Outcomes of different Class II treatments : Comparisons using the American Board of Orthodontics Model Grading System.

OBJECTIVE: The aim of this study was to evaluate the clinical outcomes of three different Class II treatment modalities followed by fixed orthodontic therapy, using the American Board of Orthodontics Model Grading System (ABO-MGS). MATERIALS AND METHODS: As a retrospective study, files of patients treated at postgraduate orthodontic  clinics in different cities in Turkey was randomly selected. From 1684 posttreatment records, 669 patients were divided into three groups: 269 patients treated with extraction of two upper premolars, 198 patients treated with cervical headgear, and 202 patients treated with functional appliances. All the cases were evaluated by one researcher using ABO-MGS. The χ (2), Z test, and multivariate analysis of variance were used for statistical evaluation (p < 0.05). RESULTS: No significant differences were found among the groups in buccolingual inclination, overjet, occlusal relationship, and root angulation. However, there were significant differences in alignment, marginal ridge height, occlusal contact, interproximal contact measurements, and overall MGS average scores. The mean treatment time between the extraction and functional appliance groups was significantly different (p = 0.017). CONCLUSION: According to total ABO-MGS scores, headgear treatment had better results than functional appliances. The headgear group had better tooth alignment than the extraction group. Headgear treatment resulted in better occlusal contacts than the functional appliances and had lower average scores for interproximal contact measurements. Functional appliances had the worst average scores for marginal ridge height. Finally, the functional appliance group had the longest treatment times.

Tratamento ortodôntico-restaurador em paciente com avulsão de incisivos centrais superiores: relato de caso / Orthodontic-restorative treatment in patients with avulsion of the maxillary central incisors: case report

O traumatismo dentário é uma ocorrência comum com impacto negativo na qualidade de vida das crianças. A avulsão de dentes permanentes é uma séria injúria dental na qual os incisivos centrais superiores são os dentes mais afetados. Existem várias opções de tratamento e a escolha adequada depende da avaliação individual de cada caso. O Programa de Traumatismos Dentários da Faculdade de Odontologia da UFMG abrange várias especialidades que, no intuito de melhorar a qualidade de vida, desenvolve ações que oferecem um tratamento de qualidade para vítimas de traumatismos dentários. Este trabalho apresenta, a partir de um relato de caso clínico, a abordagem ortodôntica e restauradora em um paciente jovem que sofreu avulsão de incisivos centrais superiores e foi tratado neste Programa. Devido ao desequilíbrio vertical e falta de selamento labial, foi definido executar uma mecânica ortodôntica de fechamento de espaços e realização final de facetas pré-fabricadas em resina composta, no intuito de devolver ao paciente estética e função. Esta terapêutica mostrou-se efetiva, podendo ser uma opção útil no tratamento em avulsões. O Programa de Traumatismos Dentários mostrou sua articulação com a resolutividade no tratamento de um paciente traumatizado, viabilizando a recuperação tanto funcional como psicossocial

Cephalometric study to test the reliability of anteroposterior skeletal discrepancy indicators using the twin block appliance.

BACKGROUND: The objectives of this study were to check the reliability of the five angular and two linear parameters for sagittal maxillo-mandibular discrepancy and to compare and correlate angular parameters with the ANB angle, and the linear parameter with Wits analysis. METHODS: The pre-treatment and post-functional lateral cephalograms of 25 subjects (17 males, 8 females) with class II division 1 malocclusion treated with twin block functional appliance were selected. Five angular (ANB, ß angle, APDI, YEN angle, W angle) and two linear (Wits analysis, App-Bpp) parameters were traced on both sets of cephalograms. Paired Student's t-test, one-way ANOVA, post hoc test, and Karl Pearson correlation statistical analysis were performed. RESULTS: All the parameters considered in our study showed highly significant difference in pre-treatment and post-functional values, suggesting their reliability (p < 0.0001). When ANB angle was compared with the other angular parameters, a highly significant change in the mean value of the difference in pre-treatment (T1) and post-functional (T2) values was noted (p < 0.001). No significant change was seen when comparing the mean value of the difference in T1 and T2 between linear parameters (p = 0.949). CONCLUSIONS: All the parameters used in the study can be reliably used to assess anteroposterior skeletal discrepancy. Whenever limitations of the ANB angle and Wits analysis are foreseen, the W angle and App-Bpp, respectively, can be reliably used. The YEN angle may reliably predict the post-functional change with the use of twin block appliance.

Temporary anchorage device usage: a survey among Swiss orthodontists.

BACKGROUND: The aim of the survey was to obtain information on the treatment plan preferences, mechanics and characteristics of temporary anchorage device (TAD) application using a single case presented to orthodontists in Switzerland. METHODS: A structured questionnaire to be completed by all study participants with case-specific (treatment plan including mechanics and TAD usage) and general questions (general fixed appliance and TAD usage as well as professional, educational and demographic questions) together with an orthodontic borderline case was utilised. The case was a female adult with dental Class II/2, deep bite and maxillary anterior crowing, who had been treated in childhood with extraction of four premolars and fixed appliance followed by wisdom tooth extraction. RESULTS: The response rate was 24.4% (108 out of 443). The majority (96.3%, 104) proposed comprehensive treatment, while 3.7% (4) planned only alignment of maxillary teeth. 8.3% (9) included a surgical approach in their treatment plan. An additional 0.9% (1) combined the surgical approach with Class II mechanics. 75.1% (81) decided on distalization on the maxilla using TADs, 7.4% (8) planned various types of Class II appliances and 3.7% (4) combined distalization using TADs or headgear with Class II appliances and surgery. Palatal implants were the most popular choice (70.6%, 60), followed by mini-screws (22.4%, 19) and mini-plates on the infrazygomatic crests (7.0%, 6). The preferred site of TAD insertion showed more variation in sagittal than in transversal dimension, and the median size of mini-screws used was 10.0-mm long (interquartile range (IQR) 2.3 mm) and 2.0-mm wide (IQR 0.3 mm). CONCLUSIONS: Distalization against palatal implants and then distalization against mini-screws were the most popular treatment plans. Preferred site for TAD insertion varied depending on type and size but varied more widely in the sagittal than in the transversal dimension.

Thirty-two-year follow-up study of Herbst therapy: a biometric dental cast analysis.

INTRODUCTION: The aim of this study was to analyze the very long-term effects of Herbst treatment on tooth position and occlusion. SUBJECTS: Fourteen patients from a sample of 22 with Class II Division 1 malocclusions consecutively treated with the banded Herbst appliance were reexamined 32 years after therapy. METHODS: Dental casts were analyzed from before (T1) and after (T2) treatment, and at 6 years (T3) and 32 years (T4) after treatment. RESULTS: Minor changes in maxillary and mandibular dental arch perimeters and arch widths were seen during treatment (T1-T2) and posttreatment (T2-T4). Mandibular incisor irregularity remained, on average, unchanged from T1 to T2 but increased continuously during the 32-year follow-up period (T2-T4). Class II molar and canine relationships were normalized in most patients from T1 to T2. During the early posttreatment period (T2-T3), there was a minor relapse; during the late posttreatment period (T3-T4), molar and canine relationships remained, on average, unchanged. Overjet and overbite were reduced to normal values in all subjects during treatment (T1-T2). After treatment (T2-T4), overjet remained, on average, unchanged, but overbite increased insignificantly. CONCLUSIONS: Thirty-two years after Herbst therapy, overall, acceptable long-term results were seen. Stability was found in 64% of the patients for sagittal molar relationships, in 14% for sagittal canine relationships, in 86% for overjet, and in 86% for overbite. A Class II relapse seemed to be caused by an unstable interdigitation of the occluding teeth, a persisting oral habit, or an insufficient retention regimen after treatment. Most posttreatment changes occurred during the first 6 years after treatment. After the age of 20 years, only minor changes were noted. Long-term posttreatment changes in maxillary and mandibular dental arch perimeters and widths as well as in mandibular incisor irregularity seemed to be independent of treatment and a result of physiologic dentoskeletal changes throughout adulthood.

Class II treatment by extraction of maxillary first molars or Herbst appliance: dentoskeletal and soft tissue effects in comparison.

AIM: To compare dentoskeletal and soft tissue treatment effects of two alternative Class II division 1 treatment modalities (maxillary first permanent molar extraction versus Herbst appliance). METHODS: One-hundred-fifty-four Class II division 1 patients that had either been treated with extractions of the upper first molars and a lightwire multibracket (MB) appliance (n = 79; 38 girls, 41 boys) or non-extraction by means of a Herbst-MB appliance (n = 75; 35 girls, 40 boys). The groups were matched on age and sex. The average age at the start of treatment was 12.7 years for the extraction and for 13.0 years for the Herbst group. Pretreatment (T1) and posttreatment (T2) lateral cephalograms were retrospectively analyzed using a standard cephalometric analysis and the sagittal occlusal analysis according to Pancherz. RESULTS: The SNA decrease was 1.10° (p = 0.001) more pronounced in the extraction group, the SNB angle increased 1.49° more in the Herbst group (p = 0.000). In the extraction group, a decrease in SNB angle (0.49°) was observed. The soft tissue profile convexity (N-Sn-Pog) decreased in both groups, which was 0.78° more (n. s.) pronounced in the Herbst group. The nasolabial angle increased significantly more (+ 2.33°, p = 0.025) in the extraction group. The mechanism of overjet correction in the extraction group was predominantly dental (65% dental and 35% skeletal changes), while in the Herbst group it was predominantly skeletal (58% skeletal and 42% dental changes) in origin. CONCLUSION: Both treatment methods were successful and led to a correction of the Class II division 1 malocclusion. Whereas for upper first molar extraction treatment more dental and maxillary effects can be expected, in case of Herbst treatment skeletal and mandibular effects prevail.

Determining skeletal maturation using insulin-like growth factor I (IGF-I) test.

OBJECTIVE: To investigate the validity of Insulin like Growth Factor -1(IGF-1) as a skeletal maturity indicator by comparing serum IGF-1 levels with the stages in cervical vertebral maturation (CVM) and in the middle phalanx of the third finger (MP3). MATERIALS AND METHODS: The study population was selected by using simple random sampling technique and consisted of 30 female subjects in the age range of 8-23 years who had blood sample, cephalometric and MP3 radiographs taken on the same day. Serum IGF-I estimation was carried out on the blood samples using chemiluminescence immunoassay (CLIA) method. CVM was evaluated using method by Baccetti et al and MP3 staging was done using Rajagopal & Kansal method. Mean IGF-1 level between the stages was compared by Kruskal-Wallis and Mann Whitney test. RESULTS: Serum IGF-1 levels in females correlate well with skeletal maturity determined by CVM and MP3 stages and increase sharply during early pubertal stages followed by a decrease in late puberty. In addition we hypothesis that serum IGF-1 testing can be undertaken as a preliminary screening test in patients in whom the orthodontist predicts the possibility of using myofunctional appliance but in whom the chronologic age is not suggestive for a growth modification therapy. CONCLUSIONS: The finding of the study highlights the fact that the serum IGF-1 estimation can be a valuable tool in assessing skeletal maturation.

[Orthodontics in general practice. 4. Eruption guidance appliances in orthodontics]. / Orthodontie in de algemene tandartspraktijk. 4. Eruptiegeleidende apparatuur in de orthodontie.

Eruption guidance appliances are recommended for early orthodontic treatment or prevention of malocclusions. The treatment effect of eruption guidance appliances and functional appliances is similar. In addition to dentoalveolar and skeletal effects, eruption guidance appliances would also have myofunctional effects for treating open mouth behaviour and swallowing problems. However, there is no solid evidence for the myofunctional effect claimed. The position of erution guidance appliances in the orthodontic treatment arsenal is limited: early treatment of Angle Class II malocclusion in 2 phases has no advantage over a 2 phase treatment. When eruption guidance is needed, preference is given to an individually produced appliance.

Complications during Herbst appliance treatment with reduced mandibular cast splints : a prospective, clinical multicenter study.

OBJECTIVE: To assess and compare the prevalence, type and frequency of complications during Herbst treatment with reduced (canine to 2nd premolars) and total (canine to molars) mandibular cast splints. SUBJECTS AND METHODS: Fifty consecutive Herbst patients treated with reduced mandibular splints (RMS) were compared to 182 consecutively treated Herbst patients with total mandibular splints (TMS). The prevalence, type and frequency of complications were analyzed. RESULTS: The prevalence of patients with complications did not differ significantly between the groups, and amounted to 58% in the RMS- and 60% in the TMS-group. The most frequent type of complication in both groups was maxillary splint loosening, making up 56.3% of all complications in the RMS- and 66.9% in the TMS-group. The second most frequent complication was mandibular splint loosening, which amounted to 32.5% of the complications in the RMS- and 26.8% in the TMS-group. We observed telescope breakage twice as often (8.8%) in the RMS- as in the TMS-group (4.3%). CONCLUSIONS: Loosening of the maxillary splints is the main complication during Herbst treatment with RMS and TMS. A reduction in mandibular splint length does not increase the prevalence of complications, but it does reduce expenses, and can thus be recommended for further use.

Effects of an anteriorly titrated mandibular position on awake airway and obstructive sleep apnea severity.

The objective of this study was to investigate whether a reduction of obstructive sleep apnea (OSA) severity was associated with significant upper airway (UA) changes after an anterior titration of the mandibular position. Eighteen OSA patients with a mean (SD) apnea hypopnea index (AHI) of 32.5 (12.3) were recruited. Baseline supine cephalometry was obtained before the initial insertion, and follow-up supine cephalometry was undertaken after titration with a titratable oral appliance in place. The mean AHI before treatment was significantly reduced to 9.7 (7.4) (P <.001) after titration. In 13 responders with AHI reduced to < or =15/h, a significant forward displacement of the anterior wall of the velopharynx (P <.05) was observed. In addition, there was a significant forward displacement of the posterior wall of the oropharynx and the hypopharynx (P <.05). In the 5 nonresponders, no significant changes in the position of the anterior and posterior wall were observed. There was no significant difference in the total amount of mandibular advancement between responders and nonresponders. We conclude that treatment success with oral appliance therapy appears to depend not only on anterior titration of the mandibular position to enlarge the UA, but also on the amount of change in the size of the UA in response to mandibular advancement.