Class III Twin Blocks: a case series.

OBJECTIVE: To evaluate the use of Class III Twin Blocks for the early treatment of Class III malocclusion. DESIGN: Retrospective analysis. SUBJECTS AND METHOD: 14 subjects were consecutively treated with a modified version of the Class III Twin Block appliance. Lateral cephalometric radiographs taken at the start and end of treatment were assessed digitally. RESULTS: The mean age of subjects was 10 years and mean treatment time was 6.6 months. The cephalometric analysis of changes during treatment shows proclination of the upper incisors [mean 5.1 degrees, SD 5.1], retroclination of the lower incisors [mean -4.5 degrees, SD 3.9], reduction in angle SNB [mean -1.3 degrees, SD 1.8] and an increase in the maxillary/ mandibular planes angle (mean 2.1 degrees, SD 2.2]. Average cephalometric digitizations and photographs of a clinical case are shown. CONCLUSIONS: Class III Twin Blocks can be used successfully for early treatment of Class III malocclusion. A randomly allocated prospective study is required to fully evaluate the efficacy of this appliance.

The relationship between arch dimensions and the 5-year index in the primary dentition of patients with complete UCLP.

OBJECTIVE: To compare dental arch dimensions of children in the primary dentition with repaired unilateral clefts of the lip and palate (UCLP) to a noncleft group of a similar age and determine how the dimensions of the cleft arches relate to an index of treatment outcome. METHOD: Dental study casts of 44 5- to 6-year-olds with complete UCLP (22 boys and 22 girls) from a single center, whose primary surgery had been carried out by one surgeon, were matched for age, sex, and ethnicity with dental study casts from a longitudinal growth study. Analysis of variance was used to ascertain differences in arch dimensions between the two groups. The cleft group casts were then assessed with an established index of surgical outcome, the 5-year-old index. Spearman's rank correlation coefficient was used to see how the arch dimensions of the cleft group related to the categories of the index. RESULTS AND CONCLUSIONS: Maxillary arch dimensions were significantly smaller in the cleft group than in the noncleft group, irrespective of sex (p < .05). In the mandibular arch, there was no difference between the cleft and noncleft groups (p > .05). Maxillary arch dimensions of the cleft group correlated significantly with the 5-year-old index for arch length and intercanine width (p < .05) but not intermolar width (p = .842). This would suggest that the 5-year-old index is a suitable tool for assessing the outcome of treatment in the primary dentition for anteroposterior and anterior transverse arch dimensions.

The reliability of the Index of Orthodontic Treatment Need over time.

The aim of this investigation was to establish whether the Index of Orthodontic Treatment Need is reliable over time between the ages of 11 and 19 years. It consisted of a longitudinal sample of 314 11- and 15-year-old and 142 19-year-old subjects who had not received orthodontic treatment or extractions. The changes in the aesthetic component (AC) and the dental health component (DHC) of the Index of Orthodontic Treatment Need (IOTN) were measured between the ages of 11 and 19 years. The results suggested that the dental health component of IOTN was reliable over time between the ages of 11-19 years despite temporal changes in the separate occlusal traits that comprise the index. The aesthetic component of IOTN tended to show an improvement over time. The Index of Orthodontic Treatment Need is a reliable index over time when taking into account occlusal changes that are occurring during the 11-19-year age range. The study provides some reassurance to clinicians that an IOTN grading at age 11 years is unlikely to change by the time the patient is 19 years. Refereed Scientific Paper

The inclined biteplane--a useful tool.

A technique is described to help maintain overjet and overbite reduction achieved with a functional appliances, while waiting to proceed with definitive treatment or for use after a definitive course of fixed appliance therapy to help maintain the achieved result.

Transverse maxillary arch changes with the use of preoperative orthopedics in unilateral cleft palate infants.

A retrospective clinical study, using a reflex microscope, measured arch widths, palatal shelf widths, cleft widths, and palatal shelf angulation from 26 sets of plaster models of infants' maxillary arches at birth, and at 3 and 6 months. All infants had unilateral clefts of the lip and palate. They were treated with active preoperative orthopedics until lip repair at 3 months and with a passive plate until palate repair. Cleft width significantly decreased during these periods, due to transverse growth, along with relative flattening of the palatal shelves. Arch width contracted slightly anteriorly, but remained stable posteriorly. Preoperative orthopedics may have helped these changes by removing the effects of the tongue action and allowing unrestricted growth of the palatal shelves.

The Consultant Orthodontists Group survey of hospital waiting lists and treated cases.

A questionnaire sent to all U.K. hospital orthodontic consultants resulted in an 88 per cent response rate. The average waiting time for initial consultation was 31.6 weeks for routine cases and 3.6 weeks for urgent cases. The average waiting time for out patient treatment was 68.7 weeks for routine cases and 7.5 weeks for urgent cases. Nearly 33 per cent of hospitals used the Dental Health Component of the Index of Orthodontic Treatment need (IOTN) as a guide to placing patients on waiting lists. 'Urgency' and 'Complexity' were used more frequently than indices. Sixty-nine per cent of hospitals exclude some categories of malocclusion from treatment in their departments. A prospective survey reported on 2480 completed treatments over a six week period and there was an average discontinuation rate of 9.2 per cent of all cases finished during the period. Comparison of the completed and discontinued groups revealed few significant treatment-related factors. There was some evidence that the more senior and experienced the operator, the less the rate of discontinuation. A greater rate of discontinuation was seen in removable appliance cases when compared with fixed appliance cases.

A method of pre-surgical oral orthopaedics.

A preliminary report of a technique of pre-surgical treatment in cleft lip and palate patients is outlined utilizing an adjustable intra-oral appliance with extra-oral strapping. The appliance is constructed with an adjustable spring for expansion and two shelves overlapping in the midline to allow palatal continuity during treatment. Frequently, only one appliance for each patient is required. The techniques of appliance construction, pre-surgical management and surgical repair of the lip are outlined.