Dietmar Gesch

New regression equations for predicting the size of unerupted canines and premolars in a contemporary population.

The determination of a tooth-size to arch-length discrepancy in the mixed dentition requires an accurate prediction of the mesiodistal widths of the unerupted permanent teeth. This is an essential factor in treatment planning. The aim of this study was to validate Tanaka and Johnstons analysis on 600 Syrian patients aged 14-22 years. Tanaka and Johnstons tables, equations, and approximations were modified in order to improve the accuracy of the prediction. The correlation coefficients found between the size of the permanent mandibular central incisors and maxillary first molars (31, 41, 16, and 26) and the maxillary and mandibular canines and premolars were high (r = .72 and .74, respectively). New, more accurate prediction tables applicable at earlier ages, and new regression equations were constructed. In addition, new easier approximations were developed to allow the prediction of the size of the unerupted maxillary canines and premolars by adding 6 mm to the half-widths of teeth 31, 41, 16, and 26. The analogous prediction of the size of the unerupted mandibular canines and premolars was obtained by adding 5.5 mm to the half-widths of same teeth, 31, 41, 16, and 26.

Association of malocclusion and functional occlusion with signs of temporomandibular disorders in adults: results of the population-based study of health in Pomerania.

The objective of this study was to determine whether associations exist between occlusal factors and signs of temporomandibular disorders (TMD) in adults using the population-based Study of Health in Pomerania (SHIP), Germany. A representative sample of 4310 men and women aged 20 to 81 years (response 68.8%) was investigated for TMD signs, malocclusions, functional occlusion factors, and sociodemographic parameters. Multiple logistic regression analysis, adjusted for sex, age, and socioeconomic status, was used. The results were compared with other population-based studies identified by a systematic review. Few malocclusions and no factors of functional occlusion except socioeconomic parameters were associated with TMD signs, and these associations were mostly weak. Only bilateral open bite up to three mm appeared to be clinically relevant and was associated with TMD signs (odds ratio [OR] = 4.0). This malocclusion, however, was of rare occurrence, with a prevalence of 0.3% (n = 9), and this finding was not confirmed by other representative studies. Occlusal factors examined in this study explained only a small part of the differences between normal subjects and those with TMD signs. This and other population-based studies indicate that malocclusions and factors of functional occlusion surveyed should be seen as merely cofactors in the sense of one piece of the mosaic in the multifactorial problem of temporomandibular dysfunction. Single occlusal factors that showed significant effects throughout several studies could not be detected. In view of the large number of occlusal variables already investigated, other variables including nonocclusal ones probably also play a role and should be looked at more intensely.

Periodontal disease, but not edentulism, is independently associated with increased plasma fibrinogen levels Results from a population-based study

The systemic response to periodontal disease was analyzed in the cross-sectional Study of Health in Pomerania (SHIP). The completed data of 2,738 subjects aged 20 to 59 years were used for logistic regression analysis with an increased plasma fibrinogen level (> or =3.25 g/L according to Clauss) as the dependent variable. Participants were divided into four groups according to the number of periodontal pockets > or =4 mm (0, 1-7, 8-14, > or =15 pocketing). An additional group comprised the 52 edentulous subjects. The adjusted odds ratio (OR) of > or =15 periodontal pockets for increased plasma fibrinogen levels was 1.88 (95% CI: 1.25-2.83). Edentulism per se was not associated with increased plasma fibrinogen levels but was contained in a two-way interaction with the number of cigarettes/day in current smokers (p = 0.031). For edentulous nonsmokers the adjusted OR was 1.10 (95% CI: 0.51-2.39). Furthermore, body mass index, the interaction between gender and body mass index, serum LDL cholesterol, medication, the interaction between LDL cholesterol and medication, aspirin, smoking, school education, chronic bronchitis, and the interaction between alcohol consumption and chronic gastritis were associated with plasma fibrinogen levels. Our results show that periodontal disease but not edentulism per se is associated with an increased plasma fibrinogen level.

Malocclusions and clinical signs or subjective symptoms of temporomandibular disorders (TMD) in adults. Results of the population-based Study of Health in Pomerania (SHIP).

Abstract.Aim and Method:The objective was to determine with reference to a representative sample of 4310 men and women aged 20 to 81 (response rate 68.8%) drawn from the population-based Study of Health in Pomerania (SHIP-0) whether associations exist between malocclusions and temporomandibular dysfunctions in adults. Besides clinically investigated signs, subjectively perceived symptoms of temporomandibular disorders (TMD) were studied in each individual together with malocclusions (plus normal occlusion), functional occlusion factors, and sociodemographic parameters. A multivariate logistic regression analysis was used, adjusted for age and discriminated for gender. The results were compared with those of other population-based studies identified by a systematic review undertaken by the present authors.Results:Some malocclusions were associated with signs or symptoms of TMD but tended to occur only rarely: unilateral open bite, negative overjet, and unilateral scissors-bite in men, and edge-to-edge bite in women. However, malocclusions (and functional occlusion factors) accounted for only a small part of the differences between the control population and the study population with signs or symptoms of TMD. In terms of the multifactorial problem of temporomandibular disorders they should be seen as cofactors. The results, together with those of other population-based studies, revealed no specific, i. e. recurring malocclusions (or other occlusal factors) presenting as risk markers.Zusammenfassung.Ziel und Methodik:Ziel war es, auf Basis der bevölkerungsrepräsentativen Study of Health in Pomerania (SHIP-0) anhand einer repräsentativen Stichprobe von 4310 Männern und Frauen im Alter von 20 bis 81 Jahren (Responserate 68,8%) festzustellen, ob Zusammenhänge bestehen zwischen Malokklusionen und temporomandibulären Dysfunktionen (TMD) bei Erwachsenen. Neben klinisch untersuchten Zeichen wurden anamnestisch erhobene, subjektiv empfundene TMD-Symptome je Studienteilnehmer untersucht sowie Malokklusionen (plus Eugnathie), Faktoren der funktionellen Okklusion und soziodemographische Parameter. Verwendet wurde die multivariate logistische Regressionsanalyse, adjustiert nach Alter und differenziert nach Geschlecht. Die Ergebnisse wurden mit anderen bevölkerungsrepräsentativen Studien eines eigenen systematischen Reviews verglichen.Ergebnis:Einige Malokklusionen waren mit TMD-Zeichen und -symptomen assoziiert, kamen jedoch nur eher selten vor: Bei Männern waren dies der einseitig offene Biss, die umgekehrte Frontzahnstufe und die einseitige bukkale Nonokklusion, bei Frauen der anteriore Kreuzbiss. Malokklusionen (und Faktoren der funktionellen Okklusion) erklärten jedoch nur einen kleinen Teil der Unterschiede zwischen der Kontrollpopulation und der Population von Fällen mit TMD-Zeichen oder -symptomen. Bezüglich des multifaktoriellen Problems der TMD sollten sie als Kofaktoren gesehen werden. Zusammen betrachtet mit anderen bevölkerungsrepräsentativen Studien stachen keine bestimmten, d. h. wiederholt auftretenden Malokklusionen (oder andere okklusalen Faktoren) als Risikomarker hervor.

A longitudinal study on growth in untreated children with angle class II, division 1 malocclusion

The aim of this longitudinal study was to analyze growth-related changes in untreated Class II, Division 1 subjects. Forty untreated Swedish children with Angle Class II, Division 1 malocclusion were cephalometrically examined. The average age of the total group was 10.1 years at the first examination and 12.0 at the second. In addition to statistical comparisons of the average values of variables at both time points, multivariate analyses (harmony box according to Hasund and Segner, regression equation analyses) were also performed. This permitted individual evaluation of skeletal structures, position of incisors, and the soft tissue profile relative to the given craniofacial configuration.With the ANB angle remaining unchanged, both jaws were transposed ventrally. The reduction of the angle between the palatal and mandibular planes and the gonial angle was accompanied by anterior rotation of the mandible. The lower incisors protruded, and upper and lower first molars exhibited a translation to ventrocaudal. According to harmony box analysis, the most frequent cause of a distal relationship between the 2 jaws was a disharmoniously anterior shift of the maxilla. This was confirmed by the additional analysis of the available unpublished raw data from untreated Norwegian and Munich Class II/1 subjects and from other studies. In such cases, orthodontic treatment methods exerting a growth-inhibitory effect on the maxilla should be used.ZusammenfassungZiel der longitudinalen Studie war es, die wachstumsbedingten Veränderungen bei unbehandelten Klasse-II/1-Probanden zu analysieren.Röntgenkephalometrisch untersucht wurden 40 unbehandelte schwedische Kinder mit einer Angle-Klasse-II/1-Malokklusion. Das durchschnittliche Alter der Gesamtgruppe betrug zum ersten Zeitpunkt 10,1, zum zweiten Zeitpunkt 12,0 Jahre. Neben statistischen Mittelwertvergleichen der Variablen beider Zeitpunkte wurden multivariate Analyseverfahren (Harmoniebox nach Hasund und Segner, Regressionsgleichungsanalysen) eingesetzt. Dadurch konnten die basalen Strukturen, die Frontzahnstellung sowie das Weichteilprofil individuell in Bezug zur vorliegenden Schädelgesichtskonfiguration beurteilt werden.Bei gleichbleibendem ANB-Winkel verlagerten sich beide Kiefer nach ventral. Die Verkleinerung des Interbasenwinkels und des Kieferwinkels ging mit einer Anteriorrotation der Mandibula einher. Die unteren Frontzähne protrudierten, obere und untere erste Molaren zeigten eine Translation nach ventrokaudal. Nach der Harmonieboxanalyse war die häufigste Ursache für die distale Kieferbasenrelation eine disharmonisch vorverlagerte Maxilla.Dies wurde durch die zusätzliche Auswertung der zur Verfügung stehenden unveröffentlichten Rohdaten unbehandelter norwegischer und Münchner Klasse-II/1-Probanden und anderer Studien bestätigt. In diesen Fällen sind jene kieferorthopädischen Therapiemittel zu bevorzugen, die einen wachstumshemmenden Effekt auf den Oberkiefer ausüben.

Prevalence of Defined Symptoms of Malocclusion among Probands Enrolled in the Study of Health in Pomerania (SHIP) in the Age Group from 20 to 49 Years

Abstract.Subjects and Methods: SHIP is a complexly structured, population-based cross-sectional study of adults in the German region of Pomerania (age group covered: 20–79 years). Findings in a population subgroup (age group 20–49 years; n = 1777; 53.1% women; 46.9% men) were subjected to orthodontic evaluation. Graduated registration of anterior crowding, overjet, frontal overbite and sagittal intermaxillary relationship of the posterior teeth; registration of ectopic canines, posterior crowding, anterior and posterior crossbite, negative overjet, retroclination of the upper incisors, buccal nonocclusion, and lateral open bite. The prevalence of almost regular dentition and of symptoms of malocclusion as well as the frequency of orthodontic treatment (subjective patient data) undergone by men and women were recorded. The correlation between the registered symptoms of malocclusion was calculated. Results: 92.2% of the subjects had symptoms of malocclusion varying in number and severity. An anatomically correct dentition was found in only 7.8% of cases, and an “almost regular dentition” (inclusion criteria defined) in 14.2%. 32.8% of the subjects had severe malocclusion (inclusion criteria defined). The most frequent symptoms were anterior crowding, increased overjet, and distoclusion. These symptoms were significantly more frequent in women, while spacing and edge-to-edge bite, excessive overbite and mesioclusion were more frequent in men. 26.7% of the probands (28.0% women, 25.3% men) reported having received orthodontic treatment. The prevalence of craniofacial malformations (cleft lip and palate, syndromes) was 0.09% in women and 0.2% in men. Increased overjet was most frequently correlated with other symptoms of malocclusion.Zusammenfassung.Probanden und Methoden: SHIP ist eine komplex aufgebaute populationsbasierte Querschnittstudie an erwachsenen Personen der deutschen Region Vorpommern (erfasste Altersgruppe 20–79 Jahre). In einer Teilpopulation (Altersgruppe 20–49 Jahre; n = 1 777; 53,1% weiblich; 46,9% männlich) wurden kieferorthopädische Befunde ausgewertet: graduierte Erfassung des Platzmangels im Frontzahnbereich, der sagittalen und vertikalen Frontzahnbeziehung, der sagittalen Seitenzahnreihenbeziehung; Erfassen von Eckzahnaußenstand, lateralem Platzmangel, frontalem und lateralem Kreuzbiss, umgekehrter Frontzahnstufe, Steilstellung der Inzisivi im Oberkiefer, bukkaler Nonokklusion sowie seitlich offenem Biss. Bestimmung der Prävalenzen nahezu regelrechter Gebisse und der erhobenen Dysgnathiesymptome sowie der Häufigkeit durchgeführter kieferorthopädischer Behandlungen (Interviewangabe) bei Männern und Frauen. Berechnung der Korrelationen zwischen den registrierten Dysgnathiesymptomen. Ergebnisse: 92,2% der Probanden haben Dysgnathiesymptome in unterschiedlicher Zahl und Ausprägung. Ein anatomisch korrektes Gebiss liegt nur in 7,8% der Fälle vor, ein “nahezu regelrechtes Gebiss” (Einschlusskriterien definiert ) in 14,2%. 32,8% der Probanden haben Dysgnathien schweren Umfangs (Einschlusskriterien definiert). Häufigste Symptome: frontaler Engstand, vergrößerter Overjet, Distalokklusion. Diese Symptome sind bei Frauen signifikant häufiger, Platzüberschuss und Kopfbiss im Frontzahnbereich, vergrößerter Overbite und Mesialokklusion bei Männern. 26,7% der Studienteilnehmer gaben an, in kieferor-thopädischer Behandlung gewesen zu sein (28,0% Frauen, 25,3% Männer). Die Prävalenz kraniofazialer Fehlbildungen (Spaltbildungen, Syndrome) liegt bei Frauen bei 0,09% und bei Männern bei 0,2%. Der vergrößerte Overjet ist am häufigsten mit anderen Dysgnathiesymptomen korreliert.

Presurgical nasoalveolar molding in patients with unilateral clefts of lip, alveolus and palate. Case study and review of the literature

INTRODUCTION The case of a newborn female patient with unilateral cleft lip, alveolus and palate is presented with a markedly sunken nasal wing at the cleft side. This finding may lead to a very unsatisfactory aesthetic result after primary cheiloplasty and nasoplasty. PATIENT AND METHOD Five months prior to surgery, the patient was treated with a palatal plate and additionally with a nasoalveolar conformer for 4 months thereof. The device consisted of an acrylic pelotte (attached to the maxillary plate with a wire) which lifted the nasal dome and was activated regularly. Under this presurgical treatment, the cleft edges moved closer to each other by 1.8 mm at the alveolar ridge and by 4.5 mm in the palatal area. The nasal wing was lifted by 5 mm. This was enabling elevation of the nasal wing during primary surgery in the case described. Questions are raised as to the remaining effects on nasal symmetry until completion of growth and, on the other hand, as to the chances to reduce postsurgical alar relapse by continued nasal molding beyond primary surgery. CONCLUSION Presurgical nasal molding seems to improve aesthetics of the nose in patients with unilateral clefts of lip, alveolus and palate and distinctly flattend nasal wings.

Malocclusions and Clinical Signs or Subjective Symptoms of Temporomandibular Disorders (TMD) in Adults

Abstract.Aim and Method:The objective was to determine with reference to a representative sample of 4310 men and women aged 20 to 81 (response rate 68.8%) drawn from the population-based Study of Health in Pomerania (SHIP-0) whether associations exist between malocclusions and temporomandibular dysfunctions in adults. Besides clinically investigated signs, subjectively perceived symptoms of temporomandibular disorders (TMD) were studied in each individual together with malocclusions (plus normal occlusion), functional occlusion factors, and sociodemographic parameters. A multivariate logistic regression analysis was used, adjusted for age and discriminated for gender. The results were compared with those of other population-based studies identified by a systematic review undertaken by the present authors.Results:Some malocclusions were associated with signs or symptoms of TMD but tended to occur only rarely: unilateral open bite, negative overjet, and unilateral scissors-bite in men, and edge-to-edge bite in women. However, malocclusions (and functional occlusion factors) accounted for only a small part of the differences between the control population and the study population with signs or symptoms of TMD. In terms of the multifactorial problem of temporomandibular disorders they should be seen as cofactors. The results, together with those of other population-based studies, revealed no specific, i. e. recurring malocclusions (or other occlusal factors) presenting as risk markers.Zusammenfassung.Ziel und Methodik:Ziel war es, auf Basis der bevölkerungsrepräsentativen Study of Health in Pomerania (SHIP-0) anhand einer repräsentativen Stichprobe von 4310 Männern und Frauen im Alter von 20 bis 81 Jahren (Responserate 68,8%) festzustellen, ob Zusammenhänge bestehen zwischen Malokklusionen und temporomandibulären Dysfunktionen (TMD) bei Erwachsenen. Neben klinisch untersuchten Zeichen wurden anamnestisch erhobene, subjektiv empfundene TMD-Symptome je Studienteilnehmer untersucht sowie Malokklusionen (plus Eugnathie), Faktoren der funktionellen Okklusion und soziodemographische Parameter. Verwendet wurde die multivariate logistische Regressionsanalyse, adjustiert nach Alter und differenziert nach Geschlecht. Die Ergebnisse wurden mit anderen bevölkerungsrepräsentativen Studien eines eigenen systematischen Reviews verglichen.Ergebnis:Einige Malokklusionen waren mit TMD-Zeichen und -symptomen assoziiert, kamen jedoch nur eher selten vor: Bei Männern waren dies der einseitig offene Biss, die umgekehrte Frontzahnstufe und die einseitige bukkale Nonokklusion, bei Frauen der anteriore Kreuzbiss. Malokklusionen (und Faktoren der funktionellen Okklusion) erklärten jedoch nur einen kleinen Teil der Unterschiede zwischen der Kontrollpopulation und der Population von Fällen mit TMD-Zeichen oder -symptomen. Bezüglich des multifaktoriellen Problems der TMD sollten sie als Kofaktoren gesehen werden. Zusammen betrachtet mit anderen bevölkerungsrepräsentativen Studien stachen keine bestimmten, d. h. wiederholt auftretenden Malokklusionen (oder andere okklusalen Faktoren) als Risikomarker hervor.

Examiner differences in the assessment of different malocclusions.

Background:In the current discussion about ensuring treatment quality and reducing costs in the health sector, indication systems with which to determine the need for a treatment and the success of therapy are increasingly being used in orthodontics. These indication systems require the objective evaluation of malocclusions. Our objective was to determine the examiner reliability in the assessment of various malocclusions.Materials and Methods:In 180 adults (64 male, 116 female, aged 20–49) from the population-based Study of Health in Pomerania (SHIP), malocclusions were recorded clinically and on models by calibrated examiners. An experienced orthodontist conducted the clinical examination. Another orthodontically-experienced examiner analyzed the models. To compare the model examiners, two examiners with varying degrees of orthodontic experience evaluated 60 of the 180 models as well (29 male, 31 female). One of the model examiners repeated the assessment of 60 models at a later time (intra-individual comparison).Results and Conclusions:Reliability amongst the examiners depended on which malocclusions were judged: crowding and contact point displacement showed little agreement, while cross bite, edge-to-edge bite, deep bite and enlarged overjet revealed greater agreement.Comparison between the clinical examination and model analysis (kappa median 0.57) revealed the greatest differences between the examiners. Comparison of the three model examiners also showed differences. The contrast to the orthodontically least experienced examiner was greater (kappa median 0.61 and 0.62) than the divergence between the two orthodontically more experienced examiners (kappa median 0.70). The intra-individual examiner comparison revealed the smallest differences (kappa median 0.82).ZusammenfassungHintergrund:In der aktuellen Diskussion um Qualitätssicherung und Kostensenkung im Gesundheitswesen werden in der Kieferorthopädie zunehmend Indikationssysteme angewendet, die den Behandlungsbedarf bzw. den Behandlungserfolg erfassen sollen. Diese Indikationssysteme setzen eine objektive Bewertung der ihnen zugrunde liegenden Dysgnathiesymptome voraus. In der vorliegenden Untersuchung soll erörtert werden, wie gut die Befunde mehrerer Untersucher bei der Erhebung unterschiedlicher Dysgnathiesymptome übereinstimmen.Material und Methodik:Bei 180 erwachsenen Probanden (64 männlich, 116 weiblich, im Alter von 20–49 Jahren) der Studie „Study of Health in Pomerania∘(SHIP) wurden von kalibrierten Untersuchern kieferorthopädische Dysgnathiesymptome klinisch und am Modell erhoben. Die klinische Untersuchung erfolgte durch eine erfahrene Kieferorthopädin, die Modellanalyse ebenfalls durch eine kieferorthopädisch erfahrene Untersucherin. Für einen reinen Modelluntersuchervergleich werteten zwei kieferorthopädisch unterschiedlich erfahrene Untersucher 60 der 180 Modelle (29 männlich, 31 weiblich) zusätzlich aus. Die Hauptmodelluntersucherin wiederholte ihre eigene Auswertung an 60 Modellen zeitversetzt (intraindividueller Vergleich).Ergebnisse und Schlussfolgerungen:Die Untersucherunterschiede hingen vom zu beurteilenden Dysgnathiesymptom ab. Engstand/Kontaktpunktabweichung zeigten geringe Übereinstimmungen in allen Untersuchungsgruppen, während für Kreuzbiss, Kopfbiss, Tiefbiss und die vergrößerte sagittale Frontzahnstufe höhere Übereinstimmungen ermittelt wurden.Im Vergleich der klinischen Untersuchung mit der Modellauswertung (Kappa-Median 0,57) zeigten sich die größten Untersucherunterschiede. Auch beim Vergleich der drei Modelluntersucher untereinander waren Unterschiede feststellbar, wobei der Vergleich mit dem kieferorthopädisch unerfahrenen Untersucher größere Unterschiede aufwies (Kappa-Median 0,61 und 0,62) als der Vergleich der kieferorthopädisch erfahrenen Untersucher untereinander (Kappa-Median 0,70). Die geringsten Untersucherunterschiede fanden sich im intraindividuellen Vergleich (Kappa-Median 0,82).

Comparison of craniofacial morphology in patients with unilateral cleft lip, alveolus and palate with and without secondary osteoplasty

PROBLEM What kind of skeletal differences do exist between juvenile patients with unilateral cleft lip, alveolus and palate treated with or without secondary osteoplasty, and between cleft patients and non-cleft patients? PATIENTS AND METHODS Thirty-nine patients with unilateral cleft lip, alveolus and palate at a mean age of 15.8 years who were surgically treated with (n = 18) and without (n 21) secondary osteoplasty were compared with a control group of non-cleft patients (mean age 15.1 years). The patients were analyzed using lateral cephalograms. Cephalometric analysis included common sagittal and vertical variables as well as measurements of anterior tooth position and soft-tissue profile. RESULTS Analysis of lateral cephalograms revealed no significant differences between the two groups of cleft patients. The differences in comparison with the control group mainly revealed maxillary retroposition, a vertically open configuration, a steep position of the upper and lower anterior teeth and a decreased Holdaway-angle (flat midface). CONCLUSION Secondary osteoplasty exhibited no significant influence on craniofacial growth in children with unilateral cleft lip and palate. Both groups of cleft patients are not markedly different regarding sagittal and vertical skeletal configurations.