treatment need (IOTN), global oral health assessment index (GOHAI) and chewing kinematic characteristics were also recorded. We used a general linear model univariate procedure followed by a Student-Newman-Keuls test. RESULTS: All the SevDFD subjects showed impaired mastication with MNI above the normal limit (d50 mean=7.23mm). All the ModDFD subjects but one were below this limit (d50 mean=2.54mm), and so could adapt to a low level of masticatory impairment as also indicated by kinematics. IOTN indicated a treatment need for ModDFD (3.7±0.5) and SevDFD (4.3±0.6) groups, while GOHAI values were unsatisfactory only for SevDFD (42.6±9.2 vs. 55.3±1.9). CONCLUSIONS: Our findings emphasize the need for an objective evaluation of masticatory function to discern truly deficient mastication from mild impairment allowing satisfactory adaptation of the function. However, malocclusions are known to worsen with time justifying thus their corrections as early as possible.

Effect of Osteoporosis on Bone Density of Orthognathic Osteotomy Sites in Maxillofacial Region.

OBJECTIVES: The aims of this study were to investigate the availability of Hounsfield unit (HU) measurement of computed tomography (CT) in evaluating the bone density of certain sites by comparing bone density between CT and dual-energy x-ray absorptiometry (DEXA), and to evaluate the effects of osteoporosis on osteotomy sites in orthognathic surgery. METHODS: This retrospective study included 80 patients who had undergone both facial CT and DEXA at our hospital. We selected 7 regions of interest from among the osteotomy sites in bimaxillary orthognathic surgery. The patients were assigned to either the normal (control) group (n = 40) or the abnormal group (n = 40), and HU values were measured in each region of interest. RESULTS: There were statistically significant differences in the mean HU values between 2 groups at all the osteotomy sites in the maxilla and mandible, with the normal group showing higher values than the abnormal group (P < 0.05). In addition, there was a significant positive correlation between T-scores obtained with DEXA and the HU values on CT at the osteotomy sites (P < 0.01). Multiple regression analysis indicated that the abnormal group was more negatively associated with 6 osteotomy sites except for 1 maxillary area, as compared with the normal group. CONCLUSIONS: Measurement of HU values on CT can be valuable in assessing bone density of the maxilla and mandible. It is suggested that osteoporosis may affect bone density at the osteotomy sites in orthognathic surgery, and the preoperative measurement of HU values might be useful in predicting unfavorable fracture or the risks involved in such surgery.

Impact of malocclusion and dentofacial anomalies on the prevalence and severity of dental caries among adolescents.

OBJECTIVES: To investigate the association between malocclusion/dentofacial anomalies and dental caries among adolescents. MATERIALS AND METHODS: A cross-sectional study was conducted with 509 adolescents aged 11 to 14 years enrolled at public schools in the city of Osório in southern Brazil. Parents/caregivers answered a structured questionnaire on demographic and socioeconomic variables. A trained examiner recorded the presence of malocclusion (Dental Aesthetic Index [DAI]), traumatic dental injury, and dental caries. Data analysis involved the chi-square, Mann-Whitney, and Kruskal-Wallis tests. Poisson regression with robust variance was used for the multivariable analysis. RESULTS: A total of 44.8% of the adolescents had dental caries (mean DFMT  =  1.33 ± 1.84). The DAI index ranged from 15 to 77 (mean  =  29.0 ± 7.9); 43.6% of the sample had severe malocclusion and 11.6% had traumatic dental injury. The prevalence and severity of dental caries were significantly greater among adolescents with severe malocclusion. The multivariate analysis demonstrated that adolescents with severe or handicapping malocclusion had a 31% greater probability of having dental caries (prevalence ratio: 1.31; 95% CI: 1.02-1.67), independently of demographic, socioeconomic, or clinical aspects. The orthodontic characteristics associated with the occurrence and severity of caries were maxillary irregularity ≥3 mm (P  =  .021) and abnormal molar relationship (P  =  .021). CONCLUSIONS: Handicapping malocclusion, maxillary irregularity, and abnormal molar relationship were associated with the occurrence and severity of dental caries. The findings suggest that the prevention and treatment of these conditions can contribute to a reduction in dental caries among adolescents.

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

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

Corticotomy-Assisted Le Fort I Osteotomy: An Alternative to Segmentation of the Maxilla in Orthognathic Surgery.

PURPOSE: The aim of this study was to describe a surgical technique that can be used to solve dentofacial deformities associated with narrow interradicular spaces of the anterior teeth of the maxilla and inadequate overbite/overjet seen in hand-articulated models. This is presented here as an alternative to segmentation of the maxilla in Le Fort I osteotomy. METHODS: Six patients with dentofacial deformities (classes II and III malocclusions) had Le Fort I osteotomy accompanied by buccal alveolar corticotomies of the maxilla. During the immediate postoperative period, elastic forces were applied to mobilize the anterior dentoalveolar segments until the planned overjet/overbite was observed. RESULTS: All patients reached the desired occlusion approximately 1 month after the surgical procedure. Pulp vitality of the teeth adjacent to the corticotomies was not compromised. CONCLUSIONS: The clinical results obtained confirm the technique as a safe and reliable alternative to segmentation of the maxilla in orthognathic surgery.

[DYNAMICS OF DENTAL CARIES' INDEXES IN CHILDREN WITH DENTOALVEOLAR ANOMALIES UNDER THE INFLUENCE OF PREVENTIVE MEASURES].

Frequency dentition anomalies in children and adolescents according to different authors, ranging from rising 50.8 to 81%. Anomalies of dental systems lead to aesthetic and functional disturbances affecting the child's psyche, and often lead to the development of dental caries and periodontal diseases. So, the purpose of our study was to investigate the dynamics of dental caries' indexes in children with dentoalveolar anomalies under the influence of preventive measures. We observed 50 children aged 12, who were divided into four groups. The most effective prophylactic complex in terms of reduction of growth of caries (59.4%) was the one that involved the use of "Tooth Mousse" (applying to the surface of the teeth 5 minutes after eating one time a day, in the morning after brushing teeth), "Osteovit" (one tablet three times a day), "Pektodent--dentifrice? (dental cleaning powder twice a day--in the morning and evening). This complex creates conditions for increasing the resistance of hard dental tissues, resulting in low levels of intensity of caries in children.

Masticatory function in patients with dentofacial deformities before and after orthognathic treatment-a prospective, longitudinal, and controlled study.

OBJECTIVES: The aim of this study was to investigate the self-estimated masticatory ability and masticatory performance in patients with dentofacial deformities before and after orthognathic treatment; in comparison to an age- and gender-matched control group. SUBJECTS AND METHODS: The masticatory ability and masticatory performance were evaluated in 121 consecutive patients (treatment group), referred for orthognathic treatment. Eighteen months after treatment, 98 patients (81%) completed a follow-up examination. Masticatory ability was assessed on a visual analog scale, while the masticatory performance was evaluated by a masticatory test using round silicon tablets. Signs and symptoms of temporomandibular disorders (TMD) were registered by a clinical examination and a questionnaire. The control group comprised 56 age- and gender-matched subjects who were examined at baseline. RESULTS: At the baseline examination, the treatment group had a significantly lower masticatory ability and performance compared with the control group. After treatment, the masticatory ability significantly improved in the treatment group and reached the same level as in the control group. The masticatory performance index increased significantly but was still lower than in the control group. Both the masticatory ability and masticatory performance were affected by the number of occlusal contacts during maximal biting pressure and by the self-estimated overall symptoms of TMD. CONCLUSIONS: Patients with dentofacial deformities, corrected by orthognathic treatment, have a significant positive treatment outcome in respect of masticatory ability and masticatory performance. Furthermore, the occlusion and symptoms of TMD have an impact on both masticatory ability and masticatory performance.