Long-term profile changes associated with successfully treated extraction and nonextraction Class II Division 1 malocclusions.

This study was undertaken to compare the post-treatment and long-term soft tissue profiles of successfully managed and stable Class II, division 1 malocclusions treated with either 4 first premolar extractions or nonextraction therapy. It was hypothesized that, if sound extraction decisions were made according to accepted treatment objectives and successful treatment outcomes were achieved, there should be no differences between groups in soft tissue profiles post-treatment and long-term post-retention. The sample consisted of 63 Caucasian adolescents (23 extraction, 40 nonextraction). Correction of the malocclusion was achieved using a combination of cervical headgear concurrent with mandibular growth and maxillary incisor retraction. Pretreatment, post-treatment, and long-term post-retention lateral cephalometric radiographs were evaluated. The soft tissue facial profiles of the extraction and nonextraction samples were the same following active treatment and long-term post-retention. Progressive flattening of the facial profile was observed in both samples. This flattening was attributed to the maturational changes associated with continued mandibular growth and nasal development and was not influenced by whether or not teeth were removed. Long-term lip positions were more retrusive than the ideals suggested by Ricketts and Steiner, but close to the values reported for normal, untreated adults of similar ages. The pretreatment position and thickness of the lower lip as well as the initial maxillomandibular skeletal relationship may be predictors of post-treatment or long-term lower lip position.

Comparison of soft tissue profile changes in serial extraction and late premolar extraction.

To assess soft tissue profile changes through time, a comparison was made of patients treated by serial extraction without subsequent orthodontic treatment (n=28), patients treated with serial extraction and orthodontic treatment (n=30), and patients treated orthodontically with late extraction (n=30). Cephalometric radiographs were traced and digitized; linear and angular measurements were made with a custom computer program that allowed digitization of specific soft tissue points. Maxillary, mandibular, and overall cephalometric superimpositions and linear measurements of change from the superimpositions were done by hand. Statistical analyses were made to determine if significant differences existed within each group at each time period and between groups at each time period, as well as between males and females at each time period. Data were also analyzed to determine if significant correlations existed between any hard tissue variable and any soft tissue variable, or between any soft tissue variable and any other soft tissue variable. It was found that in those patients treated with late premolar extraction, the most labial point of the mandibular incisor was more posterior from pretreatment to posttreatment than in the serial extraction group. While a great number of associations existed between variables, no significant differences were found between the soft tissue profiles of these three groups of patients. The gender differences that were found to exist were most likely due to normal maturational changes, not the treatment itself.

Postretention assessment of deep overbite correction in Class II Division 2 malocclusion.

The purposes of this study were to evaluate the long-term stability of deep overbite correction in Class II Division 2 malocclusion and to search for predictors of postretention overbite. The sample of 62 (31 males, 31 females) was limited to Class II Division 2 patients with initial deep overbite and successful orthodontic treatment as judged clinically at the end of treatment. Study models and cephalograms were analyzed before treatment, after treatment, and out of retention (average 15 years). The sample was divided into two groups according to the degree of postretention overbite: Group 1 (N=33; overbite > or = 4.0 mm at T3, mean = 5.17 +/- 0.87) and group 2 (N=29; overbite <4.0 mm at T3, mean = 2.95 +/- 0.87). The results showed that patients with very upright pretreatment maxillary and mandibular incisors tended to have deeper initial overbite and a tendency to return to their original relationship by the postretention stage. Posttreatment vertical growth contributed to maintenance of overbite correction. By stepwise multiple regression analysis, initial overbite was selected as the most important predictor of postretention overbite. Initial overbite was positively related with postretention overbite.

Stability and relapse of mandibular anterior alignment: University of Washington studies.

For more than 40 years, research in the Department of Orthodontics, University of Washington (Seattle, WA) has focused on a growing collection of more than 800 sets of patient records to assess stability and relapse of orthodontic treatment. All patients had completed treatment a decade or more before the last set of data. Evaluation of treated premolar extraction patients, treated lower incisor extraction patients, treated non-extraction cases with generalized spacing, patients treated with arch enlargement strategies, and untreated normals showed similar physiologic changes: (1) Arch length decreases after orthodontic treatment. (2) Arch width measured across the mandibular canine teeth typically reduces posttreatment, whether or not the case was expanded during treatment. (3) Mandibular anterior crowding during the posttreatment phase is a continuing phenomenon well into the 20-to-40 years age bracket and likely beyond. (4) Third molar absence or presence, impacted or fully erupted, seems to have little effect on the occurrence or degree of relapse. (5) The degree of post-retention anterior crowding is both unpredictable and variable and no pretreatment variables either from clinical findings, casts, or cephalometric radiographs before or after treatment seem to be useful predictors.

Early versus late treatment of crowded first premolar extraction cases: postretention evaluation of stability and relapse.

The purpose of this study was to evaluate the differences in the long-term stability of orthodontically induced changes in arch form between patients who receive early orthodontic treatment (Hellman's dental age III B, mixed dentition, n = 36) and those who are treated later (Hellman's dental age III C or after, permanent dentition, n = 47). Dental casts were evaluated before treatment, after treatment, and at a minimum of 10 years after retention. All patients had received routine edgewise orthodontic treatment that included maxillary and mandibular first premolar extraction. There were no significant differences between these groups at pretreatment and posttreatment. In the majority of cases, some degree of mandibular crowding occurred during the postretention period. There was a significant difference in the mandibular irregularity index at postretention between these groups. Regarding the deviation of the midline of the central incisors, there were no significant differences between these groups at pretreatment and posttreatment, but there was a significant difference at postretention. At the postretention stage, the late treatment group had greater mandibular anterior irregularity and deviation of the midline.

Long-term stability of mandibular incisors following successful treatment of Class II, Division 1, malocclusions.

The purpose of this study was to evaluate the long-term stability of mandibular anterior alignment in a large group of Class II, Division 1, patients who demonstrated successful occlusal results at the end of active treatment. The specific aim was to search for predictors of relapse and associations between relapse and other post-retention changes. The sample of 78 adolescents was limited to successfully treated cases as judged by subjective evaluation of intercuspation and incisor occlusion of posttreatment study models. Neither cephalometric characteristics nor post-retention occlusion were considered in sample selection. Of these patients, study models and cephalograms were available pretreatment, at the end of active treatment, and a mean of 14 years post-retention. The results demonstrated an increase of incisor irregularity and a reduction of intercanine width and arch length post-retention. At post-retention, 9.0% had irregularity index values of 6.5 mm or more and 47.4% had values equal to 3.5 mm or less. Stepwise backward multiple regression analyses revealed that narrow pretreatment intercanine width and high pretreatment incisor irregularity were significant predictors of relapse. Treatment increase of intercanine width and post-retention decrease of intercanine width and arch length were associated with relapse.

Long-term changes in arch form after orthodontic treatment and retention.

The purpose of this study was to evaluate the long-term stability of orthodontically induced changes in maxillary and mandibular arch form. Dental casts were evaluated before treatment, after treatment, and a minimum of 10 years after retention for 45 patients with Class I and 42 Class II, Division 1 malocclusions who received four first premolar extraction treatment. Computer generated arch forms were used to assess changes in arch shape over time. Buccal cusp tips of first molars, premolars, and canines plus mesial, distal, and central incisal aspects of incisors were marked, photocopied, and digitized in a standardized manner. An algorithm was used to fit conic sections to the digitized points. The shape of the fitted conics at each time period was described by calculating the parameter eccentricity; a small value represented a more rounded shape and a larger value represented a more tapered shape. Findings demonstrated a rounding of arch form during treatment followed by a change to more tapered. Arch form tended to return toward the pretreatment shape after retention. The greater the treatment change, the greater the tendency for postretention change. However, individual variation was considerable. The patient's pretreatment arch form appeared to be the best guide to future arch form stability, but minimizing treatment change was no guarantee of postretention stability.

Long-term stability of Angle Class II, division 1 malocclusions with successful occlusal results at end of active treatment.

The purpose of this study was to examine long-term stability of Angle Class II, Division 1 malocclusions with successful occlusal results at the end of active appliance therapy, search for predictors of relapse, and look for characteristics associated with successful treatment. Records taken before and after treatment and a mean of 14.0 years postretention of adolescent patients treated for a significant Angle Class II, Division 1 malocclusion both with and without tooth extraction were evaluated. The sample was limited to successfully treated cases as judged by subjective evaluation of intercuspation and incisor occlusion of posttreatment study models and included 78 patients. Cephalometric characteristics or postretention occlusion was not considered in sample selection. The mode response was no change postretention for molar, premolar, and canine relationships and relapse of 0.5 mm for overjet and overbite. Maximum relapse was 3.5 mm for molar, premolar, and canine relationship, 3 mm for overjet, and 4.5 mm for overbite. Stepwise backward multiple regression analyses revealed no associations between either pretreatment characteristics or skeletal and dental treatment changes and relapse of overjet. However, relapse of overjet was associated with relapse of molar, premolar, and canine relationships, postretention increase in overbite, postretention proclination of maxillary incisors, and postretention retroclination of mandibular incisors. Active treatment changes included redirection or inhibition of maxillary growth and retraction of maxillary incisors. Mandibular incremental growth was favorable both during and after treatment. It was concluded that successful correction of Angle Class II, Division 1 malocclusions through differential growth adaptation and tooth movement appears to be very stable.

An investigation of maxillary superimposition techniques using metallic implants.

The purpose of this study was to determine if there are discernable, stable, anatomic landmarks in the maxilla that may reliably be used for maxillary superimposition. It was hypothesized that, through the evaluation of cephalometric radiographs of patients with metallic implants, such anatomic landmarks could be identified. The material for this study consisted of pairs of cephalometric radiographs from 50 subjects, 23 males and 27 females ages 8.7 to 20.3 years. All films were taken at least 3 years apart. The mean age at the time of the first film was 11.9 +/- 1.4 years, and the mean age at the time of the second film was 16.0 +/- 1.7 years. The two serial tracings from each subject were superimposed on the implants and evaluated for best fit of anatomic structures. The maximum distance that the structures varied from perfect superimposition was measured. Rotational changes of the maxilla relative to the cranial base and of the palatal plane relative to the maxilla were evaluated. In the vertical plane, the floor of the orbit raised more than the palatal plane lowered by an average ratio of 1.5 to 1 mm. The maxilla demonstrated varying degrees and directions of rotation relative to the cranial base. The palatal plane demonstrated varying degrees and directions of rotation within the maxilla. Internal structure of the palate was of limited value as a stable area of registration. Infraorbital foramen, PTM, ANS, PNS, A point, and superior and inferior borders of the palate were not found to be stable landmarks for maxillary superimposition.(ABSTRACT TRUNCATED AT 250 WORDS)

Mandibular incisor extraction--postretention evaluation of stability and relapse.

Pretreatment, posttreatment and 10-year postretention dental cast and lateral cephalogram records of 42 patients were evaluated. Each patient had undergone edgewise orthodontic treatment following removal of one or two mandibular incisors and various maxillary teeth. Seven of 24 patients (29%) in the single-incisor extraction group and 10 of 18 (56%) patients in the two-incisor extraction group demonstrated unacceptable mandibular incisor alignment at the postretention stage. This result was considerably more favorable than the results of previously reported premolar extraction cases (70% unacceptable alignment at postretention). Intercanine width decreased during treatment and continued to decrease postretention in most cases. Overbite and overjet remained acceptable. No associations could be found to predict the amount of relapse.

Mandibular second premolar extraction--postretention evaluation of stability and relapse.

The dental casts and cephalometric radiographs of 46 patients, treated with mandibular second premolar extraction and edgewise orthodontic mechanotherapy, were evaluated for changes over a minimum 10-year postretention period. The sample was divided into two groups: early (mixed dentition) extraction of mandibular second premolars and late (permanent dentition) extraction of mandibular second premolars. Results showed no difference in long-term stability between the two groups. Arch length and arch width decreased with time and incisor irregularity increased throughout the postretention period. No predictors or associations could be found to help the clinician in determining the long-term prognosis in terms of stability. The sample was regrouped according to the postretention degree of incisor irregularity. Statistically significant differences in cephalometric measurements were found between the minimally crowded group and the moderately to severely crowded group.

Stability and relapse of dental arch alignment.

For more than 35 years, research in the Department of Orthodontics, University of Washington has focused on a growing collection of over 600 sets of patient records to assess stability and failure of orthodontic treatment. All had completed treatment a decade or more prior to the last set of data. Evaluation of treated premolar extraction cases, treated non-extraction cases with generalized spacing, cases treated by arch enlargement strategies, and untreated normal occlusions demonstrate similar physiological changes. 1. Arch length reduces following orthodontic treatment, but also does so in untreated normal occlusions. 2. Arch width measured across the mandibular canine teeth typically reduces post-treatment whether the case was expanded during treatment or not. 3. Mandibular anterior crowding during the post-treatment phase is a continuing phenomenon well into the 20-40 age bracket and likely beyond. 4. Third molar absence or presence, impacted or fully erupted, seems to have little effect on the occurrence or degree of relapse. 5. The degree of post-retention anterior crowding is both unpredictable and variable and no pretreatment variables either from clinical findings, casts, or cephalometric radiographs before or after treatment seem to be useful predictors.

Mandibular arch length increase during the mixed dentition: postretention evaluation of stability and relapse.

Increasing mandibular arch length to resolve crowding has long been debated as a treatment method. Twenty-six patients with records obtained before treatment, after treatment, and a minimum of 6 years out of retention were assessed. All the patients showed a loss of treatment arch length increase with only 6 of 26 patients showing any gain over pretreatment dimensions. Width constriction was a consistent finding, as was crowding of anterior teeth after retention. In 89% the postretention record demonstrated clinically unsatisfactory alignment. Lateral cephalometric superimposition of mandibles showed variable molar and incisor change after retention. As teeth erupted after treatment, mesial molar movement and lingual tipping of incisors were the most common cephalometric findings.

A long-term study of the relationship of third molars to changes in the mandibular dental arch.

The purpose of this study is to determine the relationship of third molars to changes in the mandibular dental arch. The sample for this study consisted of four groups and subgroups. The groups consisted of premolar extraction treated, nonextraction treated with initial generalized spacing, nonextraction treated, and serial extraction untreated subjects. The subgroups were divided into persons who had mandibular third molars that were either impacted, erupted into function, congenitally absent, or extracted at least 10 years before postretention records. The mean postretention time interval was 13 years, with a range of 10 to 28 years. The mean postretention age was 28 years 6 months, with a range of 18 years 6 months to 39 years 4 months. Two-way analysis of variance with repeated measures was used to compare the changes over time (before treatment, at end of active treatment, and after retention) of groups and third molar subgroups. With time, mandibular incisor irregularity increased while arch length and intercanine width decreased. The eruption patterns of mandibular incisors and first molars were similarly dispersed in all groups studied. The findings between the subgroups in which mandibular third molars were impacted, erupted into function, congenitally absent, or extracted 10 years before postretention records revealed no significant differences between any of the subgroups for the parameters studied. No significant differences in mandibular growth were found between the third molar subgroups; this suggests that persons with third molars erupted into satisfactory function do not have a significantly different mandibular growth pattern than those whose third molars are impacted or congenitally missing. In the majority of cases some degree of mandibular incisor crowding took place after retention, but this change was not significantly different between third molar subgroups. This finding suggests that the recommendation for mandibular third molar removal with the objective of alleviating or preventing mandibular incisor irregularity may not be justified.

Stability of mandibular incisors following excessive proclination: a study in adults with surgically treated mandibular prognathism.

The purpose of this study was to determine if mandibular incisors could be proclined markedly without increasing the potential for relapse of crowding. Patients with surgically treated mandibular prognathism were selected. In 29 patients the mandibular incisors were proclined more than 10 degrees during the presurgical orthodontic phase. The remaining 33 patients had only minimal change in incisor inclination. A long-term follow-up examination was performed 10.0 (SD 2.3) and 11.1 (SD 3.1) years postoperatively in 26 and 24 patients, respectively. Study casts were measured before and after treatment, three years after surgery, and long-term. Cephalograms were evaluated before and after treatment, immediately before and after surgery, and three years after surgery. Prior to therapy the patients treated with presurgical proclination had less dental arch length and more retroclined and crowded mandibular incisors than the patients in the other group. No differences in parameters were observed at later intervals. Dental arch length and intercanine width decreased and incisor irregularity increased in both groups during the follow-up periods. No intergroup differences in changes were observed. Indications for proclination of mandibular incisors are discussed.

Serial extraction of first premolars--postretention evaluation of stability and relapse.

Case records were evaluated for 30 patients who had undergone serial extraction of deciduous teeth plus first premolars followed by comprehensive orthodontic treatment and retention. Diagnostic records were available for the following stages: pre-extraction, start of active treatment, end of active treatment, and a minimum of 10 years postretention. All cases were treated with standard edgewise mechanics and were judged clinically satisfactory by the end of active treatment. Twenty-two of the 30 cases (73%) demonstrated clinically unsatisfactory mandibular anterior alignment postretention. Intercanine width and arch length decreased in 29 of the 30 cases by the postretention stage. There was no difference between the serial extraction sample and a matched sample extracted and treated after full eruption.

Postretention evaluation of stability and relapse--mandibular arches with generalized spacing.

Assessment of cases that had been out of retention a minimum of 10 years and had displayed generalized spacing of anterior teeth before treatment showed consistent reduction of arch length and intercanine width into adult years. Intercanine width constriction typically occurred while arch length decreased in every case, both width and length reduction being progressive with time. Crowding was minimal for the majority of cases; few demonstrated the severe crowding more typical of cases with pretreatment crowding.

An evaluation of changes in mandibular anterior alignment from 10 to 20 years postretention.

Pretreatment, end of treatment, 10-year postretention, and 20-year postretention records of 31 four premolar extraction cases were assessed to evaluate stability and relapse of mandibular anterior alignment. Crowding continued to increase during the 10- to 20-year postretention phase but to a lesser degree than from the end of retention to 10 years postretention. Only 10% of the cases were judged to have clinically acceptable mandibular alignment at the last stage of diagnostic records. Cases responded in a diverse unpredictable manner with no apparent predictors of future success when considering pretreatment records or the treated results.

Preliminary X-ray crystallographic study of cyanase from Escherichia coli.

Cyanase, an oligomeric enzyme of Escherichia coli that catalyzes the decomposition of cyanate to ammonia and bicarbonate, crystallizes in the space group P1 with unit cell parameters a = 85.96 A, b = 83.17 A, c = 83.28 A, alpha = 110.29 degrees, beta = 118.29 degrees and gamma = 72.40 degrees. Crystals diffract to a resolution of at least 2.5 A. The crystal data, in conjunction with a subunit molecular weight of 17,008, suggest that two oligomers are in the asymmetric unit of the crystal and that eight subunits comprise a single oligomer.

Structural properties of cyanase. Denaturation, renaturation, and role of sulfhydryls and oligomeric structure in catalytic activity.

Cyanase is an inducible enzyme in Escherichia coli that catalyzes bicarbonate-dependent decomposition of cyanate to give ammonia and bicarbonate. The enzyme is composed of 8-10 identical subunits (Mr = 17,008). The objective of this study was to clarify some of the structural properties of cyanase for the purpose of understanding the relationship between oligomeric structure and catalytic activity. Circular dichroism studies showed that cyanase has a significant amount of alpha-helix and beta-sheet structure. The one sulfhydryl group per subunit does not react with 5,5'-dithiobis-(2-nitrobenzoic acid) (DTNB) unless cyanase is denatured. Denaturation is apparently complete in 10 M urea or 6 M guanidine hydrochloride, but is significantly reduced in 10 M urea by the presence of azide (analog of cyanate) and is incomplete in 8 M urea. Denatured cyanase could be renatured and reactivated (greater than 85%) by removal of denaturants. Reactivation was greatly facilitated by the presence of certain anions, particularly bicarbonate, and by high ionic strength and protein concentration. The catalytic activity of renatured cyanase was associated only with oligomer. Cyanase that had been denatured in the presence of DTNB to give a cyanase-DTNB derivative could also be renatured at 26 degrees C to give active cyanase-DTNB oligomer. The active oligomeric form of the cyanase-DTNB derivative could be converted reversibly to inactive dimer by lowering the temperature to 4 degrees C or by reduction of the ionic strength and removal of monoanions. These results provide evidence that free sulfhydryl groups are not required for catalytic activity and that catalytic activity may be dependent upon oligomeric structure.