Dentofacial Orthopedics With Functional Appliances Downloads Torrent
Malena Bower
This exciting new edition describes the essential details of diagnosis for functional appliances, gives detailed instructions on how to obtain a correct construction bite, describes the fabrication and use of various types of functional appliances, and discusses the specific treatment of different malocclusion categories. New chapters discuss the expansion-activator and twin block appliance, the functional magnetic system, the Hamilton, the modern Herbst appliance, and the Jasper Jumper.
When selecting patients for the treatment group (group 1), pre- and posttreatment radiographs were evaluated, and those who met the following criteria were included: Skeletal and dental Class II malocclusion due to mandibular underdevelopment before treatment, use of only monoblock or twin block appliances to stimulate mandibular development, and Class I occlusion after treatment. The control group (group 2) was created by selecting individuals who were age- and sex-matched to those in group 1 from among those who presented for routine dental procedures, had no history of orthodontic treatment, and exhibited no systemic disease and/or deformity associated with the craniofacial area.
Dentofacial Orthopedics With Functional Appliances Downloads Torrent
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A study18 comparing the effects of monoblock and twin block appliances showed that mandibular growth was activated at similar rates in both study groups. Because the main aim of the current study was to analyze changes in the mandibular area only, patients treated with monoblock or twin block appliances were not analyzed as separate groups. In addition, patients who underwent gradual activation were not included in the study. However, skeletal and dental developmental stages were considered when choosing patients for the treatment group; all patients were selected from among individuals in, or just entering, the peak pubertal growth stage.1
The change in mandibular length induced by treatment was previously shown5,21,22 to be closely associated with the increase in condylar growth. In the current study, when the correlations between FD and cephalometric measurements were evaluated, a positive correlation between FD of the right condylar process and ramus (Co-Go) was found. This suggested that functional orthopedic devices can indeed cause changes in the osseous structures of the condyle, and this may be associated with mandibular growth.
Below is an article published in Dentistry Today Magazine explaining the benefits of an intraoral removal, functional orthopedic/orthodontic appliance. This article also explains how one improves the adult dental arch and airway through bio-engineering and dentofacial orthopedics.
A total of 48 studies were included in this review and none of which were RCTs. The quality of all included studies was assessed as medium. Overall, there is a tendency for an increase in airway volumes after various orthodontic interventions, except for studies concerning extraction therapy with fixed appliances in adults, in which both increases and decreases in airway volumes have been reported.
Orthodontic treatment by growth modification and non-extraction therapy with fixed appliances, regardless of the malocclusion, generally showed positive effects on the airway volume. Orthodontic treatment in combination with extractions does not provide an unambiguous insight. A consensus on the methodology of the airway measurement and nomenclature is urgently needed in order to gain insight into the effect of different interventions on three-dimensional airway changes.
The primary objective of orthodontic treatment is to establish an optimal dental and/or skeletal relationship in harmony with the morphology and function of the soft tissues in the oro-maxillofacial region. In addition, facilitating the development and functional demands of the airway is an important objective, especially in patients susceptible to airway obstruction or sleep apnea. Already in 1907, at the onset of orthodontics being established as a dental specialty, Angle postulated that children with a retrognathic mandible could have a smaller airway dimension. Recent studies showed that in patients with obstructive sleep apnea the underlying skeletal deformities are indeed related to a relatively restricted upper airway dimension [1,2,3,4,5,6].
In the current literature, the effect of orthodontic treatment on volumetric changes in the upper airway provides multiple outcomes. Previous reviews on volumetric changes in the airway focused on one type of treatment intervention, e.g. extraction therapy with fixed appliances [13], maxillary expansion [14], and treatment of Class II malocclusion with functional appliances [15]. Due to the differences in intervention types and high heterogeneity in the definition of the airway and/or its segments, it is not possible to make relevant comparisons of the findings between different interventions or to provide a valid interpretation of the outcomes from these reviews. Moreover, no previous reviews have investigated the effect of orthodontic treatment of Class III malocclusion on the airway.
Here we aim to provide a systematic analysis of the effect of different orthodontic interventions, including transversal and sagittal growth modifications, and extraction and non-extraction therapies with fixed appliances, on 3D volumetric changes of the upper airway using a standardized nomenclature with reliable anatomical landmarks to determine the borders of the airway on CBCT scans.
The studies on growth modification involved only growing patients (1.1, 1.2, 1.3), while those using fixed appliances or aligners involved both growing and adult subjects (2 and 3). Follow-up in the studies varied from 1 month up to 42 months, with 24 months being the most frequent follow-up.
Airway volumetric changes in mm3 after different types of interventions are presented in Table 3. Among the three airway segments, oropharynx volumes were reported in all studies except five [20, 33, 38, 39, 42] on maxillary transversal expansion, one on Class III growth modifications [45], one on fixed appliances treatment [61] and one on fixed appliances with extractions [64]. Nasopharynx volumes were reported in more than half of the studies on maxillary transversal expansion but in less than half of the other treatment groups. Only five studies reported the volumes on the hypopharynx airway [22, 23, 28, 46, 49].
In Supplementary files 1 to 5 bar graphs are presented to illustrate the percentages of post-treatment volumetric changes in relation to the respective pre-treatment level. The study of Iwasaki et al. reported an exceeding post-treatment volumetric increase of 219%, attributed to a very long follow-up (42 months), and was therefore excluded from the bar [48]. Patterns can be recognized for different treatment modalities. Volumes of the airway in studies with dentofacial-orthopedic growth modification showed almost all increases, up to 60% of the pre-treatment levels, regardless of the power of the study or the type of interventions. The increases were observed most frequently in the oropharynx (Supp. 1, 2 and 3). Treatment with fixed appliances showed distinguishable features in the oropharynx airway between extraction and non-extraction therapies. An overall increase of the volume was observed, up to 55% of the pre-treatment level after non-extraction therapy (Supp. 4). Extraction therapy, on the other hand, resulted in changes in both positive and negative directions, though to a lesser degree compared with non-extraction therapy (Supp. 5).
Orthodontic and dentofacial orthopedic treatment modifies the position of the skeletal, dental, and soft tissues within the maxillofacial complex. Therewith the soft tissues surrounding the upper airway may adapt to a new position, resulting in volumetric changes in the airway. The present review included all eligible studies on 3D volumetric changes in the upper airway after orthodontic and/or dentofacial orthopedic interventions. A meta-analysis could not be performed due to the high level of heterogeneity in the volumetric data, resulting from large variations of the defined anatomical borders of the airway.
In 7 out of 13 studies on growth modifications in subjects with Class II malocclusion, the post-treatment airway volumes were significantly higher than the pre-treatment level and/or the age-matched controls especially in the oropharynx. Demonstrating an additional gain from the intervention. These results are in line with a recent review, reporting weak evidence for a volumetric increase in the upper airway based on 5 studies on treatment with functional appliances in patients with Class II malocclusion [15].
The objective of this systematic review was to determine the orthodontic and dentofacial orthopedic treatments carried out in patients with ectodermal dysplasia to facilitate functional and aesthetic rehabilitation.
The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. We systematically searched PubMed, Web of Science, Scopus, Scielo, LILACS, EBSCOhost and Embase databases up to 6 January 2022. We included articles describing patients with any type of ectodermal dysplasia who received orthodontic or dentofacial orthopedic treatment to facilitate functional and aesthetic oral rehabilitation. The search was not restricted by language or year of publication. The quality of the studies was assessed using the Joanna Briggs Institute Quality Assessment Scale of the University of Adelaide for case series and case reports. The review was registered at the University of York Centre for reviews (CRD42021288030).
The level of evidence of the articles reviewed was low and most orthopedic and dentofacial orthodontic treatments described were focused on correcting dental malpositioning and jaw asymmetries and not on stimulating growth from an early age. Studies with greater scientific evidence are needed to determine the best treatment for these patients.
The functional and aesthetic rehabilitation of these patients is a challenge for dentists, so a multidisciplinary team is necessary. Early treatment during childhood is essential to solve the problem of multiple missing teeth and enhance the growth of the jaws to achieve better oral function and facial aesthetics. Initial dental treatment should focus on preventing cavities, restoring teeth with alterations in shape, replacing absent pieces, controlling the position of existing teeth and preventing or correcting malocclusions [14]. The first rehabilitations are usually made with removable complete or partial prostheses supported on the existing teeth previously restored aesthetically. Often these prostheses carry expansion screws to accompany maxillomandibular growth. As the patient grows, there is a need for orthopedic and/or orthodontic treatments for the management of the available space, leveling and aligning the teeth, and for orthopedic correction of the dentoskeletal malocclusion or jaw deformities.
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