Influence of anterior occlusal characteristics on self-perceived dental appearance in young adults

OBJECTIVE: To determine the individual and combined influence of some anterior occlusal characteristics on self-perceived dental appearance in a sample of young adults. MATERIALS AND METHODS: This cross-sectional study was conducted at a dental clinic of a private university in Lima, Peru. A total of 267 first-year students (16 to 25 years old) were randomly selected. A visual analog scale (VAS) was used to determine the self-perceived dental appearance. Clinical examinations were conducted to determine incisal irregularity, anterior dentoalveolar spacing, midline diastema, anterior missing teeth, overjet, and overbite. Simple and multiple linear regression analyses were performed to determine the individual and combined influence of each anterior occlusal characteristic on self-perceived dental appearance. RESULTS: From the eight occlusal characteristics and two covariables evaluated, only maxillary and mandible incisal irregularity (P=.001 and .002 respectively), presence of anterosuperior spacing (P<.001), and number of missing anterior teeth (P=.003) were inversely associated with self-perceived dental appearance, whereas gender (male) was directly associated to the dependent variable (P=.021). Specifically, anterior maxillary spacing, maxillary incisal irregularity, mandible incisal irregularity, and the number of missing teeth were, in that order, the anterior occlusal characteristics with the most negative influence on self-perceived dental appearance. CONCLUSIONS: This study confirmed that occlusal characteristics in the anterior portion of the mouth play a role on dental esthetics. However, it should be emphasized that their grouped influence is minimal (less than 20%).     

Temporomandibular joint dysfunction and occlusion in the mixed and permanent dentition

The aim of this study was to investigate the relation between occlusal factors: Angle classification, overbite, overjet, openbite, anterior and posterior crossbite, scissors bite or buccal crossbite and lateral openbite--and the presence of mandibular dysfunction in a sample of 359 Turkish children with mixed and permanent dentition. Z Test was used to compare the results. It was found that, Class III malocclusion in the permanent dentition and openbite, overbite = 0, overjet = 0, anterior-posterior crossbite in the mixed dentition were related with TMD.     

Psychosocial implications of malocclusion among 12-18 year old secondary school children in Ibadan, Nigeria.

The main purpose of this study was to analyze the current psychosocial implications of malocclusion in Ibadan, Nigeria. The study sample comprised 614 secondary school children (327 males and 287 females) aged 12-18 years (mean age, 14.9 +/- 2.9 SD) who filled in a questionnaire containing general questions about body image and specific inquires concerning self-perception and social implications of dental appearance. The children's occlusions were also assessed using the Dental Aesthetic Index (DAI) and the malocclusion traits related to body image, self-perception, and social implications of dental appearance. Subjects with malocclusion rated only the teeth significantly least satisfactory among other twelve items of body image. The lowest rating was observed in subjects with crowding of the maxillary and mandibular incisor segments. Highly significant differences (P < 0.001) were found between subjects with normal or minor malocclusion and those with marked malocclusion in indicating awareness of malocclusion, dissatisfaction with the appearance of the teeth, and unfavourable appearance of the teeth compared with those of peers. Schoolmates' teasing occurred significantly more often in the presence of malocclusion (P < 0.001). Unfavourable perceptions of the teeth were expressed significantly more often by subjects with anterior maxillary irregularities of up to 1 mm and more, spacing of both maxillary and mandibular incisor segments, midline diastema, crowding (especially of the mandibular incisor segment), anterior open bite and molar relation deviations. It was concluded that certain malocclusions, especially occlusal and space anomalies, may adversely affect body image and self-concept of Nigerian adolescents.     

骨性Ⅲ类下颌偏斜成人上颌牙列垂直特征的研究

目的 通过锥体束CT(cone-beam computed tomography,CBCT)研究骨性Ⅲ类下颌偏斜者双侧上颌牙列垂直向特征及其与下颌偏斜间的关系.方法 选取成年骨性Ⅲ类下颌偏斜患者21例(男10例,女11例),测量有关下颌骨偏斜和上颌牙列垂直向测量指标,双侧进行配对t检验或配对秩和检验,下颌偏斜指标与上颌...     

Lower premolar extraction/removable plastic Herbst treatment for mandibular retrognathia

The patient was a 12-year-old girl with a Class I malocclusion characterized by maxillary arch width constriction, dental crowding, and mandibular retrognathia. Treatment goals related to the chief compliant were anterior mandibular repositioning, maxillary arch expansion, and dental alignment. Because the preexisting overjet was minimal and prevented adequate anterior repositioning of the mandible, lower first premolar extraction was recommended to increase the overjet and allow greater anterior repositioning. Treatment was divided into four stages: (1) extraction of mandibular first premolar teeth, alignment, space closure, and an increase in the overjet, (2) anterior mandibular repositioning with a removable plastic Herbst appliance, (3) arch alignment and detailing of the occlusion with full fixed appliances and a tooth positioner, and (4) retainers. At the end of treatment, the patient had an acceptable dental alignment with a Class III molar relationship and an improvement in facial appearance.     

安氏Ⅰ类错畸形的临床分析

目的探讨安氏Ⅰ类错畸形所包含的各种错畸形。方法选择267例恒牙列安氏Ⅰ类错畸形患者,根据临床特征并结合X线头影测量,分析各种错畸形的构成比。结果①矢状向:Ⅰ类骨面型202例(75.66%),Ⅱ类骨面型45例(16.85%),其中上颌前突16例,下颌后缩30例,上颌前突合并下颌后缩1例,Ⅲ类骨面型20例(7.49%)。②垂直向:正常型99例(37.08%),高角型153例(57.30%),低角型15例(5.62%)。③安氏Ⅰ类错畸形的构成情况:牙列拥挤245例,(91.76%),牙间隙21例(7.87%),双颌前突12例(4.49%),前牙反43例(6.10%),前牙深覆盖105例(39.33%),前牙深覆110例(41.20%),其中闭锁型深覆4例,后牙反14例(5.24%),后牙正锁6例(2.25%),个别牙错位2例(0.75%),前牙及双尖牙开5例(1.87%)。结论安氏Ⅰ类错畸形临床表现多样,安氏分类法对错畸形特征的概括太笼统。     

Skeletal Class lll severe openbite treatment using implant anchorage

A female patient with a skeletal Class III severe anterior openbite was treated using miniplates as the anchorage. The patient was 15 years and 10 months of age when she reported to our university hospital with a chief complaint of anterior openbite and reversed occlusion. The patient had an anterior openbite with an overjet of -3.0 mm and overbite of -5.0 mm and a Class III molar relationship. The cephalometric analysis showed a skeletal Class III relationship (ANB 0 degrees ). After the extraction of the bilateral mandibular third molars, miniplates were placed in the mandibular external oblique line. The mandibular dentition was retracted using elastic chain and miniplates. After treatment, an Angle Class I molar relationship was achieved and overjet and overbite had become 2.0 mm and 1.5 mm. A good facial appearance and occlusal relationship were obtained. The total active orthodontic treatment period was 23 months. Wrap-around type retainers were placed on both jaws and a lingual bonded retainer was also attached in the mandibular incisors. After 1 year of retention, the occlusion was stable, and a good facial profile was also retained. The mandibular deviation to the left was improved and the strain in the circumoral musculature during lip closure disappeared. An appropriate interincisal relationship was achieved by the uprighting of mandibular dentition without changing the vertical intermaxillary relationship. A panoramic radiograph showed no marked root resorption. Our results suggest that implant anchorage is useful for correction of skeletal Class III severe anterior openbite cases.     

Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogota, Colombia. An epidemiological study related to different stages of dental development

The aim of the study was to assess the prevalence of malocclusion in a population of Bogotanian children and adolescents in terms of different degrees of severity in relation to sex and specific stages of dental development, in order to evaluate the need for orthodontic treatment in this part of Colombia. A sample of 4724 children (5-17 years of age) was randomly selected from a population that attended the Dental Health Service; none had been orthodontically treated. Based on their dental stages the subjects were grouped into deciduous, early mixed, late mixed and permanent dentition. The registrations were performed according to a method by Bj?rk et al. (1964). The need for orthodontic treatment was evaluated according to an index used by the Swedish National Board of Health. The results showed that 88 per cent of the subjects had some type of anomaly, from mild to severe, half of them recorded as occlusal anomalies, one-third as space discrepancies, and one-fifth as dental anomalies. No clear sex differences were noted, except for maxillary overjet, spacing, tooth size (all more frequent in boys), and crowding (more frequent in girls). Occlusal anomalies and space discrepancies varied in the different dental developmental periods, as did tipped and rotated teeth. Little need for orthodontic treatment was found in 35 per cent and moderate need in 30 per cent. A great need was estimated in 20 per cent, comprising children with prenormal occlusion, maxillary overjet, or overbite (> 6 mm), posterior unilateral crossbite with midline deviation (> 2 mm), severe crowding or spacing, congenitally missing maxillary incisors, impacted maxillary canines or anterior open bite (> 3 mm in the permanent dentition). Urgent need for treatment was estimated to be 3 per cent, comprising subjects with extreme post- and pre-normal occlusion, impacted maxillary incisors or extensive aplasia.     

Is the postretention relapse of maxillary and mandibular incisor alignment related?

Previous studies suggest a poor association between initial and postretention pattern of incisor irregularity. One explanation may be that the incisor movements are limited by the boundaries provided by the incisors in the opposite arch. If so, postretention malalignment of the maxillary and mandibular incisors may be related. To test this hypothesis, long-term postretention study models of 96 patients with acceptable occlusion at the time of appliance removal were examined. The occlusal surfaces of the postretention study models were photocopied, and tooth anatomical contact points were digitized. An algorithm was used to fit the dental arch to the digitized points. The amount of incisor rotation and anatomical contact point displacement of maxillary and mandibular anterior teeth, relative to their respective dental arches, were computer generated. Overbite, the number of occlusal contact points in the anterior segment, and concavity of the lingual surfaces of the maxillary incisors were recorded manually. Statistical analyses demonstrated a significant association (P <.05) between the overall irregularity of the maxillary and mandibular incisors. The association did not differ among subgroups that were stratified according to overbite or number of occlusal contacts. No associations were found for the overall amount of incisor rotation in the 2 arches (P >.05). The amount and direction of displacement of antagonistic pairs of maxillary and mandibular central incisors were also associated (P <.05), but not the amount and direction of rotation (P >.05). The lingual configuration of the maxillary incisors did not affect the pattern of mandibular incisor malalignment.     

A new method of evaluating posterior occlusion and its relation to posttreatment occlusal changes.

The purpose of this study was to assess the relationship between posterior occlusion and posttreatment changes in other occlusal variables. Pretreatment (T1), posttreatment (T2), and postretention (T3) records were obtained for 49 Class I (n = 23) and Class II (n = 26) extraction cases. Overbite, overjet, mandibular incisor irregularity, right and left molar deviations, midline deviation, and mandibular arch length were measured, and occlusal registrations were made of each set of dental casts. The proximity of posterior occlusal surfaces was measured as the contact or near-contact areas at or below 300 microm thickness, based on the optical densities of scanned images of the posterior occlusal registrations. The treatment changes for overbite, overjet, right and left molar deviation, and arch length were significantly greater in the Class II group, and the reductions in incisor irregularity were greater in the Class I group. No other class differences were found. Overbite, overjet, and incisor irregularity increased after treatment, and arch length continued to decrease, with no significant class differences. Contact and near-contact areas at or below 300 microm constituted 7% of the functional occlusal table for both classes at the end of treatment, having decreased significantly in both groups (21% in Class I and 29% in Class II) during treatment. Because contact and near-contact areas increased in some patients and decreased in others, there were no significant posttreatment changes. Negative correlations were found between contact and near-contact areas at T2 and changes in overjet from T2 to T3, and between contact and near-contact areas at T3 and changes in overbite from T2 to T3. No relationships were found between posterior contact and near-contact area and incisor irregularity. We concluded that (1) the area of actual and near contacts at or below 300 microm decreased significantly with treatment, indicating that, despite excellent treatment results by conventional standards, the proximity of posterior occlusal surfaces lessened; (2) the proximity of the posterior occlusal surfaces should not be expected to increase posttreatment; (3) posttreatment contact and near-contact areas may be factors in overbite and overjet stability; and (4) posttreatment contact and near-contact areas are not related to incisor irregularity.     

Association between occlusal anomalies and dental caries in 3‐ to 5 year‐old Brazilian children

Abstract

Objective: To investigate the association between certain occlusal anomalies and the occurrence and severity of dental caries in Brazilian preschool children.

Design: Cross‐sectional study.

Setting: Twenty‐eight public nursery schools in Canoas, southern Brazil.

Subjects and methods: The study population comprised 890 three‐ to five‐year‐old children. Five trained and calibrated observers examined children for determination of decayed, missing and filled tooth (dmft) index (World Health Organization criteria including white spots) and orthodontic variables.

Outcome measures: Caries severity (dmft) and caries occurrence (dmft?1).

Statistical analysis: Multivariable analysis was performed using Poisson regression with robust variance in order to determine the occlusal anomalies which represent risk factors for the occurrence of the binary outcome.

Results: Caries severity was significantly higher among children without spacing in the maxillary anterior teeth (P?=?0·001) and mandibular anterior teeth (P?=?0·003) and among children without accentuated overjet (P?=?0·023). The multivariable analysis demonstrated that children without spacing in maxillary anterior teeth had an increased risk of dental caries (prevalence ratio?=?1·43; 95% CI, 1·05–1·93). Open bite, accentuated overjet and posterior cross‐bite were not associated with this outcome in the final model.

Conclusions: Absence of spacing in the maxillary labial segment represents a risk factor for dental caries in preschool children.     

Extreme skeletal open bite correction with vertical elastics

Severe skeletal open bites may be ideally treated with a combined surgical–orthodontic approach. Alternatively, compensations may be planned to camouflage the malocclusion with orthodontics alone. This case report describes the treatment of an 18-year-old man who presented with a severe open bite involving the anterior and posterior teeth up to the first molars, increased vertical dimension, bilateral Class III molar relationship, bilateral posterior crossbite, dental midline deviation, and absence of the maxillary right canine and the mandibular left first premolar. A treatment plan including the extraction of the mandibular right first premolar and based on uprighting and vertical control of the posterior teeth, combined with extrusion of the anterior teeth using multiloop edgewise archwire mechanics and elastics was chosen. After 6 months of alignment and 2 months of multiloop edgewise archwire mechanics, the open bite was significantly reduced. After 24 months of treatment, anterior teeth extrusion, posterior teeth intrusion, and counterclockwise mandibular rotation were accomplished. Satisfactory improvement of the overbite, overjet, sagittal malocclusion, and facial appearance were achieved. The mechanics used in this clinical case demonstrated good and stable results for open-bite correction at the 2-year posttreatment follow-up.     

Early developmental traits in Class II malocclusion

The occlusal traits of Class II occlusion in the deciduous dentition include distal terminal plane of the second deciduous molars, distal canine relation, large overjet, and large overbite. Other findings are narrow upper dental arch and maxillary base and poor anterior spacing. Skeletally, Class II children differ less from normal children. The cranial base, including the base flexure, and the maxilla are normal. The mandibular corpus and lower facial height are short, the gonial angle is large, and the dentoalveolar position of the mandible is retruded. The height of the ramus is normal, as is the skeletal position of the mandible, with the exception of the chin, which becomes slightly retruded after 5 years of age. As most skeletal traits of Class II occlusion develop later than the occlusal characteristics, it is suggested that no evidence can be found for a skeletal Class II growth pattern in the deciduous dentition. The deficient transversal growth of the maxilla and the sagittal growth of the mandible seem to cause the typical Class II occlusion. Further skeletal changes are likely to develop as secondary adaptations.     

Early developmental traits in class II malocclusion

The occlusal traits of Class II occlusion in the deciduous dentition include distal terminal plane of the second deciduous molars, distal canine relation, large overjet, and large overbite. Other findings are narrow upper dental arch and maxillary base and poor anterior spacing. Skeletally, Class II children differ less from normal children. The cranial base, including the base flexure, and the maxilla are normal. The mandibular corpus and lower facial height are short, the gonial angle is large, and the dentoalveolar position of the mandible is retruded. The height of the ramus is normal, as is the skeletal position of the mandible, with the exception of the chin, which becomes slightly retruded after 5 years of age. As most skeletal traits of Class II occlusion develop later than the occlusal characteristics, it is suggested that no evidence can be found for a skeletal Class II growth pattern in the deciduous dentition. The deficient transversal growth of the maxilla and the sagittal growth of the mandible seem to cause the typical Class II occlusion. Further skeletal changes are likely to develop as secondary adaptations.     

A case report of bilateral Brodie bite in early mixed dentition using bonded constriction quad-helix appliance

Brodie bite is a comparatively rare type of malocclusion found in primary and mixed dentition. It not only adversely affects chewing and muscle functions, but also impairs normal growth and development of the mandible. This report describes the therapeutic results of a patient with bilateral Brodie bite in early mixed dentition after using a bonded constriction quad-helix appliance. The patient, a boy aged 9 years and 2 months, first visited our hospital after occlusal abnormality in the molar region was detected at a local dental clinic. Case analysis resulted in a diagnosis of bilateral Brodie bite with slight mandibular retrognathism. Treatment objectives were to reduce the arch width of the maxillary dentition and expand the mandibular arch in order to establish and stabilize molar occlusion and to achieve a Class I molar relation and appropriate overbite and overjet. Treatment comprised covering the occlusal surface of the maxillary molars with resin and attaching a bonded constriction quad-helix appliance joined with a 0.040-inch quad-helix wire. A bi-helix appliance was also fixed to the mandibular dentition. Brodie bite visibly improved after 5 months. Cervical headgear was then fitted and the patient observed until eruption of the permanent dentition was complete. Class I molar relation was achieved after 2 years and 6 months, although spacing remained in the maxillary and mandibular dentitions. Treatment of bilateral Brodie bite in mixed dentition by means of a bonded constriction quad-helix appliance attached to the maxillary dentition enabled effective bite opening and reduction in the width of maxillary arch independent of the patient's cooperation, providing good therapeutic outcome in a short time period.     

Anterior open bite--cephalometric evaluation of the dental pattern

The purpose of this study was to compare the dental pattern of patients with anterior open bite malocclusion to that of individuals with normal overbite by utilization of lateral cephalograms, panoramic radiographs and study casts. The findings showed that there was no significant difference in the inclination of the occlusal plane (SN.PlO) and position of the maxillary and mandibular incisors (1-NA, 1-NB) between both groups of individuals; but the angles of inclination of the maxillary and mandibular incisors (1.1, 1.NA and 1.NB) differed statistically between patients with anterior open bite of the individuals that presented normal overbite, which suggests that the anterior open bite may be of dental origin.     

En-masse retraction dependent on a temporary skeletal anchorage device without posterior bonding or banding in an adult with severe bidentoalveolar protrusion: seven years posttreatment

This report describes a novel concept of en-masse retraction with temporary skeletal anchorage devices in place of posterior bonding or banding. The patient was a Korean woman, aged 24 years 4 months, with a Class II Division 1 malocclusion with severe mandibular anterior crowding. Both molars showed decalcification of the cervical areas. Partial osseointegration-based C-implants and C-tube plates were placed bilaterally between the maxillary second premolars and the first molars and in the posterior mandible. These temporary skeletal anchorage devices were used as independent appliances for full retraction of the maxillary and mandibular anterior teeth 3-dimensionally without the assistance of posterior bonded appliances. The posterior occlusion was not changed during treatment, and Class I occlusal relationships with optimal overjet and overbite were achieved. The 7-year posttreatment records showed a stable result.     

Change in dentition over 20 years from third decade of life

PurposePrevious studies have documented long-term, age-related change in the teeth, dental arches and occlusion. However, very few studies have investigated longitudinal age-related change in the dentition using 3-dimensional (3-D) measurement. The purpose of this study was to clarify age-related change in the dentition using a laser scanner.Materials and methodsWe used dental casts obtained from the same subjects in their twenties and forties. Subjects were selected based on near-normal occlusion. We investigated age-related variation in the dentition using 3-D measurement.ResultsAge-related change in the dentition was characterized by a decrease in maxillary and mandibular width, an increase in maxillary length, and a decrease in mandibular length. Measurement of angulation revealed that the maxillary canines and molars were mesially inclined. We observed labial inclination of the maxillary incisors, and lingual inclination of the mandibular incisors, as well as the maxillary and mandibular canines and molars. Overjet, overbite, and the irregularity index all showed an increase, while occlusal vertical dimension showed a decrease. Multiple regression analysis indicated that lingual inclination of the lower central incisors was related to an increase in the irregularity index, and that lingual inclination of the upper canines and decrease in occlusal vertical dimension of the anterior teeth were related to increased overbite.ConclusionThe present findings showed that age-related changes in angulation and inclination of each tooth should be taken into account when providing occlusal rehabilitation or post-orthodontic retention.     

Occlusal traits in a group of school children in an isolated society in Jerusalem.

Abstract

The prevalence of occlusal features in 939 children, aged 6-13 years, belonging to an ultra-orthodox community of Jewish Ashkenazi descent living in Jerusalem was studied clinically. Sexual dimorphism was found for overjet, overbite, and habit practising. About one-quarter of the sample exhibited some degree of occlusal mutilation due to caries, thus creating a 'caries-affected' subgroup, the rest forming the 'caries-free' subgroup. In the latter set, normocclusion was scarce (7.4 per cent), Class I being the most frequent malocclusion (49.1 per cent). Caries had a significant effect on the symmetry of bilateral occlusal relationships, lower dental midline deviation, and on crowding/spacing conditions in the mixed dentition stage (except for the maxilla in late mixed dentition). The low prevalence of normocclusion can be attributed to genetic background, environmental influences and the definition attached to normal occlusion.     

Follow-up study of functional and morphological malocclusion trait changes from 3 to 12 years of age

The aim of this study was to evaluate morphological and functional malocclusion trait changes in 3- to 12-year-old children and to determine whether such functional traits at the 3, 4, and 5 years of age correlated with malocclusion severity score at 12 years of age. Two hundred and sixty-seven children (132 boys, 135 girls) were randomly selected for a follow-up study from a previous cohort of 560 subjects. Functional and morphological traits were clinically assessed. Five functional malocclusion traits: mouth breathing, atypical swallowing, thumb, pacifier sucking, and bottle feeding were assessed and evaluated. Intra-arch assessment involved measurements of incisor crowding, rotation of incisors, and axial inclination of the teeth. For inter-arch measurements, overbite, anterior open bite, overjet, reverse overjet, anterior crossbite, and buccal segment relationships were recorded. The weighted sum of recorded occlusal traits thus represented the total malocclusion severity score. The median morphological malocclusion severity score was almost the same at 3 and 12 years of age, while functional malocclusion decreased. Sucking habits (finger- or dummy-sucking, bottle feeding) until 5 years of age were statistically significantly correlated with an atypical swallowing pattern from 6 to 9 years (Spearman r = 0.178, P = 0.017), which in turn was statistically significantly correlated with the morphological malocclusion severity score (Spearman r = 0.185, P = 0.042) at 12 years of age. At an early age, the morphological severity score is related to the stage of dental development, while at a later period, malocclusion severity score is also the result of incorrect orofacial functions at an early stage of dental development.