[The development of dysgnathia from the primary dentition to the mixed dentition]

Effect of cephalograms on decisions for early orthodontic treatment

OBJECTIVE

To assess the extent to which cephalograms modify therapeutic decisions related to early orthodontic treatment.

MATERIALS AND METHODS

Diagnostic records of six patients requiring early treatment were digitized for this purpose. A total of 234 orthodontists were then asked to select therapeutic measures on a treatment-planning sheet at two different times (T1 and T2). Three groups of orthodontists were formed and were provided with case-specific records either including or not including cephalograms and the appended tracing values. Forty-seven orthodontists completed all phases of the questions.

RESULTS

Statistical analysis revealed only two statistically significant differences between the first (T1) and second (T2) treatment plans, both concerning options of transverse treatment. None of the other results showed any significant changes from T1 to T2 treatment planning.

CONCLUSION

It follows that cephalograms did not influence therapeutic decisions for early orthodontic treatment and should not be routinely used in very young patients.

Correlation between occlusal abnormalities and parameters investigated by three-dimensional facial photography

Objective:

To clarify, by three-dimensional (3D) facial scans, if 4- to 6-year-old children with intraoral sagittal discrepancies and open-bite occlusion show differences in facial morphology when compared to children without anomalies.

Materials and Methods:

Scans of 290 children presenting with occlusal abnormalities were compared to 1772 face scans of age-matched individuals photographed with a faceSCAN II® 3D data acquisition system. From these, three study groups were formed comprising 188 children with distal occlusion/increased overjet (Class II), 37 with mesial occlusion/inverse overjet (Class III), and 65 with open-bite occlusion. These groups were evaluated by age and gender for each group compared to the control individuals.

Results:

The Class II group showed statistically significant reduced dimensions of head width, upper face width, and midface length. In addition, the mean values for mouth width and lip thickness were higher, and their upper lips were located more anteriorly than in the control group. The Class III group exhibited more markedly retruded upper lips. The facial profile of female 5-year-old Class III patients was significantly more concave. Patients in the open-bite group showed reduced upper lip length, with differences only being statistically significant in male 4-year-olds.

Conclusion:

Dental Class II with increased overjet and dental Class III with decreased overjet influence soft tissue morphology and are represented on 3D facial scans.

Relationship between occlusal findings and orofacial myofunctional status in primary and mixed dentition: part IV: interrelation between space conditions and orofacial dysfunctions

AIM

The aim of this study was to provide basic representative data on the prevalence of malocclusions involving space deficiency in both primary and early mixed dentition and to examine the relationship between these malocclusions and orofacial dysfunctions. The results should be viewed from an orthodontic prevention and early treatment perspective.

SUBJECTS AND METHODS

Orthodontic findings in the maxilla and mandible as well as the myofunctional status of 766 children in primary dentition and 2,209 children in mixed dentition were examined clinically in a cross-sectional study. The following parameters from each jaw were subjected to orthodontic analysis: crowding in the anterior and posterior regions of the maxilla and mandible in primary and mixed dentitions, deviations from normal maxillary arch forms in the primary dentition, deviations from normal anterior maxillary arch width in mixed dentition and maxillary apical base morphology in mixed dentition. Static and dynamic orofacial dysfunctions were documented with reference to specific parameters and clinical tests.

RESULTS

Crowding was observed in every tenth child in primary dentition (10.8%) and in every second child in mixed dentition (49.7%). Habitual open mouth posture, visceral swallowing, articulation disorders and oral habits were statistically significantly more frequent in children in primary dentition presenting a narrow maxillary arch. Reduced anterior maxillary arch width (compression) was statistically more frequent in children in early mixed dentitions with habitual open mouth posture. A narrow maxillary apical base correlated positively with all the orofacial dysfunctions analyzed.

CONCLUSIONS

Deviations from a regular arch form become apparent very early during dentition development and coexist with specific orofacial dysfunctions. They are thus important indicators for the early detection of functional abnormalities, causing deviations from normal dentition development. In children with orofacial dysfunctions the development of a narrow maxillary dental arch should be prevented by myofunctional therapy and by educating the parents. Interceptive orthodontic measures to treat a narrow maxillary arch in primary and early mixed dentition should also focus on eliminating functional disturbing factors, such as orofacial dysfunctions. Interdisciplinary cooperation with specialists in other fields of medicine, e.g. otorhinolaryngology and speech therapy, is essential to achieve this goal.

Prevalence and development of KIG-relevant symptoms in primary school students from Frankfurt am Main

Objective:

To determine the actual need for orthodontic treatment in the late mixed dentition according to the German KIG system (Kieferorthopädische Indikationsgruppen = Orthodontic Indication Groups). By comparing the findings with those of the early mixed dentition, we aimed to evaluate whether a change in the spectrum of malocclusions would occur.

Subjects and Methods:

Dental check-ups took place in schools in Frankfurt am Main, during which the orthodontically-relevant symptoms of 1251 schoolchildren (female 49.5%, male 50.5%) in grades 4 and 5 were recorded and compared with findings documented 4 years earlier in the same classes at the same schools.

Results:

Of those orthodontic malocclusions in need of therapy and covered by the statutory health insurance, lateral crossbite and enlarged overjet (more than 6 mm) dominated by 9.2% and 8.7%, respectively, among the 9- to 11-year-old children. Of all the malocclusions recorded within the KIG-group showing a treatment need degree ≥ 3, category D4 (overjet greater than 6 mm) at 17.4% was the most frequent, followed by K4 (unilateral crossbite) at 15.3%, and M4 (negative overjet up to −3 mm) at 14.9%. 41.4% of all the children examined presented a treatment indication according to statutory health insurance directives (KIG ≥3). The 10% reduction in treatment cases financed by statutory health insurance has been achieved in any case [1], as mandated by health policy.

Conclusions:

Our comparison of results gathered from 2000 and 2004 showed that as the children grew older, the prevalence of already-enlarged overjets increased, as did the frequency of deep bite. We observed fewer frontal open bites and crossbites in late mixed dentition. Treatment need according to current statutory health insurance directives was clearly higher in the late mixed dentition (41.4%) than in the early mixed dentition (8%).

Influence of orthodontic treatment in the primary dentition upon development of the dentition and craniofacial growth

Thirty patients who underwent orthodontic treatment of the primary dentition were examined in this retrospective follow-up study. The mean age at the beginning of treatment was 4.4 (+/= 1.1) years, and at follow-up 15.4 (+/- 1.7) years. Different kinds of malocclusion were present.

RESULTS

The early treatment lasted on average 12.3 (+/- 7.2) months. Treatment time of Class III malocclusion and lateral crossbite was significantly shorter than that of Class II, 1 malocclusion, functional Class II, 2 malocclusion or anterior open bite (p < 0.05). A Class I occlusion was achieved in 90% of the patients during treatment of the primary dentition. No patient treated successfully in the primary dentition showed any relapse to initial malocclusion.

CONCLUSION

These results suggest that changes in occlusion and mandibular position during treatment in the primary dentition are maintained in the mixed and permanent dentition. It can be concluded that a Class I occlusion following orthodontic treatment in the primary dentition serves as a basis for physiological development of the dentition and craniofacial growth.

[Early orthodontic treatment of the deciduous dentition. The therapeutic potentials and indications]

The purpose of orthodontic treatment of the deciduous dentition is to prevent the skeletal manifestation of anomalies. Anterior open bites, abnormal posterior occlusions, lateral cross-bites and negative (reverse) overjets, may be preserved in the permanent dentition. Early recognition of the anomalies and their aetiology makes it possible, by eliminating bad habits and through the use of simple appliances, to normalise occlusion and ensure physiological development of the permanent dentition.