Unilateral Correction of Space Loss in the Mixed Dentition

Distalization of maxillary molars is indicated for correction of Class II dental malocclusion and for space gain in cases of space deficiency. The ideal treatment with an intraoral fixed appliance for molar distalization should fulfill the following requirements: patient compliance; acceptable esthetics; comfort; minimum anterior anchor loss (as evidenced by inclination of incisors); bodily movement of the molars to avoid undesirable effects and unstable outcomes; and minimum time required during sessions for placement and activations. The purpose of this paper was to present an alternative treatment for space recovery in the area of the maxillary right second premolar when there has been significant mesial movement of the permanent maxillary right first molar. We used a modified appliance that allows unilateral molar distalization in cases of unilateral tooth/arch size discrepancy using the opposite side as anchor, thus reducing the mesialization of the anterior teeth. (Pediatr Dent 2008;30:334-41) Received August 17, 2006 / Last Revision October 17, 2007 / Revision Accepted October 17, 2007

Influence of the banded Herbst appliance on dental changes in mixed dentition

OBJECTIVE: This prospective clinical study was conducted with the purpose of evaluating the influence of the banded Herbst appliance on dental changes during the early treatment of Class II malocclusion. METHOD: The sample consisted of 15 prepubertal subjects (12 boys and 3 girls, initial age: 9 years and 6 months) who were treated with the Herbst appliance. Treatment effects were compared with those of a Class II Division 1 group of 15 subjects (8 boys and 7 girls, mean initial age 9 years and 1 month), not treated orthodontically. Statistical analysis was performed using Student t-test with 5% significance level. RESULTS: The results showed that treatment with the banded Herbst appliance in the mixed dentition stage tended to upright maxillary incisors (mean: 4.14°). The maxillary molars were distalized and intruded significantly (mean 2.65 mm and 1.24 mm, respectively), the lower incisors slightly protruded anteriorly (mean 1.64 mm) and the molars showed no significant changes in the horizontal and vertical directions. Furthermore, significant improvements were noted in overbite (1.26 mm), overjet (4.8 mm) and molar relationship (12.08 mm). CONCLUSIONS: Changes in the upper dental arch were found to be greater than changes in the lower arch. Furthermore, mandibular anchorage loss was reduced due to the anchorage system used in the study.

Cephalometric evaluation of skeletal alterations induced by Herbst appliance during mixed dentition

OBJECTIVE: The present prospective clinical study was designed in order to evaluate horizontal and vertical skeletal alterations induced by the use of Herbst appliance in individuals with Class II, division 1 malocclusion during mixed dentition stage. METHODS: The sampling consisted of 15 pre-pubertal individuals (12 boys and 3 girls; initial age 9 years and 6 months), who were treated with Herbst appliance for a period of 7 months. The effects of the treatment were compared to a group of 15 individuals with Class II, division 1 malocclusion (8 boys and 7 girls, initial age averaged 9 years and 1 month), orthodontically untreated, who were followed up for a period of 12 months. Statistical analysis was performed with Student's t-test with significance level at 5%. RESULTS: It was showed that the treatment with Herbst appliance in mixed dentition stage has restricted maxilla growth. Mandibular and palatal planes have not undergone significant alteration; however, anterior and posterior facial heights have increased significantly. Facial convexity and maxillomandibular relationship were altered positively. Mandible has positioned significantly forward and its effective length increased 2.5 times more than the increase observed in control group. CONCLUSION: It was possible to conclude that Herbst appliance was able to provide satisfactory results in individuals during mixed dentition stage.

Treatment of posterior crossbite in mixed dentition with a removable appliance: Reports of cases

A posterior crossbite malocclusion is defined as an abnormal buccolingual relationship. One or more maxillary teeth improperly occludes with one or more mandibular teeth in centric relation. This alteration develops early and is seldom self-correcting. This study is a report of the benefits of treating posterior crossbite malocclusions in mixed dentitions using removable appliances.

Short-term treatment effects produced by the herbst appliance in the mixed dentition

This prospective clinical investigation evaluates the dentoalveolar and skeletal cephalometric changes produced by the Herbst appliance during treatment of mixed dentition patients with Class II division 1 malocclusion. Thirty individuals (15 male and 15 female individuals; initial mean age nine years 10 months) were treated with the Herbst appliance for a period of 12 months. For comparison, the records of 30 untreated Class II children (15 boys, 15 girls; initial mean age nine years eight months) were followed without treatment for a period of 12 months. The results indicated that the treatment effects produced in the mixed dentition patients were primarily dentoalveolar in nature. The mandibular incisors were tipped labially, and the maxillary incisors were retruded; a significant increase in mandibular posterior dentoalveolar height occurred, and there was a restriction in the vertical development of the maxillary molars. There was no difference in the forward growth of the maxilla between the two groups. In comparison with the controls, however, the Herbst treatment produced a modest but statistically significant increase in total mandibular length. This increase in total mandibular length, however, was less than that observed in adolescent Herbst patients in other studies. © 2005 by The EH Angle Education and Research Foundation, Inc.

Changes on facial profile in the mixed dentition, from natural growth and induced by Balters' bionator appliance

Objective: The purpose of this study was to evaluate the facial profile changes induced by Balters' bionator appliance in Class II division 1 patients, at mixed dentition stage. Methods: The sample consisted of 28 prepubertal individuals at stages 1 and 2 of skeletal maturation (CVM), which were divided in two groups. The experimental group consisted of 14 individuals (7 boys and 7 girls, initial mean age of 8y12m) which were treated with Balters' bionator appliance for 14.7 months. The effects of treatment were compared to a control group of 14 subjects (7 boys and 7 girls, initial mean age of 8y5m) with Class II malocclusion, division 1, not orthodontically treated, which were followed up for 15.4 months. The statistical analysis was performed using Student's t test, at a significance level of 5%. Results: The results showed that the Balters' bionator appliance promoted a significant increase on the mentolabial angle, in addition to demonstrating a tendency to reduce the facial skeletal convexity, to restrict the maxillary growth and to increase the nasolabial angle and the lower anterior facial height. Conclusion: It can be concluded that the Balters' bionator appliance improved the facial profile of children treated at mixed dentition stage. © 2013 Dental Press Journal of Orthodontics.

Prevalence of mesiodens in orthodontic patients with deciduous and mixed dentition and its association with other dental anomalies

OBJECTIVE: To determine the prevalence of mesiodens in deciduous and mixed dentitions and its association with other dental anomalies. MATERIAL AND METHODS: Panoramic radiographs of 1,995 orthodontic patients were analyzed retrospectively, obtaining a final sample of 30 patients with mesiodens. The following aspects were analyzed: gender ; number of mesiodens; proportion between erupted and non-erupted mesiodens; initial position of the supernumerary tooth; related complications; treatment plan accomplished; and associated dental anomalies. The frequency of dental anomalies in the sample was compared to reference values for the general population using the chi-square test (c²), with a significance level set at 5%. RESULTS: The prevalence of mesiodens was 1.5% more common among males (1.5:1). Most of the mesiodens were non-erupted (75%) and in a vertical position, facing the oral cavity. Extraction of the mesiodens was the most common treatment. The main complications associated with mesiodens were: delayed eruption of permanent incisors (34.28%) and midline diastema (28.57%). From all the dental anomalies analyzed, only the prevalence of maxillary lateral incisor agenesis was higher in comparison to the general population. CONCLUSION: There was a low prevalence of mesiodens (1.5%) in deciduous and mixed dentition and the condition was not associated with other dental anomalies, except for the maxillary lateral incisor agenesis.

Alveolar Bone Morphology in Patients With Bilateral Complete Cleft Lip and Palate in the Mixed Dentition: Cone Beam Computed Tomography Evaluation

Objectives: To verify the thickness and level of alveolar bone around the teeth adjacent to the cleft by means of cone beam computed tomography (CBCT) in patients with complete bilateral cleft lip and palate prior to bone graft surgery and orthodontic intervention. Method: The sample comprised 10 patients with complete bilateral cleft lip and palate (five boys and five girls) in the mixed dentition. The mean age was 9.5 years, and all subjects showed a G3 interarch relationship according to the Bauru index. The thickness of alveolar bone surrounding the maxillary incisors and the maxillary canines was measured in CBCT axial section using the software iCAT Xoran System. The distance between the alveolar bone crest and the cement-enamel junction (CEJ) was measured in cross sections. Results: The tomography images showed a thin alveolar bone plate around teeth adjacent to clefts. No bone dehiscence was observed in teeth adjacent to clefts during the mixed dentition. A slight increase in the distance between the alveolar bone crest and the CEJ was observed in the mesial and lingual aspects of canines adjacent to cleft. Conclusion: In patients with BCLP in the mixed dentition, teeth adjacent to the alveolar cleft are covered by a thin alveolar bone plate. However, the level of alveolar bone crest around these teeth seems to be normal, and no bone dehiscence was identified at this age.

Absence or weak correlation between chewing side preference and lateralities in primary, mixed and permanent dentition

Objectives: To determine whether chewing side preference (CSP) is correlated to lateralities (handedness, footedness, eyedness and earedness) in primary, mixed and permanent dentitions.Design: Three-hundred subjects were divided into 3 groups: Group 1-100 children 3-5 years old, primary dentition; Group 2-100 children 6-12 years old, mixed dentition; Group 3 - 100 subjects 18-47 years old, permanent dentition. CSP was determined using a method developed by Mc Donnell et al.(9) Subjects were given a piece of gum and the position of the chewing gum was recorded 7 times as right or left. Subjects were classified as 'observed preferred chewing side' (OPCS) when they performed 5/7, 6/7 or 7/7 strokes on the same side. OPCS corresponded to the CSP. Laterality tests were performed for handedness, footedness, eyedness and earedness tasks. The Chi-square (chi(2)) and phi correlation (r) tests were used to investigate significant correlations between CSP and sidedness.Results: There was a significant correlation between chewing and earedness (p = 0.00), although there was weak positive correlation (r = 0.30) for primary dentition. There were significant correlations between chewing and handedness (p = 0.02; r = 0.25) and chewing and footedness (p = 0.02; r = 0.26), however, there were weak positive correlations for mixed dentition; there were significant correlations between chewing and handedness (p = 0.02; r = 0.26); chewing and footedness (p = 0.00; r = 0.33) and chewing and earedness (p = 0.01; r = 0.29); however, there were weak positive correlations for permanent dentition.Conclusion: It may be concluded that CSP can be significantly correlated with: earedness for primary dentition; handedness and footedness for mixed dentition; handedness, footedness and earedness for permanent dentition, but these are weak positive relationships. Future work on larger samples of left- and right-sided individuals is required to validate the findings. (C) 2012 Elsevier Ltd. All rights reserved.

Prevalence of chewing side preference in the deciduous, mixed and permanent dentitions

Aim: This study evaluated the prevalence of the chewing side preference (CSP) in the deciduous, mixed and permanent dentitions. Materials and methods: Three-hundred subjects were divided in three groups (n = 100): Group 1 - children with deciduous dentition; group 2-children with mixed dentition; group 3 - subjects with permanent dentition. The CSP was determined using a direct method (visual observation) developed by McDonnell et al. (2004). Descriptive statistic was used to observe the prevalence of CSP. The Pearson's Chi-square was used to investigate signicant associations between gender, presence of CSP and preferred side (right/left). Results and conclusion: Eighty-seven percent of group 1 had a CSP. Eighty-two percent of group 2 had a CSP. Seventy-six percent of group 3 had a CSP. There was no statistically significant association between presence of CSP and gender in all groups. There was no statistically significant association between preferred side (right/left) and gender in all groups. Clinical significance: There is a higher prevalence of subjects in deciduous, mixed and permanent dentition that presented chewing side preference. The early diagnosis of the presence of chewing side preference can prevent the unilateral chewing pattern with prophylactic therapy applied to the first teeth (deciduous).

A New Yardstick for Rating Dental Arch Relationship in Patients With Complete Bilateral Cleft Lip and Palate

Objective: To develop yardsticks for assessment of dental arch relationship in young individuals with repaired complete bilateral cleft lip and palate appropriate to different stages of dental development. Participants: Eleven cleft team orthodontists from five countries worked on the projects for 4 days. A total of 776 sets of standardized plaster models from 411 patients with operated complete bilateral cleft lip and palate were available for the exercise. Statistics: The interexaminer reliability was calculated using weighted kappa statistics. Results: The interrater weighted kappa scores were between .74 and .92, which is in the ""good"" to ""very good"" categories. Conclusions: Three bilateral cleft lip and palate yardsticks for different developmental stages of the dentition were made: one for the deciduous dentition (6-year-olds` yardstick), one for early mixed dentition (9-year-olds` yardstick), and one for early permanent dentition (12-year-olds` yardstick).

Prevalência e determinantes de oclusopatias nas dentições decídua, mista e permanente na cidade do Natal/RN

This work is intended to bring a contribuition to the verification of the prevalance of malocclusion in the deciduous, permanent and mixed dentition in the student population in the city of Natal, Brazil. In this purpose, a sectional study of infantiles aging 5, 8 and 12 years old was carried out. The average prevalance of malocclusions in the group as a whole was 76,5%. Considering the different dentitions separately, the study showed malocclusion prevalence as follows: Deciduous Dentition 75,5%; Mixed Dentition 84% and Permanent Dentition 70,5%. The most common malocclusion cases found in the deciduous dentition were openbite (20.6%); overbite (16.6%) and maxillary overjet (14,7). Mixed Dentition: the most commonly found occlusional malfunctions in this dentitional phase were maxillary overjet (33,8%); crowding (28,3%), and mandillary discrepancy (19,9%). In the univaried analysis, he application of the Chi square test of independence, (significance 5%), has indicated a meaningful association of the variables social class (p=0,019), primata space (p = 0,036), habits (p= 0,002) and time-and-habit (P=0,03). The same test on the permanent dentition group revealed a significant association for the independent variables, as follows: Social class (p=O,OOO), School (p=O,OOI), Income (p=O,OOO), housing standard (p=0,001), facial pattem (p=0,004), caries record (p=0,031). No significant association was found in the mixed dentition. The Logistic Regression analysis on the deciduous dentition has shown that income, ethnicity, habit and canine relationship constitute factors of risk regardless of the other variables. As for the permanent dentition, only Facial Pattem was pointed as a factor of risk for the formation of malocclusion

Programa de extrações seriadas: variáveis relacionadas com a extração de pré-molares

OBJETIVO: verificar o percentual de pacientes que necessitaram extração de dentes permanentes, pré-molares, dentre aqueles tratados com extração de dentes decíduos para correção do apinhamento primário na dentição mista, bem como analisar as possíveis variáveis relacionadas. MÉTODOS: a amostra foi composta por documentações ortodônticas de 70 pacientes na dentição permanente, cujo tratamento iniciou-se na dentição mista com planejamento de um programa de extrações seriadas (PES). Todos os prontuários foram analisados por um único examinador, no intuito de verificar se o PES havia sido cumprido com a extração de dentes permanentes ou se havia sido realizada apenas extração de dentes decíduos. Verificou-se a associação entre a extração de dentes permanentes e as variáveis padrão facial; relação sagital entre as arcadas dentárias; IMPA; proporção tamanho do segundo molar permanente inferior/espaço retromolar; mecânica de controle de espaço e discrepância de modelo (teste exato de Fisher para as variáveis categóricas e modelo de regressão logística para as variáveis numéricas). Os resultados foram considerados para p<0,05. RESULTADOS: dos pacientes que haviam sido tratados com extração de dentes decíduos para a correção do apinhamento na dentição mista, 70% necessitaram de extração de dentes permanentes. A análise estatística não mostrou associação significativa entre as variáveis estudadas e a necessidade de extração de dentes permanentes, com exceção da variável discrepância de modelo. CONCLUSÃO: a discrepância de modelo representou a principal determinante de extração de pré-molares no PES.

Distalização dos molares superiores com aparelho Pendex: estudo cefalométrico prospectivo

A distalização dos molares superiores constitui um desafio na correção da má oclusão de Classe II em tratamentos sem extrações dentárias e sem avanço mandibular. Há uma procura por dispositivos que substituam a tração extrabucal (AEB) e que não exijam demasiada colaboração do paciente, o que estimula os ortodontistas a testarem métodos alternativos aos relatados na literatura. Dentre estes, destacam-se os aparelhos Pêndulo e Pendex de Hilgers. OBJETIVO: a realização desta pesquisa teve o intuito de avaliar, mediante a cefalometria, os efeitos do aparelho Pendex aplicado no final da dentadura mista e na dentadura permanente. METODOLOGIA: a amostra constou de 14 pacientes com má oclusão de Classe II bilateral, com média de idade de 11 anos e 3 meses. Foram tomadas duas telerradiografias em norma lateral, uma correspondente ao início do tratamento e outra aproximadamente 5 meses após sua finalização, quando a relação dos molares encontrava-se sobrecorrigida. RESULTADOS: após a determinação e mensuração das grandezas cefalométricas lineares e angulares e análise estatística (Teste t de Student), pode-se concluir que os efeitos do aparelho Pendex foram predominantemente ortodônticos: distalização da coroa dos primeiros molares permanentes numa velocidade média de 0,8 mm/mês e vestibularização dos incisivos superiores com aumento do trespasse horizontal. CONCLUSÃO: assim sendo, quando há indicação para distalização dos molares, cumpre-se fazer uma análise dos fatores envolvidos, a fim de eleger, com prudência, a solução terapêutica mais adequada às exigências individuais e profissionais.

Interceptive Approach to Treatment of Impacted Maxillary Canines

Impaction of maxillary canines can be prevented by early intervention in the mixed dentition phase after the correct diagnosis of malocclusion, reducing the complexity of the treatment. This article reports the case of a 10-year-old patient who possessed impacted maxillary canines and, after early extraction of primary canines, had reestablished favorable permanent successors' eruption axis. This 5-year radiographic follow-up study with panoramic radiography shows that this can be used in practice and that an effective control strategy ensures the accuracy in the inclination of the impacted canines. Treatment success is related to early diagnosis and strategic interceptive treatment choice.