Orthodontic and dentofacial orthopedic management of juvenile idiopathic arthritis: a systematic review of the literature

To systematically review the literature published on orthodontic treatment principles in patients with juvenile idiopathic arthritis (JIA). Several electronic databases (PubMed, Medpilot, Web of Science, and DIMDI) and orthodontic and rheumatologic literature were systematically searched for studies published until May 2010. The articles were rated by two independent reviewers and included after three selection steps (title-abstract-full text). Articles had to be studies performed on ≥ 5 patients with a disease onset before the age of 16. The selection process resulted in the inclusion of three publications on dentofacial orthopedics and six on combined surgical orthodontic therapy. The three studies on dentofacial orthopedics aimed to improve the mandibular retrusion by means of removable functional appliances (activator). Whereas these orthodontic approaches comprised relatively large and homogeneous patient samples (14, 22, and 72 subjects, aged 6-16), the surgical studies were basically case series with a large age span of the patients (5-12 subjects, aged 10-44). In these surgical treatment approaches, orthodontics was limited to pre-surgical leveling and post-surgical finishing, while the skeletal discrepancy was treated surgically by a variety of techniques (costochondral grafts, bilateral sagittal spilt osteotomy, Le Fort I, and genioplasty). The treatment goals of both approaches were improvement of esthetics and function and/or pain reduction, and both approaches showed satisfactory results. Because of the heterogeneity of the subject material and the low level of evidence of the papers, it is difficult to draw any conclusions on the orthodontic/dentofacial orthopedic management of JIA. It appears as if removable functional appliances may be beneficial in adolescent patients with JIA.     

Calendar of Meetings

Abstract

Over a 1-year period, all patients attending a consultant orthodontist's new patient clinics in North Derbyshire and whose treatment plans involved active appliance treatment, were accepted into a prospective longitudinal study. In all 294 patients were included in the study. Subsequent to the consultant's new patient clinic the patients' active treatments were undertaken in the Hospital, General, or Community Dental Services. Four years after the commencement of the study, 207 patients had completed active treatment and 50 had non-completed during active treatment. This gave an overall non-completion rare (NCR) of 19·5 percent for the study. Of the 50 patients who did not complete treatment during active treatment 23 (46 per cent) non-completed during the first 6 months of active treatment. A predictive model of non-completion of active orthodontic treatment (NCT) over time is suggested.     

A retrospective overview of treatment choice and outcome in 126 cases with arrested eruption of mandibular second molars

The purpose of the present retrospective study was to analyze treatment choice and outcome in patients with retention/impaction of the mandibular second molar. Radiographic material, from three large clinics, from 106 patients (60 males and 46 females) with 126 retained/impacted permanent mandibular second molars treated during the years 1985–2005 was evaluated for treatment choice and treatment outcome. Follow-up questionnaires were sent to dentists in cases where treatment outcome could not be determined from the radiographic material. Clinical evaluation was not possible as the patients were no longer associated with the clinic where they were treated. The cases were categorized into six groups: (A) no treatment; (B) orthodontic treatment; (C) surgical exposure of the second molar; (D) removal of the third molar; (E) removal of the second molar; and (F) other treatments. The various treatment choices performed during 1985–2005 showed acceptable results in 66 of the cases. In 23 cases, the results were unacceptable. In 37 cases, the radiographic material could not document the outcome nor was evaluation of the final outcome possible due to the patient's young age. Remarkable are the high percentages of unacceptable treatment outcome, 25.9% in group D (removal of third molar) and 23% in group E (removal of second molar). As the material was collected before new advanced methods of surgical uprighting and new methods of orthodontic uprighting had been introduced, these percentages are expectedly lower today. Even so, it is highly recommended to focus especially on these two groups in future studies on treatment outcome.     

Duration of orthodontic treatment in conjunction with orthognathic surgery

Patients considering undergoing combined orthodontic-orthognathic treatment for correction of malocclusion require appropriate information, particularly with respect to duration of treatment. The primary aim of this study was to determine the duration of orthodontic treatment carried out in conjunction with orthognathic surgery and to analyze the influence of selected explanatory variables. A further aim was to compare the duration of orthodontic treatment in patients treated by orthodontists at Link?ping University hospital orthodontic clinic and six regional orthodontic clinics. This is a retrospective study, based on data from the orthodontic records of patients who had undergone orthognathic surgery at the University Hospital Maxillofacial Unit in Link?ping, Sweden, from 2000 to 2005. The subjects comprised 207 out of 233 patients (107 women and 100 men), aged 15.8-56.9 years, median 24.2 years at the time of surgery: 26 patients were excluded, either diagnosed with a syndrome, or because it was impossible to follow up the entire treatment. 59 subjects had undergone orthodontic treatment at the University hospital orthodontic clinic and 148 at the 6 regional orthodontic clinics. The variables recorded were gender, malocclusion, the number of appointments (scheduled and emergency) and treatment setting. The median value for pre-operative orthodontic treatment time was 19.2 months (range 2.4-68.4); for postoperative orthodontic treatment 4.6 months (range 0-18.8) and for total orthodontic treatment 27.8 months (range 5.9-79.1). For the University hospital orthodontic clinic, pre-operative (16.7 months) and total orthodontic treatment times (25 months) were significantly shorter than for the regional clinics; the duration of postoperative treatment was significantly longer (4.1 months). No other explanatory variables had a significant influence on the duration of orthodontic treatment. Compared with the regional orthodontic clinics, there were significantly fewer scheduled appointments at the University hospital orthodontic clinic, but no significant difference in emergency attendance.     

Questionnaire investigation after orthodontic treatment in patients with unilateral cleft lip and palate: An inter-clinic collaborative study

Purpose

This six-clinic collaborative study collected patient opinions after orthodontic treatment, for quality improvement.

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。     

Impact of malocclusion on oral health–related quality of life in young adults

Objective:To assess oral health–related quality of life (OHRQoL) in young adult patients with malocclusion and to measure the association between orthodontic treatment need and OHRQoL.Materials and Methods:The study sample comprised 190 young adults aged 18 to 25 years who were attending orthodontic clinics at the Faculty of Dentistry. The Index of Orthodontic Treatment Need-Dental Health Component was used to measure orthodontic treatment need. Each participant was assessed for OHRQoL before and after treatment by using the Oral Health Impact Profile, Chinese version (OHIP-14).Results:Patients who had little or no, borderline, and actual need for orthodontic treatment represented 21.6%, 50.5%, and 27.9% of the total sample, respectively. OHRQoL (total OHIP-14 score and score for each domain) improved after treatment (P < .05). Significant differences in summary OHIP-14 scores were apparent with respect to orthodontic treatment need. Participants with high treatment need reported a significantly greater negative impact on the overall OHRQoL score. The greatest impact was seen in the psychological discomfort domain and the psychological disability domain.Conclusion:Malocclusion has a significant negative impact on OHRQoL. This is greatest for the psychological discomfort and psychological disability domains. The orthodontic treatment of malocclusion improves OHRQoL of patients.     

Dental abnormalities, bone graft quality, and periodontal conditions in patients with unilateral cleft lip and palate at different phases of orthodontic treatment.

OBJECTIVES: To evaluate the dental and periodontal condition of patients with unilateral cleft lip and palate (UCLP) before orthodontic treatment and evaluate whether the dental and periodontal condition of these patients during and after orthodontic treatment was jeopardized by the duration of the orthodontic and surgical treatment. DESIGN: Seventy-five individuals with UCLP (52 males, 23 females), between ages 8 and 20 years, participated in a retrospective study during their final follow-up visit with regard to dental abnormalities, such as hypodontia, external root resorption, crown and root malformation, and supernumerary teeth. Alveolar bone height and periodontal attachment loss on the cleft side were also screened before or after bone grafting and at different stages of orthodontic treatment. RESULTS: Hypodontia of the lateral incisor was found in more than 50% of the patients on the cleft side. Second premolars and/or lateral incisors outside the cleft area were missing in 27.2% of the patients. In 32%, malformations of the teeth near the cleft were noticed. In general, the teeth around and in the cleft of the patients showed normal septal bone heights and a healthy periodontium. Sixty of the 75 patients received a bone graft to restore the interrupted alveolar process. In 93.3% of these patients, the cleft was grafted before the eruption of the canine. CONCLUSION: The periodontium of the teeth in and around the cleft in patients with UCLP observed during and after orthodontic treatment can cope relatively well with the long orthodontic treatment and combined surgical interventions. The children, who had not yet started treatment, also showed enough bone support and no periodontal problems of the teeth besides the cleft. Early secondary bone grafting seems to give optimal periodontal results.     

MRI of TMJ in patients with severe skeletal malocclusion following surgical/orthodontic treatment

The aim of this study was to evaluate temporomandibular joints (TMJ) by magnetic resonance imaging (MRI) in patients who had undergone surgical/orthodontic or orthodontic treatment in a three-year follow-up study. Subjects consisted of 20 patients (40 TMJ), 16 females and four males (mean age 33.7 years, range 19-53 years), with severe temporomandibular disorders (TMD) referred to the Oral and Maxillofacial Department at Oulu University Hospital due to skeletal jaw discrepancy. All patients underwent extensive surgical/orthodontic or orthodontic treatment between 1996 and 2003. Clinical stomatognathic examination and MRI examinations were performed before the surgical/orthodontic or orthodontic treatment and one year after the completion of the treatment. The average treatment time was 23 months (range 12-34 months). MRI revealed a marked decrease, especially in the number of TMJ with joint effusion after the treatment. There were only a few changes in the number of diagnosed disk dislocations before and after the treatment. In five joints with anterior disk dislocation with reduction (r-ADD), a change to anterior disk dislocation without reduction (nr-ADD) was found. In 25 of the 40 condyles, the condylar configuration was normal on MRI before the treatment and in 19 condyles one year after the treatment. TMD signs and symptoms according to the Helkimo dysfunction index showed a statistically significant decrease after the treatment.     

Spider Screw: skeletal anchorage system

The stability of the anchorage unit plays a very important role in orthodontic control. Controlled orthodontic movements such as retraction and/or protraction of teeth and intrusion of overerupted teeth are very difficult to achieve without patient cooperation and without causing undesirable reciprocal movement in the anchorage unit. The article describes characteristics, surgical procedure, and clinical use of the Spider Screw as an ideal non-dental and non-cooperation based anchorage system. The Spider Screws are self-tapping, titanium mini-screws with immediate loading capability. Their utilization involves a simple biomechanical principle combined with the utilization of minimum orthodontic mechanotherapy. Ideal orthodontic forces (in the range from 50 to 250 gr) can be applied to achieve the desired orthodontic movements. Complete osteointegration is neither expected nor desired with this anchorage system. The Spider Screw anchorage system can be used to support a variety of orthodontic movements specifically in clinical situations involving incomplete dental arches and limited cooperation as in many adult orthodontic cases. The ease of surgical placement combined with the reduced dimension of the Spider Screw diameter equally permits its use in clinical situations where anchorage recovery is necessary during treatment of complete dentitions in classical orthodontic therapy.     

A case-control study of temporomandibular disorders: symptomatic disc displacement

This case-control study was designed to investigate the risk factors for disc displacement (DD) without myofascial pain (MFP). The study population included 59 cases with DD without MFP, selected in two hospital dental clinics, and 100 concurrent controls selected in one of these clinics. The association with DD was evaluated for bruxism, head-neck trauma, orthodontic treatment, and sociodemographic characteristics by using unconditional logistic regression. In the multivariate analysis, excluding psychological factors, an association was found between DD and clenching-grinding (OR=3.57; 95% CI: 1.27-9.98). This association persisted when anxiety (OR=3.07; 95% CI: 1.08-8.70) or depression (OR=4.02; 95% CI: 1.43-11.31) was included in the model. A positive association was noted between orthodontic treatment and DD (OR=3.10; 95% CI: 1.06-9.65). The effect between orthodontic treatment and DD remained and increased with the inclusion of anxiety (OR=3.65; 95% CI: 1.15-11.61) or depression (OR=3.20; 95% CI: 1.06-9.65). A high level of anxiety (OR=2.40; 95% CI: 1.01-5.73), was positively related to DD. We concluded that clenching combined with grinding, and orthodontic treatment are factors related to DD. The interpretation of these associations, however, requires caution because of the inclusion of prevalent cases.     

Treatment of a Class III anterior open bite malocclusion: a combined orthodontic and orthognathic surgical approach.

Case report of an adult Caucasian female aged 23 years and nine months who complained of some difficulty in chewing and talking. Patient was diagnosed to have a mild Class III skeletal malocclusion with an anterior open bite of 4 mm. Treatment included combined orthodontic and orthognathic surgical approach. Surgery included surgically assisted maxillary expansion, advancement and impaction, a mandibular setback and a vertical, antero-posterior reduction genioplasty. The present case report illustrates a coordinated orthodontic and orthognathic surgical approach in the treatment of skeletal open bite deformities.     

Orthodontic Treatment Following Orthognathic Surgery: How Long Does It Take and Why? A Retrospective Study

PURPOSE: This study was conducted to examine the duration of postoperative orthodontic treatment of patients who underwent combined orthodontic and orthognathic treatment and investigate factors that might influence this, to assess the strength of association between preoperative and postoperative orthodontic treatment duration, and to perform a retrospective power calculation to assess the likelihood of this study detecting a clinically significant (weeks) difference. PATIENTS AND METHODS: Records of patients who had undergone combined orthodontic and orthognathic treatment between 1998 and 2003 (n = 69) were obtained from 3 consultant orthodontists at 3 major hospitals in Leeds, UK. The duration of postoperative orthodontic treatment was calculated as the date of the operation to the date of fixed appliance removal. Variables investigated included patient age and gender, malocclusion, type of operation, presence of open bite, extractions (excluding third molars), hospital, operator, missed appointments/breakages and debonding, and retainer arrangements. RESULTS: The median duration of postoperative treatment was 7.5 months (range, 5 to 11 months). None of the variables clearly affected this duration; no correlation was found between preoperative and postoperative treatment times (r(s) = -.07; P > .05). A retrospective power calculation demonstrated a 57.5% likelihood of this study detecting a difference of 8 weeks between 2 groups. CONCLUSIONS: Patients should be informed that the postoperative orthodontic phase of combined orthognathic-orthodontic treatment may last approximately 5 to 11 months. No association was found between preoperative and postoperative treatment duration. Many more patients will have to be recruited to assess whether specific variables result in a clinically significant difference in treatment duration.     

Traumatic ulcers and pain during orthodontic treatment

In the present investigation the frequency of oral ulcers and pain in 161 orthodontic patients was recorded. Of all patients, 95% had experienced pain, but 84.5% said that the pain lasted a few days only. About 11% maintained that the treatment was constantly painful. Significantly more patients coming from private clinics complained of pain than those attending treatment at the Department of Orthodontics. About 50% said that activating or changing archwire was most annoying, whereas 28.7% said ulceration and 21% said headgear was the most annoying part of the treatment. According to 75% of the patients, sleeping habits were not influenced. Only eight patients reported truancy, and seven of these had done this only once. Of all patients, 6.2% had requested interim visits. Small wounds caused by the fixed appliance were reported by 75.8% of the patients, and 2.5% had suffered badly from ulceration caused by the fixed appliances. More girls than boys reported ulceration. There was a significant sex difference as regards recurrent aphthous ulceration (RAU). Increase in the frequency of RAU was reported by 23.1% of the girls and 9.6% of the boys while they had fixed appliances.     

正畸配合根尖下截骨术治疗严重双牙弓前突的临床研究

目的探讨骨性双牙弓前突患者经正畸正颌联合治疗后,颌面部硬组织、软组织在矢状方向上的变化及其相互关系,为临床矫治方法的选择提供参考。方法临床选择10例安氏Ⅰ类重度骨性双牙弓前突符合正颌手术的患者,术前正畸矫治完成后实施上、下前颌部截骨后退术（术中去除上下第一前磨牙牙骨块）,术后进一步正畸治疗以改善咬合关系。通过手术前后头影测量分析,比较颌面部硬组织,软组织在矢状方向上后退量及其相互关系。结果10例重度骨性双牙弓前突患者,经正畸一正颌联合矫治后,效果非常显著。上颌切牙平均后退7．13mm,上颌牙槽骨平均后退6．48mm,上颌软组织唇突点平均后移5．66nm。上颌硬、软组织后退的比例为1：0．87;下颌切牙平均后退6．62mm,下颌牙槽骨平均后退6．91mm,下颌软组织唇突点平均后移5．89mm。硬软组织后移的比值为1：0．85。结论重度骨性的双牙弓前突患者,应首选正畸正颌联合治疗,可彻底纠正前突的面型,上、下颌的硬软组织显著的内收,达到十分满意的疗效。     

Methods used to evaluate growth modification in Class II malocclusion

The methods used to study growth modification in orthodontic patients can have considerable impact on the conclusions that may be drawn. Because of the large "between-patient" variation and small mean changes usually observed, apparent differences in response may sometimes be more attributable to study design than to treatment effectiveness. A systematic review of four major orthodontic journals (1980 to 1987) identified 50 studies reporting treatment of young patients with Class II malocclusion. Variables defined to classify the studies included appliance systems, patient selection, comparison groups, research design, data collection, analysis, and reporting. The appliance systems most frequently investigated were the function regulator and the activator, used with and without headgear. Only 11 (22%) studies were prospective, and random assignment to alternative treatments was never used in this sample. Comparison groups used in 76% of the studies were untreated Class II patients (n = 18) and/or patients with alternate appliance systems (n = 17). In only 24% of the reports were groups tested for pretreatment equivalence. Few studies reported fully how patients had been selected, how decisions had been made to discontinue or change treatment, or whether patients had been lost to study. While most studies reported "p values," in only four were alpha levels adjusted for the number of tests (type I error), and no study included a post beta estimate (type II error). Age, sex, maturation, and duration of treatment were usually reported but seldom adjusted for in the analyses. Given the multiple indices of treatment effect, the generally small sample sizes, weak research designs, and incomplete reporting of important data, we cannot yet conclude whether orthodontic treatment influences the growth of Class II patients.     

骨性Ⅱ类错(牙合)畸形患者侧貌相关分析及正畸正颌联合治疗后组织变化

目的 通过研究颌面部软硬组织变化情况来了解正畸-正颌联合治疗对骨性Ⅱ类错(牙合)畸形患者的疗效,并分析患者软硬组织之间的相关性,为联合治疗技术提供参考和指导.方法 选择23例骨性Ⅱ类错(牙合)畸形患者,分别在正畸-正颌联合治疗前后影像学资料中选取21项能够反映颌面部软硬组织、侧貌形态的参数进行对照分析,并对治疗前患者软硬组织进行相关性分析.结果 骨性Ⅱ类错(牙合)畸形患者治疗后相比治疗前所有参数中除ANS-Me/N-Me(%)、Pg-Pg′(mm)外,余下19项参数差异均有统计学意义(P<0.05);通过将患者治疗前的硬组织指标及其软组织侧貌美学指标进行相关性分析,可发现侧貌美学受很多硬组织参数影响.结论 正畸-正颌联合技术对于骨性Ⅱ类错(牙合)畸形的改善成效明显,骨性Ⅱ类错(牙合)畸形患者硬组织面型构成软组织面型的基础和支架,同时软组织也具有一定的独立性.     

Temporomandibular dysfunction in patients treated with orthodontics in combination with orthognathic surgery

Fifty-two patients with malocclusions underwent orthodontic treatment in combination with orthognathic surgery involving a Le Fort I and/or sagittal split osteotomy. Approximately 5 years after surgery, the patients were examined for signs and symptoms of temporomandibular disorders (TMD). The frequencies were found to be low in comparison with epidemiological studies in this field. The aesthetic outcome and chewing ability were improved in most patients (about 80 per cent). Some of the patients had reported recurrent and daily headaches before treatment. At examination, only two patients had reported having a headache once or twice a week, while all the others suffered from headaches less often or had no headache at all. Eighty-three per cent of the patients reported that they would be prepared to undergo the orthodontic/surgical treatment again with their present knowledge of the procedure. This study shows that orthodontic/surgical treatment of malocclusions not only has a beneficial effect on the aesthetic appearance and chewing ability, but also results in an improvement in signs and symptoms of TMD, including headaches.     

Combined space management through Delaire/Joos osteotomy and postoperative orthodontic treatment. A retrospective longitudinal study

The diagnostic records of all patients who had undergone Delaire/Joos osteotomy with mandibular setback at the Muenster University Hospital (period 1995-2000, n=22) were used for space management evaluation in the context of combined surgical-orthodontic treatment.Twenty-eight dental spaces were present prior to the start of treatment and 14 were created by extracting teeth as a pretreatment measure. In two patients, unilateral setback was performed according to Obwegeser/Dal Pont. Thus, 42 tooth-bounded spaces were present at the time of Delaire/Joos osteotomy with mandibular setback, most of them in the first molar region, followed by the second premolar region. A significant space reduction was achieved by the surgical intervention, but not by the subsequent orthodontic treatment.The best results with respect to complete space closure by orthognathic surgery/orthodontic treatment without the need for subsequent prosthetic rehabilitation were recorded in the second premolar region. In the absence of spaces and with a similar long-term prognosis for all potentially extractable teeth and adequate space for the necessary surgical repositioning, the second premolars should therefore be regarded as the 'extraction teeth of choice' for mandibular setback within the context of Delaire/Joos osteotomy.