JednostranneÏ zkrïõâzï enyâ skus Unilateral crossbite

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1 ORTODONCIE rocïnõâk20 JednostranneÏ zkrïõâzï enyâ skus Unilateral crossbite MUDr. Zuzana KrizÏanovaÂ, MUDr. PavlõÂna CÏ ernochovaâ, Ph.D. Ortodonticke oddeï lenõâ, Fakultnõ nemocnice u sv. Anny Brno Souhrn CõÂlem praâ ce bylo zjistit, zda se u pacientuê s jednostranneï zkrïõâzï enyâ m skusem a ve veï koveâ m obdobõâ 6 azï 11 let objevõâ asymetrickyâ ruê st kondyluê a veï tvõâ dolnõâ cï elisti na straneï se zkrïõâzï enyâ m skusem a na straneï bez zkrïõâzï eneâ ho skusu a to ve srovnaâ nõâ s kontrolnõâ skupinou pacientuê s ideaâ lnõâmi podmõânkami okluze. MeÏ rïenõâ bylo provedeno na souborech pacientuê s jednostranneï zkrïõâzï enyâ m skusem (n=44) a s ideaâ lnõâ okluzõâ (n=38) bez prïedchozõâ ortodontickeâ leâ cï by a ke stanovenõâ vyâ sï kovyâ ch parametruê dolnõâ cï elisti byly pouzï ity panoramatickeâ snõâmky. Z vyâ sledkuê meï rïenõâ a statistickeâ ho hodnocenõâ vyplynulo, zï e nebyly nalezeny zï aâ dneâ statisticky vyâ znamneâ asymetrie u pacientuê s jednostranneï zkrïõâzïenyâ m skusem (Ortodoncie 2011, 20, cï. 2, s ). Abstract The aim of the study was to find out whether in patients with unilateral crossbite between the age of 6 and 11 the asymmetric growth of condyles and mandibular rami at the side with crossbite will appear. The patients were compared with a control group with an ideal occlusion. Measurements were performed in groups of patients with unilateral crossbite (n=44) and with an ideal occlusion (n=38) without preceding orthodontic treatment. To establish height parameters of the mandible, panoramic X-ray pictures were used. Measurements and statistical evaluation results suggest that no statistically significant asymmetry is found in patients with unilateral crossbite (Ortodoncie 2011, 20, No. 2, p ). KlõÂcÏ ovaâ slova: jednostranneï zkrïõâzï enyâ skus, funkcï nõâ zkrïõâzï enyâ skus Key words: unilateral crossbite, functional crossbite U vod ZkrÏõÂzÏ enyâ skus patrïõâ mezi transverzaâ lnõâ anomaâ l ie a jeho cï etnost v populaci kolõâsaâ od 7% do 23% [1, 2]. VysÏ sï õâ vyâ skyt muê zï e souviset s tõâm, zï e neï kterïõâ autorïi zahrnujõâ do definice zkrïõâzïeneâ ho skusu i skus hrbolek na hrbolek. Nacha zõâme jej cï asto u pacientuê s docï asnou ev. cï asneï smõâsï enou denticõâ, ale i u dospeïlyâch pacientuê se staâ lou denticõâ. NejcÏ asteïjsï õâm projevem teâ to malokluze u deï tõâ s docï asnou nebo smõâsï enou denticõâ je jednostranneï zkrïõâzï enyâ skus s funkcï nõâ slozï kou. Vyskytuje se v 80-97% prïõâpaduê zkrïõâzïeneâ ho skusu [1, 2, 3]. Zpravidla vznikaâ symetrickyâm zuâ zï enõâm hornõâho zubnõâho oblouku s uchyâlenõâm dolnõâ cï elisti smeï rem k jedneâ straneï. Introduction Crossbite belongs to transversal anomalies, the prevalence varies between 7% and 23% [1,2]. Higher incidence may be related to the fact that some authors understand cusp-to-cusp bite as a kind of crossbite. We can find this type of occlusion in patients with deciduous or early mixed dentition, as well as in adults with permanent dentition. In children with deciduous or mixed dentition the malocclusion is manifested as a unilateral crossbite with a functional component. In a functionalcrossbite, the presence of an occlusalinterference causes a shift of the mandible upon closure. Its prevalence is between 80-97% of all crossbites

2 rocïnõâk20 ORTODONCIE U pacienta cï asto pozorujeme posun hornõâho a dolnõâho strïedu zubnõâch obloukuê vuêcï i sobeï. FunkcÏ nõâ skus je relativneï dobrïe a jednodusï e l eâcï itelnyâ v ranneï smõâsï eneâm chrupu. Na zaâ kladeï zkusï enostõâ uvaâ deï nyâ ch v odborneâ literaturïe je proto doporucï ovaâ na co nejcï asneï jsï õâ l eâcï ba. MuÊzÏ eme se tak snadno vyhnout pozdeïjsï õâ, mnohem komplikovaneï jsï õâ l eâ cï beï teâ to skusoveâ vady. BeÏ hem ruêstu dochaâ zõâ k adaptacï nõâm mechanismuê m na uâ rovni skeletaâ lnõâ, dentaâ lnõâ i svaloveâ a tõâm k zafixovaâ nõâ zminï o- vaneâ dysgnaâ cie. To muêzïe veâ st i k porusï enõâ symetrie oblicï eje a malokluze pak prïedstavuje zaâ vazïnyâ estetickyâ a terapeutickyâ probleâ m. Materia l a metodika Do retrospektivnõâ studie bylo zarïazeno 44 pacientuê (10 chlapcuê a 34 dõâvek) s jednostranneï zkrïõâzï enyâm skusem (vysï etrïovanyâ soubor) a 38 pacientuê (10 chlapcuê a 28 dõâvek) s normookluzõâ(kontrolnõâ skupina) z ortodontickeâ ho oddeï lenõâ Stomatologicke kliniky FN u sv. Anny v BrneÏ. Ve skupineï pacientuê s normookluzõâ byla stanovena naâ sledujõâcõâ kriteâ ria: (1) dentaâ lnõâ a skeletaâ lnõâ I. trïõâda urcï enaâ uâ hlem ANB, hodnotou WITS a molaâ rovou okluzõâ; (2) neutraâ lnõâ ruê stovaâ tendence; (3) dobraâ artikulace v postrannõâm uâ seku chrupu s horizontaâ lnõâm a vertkaâ lnõâm prïekusem; (4) bez uprïednostnï ovaâ nõâ jedneâ zï vyâkacõâ strany; (5) bez jakyâ chkoli vyâ vojovyâ ch cï i zõâskanyâ ch kraniofaciaâ lnõâch nebo neuromuskulaâ rnõâch deformit; (6) bez systeâ movyâ ch onemocneï nõâ; (7) bez prïedchozõâ ortodontickeâ l eâ cï by; (8) bez postizï enõâ temporomandibulaâ r- nõâho kloubu; (9) bez ztraâ ty zubu; (10) bez karieâ znõâch leâzõâ, rozsaâ hlejsï õâch restauracõâ nebo s patologickyâ m stavem parodontu. VysÏ etrïovanyâ soubor zahrnovalpacienty s jednostrannyâ m zkrïõâzï enyâ m skusem, kteryâ bylurcï en klinicky a postihovalminimaâ l neï 2 zuby. Krite ria (4) azï (10) pro kontrolnõâ skupinu platila i pro vysï etrïovanyâ soubor. VsÏ echny osoby byly prïi odebõâraânõâ uâ dajuê ve veï ku od 6 do 11 let (pruêmeï r 8,4 ± 1,3 ve vysï etrïovaneâ m souboru a 8,8 ± 1,5 v kontrolnõâ skupineï). K urcï enõâ vyâsï ek kondyluê aveï tvõâ dolnõâ cï elisti byly pouzï ity panoramatickeâ snõâmky, ktereâ byly zhotoveny za standardnõâch podmõânek na jednom typu prïõâstroje. ZaÂkladem pro odvozenõâ metodiky teâ to praâ ce bylo meï rïenõâ dle Habetse a kol. [4] (Obr. 1). NejlateraÂlneÏjsÏ õâ body kondyluê aveï tvõâ dolnõâ cï elisti byly oznacï eny jako body X a Y a to na leveâ i praveâ straneï. Linie prochaâ zejõâcõâ teï mito body (tangenta veï tve mandibuly) znacï õâ linii A. K linii A byla vedena kolmice (linie B) prochaâ zejõâcõâ tangenciaâlneï k obrysu kondylu, cïõâmzï vzniklpruê secï õâk, tj. bod Z. NameÏrÏena vzdaâ lenost mezi body X a Z byla oznacï ena jako vyâsï ka kondylu (CH). ObdobneÏ i nameï rïeneâ vzdaâ lenosti mezi body X a Y a mezi body Z a Y byly oznacï eny jako vyâsïka veï tve dolnõâ cï elisti (RH) a vyâsïka [1,2,3]. It is usually the result of symmetrical narrowing of the upper dentalarch and a lateralshift of the mandibular position. We can often see the shift of the centre of both upper and lower dental arch. A functional bite is relatively easy to treat in the early mixed dentition. Therefore, the early treatment is recommended. Thus we can avoid later and more complicated treatment of the malocclusion. During the growth there appear adaptation mechanisms on the skeletal, dental and muscular levels, and thus the anomaly is fixed. This may lead to the distorted symmetry of the face, and the malocclusion thus poses a serious aesthetic as well as therapeutic problem. Material and method The retrospective study included 44 patients (10 boys and 34 girls) with unilateral crossbite (examined group) and 38 patients (10 boys and 28 girls) with normalocclusion (controlgroup) treated at the Department of Orthodontics of the Clinic of Stomatology, University Hospitalof St. Anne's in Brno. The following criteria were met in the group of patients with normal occlusion: (1) dental and skeletal Class I, determined by ANB angle, WITS value, and molar occlusion; (2) neutral growth trend; (3) good articulation in the lateral segment of dentition with physiological overjet and overbite; (4) no side preferred in mastication; (5) no developmental or acquired craniofacial or neuromuscular deformities; (6) no systemic diseases; (7) no preceding orthodontic treatment; (8) no impairment of temporomandibular joint; (9) no loss of teeth; (10) no caries lesions, extensive restorations or pathologic periodontal problems. The examined group included patients with unilateral crossbite, clinically determined, which affected two teeth at least. Criteria (4) - (10) were used for the control group as well as for the examined sample. All patients were between the age of 6 and 11 (mean age 8.4 ± 1.3 in the examined group; 8.8 ± 1.5 in the controlgroup). Panoramic pictures (OPGs) made at standard conditions with the same device were used to determine condylar and ramal height. The method of measurement was based on the technique according to Habets et al [4] (Fig.1). The most lateral points of condyles and rami of the mandible were marked as points X and Y, both on left and right side. The line running through the points (mandible ramus tangent) marks the line A. The perpendicular (line B) goes to the line A running tangentially to the condylar outline, and the intersection is Z point. The distance between X and Z is condylar height (CH). The distance between X and Y and between Z and Y were called ramal height (RH) and condylar + ramal height (CH + RH). All measurements were

3 ORTODONCIE rocïnõâk20 kondylu + veï tve (CH + RH). VsÏ echna meïrïenõâ byla provedena pro pravou a levou stranu u kontrolnõâ skupiny a pro stranu se zkrïõâzï enyâm skusem a bez zkrïõâzï eneâho skusu pro vysï etrïovanyâ soubor. Habets a kol. [4] vypracovali vzorec, podle ktereâho se vypocï õâtajõâ indexy asymetrie pro vsï echny vyâsï e zmõâneï neâ vyâsï koveâ parametry dolnõâ cï elisti. Index asymetrie (AI): [(pravaâ strana - levaâ strana) / (pravaâ strana + levaâ strana)] x 100% Vy sledky Ve vysï etrïovaneâ m souboru pacientuê s jednostranneï zkrïõâzïenyâm skusem bylo celkem 44 pacientuê. Pro testovaâ nõâ rozdõâluê velicï in bylpouzï it parametrickyâ StudentuÊ v t-test, pokud velicï iny v testu splnï ovaly podmõânky testu, nebo neparametrickyâ Mann-WhitneyuÊ v test v opacï neâm prïõâpadeï. Test rozdõâluê mezi stranou bez zkrïõâzï eneâ ho skusu a se zkrïõâzï enyâm skusem ve vysï etrïovaneâ m souboru pacientuê uvaâ dõâ Tab. 1. Z Tab. 1 je videït, zï e stranoveâ rozdõâly u dolnõâ cï elisti nejsou statisticky vyâ znamneâ u zï aâ dneâ velicï iny (p > 0,05). V kontrolnõâ skupineï pacientuê s normookluzõâ bylo celkem 38 pacientuê. Testy rozdõâlu mezi levou a pravou stranou kontrolnõâ skupiny pacientuê uvaâ dõâ Tab. 2. Z Tab. 2 je videï t,zï e stranoveâ rozdõâly nejsou statisticky vyâ znamneâ u zï aâ dneâ velicï iny (p > 0,05). Pro hodnocenõâ rozdõâluê indexovyâ ch velicï in mezi vysï etrïovanyâ m souborem a kontrolnõâ skupinou byl pouzï it vyâ hradneï neparametrickyâ test Mann-WhitneyuÊ v. VyÂsledky jsou uvedeny v Tab. 3. B line Y Z CH X RH A line Obr. 1. ScheÂma meï rïenõâ dolnõâ cï elisti na OPG. CH: vyâsï ka kondylu; RH: vyâsïkaveï tve; CH+RH: vyâsï ka kondylu plus veï tve; X a Y: nejlateraâlneïjsï õâ body veï tve dolnõâ cï elisti; Z: pruê secï õâk linie A a B; A line: tangenta veï tve dolnõâ cï elisti; B line: kolmice k linii A prochaâzejõâcõâ tangenciaâlneï k obrysu kondylu. Fig. 1. Measurements in OPG. CH: condylar height; RH: ramal height; CH+RH: condylar + ramal height; X and Y: most lateral points of ramus; Z: crossection of lines A and B; A line: ramus tangent; B line: perpendicular to line A which is tangential to the contour of condyle. carried out in both sides in the controlsample of patients as well as in the examined group. Habets et al[4] provided the formula according to which indexes of asymmetry for all height parameters of the mandible are calculated. Asymmetry index (AI): [(right side - left side) / (right side + left side)] x 100% Results In the sample with unilateral crossbite there were 44 patients. To compare the values we used parametric Student's t-test (in case the variables meet the test conditions) or non-parametric Mann-Whitney's test. The differences between the side with normalocclusion and the side with crossbite are given in Table 1. It shows, that the differences between the sides of the mandible are not statistically significant for any variable (p > 0.05). Tab. 1. Test rozdõâluê meï rïenyâch vyâsï kovyâch parametruê dolnõâ cï elisti mezi stranou bez zkrïõâzï eneâ ho skusu a se zkrïõâzï enyâm skusem ve vysï etrïovaneâ skupineï pacientuê Tab. 1. Differences of measured height parameters of the mandible between the side with normal occlusion and the side with crossbite (examined group of patients) mean N mean CB t p n (N) n (CB) p(m-wh) CH RH SUM CH -vyâsï ka kondylu, condylar height, RH -vyâsïkaveï tve dolnõâ cï elisti, mandibular ramal height, SUM -vyâsï ka kondylu + veï tve dolnõâ cï elisti, condylar height + ramal height, mean - pruêmeïr,n - nepostizï enaâ strana, side without defect, CB - strana se zkrïõâzïenyâm skusem, side with crossbite, t - hodnota Studentova t-testu, t-value of Student's t-test, p - hladina vyâznamnosti testu, level of test significance, n - pocï et, number, p(m-wh) - hladina vyâznamnosti Mann-Whitneyova testu, Mann-Whitney's test level of significance. Tab. 2. Test rozdõâluê meïrïenyâch vyâsï kovyâch parametruê dolnõâ cï elisti mezi levou a pravou stranou v kontrolnõâ skupineï pacientuê Tab. 2. Differences of measured height parameters of the mandible between the left and right side (control group - normal occlusion) mean L mean R t p n (L) n (R) p(m-wh) CH RH SUM CH -vyâsï ka kondylu, condylar height, RH -vyâsïkaveï tve dolnõâ cï elisti, mandibula ramal height, SUM -vyâsï ka kondylu + veï tve dolnõâ cï elisti, condylar height + ramal height, L - levaâ strana, links, R - pravaâ strana dolnõâ cï elisti, right side

4 rocïnõâk20 ORTODONCIE Tab. 3. Srovna nõâ indexovyâch velicï in mezi vysï etrïovanyâm souborem a kontrolnõâ skupinou Tab. 3. Comparison of indexicalvariables between the group with crossbite and the controlgroup Z p CHI RHI SUMAI CHI - index asymetrie kondylu, index of condylar asymmetry, RHI - index asymetrie veï tve dolnõâ cï elisti, index of ramal asymmetry, SUMAI - index asymetrie kondylu + veï tve dolnõâ cï elisti, index of condylar + ramal asymmetry, Z - testovaâ hodnota normaâ lnõâ aproximace, test value of normal approximation, p - hladina vyâznamnosti testu, level of test significance Jak je videï t z tabulky, vsï echny hodnoty p jsou veïtsïõâ nezï 0,05. Tedy mezi vysï etrïovanyâm souborem a kontrolnõâ skupinou pacientuê nejsou statisticky vyâ znamneâ rozdõâly v indexovyâch velicï inaâ ch. Diskuse RuÊ stovaâ adaptace meï kkyâch a tvrdyâch tkaâ nõâ jako reakce na dlouhodobeï neleâcï enyâ funkcï nõâ jednostranneï zkrïõâzï enyâ skus je v nasï õâ i zahranicï nõâ literaturïe cï asto diskutovanyâmteâ matem. CõÂlem teâ to praâ ce bylo zjistit skeletaâ lnõâ zmeïnynaveï tvõâch dolnõâ cï elisti a to pomocõâ panoramatickeâ ho snõâmku. Kilic a kol. [5] sledovali ve sveâ studii asymetrie vyâsï kovyâ ch parametruê dolnõâ cï elisti obdobneï jako v nasï õâ praâ ci. Jejich studijnõâ skupina pacientuê s jednostranneï zkrïõâzïenyâm skusem se sklaâ dala z 81 pacientuê a kontrolnõâ skupinu tvorïilo 75 pacientuê s normookluzõâ. VsÏ echny osoby byly prïi odebõâraânõâ uâ dajuê ve veï ku 11 azï 17 l et (14,68 ± 2,34 a 14,28 ± 2,17 let v kontrolnõâ a studijnõâ skupineï ). Zjistili, zï e u kontrolnõâ skupiny nebyly zï aâ dneâ rozdõâly mezi rozmeï ryvevyâsï ce kondylu (CH), vyâsï ceveï- tve (RH) a jejich soucï tu (CH+RH) mezi pravou a levou stranou, zatõâmco u studijnõâ skupiny pacientuê byly vsï echny zmõâneï neâ vyâsï koveâ parametry signifikantneï mensï õâ na straneï se zkrïõâzï enyâ m skusem v porovnaâ nõâ se stranou bez zkrïõâzïeneâ ho skusu. U indexovyâch hodnot bylsignifikantneï vysïsï õâ pouze index asymetrie kondylu (CH I) u pacientuê s jednostranneï zkrïõâzï enyâ m skusem. PrÏestozÏ e ostatnõâ indexoveâ hodnoty byly takeâ u teâ to skupiny pacientuê vysï sï õâ, nebylvsï ak rozdõâlstatisticky vyâznamnyâ. Pacienti s funkcï nõâm, jednostranneï zkrïõâzï enyâ m skusem prïi dorazoveâ faâ zi mandibuly uchylujõâ dolnõâ cï elistõâ smeï rem k postizï eneâ straneï. Inui a kol. [6] uvaâdõâ,zïe pokud beï hem ruê stoveâ periody dochaâ zõâ kontinuaâ lneï k vychylovaâ nõâ kondylu z fossa glenoidalis, muêzïe se zaâhy objevit nestejnomeï rnyâ ruê st praveâ ho a leveâ ho kondylu. Kondyla rnõâ vyâbeï zï ek je totizï velmi senzitivnõâ na vesï kereâ okluznõâ zmeï ny a to obzvlaâsï teï u rostoucõâch pacientuê [7]. RozdõÂlny ruê st kondyluê muê zï e byâ t zpuê sobenyâ i nestejno- The control group with normal occlusion included 38 patients. The differences between the left and right side in the control group are given in Table 2. Table 2 suggests that the differences between the sides of the mandible are not statistically significant for any variable (p > 0.05). To evaluate the differences in index variables between the group with crossbite and the controlgroup the non-parametric Mann-Whitney's test was used. The results are given in Table 3. The table shows that all p values are over Thus there are no statistically significant differences between the two groups. Discussion Growth adaptation of soft and hard tissues as the response to a non-treated functionalunilateralcrossbite is relatively often discussed in our as well as foreign publications. The aim of the present work was to determine skeletal changes in mandibular rami with the help of OPG. In their study, Kilic et al [5] followed asymmetry of height parameters of the mandible in similar way as we did. They worked with the group of 81 patients with unilateral crossbite; the control group included 75 patients with normal occlusion. All patients were between 11 and 17 years old (14.68 ± 2.34 and ± 2.17 in the controland in the examined group, respectively). They found out no differences in condylar height (CH), ramalheight (RH) and condylar height + ramal height (CH+RH) between the right and the left side in the controlgroup, whilst in the group with crossbite all the parameters were significantly lower on the side with crossbite. In indexical values only the asymmetric condylar index (CH I) was significantly higher in patients with crossbite. The other values were also higher in this group, however, the difference was not statistically significant. Patients with functionalunilateralcrossbite tend to shift the mandible upon closure in the direction to the affected side. Inui et al[6] reported that in case when during the period of growth the condyle is continually deviated from fossa glenoidalis, rather early an irregular growth of left and right condyle may appear. Condylar process is very sensitive to all occlusal changes, especially in growing patients [7]. The different condylar growth may be also due to the irregular activity of masseter muscles. Electromyograph showed increased activitity in anterior and posterior temporalmuscle at the side with crossbite [7]. Uysalet al. [8] worked with 3 groups of patients: 46 patients with unilateral crossbite (mean age of ± 3.52), 40 patients with bilateral crossbite (mean age of ± 3.22), and 40 patients with normalocclusion, i.e. the controlgroup (mean age ± 3.05). Unlike

5 ORTODONCIE rocïnõâk20 meï rnou aktivitou zï vyâ kacõâch svaluê. Podle elektromyografu byla na straneï se zkrïõâzïenyâm skusem v porovnaânõâ se stranou bez zkrïõâzï eneâ ho skusu zjisïteï na zvyâsï enaâ aktivita u prïednõâho a zadnõâho temporaâ lnõâho svalu [7]. DalsÏ õâ studie, kteraâ se zabyâ vala meï rïenõâm stejnyâchvyâ- sï kovyâch parametruê jako tomu bylo v nasï õâ praâ ci, byla studie Uysala a kol. [8], kteraâ obsahovala 3 skupiny pacientuê : 46 pacientuê s jednostranneï zkrïõâzï enyâ m skusem (s pruêmeï rnyâm veï kem 13,06 ± 3,52 let), 40 pacientuê s oboustranneï zkrïõâzï enyâ m skusem (s pruê meï rnyâ m veïkem 12,72 ± 3,22 let) a kontrolnõâ skupinu se 40 pacienty s normookluzõâ (s pruê meï rnyâm veï kem 14,43 ±3,05 let). Na rozdõâlod prïedchozõâ studie zde nebyly zïaâ dneâ rozdõâly mezi rozmeï ry CH, RH a CH+RH a signifikantnõâ rozdõâly nebyly nalezeny ani u indexovyâch velicï in. CõÂlem nasï õâ praâ ce bylo zhodnotit vertikaâ lnõâ vyâsï koveâ parametry dolnõâ cï elisti u skupiny pacientuê s jednostranneï zkrïõâzï enyâm skusem a porovnat je se stejnyâmi parametry meï rïenyâ mi u skupiny pacientuê s normookluzõâ. Do studie bylo zahrnuto 82 pacientuê ve veï koveâm rozmezõâ od 6 do 11 let, kterïõâ byli rozdeï leni na skupinu pacientuê s jednostranneï zkrïõâzï enyâ m skusem (vysï etrïovanyâ soubor) a skupinu pacientuê s normookluzõâ (kontrolnõâ skupina). K urcï enõâ vyâsï ek kondyluê aveï tvõâ dolnõâ cïelisti byla pouzïita metoda dle Habetse a kol. [4], jak jizï bylo zmõâneï no vyâsï e. Pro testovaâ nõâ rozdõâluê velicï in byl pouzï it parametrickyâ StudentuÊ v t-test, pokud velicï iny v testu splnï ovaly podmõânky testu, nebo neparametrickyâ Mann-WhitneyuÊ v test v opacïneâm prïõâpadeï. VyÂsledky ukaâ zaly, zï e u vertikaâ lnõâch parametruê CH, RH a CH+RH nebylstatisticky vyâ znamnyâ rozdõâlat'uzï ve vysï etrïovaneâ m souboru nebo v kontrolnõâ skupineï. DaÂle byla porovnaâ na rozdõâlnost asymetrickyâ ch indexuê mezi skupinami navzaâ jem. Pro hodnocenõâ rozdõâluê indexovyâ ch velicï in bylpouzï it vyâ hradneï neparametrickyâ test Mann-WhitneyuÊ v. Mezi kontrolnõâ skupinou a vysï etrïovanyâ m souborem pacientuê nebyly zjisï teï ny statisticky vyâ znamneâ rozdõâly v indexovyâ ch velicï inaâ ch a prïestozï e index asymetrie kondylu byl u pacientuê s jednostranneï zkrïõâzïenyâm skusem vysïsï õâ nezï u skupiny pacientuê s normookluzõâ, tento rozdõâl takeâ nebylstatisticky vyâ znamnyâ. V porovnaâ nõâ s jinyâ mi studiemi se vyâ sledky prïedklaâdaneâ praâ ce shodovaly se studiõâ Uysala a kol. [8], kterïõâ takeâ neprokaâ zali statisticky vyâ znamneâ rozdõâly mezi vyâsï kovyâ mi parametry dolnõâ cï elisti u pacientuê s jednostranneï zkrïõâzïenyâm skusem v obdobneâmveï koveâ m rozmezõâ. Naproti tomu ale studie Kilica a kol. [5] nasï la jisteâ statisticky vyâ znamneâ rozdõâly ve vsï ech vyâ sï kovyâ ch parametrech u pacientuê s jednostranneï zkrïõâzï enyâ m skusem a uvaâ dõâ nizïsï õâ hodnoty CH, RH a CH+RH na postizï eneâ straneï ve srovnaâ nõâ se stranou nepostizï enou u sledovaneâ skupiny pacientuê. Tuto rozdõâlnost mohla zpuê sobit kriteâ ria vyâbeï ru pacientuê,prïedevsï õâm jejich veï k. Ze srovnaâ nõâ vyâ sledkuê teâ to studie a studiõâ zahranicï nõâch autoruê the preceding study there were found no differences between parameters CH, RH and CH+RH, no significant differences were found in indexicalvariables. The aim of our work was to evaluate vertical height parameters of the mandible in the group of patients with unilateral crossbite, and compare them with the same parameters measured in the group of patients with normal occlusion. The study included 82 patients between the age of 6 and 11. They were subdivided into the group of patients with unilateral crossbite (the group examined) and the group of patients with normalocclusion (the controlgroup). To identify condylar and ramal heights of the mandible, the method by Habets et al[4] was employed. To test the differences in variables, a parametric Student's t-test was used (when the variables meet the criteria of the test), or a non-parametric Mann-Whitney's test (when the variables didn't meet the criteria). The results showed no statistically significant differences in vertical parameters CH, RH and CH+RH either in the group with crossbite or in the controlgroup. Further we compared asymmetry indexes between the two groups. The nonparametric Mann-Whitney's test was used. There were found no statistically significant differences between the two groups. The asymmetry condylar index was higher in the group with unilateral crossbite, however, the difference was not statistically significant. The results of our work correspond to those reported by Uysalet al[8]. On the other hand the work by Kilica et al [5] reported statistically significant differences in all height parameters in patients with unilateral crossbite, and gives the lower values of CH, RH and CH+RH on the affected side (compared to the normal one). The difference might result from the criteria adopted for the selection of patients, especially their age. The results of our study as well as other published works suggest that if the differences in height parameters of the mandible ramus occur, or if an asymmetric condylar growth appears, it is usually during the growth spurt period. Conclusion We focused on the comparison of verticalheight parameters of the mandible in patients with unilateral crossbite (examined group) and in patients with normal occlusion (control group). The results of measurements and statistical evaluation show no statistically significant lateral asymmetries in patients with crossbite and in patients with normalocclusion. By means of asymmetry indexes we compared the two groups of patients. No statistically significant differences were found between the two groups of patients. Authors have no commercial, proprietary or financial interest in products or companies mentioned in the article

6 rocïnõâk20 ORTODONCIE muê zï eme vyvodit domneï nku, zï e pokud dochaâ zõâ ke zmeïnaâ m velikosti vyâsï kovyâch rozmeïruêveï tve dolnõâ cïelisti, respektive k asymetrickeâmu ruê stu kondylu, tak azï v pruê beï hu pubertaâ lnõâho ruê stoveâ ho zrychlenõâ. ZaÂveÏr V nasïõâpraâ ci jsme se zameïrïili na stranoveâ srovnaâvaânõâ vertikaâ lnõâch vyâ sï kovyâ ch parametruê dolnõâ cï elisti u pacientuê s jednostranneï zkrïõâzï enyâ m skusem (vysï etrïovanyâ soubor) a pacientuê s normookluzõâ (kontrolnõâ skupina). Z vyâ sledkuê meï rïenõâ a statistickeâ ho hodnocenõâ vyplyâ vaâ, zï e nebyly nalezeny zï aâ dneâ statisticky vyâ znamneâ stranoveâ asymetrie u pacientuê se zkrïõâzï enyâ m skusem ani s ideaâ lnõâ okluzõâ. Da le jsme pomocõâ indexuê asymetrie navzaâ jem porovnaâ vali vysï etrïovanyâ soubor a kontrolnõâ skupinu pacientuê. Mezi skupinami nebyly teâ zï nalezeny zïaâ dneâ statisticky vyâ znamneâ rozdõâly. AutorÏi nemajõâ komercï nõâ, vlastnickeâ nebo financï nõâ zaâ jmy na produktech nebo spolecï nostech popsanyâ ch v tomto cïlaâ nku. Literatura/ References 1. Thilander, B.; Wahlund, S.; Lennartsson, B.: The effect of early interceptive treatment in children with posterior crossbite. Eur. J. Orthodont. 1984, 6, cï. 1, s Kutin, G.; Hawes, R. R.: Posterior cross-bites in the deciduous and mixed dentitions. Amer. J. Orthodont. 1969, 56, cï. 5, s Schroder, U.; Schroder, I.: Early treatment of unilateral posterior crossbite in children with bilaterally contracted maxillae. Eur. J. Orthodont. 1984, 6, cï. 1, s Habets, L. L.; Bezuur, J. N.; Naeiji, M.; Hansson, T. L.: The orthopantomogram, an aid in diagnosis of temporomandibular joint problems. II. The vertical symmetry. J. Oral. Rehabil. 1988, 15, s Kilic, N.; Kiki, A.; Oktay, H.: Condylar asymmetry in unilateralposterior crossbite patients. Amer. J. Orthodont. dentofacialorthop. 2008, 133, cï. 3, s Inui, M.; Fushima, K.; Sato, S.: Facialasymmetry in temporomandibular joint disorders. J. Oral Rehabil. 1999, 26, cï. 5, s Ingervall, B.; Thilander, B.: Activity of temporal and masseter muscles in children with a lateral forced bite. Angle Orthodont. 1975, 45, cï. 4, s Uysal, T.; Sisman, Y.; Kurt, G.; Ramoglu, S. I.: Condylar and ramal vertical asymmetry in unilateral and bilateral posterior crossbite patients and normal occlusion sample. Amer. J. Orthodont. dentofacialorthop. 2009, 136, cï. 1, s MUDr. Zuzana KrizÏanova Stomatologicka klinika FN u sv. Anny PekarÏska 53, Brno Altis Group spol. s r. o. ±vyâhradnõâ zaâstupce pro CÏ eskou republiku a Slovensko 23.± Dr. B. Giuliano MAINO M.D, D.D.S teâma bude uprïesneïno Praha, ANDEL'S HOTEL Prague Altis Group spol. s r. o., ZÏ erotõânova 901/12, BrÏeclav Tel./fax: , Petra Karafova , Marie PõÂsarÏõÂkova ± Zelena linka: (VOLEJTE ZDARMA!) 3th Worl Implant Orthodontic Conference WIOC 7-8 October th Annual Meeting of Italian Academy of Orthodontic 6 October 2011 Organizers: World Implant Orthodontic Association, Accademia Italiana di Ortodonzia October , Verona, Italy Registration: Oltrex 4M Spa, Ca'Vignola, Dorsoduro, Salizada San Baseggio n. 1648, Venezia Tel.: , Fax: , Official Language: English

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