Ilana Brin

The Clinical Characteristics of Condylar Hyperplasia: Experience With 61 Patients

PURPOSE Much reported variation and discord exist regarding mandibular condylar hyperplasia (CH). This study evaluated some of the characteristics of this disorder in a series of 61 patients with active CH. PATIENTS AND METHODS A total of 61 patients with active temporomandibular CH who had been evaluated in our departments were included. Demographic, clinical, radiologic, and bone scintiscan data were collected and analyzed. Asymmetries were classified as transverse, vertical, or combined. RESULTS CH was diagnosed during the growth period in 22 patients, and 39 patients were older than 20 years (range, 11 to 80 years). In 66% of the patients, the main complaint was progressive facial asymmetry; and in the remainder, the main complaint was pain, dysfunction, or both. Transverse asymmetry predominated (52%), and vertical or combined asymmetry occurred in 31% and 16% of patients, respectively; asymmetry type was independent of age. The occlusal plane deviated in 48% of the patients. Laterality was significantly gender-biased (females, 72% right; males, 64% left; P = .017). The condylar head shape was normal in 15% of patients, deformed in 27%, and enlarged in 58%; the condylar neck was elongated in 69% and enlarged in 19%. All of these changes were uncorrelated with the type of asymmetry (vertical, transverse, or combined). CONCLUSIONS CH may occur at any age and is more prevalent in females. Clinicians should be aware that only some patients complain primarily of facial asymmetry, and that symptoms of temporomandibular disease also may be present. Because there is no correlation between the radiologic findings and the clinical evaluation, classification should be simplified and based on clinical manifestation only--in other words, the direction of asymmetry.

External apical root resorption in Class II malocclusion: a retrospective review of 1- versus 2-phase treatment.

External apical root resorption (EARR) is an imperfectly understood problem of orthodontic treatment. The records of 138 children with Class II malocclusion (overjet > 7 mm) participating in a randomized clinical trial of early orthodontic treatment were reviewed. The patients were treated in either 1 phase with fixed appliances only (n = 49) or 2 phases with headgear (n = 49) or bionator (n = 40) followed by fixed appliances. The 3 groups were similar in age, sex, and malocclusion severity at enrollment. The records examined included anamnestic data, clinical examination records, panoramic radiographs before and after fixed appliance therapy, and posttreatment periapical radiographs. All radiographs were reviewed and scored independently by 2 examiners for maxillary incisor root development, morphology, and EARR. Of the 532 incisors scored, 11% of central and 14% of lateral incisors demonstrated moderate to severe (>2 mm) EARR. The proportion of incisors with moderate to severe EARR was slightly greater in the 1-phase treatment group. There was no difference in the incidence of EARR between teeth that had had trauma and those that had not, and there was only a slight increase in frequency of root resorption in teeth with unusual root morphology. Significant associations exist among EARR, the magnitude of overjet reduction, and the time spent wearing fixed appliances. However, not all incisors in a child respond in the same way, so other variables must play a role in determining the root response to orthodontic forces.

Skeletal and functional effects of treatment for unilateral posterior crossbite

Unilateral posterior crossbite (UPXB) is a common malocclusion, frequently presenting a lower midline deviation, accompanied by Class II subdivision relationships in final closure and a very high prevalence of the reverse sequencing (RS) pattern of jaw movement. These features often persist even after the elimination of the crossbite. The purpose of the present study was to examine in detail the morphologic, skeletal, and functional effects of the treatment for this malocclusion category. The experimental group consisted of 24 children in the mixed dentition stage with UPXB who were treated with removable expansion plates and a control group of 10 age-matched children with normal occlusion. Longitudinal follow-up revealed a stable dental maxillary arch expansion of at least 1.5 mm but a complete elimination of crossbite in only 50% of the cases. The frequent persistence of Class II subdivision relations and lower midline deviation that were not due to functional mandibular shift was striking. The pretreatment posteroanterior (P-A) cephalograms indicated reduced facial and maxillary widths. After treatment, the achieved maxillary width increase was greater than expected with normal growth. Longitudinal assessment of the mandibular movement response revealed by the electrognathograph showed a high prevalence of RS, which was reduced after treatment. In conclusion, (1) a higher than expected prevalence of skeletal transverse aberrations at the maxillary and zygomatic levels were found in the UPXB group; (2) the removable expansion appliance induces transverse growth of the maxilla; and (3) an inherent pattern of jaw movement is characteristic to the UPXB and does not change significantly with orthodontic treatment.

Resorbed lateral incisors adjacent to impacted canines have normal crown size

The importance of detecting maxillary canine impaction is that it may compromise dental health, particularly since a small but significant proportion of impacted canines is associated with the resorption of the roots of neighboring teeth. It has been shown that the existence of small and peg-shaped lateral incisors is highly correlated with maxillary canine palatal impaction. To date, however, it has not been established whether the root resorption that occurs has a similar correlation or a predilection for one or other types of lateral incisor crown structure. Accordingly, a group of patients with buccally or palatally impacted canines, in which root resorption of the lateral incisor could be diagnosed roentgenographically, was examined and compared with a group of cases with palatally impacted canines, none of which showed root resorption, which served as controls. The mesiodistal crown dimension of the lateral incisor in the experimental group was found to be normal in all patients except three (13%), which was significantly different from the distribution of lateral incisor size in the control group (p < 0.001). In the majority of the cases, aggressive root resorption of the lateral incisor root had occurred. We would speculate that in these cases, the normal-sized and early developing lateral incisor root obstructs the deviated eruption path of the canine and consequently stands a considerably greater chance of being damaged by resorption.

Congenitally missing teeth in the Israeli cleft population.

Objective The purpose of the study was to determine the prevalence of congenitally missing teeth in a group of Israeli children with various types of clefts. Design Prevalence of congenitally missing teeth was determined for 179 children with cleft lip, cleft lip and alveolar ridge, cleft lip and palate, and cleft palate. Subgroupings were assessed according to patient sex, origin, cleft type, tooth type, and the side of hypodontia. The diagnosis of congenitally missing teeth (CMT) was based on initial and follow-up panoramic roentgenograms. In case of doubt, occlusal or periapical roentgenograms as well as clinical dental photographs were also used. Setting Data collection was conducted at the Rambam Medical Center, Orthodontic and Craniofacial Unit, Haifa, Israel. Results In the total cleft group, 67.6% of the patients presented with hypodontia, totaling 246 missing teeth. A statistically significant difference was found in the distribution of patients with CMT of Jewish and minority origin according to sex. Cleft lip and palate was the most frequently affected group in which 195 teeth were missing. The most frequently missing tooth among the cleft population was the maxillary incisor. The order of frequency of the other missing teeth was the same as in the normal population. Hypodontia and malformations of permanent teeth were most common on the cleft side. Conclusion The frequency of CMT in the Israeli cleft population studied was higher than in the intact population. This confirms findings in other populations worldwide.

Trauma as a possible etiologic factor in maxillary canine impaction

A chain of events in the development of the dentition following trauma is described. Shortening of the root of the lateral incisor or displacement of the tooth bud, both as a sequel to trauma, may affect the path of eruption of the adjacent canine after dental injury. Special attention should be paid to the further development and eruption of the directly and indirectly affected teeth.

Skeletodental patterns in patients with multiple congenitally missing teeth.

Congenitally missing teeth (CMT) are a relatively frequent phenomenon. In severe cases of multiple CMT, the skeletodental pattern can be unique. However, the characteristics of this pattern are still controversial. Thus, it was our aim to evaluate the skeletodental patterns of patients with multiple CMT and compare them with norms. Lateral cephalograms of 115 subjects with at least 3 CMT, of at least 2 different tooth groups (excluding third molars), were analyzed. The measurements were compared with classical and Israeli norms. Differentiation between anterior and posterior lack of teeth was also evaluated. In the CMT patients, the maxillary and mandibular basal bones were more retruded than in normal populations, but the intermaxillary relationship was normal. The profile was flatter than in the normal Israeli population but more convex than the classical norms. In the vertical dimension, the study group exhibited a reduced Frankfort mandibular plane angle when compared with Israeli norms. The dental pattern was characterized by upright incisors. When differentiation between anterior and posterior lack of teeth was undertaken, the above features were exacerbated in the patients with anterior tooth absence. It was concluded that patients with multiple CMT demonstrate a characteristic skeletodental pattern, especially those with missing incisors.

Skeletal and dental patterns in patients with severe congenital absence of teeth

INTRODUCTION Children with severe congenital absence of teeth present uncommon morphologies and therapeutic challenges. This study was designed to investigate the characteristic skeletal and dental features of this group. METHODS A group of 28 children with at least 10 congenitally missing teeth (excluding third molars) was examined roentgenographically. The data were collected from their intraoral series or panoramic views and lateral cephalograms. The results of their cephalometric analyses were compared with classic cephalometric norms and with local population norms. RESULTS Specific patterns of incisor, premolar, and third molar absence emerged. The cephalometric parameters of the children with severe absence differed from the classic norms in bimaxillary retrognathism, chin angle, and maxillary incisor inclination. These children differed from the Israeli norms in almost all parameters examined. CONCLUSIONS Patients with severe congenital absence of teeth have unique dental and skeletal patterns.

Cephalometric pattern of Jewish East European adolescents with clinically acceptable occlusion

Knowledge of the normal dentofacial patterns of various ethnic groups is important for clinical and research purposes. The objective of this study was to describe the dentofacial pattern of one Jewish ethnic group and to compare it with accepted standards for other white populations. Lateral cephalometric radiographs of 18 children of Jewish East European origin with clinically acceptable permanent occlusion, ages 11 to 13 years, were used. A computer-aided cephalometric analysis was performed, and the mean values and standard deviations for the various cephalometric variables were obtained. When compared with some classical standards, it was found that this ethnic group tended toward a mild skeletal Class II, a convex profile, and a more vertical direction of growth. These features appeared in persons selected on the basis of a clinically acceptable occlusion, suggesting the existence of dental compensations. Understanding these natural accommodations of the dentition to skeletal variations can be clinically useful when establishing treatment goals.

Prevalence of dental features that indicate a need for early orthodontic treatment

The aim of the study was to establish the prevalence of dental features that indicate a need for early orthodontic treatment (EOT). A group of schoolchildren in the mixed dentition stage (7-11 years old) (n = 432) was clinically screened for indications for EOT. Over 1/3 of the youngsters (34.7 per cent) presented at least one of the indications for EOT: anterior and posterior crossbites (including edge to edge occlusion) were found in 9.5 and 23.3 per cent, respectively; Angle Class III was found in 3 per cent; increased overjet (≥7 mm) prevailed in 3.7 per cent and was significantly related to risk for dental trauma (P = 0.001); while oral habits were practiced by 10.9 per cent, open bite was found only in 6.5 per cent, both predominantly among girls (P = 0.006 and P = 0.012, respectively); impinging overbite was present in 5.2 per cent, mainly in boys (P = 0.006); crowding >5 mm was found in 6.9 per cent for the maxilla and in 6 per cent for the mandible. Loss of tooth material affecting tooth position was found in 15.3 per cent. Normal occlusal relationships were found in 10.9 per cent only. The findings indicate that almost 1/3 of the examined children in the mixed dentition stage require EOT. Sexual dimorphism was demonstrated for several occlusal features.