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Objective To examine skeletal morphology and dental arch relationships at 8 years of age following early 2-stage palatoplasty, which consists of soft palate plasty at 1 year of age and hard palate closure at 1.5 years of age, and to compare the results with those of conventional pushback palatoplasty. Design Retrospective. Setting Single institutional study. Patients Eighty-six patients with nonsyndromic complete unilateral cleft lip and palate (UCLP) were selected. Intervention The subjects were divided into 2 groups according to the palatoplasty protocols, as follows: 45 patients, who underwent early 2-stage palatoplasty (ETS group), and 41 patients, who underwent 1-stage pushback palatoplasty (PB group). Main Outcome Measures Skeletal morphology was assessed using lateral cephalometric analysis, and dental arch relationships were examined using the GOSLON yardstick. Results Cephalometric analysis revealed that the anterior-posterior length of the maxilla, measured by PTM-A and PTM-ANS, both projected to the nasal floor (NF) plane, was longer in the ETS group than in the PB group (PTM-A/NF, p = .04; PTM-ANS/NF, p = .03, unpaired t-test), although no significant difference was observed in SNA ( p = .09, unpaired t-test). Upper posterior facial height was shorter in the ETS group than in the PB group ( p = .02, unpaired t). Assessments with the GOSLON yardstick showed that the ETS group presented better dental arch relationships than the PB group ( p = 0.04, Mann–Whitney's U-test). Conclusions The present results suggested that the ETS protocol reduced the negative effects of palatal surgery on facial development and dental arch relationships in patients with complete UCLP at 8 years of age.

Objectives To investigate the prevalence of posterior tongue tie in orthodontic patients using numerical and clinical assessment methods in order to identify an association between posterior tongue tie and transverse maxillary deficiency. Materials and methods Seventy-nine participants from an orthodontic clinic were divided into two groups. The first group of 44 patients exhibited a skeletally narrow maxilla and required maxillary skeletal expansion (MSE group) and 35 patients without a transverse discrepancy comprised a control group. Posterior tongue tie was examined by the Kotlow tongue tie classification, tongue range of motion ratio (TRMR) and via a clinical assessment. The prevalence of posterior tongue tie was compared between the two groups. Results There was no significant difference in the level of the Kotlow classification grade between the two groups (p > 0.05) and the overall majority was diagnosed as normal. However, a higher proportion of posterior tongue tie was found in the MSE group than in the control group by clinical assessment (MSE group, 72.7%; control group, 42.9%; p = 0.005). The proportion of TRMR grade 2 was also higher in the MSE group than in the control group (p = 0.001). Of the subjects diagnosed with posterior tongue tie by clinical findings, approximately 94% showed TRMR grades 2 or 3. Conclusions A clinical assessment of posterior tongue tie was found to be simple and accurate, whereas a numerical assessment alone provided diagnostic difficulty. Considering the high prevalence of observed posterior tongue tie in the MSE group, there was a significant association between posterior tongue tie and transverse maxillary deficiency.

The purpose of the present study was to investigate the degree of overjet deemed by subjects without dental education as needing orthodontic treatment, to determine whether dental education influen...

Background The purpose of this study was to identify pretreatment factors associated with the stability of early class III treatment, since most orthodontists start the treatment with their uncertain hypotheses and/or predictions. Subjects consisted of 75 patients with a class III skeletal relationship (ANB < 2° and overjet < 0 mm) who had been consecutively treated with rapid maxillary expansion and facemask and followed until their second phase treatment. The patients were divided into two groups according to whether they showed relapse in follow-up. The stable group maintained their positive overjet (n = 55), and the unstable group experienced relapse with a zero or negative overjet (n = 20). Two general, three dental, and 13 cephalometric pretreatment factors were investigated to determine which factors were associated with stability. Results Sex, pretreatment age, and anteroposterior functional shift, which were hypothesized as associated factors, were not related to the stability of early class III treatment. Significant differences were detected between the two groups in the horizontal distance between the maxillary and mandibular molars in centric relation. Cephalometric variables, such as the mandibular length (Ar-Me), Wits appraisal, SN to ramus plane angle (SN-Rm), gonial angle, incisor mandibular plane angle (IMPA), and Frankfort plane to mandibular incisor angle (FMIA) showed significant differences between the groups. The horizontal distance was the most influential factor by logistic regression analysis. Conclusions Hypothesis (related to sex, age, functional shift) were rejected. Several cephalometric factors related to the mandible were associated with stability. The horizontal distance between the maxillary and mandibular molars in centric relation was the best predictor of early class III treatment relapse.

Purpose The purpose of the present study was to examine the three-dimensional (3D) lip morphology in cases of skeletal Class I malocclusion with labial inclination of the upper central incisors. Materials and methods Thirty-five Japanese patients with malocclusion were divided into 2 groups: 20 patients (Test group; 9 males and 11 females; 7 years 5 months–14 years 2 months) who exhibited Class I malocclusion with labial inclination of the upper central incisors and 15 patients (Control group; 7 males and 8 females; 8 years 0 month–14 years 4 months) who exhibited skeletal Class I malocclusion with standard inclination of the upper central incisors. The 3D morphology of the facial soft tissue was recorded using a 3D surface-imaging device for both groups. The differences in the lip morphology variables between the Test and Control groups were then analyzed statistically. Results The central, right and left upper lip inclination angle in the lateral and three-quarter views in the Test group were significantly larger than those in the Control group. The upper lip base area, protrusion surface area, protrusion volume, and protrusion depth were significantly increased compared with the Control group, as were also the lower lip protrusion volume and depth. However, no significant differences in the lower lip base area and surface area were determined between the Test and Control groups. Conclusions The upper lip wholly showed labial inclination and forward protrusion in Class I malocclusion with labial inclination of the upper central incisors.

The present case report describes the combination of orthodontic treatment and two-stage surgery used to treat a 16-year-old female with a severe maxillary occlusal cant and a mandibular deviation. The patient was diagnosed with right temporomandibular joint ankylosis six months after suffering a facial injury at five years of age. A unilateral condylectomy was performed 12 months later. A hybrid functional appliance was used between nine and 16 years of age to prevent deterioration of the maxillary occlusal cant. At 16 years and six months, it was determined that the patient required a combination of surgical and orthodontic treatment, the pre-surgical orthodontic phase of which was completed at 19 years. The surgery was performed in two stages, which involved a Le-Fort 1 procedure to intrude the maxilla in the left molar region and to extrude in the right molar region. Distraction osteogenesis was performed to achieve a lengthening of the right mandibular ramus. The second operation was a unilateral sagittal split ramus osteotomy to achieve a forward and upward rotation of the left hemimandible. As a result, the patient’s facial asymmetry and occlusion significantly improved. The improvements were well maintained and the patient remained stable after one year of retention.

A 22-year-old female with a mandibular rightward deviation, facial asymmetry, lower dental midline rightward deviation, anterior open bite, anterior crossbite, posterior crossbite, Class III molar relationship, and severe crowding had surgical orthodontic treatment. Following extraction of the upper second premolars, lower right first premolar, left second premolar, and all four third molars, the upper and lower teeth were aligned and dental arch widths coordinated in the preoperative orthodontic treatment. The mandible was moved backward and rotated to the left with a bilateral sagittal split ramus osteotomy. Acceptable facial esthetics and occlusion were obtained. The improvements in facial appearance and the dental arches remained stable after 2 years and 11 months.

Purpose The purpose of the present study was to present a three-dimensional method for evaluating changes in lip morphology and to apply the method to the therapy evaluation following the correction of functional anterior crossbite. Materials and methods Twenty-five Japanese patients (age: 6 years and 10 months to 10 years and 9 months) with anterior crossbite and premature contact of at least one central incisor were included. Anterior crossbite was treated with labial movement of the upper anterior teeth using a fixed or removable appliance. Treatment was completed within 6 months. The 3D morphology of the facial soft tissue was recorded using a 3D surface imaging device before and immediately after correction of anterior crossbite. The differences in lip morphology variables were statistically analyzed. Results At post-treatment, the upper lip was positioned anteriorly and was proclined on the mid-sagittal plane, and anteriorly and superiorly on the plane apart from the midline. The lower lip was positioned posteriorly not only on the mid-sagittal plane but also on the plane apart from the midline. The lower lip was retroclined on the mid-sagittal plane. The submental region was positioned posteriorly and inferiorly. Conclusions Post-treatment imaging showed forward movement of the upper lip, backward movement of the lower lip, and backward rotation of the soft tissue in the submental region. The three-dimensional method described in the present study improves the evaluation of facial morphology and provides insight into the changes in the lip morphology of preadolescent patients.

Introduction The purposes of this study were to examine the accuracy and the head positioning effects on measurements of anterior tooth length using 3-dimensional (3D) and conventional dental panoramic radiography and to investigate whether 3D panoramic radiography is suitable for the evaluation of anterior tooth length. Methods A simulated human head was radiographed at 4, 8, and 12 mm displaced positions, and at 5°, 10°, and 15° tilted positions from the standard head position using 3D and conventional panoramic radiography, and also using cone-beam computed tomography. Anterior tooth lengths were measured on the panoramic and cone-beam computed tomography images. The values for the standard head position in the panoramic radiographs were defined as the standard values. Measurement error was defined as the standard value minus the cone-beam computed tomography value on each panoramic radiograph. The head position ratio of the measurement value to the standard value at each head position was calculated. Results Measurement errors for the 3D panoramic radiographs were significantly smaller than those for the conventional panoramic radiographs. In the 3D panoramic radiographs, the head position ratios at the 4, 8, and 12 mm displaced positions and at the 5° tilted position were within ±5% of the standard value. Conclusions Three-dimensional panoramic radiography is suitable for the quantitative evaluation of anterior tooth length with high accuracy.

Objective: This study aims to assess occlusal relationships and frequency of oronasal fistula at 5 years of age following 2 hard palate closure techniques and to compare results. Design: Retrospective longitudinal study. Setting: Institutional study. Patients: Study patients included 57 patients with nonsyndromic complete unilateral cleft lip and palate who were consecutively treated. All patients underwent our early 2-stage protocol for palatoplasty, which consisted of soft palate plasty at 1 year of age and hard palate closure at 1.5 years of age. Twenty-nine patients underwent hard palate closure using vestibular flap (VF group) technique (2009-2011) and 28 patients underwent conventional hard palate closure with local palatal flap (LPF group) technique (2006-2008). Main Outcome Measures: Occlusal relationships were assessed with 5-year-olds’ index, and frequency of oronasal fistula was investigated. Results: Average 5-year-olds’ index scores for VF and LPF groups were 3.11 and 3.57, respectively ( P < .001). Oronasal fistula occurred in approximately 7% of patients in the VF group and in 18% of patients in the LPF group. Conclusion: Hard palate closure with VF technique may provide better occlusal relationships at 5 years of age than does conventional local closure with the LPF.

Objective To clarify the differences in the long-term effects of maxillary expansion (ME) and protraction (MP) in patients with complete unilateral cleft lip, alveolus, and palate (UCLP) undergoing two types of palatoplasty. Design Retrospective longitudinal study. Setting Institutional study. Patients and Interventions Thirty-eight patients with UCLP treated at Osaka University Dental Hospital, Japan, were divided into two groups: 19 patients were treated using Wardill-Kilner push-back palatoplasty (PB), and 19 patients were treated with early two-stage palatoplasty according to the modified Furlow technique (ETS). All patients exhibited a short maxilla at the initial orthodontic visit and were treated with ME using a quad helix appliance and MP with a face mask. Lateral cephalometric data recorded in the initial stage were compared with those obtained at the end of treatment. Main Outcome Measurements The dentoskeletal features and facial soft tissue profile were evaluated before and after orthodontic treatment. The variation and rate of change during treatment were also calculated. The Mann-Whitney U test was used for the statistical analyses. Results The ETS group showed significantly greater SNA, SNB, and U1-Pp angles and smaller SN-Mp angles than the PB group after face mask treatment. The variation in the anteroposterior length of the maxilla during treatment was significantly greater in the ETS group than in the PB group. Conclusions Maxillary protraction was more efficiently accomplished in the patients with UCLP after early two-stage palatoplasty compared with push-back palatoplasty.

Objective To compare the maxillofacial morphology in the early mixed dentition phase between two patient groups with unilateral cleft lip, alveolus, and palate who underwent different types of palatoplasty. Design Cross-sectional study. Setting An institutional study. Patients and Interventions Seventy-one patients with unilateral cleft lip and palate (UCLP) treated at Osaka University Dental Hospital, Japan, were divided into two groups: 33 patients were treated by early two-stage palatoplasty by the modified Furlow Technique (ETS), and 38 patients were treated by one-stage Wardill-Kilner push-back palatoplasty (PB). Intergroup comparisons were performed. Main Outcome Measures The dental, skeletal, and soft-tissue features were evaluated. For intergroup comparisons, Mann-Whitney U test was used for the statistical analyses. Result No significant differences existed between the ETS and PB groups regarding the skeletal features except for the mandibular ridge height. Meanwhile, the upper central incisor and upper lip of the ETS group showed a more anterior position than those in the PB group. Conclusions Early two-stage Furlow palatoplasty leads to more protruded upper lip, providing more anteriorly positioned upper incisors compared with PB, at least at the early mixed dentition stage.

When selecting treatment for traumatically intruded teeth, various factors should be evaluated including the degree of intrusion, pulp vitality, patient's age and maturity of the tooth. Treatment options consist of surgical repositioning, orthodontic extrusion and spontaneous re-eruption. This study describes a case of a 22-year-old male with traumatically intruded maxillary canine and first premolar that was treated comprehensively by an orthodontist, endodontist and prosthodontist two months after injury.

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.

Objective: To investigate whether individuals with malocclusion show less skillfulness, as represented by kinematic parameters that characterize masticatory jaw movement, compared with those having normal occlusion and, if so, to examine whether more skilled movements are achieved after completion of orthodontic treatment. Materials and Methods: Lower incisor point movement in space during gum chewing was recorded, and the kinematic traits of such movement were compared among four subject groups: a Control Group (36 females with good occlusion), a Malocclusion Group (24 females with dental malocclusions), an Extraction Group (31 females who had received orthodontic treatment with premolar extraction) and a Nonextraction Group (27 females who had been treated orthodontically without tooth extraction). Before treatment, all subjects in the three experimental groups exhibited dental malocclusions and skeletal class I jaw-base relationship. Results: Compared with the Malocclusion Group, the lower normalized jerk-cost, the shorter phase durations, the more symmetric property of the velocity profile, and the smaller variance of lateral jaw-closing trajectories near the tooth intercuspation position were determined in the Extraction Group and the Nonextraction Group as well as in the Control Group. Conclusions: As measured by kinematic parameters such as normalized jerk-costs, velocity profile, and variance of movement trajectories near the endpoint of movement, dental malocclusions were associated with significantly lower skillfulness of masticatory jaw motion, whereas good occlusion and orthodontically improved occlusion (either with or without premolar extraction) were both associated with more skillful motion.

This case report describes orthodontic treatment of a 20-year-old female patient having a high-angle Class I malocclusion with severe anterior crowding and a convex soft tissue profile. In this case, orthodontic diagnosis and treatment planning has been based on “soft tissue paradigm”. The preadjusted edgewise appliances were placed after the upper and lower first premolars were extracted. After active treatment, a good facial profile and occlusion were achieved. Occlusion remained stable during 2 years of follow-up.

OBJECTIVES: (1) To identify any differences in the accuracy of the prediction of the summed widths of unerupted permanent canines and premolars for males vs females and, if differences are identified, (2) to examine the sex differences in the best combination of independent variables and (3) to evaluate the practical accuracy using our models for both sexes, respectively. MATERIALS AND METHODS: Records for 200 orthodontic patients (100 males and 100 females) with discernible tooth crowding in the permanent dentition were selected. Mesiodistal tooth crown widths, dental arch widths, and basal arch lengths were measured. Predicted sum widths of permanent canines and premolars in both dental arches were calculated using stepwise regression analysis. RESULTS: Among male subjects, the best combinations of independent variables were the widths of the upper central and lateral incisors (U1, U2) and the first molar (U6) for the maxilla (R(2) = 0.615) and the mandible, lower central and lateral incisors (L1, L2), and the first molar (L6) (R(2) = 0.685), whereas in females, the best combinations for prediction were found to be U1, U2, U6, and the maxillary arch width for the maxilla (R(2) = 0.429) and L1, L2, L6, and the basal arch length for the mandible (R(2) = 0.426). Correlation coefficients between each independent and dependent variable in the female subject group were found to be weaker than those for the male subject group. CONCLUSIONS: We found the sex differences in the accuracy of prediction and the best combination of independent variables for predicting the summed widths of unerupted canines and premolars. These new models should be clinically useful, providing highly accurate prediction.

This is a report of a case in which improvement in masticatory jaw movement kinematics occurred following orthodontic treatment. A patient who demonstrated a skeletal Class II jaw relationship, with anterior crossbite between the right upper and lower lateral incisors, underwent treatment with an edgewise appliance. The trajectories and smoothness of the patient's jaw-closing movement were compared before and after orthodontic treatment. The correction of the anterior crossbite allowed the patient to consistently close the jaw with wider lateral excursion. Furthermore, after treatment, smoothness of the jaw-closing movements increased significantly, and the velocity profile was characterized as closer to that predicted by the minimum jerk (maximum smoothness) kinematic model. These findings suggest the value of trajectory smoothness (jerk-cost) as an objective indicator of kinematic improvement in gum chewing. In addition, the correction of anterior crossbite is demonstrated to enable the patient to perform smoother jaw-closing movements during chewing.