RESUMEN
BACKGROUND AND OBJECTIVES: High-angle Class II malocclusion is considered challenging to treat to a stable result and, although studies report treatment outcome in terms of morphology, patient satisfaction has not been addressed. The objectives of the present study were to examine patients' motives for treatment and satisfaction with the results. MATERIAL AND METHODS: A structured questionnaire was distributed 3 years post-operatively to 93 consecutively treated patients with an initial diagnosis of mandibular-plane angle (ML/NSL) ≥34.0 degrees and ANB angle ≥4.0 degrees. Three surgical subsamples were defined: one-piece Le Fort I, bilateral sagittal split osteotomy, or a combination of the two (Bimax). Lateral cephalometric radiographs were used to assess morphological characteristics and post-treatment changes. RESULTS: Questionnaire participation was 69.8 per cent. The most frequently reported motives for seeking treatment were to improve oral function (85.0 per cent) and dental appearance (71.7 per cent). Thirty per cent were very satisfied, 53.3 per cent were satisfied, and 16.7 per cent were dissatisfied with the overall treatment result. Dissatisfaction was associated with a persisting post-treatment anterior open bite (AOB), horizontal relapse at B point, and with sensory impairment. CONCLUSIONS AND IMPLICATIONS: A higher rate of dissatisfaction was found than what has usually been reported for othognathic surgical patients, and this was associated with a persisting AOB. In addition, mandibular relapse and impaired sensory function were related to dissatisfaction and are associated with mandibular surgery. Prospective high-angle Class II patients should be comprehensively informed about the unpredictability of treatment outcomes in terms of occlusion and facial appearance.
Asunto(s)
Maloclusión de Angle Clase III , Maloclusión Clase II de Angle , Cirugía Ortognática , Cefalometría , Estudios de Seguimiento , Humanos , Maloclusión Clase II de Angle/cirugía , Mandíbula , Maxilar , Osteotomía Le Fort , Satisfacción del Paciente , Estudios Prospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: The purpose of this study was to compare treatment outcomes for anterior occlusion and vertical skeletal stability after maxillary or mandibular surgery for correction of Class II malocclusion with a mild to moderate open bite. METHODS: The records of 57 consecutive patients were retrieved; 30 had undergone 1-piece Le Fort I osteotomy, and 27 had undergone a bilateral sagittal split osteotomy (BSSO), without additional surgery. Lateral cephalograms at 6 stages were available (pretreatment to 3 years postsurgery). RESULTS: After the surgery, 87% of the Le Fort I patients and 63% of the BSSO patients had a positive overbite, and at the 6-month follow-up, the percentages were 90% and 74%, respectively. At 3 years after surgery, 74% of the Le Fort I patients and 42% of the BSSO patients had a positive overbite. The anterior facial height decreased in the Le Fort I subsample and increased in the BSSO subsample, and the mandibular plane angle decreased in both. The Le Fort I subsample generally remained stable, whereas clinically significant relapse of the mandibular plane angle (≥2°) occurred in 80% of the BSSO subsample. CONCLUSIONS: When taking into account the limitations of retrospective clinical studies, several conclusions can be drawn. A significant improvement of the anterior occlusion can be expected in most patients when either maxillary or mandibular surgery is used for correction of Class II open bite. However, there will be individual patients in whom considerable posttreatment changes occur in both the anteroposterior and vertical dimensions. Although individual morphology needs to be taken into account, it seems that both short- and long-term stability are likely to be greater after Le Fort I surgery compared with BSSO.
Asunto(s)
Maloclusión de Angle Clase III , Mordida Abierta , Cefalometría , Estudios de Seguimiento , Humanos , Mandíbula , Maxilar , Osteotomía Le Fort , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: High-angle skeletal Class II malocclusion is one of the most challenging dentofacial deviations to treat and, in adults, a combination of orthodontic treatment and bimaxillary orthognathic surgery is often indicated. This study examines the rate of clinically significant relapse and whether a genioplasty affects the treatment outcome of high-angle Class II malocclusions. MATERIAL AND METHODS: Cephalometric tracings of 36 consecutively treated high-angle Class II patients were evaluated from pre-surgery to 3 years post-surgery. All patients had undergone bimaxillary surgery (Le Fort I and BSSO), 13 of them had in addition a genioplasty. RESULTS: The maxilla remained stable, whereas relapse (greater than or equal to 2 mm) of the mandibular advancement was seen in 40 per cent of the patients. Advancement greater than 10 mm increased the risk for horizontal relapse. The overjet was normalized and remained stable despite mandibular relapse. Half of the patients had an anterior open bite 3 years post-surgery. A supplemental genioplasty did not affect the relapse rate. CONCLUSIONS AND IMPLICATIONS: Overjet was normalized and remained stable long term; there was an open bite in half of the patients. Combined orthodontic and bimaxillary surgical treatment of high-angle Class II patients showed skeletal relapse (greater than or equal to 2 mm) of the mandible in 40 per cent of patients. Mandibular advancement greater than 10 mm increased the risk for relapse. There was no increased risk for dental or skeletal instability associated with a genioplasty in combination with maxillary and mandibular surgery in the treatment of high-angle skeletal Class II malocclusion.
Asunto(s)
Maloclusión de Angle Clase III , Maloclusión Clase II de Angle/cirugía , Procedimientos Quirúrgicos Ortognáticos , Adulto , Cefalometría , Estudios de Seguimiento , Mentoplastia , Humanos , Mandíbula , Maxilar , Recurrencia , Resultado del TratamientoRESUMEN
OBJECTIVE: To investigate whether individuals with high and low mandibular plane angles, respectively, have different patterns of long-term dental arch changes in adulthood. SUBJECTS AND METHODS: The material comprised 16 low-angle (≤ 24.4 degree) and 10 high-angle individuals (≥38.7 degree). Mean age was 22.7 years when the first recordings were made (T1), and new recordings were made 10 (T2) and 20 (T3) years later. The individuals were orthodontically untreated except for three who had been out of retention for more than 5 years before T1. Lateral cephalograms and study casts were obtained on all three occasions. RESULTS: For the total observation period, the greatest mean changes were observed as a 1mm decrease of lower intercanine width and arch depths in both groups. Intermolar widths increased less than 0.5mm. Upper and lower crowding increased in the range of 0.5-0.7mm in the two groups. Only small changes occurred in overjet and overbite. Differences between groups were not significant except for lower anterior arch depth which decreased more in the low-angle group, and overjet which increased in the high- and decreased in the low-angle group. During both periods the changes were generally in the same direction. CONCLUSION: Changes in dental arch dimensions from third to fifth decade of life are small and generally similar in individuals with high versus low mandibular plane angles. The changes are for most variables in the same direction in the two periods examined. The only significant differences between the groups are the changes in lower arch depth and overjet.
Asunto(s)
Arco Dental/crecimiento & desarrollo , Mandíbula/crecimiento & desarrollo , Maxilar/crecimiento & desarrollo , Adulto , Cefalometría/métodos , Diente Canino/anatomía & histología , Arco Dental/anatomía & histología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Maloclusión/patología , Mandíbula/anatomía & histología , Maxilar/anatomía & histología , Modelos Dentales , Diente Molar/anatomía & histología , Sobremordida/patología , Adulto JovenRESUMEN
PURPOSE: To investigate surgical outcome, long-term stability, the time course of relapse, neurosensory disturbances, and patient satisfaction after BSSO for correction of mandibular asymmetry. Another objective was to examine whether osteotomies for transverse rotation of the distal segment represent an increased risk for nerve injury. SUBJECTS AND METHODS: In a retrospective study lateral and postero-anterior cephalograms, information from patient files and questionnaires were analysed for 38 patients having more than 4 mm asymmetry at the chin pre-treatment (mean 8.4 mm). The radiographs were analysed preoperatively, postoperatively, after 6 months and 3 years. RESULTS: Asymmetry of the chin to the facial midline improved on average by 56%. Skeletal relapse was about the same for transverse and antero-posterior surgical changes (10-15%). 58% of the patients had asymmetry of more than 3 mm at menton 3 years post-surgery. Discrepancy between upper and lower dental midlines improved on average 80%. Normal or near normal sensation to the lower lip/chin was reported by 44% of the patients which is similar to sensory disturbances after BSSO straight set-back performed by the same surgical team. A difference in the incidence of neurosensory disturbance between the two osteotomy sides was observed. Satisfaction with the treatment result was reported by all patients except for two. CONCLUSION: Correction of mandibular asymmetry by BSSO is fairly stable. Although the risk for sensory impairment for the individual patient was similar to impairment in a sample having straight setback, rotation of the distal segment during surgery may represent an increased risk for sensory impairment on the deviating side (P = 0.06). Three years after surgery patients were generally satisfied with the result even if more than 3 mm of asymmetry at the chin remained for 58%. The findings have implications for treatment planning and the decision to elect one-jaw, bimaxillary surgery and/or additional genioplasty.
Asunto(s)
Asimetría Facial/cirugía , Mandíbula/cirugía , Osteotomía Sagital de Rama Mandibular/métodos , Satisfacción del Paciente , Prognatismo/cirugía , Actitud Frente a la Salud , Cefalometría/métodos , Mentón/inervación , Mentón/cirugía , Estudios de Seguimiento , Humanos , Labio/inervación , Maloclusión de Angle Clase III/cirugía , Mandíbula/patología , Nervio Mandibular/fisiopatología , Osteotomía Sagital de Rama Mandibular/psicología , Planificación de Atención al Paciente , Complicaciones Posoperatorias , Recurrencia , Reoperación , Estudios Retrospectivos , Rotación , Trastornos Somatosensoriales/etiología , Resultado del Tratamiento , Traumatismos del Nervio Trigémino/etiologíaRESUMEN
This study aimed to assess infraocclusion, root resorption and restorations and their importance for the prognosis of retained primary mandibular molars lacking successors. The sample comprised 188 persisting primary mandibular second molars in 111 subjects, 48 males and 63 females, with a mean age of 12.6 years. The patients had been referred to an interdisciplinary clinic because of extensive hypodontia, missing 8.4 teeth on average. All persisting primary mandibular molars were included in the study, as no decision had been made as to whether they should be kept or extracted. Panoramic radiographs were used to assess infraocclusion, resorption of the mesial and distal roots and whether restorations were present. Clinically significant infraocclusion was observed in 43.6 per cent of the patients and classified as severe in 18.8 per cent. The mesial and distal root exhibited no resorption in 18.9 and 33.3 per cent, respectively (P = 0.01). Most primary molars had no restorations (78.4 per cent). A significant correlation was found between root resorption and infraocclusion. Age was found to be weakly but significantly correlated with root resorption and infraocclusion. No significant relationship was observed between gender and either infraocclusion or root resorption. In conclusion, infraocclusion was estimated to be a more critical factor for the prognosis of retained primary molars than root resorption.
Asunto(s)
Anodoncia/diagnóstico por imagen , Maloclusión/diagnóstico por imagen , Diente Molar/diagnóstico por imagen , Resorción Radicular/diagnóstico por imagen , Diente Primario/diagnóstico por imagen , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Pronóstico , Radiografía Panorámica , Raíz del Diente/diagnóstico por imagenRESUMEN
AIM: To examine factors associated with patients' decision to decline surgery. MATERIAL/METHODS: Of 470 consecutive patients referred to the University of Oslo from 2007 to 2009, a sample of 160 subjects who had not undergone surgery was identified and contacted. 236 operated patients from the same period served as a comparison group. Morphology was assessed from cephalograms and photographs, and the individuals' opinions were recorded using questionnaires. RESULTS: Dentofacial morphology represented normative treatment need and was generally similar except for a higher rate of severe negative overjet in the operated group (p < 0.001). The most prevalent reasons for declining surgery were risks of side effects, the burden of care, and a general reluctance to undergo surgery. Many un-operated subjects were dissatisfied with their masticatory function and dentofacial appearance. CONCLUSION: Informed consent to orthognathic surgery represents a challenge both to the patient and the professional. The findings imply that patients' motives and fears should be explored during consultation and that the information provided should be adapted to the potential risks and benefits related to the actual treatment.
Asunto(s)
Maloclusión/cirugía , Procedimientos Quirúrgicos Ortognáticos/psicología , Negativa del Paciente al Tratamiento , Adolescente , Adulto , Actitud Frente a la Salud , Cefalometría/métodos , Toma de Decisiones , Estética , Asimetría Facial/psicología , Asimetría Facial/cirugía , Miedo/psicología , Femenino , Mentoplastia/psicología , Humanos , Consentimiento Informado , Masculino , Maloclusión/psicología , Osteotomía Mandibular/psicología , Masticación/fisiología , Motivación , Osteotomía Le Fort/psicología , Osteotomía Sagital de Rama Mandibular/psicología , Satisfacción del Paciente , Fotograbar/métodos , Adulto JovenRESUMEN
AIMS: To survey retention protocols and need for practical retention guidelines among orthodontists in Norway and to compare the results with similar studies in other countries. METHODS: A questionnaire was mailed to all members of the Norwegian Association of Orthodontists. It included questions about their background and their current retention protocol, as well as their perceived need for common retention guidelines. RESULTS: The response rate was 77.7% (69.3% males and 30.7% females). The most common maxillary retainer was a combination of a fixed and removable retainer, followed by a clear thermoplastic retainer. In the mandible, a fixed retainer bonded to all anterior teeth was most common (66.4%). Retention in the maxilla lasted 2 to 3 years (34.7%) or 3 to 5 years (23.8%). In the mandible, 41.5% of the orthodontists left the retainer in place for >5 years. When retention lasted more than 3 years, 70% of the orthodontists left the responsibility for retainer checkups to the patients or the general practitioners. The main reason for choosing a certain retention protocol was clinical experience (57.4%). Only 3.5% of the orthodontists based their protocols on information from the literature. Half?of the orthodontists, significantly women, expressed a need for common retention guidelines. CONCLUSIONS: In Norway, bonded retainers alone were reported to be most commonly used in the mandible, while bonded retainers used in combination with a removable retainer appear to be the most commonly used appliances in the maxilla. This is similar to the most frequently used retainers in other countries, but there are disparities in duration and follow-up protocols. Most female orthodontists desire common retention guidelines.
Asunto(s)
Retenedores Ortodóncicos/clasificación , Ortodoncia , Pautas de la Práctica en Odontología , Factores de Edad , Protocolos Clínicos , Recubrimiento Dental Adhesivo/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Maloclusión/terapia , Mandíbula/patología , Maxilar/patología , Noruega , Higiene Bucal , Diseño de Aparato Ortodóncico , Educación del Paciente como Asunto , Guías de Práctica Clínica como Asunto , Factores Sexuales , Factores de TiempoRESUMEN
OBJECTIVE: To analyze the impact of surgical change in anterior face height and skeletal relapse on the long-term soft tissue profile. MATERIALS AND METHODS: Cephalometric radiographs of 81 patients taken before surgery and at five time points during a 3-year follow-up period were analyzed. All patients had Le Fort I and bilateral sagittal split osteotomies. The patients were divided into three subgroups according to the change in anterior face height during surgery. Calculations of soft to hard tissue ratios were based on the long-term soft tissue response relative to the surgical repositioning. RESULTS: The horizontal surgical repositioning varied considerably, depending on whether anterior face height was increased or decreased. For upper lip prominence, the pattern of long-term change was the same irrespective of change in face height. In all groups, upper lip thickness decreased in both the short term and the long term, particularly in patients with surgical increase in face height. Lower lip thickness increased in the short term but decreased during the follow-up period. There were significant associations between horizontal soft tissue and corresponding hard tissue changes, except for soft tissue A-point and upper lip, when face height was increased. The ratios were higher for mandibular variables than for maxillary variables, particularly for B-point and pogonion when anterior face height had decreased. CONCLUSION: A change in facial height influences the soft tissue response. The mandibular soft tissues closely follow skeletal relapse beyond 2 months postsurgery. The findings have clinical implications for the relative maxillary and mandibular repositioning when planning surgery.
Asunto(s)
Cara/anatomía & histología , Anomalías Maxilomandibulares/cirugía , Maloclusión de Angle Clase III/cirugía , Cirugía Ortognática/métodos , Osteotomía Le Fort , Adolescente , Adulto , Cefalometría/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteotomía Le Fort/efectos adversos , Resultado del Tratamiento , Dimensión VerticalRESUMEN
PURPOSE: The aim was to compare outcome after extraoral vertical subcondylar osteotomy (EVSO) with rigid fixation and bilateral sagittal split osteotomy (BSSO) for correction of mandibular prognathism. The objectives were to examine treatment factors, postoperative results, and long-term stability. The surgical technique for EVSO is presented in detail. SUBJECTS AND METHODS: Lateral cephalograms and information from patient files of 65 consecutively operated patients with EVSO and 65 matching patients operated with BSSO were analyzed preoperatively, postoperatively, after 6 months and 3 years. RESULTS: No clinically significant differences were observed in long-term stability. The retromandibular scar inferior to the earlobe after EVSO was on average 25 mm long and 1 mm wide, and was of no concern for most of the patients. Normal or near normal sensation to the lower lip/chin was reported by half of the BSSO patients at the 3-year follow-up. CONCLUSION: Because no major differences in outcome were observed, EVSO with rigid fixation may be considered as a viable alternative if it is important to avoid alterations in sensation, whereas BSSO may be preferred if retromandibular scar is of concern.
Asunto(s)
Osteotomía Mandibular/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Dispositivos de Fijación Ortopédica , Osteotomía Sagital de Rama Mandibular/métodos , Prognatismo/cirugía , Adulto , Placas Óseas , Tornillos Óseos , Estudios de Casos y Controles , Cefalometría/métodos , Mentón/patología , Cicatriz/patología , Disección/métodos , Femenino , Estudios de Seguimiento , Humanos , Hipoestesia/etiología , Labio/patología , Estudios Longitudinales , Masculino , Mandíbula/patología , Osteotomía Mandibular/instrumentación , Tempo Operativo , Procedimientos Quirúrgicos Ortognáticos/instrumentación , Satisfacción del Paciente , Complicaciones Posoperatorias , Estudios Retrospectivos , Umbral Sensorial/fisiología , Tacto/fisiología , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To quantify the relative soft tissue profile response to the skeletal changes resulting from bimaxillary surgery to correct Class III malocclusion in patients with different vertical incisor relationships presurgery. MATERIALS AND METHODS: The sample comprised lateral cephalograms of 80 consecutive patients before and 2 months after surgery. All patients had one-piece Le Fort I and bilateral sagittal split osteotomies. Patients were divided in three subgroups according to their preoperative characteristics, as follows: (1) open-bite patients, (2) patients with positive overbite and the upper lip resting on upper incisors, and (3) patients with positive overbite and the upper lip resting on lower incisors (lip-block). Trimmed means of soft to hard tissue ratios were calculated for the subgroups. Regression analyses were performed to examine factors influencing the soft tissue changes. RESULTS: There were strong correlations between the horizontal movement of upper incisors and upper lip in patients with open bite (r â=â 0.77) and in patients with positive overbite and upper lip resting on upper incisors (r â=â 0.85). The upper lip followed the maxilla with a ratio of 0.5â¶1. In patients with lip-block, the association between maxillary repositioning and upper lip changes was weak. In all groups a strong association between horizontal soft and hard tissue changes was observed for the lower lip and chin, but the pattern differed depending on the vertical movement of the mandible. CONCLUSIONS: In the prediction of soft tissue response it is important to take into account the vertical incisor relationship, particularly in patients with lip-block.
Asunto(s)
Cara/anatomía & histología , Incisivo/fisiopatología , Maloclusión de Angle Clase III/cirugía , Osteotomía Le Fort , Osteotomía Sagital de Rama Mandibular , Adolescente , Adulto , Cefalometría , Femenino , Humanos , Labio/fisiopatología , Masculino , Maxilar , Persona de Mediana Edad , Mordida Abierta/patología , Sobremordida/patología , Pronóstico , Análisis de Regresión , Resultado del Tratamiento , Adulto JovenRESUMEN
Changes in the occlusion after orthodontic treatment have in several studies been analyzed by the use of the PAR Index developed by Shaw & Richmond. The use of the PAR Index has been shown by O'Brien & Shaw to be a reliable and reproducible method to evaluate orthodontic treatment results. The purpose of the study was to examine the long-range orthodontic treatment outcome by following a group of patients into adulthood to the age of 31 years. For the study 115 individuals from a previous randomized study were invited for follow-up examination at age 31 years. Seventy-two individuals, 32 males (44.4%) and 40 females (55.6%) of the original sample attended for clinical examination. Study casts were obtained and questionnaires addressing the patient's awareness and opinion of the treatment were distributed. In addition twenty-four subjects responded by returning filled-in questionnaires. The mean change in wPAR scores from start to retention represents a mean relative improvement in occlusion of 78.7%. The mean wPar score improvement from age 19 to 31 years was 11.9%. The relative mean wPar score change dropped to 53.5% at age 31 years. The differences in wPAR recordings between the recorded stages were all statistically significant. The treatment outcome as expressed by mean wPAR scores at age 31 years was significantly better among individuals treated with extractions compared to those treated without extractions. The mean wPAR scores of the individuals with retainers at age 31 years were significantly lower when compared to the mean score for those without retainers (unpaired t-test, p = 0.020). This clearly indicates the benefit of long-term retention. The changes in the concern scores from 19 to 31 years of age were small. At age 31 years only 8 of the 96 respondents (8.3%) expressed concern about the treatment outcome.
Asunto(s)
Maloclusión/terapia , Ortodoncia Correctiva , Adulto , Actitud Frente a la Salud , Femenino , Estudios de Seguimiento , Humanos , Masculino , Maloclusión/diagnóstico , Evaluación de Resultado en la Atención de Salud , Satisfacción del Paciente , Revisión por Pares , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Very few studies have addressed long-term development and risks associated with untreated malocclusion. The purpose of this study was to examine changes in occlusion in a lifelong perspective and to compare oral health and attitudes toward teeth among persons with malocclusion with those having normal occlusion. METHODS: In 1950 an epidemiologic survey of 2349 8-year-olds was conducted and included 4 intraoral photographs. Three selected samples with different malocclusions (deep bite, crossbite, or irregular teeth) and 1 sample with normal occlusion (a total of 183 subjects) were, 57 years later, invited for examination and an extensive interview about dental experiences and attitudes. Sixty-nine responded (38%) and constitute the subjects studied. RESULTS: Malocclusion remained the same or worsened except in subjects having deep bite in childhood, which in some improved and in others became worse. Crowding generally increased. Sixteen persons reported moderate or severe temporomandular joint (TMJ) problems, and of these 7 belonged to the group with crossbite in childhood. With few exceptions, the subjects in all samples had good oral hygiene, visited the dentist regularly, and had well-preserved dentitions. Mean number of missing teeth was significantly lower among those with normal occlusion compared with the malocclusion groups. Individuals with normal occlusion responded favorably to all questions related to attitudes and experiences about their teeth, while responses in the malocclusion groups varied. CONCLUSIONS: Persons with the particular malocclusions examined experienced more problems related to teeth later in life compared with those having normal occlusion in childhood.
Asunto(s)
Actitud Frente a la Salud , Maloclusión/patología , Maloclusión/psicología , Salud Bucal , Anciano , Estudios de Casos y Controles , Niño , Atención Odontológica/estadística & datos numéricos , Estética Dental , Estudios de Seguimiento , Humanos , Maloclusión/complicaciones , Maloclusión de Angle Clase III/etiología , Noruega , Higiene Bucal/estadística & datos numéricos , Fotografía Dental , Autoevaluación (Psicología) , Trastornos de la Articulación Temporomandibular/etiología , Pérdida de Diente/etiologíaRESUMEN
AIM: The aim of this study was to evaluate the upper airway changes after simultaneous maxillary advancement/impaction and mandibular setback in skeletal Class III malocclusion. METHODS: The subjects included 76 patients whose treatment included 1-piece LeFort I and bilateral sagittal split osteotomies. Lateral cephalograms were taken before surgery and 2 months and 3 years postoperatively. In order to analyze the effect of maxillary repositioning, the material was divided into subgroups according to whether the maxillary impaction and advancement were clinically significant (≥2 mm) or not. RESULTS: Advancement of the maxilla with or without impaction resulted in a significant long-term increase (P <0.001) in airway dimension at the nasopharyngeal level (13%-21% increase). At the oropharyngeal and retrolingual levels, a decrease took place but was significant (P <0.05) only at the oropharyngeal level when the maxilla was not impacted. When the maxilla was not advanced, there was no significant change, except at the hypopharyngeal level (12% decrease) (P <0.01). CONCLUSIONS: Clinically significant advancement (≥2 mm) of the maxilla significantly increased the airway dimension at the nasopharyngeal level and to some extent compensated for the effect of mandibular setback at the hypopharyngeal level.
Asunto(s)
Maloclusión de Angle Clase III/cirugía , Maxilar/cirugía , Osteotomía Le Fort , Faringe/anatomía & histología , Adolescente , Adulto , Análisis de Varianza , Cefalometría , Femenino , Humanos , Técnicas de Fijación de Maxilares , Masculino , Mandíbula/cirugía , Persona de Mediana Edad , Procedimientos Quirúrgicos Ortognáticos , Adulto JovenRESUMEN
INTRODUCTION: The purpose of this study was to evaluate long-term skeletal and occlusal stability after bimaxillary surgery to correct skeletal Class III malocclusion. METHODS: The sample comprised 81 consecutively treated patients. All subjects had received a combined 1-piece LeFort I and bilateral sagittal split ostotomies with rigid fixation between 1990 and 2003 and were followed for 3 years. Lateral cephalograms were obtained before surgery and at 5 occasions after surgery. RESULTS: The mean setback was 6.9 mm in the mandible, and the maxilla was moved forward 3.7 mm. In most patients, the posterior maxilla was impacted. Relapse of maxillary advancement was insignificant (0.1 mm), whereas relapse at B-point was on average 1.7 mm (P <0.010). After 3 years, mean overjet and overbite amounts were 2.0 and 1.9 mm, respectively. Skeletal relapse of the mandible increased significantly with the surgical setback (P <0.001) and the change in the vertical position of the posterior maxilla (P = 0.010) (multivariate regression analysis). CONCLUSIONS: Bimaxillary surgery resulted in good occlusal stability. Maxillary advancement was stable, whereas relapse of the mandibular setback varied. Risk factors for horizontal relapse of the mandible were large setback and inferior repositioning of the posterior maxilla.
Asunto(s)
Maloclusión de Angle Clase III/cirugía , Mandíbula/cirugía , Maxilar/cirugía , Adolescente , Adulto , Factores de Edad , Tornillos Óseos , Cefalometría/métodos , Oclusión Dental , Femenino , Estudios de Seguimiento , Humanos , Técnicas de Fijación de Maxilares , Masculino , Mandíbula/patología , Maxilar/patología , Persona de Mediana Edad , Hueso Nasal/patología , Ortodoncia Correctiva/instrumentación , Osteotomía/métodos , Osteotomía Le Fort/métodos , Recurrencia , Factores de Riesgo , Silla Turca/patología , Factores Sexuales , Resultado del Tratamiento , Dimensión Vertical , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVES: There is a lack of studies that have evaluated how different ways of organizing and financing orthodontic services perform with respect to access to care, and the cost of care. In Norway, orthodontic services for children and adolescents are partly financed by the state, and the size of the state subsidy depends on the severity of the malocclusion. Orthodontists have the freedom to establish a practice where they wish. The aim of this study was to examine whether there are inequalities with respect to access to orthodontic services in Norway, and to study the development of costs of the services from 2004 to 2007. METHODS: Data on mean waiting time for starting treatment and working hours in practice were collected using a questionnaire that was sent to all the orthodontists in the country (n = 165). The response rate was 74%. The number of patients who received treatment according to different criteria of need was recorded from data in each practice. Information about the development of costs for orthodontic treatment was obtained from the National Insurance Administration. RESULTS: In almost all the areas, waiting time for starting treatment was within clinically acceptable limits, and there were only small differences in supply of orthodontic treatment in different areas. Patients with the greatest need were given priority over patients with the least need, which is in line with the aims of the authorities. In 2007 the reimbursements for orthodontic treatment from the National Insurance Administration amounted to Euro 48 million. In deflated prices this was virtually the same amount as in 2004. CONCLUSION: Our results show that the combination of public funding and freedom to establish a practice ensures that services are available for the individuals who are most in need of treatment. The authorities also have control over costs. The experiences from the orthodontic services in Norway are useful for policymakers in other countries. In particular, an important finding is that an orthodontic service where the state subsidy depends on the severity of the malocclusion can secure both equal access to the services and contain costs.
Asunto(s)
Financiación Gubernamental , Accesibilidad a los Servicios de Salud , Ortodoncia/economía , Pautas de la Práctica en Odontología/estadística & datos numéricos , Humanos , Noruega , Encuestas y CuestionariosRESUMEN
The purpose of the study was to investigate the relationship between root resorption and repair in human premolars that had been orthodontically intruded. The objective was to examine these processes related to time and root development. Seventy-six premolars were divided into subgroups: 33 teeth were intruded and then extracted (G1); 25 teeth were intruded and then left in situ for varying periods before extraction (G2); 18 teeth served as the controls (G3). All teeth were examined by light microscopy. Using non-parametric statistical analysis, differences between the groups were examined with the Pearson chi-square test. Teeth in G1 and G2 had significantly more resorptive lesions, 55 and 64 per cent, respectively, than the controls of 11 per cent. Resorption was observed over the whole root surface and increased with time. The occurrence increased to 100 per cent in both experimental groups after 36 days of intrusion. The appearance of lesions in relation to root development showed no differences between G1 and G2. In the apical part of the root, total resorption of the dentine was sometimes observed, but no resorptions extended into the predentine. Resorptive lesions undergoing repair were seen in both groups, with significantly more repair in G2 (58 per cent) than in G1 (32 per cent). Active resorption and repair were sometimes seen at the same resorption site. Deposition of cellular and acellular cementum was found to the same extent over the whole root when repair took place. With time, resorption appeared over the whole root surface. In some teeth, resorptive activity continued up to 10 days after removal of forces but on the other hand, repair of the resorbed area sometimes started during active movement. The individual variation in repair was much wider compared with resorption. The predentine layer in the apical area appeared not to be affected by the resorptive process.
Asunto(s)
Diente Premolar/patología , Resorción Radicular/etiología , Técnicas de Movimiento Dental/efectos adversos , Adolescente , Cementogénesis/fisiología , Niño , Cemento Dental/patología , Dentina/patología , Femenino , Humanos , Masculino , Odontogénesis/fisiología , Osteoclastos/patología , Resorción Radicular/patología , Estrés Mecánico , Factores de Tiempo , Ápice del Diente/crecimiento & desarrollo , Ápice del Diente/patología , Raíz del Diente/crecimiento & desarrollo , Raíz del Diente/patología , Cicatrización de Heridas/fisiologíaRESUMEN
OBJECTIVES: To analyze changes in occlusion between the ages of 8 and 65 years in persons with a deep overbite at the age of 8 who did not receive orthodontic treatment. To describe their experiences regarding their own dentition as well as their opinions on dental esthetics and oral health. To compare these findings with those of the Normal Occlusion (N-Group) described in Part 1. SUBJECTS AND METHODS: With one exception, the 20 persons in our cohort had not undergone orthodontic therapy. Our documentation was based on intraoral photographs taken at the two time points in addition to an interview and facial photos at the age of 65. RESULTS: The overbite could be evaluated in 16 persons. In four persons various degrees of mucosal indentations in connection with the overbite had been registered. The average number of missing teeth was 3.4, compared to 1.6 in the N-group. All participants reported their oral health to be good or excellent and, similar to the N-group, nearly all considered dental esthetics to be important. CONCLUSION: The overbite had decreased during the observation period in nine, increased in five, and remained stable in two persons.
Asunto(s)
Actitud Frente a la Salud , Mordida Abierta/diagnóstico , Salud Bucal , Autoimagen , Adolescente , Adulto , Anciano , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: The purpose of this retrospective cephalometric study was to evaluate the long-term vertical stability of anterior open-bite correction by 1-piece Le Fort I osteotomy and rigid fixation. METHODS: The sample comprised 40 consecutively treated patients from the files of the Department of Orthodontics, University of Oslo, Norway. All subjects had received a 1-piece Le Fort I osteotomy as the only surgical procedure from 1990 through 1998 and were followed for 3 years according to a protocol for data collection. Lateral cephalograms were obtained before surgery and at 5 occasions after surgery. RESULTS: The mean open bite before surgery was 2.6 mm; at the 3-year follow-up, 35 patients had a positive overbite, and the remaining 5 patients had an open bite between 0.2 and 0.9 mm. Impaction of the posterior maxilla >or=2 mm relapsed on average by 31%, and inferior repositioning of the anterior maxilla >or=2 mm relapsed by 62%. Maxillary vertical skeletal changes during the postsurgery period were compensated for by orthodontic dentoalveolar adaptation. Most of the skeletal relapse occurred during the first 6 months after surgery and always in the direction opposite to the surgical movement. The relative contribution of mandibular and maxillary changes in anterior open-bite closure was approximately 3:1. CONCLUSIONS: Surgical correction of anterior open bite was generally stable over a 3-year period, and skeletal relapse was counteracted by dentoalveolar compensation.
Asunto(s)
Maxilar/cirugía , Mordida Abierta/cirugía , Osteotomía Le Fort/métodos , Adolescente , Adulto , Proceso Alveolar/patología , Placas Óseas , Cefalometría , Mentón/patología , Femenino , Estudios de Seguimiento , Humanos , Incisivo/patología , Estudios Longitudinales , Masculino , Mandíbula/patología , Maxilar/patología , Persona de Mediana Edad , Hueso Nasal/patología , Mordida Abierta/patología , Osteotomía Le Fort/instrumentación , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento , Dimensión VerticalRESUMEN
OBJECTIVE: To analyze occlusal changes between the ages of 8 and 65 years in 18 persons with normal occlusion at the age of 8 (N-group), to describe their attitudes toward dental esthetics and their experiences regarding their dentition. MATERIAL AND METHODS: The N-group is considered as the reference group in comparison with malocclusion groups that will be presented in subsequent articles. Documentation is based on intraoral photographs and personal interviews. RESULTS: In general, the occlusal changes were moderate. The probands were all satisfied with their teeth and tooth position. They were all examined at regular intervals by their dentists and practiced generally good oral hygiene. The average number of missing teeth was 1.4 (0-6) and the number of prosthodontically -restored or replaced teeth was 6.4 (0-24). Fifteen persons reported well-positioned teeth to be important. However, 17 found that visibly poor oral hygiene, discolored or missing teeth or the "total impression", to be more important than malpositioned front teeth. CONCLUSIONS: Generally speaking, occlusal changes were moderate and satisfaction with the dentition was good. Discolored or missing teeth and poor oral hygiene were found to be the most disturbing negative traits with respect to dental esthetics.