Orthodontic - Surgical management in a Class II case with idiopathic root resorption.

Patients with root resorption and malocclusion can benefit from orthodontic treatment with or without surgery. However, orthodontics has a risk of inducing or aggravating root resorption, therefore the duration of the treatment is of utmost importance. In this paper, a surgery-first protocol with lower jaw advancement and precise interdental alveolar osteotomies was conducted to accelerate the treatment of a 14-year-old female patient who presented with a Class II division 2 malocclusion, anterior dental crowding and idiopathic root resorption. One week after the surgery, the patient received postoperative orthodontic treatment for 6 months with weekly activation the first month. The clinical outcome was satisfactory with complete clinical resolution and no tooth loss. This surgery approach allowed an 'en bloc' tooth movement and induced an increased bone remodelling, which resulted in an accelerated tooth movement. The reduction of treatment time was beneficial and no aggravation of the root resorption was seen.

Mandibular midline distraction using a tooth-borne device and a minimally invasive surgical procedure.

In this technical note we share our experience of mandibular midline distraction, a powerful tool in orthognathic surgery. The use of a tooth-borne distractor and a minimally invasive surgical procedure to perform the midline osteotomy is discussed.

Two-stage palatoplasty using a modified Furlow procedure.

A two-stage palatal repair using a modification of Furlow palatoplasty is presented. The authors investigate the speech outcome, fistula formation and maxillary growth. In a prospective, successive cohort study, 40 nonsyndromic patients with wide cleft palate were operated on between March 2001 and June 2006 by a single surgeon. 10 patients in the first cohort underwent a Furlow palatoplasty (control group). In 30 patients in the second cohort a unilateral myomucosal cheek flap was used in combination with a modified Furlow palatoplasty (study group). The hard palate was closed in both groups 9-12 months later. The Bzoch speech quality score was superior in the study group, and the hypernasality was significantly reduced in the study group. Overall fistula formation was 0%. At the time of hard palate reconstruction palatal cleft width was significantly reduced. Relative short-term follow up of maxillary growth was excellent. There were no postoperative haematomas, infections, or episodes of airway obstruction. This technique is particularly encouraging, because of better speech outcome, absence of raw surfaces on the soft palate, no fistula formation, and good maxillary growth. Further follow-up is necessary to determine the long-term effects on facial development.

Trans-sinusal maxillary distraction for correction of midfacial hypoplasia: long-term clinical results.

Maxillary distraction osteogenesis is indicated in severe angle class III malocclusions, and severe maxillary hypoplasia among some cleft patients and other craniofacial deformities. Twenty patients, aged 8-48 years (mean 17.8+/-10.5 SD) with maxillary and midfacial hypoplasia were treated. The follow-up period was 13-65 months (mean 35+/-16.3 SD). A trans-sinusal maxillary distractor was placed intraorally at each side of the maxilla. The distraction vector was predicted using specialist software, and was transferred to the patients using stereolithographic models and individual templates. A (high) Le Fort I type osteotomy was performed. The amount of activation varied from 8 to 17.5 mm (mean 13.1+/-2.9 SD). Soft and hard tissue formation resulted in complete healing across the distraction gaps. The distractors are almost completely submerged, and can be left in place as long as necessary to avoid relapse. Wit's appraisal was used to measure the stability of the long-term distraction results. Results up to 5 years after distraction showed considerable maxillary advancement with long-term stability. Ongoing growth of the facial skeleton must be considered when distraction osteogenesis is chosen in growing patients.

Cephalometric evaluation of maxillary advancement with an internal distractor in an adult boxer dog.

OBJECTIVE: The aim of the study was to evaluate cephalometrically the effects of distraction of the maxilla over a 1-year period by means of an internal distractor applied in a boxer dog. DESIGN: Internal distractors were placed bilaterally in the internal cavity of the maxillary sinus of a 2-year-old boxer dog after a Le Fort I osteotomy. Distraction was started 5 days after surgery and activations were continued for 14 days at a rate of 1 mm/day. Standardized lateral cephalograms were taken with an extemal source of 90 kV, 60 mS immediately pre-surgery, at day 1 after the start of the distraction (dp) and at day 5 dp, day 7 dp, day 10 dp, day 14 dp (end of distraction), at 14 days of consolidation period (cp), at 28 days cp and at 56 days cp (removal of the distractors). One year after the removal of the distractor, a final lateral cephalogram was taken. Cephalometric analysis was performed and superimpositions were used for the evaluation of the sagittal position of the maxilla. RESULTS: The linear measurements, as well as the superimposition showed evidence for a significantly advanced position of the maxilla, which was stable 1 year after removal of the distractor. CONCLUSION: The application of the internal maxillary distractor in a boxer dog resulted in a sagittal advancement of the midface that was still present after 1 year.

Maxillary distraction using a trans-sinusal distractor: technical note.

In this pilot study, the principle of distraction osteogenesis was used to advance the midface of a boxer dog. A modified high Le Fort I-type osteotomy was performed. Following a latency period of 5 days the maxilla was distracted 14 mm in 14 consecutive days at a rate of 1 mm per day. Ten weeks after the completion of the distraction, multiple biopsies were taken across the distraction gap. Histological observation showed bone deposition in the osteotomy sites. Soft and hard tissue formation resulted in complete healing across the distraction gap. The maxillary sinus was used to accommodate the distraction device. Superimposition of the standardized lateral cephalograms taken at the end of distraction and 14 months after the removal of the distractors showed no sign of relapse in the achieved sagittal advancement of the maxilla. This small, intraoral trans-sinusal placed distractor has a completely new conceptual design, and may be helpful in distraction of maxilla in children and adults with midfacial hypoplasia.

Skeletal and dento-alveolar stability after surgical-orthodontic treatment of anterior open bite: a retrospective study.

The aim of this investigation was to assess skeletal and dento-alveolar stability after surgical-orthodontic correction of skeletal anterior open bite treated by maxillary intrusion (group A) versus extrusion (group B). The cephalometric records of 49 adult anterior open bite patients (group A: n = 38, group B: n = 11), treated by the same maxillofacial surgeon, were examined at different timepoints, i.e. at the start of the orthodontic treatment (T1), before surgery (T2), immediately after surgery (T3), early post-operatively (+/- 20 weeks, T4) and one year post-operatively (T5). A bimaxillary operation was performed in 31 of the patients in group A and in six in group B. Rigid internal fixation was standard. If maxillary expansion was necessary, surgically assisted rapid palatal expansion (SRPE) was performed at least 9 months before the Le Fort I osteotomy. Forty-five patients received combined surgical and orthodontic treatment. The surgical open bite reduction (A, mean 3.9 mm; B, mean 7.7 mm) and the increase of overbite (A, mean 2.4 mm; B, mean 2.7 mm), remained stable one year post-operatively. SNA (T2-T3), showed a high tendency for relapse. The clockwise rotation of the palatal plane (1.7 degrees; T2-T3), relapsed completely within the first post-operative year. Anterior facial height reduction (A, mean -5.5 mm; B, mean -0.8 mm) occurred at the time of surgery. It can be concluded that open bite patients, treated by posterior Le Fort I impaction as well as with anterior extrusion, with or without an additional bilateral sagittal split osteotomy (BSSO), one year post-surgery, exhibit relatively good clinical dental and skeletal stability.

[Syndromes 12. Turner syndrome]. / Syndromen 12. Het Turner-syndroom.

Turner syndrome is one of the most common chromosomal disorders. The incidence is about 1 on 2,500 till 1 on 10,000 living female young births. Short stature is the most common finding in patients with Turner syndrome. Besides short stature and gonadal dysgenesis, typical craniofacial and dental features are also present. Disturbance of the enchondral ossification results in abnormal craniofacial morphology. Oestrogen medication, to induce their puberty, and recombinant human growth therapy, to improve final height of these patients, are the most common treatment possibilities. It is the intention of this short paper to inform the dentist/orthodontist about the general aspects of the Turner syndrome. This information can be used in their treatment plan.

Craniofacial growth and dental maturation in short children born small for gestational age: effect of growth hormone treatment. Own observations and review of the literature.

Short children born small for gestational age (SGA) may be candidates for treatment with growth hormone (GH). We examined craniofacial growth and dental maturation in a cohort of short SGA children. The general growth failure of these children is reflected to a differential extent within the craniofacial complex. As a group, these children have a small retrognathic face with a relatively increased lower anterior face height; in contrast to skeletal maturation, dental age is not delayed. GH treatment in short prepubertal SGA children leads to craniofacial catch-up growth, which is particularly pronounced in regions where interstitial cartilage is involved, the result being that the facial profile becomes less convex; dental maturation does not appear to be influenced by GH treatment. In conclusion, in short SGA children, GH treatment does not only result in an increase of body stature but also in a trend towards normalization of craniofacial growth and this without notable advancement of dental maturation.

Short stature of prenatal origin: craniofacial growth and dental maturation.

Recently, children born small for gestational age (SGA) with a catch-up growth failure, have been selected for high dose growth hormone (GH) treatment. In order to gain greater insight concerning dentofacial growth and maturation of these patients, and to evaluate the possible effects of high does GH administration on facial structures, craniofacial growth and dental maturation were evaluated in short SGA persons. Seventy-seven cephalograms and orthopantomograms were available from 48 subjects, aged between 2 and 32 years. Craniofacial growth was assessed by calculating age- and gender-specific standard deviation scores (SDS) for eight linear and five angular measurements. Tooth formation was evaluated by means of a dental delay score (i.e. dental age minus chronological age). The SDS for craniofacial growth measurements for the lateral aspect showed a short anterior cranial base (-1.8 SDS), a small retropositioned mandible (< or = -1.7 SDS) and a small maxilla (-1.5 SDS); a high mandibular plane angle (+1.9 SDS) and a wide cranial base angle (+1 SDS). These findings result in a small retrognathic face with a relatively increased lower anterior face height (+1.7 SDS). In contrast to skeletal maturation, dental age was not delayed. The general growth retardation is, apparently, reflected to a differential extent within the craniofacial complex, while dental maturation appears to be a distinct process tightly linked to chronological age, and independent of general growth and bone age.

Craniofacial growth in short children born small for gestational age: effect of growth hormone treatment.

The effects of growth hormone (GH) therapy in children have yet to be completely catalogued. In the present study, the effect of high-dose GH treatment on craniofacial growth was evaluated once yearly in 21 pre-pubertal, non-GH-deficient children born small for gestational age. These children were randomly allocated to be either untreated or treated with GH at a daily subcutaneous dose of 0.2 or 0.3 IU/kg for 2 yrs. The group consisted of 12 girls and 9 boys with a mean age of 5.1 yr (range, 2 to 8 yr), bone age of 3.4 yr, and height SDS of -3.6. At the start of the study, all children showed an overall delay of craniofacial growth. This cohort of short children born small for gestational age showed a small SNB angle and a large ANB angle; all other angular measurements were within normal range. GH treatment accelerated growth in several craniofacial components, especially the posterior total facial height, the cranial base length, and the overall mandibular length. The increase of the mandibular length increased the SNB angle; no other angular measurements were affected. Age at start of treatment differently influenced the increase in posterior and total cranial base length, the increase in mandibular corpus length, and the position of the mandible in relation to the cranial base. Although GH treatment for 2 yrs led to a craniofacial growth acceleration, the position of the mandible in relation to the cranial base and the craniofacial size in lateral aspect were not normalized in the majority of the GH-treated children. No signs of disproportional growth were evidenced after 2 yrs of high-dose GH treatment. In conclusion, short pre-pubertal SGA children display an overall delay of linear craniofacial growth and a retrognathic mandible. High-dose GH treatment over 2 yrs leads to craniofacial catch-up growth, which is pronounced in regions where interstitial cartilage is involved and results in a less convex face in profile.

Craniofacial growth in short children born small for gestational age: two years follow-up after high-dose growth hormone treatment.

The craniofacial growth of 17 children born small for gestational age (SGA), who had received high-dose growth hormone (GH) treatment, was studied during the post-treatment phase. The preceding GH treatment consisted of a daily s.c. dose of either 0.2 or 0.3 IU/kg for 2 years. The group consisted of 9 girls and 8 boys with a mean (range) age of 6.9 yr (4-10 years) at the start of the post-treatment period, a mean (SD) bone age of 6.3 (2.1) years, and a mean (SD) height for chronological age of -1.0 (0.6) SDS. During the post-treatment period of 2 years, a catch-down effect was found for all linear craniofacial measurements in both treatment groups, even for the components that had not presented accelerated growth during GH treatment. Major growth vectors, such as the posterior total face height (S-Go) and the overall length of the mandible (Art-Pog), showed a low growth velocity, while minor growth parameters remained almost unchanged during this period. The angular measurements showed no significant changes during this period. It can be concluded that craniofacial growth in short SGA children showed, after a period of GH-induced acceleration, a catch-down period when GH administration is stopped. Despite this low post-treatment growth velocity, the craniofacial linear measurements in lateral aspect, remained larger than in untreated children.

[The dentofacial complex in hormonal treatment for growth retardation]. / Le complexe dento-facial lors du traitement hormonal pour retard de croissance.

The greater availability of growth hormone (GH) and the increasing knowledge of growth hormone physiology have led to a wider application of growth hormone treatment. GH is approved for use in the treatment of pituitary deficiency syndromes and, when properly administered at an early stage, is capable of inducing normal skeletal and muscular development. It has also been successfully used to augment growth in patients with Turner syndrome and the effect on the abnormal craniofacial skeleton of these patients is favourable. The not yet generally approved indications for GH therapy are small children after intrauterine growth retardation, patients with renal insufficiency and patients with osteoporosis. Research is done on effects and possible side-effects into different systems e.g. the craniofacial complex. Dentists and orthodontists who treat growth retarded patients must realize that most of these children have a delay in dentofacial development and in dental maturation and that the facial proportions can be thoroughly different from normal patients. The effect of GH therapy on the craniofacial complex and the dental maturation must also be taken into consideration while planning orthodontic or dental treatment.