Residents’ journal review

Effects of pacifiers on the occlusion of children aged 24 to 36 months

Lima AA, Alves CM, Ribeiro CC, Pereira AL, da Silva AA, Silva LF, et al. Effects of conventional and orthodontic pacifiers on the dental occlusion of children aged 24-36 months old. Int J Paediatr Dent 2016 Feb 9 [Epub ahead of print]

Nonnutritive sucking habits (NNSHs) change the pattern of facial muscle contraction and may contribute to malocclusion. Both conventional and orthodontic pacifiers are available commercially, with orthodontic pacifiers claiming an anatomic design that does not interfere with normal growth or development. The authors of this Brazilian study investigated the effects of conventional and orthodontic pacifiers on the severity and prevalence of malocclusion in the deciduous dentition, subjectively accounting for the duration, frequency, and intensity of NNSH. Data were collected at 3 time points: birth, 12 to 24 months old, and 24 to 36 months old. A random sample of 220 children was selected by lottery and separated into control (110), conventional pacifier (55), and orthodontic pacifier (55) groups. Precalibrated orthodontic examiners did not know the child’s history of NNSH and evaluated erupted teeth, terminal plane of deciduous molars, overbite, overjet, and posterior crossbite. Parents were asked to assess the frequency, intensity, and duration of pacifier use. A total of 168 children (76.4%) had malocclusions, with rates significantly higher among pacifier users (96.3%) compared with the control group (3.7%). Only 2 children among all the pacifier users did not have a malocclusion. However, the subjects in the conventional group exhibited malocclusions that were more severe than those in the orthodontic group and were 10.7 times more likely to have a posterior crossbite than the subjects in the control group. Additionally, the average duration of use was significantly longer for conventional pacifiers, and a strong positive correlation was found between habit duration and anterior open bite. The authors concluded that the children in both pacifier groups had an increased risk of malocclusion compared with nonusers.

Reviewed by Casey J. Burns

Mandibular stability with surgery-first vs orthodontics-first treatment

Akamatsu T, Hanai U, Miyasaka M, Muramatsu H, Yamamoto S. Comparison of mandibular stability after SSRO with surgery-first approach versus conventional ortho-first approach. J Plast Surg Hand Surg 2016;50:50-5

The orthodontics-first approach (OF) typically requires 1 to 2 years of preoperative treatment before orthognathic surgery, during which the patient’s facial esthetics worsen. With the surgery-first approach (SF), esthetics improve immediately, most tooth movement occurs during the accelerated postsurgical window, but the occlusion remains unstable until orthodontic treatment is complete. The authors of this study looked at skeletal Class III patients who received only sagittal split ramus osteotomy setback (14 SF patients, 24 OF patients). The SF patients received an average of 2.9 months of preoperative orthodontic treatment to eliminate transverse discrepancies, and both groups received intermaxillary fixation for 2 weeks after surgery with positioning elastics thereafter. Because the SF group had minimal orthodontic preparation, cuspal interferences were resolved postsurgically, and the expected mandibular rotation occurred. To correct for this in calculating relapse, the authors compared postsurgical mandibular tracings taken at 2 weeks and 1 year rotating about articulare. They then recorded horizontal and vertical changes. No significant difference was found between the treatment groups in the amounts of horizontal movement of pogonion and B-point after surgery (SF, 0.86 mm forward; OF, 0.90 mm forward). However, the mean vertical relapse at pogonion was significant, and the 2 groups moved in opposite directions (SF, 1.59 mm downward; OF, 0.14 mm upward). The authors attributed this difference to the SF group’s heavier reliance on intermaxillary elastics for postoperative stability in the absence of interdigitation, thereby extruding the posterior teeth. Skeletal anchorage for elastics is suggested if vertical relapse is a concern (eg, open-bite patients). The authors recommended minimal orthodontic treatment before surgery, even in SF patients, and cautioned that autorotation of the mandible in finishing SF patients tends to hide any relapse.

Reviewed by Stona Jackson

Mandibular stability with surgery-first vs orthodontics-first treatment

Akamatsu T, Hanai U, Miyasaka M, Muramatsu H, Yamamoto S. Comparison of mandibular stability after SSRO with surgery-first approach versus conventional ortho-first approach. J Plast Surg Hand Surg 2016;50:50-5

The orthodontics-first approach (OF) typically requires 1 to 2 years of preoperative treatment before orthognathic surgery, during which the patient’s facial esthetics worsen. With the surgery-first approach (SF), esthetics improve immediately, most tooth movement occurs during the accelerated postsurgical window, but the occlusion remains unstable until orthodontic treatment is complete. The authors of this study looked at skeletal Class III patients who received only sagittal split ramus osteotomy setback (14 SF patients, 24 OF patients). The SF patients received an average of 2.9 months of preoperative orthodontic treatment to eliminate transverse discrepancies, and both groups received intermaxillary fixation for 2 weeks after surgery with positioning elastics thereafter. Because the SF group had minimal orthodontic preparation, cuspal interferences were resolved postsurgically, and the expected mandibular rotation occurred. To correct for this in calculating relapse, the authors compared postsurgical mandibular tracings taken at 2 weeks and 1 year rotating about articulare. They then recorded horizontal and vertical changes. No significant difference was found between the treatment groups in the amounts of horizontal movement of pogonion and B-point after surgery (SF, 0.86 mm forward; OF, 0.90 mm forward). However, the mean vertical relapse at pogonion was significant, and the 2 groups moved in opposite directions (SF, 1.59 mm downward; OF, 0.14 mm upward). The authors attributed this difference to the SF group’s heavier reliance on intermaxillary elastics for postoperative stability in the absence of interdigitation, thereby extruding the posterior teeth. Skeletal anchorage for elastics is suggested if vertical relapse is a concern (eg, open-bite patients). The authors recommended minimal orthodontic treatment before surgery, even in SF patients, and cautioned that autorotation of the mandible in finishing SF patients tends to hide any relapse.

Reviewed by Stona Jackson

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Apr 4, 2017 | Posted by in Orthodontics | Comments Off on Residents’ journal review
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