ABSTRACT
INTRODUCTION: Mandibular asymmetries are the fulcrum of many debates among modern orthodontists and maxillofacial surgeons. The interest is even greater when facial asymmetries are correlated to the development of TMJ symptoms and temporomandibular disorders (TMD). OBJECTIVE: The aim of this study is to investigate how mandibular asymmetries constitute etiological or predisposing factors for the development of temporomandibular disorders (TMD). We considered patients with mandibular asymmetries associated with TMD. Using orthodontic or surgical-orthodontic treatment, patients experienced correction of their TMJ symptoms. Thus, mandibular asymmetries represent a major risk factor for the development of TMD. MATERIAL AND METHODS: We studied a sample of 16 subjects aged between 14 and 36-years-old (11 females and 5 males) with mandibular asymmetries (81% structural asymmetry, 19% functional asymmetry). These subjects presented skeletal and dental malocclusions combined with several temporomandibular disorders, mostly due to muscle tension. In 100% of cases, patients received orthodontic treatment. We compared pre- and post-treatment postero-anterior (PA) cephalometric analyses in order to evaluate asymmetry resolution. RESULTS: Comparison of measurements from pre- and post-therapy PA cephalograms showed resolution of mandibular asymmetries after treatment. The treatment resolved mandibular asymmetries and completely eliminated temporomandibular symptoms. CONCLUSIONS: Orthodontic treatment of patients presenting mandibular asymmetry enables correction of all TMJ symptoms and TMD. Mandibular symmetries can therefore be considered to constitute etiological or predisposing factors for the development of TMD.
Subject(s)
Facial Asymmetry/complications , Mandibular Diseases/complications , Temporomandibular Joint Disorders/etiology , Adolescent , Adult , Cephalometry/methods , Chin/pathology , Facial Asymmetry/therapy , Female , Humans , Joint Dislocations/etiology , Male , Malocclusion/complications , Malocclusion/therapy , Mandible/pathology , Mandibular Condyle/pathology , Mandibular Diseases/therapy , Masseter Muscle/physiology , Muscle Tonus/physiology , Orthodontics, Corrective , Orthognathic Surgical Procedures , Risk Factors , Temporal Muscle/physiology , Temporomandibular Joint Disc/pathology , Temporomandibular Joint Disorders/therapy , Tension-Type Headache/etiology , Treatment Outcome , Young Adult , Zygoma/pathologyABSTRACT
The "mandibular response" is pursued in treatment of Class II malocclusions by mandibular retrusion. The keys for correction of Class II malocclusion--in addition to a favorable natural growth--are differential diagnosis and a carefully monitored force system to allow a good dental movement and a satisfactory mandibular replacement.
Subject(s)
Malocclusion, Angle Class II/therapy , Mandible/growth & development , Adult , Alveolar Process/growth & development , Alveolar Process/pathology , Cephalometry , Child , Dentition, Mixed , Female , Humans , Incisor/pathology , Male , Malocclusion, Angle Class II/pathology , Mandible/pathology , Mandibular Condyle/growth & development , Mandibular Condyle/pathology , Maxilla/growth & development , Maxilla/pathology , Nasal Bone/pathology , Patient Care Planning , Retrognathia/pathology , Retrognathia/therapy , Sella Turcica/pathology , Skull Base/pathology , Vertical DimensionABSTRACT
OBJECTIVES: The aim of this study was to assess objectively some important factors for an accurate diagnosis and an optimal planning of finishing. The 8 criteria of the ABO "Objective Grading System"(OGS) were evaluated: alignment, marginal ridges, buccolingual inclination, overjet, occlusal contacts, occlusal relationships, interproximal contacts, and root angulation. This study focused on whether this method of evaluation is really applicable and useful in daily clinical practice. MATERIALS AND METHODS: 15 subject (7 males, 8 females), with ages ranging between 8.5 and 55 years, were retrospectively examined. Both pre-treatment and post-treatment criteria were analyzed using the OGS, and measurements were made with the special device as described by the ABO. For each parameter that deviated from normal, 1 or 2 points were subtracted. Descriptive statistics were performed for OGS scores. Additionally, differences between scores for the pre-treatment versus the post-treatment were assessed using Wilcoxon signed-rank test. RESULTS: All criteria used in the ABO OGS improved after treatment, except occlusal contacts. Alignment, overjet, occlusal relationships and root angulation improved significantly after treatment (p < .05). Marginal ridges, buccolingual inclination, interproximal contacts measurement did not show statistically significant differences between pre-treatment and post-treatment (p > .05). CONCLUSIONS: Only 3 of 15 examined cases lost 30 points or fewer and would have passed the ABO Phase III examination. Quantitative evaluation of the OGS criteria might help to attain better scores and achieve a more functional and aesthetic outcome. Pre-treatment and post-treatment use of this system can help clinicians to assess treatment difficulties, to set goals and achieve an achieve an objective finishing for completed patients.
