Effects of headgear timing on dental arch changes from 7 to 18 years of age: a follow-up study.

BACKGROUND: Dental arch effects after cervical headgear (CHG) treatment have been researched from several different perspectives. However, the long-term effects of CHG timing are still unknown. OBJECTIVES: To analyse the long-term effects of CHG timing on dental arches. MATERIAL AND METHODS: A total of 67 children with Angle Class II malocclusion comprised the study group in this trial. The participants were randomized into two equal-sized groups. In the early group (EG, n = 33), treatment was started after the eruption of the first upper molars. In the later-timed group (LG, n = 34), treatment was started 18 months later compared with the early group. Long-term effects were measured from dental casts taken at five time points between 7 and 18 years of age. RESULTS: The total maxillary dental arch length was achieved earlier, the gained length persisted better in the long term, and significantly more space was achieved in EG compared with LG (P = .048). The intermolar width in the maxillary dental arch was more stable and was reached earlier in EG compared with LG (P = .002). The results showed that in terms of total mandibular arch length increases, EG males benefited the most and LG females the least from CHG treatment (P = .031). CONCLUSIONS: Both genders benefited from earlier CHG treatment. The maxillary dental arches remained longer, and the final width was gained earlier in EG compared with LG.

Occlusal characteristics and oral health-related quality of life in adults operated due to sagittal synostosis in childhood: a case-control study with 26 years of follow-up.

PURPOSE: The aim of this case-control study was to investigate occlusal characteristics, received orthodontic treatment, oral health-related quality of life (OHRQoL), and satisfaction with dental esthetics in adults operated due to sagittal synostosis. METHODS: The study group consisted of 40 adults (25 males, 15 females, mean age 27.4 years, range 18-41) who were operated due to isolated sagittal synostosis in childhood. The control group comprised 40 age and gender-matched adults. Occlusal characteristics were evaluated clinically during study visits. Information on the previous orthodontic treatment was collected from dental records. OHRQoL was measured using the 14-item Oral Health Impact Profile (OHIP-14), and satisfaction with dental esthetics was evaluated using a visual analogue scale. RESULTS: No statistically significant differences were found between the patient group and the controls in malocclusion traits (overjet, overbite, molar relationships, crossbite, scissor bite), previous orthodontic treatment, pre-treatment malocclusion diagnoses, OHIP variables, or satisfaction with dental esthetics. However, there was a tendency toward increased overjet and overbite in scaphocephalic patients. CONCLUSION: It seems that adults with scaphocephaly operated in childhood do not differ from the average population in terms of occlusion, received orthodontic treatment, or oral health-related well-being.

Pathogenic REST variant causing Jones syndrome and a review of the literature.

Jones syndrome is a rare dominantly inherited syndrome characterized by gingival fibromatosis and progressive sensorineural hearing loss becoming symptomatic in the second decade of life. Here, we report a father and his two daughters presenting with a typical Jones syndrome (OMIM %135550) phenotype. Exome sequencing identified a repressor element 1-silencing transcription factor (REST, OMIM *600571) (NM_005612.5) c.2670_2673del p.(Glu891Profs*6) heterozygous variant segregating with Jones syndrome in the family. We review the clinical data from all previously published patients with Jones syndrome and previously published patients with pathogenic REST variants associated with gingival fibromatosis or sensorineural hearing loss. This study suggests that pathogenic REST variants cause Jones syndrome.

Comparison of effects of cervical headgear treatment on skeletal facial changes when the treatment time is altered: a randomized controlled trial.

BACKGROUND: There is a lack of evidence based on longitudinal information in the field of Class II malocclusion management with cervical headgear (CH), especially in a randomized setting. OBJECTIVES: The main objective of this study was to evaluate skeletal facial changes, particularly in vertical dimensions, after Kloehn-type CH treatment in children when the timing of treatment is altered. TRIAL DESIGN: Prospective, parallel-group, randomized controlled trial. METHODS: Screened children with Class II malocclusion were randomized in 1:1 ratio to two groups of equal size by sealed-envelope randomization: the early group (EG), where active CH treatment was started at the age of 7.8 years, and the late group (LG), where CH treatment was started at the age of 9.5 years. The active treatment was continued until normal Class I occlusion on first molars was achieved. Cephalograms were taken at three different time points. Changes in cephalometric measurements were compared between groups and genders. Blinding was applicable for outcome evaluation. RESULTS: Of 67 randomized children, 56 completed the study. Upper face height increased during the CH treatment phase, as the parameter N-ANS increased significantly during the active treatments of EG (P < 0.05) and LG (P < 0.05). Also, the parameter NSL-PL increased significantly during the treatment of EG (P < 0.01) and during the treatment of LG (P < 0.01). The Gonial angle decreased significantly in the early CH treatment group compared to the later treatment group (T0-T2: P < 0.01). CH improved the antero-posterior jaw relationship. No harms were encountered. CONCLUSIONS: Although the upper face height increased, the mandible showed anterior rotation after CH treatment. The Gonial angle was significantly decreased in the EG compared to the LG. There were gender-specific differences in both sagittal and vertical dimensions when examining interrelations in dimensional changes. The differences found between the early and later treatment groups were not clinically important when the cephalometric results are considered. CLINICAL REGISTRATION: ClinicalTrials.gov (NCT02010346).

Dental arch effects after early and later timed cervical headgear treatment-a randomized controlled trial.

BACKGROUND: Cervical headgear (CH) is a commonly used orthodontic appliance and its dentoalveolar changes are known. However, the effects related to gender and timing have gained less attention. OBJECTIVES: To examine dimensions of dental arches among children with Class II occlusion without posterior mandibular rotation according to timing of Kloehn-type CH treatment. TRIAL DESIGN: Prospective, randomized, parallel-group controlled trial. METHODS: Sixty-seven seven-year-old children with a Class II occlusion were included in the study. The children were randomized into two equal-size groups in 1:1 ratio by sealed-envelope randomization. The early group (EG, n = 33) was treated between T0 and T1 (26 months), right after eruption of the first maxillary molars. The late group (LG, n = 34) was treated between T1 and T2 (24 months). The children were treated with CH until normal Class I occlusion on first molars was achieved. Impressions for dental casts were taken from all participants at T0, T1, and T2. Blinding was applicable for outcome assessors. Changes in dental cast measurements were compared between the groups and genders using t-test, Mann-Whitney U-test, and repeated measures analysis of variance. RESULTS: Of the children, 56 completed the study. The maxillary arch length and the transversal changes between the upper canines and upper first molars were significantly increased in EG at T0-T1 (P < 0.001). At T2, the transversal dimension between the upper first molars was larger (P < 0.05), and in the lower arch the mandibular arch length (P < 0.05) and the transversal dimension between the lower first molars (P < 0.01) were increased in EG males compared to LG males. No harms were encountered. CONCLUSIONS: The male gender benefits most from early timing of the CH treatment, showing larger dimensions at the end of the follow-up. The results clearly indicated a wider and longer upper dental arch and spontaneous expansion of the lower dental arch after treatment. CLINICAL REGISTRATION: NCT02010346.

Dental age assessment on panoramic radiographs: Comparison between two generations of young Finnish subjects.

OBJECTIVE: To analyse the accuracy of a meta-analysis-based dental age assessment (DAA) method in Finnish paediatric patients and to compare the dental development between two generations of Finnish children. METHODS: Panoramic radiographs of Finnish Caucasian healthy children from two generations (early: born 1981-1984; subsequent: born 1996-2008) were analysed. All developing teeth on the left maxilla and mandible as well as the third permanent molars were analysed following Demirjian's classification. For each patient, dental age was calculated and compared with chronological age. Dental maturation patterns between the two groups were compared. RESULTS: The study included 200 Finnish Caucasian healthy children from two generations (early: aged 7-13 years; subsequent: aged 6-15 years). In the early generation, DAA underestimated the chronological age by a mean of 3.15 years. The underestimation was only 0.11 years in patients < 10 years, but 3.86 years in patients ≥ 10 years. In the subsequent generation, the dental age was overestimated by a mean of 0.34 years; by 0.40 years in patients < 10 years and by 0.08 years in patients ≥ 10 years. CONCLUSIONS: The present DAA method is applicable to current Finnish children. Differences in dental development between two generations of Finnish children were detected.

Does headgear treatment in young children affect the maxillary canine eruption path?

Objective: To test whether early headgear (HG) treatment and space conditions in the dental arch affect the eruption pathway of the maxillary canines in young children with mixed dentition. Subjects and methods: Data from two randomized controlled trials studying the effects of early HG treatment were pooled, yielding a study sample comprising 99 children (38 girls and 61 boys, mean age 7.6 years) with Angle Class II occlusion. Fifty-one children were treated with HG and 48 children served as an untreated control group (CG). Digital 3D models and panoramic radiographs were taken before (T0) and after (T1) treatment, and changes in the maxillary canine eruption angle and interdental spaces were measured at T0 and T1. A paired samples t-test was used to assess changes in maxillary canine angulation, and an independent samples t-test was used to evaluate the effect of HG treatment on spacing in the dental arch. Associations between intra-arch space conditions and changes in maxillary canine angulation were estimated with linear regression models. Results: The eruption pattern of the permanent canine was significantly more vertical in the HG group than in the CG. The linear regression models showed a statistically significant association among the intercanine distance, crowding in the anterior part of the maxilla, and changes in the maxillary canine eruption angle. The maxillary canine eruption pattern changed significantly more to a vertical direction in spaced dental arches than in crowded dental arches in the HG group. Conclusion: This study shows that early HG treatment in children with Angle Class II occlusion may change the eruption pattern of permanent maxillary canines to a more vertical direction. This change appears to be related to space conditions in the maxillary arch, especially in the intercanine region, with more effect in children with spaced dental arches than in children with crowded dental arches.

Airway and hard tissue dimensions in children treated with early and later timed cervical headgear-a randomized controlled trial.

Background: A Kloehn-type cervical headgear (CH) aims to correct skeletal jaw discrepancy in Class II children. A few studies have reported CH treatment effects on airway dimensions, but none of them have been randomized according to timing. Objectives: To evaluate related craniofacial structures and pharyngeal airway dimensions in children with a Class II occlusion treated with CH and randomized into early and late treatment groups. Trial design: Randomized, parallel-group, prospective controlled trial. Methods: The material comprised 67 seven-year-old children with a Class II occlusion. Sealed-envelope randomization in 1:1 ratio was used to divide the children into two equal groups. In the early group (EG, n = 33), CH treatment was started immediately or after eruption of the first maxillary molars. In the second, late group (LG, n = 34), the active CH treatment was started about one and half year later. The active CH treatment was continued in both groups until normal Class I occlusion on first molars was achieved. Cephalometric radiographs were taken from both groups at the beginning of follow-up (T0), at the beginning of CH treatment of the second group (T1), and at the end of CH treatment of the second group (T2). Changes in cephalometric measurements were used as primary outcomes. Blinding was applicable for outcome assessment. Results: Fifty-six children completed the study. The posterior change in the position of the maxilla was significant for early treatment males at T0-T1 (SNA; P < 0.001, ANB; P = 0.009) and T0-T2 (SNA; P = 0.012). The palato-mandibular angle (PL-ML) decreased during T0-T1 in early treatment females (P = 0.018) and early treatment males (P = 0.037). The retroglossal airway increased (P = 0.010) in early treatment males at T0-T1. Highly significant positive correlations (P < 0.001) between skeletal and upper airway dimensions during early CH treatment were found in males. No harms were encountered. Conclusions: Despite the effective CH treatment, no harmful upper airway changes were found. Clinical Registration: NCT02010346.

Long-term soft-tissue response to orthodontic treatment with early cervical headgear--a randomized study.

INTRODUCTION: The purpose of this longitudinal randomized investigation was to determine the long-term changes in the soft-tissue profile during orthodontic treatment when treatment is started with headgear (HG) in the early mixed dentition. METHODS: The subjects were 68 children (28 girls, 40 boys; mean age, 7.6 years; SD, 0.3 years) with a Class II tendency in occlusion and moderate crowding. They were randomly divided into 2 groups. In the HG group, treatment began immediately. No other appliances were used during the first 2 years. In the control group, only minor interceptive procedures were performed during the first follow-up period of 2 years. During the 8-year follow-up, orthodontic treatment, if needed, comprised fixed appliances and possible extractions in both groups. Twenty linear and 5 angular soft-tissue measurements were registered from lateral cephalograms taken before treatment and after follow-up-periods of 2, 4, and 8 years. RESULTS: The major findings were that, at the 8-year follow-up, the soft-tissue chin and the lower lip were significantly thicker, and the mentolabial sulcus was significantly deeper in the HG group than in the control group. In the control group, a larger variation in the upper lip position was found because of more extractions in this group. CONCLUSIONS: Early HG treatment has only a minor effect on the soft-tissue profile. The main effects are on the thickness of the soft-tissue chin and the contour of the lower lip. The differences were not otherwise significant during the long-term follow-up.

Early headgear effects on the eruption pattern of the maxillary canines.

OBJECTIVE: To test the null hypothesis that early headgear (HG) treatment has no effect on the eruption pattern of the maxillary canines in the early mixed dentition. MATERIALS AND METHODS: Sixty-eight children (40 boys and 28 girls) with a Class II tendency in occlusion and moderate crowding of the dental arches were randomized into two groups. HG treatment was initiated immediately in the first group. In the second group only minor interceptive procedures were performed during the first follow-up period of 2 years. Orthopantomograms were taken at the baseline, three times at 1-year intervals, and after growth at the age of 16. Eruption geometry was performed. The space from the maxillary first molar to the lateral incisor was measured on the dental casts. RESULTS: The inclination of the maxillary canine in relation to the midline appeared to be significantly more vertically oriented on the right side in the HG group 1 and 2 years after starting the HG therapy (P = .0098 and P = .0003, respectively). The inclination in relation to the lateral incisors was smaller in the HG group bilaterally after 1 year and 2 years of HG treatment, and on the right side after 3 years of treatment. CONCLUSION: The hypothesis is rejected. Early HG treatment significantly affects the inclination of the maxillary canine during eruption. The strongest influence was seen after 2 years of HG use, more prominently in the right-side canine.

A randomized controlled study of early headgear treatment on occlusal stability--a 13 year follow-up.

The purpose of this investigation was to assess the long-term occlusal stability in a group treated early with headgear (HG) compared with a control group. The total study group comprised 68 children (40 males and 28 females) aged 7.6 years (standard deviation 0.3), randomly divided into two groups of equal size. In the first group, HG treatment was initiated immediately, while in the control group only minor interceptive procedures were performed during the follow-up period. Fixed appliance treatment, if needed, including extraction of permanent teeth due to crowding, was undertaken after the completion of early treatment. The records were available from the start of the early treatment and at follow-up after 2, 4, 8, and 13 years. The US-weighted Peer Assessment Rating (PAR) Index, graded according to the severity of malocclusion, was used to evaluate occlusal stability. Little's Irregularity Index (LII)and intercanine distance in the lower arch were measured at all time periods. The Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) scores was used for evaluation of dental aesthetics at the last follow-up. Parametric tests were applied for statistical analyses, except for the evaluation of aesthetics, where a non-parametric test was used. No significant differences were found when long-term stability between the HG and control groups was evaluated at the 13 year follow-up. Lower PAR scores were observed in patients treated without extraction of teeth. A greater irregularity in lower incisor alignment before treatment was found in subjects later treated with extractions. The findings of this study seem to suggest that treatment timing has only a minor influence on stability.