Dentofacial and Occlusal Asymmetries E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Comprehensive and accessible resource that covers all crucial aspects of dentofacial and occlusal asymmetries
Dentofacial and Occlusal Asymmetries covers all crucial aspects of asymmetries encountered in the stomatognathic region regarding diagnosis, treatment planning, management, and prognosis. Divided into three core sections, the first part focuses on the etiology of asymmetry and whether it is congenital or acquired through disease or trauma. The second and third sections go on to discuss localization and management, providing information on topics such as interception, correction, and camouflage. Specific sample topics covered in the book include:
- Treatment approaches: interceptive, tooth movements, goal-oriented biomechanics, and jaw repositioning
- Treatment principles: dentofacial orthopedics, camouflage, and orthodontic-surgical treatment
- Localization and problem list: medical and dental history, clinical examination, dental cast analysis, and radiographic/imaging assessment
- Medical, social and psychological aspects: growth disorders and helping children and their families with facial differences
Written by a team of renowned experts in the field, Dentofacial and Occlusal Asymmetries will serve as an invaluable resource to postgraduates in orthodontic, pediatric dentistry, and oral and maxillofacial surgery programs as well as orthodontists, pediatric dentists, pediatricians, and oral and maxillofacial surgeons aiming for optimal results in the diagnosis and management of these complex malocclusions and dentofacial deformities.
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Veröffentlichungsjahr: 2024
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
List of Contributors
1 Introduction
References
Part I: Etiology
2 The Etiology of Dentofacial and Occlusal Asymmetries – An Overview
Introduction
Congenital
Postnatally
References
3 Congenital
3.1 Distortion/Malformation
Etiology – Definition
Craniosynostosis
Plagiocephaly
Muscular Torticollis
Developmental Dysplasia of the Hip
Scoliosis
Hemifacial Hyperplasia
References
3.2 Syndromes and Rare Diseases with Asymmetry in the Craniofacial and Dental Regions
Syndromes and Rare Diseases
Unilateral Overgrowth of Craniofacial or Dental Structures
Unilateral Underdevelopment of Craniofacial or Dental Structures
References
4 Acquired
4.1 Acquired Dentofacial Deformity and Asymmetry
Introduction
The Temporomandibular Joint (TMJ) and Its Association with Asymmetric Dentofacial Development
Dental Occlusion and Acquired Skeletal and Dental Asymmetries
Acquired Dentofacial and Dental Asymmetries
Autoimmune Conditions
Skeletal Growth Diseases
Conditions with Skeletal Undergrowth
Conditions with Skeletal Overgrowth
Soft‐tissue Conditions
Temporomandibular Joint (TMJ) Conditions
Management of Acquired Dentofacial Deformity and Asymmetry
Conclusion
Acknowledgment
References
Part II: Localization and Problem List
5 Examination of Special Features in Patients with Dentofacial and Occlusal Asymmetries
Introduction
Head Posture
Functional Assessment
Photographic Assessment
Conclusion
References
6 Imaging: Craniofacial Asymmetries
Introduction
Asymmetry
Differential Diagnosis and Decision Tree for a Craniofacial Asymmetry
Imaging for Asymmetry
Analysis
Overall Regional Changes Associated with the Developmental Onset of TMJ Disorders
Common Disorders and Associated Local and Regional Changes
Conclusions
References
7 Cephalometric Radiographic Assessment of Facial Asymmetry
Introduction
Radiographic Methods for Diagnosis of Asymmetry
Concluding Remarks
References
8 EMG and Ultrasonography of Masticatory Muscles
Introduction
Understanding the Functional Profile of the Muscle
Clinical Methods to Record Masticatory Muscles Functional Capacity
Posterior Crossbite with Functional Shift. Effects on Masticatory Muscles?
References
9 Localization and Problem List – 3‐D Face Reconstruction
Introduction
Facial Asymmetry Diagnosis and Complementary Exams for Facial Asymmetry Localization
Image Analysis in CBCT Scans for Skeletal Asymmetry
Head Orientation
Scroll Through All Cross‐Sectional Slices
Assessment of the 3D Rendering Viewing from Different Perspectives
List of Problems in Skeletal Craniofacial Asymmetries Through 3D Assessment
Zygomatic and Maxillary Unilateral Hypertrophy
Sinus and Maxillary Hypoplasia
Unilateral Condylar Hyperplasia
Unilateral Condylar Resorption
Craniofacial Macrosomia
Asymmetry Localization and Quantification
Mirroring and Superimposition
Quantification
Determining the Asymmetry Directions
Final Considerations
Acknowledgments
References
Part III: Management
10 Treatment Approaches
10.1 Very Early Treatment of Dentofacial Asymmetries: Why, When, and How?
Introduction
Etiology
Diagnostic Evaluation
Very Early Treatment for Unilateral Posterior Crossbite with Class I, II, III Malocclusion
What if a Class II Subdivision Develops After Early Crossbite Correction?
What About Stability of Very Early Crossbite Correction?
Summary
References
10.2 Tooth Movement and Goal‐oriented Mechanics in the Treatment of Patients Exhibiting Asymmetry
Introduction
Diagnosis – Problem List
Molar Rotation (First Order)
Molar Tipping (Second Order)
Posterior Crossbite (Third Order)
Early Loss of Mandibular Deciduous Canines
Treatment
Correction of Unilateral Molar Rotation
Current Mechanics Used to Correct a Class II Subdivision Malocclusion
Unilateral Tip‐back Mechanics
Conclusion
References
11 Treatment Principles
11-1 Dentofacial Orthopedics in the Management of Hemifacial Microsomia and Nager Syndrome Cases
Introduction
Case Reports
Discussion
Conclusion
References
11.2 Rational Diagnosis and Treatment of Dental Asymmetries
Introduction
Classification of Dental Asymmetries
Diagnosis of Dental Asymmetries
Management of Posterior Dental Asymmetries
Management of Anterior Dental Asymmetries
Conclusions
Acknowledgment
References
12 Orthodontics, Maxillofacial Surgery, and Asymmetries
12.1 Dental Arch Shape in Relation to Class II Subdivision Malocclusion
Introduction
Dental Arch Form
Case 1
Case 2
Discussion
References
12.2 Asymmetric Application of Lingual Arches
Introduction
Color Code of the Wire and Force System
Shape‐driven Concept
Force‐driven Concept and Definition of Shapes
Unilateral Expansion
Unilateral Tip‐back and Unilateral Tip‐forward
Summary
References
12.3 Skeletal Anchorage for the Correction of the Canted Occlusal Plane
Treatment of the Canted Occlusal Plane
Biomechanics for the Correction of the Canted Occlusal Plane
The Trans‐Palatal Arch (TPA) Plus Hooks
Details of TPA Plus Hooks
The Propeller
The Ulysses and the Anka‐Jorge Plate
Extrusion
Conclusion
References
12.4 Managing the Class II Subdivision Malocclusion with ExtractionCamouflage: Case Reports
Introduction
Case 1
Case 2
Conclusions
References
12.5 The Use of Aligners for Correction of Asymmetries
Introduction
Dental Corrections (Non‐extraction Therapies)
Dental Corrections (Extraction Therapies)
Skeletal Anchorage Therapies
Surgical Intervention
Conclusions
References
12.6 TMJ Conditions Causing Facial Asymmetry: Diagnosis and Treatment
Introduction
Overdevelopment
Unilateral Facial Under‐development
Adolescent Internal Condylar Resorption (AICR)
Reactive Arthritis
Trauma
TMJ Ankylosis
Hemifacial Microsomia (HFM)
Connective Tissue/Autoimmune Diseases (CT/AI)
References
12.7 Distraction Osteogenesis in Maxillofacial Surgery
Introduction
Biological Basis
Staging of Distraction Osteogenesis
Indications for Distraction Osteogenesis
The Distractors and Their Function
Preoperative Patient Evaluation
Surgical Procedure
Postoperative Procedure – Activation of the Device
Complications
Orthodontic Collaboration
Distraction Osteogenesis and/or Conventional Orthognathic Surgery
Conclusion
References
12.8 Maxillo‐mandibular Growth in Hemifacial (or Craniofacial) Microsomia
Introduction – Clinical Appearance
Craniofacial Growth in Hemifacial Microsomia
Long‐term Growth After Distraction Osteogenesis of the Mandible
Long‐term Results After Costochondral Graft in Growing Patients with Hemifacial Microsomia
Clinical and Prognostic Differences in the Orthopedic and Surgical Treatment of Hemimandibular Hypoplasia in Hemifacial Microsomia versus Pseudo‐hemifacial Microsomia (or Condylar Coronoid Collapse Deformity)
References
12.9 Special Treatment Considerations of Face Asymmetries
Introduction
Diagnosis
Categories of Asymmetry
Special Treatment Considerations
References
12.10 The Vertical Component of Asymmetry: Etiology and Treatment
The Three‐dimensional Nature of Asymmetry
Interaction between Maxillary and Mandibular Asymmetries
Unimaxillary Vertical Asymmetry not Affecting the Symmetry of the Other Jaw
Conclusion
References
12.11 Helping Children and Their Families with Facial Differences – Patient Centered Outcomes and Experiences
Introduction
The Face as a Functional Structure and as an Element of Identity
The Facial Difference from the Patient's Perspective
The Facial Difference from the Family Perspective
Psychosocial Support for Children and Families
References
Index
End User License Agreement
List of Tables
Chapter 3-2
Table 3.2.1 Overview of conditions included in the chapter.
Chapter 4-1
Table 4.1.1 Contributing factors with an impact on the development of denta...
Table 4.1.2 Etiological conditions that may cause dentofacial deformity and...
Chapter 9
Table 9.1 Quantification values of positional and regional asymmetry of the...
Chapter 12-4
Table 12.4.1 Pre‐treatment cephalometric values of case 1.
Table 12.4.2 Pre‐ and post‐treatment cephalometric values of case 1.
Table 12.4.3 Pre‐treatment cephalometric values of case 2.
Table 12.4.4 Pre‐ and post‐treatment cephalometric values of case 2.
Chapter 12-10
Table 12.10.1 Vertical differences (mm) between right and left sides at the...
Table 12.10.2 Difference between mandibular corpus lengths in younger and o...
Table 12.10.3 Correlations among measurements of heights at the level of th...
List of Illustrations
Chapter 1
Figure 1.1 Vitruvian Man drawn by Leonardo Da Vinci in 1492 demonstrating th...
Figure 1.2 Three images where the right face is composed of two right sides,...
Chapter 2
Figure 2.1 Asymmetric anterior open bite generated by prolonged thumb suckin...
Figure 2.2 Twelve‐year‐old girl referred for treatment of maxillary space de...
Figure 2.3 (a–c) Radiographs of a patient who days after a trauma detected a...
Figure 2.4 (a–b) Extraoral and intraoral images of a patient that had experi...
Figure 2.5 Result of a straight‐wire treatment with unilateral Class II elas...
Figure 2.6 (a) Plaster model of a patient with a canine with high labial pos...
Figure 2.7 A patient who has been treated with a straight‐wire appliance.
Chapter 3-2
Figure 3.2.1 Boy 9, 3 years of age with congenital infiltrating lipomatosis ...
Figure 3.2.2 A boy, 10.5 years of age with segmental odontodysplasia (SOD). ...
Figure 3.2.3 Clinical photos of a 16‐year‐old girl with Klippel–Weber–Trenau...
Figure 3.2.4 14‐year‐old female with focal dermal hypoplasia (FDH). (a) En f...
Figure 3.2.5 Boy (5 years of age) with incontinentia pigmentia (IP) and with...
Figure 3.2.6 Female with hypohidrotic ectodermal dysplasia (HED), 10 years o...
Figure 3.2.7 Male 18 years old with regional odontodysplasia. (a—d) Clinical...
Figure 3.2.8 Male with agenesis of all mandibular teeth in left side. (a) In...
Chapter 4-1
Figure 4.1.1 Normal and abnormal mandibular growth and development. Interpla...
Figure 4.1.2 From temporomandibular joint (TMJ) arthritis to malocclusion in...
Figure 4.1.3 Autoimmune condition. A 10‐year‐old girl with juvenile idiopath...
Figure 4.1.4 Scleroderma. Patient with facially localized scleroderma and le...
Figure 4.1.5 Hemifacial hyperplasia, (a) asymmetric mandible, longer ramus a...
Figure 4.1.6 Soft‐tissue condition (Tumor). A 17‐year‐old boy diagnosed with...
Figure 4.1.7 Distraction splint treatment of unilateral TMJ involvement in s...
Figure 4.1.8 Surgical distraction osteogenesis. (a) Correction of dentofacia...
Figure 4.1.9 Unilateral surgical distraction osteogenesis (DO). DO: A 17‐yea...
Chapter 5
Figure 5.1 Collection of children, adolescent, and adult patients with face ...
Figure 5.2 (a) Patient with a torticollis where the cervical muscle is contr...
Figure 5.3 Patient with a torticollis with mild face asymmetry as appears in...
Figure 5.4 (a) Patient with Sprengel’s deformity which influences the inclin...
Figure 5.5 (a) Radiograph of the column of a young boy; (b) the scoliosis in...
Figure 5.6 (a) An 8‐year‐old girl with a functional displacement of the mand...
Figure 5.7 Right canine crossbite developed during the mixed dentition as a ...
Figure 5.8 Differential diagnosis in midline discrepancies. Opening and clos...
Figure 5.9 Asymmetry in bicondylar position is correlated with the occlusal ...
Figure 5.10 (a) Adult patient suffering from a forced bite; (b) when opening...
Figure 5.11 Pronounced deviation of the mandible to the left during maximal ...
Figure 5.12 (a) Frontal image of a skull from the 15
th
century. It can be se...
Figure 5.13 A 9‐year‐old girl with hemifacial microsomia and with ear and so...
Figure 5.14 Photos taken at the three planes of space indicated in the corners of the...
Figure 5.15 A 8‐year‐old girl with Goldenhar syndrome with extra‐oral and in...
Figure 5.16 Extra‐oral and intra‐oral photographs of an 11‐year‐old girl wit...
Figure 5.17 A CBCT image of a 17‐year‐old female with face asymmetry due to ...
Chapter 6
Figure 6.1
DDx
. This table illustrates a differential diagnosis and decision...
Figure 6.2
Cartesian co‐ordinates (6 DOF)
: The orientation process all...
Figure 6.3
Asymmetry features
: oriented and rendered CBCT volume of a 14 yea...
Figure 6.4
Progressive condylar resorption
(Alsabban et al. 2018; Dahl Krist...
Figure 6.5
Condylar hypoplasia
: oriented and rendered CBCT volume of a 15‐ye...
Figure 6.6
Hemifacial microsomia
: oriented and rendered CBCT volume of a 7.6...
Figure 6.7
Condylar hyperplasia
: oriented and rendered CBCT volume of an adu...
Figure 6.8
Hemimandibular elongation
: oriented and rendered CBCT images of a...
Figure 6.9
Osteochondroma
: oriented and rendered CBCT images of 31‐year‐old ...
Chapter 7
Figure 7.1 Structures and landmarks of the posteroanterior radiograph. 1, Mo...
Figure 7.2 Angular and linear measurements from the posteroanterior radiogra...
Figure 7.3 Structures and landmarks of submentovertex radiograph. 1, Metalli...
Figure 7.4 Measurements from the submentovertex radiograph. Mandibular coord...
Figure 7.5 Treatment of a Class II subdivision malocclusion with 3‐premolar ...
Figure 7.6 Treatment of a Class II subdivision malocclusion with 1‐premolar ...
Figure 7.7 Treatment of a Class III subdivision malocclusion with 3‐premolar...
Chapter 8
Figure 8.1 Transverse ultrasound scan of the masseter. The wide white shadow...
Chapter 9
Figure 9.1 Schematic illustration of the rotational descriptors known as pit...
Figure 9.2 Facial photographs of a female patient with facial asymmetry. Not...
Figure 9.3 Head position in a coronal view of the scan and in the 3D model i...
Figure 9.4 Illustration of an orientated rendering skull with the Frankfurt ...
Figure 9.5 Axial, coronal, and sagittal slices with vertical red line fixed ...
Figure 9.6 Coronal, axial, and sagittal views in different slices (a–d). Cor...
Figure 9.7 Rendered skull in different views. (a) Frontal view of the skull ...
Figure 9.8 Three‐dimensional model derived from a CBCT full face scan of a p...
Figure 9.9 Patient presenting with sinus and maxillary hypoplasia in the lef...
Figure 9.10 Axial slice of a CBCT scan from a patient with sinus and maxilla...
Figure 9.11 Patient presenting with facial asymmetry caused by left mandibul...
Figure 9.12 A follow‐up of male patient with facial asymmetry. At 12 years o...
Figure 9.13 Planar scintigraphy image of the patient shown in Figure 9.12, p...
Figure 9.14 3D mandibular model of a patient with facial asymmetry and osteo...
Figure 9.15 Patient with facial asymmetry and history of mandibular trauma a...
Figure 9.16 3D craniofacial reconstruction of three young patients with cran...
Figure 9.17 Flowchart for the image analysis steps in asymmetry cases.
Figure 9.18 Original (yellow) and mirrored (white) 3D models. Superimposed m...
Figure 9.19 Original (Or, yellow) and mirrored (Mir, white) 3D models showin...
Figure 9.20 3D models showing the landmarks and reference planes for asymmet...
Chapter 10-1
Figure 10.1.1 Unilateral posterior crossbite on the right with concomitant l...
Figure 10.1.2 (a) and (b) In very young children, a UPC causes only an asymm...
Figure 10.1.3 (a)–(c) In 80% of children in the pure deciduous or early mixe...
Figure 10.1.4 (a) and (b) If the midline deviation upon opening disappears, ...
Figure 10.1.5 (a) and (b) In these patients, a cant of the lower anterior oc...
Figure 10.1.6 (a)–(c) Single tooth crossbite correction with 6 weeks of cris...
Figure 10.1.7 (a)–(e) Lower facial asymmetry due to a UPC on the left with f...
Figure 10.1.8 (a) and (b) One daily activation of the rapid maxillary expand...
Figure 10.1.9 (a)–(d) After 6 months of stabilization, the RPE was removed. ...
Figure 10.1.10 (a)–(d) Ten years later, very early crossbite correction has ...
Figure 10.1.11 (a)–(e) The right UPC causes a chin deviation to the right si...
Figure 10.1.12 (a)–(c) Despite rapid maxillary expansion, the mandible did n...
Figure 10.1.13 (a)–(c) A “box” criss‐cross elastic helps to guide the mandib...
Figure 10.1.14 (a)–(d) Successful early crossbite correction without any nee...
Figure 10.1.15 (a)–(e) Mild Class III traits with left UPC and noticeable lo...
Figure 10.1.16 (a)–(c) Rapid maxillary expansion followed by application of ...
Figure 10.1.17 (a)–(j) Bilateral Class III elastics to counteract the Class ...
Figure 10.1.18 (a)–(f) Anterolateral crossbite on the right side due to a fu...
Figure 10.1.19 (a)–(d) Rapid maxillary expansion for 4 weeks followed by 6 m...
Figure 10.1.20 (a)–(f) No further treatment is necessary. The second deciduo...
Figure 10.1.21 (a)–(e) A 4 1/2‐year‐old girl with UPC on the right in combin...
Figure 10.1.22 (a) and (b) Before and after 6 weeks of rapid maxillary expan...
Figure 10.1.23 (a)–(c) Rapid maxillary expansion with Class II elastic on th...
Figure 10.1.24 (a)–(c) Five months later, the UPC on the right side has been...
Figure 10.1.25 (a) and (b) Note the positive effect of crossbite and Class I...
Figure 10.1.26 (a)–(c) Good overall maintainability of the very early correc...
Figure 10.1.27 (a)–(e) Right UPC combined with a Class II malocclusion a den...
Figure 10.1.28 (a)–(d) Rapid maxillary expansion for 6 months followed by 9 ...
Figure 10.1.29 (a)–(e) The same patient 5 years later. Very early treatment ...
Figure 10.1.30 (a)–(c) At 6 years of age, a UPC on the right side with a low...
Figure 10.1.31 (a)–(c) After rapid maxillary expansion the UPC is corrected ...
Figure 10.1.32 (a)–(d) One year later, a Class II subdivision malocclusion o...
Figure 10.1.33 (a)–(d) Coincident midlines upon opening after a second 8‐mon...
Figure 10.1.34 (a)–(d) Apart from the positive effect on the lower facial as...
Chapter 10-2
Figure 10.2.1 (a) Frontal facial view of patient with hemifacial macrosomia....
Figure 10.2.2 (a) Frontal view of patient with asymmetry due to unilateral m...
Figure 10.2.3 Bite stick in place to demonstrate canting of the occlusal pla...
Figure 10.2.4 (a) Frontal view of patient with asymmetry associated with rig...
Figure 10.2.5 Corrected axis tomogram of left condyle revealing obliteration...
Figure 10.2.6 (a, b) Panoramic radiograph (a) and frontal cephalogram (b) of...
Figure 10.2.7 (a) Frontal view of a patient with a mandibular asymmetry due ...
Figure 10.2.8 (a) Frontal view of a Class II subdivision malocclusion in the...
Figure 10.2.9 (a) An efficient way to assess molar rotation by tracing a lin...
Figure 10.2.10 Assessment of the mesio‐distal axial inclination of the molar...
Figure 10.2.11 Evaluation of the bucco‐lingual axial inclination of the mola...
Figure 10.2.12 (a) Clinical example showing a dental midline discrepancy due...
Figure 10.2.13 Equilibrium diagram generated when a molar is rotated unilate...
Figure 10.2.14 Force system generated in the sagittal plane. As the right mo...
Figure 10.2.15 Force system generated by Class II elastics on a continuous a...
Figure 10.2.16 Frontal view. Unilateral Class II elastic wear creates a cant...
Figure 10.2.17 When unilateral Class II elastic is used with coil springs as...
Figure 10.2.18 Application of an intrusive force unilaterally will result in...
Figure 10.2.19 Jasper Jumper in place for Class II correction. Points of att...
Figure 10.2.20 Force system delivered by the Jasper Jumper. The molar will n...
Figure 10.2.21 Occlusal view of both the maxillary and mandibular dental arc...
Figure 10.2.22 Frontal view of the mandibular arch. The effect of the unilat...
Figure 10.2.23 Shamy appliance with a unilateral tip‐back spring on the righ...
Figure 10.2.24 Pendulum appliance which can be used for unilateral or bilate...
Figure 10.2.25 The desired force system necessary to achieve a unilateral mo...
Figure 10.2.26 Force system generated when a unilateral tip‐back moment is a...
Figure 10.2.27 Schematic representation of a three piece base arch.
Figure 10.2.28 Force system developed when a transpalatal arch with a second...
Figure 10.2.29 (a–c) Pretreatment views of the right and left buccal occlusi...
Chapter 11-1
Figure 11.1.1 (a–d) A 4‐year‐old female patient diagnosed with a hemifacial...
Figure 11.1.2 The principle with the use of a functional appliance with a co...
Figure 11.1.3 The approach applied in the treatment by means of a splint tha...
Figure 11.1.4 (a) The clinical examination revealed a boy with an asymmetric...
Figure 11.1.5 (a) The panoramic radiograph of the male patient with Nager sy...
Figure 11.1.6 (a) The surgical distraction for elongation of the ramus in ad...
Chapter 11-2
Figure 11.2.1 An extra‐oral clinical examination utilizing the interpupillar...
Figure 11.2.2 A clinical examination can be performed by looking from inferi...
Figure 11.2.3 A straight instrument or piece of floss placed in line with th...
Figure 11.2.4 The presence of an occlusal cant assessed by asking the patien...
Figure 11.2.5 Examination of dental midline asymmetry.
Figure 11.2.6 Asymmetry of dental arches evaluation.
Figure 11.2.7 Panoramic radiographic examination.
Figure 11.2.8 Identification of mandibular asymmetry on a lateral cephalomet...
Figure 11.2.9 Frontal cephalometric evaluation.
Figure 11.2.10 3D cephalometric analysis.
Figure 11.2.11 Occlusal asymmetry with mesial‐in rotation of the maxillary f...
Figure 11.2.12 A Class II malocclusion case in which the upper first molars ...
Figure 11.2.13 Tipping of the maxillary first molar is a common problem asso...
Figure 11.2.14 Orthodontic appliances are used to tip back the molar and reg...
Figure 11.2.15 A case in which an upper removable appliance can be used in c...
Figure 11.2.16 Asymmetry management and malocclusion correction.
Figure 11.2.17 The use of unilateral Class II elastics may lead to extrusion...
Figure 11.2.18 A traditional J‐hook or TAD can be used to mitigate this effe...
Figure 11.2.19 A J‐hook headgear is used in addition to a unilateral Class I...
Figure 11.2.20 To avoid Class II elastics use, and prevent proclining the lo...
Figure 11.2.21 Space closure management using closing loops, tiebacks, and d...
Figure 11.2.22 A case in which extractions were performed, and the lower spa...
Figure 11.2.23 Skeletal and dental crossbites can be distinguished based on ...
Figure 11.2.24 Rapid palatal expansion can be utilized to expand and split t...
Figure 11.2.25 A case of maxillary constriction treated using rapid palatal ...
Figure 11.2.26 Dental midline deviations may present in a few ways: (1) only...
Figure 11.2.27 The axial inclination of the anterior teeth may also be a cau...
Figure 11.2.28 The use of extractions and proper bracket positioning to corr...
Figure 11.2.29 Asymmetrical space closure using closing loops is an excellen...
Figure 11.2.30 A patient in which asymmetrical space closure was used to cen...
Figure 11.2.31 Asymmetric mechanics are required to treat asymmetrical probl...
Figure 11.2.32 A case in which TADs were used to correct upper midline devia...
Figure 11.2.33 Asymmetrical use of J‐hooks for malocclusion management, midl...
Figure 11.2.34 Moving each tooth separately, using sequentially activated op...
Figure 11.2.35 A case where asymmetrical rotational control is applied to co...
Figure 11.2.36 The “Yin‐Yang” archwire consists of a curve of Spee on one si...
Figure 11.2.37 A case in which asymmetrical extractions were performed to co...
Chapter 12-1
Figure 12.1.1 Patient presenting with a Class II subdivision malocclusion wi...
Figure 12.1.2 (a–e) Intra‐oral images illustrating the presence of a maxilla...
Figure 12.1.3 Combined tracing of the lateral cephalogram and the occlusogra...
Figure 12.1.4 (a–c) Distal movement of the right upper canine being performe...
Figure 12.1.5 (a–e) The retraction of the maxillary right canine into a Clas...
Figure 12.1.6 (a–e) A step was introduced to a 0.017 × 0.025‐inch stainless ...
Figure 12.1.7 (a–e) Finishing wires in place.
Figure 12.1.8 Smiling photograph illustrating coincidence of the maxillary a...
Figure 12.1.9 (a–e) Treated outcome at 5‐year follow‐up. Class I incisor rel...
Figure 12.1.10 Patient presenting with a Class II subdivision malocclusion w...
Figure 12.1.11 (a–e) Intra‐oral photographs highlighting crowding of the ant...
Figure 12.1.12 (a) As in Case 1, asymmetric extraction of a maxillary first ...
Figure 12.1.13 (a–c) The maxillary left canine was retracted to a Class I po...
Figure 12.1.14 (a–d) Following space closure, both upper and lower arch were...
Figure 12.1.15 (a–d) Power arms extending from the right side were applied t...
Figure 12.1.16 (a–d) The transpalatal arch was asymmetrically activated with...
Figure 12.1.17 (a–d) Regeneration of arch symmetry with Class I canines and ...
Figure 12.1.18 (a–e) Final occlusal outcome with well‐aligned arches, midlin...
Figure 12.1.19 Smiling photograph illustrating midline coincidence and symme...
Chapter 12-2
Figure 12.2.1 Lingual arch designs for unilateral expansion based on shape‐d...
Figure 12.2.2 Various force systems for unilateral expansion. (a) Single for...
Figure 12.2.3 The passive shape of a lingual arch. (a) Occlusal view; (b) fr...
Figure 12.2.4 Simulation of deactivation force system. Passive shape (green ...
Figure 12.2.5 Deactivated shape. (a) Deactivated shape is fabricated exactly...
Figure 12.2.6 Activated shape. (a) Before activation (green color), After ac...
Figure 12.2.7 (a) and (b) A patient with a severely lingually tipped mandibu...
Figure 12.2.8 Various force diagrams. (a) Equal and opposite forces. This is...
Figure 12.2.9 Unilateral tip back and tip forward lingual arch. (a) Passive ...
Figure 12.2.10 (a) Passive shape; (b) deactivated shape; (c) activated shape...
Figure 12.2.11 (a) and (b) A patient with Class I molar relationship on the ...
Chapter 12-3
Figure 12.3.1 Diagrammatic presentation of the envelope of discrepancy in th...
Figure 12.3.2 The deviated directions of maxilla and mandible that affect bo...
Figure 12.3.3 To correct the canted occlusal plane all four quadrants of pos...
Figure 12.3.4 Landmarks of the Grummons frontal cephalometric analysis: Ag, ...
Figure 12.3.5 Un‐face assessment of face asymmetry and evaluation of the can...
Figure 12.3.6 The 3‐D reconstruction and CBCT sections show the deviated nas...
Figure 12.3.7 When the temporal bones are asymmetrical then, as a result, th...
Figure 12.3.8 MRI examination reveals an anterior disc displacement of the r...
Figure 12.3.9 Un‐face facial photograph.
Figure 12.3.10 (a)–(e) The upper second molar lingual cusps caused occlusal ...
Figure 12.3.11 (a)–(c) Intraoral photographs taken during the course of trea...
Figure 12.3.12 Frontal cephalometric radiographs taken before the start (a) ...
Figure 12.3.13 Comparison of the initial occlusal plane with the one after t...
Figure 12.3.14 (a)–(c) Intraoral photographs taken after the treatment.
Figure 12.3.15 The TPA plus hooks with the Benefit plate integrated into the...
Figure 12.3.16 By observing the maxillary wall from the occlusal view, the o...
Figure 12.3.17 The lateral aspect of the radiograph shows that the nasal flo...
Figure 12.3.18 (a) and (b) In the mandible, the intermolar width will increa...
Figure 12.3.19 The TPA plus hooks appliance.
Figure 12.3.20 Configuration of the TPA plus hooks system combined with the ...
Figure 12.3.21 Configuration of the TPA plus hooks system for distalization ...
Figure 12.3.22 The Center of Resistance of the maxilla is different from the...
Figure 12.3.23 (a) and (b) Female patient with canted occlusal plane before ...
Figure 12.3.24 (a)–(f) Pretreatment intraoral photographs show a malocclusio...
Figure 12.3.25 (a) Pretreatment lateral cephalometric radiograph (the black ...
Figure 12.3.26 Pretreatment panoramic radiograph shows the impaction of the ...
Figure 12.3.27 (a) and (b) Views of the biomechanics with upper lingual appl...
Figure 12.3.28 (a) and (b) Lateral right view from a panoramic radiograph an...
Figure 12.3.29 (a) and (b) Intraoral occlusal photographs of the maxilla wit...
Figure 12.3.30 (a) and (b) Pretreatment and posttreatment photographs showin...
Figure 12.3.31 The en‐masse retraction in the mandible was done by engaging ...
Figure 12.3.32 (a)–(d) Posttreatment intraoral photographs.
Figure 12.3.33 Intraoral photograph 2 years after retention.
Figure 12.3.34 (a)–(c) The frontal cephalometric radiographs taken before th...
Figure 12.3.35 The entire Propeller (top) and its components.
Figure 12.3.36 The anterior TAD was placed between the left canine and the l...
Figure 12.3.37 Dental arch form correction by connecting the premolar area o...
Figure 12.3.38 (a)–(c) The horizontal use of the Propeller is shown in the l...
Figure 12.3.39 The vertical use of the Propeller can be utilized on the prem...
Figure 12.3.40 (a)–(f) The case is a male, age 11Y10M, with complaint of upp...
Figure 12.3.41 The bite jumping appliance Forsus has been used to correct th...
Figure 12.3.42 (a) and (b) A TPA with hooks was constructed on the palate to...
Figure 12.3.43 The use of the Propeller after the removal of Forsus is neces...
Figure 12.3.44 (a) and (b) Posttreatment intraoral photographs.
Figure 12.3.45 Superimposition of the lateral cephalometric tracings (black ...
Figure 12.3.46 (a)–(c) The frontal cephalometric radiographs taken before th...
Figure 12.3.47 Extraoral frontal photographs presenting the significantly im...
Figure 12.3.48 (a)–(c) The Ulysses wire when is placed on the mandible.
Figure 12.3.49 The Anka‐Jorge plate.
Figure 12.3.50 The Anka‐Jorge plate placed in the zygomatic buttress for con...
Figure 12.3.51 (a)–(c) Patient has a bruxism habit resulting to a flattening...
Figure 12.3.52 (a) and (b) Intraoral photographs of occlusal views show the ...
Figure 12.3.53 (a)–(d) Extraoral profile and un‐face photographs showing the...
Figure 12.3.54 (a)–(c) The auxiliaries used with the Anka‐Jorge plate are mo...
Figure 12.3.55 (a)–(c) Posttreatment extraoral photographs.
Figure 12.3.56 (a)–(d) Lateral cephalometric tracing superimposition 6 month...
Figure 12.3.57 (a) and (b) For better vertical control a finger spring (elev...
Figure 12.3.58 A single spring (elevator spring) can be used in selected cas...
Figure 12.3.59 (a) and (b) Pretreatment and progress frontal photographs sho...
Figure 12.3.60 (a)–(d) Pretreatment and progress intraoral photographs showi...
Figure 12.3.61 (a) and (b) Pretreatment and progress profile photographs sho...
Figure 12.3.62 (a) and (b) Pretreatment and progress frontal cephalometric t...
Figure 12.3.63 Lingual fixed orthodontic appliance combined with the spring ...
Figure 12.3.64 (a) and (b) Pretreatment and progress un‐face photographs aft...
Figure 12.3.65 (a) and (b) Left and right arms of the TPA are hooked the ele...
Figure 12.3.66 (a) and (b) Pretreatment (yellow color line of occlusal plane...
Figure 12.3.67 Superimposition of pretreatment (black line) and progress aft...
Figure 12.3.68 (a) and (b) Pretreatment and progress after the use of elevat...
Chapter 12-4
Figure 12.4.1 (a–h) Pre‐treatment photographs of case 1. The subdivision rig...
Figure 12.4.2 Pre‐treatment panoramic radiograph.
Figure 12.4.3 Pre‐treatment lateral cephalometric radiograph displaying mild...
Figure 12.4.4 (a–c) Levelling and alignment phase following extractions of t...
Figure 12.4.5 (a–c) Working phase with stainless steel wires and monolateral...
Figure 12.4.6 (a–h) Post‐treatment photographs of case 1 displaying bilatera...
Figure 12.4.7 Post‐treatment panoramic radiograph.
Figure 12.4.8 Post‐treatment lateral cephalometric radiograph.
Figure 12.4.9 (a–f) Post‐retention records displaying stability 2 years post...
Figure 12.4.10 (a–h) Pre‐treatment photographs of case 2. The subdivision ri...
Figure 12.4.11 Pre‐treatment panoramic radiograph. The previous loss of toot...
Figure 12.4.12 Pre‐treatment lateral cephalometric radiograph displaying sev...
Figure 12.4.13 (a–c) Working phase. The three orthodontic miniscrews are ins...
Figure 12.4.14 (a–c) Working phase. The end of the space closure phase (the ...
Figure 12.4.15 (a–c) Finishing phase following miniscrews removal in the max...
Figure 12.4.16 (a–h) Post‐treatment photographs of case 2 displaying a well‐...
Figure 12.4.17 (a, b). Post‐treatment photographs of spontaneous lip compete...
Figure 12.4.18 Post‐treatment panoramic radiograph.
Figure 12.4.19 Post‐treatment lateral cephalometric radiograph.
Chapter 12-5
Figure 12.5.1 (a) Pre‐treatment images of a child in mixed dentition showing...
Figure 12.5.2 (a) Pre‐treatment images of a teenager with a congenitally mis...
Figure 12.5.3 (a) Pre‐treatment images of an adult showing an asymmetrical C...
Figure 12.5.4 (a) Pre‐treatment images of an adult showing an asymmetrical C...
Figure 12.5.5 (a) Pre‐treatment Images of an adult showing a missing #12 con...
Figure 12.5.6 (a) Pre‐treatment images of an adult showing an asymmetrical C...
Figure 12.5.7 (a) Pre‐treatment images of a teenager showing an asymmetrical...
Figure 12.5.8 (a) Pre‐treatment images of an adult showing an asymmetrical C...
Figure 12.5.9 (a) Pre‐treatment images of an adult showing an asymmetrical C...
Figure 12.5.10 (a) Pre‐treatment images of an adult showing an asymmetrical ...
Figure 12.5.11 (a) Pre‐treatment images of an adult showing an asymmetrical ...
Figure 12.5.12 (a) Pre‐treatment images of an adult showing an asymmetrical ...
Figure 12.5.13 (a) Pre‐treatment images of an adult showing an asymmetrical ...
Figure 12.5.14 (a) Pre‐treatment images of an adult showing a Class II denta...
Figure 12.5.15 (a) Pre‐treatment images of an adult showing an asymmetrical ...
Figure 12.5.16 (a) Pre‐treatment images of an adult showing an asymmetrical ...
Chapter 12-6
Figure 12.6.1 Case 1. (a–c) A 14‐year‐old female presents with condylar hype...
Figure 12.6.2 Case 1. (a–c) Presurgery occlusion views showing mandibular de...
Figure 12.6.3 Case 1. (a) Cephalometric analysis shows a Class III skeletal ...
Figure 12.6.4 Case 2. (a, b) An 18‐year‐old female with significant vertical...
Figure 12.6.5 Case 2. (a–c) Presurgery occlusion shows mandibular dental mid...
Figure 12.6.6 Case 2. (a) Presurgical cephalometric analysis shows the extre...
Figure 12.6.7 Case 2. (a) MRI shows the vertical and anteroposterior enlarge...
Figure 12.6.8 Case 3. (a–c) A 16‐year‐old female (TMJ onset at age 12 years)...
Figure 12.6.9 Case 3. (a–c) Presurgery occlusion shows mandibular dental mid...
Figure 12.6.10 Case 3. (a) Cephalometric tracing shows a retruded mandible, ...
Figure 12.6.11 Case 4. (a–c) An 18‐year‐old male sustained a unilateral disp...
Figure 12.6.12 Case 4. (a–c) Presurgery occlusion demonstrates a transverse ...
Figure 12.6.13 Case 4. (a) Presurgical cephalometric analysis demonstrates a...
Figure 12.6.14 Case 5. (a–c) This 14‐year‐old female was born with left‐side...
Figure 12.6.15 Case 5. (a–c) Presurgery occlusion has a transverse cant, lef...
Figure 12.6.16 Case 5. (a) Cephalometric analysis demonstrates the retruded ...
Figure 12.6.17 Case 6. (a–c) A 16‐year‐old female with bilateral TMJ juvenil...
Figure 12.6.18 Case 6. (a–c) The occlusion demonstrates asymmetry with the m...
Figure 12.6.19 Case 6. (a) Cephalometric analysis shows the vertical differe...
Chapter 12-7
Figure 12.7.1 Girl 11 years old with rheumatoid arthritis affecting the righ...
Figure 12.7.2 Boy 5 years old with facial asymmetry due to Goldenhar syndrom...
Figure 12.7.3 Boy 5 years old with mandibular hypoplasia due to severe traum...
Figure 12.7.4 Boy 6 months old with excessive micrognathia due to P. Robin s...
Figure 12.7.5 Boy 13 years old with severe upper micrognathia. (a) Intraoral...
Chapter 12-8
Figure 12.8.1 Patient affected by an HFM with mandibular deformity Type I: t...
Figure 12.8.2 Nontreated female patient affected by HFM type III. Frontal fa...
Figure 12.8.3 Male patient affected by HFM IIb treated with early DO: fronta...
Figure 12.8.4 Nontreated female patient affected by hemifacial microsomia ty...
Figure 12.8.5 Male patient affected by HFM type III treated with early CCG: ...
Figure 12.8.6 Male patient affected by HFM. Frontal photograph of the patien...
Figure 12.8.7 Male patient mislabeled as HFM, treated with unilateral mandib...
Figure 12.8.8 Male patient mislabeled as HFM, treated with an asymmetrical f...
Figure 12.8.9 Female patient correctly diagnosed as CCC deformity treated wi...
Chapter 12-9
Figure 12.9.1 Everything that is oblique is underestimated in the lateral vi...
Figure 12.9.2 The University of Milan cephalometric analysis on CBTC includi...
Figure 12.9.3 Dentofacial deformity with the discrepancy on one plane.
Figure 12.9.4 Dentofacial deformity with the discrepancy on two planes.
Figure 12.9.5 Dentofacial deformity with the discrepancy on three planes.
Figure 12.9.6 (a) A clinical case with impaired transverse and vertical deve...
Figure 12.9.7 (a) A patient presenting oral respiration with transversal hyp...
Figure 12.9.8 (a) Unilateral fracture of the mandibular condyle passed unnot...
Figure 12.9.9 (a) Left condylar fracture with left joint function restricted...
Figure 12.9.10 (a) Patient with juvenile rheumatoid arthritis: distal positi...
Figure 12.9.11 (a) Patient with Binder syndrome; (b) correction of the midli...
Figure 12.9.12 (a) Altered mandibular position due to occlusal interference;...
Figure 12.9.13 (a) Skeletal discrepancy on one plane. The mandible is displa...
Figure 12.9.14 (a) Skeletal discrepancy on two planes; (b) the final result ...
Figure 12.9.15 (a) Skeletal discrepancy on three planes; (b) the final resul...
Figure 12.9.16 (a) Skeletal discrepancy on three planes; (b) the final resul...
Chapter 12-10
Figure 12.10.1 Facial photographs (a, b) and posteroanterior cephalometric r...
Figure 12.10.2 Hemifacial microsomia in a boy before treatment (a) with a fu...
Figure 12.10.3 Posteroanterior cephalometric images of children aged 8 years...
Figure 12.10.4 Vertical and horizontal asymmetry over time in unilateral cle...
Figure 12.10.5 Patients with VMA. Horizontal lines on facial photographs ind...
Figure 12.10.6 VMA in a 19‐year‐old woman. (a) Frontal facial photograph, di...
Figure 12.10.7 (a) Frontal facial photograph reveals differential occlusal l...
Figure 12.10.8 VMA in a 18.5‐year‐old girl. (a) Frontal facial photograph, h...
Figure 12.10.9 VMA in a 25.7‐year‐old woman. (a) Frontal facial photograph: ...
Figure 12.10.10 The following bilateral landmarks (r: right, l: left) were m...
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
List of Contributors
Begin Reading
Index
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Dentofacial and Occlusal Asymmetries
Edited by
Birte Melsen, D.D.S., Dr. Odont., Dr. h.c.
Visiting Professor of Orthodontics, College of Dentistry, New York University, New York, NY, USA
Former Professor and Head of Orthodontics, Department of Dentistry and Oral Health,
Aarhus University, Aarhus, Denmark
Athanasios E. Athanasiou, D.D.S., M.S.D., Dr. Dent.
Dean and Professor of Orthodontics, School of Dentistry, European University Cyprus, Nicosia, Cyprus
Honorary Professor of Orthodontics, Mohammed Bin Rashid University of Medicine and Health Sciences Dubai, UAE
Former Dean, Professor and Head of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki Thessaloniki, Greece
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List of Contributors
Aron Aliaga‐Del Castillo, D.D.S., M.Sc., Ph.D.Clinical Assistant Professor, Department of Orthodonticsand Pediatric Dentistry School of DentistryUniversity of MichiganAnn Arbor, MIUSA
George Anka, D.D.S., M.S.Private Practice of OrthodonticsTokyoJapan
Athanasios E. Athanasiou, D.D.S., M.S.D., Dr. Dent.Dean and Professor of Orthodontics, School of DentistryEuropean University CyprusNicosiaCyprusHonorary Professor of OrthodonticsMohammed Bin Rashid University of Medicineand Health SciencesDubaiUAEFormer Dean, Professor and Head of OrthodonticsSchool of DentistryAristotle University of ThessalonikiThessalonikiGreece
Zakaria Bentahar, D.M.D., M.D.Sc., M.Sc., Ph.D.Professor of OrthodonticsHassan II UniversityCasablancaMorocco
Joseph Bouserhal, D.D.S., M.D.S., Ph.D.Professor and Acting Chair, Department of OrthodonticsFaculty of Dental MedicineSaint Joseph University of BeirutBeirutLebanonDirector, Craniofacial Research LaboratoryFaculty of Dental MedicineSaint Joseph University of BeirutBeirutLebanonAdjunct Clinical Professor, Department of Orthodontics andDentofacial Orthopedics, Henry Goldman School of DentistryBoston UniversityBostonUSA
Lea J. Bouserhal, DDS, M.S.Private Practice of OrthodonticsBeirutLebanon
Philippe J. Bouserhal, D.D.S., M.D.S.Private Practice of OrthodonticsBeirut, Lebanon and LeuvenBelgium
Eugene Chan, B.D.S., M.D.Sc., M.Orth.R.C.S.Ed., M.R.A.C.D.S.(Ortho), Ph.D.Clinical Professor, Discipline of OrthodonticsSchool of Dentistry Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
Kwangchul Choy, D.D.S., M.S., Ph.D.Clinical Professor, Department of OrthodonticsSchool of DentistryYonsei UniversitySeoulSouth Korea
Lucia H. Soares Cevidanes, D.D.S., M.S., Ph.D.Thomas and Doris Graber Endowed Professor of Dentistryand Associate Professor, Department of OrthodonticsSchool of DentistryUniversity of MichiganAnn Arbor, MIUSA
M. Ali Darendeliler, B.D.S., Ph.D., Dip. Orth., Certif. Orth.,Priv. Doc, F.I.C.D., M.R.A.C.D.S. (Orth.)Professor and Chair, Discipline of OrthodonticsSchool of DentistryFaculty of Medicine and HealthUniversity of SydneySydneyAustraliaHead, Department of OrthodonticsSydney Dental HospitalSydneyAustralia
Karine Evangelista, D.D.S., M.S., Ph.D.Assistant Professor, Division of OrthodonticsSchool of DentistryFederal University of GoiásGoiásBrazil
Giampietro Farronato, M.D., D.D.S.Professor Emeritus of Orthodontics, School of DentistryUniversity of MilanMilanItaly
Padhraig S. Fleming, B.Dent.Sc.(Hons.), M.Sc., Ph.D., F.D.S.(Orth.), F.F.D.(Orth.), F.H.E.A.Chair and Professor of Orthodontics and ProgrammeLead, Doctorate in Orthodontics, Division of Public andChild Dental HealthDublin Dental University Hospital, The University ofDublin, Trinity College DublinIrelandHonorary Professor of OrthodonticsQueen Mary University of LondonLondonUK
Joseph G. Ghafari, D.M.D.Professor and Chair, Department of Dentofacial MedicineAmerican University of Beirut Medical CenterBeirutLebanon
Hans Gjørup, DDS, PhDSpecialist in OrthodonticsIkastDenmark
Ismaeel Hansa, B.D.S., M.D.S.Private practice of OrthodonticsDurbanSouth Africa
David C. Hatcher, D.D.S., M.Sc., M.R.C.D. (C)Specialist in Oral and Maxillofacial RadiologyUniversity of California Los Angeles, University ofCalifornia San Francisco, University of California Davisand University of PacificCaliforniaUSA
Dorte Haubek, D.D.S., Ph.D., Dr. Odont.Professor, Department of Dentistry and Oral HealthAarhus UniversityAarhusDenmark
Ioannis Iatrou, D.D.S., M.D., Ph.D.Professor Emeritus of Oral and Maxillofacial SurgerySchool of DentistryNational and Kapodistrian University of AthensAthensGreece
Guilherme Janson, D.D.S., M.Sc., Ph.D. (deceased)Professor and Head, Department of OrthodonticsBauru Dental SchoolUniversity of São PaoloBauru, São PaoloBrazil
Eleftherios G. Kaklamanos, D.D.S., Cert., Cert., M.Sc., M.A., Ph.D.Associate Professor, School of DentistryAristotle University of ThessalonikiThessalonikiGreeceAdjunct Associate Professor of Orthodontics, Hamdan BinMohammed College of Dental MedicineMohammed Bin Rashid University of Medicine andHealth SciencesDubaiUAEAssociate Professor, School of DentistryEuropean University CyprusNicosiaCyprus
Stavros Kiliaridis, D.D.S., Odont. Dr. / Ph.D.Professor Emeritus of Orthodontics, School of DentalMedicine, Faculty of MedicineUniversity of GenevaGenevaSwitzerlandAdjunct Professor, Department of Orthodontics andDentofacial Orthopedics, School of Dental MedicineFaculty of MedicineUniversity of BernBernSwitzerland
Steven J. Lindauer, D.M.D., M.Dent.Sc.Paul Tucker Goad Professor and Chair, Department ofOrthodontics, School of DentistryVirginia Commonwealth UniversityRichmond, VAUSA
Cesare Luzi, D.D.S., M.Sc.Visiting Professor, Department of OrthodonticsUniversity of Ferrara, Ferrara and University CattolicaRomeItaly
Camila Massaro, D.D.S., M.S.D., Ph.D.Bauru Dental SchoolUniversity of São PauloBauruBrazilSchool of DentistryUniversity of MichiganAnn Arbor, MIUSA
Maria Costanza Meazzini di Seyssel, D.M.D., M.Med.Sci.Scientific Director, Cleft Lip and Palate Regional CenterOperation Smile S. Paolo HospitalMilanItalyConsultant for Craniofacial Anomalies, Department ofMaxillo‐Facial SurgeryS. Gerardo HospitalMonzaItalyAdjunct Professor in Craniofacial AnomaliesUniversity of MilanMilanItaly
Birte Melsen, D.D.S., Dr. Odont., Dr. h.c.Visiting Professor of Orthodontics, College of DentistryNew York UniversityNew York, NYUSAFormer Professor and Head of OrthodonticsDepartment of Dentistry and Oral HealthAarhus UniversityAarhusDenmark
Lorenz Moser, M.D., D.D.S.Visiting Professor, Department of OrthodonticsUniversity of FerraraFerraraItaly
Thomas Klit Pedersen, D.D.S., Ph.D.Clinical Professor, Consultant OrthodontistDepartment of Oral and Maxillofacial SurgeryAarhus University Hospital and Section of OrthodonticsDepartment of Dentistry and Oral HealthAarhus UniversityAarhusDenmark
Pertti Pirttiniemi, D.D.S., Ph.D., Dr. Orthod.Professor Emeritus of Oral Development andOrthodontics, Faculty of OdontologyUniversity of OuluOuluFinland
Antonio Carlos de Oliveira Ruellas, Ph.D.Universidade Federal do Rio de JaneiroRio de JaneiroBrazil
Ute E.M. Schneider‐Moser, D.D.S., M.S.Visiting Professor, Department of OrthodonticsUniversity of FerraraFerraraItalyDepartment of OrthodonticsUniversity of PennsylvaniaPhiladelphia, PAUSA
Bhavna Shroff, D.D.S., M.Dent.Sc., M.P.A.Norborne Muir Professor and Graduate Program DirectorDepartment of Orthodontics, School of DentistryVirginia Commonwealth UniversityRichmond, VIUSA
Steven M. Siegel, D.M.D.Private Practice of OrthodonticsGlen Burnie, MDUSA
Peter B. Stoustrup, D.D.S., Ph.D.Associate Professor and Head, Section of OrthodonticsDirector of Postgraduate Orthodontic ProgramDepartment of Dentistry and Oral HealthAarhus UniversityAarhusDenmark
Emese Szabò, D.D.S.Private Practice of OrthodonticsRomeItaly
Nadia Theologie‐Lygidakis, D.D.S., M.Sc.(Med), M.Sc.(Dent), Ph.D.Associate Professor, Department of Oral and MaxillofacialSurgery School of DentistryNational and Kapodistrian University of AthensAthensGreece
Nikhillesh Vaiid, B.D.S., M.D.S., Ph.D., F.D.T.F.(Ed.), M.F.D.S. R.C.S.(Glasgow)Adjunct Professor, Department of OrthodonticsSaveetha Dental CollegeSaveetha Institute of Medical and Technical SciencesSaveetha UniversityChennaiIndia
Vidhya Venkateswaran, B.D.S., M.P.H., Ph.D.DATA Scholar, National Institute of Dental andCraniofacial ResearchBethesda, MDUSA
Larry M. Wolford, D.M.D.Clinical Professor, Departments of Oral and MaxillofacialSurgery and OrthodonticsTexas A&M University College of DentistryBaylor University Medical CenterDallas, TXUSA
1Introduction
Birte Melsen and Athanasios E. Athanasiou
CHAPTER MENU
References
Although each person shares with the rest of the population many characteristics, there are enough differences to make each human being a unique individual. Such limitless variation in the size, shape, and relationship of the dental, skeletal, and soft tissue facial structures are important in providing each individual with their identity (Bishara et al. 2001).
Dorland's Medical Dictionary defines symmetry as “the similar arrangement in form and relationships of parts around a common axis or on each side of a plane of the body” (Dorland's Illustrated Medical Dictionary2000).
The absence of symmetry is asymmetry and is frequently experienced by man in their facial features, both structurally and functionally.
The term symmetry is generally used in two different contexts:
The first meaning is a precise and well‐defined concept of balance or “patterned self‐similarity” that can be demonstrated or proved according to the rules of a formal system, namely geometry, physics, or otherwise.
The second meaning is an imprecise sense of harmonious or esthetically pleasing proportionality and balance reflecting beauty or perfection. As such, symmetry was demonstrated within art by Leonardo Da Vinci in his Vitruvian Man in 1492 (
Figure 1.1
) (Baudouin and Tiberghien
2004
).
Asymmetry has, on the other hand, been part of the features characterizing the unpleasant and the unharmonious (Edler 2001; Rhodes et al. 2001).
Whereas symmetry in art is used to express harmony, beauty, and peace, asymmetrical layouts are generally more dynamic, and by intentionally ignoring balance, the designer can generate tension, express movement, or convey a mood such as anger, excitement, joy, or casual amusement (Komoro et al. 2009).
Facial asymmetry, being a common phenomenon, was probably first observed by the artists of early Greek statuary who recorded what they had found in nature – normal facial asymmetry (Lundstrom 1961).
A perfect facial symmetry is extremely rare and practically all normal faces exhibit a degree of asymmetry (Figure 1.2). As in art, where the side has an importance in the interpretation of a movement displayed on a painting, the two sides of the face may express feelings (Schirillo 2000).
The left side of the face is considered more emotionally expressive and more often connotes more negative emotions than the right side. Also interestingly, artists tend to expose more of their models left cheek than their right. This is significant, in that artists also portray more females than males with their left cheek exposed. These psychological findings lead to explanations for the esthetic leftward bias in portraiture (Schirillo 2000; Powell and Schirillo 2009).
The studies of asymmetry of the craniofacial region can be divided into two categories. One is focusing on facial asymmetry in various populations and its impact on perception of the individual's attractiveness and health. The second category is dealing with the influence of asymmetry on treatment of patients receiving orthodontic treatment or craniofacial surgery.
Studies of various populations belong to the first category, and facial symmetry has been associated with health, physical attractiveness, and beauty of a person. It is also hypothesized as a factor in interpersonal attraction, and relevant research indicates that bilateral symmetry is an important indicator of freedom from disease and worthiness for mating (Edler 2001).
Figure 1.1 Vitruvian Man drawn by Leonardo Da Vinci in 1492 demonstrating the symmetry of the ideal body.
Figure 1.2 Three images where the right face is composed of two right sides, the middle one is the real face, and the left one is composed of two left sides.
Most facial asymmetries among nonpatients are, however, fluctuating meaning that they have no significant influence on the attractiveness of the face. The perception of a face as attractive is more influenced by averageness meaning: what do the persons I like in “my tribe” look like. The beauty ideal is clearly changing with time and between various populations (Rhodes et al. 2001). The impact of averageness was studied by Komoro et al. (2009) who let laypeople evaluate the effect of symmetry and averageness on photographs and found that symmetry had a limited if any influence on attractiveness, thus confirming earlier findings by Baudouin and Tiberghien (2004). In a more recent study, it was found that symmetry on one hand reduced attractiveness by decreasing perceived normality, but on the other hand could also increase attractiveness by promoting the perceived symmetry (Zheng et al. 2021). Furthermore, it has been suggested that completely symmetrical faces might appear unemotional and thus less attractive (Swaddle and Cuthill 1995).
The second category of studies deal with asymmetry in relation to treatment. In reference to the need for treatment, it should be noted that the point at which normal asymmetry becomes abnormal cannot be easily defined and is often determined by the clinician's sense of balance and the patient's perception of the imbalance (Bishara et al. 2001). Minor asymmetry of the craniofacial skeleton and in the dentoalveolar region is often not easily detected. This can be the reason for which the optimal result of an orthodontic treatment cannot be reached since the asymmetry will often interfere with a satisfactory finishing.
The true prevalence of asymmetries in a population has never been described. Methodological limitations related to etiological factors, timing of appearance, degree of severity, progressing characteristics, and individuals' age, have enabled relevant studies only in subgroups of patients with facial asymmetry (i.e. hemofacial microsomia) or dentofacial deformities in university orthodontic clinics.
When studying dentofacial deformity patients at the University of North Carolina, it was found that 34% demonstrated an apparent facial asymmetries. When present, asymmetry affected the upper face in only 5%, the midface (primarily the nose) in 36%, and the chin in 74% (Severt and Proffit 1997).
Recently, Evangelista et al. (2022) performed a review of the prevalence of mandibular asymmetry in different skeletal sagittal patterns and found that there was a significant difference between findings reported from different studies varying from 17.43 to 72.95%, and indicated that the more severe malocclusions exhibited more severe chin deviations than the nonorthodontic population.
Whereas most of the relevant studies have been focusing on facial asymmetry, Sheats et al. (1998) looked into the occlusal status of patients being treated in a graduate clinic and found that in 62% of the patients, the mandibular midline deviated from the facial midline.
An important part of this book will focus on the treatment of patients with various types of facial and dentoalveolar asymmetry focusing on interception, correction, or camouflage. The interception can only be performed for asymmetries related to functional deviations or/and eruption of teeth. Corrections and camouflage in some patients with skeletal asymmetries start at an early age and often continue for the remaining growth period. In adult patients, treatment comprises displacement of teeth and dentoalveolar modeling with goal‐oriented biomechanics and orthognathic surgery when needed. For asymmetries with different localization, their etiology and the possible treatment modalities from a biological, biomechanical, and surgical viewpoints will be discussed. In relation to management, generating symmetry is among the goals of most treatment plans. However, when the outcome of orthodontics is assessed, even minor asymmetries are frequently impossible to generate a result that is compatible with ideal morphology and function.
