class-III Patients Research Articles

Assessing the Impact of Maxillomandibular Difference on the Success of Orthodontic Decompensation Preparation in Orthognathic Surgical Skeletal Class-III Patients

Background: Combined orthodontic-surgical treatment includes a thorough diagnosis and analysis of dental and facial deformities. Cephalometric analysis is a common tool for this, in which measurements of specific anatomical landmarks are performed. In order to achieve a successful surgery, orthodontic teeth preparation is mandatory, including dental decompensation before surgery. This should be planned and adequately executed to allow the surgeon to move the jaws to the correct ideal position. Aim: The current study aimed to check if the orthodontic decompensation amount is influenced and compromised by the maxillomandibular difference and if there is a correlation between the deformity’s severity and the orthodontist’s difficulty in achieving an accurate result in the orthodontic decompensation preparation. Methods: The study consisted of 50 pre-operational cephalometric radiographs of patients with Class-III (prognathic) deformity. The measurements included the angles of the upper incisor (U1) longitudinal axis to the Frankfort plane (FH) and palatal plane (PP), lower incisor (L1) longitudinal axis to the lower mandibular plane (MP), overjet (OJ), effective maxillary length, effective mandibular length, and the maxilla–mandibular difference (Diff); Pearson correlation coefficient was applied. Results: There was a significant correlation between the maxilla–mandibular difference and U1 to FH angle (r = 0.254, p = 0.037), U1 to PP angle (r = 0.447, p < 0.001), OJ (r = (−0.426), p < 0.001). There was no statistical significance for Diff and L1 to MP angle (p = 0.342). Conclusions: In Class-III patients, achieving adequate decompensation is more challenging with the maxillary incisors rather than with the mandibular incisors, especially in more severe cases.

Cephalometric evaluation of pharyngeal airway and tongue space following treatment with Herbst and AdvanSync appliances : Aprospective randomized clinical trial.

To evaluate and compare pharyngeal airway and tongue space changes after treatment with fixed functional appliances-Herbst and AdvanSync™ (Ormco, Orange, CA, USA) appliances-in skeletal classII patients in pre- and posttreatment lateral cephalograms. For this randomized, controlled trial, 40patients (21male, 19female) were divided into two groups-aHerbst group (mean age 12.6 ± 0.67 years) and an AdvanSync group (mean age 12.8 ± 0.66 years). Pre- and posttreatment (appliance therapy duration-8months) lateral cephalograms were traced using a software program to evaluate pharyngeal airway and tongue space changes. Nasopharyngeal airway, velopharyngeal airway, glossopharyngeal airway, and hypopharyngeal airway increased in the Herbst group by 2.12 mm (p ≤ 0.001), 2.33 mm (p ≤ 0.001), 2.40 mm (p ≤ 0.01), and 1.57 mm (p ≤ 0.05), while in the AdvanSync group the increases were 1.89 mm (p ≤ 0.001), 1.21 mm (p ≤ 0.001), 1.18 mm (p ≤ 0.001), and 1.53 mm (p ≤ 0.001), respectively. In the Herbst group, tongue length and height increases were 2.04 mm (p ≤ 0.01) and 3.74 mm (p ≤ 0.001), while the values in the AdvanSync group were 2.41 mm (p ≤ 0.05) and 2.69 mm (p ≤ 0.001). The change of the tongue tip from the lower occlusal plane was 0.69 mm (p ≤ 0.001) in the Herbst group and 0.77 mm (p ≤ 0.001) in the AdvanSync group. The velopharyngeal airway dimension was correlated positively with that of the retroglossal oropharyngeal airway, which in-turn positively correlated with the laryngopharyngeal airway which correlated well with the distance of the tongue tip from the lower occlusal plane. The airway dimensions and tongue parameters increased significantly in both treatment groups in the present study. These changes were higher in the Herbst appliance than in the AdvanSync group, except for the distance of the tongue tip from the lower occlusal plane. Asignificant difference between the pharyngeal airways was found only for the retropalatal oropharyngeal airway.

Soft tissue evaluation after maxillary protraction with RPE or with the ALT-RAMEC protocol : Acontrolled 3D study.

To evaluate soft tissue changes following maxillary protraction with different expansion protocols using three-dimensional (3D) stereophotogrammetry. Pretreatment (T0) and postprotraction (T1) stereophotogrammetry and lateral cephalometric images of skeletal classIII patients were included in this retrospective study. In all, 32patients were treated either with acombination of rapid palatal expansion and facemask (RPE/FM; n = 16; mean age: 9.94 ± 0.68years) or with alternate rapid maxillary expansion and constriction together with afacemask (Alt-RAMEC/FM; n = 16; mean age: 9.74 ± 1.35years). As acontrol group16 untreated patients were recruited (mean age: 9.46 ± 0.8years). For superimpositioning of the 3D images taken at T0 and T1, the face was divided into defined regions and 3D and differences between the groups were evaluated using 3‑matic software (Materialise Europe, Leuven, Belgium). Cephalometric analyses were also performed. While the increases in the cephalometric parameters SNA and ANB were significantly greater in the treatment groups, the value for SNB also increased in the control group (p < 0.05). The results of the stereophotogrammetry analyses demonstrated that the mean changes in the RPE/FM and in the Alt-RAMEC/FM groups were significantly different for the midface compared to the control group (0.33 ± 0.26 mm, 0.3 ± 0.31 mm, 0.1 ± 0.18 mm). The maximum positive, negative, and mean changes were also significantly different between the treatment and control groups for the upper lip (p < 0.05). For the lower lip and the chin significant backward movements in the RPE/FM as well as in the Alt-RAMEC/FM group (-1.06 ± 1.26 mm, -0.68 ± 0.45 mm) were observed, while the control group (0.09 ± 0.53 mm) presented changes in the opposite direction. Regarding soft tissue changes, no significant differences were found between the RPE/FM and Alt-RAMEC/FM groups. Both treatment protocols improved the soft tissue profile due to aforward movement of the midface and the upper lip, and abackward movement of the lower lip and chin, compared to the control group.

Effects of maxillary expansion and protraction on pharyngeal airway dimensions in relation to changes in head posture and hyoid position : Aretrospective cohort study.

To assess changes in pharyngeal airway dimensions, head posture and hyoid position after maxillary expansion and face mask (FM) treatment compared to untreated classIII patients. This study examined 24classIII patients (10girls, 14boys, mean age: 10.97 ± 0.88years) treated with expansion and apetit-type FM appliance and 24untreated classIII patients (16girls, 8boys, mean age: 10.50 ± 1.06years). Pre- and posttreatment cephalometric radiographs were digitally analysed. Parametric data were analysed with paired and independent-samples t‑tests, nonparametric data were analysed with Wilcoxon signed-rank and Mann-WhitneyU tests. Spearman's correlation analysis was used to examine the relationship between dental/skeletal treatment changes and those of craniocervical postural position, pharyngeal airway dimension and hyoid position. With respect to the hypopharyngeal airway dimension, the hypopharyngeal sagittal length (CV3'-LPW), velar angle (HRL/U-PNS) and velar length (U-PNS) significantly increased in the treatment group. All the parameters describing head posture and those describing the distances of the hyoid bone to the HRL changed significantly after treatment, but these changes were not significantly different from the control group. In the treatment group, there also occurred asignificant increase in the sagittal growth of the maxilla (SNA, Co‑A, Na-PerpA, Wits), vertical growth of the maxillomandibular complex (SN-GoGN, N‑ANS, N‑Me), counterclockwise rotation of the maxilla (SN-PP) and overjet, while aclockwise rotation (y-axis) and anonsignificant inhibition of the sagittal growth (Co-Gn) of the mandible were observed. The treatment induced increases of hypopharyngeal sagittal length (CV3'-LPW), soft palate thickness and anteroposterior movement of hyoid bone (H-CV3) demonstrated apositive correlation with changes of craniocervical angles (NSL/OPT, NSL/CVT) and anegative correlation with craniohorizontal angles (OPT/HOR, CVT/HOR). The change of the anteroposterior movement of hyoid bone (H-CV3) was also positively correlated with oropharyngeal sagittal length (CV2'-MPW), the hypopharyngeal sagittal length (CV3'-LPW) and the minimal dimension of the pharyngeal airway space (PASmin). While expansion and FM treatment did not affect the head posture and hyoid bone position, positive effects were observed in the hypopharyngeal airway region.

Should HFrEF patients with NYHA class II expect benefit from CCM therapy? Results from the MAINTAINED observational study.

Cardiac contractility modulation (CCM) is an FDA-approved device therapy for patients with refractory systolic heart failure and normal QRS width. Randomized trials demonstrated benefits of CCM primarily for patients with severe heart failure (> NYHA class II). To better understand individualized indication in clinical practice, we compared the effect of CCM in patients with baseline NYHA class II vs. NYHA classIII or ambulatory IV over the 5-year period in our large clinical registry (MAINTAINED Observational Study). Changes in NYHA class, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), NT-proBNP level, and KDIGO chronic kidney diseasestage were compared as functional parameters. In addition, mortality within 3years was compared with the prediction of the Meta-Analysis Global Group in Chronic heart failure risk score. A total of 172 patients were included in the analyses (10% with NYHA class II). Only patients with NYHA class III/IV showed a significant improvement in NYHA class over 5years of CCM (II: 0.1 ± 0.6; p = 0.96 vs. III/IV: -0.6 ± 0.6; p < 0.0001). In both groups, LVEF improved significantly (II: 4.7 ± 8.3; p = 0.0072 vs. III/IV: 7.0 ± 10.7%; p < 0.0001), while TAPSE improved significantly only in NYHA class III/IV patients (II: 2.2 ± 1.6; p = 0.20 vs. III/IV: 1.8 ± 5.2mm; p = 0.0397). LVEF improvement was comparable in both groups over 5years of CCM (p = 0.83). NYHA class II patients had significantly lower NT-proBNP levels at baseline (858 [175/6887] vs. 2632 [17/28830] ng/L; p = 0.0044), which was offset under therapy (399 [323/1497] vs. 901 [13/18155] ng/L; p = 0.61). Actual 3-year mortality was 17 and 26% vs. a predicted mortality of 31 and 42%, respectively (p = 0.0038 for NYHAclass III/IVpatients). NYHA classIII/IV patients experienced more direct and extensive functional improvements with CCM and a survival benefit compared with the predicted risk. However, our data suggest that NYHA classII patients may also benefit from the sustained positive effects of LVEF improvement.

Short-term and long-term alterations of condylar position after bilateral sagittal split ramus osteotomy for mandibular setback: A preliminary before-after clinical trial.

Background:Because of the importance of the condyle, it is crucial to document all changes in its position after orthognathic surgery. Since previous studies in this regard are mostly controversial and limited by two-dimensional radiography technique, this study was conducted.Materials and Methods:This prospective clinical trial was performed on 102 measurements (17 patients, 2 condyles each, and 3 time points). Cone-beam computerized tomography imaging was done for 17 skeletal Class-III patients (10 females and 7 males, mean age, 24.05 ± 4.78 years) undergoing fixed orthodontic treatment, at three time points T0 (before surgery), T1 (immediately after surgery), and T2 (8 months after surgery). Condylar positions were measured. Position changes were evaluated during the course of the study. They were also compared between right/left sides and between men and women. Tests in use were repeated-measures one- and two-way analysis of variance and paired t-tests (α =0.05, α =0.017).Results:Alterations in various anatomical condyle parameters over the 8-month course of the study did not reach the level of significance (P ≥ 0.078). At all intervals, mean anterior-posterior index (API) remained between −12 and +12 (indicative of central position of the condyle in the glenoid fossa). Between men and women, left superior joint space, left anterior joint space, and left API differed (P ≤ 0.05). Left condyle mean superior joint space and anterior joint space were greater in men compared to women in all the three intervals; left condyle mean API was greater in women compared to men (more posterior in men, P ≤ 0.05).Conclusion:Condyles might not change significantly after 8 months post-surgery. However, small changes might be observed, and these changes might differ between the left and right sides and between males and females.

Bite force changes after surgical correction of mandibular prognathism in subjects with increased vertical dimension : Aprospective clinical trial.

Occlusal bite force (OBF) is the most important parameter in assessing biting efficiency. The aim of this study was to record OBF changes after surgical correction of high angle maxillary/mandibular (Max/Mand) classIII patients and to compare these with that recorded in classIII patients with average Max/Mand angle. Initially included were 42patients with severe classIII skeletal malocclusion who were scheduled for orthodontic surgery: group1-22patients with increased vertical relationship scheduled for bimaxillary surgery; group2-20patients with average vertical relationship scheduled for mandibular setback only. OBF measurements before surgery (T0), at debonding (T1) and at least 3months after debonding (T2) were recorded using aportable occlusal force gauge. The following were also measured: maximum OBF (MOBF) achieved by the subject on each side, averaged OBF on each side (AOBF) and maximum OBF at the incisal region (MIOBF). At T2, only 33patients (group 1: 17 and group 2: 16) were included in the analysis due to loss to follow-up. MOBF increased significantly in group1, while no significant changes were detected in group2. MIOBF increased after surgical correction in both groups. Significant increase in MIOBF was observed at T1 (P < 0.001) followed by an insignificant decrease during the observation period (3-6months after treatment; P > 0.05). The two groups differed significantly in MOBF at T1 and T2, while no statistically significant differences were detected between the groups for MIOBF changes at the various time intervals (P > 0.05). The number of posterior teeth with occlusal contacts increased in both groups. Relapse was detected in group1 where the number of posterior teeth in contact decreased during the observation period (T1-T2). OBF greatly improved after surgical correction of the vertical morphology. Correction of high angle mandibular prognathism improves oral function in addition to esthetics.

Management of skeletal classII malocclusion using bimaxillary skeletal anchorage supported fixed functional appliances : Anovel technique.

To evaluate the treatment effects in growing skeletal classII patients subjected to anovel treatment technique, i.e., bimaxillary miniplates supported fixed functional appliance. The null hypothesis was that there is no statistically significant difference in skeletal changes of patients with classII malocclusion treated with bimaxillary skeletal anchorage supported fixed functional appliance and those who were not provided any intervention. The sample comprised 32skeletal classII subjects (17males and 15females) with aCervical Vertebrae Maturity Index (CVMI) demonstrating peak of pubertal growth spurt. Sixteen patients (12.37 ±1.09 years of age) were treated with bimaxillary skeletal anchorage supported fixed function appliance, while 16well-matched subjects (12.06 ± 1.34years of age) were included as controls. For both groups, cephalograms (T1, T2) were taken with amatched observational interval of about 7.5months; 17linear and 10angular measurements were recorded. The intraclass correlation coefficient (ICC) was used to determine reliability of measurements recorded. Studentt test was carried out to determine the changes produced by the treatment relative to control. When compared with the control group, the treatment group demonstrated significant maxillary retrusion. No significant changes were seen in mandibular growth pattern, whereas mandibular length increased significantly more than in the control group (B-VP: 3.05 mm; Co-Gn: 2.65 mm). Treatment mechanics had minimal effects on maxillary dentition. Mandibular incisors proclined by an average of 3.06°. Maxilla-mandibular relation improved significantly (ANB: -4.29°; NA-Pog: -3.76°). The new bimaxillary skeletal anchorage supported fixed functional appliance technique was found to be highly effective in the treatment of classII malocclusion with significant skeletal changes.

Stepwise versus single-step mandibular advancement with functional appliance in treating classII patients : Ameta-analysis.

Difference in the functional orthopedic effect between stepwise mandibular advancement (SWA) and single-step mandibular advancement (SSA) in Angle classII patients remains unclarified. To compare the treatment effects of SWA and SSA on skeletal and dentoalveolar changes in classII patients. Randomized controlled trials (RCTs) and nonrandomized studies that compared differences in skeletal and dentoalveolar effects on classII patients between SWA and SSA were identified in PubMed, Embase, CENTRAL, and Web of Science. The grey literature was also searched. The primary outcomes were the mandibular length, L1-MP, and (ANB). Secondary outcomes included Pog sagittal, SNB, overjet, and mandibular plane angle. Seven studies, including three RCTs and four cohort studies, were retrieved. Meta-analyses revealed pooled mean differences (95% confidence interval) of 0.79 mm (0.45 to 1.12 mm) for Pog sagittal, 0.53° (0.19 to 0.87°) for SNB, -0.51° (-0.83 to -0.20°) for ANB, -0.17° (-0.72 to 0.39°) for the mandibular plane angle, -0.41 mm (-0.90 to 0.09 mm) for overjet, -1.87° (-3.23 to -0.52°) for L1-MP, and 1.03 mm (0.63 to 1.42 mm) for the mandibular length. Publication bias was not observed, except for Pog sagittal. The quality of evidence for each outcome was judged as low (mandibular length, SNB and overjet) and very low (Pog sagittal, ANB, L1-MP and mandibular plane angle). Although the magnitude of differences in clinical practice was limited, SWA might be more appropriate because it produces agreater skeletal change and less dental compensation than SSA. As the level of current evidence is low, more high-quality RCTs are needed.

Morphometric analysis of dental arch form changes in classII patients treated with clear aligners.

The purpose of this study was to evaluate the arch form changes in classII Caucasian patients treated with Invisalign® (Align Technology, San José, CA, USA). A total of 27classII patients, for whom amaximum of 4 mm arch expansion was planned, were selected. Both maxillary and mandibular digital casts were compared at three different times: pretreatment (T0), accepted set-up (T1), and retention phase (T2). Each digital model was imported into GOM Inspect© software (GOM GmbH, Braunschweig, Germany) to identify teeth crown facial axis (FA) and cusp points to create acoordinate system. In each model the origin of the coordinates was located at the contact point of central incisors and asystem of Cartesian axes was constructed. Using the FA points, an average arch form was obtained for each clinical step and then the following comparisons were performed for each class group: T0-T1, T0-T2, and T1-T2. T1 showed wider maxillary and mandibular dental arches compared to T0 with maximum movements observed in the premolar regions (maximum movement 1.94 mm for tooth15; P < 0.0001). In the T1-T2 comparison, amore buccal position of tooth22, tooth23, and tooth24 (maximum movement 0.56 mm; P < 0.05) and amore lingual position of tooth37 (maximum movement 0.81 mm; P < 0.01), tooth36, and tooth47 were observed at T1 with respect to T2. Although Invisalign® treatment resulted in asignificant increase in arch width according to the prescription, some of the outcomes were different than those planned especially in relation to the final position of the lower molars.

Banded versus modified appliances for anchorage during maxillary protraction.

The aim of this study was to compare banded versus modified appliances for anchorage during maxillary protraction in ClassIII malocclusions. The sample size consisted of 40 growing patients with ClassIII maxillary deficiency: 20patients received maxillary protraction with amodified appliance and 20patients with abanded appliance. Pre- and posttreatment cephalometric radiographs of all subjects were obtained and analyzed. The paired t‑test and Wilcoxon ranks test were used for statistical analysis. The patients in the modified appliance group needed fewer appointments and shorter treatment time than those in the banded appliance group. The modified appliance was superior to the banded appliance with respect to simple structure, comfort, retention, and convenience in maintaining oral hygiene. The modified appliance was as effective as the banded appliance in correcting the ClassIII malocclusion. However, agreater increase was found in mandibular plane angle, anterior facial height, total facial height, mesialization of maxillary molars, and proclination of maxillary incisors in the banded appliance group compared with that in the modified appliance group (P < 0.05). The newly developed modified appliance may be apromising approach in treating growing ClassIII patients with maxillary deficiency, which could decrease treatment time, increase treatment efficiency, and reduce anchorage loss.

Twelve-year results of LINAC-based radiosurgery for vestibular schwannomas.

To report long-term outcomes of 53patients with vestibular schwannomas (VS) submitted to asingle high-dose LINAC-based radiosurgery (SRS) in our institution. 48 (92%) patients were evaluable for clinical and MRI response as well as late toxicity. At amedian follow-up of 12years (range 2-16years), local control (LC), hearing capacity, trigeminal and facial nerve function, and toxicity were assessed. Hearing capacity was classified according to the Gardner-Robertson scale, where classI-II patients had "serviceable hearing." Median dose of SRS was 16.5 Gy (range 13-20Gy) and median tumor volume 1.7 cm3 (range 0.09-7.4 cm3). 35 (73%) patients were treated with SRS alone, in the remaining 13 (27%) patients, SRS was performed as salvage therapy for recurrent or progressive tumors after previous microsurgery. Before SRS, 44patients (92%) had hearing loss and 25 (52%) had "non-serviceable" hearing. Tumor extension, classified with Koos categories, was gradeI-II in 27 (56%) and gradeIII-IV in 21 (44%) cases. LC was 100% and hearing preservation in "serviceable hearing" patients was 91%. 4 (11%) patients developed incomplete and intermittent ipsilateral facial nerve palsy which regressed in amedian time of 6months. Trigeminal toxicity was registered in 11 (23%) patients, reversible in 6 (13%) and permanent in 5 (10%). Only Koos tumor gradeIII-IV significantly influenced late toxicity (p = 0.01). LC and hearing preservation after SRS were excellent. Toxicity proved acceptable. Although the median administered dose (16.5 Gy) was rather high, the only factor which significantly influenced late toxicity was Koos tumor gradeIII-IV.

Relationships among tongue volume, hyoid position, airway volume and maxillofacial form in paediatric patients with Class-I, Class-II and Class-III malocclusions.

To clarify the associations among tongue volume, hyoid position, airway volume and maxillofacial form using cone beam computed tomography (CBCT) data for children with Class-I, Class-II and Class-III malocclusion. Sixty children (mean age, 9.2years) divided into Class-I, Class-II and Class-III malocclusion groups according to the A-nasion-B angle. Cone beam computed tomography was used for three-dimensional reconstruction of the maxillofacial region and airway. The hyoid position and the tongue, airway and oral cavity volumes were evaluated. Upper airway ventilation status was calculated using computational fluid dynamics. The groups were compared using analysis of variance and Kruskal-Wallis tests; relationships among the parameters were assessed using Pearson's and Spearman's rank correlation tests. The tongue volume was larger in Class-III patients (50.63cm3 ) than in Class-I patients (44.24cm3 ; P<0.05). The hyoid position was lower (49.44cm), and anatomical balance (AB; tongue volume/oral cavity volume; 85.06%) was greater in Class-II patients than in Class-I patients (46.06cm, 80.57%, respectively; P<0.05 for both). The hyoid height showed a positive correlation with AB (r=0.614; P<0.001). Children with Class-III malocclusion have large tongue volumes and small AB; the reverse is true for children with Class-II malocclusion. The hyoid position is closely associated with AB in children with malocclusion.

Are morphologic and topographic alterations of the mandibular fossa after fixed functional treatment detectable on tomograms? Visual classification and morphometric analysis.

The goal was to evaluate if changes in morphology and topography of the mandibular fossa after Functional Mandibular Advancer (FMA) treatment are detectable on tomograms. Furthermore, the suitability of digital tomograms (DT) over magnetic resonance imaging (MRI) for this particular question was investigated. In all, 25patients (14female, 11male) with askeletal classII malocclusion received treatment with aFMA. DTs were available prior to (T1) and after (T2) FMA treatment. Atotal of 50 temporomandibular joints were investigated. The mandibular fossae were evaluated metrically and visually regarding treatment-induced alterations. Ap < 0.05 was set as the level for statistical significance for all tests. Results were compared to the results of arecent MRI study. Visual inspection of all 50joints in the DT at T1 and T2 revealed no alterations of the fossa shape in the sagittal plane; 24patients showed identical morphology of right and left joints. The metrical analysis revealed no significant changes regarding width, depth and ratio thereof between T1 and T2. There also were no bilateral differences. Another 18 different distance measurements between porion, mandibular fossa, articular eminence and pterygoid fossa showed no significant changes. There was no detectable proof of afossa shift. No changes in the sagittal plane, mandibular fossa, the articular tubercle, or apossible fossa shift were found in the DT of classII patients after FMA treatment. DT and MRI measurements and the visual inspection revealed identical findings; thus, DT appears to be avaluable research tool for sagittal analysis of mandibular fossa changes.

Dentoskeletal Stability in Conventional Orthognathic Surgery, Presurgical Orthodontic Treatment and Surgery-First Approach in Class-III Patients

For many years, the conventional approach to orthognathic surgery which was orthodontic treatment prior to orthognathic surgery has been the accepted method of treatment for skeletal class III malocclusion patients. This review compared the dentoskeletal stability of treatment results between conventional orthognathic surgery methods with presurgical orthodontic treatment and surgery-first approach in skeletal class III patients. The study protocol was based on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement for systematic review and meta-analysis. Electronic and manual searches for literature since 2011 were conducted. PubMed and Medline databases were accessed. Data extraction and analysis were performed by two independent individuals. Seven studies out of hundred-fourteen articles met the inclusion criteria and were selected for qualitative analysis. The included studies were 494 patients with skeletal class-III malocclusion. Stability of treatment was compared between surgery-first approach and conventionally treated patients. The statistical analysis confirmed that surgery-first approach did not show more stability compared with presurgical orthodontics. The surgery-first approach shortened the overall treatment duration. However, more skeletal stability in conventional treatment was assessed. Both surgery-first approach and conventional treatment with presurgical orthodontics resulted in favorable skeletal changes in class-III malocclusion patients. Moreover, these findings should be discussed further due to the variety of study designs, outcomes and biases. Current evidence in this field still needs to be expanded. The authors wish to see more well-designed randomized controlled trials with long-term follow ups to confirm the results.

Short-term dentoskeletal changes following ClassII treatment using afixed functional appliance: the Austro Repositioner : Apilot study.

Purpose of this prospective study was to evaluate the skeletal and dentoalveolar effects of afixed functional appliance, the Austro Repositioner, in dolicho- and brachyfacial skeletal ClassII patients. In all, 20 dolicho- and 25brachyfacial consecutive patients treated with the Austro Repositioner were compared with untreated controls (20dolicho- and 20brachyfacial patients) with the same initial dentoskeletal features. Lateral cephalograms were acquired before and 1.0±0.2year after therapy. Significant improvements in skeletal ClassII relationships were observed in both groups. The ANB angle decreased (3.56° in dolicho- and 3.13° in brachyfacial patients, P < 0.001) due to changes localized exclusively in the mandible, the SNB angle increased to 3.20° in dolicho- and 3.02° in brachyfacial patients, and the total mandibular length (Co-Pg) increased to 6.47 mm in dolicho- and 5.78 mm in brachyfacial patients (P < 0.001). Afavorable guidance of vertical pattern was also achieved in both groups, and no significant changes were observed in the upper and lower incisors in both groups. The Austro Repositioner was effective for short-term treatment of skeletal ClassII malocclusion resulting from the retrusion of the mandible in both dolicho- and brachyfacial patients.

Long-term effects of ClassII orthodontic treatment on oral health.

To investigate the long-term (≥15years) benefit of orthodontic ClassII treatment (Tx) on oral health (OH). All patients (Department of Orthodontics, University of Giessen, Giessen, Germany) who underwent ClassII correction (Herbst-multibracket Tx, end of active Tx ≥ 15years ago) and agreed to participate in arecall (clinical examination, interview, impressions, and photographs) were included. Records after active Tx were used to assess the long-term OH effects. Data were compared to corresponding population-representative age-cohorts as well as to untreated ClassI controls without orthodontic Tx need during adolescence. Of 152 treated ClassII patients, 75 could be located and agreed to participate at 33.7 ± 3.0years of age (pre-Tx age: 14.0 ± 2.7years). The majority (70.8%) were fully satisfied with their teeth and with their masticatory system. The Decayed, Missing, Filled Teeth Index (DMFT) was 7.1 ± 4.8 and, thus, almost identical to that of the untreated ClassI controls (7.9 ± 3.6). In contrast, the DMFT in the population-representative age-cohort was 56% higher. The determined mean Community Periodontal Index (CPI) maximum score (1.6 ± 0.6) was also comparable to the untreated ClassI controls (1.7 ± 0.9) but in the corresponding population-representative age-cohort it was 19-44% higher. The extent of lower incisor gingival recessions did not differ significantly between the treated ClassII participants and the untreated ClassI controls (0.1 ± 0.2 vs. 0.0 ± 0.1 mm). Patients with orthodontically treated severe ClassII malocclusions had alower risk for oral health impairment than the general population. The risk corresponded to that of untreated ClassI controls (without orthodontic Tx need during adolescence).

Radiographic growth indicators: The issue of diagnostic reliability and clinical feasibility

The use of radiographic growth indicators, such as the hand-and-wrist maturation (HWM) and cervical vertebral maturation (CVM) methods, has been recommended in previous clinical trials on the skeletal effects obtained by functional treatment in growing ClassII patients. The concept behind the use of indicators resides in the identification of the pubertal growth spurt in individual patients allowing the delivery of the treatment at this specific stage of skeletal maturation when the mandible response is expected to be maximum growth. Interestingly, while many of the former types of investigations reported a poor correlation between the stages of growth indicators (mainly the CVM) and mandibular growth spurt, most of the latter type of investigations reported clinically relevant favorable effects when the growth indicators are used. It is perhaps that investigations are still missing the relevant piece of evidence.The first critical issue relates to the correlation between two variables (i.e., stages of maturation and mandibular growth) that does not imply diagnostic accuracy, as it has been extensively reported for the case of dental maturation. The other relevant issue relates to the clinical feasibility of the repetition of the recording when dealing with invasive methods based on X-rays, irrespective of whether the methods are accurate. Meanwhile, more opportunity will be given by the use of non-invasive (serum or GCF) biomarkers. According to all these considerations, more reports will be necessary to elucidate the role of the growth indicators in orthodontics fully.

Protraction facial mask in early treatment of class III malocclusion

Summary: Treatment of mild to moderate maloclussion class III with protraction facial maskcould reduce the need of orthognatic surgery at all or reduce the size of the orthognatic surgicalintervention. Objetive: To evaluate the effect of early treatment with facial mask in angle classIII patients. Methods: Two class III patientes were estudied beinf treated with facial masthe firstpatient used the facial mask 12 hours at day 3 months periods then the patient was switched todental orthopedic treatment controlled by Rx lateral perfilogram . The second patient used facialmask 6 months ,then switched to dental orthopedic treatment 3 years.The patients were controleduntil patients were 14 years old. Discussion: This serie of 2 case reports reveal that the use of aprotactil facial mask is favourable ro treat patients suffering class III maloclussions. Theskeletal facial changes were positively significant in those patients according to the datadetectable changes of maxillar and mandibular bone size and the cefalometric points a and b thatoclussal plane. In follow up studies ,it and determend that even after reach the patients 18 yearsof age, 67% of the patients were in normal oclussion even longer than 8 years after treatment.Thisresuet indicates that only on third of the ortonagte surgeris may be truly needed to the treatmentof ,class III dental. Key words: Class III maloclussion. Facial mask. Early dentaltreatment.

Evaluation of relapse after orthodontic therapy combined with orthognathic surgery in the treatment of skeletal class III

Multidisciplinary treatment of skeletal malocclusion by orthognathic surgery in addition to orthodontics is a routine strategy believed to offer good functional and esthetic outcomes. Postoperative relapse is, however, a problem. The present study was conducted to analyze the stability of outcomes achieved by surgical treatment of skeletal classIII patients in terms of the rate and extent of relapses. A total of 30patients who had undergone orthodontic treatment combined with orthognathic surgery were included. The primary inclusion criterion was a skeletal classIII treated by mandibular setback (Obwegeser/DalPont) surgery alone or combined with maxillary advancement (Le FortI) surgery. Analysis was based on one preoperative and two postoperative cephalograms per patient. We observed relapse (defined, in accordance with Proffit, as changes >2mm or 2°) at a rate of 24% after bimaxillary procedures, compared to a lower rate of 21% after mandibular setback procedures only. The relapse rate was 21% among patients who had undergone upper-jaw surgery versus 27% among those who had undergone lower-jaw surgery, which was statistically significant. The majority of patients exhibited stable treatment outcomes. Maxillary advancement procedures were found to be less susceptible to relapse-resulting in more stable outcomes-and mandibular setback distances correlated positively with the degree of the relapse. No statistically significant differences were observed between the procedures conducted in both jaws versus in the lower jaw only, or in the extent of upper-jaw repositioning.