Description

The Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopädie is the Official Journal of Deutsche Gesellschaft für Kieferorthopädie (DGKfo) e.V. The Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopädie provides orthodontists and dentists who are also actively interested in orthodontics whether in University clinics or private practice with highly authoritative and up-to-date information based on experimental and clinical research. The Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopädie is the leading German publication for the promulgation of the results of original work both in the areas of scientific and clinical orthodontics and related areas. All articles undergo peer review before publication and appear in both English and German. The German Society of Orthodontic (DGKfo) also publishes in The Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopädie important communications statements and announcements. The journal represents the major German forum for international communication and education in the field of orofacial orthopedics. Listed in Index Medicus (Medline) · DIMDI

Publisher details

Springer Verlag

Publications in this journal

• Numerical Analyses of Biomechanical Behavior of Various Orthodontic Anchorage Implants.

  Authors: Eva Stahl, Ludger Keilig, Iman Abdelgader, Andreas Jäger, Christoph Bourauel

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 70(2):115-127.

  OBJECTIVE: : The quality and quantity of the alveolar process are considered important influential factors affecting the anchorage effectiveness of orthodontic mini-implants. The objective of thisOBJECTIVE: : The quality and quantity of the alveolar process are considered important influential factors affecting the anchorage effectiveness of orthodontic mini-implants. The objective of this study was to establish the effect of various material parameters in regard to various implant types, sizes, and load directions using the finite element method (FEM). MATERIALS AND METHODS: : FE models of the following 16 implants by six different manufacturers were made in idealized jaw bone segments with the program system MSC.Marc/Mentat: Aarhus Mini-Implant (American Orthodontics), AbsoAnchor((R)) (Dentos), Dual-Top (Jeil Medical), LOMAS (Mondeal), OrthoImplant (IMTEC), tomas ((R)) (Dentaurum). The intra-osseous parts of the mini-implants had lengths ranging between 6.7 mm and 10.0 mm, and diameters between 1.2 mm and 2.0 mm. Cortical thicknesses of 1 mm and 2 mm were simulated. The Young's modulus of cancellous bone was varied between 100 MPa and 1 GPa, the load direction of 0 degrees to 45 degrees in a buccal direction for a load of 5 N. In each case we determined the deflection of the implant head as well as the distribution of stresses and strain in the cortical and cancellous bone. RESULTS: : Deflections of the implants varied between 2 mum (Aarhus Mini-Implant 11.6 mm x 2.0 mm, 2 mm cortex) and 20 mum (AbsoAnchor((R)) 12.5 mm x 1.2 mm, 1 mm cortex), the deflection was between 4 mum and 10 mum for most of the implants. The deflections of the implant increased as Young's modulus of the cancellous bone dropped with a cortical thickness of 1 mm. We did not observe such a correlation with a cortical thickness of 2 mm. We measured the highest loads in the bone in all models when the cortical thickness measured 1 mm and with a Young's modulus of cancellous bone of 100 MPa. When the load direction was tilted in a buccal direction, the stresses and amount of strain were reduced by as much as 35%. CONCLUSION: : We have demonstrated that the cortical thickness is a decisive parameter for the stability of these mini-implants. When the cortical bone is thinner, the mobility becomes increasingly dependent on the Young's modulus of the cancellous bone. Moreover, the greatest stress and amount of strain occur in the bone when the cortical bone is less thick and Young's modulus of cancellous bone lower.

• Craniofacial Growth Patterns in Patients with Congenitally Missing Permanent Teeth*

  Authors: Natascha Bauer, Katinka Heckmann, Andrea Sand, Jörg Lisson

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 70(2):139-151.

  OBJECTIVE: : Aim of this study was to investigate any correlations between the congenital absence of certain permanent teeth and individual craniofacial growth patterns. MATERIAL AND METHODS: : TheOBJECTIVE: : Aim of this study was to investigate any correlations between the congenital absence of certain permanent teeth and individual craniofacial growth patterns. MATERIAL AND METHODS: : The lateral cephalograms of n = 101 patients (65 female symbol und 36 male symbol) with various congenitally missing teeth were analyzed according to Hasund [11] prior to orthodontic treatment. Cephalometric data to determine the craniofacial growth pattern comprised GntgoAr, NSBa, ML-NSL, NL-NSL, MLNL angles and the index between upper and lower facial heights. Correlations between the type of missing teeth and growth pattern were examined. Group distribution was A = all patients with missing teeth (n = 101), P = missing second premolars (n = 49), S = missing upper lateral incisors (n = 30), X = various missing teeth (n = 22). We included a control group for each of these groups using data from Riolo et al.'s [22] growth study. RESULTS: : Group A revealed an even distribution with n = 32 patients (31.7%) having a vertical growth pattern, n = 37 patients (36.6%) a neutral growth pattern, and n = 32 patients (31.7%) a horizontal growth pattern. The majority of patients (n = 20, 40.8%) in group P exhibited a horizontal growth pattern, whereas there were no significant correlations between the kind of congenitally missing teeth and growth patterns in groups S and X. Comparison of the mean values of groups P, S and X, revealed no significant differences. When comparing the control group to groups A, P and S, we noted significantly or highly significantly smaller gonial and basal plane angles. No significant differences were apparent concerning group X. CONCLUSIONS: : This examination demonstrates no statistically-relevant correlation between craniofacial growth pattern and the congenital absence of certain permanent teeth, although horizontal growth is more frequent (but not significant) in patients with congenitally missing second premolars.

• Influence of Diabetes Mellitus on the Development and Treatment of Malocclusions - A Case Report with Literature Review.

  Authors: Christoph Reichert, James Deschner, Andreas Jäger

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 70(2):160-175.

  Diabetes mellitus is a metabolic disorder characterized by disturbed glucose regulation, manifesting primarily as chronic hyperglycemia.Today about 6% of the world's population suffers from diabetesDiabetes mellitus is a metabolic disorder characterized by disturbed glucose regulation, manifesting primarily as chronic hyperglycemia.Today about 6% of the world's population suffers from diabetes mellitus. This metabolic disorder is known to be associated with a large number of concomitant and secondary diseases of the cardiovascular system, as well as of the joint and supporting tissue systems.It is also a recognized fact that diabetes mellitus is closely associated with diverse problems in the oral, facial and jaw regions.These facts suggest that patients with diabetes may respond to orthodontic treatment differently from those without diabetes in how the periodontium and surrounding visceral cranium react to therapy.Beginning with a clinical case report we proceed to present a general overview of the clinical features and pathophysiology of diabetes mellitus, followed by a critical discussion of the results of a systematic literature search for aspects of the disease relevant to orthodontics.

• The Effect of Premolar Extractions on Incisor Position and Soft Tissue Profile in Patients with Class II, Division 1 Malocclusion*

  Authors: Catharina Weyrich, Jörg Lisson

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 70(2):128-138.

  OBJECTIVE: : The objective of this study was to establish whether and how premolar extraction affects the soft tissue profile and incisor inclination in patients with Angle Class II, Division 1OBJECTIVE: : The objective of this study was to establish whether and how premolar extraction affects the soft tissue profile and incisor inclination in patients with Angle Class II, Division 1 malocclusion. Our primary intention was to identify differences between patients who had four premolars extracted and those who had only two upper premolars removed during camouflage treatment. Our control group consisted of patients with an Angle Class II, Division 1 treated without extractions. MATERIALS AND METHODS: : These patients' lateral cephalograms were cephalometrically analyzed before and after treatment. Computer-assisted analysis of the data using Onyx Ceph((R)) was followed by a single-factor variance analysis (one-way ANOVA). RESULTS: : Our results demonstrate that patients who have undergone camouflage treatment exhibit significantly more retruded upper central incisors than those with extractions in both jaws, and that their upper incisors are highly significantly more retruded and their mandibles significantly more retrognathic than those of patients who have not undergone extraction therapy. CONCLUSION: : We did not observe that the patients' profiles did become worse after extraction therapy.

• Geometric Influence of the Sagittal and Vertical Apical Base Relationship on the ANB Angle.

  Authors: Reza Sadat-Khonsari, Henning Dathe, Michael Knösel, Wolfram Hahn, Dietmar Kubein-Meesenburg, Oskar Bauss

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 70(2):152-158.

  OBJECTIVE: : The objective of this study consisted in determining the variability of the ANB angle in relation to the position of the A- and B-points in the sagittal vertical plane. MATERIALS ANDOBJECTIVE: : The objective of this study consisted in determining the variability of the ANB angle in relation to the position of the A- and B-points in the sagittal vertical plane. MATERIALS AND METHODS: : Using a theoretical model, we varied the position of the cephalometric points A and B in the sagittal vertical plane while its sagittal relationship was kept constant (Wits value = 0 mm). For this purpose, seven lines were erected perpendicular to the occlusal plane on a lateral cephalogram. The position of points A and B were determined on each of the vertical lines by calculating one anterior and one posterior angle in each case. In this way, the positions of all A- and B-points were clearly defined in the sagittal vertical plane. RESULTS: : The characteristic of the ANB angle in the sagittal vertical plane was graphically represented by determining both points A and B using two angles instead of one. This revealed that the ANB angle for the same sagittal base relationship was characterized by major variations depending on the position of the A- and B-points in relation to the anterior cranial base. The larger the SNA and SNB angles were, the larger the corresponding ANB angle. At the same time, the absolute value of ANB increased with the length of the vertical distance between the points A and B. CONCLUSION: : The ANB angle is strongly influenced by geometric factors. Accurate diagnosis of the sagittal base relationship should thus take the individual character of the ANB angle into account.

• Interleukin-1 Polymorphisms in Relation to External Apical Root Resorption (EARR).

  Authors: Norbert Gülden, Thomas Eggermann, Klaus Zerres, Michael Beer, Anica Meinelt, Peter Diedrich

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 70(1):20-38.

  AIM: : Recent papers have discussed genetic predisposition for root resorption. The aim of this study was to investigate this kind of relationship as dependent on the EARR phenotype. Alleles fromAIM: : Recent papers have discussed genetic predisposition for root resorption. The aim of this study was to investigate this kind of relationship as dependent on the EARR phenotype. Alleles from IL-1A and IL-1B gene polymorphisms are discussed as genetically predisposing factors. MATERIAL AND METHODS: : Orthopantomograms (OPG) exhibiting EARR (n = 96) were metrically and statistically analyzed for expression and were compared to a control group (n = 162). Additionally, the percentage of affected teeth per individual was determined. A subgroup of the EARR patient sample (n = 49) was assessed, based on blood analyses, for an association with genomic IL-1A (-889) and IL-1B (+3954) polymorphism. RESULTS: : In the case of the IL-1A variation, a significant difference of genotype distribution was found between EARR patients and the control group: genotype 2-2 could be seen significantly more frequently in the EARR group. Furthermore, the extent of resorption grades seemed to be influenced by the genetic constitution. The genotype distribution of the IL-1B polymorphism was comparable to the distribution in the control sample. In particular, allele 1 of the IL-1B polymorphism, which has been described as being associated with family histories of EARR, was observed less frequently in the patient cohort than in the control group. CONCLUSIONS: : The available data of the IL-1A polymorphism point to an association of the genotype 2-2 with EARR. As analyses of individual subgroups showed, with the increase in the extent of EARR there was a recognizable correlation with genotype 2-2. The genotype distribution of the IL-1B polymorphism in patients and control cohorts revealed no indication of a predisposition. Despite the low number of cases in the own cohort, the data collected revealed that the allele 1 of the IL-1B polymorphism in patients with sporadic EARR did not contribute to predisposition, in contrast to familial cases. The results are an initial basis for pre-orthodontic genetic EARR risk analyses.

• Orthodontic Archwire in the Nasal Cavity. A Case Report.

  Authors: Ramona Nicolas, Georg Eggers, Gerda Komposch

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 70(1):92-97.

  We present the unusual case of a patient who lost an orthodontic archwire after having, via manipulation, detached it from the brackets. It was only on a routine radiograph at the end of treatmentWe present the unusual case of a patient who lost an orthodontic archwire after having, via manipulation, detached it from the brackets. It was only on a routine radiograph at the end of treatment that the archwire was found in the patient's nasal cavity, where it had failed to cause any symptoms!We discuss the treatment following the inhalation and ingestion of foreign bodies in orthodontics, as well as their prevention.

• Guided Tissue Regeneration and Orthodontics. A Review of the Literature.

  Authors: Christoph Reichert, James Deschner, Adrian Kasaj, Andreas Jäger

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 70(1):6-19.

  Guided tissue regeneration is a common form of treatment in dentistry nowadays. The orthodontist will inevitably have to deal with patients needing such therapy more often in the future. This reviewGuided tissue regeneration is a common form of treatment in dentistry nowadays. The orthodontist will inevitably have to deal with patients needing such therapy more often in the future. This review of the literature addresses the question of whether and if so, how patients with these medical requirements can be treated. We have systematically reviewed the current literature for recommendations, guidelines and problems associated with this treatment. Our data evaluation led us to conclude that such treatment is possible, and that it delivers promising results. However, more basic research on this interdisciplinary therapy should be carried out to identify and reduce risks and offer the patient greater safety during orthodontic treatment.

• Class II Treatment in Adults: Comparing Camouflage Orthodontics, Dentofacial Orthopedics and Orthognathic Surgery - A Cephalometric Study to Evaluate Various Therapeutic Effects*

  Authors: Gero Kinzinger, Linda Frye, Peter Diedrich

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 70(1):63-91.

  AIM: : It was the aim of this clinical study to compare the skeletal and dentoalveolar effects as well as those on the profile of three different treatment approaches in Class II patients (camouflageAIM: : It was the aim of this clinical study to compare the skeletal and dentoalveolar effects as well as those on the profile of three different treatment approaches in Class II patients (camouflage orthodontics, dentofacial orthopedics, and combined orthodontic and surgical treatment). PATIENTS AND METHOD: : Our study cohort consisted of 60 young adults presenting a skeletal Class II, Division 1 malocclusion: 20 patients whose overjet was reduced by camouflage following premolar extraction, 20 patients whose occlusions were corrected by placement of a fixed functional orthopedic appliance, and 20 who underwent orthognathic surgery (bilateral sagittal split osteotomy of the mandible without genioplasty). We documented the therapeutic progress using cephalometry. RESULTS: : Each patient group achieved a reduction in overjet via their respective treatment. While no treatment-related changes in the maxillary area were assessable, the effects on the mandible differed. We observed advancement of the bony chin and an increase in mandibular length in the sagittal-diagonal dimension in the surgical and functional orthopedic groups. However, the extent of the treatment-related changes was significant only in the group of patients that had undergone orthognathic surgery. Only the surgical group presented changes in vertical relationships. Incisor repositioning as an outcome of the respective treatments differed fundamentally, with those in the surgical group revealing significant protrusion of the upper incisors. The maxillary incisors were retruded and mandibular incisors proclined in the functional orthopedic group, whereas the upper and lower incisors both retruded significantly in the extraction group. Softtissue remodeling bore no linear relationship to treatment-induced skeletal and dental effects. Still, orthognathic surgery led to the most marked profile changes. Treatment using fixed functional orthopedic appliances reduced the convexity of the soft-tissue profile at least moderately. Camouflage orthodontics, on the other hand, resulted in an increase in the nasolabial angle. CONCLUSIONS: : In young adults fixed functional appliances are a treatment alternative to extraction therapy but to a lesser extent to orthognathic surgery. Because of their limited skeletal effects and minor changes in the profile they are indicated only in patients with a moderately severe Class II malocclusion. Pre-treatment proclined mandibular incisors limit the scope of indications for fixed functional appliances, as they can cause an increase in lower incisor proclination. Significant reductions in profile convexity are achievable only by combined orthodontic and surgical treatment of the malocclusion. When performing camouflage orthodontics in conjunction with maxillary premolar extractions in adults, an increase in the nasolabial angle, which is often esthetically undesirable, has to be discussed as a potential side effect and has to be taken into account when considering the different therapeutic approaches.

• Facial Profile and Lip Position Changes in Adult Class II, Division 2 Subjects Treated with the Herbst-Multi bracket Appliance. A Radiographic Cephalometric Pilot Study.

  Authors: Niko Bock, Christina Santo, Hans Pancherz

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 70(1):51-62.

  OBJECTIVE: : To examine the treatment and post-treatment effects of the Herbst-Multibracket (MB) appliance on facial profile and lip position in adult Class II, Division 2 subjects. MATERIAL ANDOBJECTIVE: : To examine the treatment and post-treatment effects of the Herbst-Multibracket (MB) appliance on facial profile and lip position in adult Class II, Division 2 subjects. MATERIAL AND METHODS: : Lateral head films of 16 consecutivelytreated adult Class II, Division 2 subjects (8 males, 8 females) with an average age of 18.8 years pre-treatment were analyzed on three occasions: before treatment (T1), after Herbst-MB treatment (T2) and 2 years post-treatment (T3). RESULTS: : Treatment period (T2-T1): an increase occurred in the hard tissue profile angle (2.5 degrees ; p < 0.001), the soft tissue profile angle excluding the nose (2.6 degrees ; p < 0.01), and the soft tissue profile angle including the nose (1.8 degrees ; p < 0.05). The upper lip became more retrusive in relation to the Esthetic line (EL) (0.8 mm; p < 0.05) while the lower lip's position was unchanged. Lower lip coverage of the upper incisors was reduced (0.8 mm; p < 0.05). Post-treatment period (T3-T2): the soft tissue profile angle (excluding the nose) increased (1.6 degrees ; p < 0.01), while the hard and soft tissue profile angles including the nose remained unchanged. Both, the upper and lower lips became more retrusive in relation to the EL (0.9 mm; p < 0.01 and 1.0 mm; p < 0.001). The lower lip coverage of the upper incisors remained unchanged. CONCLUSION: : The hard and soft tissue profiles were straightened during Herbst-MB treatment, including a brief follow-up period. The lips became more retrusive while the lower lip coverage of the upper incisors was reduced.

• No Increased Risk of Temporomandibular Disorders and Bruxism in Children and Adolescents during Orthodontic Therapy*

  Authors: Christian Hirsch

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 70(1):39-50.

  BACKGROUND AND OBJECTIVE: : Whether orthodontic therapy is a risk factor for temporomandibular disorders (TMD) or parafunctional habits such as bruxism is a question that has long been discussed. TheBACKGROUND AND OBJECTIVE: : Whether orthodontic therapy is a risk factor for temporomandibular disorders (TMD) or parafunctional habits such as bruxism is a question that has long been discussed. The issue is highly relevant to public health due to the frequency of these functional disorders in the general population and the sheer number of orthodontic treatments. The aim of this cross-sectional study was to investigate the risk of TMD or bruxism in children and adolescents during orthodontic therapy. PROBANDS AND METHODS: : The study included 1,011 children and adolescents between the ages of 10 and 18 selected at random from the general public who had been examined for signs of TMD using the Helkimo index and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Parafunctional activities (bruxism) were surveyed and documented in reference to wear effects on the front teeth using the method developed by Egermark-Eriksson. In addition, probands were asked about their current orthodontic treatments. RESULTS: : Nearly 30% (N = 296) of the probands stated that they were undergoing orthodontic therapy. Roughly 1/10 proband presented with a clinical TMD according to the Helkimo index (9.6%; N = 97) or a TMD diagnosis according to the RDC/TMD (10.2%; N = 102). After controlling for the effects of age, gender and school-type using a multinomial logistical regression analysis there was no increased risk of anamnestic or clinical TMD symptoms or diagnoses during orthodontic treatment (odds ratios between 0.63 and 1.18; all p-values > 0.05). At the same time, both wear facets on the front teeth (tooth-related mean value with vs. without appliance: 0.12 vs. 0.16; t test: p = 0.038) and self-reported bruxing be havior (OR = 0.57; p = 0.018) were significantly reduced by orthodontic treatment. CONCLUSION: : Our study revealed no increased risk of TMD in children and adolescents during orthodontic therapy, which seems to reduce parafunctional activities and thus the likelihood of noncarious dental damage.

• Corrosion Susceptibility and Nickel Release of Nickel Titanium Wires during Clinical Application.

  Authors: Evangelia Petoumeno, Maya Kislyuk, Hildegard Hoederath, Ludger Keilig, Christoph Bourauel, Andreas Jäger

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 69(6):411-423.

  BACKGROUND AND OBJECTIVE: : Orthodontic wires are exposed to a corrosive intraoral environment and are subject to mechanical and thermal load. This could affect how nickel titanium (NiTi) wiresBACKGROUND AND OBJECTIVE: : Orthodontic wires are exposed to a corrosive intraoral environment and are subject to mechanical and thermal load. This could affect how nickel titanium (NiTi) wires corrode, as they possess temperature- and load-dependent characteristics. It was the scope of this study to determine whether the clinical application of NiTi wires would lead to corrosion defects on the wire surfaces, and whether an influence on the patients' salivary Ni ion concentration would become apparent. MATERIAL AND METHODS: : A total of 115 wires of different manufacturers (Forestadent Titanol((R)) 'Low Force' und 'Martensitic', Ormco Copper Ni-Ti((R)) 35 degrees C, Ortho Organizers NiTi) was retrieved after intraoral application lasting 1 to 12 months. The wires were examined after cleaning with a scanning electron microscope. We also analyzed the salivary Ni ion concentration in 18 patients at predefined intervals following a detailed orthodontic treatment protocol during the initial phase of orthodontic therapy. The intervals were: 1) a saliva sample before treatment commenced, 2) after bonding of brackets and bands, 3) 2 weeks after bonding, immediately before and 4) immediately after fitting the archwires, and 5) 4 and 6) 8 weeks after placing the archwires. 16 to 20 brackets and bands were bonded in the upper and lower jaws, while NiTi leveling arches (ODS Euro Arch Opto Thermtrade mark, 0.40 mm round) were fitted. The saliva samples were quick-frozen and subsequently dried under red light. Dried residuals were dissolved in aqua regia and filled up to 3 ml. The solutions were analyzed using a mass spectrometer (Perkin Elmer Elan 5000). RESULTS: : Surface analysis revealed no differences in the degree of corrosion of the different products. In fact, we observed only extremely small and isolated corrosion defects. No statisticallysignificant differences were noted in the Ni ion concentration at time points 1 (reference value), 3, 5 and 6 (34, 34, 28 and 30 mug/l, respectively). The samples taken immediately after bracket bonding or the NiTi wire application however displayed a significant increase in the salivary Ni ion concentration (2: 78 and 4: 56 mug/l). It was significantly higher after bonding of the steel brackets than after NiTi wire application. CONCLUSIONS: : Increased Ni ions are released initially after the orthodontic devices have been fitted, but they decay quickly. This is reflected in miniscule corrosion defects as pitting. It is unlikely that orthodontic nickel titanium wires are a relevant additional Ni load for the patient.

• Dental Side Effects of Mandibular Advancement Appliances - A 2-year Follow-up.

  Authors: Akssam Ghazal, Irmtrud Jonas, Edmund Rose

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 69(6):437-447.

  BACKGROUND AND OBJECTIVES: : Mandibular advancement appliances are employed in treating snoring and various forms of obstructive sleep apnea syndrome (OSAS). The splints facilitate the displacementBACKGROUND AND OBJECTIVES: : Mandibular advancement appliances are employed in treating snoring and various forms of obstructive sleep apnea syndrome (OSAS). The splints facilitate the displacement of the mandible anteriorly and widens the pharyngeal lumen during sleep. Two-splint systems are anchored on the dental arches in the maxilla and mandible. The resulting reciprocal forces are transferred onto the teeth, leading to dental side effects when used long-term. We retrospectively examined the dental changes that occurred after patients had worn the Thornton Adjustable Positioner (TAP((R))) for over two years. PATIENTS AND METHODS: : We enrolled all patients consecutively in whom the diagnosis of OSAS was made following polysomnography in a sleep laboratory between January 2004 and December 2005 and who had been treated primarily with a TAP((R)). We compared the patients' baseline findings with follow-up findings after more than 24 months of continuous appliance wear. RESULTS: : 24/47 of the patients were still wearing the splints regularly after an average of 33 +/- 9.1 months. Overbite was highly significantly reduced (p = 0.006). We noted a reduction in the frontal overbite of more than 1 mm in ten patients (47.6%), and the overbite of one patient decreased by 4 mm. The maxillary front teeth showed significant palatal tipping and those in the mandible significant labial tipping. CONCLUSIONS: : Clinically small but statistically significant dental side effects predominantly affecting the incisors' inclination occur after long-term wear of a TAP((R)) appliance. The clinical relevance of these dental changes to the patient can only be judged individually within the scope of an entire assessment.

• A 57-year Follow-up Study of Occlusion : Part 3: Oral Health and Attitudes to Teeth among Individuals with Crossbite at the Age of 8 Years.

  Authors: Rolf Elling Berg, Lisen Espeland, Arild Stenvik

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 69(6):463-483.

  OBJECTIVE: : To analyze occlusal changes occurring between the ages of 8 and 65 years in persons with anterior and/or posterior crossbite at the age of 8; to examine their attitudes toward dentalOBJECTIVE: : To analyze occlusal changes occurring between the ages of 8 and 65 years in persons with anterior and/or posterior crossbite at the age of 8; to examine their attitudes toward dental appearance and their experiences related to their own teeth. SAMPLE AND METHODS: : Of the 81 people we contacted who had been documented as having crossbite as 8-year-olds in 1950, 21 agreed to participate in this follow-up study. Their occlusal conditions had been documented initially by intraoral photographs in 1950, and a clinical examination including facial photographs, further occlusal photographs and an interview took place in 2007. For comparison, we also had available similarly-documented examples of individuals (n = 18) of the same age and with normal occlusion in 1950. RESULTS: : Oral hygiene was good or excellent in all individuals and all but one visited their dentist regularly. The average number of missing teeth was 3.8, whereas in the normal occlusion sample that number was 1.6. Of the eight persons who had undergone minor orthodontic treatment during childhood, five had an anterior crossbite resolved. Four persons who had initially presented a posterior crossbite later developed an anterior crossbite as well. In 2007, eleven individuals had a posterior and eight an anterior crossbite. At 65, four persons remembered that they had been teased in childhood because of their teeth, and could still remember the terms that had been used. Eighteen persons were satisfied with their teeth although two had severe anterior crossbite; three were dissatisfied, and their reasons were general health problems, mild crowding, and dentofacial asymmetry. Seven persons had TMJ symptoms with various types of history. With three exceptions, they all considered good tooth position to be important or very important. CONCLUSIONS: : In those not orthodontically treated, malocclusion tended to worsen, although 18 of the 21 persons expressed satisfaction with their teeth as adults. They had a higher average number of missing teeth, and more had TMJ problems than the control group with normal occlusion.

• Morphometric Analysis of Facial Profile in Adults.

  Authors: Karl-Friedrich Krey, Karl-Heinz Dannhauer

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 69(6):424-436.

  AIM: : Are centroid size, principal component analysis (PCA) and thin-plate splines (TPS) sufficient for determining facial morphology? Is it possible to identify relationships between cranialAIM: : Are centroid size, principal component analysis (PCA) and thin-plate splines (TPS) sufficient for determining facial morphology? Is it possible to identify relationships between cranial morphology, gender and facial profile? MATERIAL AND METHODS: : Profile photos of 110 adult patients were measured according to A.M. Schwarz landmarks using Onyx Cephtrade mark. Centroid size was calculated from x and y-coordinates. After Procrustes transformation, a principal component analysis for identifying major components of facial morphology was performed and the results visualized using thin-plate splines. At the same time, lateral cephalograms of all patients were analyzed according to Hasund. RESULTS: : There were significant differences in centroid size betweeen male and female patients. Only the vertical skeletal structure had an impact on centroid size. Six components (PC1 to PC6) were identified using PCA. They were responsible for 86.5% of the variance. PC1 (33.9%) described scaling along an axis from Porion to chin. PC2 (28.6%) characterized the vertical dimensions of the lower face. Significant differences were only apparent between males and females in PC3 and PC4. In terms of cephalometric parameters, PC2 and PC3 differed in the vertical, and PC1 und PC2 in the sagittal configuration. CONCLUSIONS: : The analyses presented here suffice for describing facial morphology qualitatively and quantitatively as demonstrated by this example. Separating size from shape is useful for investigating therapeutically and growth-related morphological changes. It is difficult to draw conclusions about skeletal parameters.

• Quality Development in a Dental Practice Environment : A Web-based System for Measuring Patient Satisfaction.

  Authors: Bastiaan Njio, Gea Ter Heege, Birte Prahl-Andersen

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 69(6):448-462.

  OBJECTIVE: : The aim of this study was to help orthodontic professionals to measure patient satisfaction objectively within their own clinical setting. We also aimed to share these benchmark dataOBJECTIVE: : The aim of this study was to help orthodontic professionals to measure patient satisfaction objectively within their own clinical setting. We also aimed to share these benchmark data with an international audience. MATERIAL AND METHODS: : The philosophy of the EURO-QUAL project was adopted, with 18 orthodontists participating in this benchmarking project. We used the STOPS-questionnaire tested on validity between 1998 and 2002. It consisted of 23 statements measuring five dimensions of care and two open questions. Age and gender were collected as demographic data, and the respondents were anonymized. Either the internet or a paper version of the questionnaire was used for data collection. RESULTS: : 1,538 patients responded during a 3-month period. When asked about the various dimensions of care, patients expressed satisfaction with the professional competence of their orthodontists and the treatment they received. Patients were least satisfied with the discomfort associated with the treatment and with the appointment procedures. The STOPS-questionnaire was further validated, revealing a Cronbach's Alpha score of 0.75. Average values for a benchmark were presented. CONCLUSIONS: : Changes in society are always reflected in health care, therefore knowledge management is important. This study demonstrates a method for gaining explicit knowledge about patient satisfaction, which facilitates practice management and can be done quickly.

• Influence of Overjet and Lip Coverage on the Prevalence and Severity of Incisor Trauma.

  Authors: Oskar Bauss, Stefan Freitag, Johannes Röhling, Alexander Rahman

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie. 69(6):402-410.

  OBJECTIVE: : The aim of this study was to assess the influence of overjet size and lip coverage on the prevalence and severity of incisor trauma. PATIENTS AND METHODS: : Dental records made onOBJECTIVE: : The aim of this study was to assess the influence of overjet size and lip coverage on the prevalence and severity of incisor trauma. PATIENTS AND METHODS: : Dental records made on presentation of 1,367 patients were examined for data concerning the prevalence, type and severity of incisor trauma. Original overjet was measured on the pre-treatment study models and divided into two categories: normal overjet (0-3.0 mm) and increased overjet (> 3.0 mm). Lip coverage of the upper incisors was estimated with reference to photographs showing the patient's face and was then rated as adequate or inadequate. The patients were then divided into three groups: normal original overjet and adequate lip coverage (Group 1), increased original overjet and adequate lip coverage (Group 2), and increased original overjet and inadequate lip coverage (Group 3). RESULTS: : Group 1 patients revealed a significantly lower prevalence of traumatic injuries than those in Group 2 (p = 0.028) or Group 3 (p = 0.003), and the odds ratios compared to Group 1 were 1.6634 for Group 2 and 2.0336 for Group 3. Regarding the type of trauma, Group 3 patients showed a significantly higher frequency of periodontal injuries than those in Group 1 (p = 0.018) or Group 2 (p = 0.015). Furthermore, Group 3 patients had significantly more in juries to two or more teeth per person than patients in Group 1 (p < 0.001) or Group 2 (p < 0.001). CONCLUSIONS: : Increased overjet and inadequate lip coverage increase the risk and severity of incisor trauma. Early orthodontic treatment might prevent dental trauma in these patients.

• Remodeling along the bone-screw interface.

  Authors: Thomas Michael Präger, Robert Mischkowski, Nico Laube, Paul-Georg Jost-Brinkmann, Ralf Müller-Hartwich

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopädie : Organ/official journal Deutsche Gesellschaft für Kieferorthopädie. 69(5):337-48.

  OBJECTIVE: The stability of cortical miniscrews depends on the contact between bone and implant. The aim of this study was to compare bone remodeling along the contact surface between the screw andOBJECTIVE: The stability of cortical miniscrews depends on the contact between bone and implant. The aim of this study was to compare bone remodeling along the contact surface between the screw and bone with and without pre-drilling. MATERIALS AND METHODS: Twenty-four FAMI miniscrews (length 10 mm, diameter 2 mm) were inserted into the mandibular alveolar process apical to the premolars of four miniature pigs. Each pig received six screws, three on the one side with pre-drilling, three on the other side without pre-drilling. Polychrome fluorescent labels were used to assess the bone remodeling. After 12 weeks of osseointegration, all 24 screws and surrounding bone were removed. Microsections were prepared and analyzed histomorphometrically and under fluorescent microscopy. Differences between the groups were determined using the t test with a significance level of 5%. RESULTS: All the screws osseointegrated without any complications. Those without pre-drilling revealed a bone-screw contact of 64 +/- 11%, and those subjected to pre-drilling 63 +/- 12%. This difference was not significant. The mineral apposition rate, 1.6 +/- 0.4 microm/d and 1.7 +/- 0.4 microm/d, respectively, also failed to demonstrate any significant differences between the groups, while the portion of newly-formed bone in the pre-drilled group was significantly higher (59 +/- 9% vs. 27 +/- 6%). CONCLUSION: Significant differences in the bone-to-screw contact between the two groups are no longer in evidence after three months due to new bone formation. The minor extent of bone remodeling in the not pre-drilled group rules out substantial bone damage, which might have occurred during screw placement as a result of "cracks" or an excessive increase in pressure along the interface. The similar rate of new bone formation in both groups speaks against a stimulating effect of pre-drilling. Despite the absence of quantitative differences, it remains unclear whether the mechanical quality of the newly-formed bone resembles that of preexisting bone. Our findings seem to be applicable to the human mandible, however, its thinner cortical layer means less screw-to-bone contact is likely. We must reckon with less bone contact in the maxilla for the same reason.

• Incisor inclination--risk factor for palatally-impacted canines.

  Authors: Gabriele Lüdicke, Winfried Harzer, Eve Tausche

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopädie : Organ/official journal Deutsche Gesellschaft für Kieferorthopädie. 69(5):357-64.

  OBJECTIVE: The purpose of this study was to evaluate the torque of upper incisors and the maxillary size in sagittal direction in patients with impacted canines. MATERIAL AND METHODS: PanoramicOBJECTIVE: The purpose of this study was to evaluate the torque of upper incisors and the maxillary size in sagittal direction in patients with impacted canines. MATERIAL AND METHODS: Panoramic radiographs, cephalograms and pretreatment study models were evaluated in 199 patients (12.7 +/- 3.6 years) with impacted canines. The prevalence of malocclusions, inclination of the canine to the occlusal plane, incisors' inclination and maxillary size were determined. RESULTS: 45% of the patients showed symptoms of Class II, Division 2 malocclusion: at 18.5 degrees, the inclination of upper incisors (angle U1/NA) was lower and at 81.3 degrees the SNA angle higher than in patients with neutral conditions. CONCLUSIONS: There is no guidance for the erupting canine through the labial root torque of the upper incisors like in patients with missing lateral incisors. Patients with symptoms of Class II, Division 2 malocclusion should be regarded as a risk group for canine impaction.

• Arch changes after Class II, Division 1 treatment with jumping-the-bite appliances.

  Authors: Magdalena Stec-Slonicz, Sabine Weindel, Sandra Paurevic, Jörg A Lisson

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopädie : Organ/official journal Deutsche Gesellschaft für Kieferorthopädie. 69(5):373-82.

  OBJECTIVE: The present study describes dental arch changes in patients with an Angle Class II, Division 1 malocclusion and skeletal Class II during orthodontic treatment during which onlyOBJECTIVE: The present study describes dental arch changes in patients with an Angle Class II, Division 1 malocclusion and skeletal Class II during orthodontic treatment during which only jumping-the-bite appliances according to the Hannover design were used. PATIENTS AND METHODS: 69 patients (37 female and 32 male) were treated with jumping-the-bite appliances. The measurements taken in upper and lower jaws were: length of the anterior arch and E-space, anterior and posterior arch width, overjet and overbite. Analyses of dental casts prior to treatment and after each year of treatment were carried out until the end of treatment. Statistical analysis included mean value, standard deviation and t test for paired groups for all measurements. RESULTS: Anterior arch length increased in all patients, indicating a protrusion of incisors, especially in the lower arch. The anterior and in particular, posterior arch widths of the upper and lower jaws also increased, whereas E-space was reduced. The overjet decreased in terms of physiological values, as did the overbite, but to a lesser extent. CONCLUSION: In addition to causing skeletal changes, treatment with jumping-the-bite appliances also leads to characteristic dentoalveolar changes. These factors must be considered when planning the therapy of patients with Angle Class II, Division I malocclusion.

• Influence of insertion site on the failure rates of orthodontic miniscrews.

  Authors: Georgios Tsaousidis, Oskar Bauss

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopädie : Organ/official journal Deutsche Gesellschaft für Kieferorthopädie. 69(5):349-56.

  OBJECTIVE: The aim of this study was to examine the influence of various insertion sites on the failure rates of orthodontic miniscrews. PATIENTS AND METHODS: 76 orthodontic miniscrews were insertedOBJECTIVE: The aim of this study was to examine the influence of various insertion sites on the failure rates of orthodontic miniscrews. PATIENTS AND METHODS: 76 orthodontic miniscrews were inserted in 59 patients: 20 in the buccal and 18 in the palatal side of the maxilla, and 38 in the buccal side of the mandible. We attempted to insert all the screws at a minimum depth of at least 5 mm. RESULTS: The total failure rate was 18.4% on average (n = 14). Orthodontic miniscrews in the palatal side of the maxilla failed at a significantly higher rate than miniscrews in the buccal side of the mandible (p < 0.001); they also failed at a significantly higher failure rate during the first 3 months after insertion than did miniscrews in the buccal side of the maxilla (p = 0.003) or mandible (p < 0.001). We also observed a significant correlation between failure rate and screw length, with the shorter miniscrews showing significantly higher failure rates (r = -0.743; r2 = 0.552; p < 0.001). CONCLUSIONS: Insertion site seems to affect the failure rates of orthodontic miniscrews. To ensure that orthodontic miniscrews have adequate stability in the palatal side of the maxilla, the insertion depth should exceed 5 mm.

• Biomechanics of the Keles Slider appliance for maxillary molar distalization--in-vitro analysis of force systems.

  Authors: Gero Kinzinger, Peter Diedrich

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopädie : Organ/official journal Deutsche Gesellschaft für Kieferorthopädie. 69(5):365-72.

  AIM: The aim of this in-vitro study was to analyze the forces and moments acting in the first molar region induced by the Keles Slider appliance for maxillary molar distalization, therebyAIM: The aim of this in-vitro study was to analyze the forces and moments acting in the first molar region induced by the Keles Slider appliance for maxillary molar distalization, thereby investigating this appliance's suitability for translatory distalization of the upper molars. MATERIAL AND METHODS: Over a working section of 3 mm with reactivation of the loaded spring systems, we analyzed the force systems of three laboratory-fabricated appliances of identical design using 3D measuring equipment. RESULTS: The force systems registered in-vitro exhibited complex biomechanics. Regular reactivation of the loaded coils resulted in consistent distalizing forces and uprighting moments, in forces and moments toward buccal and weak extrusive forces, and increasing mesial-inward rotating moments. CONCLUSIONS: The Keles Slider nearly achieves translatory molar distalization on a typodont in the sagittal plane. As a result, no uprighting activation is necessary for treatment. Because force application occurs palatally from the molars' center of resistance, there is a mesial-inward rotating moment that increases as distalization progresses, and this may lead to unwanted friction during clinical application. This is why regular reactivation of the coil spring systems, as well as subsequent measures for molar derotation, are indispensable. In the vertical plane, the molars are exposed to weak extrusive forces combined with moderate buccal rotating moments. These effects confirm that this appliance is indicated in patients with deep overbite.

• Shear bond strength of orthodontic brackets bonded with self-etching primer to intact and pre-conditioned human enamel.

  Authors: Elie W Amm, Louis S Hardan, Joseph P BouSerhal, Bettina Glasl, Björn Ludwig

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopädie : Organ/official journal Deutsche Gesellschaft für Kieferorthopädie. 69(5):383-92.

  OBJECTIVE: The purpose of this study was to evaluate the shear bond strength of orthodontic bracket when bonded to pre-conditioned and intact enamel using a self-etching primer within 6 hours andOBJECTIVE: The purpose of this study was to evaluate the shear bond strength of orthodontic bracket when bonded to pre-conditioned and intact enamel using a self-etching primer within 6 hours and after thermal cycling. MATERIAL AND METHODS: One hundred and twenty freshly-extracted human teeth were divided into four groups according to how the buccal surface to be bonded had been pre-conditioned: 1) acid-etched with 37% phosphoric acid, 2) sand-blasted with 50 microns aluminum-oxide, 3) matted with diamond burr, and 4) intact enamel used as control. Orthodontic metal brackets were bonded to the teeth using the same composite resin (Transbond XT) and self-etching primer (Transbond Plus Self-Etching Primer). Brackets were debonded within 6 hours or after thermal cycling for 2500 times (5 degrees C--37 degrees C--55 degrees C). Shear bond strength was measured on a testing machine at a crosshead speed of 3 mm/min. The bracket-failure interface was quantified according to the modified adhesive remnant index score (ARI). Data were analyzed using the two-way ANOVA test, Scheffé confidence interval of differences of means, and the chi-square test (p < 0.05). RESULTS: All the pre-conditioned groups showed significantly higher shear bond strength before and after thermal cycling than the control group. There was no significant correlation between thermal cycling and shear bond strength. The ARI scores revealed that the bond failed primarily on the adhesive-enamel interface in all groups before and after thermal cycling, with the exception of the acid-etched group, whose bonds failed mainly on the adhesive-bracket interface after thermal cycling. CONCLUSION: The authors recommend that the enamel be preconditioned before applying the self-etching primer when greater shear bond strength is desired.

• Evaluation of the progress of therapy in patients with cleft lip, jaw and palate, using voice analysis--a pilot study.

  Authors: Christiane Gugsch, Karl-Heinz Dannhauer, Michael Fuchs

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopädie : Organ/official journal Deutsche Gesellschaft für Kieferorthopädie. 69(4):257-67.

  BACKGROUND: The defective morphology of the hard and soft palate in patients with cleft lip, jaw and/or palate in conjunction with speech, voice and hearing disorders can considerably restrict theBACKGROUND: The defective morphology of the hard and soft palate in patients with cleft lip, jaw and/or palate in conjunction with speech, voice and hearing disorders can considerably restrict the ability to communicate. Changes in vocal timbre and the centripetal displacement of articulation are characteristic of cleft palate speech. There has not been a uniform diagnostic method in cleft centers to date which makes possible the analysis, documentation and comparison of changes in timbre. In this study we assessed a computer-aided evaluation process to determine objective vocal timbre parameters while treating children with cleft lip, jaw and palate who had undergone surgery according to the principle of delayed palate repair. PATIENTS AND METHODS: The data and findings of 24 patients with various cleft forms were evaluated. The group we investigated consisted of seven patients with bilateral clefts, fourteen with unilateral cleft, and three with isolated cleft palate. Our subject cohort was limited to those born between 1985 and 1986. At the baseline investigation the children were aged 3 to 4 years, at the second investigation 4 to 5 years, and at the third investigation 5 to 7 years. These children underwent palate repair together with velopharyngoplasty between their fourth and fifth years. Our data were based on the tape recordings taken at these three investigation time points (before velopharyngoplasty, after velopharyngoplasty, and in the year they started school). The German words "Ball", "Kaffeekanne", "Schuhe" and "Schokoladenpudding" and the sentence "Meine Puppe heisst Sabine." were analyzed using "Multi Speech" software. The individual vowels were manually extracted from these recordings and the fundamental frequency (F0) and frequency of the first formant (F1) determined RESULTS: We were able to evaluate the spectra of the vowels /a/, /i/ and /u/ of 24 children in all. There were statistically-significant differences in fundamental frequency when considering the intra-individual progress of patients with bilateral cleft lip, jaw and palate. The fundamental frequency at the second and third investigation time points was significantly lower (p=0.003; p=0.000) than that at the baseline investigation. We observed no significant differences regarding that parameter at the various time points when evaluating the children with unilateral cleft lip, jaw and palate. Careful appraisal of the individual vowels showed that the speech results correlated with the severity of the type of cleft. CONCLUSION: Since the fundamental frequency and analysis of the first formant have proven to be suitable parameters for the analytical description of the vocal timbre of cleft patients, our results provide a solid basis for further studies. We provided evidence that this investigatory method is also effective when considering time and equipment requirements.

• Analysis of condylar differences in functional unilateral posterior crossbite during early treatment--a randomized clinical study.

  Authors: Carsten Lippold, Gloria Hoppe, Tatjana Moiseenko, Ulrike Ehmer, Gholamreza Danesh

  Journal of orofacial orthopedics = Fortschritte der Kieferorthopädie : Organ/official journal Deutsche Gesellschaft für Kieferorthopädie. 69(4):283-96.

  OBJECTIVE: The analysis of potential discrepancies in condyle position among different occlusal relations (centric relation and maximum intercuspidation) is a key diagnostic component when treatingOBJECTIVE: The analysis of potential discrepancies in condyle position among different occlusal relations (centric relation and maximum intercuspidation) is a key diagnostic component when treating children with unilateral posterior crossbite. Due to strict requirements imposed by ethics committees, and new regulations regarding the use of X-rays, radiological examinations (axial cephalometric radiographs or postero-anterior cephalometric radiographs) are not feasible. Thus the aim of this study was to apply an alternative procedure for the assessment of condylar deviations. PROBANDS AND METHODS: : We employed ARCUS digma, a measuring system based on ultrasound technology, to record condylar differences occurring in 65 children (6.9+/-2.0 years of age) with functional unilateral posterior crossbite in late deciduous and early mixed dentition. After randomization, 31 patients underwent early orthodontic treatment (bonded palatal expansion appliance and U-bow activator), whereas 34 patients remained untreated. Examinations were carried out at the beginning (T1) and after 12 months of treatment (T2). A three-dimensional (3D) assessment of deviations between maximum intercuspidation and centric position was carried out. Statistical analysis was performed using the SPSS 12.0 software program. RESULTS: Initially, the electronic position analysis revealed no significant differences between the control and therapy groups. A mean condylar deviation of > 2 mm was noted at T1 in the sagittal, frontal and transversal planes for crossbite and the noncrossbite sides. This difference was reduced in the therapy group, a finding that proved statistically highly significant (p<0.001). We also observed a highly significant (p<0.001) difference between the control and therapy groups at T2. CONCLUSION: The Münster concept for early treatment of functional unilateral posterior crossbites in late deciduous and early mixed dentition significantly improved the treated patients' occlusion in comparison to a randomized control group, which exhibited no spontaneous self-healing tendencies.

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