1
|
Chen YJ, Chen HH, Hsu LF, Wang SH, Chen YJ, Lai EHH, Chang JZC, Yao CCJ. Airway increase after open bite closure with temporary anchorage devices for intrusion of the upper posteriors: Evidence from 2D cephalometric measurements and 3D magnetic resonance imaging. J Oral Rehabil 2018; 45:939-947. [PMID: 30133810 DOI: 10.1111/joor.12712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/15/2018] [Accepted: 08/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to analyse morphological changes in the upper airways in patients with anterior open bite treated with temporary anchorage devices for intrusion of upper posterior teeth. MATERIALS AND METHODS Twelve nonobese (body mass index: <25) anterior open bite patients between the ages of 19 and 44 years (mean age: 22.83 ± 8.19 years) were recruited for this study. Cephalometric radiographs and magnetic resonance imaging (MRI) scans before and after anterior bite closure without bracketing on anterior teeth were used to measure the upper airway, which was divided into retropalatal and retroglossal regions. RESULTS The mandibular plane angle and lower facial height were significantly reduced by intrusion of the upper posteriors and autorotation of the mandible. The retroglossal airway width (AW2) and retroglossal area (RG area) measured on cephalometric radiographs both increased significantly after treatment. Retroglossal volume increased and the retroglossal width/length ratio decreased significantly in MRI analysis. All other measurements were not significantly changed. However, no statistically significant correlations were observed between all measurements in 2D and 3D images, with the exception of the AW2 linear measurement in 2D images correlating with the AP length in MRI axial view images (r = 0.56, P = 0.0430). CONCLUSION Counterclockwise rotation of the mandible after anterior open bite closed using orthodontic treatment changed the airway morphology. Retroglossal volume significantly increased and the airway shape became less elliptical after bite closure.
Collapse
Affiliation(s)
- Yunn-Jy Chen
- Division of Prosthodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsin-Ho Chen
- Division of Orthodontics, Dental Department, Taoyuan Armed Forces General Hospital, Lungtan, Taiwan
| | - Li-Fang Hsu
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Shin-Huei Wang
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Jane Chen
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Eddie Hsiang-Hua Lai
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenny Zwei-Chieng Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
2
|
Mehta S, Lodha S, Valiathan A, Urala A. Mandibular morphology and pharyngeal airway space: A cephalometric study. APOS TRENDS IN ORTHODONTICS 2014. [DOI: 10.4103/2321-1407.148021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction
Mandibular retrognathism is considered to be the most important risk factor for upper airway obstruction.
Aim
This cross-sectional study intended to examine the relationship between craniofacial morphology and the pharyngeal airway space (PAS) in patients with mandibular retrognathism and mandibular prognathism, when compared to normal subjects. The study also analyzed the influence of mandibular morphology on pharyngeal length (PL).
Materials and Methods
The PAS was assessed in 92 females (age 15-30 years) further divided into three groups - Group 1- normal mandible (76°≤ SNB ≤82°; n = 31); Group 2-mandibular retrognathism (SNB <76°; n = 31); Group 3-Mandibular prognathism (SNB >82°; n = 30). All subjects were examined by lateral cephalometry with head position standardized using an inclinometer. Craniocervical angulation, uvula length, thickness and angulation were compared among different groups.
Results
The results showed no statistically significant difference in the pharyngeal airway between the three groups. Measurements of PL showed statistically significant higher values for retrognathic mandible group than normal and prognathic mandible group.
Conclusion
There is no significant difference between PAS between patients with mandibular retrognathism, normal mandible and mandibular prognathism. Mandibular retrognathism patients show a significantly higher uvula angulation than patients with mandibular prognathism. Craniocervical angulation showed maximum value in retrognathic mandible group followed by normal and prognathic mandible group respectively. Mean PL for retrognathic mandible patients was significantly higher than prognathic mandible patients.
Collapse
Affiliation(s)
- Siddharth Mehta
- Department of Orthodontics, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
| | - Surendra Lodha
- Department of Orthodontics, Jaipur Dental College, Jaipur, Rajasthan, India
| | | | - Arun Urala
- Department of Orthodontics, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
| |
Collapse
|
3
|
Laranjo F, Pinho T. Cephalometric study of the upper airways and dentoalveolar height in open bite patients. Int Orthod 2014; 12:467-82. [PMID: 25457718 DOI: 10.1016/j.ortho.2014.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Open bite is related to various etiological factors and, in many cases, is difficult to diagnose. The present study is aimed at evaluating, through cephalometric analysis, the dimensions of the upper airways and dentoalveolar heights in open bite (OB) patients versus normal overbite patients. The relationship between the width of the upper airways and the lack of overbite is also studied, in order to differentiate between dental open bite (DOB) and skeletal open bite (SOB). MATERIALS AND METHODS Eighty X-rays were selected from files of orthodontic patients to form the control sample (n=40) and open bite sample (n=40). Dimensions of the upper airways and dentoalveolar heights were measured in both samples, using 16 linear measurements, two angle values and one ratio. RESULTS In OB patients, anteroposterior narrowing of the upper airways, mainly in the nasopharynx and oropharynx, was observed, together with forward displacement of the hyoid bone and increased maxillary and mandibular dentoalveolar heights, and anterior facial height. In SOB, the overbite was more negative and facial growth was more clockwise-oriented than in DOB. Greater narrowing of the airways in the anteroposterior orientation was also noted. In DOB, there was evidence of muscular adaptation, as shown by increased values of the hyoid bone displacement to a more anterior and lower position, and increased values of the vertical dimensions of the airways. An increase in posterior facial height was also observed allowing anterior rotation of the mandible. CONCLUSION The results suggest that the airway's dimensions reflect a tendency to open bite. The variable vertical airway length (Val) and the position of the hyoid bone allow the adaptive potential of these individuals to be determined and make the treatment of open bites more predictable.
Collapse
Affiliation(s)
- Filipe Laranjo
- Instituto Superior de Ciências da Saúde-Norte, CESPU, Portugal
| | - Teresa Pinho
- Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde (IINFACTS), CESPU; Department of Orthodontics, Instituto Superior de Ciências da Saúde-Norte, CESPU, Rua Central de Gandra, 1317 4585-116 Gandra PRD, Portugal.
| |
Collapse
|
4
|
Laranjo F, Pinho T. Étude céphalométrique des voies aériennes supérieures et de la hauteur dentoalvéolaire chez les patients avec béance. Int Orthod 2014. [DOI: 10.1016/j.ortho.2014.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
5
|
Bergamo AZ, Itikawa CE, de Almeida LA, Sander HH, Fernandes RM, Anselmo-Lima WT, Valera FC, Matsumoto MA. Adenoid hypertrophy, craniofacial morphology in apneic children. PEDIATRIC DENTAL JOURNAL 2014. [DOI: 10.1016/j.pdj.2014.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
6
|
Arat ZM, Akcam MO, Esenlik E, Arat FE. Inconsistencies in the differential diagnosis of open bite. Angle Orthod 2008; 78:415-20. [PMID: 18416610 DOI: 10.2319/021907-80.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 05/01/2007] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine inconsistencies in the differential diagnosis of open bite. MATERIALS AND METHODS Using visual judgments, a total of 77 anterior open-bite cases in the postpubertal growth period were grouped as either morphogenetic, functional, or combination. The same sample was also grouped as either hyperdivergent, normodivergent, or hypodivergent using mandibular-plane angle and conventional cephalometry. Kappa analysis was used to test the agreement between the 2 methods of evaluation, and chi2 tests were used to analyze the distribution of cephalometrically grouped hyperdivergent, normodivergent, and hypodivergent cases among the visually assessed morphogenetic, functional and combination groups and vice versa. A kappa score of 0.343 indicated a weak agreement between visual judgment and cephalometric methods of evaluation (P < .001). RESULTS Despite the expectation that cases evaluated as hyperdivergent using cephalometry would be visually evaluated as morphogenetic, more than half of the cases assessed as hyperdivergent were in fact classified as functional. CONCLUSIONS These findings highlight the inadequacy of relying solely on cephalometric evaluation to classify open bite.
Collapse
Affiliation(s)
- Zuleyha Mirzen Arat
- Department of Orthodontics, University of Ankara, Faculty of Dentistry, Ankara, Turkey.
| | | | | | | |
Collapse
|
7
|
Arat ZM, Arman A. Treatment of a severe Class III open bite. Am J Orthod Dentofacial Orthop 2005; 127:499-509. [PMID: 15821695 DOI: 10.1016/j.ajodo.2004.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Z Mirzen Arat
- Department of Orthodontics, School of Dentistry, University of Ankara, Turkey.
| | | |
Collapse
|
8
|
Pae EK, Blasius JJ, Nanda R. Sex differences in genioglossus muscle response to changes in pharyngeal resistance. Am J Orthod Dentofacial Orthop 2002; 122:500-5. [PMID: 12439478 DOI: 10.1067/mod.2002.128862] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The genioglossus (GG) muscle's response to partial oropharyngeal occlusion was studied in age-matched, healthy awake men (n = 16) and women (n = 15). A miniature balloon was placed in the retroglossal pharynx, and the GG's electromyographic (EMG) reflexive response was evaluated in different body postures. We assumed that inflating the pharyngeal balloon and changing the body posture from upright to supine would increase pharyngeal airway resistance. Our hypothesis was that the change in airway resistance would elicit a different response in the GG muscle depending on sex. Our results showed that GG activity during natural breathing was higher in women than in men. GG EMG activity did not change upon inflation of the balloon in women. In contrast, when the balloon was inflated in the men, the GG's basal activity increased (P <.01) in both the upright and the supine positions. Women appeared to show a higher GG baseline EMG activity during spontaneous breathing at rest, while men were more responsive to the partial occlusion of the pharyngeal airway.
Collapse
Affiliation(s)
- Eung-Kwon Pae
- Section of Orthodontics, School of Dentistry, Center for the Health Sciences, University of California at Los Angeles, 90095-1668, USA.
| | | | | |
Collapse
|
9
|
Song HG, Pae EK. Changes in orofacial muscle activity in response to changes in respiratory resistance. Am J Orthod Dentofacial Orthop 2001; 119:436-42. [PMID: 11298317 DOI: 10.1067/mod.2001.112667] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Increased resistance in the upper airway is known to be a contributing factor to deviant facial growth patterns. These patterns are the result of a prolonged presence of unbalanced oropharyngeal muscle activity. We hypothesized that mechanically increasing airway resistance would enhance the activity of the muscles facilitating respiration, and we attempted to demonstrate that the increased muscle activity is modulated by mechanoreceptors in the pharyngeal airway. The response of oropharyngeal muscles to increased airway resistance during spontaneous breathing was observed in 11 rabbits. Electromyographic signals from the ala nasi, orbicularis oris superior, genioglossus, mylohyoid muscles, and the diaphragm were recorded by fine-wire electrodes. Pressure changes were monitored by pressure transducers at the side branch of the cannule close to openings for the nose and the trachea. The study consisted of 2 experimental sessions. First, to evoke the response of muscles to the inspiratory resistance, increasing stepwise polyethylene tubes of various diameters were attached to the nasal and tracheal opening and the diameter of the tubes was gradually reduced. Muscle activity changes in response to the increased resistance were recorded during spontaneous nasal or tracheal breathing. Second, to examine muscle responses to negative pressure to the pharyngeal airway, irrespective of breathing activity, the pharynx was isolated as a closed circuit by a stoma constructed at a more caudal side in the trachea. Muscle responses to the negative pressure generated by a syringe in the pharyngeal segment were measured. Nasal breathing induced a greater muscle activity than did tracheal breathing, in general, at P <.05. When resistance was gradually increased, nasal breathing resulted in a greater increase in muscle activity than did tracheal breathing (P <.05), except in the diaphragm. Application of negative pressure to the isolated pharyngeal airway segment increased the muscle activity significantly (P <.05). We conclude that an increased airway resistance may facilitate oropharyngeal muscle activity through mechanoreceptors in the oropharyngeal airway.
Collapse
Affiliation(s)
- H G Song
- Department of Orthodontics, School of Dental Medicine, University of Connecticut, Farmington, CT, USA
| | | |
Collapse
|
10
|
Kulnis R, Nelson S, Strohl K, Hans M. Cephalometric assessment of snoring and nonsnoring children. Chest 2000; 118:596-603. [PMID: 10988178 DOI: 10.1378/chest.118.3.596] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To determine the differences in craniofacial cephalometric variables between snoring and nonsnoring children. DESIGN Cross-sectional. SETTING Case Western Reserve University Dental School, Department of Orthodontics, and local Cleveland orthodontic private practices. PATIENTS Twenty-eight snoring and 28 nonsnoring children between the ages of 7 years and 14 years. Nonsnoring subjects were matched to snoring subjects by age, sex, and ethnicity (mean [+/- SD] age, 10+/-2 years; 82% white, 64% female). INTERVENTIONS None. MEASUREMENTS Snoring was assessed using a sleep behavior questionnaire administered to parents or guardians. The cephalometric radiographs of the study subjects were traced by a single investigator, and 1 angular measurement and 11 linear measurements of hard and soft tissues were recorded. The paired Student's t test was used to analyze the cephalometric data. RESULTS Snoring children manifest a significantly narrower anterior-posterior dimension of the pharynx at the superior and most narrow widths. Snoring children also had a greater length from the hyoid to the mandibular plane. CONCLUSIONS Snoring children appear to present craniofacial factors that differ from those of nonsnoring children.
Collapse
Affiliation(s)
- R Kulnis
- Department of Orthodontics, School of Dentistry, Case Western Reserve University, Cleveland, OH 44106-4905, USA
| | | | | | | |
Collapse
|