Functional Orthodontic Appliances Research Articles

Mandibular Endochondral Growth Is Specifically Augmented by Nutritional Supplementation with Myo-Inositol Even in Rabbits.

Mandibular retrognathism occurs by insufficient mandibular growth and causes several issues, such as respiratory difficulty and diminished masticatory function. At present, functional orthodontic appliances are used for stimulating mandibular growth in pediatric cases. However, the effectiveness of functional appliances is not always stable in daily practices. A more effective, reliable, and safer therapeutic method for mandibular growth promotion would be helpful for growing mandibular retrognathism patients. As we previously discovered that nutritional supplementation of myo-inositol in growing mice specifically increases mandibular endochondral growth, we performed preclinical animal experiments in rabbits in this study. Briefly, six-week-old male Japanese white rabbits were fed with or without myo-inositol supplementation in laboratory chow until 25 weeks old, and 3D image analysis using micro CT data and histological examinations was done. Myo-inositol had no systemic effect, such as femur length, though myo-inositol specifically augmented the mandibular growth. Myo-inositol increased the thickness of mandibular condylar cartilage. We discovered that the nutritional supplementation of myo-inositol during the growth period specifically augmented mandibular growth without any systemic influence, even in rabbits. Our results suggest the possibility of clinical use of myo-inositol for augmentation of the mandibular growth in growing mandibular retrognathism patients in the future.

Evaluation of the antibacterial effect of titanium dioxide nanoparticles combined with acrylic laminates for functional orthodontic appliances: a randomized controlled clinical trial

BackgroundThe objective of this study was to evaluate the antibacterial effect of titanium dioxide nanoparticles incorporated into the acrylic baseplates of the maxillary part of twin block appliances in orthodontic patients during the treatment period.Materials and methodsTwenty-six patients were selected randomly and divided into two groups(n = 13). Test group patients used orthodontic functional appliances containing 1% titanium dioxide nanoparticles in acrylic baseplates. Control group patients used orthodontic functional appliances without titanium dioxide nanoparticles in acrylic baseplates. Swap samples were taken from the palatal gingiva facing the fitting surface of the acrylic component of the maxillary part of a twin block appliance for each patient at five-time intervals (baseline sample, after one, two, four, and six months) and then cultured in blood agar plates to calculate bacterial colony count. The Mann‒Whitney U test and the Friedman test were used to compare data. Bonferroni correction (p value ≤ 0.05) was applied to detect significant differences.The resultsshowed a decrease in the bacterial colony count in the test group compared to the control group. Pairwise comparisons revealed a statistically significant difference in samples after four- and six-month groups (p values = 0.002 and 0.011, respectively) vs. the one-month test group. A higher statistically significant difference was observed in the six-month group (p-value = 0.037) vs. the baseline group in the control group.ConclusionThe addition of 1% titanium dioxide nanoparticles to acrylic baseplates of orthodontic functional appliances significantly reduced the bacterial colony count under the base plate after at least four months of application.

A Comparative Assessment of Acceptance of Different Types of Functional Appliances.

Background Modern clinical orthodontics' functional appliances, a well-established modality of treatment, exhibit an amazing diversity of design. Clinical findings show that people have difficulty adjusting to these devices due to their size and unfixed positioning inside the mouth and that patient adaptation may vary based on the type of orthodontic functional appliance employed. Despite the fact that they appear to inflict more pain and soreness than, for example, removable plates, the effects of various orthodontic functional appliances on patients' acclimation have not yet been researched. Aim The current study's goal was to assess how different functional appliances' shapes and designs affected patients' willingness to accept them. Materials and methods About 20 adult volunteers (10 males and 10 females, age 18-32 years) with marked Class II division 1 malocclusion and not familiar with orthodontic appliances were selected as test subjects. Impressions for working casts were taken, and construction bites were prepared for the fabrication of eight functional appliances of various designs for each individual test subject. These appliances had eight design variations. There were three tests: one for speech effects, one for initial acceptance, and one for final acceptance after wearing different scales. Results Overall, the correlation between the quality of speech and pronunciation after wearing the appliance and the type of functional appliance was statistically significant. The quality of speech and pronunciation after wearing the appliance was maximum infrequency range 1 (FR1), while it was minimum in the medium-size activator. The difference was statistically significant(p=0.001). Overall, the correlation between the comfort and acceptability of functional appliances after wearing them and the type of functional appliance was statistically significant. The acceptance of functional appliances after wearing was maximum in FR1, while it was minimum in the medium-size activator. The difference was statistically significant(p=0.001). Overall, the correlation between the type of functional appliance and initial acceptance was significant statistically, with the maximum initial acceptance in medium-sized activators and the minimum initial acceptance in small bionators(p=0.001). Conclusion The study's findings show that patient acceptance of various kinds of functional appliances varies significantly.

Periodontal Mechanoreceptors Stimulated Study of Human Masseter Reflex Control Prior and During Fixed and Functional Orthodontic Appliance Therapy

Periodontal Mechanoreceptors Stimulated Study of Human Masseter Reflex Control Prior and During Fixed and Functional Orthodontic Appliance Therapy

Effects of a Prefabricated Functional Orthodontic Appliance on Children with Class II Division 1 Malocclusion

Effects of a Prefabricated Functional Orthodontic Appliance on Children with Class II Division 1 Malocclusion

Postępowanie kliniczne w amelogenesis imperfecta w wieku rozwojowym – przypadki kliniczne

Amelogenesis imperfecta is a hereditary defect of enamel. It can affect both the primary and permanent dentition. It manifests as: change in enamel structure, shape of teeth, severe malocclusion and can also co-occur with changes in other tissues derived from the ectoderm. In the literature there are several classifications of this disease, the two main ones are the four-stage classification according to Witkop (1988) and the two-stage classification according to Sundell, distinguishing the form associated with enamel hypoplasia and enamel hypomineralization. The aim of this paper is to present the diagnostic and therapeutic management of patients with amelogenesis imperfecta at the developmental age, based on three clinical cases. Three cases were chosen to represent patients with AI: 1) hypoplastic type of AI in 14-year-old girl, 2) hypoplastic type of AI in 12-year-old girl with distoocclusion and retrusion of upper incisors, 3) hypoplastic type of AI in 13-year-old boy with deep overbite and functional retrognathia. Presented methods of treatment were selected depending on the form of lesions, patient’s age and coexisting malocclusion. Direct reconstruction with composite materials was used – free-hand, as well as the technique of indirect reconstruction with steel crowns combined with use of functional orthodontic appliances. Dental treatment in patients with AI should be interdisciplinary. The choice of treatment method depends on the coexisting disorders. It aims to eliminate caries associated with enamel development defects and to correct occlusal conditions, as well as to improve the psychosocial functioning of patients by improving the aesthetics of the teeth.

Functional Orthodontic Treatment of Mandibular Condyle Fractures in Children and Adolescent Patients: An MRI Follow-Up.

Background: The purpose of this study was to retrospectively evaluate and follow up a conservative treatment approach with functional orthodontic appliances for the management of mandibular condyle fractures in children and adolescent patients. Methods: Between 2020 and 2022, the treatment records of patients with mandibular condyle fractures receiving a functional orthodontic treatment (FOT) were evaluated. In addition to the clinical and functional findings, magnetic resonance images of the mandibular condyles and surrounding structures were assessed. Results: Out of 61 patients, 8 met the inclusion criteria. The follow-up examination records showed no functional limitations. In 75% of cases, mild midline deviations persisted (mean 1.1 mm) without significant alterations to the occlusal relationships. Magnetic resonance imaging (MRI) showed the remodeling of the condyles and the restitution of the ramus heights, even in dislocated and displaced fractures. In three cases, a partial displacement of the articular disc was observed at the follow-up. No differences in the remodeling patterns were noted depending on age, sex, or fracture location. Conclusions: A FOT led to favorable functional and morphologic outcomes, supporting the concept of a conservative functional approach in children and adolescent patients. Functional adjunctive therapy should be considered in the conservative treatment of mandibular condyle fractures in growing patients.

Computer-aided design and manufacture of a milled Twin-block: Workflow and use in a clinical patient. Have we entered the digital era?

• CAD/CAM technology was used to design and build a Twin-block appliance. • The mandibular advancement needed was simulated digitally using a virtual articulator. • This article shows a successful example of a milled twin-block fabrication and use. This article aimed to describe the fabrication and clinical use of a milled Twin-block with an expansion screw using intraoral scanning and digital bite registration without an analog impression or construction bite. Computer-aided design and manufacturing technology was used to design and build the appliance. The mandibular advancement needed was simulated digitally using a virtual articulator. The appliance was milled, and the metal components, including a prefabricated expansion screw, were inserted manually after the milling process had been completed. The Twin-block was used to treat a 9-year-old girl presenting an Angle Class II Division 1 malocclusion, a deepbite, and an overjet of 10 mm. The accurate fitting and activation of the computer-aided design and manufacturing appliance, the biocompatibility of the material used, and the achieved clinical outcome indicate that everyday orthodontic functional appliance therapy has entered a new era.

Effects of Orthodontic Functional Appliances in Relation to Skeletal Maturation of Cervical Vertebrae In Class II Malocclusion.

To evaluate the effects produced by functional orthodontic appliances at dental and skeletal level in relation to the level of skeletal maturation in class II patients Study design: Longitudinal and observational study Patients selected for the study had been wearing Sander Bite Jumping Appliance (SBJA) for at least 12 months; they were first diagnosed (T1) with skeletal class II according to Ricketts' cephalometric analysis, and had had lateral cephalograms taken before and after orthopaedic treatment (T2). Variables studied at T1 and T2 were: facial convexity, inclination of the upper and lower incisors, and facial depth. Results were compared between T1 and T2 for each variable and in relation to cervical maturation stage (CVS) according to the Lamparski analysis. Statistical analysis was performed using Shapiro-Wilk, t-student, Analysis of Variance (ANOVA) and multiple comparison tests, taking as statistically significant a p-value <0.05. A final sample of 235 patients was obtained. Statistically significant differences were found in the inclination of the mandibular incisors between T1 and T2 and among the different cervical stages when the functional appliances were placed in CVS1 (p = 0.000), CVS2 (p = 0.04) or CVS5 (p = 0.048). For the remaining variables, significant differences were also found between T1 and T2, but these differences were similar in all cervical stages. A significant proclination of the mandibular incisors was found when the functional appliance was placed during CVS1, CVS2, or CVS5. Time of placement of the functional appliances was not statistically significant for the remaining variables studied.

Effects of Orthodontic Functional Appliances in Relation to Skeletal Maturation of Cervical Vertebrae in Class II Malocclusion.

To evaluate the effects produced by functional orthodontic appliances at dental and skeletal level in relation to the level of skeletal maturation in class II patients. Longitudinal and observational study. Patients selected for the study had been wearing Sander Bite Jumping Appliance (SBJA) for at least 12 months; they were first diagnosed (T1) with skeletal class II according to Ricketts' cephalometric analysis, and had had lateral cephalograms taken before and after orthopaedic treatment (T2). Variables studied at T1 and T2 were: facial convexity, inclination of the upper and lower incisors, and facial depth. Results were compared between T1 and T2 for each variable and in relation to cervical maturation stage (CVS) according to the Lamparski analysis. Statistical analysis was performed using Shapiro-Wilk, t-student, Analysis of Variance (ANOVA) and multiple comparison tests, taking as statistically significant a p-value <0.05. A final sample of 235 patients was obtained. Statistically significant differences were found in the inclination of the mandibular incisors between T1 and T2 and among the different cervical stages when the functional appliances were placed in CVS1 (p = 0.000), CVS2 (p = 0.04) or CVS5 (p = 0.048). For the remaining variables, significant differences were also found between T1 and T2, but these differences were similar in all cervical stages. A significant proclination of the mandibular incisors was found when the functional appliance was placed during CVS1, CVS2, or CVS5. Time of placement of the functional appliances was not statistically significant for the remaining variables studied.

Comparative assessment of the cell-surface antigens and gene expression profiles of the gingival tissue biomarkers in subjects with fixed functional and removable functional orthodontic appliances

BackgroundThis study aimed to examine the cellular components of the gingiva during orthodontic treatment with fixed and removable appliances. The cellular and molecular cues of pathologies of the gingival tissue associated with the use of different orthodontic appliances could be studied. Materials and methodsTissue samples of gingiva were received from healthy patients undergoing gingivectomy for aesthetic purpose and from patients with fixed and removable functional orthodontic appliances undergoing gingivectomy for gingival overgrowth. The collected samples were stored in a sterile container with phosphate-buffered saline and to carry out further processes it was transported to the laboratory. ResultsCells positive for ECAD and NCAD were found to be increased in fixed appliances where as CD90 and CD105 positive cells showed no significant difference in all the three groups. CD24 and CD146 positive cells were increased significantly in removable and fixed than normal whereas CD133 positive cells were decreased in removable and fixed than normal. CD44 positive cells showed no noticeable change in all three groups. The gene expression levels of KRT5, SOX2, NANOG, and CXCL5 were found to be significantly increased in removable and fixed appliance groups. However, KRT8, CXCL10, and TIMP1 were increased only in fixed appliance group but CXCL10 showed decreased expression in removable appliance group. KRT6A, MYC, and MMP9 were decreased in fixed appliance group whereas MYC and MMP9 were increased in removable appliance group. KRT6A, KRT8, and TIMP1 showed no significant difference in removable appliance group. ConclusionThis study demonstrated essential roles of various genes, showing their contribution in regulating cell proliferation and migration in both the removable and fixed functional appliances.

Effects of removable functional orthodontic apparatus on mandibular condyle bone quality

Aim: This study aims to compare the impact of dynamic functional orthodontic appliances on mandibular condyle bone density in patients with Class I, Class II, and Class III malocclusion during their growth and development phases.&#x0D; Methodology: The histories of patients with three separate malocclusions who received dynamic functional orthodontic appliance treatment were analyzed in this retrospective study. Twenty-eight patients met the inclusion criteria and were divided into four groups: maxillary expansion devices (Group A), twinblock/monoblock devices (Group B), face masks (Group C), and chincups (Group D). The fractal analysis approach was used to determine the mandibular condyle bone density by analyzing panoramic films taken from the patients at the beginning (T0) and end (T1) of treatment.&#x0D; Results: In Groups A and B, the results of the mandibular condyle bone fractal analysis decreased at the end of treatment compared with the pre-treatment results (p &lt; 0.05). In Groups C and D, the post-treatment results were better than the pre-treatment ones (p &lt; 0.05).&#x0D; Conclusion: Among the different malocclusion groups, some dynamic functional orthodontic appliances (maxillary expansion and twinblock/monoblock devices) enabled an increase in bone density in the mandibular condyle, while some (face masks and chincups) decreased the density. It is important to conduct orthodontic treatment by analyzing the results obtained with the use of these appliances.&#x0D; &#x0D; How to cite this article: Yüzbaşıoğlu Ertuğrul B. Effects of removable functional orthodontic apparatus on mandibular condyle bone quality. Int Dent Res 2021;11(Suppl.1):7-11. https://doi.org/10.5577/intdentres.2021.vol11.suppl1.2&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Does An Orthodontic Functional Appliance Correct Head and Cervical Spine Posture

Does An Orthodontic Functional Appliance Correct Head and Cervical Spine Posture

English

BACKGROUND Skeletal class II division 1 malocclusion is an antero posterior discrepancy between maxilla and mandible which is usually treated by functional appliances when the patient is in the growing phase. It has been shown that these functional orthodontic appliances may lead to pressure on the oral mucosa, soft tissue tension, oral constriction, toothache and pain. They may also lead to fatigue or to functional speech and respiratory disorders, and they may affect the appearance of the face. All of these undesired consequences affect the patients’ degree of compliance in a negative manner, and may in turn affect the patients’ perception towards the treatment. This study was conducted to investigate patient perception of treatment need, appliance acceptance, expectations of treatment influence on oral health, value of dental aesthetics and information concerning treatment procedures. METHODS Total 30 samples were selected 15 samples were cases treated with twin block appliance and other 15 samples were treated with clear block appliance. After 8 months of treatment, a questionnaire survey was conducted assessing discomfort, expectations and experiences of all patients being treated with clear block appliance and twin block appliance. RESULTS Clear block seemed to be better with regard to all the parameters used in the study but on statistical analysis the difference between the two groups was insignificant. CONCLUSIONS Clear block appliance was designed to increase the compliance of the patient. However, clear block and twin block appliance have similar effects. KEY WORDS Class II, Clear Block, Twin Block

Terapija skeletnih anomalija ortodontskom kamuflažom

Camouflage is a therapeutic procedure used to treat orthodontic anomalies after the cessation of pubertal growth acceleration. The goal of camouflage is to treat skeletal inconsistencies based on tooth extraction. In that way, good intercuspation of lateral teeth and a correct ratio of incisors are achieved, despite skeletal discrepancy. Indications for this procedure refer to patients with moderate and mild distal bites, patients with mild mesial bites, patients who are "too old" for growth modification therapy, and patients with good vertical proportions. Contraindications refer to patients with crowded teeth and incisions of the incisors, patients with good growth potential (it is necessary to use functional orthodontic appliances), severe skeletal discrepancies (when orthognathic surgery is performed) and patients with pronounced vertical disproportions. The method of treatment involves placing an orthodontic appliance in the upper and lower jaw. Retention is mandatory after removing the upper and lower appliance because the teeth tend to return to their original position. Possible side effects are instability and unpredictability of therapeutic results over time (relapses), and patients are sometimes only partially satisfied with aesthetic changes.

Evaluation of stress changes in the maxilla with fixed functional appliances-A 3D FEM study.

AIM:To evaluate the stress changes in the maxilla during fixed functional appliance use using three-dimensional finite element method (FEM) stress analysis.SETTINGS AND SAMPLE POPULATION:A three-dimensional finite element model of the maxilla was constructed using the images generated from the cone-beam computed tomography of a patient treated for Class II malocclusion with a fixed functional orthodontic appliance. The FEM was used to study the stress changes seen in the maxilla, which were evaluated in the form of highest von Mises stress and maximum principal stress before and after the application of fixed functional appliance.RESULTS:Higher areas of stress were seen in the model of the maxilla with the fixed functional appliance (140 MPa) compared to that in the resting stage (58.99 MPa).CONCLUSIONS:An increase in the maximum principal stress and von Mises stress in the posterior regions of the maxilla and maxillary teeth was seen. The stresses seen were double than that without the appliance. A high distalization force on the maxilla was seen with the fixed functional appliance.

The effect of TMJ disk repositioning by suturing through open incision on adolescent mandibular asymmetry with and without a functional orthodontic appliance

The objective of this study was to evaluate the effect of combined temporomandibular joint (TMJ) disk repositioning by suturing through open incision and orthodontic functional appliance (OFA) treatment for adolescents with mandibular asymmetry. Adolescent patients (12-20 years old) with mandibular asymmetry combined with unilateral TMJ disk displacement without reduction were treated with disk repositioning by suturing through open incision with and without postoperative OFA. Magnetic resonance imaging and posteroanterior cephalometric radiographs (PA) were used to measure and compare the changes in condylar height, joint space, and menton deviation pre- and postoperatively. Twenty-six patients were included in the study. Joint space was significantly increased postoperatively and new bone mostly formed at the superior or posterior superior part of the condyle after 6 to 18 months in all surgically treated joints. Fourteen patients with OFA had a significant increase in condylar height and menton deviation compared to 12 patients without OFA (2.29 ± 0.91 mm vs 1.22 ± 0.69 mm, P=.003; 4.56 ± 1.48 mm vs 2.01 ± 0.74 mm, P=.000). Combined treatment with TMJ disk repositioning by suturing through open incision and OFA can promote condylar growth and correct mandibular deviation in adolescent patients. Postoperative OFA can maintain the increased joint space created by disk repositioning and promote new bone formation at the superior and posterior parts of the condyle.

Verification of mechanical load generated by functional orthodontic appliances

Functional appliances are widely used for promoting mandibular growth by utilizing a construction bite position. We aimed to measure the mechanical load generated by movement of functional appliances and determine the factors influencing this load. Thirteen patients aged 8–12 years were selected for the study, and the load was measured using a previously developed measurement device. To investigate the factors affecting the load, the temporomandibular joint morphology and muscles related to the mandible were examined using cone-beam computed tomography. The standard regression coefficients of the factors affecting the load per millimeter of movement distance were 0.64 and 0.66 for (a) the inclination of the articular eminence and (b) the angle between occlusal plane and posterior temporalis, respectively. Measurement of the occlusal plane to the posterior temporalis and the inclination of the articular eminence were significantly different (p < 0.05). The angle of inclination of the articular eminence emerged as a strong influencing factor. Similarly, the influence of measurements from the occlusal plane to the posterior temporalis was considerable since the posterior temporalis muscle is the most active when the mandible is extended forward. We also found a possible relationship between the occlusal force and load at the construction bite position. To our knowledge, this is the first study to determine the actual load associated with the angle of the temporalis muscle to the occlusal plane, inclination angle of the articular eminence, angle between the occlusal plane and the Frankfort plane, and the angle between the geniohyoid muscle and the occlusal plane. Therefore, mechanical considerations need to be more accurate to facilitate safe orthodontic treatment.

Concept selection and interactive design of an orthodontic functional appliance

Demand for innovation represents a driver not only in the industrial field but also in niche markets such as orthodontics. Among different type of orthodontic devices, functional appliances are used for the correction of class II skeletal malocclusion, mostly in young patients. In a previous study based on a systematic design approach, several concepts were generated for this device. This work shortly introduces the concept selection and the interactive design process of the device. The concept consisting of two-side guiding surfaces, obtained by TRIZ inventive principles, has been selected by the decision matrix. This concept consists in guiding the jaw movements without any connections between the parts of the device. Operating on patient morphometrics parameters, the proposed approach allows to establish a virtual interaction during the design of the device by facilitating the collaboration between orthodontist, dental technician, designer and the software, through a dedicated user interface. Dedicated algorithms were also developed to simulate the occlusion correction and the mandible path, and to support the geometric modelling in a virtual environment. As a result, the proposed approach allows manufacturing patient-customized devices using a digital interactive workflow in an innovative way.

An innovative method for manufacturing the Tuebingen palatal plate for infants with Robin sequence

BackgroundRobin sequence (RS) is characterized by mandibular micro- and retrognathia, glossoptosis, upper airway obstruction and optionally a cleft palate. With an incidence of 1:8000, it belongs to the so-called rare diseases; 30–50% of patients have RS as part of a syndrome. A comparatively well-studied treatment option is the Tuebingen Palatal Plate (TPP), which has proven effective in both, isolated and syndromic RS, but often requires multiple endoscopies for perfect fit and effectiveness. We report on a new method for fitting the TPP with only one session of nasopharyngeal endoscopy resulting in the plate being finished in one day.Methods and resultsFirst, a prototype is produced, consisting of a traditional acrylic palatal part and a velar extension made of thermoplastic resin, usually measuring 10x40mm. Using polymerization, a scale is added to the posterior part of the extension to help with determining its optimal length during endoscopic evaluation. The extension is pre-bent in the dental laboratory to achieve an approximate shape. During endoscopy, the prototype can be adjusted to the infant’s anatomy: first, the angulation is customized by controlled heating, bending and cooling of the thermoplastic spur. Second, the length of the spur is adapted by grinding its tip. Then the prototype is returned to the dental laboratory for completion; the final plate can be delivered to the patient on the same day. It acts by shifting the tongue into a more anterior position, thereby opening the airway and releasing upper airway obstruction, as well as by acting as a functional orthodontic appliance that stimulates mandibular growth through exerting pressure on the base of the tongue.ConclusionsWith the thermoplastic spur presented here, a TPP can be produced within one day, requiring only one endoscopy. This approach may facilitate fabricating the TPP.