Hyperdivergent Growth Research Articles

Pharyngeal width comparison in different skeletal malocclusions and growth patterns of Nepalese population

Context: Regarding the relationship between the size of the pharynx and several sagittal skeletal malocclusions and patterns of growth, contradictory findings have been documented. Aims: The intent of this research was to analyze the size of the pharynx in various sagittal malocclusions and growth patterns in the Nepalese population. Settings and Design: An analytic cross-sectional research was undertaken on patients who attended the Orthodontics Division of BPKIHS. Materials and Methods: A total of 135 patients’ lateral cephalometric radiographs were gathered. Medians and interquartile ranges of pharyngeal widths according to McNamara airway analysis and Arnett/Gunson FAB airway analysis adapted by Santiago et al. in different skeletal malocclusions and growth patterns were compared. Results: There was not any discernible statistically noteworthy variation within the upper pharynx size, lower pharyngeal width, nasopharyngeal width (WNP), oropharyngeal width, hypopharyngeal width (WHP), and deep pharyngeal width (WDP) in different skeletal malocclusions. A statistically significant variation was discovered in nasopharyngeal size (P = 0.010), hypopharyngeal size (P = 0.027), and deep pharyngeal size (P < 0.001) in various patterns of growth, i.e. hypodivergent versus normodivergent, and in hypodivergent versus hyperdivergent, not in normodivergent versus hyperdivergent group of patients. Conclusion: There was not anything statistically noteworthy variation in the pharyngeal widths of the participants with respect to the various skeletal malocclusions. WNP, WHP, and WDP showed a statistically significant variation between hypodivergent versus normodivergent and hypodivergent versus hyperdivergent growth patterns.

Assessment of Upper and Lower Airway Dimensions in Skeletal Class I and Class II Subjects Having Different Growth Patterns - A Cross-Sectional Cephalometric Study.

To compare the airway dimensions among subjects having skeletal class I and class II patterns considering their hypodivergent, normodivergent, and hyperdivergent growth patterns and to determine any variations between them. The study consisted of 156 pre-treatment lateral cephalograms of subjects aged above 18 years. The sagittal skeletal pattern was used to separate the sample into two groups. Each group was further subdivided into hypodivergent, normodivergent, and hyperdivergent growth patterns. The upper and lower airway dimensions were measured in all the subgroups. The intragroup comparison of class I and class II was performed with 1-way ANOVA and post-hoc test. Using the independent t-test, the upper and lower airways were compared between groups. Comparison of subjects according to the growth pattern showed that vertical growth patterns have statically significantly reduced upper and lower airway dimensions as compared to the average and horizontal growth patterns in both skeletal class I and class II subjects. However, the subjects with skeletal class II hyperdivergent growth patterns have significantly reduced lower airway dimensions than those with skeletal class I having hyperdivergent growth patterns. Individuals with skeletal class I and class II patterns characterized by hyperdivergent growth exhibit reduced upper and lower pharyngeal airways. The sagittal skeletal type also plays a role in influencing the dimensions of the upper and lower airways.

A patient with bimaxillary protrusion was treated by the extraction of four premolars and four compromised first molars: a case report

Abstract The first molar has been reported to be the most caries prone tooth in the permanent dentition. Rarely is the extraction of the four first molars the ideal choice in orthodontic treatment, especially the extraction of four molars and four premolars. However, the extraction program presents a treatment alternative in selected cases. In the following case report, the orthodontic treatment is described a 15-year-old male patient who presented with a dentoskeletal bimaxillary protrusion, and a chief complaint of”crooked teeth”. Moreover, the patient had a skeletal Class I malocclusion with crowded dentitions, a hyperdivergent growth pattern, deviated midlines and an extremely deep Curve of Spee. A satisfactory treatment outcome was obtained by the extraction of four premolars and four compromised first molars. The mechanics involved alignment, levelling, detailing the occlusion using a straight arch wire technique followed by retention. The active treatment time was 48 months. The treatment successfully achieved a bilateral Class I relationship of the canines and the right molars, a mild Class III relationship of the left molars, a normal overjet and overbite, aligned dental midlines, optimal intercuspation and a harmonious facial profile. The occlusion remained stable during 5 years of review.

Correlation of mandibular third molar orientation and available retromolar space with arch length discrepancy in subjects with different growth pattern.

To evaluate, compare, and correlate the mandibular third molar orientation and available retromolar space with arch length discrepancy in subjects with skeletal class II malocclusion and different growth pattern. A total of 250 patients (age >18 yrs) having skeletal class II malocclusion (based on YEN angle and WITS appraisal) were divided into two groups. Both the groups (Group I with erupted mandibular third molars {N = 150} and Group II with impacted mandibular third molars {N = 100}) were subdivided into subgroups IA (n = 71), IB (n = 19), IC (n = 71) and Group IIA (n = 54), IIB (n = 30) and IIC (n = 16) for normo-, hypo- and hyperdivergent growth patterns, respectively (based on Jarabak ratio and Sn-Go-Gn angle). Four parameters, that is, retromolar space, width of third molar, third molar angulation, and mandibular incisor angulation were measured on orthopantomogram whereas arch length discrepancy was calculated with the help of lateral cephalogram and study model. Intragroup, intergroup comparisons (using unpaired Student's 't' test), and Pearson's correlation coefficient for assessed parameters were obtained. Third molar angulation and retromolar space were significantly higher in Group I than in Group II (hyperdivergent pattern of Group II had highest value). The width of third molar was less than retromolar space in Group II and vice versa for Group I. Mandibular incisor angulation and arch length discrepancy were more in Group II than in Group I, but difference was statistically nonsignificant. Strong positive correlation was observed for mandibular third molar angulation and available retromolar space in normo- and hyperdivergent growth patterns. Lack of retromolar space along with increased amount of arch length discrepancy and mandibular incisor angulation is responsible for increased chances of third molar impaction in some subjects with class II malocclusion.

Three-dimensional evaluation of the cortical and cancellous bone density and thickness for miniscrew insertion: a CBCT study of interradicular area of adults with different facial growth pattern

AimThe purpose of this study was to evaluate the effect of the density and the thickness of the cortical and the cancellous bone at selected inter-radicular areas in subjects with different facial growth patterns using cone beam computed tomography (CBCT) in order to choose the optimal area for miniscrew insertion.Materials and methodsFrom 150 CBCT scans, 45 scans were included in the study. The subjects were categorized into three groups based on their skeletal growth pattern according to SN-GoMe angle and facial height index. Cortical and cancellous bone density and thickness were measured at the selected inter-radicular areas.ResultsCompared to the other two groups, the hyperdivergent group had thinner cortical bone in the anterior region of the maxilla between the central and the lateral incisors on the buccal side at 4 mm from the alveolar crest (P-value: 0.012) and on the palatal side at 7 mm from the alveolar crest (P-value: 0.030). Cancellous bone density values in these areas were higher in subjects with hypodivergent and hyperdivergent growth pattern. Furthermore, in hyperdivergent group less dense cortical bone in the posterior region of the maxilla on the palatal side between the second premolar and the first molar (p-value: 0.020) and on the buccal side between the first molar and the second molar (p-value: 0.038 & 0.047) was observed. No significant differences were found in the mandible between the three groups. No significant differences were found between the male and the female subjects.ConclusionHyperdivegents presented thinner cortical bone in the anterior of the maxilla between the central and the lateral incisors. Less dense cortical bone was found between maxillary second premolar and first molar on the palatal side and also between the maxillary first molar and the second molar on the buccal side in this group too. Normal showed higher density values in the posterior of the maxilla compared to the other two groups. No significant differences were found among three groups in mandible.

Associations between the timing of tongue reduction surgery, (Epi)genotype, and dentoskeletal development in patients with Beckwith-Wiedemann syndrome

Tongue reduction surgery is often pursued to manage the adverse effects of macroglossia in patients with Beckwith-Wiedemann syndrome (BWS). This study characterized dental outcomes in patients with BWS based on surgical timing and molecular diagnosis. A retrospective study was designed to include patients with BWS over the age of two who had clinical or radiographic documentation of dental development. Patients were grouped by history of tongue reduction surgery and surgical timing (early: <12 months). One hundred three patients were included (55 no tongue reduction, 18 early, 30 late). Patients who underwent late surgery had lower odds of class I occlusion (OR 0.11, 95% CI 0.02–0.58, p = 0.009) and higher odds of anterior open bite (OR 7.5, 95% CI 1.14–49.4, p = 0.036). Patients with clinical diagnoses and negative molecular testing had anterior open bite less frequently than patients with imprinting center 2 loss of methylation and paternal uniparental isodisomy of 11p15.5 (p = 0.009). Compared to reference values, patients who had tongue reductions had an increased mandibular plane angle (32.0 ± 4.5° versus 36.9 ± 5.0°, p = 0.001), indicative of hyperdivergent growth. The results of this study help to understand the complex nature of dentoskeletal growth in BWS and shed insight on how surgical timing and molecular diagnosis influence prognosis.

Clear Aligner Treatment in an Adolescent Female with Hyperdivergent Growth Pattern of the Mandible

Clear Aligner Treatment in an Adolescent Female with Hyperdivergent Growth Pattern of the Mandible

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.

An evidence-based stepwise approach to orthopedic treatment

Treatment protocols help organize data for accurate diagnosis and treatment planning. The aim was to develop a logical series of steps predicated on the latest credible body of evidence. The steps were developed for Class II patients with hyperdivergent growth patterns. The steps include establishing 1) the patient's problem list to determine the treatment objectives; 2) the theoretical basis modifying growth; 3) the etiology of the problem 4) the growth mechanisms that produce normal growth, and 5) a practical and realistic treatment approach. Departing from traditional assessments by reverse engineering the problem, potential gaps in the application of knowledge to practice may be recognized and addressed.

Comparative evaluation of various nasal shapes and angles in different vertical growth patterns – A Cephalometric Study

Background: Factors affecting the appearance of the nose and the size of the nasal angles are different. The aim of this study was to examine the influence of the vertical developmental pattern on the nose appearance. Material and methods: Lateral cephalogram from 144 adult Caucasian subjects from the central Balkan were analyzed (72 male and 72 female), with orthognathic jaw relationship - class I and different types of divergence pattern. The profile type of nose, the shape of the nasal dorsum and the value of the nasal angles (nasofrontal, nasofacial, nasolabial and nasal tip angle) were determined for each person. Subjects were divided into three groups based on the values of ANB angle (sagital relation between the maxilla and mandible), Wit's appraisal, SN/GoGn (the angle of mandibular divergence pattern). These groups are subjects with hypodivergent, normaldivergent and hyperdivergent growth pattern. Statistical analysis included differences separately for each gender between different types of divergence. Results: The results indicated that some nasal forms are more common in certain types of divergence, but that these differences did not show statistical significance, in contrast to the results of authors from other areas. Conclusions: The clinical implication of current study relates to the fact that nasal reconstruction should not be based on the type of divergence, but on other factors.

Evaluate and compare dental age with chronological age in hyperdivergent and hypodivergent growth pattern

Aim: To evaluate and compare dental age with chronological age of different facial patterns in growing patients. Materials and method: This study comprises of lateral cephalogram and panoramic radiographs of 100 subjects. Subjects were classified into two groups of 50 each on the basis of angular and linear measurements Group I – Hypodivergent and Group II – Hyperdivergent growth patterns respectively. Comparison between intergroups and within intragroup is made by using t –test. Result: Statistically significant results were obtained while comparing dental age with chronological age in hyperdivergent and hypodivergent subjects indicating hyperdivergent group had more advance dental age than hypodivergent. Conclusion: Orthodontic therapy should be started earlier in patients with hyperdivergent growth pattern than those with hypodivergent growth pattern.

Characteristic Variants in Long Faces with Increased Anterior Facial Height

Facial characteristics are affected by facial proportions, growth pattern, facial heights and smile of the patients. Long face syndrome usually presents with an increased lower anterior and total anterior facial height, a gummy smile, a hyperdivergent growth pattern and decreased facial height. However, there are many variations in the posterior facial height and the growth pattern. There can be patients having an increased anterior facial height with increased or average posterior facial height, or an average and reduced mandibular plane angle. This paper aimed at reviewing the various characteristic facial variants of an increased anterior facial height. This article reviews three such variants of an increased anterior facial height. It particularly highlights the variant with increased anterior and posterior facial height and the modification in the treatment of such cases. The most common treatment option for the normally occurring variant of hyperdivergent growth pattern with a reduced posterior facial height is surgical superior impaction.

Treatment of severe crowding with constricted arches in a patient with high angle Class I malocclusion: A case report

The goal of orthodontic treatment in a severely crowded malocclusion is to obtain a harmonious face with a well-balanced soft tissue profile, functional occlusion and a consonant smile. Etiology involving both genetic and non-genetic factors are associated with severe crowding. This case report is on correction of class I severely crowded malocclusion in a vertical grower treated with extraction of all first premolars. Intra oral, extra oral and radiographic examination revealed skeletal Class I with straight profile, hyper divergent growth pattern, increased overjet and severe crowding in maxillary and mandibular dentition, constricted arches, potentially competent lips with increased lip strain and a non-consonant smile arc, treated with extraction of all 1st premolars, significant improvement in patient's smile, profile and occlusion were obtained. The successful results were obtained due to correct case selection and proper treatment planning. The meticulous space analysis and management without anchorage loss is a result of proper anchorage planning prior to extractions.

Anatomical limitations and factors influencing molar distalization.

To analyze the anatomical limitations and characteristics of maxillary and mandibular retromolar regions affecting molar distalization using cone-beam computed tomography (CBCT). A total of 120 qualifying patients were classified into equal groups of skeletal Class II and Class III and stratified by vertical growth pattern, age, sex, and third molar presence. The available distance along the axis of distalization and cortical bone thickness (CBT) were measured in the maxillary and mandibular retromolar regions of Class II and Class III patients, respectively. One-way analysis of variance was used to examine the effects of the factors on the measured data. The minimum available distance of the Class II maxilla was observed at a level 3 mm from the cementoenamel junction (CEJ), while that of the Class III mandible was at a level 9 mm from the CEJ. The average available distance at the limit level was 4.06 ± 1.93 mm in the Class II maxilla, and the average corresponding CBT was 1.00 mm. The average available distance at the limit level in the Class III mandible was 2.80 ± 1.96 mm, and the corresponding CBT was 2.24 mm. In both skeletal Class II and Class III patients, hyperdivergent groups had the least available distance for molar distalization. The limit for available distance in the Class II maxilla is closer to the coronal level, while that of the Class III mandible is closer to the apical level. A hyperdivergent growth pattern in a patient is indicative of less potential for molar distalization. Axial slices of CBCT images provide valuable evaluation for molar distalization regarding limit levels.

Angle Class II Division 1 Malocclusion in an Adolescent Patient Treated with Four First Premolars Extraction and Temporary Anchorage Devices

This case report describes a successful orthodontic treatment in an Angle Class II division 1 malocclusion with severe space deficiency by temporary anchorage device (TAD) in a 15-year-old male patient. The skeletal analysis showed mandibular retrognathism and slightly hyperdivergent growth pattern. The treatment plan included four first premolars extractions combined with TAD application which used for anteroposterior and vertical anchorage control. The orthodontic treatment was to achieve the effect of counter-clockwise rotation of mandible for the patient who still has remaining growth. After 23 months of orthodontic treatment, Angle Class I molar relationship was achieved. The patient was satisfied with his facial appearance.

Evaluation and Correlation Between Pharyngeal Space, Mandible, and Tongue in Two Different Facial Patterns

Introduction: Respiratory function has a direct relationship with the pharyngeal airway dimension and mandibular morphology. The objective of the present study was to compare and correlate pharyngeal airway, mandibular morphology, and tongue position in hyperdivergent and normodivergent patterns using standard cephalometric radiographs. Materials and Methods: A total of 130 individuals with age 13 to 19 years, with no craniofacial skeletal abnormalities, were taken. The individuals were divided into 2 groups based on their Frankfort mandibular angle (FMA). Group I consist of 65 hyperdivergent individuals (34 males, 31 females) with FMA &gt;28. Group II consisted of 65 normodivergent individuals (28 males, 37 females) with FMA &gt;25 to &lt;28. For statistical analysis, variables were analyzed by unpaired t-test, with P value &lt;.05. Correlation between the pharyngeal space and the other variables was analyzed with the Pearson correlation test. Results: Upper pharyngeal airway space in hyperdivergent growth pattern exhibited a significant negative correlation with ramus width (r = −0.02 and P = .028). Gonial angle showed a statistically significant inverse correlation with lower pharyngeal airway space (r = −0.398 and P = .029). A-point-nasion-B-point (ANB), saddle angle, posterior tongue space, tongue gap, and pharyngeal airway among normodivergent subjects, showed a statistically significant negative correlation. Conclusion: The present study showed a significant relationship between pharyngeal airway space, craniofacial morphology, and tongue position suggesting that narrower airway space may be a causative factor for altered dentofacial skeletal patterns. Reduced ramus width, lowered tongue, and narrower posterior pharyngeal wall might be a balancing mechanism set for morphological imbalance in hyperdivergent pattern.

Elastodontic Therapy of Hyperdivergent Class II Patients Using AMCOP® Devices: A Retrospective Study

Background: The management of a hyperdivergent growth pattern is one of the most challenging in orthodontics and different treatments are advocated. The present study analyses the effectiveness of elastodontic therapy with AMCOP® devices in treating children with hyperdivergent class II malocclusion and the effect on the upper airway patency. Methods: The study group included 21 patients (10 males and 11 females, mean age 8.22 ± 1.17 years) with a hyperdivergent growth and a class II malocclusion treated with AMCOP® devices. Cephalometric analysis was performed before treatment (T0) and after treatment (T1). Results: After treatment, the cephalometric analysis revealed a correction of the class II malocclusion and a modification of the growth pattern with a divergence reduction. The improvement of the upper airway space was also observed. Conclusion: The elastodontic therapy effectively corrected hyperdivergent class II malocclusion in growing patients over a short period.

Incidence and management of condylar resorption after orthognathic surgery: An overview.

ObjectiveCondylar resorption (CR) is one of the major post-surgical complications of orthognathic surgery. This systematic review (SR) aimed to evaluate epidemiological data, risk factors, and therapeutical management of CR.MethodsSix databases were screened by two investigators until September 2020 to obtain all SRs. After reading the titles and abstracts, eligible SRs were determined and data extraction was performed. Using the latest version of A Measurement Tool to Assess Systematic Reviews, the methodological quality of the included SRs was determined.ResultsTen SRs with low or critically-low methodological quality were included in this review. Mandibular hypoplasia on the sagittal plane and hyperdivergent growth pattern on the vertical plane were the most common skeletal alterations in which CR could occur after orthognathic surgery. Post-operative condylar changes were analyzed both on two-dimensional and three-dimensional (3D) radiographic examinations. The incidence of CR was not related to the fixation method. Based on the severity of the pathological conditions, management of CR can include conservative or surgical therapy.ConclusionsDespite the limited evidence in literature, CR is considered a consequence of orthognathic surgery. However, an accurate diagnosis of CR and a better orthognathic surgical planning must include 3D radiographic examinations to improve pre- and post-surgical comparison. Well-designed studies with long-term follow-up and 3D data are needed to clarify the findings of this analysis..

Balance and thickness of soft tissue of the lower third of the face in different vertical patterns of growth

Introduction/Objective. Variations in thickness of soft tissues can influence the position of facial structures as well as facial aesthetics. The objective of the study was to determine whether the frequency of soft tissues imbalance depends on the vertical growth pattern of the face. Methods. The present study consisted of 90 pretreatment lateral cephalograms of adult Serbian Caucasian orthodontic patients (30 male and 60 female), between 18?27 years of age, average 23.6 years. Only the patients with the skeletal class I, based on the values of A-Nasion-point B angle and Wits appraisal, were chosen for the study. All patients were divided into three groups of 30 patients, those with hyperdivergent, hypodivergent and normal vertical growth patterns based on the values of Frankfort mandibular plane angle. Soft tissue of each patient was evaluated following the method given by Merrifield. Results. The obtained results showed that soft tissues of the chin and upper lip were thickest in hypodivergent and thinnest in patients with hyperdivergent growth type. The largest number of patients with soft tissue imbalance was observed in the normal and hyperdivergent vertical growth pattern groups, eight out of 30 patients. The number of patients with imbalance greater than 3 mm was largest in the group with hyperdivergent growth pattern. Conclusion. The pathological skeletal pattern of growth combined with the common occurrence of soft tissue imbalance makes orthodontic treatment in hyperdivergent group of patients more difficult in comparison to patients with normal or hypodivergent growth pattern.

Cephalometric evaluation of the main airway dimensions in subjects with different growth patterns and their relationship to patients&amp;apos; ages and genders

Background: Airway shape and dimensions have attracted attention during the past few decades; this can be attributed to the relationship between the upper airway configuration and sleep-disordered breathing and its relationship with craniofacial morphology in general. This study was conducted to 1. Compare the pharyngeal dimensions of subjects with different vertical growth patterns and 2. Assess the impact of modifying variables, like age and gender, on the airway dimensions. Methods: Data collection was based on both cephalometric radiographs and patients\&amp;apos; files analysis. Radiographs were grouped according to patients\&amp;apos; ages, genders, and vertical growth patterns. Lateral cephalometric radiographs were taken using a standardized technique. The simple network management angle was used to divide the sample into hypodivergent, noromodivergent, hyperdivergent growth patterns with 38&amp;#xb0;, respectively. The upper and lower pharyngeal airway widths were measured by using McNamara\&amp;apos;s airway analysis. Results: The widest upper and lower pharyngeal widths (LPWs) were found among hypodivergent subjects (20.1 ± 2.3 and 11.6 ± 4, respectively), and gender differences were found in the upper pharyngeal width (UPW) but in the lower (17.4 ± 3.4 and 18.1 ± 3.5, 10.1 ± 2.3 and 10.2 ± 3.1) for males and females in the upper and lower airways, respectively. Increasing the subject\&amp;apos;s ages significantly increased the UPW but did not affect the LPW. Conclusion: Hypodivergent patients had a higher UPW and LPW compared to the noromodivergent and hyperdivergent growth patterns. Also, the UPW and LPW were slightly higher in females than in males and increasing age had significantly increased UPW but did not affect LPW.