Facial growth and management of orthodontic problems

Z-plasty surgery combined with orthodontic-prosthodontic approach in the rehabilitation of aberrant frenum with congenitally multiple agenesis: A case report

INTRODUCTION

Orthodontists often encounter a clinical challenge while dealing with a big space of anterior teeth. Aberrant frenum with congenitally multiple agenesis is a complex case that requires an interdisciplinary approach. The purpose of this paper is to describe the well-synchronized periodontal surgery, orthodontic, and prosthodontic treatment of an aberrant frenum cases with congenitally multiple agenesis.

CASE PRESENTATION

A female patient, aged 20, presented with complaints of misaligned, spaced teeth, and several missing teeth. A Class III malocclusion type 1 with a high and hypertrophied maxillary labial frenum was found and diagnosed. A positive blanch test, diastemata, as well as persistent teeth 53, 71, and 81, were detected. Panoramic radiographs confirmed the teeth's agenesis. Orthodontic treatment was performed using the straightwire technique to close the spaces. The frenulum was corrected by a frenectomy utilizing the Z-plasty surgical procedure. Subsequently, prosthodontic treatment involved the fabrication of lucitone dentures to close the remaining space.

DISCUSSION

This case alerted periodontists, orthodontists, and prosthodontists that collaboration is essential to intervene in such specific congenital anomalies. An interdisciplinary effort should focus on eliminating the etiology of malocclusion, considering periodontal factors, maintaining dental arch integrity, addressing biomechanical elements, designing appropriate prostheses, ensuring better retention of tooth position, and achieving aesthetic appearance.

CONCLUSION

The Z-plasty frenectomy surgery treatment resulted in successful and rapid healing after the operation, with no occurrence of hypertrophic scar formation. The final outcome of orthodontic-prosthodontic treatment was also pleasing for both the patient's aesthetic and functional requirements and the operator's satisfaction.

Impacts of Development, Dentofacial Disharmony, and Its Surgical Correction on Speech: A Narrative Review for Dental Professionals

Speech is a communication method found only in humans that relies on precisely articulated sounds to encode and express thoughts. Anatomical differences in the maxilla, mandible, tooth position, and vocal tract affect tongue placement and broadly influence the patterns of airflow and resonance during speech production. Alterations in these structures can create perceptual distortions in speech known as speech sound disorders (SSDs). As craniofacial development occurs, the vocal tract, jaws, and teeth change in parallel with stages of speech development, from babbling to adult phonation. Alterations from a normal Class 1 dental and skeletal relationship can impact speech. Dentofacial disharmony (DFD) patients have jaw disproportions, with a high prevalence of SSDs, where the severity of malocclusion correlates with the degree of speech distortion. DFD patients often seek orthodontic and orthognathic surgical treatment, but there is limited familiarity among dental providers on the impacts of malocclusion and its correction on speech. We sought to review the interplay between craniofacial and speech development and the impacts of orthodontic and surgical treatment on speech. Shared knowledge can facilitate collaborations between dental specialists and speech pathologists for the proper diagnosis, referral, and treatment of DFD patients with speech pathologies.

Impacts of anterior-posterior jaw disproportions on speech of dentofacial disharmony patients

BACKGROUND/OBJECTIVES

Articulation problems impact communication, development, and quality of life, and are diagnosed in 73-87% of patients with Class II Dentofacial Disharmony (DFD). We evaluated whether differences exist in stop (/t/ or/k/), fricative (/s/ or/ʃ/), and affricate (/tʃ/) consonant sounds of Class II DFD subjects, and whether extent of malocclusion correlates with severity of speech distortion. We hypothesized that Class II patients display milder distortions than Class III and anterior open bite (AOB), as Class II patients can posture into a Class I occlusion.

MATERIALS/METHODS

Audio and orthodontic records were collected from DFD patients (N = 53-Class II, 102-Class III, 72-Controls) who were pursuing orthodontics and orthognathic surgery. A speech pathologist perceptually scored speech. Acoustic differences in recordings were measured using Spectral Moment Analysis.

RESULTS

When Class II subjects were compared to controls, significant differences were found for the centroid frequency (M1) of the /s/ sound and the spectral spread (M2) of /t/, /tʃ/, and /s/ sounds, with pairwise significance for controls relative to Class II AOB and all Class II subjects. Class II AOB subjects had higher M1 and M2 values than patients with Class II closed bites and Class I controls for most sounds. When comparing across anterior-posterior (AP) groups, differences exist between controls, Class II and III DFD subjects for M1 of /t/, /tʃ/, and/ʃ/ and M2 for /t/, /tʃ/, /s/, and /ʃ/ sounds. Using linear regression, correlations between Class II and III severity and spectral measures were found for /t/ and /tʃ/ sounds.

CONCLUSIONS/IMPLICATIONS

Class II and III patients have a higher prevalence of qualitative distortions and spectral changes in consonants compared to controls, but Class II spectral shifts are smaller and affect fewer sounds than in Class III and AOB cohorts. Linear correlations between AP discrepancy and spectral change suggest causation and that treatment may improve articulation problems.

Effects of maxillary incisor inclination on dentoalveolar changes in class II division 1 and 2 non-extraction treatment for Caucasian children - A retrospective study using CBCT

OBJECTIVE

The objective of this study was to investigate the effects of maxillary central incisor (U1) inclination changes on alveolar bone and root length in the 20 Class II division 1 and 20 Class II division 2 (CII div1, CII div2) Caucasian adolescents treated without extraction.

MATERIAL AND METHODS

Forty U1s from each group were assessed for root length and alveolar variables at the crestal, mid-root, and apical levels using sagittal sections obtained from CBCT images pre- and post-treatment. Mixed MANOVAs, Repeated measures MANOVAs, Pearson correlations, and regression analyses were performed.

RESULTS

The facial bone height did not change significantly after an average of 15 degrees of proclination in the CII div2 group, whereas a statistically significant decrease in the palatal bone height was noted. However, in the CII div1 group, a statistically significant reduction in the facial and palatal bone height was observed with mild crown retroclination. Both groups had a significant decrease in total bone thickness at all levels, more decrease in the CII div2 group after treatment. No statistically significant difference in root length was observed between the groups during treatment.

CONCLUSIONS

The findings support that the flaring of retroclined U1s as a process for normalizing U1 inclination did not harm the facial alveolar bone height in the CII div2 non-extraction treatment. Crown proclination itself was not correlated to the amount of root resorption in Class II div1&2 non-extraction treatments in adolescents.

Association Between Self-Reported Bruxism and Malocclusion in University Students: A Cross-Sectional Study

OBJECTIVES

Bruxism can result in temporomandibular disorders, oral pain, and tooth wear. However, it is unclear whether bruxism affects malocclusion. The aim of this study was to examine the association between self-reported bruxism and malocclusion in university students.

METHODS

Students (n = 1503; 896 men and 607 women) aged 18 and 19 years were examined. Malocclusion was defined using a modified version of the Index of Orthodontic Treatment Need. The presence of buccal mucosa ridging, tooth wear, dental impression on the tongue, palatal/mandibular torus, and the number of teeth present were recorded, as well as body mass index (BMI). Additional information regarding gender, awareness of bruxism, orthodontic treatment, and oral habits was collected via questionnaire.

RESULTS

The proportion of students with malocclusion was 32% (n = 481). The awareness of clenching in males with malocclusion was significantly higher than in those with normal occlusion (chi square test, P < 0.01). According to logistic regression analysis, the probability of malocclusion was significantly associated with awareness of clenching (odds ratio [OR] 2.19; 95% confidence interval [CI], 1.22-3.93) and underweight (BMI <18.5 kg/m(2)) (OR 1.89; 95% CI, 1.31-2.71) in males but not in females. In subgroup analyses, the probability of crowding was also significantly associated with awareness of clenching and underweight (P < 0.01) in males.

CONCLUSIONS

Awareness of clenching and underweight were related to malocclusion (crowding) in university male students.

The prevalence of malocclusion and oral habits among 5-7-year-old children

BACKGROUND

Digit sucking, tongue thrust swallowing, and mouth breathing are potential risk factors for development of malocclusion. The purpose of this study was to verify the prevalence of different occlusal traits among 5-7-year-old children and assess their relationship with oral habits.

MATERIAL AND METHODS

The study included 503 pre-school children (260 boys and 243 girls) with a mean age of 5.95 years. Different occlusal traits were verified by intraoral examination. Oral habits were diagnosed using data gathered from clinical examination of occlusion and extra-oral assessment of the face, combined with a questionnaire for parents.

RESULTS

The study demonstrated that 71.4% of the children presented with 1 or more attributes of malocclusion and 16.9% had oral habits. The vertical and sagittal malrelation of incisors, as well as spacing, were the predominant features. This study showed that digit suckers have higher incidence of anterior open bite (P=0.013) and posterior crossbite (P=0.005). The infantile type of swallowing demonstrated strong association (P=0.001) with anterior open bite.

CONCLUSIONS

Non-nutritive sucking habits and tongue thrust swallowing are significant risk factors for the development of anterior open bite and posterior crossbite in pre-school children.

Malocclusion in preschool children: prevalence and determinant factors

PURPOSE

To evaluate the prevalence of malocclusion and associated factors in the primary dentition of preschoolers in the city of Diamantina, Brazil.

METHODS

A cross-sectional study was carried out with 381 children aged 3-5 years treated at the 10 basic health care units in the city during immunisation campaigns. The dependent variables (presence of malocclusion, open bite, crossbite and crowding) were evaluated through a clinical oral exam. The independent variables (gender, age, health problems, breastfeeding, bottle feeding, harmful oral habits, mother's schooling, household income and number of children in the home) were collected through interviews. Statistical analysis involved descriptive analysis, Chi square test and Poisson regression.

RESULTS

The prevalence of malocclusion was 32.5%. Open bite was the most frequent type of malocclusion. Children with a history of bottle feeding (PR 1.74; 95% CI 1.24-2.44) and those with harmful oral habits (PR 1.49; 95% CI 1.23-1.99) had greater prevalence rates of malocclusion. Greater prevalence rates of open bite were also found in children with a history of bottle feeding (PR 5.00; 95% CI 1.99-12.5) and those with harmful oral habits (PR 2.90; 95% CI 1.59-5.29), whereas greater prevalence rates of crossbite were found in boys (PR 1.79; 95% CI 1.10-2.91) and were associated with mother's schooling (PR 1.91; 95% CI 1.20-3.06).

CONCLUSION

A history of bottle feeding and the presence of harmful oral habits were identified as determinants for the occurrence of malocclusion in preschoolers.

Non-nutritive sucking habits, anterior open bite and associated factors in Brazilian children aged 30-59 months

The aim of the present study was to investigate the prevalence of non-nutritive sucking habits and anterior open bite as well as their main causes (associated factors) in Brazilian children aged 30-59 months. A cross-sectional study was carried out during the National Immunization Day for polio in the city of Recife in the northeastern region of Brazil. The sample was made up of 1,308 children. Data were collected from interviews with mothers or guardians as well as from clinical examinations carried out by previously trained dental students. The chi-square test was used for statistical analysis at 5% significance level. The prevalence of non-nutritive sucking habits was 40%, and the habits were associated with gender (p=0.001), age (p=0.003) and feeding type (p<0.001). Anterior open bite was detected in 30.4% of children, and it was significantly associated with feeding type (p<0.001) and non-nutritive sucking habits (p<0.001). The variables found to be associated factors in the present study for the occurrence of non-nutritive sucking habits and anterior open bite emphasize the need to establish strategies that include orientation regarding health promotion based on the "common determining factors" approach. Public health policies should be adopted to encourage a longer duration of breastfeeding, thereby contributing towards reducing the prevalence of non-nutritive sucking habits and anterior open bite.

Anterior open bite: a case-control study

OBJECTIVE

The aim of this study was to assess the influence of sucking habits and facial pattern measurements on the development of anterior open bite (AOB).

METHODS

A case-control study was carried out on 60 children aged 7 and 8 years attending municipal public schools in the city of Recife, Brazil. Data collection included interviews with guardians, oral examinations, and facial growth pattern analysis using cephalometric radiographs. The following cephalometric measurements were assessed: SN.Gn, SN.GoGn, FMA, and Facial Axis. Statistical analyses were performed using the Student's t-test and Pearson's chi-square test at a 5% level of significance.

RESULTS

The percentage of children with sucking habits in the case group was much higher than in the control group (53.3%vs 16.7%) (P = 0.003). Children with sucking habits were six times more likely to develop AOB. Regarding the measurements assessed, no statistically significant differences were observed between groups.

CONCLUSION

This study found no evidence that variations in cephalometric angles (SN.Gn, FMA, SN.GoGn, and facial axis) are risk factors for AOB. Only sucking habits demonstrated a positive correlation with an increased AOB.

Three-dimensional analysis of facial morphology surface changes in untreated children from 12 to 14 years of age

INTRODUCTION

The developing face is of interest to orthodontists, especially if orthodontic treatment can influence the outcome of facial growth. New 3-dimensional (3D) modalities have enabled clinicians to better understand the facial changes in a developing child.

METHODS

Fifty-nine children with normal body mass indexes were evaluated with a previously validated 3D laser imaging device over a 2-year period. Surface changes were evaluated on normal and average faces. These changes were seen as mean surface changes and color maps.

RESULTS

The results suggest that the surface areas of change in average faces were generally downward and forward with respect to the nose and soft-tissue nasion. The lips also translated in a downward direction as the nose grew, and there was a general increase in the vertical dimension. Some subjects were in the "great changes" category, boys significantly more so than girls.

CONCLUSIONS

The following conclusions can be made from this 3D study of changes of facial morphology in children: (1) surface changes are greater in boys than in girls; (2) differences in the timing of surface changes in boys and girls are clinically significant, with boys exhibiting more changes later; (3) positive surface changes occur in the nose, brows, lips, and vertical dimensions of the face; (4) the eyes deepen, and the cheeks become flatter; and (5) 3D imaging is a useful tool in analyzing changes to the face over time.

Non-nutritive sucking habits, dental malocclusions, and facial morphology in Brazilian children: a longitudinal study

The aim of this longitudinal study was to assess the relationship between non-nutritive sucking habits and the presence of anterior open bites (AOBs) and posterior crossbites and their association with facial morphology among 4- to 6-year-old children attending state schools in the city of Recife, Brazil. The sample comprised 287 children, both males and females. The proportion of boys to girls was approximately 50 per cent. The average age was 4 years 5 months at the beginning and 6 years 6 months at the end of the study. Data were collected from interviews with mothers or carers, and the clinical examination was carried out by two calibrated examiners. Statistical analysis was undertaken using bivariate analysis, Pearson's chi-square, McNemar, and Stuart-Maxwell tests. The results revealed a significant reduction in AOB (P < 0.001) and a slight increase in the prevalence of posterior crossbites. Both occlusal traits were associated with a previous history of sucking habits. The most prevalent morphological facial type, assessed using the morphological facial index, was high (> or =88 mm) and a statistically significant (P = 0.02) association was found between facial morphology and an AOB. Children with an average or high facial morphology measurement exhibited a greater prevalence of AOB when compared with those with lower measurements. Self-correction of AOB was associated with cessation of sucking habits but facial morphology remained unaltered.

Geometric morphometric assessment of treatment effects of maxillary protraction combined with chin cup appliance on the maxillofacial complex

The aim of this study was to investigate the treatment effects on the maxillofacial complex by maxillary protraction combined with chin cup therapy among growing children. An effective geometric morphometric assessment of cephalometric radiographs, using Procrustes analysis and thin-plate spline analysis, was applied to evaluate shape change in the craniofacial and midfacial configurations of a treated sample of 20 children with skeletal Class III malocclusion. This was compared with matched untreated skeletal Class III controls. Marked treatment induced change involved the maxilla and the mandible. Major deformation consisted of forward advancement of the maxillary complex with negligible rotation of the palatal plane and a forward direction of growth of the mandibular condyle associated with a restriction in sagittal advancement of the chin. Considerable dentoalveolar components contributed to the correction of anterior crossbite. Further detailed study of skeletofacial remodelling in response to maxillary protraction in other skeletal components, including the cranial base and the mandibular complex that contribute to Class III skeletal discrepancies, is warranted.

Nonnutritive sucking habits in Brazilian children: effects on deciduous dentition and relationship with facial morphology

This study assessed the relationship between nonnutritive sucking habits, facial morphology, and malocclusion in 3 planes of space (transverse, vertical, and anteroposterior) in 330 Brazilian children (4 years of age) attending state schools in the city of Recife, Brazil. The data were collected by interviews with the children's mothers or minders and by clinical examinations carried out by a calibrated examiner (kappa = 1). The chi-square test, Fisher's exact test, and multivariate analysis were used for statistical analysis. The prevalence of malocclusion in the sample was 49.7%, according to occlusal classification, and 28.5% of the children had 2 or 3 factors contributing to their malocclusion. Posterior crossbite was detected in 12.1%, anterior open bite in 36.4%, and increased overjet in 29.7%. A significant association was found between malocclusion and sucking habits (P <.001). Most of the children had a high facial skeletal pattern, although no association was found between facial morphology and malocclusion. The results draw attention to the magnitude of the problem in childhood and emphasize the need for longitudinal studies to support clinical practice guidelines for the target population.

Clinical presentation of allergic fungal sinusitis in children

OBJECTIVE

To compare the differences in the clinical and radiographic presentation of allergic fungal sinusitis in children and adults.

STUDY DESIGN

Retrospective chart and computed tomography review.

METHODS

The settings included a tertiary care children's hospital, adult academic private hospital, and academic affiliated county hospital. All patients with documented allergic fungal sinusitis who underwent computed tomography evaluation and had surgical treatment of their disease from 1988 to 1999 were included in the study. In total, 151 patients aged 5 to 75 years; 44 of these patients were less than or equal to 17 years of age (children) and 107 were greater than 17 years of age (adults). Main outcome measures included 1) the presence of obvious bony facial abnormalities on presentation, 2) bilateral or unilateral sinus disease on presentation, 3) the presence of asymmetrical disease on presentation, 4) the presence of bony extension on computed tomography scan, and 5) type of fungus present.

RESULTS

Fifteen of 36 (42%) pediatric patients and 10 of 103 (10%) adult patients had obvious alteration of their facial skeleton (proptosis, telecanthus, or malar flattening) on presentation (P <.05). Proptosis was the most common facial abnormality in both groups and was seen more often in children (8 of 36 [22%]) than in adults (9 of 103 [9%]) (P <.05). Twenty-eight of 40 (70%) pediatric patients and 37 of 100 (37%) adult patients presented with unilateral sinus disease (P <.05). Thirty-five of 40 (88%) pediatric patients and 58 of 100 (58%) adults presented with asymmetrical disease (P <.05). Computed tomography scans showed that 10 of 40 (25%) pediatric patients and 23 of 100 (23%) adult patients had bony erosion with extension of disease into surrounding structures (P >.05). Cultures from both adults and children showed mainly Bipolaris and Curvilaria species in equal amounts (P >.05). Adults had a greater incidence of Aspergillus species.

CONCLUSIONS

Presentation in pediatric patients with allergic fungal sinusitis is different from that in adults, with children having obvious abnormalities of their facial skeleton, unilateral sinus disease, and asymmetrical disease more often. Findings on computed tomography scan show an equal amount of bony erosion with extension of disease. The types of fungus cultured in the sinus cavities are similar in both groups.