RESUMEN
Objective : To clarify the short- and long-term effects of maxillary protraction (MP) in mixed dentition in patients with unilateral cleft lip and palate (UCLP). Design : Retrospective study. Setting : University of Tokyo Hospital. Patients and Intervention : Eleven Japanese patients with UCLP in mixed dentition were treated with MP and followed up until the completion of growth. Multibracket treatment had been performed after MP treatment in all patients. Main Outcome Measure : Lateral cephalograms taken before and after MP and after completion of growth were used. Posterior and anterior vertical reference lines (PV, AV) were used to measure the horizontal movements of point A, pogonion, and maxillary first molar (U6). SNA, SNB, ANB, maxillary and mandibular length, mandibular plane angle, Wits value, upper incisor inclination, overjet, and overbite were also measured. Results : Large variation was found in the effects of MP, and five patients eventually required orthognathic surgery. In average change with MP, the maxilla showed favorable forward growth. Point A had moved forward from PV but not AV. The mandible rotated backward. However, ANB and the Wits value did not improve. U6 moved forward, and the overjet improved. After MP, the skeletal Class III relationship became severe. Conclusions : MP was effective as an early treatment for UCLP patients. However, its effects showed large variation and were in conflict with facial growth. Conscientious explanation of the expected effects and associated problems should be given to the patients/parents before its application.
Asunto(s)
Cefalometría , Labio Leporino/diagnóstico por imagen , Labio Leporino/terapia , Fisura del Paladar/diagnóstico por imagen , Fisura del Paladar/terapia , Maloclusión de Angle Clase III/terapia , Desarrollo Maxilofacial , Injerto de Hueso Alveolar , Niño , Preescolar , Labio Leporino/fisiopatología , Fisura del Paladar/fisiopatología , Aparatos de Tracción Extraoral , Femenino , Humanos , Lactante , Masculino , Aparatos Ortodóncicos , Ortodoncia Interceptiva , Procedimientos Quirúrgicos Ortognáticos , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare the accuracy of three-dimensional computed tomography (3D-CT) and panoramic radiography in the evaluation of mandibular hypoplasia in patients with hemifacial microsomia (HFM). DESIGN: Retrospective study of imaging data. Setting : Images selected from the archives of the University of Tokyo Hospital. SUBJECTS: Twenty patients with unilateral HFM who had undergone both panoramic radiography and 3D-CT in the same period. METHOD: Mandibular deformities were classified according to the Pruzansky classification; eight patients had Grade I deformity and 12 patients had Grade II deformity. Ramus heights were measured on both panoramic radiographs and 3D-CT. MAIN OUTCOME MEASURES: Magnification in panoramic radiographs and extent of mandibular asymmetry as estimated by the affected/unaffected side ratio based on two methods were examined. The Pearson product-moment correlation coefficient was used to estimate correlations between parameters. RESULTS: The magnification of ramus heights on panoramic radiographs showed large variations in Grade II patients. The affected/unaffected side ratio estimated by the two methods showed a strong correlation in Grade I patients (correlation coefficient 0.99; p < .0001). Conversely, a weak correlation was seen in Grade II patients (correlation coefficient 0.77; p â=â .0036), and affected/unaffected side ratios from panoramic radiographs were both over- and underestimated. CONCLUSIONS: The accuracy of evaluation using panoramic radiography was fairly reliable in Grade I patients. Conversely, accuracy was poor in Grade II patients, and evaluation using 3D-CT seems preferable. The combination of two methods with careful consideration is recommended for clinical applications.
Asunto(s)
Síndrome de Goldenhar , Radiografía Panorámica , Asimetría Facial , Huesos Faciales , Humanos , Mandíbula/anomalías , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Fibrodysplasia ossificans progressiva (FOP) is a rare disease characterized by postnatal heterotopic ossification (HO). When HO affects the masticatory muscles, mouth opening becomes restricted. This paper presents the changes in facial morphology and occlusion of a patient with FOP who was followed from the age of 8 to age 21. At the initial examination, he had a severely protruded maxilla and Angle Class II Division 1 malocclusion. His mouth opening was restricted (5.0 mm). He had a large overjet and this enabled him to clean his teeth and to eat. Orthodontic correction was not planned, and his facial growth was closely followed with attention to his oral hygiene. The maxillary protrusion and a low mandibular plane angle became more prominent as the patient aged. His mandible rotated in a counterclockwise direction. His molars had delayed eruption or were impacted and seven were extracted. His mouth opening increased slightly and his oral hygiene improved to excellent.
Asunto(s)
Atención Dental para Enfermos Crónicos , Miositis Osificante/patología , Cefalometría , Niño , Humanos , Masculino , Maloclusión Clase II de Angle/etiología , Mandíbula/anomalías , Maxilar/anomalías , Desarrollo Maxilofacial , Miositis Osificante/complicaciones , Higiene Bucal , Osificación Heterotópica/etiología , Prognatismo/etiologíaRESUMEN
When tooth ankylosis occurs in growing children, the ankylosed tooth fails to erupt and gradually positions itself below the occlusal plane. This causes functional and esthetic problems, and orthodontic treatment is often impossible. To clarify this problem, we developed a new treatment protocol for the movement of ankylosed teeth. This consists of single-tooth dento-osseous osteotomy and alveolar bone distraction using orthodontic multibracket appliances. A special distraction device is not required, thus reducing the burden to patients. Two cases in which an ankylosed maxillary central incisor was successfully treated with this protocol are presented.
Asunto(s)
Proceso Alveolar/cirugía , Incisivo/patología , Maxilar/cirugía , Osteogénesis por Distracción , Anquilosis del Diente/cirugía , Adolescente , Femenino , Humanos , Incisivo/cirugía , Masculino , Soportes Ortodóncicos , Osteogénesis por Distracción/instrumentación , Osteogénesis por Distracción/métodos , Osteotomía/métodos , Dimensión VerticalRESUMEN
OBJECTIVES: Distraction osteogenesis has been applied to the craniofacial region. To reduce the cleft width of patients with cleft lip and palate, alveolar bones are distracted toward the cleft. However, no reports have described limitations to the amount of lengthening that can be achieved by distraction osteogenesis in this area. Therefore, we investigated the healing process following different extents of distraction osteogenesis using a canine cleft palate model. METHODS: A 10-mm bone defect was made in the palates. A bony segment including the canine was prepared and translocated into the defect area at a rate of 1 mm/d for 6 or 10 days, resulting in two groups (6- and 10-mm groups). Canine pulpal blood flow was monitored for 100 days with Doppler flowmetry. Then, the animals were sacrificed and the regenerated bone area was evaluated radiologically and histologically. Statistical significance was confirmed with the Mann-Whitney rank test. RESULTS: Pulpal blood flow in the 6-mm group recovered to original levels earlier than in the 10-mm group. Cortical bone density in the regenerated bone, measured by peripheral quantitative computed tomography, was significantly greater in the 6-mm group than in the 10-mm group. The amount of regenerated bone in histologic sections was also significantly greater in the 6-mm group. CONCLUSION: We clearly showed that healing progress depends on the extent of distraction osteogenesis, highlighting the importance of limited distraction osteogenesis in the alveolar area.
Asunto(s)
Proceso Alveolar/irrigación sanguínea , Proceso Alveolar/cirugía , Calcificación Fisiológica , Fisura del Paladar/cirugía , Pulpa Dental/irrigación sanguínea , Osteogénesis por Distracción/métodos , Animales , Densidad Ósea , Modelos Animales de Enfermedad , Perros , Flujometría por Láser-Doppler , Estadísticas no Paramétricas , Cicatrización de HeridasRESUMEN
OBJECTIVE: To analyze the effect of hyperbaric oxygen on newly formed bone in distracted areas surrounding the root of a moving tooth by histological and radiological analysis. It was hypothesized that the application of hyperbaric oxygen to a tooth moving into the distracted area would accelerate ossification and vascularization of newly formed bone in the distracted space. DESIGN: Ten dogs were used. After creating a 10-mm-long bone defect, a bony segment was prepared and translocated into the defect area at a rate of 1 mm/d for 10 days. Following the distraction period, tooth movement was started and the dogs were divided into two groups. The HBO group received hyperbaric oxygen; whereas, the control group did not. At 150 days after tooth movement, the distracted area around the moving tooth was evaluated radiologically and histologically. Differences between groups were confirmed by a Mann-Whitney U test. RESULTS: Trabecular bone density and cortical and subcortical bone areas measured by peripheral quantitative computed tomography in the HBO group were significantly higher than those in the control group. Histological observations revealed regenerated bone and blood vessels formation in the tension site of the moving tooth in the HBO group. The regenerated bone structure measured by bone histomorphometry was larger and more active in bone formation in the HBO group than in the control group. CONCLUSIONS: Applying hyperbaric oxygen to tooth movement into a distracted area appears to accelerate ossification and vascularization of regenerated bone in the that area.