interceptive orthodontics and temporomandibular joint...

EditorialInterceptive Orthodontics and Temporomandibular JointAdaptations: Such Evidences?

Simona Tecco,1 Alberto Baldini,2 Enita Nakaš,3 and Jasmina Primozic4

1Dental School, University Vita-Salute San Raffaele, Milan, Italy2University Tor Vergata, Rome, Italy3School of Dental Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina4University Clinical Centre of Ljubljana, Ljubljana, Slovenia

Correspondence should be addressed to Simona Tecco; [email protected]

Received 10 April 2017; Accepted 11 April 2017; Published 26 April 2017

Copyright © 2017 Simona Tecco et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The research of the anatomy of the temporomandibular joint(TMJ) and its development during the growing period is farbeyond the classical approach. TMJ area has been thought tobe a reactive growth site, which makes it more interesting forresearch. During the period of mixed dentition, TMJ area isaffected by a considerable amount of growth and adaptation,which can alter the jaws relationships. Also, a variable adapta-tion can occur during an interceptive functional orthodontictreatment. Nowadays, TMJ studies comprise various fieldsof medicine, starting from clinical investigations, up to thein vitro models, which are useful in studies of the anatomyand disorders of the two jaws. This is the reason why wehave gathered researches that are closely related to TMJ.The leitmotif of the special issue is the anatomy of the jawsand their adaptions during the growth and development ofindividuals and the interceptive orthodontic treatments.

G. Perinetti and L. Contardo, on the basis of a literaturereview, explain the current evidence and controversies onthe efficiency of interceptive orthodontics and conclude thatmore favorable response is seen when subjects are treatedduring their pubertal growth spurt, mostly in skeletal ClassII patients (even though high individual responsivenessremains). They also clarify that no growth indicatormay be con-sidered to have a full diagnostic reliability to assess the puber-tal growth spurt of a patient. Nevertheless, their use maystill be recommended for increasing efficiency of interceptiveorthodontics, in particular for skeletal Class II malocclusion.

Another paper by G. Perinetti et al. is more specif-ically dealing with a growth indicator of the timing of

circumpubertal skeletal maturation (circumpubertal cervicalvertebral maturation, CVM) to assess its relationship withthe sagittal and vertical mandibular development. This is across-sectional study aimed at evaluating whether sagittaland vertical craniofacial growth has an association with thetiming of circumpubertal skeletal maturation. A total of 320subjects (160 females and 160 males) are included in thestudy (mean age, 12.3 ± 1.7 years; range, 7.6–16.7 years).These subjects were equally distributed in the circumpubertalcervical vertebral maturation (CVM) stages 2 to 5. Significantassociations were seen only for Stage 3, where themandibularto cranial base angle (i.e., the mandibular divergence withcranial base) results negatively when associated with age (𝛽coefficient, −0.7), suggesting that the mandibular divergence(linked to TMJ development) may have an anticipated anddelayed attainment of the pubertal CVM Stage 3.The clinicalconclusion is that this association remains of a small entity,and it becomes clinically relevant only in extreme cases.

M. C. Sobral de Aguiar et al. present a review of stud-ies performed to evaluate whether the gingival crevicularfluid (GCF) biomarkers in growing subjects reflect boththe stages of individual skeletal maturation and the localtissue remodeling triggered by orthodontic force. Howeverthe conclusion is that, in spite of several investigations, theclinical applicability of the GCF method is still limited tofurther data needed to reach a full diagnostic utility of specificGCF biomarkers in interceptive orthodontics.

T. Lauc et al. investigated whether skeletal pattern ofthe growth can influence dental development and found

HindawiBioMed Research InternationalVolume 2017, Article ID 8953572, 2 pageshttps://doi.org/10.1155/2017/8953572

https://doi.org/10.1155/2017/8953572

2 BioMed Research International

that males with Class III skeletal pattern have faster dentaldevelopment. Research results suggest that diversity of theskeletal pattern could be connected with the different timingof dental development.

J. Badrov et al. have found that changes in the develop-ment of permanent teeth during growth can occur in childrenwith the congenitallymissing permanent teeth (CMPT).Theyalso reported that the dental age is significantly delayed inCMPT children compared to the nonaffected group; themean differences are−0.57± 1.20 years and−0.61 ± 1.23 yearsin males and females, without difference between sexes.

A. H. Al-Ani et al. also declared that the tooth agen-esis, especially in its severe forms, is often associated withvarious anomalies in other teeth, such as delays in devel-opment, ectopic eruption, reduction in tooth dimensionsandmorphology, shortened roots, taurodontism, and enamelhypoplasia. Also, the authors explained that the hypodontiapatients tend to show with lower mandibular plane angles,associated with a smaller lower anterior face height andlip protrusion. Other features associated with hypodontiainclude shortermaxillary andmandibular lengths and a ClassIII skeletal relationship tendency.

In reference to interceptive functional orthodontic treat-ment, the following two papers are dealing with the efficacyof functional appliances in growing subjects.

A study of the comparison between the Activator-Head-gear (AH) and the Twin Block (TB) treatments approachesin Class II division 1 malocclusion has been conducted byS. Spalj et al. Their results suggest that both AH and TBappliances contribute successfully to the correction of ClassII division 1 malocclusion when compared to the untreatedsubjects with primarily dentoalveolar changes. The authorsexplained that the correction of malocclusion is made by ret-roclination ofmaxillary incisors andproclination ofmandibu-lar incisors, the latter being significantly more evident inthe TB group, and with the increase of effective mandibularlength that was also more evident in the TB group.

Another clinical study to appraise the factors affectingthe wearing time and patient’s behavior during a functionaltreatment with a newly designed reverse pull headgear ispresented by N. Ozkalayci and O. Cicek. They found thatpatients wore the new reverse pull headgears mostly duringthe night, due to problems related to aesthetic appearance,and during the weekends.

Two interesting papers are dealing with the study of themorphology of TMJ on 3D-imaging.

Cone-Beam Computerized Tomography (CBCT) repre-sents widely used diagnostic image system, and it is based on3D visualization. The study by S. Caruso et al. analyzed therecent literature about TMJ visualization on CBCT imaging.Sources included PubMed from June 2008 to June 2016.Eleven articles were finally included in the qualitative syn-thesis. The main topics treated in the studies are the volumeand surface of the mandibular condyle, the bone changes onthe cortical surface, the morphological asymmetry betweenthe two condyles, and the optimumposition of the condyle inthe glenoid fossa. In particular, the conclusion of this review isthat CBCT 3D imaging allows the calculation of volume andsurface of themandibular condyle, the calculation of its linear

dimensions (height and length), and the measurement of theintra-articular space to clarify the position of the condyle inthe glenoid fossa.

S. Mummolo et al. presented data about the 3D TeleMotion Tracking (3D-TMT), as a useful tool for facial anal-ysis. A group of 40 patients (20 males and 20 females; meanage, 12–18 years)was included in the study.Themeasurementsobtained by the 3D-TMT and by a traditional 2D radiologicalanalysis were compared for each subject.The 3D-TMT systemvalues resulted slightly higher, statistically significant, thanthe values obtained on radiographs; nevertheless, their corre-lation resulted very high, and the Dahlberg errors resulted inbeing always lower than the mean difference between the 2Dand 3D measurements. The authors suggest that a clinicianshould always use, during the clinical monitoring of a patient,the same method (2D or 3D), to avoid comparing differentmillimeter magnitudes in the dimensions of a face.

Overall, studies show that the maxillary and mandibulararea are affected by significant morphological changes duringthe period of the circumpubertal spurt and, therefore, canundergo a significant remodeling during that time, alsoin response to orthodontic interceptive devices. Althoughthere are several methods in the literature useful to predictthe coming of the circumpubertal spurt, none of them isinfallible, and future studies are needed to clarify this point.Also, the dental age is influenced by several variables, suchas the agenesis of the permanent elements. The clinicalmonitoring of facial changes during the interceptive therapyseems possible using 3D imaging techniques, such as CBCTimages, and also through noninvasive methods for the studyof facial structures (as, e.g., the 3D Tele Motion Tracking).

All presented papers share the same interest related tothe anatomy of stomatognathic system during the growthdevelopment.

All of the above presented papers along with the latesttechnologies have contributed to advancing knowledge ofanatomical structures and their changes during growth andinterceptive orthodontics treatment. Their role in the patho-genesis of diseases and disorders of different origin is goingto be, even partially, clarified.

Simona TeccoAlberto Baldini

Enita NakasJasmina Primozic

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