Effects of activator and high-pull headgear combination therapy: skeletal, dentoalveolar, and soft tissue profile changes.
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The aim of this study was to evaluate skeletal, dentoalveolar, and soft tissue profile changes with activator and high-pull headgear combination therapy in patients with Class II malocclusions caused by maxillary prognathism and mandibular retrognathism. The subjects, all in the mixed dentition, were selected from a single centre and were divided into two groups: 28 patients were treated with an incisor double capping activator and a high-pull headgear combination appliance (13 girls, 15 boys mean chronological age 11.7 +/- 1.2 years, skeletal age 12.1 +/- 1.4 years) and an untreated group of 28 subjects (14 girls, 14 boys mean chronological mean age 11.9 +/- 1.1 years, skeletal age 12.3 +/- 1.3 years). The skeletal, dentoalveolar, and soft tissue profile changes that occurred were compared on lateral cephalograms taken before treatment (T0) and after 1.1 +/- 0.3 years when the combination appliance was removed (T1). In the control group, the radiographs were obtained at the start (T0) and after an observation period 1.2 +/- 0.4 years (T1). Statistical analysis was undertaken with Wilcoxon's ranked-sum test for intra-group comparisons and differences between groups with t-test and Bonferroni's test at a level of significance of P < 0.05. Activator and high-pull headgear combination treatment in these growing patients resulted in a correction of the skeletal Class II relationship (ANB -3.4 degrees), a restriction of maxillary growth (SNA -2.0 degrees, OLp-A -2.3 mm), an advancement of the mandibular structures (SNB +2.6 degrees, FH-NPg +2.3 degrees, OLp-B +2.7 mm, OLp-Pg +2.2 mm), an increase in lower face height (ANS-Me +3.9 mm), a correction of the overjet (-5.4 mm), an improvement in overbite (-2.2 mm), uprighting of the maxillary incisors (U1-FH -5.3 degrees, OLp-U1 -2.5 mm), protrusion of the mandibular incisors (IMPA +2.0 degrees, OLp-L1 +2.7 mm), and a correction of the dental Class II malocclusion (OLp-L6 +3.5 mm). The soft tissue profile changes were a correction of facial convexity (G'-Sn-Pg' angle 2.3 degrees, Mlf-Li-x-axis angle 9.1 degrees), and an increase in lower antero-posterior (Mlf-y-axis 5.6 mm, Pg'-y-axis 5.3 mm), and lower vertical (Sls-x-axis 3.8 mm, Pg'-x-axis 3.8 mm, Me'-x-axis 5.1 mm) soft tissue dimensions. The mentolabial fold depth (Mlf-E line) also significantly decreased, -0.8 mm in the treated group. The activator and high-pull headgear combination appliance was effective in treating growing patients with maxillary prognathism, mandibular deficiency, and facial convexity by a combination of skeletal and dentoalveolar changes and improvement in the soft tissue facial profile. (+info)
Success rate and efficiency of activator treatment.
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In a retrospective multicentre study, the success rate and efficiency of activator treatment were analysed. All patients from two University clinics (Giessen, Germany and Berne, Switzerland) that fulfilled the selection criteria (Class II division 1 malocclusion, activator treatment, no aplasia, no extraction of permanent teeth, no syndromes, no previous orthodontic treatment except transverse maxillary expansion, full available records) were included in the study. The subject material amounted to 222 patients with a mean age of 10.6 years. Patient records, lateral head films, and dental casts were evaluated. Treatment was classified as successful if the molar relationship improved by at least half to three-fourths cusp width depending on whether or not the leeway space was used during treatment. Group comparisons were carried out using Wilcoxon two-sample and Kruskal-Wallis tests. For discrete data, chi-square analysis was used and Fisher's exact test when the sample size was small. Stepwise logistic regression was also employed. The success rate was 64 per cent in Giessen and 66 per cent in Berne. The only factor that significantly (P < 0.001) influenced treatment success was the level of co-operation. In approximately 27 per cent of the patients at both centres, the post-treatment occlusion was an 'ideal' Class I. In an additional 38 per cent of the patients, marked improvements in occlusal relationships were found. In subjects with Class II division 1 malocclusions, in which orthodontic treatment is performed by means of activators, a marked improvement of the Class II dental arch relationships can be expected in approximately 65 per cent of subjects. Activator treatment is more efficient in the late than in the early mixed dentition. (+info)
Effects on the sagittal pharyngeal dimensions of protraction and rapid palatal expansion in Class III malocclusion subjects.
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This study examined the effects of rapid palatal expansion (RPE) and maxillary protraction headgear therapy in 18 patients with a skeletal Class III malocclusion (11 girls and seven boys; mean age 10.9 years) on upper airway dimensions compared with an untreated control group (nine girls and eight boys; mean age 10.9 years). Pre- and post-treatment cephalometric radiographs were traced and analysed at similar time intervals. The average treatment time was 6.94 +/- 0.56 months. Wilcoxon's test was used for intragroup comparisons and the Mann-Whitney U-test for intergroup comparisons. A significant increase occurred in the maxillary forward position. Mandibular forward movement and downward and backward rotation were inhibited. In addition, the upper incisors were proclined (P < 0.001), and the lower incisors were significantly retroclined (P < 0.05). When the treatment and control groups were compared, the upper airway linear measurements (pns-ad1, pns-ad2, APW-PPW, APW'-PPW') and the nasopharyngeal area had increased in the treatment group. These results demonstrated that maxillary expansion together with protraction of the maxilla improved naso- and oropharyngeal airway dimensions in the short term. (+info)
Orthodontists' views on indications for and timing of orthodontic treatment in Finnish public oral health care.
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The aim of this study was to analyse the variation in the views of Finnish orthodontists on the indications for orthodontic treatment, timing of orthodontic assessment, and treatment methods used. The views were elicited by a questionnaire that was sent to all 146 specialist orthodontists under 65 years of age living in Finland in 2001. The response rate was 57 per cent. The association between an orthodontist's experience and timing of treatment was tested by Fisher's exact test. Stepwise logistic regression analysis was used to estimate the association between the demographic characteristics of orthodontists and the tendency to start Class II division I treatment early. Most orthodontists recommended that the first assessment of occlusion should be carried out before 7 years of age. A crossbite was mentioned as the most frequent indication for treatment in the primary and early mixed dentition, and a severe Class II division I malocclusion with an increased overjet as the most frequent indication in the late mixed dentition. Most respondents preferred early treatment, but there was a wide variation in the choice of appliances and in the timing of treatment of malocclusions other than crossbite and Class II malocclusions. A quadhelix, headgear, and the eruption guidance appliance were the most frequently used appliances in early treatment, with fixed appliances being most frequently used during the late mixed and permanent dentition phase. Orthodontists working full time in municipal health centres tended to prefer early treatment more often than those working part-time or outside health centres. There was no statistically significant association between an orthodontist's experience and timing of Class II division I and Class III treatment (P = 0.142 and P = 0.296, respectively). The preference for an early start in Class II division I treatment might be related to differing professional decisions, but no explaining factors could be found in the regression analysis. (+info)
Long-term effects of mandibular repositioning appliances on symptoms of sleep apnoea.
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Mandibular repositioning appliances (MRAs) reduce symptoms of obstructive sleep apnoea in the short term, but the long-term effects are unknown. Our objective was to evaluate the long-term symptomatic effects of custom-made MRAs and to identify the patients who will experience subjective benefits from treatment. A cohort of 260 consecutive patients treated with appliances for non-apnoeic snoring or sleep apnoea was followed up by a questionnaire and examination after an average of 5.4 years. The subjective effect was defined as good when complaints of daytime sleepiness occurred less than once a week. A total of 185 patients (71%) responded to the questionnaires. Of the respondents, 96 reported frequent use, 33 reported infrequent use, 26 reported discontinued treatment and 30 reported modified treatment. Mild cases (apnoea-hypopnoea index [AHI] < 15) were likelier than more severe cases to continue treatment. Patients who had used MRAs reported fewer complaints of sleepiness, headaches and daytime naps. Frequent use (P = 0.001), few night-time awakenings before start of treatment (P = 0.02) and effective apnoea reduction during treatment of more severe cases (P = 0.02) correlated with a good subjective effect at long-term follow-up. Our conclusion is that custom-made MRAs reduce sleep apnoea symptoms in the long term. The mildest cases will experience the greatest long-term benefit. The reason is that non-apnoeic snorers and patients with a mild disease are more likely to continue treatment and that their long-term results with regard to excessive sleepiness are similar to patients with a more severe disease. (+info)
Early class III occlusal tendency in children and its selective management.
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Class III malocclusion may develop in children as a result of an inherent growth abnormality, i.e., true class III malocclusion, or as a result of premature occlusal contacts causing forward functional shift of the mandible, which is known as pseudo class III malocclusion. These cases, if not treated at the initial stage of development, interfere with normal growth of the skeletal bases and may result in severe facial deformities. The treatment should be carried out as early as possible with the aim of permitting normal growth. This paper deals with the selection of an appropriate treatment approach from the various current options available for early intervention in children developing class III occlusal tendencies; the different clinical features are depicted in the three case reports. (+info)
Long-term changes in pharyngeal airway dimensions following activator-headgear and fixed appliance treatment.
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