Overjet Correction Research Articles

Three-Dimensional Assessment of the Effects of Kinesio Taping on Mandibular Condylar Volume with Skeletal Class II Malocclusions

This study aimed to perform a three-dimensional assessment of the effects of Kinesio taping (KT) on mandibular condylar volume during Twin Block (TB) appliance therapy in individuals with skeletal Class II malocclusions. Thirty children (16 female, 14 male) aged between 10 and 15 years (12.80 ± 1.08) who were scheduled for TB therapy were randomly assigned to two groups of 15 patients each. One group (Group 1) received KT on the temporomandibular joint (TMJ) area with TB therapy while the other group (Group 2) only received the TB. KT was applied in cycles of 3 days, followed by 1 day off for 3 months. All patients underwent computed tomography (CT) scanning before KT and TB therapy (T0) and 3 months later (T1). Changes in right and left condylar volumes were measured (cm3) using a GE Advantage Workstation (General Electric Medical Systems, USA) and compared between the two groups using the Mann–Whitney U test and Wilcoxon signed-rank test. The KT group showed a significant differences in condylar volumes for both right (mean 0.13; p = 0.015; [0.04: 0.22]) and left condyle (0.30; p = 0.001; [0.18: 0.42]) from baseline (T0) to 3 months (T1). The comparisons between Group 1 and Group 2 revealed no statistically significant difference in initial and final condylar volumes for both the right (0.13; p > 0.05; [−0.16: 0.09]) and the left condyle (0.30; p > 0.05; [−0.04: 0.42]). Kinesio taping, which demonstrated a relative and slight increase on condylar volume, may provide clinical benefits such as a reduction in the duration of functional appliance use, decreased risk of relapse, and effective correction of overjet.

Class II Division 1 Malocclusion Treated with Two-Phase Orthodontic Approach

Enhancing facial aesthetics is a primary motivation for individuals with class II division 1 malocclusion seeking orthodontic treatment. Among the different techniques available to treat Class II malocclusions, a two-phase approach involving functional jaw orthopedics and fixed orthodontic treatment is commonly employed. In this case report, we present the treatment of a young male patient with a Class II Division 1 malocclusion. In the initial phase, the patient underwent growth modification and correction of overjet, overbite, and profile using the Andresen activator. Subsequently, a fixed orthodontic appliance was utilized in the second phase to achieve well-aligned arches and enhance both aesthetics and functionality.

Evaluation of Effects of Bimaxillary Anchored Fixed Functional Appliance on Temporomandibular Joint and Maxillomandibular Complex in Late Adolescents: An MRI Study

Objective To evaluate and assess changes in temporomandibular joint (TMJ), dental, skeletal and soft tissue changes following bimaxillary anchored fixed functional appliance (FFA) treatment of skeletal Class II malocclusion using Magnetic Resonance Imaging. Methods The prospective single-arm clinical trial included 15 patients (8 males, 7 females; mean age 15.71 + 1.81years) with Class II Division 1 malocclusion treated with bimaxillary anchored Forsus FRD. Four miniplates were placed bilaterally in maxilla and mandible. Then Forsus FRD L pin module was attached to miniplates without levelling of the arches. Pre-treatment (T1) and post-functional (T2) lateral cephalograms and MRI of TMJ were recorded. A total of 7 parameters were used to assess TMJ in all the 3 planes using MRI. Student’s t-test was carried out to compare pre- and post-treatment-induced changes. Results The mandible significantly moved forward (SNB, 3.71 + 0.91°; SND, 3.21 + 1.25°; Pg-OLp, 2.61 + 0.66 mm, p < 0.001) and there was distalizing effect on maxilla (SNA, –0.79 + 0.89°; A-OLp, –0.57 + 0.47mm, <0.001). Mean overjet correction of 4.43mm was achieved, of which 71.8% were skeletal changes. 65% of skeletal changes contributed to molar relationship correction. The forward positioning of mandible seems to be because of condylar and glenoid fossa remodelling, with condyle moving in anterior position within glenoid fossa (3.28 + 2.29) and articular disc moved posteriorly relative to condylar head (2.27 + 1.62°). Conclusion Significant skeletal changes and TMJ remodelling were observed with bimaxillary anchored FFA in correcting skeletal Class II malocclusion.

Effects of fixed functional orthodontic treatment in hypodivergent and hyperdivergent class II patients—a retrospective cephalometric investigation

ObjectiveTo compare skeletal and dentoalveolar changes after orthodontic treatment of class II malocclusion in patients with hypodivergent and hyperdivergent growth patterns through cast splint fixed functional appliances (FFA).Materials and methodsN = 42 out of n = 47 patients with mandibular plane angles < 34° or ≥ 34° were divided into a hypodivergent (n = 24) and a hyperdivergent (n = 18) group. All patients received a single-step mandibular advancement protocol through an FFA. Lateral cephalograms were analyzed after initial leveling and alignment (T1) and immediately after FFA removal (T2). The therapeutic effect was calculated through comparison with age-matched controls from a growth survey. Statistical significance was set at p < 0.05.ResultsHypodivergent and hyperdivergent patients showed different treatment outcomes, but significant differences existed only for overbite and interincisal angle. Nearly all measurements suggested similar treatment-related changes for both groups with exception for dentoalveolar parameters.ConclusionTreatment with FFA causes similar skeletal and dentoalveolar effects in hypodivergent and in hyperdivergent patients. The correction of overjet and molar relationship is mainly caused by dentoalveolar changes.Clinical relevanceHyperdivergent patients do not respond unfavorably to FFA treatment compared to hypodivergent patients. Lower incisor protrusion occurs more pronounced in hypodivergent patients. The growth pattern ought to be considered when choosing FFA for class II treatment.

Does mandibular advancement with clear aligners have the same skeletal and dentoalveolar effects as traditional functional appliances?

BackgroundThe study aimed to compare the dentoskeletal effects of Vanbeek Activator, Herbst, Twin-Block and Mandibular Advancement with clear aligners in children with skeletal Class II malocclusions.MethodsA sample with sixty-three patients (37 males, 26 females) was included and divided into untreated control group (C, n = 12), Vanbeek Activator group (V, n = 14), Herbst group (H, n = 11), Twin-Block group (TB, n = 12) and MA group (MA, n = 14). Cephalometric analysis and Johnston Pitchfork analysis were performed to quantify the skeletal and dentoalveolar components in molar relationship and overjet correction. Compare the differences of cephalometric data and Johnston-analysis data.ResultsThe treatment changes showed significant differences in SNB, FH-NP, NA-PA, Co-Go, Co-Pog, ANB, lower facial height ratio, U1-PP, U6-PP, L1-MP and U1-L1. All the appliances improved overjet relationships significantly (Vanbeek, Herbst, Twin-Block and MA were 2.77 mm, 5.53 mm, 4.73 mm and 3.66 mm respectively) with significant retraction of maxillary incisors. The lower incisor displacement of group V and MA was negative, while that of group H and TB was positive and there were significant differences. Molar relationships were also improved by 3.45 mm, 6.85 mm, 3.48 mm and 0.92 mm for Vanbeek, Herbst, Twin-Block and MA. Mandible displacement showed a trend of group H > TB > V > MA. The displacement of maxillary molars in group H was greater than that in group C, TB and MA, and that of mandibular ones was greater than that in group C, V and MA, significantly. Herbst, Twin-Block and MA have more significant dentoalveolar effect than Vanbeek, while Vanbeek has more skeletal effect than the others especially in restraining maxillary growth.ConclusionsFour appliances are all effective in mandibular advancement, modification of class II molar relationship and deep overjet, with unavoidable increase in lower facial ratio. Vanbeek Activator has the most skeletal effects. Vanbeek and MA have a good control of mandibular incisors while more compensatory lower incisors proclination in Herbst and Twin-Block. Herbst has greater maxillary molar distalization. MA allows aligning and leveling meanwhile leading the mandible forward.

Cephalometric effects of Twin-block and van Beek Headgear-Activator in the correction of Class II malocclusion

The Twin-block (TB) and the van Beek Headgear-Activator (vBHGA) are indicated for patients with Class II malocclusion with a retrognathic mandible. Although the former is commonly prescribed for horizontally growing patients, the latter is often recommended for those growing vertically. This study aimed to compare the skeletal, dentoalveolar, and soft-tissue short-term effects of TB and vBHGA, taking growth patterns into account. Immediate prefunctional (T1) and postfunctional appliance (T2) lateral cephalometric radiographs were retrospectively obtained for vBHGA (n= 46), TB (n= 45), and untreated control (n=45) groups. The interaction of several variables at T1, T2, and T2 - T1, as well as the resultant treatment effect, were analyzed using the analysis of covariance regression models at the 5% significance level. Except for a greater reduction in Wits measurement (3.0 mm; P<0.0001) in the TB group, no anteroposterior (AP) skeletal difference was observed between the 2 appliances (ANB, 0.530; P= 0.07) (Harvold, 0.13 mm; P= 0.81). Both improved the AP skeletal relationship (ANB and Harvold) compared with the control (P<0.05). Although this mostly occurred because of the forward positioning of the mandible with the TB (SNB, 0.960; P= 0.01), the maxillary restriction was the main mechanism with the vBHGA (SNA, 1.590; P<0.01). Dentoalveolar compensations were more pronounced with the TB (IMPA, 1.92; P= 0.02), leading to greater overbite and overjet correction. Only the inclination of the maxillary incisors showed interaction with the growth pattern, with the TB horizontal growers experiencing more retroclination (U1-NA°. 3.620; P=0.0067). Both appliances produced similar modest AP skeletal changes that, together with dentoalveolar compensations, were able to correct the Class II malocclusion regardless of growth pattern.

Evaluation of Treatment Outcomes of Skeletal Class III Malocclusion Resulted from Dynaflex Appliance: A Clinical study

Purpose: This clinical study was carried out to assess skeletal and dentoalveolar changes introduced by Dynaflex appliance on skeletal class III malocclusion treatment. Materials and methods: 8 patients (4 males & 4 females) aged 10-13 years old with skeletal class III discrepancy (-3 < ANB < 0) and dental class III malocclusion were treated using Dynaflex. Following leveling and alignment the appliance was positioned mesial to maxillary first molars and distal to mandibular canines. After reaching normal overbite and overjet with Class I molar and canine relationship, Dynaflex was removed. Lateral cephalometric radiographs were taken before treatment and after Dynaflex removal. Tracing for the two radiographs were done digitally using Webceph software. Skeletal, dental, and soft tissue changes were calculated by subtracting measurements taken before treatment from measurements taken after Dynaflex removal. Results: Positive overjet with class I molar and canine relationship was accomplished. Significant skeletal, dental, and soft tissue changes between pre and post treatment radiographs were detected. Forward movement of maxillary base by 1.9 mm and backward movement of mandibular base by 1.3 mm were seen with ANB improvements. Forward movement of maxillary incisors by 2.1 mm was found. Upper and lower lip showed significant protrusion and retrusion, respectively. Conclusion: Dynaflex appliance can be used to correct mild to moderate skeletal class III malocclusion (-3 < ANB < 0) with minimal patient compliance. Factors that contributed to overjet correction were anterior movement of maxilla, posterior and downward movement of mandible together with maxillary incisors proclination.

“Canine First Technique”, An Innovative Approach in Maxillary Impacted Canines: A Case Report

Background: Maxillary canine impaction is one of the most challenging issues in orthodontics. The best treatment protocol in these cases is still debated. The purpose of this study is to describe the management of maxillary canine impaction in an adult female patient with the “Canine First Technique”. Case Report: A 21-years-old female attended our dental unit seeking orthodontic treatment. Clinical examination revealed a class II relationship, the persistence of both upper deciduous canines. The panoramic X-ray and Cone Beam Computed Tomography showed bilateral palatal permanent canine displacements and close proximity between crowns of impacted canines and roots of lateral incisors. The canines were disimpacted by means of two cantilevers inserted directly in two Temporary Anchorage Devices placed palatally and when canines were near the crest, the fixed orthodontic treatment was started. Results: At the end of the treatment, canine Class I relationships with torque correction of canines, normal overjet and overbite, and good alignment of dental arches were achieved. The radiographic evaluation showed ideal root parallelism and preserved periodontal health in the canine region. Conclusion: The Canine First Technique could provide some advantages compared to conventional approaches in terms of biomechanics, esthetics, oral hygiene, and risk reduction of root resorption of upper lateral incisors.

Treatment of class II malocclusion with Invisalign®: A pilot study using digital model-integrated maxillofacial cone beam computed tomography

Background/purposeThe treatment effects of Invisalign® are still obscure due to methodological limitations of previous studies. We introduced a method to comprehensively evaluate the dental and skeletal changes of Class II malocclusion treated non-extraction with Invisalign® and compare with the virtual simulation of ClinCheck® using digital models integrated into maxillofacial cone-beam computed tomography (CBCT). Materials and methodsThe pretreatment (T1) and posttreatment (T2) scanned digital images of actual dentitions were integrated into maxillofacial CBCT images. To evaluate three-dimensional movement of maxillary teeth and change of mandible position, T1 and T2 digital model-integrated maxillofacial CBCT images were superimposed using voxel-based registrations of stable cranial base structures. To evaluate movement of mandibular teeth, model-integrated mandibular CBCT superimposition was registered on mandibular basal bone. To compare achieved and predicted tooth movements, the actual dental images and the virtual digital models created by ClinCheck® were registered on the T1 dentitions. ResultsFor simulated upper first molar (U6) distalization of more than 1 mm, treatment accuracy ranged from 31.1% to 40.1%, which was significantly less than virtual planning and previous reports. In unilateral Class II subjects, the amount of U6 distalization on the Class II side was not significantly different from contralateral side, indicating efficacy of sequential distalization was questionable. Those with favorable overjet correction showed evidence of condylar distraction. ConclusionDigital model-integrated CBCT superimpositions reflected the actual treatment changes in comparison with the virtual simulation, and showed that ideal occlusion was not achieved in mild to moderate Class II adult patients treated non-extraction with Invisalign®.

Dentoskeletal effects of the maxillary splint headgear in the early correction of Class II malocclusion

To compare dentoskeletal changes produced by the maxillary splint headgear and cervical headgear appliance during the early phase of Class II treatment, specially the initial overjet and upper incisors position. In this retrospective study, 28 Class II patients treated with the maxillary splint headgear (maxillary splint headgear or MSG, mean age 10.1 ± 1.9 years) and 28 Class II patients treated with cervical headgear (cervical headgear group or CHG, mean age 9.5 ± 1.9 years) were evaluated before and after treatment. Statistical comparisons between the two groups for cephalometric measurements at T1 and for T2-T1 changes were performed by means of independent sample t tests. The MSG showed a significantly greater reduction of the overjet in comparison to the CHG (-2.4 mm and -0.7 mm, respectively) and a significantly greater maxillary incisor uprighting (-1.8 mm and 0.4 mm, respectively). In the MSG, overjet correction was due mainly to mandibular advancement (3.5 mm), while the correction of molar relationship (3.9 mm) was 64% skeletal and 36% dentoalveolar. In the CHG, the overjet correction was also more skeletal, due to mandibular growth (1.8 mm), while correction of molar relationship (3.5 mm) was 63% dentoalveolar and 37% skeletal. Both groups showed favorable skeletal mandibular changes, which was more significant in the MSG. Regarding tooth movement, the maxillary splint headgear was more effective in uprighting upper incisors and reducing the overjet than cervical headgear appliance.

Invisalign treatment with mandibular advancement: A retrospective cohort cephalometric appraisal.

ObjectiveTo examine the skeletal, dental, and soft-tissue cephalometric effects of class II correction using Invisalign’s mandibular advancement feature in growing patients.Materials and MethodsA retrospective cohort clinical study was performed on cases that were started between 2017 and 2019. A total of 32 patients (13 females, 19 males), with an average age of 13 years old (9.9-14.8 years) had undergone Invisalign treatment (Align Technology, Inc., San Jose, CA) wherein the mandibular advancement phase was completed were included. Photos, digital study models, and cephalograms were taken once during the patients’ initial visit and again upon completing the mandibular advancement phase of treatment. The number of aligners worn and the time of treatment in months was recorded for each subject. Cephalometric analysis was performed and overjet and overbite were measured. Statistical analysis was performed using SPSS statistical software (version 25; SPSS, Chicago, Ill) and the level of significance was set at P <0.05. Descriptive statistics were performed to generate means and differences for each cephalometric measurement as well as patient data including age, treatment time, and aligner number. Differences between measurements from patients before treatment (T1) and after treatment (T2) with the mandibular advancement feature were evaluated using a paired t -test.ResultsAll 32 patients had multiple jumps staged for the precision wings, i.e., incremental advancement. The average length of treatment for the MA phase was 9.2 months (7.5-13.8 months) and the average number of aligners used during this time was 37 (30-55). Statistically significant differences between T1 and T2, in favor of class II correction, were observed in the ANB angle, WITS appraisal, facial convexity, and mandibular length. The nasolabial angle, overjet, and overbite also showed statistically significant changes between T1 and T2.ConclusionInvisalign aligners with the mandibular advancement feature took approximately 9 months for 1.5 mm of overjet correction. The lower incisor angulation was maintained during class II correction. The minimal skeletal changes are in favor of class II correction.

A case of maxillary protrusion and excessive overjet treated successfully by implantation of a temporary anchorage device

This case report describes the treatment of a 15-year-old girl showing Angle’s Class II Division 1 malocclusion with maxillary prognathism and marked labial inclination of the maxillary anterior teeth, which was characterized by a large overjet, overjet occlusion, and mild crowding in the lower jaw. Our treatment completed without root resorption as a result of the combined use of a wire mechanism and anchors has rarely been reported before. The left and right maxillary first premolars were extracted, a temporary anchorage device (TAD) was used for space closure, and oral hygiene maintenance guidance was provided. The total treatment time was approximately 2 years and 7 months. Ideal overjet and overbite relationships were established, and the facial profile improved substantially. The 2-year follow-up assessment showed a morphologically and functionally stable result. For patients with marked maxillary prognathism, orthodontic treatment using TADs enables simultaneous and efficient maxillary anterior tooth retraction and reduction of overjet. Moreover, this treatment has the potential to shorten the treatment duration and contribute to the long-term stability of excessive overjet correction.

A retrospective long-term comparison of early RME-facemask versus late Hybrid-Hyrax, alt-RAMEC and miniscrew-supported intraoral elastics in growing Class III patients

To compare the long-term dentoskeletal effects of early treatment with banded or bonded RME (Rapid Maxillary Expansion)-Face Mask (RME-FM) versus late treatment with bonded Hybrid-Hyrax, alt-RAMEC (Alternate Rapid Maxillary Expansion and Contraction) and intraoral Class III elastics anchored to miniscrew-reinforced-Lower-lingual-Arch (alt-RAMEC-HH-LLA) in growing, maxillary retrognathic patients. Two groups were matched at long-term follow-up retrospectively. Patients received either early RME-FM (n=16, 5 males, 11 females, age T1: 6.5±0.9 years, age T2: 15.8±2.5 years) or late alt-RAMEC-HH-LLA (n=15, 7 males, 8 females, age T1: 12.52±0.94 years, age T2: 16.8±0.9 years). Total follow-up was 9.2±2.3 years and 4.2±0.2 years respectively, including fixed appliances to compete treatment. Both treatments resulted in Class III correction except one unsuccessful case of alt-RAMEC-HH-LLA. Active maxillary protraction was 1.6±0.5years with RME-FM and 0.5 years with alt-RAMEC-HH-LLA being significantly shorter (P<0.001). Values at T2 estimation with multivariate linear regression for correlated multiple outcomes, conditional on baseline estimates, age and sex showed alt-RAMEC-HH-LLA inducing significantly more retroclined lower incisors (mean: -6.11°; 95%CI: -10.66, -1.57; P=0.01), less overbite (mean: -1.28mm; 95%CI: -1.79, -0.761; P<0.001), less maxillo (Co-A)- (mean: -4.54mm; 95%CI: -7.91, -1.16; P=0.01) mandibular (Co-Gn) (mean: -10.5mm; 95%CI: -17.45, -3.55; P=0.003) projections/size, more open gonial angle (mean: 4.93°; 95%CI: 2.27, 7.59; P<0.001), and less S-N length (mean: -5.04mm; 95%CI: -6.57, -3.51; P<0.001). Patients treated with either early RME-FM or late Alt-RAMEC-HH-LLA had comparable overall post-pubertal skeletal and overjet corrections. However, the late Alt-RAMEC-HH-LLA showed less correction of dentoalveolar compensations and in particular of the mandibular incisors. The overbite, maxillary and mandibular projection and size were lower and the gonial angle was more open.

Dentoskeletal comparison of miniscrew-anchored maxillary protraction with hybrid and conventional hyrax expanders: A randomized clinical trial

This randomized clinical trial aimed to compare the skeletal and dental effects of miniscrew-anchored maxillary protraction (MAMP) using hybrid hyrax (HH) and conventional hyrax (CH) expanders in growing patients with Class III malocclusion. This was a randomized, parallel, controlled trial. Forty growing patients with Class III malocclusion and maxillary deficiency (Wits appraisal of less than -1mm) were randomized into 2 groups. Patients were recruited at the Orthodontic Clinic of Bauru Dental School, University of São Paulo, Brazil. The HH group was composed of patients with Class III malocclusions in the late mixed or early permanent dentition treated with a HH expander with 2 miniscrews in the maxilla and 2 miniscrews in the anterior region of the mandible. Class III elastics were used from the maxillary first molars to the mandibular miniscrews placed between permanent canines and first premolars. The CH group was composed of patients treated with a similar protocol except for the use of a CH expander in the maxilla. The primary outcomes included the frequency of overjet correction and sagittal skeletal effects produced with treatment. Allocation was performed with a simple randomization process. Blinding was performed only during assessments. Data were analyzed blindly on an intention-to-treat basis. Intergroup comparison was performed using analysis of covariance. Mean differences (MD) and 95% confidence interval (CI) were obtained for all variables. The final sample for the HH group was 20 subjects (8 female, 12 male; initial age of 10.7years), whereas the final sample for the CH group was 15 subjects (6 female, 9 male; initial age of 11.5years). The frequency of overjet correction observed in the HH and CH groups was 94.4% and 71.4% (risk ratio, 1.32; 95% CI, 0.93-1.88), respectively. Both groups presented similar skeletal sagittal and vertical outcomes after maxillary protraction. The maxillary length (CoA) showed a similar increase in both groups (MD, 1.12mm; 95% CI, -0.03 to 2.27). The CH group demonstrated a greater mesial displacement of maxillary first molars after treatment than the HH group (MD, 1.22mm; 95% CI, 0.33-2.11). HH and CH groups produced 2.88 and 1.97 overjet corrections (MD, 0.53mm; 95% CI, -0.52 to 1.59), respectively. MAMP using HH and CH expanders produced a frequency of overjet correction of 94.4% and 71.4%, respectively. Similar skeletal effects were observed between MAMP using HH and CH expanders. Greater control of the mesial displacement of maxillary first molar during maxillary protraction using hybrid expanders was observed. The trial was registered at http://ClinicalTrials.gov, under the identifier NCT03712007. This trial protocol was not published. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brasil (CAPES) - Finance Code 001, and by the São Paulo Research Foundation (FAPESP) - Grants nos. 2017/04141-9, 2017/24115-2, and 2019/03175-2.

Class II correction by maxillary en masse distalization using a completely customized lingual appliance and a novel mini-screw anchorage concept \u2013 preliminary results

BackgroundThe aim of the study was to evaluate the efficacy of a novel en masse distalization method in the maxillary arch in combination with a completely customized lingual appliance (CCLA; WIN, DW Lingual Systems, Germany). Therefore, we tested the null-hypothesis of a significant deviation from an Angle-Class I canine relationship and a normal overjet defined by an individual target set-up after dentoalveolar compensation in Angle Class II subjects.Methods This retrospective study included 23 patients, (m/f 3/20, mean age 29.6 years (min/max, 13.6/50.9 years)), with inclusion criteria of an Angle Class II occlusion of more than half a cusp prior to en masse distalization and treatment completed consecutively with a CCLA in combination with a mini-screw (MS) anchorage for uni- or bilateral maxillary distalization (12 bilateral situations, totalling 35). Plaster casts taken prior to (T0) and following CCLA treatment (T3) were compared with the treatment plan / set-up (TxP, with a Class I canine relationship and a normal overjet as the treatment objective). MSs were placed following levelling and aligning (T1) and removed at the end of en masse distalization at T2. Statistical analysis was carried out using Schuirmann’s TOST [two one-sided tests] equivalence test, based on a one-sample t-test with α = 0.025 on each side (total α = 0.05).ResultsNinety-seven percent of planned correction of the canine relationship was achieved (mean 3.6 of 3.7 mm) and also 97 % of the planned overjet correction (mean 3.1 of 3.2 mm), with a statistically significant equivalence (p < 0.0001) for canine relationship and overjet between the individual treatment plan (set-up) and the final outcome. Adverse effects were limited to the loss of n = 2 of 35 mini-screws. However, in each instance, the treatment was completed, as scheduled, without replacing them. Accordingly, the null-hypothesis was rejected.ConclusionsThe technique presented allows for a predictable correction of an Angle-Class II malocclusion via dentoalveolar compensation with maxillary en masse distalization.

Skeletal and dentoalveolar contributions during ClassII correction with Forsus™ FRD appliances : Quantitative evaluation.

Primary objective of the study is to quantify and evaluate the skeletal and dental contributions during sagittal ClassII correction with the Forsus™ fatigue resistant device (FRD; 3M Unitek Corp., Monrovia, CA, USA). Secondary objective is to evaluate the overall vertical, soft tissue and chin-throat relation changes with the Forsus™ appliance. Aretrospective sample of 27ClassII patients treated with the Forsus™ FRD appliance was compared to 20untreated control subjects who were matched according to age and craniofacial morphology. Pre-Forsus™ (T0) and Post-Forsus™ (T1) cephalograms were subjected to composite cephalometric analysis. Growth changes were subtracted from the treatment changes to obtain the treatment effects of the appliance. The data were analyzed using Student's t‑test and independent ttest. Significant differences were found between the treated and the control group in 16of 29measured variables. The overjet and molar relation improved by 4.23 mm and 4.49 mm, respectively. This was mainly achieved by backward movement of maxillary incisors (1.4 mm) and molars (1.22 mm) and forward movement of mandibular incisors (2.26 mm) and molars (2.70 mm). Overbite decreased by 2.24 mm with no changes in mandibular and nasal plane angles. The Forsus™ FRD was effective in correcting ClassII malocclusion mainly at the dentoalveolar level. The net skeletal and dentoalveolar contributions towards both overjet and molar correction was 13% and 87%, respectively. The improvement in soft tissue profile and chin-throat configuration was statistically insignificant.

Skeletal and dental changes induced by the Flip-Lock Herbst appliance in the treatment of Angle's class II division 1 malocclusion during active growth period: A preliminary study.

Background. The Flip-Lock Herbst (TP Orthodontics Inc.) is a fixed functional appliance, a variant of the Herbst appliance, introduced by Miller. It is claimed to have better patient tolerance due to its increased freedom for the mandible’s lateral movements. There have been no studies on the flip lock Herbst till date. This study was undertaken to assess the efficiency of the Flip-Lock Herbst appliance in correcting Angle’s class II division 1 malocclusion. Methods. Eight subjects in their active growth period with class II division 1 malocclusion due to a retrognathic mandible were included in the study. Standardized lateral cephalometric radiographs were used to evaluate skeletal and dental changes with the SO analysis. Paired samples t-test was used to assess statistical significance. Results. Statistically significant increases in mandibular length (pg/OLp) and effective mandibular length (ar/OLp + pg/OLp) were observed. There was a significant maxillary restraining effect. Dental effects were significant and exhibited class II correction features except for the position of lower incisors within the mandible (ii/OLp - pg/OLp). Skeletal changes accounted for 61% and dental changes for 39% of the total treatment for molar correction. For overjet correction, skeletal changes contributed to 63% and dental changes to 37% of the total treatment. Conclusion. The Flip-Lock Herbst appliance was efficient in correcting Angle’s class II division 1 malocclusion due to a retrognathic mandible. Both skeletal and dental changes were evident, with the former predominating (60:40).

Relationship between back posture and early orthodontic treatment in children

BackgroundThe purpose of this study was to analyze the relationship between body posture and sagittal dental overjet in children before and after early orthodontic treatment with removable functional orthodontic appliances.MethodsAngle Class II patients (mean age 8.2 ± 1.2 years; 29 males and 25 females) with a distinctly enlarged overjet (> 9 mm) were retrospectively examined regarding body posture parameters before and after early orthodontic treatment. In addition, changes in overjet were investigated with the aid of plaster models. Forms of transverse dysgnathism (crossbite, lateral malocclusions) and open bite cases were excluded. Body posture parameters kyphosis, lordosis, surface rotation, pelvic tilt, pelvic torsion and trunk imbalance were analyzed by means of rasterstereographical photogrammetry to determine, if the orthodontic overjet correction is associated with specific changes in posture patterns.ResultsIn nearly all patients an overjet correction and an improvement regarding all body posture and back parameters could be noted after early orthodontic treatment. Overjet reduction (− 3.9 mm ± 2.1 mm) and pelvic torsion (− 1.28° ± 0,44°) were significantly (p < 0.05) and moderately correlated (R = 0.338) with no significant associations found for the other posture and back parameters (p > 0.05).ConclusionOverjet reduction during early orthodontic treatment may be associated with a detectable effect on pelvic torsion.

Relative effectiveness of facemask therapy with alternate maxillary expansion and constriction in the early treatment of Class III malocclusion

This study aimed to investigate the relative efficacy of maxillary protraction combined with a modified alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol compared with conventional protocols in the early orthopedic treatment of skeletal Class III malocclusion. A sample of 39 patients was divided into 3 groups on the basis of different interventions. Conventional facemask (FM) with splint-type intraoral devices was performed in the FM group (7 males and 5 females; mean age, 9.53±1.37years). Maxillary expansion with an activation rate of 0.5mm/d (twice a day) followed by FM therapy was applied in the rapid maxillary expansion group (RME/FM) (6 males and 6 females; mean age, 9.31±1.60years). In the Alt-RAMEC/FM group (7 males and 8 females; mean age, 10.01±1.31years), Alt-RAMEC was started simultaneously and throughout the entire course of maxillary protraction, with repetitive alternations between activation and deactivation of expanders (0.5mm/d for 7days). The patients in all groups were instructed to wear FMs for a minimum of 12h/d. Pretreatment and posttreatment lateral cephalograms were all traced and measured. The Alt-RAMEC group showed statistically more significant maxillary advancement than other groups (A-VRP, 3.87mm vs 3.04mm [RME/FM], vs 2.04mm [FM]; P<0.05). Analysis of variance did not reveal significant intergroup differences in palatal plane angulation changes (P>0.05). No pronounced mandibular clockwise rotations were noted in the Alt-RAMEC/FM group with distinct intergroup differences (P<0.05). There were more skeletal effects (88.7%) during overjet correction in the Alt-RAMEC/FM protocol. A combination of the modified Alt-RAMEC protocol with FM revealed more favorable skeletal effects compared with FM and RME/FM protocols in treating prepubertal patients with maxillary deficiency.

Tratamento da Classe II com Invisalign

Complete correction of Class II malocclusion in an adult patient is not an easy task. In a case with large skeletal discrepancy, orthognathic surgery is the treatment of choice. However, in case of slight or borderline discrepancy, other treatment options are available, such as tooth extractions and miniscrews. Intermediate cases can also be treated with Class II correctors and elastics. This clinical report presents the orthodontic treatment of a 25-year-old female patient with Class II malocclusion. Clinically, the maxilla was well positioned, and the mandible was slightly retruded. The patient presented vestibularized upper incisors, well-positioned lower incisors and opted for a more aesthetically attractive orthodontic appliance. The treatment plan included teeth leveling and aligning in both arches, Class II correction, establishment of Class I molar and canine relationships, correction of overjet and overbite, midline correction, and improvement of facial and dental aesthetics. The orthodontic treatment consisted of removable Invisalign aligners and Class II elastics.