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BMC Oral Health Apr 2024Temporomandibular disorder (TMD) is a grouping of heterogeneous disorders with multifactorial origins. Stabilization splints (SS) have demonstrated an acceptable...
BACKGROUND
Temporomandibular disorder (TMD) is a grouping of heterogeneous disorders with multifactorial origins. Stabilization splints (SS) have demonstrated an acceptable treatment effect in TMD. The possible changes at the skeletal, dental, and soft tissue levels need to be addressed to evaluate the benefit/risk ratio of this therapeutic procedure. Accordingly, this study aimed to three‑dimensionally evaluate skeletal, dentoalveolar and soft tissue changes after SS treatment for patients with TMD.
METHODS
This retrospective study included 74 adult patients with myofascial and/or intra-articular disorders (25 males and 49 females), with an average age of 22.88 ± 4.8 years, who underwent SS treatment. Pre- and post-treatment Cone beam computed tomography were analysed using Invivo 6.0.3 software. The primary outcome was the vertical skeletal and dentoalveolar changes, while the secondary outcomes were the anteroposterior skeletal, dentoalveolar and soft tissue changes. Paired t-test and Wilcoxon rank sum test were used for statistical analyses.
RESULTS
For the primary outcome; skeletally, there was a significant increase in mandibular plane inclination (difference: 0.82°±1.37), decrease facial height ratio (difference: 0.45%±1.07) and at the dentoalveolar level, the inclination of the functional (FOP-SN, FOP-FH) and bisecting (BOP-SN, BOP-FH) occlusal planes exhibited a significant increase too (difference: 0.38 ± 1.43°, 0.49 ± 1.62°, 0.44 ± 1.29° and 0.41 ± 1.17°, respectively) and also a decrease in the overbite (difference: -0.54 ± 0.83). For the secondary outcomes; there was a significant decrease in mandibular position (SNB) (difference: 1.60 ± 1.36°) and increase in the overjet (difference: 0.93 ± 1.04, p < 0.001) and a significant lower lip retrusion (difference: 0.33 ± 1.01 mm p < 0.01), was observed too.
CONCLUSIONS
SS therapy resulted in significant vertical skeletal and dentoalveolar changes that were manifested mainly by facial height ratio, mandibular and occlusal plane changes, and to a lesser extent, significant anteroposterior skeletal, dentoalveolar, and soft tissue changes in the form of mandibular position, increased overjet and a more retrusive lower lip. These changes should be considered during patients' selection prior to initiating SS therapy.
Topics: Male; Adult; Female; Humans; Adolescent; Young Adult; Maxilla; Retrospective Studies; Splints; Cephalometry; Mandible; Overbite; Malocclusion, Angle Class II; Temporomandibular Joint Disorders; Temporomandibular Joint
PubMed: 38643111
DOI: 10.1186/s12903-024-04260-3 -
The Angle Orthodontist May 2024To evaluate the dentoskeletal effects and effectiveness of the eruption guidance appliance in Class III patients in the mixed dentition.
OBJECTIVES
To evaluate the dentoskeletal effects and effectiveness of the eruption guidance appliance in Class III patients in the mixed dentition.
MATERIALS AND METHODS
The experimental group comprised 22 patients with Class III malocclusion and anterior cross-bite (12 males, 10 females, mean age 7.63 ± 0.96 years) treated with the eruption guidance appliance over a mean period of 1.72 ± 0.48 years. The control group comprised 22 untreated subjects (12 males, 10 females, mean age 7.21 ± 0.60 years) with Class III malocclusion. Lateral cephalometric radiographs were obtained at pretreatment (T1) and posttreatment (T2). Intergroup comparisons were performed with Mann-Whitney and t-tests (P < .05).
RESULTS
In the experimental and control groups, the anteroposterior relationship between the maxilla and mandible (ANB angle) remained stable during the treatment period (T1 to T2). The mandibular plane angle decreased in the experimental group and increased in the control group. In the experimental group, the lower anterior face height increase and maxillary molar vertical development were significantly smaller compared to controls. Positive overjet was achieved in 54% of the experimental group.
CONCLUSIONS
The eruption guidance appliance produced no change in the skeletal anteroposterior relationship. The anterior cross-bite/edge-to-edge relationship was corrected in only about half of the treated subjects.
Topics: Male; Female; Humans; Child; Malocclusion, Angle Class III; Malocclusion; Mandible; Overbite; Maxilla; Cephalometry; Malocclusion, Angle Class II
PubMed: 38639459
DOI: 10.2319/071223-488 -
Case Reports in Dentistry 2024A 26-year-old woman had a masticatory dysfunction, straight profile, retrognathic maxilla and mandible, and Angle's class I with a tendency to class III malocclusion on...
A 26-year-old woman had a masticatory dysfunction, straight profile, retrognathic maxilla and mandible, and Angle's class I with a tendency to class III malocclusion on both sides, with bilateral posterior crossbites and a 4 mm anterior open bite. Orthognathic surgery and orthodontic camouflage with and without tooth extraction were considered as treatment options. The patient's preferred method of treatment was orthodontic camouflage without extraction. The transpalatal arch had been placed for the bilateral molars' derotation. After 3 months, the upper segmented fixed appliance was implanted to address the posterior crossbites in the premolar's region. One mini-implant was inserted into the anterior palatum after the transpalatal arch was removed, and a supporting device was attached to the first permanent molars to give indirect skeletal stability. Orthodontic treatment's active phase lasted 23 months, and all treatment objectives were achieved during that time: the desired facial profile, adequate occlusion, appropriate overbite, and overjet.
PubMed: 38623492
DOI: 10.1155/2024/7768109 -
Journal of Dental Sciences Apr 2024This scoping review investigated the evidence on the three-dimensional analysis of a posed smile in adults to discover any research gaps in this research area.... (Review)
Review
This scoping review investigated the evidence on the three-dimensional analysis of a posed smile in adults to discover any research gaps in this research area. Electronic searches of articles written in English were performed using the four databases of Embase, PubMed, Springer, and Web of Science with publications from 2010 to 2023. Reference lists were also manually searched to identify additional studies. The results showed that 13 cross-sectional descriptive studies from Asia, Europe, North and South America met our inclusion criteria. Studies mainly focused on linear and angle measurement for resting and smiling faces and landmark movement from resting to smiling. Most studies conducted analysis of smiles stratified by sex, ethnicity, smile type, dental occlusion, skeletal pattern, and age. Two studies compared smiling with the resting position and one study compared the attractive smiling group with the ordinary group. Our scoping review revealed the insufficiency of some measurement methods, such as those employing area, volume, and soft tissue thickness. Furthermore, few studies were conducted in Asian populations, and comparisons of various smile types, overjet types, horizontal skeletal patterns, and comparisons of smiles between people with untreated normal occlusion and those who had been orthodontically treated were lacking.
PubMed: 38618097
DOI: 10.1016/j.jds.2023.10.021 -
Journal of the Indian Society of... Jan 2024Nutritive sucking and nonnutritive sucking (NNS) may affect the craniofacial development, differently.
BACKGROUND
Nutritive sucking and nonnutritive sucking (NNS) may affect the craniofacial development, differently.
AIM AND OBJECTIVES
We investigated associations between NNS habits (NNSHs), developing malocclusion, and various feeding practices in 3-6-year-old children.
METHODOLOGY
A sample of 350 children 3-6-year-old from various preschools were selected for this case-control study (94 with NNSH and 256 without NNSH). NNSH (outcome) and feeding practices and developing malocclusions (exposures) were assessed using a structured study tool.
RESULTS
The prevalence of NNSH in 3-6-year-old children was 26.8%. The odds (95% [confidence interval (CI)]) of boys compared to girls having NNSH were 0.66 (0.4121-1.706) (P = 0.0290). The overall prevalence of developing malocclusion in 3-6-year-old children was 34.01% out of which open bite was most commonly reported with 12.57% followed by spacing 8.5%, increased overjet 6.8%, crowding 2.2%, posterior crossbite and rotation 1.4%, and overbite 1.14%. Breastfeeding was found to be the most commonly used mode of feeding reported by 53.42% of mothers. It was found that the odds (95% [CI]) of subjects having NNSH were 0.66 (0.4694-0.9460) (P < 0.0001) who were not breastfed as compared to those who were breastfed. Among developing malocclusions, increased overjet with P = 0.0019, open bite with P = 0.0416, and spacing with P = 0.0243 were found to be associated with feeding practices.
CONCLUSION
The prevalence of NNSH and developing malocclusions (increased overjet, open bite, and spacing) was 26.8% and 34.01%, respectively. Breastfeeding played a protective role against developing NNSH.
Topics: Male; Child; Female; Child, Preschool; Humans; Open Bite; Case-Control Studies; Urban Population; Malocclusion; Habits
PubMed: 38616426
DOI: 10.4103/jisppd.jisppd_559_23 -
International Journal of Surgery Case... May 2024Maxillary anterior teeth that have not erupted may substantially alter the appearance of the teeth and face. Orthodontists often encounter a clinical challenge while...
INTRODUCTION
Maxillary anterior teeth that have not erupted may substantially alter the appearance of the teeth and face. Orthodontists often encounter a clinical challenge while dealing with an impacted maxillary incisor, which creates space problems in the anterior region. The purpose of this paper is to describe the well-synchronized orthodontic and surgical treatment of a horizontally impacted maxillary central incisors.
CASE PRESENTATION
A male patient, aged 27, presented with a complaint of unerupted two maxillary front teeth. This resulted in the displacement of adjacent teeth into the vacant region. An intraoral examination revealed a Class II molars on both sides, a deep curve of the space with a 2.3 mm overjet, and an edge-to-edge bite of 0.1 mm. The 3D cone beam computed tomography (CBCT) imaging unveiled a labial impacted and a rotation of approximately 90 degrees (horizontal impacted) on both central maxillary incisors.
DISCUSSION
The self-ligating bracket was installed and orthodontic traction aligned the affected tooth in the dental arch. To reach the labial surface of the impacted incisor, open surgical exposure by window excision of soft tissues with a laser was preferable due to the large bulge in the sulcus. Because self-ligating bracket systems employed modest pressures to position the maxillary right central incisor in the arch, the window surgical technique did not produce gingival scarring or increased clinical crown length.
CONCLUSION
The impacted upper central incisor was successfully treated using a collaborative interdisciplinary (surgical-orthodontic) approach, which resulted in a favorable aesthetic and functional outcome.
PubMed: 38615467
DOI: 10.1016/j.ijscr.2024.109620 -
The Cochrane Database of Systematic... Apr 2024Prominent lower front teeth (Class III malocclusion) may be due to jaw or tooth position or both. The upper jaw (maxilla) can be too far back or the lower jaw (mandible)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prominent lower front teeth (Class III malocclusion) may be due to jaw or tooth position or both. The upper jaw (maxilla) can be too far back or the lower jaw (mandible) too far forward; the upper front teeth (incisors) may be tipped back or the lower front teeth tipped forwards. Orthodontic treatment uses different types of braces (appliances) fitted inside or outside the mouth (or both) and fixed to the teeth. A facemask is the most commonly reported non-surgical intervention used to correct Class III malocclusion. The facemask rests on the forehead and chin, and is connected to the upper teeth via an expansion appliance (known as 'rapid maxillary expansion' (RME)). Using elastic bands placed by the wearer, a force is applied to the top teeth and jaw to pull them forwards and downward. Some orthodontic interventions involve a surgical component; these go through the gum into the bone (e.g. miniplates). In severe cases, or if orthodontic treatment is unsuccessful, people may need jaw (orthognathic) surgery as adults. This review updates one published in 2013.
OBJECTIVES
To assess the effects of orthodontic treatment for prominent lower front teeth in children and adolescents.
SEARCH METHODS
An information specialist searched four bibliographic databases and two trial registries up to 16 January 2023. Review authors screened reference lists.
SELECTION CRITERIA
We looked for randomised controlled trials (RCTs) involving children and adolescents (16 years of age or under) randomised to receive orthodontic treatment to correct prominent lower front teeth (Class III malocclusion), or no (or delayed) treatment.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. Our primary outcome was overjet (i.e. prominence of the lower front teeth); our secondary outcomes included ANB (A point, nasion, B point) angle (which measures the relative position of the maxilla to the mandible).
MAIN RESULTS
We identified 29 RCTs that randomised 1169 children (1102 analysed). The children were five to 13 years old at the start of treatment. Most studies measured outcomes directly after treatment; only one study provided long-term follow-up. All studies were at high risk of bias as participant and personnel blinding was not possible. Non-surgical orthodontic treatment versus untreated control We found moderate-certainty evidence that non-surgical orthodontic treatments provided a substantial improvement in overjet (mean difference (MD) 5.03 mm, 95% confidence interval (CI) 3.81 to 6.25; 4 studies, 184 participants) and ANB (MD 3.05°, 95% CI 2.40 to 3.71; 8 studies, 345 participants), compared to an untreated control group, when measured immediately after treatment. There was high heterogeneity in the analyses, but the effects were consistently in favour of the orthodontic treatment groups rather than the untreated control groups (studies tested facemask (with or without RME), chin cup, orthodontic removable traction appliance, tandem traction bow appliance, reverse Twin Block with lip pads and RME, Reverse Forsus and mandibular headgear). Longer-term outcomes were measured in only one study, which evaluated facemask. It presented low-certainty evidence that improvements in overjet and ANB were smaller at 3-year follow-up than just after treatment (overjet MD 2.5 mm, 95% CI 1.21 to 3.79; ANB MD 1.4°, 95% CI 0.43 to 2.37; 63 participants), and were not found at 6-year follow-up (overjet MD 1.30 mm, 95% CI -0.16 to 2.76; ANB MD 0.7°, 95% CI -0.74 to 2.14; 65 participants). In the same study, at the 6-year follow-up, clinicians made an assessment of whether surgical correction of participants' jaw position was likely to be needed in the future. A perceived need for surgical correction was observed more often in participants who had not received facemask treatment (odds ratio (OR) 3.34, 95% CI 1.21 to 9.24; 65 participants; low-certainty evidence). Surgical orthodontic treatment versus untreated control One study of 30 participants evaluated surgical miniplates, with facemask or Class III elastics, against no treatment, and found a substantial improvement in overjet (MD 7.96 mm, 95% CI 6.99 to 8.40) and ANB (MD 5.20°, 95% CI 4.48 to 5.92; 30 participants). However, the evidence was of low certainty, and there was no follow-up beyond the end of treatment. Facemask versus another non-surgical orthodontic treatment Eight studies compared facemask or modified facemask (with or without RME) to another non-surgical orthodontic treatment. Meta-analysis did not suggest that other treatments were superior; however, there was high heterogeneity, with mixed, uncertain findings (very low-certainty evidence). Facemask versus surgically-anchored appliance There may be no advantage of adding surgical anchorage to facemasks for ANB (MD -0.35, 95% CI -0.78 to 0.07; 4 studies, 143 participants; low-certainty evidence). The evidence for overjet was of very low certainty (MD -0.40 mm, 95% CI -1.30 to 0.50; 1 study, 43 participants). Facemask variations Adding RME to facemask treatment may have no additional benefit for ANB (MD -0.15°, 95% CI -0.94 to 0.64; 2 studies, 60 participants; low-certainty evidence). The evidence for overjet was of low certainty (MD 1.86 mm, 95% CI 0.39 to 3.33; 1 study, 31 participants). There may be no benefit in terms of effect on ANB of alternating rapid maxillary expansion and constriction compared to using expansion alone (MD -0.46°, 95% CI -1.03 to 0.10; 4 studies, 131 participants; low-certainty evidence).
AUTHORS' CONCLUSIONS
Moderate-certainty evidence showed that non-surgical orthodontic treatments (which included facemask, reverse Twin Block, orthodontic removable traction appliance, chin cup, tandem traction bow appliance and mandibular headgear) improved the bite and jaw relationship immediately post-treatment. Low-certainty evidence showed surgical orthodontic treatments were also effective. One study measured longer-term outcomes and found that the benefit from facemask was reduced three years after treatment, and appeared to be lost by six years. However, participants receiving facemask treatment were judged by clinicians to be less likely to need jaw surgery in adulthood. We have low confidence in these findings and more studies are required to reach reliable conclusions. Orthodontic treatment for Class III malocclusion can be invasive, expensive and time-consuming, so future trials should include measurement of adverse effects and patient satisfaction, and should last long enough to evaluate whether orthodontic treatment in childhood avoids the need for jaw surgery in adulthood.
Topics: Adolescent; Child; Humans; Child, Preschool; Orthodontics, Corrective; Orthodontic Appliances; Malocclusion, Angle Class III; Dental Care; Mouth
PubMed: 38597341
DOI: 10.1002/14651858.CD003451.pub3 -
Journal of Pharmacy & Bioallied Sciences Feb 2024The mixed dentition stage in children is a critical period for orthodontic assessment and intervention. This study investigates the effects of interceptive orthodontics...
BACKGROUND
The mixed dentition stage in children is a critical period for orthodontic assessment and intervention. This study investigates the effects of interceptive orthodontics on dental and skeletal development in children with mixed dentition, aiming to evaluate the potential benefits of early orthodontic treatment.
MATERIALS AND METHODS
A retrospective analysis was conducted on a cohort of 150 children with mixed dentition (aged 7-11 years), who received interceptive orthodontic treatment. Dental and skeletal records, including cephalometric radiographs and dental cast models, were collected before and after treatment. A control group of 150 untreated children with mixed dentition was also assessed for comparison. Various dental and skeletal parameters, such as dental alignment, overjet (OJ), overbite (OB), and cephalometric measurements, were recorded and analyzed.
RESULTS
The results of this study indicate significant improvements in dental alignment and occlusion in the group of children who received interceptive orthodontic treatment. The average reduction in OJ was 3.5 mm, and the OB correction averaged 2.1 mm. Cephalometric analysis showed positive changes in skeletal relationships, with a mean reduction in the angle formed by point A, nasion (N) and point B. (ANB) angle of 2.8 degrees. These improvements were statistically significant compared to the control group ( < 0.05).
CONCLUSION
Early orthodontic intervention, such as interceptive orthodontics, has a positive impact on dental and skeletal development in children with mixed dentition.
PubMed: 38595457
DOI: 10.4103/jpbs.jpbs_1035_23 -
Journal of Pharmacy & Bioallied Sciences Feb 2024Class II malocclusions are a common dental issue characterized by the misalignment of the upper and lower teeth. Early orthodontic treatment is often considered to...
BACKGROUND
Class II malocclusions are a common dental issue characterized by the misalignment of the upper and lower teeth. Early orthodontic treatment is often considered to correct these malocclusions, but its long-term effectiveness remains unclear.
MATERIALS AND METHODS
In this study, we examined the impact of early orthodontic treatment on the long-term stability of Class II malocclusions. We conducted a retrospective analysis of dental records from a sample of 150 patients who had received early orthodontic treatment for Class II malocclusions. The treatment involved braces and other orthodontic appliances. We compared their dental measurements before and after treatment, with a follow-up period of 5 years.
RESULTS
Our analysis revealed that the early orthodontic treatment led to a significant improvement in the alignment of upper and lower teeth, as indicated by a reduction in the overjet (the horizontal distance between upper and lower incisors). The mean overjet reduction was 3.2 millimeters. Furthermore, the Angle's Class II molar relationship was corrected in 80% of the cases.
CONCLUSION
Early orthodontic treatment for Class II malocclusions demonstrated positive long-term stability, as evidenced by a reduction in overjet and improvement in molar relationships.
PubMed: 38595420
DOI: 10.4103/jpbs.jpbs_863_23 -
Journal of Pharmacy & Bioallied Sciences Feb 2024Orthognathic surgery is a surgical procedure performed to correct severe jaw misalignments that can affect a patient's facial aesthetics and functional occlusion. While...
BACKGROUND
Orthognathic surgery is a surgical procedure performed to correct severe jaw misalignments that can affect a patient's facial aesthetics and functional occlusion. While the primary goal of orthognathic surgery is to improve functional outcomes and facial appearance, it is essential to assess patient satisfaction as a crucial aspect of overall treatment success.
MATERIALS AND METHODS
Patient selection: We conducted a prospective study involving 50 patients who underwent orthognathic surgery. All patients had a confirmed diagnosis of severe jaw misalignment, as determined by clinical and radiographic assessments. The surgical procedures performed included maxillary advancement, mandibular setback, or a combination of both, depending on the patient's specific diagnosis. Preoperative orthodontic treatment was provided to align the teeth and prepare the patient for surgery. Patients were evaluated preoperatively and at postoperative intervals of 3 months, 6 months, and 1 year.
RESULTS
Patient satisfaction scores and functional outcomes were as follows: aesthetics of facial profile (1-year post-op): mean score = 4.6, chewing function (1-year post-op): mean score = 4.4, speech function (1-year post-op): mean score = 4.3, and overall satisfaction with surgical outcome (1-year post-op): mean score = 4.5. Objective assessments revealed a significant improvement in occlusion and facial aesthetics. The mean reduction in overjet was 4.8 mm, and the mean reduction in overbite was 3.2 mm. Additionally, the mean postoperative ANB angle improved by 3.7°, indicating a better facial balance.
CONCLUSION
Orthognathic surgery in our cohort of 50 patients resulted in high levels of patient satisfaction with both functional outcomes and facial aesthetics. Objective measurements also indicated significant improvements in occlusion and facial balance.
PubMed: 38595408
DOI: 10.4103/jpbs.jpbs_864_23