The present study aimed to provide a version of the Cervical Vertebral Maturation (CVM) method for the detection of the peak in mandibular growth based on the analysis of the second through fourth ...cervical vertebrae in a single cephalogram. The morphology of the bodies of the second (odontoid process, C2), third (C3), and fourth (C4) cervical vertebrae were analyzed in six consecutive cephalometric observations (T1 through T6) of 30 orthodontically untreated subjects. Observations for each subject consisted of two consecutive cephalograms comprising the interval of maximum mandibular growth (as assessed by means of the maximum increment in total mandibular length, Co-Gn), together with two earlier consecutive cephalograms and two later consecutive cephalograms. The analysis consisted of both visual and cephalometric appraisals of morphological characteristics of the three cervical vertebrae. The construction of the new version of the CVM method was based on the results of both ANOVA for repeated measures with post-hoc Scheffé's test (P < .05) and discriminant analysis. The new CVM method presents with five maturational stages (Cervical Vertebral Maturation Stage CVMS I through CVMS V, instead of Cvs 1 through Cvs 6 in the former CVM method). The peak in mandibular growth occurs between CVMS II and CVMS III, and it has not been reached without the attainment of both CVMS I and CVMS II. CVMS V is recorded at least two years after the peak. The advantages of the new version of the CVM method are that mandibular skeletal maturity can be appraised on a single cephalogram and through the analysis of only the second, third, and fourth cervical vertebrae, which usually are visible even when a protective radiation collar is worn.
Objective
To compare the transverse dental and skeletal changes in patients treated with bone‐anchored palatal expander (bone‐borne, BB) compared to patients treated with tooth and bone‐anchored ...palatal expanders (tooth‐bone‐borne, TBB) using cone‐beam computer tomography (CBCT) and 3D image analysis.
Methods
The sample comprised 30 patients with transverse maxillary discrepancy treated with two different types of appliances: bone‐borne (Group BB) and tooth‐bone‐borne (Group TBB) expanders. CBCT scans were acquired before (T1) and after completion of maxillary expansion (T2); the interval was 5.4 ± 3.4 and 6.2 ± 2.1 months between the T1 and the T2 scans of Group TBB (tooth‐bone‐borne) and Group BB (bone‐borne), respectively. Transverse, anteroposterior and vertical linear and angular three‐dimensional dentoskeletal changes were assessed after cranial base superimposition.
Results
Both groups displayed marked transverse skeletal expansion with a greater ratio of skeletal to dental changes. Greater changes at the nasal cavity, zygoma and orbital levels were found in Group BB. A relatively parallel sutural opening in an anterior–posterior direction was observed in Group TBB; however, the Group BB presented a somewhat triangular (V‐shaped) opening of the suture that was wider anteriorly. Small downward‐forward displacements were observed in both groups. Asymmetric expansion occurred in approximately 50% of the patients in both groups.
Conclusion
Greater skeletal vs dental expansion ratio and expansion of the circummaxillary regions were found in Group BB, the group in which a bone‐borne expander was used. Both groups presented skeletal and dental changes, with a similar amount of posterior palate expansion. Asymmetric expansion was observed in both groups.
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Aim: To investigate the effect of rapid maxillary expansion (RME) and/or transpalatal arch (TPA) therapy in combination with deciduous canine extraction on the eruption of palatally displaced canines ...(PDCs).
Subjects and Methods: Hundred and twenty subjects were enrolled in an RCT based on PDCs diagnosed on panoramic radiographs and they were randomly assigned to one of four study groups. Three treatment groups (TGs) (RME followed by TPA therapy plus extraction of deciduous canines, RME/TPA/EC group, 40 subjects; TPA therapy plus extraction of deciduous canines, TPA/EC group, 25 subjects; extraction of deciduous canines, EC group, 25 subjects) were analyzed. A control group (CG, 30 subjects) received no orthodontic treatment. Prevalence rates of eruption of PDCs in the three TGs were compared with the CG at T2. Predictive features at T1 for successful canine eruption were tested in the three TGs.
Results and Discussion: The prevalence of canine eruption was 80 per cent for the RME/TPA/EC group, 79 per cent for the TPA/EC group, 62.5 per cent for the EC group, versus 28 per cent in the CG, with statistically significant differences between all the groups, with the exception of the comparison between RME/TPA/EC and TPA/EC. Predictive pretreatment variables for the success of treatment were less severe sectors of canine displacement, prepubertal stages of skeletal maturity, and an open root apex of PDCs.
Conclusions: The use of a TPA in absence of RME can be equally effective than the RME/TPA combination in PDC cases not requiring maxillary expansion, thus reducing the burden of treatment for the patient.
Introduction The objective of this prospective clinical study was to evaluate the dentoalveolar and skeletal effects induced by rapid maxillary expansion (RME) therapy in mixed dentition patients ...with Class II Division 1 malocclusion compared with a matched untreated Class II Division 1 control group. Methods The treatment sample consisted of cephalometric records of 50 patients with Class II malocclusion (19 boys, 31 girls) treated with an RME protocol including an acrylic splint expander. Some patients also had a removable mandibular Schwarz appliance or maxillary incisor bracketing as part of their treatment protocol. Postexpansion, the patients were stabilized with a removable maintenance plate or a transpalatal arch. The mean age at the start of treatment of the RME group was 8.8 years (T1), with a prephase 2 treatment cephalogram (T2) taken 4.0 years later. The control sample, derived from the records of 3 longitudinal growth studies, consisted of the cephalometric records of 50 Class II subjects (28 boys, 22 girls). The mean age of initial observation for the control group was 8.9 years, and the mean interval of observation was 4.1 years. All subjects in both groups were prepubertal at T1 and showed comparable prevalence rates for prepubertal or postpubertal stages at T2. Independent-sample Student t tests were used to examine between-group differences. Results Class II patients treated with the described bonded RME protocol showed statistically significant increases in mandibular length and advancement of pogonion relative to nasion perpendicular. The acrylic splint RME had significant effects on the anteroposterior relationship of the maxilla and the mandible, as shown by the improvements toward Class I in the maxillomandibular differential value, the Wits appraisal value, and the ANB angle. Patients treated with the bonded RME showed the greatest effects of therapy at the occlusal level, specifically highly significant improvement of Class II molar relationship and decrease in overjet. Treatment with the acrylic splint RME had no sustainable effects on the skeletal vertical dimension, maxillary skeletal position, or maxillary dentoalveolar dimensions. Conclusions This study suggests that the protocol described including treatment with a bonded rapid maxillary expander used in the early mixed dentition in Class II Division 1 patients can help to improve the Class II malocclusion as a side-effect, both skeletally and dentally. Evidence for this phenomenon was based previously on anecdotal data; the results of this study show that the improvements are far more pervasive than anticipated.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Introduction The purpose of this study was to evaluate the long-term stability of quad-helix/crib treatment in subjects with dentoskeletal open bite. Methods Twenty-eight subjects (11 boys, 17 girls; ...mean age, 8.2 ± 1.3 years) were treated consecutively with quad-helix/crib appliances. The patients were reevaluated at the end of active treatment with the quad-helix/crib (mean age, 9.7 ± 1.6 years) and at least 5 years after the completion of treatment (mean age, 14.6 ± 1.9 years). A control group of 20 untreated subjects with the same dentoskeletal disharmony was used for the statistical comparison (Mann-Whitney U test). Results In the long term, the quad-helix/crib group showed a significant reduction in the ANB angle (−1.3°), a downward rotation of the palatal plane (1.8°), a greater increase in overbite (2.1 mm), and a decrease in overjet (−1.5 mm) when compared with the controls. Conclusions In the long term, the use of the quad-helix/crib appliance led to successful outcomes in about 93% of the patients considered. Correction of dentoskeletal open bite was associated with a clinically significant downward rotation of the palatal plane.
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Longitudinal growth changes in subjects with deepbite Baccetti, Tiziano; Franchi, Lorenzo; McNamara, James A
American journal of orthodontics and dentofacial orthopedics,
08/2011, Volume:
140, Issue:
2
Journal Article
Peer reviewed
Introduction This study was a cephalometric evaluation of the growth changes in untreated subjects with deepbite at 4 time points during their developmental ages (from the early mixed dentition to ...the permanent dentition, and from the prepubertal phase to young adulthood). Methods A sample of 29 subjects with deepbite (overbite >4.5 mm) was followed longitudinally from about 9 through about 18 years of age. Dentofacial changes at 4 times, defined by the cervical vertebral maturation method, were analyzed on lateral cephalograms. Nonparametric statistical analysis was used for comparisons. Results Overbite improved on average by 1.3 mm between the first and last measurements; it worsened significantly during the prepubertal period, but it improved significantly at the pubertal growth spurt. From the prepubertal ages through young adulthood, overbite improved in 83% of the subjects and self-corrected in 62% of the subjects. Improvements in overbite were related to the initial amount of maxillary incisor proclination. The significant improvement in overbite during the adolescent growth spurt depended on the amount of vertical growth of the mandibular ramus and the eruption of the mandibular molars. Conclusions Subjects with deepbite showed worsened occlusal conditions during the prepubertal and mixed dentition phases, but had significant improvements thereafter. Improvements in overbite cannot be predicted on the basis of skeletal vertical relationships. These results provide useful indications for appropriate orthodontic treatment timing for an increased overbite.
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Introduction Our aim was to investigate the effect of rapid maxillary expansion and transpalatal arch therapy combined with deciduous canine extraction on the eruption rate of palatally displaced ...canines (PDCs) in patients in the late mixed dentition in a 2-center prospective study. Methods Seventy subjects were enrolled based on PDCs diagnosed on panoramic radiographs. The treatment group (TG, 40 subjects) underwent RME followed by TPA therapy and extraction of the deciduous canines. The control group (CG, 30 subjects) received no orthodontic treatment. At the start of the trial, panoramic radiographs and dental casts were compared between the TG and the CG with the Mann-Whitney U test ( P <0.05). At the second observation (cervical vertebral maturation stage 5 or 6), all subjects were reevaluated, and the eruption of the maxillary permanent canines was assessed. The rates of success in the TG were compared with those in the CG by means of chi-square tests ( P <0.05). The association of PDCs with other dental anomalies was reported. Results No statistically significant difference was found for any measurement at the start of the trial between the 2 groups. The prevalence rates of eruption of the maxillary canines were 80% for the TG and 28% in the CG, a statistically significant difference (chi-square =16.26, P <0.001). The prevalence rate at the start for the pubertal stages of cervical vertebral maturation (63%) was significantly greater in the unsuccessfully treated subjects than in the successfully treated ones (16%). In the CG, all successful subjects had PDCs that overlapped the corresponding deciduous canine or the distal aspect of the lateral incisor. Eruption of PDCs in both groups was associated significantly with an open root apex. Conclusions Rapid maxillary expansion therapy followed by a transpalatal arch combined with extraction of the deciduous canine is effective in treating patients in the late mixed dentition with PDCs. Pretreatment variables indicating success of treatment on the eruption of PDCs were less severe sectors of displacement, prepubertal stages of skeletal maturity, and open root apices of PDCs. Several dental anomalies were associated significantly with PDCs, thus confirming the genetic etiology of this eruption disturbance.
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49.
Robert P. Scholz, 1939-2015 McNamara, James A; Proffit, William R
American journal of orthodontics and dentofacial orthopedics,
09/2015, Volume:
148, Issue:
3
Journal Article
Peer reviewed
Open access
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objectives
To perform a three‐dimensional evaluation of the position of the condyles in patients treated with Herbst appliance (HA) in two stages of cervical vertebral maturation.
Setting and sample ...population
Retrospective case‐control study. Pubertal Herbst group (PHG; n = 24, mean age 14.5 years, CS 3 and CS 4) and pre‐pubertal Herbst group (PPHG; n = 17, mean age 9.9 years, CS 1 and CS 2) were contrasted with comparison groups of non‐orthopaedically treated Class II patients in pubertal (PCG; n = 17, mean age 13.9 years) and pre‐pubertal maturational stages (PPCG; n = 18, mean age 10.6 years).
Materials and Methods
Cone‐beam computer tomography scans were taken before treatment (T0) and at T1 after 8 to 12 months. Point‐to‐point measurements of the displacement of the condyles between T0 and T1, relative to the glenoid fossae, were performed in the X, Y, Z and 3D perspectives. Qualitative assessments using semi‐transparent overlays and colour mapping also were produced.
Results
The displacement of the condyles within the glenoid fossae in the treated groups was small (<0.75 mm; P > .05). Relative to the glenoid fossa, condylar position at T1 was similar to T0 in pre‐pubertal and pubertal groups (P > .05). Similar condylar rotations from T0 to T1 were observed in Herbst and comparison groups, and no significant difference was found between pre‐pubertal and pubertal patients.
Conclusions
Regardless the stage of skeletal maturation, HA treatment did not change the condyle‐glenoid fossa relationship.
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CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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