Dentofacial Discrepancies Research Articles

The change of state-trait anxiety among patients undergoing orthognathic surgery: A longitudinal study

This study aimed to assess state-trait anxiety level changes in Chinese patients with dentofacial discrepancies before and after orthognathic surgery and to explore the feasibility of developing a reference index for the preoperative screening of postoperative patients with high anxiety. A total of 96 Chinese patients with dentofacial discrepancies who underwent orthognathic surgery were included in this study. Data were collected before orthognathic surgery and at 2 weeks (T2), 3 months, and 6 months (T4) after surgery using the State-Trait Anxiety Inventory. Receiver operating characteristic and linear regression analyses were performed to screen for preoperative indicators of postoperative high-state anxiety. State-trait anxiety levels in patients with dentofacial discrepancies decreased after surgery (F= 18.95, P<0.01; F= 6.90, P<0.01). Trait Anxiety Inventory can be used to screen patients with high-state anxiety from T2 to T4 (area under cover 95% confidence interval: T2, 0.74 [0.62-0.86]; 3 months, 0.79 [0.69-0.90]; T4, 0.77 [0.66-0.87], P<0.01), corresponding to cutoff values of 48.5, 46.5, and 45.5, respectively. All participants' state-trait anxiety levels improved after surgery compared with their preoperative levels. Preoperative trait anxiety levels can be used as a reference indicator to screen patients who may have high-state anxiety levels after orthognathic surgery. The creation of a screening scale will assist health care professionals to more pertinently help patients with high anxiety.

A Cross-Sectional Study of Factors Influencing Pre-Operative Anxiety in Orthognathic Patients.

Orthognathic treatment is an important treatment modality to manage severe dentofacial discrepancies. Patients awaiting orthognathic surgery often experience increased anxiety, which may adversely affect post-operative recovery and treatment satisfaction. This study investigated the effects of a number of factors on pre-operative anxiety in orthognathic patients. Seventy patients prospectively recruited from three orthognathic centres in the UK completed a pre-operative questionnaire that included validated scales for measuring anxiety, social support, resilience, and coping styles. Sociodemographic data and satisfaction with the information provided by the clinical team were also elicited from the questionnaire. Univariable analysis showed that social support from a significant other (p = 0.026), resilience (p < 0.001), and satisfaction with the information provided by the clinical team (p = 0.002) were significantly associated with reduced anxiety, whilst avoidance coping (p < 0.001) and coping through seeking social support (p = 0.006) were significantly related to increased anxiety. With the exception of coping by seeking social support, these relationships retained significance in a multivariable regression analysis. Neither gender nor ethnicity moderated the effects of social support on pre-operative anxiety. These findings suggest potential avenues for clinicians to address with future interventions to reduce pre-operative anxiety. Further qualitative research may provide greater clarity on the relationship between these variables and anxiety.

Potential Side Effects of Comprehensive Fixed Orthodontic Treatment: A Narrative Review

Orthodontics is a specialty derived from dental sciences that starts by diagnosing, preventing, intercepting, modifying growth, and treating all dentofacial discrepancies. Medical interventions can cause harm besides their benefits. This review is done to evaluate the most common potential risks that can be caused by orthodontic treatment and detect the most common factor in the treatment that may lead to this hazard. The review was conducted based on PRISMA-S guidelines for literature search strategy for systematic reviews. Despite all the beneficial effects of orthodontic treatment, it also has negative effects on oral and peri-oral structures and social well-being. It is also important to obtain informed consent from patients before the initiation of any orthodontic procedure, especially in cases with a history of trauma or known adverse reactions.

Potential Side Effects of Comprehensive Fixed Orthodontic Treatment: A Narrative Review

Orthodontics is a specialty derived from dental sciences that starts by diagnosing, preventing, intercepting, modifying growth, and treating all dentofacial discrepancies. Medical interventions can cause harm besides their benefits. This review is done to evaluate the most common potential risks that can be caused by orthodontic treatment and detect the most common factor in the treatment that may lead to this hazard. The review was conducted based on PRISMA-S guidelines for literature search strategy for systematic reviews. Despite all the beneficial effects of orthodontic treatment, it also has negative effects on oral and peri-oral structures and social well-being. It is also important to obtain informed consent from patients before the initiation of any orthodontic procedure, especially in cases with a history of trauma or known adverse reactions.

Recreation of esthetic smile from flared anterior teeth with midline diastema utilizing zirconia ceramic fixed bridge: A case report

Recreation of esthetic smile from flared anterior teeth with midline diastema utilizing zirconia ceramic fixed bridge: A case report - APRD- Print ISSN No: - 2581-4796 Online ISSN No:- 2581-480X Article DOI No:- 10.18231/j.aprd.2019.028, IP Annals of Prosthodontics and Restorative Dentistry-IP Ann Prosthodont Restor De

Association Between Canine Impaction and Skeletal Pattern in the Sagittal and Vertical Planes.

In the present study, the authors evaluated the association of canine impaction with different skeletal discrepancies in two planes of space (sagittal and vertical). Cephalometric and orthopantomographic radiographic images of 45 patients with one or more impacted canines were used in this retrospective study. Five radiographic morphologic parameters-ANB angle, canine angulation, angle between the Frankfort horizontal plane and the mandibular plane (FH-MP), Wits appraisal analysis, and axial inclination of the maxillary incisors in the sagittal plane-were recorded for comparison. Statistical analysis was performed using SPSS 9.0 statistical package (IBM). Impaction of the maxillary canine was more frequent than mandibular canine impaction in both males and females, and palatal impaction was more common than buccal impaction, with a higher significance in males (64.7%) than in females (50%). In the sagittal relationship, the highest frequency of impacted canines was found in patients with a Class III skeletal discrepancy (44.4%), followed by Class I (28.9%) and Class II division 1 (15.6%), while the lowest frequency was in Class II division 2 (11.1%). Comparison between sexes in the vertical plane showed that impacted canines occurred more frequently in hyperdivergent female faces (51.1%) and hypodivergent male faces (48.9%). The result of this study indicates a statistically significant association of impaction with canine, sagittal, and/or vertical dentofacial discrepancies. The results also showed a higher risk of having impacted canines in patients with certain dentofacial deformities. Therefore, canine impaction may be used to represent a substitute scale for the study of different malocclusion groups with respect to race and ethnicity.

Temporary Skeletal Anchorage Techniques.

As orthodontic treatment has advanced in complexity and in frequency, more recent techniques, using temporary skeletal anchorage, were developed to help correct more severe occlusal and dentofacial discrepancies that were treated with orthognathic surgery alone previously. These techniques have allowed the orthodontist to move teeth against a rigid fixation, allowing for more focused movements of teeth and for orthopedic growth modification. These types of treatments using rigid fixation have allowed for greater interaction between the orthodontist and the oral and maxillofacial surgeon, and have vastly enhanced the treatment planning for the orthodontist in today's society.

Principles of orthognathic management of dentofacial discrepancies

Abstract: Individuals with severe dentofacial discrepancies that are beyond the scope of conventional orthodontic treatment will often require a joint orthodontic-surgical approach to manage their malocclusion. This treatment approach involving orthodontics in combination with orthognathic surgery is used to manage severe underlying skeletal discrepancies in the anterior-posterior (AP), vertical and transverse dimensions. The purpose of this article is to highlight the principles of orthognathic treatment. The general dental practitioner (GDP) plays an important role in maintaining dental health, especially whilst patients are on the orthognathic care pathway. Patients may also seek the advice of the GDP about the possible benefits of such a treatment approach before deciding to embark upon treatment.CPD/Clinical Relevance: It is important for GDPs to understand the principles of orthognathic management in order to support their patients through treatment.

Complications after orthognathic surgery: our experience on 423 cases.

Orthognathic surgery is widely used to correct dentofacial discrepancies. However, this procedure presents numerous possible complications. The aim of our study is to review intraoperative and postoperative complications related to orthognathic surgery based upon a 10-year period in the Maxillofacial Surgery Department of Federico II University of Naples. Medical records of 423 patients who undergone orthognathic surgery in a 10-year period were retrospectively analyzed and complications was noted. Statistical analysis was conduced in order to understand if the type of surgical procedure influenced complications rate. One hundred eighty-five complications in 143 (33.8%) of the 423 treated patients were reported. Complications detected were nerve injury (49 cases, 11.9%), infections (10 cases, 2.4%), complications related to fixation plates or screws (30 cases, 7.1%), bad split osteotomy (8 cases, 1.9%), secondary temporo-mandibular joint disorders (36 cases, 8.5%), dental injuries (21 cases, 5%), condilar resorption (2 cases, 0.5%), and necessity of a second-time surgery (24 cases, 5.7%). Serious complications seem to be quite rare in orthognathic surgery. Some of the surgical complications found are related to the surgeon experience and not strictly to the risks of the operation itself. Understanding potential complications allows the surgeon to guarantee safe care through early intervention and correctly inform the patient in the preoperative colloquy.

An Overview of the Surgical Correction of Dentofacial Deformity.

The correction of severe dentofacial discrepancies involving a combination of orthodontic and surgical therapies (termed ‘orthognathic treatment’) is commonplace. There is an abundance of evidence within this field but it is often inconsistent. This article is an evidence-based overview of such treatments and is aimed at the general dental practitioner. It will cover: the timing of treatment; the indications and risks associated with different surgical osteotomies; the magnitude of surgical movements that can be achieved with these procedures; and the importance of mandibular autorotation when planning treatment. Orthognathic treatment is considered to be the gold standard for comprehensive correction of severe dentofacial discrepancies. It is undertaken by a multidisciplinary team of clinicians involving, but not exclusive to, consultants in orthodontics and oral and maxillofacial surgery in secondary and tertiary medical centres throughout the United Kingdom. Clinical relevance: It is imperative that general dental practitioners have a good understanding of orthognathic treatment in order to recognize when such treatments are indicated, to inform the patient of possible treatment modalities and to be able to discuss associated risks in order to make appropriate referrals. Since treatment timing and magnitude of surgical movements have a profound effect on stability of the treatment result, these must be carefully considered by all clinicians involved in patient care to minimize relapse potential.

The impact of an educational pamphlet on the awareness of parents about 4‒6-year-old children's oral habits and dentofacial discrepancies.

Background. This study aimed to evaluate whether the parents’ knowledge about the adverse effects of oral habits and dentoskeletal discrepancies would improve by an educational pamphlet.Methods. A parallel-group randomized clinical trial was conducted on parents in kindergartens of Shiraz, Iran, 2013. The parents completed a designed questionnaire to determine the pre-intervention score. The study group received an educational pamphlet on the oral habits and dentoskeletal discrepancies, in contrast to the control group. Three weeks later, the parents in both groups took the questionnaire again (post-intervention score). The primary outcome was a change in the parents’ knowledge about oral habits and dentoskeletal discrepancies, which was measured by 13 questions of the questionnaire. Each correct answer was given a positive point and each incorrect answer a negative point. The total pre- and post-intervention scores were calculated by summing up the points and compared using Mann–Whitney U test.Results. A total of 550 subjects were assessed for eligibility and 413 were randomized. Of the study group, 203 subjects (98.56%), and of the control group, 204 parents (98.54%) completed the questionnaire for the second time. The score of the study group in the "normal occlusion" section of the questionnaire had significantly improved (P < 0.001) and in the "oral habits" section the score of both groups had improved but in the study group the improvement was significantly higher (P < 0.001).Conclusion. The educational pamphlet can be effective in increasing the level of parents’ knowledge about normal occlusion and complications of oral habits.

Orthognathic correction of dento-facial discrepancies.

Orthognathic treatment is a process which involves orthodontics and maxillofacial surgery and is used to treat those dento-facial discrepancies which are outside the scope of conventional orthodontic treatment, for example severe Class II or Class III problems, anterior open bites and facial asymmetries. Patients who present with these severe problems may encounter a wide range of different problems ranging from functional problems (for example, difficulties biting and chewing) to self-consciousness in a wide range of work and social situations. This paper discusses the possible indications for orthognathic treatment and looks at the risks and benefits of treatment. The treatment pathway is also described.

Psychosocial and functional outcomes of orthognathic surgery: Comparison with untreated controls

ObjectivesOrthognathic surgery is a procedure for patients with dentofacial deformities and provides dramatical dentofacial and psychological alterations. The aim of this controlled study was to evaluate how orthognathic surgery affects patients’ psychosocial well-being and compare them with patients having dentofacial discrepancies and with individuals who do not have any skeletal discrepancies. MethodsHundred and sixty-three adult individuals were included in this study as three groups: patients who underwent orthognathic surgery, patients having skeletal discrepancies and individuals who do not have any skeletal discrepancies. Patients in all groups were asked to fill out two questionnaires concerning the psychological and physical status of the patients at that moment and additional questions were asked to patients in post-surgical phase regarding post-surgical satisfaction. Categorical variables were statistically evaluated by Fisher Exact and chi-square tests. ResultsPatients who were going to seek orthognathic surgery were significantly concerned about their dentofacial appearance, body image and psychosocial status when compared with patients in the post-surgical phase and the individuals who did not have skeletal discrepancies. The results of the patients who underwent orthognathic surgery were approximated to the results of non-patient control group and had high degrees of satisfaction with improvement in appearance brought about by surgery at 6-month post-operatively. ConclusionFollowing orthognathic surgery, patients had better psychosocial status when compared to patients without skeletal deformities. Patients in the pre-surgical phase were not only functionally but also psychosocially the least satisfied group of individuals.

Corrección ortodóncico-quirúrgica de clase III esquelética a través de avance y descenso del maxilar con injerto óseo. Caso clínico

Class III malocclusion can involve a lot of factors such as excessive mandibular growth, deficient maxillary growth, other environmental factors and maxillary trauma. The correction of this malocclusion can be with orthodontic treatment (camouflage) and when there is a more significant bone discrepancy, esthetic or functional problems; it can be solved with a combination of orthodonticsurgical treatment. In this case report, a 17-year-old patient with a dental and maxillofacial deformity (Angle class III malocclusion) due to a deficient vertical and sagittal maxillary growth, with no transverse discrepancy; excessive mandibular growth, brachyfacial with concave profile, a 1mm incisor display when smiling which had a major impact on the patient's aesthetic perception of herself. An orthodontic-surgical treatment was planned using Roth 0.018″×0.025″ slot appliances. The surgical treatment was a maxillary inferior repositioning and advancement using an autogenous chin graft. Maxillary segmentation was performed to coordinate both arches. Le Fort I surgery is an effective procedure in the correction of dentofacial discrepancies with maxillary deficiency. The aesthetic and functional results obtained by using this type of surgery were successful and treatment was continued with postsurgical-orthodontic treatment to get a detailed finishing of the case. ConclusionsMaxillary repositioning is used nowadays to achieve long term stability in the correction of class III skeletal discrepancies, when in the past the only solution was to treat with mandibular surgery only, thus producing poor facial aesthetics.

Skeletal class III correction by advancing and descending the maxilla with a bone graft. Case report

Class III malocclusion can involve a lot of factors such as excessive mandibular growth, deficient maxillary growth, other environmental factors and maxillary trauma. The correction of this malocclusion can be with orthodontic treatment (camouflage) and when there is a more significant bone discrepancy, esthetic or functional problems; it can be solved with a combination of orthodontic-surgical treatment. In this case report, a 17-year-old patient with a dental and maxillofacial deformity (Angle class III malocclusion) due to a deficient vertical and sagittal maxillary growth, with no transverse discrepancy; excessive mandibular growth, brachyfacial with concave profile, a 1mm incisor display when smiling which had a major impact on the patient’s aesthetic perception of herself. An orthodontic-surgical treatment was planned using Roth 0.018”×0.025” slot appliances. The surgical treatment was a maxillary inferior repositioning and advancement using an autogenous chin graft. Maxillary segmentation was performed to coordinate both arches. Le Fort I surgery is an effective procedure in the correction of dentofacial discrepancies with maxillary deficiency. The aesthetic and functional results obtained by using this type of surgery were successful and treatment was continued with postsurgical-orthodontic treatment to get a detailed finishing of the case. ConclusionMaxillary repositioning is used nowadays to achieve long term stability in the correction of class III skeletal discrepancies, when in the past the only solution was to treat with mandibular surgery only, thus producing poor facial aesthetics.

Facial analysis of patients with dentofacial discrepancies: comparison among patients with and without cleft lip/palate

Facial analysis of patients with dentofacial discrepancies: comparison among patients with and without cleft lip/palate

S321: Secondary Management of Cleft Lip/Cleft Palate Deformities in Both Soft and Hard Tissues

The management of the primary cleft lip and palate deformities often may be followed by several secondary sequelae in different areas: nose, lip, alveolar ridge, hard and/or soft palate and also dentofacial discrepancies.

S215: Secondary Management of Cleft Lip/Cleft Palate Deformities in Both Soft and Hard Tissues

The management of the primary cleft lip and palate deformities often may be followed by several secondary sequelae in different areas: nose, lip, alveolar ridge, hard and/or soft palate and also dentofacial discrepancies.

TMJ ankylosis release followed by mandibular distraction osteogenesis: is there a need for coronoidectomy?

Unilateral TMJ ankylosis occurring in childhood can lead to both serious functional problems and marked facial deformity. Restricted mouth opening can cause difficulties in maintaining oral health and may also limit the amount and type of food eaten. Inhibition of growth on the ankylosed side together with continued growth from the unaffected condyle can often lead to both vertical and horizontal dentofacial discrepancies. Coronoidectomy of the hypertrophied coronoid process on the affected side has traditionally been recommended as part of the operation to release TMJ ankylosis to improve opening and prevent relapse.

S222: Secondary Management of Cleft Lip/Cleft Palate Deformities in Both Soft and Hard Tissues

The management of the primary cleft lip and palate deformity is follow by several sequelae that could be present in different areas: nose, lip, alveolar ridge hard and soft palate and also dentofacial discrepancies. The goal of this surgical clinic will be to analyze and to review the different techniques we can use to repair them. We will discuss the diagnosis and treatment of different nasal sequelae such as flat nose, short columella, deviation and misplaced alar cartilage, opened floor of the nose, asymmetric nostrils, etc. Lip problems such as short vertical length, whistle defect, lack of vermillion border, bad scars, etc. In the palate the most common problems are anterior fistulae, posterior dehiscence and velopharyngeal insufficiency or incompetence, its treatment including the tongue flap and both retropharyngeal grafts and the functional sphincter will be review. Also all the bone problems will be revised and their treatment will be discussed as nasoalveolar grafting, premaxillary repositioning, and orthognathic treatment based on the diagnosis of the speech will be revised.