Gd Singh

The aim of this study is to test the null hypothesis that changes in soft tissue facial profile in children who undergo orthodontic treatment, using either an extraction or non-extraction technique, do not differ. Longitudinal, retrospective. San Juan, PR and Aberdeen, UK. Fifty-eight consecutively treated children using fixed appliances with a mean age of 13.2 (+/- 2.1) years. Extraction of the upper and lower, first or second premolars. The mean pre- and post-treatment, extraction and non-extraction configurations were compared using finite-element scaling analysis (FESA), incorporating a thin-plate spline interpolation. Post-treatment the two groups differed statistically in the premaxillary region (p < 0.05) with the non-extraction group being relatively larger in that region by 25%. For the non-extraction group after treatment, localized increases in relative size in the naso-maxillary region size of 25% (p < 0.01) were present. For the extraction group after treatment, a non-significant reduction in relative size of 15% was localized in the putative bicuspid area. Soft tissue facial differences in non-extraction and extraction cases prior to treatment may be accentuated following orthodontic treatments that elect non-extraction or extraction protocols. Robust diagnosis and treatment planning, incorporating the judicious use of extractions if appropriate, may yield optimal orthodontic outcomes.

Objective: To evaluate three-dimensional changes in nasal morphology in patients with unilateral cleft lip and palate treated with presurgical nasoalveolar molding (NAM) to correct naso-labio-alveolar deformity. Design: This was a prospective, longitudinal study. Digital stereophotogrammetry was used to capture three-dimensional facial images, and x, y, and z coordinates of 28 nasal landmarks were digitized. Sample: Ten patients with unilateral cleft lip and palate. Main Outcome Measures: Nasal form changes between T1 (age: 28 ± 2 days, pre-NAM) and T2 (age: 140 ± 2 days, post-NAM), using conventional measurements and finite-element scaling analysis. Results: Overall nasal changes were statistically different (p < .01), but no linear or curvilinear changes were found. Specifically, relative size increases were found on the noncleft side, involving the upper nose (30%), alar depth (20%), alar dome (30%), columella height (30%), and lateral wall of the nostril (17%). On the cleft side, the following showed a size increase: upper nose (8%), alar dome (5%), columella height (30%), and lateral wall of the nostril (30%). The cleft-side alar curvature, however, showed a large decrease in size (80%), but no changes on the noncleft side were found. Corresponding shape changes and angular changes were also found. Conclusions: Using NAM, bilateral nasal symmetry in patients with unilateral cleft lip and palate was improved before surgical repair. Furthermore, slight overcorrection of the alar dome on the cleft side using pressure exerted by the nasal stent is indicated to maintain the NAM result.

The purpose of this study is to determine soft tissue facial changes in adults with mild Class I or Class II malocclusions, treated with a removable orthodontic appliance (Homeoblock '). Standardized intra-oral and frontal facial photographs of 25 adults were scanned and x, y coordinates of 16 maxillary arch and nine facial landmarks were digitized. Mean maxillary arch and facial configurations were subjected to finite-element analysis (FEA). Results showed that the mean pre- and post-treatment maxillary and facial configurations differed statistically (p < 0.05). Specifically, the maxillary arch showed a 30% relative size increase in the mid-palatal region with shape changes consistent with improved dental alignment and maxillary expansion in the transverse direction. For facial changes, a 10% size increase was localized in the nasomaxillary region, and the intercanthal angle changed from -4.6(0) to +4.2(0) (p < 0.05). It is concluded that dental and facial changes associated with the Homeoblock' removable orthodontic appliance are consistent with a broader smile and a more symmetrical facial appearance in non-growing adults.

Objective: To demonstrate craniofacial developmental patterns in repaired cleft lip and cleft palate (CLP). Design: Retrospective, longitudinal. Setting: Center for Craniofacial Disorders, San Juan, Puerto Rico. Sample: Males aged 9 to 17 years: 13 noncleft (NC) Class I occlusion (NCC1); 13 NC Class III malocclusion (NCC3); 12 CLP Class I occlusion (CLPC1); and 15 CLP Class III malocclusion (CLPC3). Main Outcome Measures: Form changes (ages 10, 13, and 16 years), using finite-element scaling analysis. Results: NCC1, 10 to 13 interval: 30% size increase in upper midface (p < .05), mental region (p < .01), mandibular body (p < .05); 13 to 16 interval: 10% to 35% size increase in bimaxillary region and ramus (p < .01). NCC3, 10 to 13 interval: 10% to 40% size increase in posterior cranial base, upper midface, and mandible (p < .05); 13 to 16 interval: 10% to 30% size increase in bimaxillary region (p < .01), especially ramus. CLPC1, 10 to 13 interval: 10% to 15% size increase in posterior cranial base (p < .01), midface (p < .05), and mandibular ramus (p < .05); 13 to 16 interval: 8% to 20% size increase in upper midface (p < .01), lower midface (p < .05), and mandible (p < .05). CLPC3, 10 to 13 interval: no significant changes; 13 to 16 interval: upper midface and cranial base show nonsignificant size decreases, but ramus showed size increase. Conclusions: Noncleft and CLP Class 1 occlusion groups show similar craniofacial growth patterns. Noncleft Class III groups show excessive cranial and mandibular growth. Class III malocclusion in CLP patients is associated with clinically deficient craniomaxillary growth. Growth guidance may be indicated in children with CLP with unfavorable craniofacial growth patterns.

Authors – Singh GD, Thind BS Objectives – To test the hypothesis that there are no gender differences in the outcomes of patients with class II malocclusion treated with the headgear‐activator Teusc...

To assess changes in bimaxillary morphology in patients with Class II division I malocclusion treated using Twin Block appliances (TBA), pre- and posttreatment lateral cephalographs of 100 patients seven to 16 years of age were compared. The patients were divided into four groups: (1) prepubertal boys (mean treatment time; 13.6+/-4.0 months), (2) adolescent boys (20.1+/-7.7 months), (3) prepubertal girls (12.3+/-1.4 months), and (4) adolescent girls (22.3+/-6.7 months). Five landmarks were digitized on pre- and posttreatment cephalographs for all groups, and the resulting configurations were analyzed using linear analysis, Euclidean Distance Matrix Analysis (WinEDMA), and Thin Plate Spline (TPS) analysis. Results of linear analysis indicated anteroposterior midfacial distances generally increased in all groups. In contrast, WinEDMA indicated that midfacial distances proportionately decreased in all groups treated with TBA. Graphical analysis with TPS showed anteroposterior compression of the configurations, most marked in the region of Prosthion. The affine components of the configurations following the TBA treatment indicated little deformation, but the nonaffine components demonstrated posterior displacement of Prosthion. Thus, improvements in facial balance following TBA treatment are associated with a relative restriction of anterior displacement within the midfacial complex as well as maxillary dento-alveolar effects. Orthodontic treatment methods exerting growth-inhibitory effects within the maxilla may be useful in the correction of Class II division I malocclusions.