The impact of the long-term playing of musical instruments on the stomatognathic system - review

In this article, we have made a review of the influence of playing musical instruments on the formation of malocclusion and TMJ disorders in musicians. Primary attention was paid to the effects of wind and stringed instruments. The aim of the article was the presentation of research and opinions about this problem in the last 25 years. It is reported that long-term and repetitive playing of musical instruments, particularly stringed (violin and viola) and wind instruments can cause dysfunctions of the stomatognathic system. The impact of wind instruments was assessed in terms of the type of mouthpiece. We studied the possibility of repositioning the front teeth and reducing the width of the upper dental arch and overbite. There were also reports on the use of a specific instrument to improve the child's occlusion. Studies have also been performed on the usefulness of relaxation plates in order to improve, and even prevent, dysfunction caused by the constant stress on the same parts of the stomatognathic system. The experiments were mainly based on interviews, dental cast analyses and cephalometric analyses. Additional methods were dynamometer tests and muscle tension palpation.

Do wisdom teeth induce lower anterior teeth crowding? A systematic literature review

OBJECTIVE

Individuals with dental crowding are the most frequent patients in the orthodontic practice.The purpose of this article is to find out if the lower third molars are the main reason of crowding in the lower dental arch. As well to find out other factors which can influence the lower incisors crowding.

METHODS

The aim was to identify studies and reviews related to the effect of the lower third molars on the lower dental arch crowding. A literature survey was performed using Medline database. Used key words were lower third molar, influence of wisdom teeth, wisdom teeth and anterior crowding, lower dental arch changes. The articles from 1971 to 2011 related to topic were identified. Selected articles were published in dental journals in English. Full texts of the selected articles were analyzed. Articles about the dental crowding after orthodontic treatment were not included. All studies accomplished with human participants.

RESULTS

It was found 223 articles but only 21 articles corresponded to selected criteria and were analyzed. This review is based on the investigations of 12 laboratory researchers, 4 clinical researches, 2 questionnaires and 3 literature reviews.

CONCLUSION

The results are quite contradictory: some authors support the opinion that lower third molars cause teeth crowding, the others confirm conversy. Exist other factors affecting the mandibular incisors crowding: dental (teeth crown size, dental arch length loss, poor periodontal status and primary teeth loss), skeletal (growth of the jaws and malocclusion) and general (age and gender).

How various surgical protocols of the unilateral cleft lip and palate influence the facial growth and possible orthodontic problems? Which is the best timing of lip, palate and alveolus repair? literature review

OBJECTIVES. Cleft lip palate is congenital growth disease with unknown etiology, probably linked to both genetically and external causes. The aim of this work consists in presenting the effects of these diseases on cranio facial growth and the surgical protocols described in literature. MATERIALS AND METHODS. The literature review articles conducted by Medline ranged from 1998 to 2011 have been selected. The key words of the research were "cleft lip palate", "cleft lip palate facial growth", "cleft lip palate surgery". The inclusion criteria were articles that analyzed surgical protocols and the growth of unilateral lip and palate clefts, the timing repair of lip, palate and alveolus. We excluded case reports, studies without control group in the sample and the other types of publication as thesis or conference presentation. 60 articles had the selection criteria of the research. RESULTS. The cleft lip and palate is one of the most common birth defects that needs long rehabilitation between birth and adulthood. Several authors have presented surgical protocols and timing. The effects of these diseases on cranio facial growth and the importance of the early intervention have been described. CONCLUSIONS. The review describes the main surgical protocols and treatment strategies of the unilateral lip and palate clefts. The review discusses how surgery effects the midfacial skeletal growth. Studies agree that the palate repair is the main cause of the maxilla growth disturbances. About the timing of palate repair in the unilateral clefts it can be concluded that most studies found no difference between one or two stages palate repair techniques for the midfacial growth. Also from the research, studies agree that delayed hard palate repair has more positive effects on maxillary growth than that of early hard palate repair. Nevertheless good results, delayed hard palate repair technique is abandoned by many hospital centres because of worse speech outcome. The best technique of palate repair is difficult to conclude, because the research results are part of a big controversy between the centers. From the studies about the alveolar repair it can be concluded that the primary bone grafting had more negative results on the skeletal growth. Gingivoperiosteoplasty and the secondary bone grafting had more positive results for intracranial relationship. The studies agree that the best timing of lip repair is during third-sixth month of life and that lip repair could have negative influence on the maxillary growth.

Tooth developmental anomalies in severe combined immunodeficiency disease and juvenile myelomonocytic leukemia: common clinical features and treatment outcomes

AIM

Human Severe Combined Immunodeficiency (SCID) is a prenatal disorder of T lymphocyte development that depends on the expression of numerous genes. Juvenile myelomonocytic leukemia (JMML), previously known as juvenile chronic myeloid leukemia (JCML), is a rare, myelodysplastic/myeloproliferative disease typically presenting in early childhood.

CASE REPORTS

Two cases are described of immunodeficiency disorders, both treated with chemotherapeutic drugs (Busulfan plus cyclophosphamide) before bone marrow transplantation. After treatment, these two different cases showed several similar oral lesions: microdontia, root alterations, numerous tooth ageneses, incomplete calcification, enamel hypoplasia, premature apexification and hypodontia. Both subjects underwent dental and orthodontic treatment. The first phase comprised orthopaedic treatment using a removable appliance (Interim-G®) followed by rapid palatal expansion; in the second phase patients underwent tooth extraction and were treated using fixed appliances for 19 and 26 months, respectively (mean 2 years) to obtain final alignment and maximum intercuspation. In the third and final phase, reconstruction of malformed teeth was completed, and implant-supported protheses were applied.

CONCLUSION

The difficulties of managing and treating these diseases are discussed, with particular focus on tooth anomalies and malocclusion disorders. Collaboration between dentist and paediatrician in dealing with patients with a variety of oral lesions and tooth anomalies is important in order to prevent any other possible tooth lesions and ensure correct jaw development.

Oral habits in a population of Albanian growing subjects

AIM

The aim of this study was to assess the prevalence of oral habits in an Albanian population of schoolchildren.

STUDY DESIGN

A sample of 2617 subjects, aged 7-15, was examined by clinical observation without radiograms. The sample comprised 1257 males and 1360 females, with no history of orthodontic treatment. Aestethical frontal and profile analysis, intraoral and functional analysis were performed.

STATISTICS

Gender and age differences were compared by chi-square test. The relationship between malocclusions and oral habits was assessed by t-test and the level of significance was assessed at 0.01.

RESULTS

The findings indicated that oral habits were present in 2225 subjects (85.0%), 1103 males (87.7%) and 1121 females (82.4%); the most frequent oral habit was pacifier sucking (30%) and it was mostly present in the 7-11 years group. It was observed a significant correlation between oral habits and dental malocclusions, open bite, altered overjet and maxillary contraction. CONCLUSION The high number of oral habits observed in the studied sample suggest that prevention strategies adopted in other countries could be successfully integrated in the development of an effective national programme in Albania aimed at reducing malocclusion risk factors.

Malocclusion in early anatomically modern human: a reflection on the etiology of modern dental misalignment

Malocclusions are common in modern populations. Yet, as the study of occlusion requires an almost intact dentition in both the maxilla and mandible, searching for the ultimate cause of malocclusion is a challenge: relatively little ancient material is available for research on occlusal states. The Qafzeh 9 skull is unique, as its preserved dentition allowed us to investigate the presence and manifestations of malocclusion. The aim of this study was thus to examine the occlusal condition in the Qafzeh 9 specimen in light of modern knowledge regarding the etiology of malocclusion. We revealed a pathologic occlusion in the Qafzeh 9 skull that probably originated in the early developmental stage of the dentition, and was aggravated by forces applied by mastication. When arch continuity is interrupted due to misalignment of teeth as in this case, force transmission is not equal on both sides, causing intra-arch outcomes such as mesialization of the teeth, midline deviation, rotations and the aggravation of crowding. All are evident in the Qafzeh 9 skull: the midline deviates to the left; the incisors rotate mesio-buccally; the left segment is constricted; the left first molar is buccally positioned and the left premolars palatally tilted. The inter-arch evaluation revealed anterior cross bite with functional shift that might affect force transmission and bite force. In conclusion, the findings of the current study suggest that malocclusion of developmental origin was already present in early anatomically modern humans (AMH) (the present case being the oldest known case, dated to ca. 100,000 years); that there is no basis to the notion that early AMH had a better adjustment between teeth and jaw size; and that jaw-teeth size discrepancy could be found in prehistoric populations and is not a recent phenomenon.

Odontostomatological aspects in patients with Williams syndrome: a series of 4 cases

The authors examined four patients with Williams syndrome presenting characteristic odontostomatological alterations. Agenesis, dental deposits, chewing difficulties due to bone malformations and poor cooperation of patients with malformations also in other districts and mental and physical retardation require the dentist to adopt different approaches, from restorative to orthodontic treatment, from periodontal to professional oral hygiene treatment.

Respiratory disorders in paediatric age: orthodontic diagnosis and treatment in dysmetabolic obese children and allergic slim children

AIM

Obesity and allergic susceptibility are worsening problems in the most industrialised countries. With different mechanisms, they both lead to a deterioration of children's life quality because they affect the respiratory system, leading to asthma and respiratory disorders such as mouth breathing and obstructive sleep apnoea. The latter are related to specific types of malocclusions that require an early diagnosis and specific multidisciplinary treatment. The purpose of this work is to show the characteristic signs and symptoms of these disorders in children of the two phenotypes (allergic and slim, obese and dysmetabolic). Intercepting such issues allows both pediatricians and paediatric dentists to refer the child to a multidisciplinary team of specialists able to deal, in a holistic way, with both the physical and behavioural causes, and also with the consequences on systemic and craniofacial development in particular.

MATERIALS AND METHODS

The literature available on this topic in the years between 1997 and 2011 was reviewed, paying special attention to prevention, paediatric visits, diagnostic tools and treatment options for each of the two conditions.

CONCLUSION

Dysmetabolic obese children and allergic slim children have specific respiratory problems during rest and exercise. Mouth breathing and obstructive sleep apnoea are due to an abnormal craniofacial development and can cause serious systemic problems in adulthood. Intercepting early signs of pathognomonic symptoms of sleep aponea and mouth breathing permits to treat children with an early multidisciplinary approach, and allows for proper physical and psychological development of the child.

Inter-relations between infraocclusion of primary mandibular molars, tipping of adjacent teeth, and alveolar bone height

PURPOSE

The purpose of this study was to examine inter-relations between infraocclusion of primary mandibular molars, tipping of adjacent teeth, and alveolar bone height of infraoccluded teeth.

METHODS

A total of 402 periapical radiographs of infraoccluded primary mandibular molars were reviewed. Infraocclusion, alveolar bone height, and tipping of adjacent teeth were measured.

RESULTS

Infraocclusion was most prevalent among primary mandibular first molars. The amount of infraocclusion was most profound among primary mandibular second molars (2.79±1.25). The shortest distal alveolar crest (reflected by the highest distance between the cementoenamel junction and bone crest) was observed among infraoccluded primary mandibular first molars (0.9±0.92). The permanent mandibular first molar and the primary mandibular first molar demonstrated the maximum tipping mesially and distally.

CONCLUSIONS

Infraocclusion of primary mandibular molars, tipping of adjacent teeth, and alveolar bone height of the infraoccluded teeth are inter-related.

Fingers in mouths: from cause to management

Digit sucking is a habit that occurs in childhood and can lead to malocclusion if it persists for a long time. Understanding the cause and available management approaches for habit cessation can lead to more positive outcomes for clinicians, parents and children alike. Increasing clinicians' awareness of the causes and management of digit sucking behaviours can aid in their effective and systematic management, thereby reducing the risk of future malocclusion in some individuals.

Masseter function and skeletal malocclusion

The aim of this work is to review the relationship between the function of the masseter muscle and the occurrence of malocclusions. An analysis was made of the masseter muscle samples from subjects who underwent mandibular osteotomies. The size and proportion of type-II fibers (fast) decreases as facial height increases. Patients with mandibular asymmetry have more type-II fibers on the side of their deviation. The insulin-like growth factor and myostatin are expressed differently depending on the sex and fiber diameter. These differences in the distribution of fiber types and gene expression of this growth factor may be involved in long-term postoperative stability and require additional investigations. Muscle strength and bone length are two genetically determined factors in facial growth. Myosin 1H (MYOH1) is associated with prognathia in Caucasians. As future objectives, we propose to characterize genetic variations using "Genome Wide Association Studies" data and their relationships with malocclusions.

Provision of an appliance to correct mandibular deviation secondary to temporomandibular joint replacement

This report outlines the provision of an appliance of novel design to correct mandibular deviation secondary to temporomandibular joint replacement. The aim of the appliance was to reduce the deviation of the mandible by guiding its path during function, thus reducing the symptoms of facial pain. A significant improvement in symptoms was noted as a result of wearing the appliance which was still evident at the 12 month review. In a patient with high levels of chronic pain associated with TMJ dysfunction, reversible minimally invasive treatment has definite advantages, particular if there is a wish to avoid further surgical intervention.

[Complex prosthetic rehabilitation of a patient with temporomandibular dysfunction. Case report]

There are varying opinions regarding the contribution of occlusal interferences to the development and progression of temporomandibular dysfunction (TMD). Several studies have demonstrated that the use of occlusal adjustment might prevent the development of TMD and the exacerbation of its symptoms. Since the aetiology of TMD is multiple, the prosthodontic treatment cannot always be sufficient, but tends to be effective in some cases. The present article describes a case of a complex prosthetic rehabilitation of a patient with TMD that originates from her previous prosthesis, resulting in reduced vertical dimension. Treatment included the registration of vertical and horizontal dimensions of occlusion by gothic arch (arrow-point) tracing. Degrees of the mandibular movement were recorded by digital axiograph (ARCUSdigma-KaVo) and transferred to a semi-adjustable articulator (KaVo Protar 5B). Appropriate vertical and horizontal occlusal dimensions and individual mandibular movements were then transferred to the final prosthesis.

Transverse dental changes after tooth-borne and bone-borne maxillary expansion

OBJECTIVE

Determine the differences in skeletal and dental maxillary expansion as evidenced by the degree of dental tipping and if this is symmetrical or not.

METHODS

Sixty-two patients who were diagnosed as requiring maxillary expansion treatment were recruited over an 18-month period. Patients were randomly allocated into three groups where a total of three to four cone-beam computerized tomographies (CBCT) were obtained throughout a one-year period depending on the group allocated. Landmarks used were from the first and second molars and premolars of the maxilla. For each of the eight teeth, three landmarks were identified: the root apex, alveolar bone and pulp chamber. Statistical analysis consisted in the use of MANOVA and after significant overall effects were detected, the univariate repeated measures results were analyzed along with separate ANOVA for each variable at each of the four time points.

RESULTS

There was strong overall significance for time, group, and time*group. The first and second molars saw both bone- and tooth-anchored treatment groups with significantly different dental inclination than the control group. For the second premolars, only the tooth-anchored group was significantly different from control. The tooth-anchored group was also significantly different than the control group in the first premolar measurements. For the analysis of asymmetry in dental inclination, no significant time, group, or time*group effects were seen overall.

CONCLUSION

The analysis provided evidence that dental tipping does occur in the molars for both RME treatments, while the premolars showed increased tipping in the tooth-anchored, but not the bone-anchored group.

Relationship between breastfeeding, bottle-feeding and development of malocclusion

The importance of breastfeeding to the child's psychological and physical development is evidence-based. However, scientific literature contains controversial opinions on its influence to the development of maxillofacial system. This article aims at reviewing the effects of breastfeeding and bottle-feeding to the development of malocclusion and non-nutritive sucking habits. Thirty-four articles analyzing the above mentioned associations were selected from Pubmed database. Breastfeeding and bottle-feeding may have different impact on the development of maxillofacial system due to unequal functional load of certain facial muscles involved in the feeding processes. Shortage of scientific research prevents from relating bottle-feeding with the development of skeletal malocclusions. Prolonged breastfeeding may have protective effect on developing posterior crossbite and anterior openbite. However, conflicting opinions have been observed. It has been stated that longer duration of breastfeeding diminishes the risk of acquiring non - nutritive sucking habits.

Increased vertical dimension of occlusion: signs, symptoms, diagnosis, treatment and options

During the planning of oral rehabilitation, the vertical dimension of occlusion (VDO) is one of the first parameters to be measured since its improper restoration can lead to the failure of any prosthetic rehabilitation. A decreased VDO can lead to the appearance of lesions, such as angular cheilitis, facial disharmony, and temporomandibular disorders; meanwhile, an increased VDO may lead to the onset of joint and muscle pain, tension in functional speech, difficulty in swallowing, impaired chewing, tooth sensitivity due to traumatogenic forces, pathologic bone resorption, abnormal wearing of teeth, the appearance of an elongated face, and a facial expression of fatigue. Most scientific articles deal with methods and techniques for re-establishing VDO in edentulous patients or those who have lost their tooth reference due to prosthetic preparations. However, patients with increased VDO are also found in everyday practice. One treatment option for these patients is occlusal adjustment by selective tooth wear; it is still possible to perform orthodontic intrusion and/or orthognathic surgery in severe cases. The aim of this study was to discuss signs, symptoms, diagnosis, and treatment, and to report a clinical case of a patient with increased VDO.

Rehabilitation of a patient with an elusive medical history and loss of occlusal vertical dimension

In this clinical report, we describe the medical history, diagnosis and prosthodontic treatment of a 61-year-old man with a previous history of oral cancer. Loss of a full upper denture and severe erosion of his teeth prompted the patient to seek treatment at the dental clinic at the British Columbia Cancer Agency. Although he stated that he was being treated for a sleeping disorder, hospital records revealed multiple recent admissions for alcoholism and depression. The patient's limited finances prevented complex restoration of worn lower dentition; thus, definitive treatment consisted of extraction of teeth with a poor prognosis, removal of a glandular odontogenic cyst and fabrication of a full maxillary prosthesis and a removable mandibular cast-metal overlay.

Dynamical changes of occlusion and articulation during treatment of mandibular angle fractures

Outcomes of mandibular fractures were stated as frequent reason of temporomandibular joint dysfunctions. The objective of this study was to evaluate dynamical changes of occlusion and articulation during treatment of mandibular angle fractures. 12 subjects with mandibular angle fractures underwent analysis of occlusion and articulation in all stages of healing. Findings of investigations were presented in Posselt's and intercondylar axis diagrams, occlusiograms and relative force vs. time graphs. Comparison of results in first day, 1, 3 and 6 months after trauma showed that despite typical process of fragments healing and good fixation but with insufficiently balanced occlusion and posttraumatic discoordination of muscle activity first signs of TMJ articular discs dysfunction were found. Our results confirm the concept that early rehabilitation of mandibular function and occlusion are essential to prevent developing functional disorders of TMJ.

[A review of the oro-dento-facial characteristics of hereditary sensory and autonomic neuropathy type III (familial dysautonomia)]

The oro-dento-facial features and dysfunction of children with hereditary sensory and autonomic neuropathy type Ill, known as familial dysautonomia or Riley-Day syndrome, was first described in the scientific literature in 1949. They include dental trauma; dental and soft tissue self-mutilation; normal dental age; normal sequence and timing of eruption and exfoliation of teeth; smaller tooth size; different and disproportional tooth components; normal alveolar bone height; small jaws, mild crowding, and malocclusions. These persons have craniofacial morphology that is different from accepted norms but they resemble norms of their ethnic origin. The subjects can have gray, pale, shiny faces with an asymmetric suffering expression; frontal bossing, with eventual hypertelorism and narrow lips; a low caries rate; drooling, and hypersalivation. They can have changes in salivary composition and content, which influences plaque and calculus and increases the risk of gingival and periodontal diseases. They also have difficulty in controlling oral muscles; a progressive decrease in number of tongue fungiform papillae, accompanied by lack of taste buds; and specific dysgeusia, but a normal sense of smell.

Molar position associated with a missing opposed and/or adjacent tooth: a follow up study in women

The purpose of the study was to assess (i) the degree of overeruption of molars lacking opposed teeth and (ii) the inclination of molars with a mesial edentulous space and alsoto study (iii) changes during a 12 year period. The subject sample originated from the prospective population study of women in Gothenburg, Sweden where scanned panoramic radiographs taken with an interval of 12 years were analysed. Tipping as well as overeruption were scored on the two images according to a five-level scale. Sixty-seven subjects fulfilled the inclusion criteria at baseline and were referred to as "the non-extraction group". Further 35 subjects had lost the opposed and/or the adjacent tooth/teeth during the 12-year follow-up period: "the extraction-group". These groups were studied separately and a comparison between these groups was performed. The prevalence of molars tipped more than 15 degrees at baseline was 17.1% in the upper jaw and 44.3 % in the lower jaw, in the non-extraction group. At baseline overeruption was seen in 25 % of the unopposed upper molars and none of lower molars in the non-extraction group. The prevalence of tipping and overeruption was statistical significant less in the extraction group (P<0.01), than in the non-extraction group at baseline, but at follow-up no statistical significant group differences existed.

IN CONCLUSION

The prevalence of tipped molars facing a mesial edentulous space and overerupted unopposed molars increased in adults during the 12-year period but the changes were small. Overeruption and tipping is most pronounced immediately after extractions.

Type II vitamin D-dependent rickets with diabetic ketoacidosis

The high prevalence of vitamin D deficiency in relation to diabetes mellitus is well reported in the literature. However, type I diabetes mellitus (T1DM) in association with resistant rickets is extremely rare and reported in only one previous case. The authors describe here a case of type II vitamin D-dependent rickets (VDDR type II) in a 10-year-old Indian girl who presented with diabetic ketoacidosis (DKA). DKA as a presenting manifestation of T1DM in a patient with VDDR type II has never been reported before in worldwide literature.

[Dentigerous cyst associated with maxillary canine as a reason of occlusion defect - case report of 7-year old boy]

Dentigerous cysts are characterized by slow and non-symptomatic growth. Usually they are recognized accidentally during the radiological examination of patients with an occlusion defect or dental age different than growing age. In the case described, the patient presented for dental treatment with the complaint of an occlusion defect and the appearance of a right deciduous maxillary lateral incisor (52). Radiological examination showed the presence of a horizontally positioned maxilla right lateral incisor (12) and dentigerous cyst of tooth 13 (right canine) in the maxilla sinus. After surgical consultation the cyst enucleation and extraction of the unerupted maxillary right canine were performed. Four months later the orthodontic treatment began.