Fig 57 - uploaded by Theodosia Bartzela
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Posterior crossbite in the primary dentition. Fig. 58: Persistent mandibular midline deviation after crossbite correction.
Source publication
The aim of this retrospective odontometric study was to evaluate the stability of orthodontically corrected
unilateral crossbite. This was done by comparing the long-term therapeutic results of patients treated either with
rapid maxillary expansion (RME) or with slow expansion devices in the early (mean age: 7.2 years) or in the late mixed dentitio...
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Background
Pushing Splints 3 (PS3) device was recently introduced for the treatment of Class III malocclusion in children.
Objectives
To assess the effect on the sagittal maxillary position (SNA, primary outcome) of PS3 therapy compared with rapid maxillary expansion and facemask therapy (RME/FM) and to compare skeletal and dento-alveolar effects...
Citations
... In effect, when compared to normal, the buccal-lingual relationships are reversed in a posterior crossbite. The incidence of this malocclusion varies among the Hispanic, African American and Caucasian populations at 7.3%, 9.6% and 9.1%, respectively [2,3]. The etiology of this malocclusion is typically multifactorial and can include a combination of dental, skeletal and functional components [4]. ...
... This idea is supported by many experimental observations. A mono-or a bi-lateral cross-bite is a malocclusion which is regarded as a primary or a secondary condition which is associated with bad habits and which affects 8 to 23% of the paediatric population [15,16] . In our cohort of paediatric patients, cross-bite was present in 56% of the cases, which suggested that this characteristic was 2.5 to 7 times more frequent in the MFS patients. ...
Background:
It is important to establish an early diagnosis of the Marfan Syndrome (MFS) for providing an adequate pharmacological or surgical therapy. Nevertheless, this diagnosis may be complex, given the multi-organic involvement of this disease.
Aims:
In this work, we evaluated the oral phenotype in a group of paediatric patients with a clinical diagnosis of MFS, to quantify the association of the oro-facial defects with other systemic alterations.
Settings and design:
Paediatric subjects who were aged, with a clinical diagnosis of MFS, were selected from our regional Marfan monitoring unit.
Methods and material:
All the patients were subjected to Paediatric Dentistry examinations and a radiological screening with Panoramic and Cephalometric X-Rays. The aortic dilation (Aortic Z-score value), the hyperlaxity of the ligaments and scoliosis were evaluated by cardio-surgical and orthopaedics specialists.
Statistical analysis:
The correlations between the oral and systemic alterations were analyzed by using the chi square test for the nominal variables.
Results and conclusions:
We found a significant correlation of the Aortic Z - score with multiple oral defects which included retrognathia, malar hypoplasia, cross bite, oral respiration and an ogival palate. An association of the oral defects with hyperlaxity of the ligaments and scoliosis was also found. Thus, the data suggested that dentists should be more involved in a multidisciplinary approach, to provide an early MFS diagnosis in paediatric patients.
Evidence-based dentistry is currently a high priority in the clinical practice of orthodontics. Treatment decisions are made using evidence-based information whenever it is available to the clinician. The focus of this article is to evaluate the current literature available on the long-term stability of rapid maxillary expansion. The literature was reviewed from 1979 to 2009, and all systematic reviews and meta-analyses were included in this evaluation. Clinical trials, retrospective or prospective, were also reviewed, even though they did not always meet the inclusion criteria set forth. This review of the literature shows that, based on the evidence provided by 2 trials, there is a lack of strong evidence of the long-term stability of maxillary expansion in adolescent patients with posterior crossbites at the initiation of orthodontic therapy. Factors responsible for this include high attrition rates, lack of adequate control groups, unclear diagnosis and ill-defined study end points, and lack of standardization of studies. The conclusions that can be drawn from our review are as follows: there is a clear need for well-designed and well-controlled retrospective or prospective clinical trials for the evaluation of stability of maxillary expansions. At the present time, orthodontists must accept that some treatment modalities do not yet have a high level of evidence for treatment effectiveness.
Unilateral posterior crossbite of dento-alveolar origin is a transverse discrepancy of the maxillo-mandibular relationship and is one of the most common malocclusions in the mixed dentition. If untreated, the crossbite and the abnormal lateral movement of the lower jaw may strain the orofacial structures, causing adverse effects on the temporomandibular joints, the masticatory system and facial growth. Thus, early orthodontic intervention is usually undertaken to correct the condition at the mixed dentition stage and the orthodontist may choose from a range of treatment methods. The method of choice for orthodontic treatment should not only be clinically effective, with long-term stability, but also cost-effective. The overall aim of this thesis was to compare and evaluate different methods of correcting unilateral posterior crossbite, in terms of clinical effectiveness, stability and cost-effectiveness. The approach was evidence-based; randomized controlled trial (RCT)-methodology was used in order to generate a high level of evidence.
The long-term stability of posterior crossbite correction in the mixed dentition has not been sufficiently evaluated. Our aim was to compare long-term outcomes in patients with crossbite correction by using matched controls with normal occlusion.
After 35 patients were treated for crossbite with a quad-helix or an expansion plate, we used randomized controlled trial methodology to follow them for 3 years posttreatment. All had fulfilled our pretreatment criteria: mixed dentition, unilateral posterior crossbite, no sucking habits, and no previous orthodontic treatment. Transverse relationships, maxillary and mandibular widths, overbite, overjet, arch lengths, and midlines were registered on the study models immediately before and after treatment and at the follow-up 3 years after treatment. The matched control group comprised 20 subjects with normal occlusion and was compared with the first and last registrations for the treated groups.
At follow-up, changes in the treatment groups were equal and stable. The changes were comparable with the control group. All other changes were minor and had no clinical implications. The long-term effect of crossbite correction on midline deviation was unpredictable.
If crossbite is successfully corrected by the quad-helix appliance or the expansion plate, similar long-term stability is achieved. However, in treated patients, mean maxillary widths never reached those of normal control subjects.
