Chester S. Handelman

The anterior alveolus: its importance in limiting orthodontic treatment and its influence on the occurrence of iatrogenic sequelae

Delineating the limits of orthodontic treatment in nongrowing individuals is important when making treatment decisions, especially in borderline orthodontic-surgical cases. The labial and lingual cortical plates at the level of the incisor apex may represent the anatomic limits of tooth movement. Cephalometric films of 107 adults were measured to determine the width of alveolar bone anterior and posterior to the incisor apex in each arch. Thin alveolar widths were found both labial and lingual to the mandibular incisors in groups of Class I, II, and III individuals with high SN-MP angle and in a group of Class III average SN-MP individuals. Thin alveolar widths were also found lingual to the maxillary incisors in a Class II high angle group. Clinical cases are presented showing that orthodontic tooth movement may be limited in patients with narrow alveolar bone widths and that these patients are likely to experience increased iatrogenic sequelae.

Growth of the Nasopharynx and Adenoid Development from One to Eighteen years

1. The dimensions of the nasopharynx, the adenoids and the nasopharyngeal airway were analyzed in twelve subjects selected from the longitudinal growth study of the Child Research Council of Denver. 2. The nasopharyngeal area was defined by four skeletally defined lines which formed a trapezoid. The nasopharyngeal area was divided into an adenoid-pharyngeal wall and airway areas which were measured using a polar planimeter. The trapezoid analysis proved to be a useful technique for quantification of nasopharyngeal dimensions. 3. The growth of the nasopharynx from nine months to 18 years was established and reflected the different growth patterns of males and females. 4. The sphenoid line/palatal line angle (theta) and nasopharyngeal depth were established early in life and contributed little to the increase of nasopharyngeal area. The increase in nasopharyngeal area corresponded to the descent of the palate from the sphenoid bone which increased nasopharyngeal height. 5. Restriction of the nasopharyngeal airway frequently occurred during the pre- and early school years due to adenoid hypertrophy which exceeded the usual increase in nasopharyngeal capacity. 6. The nasopharyngeal airway increased during pre- and early adolescence due to the concurrent increase in nasopharyngeal area and adenoid involution. 7. Ten subjects had a history of tonsil and adenoid surgery, but of these only five demonstrated what appeared to be complete removal of nasopharyngeal and adenoid tissue as seen on postsurgical radiographs. The possibility that surgical technique may be the critical factor in the completeness of adenoid removal is presented. 8. The mandibular angle did not apear to be affected by periods of nasopharnygeal airway obstruction is any of the subjects in this study. However, an expanded longitudinal study would be required to determine if restriction of the nasopharyngeal airway influences facial form and occlusion.

Prevalence and severity of apical root resorption and alveolar bone loss in orthodontically treated adults

This study assessed the frequency of root resorption and alveolar bone loss in 88 adults who had undergone orthodontic treatment. Pretreatment and posttreatment periapical radiographs were used to determine the amount of external apical root resorption and alveolar bone loss of the maxillary and mandibular incisors. Alveolar bone loss in the posterior quadrants was determined from bite-wing radiographs. The number of incisors showing root resorption, including blunting, increased from 15% before treatment to 73% after treatment. The number of incisors having moderate to severe apical root resorption was 2% before treatment and 24.5% after treatment. The number of anterior sites in which loss of alveolar bone height exceeded 2 mm from the cementoenamel junction to the alveolar crest increased from 19% before treatment to 37% after treatment; the number of posterior sites was 7% before treatment and 14% after treatment. Bone LOSS > or = 1.5 mm from the pretreatment to posttreatment stages occurred in 11% of the incisors and 3% of the posterior sites. A marked increase in the prevalence of root resorption and alveolar bone loss occurred over the course of treatment. The prevalence of iatrogenic effects for adults may be higher for incisors than in previously reported adolescent studies. A small subgroup with multiple sites of either root resorption or bone loss account for a disproportionate number of iatrogenic sequelae. However, in general, the iatrogenic experience did not preclude the orthodontic treatment of adults.

Nonsurgical rapid maxillary alveolar expansion in adults: a clinical evaluation.

Palatal expansion in adults has traditionally been performed on a very limited basis. The expansion has been thought to be limited in scope and stability and to be associated with unacceptable complications. Instead, surgically assisted rapid maxillary expansion (SA-RME) has been advocated. Five adults with transverse arch deficiency are presented to illustrate the feasibility of nonsurgical expansion using the Haas appliance. Transmolar expansions of 3.9 to 7.5 mm, sufficient to correct the malocclusions, were achieved. Limiting the rate of appliance activation is thought to be important to avoid pain, swelling, and ulceration. Measurements of molar axial angulation, facial divergence, and clinical crown heights demonstrated modest molar tipping, stable mandibular divergence, and only minimal gingival recession. Radiographs revealed minimal observable root resorption of the maxillary molars and premolars. Contour tracings of the palate indicated that most of the correction of the maxillary transarch deficiency occurred at the level of the lateral walls of the palate (the alveolar process) rather than in the skeletal base of the maxilla. For this reason the technique is defined as rapid maxillary alveolar expansion (RMAE). RMAE is an acceptable alternative to SA-RME in adults for most cases of maxillary transarch deficiency. This article is followed by a commentary by Robert L. Vanarsdall Jr., and by an authors response.

Bimaxillary Dentoalveolar Protrusion: Traits and Orthodontic Correction

A group of 48 ethnically diverse patients with bimaxillary protrusion was used to study the pretreatment cephalometric traits of this malocclusion and the effect of orthodontic correction. All patients were treated with four premolar extractions and retraction of the anterior teeth. Pre- and posttreatment lateral cephalograms were evaluated using a series of 18 linear and angular measurements, and the effect of orthodontic correction was determined using paired t-tests. Cephalometric standards were developed for bimaxillary protrusions, which clarify the overall presentation of this malocclusion for clinicians. Patients with bimaxillary protrusion demonstrated increased incisor proclination and protrusion, a vertical facial pattern, increased procumbency of the lips, a decreased nasolabial angle, and thin and elongated upper and lower anterior alveoli. This study also showed that the extraction of four premolars can be extremely successful in reducing the dental and soft tissue procumbency seen in patients with bimaxillary protrusion, thus providing a stronger evidence-based rationale for this treatment modality.

Occlusion and dental profile with complete bilateral cleft lip and palate.

Abstract No Abstract Available. Cleft Palate Clinic, Center for Handicapped Children, Research and Educational Hospitals, University of Illinois. This investigation was supported in part by grants from the Childrens Bureau and The National Institutes of Health. (HD DE 01153), Department of Health, Education and Welfare.

Palatal expansion in adults: The nonsurgical approach

4 The concept that nonsurgical maxillary expansion can be successful in adults has raised questions in the literature. Overall, the consensus is that, once patients are out of their teens, that type of expansion is no longer feasible, and instead, surgically assisted rapid maxillary expansion is necessary. The purpose of this article is to challenge this commonly accepted orthodontic paradigm. Let us assume that the first consult at your office is a 30-year-old woman with bilateral posterior and anterior crossbites with crowding of the maxillary left lateral incisor and edge-to-edge occlusion of the right lateral incisor. You estimate transarch deficiencies of 9 mm at the first premolars and 7.5 mm at the first molars. You suggest surgically assisted rapid maxillary expansion to correct the posterior occlusion and to gain arch length to correct the crossbite of the maxillary left lateral incisor. Surprised by the suggestion of surgery, the patient asks whether you can just correct the displaced lateral incisor. Obviously, she would much prefer that you treat her malocclusion without surgery. In 1997, I presented a series of 5 cases (including the one just described) on nonsurgical maxillary alveolar expansion in adults using the Haas expander. In a commentary on these 5 cases and in a letter to the editor, it was suggested that these 5 patients might have been selected for the excellence of the results and the lack of true skeletal deficiency. To move beyond the anecdotal case series, I collected the records of every adult patient in my office who had nonsurgical expansion with the Haas expander from 1978 to 1995. To this group of 29 subjects, I added 18 patients from the office of Dr Andrew Haas. This combined group of 47 adults (mean age, 30 years) became the adult nonsurgical expansion group in our study. We also looked at 2 additional groups: 47

Idiopathic/Progressive Condylar Resorption: An Orthodontic Perspective

Idiopathic condylar resorption (ICR), which is alternatively called progressive condylar resorption (PCR), is an uncommon aggressive form of degenerative disease of the temporomandibular joint (TMJ). It is usually encountered in adolescent and young females, although it has also been observed in males. Pathognomonic features of this condition include a loss of condylar mass, thereby decreasing the height of the ramus and length of the mandible, and an opening rotation of the mandible resulting in a Class II open bite.

Quantitative measures of gingival recession and the influence of gender, race, and attrition

BackgroundGingival recession in dentitions with otherwise healthy periodontium is a common occurrence in adults. Recession is clinically measured using a periodontal probe to the nearest millimeter. The aim of this study is to establish quantitative measures of recession, the clinical crown height, and a new measure the gingival margin-papillae measurement. The latter is seen as the shortest apico-coronal distance measured from the depth of the gingival margin to a line connecting the tips of the two adjacent papillae.MethodsMeasurements on all teeth up to and including the first molar were performed on pretreatment study models of 120 adult Caucasian and African-American subjects divided into four groups of 30 by gender and race.ResultsBoth the clinical crown height and the gingival margin-papillae measurements gave a true positive result for changes associated with gingival recession. Tooth wear shortens the clinical crown, and therefore, the measure of clinical crown height can give a false negative result when gingival recession is present. However, the gingival margin-papillae measurement was not affected by tooth wear and gave a true positive result for gingival recession. Tooth wear (attrition) was not associated with an increase in gingival recession. These measures are also useful in detecting recession prior to cemental exposure. Measures for recession and tooth wear were different for the four demographic groups studied.ConclusionsThese measures can be used as quantitative standards in both clinical dentistry, research, and epidemiological studies.

Nonextraction treatment of a Class II deepbite malocclusion with severe mandibular crowding: Visualized treatment objectives for selecting treatment options

A 14-year-old girl with Class II Division 2 malocclusion and a severe deepbite, retroclined incisors in both arches, and extreme crowding in the mandibular arch was treated by orthodontic residents, with supervision of the clinical faculty, at the University of Illinois at Chicago. A visualized treatment objective (VTO) was developed for the patient and used to select the best treatment alternative.