Changes of pharyngeal airway size and hyoid bone position following

Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of Class I bimaxillary protrusion Qingzhu Wanga; Peizeng Jiab; Nina K. Andersonc; Lin Wangd; Jiuxiang Line ABSTRACT Objectives: To test the hypothesis that the sagittal position of the anterior teeth has no effect on pharyngeal airway dimension or hyoid bone position and to investigate the influence of orthodontic retraction of the anterior teeth on each section of pharynx and hyoid position. Materials and Methods: Forty-four Class I bimaxillary protrusion adults, treated with preadjusted appliances and maximum anchorage after extraction of four premolars, were divided into two groups according to their vertical craniofacial skeletal patterns. Pretreatment and posttreatment variables were compared using paired t-test, and the relationship between pharyngeal airway size and dentofacial variables was analyzed using Pearson correlation coefficient. The changes of pharyngeal airway size and hyoid position after treatment were compared between two groups using independent t-test. Results: Upon retraction of the incisors, the upper and lower lips were retracted by 2.60 mm and 3.87 mm, respectively. The tip of upper incisor was retracted by 6.84 mm and lower incisor retracted by 4.95 mm. There was significant decrease in SPP-SPPW, U-MPW, TB-TPPW, V-LPW, VAL, C3H, and SH (P , .05). No statistically significant different changes were observed in the dentofacial structures, pharyngeal airway, and hyoid position between the two groups after the treatment. There was a significant correlation between the retraction distance of lower incisor and the airway behind the soft palate, uvula, and tongue. Conclusions: The pharyngeal airway size became narrower after the treatment. Extraction of four premolars with retraction of incisors did affect velopharyngeal, glossopharyngeal, hypopharyngeal, and hyoid position in bimaxillary protrusive adult patients. (Angle Orthod. 0000;00:1–7.)

Obstructive Sleep Apnea and Bruxism in Children

Obstructive Sleep Apnea and Bruxism in Children Stephen H. Sheldon, DO AffiliationsNorthwestern University, Feinberg School of Medicine, Chicago, IL, USASleep Medicine Center, Children's Memorial Hospital, 2300 Children's Plaza, Box 43, Chicago, IL 60614, USASleep Medicine Center, Children's Memorial Hospital, 2300 Children's Plaza, Box 43, Chicago, IL 60614. Abstract Full Text PDFImages References .Obstructive sleep apnea (OSA) is common in childhood. Current epidemiologic data have shown that snoring occurs in 7% to as much as 30% of school-aged children. The most common cause of OSA in pediatric patients is hypertrophy of the tonsils or adenoids. Nonetheless, various factors are involved in upper airway obstruction during sleep in children. Craniofacial structure and function of the upper airway musculature are extensively involved in airflow dynamics. Conversely, obstructive upper airway disease can contribute to abnormalities in craniofacial structure and function. This article focuses on differences between upper airway function in children and adults, factors that predispose children to OSA, and treatment options. Bruxism, jaw clenching, and rhythmic mandibular thrusting have been associated with OSA in children, and the frequency and prevalence of these findings are discussed.

Breast feeding, bottle feeding, and non-nutritive sucking; effects on occlusion in deciduous dentition

Breast feeding, bottle feeding, and non-nutritive sucking; effects on occlusion in deciduous dentition

D Viggiano1,
D Fasano2,
G Monaco3,
L Strohmenger4

+ Author Affiliations

1Ambulatory Paediatrician, Local Health Unit “Salerno 1”, Campania Region, Italy


2Paediatric Dentistry, Local Health Unit “Salerno 1”, Campania Region, Italy


3Chief of Epidemiology Unit, Local Health Unit 11, Lombardy Region, Italy


4Full Professor of Paediatric Dentistry, University of Milan and Head of the WHO Collaborating Centre for Epidemiology and Community Dentistry, Milan, Italy

Correspondence to:
Dr D Viggiano
Piazza De Marinis, 10, 84013 Cava de’ Tirreni (Salerno), Italy; domviggi@tin.it
Accepted 10 March 2004


Abstract

Aims: To assess the effect of the type of feeding and non-nutritive sucking activity on occlusion in deciduous dentition.

Methods: Retrospective study of 1130 preschool children (3–5 years of age) who had detailed infant feeding and non-nutritive sucking activity history collected by a structured questionnaire. They all had an oral examination by a dentist, blinded to different variables evaluated.

Results: Non-nutritive sucking activity has a substantial effect on altered occlusion, while the effect of bottle feeding is less marked. The type of feeding did not have an effect on open bite, which was associated (89% of children with open bite) with non-nutritive sucking. Posterior cross-bite was more frequent in bottle fed children and in those with non-nutritive sucking activity. The percentage of cross-bite was lower in breast fed children with non-nutritive sucking activity (5%) than in bottle fed children with non-nutritive sucking activity (13%).

Conclusions: Data show that non-nutritive sucking activity rather than the type of feeding in the first months of life is the main risk factor for development of altered occlusion and open bite in deciduous dentition. Children with non-nutritive sucking activity and being bottle fed had more than double the risk of posterior cross-bite. Breast feeding seems to have a protective effect on development of posterior cross-bite in deciduous dentition.

Associations between orthopaedic disturbances and unilateral crossbite in children with asymmetry of the upper cervical spine

Associations between orthopaedic disturbances and unilateral crossbite in children with asymmetry of the upper cervical spine

Heike Korbmacher*,
L Koch**,
G Eggers-Stroeder*** and
B Kahl-Nieke*

+ Author Affiliations

*Department of Orthodontics, Center of Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg


**Child Orthopaedic Center, Eckenfoerde


***Private Practice for Orthopaedics and Chiropractice, Hamburg, Germany

Address for correspondence
Dr Heike Korbmacher, Department of Orthodontics, Center of Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany, E-mail: korbmacher@uke.uni-hamburg.de


Abstract

The objective of the present study was to detect possible associations between unilateral crossbite and orthopaedic disturbances in children with asymmetry of the upper cervical spine.

Fifty-five children aged 3–10 years (22 girls and 33 boys) with a unilateral crossbite and 55 gender- and age-matched children with a symmetric occlusion but no crossbite, who served as the control group, were selected from an orthopaedic cohort of 240 patients. In all children, asymmetry of the upper cervical region was confirmed by radiographs and palpation. The following orthopaedic aspects were investigated: oblique shoulder and pelvis, scoliosis, functional leg length difference, and laxity of ligaments of the foot. The differences between the groups were analysed by means of an unpaired t-test.

An increased occurrence of orthopaedic parameters in the frontal plane was observed in children with a unilateral malocclusion. A unilateral crossbite was not necessarily combined with a pathological orthopaedic variable, but statistically, children with a unilateral malocclusion showed more often an oblique shoulder (P = 0.004), scoliosis (P = 0.04), an oblique pelvis (P = 0.007), and a functional leg length difference (P = 0.002) than children with symmetry.

The results suggest that a unilateral crossbite in children with asymmetry of the upper cervical spine is associated with orthopaedic disturbances. There is no evidence of a causal link.
© The Author 2007. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Title

Mouth breathing: adverse effects on facial growth, health, academics, and behavior.



Author(s)

Jefferson Y



Source

Gen Dent 2010 Jan-Feb; 58(1):18-25; quiz 26-7, 79-80.



Abstract

The vast majority of health care professionals are unaware of the negative impact of upper airway obstruction (mouth breathing) on normal facial growth and physiologic health. Children whose mouth breathing is untreated may develop long, narrow faces, narrow mouths, high palatal vaults, dental malocclusion, gummy smiles, and many other unattractive facial features, such as skeletal Class II or Class III facial profiles. These children do not sleep well at night due to obstructed airways; this lack of sleep can adversely affect their growth and academic performance. Many of these children are misdiagnosed with attention deficit disorder (ADD) and hyperactivity. It is important for the entire health care community (including general and pediatric dentists) to screen and diagnose for mouth breathing in adults and in children as young as 5 years of age. If mouth breathing is treated early, its negative effect on facial and dental development and the medical and social problems associated with it can be reduced or averted.

Mode of respiration and facial growth

American Journal of Orthodontics
Volume 78, Issue 5, November 1980, Pages 504-510

Original article
Mode of respiration and facial growth




Robert M. Rubin D.M.D., M.S.

, Norfolk, Va., USA


Available online 2 March 2004.

Abstract
There is a substantial amount of evidence to support the theory that the spatial relationship of the mandible to the craniomaxillary complex is influenced, in part, by the function of the muscular elevators of the mandible. One factor acting on the elevators of the mandible is the rest position of the mandible, which may be influenced by the patient's mode of respiration. Obstruction of the nasal airway is followed by the lowering of the mandible to establish an oral airway. Allergic rhinitis is one cause of nasal airway obstruction. There are reports that avoidance of the ingestion of foreign protein during the first 6 months of life may contribute to a healthy, patent nasal airway. The orthodontist should recognize early signs of the development of the long face syndrome and make appropriate referrals to medical colleagues to promote nasopharyngeal health.

Author Keywords: Author Keywords: Anterior face height; incompetent lip posture; nasopharyngeal airway; allergic rhinitis; adenotonsillectomy

Orthodontists Guilty Of Institutional Professional Misconduct, Says UK Lobby Group 'Orthodontic Outrage'

According to a new lobby group called Orthodontic Outrage, the UK's professional orthodontic body is using its power to intimidate and suppress dissenting opinion - to the potential harm of patients.

"Their behaviour certainly amounts to institutional professional suppression and - given the harm that can be caused by unnecessary surgery and inappropriate extractions - could even be seen as institutional professional misconduct," claims John Mew from Orthodontic Outrage who is a leading advocate of the non-extraction and growth guidance approach. "In most other countries there is a healthy debate on the recent scientific evidence which has questioned the merits of extractions, but in the UK the professional body is closing ranks to suppress any form of debate."

"They are afraid of engaging dissenting intellectuals such as myself in open debate - either in the press or in court - because they know that they're on weak scientific ground," adds Mew. "Instead they use their professional power - resorting to intimidation and suppression."

For over a hundred years orthodontic opinion has been split in two. One group favours straightening teeth by mechanics and surgery and the other by natural growth guidance to avoid the need for extractions. At different times over the past century each group held ascendancy almost to the exclusion of the other.

In 1999 orthodontics became a recognised specialty within dentistry and by 2003 the mechanical group had established control in the UK and, claiming to have become the 'recognised authority', they ensured that their own views were used to define the guiding criteria* (on which any profession is based):

1 a common body of knowledge resting on a well-developed, widely accepted theoretical base;

2 a system for certifying that individuals possess such knowledge before being licensed or otherwise allowed to practice;

However the UK body's definition of the common body of knowledge promotes the mechanical and surgical group's views, and excludes the views of the rival growth guidance group. This ideological bias is not supported by any sound theoretical base - something recognised by a series of the world's top independent scientists:

-- Sackett, D. Professor of Evidenced Based Research at Oxford. 1985 "Orthodontics is behind such treatment modalities as acupuncture, hypnosis, homeopathy, and on a par with scientology".

-- Johnston L.E. Professor of orthodontics at Ann Arbour Michigan. 1990 "Clinical practice �is at bottom largely an empirical process that is little influenced by theory inferred from any of the life sciences".

-- Richards Derek. Director of Evidenced Based Dentistry, 2000 "The current focus of dental schools leans toward the teaching of technical skills rather than scientific thinking".

-- Shaw, W C, 2000. Dean Manchester Dental School. "Sadly it is hard to see this situation changing unless the inadequacy of current (orthodontic) knowledge is acknowledged by its practitioners".


-- Frankel Rolf. 2001 "A mechanical approach treats a symptom, not the cause".

The UK body is also demonstrating bias in the implementation of its certification criteria - certifying only those that support its own views and actively enforcing sanctions in an attempt to oust its rivals

They have reported several dissenting dentists to the General Dental Council for disciplinary action for 'inappropriate' (in their eyes) treatment with the aim of preventing them from practicing. In seeking to use their 'recognised authority' to impose their ideological views, they are not only threatening any unfortunate colleagues who believe in 'natural growth guidance' with financial ruin, but are also denying the public access to non-extraction treatment.

The dominance of the established mechanical group within the profession has meant that almost all children in the UK with overcrowding are treated with the extraction of four or eight permanent teeth, followed by the use of 'train tracks' to move the remaining teeth into line, whereas in other countries various forms of growth guidance are widely used.

Many parents do not find out about growth guidance until it is too late. "I took my son to the dentist and the orthodontist every year but it was not until he was thirteen that they said he would need teeth extracting and a major operation to his jaws," said Mrs Tzaplewski, an outraged mother. "Now I am told that all this could have been avoided if he had had preventive treatment when he was six or seven. This almost amounts to supervised neglect."

Mew has formed Orthodontic Outrage, a crusading group of orthodontists and patients that support either growth guidance or at least a more open debate. They claim that the following areas of concern should be open to debate:

1) Conventional orthodontics, as practiced by the majority of orthodontists in the UK, often causes more harm than good.

2) Patients are not being informed of the risks of or alternatives to orthodox treatment and are therefore unable to provide fully informed consent.

3) The 'orthodox' group is so sure that it is right that it feels justified in suppressing those who use non-extraction methods.

4) Monopolisation of education over the last three decades has lead to a severe shortage of clinicians with non-extraction skills.

5) Many orthodontists are engaging in 'Supervised Neglect' by delaying treatment until puberty when it is often too late to use growth guidance to avoid surgery or the extraction of teeth.

A guiding principle for all professions* is "a commitment to use specialized knowledge for the public good, and a renunciation of the goal of profit maximization, in return for professional autonomy and monopoly power".

"The orthodontic profession has a monopoly on the largest health expense that many families will ever face," adds Mew. "At the moment the public are being forced to accept a single treatment option with potentially harmful effects by orthodontists who are earning very large incomes. This could hardly be argued as using their monopoly for the public good."

About Orthodontic Outrage:

Orthodontic Outrage is a lobby group formed to promote greater debate, and indeed balance, between the competing orthodontic groups that promote either mechanical and surgical methods or non-extraction and natural growth guidance methods. It is supported by the following groups:

-- Patients Association
PO Box 935, Harrow, Middlesex, HA1 3YJ. Phone: 0208 423 9111

-- International Association of Facial growth Guidance.
http://www.orthotropics.com

-- Society for the Study of Craniomandibula Disorders.
http://www.craniogroup.com

About John Mew:

John Mew is a leading advocate of the non-extraction and growth guidance approach and the world's leading practitioner of Orthotropics (see http://www.orthotropics.com). He is an internationally recognised lecturer and has been invited to present at many of the world's most important international orthodontic conferences in recent years. Although he is also the author of numerous international scientific papers - most recently in the American Journal of Orthodontics - his views are rarely published in the UK.

While John Mew's contribution to the dental profession has been recognised by many national and international bodies - including honorary life membership of the British Dental Association - the main orthodontic body in the UK sees him very differently.

*guiding principles of all professions

For further information contact:
John Mew at Orthodontic Outrage
Tel: +44 1435 862045
orthodontic.outrage@virgin.net
http://www.orthodontic-outrage.com

Breast-feeding Lowers Risk of Crossbite

The World Health Organization recommends breastfeeding exclusively for the first six months of an infant's life. This recommendation is based on benefits for both the mother and the child. Breast-feeding exclusively enhances craniofacial growth and development, and helps prevent non-nutritive sucking habits. Breast-feeding for less than six months or not at all has been shown to result in malocclusion and posterior crossbite in particular. Crossbite in deciduous teeth develops early and rarely self-corrects, so early preventive action is warranted.

Researchers in University of Sao Paulo City, in Brazil clinically examined 1,377 children from 11 public schools in Sao Paulo. The children ranged in age from three to six years. Mothers completed a questionnaire to determine breast-feeding history.

Posterior crossbites were divided into three categories: bilateral, true unilateral, and unilateral with functional deviation of the mandible. Four categories of breast-feeding were identified: never (119), less than six months (720), six to 12 months (312), and more than 12 months (226).

Crossbite was diagnosed in 16.2 percent of the entire group, with subcategories being 2.8 percent bilateral, 4.4 percent true unilateral and 9.4 percent with functional unilateral crossbite. Crossbite decreased with longer history of breast-feeding. In children who were not breast-fed, the crossbite incidence was 31.1 percent. For those breast-fed less than six months, the incidence was 22.4 percent. Much lower incidence was found for those breast-fed six to 12 months - 8.3 percent and 2.2 percent for those breast-fed more than 12 months.

Clinical Implications: Breast-feeding exclusively for at least six months and more than 12 months can reduce the potential for posterior crossbite in deciduous teeth.

Kobayashi, H., Scavone, H, Ferreira, R., et al. Relationship Between Breastfeeding Duration and Prevalence of Posterior Crossbite in the Deciduous Dentition. Am J Orthod Dentofacial Orthop 137: 54-58, 2010.

Thanks to Dr Derek Mahony for this information!

Posture and the Jaws

Sakaguchi K, Mehta NR, Abdallah EF, Forgione AG, Hirayama H, Kawasaki T, Yokoyama A. Examination of the relationship between mandibular position and body posture. Cranio. 2007 Oct;25(4):237-49.


Evaluating 45 asymptomatic subjects Sakaguchi et al concluded that:

1. Body posture was more stable when subjects bit down in centric occlusion.

2. Changes in body posture affected occlusal force distribution.

3. Altering body posture by changing leg length shifted the occlusal force distribution to the same side that had a heel lift.

In a clinical setting, when dental occlusion is developed and finished, body posture should be taken into account.

If a patient has a leg length discrepancy, hip rotation or any other problem altering body posture, occlusal contacts may differ as the patient stands up and starts walking.

The ControlledArch System

J Gen Orthod. 1999 Winter;10(4):9-15.
The controlled arch system: a new method of straightwire treatment.
Sim JM, Galella SA.

Abstract
The "Controlled Arch System", coupled with a proper diagnosis and treatment plan, should produce excellent occlusion and esthetics for your patients from their Mixed Dentition growth period onward. The authors have offered a method of Phase I treatment for children of Mixed Dentition age that can be outlined as follows: 1. Fit maxillary and mandibular Functional Orthopedic appliances to produce whatever transverse expansion of the arches is needed, then distalize the maxillary 6 year molars to a super Class I relation, according the measurements assessed by the Sim Model Analysis. 2. On removal of the Functional Orthopedic appliances, upper and lower Fixed-Removable Lingual Arches are fitted to stabilize teeth and bone. 3. As needed, fit maxillary and mandibular 2 x 4 or 2 x 6 fixed Straightwire appliances with Nickel Titanium wires, utilizing pinched molar hook/stops to establish molar anchorage to level, align and rotate permanent incisors (and lower permanent canines, if erupted). 4. When alignment of the permanent incisors is completed, the FRLAs are left in place as "insurance" appliances to insure that no loss of arch width or arch length occurs. The FRLAs are left in place for up to two years as retainers. 5. Be sure to inform parents and patients that Phase II comprehensive fixed Straightwire treatment is almost certain to be needed during adolescence when the 28 permanent teeth have erupted. 6. Use of this "Controlled Arch System" not only simplifies and shortens the duration of orthodontic treatment, but also can dramatically lower the percentage of extraction cases in an orthodontic practice

How to diagnose sleep apnea in children

Excerpt from:

Sleep apnea in children
Kleoniki Papazoglou,1 Manolis J. Papagrigorakis2
1.Pediatrician-Intensivist, Associate Director of Intensive Care Unit at "P. & A. Kyriakou" Children's Hospital, Athens, Greece.
2.Assistant Professor, Department of Orthodontics, School of Dentistry, University of Athens, Greece.

DIAGNOSIS
Syndrome diagnosis in children is now performed on
the basis of specific laboratory tests (Guilleminault et
al., 1996; Coleman, 1999; Bower and Gungor,
2000), so that diagnosis is documented with
maximum possible certainty.
Laboratory testing may include:
– sleep study - polysomnography,
– upper airway radiographs (face/profile),
– rhinopharyngoscopy,
– computed tomography,
– MRI and
– cephalometric studies.



In conclusion, Obstructive Sleep Apnea is a syndrome with
specific features in children. Clinicians should be aware of it
to ensure its early diagnosis, detailed laboratory screening
should be performed when there is suspicion or signs of the
syndrome and its treatment should be immediate in order to
avoid side effects on child growth.

Functional orthopaedic treatment does work!

SCIENTIFIC ARTICLES
Stomatologija, Baltic Dental and Maxillofacial Journal, 7:7-10, 2005

SUMMARY
The aim of the present study was to assess clinical effectiveness of Class II Division 1 malocclusion
treatment with Twin block appliance.
Material and methods: analysis of cepahlometric radiographs of 34 Class II Divison 1 patients treated
with Twin block appliance was performed before and after treatment. A control group was generated from the
normative growth data published by Bhatia and Leighton. The treatment effect was calculated by subtracting
the natural growth change from the treatment change. This was then compared to twice the method error to see
if the treatment change was clinically significant.
Results: Mean mandibular length as measured from point Art to point Pog increased by 6.4 mm in the
Twin–block group compare with 4.1 mm in the control group. The overjet during treatment was reduced by 4.9
mm. Relative to the maxilla upper incisor tipped backward by 6.7° and in the control group natural growth
proclined them by 2.4°. Lower incisor after the treatment tipped forward and the angle between long axis of
lower incisor and mandibular plane increased by 3.3°, whereas in the control group they stay almost in the same
position, proclination only 0.7°.
Conclusions: Twin block appliance clinically significantly increases mandibular length (net effect 2.3 mm)
and reduce overjet (net effect 4.9 mm). Modification of the Twin block appliance by acrylic extension to cover
the edges of lower incisors reduce dentoalveolar tipping and maximize skeletal changes

Patients prefer fuller smiles than orthodontists generally

This is a good article showing why we should try to create full profiles for our patients.
http://www.angle.org/doi/pdf/10.1043/0003-3219(1970)040%3C0284:ACOFE%3E2.0.CO%3B2

Cost-effectiveness and patient satisfaction: Hawley and vacuum-formed retainers -- Hichens et al. 29 (4): 372 -- The European Journal of Orthodontics

Cost-effectiveness and patient satisfaction: Hawley and vacuum-formed retainers

Lisa Hichens*, Heidi Rowland*, Alison Williams**, Sandra Hollinghurst***, Paul Ewings****, Steven Clark*****, Anthony Ireland*** and Jonathan Sandy**** Specialist Practice, Bristol** King's College Hospital, Denmark Hill, London*** Bristol University, Bristol**** Musgrove Park Hospital, Taunton and Somerset National Health Service Trust, Taunton***** Queens Medical Centre, University Hospital National Health Service Trust, Nottingham, UKAddress for correspondence, Professor J. R. Sandy, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK, E-mail: jonathan.sandy@bristol.ac.uk

Abstract:

In the United Kingdom (UK) over the last 10 years, there has been a significant increase in the use of vacuum-formed retainers (VFRs) rather than conventional Hawley retainers. There are currently no data to compare the cost-effectiveness of this change in practice. The two aims of this study were to compare (1) the cost-effectiveness of VFRs and Hawley retainers over 6 months, from the perspective of the National Health Service, orthodontic practice, and the patient and (2) patient satisfaction in the two retainer groups. A randomized controlled trial (RCT) was carried out in a specialist orthodontic practice. Three hundred and ninety-seven eligible patients were randomized to one of two retainer groups, and followed up for 6 months. All subjects were invited to complete patient satisfaction questionnaires. Additional data were collected for the cost analysis from the patient records and national databases. Descriptive and bivariate analyses were used to compare patient satisfaction between retainer groups.In all, 196 subjects were randomized to the Hawley group (mean age 14 years 8 months, 63 per cent female, 37 per cent male) and 201 to the VFR group (mean age 15 years, 59 per cent female, 41 per cent male). VFRs were more cost-effective than Hawley retainers from all perspectives. The majority of subjects showed a preference for VFRs compared with Hawley retainers. There were also fewer breakages than in the Hawley group.

Cost-effectiveness and patient satisfaction: Hawley and vacuum-formed retainers -- Hichens et al. 29 (4): 372 -- The European Journal of Orthodontics

Long-term periodontal status of patients with mandibular lingual fixed retention -- Pandis et al. 29 (5): 471 -- The European Journal of Orthodontics

Long-term periodontal status of patients with mandibular lingual fixed retentionN. Pandis*, K. Vlahopoulos*, P. Madianos** and T. Eliades**** Private practice, Corfu** Department of Periodontology, School of Dentistry, University of Athens*** Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, GreeceAddress for correspondence Theodore Eliades, 57 Agnoston Hiroon, Nea Ionia 14231, Greece, E-mail: teliades@ath.forthnet.gr AbstractThe purpose of this study was to evaluate the periodontal tissues of patients with mandibular fixed retention for long or short periods of time. A total of 64 individuals were selected for this study using the following inclusion criteria: long-term lingual fixed retention; identical type of lingual fixed retainer bonded with the same materials; no cavities, restorations, or fractures of the mandibular anterior teeth; absence of habits and occlusal interferences; and canine guidance bilaterally. The resultant sample comprised 32 patients (mean age 25 years) who had been in retention for a mean period of 9.65 years (range 9–11 years) and an equal number retained for a period between 3 and 6 months. Plaque, gingival, and calculus indices, probing pocket depth, marginal recession, and bone level at the mandibular six anterior teeth were recorded for both groups. Demographic, clinical, and radiographic data were investigated with conventional descriptive statistics. Comparisons of the different variables between the two participant groups (long- and short-term retention) were carried out using a Mann–Whitney test for indices (plaque, gingival, and calculus), and a Fisher's exact test (two sided) for the remaining variables.No significant difference was found with respect to the plaque and gingival indices and bone level between the two groups. The long-term group presented higher calculus accumulation, greater marginal recession, and increased probing depth (P < 0.05). The results of this study raise the question of the appropriateness of lingual fixed retainers as a standard retention plan for all patients regardless of their attitude to dental hygiene. They also emphasize the importance of individual variability and cautious application of retention protocols after a thorough consideration of issues related to the anatomy of tissues and oral hygiene.

Long-term periodontal status of patients with mandibular lingual fixed retention -- Pandis et al. 29 (5): 471 -- The European Journal of Orthodontics

Does labial movement of lower incisors influence the level of the gingival margin? A case-control study of adult orthodontic patients -- Allais and Melsen 25 (4): 343 -- The European Journal of Orthodontics

Does labial movement of lower incisors influence the level of the gingival margin? A case–control study of adult orthodontic patientsDelfino Allais1 and Birte Melsen11 Department of Orthodontics, Royal Dental College, University of Aarhus, DenmarkIt has been suggested that proclination of the lower incisors results in gingival recession. Proclination is, however, a valuable alternative to extraction especially when considering facial aesthetics in adult patients.The aim of this study was to evaluate the association between the extent of labial movement of the lower incisors and the prevalence and severity of gingival recession in orthodontically treated adult patients. A retrospective case–control study based on the analysis of study-casts and intra-oral slides of 300 adult patients was carried out. One hundred and fifty pairs matched by age and sex were selected using simple random sampling. Recordings of gingival recession were made using casts as well as intra-oral slides. Dental displacement was measured on casts comparing the measurements before and after treatment.The intra-oral slide recordings of gingival recession were more reliable than the cast recordings. Although the difference in prevalence of individuals with gingival recession among cases and controls was statistically significant (P < 0.001), no significant difference in the mean recession value could be found between cases and controls (P > 0.10). The mean value of the extent of recession of the four lower incisors amounted to 0.36 mm for treated subjects and 0.22 mm for the controls. This mean difference of 0.14 mm between members of a pair was not clinically relevant. Faced with the alternative between extraction and labial movement of lower incisors the present study indicates that the latter is a valuable alternative leading to no clinically relevant deterioration of the periodontium.

Does labial movement of lower incisors influence the level of the gingival margin? A case-control study of adult orthodontic patients -- Allais and Melsen 25 (4): 343 -- The European Journal of Orthodontics

Temporomandibular Joint ears hearing - Google Scholar

Temporomandibular Joint ears hearing - Google Scholar
More than 2000 article showing a relationship between TMJ and ear problems

posture and airway - Google Scholar

posture and airway - Google Scholar
15600 articles showing how posture and airways are related!!!

nasal breathing and orthodontics - Google Scholar

nasal breathing and orthodontics - Google Scholar
More than 2000 references showing the relationship between mouth breathing and orthodontic problems!!!

Airway dimensions and head posture in obstructive sleep apnoea

Airway dimensions and head posture in obstructive sleep apnoea

Beni Solow^*, Søren Skov^*, Jan Ovesen^**, Pia W. Norup^** and Gordon Wildschiødtz^**

^*Orthodontic Department, School of Dentistry, University of Copendhagen Denmark
^**Sleep Laboratory, Glostrup Country Hospital Denmark

The present cephalometric study aimed to describe the antero-posterior diameters of the pharyngeal airway in a sample of 50 male obstructive sleep apnoea (OSA) patients and a reference sample of 103 male students, and to examine the relationship between these diameters and the posture of the head and the cervical column. Subjects were recorded in the cephalometer standing with the head in its natural position (mirror position). Pharyngeal airway diameters were measured at seven levels ranging from the maxillary tuberosity to the vallecula of the epiglottis. The largest difference was observed at the level behind the soft palate where the diameter was 50 per cent narrower in the OSA sample than in the reference sample. Extension of the cranio-cervical angle and forward inclination of the cervical column were correlated with an increase in the three most caudal airway diameters in the OSA sample: at the uvula, the root of the tongue, and the epiglotis, but only to increase in the lowest diameter in the reference sample. The findings were considered to reflect a compensatory physiological postural mechanism that serves to maintain airway adequacy in OSA patients in the awake erect posture, most efficiently so at the lowest levels of the oropharyngeal airway.

Usefulness and tolerability of an oral jaw-positioning appliance in the treatment of obstructive sleep apnea syndrome in children

Am. J. Respir. Crit. Care Med., Volume 165, Number 1, January 2002, 123-127
Randomized Controlled Study of an Oral Jaw-Positioning Appliance for the Treatment of Obstructive Sleep Apnea in Children with Malocclusion

MARIA P. VILLA, EDOARDO BERNKOPF, JACOPO PAGANI, VANNA BROIA, MARILISA MONTESANO, and ROBERTO RONCHETTI

Department of Pediatrics, II Faculty S. Andrea, University of Rome La Sapienza, Rome, Italy

To evaluate the clinical usefulness and tolerability of an oral jaw-positioning appliance in the treatment of obstructive sleep apnea syndrome in children, we studied 32 patients (mean age, 7.1 ± 2.6 yr; 20 males) with symptoms of obstructive sleep apnea, malocclusion, and a baseline apnea index > 1 event/h. A group of 19 subjects was randomly assigned to a 6-mo trial of an oral appliance; the remainder acted as control subjects. At baseline and after the trial all patients underwent physical examination, a standard polysomnography, and orthodontic assessment. A modified version of the Brouillette questionnaire related to obstructive sleep apnea symptoms was administered to parents before and after the trial and a clinical score was calculated. Of the 32 subjects enrolled, 4 treated subjects and 5 control subjects were lost to follow-up. Polysomnography after the trial showed that treated subjects all had significantly lower apnea index (p < 0.001) and hypopnea index values (p < 0.001) than before the trial, whereas in untreated control subjects these values remained almost unchanged. Clinical assessment before and after treatment showed that in 7 of the 14 subjects (50%) the oral appliance had reduced (a fall of at least 2 points in the respiratory score) and in 7 had resolved the main respiratory symptoms, whereas untreated patients continued to have symptoms. In conclusion, treatment of obstructive sleep apnea syndrome with an oral appliance in children with malocclusion is effective and well tolerated.

Posture and Occlusion

Posture and Occlusion are intimately related To maintain a healthy posture a balanced occlusion is important and to maintain a healthy occlusion posture is important. This relationship makes it essential that chiropractors and dentists work together [1].

1. .Sakaguchi K, Mehta NR, Abdallah EF, Forgione AG, Hirayama H, Kawasaki T, Yokoyama A. Examination of the relationship between mandibular position and body posture. Cranio. 2007 Oct;25(4):237-49.

Retention and stability with light forces in orthodontics

Retention and stability with light forces in orthodontics By Dr Derek Mahoney Many clinicians misquote the research from Seattle, Washington to make it appear that non-extraction, expansion style cases have greater relapse potential than extraction cases. For more than forty years, research in the Department of Orthodontics at the University of Washington (Seattle WA) has focused on a growing collection of more than 800 sets of patient records to assess stability and relapse of orthodontic treatment. All the patients included in this sample had concluded treatment a decade or more before the last set of data. Evaluation of treated premolar extraction patients, treated lower incisor extraction patients, treated non-extraction cases with generalized spacing, and patients treated with arch enlargement strategies, together with untreated norms showed similar physiological changes i.e. there is no more lower incisor stability in the extraction cases versus those patients that were treated with arch enlargement.(1) What general dentists must understand is that if patients want perfectly straight teeth for life they must be prepared to have fixed retainers for life. This comment has been backed up by numerous reports in the scientific literature, but the question I pose is should we offer our patients wider smiles, fuller lip profiles, and permanent retention versus premolar extractions and permanent retention? There is no doubt relapse is expected unless permanent retention is used. With the Damon philosophy, (which is more than just an expensive bracket), we expect less relapse because the teeth are moved within bone and not through bone. By using a low friction and LOW FORCE system (not more than 25gm/cm2) we allow bone to develop around the roots permitting better, but not perfect stability. This is supported by the CT scans taken at the end of treatment. Readers would be advised to look at the article by Dr. Damon in the latest Clinical Impressions magazine.(2) In this article Damon shows a patient that would normally be a four bicuspid extraction case which he has treated non-extraction. This case illustrates that with the Damon system: 1.Clinicians can gain significant transverse arch width without rapid palatal expansion. 2.Gains in posterior arch width result primarily from bodily movement. 3.Bone displays remodeling. 4.The Damon approach in this case appears to be very stable after 5 years of no posterior retention. Some of Damon’s cases now have nine year records after treatment and again show stability of posterior arch adaptation (as opposed to arch expansion). It must also be noted that the Damon philosophy suggests an archform that is not over-expansive in the cuspid area and allows more expansion in the bicuspid and molar area, where we know that we get more stability.(3) Dr. Damon suggests permanent retention, which Dwight does even more so in bilateral crossbite and anterior openbite cases where nobody seems to have the correct answers regarding retention. The suggestion that Damon type expansion is biologically sound and stable has not been scientifically validated, but I feel that it is biologically sound as it has been validated by the numerous CT scans which show bony apposition post treatment. No other technique has yet shown this, but it is correct in saying that the results are not yet published, but only shown in the different lectures of Dr. Damon. It will probably take another five years before we get a clinical randomized trial. Clinicians employing the Begg technique state that light forces are not new, but what is new is the concept of keeping the forces below 25gm per square cm, not overpowering the lip and cheek musculature, thus avoiding excessive tipping of the teeth. The teeth are then placed in a neutral corridor in balance with the facial musculature. Here are some more scientific facts….. 1.The range of variation of the maxillary width within primitive societies is low while in industrialized societies it is high. This shows that it is not controlled by the genes. 2.Careful study of the literature discloses a rather astonishing fact; even the critics have found that about half the expansion is usually permanent, and where relapse did take place, it was usually in the alveolus and not in the vault. Labret (4) found the widening here “maintained in all instances”; a view that was supported in the same year by the implant studies of Skieller (7) and later by Mayoral & Aristeguinta (5). John Mew (6) using a special semi-rapid rate of expansion at 1mm per week found that there was no relapse two and a half years out of retention. “The net expansion had been 3.5 mm and this had subsequently not relapsed”, but Dr. Mew was also training the patients to keep their mouths closed. This may be a major factor because patients with open mouth postures are known to have narrower maxillae. We know that clinical effectiveness is usually measured in cost, time, ease, etc and that the simpler methods are often found to provide the most “effective” if not the best results. From a paymaster’s point of view it is hard to justify any method that is less effective and as you know the final assessment of orthodontic effectiveness is usually made at the end of treatment regardless of subsequent changes. Obviously this acts as a real deterrent to the development of improved techniques which may take longer and require greater skills. Unfortunately, it is not easy for us to demonstrate the advantage of more complex methods if they are dependent on high levels of co-operation or require special clinical skills. This is especially true for Head Gear, Functional Appliances and long-term retention where co-operation may be in doubt and clinical skills vary widely. One method might have greater potential (be more “efficacious”) but is only “effective” with some clinicians and some patients. Never-the-less it may be possible to compare “efficaciousness” by selecting the “best results” achieved by a number of different techniques. Under these circumstances the numbers of patients in each group becomes less important as it can reasonably be assumed that the cases selected, represent the “best results” of the technique in question. In addition any selection is of more or less equal consequence and therefore relatively random. Comparing the “best results” may be the only method of testing “efficaciousness” when assessing the potential of techniques that require high clinical skills and patient co-operation. My Damon treatment outcomes are certainly amongst the best results when compared to previous expansion techniques. In the last few decades there has been a number of long term studies to evaluate the effect of different treatment modalities. The main topics of discussion have been related to the timing of treatment i.e. early or late and also the treatment options i.e. extraction or non-extraction, orthopaedic treatment with headgear or functional appliance therapy.(8-14) If one closely analyzes these studies you will find a very few of the methodologies presented are sound. Most of the studies dealing with extraction versus non extraction treatment options compared short and long term treatment outcomes without looking at the similarity of both groups at the commencement of treatment.(15-16) To have a scientifically correct comparison, the end of treatment outcomes should be compared only in those patients who are similar and thus equally susceptible to both treatment modalities. In the study by Pacquette and co workers, boarderline cases were compared for extraction and non extraction.(17) By boarderline they meant that the case only exhibited 4 – 5mm of crowding and thus could be treated either with or without extractions. When the cases were evaluated, on average 14.5 years after orthodontic treatment, the results showed that the upper incisors, as well as the upper and lower lips, were 2 mm more retruded in the extraction cases compared with the non-extraction cases. Any clinicians would consider this 2 mm insignificant and of no consequence, however, according to constructive profile studies a change of a few millimeters in one feature is enough to alter the appeal of the rest of the face.(18) In a similar study, Bowman and Johnston found that extraction patients demonstrated 1.8 mm less lip protrusion than non-extraction patients. So to summarize I wish to state that the case I demonstrated in my article showed considerable expansion, but was treated with the principles of Damon and thus the end of treatment CT scans showed more bone around the teeth at the end of orthodontic treatment than before. Although I do not have many Damon cases five years post retention I currently have, in my two practices, over 700 case records of patients who were treated as second opinions against four bicuspid extractions. I have successfully treated these 700 individuals without removing premolar teeth and we now have 10 years post treatment records with perfect stability. This is due not only to the fixed retention employed, but also due to the fact that the majority of these 700 patients were treated during their pubertal growth phase. I welcome any clinician to assess these long term records which I will eventually hope to publish in an attempt to change people’s perception of the need for premolar extractions versus arch development as part of the an orthodontic treatment plan. In this way people may realize that achieving beautiful facial profiles and wide smiles, via arch development, is certainly not a mystery. References 1. Little, RM Stability and relapse of mandibular anterior alignment...University of Washington studies, Semin Orthod 1999; 5:191-204. 2. Damon D, Clinical Impressions, Volume 15, No. 1 2006, page 16 & 17. 3. BeGolle EA, Fox DL, Sadowski C. AJODO 1998 Mar;113(3):307-315. 4. Labret, L.M.L. “Expansion with Labiolingual and Removable Appliances”.Am. J. Orthod. 1964 (50). 786-787. 5. Mayoral, P. & Aristeguinta, R. “What Happens with palatal Dysjunction”. J. Clin. Orth. 12. 561-565. 1978. 6. Mew, JRC “Relapse Following Maxillary Expansion: A Study of 25 Consecutive Cases” American Journal of Orthodontics. 83: 56-61 1983. 7. Skieller, V. “Expansion of the midpalatal suture by removable plates analysed by the implant method” Transactions of Eur. Orthod. Soc. P.p. 143-158. 1964. 8. Baumrind S. Korn EL: Patterns of change in mandibular and facial shape associated with the use of forces to retract the maxilla. Am J Orthod. 80:31-47, 1981 9. Johnston LE: A comparative analysis of Class II treatments, in Vig PS, Ribbens KA, eds: Science and Clinical Judgement in Orthodontics. Monograph No. 19, Craniofacial Growth Series. Ann Arbor, Center for Human Growth Development, University of Michigan Press, 1986, pp 103-148 10. Tulloch JF, Phillips C, Koch G, Proffit WR: The effect of early intervention on skeletal pattern in Class II malocclusion: a randomized clinical trial. Am J Orthod Dentofacial Orthop 111:391-400, 1997 11. Keeling SD, Wheeler TT, King GJ, et al: Anteroposterior skeletal and dental changes after early Class II treatment with bionators and headgear. Am J Orthod Dentofacial Orthop 113:40-50, 1998 12. Ghafari J, Shofer FS, Hunt-Jacobsson U, et al: Headgear versus functional regulator in the early treatment of Class II, Division 1 malocclusion: a randomized clnical study. Am J Orthod Dentofacial Orthop 113:51-61, 1998 13. Tulloch CFC, Phillips C, Proffit WR: Benefit of early Class II treatment: progress report of a two-phase randomized clinical trial. Am J. Orthod Dentofacial Orthop 113:62-72, 1998 14. Boley JC, Pontier JP, Smith S, Fullbright M: Facial changes in extraction and nonextraction patients. Angle Orthod 68:539-546, 1998 15. Zierhut EC, Joondeph DR, Artun J, Little RM: Long-term profile changes associated with successfully treated extraction and nonextraction Class II Division 1 malocclusions. Angle Orthod 70:208-219, 2000 16. Luppanapornlarp S, Johnston LE: The effects of premolar extraction: a long term comparison of outcomes in a “clear-cut” extraction and non-extraction Class II patients. Angle Orthod 63:257-272, 1993 17. Paquette DE, Beattie JR, Johnston LE: A long term comparison of non-extraction and premolar extraction edge-wise therapy “borderline” Class II patients. Am J Orthod Dentofacial Orthop 102:1-14, 1992 18. Romani KL, Agahi F, Nanda R, Zernik JH: Evaluation of horizontal and vertical differences in facial profiles by orthodontists and lay people. Angle Orthod 63:175-182, 1993 19. Bowman SJ, Johnston LE Jr: The esthetic impact of extraction and nonextraction treatments on Caucasian patients. Angle Orthod 70:3-10, 2000 20. Johnston LE Jr: Functional appliances: a mortgage on mandibular position. Aust Orthod J 14:154-157, 1996

The esthetics of the smile: a review of some recen...[Int J Prosthodont. 1999 Jan-Feb] - PubMed Result

The esthetics of the smile: a review of some recen...[Int J Prosthodont. 1999 Jan-Feb] - PubMed Result: "The esthetics of the smile: a review of some recent studies.
Dong JK, Jin TH, Cho HW, Oh SC.

Department of Prosthodontics, Wonkwang University School of Dentistry, Iksan, South Korea. dong@wonnms.wonkwang.ac.kr

PURPOSE: This article reviews recent research on the esthetics of the smile, covering the attractiveness of the smile, the effect of aging on the smile, oral condition and the smile, personality and smile, and smile exercises. MATERIAL AND METHODS: The subjects were Koreans with normal occlusion. Photographs of a full smile were taken and the esthetic quality of the subjects' smiles was estimated. Smile scores were correlated with oral condition, personality, the practice of smile exercises, and elements of the smile, such as the position of the lip in a smile. The personality of the subjects was assessed by means of a Sixteen Personality Factor Questionnaire. Gibson's smile exercises were used to investigate the effect of smile exercise. RESULTS: In an attractive smile, the full shape of the maxillary anterior teeth was shown between the upper and lower lip, the upper lip curved upward or was straight, the maxillary anterior incisal curve was"

Some esthetic factors in a smile. [J Prosthet Dent. 1984] - PubMed Result

Some esthetic factors in a smile. [J Prosthet Dent. 1984] - PubMed Result: "Some esthetic factors in a smile.
Tjan AH, Miller GD, The JG.

A survey of the characteristics of an open smile was conducted with 454 full-face photographs of randomly selected dental and dental hygiene students. Findings show that an average smile exhibits approximately the full length of the maxillary anterior teeth, has the incisal curve of the teeth parallel to the inner curvature of the lower lip, has the incisal curve of the maxillary anterior teeth touching slightly or missing slightly the lower lip, and displays the six upper anterior teeth and premolars. Consideration of the characteristics may be useful in improving the esthetics of restorations."

The importance of incisor positioning in the esthe...[Am J Orthod Dentofacial Orthop. 2001] - PubMed Result

The importance of incisor positioning in the esthe...[Am J Orthod Dentofacial Orthop. 2001] - PubMed Result: "The importance of incisor positioning in the esthetic smile: the smile arc.
Sarver DM.

Department of Orthodontics, University of North Carolina, USA. sarverd@aol.com

The smile arc is defined as the relationship of the curvature of the incisal edges of the maxillary incisors and canines to the curvature of the lower lip in the posed smile. The ideal smile arc has the maxillary incisal edge curvature parallel to the curvature of the lower lip. Evaluation of anterior smile esthetics must include both static and dynamic evaluations of profile, frontal, and 45 degrees views to optimize both dental and facial appearance in orthodontic planning and treatment. This article presents the concept of the smile arc and how it relates to orthodontics-from the recognition of its importance, to its impact on orthodontic treatment planning, to how procedures and mechanics are adapted to optimize the appearance of the smile. Three cases are used to illustrate how treatment is directed, emphasizing how facial and smile goal setting go hand in hand."

The perceived impact of extraction and nonextracti...[Am J Orthod Dentofacial Orthop. 1999] - PubMed Result

The perceived impact of extraction and nonextracti...[Am J Orthod Dentofacial Orthop. 1999] - PubMed Result: "The perceived impact of extraction and nonextraction treatments on matched samples of African American patients.
Scott SH, Johnston LE Jr.

Department of Orthodontics, The University of Michigan, Ann Arbor, USA.

Orthodontic patients of African descent often seek some measure of reduction in profile protrusion. Lip retraction, however, seems to imply a need for premolar extraction. But in a nonextraction era, what does orthodontics have to offer the bimaxillary protrusion patient? To a considerable extent, it depends on what the patient wants and what treatment can provide. The present study was designed to address these questions by comparing the esthetic impact of extraction and nonextraction therapy on two morphologically similar samples of African American patients with Class I and II malocclusions. In addition to the patients, four panels of judges (black and white orthodontists and black and white laypersons) were asked to compare the pretreatment and posttreatment profile tracings and to quantify their perceptions of the esthetic impact of the change that occurred during treatment. Although there was a strong correlation among the various groups' ratings, there were a number of"

Arch width changes in extraction and nonextraction...[Angle Orthod. 2005] - PubMed Result

Arch width changes in extraction and nonextraction...[Angle Orthod. 2005] - PubMed Result: "Arch width changes in extraction and nonextraction treatment in class I patients.
Aksu M, Kocadereli I.

Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Sihhiye, Ankara, Turkey. mugepeh@hacettepe.edu.tr

The aim of this retrospective study was to examine the dental arch width changes of extraction and nonextraction treatment in Class I patients. The study was performed on pretreatment and posttreatment dental casts of 60 patients (30 extraction and 30 nonextraction). The mean ages were 14.3 +/- 2.02 years for the extraction group and 14.1 +/- 2.9 years for the nonextraction group. The maxillary and mandibular crowding was -6.7 +/- 3.1 and -6.3 +/- 2.8 mm for the extraction group and -4.5 +/- 3.6 and -2.1 +/- 3.5 mm for the nonextraction group, respectively. The intercanine and intermolar arch width measurements were measured using a digital caliper. Paired samples t-test was used to evaluate the treatment changes within each group. To compare the changes between groups, independent samples t-test was performed. At the start of treatment, the maxillary and the mandibular intercanine and intermolar widths of both groups did not differ statistically. At the end"

Which hard and soft tissue factors relate with the...[Angle Orthod. 2008] - PubMed Result

Which hard and soft tissue factors relate with the...[Angle Orthod. 2008] - PubMed Result: "Which hard and soft tissue factors relate with the amount of buccal corridor space during smiling?
Yang IH, Nahm DS, Baek SH.

Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, South Korea.

OBJECTIVE: To investigate which hard and soft tissue factors relate with the amount of buccal corridor area (BCA) during posed smiling. MATERIALS AND METHODS: The samples consisted of 92 adult patients (19 men and 73 women; 56 four first bicuspids extraction and 36 nonextraction treatment cases; mean age = 23.5 years), who were treated only with a fixed appliance and finished with Angle Class I canine and molar relationships. To eliminate the crowding effect on the buccal corridor area, lateral cephalograms, dental casts, and standardized frontal posed smile photographs were obtained at debonding stage and 28 variables were measured. Pearson correlation analysis, multiple linear regression analysis, and independent t-test were used to find variables that were related with buccal corridor area ratio (BCAR). RESULTS: Among the lateral cephalometric and dental cast variables, FMA, lower anterior facial height, upper incisor (U1) exposure, U1 to facial plane, lower"

Characterization of posed smile by using visual an...[Am J Orthod Dentofacial Orthop. 2008] - PubMed Result

Characterization of posed smile by using visual an...[Am J Orthod Dentofacial Orthop. 2008] - PubMed Result: "Characterization of posed smile by using visual analog scale, smile arc, buccal corridor measures, and modified smile index.
Krishnan V, Daniel ST, Lazar D, Asok A.

Department of Orthodontics, Rajas Dental College, Tirunelveli District, Tamilnadu, India. vikrishnan@yahoo.com

INTRODUCTION: Smile evaluation and designing are important; recent emphasis on the soft tissues has been on par with that on the hard tissues in orthodontic diagnosis and treatment planning. This importance has not yet gained proper attention, and smile analysis is often ignored in clinical examinations. We attempted a comprehensive evaluation of smile characteristics with the following aims: (1) evaluation of perception differences, if any, between dental specialists and laypersons; and (2) quantification of smile characteristics with the smile arc, buccal corridor measurements, and a modified smile index (MSI). METHODS: The sixty subjects included in the study had an age range of 18 to 25 years (mean, 21 years) with equal numbers of men and women. Frontal posed smile photographs were taken of all subjects. The study had 2 parts. Analysis of perception differences between dental specialists and la"

Hard- and soft-tissue contributions to the estheti...[Am J Orthod Dentofacial Orthop. 2008] - PubMed Result

Hard- and soft-tissue contributions to the estheti...[Am J Orthod Dentofacial Orthop. 2008] - PubMed Result: "Hard- and soft-tissue contributions to the esthetics of the posed smile in growing patients seeking orthodontic treatment.
McNamara L, McNamara JA Jr, Ackerman MB, Baccetti T.

Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078, USA. lmcnam@umich.edu

INTRODUCTION: The purpose of this investigation was to broaden the understanding of how various skeletal, dental, and soft-tissue relationships are related to the esthetics of the smile in patients with malocclusions before orthodontic treatment. METHODS: Images of the posed smile were captured from digital video clips of 60 growing patients (33 girls, 27 boys) seeking orthodontic treatment; they were judged by panels of laypersons and orthodontists. Discriminant analysis identified determinants of the 'pleasing smile' from the results of a visual analog scale. Quantitative measurements of the soft and hard tissues were made by using the smile images, cephalometric radiographs, and study models. The esthetics of the smile were correlated with specific skeletal, dental, and soft-tissue structures in the anteroposterior, vertical, and transverse dimensions (Pearson test"

Tooth display and lip position during spontaneous ...[Acta Odontol Scand. 2008] - PubMed Result

Tooth display and lip position during spontaneous ...[Acta Odontol Scand. 2008] - PubMed Result: "Tooth display and lip position during spontaneous and posed smiling in adults.
Van Der Geld P, Oosterveld P, Berge SJ, Kuijpers-Jagtman AM.

Department of Orthodontics and Oral Biology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

OBJECTIVE: To analyze differences in tooth display, lip-line height, and smile width between the posed smiling record, traditionally produced for orthodontic diagnosis, and the spontaneous (Duchenne) smile of joy. MATERIAL AND METHODS: The faces of 122 male participants were each filmed during spontaneous and posed smiling. Spontaneous smiles were elicited through the participants watching a comical movie. Maxillary and mandibular lip-line heights, tooth display, and smile width were measured using a digital videographic method for smile analysis. Paired sample t-tests were used to compare measurements of posed and spontaneous smiling. RESULTS: Maxillary lip-line heights during spontaneous smiling were significantly higher than during posed smiling. Compared to spontaneous smiling, tooth display in the (pre)molar area during posed smiling decreased by up to 30%, along with a significant reduction of smile width. During posed smiling, also mandibular"

The importance of incisor positioning in the esthe...[Am J Orthod Dentofacial Orthop. 2001] - PubMed Result

The importance of incisor positioning in the esthe...[Am J Orthod Dentofacial Orthop. 2001] - PubMed Result: "Am J Orthod Dentofacial Orthop. 2001 Aug;120(2):98-111.Click here to read Links
The importance of incisor positioning in the esthetic smile: the smile arc.
Sarver DM.

Department of Orthodontics, University of North Carolina, USA. sarverd@aol.com

The smile arc is defined as the relationship of the curvature of the incisal edges of the maxillary incisors and canines to the curvature of the lower lip in the posed smile. The ideal smile arc has the maxillary incisal edge curvature parallel to the curvature of the lower lip. Evaluation of anterior smile esthetics must include both static and dynamic evaluations of profile, frontal, and 45 degrees views to optimize both dental and facial appearance in orthodontic planning and treatment. This article presents the concept of the smile arc and how it relates to orthodontics-from the recognition of its importance, to its impact on orthodontic treatment planning, to how procedures and mechanics are adapted to optimize the appearance of the smile. Three cases are used to illustrate how treatment is directed, emphasizing how facial and smile goal setting go hand in hand."

Smile

Pitch, roll, and yaw: Describing the spatial orientation of dentofacial traits .

American Journal of Orthodontics and Dentofacial Orthopedics , Volume 131 , Issue 3 , Pages 305 - 310

J . Ackerman , W . Proffit , D . Sarver , M . Ackerman , M . Kean"

Elsevier Article Locator: "Abstract


The value of systematically enhancing the Angle classification by including transverse and vertical characteristics in addition to anteroposterior relationships for the face and the dentition is universally accepted. Three aeronautical rotational descriptors (pitch, roll, and yaw) are used here to supplement the planar terms (anteroposterior, transverse, and vertical) in describing the orientation of the line of occlusion and the esthetic line of the dentition. Each of the latter traits affects the modern clinical practice of orthodontics because of its greater focus on dentofacial traits beyond the correction of malocclusion. Consistent with the principle that every orthodontic intervention should begin with a thorough consideration of variation in a patient’s dentofacial traits, this article offers further refinement of diagnostic description and classification."