Australian Orthodontic Journal最新文献

Introduction: Cherubism is a rare hereditary disease that frequently manifests as a painless enlargement of the mandible and/or maxilla. The disease usually progresses rapidly during the first and second decades of life but it is self-limiting and often regresses. Although few orthodontic case reports describing cherubic patients exist, the timing and extent of surgical intervention is controversial.

Aim: This present paper aims to review the treatment literature and provide a case report of a patient who underwent orthodontic/surgical management.

Methods: The patient presented with severe cherubism in her late teenage years; her main complaint was poor facial and dental appearance. Multiple teeth were missing and those present demonstrated significant preoperative root resorption. Treatment consisted of orthodontic alignment of the upper anterior teeth and a recontouring osteotomy.

Results: Confirmed by the patient, the combination approach led to a significant improvement in facial aesthetics and better self-esteem. Tooth movement through the osseous lesions was uneventful and no further root resoption was observed.

Conclusion: Orthodontic treatment may be undertaken in those affected by Cherubism even with pre-existing idiopathic root resorption, but patients need to be appropriately informed and consented.

Introduction: Patients with body dysmorphic disorder (BDD) often seek aesthetic medical treatment including orthodontics to correct their perceived physical defects. When the disorder pertains to the dentofacial region, it is important for orthodontists to be familiar with this condition.

Objective: The purpose of this article is to provide an overview of the current knowledge on BDD and its relationship to orthodontics.

Method: PubMed, Scopus, Science Direct, and Google Scholar databases were searched for publications relating to BDD and orthodontics. Further articles were sourced from the reference lists of the articles identified through the search.

Results: The literature recommends that orthodontic patients suspected of having BDD should be referred to a psychiatrist for a definitive diagnosis and subsequent management. However, this may be difficult to implement in clinical practice. Management by a psychiatrist could include pharmacotherapy and cognitive behavioural therapy. There is still debate as to whether orthodontic treatment should be provided for these patients.

Conclusion: As health care workers providing aesthetic treatment to patients, orthodontists should be aware of BDD and its implications. Risks include repeated requests for unnecessary treatment, dissatisfaction with the result and thus potential for litigation. BDD still remains a challenge to diagnose, and further research is needed to determine the appropriate management of orthodontic patients suffering from the disorder.

A treatment objective of upper molar distalisation may often be required during the correction of a malocclusion. Distalisation is not only indicated for the management of Class II patients, but also for Class III surgery patients who require decompensation in the upper arch if upper incisor retrusion is needed. Unfortunately, most conventional intra-oral devices for non-compliance maxillary molar distalisation experience anchorage loss. A Pendulum type of appliance and a mini-implant-borne distalisation mechanism have been designed which can be inserted at chair-side, without a prior laboratory procedure and immediately after mini-implant placement. For re-activation purposes, a distal screw may be added to the Pendulum B appliance.

Objective: To identify and demonstrate possible alterations of skeletal structures which might follow either unilateral surgical denervation of the masseter muscle, unilateral intramuscular injection of formoterol directly into the masseter muscle, or intramuscular formoterol injection after surgical denervation.

Materials and methods: Male Sprague Dawley rats (N = 16; four weeks of age) were prepared as four groups: 1. surgical sham + saline injection into the masseter muscle (sham); 2. surgical denervation of the masseter muscle only (den.); 3. surgical denervation of the masseter muscle plus intramuscular formoterol injection into the affected muscle (den.+form.); 4. intramuscular formoterol injection into the masseter muscle only (form.). The specimens were submitted for CT examination, the skulls and hemimandibles were photographed and measurements of craniofacial bones were made.

Results: In this relatively small sample, comparisons between non-experimental and experimental sides revealed differences, both within the groups and for the same measurements between groups, with the den. and den.+form. groups showing the most change. Relative increases in the gonial angle shown in these groups occurred bilaterally, with the change on the experimental side always greater in magnitude than the change on the contralateral side.

Conclusions: Surgical denervation of the masseter muscle leads to an alteration in the size and shape of the skeletal structures close to the zygoma and the mandible. The intramuscular injection of formoterol into denervated masseter muscle seems to limit this skeletal alteration after surgical denervation.

Objectives: To investigate and compare cortical bone thickness of the posterior alveolar process in adult patients presenting with skeletal Class I, II and III malocclusions.

Methods: Cone beam computed tomographic (CBCT) images of 196 adult subjects, aged 20-45, were evaluated. Cortical bone thickness was measured 4 mm from the alveolar crest, as the shortest bucco-lingual dimension of the cortical bone at interdental sites from the distal of the maxillary canine to the mesial of the maxillary second molar.

Results: There were no differences between the malocclusion groups in mean age, gender, or vertical pattern (p > 0.05). At all sites measured, there were no statistically significant differences in the means of cortical bone thickness between the groups (p > 0.05). Maxillary palatal bone thickness was reduced in the Class I (p < 0.0001), and Class II (p < 0.001) groups; but mandibular buccal thickness increased significantly (p < 0.001) in all malocclusion groups from anterior to posterior.

Conclusions: There was no difference in cortical bone plate thickness between Class I, II and III subjects when related to mini-implant placement sites. As the measurement site moved towards the posterior, maxillary palatal cortical thickness decreased except in Class III cases, while mandibular buccal bone thickness increased in all malocclusion groups.

It is known that Cone Beam Computed Tomography (CBCT) provides reliable spatial data and has many clinical applications for dental and particularly orthodontic patients. The present article provides a short review of the literature and reports an unusual CBCT finding in an orthodontic patient referred for the assessment of impacted upper canines. A unilateral lesion in the left maxillary sinus, was an incidental finding. Following a histological examination, which revealed unilateral nasal polyps, surgical removal was performed as the treatment of choice.

Objective: The long-term treatment results of surgically-assisted facemask therapy were assessed by a comparison of the immediate protraction effects with those seen at five years review.

Materials and methods: Nine patients treated with a corticotomy-assisted maxillary protraction protocol were recalled five years following protraction. Cephalometric films taken before treatment (T0), immediately after maxillary protraction (T1) and five years after treatment (T2) were compared.

Results: The short-term results of surgically-assisted facemask therapy showed significant skeletal and soft tissue changes. After five years, the profile and dental relationships were well maintained and a cephalometric analysis revealed a stable vertical increase but only partially maintained soft tissue changes with loss of sagittal advancement. There was significant upper incisor proclination providing dental camouflage.

Conclusion: Patients who are treated with corticotomy-assisted maxillary advancement should be very carefully selected. Assessment criteria include a low mandibular plane angle Class III patients who have severe maxillary retrognathism unable to be treated by conventional orthopaedic correction alone; patients who have almost completed growth and missed the chance of earlier orthopaedic correction, as well as patients who are not willing to accept bimaxillary orthognathic surgery, may be successfully treated.

Aims: This case report describes the management of an adult patient presenting with a skeletal Class II malocclusion with congenitally missing lower second premolars, maxillary dentoalveolar protrusion, and an excessive gingival display in full smile.

Methods: The treatment plan consisted of a combination of a segmental osteotomy to reposition the anterior part of the maxilla after upper premolar extractions and a bilateral sagittal split osteotomy (BSSO) to advance the mandible. Because the upper left permanent second molar required extraction, the upper left third molar was moved mesially during post-surgical orthodontic treatment.

Results: After active treatment, bilateral Class I molar and canine relationships were achieved. Two years after retention, a satisfactory facial profile and dental occlusion remained with optimum overjet and overbite. Treatment also produced changes in the threedimensional (3D) configuration of the face, which was characterised by decreased labial protrusion, increased protrusion of the chin, and increased cheek prominence.

Conclusion: A segmental osteotomy of the anterior part of the maxilla produced favourable treatment results by reducing excessive gingival display, but also by a relative improvement in cheek prominence.