Mandibular orthopedic advancement in different facial patterns and distinct stages of skeletal maturation

ABSTRACT The Herbst appliance can be very effective in treatment of Class II patients with mandibular retrognathism. Because of the continuous action in a full-time basis, treatment time using it normally takes from six to ten months, and is usually followed by a second phase of full fixed appliances, in order to obtain both occlusal refinement and long term stability. Despite Herbst appliance's effectiveness in the occlusal and dentoalveolar perspectives, its facial results may differ among patients with different growth patterns, as well as in distinct stages of skeletal maturation. In the current paper, two patients with different facial patterns are presented, who were treated under the same protocol, using Herbst and full fixed appliances in different skeletal maturation stages, and both dentoalveolar and facial results are compared and discussed.

RESUMO Um número significativo de pacientes que procuram o tratamento ortodôntico apresenta má oclusão de Classe II acompanhada pelo retrognatismo mandibular. Abordagens ortopédicas para avanço mandibular são comumente utilizadas enquanto houver crescimento facial remanescente e, nesses casos, o estágio de maturação esquelética deve ser avaliado para definir a melhor época de intervenção terapêutica. Após concluída a fase ortopédica, normalmente é realizada uma segunda fase ortodôntica para refinamento oclusal, com o intuito de oferecer maior estabilidade das correções em longo prazo. No presente artigo, serão discutidos os resultados do avanço mandibular ortopédico considerando-se diferentes estágios de crescimento.

Orthodontic and orthopedic treatment for a growing patient with Tessier number 0 cleft / 대한치과교정학회지

The purpose of this case report was to introduce the concept of orthodontic and orthopedic treatment for a growing patient with Tessier number 0 cleft. A 5-year-old boy patient with Tessier number 0 cleft presented congenitally missing maxillary central incisors (MXCI), a bony defect at the premaxilla, a constricted maxillary arch, an anterior openbite, and maxillary hypoplasia. His treatment was divided into three stages: management of the bony defect at the premaxilla and the congenitally missing MXCIs using a fan-type expansion plate, iliac bone grafting, and eruption guidance of the maxillary lateral incisors into the graft area for substitution of MXCIs; management of the maxillary hypoplasia using sequential facemask therapy with conventional and skeletal anchorage; and management of the remaining occlusal problems using fixed orthodontic treatment. The total treatment duration was 15 years and 10 months. Class I canine and Class II molar relationships and normal overbite and overjet were achieved at the end of treatment. Although the long-term use of facemask therapy resulted in significant protraction of the retrusive maxilla, the patient exhibited Class III profile because of continued mandibular growth. However, the treatment result was well maintained after 2 years of retention. The findings from this case suggest that interdisciplinary and customized approaches are mandatory for successful management of maxillary hypoplasia, bony defect, and dental problems in Tessier number 0 cleft. Moreover, considering the potential of orthognathic surgery or distraction osteogenesis, meticulous monitoring of mandibular growth until growth completion is important.

Functional evaluation of orthopedic and orthodontic treatment in a patient with unilateral posterior crossbite and facial asymmetry / 대한치과교정학회지

An 8-years old boy with facial asymmetry and unilateral posterior crossbite on the left side received orthopedic and orthodontic treatment. During the first phase of treatment, the narrow maxillary arch was expanded using an acrylic plate. Then, the acrylic plate was used as a bite block with occlusal indentations from the construction bite that was obtained with the incisors in a coincident dental midline. After the position of the mandible was stabilized, the second phase of orthodontic treatment was initiated using fixed appliances for detailing of the occlusion. Skeletal symmetry, ideal occlusion, and coincident dental midlines were thus achieved. Functionally, occlusal force balance and masticatory muscle activity were improved, and the chewing patterns were normalized.

Expression of nitric oxide synthases in the mandibular condyle of anterior repositioned rat mandibles / 대한치과교정학회지

OBJECTIVE: The aim of this study was to identify the expression of nitric oxide synthases (NOS) in the mandibular condyle during mandible advancement by functional appliance and to correlate it with the histologic changes and bone remodeling. METHODS: Twenty-four female, 35-day-old Sprague-Dawley rats were randomly divided into 3 experimental groups. In all experimental groups, the mandibles of the rats were kept in a continuous forward position with a fixed bite jumping appliance. The rats were sacrificed on the 3rd, 14th, and 30th days of experiment. More than 2 rats in each group were used for staining. RESULTS: There were no remarkable histologic changes and NOS expression differences in the control group. The most prominent histologic changes occurred in the 14th day experimental group. NOS decreased in the 30th day experimental group. There was increased expression of NOS2 and NOS3 in all experimental groups, comparative to the control group. In all the experimental groups and control group, the expression of NOS2 was greater than that of NOS3. CONCLUSIONS: It is postulated that NOS2 and NOS3 in the mandibular condyle might play an important role in bone remodelling of the mandibular condyle.

Efectos de los aparatos ortopédicos en el crecimiento y desarrollo del sistema estomatognático en niños con hendidura unilateral del labio y paladar: una revisión sistemática / Effect of bracing on the growth and development of the stomatognathic system in children with unilateral cleft lip and palate: a systematic review

Evaluar el efecto de los aparatos ortopédicos en el crecimiento y desarrollo del sistema estomatognático en niños con hendidura unilateral de labio y paladar. La búsqueda electrónica abarcó las bases de datos: Medline y Registro Cochrane Central de Ensayos Controlados. Ensayos clínicos aleatorios controlados (ECA) de intervenciones con aparatología ortopédica en niños con hendidura unilateral de labio y paladar (HULP), quienes recibieron el tratamiento ortopédico entre los 0 y 5 años de edad; que evaluaban como medida de resultado el crecimiento y desarrollo maxilar y mandibular, la morfología facial y nasal y la oclusión dentaria. Recopilación y análisis: Independientemente se evaluó un estudio con tres 3 reporte de resultados, se excluyeron 68 porque no cumplían con los criterios de inclusión. En el estudio se comparó la utilización de la placa Hotz versus ausencia de placa; valorándose la dimensión maxilar, la prevención del colapso de los segmentos alveolares y la oclusión en la dentición primaria. Este estudio muestra una evidencia débil acerca de que se produce inicialmente disminución de la anchura anterior del arco, no previene el colapso de los segmentos alveolares y no mejora la oclusión dentaria. No se hallo diferencia significativa entre el grupo que utilizó placa Hotz y los que no, en lo referente a la prevención del colapso de los segmentos alveolares, la oclusión y dimensión maxilar. No se hallaron pruebas para evaluar otros aparatos

Evaluate the effect of orthopedic appliances on estomathognatic system`growth and development, in children with unilateral cleft lip and palate. Search Strategies: The search included electronic databases: MEDLINE y Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) of orthopedics appliances interventions in children with unilateral cleft lip and palate, who's received orthopedic treatment between 0 and 5 years of age; evaluating as a result jaw and maxilar´s growth and development, nose and facial morphology and dental occlusion. Regardless assessed a study with three duplicated publications, 68 were excluded because they did not meet criteria for inclusion. In the study with 3 duplicate publications were compared using the plate Hotz versus absence of plate; valued dimension jaw, preventing the collapse of the alveolar segments and occlusion in the primary teeth, respectively. There is a weak evidence about that initially occurs a declining of the anterior width of the arc, does not prevent the collapse of the alveolar segments and does not improve dental occlusion. No significant differences were found between the group that used Hotz plate and those without, in terms of preventing the collapse of the alveolar segments, occlusion and jaw dimension. We found no evidence to evaluate other appliances

Clinical effect of orthopedic-orthodontic treatment in crossbite in deciduous dentition / 中华医学美学美容杂志

Objective To study the clinical effect of orthopedic-orthodontic treatment in crossbite in deciduous dentition through cephalmetric analysis. Methods 12 children with crossbite in deciduous dentition were enrolled in treatment group. Control group included 8 patients with normal deciduous dentition. Modified reverse headgear was used in each patient in the treatment group. Orthodontic force was a-bout 2. 94-4. 90 N (300-500 g) , and the direction of force was under occlusion plane for 37 degree. Each patient wore reverse headgear for 10 hour per day. Orthodontic treatment lasted for 6 months, and then orthodontic treatment began at once. Orthodontic treatment was not over until crossbite was corrected. The cephalmetric change was compared between two groups before treatment (T1) , after orthopedic treatment (T2)and after orthodontic treatment (T3). The effect of orthopedic-orthodontic treatment was analyzed in two group. Results Crossbite was corrected successfully in all patients in the treatment group. After treatment, A point moved forward by 2. 8mm, Is-FHp increased 8. 38 mm, ＜SNA increased 2. 65, incisors in mandible moved backward a little bit. All these changes were statistical different as compared with those in the control group. Conclusion Skeletal and dental deformity are improved progressively after combined orthopedic-orthodontic treatment. It is recommended to perform orthopedic-orthodontic therapy in skeletal crossbite in deciduous dentition.

Orthopedic Treatments for Genetic and Metabolic Bone Diseases / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to investigate the distribution of diseases and the orthopedic procedures performed in patients with genetic and metabolic bone diseases. MATERIALS AND METHODS: One hundred and fifty-three patients, who were admitted to the orthopedic ward under a diagnosis of genetic or metabolic bone disease from January 1990 to December 2000, were investigated. Their medical records, radiographs and laboratory data were reviewed, and orthopedic procedures analyzed. RESULTS: One hundred and fifty-one cases were diagnosed with specific diseases, while 2 remained unspecified. Achondroplasia, multiple epiphyseal dysplasia-pseudoachondroplasia and metaphyseal chondrodysplasia were common among the skeletal dysplasia cases. Hypophosphatemic rickets and osteogenesis imperfecta were common diseases among the metabolic and connective tissue categories. Limb lengthening was frequently performed in achondroplasia and in hypophosphatemic rickets, while deformity correction and hip surgery were frequent in multiple epiphyseal dysplasia - pseudoachondroplasia and metaphyseal chondrodysplasia. CONCLUSION: In genetic and metabolic bone diseases, only a limited number of clinical problems can be solved by orthopedic procedures. As new techniques are developed the pattern of orthopedic treatmen may change.