Long-Term Orthognathic Considerations in the Pierre Robin Sequence Patient.

BACKGROUND: One of the arguments against early intervention for micrognathia in Pierre Robin sequence is the concept that the growth of the mandible will eventually "catch up." Long-term growth of the mandible and occlusal relationships of conservatively managed Pierre Robin sequence patients remain unknown. In this study, the authors evaluated the orthognathic surgery requirements for Pierre Robin sequence patients at skeletal maturity. METHODS: Orthognathic surgical requirements of conservatively managed Pierre Robin sequence and isolated cleft patients (aged ≥13 years) at two institutions were reviewed and analyzed using t test, chi-square test, and Fisher's exact test. Values of p < 0.05 were considered statistically significant. RESULTS: Of the Pierre Robin sequence patients (n = 64; mean age ± SD, 17.9 ± 2.9 years), 65.6 percent were syndromic (primarily Stickler and velocardiofacial syndrome), 96.9 percent had a cleft palate, and 39.1 percent required orthognathic surgery at skeletal maturity. Nonsyndromic and syndromic Pierre Robin sequence patients demonstrated no differences in occlusal relationships or mandibular surgery frequency. The majority of Pierre Robin sequence patients requiring mandibular advancement had a class II occlusion. Comparison of Pierre Robin sequence patients to isolated cleft palate patients (n = 17) revealed a comparable frequency of orthognathic surgery between the two; however, Pierre Robin sequence patients did require mandibular advancement surgery at a greater frequency than cleft palate patients (p = 0.006). CONCLUSIONS: The present study found that 39.1 percent of conservatively managed Pierre Robin sequence patients required orthognathic surgery at skeletal maturity, of which the vast majority required mandibular advancement for class II malocclusion. These data suggest that mandibular micrognathia in conservatively managed Pierre Robin sequence patients may not resolve over time and may require surgical intervention. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Upper airway changes following single-step or stepwise advancement using the Functional Mandibular Advancer.

OBJECTIVES: Purpose of the present study was to determine and compare possible changes in the dimensions of the pharyngeal airway, morphology of the soft palate, and position of the tongue and hyoid bone after single-step or stepwise mandibular advancement using the Functional Mandibular Advancer (FMA). PATIENTS AND METHODS: The sample included 51 peak-pubertal Class II subjects. In all, 34 patients were allocated to two groups using matched randomization: a single-step mandibular advancement group (SSG) and a stepwise mandibular advancement group (SWG). Both groups were treated with FMA followed by fixed appliance therapy; the remaining 17 subjects who underwent only fixed appliance therapy constituted the control group (CG). The study was conducted using pre- and posttreatment lateral cephalometric radiographs. Data were analyzed by paired t test, one-way analysis of variance, and Pearson's correlation coefficient. RESULT: In the SWG and SSG, although increases in nasopharyngeal airway dimensions were not significant compared with those in the CG, enlargements in the oropharyngeal airway dimensions at the level of the soft palate tip and behind the tongue, and decreases in soft palate angulation, were significant. Tongue height increased significantly only in the SWG. Compared with the CG, while forward movement of the hyoid was more prominent in SSG and SWG, the change in the vertical movement of the hyoid was not significant. No significant difference between SWG and SSG was observed in pharyngeal airway, soft palate, tongue or hyoid measurements. CONCLUSIONS: The mode of mandibular advancement in FMA treatment did not significantly affect changes in the pharyngeal airway, soft palate, tongue, and hyoid bone.

The Effect of a Unique Pacifier on Anterior Open Bite and Overjet in the Primary Dentition: A Pilot Study.

PURPOSES: Pacifiers are the most common device used by children to satisfy their sucking needs. Because of their design, reports of anterior open bite and increased overjet are common. The purposes of this pilot study were to measure the effects of a unique pacifier in toddlers who have existing open bites and increased overjets; and secondly to determine the feasibility of recruiting and retaining toddlers for a six-month study. METHODS: Toddlers with existing open bite and increased overjet currently using a conventional pacifier were recruited from a university pediatric dental clinic. Baseline information was obtained. Visual examination and intraoral measurements were obtained. The study pacifier was introduced to replace the existing pacifier. Follow-up data was collected at three and six months post-intervention. RESULTS: Eight of the 11 toddlers (73 percent) completed the study. Recruitment was challenging because of the inclusion criteria and transportation; retaining participants required numerous reminders to parents. There was a significant difference between initial and final open bite and overjet measurements. CONCLUSION: It is feasible to recruit and retain toddlers but it required significant staff interventions. There was a significant improvement in reducing existing open bite and overjet with the pacifier after six months.

Hábitos bucales deformantes y maloclusiones dentarias en niños de 5-11 años, Matanzas, 2006 / Deforming buccal habits and dental malocclusions in children aged 5-11 years

Introducción: los hábitos bucales pueden alterar el normal desarrollo del sistema estomatognático, provocar un desequilibrio entre las fuerzas musculares y provocar la aparición de una deformación. Estos hábitos modifican la posición de los dientes, la relación y la forma que guardan las arcadas dentarias entre sí, interfiriendo en el crecimiento normal y en la función de la musculatura bucofacial. El propósito de este trabajo es identificar los niños afectados por prácticas de hábitos no nutritivos y su relación con la presencia de maloclusiones dentarias.Método: se realizó un estudio descriptivo y transversal en niños de 6 a 11 años, pertenecientes a las escuelas primarias del área de salud Policlínico de Milanés, en la ciudad de Matanzas. El universo estuvo integrado por 2 300 niños de los cuales fue seleccionada una muestra de tipo no aleatoria estratificada según edades, constituida por 506 escolares de ambos sexos matriculados en las escuelas primarias José A Echeverría y Manuel Ascunce, curso 2005-2006, que reciben atención en la Clínica Estomatológica Docente III Congreso del PCC. Se identificaron los hábitos: respiración bucal, succión digital y deglución atípica, y fue determinada su relación con las maloclusiones dentarias.Resultados: el 58,7 por ciento de niños fue identificado con hábitos bucales deformantes. La mayor prevalencia detectada estuvo en la deglución atípica (25,3 por ciento), seguidos por la respiración bucal (19,4 por ciento) y la succión digital (14,0 por ciento). Las maloclusiones de Clase II división 1 predominaron en los identificados con hábitos, cuyos valores fueron: 34,7 por ciento, 39,4 por ciento y 32 por ciento en los que presentaron respiración bucal, succión digital y deglución atípica, en ese orden. Hubo una disminución progresiva de los hábitos a medida que se incrementaron las edades...(AU)

Introduction: buccal habits may alter the stomatognathic system normal development; provoke disequilibrium among the muscular forces and cause deformation. These habits modify teeth position, the relation and form the dental arches keep between them, interfering in the normal grow and function of the buccal-facial muscles. The purpose of this term is identifying children affected by non-nutritive habits practices and their relation with dental malocclusion presence. Method: we carried out a cross sectional descriptive research in children aged 5-11 years, assisting to primary schools located in the health area of the Milanes policlinic, in Matanzas. The universe was formed by 2 300 children from which we selected an age-stratified, non-randomized sample of 506 male and female students assisting to Jose A. Echeverría and Manuel Ascunce Domenech primary schools, 2005-2006 school years, treated at the Teaching Stomatologic Clinic III Congreso del PCC. We identified the following habits: buccal breathing, digital suction and atypical swallowing, and we determined their relation with dental malocclusions.Results: 58,7 per cent of the children practiced deforming buccal habits. Atypical swallowing showed the highest prevalence (25,3 per cent), followed by buccal breathing (19, 4 per cent) and digital suction (14,0 per cent). Class II, division 1 malocclusions predominated in the children identified with deforming habits, and their values were: 34,7 per cent. 39,4 per cent and 32 per cent in those practicing buccal breathing, digital suction and atypical swallowing, in that order. There it was a progressive habit decrease proportional to age increase...(AU)

Tratamiento de maloclusion clase II con aparatología ortopédica funcional: Bionator: reporte de un caso / Treatment of malocclusion class II with orthopedic functional apliances: Bionator: a case report

La eficiencia en la corrección de la maloclusión de clase II, mediante la utilización de aparatos ortopédicos funcionales se ha reportado en la literatura desde tiempo atrás. Diferentes estudios han permitido esclarecer la forma en que los aparatos ortopédicos funcionales actúan sobre las estructura óseas, musculares, y dentales en pacientes que se encuentran en estadios previos al pico máximo puberal. Los aparatos ortopédicos funcionales aprovechan las fuerzas naturales del crecimiento y desarrollo, lo que logra una función normal del sistema estomatognático que garantiza adecuada masticación, deglución, fonación, mejora la estética y el autoestima del paciente en edades tempranas. El objetivo de este reporte de caso es mostrar los resultados satisfactorios que se logran con el tratamiento de maloclusiones clase II división 1 en pacientes jóvenes utilizando un aparato ortopédico funcional como el Bionator del Dr. Balters, también dar a conocer los cambios favorables tanto faciales, como dentales y cefalométricos, que fueron el resultado del diagnostico apropiado, selección adecuada del aparato ortopédico y excelente cooperación del paciente.

The efficiency of correction of Class II malocclusion, using functional appliances have been reported in the literature some time ago. Several studies have showed how functional orthopedic appliances act on bone, muscle, and dental structures of patients who are at stages prior to the pubertal growth peak. Functional appliances take advantage of the natural forces of growth and development which achieves a normal function of the stomatognathic system that ensures adequate chewing, swallowing, speech, aesthetics and improving patient’s selfesteem at early age. The purpose of this case report is to show how satisfactory results are achieved with the treatment of Class II division 1 malocclusion in young patients using a functional appliance as Dr. Balters Bionator. Also to present the positive facial, dental and cephalometric changes, which were the result of proper diagnosis, proper selection of the appliance and excellent cooperation of the patient.

Preventive orthodontics for the 5- to 7-year-old with the Nite-Guide technique.

This preventive orthodontic technique is applicable for the 5- to 7-year-old to prevent problems involving crowding, spacing, rotations, overbite, overjet, gummy smiles, Class II molar relations, and TMJ dysfunction from developing. The technique is based on accepted published research on the development of the dentition. Patients are typically started at 5 or 6 years of age and wear two preformed appliances only while sleeping. The active stage lasts about 2 years. The same appliance is used as a retainer until 12 years when the patient is dismissed About 75% to 80% do not require further orthodontics. The total procedure takes about 2 to 3 hours of total chair time.

Orthodontic intervention in the early mixed dentition: a prospective, controlled study on the effects of the eruption guidance appliance.

INTRODUCTION: A prospective, controlled cohort study was started in 1998 to investigate the effects of orthodontic treatment in the early mixed dentition with the eruption guidance appliance. METHODS: Occlusal changes were recorded in 167 treated children and 104 controls after they had reached the middle mixed-dentition stage. Treatment began when the first deciduous incisor was exfoliated (T1) and ended when all permanent incisors and first molars were fully erupted (T2). The children's mean ages were 5.1 years (SD 0.5) at T1 and 8.4 years (SD 0.5) at T2. RESULTS: From T1 to T2, overjet in the treatment group decreased from 3.1 to 1.9 mm and overbite from 3.2 to 2.1 mm. In the control group, overjet increased from 2.9 to 4.1 mm and overbite from 3.3 to 4.1 mm. At T2, the differences between the groups were highly significant (P <.001). At T1, 18% of the children in the treatment group and 22% of the controls had tooth-to-tooth contact between the maxillary and mandibular incisors. All others had an open bite, or the mandibular incisors were in contact with the palatal gingiva. At T2, tooth-to-tooth contact was observed in 99% of the treated children and 24% of the controls (P <.001). Almost half of children in both groups showed incisor crowding at T1. Good alignment of the incisors was observed in 98% of the treated children at T2, whereas maxillary crowding was found in 32% and mandibular crowding in 47% of the controls (P <.001). At T1, 41% of the children in the treatment group and 53% of the controls had a Class I relationship; the rest had either a unilateral or a bilateral Class II relationship. At T2, a Class I relationship was found in 90% of the treated children and 48% of the controls (P <.001). At least 1 occlusal deviation, including overjet > or =5 mm, overbite > or =5 mm, open bite, gingival contact of the mandibular incisors, crowding, or Class II relationship, was observed in 13% of the treated children, but the deviations were mild, and no child was considered to need treatment. In the control group, 88% of the children showed at least 1 occlusal deviation (P <.001). CONCLUSIONS: Treatment in the early mixed dentition with the eruption guidance appliance is an effective method to restore normal occlusion and eliminate the need for further orthodontic treatment. Only a few spontaneous corrective changes can be expected without active intervention.

A retrospective and prospective view of orofacial myology.

Orofacial myofunctional disorders include specific conditions or behaviors that can have a negative impact on oral postures and functions. Historically, interest has focused on behaviors in the horizontal plane, highlighted by tongue thrusting. Currently, the scope of practice also includes tongue forward posturing, lip incompetence, open mouth rest posture, thumb and finger sucking, bruxism, and biting habits involving lips, fingers, tongue and cheeks. The common denominator for myofunctional conditions is a change in the inter-dental arch vertical rest posture dimension, the dental freeway space. The purposes of myofunctional therapy include normalizing the freeway space dimension by eliminating noxious habits or postures related to freeway space change. Improving cosmesis with a lips-together rest posture is also an important treatment goal. The clinical significance of the freeway space is explained in terms of the dental consequences of differential eruption patterns that can develop from postural modification of the freeway space. When the freeway space is opened for extended periods beyond the normal range, the tongue can act as a functional appliance and contribute to the development of anterior open bite or a Class II malocclusion. A clinical procedure is proposed for evaluating the freeway space dimension and incorporating the information into treatment planning and evaluation of treatment success. While dentistry/orthodontics has a primary focus on dental occlusion, or teeth-together relationships, orofacial myologists focus on teeth-apart behaviors and postures that can lead to, or have already resulted in malocclusion.

Interdisciplinary study of orthopedic and orthodontic findings in pre-school infants.

BACKGROUND AND AIM: The assessment of correlations between orthopedic and orthodontic data based on interdisciplinary studies is of scientific and practical interest in the differentiation of preventive diagnostic and therapeutic fields between orthodontics and orthopedics. In the published literature there are various studies analyzing the correlations between specific Angle classes and orthopedic parameters. Results of these studies indicate a potential correlation between scoliosis and Class II malocclusion as well as between weak body posture and Class II malocclusion. The aim of the present interdisciplinary study was to examine correlations between orthodontic and orthopedic findings in pre-school infants and to evaluate them with respect to preventive recommendations. PATIENTS AND METHOD: 59 pre-school infants (29 boys, 30 girls) aged 3.5-6.8 years (mean: 5.0 years) were enrolled in this study. A standardized orthodontic and orthopedic examination protocol was used. RESULTS: The orthodontic examination showed Angle class distributions comparable with those in non-selected groups (Class I: 63%, Class II: 32%, Class III: 5%). The orthopedic examination revealed pathologic findings in 52% of the subjects, with statistically significant correlations between scoliosis and Class II malocclusion (p = 0.033) and between weak body posture and Class II malocclusion (p = 0.028). CONCLUSION: It can be concluded from the results that the orthodontic finding of Angle Class II in pre-school infants should induce prophylactic screening. The orthodontist could then not only initiate early orthodontic treatment to prevent incisor trauma in patients with extreme overjet, but could also take account of potential orthopedic malformations on a preventive interdisciplinary basis in pre-school infants with Class II malocclusions.

Pistas planas. Presentación de un caso / Flat tracks. A case presentation

Se presenta el caso de una paciente de 12 años, sexo femenino con maloclusión clase II división I de Angle, resalte 10 mms y sobrepase corona completa a la que se le coloca un aparato funcional de pistas planas, a los 8 meses de colocado se observa relación molar de clase I, resalte de 4 mms y sobrepase de tercio de corona, lo cual valoramos como una satisfactoria evolución

Comprehensive mixed dentition treatment.

At the University of the Pacific, mixed dentition treatment is an integral part in the graduate program in orthodontics. One patient had a severe skeletal ANB discrepancy of 7 degrees, lower incisors crowding, and 12 mm of overjet. He was considered an excellent candidate for Phase I treatment to reduce the severity of the problem. It is our philosophy to take advantage of the growth potential in a patient by initiating Phase I treatment between the ages of 7 and 9 years, depending on the eruption of the permanent first molars and incisors and the severity of the malocclusion. We use leeway space to resolve crowding and to align lower incisors in the early mixed dentition. We find that these young patients are more compliant with orthodontic treatment than most adolescent patients. If treatment was postponed until eruption of the permanent dentition, we would have one chance for correction of the problem rather than a Phase I and Phase II (if needed) approach. We believe that the key to successful Phase I treatment is this comprehensive approach to early treatment. The entire malocclusion is addressed at an early age rather than only addressing one or two problems and postponing the majority of the orthodontic correction until the permanent dentition.

[Indications for preventive removal of impacted third molars]. / Az impactált bölcsességfogak preventív eltávolításának indikációi.

The impacted third molars are clinically important due to the pathological alterations caused by them. It is important from orthodontic viewpoint, that during their development the anomalies combined with the constriction, or unsuitable length of the dental arch may lead to recrudescence. For this reason the preventive removal of impacted third molars is suitable at the proper stade of their development.