Ivana Scepan

[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.

Growth hormone positive effects on craniofacial complex in Turner syndrome.

OBJECTIVE Turner syndrome occurs in phenotypic females with complete or partial absence of X chromosome. The leading symptom is short stature, while numerous but mild stigmata manifest in the craniofacial region. These patients are commonly treated with growth hormone to improve their final height. The aim of this study was to assess the influence of long-term growth hormone therapy on craniofacial morphology in Turner syndrome patients. DESIGN In this cross-sectional study cephalometric analysis was performed on 13 lateral cephalograms of patients with 45,X karyotype and the average age of 17.3 years, who have received growth hormone for at least two years. The control group consisted of 13 Turner syndrome patients naive to growth hormone treatment, matched to study group by age and karyotype. Sixteen linear and angular measurements were obtained from standard lateral cephalograms. Standard deviation scores were calculated in order to evaluate influence of growth hormone therapy on craniofacial components. RESULTS In Turner syndrome patients treated with growth hormone most of linear measurements were significantly larger compared to untreated patients. Growth hormone therapy mainly influenced posterior face height, mandibular ramus height, total mandibular length, anterior face height and maxillary length. While the increase in linear measurements was evident, angular measurements and facial height ratio did not show statistically significant difference. Acromegalic features were not found. CONCLUSIONS Long-term growth hormone therapy has positive influence on craniofacial development in Turner syndrome patients, with the greatest impact on posterior facial height and mandibular ramus. However, it could not compensate X chromosome deficiency and normalize craniofacial features.

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.

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.