Joydeep Ghosh

Evaluation of an intraoral maxillary molar distalization technique

The purpose of this study was to determine the effects of the pendulum appliance on distalization of maxillary molars and the reciprocal effects on the anchor premolars and maxillary incisors. Initial and follow-up cephalometric radiographs were obtained on 41 subjects (26 girls and 15 boys) who were treated with the pendulum appliance for bilateral distalization of the maxillary first molar teeth, for correction of the Class II molar relationship or for gaining space in the maxillary arch. Dental casts were available on 31 patients. Dental, skeletal, and soft tissue changes were determined. The mean maxillary first molar distalization was 3.37 mm, with a distal tipping of 8.36 degrees. The mean reciprocal mesial movement of the first premolar was 2.55 mm, with a mesial tipping of 1.29 degrees. The maxillary first molar position intruded 0.1 mm, whereas the first premolar extruded 1.7 mm. The transverse width between the mesiobuccal cusps of the first molars increased 1.40 mm. The maxillary second molars were also distalized 2.27 mm, tipped distally 11.99 degrees, and moved buccally 2.33 mm. The effect of distalization on the maxillary third molars was extremely variable. The eruption of maxillary second molars had minimal effect on distalization of first molars. The lower anterior face height increased by 2.79 mm. This increase was greater in patients with higher Frankfort-mandibular plane angle measurements. The pendulum appliance is an effective and reliable method for distalizing maxillary molars, provided the anchor unit is adequately reinforced. Its major advantages are minimal dependence on patient compliance, ease of fabrication, one-time activation, adjustment of the springs if necessary to correct minor transverse and vertical molar positions, and patient-acceptance.

Tomographic assessment of temporomandibular joints in patients with malocclusion

There is a paucity of information on the morphological assessment of the temporomandibular joint in relation to varying skeletal and dental relationships. The purpose of this study was to evaluate the morphologic relationship of the condyle and fossa in patients with different malocclusions and skeletal relationships. Pretreatment records of 232 orthodontic patients, 95 males and 137 females, of Caucasian descent and ranging in age from 9 years 4 months to 42 years 6 months, were examined. Records included dental casts, lateral cephalometric radiographs, hand-wrist radiographs, and corrected tomograms of right and left TM joints. Nonconcentricity and mild asymmetry of the condyle-fossa relationship were commonly observed. The left condyle was found to be more anteriorly positioned than the right, with the mean percentage of joint space being 6.93% on the left side and -1.24% on the right. Skeletal and dental Class III patients demonstrated significantly more anteriorly positioned condyles (P < 0.05). There were no significant differences in condylar position between Class I and Class II groups based on ANB or Angles classification. Further, no significant difference in condylar position was observed between groups based on overbite or crossbite.

A longitudinal cephalometric study of the soft tissue profile of short- and long-face syndromes from 7 to 17 years.

The longitudinal growth and development of the soft tissue drape for boys and girls with long and short vertical patterns was examined from age 7 to 17 years. The sample was taken from the Denver Growth Study and consisted of 32 subjects who were selected on the basis of their percentage of lower anterior vertical face height. All subjects were of northern European ancestry, and none had undergone orthodontic treatment. The sexual dimorphism was evident as anticipated for several soft tissue measurements. The boys showed continued growth through age 16 years in contrast to the girls who attained the adult size of the soft tissue integument around 14 years. A significant difference between vertical facial patterns was reported for all soft tissue variables with the exception of the soft tissue thickness at A point and the upper lip height. The boys and girls with long vertical patterns exhibited a thicker and longer soft tissue drape for the most variables when compared with those with short facial patterns. These soft tissue differences are believed to be compensatory mechanisms in long-face subjects, which may attempt to mask the vertical dysplasia, thereby producing a more normal facial profile. Individual growth assessments revealed that the perioral soft tissues follow a pattern similar to that of the mean group patterns. The subjects with long vertical facial patterns experienced their pubertal growth spurt earlier than the short-face subjects. This may have clinical implications in the timing of orthodontic intervention and treatment.

Facial soft tissue harmony and growthin orthodontic treatment

The introduction of cephalometric radiography in orthodontic diagnosis inadvertently shifted the specialtys attention from the facial soft tissues to the skeletal structures. It has been shown that rigid adherence to the hard tissue norms results in neither facial balance and harmony nor long-term retention. The purpose of this article is to refocus the attention of the orthodontist on the consideration of harmonized facial structures as a primary goal of treatment. Balancing the position of the lips in relation to the nose and chin has a direct relationship with esthetic preference. Growth studies have clearly shown that dynamic changes in dental, skeletal, and facial integument occur over the entire period of active growth and even into the decades past the age of 20 years. Esthetic standards, therefore, must be different for children and for adults. Treatment results should be projected to when the patient is well into adulthood. Facial types also need to be considered because long-face and short-face individuals have different growth and maturational patterns. The compensatory nature of soft-tissue growth in these individuals should be noted. Caution must be exercised in using mean data from growth studies and applying them to all individuals at all ages, because of the wide variation among individuals in all races and both sexes.

Longitudinal growth changes in the sagittal relationship of maxilla and mandible.

This is a longitudinal study of the growth pattern in sagittal linear measurements at points A, B, and pogonion relative to the pterygoid vertical plane in a Class I sample. Serial cephalometric radiographs were traced and digitized at ages 6, 12, 18, and 24 years. The results indicated that between the ages of 6 and 24 years there was a total growth increment of 6.07, 7.53, and 11.17 mm at points A, B, and pogonion, respectively, in the female Class I sample and 9.49, 11.65, and 16.21 mm at points A, B, and pogonion, respectively, in the male sample. Although the actual change in length of these measurements was larger in the male subjects than in the female subjects, in terms of percentage of growth increment in each of these three measurements from age 6 to 24 years, the anterior movement at point B relative to point A, and at pogonion relative to points B and A was approximately the same for both male and female subjects. When each of the subjects in both male and female samples was rank-ordered according to the size at age 6 years, considerable individual variation was noticeable for most persons within the group. The individual variation in growth pattern in each of the different measurements continues to raise questions about growth prediction and its application in visual treatment objectives.

Comparison of treatment outcomes with banded and bonded RPE appliances

The purpose of this retrospective study was to compare the treatment outcomes with a banded (n = 38) versus a bonded (n = 55) rapid palatal expansion appliance followed by edgewise orthodontics. Both lateral cephalometric radiographs and orthodontic study casts were evaluated at pretreatment and posttreatment time periods. Overall, the banded rapid palatal expansion group had more vertical change than the bonded group. However, most of these changes were less than 1 degrees or 1 mm and may be considered clinically insignificant. This study could not establish superiority of one type of rapid palatal expansion technique over another.

Perioral forces and dental changes resulting from mandibular lip bumper treatment

This prospective study compares pretreatment and posttreatment forces produced by a lip bumper on the mandibular first molars and determines the dental effects of this appliance after 1 year of treatment. Twenty-five patients, ages 10 to 17 years, received fixed 0.045-inch passive stainless steel lip bumpers positioned at the level of the gingival margin, 2 mm from the labial surface of the teeth as the only form of treatment in the mandibular arch. At the end of 1 year, cephalometric radiographs and dental casts were taken, and lower lip forces remeasured during rest, speech, and swallowing. Lip force measurements were performed using specially designed strain gauges mounted bilaterally in the lip bumper tubes. Measurements of lip forces made before and after treatment were compared to explore the changes, if any, due to muscle adaptation to the appliance. Dental changes were measured from casts and cephalometric radiographs. Correlation analyses were performed to determine whether a relationship existed between initial force levels and resulting tooth movement. Pretreatment and posttreatment forces did not demonstrate a statistically significant difference. On the other hand, measurement of the dental casts revealed a significant increase in arch length caused by incisor proclination and protrusion, combined with molar distalization. The arch width significantly increased at the canines, first and second premolars, and first molars. The amount of force exerted by the lower lip on the molars was not correlated to the degree of tooth movement recorded in this sample.

Stiffness-deflection behavior of selected orthodontic wires

Treatment of horizontal and vertical tooth discrepancies requires wires of low stiffness to produce forces as the teeth are leveled and aligned. In this investigation, the stiffness characteristics of several solid and multistrand nickel-titanium and stainless steel orthodontic wires were determined at selected clinically relevant deflections. Twenty specimens of 24 different wires were tested in both three-point and three-bracket bending modes. The unloading force deflection plot of each wire was described by a polynomial regression from which wire stiffnesses were obtained by mathematical differentiation. Graphs of the functional relationship between stiffness and deflection are presented. The results of this investigation show that wire stiffness can be altered not only by changing the size, but also by varying the number of strands and the alloy composition. An equally important finding was the dependence of stiffness on deflection for most of the wires measured. Comparisons were also made between the stiffness values obtained in three-point bending and the three-bracket bending systems.

The effects of exogenous prostaglandin E2 on root resorption in rats

This study evaluated the amount and depth of root resorption associated with varying concentrations and frequencies of injectable, exogenous prostaglandin E2 (PGE2) in conjunction with orthodontic tooth movement in rats. The sample consisted of 155 maxillary right and left first molars from 88, 8-week old, male Sprague-Dawley rats. The animals were divided into three control groups and two experimental groups. The control animals were divided into one nonappliance and two appliance groups. The experimental animals were divided into 2- and 4-week experimental time periods that were further subdivided based on single and weekly injection intervals of PGE2 and four different injectable concentration levels, i.e., 0.1, 1.0, 5.0, and 10.0 micrograms. A fixed orthodontic appliance was ligated between the maxillary incisors and maxillary first molars with closed-coil nickel-titanium springs. The appliance had an initial activating force of 60 gm. Serial histologic sections of the mesial root of the maxillary first molar were made, and a quantitative histomorphometric analysis of root resorption on the mesial and distal surfaces was performed. This study demonstrated increased root surface resorption when using exogenous PGE2 injections to enhance orthodontic tooth movement over a 2-week period with increasing root resorption on the mesial surface as compared with the distal surface in PGE2 treated teeth. No differences in root resorption were found with either multiple injections or increasing concentration in the 4-week experimental group. Local injection of PGE2 appeared to have no effect on the number or depth of resorption lacunae in either the 2- or 4-week groups.

Three-dimensional facial analysis using a video imaging system

The purpose of this article was twofold: (1) to provide an estimate of error in the digitization of various soft tissue landmarks using a video imaging system, and (2) to evaluate the relationships of various soft tissue measurements in balanced young adult faces. A video imaging system was used to digitize frontal and lateral soft tissue landmarks on 25 male and 25 female Caucasian young adults with Class I occlusion and esthetically pleasing and balanced soft-tissue profiles. Twenty subjects were redigitized and only two measurements showed a statistically significant error. Large variabilities were found for several measurements. Males, in general, had greater soft tissue thickness, facial depth and width, and lip length than females. The measurements were found to compare favorably with previous reports. Imaging systems were seen to have the advantage of providing reliable measurements in all three dimensions without the potential hazards of ionizing radiation.