Search Results (22)

Background/Objectives: Down Syndrome (DS) is frequently associated with oral-motor dysmorphologies, like oral hypotonia, tongue protrusion, short palate, and malocclusion, compromising the oral functions of sucking, chewing, swallowing, and speech production. Therapeutic interventions with stimulating palatal plates (SPP) have been proposed to prevent and improve oral-motor dysmorphologies in DS. This study proposes a new digital workflow for the manufacturing and use of a modified SPP. Methods: We report the application of the new workflow to five clinical cases, all infants with DS showing oral-motor disorders, aged between 5 and 11 months. The workflow is described step-by-step, from the mouth scanning protocol and model printing to SPP manufacturing and delivering, and assessment of oral-morphological features and language abilities via video captures and parental questionnaires. Key novel features include an SPP with an acrylic extension with a pacifier terminal and, importantly, the use of an infant-friendly intraoral scanner. Results: The new workflow had good acceptability by infants and parents, offering a safe, easy-to-implement, and feasible solution for SPP design, as it avoided the high risks associated with impression materials. It also supported the use of the SPP to promote tongue stimulation, retraction, and overall oral-muscle function in oral-motor disorders in children with DS, especially in infants. Conclusions: Within the limitations of the current study, it was shown that the proposed digital workflow constitutes a viable and infant-friendly approach to the production and use of a modified SPP, and thus promises to contribute to improving oral morphology and auditory-motor language abilities. Full article

One of the most common malocclusions encountered in everyday practice by orthodontists is skeletal Class II malocclusion, namely a protrusion of the maxilla, a retrusion of the mandible or a combination of both. To correct it, many clinicians use functional devices that guide the mandible into a more forward position. This stimulates bone growth, correcting the skeletal discrepancy. Controversy exists as to whether these appliances accelerate the growth rate, helping the mandible reach its final size earlier, or whether the growth of the mandible is observed as a positive response to the stimuli. This study examined whether the protrusion of the mandible in rats accelerates the growth rate or increases the overall growth of the mandible in the long run. Relapse was also assessed by removing the appliance prior to the end of the experiment. Seventy-two four-week-old Wistar rats were used. The treatment group, which consisted of 36 rats, had a device fitted on their upper incisors that led to a protrusion of their mandible. The device, a bite-jumping appliance, consisted of an iron-cast inclined plane and was fitted for 24 h a day, inducing a 3.5 mm anterior protrusion and 3 mm inferior displacement of the mandible. The control group consisted of 36 rats that were fed the same soft diet as the treatment group. Both groups were divided into three subgroups. The first was sacrificed 30 days after the onset of the experiment, the second at 60 days, and the last subgroup had the appliance removed for 30 days and was sacrificed 90 days after the onset of the experiment. At the beginning of the experiment, as well as at each time interval prior to the sacrifice of the animals, the appliances were removed, and cone beam-computed tomography was performed on every animal. Linear measurements were made on each 3D scan, measuring the growth of the mandible. Measurements of mandibular growth were higher compared to the control group. For instance, Gonion-Menton was 1.18 mm higher on month 2 compared to month 1 in the control group, whereas the same measurement marked a 1.82 mm difference in the experimental group. Condylion–Menton on the same intervals marked a 0.84 mm difference in the control, whereas a 1.35 mm difference was noted in the experimental group. Given the results, true mandibular growth is achieved using functional appliances for Class II malocclusion correction in rats. Full article

This study aimed to evaluate the impact of Twin Block appliance therapy on skeletal, dentoalveolar, and facial soft tissue characteristics. The study included 18 participants with Class II skeletal malocclusion who were treated with the Twin Block appliance. Lateral cephalograms and 3D face scans were analyzed before and after therapy for each participant. Dependent t-test results showed a significant increase in the protrusion of the lower incisors (p < 0.001), proclination of the lower incisors (p = 0.021), SNB (p = 0.005), Ls:E (p = 0.040), mandibular length (p < 0.001), and soft tissue mandible length (p < 0.001) and a significant decrease in the ANB (p = 0.003), Wits (p = 0.001), ANPG (p = 0.001), overbite (p = 0.001), and the retrusion of upper incisors (p = 0.002). Twin Block therapy caused changes in skeletal and soft tissue characteristics. The increase in the SNB angle and mandibular length, accompanied by the decrease in the ANB and Wits values reduced the skeletal discrepancy. The reduction in the ANPG indicated an improvement in the skeletal profile. Additionally, the increase in the soft tissue mandible length and distance between the upper lip and E-line contributed to improved esthetic soft tissue profile characteristics. Full article

Background/Objectives: This study evaluates the diagnostic and referral skills of final-year dental students at Al-Iraqia University using a questionnaire based on malocclusion cases ranging from mild to severe. Methods: The questionnaire, featuring photos and radiographs of five selected treated cases from two textbooks, was answered by 165 students who were asked to assess each case and determine whether orthodontic or surgical treatment was necessary, as well as to identify factors contributing to an unesthetic profile, such as irregular teeth. Frequency distribution and the Chi-square test were used for statistical analysis. Results: The results indicated good overall clinical competence. The unesthetic profile and irregular teeth were the main reasons for referring both Class II and III cases for surgery, with mandibular retrusion being the most common factor in aesthetic concerns. Maxillary protrusion was less frequently selected as a key factor in Class II malocclusion cases. Conclusions: The findings suggest that students demonstrated a high level of diagnostic accuracy in identifying treatment needs for various malocclusion cases. Full article

Objectives: This study aimed to explore the association between the ANB angle and mandibular bone thickness in individuals with skeletal malocclusion. Methods: We analyzed 224 adults, with a gender imbalance noted (68 men and 156 women), and an age range between 18.0 and 65.1 years. The thicknesses of the ramus (RT) and the body of the mandible (BT) were measured at 25 sites on each side (left and right) of the jaw, using CT images. The main focus was on the statistical associations between the ANB angle and the ratio (BT-RT)/volume of the mandible (V). Results: Results revealed a significant negative association between (BT-RT)/V and the ANB angle (p < 0.001), while a positive association was found for RT/V (p < 0.001). No significant association emerged for BT/V. Conclusions: The findings indicated that with increased mandibular protrusion, the ramus thickness decreased, whereas the body thickness remained unchanged. The differing relationships in mandibular thickness underscore the significance of CT imaging in predicting craniofacial growth patterns, particularly in observing discrepancies between the mandibular body and ramus as they relate to the anterior–posterior jaw relationship. Full article

Background. The impact of tongue protrusion forces on the formation of malocclusions is well documented in academic literature. In the case of bone dehiscence of the buccal wall in front of the lower frontal teeth, this process may be even more pronounced. Augmentation with 3D customized allogenic bone blocks (CABB) has been proposed as a potential solution for treating such defects. The objective was to assess the impact of bone block adjustment accuracy on the resistance of teeth to protrusion forces at various stages of alveolar bone loss. Methods: A finite element analysis (FEM) was conducted to ascertain whether augmentation with a CABB will result in increased resilience to tongue protrusion forces. Three-dimensional models of the mandible with dehiscenses were created, based on the dehiscences classification and modification proposed in the journal by the authors of regenerative method. The models feature a CABB positioned at three different distances: 0.1 mm, 0.4 mm, and 1.0 mm. The material parameters were as follows: bone (homogenous, isotropic, E = 2 GPa), teeth (E = 20 GPa), periodontal ligament (E = 0.44 MPa), and membrane between bones (E = 3.4 MPa). A tongue protrusion force within the range of 0–5 N was applied to each individual frontal tooth. Results: The use of an CABB has been shown to positively impact the stability of the teeth. The closer the bone block was placed to the alveolar bone, the more stable was the result. The best results were obtained with a ¼ dehiscence and 0.1 mm distance. Conclusions: The protrusive forces produced by the tongue might not be the biggest one, but in a presence of the bone loss they might have serious results. Even shortly after the surgery, CABB has a positive impact on the incisor resilience. Full article

Background/Objectives: Skeletal Class III malocclusion (Cl III) presents a significant orthodontic challenge, particularly in growing patients, requiring interceptive treatment to achieve effective functional and aesthetic correction. This review aims to compare various orthopedic devices and therapeutic protocols used in Cl III correction, identifying the most effective options in an interceptive context. Methods: We searched the PubMed, Scopus, and Web of Science databases for studies published between 1 January 2003, and 19 July 2023. Inclusion criteria included English language, human studies, open access, and studies addressing Cl III correction with interceptive orthopedic devices. Results: Exclusions included in vitro, animal, off-topic studies, reviews, meta-analyses, and articles in languages other than English. After removing duplicates, 30 articles were selected from a total of 1193 results. Conclusions: The application of orthopedic devices in growing patients can lead to rapid improvement of Cl III malocclusion, although each device has specific effects on the surrounding skeletal structure. Full article

This retrospective study compared Class II orthodontic non-extraction treatment using Carriere Motion Appliance (CMA) and Twin Block (TB) appliances. Methods: The treatment of 38 patients was assessed. Pre- and post-treatment cephalometric radiographs were analyzed to evaluate skeletal, dental, and soft tissue treatment outcomes and efficacy. Results: Both appliances effectively corrected the Class II molar relationship. When measured at the distal aspect of the first molar, TB achieved 4.22 mm, while CMA had a 2.55 mm correction. When measured in the mesial aspect, the CMA achieved a 3.9 mm correction. The changes in SNB and ANB were statistically significant only in the TB group. The CMA appliance demonstrated statistically significantly less protrusion of the mandibular incisors and less upper incisor retrusion without vertical changes compared to the TB appliance. The TB demonstrated statistically significant lower lip protrusion compared to the CMA. Conclusion: The CMA corrects Class II malocclusions only by exerting a dentoalveolar influence and does not demonstrate the added effects associated with TB, such as elongation of lower facial height (LFH) and less loss of lower anchorage. Nonetheless, the correction in the TB group comprised both dentoalveolar and skeletal components. The CMA promotes a multidirectional upper and lower molar movement, and despite our 2D cephalometric analysis, we were able to estimate the extent of upper molar derotation. Full article

Study Design: The purpose of this study was to do a retrospective analysis about patients with mandibular fracture who were treated at the department of Maxillofacial Surgery, Regional University Hospital of Ancona, Italy, between 2011 and 2021. Objective: In this study we evaluated clinical and epidemiological findings of mandible fractures focusing on the association between surgical timing, type of surgical approach and mid- and long-term outcomes. Methods: Patients were evaluated based on various parameters including age, sex, etiology, symptoms, comorbidity, clinical findings, mandible fracture type, other facial fractures, treatment, waiting time before the operation, complications and sequelae. In the period described, we recorded 1023 mandibular fractures. 93% of patients underwent surgery under general anesthesia, almost exclusively patients undergoing an open approach to internal fixation. Results: Of the patients, 684 were male (66.86%) and 339 were female (33.13%). The average age of the patients was 42, 38 years (range, 7–94 years). The leading cause of these fractures was traffic accidents (27.3%) and mandibular parasymphysis fractures were the most frequent (34.1%). The most common clinical signs and symptoms were malocclusion, difficulty in chewing, limitation of the buccal opening, hypoesthesia extending through the territory of the inferior alveolar nerve, difficulty in protrusion movements and mandibular lateralization. Conclusions: The continuous research in epidemiology, etiology, materials, and techniques will further refine the treatments of mandible fractures, which are nowadays more and more customized according to the type of trauma. Full article

Protrusion can occur after correction of the anterior crossbite in Class III malocclusions. Four-premolar extractions might be indicated if the patients asked for a profile reduction. Two similar Class III anterior crossbite cases illustrate how the skeletal anchorage can prevent protrusion after anterior crossbite correction and the need for four- premolar extractions, as in the first case. The use of extra-radicular miniscrews at the infrazygomatic crest and buccal shelf are recommended for whole arch distalization of the maxillary and mandibular arches to reduce protrusion after anterior crossbite correction. It is an effective and efficient treatment alternative to extraction therapy for the protrusion after anterior crossbite correction. Long-term follow-up records show encouraging results supporting this paradigm shift in anterior crossbite correction with extra-radicular miniscrews. Full article

Adequate alveolar bone volume is a prerequisite condition for successful orthodontic tooth movement and posttreatment stability. Mandibular anterior teeth are more likely to exhibit dehiscence and fenestration in adult patients, which make orthodontic treatment in adults challenging, especially when the amount of retraction of the anterior teeth is large. Herein, we report the treatment of augmented corticotomy only on the lingual side in the mandibular anterior region to increase the volume of soft and hard tissue assisting orthodontics in a Class I bialveolar protrusive malocclusion and propose management strategies of mandibular incisor retractions. A 22-year-old female with a chief complaint of protrusive mouth presented to the Department of Orthodontics for orthodontic treatment, diagnosed with Class I bialveolar protrusive. The orthodontic treatment plan involved the extraction of four premolars and extensive retraction of the anterior teeth using microimplant anchorage. In consideration of the fenestration and dehiscence in the mandibular anterior alveolar bone and the pattern of tooth movement, augmented corticotomy was performed on the lingual side combined with bone grafting. Clinical and radiographic evaluation after treatment revealed significant improvements in the facial profile and in periodontal phenotype. Augmented corticotomy assisting orthodontic treatment could be a promising treatment strategy for adult patients with alveolar protrusion to maintain periodontal health. Full article

Skeletal Class II malocclusion is the most common skeletal anomaly in orthodontics. Growth in the body of the deficient mandible is induced by periosteal apposition and endochondral ossification in the condyle. Functional appliances have been used in the correction of Class II malocclusions by inducing mandibular growth. Despite their utilization though, their effect still remains controversial. The aim of the present study is to review the existing literature regarding the effects of mandibular protrusion in mandibular growth of growing rats. A protocol was followed according to the guidelines of the Cohrane Handbook for Systematic Reviews. Databases were searched using a specific algorithm. From the ten studies finally analyzed, we conclude that the use of a functional appliance in growing rats induces cell proliferation and bone formation in their condyles, resulting in mandibular growth. Full article

Mothers practice co-sleeping and breastfeeding simultaneously, for convenience and to strengthen bonding. Due to the scarcity of studies analyzing the impact of co-sleeping on primary dentition, this study aimed to analyze the possible effects of co-sleeping on children’s occlusion. In this cross-sectional study, mothers of 221 children aged 2–5 years who had been breastfed for less than 6 months completed a questionnaire about non-nutritive sucking habits. The WHO (World Health Organization) and IOTN-AC indices (the Aesthetic Component of the Index of Orthodontic Treatment Need) were used to assess malocclusion. The type of sagittal (dental and skeletal), transverse and vertical malocclusion was recorded. The non-co-sleeping group showed significantly higher pacifier use (p < 0.05), digital sucking (p < 0.05) and atypical swallowing (p < 0.05) habits. The non-co-sleeping group showed significantly higher mean scores on the IOTN-AC (p < 0.05) and WHO (p < 0.01), a significantly higher presence of canine class II (p < 0.05), anterior open bite (p < 0.05), posterior crossbite (p < 0.05), overbite (p < 0.05), skeletal class II (p < 0.01) and protrusion (p < 0.05). In conclusion, children who practice co-sleeping appear to have a lower frequency and duration of non-nutritive sucking habits. Co-sleeping may contribute to a lower development of malocclusions in children who are weaned early (before six months of age). Full article

Idiopathic mandibular condylar resorption (ICR) is a pathological condition characterized by idiopathic resorption of the mandibular condyle, resulting in a decrease in the size and height of the mandibular condyle. The purpose of this study was to characterize the maxillofacial morphology of ICR patients. Subjects were selected from patients that attended our orthodontic clinic between 1991 and 2019. Twenty-five patients were diagnosed with ICR by magnetic resonance imaging; however, growing patients were excluded. In total, 18 patients were finally selected. The control group comprised 18 healthy volunteers. Lateral and frontal cephalograms were also used. The ICR group had significantly more severe skeletal class II malocclusions than the control group, mainly due to retrusion of the mandible. In the ICR group, there was a tendency for a skeletal open bite due to a significantly larger clockwise rotation of the mandible than in the control group. There was no significant difference between the two groups in the inclination of the upper and lower central incisors or protrusion of the upper and lower central incisors and first molars. ICR patients have been suggested to exhibit skeletal open bite and maxillary protrusion with changes in maxillofacial morphology due to abnormal resorption of the mandibular condyle. Full article

Background and Objectives: Dental occlusion and gingival recession have been studied over the past years especially because of the increasing incidence of occlusal interferences in young patients. The purpose of this pilot study is to investigate any association between occlusal dysfunctions and gingival recessions. Data on gingival phenotype and previous orthodontic treatment were also collected to assess any correlation with the presence of gingival recession. Materials and Methods: Forty systemically healthy subjects, without signs of periodontitis and with gingival recessions, were included in the study. The following parameters were determined: location and extent of the gingival recession, gingival phenotype and functional occlusion by means of observing and registering the occlusal contacts in maximum intercuspation position, protrusive and lateral guidance. Results: Premolars were mostly affected in cases of working-side interferences during lateral guidance (71.19% of the affected teeth during left and 75% during right mandibular movements). The chi-squared exact test applied for the analysis of contingency tables revealed statistically significant associations between excursive interferences during lateral guidance and anterior guidance and the presence of gingival recession on the involved group of teeth. Conclusions: The results suggest that most gingival recessions might be associated with working-side interferences, the highest number of gingival recessions being associated with active interferences during lateral guidance. Full article