ORAL PRESENTATION

ORAL PRESENTATION

 

The role of the orthodontist in the treatment of cleft lip and palate and cleft research
Gunvor Semb

The orthodontic specialist responsible for the care of children with cleft lip and palate must have an appreciation of the overall burden of care that children with clefts endure. The nature of dental development in repaired clefts is such that there may be temptations to intervene at almost any point between birth and end of the teens. Consequently clear choices must be made and orthodontic treatment that does not significantly contribute to the end result should be eliminated from the programme of care.

The orthodontist will aim to provide a dentition that functions well and is capable of lifetime maintenance by routine oral hygiene and dental care. The anterior maxillary dentition should align symmetrically around the facial midline. However, without osteotomy, it must be appreciated that the underlying skeletal morphology that reflects intrinsic variation and the consequences of surgery severely restricts occlusal change.

Thus orthodontic treatment for children with clefts should: 

• achieve an optimal occlusion and dentofacial aesthetics within the constraints imposed by the underlying skeletal pattern
• keep the duration of treatment to a minimum
• accomplish as much as possible during periods of active treatment
• be sympathetic to individual needs and circumstances

In many countries children from poorer backgrounds would not commonly receive orthodontics. When affected by clefts, however, such children may become orthodontic patients. Their need for special assistance in maintaining good oral hygiene and additional support for completing lengthy complex treatment must be recognised.

The orthodontists will with other members of the multidisciplinary team monitor the patient’s general well-being particularly during the years of greater involvement e.g. 7-16 years.

A centralised service for cleft lip and palate has existed in Oslo since the 1950’s and the orthodontic protocols employed there evolved gradually, taking advantage of advances in appliance systems and the introduction of alveolar bone grafting. Long-term follow-up of cases from infancy to adulthood suggest that reliable outcomes can be achieved with simplified orthodontic protocols that minimise the burden of care for the child and family.

The orthodontist also has a central role in quality assurance in cleft care and in setting the team’s research agenda. The lecture will illustrate clinical care and research. 

International Collaboration on the Treatment and Prevention of Craniofacial Anomalies Research
The orthodontist also has a central role in quality assurance in cleft care and in setting the team’s research agenda. The lecture will illustrate clinical care and research. 

International Collaboration on the Treatment and Prevention of Craniofacial Anomalies Research
Bill Shaw

Craniofacial anomalies (CFA) are a diverse group of complex craniofacial anomalies. Together they affect a significant proportion of the people around the world, yet research to increase the understanding of the causes of CFA, improve treatment, and lead to prevention, has lacked an international strategy.

An early result of international cooperation was the finding that English cleft surgery performed in the 1970’s was less successful than surgery in Scandinavia. This ‘Eurocleft’ project eventually led to EU and World Health Organisation recommendations on minimum standards of care.

Following this, the EUROCRAN Project, funded by the EU, has been building research capability across Europe. It consists of a series of projects involving large populations of affected individuals, carried out by a growing critical mass of clinical and basic science researchers. These preliminary projects include:

• three randomised control trials of primary surgery for UCLP;

• the promotion of international standards of treatment and documentation via the Eurocleft Clinical Network;

• the creation of a multifunctional web site that will include interactive appraisal of clinical standards;

• a multicentre critical appraisal of distraction osteogenesis with consecutive pre-and post treatment case registration;

• a multicentre case-parent triad study of genetic and environmental factors associated with cleft lip and/or palate;

• a chromosomal approach to identifying genes associated with cleft lip and/or palate;

 The development of molecular diagnostic techniques for monogenic craniofacial anomalies such as Treacher Collins Syndrome 

The Treatment of Patients with Clefts
Irena Klímová

The treatment of patients with orofacial clefts is provided by the specialists from various medical fields. They must coordinate their procedures so that contradictory effects and excessive burden on the patient is avoided. That is why the treatment of cleft patients should be centralized into cleft centers. Cleft team should consist of a plastic surgeon, an orthodontist, a speech pathologist, a psychologist, a pediatrician and a geneticist. In optimal conditions it should also have additional specialists such as ENT, maxillofacial surgeon, prosthodontist etc. Every cleft team has its own treatment protocol with specific sequence and timing of the treatment procedures which succeed and complement each other. Despite significant differences in treatment protocols among different cleft centers they can all produce satisfactory results. It appears that the quality of treatment depends primarily on the experience and skill of the professionals. That is why the area assigned to a particular cleft center should be big enough to provide at least 50 new patients per year for each member of the cleft team. The treatment protocol should not be altered very frequently so that the long time effect of specific treatment procedures can be observed and sufficient amounts of data for the statistical evaluation can be collected.
The treatment protocol of the cleft center in Bratislava will be presented. Complexity of the current situation as a result of the recent health care and financial coverage reform will also be discussed.

 

Orthodontic – surgical treatment of the severe post cleft deformities of the positions teeth and jaws
Kozák J., Müllerová Ž., Hubáček M., Lonská J.

Across systematic orthodontic treatment and good cooperation of the patient and his family the part of the cleft lip patients has anomal development of the jaws. The next orthodontic treatment is sometimes unsuccessful. Pseudomandibular prognathism originates very often from severe hypoplastic maxilla by no growth retardation of the mandible. Experienced orthodontist has to decide aboud next orthodontic treatment in this case and in indicated cases should recommend surgical treatment with concecutive orthodontic treatment. In some cleft – lip pacients in chilhood it is possible to achieve at least near anatomical position of the upper jaw using method of the distraction of the upper jaw. Next growth ot the upper jaw is supported by the pressure of the growing mandible. We solve significant colaps of the upper jaw performing horizontal osteotomy of the upper jaw and transversal distraction of the maxilla. In pacients with bilateral cleft we sometimes find severe protrusion and caudal shift of the premaxilla. This situation we solve by operation procedure which includes osteotomy and cranial shift of the premaxilla, its fixation and osteoplasty of the alveolar defects. Adjustment of the premaxilla is indicated especialy from psychological reasons. The authors present their results of the operation procedures and sometimes underline the fact, that definitive evaluation is possible only after long time distance and underline necessity of the postoperative orthodontic treatment. 

 

3D Morphology of the Palate in Patients with Orofacial Clefts
Šmahel, Z., Trefný, P., Mullerová, Ž., Peterka M.

The palate size and shape in patients with orofacial clefts were three-dimensionally analysed at the stage of permanent dentition with the use of Fourier transform profilometry (FTP). The series studied comprised randomly selected dental casts of 30 boys with unilateral complete cleft lip and palate (UCLPc) and 29 boys with isolated cleft palate (CP), while 28 dental casts of normal boys were used as controls. All patients were operated on in Prague, using the same method. The palate in patients was narrower, in UCLPc more anteriorly than posteriorly, in CP more posteriorly than anteriorly. The height of the palate was lower, in UCLPc from the very beginning, in CP from the level of the first premolars In comparison with controls the difference increased, moving in a posterior direction, reaching up to 25% in CP and 30% in UCLPc. The area of the transversal sections of the palate was reduced by up to 35% in CP and 45% in UCLPs. This confirmed the substantially reduced space for the tongue with clinical consequences. The palate vault in CP was on average symmetrical, in UCLPs asymmetrical " highest anteriorly on the cleft side and posteriorly on the non-cleft side. The reduction of the palatal height did not depend on the width of the dentoalveolar arch, and the palate was shorter only in CP.

 

Complex Treatment of Facial Clefts. Results of 20 years of interdisciplinary co-operation.
Šimeček V., Bařinka L., Novotný P.

Specialists with different branches participate on the treatment of patients with facial clefts. the time and intensity of their intrventions vary:

1. primary operation - plastic surgeon
   lip suture at 3 months of age, palate suture at 10 - 15 months of age, always without preoperative orthopedics.

2. speech therapy - phoniatrist, speech therapeutist
   phoniatric check-ups from palate suture. Any intervention inside the mouth are discussed with a phoniatrist, velopharyngeal fixation are carried out only exceptrionally and always upon phoniatrist's recommendation.

3. orthodontic treatment - orthodontist
   treatment of temporary teeth is rare, intensive treatment begins upon the eruption of permanent incisors. The priority is to remove growth obstructions; the position of the tooth on the alveolar process is corrected secondary.

4. secondary operation - plastic surgeon
   at age 10 - 12 years, after full eruption upper permanent incisors. Closure of oronasal communications, excision of the mucousa foulds, implantation bone grafts.

5. prosthetics consultation - stomatological- prosthetic specialist
   first examination by prosthetic specialist at age 12 - 14 years. Preliminary plan of prosthetic treatment suggested and/or proposal of orthognatic surgery with a definition of a corresponding plan of continued orthodontic treatment.

6. orthognatic surgery - gnatic surgeon
   after respective orthodontic preparation, operation on jaws. Orthodontic after-treatment and retention.

7. artificial denture - stomatological-prosthetic specialist after age 18, replacement of the missing teeth, correction of the crown shape on malformed teeth.

8. corrective aesthetic operations - plastic surgeon
   after full stomatological treatment, correction of the surgery scars, of the upper lip, correction of the labium vermilion border, corrective nose surgery.

In order to ensure miltidisciplinary care it would be optimal to concentrate it on one academie site. The establishment of a cleft-oriented centre fully equipped for the activities of external specialists is currently limited by the financial possibilities. More viable could be the requirement to establish and organisational centre which would be able to plan and coordinate such treatment. Such a centre was succesfully established in the Clicic of Plastic Surgery, Medical Faculty Masaryk University in Brno in years 1978 - 1992. A part of the patients who received such treatment are still being monitored,with the monitoring period exceeding 25 years in the oldest patients.

 

Class III : From easy to tough
Differential Diagnosis leads to the choice of treatment modalities: the orthodontic, the orthopedic or the combined surgical solution
Prof. Dr. J. P. Joho

1. Class III problems in deciduous and early mixed dentition: from single anterior crossbite to complete crossbite of the incisor segment or up to complete circular cross bite will be discussed through case presentations.

2. Special importance will be given to the Class III patients just before or during puberty: what are the limits to try a non-surgical approach and are there criteria leading to the decision: we don’t even try but we will wait until puberty is over. How long do we have to wait after puberty in order to be safe? Are there special situations where two surgical interventions should be planned: during and after puberty?

3. The really grown-up adult Class III patient where it is of great importance to take in account the vertical dimension as well as the therapeutic effect of maxillary advancement versus mandibular set-back, single jaw surgery versus bimaxillary surgery. The importance of dental and surgical set-ups, of profile-prediction during the planning phase will be stressed in order to define more clearly the importance of pre-surgical Orthodontics. Only long-term results can help us to improve our treatment planning and may-be give us some answers to what we did wrong in the past and what therefore should be changed in the future.

 

The Class III Patient
Williams S.

In this overview lecture the subject of the Class III patient will be looked at from every aspect. The aetiology of the anomaly must be related to the growth environment and as such is related to various types of tissue concerned with the growth of the dento-facial skeleton. Which factors can lead to the development of the malocclusion, are there various types and how can they be catagorised, what is the differential diagnosis?. In this presentation a differential diagnosis will be presented an illustrated by a number of cases.

While originally the Class III malocclusion was thought to be related to over-development of the mandible, a study of children with a developing Class III malocclusion showed how important the role of the maxilla is in these cases and made us consider new methods of treatment.

Early treatment has been suggested as a way of normalising the facial pattern and thereby creating an optimal situation for further growth. Early treatment usually involves restriction of mandibular growth or protraction of the maxillary structures. What do we know about the effect of these orthopedic treatments, how succesful and reliable are they and in particular their long term effects should be considered.

The treatment of class III patients usually involves expansion of the maxilla and the results of a new CT scanning study on maxillary expansion will also be presented.

Late treatment of the ClassIII anomaly will often involve surgery and the principles of the surgical 

treatment will be described in a number of cases. What is the motivation for such treatment, do the patients report pain or dysfunction as an indication for treatment, or is the esthetic aspect of major importance. Again the results of a new questionaire study will be presented. 

The general aim of the presentation is to give an all round overview of the state of the art of this interesting and challenging occlusal anomaly

 

Orthosurgical treatment of Class III skeletal and dental deformities
Ivanov I. H., Foltán R.

Aim: To demonstrate the effect of orthodontic-surgical treatment in patients with severe dental and skeletal Class III malformation.

Subjects and methods: Case presentation - patient one: 18 years old male – treatment for 2 years and 7 months. Patient two: 30 years old female - treated for 1 year 11 months. Surgical correction was done in both patients bimaxillary in general anesthesia - Le Fort I osteotomy with advancement and distal impaction of maxilla. Bilateral sagital split osteotomy in the lower jaw with set back. For fixatio we used rigid internal fixation and elastic intermaxillar fixation was applied for six weeks. For retention, a monoblock appliance with “van der Linden” type of vestibular wire and fixed wire retainer in the lower jaw from 33 to 43 were used.

Results: Following was achieved: 1. A regular form of upper and lower jaw arches, straightening of the occlusal plane. 2. Class I relationship in both canine and first molar area with satisfactory occlusion and intercuspation. 3. An outstanding improvement of patients appearance – en face, in profile and smile. 4. Higher self-confidence of patients and satisfaction with a new image. 5. Excellent stability. 

Conclusion: Successful orthodontic treatment of severe Class III dentofacial malformations depends on the correct choice of treatment plan and on good orthodontic-surgical cooperation.

 

Osseointegrated Implants as an Adjunct to facemask Therapy
Mahony D. 

Facemask therapy is an effective modality for the early correction of a Class III malocclusion where maxillary retrusion or hypoplasia is a component. The aim of facemask therapy is to displace the maxillary complex anteriorly by the application of force from an external face frame to the circummaxillary sutures via the dentition. The necessity to use teeth as anchorage results in stimulation of the periodontal membrane and dissipation of the protraction force transmitted to the circummaxillary sutures. The application of force to purposefully ankylosed deciduous canines has also been suggested as a method of direct transmission of force to the circummaxillary sutures. This technique in conjunction with facemask therapy has been shown to be clinically viable, however, the anchor teeth inevitably resorb as their permanent successors erupt. This limits the time available for treatment and restricts the facemask option to a younger age group. Osseointegrated implants are an alternative method of obtaining attachment of a traction force directly to the maxilla. Implants have been demonstrated to be biologically compatible and to provide absolute anchorage when subjected to orthodontic forces in both animal models and human case reports.

 

Stable Orthodontic Anchorage with Palatal Osseointegrated Implants
Hans Peter Bantleon MD, DDS, PhD

Implants are widely used for single tooth replacement. In contrast to permanent implants smaller temporary implants are placed in the hard palate for anchorage control. These temporary implants are useful in critical anchorage situations. The possibility to distalize, mesialize teeth, or increase the palatal width will be discussed clinically as well as the use of onplants and bicortically palced screws which solve the problem of difficult anchorage situations.

 

Orthodontic and implantological treatment of alveolar ridge cleft
Strecha J., Preisler J., Mračna J.

The final goal in clefts anomalies treatment process is the functional and esthetical rehabilitation of teeth as considered in adults. This process deals with the bite and loss of lateral maxillary incisor replacement, which is the most frequent case in these anomalies. 
The result depends on previous plastic - surgical and orthodontic treatment, where its indications and course set the conditions of functional and esthetic final correction of the tooth arches. 
From the surgical view the problem frequently deals with the treatment of bone loss in alveolar ridge in the area of maxillary lateral incisors. The surgical treatment od these defects is substantially complicated by the quality of soft tissues after multiple surgical interventions and defects in the nutrition of these tissues. While the result of such surgical methods of bone defects reconstruction is dependent on good nutrition of tissues and accurate indication of the operating method, the plastic surgery of surrounding soft tissues is very important.
The research and development of augmentation materials, barrier membranes and operation techniques played an important role in the progress of this part of oral surgery.
We treated an 18 year old female patient with the diagnosis of labio-gnato-palatoschisis. The cleft was located in the lip, alveolar ridge, nasal area to the primary palate. Our patient underwent an operation of lip and palate reconstruction in first phase (in 13 years of age), it was a closure of oronasal communication with bone graft implantation of nasal cavity bottom. In 17 years of age, she was operated in the left nasal area. After this procedure she underwent an orthodontic bite reconstruction with the creation of space for the replacement of the left lateral maxillary incisor (tooth 22).
We were then asked by the orthodontist to consider the replacement of tooth 22 with an implant. 
This report is directed at the operation technique and procedure in the treatment of this situation.

 

The Use of Dental Implants in the Orthodontic Surgical Reconstruction of Clefts Defects
Koťová M., Urban F., Dušková M.

Lip and Palate clefts are considered to be one of the most common congenital anomalies.
Their incidence in the Czech Republic is between 1,8 and 2 on each 1000 born children.
Isolated defects aren’t lethal. However they represent a severe morphological, functional and aesthetic handicap. The final reconstruction of the upper's jaw oro-nasal defect is the result of years of interdisciplinary co-operation. The complex treatment of cleft anomalies is based upon surgical correction of both the lip's and palate soft tissues and the reconstruction of the alveolar bone. The orthodontic treatment, on the other hand, focuses on the correction of the affected jaw's dental arch morphology, as well as the intermaxillar relationship.
The dentition defect in the cleft line can be treated, not only by means of fixed bridge, but also by performing the alveolar's ridge osteoplastic surgery with subsequent insertion of a dental implant. This alternative eliminates large irreversible loss of hard dental tissues during prosthodontic preparation and stabilizes the alveolar's ridge osteoplastic reconstruction.

 

Anchorage implants – extravagancy in orthodontics or its future?
Marek I., Starosta M.

Major cooperation between orthodontists and implantologists is focused on treatment of missing upper lateral incisors, second premolars or a loss in frontal segment of maxila due to injury. Anyway, there are clinical situation when one field needs the other one. Implantologists need orthodontists for bone creation by tooth movement for the following implantation and orthodontists can use implant as anchorage element. To insure an absolute anchorage is every orthodontist´s dream and an this connection of bone – implant makes it possible.
The authors present a list various types of anchorage implants, their possible usage and show two types of anchorage implants in clinical case reports, screw titanium miniimplant and palatal enoseal implant. Anchorage implants are excellent aid for patients with critical anchorage and patients with periodontal desease. It enables us to manage situations which are orthodotically insolveable. Mainly concerning local intrusion overerupted upper and lower molars. 

 

Dental rehabilitation, implantology and orthodontic treatment
Mazur Z. 

From the patient´s point of view he or she is not interested in the treatment method such as of we make the crown or bridge, place the implant or orthodontic appliance. The patient preferes adequate rehabilitation of a malocclusion or of the loss of teeth which will satisfy him/her both functionally and esthetically with long-term prognosis. He percives the surgery phase of implantology as an unpleasant but important step to the permanent crown or bridge.

If the absence of the tooth occurs during the orthodontic treatment or is predictable because of hypodontia, tooth impaction, etc., the orthodontist has to make the decision whether to close the space or to open it and prepare it for the subsequent rehabilitation. In the case of the space opening an orthodontist should coordinate the treatment plan with a dentist who can explain to the patient or to his parents possibilities of the subsequent prosthetic treatment wheather it is with or without utilizing the dental implants, and also with regard to the price of the rehabilitation. The patient´s decision about the type of the subsequent rehabilitation influences the orthodontic treatment strategy.

Dentists, who are well-experienced in implantology, can offer much more to the orthodontic treatment. The implants utilized in orthodontic therapy can improve the course of recovery using total anchorage based on their osseointegration. The success of the dental implant therapy has changed the contemporary dentistry because the loss of the tooth can be solved immediately with the help of implants. Therefore, we can expect, that utilizing dental implants in the orthodontic therapy will bring many positive changes in the near future.

 

Lékařská etika a implantologie
Nemeth T., Racek J. 

Lékařská etika souhrnně značuje etické problémy v medicíně a to jak ve vztahu lékař-lékař, tak ve vztahu lékař-pacient.
Práce implantologa i ortodontisty musí mít hluboce morální princip, protože mu nabízíme nadstandartní výkon, za který musí pacient zaplatiti ne vždy zanedbatelnou sumu.
V rámci vyšetření musíme získat jeho důvěru, vyslechnout je, zjistit, co si vlastně přeje a v této době se pokusit odhadnout typ pacienta. Zda bude s ním možná spolupráce a zda požaduje od nás něco, co mu nemůžeme splnit, anebo jen za cenu operace, operací a to někdy i s možností nejistého výsledku.
Chyby a z nich plynoucí etická pochybení vychází většinou z toho, že pacientům se nevěnuje dostatek pozornosti, že se nevyhodnotí stav chrupu,
alveolu nebo přítomné anatomické zvláštnosti apod.
Otázkami etiky se začíná čím dál více zabývat denní tisk. Píše se v něm, že doba, kdy pacient bude brán jako partner, nebo klient je ještě pro mnohé lékaře hodně vzdálena.
Většina zdravotníků jak s pacienty cítí a nelze je házet do jednoho pytle.
Vše je v lidských vztazích. Přejeme nám všem, abychom neměli a nemuseli řešit etické problémy, protože jejich řešení je nepříjemné, zdlouhavé a nepřináší prospěch ani jedné z účastnických stran.

 

Genetics in stomatology –new knowlege
Švábová M.

Human genome- the sequency of units completing DNA is known. Many problems concerning development of oral facial region were solved. We have known many genes
responsible for anomalies and diseases of oral facial region eg. hypodontia, clefts,dentinogenesis imperfecta or amelogenesis imperfekta. This information will changed
our health care for craniofacial komplex in future.

 

The solution to anodontia by permanent implant after orthotherapy
Liberda L.

The absence of single permanent teeth caused by anodontia, a developmental abnormality, is not an easy problem for an orthodontist to solve. High incidence of anodontia in the frontal segment and the necessity of treatment early in the patient’s life only add to the significance of this problem. Non-standard number of teeth in the arch and the subsequent abnormalities in the alignment of teeth also bring with them intermaxillar complications. For that reason most cases are primarily referred to orthodontic treatment. Individual methods, even while devising other disciplines, especially prosthetics, have not previously been able to bring about a reliable result. Given the development of implantology in the recent years, however, even this particular problem has seen a new, very effective solution – the use of implant as a substitute for the missing teeth. In order to obtain a perfect result, almost identical with the natural original, these cases need to be treated in close co-operation of both aforementioned specialists; the orthodontist prepares the appropriate space for the implant, while the final realization is the task of the implantologist. Issues arising from the co-operation, description of diagnostic procedures and the actual topics are all subjects of this presentation.
 

 

Estetical implantation due to agenesis of upper lateral incisors
Starosta M., Marek I.

The upper lateral incisors are the most frequent congenitally missing teeth and solution of its absence is possible by insertion of implants. But insertion of implant in this region has some importatnt roles because of aesthetic interest. The implantologist have to know the influence of tissue growth, the architecture of hard and soft tissue around implants and appropriate implant system which are suitable for achieving a good, long term aesthetic result. The main roles of aesthetic implantation will be discused during this lecture,

 

The criterions of the puting of the dental implants by the hypodontiae
Prachár P., Černochová P., Dospíšilová I., Kuklová M., Mišurcová H.

The hypodontia = reduction, incomplet development of teeth.
The authors divide the hypodontiae to the gainable h. and the hereditary h. The treatmets of the hypodontiae of dental implants have got their criterions, which the authors develop.
They show the possibilities and the boundaries of usány of implants. The criterions they divide to eight groups. the firsth there is the orthodontic anamnesis with the examination and the interdisciplinary co-operation. The second coresponds the alveolar bone, its volume. The third there is the mesiodistal dimension of the alveolár bone. The fourth there is the seting of neighbouring teeth, their apices. The fifth there is the esthetic. The sixth there is the probable seting of implants. The seventh there is the insiding of the implant, and the age. The eighth there is the colour of prosthetic works, the lapse of time after the usány of the fixed orthodontic treatment.
The whole lecture is directed from the view of the implantology and the interdisciplinary co-operation. 

 

Stability After Mandibular Advancement
Petr J., Rybínová K., Foltán R.

Aim of Study:
To investigate the stability of mandibular surgery following bilateral sagittal split osteotomy and mandibular advancement.
Material and Methods:
The subject of this study is a group of 20 patients who have undergone the surgical correction
of class II malocclusion at the Departement of Maxillofacial Surgery of the Stomatological Clinic Prague.
All the patients have undergone orthodontic decompensation by fixed appliance used in both lower and upper jaws in advance.
The surgical technique was bilateral sagittal split ramus osteotomy (BSSO) of mandible in Hunsuck-Epker´s modification using the rigid internal fixation (RIF) combined with intermaxillary elastics for 6 weeks.
Orthodontic finishing of the treatment was performed by fixed appliance up to 6 months. After removal of fixed appliance started the activator retention phase. 
Measurement was always done at three profile cephalometric radiographs taken after the decompensation preoperatively, just after surgery and finally at least 6 months after removal of fixed appliance. All measures were taken twice and the error of the method was stated. Statistical dates were evaluated. The results were described and discuss imput to the clinic practice.

25.9. 3:15 pm 

Treatment of temporomandibular joint ankylosis 
Kulewicz M.

Introduction: 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. Condylar damage during childhood can produce ankylosis and alternation of the mandibular growth.
Aim: The aim of this paper is to present our clinical experience in using external distraction devices for reconstruction of temporomandibular joint. 
Subject: 10 patients, aged 2 to 14 years with temporomandibular joint ankylosis, mount opening 1,5-4,5 mm were treated in our center by distraction osteogenesis. Radiographic analysis, including orthopantomography, lateral and posteroanterior cephalometry ,and computed tomography was carried out. We performed simultaneous release of the joint and reconstruction of the condyle with distraction and bone transportation. A reverse-L osteotomy was performed on the mandibular ramus and a extraoral Molina distractor was fixed on the osteotomised fragment and the mandibular ramus. The osteotomized ramus fragment was activated after a latency of five days at a rate of 1-mm per day until satisfactory results were obtained.. Distractor was kept in place for 3 approximately 4 months after completion of distraction and then removed under local anesthesia.
Results: The average duration of distraction was 18 days. Excellent results were achieved both clinically and radiologically with minimal relapse. We achieve good occlusal relation revealed normalization of most cephalometric values. Mean preoperative and postoperative sixth-month interincisor opening values were 4,5 and 30.6 mm, respectively.
Conclusion: Osseus mandibular distraction together with arthroplasty offer an excellent new alternative for treatment of patients with mandibular hypoplasia and associated ankylosis, with minimal morbidity and complications.

25.9. 3:30 pm 

Interceptive Orthodontics - History or Present?
Šimeček V.

Procedures in which certain forces are prevented from effecting the jaws and teeth, or on the contrary, such forces are excied have been used in orthodontics since its establishment. In membrane therapies, the membrane protects the growing jaw or tooth from the deforming force. By contrast, activators induce forces supporting the poor autogenous activity.
according to the recent viewpoint of cellular biology, genes include not only the program of organism development and growth but also a number of controlling and autocorrective systems. Their use in orthodontic treatment - strart-up at the proper stage of the individual's maturity - leads to the correction of an orthodontic anomaly by means of growth and development of the orofacial system. By using using fine, non-aggessie means, the development type and growth direction are redirected in order to achieve positive and, more importanty, permanent results.

 

Application of the geometrical models for autotransplantion of teeth
Černochová P., Kaňovská K., Kršek P., Krupa P.

Aim: Show the possibility of employing biomodels created using the “rapid prototyping” method for autotransplantion of teeth.
Material and methods: Patients with a planned tooth autotransplantation underwent a CT examination. The data obtained by the computer tomography (CT) were used to create biomodels of teeth intended for autotransplantation in a special computer system. 
Results: The biomodel of a tooth intended for transplantation represents its true-to-size replica. During the autotransplantation itself, the biomodel can replace the transplant especially in the phase of the new alveolus preparation. It is possible to insert the biomodel into the prepared alveolus and try its size. The biomodel inserted in the prepared alveolus will permit to check articulation and the position in respect of the occlusal plane. For the whole time of the new alveolus preparation the donor tooth may stay in its original place.
Conclusions: The use of a biomodel shortens the extraalveoar period of autotransplantation and minimizes the risk of mechanical damage to the tooth autotransplant periodontal ligament. It is to presume that the use of biomodels in autotransplantations will lead to a greater success of this type of procedures.

 

Prosthetic Treatment of Patients with Cleft Defects - Results of 20 - years Continuous Interdisciplinary Cooperation
Šimeček V., Novotný P.

According to the information the authors have described the problems of prosthetic treatment of cleft lip and palate (CLAP) patients. 
The specifities in production of denture for CLAP patients in comparasion with other ones have been referred.The erudition and the experience of dental surgeons and dental technician 
are needed. 
The authors have common experience obtained during their 20 - years cooperation.

POSTER PRESANTION

 

3D spiral CT scan by patient with cleft upper jaw
Effenberková D., Černochová P., Kotová M., Krupa P.

Spiral CT scanning belongs to the most modern radiological techniques. Its big advantage is high resolution mainly off osseous tissue. It is commonly used in many medical fields and recently more frequently also in orthodontics especially in patients with severe orthodontics anomalies – with not clearly arranged anatomical structures of orofacial system. In patients with clefts, CT scanning improves diagnostics and treatment planning. Presented case of 12 years old patient with bilateral cleft of upper jaw, demonstrates the contribution of this method and compares it with standard x-ray scans (panoramic, cephalometric X-rays). Continuous, axial CT scans were made, and on its basis 3D reconstruction of anatomical situation of affected area was created. This, no other way accessible information, gives us perfect overview of dental morphology and amount of bone and its quality in the line of cleft. CT scans were performed on spiral CT - Marconi Mx8000 at the Faculty Hospital St. Anne in Brno. In the presented case is the examination contributing not only to orthodontic tooth movement planning, but also to plan the extend of surgical reconstruction of bone defect and oronasal communication closure.

 
Dental anomalies by cleft patiens
Kleindienstová Z., Šrytr M.

Dental Clinic, 3rd Faculty of Medicine, Charles University, Prague

Our work studies the incidence of numerical dental anomalies in the large sample of patiens suffering with maxillary clefts.

Today’s common understanding is that frequency of facial clefts correlates with the frequency of dental crista failures. This study contributes to this notion by providing the numeric evidence of agenesis and hyperodoncy occurrences among the young pacients affected with cleft palate anomalies.

The sample consists of X-ray documentation of five hundred cleft pacients ( born 1990-1995 ) treated at the Department of Orhodontics and Department of Plastic Surgery, 3rd Faculty of Medicine, Charles University in Praque. The pacients were divided into groups according to the type of cleft defect. Each group has been evaluated separately and the frequency of observed dental anomalies compared among groups.

 
Use of orthodontic miniimplant
Urban F., Kotová M., Hajník O. 

The use of implants as a bone anchors provides a valuable tool for orthodontic therapy.
The anchorage of fixed orthodontic appliances to the bonding base abutment or the use of endosteal palatal implant is well known. For a short time anchorage can be used the temporary transversal miniimplant.
Case of  miniimplant extradental anchorage of orthodonic appliance in the mandible is presented. Required tooth movement was achieved.

 
Orthodontic-surgery treatment of a patient with III. skeletal class
Šimůnková-Vítová L., Foltán R. 

AIM: To present a cooperation of an orthodontist and a maxillofacial surgeon in the solution of III. skeletal class of an adult patient
SUBJECTS: The casuistic of the patient J. Z., 20 year-old, orthodontic diagnosis – III. skeletal class, hypoplasia maxillae, hyperplasia mandibulae, laterogenia l.dx., III. Angle´s class in molars and caninnes, hyperodontia of 9+9.
METHODS AND TREATMENT: The duration of the orthodontic pre-treatment – 2 years. The patient was treated with fixed appliance in upper and lower jaw by straight wire technique.The surgery operation was practised bimaxillarly and completed by genioplastic for flattening scoliosis faciei. After the post-operating reconvalescation was closed a minimal gap after the extraction of the tooth 14. The time of post-operating observation was 1 year.
RESULTS AND CONCLUSIONS: After the successful treatment was achieved the more satisfactory functional and anatomic occlusion and correspodingly the positive change of the face aesthetics. In the case of adult patients with III. skeletal class severe defects it is possible to use the complex orthodontic-surgical therapy.

 
Case report – Treatment of a reversed overjet in the mixed dentition, using a fixed appliance
Mišurcová, H., Černochová, P.

Objectives: Presentation of a way of treating a reversed overjet in the mixed dentition.
Subject and method: A 9-year old boy with a reversed overjet of all 4 incisors. A fixed orthodontic appliance was used for the treatment.
Discussion: A reversed overjet is a prognathic anomaly, which is characterised by a frontal crossbite of upper incisors (from one up to all four). Etiology of such anomalies can be both dental and skeletal and according to the type, diagnosis, treatment and prognosis differ.
The anomaly originates at the beginning of the mixed dentition so it is possible to recognize it in this early period and start the treatment immediately. If this anomaly lasts over a longer period of time, the growth of the upper jaw can be limited and followed by further problems, such as not enough space for permanent canines. Furthermore this provokes the formation of a characteristic profile – where the lower third of the face dominates and the defect which was originally functional now becomes a morfological defect. During the treatment, it is generally possible to use both removable and fixed orthodontic appliance. Their usage is based on the detailed analysis of a particular case.
Conclusion: This case report shows an early treatment of the reversed overjet of all 4 incisors in the boy´s mixed dentition, using a fixed appliance.

 
Ectopic disturbances of the first permanent molar and the canine in cleft patients
Śmiech-Słomkowska G., Kowalczyk A.

Cleft palate is a pathological state which is strongly connected with dental abnormalities and ectopic disturbances. The prevalence of ectopic eruption is increased in children with cleft palate. The aim of this study was to evaluate the range of ectopic eruption of maxillary first permanent molars and canines. Etiological factors, types of ectopic eruption and prevalence were presented. 
Researches were performed on the representative group of 30 patients, who were treated in Departament of Orthodontics, Medical University of Lodz. Measurements were made on orthopantomograms. Mesial angulation of the maxillary first permanent molar and canine was measured. Ectopic eruption of these teeth is increased in children with cleft and is intensified on the cleft side. Evaluation of path eruption in cleft children is very important in planning of their orthodontic treatment. 

 
Soft tissue profile changes after maxillary distraction
Kulewicz M.

Aim: The purpose of this study was to evaluate the skeletal and soft tissue changes after maxillary advancement with distraction osteogenesis.
Materials and methods: 31 UCLP patients aged 12 to 18 years underwent maxillary advancement with distraction osteogenesis after a high Le Fort I osteotomy. Lateral cephalometric radiographs and facial photographs were obtained preoperatively, 3,6,12 months after distraction. A line 70 below the SN plane was used as the horizontal line, and perpendicular line through Sella was used as the vertical line in an XY coordinate.
Results: The mean preoperative facial concavity was reduced by 20,80 (N’SnPg’). The nasolabial angle increased by 5,50 ;upper lip length was increased by 2,2 mm. Nasal tip was moved forward by 3,3 mm, and upward by 2,1 mm. Maxillary height (Sn to maxillary incisor tip) to mandibulary height (mandibular incisor tip to Me’) ratio was increased by 8,4%. The mean maxillary skeletal advancement ( point A) during surgery was 6,8 mm, and men vertical lengthening was 2,2mm.The mean mandibular skeletal backward movement ( point B) during surgery was –3,8 mm, and mean vertical movement was 4,5 mm.
Conclusion: Distraction osteogenesis is a valuable method for improving the soft tissue profile in cleft lip and palate patients with marked retrusion of the midface. Maxillary distraction improved the soft tissue profile by increasing nasal projection, normalizing the nasolabial angle and making the upper lip more prominent.

 
A cephalometric and dental analysis of treatment outcomes of UCLP patients.
Kulewicz M.

Aim of study: The aim of this study was to compare craniofacial morphology of three different groups of children with complete unilateral cleft lip and palate, treated by means of different surgical protocols at the National Research Institute for Mother and Child, Center of Craniofacial Disorders.
Material and methods: The study group covered 66 children patients (42 boys and 20 girls) with mean of age10 years, and complete unilateral cleft lip and palate. Each of the three
groups comprised of 22 patients. Children underwent one-stage technique surgery performed by a single surgeon at the age of seven months. During the surgical intervention the soft and hard palate as well as the lip underwent correction. The difference between particular groups regarded the hard palate closure. Group I patients had the mucoperiosteal flap elevated on both sides of the cleft. Group II patients had the mucoperiosteal flap elevated on the non-cleft side of the cleft. Group III patients did not undergo mucoperiosteal flap elevation. Craniofacial morphology was diagnosed by means of Steiner cephalometric analysis. The quality of dental arch relationship was measured according to the Goslon Yardstick.
Results: Significant craniofacial morphology differences were identified between groups I, II and III. Group III demonstrated the most favorable morphology. Eighty eight percent of the Centre of Craniofacial Disorders group had excellent to satisfactory dental arch relationship according to the Goslon Yardstick.
Conclusions: This indicates that the technique of hard palate closure has significant influence on craniofacial growth and development.

 
Long term comparison of two surgical methods for UCLP postoperative results
Soós A., Budai M.

The authors report on experiences based on the follow up of 33 patients, 19 boys and 14 girls, operated with cleft palate. Two primary surgical methods of cleft unilateral palate closure have been compared using cephalometric analysis. The anatomical and functional results seemed to be better with the Ganzer-Veau method than the Langenbeck-Axhausen method. The long term results of one-stage closure of UCLP with either the Ganzer-Veau pushback procedure or Langenback-Axhausen tubeflap were evaluated and compared at the average age of 10,5. In Ganzer-Veau group the cranial base was longer, the cranial base angle and the posterior facial height was larger. Ganzer- Veau showed larger sagittal depths of the bony nasopharyngeal airway. Langenback-Axhausen operation seemed to shorten the maxillary arch which resulted in speech deficiency and in many cases there was a need of secondary velopharyngoplastic operation by Sanvenero-Rosselli method. The conclusion of this study shows that the method for the primary palatal repair should be based mainly on speech results. Out of these two methods used in Hungary, the Ganzer-Veau method proved to be more efficient especially in the nasopharyngeal area and shows more improvements in cephalometric dimensions.

 
Influence of low orthodontic forces on the structure of the dental pulp.
Kukletová M., Jedličková O.

Aim
Our previous light and electron microscopic studies have revealed a range of dystrophic changes in the dental pulp following orthodontic treatment with forces between 60-250g, which can result in irreversible damage to the teeth. The aim of the current study was to identify forces which would be biologically favourable and clinically effective. 
Methodology
The authors studied the structure of the dental pulp structure of upper premolars that were treated with orthodontic appliances and later extracted for orthodontic reasons. These teeth in children 11 to 13 years old had been moved buccally by applying forces of 30g to 40g for 12 weeks to 11 months. The effect of 30g forces was studied in 34 teeth in light microscope, in 9 teeth in transmission (TEM) and scanning electron microscope (SEM). The influence of 40g forces was studied in 15 teeth under light microscope and in 5 teeth in TEM and SEM. The teeth were exposed to orthodontic forces for 12 weeks to 11 months. 
Results
Light microscopical studies revealed no substantional changes in the morphology of the dental pulp. Hyperemia was regularly found, Weill cell-free zone was frequently not discernible, while cell rich zone was enlarged. Occasionally the light hyalinization of the dental pulp and vacuolar dystrophy of odontoblasts in in the root canal was observed. TEM and SEM studies confirmed light microscopical observation. No significant tertiary dentine formation was revealed on SEM investigation.
Conclusions
Our study demonstrated that the low forces between 30g-40g had significant clinical effect and caused no serious irreversible changes in the dental pulp structure. No blood stagnation or extensive tertiary dentine formation was recorded. The use of forces in this range can be considered acceptable, biologically favourable and clinically fully effective for the orthodontic treatment of upper premolars.

This study was supported by the grant No. 1090-5 from the Czech Ministry of Health.

 
Kaminek‘s Model Operation in Segmental Orthognathic Surgery in lower jaw
Štefková M., Fritschová E., Kamínek M.

There are two types of orthognathic surgery on the lower jaw in Class III cases:
The Mandible Body Ostectomy and the Sagittal Split Osteotomy of the mandible. The lower jaw moves in dorsal direction during the Sagittal Split Osteotomy, but the cranial movement of lower incisors is necessary to correct the open bite. In those cases the distal part of lower jaw moves in caudal direction. The elongation of ramus is the result and the elongation of the muscular sling can cause the instability. The LeFort downfracture operation is useful to prevent the ramus elongation.

The rectangular block of bone in either the second premolar or the first molar region is removed in mandible body ostectomy. The frontal segment of lower jaw is moved in dorsal and cranial direction to correct the open bite and the frontal crossbite. The model operation is necessary to check the type of operation, to simulate dental, skeletal and profile changes. Achieved changes are marked on X-ray and used for planning the operation.
Model operation is performed on models mounted in articulator or in occludator. The treatment planning is shown on case report.

 
Stomatological Rehabilitation of Severe Facial Cleft
Šimeček V.

Figures illustrating the treatment of a severe total unilateral cleft The patient has been monitored since primary lip suture.The standard orthodontic treatment did not show good results; substantial maxillary hypoplasia caused negative incisal edgeand an anterior open bite.The X-ray imagines demonstrate the pre-and post-operative condition - LeFort I maxillary osteotomy. The last set of photographs features the patient after a prosthetic treatment and a correction of the surgery scars on the upper lip.

 
Ortho - plaque index
Tichá R., Tichý J.

Ortho – plaque index was developed for easy control presence of the plaque on the teeth by patients  with fixed orthodontic appliances. The fixed appliance have high claims on the quality of oral hygiene by patient. Most critical places for accumulation of the plaque are places cervicaly and aproximaly by the orthodontic brackets, „ in the shadow of the bracket“. By measurement of OP index is used disclosing of plaque with indicator and evaluate with system YES – NO (presence or absence of the plaque). OP is qickly  to evaluate during routine visit of the patient and motivate him for improvement oral hygiene.