Elastic Traction Research Articles

Impacted Central Incisors in the Upper Jaw in an Adolescent Patient: Orthodontic-Surgical Treatment—A Case Report

The inclusion of both maxillary permanent central incisors is uncommon. This condition compromises face aesthetics, phonation and masticatory function. Therefore, early diagnosis is essential to avoid complications and failures. There are various reasons for inclusion, but supernumerary teeth are the leading cause. Early causes of removal and rapid expansion of the palate determine a high probability of success with the spontaneous eruption of the impacted elements. However, it is often necessary to proceed with a surgical–orthodontic treatment. The inclination of teeth in relation to the midline and the root maturation degree determine prognosis and therapeutic timing. In this case report, the orthopantomogram (OPG) X-ray of a 9-year-old boy revealed two impacted supernumerary teeth in the anterior maxillary region, preventing the eruption of the permanent upper central incisors. The impacted supernumerary teeth were surgically removed at different times. A straight wire multibrackets technique associated with a fixed palatal appliance was used. The palatal appliance featured an osteomucous resin support at the level of the retroincisal papilla. Subsequently, surgical exposure was carried out using the closed eruption technique and elastic traction, bringing 11 and 21 back into the arch.

Experimental and finite element analysis studies of a reduction-force reducing traction method for pelvic fracture surgeries

Pelvic fracture is among the most complicated fractures in traumatic orthopedics, with high mortality and morbidity rates. The main difficulty associated with the reduction surgery is significant muscle resistance. It then becomes necessary to decrease the reduction force against this strong muscle resistance, for improving surgical safety. Here, we propose a novel traction method for decreasing the reduction force during pelvic reduction, and investigate the performance of the elastic traction method on decreasing the reduction force using experimental tests and simulation-based analyses. From the experimental results, the reduction force decreased by 59.2% when 10 ​kg of elastic traction was applied. We also establish a musculoskeletal model of the pelvic fracture reduction, for analyzing the muscle resistance and the optimal traction force applied in reduction surgeries. The elastic traction method can counteract the muscle resistance increase in the non-traction direction owing to its flexibility. We conclude that the optimal traction force applied should be in the 10–15 ​kg range, and recommend adopting a dynamic traction strategy rather than continuous traction in clinical settings. Elastic traction is very promising for various surgeries that require traction, including pelvic reduction. It significantly reduces force, which can significantly reduce the physical exertion of the operating surgeon, the possibility of additional injuries to the operated patient, and promotes robot-assisted reduction surgeries.

Дооперационная подготовка пациентов к эндопротезированию тазобедренного сустава

Актуальность. Проанализировано влияние мышц — стабилизаторов таза на сохранение постурального баланса у больных коксартрозом и выдвинута рабочая гипотеза, согласно которой позиционная адаптация компонентов эндопротеза тазобедренного сустава во время операции определяется состоянием этих мышц. Цель работы — разработка методики предоперационной лечебной физкультуры, положительно влияющей на состояние мышц — горизонтальных стабилизаторов таза, для оптимизации позиционной адаптации эндопротеза тазобедренного сустава во время операции. Материалы и методы. Разработана методика упражнений, выполняемых из облегченного исходного положения. Для увеличения силы мышц тазового пояса упражнения выполняют с противодействием максимальному сопротивлению при гравитационно разгруженном суставе. Для увеличения объема движений в тазобедренном суставе упражнения выполняют при гравитационной разгрузке сустава вытяжением или специальными эластичными тягами, используют маховые и пассивные упражнения. Повышенный тонус мышечных групп (аддукторы, флексоры) устраняют при помощи релаксирующих техник и пассивных упражнений. Тонус гипотрофичных мышц (абдукторы, экстензоры) повышают стимулирующим массажем. Болевой синдром снижаем путем экстензии нижней конечности за счет дозированного манжеточного вытяжения, также выполняем часть упражнений. Результаты работы апробированы на группе из 10 пациентов с односторонним коксартрозом, которым применялась разработанная нами методика дооперационного лечения. Результаты лечения и эффективность предлагаемой методики оценивали по разработанной нами методике оценки функции мышц, отвечающих за постуральный баланс. Результаты. Клиническая апробация разработанной методики предоперационного лечения показала, что после проведения курса лечебной физкультуры перед операцией некоторые пациенты отмечали снижение уровня боли, увеличение объема движений в больном тазобедренном суставе, субъективное улучшение опороспособности скомпрометированной конечности и улучшение качества жизни. Сравнение величины плеча силы абдукторов до операции и после выполнения эндопротезирования показало, что ни в одном случае не отмечено расхождение показателей более чем на 5 мм, что говорит о том, что позиционная адаптация компонентов эндопротеза тазобедренного сустава зависит от состояния мягких тканей, окружающих тазобедренный сустав. Это позволяет утверждать, что устранение мышечной контрактуры аддукторов и сгибателей бедра, а также восстановление эластичности и силы абдукторов и разгибателей бедра обеспечивают оптимальную позиционную адаптацию компонентов эндопротеза тазобедренного сустава. Выводы. Предварительные исследования показали, что у больных, получавших до операции специальный курс лечебной физкультуры, благодаря устранению мышечной контрактуры и восстановлению эластичности и силы абдукторов и разгибателей бедра обеспечивается оптимальная позиционная адаптация компонентов эндопротеза тазобедренного сустава, однако подтверждение достоверности исследований требует дальнейших наблюдений.

Using orthodontic elastic traction during the active period of distraction osteogenesis to increase the effective vertical extension of hemifacial microsomia patients: A multi-center randomized clinical trial

In this study, the aim was to assess whether using elastic traction during the active period of distraction osteogenesis could effectively increase the vertical extension.Patients with Pruzansky-Kaban Type II mandibular deformity were recruited and randomly assigned into Elastic traction + Distraction Osteogenesis group or Distraction Osteogenesis group, respectively. During the active period, the experimental group received orthodontic elastic traction 3 days after distraction osteogenesis implantation, while the control group received no treatment. All the participants underwent computed tomography (CT) examination before surgery, at the end of the active period, 6 months and 2 years after distraction osteogenesis tractor implantation. The primary outcome was the effective vertical extension rate of the mandible from the baseline to the end of the active period after operations, and there were 7 secondary outcomes used.70 patients were included. The effective vertical extension rates were 85.021% ± 7.432% (mean ± SD) and 68.811% ± 9.510% (mean ± SD) in the experimental and control groups, respectively (P = 0.001). The average distances between the lower middle incisor point to the sagittal plane at the end of the active period were 2.485 ± 1.411 mm and 3.938 ± 2.293 mm in the experimental and control groups, respectively (P = 0.026). At the end of the active period of distraction osteogenesis, the average values of the mandibular occlusal plane canting were −4.887 ± 3.126 mm and −0.177 ± 4.029 mm in the experimental and control groups, respectively (P = 0.026).Elastic traction-assisted distraction osteogenesis could improve traction efficiency and facial symmetry.

Long-term follow-up of late maxillary orthopedic advancement with the Liou-Alternate rapid maxillary expansion-constriction technique in patients with skeletal Class III malocclusion

The objective of this study was to evaluate short and long-term results of the application of the alternate rapid maxillary expansion/constriction (Alt-RAMEC) technique in patients with skeletal Class III malocclusion. Forty-two white patients were consecutively treated with the Alt-RAMEC technique. The average age of the patients was 12.7±1.6years (range, 9.4-15.9years) before protraction. The average age at long-term follow-up was 19.4±2.8years (range, 17.2-26.9years). A sample of nontreated patients with Class III malocclusion from the archives of orthognatic surgery in our hospital was used as a control group. The initial records were matched for sex, the severity of Class III malocclusion, and age (mean, 12.1±1.4years; range, 9.7-14.1years) with the old records available in the archive. The control sample had records presurgery (mean, 19.8±2.2years; range, 16.6-21.6years). The sagittal advancement of A-point, after the application of the technique, was 5.43±2.71mm. Some mandibular dentoalveolar adaptation was noted. The position of the maxilla was stable in the long term. In contrast, the control group showed limited growth at the maxillary level during the long-term follow-up period. Our results showed that the Alt-RAMEC technique, performed at the correct time, with a double-hinged expander, followed by Class III spring or elastic traction, 24h/d, allows for satisfactory maxillary protraction, with stable long-term results. The comparison with a sample of matched nontreated patients with Class III malocclusion allowed to suggest the positive effect of the treatment on the maxillary position vs the natural evolution of the Class III skeletal discrepancy.

Factors Associated with Pain Intensity in Patients Undergoing Orthodontic Treatment Based on Mini-Implants

Abstract Introduction: Pain is currently reported as the most common side effect associated with orthodontic treatment. The aim of this study was to evaluate the factors associated with the intensity of pain perception during orthodontic procedures consisting in anesthesia, orthodontic mini-implant placement and removal, as well as during the postoperative period following these procedures. Material and Methods: The study included 50 young adults with a permanent dentition in need of orthodontic treatment. The pain assessment was based on visual analogue scale (VAS), using self-report questions from approved questionnaires. Pain severity was analyzed in relation to: anesthesia, implant placement, implant removal, implant movement, elastic traction and gingiva/bone pain around the implant. The study lot was divided into Group 1 – patients experiencing a pain degree of 1 or 2, and Group 2 – patients experiencing a pain degree of 3 or 4 during implant placement. Results: The maximum pain intensity (PI) was recorded during implant placement, which has been associated with a PI of 2.4 ± 0.8 (95% CI: 2.17–2.63), followed by implant removal (PI = 2.36 ± 0.66, 95% CI: 2.17–2.54), gingiva/bone pain around the implant (PI = 2.32 ± 2.58, 95% CI: 2.15–2.48), and elastic traction (PI = 2.26 ± 0.63, 95% CI: 2.08–2.44). Male gender was present in a significantly higher extent in the group of patients presenting a high intensity pain during implant placement (86.3% in Group 2 vs. 3.5% in Group 1, p <0.0001). The age group most sensitive to pain was 18 to 21 years. Conclusions: In our study, pain perception was significantly higher in males and in the 18–21 years age group. The most painful procedure during surgery was the initial moment of implant placement, followed by the moment of implant removal, gingival/bone pain around the implant, and the elastic tractions placed on the implant during anchorage.

Use of Elastomeric Separators in Maxillofacial Fracture Reduction.

Management of maxilla and mandibular fractures are based on the principles of reduction, fixation and immobilization of the fracture segments. One of the processes of reduction is to apply continuous and gradual elastic traction by placing elastics from the upper and lower arch bars in a definite manner and direction as per the fracture line. Orthodontic elastic separators are versatile, and the major advantage is the higher traction forces as compared to conventional elastics. Prestretched separator elastics were guided over the arch bar or fixed orthodontic appliances to provide desired traction. Orthodontic elastic separators are therefore versatile, and the major advantage is the higher traction forces as compared to conventional elastics. They provide an edge over the use of wires as they tend to break off by work hardening. Therefore, we have adapted orthodontic separators and have used them in place of conventional elastics for the last 10 years with appreciable results after taking informed consent from the patients.

Features of the course of comorbid somatic pathology depending on the method of treatment of lower jaw fracture without displacement of fragments

AIM: The aim is to study the effect of the method of reducing the fractures of the mandible without displacement of fragments on the course of comorbid somatic pathology
 
 MATERIALS AND METHODS: The study included 60 patients (45 men and 15 women) aged 18 to 69 years with fractures of the mandible without displacement of fragments and comorbid somatic pathology. The subjects were divided into three groups. The first group included 20 patients who received intraosseous orthodontic screws with intermaxillary rubber traction. The second group consisted of 20 patients who underwent immobilization with a Tigerstedt splint with intermaxillary rubber traction. The third group included 20 patients who underwent immobilization with a Vasiliev double-mandibular splint with intermaxillary rubber traction. We studied the effect of the method of reducing of fractures of the mandible without displacement of fragments on the course of comorbid somatic pathology.
 RESULTS: As a result of the treatment in the first group, angina pectoris became unstable in 1 patient, which required a consultation with a cardiologist and correction of treatment. In the second group, in 3 patients (15%) with chronic polyarthrosis, prolonged wearing of dental splints resulted in the aggravation of deforming osteoarthritis of the TMJ and longer outpatient rehabilitation was required. In the third group, 13 patients (65%) with diabetes mellitus and ischemic heart disease demanded a prolonged oral tissue regeneration.
 CONCLUSIONS: When choosing a method for reducing a fracture of the lower jaw, it is necessary to take into account the features of comorbid somatic pathology. The conservative method of treatment using dosed intermaxillary elastic traction is the most gentle.

The three-dimensional evaluation of positional change in mandibular condyle after intraoral vertical ramus osteotomy

ObjectivesThe purpose of this study was to compare the changes of the condylar axis, the anteroposterior condylar position relative to the glenoid fossa, after intraoral vertical ramus osteotomy (IVRO). Study design21 patients diagnosed as skeletal class III malocclusion underwent IVRO and were followed according to the authors’ postoperative management regimen. The three-dimensional positions of the condyles were evaluated by cone-beam computerized tomography (CBCT) at pre-op, post-op, and at follow-up. CBCT images were referenced to assess the condylar axis change and the anteroposterior condylar position in the glenoid fossa. A repeated-measures analysis of variance (P<0.05) also was performed. ResultsAfter surgery, both the axial condylar angles and the anteroposterior condylar position were significantly different (P<0.05). The coronal condylar axis rotated outwardly. The anteroposterior condylar position in the glenoid fossa had moved from the concentric to the anterior position. But the condyle changes between post-op and follow-up (P>0.05) were insignificant. ConclusionsWith postoperative intermaxillary elastic traction, the condyles changed their positions physiologically for newly established jaw movement after IVRO.

Orthognathic Surgery and Orthodontics: Inadequate Planning Leading to Complications or Unfavorable Results.

Complications in orthognathic surgery are commonly a result of inadequate preoperative planning and communication between the surgeon and orthodontist. Unfavorable outcomes can often be avoided when overall treatment goals along with a surgical and orthodontic plan are developed and agreed upon by the orthodontist, surgeon, and patient before the start of active tooth movement or any surgical procedures. Continuous evaluation of the patient's progress throughout treatment and subsequent communication between the surgeon and orthodontist are recommended to prevent frequent errors, such as inadequate dental decompensation, poor appliance selection or management, and occasional contraindicated orthodontic elastic traction or tooth movements.

Body Weight Loss After Orthognathic Surgery: Comparison Between Postoperative Intermaxillary Fixation with Metal Wire and Elastic Traction, Factors Related to Body Weight Loss.

The aim of this study was to compare body weight loss between postoperative intermaxillary fixation with metal wire and elastic traction and to investigate factors related to body weight loss after orthognathic surgery. Subjects were 59 patients with dentofacial deformity, comprising 31 patients treated with intermaxillary fixation (IMF) and 28 patients treated with elastic traction without IMF (ELT) just after surgery. Body weight loss was measured at 1week (T1) and 2weeks (T2) after surgery. Body weight loss was compared between IMF and ELT, and factors related to body weight loss were statistically analyzed. Body weight loss ratio was significantly increased in IMF (2.6%) rather than in ELT (1.4%) at T1, but only tended to be increased in both groups at T2, showing no statistical difference. Body weight loss ratio was significantly increased at T2 compared to T1 in both groups. Body weight loss was significantly greater at T2 than at T1. Both IMF and ELT cause body weight loss after orthognathic surgery, but IMF causes body weight loss earlier than ELT and increased early body weight loss increases continuous body weight loss after orthognathic surgery.

S4B-15 SESSION 4B: ORTHOGNATHIC / TREACHER-COLLINS TWO-POINT FIXATION OF THE LE FORT I OSTEOTOMY: A 1-YEAR ASSESSMENT OF STABILITY

Introduction: Rigid fixation of the Le Fort I osteotomy commonly utilizes plates at the bilateral medial and lateral maxillary buttresses (four points of fixation). The purpose of this study was to assess whether fixation placed only at the medial buttresses results in stable maxillary positioning. Methods: This was a retrospective cohort study of patients undergoing elective orthognathic surgery at a tertiary care children’s hospital. Patients were included as study subjects if they underwent a conventional Le Fort I osteotomy with fixation at the bilateral medial maxillary buttresses (two-point fixation), with or without concomitant mandibular surgery, and had at least 1-year of documented follow-up. Fixation was achieved with prebent 1.5–1.7 plates placed at the medial maxillary buttresses bilaterally and affixed with at least 3 monocortical screws above and below the osteotomy. Elastic traction was used as needed to alter the occlusal plane in the first 6-weeks post-operatively. The primary outcome measures were linear and angular assessments of jaw position and included: SNA (degrees), maxillary length (Co-A), and maxillary occlusal plane angle (degrees), measured at T0 (pre-operatively), T1 (immediately post-operatively), T2 (6-weeks post-operatively) and T3 (1-year post-operatively). Stability was defined as an absolute angular change of ≤2 degrees and an absolute linear change of ≤2 mm. Results: Over a three-year period, 33 patients undergoing Le Fort I osteotomy met the inclusion criteria. The mean age of the sample was 18.3 ± 1.8 years; 17 were male. Twenty-seven patients (81.8%) had a history of craniofacial differences; 23 subjects had bimaxillary surgery (69.7%). The mean maxillary advancement was 5.2 ± 3.2 mm. The mean change in maxillary angular position was 1.1 ± 1.2 degrees between T1 and T3 and 0.8 ± 0.6 degrees between T2 and T3. Twenty-nine subjects (87.8%) had changes ≤ 2 degrees between T1 and T3; no subject had a change >2 degrees between T2 and T3. The mean absolute change in maxillary occlusal plane angle was 1.7 ± 1.6 degrees between T2 and T3; 28 subjects (84.8%) had occlusal plane changes ≤ 2 degrees between T2 and T3. The mean absolute change in maxillary linear position was 1.6 ± 1.3 mm between T1 and T3 and 1.1 ± 1.1 mm between T2 and T3; 30 subjects (90.9%) had mean linear changes ≤ 2 mm between T2 and T3. No patients in the sample experienced non-union, malocclusions, or need for repeat surgery. Conclusion: Two-point fixation of Le Fort I osteotomies results in stable maxillary positioning at 1-year post-operatively. Furthermore, the use of two fixation plates at the bilateral medial maxillary buttresses alone allows for decreased operative time and cost.

Outcome of orthodontic treatment in subjects with periodontal disease. Part III: a CBCT study of external apical root resorption.

No evidence is present on the risk for external apical root resorption (EARR) during orthodontic treatment (OT) of adult patients with periodontal disease. To examine EARR after OT in subjects with periodontal disease and to analyse how intrusion and change in inclination of the most proclined maxillary incisors influence EARR. The study included 50 patients with periodontal disease. Sub-gingival debridement by ultrasonic instrumentation supplemented with hand instruments was performed by experienced dental hygienist after baseline examination for all patients. For the control group, final periodontal treatment (PT) was performed before orthodontic tooth movement. For the test group patients, final PT was performed after levelling and alignment phases were finished, before the active space closure with elastic chain and/or inter-arch elastic traction for sagittal correction was started. OT was performed with a straight-wire appliance. Micro-implants or implants were used for posterior anchorage. Cone beam computed tomography examinations were performed before and after OT. EARR of all single-rooted teeth were measured. EARR of the most proclined maxillary incisor was related to intrusion and change in inclination angle. EARR after OT was observed in median 80.7 per cent (interquartile range 22.02) of single-rooted teeth [mean 1.2 (standard deviation 0.44) mm]. In 82.3 per cent of teeth, EARR was 2 mm or less. Severe EARR was found in 8 per cent of patients and five maxillary incisors (less than 1 per cent of all teeth). The amount of intrusion and change in inclination angle of the most proclined maxillary central incisor influenced the extent of EARR. Mean EARR was significantly higher when OT lasted more than 18 months (P = 0.02). OT in conjunction with PT in periodontal patients resulted in EARR in 81 per cent of all single-rooted teeth. Intrusion and change in inclination angle of the most proclined maxillary central incisor influenced the extent of EARR, as did longer OT.

Infant Multiple Mandibular Fracture: Case Report

Infant facial fracture incidence is low. Most reported cases affect the jaw and are single fractures. We present a twenty-two-month old patient, who had a high-energy car accident. Among other injures, she suffered a multiple mandibular fracture: bicondylar, left body and right parasymphyseal. Stable internal fixation of parasymphyseal and body mandibular fracture was performed on the third day. Condylar fractures had a functional treatment with switching elastic traction to prevent ankylosis. Computed tomography (CT) showed mandibular condyles remodelling after six months. Clinical examination showed that mandibular movement ranges were preserved without alteration. Successful treatment of paediatric patients is based on the achievement of an adequate anatomic reduction and the stability of the fracture, allowing opportune form and function recovery, in order to assure further development of dental and facial structures.

Bone-anchored maxillary protraction to correct a class III skeletal relationship: A multicenter retrospective analysis of 218 patients

This study evaluated the impact of class III correction by elastic traction on four miniplates and the failure rate of bone-anchored miniplates in nonsyndromic patients. A total of 218 patients (112 males and 106 females; average 11.4 years), treated by 38 orthodontists, received four miniplates (total 872 miniplates) from 2008 to 2016 at three maxillofacial centers in two countries. Factors affecting the success and failure of the miniplates were retrospectively examined and skeletal changes on cephalometric radiographs examined for 52 patients. Elastic traction was performed for 22.9 months, on average. The miniplate survival rate was 93.6%; 25.7% of the patients suffered failure of one of the miniplates. Postoperative antibiotics and placement of the neck of the miniplate in the attached gingiva significantly improved the success rate. Miniplate failure was six times higher in the maxilla and occurred more in younger patients. Self-drilling screws were significantly better than self-tapping screws for fixing the miniplate. Small cephalometric changes were seen: SNA (+1.9°), SNB (+0.4°), ANB (+1.4°), Wits analysis (+1.3 mm). In conclusion, bone-anchored maxillary protraction on four miniplates is an effective method for correcting a class III relationship, but has less skeletal effect than previously reported in the literature.

Utility of a novel elastic traction system in endoscopic thyroidectomy via breast approach: initial experience with 34 patients.

ObjectiveTo summarize our experiences in using an elastic traction, space-making technique for endoscopic thyroidectomy via breast approach in the treatment of early-stage differentiated papillary thyroid carcinoma.MethodsA retrospective analysis was performed on patients who underwent endoscopic thyroidectomy via breast approach for thyroid carcinoma in our department. We used our self-developed “mini elastic traction space-maker” in a group of 34 patients; another 45 patients who underwent the procedure with the conventional CO2 insufflation method were enlisted as the control group.ResultsAll patients had successful unilateral lobectomy and central lymph node dissection (CLND) surgeries. The adoption of the intraoperative elastic traction system increased the height of the subcutaneous working space (by 1 cm) and significantly decreased the times required for lobectomy and CLND compared with the controls (46.7 ± 4.7 min vs. 50.7 ± 4.9 min). However, there was no significant difference between the two groups in the set-up time to create the working space.ConclusionsThe elastic traction, space-making technique is a safe and feasible technique for endoscopic thyroidectomy via breast approach.

Short- and Long-Term Effects of Late Maxillary Advancement With the Liou-Alt-RAMEC Protocol in Unilateral Cleft Lip and Palate.

The objective of this retrospective longitudinal study was to evaluate short- and long-term results of the application of the Liou Alt-RAMEC (alternate rapid maxillary expansion and constriction) technique, a late orthopedic maxillary protraction technique, with intraoral anchorage, in patients with cleft. Twenty-six patients with unilateral cleft lip and palate (UCLP) were consecutively treated with the Alt-RAMEC technique. The average age of the patients was 11.7 years (10.3-13.2 years) before protraction and 18.3 years (17.4-21.1 years) at long-term follow-up. A sample of nontreated patients with UCLP was used as a control group. It was matched for sex, skeletal class III, and age (11.3 years). The control sample had records at the end of growth (18.7 years). The sagittal advancement of A-point, after the application of the technique, was 5.7 (2.17) mm. Some mandibular dentoalveolar and positional adaptation was noted. The position of the maxilla was stable in the long term. On the other hand, the UCLP control group showed hardly any growth at the maxillary level during the long-term follow-up period. Our results showed that the Alt-RAMEC technique, performed at the correct time, with a double-hinged expander, followed by class III spring or elastic traction, 24 hours per day, allows for satisfactory maxillary protraction, with, at this stage, apparently stable long-term results. Nevertheless, as only 50% of the patients had long-term follow-up data, we are still unable to predict the percentage of patients which will not eventually need orthognathic surgery.

Diagnosis of the Auditory System of a CCD Case Treated Surgically and Orthodontically

Cleidocranial dysplasia (CCD) represents a rare genetic disease characterized by disturbances in osseous structures, face dysmorphia, hypoplasia or aplasia of clavicles and numerous supranumerary teeth causing permanent teeth impaction. The study aimed at presenting a case of 12-year-old girl with CCD at the phase of active orthodontic treatment, involving successive extraction of multiple supranumerary teeth and repositioning of additional teeth using elastic traction. The patient was also subjected to a complex auditory examination which detected a hearing loss. Patients with CCD from their youngest years should be covered by a broad diagnosis and therapy, involving a comprehensive collaboration of multiple specialities.

Late maxillary protraction techniques for cleft lip and palate

Maxillary protraction has been used in childhood to improve Class III malocclusion in children with cleft lip and palate; however, the correction at this age tends to be temporary and needs to be readdressed after growth is complete. In this article, we discuss methods to combine maxillary protraction with sutural loosening in young adolescents and with LeFort 1 osteotomies in older adolescents. Maxillary protraction depends solely on patient compliance, which is both an advantage and disadvantage. Elastic traction in place of a distractor is less precise and reliable than a fixed distractor. Despite these limitations, maxillary protraction has helped us to treat patients with Class III malocclusions who avoided the morbidity and long recovery periods associated with orthognathic surgery. Several of the current modifications of the protraction protocol are presented. Although it takes hard work, maxillary protraction is a viable alternative to orthognathic surgery if the patient is responsible and motivated.

ヒト乾燥頭蓋骨を用いたIII級ゴムの上顎骨に及ぼす影響に関する実験的研究 : Anchorage preparationに際して

ヒト乾燥頭蓋骨を用いたIII級ゴムの上顎骨に及ぼす影響に関する実験的研究 : Anchorage preparationに際して