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Residents' journal review
RESIDENTS' JOURNAL REVIEW
ARTICLES FROM THE CURRENT ORTHODONTIC LITERATURE, SELECTED AND REVIEWED BY: SENIOR ORTHODONTIC RESIDENTS, BOSTON UNIVERSITY, BOSTON, MASS Dr Leslie A. Will, Department Chair and Program Director
The association between anterior crossbite, deepbite, and temporomandibular joint morphology Wohlberg V, Schwahn C, Gesch D, Meyer G, Kocher T, Bernhardt O. The association between anterior crossbite, deep bite and temporomandibular joint morphology validated by magnetic resonance imaging in an adult non-patient group. Ann Anat 2012;194:339-44.
T
he morphology of the temporomandibular joint (TMJ) has been extensively studied under various occlusal conditions such as tooth loss, occlusal disharmonies, and excessive oral function or dental abrasion. However, few studies have explored the possible correlations between malocclusions and TMJ morphology. The objective of this study was to determine whether associations exist between malocclusions of the anterior teeth affecting anterior guidance and the morphologic variability of the TMJ in an adult nonpatient group. The investigators selected 148 subjects from a cross-sectional epidemiologic population-based study, based on the presence of anterior edge-toedge bite, anterior crossbite, or deepbite without gingival contact. Magnetic resonance imaging scans were taken; eminence height, postglenoid process height, fossa depth, distance between eminence crest and the highest point of the fossa, and the eminence height/ postglenoid process height ratio were used to describe TMJ morphology. The results showed that an anterior edge-to-edge bite or a crossbite is connected to reduced eminence height, and that deepbite without gingival contact is connected to an increased ratio between eminence height and postglenoid process height. In other words, the condylar path in the subjects with anterior edge-to-edge bite and crossbite can be interpreted to be reduced; in those with deepbite without gingival contact, the condylar path is steepened. Reconstructing the anterior guidance through orthodontic or prosthetic
treatments must be in concordance with the TMJ morphology to allow harmonious functioning of the stomatognathic system. Reviewed by Yang Li
Condylar remodeling accompanying splint therapy Liu MQ, Chen HM, Yap AUJ, Fu KY. Condylar remodeling accompanying splint therapy: a conebeam computerized tomography study of patients with temporomandibular joint disk displacement. Oral Surg Oral Med Oral Path Oral Radiol 2012;114:259-65.
T
emporomandibular joint (TMJ) disc displacement is the most common type of TMJ arthropathy. It can be subdivided into disc displacement with reduction and disc displacement without reduction. Patients with advanced disc displacement with reduction can experience intermittent closed-lock, restricted motion, and painful function before progression to acute disc displacement without reduction. Anterior repositioning splint therapy has been shown to be effective for the management of TMJ disc displacement with reduction. It not only allows displaced articular discs to reposition, but also leads to condylar bone remodeling that is manifested as a “double contour” on magnetic resonance imaging of the condylar heads. The aim of this study was to evaluate osseous changes accompanying anterior repositioning splint therapy in patients with TMJ disc displacement. Cone-beam computerized tomography (CBCT) data of 36 patients with intermittent or permanent closed-lock were used; 23 patients with permanent closed-lock had their displaced discs physically reduced by mandibular manipulation before anterior repositioning splint therapy. CBCT was performed before and 6 months after anterior repositioning splint therapy. The presence and location of “double contour” images suggesting condylar bone remodeling were statistically analyzed. “Double contour” images after anterior repositioning splint therapy were observed in 80% of patients, more frequently in joints with signs of displaced discs. The “double contour” appeared more often on the posterior bevel as well as the medial and middle parts of the condyles. It can be concluded that CBCT is a useful tool for monitoring osseous changes in condyles. Reviewed by Aziz Almudhi
573
Residents' journal review
574
Laser therapy in orthodontic retention and relapse Kim SJ, Kang YG, Park JH, Kim EC, Park YG. Effects of low-intensity laser therapy on periodontal tissue remodeling during relapse and retention of orthodontically moved teeth. Lasers Med Sci 2012 Jul 20 [Epub ahead of print].
A
lthough it is not fully understood, a primary factor in orthodontic relapse is the memory of transformed periodontal ligament (PDL) fibers. The aim of this animal study was to look at the effects of lowintensity laser therapy on PDL remodeling during orthodontic relapse and retention. The maxillary central incisors of 52 rats were divided into 5 groups: a control group, a postorthodontic relapse group with no retainers, a postorthodontic fixed retention group, a postorthodontic and low-intensity laser therapy relapse group, and a postorthodontic and low-intensity laser therapy retention group. The rats were killed on days 1, 3, and 7 after removal of the orthodontic appliances. Qualitative analysis was then done by using reverse transcriptase polymerase chain reaction for matrix metalloproteinases mRNA expression. Both the compression and the tension sides were observed for immunoreactivities of collagen and tissue inhibitor of metalloproteinase. Both the relapse and the retention groups that had low-intensity laser therapy showed significantly more expression of the 5 tested metalloproteinase mRNAs. TIMP-1 immunoreactivity was inhibited in both low-intensity laser therapy groups, whereas Col-I immunoreactivity was increased only in the low-intensity laser therapy retention group. These results suggest that low-intensity laser therapy would have differing effects on postorthodontic stability depending on retainer use. Low-intensity laser therapy combined with retainer wear might shorten the retention period by accelerating the PDL remodeling of the teeth in their new positions; however, lowintensity laser therapy used without a retainer would actually cause an increase in postorthodontic relapse. This study offers a strong foundation for future clinical studies to investigate whether low-intensity laser therapy can be used to enhance postorthodontic stability as a noninvasive biologic retainer. Reviewed by Arash Rajaei
November 2012 Vol 142 Issue 5
Stability of surgical maxillary advancement in patients with cleft lip and palate Saltaji H, Major MP, Alfakir H, Al-Saleh M, Flores-Mir C. Maxillary advancement with conventional orthognathic surgery in patients with cleft lip and palate: is it a stable technique? J Oral Maxillofac Surg 2012 Jun 6 [Epub ahead of print].
P
atients with cleft lip and palate often develop significant maxillary retrusion that requires orthognathic surgery. LeFort I maxillary osteotomy is the standard procedure and is more prone to postoperative relapse in patients with clefts because of increased soft-tissue tensions from scar contracture. These authors evaluated the long-term skeletal stability after maxillary surgical advancement with conventional LeFort I osteotomy in patients with clefts by a systematic review of published data up to December 2011. The included studies assessed the stability of maxillary surgical advancement with conventional LeFort I osteotomy fixed with plates at least 1 year after treatment in patients with cleft lip or palate. Ten articles were selected based on their quality. No meta-analysis was performed because of the heterogeneity of the outcome measures. All included studies demonstrated less than 8 mm of maxillary advancement, with relapses at Point A of 20% to 30% in 4 studies and 30% to 40% in 3 studies. Vertical movements in the inferior direction were less than 3 mm in 3 studies and 3 to 6 mm in 6 studies, with relapses greater than 50% in 4 studies. The study judged as having high quality reported a 37% rate of horizontal relapse and a 65% rate of vertical relapse at Point A. Only 1 randomized controlled clinical trial was found. These authors compared the long-term stability of distraction osteogenesis and LeFort I osteotomy, and reported that the relapse rate was greater in the osteotomy group compared with the distraction group. They concluded that maxillary surgical advancement in patients with cleft lip or palate having LeFort I osteotomy has a moderate relapse rate in the horizontal plane and a high relapse rate in the vertical plane. Reviewed by Ritu Gupta
American Journal of Orthodontics and Dentofacial Orthopedics
Residents' journal review
Dentofacial changes in the third and fourth decades of life Bondevik O. Dentofacial changes in adults: a longitudinal cephalometric study in 22-33 and 3343 year olds. J Orofac Orthop 2012;73:277-88.
G
rowth and remodeling of the human skeleton and throughout adulthood has been well documented in the literature. In this study, the author analyzed linear and angular cephalometric changes in a group of 52 men and 41 women during their third and fourth decades of life. The mean age at the initial cephalometric film was 22.6 years. Follow-up films after 10 years and 20 years were taken and evaluated. Linear changes in the anterior cranial base (S-N), anterior face height (N-Me), posterior face height (S-TGo), and mandibular length (Co-Gn and Ar-Gn) were found. Additionally, changes in mandibular plane angle (ML-NSL), maxillary position (S-N-A), mandibular position (S-N-B and S-N-Po), maxillary incisor inclination (UI-NSL), and mandibular incisor inclination (LI-ML) were recorded. The results showed that the anterior cranial base continues to grow in both sexes. The anterior face height grew more in women, and the posterior face height grew more in men. The mandibular length increased in both sexes, but more in men. When the authors evaluated mandibular rotation through mandibular plane angles, they found that women had backward rotation, whereas men had a stable mandibular plane angle. Both sexes showed slight decreases in S-N-A, S-N-B, and S-N-Po, but these changes were greater in women. Both maxillary and mandibular incisors became more upright, although the maxillary incisors uprighted more in the women than in the men. This could be explained as a response to maintain contact with the mandibular incisors. Clinicians should remember that, even when somatic growth has ceased, facial growth continues throughout adulthood. Reviewed by Suliman Shahin
TMD in patients with juvenile idiopathic arthritis ~es JP. nior AM, Devito KL, Guimara Ferraz Ju Temporomandibular disorder in patients with juvenile idiopathic arthritis: clinical evaluation and correlation with the findings of cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2012 Jul 6 [Epub ahead of print].
J
uvenile idiopathic arthritis (JIA) is a common chronic disease in children in developed countries. The age at onset of JIA is younger than 16 years, and girls are more
575
frequently affected. JIA is characterized by chronic synovitis in at least 1 joint; this results in joint alterations, destruction, subluxation, and inflammation of the periarticular soft tissues. The objective of this study was to assess the presence of temporomandibular disorder (TMD) in patients with JIA, and correlate the tomographic findings and the clinical signs and symptoms. Fifteen patients with JIA were evaluated for research diagnostic criteria for TMD and had cone-beam computerized tomography examinations. The clinical findings were then correlated with tomographic findings, sex, age at evaluation, time since the onset of symptoms, and time of treatment of JIA. Research diagnostic criteria classified TMD into 3 subtypes: group I, muscle disorder; group II, disc displacement; and group III, arthralgia/arthritis/arthrosis. In this classification system, a patient might receive a diagnosis ranging from no diagnosis to 5 diagnoses (a muscle diagnosis plus 1 diagnosis from group II for each joint and 1 diagnosis from group III for each joint). In the 30 temporomandibular joints evaluated, 25 (83.3%) were clinically diagnosed with TMD. Although tomographic alterations have frequently been found (83.3%), only 5 (16.7%) were clinically diagnosed with osteoarthritis or arthrosis. There was a difference in the degree of TMD when evaluated, the time elapsed since the onset of symptoms, and the time of treatment of JIA. The authors concluded that, despite the small sample size, the use of refined clinical and radiologic examinations resulted in a reliable diagnosis. Reviewed by Yuhe Lu
Relapse after mandibular setback surgery with minimal orthodontic preparation Lee NK, Kim YK, Yun PY, Kim JW. Evaluation of post-surgical relapse after mandibular setback surgery with minimal orthodontic preparation. J Craniomaxillofac Surg 2012 Jul 20 [Epub ahead of print].
R
eduction in surgical orthodontic treatment time and immediate profile improvement after orthognathic surgery are advantages of orthognathic surgery with minimal orthodontic preparation. These authors' goal was to describe the relapse of mandibular setback with minimal presurgical orthodontics. They used 15 patients who underwent orthodontic preparation for mandibular setback for 1 to 2 months on average. Lateral cephalograms were taken at 3 times: initial, postsurgical, and after debanding. Relapse was determined
American Journal of Orthodontics and Dentofacial Orthopedics
November 2012 Vol 142 Issue 5
Residents' journal review
576
by comparing multiple linear and angular measurements from the postsurgical to the deband times. Calculating the pure surgical relapses at porion and menton showed rotational relapses of 0.5 mm in the anterior direction and 0.8 mm in the inferior direction as the bite closed down with orthodontic treatment. Ar-Pog and Ar-Me were displaced rotationally to evaluate the remaining relapse without the rotational change. The changes in the linear measurements of pogonion and menton showed sagittal relapses of 3.53 mm at pogonion and 4.00 mm at menton, and vertical relapses superiorly of 2.72 mm at pogonion and 2.44 mm at menton. In addition, the angular measurements of Ar-Pog and Ar-Me to the Frankfort horizontal decreased by 2 . The authors concluded that more occlusal interferences were seen with this approach, and, because of inadequate alignment, the rotational relapse might contribute to the vertical and horizontal relapses. Based on these results, longer presurgical orthodontic preparation is indicated. Reviewed by Mohamed Bamashmous
Rapid maxillary expansion and adenotonsillectomy for children with obstructive sleep apnea Pirelli P, Saponara M, Guilleminault C. Rapid maxillary expansion before and after adenotonsillectomy in children with obstructive sleep apnea. Somnologie 2012;16:125-32.
I
n children with obstructive sleep apnea (OSA), the recommended treatment has been adenotonsillectomy in association with nasal inferior
November 2012 Vol 142 Issue 5
turbinate reduction, if necessary. However, reports have shown that this treatment has not always been successful in fully resolving abnormal breathing in children. The aim of this study was to determine whether orthodontic treatment alone— specifically, rapid maxillary expansion—could resolve OSA without the need for adenotonsillectomy. Eighty nonoverweight children (ages, 6-13 years) with OSA and a narrow maxilla were subdivided into 2 groups of 40 each. Subjects with chronic inflammation were treated with adenotonsillectomy first whereas all others were initially treated with rapid maxillary expansion alone. All children underwent an evaluation consisting of clinical examination, polygraphic recording, and cephalometric analysis. At the 4-month follow-up, the rapid maxillary expansion group had 15 patients with resolved symptoms compared with 6 patients who were treated with adenotonsillectomy. Eight children from the rapid maxillary expansion group and 16 from the adenotonsillectomy group showed no improvement. At this phase, children with incomplete resolution were allowed to cross over to the other treatment venue. After cross-over treatment (42 patients), all but 3 children had complete remission of symptoms. This article suggests that, with the appropriate clinical examination, children with OSA and a narrow maxilla have the potential for a more successful outcome when treated with orthodontics than with adenotonsillectomy. A multidisciplinary approach between orthodontists and ear-nose-throat specialists is paramount in the diagnosis and treatment planning for children with sleep-disordered breathing. Reviewed by Kelly Labs
American Journal of Orthodontics and Dentofacial Orthopedics
ARTICLES FROM THE CURRENT ORTHODONTIC LITERATURE, SELECTED AND REVIEWED BY: SENIOR ORTHODONTIC RESIDENTS, BOSTON UNIVERSITY, BOSTON, MASS Dr Leslie A. Will, Department Chair and Program Director
The association between anterior crossbite, deepbite, and temporomandibular joint morphology Wohlberg V, Schwahn C, Gesch D, Meyer G, Kocher T, Bernhardt O. The association between anterior crossbite, deep bite and temporomandibular joint morphology validated by magnetic resonance imaging in an adult non-patient group. Ann Anat 2012;194:339-44.
T
he morphology of the temporomandibular joint (TMJ) has been extensively studied under various occlusal conditions such as tooth loss, occlusal disharmonies, and excessive oral function or dental abrasion. However, few studies have explored the possible correlations between malocclusions and TMJ morphology. The objective of this study was to determine whether associations exist between malocclusions of the anterior teeth affecting anterior guidance and the morphologic variability of the TMJ in an adult nonpatient group. The investigators selected 148 subjects from a cross-sectional epidemiologic population-based study, based on the presence of anterior edge-toedge bite, anterior crossbite, or deepbite without gingival contact. Magnetic resonance imaging scans were taken; eminence height, postglenoid process height, fossa depth, distance between eminence crest and the highest point of the fossa, and the eminence height/ postglenoid process height ratio were used to describe TMJ morphology. The results showed that an anterior edge-to-edge bite or a crossbite is connected to reduced eminence height, and that deepbite without gingival contact is connected to an increased ratio between eminence height and postglenoid process height. In other words, the condylar path in the subjects with anterior edge-to-edge bite and crossbite can be interpreted to be reduced; in those with deepbite without gingival contact, the condylar path is steepened. Reconstructing the anterior guidance through orthodontic or prosthetic
treatments must be in concordance with the TMJ morphology to allow harmonious functioning of the stomatognathic system. Reviewed by Yang Li
Condylar remodeling accompanying splint therapy Liu MQ, Chen HM, Yap AUJ, Fu KY. Condylar remodeling accompanying splint therapy: a conebeam computerized tomography study of patients with temporomandibular joint disk displacement. Oral Surg Oral Med Oral Path Oral Radiol 2012;114:259-65.
T
emporomandibular joint (TMJ) disc displacement is the most common type of TMJ arthropathy. It can be subdivided into disc displacement with reduction and disc displacement without reduction. Patients with advanced disc displacement with reduction can experience intermittent closed-lock, restricted motion, and painful function before progression to acute disc displacement without reduction. Anterior repositioning splint therapy has been shown to be effective for the management of TMJ disc displacement with reduction. It not only allows displaced articular discs to reposition, but also leads to condylar bone remodeling that is manifested as a “double contour” on magnetic resonance imaging of the condylar heads. The aim of this study was to evaluate osseous changes accompanying anterior repositioning splint therapy in patients with TMJ disc displacement. Cone-beam computerized tomography (CBCT) data of 36 patients with intermittent or permanent closed-lock were used; 23 patients with permanent closed-lock had their displaced discs physically reduced by mandibular manipulation before anterior repositioning splint therapy. CBCT was performed before and 6 months after anterior repositioning splint therapy. The presence and location of “double contour” images suggesting condylar bone remodeling were statistically analyzed. “Double contour” images after anterior repositioning splint therapy were observed in 80% of patients, more frequently in joints with signs of displaced discs. The “double contour” appeared more often on the posterior bevel as well as the medial and middle parts of the condyles. It can be concluded that CBCT is a useful tool for monitoring osseous changes in condyles. Reviewed by Aziz Almudhi
573
Residents' journal review
574
Laser therapy in orthodontic retention and relapse Kim SJ, Kang YG, Park JH, Kim EC, Park YG. Effects of low-intensity laser therapy on periodontal tissue remodeling during relapse and retention of orthodontically moved teeth. Lasers Med Sci 2012 Jul 20 [Epub ahead of print].
A
lthough it is not fully understood, a primary factor in orthodontic relapse is the memory of transformed periodontal ligament (PDL) fibers. The aim of this animal study was to look at the effects of lowintensity laser therapy on PDL remodeling during orthodontic relapse and retention. The maxillary central incisors of 52 rats were divided into 5 groups: a control group, a postorthodontic relapse group with no retainers, a postorthodontic fixed retention group, a postorthodontic and low-intensity laser therapy relapse group, and a postorthodontic and low-intensity laser therapy retention group. The rats were killed on days 1, 3, and 7 after removal of the orthodontic appliances. Qualitative analysis was then done by using reverse transcriptase polymerase chain reaction for matrix metalloproteinases mRNA expression. Both the compression and the tension sides were observed for immunoreactivities of collagen and tissue inhibitor of metalloproteinase. Both the relapse and the retention groups that had low-intensity laser therapy showed significantly more expression of the 5 tested metalloproteinase mRNAs. TIMP-1 immunoreactivity was inhibited in both low-intensity laser therapy groups, whereas Col-I immunoreactivity was increased only in the low-intensity laser therapy retention group. These results suggest that low-intensity laser therapy would have differing effects on postorthodontic stability depending on retainer use. Low-intensity laser therapy combined with retainer wear might shorten the retention period by accelerating the PDL remodeling of the teeth in their new positions; however, lowintensity laser therapy used without a retainer would actually cause an increase in postorthodontic relapse. This study offers a strong foundation for future clinical studies to investigate whether low-intensity laser therapy can be used to enhance postorthodontic stability as a noninvasive biologic retainer. Reviewed by Arash Rajaei
November 2012 Vol 142 Issue 5
Stability of surgical maxillary advancement in patients with cleft lip and palate Saltaji H, Major MP, Alfakir H, Al-Saleh M, Flores-Mir C. Maxillary advancement with conventional orthognathic surgery in patients with cleft lip and palate: is it a stable technique? J Oral Maxillofac Surg 2012 Jun 6 [Epub ahead of print].
P
atients with cleft lip and palate often develop significant maxillary retrusion that requires orthognathic surgery. LeFort I maxillary osteotomy is the standard procedure and is more prone to postoperative relapse in patients with clefts because of increased soft-tissue tensions from scar contracture. These authors evaluated the long-term skeletal stability after maxillary surgical advancement with conventional LeFort I osteotomy in patients with clefts by a systematic review of published data up to December 2011. The included studies assessed the stability of maxillary surgical advancement with conventional LeFort I osteotomy fixed with plates at least 1 year after treatment in patients with cleft lip or palate. Ten articles were selected based on their quality. No meta-analysis was performed because of the heterogeneity of the outcome measures. All included studies demonstrated less than 8 mm of maxillary advancement, with relapses at Point A of 20% to 30% in 4 studies and 30% to 40% in 3 studies. Vertical movements in the inferior direction were less than 3 mm in 3 studies and 3 to 6 mm in 6 studies, with relapses greater than 50% in 4 studies. The study judged as having high quality reported a 37% rate of horizontal relapse and a 65% rate of vertical relapse at Point A. Only 1 randomized controlled clinical trial was found. These authors compared the long-term stability of distraction osteogenesis and LeFort I osteotomy, and reported that the relapse rate was greater in the osteotomy group compared with the distraction group. They concluded that maxillary surgical advancement in patients with cleft lip or palate having LeFort I osteotomy has a moderate relapse rate in the horizontal plane and a high relapse rate in the vertical plane. Reviewed by Ritu Gupta
American Journal of Orthodontics and Dentofacial Orthopedics
Residents' journal review
Dentofacial changes in the third and fourth decades of life Bondevik O. Dentofacial changes in adults: a longitudinal cephalometric study in 22-33 and 3343 year olds. J Orofac Orthop 2012;73:277-88.
G
rowth and remodeling of the human skeleton and throughout adulthood has been well documented in the literature. In this study, the author analyzed linear and angular cephalometric changes in a group of 52 men and 41 women during their third and fourth decades of life. The mean age at the initial cephalometric film was 22.6 years. Follow-up films after 10 years and 20 years were taken and evaluated. Linear changes in the anterior cranial base (S-N), anterior face height (N-Me), posterior face height (S-TGo), and mandibular length (Co-Gn and Ar-Gn) were found. Additionally, changes in mandibular plane angle (ML-NSL), maxillary position (S-N-A), mandibular position (S-N-B and S-N-Po), maxillary incisor inclination (UI-NSL), and mandibular incisor inclination (LI-ML) were recorded. The results showed that the anterior cranial base continues to grow in both sexes. The anterior face height grew more in women, and the posterior face height grew more in men. The mandibular length increased in both sexes, but more in men. When the authors evaluated mandibular rotation through mandibular plane angles, they found that women had backward rotation, whereas men had a stable mandibular plane angle. Both sexes showed slight decreases in S-N-A, S-N-B, and S-N-Po, but these changes were greater in women. Both maxillary and mandibular incisors became more upright, although the maxillary incisors uprighted more in the women than in the men. This could be explained as a response to maintain contact with the mandibular incisors. Clinicians should remember that, even when somatic growth has ceased, facial growth continues throughout adulthood. Reviewed by Suliman Shahin
TMD in patients with juvenile idiopathic arthritis ~es JP. nior AM, Devito KL, Guimara Ferraz Ju Temporomandibular disorder in patients with juvenile idiopathic arthritis: clinical evaluation and correlation with the findings of cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2012 Jul 6 [Epub ahead of print].
J
uvenile idiopathic arthritis (JIA) is a common chronic disease in children in developed countries. The age at onset of JIA is younger than 16 years, and girls are more
575
frequently affected. JIA is characterized by chronic synovitis in at least 1 joint; this results in joint alterations, destruction, subluxation, and inflammation of the periarticular soft tissues. The objective of this study was to assess the presence of temporomandibular disorder (TMD) in patients with JIA, and correlate the tomographic findings and the clinical signs and symptoms. Fifteen patients with JIA were evaluated for research diagnostic criteria for TMD and had cone-beam computerized tomography examinations. The clinical findings were then correlated with tomographic findings, sex, age at evaluation, time since the onset of symptoms, and time of treatment of JIA. Research diagnostic criteria classified TMD into 3 subtypes: group I, muscle disorder; group II, disc displacement; and group III, arthralgia/arthritis/arthrosis. In this classification system, a patient might receive a diagnosis ranging from no diagnosis to 5 diagnoses (a muscle diagnosis plus 1 diagnosis from group II for each joint and 1 diagnosis from group III for each joint). In the 30 temporomandibular joints evaluated, 25 (83.3%) were clinically diagnosed with TMD. Although tomographic alterations have frequently been found (83.3%), only 5 (16.7%) were clinically diagnosed with osteoarthritis or arthrosis. There was a difference in the degree of TMD when evaluated, the time elapsed since the onset of symptoms, and the time of treatment of JIA. The authors concluded that, despite the small sample size, the use of refined clinical and radiologic examinations resulted in a reliable diagnosis. Reviewed by Yuhe Lu
Relapse after mandibular setback surgery with minimal orthodontic preparation Lee NK, Kim YK, Yun PY, Kim JW. Evaluation of post-surgical relapse after mandibular setback surgery with minimal orthodontic preparation. J Craniomaxillofac Surg 2012 Jul 20 [Epub ahead of print].
R
eduction in surgical orthodontic treatment time and immediate profile improvement after orthognathic surgery are advantages of orthognathic surgery with minimal orthodontic preparation. These authors' goal was to describe the relapse of mandibular setback with minimal presurgical orthodontics. They used 15 patients who underwent orthodontic preparation for mandibular setback for 1 to 2 months on average. Lateral cephalograms were taken at 3 times: initial, postsurgical, and after debanding. Relapse was determined
American Journal of Orthodontics and Dentofacial Orthopedics
November 2012 Vol 142 Issue 5
Residents' journal review
576
by comparing multiple linear and angular measurements from the postsurgical to the deband times. Calculating the pure surgical relapses at porion and menton showed rotational relapses of 0.5 mm in the anterior direction and 0.8 mm in the inferior direction as the bite closed down with orthodontic treatment. Ar-Pog and Ar-Me were displaced rotationally to evaluate the remaining relapse without the rotational change. The changes in the linear measurements of pogonion and menton showed sagittal relapses of 3.53 mm at pogonion and 4.00 mm at menton, and vertical relapses superiorly of 2.72 mm at pogonion and 2.44 mm at menton. In addition, the angular measurements of Ar-Pog and Ar-Me to the Frankfort horizontal decreased by 2 . The authors concluded that more occlusal interferences were seen with this approach, and, because of inadequate alignment, the rotational relapse might contribute to the vertical and horizontal relapses. Based on these results, longer presurgical orthodontic preparation is indicated. Reviewed by Mohamed Bamashmous
Rapid maxillary expansion and adenotonsillectomy for children with obstructive sleep apnea Pirelli P, Saponara M, Guilleminault C. Rapid maxillary expansion before and after adenotonsillectomy in children with obstructive sleep apnea. Somnologie 2012;16:125-32.
I
n children with obstructive sleep apnea (OSA), the recommended treatment has been adenotonsillectomy in association with nasal inferior
November 2012 Vol 142 Issue 5
turbinate reduction, if necessary. However, reports have shown that this treatment has not always been successful in fully resolving abnormal breathing in children. The aim of this study was to determine whether orthodontic treatment alone— specifically, rapid maxillary expansion—could resolve OSA without the need for adenotonsillectomy. Eighty nonoverweight children (ages, 6-13 years) with OSA and a narrow maxilla were subdivided into 2 groups of 40 each. Subjects with chronic inflammation were treated with adenotonsillectomy first whereas all others were initially treated with rapid maxillary expansion alone. All children underwent an evaluation consisting of clinical examination, polygraphic recording, and cephalometric analysis. At the 4-month follow-up, the rapid maxillary expansion group had 15 patients with resolved symptoms compared with 6 patients who were treated with adenotonsillectomy. Eight children from the rapid maxillary expansion group and 16 from the adenotonsillectomy group showed no improvement. At this phase, children with incomplete resolution were allowed to cross over to the other treatment venue. After cross-over treatment (42 patients), all but 3 children had complete remission of symptoms. This article suggests that, with the appropriate clinical examination, children with OSA and a narrow maxilla have the potential for a more successful outcome when treated with orthodontics than with adenotonsillectomy. A multidisciplinary approach between orthodontists and ear-nose-throat specialists is paramount in the diagnosis and treatment planning for children with sleep-disordered breathing. Reviewed by Kelly Labs
American Journal of Orthodontics and Dentofacial Orthopedics