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Record for a UF thesis. Title & abstract won't display until thesis is accessible after 2014-12-31.

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Permanent Link: http://ufdc.ufl.edu/UFE0045091/00001

Material Information

Title: Record for a UF thesis. Title & abstract won't display until thesis is accessible after 2014-12-31.
Physical Description: Book
Language: english
Creator: Kovaleski, Lauren
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2012

Subjects

Subjects / Keywords: Dentistry -- Dissertations, Academic -- UF
Genre: Dental Sciences thesis, M.S.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Statement of Responsibility: by Lauren Kovaleski.
Thesis: Thesis (M.S.)--University of Florida, 2012.
Local: Adviser: Dolce, Calogero.
Electronic Access: INACCESSIBLE UNTIL 2014-12-31

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2012
System ID: UFE0045091:00001

Permanent Link: http://ufdc.ufl.edu/UFE0045091/00001

Material Information

Title: Record for a UF thesis. Title & abstract won't display until thesis is accessible after 2014-12-31.
Physical Description: Book
Language: english
Creator: Kovaleski, Lauren
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2012

Subjects

Subjects / Keywords: Dentistry -- Dissertations, Academic -- UF
Genre: Dental Sciences thesis, M.S.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Statement of Responsibility: by Lauren Kovaleski.
Thesis: Thesis (M.S.)--University of Florida, 2012.
Local: Adviser: Dolce, Calogero.
Electronic Access: INACCESSIBLE UNTIL 2014-12-31

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2012
System ID: UFE0045091:00001


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1 CHANGE IN THE POSTERIOR OCCLUSAL PLANE VERSUS CLINICAL OUTCOMES B y LAUREN M. KOVALESKI A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MA STER OF SCIENCE UNIVERSITY OF FLORIDA 201 2

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2 2012 Lauren M. Kovaleski

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3 To my family and friends for all their support

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4 ACKNOWLEDGMENTS I would like to thank my family for their unwavering support during this time and throughout my life. I n addition, I would like to thank Dr. Wheeler and Dr. Coro for their guidance and expertise in completing this project. I also acknowledge financial and/or logistical support from the University of Florida Department of Orthodontics, the University of Flor ida Graduate Student Council, the American Association of Orthodontists, the Southern Association of Orthodontists and the Florida Association of Orthodontists.

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5 TABLE OF CONTENTS page ACKNOWLEDGMENTS .................................................................................................. 4 LIST OF TABLES ............................................................................................................ 6 LIST OF FIGURES .......................................................................................................... 7 LIST OF ABBREVIATIONS ............................................................................................. 8 ABSTRACT ..................................................................................................................... 9 CHAPTER 1 INTRODUCTION .................................................................................................... 11 2 METHODS .............................................................................................................. 14 3 RESULTS ............................................................................................................... 18 4 DISCUSSION ......................................................................................................... 20 5 CONCLUSION ........................................................................................................ 22 LIST OF REFERENCES ............................................................................................... 23 BIOGRAPHICAL SKETCH ............................................................................................ 24

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6 LIST OF TABLES Table page 3 1 Class II Mixed model correlation coefficients. ..................................................... 19

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7 LIST OF FIGURES Figure page 1 1 Changes in Inclination of Posterior Occlusal Plane with Age ............................. 13 2 1 Posterior Occlusal Plane Angle .......................................................................... 16 2 2 Addtitional Measurements:Vertical Height of U6, Vertical Height of L6, Posterior Face Height, Anterior Face Height ...................................................... 16 2 3 Anteroposterior Dysplasia Indicator ................................................................... 17 3 1 Class III Correlation coefficients. (P values) ...................................................... 19 3 2 Class II Correlation Coefficients (P values). ....................................................... 19 3 3 Change (mm) in vertical variables with respect to treatment modality No changes were statistically significant. ................................................................. 19

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8 LIST OF ABBREVIATIONS AFH Anterior Face Height AP Anterior Posterior APDI AnteroPosterior Dysplasia Indicator FH Frankfort Horizontal MPA Mandibular Plane Angle ODI Over bite Depth Indicator OJ Overjet OP Occlusal Plane PFH Posterior Face Height POP Posterior Occlusal Plane

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9 Abstract of Thesis Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Science CHANGE IN THE POSTERIOR OCCLUSAL PLANE VERSUS CLINICAL OUTCOMES By Lauren Kovaleski December 2012 Chair: C alogero Dolce Major: Dental Sciences Orthodontics The etiology of malocclusion is multifaceted, with contributions from skeletal growth, dental eruption, genetics, environment, and many other areas. Most studies tend to focus on the anterior posterior dimension of the dentition in an attempt to achieve ideal molar and canine relationship. This is a retrospective cephalometric study to look at the vertical component of the development of the occlusion. One hundred fifty two Class II and 25 Class III preand post treatment lateral cephalograms were analyzed for the following measurements: posterior occlusal plane angle, overjet (OJ), anteroposterior dysplasia indicator (APDI) saddle angle, ANB MPA, posterior face height, anterior face height, gonial angle, vertical height of maxillary first molar(U6) and vertical height of mandibular first molar(L6). There was no significant correlation in subjects with a Class III malocclusion between OJ and ANB with any of the other variables except between ANB and APDI, most likely due to the small sample size. In Class II subjects however, there was significant correlation bet ween ANB and OJ with posterior face height, anterior face height, vertical height of U6 and vertical height of L6. These results show that for Class II patients, the change in vertical position of the upper and lower molars influenced their final anterior posterior position towards correction to a

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10 Class I occlusion This suggests that treatment modalities might need to be modified to ta ke into consideration the vertical dimension of occlusion.

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11 CHAPTER 1 INTRODUCTION The etiology of malocclusion is multifaceted, with contributions from skeletal growth, dental eruption, genetics, environment, and many other areas. In orthodontics it is important to be able to diagnose malocclusions and identify potential contributing factors. Most studies tend to focus o n the anterior posterior dimension of the dentition in an attempt to achieve ideal molar and canine relationship. However, the vertical component of occlusion may be just as important in diagnosis and treatment. Previous research has shown that there is a strong correlation between inclination of the posterior occlusal plane (measured from the buccal cusp of the maxillary second premolar to the cusp of the maxillary first molar with the Frankfort Horizontal reference plane) and development of Class II or C lass III Malocclusion1. (Figure 1 1 ) In addition, a steep posterior occlusal plane was found to be correlated with smaller mandibular lengths and ramus heights.2 This suggests that the occlusal plane angle might be related to deficient mandibular growth and/or the backward rotation of the mandible that is often seen in patients with a Class II malocclusion. It is also believed that the steep angulation of the posterior occlusal plane prevents the mandible from rotating forward to try to correct the malocclusion.4 While Class II malocclusions show a steeper posterior occlusal plane, Class III malocclusions tend to show flatter posterior occlusal planes.4 The more acute the angle between the posterior occlusal plane and the Frankfort Horizontal plane, the more forward the mandible tended to be.4 No studies to date have looked at the treatment effects related to changes in the posterior occlusal plane and Class III treatment. Although numerous other factors are involved in the etiology of malocclusion, it is

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12 reasonable to suggest that changes to the occlusal plane inclination have the potential to influence mandibular position and thus help to correct anterior posterior malocclusions. The aim of this project was to examine the changes in the posterior occlusal plane with the correction of Class II and Class III patients with they hypothesis that Class II and Class III malocclusions can be treated to a stable result by altering the posterior occlusal plane.

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13 Figure 1 1. Changes in Inclination of Post erior Occlusal Plane with Age

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14 CHAPTER 2 METHODS This is a retrospective study with the sample consisting of 25 Class III patients previously treated at the Department of Orthodontics at the University of Florida College of Dentistry as well as those treated in private practice by Jorge Coro, DMD and 152 Cl II patients from the archives at the University of Florida.5 Cl III patients were selected based on negative overjet pretreatment and the availability of preand pos t treatment lateral cephalograms. Cl II patients were selected based on pretreatment Cl II molar classification and availability of preand post treatment lateral cephalograms. Lateral cephalometric x rays taken before and after treatment were analyzed for the following measurements: P OSTERIOR OCCLUSAL PLANE (POP) ANGLE (FH OP) Angle between the line extending from the cusp tip of the maxillary second premolar to the midpoint of the maxillary second molar at the occlusal surface and the Frankfort Horiz ontal plane extending from porion to orbitale. (Figure 21) O VERJET Distance measured from the labial incisal edge of the most protruded maxillary incisors to the labial incisal edge of the most protruded mandibular incisor. A NTERO POSTERIOR DYSPLASIA INDICATOR Sum of the angle between the Frankfort Horizontal Plane and the Facial Plane (the line extending from Nasion to Pogonion), the angle between the A B plane and the Facial Plane, and the angle between the Palatal plane and the Frankfort Horizontal Plane. (Fig. 3) S ADDLE A NGLE Inferior angle formed by lines connecting Nasion, Sella, and Basion. ANB A NGLE Inferior angle formed by lines connecting A point, Nasion, and B point. MPA Angle between Porion Orbitale and Menton Gonion P OSTERIOR F ACE H EIGHT (PFH) Vertical distance from Gonion to Horizontal Reference Line

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15 A NTERIOR F ACE HEIGHT (AFH) Vertical distance from Menton to Horizontal Reference Line G ONIAL A NGLE Interior angle formed by Articulare, Gonion, and Menton V ERTICAL H EIGHT OF U6 Vertical distance from U6 to Horizontal Reference Line V ERTICAL H EIGHT OF L6 Vertical distance from L6 to Menton Gonion Descriptive statistics and graphical techniques were used to characterize the data. Correlation between baseline variables and changes over time was evaluated using parametric Pearson correlation coefficients and nonparametric Spearman rank correlation coefficients. Linear mixed models were used to examine changes in overjet as a function of posterior occlusal plane angle, initial overjet, anteroposterior dysplasia indicator, age, sex, and treatment time. In this framework, the correlation between multiple measures within a subject over time is taken into account, and the pattern of change and/or stability and factors affecting thi s can be examined. Interactions between variables and model diagnostics were examined. A pvalue of less than 0.05 was considered statistically significant.

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16 Figure 21. Posterior Occlusal Plane Angle Figure 22. Addtitional Measurements :Vertical Height of U6, Vertical Height of L6, Posterior Face Height, Anterior Face Height

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17 Figure 23. Antero posterior Dysplasia Indicator

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18 CHAPTER 3 RESULTS There was no significant correlation in Class III patients between OJ correction or ANB with any of the other variables besides ANB with APDI, which had a correlation coefficient of 0.79 and a p value less than 0.0001 ( Figure 31). The lack of other significant correlations was most likely due to the small sample size. In Class II patients however, OJ correc tion was significantly correlated with U6, L6, AFH, and PFH while ANB was significantly correlated with PFH only ( Figure 32). Mixed model analysis showed correlation coefficients as high as 0.66 (Table 31 ). However, further analysis of the Class II data show that there are no significant differences between subjects treated with either onephase or twophase treatment in the vertical dimension outcomes examined ( F igure 33 ).

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19 POP MPA Saddle Angle APDI ANB 0.09 (0.69) 0.11 (0.59) 0.014 (0.94) 0.79 (<0.0001) OJ 0.20 (0.38) 0.08 (0.70) 0.12 (0.57) 0.24 (0.25) Figure 3 1. Class III Correlation coeffic ients. (P values) U6 L6 AFH PFH ANB 0.08 (0.26) 0.01 (0.85) 0.10 (0.13) 0.30 (<0.0001) OJ 0.15 (0.03) 0.14 (0.04) 0.18 (0.006 ) 0.24 (0.0003) Figure 3 2. Class II Correlation Coefficients (P values). Table 31. Class II Mixed model correlation coefficients. Variables R 2 ANB 0.52 ANB + MPA 0.60 ANB + L6 + PFH 0.66 PFH AFH U6 L6 Headgear 1.40 (0.47) 1.49 (0.47) 1.04 (0.33) 0.46 (0.20) Bi onator 1.53 (0.60) 1.47 (0.42) 1.06 (0.32) 0.44 (0.18) Control 1.47 (0.51) 1.47 (0.45) 1.06 (0.31) 0.44 (0.18) Figure 3 3 Change in mm from baseline to end of treatment in vertical variables with respect to treatment modality. No changes were statistic ally significant. (Standard deviation)

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20 CHAPTER 4 DISCUSSION Traditionally, molar classification has been viewed as an anterior posterior (AP) problem and treatment has been focused on this dimension of occlusion. For example, in previous studies at the Uni versity of Florida, the Johnston analysis was used to determine the AP changes during Class II treatment 5. Vertical changes were examined using a centrographic analysis7, but no vertical measures were made. The centrographic analysis used 5 triangles based on craniofacial landmarks from which 5 centroids were determined and used as reference points. It is reasonable to assume that because Class III and II problems are assessed in the sagittal plane that treatment should be focused on this plane, however, as shown by this study, the vertical dimension may also be important and should be considered. Previously Zhou6 has shown that molar classification did not match the anterior posterior assessment of skeletal jaw base relationship in up to 30% o f subjects therefore there might be something else contributing to sagittal classification. To date, no research on Cl III patients has been done to compare overjet with the occlusal variables used in this study. The data provided here show no correlation except b etween ANB and APDI, which is reasonable considering they are both indicators of sagittal discrepancy. Changes that occur to the posterior occlusal plane would necessitate a change in the vertical at either the anterior or posterior occlusion. Tanaka and Sato4 concluded a possible relationship between posterior occlusal plane inclination and the position of the mandible, namely, the flatter the posterior occlusal plane angle, the more forward the mandible tended to be. Changes in the inclination of the posterior occlusal plane could alter the position of the mandible relative to the maxillary teeth as well as induce a

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21 condylar adaptive response to the new position3. This is supported by this study which showed that changes in the vertical positioning of t he upper and lower molars as well as changes in facial height can help predict final molar classification in the Class II subjects. Current treatment (Herbst, Forsus, Bionator, Facemask, etc.) focuses on sagittal correction but actual correction might be dependent on other dimensions such as vertical changes. Treatment which incorporates vertical changes (i.e. Headgear, Utility arch, Multiloop Edgewise Archwires ( MEAW ) etc) might lead to more predictable treatment outcomes. To date, studies have only looked at Cl 2 correctors and their impact on facial height and changes in the MPA although none have looked at actual vertical changes in molar positions or inclinations of the posterior occlusal plane. SiaraOlds8 looked at the Bionator, Herbst, TwinBlock and Mandibular Anterior Repositioning Appliance ( MARA ) and found that the Twin Block was best at controlling the MPA while Oztoprak9 compared the Sabbagh Universal Spring with the Forsus and found that neither produced any statistically significant changes in the vertical dimension with regards to facial height although there was clockwise rotation of the occlusal plane due to intrusion of the upper molars from the headgear effect. Limitations of this study included small sample size for Cl III patients which could contribute to the lack of statistically significant findings. Another limitation was the analysis of only growing adolescents for the Cl II portion; this may confound the results and should be supported by additional research on nongrowing subj ects.

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22 CHAPTER 5 CONCLUSION Although more research is needed, this data shows that for Cl III patients there was si gnificant correlation between ANB and APDI but not with any other variables. For Class II patients, the vertical position of the upper a nd lower molars influenced their final anterior posterior position. This suggests that treatment modalities might need to be modified to take into consideration the vertical dimension of occlusion.

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23 LIST OF REFERENCES 1. Kim JI, Akimoto S, Shinji H, Sato S Importance of vertical dimension and cant of occlusal plane in craniofacial development. J Stomat Occ Med 2002; 2:114121. 2. Fushima K, Kitamura Y, Hiroaki M, Sato S, Suzuki Y, Kim Y. Significance of the cant of the posterior occlusal plane in Class II division 1 malocclusions. Eur J Orthod 1996; 18: 2740. 3. Ishizaki K, Suzuki K, Mito T, Tanaka EM, Sato S. Morphologic, functional, and occlusal characterization of mandibular lateral displacement malocclusion. Am J Orthod Dentofacial Orthop. 2010; 137(4): 454.e1 9. 4. Tanaka EM, Sato S. Longitudinal alteration of the occlusal plane and development of different dentoskeletal frames during growth. Am J Orthod Dentofacial Orthop. 2008; 134(5): 602.e111. 5. Dolce C, McGorray SP, Brazeau L, King GJ, Wheeler TT. Ti ming of Class II treatment: Skeletal changes comparing 1phase and 2phase treatment. Am J Orthod Dentofacial Orthop. 2007;132(4):481489. 6. Zhou L, Mok CW, Hagg U, McGrath C, Bendeus M, Wu J. Anteroposterior Dental Arch and Jaw Base Relationships in a Popul ation Sample. Angle Orthod 2008; 78(6):102329. 7. Dolce C,Schader RE, McGorray SP, Wheeler TT. Centrographic analysis of 1phase versus 2phase treatment for Class II malocclusion. Am J Orthod Dentofacial Orthop. 2005;128(2):195200. 8. Siara Olds NJ, Pangrazi o Kulbersh V, Berger J, Bayirli B. Long Term Dentoskeletal Changes with the Bionator, Herbst, TwinBlock, and MARA functional appliances. Angle Orthod 2010; 80(1): 1829. 9. Oztoprak, MO, Nalbantqil D, Uyanlar A, Arun T. A Cephalometric study of Class II Cor rection with Sabbagh Universal Spring (SUS) and Forsus FRD Appliances. Eur J Dent 2012; 6(3): 30210.

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24 BIOGRAPHICAL SKETCH Lauren Kovaleski was born and raised in Panama City, FL where she graduated from Bay High School in 1999. She subsequently went to the University of Florida where she received a Bachelor of Science degree in m athematics. She took a year away from academics to pursue volunteerism with AmeriCorps NCCC from 20052006. She then went to the University of Pennsylvania and earned her Doctorate of Dental Medicine degree in 2010. She received a Master of Science in dental sciences as well as a certificate in orthodontics from the University of Florida in 2013.