Dental Alignment Research Articles

Les séquelles maxillaires dans les fentes labioalvéolopalatovélaires. Prise en charge orthodontique

Routine othodontic management is unavoidable in all patients with cleft lip and palate after primary surgery. This management combines dental arch alignment with maxillary expansion of the lesser fragment before alveolar bone grafting. To treat dental arch asymmetry, the space of the missing lateral incisor is preserved until the age of dental implant. Otherwise, dento-orthopedic treatment attempts to normalize transversal dental dimension once alveolar bone grafting is done in order to prepare the surgical advancement of the maxilla.

Long-term stability after orthodontic treatment remains inconclusive

PubMed and Cochrane Library electronic databases were searched from 1966 to January 2005. Reference lists of the relevant studies were searched by hand. For inclusion, articles had to satisfy the following criteria: have a follow-up period of at least 5 years post-retention; report on randomised clinical trials (RCT), prospective or retrospective clinical controlled studies or on cohort studies; and investigate orthodontic treatment including fixed or removable appliances, selective grinding or extractions. Screening of eligible studies, data extraction and assessment of methodological quality was conducted independently and in duplicate. The level of evidence of the included studies was graded as high, moderate or low according to predetermined criteria. The search strategy resulted in 1004 abstracts or full-text articles, of which 38 met the inclusion criteria. Treatment of crowding resulted in successful dental alignment but the mandibular arch length and intercanine width gradually decreased, and crowding of the lower anterior teeth reoccurred post-retention. This condition was unpredictable at the individual level. Treatment of Angle class-II division-1 malocclusion with a Herbst appliance normalised the occlusion. Relapse occurred but could not be predicted at the individual level. The scientific evidence was insufficient to draw conclusions about treatment of cross-bite, angle class III, open-bite and various other malocclusions, or about long-term patient satisfaction. Despite a large number of studies on long-term stability after orthodontic treatment, this systematic review shows that evidence-based conclusions are few. This is mostly because of inherent problems with retrospective and inferior study design. There is a great need for well-designed prospective studies with untreated control groups; sufficient sample sizes; and sample selection according to type of malocclusion, age and growth pattern.

Desgaste interproximal e suas implicações clínicas

INTRODUÇÃO: o alinhamento dentário correto, bem como sua estabilidade, representam objetivos importantes do tratamento ortodôntico. O apinhamento na região anterior é uma anomalia de posição dentária comum e para obter sua correção as opções clínicas disponíveis para o ortodontista são as extrações dentárias, a expansão do arco dentário ou os desgastes interproximais. Os desgastes freqüentemente são indicados, mas existem questionamentos quanto às indicações, técnicas e condições pré e pós-tratamento. OBJETIVO: o objetivo deste artigo é apresentar uma discussão, embasada na literatura pertinente, dos principais fatores envolvidos com este procedimento clínico.

Long-term Stability of Orthodontic Treatment and Patient Satisfaction

To evaluate morphologic stability and patient satisfaction at least 5 years after orthodontic treatment. Published literature was searched through the PubMed and Cochrane Library electronic databases from 1966 to January 2005. The search was performed by an information specialist at the Swedish Council on Technology Assessment in Health Care. The inclusion criteria consisted of a follow-up period of at least 5 years postretention; randomized clinical trials, prospective or retrospective clinical controlled studies, and cohort studies; and orthodontic treatment including fixed or removable appliances, selective grinding, or extractions. Two reviewers extracted the data independently and also assessed the quality of the studies. The search strategy resulted in 1004 abstracts or full-text articles, of which 38 met the inclusion criteria. Treatment of crowding resulted in successful dental alignment. However, the mandibular arch length and width gradually decreased, and crowding of the lower anterior teeth reoccurred postretention. This condition was unpredictable at the individual level (limited evidence). Treatment of Angle Class II division 1 malocclusion with Herbst appliance normalized the occlusion. Relapse occurred but could not be predicted at the individual level (limited evidence). The scientific evidence was insufficient for conclusions on treatment of cross-bite, Angle Class III, open bite, and various other malocclusions as well as on patient satisfaction in a long-term perspective. This review has exposed the difficulties in drawing meaningful evidence-based conclusions often because of the inherent problems of retrospective and uncontrolled study design.

上顎切歯の位置異常を伴った小児の鼻口蓋管嚢胞の１例

We report the case of a 6-year-old boy with a nasopalatine duct cyst. He consulted a dental clinicbecause of median diastema in the upper medial incisors. Radiographic examinations revealed a radiolucent areain the maxilla, extending from the nasal floor to the alveolar ridge between the medial incisors, which inclinedmedially. The upper lateral incisors were still impacted far from the normal position. We performed marsupializationto prevent damaging the incisor pulp. After that the lateral incisors erupted and malalignment of both incisorsimproved; however, the cystic cavity did not disappear completely. Extirpation of the remaining cyst followed bywound closure was performed at a secondary operation 9 months later. This case was considered to be rarebecause it occurred in childhood and affected the dental alignment at the time of teeth eruption.

Influence of lips on the perception of malocclusion

The purpose of the study was to determine the influence of variations in the size of the vermilion borders of the upper and lower lips on the perception of the attractiveness of various occlusal traits. Ten occlusal traits and 3 upper and 3 lower vermilion variations, placed in combinations on a facial image, were used in a questionnaire. Statistical analyses for attractiveness and social and sex attributes were performed for various occupational groups. The occlusion, vermilion border of the upper and lower lips separately, and the raters' occupations were all highly significant in influencing attractiveness, social perceptions, and perceived sex of the images (P < .01). All occlusal traits were perceived as more attractive with a thicker vermilion border. Thin vermilion borders and more severe irregularity were associated with unattractiveness, aggressiveness, and masculine traits. This study demonstrates that the thickness of the vermilion border has a profound effect on how people rate the attractiveness of the dentition. Therefore, treatment plans that could affect lip vermilion might result in improved dental alignment but also deterioration in overall attractiveness. Orthodontists placed more emphasis on the teeth than other occupation groups; this demonstrated an occupational bias.

O aparelho quadrihélice (Quad-helix) e suas variações

O presente artigo objetivou mostrar a eficiência dos vários desenhos do aparelho quadrihélice, de Ricketts, na correção das desarmonias dentoalveolares. Devido às suas várias formas de confecção, assim como de sua ativação, o quadrihélice tornou-se um acessório útil não somente na sobrecorreção da discrepância transversal e sagital, mas também no tratamento das más oclusões da Classe II, divisão 1, de Angle, principalmente nos casos em que a rotação do molar é desejada como parte do tratamento. Também é relevante o seu efeito no tratamento das mordidas abertas anteriores, atuando como coadjuvante no tratamento dos fatores ambientais que contribuem, muitas vezes, para exacerbar o desenvolvimento das más oclusões. Em relação ao alinhamento do arco dentário, o quadrihélice abrevia essa fase do tratamento em 4 a 5 meses (o tratamento convencional levaria muito mais tempo e pelo menos uma grande série de troca de arcos em mecânicas de nivelamento). Portanto, este trabalho tem a intenção de mostrar algumas das ativações possíveis do aparelho quadrihélice, bem como algumas de suas variações, que contribuem para conseguir resultados estáveis em longo prazo.

Localized sequential use of resilient lining to generate orthodontic force in thermoformed active removable appliances

A new modality of orthodontic treatment based on the thermoformed appliance was developed and trialled clinically. A light-cured resilient lining material commonly used for denture relining was placed locally and sequentially in thermoformed appliances to generate orthodontic forces. The new method appeared to be effective. All the presented cases showed substantial improvement in dental alignment. A number of orthodontic movements were demonstrated. Localized use of resilient lining in thermoformed orthodontic appliances appeared to be a promising alternative to other thermoformed active removable appliance (TARA) treatments. Further studies are required to optimize the procedures and explore its full potential.

Simultaneous functional and fixed appliance therapy for growth modification and dental alignment prior to prosthetic habilitation in hypohidrotic ectodermal dysplasia: A clinical report

This clinical report describes the simultaneous use of functional and fixed appliances to modify the pattern of dentofacial development and align teeth in preparation for prosthodontic habilitation of a growing child with hypohidrotic ectodermal dysplasia. The treatment objective was to create a more favorable starting point for the prosthodontic phase of habilitation by improving the sagittal and vertical skeletal relationships and facial esthetics. This was accomplished through growth modification with functional appliances conducted simultaneously with eruption of maxillary and mandibular molars, dental arch expansion, alignment, and space management using fixed orthodontic appliances. Orthodontic retention was accomplished by means of removable partial dentures. A second phase of orthodontics conducted closer to the age of skeletal maturation will aim at definitive tooth alignment in preparation for dental implant-supported restorations.

Closure of an unusually large palatal fistula in a cleft patient by bony transport and corticotomy-assisted expansion

The management of cleft lip and palate can vary among patients because the size of a cleft defect and its anatomy vary. Although treatments involving orthodontics and surgery have been developed that can help a large number of children with cleft lip and palate, there are always unusual clefts that defy conventional treatments. In such cases, with each gain made during treatment, there also is the possibility of introducing an additional complication. The secondary bone graft performed during the mixed dentition stage of dental development is an example of treatment gains that are balanced against additional complications. Ordinarily, the maxillary segments are expanded to attain a normal archform before the alveolar bone graft. If there is an anterior palatal fistula present before orthodontic expansion, the size of the fistula concomitantly increases as the expanders widen the anterior maxillary segments. There are, however, extreme cases that present with a combination of collapsed maxillary segment, large anterior palatal fistula, and large alveolar clefts. In such cases, orthodontic expansion could make both the alveolar clefts and anterior palatal fistula unmanageable. In the expanded position, there would be insufficient soft tissue to close the fistula or cover the alveolar bone graft. Consequently, dental prosthetics is often needed to cover the palatal fistula to support speech and eating. In this report, we present the case of an 11-year-old girl who had a 20-mm anterior palatal fistula before orthodontic expansion. In the opinion of our surgeons, the fistula was too large to close before the segments were expanded and would prove more difficult to treat after expansion. To make the palatal fistula and cleft sites manageable, the treatment sequence and procedures were modified. Rather than expand the maxillary segments, the segments were compressed to make the cleft space narrower so that the surgeons could graft the alveolar cleft. To provide more bone support and donor soft tissue for a palatal flap, the palatal tooth and surrounding bone were distracted across the anterior palatal opening. A sequence of minor procedures allowed the cleft sites to be grafted, the unusually large palatal fistula to be closed, the lateral segments to be expanded, and the dental alignment to be improved.

Odontometrical method useful in determining gender and dental alignment.

Rao et al.'s method of sex determination, which considers the mandibular canine index (MCI) is one giving satisfactory results. However, they did not take occlusion into consideration. The aim of this study, therefore, was to evaluate the effectiveness of this method with respect to tooth alignment. The study population involved the students enrolled in the University of Nice-Sophia Antipolis. Two hundred and ten girls and 214 boys were randomly sampled (1/20). Both tooth sizes and dental arches were measured using a vernier calliper to calculate MCI for both sexes. The results were compared to standard MCI, taking into account tooth alignment.Rao et al.'s method can only be used in the case of correct lower-anterior dental alignment and by using the standard MCI of the local population.

Second premolar extraction procedures

Dental alignment is only one of the objectives of orthodontic treatment. Other equally important objectives are the stability of dentition, health of the tissues, and the harmony and balance of facial aesthetics. The most important question that the clinician has to ask is whether the extraction of four teeth is warranted in borderline cases. Even if the extraction of four first premolars is a universally accepted procedure in borderline cases with light crowding, but without significant skeletal disharmony, it is best to wait for the permanent teeth to erupt and the profile to mature before decisions to extract and which teeth to extract are made. When the profile is harmonious or somewhat flat, in order to resolve the crowding problem, extraction of the second premolars can help because the anterior region can be controlled excellently. A treatment plan with these teeth extracted keeps the facial aesthetics unaffected.

Presurgical Orthopedics in the Surgical Management of Unilateral Cleft Lip and Palate

Forty years after its introduction by McNeil and Burston, presurgical orthopedics remains a controversial subject. Although the more extravagant claims for the technique have been dismissed, assessment of its proper place in cleft rehabilitation has been hampered by the poor design of early studies. Furthermore, although the principles of presurgical orthopedics are derived from the venerable tradition of reducing cleft width to facilitate reconstructive surgery, almost all research has focused on matters of dental alignment, cross bites, and maxillary arch form. Not one research paper has ever been published investigating the possible benefits to cleft surgery resulting from presurgical orthopedic treatment. Although it is now generally accepted that presurgical orthopedics does not give significant orthodontic benefits, there are still numerous opinions indicating that presurgical orthopedics does facilitate primary reconstructive surgery for cleft lip and palate. Furthermore, presurgical alignment of the maxillary skeletal base is considered essential to some of the new techniques of primary rhinoplasty.

Esthetic Considerations for the Generalist in the Preadolescent Orthodontic Patient Part I: Dental Alignment and Soft Tissue Concerns

Journal of Esthetic and Restorative DentistryVolume 6, Issue 1 p. 10-14 Esthetic Considerations for the Generalist in the Preadolescent Orthodontic Patient Part I: Dental Alignment and Soft Tissue Concerns MAURICE A. SALAMA DMD, Corresponding Author MAURICE A. SALAMA DMD Visiting Professor in Orthodontics and Periodontics. Graduate Program. Uniwerstiy of Pennsyleania. Philadelphia. Pennsylvania, and private practice. Atlanta. GeorgiaReprint requests: Maurice A. Salama, DMD, 1218 W. Paces Ferry Rd. NW, Suite 200, Atlanta, GA 30327Search for more papers by this author MAURICE A. SALAMA DMD, Corresponding Author MAURICE A. SALAMA DMD Visiting Professor in Orthodontics and Periodontics. Graduate Program. Uniwerstiy of Pennsyleania. Philadelphia. Pennsylvania, and private practice. Atlanta. GeorgiaReprint requests: Maurice A. Salama, DMD, 1218 W. Paces Ferry Rd. NW, Suite 200, Atlanta, GA 30327Search for more papers by this author First published: January 1994 https://doi.org/10.1111/j.1708-8240.1994.tb00826.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume6, Issue1January 1994Pages 10-14 RelatedInformation

A Comparison of the Awareness of the Dental Alignment and the Occlusion between Children and Their Parents

A Comparison of the Awareness of the Dental Alignment and the Occlusion between Children and Their Parents

Acrylic splints for dental alignment in complex facial injuries.

Twenty-four patients with complex facial injuries were managed by wide subperiosteal exposure, precise anatomical reduction, rigid internal fixation, and immediate bone grafting when indicated, in conjunction with dental impressions, model surgery, and fabrication of dental splints to establish proper preinjury occlusion. The study population consisted of 18 men and 6 women, whose ages ranged from 18 to 49 years (mean, 30.7 yr) at the time of injury. High velocity motor vehicle accidents were responsible for facial injuries in 18 patients, gunshot wounds in 2, low velocity blunt trauma in 3, and falls in 1. All facial fractures involved the occlusion, and unstable and/or comminuted palatal/maxillary and mandibular fractures, often with edentulous segments, were the major indications for fabrication of acrylic splints. Depending on the nature of the fracture pattern, model surgery was performed on the maxillary and/or mandibular models and segmented along fracture lines. These fragments were then repositioned according to dental wear facets and preinjury occlusion. When possible, preinjury occlusal records were obtained before splint fabrication. Models were mounted on a Galetti articulator and palatal, lingual, and/or occlusal splints were fabricated. Edentulous segments were compensated for by local buildup of the splints to produce an occlusal stop. Arch bars were fixed directly to the splint with acrylic. Twenty-six splints were used in the 24 patients to establish proper occlusal relationships before internal fixation of fractures. The types of splints were palatal (n = 8), palatal-occlusal (n = 6), lingual (n = 8), lingual-occlusal (n = 1), and occlusal (n = 3).(ABSTRACT TRUNCATED AT 250 WORDS)

A growth control approach to Class II, Division 1 cases during puberty involving the simultaneous application of maxillary growth restriction and mandibular forward induction

A simple method that used headgear and a functional appliance simultaneously was used for the correction of Class II, Division 1 cases with severe denture base discrepancy. The treatment restricted the forward growth of the maxilla and advanced the mandible. The functional appliance, referred to as the mandibular growth advancer (MGA), advances the mandible progressively with a splint, with the objective of remodeling the condyle and the glenoid fossa in the temporomandibular joint. Functional adaptation was achieved as the muscles that are attached to the mandible adjusted to new positions. In the two cases that illustrate this method, the ANB angle decreased and the Ar-B distance increased over a short period to four and six times the mean Japanese growth rate, respectively. After the correction of the denture-base discrepancy, a multibracket fixed appliance was used for dental alignment, and good skeletal, occlusal relationships and profiles were obtained. Treatment of severe denture-base discrepancy in this manner may reduce the skeletal abnormality, decrease the number of extraction cases, and shorten the subsequent multibracket treatment time. And it may reduce the iatrogenic side effects caused by prolonged mechanotherapy with a fixed appliance.

Lower premolar extraction/removable plastic Herbst treatment for mandibular retrognathia

The patient was a 12-year-old girl with a Class I malocclusion characterized by maxillary arch width constriction, dental crowding, and mandibular retrognathia. Treatment goals related to the chief complaint were anterior mandibular repositioning, maxillary arch expansion, and dental alignment. Because the preexisting overjet was minimal and prevented adequate anterior repositioning of the mandible, lower first premolar extraction was recommended to increase the overjet and allow greater anterior repositioning. Treatment was divided into four stages: (1) extraction of mandibular first premolar teeth, alignment, space closure, and an increase in the overjet, (2) anterior mandibular repositioning with a removable plastic Herbst appliance, (3) arch alignment and detailing of the occlusion with full fixed appliances and a tooth positioner, and (4) retainers. At the end of treatment, the patient had an acceptable dental alignment with a Class III molar relationship and an improvement in facial appearance.

Relapse following maxillary expansion: A study of twenty-five consecutive cases

Twenty-five patients consecutively treated with maxillary expansion were studied. Both successful and unsuccessful cases were included, but five were excluded for other reasons. The expansion was measured 2 or 3 months out of retention to allow the overexpansion to settle. Measurements were made again 2 1 2 years out of retention. The net expansion had been 3.5 mm., and this had subsequently not relapsed. Possible reasons for this are discussed. The associated improvement in dental alignment was measured by an index which is also discussed.

The combined surgical and orthodontic treatment of mandibular prognathism.

Patients with severe mandibular prognathism are best managed with a combined orthodontic-surgical approach. In our patients, the orthodontic treatment consisted of six to eighteen months of presurgical preparation, which in some patients may accentuate the dental deformity. This is done to provide two well-aligned dental arches that will fit accurately at surgery. The surgical procedure used was an oblique subcondylar osteotomy. This was followed by six to eight months of orthodontic treatment to complete dental alignment. Thirty patients were treated using this combined approach, with excellent results and few complications.