Three-dimensional changes in the position of unopposed molars in adults

The aim of this study was to longitudinally examine, in adults, changes of position in the three dimensions of maxillary molars unopposed for more than 10 years. Twelve healthy mature adults (six males, six females; mean age 45 years 11 months) with unopposed molars were followed-up for a mean period of 10 years 7 months. Plaster casts were made at the first and last examination. The patients presented 22 unopposed maxillary molars at both recordings and 14 posterior teeth with antagonists, at least one in each subject, without significant modifications during the study period. On three-dimensional scanned plaster casts, changes in the centroid of the occlusal surface were measured in the three dimensions. The changes observed on both occasions were compared with a t-test. Vertical displacement of unopposed molars [0.8 mm, standard deviation (SD) 0.65 mm] and controls (0.4 mm, SD 0.2 mm) was noted. The unopposed teeth overerupted more than the controls (P ≤ 0.06); periodontally affected molars erupted more than periodontally healthy molars (P ≤ 0.01). There was significant mesial displacement of unopposed molars without mesially adjacent teeth when compared with their respective controls (P ≤ 0.04). Palatal movement was observed in the unopposed teeth (0.9 mm, SD 0.6 mm) and was significantly greater than that in the controls (0.5 mm, SD 0.3 mm; P ≤ 0.02). There is displacement of unopposed teeth in the three dimensions in the long term, although this is clinically insignificant in periodontally healthy adults. The observed changes are either the result of late growth remodelling or a consequence of altered dental equilibrium following antagonist tooth los

Facial palsy in individuals with thalidomide embryopathy: frequency and characteristics

Abstract Background: Earlier studies have shown that individuals with thalidomide embryopathy can have skeletal deformities, ear and eye aberrations, and facial palsy. This study aimed to survey the frequency and characteristics of facial palsy in this group of individuals. Participants: Thirty-one individuals with thalidomide embryopathy (age range, 45-47 years) and 25 healthy adults (age range, 41-56 years; mean age±standard deviation, 49±4.2 years). Main outcome measures: Voluntary facial movements, lip force and three-dimensional lip motion analysis. Results and conclusion: Four of the thalidomide embryopathy individuals (13 per cent) had congenital facial palsy. All four had eye aberrations, three had ear anomalies and one had a limb anomaly. Individuals with thalidomide embryopathy without a clinical diagnosis of facial impairment had significantly weaker lips and more restricted lip mobility than healthy controls. This study contributes to the overall knowledge of thalidomide embryopathy by adding a description of how facial expression can be affected in this conditio

Predictive value of masseter muscle thickness and bite force on Class II functional appliance treatment: a prospective controlled study

SummaryAim: To prospectively evaluate the functional capacity of the masticatory musculature as a predictive variable in determining functional appliance treatment outcomes in Class II/1 malocclusion children. Methods: Twenty Class II/1 malocclusion children (11.4±1.7 years) were treated with functional appliances during 1 year. Masseter muscle thickness and maximal molar bite force measurements, lateral cephalograms, and study casts were taken before and after treatment. Twenty age- and gender-matched untreated children were included as a control group. Regression analyses were used to identify correlations between pre-treatment muscle characteristics and treatment outcomes. Results: All treated patients showed dentoalveolar sagittal improvement. Maximal molar bite force and masseter muscle thickness decreased during the treatment period in the experimental group but increased in the control group. Children with lower pre-treatment maximal molar bite force showed more mesial movement of mandibular first molars, distal movement of maxillary first molars, and larger change in molar class during treatment. Children with thinner pre-treatment masseter muscles demonstrated more mandibular first molar mesialisation, mandibular incisor proclination, and opening of the gonial angle during treatment. Conclusions: The initial condition of the masticatory muscles may partly determine treatment outcomes. Children with thinner pre‐treatment masseter muscles or weaker bite force show greater dentoalveolar change

Predictive value of molar bite force on Class II functional appliance treatment outcomes

Sagittal intermaxillary changes brought about by functional appliances show large inter-individual variation. One factor that may in part explain these differences is the masticatory musculature and its functional capacity. The aims of this study were to investigate changes in maximal molar bite force during functional appliance treatment and to assess the influence of pre-treatment maximal molar bite force on treatment outcomes with functional appliances used in Class II malocclusion children. Twenty-five children (17 males and 8 females), aged 9-13 years, with a Class II malocclusion and increased overjet were treated with functional appliances for 1-2 years. Dental casts, lateral cephalograms, maximal molar bite force, and finger force measurements were performed before (T1) and after (T2) treatment. These same measurements were also performed 1-2 years before treatment (T0); the intermediate period before starting treatment served as the control. Multiple regression analyses were used to determine possible correlations between initial maximal molar bite force and dental or cephalometric changes during treatment. Maximal molar bite force, which increased pre-treatment (T0-T1), decreased during functional appliance treatment (T1-T2). Children with a weaker T1 maximal molar bite force showed a larger overjet reduction, greater improvement in molar relationship, greater reduction in ANB angle, and greater augmentation in SNB angle from T1 to T2. Treatment of children with Class II malocclusions with functional appliances seems to lead to more favourable treatment outcomes in those with a weaker maximal molar bite force. This was observed both as regards improvements in dental sagittal relationships, namely overjet and molar Class, as well as skeletal changes due to a decrease in ANB and an increase in SNB angle

Craniofacial Cephalometric Characteristics and Open Bite Deformity in Individuals with Amelogenesis Imperfecta-A Systematic Review and Meta-Analysis.

BACKGROUND Individuals with amelogenesis imperfecta (AI) often present with malocclusions, especially a dental or skeletal anterior open bite (AOB). OBJECTIVES To evaluate the craniofacial characteristics in individuals with AI. MATERIAL AND METHODS A systematic literature search was conducted with the PubMed, Web of Science, Embase and Google Scholar databases to identify studies relating to the cephalometric characteristics of individuals with AI, without any language or publication date restrictions. The grey literature was searched using Google Scholar, Opengrey and Worldcat. Only studies with a suitable control group for comparison were included. Data extraction and a risk of bias assessment were carried out. A meta-analysis was performed using the random effects model for cephalometric variables that were evaluated in at least three studies. RESULTS The initial literature search yielded 1857 articles. Following the removal of duplicates and a screening of the records, seven articles were included in the qualitative synthesis, representing a total of 242 individuals with AI. Four studies were included in the quantitative synthesis. The meta-analysis results showed that individuals with AI present a smaller SNB angle and larger ANB angle than those of control groups in the sagittal plane. In the vertical plane, those with AI present a smaller overbite and larger intermaxillary angle than those without AI. No statistically significant differences were found for the SNA angle when comparing the two groups. CONCLUSIONS Individuals with AI seem to present with more vertical craniofacial growth, leading to an increased intermaxillary angle and decreased overbite. This possibly leads to a more retrognathic mandible with a larger ANB angle due to an anticipated posterior mandibular rotation

Orthodontists' and laypersons' aesthetic assessment of Class III subjects referred for orthognathic surgery

This study was undertaken to compare laypersons' and professionals' perception of soft tissue profiles of Class III adults, and to evaluate which cephalometric variables are likely to influence the profile assessment score (PAS). Lateral headfilms and coloured profile photographs of 18 skeletal Class III Caucasian adult patients (10 males, 8 females with a mean age of 24.5 years) prior to surgery, and nine adult Caucasian patients (four males, five females with a mean age of 27.4 years) with a dental Class I occlusion and no major skeletal discrepancy were included in the study. The headfilms were hand traced and digitized. Various cephalometric variables were calculated by computer software. Each printed profile photograph was evaluated aesthetically by 18 laypersons and 18 orthodontists using a 10-graded visual analogue scale (VAS) and a standard profile for calibration. Intra-observer reliability was tested and no significant error was found. Paired and unpaired t-tests were used to compare the scores. The association between various cephalometric variables and the PAS was tested. In general, compared with orthodontists, laypersons were less critical in their evaluation of the Class III profiles (+0.3 grade on the VAS) as well as the reference profiles (+0.7). The reference profiles were found to be more attractive than the Class III profiles by both laypersons and orthodontists (+2.3 grades). The degree of facial concavity had a negatively predictive value for the orthodontists' and laypersons' evaluations. The degree of facial concavity together with the steepness of the mandibular plane were negatively predictive factors for the PAS given by the orthodontist

Light curing time reduction: in vitro evaluation of new intensive light-emitting diode curing units

The aim of the present in vitro study was to establish the minimum necessary curing time to bond stainless steel brackets (Mini Diamond Twin™) using new, intensive, light-emitting diode (LED) curing units. Seventy-five bovine primary incisors were divided into five equal groups. A standard light curing adhesive (Transbond™ XT) was used to bond the stainless steel brackets using different lamps and curing times. Two groups were bonded using an intensive LED curing lamp (Ortholux™ LED) for 5 and 10 seconds. Two more groups were bonded using another intensive LED curing device (Ultra-Lume™ LED 5) also for 5 and 10 seconds. Finally, a high-output halogen lamp (Optilux™ 501) was used for 40 seconds to bond the final group, which served as a positive control. All teeth were fixed in hard acrylic and stored for 24 hours in water at 37°C. Shear bond strength (SBS) was measured using an Instron testing machine. Weibull distribution and analysis of variance were used to test for significant differences. The SBS values obtained were significantly different between groups (P < 0.001). When used for 10 seconds, the intensive LED curing units achieved sufficient SBS, comparable with the control. In contrast, 5 seconds resulted in significantly lower SBS. The adhesive remnant index (ARI) was not significantly affected. A curing time of 10 seconds was found to be sufficient to bond metallic brackets to incisors using intensive LED curing units. These new, comparatively inexpensive, curing lamps seem to be an advantageous alternative to conventional halogen lamps for bonding orthodontic bracket

Bite force and its association with stability following Class II/1 functional appliance treatment

SUMMARY The aims of this study were to investigate the value of pre-treatment maximal molar bite force as a predictive variable in determining post-treatment changes and stability following functional appliance treatment in Class II malocclusion children. Twenty-eight Class II malocclusion children having undergone functional appliance treatment were followed for at least 1 year post-treatment. Maximal molar bite force measurements, lateral cephalograms, and study casts were taken before treatment, after treatment, and after post-treatment follow-up. Relationships between pre-treatment maximal molar bite force and dental or cephalometric changes post-treatment were examined. Patients were divided into stable and unstable groups, based on dental sagittal changes (overjet and molar relationship), and differences between the two groups of patients determined. Post-treatment changes varied widely. Thirteen children showed dentoalveolar sagittal relapse, namely a shift in molars towards a Class II relationship and an increase in overjet, while 15 did not. The unstable group demonstrated a lower pre-treatment maximal molar bite force, as well as a more obtuse gonial angle, than the stable group. The gonial angle was found to be negatively correlated to maximal molar bite force and may thus be a cephalometric indicator partly reflecting the functional condition of the masticatory muscles. Children with a lower pre-treatment maximal molar bite force were more prone to dentoalveolar sagittal relapse following functional appliance treatmen

Professionals' and laypersons' appreciation of various options for Class III surgical correction

The objectives of this study were to evaluate the assessments of maxillofacial surgeons, orthodontists, and laypersons on the predicted aesthetic outcome of various surgical options in Class III correction and the associations between certain initial cephalometric values and the judges' preferred option. Pre-surgical lateral headfilms and coloured profile photographs of 18 skeletal Class III Caucasian adult patients (10 males and 8 females) with a mean age of 24.5 years were used. The headfilms were hand traced and digitized. Conventional cephalometric analysis was performed. Computerized predictions of three surgical options, mandibular setback, Le Fort I advancement, and bimaxillary surgery, were made. For each case, the pre-surgical profile photograph with the three predictions was presented on a printed page. The questionnaire was sent to 51 maxillofacial surgeons (response rate 45.1 per cent), 78 orthodontists (response rate 71.8 per cent), and 61 laypersons (response rate 100 per cent) to aesthetically evaluate the pre-surgical photographs and the surgical predictions by placing a mark along a 10-graded visual analogue scale (VAS) using a standard profile for calibration. Confidence interval was calculated for each patient. An independent samples t-test was used to detect initial cephalometric values associated with the judges' preferred option and analysis of variance/Tukey's honestly significant differences to evaluate differences between judges. Intra-observer reliability was assessed with a paired t-test. All treatment predictions led to improved scoring of facial aesthetics with the exception of the setback option for three patients. For 14 patients, general agreement for the preferred option existed between the three groups of judges. Laypersons tended to give lower improvement scores than professionals. Overjet, nasofacial, and nasomental angles were important in decision making between the mandibular setback and Le Fort I options (the more negative the overjet, the larger the nasofacial angle, the smaller the nasomental angle, the greater the preference for the Le Fort I option). Wits appraisal seemed to be important in decision making between the mandibular setback and bimaxillary options (the more negative the Wits appraisal, the greater the preference for the latter option

An In Vitro Evaluation of the Effects of Air-Polishing Powders on Sound and Demineralised Enamel.

AIM To evaluate the effects of two air-polishing powders, during orthodontic treatment, on the surface roughness of sound and demineralised enamel. MATERIALS AND METHODS Forty-two caries-free human molars were collected, and the enamel surfaces were flattened and polished. Teeth were assigned to two groups (n = 21 each), a sound- and a demineralised-enamel group (subjected to pH-cycling over 2 weeks to create artificially induced white spot-like lesions). Within each group, teeth were further assigned to three groups (n = 7 each), air polished with either sodium bicarbonate, erythritol, or a negative control (water). Each sample was treated for 5 and 150 s. The average surface roughness (Ra) for each sample was measured using white-light-sensor profilometry. RESULTS On sound enamel, the Ra was roughly 0.17 ± 0.07 μm. After 150 s of air polishing, the Ra increased with erythritol (by 0.28 μm), and even more so with bicarbonate treatment (by 0.68 μm) (p < 0.01). On demineralised enamel, the Ra was roughly 0.79 ± 0.56 μm. The Ra increased after 5 s of air-polishing treatment similarly with erythritol and bicarbonate powders (by 1.03 μm and 1.04 μm, respectively) (p = 0.025), and even more after 150 s (by 2.48 μm and 2.49 μm, respectively) (p < 0.001). CONCLUSIONS On white spot lesions, one should be aware that enamel surface roughness will increase with both erythritol and bicarbonate air-polishing powders, especially with longer exposure times