Postsurgical Orthodontic Treatment Planning: a Case Report with 20 Years Follow-up.

BACKGROUND: Traditionally, maxillofacial deformities are corrected surgically after an initial orthodontic treatment phase. However in, this article, the authors emphasize the postsurgical therapeutic protocol which is extremely important for determining the final and permanent retention of the corrected occlusion. METHODS: A 55 year old female with severe skeletal Class II malocclusion is presented. Combined surgical and orthodontic correction of the malocclusion was used. RESULTS: : The step-by-step procedure the authors followed for the postsurgical therapy is described. The goals of the postoperative therapy were to restore and rehabilitate neuromuscular function, obtain occlusal stabilization, grind teeth selectively, and final occlusion retention. The importance of a surgical occlusal splint for rehabilitating stomatognathic neuromuscular function postoperatively was demonstrated. Furthermore, the orthodontic-prosthodontic treatment ensured occlusion stability after the surgical correction. The long-term results confirmed the efficacy of the treatment protocol presented here from both functional and aesthetical perspectives. CONCLUSIONS: Postsurgical orthodontic treatment is an important step in the surgical and orthodontic therapy of maxillofacial deformities.

"Ten-point" 3D cephalometric analysis using low-dosage cone beam computed tomography.

OBJECTIVE: The aim of this study was to combine the huge amount of information of low dose Cone Beam CT with a cephalometric simplified protocol thanks to the latest informatics aids. Lateral cephalograms are two-dimensional (2-D) radiographs that are used to represent three-dimensional (3-D) structures. Cephalograms have inherent limitations as a result of distortion, super imposition and differential magnification of the craniofacial complex. This may lead to errors of identification and reduced measurement accuracy. The advantages of CBCT over conventional CT include low radiation exposure, imaging quality improvement, potentially better access, high spatial resolution and lower cost. MATERIALS AND METHODS: This study assessed cephalometric 2D and 3D measurements and the analysis of CBCT cephalograms of the volume and centroid of the maxilla and mandible, in 10 clinical cases. RESULTS: With a few exceptions the linear and angular cephalometric measurements obtained from CBCT and from conventional cephalograms did not differ statistically (p>0.01). There was a correlation between the variation in the skeletal malocclusion and growth direction of the jaws, and the variation in the spatial position (x, y, z) of the centroids and their volumes (p<0.01). CONCLUSIONS: The 3D cephalometric analysis is easier to interpret than 2D cephalometric analysis. In contrast to those made on projective radiographies, the angular and linear measurements detected on 3D become real, moreover the fewest points to select and the automatic measurements made by the computer drastically reduced human error, for a much more reliable reproducible and repeatable diagnosis.

Psoriatic arthritis: temporomandibular joint involvement as the first articular phenomenon.

Psoriatic arthritis (PA) is a chronic systemic disease that is difficult to detect. The diagnosis is made on mainly clinical grounds based on the findings of psoriasis and inflammatory arthritis of the joints. Many reports have described the damaging effects of PA on the temporomandibular joints (TMJs), but no study has clearly reported the TMJ as the first articulation to be involved in PA. This article reports a case of PA that was diagnosed several years after TMD onset because no signs besides psoriasis were present. The missed early diagnosis resulted in severe TMJ damage. The TMJ can be the first joint involved in PA. For a correct, early diagnosis of PA, collaboration between dental clinicians and rheumatologists is very important.

Craniofacial growth in children affected by juvenile idiopathic arthritis involving the temporomandibular joint: functional therapy management.

UNLABELLED: The aim of this study was twofold: 1) to asses the effects of a functional appliance on condyles damaged by juvenile idiopathic arthritis (JIA). and 2) to evaluate its ability to reduce alterations in craniofacial development. STUDY DESIGN: Seventy-two JIA patients with temporomandibular involvement, ages ranging between 4 and 16 years, were treated. All of them presented temporomandibular joint involvement. They were treated with an activator and followed for 4 years. RESULTS: At the second examination, it was possible to observe a reduction in mandibular retrusion and in the sagittal discrepancy between mandible and maxilla, a reduction in the angle of divergence, a counterclockwise rotation of the mandible, a reduction of the gonial angle, a longer mandibular ramus, a reduction in the discrepancy between anterior and posterior height caused by an increase in posterior height and a forward positioning of the chin. CONCLUSION: The functional appliance reduces the severity of facial alterations improving mandibular and condylar growth.