The functional shift of the mandible in unilateral posterior crossbite and the adaptation of the temporomandibular joints: a pilot study.
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Changes in the functional shift of the mandibular midline and the condyles were studied during treatment of unilateral posterior crossbite in six children, aged 7-11 years. An expansion plate with covered occlusal surfaces was used as a reflex-releasing stabilizing splint during an initial diagnostic phase (I) in order to determine the structural (i.e. non-guided) position of the mandible. The same plate was used for expansion and retention (phase II), followed by a post-retention phase (III) without the appliance. Before and after each phase, the functional shift was determined kinesiographically and on transcranial radiographs by concurrent recordings with and without the splint. Transverse mandibular position was also recorded on cephalometric radiographs. Prior to phase I, the mandibular midline deviated more than 2 mm and, in occlusion (ICP), the condyles showed normally centred positions in the sagittal plane. With the splint, the condyle on the crossbite side was displaced 2.4 mm (P < 0.05) forwards compared with the ICP, while the position of the condyle on the non-crossbite side was unaltered. After phase III, the deviation of the midline had been eliminated. Sagittal condylar positions in the ICP still did not deviate from the normal, and the splint position was now obtained by symmetrical forward movement of both condyles (1.3 and 1.4 mm). These findings suggest that the TMJs adapted to displacements of the mandible by condylar growth or surface modelling of the fossa. The rest position remained directly caudal to the ICP during treatment. Thus, the splint position, rather than the rest position should be used to determine the therapeutic position of the mandible. (+info)
A comparison of sagittal and vertical effects between bonded rapid and slow maxillary expansion procedures.
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The purpose of this study was to determine the vertical and sagittal effects of bonded rapid maxillary expansion (RME), and bonded slow maxillary expansion (SME) procedures, and to compare these effects between the groups. Subjects with maxillary bilateral crossbites were selected and two treatment groups with 12 patients in each were constructed. The Hyrax screw in the RME treatment group and the spring of the Minne-Expander in the SME treatment group were embedded in the posterior bite planes, which had a thickness of 1 mm. At the end of active treatment these appliances were worn for retention for an additional 3 months. Lateral cephalometric radiographs were taken at the beginning and end of treatment, and at the end of the retention period. The maxilla showed anterior displacement in both groups. The mandible significantly rotated downward and backward only in the RME group. The inter-incisal angle and overjet increased in both groups. No significant differences were observed for the net changes between the two groups. (+info)
Intra-oral temperature variation over 24 hours.
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This study aimed to investigate temperature variation at archwire sites adjacent to the maxillary right central incisor and first premolar, its correlation with ambient temperature, and the influence of inter-racial variation. Twenty young adult male subjects were randomly selected (13 Asian, seven Caucasian). Thermocouples were attached to the labial archwire component of custom-made orthodontic retainers at the two intra-oral sites. A third thermocouple measured ambient temperature. A data-logger recorded temperatures at 5-second intervals over a 24-hour period. Temperatures ranged from 5.6 to 58.5 degrees C at the incisor and from 7.9 to 54 degrees C at the premolar, with medians of 34.9 degrees C and 35.6 degrees C, respectively. Ambient temperature correlated poorly with the intra-oral temperatures. The Asian and Caucasian groups had significantly different temperature distributions. On average during the 24-hour period, temperatures at the incisor site were in the range of 33-37 degrees C for 79 per cent of the time, below it for 20 per cent, and above it for only 1 per cent of the time. Corresponding figures for the premolar site were 92, 6, and 2 per cent. At both archwire sites the most frequent temperatures were in the range of 35-36 degrees C. The data presented demonstrate that the temperature at sites on an archwire in situ varies considerably over a 24-hour period and that racial differences may exist. This information should be considered during the manufacture and use of temperature-sensitive orthodontic materials, in particular nickel-titanium archwires and springs. (+info)
A long-term evaluation of treated Class II division 2 malocclusions: a retrospective study model analysis.
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Pre-treatment, end of treatment, and post-retention study models of 30 subjects with a Class II division 2 malocclusion were assessed, after a period of at least 3 years, in order to evaluate the long-term changes in occlusion, alignment, and arch dimensions. Molar relationship correction was found to be stable after retention. There were no variables which could be used to establish a prognosis of vertical stability. Over-correction of overbite was seen to relapse. Ten per cent of the cases showed unacceptable anterior maxillary irregularities after retention. Mandibular arch width and length usually showed a decrease after retention. An increase in lower intercanine width and arch length achieved by orthodontic treatment always relapsed. This relapse was associated with post-retention mandibular irregularity and crowding. Nine cases (30 per cent) showed an unacceptable degree of mandibular irregularity after retention. Pre-treatment crowding in the mandible showed a relationship with post-retention lower irregularity and crowding. There was a correlation between the number of years which had elapsed after retention, overbite relapse and post-retention mandibular irregularity. (+info)
Breakage incidence with direct-bonded lingual retainers.
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This study examined the effects of a number of patient and clinical variables on the breakage of bonded retainers, and consisted of a retrospective review of the survival of 200 bonded retainers. Data was collected from two clinical centres between November 1996 and February 1997. The subjects comprised 198 patients of both sexes divided into three age groups. Retainers at both centres were made in 018-inch co-axial wire with Relyabond and Helioprogress adhesives used at each respective centre. The effects on time to first breakage of adhesive, patient sex, and arch (upper/lower) were considered using Kaplan Meier survival graphs and in Log Rank Tests. Finally, a Cox Proportional Hazard Model was used to examine the joint effects of these factors and the patients' ages. Breakage over a 5-year period with Relyabond was 38.8 per cent upper, 22.1 per cent lower, and with Helioprogress 75 per cent upper and 23.2 per cent lower. Breakage appears to be unrelated to the materials used or to the age and sex of the patients. Upper retainers break more often than lowers (P = 0.016) and early breakage is more likely to occur at an adhesive pad than at a wire (9.6 versus 2.5 per cent within 6 months). (+info)
Maxillary unilateral molar distalization with sliding mechanics: a preliminary investigation.
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Fifteen patients, eight males and seven females with a mean age of 13.32 years, were selected for unilateral molar distalization. Dentally, all presented with a unilateral Class II molar relationship. The subjects were all in the permanent dentition with second molars erupted and with a well aligned lower dental arch. For maxillary molar distalization a new intra-oral appliance was developed, the Keles Slider, which comprised two premolar and two molar bands. The anchorage unit was a Nance button with an anterior bite plane. From the palatal side, the point of distal force application was carried towards the level of centre of resistance of the maxillary first molar. A Ni-Ti coil spring was used and 200 g distal force was applied to the Class II first molar. Lateral cephalograms were taken and analysed before and 2 months after molar distalization. The Class II molars were distalized bodily, on average, 4.9 mm (P < 0.001). Mesial migration of the Class II first premolars was 1.3 mm (P < 0.05), incisor protrusion was 1.8 mm (P < 0.05) and incisor proclination 3.2 degrees (P < 0.05). The overbite was reduced by 3.1 mm (P < 0.001) and the overjet increased 2.1 mm (P < 0.01). For stabilization, the corrected Class II unilateral molar relationship was maintained with a Nance button for 2 months. The results show that this newly developed device achieved bodily distal molar movement with minimum anchorage loss. (+info)
Maxillary retention: is longer better?
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Two different maxillary retention regimes were compared to ascertain if differences in posttreatment relapse existed. The patient pool was derived from subjects being treated at two orthodontic departments in the west of Scotland. Group 1 (20 patients) followed a 6 month regime using removable upper Hawley retainers for a period of 3 months full time and 3 months nights only. Group 2 (18 patients) followed a 1 year regime of 6 months full time and 6 months nights only. The results revealed that maxillary incisor alignment, as determined by Little's irregularity index, had relapsed by an average of 50 per cent of the end of retention value 3 months out of retention in Group 1 but only 23 per cent in Group 2. Although the actual mean values for relapse were 0.77 and 0.23 mm, respectively, seven subjects in Group 1 showed relapse of more than 3 mm as compared with only one in Group 2. This suggests that retaining a case for 1 year rather than 6 months is clinically beneficial. (+info)
Restoration of mechanical strength and morphological features of the periodontal ligament following orthodontic retention in the rat mandibular first molar.
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Biomechanical properties and morphological features of the periodontal ligament (PDL) in the rat mandibular molars were examined during orthodontic retention. Seventy-three male rats of the Wistar strain, 8 weeks of age, were used for biomechanical analysis and six rats for morphological analysis. An elastic band was inserted between the mandibular first and second molars for 4 days; after removal of the elastic band the interdental space was filled with resin for 4 and 8 days. The maximum shear stress, tangent modulus, and failure strain energy density of the PDL of the first molar in the experimental animals decreased markedly following application of an orthodontic force. They increased rapidly and were restored completely to the control levels by the 8th day after retention. Light microscopy showed severe compression and extension of the PDL in the experimental animals on the 8th day after retention. Birefringent collagen fibre bundles running across the compressed and expanded PDL were observed, although they appeared to be thinner with less insertions into the alveolar bone or cementum in the experimental animals than in the controls. This suggests that the periodontal collagen fibres were partially reorganized and rearranged during retention. The reorganization and rearrangement of periodontal collagen fibres seemed to be partly related to the restoration of mechanical strength of the rat molar PDL during the 8 days of retention. (+info)