Maxillary Anterior Segment Research Articles

Evaluation of soft tissue profile changes around the nose and upper lip following maxillary anterior alveolar osteotomy with Wassmund and Wunderer technique in Japanese

PurposeThe extent to which maxillary anterior alveolar osteotomy alters the facial profile remains unclear. The present study retrospectively analyzed and evaluated changes in maxillary anterior fragments and soft tissue from the nose to upper lip from pre- to postoperatively in patients who underwent the Wassmund and Wunderer (WW) technique. MethodsThirty-seven Japanese patients with maxillary prognathism underwent orthognathic surgery with the WW technique were retrospectively included in the present study. Changes in both hard- and soft-tissue landmarks and correlations between both tissues were evaluated using lateral cephalograms taken immediately before and ≥6 months after orthognathic surgery. ResultsThe maxillary anterior segment showed predominantly posterior movement, with only slight upward movement. Posterior shift and lingual inclination of the maxillary anterior teeth were prominent. As for soft tissues, the change in the nasal tip was small and posterior change was large in the subnasal and upper lip areas. Nasolabial angle, nasal height, and inclination of nasal tip increased, while upper lip protrusion, nasal tip angle, and philtrum length decreased. Correlations were found between posterior changes in hard tissues and posterior changes in soft tissues. Among these, posterior changes and lingual inclination of the maxillary anterior teeth strongly correlate with posterior changes of the upper lip. ConclusionPosterior shift of the maxillary anterior segment using the WW technique is useful because it can greatly improve the protrusion of the upper lip while minimizing nasal morphological changes, and the positioning of the maxillary anterior teeth may be an important key factor.

Esthetic rehabilitation of mutilated maxillary anterior alveolar segment by combining orthodontic osseous distraction and implant-supported crowns: A clinical report

Bony defects in the esthetic zone, especially in the maxillary anterior region, increase the complexity of surgical and prosthetic procedures. Moving teeth with preprosthetic osseous distraction techniques can be an alternative nonsurgical option to traditional regenerative or reparative surgical therapies to increase bone volume. Healthy peri-implant bone, periodontium, and adjacent teeth provide a favorable environment for implant restorations. The esthetic rehabilitation of the maxillary region after the removal of 2 ankylosed central incisors is presented. The lateral incisors were moved mesially to the central incisor positions, and implants placed in the lateral incisor positions after new healthy bone had been induced.

Nasolabial soft tissue changes associated with posterior maxillary movement following anterior segmental osteotomy in skeletal Class II patients: A case series

ObjectiveThis study investigated the relationship between the external nasal morphology and hard tissue movement in patients who underwent anterior segmental maxillary osteotomy (ASMO) to correct maxillary protrusion correction. MethodsThe study enroled patients with an overjet ≥ 5 mm, and an ANB ≥ 2° who underwent ASMO with or without Le Fort I osteotomy. Linear and angular measurements were performed on computed tomography images obtained preoperatively and one year post-surgery. ResultsThe movement of the maxilla at U1 was 6.7 ± 2.9 mm backward and 1.9 ± 2.0 mm upward. Tooth axis inclination of U1 (∠U1 to FH) increased 5.5 ± 6.1°. The nasolabial angle significantly increased from 90.0 ± 16.8° to 101.0 ± 13.2°. No significant differences were observed in alar base width or nasal tip angles. The change of ∠U1 to FH and the backward movement of U1 were relevant factors influencing the change of nasolabial angle. ConclusionsThis study provides insights into the relationship between external nasal morphology and posterior movement of the anterior maxillary segment after ASMO surgery. These findings are significant for predicting post-operative patient profiles.

Study of dental arch width in patients with idiopathic condylar resorption

Objective:To investigate the relationship between idiopathic condylar resorption （ICR） and arch width disorder. Methods:Thirty-two patients with ICR and twenty patients without condylar resorption were enrolled according to the same inclusion criteria. They were divided into experimental group and control group. The experimental group was divided into unilateral ICR group and bilateral ICR group according to the affected side of condylar resorption, and then experimental group was divided into subgroups ICR Ⅰ, ICRⅡand ICR Ⅲ according to the degree of condylar resorption. Patients with no condylar resorption were used as a control group. The width of anterior, middle and posterior segments of dental arch on cone beam computed tomography（CBCT） was measured and the two groups of measured values were statistically analyzed. Results:Compared with the control group, the width of maxillary anterior, middle and posterior segments in ICR group was significantly reduced, and the difference was statistically significant（P<0.01）. But the width of mandibular segment was not significantly different from that in control group（P>0.05）. There was no significant difference in the width of anterior, middle and posterior dental arch between subgroups（P>0.05）. Conclusion:Almost all patients with ICR have malocclusion of maxillary and mandibular arch width, but there is no significant correlation between the malocclusion width and the severity of condylar resorption.

Fixed Flexible Spiral Wire Retainers and Unwanted Tooth Movements: A Case Report

This case report presents a study of unwanted tooth movements during the retention phase after orthodontic treatment. The early recognition of these unwanted tooth movements is paramount for patients and clinicians to prevent the associated negative consequences. A 21-year-old male presented with aesthetic complaints regarding his upper front teeth. He underwent orthodontic treatment at the age of 9 years and 11 months and finished his treatment 2 years and 11 months later. Flexible spiral wires (FSW) were bonded to the anterior segment of the upper and lower jaws to stabilize the end result. The failure of the fixed retainers had never occurred previously. The diagnostic assessment demonstrated a previously orthodontically treated class I malocclusion with excessive angulation and torque differences in the maxillary anterior segment. To correct the position of the maxillary anterior segment and prevent further misalignment, the patient received orthodontic re-treatment. Thereafter, the result was retained with fixed braided-rectangular-wire (BRW) retainers located at 12–22 and 33–43 and a vacuum-formed retainer (VFR) in the maxilla. The end result appeared to be stable after 28 months of retention. Unwanted tooth movements can occur during the orthodontic retention phase and might result from the use of fixed flexible spiral wire retainers. Follow-up appointments are recommended to monitor the stability and recognize these movements.

The development of a novel Orthodontic Alignment Index and its use to evaluate the effect of residual overjet on the stability of the alignment of the maxillary anterior dentition

BackgroundIt is thought that achieving a normal overjet may help to stabilise the alignment of the maxillary anterior dentition. Little’s Irregularity Index is limited in assessing discrete post-orthodontic changes, fails to account for reciprocal rotations and is not sensitive to dental changes in three planes. A more holistic tool for the assessment of post-treatment change is therefore required.AimTo compare the post-treatment stability of maxillary anterior dental alignment in subjects treated either to a Class I incisor relationship or an increased overjet (> 4 mm) following fixed appliance-based orthodontics using a novel measurement tool.Materials and methodsThe Orthodontic Alignment Index (OAI) was developed and validated using a panel of 63 raters. The new index accounts for a range of weighted features including contact point displacement, spacing, reciprocal rotations, inclination, angulation and vertical discrepancy. A retrospective cohort study was undertaken at the Institute of Dentistry, Queen Mary University of London. Recruitment took place over a 4-year period. All participants had removable retainers in the maxillary arch only. The stability of maxillary anterior teeth was assessed using Little’s Irregularity Index (LII) and the OAI. Subjects were recruited at least 12 months following completion of dual-arch fixed appliance-based treatment.ResultsEighty-two participants were included with a positive correlation observed between LII and OAI at the 12-month post-treatment review with a 1-mm increase in LII associated with a 2-point increase in the OAI (P < 0.001). Limited relapse was observed in both groups: normal overjet group (OAI = 1.28; LII = 0.52); residual overjet group (OAI = 0.88; LII = 0.47). Median regression analysis failed to identify a significant association between an increased overjet at debond and the alignment of the maxillary anterior segment when assessed with OAI (P = 0.389) and LII (P = 0.577). Furthermore, age, gender, extraction protocols and retention regime were not predictive of post-treatment change.ConclusionsUsing a novel index (OAI) and LII, there was limited post-treatment relapse in alignment of the maxillary anterior dentition over a 12-month period. Based on this retrospective evaluation, achieving a normal overjet at the end of treatment may have little bearing on the post-treatment stability of maxillary anterior alignment at 12 months.

Gambaran Tingkat Keberhasilan Perawatan Ortodonti di Klinik Ortodonti RSGM-P FK Usakti Berdasarkan Indeks PAR (Laporan Penelitian)

Background: The success of orthodontic treatment is very much dependent on the degree of malocclusion of the patient's teeth also affects the success of orthodontic treatment. The success of orthodontic treatment can also be assessed using an index, such as the Peer Assessment Rating Index (PAR).Objective:To describe the success rate of orthodontic treatment in the orthodontic clinic of RSGM-P FKG USAKTI based on the PAR index. Method: Descriptive observational study on a study model of orthodontic clinic patients aged 8-12 years. PAR index was measured in 40 pre emptive study models and orthodontic treatment evaluation study models. The components of the PAR index measured included 5 components, namely the assessment of the maxillary and mandibular anterior segments, the assessment of the right and left buccal segment occlusion scores, the overjet score assessment, the overbite score assessment, and the median line score assessment. Result: There were 47.5% included in the "unchanged" category, 50% included in the "changed" category and 2.5% included in the "very much change" category. Conclusion: The description of the success rate of orthodontic treatment in the orthodontic clinic of the RSGM-P FKG Usakti based on the PAR index is changing.

Palatal Bone Wall Thickness in Anterior Maxillary Sites: CBCT Assessments in Dentate Patients.

To assess the thickness of the palatal bone wall of maxillary anterior teeth in relation to age, sex, and tooth type. A total of 100 CBCT images of patients ≥ 18 years of age were used. The thickness of the palatal bone at the maxillary canines and incisors was assessed perpendicular to the long axis of the teeth at three locations: 4 mm apical to the cementoenamel junction (CEJ; MP1), halfway between the CEJ and the root apex (MP2), and at the root apex (MP3). At the MP1 site, 96% of the maxillary anterior teeth had a palatal bone thickness of < 1 mm, with a mean thickness of 0.5 mm. At the MP2 and MP3 sites, 86% and 100% of the teeth had ≥ 1 mm bone thickness, and the means were 2 and 5 mm, respectively. There were no significant differences among the age or gender groups. Maxillary canines showed significantly greater bone thickness than maxillary incisors, particularly at MP2 and MP3 sites. Most of the examined teeth had thin palatal bone at the MP1 measurement site, and maxillary canines showed significantly thicker palatal bone than maxillary incisors. This finding should be considered when treatment planning for immediate implants in the maxillary anterior segment.

Dental pattern diversity in a Saudi Arabian population

Background: Dental pattern diversity was investigated in different populations, but none have focused on Saudi Arabia. Aim: The aim of this study was to investigate the dental pattern diversity in Saudi Arabia. Setting and Design: This was a retrospective study. Materials and Methods: Five thousand two hundred and twenty-five orthopantomograms of healthy dentate adults were divided into four age groups: Group 1, 18–30 years; Group 2, 31–45 years; Group 3, 46–55 years; and Group 4, &gt;55 years. The conditions of the 32 teeth in each individual were assigned to 10 characteristics to form a dental pattern, and the diversity of patterns was estimated using the Simpson's Diversity Index. Statistical Analysis: The diversity, proportions, and frequency of unique dental patterns were descriptively compared between age groups and sexes. Results: The dental pattern diversity for full dentition was &gt;0.99, with 5024 unique dental patterns. The diversity and frequency of dental patterns were lower in the maxillary and mandibular anterior segments compared to those in posterior segments. All virgin teeth were the most frequently observed dental pattern for full dentition (1.24%). The dental pattern diversity for full dentition was similar across the age groups, but the frequency of unique dental patterns was 68.23%, 91.47%, 90.39%, and 88.89% for Groups 1, 2, 3, and 4, respectively. Further, the frequency of unique dental patterns was 10%–20% higher in females than in males. Conclusions: The dental pattern diversity was high in the studied Saudi Arabian sample and was affected by individuals' age and sex, where older individuals and females have higher diversity than younger individuals and males.

Anterior maxillary osteotomy for correction of gummy smile

Repositioning of the anterior dento-osseous segment posteriorly is carried out with the Anterior Maxillary Osteotomy (AMO) procedure. Maxillary excess can be corrected by a combined orthodontic and orthognathic approach. Anterior Maxillary Osteotomy has been performed since its inception in 1921 by Cohn Stock wherein, elastic force was used to retract the anterior maxillary segment. Wassmund, Wunderer and Cupar proposed modifications for AMO. This article gives an insight of a case treated by anterior maxillary osteotomy along with fixed orthodontic treatment for correction of maxillary anterior excess.

Excessive overjet, steep mandibular plane, and posterior buccal crossbite treated with aligners, infrazygomatic crest bone screws, and Class II elastics

A 23-year-old male with dysfunctional incisors due to a large overjet preferred clear aligner therapy. Facial profile was convex with a skeletal Class II relationship (ANB, 8.4°). Overjet of 8.0 mm was associated with a hyperdivergent facial pattern and recessive chin. The UL7 was in buccal scissors bite, which contributed to a 2.0 mm functional shift to the right. Buccal relationships were Class I molar and Class II canines bilaterally. Other dental and facial structures were within normal limits. Aligners alone corrected the buccal scissors bite in 6 months and provided intrusive force in maxillary and mandibular buccal segments. Infrazygomatic crest bone screws served as anchorage for intra-arch elastics to retract the maxillary anterior segment. Class II intermaxillary elastics were added for the last stages of aligner treatment to help retract the upper incisors. After 12 months of treatment, the 8.0 mm overjet was resolved. Alignment with the initial set of aligners was completed in 15 months. A 5-month refinement phase with a second set of aligners was initiated to finish the occlusion. Total treatment time was 20 months. Overall, a malocclusion with a Discrepancy Index of 41 was treated to a Cast-Radiograph Evaluation score of 16 and a Pink and White esthetic score of 4.

The Effect of Symmetric and Asymmetric Loading of Frontal Segment with Two Curved Cantilevers: An In Vitro Study.

Cantilevers generate statically determined force systems. The frontal segment loading with symmetric and asymmetric cantilevers in a three-piece intrusion base arch can be used to correct midline asymmetry. Three types of 0.017″ × 0.025″ beta-titanium cantilevers: tip-back (TB), deep curve (DC), utility arch (UA) were tested on typodonts simulating intrusion of the maxillary anterior segment. Typodonts with symmetric and asymmetric cantilevers were scanned with intraoral scanner (3Shape, TRIOS, Copenhagen, Denmark) before (T0) and after (T1) the experiment, scans were superimposed using Mimics software (Materialise, Leuven, Belgium). Data were analysed with qualitative analysis. All cantilevers generated vertical and horizontal forces. For symmetric design, the DC and TB displayed intrusive force with retrusive component, UA intrusion and protrusion. The asymmetric cantilevers produced transverse displacement of anterior segment. DC created lateral, UA medial force, the anterior segment displacement was consistent with the used configuration. The movement of an anterior segment with TB is smaller compared to DC and UA. Symmetric cantilevers configurations can achieve simultaneous intrusion and retrusion or protrusion of the anterior segment. The asymmetric design with transversal force can clinically aid the correction of midline discrepancies. The effect of the cantilever configuration on delivered force direction was confirmed.

Orthodontic management of skeletal Class II malocclusion using three mini-implants- A case report

Vertical dimension issues are frequently regarded as the most difficult dentofacial problems to treat in clinical practice. The difficulty level increases when vertical dysplasia is paired with sagittal discrepancy. The use of mini-implants in Orthodontics has broadened the scope of orthodontic treatment options. The treatment of a 14-year-old female patient with skeletal Class II malocclusion, slight hyperdivergent profile, and enhanced incisor visibility with four premolar extraction followed by comprehensive orthodontic treatment to correct the convex profile and increased incisor visibility, with two posterior implants for retraction and a midline mini implant for intrusion of the anterior maxillary dentoalveolar segment is described in this case report. The active therapy period was 25 months long.

Modified Cupar's method for immediate diastema closure

Anterior maxillary osteotomy or ostectomy (AMO) is a safe, reliable, and easily adaptable procedure routinely performed in orthognathic surgery for the management of the dentoalveolar segment of the anterior maxilla. The anterior segmental maxillary osteotomy was first performed in 1921 by Cohn-Stock. Several modifications were done regarding approaches for AMO; however, Cupar's method is the most preferred approach by the surgeons and in practice since several decades. A novel midline split osteotomy is performed in combination with Cupar's method for superior and posterior repositioning of anterior maxillary segment in combination with immediate closure of diastema in this case report.

A Cross-Sectional Study of Labial Bone and Covering Soft Tissue in Maxillary Anterior Segment: A Dilemma in Orthodontics.

Purposes The thickness of the buccal bone and its covering gingiva is pivotal in determining the prognosis of implant therapy as well as fixed orthodontic appliances, especially nonextraction treatments. The purpose of this study was to evaluate the buccal bone thickness and covering soft tissue in the maxillary anterior segment. Methods This study measured the hard tissue thickness at 2 and 5 mm more apical from the crest and at the root apical apex, as well as the distance from the CEJ to the alveolar crest, using 80 CBCT images divided into three age groups. In addition, the distance from free gingiva to alveolar crest and from free gingiva to CEJ was measured. The acquired data then was analyzed using an ANOVA, t-test, and Pearson correlation to investigate any associations or statistically significant differences between parameters. Results The highest mean soft tissue thickness at the 5 mm level was for central incisors and the least for canine. The highest mean thickness of soft tissue at the crest level and its 2 mm apical level was related to central incisors and the lowest mean thickness at these levels was related to canine. Analysis of hard tissue variables showed the lower thickness of hard tissue at higher ages compared to the young patients group, but the thickness of the soft tissue increases with age. Conclusion The highest mean thickness of the buccal hard tissue in the maxillary anterior segment was in lateral and central incisors. Also, the most prominent thickness of the labial soft tissue was in the central and lateral incisors at levels close to the crest.

The Effect Of Different Force Levels for Maxillary Protraction on The Upper Inciosrs’ Position in Growing Class 3 Patients

Objective: To evaluate changes in the anterior maxillary dentoalveolar segment concomitant with different levels of force application for maxillary protraction in growing skeletal class3 patients. Subjects and Methods: The current study was conducted on 30 class 3 patients (19 boys and 11 girls) with maxillary difficieny. The age of the recrutted sample ranged from 7-10 years. The patients were randomely allocated into three equal groups. The point of protraction force application varied among the three groups; group A at the occlusal plane, group B 20 mm above the occlusal plane and group C at the infraorbital foramen. The duration of the treatment laste for 8 months, the patients were instructed to werethe appliance 16 hour/day with the applied 550gs protraction force. The analysis of the outcomes of this study was doneusing CBCT images were taken before and after maxillary protraction. Results: The average amount the upper midface projection varied significantly (p˂ 0.05) among the three studied groups as demonstrated by L&R IOF –TVP. The maximum amount of the upper midface anterior displacement was observed in group C (2.65 mm) followed by group B (1.77 mm) . the least amount of displacement was observed in group A (0.93 mm) . Conclusions: The application of the protraction force in a level higher than the occlusal plane is an efficient tool to maximized the amount of upper midface projection after protraction facemask without affecting the amount of maxillary advancement.

Skeletal, dental and facial aesthetic changes following anterior maxillary segmental distraction by tooth-borne device in patients with cleft lip and palate

Maxillary skeletal deficiency secondary to cleft lip and palate (CLP) remains a significant challenge. The aim of this study was to present the comprehensive skeletal, dental and facial aesthetic outcomes of anterior maxillary segmental distraction osteogenesis (AMSDO) for treatment of maxillary hypoplasia in patients with CLP. Twelve patients with maxillary hypoplasia treated with AMSDO by a customized tooth-borne distractor were included. Three-dimensional changes of anterior maxillary segment, upper incisor and pharyngeal space were measured by three-dimensional reconstruction derived from cone beam computed tomography (CBCT) data. Length and width of dental arch during distraction were determined in dental casts. Nasolabial angle, soft-tissue convexity and patient’s subjective satisfaction were assessed to evaluate facial aesthetic improvements. Nasopharyngoscopic evaluation and speech assessment were also performed before and after distraction. All patients successfully received AMSDO without serious complications. Following AMSDO, the anterior maxillary segments moved forward 5.56±0.28mm and slightly upward 1.15±0.13mm. AMSDO significantly lengthened maxillary dental arch, generated new bone to relieve dental crowding and improved patients’ facial aesthetic without worsening velopharyngeal closure and speech quality. AMSDO by tooth-borne distractor is an effective surgical alternative for the advancement in patients with cleft maxillary hypoplasia.

Segmental intrusion and retraction with tads for the correction of gummy smile -A case report

The intrusion of the maxillary anteriors with Temporary Anchorage Devices (TADs) is one of the most common and effective treatment methods for the correction of gummy smile, but the main disadvantage of this method is the extrusion of posterior teeth, especially when used in conjunction with a continuous arch wire leading to an increase in the lower anterior facial height. The objective of this case report is to demonstrate the true intrusion of the maxillary anterior segment without causing extrusion of the posterior segment using a segmented arch wire rather than the routine continuous arch wire with the assistance of TADs in a patient diagnosed with a 5 mm gummy smile. After the initial leveling and alignment, a 0.019×0.025 stainless steel posted arch wire was sectioned distal to the canines. The TADs were positioned bilaterally mesial to upper first molars and an intrusive force of 250gm was applied per side using elastomeric chains attached to the miniscrews. At the end of the treatment, complete correction of the gummy smile was achieved by the intrusion of maxillary anteriors without any significant extrusion of the posteriors. The TAD assisted segmented arch wire for intrusion and retraction of maxillary anteriors is an excellent method for the successful correction of the gummy smile rather than using regular continous arch wire as we can avoid the unwanted extrusion of posteriors. Keywords: Gummysmile, TADS, Segmental mechanics, Intrusion, Gummysmile, TADS, Segmental mechanics, Intrusion.

Patients' perception on mini-screws used for orthodontic treatment in Class II Malocclusion

Introduction: The aim of the present study was to clinically evaluate the perception of pain of mini-screws in the maxillary arch for anchorage control for retraction of maxillary anterior segment in conjunction with orthodontic treatment. Materials and Methods: The sample consisted of fifty adult patients with a mean age of 24.5 years, with Class II malocclusion, and the patients were divided into two groups. In Group A, 0.022” McLaughlin, Bennett, and Trevisi Bracket System (MBT) was used in 25 patients as fixed orthodontic treatment and 0.016” nickel-titanium (Ni-Ti) wire was placed for initial alignment, whereas in Group B, a total of fifty mini-screws were placed in 25 patients, one mini-screw on each side in the maxilla between the 2nd premolar and the 1st molar. The patients answered a questionnaire to assess their opinions on treatment. Results: The data of description of pain experienced in 24 h, 2nd day, and 7th day in Group A and Group B are enumerated. In Group A, the pain experienced in 24 h, 2nd day, and 7th day was 49.72 (36.22), 37.17 (35.32), and 17.34 (14.45) and in Group B, it was 24.72 (15.65), 13.32 (14.34), and 12.45 (11.60), respectively. The questionnaire set was completed for functional aspect evaluation. The descriptive data of visual analog scale were presented. During this study, patient had difficulty in eating, food sticking around implant, and interference during tooth brushing was moderate, but there was no any anaesthetic appearance and disturbance in chewing ability was noted. Statistical Analysis: The nonparametric Kruskal–Wallis and Mann–Whitney tests were performed to evaluate the differences between the groups for pain. The Chi-square test was used to determine differences between the procedures. Differences at P Conclusion: The present study stated that the pain experience after mini-screw insertion is significantly low. The peak of the pain and discomfort level was recorded 4 h to 24 h following the insertion. Thus, mini-screws were found to be an acceptable option in providing orthodontic treatment

Maxillary arch dimensions in the first 6months of life and their relationship with pacifier use.

This study evaluated the maxillary arch dimensions at birth and 6months of life, and to verify the influence of pacifier use on palatal development. Maxillary arch impressions were taken from 80 full-term newborns, appropriate for gestational age, from 24 to 72h of life, and repeated after 6months. Anatomical references were mapped on dental casts and measurements were taken. Parents were questioned about feeding practices and sucking habits. Data were analysed by Kruskal-Wallis test and hierarchical mixed regression model (p < 0.05). Anterior maxillary segment (median [interquartile range]) presented an increase in transverse (Δ% = 81.90 [74.40-89.70]) and in length (Δ% = 76.20 [49.10-102.70]) relative growth. No differences were detected in palatine depth from birth (11.00mm [10.30-11.70]) to 6months (12.60mm [12.0-13.90]). Pacifier use was positively related to the increase in anterior segment length. In the first 6months of life, the greatest relative growth of the maxillary arch occurs in the anterior region, showing this growth does not occur homogeneously. The use of pacifiers came to influence this process, even before the eruption of the upper incisors.