Guidance Appliance Research Articles

Tongue pearl: A novel technique for treatment of an infant with median facial cleft and microcephaly

This case report illustrates the presurgical treatment of a patient having a median facial cleft and microcephaly, using a guidance appliance. The appliance was custom designed and modified with a pearl-like acrylic structure attached to its lingual surface for pushing the extremely protruded tongue back to its normal position to facilitate anesthesia and surgical lip closure. Total treatment time was 5weeks. Regaining normal tongue position, in turn, facilitated both intubation and extubation, preventing the postoperative respiratory distress the authors had experienced with similar cases.

POST RESECTION PHYSIOTHERAPY AND REHABILITATION; USING FUNCTIONALLY MOULDED MAXILLARY GUIDE RAMP

Often the loss of the continuity of the mandible hampers the balance and the symmetry of mandibular function, leading to altered mandibular movements and deviation of the residual fragment towards the surgical side. Successful intercuspal position with the antagonist in the remainder arch was accomplished through the use of functionally moulded palatal guidance appliance in a patient who underwent hemisection and postsurgical radiation of the mandible, subsequent to treatment for a squamous cell carcinoma of right side of the ramus of mandible. This article describes the fabrication and function of a maxillary palatally positioned, functionally moulded guide flange to assist post resection physiotherapy and rehabilitation.

Dentofacial Changes after Orthodontic Intervention with Eruption Guidance Appliance in the Early Mixed Dentition

To evaluate skeletal and dentoalveolar changes induced by the eruption guidance appliance in the early mixed dentition. Pre- and posttreatment cephalometric radiographs of 115 consecutively treated children, 62 boys and 53 girls, were compared with those obtained from a control group of 104 children, 52 boys and 52 girls. Pretreatment radiographs were taken at the deciduous-mixed dentition interphase (T1) and after full eruption of all permanent incisors and first molars (T2). The mean age of the children in both groups was 5.1 years at T1 and 8.4 years at T2. A significant difference between the groups at T2 was found in the mandibular length, midfacial length, and maxillomandibular differential. The increase in mandibular length was 11.1 mm in the treatment group and 7.2 mm in the control group. No differences were found in measurements of maxillary position or size. There was a significant shift toward a Class I relationship in the treatment group. Labial tipping and linear protrusion of the mandibular incisors was evident in the treatment group at T2. There was no effect on the inclination or position of the maxillary incisors. Occlusal correction was achieved mainly through changes in the dentoalveolar region of the mandible. In addition, the appliance enhanced condylar growth resulting in a clinically significant increase in mandibular length. No effect was observed on maxillary position, maxillary size, inclination or protrusion of the maxillary incisors, or facial height.

Orthodontic intervention in the early mixed dentition: A prospective, controlled study on the effects of the eruption guidance appliance

A prospective, controlled cohort study was started in 1998 to investigate the effects of orthodontic treatment in the early mixed dentition with the eruption guidance appliance. Occlusal changes were recorded in 167 treated children and 104 controls after they had reached the middle mixed-dentition stage. Treatment began when the first deciduous incisor was exfoliated (T1) and ended when all permanent incisors and first molars were fully erupted (T2). The children's mean ages were 5.1 years (SD 0.5) at T1 and 8.4 years (SD 0.5) at T2. From T1 to T2, overjet in the treatment group decreased from 3.1 to 1.9 mm and overbite from 3.2 to 2.1 mm. In the control group, overjet increased from 2.9 to 4.1 mm and overbite from 3.3 to 4.1 mm. At T2, the differences between the groups were highly significant (P <.001). At T1, 18% of the children in the treatment group and 22% of the controls had tooth-to-tooth contact between the maxillary and mandibular incisors. All others had an open bite, or the mandibular incisors were in contact with the palatal gingiva. At T2, tooth-to-tooth contact was observed in 99% of the treated children and 24% of the controls (P <.001). Almost half of children in both groups showed incisor crowding at T1. Good alignment of the incisors was observed in 98% of the treated children at T2, whereas maxillary crowding was found in 32% and mandibular crowding in 47% of the controls (P <.001). At T1, 41% of the children in the treatment group and 53% of the controls had a Class I relationship; the rest had either a unilateral or a bilateral Class II relationship. At T2, a Class I relationship was found in 90% of the treated children and 48% of the controls (P <.001). At least 1 occlusal deviation, including overjet > or =5 mm, overbite > or =5 mm, open bite, gingival contact of the mandibular incisors, crowding, or Class II relationship, was observed in 13% of the treated children, but the deviations were mild, and no child was considered to need treatment. In the control group, 88% of the children showed at least 1 occlusal deviation (P <.001). Treatment in the early mixed dentition with the eruption guidance appliance is an effective method to restore normal occlusion and eliminate the need for further orthodontic treatment. Only a few spontaneous corrective changes can be expected without active intervention.

Orthodontists' views on indications for and timing of orthodontic treatment in Finnish public oral health care

The aim of this study was to analyse the variation in the views of Finnish orthodontists on the indications for orthodontic treatment, timing of orthodontic assessment, and treatment methods used. The views were elicited by a questionnaire that was sent to all 146 specialist orthodontists under 65 years of age living in Finland in 2001. The response rate was 57 per cent. The association between an orthodontist's experience and timing of treatment was tested by Fisher's exact test. Stepwise logistic regression analysis was used to estimate the association between the demographic characteristics of orthodontists and the tendency to start Class II division I treatment early. Most orthodontists recommended that the first assessment of occlusion should be carried out before 7 years of age. A crossbite was mentioned as the most frequent indication for treatment in the primary and early mixed dentition, and a severe Class II division I malocclusion with an increased overjet as the most frequent indication in the late mixed dentition. Most respondents preferred early treatment, but there was a wide variation in the choice of appliances and in the timing of treatment of malocclusions other than crossbite and Class II malocclusions. A quadhelix, headgear, and the eruption guidance appliance were the most frequently used appliances in early treatment, with fixed appliances being most frequently used during the late mixed and permanent dentition phase. Orthodontists working full time in municipal health centres tended to prefer early treatment more often than those working part-time or outside health centres. There was no statistically significant association between an orthodontist's experience and timing of Class II division I and Class III treatment (P = 0.142 and P = 0.296, respectively). The preference for an early start in Class II division I treatment might be related to differing professional decisions, but no explaining factors could be found in the regression analysis.

Apical root resorption comparison between Fränkel and eruption guidance appliances

The objectives of this study were to compare the amounts of apical root resorption that occur after treatment with 2 removable appliances-the Fränkel function regulator and the eruption guidance appliance (EGA)-in an untreated control group, and to determine the prevalence of root resorption in the maxillary and mandibular incisors and the dental arches. After treatment, periapical radiographs were obtained of the maxillary and mandibular incisors with the long-cone paralleling technique from 72 patients divided into 3 groups. Group 1 included 24 patients treated with the Fränkel appliance, group 2 consisted of 24 patients treated with the EGA, and group 3 comprised 24 untreated subjects. Some patients in groups 1 and 2 were also treated with fixed appliances. Subgroups of patients who had used exclusively 1 functional appliance were also formed and evaluated. Root resorption was scored according to the method of Levander and Malmgren. Results of the Kruskal-Wallis tests showed significantly greater resorption in the Fränkel group, the EGA group, and the EGA subgroup in relation to the control group. However, there were no statistically significant differences between the Fränkel and the EGA groups and the subgroups. The amounts of resorption were predominantly small and similar in the experimental groups and the subgroups. The prevalence of resorption for the incisors was greatest for the maxillary central, followed by the maxillary lateral, mandibular central, and mandibular lateral. It was concluded that the Fränkel group, the EGA group, and the EGA subgroup had significantly greater resorption than the control group. There was no difference in the amount of resorption between the Fränkel and the EGA groups.

Treatment stability with the eruption guidance appliance

Although the eruption guidance appliance has been used to correct Class II malocclusions for many years and its effects have been demonstrated, there is no study on the stability of the changes it produces. Therefore, the objective of this study was to investigate the long-term stability of cephalometric dentoskeletal and occlusal changes after eruption guidance appliance therapy. Thirty-nine patients were evaluated. Occlusal evaluations were made with the peer asseessment rating index, and anterior tooth irregularity was evaluated with the Little irregularity index. Cephalometric and occlusal data were obtained at pretreatment, posttreatment, and postretention. The data were analyzed by dependent 1-way analysis of variance (ANOVA) for comparison between the 3 stages of the experimental group, with the Newman-Keuls test as a second step. To compare the cephalometric experimental group changes with mean population changes, the t test was used. Cephalometrically, in the postretention stage, overjet remained stable, overbite showed significant relapse, and molar relationship improved toward a Class I relationship. The peer asseessment rating index showed stability of the occlusion. The Little irregularity index demonstrated a statistically significant relapse of crowding in the postretention stage. Cephalometrically, overjet and molar relationship were stable in the long term after treatment with the eruption guidance appliance; however, there was relapse of the overbite. Occlusally, correction of the malocclusion elevated by the peer assessment rating was stable. There was relapse of the anterior teeth crowding.

Eruption guidance appliance effects

Eruption guidance appliance effects

Eruption guidance appliance effects in the treatment of Class II, Division 1 malocclusions

The objective of this research was to cephalometrically evaluate the possible effects of the Eruption Guidance Appliance on the craniofacial complex in a sample of 30 patients, over a treatment period of 26 months. The experimental sample consisted of 30 patients (13 females and 17 males), 27 of which presented with a Class II, Division 1 malocclusion and 3 with a Class I malocclusion. The mean initial chronologic age was 9 years; the treatment period lasted 26 months. A control group was used for comparison and consisted of 30 subjects (13 females and 17 males) of similar ages and spanned a similar observation period. Twenty-six subjects of this control group had Class II, Division 1 malocclusions, and 4 had Class I malocclusions. Lateral cephalometric headplates were obtained for the experimental group initially and after 26 months of treatment. The subjects in the control group were randomly selected from a serial growth study sample from the Orthodontic Department at Bauru Dental School, University of São Paulo, for whom cephalometric headplates were obtained annually from 4 to 18 years of age. Comparative statistics were used to assess possible differences between the experimental and control groups during the 26-month period of observation. Results demonstrated statistically significant increases in mandibular growth, degree of mandibular protrusion, lower anterior and total anterior face height, mesial migration of the lower molars, and mandibular posterior dentoalveolar height. There was also lingual tipping and retrusion of the upper incisors, linear protrusion of the lower incisors, improvement in the maxillomandibular relationship and in molar relationship, as well as a significant decrease in the overjet and overbite and an inhibition of the vertical development of the upper incisors. The study demonstrated no significant changes in maxillary growth during the evaluation period. It was concluded from these results that the effects of the Eruption Guidance Appliance during this time period were mostly dentoalveolar, with a smaller, but significant, skeletal effect. (Am J Orthod Dentofacial Orthop 2000;117:119-29)

A simple appliance for controlling mandibular movement following segmental resection

The loss ofcontinuity of the mandible after resection ofa tumor leads to altered mandibular movement, disfigurement, and deviation of the residual fragment toward the affected side.? There are a number of methods that will reduce mandibular deviation, including maxillomand ibular fixation and the use of mandibularbased or palatally-based guidance appliances. These guide appliances are usually constructed ofacrylic resin with cast metal flanges. They are often difficult and time consuming to make, and may be uncomfortable to wear. Inthis report, a simple , quickly produced, training appliance is described that is based on the commonly used bite appliance.

Use of a two-piece Gunning splint as a mandibular guide appliance for a patient treated for ameloblastoma

Prosthodontic restoration in edentulous patients who have undergone hemisection of the mandible is difficult because of the instability of the mandible after resection and the lack of teeth necessary for successful retention of a guidance appliance. Successful prosthodontic restoration was accomplished through the use of a two-piece Gunning splint both for intermaxillary fixation and as a guidance appliance in an edentulous patient who underwent a hemisection of the mandible subsequent to treatment for an ameloblastoma. Because mandibular guidance therapy is most successful in patients whose resection involves only bony structures with minimal loss of soft tissue and no radical neck dissection or radiation therapy, the patient treated for ameloblastoma is an ideal candidate for the use of a two-piece Gunning splint for intermaxillary fixation and mandibular guidance therapy.