Post-pubertal effects of the Alt-RAMEC/FM and RME/FM protocols for the early treatment of Class III malocclusion: a retrospective controlled study.

OBJECTIVE: To assess the stability of the effects of the modified Alt-RAMEC and facial mask (FM) protocol at a post-pubertal observation. METHODS: Twenty-one Class III patients (11 males and 10 females, 6.5 ± 0.7 years) treated consecutively with the Alt-RAMEC/FM approach and presenting with lateral cephalograms taken before treatment (T1), after treatment (T2), and at post-pubertal observations (T3) were compared with 22 Class III patients (9 males and 13 females, 6.9 ± 1.2 years) treated with the rapid maxillary expansion (RME) and FM protocol and with 15 Class III untreated subjects (7 males and 8 females, 6.2 ± 2.2 years). At T3, all patients showed a post-pubertal skeletal maturation stage (CS4-CS6). Descriptive statistics and statistical comparisons between the three groups at T1 and for the T3-T1, T2-T1, and T3-T2 changes were assessed by means of the ANOVA or Kruskal-Wallis test. RESULTS: During the overall observation period, Alt-RAMEC/FM and RME/FM protocols produced statistically significant favourable effects when compared with the Control group (ANB + 2.8° and +2.2°, respectively; Wits appraisal +4.4 mm and +2.7 mm, respectively). No statistically significant differences were found between the outcomes of the Alt-RAMEC/FM and RME/FM protocols neither at the post-pubertal or short-term observations. LIMITATIONS: Retrospective study and the comparison with an historical control sample of subjects with untreated Class III malocclusion. CONCLUSIONS: The Alt-RAMEC/FM protocol cannot be recommended as the approach of choice for the therapy of Class III dentoskeletal disharmony in very young subjects compared to the conventional RME/FM protocol.

Three-dimensional evaluation of the maxillary effects of two orthopaedic protocols for the treatment of Class III malocclusion: A prospective study.

OBJECTIVES: To compare the three-dimensional maxillary dentoskeletal effects of a modified alternate rapid maxillary expansion and constriction facemask protocol (Alt-RAMEC/FM) with the traditional rapid maxillary expansion facemask protocol (RME/FM) performed in deciduous or early mixed dentition Class III patients. SETTING AND SAMPLE POPULATION: Orthodontic Clinic of the Section of Dentistry of the Department of Surgery and Translational Medicine of the University of Florence. Thirty-four Class III patients were enrolled and allocated by alternating assignment to either Alt-RAMEC/FM or RME/FM therapy. MATERIALS AND METHODS: Prior to treatment, all patients were evaluated, and a cone beam computed tomography (CBCT) scan was acquired. After completion of the orthopaedic therapy (average interval 1.2 years), a follow-up CBCT scan was obtained. Anatomic landmark identification on the CBCTs and subsequent quantification of the changes were performed. The primary outcome variable was the anteroposterior displacement of the anterior nasal spine (ANS AP). The treatment groups were compared with independent samples t tests. RESULTS: The patients in the two treatment groups showed a similar degree of compliance. No statistically significant differences were recorded for any variable when comparing the Alt-RAMEC/FM and RME/FM groups. In particular, the between-group difference for ANS AP was 0.0 mm (95%CI: -0.6;0.7, P = 0.933). CONCLUSIONS: Both Alt-RAMEC/FM and RME/FM produced favourable orthopaedic changes in Class III growing patients. Neither protocol was superior to the other in terms of maxillary protraction effectiveness.

Transverse relationship of permanent molars after crossbite correction in deciduous dentition.

OBJECTIVE: To evaluate the transverse relationships of the first permanent molars after the correction of posterior crossbite performed during the deciduous dentition with two different treatment protocols. MATERIALS/METHODS: Ninety patients (40 males and 50 females) with posterior crossbite were treated during the deciduous dentition with either a removable expansion plate (RP group, 60 patients) or rapid maxillary expander (RME group, 30 patients). The dental casts before treatment (T0, mean age 5.1 ± 0.7 years) and after treatment, when the first permanent molars were fully erupted, (T1, mean age 7.7 ± 1.0 years) were analysed. The prevalence rates for posterior crossbite on the first permanent molars in the two groups were compared by means of chi-squared test with Yates correction. A logistic regression was performed to evaluate the factors that could influence the presence/absence of posterior crossbite on the first permanent molars. RESULTS: Prevalence rate of posterior crossbite on the first permanent molars at T1 was 34.4 per cent in the total sample, 28.3 per cent for the RP group and 46.6 per cent for the RME group. No significant predictors for the 'presence/absence of posterior crossbite on the first permanent molars' at T1 were found. LIMITATIONS: Retrospective study. CONCLUSIONS: After treatment of posterior crossbite during the deciduous dentition phase, the first permanent molars erupted in crossbite in the 34.4 per cent of the cases. The type of treatment is not a significant predictor for the presence of posterior crossbite on the first permanent molars.

Comparisons of two protocols for the early treatment of Class III dentoskeletal disharmony.

OBJECTIVE: To assess the short-term outcomes of splints, Class III elastics, and chincup (SEC III) and rapid maxillary expansion and facial mask (RME/FM) protocols. MATERIALS AND METHODS: 25 patients with Class III dentoskeletal disharmony (10 males, 15 females) treated with the SEC III protocol were evaluated at the beginning (T1, mean age 7.5±1.4 years) and at the end of treatment (T2, mean age 8.7±1.4 years). The SEC III group was compared to a matched sample of 32 Class III patients (16 males, 16 females) treated with the RME/FM protocol and to a matched control group (CG) consisting of 23 subjects (12 males, 11 females) with untreated Class III dentoskeletal disharmony. The statistical comparisons between the three groups were performed with analysis of variance with Tukey's post hoc tests. RESULTS: With respect to the CG the SEC III and the RME/FM groups showed significantly favourable effects in terms of maxillary advancement (SNA +1.2 and +1.4 degrees, respectively), control of mandibular projection (SNB -1.3 and -1.4 degrees, respectively), and intermaxillary relationships (ANB +2.6 and +2.9 degrees, respectively; WITS +3.7 and +2.6mm, respectively). The RME/FM group showed a significantly greater increase in the intermaxillary divergency than the SEC III group (+1.8 degrees) and the CG (+2.0 degrees). LIMITATIONS: A limitation of this study is its short-term nature. CONCLUSIONS: Both SEC III and RME/FM protocols are efficient treatments for Class III dentoskeletal disharmony. The SEC III protocol produces more favourable control in intermaxillary vertical relationships than the RME/FM therapy.

What are the prevalence and risk factors associated with wire syndrome in dental students? A cross-sectional study.

INTRODUCTION: Wire syndrome (WS) refers to dental displacements that can be described as aberrant, inaccurate, unexplained, or excessive, on teeth still contained by an intact bonded retainer, without detachment or fracture, leading to evolving dental and periodontal, aesthetic and/or functional consequences. The objective of this study was to define the prevalence rate of mandibular WS and the associated risk factors. METHODS: Participants were dental students who had undergone orthodontic treatment and were wearing an intact fixed mandibular retainer. They completed a 20-item questionnaire, after which an extraoral and intraoral clinical examination was conducted. Participants were assigned to either the non-wire syndrome group or the wire syndrome group by two independent practitioners. Univariate and multivariate logistic regression models were used to investigate potential risk factors. RESULTS: A total of 59 students (23.4years±1.7years) were included. Among these, 9 students presented with mandibular WS, resulting in a prevalence rate of 15.25% (95% CI: 6.08%-24.43%). Univariate analysis revealed a significant association between a deep labio-mental fold, a concave profile, and a multi-strand round wire, and an excess risk of WS. The odds ratios were 16.5 (95% CI: 1.9-146.8, P=0.01), 6.4 (95% CI: 1.0-41.0, P=0.05), and 9.0 (95% CI: 1.7-48.7, P=0.01), respectively. Multivariate analysis confirmed these significant associations, except for the concave profile. CONCLUSIONS: The prevalence rate of wire syndrome was 15.25%. Two risk factors associated with WS were identified: a deep labio-mental fold and a multi-strand round wire retainer.

Does the oral microbiota evolve differently during orthodontic treatment with vestibular multi-attachment fixed appliances versus aligners? A systematic review of the literature / Est-ce que le microbiote oral évolue différemment lors d'un traitement orthodontique par appareil fixe multi-attache vestibulaire versus par aligneurs ? Une revue systématique de la littérature.

Introduction: Oral microbiota of patients is impacted during orthodontic treatment. The objective of this systematic review was to observe the evolution of oral microbiota (primary objective) and periodontal health (secondary objective) during orthodontic treatment, and to compare these changes during treatment with vestibular fixed appliances and aligners. Materials and Methods: In accordance with PRISMA guidelines, an electronic search was performed in four databases until January 2022, completed by a manual search, including all prospective controlled studies, randomized or not, on the subject. Two independent authors were involved in the selection of studies, and a third author was consulted in case of disagreement. The Cochrane Collaboration's tool and ROBINS-I tool was used to assess the risk-of-bias in randomized and non-randomized trials, respectively. Finally, the risk of bias graphs were made with the robvis visualization tool. Results: Out of the 994 results obtained from these searches, 11 eligible articles were included (4 randomized clinical trials and 7 non-randomized controlled studies) with varying levels of bias. Results suggested that patients treated with aligner appliances have more favorable microbial flora and less biofilm mass during their treatment compared with those treated with fixed appliances. In addition, inflammatory marker cytokines and periodontal indices were higher in fixed orthodontic treatment compared to aligners treatment. Conclusion: Considering the limitations of this systematic review of the literature, the results suggested that aligners have a more favorable impact on the oral microbiota and periodontium compared to vestibular fixed appliances. PROSPERO registration: CRD42022276486.

Introduction: Il est désormais reconnu que le microbiote oral des patients est impacté au cours du traitement orthodontique. L'objectif de cette revue systématique était d'observer l'évolution du microbiote oral (objectif principal) et de la santé parodontale (objectif secondaire) lors du traitement orthodontique, et de comparer ces modifications lors du traitement par appareils multi-attaches vestibulaires et par aligneurs. Matériels et méthodes: Conformément aux directives PRISMA, une recherche électronique a été réalisée dans quatre bases de données jusqu'à janvier 2022, complétée par une recherche manuelle, incluant toutes les études prospectives contrôlées, randomisées ou non, sur le sujet. Deux auteurs indépendants ont été impliqués dans la sélection des études et un troisième auteur a été sollicité en cas de désaccord. L'outil The Cochrane Collaboration's tool et l'outil ROBINS-I ont été utilisés pour évaluer le risque de biais dans les essais randomisés et non randomisés, respectivement. Finalement, les graphiques des risques de biais ont été réalisés avec l'outil robvis. Résultats: Parmi les 994 résultats issus de ces recherches, onze articles éligibles ont été inclus, comprenant quatre essais cliniques randomisés et sept études contrôlées non randomisées, avec des niveaux de biais variables. Les résultats suggèrent que les patients traités par gouttières orthodontiques présentent une flore microbienne plus favorable, ainsi qu'une masse de biofilm moins élevée au cours du traitement par rapport à ceux traités par appareils fixes multi-attaches. De plus, les cytokines marqueuses d'inflammation et les indices parodontaux étaient plus importants lors des traitements orthodontiques par appareils multi-attaches. Conclusion: Tenant compte des limites associées à cette revue systématique de la littérature, les résultats semblent suggérer que les aligneurs ont un impact plus favorable sur le microbiote oral et sur le parodonte que les appareils fixes multi-attaches. Enregistrement PROSPERO : CRD42022276486.

Early vs late orthodontic treatment of deepbite: a prospective clinical trial in growing subjects.

INTRODUCTION: The aim of this prospective clinical trial was to compare the outcomes of prepubertal vs pubertal treatment of deepbite patients with a protocol including biteplane and fixed appliances. METHODS: A sample of 58 subjects with deepbite completed the study. A total of 34 subjects received treatment with removable biteplane appliances in the mixed dentition at a prepubertal stage of skeletal maturation (early treatment group), and 24 subjects were treated at a pubertal stage of skeletal maturation in the permanent dentition (late treatment group). All subjects of both groups were reevaluated after an average period of 15 months after the completion of fixed appliance therapy. Treatment outcomes were assessed statistically after a phase with removable biteplane appliances and at the posttreatment observation. RESULTS: Treatment duration was significantly shorter in the early treatment group than in the late treatment group. Overbite reduction was significantly greater in the late treatment group (-3.1 mm) than in the early treatment group (-1.4 mm). In the late treatment group, 92% of the patients had a corrected overbite 1 year after therapy. CONCLUSIONS: Treatment of deepbite at puberty in the permanent dentition leads to significantly more favorable outcomes than treatment before puberty in the mixed dentition.

Relevance of teleorthodontic tools: a systematic review of the literature / Pertinence des outils de téléorthodontie : une revue systématique de la littérature

Introduction: The concept of teleorthodontics was recently born; the Covid-19 crise has participated to the emergence and the amplification of this phenomenon. Objective: The main aim of the present systematic review was to evaluate the teleorthodontics relevance. Method: An electronic and manual search was performed in four databases (PubMed, Scopus, Embase and Cochrane Library) up to December 2021 according to PRISMA guidelines. Both prospective and retrospective studies, as well as case reports, case series and satisfaction surveys published in English or in French without time restriction were included. Two independant reviewers were involved in the selection of the studies and a third reviewer was required in case of disagreement. A bias assessment was performed using the Mixed Methods Appraisal Tools. Results: Out of 1757 articles, 22 articles published mainly between 2019 and 2021 and with varying levels of evidence, were included. Considering the results obtained, different concepts were discussed (time management, quality of communication, reliability and use of tools, satisfaction, quality of human relations, emergency management, compliance). Conclusions: Teleorthodontics is an interesting and complementary tool that is, in no way, a systematic alternative to face-to-face orthodontic appointments in the office. However, many essential aspects of telemedicine in orthodontics, such as data protection, still need to be investigated in order to fully analyze this tool.

Introduction: Le concept de téléorthodontie a récemment vu le jour ; la crise de la Covid-19 a fortement participé à l'émergence et à l'amplification de ce phénomène. Objectif: L'objectif premier de cette revue systématique de la littérature était d'évaluer la pertinence de la téléorthodontie. Méthode: Une recherche électronique a été menée dans quatre bases de données (PubMed, Scopus, Embase et Cochrane Library), complétée par une recherche manuelle jusqu'à fin décembre 2021 conformément aux directives PRISMA. Tous types d'études cliniques, prospectives ou rétrospectives, y compris les rapports et les séries de cas ainsi que les enquêtes de satisfaction publiées en anglais ou en français sans restriction de temps, ont été inclus. Deux auteurs indépendants ont été impliqués dans la sélection des études et un troisième auteur a été sollicité en cas de désaccord. Une évaluation des biais a été réalisée à partir du Mixed Methods Appraisal Tools. Résultats: Sur les 1757 articles, 22 articles, publiés majoritairement entre 2019 et 2021 et de niveaux de preuve variables, ont été inclus. Tenant compte des résultats obtenus, différentes notions ont pu être discutées (gestion du temps, qualité de la communication, fiabilité des outils, facilité d'utilisation, satisfaction, qualité du rapport humain, gestion des urgences, observance). Conclusions: La téléorthodontie est un outil intéressant et complémentaire à une approche classique pour certaines indications. Cependant, elle ne constitue en aucun cas une alternative systématique aux rendez-vous orthodontiques en présentiel au cabinet. De nombreux aspects pourtant essentiels (protection des données, etc.) doivent être encore investigués pour analyser pleinement cet outil.

Dentoskeletal effects of the maxillary splint headgear in the early correction of Class II malocclusion / Effets dento-squelettiques de la force extra-orale sur gouttière maxillaire dans la correction précoce des malocclusions de classe II

Objective: To compare dentoskeletal changes produced by the maxillary splint headgear and cervical headgear appliance during the early phase of Class II treatment, specially the initial overjet and upper incisors position. Subjects and methods: In this retrospective study, 28 Class II patients treated with the maxillary splint headgear (maxillary splint headgear or MSG, mean age 10.1 ± 1.9 years) and 28 Class II patients treated with cervical headgear (cervical headgear group or CHG, mean age 9.5 ± 1.9 years) were evaluated before and after treatment. Statistical comparisons between the two groups for cephalometric measurements at T1 and for T2-T1 changes were performed by means of independent sample t tests. Results: The MSG showed a significantly greater reduction of the overjet in comparison to the CHG (-2.4 mm and -0.7 mm, respectively) and a significantly greater maxillary incisor uprighting (-1.8 mm and 0.4 mm, respectively). In the MSG, overjet correction was due mainly to mandibular advancement (3.5 mm), while the correction of molar relationship (3.9 mm) was 64% skeletal and 36% dentoalveolar. In the CHG, the overjet correction was also more skeletal, due to mandibular growth (1.8 mm), while correction of molar relationship (3.5 mm) was 63% dentoalveolar and 37% skeletal. Conclusions: Both groups showed favorable skeletal mandibular changes, which was more significant in the MSG. Regarding tooth movement, the maxillary splint headgear was more effective in uprighting upper incisors and reducing the overjet than cervical headgear appliance.

Objectif: L'objectif de cet article était de comparer les changements dento-squelettiques produits par la force extra-orale sur gouttière maxillaire et la force extra-orale cervicale pendant la phase précoce du traitement de classe II, en particulier au niveau du surplomb initial et de la position des incisives supérieures. Matériels et méthodes: Dans cette étude rétrospective, les cas de 28 patients en classe II traités avec la force extra-orale sur gouttière maxillaire (maxillary splint headgear ou MSG, âge moyen 10,1 ± 1,9 ans) et de 28 patients en classe II traités avec la force extra-orale à traction cervicale (cervical headgear group ou CHG, âge moyen 9,5 ± 1,9 ans) ont été étudiés avant et après le traitement. Les comparaisons statistiques entre les deux groupes pour les mesures céphalométriques à T1 et pour les changements entre T2 et T1 ont été effectuées au moyen de tests t d'échantillons indépendants. Résultats: Le MSG a montré une réduction significativement plus importante du surplomb par rapport au CHG (-2,4 mm et -0,7 mm, respectivement) et un redressement significativement plus important des incisives maxillaires (-1,8 mm et 0,4 mm, respectivement). Dans le MSG, la correction du surplomb était principalement due à l'avancement mandibulaire (3,5 mm), tandis que la correction de la relation molaire (3,9 mm) était à 64 % squelettique et à 36 % dento-alvéolaire. Dans le CHG, la correction du surplomb était également plus squelettique, en raison de la croissance mandibulaire (1,8 mm), tandis que la correction de la relation molaire (3,5 mm) était à 63 % dento-alvéolaire et à 37 % squelettique. Conclusions: Les deux groupes ont présenté des modifications squelettiques mandibulaires favorables, qui étaient plus significatives dans le groupe MSG. En ce qui concerne le mouvement des dents, la force extra-orale sur gouttière maxillaire était plus efficace pour redresser les incisives supérieures et réduire le surplomb que la force extra-orale cervicale.

A retrospective long-term comparison of early RME-facemask versus late Hybrid-Hyrax, alt-RAMEC and miniscrew-supported intraoral elastics in growing Class III patients.

OBJECTIVE: To compare the long-term dentoskeletal effects of early treatment with banded or bonded RME (Rapid Maxillary Expansion)-Face Mask (RME-FM) versus late treatment with bonded Hybrid-Hyrax, alt-RAMEC (Alternate Rapid Maxillary Expansion and Contraction) and intraoral Class III elastics anchored to miniscrew-reinforced-Lower-lingual-Arch (alt-RAMEC-HH-LLA) in growing, maxillary retrognathic patients. MATERIALS AND METHODS: Two groups were matched at long-term follow-up retrospectively. Patients received either early RME-FM (n=16, 5 males, 11 females, age T1: 6.5±0.9 years, age T2: 15.8±2.5 years) or late alt-RAMEC-HH-LLA (n=15, 7 males, 8 females, age T1: 12.52±0.94 years, age T2: 16.8±0.9 years). Total follow-up was 9.2±2.3 years and 4.2±0.2 years respectively, including fixed appliances to compete treatment. RESULTS: Both treatments resulted in Class III correction except one unsuccessful case of alt-RAMEC-HH-LLA. Active maxillary protraction was 1.6±0.5years with RME-FM and 0.5 years with alt-RAMEC-HH-LLA being significantly shorter (P<0.001). Values at T2 estimation with multivariate linear regression for correlated multiple outcomes, conditional on baseline estimates, age and sex showed alt-RAMEC-HH-LLA inducing significantly more retroclined lower incisors (mean: -6.11°; 95%CI: -10.66, -1.57; P=0.01), less overbite (mean: -1.28mm; 95%CI: -1.79, -0.761; P<0.001), less maxillo (Co-A)- (mean: -4.54mm; 95%CI: -7.91, -1.16; P=0.01) mandibular (Co-Gn) (mean: -10.5mm; 95%CI: -17.45, -3.55; P=0.003) projections/size, more open gonial angle (mean: 4.93°; 95%CI: 2.27, 7.59; P<0.001), and less S-N length (mean: -5.04mm; 95%CI: -6.57, -3.51; P<0.001). CONCLUSIONS: Patients treated with either early RME-FM or late Alt-RAMEC-HH-LLA had comparable overall post-pubertal skeletal and overjet corrections. However, the late Alt-RAMEC-HH-LLA showed less correction of dentoalveolar compensations and in particular of the mandibular incisors. The overbite, maxillary and mandibular projection and size were lower and the gonial angle was more open.

Stability of rapid maxillary expansion and facemask therapy: a long-term controlled study.

INTRODUCTION: The aim of this prospective controlled study was to evaluate the long-term effects of rapid maxillary expansion and facemask therapy in Class III subjects. METHODS: Twenty-two subjects (9 boys, 13 girls; mean age, 9.2 years ± 1.6) with Class III disharmony were treated consecutively with rapid maxillary expansion and facemask therapy followed by fixed appliances. The patients were reevaluated at the end of the 2-phase treatment (mean age, 14.5 years ± 1.9) and then recalled about 8.5 years after the end of rapid maxillary expansion and facemask treatment (mean age, 18.7 years ± 2.1). Two groups of controls with untreated Class III malocclusion were used for statistical comparisons of the short-term and long-term intervals. Statistical comparisons were performed with the Mann-Whitney U test. RESULTS: In the long term, no significant differences in maxillary changes were recorded, whereas the treatment group showed significantly smaller increases in mandibular protrusion. The sagittal maxillomandibular skeletal variables maintained significant improvements in the treatment group vs the control groups. CONCLUSIONS: In the long term, rapid maxillary expansion and facemask therapy led to successful outcomes in about 73% of the Class III patients. Favorable skeletal changes were mainly due to significant improvements in the sagittal position of the mandible.

Meta-analysis of skeletal mandibular changes during Frankel appliance treatment.

The purpose of this study was to perform a meta-analysis of articles to verify the mandibular changes produced by the Fränkel-2 (FR-2) appliance during the treatment of growing patients with Class II malocclusions when compared with untreated growing Class II subjects. The literature published from January 1966 to January 2009 was reviewed with search engines. A quality analysis was performed. The effects on primary end points were calculated with random-effect models. Heterogeneity was assessed using Q statistic and investigated using study-level meta-regression. A total of nine articles were identified. The quality of the studies ranged from low to medium. Meta-analysis showed that the FR-2 was associated with enhancement of mandibular body length [0.4 mm/year 95 per cent confidence interval (CI) 0.182-0.618], total mandibular length (1.069 mm/year, 95 per cent CI 0.683-1.455), and mandibular ramus height (0.654 mm/year, 95 per cent CI 0.244-1.064). A consistent heterogeneity among studies was found for all the considered linear measurements. The FR-2 appliance had a statistically significant effect on mandibular growth. Nevertheless, the heterogeneity of the FR-2 effects, the quality of studies, the differences in age, skeletal age, treatment duration, and the inconsistent initial diagnosis seem to overstate the benefits of the FR-2 appliance. An evidence-based approach to the orthodontic outcomes of FR-2 appliance is needed, by selecting and comparing groups of children with the same cephalometric characteristics with and without treatment.

Prevalence of orthodontic treatment need in southern Italian schoolchildren.

The present survey was performed to determine orthodontic treatment need in a large sample (n = 703) of 12-year-old schoolchildren from the southern part of Italy. The sample comprised 331 males (47 per cent) and 372 females (53 per cent), all orthodontically untreated. Two examiners, who had been previously trained in the use of occlusal indices, screened all the schoolchildren. The prevalence rates for the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) as well as for occlusal features (Angle Class, overjet, overbite, crowding, posterior crossbite) were calculated for the total sample. The IOTN grades were statistically compared in the two genders using the chi-square test. The findings indicated that this southern Italian school population showed a rather low prevalence rate for objective need for treatment (grades 4 and 5; 27.3 per cent of the total sample). This prevalence rate is generally lower than those reported in northern and central European countries (Sweden, Germany, and UK) but slightly greater than those in France. No significant differences in the DHC grades of the IOTN were found between genders. Among the occlusal features diagnosed in the subjects examined, a high prevalence rate was found for crowding (45.9 per cent). Moreover, posterior crossbites and Class III malocclusions, which would presumably have benefited from early orthodontic intervention, were still present in 14.2 and 4.3 per cent of the students, respectively.

[What is a malocclusion?] / Qu'est-ce qu'une malocclusion ?

Since 1907, the international community has used Angle's classification to assess the mesio-distal relationships of the dental arches. It is the basis of the diagnosis of malocclusion in the sagittal dimension and indicates or not an orthodontic correction treatment. This work was aimed to inventory the classification methods of malocclusions used today. Indices of treatment need were also presented because they are based on one or more occlusal anomalies to indicate treatment. The classifications were criticized and the contribution of a functional analysis based on the use of the trilogy setting, centering and guiding was detailed. The type of anomalies (skeletal and dental) must be completed by the analysis of the occlusal anomaly of setting (centering or guiding) and of the category of occlusion (functional occlusion, functional malocclusion or pathogenic malocclusion), ie its possible pathogenic impact on orofacial structures. A consensus on the classification of occlusal anomalies is necessary in order to better identify the anomalies and their global repercussions, and to better define the needs for orthodontic treatment.

Dentoskeletal effects of the maxillary splint headgear in the early correction of Class II malocclusion.

BACKGROUND: To compare dentoskeletal changes produced by the maxillary splint headgear and cervical headgear appliance during the early phase of Class II treatment, specially the initial overjet and upper incisors position. SUBJECTS AND METHODS: In this retrospective study, 28 Class II patients treated with the maxillary splint headgear (MSG, mean age 10.1 ± 1.9 years) and 28 Class II patients treated with cervical headgear (CHG, mean age 9.5 ± 1.9 years) were evaluated before and after treatment. Statistical comparisons between the two groups for cephalometric measurements at T1 and for T2-T1 changes were performed by means of independent sample t tests. RESULTS: The MSG showed a significantly greater reduction of the overjet in comparison to the CHG (- 2.4 mm and - 0.7 mm, respectively) and a significantly greater maxillary incisor uprighting (- 1.8 mm and 0.4 mm, respectively). In the MSG, overjet correction was due mainly to mandibular advancement (3.5 mm), while the correction of molar relationship (3.9 mm) was 64% skeletal and 36% dentoalveolar. In the CHG, the overjet correction was also more skeletal, due to mandibular growth (1.8 mm), while correction of molar relationship (3.5 mm) was 63% dentoalveolar and 37% skeletal. CONCLUSIONS: Both groups showed favorable skeletal mandibular changes, which was more significant in the MSG. Regarding tooth movement, the maxillary splint headgear was more effective in uprighting upper incisors and reducing the overjet than cervical headgear appliance.

Short-term effects produced by rapid maxillary expansion and facemask therapy in Class III patients with different vertical skeletal relationships.

OBJECTIVE: To evaluate the dentoskeletal short-term effects of rapid maxillary expansion and facemask therapy (RME/FM) in a sample of Class III patients showing different vertical skeletal relationships. MATERIALS AND METHODS: Seventy-nine patients (35 females and 44 males) having Class III malocclusion were consecutively treated using RME/FM therapy with application of the protraction force in a downward and forward direction and inclination of about 30° to the occlusal plane. All patients were evaluated at the beginning (T1; mean age, 7.7 years) and at the end (T2; mean age, 9.2 years) of orthopedic therapy and divided into three groups according to their vertical skeletal relationships: normal group (NG), hypodivergent group (HypoG), and hyperdivergent group (HyperG). Statistical comparisons between the three groups were performed on the starting forms (T1), the final forms (T2), and the treatment changes (T1-T2) using the ANOVA with Tukey's post hoc tests. RESULTS: Favorable modification in terms of maxillary advancement (changes in SNA ranging from 1.4° to 1.8°) and intermaxillary sagittal skeletal relationships (changes in Wits appraisal ranging from 2.5 mm to 3.5 mm) were recorded in all groups. The three groups showed no statistically significant differences in changes in either sagittal or vertical skeletal variables. CONCLUSIONS: The various vertical skeletal features do not influence the short-term outcomes of RME/FM therapy.

Treatment effects produced by the Twin-block appliance vs the Forsus Fatigue Resistant Device in growing Class II patients.

OBJECTIVE: To compare the dentoskeletal changes produced by the Twin-block appliance (TB) followed by fixed appliances vs the Forsus Fatigue Resistant Device (FRD) in combination with fixed appliances in growing patients having Class II division 1 malocclusion. MATERIALS AND METHODS: Twenty-eight Class II patients (19 females and 9 males; mean age, 12.4 years) treated consecutively with the TB followed by fixed appliances were compared with a group of 36 patients (16 females and 20 males; mean age, 12.3 years) treated consecutively with the FRD in combination with fixed appliances and with a sample of 27 subjects having untreated Class II malocclusion (13 females and 14 males; mean age, 12.2 years). Mean observation interval was 2.3 years in all groups. Cephalometric changes were compared among the three groups by means of ANOVA and Tukey's post hoc tests. RESULTS: The FRD produced a significant restraint of the maxilla compared with the TB and control samples (SNA, -1.1° and -1.8°, respectively). The TB sample exhibited significantly greater mandibular advancement and greater increments in total mandibular length than either the FRD or control groups (SNB, 1.9° and 1.5°, respectively; and Co-Gn, 2.0 mm and 3.4 mm, respectively). The FRD produced a significantly greater amount of proclination of the mandibular incisors than what occurred with the TB or the control samples (2.9° and 5.6°, respectively). CONCLUSION: The TB appliance produced greater skeletal effects in terms of mandibular advancement and growth stimulation while the Forsus caused significant proclination of the mandibular incisors.

Prevalence of malocclusions, oral habits and orthodontic treatment need in a 7- to 15-year-old schoolchildren population in Tirana.

BACKGROUND: The aim of present study was to determine the prevalence of malocclusions, oral habits and the need for orthodontic treatment in a sample of 7- to 15-year-old Albanese schoolchildren. METHODS: The final sample comprised 2,617 subjects (1,257 males and 1,360 females), all orthodontically untreated. Occlusal relationship and the functional analysis were recorded for all subjects. The prevalence rates for the dental health component of the index of orthodontic treatment need (IOTN) were calculated. Comparisons between genders were performed for the prevalence of malocclusions, oral habits and IOTN grades (chi-square tests). RESULTS: Class I, class II and class III malocclusions and asymmetries were observed in 40.4%, 29.2%, 3.2% and 27.1% of the sample, respectively. There were 2,108 subjects (80.6%) that showed oral habits, with females (82.1%) presenting with a greater prevalence rate than males (78.9%). The objective need for orthodontic treatment (grades 4 and 5 of IOTN) was registered in 1,077 subjects (41.2%). This prevalence rate is higher than those reported for other European countries. No significant differences between genders were found for the IOTN grades. CONCLUSIONS: The findings of the present study revealed the need to improve public health plans for orthodontic prevention and screening and to organise the resources in this area in Albania.