Dental Changes In Patients Research Articles

Evaluation of the success of predicted dental changes with clear-aligner treatment: A pilot study

ObjectiveThis pilot study concerned evaluation of the success of predicted dental changes in patients presenting with Class I malocclusions who were submitted to treatment aligners, using the superimposition. MethodsThe digital models were superimposed and analyzed using 3DSlicer 5.0 software. Treatment and predicted changes regarding horizontal and vertical linear displacements, mesiodistal rotations, and incisor buccolingual tipping were quantified. The success rates were calculated by dividing the mean treatment change amount by the predicted change amount. ResultsLower-incisor intrusion was the most accurate of the predicted vertical displacements (86.96 %), and buccal expansion of upper canines (99.32 %) and mesial translation of the lower incisors (98.57 %) were the most accurate horizontal linear displacements. The predicted rotation was achieved with the highest accuracy for lower incisors (75.69 %). Incisor buccolingual tipping success rates ranged between 45.78 % and 69.31 %. Low accuracy of predicted changes was found for upper-molar extrusion (10.23 %) and constriction (8.91 %). However, minimal corrections in these directions were planned. ConclusionsDental changes for all regions of maxillary and mandibular arches could be evaluated. High success rates were observed for most of the movements planned for ClearCorrect aligner therapy.

A comparison of skeletal and dental changes in patients with a Class II relationship treated with clear aligner mandibular advancement and Herbst appliance followed by comprehensive orthodontic treatment

The objective of this study was to compare the skeletal and dental changes of patients with a Class II relationship treated with clear aligner mandibular advancement (MA) and Herbst appliances followed by comprehensive orthodontic treatment. The participants included 20 patients treated with MA and 20 with the Herbst appliance. Orthodontic records were taken before treatment, after the functional appliance, and completion of phase II treatment. The skeletal and dental changes across the 3-time periods were evaluated using a matched paired t test for each treatment. A 2-sample t test was used to examine the changes across periods between 2 treatment groups (P<0.05). Significant reduction in overjet, overbite, and change in molar relationship were obtained by both appliances with similar skeletal and dental contributions. This was contributed by a forward movement of the mandible and mandibular molars, backward movement of the maxillary molars, and retraction of the maxillary incisors. After phase II treatment, both appliances could maintain the skeletal and dental changes achieved during the advancement phase. Greater change in overbite (2.4 mm vs 1.4 mm), an eruption of maxillary incisors (0.9 mm vs 0.1 mm), and proclination of mandibular incisors were found with the Herbst group (3.9° vs -2.1°). The average total treatment time was similar with the 2 appliances. Both functional appliances were equally effective in reducing the overjet and overbite and achieving a Class I molar relationship with a similar length of treatment time. The Herbst design lacked control of the mandibular incisor proclination, and clear aligners offered better vertical control and management of the mandibular incisor inclination.

Effect of Conventional Versus Passive Self-Ligating Vestibular Appliances on Torque, Tip and Transverse Dental Changes in Patients Affected by Class I Malocclusion: A Retrospective Study

Objective: To evaluate the effects of passive self-ligating appliances (PSLAs) and conventional ligating appliances (CLAs) during orthodontic treatment regarding torque, tip, and transversal dental changes. Material and Methods: Dental parameters were digitally acquired from pre- and post-treatment models of each subject belonging to two groups of patients treated with PSLAs (23 patients; 11 females and 12 males with a mean age of 14.2 ± 1.6 years) and CLAs (18 patients; 10 females and 8 males with a mean age of 14.3 ± 1.9 years), respectively. All subjects had Class I or slight Class II malocclusion (= 2mm), permanent dentition and no previous orthodontic treatment. After normality of data was assumed, a paired sample t-test rejected any side differences at T0 and, therefore, the data were grouped by tooth group. Statistical analyses were performed using a linear mixed-effect framework, assuming the appliance, time, and interactions as fixed effects and the tooth type as random effects. Finally, post-hoc effect analysis was used to contrast modeled marginal effects (p<0.05). Results: For both appliances, there is a general increase of both torque and transverse values at T1, especially for PSLAs. Tip shows a general reduction in the lateral sectors for both appliances is registered. The only significant statistical difference referred to appliances’ efficacy is located to mandibular intermolar width. Conclusion: Both appliances have an expansive potential for both torque and transverse dental changes. No evident differences are detectable between appliances except for the rate of the mandibular intermolar width increase.

Three-dimensional evaluation of skeletal and dental changes in patients with skeletal class III malocclusion and facial asymmetry after surgical-orthodontic treatment

To evaluate skeletal and dental changes in patients with skeletal Class III malocclusion and facial asymmetry after surgical-orthodontic treatment using cone-beam computerized tomography (CBCT). This study included forty adult patients diagnosed with skeletal Class III malocclusion and asymmetry who underwent either isolated mandibular surgery or bimaxillary surgery. CBCT scans were taken before treatment (T0), at the completion of presurgical orthodontic treatment (T1) and after treatment (T2). Mimics 17.0 and 3-Matics 7.0 were used to measure skeletal and dental parameters. Skeletal and dental changes within each group from pretreatment to posttreatment were assessed, and Pearson correlation analysis was used to analyze the correlations among skeletal changes. The three-dimensional changes in condylar position were insignificant after surgical-orthodontic treatment in either group (P > 0.05). However, in the one-jaw surgery group, there were significant backward rotations of the condyle and ramus on the nondeviated side (P < 0.05), and the condyle on the deviated side rotated inward and forward significantly in the two-jaw surgery group (P < 0.05) at T2. There were no significant differences in the changes in the total alveolar bone thickness of bilateral first molars during dental decompensation (P > 0.05). The ratio between the buccal and the total bone thickness around the maxillary first molar on the deviated side decreased significantly at T1, as did those around the mandibular first molar on the nondeviated side (P < 0.05). Condylar angulations were less stable after treatment (7 to 9 months after surgery) in both the one-jaw and the two-jaw surgery groups, while condylar displacements were insignificant. In addition, orthodontists should keep a watchful eye to the relative position of the root in the alveolar bone during tooth decompensation.

Assessment of respiratory muscle strength and airflow before and after microimplant-assisted rapid palatal expansion.

To assess alterations in respiratory muscle strength and inspiratory and expiratory peak flow, as well as skeletal and dental changes in patients diagnosed with transverse maxillary deficiency before and after microimplant-assisted rapid maxillary expansion (MARPE). Twenty patients (13 female and 7 male) were assessed by respiratory tests in three different periods: T0 initial, T1 immediately after expansion, and T2 after 5 months. Tests included: maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), oral expiratory peak flow, and inspiratory nasal flow. Cone-beam computed tomography measurements were performed in the maxillary arch, nasal cavity, and airway before and immediately after expansion. There was a significant increase in MIP between T0 and T2 and MEP between T0 and T1 (P<.05). Oral and nasal peak flow increased immediately after and 5 months later, especially in patients with initial signs of airway obstruction (P<.05). In addition, after expansion there was a significant enlargement of the nasal cavity, alveolar bone, and interdental widths at the premolar and molar region. Molars tipped buccally (P<.05) but no difference was found in premolar inclination. MARPE increased airway volume significantly. Skeletal changes promoted by MARPE directly affected airway volume, resulting in a significant improvement in muscle strength and nasal and oral peak flow.

Evaluation of lower anterior dental changes in patients treated with self-ligating brackets

The aim of this study was to evaluate and compare changes in linear distance and inclination of lower incisors and canines and intercanine distance after a 30 months orthodontic treatment with self-ligating appliances. Seven patients were treated orthodontically with a Roth prescription passive self-ligating bracket. To perform the measurements and comparisons, CBCT scans were taken before the start of the orthodontic treatment (T1) and after a period of 30 months treatment (T2). The following measurements were performed: (1) the lower incisors and canines inclination in relation to the mandibular plane, (2) intercanine linear distance in millimeters and (3) linear distance in millimeters of the incisal and apical part of lower anterior teeth to a plane (POGM) passing through pogonion point and perpendicular to the mandibular plane. No significant difference were observed between T1 and T2 for canine inclination (p=0.835), incisors inclination (p=0.149), canine incisal distance to POGM (p=0.423) and incisors incisal distance to POGM (p=0.966), however canine apical distance (p=0.049) and incisors apical distance (p=0.002) to POGM was lower at T1 than at T2. The intercanine distance was significantly lower (p=0.022) at T1 when compared to T2. The use of passive self-ligating brackets in orthodontic treatment to solve 4mm tooth crowding were able to produce dental arch expansion by bodily tooth movement.

Effects of three types of functional appliances in class II malocclusions treatment - sagittal and vertical changes

Introduction/Objective. Class II malocclusions are sagittal malocclusions characterized by a distal relationship of posterior teeth. Depending on the underlying problem, class II can be skeletal or dentoalveolar. Class II treatment modality will depend on the cause, severity and age. Growth modification is the best treatment option in skeletal Class II growing patients. The aim of this study was to establish and compare sagittal and vertical skeletal and dental changes in patients treated with the ?M block? appliance, the Fr?nkel functional regulator and the Balters? Bionator. Methods. The sample consisted of 70 patients diagnosed with skeletal class II (ANB &gt; 4?) and mandibular retrognathism (SNB &lt; 80?). Patients were divided into 3 groups according to the type of appliance. All patients went through the standard diagnostic procedure (anamnesis, clinical and functional analysis, study model, panoramic radiograph and cephalometric analysis) and dental and skeletal age was determined. Treatment effects were analyzed on study models and cephalograms at the end of treatment. Results. All appliances led to significant mandibular anterior movement and sagittal growth, which reduced ANB values. All three groups of patients presented with neutral growth pattern, upper incisor retrusion and lower incisor protrusion at the end of treatment. Conclusion. Results of this study indicate efficacy of all three appliances in skeletal class II treatment.

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

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. The study group consisted of 30 patients (16 boys, 14 girls; mean age, 12.3±2.5years) 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±0.7years for the Herbst treatment and 1.8±0.5years 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. After the Herbst treatment, the incisal relationships of all subjects had been overcorrected to end-to-end relationships. Overjet was reduced by 7.2mm after subtracting changes from growth. The skeletal contribution was 2.5mm (35%), and the dental contribution was 4.7mm (65%). The molar relationship was overcorrected to a more Class I relationship by 7.5mm. The Wits appraisal was improved by 4.2mm. Vertically, overbite was decreased by 3.3mm. The maxillary and mandibular molars were extruded by 1mm. 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 7.6mm. The skeletal contribution was 2.9mm (38%), and the dental contribution was 4.7mm (62%). The molar relationship was corrected to a Class I relationship by 5.9mm. The Wits appraisal was improved by 3.2mm. Vertically, overbite was decreased by 4.2mm. The maxillary and mandibular molars were extruded by 0.3 and 0.8mm, respectively. The occlusal plane rotated clockwise by 1.2° with little change in the mandibular plane angle. 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.

Comparison between rapid and mixed maxillary expansion through an assessment of arch changes on dental casts

BackgroundAim of this retrospective observational study was to compare upper and lower dental changes in patients treated with Rapid Maxillary Expansion (RME) and Mixed Maxillary Expansion (MME), assessed by dental cast analysis.MethodsTreatment groups consisted of 42 patients: the RME group (n = 21) consisted of 13 female and 8 male subjects with the mean age of 8.8 years ± 1.37 at T0 and 9.6 years ± 1.45 at T1; the MME group (n = 21) consisted of 12 female and 9 male patients with a mean age of 8.9 years ± 2.34 at T0 and 10.5 years ± 2.08 at T1. The upper and lower arch analysis was performed on four dental bilateral landmarks, on upper and lower casts; also upper and lower arch depths were measured. The groups were compared using independent sample t-test to estimate dental changes in upper and lower arches.ResultsBefore expansion treatment (T0), the groups were similar for all examined variables (p>0.05). In both RME and MME group, significant increments in all the variables for maxillary and mandibular arch widths were observed after treatment. No significant differences in maxillary and mandibular arch depths were observed at the end of treatment in both groups. An evaluation of the changes after RME and MME (T1) showed statistically significant differences in mandibular arch depth (p<0.001) and maxillary intercanine widths (p<0.05). Differences in maxillary arch depth and arch width measurements were not significant.ConclusionsRME and MME can be considered two effective treatment options to improve transverse arch dimensions and gain space in the dental arches. A greater lower arch expansion was observed in the MME group, which might be attributed to the “lip bumper effects” observed in the MME protocol.

Stability of Class II treatment with an edgewise crowned Herbst appliance in the early mixed dentition: Skeletal and dental changes

The objectives of this research were to assess skeletal and dental changes in patients with Class II malocclusion treated with the edgewise crowned Herbst appliance in the early mixed dentition and to measure the stability of treatment after a second phase of fixed appliance therapy. Twenty-two patients (ages, 8.4 ± 1.0 years) with Class II Division 1 malocclusion treated consecutively with the edgewise crowned Herbst appliance in the early mixed dentition were studied. Lateral cephalograms were taken before Herbst treatment, immediately after Herbst treatment, and after a second phase of fixed appliance therapy. The results were compared with a control group of untreated Class II subjects selected from the Bolton-Brush study, matched by age, sex, and craniofacial morphology. A total of 37 sagittal, vertical, and angular cephalometric variables were evaluated. Changes in overjet and molar relationship were calculated. Changes due to growth were subtracted to obtain the net changes due to treatment. The data were analyzed by using analysis of variance (ANOVA) and the t tests. Overcorrection with the Herbst appliance resulted in an average reduction in overjet of 7.0 mm and a change in molar relationship of 6.6 mm. Several factors contributed to the change in overjet: restraint of the forward movement of the maxilla (0.4 mm), forward movement of the mandible (2.0 mm), backward movement of the maxillary incisors (3.7 mm), and forward movement of the mandibular incisors (0.9 mm). Skeletal changes together with a 3.1-mm backward movement of the maxillary molars and a 1.1-mm forward movement of the mandibular molars contributed to the changes in molar relationship. After the second phase of fixed appliance therapy, the change in overjet was reduced to 2.8 mm. Most of the remaining overjet corrections were contributed by the restraint of maxillary growth (2.8 mm). The mandible moved posteriorly by 1.6 mm, and the mandibular incisors moved forward by 0.2 mm. Change in molar relationship was reduced to 2.2 mm. The maxillary molars moved backward by 0.2 mm, and the mandibular molars moved forward by 0.8 mm. Overcorrection of Class II malocclusion with the edgewise crowned Herbst appliance in the early mixed dentition resulted in a significant reduction in overjet and correction of the molar relationship. A portion of the correction was maintained after a second phase of fixed appliance therapy because of the continuous restraint of maxillary growth and the dentoalveolar adaptations.

Rapid Maxillary Expansion Treatment may Maintain Long-term Dental Changes in Patients with Constricted Arches

Article Title and Bibliographic Information Long-term dental arch changes after rapid maxillary expansion treatment: a systematic review. Lagravere MO, Major PW, Flores-Mir C. Angle Orthod 2005;75(2):155-61. Reviewer Jorge L. Castillo, DDS, MSD Purpose/Question Does rapid maxillary expansion maintain long-term dental arch changes in patients with constricted arches? Source of Funding Information not available Type of Study/Design Systematic review Level of Evidence Level 2: Limited-quality, patient-oriented evidence Strength of Recommendation Grade Grade B: Inconsistent or limited-quality, patient-oriented evidence

Comparison of Transverse Dimensional Changes in Surgical Skeletal Class III Patients With and Without Presurgical Orthodontics

To investigate transverse dimensional changes of dental arches in surgical skeletal Class III patients with and without presurgical orthodontics. Thirty-six patients with skeletal Class III were included and grouped into those with or without presurgical orthodontics. Eighteen patients (mean age, 22.3 +/- 3.8 years) with presurgical orthodontics (mean presurgical orthodontic treatment time, 176.3 +/- 38.3 days) were in the orthodontics-first (OF) group; the other 18 patients (mean age, 23.3 +/- 4.2 years) without presurgical orthodontics were in the surgery-first (SF) group. The posteroanterior cephalograms initially, before surgery, immediately after surgery, and 1 year after surgery were traced and analyzed. The inclination change of canines and molars was measured to interpret the changes of transverse dimension in both dental arches. Paired and unpaired t tests were performed to test intra- and intergroup differences (P < .05). Dental changes in transverse planes demonstrated a similar trend in both groups. The maxillary canines were buccally tilted (SF vs OF group, 1.7 degrees vs 1.9 degrees), the maxillary molars were lingually tilted (SF group vs OF group, -4.7 degrees vs -1.0 degrees), the mandibular canines were lingually tilted (SF group vs OF group, 2.9 degrees vs 2.8 degrees), and the mandibular molars were buccally tilted (SF group vs OF group, -6.1 degrees vs -5.4 degrees). The magnitude and trend of transverse dental changes in patients with surgical skeletal Class III were similar whether receiving presurgical orthodontics or not.

The effect of anterior inclined plane treatment on the dentoskeletal of Class II division 1 patients

Most of Class II malocclusions are due to underdeveloped mandible with increased overjet and overbite. Lack of incisal contact results in the extrusion of the upper and lower anterior dentoalveolar complex, which helps to lock the mandible and prevent its normal growth and development, and this abnormality is exaggerated by soft tissue imbalance. The purpose of this study was to evaluate the skeletal and dental changes in patients treated with anterior inclined plane appliance in growing patients with moderate Class II Division 1 having deep overbite. In this study, 25 patients, including 15 girls and 10 boys, with a mean age of 9 +/-1.2 years were selected; all of them presented with moderate Class II deep bite with increased overjet and normal or horizontal growth pattern. Pre- and post-treatment X-rays and photos for an average of 8 months were taken. The statistical assessment of the data suggested that there were no significant changes in the vertical skeletal parameters. The mandibular incisors were protruded, whereas the maxillary incisors were retruded. Overbite and overjet were also reduced. There was significant increase in the mandibular length. The results revealed that in mixed dentition patients, the inclined plane corrected Class II discrepancies mostly through dentoskeletal changes.

Treatment effects of the edgewise Herbst appliance: A cephalometric and tomographic investigation

The crown Herbst appliance was introduced in the late 1980s because of shortcomings of the banded Herbst. In edgewise Herbst treatment, a fixed appliance is used with the crown Herbst to maximize the skeletal effects of treatment. Treatment response to the edgewise Herbst appliance has not been reported in the literature. Our objective was to investigate skeletal and dental changes in patients with Class II malocclusions treated with the edgewise Herbst appliance. Fifty-two consecutive patients were treated with the edgewise Herbst appliance; 32 (18 girls, 14 boys) met the criterion of 16 months out of Herbst treatment and were included in the study. Mean treatment time with this appliance was 8.0 +/- 1.8 months. Patients in the mixed dentition received additional treatment with 2 x 4 appliances until proper overbite, overjet, and torque on the incisors and permanent first molars were achieved. Patients in the permanent dentition were treated with full appliances to finalize the occlusion. Cephalometric measurements were taken at pretreatment, posttreatment, and 16 months after removal of the Herbst appliance, and the results were compared with 32 untreated Class II subjects from the Bolton Brush Study, matched for sex, age, and cephalometric dentofacial morphology. Data were analyzed with ANOVA, Tukey-Kramer multiple comparison tests, and 2-tailed t tests. After 8 months of Herbst treatment, incisal relationship was overcorrected to an end-to-end incisal relationship and improved 8.4 mm, compared with the control group. The maxilla moved backward 1.4 mm at Point A, and the mandible moved forward 1.7 mm. The maxillary incisors moved lingually 1.7 mm, and the mandibular incisors were proclined 3.6 mm. The molars were corrected to a Class III relationship with a change of 7.2 mm compared with the control group. The mandible moved downward and forward. However, the condyle showed only 0.2 mm forward movement in the fossa. Sixteen months after appliance removal, the molars had relapsed into a Class I relationship, for a net change of 2.4 mm compared with the control group. Net overjet gain was 2.7 mm. Net restraint of maxillary growth was 1.3 mm, and net forward movement of the mandible was 1.0 mm. The maxillary incisors had no net movement, and the mandibular incisors had a net forward movement of 0.3 mm. Overall, skeletal change contributed 85% of the net overjet correction. Class II treatment with the edgewise Herbst appliance is accompanied by both skeletal and dental changes. The changes are stable, with significant skeletal differences remaining 16 months after appliance removal. The forward and downward movement of the mandible with minimal changes in the position of the condyles in the fossae suggests a combination of condylar growth and remodeling of the glenoid fossa with treatment.

Sagittal, vertical, and transverse changes consequent to maxillary molar distalization with the pendulum appliance

The purpose of this study was to evaluate the skeletal and dental changes in patients who underwent distalization of their maxillary molars with pendulum appliances. The sample consisted of 31 patients (initial mean age, 14.58 years) with Angle Class II molar relationships and all permanent teeth up to the second molars. The maxillary molars were distalized with pendulum appliances for a mean period of 5.87 months. Lateral cephalograms, 45 degrees oblique radiographs, and dental casts were obtained before and after distalization. Changes produced by the pendulum appliance were analyzed with paired t tests. Maxillary first molar distalization accounted for 63.5% of the space opening; mesial movement of the maxillary first premolars contributed 36.5% of the space. The mean space opening on lateral cephalograms was 7.25 mm, and the rate of molar movement was 1.23 mm per month. The mean distalization of the maxillary molars was 4.6 mm, with a mean distal crown tipping of 18.5 degrees The maxillary molars experienced expansion, with a smaller effect on the first molars than on the second molars. The pendulum appliance produced symmetrical expansion, with a rate of 1.04 mm per month on the right and 1.10 mm per month on the left. The pendulum appliance is effective for distalization of the maxillary molars and the establishment of a Class I molar relationship in a relatively short time. However, caution is needed to control collateral effects, including mesial movement of the first premolars and distal tipping of the molar crowns.

Long-Term Skeletal and Dental Changes in Patients with Cleft Lip and Palate After Maxillary Distraction: A Report of Three Cases Treated with a Rigid External Distraction Device

We examined long-term skeletal and dental changes in three patients with cleft lip and palate who underwent maxillary distraction using a rigid external distraction device. Two were children, and one was an adult. Changes in the overjet (OJ), overbite (OB), and positions of the anterior nasal spine (ANS), upper incisors (U1), pogonion (Pog), and lower incisors (L1) were measured on preoperative to 36 months postoperative lateral-cephalograms. In the adult, the positions of all examination points were relatively stable from 6 to 36 months postoperatively, and the OJ and OB were maintained at over 2 mm at 36 months. In the children, the positions of ANS and U1 changed inferiorly, Pog and L1 changed anteroinferiorly, and OJ and OB tended to decrease from 6 to 36 months postoperatively. Long-term skeletal and dental stability following maxillary distraction was relatively well maintained in the adult patient. In the children, the maxillomandibular growth was observed after maxillary distraction, but the mandibular overgrowth might have been inhibited by the correction of class III dentoskeletal deformity resulting from the maxillary distraction.