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Lorenzoni DC, Barbosa OTDAM, Cury-Saramago ADA, Mattos CT. Class II subdivision treatment and stability with asymmetric Herbst appliance: A case report. Int Orthod 2024; 22:100838. [PMID: 38290193 DOI: 10.1016/j.ortho.2023.100838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 02/01/2024]
Abstract
Non-surgical treatment of Class II subdivision may involve complex mechanics or asymmetric tooth extraction in its resolution. This report demonstrates the result and the short-term stability of Class II subdivision treated with asymmetrically installed Herbst appliance followed by conventional fixed orthodontic appliance. The approach allowed the correction of the unilateral Class II molar relationship and increased overjet, as well as the deviation of dental midlines, with improvement in lip posture and facial profile. The results remained stable two years after treatment, confirming the treatment success.
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Affiliation(s)
- Diego Coelho Lorenzoni
- Departamento de Odontoclínica, Disciplina de Ortodontia, Faculdade de Odontologia, Universidade Federal Fluminense, Niterói, RJ, Brazil.
| | | | | | - Cláudia Trindade Mattos
- Departamento de Odontoclínica, Disciplina de Ortodontia, Faculdade de Odontologia, Universidade Federal Fluminense, Niterói, RJ, Brazil
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Gurgel M, Alvarez MA, Aristizabal JF, Baquero B, Gillot M, Al Turkestani N, Miranda F, Castillo AAD, Bianchi J, de Oliveira Ruellas AC, Ioshida M, Yatabe M, Rey D, Prieto J, Cevidanes L. Automated artificial intelligence-based three-dimensional comparison of orthodontic treatment outcomes with and without piezocision surgery. Orthod Craniofac Res 2024; 27:321-331. [PMID: 38009409 PMCID: PMC10949222 DOI: 10.1111/ocr.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/26/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE(S) This study aims to evaluate the influence of the piezocision surgery in the orthodontic biomechanics, as well as in the magnitude and direction of tooth movement in the mandibular arch using novel artificial intelligence (AI)-automated tools. MATERIALS AND METHODS Nineteen patients, who had piezocision performed in the lower arch at the beginning of treatment with the goal of accelerating tooth movement, were compared to 19 patients who did not receive piezocision. Cone beam computed tomography (CBCT) and intraoral scans (IOS) were acquired before and after orthodontic treatment. AI-automated dental tools were used to segment and locate landmarks in dental crowns from IOS and root canals from CBCT scans to quantify 3D tooth movement. Differences in mesial-distal, buccolingual, intrusion and extrusion linear movements, as well as tooth long axis angulation and rotation were compared. RESULTS The treatment time for the control and experimental groups were 13.2 ± 5.06 and 13 ± 5.52 months respectively (P = .176). Overall, anterior and posterior tooth movement presented similar 3D linear and angular changes in the groups. The piezocision group demonstrated greater (P = .01) mesial long axis angulation of lower right first premolar (4.4 ± 6°) compared with control group (0.02 ± 4.9°), while the mesial rotation was significantly smaller (P = .008) in the experimental group (0.5 ± 7.8°) than in the control (8.5 ± 9.8°) considering the same tooth. CONCLUSION The open source-automated dental tools facilitated the clinicians' assessment of piezocision treatment outcomes. The piezocision surgery prior to the orthodontic treatment did not decrease the treatment time and did not influence in the orthodontic biomechanics, leading to similar tooth movements compared to conventional treatment.
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Affiliation(s)
- Marcela Gurgel
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Baptiste Baquero
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Maxime Gillot
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Najla Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Felicia Miranda
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Aron Aliaga-Del Castillo
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonas Bianchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Marcos Ioshida
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Diego Rey
- Department of Orthodontics, CES University, Medellin, Colombia
| | - Juan Prieto
- Department of Computer Sciences, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
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Austro-Martinez MD, Nicolás-Silvente AI, Requena MA, Carazo-Austro M, Alarcón JA. Stability of class II correction with the Austro Repositioner associated with multi-brackets fixed appliances in dolichofacial patients. BMC Oral Health 2024; 24:44. [PMID: 38191391 PMCID: PMC10773075 DOI: 10.1186/s12903-023-03692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The purposes of the present study were to evaluate the changes produced by the Austro Repositioner, and to assess the stability of Class II malocclusion treatment with the Austro Repositioner associated with fixed appliances and its capacity to control the vertical dimension in dolichofacial patients. METHODS A group of patients with Class II malocclusion due to mandibular retrognathism and a dolichofacial growth pattern treated with the Austro Repositioner combined with fixed appliances were compared to a matched untreated control group of subjects with Class II malocclusion. Evaluations were made on the basis of lateral cephalograms taken at T1 (initial records), T2 (end of treatment), and T3 (1 year after treatment). Statistical comparisons were performed with paired- and two-sample t tests. RESULTS The experimental (treated) group comprised 30 patients, 14 boys and 16 girls, and the control group comprised 30 subjects (15 boys and 15 girls) with similar ages at T1, T2 and T3. In the treated group, a significant decrease in the ANB angle was found (- 3.79 ± 1.46; p < 0.001). No significant differences were found in the maxillary skeletal measurements. In contrast, the SNB angle showed a significant increase of 3.77 ± 1.49 in the treated group compared with a nonsignificant increase of 0.77 ± 1.55 in the control group (p = 0.002). Vertical changes showed a significant decrease in the FMA angle (- 3.36 ± 1.62), while the lower anterior facial height distance and the overbite increased significantly in the treated group, reflecting a change in vertical dimensions after treatment. No significant changes were observed in either the treated or control group during the one-year posttreatment period; thus, the treatment results remained stable. CONCLUSIONS The Austro Repositioner combined with fixed appliances could be considered an optimal treatment modality in Class II dolichofacial patients.
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Affiliation(s)
- María Dolores Austro-Martinez
- Department of Restorative Dentistry, School of Dentistry, CEIR Campus Mare Nostrum, University of Murcia, Murcia, 30008, Spain
| | - Ana I Nicolás-Silvente
- Department of Dental Pathology and Therapeutics, School of Dentistry, CEIR Campus Mare Nostrum, University of Murcia, Murcia, 30008, Spain
| | | | - Marta Carazo-Austro
- Undergraduate student, Faculty of Odontology, University of Granada, Granada, 18071, Spain
| | - José Antonio Alarcón
- Department of Stomatology, Section of Orthodontics, Faculty of Odontology, University of Granada, Granada, 18071, Spain.
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Marino Merlo M, Quiroga Souki B, Nieri M, Bonanno A, Giuntini V, McNamara JA, Franchi L. Comparison of the effects on facial soft tissues produced by rapid and slow maxillary expansion using stereophotogrammetry: a randomized clinical trial. Prog Orthod 2024; 25:1. [PMID: 38168740 PMCID: PMC10761642 DOI: 10.1186/s40510-023-00498-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/28/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To compare the effects on facial soft tissues produced by maxillary expansion generated by rapid maxillary expansion (RME) versus slow maxillary expansion (SME). MATERIALS AND METHODS Patients in the mixed dentition were included with a transverse discrepancy between the two arches of at least 3 mm. A conventional RME screw was compared to a new expansion screw (Leaf expander) designed to produce SME. Both screws were incorporated in a fixed expander. The primary outcome was the difference of the facial tissue changes in the nasal area measured on facial 3D images captured immediately before application of the expander (T0) and after one year of retention, immediately after the expander removal (T1). Secondary outcomes were soft tissue changes of other facial regions (mouth, lips, and chin). Analysis of covariance was used for statistical analysis. RESULTS Fourteen patients were allocated to the RME group, and 14 patients were allocated to the SME group. There were no dropouts. Nasal width change showed a difference between the two groups (1.3 mm greater in the RME group, 95% CI from 0.4 to 2.2, P = 0.005). Also, intercanthal width showed a difference between treatments (0.7 mm greater in the RME group, 95% CI from 0.0 to 1.3, P = 0.044). Nasal columella width, mouth width, nasal tip angle, upper lip angle, and lower lip angle did not show any statistically significant differences. The Y-axis (anterior-posterior) components of the nasal landmark showed a statistically significant difference between the two groups (0.5 mm of forward displacement greater in the RME group, 95% CI from 0.0 to 1.2, P = 0.040). Also, Z-axis (superior-inferior) components of the lower lip landmark was statistically significant (0.9 mm of downward displacement in favor of the RME group, 95% CI from 0.1 to 1.7, P = 0.027). All the other comparisons of the three-dimensional assessments were not statistically significant. CONCLUSIONS RME produced significant facial soft tissue changes when compared to SME. RME induced greater increases in both nasal and intercanthal widths (1.3 mm and 0.7 mm, respectively). These findings, though statistically significant, probably are not clinically relevant. Trial registration ISRCTN, ISRCTN18263886. Registered 8 November 2016, https://www.isrctn.com/ISRCTN18263886?q=Franchi&filters=&sort=&offset=2&totalResults=2&page=1&pageSize=10.
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Affiliation(s)
- Matilde Marino Merlo
- Graduate Orthodontic Program, Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
| | - Bernardo Quiroga Souki
- Graduate Orthodontic Program, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Michele Nieri
- Department of Experimental and Clinical Medicine, Orthodontics, The University of Florence, Florence, Italy
| | - Agnese Bonanno
- Graduate Orthodontic Program, Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
| | - Veronica Giuntini
- Graduate Orthodontic Program, Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy
| | - James A McNamara
- Thomas M. and Doris Graber Endowed Professor of Dentistry Emeritus, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
- Professor Emeritus of Cell and Developmental Biology, School of Medicine, The University of Michigan, Ann Arbor, MI, USA
- Center for Human Growth and Development, The University of Michigan, Ann Arbor, MI, USA
| | - Lorenzo Franchi
- Graduate Orthodontic Program, Department of Experimental and Clinical Medicine, The University of Florence, Florence, Italy.
- Thomas M. Graber Visiting Scholar, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, USA.
- Director of the Division of Dentistry, University Hospital of Careggi, Via del Ponte di Mezzo, 46-48, 50127, Florence, Italy.
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Gurgel ML, de Oliveira Ruellas AC, Bianchi J, McNamara JA, Tai S, Franchi L, Deleat-Besson R, Le C, Logan C, Turkestani NA, Massaro C, Del Castillo AA, Arruda KEM, Benavides E, Yatabe M, Cevidanes L. Clear aligner mandibular advancement in growing patients with Class II malocclusion. AJO-DO CLINICAL COMPANION 2023; 3:93-109. [PMID: 37636594 PMCID: PMC10454533 DOI: 10.1016/j.xaor.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Treatment effects occurring during Class II malocclusion treatment with the clear aligner mandibular advancement protocol were evaluated in two growing patients: one male (12 years, 3 months) and one female (11 years, 9 months). Both patients presented with full cusp Class II molar and canine relationships. Intraoral scans and cone-beam computed tomography were acquired before treatment and after mandibular advancement. Three-dimensional skeletal and dental long-axis changes were quantified, in which the dental long axis was determined by registering the dental crowns obtained from intraoral scans to the root canals in cone-beam computed tomography scans obtained at the same time points. Class II correction was achieved by a combination of mandibular skeletal and dental changes. A similar direction of skeletal and dental changes was observed in both patients, with downward and forward displacement of the mandible resulting from the growth of the mandibular condyle and ramus. Dental changes in both patients included mesialization of the mandibular posterior teeth with flaring of mandibular anterior teeth. In these two patients, clear aligner mandibular advancement was an effective treatment modality for Class II malocclusion correction with skeletal and dental effects and facial profile improvement.
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Affiliation(s)
- Marcela Lima Gurgel
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Antonio Carlos de Oliveira Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
- Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jonas Bianchi
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, Calif
| | - James A. McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Sandra Tai
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, School of Dentistry, University of Florence, Florence, Tuscany, Italy
| | - Romain Deleat-Besson
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Celia Le
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Candice Logan
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Najla Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
- Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Camila Massaro
- Department of Orthodontics, School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Aron Aliaga Del Castillo
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Erika Benavides
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
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Kong L, Liu XQ. Efficacy of invisible advancement correction for mandibular retraction in adolescents based on Pancherz analysis. World J Clin Cases 2023; 11:1299-1309. [PMID: 36926124 PMCID: PMC10013113 DOI: 10.12998/wjcc.v11.i6.1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/03/2023] [Accepted: 02/08/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Mandibular retraction is the main etiological mechanism of class II malocclusion in China and the subsequent distal molar relationship can cause functional discomfort in mastication, breathing and the temporomandibular joint. The use of mandibular advancement (MA) devices has recently emerged as an adolescent mandibular retraction treatment; however, current studies regarding the effect thereof are relatively few, and there is lack of sufficient clinical support. AIM To investigate the clinical effect of invisalign MA on the treatment of mandibular retraction in adolescents. METHODS This study included 30 adolescent patients who underwent treatment with the MA appliances from December 2017 to June 2021. The lateral cephalometric data before and after treatment were collected and imported into Dolphin Imaging software. The changes were measured by linear measurement superimposed with lateral cephalometric trajectory based on the Pancherz technology. RESULTS There was no significant difference in the length and position of maxilla before and after the treatment. The position of the mandible moved 3.13 mm, the length increased 4.14 mm, the mandibular ramus length increased 4.09 mm, the body length increased 4.25 mm, and the position of the condyle moved 1.03 mm forward after treatment. Additionally, changes in the incisor sagittal position and labial inclination were observed. The position of the upper incisor point moved back 1.33 mm, without statistical difference, the inclination and tooth angle decreased by 3.44° and 4.06°, respectively; the position of the lower incisor point was moved 2.98 mm, and the inclination and tooth angle increased by 2.62° and 1.23°, respectively. Furthermore, changes in the incisor overjet and molar relationship were seen. Overjet decreased by 4.31 mm, of which 1.78 mm was due to dental factors, accounting for 41.3% of the effect as opposed to 58.7% due to skeletal factors. Molar relationship improved 3.87 mm, with 1.34 mm due to dental factors, and dental and skeletal factors were accounted for 34.6% and 65.4% of the effect, respectively. CONCLUSION For adolescent patients with mandible retraction, invisalign MA can effectively promote the mandible growth, and it was proven to be mainly due to skeletal effects.
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Affiliation(s)
- Lei Kong
- Department of Stomatology and Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
- Department of Stomatology, Qingdao University, Qingdao 266003, Shandong Province, China
| | - Xin-Qiang Liu
- Department of Stomatology and Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
- Department of Stomatology, Qingdao University, Qingdao 266003, Shandong Province, China
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de Arruda Aidar LA, Marchi LC, Fuerte S, Yamashita HK, Dominguez GC. Evaluation of the stability of treatment with Herbst appliance associated with Hyrax expander and fixed orthodontics through counterpart analysis: A longitudinal follow-up study. Orthod Craniofac Res 2023; 26:27-36. [PMID: 35347846 DOI: 10.1111/ocr.12574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/04/2022] [Accepted: 03/23/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the stability of treatment with a Herbst appliance associated with Hyrax expander (Stage I), followed by fixed appliances (Stage II) and follow-up for an average of 4 years after Stage II, on dentoskeletal facial structures. METHODS This study involved 50 adolescents with Angle Class II division 1 malocclusion associated with mandibular retrognathism: Treated Group (TG-25) and Control Group (CG-25). Lateral cephalometric radiographs were taken: T1, immediately before Stage I (TG) or at the beginning of the follow-up period (CG); T2, at the end of Stage I (TG) or the follow-up period (CG); T3, at the end of Stage II (TG); and T4, on average, 4 years after Stage II (TG). Enlow's counterpart analysis and some cephalometric measurements were evaluated. Parametric and non-parametric tests were used (P ≤ 0.05). RESULTS The ramus alignment variables (P < 0.001), SNB (0.040), ANB (<0.001), 1.PP (P = 0.015), 1.MP (P < 0.001), ms/RLp (P < 0.001), mi/RLp (P < 0.001) and S-LS (P = 0.005) showed differences between TG and CG from T1 to T2. Longitudinally, there were differences in ramus alignment, P = 0.003, T1 > T2 < T3 = T4; SNB, P = 0.016, T1 < T2 = T3 = T4; ANB, P < 0.001, T1 > T2 = T3 = T4; 1.MP, P < 0.001, T1 < T2 = T3 = T4; ms/RLp, P = 0.002, T1 = T2 < T3 = T4; mi/RLp, P < 0.001, T1 < T2 = T3 = T4; S-LS, P < 0.001, T1 > T2 = T3 = T4 and S-LI, P = 0.003, T1 = T2 = T3 > T4. CONCLUSION The nasomaxillary complex (MCF/PM alignment) tended to a retrusive effect to compensate the degree of mandibular retrusion. The protrusive effect of the lower facial third was evident after the Herbst stage and did not remain stable in the follow-up. The dentoalveolar compensation and improvement in facial profile remained stable.
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Affiliation(s)
| | - Luiz Carlos Marchi
- Department of Orthodontics, School of Dentistry, West Paraná State University, Cascavel, Brazil
| | - Silvia Fuerte
- Department of Orthodontics, School of Dentistry, Santa Cecília University, Santos, Brazil
| | - Hélio K Yamashita
- Department of Diagnostic Imaging, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Shi Y, Shao J, Zhang Z, Zhang J, Lu H. Effect of condylar chondrocyte exosomes on condylar cartilage osteogenesis in rats under tensile stress. Front Bioeng Biotechnol 2022; 10:1061855. [PMID: 36561044 PMCID: PMC9766957 DOI: 10.3389/fbioe.2022.1061855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Functional orthoses are commonly used to treat skeletal Class II malocclusion, but the specific mechanism through which they do this has been a challenging topic in orthodontics. In the present study, we aimed to explore the effect of tensile stress on the osteogenic differentiation of condylar chondrocytes from an exosomal perspective. Methods: We cultured rat condylar chondrocytes under resting and tensile stress conditions and subsequently extracted cellular exosomes from them. We then screened miRNAs that were differentially expressed between the two exosome extracts by high-throughput sequencing and performed bioinformatics analysis and osteogenesis-related target gene prediction using the TargetScan and miRanda softwares. Exosomes cultured under resting and tensile stress conditions were co-cultured with condylar chondrocytes for 24 h to form the Control-Exo and Force-Exo exosome groups, respectively. Quantitative real time PCR(RT-qPCR) and western blotting were then used to determine the mRNA and protein expression levels of Runx2 and Sox9 in condylar chondrocytes. Results: The mRNA and protein expression levels of Runx2 and Sox9 in the Force-Exo group were significantly higher than those in the Control-Exo group (p < 0.05). The differential miRNA expression results were consistent with our sequencing results. Bioinformatics analysis and target gene prediction results showed that the main biological processes and molecular functions involved in differential miRNA expression in exosomes under tensile stress were biological processes and protein binding, respectively. Kyoto Gene and Genome Data Bank (KEGG) pathway enrichment analysis showed significant enrichment of differentially expressed miRNAs in the mTOR signaling pathway. The differentially expressed miRNAs were found to target osteogenesis-related genes. Conclusion: These results suggest that stimulation of rat condylar chondrocytes with tensile stress can alter the expression levels of certain miRNAs in their exosomes and promote their osteogenic differentiation. Exosomes under tensile stress culture conditions thus have potential applications in the treatment of Osteoarthritis (OA).
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Affiliation(s)
- Yuan Shi
- Department of Stomatology, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiaqi Shao
- Department of Stomatology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, China
| | - Zanzan Zhang
- Department of Stomatology, Ningbo No. 2 Hospital, Ningbo, China
| | - Jianan Zhang
- Department of Dentistry, Center of Orthodontics, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, China
| | - Haiping Lu
- Department of Stomatology, Zhejiang Chinese Medical University, Hangzhou, China,*Correspondence: Haiping Lu,
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Cong A, Ruellas ACDO, Tai SK, Loh CT, Barkley M, Yatabe M, Caminiti M, Massaro C, Bianchi J, Deleat-Besson R, Le C, Prieto JC, Al Turkestani NN, Cevidanes L. Presurgical orthodontic decompensation with clear aligners. Am J Orthod Dentofacial Orthop 2022; 162:538-553. [PMID: 36182208 PMCID: PMC9531869 DOI: 10.1016/j.ajodo.2021.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Orthodontists, surgeons, and patients have taken an interest in using clear aligners in combination with orthognathic surgery. This study aimed to evaluate the accuracy of tooth movements with clear aligners during presurgical orthodontics using novel 3-dimensional superimposition techniques. METHODS The study sample consisted of 20 patients who have completed presurgical orthodontics using Invisalign clear aligners. Initial (pretreatment) digital dental models, presurgical digital dental models, and ClinCheck prediction models were obtained. Presurgical models were superimposed onto initial ones using stable anatomic landmarks; ClinCheck models were superimposed onto presurgical models using surface best-fit superimposition. Five hundred forty-five teeth were measured for 3 angular movements (buccolingual torque, mesiodistal tip, and rotation) and 4 linear movements (buccolingual, mesiodistal, vertical, and total scalar displacement). The predicted tooth movement was compared with the achieved amount for each movement and tooth, using both percentage accuracy and numerical difference. RESULTS Average percentage accuracy (63.4% ± 11.5%) was higher than in previously reported literature. The most accurate tooth movements were buccal torque and mesial displacement compared with lingual torque and distal displacement, particularly for mandibular posterior teeth. Clinically significant inaccuracies were found for the buccal displacement of maxillary second molars, lingual displacement of all molars, intrusion of mandibular second molars, the distal tip of molars, second premolars, and mandibular first premolars, buccal torque of maxillary central and lateral incisors, and lingual torque of premolars and molars. CONCLUSIONS Superimposition techniques used in this study lay the groundwork for future studies to analyze advanced clear aligner patients. Invisalign is a treatment modality that can be considered for presurgical orthodontics-tooth movements involved in arch leveling and decompensation are highly accurate when comparing the simulated and the clinically achieved movements.
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Affiliation(s)
- Amalia Cong
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Antonio Carlos de Oliveira Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich; Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sandra Khong Tai
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlene Tai Loh
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary Barkley
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Marco Caminiti
- Division of Oral and Maxillofacial Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Camila Massaro
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Jonas Bianchi
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, Calif
| | - Romain Deleat-Besson
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Celia Le
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | | | - Najla N Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich; Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich.
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10
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Bates WR, Cevidanes LS, Larson BE, Adams D, De Oliveira Ruellas AC. Three-dimensional cone-beam computed technology evaluation of skeletal and dental changes in growing patients with Class II malocclusion treated with the cervical pull face-bow headgear appliance. Am J Orthod Dentofacial Orthop 2022; 162:491-501. [DOI: 10.1016/j.ajodo.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/01/2022]
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Sangalli KL, Dutra-Horstmann KL, Correr GM, Topolski F, Flores-Mir C, Lagravère MO, Moro A. Three-dimensional skeletal and dentoalveolar sagittal and vertical changes associated with cantilever Herbst appliance in prepubertal patients with Class II malocclusion. Am J Orthod Dentofacial Orthop 2022; 161:638-651.e1. [PMID: 35016812 DOI: 10.1016/j.ajodo.2020.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 11/01/2022]
Abstract
INTRODUCTION This study aimed to assess sagittal and vertical skeletal and dentoalveolar changes through the use of 3-dimensional imaging in prepubertal Class II malocclusion patients treated with a cantilever Herbst appliance (HA). Condyle-glenoid fossa positional changes were also quantified. METHODS This retrospective cohort study assessed 22 children (11.2 years ± 1.2) consecutively treated with a cantilever HA for 12 months and 11 untreated children (aged 9.3 ± 0.30 years) that served as controls. Cone-beam computed tomography was performed at baseline (T1) and at the end of the observation period (T2). Movements in the regions of interest were measured as linear displacements from cone-beam computed tomography images through algebraic calculations. A Student t test for independent samples was used for group equivalence testing at T1, and the treatment differences between T2 and T1 were evaluated by 2 analyses of covariance, one considering the expected growth unit as a covariate and the other with an annualized factor. RESULTS The largest dental movement was a mesial movement of mandibular molars (3.70 mm), whereas the largest skeletal changes consisted of a larger relative length of the mandible (difference of 1.2 mm) in the HA group than in the control group. CONCLUSIONS Within the study limitations (retrospective cohort, historical control group, and sample size), 3-dimensional imaging suggests that HA corrected Class II malocclusion in a predominantly prepubertal sample through more dental than skeletal changes. The changes were more significant in the sagittal than in the vertical direction. In addition, relative stability in the condyle-fossa relationship was noted.
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Affiliation(s)
- Kamilla Leonardo Sangalli
- School of Health Sciences, Graduate Program in Dentistry, Universidade Positivo, Curitiba, Paraná, Brazil
| | | | - Gisele Maria Correr
- School of Health Sciences, Graduate Program in Dentistry, Universidade Positivo, Curitiba, Paraná, Brazil
| | - Francielle Topolski
- School of Health Sciences, Graduate Program in Dentistry, Universidade Positivo, Curitiba, Paraná, Brazil
| | - Carlos Flores-Mir
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Manuel O Lagravère
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Alexandre Moro
- School of Health Sciences, Graduate Program in Dentistry, Universidade Positivo, Department of Orthodontics, Federal University of Paraná, Curitiba, Paraná, Brazil.
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12
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Three-Dimensional Evaluation of Condyle-Glenoid Fossa Complex Following Treatment with Herbst Appliance. J Clin Med 2021; 10:jcm10204730. [PMID: 34682852 PMCID: PMC8538158 DOI: 10.3390/jcm10204730] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
The purpose of the present retrospective observational study was to compare the effects of treatment with Herbst appliance and fixed therapy with elastics on the condyle and glenoid fossa complex. Thirty patients aged between twelve and sixteen years with skeletal Class II malocclusion who met the inclusion criteria were included in the study: fifteen patients treated with Herbst appliance (Group 1), and fifteen patients treated with orthodontic camouflage using MBT prescription (MBTTM Versatile+ Appliance System) (Group 2). For Group 2, patients had CBCT scans taken before treatment either after Herbst appliance removal or at the end of treatment. CBCT scans were evaluated for changes in condyle-glenoid fossa complex using the In Vivo Dental 5.1 software. Statistical significance was set at p ≤ 0.05. On inter-group comparison, the Herbst group showed statistically significant increases in the condylar height of 1.35 mm (p ≤ 0.001) on the right and 1.21 mm (p ≤ 0.01) on the left side, and a condylar volume of 111.03 mm3 (p ≤ 0.01) on the right and 127.80 mm3 (p ≤ 0.001) on the left side. The Herbst group showed anterior remodelling on the postero-superior aspect of glenoid fossa. Herbst appliance treatment induced growth at the condylar head and anterior remodelling of glenoid fossa, thereby improving the maxilla-mandibular relationship in growing skeletal Class II patients.
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13
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Stability of Class II Malocclusion Treatment with the Austro Repositioner Followed by Fixed Appliances in Brachyfacial Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189793. [PMID: 34574718 PMCID: PMC8465120 DOI: 10.3390/ijerph18189793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/02/2022]
Abstract
One of the goals of functional-appliance devices is to modify the vertical growth pattern, solving several kinds of malocclusion. This study aimed to evaluate Class II malocclusion treatment’s stability with Austro Repositioner, followed by fixed appliances, and assess its capacity to modify vertical dimensions in brachyfacial patients. A test group of 30 patients (16 boys and 14 girls, mean 11.9 years old) with Class II malocclusion due to mandibular retrognathism and brachyfacial pattern treated with Austro Repositioner and fixed appliance were compared to a matched untreated Class II control group of 30 patients (17 boys and 13 girls, mean age 11.7 years old). Lateral cephalograms were taken at T1 (initial records), T2 (end of treatment), and T3 (one year after treatment). Statistical comparisons were performed with a paired-sample t-test and two-sample t-tests. Significant improvements in the skeletal Class II relationship were observed in the treated group. The ANB angle decreased (4.75°), the SNB angle increased (3.92°), and the total mandibular length (Co-Pg) increased (8.18 mm) (p < 0.001). Vertical dimensions were also significantly modified, the FMA angle increased (3.94°), LAFH-distance increased (3.15 mm), and overbite decreased (3.35 mm). These changes remained stable one year after treatment. The Austro Repositioner was adequate for treating the skeletal Class II malocclusion resulting from the mandible retrusion in brachyfacial patients.
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Duggal I, Sidhu MS, Chawla A, Dabas A, Dhimole VK. Effects of miniplate anchored Herbst appliance on skeletal, dental and masticatory structures of the craniomandibular apparatus: A finite element study. Int Orthod 2021; 19:301-309. [PMID: 33933415 DOI: 10.1016/j.ortho.2021.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the stress distribution in the hard and soft tissue structures of craniomandibular complex during mandibular advancement with miniplate anchored rigid fixed functional appliance (FFA) using Finite Element Analysis (FEA). MATERIAL AND METHODS The virtual model consisting of all the maxillofacial bones (up to calvaria), the mandible and temporomandibular joint (TMJ) was generated using the volumetric data from pre-treatment CBCT-scan of a growing patient. The masticatory muscles, other soft tissues, Herbst appliance and plate geometry were modelled mathematically. Force vectors simulating muscle contraction at rest and advanced mandibular positions, with protraction force of 8N were applied. The final model was imported into ANSYS for analysis after assigning material properties. RESULTS The maximum von Mises stress of 11.69MPa and 11.96MPa magnitude was observed in the region of pterygoid plates and at the bone-miniplate interface respectively, with the mandibular advancement of 7mm. Stress patterns were also noted at the condylar neck. The stress values observed in the medial and lateral pterygoid muscles were of 10.42MPa and 4.16MPa magnitude, respectively. Stress was noted in the bucco-cervical region of the upper posterior teeth, but negligible change was seen on the lower anterior teeth and periodontal ligament. CONCLUSION Miniplate Anchored Herbst Appliance brought about Class II skeletal correction in growing children as it was accompanied by minimal changes in the inclination of the lower incisors. Soft tissue structures like pterygoid muscles and discal ligaments exhibited increased stress whereas masseter muscle displayed reduction in stresses.
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Affiliation(s)
- Isha Duggal
- SGT University, Faculty of Dental Sciences, Department of Orthodontics and Dentofacial Orthopaedics, 122505 Gurugram, Haryana, India.
| | - Maninder Singh Sidhu
- SGT University, Faculty of Dental Sciences, Department of Orthodontics and Dentofacial Orthopaedics, 122505 Gurugram, Haryana, India
| | - Anoop Chawla
- Indian Institute of Technology, Department of Mechanical Engineering, 110016 New Delhi, India
| | - Ashish Dabas
- SGT University, Faculty of Dental Sciences, Department of Orthodontics and Dentofacial Orthopaedics, 122505 Gurugram, Haryana, India
| | - Vivek Kumar Dhimole
- Indian Institute of Technology, Department of Mechanical Engineering, 110016 New Delhi, India
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Wei RY, Atresh A, Ruellas A, Cevidanes LHS, Nguyen T, Larson BE, Mangum JE, Manton DJ, Schneider PM. Three-dimensional condylar changes from Herbst appliance and multibracket treatment: A comparison with matched Class II elastics. Am J Orthod Dentofacial Orthop 2020; 158:505-517.e6. [PMID: 32828608 DOI: 10.1016/j.ajodo.2019.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/01/2019] [Accepted: 09/01/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of this study was to quantify and qualify the 3-dimensional (3D) condylar changes using mandibular 3D regional superimposition techniques in adolescent patients with Class II Division 1 malocclusions treated with either a 2-phase or single-phase approach. METHODS Twenty patients with Herbst appliances who met the inclusion criteria and had cone-beam computed tomography (CBCT) images taken before, 8 weeks after Herbst removal, and after the completion of multibracket appliance treatment constituted the Herbst group. They were compared with 11 subjects with Class II malocclusion who were treated with elastics and multibracket appliances and who had CBCT images taken before and after treatment. Three-dimensional models generated from the CBCT images were registered on the mandible using 3D voxel-based superimposition techniques and analyzed using semitransparent overlays and point-to-point measurements. RESULTS The magnitude of lateral condylar growth during the orthodontic phase (T2-T3) was greater than that during the orthopedic phase (T1-T2) for all condylar fiducials with the exception of the superior condyle (P <0.05). Conversely, posterior condylar growth was greater during the orthopedic phase than the subsequent orthodontic phase for all condylar fiducials (P <0.05). The magnitude of vertical condylar development was similar during both the orthopedic (T1-T2) and orthodontic phases (T2-T3) across all condylar fiducials (P <0.05). Posterior condylar growth during the orthodontic phase (T2-T3) of the 2-phase approach decreased for all condylar fiducials with the exception of the posterior condylar fiducial (P <0.05) when compared with the single-phase approach. CONCLUSIONS Two-phase treatment using a Herbst appliance accelerates condylar growth when compared with a single-phase regime with Class II elastics. Whereas the posterior condylar growth manifested primarily during the orthopedic phase, the vertical condylar gains occurred in equal magnitude throughout both phases of the 2-phase treatment regime.
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Affiliation(s)
- Robert Y Wei
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia.
| | - Arjun Atresh
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Tung Nguyen
- Department of Orthodontics, University of North Carolina, Chapel Hill, NC
| | - Brent E Larson
- Division of Orthodontics, University of Minnesota, Minneapolis, Minn
| | - Jonathan E Mangum
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia; Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Australia
| | - David J Manton
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia; Centrum voor Tandheelkunde en Mondzorgkunde UMCG, University of Groningen, Groningen, The Netherlands
| | - Paul M Schneider
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia
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Fan Y, Schneider P, Matthews H, Roberts WE, Xu T, Wei R, Claes P, Clement J, Kilpatrick N, Penington A. 3D assessment of mandibular skeletal effects produced by the Herbst appliance. BMC Oral Health 2020; 20:117. [PMID: 32299402 PMCID: PMC7164294 DOI: 10.1186/s12903-020-01108-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/06/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND A functional appliance is commonly used to optimize the development of the facial skeleton in the treatment of Class II malocclusion. Recent three-dimensional(3D) image-based analysis offers numerous advantages in quantitative measurement and visualization in orthodontics. The aim of this study was to localize in 3D the skeletal effect produced by the Herbst appliance on the mandible using the geometric morphometric technique. METHODS Twenty patients treated with a Herbst appliance and subsequent fixed appliances were included. Cone-beam computed tomography (CBCT) images were taken before treatment (T1), 8 weeks after Herbst appliance removal (T2), and after subsequent fixed appliance treatment (T3). Spatially dense morphometric techniques were used to establish the corresponding points of the mandible. The mandibular morphological changes from T1-T2, T2-T3, and T1-T3 were calculated for each patient by superimposing two mandibular models at two time points with robust Procrustes superimposition. These changes were then compared to the morphological changes estimated from normative mandibular growth curves over the same period. The proportion of cases exceeding the growth expression for controls was compared to a normal population using a one tailed binomial test. RESULTS Approximately 1.5-2 mm greater condylar changes and 0.5 mm greater changes in the chin occurred from Tl to T2. This effect lasted until the completion of treatment (T1-T3), but there was no obvious skeletal effect during the orthodontic phase (T2-T3). Approximately 40-50% of the patient sample exceeded condylar growth by > 1.5 mm compared to untreated controls (p < .05). However, changes at the chin were not statistically significant. CONCLUSIONS The principal skeletal effect of Herbst appliance treatment was additional increase in condylar length for about half of the sample. This inconsistency may relate to the degree of mandibular growth suppression associated with a specific malocclusion.
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Affiliation(s)
- Yi Fan
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, 10081, China
- Melbourne Dental School, University of Melbourne, Melbourne, 3053, Australia
- Facial Science, Murdoch Children's Research Institute, Melbourne, 3052, Australia
| | - Paul Schneider
- Melbourne Dental School, University of Melbourne, Melbourne, 3053, Australia
| | - Harold Matthews
- Facial Science, Murdoch Children's Research Institute, Melbourne, 3052, Australia
- Department of Human Genetics, 3000, Leuven, KU, Belgium
- Medical Imaging Research Centre, Universitair Ziekenhuis, 3000, Leuven, Belgium
| | - Wilbur Eugene Roberts
- Department of Orthodontics and Oral Facial Genetics, Indiana University-Purdue University Indianapolis, Indianapolis, 46236, USA
| | - Tianmin Xu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, 10081, China
| | - Robert Wei
- Melbourne Dental School, University of Melbourne, Melbourne, 3053, Australia
| | - Peter Claes
- Facial Science, Murdoch Children's Research Institute, Melbourne, 3052, Australia
- Department of Human Genetics, 3000, Leuven, KU, Belgium
- Medical Imaging Research Centre, Universitair Ziekenhuis, 3000, Leuven, Belgium
- Department of Electrical Engineering, KU Leuven, Leuven, 3000, Belgium
| | - John Clement
- Melbourne Dental School, University of Melbourne, Melbourne, 3053, Australia
| | - Nicky Kilpatrick
- Facial Science, Murdoch Children's Research Institute, Melbourne, 3052, Australia
- The University of Melbourne Department of Paediatrics at the Royal Children's Hospital, 50 Flemington Rd, Parkville VIC, Melbourne, 3052, Australia
| | - Anthony Penington
- Facial Science, Murdoch Children's Research Institute, Melbourne, 3052, Australia.
- The University of Melbourne Department of Paediatrics at the Royal Children's Hospital, 50 Flemington Rd, Parkville VIC, Melbourne, 3052, Australia.
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17
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Jiang YY, Sun L, Wang H, Zhao CY, Zhang WB. Three-dimensional cone beam computed tomography analysis of temporomandibular joint response to the Twin-block functional appliance. Korean J Orthod 2020; 50:86-97. [PMID: 32257934 PMCID: PMC7093662 DOI: 10.4041/kjod.2020.50.2.86] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/06/2020] [Accepted: 02/08/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To propose a three-dimensional (3D) method for evaluating temporomandibular joint (TMJ) changes during Twin-block treatment. Methods Seventeen patients with Class II division 1 malocclusion treated using Twin-block and nine untreated patients with a similar malocclusion were included in this research. We collected their cone beam computed tomography (CBCT) data from before and 8 months after treatment. Segmentations were constructed using ITK-SNAP. Condylar volume and superficial area were measured using 3D Slicer. The 3D landmarks were identified on CBCT images by using Dolphin software to assess the condylar positional relationship. 3D models of the mandible and glenoid fossa of the patients were constructed and registered via voxel-based superimposition using 3D Slicer. Thereafter, skeletal changes could be visualized using 3DMeshMetric in any direction of the superimposition on a color-coded map. All the superimpositions were measured using the same scale on the distance color-coded map, in which red color represents overgrowth and blue color represents resorption. Results Significant differences were observed in condylar volume, superficial area, and condylar position in both groups after 8 months. Compared with the control group (CG), the Twin-block group exhibited more obvious condyle-fossa modifications and joint positional changes. Moreover, on the color-coded map, more obvious condyle-fossa modifications could be observed in the posterior and superior directions in the Twin-block group than in the CG. Conclusions We successfully established a 3D method for measuring and evaluating TMJ changes caused by Twin-block treatment. The treatment produced a larger condylar size and caused condylar positional changes.
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Affiliation(s)
- Yuan-Yuan Jiang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Lian Sun
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China.,Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Hua Wang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China.,Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Chun-Yang Zhao
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China.,Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Wei-Bing Zhang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China.,Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
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Martina S, Di Stefano ML, Paduano FP, Aiello D, Valletta R, Paduano S. Evaluation of Profile Changes in Class II Individuals Treated by Means of Herbst Miniscope Appliance. Dent J (Basel) 2020; 8:dj8010027. [PMID: 32244893 PMCID: PMC7175301 DOI: 10.3390/dj8010027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 11/16/2022] Open
Abstract
Background: To evaluate the profile changes following orthopedic/orthodontic treatment with the Herbst Miniscope® appliance in subjects affected with Class II malocclusion with mandibular retrusion. Methods: A total of 44 patients presenting a skeletal Angle Class II malocclusion (ANB > 4°) due to mandibular retrusion and a cervical maturation stage between CS2 and CS3 were included in the study. Of these 44 patients, 22 (mean age 11.9 ± 1.3, HBT group) were treated using the Herbst appliance, while 22 (mean age 10.6 ± 1.3, CTR group) were followed for a 12-month observational period. A cephalometric tracing was performed at the beginning of treatment (T0) and after 12 months (T1). Results: In both groups there was a significant advancement of soft tissue pogonion (HBT = 3.5 ± 3.0 mm, p < 0.001; CTR = 2.2 ± 2.9 mm, p < 0.001), but the difference between the two groups was not significant (p = 0.172). On the contrary, both groups had a significant advancement of the mandibular sulcus (HBT = 3.7 ± 2.8 mm, p < 0.001; CTR = 1.2 ± 2.2 mm, p < 0.001) and a lower lip protrusion (HBT = 3.45 ± 2.51 mm, p < 0.001; CTR = 1.7 ± 2.7 mm, p = 0.008), but in both cases the HBT group showed a statistically significant greater increase in sulcus protrusion (p = 0.002) and lower lip protrusion (p = 0.029) than controls. There were no statistically significant effects on the upper jaw. Conclusions: The Herbst appliance advanced the lower jaw soft tissues.
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Affiliation(s)
- Stefano Martina
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi SA, Italy;
| | - Maria Luisa Di Stefano
- Department of Health, University “Magna Graecia” of Catanzaro, 88100 Catanzaro CZ, Italy; (M.L.D.S.); (S.P.)
| | | | - Domenico Aiello
- Department of Health, University “Magna Graecia” of Catanzaro, 88100 Catanzaro CZ, Italy; (M.L.D.S.); (S.P.)
- Correspondence:
| | - Rosa Valletta
- Discipline of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples “Federico II”, 80131 Napoli NA, Italy;
| | - Sergio Paduano
- Department of Health, University “Magna Graecia” of Catanzaro, 88100 Catanzaro CZ, Italy; (M.L.D.S.); (S.P.)
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Taylor KL, Evangelista K, Muniz L, Ruellas ACDO, Valladares-Neto J, McNamara J, Franchi L, Kim-Berman H, Cevidanes LHS. Three-dimensional comparison of the skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed appliances: A CBCT study. Orthod Craniofac Res 2019; 23:72-81. [PMID: 31514261 DOI: 10.1111/ocr.12345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/02/2019] [Accepted: 09/06/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare three-dimensional (3D) skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed orthodontic treatment in growing patients. SETTING AND SAMPLE POPULATION A sample of 35 adolescents with cone-beam computed tomography scans obtained prior to Herbst and Pendulum treatment (T1) and immediately after fixed appliance treatment (T2). MATERIALS AND METHODS Patients with Class II malocclusion was assessed retrospectively and divided into two treatment groups: Herbst group (n = 17, age: 12.0 ± 1.6 years) and Pendulum group (n = 18, age: 12.1 ± 1.5 years), with a mean treatment duration of 2.8 ± 0.8 years and 2.5 ± 0.7 years, respectively. Reconstructions of the maxillomandibular and dentoalveolar regions and data in 3D were obtained relative to cranial base, maxillary and mandibular regional superimpositions. Treatment outcomes (T2-T1) were compared between both groups using t tests for independent samples (P<.05). RESULTS Significant increase in mandibular length was observed in the Herbst group (7.3 ± 3.5 mm) relative to the Pendulum group (4.6 ± 4.5 mm). Inferior and anterior displacements of Pogonion were 2.2 mm and 1.6 mm greater in the Herbst group, respectively. The mesial displacement of the lower first molars was significantly greater in the Herbst group (1.9 mm). The upper first molars had contrasting results in sagittal displacement, with 0.6 ± 1.7 mm of distal displacement with the Pendulum and 1.4 ± 2.1 mm of mesial displacement with the Herbst. Lower incisor projection and proclination were similar between groups. CONCLUSIONS The Herbst and Pendulum appliances followed by comprehensive orthodontic treatment effectively corrected Class II malocclusion in growing patients, but with differing skeletal and dentoalveolar effects.
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Affiliation(s)
- Kyle L Taylor
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Karine Evangelista
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.,School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - Luciana Muniz
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | | | | | - James McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, Orthodontics, Università degli Studi di Firenze, Florence, Italy
| | - Hera Kim-Berman
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
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20
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Cheib Vilefort PL, Farah LO, Gontijo HP, Moro A, Ruellas ACDO, Cevidanes LHS, Nguyen T, Franchi L, McNamara JA, Souki BQ. Condyle-glenoid fossa relationship after Herbst appliance treatment during two stages of craniofacial skeletal maturation: A retrospective study. Orthod Craniofac Res 2019; 22:345-353. [PMID: 31419375 DOI: 10.1111/ocr.12338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 12/15/2022]
Abstract
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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Affiliation(s)
| | | | - Henrique Pársia Gontijo
- Graduate Program in Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Alexandre Moro
- Graduate Program in Dentistry, University Positivo, Curitiba, Brazil
| | | | | | - Tung Nguyen
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Lorenzo Franchi
- School of Dentistry, University of Florence, Florence, Italy
| | - James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Bernardo Quiroga Souki
- Graduate Program in Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
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Gandedkar NH, Shrikantaiah S, Patil AK, Baseer MA, Chng CK, Ganeshkar SV, Kambalyal P. Influence of conventional and skeletal anchorage system supported fixed functional appliance on maxillo-mandibular complex and temporomandibular joint: A preliminary comparative cone beam computed tomography study. Int Orthod 2019; 17:256-268. [DOI: 10.1016/j.ortho.2019.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Moro A, Borges SW, Spada PP, Morais ND, Correr GM, Chaves CM, Cevidanes LHS. Twenty-year clinical experience with fixed functional appliances. Dental Press J Orthod 2018; 23:87-109. [PMID: 29898162 PMCID: PMC6018450 DOI: 10.1590/2177-6709.23.2.087-109.sar] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/23/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction: Considering the large number of fixed functional appliances, choosing the best device for your patient is not an easy task. Objective: To describe the development of fixed functional appliances as well as our 20-year experience working with them. Methods: Fixed functional appliances are grouped into flexible, rigid and hybrid. They are different appliances, whose action is described here. Four clinical cases will be reported with a view to illustrating the different appliances. Conclusions: Rigid fixed functional appliances provide better skeletal results than flexible and hybrid ones. Flexible and hybrid appliances have similar effects to those produced by Class II elastics. They ultimately correct Class II with dentoalveolar changes. From a biomechanical standpoint, fixed functional appliances are more recommended to treat Class II in dolichofacial patients, in comparison to Class II elastics.
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Affiliation(s)
- Alexandre Moro
- Universidade Federal do Paraná, Programa de Pós-graduação em Ortodontia (Curitiba/PR, Brazil).,Universidade Positivo, Programa de Mestrado e Doutorado em Odontologia Clínica (Curitiba/PR, Brazil)
| | - Suellen W Borges
- Mestre em Odontologia Clínica, Universidade Positivo (Curitiba/PR, Brazil)
| | - Paula Porto Spada
- Universidade Positivo, Programa de Mestrado e Doutorado em Odontologia Clínica (Curitiba/PR, Brazil).,Mestre em Odontologia Clínica, Universidade Positivo (Curitiba/PR, Brazil)
| | - Nathaly D Morais
- Universidade Positivo, Programa de Mestrado e Doutorado em Odontologia Clínica (Curitiba/PR, Brazil).,Mestre em Odontologia Clínica, Universidade Positivo (Curitiba/PR, Brazil)
| | - Gisele Maria Correr
- Universidade Positivo, Programa de Mestrado e Doutorado em Odontologia Clínica (Curitiba/PR, Brazil)
| | - Cauby M Chaves
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem (Fortaleza/CE, Brazil)
| | - Lucia H S Cevidanes
- University of Michigan, School of Dentistry, Orthodontics and Pediatric Dentistry (Ann Arbor, EUA)
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23
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Mendoza LV, Bellot-Arcís C, Montiel-Company JM, García-Sanz V, Almerich-Silla JM, Paredes-Gallardo V. Linear and Volumetric Mandibular Asymmetries in Adult Patients With Different Skeletal Classes and Vertical Patterns: A Cone-Beam Computed Tomography Study. Sci Rep 2018; 8:12319. [PMID: 30120301 PMCID: PMC6098024 DOI: 10.1038/s41598-018-30270-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/25/2018] [Indexed: 11/25/2022] Open
Abstract
This study aimed to quantify the height of the mandibular condyle and ramus, condylar volume, and the asymmetry index in adult patients of different sex, skeletal class and vertical pattern using Cone-Beam Computed Tomography (CBCT), and to determine whether there were differences between these groups. The study used CBCT scans of 159 patients with a mean age of 32.32 ± 8.31 years. InVivoDental® software was used to perform both linear (condylar, ramal, and total height) and condylar volume measurements. Linear and volumetric asymmetries were calculated. There were not significant differences between right and left sides. The mean value obtained for condyle height was 7.27 mm, ramus height 42.3 mm, total height 49.6 mm and condyle volume 1907.1 mm3, with significant differences between men and women. Significantly higher values were found for condylar volume in hypodivergent patterns (p = 0.001) and for the asymmetry index of the condylar volume in Class II patients (p < 0.05). The prevalence of relevant asymmetry was high for condyle height and volume (73.1% y 75.6% respectively). Higher height and volume values were found among men, Class III, and hypodivergent patients. Linear and volumetric asymmetries were more prevalent among men, Class III and hyperdivergent patterns.
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Affiliation(s)
- Luz Victoria Mendoza
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Carlos Bellot-Arcís
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - José María Montiel-Company
- Department of Preventive Dentistry, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain.
| | - Verónica García-Sanz
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - José Manuel Almerich-Silla
- Department of Preventive Dentistry, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Vanessa Paredes-Gallardo
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
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Okano KS, Cevidanes LHS, Cheib PL, de Oliveira Ruellas AC, Yatabe M, Nguyen T, Franchi L, McNamara JA, Souki BQ. Three-dimensional assessment of the middle cranial fossa and central skull base following Herbst appliance treatment. Angle Orthod 2018; 88:757-764. [PMID: 30004786 DOI: 10.2319/101517-694.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES: The purpose of this three-dimensional (3D) study was to assess retrospectively the middle cranial fossa and central skull base of patients treated with the Herbst appliance (HA). MATERIALS AND METHODS: 3D surface virtual models of 40 Class II, division 1 malocclusion patients were generated from cone-beam computed tomography (CBCT) acquired before treatment (T0) and after 8 months of HA treatment (T1). T0 and T1 3D models were superimposed volumetrically at the anterior cranial fossa. Twenty subjects who had been treated with the Herbst appliance (HAG) were compared to 20 subjects who were not treated orthopedically. The latter group served as a comparison control group (CG). Quantitative assessments of the location and directional changes were made with linear and angular measurements between anatomical landmarks. Qualitative assessments of the spatial behavior of the middle cranial fossa and central skull base relative to the anterior cranial fossa were displayed graphically for visualization with color maps and semitransparent overlays. Non-parametric tests were performed to compare the between the HAG and CG. RESULTS: Point-to-point linear measurements and skeletal rotation (pitch, roll, and yaw) changes were very small along the observational period and were not significantly different between HAG and CG. Visual analysis of color maps and overlays confirmed that no changes in the cranial base were associated with HA. CONCLUSIONS: HA therapy did not produce clinically significant changes in the middle cranial fossa and central skull base.
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Stoustrup P, Iversen CK, Kristensen KD, Resnick CM, Verna C, Nørholt SE, Abramowicz S, Küseler A, Cattaneo PM, Herlin T, Pedersen TK. Assessment of dentofacial growth deviation in juvenile idiopathic arthritis: Reliability and validity of three-dimensional morphometric measures. PLoS One 2018. [PMID: 29534095 PMCID: PMC5849319 DOI: 10.1371/journal.pone.0194177] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Patients with juvenile idiopathic arthritis (JIA) and involvement of the temporomandibular joint (TMJ) often experience abnormal facial growth. Three-dimensional (3D) assessment of dentofacial growth deviation has become more common with advancement and commercialization of imaging technologies. However, no standardized guidelines exist for interpretation of 3D imaging in patients with JIA. The aim of this study was to propose and validate morphometric measures for the 3D radiographic assessment of dentofacial growth deviation in patients with JIA to enhance: 1) Description of dentofacial growth deviation; 2) Treatment planning; 3) Longitudinal follow-up. Methods The study was conducted in a standardized sequential-phased approach involving: 1) Preliminary decision-making; 2) Item generation; 3) Test of content-validity; 4) Test of reliability; 5) Test of construct validity; 6) Establishment of final recommendations. Results Twenty-one morphometric measures were evaluated. Based on results of reliability and validity-testing including subjects with JIA (n = 70) and non-JIA controls (n = 19), seven measures received a “high recommendation” score. Those measures were associated with posterior mandibular height, occlusal cant, mandibular asymmetry, mandibular inclination, and anterior/posterior lower face height. Nine other measures were “moderately recommended” and five received a “somewhat recommendation” score. Conclusion Seven morphometric measures were considered very useful in the 3D assessment of growth deviation in patients with TMJ disease associated with JIA. These variables can be used to standardize the description of dentofacial deformities and to plan corrective interventions.
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Affiliation(s)
- Peter Stoustrup
- Section of Orthodontics, Aarhus University, Aarhus, Denmark
- * E-mail:
| | | | - Kasper Dahl Kristensen
- Section of Orthodontics, Aarhus University, Aarhus, Denmark
- Section of Orthodontics, University of Bergen, Bergen, Norway
| | - Cory M. Resnick
- Harvard School of Dental Medicine, Boston, MA, United States of America
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, United States of America
| | - Carlalberta Verna
- Clinic for Orthodontics and Pediatric Dentistry, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| | - Sven Erik Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
- Section of Oral Maxillofacial Surgery, Aarhus University, Aarhus, Denmark
| | - Shelly Abramowicz
- Oral and Maxillofacial Surgery and Pediatrics, Emory University, Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Annelise Küseler
- Section of Orthodontics, Aarhus University, Aarhus, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Klit Pedersen
- Section of Orthodontics, Aarhus University, Aarhus, Denmark
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
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