Angelika Stellzig

Mesiodentes: Inzidenz, morphologie, ätiologie

ZusammenfassungTrotz zahlreicher Veröffentlichungen über klinische, radiologische und chirurgische Aspekte in der Therapie von Mesiodentes bleibt die Frage nach der Ätiologie dieser Zähne weitgehend unbeantwortet. Ziel dieser Studie war daher, ursächliche Faktoren bei unseren Patienten mit Mesiodentes zu eruieren. Die Untersuchung beinhaltete 30 Patienten mit insgesamt 45 Mesiodentes. Bei 31% der Patienten lag eine familiäre Disposition vor, so daß der Vererbung eine maßgebliche Rolle bei der Entstehung von Mesiodentes zugemessen werden muß. Die Ergebnisse legen weiterhin die Vermutung nahe, daß ein ätiologischer Zusammenhang zwischen dem Auftreten von Mesiodentes und anderen Zahn- und Kieferanomalien wie Hyperdontie, Hypodontie und Spaltbildung besteht. Zuletzt sprechen sowohl die Gemination des Milchschneidezahnes auf der Seite des Mesiodens bei einem unserer Patienten als auch die mesiodistalen Breitenvergleiche der mittleren Schneidezähne dafür, daß der Theorie der Dichotomie des Zahnsäckchens bei der Entstehung von Mesiodentes den Vorzug gegenüber der Theorie einer Überaktivität der Zahnleiste gegeben werden muß.SummaryThere are many publications in the literature focusing on clinical, radiological and surgical aspects of the treatment of mesiodentes. However, the etiology of this dental anomaly remains widely unclear. The purpose of this study was to evaluate etiologic factors for mesiodentes in a collective comprising 30 patients with a total of 45 mesiodentes. Thirty-one percent of the patients showed a familial disposition, pointing to inheritance as a key factor in the development of mesiodentes. Our results further support the hypothesis of related etiologic factors for several dental and craniofacial anomalies, such as hyperdontia, hypodontia and cleft lip and palate. Finally, we report the gemination of a deciduous incisor on the same side as a mesiodens. We also found differences in the mesiodistal width of central incisors depending on unilateral or bilateral occurrence of mesiodentes. Both these findings support the dichotomy theory of the split in the tooth bud inducing the development of mesiodentes, a theory we favor over that of local hyperactivity of the dental lamina.

Rare dental abnormalities seen in oculo-facio-cardio-dental (OFCD) syndrome: three new cases and review of nine patients.

Oculo-facio-cardio-dental syndrome is a very rare condition. So far, only nine cases have been documented. We report on three additional female patients representing the same entity. The clinical findings were: congenital cataract, microphthalmia/microcornea, secondary glaucoma, vision impairment, ptosis, long narrow face, high nasal bridge, broad nasal tip with separated cartilages, long philtrum, cleft palate, atrial septal defect, ventricular septal defect, and skeletal anomalies. The following dental abnormalities were found: radiculomegaly, delayed dentition, oligodontia, root dilacerations (extension), and malocclusion. For the first time, fusion of teeth and hyperdontia of permanent upper teeth were seen. In addition, structural and morphological dental changes were noted. These findings expand the clinical spectrum of the syndrome.

[The etiology of canine tooth impaction--a space analysis].

ZusammenfassungZiel dieser Untersuchung ist es festzustellen, inwieweit ein Platzüberschuß als ätiologischer Faktor für die Impaktierung der Oberkieferenckzähne, unter besonderer Berücksichtigung der Rolle der seitlichen Schneidezähne, in Betracht gezogen werden muß. Zur Klärung dieser Frage wurden sowohl die Anfangs- und Abschlußmodelle von 63 Patienten mit 84 impaktierten Eckzähnen als auch die Fernröntgenseitenbeilder von 116 Patienten mit 144 verlagerten Eckzähnen vermessen. Die Ergebnisse dieser Studie zeigen: Die palatinale Verlagerung Überwog mit 84,5% deutlich gegenüber der verstibulären Retention mit 15,5%. Ein Platzmangel konnte lediglich bei 18% deer Patienten mit palatinaler Verlagerung im Gegensatz zu 46% bei vestibulärer Impaktierung festgestellt werden. Hypoplastische seitliche Schneidezähne traten in 35% der Fälle mit palatinaler Verlagerung, edoch bei keinem Patienten mit vestibulärer Retentiion auf. Die kephalometrische Analyse zeigte ebenfalls einen unterschiedlichen Gesichtsschädelaufbau bei palatinaler und vestibulärer Verlagerung. Während 80% der Patienten mit palatinaler impaktierung einen horizontalen achstumtyp aufwiesen, wurde ein solcher nur in 23% der Fälle mit vestibulärer Retention gefunden.SummaryThe aim of this study was to examine to what extent excess space must be taken into consideration as an etiological factor in upper canine impaction with special attention paid to the role of the adjacent laterals. To clarify this question the pre- and post-treatment models of 63 patients with a total of 84 impacted cuspids were measured and the cephalograms of 116 patients havign 144 impacted cuspids were analyzed. The results of this study revealed: 85.5% of the cuspids were palataly impacted while 15.5% were labially impacted. An arch deficiency was found in only 18% of the palatally impacted cuspids, whereas there was an arch-length deficiency in 46% of the buccally impacted. In 35% of the cases there was a correlation between peg shaped laterals and palatal impaction, however, such was not present in te patients with vesbibular retention. Finally the cephalometric data revealed horizontal growth characteristics in 80% of the palatally impacted canines as opposed to 23% in those labially impacted.The aim of this study was to examine to what extent excess space must be taken into consideration as an etiological factor in upper canine impaction with special attention paid to the role of the adjacent laterals. To clarify this question the pre- and post-treatment models of 63 patients with a total of 84 impacted cuspids were measured and the cephalograms of 116 patients having 144 impacted cuspids were analyzed. The results of this study revealed: 84.5% of the cuspids were palatally impacted while 15.5% were labially impacted. An arch deficiency was found in only 18% of the palatally impacted cuspids, whereas there was an arch-length deficiency in 46% of the buccally impacted. In 35% of the cases there was a correlation between peg shaped laterals and palatal impaction, however, such was not present in the patients with vestibular retention. Finally the cephalometric data revealed horizontal growth characteristics in 80% of the palatally impacted canines as opposed to 23% in those labially impacted.

Extraction of maxillary second molars in the treatment of Class II malocclusion

The results of treatment following the extraction of maxillary second molars for Class II correction were evaluated. Records (cephalograms, orthopantomograms, and models) of 32 patients treated with maxillary second molar extraction were analyzed. Cephalograms taken before and after treatment were traced and 18 variables were compared. Changes in the axial inclination of the erupted third molars relative to the occlusal plane were measured on the orthopantomograms. The form and the position (eruption in occlusion, rotations) of the maxillary third molars were evaluated on the models. The average treatment time was 26 months. The results of this study show significant changes of the angles SNA, SNB, ANB, 1/4:SN, and the distances 1-NPog, and 1-APog, as well as significant effects on the soft tissue profile. In 19 cases examined 4 years postretention, all maxillary third molars had erupted into occlusion with a mesial contact point and acceptable mesiodistal axial inclination.

Factors Influencing Changes in Maxillary Arch Dimensions in Unilateral Cleft Lip and Palate Patients until Six Months of Age

OBJECTIVE The objectives of the present study were (1) to investigate whether growth increments until 6 months of age are influenced by particular factors, (2) to analyze whether anterior cleft reduction is dependent on the extent of the cleft width at birth, and (3) to examine the correlation between maxillary measurements at birth and the anterior cleft width at 6 months of age. DESIGN The study design was prospective and longitudinal. SETTING Heidelberg University Hospital Interdisciplinary Cleft/Craniofacial Center. PATIENTS AND METHOD The longitudinal records of 34 patients (24 male and 10 female) with complete unilateral cleft lip, alveolar ridge, and hard and soft palate were included in this study. All patients were treated with the same protocol. All participants were assessed at 0 and 6 months of age. Maxillary plaster casts of the patients were analyzed using a computer-controlled three-dimensional digitizing system. MAIN OUTCOME MEASURE Maxillary models were measured and compared to putative factors influencing growth. RESULTS No statistically significant differences were found between maxillary growth changes and increases in weight and length. Similarly, there was no significant interaction between the extent of the alveolar cleft width at birth and its reduction prior to lip closure. In contrast, significant differences of maxillary growth increments could be found between male and female patients. Stepwise regression analysis demonstrated a correlation between maxillary measurements at birth and growth increments. CONCLUSION The results of the study indicate that gender plays a certain role in growth changes within the first 6 months of age.

The nasometer. An instrument for the objective study of hyperrhinophonia in cheilognathopalatoschisis patients

ZusammenfassungAufgabe dieser Studie war es, die Zuverlässigkeit und Gültigkeit des Nasometers in der Diagnose der Hyperrhinophonie bei Patienten mit Lippen-Kiefer-Gaumen-Spalten zu überprüfen. Hierzu wurder die Ergebnisse der Nasometer-Untersuchung von 30 Spaltträgern den logopädischen Einschätzungen gegenübergestellt. Die Sensitivität erreichte einen Wert von 0,80, die Spezifität von 1,00 Die insgesamte Übereinstimmung belief sich auf 0,90. Unsere Ergebnisse-die nahezu denen vergleichbarer Untersuchungen im anglo-amerikanischen Sprachraum entsprechen-weisen das Nasometer als zuverlässiges Instrument in der Diagnose des offenen Näselns auch in der deutschen Sprache aus. Zudem bietet es die Möglichkeit, das Ausmaß der Hyperrhinophonie in der Routinediagnostik zu objektivieren.SummaryThe aim of this study was to evaluate the reliability and validity of the nasometer indiagnosing hypernasality in cleft palate patients. For this purpose the results of the nasometric examination of 30 patients with hypernasality were compared with the results obtained by using the currently taught methods. Sensitivity and specificity of nasometry were high with coefficients, respectively, of 0.80 and 1.00. Overall accuracy reached 0.90. Our results, which correspond almost exactly to those obtained in similar Anglo-American studies, demonstrate that also in German speaking countries the nasometer can be a reliable instrument for diagnosing hypernasality. Moreover, the nasometer presents the possibility of calculating the extent of hypernasality during routine examination and diagnosis.The aim of this study was to evaluate the reliability and validity of the nasometer in diagnosing hypernasality in cleft palate patients. For this purpose the results of the nasometric examination of 30 patients with hypernasality were compared with the results obtained by using the currently taught methods. Sensitivity and specificity of nasometry were high with coefficients, respectively, of 0.80 and 1.00. Overall accuracy reached 0.90. Our results, which correspond almost exactly to those obtained in similar Anglo-American studies, demonstrate that also in German-speaking countries the nasometer can be a reliable instrument for diagnosing hypernasality. Moreover, the nasometer presents the possibility of calculating the extent of hypernasality during routine examination and diagnosis.

Spectral Analysis of Prespeech Sounds (Spontaneous Cries) in Infants With Unilateral Cleft Lip and Palate (UCLP): A Pilot Study

OBJECTIVE The objectives of the present study were: (1) to analyze the cry features of infants with cleft lip and palate (UCLP) by means of spectral analysis, (2) to describe changes of the acoustic parameters from birth until 9 months of age, and (3) to compare these data with existing cry data of infants without cleft (control group). DESIGN The study was designed on a interdisciplinary, prospective, and longitudinal basis. SETTING Interdisciplinary study: (1) Institute of Anthropology at the Humboldt-University, Berlin; (2) Heidelberg University Hospital: Interdisciplinary Cleft Palate and Craniofacial Center. PATIENTS AND METHOD The cry parameters of five patients with complete unilateral cleft lip, alveolar ridge, and hard and soft palate were analyzed from birth to 9 months of age. The patients were treated with the same protocol. At the age of 24 months, sensomotor development was assessed using the KIPHARD test. Perceptual judgment of speech, performed after 36 months of life, included nasal resonance, nasal emission of air, articulation disorders, and speech intelligibility. MAIN OUTCOME MEASURE The cry parameters of fundamental frequency (F(0)), pitch period perturbation quotient (PPQ), and cry duration (Tsam) were analyzed. RESULTS Contrary to the expectation that laryngeal parameters are not affected by vocal tract malformations, differences of cry parameters were found between the patients with UCLP and the non-cleft group. Particularly, the F(0) and its short-time variability (PPQ) were affected. CONCLUSIONS The preliminary results of this study showed that F(0) and PPQ of spontaneous cries are influenced in patients with UCLP, and a cry analysis might become a noninvasive tool for early detection of an at-risk status for neuromuscular development and prediction of an at-risk status for later speech and language acquisition in infants with cleft lip and palate. Future research strategies are outlined.

Extraction therapy in patients with class II/2 malocclusion

The aim of this study was to analyze the dynamic development of Class II, Division 2 malocclusion with reference to the untreated patients from the Belfast Growth Study. As a second step, the influences of premolar extraction in all 4 quadrants and of maxillary second molar extraction in the upper jaw in Class II/2 patients were examined, focusing on the cephalometric variables in comparison to those of the untreated patients from the Belfast study. The longitudinal cephalometric values of 20 patients in each group were compared.In addition, the possibility of thirds molar eruption was evaluated in the extraction patients from the panoramic radiographs. The overbite based on study models at the beginning and end of treatment was calculated. Furthermore, renewed spacing after premolar extraction was assessed.The results derived from cephalometric analysis demonstrated that profile flattening was also observed in untreated Class II/2 patients during the growth period. Comparison of these data with those obtained from the extraction groups revealed a significantly marked recession of the upper lip after premolar extraction. In contrast, only slightly increased flattening after maxillary second molar extracton was observed compared with the untreated patients of the control group. Whereas the interincisal angle was reduced to a value approximating that of untreated Class I patients after maxillary second molar extraction, only a small decrease was recorded after premolar extraction.From our point of view, the claim that premolar extraction facilitates third molar eruption should be seen in an extremely critical light and should not contribute to the decision in favor of extraction. In addition, there is a problem of renewed spacing in the extraction area after premolar extraction.ZusammenfassungGegenstand der Arbeit war, am Beispiel der uns zur Verfügung gestellten Belfaster Wachstumsstudie unbehandelter Patienten, die dynamische Entwicklung der Angle-Klasse II/2 zu analysieren. In einem zweiten Schritt wurden die Einflüsse der Prämolarenextraktion in allen vier Quadranten bzw. der Siebenerextraktion im Oberkiefer bei Klasse-II/2-Patienten auf die kephalometrischen Variablen untersucht und mit denen der unbehandelten Belfaster Patienten verglichen. Die longitudinalen fernröntgenologischen Befunde von jeweils 20 Patienten wurden gegenübergestellt. Zusätzlich wurden bei den Extraktionspatienten anhand der Orthopathomogramme die Durchbruchsmöglichkeit der Weisheitszätzlich wurden bei den Extraktionspatienten anhand der Orthopantomogramme die Durchbruchsmöglichkeit der Weisheitszähne beurteilt sowie anhand der Kiefermodelle der vertikale Überbiß bei Behandlungsbeginn und-abschluß bestimmt. Weiterhin wurde eine erneute Lückenbildung nach Prämolarenextraktion abgeklärt.Die Ergebnisse der kephalometrischen Analyse zeigten, da\ eine Abflachung des Profils auch bei den unbehandelten Klasse-II/2-Patienten während des Wachstums beobachtet werden kann. Der Vergleich dieser Messungen mit denen der Extraktionsgruppen ergab, daß die Oberlippe nach Prämolarenextraktion signifikant stärker zurückwich. Hingegen kam es nach Siebenerextraktion zu geringfügig größeren Abflachung im Vergleich zur unbehandelten Kontrolgrppe. Während der Interinzisalwinkel nach Siebenerextraktion auf einen Wert verringert werden konnte, der nahezu dem unbehadelter Klassel-Patienten entspricht, wurde nach Prämolarenextraktion lediglich eine geringe Reduktion beobachtet.Das Argument, daß Prämolarenextraktionen die Durchbruchsmöglichkeiten der Weischeitszähne verbessern, muß aus unserer Sicht äußerst kritisch betrachtet werden und sollte daher nicht zur Extraktionsentscheidung beitragen. Nach Prämolarenextraktion stellt sich zudem das Problem einer erneuten Lückenbildung im Extraktionsbereich.

Early Maxillary Orthopedics in a Child with an Oblique Facial Cleft

OBJECTIVE Oblique facial clefts are extremely rare. In view of their variability, surgical treatment cannot be standardized. To date, early maxillary orthopedics in the treatment of oblique facial clefts have not been reported. The case described here presents a newborn child with a Tessier 3 cleft. Because of the enormous width of the alveolar cleft, a narrowing of the segments was regarded as prerequisite for definitive lip closure. To bring the segments together, an actively working plate with a forward pull was designed. CONCLUSION After a period of 4 weeks, proper alignment and proximity of the segments were achieved, so that definitive lip closure and plastic reconstruction of the remaining soft tissue defect could be easier performed.

Skelettale und dentoalveoläre Veränderungen nach Extraktion der zweiten molaren im oberkiefer

ZusammenfassungIm Rahmen dieser Studie wurden die Behandlungsergebnisse nach Extraktion der oberen zweiten Molaren untersucht. Diese Therapieform wurde bei Patienten mit einer Distalverzahnung, horizontalem Wachstumsmuster bzw. Gesichtsschädelaufbau und Tiefbiß gewählt, wenn eine Extraktion zum Erreichen einer Neutralverzahnung unumgänglich war. Ziel dieser Untersuchung war daher, den Einfluß der Siebenerextraktion auf den vertikalen überbiß zu prüfen und zu analysieren, wie eine Korrektur der Bißstellung erreicht werden konnte. Zu diesem Zweck wurden sowohl die prä- und posttherapeutischen Kiefermodelle von 25 Patienten mit 48 extrahierten oberen zweiten Molaren vermessen als auch deren Fernröntgenseitenbilder entsprechend überlagert und die skelettalen und dentoalveolären Veränderungen im Ober- und Unterkiefer bestimmt. Der Overbite konnte im Durchschnitt von 4,7 mm auf 2,7 mm reduziert werden. Keiner der Patienten zeigte posttherapeutisch eine Bißsenkung. Trotz zum Teil erheblicher prätherapeutischer Distalbißstellung konnte bei 92% der Patienten eine Neutralverzahnung erzielt werden. Die Korrektur der Okklusion wurde primär durch Distalisation der oberen ersten Molaren erreicht. Weiterhin trugen sowohl eine Mesialwanderung der unteren ersten Molaren, skelettale Veränderungen im Unterkiefer als auch die Hemmung des Oberkieferwachstums zur Einstellung einer Neutralverzahnung bei.SummaryThe aim of this study was to evaluate treatment results after extraction of maxillary second molars. Since this therapy was chosen in patients with class II malocclusion, deep overbite and counterclockwise growth pattern, its effects on overbite and correction of the malocclusion were examined. For this purpose pre- and post-treatment models of 25 patients with 48 extracted upper second molars were measured and lateral cephalograms were appropriately superimposed in order to determine maxillary and mandibular skeletal and dentoalveolar changes. Our results indicate an average overbite reduction from 4.7 mm to 2.7 mm. None of the patients showed a posttreatment overbite increase. Despite the considerable initial Class II relation in many cases, a Class I occlusion was achieved in 92% of the patients. Primarily, the correction was achieved by distalisation of the upper first molars. Furthermore, the mesial migration of the lower first molars, skeletal changes in the lower jaw, and the growth inhibition in the upper jaw contributed to the correction of the class II malocclusion.The aim of this study was to evaluate treatment results after extraction of maxillary second molars. Since this therapy was chosen in patients with class II malocclusion, deep overbite and counterclockwise growth pattern, its effects on overbite and correction of the malocclusion were examined. For this purpose pre- and post-treatment models of 25 patients with 48 extracted upper second molars were measured and lateral cephalograms were appropriately superimposed in order to determine maxillary and mandibular skeletal and dentoalveolar changes. Our results indicate an average overbite reduction from 4.7 mm to 2.7 mm. None of the patients showed a posttreatment overbite increase. Despite the considerable initial Class II relation in many cases, a Class I occlusion was achieved in 92% of the patients. Primarily, the correction was achieved by distalization of the upper first molars. Furthermore, the mesial migration of the lower first molars, skeletal changes in the lower jaw, and the growth inhibition in the upper jaw contributed to the correction of the class II malocclusion.