Lip morphology: a factor leading to bimaxillary dentoalveolar protrusion

The objective of this study was to see the effect of lip morphology in the study sample presenting with bimaxillary dentoalveolar protrusion on normal skeletal pattern. This cross sectional study comprised 50 subjects having bimaxillary dentoalveolar protrusion on class I skeletal pattern. Age of the subjects ranged from 18-25 years. The sampling comprised random selection of the subjects. The method involved Cephalometric analysis of skeletal, dental and soft tissues made on lateral cephalograms taken in natural head position of the subjects. A total of twenty variables were used in this study, comprising six skeletal, three dental and eleven soft tissue variables. Data were analyzed using SPSS version 10.00. Descriptive analysis and Independent t-test were carried out for significance [P<0.05]. Variables of the skeletal analysis were found within norms, whereas dental variables showed an increased value of Upper Incisor to Sella-Nasion plane [UI-SN] 115.120 [SD 5.500], Incisor Mandibular Plane Angle [IMPA] 102.700 [SD 3.400] and consequent decrease in Frankfort Mandibular Incisor Angle [FMIA] 55.500 [SD 5.490]. Soft tissue analysis determined full profile with greater vermilion of upper and lower lips, deficient lip strain and decreased length of upper and lower lips. Among six variables of skeletal analysis four were found very highly significant, among three variables of dental analysis only one was analyzed as significant and among eleven variables of soft tissue analysis four were found as very highly significant. This study concluded that the yielding effect of lips, because of relaxed orbicularis oris muscle and greater lip vermilion is the contributing factor in bimaxillary protrusion

Lip morphology in bimaxillary dentoalveolar protrusion in class I and class II adults

The objective of this study was to compare lip morphology in the young adult population of Pakistani origin, having bimaxillary dentoalveolar protrusion on class I and class II skeletal pattern. This cross sectional comparative study included 100 subjects, 50 with class I skeletal pattern and other 50 with skeletal class II pattern. Age of these subjects ranged from 18-25 years. The sampling included random selection of the subjects. The method comprised skeletal, dental and soft tissue cephalometric analysis made on lateral cephalograms taken in natural head position of the subject. A total of 20 variables were used in the study comprising 6 skeletal, 3 dental and 11 soft tissue variables. Among the skeletal I subjects variables of the sagittal and vertical skeletal analysis showed more or less normal values. Variables of the dental analysis however, determined increased inclinations of the upper and lower incisors and consequent reduction of Frankfurt mandibular incisor angle FMIA. The soft tissue variables showed full profile with greater upper and lower lip vermilion, decreased lip strain, lower lip thickness and deficient upper and lower lip lengths. In skeletal II subjects almost all these variables gave relatively enhanced readings, but difference was not of statistical significance. The study concluded that there is no significant difference in the lip morphology with bimaxillary protrusion on class I and class II skeletal pattern

Nasoalveolar molding of the unilateral cleft of the lip and palate infants with modifed stent plate

Purpose of this study was to introduce an effective, simple and cost effective nasoalveolar molding appliance in order to provide molding therapy to the socially compromised cleft infants, more commonly in the cleft clinic of CH and ICH Lahore. This intervention study also aimed at evaluating the effects of this plate in terms of nasal dome elevation and alignment/ approximation of the cleft alveolar segments. The sample comprised 32 neonates [18 males and 14 females], age ranging from 3 days to 12 days. The methods included photocopy analysis of the pre and post molding casts, comprising four variables and two anthropometric variables. The data was subjected to paired T-test using SPSS 12 for statistical analysis. Five out of six variables were found very highly significant with alpha p value of <0.001 except one variable [intermolar width] which was found as not significant [p=o.604]. The study concluded that this self retentive stent plate is an effective, inexpensive and comfortable device

Ideas and innovation. Management of vertical excess in bimaxillary hypoplasia with custom made frontal high-pull head gear

The purpose of this case report is to introduce a custom made frontal high pull head gear for the management of vertical excess in cases with bimaxillary Hypoplasia. The need, technique and results of phase 1 treatment relating to orthpaedic effect of frontal high pull headgear is described. Conventional means include the use of high pull headgear during growth spurt, orthognathic surgery [for vertical dysplasia of skeletal origin] intrusion of upper buccal segments with titanium, mini screws or plates. Treating this condition during growth period is a problem with existing head gears. This article reports on two cases, treated with custom made frontal high pull headgear using three of 500g per side, for six months. Results showed a significant improvement in the vertical dimension. An added advantage was an acceptable advancement of the maxilla and mandible

Soft tissue facial profile analysis in patients with class I and class II skeletal pattern visiting children's hospital, Lahore

The soft tissues covering the face play an important role in facial aesthetics, speech and function. Detailed soft tissue analysis is an important component of comprehensive diagnosis and treatment planning. A balance between the dental and the perioral muscles must be achieved to attain stability of the treatment outcome. The aim of the study was to compare soft tissue facial profile between skeletal class I and class II subjects and to find out difference in soft tissues adaptation on the basis of gender. Non probability sampling technique was used. Eighty patients were selected with age ranging 14 to 18 years. For each patient a lateral cephalogram was taken and cephalometric analysis was performed. The study showed that patients with class II skeletal pattern have more convex profile. Both upper and lower lips are more protrusive than the normal and lower lip length in males is slightly greater than the normal

seven year study [2000 - 07] of the cleft proportions at the cleft clinic of the children's hospital, Lahore

The study assessed proportions of clefts in patients visiting orthodontic unit of Children's Hospital Lahore from 24-01-2000 to 24-01-2007. This observational descriptive study included 313 subjects comprising 189 males and 124 females with the age range of day one to 13 years. The method used for this study was Kernahan's modified double 'Y' with numeric coding. A total of 30 combinations were used to describe all types of clefts. The data was analyzed using SPSS 12. An increased proportion of the male patients [189] was examined compared to 124 females. The most common finding was complete bilateral cleft affecting 126 cases [40.3%]. The second common type was complete unilateral cleft seen in 95 patients [30.4%]. The clefts involving the left side were more common and were identified in 54 patients [17.3%]. The 3[rd] largest type was cleft involving median soft palate. An unusual finding of this study was complete unilateral and partial clefts of the opposite side found in 21 infants [6.7%]. The most common finding was complete bilateral cleft of the lip and palate. An unusual type of cleft was identified with Kernahan's double 'Y'

Prediction of the sizes of unerupted canines and premolars in Pakistani subjects

The objective of this study is to derive probability tables for Pakistani subjects visiting Children's Hospital, Lahore. Two hundred dental casts of the Pakistani subjects with age ranging from 12-25 years, who presented with complete eruption of permanent mandibular incisors, all canines and premolars, were measured with a pointed vernier caliper. The non-probability convenient sampling technique was used. Statistical analysis was made by using SPSS 10 to calculate means, standard deviations and range. Student t-test was used to compare tooth size between males and females. Male subjects had greater tooth size as compared to the female subjects. However, this difference was found to be insignificant statistically. The data illustrated the limitation of Moyers probability tables when applied to Pakistani population. The Moyers probability tables were not considered 100% accurate when applied on Pakistani population

Molar distalization with modified palatal distalizer

The aim of the study was to introduce a modified palatal molar distalizer and evaluate its dental effects. 20 Adolescent and post adolescent patients [6 boys, 14 girls] with crowded upper arch and class II canine relationship were included in this study. The skeletal pattern of these patients was class I, II or bimaxillary hypoplasia. This study analyzed the maxillary first molar distalization with intervention device-The Modified Palatal Distalizer, its effects on the anchor teeth as well as on the maxillary second molars. The appliance was composed of four premolar bands, two first molar bands, wider Nance and 15mm Ni-Ti coil springs [0.012x0.032] applied on the palatal surface delivering 240gms of force. The period of appliance wear was 7.7months. Maxillary first molars were distalized bodily with minimal anchorage loss [11.1%] compared to 88.9% molar distal movement. An average of 5.39mm bodily distalization of the maxillary first molars was attained. The distal movement of maxillary second molars was recorded 4.35mm. Numerical data was statistically analyzed using paired t-test [SPSS version 12]. The modified palatal distalizer is an effective and reliable device producing bodily molar distalization, besides being cost effective

Proportion of maxillary vertical excess in dental patients visiting the Children's Hospital Lahore

The purpose of this study was to find the proportion of maxillary vertical excess in patients visiting orthodontic department of The Children Hospital and The Institute of Child Health Lahore, and male to female ratio among the maxillary vertical excess cases. The material for the study consisted of 100 lateral cephalograms of subjects visiting the department of Orthodontics, The Children Hospital Lahore. There were 50 males and 50 females in the study sample. The mean age of the whole sample was 12.93 +/- .956 years with the range of 12 to 15 years. Lateral cephalograms of all subjects were taken in centric occlusion. The same operator traced all the cephalograms on acetate matt paper manually. Cephalometric parameters included three skeletal angular and three skeletal linear measurements. Two ratios including Jaraback and lower anterior facial were also evaluated. 25 cephalograms were retraced to eliminate error of method. The vertical excess subjects showed significantly increased values of < SN/MP, MMA and sum of posterior [inner] angles when compared to normal subjects. The Jaraback ratio was small indicating greater value of total anterior facial height [TAFH] of the vertical excess subjects. The value of lower anterior facial ratio was greater than normal indicating greater lower anterior facial height [LAFH] in vertical excess subjects. Numerical data was statistically analyzed using paired t-test [SPSS version 10]. The results showed thirty three cases of maxillary vertical excess and eleven cases of maxillary vertical deficiency in the study sample. Among the maxillary vertical excess cases 19 were males and 14 females

Linear photogrammetric analysis of the adult soft tissue facial profile

The objective of this study was to assess the soft tissue profiles and determine gender dimorphism in the young adult population of Pakistani origin, working in the Children Hospital in different capacities. This cross sectional descriptive study included 32 subjects including 16 males and 16 females. Age of these subjects ranged from 18-25 years. The sampling comprised random selection of the subjects. The method involved photogrammetric analysis with linear horizontal and vertical measurements made on standard photographic records taken in natural head position. Photocopies of the photographs with clearly identified landmarks were used for measurements. A total of21 variables were used in the study comprising 11 horizontal and 10 vertical linear measurements. Amongst horizontal linear measurements, gender dimorphism was seen in seven out of eleven variables. Out of the ten vertical variables only two variables showed sexual dimorphism. Facial depth, nasal depth, labial and chin areas showed sexual dimorphism in most of horizontal measurements. However length of the mid face, nose, upper and lower lips as well as height of the chin and nasal tip were found greater in females, reflecting vertical growth tendency

Orthodontic management and tertiary graft in unilateral cleft lip and palate

Bone grafting to repair an alveolar cleft is an integral part of the treatment in unilateral and bilateral clefts of the lip and palate. The graft may be primary secondary or tertiary. Tertiary graft is placed to provide a firm anatomic base for prosthodontic rehabilitation, to improve stability and health of periodontium and to assist in the closure of persistent bucconasal fistulae. Presented here is a case of a female patient with right unilateral alveolar cleft and repaired lip and anterior palate on the right side. Orthodontic and surgical management of this anomaly is described. After about over a year of orthodontic alignment leveling and cuspid retraction [on the right side], tertiary bone grafting was performed. An autogenous corticocancellous particulate bone graft was harvested from the anterior iliac crest using the standard lateral approach. The graft was held in position for six months with stabilizing heavy rectangular arch. Later on minor dental adjustments were followed by Hawley's retainers and the patient was referred for fixed prosthesis. The treatment outcome was an acceptable occlusal relationship, a successful closure of the alveolar cleft as well as improved periodontal conditions of the teeth adjacent to the cleft area

Management of the cleft deformities at the cleft center of Children's Hospital Lahore during 5 years [2000-2005]

To describe management of cleft children during five year period from 24-1-2000 to 24-1-2005 at Orthodontic department of the Dental section CH and ICH Lahore, a tertiary level hospital. This quasi experimental study was conducted on 128 subjects comprising of 72 males and 56 females. Age of these subjects ranged from one day to thirteen years. These patients were classified with Kernahan's modified double Y system. Thirty six patients out of 54 [42.2% with complete bilateral cleft lip and palate] were treated with custom made orthopedic plate having anteriorly extending acrylic ring. The next common type of cleft seen was complete unilateral cleft lip and palate affecting 27 patients [21%]. An unusual finding was complete unilateral cleft lip and palate and partial opposite side cleft. Treatment given to unilateral cleft was pre-surgical infant orthopedic plate given in 30 patients. Supportive instructions were provided to 21 infants that included 10 neonates with Pierre Robin's sequence. 19 subjects out of the whole sample were given post surgical Obturators for the treatment of residual fistula or cleft following palatal closure. Ten patients were instructed on oral hygiene measures. Four patients were referred for surgical procedures. Three patients in early mixed dentition were provided custom made modified expansion device. One patient in mixed dentition was given Petit headgear after expanding maxilla with splinted hyrax while another one was given holding arch. Three patients, two in mixed dentition and one in permanent dentition were treated with comprehensive fixed mechanics followed by bone graft. In bilateral deformities PSIOP with anterior ring produced significant retraction of pre maxilla which made initial lip repair easy. In unilateral cases PROP served the purpose of obturator and improved the function while MED provided an effective substitute to splinted expanders

Proportions of oral clefts in patients visiting the cleft center of Children's Hospital and Institute of Child Health Lahore: a Five year study [2000 - 2005]

The objective of the study was to identify proportions of oral clefts in patients visiting Children's Hospital Institute of Child Health, Lahore during five year period from 24-01-2000 to 24-01-2005. This observational descriptive study included 128 subjects comprising 72 males and 56 females. Age of these patients ranged from one day old to 13 years. The method used for this study was Kernahan modified double [Y] with numeric coding system. A Total of 24 combinations were used to describe all types of clefts. The data was analyzed in SPSS 10 statistical package. Out of the whole sample size an increased number of male subjects [72] were examined as compared to female subjects [56]. The most common finding of this study was complete bilateral clefts affecting 54 patients [42.2%]. The next common type was complete unilateral cleft of the lip and palate, occurring in 27patients [21%]. Among these, clefts involving left side were more common and were seen in 19 patients [14.8%]. An unusual finding of this study was complete unilateral and partial clefts of the opposite side. Increased number of complete bilateral cleft of the lip and palate was because of referrals to the CH and ICH from various surrounding and remote localities for the tertiary level treatment of this particular deformity. The unusual type of the cleft was identified with Kernahan's modified double stem of the symbolic [Y]

Age of high growth rate in adolescent period of development

The aim of this study was to assess the chronological age of different skeletal maturity events in young adolescents. A total of 100 subjects [50 males 50 females] visiting the children's hospital and the Institute of Child Health, Lahore, were included in the study. The mean age of these subjects was 12.23+ 2.33years. Skeletal maturity was assessed with left hand-wrist radiograph through method described by Fishman. Chronological age was determined by knowing the exact date of birth of adolescent. Result showed that the females were advanced than males in about 1.2 years in attaining peak growth velocity. The peak growth velocity of females arrived at the age 12.78+ 1.73 and that of males is at 13.9+1.37 years. The study also showed racial differences. Through these results the simple information of patient's chronological age aids the clinician in evaluating the patient's growth potential and facilitates establishment of appropriate timing and types of orthodontic treatment, retention needs, and proper timing for surgical intervention

Molar distalization with custom made bilateral palatal distalizer

Class II malocclusion with moderate space deficiency in the maxillary arch and relatively well-aligned Mandibular arch can be treated with both extraction and non-extraction strategies. In case of therapeutic extractions however, bite opening may become a problem, particularly in excessive overbite. In non-extraction mechanics, the aim is to distalize the maxillary first molars to class I molar relationship in order to gain space in the buccal segments for retraction of cuspids and anterior teeth. Different methods may be used for maxillary molars distalization, namely extra oral traction, combination of removable and extra oral appliances and intra oral fixed distalizers. The last being the most recent approach, specifically in Dental Class II malocclusion where skeletal effect is not needed. Amongst the intra oral fixed molar distalizers, the palatal or lingual distalizer system comprises the latest approach, being more aesthetic and most effective. This presentation reports on a female patient of 15 years, who presented with a mild Class II malocclusion. Her prominent nose and excessive overbite did not allow therapeutic extractions. The final treatment plan came to be the Bilateral Palatal Distalizer, which was custom made and modified in its design from an existing Italian appliance. The appliance was used for seven months with excellent results attaining an average of5.5mm distalization of maxillary first molars

comparative study between two molar distalization appliances

Class II malocclusion with moderate space deficiency in the maxillary arch and a relatively well-aligned mandibular dental arch can be treated in many ways. One possibility to treat without extraction is to distalize the maxillary first molars to a class I molar relationship in order to gain space in the lateral segments, for retraction of cuspids and anterior teeth. The aim of this study was to compare the clinical dental effects of these two different molar distalization devices, involving 29 patients having class IImalocclusion with low angle or normal angle. The Intra-oral Bodily Distalizer [I.B.M.D], which is a fixed appliance that consisted oftwopre-activated molar distalization springs bent in TMA wire 0.032 x 0.032 inch and a modified Nance to maintain anchorage, was used in 14 patients. The Acrylic Cervical Occipital Anchorage [A. C. C. O] appliance being a combination of fixed and removable appliance consisting of an acrylic plate with 2 finger springs and a modified labial section-containing groove for the anterior elastic as well as cervical headgear was given in 15 patients. The I.B.M.D and A. C. C. O were used for the mean period of 7.2 months and 11 months respectively. Measurements were made from the lateral cephalogram tracings before and after molar distalization. The results showed that with I.B.M.D maxillary first molar distalized bodily on an average of 4.5 mm and the mean anchorage loss was 4.75 mm. With A.C.C.O mean distal movement of the maxillary first molar was 4.38 mm with mesial tip of 3.03 degree. However, anchorage loss with A.C.C.O appliance was less being 2.11 mm on an average due to the use of the headgear. In I.B.M.D the distalization spring being composed of square sectioned TMA wire distalized the maxillary first molar bodily without any rotation. While with A.C.C.O appliance tipping was seen. However in the maxilla the use of headgear may be effective for orthopedic purpose. Moreover the I.B.M.D. appliance was not patient dependent whereas for A.C.C.O. patient's compliance was found to be a must

Rapid palatal expansion in mixed dentition stage with custom made modified expansion device

The aim of this study was to. determine the sagittal, transverse and vertical effects of a custom made Modified Expansion Device on dentofacial structures in patients with severe crowding and narrow upper arches in the mixed dentition. A total of 20patients [13 females and 7 males] with an age range of 8-11 years were selected without regard to their skeletal class and gender. All subjects had mixed dentition [mean age 9.8years] and needed maxillary expansion. Lateral and frontal cephalom-etric radiographs, maxillary and mandibularplaster models and occlusal radiographs were obtained from each patients at pre-expansion [Tl], post-expansion [T2] and at the end of retention period [T3]. Occlusal radiographs were used to demonstrate changes in the midpalatal suture. The measurements were made on the patients'cephalometric films and plaster models. The means and standard deviations for independent and dependent variables were analyzed statistically and evaluated by paired-t test using SPSS 10.1 for windows. In the transverse plane, a significant increase in intercanine width [ICW], interpremolar width [IPW] and intermolar width [IMW] was found. Sagitally, 2mm of maxillary protraotion and significant increase in arch length was noted. Mesial tip was more marked than distal although both were statistically insignificant Extrusion, buccal tipping and other cephalometric variables used for vertical analysis showed insignificant values. We conclude that the custom made modified expansion device with rapid maxillary expansion is an effective appliance for correction of crowding and constricted upper arches as phase I treatment

cephalometric study to identify classification of malocclusion in patients attending orthodontic unit of the dental section at CH and ICH Lahore

This study was conducted to identify different classifications of malocclusion in patients attending orthodontic unit of dental section at the Children's Hospital and the Institute of Child Health Lahore. This analytical, cross sectional study included 50 patients [25 boys and 25 girls]. Age of these patients ranged from 9 to 14 years with a mean of 11.5 years, SD +/- 1.84. The age range for the boys was from 9 to 14 years having a mean of 11.4 years, where as in girls the age ranged from 9 to 14 years with a mean of 11.1 years. Lateral cephalometric radiographs were used for the analysis. A comprehensive cephalometric analysis was made on tracing sheets using multiple reference planes and 28 linear and angular measurements. Paired t- test was applied for the significant difference between the mean values. The results showed that 23 patients, 11 male and 12 female presented with skeletal class I malocclusion where as 26 patients, 14 male and 12 female were found to have Skeletal class II malocclusion only one patient presented with skeletal class III malocclusion. Dental analysis of the whole sample size was found to have 18 patients with dental class 2 div I malocclusion, 12 patients with bimaxillary proclination, lI patients with normal class 1 occlusal relationship, 7 with dental class 2 div II malocclusion and the remaining 2 were seen with dental class 3 occlusal relationships. Statistically significant differences were found with p<0.05. The study concluded that certain measurements used for cephalometric analysis did not correlate with this study sample