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Orthodontic treatment of cranio-maxillo-mandibular dysmorphia is based on an accurate diagnosis of the intra-arch anomalies (agenesis, supernumerary teeth, impacted teeth, dental discrepancies...), the inter-arch gaps observed (sagittal, vertical and/or transverse) and the associated dysfunctions. For each anomaly, gap and/or dysfunction, a therapeutic flow-chart enables a treatment strategy to be established based on the age of the patient and the severity of the symptoms. The superposition of these flow-charts allows the treatment to be refined as much as possible and enables a prognostic to be established. It is therefore important to understand all of the problems in order to take action at the best time.
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This lecture will discuss the examples of TSADs failures and iatrogenic problems created by TSADs. It will also show how to prevent these problems.
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Orthodontists, with their knowledge of functional appliances and established skills to evaluate jaw position, are ideally suited to provide oral appliance therapy in this field. Oral appliances have a direct effect on tongue posture during sleep and help to stabilize the mandible in a closed vertical position. These appliances are commonly regarded as a simple, silent, bed partner-friendly, less invasive, reversible, tolerable and efficacious choice. Several factors appear to contribute to the effectiveness of oral appliances – appliance design and titration method, the severity of the sleep apnea, the amount of advancement, the vertical opening of the mandible, positional sleep apnea and the Body Mass Index (BMI). Oral appliances appear to work by enlarging the upper airway patency at multiple levels and by improving muscle airway tone and thus decreasing upper airway collapsibility. The advantages and disadvantages of four different oral appliance titration techniques will be discussed to facilitate better utilization of oral appliances in dental sleep medicine.
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Class II malocclusion affects about 15-20% of the United Stated population. However, the precise etiology, involving environmental and genetic components, remains unclear. To characterize the disorder, lateral cephalometric films are digitalized resulting in numerous linear and angular measurements. Correlational analysis provides limited insights regarding common features or distinctive subgroups. The use of data reduction techniques, such as principal component analysis, and clustering algorithms may provide another grouping strategy. For the current analysis, cephalometric measurements from participants enrolled in the Florida Class II Malocclusion study were used. Participants’ mean age at baseline visit was 9.6 (range 6.9 -12.9). Measurements used include skeletal, soft tissue and dental measures. Early treatment results among groups are described.
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Modern TADs have been around well over a decade as excellent sources of anchorage from treatment planning to biomechanics. They have evolved in design and technique. This presentation will evaluate where we stand with their use and recognize current concepts that have been universally accepted.
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This lecture is based on a histomorphometric and scanning electron microscopy study of human condylar cartilage and bone tissue changes in relation to age. Its aim is to determine the possibility of stimulated adaptive growth in human condylar cartilage and bone tissue changes in relation to age in a larger sample of human autopsy condyles. Human condylar cartilage and bone were examined in an autopsy material comprising 20 individuals aged 18-31 years. The condyles were embedded in methylmetacrylate and cut on a microtome and stained. Histomorphometry, scanning electron microscopy and cartilage histology were used to analyse the tissue. The fibrocartilage could clearly be described in four zones: the hypertropic zone with `caught´ hypertropic chondrocytes, the hypertropic zone of chondrocytes arranged in columns, the proliferative zone, and the fibrous zone with collagen fibres. Chondrocytes could bee seen `caught´ in the underlying cancellous bone tissue with remodelling activity. There was a statistically significant correlation between age and the fibrocartilage thickness, between age and the hypertropic chondrocytes, and between age and the hypertropic chondrocytes in bone. In conclusion, quantitative and qualitative investigations of the turnover activity in the fibrocartilage and the bone tissue indicated condylar growth potential in the age group until 31 years of age. The growth activity seemed to decline with age. The results show possibilities for biomechanical growth stimulation of the condylar tissue, ie. Herbst treatment as an alternative to surgical treatment. A clinical Herbst treated case in adulthood will end up the lecture presentation.
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This lecture will review the diagnosis, treatment plans, and treatment mechanics for 2 complex open bite cases. The first case is an adult patient with a severe anterior open bite and right posterior crossbite treated w/ SureSmile, TADs, and Acceledent. The second case is a late adolescent with a right unilateral Class III and right posterior open bite treated w/ RPE, SureSmile, and TADs.
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Gingival crevicular fluid (GCF) has been widely investigated as a potential source of biomarkers for an individual’s oral and general health information. Various biomolecules presented in GCF were reported as potential biomarkers for orthodontic tooth movement (OTM). MicroRNAs (miRNAs) are small non-coding RNAs involved in post-transcriptional gene regulation. Secretory miRNAs are being investigated as diagnostic as well as therapeutic tools in many pathological conditions. In this study, we investigated the expression profile of secretory miRNA-29 in GCF during OTM in human.
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The treatment of patients with hyper-divergent skeletal patterns have been considered as one of the most difficult task for orthodontists. With traditional mechanics, it was almost impossible to reduce vertical dimension during orthodontic treatment. Occlusal correction can be obtained but there was deterioration of facial harmony. The microimplants have brought tremendous paradigm shift in orthodontic treatment. Among those, the advances in vertical control are of a paramount importance. Nowadays, the intrusion of the posterior teeth with/or without anterior teeth can be achieved easily and consistently with microimplants. In openbite treatment, the intrusion of the posterior teeth is known as best treatment strategy. The intrusion of the posterior teeth can produce the increase of the anterior overbite, and resulted in resolution of the anterior openbite. However, even though intrusion of the posterior teeth is obtained and anterior openbite is closed, the profile improvement is less than desirable occasionally in Hyperdivergent patients. In order to get better profile changes, vertical control should be done not only in the posterior teeth but also in the anterior teeth. And this should be done on both arches, not to one arch. In hyper-divergent patients, the extraction of premolars can be planned and this will be helpful in reducing vertical dimension. However the facial changes can be very different according to which teeth are extracted. Occasionally, extraction of teeth may results in dished in face with counterclockwise rotation of the mandible. The cant of occlusal plane in antero-posterior dimension can also affect on facial harmony. Speaker will discuss the importance of extraction sites, and its role in controlling the occlusal plane, and importance of intrusion of the whole arch in regard to facial harmony.
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All Class II malocclusions are not created equal. A comprehensive diagnosis and individualized treatment plan are necessary to ensure that each patient receives the proper treatment for their specific problems. Several cases having different Class II malocclusions, treated with the appropriate diagnosis, treatment plan and mechanics, will be shown.
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