Current trends in the diagnosis of transverse malocclusions

Abstract

Introduction. The increase in the frequency of transverse malocclusions, determined based on the frequent presentation of patients, has led to a need to identify predisposing factors. Transverse malocclusion is caused by: the discordant development of the two jaws, midline discrepancies of dental arches in asymmetric lateral areas, isolated dental malpositions, guidance slopes, lateral movements, and nasal breathing disorders. Depending on its duration, mouth breathing can lead to numerous functional, structural, postural, and behavioral changes, including at the level of the maxillary system, which is closely structurally and functionally linked to the upper respiratory pathways. Therefore, addressing these issues will allow for a deeper understanding of the etiology of transverse malocclusions, the influence of nasal breathing disorders, and the determination of optimal terms for orthodontic treatment, its types, as well as the possibility of preventing relapses. Objective of the study. Developing new diagnostic criteria for patients with transverse malocclusion through studying the effects of nasal breathing dysfunctions. Study goals. Identification and analysis of the frequency of nasal respiratory disorders among patients with transverse malocclusions; Investigating clinical and anthropometric changes in the stomatognathic system in cases of transverse malocclusions through transnasal airway passage analysis; Comparing patterns of transverse malocclusion manifestation based on clinical, biometric, cephalometric parameters, and nasal respiratory volume.Methods and Materials. The study was conducted based on the analysis of a group of 201 patients aged between 7 and 18 years, including 120 girls (59.7%) and 81 boys (40.3%) with transverse malocclusions. The patients were divided into two study groups, depending on the type of malocclusion they presented. Consequently, they were assigned to T0 and T1. The T0 group consisted of 92 patients (45.8%) with transverse malocclusions without nasal breathing disorders, and the T1 group consisted of 109 patients (54.2%) with transverse malocclusions associated with nasal breathing disorders. Among the 109 patients, there were cases of chronic hypertrophic rhinitis - 10 (5.0%), predominantly determined in patients with nasal septum deviation - 57 (28.4%), followed by chronic and recurrent sinusitis - 22 (10.9%), and chronic adenoiditis - 20 (10.0%). The diagnosis was established based on clinical examination, paraclinical methods such as orthopantomography and lateral and posteroanterior cephalometric radiography, using Downs, Tweed-Merifeld, and Ricketts methods. For patients in the T1 group, the diagnosis was complemented with a medical history that revealed complaints related to the location of the pathological process, and nasal permeability assessment was performed using the ATMOS PC 2000 rhinomanometer (Germany). Results. According to the obtained results, a prevalence of 54.2% of nasal breathing disorders found among patients with transverse malocclusions. In the case of girls, chronic hypertrophic rhinitis was predominant in 83% of situations, while chronic and recurrent sinusitis was encountered in 64% of cases. Regarding boys, an increased incidence of nasal septum deviation was observed in 57% of cases, and chronic adenoiditis in 61% of cases. In this study, the evaluation of clinical and anthropometric parameters was applied to analyze additional parameters, where craniofacial growth was assessed through the average value of brachycephalic type, identifying 46 patients (29.9%) with significant growth, and dolichocephalic type observed in 77 patients (49.0%), confirming the impact of nasal breathing disorders on the development of the upper maxilla. Conclusions. The clinical significance of this study lies in the fact that diagnosing patients with transverse malocclusions should be comprehensive, considering not only cephalometric and biometric parameters but also the assessment of nasal permeability. It is important to determine the causal factor so that we can plan the treatment stages and identify the chronological order of diagnostic methods. In conclusion, the multidisciplinary approach between the orthodontist and otolaryngologist has a valuable impact on the diagnosis and treatment of patients with transverse malocclusion, caused by nasal breathing disorders.