Classification of Skeletal Phenotypes of Adult Patients With Cleft Skeletal Class III Malocclusion Using Principal Component Analysis and Cluster Analysis

The purpose of this study was to classify the skeletal phenotypes of adult patients with skeletal class III (C-III) malocclusion and unilateral or bilateral cleft lip and palate using principal component analysis and cluster analysis. The samples consisted of 81 adult C-III patients with cleft lip and palate (CLP) who underwent orthognathic surgery (OGS) or distraction osteogenesis (59 males and 22 females; 50 unilateral cleft lip and palate and 31 bilateral cleft lip and palate; mean age when lateral cephalograms were taken, 22.2±4.6 y). Thirteen angular and one ratio cephalometric variables were measured. Using 4 representative variables obtained from principal component analysis (SNA, SNB, Gonial angle, and Bjork sum), K-means cluster analysis was performed to classify the phenotypes. Then, statistical analysis was conducted to characterize the differences in the variables among the clusters. Five clusters were obtained from 3 groups: severely retrusive maxilla and moderately retrusive mandible group: cluster-1 (23.5%, severely hyperdivergent pattern), cluster-4 (27.2%, moderately hyperdivergent pattern), and cluster-5 (11.1%, normodivergent pattern); moderately retrusive maxilla and normal mandible group: cluster-2 (30.9%, normodivergent pattern); normal maxilla and moderately protrusive mandible group: cluster-3 (7.4%, normodivergent pattern). Although skeletal phenotypes were diverse, distribution of sex and cleft type did not differ among 5 clusters ( P >0.05). Sixty-two percent of cleft patients showed a severely retrusive maxilla and moderately retrusive mandible (cluster-1, cluster-4, and cluster-5), which indicated that these are the main cause of skeletal C-III malocclusion in CLP patients who were treated with OGS. Therefore, it is necessary to consider presurgical orthodontic treatment and surgical planning based on the skeletal phenotypes of CLP patients.

Oral Rehabilitation of an Orthodontic Patient with Cleft Lip and Palate and Hypodontia Using Secondary Bone Grafting, Osseo-Integrated Implants, and Prosthetic Treatment

Objective

Complete skeletal and dental reconstruction of the anterior maxilla is of great importance to patients with cleft lip and palate. Accordingly, osseo-integrated implants have been utilized for dental reconstruction after secondary bone grafting. In this report, the orthodontic management of a patient with unilateral cleft lip and plate with associated hypodontia is described. The patient was treated with comprehensive orthodontic treatment in addition to secondary bone grafting, and dental reconstruction was achieved with a combination of osseo-integrated implants and fixed prosthodontic treatment.

Dual Segmental Distraction Osteogenesis of the Midface in a Patient with Apert Syndrome

Objective

To present orthodontic treatment combined with dual segmental distraction osteogenesis in a patient with Apert syndrome.

Patient

A 15-year-old boy exhibited severe midfacial hypoplasia with retruded and hypoplastic maxilla and anterior open bite. The patient was treated with a rigid external distraction II system for distraction osteogenesis, a preadjusted edgewise appliance, and a modified maxillary protraction headgear. The concave profile with midfacial hypoplasia was improved. A tight occlusal relationship between maxillary and mandibular teeth was achieved. Postoperative treatment results have been stable for 1 year.

Dental anomalies in different growth and skeletal malocclusion patterns

OBJECTIVES

To evaluate prevalence, distribution, and sexual dimorphism of dental anomalies (DA) among different skeletal malocclusions (SM) and growth patterns (GP) under the hypothesis that specific clinical patterns exist and may indicate common etiological roots.

MATERIALS AND METHODS

A total of 1047 orthodontic records of patients older than 8 years were evaluated. The SN-GoGn angle was used to classify GP (hypodivergent, normal, and hyperdivergent), and the ANB angle was used to verify SM (Angle Classes I, II, and III). These assessments were done from lateral cephalometric radiographs. DA were diagnosed using panoramic radiographs by one calibrated investigator. Odds ratios, chi-square, and Student's t-tests were used.

RESULTS

Of the subjects, 56.7% were female, with mean age of 16.41 (±10.61) years. The prevalence of DA was 15.7%. Impaction and tooth agenesis were the most prevalent DA, with relative frequencies of 14.4% and 9.7%, respectively. DA were most prevalent in Class III SM (80.8%) and in hypodivergent GP (82.5%), although this was not statistically significant. Tooth agenesis ( P < .01) and microdontia ( P = .025) were significantly more common among hypodivergent GP and Class III SM, respectively.

CONCLUSIONS

The results of this study support the idea that DA are preferentially associated with certain patterns of malocclusion.

Infraoccluded Upper Deciduous Second Molars Leading to Caries in the Permanent Dentition

Infraocclusion of primary teeth is a problem that can be recognized early by the general dental practitioner. Allowing affected teeth to deteriorate beyond a point where active intervention would be recommended can make treatment of the condition more complex or may lead to unexpected sequelae. The case described in this report of infraoccluded primary teeth, suffered pathology in adjacent teeth, leading to multiple extractions and fixed orthodontic treatment post surgery. This case highlights the need for early recognition of infraocclusion by the GDP and will suggest interceptive treatment options. CPD/CLINICAL RELEVANCE: To highlight the need of interceptive orthodontics in primary care when required.

Upper airway obstruction and resultant growth factors influencing malocclusions

Upper airway obstruction is associated with many dental and skeletal malocclusions. Recognizing and removing the problems at an early age is encouraged. However, the malocclusions caused by upper airway obstruction can be addressed and corrected at different stages of dentitions using various types of appliances and orthodontic techniques. This article reports several cases, which were treated with the help of medical experts and otolaryngologists.

An interview with Peter H. Buschang

Dr. Peter Buschang is regent professor and director of orthodontic research. He has been at Texas A&M University Baylor College of Dentistry since 1988. Dr. Buschang received his PhD in 1980 from the University of Texas at Austin; he spent 3 years as a NIDR postdoctoral fellow at the University of Connecticut, and five years as a FRSQ scholar at the University of Montreal. Every year, Dr. Buschang teaches in 16 different courses, 7 of which he directs. In addition to more than 100 lecture hours per year, he spends hundreds of hours mentoring students. For his teaching efforts, Dr. Buschang was awarded the Robert E. Gaylord Award of Excellence in Orthodontic education in 1992, 1998, 2004, and 2010. He also gives 1-2 day evidence-based CE courses throughout the world. The residents he has taught recently honored him by pledging to fund the Peter H. Buschang Endowed Professorship of Orthodontics. His research interests pertain to craniofacial growth and assessment of treatment effects. Dr. Buschang has been funded regularly over the years by the Medical Research Council of Canada, Fonds de le Recherche en Santé du Québec, the NIH, and the American Association of Orthodontics Foundation. He has mentored over 140 Master's and PhD students, and 49 dental students. Dr. Buschang has published over 250 peer-reviewed articles, 15 book chapters and 198 abstracts. He has given over 150 invited talks and lectures in 14 different countries. For his work with the American Board of Orthodontics, Dr. Buschang was awarded the Earl E. and Wilma S. Shepard Award. Dr. Buschang is the only non-orthodontist ever to have been made an honorary member of both the American Association of Orthodontics (2005) and the Edward H. Angle Society of Orthodontics (2009), the two most prestigious orthodontic groups.

[Prosthetic rehabilitation in patient with forced class III malocclusion]

The paper presents clinical case of 63 years old edentulous patient with slight class III malocclusion. For 15 years he was using inadequately fabricated dentures causing forced severe class III malocclusion. Forced progeny was corrected by newly fabricated dentures which restored normal orofacial function and facial harmony.

Dynamic changes in morphometric analysis in patients following Class III bimaxillary surgery

BACKGROUND

Prognathism of the mandible is a skeletal Class III abnormality, caused either by excessive forward growth of the mandible or maxillary underdevelopment.

OBJECTIVES

The aim of the study was to assess dynamic changes in morphometric analysis on subjects presenting with Class III malocclusions before orthodontic treatment, before bimaxillary surgery and after surgery.

MATERIAL AND METHODS

The sample consisted of 30 non-growing patients, at the age of 18 to 30, treated with mandibular set-back sagittal split osteotomy and maxillary Le Fort I advancement. Cephalometric analysis by Segner and Hasund was performed. Lateral cephalograms were taken at the beginning of orthodontic treatment (T0), immediately before surgery (T1) and at least 3-6 months after surgery (T2).

RESULTS

The results showed that there was normalization of the cephalometric variables after surgery. In the sagittal plane the following skeletal changes were observed: preoperative anterior mandibular growth confirmed by SNB increased angle was significantly reduced after surgery; preoperative decreased SNA angle largely increased after surgery. Statistically significant GntgoAr mandible angle decreased after surgery in relation to the beginning state. Also, the H angle was increased as a result of orthodontic-surgical treatment which influenced positively on face esthetics.

CONCLUSIONS

The results of our study indicate that there was a significant improvement in the correlation between soft and hard tissue change in the facial profiles of the Class III bimaxillary surgery patients, which was improved by the H angle. The face's photographs and cephalometric analysis indicate, after the operation there is a decrease of total face length, but the lower part still remains longer than a middle part of the face.

The final orthodontic treatment outcome evaluation in patients with cleft lip and palate at Khon Kaen University Cleft Lip and Palate Center: a pilot study

The primary objective of the present study was to use the Peer Assessment Rating (PAR) Index to assess the outcome of the final phase of treatment in cleft lip and palate patients with orthodontic treatment alone and with orthognathic surgery. A secondary objective was to determine the improvement in the occlusion of the two treatment alternatives. The study sample consisted of 27 patients who received orthodontic treatment alone and 7 patients who received orthodontic treatment combined with orthognathic surgery were evaluated. The results showed that the orthognathic surgery group had greater PAR scores pre-treatment than did the orthodontic treatment alone group. Post-treatment and improvement of PAR scores were similar for both groups. Two subjects in orthodontic treatment alone group had excellent improvement whereas other cases presented less but still desired improvement. For the orthognathic surgery group, all cases demonstrated great improvement in malocclusion.

Oral findings in 50 children with neurofibromatosis type 1. A case control study

AIM

The scientific literature is poor of data concerning NF1-related oral manifestations in children. The purpose of this study was to investigate the oral findings in a group of children with NF1.

MATERIALS AND METHODS

This study was designed as a clinical research. A total of 50 children affected by NF1 were enrolled. Non-NF1 controls were selected among subjects referred to the Paediatric Dentistry Department of the Dental Clinic at the University of Brescia, Italy. The craniofacial and all the dental examinations were carried out. The following parameters were investigated: dental caries, dental abnormalities, periodontal status, oral and perioral neurofibromas, orthodontic features, mandible and temporomandibular joint abnormalities. Statistics Unpaired Student's t test was calculated for Gaussian distributed variables; Fisher's test for non-Gaussian distributed binomial variables was used. The values inferior to p <0.05 (threshold) were considered significant for the study.

RESULTS

Children with NF1 showed poorer oral hygiene conditions, more frequent Class III dental malocclusions and severe alterations of the mandible and the temporal mandibular joint, if compared with the control group.

CONCLUSION

NF1 related-oral manifestations are evidenced also during childhood, even if some of the best known, like the neurofibromas, are not yet developed. It is important to keep a long-term follow-up to monitor the possible development of other oral lesions.

Transantral distraction devices in correction of severe maxillary deformity in cleft patients

Maxillary advancement by Le Fort I osteotomy in cleft patients has an average relapse of about 40-60 percent. With extraoral distraction devices it is possible to obtain an almost unlimited advancement of the upper jaw. Due to the social problems the retention period is normally reduced to some monthes. A relapse of 10-25 % can be seen in these cases. Le Fort I internal distraction osteogenesis offers an alternative to one-step orthognathic advancement, with advantages of gradual lengthening through scar and earlier treatment in growing patients. The objective of this study was to present our experience in the treatment of maxillary deficiency in cleft patients using transantral internal distraction devices. The distraction procedure was successfully accomplished in seventeen patients. For all the seventeen patients maxillary distraction device designed by Konrad Wangerin was used. The distraction distances were 8 to 24 mm. Preoperative, postoperative, and follow-up (12 and 24 months) lateral cephalogram measurements were compared including angular and linear changes. A good new bone was found that was formed in distraction pitch between lines of osteotomy. After distraction of median facial zone, occlusion and profile of soft tissues were considerably improved. All patients after postoperative time required final orthodontic treatment and their final occlusal relationships were satisfactory. The transantral distraction device is a new option for the treatment of severe maxillary hypoplasia in cleft patients.

Mouth breathing: adverse effects on facial growth, health, academics, and behavior

The vast majority of health care professionals are unaware of the negative impact of upper airway obstruction (mouth breathing) on normal facial growth and physiologic health. Children whose mouth breathing is untreated may develop long, narrow faces, narrow mouths, high palatal vaults, dental malocclusion, gummy smiles, and many other unattractive facial features, such as skeletal Class II or Class III facial profiles. These children do not sleep well at night due to obstructed airways; this lack of sleep can adversely affect their growth and academic performance. Many of these children are misdiagnosed with attention deficit disorder (ADD) and hyperactivity. It is important for the entire health care community (including general and pediatric dentists) to screen and diagnose for mouth breathing in adults and in children as young as 5 years of age. If mouth breathing is treated early, its negative effect on facial and dental development and the medical and social problems associated with it can be reduced or averted.

Prevalence of malocclusion traits and sucking habits among 3-year-old children

The aim of the present study was to evaluate the prevalence of malocclusion traits and sucking habits among 3-year-old children. A sample of 457 3-year-old children (234 girls and 223 boys) was obtained from three Public Dental Health clinics in Orebro County Council, Sweden. Data from clinical examination and a questionnaire were used to determine malocclusion traits, sucking habits, snoring and breathing pattern including nocturnal breathing disturbances. The results showed that 70% had one or more malocclusion traits at 3 years of age. The most common malocclusion traits were anterior open bite (50%), Class II occlusion (26%), increased overjet (23%) and posterior crossbite (19%). The prevalence of sucking habit was 66% and dummy sucking was dominating and in connection with more malocclusion traits than finger/thumb sucking. A significant association was found between the sucking habits and the most prevalent malocclusions, anterior open bite, Class II occlusion, increased overjet and posterior crossbite. In conclusion, the prevalence of malocclusion traits in 3-year-old children was high. Sucking habits was highly prevalent and dummy sucking resulted in more malocclusion traits than finger/thumb sucking did.

Langerhans cell histiocytosis: impact on the permanent dentition after an 8-year follow-up

Langerhans cell histiocytosis (LCH) is a rare disorder which mainly affects children. Oral changes, such as gingival ulceration, halitosis, osseous lesions associated with tooth mobility, and early loss of primary teeth, comprise the disease's first manifestations for most patients. In the long term, dental changes may occur as a result of dental and systemic treatment. Therefore, this study's purpose is to report Langerhans cell histiocytosis' effects on the permanent dentition 8 years after diagnosis, which had been established by performing a biopsy of gingival tissue on a 3-year-old patient.

Response of maxillary retrusion cases to face mask treatment

AIM

This study was carried out to investigate the effects of protractive face mask on maxillary retrusion in 2 groups of patients.

METHODS

Two groups each consisting of 10 male patients participated in the present study. The first group had skeletal Class III malocclusions due to maxillary underdevelopment, while the second group had (corrected) unilateral cleft lips and palates on the left side. The subjects' ages ranged from 5 to 8 years, and the treatment was applied with face mask for 1 year. Pre- and posttreatment lateral cephalometric films were compared.

RESULTS

The results revealed significant forward maxillary movement, which led to improvement in facial convexity in both groups, while in the Class III malocclusion group, it was more evident. There were significant changes regarding the axial inclination of the maxillary incisors, the palatal plane inclination in relation to SN, and mandibular planes.

CONCLUSION

The cross bite in the Class III group was fully corrected and overjet was achieved after 1 year of face mask treatment, while in the cleft palate group, there was edge-to-edge relation in the incisor region, which required a second phase of orthodontic treatment.

Nonsurgical correction of skeletal Class III malocclusion with lateral shift in an adult

In an adult patient with a severe skeletal Class III malocclusion with midline deviation, combined surgical-orthodontic therapy is often the treatment of choice because it has a satisfying outcome, and the results tend to be stable. Sometimes, however, patients will not accept surgery as a part of the treatment. We report a nonsurgical treatment approach and its outcomes for an adult patient with a skeletal Class III malocclusion with a lateral shift. Treatment included distal movement of the mandibular arch and extraction of the third molars.

Anatomic and dynamic aspects of stomatognathic structures in osteogenesis imperfecta: a case report

The osteogenesis imperfecta congenita (OMIM 166210) type II phenotype can be caused by mutation in either the COL1A1 gene or the COL1A2 gene that encode the chains of type I procollagen, the major protein in bones. Patients can therefore present a combination of features, including multiple long bone fractures and deformities, growth deficiency, joint laxity, hearing loss, blue sclera, and dentinogenesis imperfecta. The purpose of this study is to describe a clinical case of this syndrome, focusing on the anatomy of the temporomandibular joint (TMJ) that was assessed using computed tomography (CT) method. Clinical examination included evaluation of mandibular dynamics and investigation of temporomandibular dysfunction (TMD).

The craniofacial characteristics of osteogenesis imperfecta patients

The aim of this study was to identify the craniofacial characteristics of 16 osteogenesis imperfecta (OI) patients, 10 males and 6 females, aged 7-15 years. The control group comprised 863 Chinese children from 6 to 18 years of age. Eleven cephalometric reference points and 25 variables were measured on the lateral cephalometric radiographs. Cochrane's method of unequal variance t-test was used to differentiate the differences between two groups. A Class III occlusal relationship was found in 62.5 per cent of the OI patients. The maxilla was more retrusive than the mandible in relation to the cranial base. Face heights, the effective maxilla and mandibular lengths, and anterior and posterior cranial base lengths were significantly shorter than the control subjects. The facial divergence, the cranial base (N-S-Ar, P<0.001), and the gonial (Ar-Go-Gn, P<0.001) angles were significantly enlarged, while the articular angle (S-Ar-Go, P<0.001) was significantly reduced. The findings showed that the OI patient had a more prominent Class III occlusal relationship, prognathic mandible, larger facial divergence, shorter face heights, defective sagittal growth of the maxilla and mandible, a flattened cranial base angle, impaired cranial base growth, and more forward counterclockwise rotation in mandibular growth compared with the controls.

Acromegaly in an orthodontic patient

A 32-year-old white man presented for orthodontic treatment with the chief complaint of mandibular prognathism; he was later found to have acromegaly. General information about pituitary adenomas, specifically growth hormone adenomas, is given, and treatment options are discussed.

The effect of tongue appliance on the nasomaxillary complex in growing cleft lip and palate patients

Midfacial deficiency is a common feature of cleft lip and palate patients due to scar tissue of the lip and palate closure procedure. The aim of this study was to evaluate the effectiveness of the physiological force of the tongue to move the maxilla in forward position. This research has been done experimentally by, before and after treatment following up in private practice. Ten patients (6 female, 4 male) with complete bilateral cleft lip and palate were selected. All of them had Cl III malocclusion with maxillary deficiency due to scar tissue of lip and palate surgery. Their age ranged from 7.6 to 9.8 years. All the patients were delivered tongue appliance to transfer the force of the tongue to maxillary complex. The mean observation time was 13+/-2 months to achieve positive overjet. Pre- and post-lateral cephalograms were compared to evaluate the skeletal changes with paired t-test. The results showed that after the application of tongue appliance, normal sagittal maxillomandibular relationship was achieved. SN-ANS angle was increased 1.9+/-1.8 - P < 0.03. This study showed that the tongue appliance could transfer considerable force during rest and swallowing period to the maxilla. This method might be considered to improve the deficient maxilla by means of growth modification and redirect concept.

Two cases of familial hypomagnesemia with hypercalciuria and nephrocalcinosis: dental findings

BACKGROUND

The authors describe dental and periodontal conditions of two Chinese sisters affected by familial hypomagnesemia with hypercalciuria and nefrocalcinosis (FHHNC). FHHNC is a rare syndrome, genetically investigated since 1999, transmitted as an autosomal recessive disease. It is related to a mutation of PCN-1 gene which encodes for a tight junction protein named paracellin.

CASE REPORT

Oral examination of two Chinese patients showed marked enamel hypoplasia, acute gingivitis and periodontal bone loss and severe malocclusion. The literature does not report previous investigations about the dental conditions of FHHNC patients. The syndrome is not definitely described from the clinical point of view.

CONCLUSION

Further researches are necessary to understand the linkage between bone loss and enamel structure anomalies in FHHNC and to discover the relationships between nefrocalcinosis, hypomagnesemia, hypercalciuria and amelogenesis imperfecta.

A 2-stage procedure combining maxillary advancement by distraction technique with mandibular setback surgery in patients with cleft lip and palate

A 2-stage procedure combining maxillary advancement by distraction technique with mandibular setback surgery was used to correct jaw deformities in 5 patients with severe maxillary retrusion secondary to cleft lip and palate. First, a Le Fort I maxillary osteotomy was performed. Immediately after maxillary distraction, the distraction device was removed. The advanced maxilla was fixed with miniplates after adjusting the length and direction of advancement, and mandibular setback surgery was performed simultaneously to obtain a normal occlusal relationship. This 2-stage procedure resulted in stable occlusion and a markedly improved facial profile.

Cleidocranial dysplasia: 2 generations of management

Patients with cleidocranial dysplasia (CCD) commonly present with significant dental problems, such as retention of multiple deciduous teeth, impaction or delay in eruption of permanent teeth and, often, the presence of supernumerary teeth. Several approaches have been described for the management of such patients. We report 2 cases illustrating the shift in the management paradigm from edentulation and prosthetic replacement to orthodontically assisted forced eruption and fixed appliance orthodontic treatment combined with orthognathic surgery.

[Growth of the skull and bony kinetics interfering with facial morphogenesis. Conceptual bases of success in orthopedic treatments before the age of 6]

In order to perform an orthopedic treatment without relapse, one needs to identify properly the cranial patterns responsible for the malocclusion and act on them before the age of 6.

Orthodontic treatment protocol of Ehlers-Danlos syndrome type VI

Ehlers-Danlos syndrome (EDS) type VI is an autosomal recessive disorder of the connective tissue characterized by joint hypermobility, muscle hypotonia, scoliosis, and ocular fragility. In this case report, an EDS type VI patient with a skeletal and dental Class III malocclusion is presented and the clinical approach to his orthodontic problem is emphasized. A 17-year-old male patient presenting some major and minor symptoms of the syndrome was referred to our orthodontic department for diagnosis and treatment. The typical clinical signs confirmed the diagnosis of EDS type VI. He was a skeletal and dental Class III malocclusion patient (both mandibular protrusion and maxillary retrusion) with a noncontributory family history. He had severe crowding in the lower and upper dental arches with retruded incisors. His first treatment plan included orthognathic surgery, but because of the risks of bleeding and poor healing, we elected to treat the patient without surgery.

Cephalometric evaluation of maxillomandibular relationships in patients wearing complete dentures: a pilot study

The purpose of this study was to evaluate the changes in vertical and sagittal maxillomandibular relationship of the patients who had been wearing dentures for an extensive period. Fifteen edentulous patients (seven men and eight women; mean age 63.5 years) who had worn dentures for six to 16 years (mean 10 years) were selected for this study. New prostheses were fabricated by conventional methods, and the patients were evaluated cephalometrically before and after the new prosthesis. The results were compared by Wilcoxon signed rank test (P < .05). Results indicated that a prognathic mandible and a pseudo Class III relationship with a reduced occlusal vertical dimension became a normal Class I maxillomandibular relation when the new prosthesis was inserted. A better facial profile was achieved.

An enlarged sella turcica on cephalometric radiograph

A 28-year-old male presented to the Orthodontic clinic for correction of his anterior crossbite due to mandibular prognathism as a result of pituitary adenoma with acromegaly. A radiographic cephalometric analysis and clinical orthodontic examination were made. This article describes in detail the methods of correcting the magnification of cephalometric linear measurements in sellar dimensions (length, depth and width) from lateral and posteroanterior cephalograms. Cephalometric findings revealed that the sella enlarged in all its dimensions with a deepening of the floor in this acromegalic case. We discuss the radiographic diagnosis of an enlarged sella turcica in intrasellar tumours and also emphasise the dentist's important role in the initial diagnosis of pituitary adenoma cases.

Class-III malocclusion: genetics or environment? A twins study

Etiology of class-III malocclusion is generally believed to be genetic. A wide range of environmental factors have been suggested as contributing factors for the development of class-III malocclusion. Twin study is one of the most effective methods available for investigating genetically determined variables of malocclusion. Discordancy for class-III malocclusion is a frequent finding in dizygotic twins. However, class-III malocclusion discordancy in monozygotic twins is a rare finding. The purpose of this study of monozygotic twins is to assess the genetic and environmental components of variation within the cranio-dento-facial complex.

Maxillofacial intraoral distraction osteogenesis followed by elastic traction in cleft maxillary deformity

We present a case of severe maxillary hypoplasia in a 16 years old cleft patient treated by distraction osteogenesis maxillary advancement. Initial evaluation showed vertical and antero-posterior maxillary deficiencies, and a Class III malocclusion. Two intraoral distractors (Zurich Pediatric Maxillary Distractor, KLS Martin, Tuttlingen, Germany) were placed in a high Le Fort I osteotomy. An initial advancement of 11 mm was obtained, but the resulting occlusion was unsatisfactory (end-to-end occlusion). The consolidation period was reduced to 3 weeks to allow the mechanical manipulation of the newly formed bone with Class III elastics. An additional advancement of 3 mm, caused by elastic orthodontic traction produced both normal skeletal relationship and satisfactory occlusion. This observation shows that it is possible to carry on a skeletal maxillary displacement by interdental elastics before the complete fusion of the callus. After 12 months of postoperative follow-up no osseous relapse could be detected and the occlusal result was stable.

An orthopaedic approach to the treatment of Class III malocclusions in the early mixed dentition

The aim of this investigation was to study cephalometrically the skeletal, dental and soft tissue modifications induced by a Delaire facemask and Bionator III appliance in a sample of 30 patients (17 boys and 13 girls), aged 4.1-9 years [mean 5.85 years, confidence interval (CI) 5.41-6.29], in the early mixed dentition with a skeletal Class III malocclusion caused by maxillary retrognathism (group 1) and compared with a control sample of 24 subjects (14 boys and 10 girls), aged 4-9 years (mean 5.97 years, CI 5.35-6.58) with untreated Class III malocclusions (group 2). For each patient a lateral cephalogram was taken before treatment (T0), after facemask removal (T1), and at the end of the retention period with a Bionator III (T2). Cephalometric analysis was carried out. The post-treatment cephalometric values in the treated group showed a forward displacement of the maxilla resulting in a statistically significant increase (P < 0.001) in the SNA angle, A-NPg (mm) and PNS-A (mm) linear values. There was a clockwise rotation of the mandible, with a decrease in the SNB angle and a satisfactory correction of the Class III relationship. The beneficial effects on the facial profile were confirmed by an increase in UL-EL distance and in NB--HL and NsPgs--HL angles, and by a decrease in the facial convexity angle. These findings indicate that the Delaire facemask and Bionator III treatment is effective for correcting skeletal Class III malocclusions caused by maxillary retrognathism in the early mixed dentition.

[Seip Berardinelli: the effect of the partial tongue resection]

The Seip Berardinelli or undiagnosed endocrine metabolic syndrome is a rare autosomal recessive pathology mainly described in families of Portuguese origins. This syndrome presents various metabolic disturbances responsible of various dysmorphies. We report the case of two brothers seen during their childhood for respiratory, speaking and feeding problems related to a class 3 of Angle and macroglossia. The object was to study the interaction between the size of the tongue, the prognathism and the disturbances presented in order to organize early surgery (partial glossectomy).

Hajdu-Cheney syndrome (acro-osteolysis): a case report of dental interest

Hajdu-Cheney syndrome (acro-osteolysis) is a rare disorder of bone metabolism characterized by progressive lytic lesions in a number of bones. Constant features of this condition include an osteoporotic skeleton, acro-osteolysis, and a shortened lower third of face. The purpose of this report was to focus on the craniofacial and oral manifestations of the disorder in a 9-year-old boy.

The Orthoworld Specialist Practitioner Prize Cases 2000

This paper describes the orthodontic management of three diverse malocclusions that were awarded the Orthoworld Specialist Practitioner Prize (2000) and presented at the British Orthodontic Conference in Harrogate 2001.

The pattern of malocclusion among orthodontic patients seen in Dental Centre, University College Hospital, Ibadan, Nigeria

The aim of this study was to analyse the malocclusion pattern among patients who presented for treatment in the Orthodontic Unit of the Dental Centre, University College Hospital, Ibadan, as baseline data for proper treatment planning, teaching and further research. A total of 289 subjects aged 5-34 years with mean age of 10.6 +/- 1.5 (S.D.) years were seen. Angle's classification of molar relationships among those seen is as follows: class I - 76.5%, Class II - 15.5% and Class III - 8.0%. There was increased overjet in 16.2% of the patients, reduced overjet in 0.7% while 2.1% had reversed overjet. Other occlusal abnormalities included: increased overbite (3.8%), reduced overbite (1.4%); anterior open bite (5.2%; crossbite (8.4%) and scissorsbite (0.6%). Crowding, spacing and retained primary incisors constituted 29.7%, 1.4% and 40.1%, respectively. Delayed eruption of canine (1.0%), Bimaxillary protrusion (0.7%), incompetent lips (0.7%), supernumerary teeth (0.7%) malformed tooth (0.3%), mandibular deviation on closure (1.0%) and oral habits (4.5%) were other forms of malocclusion diagnosed. Males were found to have significantly more of classes II and III molar relationships than females (P < 0.05). Occurrence of retained primary teeth as well as overjet deviations from normal were significantly higher in females (P < 0.05). No significant sex differences were found in the other occlusal disorders (P > 0.05): The findings were comparable with previous epidemiological surveys in other parts of the country.

Temporomandibular joint and masticatory muscle involvement in myotonic dystrophy: a study by magnetic resonance imaging

OBJECTIVE

The purpose of this study was to evaluate the masticatory muscles and the temporomandibular joint (TMJ) by magnetic resonance imaging (MRI) in myotonic dystrophy (MD) patients.

STUDY DESIGN

MRI of the masticatory muscles and TMJ was performed in 15 MD patients, 11 male and 4 female, aged 16 to 53 years (mean, 31 years). Many of them had dental malocclusion, especially Angle class III and anterior open bite, and 3 complained of recurrent TMJ dislocation. TMJ and masticatory muscle pain was not observed, and joint sounds were noted in only 1 patient.

RESULTS

The analysis of MRI scans showed masticatory muscle involvement in 13 patients (86.6%). In 11, the involvement was moderate to intense. The main abnormalities observed were increased intramuscular tissue signal on T1 (fatty infiltration) and volumetric reduction of muscles. Regarding the TMJ, articular disk displacement was seen in only 1 patient, but abnormalities of disk shape were common. Mild bone abnormalities were frequently observed, including changes of shape and contour of bone surface, and sclerosis of bone marrow. In 4 patients the condyle moved anterior to the eminence with the mouth opened fully (condylar hyperexcursion).

CONCLUSIONS

This study shows that masticatory muscles are frequently and intensively affected in MD patients. Bone changes are the most consistent abnormalities observed in the TMJ. It is possible that remodeling is caused by biomechanical changes in the jaw as a result of masticatory muscle involvement.

Analysis of facial growth in subjects with syndromic ectodermal dysplasia: a longitudinal analysis

OBJECTIVE

To examine the craniofacial growth pattern of patients diagnosed with syndromic ectodermal dysplasia.

DESIGN

Mixed longitudinal analysis of lateral cephalograms.

SETTING

The data were analysed using a multilevel modelling technique with the MLwiN application software and the results presented numerically and graphically.

SAMPLE POPULATION

All 61 subjects had severe hypodontia with the number of absent teeth (excluding third molars) ranging from 6 to 28 (mean = 15.4). At presentation the subjects had a mean age of 133 months and were followed longitudinally for between one and five subsequent occasions (mean 2.66 occasions; mean age at completion of observation 207 months).

OUTCOME MEASURES

Lateral cephalograms taken at each visit.

EXPERIMENTAL VARIABLES

Analysis of four angular measurements and four linear measurements, together with one calculated ratio.

RESULTS

Growth curves are presented showing the trends of craniofacial growth.

CONCLUSIONS

The most significant findings were for a universal tendency for the individuals to undergo a change in sagittal relationship of the jaws, becoming markedly more Class III with time. We have also demonstrated a significant difference in growth between the anterior and posterior face heights indicating that the subjects have a tendency to an anterior growth rotation.

Traumatic chronic TMJ dislocation: report of an unusual case and discussion of management

Dislocation of the temporomandibular joint (TMJ) is most often spontaneous, but it can be associated with direct or indirect head and neck trauma. The disorder may be treated in general by simple closed techniques, if managed acutely. If the dislocation becomes chronic, however, open reduction is usually required. The article discusses various methods for an open surgical approach described in the literature. A case of a prolonged TMJ dislocation is presented, involving a severe bilateral mandibular dislocation with the condyles displaced into the infratemporal fossa and the lateral poles of the condyles articulating on the inner aspect of the zygomatic arch. An open approach, involving masseter, temporalis, and the medial pterygoid muscles, was utilized, followed by the use of scissors mouth props, Erich arch bars, and postoperative elastic traction.

Modifying the two-stage cleft palate surgical correction

OBJECTIVE

This paper reports the experience with a two-stage approach to surgical correction of the complete cleft palate, wherein timing of the second stage is dependent on the judgment of the speech pathologist and the orthodontist together with the surgeon.

PATIENTS

Of a total of 35 patients having complete unilateral clefts a sample of 22 were available for postsurgical assessment. The first-stage repair of the palate was carried out at an average age of 10.7 months (range 6 to 17 months), and the second-stage repair of the residual cleft was completed at an average age of 32.7 months (range 26 to 34 months).

INTERVENTIONS

The first-stage repair of the soft palate defect involved mobilizing two short posteriorly based flaps, which extend onto the posterior quarter of the hard palate thus including up to 1 cm of mucoperiosteum. Careful freeing of the muscle is followed by an intravelar veloplasty. The later closure of the residual cleft involved turnover hinge flaps and small mucoperiosteal flaps.

RESULTS

Eighty-seven percent of the sample had good to excellent speech as assessed by the Great Ormond Street screening method. Only two patients showed evidence of recessive maxillae with Class III malocclusions.

CONCLUSIONS

A two-stage surgical closure of the palate using this procedure would appear to confer several valuable advantages to the patient. These include favorable outcomes for speech in the large majority of cases and minimal adverse effects on the growth of the midface region.

Efficacy of high condylectomy for management of condylar hyperplasia

The purpose of this study was to compare the treatment outcome and long-term stability of 2 groups of young adult patients diagnosed with active condylar hyperplasia and treated with 2 different surgical methods. Thirty-seven patients (19 females and 18 males) met the criteria for inclusion in the study. Group 1 (n = 12; average age at surgery, 17.5 years) was treated with orthognathic surgery only, while group 2 (n = 25; average age at surgery, 16.7 years) had high condylectomy, articular disc repositioning, and orthognathic surgery. All patients underwent standardized clinical and radiographic examination at initial consultation, immediately before surgery, immediately after surgery, and at longest follow-up. Objective evaluation of temporomandibular joint (TMJ) function included maximum incisal opening and lateral excursions. Subjective evaluations were performed in group 2 for TMJ pain, jaw function, and diet. Lateral cephalometric radiographs were evaluated for presurgical and postsurgical mandibular growth. There were no statistically significant differences (P >.05) between the 2 groups for maximal incisal opening, lateral excursions, or subjective jaw function before surgery. Presurgical growth differed significantly (P <.05), with group 2 showing more active growth. At the long-term follow-up, no differences were found in lateral excursions or subjective jaw function. There was a statistically significant difference in maximum incisal opening (P <.01), with a greater increase in group 2, as well as a statistically significant difference (P <.05) in cephalometric stability, with group 2 being much more stable at long-term follow-up. All patients in group 1 grew back into skeletal and occlusal Class III relationships and required secondary intervention. Only 1 patient in group 2 required secondary surgery, involving maxillary surgery to correct postsurgical transverse maxillary relapse; the mandible was stable at long-term follow-up. The results of this study showed that patients with active condylar hyperplasia treated with high condylectomy, articular disc repositioning, and orthognathic surgery have stable, predictable outcomes compared with those treated with orthognathic surgery alone.

A less-invasive approach with orthodontic treatment in Beckwith-Wiedemann patients

The Beckwith-Wiedemann syndrome (BWS) is a rare genetic disorder, linked to an alteration on the short arm of chromosome 11 that comprises multiple congenital anomalies. Macroglossia is the predominant finding, with subsequent protrusion of dentoalveolar structures, which results in a protruding mandible, anterior open bite, abnormally obtuse gonial angle and increased mandibular length. A less-invasive treatment with orthopaedic appliances in a patient with early tongue reduction is presented. This work summarizes the oral signs linked to macroglossia, and highlights the influence of macroglossia on mandibular growth structures. In our opinion, glossotomy could be carried out in the paediatric patient as a preventive measure in that it curbs the tongue's influence on skeletal growth and dramatically reduces the duration and extensiveness of subsequent treatment.

A classification and characterization of skeletal class III malocclusion on etio-pathogenic basis

Skeletal Class III malocclusion has been classified by the position of the maxilla, the mandible, the maxillary alveolus, the mandibular alveolus and vertical development. This morphologic approach is simple and useful for clinical use, but it is insufficient to permit understanding of the pathophysiology of dysmorphoses. The authors hypothesized that there were different patterns of mutual relation of the skeletal components contributed to pathologic equilibrium of skeletal Class III malocclusion. The purpose of this study is 3-fold; (1) to classify skeletal Class III malocclusion in subgroups that can show the architectural characteristics of the deformity, (2) to analyze the craniofacial architecture of each subgroup on etio-pathogenic basis, and (3) to characterize and visualize the pattern as a prototype. Materials used in this study were lateral cephalograms of 106 untreated skeletal Class III malocclusion adults, which were analyzed with modified Delaire's analysis. Linear and angular measurements of each subject were obtained and cluster analysis was used for grouping. In the results, seven groups were identified and presented as prototypes, which could show the etio-pathology of the skeletal architecture. The classification and description presented in this study is thought to be biologic and helpful in the understanding of skeletal Class III malocclusion and treatment planning.

Bending of the distraction site during mandibular distraction osteogenesis in the rabbit: a model for studying segment control and side effects

PURPOSE

The purpose of this investigation was to develop an animal model for studying and correcting mandibular distraction side effects.

MATERIALS AND METHODS

Twenty-nine rabbits underwent bilateral mandibular distraction. Bending of the mandible was accomplished by offsetting a linear distraction by 35 degrees from the occlusal plane (4 screws per distractor), rotating the anterior segment inferiorly (2 screws per distractor), and removing a 3- or 6-mm wedge of the distraction site. The amount of bite opening varied according to the surgical design. Direct measurements, radiographs, and histology samples were compared.

RESULTS

Linear distraction produced a 4-mm anterior open bite and a Class III malocclusion after 2 weeks of distraction. Segmental rotation produced an 8-mm anterior open bite without complications. Removal of a wedge initiated rotation of the anterior segment. A large wedge (6 mm) produced fibrous union in the distraction site. The amount of bite opening or closure depended on the number of surgical screws and position of the distractor. Serial histologic sections showed bone formation at the rotated, triangular distraction site.

CONCLUSION

Bite opening or closure can occur from loss of segment control or by altering surgical design. This information is needed to counter unwanted side effects or to plan segment rotations.