Preventive and interceptive orthodontics for the 5 to 12 year-old. Functional appliances: the Nite-Guide and Occlus-o-Guide techniques.

hree orthodontic procedures are described that are used to prevent, intercept, and correct malocclusions at three distinct stages of dental development. Each stage of development (5 to 7 years, 8 to 12 years, and 12 years through adulthood) uses an appliance selected from a series of several preformed sizes. All have predicted socket dimensions to receive unerupted, erupting or fully erupted teeth. These sockets are prearranged in a perfect Class I occlusion. In the first group of appliances, specifically designed for the 5 to 7 year-old (called Nite-Guide), one selects a single size that is large enough to accommodate the teeth after they become straight. This appliance is worn passively while sleeping and simply guides the incoming incisors to straighten themselves using only their own force of eruption. Once straight, the adult collagenous fibers form and thereby prevent most future relapse from occurring. At the same time, the incoming incisors are prevented from over-erupting into a deep overbite and the mandible is advanced to correct any excess overjet. Similarly-designed appliances are also used to correct malocclusions in the mixed and adult dentitions. To obtain optimum results at these ages, active wear of about two hours per day is required. The treatment time is very fast (1 to 12 months in most cases) and the same appliance is also used as the retainer of choice. Most malocclusion problems such as crowding, rotations, overbite, overjet and TMD are 80 to 95% corrected in those wearing the appliance as directed.

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.

La “estímuloterapia programada” como base para el desarrollo de un protocolo dereeducación funcional oral que nos lleva al concepto de “prevención en ortodoncia” / No disponible

El conocimiento de la acción de los estímulos, la estimuloterapia programada, el diagnostico de la matriz funcional y su codificación, nos ayudará a la normalización del llamado triunvirato funcional. En el presente trabajo, se establece un nuevo protocolo de tratamiento, utilizando los diferentes elementos prefabricados “MFS”, y la combinación entre ellos para conseguir un resultado óptimo para lograr así la reeducación temprana de las funciones orales como un programa de prevención en ortodoncia (AU)

The understanding of the action of the stimulants, programmed stimulation therapy, the diagnosis of the functional matrix and its codification will help us in the normalization of the so called functional triumvirate. In this task a new treatment protocol is established, using the various prefabricated “MFS” devices and their combination to obtain optimum results and so achieve the early re-education of oral functions and a prevention programme in orthodontics (AU)

Difference in alveolar molding effect and growth in the cleft segments: 3-dimensional analysis of unilateral cleft lip and palate patients.

OBJECTIVE: This study was performed to observe the alveolar molding (AM) effect and growth of unilateral cleft lip and palate (UCLP) patients using 3-dimensional (3D) analysis. STUDY DESIGN: The sample consisted of 16 Korean UCLP infants who were treated using presurgical nasoalveolar molding (PNAM) appliance and rotation-advancement cheiloplasty. The maxillary models were obtained at the initial visit, after PNAM treatment 1 month before cheiloplasty, and 2 months after cheiloplasty. RESULTS: The cleft gap was reduced by AM of the greater segment (GS) during PNAM treatment and of the anterior alveolar segments (AAS) through lip pressure after cheiloplasty. Although forward growth of GS was restrained by the PNAM treatment, it resumed after cheiloplasty. The amount of increase in the area and distance variables were largest in the posterior alveolar segments (PAS) only after cheiloplasty. CONCLUSION: Alveolar molding took place mainly in AAS during PNAM treatment, and growth occurred mainly in PAS after cheiloplasty.

[Treatment of Class III malocclusions]. / Traitements des classes III.

Current knowledge about cranio-facial growth, the identification of different anatomic types by architectural cephalometric analysis, the new therapeutic methods and a multidisciplinary have changed the mode and the results of these treatments. However the key of success is: begin the treatment as soon as possible. The correction of skeletal anomalies and the normalization of all the oro-facial functions need a lot of time. It is advisable to be efficient at the good time with the good appliance. The quality of the result will be estimated at the end of the growth. In this way, a lot of orthognathic surgery can be avoided. So, certainly the results reward the efforts.

[Prevention and treatment of dento-maxillary discrepancy]. / Prévention et traitement de la dysharmonie dento-maxillaire.

The many clinical and radiological signs of arch length discrepancy simplify the practitioner's task of diagnosing it early. When they need to deal with insufficient room in the dental arch, orthodontists have available to them a large variety of therapeutic possibilities that require relatively little cooperation from young patients and that often work quickly to correct beginning malocclusions in the mixed dentition or that prevent them from worsening. Orthodontists decide whether to use space maintainers, increase arch length, or embark on a program of serial extraction depending upon the type of disorder, its severity, and its etiology. The principle objectives of early treatment in arch length discrepancy cases are to re-establish a balanced occlusion and to reduce the duration and the complexity of definitive treatment in the adult dentition.

[Prevention and treatment after age 10 with the edgewise technique]. / Prévention et traitement après 10 ans dans une logique Edgewise.

The success of therapy for Class II malocclusions depends on the choice orthodontists make on when to intervene. Usually they begin a two-stage treatment, first orthopedic, then orthodontic, in the mixed dentition. If they want to their non-extraction therapy to coincide with and benefit from growth, they need to diagnose the malocclusion as early as possible. Treatment of Class II malocclusions works best when it is undertaken before the second molars erupt. By correcting the malrelationship between the jaws with an orthopedic appliance, they facilitate the second, full-banded stage of treatment.

Diagnóstico y tratamiento precoz de las alteraciones funcionales del desarrollo craneofacial / Early diagnosis and treatment of the functional alterations of craniofacial growth

En este artículo se desarrollan algunos esquemas de diagnóstico funcional y de tratamiento morfológico precoz de las mal oclusiones asociadas a problemas esqueléticos, cuyo objetivo es recuperar tanto la forma como la función, con el fin de reconducir el crecimiento facial alterado (AU)

In this article some schemes about early functional diagnosis and treatment of malocclusions associated to sekeletal problems are presented. Their objective is to retrieve both form and function, to achieve a redirection of the altered facial growth (AU)

The effect of infant orthopedics on the occlusion of the deciduous dentition in children with complete unilateral cleft lip and palate (Dutchcleft).

OBJECTIVE: Evaluation of the effect of infant orthopedics (IO) on the occlusion of the deciduous dentition in patients with unilateral cleft lip and palate (UCLP). DESIGN: Prospective, two-arm, randomized, controlled clinical trial with three participating cleft palate centers (Dutchcleft). SETTING: Cleft Palate Centers of the University Medical Center Nijmegen, Academic Center of Dentistry Amsterdam, and Dijkzigt University Hospital Rotterdam, The Netherlands. PATIENTS: Children with complete UCLP (n = 54) were included. INTERVENTIONS: In a concealed allocation procedure, half of the patients was randomized to wear a plate till surgical closure of the soft palate (IO+), and the other half (IO-) did not have a plate. MEAN OUTCOME MEASURES: Dental arch relationships were assessed at 4 and 6 years of age with the 5-year-old index; the Huddart-score; and measurements of overjet, overbite, and sagittal occlusion. RESULTS: There were no significant differences found between the IO+ and IO- groups for the 5-year-old index; the Huddart-score; and overjet, overbite, and sagittal occlusion. CONCLUSIONS: IO had no observable effect on the occlusion in the deciduous dentition at 4 and 6 years of age. Considering the occlusion only, there is no need to perform IO in children with UCLP.

A modified muscle-activated maxillary orthopedic appliance for presurgical nasoalveolar molding in infants with unilateral cleft lip and palate.

OBJECTIVE: The purpose of this article is to describe a modified appliance and treatment approach for presurgical nasoalveolar molding in infants with unilateral cleft lip and palate. METHODS: This approach uses a plate held in with outriggers, which prevents the cleft-widening effect of the tongue, helps with tongue tip placement, and utilizes the functional movements of the facial musculature to guide and relocate the major segment medially to its normal position. Nasal molding is undertaken after most of the lateromedial correction of the alveolar position. CONCLUSIONS: This technique helps to improve alveolar position, nasal septum alignment, nasal symmetry, and nasal tip projection prior to lip repair.

[Principles of treatment of total unilateral cleft lip and palate. Suggested protocol]. / Principes de prise en charge des fentes labio-maxillo-palatines unilatérales totales. Propositions de protocole.

Complete uni-lateral cleft palates resulting from failed union between internal and external nasal buds cause an imbalance of both superficial and deep nasal structures. After summarizing the principles that should guide the care of these anomalies, the authors present their therapeutic procedure, in which orthopaedic and surgical treatments are intimately associated. They conclude their presentation by emphasizing the difficulty of predicting the definitive result because of the extreme diversity of the sequellae that always accompany the treatment of cleft palates.

[Bilateral cleft lip and palate. Anatomic and clinical characteristics and therapeutic results]. / La fente labio-maxillo-palatine bilatérale particularités anatomo-cliniques et mise au point thérapeutique.

Treatment teams that conceive and nourish their ideas in a multi-disciplinary environment are best suited to elaborate therapeutic protocols. Their concepts should be based on consistent evaluation of their treatment results as documented by precise and reproducible records. In the wide array of maxillo-facial anatomical deformities presented clinically, bilateral cleft lips and palates are the rarest (20%), but they are also the most serious because of the inherent disconnection of maxillary structures that accompanies them and because of the grave disturbances they inflict on the development of the middle third of the face. Surgeons have devised an extraordinary gamut of protocols to correct these disorders and then abandoned them because of the problematical and ephemeral results they provided. The authors, after evaluating their own results, modified their therapeutic approach in 1994. They present their current protocol, which calls for an orthopedic phase carried out when the patient is 2 months old and two surgical phases when the patient is 3 and then 7 months old.

[Orthodontic treatment in children and adults]. / L'orthodontie de l'enfant et de l'adulte.

Orthodontics is concerned with the study of dental-maxillofacial development, and the analysis and treatment of anomalies in this development. The orthodontic approach commences with the monitoring of oro-facial functions as of the early stages of childhood (3 to 4 years). This first stage is chiefly preventative. Interceptive orthopaedic treatment is performed, if necessary, on young patients who have reached the mixed dentition stage. This treatment involves the use of fixed or removable braces to correct any irregularity in the maxillofacial development and dental malposition. The treatment for most dental malpositions commences as of the setting in of the secondary dentition (11 to 13 years). The movements of the teeth in the three precise spatial directions are defined with the use of fixed braces. Residual maxillary deformities (prognathism, retrognathism, laterognathism, etc.) are corrected at the end of the growth process or in adulthood through fixed orthodontic treatment combined with maxillofacial osteotomies. Adult patients are treated with the same fixed orthodontic techniques and according to a therapeutic protocol adapted to their specific dental or periodontal mutilations.

Examen funcional de la articulación temporomandibular y de sus estructuras adyacentes en pacientes ortodonticos de la Universidad Central de Venezuela / Functional examen of the temporomandibular joint and peripheral structures in orthodontic patients

Se encuestaron 8 profesores y 13 estudiantes del Postgrado de Ortodoncia de la Facultad de Odontología de la Universidad Central de Venezuela, con el objetivo de indagar acerca del análisis funcional de la articulación temporomandibular realizado en las historias clínicas de dicho postgrado. Como resultado encontramos que el 100 por ciento de los encuestados consideró dicho examen funcional como incompleto, 72 por ciento como confuso, 25 por ciento no operativo y el 95 por ciento como no acertado. Además fueron revisadas 318 historias clínicas del archivo de postgrado, encontrándose que en el 73 por ciento se toman los datos y en el 27 por ciento no se tomaron los datos. Del 73 por ciento de las historias en las cuales se registraron los datos del 32 por ciento de los mismos se tomaron completos, y el 68 por ciento se tomaron incompletos. En base a estos resultados recomendamos un análisis funcional de la ATM que sea funcional, operativo y sistemático para ser aplicado antes, durante y después del tratamiento ortodóncico.