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1/86. Molarization of the lower second premolars.

    This paper presents a case of extreme tooth variation. The patient was first observed during the mixed dentition period, when she presented a mild Class II malocclusion with increased overjet and acceptable overbite. In a panoramic radiograph, the presence of lower second premolars of disproportionate dimensions was discovered. When these oversized premolars erupted, the Class I malocclusion tended toward Class III, with an edge-to-edge bite. This created an unstable occlusion and the possible need for extractions.
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2/86. Biomechanical considerations in distraction of the osteotomized dentomaxillary complex.

    The completely osteotomized dentomaxillary complex is essentially a free body constrained only by its soft tissue attachments. Therefore the line of action and point of application of any protractive force(s) used during distraction osteogenesis must be considered relative to its center of mass. This is in contrast to the nonsurgically separated dentomaxillary complex, which is a constrained body, and therefore the application of protractive force(s) must be considered relative to its center of resistance. These two centers are not coincident. With knowledge of the location of the center of mass, predictable protraction of the dentomaxillary complex can be achieved. In this study, the center of mass of an adult maxillary specimen osteotomized to emulate a Le Fort I osteotomy was determined. Protractive force(s) through the center of mass will produce linear advancement along its line of action. Protractive movement of the dentomaxillary complex can be adjusted downward and forward or upward and forward by locating the protractive force(s) line of action superior or inferior to the center of mass. A cleft patient is described wherein the surgically separated dentomaxillary complex is protracted downward and forward with a force vector superior to its approximate center of mass. This results in a predictable increase in overbite and overjet with negligible mandibular rotation.
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3/86. An unusual treatment with sagittal split osteotomy: report of a case involving an odontoma.

    Sagittal split osteotomy is one of the most commonly performed surgical techniques in the world and has been modified by many authors. The efficacy of this operation has been studied by many groups. When performing this surgery, there should be adequate contact of wide, cancellous bone surfaces, which guarantees excellent and rapid bony union in the desired position. In the present article, treatment of mandibular prognathism with open bite by sagittal split osteotomy with an odontoma in the third molar area is presented.
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4/86. Nonsurgical and nonextraction treatment of skeletal Class III open bite: its long-term stability.

    Two female patients, aged 14 years 5 months and 17 years 3 months with skeletal Class III open bite and temporomandibular dysfunction are presented. They had previously been classified as orthognathic surgical cases, involving first premolar removal. The primary treatment objective was to eliminate those skeletal and neuromuscular factors that were dominant in establishing their malocclusions. These included abnormal behavior of the tongue with short labial and lingual frenula, bilateral imbalance of chewing muscles, a partially blocked nasopharyngeal airway causing extrusion of the molars, with rotation of the mandible and narrowing of the maxillary arch. Resultant occlusal interference caused the mandible to shift to one side, which in turn produced the abnormal occlusal plane and curve of Spee. As a result, the form and function of the joints were adversely affected by the structural and functional asymmetry. These cases were treated by expanding the maxillary arch, which brought the maxilla downward and forward. The mandible moved downward and backward, with a slight increase in anterior facial height. Intruding and uprighting the posterior teeth, combined with a maxillary protraction, reconstructed the occlusal plane. A favorable perioral environment was created with widened tongue space in order to produce an adequate airway. myofunctional therapy after lingual and labial frenectomy was assisted by vigorous gum chewing during and after treatment, together with a tooth positioner. Normal nasal breathing was achieved.
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5/86. A comparison of autotransplantation and orthodontics in a case exhibiting two ectopic upper cuspids.

    Bilateral severely ectopic maxillary cuspids were treated differently on each side. On one side the ectopic cuspid was moved into position orthodontically, and on the other, the ectopic cuspid was positioned by autotransplantation. The orthodontic positioning took a long time and the tooth exhibited root resorption. Treatment time for the autotransplantation positioning was far quicker, and there was no resorption nor were there any other side effects.
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6/86. Long-term changes in dentoskeletal pattern in a case with beckwith-wiedemann syndrome following tongue reduction and orthodontic treatment.

    Long-term changes in the dentoskeletal pattern in a 6-year-old Japanese girl with beckwith-wiedemann syndrome were demonstrated. The patient showed macroglossia, which is the most common symptom of the syndrome, protruded lower lip, mandibular protrusion and anterior open bite. The jaw base relationship improved to skeletal Class I and the molar relationship to Angle Class I at the early preadolescent period following tongue reduction and phase I orthodontic treatment using a chin cap and tongue crib. Optimum intercuspation of teeth was achieved after edgewise treatment without orthognathic surgery, and a skeletal Class I apical base relationship and good facial profile were maintained after the retention period of 2 years. This case report suggests that early orthodontic treatment with tongue reduction can be effective in a case with beckwith-wiedemann syndrome to improve an abnormal dentoskeletal pattern.
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7/86. Evaluation of the modified maxillary protractor applied to Class III malocclusion with retruded maxilla in early mixed dentition.

    The purpose of this study was to evaluate the effects of orthodontic treatment with a maxillary protraction bow appliance on anterior crossbite patients with Class III malocclusion in the mixed dentition. The 29 patients treated with a maxillary protraction bow appliance (11 boys, 18 girls) were compared with 25 matched, untreated controls with anterior crossbite (10 boys, 15 girls). The mean age before treatment was 8 years 7 months (range, 6 years 3 months to 11 years 6 months). The mean treatment period to achieve a normal overjet was 10.2 months (range, 5 to 18 months). Fifty-nine cephalometric angular and linear parameters were compared between the treated group and the untreated controls using the analysis of variance and the paired t test to evaluate the effect of gender and the maxillary protraction bow appliance treatment. Skeletal and dentoalveolar advancement of the maxilla and retrusion of the mandible contributed significantly to the improvement of Class III malocclusion in the treated group. These results suggest that a maxillary protraction bow appliance is effective for correcting anterior crossbite with a retruded maxilla in the early mixed dentition.
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8/86. Dental changes and space gained as a result of early treatment of pseudo-Class III malocclusion.

    This study was designed to investigate the dental changes and the space gained following early treatment of pseudo-Class III malocclusion, using a simple fixed appliance. Twenty-one consecutively treated patients who had a pseudo-Class III malocclusion comprised the treated group. Fifteen untreated control subjects were used as matched controls for the three-year follow-up after completion of treatment. Lateral cephalograms and study models were analysed for the treated, the control and the follow-up group. The arithmetic mean and standard deviation were calculated for each variable, and paired t-tests were performed to assess the effects of treatment on the treated group. The Mann-Whitney test was performed to evaluate the difference between the follow-up group and the control group. Anterior crossbites and mandibular displacements were eliminated after the treatment. On average, the space gained as a result of the treatment was 4.7 mm in the upper arch (p < 0.001 degree). Comparison of the space available as a result of early treatment with the space required for alignment of posterior segments in the upper arch of the untreated control group indicated that there was enough space for the eruption of the canines and premolars as a result of early treatment; whereas, lack of space was evident in the untreated controls. In conclusion, a pseudo-Class III malocclusion, proclination of the upper incisors and/or retroclination of the lower incisors contributed to the correction of anterior crossbite and the elimination of mandibular displacement. Proclination of the upper incisors, utilisation of leeway space, and arch-width increase provided the space required for eruption of the premolars and canines.
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9/86. Non-extraction treatment of a thirteen-year-old boy with a Class III skeletal discrepancy and severe crowding in both the upper and lower dentitions.

    A thirteen-year-old boy presented with a Class III skeletal tendency in association with severe crowding in both the upper and lower arches. Whilst there was not a frank posterior crossbite, it was felt that the upper arch was narrow and that the lower arch was similarly constricted. Taking this into account along with the fact that his upper lip was flat and the nasolabial angle obtuse, it was decided to pursue a non-extraction treatment, with the aim of providing by expansion an extra 16 mm of space in the upper arch and 8 mm in the lower arch to accommodate the full dentition, and with a view to extracting third molar teeth later. This proved to be successful, albeit over an extended period of time, with active treatment taking nearly three and a half years. A realistic alternative would have been to remove four bicuspid teeth and pursue an orthodontic/surgical approach to treatment. In retrospect, and with the benefit of reviewing his records without surgical intervention, the treatment plan decided upon has been well justified.
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10/86. Orthodontic and orthognathic surgical correction of a Class III open bite: a case report.

    A significant Class III skeletal discrepancy with open bite and excessive lower facial height is presented. The malocclusion was treated with a combination of orthodontics and orthognathic surgery.
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