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ABSTRACT: Maxillary impaction and bimaxillary osteotomies are used to treat anterior open-bite malocclusions but can have adverse soft-tissue effects. Correcting an anterior open bite with a single mandibular procedure avoids these undesirable soft-tissue effects, but the stability of this procedure is unknown. The purpose of this study was to assess the long-term stability of anterior open-bite correction with bilateral sagittal split osteotomy and rigid internal fixation.
Orthognathic surgical records of 1 oral surgeon were searched for all patients treated for anterior open bite with bilateral sagittal split osteotomy and surgical closing rotation of the mandible with rigid internal fixation. Cephalometric films from initial consultation, presurgery, postsurgery, orthodontic appliance removal, and a mean of 4.5 years after orthodontic appliance removal were collected, traced, and measured.
Thirty-one patients fit the inclusion criteria for this study and had an initial mean open bite of -2.6 mm (SD, 1.1 mm). The patients experienced an average mandibular closing rotation of 3.7° (SD, 2.4°) with surgery. By orthodontic appliance removal, the mandible rotated open 1.1°, and incisor overlap was 1.4 mm (SD, 1.0 mm). Approximately 4.5 years after orthodontic appliance removal, the mean incisor overlap was maintained at 1.0 mm (SD, 1.0 mm), yet the mandible rotated open an additional 1.1°. Only 3 patients relapsed to no incisor overlap in the long term, and only 3 patients experienced relapse greater than 1 mm in the long term.
Approximately 90% of the treated patients had a positive incisor overlap 4.5 years after orthodontic appliance removal. Despite a 60% loss of mandibular surgical closing rotation, only 10% of the patients relapsed to no incisor overlap in the long term. Bilateral sagittal split osteotomy and surgical closing rotation of the mandible by using rigid internal fixation should be considered a stable alternative in the treatment of mild-to-moderate anterior open-bite malocclusions.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 12/2012; 142(6):792-800. · 1.33 Impact Factor
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ABSTRACT: Bisphosphonates are a class of drugs commonly prescribed to treat osteoporosis. They act by decreasing the resorption of bone. Since tooth movement depends on bone remodeling, these drugs can impact orthodontic treatment. The purpose of this study was to evaluate the extent to which bisphosphonate therapy is a risk factor for poor orthodontic outcomes.
Orthodontists were invited to participate in the study by performing case reviews of women over age 50 who were treated from 2002 through 2008. Women who used bisphosphonates were compared with women who did not have a history of bisphosphonate use. Outcomes assessed included treatment time, osteonecrosis of the jaws, incisor alignment, incomplete space closure, and root parallelism.
The records for 20 subjects with bisphosphonate exposure were collected, as well as records for 93 subjects without bisphosphonate exposure. In patients undergoing extractions, treatment times were significantly longer if they had a history of bisphosphonate use. No occurrences of osteonecrosis of the jaws were reported, nor did patients end treatment with incisor alignment discrepancies greater than 1 mm, regardless of bisphosphonate exposure. Among patients with extractions or initial spacing, there were higher odds of incomplete space closure (odds ratio, 13) and poor root parallelism (odds ratio, 26) at the end of treatment for patients using bisphosphonates.
Bisphosphonate use is associated with longer treatment times among extraction patients, increased odds of poor space closure, and increased odds of poor root parallelism.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 11/2012; 142(5):625-634.e3. · 1.33 Impact Factor
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ABSTRACT: Deep bite occurs in about 15% to 20% of the US population. Currently, it is unknown which types of correction are most efficient or stable. The purpose of this systematic review was to investigate factors related to stability of deep-bite correction.
An electronic search of 4 databases was performed from January 1, 1966 to June 27, 2012. Studies were considered for inclusion if they reported on deep bite samples that underwent orthodontic treatment in the permanent dentition. Records were required at the initial, posttreatment, and 1-year posttreatment times. Hand searching of reference lists of the included studies was performed. Data were abstracted using custom forms, and risk of bias was assessed using a modified Newcastle-Ottawa Scale.
Twenty-six studies met the inclusion criteria. Most were case series, with considerable potential for bias. The significant heterogeneity of the studies precluded meta-analyses, and only descriptive statistics and stratified comparisons were reported. On average, patients underwent significant overbite improvement during treatment, and most of the correction was maintained long-term. Across all studies, the mean initial overbite, posttreatment overbite, and long-term overbite were 5.3, 2.6, and 3.4 mm, respectively. Initial severity appeared to be related to long-term stability. However, this relationship was difficult to isolate from other factors. The length of follow-up did not appear to be related to the amount of relapse.
Although the quality of the current evidence is not high, patients with deep-bite malocclusion appear to undergo relatively successful treatment, and most of the correction appears to be stable.
Journal of the world federation of orthodontists. 09/2012; 1(3):e89-e86.
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ABSTRACT: This study compares occlusal and psychosocial outcomes from comprehensive orthodontic treatment in Medicaid (MC) and privately financed (private pay, PP) patients.
Two cohorts received comprehensive orthodontics: MC (n = 66); PP (n = 60). A calibrated, blinded examiner scored dental casts at baseline (pretreatment, T1) and after completing 2 years of treatment (posttreatment, T2) using the Peer Assessment Rating (PAR) and the Index of Complexity, Outcome, and Need (ICON). The prevalence of patients in the validated ICON categories for treatment need, complexity, and improvement were calculated. Questionnaires to assess body image (BI) and expectations/experiences were administered. Occlusal measures at T2 were compared after adjustment for baseline characteristics. Psychosocial measures were compared between and within groups. Occlusal and psychosocial associations were evaluated.
MC was 1.3 years younger (P < 0.001) and had worse malocclusions at baseline (PAR 32 versus 25; P < 0.001); (ICON 64 versus 56; P = 0.06). After adjustment for age and initial severity, estimated average differences between groups at T2 (MC-PP) were slight: 1.5 [95 percent confidence interval (CI) -2.9, 5.9] and 2.4 (95 percent CI -4.4, 8.9) for PAR and ICON, respectively. More PP completed treatment under 2 years (85 percent versus 62 percent; P = 0.03). At baseline, both groups needed treatment, but MC malocclusions were more complex (P = 0.05). At T2, both groups were acceptable and there were no differences in ICON improvement categories. Group differences in psychosocial measures and associations between psychosocial and occlusal measures were evident in the "teeth" domain but weak or lacking elsewhere.
Occlusal and psychosocial outcomes from orthodontics in MC and PP were comparable, despite worse MC malocclusions at baseline.
Journal of Public Health Dentistry 10/2011; 72(2):94-103. · 1.19 Impact Factor
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ABSTRACT: Anterior open-bite (AOB) treatment is considered challenging because of difficulties in determining and addressing etiologic factors and the potential for relapse in the vertical dimension after treatment. In this review, we compiled evidence on the long-term stability of the major therapeutic interventions for correcting AOB. Our objective was to review and compile evidence for the stability of surgical and nonsurgical therapies for AOB malocclusion. Our data sources were PubMed, EMBASE, Cochrane Library, limited gray literature search, and hand searching.
A search was performed of the electronic health literature on the stability of AOB after treatment. Hand searching of major orthodontic journals and limited gray literature searching was also performed, and all pertinent abstracts were reviewed for inclusion. Full articles were retrieved for abstracts or titles that met the initial inclusion criteria or lacked sufficient detail for immediate exclusion. Studies accepted for analysis were reviewed and their relevant data retrieved for pooling. The long-term stability estimates were pooled into nonsurgical and surgical groups, and summary statistics were generated.
One hundred five abstracts met the initial search criteria, and 21 articles were included in final analyses. Rejected articles failed to exhibit follow-up times of 12 months or more, did not include measurements of overbite (OB), or did not meet inclusion criteria. All included articles were divided into a surgical group (SX) with a mean age of 23.3 years and a nonsurgical group (NSX) with a mean age of 16.4 years. All studies were case series. Random-effects statistical models were used to pool the mean OB measures before and after treatment and also at the long-term follow-up. The pretreatment adjusted means of OB were -2.8 mm for the SX and -2.5 mm for the NSX. AOB closures up to +1.6 mm (SX) and +1.4 mm (NSX) were achieved. Relapse in the SX group during the mean 3.5 years of follow-up reduced the OB to +1.3 mm; the NSX group relapsed to +0.8 mm in the mean 3.2 years of follow-up. Pooled results indicated reasonable stability of both the SX (82%) and NSX (75%) treatments of AOB measured by positive OB at 12 or more months after the treatment interventions.
In the included case series publications, success of both the SX and NSX treatments of AOB appeared to be greater than 75%. Because the SX and the NSX were examined in different studies and applied to different clinical populations, no direct assessment of comparative effectiveness was possible. The pooled results should be viewed with caution because of the lack of within-study control groups and the variability among studies.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 02/2011; 139(2):154-69. · 1.33 Impact Factor
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Journal of clinical orthodontics: JCO 08/2010; 44(8):481-6.
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ABSTRACT: INTRODUCTION: Self-ligating brackets have been gaining popularity over the past several decades. Various advantages for these systems have been claimed. The purposes of this systematic review were to identify and review the orthodontic literature with regard to the efficiency, effectiveness, and stability of treatment with self-ligating brackets compared with conventional brackets. METHODS: An electronic search in 4 data bases was performed from 1966 to 2009, with supplemental hand searching of the references of retrieved articles. Quality assessment of the included articles was performed. Data were extracted by using custom forms, and weighted mean differences were calculated. RESULTS: Sixteen studies met the inclusion criteria, including 2 randomized controlled trials with low risk of bias, 10 cohort studies with moderate risk of bias, and 4 cross-sectional studies with moderate to high risk of bias. Self-ligation appears to have a significant advantage with regard to chair time, based on several cross-sectional studies. Analyses also showed a small, but statistically significant, difference in mandibular incisor proclination (1.5 degrees less in self-ligating systems). No other differences in treatment time and occlusal characteristics after treatment were found between the 2 systems. No studies on long-term stability of treatment were identified. CONCLUSIONS: Despite claims about the advantages of self-ligating brackets, evidence is generally lacking. Shortened chair time and slightly less incisor proclination appear to be the only significant advantages of self-ligating systems over conventional systems that are supported by the current evidence.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 06/2010; 137(6):726-727. · 1.33 Impact Factor
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ABSTRACT: Self-ligating brackets have been gaining popularity over the past several decades. Various advantages for these systems have been claimed. The purposes of this systematic review were to identify and review the orthodontic literature with regard to the efficiency, effectiveness, and stability of treatment with self-ligating brackets compared with conventional brackets.
An electronic search in 4 data bases was performed from 1966 to 2009, with supplemental hand searching of the references of retrieved articles. Quality assessment of the included articles was performed. Data were extracted by using custom forms, and weighted mean differences were calculated.
Sixteen studies met the inclusion criteria, including 2 randomized controlled trials with low risk of bias, 10 cohort studies with moderate risk of bias, and 4 cross-sectional studies with moderate to high risk of bias. Self-ligation appears to have a significant advantage with regard to chair time, based on several cross-sectional studies. Analyses also showed a small, but statistically significant, difference in mandibular incisor proclination (1.5 degrees less in self-ligating systems). No other differences in treatment time and occlusal characteristics after treatment were found between the 2 systems. No studies on long-term stability of treatment were identified.
Despite claims about the advantages of self-ligating brackets, evidence is generally lacking. Shortened chair time and slightly less incisor proclination appear to be the only significant advantages of self-ligating systems over conventional systems that are supported by the current evidence.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 06/2010; 137(6):726.e1-726.e18; discussion 726-7. · 1.33 Impact Factor
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ABSTRACT: INTRODUCTION: The postretention stability of open-bite treatment is a controversial topic in orthodontics. METHODS: In this study, the lateral cephalometric radiographs of 64 patients treated with orthodontics alone were evaluated to determine the amount of postretention change. The mean postretention interval was 14 years. The sample was divided into 3 groups based on the amounts of pretreatment overbite: (1) the contact group (n = 24), incisal overlap and incisal contact; (2) the overlap group (n = 25), incisal overlap and no incisal contact; and (3) the open-bite group (n = 15), no incisal overlap. The headfilms were digitized, and the values were analyzed. RESULTS: The 3 groups reacted differently. During the postretention period, mean overbite deepened in all groups, with the contact group deepening significantly more than the open-bite group. Overjet increased significantly more in the open-bite group than in the contact group. Pretreatment overjet correlated mildly with postretention overjet relapse in the open-bite group. CONCLUSIONS: All 64 subjects had positive incisal overlap at the postretention recall.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 03/2010; 137(3):302-303. · 1.33 Impact Factor
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ABSTRACT: The postretention stability of open-bite treatment is a controversial topic in orthodontics.
In this study, the lateral cephalometric radiographs of 64 patients treated with orthodontics alone were evaluated to determine the amount of postretention change. The mean postretention interval was 14 years. The sample was divided into 3 groups based on the amounts of pretreatment overbite: (1) the contact group (n = 24), incisal overlap and incisal contact; (2) the overlap group (n = 25), incisal overlap and no incisal contact; and (3) the open-bite group (n = 15), no incisal overlap. The headfilms were digitized, and the values were analyzed.
The 3 groups reacted differently. During the postretention period, mean overbite deepened in all groups, with the contact group deepening significantly more than the open-bite group. Overjet increased significantly more in the open-bite group than in the contact group. Pretreatment overjet correlated mildly with postretention overjet relapse in the open-bite group.
All 64 subjects had positive incisal overlap at the postretention recall.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 03/2010; 137(3):302.e1-8; discussion 302-3. · 1.33 Impact Factor
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ABSTRACT: There are disparities in access to orthodontic treatment for children from low-income families. Systematic programs of limited-care interceptive and preventive orthodontics have been proposed as a solution. The purpose of this randomized clinical trial was to compare dental outcomes and funding eligibility from a group of Medicaid patients randomized to receive interceptive orthodontics (IO) in the mixed dentition or observation (OBS).
One hundred seventy Medicaid-eligible children were randomized to receive IO or OBS and followed for 2 years, when complete data were available on 72 and 74 children, respectively. The 2-year changes in the peer assessment rating (PAR) were compared using the Student t test. The proportions of children no longer eligible for Medicaid funding as defined by handicapping labiolingual deviation (HLD) scores less than 25 at the 2-year follow-up were compared with the chi-square test.
The IO patients had significantly greater decreases in the PAR scores--50%-compared with the OBS subjects, -6% (P <0.001). Negative and positive overjet and maxillary alignment were the components most affected by IO; they decreased by 11.0, 7.2, and 3.7 PAR points, respectively (P <0.001). Overbite showed little change. At the 2-year follow-up, 80% of the IO patients' malocclusions that qualified initially were no longer deemed medically necessary by the HLD index, compared with 6% in the OBS group (P <0.001).
IO significantly reduces the severity of malocclusions and moves most from the "medically necessary" category to elective but does not produce finished results for most patients. Overjet and alignment were most readily corrected by interceptive treatment. Deep overbites were the least susceptible to IO correction.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 03/2010; 137(3):324-33. · 1.33 Impact Factor
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ABSTRACT: A review of the literature showed that there are disturbances of muscle activity and tongue function in patients with anterior open bite (AOB). However, most studies have had white subjects, even though open bite is more prevalent in black populations. In this pilot study, we examined jaw muscle activity and tongue pressure in East African black subjects.
Ten subjects (4 boys, 6 girls; ages, 10.1-13.2 years) were recruited. A cephalometric comparison of subjects with and without AOB was performed. Surface electrodes were placed on the bilateral anterior temporalis, superficial masseter, superior orbicularis oris, and anterior digastric muscles. Electromyograms were recorded at rest, maximal voluntary clenching, chewing, and swallowing. Tongue pressure during rest and swallowing, and maximal bite force were also measured.
There was no statistically significant difference between the 2 groups in cephalometric measures (except in amount of open bite and overbite) and maximum bite force. During chewing, both groups showed similar coordinated activity patterns in the muscles, but the AOB subjects tended to show more electromyographic activity in the muscles of the balancing side. During clenching, the AOB subjects exhibited lower electromyographic activity compared with the controls. AOB subjects also had greater anterior tongue pressure during swallowing. Data from tongue pressure at rest were inconclusive.
East African blacks appear to have neuromuscular and skeletal predispositions to AOB, but their vertical incisor relationships are variable. Factors in addition to those investigated might be involved.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 02/2010; 137(2):236-46. · 1.33 Impact Factor
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Journal of the American Dental Association (1939) 01/2010; 141(1):77-8. · 1.77 Impact Factor
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ABSTRACT: In this study, we compared the pretreatment conditions, treatment characteristics, and orthodontic outcomes of 3 groups of subjects selected for the American Board of Orthodontics (ABO) phase III clinical examination. One group was selected retrospectively by graduating residents just before their graduation. The 2 prospective groups were treated at separate institutions. The students at 1 institution were not aware that these patients would be potential ABO cases (prospective, blinded), but the students at the second institution were aware that these subjects would serve as their pool of potential patients for the ABO examination (prospective, unblinded). In addition to comparing the 3 groups, all cases were categorized as passing or failing based on their total objective grading system (ABO-OGS) score to assess the ABO-OGS criteria that were the most challenging to meet.
Chart histories and orthodontic dental casts (pretreatment and posttreatment) were collected for 133 subjects. Information regarding demographics, initial malocclusion type, treatment modality, treatment duration, appointment frequency, and missed appointments were collected from chart histories. Pretreatment dental casts were evaluated by using the discrepancy index; the index of complexity, outcome, and need; and the peer assessment rating. Posttreatment dental casts were evaluated with the peer assessment rating and the ABO-OGS.
The only significant pretreatment characteristic with predictive power for favorable orthodontic outcome was Angle Class I (3.1 odds ratio for passing the ABO-OGS) compared with the Class II subjects. The prospective unblinded group received more extraction and headgear therapy than did the other groups. The retrospective group had significantly lower total ABO-OGS posttreatment scores and a higher passing rate compared with the prospective groups.
Angle Class I malocclusions appear to have some advantage for achieving passing ABO-OGS scores, as does the retrospective selection of cases. Successful board certification appears difficult to accomplish based on a prospective model for orthodontic graduate residents. New graduate candidates might be at a disadvantage compared with traditional candidates because they often cannot take advantage of the posttreatment settling phase. Alignment, marginal ridges, and occlusal contacts appear to be where most points are deducted in the evaluation of ABO-OGS certification cases.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 01/2010; 137(1):6.e1-8; discussion 6-8. · 1.33 Impact Factor
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Journal of the American Dental Association (1939) 12/2009; 140(12):1524-5. · 1.77 Impact Factor
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ABSTRACT: The relationship between malocclusion and quality of life (QoL) is complex and not well understood. The objective of this study was to determine whether malocclusion and its treatment influence an adolescent's general and oral health-related QoL.
An observational, cross-sectional design with a longitudinal component was used. Clinical and self-reported data were collected from 293 participants aged 11 to 14. The children were recruited from orthodontic and pediatric dental clinics at the University of Washington and a community health clinic in Seattle. The participants were classified into precomprehensive orthodontic (n = 93), postinterceptive orthodontic (n = 44), and nonorthodontic comparison (n = 156) groups. Assessments of dental esthetics and occlusion were evaluated with the Index of Complexity, Outcome, and Need. Three QoL questionnaires were completed: Youth Quality of Life to assess general QoL, Children's Oral Health-Related Quality of Life to assess oral health QoL, and Treatment Expectations and Experiences to evaluate participants' expectations for changes in specific aspects of their lives. Nonparametric tests were used for all analyses.
In general, overall and oral health QoL were high in this population. The instruments were correlated so that when oral health QoL improved, so did general QoL. No differences were found in these measurements between the university and community health clinics. Nor were there differences between the 3 study groups on general QoL and oral health QoL. There was little effect of malocclusion complexity on any QoL measure. Both preorthodontic and postorthodontic participants expected improvements in their health, oral function, appearance, and social well-being after orthodontic treatment; the postinterceptive sample's posttreatment experiences were consistent with their pretreatment expectations in all domains.
Malocclusion and orthodontic treatment do not appear to affect general or oral health QoL to a measurable degree, despite subjective and objective evidence for improved appearance, oral function, health, and social well-being.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 10/2009; 136(3):382-92. · 1.33 Impact Factor
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Greg J Huang
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ABSTRACT: SYSTEMATIC REVIEW CONCLUSION. The current evidence is insufficient to demonstrate the superiority of power toothbrushes to manual toothbrushes in reducing gingivitis in orthodontic patients. CRITICAL SUMMARY ASSESSMENT. This systematic review identified five randomized trials, only one of which demonstrated that power toothbrushes were significantly more effective than manual toothbrushes in reducing gingivitis in patients undergoing orthodontic treatment.
Journal of the American Dental Association (1939) 08/2009; 140(7):914-5. · 1.77 Impact Factor
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Greg J Huang
The journal of evidence-based dental practice 07/2008; 8(2):63.
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ABSTRACT: Orthodontic therapy has been suggested to lead to an improved periodontal status through mechanisms such as increased ease of plaque removal and reduced occlusal trauma. The objective of the authors' systematic review was to compare contemporary orthodontic treatment with no intervention, by means of evaluating periodontal outcomes measured after end of treatment.
The authors completed electronic searches in eight databases (1980-2006) and hand searches in six dental journals (1980-2006). They extracted data using standardized forms and calculated weighted mean differences.
Weak evidence from one randomized study and 11 nonrandomized studies suggested that orthodontic therapy was associated with 0.03 millimeters of gingival recession (95 percent confidence interval [CI], 0.01-0.04), 0.13 mm of alveolar bone loss (95 percent CI, 0.07-0.20) and 0.23 mm of increased pocket depth (95 percent CI, 0.15-0.30) when compared with no treatment. The effects of orthodontic therapy on gingivitis and attachment loss were inconsistent across studies.
This systematic review identified an absence of reliable evidence describing positive effects of orthodontic treatment on periodontal health. The existing evidence suggests that orthodontic therapy results in small detrimental effects to the periodontium.
Journal of the American Dental Association (1939) 05/2008; 139(4):413-22. · 1.77 Impact Factor
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Greg J Huang
The journal of evidence-based dental practice 04/2008; 8(1):43-4.
