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Introduction: The study aimed to compare daytime sleepiness in children with severe malocclusion with healthy children with neutral occlusion (controls) and to analyze associations between daytime sleepiness and craniofacial morphology in children with severe malocclusion., Methods: In 120 children with severe malocclusion (73 girls, 47 boys; mean age, 11.96 years; mean body mass index [BMI] score, 18.97 kg/m 2 ) and 35 controls (18 girls, 17 boys; mean age, 11.97 years; mean BMI score, 20.28 kg/m 2 ), sleep and daytime sleepiness were recorded using Epworth Sleepiness Scale and Berlin Questionnaire. Occlusion was registered clinically, and craniofacial morphology was assessed on lateral cephalograms. Differences in daytime sleepiness and sleep between the groups and associations between daytime sleepiness and sleep and craniofacial morphology were analyzed by a general linear model adjusted for age, gender, and BMI score., Results: Daytime sleepiness occurred significantly more often in children with malocclusion than in control subjects (P = 0.015). There was a tendency for children with malocclusion to feel extremely tired during the day more often than controls (P = 0.054). There was no significant difference between the groups in sleeping hours during night-time, but the amount of sleep was negatively associated with age (P <0.001) and BMI score (P = 0.004). Only maxillary inclination was significantly associated with daytime sleepiness (P = 0.043)., Conclusions: Daytime sleepiness occurred significantly more often in children with severe malocclusion than in those with neutral occlusion, and the association between daytime sleepiness and craniofacial morphology may exist. The results might prove valuable in interdisciplinary collaboration between medical doctors and orthodontists in diagnostics, prevention, and treatment of children at risk for sleep-disordered breathing., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: Sleep-disordered breathing (SDB) has negative influence on children's development and well-being. Malocclusion due to some craniofacial anatomical characteristics may be associated with SDB., Objectives: The aim of this paper is to ascertain whether SDB is associated with malocclusion in children/adolescents, aged 6-15 years compared to healthy controls., Methods: Prospero ID: CRD42021232103. A systematic electronic literature search following PRISMA was performed in PubMed, Embase and Cochrane Library. Inclusion criteria were as follows: Healthy children/adolescents aged 6-15 years with malocclusion undergoing polysomnography (PSG) or polygraphy (PG) and/or sleep questionnaire and orthodontic screening; compared to a healthy age-matched control group with neutral or minor deviation in the occlusion without requirement for orthodontic treatment; publications in English, Danish, Norwegian or Swedish published until 23 March 2021. JBI Critical Appraisal Tools and GRADE were used to evaluate the risk of bias and level of evidence., Results: The search resulted in 1996 records, 610 duplicates were removed, 1386 records were screened, and 1322 records were excluded. Sixty-four studies were selected for full-text reading, and four publications fulfilled the inclusion criteria. The included studies had moderate risk of bias, and the quality of evidence was low., Conclusion: No firm conclusion can be drawn regarding an association between specific malocclusion traits and SDB. Thus, the studies found no association between molar relationship and crowding and SDB symptoms in children. It may be recommended that future studies include objective PSG or PG in diagnosis of SDB and compare groups of children with skeletal malocclusion and controls with neutral malocclusion., (© 2021 John Wiley & Sons Ltd.)

Aim: To ascertain and illustrate specific clinical dento-craniofacial characteristics associated with sleep-disordered breathing (SDB) in non-syndromic children., Methods: Narrative review of literature on SDB, dental occlusion and craniofacial morphology retrieved through online literature database search for these terms. The review focused on clinical examples and graphical illustrations in order to ascertain the association between dento-craniofacial characteristics and SDB. Only publications concerning healthy non-syndromic children without any somatic or psychological diagnosis were included., Results: Dento-craniofacial characteristics such as anterior open bite, large overjet, cross bite and facial appearance such as convex profile due to mandibular retrognathia and inclination, narrow and high palate can predispose to SDB in non-syndromic children. Furthermore, extended head posture, mouth breathing and general adenoidal face may be symptoms or predisposing factors to SDB in non-syndromic children., Conclusion: Dento-craniofacial characteristics as anterior open bite, large overjet due to mandibular retrognathia, cross bite, and narrow and high palate can predispose to SDB in non-syndromic children. Facial characteristics predisposing to SDB can be a convex facial profile, extended head posture, mouth breathing and general adenoidal face. Interdisciplinary collaboration between medical doctors and dentists can prove valuable in diagnostics, prevention and treatment of SDB in non-syndromic children., (©2021 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Objective: To compare changes in pharyngeal airway volume and minimal cross-sectional area (MCA) between patients undergoing rapid maxillary expansion (RME) and a matched control group and to identify markers for predicting airway changes using cone-beam computed tomography (CBCT)., Materials and Methods: Pre- and posttreatment CBCT scans were selected of children who had RME (14 girls and 12 boys; mean age, 12.4 years) along with scans of a control group (matched for chronological age, skeletal age, gender, mandibular inclination) who underwent orthodontic treatment for minor malocclusions without RME. Changes in airway volume and MCA were evaluated using a standardized, previously validated method and analyzed by a mixed-effects linear regression model., Results: Upper airway volume and MCA increased significantly over time for both the RME and matched control groups ( P < .01 and P = .05, respectively). Although the RME group showed a greater increase when compared with the matched controls, this difference was not statistically significant. A reduced skeletal age before treatment was a significant marker for a positive effect on the upper airway volume and MCA changes ( P < .01)., Conclusions: Tooth-borne RME is not associated with a significant change in upper airway volume or MCA in children when compared with controls. The younger the skeletal age before treatment, the more positive the effect on the upper airway changes. The results may prove valuable, especially in RME of young children.

Objective: Based on the results of previous studies of osseous structures within the frontonasal field in patients with a known malformation in the frontonasal field, the aim of the present study was to clarify whether the same structures were malformed in patients with severe skeletal malocclusions., Material and Methods: Incisor, nasal, and cranial base lengths were measured on lateral radiographs of adult patients with skeletal malocclusions, including open bite (n=35), mandibular overjet (n=56), maxillary overjet (n=31), deep bite (n=19), and compared with those of a control group with neutral occlusion and normal craniofacial morphology (n=39). Two-way ANOVA tests were used to evaluate differences in lengths between groups and gender., Results: Statistically shorter maxillary central incisor length was found in the open bite group (p<0.05), the mandibular overjet group (p<0.001), and in the deep bite group (p<0.001) compared to the controls. Nasal bone length was shorter in the maxillary overjet group compared to controls (p<0.05)., Conclusions: The lengths of the maxillary central incisor and nasal bone, both parameters located in the frontonasal field, are affected in different skeletal malocclusions. The present findings, especially the deviation of the upper incisor length in different skeletal malocclusions, are considered relevant for orthodontic diagnostics and treatment.

Temporomandibular disorders (TMDs) and psychological status were examined in adult patients with a deep bite and compared with an adult age- and gender-matched control group with neutral occlusion. The deep bite group consisted of 20 females (mean age 30.3 years) and 10 males (mean age 33.1 years). The control group comprised 20 females (mean age 29.4 years) and 10 males (mean age 34.2 years). TMD examination, according to the Research Diagnostic Criteria for TMD (RDC/TMD), cephalometric lateral radiographs, registration of occlusion, and bite force were performed. To test the mean differences between craniofacial morphology, bite force, the occurrence of RDC/TMD diagnostic groups, and headache between the two groups, unpaired t-test, Fisher's exact test, Mann-Whitney U test, and multiple logistic regression analyses were performed. Deep bite patients more frequently reported nocturnal and diurnal clenching (P < 0.01), an uncomfortable bite (P < 0.001), jaw stiffness (P < 0.05), and 'ringing' in the ears (P < 0.001) than the controls. Headache (P < 0.001), muscle disorders (P < 0.001), disc displacement (P < 0.05), and other joint disorders (P < 0.05) occurred significantly more often in the deep bite group compared with the controls. Somatization scores were significantly higher in the deep bite group compared with the controls (P < 0.001). Headache, muscle disorders, disc displacement, and other joint disorders were significantly associated with a number of craniofacial dimensions and psychological factors [R between 0.32 and 0.72; P < 0.05 and odds ratio (OR) from 0.45 to 7.46; P < 0.05]. These findings suggest that a deep bite, in particular with retroclined upper incisors, can represent a risk factor for TMD.

Cervical column morphology was examined in 41 adult patients with a skeletal deep bite, 23 females aged 22-42 years (mean 27.9) and 18 males aged 21-44 years (mean 30.8) and compared with the cervical column morphology in an adult control group consisting of 21 subjects, 15 females, aged 23-40 years (mean 29.2 years) and six males aged 25-44 years (mean 32.8 years) with neutral occlusion and normal craniofacial morphology. None of the patients or control subjects had received orthodontic treatment. For each individual, a visual assessment of the cervical column and measurements of the cranial base angle, vertical craniofacial dimensions, and morphology of the mandible were performed on a profile radiograph. In the deep bite group, 41.5 per cent had fusion of the cervical vertebrae and 9.8 per cent posterior arch deficiency. The fusion always occurred between C2 and C3. No statistically significant gender differences were found in the occurrence of morphological characteristics of the cervical column (females 43.5 per cent, males 38.9 per cent). Morphological deviations of the cervical column occurred significantly more often in the deep bite group compared with the control group (P < 0.05). Logistic regression analysis showed that the vertical jaw relationship (P < 0.05), overbite (P < 0.001), and upper incisor inclination (P < 0.01) were significantly correlated with fusion of the cervical vertebrae (R(2) = 0.40).

In this prospective, longitudinal study, bite force was examined in children with a unilateral posterior crossbite before (stage 1), immediately after orthodontic treatment (stage 2), and after retention (stage 3). The sample comprised 19 (7 girls, 12 boys) children aged 7-11 years. The children were treated according to conventional practice, with an expansion plate (seven subjects) or a quadhelix appliance (12 subjects). Unilateral bite force was measured at the first molars by means of a standardized method. Statistical analysis was undertaken using Shapiro-Wilks W- and t-tests, and analysis of variance. There was no significant difference in bite force regarding age, gender, appliance, or side, i.e. right or left molar region. However, during stage 2 the bite force was significantly lower ipsilaterally to the crossbite than contralaterally (P<0.05). In general, the bite force was systematically lower than reference values, but the mean bite force (P<0.05) and the bite force on the ipsilateral side (P<0.01) increased significantly from stage 2 to stage 3. The bite force level was reduced immediately after treatment, but increased again after retention and approached the bite force level in children with neutral occlusion. The fluctuation in bite force level during orthodontic treatment may be due to transient changes in occlusal support, periodontal mechanoreceptors, and jaw elevator muscle reflexes.

The present study examined bite force in relation to occlusion, craniofacial dimensions, and head posture. The sample comprised 88 children (48 girls, 40 boys) aged 7-13 years, sequentially admitted for orthodontic treatment of malocclusions entiling health risks. Bite force was measured in the molar region by means of a pressure transducer. Angle classification, number of teeth and contact in the intercuspal position (ICP) were recorded and dental arch widths were measured on plaster casts. Craniofacial dimensions and head posture were recorded from lateral cephalometric radiographs taken with the subject standing with their head in a standardized posture (mirror position). Associations were assessed by Spearman correlations and multiple stepwise regression analyses.The maximum bite force increased significantly with age in girls, with teeth in occlusal contact in boys, and with increasing number of erupted teeth in both genders. Bite force did not vary significantly between the Angle malocclusion types. Only in boys was there a clear correlation between bite force and craniofacial morphology: cranial base length (n-ba, n-ar), posterior face height (s-tgo, ar-tgo), vertical jaw relationship (NL-ML), mandibular inclination (NSL-ML), form (ML-RL) and length (pg-tgo), and inclination of the lower incisors (Ili-ML). Multiple regression analysis showed that the vertical jaw relationship (P < 0.001) and the number of teeth present (P < 0.01) were the most important factors for the magnitude of bite force in boys. In girls, the most important factor was the number of teeth present (P < 0.001). No correlations between bite force and head posture were found.

Background/Objectives: Clear aligner treatment (CAT) has gained interest among clinicians as well as among patients. The aim of the present study was to systematically review the literature regarding current viewpoints on indications, contraindications, advantages, disadvantages, and adverse effects in CAT. Methods: A search was performed in the PubMed and Embase databases, yielding 18 studies eligible for inclusion. Results: Current indications for CAT are mild to moderate malocclusions. Severe malocclusions with impactions or severe craniofacial skeletal deviations are contraindications. The advantages were oral hygiene and oral health as the most common, and disadvantages of CAT have been noted by several studies, including CAT still being inferior to fixed appliance treatment (FAT) in all orthodontic movements. Adverse effects were potential health risks due to microplastics and a decrease in condyle bone volume. Conclusions: No firm conclusions can be drawn regarding indications for CAT except for mild to moderate malocclusion. Severe malocclusions with impactions or severe craniofacial skeletal deviations are considered contraindications. In more complex cases, CAT is still considered inferior to FAT, although CAT contains advantages. There are disadvantages in CAT which clinicians should consider when choosing a type of orthodontic appliance for treating specific malocclusions. Only a few adverse effects in CAT were presented by the included studies. More high-quality research is needed regarding indications and contraindications for CAT. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this case-control study was to examine upper airway by acoustic reflection in class II children with large horizontal maxillary overjet compared to children with neutral occlusion. Material and Methods: The study group included children of 9 to 14 years with class II and large horizontal maxillary overjet (= 6 mm) compared to children with neutral occlusion (controls). Acoustic pharyngometry and rhinometry were performed in natural head position. Differences between groups were tested by chi-square test, general linear model (adjusted for age, gender and body mass index [BMI]), and Mann-Whitney test. Results: The study and control group consisted of 37 (boys: 19, girls: 18) and 32 (boys: 16, girls: 16) participants, respectively. No significant differences in age, gender, and BMI were found between the groups. For the acoustic rhinometry measurements significantly increased resistance (P = 0.04), reduced volume (P = 0.03) and distance to minimal cross-section area (MCA) (P = 0.035) were found in the study group, but only for the right nostril. However, significantly reduced MCA for both nostrils was found in the study group (P = 0.025 to 0.04). No significant differences in acoustic pharyngometry measurements were found. Conclusions: Nasal airway dimensions were significantly reduced, and nasal resistance was significantly increased in the study group compared to controls. Thus, class II and large overjet with indication for growth adaptive treatment may be a risk factor for sleep-disordered breathing. In the future, orthodontic paediatric patients may benefit from non-invasive risk assessment of narrow upper airway using acoustic reflection. [ABSTRACT FROM AUTHOR]

Background: Large horizontal maxillary overjet (overjet) is associated with reduced bite force (BF) and number of contacts, which influence the chewing effectivity (CE). Oral health, oro‐facial function (OF) and malocclusion have great impact on psychological well‐being and quality of life (QoL). Objectives: The aims of the study were to examine OF, temporomandibular disorders (TMD), BF, CE, QoL and well‐being in children and adolescents with large overjet. Methods: The study was a case–control study including healthy children with large overjet in the study group compared to a control group of healthy children with neutral occlusion, all 9–14 years old. OF was examined by use of Nordic Orofacial Test‐Screening (NOT‐S), Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and registration of morphological and functional occlusion. QoL and well‐being were examined using KIDSCREEN‐10 and Strengths and Difficulties Questionnaire. Results: The study and control groups included 37 and 32 participants, respectively. Significantly increased NOT‐S score (p <.001) and reduced BF (p =.011), numbers of contacts (p <.001) and CE (p =.005) were found in the study group. BF, numbers of contacts and CE were negatively associated with erupting canines and premolars. No significant difference was found in age, gender, dental eruption, TMD diagnosis or QoL between the groups. Significantly increased emotional symptoms (p =.007), hyperactivity (p =.043) and total difficulties score (p =.009) were found in the study group. Conclusion: The study group showed higher NOT‐S score and reduced BF, number of contacts and CE. No difference in QoL were found between the groups, although reduced well‐being and increased emotional symptoms, hyperactivity and total difficulties were found in the study group. [ABSTRACT FROM AUTHOR]

Aims: To compare pain sensitivity between deep bite patients and a sex- and age-matched control group with normal occlusion. Methods: Pain sensitivity was assessed by injections of the excitatory amino acid glutamate into the masseter and brachioradialis muscles. Intensity of glutamate-evoked pain was scored by the subjects ( n = 60) on a 0 to 10 cm visual analog scale. Subjects drew the perceived pain area on a face and arm chart and described the quality of pain on the McGill Pain Questionnaire. Thresholds for cold detection, cold pain, cold tolerance, warmth detection, heat pain, and heat tolerance were assessed on the masseter and brachioradialis muscles. Pressure pain threshold and pain tolerance threshold were determined on the temporomandibular joint, masseter, anterior temporalis, and brachioradialis muscles. The differences between groups, age, and gender were tested by two-way ANOVA, and the significant differences were then tested for the effect of the presence of temporomandibular disorder (TMD) by linear regression. Results: Glutamate-evoked pain intensity was significantly different between groups with no gender differences. Quality of pain did not vary between groups, but significant gender-related differences were observed. Significant differences in thermal sensitivity between groups and gender were found, whereas mechanical sensitivity did not vary between groups but between genders. None of the significant differences were due to the effect of TMD. Conclusion: These data provide further evidence of gender-related differences in somatosensory sensitivity and for the first time indicate that subjects with deep bite may be more sensitive to glutamate-evoked pain and thermal stimuli. [ABSTRACT FROM AUTHOR]

The aim was to analyse which parameters in a standard orthodontic material are most important for identifying factors for low bite force. Such analyses have not previously been reported in adult orthodontic patients. The sample comprised 95 adults (67 females and 28 males) aged 18–55 years sequentially admitted for conventional orthodontic treatment. All subjects had moderate to severe malocclusions. Bite force was measured by a pressure transducer, craniofacial dimensions and head posture were measured on profile radiographs, number of teeth in contact were evaluated with a plastic strip in intercuspidal position, and symptoms and signs of temporomandibular disorders (TMD) were evaluated by TMD screening. Associations were assessed by Spearman correlations, Wilcoxon signed-rank sum test, and multiple stepwise regression analyses. Associations were found between bite force and craniofacial dimensions as mandibular prognathia (S–N–Pg, P < 0.05; S–N–sm, P < 0.05), sagittal jaw relationship (SS–N–Pg, P < 0.05), mandibular inclination (NSL/ML, P < 0.05), and mandibular plane angle (ML/RL, P < 0.01) and between bite force and TMD symptoms (P < 0.05) and TMD signs (P < 0.05). Multiple regression analysis showed that gender (P < 0.001), TMD symptoms (P < 0.01), and mandibular plane angle (P < 0.001) were the most important factors for the magnitude of the bite force in adult orthodontic patients (R2 = 0.32). The results showed that particularly women with TMD symptoms and an increased mandibular plane angle are at risk of having low bite force. This may prove valuable in the clinic, especially in orthodontic cases with an increased need for vertical anchorage during treatment. [ABSTRACT FROM PUBLISHER]

Significant associations have previously been described between craniofacial morphology, posture of the head and neck, and obstruction of the upper airways as seen in patients with obstructive sleep apnea. Morphological deviations in the cervical vertebral column have also been described in relation to craniofacial syndromes and to cleft lip and/or palate. New findings have been made concerning associations between fusion of the cervical vertebral column and craniofacial morphology, including the cranial base, in patients with severe skeletal malocclusions. Another new finding was the association between fusion of the cervical vertebral column and head posture and between fusion of the cervical vertebral column and obstructive sleep apnea. Accordingly, it is suggested that fusion of the cervical vertebral column is associated with the development and function of the craniofacial morphology in the sagittal, vertical, and transversal planes. [ABSTRACT FROM AUTHOR]

In the present study bite force was examined in pre-orthodontic children with unilateral posterior crossbite and compared with an age- and sex-matched control group. The sample comprised 52 children aged 7-13 years, 26 pre-orthodontic children with unilateral posterior crossbite (crossbite group), and 26 children with neutral occlusion (control group). Unilateral bite force was measured at the first molar by means of a pressure transducer. Furthermore, symptoms and signs of temporomandibular disorders (TMD) and number of teeth in contact in the intercuspal position (ICP) were recorded. In both groups, the maximum bite force increased significantly with age and with increasing stages of dental eruption, but the bite force in both sexes did not differ significantly. There were no significant differences in bite force between sides, but this was significantly smaller in the crossbite group than in the controls (P < 0.001). Regression analysis showed that stage of dental eruption (P < 0.001), number of teeth in occlusal contact (P < 0.01), and unilateral crossbite (P< 0.001) were the only variables significantly correlated with bite force. The number of teeth in contact was significantly smaller in the crossbite group than in the controls (P < 0.05) and the frequency of muscle tenderness was significantly higher in the crossbite group than in the controls (P < 0.05). These results suggest that differences in the muscle function associated with unilateral crossbite lead to a significantly smaller bite force in the crossbite group compared with controls and this difference did not diminish with age and development. These findings indicate that early treatment of unilateral posterior crossbite is advisable to optimize conditions for function. [ABSTRACT FROM AUTHOR]

Previously, bite force, occlusal contact and pain were investigated in orthodontic patients with moderate-to-severe malocclusion, but not in patients with minor malocclusion. The purpose of this study was to investigate changes in bite force, teeth in occlusal contact and pain in orthodontic patients with minor crowding before orthodontic treatment (T0), after bonding (T1), during treatment (T2), post-treatment (T3) and during retention (T4). In total, 27 patients (21 females, 6 males, median age 15.3 years) with neutral occlusion and normal craniofacial morphology were treated with non-extractions and fixed appliances. Differences in the registered data were analysed by a mixed linear model with repeated measures. Bite force and teeth in occlusal contact significantly decreased between T0 and T1 (p < 0.0001, respectively) and between T0 and T2 (p < 0.01, respectively). Bite force and teeth in occlusal contact significantly increased between T1 and T4 (p < 0.05, p < 0.0001, p < 0.001, respectively) and between T2 and T4 (p < 0.05, p < 0.0001, p < 0.01, respectively). No significant difference in pain was found. The results indicate that bite force and teeth in occlusal contact significantly decreased during treatment and reached baseline level at retention. The findings may prove valuable for informing orthodontic patients with minor malocclusion. [ABSTRACT FROM AUTHOR]

This research aimed to evaluate the effects of presurgical mandibular incisor decompensation on long-term outcomes of Class III surgical orthodontic treatment. Thirty-five patients with skeletal Class III malocclusion who received conventional surgical orthodontic treatment were included. Mandibular incisor brackets with −6° of inclination were placed normally in 18 patients (NB group) and inversely in 17 patients (RB group). Between-group differences and relationships between incisal and skeletal variables were analyzed based on lateral cephalograms at pretreatment, presurgery, postsurgery, posttreatment, and retention. Mandibular incisors were more labially inclined in the RB group than in the NB group from presurgery to retention. No significant between-group differences were observed in presurgical and postsurgical skeletal relationships. The NB group exhibited a larger overjet with deficient interincisal contact at postsurgery than the RB group. Skeletal Class III relationship was also more severe in the NB group at retention. More lingually inclined mandibular incisors at presurgery and larger overjet at postsurgery were correlated with a more severe skeletal Class III relationship at retention. Thus, establishing appropriate postsurgical overjet by sufficient presurgical mandibular incisor decompensation may play a significant role in postsurgical stability of Class III surgical orthodontic treatment. [ABSTRACT FROM AUTHOR]