An inference modeling of human visual judgment of sagittal jaw-base relationships based on cephalometry: Part I

When there appears to be a contradiction between a cephalometric tracing and what is seen, the clinician tends to place more reliance on the appearance of the face in profile than on a formal cephalometric evaluation of the sagittal jaw relationship. With this in mind, we derived a multiple regression model with cephalometric variables to explain the visual influences that affect the subjective classification of sagittal jaw relationships made by experienced orthodontists. The regression model that showed the highest coefficient of determination, 0.90, was constructed from a linear combination of the angle ANB, the anteroposterior position of Gnathion, the SN length, and the mandibular body length. The performance reliability of the inference system has been tested for 175 female adult cases and will be reported in Part II of this article. (Am J Orthod Dentofacial Orthop 2000;117:140-7)     

Orthodontic treatment planning: do orthodontists treat to cephalometric norms?

Cephalometric norms are important to orthodontists in their diagnosis, treatment, and evaluation of orthodontic treatment outcomes. The purpose of the present study is to establish if orthodontists treat and finish their cases to the cephalometric means or norms. Pre- and post-cephalometric radiographs and dental casts of 35 orthodontically treated cases were analyzed. The Kappa test, Wilcoxon Signed-Rank test, Paired t- test, and Z-test were used for the statistical analysis of the data. The result revealed that orthodontists do not reach the cephalometric mean values post-treatment. However, sagittal maxillomandibular relationship and interlabial gap are the main areas of improvements. This leads to improvement of soft tissue esthetics by camouflaging the skeletal and dental relationship.     

下颌升支矢状劈开前移术对成年骨性Ⅱ类下颌后缩女性患者上气道影响的CBCT研究

目的:研究下颌升支矢状劈开前移术对成年骨性Ⅱ类下颌后缩女性患者上气道影响.方法:选取成年骨性Ⅱ类下颌后缩女性患者40例,根据采用不同的治疗方式分为两组:手术组20例采用双侧下颌升支矢状劈开截骨术前移下颌+正畸治疗,代偿组20例采用单纯正畸掩饰治疗.收集患者正畸治疗前和正畸治疗结束时的CBCT数据.分别测量正畸治疗前和正...     

A manpower study of orthodontic specialists for the State of Indiana: a preliminary report.

To develop current manpower data and project the future need for orthodontic specialists, a survey questionnaire was mailed to Indiana orthodontists (90 percent response). In addition, a telephone survey of orthodontic receptionists was conducted during the same time period (95 percent response). In general, orthodontists perceived a lower state of business than did their staffs. About 77 orthodontists are expected to retire by the year 2010. Based on maintaining the adjusted potential patient-to-orthodontist ratio (increasing adult and declining children in the population), it was projected that only about 66 (86 percent) of the retirees require replacement. To maintain manpower at eight percent fewer orthodontists than are currently in practice, three to four new orthodontists per year will be needed in Indiana over the next two decades.     

Skeletal anchorage for orthodontic correction of maxillary protrusion with adult periodontitis

Because the number of adult patients seeking orthodontic treatment is increasing, orthodontists are becoming more likely to encounter patients with adult periodontitis. However, it is sometimes difficult to establish anchorage because of poor periodontal tissues in patients with adult periodontitis. This article reports the successful use of skeletal anchorage to treat a maxillary protrusion case complicated by severe adult periodontitis. A female patient aged 50 years seven months showed a skeletal Class II jaw base relationship. A spacing of five mm in the upper anterior teeth with an overjet of 7.5 mm and overbite of four mm was observed. She had generalized horizontal bone loss in both arches, with vertical bone loss in the posterior segment. After periodontal treatment, miniplates were placed in the zygomatic process, and retraction and intrusion of the maxillary incisors were performed. After active treatment for 21 months, the upper incisors had been inclined 9.5 degrees lingually, intruded two mm at the apex, and good anterior occlusion was achieved. Acceptable occlusion and periodontal tissue were maintained after a retention period of two years. Our results suggest that skeletal anchorage is useful for retraction and intrusion of upper incisors in cases of maxillary protrusion with severe adult periodontitis.     

Traction of an impacted maxillary canine with corticotomy in a 53-year-old patient: Case report

The viability of orthodontic traction of impacted teeth in adults is often questioned by a large percentage of orthodontists who would rather consider the extraction of these teeth. Although possible, orthodontic traction of impacted canines in adults takes longer than in younger patients, present a poorer prognosis that worsens with age. Because of the prevalence of periodontitis in adults versus children, periodontal inflammation must be identified and resolved in order to keep attachment loss from progressing during orthodontic care. Likewise mucogingival changes need to be predicted and managed. This article reports a successful case of impacted maxillary right canine traction in an adult female, associated with alveolar corticotomies and the use of skeletal anchorage. At the end of treatment, the canine was ideally positioned in the occlusion, presenting excellent esthetics, function, and healthy periodontal tissues.     

下颌第三磨牙萌出相关问题的研究进展

接受正畸治疗的青少年患者的第三磨牙处于发育阶段,第三磨牙的萌出情况备受正畸医生和患者家长的关注。与第三磨牙萌出有关的牙颌因素较多,包括磨牙后间隙、第三磨牙倾斜角、拔除第二磨牙、拔除前磨牙、垂直骨面型、矢状骨面型、第三磨牙牙龄、第一二磨牙倾斜角、第三磨牙牙冠宽度和性别等。本研究总结分析其相关文献,以期为临床预测第三磨牙萌出提供指导。     

Relationship between cranial mechanics and dysmorphic dentofacial characteristics: a cross-sectional study

Aims: The aim of the present study was to evaluate if cranial dysfunctions felt by osteopaths could correlate with sagittal dysmorphologies diagnosed by orthodontists, using cephalometric traces in the sagittal plane.

Metholology: One hundred - six children between 6 and 12 years old (42 boys and 64 girls) were tested by an osteopath to determine if the cranial movement felt was considered to be eased in flexion or extension. To test reproducibility intra-operator, 27 randomly selected subjects were tested twice, at a one-month interval by the same osteopath before the start of their orthodontic treatment. These tests were then correlated with a cephalometric analysis of the sagittal plane to determine what type of dysmorphology existed, if any, as well as the angle of the spheno-occipital synchondrosis (SOS).

Results: Practitioners systematically found more cranial movement in extension for all the bones in patients in skeletal class II than in the others. Similarly, they systematically found more cranial movement in flexion in patients in skeletal class III than in the other skeletal classes. However, there was no significant difference found in SOS angulation between skeletal classes I, II, and III.

Discussion: This study tends to confirm the correlation, described previously by orthodontists, between the mobility of the bones of the cranial vault and dysmorphic dentofacial characteristics in the sagittal plane. Anomalies during development could lead to the typical cranial characteristics of flexion or extension. As such, these situations could be related to skeletal classes III and II respectively.     

Mandibular advancement using an intra-oral osteogenic distraction technique: a report of three clinical cases

Osteogenic distraction has been used for decades to lengthen limbs and now attention is focused upon its use within the craniofacial skeleton. This paper addresses distraction of the mandible. It is proposed that mandibular osteogenic distraction could be a possible adjunct to the orthodontic treatment of those adult patients with skeletal anomalies, who would benefit from combined orthodontic/orthognathic treatment. Three consecutive cases from one unit are presented, where adult patients with severe Class II division 1 malocclusions have undergone orthodontic treatment combined with mandibular osteogenic distraction, instead of conventional bilateral sagittal split osteotomies.     

A comparison of the perception of facial profile by the general public and 3 groups of clinicians

Orthodontists and maxillofacial surgeons frequently plan orthognathic treatment to produce an "ideal" Class I occlusion and skeletal relationship. The aim of this study was to investigate whether the preferred facial profile chosen by orthodontists, maxillofacial surgeons, dental students, and members of the general public conformed to a Class I profile. Photographs were taken of 2 male and 2 female adult subjects with Class I profiles, and by means of a computer program the images were manipulated to produce Class II, Class III, and long face profiles. The orthodontists, surgeons, dental students, and members of the general public ranked each group of 4 photos in order of their attractiveness. Orthodontists and maxillofacial surgeons were found to be significantly more likely to choose a Class I skeletal relationship as the most attractive profile. A significant difference was found between orthodontists and dental students (P < 0.01) and between orthodontists and the general public (P < 0.001) with regard to the assessment of the Class I profile as the most attractive, when all 4 subjects were considered. Similar results were noted for maxillofacial surgeons. Whether the assessor was an orthodontist, maxillofacial surgeon, or a member of the general public was found to be significant when examining subjects 1 (female) and 3 (male). The sex of the assessor was also a significant factor for subject 3 (male), where female assessors were more likely to rank the Class I profile as most attractive (P < 0.05).     

Three-dimensional surgical guide approach to correcting skeletal Class II malocclusion with idiopathic condylar resorption

Treatment of skeletal Class II patients with dual bite and idiopathic condylar resorption (ICR) is challenging for orthodontists because of the unstable position of the mandible as well as skeletal relapse attributed to improper seating of the mandibular condyles. This case report describes the successful treatment of an 18-year-old Mongolian man diagnosed with centric relation–maximum intercuspation discrepancy and ICR. After making a definitive diagnosis from verified centric relation using bilateral manipulation, orthodontic treatment was initiated followed by three-dimensional computer-aided design/computer-aided manufacturing prebent titanium plate–guided sagittal split ramus osteotomy and genioplasty. Postoperative 3D superimposition demonstrated that this surgical guide approach provided accurate repositioning of the condyles, which were well positioned in the fossae. Complete orthodontic and surgical treatment time was 24 months. The patient''s facial appearance and occlusion improved significantly, and a stable result was obtained with a 1-year follow-up.     

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.     

Oculo-facio-cardio-dental syndrome: report of a rare case

Oculo-facio-cardio-dental (OFCD) syndrome is an extremely rare condition with ocular, facial, cardiac, and dental abnormalities. It is often unrecognized by many medical and dental professionals. Only 17 cases have been documented to date. Because all reported patients have been female, it has been suggested that OFCD syndrome is an X-linked dominant trait. Isolation and diagnosis of this syndrome is hard for the medical specialists. Only unique and specific findings are observed in dental and skeletal structures, which can easily be diagnosed by an orthodontist or general dentist. Therefore, it was the aim of this study to present a new case of this syndrome and to evaluate it from an orthodontic perspective in order to call the attention of orthodontists to this rare anomaly.     

骨性安氏Ⅱ类错He的外科与正畸联合治疗

目的：探讨外科与正畸联合治疗骨性安氏Ⅱ类错Ｈｅ的方法和特点。方法：总结分析近年一经外科与正畸联合治疗的骨性安氏Ⅱ类错Ｈｅ病例２２例,介绍典型病例治疗过程,着重讨论拔牙时机,术前后正畸治疗特点及术式选择。结果：本研究２２例患者经联合治疗后,颌骨关系正常,牙弓形态衣Ｈｅ曲线正常,牙排列整齐,咬合关系好,面形及功能均获明显改善,疗效满意。     

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.     

Combined surgical and orthodontic treatment of bimaxillary protrusion

Bimaxillary protrusion can be treated effectively in growing patients and in adults with conventional orthodontic therapy. In the adult patient, however, combined surgical and orthodontic treatment modalities may offer distinct advantages over such conventional therapy. Treatment time and possible adverse effects of lengthy and extensive orthodontic therapy may be reduced and optimum esthetic improvement may be facilitated. Those cases that exhibit severe skeletal discrepancies in the vertical, transverse, or sagittal dimensions in addition to dentoalveolar protrusion may be best treated in this manner to simultaneously correct all existing problems and obtain optimal esthetic and functional results. This article delineates the rationale for such therapy and tridimensional diagnostic and treatment-planning considerations from both the orthodontic and surgical standpoints. Case reports illustrate clinically the results obtainable with such treatment.     

Stability of the mandible after advancement and use of dental plus skeletal maxillomandibular fixation: an experimental investigation in Macaca mulatta

This study examined short-term stability of the mandible following advancement surgery and the use of skeletal suspension wires plus dental maxillomandibular fixation. Twenty-four adult female Macaca mulatta underwent bilateral sagittal ramus osteotomy and advancement of approximately 6 mm. All animals had dental maxillomandibular fixation secured by bonding the upper and lower teeth together with an orthodontic composite resin. In half of the animals, the use of circummandibular wires connected to pyriform aperture wires were additionally applied. Tantalum bone markers were placed and cephalograms analyzed during the first six postoperative weeks to evaluate skeletal stability. A statistically significant mean horizontal relapse at the mandibular symphysis occurred in the group without the skeletal wires, whereas no relapse occurred in the group with the skeletal wires. A significant difference in the vertical displacement of the anterior mandible occurred, with an inferior movement of the symphysis in the group without skeletal wires, and a superior movement of the symphysis in the group with skeletal wires. The results of this study indicate that the use of skeletal suspension wires is advantageous in the prevention of horizontal and vertical skeletal relapse.     

Adult orthodontics in the Republic of Ireland: specialist orthodontists’ opinions

Objectives: To report the opinions of specialist orthodontists regarding the profile, characteristics and treatment of adults currently undergoing orthodontic treatment in the Republic of Ireland (ROI)

Design/setting: A national cross-sectional questionnaire study in the ROI.

Method: A pilot-tested questionnaire was distributed to 122 specialist orthodontists in the ROI. Questions addressed general and treatment information for current adult orthodontic patients. Those whose treatment involved orthognathic surgery were not excluded.

Results: A response of 83% was obtained. Ninety-five per cent of specialists reported treating adults, most of whom were self-referred and were typically professional, female and aged 25–35 years. The overall ratio quoted of professionals to non-professionals was almost 3:2. For 50% of specialists, males were estimated to account for 20–40% of their adult cases and for 23%, this increased to an estimated 40–60%. Class II division 1 malocclusion and skeletal II were considered the most common dentofacial characteristics. Occlusal features encountered in decreasing frequency were generalised crowding, increased overjet, deep overbite, late lower incisor crowding, spacing and impacted teeth. Fifteen per cent reported that at least 10% of their adult cases required orthodontics with maxillofacial surgery but 8% reported that this was at least 50%. Treatment challenges commonly acknowledged were overbite reduction, anchorage management, ‘black triangles’ and overjet reduction. Tooth whitening was reckoned to be used by 19% of specialists. Aesthetic upper and stainless steel lower brackets were indicated to be used most often whereas only 19% used clear aligners and 10% used lingual appliances often.

Conclusions: The profile and characteristics of adults currently undergoing orthodontic treatment in the ROI were diverse. Higher estimates were quoted for self- than for general dental practitioner-referral. A high percentage of treatment was reported to be undertaken for non-professionals and males. A wide range of treatment and varying use of appliance types were cited.     

数字化正畸中前牙转矩设计的比较

正畸治疗过程中,前牙转矩不仅会影响前牙区的美观,也会影响后牙咬合关系,因此前牙转矩的控制具有重要意义.如何通过数字化技术控制前牙转矩是目前正畸临床应用的热点问题,而前牙转矩控制的方案设计是许多正畸医生临床操作的疑难和困惑所在.笔者通过文献复习,结合临床病例的研究结果,对个性化唇侧矫治器、个性化舌侧矫治器和透明矫治器3种...     

Correction of skeletal open bite with implant anchored molar/bicuspid intrusion

Implant-anchored orthodontics is a rapidly developing new field in the treatment of major malocclusion. In particular, the use of skeletal fixtures as orthodontic anchors is affording a minimally invasive treatment option for correction of skeletal anterior open bite as an alternative to major surgery. This article reviews the literature and guides oral and maxillofacial surgeons and orthodontists in case selection and management of open bite with implant-assisted orthodontics.