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

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

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

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

Altersabhängige Efekte einer Gesichtsmaskenbehandlung nach Delaire bei Klasse-III-Anomalie : Auswirkungen auf die maxillären Suturen und die Gaumenmorphologie

Background and aim Treatment effects of a combined rapid maxillary expansion (RME) and Delaire facemask (DFM) therapy have so far only been scientifically investigated through cephalometric analyses. The combination of cephalometric, dental cast and cone-beam computed tomography (CBCT) scan analysis was not yet used for investigating morphologic changes of the tooth-bearing palate. The aim of the present study was to determine whether patient age at treatment begin has an influence upon palatal length changes after RME/DFM therapy, and to what extent transverse palatal sutures contribute to these. Patients and methods In n= 6 patients (min 10.5 years, max 14.7 years) from a total group of n= 40, CBCT datasets showing all palatal sutures were visually assessed, and palatal morphology was compared with a dental cast analysis. In addition, lateral cephalograms and dental casts of n= 40 patients were divided into two groups (PG1: < 12 years, n= 20; PG2: ≥12 years, n= 20), and an analysis was performed to investigate changes in the tooth-bearing palate after RME/DFM treatment. Results The CBCT analysis showed that the median and transverse palatine sutures were always open. On the contrary, the pterygopalatomaxillary sutures were partially open only in the youngest patients. The transverse palatal suture showed age-dependent morphologic changes in the transverse and sagittal planes. The changes of the palatal width and length show clear differences between the two younger and the four older patients in the corresponding dental cast analysis. The cephalometric analysis showed that a significant improvement of the sagittal jaw relation due to ventral displacement of the maxilla during treatment occurred only in younger patients (< 12 years) despite similar initial findings in both patient groups. The dental cast analysis also revealed that changes are age-dependent: In PG1, the width increases posteriorly more than anteriorly; in PG2, this is reversed. The length increases are always significant in both patient groups, whereby the anterior, posterior, and total amounts are greater in PG1 than in PG2. In relative terms, the increases in both groups are greater posteriorly than anteriorly. There is a significant difference between the groups posteriorly and overall. Conclusions Morphological changes of the sutures appear to have a decisive influence on the success of RME/DFM therapy. The age-dependent reactions of pterygopalatomaxillary and transverse palatine sutures represent a further main therapeutic effect of DFM treatment in addition to those described by Delaire and explain the different changes in palate length before and after the age of 12. If the maximum effect of RME/DFM treatment is desired, it should be started before the age of 12. Treatment success is age-dependent.Hintergrund und Ziel Die Behandlungseffekte einer kombinierten Therapie aus „rapid maxillary expansion“ (RME) und „facemask“ nach Delaire (DFM) wurden bislang nur durch kephalometrische Studien wissenschaftlich überprüft. Durch diese Therapie veranlasste morphologische Veränderungen des Gaumens sind dagegen bislang nicht kombiniert durch kephalometrische, Modell- und DVT(digitale Volumentomographie)-Analysen untersucht worden. Ziel der vorliegenden Studie war es festzustellen, ob das Alter der Patienten bei Behandlungsbeginn einen Einfluss auf die Längenveränderungen des Gaumens nach RME/DFM-Therapie hat und inwieweit die quer verlaufenden palatinalen Suturen dazu beitragen. Patienten und Methoden Bei n= 6 Patienten (min. 10,5 Jahre, max. 14,7 Jahre) aus einer Gesamtgruppe von n= 40 wurden DVT-Datensätze im Bereich aller palatinalen Suturen visuell befundet und die Gaumenmorphologie mit einer Modell-Analyse abgeglichen. Zusätzlich wurden Fernröntgenseitenbilder und Modelle von n= 40 Patienten in zwei Gruppen unterteilt (PG1: < 12. Lebensjahr, n= 20; PG2: ≥12, n= 20), und es wurde eine Analyse durchgeführt, um Veränderungen des zahntragenden Gaumens nach der RME/DFM-Behandlung zu beurteilen. Ergebnisse Die DVT-Analyse zeigte, dass die Sutura palatina mediana und die Sutura palatina transversa immer geöffnet waren. Die pterygopalatomaxillären Suturen waren dagegen nur bei den jüngsten Patienten partiell geöffnet. Die Sutura palatina transversa zeigt in der Transversal- sowie in der Sagittalebene altersabhängige morphologische Veränderungen. Die Werte der Gaumenbreiten- und Gaumenlängenveränderungen zeigen bei der korrespondierenden Modellanalyse deutliche Unterschiede zwischen den beiden jüngeren und den 4 älteren Patienten. Die FRS-Analyse zeigt vergleichbare Anomalien in beiden Patientengruppen zu Behandlungsbeginn, eine signifikante Verbesserung der mesiobasalen Kieferbasenrelation durch sagittale Ventralverlagerung der Maxilla unter der Behandlung aber nur bei den jüngeren Patienten (< 12. Lebensjahr). In der Modellstudie sind die Veränderungen ebenfalls altersabhängig: Bei PG1 nimmt die Breite im posterioren Bereich mehr als anterior zu, bei PG2 ist dies umgekehrt. Die Längenzunahmen sind in beiden Patientengruppen immer signifikant, wobei sowohl anterior, posterior als auch gesamt die Beträge bei PG1 größer sind als bei PG2. Relativ betrachtet sind die Zunahmen in beiden Gruppen posterior größer als anterior. Ein signifikanter Unterschied zwischen den Gruppenwerten besteht posterior und gesamt. Schlussfolgerungen Morphologische Veränderungen der Suturen scheinen einen entscheidenden Einfluss auf den Erfolg der RME/DFM-Therapie zu haben. Die altersabhängigen Reaktionen der pterygopalatomaxillären Suturen und der Sutura palatina transversa stellen einen weiteren, zusätzlich zu den von Delaire beschriebenen therapeutischen Haupteffekt der DFM-Behandlung dar und erklären die unterschiedlichen Gaumenlängenveränderungen vor und nach dem 12. Lebensjahr. Will man den maximalen Effekt der RME/DFM-Behandlung erzielen, sollte sie vor dem 12. Lebensjahr begonnen werden. Der Behandlungserfolg ist altersabhängig

Incidence of pulp sensibility loss of anterior teeth after paramedian insertion of orthodontic mini-implants in the anterior maxilla

BACKGROUND: The aim of this retrospective investigation was to evaluate the incidence of loss to pulp sensibility testing (PST) of maxillary front teeth after paramedian (3 to 5 mm away from the suture) orthodontic mini-implant (OMI) insertion in the anterior palate. METHODS: A total of 284 patients (102 males, 182 females; mean age was 14.4 years (±8.8) years at time of OMI-Insertion) with a total of 568 OMIs (1.7 mm diameter, length 8 mm) were retrospectively investigated. A binomial regression analysis was performed to explore covariates, such as age, gender, inclination of upper central incisors, dentition status and insertion position of OMIs that could have contributed to loss of sensibility. Statistical significance was set at p < 0.05. RESULTS: Loss of response to PST was encountered during retention in 3 out of 284 patients and the respective OMIs had been placed at height of the second rugae (R-2). Affected teeth were a right canine, a left lateral and a left central incisor. Subsequent root canal treatment was successful. Results of the binomial regression analysis revealed that the covariate insertion position (R-2) of OMIs (p = 0.008) had statistically significant influence on loss of response to PST. CONCLUSIONS: (1) Although there was no radiographic evidence for direct root injury, the proximity of the implants to the anterior teeth was nevertheless statistically related to loss of PST. (2) In all cases of PST loss OMIs were inserted at the second rugae. Therefore OMIs should be placed either more posteriorly, at the third rugae or in the median plane. (3). Loss of PST was not increased for patients with palatal OMI (0.18%) compared to samples without OMI (0.25%)

A Novel Diagnostic Target in the Hepatitis C Virus Genome

Christian Drosten and colleagues develop, validate, and make openly available a prototype hepatitis C virus assay based on the conserved 3' X-tail element, with potential for clinical use in developing countries