Compliance-free and non invasive treatment of an anterior open bite in a 11-year-old girl

CASE REPORT

This case report shows a compliance-free treatment of an anterior open bite in a 11-year-old girl. This treatment is also non invasive, therefore well accepted by the patient and her parents.

Low-level laser therapy and invisible removal aligners

It seems that Low Level Laser Therapy (LLLT) stimulates orthodontic tooth movements, increasing the alveolar bone turnover. The aim of this study is to evaluate how LLLT can influence the orthodontic treatment with invisible removal aligner. A sample of 21 subjects was divided into two groups, a laser group (10 patients) and a control group (11 patients). All subjects were instructed to wear each aligner 12 hours a day for 2 weeks. Laser external bio-stimulation was given in the laser group every second week. The laser group successfully finished the treatment, while at 3rd – 5th aligner the control group did not finish the treatment. Laser treatment seemed to be better than treatment without laser. LLLT combined with aligners is able to favour, in 12 hours, the same tooth movement obtained by wearing the aligner 22 hours a day, according to the traditional protocol. This aspect could be useful for those patients who prefer not to use the aligners during the day. LLLT makes invisible removal aligner treatment more comfortable also because during the day the patients have to wear the aligners less hours than the treatment without laser.

Rapid maxillary expansion in early-mixed dentition: effectiveness of increasing arch dimension with anchorage on deciduous teeth

AIM

To assess the effectiveness of a Haas expander anchored to deciduous teeth in changing dental arch dimension and improving crowding and to evaluate stability of changes until permanent dentition.

STUDY DESIGN

closed cohort retrospective and case-control study. Eighteen patients undergoing early treatment for lateral crossbite (mean age 7.6 yrs; SD 1.0) at two practices located in La Spezia and Massa (Italy) were analysed. The treated group was compared with 72 control subjects divided into: 32 untreated adolescents with and without lateral crossbite and the same canine dental class as treated patients before expansion (Class II Division 2), 18 adults and 18 adolescents with dental Class I. All groups were matched for gender (ratio males:females, 8:10). The dental casts images of treated patients were digitally measured before and after treatment, and in permanent dentition. Patients at the last follow-up were compared with control subjects.

RESULTS

In treated patients the increase in intermolar width and the improvement in anterior crowding were significant and stable until adolescence. Untreated adolescents with lateral crossbite showed the narrowest transversal widths and the highest irregularity. No difference was found among treated patients, adolescents without lateral crossbite, and adolescents and adults with a normal occlusion.

CONCLUSIONS

The Haas expander anchored on deciduous teeth is effective in improving dental arch constriction and crowding in patients treated for lateral crossbite. The result is stable until permanent dentition. In absence of treatment, constriction of dental arch may persist, with a higher level of irregularity.

Maxillary molar distalization therapy in adult patients: a multicentre study

OBJECTIVES

To evaluate dento-skeletal changes following conventional anchorage molar distalization therapy in adult patients.

SETTING AND SAMPLE POPULATION

Thirty-three patients (25 women, mean age 23 years 1 months ± 3 months; 8 men, mean age 28 years 3 months ± 7 months) were recruited from 4 Board Certified specialists. All subjects underwent molar distalization therapy using intra-oral distalizing appliances.

SUBJECTS AND METHODS

Cephalometric headfilms were available for all subjects before (T1) and at the end of comprehensive treatment (T2). The initial and final measurements and treatment changes were compared by means of a paired t-test.

RESULTS

Mean total treatment time was 3 years 2 months ± 6 months. Maxillary first molar distalized 2.9 ± 0.6 mm contributing 64.4% to Class II molar correction, whereas mandibular first molar showed a concomitant mesial movement of 1.6 ± 0.5 mm. Maxillary incisors retroclined an average of 5.8° ± 3.9°, lower incisors proclined 4.1° ± 1.1° and the occlusal plane rotated downwards and backwards 1.8° ± 2.1°. Clockwise rotation of the mandible (1.7° ± 0.5°) and increase in lower facial height (2.5 ± 1.5 mm) were also observed.

CONCLUSIONS

Maxillary molar distalization therapy can be successfully performed in adult patients despite a slight increase in vertical facial dimension should be considered.

Bilateral cross-bite treated by repeated rapid maxillary expansions: a 17-year follow-up case

BACKGROUND

The objective of this paper is to show the clinical results after the repeated application of a Haas expander for rapid maxillary expansion (RME) anchored onto deciduous teeth in a 7-year-old patient that presented bilateral cross-bite, superior crowding and no space for permanent lateral incisors eruption.

CASE REPORT

A first Haas expander was applied to the patient. She was told to activate it once a day, each activation was equal to 0.20 mm. After the first RME, the bilateral cross-bite was solved but still there was not enough space for lateral incisor eruption. A second and then a third Haas expander were applied, with the same activation protocol as the first one, in order to gain space in the anterior region and to achieve proper eruption of the lateral incisors. The patient was then treated with fixed appliances. At debonding the patient presented well aligned arch-forms: space for lateral incisor eruption was gained and superior crowding was solved. Bilateral cross-bite was also corrected. She was seen again 10 years and 17 years after expansions: she showed no relapse and presented a good functional occlusion that had remained stable, and an aesthetically pleasant smile, however she exhibited gingival recessions.

CONCLUSION

Repeated rapid maxillary expansion, anchored onto deciduous teeth, performed in early mixed dentition represents a safe and successful treatment to correct severe bilateral cross- bites and to create space for maxillary incisor eruption.

Analysis of the performance of different orthodontic devices for mandibular symphyseal distraction osteogenesis

The aim of this study was to investigate the performance of different orthodontic devices for mandibular symphyseal distraction osteogenesis (MSDO). Two performance parameters were analysed, the first of which concerned the stability guaranteed by a distractor in the fracture gap under mastication loads and the second the level of reliability with which a distractor transfers a given expansion to the mandibular bone, inasmuch as the more reliable the device the smaller the difference between the degree of expansion provided to the device and the displacement achieved on the mandibular arch. Hence, a non-linear finite element (FE) model of a human mandible with different devices (tooth-borne, bone-borne, and hybrid) was constructed and then utilized to assess the structural behaviour of the mandibular bone under distraction and mastication loads. An ad hoc algorithm was developed to simulate progressive expansion of the devices; a distraction protocol comprising a 10 day latency period and a 6 day distraction period was hypothesized. The first hypothetical expansion given to the device was 2 mm, and the five subsequent expansions were 1 mm. The results showed that the hybrid device was the most stable appliance under mastication loads, followed by the tooth- and bone-borne devices. However, parasitic rotations of the mandibular arms caused by mastication might counteract the benefits of distraction. The tooth-borne device was found to have the highest reliability in transferring expansion to the mandibular bone. For this device, mandibular expansion was less than the nominal aperture of the distractor by no more than 15 per cent. Lower values of reliability were achieved with the bone-borne device. As the values of the aperture of the appliances increased, the stability guaranteed in the fracture gap increased while the reliability in transferring expansion to the mandibular arch decreased.

Mechanical behavior of an osteotomized mandible with distraction orthodontic devices

This work analyzes the mechanical behavior of a human mandible when distraction orthodontic devices are used for correcting problems of dental overcrowding and/or arch shrinkage. The mandible 3D model is reconstructed from CT scan data and meshed into finite elements. The distractor is also modeled. FEM analysis included geometric non-linearity. Displacement field of healthy and osteotomized mandibles are compared. Progressive expansion of the distractor and effects of mastication are also analyzed. Finally, we compare two distraction protocols PROT1 and PROT2 where device is, respectively, expanded by 0.6 or 1.2mm/day. The global displacement is 6mm according to clinical recommendations. It came out that mastication forces generate displacements compatible with bone remodeling. However, parasitic rotations of the mandible arms due to mastication may counteract arch expansion induced by the device. Stress concentrations occurred where the device is fixed: stress peaks stay however below yield limit. Finally, PROT2 reduced by about 10% stresses in mandible and reproduces better than PROT1 the displacement field imposed by the device.

A mathematic-geometric model to calculate variation in mandibular arch form

A mathematic-geometric model was used to evaluate the variation of mandibular dental arch length with respect to the incisor inclination, but without modifying the intercanine width. In analytical terms, the equations of the curves representing the lower dental arch, before and after incisor inclination of 1 mm and of 1 degree, with controlled and uncontrolled tipping, were studied. The length of the mandibular dental arch changed in the parabolic arch form by 1.51 mm for each millimetre of incisor inclination with respect to the occlusal functional plane, by 0.54 mm for each degree of controlled tipping and by 0.43 mm for each degree of uncontrolled tipping. In the elliptical arch form (e = 0.78), it changed by 1.21, 0.43, and 0.34 mm, respectively, in the hyperbolic form by 1.61, 0.57, and 0.46 mm, in the circular form by 1.21, 0.43, and 0.34 mm, and in the catenary form by 2.07, 0.74, and 0.59 mm. The results show that by changing the arch form without modifying the dimension of the dental arch, different arch lengths can be gained for each millimetre of proclination. In addition, by controlled tipping an inter-incisive arch one-fifth longer than by uncontrolled tipping can be obtained. It would be advisable in orthodontic treatment planning to evaluate the type of dental arch, since the space available or the space required changes depending on the arch form and on the orthodontic tooth movement.

Effects of transforming growth factor beta and interleukin-1 beta on expression of cyclooxygenase 1 and 2 and phospholipase A2 mRNA in lung fibroblasts and endothelial cells in culture

Experiments were conducted to determine the roles of the rate limiting enzymes, cyclooxygenase 1 and 2 (COX1 and COX2) and cytoplasmic phospholipase A2 (PLA2), in transforming growth factor beta (TGF-beta) and interleukin-1 (IL-1 beta) activated prostaglandin synthesis. Results show that TGF-beta increases steady state levels of COX1 mRNA in both human embryo lung fibroblasts (IMR90) and calf pulmonary artery endothelial cells (BPAEC). Temporal experiments show that TGF-beta increases, within 2hrs, a 5.5kb COX1 in IMR90 and the 2.7kb COX1 mRNA in BPAEC. IL-1 beta increases COX1 mRNA only in IMR-90, not BPAEC. COX2 mRNA, under basal conditions, is not detected in BPAEC and is expressed only marginally in IMR90. TGF-beta or IL-1 beta have no effect on expression of COX2 gene in either cell type. IL-1 beta increases steady state levels of PLA2 mRNA in both IMR90 and BPAEC while TGF-beta increases expression of the PLA2 gene only in BPAEC. Time experiments with TGF-beta show induction of PLA2 mRNA within 1hr, peaking at 4hrs. PG synthesis in response to the cytokines was determined in IMR90 and BPAEC to further assess the significance of the above results. TGF-beta increases the synthesis of prostacyclin in BPAEC in a time related fashion peaking at 8hrs at 13 fold above basal. To focus on the action of COX1 and bypass the action of PLA2, exogenous arachidonic acid was used as substrate for PG synthesis. In these experiments IL-1 beta increases PGE2 synthesis 8 fold in IMR90 while IL-1 beta and TGF-beta added simultaneously increases PGE2 synthesis 25 fold. These results in sum illustrate that the cytokines, TGF-beta and IL-1 beta, regulate both COX1 and PLA2 mRNA levels. Furthermore, this regulation appears coordinated to bring about elevation of prostaglandin synthesis.

[Dental compromise for bite closing in patients with minimal or negative overjet]

The Authors evaluate the most common techniques to close the bite in patients with no overjet, then they suggest a method (anterior cross-bite elastics) that can obviate some of the disadvantages experienced using those techniques.

Condylar position and maxillary first premolar extraction

Condylar position in 17 patients whose Class II treatment (14 with edgewise appliances and 3 with Begg appliances) included extraction of the maxillary first premolars and in 17 control patients was compared by means of corrected tomography. The condyles in both groups were in an anterior position, and there were no statistical differences between the groups. In addition, no statistical correlation was found when the posttreatment bite depth, interincisal angle, and maxillary incisor inclination were correlated with condylar position. Thus, as determined in this study, condylar position was unrelated to treatment, bite depth, interincisal angle, and maxillary incisor inclination.

[Asymmetrical distalization of upper molars with magnets. A clinical case]

The treatment of a patient with an asymmetric malocclusion (class II, division I--subdivision) was presented. The treatment involved the use of repelling magnets for the distalization of the upper right molar which was in a class II relationship. A fixed "Nance" appliance attached to the second premolars was used for anchorage. Magnets are relatively easy to insert, are well tolerated, and they can distalize molars rapidly without significant loss of anchorage. No cooperation was required during the distalization phase of treatment and the second premolar distalized spontaneously once the "Nance" appliance was removed.