A finite element analysis of the maxillary first molar PDL with maxillary protraction in a mixed dentition Class III malocclusion.

OBJECTIVES: To analyze the stress distribution on the PDL of the maxillary first molar in a mixed dentition Class III malocclusion, using a Hyrax-type appliance and maxillary protraction. SETTING AND SAMPLE POPULATION: A Class III malocclusion in the mixed dentition was reconstructed based on CBCT images. MATERIAL AND METHODS: The 3D FEM comprised the maxilla, alveolar bone, right first permanent molar teeth, and PDL and consisted of 1 133 497 nodes and 573 726 elements. Maxillary protraction force was applied to a hook positioned close to the deciduous canines with 600 g and at 15°, 30°, and 45° downward angles to the maxillary occlusal plane. RESULTS: Analysis was carried out from the top and buccal view of the sagittal plane. The magnitude of the stresses at 15°, 30°, and 45° of protraction angulation resulted in the highest stress magnitude being in the region between the distobuccal and palatal roots, as well as on the distal surface of the mesial root. The vector direction in this area showed traction and mesial movement. With 30° and 45° protraction angulations, the stress was located only between the distobuccal and palatal roots, and the vector direction was more extrusive at 15°. CONCLUSIONS: The suggested orthodontic movement is in the mesial direction with a small amount of extrusion with 15° angulation and greater extrusion with 30° and 45°.

Facial divergence and mandibular crowding in treated subjects.

OBJECTIVE: To understand the relationships between facial divergence, vertical growth, and postretention mandibular crowding. MATERIALS AND METHODS: Seventy-five white extraction patients were evaluated immediately posttreatment (15.4 years) and again 16.6 years later. Hyperdivergent subjects, subjects with open bite or severe deep bites were not evaluated. Changes in incisor irregularity and tooth-size arch-length discrepancies (TSALD) were evaluated and correlated with measures of divergence and skeletal growth. RESULTS: Incisor irregularity increased 0.9 mm and TSALD increased 0.7 mm after treatment; 68% of the subjects had less than 3.5 mm incisor irregularity at postretention. Male patients showed significantly more growth than female patients did. Female patients, who were significantly more hyperdivergent than male patients, showed weak to moderately weak associations between posttreatment facial divergence and crowding. Female posttreatment changes in anterior face height, lower incisor eruption, and changes in arch depth were also related to crowding; male patients showed moderate relationships between posttreatment changes in arch width and crowding. CONCLUSIONS: Greater vertical growth, incisor eruption, and especially facial divergence are related to greater posttreatment mandibular crowding.

An evaluation of growth and stability in untreated and treated subjects.

This retrospective longitudinal study compared skeletal and dental changes in orthodontically treated patients with changes in a comparable untreated group to evaluate the relationship between skeletal changes and mandibular incisor crowding. Cephalograms and models of 44 untreated subjects from the Broadbent-Bolton Growth Study and 43 treated patients were evaluated at "posttreatment" (14.3 +/- 1.5 and 15.2 +/- 1.1 years, respectively) and at "postretention" (23.2 +/- 3.4 and 28.9 +/- 3.6 years, respectively). Cranial base and mandibular superimpositions were used to measure cephalometric changes. Tooth-size-arch-length discrepancy, contact irregularity, and space irregularity were measured. In both groups, growth in the vertical dimension was twice that in the horizontal dimension. The untreated subjects, who were younger, exhibited greater yearly vertical growth increments than did the treated subjects. The treated subjects exhibited greater overjet and overbite increases than did the untreated subjects. Yearly changes in tooth-size-arch-length discrepancy were greater in the untreated than in the treated subjects, but there were no differences in the changes in irregularity between the 2 groups. A multivariate regression model, relating posterior facial height (Ar-Go) increase and lower incisor eruption to change in space irregularity, explained 42% of the variation in the untreated group (r = 0.64; P <.001). A weaker relationship was found in the treated group. Overjet change was negatively correlated with tooth-size-arch-length discrepancy. Changes in lower incisor crowding were related to growth in the vertical dimension and lower incisor eruption in both untreated (r = 0.64) and treated (r = 0.51) subjects.

A new method of evaluating posterior occlusion and its relation to posttreatment occlusal changes.

The purpose of this study was to assess the relationship between posterior occlusion and posttreatment changes in other occlusal variables. Pretreatment (T1), posttreatment (T2), and postretention (T3) records were obtained for 49 Class I (n = 23) and Class II (n = 26) extraction cases. Overbite, overjet, mandibular incisor irregularity, right and left molar deviations, midline deviation, and mandibular arch length were measured, and occlusal registrations were made of each set of dental casts. The proximity of posterior occlusal surfaces was measured as the contact or near-contact areas at or below 300 microm thickness, based on the optical densities of scanned images of the posterior occlusal registrations. The treatment changes for overbite, overjet, right and left molar deviation, and arch length were significantly greater in the Class II group, and the reductions in incisor irregularity were greater in the Class I group. No other class differences were found. Overbite, overjet, and incisor irregularity increased after treatment, and arch length continued to decrease, with no significant class differences. Contact and near-contact areas at or below 300 microm constituted 7% of the functional occlusal table for both classes at the end of treatment, having decreased significantly in both groups (21% in Class I and 29% in Class II) during treatment. Because contact and near-contact areas increased in some patients and decreased in others, there were no significant posttreatment changes. Negative correlations were found between contact and near-contact areas at T2 and changes in overjet from T2 to T3, and between contact and near-contact areas at T3 and changes in overbite from T2 to T3. No relationships were found between posterior contact and near-contact area and incisor irregularity. We concluded that (1) the area of actual and near contacts at or below 300 microm decreased significantly with treatment, indicating that, despite excellent treatment results by conventional standards, the proximity of posterior occlusal surfaces lessened; (2) the proximity of the posterior occlusal surfaces should not be expected to increase posttreatment; (3) posttreatment contact and near-contact areas may be factors in overbite and overjet stability; and (4) posttreatment contact and near-contact areas are not related to incisor irregularity.

Vertical components of overbite change: a mathematical model.

The purpose of this study was to better understand the multidimensional nature of overbite changes that occur during adolescence. The study used longitudinal cephalograms of 181 untreated children (102 males, 79 females) taken at ages 10 and 15. Four major components that directly affect overbite were measured: (1) maxillary vertical displacement, (2) mandibular vertical displacement, (3) upper incisor vertical change within the bone, (4) lower incisor vertical change within the bone. Cranial base, maxillary, and mandibular superimpositions were performed for each subject to assess the vertical changes that occurred in these 4 components and to assess overbite. A multiple regression analysis was used to develop a mathematical model describing the relationships of these components to changes in overbite. The model was validated with an independent subsample and a comparison of subjects whose overbites decreased and those whose overbites increased. The results showed that overbite changed minimally (0.2 mm) over the 5-year period; variation ranged from a 2.4 mm decrease to a 5.6 mm increase. The regression model indicated that the mandibular skeletal changes were twice as important as the mandibular dental changes and about 2.5 times as important as the maxillary changes in effecting overbite change. Within the mandibular skeletal component, vertical growth was more important than mandibular rotation in determining overbite change. The model demonstrated that a multivariate approach is necessary to understand overbite changes. More effective orthodontic treatment might be achieved by focusing on the primary components effecting overbite change, especially those with the greatest potential for therapeutic modification.

The demographic outlook for orthodontists in Texas at the start of the next millennium.

Like all health care professionals, orthodontists are concerned about the need and demand for their services. Orthodontists should experience an increase in demand for their services as a result of an increasing population and an aging orthodontist population. How many additional orthodontic graduates do we need per year in Texas? Based on many factors, Texas dental schools could graduate additional students per year to be consistent with those factors. In conclusion, it appears that Texas can easily support three graduate orthodontic residency programs. As we enter the next millennium, the future of orthodontics has never looked better.

The effect of orthodontic treatment on centric discrepancy.

The purpose of this study is to investigate the effects of orthodontic treatment on centric discrepancy. Thirty-six orthodontic patients who had been treated with an edgewise appliance were selected for this study while 30 persons who had no history of orthodontic treatment were used as a control group. After recording centric relation using a leaf gauge, centric prematurity, and centric slide were compared using a SAM2 articulator and mandibular position indicator. Results indicated that the number of subjects with one prematurity was significantly greater in the control group (86.7%); however, the number of subjects with two or more prematurities was greater in the orthodontic treatment group (41.6%). The orthodontic treatment group showed more bilateral prematurities. There were no differences between the two groups with regard to the teeth involved in centric prematurities. Just considering the anatomic portion of teeth, centric prematurities were significantly associated with the buccal incline of the maxillary palatal cusp. There were no significant differences in the amount or direction of centric slide between the orthodontic and control groups. This study indicates that orthodontic treatment does not generally result in an increase in centric discrepancy.

Adult versus adolescent Class II correction: a comparison.

The interest of the adult patient in orthodontics has increased as the demographics of the specialty of orthodontics has changed. There are major intreatment and posttreatment differences in Class II malocclusion correction between the adolescent and the adult. This article outlines the differences--and the similarities--between adolescent and adult Class II malocclusion correction. The differences and similarities are illustrated with case reports of a representative adolescent from the adolescent group and a representative adult from the adult group.

Effects of patient age on postorthodontic stability in Class II, division 1 malocclusions.

The increase in the proportion of adults in the typical orthodontic practice merits closer scrutiny of the treatment differences involved in adult vis-à-vis adolescent patients. Orthodontic treatment in the adolescent relies heavily on growth; in the adult, the practitioner must reposition teeth within the nongrowing arches. This difference may create the potential for greater postretention relapse in the adult; alternatively, continued growth in the subadult might detract from stability of the case. Two samples of Class II, Division 1 cases, all treated by one specialist, were examined an average of 5 years out of treatment. One group had been treated during adolescence (approximately 12 years of age), the other in adulthood (approximately 28 years). The orthodontic corrections were stable in both groups, but for different reasons: Posttreatment changes in the bony and dental structures of the adults were minimal. Bony changes (i.e., continued midface and mandibular growth) were appreciable in adolescents, and this growth--notably growth of the mandible--compensated for unfavorable drift of the dental elements (primarily mesial shift of the maxillary molar) after treatment. In sum, orthodontic corrections in adults were found to be at least as stable as those in the conventional adolescent patient.

Sexual dimorphism in normal craniofacial growth.

The purpose of this investigation is to re-evaluate an existing sample of Caucasian individuals, of mostly Northern European ancestry and undefined ethnic origins, who have been characterized as having excellent occlusions and balanced facial proportions (from a subjective assessment). The focus is the emergence of sexual dimorphism in the skeletal and dental relationships. Serial lateral cephalograms of 51 subjects were obtained from the Bolton-Brush Study at ages 6, 9, 12, 14, 16 and 18 yrs. At each age, the records of 16 males and 16 females were selected. Cephalometric evaluation indicated that the length of the anterior cranial base was larger in males but the cranial base angle was similar for both sexes at all age intervals studied. The effective lengths of the maxilla and mandible were similar in both sexes up to 14 years; thereafter in females this length remained relatively constant while in males it increased. The direction of facial growth was similar for both sexes, with a tendency towards a more horizontal growth pattern in females.

Metacarpophalangeal length changes in humans during adulthood: a longitudinal study.

Total lengths of the 19 diaphyseal hand bones were measured from standardized radiographs of healthy American whites as young adults (ca. 21 years) and again at ca. 55 years of age. The four hand-bone rows exhibit distinctive length changes: Distal and middle phalanges continue to increase significantly in length, proximal phalanges constitute a transition zone of little change, and metacarpals uniformly decrease in length. Clear-cut sex differences are noteworthy: Males change more (lose more in some bone rows, gain more in others) than females. Progressive elongation was greatest in the distal phalanges where apposition around the distal aspect ("tufting") is not constrained by a joint or epiphysis. Loss of bone length in the metacarpals by subchondral resorption is consistent with documented reductions in activity levels and grip strength with age, as well as diminished joint spaces which alter loading of the joints.

An example of regional variation in the tempos of tooth mineralization and hand-wrist ossification.

Two groups of adolescent orthodontic patients, one from the Midwest and one from the Midsouth, were compared to test the clinical impression that the permanent teeth of southern children form and erupt at significantly later ages. Indeed, a marked difference is documented, with the Midsouth series achieving mineralization stages at least 1 1/2 years later on average. This suggests that regional differences are appreciably greater than previously suspected. Clinical consequences revolve on the use of conventional (generally Northeast-based) norms for tooth formation and eruption and predictive models of facial growth. In contrast, the analysis of rates of hand-wrist development (bone age) of these same subjects disclosed no difference; this further confirms the essential independence of development of the dental and osseous tissue systems.

Education, research, and personnel needs in orthodontics.

Because of changing patterns of dental care delivery, the nature of orthodontic education, research, and personnel needs has changed markedly in recent times. Changes have occurred in the university environment, dental education, and undergraduate and graduate orthodontic education. Orthodontic research is shifting to more clinically oriented topics. Orthodontic personnel needs are being addressed by changing levels of specialist and general practitioner involvement.