Correction of skeletal anterior open bite and vertical stability
Solano-Hernandez B, Antonarakis G, Scolozzi P, Kiliaridis S. Combined orthodontic and orthognathic surgical treatment for the correction of skeletal anterior open-bite malocclusion: a systematic review on vertical stability. J Oral Maxillofac Surg 2012 Jun 11 [Epub ahead of print]
The correction of an anterior open-bite malocclusion in an adult is a great challenge in orthodontics. The authors of this systematic review aimed to evaluate vertical stability after combined orthodontic and surgical treatment of skeletal anterior open-bite malocclusion. A comprehensive review of electronic databases and hand-searching of nonelectronic journals was completed. Data from the identified studies were extracted and assessed for quality. The inclusion criteria were studies in humans with cephalometrics to assess vertical changes and a follow-up of at least 12 months. Nine studies, all retrospective clinical trials, were deemed acceptable for this review. Short-term and long-term changes in overbite; mandibular plane, palatal plane, and intermaxillary angles; and anterior facial heights were evaluated. Regardless of the type of surgery used, vertical relapse was observed in patients after combined orthodontic and surgical treatment. Long-term dental relapse was more common in patients after LeFort I osteotomy. On the other hand, long-term skeletal relapse was more common after bimaxillary surgery. The heterogeneity of the studies made a meta-analysis impossible. The authors emphasized the need for well-designed prospective studies with untreated control groups. Furthermore, the authors suggested using newer techniques such as cone-beam computed tomography or 3-dimensional imaging to better assess and quantify relapse and stability.
Reviewed by Harrison H. Jo
Does rapid maxillary expansion change the soft-tissue profile?
dos Santos BM, Stuani AS, Stuani AS, Faria G, Quintão CC, Stuani MB. Soft tissue profile changes after rapid maxillary expansion with a bonded expander. Eur J Orthod 2012;34:367-73
Orthodontic literature dating back to the classic Haas report indicates that rapid maxillary expansion is associated with downward and forward displacement of the maxillary complex, but the effect on the patient’s profile remains controversial. The authors of this article did not study this relationship per se; they were interested in whether rapid maxillary expansion has an effect on the soft-tissue profile. The purpose of this study was to evaluate the short-term and long-term changes on the soft-tissue profile that are associated with rapid maxillary expansion with a bonded expander. The authors studied 20 patients in the mixed dentition. Each patient had a narrow maxilla and a corresponding posterior crossbite before treatment. The patients were treated with a fixed bonded expander with occlusal coverage. One week after insertion, the expander was activated at the rate of 0.5 mm per day. Once the posterior crossbite was slightly overcorrected, the expansion screw was secured, and the expander remained in place as a passive retainer for 6 months. Pretreatment, postexpansion, and postretention study casts and lateral cephalograms were obtained to study the possible changes in the soft-tissue profile. The cephalograms were traced, and the linear and angular measurements were compared. The results showed that measurements taken at postexpansion were significantly different from those taken at pretreatment and postretention, but when the measurements were compared at pretreatment and postretention, there was no statistically significant difference in the soft-tissue profile. The authors concluded that rapid maxillary expansion with a fixed bonded expander does produce changes in the soft-tissue profile during its use, but, at the end of retention, there are no significant changes.
Reviewed by Mark Hamanishi