Influence of sucking habits and breathing pattern on palatal constriction in unilateral posterior crossbite--a controlled study

3D evaluation of cranial and dentofacial morphological differences between individuals with mouth breathing and nasal breathing

INTRODUCTION

The present study aimed to identify the morphological differences in cranial and dentofacial structures between individuals with mouth-breathing and nasal-breathing.

MATERIALS AND METHODS

The study included 120 individuals, 60 each in the nasal breathing (NB) and mouth breathing (MB) groups. 3D stereophotogrammetry, lateral cephalometric radiographs, and intraoral examination results were recorded by the researchers to determine the morphological differences between the MB group and the NB group. The study utilized cephalometric radiographs for 2D hard tissue measurements and 3D stereophotogrammetric records for linear and angular measurements.

RESULTS

Statistically significant differences were found between the NB and MB groups' SNB angles (respectively, 79.3 ± 3.04, 76.6 ± 4.24, and p=0.002). Also, the NB group's SN-GoGn angle was lower than the MB group's (respectively, 31.5 ± 5.12, 36.0 ± 5.55, and p=0.002). Considering the Jarabak ratio, the NB group's Jarabak ratio was higher than the MB group (respectively,65.7 ± 4.16, 62.6 ± 4.10, and p=0.014). In 3D stereophotogrammetry measurements, increased Li-Me' was detected in the MB group than in NB group.

CONCLUSION

Mouth breathing results in significant morphological differences that affect the development of both soft tissues and skeletal structures. Orthodontists utilize these characteristic features observed in mouth-breathing anomalies for early diagnosis and consider referring their patients for medical treatment of mouth breathing.

Comparative Evaluation of the Relationship Between Airway Inadequacy, Head Posture, and Craniofacial Morphology in Mouth-Breathing and Nasal-Breathing Patients: A Cephalometric Observational Study

BACKGROUND

The process of respiration is the primary factor of the posture of the jaws and tongue. Thus, a changed respiratory form like mouth breathing can change the posture of the head, jaw, and tongue. This, in turn, could change the equilibrium of pressure on the jaws and teeth thus affecting jaw growth and teeth positions. The influence of nasorespiratory function on craniofacial growth has stimulated interest and debate for more than a century. Mouth breathing is the reason for numerous orthodontic glitches such as a mouth breather's face evolving aberrantly because of of functional disruptions triggered by chronic airway obstruction. The relationship between nasorespiratory function and dentofacial development remains controversial despite the long-standing clinical concern of orthodontists, so there was a need to evaluate and compare the relationship between head posture, airway inadequacy, and craniofacial morphology in mouth breathers and nasal breathers.

METHODOLOGY

Forty patients were selected and divided equally into two groups: mouth breathers and nasal breathers. Patients were diagnosed as mouth breathers based on physical examination and a history of chronic allergic rhinitis, adenoid, and tonsil enlargement. Lateral cephalograms were taken for all patients in the natural head position (NHP) with the Planmeca Proline XC Dimax3 x-ray machine (Planmeca, Helsinki-Uusimaa, Finland). All lateral cephalograms were traced and analysis was done to check airway, head posture, and craniofacial morphology. Descriptive statistics were performed to obtain the means and standard deviation of all the sample sizes. Unpaired t test was performed between nasal breathers and mouth breathers to check and evaluate the relationship.

RESULT

Mouth-breathing patients varied from nasal-breathing patients in airway adequacy and craniofacial morphology. A little, but not statistically significant, difference was seen in head posture between the two groups.

CONCLUSIONS

Early interception of mouth breathing in patients could be very helpful, as the postural changes in the mouth-breathing patients, if continued for a longer period of time, could be the reason for severe skeletal deformities as well as dental malocclusion.

Prevalence of malocclusions in children with microcephaly associated with the Zika virus

INTRODUCTION

The objectives of this study were to determine the prevalence of malocclusion among children with Zika virus-associated microcephaly (MZV) and to describe the most common malocclusion in this population.

METHODS

This was a cross-sectional study including patients aged between 30 and 36 months diagnosed with MZV. Healthy children were randomly selected with the same sociodemographic characteristics as the control group. Information about arch-type, primate spaces, arch form, overbite, overjet, midline deviation, anterior crossbite, anterior open bite, and the posterior crossbite was recorded. The statistical analysis used descriptive analysis, Pearson chi-square test, and multivariate logistic regression.

RESULTS

Forty children comprised the MZV group, and 40 comprised the control group. Our results demonstrated a significantly higher prevalence of malocclusions in children who had MZV than the control group (P <0.001). Patients with MZV were more likely to have late eruption (P <0.001), hypoplastic maxillary arch (P <0.001), hypoplastic mandibular arch (P <0.001), excessive overjet (P <0.001), and posterior crossbite (P = 0.004).

CONCLUSIONS

The prevalence of malocclusion was higher among children with MZV. Late eruption, hypoplastic maxillary arch, hypoplastic mandibular arch, excessive overjet, and posterior crossbite were the most common characteristics for this population.

Relationship between olfaction and maxillofacial morphology in children with malocclusion

OBJECTIVES

Functional problems, including nasal flow problems, are associated with specific skeletal and dental features. Further, maxillary expansion has been associated with nasal airway resistance alterations. This study aimed to investigate whether there is a correlation between skeletal features and nasal airflow- and olfaction-related problems.

MATERIALS AND METHODS

This prospective study included 68 patients (30 boys, 38 girls; mean age 9 ± 2 years) examined at the Ohu University Hospital. We classified patients into three skeletal Classes (Class I, II, and III) based on the ANB angle. Olfactory disorder history was collected from the guardians. Maxillofacial measurements, nasal airflow assessments, and olfactory tests were performed using cephalometric analysis, rhinomanometry, and T&T olfactometer, respectively.

RESULTS

Malocclusion, resulting from skeletal mandibular protrusion and smaller maxilla, was associated with reduced olfaction in children. The detection and recognition thresholds of skeletal Class III were significantly higher than those of Classes I (p = .01) and II (p = .01). Significant correlations were observed between SNA and the detection threshold (r = -.50) as well as between nasion perpendicular-point A and the recognition threshold (r = -.53). The detection and recognition thresholds were significantly higher in Class III than in Classes I (r = .3) and II (r = -.1).

CONCLUSIONS

Maxillary growth and development may be associated with olfaction in children. Changing the maxillofacial morphology may improve olfactory function. In the future, we will investigate how malocclusion treatment affects olfactory function.

Geometric morphometric analysis of the palatal morphology in growing subjects with skeletal open bite

OBJECTIVES

To assess the morphological shape variations of the palatal vault in Open Bite (OB) growing subjects when compared with a Control Group (CG) by means of Geometric Morphometric Method (GMM).

MATERIALS AND METHODS

The OB Group (OBG) consisted of 75 subjects (39 females, 36 males; mean age: 8.5 ± 0.8 years) who were collected retrospectively with the following inclusion criteria: European ancestry, overbite less than 0 mm, mixed dentition stage, prepubertal skeletal maturation (CS1-CS2), hyperdivergent skeletal pattern (SN^GoGn > 37°). The OBG was compared with a CG of 46 prepubertal subjects presenting normal occlusion (24 females, 22 males; mean age of 8.3 ± 1.7 years). For each subject, lateral cephalograms and maxillary dental casts were available. Landmarks and semilandmarks were digitized on digital dental casts and GMM was applied. Procrustes analysis and principal component analysis (PCA) were performed. OBG was divided in two subgroups: Sucking Habits Group (SHG) (39 subjects) and Non-Sucking Habits Group (NSHG) (36 subjects).

RESULTS

PC1 showed significant morphological changes in transverse and vertical dimensions with OBG palates higher and narrower when compared with CG. When comparing the two subgroups no statistically significant differences were found. NSHG demonstrated a slight reduction of the transverse dimension and a deeper palatal vault respect to SHG.

LIMITATIONS

The limitations of this study were the division of OBG in two subgroups based on referral of thumb sucking habits without assessing the duration and the intensity of thumb sucking.

CONCLUSIONS

OB subjects presented with a significant constriction of the maxillary arch when compared with CG. The morphological palatal shape variations in OBG were not influenced by the presence or absence of non-nutritive sucking habits.

[Three-dimensional morphological analysis of the palate of mouth-breathing children in mixed dentition]

OBJECTIVE

To study the effects of mouth-breathing on maxillary arch development by comparing the palatal morphology of mouth- and nose-breathing children in mixed dentition.

METHODS

Children in mixed dentition were enrolled and categorized into mouth-breathing (test group) and nose-breathing groups (control group) according to their breathing patterns. Children's plaster models were scanned with 3D laser scanner, and the 3D data were reconstructed and measured using Minics 15.0 and Geomagic 12.0 software. Measurement data (inter-molar width, palatal height, palatal volume, and palatal surface area) of the two groups were compared, and the correlation among the four measurement items was analyzed.

RESULTS

The participants were 73 children (37 in test group and 36 in control group) with a mean age of (8.63±0.78) years old. The test group had significantly smaller inter-molar width, palatal volume, and palatal surface area but significantly higher palatal height than the control group (P<0.05). Inter-molar width and palatal volume were positively correlated with the palatal surface area in the test group (P<0.05). Inter-molar width and palatal height were positively correlated with the palatal surface area in the control group (P<0.01).

CONCLUSIONS

Mouth-breathing children have significantly reduced inter-molar width, palatal volume, and surface, and substantially increased palatal height, leading to different developmental patterns of the palatal morphology.

Palatal volume and area assessment on digital casts generated from cone-beam computed tomography scans

OBJECTIVES

The objective of this study was to develop a reproducible method to measure the change of palatal volume and area through superimposition using maxillary expansion digital cast models.

MATERIALS AND METHODS

A total of 10 pre- and 10 postexpansion dental cast models were scanned by the same cone-beam computed tomography machine. Superimposition was performed using a fully automated surface-best fit of the palatal surfaces on the digital cast models. A gingival plane, identified only once on superimposed casts, and a distal plane with the lateral closing border and the palatal surface were used to localize this selection of air. Area and volume were calculated for pre- and postexpansion records. Pre- and postexpansion palatal volume and area were measured by the main investigator and three different observers for inter- and intra-observer reproducibility assessment.

RESULTS

The level of intra- and inter-observer agreement was very strong (intraclass correlation coefficients ≥ 0.953; P value < .0001) for all measurements.

CONCLUSIONS

Palatal volume and area measurements based on the proposed superimposition are reproducible and can be used reliably.

Palatal surface and volume in mouth-breathing subjects evaluated with three-dimensional analysis of digital dental casts-a controlled study

OBJECTIVE

To compare the anatomical characteristics of the maxillary arch, identified as palatal surface area and volume, between mouth-breathing and nose-breathing subjects using a three-dimensional (3D) analysis of digital dental casts.

METHODS

Twenty-one Caucasian subjects (14 females and 7 males) with a mean age of 8.5 years [standard deviation (SD) 1.6 years] were selected according to the following criteria: mouth-breathing pattern due to allergic rhinitis, early mixed dentition, skeletal Class I relationship, and pre-pubertal stage of cervical vertebral maturation. This study group (SG) was compared with a control group (CG) of 17 nose-breathing subjects (9 females and 8 males, mean age: 8.5 years; SD: 1.7 years). For each subject, initial dental casts were taken and the upper arch was scanned using a 3D laser scanner. On each digital model, 3D measurements were performed to analyse maxillary arch morphology. Between-group differences were tested with the independent sample Student's t-test (P < 0.05).

RESULTS

In mouth-breathing subjects, changes in physiological function of the upper respiratory tract resulted in skeletal adaptations of the maxillary arch. In the SG, both palatal surface area and volume were significantly smaller when compared with values of the CG. In particular, the palatal surface area and palatal volume were, respectively, 13.5 and 27.1 per cent smaller in the SG when compared to the CG.

CONCLUSIONS

Subjects with prolonged mouth breathing showed a significant reduction of the palatal surface area and volume leading to a different development of the palatal morphology when compared with subjects with normal breathing pattern.