Stability of anterior crossbite correction: A randomized controlled trial with a 2-year follow-up

Objective:To compare and evaluate the stability of correction of anterior crossbite in the mixed dentition by fixed or removable appliance therapy.Material and Methods:The subjects were 64 consecutive patients who met the following inclusion criteria: early to late mixed dentition, anterior crossbite affecting one or more incisors, no inherent skeletal Class III discrepancy, moderate space deficiency, a nonextraction treatment plan, and no previous orthodontic treatment. The study was designed as a randomized controlled trial with two parallel arms. The patients were randomized for treatment with a removable appliance with protruding springs or with a fixed appliance with multibrackets. The outcome measures were success rates for crossbite correction, overjet, overbite, and arch length. Measurements were made on study casts before treatment (T0), at the end of the retention period (T1), and 2 years after retention (T2).Results:At T1 the anterior crossbite had been corrected in all patients in the fixed appliance group and all except one in the removable appliance group. At T2, almost all treatment results remained stable and equal in both groups. From T0 to T1, minor differences were observed between the fixed and removable appliance groups with respect to changes in overjet, overbite, and arch length measurements. These changes had no clinical implications and remained unaltered at T2.Conclusions:In the mixed dentition, anterior crossbite affecting one or more incisors can be successfully corrected by either fixed or removable appliances with similar long-term stability; thus, either type of appliance can be recommended.     

Removable appliances to correct anterior crossbites in the mixed dentition: a systematic review

Abstract

Objectives: To investigate the effectiveness of an upper removable appliance in the treatment of an anterior crossbite in term of quality of life, effectiveness, treatment time, long term stability and cost minimization.

Design: Systematic review

Data source: A search strategy was implemented using both manual hand search and electronic databases, including Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, ScienceDirect, Scopus and Ebsco.

Study eligibility criteria: Randomized controlled clinical trials

Participants: Children in the early or late mixed dentition with an anterior crossbite affecting one or more incisors, and no underlying skeletal class III pattern.

Interventions: Upper removable appliance compared with other orthodontic appliances.

Study appraisal and synthesis: All potential articles were checked against the inclusion criteria independently, and in duplicate by two investigators. Risk of bias of eligible studies to be included in the final analysis was assessed independently by two authors using Cochrane risk of bias tool.

Results: A total of 524 articles were identified in both manual and electronic searches as well as by checking the reference lists of the final articles to be included in the study. Only 7 reports of 3 RCTs met the inclusion criteria and thus were included in the final analysis. All but one of the 3 RCTs were judged to be of very low quality. No statistical methods were employed to combine the studies due to the heterogeneity of the studies.

Conclusion: A fixed appliance was more cost-effective than a removable appliance in the correction of an anterior crossbite with a functional shift. There was no significant difference in terms of quality of life, pain intensity or long-term stability between the two appliances. On the other hand, both a removable appliance and cemented bite-pads were equally effective in the correction of an anterior dental crossbite without having any side effect.     

Development of patient information leaflets for fixed,removable, and functional appliances for Arabic-speaking orthodontic patients

ObjectiveTo develop Orthodontic Patient Information Leaflets (PILs) in Arabic.Material & methodThis study included five phases starting with Arabic translation of existing British Orthodontic Society leaflets; initial face validation with three orthodontists; content validation with ten orthodontists; final face validation with ten orthodontists, five postgraduate students, and ten patients; and re-translation to English prior to comparing the new documents with the original PILs to verify that all the necessary information were included. The content validity index (CVI) assessed item level (I-CVI) and scale level (S-CVI).ResultsThe three Arabic PILs were face validated with inclusion of mini-screws, rapid maxillary expansion, and interproximal reduction. Content validity was perfect with no item I-CVI < 0.80. The S-CVI/Ave for PIL Fixed Appliances = 0.98, PIL Removable Appliances = 0.98 and PIL Functional Appliances = 0.97. In the final face validation, the three leaflets received 100% agreement from all observers for consistency of leaflet format and style, clarity, readability and use of adequate phrases. Finally, the leaflets were re-translated and the information was checked by native English speakers to ensure the completeness of information. There were no discrepancies and face validity was excellent.ConclusionValid PILs for Arabic-speaking patients undergoing orthodontic treatment with fixed, removable, and functional appliances have been developed.     

垫式舌侧矫治器矫治前牙反

目的：对舌侧矫治器进行改良,应用于前牙反的矫治,疗效好,临床操作简化。方法：制作＂联冠垫＂粘固在后牙牙冠上,成为＂固定垫＂,磨牙舌面管和前磨牙托槽埋于垫中和＂联冠垫＂合为一体,成为＂垫式舌侧矫治器＂。结果：6例患者治疗后磨牙关系中性,前牙覆覆盖正常,牙列整齐。结论：垫式舌侧矫治器矫治假性前牙反效果良好,椅旁操作时间减少。     

Dimensional changes of dental arches produced by fixed and removable palatal cribs: A prospective,randomized, controlled study

Objective:To evaluate the dimensional changes of dental arches on digital models of open bite treatment with fixed and removable palatal cribs.Materials and Methods:The sample comprised 41 patients of both sexes who were white, aged 7–10 years, and who had mixed dentition, Angle Class I molar relationship, and a negative overbite of at least 1 mm. The sample was randomly divided into two groups: G1, fixed palatal crib; and G2, removable palatal crib. Cast models, obtained initially (T1) and after 1 year of treatment (T2), were scanned by a three-dimensional (3D) scanner, 3Shape R700, producing a 3D image. Measurements were performed by a calibrated examiner using OrthoAnalyzer™ 3D software.Results:At T2–T1, differences were observed between the groups regarding vertical dentoalveolar development and overjet. There was more mandibular incisor extrusion for G1 (−1.66 mm) than for G2 (−0.54 mm). An overjet increase was observed in G1 (0.56 mm), in contrast to a reduction in G2 (−0.40 mm). There was a similar overbite increase for both groups (3.51 mm for fixed palatal crib and 3.88 mm for removable palatal crib).Conclusions:Both the treatment protocols are similarly effective for anterior open bite correction, providing an overbite increase with dentoalveolar arch changes, especially in the anterior region.     

Occlusal traits,orthodontic treatment need and treatment complexity among untreated 17–21-year-olds in Estonia

Objective: To analyze data on occlusal traits, orthodontic treatment need and treatment complexity in orthodontically untreated 17–21-year-old Estonians.

Materials and methods: Clinical records and plaster casts of 390 untreated young adults (219 females and 171 males, mean age 18.5 years, range 17–21 years) were analyzed. Assessed occlusal traits included first molar and canine sagittal relationship, overjet, overbite, crowding, midline diastema, crossbite and scissor bite. The Index of Complexity, Outcome and Need (ICON) was used to assess orthodontic treatment need and complexity. Participants’ opinions regarding their teeth were determined with a questionnaire.

Results: The most prevalent occlusal traits were Class I sagittal relationship in canines (76%) and molars (70%), crowding (51%), overbite ≥3.5?mm (48%), the end-to-end sagittal relationship in canines (48%) and overjet ≥3.5?mm (47%). Antero-posterior asymmetry was common both in canines (39%) and molars (37%). According to ICON, 36% of participants had orthodontic treatment need.

Conclusions: Desire for orthodontic treatment was associated with crowding and increased overjet, and with no gender difference, participants’ main expectation of treatment was an improvement in dentofacial aesthetics. Treatment needs determined with ICON was moderate and in line with the participants’ desire for orthodontic treatment.     

A randomized controlled trial of self-perceived pain,discomfort, and impairment of jaw function in children undergoing orthodontic treatment with fixed or removable appliances

Objective:To compare patients’ perceptions of fixed and removable appliance therapy for correction of anterior crossbite in the mixed dentition, with special reference to perceived pain, discomfort, and impairment of jaw function.Material and Methods:Sixty-two patients with anterior crossbite and functional shift were recruited consecutively and randomized for treatment with fixed appliances (brackets and archwires) or removable appliances (acrylic plates and protruding springs). A questionnaire, previously found to be valid and reliable, was used for evaluation at the following time points: before appliance insertion, on the evening of the day of insertion, every day/evening for 7 days after insertion, and at the first and second scheduled appointments (after 4 and 8 weeks, respectively).Results:Pain and discomfort intensity were higher for the first 3 days for the fixed appliance. Pain and discomfort scores overall peaked on day 2. Adverse effects on school and leisure activities were reported more frequently in the removable than in the fixed appliance group. The fixed appliance group reported more difficulty eating different kinds of hard and soft food, while the removable appliance group experienced more speech difficulties. No significant intergroup difference was found for self-estimated disturbance of appearance between the appliances.Conclusions:The general levels of pain and discomfort were low to moderate in both groups. There were some statistically significant differences between the groups, but these were only minor and with minor clinical relevance. As both appliances were generally well accepted by the patients, either fixed or removable appliance therapy can be recommended.     

Prevalence of malocclusion traits and orthodontic treatment in a Finnish adult population

Objective The aim of the study was to examine the prevalence of malocclusion traits and the extent of orthodontic treatment in a Finnish adult population. Materials and methods The study population comprised subjects (n?=?1964) from the Northern Finland Birth Cohort 1966 living in the city of Oulu and within 100?km of it. A clinical oral and dental examination with registration of occlusion was carried out in 2012 in connection with a 46-year follow-up survey. Data on previous orthodontic treatment were collected based on a questionnaire. Results In the clinical examination, 39.5% of the subjects had at least one malocclusion trait. The most common malocclusion traits were lateral crossbite (17.9%), overbite?≥?6?mm (11.7%) and overjet?≥?6?mm (9.7%). Crossbite on the left premolars, negative overjet and increased overbite were found more frequently in men. The prevalence of malocclusion traits was at the same level in treated and untreated groups. Overall, 18.6% of the subjects had undergone orthodontic treatment. Women showed a significantly higher prevalence of orthodontic treatment. Conclusions The most common malocclusion trait in the present study was lateral crossbite. Significant male dominance in the prevalence of malocclusion was observed, which has not been reported earlier in Finland. Orthodontic treatment of malocclusion traits was more common among females in Northern Finland. This study indicates that orthodontic treatment provided in childhood was, on average, adequate in reducing malocclusion traits to the level observed in the general population.     

A case of anterior open bite with severely narrowed maxillary dental arch and hypertrophic palatine tonsils

Abstract

This case report describes an adolescent patient with an open bite and severely narrowed maxillary dentition and hypertrophic palatine tonsils, treated efficiently with rapid maxillary expansion (RME) and subsequent orthodontic tooth alignment using fixed appliances. The treatment demonstrates that RME can be effective for the correction of a severely narrowed maxillary arch, as well as, in this case, the correction of an anterior open bite in an adolescent patient where no substantial vertical skeletal discrepancy existed.     

Combined orthodontic and surgical open bite correction:: Principles for success. Part 1

Objectives:To examine the stability of combined surgical and orthodontic bite correction with emphasis on open-bite closure. All study patients were treated with strict and consistent orthodontic and surgical protocols.Materials and Methods:Study inclusion required all patients to have anterior open bites, maxillary accentuated curve of Spee, 36-month minimum follow-up, and no temporomandibular joint pathology. Thirty patients met the inclusion/exclusion criteria. Importantly, segmental upper arch orthodontic preparation (performed by EG) was used. Surgery consisted of a multisegment Le Fort I (MSLFI) combined with a bilateral sagittal osteotomies (BSSO). Surgery was performed (by ADA and LT) at the Department of Dentistry and Maxillofacial Surgery of the University of Verona, Italy.Results:The long-term open bite and overjet relapse were not statistically significant. The mean transverse relapse of the upper and lower molars was statistically significant. Of great importance, the upper and lower arch widths narrowed together, maintaining intercuspation of the posterior dentition which prevented anterior open bites from developing.Conclusions:This study revealed stability of three-dimensional occlusal correction including anterior open bite. Stable open bite closure was achieved by using rigid protocols for orthodontic preparation, surgical techniques, surgical follow-up, and orthodontic finishing.     

An Approach to Appliance Therapy

Abstract

This is the first of a short series of articles in which it is proposed to review various types of appliance treatment available to the orthodontist. In the present article the simpler forms of treatment are considered; treatment without orthodontic appliances or with removable appliances only. In future article consideration will be given to the combined use of removable and fixed appliances, and finally of the more advanced, wholly fixed techniques.     

A three dimensional clinical approach for anterior crossbite treatment in early mixed dentition using an Ultrablock appliance: case report

An 8-year-old girl patient presented to Pediatric Dentistry Department at Tufts University School of Dental Medicine for orthodontic consultation. The patient was in early mixed dentition with anterior crossbite and underdeveloped posterior occlusal vertical. Anterior crossbite correction and proper posterior occlusal vertical were established in 6 months of treatment by using an Ultrablock appliance (a removable Ultrablock appliance followed by fixed Ultrablock appliance) which was designed in three dimensions (horizontal, vertical and transverse) on Denar Witzig articulator. An increase of 5 mm in the posterior occlusal vertical is reported.     

Orthodontic treatment provided by pediatric dentists.

The purposes of this study were to document orthodontic treatment currently provided by pediatric dentists for comparison with past and future studies and to ascertain variables that influence practitioners' orthodontic treatment patterns. A 25-item survey was mailed to 492 diplomates of the American Board of Pediatric Dentistry. Surveys returned within 16 weeks were included for statistical analysis. The response rate was 73%. Most practitioners spent less than 10% of their practice time providing orthodontic treatment and reported that this would not change in the future. Practitioners who were dual trained in pediatric dentistry and orthodontics spent more time providing orthodontic treatment, although nearly half spent at least 50% of their time providing traditional pediatric dental treatment. Most pediatric dentists provided orthodontic treatment in the primary or early mixed dentition stages. The most common conditions treated were anterior crossbite, ectopic eruption, habits, posterior crossbite, and space maintenance. The most common orthodontic appliances used were fixed rapid palatal expanders and removable Hawley appliances with finger springs. Orthodontic treatment provided by pediatric dentists has decreased since it was last surveyed in 1983 and is not expected to change in the next 5 years.     

（牙合）垫舌簧活动矫治器矫治乳前牙反三种施力装置的疗效对比研究

目的：寻求一种省时、便捷、有效的垫舌簧加力装置矫治乳前牙反,提高临床工作效率。方法：选择乳前牙反病例22例,随机分为三组。第一组10例应用普通牙科不锈钢丝制作双曲舌簧上颌垫活动矫治器、第二组6例用正畸不绣钢丝制作双曲舌簧上颌垫活动矫治器,第三组6例用正畸不绣钢丝制作双圈曲舌簧上颌垫活动矫治器,分别于1、3、5周复诊加力一次,观察比较三组病例的矫正时间及复诊次数。结果：第一组平均矫正时间10.2周,平均复诊次数10.2次。第二组平均治愈时间10周,平均复诊次数3.7次。第三组平均治愈时间9.7周,平均复诊次数2.3次。三者相比较,矫治时间无显著差异（P〉0.05）,但平均复诊次数却有显著性差异（P〈0.05）。结论：固定正畸用不锈钢丝双圈曲舌簧垫活动矫治器能省时、有效地矫治乳前牙反,可提高临床工作效率。     

Orthodontics. Part 5: Appliance choices

There are bewildering array of different orthodontic appliances. However, they fall into four main categories of removable, fixed, functional and extra-oral devices. The appliance has to be selected with care and used correctly as inappropriate use can make the malocclusion worse. Removable appliances are only capable of very simple movements whereas fixed appliances are sophisticated devices, which can precisely position the teeth. Functional appliances are useful in difficult cases and are primarily used for Class II Division I malocciusions. Extra-oral devices are used to re-enforce anchorage and can be an aid in both opening and closing spaces.     

Medical emergencies in a dental office: inhalation and ingestion of orthodontic objects

BackgroundThe authors reviewed the literature regarding inhalation and ingestion of orthodontic appliances and suggest ways to manage and prevent these events.Types of Studies ReviewedThe authors conducted literature searches of free text and Medical Subject Headings terms by using PubMed and Embase databases and selected appropriate studies. They analyzed retrieved articles according to several parameters: inhalation or ingestion event, number of cases, patient's sex and age, type of orthodontic appliance, in-office event or out-of-office event, and medical treatment.ResultsThe authors found a total of 2,279 articles in their preliminary search. Eighteen reports of 24 cases from this search met all of the search criteria (that is, clinical studies, case reports or reviews limited to English, Hebrew or Arabic on any form of aspiration or inhalation of orthodontic appliances). Most cases (67 percent) involved ingested objects, and of those cases, the majority (57 percent) occurred in female patients. Most cases (85 percent) occurred outside the orthodontist's office. Seventeen patients (71 percent) had been treated with a fixed orthodontic appliance. In 60 percent of cases, the maxilla was involved. With one exception, no severe complications were reported (only seven patients were examined in a hospital emergency department), and patients were discharged uneventfully from the orthodontic office or emergency department.Clinical ImplicationsOrthodontists and team members should participate in medical emergency management courses that emphasize the use of guidelines in cases of inhalation or ingestion of orthodontic objects. Each orthodontist's office should develop written emergency protocols for out-of-office events and present them to patients and their parents at the start of treatment.     

The role of the orthodontist in the treatment of adolescents with orofacial clefts

In the orthodontic treatment of patients with clefts the main aim is to maximize the growth and development of the maxillary complex and, at the same time, to improve functional efficiency and facial aesthetics. The commonest malocclusions found in adolescents with lip and palate clefts are: frontal or anterior crossbite; posterior or buccal crossbite which is either unilateral or bilateral; retrusion of the middle third of the face to a greater or a lesser degree; open bite; and finally malformation and displacement of the teeth adjacent to the cleft. Treatment may be divided into: correction of malocclusions in the transverse plane; correction in the antero-posterior plane; vertical corrections; and correction of misplaced individual teeth. Posterior (lateral) crossbite can be corrected by both gradual and rapid (forced) expansion using various removable appliances. Following this, correction of anterior crossbite and restoration of vertical occlusal relationships will be necessary. Finally, misplaced individual teeth will need to be repositioned. Traumatic surgery and consequent scar tissue affects the growth of the maxillary arch and the development of the occlusion. This was demonstrated in a comparative analysis of monozygotic and dizygotic twins discordant for clefts as well as in twin pairs whose clefts were non-identical in type and extent. The adolescents who still have unoperated clefts have special problems.     

Provision of orthodontic care to adolescents in South Australia: The type, the provider, and the place of treatment

There are many pathways involving different providers and locations that individuals may take in obtaining orthodontic services. The aim of this study was to document the provision of orthodontic services and establish the pathways taken toward fixed orthodontic treatment by adolescents in South Australia. Data were collected on the use of orthodontic services by a cohort of adolescents enrolled in the School Dental Service at age 13 years and again at age 15 years. By age 15 years, 83.2 per cent of the adolescents had received orthodontic consultations, 27.3 per cent had received fixed orthodontic treatment and 41.4 per cent had received other forms of orthodontic treatment (extractions, space retainers or removable appliances). The majority of fixed orthodontic treatment was supplied by orthodontists in the private sector, while extractions and removable appliances were provided mainly by public sector general dentists. Most individuals used services in both the public and private sectors and the most frequent pathway taken by the adolescents receiving fixed orthodontic treatment involved consultation in both the public and private sectors, non-fixed orthodontic treatment in the public sector and fixed orthodontic treatment in the private sector. The findings indicate wide access to orthodontic consultation and a high uptake of fixed orthodontic treatment once the adolescent sought private sector orthodontic consultation. Orthodontic care was seen to be an interactive process between public sector general dentists and private sector orthodontists.     

An orthodontic oral appliance: A randomized,controlled pilot study

Objective:This pilot study was performed to test the hypothesis that an orthodontic oral appliance (OA) that is designed to work against the backwardly directed forces on the upper incisors may counteract the reduction in overjet from these devices.Materials and Methods:Thirty patients with normal bites, good oral health, and milder sleep apnea were randomized to treatment with either OAs or orthodontic OAs. Bite changes were evaluated on plaster casts and radiographs and by questionnaires after a mean of 2.4 years in 19 frequent users.Results:Four of nine patients in the orthodontic OA group increased their overjet by ≥0.4 mm, while none of the 10 patients in the OA group experienced that effect.Conclusion:Only the orthodontic OA increases the overjet; this design may therefore be beneficial to patients at risk of negative effects on their bite during OA treatment.