Extraoral Device Research Articles

Finite element and clinical analyses of effects of a new intraoral device (VomPress) combined with extraoral RAMPA on improving the overjet of craniofacial complex

This research intends to investigate the effects of a new intraoral device, VomPress, combined with a Right Angle Maxillary Protraction Appliance (RAMPA) extraoral device on the treatment of maxillary hypoplasia. To this end, finite element (FE) method has been employed and a skull model, including all sutures, has been investigated. In addition, the effects of VomPress combined with RAMPA on a seven-year-old girl with the malocclusion and other side problems were monitored. The results of both FE simulations and the clinical data revealed that VomPress combined with RAMPA effectively improved the malocclusion and straight neck problem by creating more space in the patient’s mouth and anterosuperior protraction effects.

Interdisciplinary full digital restorative treatment of a young patient with severe open bite and amelogenesis imperfecta: a case report

Background Amelogenesis Imperfecta (AI) is a syndromic entity comprising several clinical conditions, mostly genetic-based, affecting quality and quantity of enamel. The use of digital tools can be advantageous to enhance communication between the dental team and patients. Moreover, a full digital approach would allow to check each single clinical step according to the treatment plan with a backward approach. The aim of this case report is to describe a multidisciplinary treatment program of a young patient with severe open bite and amelogenesis imperfecta, whose restorative rehabilitation was planned in a full-digital workflow, from the initial communication phase up to the final prosthodontic rehabilitation. Case report An 8-year old female patient was diagnosed with a Class II division 1 malocclusion, severe open bite and AI. The treatment plan included 3 phases: the elimination of the tongue interposition habit and the anterior open bite, the orthodontic correction of dental deviation and leveling of both dental arches and a prosthetic rehabilitation. The extraction of the four first molars corrected the canine and molar Angle Class II relationships, deviation of the midline and repositioning of the maxillary incisors on the sagittal plane. Feldspathic ceramics was used in anterior sites to enhance the esthetic outcome. CAD/CAM hybrid ceramo-polymeric restorative material (PICN) was chosen for posterior regions. Conclusion The outcomes of the present case report proved that the planned objectives were satisfactorily obtained thanks to proper treatment planning, full digital workflow and the patient’s optimal compliance with the extraoral device.

Protração maxilar usando mini-implantes em paciente Classe III: relato de caso

Uma alternativa já consolidada ao tratamento ortopédico convencional com disjunção palatina e máscara facial para pacientes em crescimento com Classe III esquelética por deficiência maxilar é a utilização de ancoragem esquelética para protração da maxila. Seu uso elimina os efeitos dentários adversos da terapia convencional, como extrusão e mesialização de molares superiores, projeção de incisivos superiores e retroinclinação de incisivos inferiores. Além disso elimina a necessidade de uso de um dispositivo extra-oral, o que contribui para a motivação dos pacientes. As miniplacas são a forma de ancoragem esquelética mais usada para esse tipo de terapia, entretanto a necessidade de um passo cirúrgico para instalação e outro para remoção das placas representa um ponto desvantajoso para essa técnica, e dessa forma o uso de mini implantes foi proposto com a finalidade de promover protração maxilar eliminando o passo cirúrgico. Este trabalho se propõe a descrever a técnica de prostração maxilar apoiada em mini implantes ortodônticos, ilustrada através de um caso clínico de um paciente tratado com esta terapia, mostrando os resultados faciais e oclusais positivos alcançados.

Estimation of jaw-opening forces, energy expenditure and jaw-opening patterns in adults

ObjectivesThe aims of this study were to investigate (1) the jaw-opening forces in different stages of jaw-opening, and determine the correlation among maximum jaw-opening force, maximum jaw-opening, and parameters such as age, height, weight, and gender, (2) the energy expenditure during jaw-opening, and (3) the jaw-opening patterns in adults. DesignThis was a cross-sectional study. The sample consisted of 87 participants were recruited from Dunedin, New Zealand. Jaw-opening forces were measured using an adjustable, rigid extra-oral device connected to a 1000 N load cell. Main resultsOutcomes were highly skewed. The median (IQR) value of maximum jaw-opening was 48 mm (8 mm). The median of maximum jaw-opening force (40.0 N) was higher than jaw-opening force at maximum jaw-opening (35.2 N) (P < 0.01). The median (IQR) of the work was 1.30 J (1.28 J), ranging from 0.38 J to 4.03 J. The median of maximum jaw-opening force and work was higher in males (54.8 N; 1.22 J) than females (33.5 N; 0.74 J) (P < 0.05). Four jaw-opening force patterns (Pattern 1, 2, 3 and 4) were fitted and generated using Origin Pro software. ConclusionA wide range of variation in jaw-opening force and work was observed, and they displayed a non-parametric, highly skewed distributions. The maximum jaw-opening force did not correspond to the maximum jaw-opening. Further studies could explore the potential association among the jaw-opening force pattern, the work of jaw-opening and TMJ diseases.

REPLACEMENT AFTER RECONSTRUCTION - PROSTHETIC MANAGEMENT OF DISTRACTED MANDIBLE AFTER HEMIMANDIBULECTOMY: A CASE REPORT

Maxillary or mandibular defects due to pathological or traumatic reasons need to be managed with a clinical challenge in order to assure the psychological, esthetical and functional needs of the patient. Post mandibulectomy would result with loss of teeth, bone height, width and deviation of mandible to the affected side. The degree of deviation might be due to the type of surgery and soft tissue contracture. Distraction osteogenesis or osteodistraction is one of the accepted treatment modality for a mandibular defect in which the segments of natural bone distracted sequentially for bone formation by means of intraoral or extraoral device. Here, we report the case of prosthetic management of distracted mandible after hemimandibulectomy in a 27-year-old female. This case succinctly explains the management of post distraction hemimandibulectomy by simple removable prosthetic rehabilitation which assured patient demands. This simple conservative approach was cost-effective and promisable prosthetic replacement in a short period than other treatment options.

Anterosuperior protraction of maxillae using the extraoral device, RAMPA; finite element method

This paper presents a boosting effect against gravity by analyzing the displacement and stress distribution of craniofacial structures due to the protraction of the extraoral device, the Right Angle Maxillary Protraction Appliance(RAMPA) system, including semi-rapid maxillary expansion (sRME) using the finite element method. In addition, a patient case was illustrated and compared with the results calculated from a simulation. The results from the finite element method were obtained for 0.5 mm activation using the screw of the intraoral device, gHu-1. This study reveals that RAMPA rotates the patient’s maxilla and mandible in the forward direction and forces them to move forward and upward.

Estimation of jaw-opening forces in adults.

To estimate maximum jaw-opening forces in healthy participants of diverse ancestry and to estimate whether opening forces are associated with sex, age and anthropometric parameters such as height, weight and BMI. One hundred and forty-nine participants aged 20-60years with overall good oral and general health. Exclusion criteria included myofascial or neck pain, symptomatic temporomandibular joint disorders (TMD), current orthodontic treatment or the absence of a natural dentition. Jaw-opening forces were measured with an adjustable rigid extra-oral device connected to a 1000N load cell. Seven attempts were recorded, with 10seconds interval. Median force values were obtained after discarding the first and last attempt. The height and weight of each participant were measured and recorded, alongside age, sex and ethnicity. Men had greater maximum opening force median values than women (P<.001). Median (IQR) values for women were 41.16N (30.44) and 79.00N for men (63.86). Jaw-opening force values were poorly associated with biological and anthropometric parameters. In this study, which included a large sample of participants of broad age range and from a demographically diverse background, jaw-opening force values were greater in males than in females; however, force values were poorly associated with biological and anthropometric parameters. Future studies should explore the potential of this method as a screening tool for TMJ disorders and other conditions.

Digital capture, design, and manufacturing of an extraoral device for a clarinet player with Bell’s palsy

An extraoral device was fabricated to assist a clarinet player with Bell’s palsy. The device was fabricated by using stereophotogrammetry, digital design, and additive manufacturing technologies.

Early orthodontic treatment of children with dentofacial anomalies in the mixed dentition with the use of fixed appliances

The article summarizes the authors experience in the treatment of patients with dentofacial anomalies in mixed dentition with fixed orthodontic appliances ("system 2×4") and combined treatment type with the use of extraoral device. Indications and contraindications, advantages and disadvantages, special conditions of the treatment, the mechanism of a face-bow action with extraoral traction, the sequence of events during the treatment are described in the article. Clinical cases of early treatment with "system 2×4" and in combination with the face-bow and extraoral traction demonstrate the effectiveness of the methods.

Prospective Phase II Study of the Efficacy of Transcutaneous Electrical Nerve Stimulation in Post-radiation Patients

AimsTo evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) delivered using an extra-oral device in patients with radiation-induced xerostomia. Materials and methodsThirty oral cavity and oropharyngeal cancer patients post-adjuvant (n = 26) or definitive radiotherapy (n = 4) were enrolled in this study. The TENS electrode pads were placed externally on the skin overlying the parotid glands. Unstimulated whole saliva was collected for 5 min into graduated tubes using the low forced spitting method. The TENS unit was then activated and stimulated saliva was collected for an additional 5 min. The difference between unstimulated and stimulated saliva output was measured using the paired t-test. Linear regression was used to determine factors significantly influencing the improvement in salivary output. ResultsTwenty-nine of 30 patients showed increased saliva flow during stimulation. A statistically significant improvement in saliva production (P < 0.05) during stimulation was noted. The mean unstimulated saliva flow was 0.056 ml/min and the mean stimulated saliva flow was 0.12 ml/min with a median increase of 0.06 ml/min. The interval to the application of TENS after radiotherapy significantly influenced the improvement in salivary flow. ConclusionExtra-oral application of TENS is effective in increasing the whole salivary flow in most of the post-radiated oral cavity/oropharyngeal cancer patients with xerostomia. TENS therapy may be useful as an effective supportive treatment modality in post-radiated oral cancer patients.

Effects of protocol utilized for collection of whole saliva stimulated by TENS in healthy adult Indians

Objective: The objective of this study was to evaluate the effects of Transcutaneous Electric Nerve stimulation (TENS) on whole salivary flow rate in healthy adult subjects and to find out whether the protocol utilized for collection of saliva influence the quantity of saliva stimulated. Materials and Methods: Using an extraoral TENS applied over parotid glands stimulated whole saliva flow rate in fifty healthy adult subjects was measured Collection of TENS stimulated saliva was performed on day 1 after collection of unstimulated saliva, on day 2 only TENS stimulated saliva was measured. The data obtained was subjected to statistical analysis using paired ‘t’ test. Results: Thirty nine patients on day one and thirty six patients on day two out of 50 (75 % of the subjects tested) responded to TENS therapy with an increase of stimulated whole saliva flow rate .There was a reduction in quantity of TENS stimulated saliva on day one and two with a difference of 4% which statistically significant with p value 0.009. Conclusions: Transcutaneous electric nerve stimulation (TENS) as an extra-oral device can be considered as a safe, non-pharmacological measure in order to achieve an increase of the rate of unstimulated saliva. Further studies should be conducted to evaluate the possibility of using TENS in relieving the symptoms of xerostomia.

Interim Obturator Retained by an Extraoral Device: A Clinical Report

This clinical report presents the treatment of an unfavorable bilateral maxillary defect with the use of an extraoral device to hold an interim obturator in place during tissue healing and maturation.

The development of a novel automated taste stimulus delivery system for fMRI studies on the human cortical segregation of taste

fMRI indicated that the primary taste cortex is activated not only by taste but also by non-taste information from oral stimuli. Head movements caused by swallowing are very critical problem in fMRI and inherent difficulties to modulate taste stimuli in the mouth exist to elucidate functional segregation of human brain. We developed a novel automated taste stimulus delivery system for fMRI studies to segregate the pure taste area in the primary taste cortex in humans. As a novel intra-oral device, an elliptic cylinder was attached to an individual mouthpiece and then subject placed the tongue tip in it. Using a computer-controlled extra-oral device, the solutions ran through the intra-oral device in constant conditions. Three adult volunteers participated in the experimental session, alternately consisting of 30 pairs of taste stimuli (0.5 mol/l sucrose solution) and control (water) blocks. The typical findings of the three subjects revealed activation only in the primary taste cortex ( P < 0.001), and none in the secondary taste cortex. This is the first system that delivers the taste stimuli automatically to a standardized area on the subject's tongue under constant conditions, thus allowing us to successfully segregate the pure taste area in the primary taste cortex in humans.

Distraction osteogenesis in the management of temporomandibular joint ankylosis

Objectives: The objective of this study is to evaluate the facial profile after mandibular advancement with distraction osteogenesis using an extra-oral device in patients with temporomandibular joint (TMJ) ankylosis. Soft tissue response to the mandibular advancement and stability were also evaluated over a period of 6 months. Study: Six patients—five patients with bilateral and one patient with unilateral TMJ ankylosis were considered. These patients underwent surgical correction of TMJ ankylosis and mandibular hypoplasia using distraction osteogenesis with extra-oral device. Results: There was an effective horizontal advancement of mandible that was clinically significant as noted by increase in the Go-Pog length (average increase by 13 mm) and angle of Ar-Go-Pog (average increase by 16o). In all patients the mouth opening was well maintained with an average of 22 mm. The 6 months post distraction evaluation indicated a minimal degree of relapse of both the hard tissue and soft tissue profiles which were clinically insignificant. Conclusion: Distraction osteogenesis for TMJ ankylosis serves dual purposes of achieving mouth opening and of lengthening of the hypoplastic mandible. This avoids a second procedure, its risks and complications. This is a viable alternative to conventional procedures in the management of TMJ ankylosis.

Distraction osteogenesis in a severe mandibular deficiency

ObjectiveDistraction osteogenesis is an alternative treatment method for the correction of mandibular hypoplasia. In this case report, distraction with a multidirectional extraoral device was performed to gradually lengthen the corpus and ramus of a patient who had a severe hypoplastic mandible.Materials and methodsThe patient underwent bilateral extraoral ramus and corpus distraction osteogenesis. After seven days of latency period, distraction was performed 0.5 mm twice a day. Subsequent consolidation period was 12 weeks.ResultsThe patient's mandible was elongated successfully. Cephalometric analysis revealed that ANB angle decreased from 13° to 6°, overjet of 15 mm decreased to 4 mm, corpus length increased from 49 mm to 67 mm, and ramus length increased from 41 mm to 43 mm. Posterior airway space (PAS) also increased due to advancement of the mandible. In stereolithographic model evaluation it was determined that the distances from condylion to gonion and from gonion to pogonion increased.ConclusionSatisfactory results from both aesthetic and functional standpoints were obtained by distraction osteogenesis of the ramus and corpus.

P.093 Evaluation of three-dimensional stereolithographic model and cephalometric analysis in mandibular distraction osteogenesis with a multiplanar extraoral device

P.093 Evaluation of three-dimensional stereolithographic model and cephalometric analysis in mandibular distraction osteogenesis with a multiplanar extraoral device

Maxillary distraction osteogenesis using Le Fort I osteotomy without intraoperative down-fracture

The aim of this study is to present a technique for maxillary distraction osteogenesis using Le Fort I osteotomy without down-fracture. Six cleft-related patients suffering from severe midfacial deficiency were treated with maxillary distraction osteogenesis. The RED II system was chosen as the extraoral device and the Leipzig retention plate system to anchor the maxillary segment. Maxillary distraction osteogenesis was successful in all cases. Cephalometric and clinical evaluation after an average follow-up period of 1 year showed stable results with respect to skeletal and dental relationships. The SNA angle increased from 72.3° to 81.4° and the ANB angle increased by 11.0° immediately after removing the distraction device. After 1 year, the sagittal bone gain remained and the SNA angle had decreased by 0.8°. This technique seems to minimize the risk of the surgical procedure and shorten the operation time. It may become an alternative method for the treatment of patients with severe midfacial hypoplasia.

Mandibular Widening by Distraction Osteogenesis in the Treatment of a Constricted Mandible and Telescopic Bite

Documentation of the application of mandibular widening by distraction osteogenesis and orthodontics. Three patients with telescopic bite resulting from an extremely constricted mandible related to hypoglossia-hypodactyly syndrome. Mandibular widening by distraction osteogenesis using an extraoral device and subsequent orthodontic treatment. The extremely constricted mandible and telescopic bite were dramatically improved by mandibular widening using distraction osteogenesis and subsequent orthodontics. Two of the three patients had transient complications; one reported temporomandibular joint pain and the other showed evidence of periodontal damage. Mandibular widening by distraction osteogenesis is an effective technique for the treatment of telescopic bite resulting from an extremely constricted mandible.

口腔外骨延長装置を下顎両側に用いた開こう症の１例

The skeletal open bite of a 52-year-old female which condition was accompanied by temporomandibular joint disorder, was treated by orthognathic surgery that distracted the lower border of the mandibular body using an extra-oral device, to change the angle of the mandibular body with the ramus. A wedgeshaped osteotomy was performed at the third molar area, and multi-guide distraction devices were applied bilaterally. Mandibular bone was distracted with three-dimensionally controlled displacement of the distal fragment. After a waiting period of 8 days, the device was advanced 0.1mm, or 3°, per day, for 16 days. As a result of this treatment, the open bite was improved, and the occlusal relationship was stabilized. Although a cutaneous scar and difficulty in device-setting were problems, control of osteodistraction was very easy.

Perawatan Maloklusi Kelas III Skeletal dengan Kombinasi Ortodontik-Bedah Orthognatik

Non-growing patient with excessive mandible and underdeveloped of the maxilla who classified as a class III skeletal malocclusion often found in the orthodontic daily practice. If they come earlier when potential growth is still left, sometimes growth modification can be applied to prevent further facial deformity (by using extra-oral device, for instance). In non-growing class III malocclusions, treatment alternative may consist of compromised-treatment without concerning an ideal treatment goal. However, with the development of knowledge and skills and with the potential improvement of interspecialistic team-work, nowadays, ideal facial aesthetics become possible. The combined orthodontic-orthognathic surgical treatment alternative to correct skeletal facial deformity may be a better alternative. This treatment changes the hostile environment, so that a more stable treatment result with better facial appearance can be achieved. This poster presents a case report of severe class III skeletal malocclusion whose treted with combined orthodontic-orthognathic surgery. The facial and dental improvements as well as the cephalometric changes are presented. The procedure of treatment and the interspecialistic team-work will also be briefly described.