Branislav Glisic

Three‐dimensional pharyngeal airway changes in orthodontic patients treated with and without extractions

OBJECTIVE To evaluate and compare three-dimensional pharyngeal airway changes in orthodontic patients treated with and without extractions. MATERIAL AND METHODS Pharyngeal airway was analyzed for 31 subjects (15 males, 16 females) treated with extractions of four first premolars and 31 age- and gender-matched controls (15 males, 16 females) treated without extractions. The mean age of subjects was 12.97 ± 1.15 years at the beginning and 15.69 ± 1.28 years at the end of treatment. The mean age of controls was 12.86 ± 0.74 years at the beginning and 15.18 ± 0.86 years at the end of treatment. Nasopharyngeal (NP) and oropharyngeal (OP) volumes, area of maximum pharyngeal constriction (AMPC), and upper arch perimeter were measured on T0 and T1 cone beam computed tomography (CBCT) scans. Paired samples t-test was used for analyzing statistical significance of changes (p ≤ 0.05). RESULTS There were no statistically significant differences in the pharyngeal airway values between the extraction and non-extraction groups at neither T0 nor T1. The extraction group showed a statistically significant increase for NP and OP volumes and AMPC values. Such increase was also noted in the non-extraction group, without statistical significance for AMPC values. CONCLUSIONS The findings suggest that an extraction or non-extraction choice for orthodontic treatment would not affect the pharyngeal airway.

[Dentaoalveolar changes in young adult patients with class II/1 malocclusion treated with the herbst appliance and an activator].

BACKGROUND/AIM Functional appliances can be used effectively in the treatment of skeletal Class II/1 malocclusions. The best treatment results are obtained during active period of facial growth when skeletal, as well as dentoalveolar, changes occur. In comparison with removable functional appliances, such as activator, that are effective only during adolescent period of growth, the Herbst fixed appliance is also successful at the end of the growth period. It also offers a shorter treatment time and a patient compliance is not necessary. The aim of this study was to analyze and compare dentoalveolar changes in the group of young adult patients with Class II/1 malocclusion treated with the Herbst appliance and an activator. METHODS The sample for this study consisted of 50 patients of both sexes, 14-21 years of age with Class II/1 malocclusion. For estimating the effect of functional appliances used, the following cephalometrics parameters were determined: inclination of the upper and lower incisors, interincisal angle, antero-posterior molars relationships, overjet and overbite. The results obtained were statistically tested. RESULTS The cephalometric findings after the treatment indicated retroinclination of upper incisors (average value of 9 degrees) and proclination of lower incisors (average value of 7 degrees), mostly expressed in the patients treated by Herbst appliance (p < 0.001). Increased overjet and distocclusion were completely corrected in the group of patients treated with the Herbst appliance, while the correction of malocclusion in the activator group was only partially accomplished. No changes in the overbite were noticed at the end of the treatment in both groups. CONCLUSION The results of this study revealed that the Herbst appliance is more effective in the treatment of Class II/1 malocclusion in young adults in comparison with the activator.

Long-term influence of fixed lingual retainers on the development of gingival recession: A retrospective, longitudinal cohort study

OBJECTIVE To investigate the long-term influence of fixed lingual retainers on the development of mandibular gingival recession and to compare the prevalence with untreated individuals. MATERIALS AND METHODS The material consisted of 144 subjects: 96 orthodontically treated patients followed for 5 years after therapy and 48 untreated age-matched subjects. The treated patients were divided in two groups: one receiving a fixed mandibular retainer (n = 48) and one receiving no form of retention in the mandible (n = 48). The presence or absence of gingival recession and calculus accumulation were scored before treatment (T0), after debonding (T1), and 5 years after debonding (T5) for each tooth in the mandibular intercanine region using plaster models and intraoral photographs. The chi-square test, one-way ANOVA, and Cochrans Q test were used to evaluate inter- and intragroup differences. RESULTS The prevalence of patients with recession increased gradually and significantly throughout the observation periods in all groups, but the intergroup differences at T5 were not significant. Significantly more calculus accumulation was observed at T5 in the retainer group compared with the group without retainers. CONCLUSIONS Long-term presence of fixed lingual retainers does not seem to increase the development of mandibular gingival recession, but does increase calculus accumulation.

Application of occlusal indices in orthodontic practice

Introduction. Occlusal indices were designed to improve diagnostic criteria and to enable an objective assessment of malocclusion severity. The aim of this study was to present the most frequently used occlusal indices in orthodontic practice and to determine their reliability when applied to dental models. Material and Methods. Three occlusal indices were selected for analysis: the Index of Orthodontic Treatment Need (IOTN), the Peer Assessment Rating Index (PAR) and the Index of Complexity, Outcome and Need (ICON). Twenty dental models of patients referred to Department of Orthodontics, School of Dentistry, Belgrade, with malocclusions of different type and severity were used in this study. All dental models were measured by three afore mentioned indices twice, two months apart, in order to determine intraexaminer reliability. Results. The results showed that three indices had good reliability. Weighted Kappa was calculated for IOTN (0.72 and 0.79 for the aesthetic and the dental health component, respectively) and root mean square error was calculated for PAR and ICON (2.1 and 4.5, respectively). There was no statistically significant difference in scores between two measurements of these two indices (p<0.01). Conclusion. Application of occlusal indices enables orthodontists to determine priorities in patient care, planning of orthodontic service, monitoring and promotion of standards. Occlusal indices are reliable diagnostic criteria.

Craniofacial complex specificities in five men with sex reversal syndrome

In order to clarify the role of sex chromosome constitution in craniofacial growth control, we compared craniofacial morphology of men with sex reversal syndrome (46, XX) with the morphology of normal men, Klinefelter’s syndrome and normal women, using cephalometric measurements. Due to physical resemblance between men with 46, XX karyotype and men with 47, XXY karyotype, cephalometric analysis comprised parametres which had already been found to be specific for Klinefelter’s syndrome, i.e. cranial base length and flexion, maxillary and mandibular base length, jaw position in relation to cranial base and sagittal jaw relationship. Linear measurements showed reduction of about 10% in maxillary base length in 46, XX men in relation to normal men. Mandibular base in men with sex reversal syndrome was also shortened for about 10% in relation to both normal men and Klinefelter’s syndrome. Cranial base flexion in men with Klinefelter’s syndrome and in men with sex reversal syndrome showed similarity. The basal angle was found to be more acute, for about 4°, in comparison to individuals with normal karyotype. Unlike in men with Klinefelter’s syndrome, mandibular and maxillary prognathism were not registered in men with sex reversal syndrome.

Orthodontic treatment of nongrowing patient with class II division 2 malocclusion by Herbst appliance

BACKGROUND Inheritance is most casual etiological factor of Class II division 2 malocclusion. This kind of malocclusion is very difficult for treatment specially in older patients. CASE REPORT In the female patient, 20 years old, at the beginning of the treatment at the School of Dentistry in Belgrade, lateral cephalogram showed skeletal and dentoalveolar Class II division 2 malocclusion. She was in the Herbst treatment for 8 months and 12 months more with a fixed multibracket appliance. The measurements were performed on lateral cephalograms before and after the treatment: ii, is, mi, ms, Pg and ss. The distance from these points to occlusal perpendicular line (Olp) were measured and compared from cephalogram before to cephalogram after the treatment. Temporomandibular joint (TMJ) tomograms were compared from before and after the treatment by superimposition. Correction was found in molar and incisor relation, overjet and overbite. There were found sagital skeletal changes and soft tissue profile improvement. CONCLUSION Herbst appliance is effective in the treatment of Class II malocclusions, even in adult patients. Dental and skeletal changes as a result of Herbst treatment could be good choice instead of camouflage orthodontics or surgical decision.

Examination of Scanner Precision by Analysing Orthodontic Parameters

Summary Background: 3D modelling in orthodontics is becoming an increasingly widespread technique in practice. One of the significant questions already being asked is related to determining the precision of the scanner used for generating surfaces on a 3D model of the jaw. Materials and methods: This research was conducted by generating a set of identical 3D models on Atos optical 3D scanner and Lazak Scan laboratory scanner, which precision was established by measuring a set of orthodontic parameters (54 overall) in all three orthodontic planes. In this manner we explored their precision in space, since they are used for generating spatial models – 3D jaws. Results: There were significant differences between parameters scanned with Atos and Lazak Scan. The smallest difference was 0.017 mm, and the biggest 1.109 mm. Conclusion: This research reveals that both scanners (Atos and Lazak Scan), which belong to general purpose scanners, based on precision parameters can be used in orthodontics. Early analyses indicate that the reference scanner in terms of precision is Atos.

Dental occlusion analysis in the Mesolithic–Neolithic Age, Bronze Age, and Roman to Medieval times in Serbia: Tooth size comparison in skeletal samples

OBJECTIVE Anthropological studies have reported that tooth size decreases in the context of diet changes. Some investigations have found a reverse trend in tooth size from the prehistoric to the modern times. The aims of this study were to analyze tooth size in skeletal samples from Mesolithic-Neolithic Age, Bronze Age, and Roman to Medieval times to determine sex differences and establish a temporal trend in tooth size in the aforementioned periods. DESIGN Well-preserved permanent teeth were included in the investigation. The mesiodistal (MD) diameter of all teeth and buccolingual (BL) diameter of the molars were measured. Effects of sex and site were tested by one-way ANOVA, and the combined effect of these factors was analyzed by UNIANOVA. RESULTS Sexual dimorphism was present in the BL diameters of all molars and MD diameters of the upper first and the lower third molar. The lower canine was the most dimorphic tooth in the anterior region. The MD diameter of most teeth showed no significant difference between the groups, (sample from: Mesolithic-Neolithic Age-group 1; Bronze Age-group 2; Roman times-group 3; Medieval times-group 4), whereas the BL diameters of the upper second and the lower first molar were the largest in the first group. Multiple comparisons revealed a decrease in the BL diameter of the upper second and the lower first molar from the first to the later groups. Lower canine MD diameter exhibited an increase in the fourth group compared to the second group. CONCLUSION On the basis of the MD diameter, a temporal trend could not be observed for most of the teeth. The lower canine exhibited an increase in the MD diameter from the prehistoric to the Medieval times. Changes of BL diameter were more homogeneous, suggesting that the temporal trend of molar size decreased from the Mesolithic-Neolithic to Medieval times in Serbia.

The Treatment of Class III Malocclusion in Early Mixed Dentition: Two Case Reports/ Terapija malokluzija III klase u ranoj mešovitoj denticiji – prikaz dva slučaja

SUMMARY Class III malocclusion is orthodontic anomaly where mandibular arch is in mesial position to maxillary arch. Reasons for Class III malocclusion can be found in mandibular prognathism, maxillar retrognathism or combination of these two. In most cases of mandibular prognathism, it is necessary to postpone the treatment until the growth ceases. However, if certain conditions are accomplished it is possible to start early treatment of class III malocclusion to improve occlusal relations and provide more favorable environment for future growth. The aim of this study was to present treatment of two patients with Class III maloclussion in early mixed dentition, using two different appliances: Delaire mask and Frankel functional regulator type 3. The treatment with Delaire mask resulted in rotation of maxilla downward and forward due to the angle of extraoral part of the mask to the occlusal plane that was modified to be almost 45°. At the end of the treatment facial esthetics was significantly improved. Moving maxilla forward resulted in straight profile, whereas moving maxilla downward lead to coordination of upper, middle and lower facial third. The result of the treatment in patient who used Frankel functional regulator was correction of anterior crossbite by premaxilla development and incisors protrusion. Significant differences in SNA, SNB and ANB angle values at the beginning and at the end of the treatment were not found suggesting that most changes were dental but not skeletal KRATAK SADRŽAJ Skeletna malokluzija III klase je nesklad u međusobnom odnosu gornje i donje vilice, jer je donja vilica postavljena mezijalnije u odnosu na gornju. Uzrok nastanka skeletne malokluzije III klase može biti mandibularni prognatizam, maksilarni retrognatizam ili kombinacija ova dva uzroka. U slučaju isuviše razvijene donje vilice najčešće je potrebno sačekati završetak rasta, kako bi se primenilo konačno lečenje. Međutim, ako su ispunjeni određeni uslovi, moguće je primeniti ranu terapiju III klase, da bi se poboljšali okluzalni odnosi i obezbedila dobra osnova za dalji rast. Cilj ovog rada bio je da se prikaže terapijski efekat dva slučaja malokluzije III klase u ranom uzrastu pomoću različitih ortodontskih aparata: Delerove maske i Frenklovog regulatora funkcije tip 3. Kod pacijentkinje koja je tokom lečenja nosila Delerovu masku gornja vilica je zarotirana unapred i nadole, jer je ugao delovanja sile modifikovan da bude skoro 45 stepeni. Na kraju lečenja postignut je znatno bolji izgled lica. Pomeranjem gornje vilice unapred postignut je prav profil, dok je pomeranje nadole dovelo do usklađivanja visine srednje trećine lica sa gornjom i donjom. Kod pacijenta kod kojeg je tokom lečenja primenjena terapija Frenklovim regulatorom funkcije tip 3 do korekcije obrnutog preklopa sekutića došlo je kombinacijom razvijanja premaksile i protruzije sekutića. Značajne promene u vrednostima uglova SNA, SNB i ANB nisu zabeležene na kraju terapije u odnosu na početak, što bi ukazivalo na to da su postignute promene uglavnom dentalne, a ne skeletne.

Changes in Cervical Lordosis and Cervicovertebral Morphology in Different Ages with the Possibility of Estimating Skeletal Maturity.

INTRODUCTION During growth, proportions of craniofacial and cervical structures are changed. Craniofacial and cervicovertebral structures are morphologically and functionally connected, but their each others influence is still unknown. OBJECTIVE The aim of this study was to determine the changes in cervical lordosis and cervicovertebral morphology in different age periods and the possibility of estimating skeletal maturity, based on the percentage of anterior cervical vertebrae body height sum in the total anterior C2-C5 height. METHODS The study included lateral radiographs of 120 patients of both sexes, divided into three different age groups: eight, 12-13 and 17-18 years of age. Five craniofacial and 15 cervical parameters were measured and analyzed. RESULTS The results showed significant correlation between cervical lordosis angle and age, gender, anterior and posterior body height of C3, C4, C5, anterior C4-C5 and posterior C2-C3, C3-C4, C4-C5 intervertebral space, anterior body height of C2-C5. Overall values of all cervical body heights were more present in the total height of the spine in females, while all intervertebral spaces were more present in males. The percentage of anterior and posterior C2, C3, C4, C5 body height sum compared to total C2-C5 height increases with age. CONCLUSION The cervical lordosis becomes more curved and vertebral bodies occupy more space in females, while intervertebral spaces occupy more in males. Skeletal maturity could be estimated following vertebral percentage distribution in the total anterior C2-C5 part.