Importance of Skeletal Analysis Before Surgery

Importance of Skeletal Analysis Before Surgery

**Early Intervention with Invisalign First for Kids**

The importance of skeletal analysis in orthodontic treatment, especially before surgery, can't be overwized. It is a comprehensive tool that provides a detailed evaluation of the proportions of the facial skeleton, which is particularly critical for children. This analysis is essential for ensuring that any treatment, including surgery, is both appropriate and effective.


When it's about children, the timing and type of intervention are critical. Skeletal analysis, through the use of cephalometry and other diagnostic records, can help identify growth patterns and anomalies early on. This early diagnosis is beneficial in managing developing dentition and occlusion, which are essential components of comprehensive oral health care. Thumb-sucking habits can affect the alignment of a child's teeth Braces for kids and teens dental caries. It also facilitates interceptive orthodontic treatments that can correct or improve adverse growth patterns before they become more severe[2][3]. For example, in cases of skeletal Class III malocclusion, early analysis can determine whether orthodontic camouflage or surgical intervention is necessary, ensuring that the treatment plan is optimized for the patient's specific needs[1][3]. This not only prevents future malocclusions but also provides the best possible aesthetic and functional outcomes.


The process of skeletal analysis is thorough and includes both two- and three- dimensional evaluations. It can be based on plain X-rays or more detailed imaging like 3D reformatted CT scans. These diagnostic images help in planning orthognathic surgery by determining the precise movements needed to correct skeletal deformities. Mock surgery on models of the patient's jaw can also be performed to visualize and demonstrate the planned surgical outcomes, ensuring that both the surgeon and orthodontist are on the same page[3]. This interdisciplinary coordination is essential for achieving long-term stability and avoiding relapse.


The use of skeletal analysis also facilitates patient and parent informed consent by clearly presenting the treatment options and expected outcomes. This is especially important in pediatric cases where the patient's growth and development are ongoing, and the treatment plan must be both effective and appropriate for their age and condition[2]. In summary, skeletal analysis is a critical tool in orthodontic treatment planning, particularly before surgery, as it provides a comprehensive assessment of the facial skeleton and facilitates effective and appropriate interventions.

The importance of skeletal analysis before surgery, particularly in the planning of orthognathic procedures, cannot be overemized. Orthognathic surgery is a complex process that requires precise diagnosis and planning to correct skeletal deformities of the jaws, ensuring both functional and esthetical outcomes. This analysis, which includes cephalometric X-rays and 3D CT scans, provides detailed information about the patient's bone and dental alignment, which is crucial for determining the need for surgery and for crafting an effective treatment plan.


Cephalometric X-rays are a fundamental tool in this process. They provide a side view of the face, showcasing the relationship between the teeth and jaws. This imaging is invaluable for understanding the patient's skeletal structure and planning tooth movement. By using cephalometric analysis, orthodontists and oral maxillofacial surgeon can assess the proportions of the facial skeleton and compare them to standard norms, helping to identify any discrepancies that need correction.


3D CT scans further enhance this analysis by offering a comprehensive, three-dimensional view of the patient's skull. This detailed imaging includes not only bone structure but also soft tissues, nerve pathways, and other critical anatomical features. The use of 3D CT scans is particularly important for complex cases, such as asymmetric deformities, where precise planning is essential to achieve optimal results.


The data obtained from these imaging techniques are used to create personalized treatment plans. By understanding the patient's unique anatomy, orthodontists and oral maxillofacial surgeon can design surgical interventions that address specific needs, such as aligning the jaws correctly or repositioning dental arches. This tailored approach not only aids in achieving functional occlusion but also in achieving facial harmony and aesthetics, which are often significant factors for patients undergoing orthognathic surgery.


In planning orthognathic surgery, mock surgery is often performed using the data from these analyses. This process, which can be done with traditional models or using 3D printed models, is a powerful tool for both the treatment planning and patient consultation. It enables the surgical and orthodontic treatment to be visually represented, helping patients understand the proposed changes and expected outcomes.


In short, skeletal analysis through cephalometric X-rays and 3D CT scans is a cornerstone of orthognathic surgery planning. It provides the necessary insights into the patient's anatomy, ensuring that any surgical interventions are well- planned, precise, and tailored to achieve the best possible outcomes.

**The HealthyStart System**

Skeletal analysis is a crucial step in orthodontic treatment, particularly for identifying potential skeletal malocclusions in young patients. One common type of skeletal malocclusion is Class III malocclusion, where the lower jaw protrudes beyond the upper jaw, resulting in an underbite. This type of malocclusion often requires a combination of surgical intervention and orthodontic treatment to achieve optimal results.


The importance of skeletal analysis lies in understanding the structural discrepancies between the upper and lower jaws. This involves detailed diagnostic tools such as cephalometric X-rays and 3D imaging, which provide comprehensive information about jaw positioning and growth patterns. By identifying these discrepancies early, orthodontists and maxillofacial surgeon can plan a tailored treatment approach that may include growth modification appliances for growing patients or orthognathic surgery for more severe cases.


Orthognathic surgery, often performed in combination with orthodontics, is particularly effective for treating severe skeletal malocclusions like Class III. This approach not only corrects the jaw alignment but also significantly improve facial aesthetics and masticatory function. The success of such treatments depends on a well- planned interdisciplinary approach between orthodontists and maxillofacial surgeon, ensuring that both aesthetic and functional objectives are met.


Skeletal analysis also helps in assessing the potential need for surgical intervention early on, which can be critical in preventing more severe issues later in a patient's dental and facial growth. By understanding the structural issues at play, professionals can provide more accurate treatment outcomes and better patient management, leading to improved long-term stability and aesthetic results. In cases where surgery is necessary, the use of mock surgery and virtual planning tools can help visualize and discuss treatment outcomes with patients, ensuring that all parties are well-informed and on the same treatment plan.


While nonsurgical treatments can be effective for some patients, particularly adolescents who may reject surgery, the combination of orthodontics and surgery often provides the most comprehensive and long-term solution for severe skeletal malocclusions. This approach not only corrects the structural issues but also helps in achieving a more ideal occlusion and facial balance, which are essential for both functional and aesthetic outcomes.

**The HealthyStart System**

This non-invasive approach targets the natural development of children's teeth and jaw, using soft dental appliances to align teeth and address breathing issues, reducing the need for more invasive treatments.

The combination of orthodontics and surgery is a powerful tool in addressing skeletal malocclusions, offering both aesthetic and functional benefits that are crucial for long-term stability and reducing the risk of relapse. This is particularly significant in children's treatment, where early intervention can guide jaw and facial growth, creating a foundation for a healthy and aligned smile.


Orthodontic treatment plays a crucial role in aligning teeth and jaws properly, which not only enhances the appearance of the smile but also improves the overall function of the bite. By addressing orthodontic issues early on, further complications such as impacted teeth, overcrowding, and bite issues can be minimized or even prevented. This early intervention is especially important in children, as their growing bodies offer a window of opportunity to effectively address potential issues before they become more severe.


When it comes to skeletal malocclusions, such as Class III malocclusion, a comprehensive analysis is necessary to plan effective treatment. Cephalometric analysis, which includes evaluating the proportions of the facial skeleton using X-rays or 3D CT scans, is a gold standard in evaluating soft and hard tissues before orthodontic treatment. This analysis allows for the assessment of skeletal anomalies and the planning of orthognathic surgery, which can correct maxillomandibular differences and improve facial aesthetics and masticatory function.


The planning of orthognathic surgery is a combined endeavor between orthodontists and maxillofacial surgeon, where mock surgery and 3D models are used to mimic the planned surgical procedure. This not only demonstrates the treatment plan to the patient but also allows for precise surgical splints to be designed and printed using CAD-CAM technology.


The success of the treatment depends on a good interdisciplinary relationship between the orthodontist and the maxillofacial surgeon. Bimaxillary orthognathic surgery, for example, presents greater stability in the long term, offering better aesthetic and functional results. By aligning the teeth and jaws properly, the risk of future dental problems is reduced, and the benefits of treatment can be enjoyed for a lifetime.


Early skeletal analysis is crucial for identifying potential issues and planning appropriate treatment. It allows for the assessment of maxillomandibular differences and the development of a treatment plan that can address these issues effectively. By taking advantage of growth potential in children, skeletal anomalies can sometimes be corrected or reduced, promoting normal dental and skeletal growth.


The combination of orthodontics and surgery provides a comprehensive treatment plan that not only improves facial aesthetics but also enhances functional outcomes. It is an investment in oral health and overall well-being, offering long-term stability and reducing the risk of relapse. This makes it a significant consideration in children's treatment, where early intervention can set the stage for a lifetime of improved oral health and enhanced self-esteem.

**Myobrace: A No-Braces Approach**

S skeletal analysis is a crucial step in the planning of orthognathic surgery, as it provides a detailed understanding of the facial structure and its potential for improvement. This analysis is essential for developing a comprehensive treatment plan that not only enhances facial aesthetics but also rectify occlusal issues, which are critical for both the psychological and physiological well being of children.


When children have skeletal discrepancies, such as jaw malaligns, it can impact their overall quality of life. These discrepancies can result in malocclusion, which is a condition where the upper and lower teeth do not align properly. This can cause discomfort, pain, and even psychological issues due to aesthetic concerns. A thorough skeletal analysis, often using cephalometric measurements, can help orthodontists and oral maxilla facial (Omf) surgeon to understand the extent of these discrepancies and plan the necessary surgical and orthodontic treatments.


The COGS analysis, for example, is a specialized system used in orthognathic surgery to evaluate the hard tissue in the face. It provides detailed information about the horizontal and vertical positions of the facial bones, which is crucial for planning surgical procedures. This analysis also includes soft tissue evaluation to ensure that the treatment outcomes align with the patient's aesthetic expectations.


The use of 3D-imaging and mock surgery further enhances the planning process. These models allow for the precise repositioning of the jaws and the prediction of post-surgery outcomes, including changes in facial aesthetics and occlusion. This not only aids in the communication with the patient about potential outcomes but also in the actual surgical procedure, ensuring that the treatment objectives are met effectively.


S skeletal analysis is not just about improving aesthetics; it also has a significant impact on the physiological well being of children. Malocclusion can increase the risk of dental problems like premature wear, tooth loss, and gum disease. It can also contribute to issues such as temporomandibular disorder (TMD) and discomfort in the jaw. A detailed treatment plan based on skeletal analysis can address these issues by ensuring proper alignment of the teeth and jaws, which in the long term, can improve oral hygiene, reduce the risk of dental complications, and enhance overall health.


The psychological benefits of skeletal analysis and orthognathic surgery should not be underestimatted. For children, a more normal facial appearance can improve confidence and reduce social anxiety related to their appearance. This can have a significant impact on their psychological well being and social life, as they are more likely to engage in social and academic life without the discomfort of aesthetic concerns.


To summarize, a detailed treatment plan based on skeletal analysis is crucial for ensuring that orthognathic surgery not only enhances facial aesthetics but also provides significant physiological and psychological benefits. It is a comprehensive tool that aids in precise diagnosis and treatment planning, which are essential for improving the quality of life for children with skeletal discrepancies.

Myobrace offers a brace-free solution that corrects poor oral habits, guiding jaw and teeth alignment development in children, promoting natural growth and oral health.

The importance of thorough preoperative assessment, particularly in the form of detailed bone density and structure evaluation, is paramount in planning surgical treatments. This is especially crucial in orthopedic and spinal surgeries, where understanding the patient's bone health can significantly affect surgical outcomes and the risk of complications such as fractures or implant failures[1][3]. However, the use of mock surgery and virtual models can also be a critical tool in this process, offering both patients and medical teams a clear and detailed understanding of the proposed treatment outcomes.


In the specific contexts of children's orthodontic and surgical care, such as cleft lip and palate repair, the use of mock surgery and virtual models can be particularly beneficial. These techniques provide a precise and detailed forecast of how the treatment will affect the child's facial structure and dental positioning. This not only helps in planning the most appropriate surgical strategy but also in ensuring that both the patient and their care team are well-prepared and aligned in their understanding of the treatment's outcomes.


Virtual surgical planning can significantly improve the consent process by providing a clear and comprehensive understanding of what the surgery will aim to change and how it will be performed. This clarity can help in all types of surgical planning, including orthognathic surgery, where patient-specific osteosynthesis plates are used to improve outcomes[2]. In children, where the bone is more complex and less dense, understanding the precise changes that will be needed and how they will affect the child's future development is crucial.


In the end, the use of mock surgery and virtual models in planning children's orthodontic and surgical care represents a significant step in optimizing treatment outcomes and ensuring that both patients and their care teams are well-prepared for the surgery. This not only helps in improving surgical success rates but also in providing a more comprehensive and patient-specific care experience.

**Comprehensive Orthodontic Solutions**

The importance of skeletal analysis before surgery cannot be overemphasized, especially in the treatment of dental and facial anomalies. Skeletal analysis provides a comprehensive evaluation of the facial skeleton, which is crucial for planning orthognathic surgery. This type of surgery is often necessary for correcting severe jaw irregularities that cannot be fully corrected with orthodontics alone, such as significant underbite, overbite, or facial asymmetry.


In the process of skeletal analysis, various imaging and analysis are used, including cephalometric X-rays and 3D CT scans. These imaging and analysis help in the precise evaluation of the facial skeleton's proportions and alignment. The data obtained from these images are analyzed using computer programs that help in planning the surgical intervention by highlighting the specific movements needed to correct skeletal discrepancies.


The planning process involves not only the surgeon but also the orthodontist, as both need to align their objectives to achieve optimal results. The treatment plan is developed based on a thorough clinical examination, facial photographs, and detailed imaging. This interdisciplinary approach ensures that both the aesthetic and functional outcomes are optimized.


After surgery, skeletal analysis also provides a basis for long-term follow-up and assessment of treatment outcomes. It helps in monitoring the stability of the surgical results and ensures that any necessary post-surgical orthodontic care is provided promptly. This follow-up is crucial for fine-turing the alignment of the teeth and ensuring that the bite is perfect, which is often achieved through additional orthodontic treatment after surgery.


In summary, skeletal analysis is a critical tool in the management of skeletal malocclusions. It not only guides the surgical planning but also ensures that post-surgical care is optimized to achieve the best functional and aesthetic results. The combination of thorough pre-surgical planning and post-surgical follow-up based on skeletal analysis is what makes orthognathic surgery so successful in correcting facial anomalies and ensuring long-term stability.

 

Pediatrics
A pediatrician examines a neonate.
Focus Infants, Children, Adolescents, and Young Adults
Subdivisions Paediatric cardiology, neonatology, critical care, pediatric oncology, hospital medicine, primary care, others (see below)
Significant diseases Congenital diseases, Infectious diseases, Childhood cancer, Mental disorders
Significant tests World Health Organization Child Growth Standards
Specialist Pediatrician
Glossary Glossary of medicine

Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, pediatrics covers many of their youth until the age of 18.[1] The American Academy of Pediatrics recommends people seek pediatric care through the age of 21, but some pediatric subspecialists continue to care for adults up to 25.[2][3] Worldwide age limits of pediatrics have been trending upward year after year.[4] A medical doctor who specializes in this area is known as a pediatrician, or paediatrician. The word pediatrics and its cognates mean "healer of children", derived from the two Greek words: παá¿–ς (pais "child") and á¼°ατρÏŒς (iatros "doctor, healer"). Pediatricians work in clinics, research centers, universities, general hospitals and children's hospitals, including those who practice pediatric subspecialties (e.g. neonatology requires resources available in a NICU).

History

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Part of Great Ormond Street Hospital in London, United Kingdom, which was the first pediatric hospital in the English-speaking world.

The earliest mentions of child-specific medical problems appear in the Hippocratic Corpus, published in the fifth century B.C., and the famous Sacred Disease. These publications discussed topics such as childhood epilepsy and premature births. From the first to fourth centuries A.D., Greek philosophers and physicians Celsus, Soranus of Ephesus, Aretaeus, Galen, and Oribasius, also discussed specific illnesses affecting children in their works, such as rashes, epilepsy, and meningitis.[5] Already Hippocrates, Aristotle, Celsus, Soranus, and Galen[6] understood the differences in growing and maturing organisms that necessitated different treatment: Ex toto non sic pueri ut viri curari debent ("In general, boys should not be treated in the same way as men").[7] Some of the oldest traces of pediatrics can be discovered in Ancient India where children's doctors were called kumara bhrtya.[6]

Even though some pediatric works existed during this time, they were scarce and rarely published due to a lack of knowledge in pediatric medicine. Sushruta Samhita, an ayurvedic text composed during the sixth century BCE, contains the text about pediatrics.[8] Another ayurvedic text from this period is Kashyapa Samhita.[9][10] A second century AD manuscript by the Greek physician and gynecologist Soranus of Ephesus dealt with neonatal pediatrics.[11] Byzantine physicians Oribasius, Aëtius of Amida, Alexander Trallianus, and Paulus Aegineta contributed to the field.[6] The Byzantines also built brephotrophia (crêches).[6] Islamic Golden Age writers served as a bridge for Greco-Roman and Byzantine medicine and added ideas of their own, especially Haly Abbas, Yahya Serapion, Abulcasis, Avicenna, and Averroes. The Persian philosopher and physician al-Razi (865–925), sometimes called the father of pediatrics, published a monograph on pediatrics titled Diseases in Children.[12][13] Also among the first books about pediatrics was Libellus [Opusculum] de aegritudinibus et remediis infantium 1472 ("Little Book on Children Diseases and Treatment"), by the Italian pediatrician Paolo Bagellardo.[14][5] In sequence came Bartholomäus Metlinger's Ein Regiment der Jungerkinder 1473, Cornelius Roelans (1450–1525) no title Buchlein, or Latin compendium, 1483, and Heinrich von Louffenburg (1391–1460) Versehung des Leibs written in 1429 (published 1491), together form the Pediatric Incunabula, four great medical treatises on children's physiology and pathology.[6]

While more information about childhood diseases became available, there was little evidence that children received the same kind of medical care that adults did.[15] It was during the seventeenth and eighteenth centuries that medical experts started offering specialized care for children.[5] The Swedish physician Nils Rosén von Rosenstein (1706–1773) is considered to be the founder of modern pediatrics as a medical specialty,[16][17] while his work The diseases of children, and their remedies (1764) is considered to be "the first modern textbook on the subject".[18] However, it was not until the nineteenth century that medical professionals acknowledged pediatrics as a separate field of medicine. The first pediatric-specific publications appeared between the 1790s and the 1920s.[19]

Etymology

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The term pediatrics was first introduced in English in 1859 by Abraham Jacobi. In 1860, he became "the first dedicated professor of pediatrics in the world."[20] Jacobi is known as the father of American pediatrics because of his many contributions to the field.[21][22] He received his medical training in Germany and later practiced in New York City.[23]

The first generally accepted pediatric hospital is the Hôpital des Enfants Malades (French: Hospital for Sick Children), which opened in Paris in June 1802 on the site of a previous orphanage.[24] From its beginning, this famous hospital accepted patients up to the age of fifteen years,[25] and it continues to this day as the pediatric division of the Necker-Enfants Malades Hospital, created in 1920 by merging with the nearby Necker Hospital, founded in 1778.[26]

In other European countries, the Charité (a hospital founded in 1710) in Berlin established a separate Pediatric Pavilion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (now WrocÅ‚aw), both in 1837. In 1852 Britain's first pediatric hospital, the Hospital for Sick Children, Great Ormond Street was founded by Charles West.[24] The first Children's hospital in Scotland opened in 1860 in Edinburgh.[27] In the US, the first similar institutions were the Children's Hospital of Philadelphia, which opened in 1855, and then Boston Children's Hospital (1869).[28] Subspecialties in pediatrics were created at the Harriet Lane Home at Johns Hopkins by Edwards A. Park.[29]

Differences between adult and pediatric medicine

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The body size differences are paralleled by maturation changes. The smaller body of an infant or neonate is substantially different physiologically from that of an adult. Congenital defects, genetic variance, and developmental issues are of greater concern to pediatricians than they often are to adult physicians. A common adage is that children are not simply "little adults". The clinician must take into account the immature physiology of the infant or child when considering symptoms, prescribing medications, and diagnosing illnesses.[30]

Pediatric physiology directly impacts the pharmacokinetic properties of drugs that enter the body. The absorption, distribution, metabolism, and elimination of medications differ between developing children and grown adults.[30][31][32] Despite completed studies and reviews, continual research is needed to better understand how these factors should affect the decisions of healthcare providers when prescribing and administering medications to the pediatric population.[30]

Absorption

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Many drug absorption differences between pediatric and adult populations revolve around the stomach. Neonates and young infants have increased stomach pH due to decreased acid secretion, thereby creating a more basic environment for drugs that are taken by mouth.[31][30][32] Acid is essential to degrading certain oral drugs before systemic absorption. Therefore, the absorption of these drugs in children is greater than in adults due to decreased breakdown and increased preservation in a less acidic gastric space.[31]

Children also have an extended rate of gastric emptying, which slows the rate of drug absorption.[31][32]

Drug absorption also depends on specific enzymes that come in contact with the oral drug as it travels through the body. Supply of these enzymes increase as children continue to develop their gastrointestinal tract.[31][32] Pediatric patients have underdeveloped proteins, which leads to decreased metabolism and increased serum concentrations of specific drugs. However, prodrugs experience the opposite effect because enzymes are necessary for allowing their active form to enter systemic circulation.[31]

Distribution

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Percentage of total body water and extracellular fluid volume both decrease as children grow and develop with time. Pediatric patients thus have a larger volume of distribution than adults, which directly affects the dosing of hydrophilic drugs such as beta-lactam antibiotics like ampicillin.[31] Thus, these drugs are administered at greater weight-based doses or with adjusted dosing intervals in children to account for this key difference in body composition.[31][30]

Infants and neonates also have fewer plasma proteins. Thus, highly protein-bound drugs have fewer opportunities for protein binding, leading to increased distribution.[30]

Metabolism

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Drug metabolism primarily occurs via enzymes in the liver and can vary according to which specific enzymes are affected in a specific stage of development.[31] Phase I and Phase II enzymes have different rates of maturation and development, depending on their specific mechanism of action (i.e. oxidation, hydrolysis, acetylation, methylation, etc.). Enzyme capacity, clearance, and half-life are all factors that contribute to metabolism differences between children and adults.[31][32] Drug metabolism can even differ within the pediatric population, separating neonates and infants from young children.[30]

Elimination

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Drug elimination is primarily facilitated via the liver and kidneys.[31] In infants and young children, the larger relative size of their kidneys leads to increased renal clearance of medications that are eliminated through urine.[32] In preterm neonates and infants, their kidneys are slower to mature and thus are unable to clear as much drug as fully developed kidneys. This can cause unwanted drug build-up, which is why it is important to consider lower doses and greater dosing intervals for this population.[30][31] Diseases that negatively affect kidney function can also have the same effect and thus warrant similar considerations.[31]

Pediatric autonomy in healthcare

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A major difference between the practice of pediatric and adult medicine is that children, in most jurisdictions and with certain exceptions, cannot make decisions for themselves. The issues of guardianship, privacy, legal responsibility, and informed consent must always be considered in every pediatric procedure. Pediatricians often have to treat the parents and sometimes, the family, rather than just the child. Adolescents are in their own legal class, having rights to their own health care decisions in certain circumstances. The concept of legal consent combined with the non-legal consent (assent) of the child when considering treatment options, especially in the face of conditions with poor prognosis or complicated and painful procedures/surgeries, means the pediatrician must take into account the desires of many people, in addition to those of the patient.[citation needed]

History of pediatric autonomy

[edit]

The term autonomy is traceable to ethical theory and law, where it states that autonomous individuals can make decisions based on their own logic.[33] Hippocrates was the first to use the term in a medical setting. He created a code of ethics for doctors called the Hippocratic Oath that highlighted the importance of putting patients' interests first, making autonomy for patients a top priority in health care.[34]  

In ancient times, society did not view pediatric medicine as essential or scientific.[35] Experts considered professional medicine unsuitable for treating children. Children also had no rights. Fathers regarded their children as property, so their children's health decisions were entrusted to them.[5] As a result, mothers, midwives, "wise women", and general practitioners treated the children instead of doctors.[35] Since mothers could not rely on professional medicine to take care of their children, they developed their own methods, such as using alkaline soda ash to remove the vernix at birth and treating teething pain with opium or wine. The absence of proper pediatric care, rights, and laws in health care to prioritize children's health led to many of their deaths. Ancient Greeks and Romans sometimes even killed healthy female babies and infants with deformities since they had no adequate medical treatment and no laws prohibiting infanticide.[5]

In the twentieth century, medical experts began to put more emphasis on children's rights. In 1989, in the United Nations Rights of the Child Convention, medical experts developed the Best Interest Standard of Child to prioritize children's rights and best interests. This event marked the onset of pediatric autonomy. In 1995, the American Academy of Pediatrics (AAP) finally acknowledged the Best Interest Standard of a Child as an ethical principle for pediatric decision-making, and it is still being used today.[34]

Parental authority and current medical issues

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The majority of the time, parents have the authority to decide what happens to their child. Philosopher John Locke argued that it is the responsibility of parents to raise their children and that God gave them this authority. In modern society, Jeffrey Blustein, modern philosopher and author of the book Parents and Children: The Ethics of Family, argues that parental authority is granted because the child requires parents to satisfy their needs. He believes that parental autonomy is more about parents providing good care for their children and treating them with respect than parents having rights.[36] The researcher Kyriakos Martakis, MD, MSc, explains that research shows parental influence negatively affects children's ability to form autonomy. However, involving children in the decision-making process allows children to develop their cognitive skills and create their own opinions and, thus, decisions about their health. Parental authority affects the degree of autonomy the child patient has. As a result, in Argentina, the new National Civil and Commercial Code has enacted various changes to the healthcare system to encourage children and adolescents to develop autonomy. It has become more crucial to let children take accountability for their own health decisions.[37]

In most cases, the pediatrician, parent, and child work as a team to make the best possible medical decision. The pediatrician has the right to intervene for the child's welfare and seek advice from an ethics committee. However, in recent studies, authors have denied that complete autonomy is present in pediatric healthcare. The same moral standards should apply to children as they do to adults. In support of this idea is the concept of paternalism, which negates autonomy when it is in the patient's interests. This concept aims to keep the child's best interests in mind regarding autonomy. Pediatricians can interact with patients and help them make decisions that will benefit them, thus enhancing their autonomy. However, radical theories that question a child's moral worth continue to be debated today.[37] Authors often question whether the treatment and equality of a child and an adult should be the same. Author Tamar Schapiro notes that children need nurturing and cannot exercise the same level of authority as adults.[38] Hence, continuing the discussion on whether children are capable of making important health decisions until this day.

Modern advancements

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According to the Subcommittee of Clinical Ethics of the Argentinean Pediatric Society (SAP), children can understand moral feelings at all ages and can make reasonable decisions based on those feelings. Therefore, children and teens are deemed capable of making their own health decisions when they reach the age of 13. Recently, studies made on the decision-making of children have challenged that age to be 12.[37]

Technology has made several modern advancements that contribute to the future development of child autonomy, for example, unsolicited findings (U.F.s) of pediatric exome sequencing. They are findings based on pediatric exome sequencing that explain in greater detail the intellectual disability of a child and predict to what extent it will affect the child in the future. Genetic and intellectual disorders in children make them incapable of making moral decisions, so people look down upon this kind of testing because the child's future autonomy is at risk. It is still in question whether parents should request these types of testing for their children. Medical experts argue that it could endanger the autonomous rights the child will possess in the future. However, the parents contend that genetic testing would benefit the welfare of their children since it would allow them to make better health care decisions.[39] Exome sequencing for children and the decision to grant parents the right to request them is a medically ethical issue that many still debate today.

Education requirements

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Aspiring medical students will need 4 years of undergraduate courses at a college or university, which will get them a BS, BA or other bachelor's degree. After completing college, future pediatricians will need to attend 4 years of medical school (MD/DO/MBBS) and later do 3 more years of residency training, the first year of which is called "internship." After completing the 3 years of residency, physicians are eligible to become certified in pediatrics by passing a rigorous test that deals with medical conditions related to young children.[citation needed]

In high school, future pediatricians are required to take basic science classes such as biology, chemistry, physics, algebra, geometry, and calculus. It is also advisable to learn a foreign language (preferably Spanish in the United States) and be involved in high school organizations and extracurricular activities. After high school, college students simply need to fulfill the basic science course requirements that most medical schools recommend and will need to prepare to take the MCAT (Medical College Admission Test) in their junior or early senior year in college. Once attending medical school, student courses will focus on basic medical sciences like human anatomy, physiology, chemistry, etc., for the first three years, the second year of which is when medical students start to get hands-on experience with actual patients.[40]

Training of pediatricians

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Pediatrics
Occupation
Names
  • Pediatrician
  • Paediatrician
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
  • Doctor of Medicine
  • Doctor of Osteopathic Medicine
  • Bachelor of Medicine, Bachelor of Surgery (MBBS/MBChB)
Fields of
employment
Hospitals, Clinics

The training of pediatricians varies considerably across the world. Depending on jurisdiction and university, a medical degree course may be either undergraduate-entry or graduate-entry. The former commonly takes five or six years and has been usual in the Commonwealth. Entrants to graduate-entry courses (as in the US), usually lasting four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Medical graduates hold a degree specific to the country and university in and from which they graduated. This degree qualifies that medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for "internship" or "conditional registration".

Pediatricians must undertake further training in their chosen field. This may take from four to eleven or more years depending on jurisdiction and the degree of specialization.

In the United States, a medical school graduate wishing to specialize in pediatrics must undergo a three-year residency composed of outpatient, inpatient, and critical care rotations. Subspecialties within pediatrics require further training in the form of 3-year fellowships. Subspecialties include critical care, gastroenterology, neurology, infectious disease, hematology/oncology, rheumatology, pulmonology, child abuse, emergency medicine, endocrinology, neonatology, and others.[41]

In most jurisdictions, entry-level degrees are common to all branches of the medical profession, but in some jurisdictions, specialization in pediatrics may begin before completion of this degree. In some jurisdictions, pediatric training is begun immediately following the completion of entry-level training. In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing pediatric (or any other) specialization. Specialist training is often largely under the control of 'pediatric organizations (see below) rather than universities and depends on the jurisdiction.

Subspecialties

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Subspecialties of pediatrics include:

(not an exhaustive list)

  • Addiction medicine (multidisciplinary)
  • Adolescent medicine
  • Child abuse pediatrics
  • Clinical genetics
  • Clinical informatics
  • Developmental-behavioral pediatrics
  • Headache medicine
  • Hospital medicine
  • Medical toxicology
  • Metabolic medicine
  • Neonatology/Perinatology
  • Pain medicine (multidisciplinary)
  • Palliative care (multidisciplinary)
  • Pediatric allergy and immunology
  • Pediatric cardiology
    • Pediatric cardiac critical care
  • Pediatric critical care
    • Neurocritical care
    • Pediatric cardiac critical care
  • Pediatric emergency medicine
  • Pediatric endocrinology
  • Pediatric gastroenterology
    • Transplant hepatology
  • Pediatric hematology
  • Pediatric infectious disease
  • Pediatric nephrology
  • Pediatric oncology
    • Pediatric neuro-oncology
  • Pediatric pulmonology
  • Primary care
  • Pediatric rheumatology
  • Sleep medicine (multidisciplinary)
  • Social pediatrics
  • Sports medicine

Other specialties that care for children

[edit]

(not an exhaustive list)

  • Child neurology
    • Addiction medicine (multidisciplinary)
    • Brain injury medicine
    • Clinical neurophysiology
    • Epilepsy
    • Headache medicine
    • Neurocritical care
    • Neuroimmunology
    • Neuromuscular medicine
    • Pain medicine (multidisciplinary)
    • Palliative care (multidisciplinary)
    • Pediatric neuro-oncology
    • Sleep medicine (multidisciplinary)
  • Child and adolescent psychiatry, subspecialty of psychiatry
  • Neurodevelopmental disabilities
  • Pediatric anesthesiology, subspecialty of anesthesiology
  • Pediatric dentistry, subspecialty of dentistry
  • Pediatric dermatology, subspecialty of dermatology
  • Pediatric gynecology
  • Pediatric neurosurgery, subspecialty of neurosurgery
  • Pediatric ophthalmology, subspecialty of ophthalmology
  • Pediatric orthopedic surgery, subspecialty of orthopedic surgery
  • Pediatric otolaryngology, subspecialty of otolaryngology
  • Pediatric plastic surgery, subspecialty of plastic surgery
  • Pediatric radiology, subspecialty of radiology
  • Pediatric rehabilitation medicine, subspecialty of physical medicine and rehabilitation
  • Pediatric surgery, subspecialty of general surgery
  • Pediatric urology, subspecialty of urology

See also

[edit]
  • American Academy of Pediatrics
  • American Osteopathic Board of Pediatrics
  • Center on Media and Child Health (CMCH)
  • Children's hospital
  • List of pediatric organizations
  • List of pediatrics journals
  • Medical specialty
  • Pediatric Oncall
  • Pain in babies
  • Royal College of Paediatrics and Child Health
  • Pediatric environmental health

References

[edit]
  1. ^ "Paediatrics" (PDF). nhs.uk. Archived (PDF) from the original on 13 July 2020. Retrieved 2 July 2020.
  2. ^ "Choosing a Pediatrician for Your New Baby (for Parents) - Nemours KidsHealth". kidshealth.org. Archived from the original on 14 July 2020. Retrieved 13 July 2020.
  3. ^ "Age limits of pediatrics". Pediatrics. 81 (5): 736. May 1988. doi:10.1542/peds.81.5.736. PMID 3357740. S2CID 245164191. Archived from the original on 19 April 2017. Retrieved 18 April 2017.
  4. ^ Sawyer, Susan M.; McNeil, Robyn; Francis, Kate L.; Matskarofski, Juliet Z.; Patton, George C.; Bhutta, Zulfiqar A.; Esangbedo, Dorothy O.; Klein, Jonathan D. (1 November 2019). "The age of paediatrics". The Lancet Child & Adolescent Health. 3 (11): 822–830. doi:10.1016/S2352-4642(19)30266-4. ISSN 2352-4642. PMID 31542355. S2CID 202732818.
  5. ^ a b c d e Duffin, Jacalyn (2010). History of Medicine, Second Edition: A Scandalously Short Introduction. University of Toronto Press.
  6. ^ a b c d e Colón, A. R.; Colón, P. A. (January 1999). Nurturing children: a history of pediatrics. Greenwood Press. ISBN 978-0-313-31080-5. Retrieved 20 October 2012.
  7. ^ Celsus, De Medicina, Book 3, Chapter 7, § 1.
  8. ^ John G. Raffensperger. Children's Surgery: A Worldwide History. McFarland. p. 21.
  9. ^ David Levinson; Karen Christensen. Encyclopedia of modern Asia. Vol. 4. Charles Scribner's Sons. p. 116.
  10. ^ Desai, A.B. Textbook Of Paediatrics. Orient blackswan. p. 1.
  11. ^ Dunn, P. M. (1995). "Soranus of Ephesus (Circa AD 98-138) and perinatal care in Roman times". Archives of Disease in Childhood. Fetal and Neonatal Edition. 73 (1): F51 – F52. doi:10.1136/fn.73.1.f51. PMC 2528358. PMID 7552600.
  12. ^ Elgood, Cyril (2010). A Medical History of Persia and The Eastern Caliphate (1st ed.). London: Cambridge. pp. 202–203. ISBN 978-1-108-01588-2. By writing a monograph on 'Diseases in Children' he may also be looked upon as the father of paediatrics.
  13. ^ U.S. National Library of Medicine, "Islamic Culture and the Medical Arts, Al-Razi, the Clinician" [1] Archived 5 January 2018 at the Wayback Machine
  14. ^ "Achar S Textbook Of Pediatrics (Third Edition)". A. B. Desai (ed.) (1989). p.1. ISBN 81-250-0440-8
  15. ^ Stern, Alexandra Minna; Markel, Howard (2002). Formative Years: Children's Health in the United States, 1880-2000. University of Michigan Press. pp. 23–24. doi:10.3998/mpub.17065. ISBN 978-0-472-02503-9. Archived from the original on 30 November 2021. Retrieved 30 November 2021.
  16. ^ Lock, Stephen; John M. Last; George Dunea (2001). The Oxford illustrated companion to medicine. Oxford University Press US. p. 173. ISBN 978-0-19-262950-0. Retrieved 9 July 2010. Rosen von Rosenstein.
  17. ^ Roberts, Michael (2003). The Age of Liberty: Sweden 1719–1772. Cambridge University Press. p. 216. ISBN 978-0-521-52707-1. Retrieved 9 July 2010.
  18. ^ Dallas, John. "Classics of Child Care". Royal College of Physicians of Edinburgh. Archived from the original on 27 July 2011. Retrieved 9 July 2010.
  19. ^ Duffin, Jacalyn (29 May 2010). History of Medicine, Second Edition: A Scandalously Short Introduction. University of Toronto Press.
  20. ^ Stern, Alexandra Minna; Markel, Howard (2002). Formative Years: Children's Health in the United States, 1880-2000. University of Michigan Press. pp. 23–24. doi:10.3998/mpub.17065. ISBN 978-0-472-02503-9. Archived from the original on 30 November 2021. Retrieved 30 November 2021.
  21. ^ "Broadribb's Introductory Pediatric Nursing". Nancy T. Hatfield (2007). p.4. ISBN 0-7817-7706-2
  22. ^ "Jacobi Medical Center - General Information". Archived from the original on 18 April 2006. Retrieved 6 April 2006.
  23. ^ Kutzsche, Stefan (8 April 2021). "Abraham Jacobi (1830–1919) and his transition from political to medical activist". Acta Paediatrica. 110 (8): 2303–2305. doi:10.1111/apa.15887. ISSN 0803-5253. PMID 33963612. S2CID 233998658. Archived from the original on 7 May 2023. Retrieved 7 May 2023.
  24. ^ a b Ballbriga, Angel (1991). "One century of pediatrics in Europe (section: development of pediatric hospitals in Europe)". In Nichols, Burford L.; et al. (eds.). History of Paediatrics 1850–1950. Nestlé Nutrition Workshop Series. Vol. 22. New York: Raven Press. pp. 6–8. ISBN 0-88167-695-0.
  25. ^ official history site (in French) of nineteenth century paediatric hospitals in Paris
  26. ^ "Introducing the Necker-Enfants Malades Hospital". Hôpital des Necker-Enfants Malades.
  27. ^ Young, D.G. (August 1999). "The Mason Brown Lecture: Scots and paediatric surgery". Journal of the Royal College of Surgeons Edinburgh. 44 (4): 211–5. PMID 10453141. Archived from the original on 14 July 2014.
  28. ^ Pearson, Howard A. (1991). "Pediatrics in the United States". In Nichols, Burford L.; et al. (eds.). History of Paediatrics 1850–1950. Nestlé Nutrition Workshop Series. Vol. 22. New York: Raven Press. pp. 55–63. ISBN 0-88167-695-0.
  29. ^ "Commentaries: Edwards A Park". Pediatrics. 44 (6). American Academy of Pediatrics: 897–901. 1969. doi:10.1542/peds.44.6.897. PMID 4903838. S2CID 43298798.
  30. ^ a b c d e f g h O'Hara, Kate (2016). "Paediatric pharmacokinetics and drug doses". Australian Prescriber. 39 (6): 208–210. doi:10.18773/austprescr.2016.071. ISSN 0312-8008. PMC 5155058. PMID 27990048.
  31. ^ a b c d e f g h i j k l m Wagner, Jonathan; Abdel-Rahman, Susan M. (2013). "Pediatric pharmacokinetics". Pediatrics in Review. 34 (6): 258–269. doi:10.1542/pir.34-6-258. ISSN 1526-3347. PMID 23729775.
  32. ^ a b c d e f Batchelor, Hannah Katharine; Marriott, John Francis (2015). "Paediatric pharmacokinetics: key considerations". British Journal of Clinical Pharmacology. 79 (3): 395–404. doi:10.1111/bcp.12267. ISSN 1365-2125. PMC 4345950. PMID 25855821.
  33. ^ Katz, Aviva L.; Webb, Sally A.; COMMITTEE ON BIOETHICS; Macauley, Robert C.; Mercurio, Mark R.; Moon, Margaret R.; Okun, Alexander L.; Opel, Douglas J.; Statter, Mindy B. (1 August 2016). "Informed Consent in Decision-Making in Pediatric Practice". Pediatrics. 138 (2): e20161485. doi:10.1542/peds.2016-1485. ISSN 0031-4005. PMID 27456510. S2CID 7951515.
  34. ^ a b Mazur, Kate A.; Berg, Stacey L., eds. (2020). Ethical Issues in Pediatric Hematology/Oncology. pp. 13–21. doi:10.1007/978-3-030-22684-8. ISBN 978-3-030-22683-1. S2CID 208302429.
  35. ^ a b Stern, Alexandra Minna; Markel, Howard (2002). Formative Years: Children's Health in the United States, 1880-2000. University of Michigan Press. pp. 23–24. doi:10.3998/mpub.17065. ISBN 978-0-472-02503-9. Archived from the original on 30 November 2021. Retrieved 30 November 2021.
  36. ^ Friedman, Lainie Ross (2004). Children, families, and health care decision making. Clarendon Press. ISBN 0-19-925154-1. OCLC 756393117.
  37. ^ a b c Martakis, K.; Schröder-Bäck, P.; Brand, H. (1 June 2018). "Developing child autonomy in pediatric healthcare: towards an ethical model". Archivos Argentinos de Pediatria. 116 (3): e401 – e408. doi:10.5546/aap.2018.eng.e401. ISSN 0325-0075. PMID 29756714. S2CID 46889502.
  38. ^ Schapiro, Tamar (1 July 1999). "What Is a Child?". Ethics. 109 (4): 715–738. doi:10.1086/233943. ISSN 0014-1704. S2CID 170129444. Archived from the original on 30 November 2021. Retrieved 30 November 2021.
  39. ^ Dondorp, W.; Bolt, I.; Tibben, A.; De Wert, G.; Van Summeren, M. (1 September 2021). "'We Should View Him as an Individual': The Role of the Child's Future Autonomy in Shared Decision-Making About Unsolicited Findings in Pediatric Exome Sequencing". Health Care Analysis. 29 (3): 249–261. doi:10.1007/s10728-020-00425-7. ISSN 1573-3394. PMID 33389383. S2CID 230112761.
  40. ^ "What Education Is Required to Be a Pediatrician?". Archived from the original on 7 June 2017. Retrieved 14 June 2017.
  41. ^ "CoPS". www.pedsubs.org. Archived from the original on 18 September 2013. Retrieved 14 August 2015.

Further reading

[edit]
  • BMC Pediatrics - open access
  • Clinical Pediatrics
  • Developmental Review - partial open access
  • JAMA Pediatrics
  • The Journal of Pediatrics - partial open access
[edit]
  • Pediatrics Directory at Curlie
  • Pediatric Health Directory at OpenMD

 

Crossbite
Unilateral posterior crossbite
Specialty Orthodontics

In dentistry, crossbite is a form of malocclusion where a tooth (or teeth) has a more buccal or lingual position (that is, the tooth is either closer to the cheek or to the tongue) than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.[1][2]

Anterior crossbite

[edit]
Class 1 with anterior crossbite

An anterior crossbite can be referred as negative overjet, and is typical of class III skeletal relations (prognathism).

Primary/mixed dentitions

[edit]

An anterior crossbite in a child with baby teeth or mixed dentition may happen due to either dental misalignment or skeletal misalignment. Dental causes may be due to displacement of one or two teeth, where skeletal causes involve either mandibular hyperplasia, maxillary hypoplasia or combination of both.

Dental crossbite

[edit]

An anterior crossbite due to dental component involves displacement of either maxillary central or lateral incisors lingual to their original erupting positions. This may happen due to delayed eruption of the primary teeth leading to permanent teeth moving lingual to their primary predecessors. This will lead to anterior crossbite where upon biting, upper teeth are behind the lower front teeth and may involve few or all frontal incisors. In this type of crossbite, the maxillary and mandibular proportions are normal to each other and to the cranial base. Another reason that may lead to a dental crossbite is crowding in the maxillary arch. Permanent teeth will tend to erupt lingual to the primary teeth in presence of crowding. Side-effects caused by dental crossbite can be increased recession on the buccal of lower incisors and higher chance of inflammation in the same area. Another term for an anterior crossbite due to dental interferences is Pseudo Class III Crossbite or Malocclusion.

Single tooth crossbite

[edit]

Single tooth crossbites can occur due to uneruption of a primary teeth in a timely manner which causes permanent tooth to erupt in a different eruption pattern which is lingual to the primary tooth.[3] Single tooth crossbites are often fixed by using a finger-spring based appliances.[4][5] This type of spring can be attached to a removable appliance which is used by patient every day to correct the tooth position.

Skeletal crossbite

[edit]

An anterior crossbite due to skeletal reasons will involve a deficient maxilla and a more hyperplastic or overgrown mandible. People with this type of crossbite will have dental compensation which involves proclined maxillary incisors and retroclined mandibular incisors. A proper diagnosis can be made by having a person bite into their centric relation will show mandibular incisors ahead of the maxillary incisors, which will show the skeletal discrepancy between the two jaws.[6]

Posterior crossbite

[edit]

Bjork defined posterior crossbite as a malocclusion where the buccal cusps of canine, premolar and molar of upper teeth occlude lingually to the buccal cusps of canine, premolar and molar of lower teeth.[7] Posterior crossbite is often correlated to a narrow maxilla and upper dental arch. A posterior crossbite can be unilateral, bilateral, single-tooth or entire segment crossbite. Posterior crossbite has been reported to occur between 7–23% of the population.[8][9] The most common type of posterior crossbite to occur is the unilateral crossbite which occurs in 80% to 97% of the posterior crossbite cases.[10][3] Posterior crossbites also occur most commonly in primary and mixed dentition. This type of crossbite usually presents with a functional shift of the mandible towards the side of the crossbite. Posterior crossbite can occur due to either skeletal, dental or functional abnormalities. One of the common reasons for development of posterior crossbite is the size difference between maxilla and mandible, where maxilla is smaller than mandible.[11] Posterior crossbite can result due to

  • Upper Airway Obstruction where people with "adenoid faces" who have trouble breathing through their nose. They have an open bite malocclusion and present with development of posterior crossbite.[12]
  • Prolong digit or suckling habits which can lead to constriction of maxilla posteriorly[13]
  • Prolong pacifier use (beyond age 4)[13]

Connections with TMD

[edit]

Unilateral posterior crossbite

[edit]

Unilateral crossbite involves one side of the arch. The most common cause of unilateral crossbite is a narrow maxillary dental arch. This can happen due to habits such as digit sucking, prolonged use of pacifier or upper airway obstruction. Due to the discrepancy between the maxillary and mandibular arch, neuromuscular guidance of the mandible causes mandible to shift towards the side of the crossbite.[14] This is also known as Functional mandibular shift. This shift can become structural if left untreated for a long time during growth, leading to skeletal asymmetries. Unilateral crossbites can present with following features in a child

  • Lower midline deviation[15] to the crossbite side
  • Class 2 Subdivision relationships
  • Temporomandibular disorders [16]

Treatment

[edit]

A child with posterior crossbite should be treated immediately if the child shifts their mandible on closing, which is often seen in a unilateral crossbite as mentioned above. The best age to treat a child with crossbite is in their mixed dentition when their palatal sutures have not fused to each other. Palatal expansion allows more space in an arch to relieve crowding and correct posterior crossbite. The correction can include any type of palatal expanders that will expand the palate which resolves the narrow constriction of the maxilla.[9] There are several therapies that can be used to correct a posterior crossbite: braces, 'Z' spring or cantilever spring, quad helix, removable plates, clear aligner therapy, or a Delaire mask. The correct therapy should be decided by the orthodontist depending on the type and severity of the crossbite.

One of the keys in diagnosing the anterior crossbite due to skeletal vs dental causes is diagnosing a CR-CO shift in a patient. An adolescent presenting with anterior crossbite may be positioning their mandible forward into centric occlusion (CO) due to the dental interferences. Thus finding their occlusion in centric relation (CR) is key in diagnosis. For anterior crossbite, if their CO matches their CR then the patient truly has a skeletal component to their crossbite. If the CR shows a less severe class 3 malocclusion or teeth not in anterior crossbite, this may mean that their anterior crossbite results due to dental interferences.[17]

Goal to treat unilateral crossbites should definitely include removal of occlusal interferences and elimination of the functional shift. Treating posterior crossbites early may help prevent the occurrence of Temporomandibular joint pathology.[18]

Unilateral crossbites can also be diagnosed and treated properly by using a Deprogramming splint. This splint has flat occlusal surface which causes the muscles to deprogram themselves and establish new sensory engrams. When the splint is removed, a proper centric relation bite can be diagnosed from the bite.[19]

Self-correction

[edit]

Literature states that very few crossbites tend to self-correct which often justify the treatment approach of correcting these bites as early as possible.[9] Only 0–9% of crossbites self-correct. Lindner et al. reported that 50% of crossbites were corrected in 76 four-year-old children.[20]

See also

[edit]
  • List of palatal expanders
  • Palatal expansion
  • Malocclusion

References

[edit]
  1. ^ "Elsevier: Proffit: Contemporary Orthodontics · Welcome". www.contemporaryorthodontics.com. Retrieved 2016-12-11.
  2. ^ Borzabadi-Farahani A, Borzabadi-Farahani A, Eslamipour F (October 2009). "Malocclusion and occlusal traits in an urban Iranian population. An epidemiological study of 11- to 14-year-old children". European Journal of Orthodontics. 31 (5): 477–84. doi:10.1093/ejo/cjp031. PMID 19477970.
  3. ^ a b Kutin, George; Hawes, Roland R. (1969-11-01). "Posterior cross-bites in the deciduous and mixed dentitions". American Journal of Orthodontics. 56 (5): 491–504. doi:10.1016/0002-9416(69)90210-3. PMID 5261162.
  4. ^ Zietsman, S. T.; Visagé, W.; Coetzee, W. J. (2000-11-01). "Palatal finger springs in removable orthodontic appliances--an in vitro study". South African Dental Journal. 55 (11): 621–627. ISSN 1029-4864. PMID 12608226.
  5. ^ Ulusoy, Ayca Tuba; Bodrumlu, Ebru Hazar (2013-01-01). "Management of anterior dental crossbite with removable appliances". Contemporary Clinical Dentistry. 4 (2): 223–226. doi:10.4103/0976-237X.114855. ISSN 0976-237X. PMC 3757887. PMID 24015014.
  6. ^ Al-Hummayani, Fadia M. (2017-03-05). "Pseudo Class III malocclusion". Saudi Medical Journal. 37 (4): 450–456. doi:10.15537/smj.2016.4.13685. ISSN 0379-5284. PMC 4852025. PMID 27052290.
  7. ^ Bjoerk, A.; Krebs, A.; Solow, B. (1964-02-01). "A Method for Epidemiological Registration of Malocculusion". Acta Odontologica Scandinavica. 22: 27–41. doi:10.3109/00016356408993963. ISSN 0001-6357. PMID 14158468.
  8. ^ Moyers, Robert E. (1988-01-01). Handbook of orthodontics. Year Book Medical Publishers. ISBN 9780815160038.
  9. ^ a b c Thilander, Birgit; Lennartsson, Bertil (2002-09-01). "A study of children with unilateral posterior crossbite, treated and untreated, in the deciduous dentition--occlusal and skeletal characteristics of significance in predicting the long-term outcome". Journal of Orofacial Orthopedics. 63 (5): 371–383. doi:10.1007/s00056-002-0210-6. ISSN 1434-5293. PMID 12297966. S2CID 21857769.
  10. ^ Thilander, Birgit; Wahlund, Sonja; Lennartsson, Bertil (1984-01-01). "The effect of early interceptive treatment in children with posterior cross-bite". The European Journal of Orthodontics. 6 (1): 25–34. doi:10.1093/ejo/6.1.25. ISSN 0141-5387. PMID 6583062.
  11. ^ Allen, David; Rebellato, Joe; Sheats, Rose; Ceron, Ana M. (2003-10-01). "Skeletal and dental contributions to posterior crossbites". The Angle Orthodontist. 73 (5): 515–524. ISSN 0003-3219. PMID 14580018.
  12. ^ Bresolin, D.; Shapiro, P. A.; Shapiro, G. G.; Chapko, M. K.; Dassel, S. (1983-04-01). "Mouth breathing in allergic children: its relationship to dentofacial development". American Journal of Orthodontics. 83 (4): 334–340. doi:10.1016/0002-9416(83)90229-4. ISSN 0002-9416. PMID 6573147.
  13. ^ a b Ogaard, B.; Larsson, E.; Lindsten, R. (1994-08-01). "The effect of sucking habits, cohort, sex, intercanine arch widths, and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3-year-old children". American Journal of Orthodontics and Dentofacial Orthopedics. 106 (2): 161–166. doi:10.1016/S0889-5406(94)70034-6. ISSN 0889-5406. PMID 8059752.
  14. ^ Piancino, Maria Grazia; Kyrkanides, Stephanos (2016-04-18). Understanding Masticatory Function in Unilateral Crossbites. John Wiley & Sons. ISBN 9781118971871.
  15. ^ Brin, Ilana; Ben-Bassat, Yocheved; Blustein, Yoel; Ehrlich, Jacob; Hochman, Nira; Marmary, Yitzhak; Yaffe, Avinoam (1996-02-01). "Skeletal and functional effects of treatment for unilateral posterior crossbite". American Journal of Orthodontics and Dentofacial Orthopedics. 109 (2): 173–179. doi:10.1016/S0889-5406(96)70178-6. PMID 8638566.
  16. ^ Pullinger, A. G.; Seligman, D. A.; Gornbein, J. A. (1993-06-01). "A multiple logistic regression analysis of the risk and relative odds of temporomandibular disorders as a function of common occlusal features". Journal of Dental Research. 72 (6): 968–979. doi:10.1177/00220345930720061301. ISSN 0022-0345. PMID 8496480. S2CID 25351006.
  17. ^ COSTEA, CARMEN MARIA; BADEA, MÎNDRA EUGENIA; VASILACHE, SORIN; MESAROÅž, MICHAELA (2016-01-01). "Effects of CO-CR discrepancy in daily orthodontic treatment planning". Clujul Medical. 89 (2): 279–286. doi:10.15386/cjmed-538. ISSN 1222-2119. PMC 4849388. PMID 27152081.
  18. ^ Kennedy, David B.; Osepchook, Matthew (2005-09-01). "Unilateral posterior crossbite with mandibular shift: a review". Journal (Canadian Dental Association). 71 (8): 569–573. ISSN 1488-2159. PMID 16202196.
  19. ^ Nielsen, H. J.; Bakke, M.; Blixencrone-Møller, T. (1991-12-01). "[Functional and orthodontic treatment of a patient with an open bite craniomandibular disorder]". Tandlaegebladet. 95 (18): 877–881. ISSN 0039-9353. PMID 1817382.
  20. ^ Lindner, A. (1989-10-01). "Longitudinal study on the effect of early interceptive treatment in 4-year-old children with unilateral cross-bite". Scandinavian Journal of Dental Research. 97 (5): 432–438. doi:10.1111/j.1600-0722.1989.tb01457.x. ISSN 0029-845X. PMID 2617141.
[edit]

 

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Frequently Asked Questions

The collaboration between orthodontists and surgeons is based on a detailed plan that includes precise surgical movements and post-surgical orthodontic alignment. This collaboration is necessary to achieve both aesthetic and functional goals while ensuring long-term stability of the treatment.