Effect of airway and tongue in facial morphology of prepubertal Class I, II children / 대한치과교정학회지

OBJECTIVE: This study examined the craniofacial morphology of young patients in their prepubertal stage showing class I, II malocclusion, by analyzing lateral cephalograms, and analyzed its relationship with tongue position, tongue space, and airway space in order to ascertain the effects of nasopharyngeal airway and tongue morphology on the form of the malocclusion. METHODS: Seventy-six patients aging from 9 to 11 were divided into two groups depending on the ANB difference on the lateral cephalogram: Experimental group (Cl II malocclusion group) showing 0 ANB difference < or = < 4.0; Control group (Cl I malocclusion group) showing 0 < ANB difference < 4.0. The tongue space, space between palate and tongue, nasopharyngeal airway space and craniofacial morphology were compared between the two groups. RESULTS: Tongue space, palate-tongue space, nasopharyngeal airway space showed no significant differences between class I and class II malocclusion groups. Hyperdivergent faces were associated with smaller nasopharyngeal airway space. Longer anterior facial height and posterior facial height were associated with larger tongue space, and greater anterior facial height were associated with lower tongue position. Smaller nasopharyngeal airway space showed smaller tongue space. CONCLUSIONS: Tongue space and nasopharyngeal airway space showed no significant differences between class I malocclusion group and class II malocclusion group. Only anterior facial height and posterior facial height had an influence on tongue space and nasopharyngeal airway space.

Treatment of anterior open bite with bimaxillary anterior segmental osteotomy and genioplasty

Skeletal anterior open bite is a difficult problem to correct in orthodontic treatment. To treat adult patients who have skeletal anterior open bite, we considered two methods. Combination treatment of orthodontics & surgery and camouflage orthodontic treatment. In adults, treatment of severe skeletal anterior open bite consists mainly of surgically repositioning the maxilla or the mandible. However, camouflage therapy is often the treatment of choice for skeletal open bite patients who have mild to moderate skeletal discrepancies when growth modification is no longer possible. But excellent results generally require careful coordination of the orthodontic and surgical phases of treatment. This is a case report of a skeletal anterior open bite patients who were treated with orthodontic treatment and orthognathic surgery. First case was diagnosed as skeletal class I malocclusion & bimaxillary protrusion with anterior open bite, and finally treatment ended for removal of open bite with orthodontic procedure and bimaxillary anterior segmental osteotomy surgery. Second case was diagnosed as skeletal class II malocclusion with open bite & mandibular retrusion, and was treated with only camouflage orthodontics because she feared to have a surgery. In a regular follow up visit after debonding we proposed to the patient advanced genioplasty, and in her agreement her facial esthetics was improved through the surgery.

Treatment of transverse deficiency of maxilla with sarpe in cleft palate

Patients who have repaired cleft lip and palate generally undergo restriction of maxillary growth. Concave facial profile is often exhibited with relatively normalized mandible. Horizontal and sagittal deficiency of the maxilla could cause anterior and posterior crossbites. In growing patients, orthodontic and orthopedic treatment is acceptable with maxillary expansion and protraction. However, surgical approach has to be accompanied with orthodontic treatment in skeletally matured patients. We used SARPE and BSSRO to expand the constricted maxilla and retract the mandible in a patient who had cleft palate repaired in infancy. Through SARPE, orthodontic treatment and BSSRO, we sufficiently expanded the maxillla and improved facial profile.

Treatment of transverse deficiency of maxilla with sarpe in cleft palate

Patients who have repaired cleft lip and palate generally undergo restriction of maxillary growth. Concave facial profile is often exhibited with relatively normalized mandible. Horizontal and sagittal deficiency of the maxilla could cause anterior and posterior crossbites. In growing patients, orthodontic and orthopedic treatment is acceptable with maxillary expansion and protraction. However, surgical approach has to be accompanied with orthodontic treatment in skeletally matured patients. We used SARPE and BSSRO to expand the constricted maxilla and retract the mandible in a patient who had cleft palate repaired in infancy. Through SARPE, orthodontic treatment and BSSRO, we sufficiently expanded the maxillla and improved facial profile.

Evaluation of clinical methods in the diagnosis of temporomandibular joint disorders: a comparison study with magnetic resonance imaging

PURPOSE: The diagnostic relevancies and characteristics and of clinical methods in the diagnosis of internal derangement (ID) were tested by comparing the results of them with those of magnetic resonance imaging (MRI). METHODS: 75 patients (150 temporomandibular joints; TMJs), who were suspected to have ID by clinical diagnoses, were included. Clinical diagnoses including mouth opening pathway and TMJ sound were conducted and MRI takings were done. Accuracies, sensitivities, specificities, positive predictive values, and negative predictive values of clinical diagnosis, mouth opening pathway, and TMJ sound were calculated by comparing with diagnoses with MRIs. RESULTS: Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of clinical diagnosis were 59.3%, 83%, 49%, 81%, and 51%. They were 59%, 82%, 25%, 73%, and 35% for mouth opening pathways. Although deviation was somewhat accurate for representing disc displacement with reduction (ADDWR), other discrepancies on opening pathways were not clinically relevant. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of clicking sounds were 85%, 49%, 78%, 85%, and 37%. TMJs with crepitus were only three. But all TMJs with crepitus were diagnosed to have disc displacement without reduction (ADDWOR). CONCLUSION: When compared with diagnoses with MRIs, clinical diagnoses for ID were not so accurate. But they were suitable for screening tests for ID. Opening pathways and TMJ sounds were not so relevant in the diagnoses of IDs and so it was concluded that considerations for other factors must be included in the diagnoses of IDs.

Changes in Tongue Position, Airway Width, Gonial Angle, Lower Facial Height after Bilateral Sagittal Split Ramus Osteotomy in Mandibular Prognathic Patients

INTRODUCTION: In patients with mandibular prognathism, Bilateral Sagittal Split Ramus Osteotomy(BSSRO) combined with orthodontic treatment reduces oral volume and influences tongue and other surrounding tissues. Purpose of this study was to analyze post-operative tongue position and airway dimension, as well as mandibular changes in vertical, horizontal, and angular dimensions. MATERIALS AND METHODS: Height of dorsum of tongue, width of airway, gonial angle and lower facial height of mandibular prognathic patients who visited Kangdong Sacred Heart Hospital from Jan. 2001 to Dec. 2006 were anaylzed via pre-operative and post-operative cephalograms. T-test was used to compare pre-operative and post-operative measurements. Also, correlations among pre-operative measurements of the patients were analyzed. RESULTS AND CONCLUSION: A significant correlation was shown between ANS-Xi-PM area and location of dorsum of tongue in pre-operative patients. A significant superior movement of tongue and decrease of airway width was observed in post-operative patients. Also the upper gonial angle decreased significantly.

Considerations for Orthodontic Treatment in Elderly Patients

BACKGROUND: The growth of elderly population increased the need for oral health care. Elderly patients with poor teeth alignment needs more attention with orthodontic treatment METHODS: Elderly patients visiting department of orthodontics, Kangdong Sacred Heart Hospital between 2000-2004 were treated with fixed appliances in one or both dental arches. Treatment plans were different from than that of younger patients and included uncommon and strategic removals of teeth and prosthesis. RESULTS: There was decrease in orthodontic treatment forces with increasing age, and the observation made from this study was favorable in the patients' as well as in the orthodontist's, point of view. It was possible to move the remaining teeth considerably, and the retention was made with various fixed appliances. CONCLUSIONS: Orthodontic treatment is not limited by patient age. However, it is wise not to extend treatment goals too far beyond the patients' objective needs