1/72. Surgical cephalometric prediction tracing for the alteration of the occlusal plane by means of rotation of the maxillomandibular complex.The surgical cephalometric prediction tracing involving the alteration of the occlusal plane differs from the conventional surgical prediction tracing. When conventional surgical prediction is developed, the final occlusal plane is dictated by the occlusal plane of the mandible, with or without autorotation. The mandible (and therefore the mandibular occlusal plane) will rotate around a point at or just posterior to the condyle. This principle is not adhered to in treatment planning requiring rotation of the maxillomandibular complex and consequent alteration of the occlusal plane. The aim of this paper is to present a method for developing a surgical cephalometric prediction tracing involving rotation of the maxillomandibular complex.- - - - - - - - - - ranking = 1keywords = mandible (Clic here for more details about this article) |
2/72. Case report of malocclusion with abnormal head posture and TMJ symptoms.Abnormal cervical muscle function can cause abnormal head posture, adversely affecting the development and morphology of the cervical spine and maxillofacial skeleton, which in turn leads to facial asymmetry and occlusal abnormality. There can be morphologic abnormalities of the mandibular fossa, condyle, ramus, and disk accompanying the imbalance of the cervical and masticatory muscles activities. Two normally growing Japanese female patients with Class II Division 1 malocclusion presented with TMJ symptoms and poor head posture as a result of abnormal sternocleidomastoid and trapezius cervical muscle activities. One patient underwent tenotomy of the two heads of the sternocleidomastoid muscle and the other patient did not. In addition to orthodontics, the 2 patients received physiotherapy of the cervical muscles during treatment. Both were treated with a functional appliance as a first step, followed by full multi-bracketed treatment to establish a stable form of occlusion and to improve facial esthetics with no head gear. This interdisciplinary treatment approach resulted in normalization of stomatognathic function, elimination of TMJ symptoms, and improvement of facial esthetics. In the growing patients, the significant response of the fossa, condyle, and ramus on the affected side during and after occlusal correction contributed to the improvement of cervical muscle activity. Based on the result, early occlusal improvement, combined with orthopedic surgery of the neck muscles or physiotherapy to achieve muscular balance of the neck and masticatory muscles, was found to be effective. Two patients illustrate the potential for promoting symmetric formation of the TMJ structures and normal jaw function, with favorable effects on posttreatment growth of the entire maxillofacial skeleton.- - - - - - - - - - ranking = 0.019137559796261keywords = jaw (Clic here for more details about this article) |
3/72. Idiopathic condylar resorption: diagnosis, treatment protocol, and outcomes.Idiopathic condylar resorption is a poorly understood progressive disease that affects the TMJ and that can result in malocclusion, facial disfigurement, TMJ dysfunction, and pain. This article presents the diagnostic criteria for idiopathic condylar resorption and a new treatment protocol for management of this pathologic condition. Idiopathic condylar resorption most often occurs in teenage girls but can occur at any age, although rarely over the age of 40 years. These patients have a common facial morphology including: (1) high occlusal and mandibular plane angles, (2) progressively retruding mandible, and (3) Class II occlusion with or without open bite. Imaging usually demonstrates small resorbing condyles and TMJ articular disk dislocations. A specific treatment protocol has been developed to treat this condition that includes: (1) removal of hyperplastic synovial and bilaminar tissue; (2) disk repositioning and ligament repair; and (3) indicated orthognathic surgery to correct the functional and esthetic facial deformity. patients with this condition respond well to the treatment protocol presented herein with elimination of the disease process. Two cases are presented to demonstrate this treatment protocol and outcomes that can be achieved. Idiopathic condylar resorption is a progressive disease that can be eliminated with the appropriate treatment protocol.- - - - - - - - - - ranking = 0.5keywords = mandible (Clic here for more details about this article) |
4/72. Condylar resorption 2 years following active orthodontic treatment: a case report.We recently treated a patient with degenerative disease of the temporomandibular joint. A healthy, 12-year-old female with bilateral high maxillary canines presented for orthodontic treatment. Two years after active orthodontic treatment, at age 17, symptoms in her temporomandibular joint manifested and progressed. By the time she revisited our hospital at age 21, the patient had developed an anterior open bite with a long, slender facial appearance. Cephalometric analysis showed shortening of the ramus and backward and downward rotation of the mandible. Imaging studies revealed severe deformity and resorption of the bilateral condyles. Her occlusal and morphologic changes seemed to be caused by degenerative disease of the temporomandibular joint.- - - - - - - - - - ranking = 0.5keywords = mandible (Clic here for more details about this article) |
5/72. Treatment of a Class II Division 1 malocclusion with a severe unilateral lingual crossbite with combined orthodontic/orthognathic surgery.A 24-year-old woman had a Class II Division 1 malocclusion with a severe unilateral crossbite. The crossbite was due partially to the maxilla being much wider than the mandible, allowing the mandibular left canine and first and second premolars to overerupt, impinging on the palatal tissue in habitual occlusion. The maxillary left segment from the lateral incisor to the first molar also overerupted producing 2 planes of occlusion. The malocclusion was treated successfully with comprehensive orthodontics, combined with a 2 piece Lefort I osteotomy procedure, a 3 tooth mandibular segmental osteotomy procedure, and a bilateral sagittal split osteotomy procedure.- - - - - - - - - - ranking = 0.5keywords = mandible (Clic here for more details about this article) |
6/72. The integration of functional and fixed appliance treatment.This article describes a functional appliance system to correct Class II problems, which is clipped on to bands, cemented to the teeth. This appliance has several advantages, as the patient cannot remove it. It acts on the teeth and jaws for 24 hours each day, patient co-operation is not a problem, and as a result the treatment time is short. Any fixed appliance system can be added while the functional phase is being completed so allowing full integration of the two treatment systems.- - - - - - - - - - ranking = 0.019137559796261keywords = jaw (Clic here for more details about this article) |
7/72. Early treatment of angle Class II, division 2 in combination with functional therapy of TMJ fracture.Children who have sustained condylar fractures are treated with functional appliances because surgical repositioning of the condyle is more resource-intensive without producing better results. In cases with additional malocclusions it is practicable to combine the functional therapy of the fracture with skeletal Class II therapy. A 10-year-old boy suffering from a left condylar fracture and showing Class II, Division 2 malocclusion was treated with a skeletal functional appliance in combination with a utility arch for uprighting of the incisors. A modified transpalatal bar was then used to retain the incisor position. The remodeling process of the mandibular condyle following its fracture with dislocation signifies a high adaptability of the affected tissues. This reaction can be used simultaneously for effective sagittal repositioning of the mandible in certain cases of Class II malocclusion.- - - - - - - - - - ranking = 0.5keywords = mandible (Clic here for more details about this article) |
8/72. A relatively minor adult case becomes significantly complex: A lesson in humility.A 41-year-old white woman with no particular concerns about facial esthetics was first seen with bilateral Class II molar relationship, a Class I right canine, and a Class II left canine. Overjet was 3 mm and overbite was 0.5 mm, with no incisor contact. A maxillary right premolar was missing for unknown reasons and all 4 third molars had previously been extracted. The maxillary midline was 2 mm to the right of the facial midline, and the mandibular midline was 3.5 mm to the left of the maxillary midline. There was 7 mm of crowding in the maxillary arch and 6 mm of crowding in the mandibular arch, with an increased curve of Spee. The patient had a well-positioned maxilla, a retrognathic mandible with increased convexity, a Class II denture base relationship, and a vertical facial pattern. The treatment plan consisted of extracting the maxillary left first premolar and the mandibular left central incisor. After 4 months of treatment, an open bite from second premolar to second premolar was noted. After 6 months of treatment, the patient expressed concern with her chin position and mentalis hyperactivity. It was apparent that the orthodontic treatment had resulted in molar extrusion, which the musculature was not able to withstand. Treatment continued and the case was set up for posterior maxillary impaction and mandibular advancement surgical procedures.- - - - - - - - - - ranking = 0.5keywords = mandible (Clic here for more details about this article) |
9/72. mandibular advancement using an intra-oral osteogenic distraction technique: a report of three clinical cases.Osteogenic distraction has been used for decades to lengthen limbs and now attention is focused upon its use within the craniofacial skeleton. This paper addresses distraction of the mandible. It is proposed that mandibular osteogenic distraction could be a possible adjunct to the orthodontic treatment of those adult patients with skeletal anomalies, who would benefit from combined orthodontic/orthognathic treatment. Three consecutive cases from one unit are presented, where adult patients with severe Class II division 1 malocclusions have undergone orthodontic treatment combined with mandibular osteogenic distraction, instead of conventional bilateral sagittal split osteotomies.- - - - - - - - - - ranking = 0.5keywords = mandible (Clic here for more details about this article) |
10/72. Combined surgical therapy of temporomandibular joint ankylosis and secondary deformity using intraoral distraction.temporomandibular joint (TMJ) ankylosis is a pathological process caused by damage of the mandibular condyle. When this event takes place in subjects during the developmental age, it results in an alteration of the entire maxillofacial complex. Therefore, surgical methods able to remove the temporomandibular ankylosis also include necessary operations to correct the secondary maxillofacial deformity. The distraction osteogenesis has induced our center to modify the surgical protocol for the therapy of patients who have developed TMJ ankylosis and secondary maxillomandibular deformity. We have treated four patients with monolateral ankylosis of the TMJ and serious deformities of the maxillomandibular complex secondary to functional limitation. During the same operation, arthroplasty was performed with the removal of the ankylotic block and the interposition of a temporal muscle flap in the new articular space; an intraoral osteodistractor was also positioned to lengthen the mandible. All patients showed recovery of the eurhythmy of the face and good re-establishment of the symmetry. An average 12-month follow-up showed the average opening of the mouth to be at least 35 mm. The combination of TMJ arthroplasty and intraoral osteodistraction provides good functional and aesthetic results in patients affected by ankylosis who have developed secondary maxillofacial deformities.- - - - - - - - - - ranking = 0.5keywords = mandible (Clic here for more details about this article) |
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