S. Kopp

Comparison of Bipartite Versus Tripartite Osteotomy for Maxillary Transversal Expansion Using 3-Dimensional Preoperative and Postexpansion Computed Tomography Data

PURPOSE To evaluate tripartite paramedian versus bipartite median osteotomy in surgically assisted rapid maxillary expansion. Tripartite osteotomy was performed between the lateral incisors and canines at the former premaxillary junction to avoid midline diastema, septal and columellar dislocation, and asymmetric expansion, minimizing high-distraction forces through bilateral doubled osteotomy on periodontia and thus reducing vestibular attachment loss and producing stable callus formation to avoid relapse. PATIENTS AND METHODS The preoperative and postexpansion computed tomography data from 50 patients were analyzed in multiplanar viewing for bodily segment movement, vestibular bone loss, and transverse skeletal and dental widening with predefined landmarks. Of the 50 patients, 22 had undergone tripartite and 28 had undergone bipartite osteotomy. RESULTS Using an independent t test, both osteotomies permitted adequate transverse skeletal expansion in the premolars, converging, however, in the molars. Bipartite osteotomy resulted in less symmetry in transverse skeletal widening, greater bodily segment movement in the first premolar/molar, and greater vestibular bone loss. Tripartite osteotomy resulted in greater overall expansion and less bone remodeling. On variance analysis, tripartite bone-borne distraction resulted in the greatest decrease of transverse expansion in patients older than 20 years. The tripartite osteotomy also provoked distractor- and age-independent outward segmental movement. Bipartite osteotomy resulted in distractor- and age-independent inward segmental movement. Bipartite osteotomy showed the greatest bone resorption in patients younger than 20 years old in the molars and tripartite osteotomy in patients older than 20 years in the premolars. CONCLUSIONS Tripartite paramedian osteotomy allowed greater overall symmetric expansion compared with bipartite median osteotomy, with, however, a decline in transverse widening to the posterior. Bipartite osteotomy should be preferred whenever good periodontal status permits greater vestibular bone loss and a midline diastema and asymmetric expansion and a midline shift will be tolerated by the patient. Tripartite osteotomy should be chosen whenever a midline diastema and shift, septal and columellar dislocation, asymmetric expansion, and larger distraction forces on the paradontia, resulting in vestibular attachment loss, are to be avoided.

Radiological location monitoring in skeletal anchorage: introduction of a positioning guide.

Background and Objective:As the insertion of miniscrews necessarily involves the risk of damaging the hard and soft tissues, particular attention must be paid to the diagnostics carried out prior to surgery, which include checking the insertion site radiologically by applying positioning devices. The placement of many common radiological positioning guides is difficult and timeconsuming, and some varieties must be specially constructed at great cost, which led us to develop in this study a simple and easily applicable X-ray aid offering the mandatory safety features in terms of reliability and forensics. We aimed to design a device as small as possible to avoid as many falsely-positive and falselynegative findings as possible with not-100% orthoradial dental films. We also wanted the device to be applicable in all potential insertion areas.Materials and Methods:We initially performed a thorough literature research for suggestions for radiological positioning guides in pre-operative diagnostics. Based on those descriptions, we fabricated two common positioning devices, which we then applied and tested clinically regarding their handling, general applicability, and quality.To meet the stringent demands made of pre-operative radiological diagnostics, we developed a positioning guide with probing function (“X-ray pin”). Its applicability and diagnostic value were examined in a clinical study of prospective design.Results and Conclusions:Our radiological positioning device has a total length of 3.5 mm and has a ball on its end, thus resembling conventional pins in principle. Due to its conical form, the device can be easily placed in the mucosa at the designated insertion site. The X-ray pin is reliably stable in position, guaranteeing an accurate assessment of the designated miniscrew position. There is no need for advance bending; or for later adjustment and attachment attempts. The pin can be inserted in all regions, including the palatal area. Our X-ray pin proved to be an easily affordable, clinically simple, and safe-to-apply alternative.ZusammenfassungHintergrund und Zielsetzung:Da bei der Insertion einer Minischraube die potentielle Gefahr einer Hart- bzw. Weichgewebeschädigung gegeben ist, sollte der Behandelnde besondere Sorgfalt auf die präoperative Diagnostik verwenden. Dazu trägt eine röntgenologische Lagekontrolle an der geplanten Insertionsregion unter Nutzung von Positionierungsvorrichtungen bei. Da viele bekannte Röntgenhilfen schwer und aufwendig zu platzieren sind und einige Varianten kostenintensiv laborgefertigt werden müssen, war es Ziel der Studie, eine einfach und schnell anzuwendende Röntgenhilfe zu entwickeln, die die nötige Sicherheit im Hinblick auf Aussagewert und Forensik bietet. Dabei sollte ein möglichst kleiner Behelf entstehen, der auch bei nicht absolut orthoradialen Zahnfilmen kaum falsch positive bzw. falsch negative Ergebnisse liefert. Des Weiteren sollte ein Einsatz in allen möglichen Planungsregionen möglich sein.Material und Methode:Vorab erfolgte eine gründliche Literaturrecherche nach Vorschlägen für Röntgenhilfsmittel zur präoperativen Diagnostik. Basierend auf diesen Beschreibungen wurden zwei gängige Modelle angefertigt, klinisch eingesetzt und in Bezug auf Handhabung, universelle Einsetzbarkeit und Ergebnisqualität getestet.Um einen Großteil der Anforderungen im Bereich der präoperativen Röntgendiagnostik zu erfüllen, wurde eine Orientierungshilfe mit Sondierungsfunktion („Röntgen-Pin“) entwickelt. Der Einsatz und diagnostische Wert wurden in einem klinisch prospektiven Studiendesign überprüft.Ergebnisse und Schlussfolgerung:Der entstandene Röntgenbehelf hat eine Gesamtlänge von 3,5 mm, trägt an seinem Ende eine Kugel und gleicht prinzipiell einer herkömmlichen Stecknadel. Durch die konische Form lässt er sich an der geplanten Insertionsstelle leicht in die Schleimhaut einbringen. Er ist zuverlässig lagestabil und gewährleistet eine gute Beurteilung der späteren Schraubenposition. Vorbiegungen, Justierungs- und Befestigungsversuche entfallen. Er kann in allen Regionen, so auch palatinal, eingesetzt werden. Klinisch zeigte er eine einfache und sichere Anwendbarkeit und erwies sich als eine kostengünstige Alternative.

Assessment of Surgically Assisted Rapid Maxillary Expansion Regarding Pterygomaxillary Disjunction Using Thin Volume-Rendering Technique: In Variance Analysis and in Reliability, Accuracy, and Validity

PURPOSE To assess surgically assisted rapid maxillary expansion (SARME) with or without pterygomaxillary disjunction using a thin volume-rendering technique in variance analysis and in reliability, accuracy, and validity. MATERIALS AND METHODS Thin volume-rendered images of 68 patients were evaluated preoperatively and 2.87 ± 1.59 months after expansion with respect to dentoskeletal effects. RESULTS Variance analysis of SARME with pterygomaxillary disjunction showed an important decrease in transverse widening and segmental outward inclination and an increase in vestibular bone plate thickness (premolars) in patients younger than 20 years with bone-borne devices; the greatest increase in transverse widening was in patients with 3-segment osteotomy and tooth-borne devices. Analysis of SARME without pterygomaxillary disjunction showed an important decrease in transverse widening and segmental inward inclination in patients older than 20 years with bone-borne devices; the greatest pterygoid lateral bending was in patients with 2-segment osteotomy and bone-borne devices. CONCLUSION The performance of pterygomaxillary disjunction should depend on patient age (ie, treatment with pterygomaxillary disjunction in those >20 years old; treatment without pterygomaxillary disjunction in those <20 years old). Patients with pterygomaxillary disjunction, 3-segment osteotomy, and tooth-borne devices tended to show an increase in transverse widening but at the price of greater attachment loss. Patients younger than 20 years with pterygomaxillary disjunction and bone-borne devices tended to show an increase in vestibular bone plate (premolars) but at the price of decrease in transverse widening.

The effects of a temporarily manipulated dental occlusion on the position of the spine: a comparison during standing and walking

BACKGROUND CONTEXT The relationship between dental occlusion and body posture or even the spine position is often analyzed and confirmed. However, this relationship has not been systematically investigated for standing and walking. PURPOSE To examine whether a symmetric or asymmetric dental occlusion block, using 4 mm thick silicon panels, can significantly change the spine position (cervical, thoracic, or lumbar region) during standing and walking. STUDY DESIGN The following study is a cross-sectional study. PATIENT SAMPLE This study was carried out with 23 healthy subjects (18 women, 5 men) without discomfort in the temporomandibular system or body movement apparatus. OUTCOME MEASURES Position changes (millimeter) of the spine (cervical, thoracic, lumbar) in frontal, sagittal, and transverse planes of motion. METHODS The upper spine position was quantified with an ultrasonic distance measurement system (sonoSens Monitor). Every subject placed the 4 mm thick silicon panel systematically between the left/right premolars or the front teeth. Differences between the habitual and manipulated occlusion positions were determined by the Friedman test, followed by pairwise comparisons with applied Bonferroni-Holm correction. RESULTS During standing and walking there were significant (p≤.05) differences between the occlusion block conditions and the habitual dental position in all body planes except in the right lumbar region during walking. In addition, differences within the manipulated occlusion position could be detected. Significant differences were also shown between the standing and walking trials in the frontal, sagittal, and transverse planes, particularly with respect to the lumbar region (p≤.001). CONCLUSIONS Symmetrical and asymmetrical occlusion blocks in the premolar region can be associated with changes in all three spine regions during standing and walking. The results showed highly similar reaction patterns in all spine positions, regardless of the location of the silicon panel. Between standing and walking, the main differences were in the lumbar spine. The results suggest a relationship between the chewing and the movement system. However, it must be stated that this study has no direct clinical impact. The study design cannot determine the causality of the observed associations; also the clinical significance of the small postural changes remains unknown.

Können experimentell herbeigeführte Veränderungen der Okklusion das menschliche Gleichgewicht beeinflussen

ZusammenfassungEs besteht eine Assoziation zwischen der Zahnokklusion und der Gleichgewichtsverteilung des Körpers beim Stehen. Durch eine systematisch hervorgerufene Veränderung der Bisslage im Sinne einer symmetrischen bzw. asymmetrischen Sperrung des Bisses sollte ein Wirkungszusammenhang zwischen der Bisslage und der Körperschwerpunktverteilung nachgewiesen werden. Hierfür wurden bei 62 gesunden erwachsenen Probanden Watterollen an vorab definierten Stellen des Gebisses sowohl symmetrisch als auch asymmetrisch platziert. Mit dieser Bisslage standen sie auf einer Druckmessplatte, mit der die Gewichtsverteilung gemessen wurde. Die Ergebnisse zeigen, dass eine Veränderung im stomatognathen System die Auslenkungen des Körperschwerpunktes sowohl verbessern (p=0,006 bzw. p=0,05) als auch verschlechtern (p=0,04) kann.AbstractThere is a connection between dental occlusion and body posture. By systematically induced alterations of the occlusion, in the sense of a symmetrical or asymmetrical closed bite, interdependencies between the occlusion and the balance of body posture were investigated. For this cotton wool pads were placed in predefined symmetrical and asymmetrical positions in the dentition of 62 healthy adults. With this provoked occlusion they stood on a pressure gauge platform and the weight distribution was recorded. The results showed that a change in the stomatognathic apparatus can improve (p=0.006 or p=0.05) as well as deteriorate (p=0.04) the deflection of the bodies centre of gravity.

Evidence - The intraoral palpability of the lateral pterygoid muscle - A prospective study.

The intraoral palpability of the inferior caput of the lateral pterygoid muscle has been a matter of ambiguity because of its topography. Thus, none of the recently published studies has provided reliable proof of the possibility of digital intraoral palpation, although palpation of the muscle is part of most of the examination catalogs for clinical functional analysis and functional therapy. Digital muscle palpation was performed intraorally on five preparations after exposure of the infratemporal fossa and visualization of the lateral pterygoid muscle. Direct digital palpation of the lateral pterygoid muscle was seen in all five cases. The successful palpation was carried out and approved during laterotrusion to the examined side (relaxation). While opening and closing the mouth (contraction) the muscle is palpable. In real-time kinematic measurements (MRI) an impression of the lateral caput of the left lateral pterygoid muscle of a 30-year-old control male person was found up to 6mm. Electromyographic detection by direct signal conduction with concomitant palpation is possible. The injection electrode tested in situ in the muscle was felt transorally with the palpating finger. The intraoral palpability of the inferior caput of the lateral pterygoid muscle is verified. The basic requirement for successfully palpating the lateral pterygoid muscle is the exact knowledge of muscle topography and the intraoral palpation pathway. After documented palpation of the muscle belly in cadaverous preparations, MRI and EMG also visualized palpation of the lateral pterygoid muscle in vivo. The palpation technique seems to be essential and basically feasible.

The impact of a total hip replacement on jaw position, upper body posture and body sway

Abstract Objectives: The purpose of this study was to examine whether, and to what extent, a total hip replacement can influence the position and the movement of the jaw, the upper body posture and body sway. Methods: Twenty test subjects (6 females, 14 males) participated in this study pre- and post-total hip replacement, in addition to a healthy control group of 20 subjects (5 females, 15 males). The measurements were conducted by means of an ultrasound system to measure jaw condyle position and movement of the lower jaw, a three-dimensional back scan to analyze upper back posture, and a static and dynamic force plate to measure body sway. For statistical analysis the Wilcoxon-Matched-Pairs-Test or Man–Whitney-U-Test, including a Bonferroni–Holm correction, respectively, was used. Results: After surgery, the mean values of the left and right jaw condyles of the test group moved posterior, and the left condyle position was located more caudally. There were no significant differences concerning the jaw position between the two groups. There was little change in upper body posture in both groups. The test group had a more anteriorly inclined thoracic spine and a less pronounced lumbar lordosis. During static body sway measurements, increased fluctuations in the test group after surgery could be seen. Conclusion: Differences between both groups in the pre- and post-surgical condition could be detected. These differences were more prominent when the measured body segments were more distally located with respect to the hip region.

An Evaluation of Horizontal Jaw Relations During Standing and Sitting with Open or Closed Eyes

Abstract When determining the horizontal jaw relation and mandibular movements, a question arises as to the appropriate choice of registration positions. The current study was carried out using 22 adults with full dentition who did not have any discomfort in their skeletal and craniomandibular systems. Occlusion and mandibular movements were investigated with open and closed eyes in standing and sitting positions using an electronic, central-bearing tracing device. The coordinates of the measured parameters are presented using a two-dimensional computer vector diagram. The non-parametric Friedman test was used for statistical data analysis. The measured data obtained for the initial habitual centric relation record (HR), centric relation record (CR), final habitual centric relation record (HR), and protrusion (P) did not significantly differ in the sitting and standing positions or with opened and closed eyes (p=1.00). With closed eyes, the differences in the average values between the two condylar positions (initial HR/final HR, initial HR/CR, and final HR/CR) decreased in a manner that was independent of the registration position. The CR that was measured in a sitting position with closed eyes was 2.26 mm more retrusive than that measured with open eyes. Before and after CR measurements, only laterotrusion showed significant differences (p=0.02) in patients who were standing with closed eyes. It was concluded that the registration position and visual system could individually influence the measurements of condylar position and mandibular movements. From a clinical perspective, these measurements exhibited the smallest differences when they were conducted with patients in a sitting position with closed eyes.

Screening im kraniomandibulären System

Wenn mindestens 10% aller neuen Patienten einer Praxis Symptome einer kraniomandibulären Dysfunktion (CMD) aufweisen, so bedeutet das für die tägliche Praxis, dass jeder Zahnarzt ein funktionelles Screening beherrschen sollte, um bei den Patienten diese Befunde diagnostisch nicht zu übersehen. Ein Screening ist deshalb nötig, um mit vertretbarem Zeitaufwand die Patienten zu erkennen, die einer ausführlichen Funktionsanalyse zugeführt werden müssen.

Standard values of the upper body posture in male adults

BACKGROUND Interactions within the musculoskeletal system have been investigated and confirmed in numerous studies. OBJECTIVES Since there are no standard values for the posture of healthy persons, this study attempts to define reference values for the upper body posture in healthy men. MATERIAL AND METHODS A 3-dimensional back scan was performed to quantify the upper back posture while habitually standing. Tolerance regions for habitual posture were calculated, including the upper and lower limit for 95% of all values. Furthermore, the left and right limit of the confidence interval (CI) was carried out. Group differences were tested by using the t-test or the Wilcoxon-Mann-Whitney U test. RESULTS Height, weight and body mass index (BMI) of the participants were comparable to those of the average young German males. The spinal column was marginally twisted to the right. The spinal curves, defined by the thoracic or lumbar flexion angle, and the kyphosis and lordosis angle, indicated that the angle in the thoracic spine area was larger than that in the lumbar region. Consequently, a more kyphotic posture was observed in the sagittal plane. The habitual posture was slightly scoliotic, with a rotational component (scapular depression left, right scapula marginally located more dorsally, high state of pelvic left, iliac left further rotated posteriorly and simultaneously tilted further ventrally). No significant difference between right and left-handed persons could be proven. CONCLUSIONS Video raster stereography is a suitable method to measure the 3-dimensional back surface. Using this method for healthy young men, we observed that they had an almost ideally balanced posture with minimal ventral body inclination and a marginal scoliotic deviation. The normal values allow a better comparison of data between different studies of body posture.