Tratamiento Rehabilitador Estético-Oclusal con Resinas Compuestas en una Paciente con Mordida Profunda y Desgaste Severo / Aesthetic-Occlusal Rehabilitation Treatment with Composite Resins in a Patient with Deep Bite and Dental Wear

RESUMEN: La rehabilitación oral tradicional del paciente con mordida profunda y braquifacial puede ser muy compleja e invasiva, sin embargo, podría involucrar muchas especialidades para su resolución ideal. Un análisis integral estético-oclusal es necesario antes de empezar el tratamiento para hacer propuestas con el menor costo biológico, de tiempo y económico. La odontología adhesiva permite una propuesta aditiva y no invasiva como un tratamiento de mediano plazo o transitorio. Este artículo presenta un caso de una paciente de 46años de edad con mordida profunda anterior y desgaste dental severo en las caras palatinas de los dientes antero-superiores, sin disfunción temporomandibular, ni compromisos sistémicos. Se destaca la rehabilitación estética- oclusal con el mínimo compromiso biológico (ultra-conservadora), mediante restauraciones adhesivas semi-indirectas de resina compuesta con acompañamiento de 12meses. Esta propuesta rehabilitadora con resinas compuestas representa una alternativa de tratamiento para el manejo del paciente con mordida profunda anterior. El control a un año de tratamiento demostró que se siguió una secuencia y resolución que aseguró los principios de la rehabilitación oral, al mismo tiempo, se procedió de la manera menos invasiva posible.

ABSTRACT: The traditional oral rehabilitation of the patient with deep bite and brachifacial can be very complex and invasive, however, a number of treatments could be considered to improve rehabilitation. A comprehensive aesthetic-occlusal analysis is necessary prior to starting treatment in order to consider the best procedure, time involved, and economic cost. Adhesive dentistry allows an additive and non-invasive proposal as a medium-term or transitory treatment. A case of a 46-year-old patient is presented, with anterior deep bite and severe dental wear on palatal surfaces of the antero-superior teeth, without temporomandibular dysfunction, or systemic compromises. The objective was to emphasize the aesthetic and occlusal rehabilitation with the least biological commitment (ultraconservative), through semi-indirect adhesive restorations of composite resin with 12 months follow-up. This restorative proposal with composite resins represents an alternative treatment for patient management with anterior deep bite. Control at one year of treatment showed that a sequence and resolution was followed, that ensured adequate oral rehabilitation in the least invasive manner possible.

Orthodontic-Orthognathic Management of a patient with skeletal class II with bimaxillary protrusion, complicated by vertical maxillary excess: A multi-faceted case report of difficult treatment management issues.

This case reports the unsuccessful first treatment and the subsequent retreatment of a 35-year old Asian female with a skeletal class II with bimaxillary protrusion, complicated by a deep bite and vertical maxillary excess. This case report highlights the multiple facets of a challenging treatment plan and discusses the ramifications of treatment when treatment does not go as planned. The initial treatment plan consisted of a surgical approach with a maxillary Le Fort I surgery to correct the malocclusion as per the patient's requests without mandibular surgery due to the inherent risk of paraesthesia. The second treatment plan consisted of a bimaxillary surgery with genioplasty. The surgical treatment utilized virtual surgical planning (VSP). The orthodontic treatment was concluded with a corrected overjet and overbite achieving optimum function and balancing the facial profile aesthetically. This case report highlights the need for clear communication of the treatment plan and also the unpredictability of certain treatment outcomes especially when the literature does not provide for definitive conclusions. In addition, it sheds light on the challenge of unpredictable response of soft tissue after surgical treatment and the importance of patient expectations of outcomes. It is hoped that the paper provides a platform for future discussions of difficult malocclusions.

Dentoskeletal morphology in adults with Class I, Class II Division 1, or Class II Division 2 malocclusion with increased overbite.

INTRODUCTION: The treatment options for adults with increased overbite are limited to dentoalveolar changes that camouflage the condition. Because of high relapse tendency, defining the problem area is important when creating a treatment plan. This study aimed to evaluate dentoskeletal morphology in skeletal Class I and II anomalies associated with Angle Class I, Class II Division 1 (Class II/1), and Class II Division 2 (Class II/2) malocclusions with increased overbite compared with normal occlusion. METHODS: Pretreatment cephalograms of 306 patients (131 men, 175 women; overall ages 18-45 years) were evaluated. Four groups were constructed. Three groups had increased overbite (>4.5 mm): group 1 (n = 96) skeletal Class I (ANB = 0.5°-4°), group 2 (n = 85) skeletal Class II (ANB >4.5°) with Class II/1; and group 3 (n = 79) skeletal Class II with Class II/2 malocclusion. Group 4 as a control (n = 46) skeletal Class I normal overbite. Dental and skeletal characteristics of the groups were compared by sex. For statistical evaluations, analysis of variance followed by Tukey post hoc, Mann-Whitney U, and Kruskall-Wallis tests were used. Additionally correlation coefficients between overbite and skeletal/dental parameters were calculated. RESULTS: Between sexes, with regard to skeletal parameters, the men had greater values in millimetric measurements, and the women had higher SN/GoGn values. Maxillary/mandibular molar heights and the mandibular incisor heights were higher in men. In group 1, decreased lower anterior facial height (LAFH), retrusive mandibular incisors, and increased interincisal degree were determined. The maxillary molars were intrusive, whereas the vertical position of the mandibular molars and incisors in both jaws were normal. In group 2, retrognathic mandible, increased LAFH and mandibular plane angle, extrusive maxillary/mandibular incisors, protrusive mandibular incisors, and decreased interincisal degree were found. In group 3, decreased LAFH, increased interincisal degree, and retrusive incisors in both jaws were determined. There were significant negative correlations between SN/GoGN, palatal plane, and overbite in group 2 and between ANS-SN and overbite in group 3, and positive correlation between interinsical angle and overbite in all increased overbite groups. CONCLUSIONS: Dental morphology seems to be the main factor of increased overbite. Differences between groups were related primarily to inclinations and vertical positions of the incisors, rather than molar positions.

The normal range of maximal incisal opening in pediatric population and its association with physical variables.

Background: Restricted mouth opening is a common complaint in patients suffering from temporomandibular joint disorders, ankylosis, impaired masticatory muscle function, rheumatic disease, infection, or malignancy. As with any disease, the aim of treatment of disorders affecting mouth opening is to restore the mouth opening to its normal value. It is thus of paramount importance to determine the normal value. Objective: To establish the normal range of maximal incisal opening (MIO) in children aged 4 to 15 years and to investigate the correlation between MIO and age, gender, height, and body weight. Materials and Methods: Six hundred and two children from various schools in Bengaluru, India, participated in the study. The children were divided into the following age groups: 4-5, 6-7, 8-9, 10-11, 12-13, and 14-15 years. MIO for the children was recorded using Therabite® scale. The measurements of MIO were then correlated with gender, body weight, and height of the children in different age groups. Results: It was observed that MIO gradually increased with age with a mean MIO of 41.34 mm at 4-5 years to a mean MIO of 51.73 mm at 14-15 years. The mean MIO value for males (48.90 ± 6.49 mm) was found to be higher when compared to that of females (46.17 ± 5.58 mm). The results indicated a strong positive correlation of MIO with height and weight. Conclusion: MIO gradually increased with age in both the genders, and a strong positive correlation of MIO with height and weight was observed.

RésuméContexte: L'ouverture restreinte de la bouche est une plainte fréquente chez les patients souffrant de troubles de l'articulation temporo-mandibulaire, d'ankylose, d'altération de la fonction musculaire masticatoire, de rhumatisme articulaire, d'infection ou de cancer. Comme pour toute maladie, le traitement des troubles de l'ouverture de la bouche a pour objectif de ramener cette ouverture à sa valeur normale. Il est donc primordial de déterminer la valeur normale. Objectif: Établir la plage normale d'ouverture maximale de l'incision (OMI) chez les enfants âgés de 4 à 15 ans et étudier la corrélation entre l'ouverture maximale de l'incision et l'âge, le sexe, la taille et le poids corporel. Conception de l'étude: Six cent deux sujets de diverses écoles de Bangalore, en Inde, ont participé à l'étude. Les sujets ont été répartis dans les groupes d'âge suivants: 4-5, 6-7, 8-9 ans, 10-11 ans, 12-13 ans et 14-15 ans. L'ouverture incisive maximale des sujets a été enregistrée avec l'échelle Therabite®. Les mesures de MIO ont ensuite été corrélées avec le sexe, le poids corporel et la taille des enfants dans différents groupes d'âge. Résultats: Il a été observé que le MIO augmentait progressivement avec l'âge, avec un MIO moyen de 41,34 mm à 4-5 ans, pour atteindre un MIO moyen de 51,73 mm à 14-15 ans. La valeur moyenne maximale de l'ouverture incisive chez les hommes (48,90 ± 6,49 mm) s'est avérée plus élevée que celle des femmes (46,17 ± 5,58 mm). Les résultats ont montré une forte corrélation positive entre le MIO et la taille et le poids. Conclusion: le MIO a augmenté progressivement avec l'âge chez les deux sexes et une forte corrélation positive entre le MIO et la taille et le poids a été observée.

Growth patterns and overbite depth indicators of long and short faces in Korean adolescents: Revisited through mixed-effects analysis.

OBJECTIVE: The purpose was to evaluate skeletal factors related to the growth of subjects with skeletal open and deep bites based on lateral cephalographs from 9 years of pure longitudinal data using mixed effect analysis. SETTING AND SAMPLE POPULATION: Fifty-one children with extreme lower anterior facial height to total anterior facial height (LAFH/TAFH) ratio values at the age of 14 were assigned to either skeletal open bite or skeletal deep bite groups from a total of 223 subjects. MATERIAL & METHODS: The palatal plane angle (PPA), mandibular plane angle (MPA), gonial angle (GA), palatomandibular plane angle (PMA), upper gonial angle (UGA), lower gonial angle (LGA), occlusal plane angle (OPA) and overbite depth indicator (ODI) were measured and analysed. Mixed-effects regression model analysis was used for the interpretation of data with random effects. RESULTS: Morphological differences were evident from the beginning and became more pronounced with age in MPA, GA, PMA, ODI and LGA. The initial values of all variables were statistically significant. Annual increases with age were statistically significant in GA, OPA, ODI and UGA. The morphological differences in the annual increases in MPA, GA, PMA and UGA were also statistically significant. CONCLUSIONS: Morphologically different growth patterns were mainly contributed by lower anterior facial height dimensions. The extent of individual variations mandates judicious decision-making in clinical situations.

[Relationships between the size of the adenoids and the dental arch measurements]. / Corrélations entre les dimensions des végétations adénoïdes et les mensurations des arcades dentaires.

INTRODUCTION: Enlarged adenoids are often associated with oral breathing. The latter can impact the dental arches. The purpose of this study was to determine the relationships between dental arch measurements and the size of adenoids. MATERIALS AND METHODS: A cross-sectional study was carried out on 86 children. The dimensions of the adenoids were determined from nine radiographic evaluation methods and the dental arch measurements made on the casts. The association between the grade of adenoids and the dental arch measurements was sought by Spearman correlation. That between the quantitative variables assessing adenoids and dental arch measurements was sought by Pearson correlation. The strength of these associations was analyzed using Cohen's values in 1988. The significance was set at p = 0.05. RESULTS: Palatal depth was significantly and positively correlated with adenoid grade according to the method of Holmberg and Linder-Aronson (rho = 0.55, p = 0.005) and with the adenoid measurements according to the methods of Kemaloglu, Fujioka, Johannesson, De Menezes and Maran with r respectively equal to 0.65, 0.59, 0.63, 0.47, 0.74; and p respectively equal to 0.001, 0.002, 0.001, 0.019, and < 0.001. It was also significantly but negatively correlated with the adenoids measurements according to Hibbert's method (r = -0.52, p = 0.008). Overbite was significantly and negatively correlated with adenoid dimension using the De Menezes method (r = -0.541, p = 0.006). DISCUSSION: The strength of the associations shows that using respectively Maran and De Menezes methods can allow to better highlight the association between the dimensions of the adenoids and the palatal depth and the overbite.

Morphological differences in lower facial third soft tissues in children with and without gingival smile: A cross-sectional comparative study.

AIM: The aim of the present study was to establish the relationship between lower facial third and smile type in silent mixed-dentition patients. METHODS: This cross-sectional study, approved by the ethics committee, was conducted in a population of 2760 children, from which a convenient sample of 198 was included: 75 with gingival smile (GS) and 123 without GS (1:1.64). Clinical examination and videos were taken. Occlusal relation, overjet (OJ), overbite (OB), superior lip length at rest, superior lip length while smiling (SLLS), lower facial third height (LFTH), mid-facial third height (MFTH), clinical crown length, and lip lift ability (LLA) were measured by two calibrated examiners (intraclass correlation coefficient: ≥.95). A normality test and demographic and bivariate analyses were undertaken. A non-paired Student's t test was carried out in order to observe statistically-significant differences between variables. RESULTS: There were no differences between sexes or associations between LFTH and GS. Statistically-significant differences (P < .05) in MFTH, SLLS, LLA, OJ, and OB were found. A logistic regression model showed that the sum of LLA (odds ratio [OR]: .65, 95% confidence intervals [CI]: .50,.83]) and OB (OR: .88, 95% CI: .82, .93]) were GS predictive factors in 81.3% of cases. CONCLUSIONS: OB and LLA are GS predictive factors in prepubertal participants. There is no relation between LFTH and GS.

Outcome quality and long-term (≥15 years) stability after Class II:2 Herbst-multibracket appliance treatment in comparison to untreated Class I controls.

Aim: To investigate the outcome quality and the long-term (≥15 years) post-treatment (Tx) changes after Class II:2 Herbst-multibracket appliance (MBA) Tx. Subjects and Methods: In this longitudinal observational study, a recall of Class II:2 patients who had been treated by a Herbst-MBA during adolescence was conducted. Study models from before and after active Tx, after retention and after recall were assessed using standard occlusal variables and the peer assessment rating index (PAR). These data were compared to historical untreated Class I controls. Results: Twenty out of 33 patients (61%) could be located and participated at age 33.9 ± 2.7 years. When comparing their data to the 13 patients who did not participate, the pre- and post-Tx occlusal findings did not differ systematically; however, the PAR scores of the non-participants were by 3.3-8.2 points higher at all times and the non-participants were 2.1-2.5 years older. Pre-Tx at age 14.4 ± 2.7 years, the participants showed the following mean values: PAR = 15.0 ± 7.0, Class II molar relationship (MR) = 0.8 ± 0.3 cusp widths (cw), overbite = 5.3 ± 1.3 mm. After Tx, a PAR score of 2.9 ± 1.3 and a super Class I MR (-0.1 ± 0.1 cw) with normal overbite (1.2 ± 0.8 mm) existed. At recall, a PAR score increase to 5.9 ± 3.6 points had occurred, mainly caused by an increase of overbite to 2.5 ± 1.5 mm. The average MR remained Class I (0.0 ± 0.2 cw). For all variables, the untreated controls exhibited similar findings. Conclusion: The occlusal outcome of Class II:2 Herbst-MBA Tx exhibited very good long-term stability. While mild post-Tx changes occurred, the long-term findings are similar to untreated Class I controls.

Radiographic evaluation of dental and cervical vertebral development for age estimation in a young Brazilian population

Age estimation is guided by the evaluation of events that happen during the processes of bone and dental development. The purpose of this study was to validate the method of age estimation proposed by Lajolo et al. (2013) through oro-cervical radiographic indices in Brazilians. The study aimed to verify the effectiveness of age estimation equations through dental and cervical vertebrae examinations, in addition to including dental and cervical vertebrae data in new age estimation equations. The sample consisted of panoramic radiographs and teleradiographs from 510 subjects (8-24.9 years). Age estimation methods were applied by assessing the development of seven mandibular teeth, cervical vertebrae and third molars. Techniques used previously have been combinations of radiographic indices: Oro-Cervical Radiographic Simplified Score (OCRSS) and Oro-Cervical Radiographic Simplified Score without Wisdom Teeth (OCRSSWWT). In the second phase of the study, dental maturation, vertebral measurements, and real age were estimated by regression equations. OCRSS and OCRSSWWT had success rates of 67.4% (R2=0.64) and 70.8% (R2=0.62), respectively. When age estimation equations for tooth evaluations were applied, the average error was 1.3 years, and for cervical vertebrae measurements, the error was 1.9 years. When dental variables and the measurements of cervical vertebrae were included, the average error of equations was 1.0 year. Radiographic indices were easy to perform, and after adequate training, are reliable and can be used in forensic practice. The use of the new equations presented in this study is recommended because including cervical vertebrae and dental data provides greater accuracy for age estimation.

Characteristic of Malocclusion among Saudi Special Need Group Children.

INTRODUCTION: The present study analyzed the characteristics of malocclusions, occlusal traits among Special Health care Needs (SHCN) children with Down syndrome (DS) and autism disorder (AD) in Riyadh City, Kingdom of Saudi Arabia. MATERIALS AND METHODS: A total of 100 DS and 100 AD children from five rehabilitation centers in and around Riyadh, Kingdom of Saudi Arabia, were included in the study. Any children with history of ongoing medical treatment, extraction, or orthodontic treatment were excluded from the study. Out of the 200 patients examined, 131 were males and 69 were females and the age of the children ranged from 6 to 14 years. The children were examined for malocclusion characteristics using the Angle's classification of malocclusion, and also other occlusal traits, such as overjet, overbite, cross bite, and open bite were also determined. The data obtained were analyzed using Statistical Package for the Social Sciences, version 16 to generate descriptive statistics for each variable. RESULTS: The analyzed data of the right and left permanent molar relation showed higher incidence of class III malocclusion (66%) in DS children as compared with (3-4%) AD children. The AD children presented with higher percentage of class I malocclu-sion (40-41%) as compared with (10-14%) DS children. During examination of the primary molars, the analyzed data showed that left primary molar had more mesial shift in AD children as compared with DS children. CONCLUSION: Down syndrome children had high incidence of class III malocclusion and autistic children had high incidence of class I malocclusion. Overall, the DS children were more prone to malocclusion. CLINICAL SIGNIFICANCE: This study provides database for health professionals in Saudi Arabia in regard to malocclusion of autis-tics and DS patients.

Early vertical correction of the deep curve of Spee.

Even though few technological advancements have occurred in Orthodontics recently, the search for more efficient treatments continues. This paper analyses how to accelerate and improve one of the most arduous phases of orthodontic treatment, i.e., correction of the curve of Spee. The leveling of a deep curve of Spee can happen simultaneously with the alignment phase through a method called Early Vertical Correction (EVC). This technique uses two cantilevers affixed to the initial flexible archwire. This paper describes the force system produced by EVC and how to control its side effects. The EVC can reduce treatment time in malocclusions with deep curves of Spee, by combining two phases of the therapy, which clinicians ordinarily pursue sequentially.

Early vertical correction of the deep curve of Spee

ABSTRACT Even though few technological advancements have occurred in Orthodontics recently, the search for more efficient treatments continues. This paper analyses how to accelerate and improve one of the most arduous phases of orthodontic treatment, i.e., correction of the curve of Spee. The leveling of a deep curve of Spee can happen simultaneously with the alignment phase through a method called Early Vertical Correction (EVC). This technique uses two cantilevers affixed to the initial flexible archwire. This paper describes the force system produced by EVC and how to control its side effects. The EVC can reduce treatment time in malocclusions with deep curves of Spee, by combining two phases of the therapy, which clinicians ordinarily pursue sequentially.

RESUMO Apesar de haver poucos desenvolvimentos tecnológicos nos últimos anos dentro da Ortodontia, a busca por tratamentos mais eficientes não cessou. Assim, o presente artigo visa analisar, de maneira lógica, como otimizar uma das fases do tratamento ortodôntico que mais demandam tempo: a correção da sobremordida exagerada. Pretende-se demonstrar como realizá-la concomitantemente ao alinhamento inicial, por meio de uma técnica denominada correção vertical precoce (CVP). Essa técnica utiliza dois cantilevers associados ao primeiro fio de alinhamento ortodôntico, mas não restritos a ele, a fim de iniciar a planificação da curva de Spee o mais cedo possível. Assim, o tempo de tratamento pode ser diminuído, já que duas fases do tratamento, normalmente realizadas de forma independente, podem ser realizadas ao mesmo tempo. Além disso, tanto o sistema de forças quanto os efeitos colaterais e os passos da execução da técnica serão devidamente apresentados e discutidos.

Comparisons of two protocols for early treatment of anterior open bite.

Aim: The purpose of this study was to compare the outcomes of the treatment with the quad-helix/crib (Q-H/C) appliance with those of a combination of transpalatal arch, high-pull headgear, and lip bumper (TPA/HG/LB) in growing patients with anterior open bite malocclusion. Methods: The TPA/HG/LB sample consisted of 22 subjects, 16 girls and 6 boys (mean age 7.5±1.4 years at the start of treatment, T1, and 8.7±1.5 years at the end of active treatment, T2). The Q-H/C sample consisted of 28 subjects, 17 girls and 11 boys (mean age 8.2±1.3 years at T1, and 8.7±1.6 years at T2). Both treated groups were compared with a control group of 20 untreated subjects matched for dentoskeletal disharmony and observation interval. The changes from T2 to T1 between the three groups were compared with the analysis of variance. Results: Both TPA/HG/LB and Q-H/C groups exhibited greater reduction of the palatal plane to mandibular plane angle (-1.7° and -1.9°, respectively) and a significantly greater increase in overbite (2.2 and 2.3mm, respectively) with respect to controls. Conclusions: Q-H/C and TPA/HG/LB protocols were equally effective in correcting the anterior open bite.

Dentoskeletal effects of oral appliance wear in obstructive sleep apnoea and snoring patients.

OBJECTIVES: To evaluate the dentoskeletal changes associated with long-term and continuous mandibular advancement device (MAD) use in sleep-related breathing disorder patients. METHODS: Cephalometric measurements and three-dimensional model analysis were performed at baseline and after 3.5 ± 1.1 years in 20 snoring and obstructive sleep apnoea patients treated with the Silensor® appliance. Intra-group differences were compared using paired t-test or Wilcoxon signed-rank test. A regression analysis was performed for variables that showed a statistically significant difference between time points to evaluate the influence of treatment time and patient's initial characteristics on their variations. The statistical significance was set at P < 0.05. RESULTS: At cephalometric assessment, the maxilla revealed a significant decrease in horizontal position (SNA: -0.4 ± 0.72 degree, P = 0.021) and a significant retroclination of the upper incisor (-1.59 ± 1.07 degree, P < 0.001), while the mandible displayed a significant downward rotation (0.88 ± 1.28 degree, P = 0.006) and a proclination of the lower incisor (2.27 ± 1.38 degree, P < 0.001). Model analysis showed a decrease in upper total space discrepancy (-0.66 ± 0.72 mm, P < 0.002), overjet (OJ; -0.34 ± 0.47 mm, P < 0.011), and overbite (-0.4 ± 0.52 mm, P < 0.004). In the regression analysis, treatment time influenced the lower incisor inclination (Beta = -0.713, P = 0.018) and OJ (Beta = -0.218, P = 0.018); patients' initial characteristics had an effect on OJ (Beta = -0.195, P = 0.011). LIMITATIONS: A larger sample size could increase the generalizability of the findings. CONCLUSION: MAD wear after a mean of 3.5 years determines statistically significant but clinically irrelevant dentoskeletal changes. Their potential occurrence should be thoroughly discussed with patients; regular follow-up visits by a specialist experienced in dental sleep medicine are also mandatory during treatment in addition to polysomnographic examinations.

Cephalometric study of Class II Division 1 patients treated with an extended-duration, reinforced, banded Herbst appliance followed by fixed appliances.

INTRODUCTION: The Herbst appliance has been used in the treatment of Class II malocclusions with deficient mandibles. Various protocols, including different durations of the orthopedic treatment phase and stepwise advancement of the mandible, have been advocated for increasing the orthopedic effects. The objective of this study was to investigate the skeletal and dental changes in patients treated with a reinforced banded Herbst appliance for an extended duration and fixed appliance therapy. METHODS: The study group consisted of 30 patients (16 boys, 14 girls; mean age, 12.3 ± 2.5 years) with Class II Division 1 malocclusions who were successfully treated with the new Herbst protocol followed by fixed appliances. Lateral cephalometric radiographs were taken before treatment, at the completion of Herbst treatment, and after removal of fixed appliances. The average treatment times were 1.5 ± 0.7 years for the Herbst treatment and 1.8 ± 0.5 years for the fixed appliances. A control Class II sample from the Bolton-Brush study was used to subtract growth from treatment changes to determine the appliance effect. Data were analyzed using analysis of variance and the Tukey-Kramer test. RESULTS: After the Herbst treatment, the incisal relationships of all subjects had been overcorrected to end-to-end relationships. Overjet was reduced by 7.2 mm after subtracting changes from growth. The skeletal contribution was 2.5 mm (35%), and the dental contribution was 4.7 mm (65%). The molar relationship was overcorrected to a more Class I relationship by 7.5 mm. The Wits appraisal was improved by 4.2 mm. Vertically, overbite was decreased by 3.3 mm. The maxillary and mandibular molars were extruded by 1 mm. The occlusal plane rotated clockwise by 5° with little change in the mandibular plane angle. After the treatment with fixed appliances, the overjet correction was maintained at 7.6 mm. The skeletal contribution was 2.9 mm (38%), and the dental contribution was 4.7 mm (62%). The molar relationship was corrected to a Class I relationship by 5.9 mm. The Wits appraisal was improved by 3.2 mm. Vertically, overbite was decreased by 4.2 mm. The maxillary and mandibular molars were extruded by 0.3 and 0.8 mm, respectively. The occlusal plane rotated clockwise by 1.2° with little change in the mandibular plane angle. CONCLUSIONS: Doubling the usual orthopedic treatment time with the reinforced Herbst appliance followed by fixed appliance therapy was effective in correcting Class II Division 1 malocclusions with excess overjet and overbite. In this sample of successfully treated patients, most changes after Herbst and fixed appliance therapy were dentoalveolar (62%). However, the skeletal changes attained in the orthopedic phase of treatment were maintained after fixed appliance therapy.

Herbst plus Lingual versus Herbst plus Labial: a comparison of occlusal outcome and gingival health.

OBJECTIVES: To analyse and compare the effects during Herbst treatment combined with a lingual (completely customized) or labial (straight-wire) multibracket appliance (MBA), with special regard to lower incisor gingival recessions. SUBJECTS AND METHODS: Eighteen Class II:1 patients [overjet ≥ 5mm, Class II molar relationship ≥ 0.5 cusp widths (CW) bilaterally or 1.0 CW unilaterally, median age 16.0 years] treated with a Herbst appliance in combination with a lingual MBA (group LINGUAL) were retrospectively matched (molar relationship and skeletal maturity) to 18 Class II:1 patients treated with a Herbst appliance combined with a labial MBA (group LABIAL). Study models and intraoral photographs from before and after treatment were evaluated regarding occlusal variables and gingival recessions. Lateral cephalograms from before, during (before and after Herbst), and after treatment were analysed to assess lower incisor changes. RESULTS: Both groups showed similar reductions of overjet (5.4/5.6mm), overbite, (2.9/2.7mm) and sagittal molar relationship (0.9/0.8 CW). During the Herbst phase, the changes in lower incisor inclination and incisal edge position were significantly smaller in the LINGUAL than in the LABIAL group (iiL/ML: +7.0/+12.7degrees, P = 0.002; ii-MLppg: +2.5/+3.9mm, P = 0.004). For the total treatment period, no significant differences were found (iiL/ML: +5.3/+8.6degrees; ii-MLppg: +2.1/+2.4mm). No clinically relevant gingival recessions were seen. CONCLUSION: Both treatment approaches successfully corrected the malocclusion. The group LINGUAL exhibited significantly less proclination during the Herbst phase only. Neither treatment approach induced deleterious gingival recessions.

Treatment of large overjet in Angle Class II: division 1 malocclusion with Andresen activators versus prefabricated functional appliances-a multicenter, randomized, controlled trial.

OBJECTIVES: The purpose of this study was to compare the clinical effectiveness in reducing large overjet between a prefabricated functional appliance (PFA) and a slightly modified Andresen activator (AA). SETTING AND SAMPLE POPULATION: Public Dental Service, Gothenburg, Sweden. PARTICIPANTS, STUDY DESIGN, AND METHODS: A multicentre, prospective randomized clinical trial was conducted with patients from 12 general dental practices. One hundred and five patients with an Angle Class II, division 1 malocclusion and an overjet of ≥6mm were eligible for the study. Eight patients were excluded due to various reasons and the sample consisted thus of 97 subjects (44 girls, 53 boys) with a mean age of 10.3 years. The study was designed as intention to treat and the patients were randomly allocated by lottery to treatment with either a PFA or an AA. The PFA and AA group consisted of 57 subjects (28 girls, 29 boys) and 40 subjects (16 girls, 24 boys), respectively. Overjet, overbite, lip seal, and sagittal molar relationship were recorded before, at the end of treatment and 1-year post-treatment. Blinding was not performed. The endpoint of treatment was set to overjet ≤3mm and after this a 6 months retention period followed. RESULTS: No significant difference was found in overjet, overbite, sagittal relation, and lip seal between the two groups for the total observation period. The treatment of 40 (70 per cent) patients with PFA and 21 (53 per cent) with AA were considered unsuccessful mainly due to poor compliance. LIMITATIONS: No cephalometric records were taken as only patient-centred clinical outcome were used as an indicator for treatment success. The criteria of reduction of overjet to as low as 3mm could have affected the success rate. CONCLUSION: No difference in effectiveness could be shown between PFAs and AAs in correcting overjet, overbite, sagittal molar relation, and lip seal. The success rate in treatment with both appliances is, however, low. REGISTRATION: This trial was registered in "FoU i Sverige" (http://www.fou.nu/is/sverige), registration number: 97131. PROTOCOL: The protocol was not published before trial commencement.

Influence of maxillary posterior discrepancy on upper molar vertical position and facial vertical dimensions in subjects with or without skeletal open bite.

OBJECTIVES: To determine the influence of maxillary posterior discrepancy on upper molar vertical position and dentofacial vertical dimensions in individuals with or without skeletal open bite (SOB). MATERIALS AND METHODS: Pre-treatment lateral cephalograms of 139 young adults were examined. The sample was divided into eight groups categorized according to their sagittal and vertical skeletal facial growth pattern and maxillary posterior discrepancy (present or absent). Upper molar vertical position, overbite, lower anterior facial height and facial height ratio were measured. Independent t-test was performed to determine differences between the groups considering maxillary posterior discrepancy. Principal component analysis and MANCOVA test were also used. RESULTS: No statistically significant differences were found comparing the molar vertical position according to maxillary posterior discrepancy for the SOB Class I group or the group with adequate overbite. Significant differences were found in SOB Class II and Class III groups. In addition, an increased molar vertical position was found in the group without posterior discrepancy. LIMITATIONS: Some variables closely related with the individual's intrinsic craniofacial development that could influence the evaluated vertical measurements were not considered. CONCLUSIONS AND IMPLICATIONS: Overall maxillary posterior discrepancy does not appear to have a clear impact on upper molar vertical position or facial vertical dimensions. Only the SOB Class III group without posterior discrepancy had a significant increased upper molar vertical position.

Shape variation and covariation of upper and lower dental arches of an orthodontic population.

OBJECTIVES: This study aimed to quantify the patterns of shape variability and the extent and patterns of shape covariation between the upper and lower dental arch in an orthodontic population. METHODS: Dental casts of 133 white subjects (61 males, 72 females; ages 10.6-26.6) were scanned and digitized in three dimensions. Landmarks were placed on the incisal margins and on the cusps of canines, premolars, and molars. Geometric morphometric methods were applied (Procrustes superimposition and principal component analysis). Sexual dimorphism and allometry were evaluated with permutation tests and age-size and age-shape correlations were computed. Two-block partial least squares analysis was used to assess covariation of shape. RESULTS: The first four principal components represented shape patterns that are often encountered and recognized in clinical practice, accounting for 6-31 per cent of total variance. No shape sexual dimorphism was found, nevertheless, there was statistically significant size difference between males and females. Allometry was statistically significant, but low (upper: R(2) = 0.0528, P < 0.000, lower: R (2) = 0.0587, P < 0.000). Age and shape were weakly correlated (upper: R(2) = 0.0370, P = 0.0001, lower: R (2) = 0.0587, P = 0.0046). Upper and lower arches covaried significantly (RV coefficient: 33 per cent). The main pattern of covariation between the dental arches was arch width (80 per cent of total covariance); the second component related the maxillary canine vertical position to the mandibular canine labiolingual position (11 per cent of total covariance). LIMITATIONS: Results may not be applicable to the general population. Age range was wide and age-related findings are limited by the cross-sectional design. Aetiology of malocclusion was also not considered. CONCLUSIONS: Covariation patterns showed that the dental arches were integrated in width and depth. Integration in the vertical dimension was weak, mainly restricted to maxillary canine position.

Reliability and validity of measurements on digital study models and plaster models.

OBJECTIVE: To compare manual plaster cast and digitized model analysis for accuracy and efficiency. MATERIAL AND METHODS: Nineteen plaster models of orthodontic patients in permanent dentition were analyzed by two calibrated examiners. Analyses were performed with a diagnostic calliper and computer-assisted analysis after digitization of the plaster models. The reliability and efficiency of different examiners and methods were compared statistically using a mixed model. RESULTS: Statistically significant differences were found for comparisons of all 28 teeth (P < 0.001), mandibular intermolar width (IMW, P = 0.0453), and overjet (P < 0.001 to P = 0.0329). Single-tooth measurements tended to have larger values when measured manually and the SD was between 0.06 and 1.33mm. Digital analyses gave significantly higher values for mandibular IMW and overjet. Less time was needed for digital measurements. CONCLUSION: Clinical significance of the differences between the methods compared did not appear significant. 3D laser-scanned plaster model analysis appears to be an adequate, reliable, and time saving alternative to analogue model analysis using a calliper.