Prevalence of Orthodontic Malocclusions in Healthy Children and Adolescents: A Systematic Review

Euler-angle norms for tooth rotation, torque and tip

INTRO

The aim of the current study was to develop and describe a new measuring system for the orientation of a tooth in a digitalized cast of a jaw and provide new angular values for the rotation, torque and tip of maxillary and mandibular teeth.

METHODS

This retrospective cross-sectional study involved the utilization of a sub-group of extrinsic Euler-angles to derive optimal norm values per tooth in three different planes of orientation ('rotation', 'torque' and 'tip') by evaluating the digital representations of the teeth derived from a database containing over 17,500 patients. The process involved the entry of the .stl files of the jaw pairs into a fully automated software system (Smyl:Ai, Ulm, Germany) whereupon jaw alignment, teeth segmentation, landmark identification and visual validation of input files was conducted prior to calculation of the norm values for the three different planes of orientation.

RESULTS

The digital scans in stereolithography (.STL)-file format of the upper and lower dentitions of 1914 individuals with optimal occlusion were chosen and evaluated. New mean (standard deviation) angular values were determined for the rotation, torque and tip of maxillary and mandibular teeth.

CONCLUSION

The findings facilitate the reappraisal of rotation, torque and tip values currently acceptable as ideal. They will inform anthropologists and dental researchers about occlusion and alignment in orthodontic and non-orthodontic patients and provide baseline data for future studies. The methodology will also enable the evaluation of large numbers of data in relatively short timeframes.

New Solution in the Treatment of Children with Class II Malocclusion: Biblock Appliance

BACKGROUND

A new design, the Biblock appliance, was developed for the functional treatment of Class II malocclusions.

AIM

To compare the effects of Biblock appliance (BA) and Activator appliance (AA) on the skeleton, dentoalveolar, and soft tissue in Class II malocclusions.

METHODS

Thirty-five patients with mandibular retrognathia caused by skeletal Class II malocclusion and normodivergent growth pattern were included in this study. After selecting the BA group (n = 17, 8 boys and 9 girls, mean age = 12.08 ± 0.37 years), we selected the active control group treated with AA (n = 18, 9 boys and 9 girls, mean age = 12.3 ± 0.27 years), which matched the BA group's development and gender. All patients were between PP2 = DP3u periods according to hand-wrist maturation. Cephalometric variables related to the skeletal, dentoalveolar, and soft tissue were measured.

RESULTS

Treatment duration was 18.17 ± 1.45 months with BA and 16.92 ± 1.09 months with AA. Skeletal Class II malocclusion improved significantly in both groups. In the compared groups, the increase in ANS-Me was significantly higher in the AA group (P < 0.05). The Cd⊥SN and S-Cd increase in the compared groups was significantly higher in the BA group (P < 0.05). There was no significant difference in measurements between the groups in skeletal, dentoalveolar, and soft tissue measurements (P > 0.05).

CONCLUSION

The effects of AA, an appliance accepted by the orthodontic community, and BA, a new design, on the skeletal, dentoalveolar, and soft tissue were similar.

A longitudinal study of the probability of developing malocclusion in children using a Bayesian analysis

INTRODUCTION

This study evaluated the probability of developing malocclusions in mixed dentition.

METHODS

A longitudinal study was conducted with 598 children (aged 5 years) in deciduous dentition. The children were followed for 3 years until mixed dentition (aged 8 years). Overjet, overbite, and transversal relations were evaluated. Bayesian models were used to analyze the data and estimate the parameters.

RESULTS

The parameter θ was used for the distributions, indicating the probability of presenting a given condition with a credibility index (ICr) of 95%. After 3 years of follow-up, 121 children were reevaluated. The results showed that children have a high probability of malocclusion in mixed dentition. There was a higher probability of developing an increased overjet in the mixed dentition of 20.5% (ICr 95%, 13.6-28.4) to 48.3% (ICr 95%, 39.1-57.7) and a higher probability of having a normal overbite in the deciduous dentition and a lower probability in the mixed dentition (ICr 95%, 9.2-21.3).

CONCLUSIONS

Considering the probabilistic model of Bayesian analysis, children with normal overjet in the deciduous dentition may show an increased overjet in the mixed dentition. Concerning overbite, children may present an anterior open bite during the transition between deciduous and mixed dentition, as well as self-correction of deep overbite in mixed dentition. Furthermore, they may present a posterior crossbite during the mixed dentition when there is a normal transverse relationship in the deciduous dentition.

Orthodontic diagnosis rates based on panoramic radiographs in children aged 6-8 years: A retrospective study

Objective

This study aimed to retrospectively analyze the prevalence of orthodontic problems and the proportion of patients who underwent orthodontic diagnosis among children aged 6 (n = 300), 7 (n = 400), and 8 (n = 400) years who had undergone panoramic radiography.

Methods

Children were divided into five groups according to their chief complaint and consultation: conservative dentistry, oral and maxillofacial surgery, orthodontics, periodontics, and prosthodontics). Chief complaints investigated included first molar eruption, lack of space for incisor eruption, frequency of eruption problems, lack of space, impaction, supernumerary teeth (SNT), missing teeth, and ectropion eruption. The number of patients whose chief complaint was not related to orthodontics but had dental problems requiring orthodontic treatment was counted. The proportion of patients with orthodontic problems who received an orthodontic diagnosis was also examined.

Results

Dental trauma and SNT were the most frequent chief complaints among the children. The proportion of patients with orthodontic problems increased with age. However, the orthodontic diagnosis rates based on panoramic radiographs among children aged 6, 7, 8 years were only 1.5% (6 years) and 23% (7 and 8 years).

Conclusions

Accurate information should be provided to patient caregivers to correct misconceptions regarding the appropriateness of delaying orthodontic examination until permanent dentition is established.

Is There Variation in the Morphology of the Frontal Sinus in Individuals with Different Craniofacial Patterns? A Systematic Review with Meta-Analysis

To evaluate differences in the morphology of the frontal sinus in adolescents and adults with different craniofacial patterns, searches up to April 2024 were conducted in six databases and other information sources to identify observational studies. Study selection, data extraction, and quality assessment using the NOS scale were performed independently by two reviewers. Random effects meta-analyses were conducted to estimate the difference in frontal sinus measurements between different craniofacial skeletal patterns (α = 0.05). The certainty of the evidence was evaluated according to GRADE. Fourteen studies were included in the review. All studies had methodological limitations that affected their quality. The syntheses showed that skeletal Class II subjects presented a significantly smaller width of the frontal sinus than skeletal Class I subjects (MD = 0.56; 95% CI: 0.38, 0.74; p < 0.0001; I2 = 3%). Skeletal Class III subjects showed a frontal sinus width (MD = -0.91; 95% CI: -1.35, -0.47; p < 0.0001; I2 = 36%) and area (MD = -28.13; 95% CI: -49.03, -7.23; p = 0.0084; I2 = 66%) significantly larger than those of the skeletal Class I subjects. The available evidence suggests a positive relationship between mandibular and frontal sinus size. There is limited evidence to make reliable estimates of the association of other craniofacial patterns and frontal sinus characteristics. These reported results are not conclusive and should be evaluated carefully due to the very low certainty of the evidence. The current evidence is scarce and consists of studies with methodological limitations; the results of the studies are often inconsistent, and the pooled estimates are imprecise. New high-quality research is still necessary.

Malocclusion among patients at Agartala, Tripura, India

Malocclusion is the mal-relationship of dental arches with or without an irregularity of the teeth. Therefore, it is of interest to estimate the rate of occurrence of malocclusion within the population of Agartala city, Tripura, India. The study included 850 individuals ranging from 16 to 24 years of age, which were categorized into five distinct classifications, namely normal occlusion, Angle's Class I malocclusion, Class II Division 1, Class II Division 2, and Class III malocclusion. Data shows that normal occlusal alignment was observed in 29.41% of the participants, whereas a majority of 70.59% exhibited various forms of malocclusion among this population.

Malocclusion among children in Vietnam: Prevalence and associations with different habits

Background

This study aimed to measure the prevalence of malocclusion and identify associated factors among elementary school students in Vietnam.

Method

A cross-sectional study was conducted from March to December 2022 at six primary schools located in the province of Thai Binh, Vietnam. A total of 873 students were recruited for research purposes. Students were classified into normal, malocclusion classes I, II and III. Bad habits were examined. Multivariate logistic regression was used to detect associations.

Results

The prevalence of malocclusion was 60.7 %; 19.0 % had Class I, 31.0 % had Class II and 10.7 % had Class III. Having finger sucking habit was associated with Class I malocclusion (OR: 3.28), and Class II malocclusion (OR: 3.22). Having lip biting habit was related to a higher odds of having Class II malocclusion (OR = 4.37) Class III malocclusion (OR = 6.83). Having tongue thrusting habit was associated with higher odds of having Class I (OR: 5.25), and Class II malocclusion (OR: 6.42). Mouth breathing was related to a higher likelihood of having Class II malocclusion (OR = 2.71). Having early loss of deciduous teeth was associated with a higher odds of having Class III malocclusion (OR = 3.83).

Conclusion

Findings showed high prevalence of malocclusion, mostly class II, in elementary students in Vietnam. Bad habits such as finger sucking, biting the lower lip, tongue thrusting, mouth breathing, and early loss of deciduous teeth play important roles in developing malocclusion, which should be considered in the development of interventions.

Cross-cultural adaptation and validation of the Chinese version of the Malocclusion Impact Scale for Early Childhood (MIS-EC/C)

BACKGROUND

The Malocclusion Impact Scale for Early Childhood (MIS-EC) is a newly developed questionnaire used to measure the parental perceptions of the impact of malocclusion on oral health-related quality of life (OHRQoL) of preschool children aged 3-5 years. This study describes the cross-cultural adaptation and validation of the MIS-EC questionnaire into Chinese version (MIS-EC/C).

METHODS

The MIS-EC/C was developed in accordance with international standards. The scale was then evaluated in a cross-sectional study comprising 210 preschool children aged 3-5 years. The reliability of the MIS-EC/C was tested using internal consistency and test-retest reliability analyses. Cross-cultural validity, discriminant validity and convergent validity were tested.

RESULTS

The Cronbach's α value and intraclass correlation coefficient (ICC) value for the MIS-EC/C were 0.943 and 0.873, respectively. Confirmatory factor analysis indicated that the fitting indicators of the two-factor model all reached the standard. The MIS-EC/C can differentiate preschool children with malocclusion from those without malocclusion. In addition, there is a good relationship between the MIS-EC/C and the general oral health question.

CONCLUSION

The MIS-EC/C is a reliable and effective assessment tool for assessing the effect of malocclusion on the OHRQoL of preschool children in China.

Finite element analysis of sagittal screw expander appliance in the treatment of anterior maxillary hypoplasia

The skeletal anterior crossbite is a common malocclusion in clinic. However, there have been no reports on the maxillary sagittal expansion to correct the premaxillary hypoplasia, which greatly influences the facial morphology and masticatory function, using finite element analysis. In the present study, a three-dimensional finite element model of craniomaxillofacial complex with maxillary sagittal hypoplasia is constructed and the treatment for premaxillary hypoplasia by the sagittal screw expander appliance is simulated. The hypoplasia of the left premaxilla is more serious than that of the right and thus the size of the left part of premaxillary expander baseplate is designed to be larger than that of the right part and the loading is applied at 10° leftward to the sagittal plane and 30° forward and downward to the maxillary occlusal plane. The displacements or equivalent stress distributions of the maxilla, teeth and their periodontal ligaments, are analyzed under the loads of 5.0 N, 10.0 N, 15.0 N, and 20.0 N. Consequently, as the load increases, the displacements or equivalent stresses of the maxilla, teeth and their periodontal ligaments all increase. Almost the whole premaxilla markedly move forward, downward, and leftward while other areas in the craniomaxillofacial complex remain almost static or have little displacement. The equivalent stress concentration zone of the maxilla mainly occurs around and in front of the incisive foramina. The displacements of left premaxilla are generally greater than those of the right under the loading forces. The maximum equivalent stress on the teeth and their periodontal ligaments are 2.34E-02 MPa and 2.98E-03 MPa, respectively. Taken together, the sagittal screw expander appliance can effectively open the premaxillary suture to promote the growth of the premaxilla. An asymmetrical design of sagittal screw expander appliance achieves the asymmetric expansion of the premaxilla to correct the uneven hypoplasia and obtains the more symmetrical aesthetic presentation. This study might provide a solid basis and theoretical guidance for the clinical application of sagittal screw expander appliance in the efficient, accurate, and personalized treatment of premaxillary hypoplasia.

Prevalence of Malocclusions in Down Syndrome Population: A Cross-Sectional Study

Background and Objectives: A higher prevalence of dental malocclusion has been suggested among individuals with Down Syndrome (DS) compared to controls, although no studies to date have investigated such a difference according to age group. Therefore, the aim of this study was to compare the prevalence of dental malocclusion and other orthodontic measures between DS and non-syndromic (non-DS) individuals across three age groups of children, adolescents, and adults. Materials and Methods: This cross-sectional study was conducted on a total of 147 patients. Of those, 72 were diagnosed with DS and were divided into N = 15 children (<10 years), N = 23 adolescents (10-18 years) and N = 34 adults (>18 years). The remaining 75 patients were sex- and age-matched controls. The two groups were compared according to age group in terms of the prevalence of dental malocclusion, measures of sagittal, vertical, and transverse discrepancy, facial profile, and probable sleep bruxism with chi-square tests for proportion. Results: The DS patients consistently exhibited a higher prevalence of Class 3 malocclusion, concave profile and anterior crossbite compared to the non-DS patients, regardless of age group. The non-DS adolescents presented with a significantly higher prevalence of convex profile than the DS adolescents. The adolescent and adult DS patients most commonly presented with a maxillary transverse discrepancy and posterior crossbite compared to the non-DS controls. The DS adults had a higher prevalence of probable sleep bruxism. Conclusions: Patients with DS showed a higher prevalence of Class 3 malocclusion, concave profile and anterior crossbite compared to non-DS controls, regardless of age group. Other orthodontic measures showed a fluctuation according to the age group considered.

Exploring the Intricate Links between Adenotonsillar Hypertrophy, Mouth Breathing, and Craniofacial Development in Children with Sleep-Disordered Breathing: Unraveling the Vicious Cycle

Adenotonsillar hypertrophy has been well-acknowledged as the primary instigator of sleep-disordered breathing in the pediatric population. This condition spans a spectrum, from typical age-related growth that the immune system influences to persistent pathological hypertrophy. Reduction in air spaces, metabolic changes, neurobehavioral alterations, and chronic inflammation characterizes the latter form. As the go-to treatment, adenotonsillectomy has proven effective. However, it is not a guarantee for all patients, leaving us without reliable predictors of treatment success. Evidence suggests a connection between adenotonsillar hypertrophy and specific oral breathing patterns resulting from craniofacial development. This finding implies an intricate interdependence between the two, hinting at a self-sustaining vicious cycle that persists without proper intervention. The theories regarding the relationship between craniofacial conformation and sleep-disordered breathing have given rise to intriguing perspectives. In particular, the "gracilization theory" and the "gravitational hypothesis" have provided fascinating insights into the complex interaction between craniofacial conformation and SDB. Further investigation is crucial to unraveling the underlying pathophysiological mechanisms behind this relationship. It is also vital to explore the risk factors linked to adenotonsillectomy failure, study the long-term effects of adenotonsillar hypertrophy on craniofacial growth, and devise innovative diagnostic techniques to detect upper airway compromise early. Moreover, to assess their efficacy, we must delve into novel therapeutic approaches for cases that do not respond to traditional treatment, including positional therapy and orofacial myofunctional therapy. Though complex and unpredictable, these challenges promise to enhance our understanding and treatment of adenotonsillar hypertrophy and its related complications in children. By taking on this task, we can pave the way for more effective and targeted interventions, ultimately improving affected individuals' well-being and quality of life.

Association between Dentofacial Features and Bullying from Childhood to Adulthood: A Systematic Review

Bullying occurs when an individual is repeatedly victimised by negative actions performed by peers. As oral features, like malocclusion and dental structural defects, can promote psychological distress, which is also found in those who are bullied, we aimed to study the association between orofacial conditions and bullying. A systematic review (PROSPERO CRD42022331693), including articles dealing with bullying and dentofacial traits, was performed following the PRISMA chart. The iterative search of eligible publications was carried out on 27 March 2023 on four databases (PubMed, PubPsych, Web of Science and Cochrane Reviews) and in the grey literature. Among the 25 articles included, 4 referred to qualitative studies, which analysed 632 interviews with children, 8 interviews with parents, 292 letters, and 321 Twitter posts. The other 21 were cross-sectional studies, which included 10,026 patients from 7 to 61 years old. Two of the qualitative studies and seven of the cross-sectional studies rated a low risk of bias, according to Joanna Briggs Institute's Critical Appraisal Tools. The majority of studies (88%) reported a relationship between malocclusion or structural defects and exposure to bullying among young adolescents. Structural dental abnormalities and severe malocclusion should be managed, among others, for psychological questions because they crystallise the loss of self-confidence and increase the risk of bullying.

Implications of occlusal plane in diagnosis and treatment of malocclusion

Occlusal plane (OP) is one of the essential factors affecting craniofacial morphology and function. The OP not only assists in diagnosing malocclusion but also serves as an important reference for making treatment plans. Patients with different types of malocclusions have different forms of OP. Compared with patients with standard skeletal facial type, the occlusal plane of patients with skeletal class Ⅱ and high angle is steeper, while that of patients with skeletal class Ⅲ and low angle is more even. In orthodontic treatment, adjusting and controlling the OP can promote the normal growth and development of the mandible in most patients with malocclusion during the early stage of growth, while causing favorable rotation of the mandible in some adults with mild-to-moderate malocclusion. For moderate-to-severe malocclusion, the OP rotation by orthodontic-orthognathic treatment can achieve better long-term stability. This article reviews the evolution of the definition of OP and its implications for diagnosing and the guiding treatment of malocclusion.

A pilot investigation of condylar position and asymmetry in patients with unilateral posterior scissors-bite malocclusion based on three-dimensional reconstructive imaging technique

OBJECTIVE

Unilateral posterior scissors-bite (uPSB) malocclusion is common clinically. This study aimed to investigate the condylar morphological alterations and condyle-fossa relationship in patients with uPSB, through cone beam computed tomography (CBCT) and three-dimensional reconstructive imaging technique.

METHODS

A retrospective study was designed to comparatively analyze 95 patients with uPSB between July 2016 and December 2021. They were divided into three subgroups: 12 to 20, 21 to 30, and ≥ 31 years, according the age distribution. The morphological parameters regarding condyle, fossa, and joint space after three-dimensional reconstruction were measured and analyzed by a series of digital software. SPSS 26.0 software package was performed for statistical analysis on data sets, using paired t-test, one-way analysis of variance, Wilcoxon signed-rank sun test, Kruskal-Wallis H test, and Bonferroni correction.

RESULTS

The condylar volume (CV) of scissors-bite side was greater than that of the non-scissors-bite side (CV _A = 1740.68 ± 559.80 mm³ > CV _N = 1662.25 ± 524.88 mm³, P = 0.027). So was the condylar superficial area (CSA) (CSA _A = 818.71 ± 186.82 mm² > CSA _N = 792.63 ± 173.44 mm², P = 0.030), and the superior joint space (SJS) [SJS _A = 2.46 (1.61, 3.68) mm) > SJS _N = 2.01 (1.55, 2.87) mm), P = 0.018], and the anterior joint space (AJS) (AJS _A = 3.94 ± 1.46 mm > AJS _N = 3.57 ± 1.30 mm, P = 0.017). The constituent ratios of the different parts of the bilateral condyles were 23% on the posterior slope, 21% on the top, 20% on the anterior slope, 19% on the lateral slope and 17% on the medial slope, respectively.

CONCLUSION

Due to long-term abnormal occlusion of uPSB, the pathological bite force in temporomandibular joint would cause changes in the shape of the condyle. Among them, CV, CSA, SJS and AJS had significant changes in the scissors-bite status, which has the greatest damage to the posterior slope of the condyloid process.

The Cognitive and Emotional Aspect in Fibromyalgia: The Importance of the Orofacial Sphere

Fibromyalgia syndrome (FMS) is a systemic and multifactorial disease of unknown etiology. There are many co-morbidities that the patient presents, making the clinical picture not immediate. Cognitive decline and emotional alteration (anxiety and depression) are found in fibromyalgic patients, as well as temporomandibular joint arthrokinematic disorders, dental malocclusion, and periodontitis. There seems to be a biunivocal relationship between oral and psychiatric dysfunctions in fibromyalgia. The article reviews the information regarding oral health alterations with respect to the patient's cognitive and emotional response, as the most recent information we have raises new hypotheses about the diagnosis of FMS.

Treatment outcome of class II malocclusion therapy including extraction of maxillary first molars: a cephalometric comparison between normodivergent and hyperdivergent facial types

Background

The dentoalveolar component of a Class II division 1 malocclusion can be orthodontically treated either with extractions or by distalization of the molars. This study aimed to compare skeletal, dentoalveolar and profile changes in normodivergent and hyperdivergent Class II Division I growing patients orthodontically treated with fixed appliances including maxillary first molar extraction.

Methods

Sixty-four patients treated orthodontically with full fixed appliances including maxillary first molar extractions were retrospectively analyzed. Patients were divided into a normodivergent group (Group N; 30° ≤ SN^GoGn < 36°) consisting of 38 patients (17M, 21F; mean age 13.2 ± 1.3 years) and a hyperdivergent (Group H; SN^GoGn ≥ 36°) including 26 patients (12M, 14F; mean age 13.7 ± 1.1 years). Lateral cephalograms were available before (T0) and after treatment (T1) and cephalometric changes were calculated for 10 linear and 13 angular variables. The Shapiro-Wilk test confirmed a normal distribution of data, hence parametric tests were employed. The Student t-test was used to compare groups at baseline. The paired t-test was used to analyze intragroup changes between timepoints, and the Student t-test for intergroup comparisons. The level of significance was set at 0.05.

Results

The Class II division 1 malocclusion was successfully corrected, and the facial profile improved both in normodivergent and hyperdivergent patients. Divergency increased by 0.76 ± 1.99° in Group N (p = 0.02) while it decreased -0.23 ± 2.25° (p = 0.60); These changes were not significant between groups after treatment (p = 0.680). Most dentoskeletal measurements changed significantly within groups but none of them showed statistically significant differences between groups after treatment. Dental and soft tissue changes were in accordance with the biomechanics used for this Class II orthodontic therapy.

Discussion

The effect of orthodontic treatment of Class II division 1 malocclusion including extraction of the maxillary first molars in growing patients can be considered clinically equivalent in normodivergent and hyperdivergent patients. For this reason, this orthodontic treatment can be considered a viable option in the armamentarium of the Class II Division I therapy for both facial types.

Oral Health in 12- and 15-Year-Old Children in Serbia: A National Pathfinder Study

The aim of the paper is to present the oral health profile of 12- and 15-year-old schoolchildren in Serbia. Basic Methods for Oral Health Surveys of the WHO were implemented to record: Decayed, Missing, and Filled Teeth/Surfaces Index (DMFT/DMFS), gingival bleeding, enamel fluorosis and other structural anomalies, dental erosion, dental trauma, and oral mucosal lesions. In addition, Silness and Löe plaque index and orthodontic status were assessed. A total of 36% of 12-year-olds and 22% of 15-year-olds in Serbia were caries-free. The mean DMFT was 2.32 ± 2.69 for 12-year-olds and 4.09 ± 3.81 for 15-year-olds. DMFT was made up largely by the decayed component. Gingival bleeding was present in 26% of examined 12-year-old and 18% of 15-year-old children. Dental plaque was observed in 63% of both 12- and 15-year-olds. Fluorosis, structural anomalies, dental erosion, dental trauma, and oral mucosal lesion were rarely detected. Low prevalence of malocclusions was found. Oral disease is still a common public health problem among schoolchildren in Serbia. A significant increase in the prevalence of caries disease between 12- and 15-year-old groups implies that preventive care for adolescents requires special attention. Corrective actions and reforms to the current school-based oral health prevention program are needed to further improve oral health in Serbian children.