Epidemiology and aetiology of malocclusion among Syrian paediatric patients.

AIM: The knowledge of the distribution and causes of malocclusion in early childhood can prevent such malocclusions and their consequences and possibly to reduce complex orthodontic treatment. METHODS: All children (n = 234; 116 male, 118 female, age 2-16) who presented with occlusal or functional problems at the Department of Paediatric Dentistry at Damascus University (1995-1999) were classified according to the type and causes of malocclusion and the subsequent orthodontic treatment. RESULTS: 57.3% of the malocclusions affected the anterior-posterior plane, 12.4% the vertical, and 35.9% the transverse. Most of the malocclusions had causes which could be modified by preventive or interceptive efforts: thumb sucking (5.12%), infantile swallowing (3.84%), mouth breathing (0.85%), tongue thrusting (1.7%), delayed exfoliation of a primary tooth (3.41%), premature loss of a primary tooth (9.82%), delayed eruption of a permanent tooth (2.13%), or an impacted tooth (6.41%). The subsequent early orthodontic treatment consisted of space maintainers (26%), removable (40.9%), functional (11.9%), or fixed appliances (21.2%). CONCLUSION: These data stress the importance of early orthodontic diagnosis in paediatric practice. Malocclusion in this Syrian sample could be treated to a great extent with preventive or interceptive orthodontics, which required only simple appliances and techniques.     

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.     

牙弓/牙槽骨弓的塑形矫治——基于牙弓形态发育不良的儿童错牙合畸形诊断与阻断治疗

错畸形是颅面颌系统生长发育的异常,其产生是遗传、环境及特殊病因共同作用的结果。儿童错畸形的早期矫治是去除造成错畸形的病因,维持、恢复及矫正异常发育的颅面颌结构,矫正咬合关系异常;其主要目的就是要利用个体生长潜力,用较小的代价达到有效的稳定的矫治效果。错畸形早期矫治的范围很宽,包括口腔功能的早期矫治（口腔不良习惯早期矫治）、口周肌肉功能训练、牙替换的维护、牙发育不良的矫治、上下颌骨关系异常的矫治等等。从正畸学角度上看,牙错位的矫正称为“正牙”（orthodontics）,上下颌骨发育关系异常的矫治称为“矫形”（orthopedics）;而在牙弓/牙槽骨弓形态大小异常上的矫治,临床仍有进一步梳理和发展的空间。四川大学华西口腔医院儿童与口腔正畸科·儿童早期矫治专科在大量的临床实践中,总结了牙弓/牙槽骨弓发育的特点与规律,探索早期矫治异常牙弓发育的正畸临床思路与技术,在国内首次提出“牙弓/牙槽骨弓发育不良的塑形矫治”理论。把牙弓/牙槽骨弓发育不良的早期阻断矫治定义为“塑形”（remodeling）,丰富除“正牙”与“矫形”等正畸治疗理论与技术外的错治疗方法,并用于指导错畸形早期矫治的临床工作,以期达到早期预防、阻断错畸形的发生发展,简化错复杂程度、降低错治疗难度的效果。本文从临床矫治的基础及儿童生长发育的角度,全面归纳分析“牙弓/牙槽骨弓发育不良的塑形矫治”的理论基础和临床思路,阐述该理论的可能性及必要性,希望借此促进儿童错畸形的早期预防与阻断矫治的理论与技术的发展。     

Early orthodontic treatment?

Today orthodontists in the United States tend to treat much earlier. During an early treatment phase, removable appliances are used to correct the gross malocclusion. After a subsequent retention-observation phase the remaining orthodontic anomalies are corrected using fixed appliances. In this review article the advantages and disadvantages of early orthodontic treatment are evaluated.     

Relationship of malocclusion severity and treatment fee to consumer's expectation of treatment outcome.

Understanding consumer expectations is important if orthodontists are to be successful in marketing their elective services. The purpose of this study was to examine the relationship between consumer outcome expectations and treatment variables, including cost of treatment and malocclusion severity. The subjects were parents of patients recruited from 9 private orthodontic practices in southwestern Pennsylvania who were entering a single comprehensive phase of orthodontic treatment, characterized by a full fee and complete fixed appliances. The parents completed a questionnaire regarding outcome expectations for their child's orthodontic treatment. Pretreatment orthodontic study models of each child were evaluated with the peer assessment rating. The results of this study suggest that orthodontic consumers have very high outcome expectations. Also, the parents of patients with severe overall malocclusions, overjet, or midline deviations have expectations that exceed probable treatment outcomes. Orthodontists should consider that consumers seeking their services have increased expectations not related to the treatment outcomes.     

Treatment of adults with lingual orthodontic appliances

With the advent of lingual orthodontic treatment, an alternative became available to the adult patient who preferred to avoid the unesthetic appearance of conventional orthodontic appliances. The newer brackets and archwires described in this article, in combination with the proven technique developed by the author and others, has made lingual orthodontic treatment a practical reality. The appliance has been shown to be as effective as labial counterparts in correcting all types of malocclusions. New laboratory and indirect bonding techniques have eliminated the need for intricate wire bending and have reduced patient chair time and overall treatment time. Because of the premature introduction of early lingual appliances, many dental practitioners mistakenly believe that lingual treatment is less effective than labial treatment. As more examples of successful treatment are seen, dental practitioners will be more apt to refer patients to orthodontists proficient in this technique. Many graduate orthodontic programs now are teaching this technique to their residents. About 3000 patients currently are starting treatment with lingual appliances each year. This represents only about 1 per cent of adult patients. It is projected that this slowly will climb to about 10 per cent of adult orthodontic treatment over the next 5 years. The increased cost of this treatment, coupled with the resistance on the part of many orthodontists to learn the new technique, seem to be the limiting factors.     

Orthodontics in general practice. 4. Eruption guidance appliances in orthodontics

Eruption guidance appliances are recommended for early orthodontic treatment or prevention of malocclusions. The treatment effect of eruption guidance appliances and functional appliances is similar. In addition to dentoalveolar and skeletal effects, eruption guidance appliances would also have myofunctional effects for treating open mouth behaviour and swallowing problems. However, there is no solid evidence for the myofunctional effect claimed. The position of erution guidance appliances in the orthodontic treatment arsenal is limited: early treatment of Angle Class II malocclusion in 2 phases has no advantage over a 2 phase treatment. When eruption guidance is needed, preference is given to an individually produced appliance.     

Attitudes and satisfaction with dental appearance in young adults with and without malocclusion

The aim of the study was to assess the quality of a Public Dental Service (PDS) system in Sweden with regard to the orthodontic care and to investigate the selection made for the consultation by the general practitioners (GPs) and by orthodontists of those patients with malocclusion. In the individuals leaving the PDS system, the residual need and demand for treatment due to malocclusions and satisfaction with and opinion of their teeth was assessed in orthodontically treated and untreated 19-year-olds. Altogether 121 19-year-olds were clinically investigated with respect to six defined malocclusion traits and given a questionnaire. The following results were found: Ten per cent of the 19-year-olds that had not had an orthodontic consultation showed a residual treatment need. One third of the individuals judged by the orthodontist not to need treatment and one third that had been treated by the GP showed a marked orthodontic treatment need at the age of 19 years. Twenty-two per cent of all 19-year-olds left the PDS with an orthodontic treatment need. Ninety-four per cent were satisfied with their teeth irrespective of malocclusion or not. Every second individual considered their teeth important for their self-esteem. It was concluded that 19-year-olds in general were satisfied with their dental appearance. Half of the registered residual need and demand for orthodontic treatment was not related to measurable malocclusions.     

Consistency of orthodontic treatment decisions relative to diagnostic records

The purpose of this study was to evaluate how incremental information obtained from different types of diagnostic records contributes to the determination of orthodontic treatment decisions. Pretreatment records of 57 orthodontic patients were assessed by five orthodontists who were part-time faculty members and also in private practice. This sample consisted of dental school orthodontic patients who had Class II malocclusions and included patients at three different dental developmental stages. The following diagnostic records were used: study models (S), facial photographs (F), a panoramic radiograph (P), a lateral cephalogram (C), and its tracing (T). Five combinations of diagnostic records were presented to the orthodontists in the following sequence: (1) S; (2) S + F; (3) S + F + P; (4) S + F + P + C; and (5) S + F + P + C + T. The simultaneous interpretation of all diagnostic records (S + F + P + C + T) was used as the "diagnostic standard." There was a diagnostic standard for each of the patients and for each of the orthodontists. The diagnostic standard was achieved: (1) S = 54.9%, (2) S + F = 54.2%, (3) S + F + P = 60.9%, and (4) S + F + P + C = 59.9%. Thus, in a majority of cases (55%), study models alone provided adequate information for treatment planning, and incremental addition of information from other types of diagnostic records made small differences.     

Prevention and treatment after age 10 with the edgewise technique

The success of therapy for Class II malocclusions depends on the choice orthodontists make on when to intervene. Usually they begin a two-stage treatment, first orthopedic, then orthodontic, in the mixed dentition. If they want to their non-extraction therapy to coincide with and benefit from growth, they need to diagnose the malocclusion as early as possible. Treatment of Class II malocclusions works best when it is undertaken before the second molars erupt. By correcting the malrelationship between the jaws with an orthopedic appliance, they facilitate the second, full-banded stage of treatment.     

Orthodontic correction of a class III malocclusion in an adolescent patient with a bonded RPE and protraction face mask.

A case report of a 14-year-old Hispanic male with a Class-III skeletal profile and dental malocclusion with a long mandibular body and ramus and retrusive maxilla. The patient was initially referred for a surgical evaluation for a LeFort I maxillary advancement, but he wanted to avoid surgery. The Class-III malocclusion was corrected with a bonded rapid palatal expander and a maxillary protraction mask followed by nonextraction orthodontic treatment. A Class-I molar and canine relationship was achieved, and the facial profile improved. This case report demonstrates the orthodontic correction of a Class-III malocclusion in an adolescent patient with a bonded rapid palatal expander and protraction face mask. This case was presented to American Board of Orthodontics as partial fulfillment of the requirements for the certification process conducted by the Board.     

儿童早期矫治与咬合管理

儿童生长发育期的咬合管理是儿童口腔健康管理的重要组成部分,对儿童口腔临床工作具有重要的指导作用。咬合管理中的早期矫治,也一直是口腔医学关注和研究的热点。早期矫治通过预防、诱导和矫治等手段,引导颅颌面各时期的正常发育,阻断错牙合畸形的发生发展,最终降低儿童错牙合畸形的发生率与严重程度,促进儿童身心健康发展。结合儿童口腔发育特点、儿童错牙合畸形成因以及早期预防矫治方法,文章对儿童早期矫治与咬合管理进行探讨,希望进一步完善咬合管理的临床技术体系与理论基础,促进儿童口腔医学的发展。     

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??Occlusion managment during child growth and development is an important part of the oral healthy management in children??which plays a vital instructive role in the childhood clinical dentistry. Early orthodontic treatment in the occlusion management has always been the focus of attention and research. By prevention?? induction and correction??early orthodontic treatment guide normal development of craniofacial and block the deterioration of malocclusion??which results in reducing the occurrence and severity of malocclusions. It is also beneficial to promoting the physical and mental health of children. Based on the childhood development features??the causes of malocclusion and early prevention and orthodontic treatment methods??this paper explores the early orthodontic treatment and occlusion management in order to further improve the clinical technique system in the occlusion management and promote the advancement of pediatric stomatology.     

Indication for and Frequency of Early Orthodontic Therapy or Interceptive Measures

The early treatment of nonskeletal and skeletal orthodontic anomalies in the deciduous and early mixed dentition is intended to prevent the development of pronounced anomalies in the late mixed and permanent dentition with the ultimate aim of reducing or even eliminating the need for later orthodontic treatment. There is a general consensus in the international literature that early therapy is indicated in cases of anterior and lateral crossbite and Class III malocclusion, and possibly for extreme forms of mandibular retrognathism (overjet > or =10 mm) and of open bite. However, evidence of the efficiency of early orthodontic measures is just as rare as studies providing serviceable information on the incidence of tooth malalignments and malocclusions in the deciduous and early mixed dentition, some of whose findings are in any case highly divergent. This makes it substantially more difficult to draw conclusions on the extent to which early orthodontic therapy may be indicated. In order to obtain information on the incidence of nonskeletal and skeletal orthodontic problems constituting a treatment need, 2326 first-year schoolchildren aged between 6 and 7 years were examined in Frankfurt am Main and in the Rural District of Offenbach. In only 14.7% of the children were no relevant orthodontic findings recorded. 77.2% displayed mild to severe dysgnathic symptoms, though without early orthodontic therapy being considered indicated. Treatment with orthodontic appliances was considered urgent for 187 of the children (8.04%). With 8.3% and 7.9% respectively, lateral and anterior crossbite were top of the list of anomalies with an urgent treatment need. Among the patients with lateral crossbite, the prognostically less favorable unilateral form was recorded approximately four times more often than the bilateral form. Markedly increased sagittal overjet > or =10 mm) was registered in only 1.4% of the children, and negative overjet (Class III) (with the exception of edge-to-edge bite) in 1.9%. Extreme anterior open bite > or =6 mm) was recorded in only two children (0.09%). In 19.6% of the children, a supporting zone was reduced in at least one quadrant, necessitating interceptive measures such as the insertion of a space maintainer or later orthodontic treatment (space opening or extraction therapy).     

Orthodontic Findings in the Deciduous and Early Mixed Dentition—Inferences for a Preventive Strategy

AIM AND METHOD: The aim of the present epidemiologic study was to obtain representative basic data on the frequency, extent and age-dependence of malocclusions in the deciduous and early mixed dentition. The developmental tendencies of specific malocclusions were investigated from the aspect of orthodontic prevention. The collective comprised 8,864 preschool and school-aged children, of whom 1,225 were in the deciduous dentition (mean age 4.5 years) and 7,639 in the mixed dentition (mean age 8.9 years). The orthodontic data were clinically assessed as sagittal, transversal, or vertical single-arch and occlusal findings. In addition, the malocclusions were classified according to their primary symptoms. Early infantile habits, tongue dysfunctions, speech defects and incompetent lip closure were registered separately. RESULTS: 57% of the children were found to have malocclusions, with the frequency rising statistically significantly in dependence on age from the deciduous to the mixed dentition (p < or = 0.001). The mean extent of excessive overjet increased significantly from the deciduous to the mixed dentition. Crossbite with mandibular midline discrepancies were observed significantly more frequently in the deciduous dentition. Although the frequency of anterior open bite underwent a significant decline from the deciduous to the mixed dentition, open bite was the malocclusion most frequently associated with dysfunction in both groups. The significant increase in traumatic deep bite in the mixed dentition indicates an unfavorable developmental tendency in this anomaly until after the eruption of the permanent incisors. CONCLUSION: The need for preventive orthodontic therapy and for the intensified application of interceptive and early treatment measures is stressed in view of the high number of malalignments and malocclusions in the deciduous and mixed dentition and the tendency for some forms of malocclusion to deteriorate as the dentition develops.     

Differences in the perception of needs and demands for orthodontic treatment between Koreans and Japanese

The objective of this study was to determine the differences in the perception of the needs and demands for orthodontic treatment between the members of two different countries, Korea and Japan. Based on 10 representative malocclusions, a questionnaire survey was carried out in patients, dental students, and orthodontists from Korea and Japan. After showing the participants frontal, lateral photographs along with the orthodontic casts of the 10 selected malocclusions, the “Needs for Orthodontic Treatment (NOT, 10-point VAS scale)” and the “Demands for Orthodontic Treatment (DOT, yes or no question)” of each malocclusion were scored by the participants. As the result, high needs and demands for orthodontic treatment were associated with severe skeletal and dental discrepancies in all three groups from both countries. In other malocclusion cases, the Patient group indicated lower needs and demands compared to the Orthodontist group while the Dental student group scored an intermediate value. Interestingly, Koreans tended to score higher needs for class I, class II and deep bite malocclusion compared to the Japanese, while reversely they scored lower needs and demands for class III and openbite malocclusion. Overall, it is important to recognize the discrepancies in the perception of malocclusion between different ethnic groups even in neighboring countries as well as between patients and orthodontists of the same racial/ethnic background.     

Clinical application of positioner and its fabrication]

Positioner is one type of removable appliances made of elastic material. This material, which is a kind of high polymer and has recoverable ability, may be as a new type of orthodontic material used not only in orthodontic treatment of various kind of malocclusions but also in retention in later stage of treatment. It is not same to the stainless steel wire of traditional removable appliances which must be activated every time to produce a little tooth movement. The advantages of positioner are to reduce the visit frequency and to shorten the duration of treatment. According to our clinical experiences, the indications are: simple individual malocclusion; treatment and retention in later stage of various kind of malocclusions; and patients who couldn't come to clinic regularly.     

Prevalence and change of malocclusions from primary to early permanent dentition: A longitudinal study

Objective:To follow a group of children from primary to early permanent dentition and determine the prevalence, self-correction, and new development of malocclusions; the need for orthodontic treatment; and the possible influences of habits, breathing disturbances, and allergies.Materials and Methods:Two hundred and seventy-seven children were followed at 3, 7, and 11.5 years of age. Malocclusions and orthodontic treatment need were determined by clinical examinations. Data on sucking habits, breathing disturbances, allergies, dental trauma, and orthodontic treatments were collected from a questionnaire and dental records.Results:Malocclusions were found in 71% of participants at 3 years of age, 56% at 7 years of age, and 71% at 11.5 years of age. Self-correction was noted for anterior open bite, sagittal malocclusions, and posterior crossbite, while deep bite developed. A high number of contact point displacements and spacings contributed to the prevalence of malocclusion rate of 71% at 11.5 years. Severe or extreme orthodontic treatment need was apparent in 22%. Habits, allergies, or breathing disturbances found at 3 years of age had no associations with malocclusions at 11.5 years of age.Conclusions:This sample revealed a significant percentage of malocclusions and orthodontic treatment need. A substantial number of self-corrections and establishment of new malocclusions occurred during the transition from primary to early permanent dentition.     

Three-dimensional diagnosis andorthodontic treatment of complex malocclusions with the invisalign appliance

Recent developments in software technology have made it possible to create a virtual three-dimensional (3D) model of the dental arches from digitally scanned impressions of a patient's dentition. This model may then be manipulated with software to produce stages of tooth movement from the initial malocclusion to the final desired occlusion. A stereolithographic model is made for each stage of tooth movement which is the basis for construction of a series of clear, thin, overlay appliances. These appliances are worn full time by the patient to move the teeth according to the programmed stages of movement. Malocclusions involving mild to moderate crowding and space closure have been proven to be successfully treated with this appliance. The present study shows orthodontic treatment of patients with more complex orthodontic problems, requiring dental expansion, Class II and Class III correction, extraction treatment and correction of overbite. Experience with this appliance, thus far, has demonstrated excellent patient compliance with less discomfort, and improved esthetics and oral hygiene, when compared with fixed orthodontic appliances. Orthodontic treatment with this appliance is a potentially useful alternative approach to fixed appliances for treatment of a variety of malocclusions in patients with fully erupted permanent teeth.     

Orthodontic treatment and referral patterns: A survey of pediatric dentists,general practitioners,and orthodontists

Objective

This study aims to assess the orthodontic diagnostic skills, referral patterns, and the perceptions of orthodontic benefits of pediatric and general dentists in comparison with orthodontists.

Materials and methods

Two online surveys were e-mailed to pediatric dentists, general dentistry practitioners, and orthodontists registered as members of the Saudi Dental Society and the Saudi Orthodontic Society. The surveys included questions about the type of orthodontic treatment provided, referral trends, and timing; presumed benefits associated with successful orthodontic treatment; and diagnosis and treatment plans of seven cases representing different malocclusions.

Results

In total, 25 orthodontists, 18 pediatric dentists, and 14 general practitioners completed the survey. Only 38.8% of pediatric dentists and 7.1% of general practitioners reported that they practiced orthodontics clinically. The perceptions of the three groups toward the benefits of orthodontic treatment were comparable in the psychosocial areas. However, the orthodontists perceived significantly lesser effects of orthodontic treatment on the amelioration of temporomandibular disorder (TMD) symptoms. Pediatric dentists tended to rate the need and urgency of treatment higher, while general practitioners tended to rate the need of treatment lower. The selected treatment plans for three early malocclusion cases showed the greatest discrepancies between the orthodontists and the other two groups.

Conclusions

The orthodontists consistently and significantly downplayed the perceived benefit of orthodontic treatment to reduce TMD symptoms. Also, while there was a similarity in the diagnosis, there were notable differences in the proposed treatment approaches, perceived treatment need, and timing of intervention between the three groups of practitioners.