Efisio Defraia

Effectiveness of comprehensive fixed appliance treatment used with the Forsus Fatigue Resistant Device in Class II patients

OBJECTIVE To assess the dental, skeletal, and soft tissue effects of comprehensive fixed appliance treatment combined with the Forsus Fatigue Resistant Device (FRD) in Class II patients. MATERIALS AND METHODS Thirty-two Class II patients (mean age 12.7 ± 1.2 years) were treated consecutively with the FRD protocol and compared with a matched sample of 27 untreated Class II subjects (mean age 12.8 ± 1.3 years). Lateral cephalograms were taken before therapy and at the completion of comprehensive therapy. The mean duration of comprehensive treatment was 2.4 ± 0.4 years. Statistical comparisons were carried out with the Students t-test (P < .05). RESULTS The success rate was 87.5%. The FRD group showed a significant restraint in the sagittal skeletal position of the maxilla (also at the soft tissue level), a significant increase in mandibular length, and a significant improvement in maxillo-mandibular sagittal skeletal relationships. The treated group exhibited a significant reduction in overjet and a significant increase in molar relationship. The lower incisors were significantly proclined and intruded, while the lower first molars moved significantly in a mesial and vertical direction. CONCLUSIONS The FRD protocol is effective in correcting Class II malocclusion with a combination of skeletal (mainly maxillary) and dentoalveolar (mainly mandibular) modifications.

Maxillary dental anomalies in children with cleft lip and palate: a controlled study

OBJECTIVE To evaluate the prevalence of dental abnormalities of the primary and permanent maxillary dentitions in children affected by unilateral (UCLP) and bilateral (BCLP) cleft of the lip and palate. METHODS One hundred and fifty-six Caucasian patients (64 females and 92 males) affected by non-syndromic UCLP or BLCP were selected. A control sample of 1000 subjects (482 males and 518 females) without CLP was selected. All comparisons were carried out by means of z-tests on proportions. RESULTS The prevalence rate for missing primary lateral incisors in UCLP subjects was 8.1% and it was 27.9% for the permanent lateral incisors. In BLCP subjects, the prevalence rates were 17% for the primary lateral incisors and 60% for the permanent lateral incisors. The second premolar was absent in 5.4% of UCLP subjects and in 8.8% in the BCLP sample. The statistical analysis revealed significant differences for the prevalence rates of all dental anomalies compared with the control group except for second premolar agenesis. CONCLUSIONS In both UCLP and BCLP subjects the most prevalent missing teeth were the lateral incisors. The dental anomalies occurred predominantly in the cleft area, thus suggesting that the effect of the cleft disturbance is more local than general on the dentition.

Stability of rapid maxillary expansion and facemask therapy: A long-term controlled study

INTRODUCTION The aim of this prospective controlled study was to evaluate the long-term effects of rapid maxillary expansion and facemask therapy in Class III subjects. METHODS Twenty-two subjects (9 boys, 13 girls; mean age, 9.2 years ± 1.6) with Class III disharmony were treated consecutively with rapid maxillary expansion and facemask therapy followed by fixed appliances. The patients were reevaluated at the end of the 2-phase treatment (mean age, 14.5 years ± 1.9) and then recalled about 8.5 years after the end of rapid maxillary expansion and facemask treatment (mean age, 18.7 years ± 2.1). Two groups of controls with untreated Class III malocclusion were used for statistical comparisons of the short-term and long-term intervals. Statistical comparisons were performed with the Mann-Whitney U test. RESULTS In the long term, no significant differences in maxillary changes were recorded, whereas the treatment group showed significantly smaller increases in mandibular protrusion. The sagittal maxillomandibular skeletal variables maintained significant improvements in the treatment group vs the control groups. CONCLUSIONS In the long term, rapid maxillary expansion and facemask therapy led to successful outcomes in about 73% of the Class III patients. Favorable skeletal changes were mainly due to significant improvements in the sagittal position of the mandible.

Treatment and posttreatment outcomes induced by the Mandibular Advancement Repositioning Appliance; A controlled clinical study

OBJECTIVE To evaluate the treatment and posttreatment dentoskeletal effects induced by the Mandibular Advancement Repositioning Appliance (MARA) in the treatment of Class II malocclusion. MATERIALS AND METHODS The treated sample consisted of 23 consecutively treated patients at prepubertal or pubertal stages, as assessed by the cervical vertebral maturation method. A control group of untreated Class II subjects was generated from published normative growth data. Lateral cephalograms were digitized and superimposed via cephalometric software at three different times: T1, pretreatment; T2, post-MARA treatment; and T3, at least 1 year after T2. The T1-T2, T2-T3, and T1-T3 changes in the treated group were compared to those in the control group with independent-sample Students t-tests. RESULTS Skeletal and dentoalveolar effects of MARA were assessed after the active phase of the treatment (T1-T2). Mandibular elongation in length (Co-Gn, +2.2 mm) was evident together with lower incisor proclination (IMPA, +5.8 mm). A relapse tendency for IMPA was noticed after removing the appliance (IMPA, -2.1° during T2-T3). Significant skeletal effects (Co-Gn, +2.0 mm) and headgear effects on the maxilla (SNA, -1.2°) were significant in the long term (T1-T3). CONCLUSIONS The MARA appliance provides an effective correction of Class II malocclusion, which is maintained at a posttreatment observation with a moderate skeletal effect.

Periodontal Plastic Surgery to Improve Aesthetics in Patients with Altered Passive Eruption/Gummy Smile: A Case Series Study

Altered passive eruption/gummy smile is a common challenge in patients requiring aesthetic treatment. A specific surgical protocol was designed and tested in patients with altered passive eruption. Standardized preoperative X-rays were used to assess crown length at baseline and to place submarginal incisions. Osseous respective therapy was performed to achieve biological width. Clinical outcomes were recorded 6 months after surgery. Eleven patients with a total of 58 teeth were treated with flap surgery and osseous resective therapy at upper anterior natural teeth. At the last followup, a significant and stable improvement of crown length was obtained when compared to the baseline (P < 0.0001). All patients rated as satisfactory in the final outcomes (final VAS value = 86.6). In conclusion, this study showed that periodontal plastic surgery including osseous resection leads to predictable outcomes in the treatment of altered passive eruption/gummy smile: A careful preoperative planning avoids unpleasant complications and enhances postsurgical stability of the gingival margin.

Active-treatment effects of the Forsus fatigue resistant device during comprehensive Class II correction in growing patients.

Objective To evaluate the active-treatment effects of the Forsus fatigue resistant device (Forsus) during comprehensive correction of Class II malocclusion in growing patients. Methods Fifty-four patients (mean age, 12.5 ± 1.2 years) with Class II division 1 malocclusion were consecutively treated with fixed app-liances in combination with Forsus. Lateral cephalograms were analyzed at the beginning of the fixed treatment (T1), Forsus insertion (T2), its removal (T3), and end of the comprehensive therapy (T4). Statistical comparisons were carried out by repeated-measures ANOVA with Tukeys post-hoc test (p < 0.05). Results The overall therapeutic effects were mainly dentoalveolar and occurred mostly during the active treatment with Forsus (T2-T3, mean duration = 0.5 ± 0.1 years). The overjet and overbite decreased significantly (-3.5 and -1.5 mm, respectively) and the molar relationship improved by 4.3 mm. These changes were associated with significant retroclination of the maxillary incisors (-3.1°), proclination and intrusion of the mandibular incisors (+5.0° and -1.5 mm, respectively), and mesialization of the mandibular molars (+2.0 mm). Conclusions Forsus had mainly dentoalveolar effects and contributed largely to the overall therapeutic outcome.

Class II malocclusion with maxillary protrusion from the deciduous through the mixed dentition: a longitudinal study.

The aim of this study was to analyze the skeletal characteristics of Class II malocclusion with maxillary protrusion in the deciduous dentition and to describe the growth features of this type of skeletal imbalance during the transition from the deciduous through the mixed dentition. A group of 17 subjects having skeletal Class II malocclusions in the deciduous dentition due to maxillary protrusion was compared with a control group of 30 untreated subjects with ideal occlusion at the same stage of development. Both groups were observed for the first time in the deciduous dentition (T(1)) and followed during the transition from the deciduous to the mixed dentition (T(2)). During this time no orthodontic treatment was provided. Lateral cephalograms were taken for all subjects at T(1) and T(2). A cephalometric analysis was performed based on a reference system that consisted of two perpendicular lines traced through stable basicranical structures. The results indicate that a Class II skeletal pattern due to a maxillary protrusion is established early in the deciduous dentition and remains unmodified in the transition to the mixed dentition. The maxilla appeared to be displaced forward in Class II subjects, whereas the mandibles of the Class I and Class II subjects did not show any significant differences at this stage of growth. In the passage from the deciduous through the mixed dentition, Class I and Class II subjects showed growth increments that were not significantly different from each other. Sucking habits appeared to be correlated with the skeletal maxillary protrusion.

Glenoid fossa position in Class III malocclusion associated with mandibular protrusion

INTRODUCTION Our aim in this study was to investigate the position of the glenoid fossa in subjects with Class III malocclusion associated with mandibular protrusion to better clarify the role of this craniofacial component in Class III skeletal disharmony. METHODS A sample of 30 subjects, aged 8 years +/- 6 months, with skeletal and dental Class III malocclusion associated with mandibular protrusion, normal skeletal vertical relationships, and normal mandibular dimensions, was compared with a control group of 33 subjects with skeletal and dental Class I relationships. The comparisons between the Class III group and the control group on the cephalometric measures for the assessment of glenoid fossa position were performed with the Mann-Whitney U test at P <0.05. RESULTS Subjects with Class III malocclusion had a significantly more mesial position of the glenoid fossa, when compared with the control group as measured with 3 parameters. CONCLUSIONS An anterior position of the glenoid fossa is a possible diagnostic anatomic feature of Class III malocclusion associated with mandibular protrusion. An effective measurement to evaluate glenoid fossa position in craniofacial relationships is the cephalometric distance from the glenoid fossa to the frontomaxillary-nasal suture.

Tooth wear in the mixed dentition: a comparative study between children born in the 1950s and the 1990s.

The aim of this study was to evaluate the degree of tooth wear in posterior deciduous teeth of 100 subjects in the second phase of mixed dentition who were born in the 1950s (50sG) and 100 subjects born in the 1990s (90sG). The degree of abrasion for each posterior deciduous tooth was scored ranging from 0 to 3. The comparison of the degree of abrasion showed significant differences between the two groups for all examined teeth (upper and lower deciduous canines and first and second primary molars) all of which appeared to be more abraded in the 50sG. The findings of the present study indicate that subjects who were born in the 1950s exhibited a significantly greater degree of tooth wear on the posterior deciduous teeth when compared with contemporary subjects, along with a well-recognized lower prevalence of malocclusions. Changes in dietary habits and a diet based on processed foods may be postulated as factors involved with a decrease of dental attrition in contemporary populations. An increase in the prevalence of mouth breathing (tested in the present study) appears to be associated with a decrease in tooth wear in the contemporary population as well.

Treatment effects produced by the Twin-block appliance vs the Forsus Fatigue Resistant Device in growing Class II patients

OBJECTIVE To compare the dentoskeletal changes produced by the Twin-block appliance (TB) followed by fixed appliances vs the Forsus Fatigue Resistant Device (FRD) in combination with fixed appliances in growing patients having Class II division 1 malocclusion. MATERIALS AND METHODS Twenty-eight Class II patients (19 females and 9 males; mean age, 12.4 years) treated consecutively with the TB followed by fixed appliances were compared with a group of 36 patients (16 females and 20 males; mean age, 12.3 years) treated consecutively with the FRD in combination with fixed appliances and with a sample of 27 subjects having untreated Class II malocclusion (13 females and 14 males; mean age, 12.2 years). Mean observation interval was 2.3 years in all groups. Cephalometric changes were compared among the three groups by means of ANOVA and Tukeys post hoc tests. RESULTS The FRD produced a significant restraint of the maxilla compared with the TB and control samples (SNA, -1.1° and -1.8°, respectively). The TB sample exhibited significantly greater mandibular advancement and greater increments in total mandibular length than either the FRD or control groups (SNB, 1.9° and 1.5°, respectively; and Co-Gn, 2.0 mm and 3.4 mm, respectively). The FRD produced a significantly greater amount of proclination of the mandibular incisors than what occurred with the TB or the control samples (2.9° and 5.6°, respectively). CONCLUSION The TB appliance produced greater skeletal effects in terms of mandibular advancement and growth stimulation while the Forsus caused significant proclination of the mandibular incisors.