Effizienz der skelettierten Pendulum-K-Apparatur bei der kooperationsunabhängigen Distalisation von Oberkiefermolaren : Eine klinische Pilotstudie

Purpose Conventional anchorage with exclusively intraorally anchored appliances for non-compliance molar distalization combines a palatal acrylic button with periodontal anchorage. This type of anchorage is critically discussed because of the temporary hygienic impairment of the palate and the uncertain anchoring quality of the button. A purely dentally/periodontally anchored Pendulum K appliance was developed, which is exclusively anchored via four occlusal rests. The aims of this pilot study were to examine the suitability of the skeletonized Pendulum K for distalization of maxillary molars, and to investigate the quality of this alternative anchoring modality. Patients and methods In all, 10 patients received skeletonized Pendulum K appliances attached to all maxillary premolars for bilateral molar distalization. Supporting anchorage through an acrylic button adjacent to the anterior palate was not used. The pendulum springs were initially activated on both sides with a distalization force of 220 cN each and provided with uprighting and toe-in bends. The specific force/moment system was regularly reactivated intraorally by adjustment of the distal screw. Results The study demonstrates the suitability of the skeletonized Pendulum K appliance for the distalization of maxillary molars (3.28 ± 0.73 mm). Side effects on the molars were slight distal tipping (3.50 ± 2.51°/PP, 3.00 ± 1.41°/SN) and mesial inward rotation (average 2.75 ± 7.50° and 4.50 ± 12.77°). Significant anchorage loss occurred in the form of mesialization of the incisors by 1.40 ± 0.82 mm and of the first premolars by 2.28 ± 0.85 mm. Conclusion The skeletonized Pendulum K appliance allows compliance-free upper molar distalization. Exclusively dental/periodontal anchorage resulted in a lower percentage of molar distalization compared to a conventional anchoring preparation of the Pendulum K with a palatal acrylic button. Anchorage loss had a comparatively stronger effect on the anchoring premolars but less on the incisors. Typical side effects on the molars such as distal tipping and mesial inward rotation were remarkably low

Prevalence of KIG-grades 3–5 in an orthodontic practice in North Rhine Westphalia compared with results of the DMS•6 and with KZBV data

Background and aim The prevalence of tooth and jaw malocclusions in 8- to 9-year-olds was surveyed in a nationwide setting as part of the orthodontic module of the Sixth German Study on Oral Health (DMS•6), using the orthodontic indication groups (KIG) as index. Aim of this study was the detection of the prevalence of malocclusions requiring treatment according to the KIG index in statutorily insured patients of an orthodontic practice in North Rhine Westphalia, Germany, and to compare results with corresponding DMS•6 and KZBV data. Patients and methods Between 2017–2021, n=953 statutorily insured patients called for an initial consultation and subsequent determination of the KIG-classifcation and -grades. The malocclusions were classifed and graded in the highest possible KIG-grade according to valid SHI guidelines. Multiple classifcations were not recorded. KIG-grade>3 according to the valid guidelines was detected in n=815 patients. Since the DMS•6 does not contain information on KIG classifcations "U" and "S", their inclusion was waived despite evaluation, leaving data from n=683 patients for analysis and comparison. Results During the study period, n=235 patients (34.4%) had KIG-classifcation "D". More than 10% were classifed as "K" (120 patients, 17.6%), "P" (98 patients, 14.2%), "M" (89 patients, 13.0%), and "E" (81 patients, 11.9%). Of 16 possible classifcations with KIG-grade>3, "D4" was the most common with 26.6% (182 patients). The results confrm the fndings from the multicentric DMS•6 from2021 and corresponding KZBV data from 2020. Conclusions Sagittal deviations described by classifcations "D" and "M" represent with 47.4% almost half of the malocclusions with treatment need. KIG-grade D4 is the most frequent classifcation. There were no regional deviations of the prevalence of KIG-grades 3–5 in the district of Viersen / North Rhine compared with the national average, not even when scrutinizing a fve-year-period

Outcome differences after orthodontic camouflage treatment in hypo- and hyperdivergent patients - A retrospective cephalometric investigation

Objectives To compare diferences in outcome in skeletal and dental parameters in hypo- and hyperdivergent Class II patients after extraction of upper frst premolars and comprehensive orthodontic treatment. Materials and methods 37 Class-II-patients with dental camoufage treatment were divided into a hypo- (n=18) or a hyperdivergent (n=19) group depending on the mandibular plane angle (hypo:<34° or hyper:≥34°). Lateral cephalograms were available before (T1) and after (T2) treatment and were analyzed with customized measurements. Data from a growth survey served as a control and were used to calculate the actual treatment efect. Data were analyzed by one-sample Student’s t-tests and independent Student’s t-tests. Statistical signifcance was set at p<0.05. Results The measurements showed similar changes in both groups. The efects were mainly dentoalveolar. Hypodivergent patients showed an almost equal increase in anterior and posterior facial height, while hyperdivergent patients only showed an increase in anterior facial height. Conclusions In hyperdivergent patients, the anterior facial height increases despite camoufage treatment. This indicates a tendency towards bite opening and backward rotation of the mandible. Hypodivergent patients do not experience deepening of the bite. Clinical relevance In hyperdivergent patients with upper frst premolars extraction the anterior facial height increased diferently than in hypodivergent patients. This should be considered if a bite opening is a possible contraindication to treatment

Frequency and severity of malocclusions in patients with statutory health insurance in a German orthodontic practice in North Rhine Westphalia – a multi‑part cross‑sectional study over a 20‑year period

Objective Since 2002, patients with statutory health insurance in Germany must undergo an assessment of orthodontic treatment need using the "Kieferorthopädische Indikationsguppen" (KIG; orthodontic indication groups) classifcation system. According to this system, tooth and jaw misalignment are divided into 11 subgroups and fve grades. The objectives of this study were to determine the distribution of KIG classifcations in patients with statutory insurance of a German orthodontic practice (North Rhine, Germany) and to analyze changes over a 20-year period. Materials and Methods Since the introduction of the KIG index in 2002, 4940 statutorily insured patients over a 20-year period (2330 m, 2610 f, min 3.2, max 49.5 years, peak between 10 and 12 years) were classifed at their frst appointment. According to the valid guidelines of the statutory health insurance (GKV), the division was made into the highest possible KIG classifcation. Multiple entries were thus not made. In accordance with the operating cycles of the practice, the progression was divided into four 5-year periods. Results Over a 20-year period, 24.98% of the patients were assigned to the classifcation "D". 86.52% of the patients were among the 6 most frequently ("D", "E", "K", "S", "P" and "M",>10% each) and only 13.49% among the 5 least frequently recorded classifcations ("U", "B", "T", "O" and "A",<5% each). Conclusion The distribution of the 6 most frequent and the 5 least frequent KIG classifcations was constant over a 20-yearperiod. Among all possible tooth and jaw misalignment variants, the sagittal classifcations "D" and "M" represent the most frequent malocclusions. Clinical relevance The results and their comparison with historical data show that both frequency and severity of tooth and jaw misalignment with orthodontic treatment need appear identical for patients with statutory health insurance over a 20-year period

Effects of fixed functional orthodontic treatment in hypodivergent and hyperdivergent class II patients : a retrospective cephalometric investigation

Objective To compare skeletal and dentoalveolar changes after orthodontic treatment of class II malocclusion in patients with hypodivergent and hyperdivergent growth patterns through cast splint fxed functional appliances (FFA). Materials and methods N=42 out of n=47 patients with mandibular plane angles<34° or≥34° were divided into a hypodivergent (n=24) and a hyperdivergent (n=18) group. All patients received a single-step mandibular advancement protocol through an FFA. Lateral cephalograms were analyzed after initial leveling and alignment (T1) and immediately after FFA removal (T2). The therapeutic efect was calculated through comparison with age-matched controls from a growth survey. Statistical signifcance was set at p<0.05. Results Hypodivergent and hyperdivergent patients showed diferent treatment outcomes, but signifcant diferences existed only for overbite and interincisal angle. Nearly all measurements suggested similar treatment-related changes for both groups with exception for dentoalveolar parameters. Conclusion Treatment with FFA causes similar skeletal and dentoalveolar efects in hypodivergent and in hyperdivergent patients. The correction of overjet and molar relationship is mainly caused by dentoalveolar changes. Clinical relevance Hyperdivergent patients do not respond unfavorably to FFA treatment compared to hypodivergent patients. Lower incisor protrusion occurs more pronounced in hypodivergent patients. The growth pattern ought to be considered when choosing FFA for class II treatment

Efficiency of the skeletonized Pendulum K appliance for non-compliance maxillary molar distalization

Purpose!#!Conventional anchorage with exclusively intraorally anchored appliances for non-compliance molar distalization combines a palatal acrylic button with periodontal anchorage. This type of anchorage is critically discussed because of the temporary hygienic impairment of the palate and the uncertain anchoring quality of the button. A purely dentally/periodontally anchored Pendulum K appliance was developed, which is exclusively anchored via four occlusal rests. The aims of this pilot study were to examine the suitability of the skeletonized Pendulum K for distalization of maxillary molars, and to investigate the quality of this alternative anchoring modality.!##!Patients and methods!#!In all, 10 patients received skeletonized Pendulum K appliances attached to all maxillary premolars for bilateral molar distalization. Supporting anchorage through an acrylic button adjacent to the anterior palate was not used. The pendulum springs were initially activated on both sides with a distalization force of 220 cN each and provided with uprighting and toe-in bends. The specific force/moment system was regularly reactivated intraorally by adjustment of the distal screw.!##!Results!#!The study demonstrates the suitability of the skeletonized Pendulum K appliance for the distalization of maxillary molars (3.28 ± 0.73 mm). Side effects on the molars were slight distal tipping (3.50 ± 2.51°/PP, 3.00 ± 1.41°/SN) and mesial inward rotation (average 2.75 ± 7.50° and 4.50 ± 12.77°). Significant anchorage loss occurred in the form of mesialization of the incisors by 1.40 ± 0.82 mm and of the first premolars by 2.28 ± 0.85 mm.!##!Conclusion!#!The skeletonized Pendulum K appliance allows compliance-free upper molar distalization. Exclusively dental/periodontal anchorage resulted in a lower percentage of molar distalization compared to a conventional anchoring preparation of the Pendulum K with a palatal acrylic button. Anchorage loss had a comparatively stronger effect on the anchoring premolars but less on the incisors. Typical side effects on the molars such as distal tipping and mesial inward rotation were remarkably low

Occlusal height difference between maxillary central and lateral incisors: should aesthetic perception influence bracket placement?

Abstract Background The aim of this study was to verify anecdotal evidence that the maxillary central-to-lateral occlusal height difference (OHD) of more than 0.5 mm is a feature displayed in the majority of media and to discuss its implications for individualized orthodontic treatment planning. Methods Photographs of smiling female models were collected from a variety of printed advertisements and allocated to 3 groups (n = 30 each): 1 dental, 2 fashion and 3 orthodontics. Group 4 used female patient images from orthodontic textbooks, assuming an OHD of 0.5 mm between maxillary central and lateral incisors. OHD was assessed by measuring the incisor height on the photographs and using average values to establish height differences. Results The average maxillary central-to-lateral incisor OHD differences were 1.39 mm (dental literature), 1.34 mm (fashion advertisements), 1.23 mm (orthodontics) and 0.62 mm (orthodontic textbooks) respectively. The differences between the advertisement groups were not significant (P >  0.05), but for orthodontic textbooks they were (P <  0.001). Conclusions Advertisers seem to prefer greater maxillary central-to-lateral OHD compared to commonly used bracket placement protocols. Therefore, discussing OHD at start of treatment is recommended; modification of commonly used bracket placement protocols may be helpful to achieve desired aesthetic outcome

Influence of interradicular and palatal placement of orthodontic mini-implants on the success (survival) rate

The purpose of this retrospective cohort study was to investigate the success rates of orthodontic mini-implants (OMIs) placed in different insertion sites and to analyse patient and site- related factors that influence mini-implant survival.; Three hundred eighty-seven OMIs were inserted in 239 patients for orthodontic anchorage and were loaded with a force greater than 2 N. Two different insertion sites were compared: 1. buccal inter-radicular and 2. palatal, at the level of the third palatal ruga. Survival was analysed for location and select patient parameters (age, gender and oral hygiene). The level of statistical significance was set at p < 0.05.; The overall success rate was 89.1%. There were statistically significant differences between insertion sites; success rate was 98.4% for OMIs placed in the anterior palate and 71% for OMIs inserted buccal between roots (p < 0.001).; Success rate of OMIs was primarily affected by the insertion site. The anterior palate was a more successful location compared to buccal alveolar bone

Mandibular fossa morphology during therapy with a fixed functional orthodontic appliance: A magnetic resonance imaging study

PeerReviewe

Age-dependent effects on palate volume and morphology during orthodontic RME treatment

Objectives Rapid maxillary expansion (RME) shows diferent age-dependent efects. It has been shown that RME leads to a parallel expansion prior to the age of 10, while later and especially from the age of 12, a V-shaped expansion happens (transverse, anterior > posterior; horizontal, inferior > superior). However, it is not clear to what extent these efects infuence palatal volume and morphology and eventually maxillary functional space. The aim of the present study was to examine possible age-related efects of treatment with a dental anchored RME appliance upon volume and width/height ratio of the anterior and posterior palate. Materials and methods Sixty children and adolescents with documented treatment histories after RME were divided into three equal groups according to age at treatment begin (PG 1, 12 years, n=20). Maxillary dental casts before and after therapy were digitised. Changes in palatal volume were determined using 3D analyses. Results In all patients, the palatal volume increases signifcantly after RME. Older patients experienced smaller increases in total and posterior volume in absolute and percentage terms. The anterior palate volume increases are almost equal in all patients. Since palatal width increases more markedly than palatal height, the width/height ratio always increases. Except for the posterior region in PG 3, its increase is signifcant in all groups, both anteriorly and posteriorly. After successful RME, the palatal morphology appears normal anteriorly in PG 1, PG 2 and PG 3 and rather steep posteriorly in PG 3. Conclusions RME treatment with identical force application causes diferent, age-dependent efects upon palate volume and morphology. Width changes have a greater infuence on palate volume than height changes. Clinical relevance It is preferable to use an RME prior to the age of 10 if homogeneous changes of the anterior and posterior palate regarding maxillary symmetry and functional space are desired