Ariane Hohoff

Interdisciplinary Study of Orthopedic and Orthodontic Findings in Pre-school Infants

Abstract.Background and Aim:The assessment of correlations between orthopedic and orthodontic data based on interdisciplinary studies is of scientific and practical interest in the differentiation of preventive diagnostic and therapeutic fields between orthodontics and orthopedics. In the published literature there are various studies analyzing the correlations between specific Angle classes and orthopedic parameters. Results of these studies indicate a potential correlation between scoliosis and Class II malocclusion as well as between weak body posture and Class II malocclusion. The aim of the present interdisciplinary study was to examine correlations between orthodontic and orthopedic findings in preschool infants and to evaluate them with respect to preventive recommendations.Patients and Method:59 pre-school infants (29 boys, 30 girls) aged 3.5–6.8 years (mean: 5.0 years) were enrolled in this study. A standardized orthodontic and orthopedic examination protocol was used.Results:The orthodontic examination showed Angle class distributions comparable with those in non-selected groups (Class I: 63%, Class II: 32%, Class III: 5%). The orthopedic examination revealed pathologic findings in 52% of the subjects, with statistically significant correlations between scoliosis and Class II malocclusion (p = 0.033) and between weak body posture and Class II malocclusion (p = 0.028).Conclusion:It can be concluded from the results that the orthodontic finding of Angle Class II in pre-school infants should induce prophylactic screening. The orthodontist could then not only initiate early orthodontic treatment to prevent incisor trauma in patients with extreme overjet, but could also take account of potential orthopedic malformations on a preventive interdisciplinary basis in pre-school infants with Class II malocclusions.Zusammenfassung.Hintergrund und Ziel:Die Bewertung von Beziehungen zwischen orthopädischen und kieferorthopädischen Befunden auf der Basis von interdisziplinären Studien ist von wissenschaftlichem und praktischem Interesse für die Differenzierung von präventiven gemeinsamen Diagnostik- und Therapiebereichen zwischen Kieferorthopädie und Orthopädie. Im bekannten Schrifttum finden sich mehrere Studien, welche Zusammenhänge zwischen bestimmten Angle-Klassen und orthopädischen Parametern evaluieren. Ergebnisse dieser Studien deuten auf eine mögliche Beziehung von Skoliosen und hypotoner Körperhaltung mit Angle-Klasse-II-Dysgnathien hin. Prospektives Ziel der vorliegenden interdisziplinären Studie war es, Beziehungen zwischen orthopädischen und kieferorthopädischen Befunden bei Vorschulkindern zu untersuchen und hinsichtlich präventiver Empfehlungen zu evaluieren.Patienten und Methode:59 Vorschulkinder im Alter von 3,5 bis 6,8 Jahren wurden in diese Studie einbezogen. 29 Patienten waren männlich, 30 weiblich. Es erfolgten eine standardisierte klinische kieferorthopädische und orthopädische Untersuchung.Ergebnisse:Bei der kieferorthopädischen Untersuchung zeigte sich eine der Verteilung in unselektierten Gruppen entsprechende Angle-Klasse-Häufigkeit (Angle-Klasse I 63%, Angle-Klasse II 32% und Angle-Klasse III 5%). Die orthopädische Untersuchung ergab bei 52% der Probanden Auffälligkeiten mit den folgenden statistisch signifikanten Korrelationen: Angle-Klasse II und Skoliose (p = 0,033) sowie Angle-Klasse II und hypotone Körperhaltung (p = 0,028).Schlussfolgerung:Aus den Ergebnissen kann geschlussfolgert werden, dass bei Kindergartenkindern der kieferorthopädische Befund der Angle-Klasse II eine mögliche prophylaktische Screeninguntersuchung auslösen sollte. Der Kieferorthopäde kann somit nicht nur bei extremer Frontzahnstufe eine kieferorthopädische Frühbehandlung zur Frontzahntraumaprophylaxe initiieren, sondern auch bei Angle-Klasse-II-Dysgnathien aller Schweregraduierungen interdisziplinär präventiv mögliche orthopädische Fehlentwicklungen berücksichtigen.

Prediction of oral discomfort and dysfunction in lingual orthodontics: A preliminary report

INTRODUCTION The purpose of this prospective study was to examine the influence of malocclusion on the amount of discomfort of patients who were treated with Incognito lingual brackets (T.O.P. Service, Ormco, Amersfoort, the Netherlands; ibraces in North and South America, Lingualcare, Dallas, Tex). METHODS Twenty-one female patients (mean age, 24.8 years; SD 10.7) participated in the investigation and completed a standardized questionnaire before and the day after placement of the appliance. One experienced orthodontist, blinded to the results of the questionnaires, evaluated their initial cephalograms and casts with respect to the parameters SNA, SNB, and ANB angles; overjet; overbite; maxillary and mandibular anterior contact-point displacement; crossbite; open bite; and missing teeth. RESULTS Malocclusion measured on the casts had no significant impact on the amount of discomfort or dysfunction reported by the patients. The SNA (r = -0.619, P = .003) and SNB (r = -0.615, P = .003) angles, however, correlated significantly with the restriction of tongue space; patients with an SNB angle that was smaller than 1 SD from the norm were significantly more prone to experience severe restriction of tongue space (P = .003). CONCLUSIONS The SNA and SNB angles are predictors for the level of tongue-space restriction after placement of lingual brackets: the smaller the angles, the more prone the patients are to experience discomfort.

Comparison of the Effect on Oral Discomfort of Two Positioning Techniques with Lingual Brackets

Using a standardized questionnaire, 41 patients (12 men, 29 women; mean age 31.5 +/- 12.1 years) were interviewed prospectively on their subjective oral comfort, various oral functions, and professional qualification before indirect application of lingual brackets (T0), within 24 h of application (T1), and three months later (+/- 1 week) (T2). In 22 of the 41 patients, the brackets were positioned with the Bonding with Equalized Specific Thickness (BEST) technique (BEST group) and in 19 patients by the Transfer Optimized Positioning (TOP) method (TOP group). Despite positive adaptation, the patients in both groups still reported a significant deficiency in tongue space at T2 as well as significantly more frequent lesions to the tongue. The BEST group was affected significantly more often by these problems than the TOP group. At T2, the tongue position was also rated as changed significantly more often in the BEST group than in the TOP group. Although the BEST positioning technique leads to greater impairments in oral comfort than the TOP technique, it offers the orthodontist the advantage of less bending input. In both techniques, there is a need for detailed briefing of patients about the extent and duration of impairments induced by lingual brackets.

Control of mandibular incisors with the combined Herbst and completely customized lingual appliance - a pilot study

BackgroundThe traditional Herbst appliance induces mandibular incisor proclination independent of the anchorage system used. The dental effects of the Herbst appliance as an element of a completely customized lingual orthodontic (LO) appliance (Incognito, 3 M) has not been analyzed yet and the aim of this paper was to measure the effect of mandibular incisor proclination using this Herbst-LO device.MethodsRetrospective study. Inclusion criteria: a) Class II ≥ 5 mm molar relationship; b) Herbst appliance ≥ 9 months in situ; and c) finished active treatment. Incisor position was measured on digital models before treatment, on the digital target setup, and on digital models obtained at the day of debonding. All measurements were performed by one investigator.ResultsTwelve patients (8 females, 4 males) out of 632 cases treated with a lingual appliance were included in the study. The measurement error computed with Dahlbergs formula was 0.2°. Seven cases had planned (target setup) mandibular incisor uprighting (ccr), and five cases had proclination (clockwise rotation). There was no statistical difference (p > 0.05) between planned incisor rotations of the target setup and achieved incisor rotations at the day of debonding. The overall mean difference was 2.2° ± 1.0°.ConclusionsThe Incognito-Herbst combination is the first Herbst device with full control over mandibular incisor movement. Using this system, anchorage loss or anchorage gain is independent of the Herbst treatment. It depends only on the planned tooth position of the individual target setup.

Oral Comfort, Function and Hygiene in Patients with Lingual Brackets

Abstract.Background:Oral comfort, speech, mastication and swallowing, as well as oral hygiene were to be evaluated in a prospective longitudinal study before and after insertion of lingual brackets.Patients and Method:22 patients (five male, 17 female, mean age 34.7 years, SD 10.4) were enrolled in the study and filled in a standardized questionnaire directly before placement of lingual brackets (T0), within 24 hours thereafter (T1), and 3 months (± 1 week) later (T2). At both T1 and T2, treatment was confined to the upper arch.Results:In comparison with T0, significantly poorer results were recorded at T2 for the parameters “restriction of the tongue space”, “lesions to the tongue”, “tongue position”, “subjective and semiobjective rating of articulation”, “chewing”, “biting” and “oral hygiene”, although significant improvements, i. e. adaptations, had been recorded from T1 to T2 with the exception of the parameters “tongue space”, “tongue position”, “chewing”, ”biting” and “oral hygiene”. At none of the registration timepoints was fluid intake impaired by the lingual brackets.Conclusions:The results of the present study suggest that detailed briefing on the extent and duration of potential impairments in oral comfort, functions and hygiene is advisable prior to the insertion of lingual brackets.Zusammenfassung.Hintergrund:In einer prospektiven Longitudinalstudie sollten oraler Komfort, Sprach-, Kau- und Schluckfunktion sowie Mundhygiene vor und nach Applikation von Lingualbrackets evaluiert werden.Patienten und Methode:22 Patienten (fünf männlich, 17 weiblich, Durchschnittsalter 34,7 Jahre, SD 10,4) wurden in die Studie inkludiert und beantworteten unmittelbar vor Behandlungsbeginn (T0), innerhalb von 24 Stunden danach (T1) und 3 Monate (± 1 Woche) später (T2) einen standardisierten Fragebogen. Zu T1 und T2 wurde ausschließlich im Oberkiefer behandelt.Ergebnisse:Im Vergleich zu T0 bestanden zu T2 noch immer signifikante Verschlechterungen für die Parameter „Einengung des Zungenraums“, „Verletzungen der Zunge“, „Zungenlage“, „subjektiv und semiobjektiv beurteilte Lautbildung“, „Kauen“, „Abbeißen“ und „Zahnpflege“, obwohl von T1 zu T2 signifikante Verbesserungen, das heißt Adaptationen zu konstatieren waren. (Von diesen Verbesserungen ausgenommen waren die Parameter “Einengung des Zungenraums“, „Zungenlage“, „Kauen“, „Abbeißen“ und „Zahnpflege“.) Die Aufnahme von Flüssigkeiten wurde durch die Lingualbrackets zu keinem Untersuchungszeitpunkt beeinträchtigt.Schlussfolgerung:Vor der Applikation von Lingualbrackets empfiehlt sich gemäß den Ergebnissen der vorliegenden Studie eine Maximalaufklärung über Ausmaß und Dauer möglicher Beeinträchtigungen in oralem Komfort, oraler Funktion und Mundhygiene.

Short-term and long-term results after early treatment with the castillo morales stimulating plate

The present study is divided into 2 parts: The first explains the concept of stimulating plate therapy at the Muenster Clinic and the second presents a longitudinal study of mouth and tongue posture in trisomy 21 children treated with this concept.47 children underwent a pre-treatment examination (Rec1), and 38 attended a first follow-up examination (Rec2) after an average of 4 months of stimulating plate treatment. The second follow-up examination (Rec3) was on average 53 months after the end of treatment and covered 18 patients. Data acquisition was based on standardized parent questionnaires and standardized clinical examination records. Rec2 showed in part a highly significant improvement in orofacial appearance. These results were confirmed by the parent interview, according to which the mouth and tongue posture improved in 76.3% of the children during the time they were wearing the plate. Even when the plate was not in place, the result remained stable in 65.8% of the patients. Up to Rec3, further improvement was recorded in some results. The symptoms: “mouth mostly wide open” and “tongue mostly protruding way over lips” were reduced. The number of children whose tongue was “mostly in the oral cavity” increased correspondingly.At Rec3, the parents also rated the mouth posture in 88.9% and the tongue posture in 77.7% of the children as stable or further improved.It can be concluded from the results of this study that stimulating plate treatment in combination with physiotherapy provides a long-term improvement in the mouth and tongue posture of children with Downs syndrome.ZusammenfassungDie vorliegende Arbeit gliedert sich in zwei Teile: 1. Erläuterung des Münsteraner Behandlungskonzepts bei Anwendung der Stimulationsplatte nach Castillo Morales, 2. Darstellung einer Longitudinalstudie zur Mund- und Zungenhaltung von Kindern mit Trisomie 21, die nach diesem Therapiekonzept behandelt wurden.47 kleine Patienten wurden im Rahmen einer Voruntersuchung (Rec1) vor Behandlungsbeginn erfaßt, 38 Kinder erschienen zu einer ersten Kontrolle (Rec2) nach durchschnittlich vier Monaten laufender Stimulationsplattenbehandlung. Bei einer zweiten Nachuntersuchung (Rec3) im Mittel 53 monate nach Therapieende konnten Befunde von 18 Patienten beurteilt werden. Die Datenerhebung erfolgte mit Hilfe standardisierter Elternfragebögen und genormter klinischer Untersuchungsprotokolle. Die klinischen Befunde wiesen auf eine zum Teil hochsignifikante Verbesserung des orofazialen Erscheinungsbildes in der Therapiephase (Rec2) hin. Dieses Ergebnis wurde durch das Elteminterview bestätigt. Nach Angabe der Erziehenden verbesserte sich die Mund- und Zungenhaltung bei 76,3% der Kinder, während sich die Platte in situ befand. Auch wenn die Platte nicht in der Mundhöhle war, blieb der erzielte Erfolg bei 65.8% der Probanden stabil.Bis zur zweiten Nachuntersuchung (Rec3) wurden einige Resultate im Rahmen der klinischen Befunderhebung als noch weiter verbessert eingestuft. Die Symptome “Der Mund ist meist weit geöffnet” sowie “Die Zunge ragt meist weit über die Lippen” wurden reduziert. Hierzu korrespondierend erhöhte sich der Anteil von Kindem mit “meist in der Mundhöhle liegender Zunge”.Auch die Eltern beurteilten zum Zeitpunkt der zweiten Nachuntersuchung (Rec3) die Mundhaltung von 88,9%, die Zungenhaltung von 77,7% der Kinder als stabil oder weiter verbessert.Aus den dargestellten Ergebnissen läßt sich schlußfolgern, daß durch Stimulationsplattenbehandlung in Kombination mit Physiotherapie die Mund- und Zungenhaltung von Kindem mit Trisomie 21 dauerhaft verbessert werden kann.

Herbst appliance in lingual orthodontics.

INTRODUCTION The aims of this article were to outline a technique for attaching Herbst telescopes to a customized lingual orthodontic (LO) appliance and to demonstrate the treatment phases and outcome with a case report. METHODS The interface between the LO appliance and the telescopes consists of a computer-aided design/computer-aided manufacturing (CAD/CAM), custom-made labial pivot base connected to the custom-made bands of the maxillary molars and mandibular canines. The individual CAD depiction of the interface ensures an optimal 3-dimensional tube-and-plunger position for correct and smooth function of the telescope mechanism. Because of the lingual location of the brackets, a small buccal tooth-to-telescope distance can be achieved, increasing patient comfort. Various options of anchorage are possible with only 1 device. After bite jumping, the telescopes and pivot bases can be removed easily without debonding the bands or removing the archwires. RESULTS Experience from the first patient suggests that the Herbst-LO appliance facilitates treatment control during all phases, decreases the risk of interface breakage and mandibular incisor flaring, and might reduce overall treatment time. CONCLUSIONS These initial clinical observations justify further research to provide evidence about the efficacy of Herbst-LO appliances.

Effects of a Mechanical Interdental Cleaning Device on Oral Hygiene in Patients with Lingual Brackets

This study was aimed at determining the influence of a battery-operated interdental cleaning device (icd) (WaterPik Flosser) on the oral hygiene of 32 female right-handed patients (mean age 25.9 years) with lingual brackets in the upper (n = 29) and or in the lower arch (n = 25). Approximal plaque index (API) and bleeding on probing (BOP) were recorded at the lingual surfaces by a single blinded examiner before application (t0), on average 38.6 days after (t1), and again on average 46.0 days after (t2) the application of the icd. The patients used the icd once a day in the second and fourth quadrants only (icdq). In all quadrants (icdq and non-icd quadrants [n-icdq]), oral hygiene was performed with a manual toothbrush. Of the patients enrolled in the study, 96.9% found the icd subjectively very helpful to moderately helpful for cleaning their teeth and 65.6% had the subjective impression that their teeth were cleaner with the appliance. Despite those positive subjective assessments, an objective comparison of the icdqs with the n-icdqs revealed no statistically significant differences in the mean changes in API and BOP from t0 to t1, from t0 to t2, or from t1 to t2. Because there were spectacular improvements in API in all quadrants, the improvements could be interpreted as an outcome of the instruction and motivation given to the patients, the increasing awareness of oral hygiene, and the greater skill in using the toothbrush in the course of time.

Principles of cartilage tissue engineering in TMJ reconstruction.

Diseases and defects of the temporomandibular joint (TMJ), compromising the cartilaginous layer of the condyle, impose a significant treatment challenge. Different regeneration approaches, especially surgical interventions at the TMJs cartilage surface, are established treatment methods in maxillofacial surgery but fail to induce a regeneration ad integrum. Cartilage tissue engineering, in contrast, is a newly introduced treatment option in cartilage reconstruction strategies aimed to heal cartilaginous defects. Because cartilage has a limited capacity for intrinsic repair, and even minor lesions or injuries may lead to progressive damage, biological oriented approaches have gained special interest in cartilage therapy. Cell based cartilage regeneration is suggested to improve cartilage repair or reconstruction therapies. Autologous cell implantation, for example, is the first step as a clinically used cell based regeneration option. More advanced or complex therapeutical options (extracorporeal cartilage engineering, genetic engineering, both under evaluation in pre-clinical investigations) have not reached the level of clinical trials but may be approached in the near future. In order to understand cartilage tissue engineering as a new treatment option, an overview of the biological, engineering, and clinical challenges as well as the inherent constraints of the different treatment modalities are given in this paper.

The spectrum of Apert syndrome: phenotype, particularities in orthodontic treatment, and characteristics of orthognathic surgery

In the PubMed accessible literature, information on the characteristics of interdisciplinary orthodontic and surgical treatment of patients with Apert syndrome is rare. The aim of the present article is threefold: (1) to show the spectrum of the phenotype, in order (2) to elucidate the scope of hindrances to orthodontic treatment, and (3) to demonstrate the problems of surgery and interdisciplinary approach.Children and adolescents who were born in 1985 or later, who were diagnosed with Apert syndrome, and who sought consultation or treatment at the Departments of Orthodontics or Craniomaxillofacial Surgery at the Dental School of the University Hospital of Münster (n = 22; 9 male, 13 female) were screened. Exemplarily, three of these patients (2 male, 1 female), seeking interdisciplinary (both orthodontic and surgical treatment) are presented. Orthodontic treatment before surgery was performed by one experienced orthodontist (AH), and orthognathic surgery was performed by one experienced surgeon (UJ), who diagnosed the syndrome according to the criteria listed in OMIM™.In the sagittal plane, the patients suffered from a mild to a very severe Angle Class III malocclusion, which was sometimes compensated by the inclination of the lower incisors; in the vertical dimension from an open bite; and transversally from a single tooth in crossbite to a circular crossbite. All patients showed dentitio tarda, some impaction, partial eruption, idopathic root resorption, transposition or other aberrations in the position of the tooth germs, and severe crowding, with sometimes parallel molar tooth buds in each quarter of the upper jaw.Because of the severity of malocclusion, orthodontic treatment needed to be performed with fixed appliances, and mainly with superelastic wires. The therapy was hampered with respect to positioning of bands and brackets because of incomplete tooth eruption, dense gingiva, and mucopolysaccharide ridges. Some teeth did not move, or moved insufficiently (especially with respect to rotations and torque) irrespective of surgical procedures or orthodontic mechanics and materials applied, and without prognostic factors indicating these problems. Establishing occlusal contact of all teeth was difficult. Tooth movement was generally retarded, increasing the duration of orthodontic treatment. Planning of extractions was different from that of patients without this syndrome.In one patient, the sole surgical procedure after orthodontic treatment with fixed appliances in the maxilla and mandible was a genioplasty. Most patients needed two- jaw surgery (bilateral sagittal split osteotomy [BSSO] with mandibular setback and distraction in the maxilla). During the period of distraction, the orthodontist guided the maxilla into final position by means of bite planes and intermaxillary elastics.To our knowledge, this is the first article in the PubMed accessible literature describing the problems with respect to interdisciplinary orthodontic and surgical procedures. Although the treatment results are not perfect, patients undergoing these procedures benefit esthetically to a high degree.Patients need to be informed with respect to the different kinds of extractions that need to be performed, the increased treatment time, and the results, which may be reached using realistic expectations.