Infant Orthopedics in UCLP: Effect on Feeding, Weight, and Length: A Randomized Clinical Trial (Dutchcleft)

Objective

To study the effects of infant orthopedics (IO) on feeding, weight, and length.

Design

Prospective two-arm randomized controlled trial in three academic Cleft Palate Centers. Treatment allocation was concealed and performed by means of a computerized balanced allocation method.

Setting

Cleft Palate Centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands.

Patients

Infants with complete unilateral cleft lip and palate (UCLP), no other malformations.

Interventions

One group (IO+) wore passive maxillary plates during the first year of life, but the other group (IO−) did not. All other interventions were the same for both groups.

Main Outcome Measures

Bottle feeding velocity (mL/min) at intake, 3, 6, 15, and 24 weeks (T0 to T24); weight-for-age, length-for-age, and weight-for-length using z scores; reference values from the Netherlands’ third nationwide survey on growth.

Results

Feeding velocity increased with time from 2.9 to 13.2 mL/min in the IO− group and from 2.6 to 13.8 mL/min in the IO+ group; no significant differences were found between groups. Weight-for-age, length-for-age, and weight-for-length (z scores) did not differ significantly between groups, but overall the infants with unilateral cleft lip and palate in both groups had significantly lower mean z scores for weight-for-age and height-for-age than the reference during the first 14 months, and had lower mean values for weight-for-length after soft palate closure.

Conclusion

Infant orthopedics with the aim of improving feeding and consequent nutritional status in infants with unilateral cleft lip and palate can be abandoned.

[Effectiveness of Paradontax toothpaste in patients undergoing orthodontic treatment]

The purpose of this study was to determine the effectiveness of toothpaste Parodontax in patients undergoing orthodontic treatment. The results showed that fixed orthodontic appliances deteriorated oral hygiene, increased the viscosity of saliva and reduced mineralizing capacity of saliva (MCS). Use of Parodontax toothpaste based on sodium bicarbonate improved OHI-S, reduced the viscosity of saliva, increased MCS and normalized oral microbiota.

The Unilateral Chewing Phenomenon, Occlusion, and TMD

The aim of this study was to evaluate the role of occlusal factors to determine the extent of their role in temporomandibular disorders (TMD). Two groups were selected: a patient group (I) of 100 patients with TMD problems (pain and clicking) and a control group (II) of 100. Each individual had to have 28 permanent teeth. A clinical evaluation was conducted and the models were evaluated according to the criteria of the Angle Classes and the Reinhardt Index, with the number of permanent teeth (A), the number of the correctly (R) and the number of incorrectly (F) related antagonist pairs of teeth. The individuals had to observe the preference of their chewing side. The results of this investigation revealed: the number of F can be used as an occlusal indicator for possible functional disorders (p=0.041). Individuals with one chewing side have more signs and symptoms of TMD (p<6.22x10(-9)).

[Severe hypodontia in permanent dentition. Orthodontic treatment of oligodontia in children]

Our study is aimed to focus on severe hypodontia, the absence of multiple teeth in permanent dentition. Examining the variation of the number of teeth agenesis of permanent teeth is relatively common but real oligodontia is rarely encountered during our daily work. At a number of patients recently attending the Pedodontics and Orthodontics Department of the Dental Faculty of Semmelweis University oligodontia, the absence of at least six or more permanent teeth was found. Examining the aetiology of oligodontia it can be determined that both endogen and exogenous environmental factors may contribute to the cause of the anomaly. In its pathology genetics is considered as the dominant factor what is also proved by familiar inheritance aggregation however it is hard to determine the aetiology in most cases. Severe oligodontia most often is part of certain syndromes. The anomaly causes not only aesthetical and functional problems but also may lead to several complications so early recognition and referral is considered essential. Therapy often involves multidisciplinary approach with individual assessment and planning. We would like to present the possibilities of orthodontic pre-treatment for prosthetic and implant replacement through our cases.

The airway, breathing and orthodontics

Dentists need to play a bigger role in managing airway development and craniofacial formation even though the relationship between the airway, breathing and malocclusion remains quite controversial. Certainly the airway, the mode of breathing and craniofacial formation are so interrelated during growth and development that form can follow function and function can follow form. So, it is imperative to normalize form and function as early as possible so that function is optimized for life.

Early dental management of patients with Mobius syndrome

OBJECTIVE(S)

The aim of this study was to evaluate the orofacial manifestations in patients with Mobius syndrome (MS), establish an early adequate dental treatment and discuss the possible etiology of all cases examined based on information about the gestational intercurrences.

DESIGN

Prospective study.

SETTING

Special Care Dentistry Center, School of Dentistry, University of Sao Paulo, Brazil. Subject(s) and methods: Twenty-nine patients with MS aged 0 to 4 underwent prospective dental examination as well as early orthodontic treatment.

RESULTS

All patients presented micrognathia, lack of lip seal, high arched palate and weak soft palate. The use of orthopedic appliances was recommended to all 29 patients, but only 13 adhered to treatment and were monitored for at least 24 months. We observed that, after 24 months of treatment, the palate was expanded and micrognathia became less severe in the majority of the cases. Pregnancy-related complications were reported by 27 (97%) of the 29 mothers.

CONCLUSION(S)

The early use of orthopedic appliances was important to prevent malocclusion and glossoptosis. Attempted abortion with misoprostol is associated with an increased risk of MS in infants.

The influence of early orthodontic treatment on the growth of craniofacial complex in deciduous occlusion of unilateral cleft lip and palate patients

This study evaluates dental occlusion and dental arch parameters of 5-6 year old children with unilateral cleft lip and palate (UCLP) treated and untreated orthodonticly before lip plastic with noncleft children. The aim of the study was to verify whether early orthodontic treatment improves deciduous dental arch relationship of children with unilateral cleft lip and palate.135 casts of 5-6 year old children from Riga and Vilnius were evaluated. 90 casts from children with UCLP (45 - got early orthodontic treatment, 45 - without early orthodontic treatment) and 45 casts from noncleft children. All patients with UCLP had surgically closed lip and palate; five-Year-Olds, Index was used to assess dental arch relationship of UCLP patients. Measurements of dental arch length, canine and molar arch width was taken similar to Bland and Altman method.

STATISTICAL ANALYSIS

the difference of the mean values was tested using t-test between and within groups: UCLP-1 (without early orthodontics), UCLP-2 (treated orthodonticaly before lip plastic) and control group - noncleft children). Measurements were performed by two calibrated orthodontists, mean error was calculated according to the Dalberg method. Measurement error was less than 1 mm. Measurements showed that the occlusion parameters and transverse distance between deciduous molars of UCLP-1 group differed from the occlusion of UCLP-2. Children who had got early orthodontics showed better growth of the maxillae. More cases with positive overjet and meziodistal or distal deciduous molar relationship had treated with early orthodontics. Maxillary width between deciduous molars was statistically significant wider in children with UCLP who had early orthodontic treatment comparing with untreated children. Growth of mandible was not inhibited and did not differ treated and untreated children with UCLP and control group.

Results of randomized controlled trial of soft palate first versus hard palate first repair in unilateral complete cleft lip and palate

OBJECTIVE

To compare the outcomes for primary repair of unilateral cleft lip and palate, operating on the soft palate first versus the hard palate first.

DESIGN

Randomized controlled trial.

SETTING

The Regional Cleft Service of West Nepal.

PATIENTS

Forty-seven consecutive patients with nonsyndromic unilateral cleft lip and palate, of whom 37 were assessed 4 to 6 years after completing primary surgical repair.

INTERVENTIONS

Primary repair of unilateral cleft lip and palate by two differing sequences: (1) soft palate repair, with hard palate and lip repair 3 months later; and (2) lip and hard palate repair, followed by the soft palate repair 3 months later.

MAIN OUTCOME MEASURES

Analysis of dental study models, weight gain, and speech recordings.

RESULTS

Four to 7 years after completing the cleft closure, there was no significant difference in facial growth between the two types of repair sequencing. Completing posterior repair first had no effect on anterior alveolar gap width. It narrowed the hard palate gap by reducing the intercanine distance. Anterior repair dramatically closed the anterior alveolar gap, and narrowed the intercanine distance. Comparing anterior alveolar gap width with age at first presentation demonstrated that there was no spontaneous narrowing of the cleft in older children. Completing posterior closure first had a weight gain advantage over anterior closure first. Improved oropharyngeal closure, and thus swallowing, is the likely explanation.

CONCLUSION

Changing the sequencing of cleft closure has no demonstrable difference in facial growth at 4 to 7 years after completion of the primary surgery.

Preventive and interceptive orthodontic treatment needs of an inner-city group of 6- and 9-year-old Canadian children

OBJECTIVE

Early recognition of developing malocclusions and the potential for uncomplicated orthodontic treatment procedures can minimize or eliminate future costly treatment. This study was designed to assess the potential for this approach in children living in a limited-income environment. A modified index for preventive and interceptive orthodontic needs (IPION) was used to determine the need for such treatment in schoolchildren aged 6 and 9 years.

METHODS

Two calibrated examiners examined each child independently and assessed several components of his or her occlusion, including molar relationship, crossbite, open bite, overbite and overjet. Dental variables such as presence of caries and early loss of teeth were also noted. Informed consent was obtained and all children present at school on the day of the field study were included. A total of 395 children were divided into 2 groups, aged 6 and 9 years.

RESULTS

A high prevalence of caries in the deciduous dentition (30.4% for 6 year olds; 20.6% for 9 year olds) and early loss of primary teeth (11.9% for 6 year olds; 29.4% for 9 year olds) was observed. A large percentage of children had crossbite in the anterior or posterior segments, or both. Open bites were also a common finding. Future orthodontic problems were identified in 28% of this population by using the modified IPION. No statistically significant differences (p > 0.05) were found between sexes or age groups using the chi2 test.

CONCLUSIONS

Most of the developing malocclusions identified in this study would be amenable to interceptive orthodontics, consisting of space maintenance, crossbite correction and arch expansion.

Orthodontic findings in the deciduous and early mixed dentition--inferences for a preventive strategy

AIM AND METHOD

The aim of the present epidemiologic study was to obtain representative basic data on the frequency, extent and age-dependence of malocclusions in the deciduous and early mixed dentition. The developmental tendencies of specific malocclusions were investigated from the aspect of orthodontic prevention. The collective comprised 8,864 preschool and school-aged children, of whom 1,225 were in the deciduous dentition (mean age 4.5 years) and 7,639 in the mixed dentition (mean age 8.9 years). The orthodontic data were clinically assessed as sagittal, transversal, or vertical single-arch and occlusal findings. In addition, the malocclusions were classified according to their primary symptoms. Early infantile habits, tongue dysfunctions, speech defects and incompetent lip closure were registered separately.

RESULTS

57% of the children were found to have malocclusions, with the frequency rising statistically significantly in dependence on age from the deciduous to the mixed dentition (p < or = 0.001). The mean extent of excessive overjet increased significantly from the deciduous to the mixed dentition. Crossbite with mandibular midline discrepancies were observed significantly more frequently in the deciduous dentition. Although the frequency of anterior open bite underwent a significant decline from the deciduous to the mixed dentition, open bite was the malocclusion most frequently associated with dysfunction in both groups. The significant increase in traumatic deep bite in the mixed dentition indicates an unfavorable developmental tendency in this anomaly until after the eruption of the permanent incisors.

CONCLUSION

The need for preventive orthodontic therapy and for the intensified application of interceptive and early treatment measures is stressed in view of the high number of malalignments and malocclusions in the deciduous and mixed dentition and the tendency for some forms of malocclusion to deteriorate as the dentition develops.

[Eruption disturbances]

Eruption disturbances of teeth should not be considered as a curiosity. Acquaintance with these phenomena should form a substantial component of the dentist's, orthodontist's and oral and maxillofacial surgeon's basic expertise. Early detection of these disturbances followed by treatment in due time, can minimise progressive negative effects, such as the development of severe malocclusion. Treatment modalities are described.

[Early recognition of orthodontic problems by the general dentist during oral examination: signs which should attract attention]

The last decennia more and more patients are aware of the advantages of a good dental health. Dental minded parents in their children visit the dentist (general practitioner, GP) on a regular basis for a routine check up. During this check up, signs of possible future orthodontic problems can be encountered by the GP. In this article guidelines are handed to the GP by means of a flow chart which can be used at the end of the dental examination. Anterior/posterior relation, cross-bites, deep and open bite, habits and crowding shall be briefly discussed. Heaving knowledge of these, the GP can decide referring the patient to the orthodontist for further orthodontic evaluation.

A randomized prospective clinical trial of the effect of infant orthopedics in unilateral cleft lip and palate: prevention of collapse of the alveolar segments (Dutchcleft)

OBJECTIVE

To study the effect of infant orthopedics (IO) on maxillary arch form and position of the alveolar segments.

DESIGN

Prospective two-arm randomized, controlled trial in parallel with three participating academic cleft palate centers. Treatment was assigned by means of a computerized balanced allocation method.

SETTING

Cleft palate centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands.

PATIENTS, PARTICIPANTS

Infants with complete unilateral cleft lip and palate and no other malformations.

INTERVENTIONS

One group (IO+) wore passive maxillary plates during the first year of life; the other group (IO-) did not. All other interventions were the same.

MAIN OUTCOME MEASURE(S)

The presence of contact and/or overlap (collapse) between the maxillary segments at maxillary casts made shortly after birth, at 15, 24, 48, 58, and 78 weeks. Survival experience of contact and collapse with time as well as the frequencies of different arch forms and severity of collapse were evaluated.

RESULTS

Comparable arch forms with no contact or overlap of the maxillary segments were seen at birth in both groups. With time the frequency of collapse increased, with no significant differences between groups. No significant group differences were found with respect to the survival experience of contact and collapse or for the severity of collapse at the end of the observational period.

CONCLUSIONS

Infant orthopedics does not prevent collapse and can be abandoned as a tool to improve maxillary arch form.

Language skills of young children with unilateral cleft lip and palate following infant orthopedics: a randomized clinical trial

OBJECTIVE

To investigate the effects of infant orthopedics (IO) on the language skills of children with complete unilateral cleft lip and palate (UCLP).

DESIGN

In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed up longitudinally: one group was treated with IO based on a modified Zurich approach in the first year of life (IO group); the other group did not receive this treatment (non-IO group). At the ages of 2, 2(1/2), 3, and 6 years, language development was evaluated in 12 children (six IO and six non-IO). Receptive language skills were assessed using the Reynell test. Expressive language skills of the toddlers were evaluated by calculating mean length of utterance (MLU) and mean length of longest utterances (MLLU); in the 6-year-olds, the expressive language skills were measured using standardized Dutch language tests.

PATIENTS

The participants had complete UCLP without soft tissue bands or other malformations.

RESULTS

IO did not affect the receptive language skills. However, the expressive language measures MLU and MLLU were influenced by IO. At age 2(1/2) and 3 years, the IO group produced longer utterances than the non-IO group. In the follow-up, the difference in expressive language between the two groups was no longer significant.

CONCLUSIONS

Children treated with IO during their first year of life produced longer sentences than non-IO children at the ages of 2(1/2) and 3 years. At 6 years of age, both groups presented similar expressive language skills. Hence, IO treatment did not have long-lasting effects on language development.

Preventive and interceptive orthodontic demand for malocclusion

Orthodontic unit, University College Hospital, Ibadan is young and in need of baseline data for effective planning. The main aim of this study was to determine the nature of orthodontic demands in the unit that could benefit from preventive and interceptive treatment so as to enhance treatment planning, teaching and further research. Consecutive patients who presented for treatment in the Unit between May 1997 and November 1999 were included in the study. The patients aged 5-19 years with mean age of 8.8 +/- 0.82 years. One hundred and twenty-one (60.5%) of the orthodontic cases that presented for treatment needed one form of preventive and interceptive treatment or the other such as extraction of retained primary teeth, use of upper removable orthodontic appliances to correct teeth in cross bite, extraction of erupted supernumerary teeth and fabrication of oral habit breaking appliances such as goal post appliance. Ninety-three (76.9%) of these children had retained primary anterior teeth while 9.1% had proclination of maxillary anterior teeth with moderate spacing. Based on dental history and clinical examination, nine (7.4%) children were involved with oral habits, seven (5.8%) and one (0.8%) had anterior crossbite and supernumerary teeth, respectively. The remaining 39.5% needed full-blown orthodontic treatments. No sex predilection was found in relation to the various needs (P > 0.05). We suggest a need for more emphasis on preventive and interceptive orthodontic treatment in our environment due to the relatively high prevalence ofthese presenting needs.

Need for preventive and interceptive orthodontic treatment in 3-5 year-old Nigerian children in two major cities

There is a growing emphasis world-wide for early orthodontic treatment but in Nigeria there is very little information regarding the occlusal development in pre-school children reported. The need for preventive and interceptive intervention for malocclusion was studied in a sample of 563 Nigerian children (289 boys and 274 girls) aged 3-5 years. Orthodontic intervention was estimated to be needed in 12.8% of the children due to cross bite of the anterior or lateral segments. Education was needed in 12.5% of the children in cases of digit sucking, lip sucking and tongue thrusting. Extraction was indicated in 0.4% of children in cases of retained primary incisors causing displacement of the erupting successors. The need for further follow-up of occlusal development was noted in 1.4% of the children due to double primary teeth (0.4%), numerical variation of primary teeth (0.4%), crown dilaceration of a tooth (0.2%) and true class III skeletal malocclusion (0.4%).

The role of prevention and simple interceptive measures in reducing the need for orthodontic treatment

The purpose of the interceptive orthodontic treatment is to eliminate or reduce the need for treatment in the permanent dentition. The major advantage of such a treatment may also be that it is technically simple and relatively cheap, compared to comprehensive treatment with full fixed appliances. The need for interceptive measures to avoid adverse occlusal and dental consequences, which are effects of the early loss of primary molars and nonnutritive sucking habits, is discussed. The need for prevention and early intervention in patients with anterior open bites, posterior functional crossbites and signs of ectopic erupting canines is also discussed.

Space maintenance in the primary and mixed dentition

The maintenance of arch length in the primary, mixed and early permanent dentition is important for the normal development of the occlusion. Premature loss of primary teeth can result in the loss of arch length leading to malocclusion. Space maintenance can often prevent space loss and either prevent the development of a later malocclusion or reduce its severity. The pattern of space loss depends on many factors including age, stage of development, which teeth have been lost, the presence of crowding or spacing, and occlusal relationships. Careful consideration of many factors is required when deciding whether space maintenance is indicated. Radiographs and space analysis can be helpful. Space maintainers can be fixed or removable. Band and loop space maintainers have fewer problems than other types. Frequent follow-ups to check for any problems following space maintainer insertion is recommended.

Initial tooth displacement in vivo as a predictor of long-term displacement

In the past, the dry skull has been used as a hypothetical model to test initial orthodontic and orthopaedic force systems. However, the question as to whether this hypothetical model can be used as a predictor of long-term displacements in vivo remains unanswered. In this study, an attempt was made to compare initial tooth displacement with the long-term effect after application of the force system for a longer period of time, in six adult dogs. Tooth displacement was obtained by applying a force by means of a coil spring (push) system. Following application of a force of 50 g in the first series (n = 3) and 80 g in the second series (n = 3), initial displacements were registered by means of speckle interferometry. The long-term displacement was registered by means of standardized cephalometry in the same dog by leaving the force system in place for 5 weeks. The mean values of the displacement vectors of the second premolars in the six dogs were compared. A paired t-test revealed no significant differences between the initial and long-term displacements in any of the dogs. The results show that both groups of measurements belong statistically to the same sample and that initial tooth displacement measured by means of speckle interferometry is a valuable predictor for forecasting long-term displacement in vivo after 5 weeks.

Possibilities for prevention of malocclusions in South African children

An effective preventive and interceptive (P & I) orthodontic programme for young children would reduce the need for comprehensive orthodontic treatment. The aim of this study was to determine the incidence of the development of preventable malocclusions amongst a group of children at the mixed dentition stage. An examination (T1) was performed on 951 8-9 year old children from 9 primary schools in Pretoria. Of these, 493 children could be traced for re-examination 2 years later (T2). The following changes in the occlusion were noted: In 12.1 per cent of the 493 children, an acceptable occlusion at T1 had developed into a malocclusion at T2. A malocclusion was recorded for 97 per cent of the sample at T2, yet only 32.4 per cent of the subjects had received orthodontic treatment between T1 and T2. A mere 3.3 per cent of the children examined were treated at state clinics. In 64.6 per cent of cases the malocclusion was not diagnosed nor addressed. It is suggested that bi-annual orthodontic screening of all 7-12 year old children and implementation of P & I orthodontic treatment at community clinics would contribute to achieving the primary health care objectives of the Reconstruction and Development Programme for South Africa.

The impacted maxillary canine. Further observations on aetiology, radiographic localization, prevention/interception of impaction, and when to suspect impaction

Adjacent anomalous or missing maxillary lateral incisors have been implicated in the aetiology of palatally displaced canines by not providing proper guidance to the canine during its eruption. However, a recent review of the literature suggests that the aetiology of palatally displaced canines is genetic in origin. The aetiology of labially impacted canines differs, being due to inadequate arch space. Vertex occlusal radiographs have been recommended for localization but have limitations, and a case is illustrated where this radiograph is deceptive. The prevention/interception of a palatally displaced canine by the extraction of the deciduous canine is best carried out as early as the displacement is detected, mostly soon after 10 years of age. Usually, prevention/interception will avoid the surgical and orthodontic treatment needed to align a palatally impacted canine and may help prevent resorption of the adjacent incisor root. Suspicions that an impaction could occur or has occurred arise a) before the age of 10 years if there is a familial history and/or the maxillary lateral incisors are anomalous or missing; b) after the age of 10 years if there is asymmetry in palpation or a pronounced difference in eruption of canines between the left and right side; or the canines cannot be palpated and occlusal development is advanced; or, the lateral incisor is proclined and tipped distally; and, on a panoramic radiograph of the late mixed dentition if the incisal up of the canine overlaps the root of the lateral incisor.

The provision of orthodontic services by general dental practitioners. 1. Methods and descriptive results

Information regarding orthodontic service provision by general dental practitioners in Australia is limited. The aim of this survey was to determine the amount and variety of orthodontic services provided by general dental practitioners in the Melbourne Statistical Division, Victoria, Australia. A random sample of 307 dentists drawn from the Victorian Dentists Register was surveyed by mailed questionnaire: 218 (71%) replied. Data were collected using a fortnight log. During this time 59 per cent of the dentists saw at least one orthodontic patient; one dentist saw 66 orthodontic patients. Removable orthodontic appliances were used by 35 per cent of the dentists and fixed orthodontic appliances by 18 per cent. Twenty-six per cent provided comprehensive orthodontic treatment, 22 per cent aligned incisors, and 21 per cent corrected anterior crossbites. The general dental practitioners surveyed provided a wide range of preventive and interceptive orthodontic services to generally a small percentage of their patients.

[Indications for preventive removal of impacted third molars]

The impacted third molars are clinically important due to the pathological alterations caused by them. It is important from orthodontic viewpoint, that during their development the anomalies combined with the constriction, or unsuitable length of the dental arch may lead to recrudescence. For this reason the preventive removal of impacted third molars is suitable at the proper stade of their development.

[Autotransplantation of teeth]

Autotransplantation of teeth has become a common procedure in oral surgery. The most usual procedures are autotransplantation of premolars, canines and third molars. The method can be performed on young patients in combination with orthodontic treatment, creating optimal occlusal relationship. Indication, selection and timing in connection with the surgical procedure are of paramount importance for optimal results.

Reducing the incidence of palatally impacted maxillary canines by extraction of deciduous canines: a useful preventive/interceptive orthodontic procedure. Case reports

The early detection of palatally impacted permanent maxillary canines is stressed. Appropriate radiographs to determine impactions are suggested and removal of deciduous canines to eliminate impactions in patients who have good dental arches with no space deficiency is recommended. Two case histories are presented to illustrate the method.

[Preventive gnathology; maintenance of the functional status quo]

Preventive gnathology concerns all the procedures contributing to the maintenance of a physiologic occlusion. This demands an early recognition of patients at risk and a correct 'occlusal hygiene'. The importance of the use of preventive measures to preserve the existing functions in all patients during dental treatment is stressed.

[The anatomical and physiological aspects in the treatment of temporomandibular joint disorders]

The specialty of orthodontics and its relationship to TMJ problems is in the thick of controversy. Several anatomic and physiologic aspects are discussed so as to improve the understanding of the multi-faceted problems. The use of this biologically-based information is likely to make therapy more successful. From a therapeutic point of view, it is incumbent on the dentist to institute early preventive or interceptive procedures.

[Epidemiological study and orthodontics]

Prevention is now playing a major role in all fields. An epidemiological survey of malocclusions has evaluated 6 years old children in one district in the Regione Veneto (Northern Italy). Some indications are provided as regards preventive and interceptive orthodontics (including treatment aimed to reducing the severity of problems) in the therapy of the most frequent malocclusions in this age group.

[Epidemiological study of the prevalence of malocclusion in a Bersaglio group]

The Authors planned an epidemiological survey to evaluate the prevalence of malocclusion in a target group of children living in the Ussl 8-Vicenza. The results confirm the data in the literature. The Authors think necessary to carry on more precise longitudinal epidemiological studies, orthodontic prevention of malocclusion during childhood and interceptive therapy.

[Juvenile rheumatoid arthritis: the role of the TMJ and stomatognathic system]

Juvenile chronic arthritis (j.c.a) often affects the maxillo-facial complex over all in relation to jaw and temporo-mandibular joint (TMJ). In this work 35 j.c.a. patients (aged 6 to 16 years) have been selected and studied in order to detect functional and morphostructural involvement of stomatognathic apparatus and TMJ. The involvement of these structures is appeared significantly increased during j.c.a. also in patients without clinic symptoms referable to a stomatognathic apparatus pathology. Therefore an early diagnosis as well as a preventive orthognatodontic treatment are necessary to reduce long term effects on the stomatognathic apparatus multifunctions.

[Etiological problems of anterior tooth crowding: the role of the third molar]

The authors discussed about the extraction or not of the 3 degrees molar either to prevent or correct the dental crowding. They state that, since there is no definitive evidence of the real importance of the 3 degrees molar in creating dental crowding, it is not possible to perform without discrimination 3 degrees molar germectomy nor the extraction for prevention.