Soonshin Hwang

Changes of hyoid, tongue and pharyngeal airway after mandibular setback surgery by intraoral vertical ramus osteotomy

OBJECTIVE To assess changes in hyoid, tongue, pharyngeal airway, and head posture in patients who had mandibular setback surgery by intraoral vertical ramus osteotomy (IVRO) and to investigate the influence of LeFort I osteotomy. MATERIALS AND METHODS Sixty patients with skeletal Class III malocclusion were evaluated. All patients had mandibular setback surgery via IVRO, and 45 patients had additional maxillary impaction surgery via LeFort I osteotomy. Lateral cephalograms were taken before, immediately after, approximately 1 month after, and at least 1 year after surgery. Parameters indicating the hyoid, tongue, pharyngeal airway, and head posture were evaluated. RESULTS The hyoid significantly moved inferoposteriorly immediately after surgery and relapsed superoanteriorly during observation periods. The tongue significantly moved posteriorly during all periods. The final position of the hyoid and tongue was significantly posterior, and the final pharyngeal airway was significantly narrower compared with its presurgical position. Significant cervical hyperflection occurred during observation periods and was strongly correlated with anterior movement of the hyoid. The hyoid and tongue showed similar positions regardless of the presence of different genders or LeFort I osteotomy after the long-term observation period. CONCLUSIONS The hyoid and tongue moved posteriorly after mandibular setback surgery via IVRO, and there was a tendency to relapse back to its original position. However, the final pharyngeal airway width remained narrower after the long-term observation period. Based on our results, careful monitoring of the airway may be needed after mandibular setback surgery via IVRO.

Treatment of skeletal open-bite malocclusion with lymphangioma of the tongue.

Lymphangioma of the tongue causes massive tongue enlargement, leading to difficulties in swallowing and mastication, speech disturbances, airway obstruction, and skeletal deformities such as open-bite malocclusion. Early reduction of tongue volume improved the excessive open bite in a young girl, but it was not sufficient to redirect the original hyperdivergent growth pattern. Orthodontic camouflage treatment was therefore rendered. Long-term evaluation after tongue-reduction surgery and orthodontic treatment is presented.

Long-term survival of retained deciduous mandibular second molars and maxillary canine incorporated into final occlusion

Orthodontic treatment of a complex case that involves retained deciduous mandibular second molars with missing permanent successors is challenging. Usually, congenitally missing teeth are manifested with other dental anomalies that further complicate orthodontic treatment, such as retained deciduous teeth, impactions, transpositions and peg-shaped lateral incisors. Even though the long term prognosis of the retained deciduous tooth is not fully predictable, if the teeth are in good condition, the patient and clinician may incline towards a decision to preserve the deciduous teeth as long as possible. This case report demonstrates that deciduous teeth, in this case the mandibular second molars and maxillary canine, can be incorporated into final occlusion with clinically stable long-term results.

Local Injection of Hyaluronic Acid Filler Improves Open Gingival Embrasure: Validation Through a Rat Model

BACKGROUND The open gingival embrasure, the so-called black triangle, is one of the unsolved dilemmas in adult dentistry. Although various techniques have been introduced to improve black triangles, the lack of reproducible experimental models has prevented development of successful protocols to regenerate or to compensate loss of the interdental papilla. Therefore, the objective of this study is first to develop a reliable animal model of open gingival embrasure and then to validate a minimally invasive injection technique using hyaluronic acid (HA) filler to augment the interdental papilla. METHODS To reproduce open gingival embrasure in rats, rapid space opening was induced between the mandibular incisors by attachment of a compression spring. Loss of interdental papilla height was morphologically evaluated and calculated using standardized serial photographs, microcomputed tomography, and histologic sections. Afterward, HA fillers or phosphate-buffered saline (PBS) was locally injected, and changes in the interdental papilla were evaluated. RESULTS After 7 days of space opening, the margin of the interdental papilla between the mandibular incisors gradually became irregular and flat, indicating a condition similar to the open gingival embrasure (P <0.05). Local injection of HA filler induced an augmentation effect of the interdental papilla compared with injection of PBS (P <0.05). Interdental papilla became convex, and inner granules containing HA were detected within the submucosal layer after its injection. CONCLUSIONS Open gingival embrasure was reproduced reliably in vivo. Local injection of HA filler was validated as a meaningful minimally invasive procedure to improve open gingival embrasure.

Assessment of lower incisor alveolar bone width using cone-beam computed tomography images in skeletal Class III adults of different vertical patterns

Objective This study was performed to investigate the alveolar bone of lower incisors in skeletal Class III adults of different vertical facial patterns and to compare it with that of Class I adults using cone-beam computed tomography (CBCT) images. Methods CBCT images of 90 skeletal Class III and 29 Class I patients were evaluated. Class III subjects were divided by mandibular plane angle: high (SN-MP > 38.0°), normal (30.0° < SN-MP < 37.0°), and low (SN-MP < 28.0°) groups. Buccolingual alveolar bone thickness was measured using CBCT images of mandibular incisors at alveolar crest and 3, 6, and 9 mm apical levels. Linear mixed model, Bonferroni post-hoc test, and Pearson correlation analysis were used for statistical significance. Results Buccolingual alveolar bone in Class III high, normal and low angle subjects was not significantly different at alveolar crest and 3 mm apical level while lingual bone was thicker at 6 and 9 mm apical levels than on buccal side. Class III high angle group had thinner alveolar bone at all levels except at buccal alveolar crest and 9 mm apical level on lingual side compared to the Class I group. Class III high angle group showed thinner alveolar bone than the Class III normal or low angle groups in most regions. Mandibular plane angle showed negative correlations with mandibular anterior alveolar bone thickness. Conclusions Skeletal Class III subjects with high mandibular plane angles showed thinner mandibular alveolar bone in most areas compared to normal or low angle subjects. Mandibular plane angle was negatively correlated with buccolingual alveolar bone thickness.

Dentofacial transverse development in Koreans according to skeletal maturation: A cross-sectional study

Objective The aim of this study was to establish the normative data of dentofacial transverse dimensions according to the skeletal maturation stage in Korean adolescents with good occlusion, assess gender differences and determine correlations between transverse variables. Methods A total of 577 Korean subjects between ages 7 to 19 years and exhibiting skeletal Class I occlusion were categorized by skeletal maturation index (SMI) of Fishman using hand-wrist radiographs. Dentofacial transverse dimensions were assessed using posteroanterior cephalograms. Independent two-sample t-tests were used to analyze differences between genders. Pearson correlation coefficient was used to determine the correlation between transverse measurements. Results Dentofacial transverse norms relevant to skeletal maturation stages were established. The average maxillomandibular width difference and ratio at growth completion was 22.16 mm and 77.01% for males; 23.70 mm and 74.06% for females, respectively. Males had greater facial, maxillary and mandibular widths compared to females at every SMI stage. The maxillary and mandibular intermolar widths showed the strongest correlation for both sexes (r = 0.826 for males, r = 0.725 for females). Conclusions Dentofacial transverse norms of Korean adolescents were established according to developmental stage. All dentofacial widths were greater in males at growth completion. Maxillary and mandibular intermolar widths were strongly correlated. This study may serve as a guideline for the assessment of dentofacial transverse growth according to skeletal maturation stage in Korean adolescents with good occlusion.

Nonsurgical and nonprosthetic camouflage treatment of skeletal Class II open bite with bilaterally missing lower first molars

This report illustrates the successful nonsurgical and nonprosthetic camouflage treatment of a skeletal Class II open bite malocclusion combined with missing mandibular first molars bilaterally. In the mandible, the second and third molars were uprighted and protracted, substituting for the missing first molars. In the maxilla, anterior bodily retraction and full-arch intrusion were achieved following premolar and second molar extraction, which also induced autorotation of the mandible. The treatment outcome and prognosis were confirmed with three-dimensional superimposition techniques, along with long-term stability.

Quantitative and perceived visual changes of the nasolabial fold following orthodontic retraction of lip protrusion

OBJECTIVES The objectives of this study were to evaluate the quantitative and perceived visual changes of the nasolabial fold (NLF) after maximum retraction in adults and to determine its contributing factors. MATERIALS AND METHODS A total of 39 adult womens cone-beam computed tomography images were collected retrospectively and divided into the retraction group (age 26.9 ± 8.80) that underwent maximum retraction following 4 premolar extraction and the control group (age 24.6 ± 5.36) with minor changes of the incisors. Three-dimensional morphologic changes of hard and soft tissue including NLF were measured by pre- and posttreatment cone-beam computed tomography. In addition, perceived visual change of the NLF was monitored using the modified Global Aesthetic Improvement Scale. The influence of age, initial severity of NLF, and initial soft tissue thickness was evaluated. RESULTS Anterior retraction induced significant changes of the facial soft tissue including the lips, perioral, and the NLF when compared with the controls ( P < .01). Perceived visual changes of the NLF was noted only in women younger than age 30 ( P < .05), with the odds ratio (95% confidence interval) of 2.44 (1.3461-4.4226), indicating greater possibility for improvement of NLF esthetics in young women of the retraction group when compared with the controls. CONCLUSIONS Orthodontic retraction induced quantitative and perceived visual changes of the NLF. For adult women younger than age 30, the appearance of the NLF improved after maximum retraction despite the greater posterior change of the NLF.

A 15-year follow up of an orthodontic treatment including a lower incisor extraction and keeping the maxillary canine–premolar transposition

Lower incisor extraction is an effective option for treating lower anterior crowding in patients with a good facial profile, Class I molar occlusion, and narrow upper incisors. This report describes the successful treatment of an adolescent patient with lower anterior crowding and a transposed maxillary canine and premolar treated by extracting a lower incisor and keeping the transposed positions of the teeth. With the use of retainers, treatment results were stable up to the 2-year postretention visit. However, upon a 15-year postretention appointment, the fixed retainer had been removed and the removable retainer was no longer in use, which resulted in relapse of lower anterior alignment. Moreover, the transposed canine had extruded during this period, causing occlusal interference and gingival recession, as well as loss of tooth vitality, which indicates the importance of maintaining orthodontic retainers for long-term stable occlusion.

Three-dimensional evaluation of dentofacial transverse widths of adults with various vertical facial patterns

Introduction: The purpose of this study was to investigate maxillomandibular transverse widths and molar inclinations of adults with hypodivergent, normodivergent, and hyperdivergent facial patterns using cone‐beam computed tomography. Methods: We evaluated Class I subjects (55 men, 66 women) who were divided into hypodivergent (<27°), normodivergent (28°‐37°), and hyperdivergent (>38°) groups by their mandibular plane angles. Frontal and coronal views of the images were analyzed. Sex differences, vertical facial pattern differences, and related factors were assessed with independent 2‐sample t tests, 1‐way analysis of variance followed by post hoc Tukey tests, and Pearson correlation analysis. Results: The hypodivergent group had greater maxillary alveolar widths 7 mm apically from the alveolar crest. The intermolar widths and molar inclinations showed no significant differences among the groups. As the mandibular plane angles increased, interjugular widths, transverse mandibular widths, and buccolingual maxillary alveolar widths at the midroot level decreased, whereas the maxillomandibular width differences and palatal heights increased im both sexes. Conclusions: An increase in the mandibular plane angle is associated with tendencies of narrow mandibular arches, thinner maxillary alveolar bones at the midroot level, and higher palatal arches in both sexes. Intermolar widths and molar inclinations were not significantly affected by vertical facial patterns. HighlightsMaxillomandibular transverse width and molar inclinations were assessed in adults.Subjects were grouped by hypodivergent, normodivergent, and hyperdivergent facial pattern.Intermolar widths and molar inclinations were not significantly affected by facial pattern.Increased mandibular plane angle was associated with narrow mandibular arches.It was also associated with thinner maxillary alveolar bones midroot and high palatal arches.