Lip Bumper Teza

8/12/2019 Lip Bumper Teza

1/59

EVALUATION OF THE EFFECT OF LIP BUMPER THERAPY ON

THE CURVE OF SPEE AND MANDIBULAR DIMENSIONS

Joshua H. Gotli! D.D.S.

A" Ast#a$t P#%s%"t%& to th% G#a&uat% Fa$ult' o(

Sai"t Louis U"i)%#sit' i" Pa#tial Ful(ill*%"t

o( th% R%+ui#%*%"ts (o# th% D%,#%% o( Mast%# o( S$i%"$% i" D%"tist#'

-/-

Ast#a$t

O0%$ti)%1 Th% ai* o( this #%t#os2%$ti)% stu&' 3as to

loo4 at th% %((%$ts o( *a"&iula# li2 u*2%# th%#a2' o" th%

&%2th o( th% $u#)% o( S2%% a"& oth%# *a"&iula# &i*%"sio"s.

Mat%#ials a"& M%tho&s1 Fo#t'5si6 2ati%"ts 7-8 *al%! --

(%*al%9 3ho ha)% u"&%#,o"% li2 u*2%# th%#a2' 3ithout a"'

oth%# *a"&iula# a22lia"$%s 3%#% i&%"ti(i%& (#o* o"% si",l%

2#i)at% 2#a$titio"%#. Th% *a"&iula# *o&%ls a"& lat%#al

$%2halo,#a*s (#o* %(o#% a"& a(t%# li2 u*2%# th%#a2' 3%#%

#%$o#&%& a"& i*2o#t%& i"to Dol2hi" I*a,i",. Fi)%

*%asu#%*%"ts 3%#% ta4%" (#o* %a$h $%2halo,#a* a"& (ou#t%%"

(#o* %a$h *o&%l. D%s$#i2ti)% statisti$s! 2ai#%& t t%sts!

a"& $o##%latio"s 3%#% $o*2ut%& to a"al':% th% &ata a"&

&%t%#*i"% 3h%th%# th%#% 3as a si,"i(i$a"t $ha",% &u#i",

t#%at*%"t. R%sults1 Th% &%2th o( th% $u#)% o( S2%%

&%$#%as%& at all *%asu#%& t%%th ut *ost "oti$%al' at th%

(i#st 2#%*ola# 3hi$h &%$#%as%& /./ ** (#o* /.; ** to .

M%asu#%*%"t o( th% Cu#)% o( S2%%............;

A#$h L%",th R%+ui#%& i" L%)%li",............

M%tho&s o( L%)%li",........................//Li2 Bu*2%#....................................../-

D%s$#i2tio"................................/-

Positio"i", Di((%#%"$%s..................../ P#%)ious Stu&i%s.........................../8

R%(%#%"$%s....................................../;

CHAPTER 1 JOURNAL ARTICLE

Ast#a$t........................................- I"t#o&u$tio"....................................--

Mat%#ials a"& M%tho&s...........................-

Sa*2l%.....................................-

Data Coll%$tio"............................-8 Mo&%ls................................-8

Lat%#al C%2halo,#a*s..................-;

Statisti$al A"al's%s.......................- R%sults.........................................

A#$h Si:%..................................

Cu#)% o( S2%%............................../

C%2halo*%t#i$s.............................8 Dis$ussio"......................................;

A#$h Si:% Cha",%s..........................;

C%2halo*%t#i$ Cha",%s...................... Cu#)% o( S2%% Cha",%s......................8/

Co"$lusio"s.....................................8-

R%(%#%"$%s......................................8

A22%"&i6..................................................8>

Vita Au$to#is.............................................8

i)


8/59

LIST OF TABLES

Tal% -./ D%2ths o( $u#)% o( S2%% th#ou,hout &%)%lo2*%"t.

Tal% -.- M%tho&s o( *%asu#%*%"t o( th% $u#)% o( S2%%....

Tal% -. Cha",%s i" a#$h 3i&th (#o* li2 u*2%# th%#a2'./>

Tal% ./ A,% a"& t#%at*%"t ti*% o( sa*2l%..............-8

Tal% .- 5 A#%)iatio"s a"& &%(i"itio"s o( la"&*a#4s us%&

i" $usto* $%2halo*%t#i$ a"al'sis ..............-

Tal% . L%,%"& o( *%asu#%*%"ts us%& i" $usto*

$%2halo*%t#i$ a"al'sis ........................-

Tal% .8 A#$h 3i&th a"& a#$h &%2th statisti$s........../

Tal% .> Cu#)% o( S2%% statisti$s......................8

Tal% .< C%2halo*%t#i$ statisti$s......................>

Tal% .; s$o#%s (o# (i#st 2#%*ola# a#$h 3i&th! (i#st

*ola# a#$h 3i&th a"& a#$h &%2th ...............

)ii


11/59

CHAPTER /1 INTRODUCTION

Th% $u#)% o( S2%% as "a*%& a(t%# F%#&i"a"& G#a( )o"

S2%% i" /! is th% a"t%#o2ost%#io# $u#)% o( th% ali,"*%"t

o( th% t%%th. O"% o( th% (a$to#s loo4%& at &u#i",

o#tho&o"ti$ &ia,"osis is th% &%2th o( th% $u#)% o( S2%%.

A" %6$%ssi)% o# &%%2 $u#)% o( S2%% is $o"si&%#%&

u"&%si#al% a"& i"&i$at%s a &%%2 it% t%"&%"$'.

Stu&i%s o( th% $u#)% o( S2%% &u#i", "o#*al &%)%lo2*%"t

ha)% sho3" th% &%2th o( th% $u#)% o( S2%% sta#ts out

#%lati)%l' (lat i" th% &%$i&uous &%"titio"! i"$#%as%s i"

th% *i6%& &%"titio" a"& th%" l%)%ls out to a22#o6i*at%l'

t3o *illi*%t%#s i" a&ults./ Co*2a#i", a 2ati%"ts &%2th to

th%s% a)%#a,%s is a +ui$4 3a' to ass%ss i( a 2ati%"t has a

(lat! "o#*al! o# &%%2 $u#)% o( S2%%. I" 'ou", 2ati%"ts

3ith &%%2 $u#)%s o( S2%%! th%#% 3oul& % a $l%a# %"%(it i"

%,i""i", to l%)%l th% $u#)% o( S2%% &u#i", a" %a#l'

t#%at*%"t 2has% so that a s%$o"& 2has% o( t#%at*%"t *a' %

+ui$4%# a"& i")ol)% l%ss tooth *o)%*%"t.

Th% li2 u*2%# is a" o#tho&o"ti$ a22lia"$% that is

us%& to ,ai" s2a$% i" th% lo3%# a#$h a"& i"$#%as% a#$h

2%#i*%t%# ' a$ti", as a shi%l& to 4%%2 th% li2 a"& $h%%4s

a3a' (#o* th% lo3%# &%"titio" thus *o&i('i", th%

%+uili#iu* %t3%%" th% *us$l%s a"& th% t%%th.-

/


12/59

P#%)ious stu&i%s o" li2 u*2%# th%#a2' ha)% sho3" that

th% li2 u*2%# i"$#%as%s a#$h &%2th a"& 3i&th!!-!-85 ti2s

th% *a"&iula# *ola#s 2ost%#io#l'! allo3s (o# 2#o$li"atio"

o( i"$iso#s thus h%l2i", 3ith tooth si:% a#$h l%",th

&is$#%2a"$' ' u2 to (ou# *illi*%t%#s. No"% o( th%

2#%)ious lit%#atu#% has stu&i%& th% %((%$t o( th% li2

u*2%# o" th% &%2th o( th% $u#)% o( S2%%. This stu&'

i"t%"&s to i")%sti,at% 3h%th%# li2 u*2%# th%#a2' is a ,oo&

o2tio" "ot o"l' to h%l2 3ith lo3%# %62a"sio" ut also %,i"

th% l%)%li", o( th% $u#)% o( S2%%.

Th% 2u#2os% o( this #%s%a#$h is to %)aluat% th%

%((%$ts o( li2 u*2%# th%#a2' o" th% &%2th o( th% $u#)% o(

S2%% a"& oth%# lo3%# a#$h $ha",%s. This stu&' 3ill *%asu#%

th% &%2th o( th% $u#)% o( S2%%! a#$h 3i&th! a#$h &%2th! a"&

a#$h l%",th %(o#% a"& a(t%# li2 u*2%# th%#a2' o"

*a"&iula# *o&%ls. A&&itio"all'! lat%#al $%2halo,#a*s 3ill

% stu&i%& to &%t%#*i"% th% $ha",%s that o$$u# to th% lo3%#

$%"t#al i"$iso#s a"& (i#st *ola#s.

-


13/59

CHAPTER -1 REVIE@ OF THE LITERATURE

Goals o( O#tho&o"ti$ T#%at*%"t

I" th% *i& /s! E&3a#& H. A",l% 3as o"% o( th% (i#st

to s2%$i(' ,oals o( o#tho&o"ti$ t#%at*%"t. H% (%lt th%

%st o$$lusio"s 3%#% thos% that i"$lu&%& all - 2%#*a"%"t

t%%th a"& 3h%#% th% *%siou$$al $us2 ti2 o( th% u22%# (i#st

2%#*a"%"t *ola# o$$lu&%& 3ith th% u$$al ,#oo)% o( th%

lo3%# (i#st 2%#*a"%"t *ola#.8

I" th% /


14/59

t%%th. I" #%latio" to i"t#a5a#$h $o"ta$t 2oi"ts! th% (i(th

4%' stat%s that th%#% shoul& % "o s2a$%s %t3%%" t%%th a"&

$o"ta$ts shoul& % ti,ht. Fi"all'! th% si6th 4%' #%(%#s to

th% os%#)atio" o( th% o$$lusal 2la"% 3hi$h shoul& #a",%

(#o* (lat to a sli,ht $u#)% o( S2%%.

A"%3s (%lt that th%s% si6 4%'s 3o#4%& ha#*o"iousl'

a"& a#% all %ss%"tial to su$$%ss(ul o#tho&o"ti$ t#%at*%"t.

As $a" % "ot%& (#o* Fi,u#% -./! tooth i"t%#$us2atio" a"&

#oot 2a#all%lis* is %st 3ith th% (lat o$$lusal 2la"%.

th% 2ati%"t 3ith a s%)%#% &%%2 $u#)% o( S2%%! "ot o"l'

tooth #oots $oul& % o)%#la22i", ut also th% i"t%#5a#$h

$us2s &o "ot o$$lu&% 3%ll. Si*ila#l' i" th% #%)%#s% $u#)%

I"

o( S2%%! t%%th &o "ot o$$lu&% 3%ll a"& %6$%ssi)% s2a$%

$oul& % os%#)%&. I" th% (lat to *il& $u#)% o( S2%%! th%

u22%# a"& lo3%# t%%th o$$lu&% i&%all' a"& ha#*o"iousl'.

It is %li%)%& that i( a (latt%# o$$lusal 2la"% $oul&

% *ai"tai"%& u"til a(t%# th% *a0o#it' o( ,#o3th has

$%as%&! th% o$$lusio" 3oul& % *o#% stal%.-

8


15/59

A B C

Fi,u#% -./ A9 D%%2 $u#)% o( S2%%. B9 Flat $u#)% o( S2%%. C9

R%)%#s% $u#)% o( S2%% 7A&a2t%& (#o* A"%3s9>

As A"%3s ,oals 3%#% as%& o" stati$ *o&%ls! Roth!

a"& >9

Lat% $o*2l%t% &%$i&uous &%"titio" 7th% stu&' $ast o(th% ol&%st a,% (o# 3hi$h th% &%$i&uous s%$o"& *ola#sa"& i"$iso#s still s%#)%& as th% t%#*i"al #%(%#%"$%

2oi"ts (o# th% *%asu#%*%"t 2la"%9Ea#l' *i6%& &%"titio" 7th% stu&' $ast o( th% 'ou",%st

a,% (o# 3hi$h th% 2%#*a"%"t (i#st *ola#s a"& i"$iso#s

3%#% th% #%(%#%"$% 2oi"ts (o# th% *%asu#%*%"t 2la"%9

Lat% *i6%& &%"titio" 7th% stu&' $ast o( th% ol&%st

a,% 3h%#% th% 2%#*a"%"t (i#st *ola#s s%#)%& as th%

t%#*i"al #%(%#%"$% 2oi"ts (o# th% *%asu#%*%"t 2la"%9

Ea#l' 2%#*a"%"t &%"titio" 7th% stu&' $ast o( th%

'ou",%st a,% (o# 3hi$h th% 2%#*a"%"t s%$o"& *ola#s3%#% th% t%#*i"al #%(%#%"$% 2oi"ts (o# th%

*%asu#%*%"t 2la"%9/< '%a#s ol&

-< '%a#s ol&

Cu#)% o(

S2%% 7**9

.-8

.->

T

T8

T>

/.-

/./

-./;

T.

-. Va"a#s&all RL J#! S%$$hi AG! Chu", C5H! ?at: SH.

Ma"&iula# asal st#u$tu#% #%s2o"s% to li2 u*2%# t#%at*%"t i" th% t#a"s)%#s% &i*%"sio". A",l% O#tho&.

-8;818;.

-8. Moi" ?. Bu$$al shi%l& a22lia"$% (o# *a"&iula# a#$h

%62a"sio". J Cli" O#tho&. /--1>.

/


29/59

->. N%)a"t CT! Bus$ha", PH! Al%6a"&%# RG! St%((%" JM. Li2

u*2%# th%#a2' (o# ,ai"i", a#$h l%",th. A* J O#tho&

D%"to(a$ial O#tho2. ///1-;-.

-;. @%#"%# SP! Shi)a2u0a P?! Ha##is EF. S4%l%to&%"tal $ha",%s i" th% a&ol%s$%"t a$$#ui", (#o* us% o( th% li2

u*2%#. A",l% O#tho&. /8


30/59

CHAPTER 1 JOURNAL ARTICLE

Ast#a$t

O0%$ti)%1 Th% ai* o( this #%t#os2%$ti)% stu&' 3as to

loo4 at th% %((%$ts o( *a"&iula# li2 u*2%# th%#a2' o" th%

&%2th o( th% $u#)% o( S2%% a"& oth%# *a"&iula# &i*%"sio"s.

Mat%#ials a"& M%tho&s1 Fo#t'5si6 2ati%"ts 7-8 *al%! --

(%*al%9 3ho ha)% u"&%#,o"% li2 u*2%# th%#a2' 3ithout a"'

oth%# *a"&iula# a22lia"$%s 3%#% i&%"ti(i%& (#o* o"% si",l%

2#i)at% 2#a$titio"%#. Th% *a"&iula# *o&%ls a"& lat%#al

$%2halo,#a*s (#o* %(o#% a"& a(t%# li2 u*2%# th%#a2' 3%#%

#%$o#&%& a"& i*2o#t%& i"to Dol2hi" I*a,i",. Fi)%

*%asu#%*%"ts 3%#% ta4%" (#o* %a$h $%2halo,#a* a"& (ou#t%%"

(#o* %a$h *o&%l. D%s$#i2ti)% statisti$s! 2ai#%& t t%sts!

a"& $o##%latio"s 3%#% $o*2ut%& to a"al':% th% &ata a"&

&%t%#*i"% 3h%th%# th%#% 3as a si,"i(i$a"t $ha",% &u#i",

t#%at*%"t. R%sults1 Th% &%2th o( th% $u#)% o( S2%%

&%$#%as%& at all *%asu#%& t%%th ut *ost "oti$%al' at th%

(i#st 2#%*ola# 3hi$h &%$#%as%& /./ ** (#o* /.; ** to ./

;.;

SD

.

/-.;;

Data Coll%$tio"

P#%t#%at*%"t #%$o#&s 7T/9 a"& 2#o,#%ss #%$o#&s %(o#%

th% i"itiatio" o( (i6%& a22lia"$%s 7T-9 3%#% $oll%$t%& (o#

%a$h 2ati%"t. Th% #%$o#&s utili:%& i" this stu&' 3%#%

*a"&iula# *o&%ls a"& lat%#al $%2halo,#a*s.

Mo&%ls

All *o&%ls 3%#% t#i**%& a$$o#&i", to th% A*%#i$a"

Boa#& o( O#tho&o"ti$s sta"&a#&s. Di,ital 2hoto,#a2hs 3%#%

ta4%" o( %a$h *a"&iula# *o&%l usi", a Ca"o" T-i 3ith /

** l%"s a"& #i", (lash. Th% $a*%#a 3as 2la$%& o" a Ha"i*%6

t#i2o& a22#o6i*at%l' t%" (%%t (#o* th% *o&%l sta"& to

-8


35/59

staili:% th% $a*%#a a"& %"su#% $o"sist%"t &ista"$% a"&

$a*%#a 2ositio" (o# all 2hoto,#a2hs. To allo3 (o#

$ali#atio"! a *illi*%t#i$ #ul%# 3as 2ositio"%& i" th%

ho#i:o"tal &i*%"sio" a"& a s%$o"& *illi*%t#i$ #ul%# 3as

2la$%& i" th% )%#ti$al &i*%"sio". A la$4 2i%$% o( 3oo&

3as 2la$%& %hi"& th% *o&%l sta"& (o# i*2#o)%& $o"t#ast o(

th% 2hotos. Th#%% 2hoto,#a2hs 3%#% ta4%" o( %a$h

*a"&iula# *o&%l! /9 o( th% #i,ht si&% o#i%"t%& 3ith th%

#i,ht u$$al s%,*%"t (lush 3ith th% %&,% o( th% *o&%l sta"&

7Fi,u#% ./A9! -9 o( th% l%(t si&% o#i%"t%& 3ith th% l%(t

u$$al s%,*%"t (lush 3ith th% *o&%l sta"& 7Fi,u#% ./B9!

a"& o( th% o$$lusal su#(a$% o#i%"t%& 3ith th% *ost o$$lusal

2o#tio" o( th% *o&%l (lush 3ith th% %&,% o( th% *o&%l sta"&

7Fi,u#% ./C9.

Fi,u#% ./ 5 Photo,#a2hs ta4%" o( %a$h *o&%l. A9 #i,ht si&%B9 l%(t si&% C9 o$$lusal )i%3

All &i,ital 2hoto,#a2hs 3%#% u2loa&%& i"to Dol2hi"

I*a,i", V%#sio" //...8 P#%*iu* a"& $ali#at%& usi", th%

> ** a"& ** *a#4s o" th% ho#i:o"tal #ul%# to %+uat% to


36/59

us%& to #%$o#& all *%asu#%*%"ts to th% "%a#%st ./ **. Th%

o$$lusal 2la"% 3as &%(i"%& (#o* th% *ost %6t#u&%& i"$iso#

ti2 to th% &istou$$al $us2 ti2 o( th% 2%#*a"%"t (i#st

*ola#. F#o* this 2la"%! $u#)% o( S2%% *%asu#%*%"ts 3%#%

*a&% as th% 2%#2%"&i$ula# &ista"$%s (#o* th% $us2 ti2s o(

th% $a"i"%! &%$i&uous (i#st a"& s%$o"& *ola#s! (i#st a"&

s%$o"& 2#%*ola#s! a"& th% *%siou$$al $us2 ti2 o( th% (i#st

*ola#. Fo# &%$i&uous (i#st *ola#s! th% *%asu#%*%"ts o( th%

*%siou$$al a"& &istou$$al $us2 ti2s 3%#% a)%#a,%&.

Si*ila#l'! (o# &%$i&uous s%$o"& *ola#s! th% *%asu#%*%"ts o(

th% *%siou$$al! $%"t#ou$$al a"& &istou$$al $us2 ti2s

3%#% a)%#a,%&. @h%" a $us2 ti2 3as ao)% th% o$$lusal

2la"%! th% &ista"$% 3as #%2o#t%& as a "%,ati)% "u*%#

3h%#%as 3h%" a $us2 ti2 3as %lo3 th% o$$lusal 2la"%! th%

&ista"$% 3as #%$o#&%& as a 2ositi)% "u*%#. I( a"' tooth

3as *issi", o# u"%#u2t%&! a la"4 3as #%$o#&%&. A#$h

l%",th 3as *%asu#%& o" th% #i,ht a"& l%(t si&%s (#o* th%

&istou$$al $us2 ti2 o( th% *ost &istal *ola# to th%

*i&li"%.

A#$h 3i&th a"& a#$h &%2th *%asu#%*%"ts 3%#% ta4%" (#o*

th% o$$lusal 2hoto,#a2hs i" th% sa*% 3a' as Mo'%#s %t al.8

A#$h 3i&th 3as *%asu#%& at th% (i#st 2#%*ola#! s%$o"&

2#%*ola#! a"& (i#st *ola#s as illust#at%& i" Fi,u#% .-.

-


37/59

Fi,u#% .- A#$h 3i&th a"& a#$h &%2th *%asu#%*%"ts A9A#$h

3i&th 3as *%asu#%& i" *illi*%t%#s (#o* th% $%"t#oi& o( th%

l%(t si&% to th% $%"t#oi& o( th% #i,ht si&% B9 A#$h &%2th3as *%asu#%& i" *illi*%t%#s as th% &ista"$% (#o* th%

$o"ta$t 2oi"t o( th% $%"t#al i"$iso#s 2%#2%"&i$ula# to a

li"% $o""%$ti", th% &istal *i&2oi"ts o( th% #i,ht a"& l%(t(i#st *ola#s

Lat%#al C%2halo,#a*s

Th% lat%#al $%2halo,#a*s 3%#% s$a""%& 3ith a" EPSON

P%#(%$tio" 8 PHOTO s$a""%# usi", th% Fil* A#%a Gui&%.

Th% s$a""%# s%tti",s us%& 3%#% i*a,% t'2% o( /< it

,#a's$al%! #%solutio" o( ** #ul%# 3as ta2%&

to th% s$a""%# %& (o# $ali#atio" 2u#2os%s.

Th% s$a""%& i*a,%s 3%#% i*2o#t%& i"to Dol2hi" a"&

$ali#at%&. A $usto* a"al'sis 3as $#%at%& to t#a$% "i"%

2oi"ts as &%(i"%& i" Tal% .- a"& illust#at%& i" Fi,u#%

.. Usi", th%s% la"&*a#4s! (i)% *%asu#%*%"ts 3%#%

$o*2ut%& as outli"%& i" Tal% ..

-;


38/59

Tal% .- 5 A#%)iatio"s a"& &%(i"itio"s o( la"&*a#4s us%&

i" $usto* $%2halo*%t#i$ a"al'sis

A#%)

G"

Go

L/R

L/

L./ **. A#$h &%2th! as *%asu#%& as a li"%

(#o* th% $o"ta$t 2oi"t o( th% *a"&iula# i"$iso#s

2%#2%"&i$ula# to a li"% (#o* th% &istal o( th% #i,ht (i#st

*ola# to th% &istal o( th% l%(t (i#st *ola#! &%$#%as%&


41/59

sli,htl' ' 5.> ** (#o* . ** to .8> **. This $ha",%

3as "ot statisti$all' si,"i(i$a"t.

A P%a#so" $o##%latio" t%st 3as us%& to %6a*i"% th%

#%latio"shi2 %t3%%" th% a*ou"t o( $ha",% i" th% &%2th o(

th% $u#)% o( S2%% a"& th% a*ou"t o( $ha",% i" a#$h 3i&th.

A si,"i(i$a"t #%latio"shi2 3as "ot%& at th% i"t%#*ola# a#%a

3ith a $o##%latio" (o# th% #i,ht *ola# o( 5.- 72 K .9

a"& (o# th% l%(t *ola# o( 5.8 72 K ./9. A si,"i(i$a"t

#%latio"shi2 3as "ot (ou"& at th% (i#st o# th% s%$o"&

2#%*ola#.

Tal% .8 P#%t#%at*%"t 7P#%T69! 2ostt#%at*%"t7PostT69!

a"& t#%at*%"t $ha",% 7T6 Cha",%9i" i"t%#2#%*ola# a"&i"t%#*ola# a#$h 3i&ths a"& a#$h &%2th 7AD9

M%asu#%*%"t

858>5>

T6 Cha",%

SDP#o

/.;=./

/.8=./

-./=./

/.-8.


42/59

th%#a2'. Th% *ost si,"i(i$a"t &%$#%as% 3as os%#)%& to %

at th% (i#st 2#%*ola# 75/./> ** .; ** #i,ht a"&

5/.; ** .8 ** l%(t9. This is (ollo3%& ' th% s%$o"&

2#%*ola#! $a"i"%! a"& *%siou$$al $us2 ti2 o( th% (i#st

*ola# 75./< ** .8 ** #i,ht si&% a"& 5./- ** .88 **

l%(t si&%9.

Ta4i", th% &%%2%st tooth (#o* th% o$$lusal 2la"% o"

%a$h $as%! th% #i,ht si&% l%)%l%& 5.;; ** a"& th% l%(t

si&% l%)%l%& 5. **. @h%" a&&i", th% &%%2%st 2oi"t o(

th% $u#)% o( S2%% o" th% #i,ht si&% to th% &%%2%st 2oi"t o"

th% l%(t si&% a"& &i)i&i", ' t3o! th% $u#)% o( S2%%

o22%& (#o* /.> ** to /./8 ** l%)%li", ' a" a)%#a,% o(

5.;/ **.

A#$h l%",th i"$#%as%& ' .8- ** o" th% #i,ht si&% a"&

./ ** o" th% l%(t.

-


43/59

A

B

Fi,u#% .8 Cu#)% o( S2%% *%asu#%*%"ts. B%(o#%! a(t%#!

a"& t#%at*%"t $ha",%s o( th% $u#)% o( S2%% as *%asu#%& (#o*

th% o$$lusal #%(%#%"$% 2la"% a3" (#o* th% i"$iso# to th%

&istal $us2 ti2 o( th% (i#st *ola# to th% $us2 ti2s o( th%$a"i"%! (i#st 2#%*ola#! s%$o"& 2#%*ola#! a"& *%siou$$al

$us2 o( th% (i#st *ola#. A9 Ri,ht Si&% B9 L%(t Si&%

Statisti$all' si,"i(i$a"t 72 = .>9


44/59

Tal% .> P#%t#%at*%"t 7P#%T69! 2ostt#%at*%"t7PostT69!

a"& t#%at*%"t $ha",% 7T6 Cha",%9i" a#$h l%",th a"& &%2ths

o( $u#)% o( S2%% at th% $a"i"%! (i#st 2#%*ola#! s%$o"&2#%*ola#! (i#st *ola# (o# th% #i,ht a"& l%(t si&% o( th%

a#$h

M%asu#%*%"ts

A#$h l%",thCa"i"%

Fi#st 2#%*ola#S%$o"& 2#%*ola#

Fi#st *ola#

Ma6i*u*

A#$h l%",th

Ca"i"%

Fi#st 2#%*ola#S%$o"& 2#%*ola#

Fi#st *ola#Ma6i*u*

7Ma6i*u* Ri,ht Ma6i*u* L%(t9-

U"it

****

****

**

**

**

**

****

****

**

P#%T6

M%a"SD

5.

5/.;5.>

5

-.>

-.8-.-

/.

/./.>.8./;

-.

-.>8./--./

-.85>

.8

-.8

/.

/.-/.

/.-/. **! Moi"< os%#)%& a /.< ** i"$#%as% a"&

Oso#" %t al "ot%& a /./; ** i"$#%as%. Oso#" %t al

$o**%"t%& that th% a#$h l%",th i"$#%as% 3as *ostl' &u% to

th% a"t%#io# ti22i", o( th% i"$iso#s. Si"$% th% $u##%"t

#%s%a#$h sho3%& *i"o# i"$iso# ti22i",! it (ollo3s that

th%#% 3oul& "ot % as la#,% a" i"$#%as% i" a#$h l%",th.

Th% *%a" $ha",% i" a#$h &%2th! 5.> **! 3as s*all a"&

"ot si,"i(i$a"t 3hi$h (ollo3s th% (i"&i",s o( @%#"%# %t al

a"& F%##is %t al/- 3ho os%#)%& $ha",%s o( .-/ ** a"&

5./; ** #%s2%$ti)%l'. This s*all $ha",% i" a#$h &%2th is

%asil' u"&%#stoo& 3h%" $o*2a#%& to th% s*all $ha",% (ou"&

i" a#$h l%",th i" th%s% stu&i%s. O"% 2ossiilit' (o# th%

s*all $ha",% i" a#$h l%",th a"& a#$h &%2th *a' % &u% to a


49/59

*o#% ,i",i)al 2la$%*%"t o( th% li2 u*2%#. Da)i&o)it$h %t

al a"& G#oss%" a"& I",%#)all/ (ou"& la#,%# a#$h &%2th

i"$#%as%s! -./ ** a"& /.> ** #%s2%$ti)%l'! 3hi$h

$o##%s2o"&s to th%i# la#,%# IMPA $ha",%.

Si"$% th% 2#%t#%at*%"t (i#st 2#%*ola# a#$h 3i&th!

(i#st *ola# a#$h 3i&th a"& a#$h &%2th 3%#% all

si,"i(i$a"tl' s*all%# tha" th% u"t#%at%& sa*2l% a"al':%& '

Mo'%#s %t al8! it $a" % su#*is%& that th% li2 u*2%# 3as

%i", us%& 2#i*a#il' o" 2ati%"ts 3ith s*all lo3%# a#$h%s.

This t#%at*%"t ha& a si,"i(i$a"t %((%$t o" th% a#$h 3i&th

at th% (i#st 2#%*ola# a"& (i#st *ola# #%,io"s 3hi$h

su,,%sts that li2 u*2%# th%#a2' is %((%$ti)% i" h%l2i",

&%)%lo2 s*all lo3%# a#$h%s. Du#i", t#%at*%"t! th% (i#st

*ola# a#$h 3i&th i"$#%as%& (#o* th% /;th2%#$%"til% to th%


50/59

u*2%# th%#a2'. This #%i"(o#$%s th% #%sults o( B%#,%#s%"/

3ho (ou"& "o si,"i(i$a"t $o##%latio" %t3%%" th% &istal

*ola# *o)%*%"t o# th% *%sial *o)%*%"t o( th% lo3%# i"$iso#s

3ith th% *a"&iula# 2la"% a",l%. No oth%# #%)i%3%&

lit%#atu#% a&%ss%s this *%asu#%*%"t.

This stu&' sho3%& o"l' a *o&%st i"$#%as% i" IMPA o(

.. This #%sult is +uit% si*ila# to Moi" %t al/8 3ho

@ith su$h a la#,%(ou"& a" i"$#%as% o( /.- 8./.

sta"&a#& &%)iatio"! th%' (ou"& that IMPA o"l' i"$#%as%& i"

hal( o( th% 2ati%"ts a"& %ith%# sta'%& th% sa*% o#

&%$#%as%& i" th% oth%# hal(. This )a#i%s (#o* oth%#

stu&i%s that sho3%& a *o#% si,"i(i$a"t i"$#%as% i" IMPA

#a",i", (#o* -.8 to -..!


51/59

Th% *ola# u2#i,hti", os%#)%& i" this stu&' is

$o"sist%"t 3ith th% lit%#atu#%. Ho3%)%#! th% 5-.8 (ou"&

3as sli,htl' l%ss tha" that o( ODo""%ll %t al// 3ho (ou"&

58.; a"& Da)i&o)it$h %t al 3ho (ou"& 5..

Lo3%# a"t%#io# &%"tal h%i,ht a"& lo3%# 2ost%#io#

&%"tal h%i,ht as *%asu#%& (#o* th% *%sial $us2 o( th% *ola#

a"& th% i"$isal %&,% o( th% $%"t#al i"$iso# 2%#2%"&i$ula#

to th% *a"&iula# 2la"% i"$#%as%& -.-; ** a"& /. **

#%s2%$ti)%l'. Th%s% $ha",%s a#% $o*2a#al% to thos% (ou"&

' Riolo %t al/> i" a" u"t#%at%& sa*2l% o( si*ila# a,%&

*al%s a"& (%*al%s. Th%' (ou"& a" i"$#%as% o( -./ ** a"&

-.> ** i" th% th#%% '%a# 2%#io& (#o* a,% t%" to thi#t%%".

Th% #%aso" (o# this i"$#%as% is th%#%(o#% &u% to "o#*al

,#o3th a"& th% %#u2tio" o( th% t%%th as th% )%#ti$al ,#o3th

o( th% al)%ola# o"% 2#o,#%ss%s.

Cu#)% o( S2%% Cha",%s

Th% #%sults o( this stu&' sho3 that th% $u#)% o( S2%%

&%$#%as%& (o# %a$h tooth that 3as *%asu#%& a"& all $ha",%s

3%#% si,"i(i$a"t %6$%2t (o# th% l%(t (i#st *ola#.

su,,%sts that th% li2 u*2%# is a )ali& o2tio" (o#

o#tho&o"tists 3h%" ai*i", to l%)%l th% $u#)% o( S2%% i"

a&&itio" to th% oth%# a#$h $ha",%s 2#%)iousl' *%"tio"%&.

O" a)%#a,%! th% $u#)% o( S2%% l%)%l%& .;/ ** (#o* /.> **

8/

This


52/59

to /./8 **. Th%s% "u*%#s $a" % $o*2a#%& to Ma#shall %t

als/ (i"&i", that th% &%2th o( th% $u#)% o( S2%% o(

u"t#%at%& &%"tal $asts i" th% %a#l' 2%#*a"%"t &%"titio" is

-./; **.

Co"$lusio"s

/. Li2 u*2%# th%#a2' is a" %((%$ti)% a22lia"$% i" l%)%li",

th% $u#)% o( S2%% 2#io# to th% i"itiatio" o( (i6%&

a22lia"$%s.

-. Lo3%# a#$h 3i&th si,"i(i$a"tl' i"$#%as%s at th% 2#%*ola#

a"& *ola# l%)%ls.

. Th%#% is a *o#% si,"i(i$a"t &istal ti22i", o( th% (i#st

*ola# tha" th% *%sial ti22i", o( th% lo3%# i"$iso#s.

8-


53/59

R%(%#%"$%s

/. Ma#shall SD! Cas2%#s%" M! Ha#&i",%# RR! F#a"$is$us RG!

A+uili"o SA! Southa#& TE. D%)%lo2*%"t o( th% $u#)% o(S2%%. A* J O#tho& D%"to(a$ial O#tho2. -/8188>-.

S2%"a R. No"%6t#a$tio" T#%at*%"t1 A" Atlas o" C%tli"M%$ha"i$s. D%"ts2l' GAC Boh%*ia! NY! --.

Da)i&o)it$h M! M$I""is D! Li"&au%# SJ. Th% %((%$ts o(

li2 u*2%# th%#a2' i" th% *i6%& &%"titio". A* J O#tho&

D%"to(a$ial O#tho2. /;///1>-.

Mo'%#s RE! Li"&%" FPGM )a" &%#! Riolo ML! M$Na*a#a JA.

Sta"&a#&s o( Hu*a" O$$lusal D%)%lo2*%"t. A"" A#o#! MI1

C%"t%# (o# Hu*a" G#o3th a"& D%)%lo2*%"t! U"i). o(

Mi$hi,a" /;.

N%)a"t CT! Bus$ha", PH! Al%6a"&%# RG! St%((%" JM. Li2

u*2%# th%#a2' (o# ,ai"i", a#$h l%",th. A* J O#tho&

D%"to(a$ial O#tho2. ///1-;-.

@%#"%# SP! Shi)a2u0a P?! Ha##is EF. S4%l%to&%"tal

$ha",%s i" th% a&ol%s$%"t a$$#ui", (#o* us% o( th% li2u*2%#. A",l% O#tho&. /8


54/59

/-. F%##is T! Al%6a"&%# RG! Bol%' J! Bus$ha", PH. Lo",5t%#*

stailit' o( $o*i"%& #a2i& 2alatal %62a"sio"5li2

u*2%# th%#a2' (ollo3%& ' (ull (i6%& a22lia"$%s. A* J O#tho& D%"to(a$ial O#tho2. ->/-1/->.

/. B%#,%#s%" EO. A $%2halo*%t#i$ stu&' o( th% $li"i$al us%

o( th% *a"&iula# laial u*2%#. A* J O#tho&. /;-;


55/59


56/59

Tal% A. 5 Cu#)% o( S2%% 5 D%s$#i2ti)% statisti$s

N

A#$h l%",th 7T/9

7T-9

Ca"i"% 7T/9

7T-9

RIGHTSIDE

Fi#st 2#%*ola# 7T/9

7T-9

S%$o"& 2#%*ola# 7T/9

7T-9

Fi#st *ola# 7T/9

7T-9

Ma6i*u* 7T/9

7T-9

A#$h l%",th 7T/9

7T-9

Ca"i"% 7T/9

7T-9

LEFT SIDEFi#st 2#%*ola# 7T/9

7T-9

S%$o"& 2#%*ola# 7T/9

7T-9

Fi#st *ola# 7T/9

7T-9

Ma6i*u* 7T/9

7T-97Ma6i*u* Ri,ht

Ma6i*u* L%(t9- 7T/9

7T-9

8

8.

.8

.

.;

/.8

/.;

8.-

8.

.

.8

.

;.

.>

.8

-.8

8..

.8

8.

8


57/59

Tal% A.8 5 Cu#)% o( S2%% 5 Pai#%& Di((%#%"$%s

M%a"Cha",%

A#$h l%",th

Ca"i"%

RIGHTFi#st 2#%*ola#

S%$o"& 2#%*ola#

Fi#st *ola#

Ma6i*u*

A#$h l%",th

Ca"i"%

LEFT Fi#st 2#%*ola#

S%$o"& 2#%*ola#

Fi#st *ola#

Ma6i*u*

7Ma6i*u* #i,ht *a6i*u* l%(t9-

.8-

5.>

5.

5/.;

5.>

/./8

.;

/.-/

.8

/.

/./

.>

.8

.;

.88

/.

.

> Co"(i&%"$% I"t%#)al

5. to . to 5.

5. to 5.-

5/. to 5.8;

.- to /.>

5. to 5.>

5/.- to 5.-

5.; to 5.8

5.-> to ./

5.; to 5.-

5.; to 5.8>

T

5/.

.

.-

.

-.

.

>./

8>

8>

8>

8>

8>

8

8>

88

8>

8>

8>

P#o

.

.8

=./

=./

.-

=./

.8

.--

=./

=./

.


58/59

Tal% A.> 5 C%2halo*%t#i$ *%asu#%*%"ts D%s$#i2ti)%

statisti$s7NK8

.;/

/../

-8.>

;./

;.

.

Ra",%

/./

-.-

5.8 to -.-8

5.< to 5.;/

/. to -.;8

/.>/ to -.-

8>

8>

8>

P#o

.


59/59

VITA AUCTORIS

Joshua Ha#l%' Gotli 3as o#" o" D%$%*%# ! /; i"

S2#i",(i%l&! Massa$hus%tts as th% (i(th so" to D#. B%#"a#&

a"& M#s. Sa*#a Gotli. I" /- h% #%$%i)%& his

u"&%#,#a&uat% &%,#%% i" G%"%#al Busi"%ss a"& Fi"a"$% 3ith a

$o"$%"t#atio" i" Co*2ut%# S$i%"$% (#o* th% U"i)%#sit' o(

Massa$hus%tts at A*h%#st. Follo3i", $oll%,%! h% %"0o'%& a

/8 '%a# $a#%%# i" i"(o#*atio" t%$h"olo,' %(o#% att%"&i",

th% I"&ia"a U"i)%#sit' S$hool o( D%"tist#' 3h%#% h%

#%$%i)%& his Do$to#at% o( D%"tal Su#,%#' &%,#%% i" -/.

Lat%# i" -/ h% #%lo$at%& to St. Louis! Missou#i 3ith his

3i(% Roi" 3h%#% h% %,a" his o#tho&o"ti$ #%si&%"$'

t#ai"i", at Sai"t Louis U"i)%#sit'. H% %62%$ts to #%$%i)%

a Mast%# o( S$i%"$% i" D%"tist#' as 3%ll as a $%#ti(i$at%

as a s2%$ialist i" o#tho&o"ti$s (#o* Sai"t Louis U"i)%#sit'

i" D%$%*%# -/-.

Documents

Lip Bumper Teza