[Show abstract][Hide abstract] ABSTRACT: To investigate changes in the craniofacial skeleton in relation to the changes in condylar alterations that occur during long-term follow-up in patients with juvenile idiopathic arthritis.
Temporomandibular joint (TMJ) involvement is defined as a condylar alteration that is observed on the orthopantomogram. Lateral cephalograms were used to determine linear and angular measurements.
Seventy of 97 patients from the initial study cohort were included, with a mean follow-up of 68 months. The overall prevalence of condylar alterations and posterior rotation of the mandible decreased; however, the prevalence of retrognathia remained the same. Patients showed improvement in the degree of retrognathia and posterior rotation (40% ANB, 51% OP-SN, and 44% GO-GN-SN). Improvement in the degree of retrognathia was seen more often in patients with improved condylar alterations than in patients with persistent alterations and in those without alterations (50%, 33%, and 28%, respectively). The degree of posterior rotation improved almost equally in patients without TMJ involvement and in patients with improved condylar alterations (57% and 50% by OP-SN, and 67% and 38% GO-GN-SN, respectively) and did not improve in patients with stable persistent alterations.
Both condylar and craniofacial alterations can improve in patients with juvenile idiopathic arthritis.
The Angle Orthodontist 11/2009; 79(6):1057-62. DOI:10.2319/093008-511R.1 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study evaluated stability, tipping and relapse after surgically assisted rapid maxillary expansion (SARME), comparing bone-borne and tooth-borne devices, in skeletally matured non-syndromal patients with transverse maxillary hypoplasia. The study is a randomized, open-label, clinical trial. Patients were randomized to bone-borne (n=25) and tooth-borne (n=21) groups. The surgical technique for corticotomy was the same in both groups. Expansion was performed using a bone-borne or tooth-borne device. Dental study casts, lateral and postero-anterior cephalograms were taken before treatment, after the distraction phase and at 12-month follow up. Stability, segmental maxillary tipping and relapse were studied. 23 bone-borne and 19 tooth-borne patients were analyzed. There were no significant differences between the two groups. Widening was comparable at canine, premolar and molar level. Relapse was not significant and at follow up the significant increase in distance was sustained. A significant increase in palatal width, at premolar and molar level, occurred in both groups. The maxilla moves slightly downward in SARME. Segmental maxillary tipping occurred in both groups and did not affect relapse. There is no significant difference between the two groups. In SARME, the widening achieved at dental level is stable after 12 months. Over-correction is not necessary. Tipping of the maxillary segments and increases in the retention period are equal in both groups.
International Journal of Oral and Maxillofacial Surgery 05/2009; 38(4):308-15. DOI:10.1016/j.ijom.2009.02.012 · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This anatomic biomechanical study was undertaken to gain insight into the underlining mechanism of tipping of the maxillary segments during transverse expansion using tooth-borne and bone-borne distraction devices.
An anatomic biomechanical study was performed on 10 dentate human cadaver heads using tooth-borne and bone-borne distraction devices.
The amount of tipping of the maxillary halves was greater in the tooth-borne group, but the difference was not significant. Four of the specimens demonstrated an asymmetrical widening of the maxilla.
Segmental tipping was seen in both study groups. In this anatomic model, tooth-borne distraction led to greater segmental tipping compared with bone-borne distraction. Keep in mind, however, that this anatomic model by no means depicts a patient situation, and any extrapolation from it must be done with great care. The fact that the tooth-borne group demonstrated greater tipping might reflect the general opinion that bone-borne distraction causes less segmental angulation than tooth-borne distraction. Some tipping was seen in the bone-borne group, suggesting that overcorrection to counteract relapse will be necessary with this treatment modality.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 02/2009; 67(1):10-4. DOI:10.1016/j.joms.2007.11.026 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Temporomandibular joint (TMJ) involvement is a frequent feature in cross-sectional prevalence studies among patients with juvenile idiopathic arthritis (JIA). In this followup study, patients were reviewed after 5 years to study the course of TMJ involvement in relation to disease characteristics.
Children with JIA from a previous study on TMJ involvement were included. A rheumatologic evaluation including the 6 parameters of the JIA core set and an orthodontic evaluation including an orthopantomogram (OPT) were performed. OPTs were scored according to Rohlin's grading system (grades 0-5).
The overall prevalence of patients with condylar alterations decreased from 49% to 40%. Improvement of the alterations was seen in 69% of the initially affected condyles, and consequently improvement was seen in 83% of the initially affected patients. Normalization of the alterations was seen in 67% of the improved condyles, and consequently in 44% of the patients. This proves that the condyle has a regenerative capacity. Improvement was related to low disease activity and a less extensive therapeutic regimen.
In patients with JIA, condylar alterations can improve and even regenerate. Condylar improvement is associated with a low disease activity.
[Show abstract][Hide abstract] ABSTRACT: To investigate the facioskeletal morphology in patients with juvenile idiopathic arthritis (JIA) with and without temporomandibular joint (TMJ) involvement.
Eighty five patients were included. TMJ involvement was defined by orthopantomogram alterations. Lateral cephalograms were used to determine linear and angular measurements and occlusion.
Patients regardless of their TMJ status had a 67% chance for retrognathia and a 52% chance for posterior rotation of the mandible and, respectively, 82% and 58% if TMJ involvement were present. Changes were not uniformly distributed among the different subtypes.
Patients with JIA have an altered facial morphology, especially in the presence of TMJ involvement.
Annals of the Rheumatic Diseases 07/2006; 65(6):823-5. DOI:10.1136/ard.2005.042671 · 10.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Transverse maxillary hypoplasia, in adolescents and adults, is frequently seen as an acquired deformity and in congenital deformities patients and can be corrected by means of surgically assisted rapid maxillary expansion. Traditionally, the distractors for expansion are tooth-borne devices, i.e. hyrax appliances, which may have some serious disadvantages such as tooth tipping, cortical fenestration, skeletal relapse and loss of anchorage. In contrast, with bone-borne distractors most of the maxillary expansion is orthopedic and at a more mechanically desired level with less dental side effects. A new bone-borne palatal distractor has been developed. By activation the nails of the abutments plates automatically stabilizes the device and no screw fixation is necessary anymore. This new distractor is presented and the data of five acquired deformity and eight congenital deformity patients that were treated with this distractor are reported.
International Journal of Oral and Maxillofacial Surgery 02/2006; 35(1):31-5. DOI:10.1016/j.ijom.2005.07.002 · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Transverse maxillary hypoplasia, in adolescents and adults, is frequently seen in non-syndromal and syndromal patients including cleft patients. In skeletally matured patients, the uni- or bilateral transverse hypoplasia can be corrected by means of a surgically assisted rapid maxillary expansion. The treatment is a combination of orthodontics and surgical procedures and provides dental arch space for alignment of teeth. The procedure also causes a substantial enlargement of the maxillary apical base and of the palatal vault, providing space for the tongue for correct swallowing and thus preventing relapse. In addition, a distinct subjective improvement in nasal breathing associated with enlargement of the nasal valve towards normal values is seen with an increase of nasal volume in all compartments. In this article we give a review on surgically assisted rapid maxillary expansion. We conclude that there is no consensus in the searched literature regarding either the surgical technique, the type of distractor used (tooth-borne or bone-borne), the existence, cause and amount of relapse and whether or not overcorrection is necessary. A proposal for a prospective randomized patient study in order to find answers to the lacunas in knowledge regarding this treatment is done.
International Journal of Oral and Maxillofacial Surgery 11/2005; 34(7):709-14. DOI:10.1016/j.ijom.2005.04.025 · 1.36 Impact Factor