Longitudinal growth changes of the cranial base from puberty to adulthood. A comparison of different superimposition methods.

OBJECTIVE: To investigate the stability of cranial reference landmarks from puberty through adulthood and to compare the displacement of these landmarks among the superimposition methods of Björk, Ricketts, Steiner, and the proposed tuberculum sella-wing (T-W) reference line. MATERIALS AND METHODS: The sample consisted of serial lateral cephalometric radiographs of 30 Class II division 1 patients taken at the pretreatment (T1; mean age, 11.98 years), posttreatment (T2; mean age, 15.32 years) and postretention (T3; mean age, 32.12 years) periods. All cephalometric radiographs were superimposed at the cranial base according to the overall superimposition methods of Björk, Ricketts, Steiner, and the T-W method. The horizontal and vertical displacements of cranial landmarks (nasion, wing, tuberculum sella, sella, basion, and pterygomaxillare) were assessed by paired t-test according to Björk's structural method. One-way analysis of variance (ANOVA) was used for comparison of the displacement of cranial landmarks among the superimposition methods. RESULTS: The tuberculum sella and wing were the most stable cranial landmarks of the cranial base. The stability of sella and pterygomaxillare points were somewhat questionable. Nasion and basion were highly variable. The displacements of all cranial landmarks were similar between the Björk and T-W methods in all study periods. Most of the cranial landmarks displaced similarly in the horizontal direction among the methods. Vertically, the behaviors of the cranial landmarks were frequently different. CONCLUSIONS: T-W is the most similar superimposition method to Björk's structural method; thus, it is a reliable method for examining overall facial changes.

Age-related long-term posttreatment occlusal and arch changes.

OBJECTIVE: To evaluate differences in long-term postretention changes between adolescents and adults. MATERIALS AND METHODS: The sample included 96 subjects, 51 adolescents and 45 adults (14.2 +/- 0.8 and 21.5 +/- 6.8 years of age, respectively, at the end of treatment) retained for 3 years and followed approximately 16 years post treatment, who were randomly selected from two private practices. Prior to treatment, 38 and 58 had Class I and Class II malocclusions, respectively. RESULTS: With the exception of adult midlines, all of the occlusal variables (overjet [0.50-0.77 mm], overbite [0.85-0.95 mm], the maxillary incisor irregularity [0.69-0.80 mm], the mandibular incisor irregularity [0.85-1.50 mm] and the PAR score [0.86-1.92 points]) showed significant increases over time. Adolescents consistently showed greater increases of the occlusal variables than adults, with mandibular incisor irregularity and the PAR index attaining statistically significant (P < .05) levels. Arch length and mandibular intercanine width showed statistically significant decreases over time in both groups; maxillary intercanine and intermolar widths did not change significantly. Overjet increased significantly more in Class II patients than in Class I patients, whereas Class I patients showed significantly greater decreases in mandibular intermolar width than Class II patients. CONCLUSIONS: Over the 16-year posttreatment period, adolescents showed significantly greater increases in mandibular incisor irregularity, and the PAR index than adults. Treated Class I patients demonstrated less increase in overjet and greater decreases in mandibular intermolar width than Class II patients.

Prediction of lip response to four first premolar extractions in white female adolescents and adults.

OBJECTIVE: To develop models for predicting changes in lip position of Class I extraction patients. MATERIALS AND METHODS: Pretreatment and posttreatment lateral cephalograms of 46 white female adults and 109 white female adolescents were examined. Mean pretreatment ages for the adolescent and adult groups were 12.2 +/- 1.2 years and 23.0 +/- 8.5 years, respectively. Subjects were treated with conventional edgewise mechanics. Multivariate prediction models were derived from a randomly selected sample of 119 subjects and validated on the remaining 36 subjects. RESULTS: Adolescents demonstrated significant vertical and horizontal skeletal growth and treatment changes, while adults showed only small increases in anterior face height. While significant retraction of the upper and lower incisors occurred in both groups, the amounts were greater in adults than in adolescents. Ratios for horizontal hard tissue to soft tissue movements ranged from 1.4:1 to 1.1:1 and 1.3:1 to 1:1 for the upper (Ls) and lower (Li) lips, respectively. There were moderate relationships between horizontal lip and underlying hard tissue movements (correlations ranged from .57 to .78 for Ls and from .58 to .86 for Li). Multiple regressions to predict lip movements showed moderately strong relationships for the upper lip (R = .79 to .81) and strong relationships for the lower lip (R = .89 to .90). Two to three variables were necessary to predict vertical lip movements (R = .82 to .87). The validation sample showed no systematic biases and similar levels of accuracy. CONCLUSIONS: Upper and lower lip retraction in four first premolar extraction cases can be predicted with moderately high levels of accuracy in white female adolescents and adults.

Orthodontic treatment changes of chin position in Class II Division 1 patients.

INTRODUCTION: Because most patients with skeletal Class II malocclusions also have mandibular deficiencies, treatment plans should include improvement in chin projection. On that basis, the purposes of this study were to (1) determine how Class II treatment affects anteroposterior (AP) chin position in growing subjects and (2) ascertain the most important determinants of AP chin position. METHODS: Pretreatment and posttreatment lateral cephalograms of 67 treated patients (25 extraction headgear and Class II elastics, 23 nonextraction headgear, and 19 Herbst) were collected, traced, and digitized. The average pretreatment age was 12.2 years (range, 9-14 years), and the average treatment duration was 30.2 months (range, 17-65 months). Cephalometric changes were compared with 29 matched untreated Class II controls. Mandibular superimpositions were used to evaluate condylar growth and true mandibular rotation. RESULTS: All 3 treatment methods produced normal dental relationships and restricted or inhibited AP maxillary growth, with no significant improvement of AP chin position. Differences between changes in vertical position of the maxilla, maxillary and mandibular molars, and condylar growth could not reliably predict changes in chin position. Analyses demonstrated that true mandibular rotation was the primary determinant of AP chin position. Stepwise multiple regression showed that, combined with true mandibular rotation, condylar growth and movements of the glenoid fossa accounted for 81% of the variation in AP changes of pogonion. CONCLUSIONS: Contemporary treatments do not adequately address mandibular deficiencies. Future treatments must incorporate true mandibular rotation into Class II skeletal correction.