Seiji Haraguchi

Facial Asymmetry in Subjects with Skeletal Class III Deformity

We investigated the frequency, site, amount, and direction of facial asymmetry in human adults with mandibular prognathism and examined if these characteristics were associated postnatally with cardinal clinical signs that may indicate a predisposition to facial asymmetry. Two hundred twenty young Japanese adults (69 men and 151 women) who exhibited skeletal Class III malocclusions were selected. The sample was divided into a Postnatal Factor Group and a Nonpostnatal Factor Group. The former group included those who had: (1) received orthodontic treatment using a chin cap; (2) exhibited clinical symptoms of temporomandibular joint (TMJ) disorder; (3) reported a history of maxillofacial trauma; or (4) radiographic abnormality of the condyles. Subjects with a deviation of more than 2 mm from the facial midline associated with any of the 4 landmarks (ANS, U1, L1 and Me) were classified as asymmetric and the asymmetry was measured on a postero-anterior (P-A) cephalogram. Radiographic facial asymmetry was found frequently (70%-85%, for Menton), and most obviously in the lower jaw (P < .05). Lateral displacement toward the left side of the face occurred more often than right-sided deviation (P < .001, for Menton). However, the Postnatal Factor Group showed a higher proportion of subjects with lateral deviation toward the right side (P = .0031) and a greater amount (P < .0001) of chin deviation. This was due to the fact that the subjects having TMJ problems as a postnatal factor showed no directional uniqueness in jaw deviation and exhibited a longer distance of deviation.

Asymmetry of the Face in Orthodontic Patients

OBJECTIVE To investigate the laterality of the normal asymmetry of the human face, examining differences in laterality in relation to sex, growth stage, and skeletal classification. MATERIALS AND METHODS A total of 1800 Japanese subjects (651 males and 1149 females; mean age, 15 years 3 months; range, 4 years 2 months to 59 years 11 months) were selected. Individuals in the sample were categorized according to sex, one of three growth stages, and one of three skeletal patterns. Differences in length between distances from the points at which ear rods were inserted to the facial midline and the perpendicular distance from the soft-tissue menton to the facial midline were measured on a frontal facial photograph. Subjects with a discrepancy of more than 3 standard deviations of the measurement error were categorized as having left- or right-sided laterality. RESULTS Of subjects with facial asymmetry, 79.7% had a wider right hemiface, and 79.3% of those with chin deviation had left-sided laterality. These tendencies were independent of sex, age, or skeletal jaw relationships. In this regard, during pubertal growth, the proportion of subjects with wider right hemiface decreased (P < .0001), whereas the proportion of those with a wider left hemiface increased (P < .01), despite a consistent tendency for right-sided dominance. CONCLUSION These results suggest that laterality in the normal asymmetry of the face, which is consistently found in humans, is likely to be a hereditary rather than an acquired trait.

Laterality of Asymmetry in Movements of the Corners of the Mouth during Voluntary Smile

OBJECTIVES To examine (1) the laterality of asymmetry in movements of the right and left corners of the mouth in space during voluntary smile and (2) the laterality of asymmetry in relation to the difference between the right and left hemiface size and the handedness. MATERIALS AND METHODS Participants were 155 volunteer Japanese female adults. They were categorized into the symmetric group (n = 120) and the right-side hemiface dominant group (n = 26) according to the hemiface size. In addition, the symmetric group was categorized into the right-handed group (n = 98) and the left-handed group (n = 22) according to the Edinburgh Handedness Inventory. Position vectors of the right and left corners of the mouth were obtained from the three-dimensional facial images for the rest, the maximal lip corner retraction, and the portrait smile. The displacements of the right and left corners of the mouth for each expression and the proportions of the subjects with the right- and left-sided laterality were compared. RESULTS The left corner of the mouth showed significantly greater displacement (P < .01) than the right in the symmetric group for the portrait smile. The left-sided laterality was found regardless of the handedness. CONCLUSIONS Displacements of the right and left corners of the mouth during voluntary smile were asymmetric, and the left-sided laterality was found. Also, the laterality of the facedness differed in relation to the hemiface size, but was not related to the handedness.

Rotational movement of the anterior maxillary segment by hybrid distractor in patients with cleft lip and palate.

OBJECTIVE Maxillary anterior segmental distraction osteogenesis (MASDO) is an effective surgical orthodontic treatment for the retruded maxilla in cleft lip and palate because of its benefit of the conservation of velopharyngeal function. Some reports showed MASDO using various devices, but they do not allow the rotational movement of the distracted anterior segment. In this article, we showed MASDO using hybrid distracters (DynaForm System: Stryker Osteosymthesis, Leibinger Micro Implants, Kalamazoo, MI), which allow the advance of the distracted segment with rotational movement. METHOD The hybrid distractor with 4 metal arms is secured beyond both alveolar osteotomy lines on each side. These 2 distractors permit rotational movement of the segment by controlling the amount of advancement on each side. RESULTS For 6 patients with cleft lip and palate, MASDO using hybrid distractors was performed and the anterior segment moved at planned positions without any complications except lip discomfort, which disappeared after removal of the distractor. CONCLUSION MASDO, using an institutionally diagnosed hybrid distractor can successfully achieve the necessary rotational movements of the anterior maxillary segment owing to its design, which incorporates some mechanical flexibility.

Conventional bone-anchored palatal distractor using an orthodontic palatal expander for the transverse maxillary distraction osteogenesis: technical note

OBJECTIVE Surgical-assisted rapid palatal expansion includes various treatment procedures for solving transverse maxillary deficiencies, especially in cases with a matured palatal suture. Recent introduction of the concept of distraction osteogenesis has contributed to generalize this useful treatment and to develop some bone-borne devices that will not cause the problems found in cases treated by tooth-supported palatal expander. This report shows a conventional bone-borne distractor using commercially available orthodontic palatal expansion screws. METHOD The distractor consists of 2 parts: one is a commercially available orthodontic palatal expansion screw (Hyrax type, Fan style) and another is a screw-ring, which is one of the attached parts of the mandibular distraction system. The bone screws are inserted transmucosally to the palatal bone via the screw-rings. RESULT The palatal distractor can be applied to varied palatal shapes and can expand the palate without any trouble. CONCLUSION This conventional palatal distractor may contribute to generalize the transpalatal maxillary distraction osteogenesis for cases with maxillary teeth problems.

Autotransplantation of a premolar tooth in a case of dental bimaxillary protrusion with multiple missing permanent premolars

Abstract This paper describes orthodontic treatment combined with autotransplantation of a premolar tooth in a girl aged 8 years 10 months with dental bimaxillary protrusion associated with congenitally missing bilateral lower second premolars and the upper left first and second premolars. We transplanted the right second premolar to the socket of the left second deciduous molar tooth prior to comprehensive orthodontic treatment, and the other socket spaces were closed orthodontically appliances. Good occlusion and facial esthetics were achieved, and these results have been maintained for 3 years after completion of the active treatment.

Orthodontic camouflage of a late adolescent patient with Class III malocclusion

Abstract This paper concerns orthodontic treatment of a 11-year-old female having an Angle Class III malocclusion with incisor edge-to-edge occlusion, a skeletal Class III jaw base relationship and a normal mandibular plane angle. When she was 13 years old, the mandibular third molars were extracted and the remaining mandibular molars were distalized. Good occlusion and facial esthetics were achieved. These results have been maintained for 4 years following completion of active treatment.

Maxillary Anterior Segmental Distraction Osteogenesis to Correct Maxillary Deficiencies in a Patient With Cleft Lip and Palate.

This report describes a case of successful orthodontic treatment using maxillary anterior segmental distraction osteogenesis with an internal maxillary distractor and bilateral sagittal split ramus osteotomy in a girl with cleft lip and palate. A 16-year-old girl with unilateral cleft lip and palate exhibited midface retrusion because of growth inhibition of the maxillary complex and mandibular excess. After the presurgical orthodontic treatment, 6.0-mm advancement of the maxillary anterior segment and 4.0-mm set back of the mandible were performed. After a retention period, the patients midface convexity was greatly improved and the velopharyngeal competence was preserved without relapse.

Two-phase treatment in a patient with a skeletal Class III malocclusion: Early orthopedic treatment and subsequent camouflage treatment with temporary anchorage devices

Abstract In this case report, we describe the outcome of a two-phase orthodontic approach used to treat a 4-year and 8-month-old girl who exhibited excessive negative overjet and skeletal Class III jaw relationship. In Phase I treatment, growth modification using a protraction headgear appliance was used to normalize maxillomandibular growth. A forward growth of the maxilla and a normal overjet were achieved. During pubertal growth period, a skeletal Class III jaw relationship persisted due to differential jaw growth. A Phase II camouflage treatment with the help of temporary anchorage devices (TADs) was used to distalize the mandibular dentition. Good occlusion and facial esthetics were achieved, and the outcome has been maintained for 2 years after completion of the active treatment.

The use of temporary anchorage devices for orthodontic treatment of high-angle Class III malocclusion in a patient with impacted upper canine teeth

Abstract This case report describes the orthodontic treatment of a 13-year-old female patient with high-angle Class III malocclusion, including anterior open bite and impacted upper canine teeth with a convex soft tissue profile. In this case, preadjusted edgewise appliances were placed after the extraction of the upper deciduous canine teeth, impacted upper canine teeth and lower first premolars. The upper and lower dental arches were aligned using a temporary anchorage device (TAD) for retraction and intrusion of the lower incisors avoiding the extrusion of the lower molars. A good facial profile and occlusion were achieved after active treatment.