ISSN : 0376-4672
This study investigated the positional changes of maxillary and mandibular incisors during growth and the difference of positional changes accord ing to the three superimposition methods. Lateral cephalographs including 10 subjects(7 males and 3 females) between 7-14 years old were used, which had been taken at University of California in San Francisco and kept at University of the Pacific. Four lateral cephalographs were selected based on chronologic age and development of dental occlusion. After tracing of cephalographs, superimposition was performed in three methods; based on cranial base, maxilla or mandible, and implants of maxilla and mandible. The repeated measure analysis of variance (ANOVA) and ANOVA with post-hoc analysis were performed. With growth, both maxillary and mandibular incisors showed changes in the anterior and downward directions, and the amount of positional changes was different according to the superimposition methods. As a result of comparing the changes of the upper and lower incisors according to three superimposition methods, the horizontal change of the upper incisor showed statistically significant differences between the three superim position methods in all three periods. The change of the lower incisor showed a statistically significant difference only in the T3-T4 period, and no statistically significant difference in the other periods. In growing children, superimposition based on the facial bone shows that growth of the facial bones including the maxilla and mandible is con tained together. This suggests that growth needs to be considered even when evaluating orthodontic treatment.
Pediatric sleep disordered breathing (SDB) includes snoring and obstructive sleep apnea (OSA) in growing children. Because diagnostic criteria and subjective symptoms of OSA in children differ from those in adults, different diagnostic and therapeutic approach is necessary. Based on the differential growth of craniofacial struc ture and upper airway soft tissues, phenotype-based, timely-target intervention is needed to interrupt abnormal craniofacial growth inducing or aggravating SDB symptoms and ultimately to prevent the progression to adult hood OSA. Although adenotonsillar hypertrophy is known to be first-line treatment in pediatric OSA patients, craniofacial growth modification treatment needs to be primarily considered for the patients with craniofacial skeletal phenotypic cause. Growth modification treatment can be categorized into four modalities depending on the craniofacial target related to the upper airway collapsibility: 1) Unlocking the mandibular growth for skeletal Class II patients with retruded small mandible; 2) Nasomaxillary protraction for skeletal Class III pa tients with deficient midface; 3) Nasomaxillary expansion for the patients with transverse discrepancy and nasal obstruction; 4) Control of vertical maxillary excess in patients with long face and structural mouth breathing.
Patients having obstructive sleep apnea frequently present malocclusion such as maxillary constriction, pos terior crossbite, and long face. Maxillary expansion has been addressed to correct the malocclusion and to improve obstructive sleep apnea. In growing patients, rapid palatal expander (RPE) can separate the midpalatal suture and expand the maxilla, which results in increase of volume in the nasal cavity and nasopharynx as well as increase of the cross-sectional area. In non-growing patients, miniscrew-assisted rapid palatal expander can be used for the same effect. Maxillary expansion can be used for correction of obstructive sleep apnea in case of maxillary constriction.
How reliable is the assessment of snoring apps in the medical field? Although research on this has been continuously reported, the authors would like to introduce points that dentists as sleep experts understand the functions and limitations of snoring apps and use them as screening tests for sleep diseases. We would also like to explore the latest treatments using ICT technology to increase patient compliance with oral devices to treat sleep disorders.
