Initial Malocclusion Severity Research Articles

Effect of Early Orthodontic Treatment on Long-Term Stability of Class II Malocclusions

ABSTRACT Background: Class II malocclusions are a common orthodontic problem, often requiring comprehensive treatment to achieve proper occlusion and facial harmony. Early orthodontic intervention in the mixed dentition phase has been advocated to address these issues. Materials and Methods: A retrospective analysis was conducted on a cohort of 150 patients with class II malocclusions who underwent early orthodontic treatment between the ages of 7 and 10 years. The treatment included fixed or removable appliances, headgear, and functional appliances, depending on individual needs. Records of their initial malocclusion severity, treatment modalities, and long-term follow-up data (mean follow-up duration of 10 years) were collected and analyzed. Stability was assessed by evaluating overjet and overbite changes from post-treatment to the long-term follow-up. Results: The initial mean overjet and overbite values were 8.5 mm and 4.0 mm, respectively. Following early orthodontic intervention, these values were significantly reduced to 3.0 mm and 1.5 mm, respectively (P < 0.001). At the long-term follow-up, the mean overjet and overbite remained stable at 3.2 mm and 1.6 mm, respectively. Analysis revealed that 85% of patients maintained their corrected class II occlusion within clinically acceptable limits, while 15% experienced minor relapse requiring minimal additional treatment. Conclusion: Early orthodontic treatment in class II malocclusions can lead to significant improvements in overjet and overbite, and these corrections tend to remain stable over the long term.

Assessment of AI Models in Predicting Treatment Outcomes in Orthodontics

ABSTRACT Background: In the realm of orthodontics, the evaluation of treatment outcomes is a pivotal aspect. In recent times, artificial intelligence (AI) models have garnered attention as potential tools for predicting these outcomes. These AI models have the potential to enhance treatment planning and decision-making processes. However, a comprehensive assessment of their effectiveness and accuracy is essential before their widespread integration. Materials and Methods: In this study, we assessed the capability of AI models to predict treatment outcomes in orthodontics. A sample of 30 patients undergoing orthodontic treatment was selected. Various patient-specific parameters, including age, initial malocclusion severity, and treatment approach, were collected. The AI model was trained using a dataset comprising historical treatment cases and their respective outcomes. Subsequently, the trained AI model was applied to predict the treatment outcomes for the selected patients. Results: The results of this study indicated a moderate level of accuracy in the predictions made by the AI model. Out of the 30 patients, the model accurately predicted treatment outcomes for 22 patients, yielding a success rate of approximately 73%. However, the model exhibited limitations in accurately predicting outcomes for cases involving complex malocclusions or those requiring non-standard treatment approaches. Conclusion: In conclusion, this study underscores the potential of AI models in predicting treatment outcomes in orthodontics. While the AI model demonstrated promising accuracy in the majority of cases, its efficacy was diminished in complex and non-standard cases. Therefore, while AI models can serve as valuable tools to aid orthodontists in treatment planning, they should be utilized in conjunction with clinical expertise to ensure optimal decision-making and patient care.

Stability of Class II malocclusion treatment with Class II elastics

The objective of this study was to compare the long-term cephalometric stability after successful therapy of nonextraction Class II malocclusion with elastics and with headgear. The sample comprised 43 patients with Class II malocclusion and was divided into 2 groups. The elastic group (EG) consisted of 20 patients treated with fixed appliances associated with Class II elastics, and the headgear group (HG) consisted of 23 patients treated with fixed appliances and extraoral headgear. Pretreatment, posttreatment, and long-term posttreatment lateral radiographs were evaluated; t tests were used to compare the long-term posttreatment changes between the groups. The groups were matched regarding initial age, time of long-term posttreatment evaluation, initial malocclusion severity, quality of treatment result, and all pretreatment cephalometric variables. Intergroup comparisons of long-term posttreatment changes showed that the HG group presented significantly greater mandibular protrusion, occlusal plane angle decrease, and maxillary molar mesialization. However, long-term posttreatment stability was similar in overjet, overbite, and molar relationships. Nonextraction Class II malocclusion treatment with elastics or extraoral headgear have similar long-term posttreatment stability.

Root resorption in Class II malocclusion treatment with and without maxillary premolar extractions

Class II malocclusion treatment efficiency with maxillary premolar extractions has been reported. However, no study evaluated the root resorption associated with this protocol. Therefore, this study aimed to compare the degree of root resorption of the maxillary incisors in Class II malocclusion treatment with and without maxillary premolar extractions. The sample consisted of 56 patients with complete Class II malocclusion, divided into 2 groups. Group 1 comprised 28 patients (10 female, 18 male) treated with maxillary first premolar extractions, and group 2 was composed of 28 patients (16 female, 12 male) treated without extractions. The groups were matched regarding initial age, treatment time, crowding, initial malocclusion severity, finishing quality, initial overjet, and overbite. Periapical radiographs of the maxillary incisors were used to assess the degree of root resorption using a scoring system. In addition, treatment changes involving maxillary incisors were evaluated in lateral headfilms. Intergroup comparisons were performed with t, Mann-Whitney U, and chi-square tests (P<0.05). Overjet, overbite, inclination, vertical positional changes, and vertical and horizontal apical displacements of maxillary incisors were similar between groups. There was no statistically significant difference between groups regarding root resorption of maxillary incisors. Root resorption degree ranged from mild to moderate in both groups. Treating complete Class II malocclusion with 2 maxillary premolar extractions resulted in a similar root resorption as treating without maxillary premolar extractions. An individualized evaluation of root resorption predisposing factors should be performed for each patient.

Cephalometric and occlusal changes of Class III malocclusion treated with or without extractions.

ABSTRACTObjective: The aim of this retrospective study was to evaluate the cephalometric and occlusal changes of orthodontically treated Class III malocclusion patients. Methods: The experimental groups comprised 37 Class III patients treated: G1) without (n=19) and G2) with extractions (n=18) . The control group (G3), matched by age and sex with the experimental groups, consisted of 18 subjects with untreated Class III malocclusion. Cephalometric (radiographs) and occlusal (study models) changes were assessed between the beginning (T1) and the end (T2) of treatment. Intergroup comparisons were performed with one-way ANOVA followed by Kruskal-Wallis tests (p< 0.05). Occlusal changes were evaluated by the peer assessment rating (PAR) index (ANOVA and Kruskal-Wallis tests), and the treatment outcomes were evaluated by the Objective Grading System (OGS) (t-tests). Results: The experimental groups showed a restrictive effect on mandibular anterior displacement and a discrete improvement in the maxillomandibular relationship. Extraction treatment resulted in a greater retrusive movement of the incisors and significant improvements in the overjet and molar relationship in both groups. The PAR indexes were significantly reduced with treatment, and the OGS scores were 25.6 (G1) and 28.6 (G2), with no significant intergroup difference. Conclusions: Orthodontic treatment of Class III malocclusion patients with fixed appliances improved the sagittal relationships, with greater incisor retrusion in the extraction group. Both the extraction and non-extraction treatments significantly decreased the initial malocclusion severity, with adequate and similar occlusal outcomes of treatment.

The long-term influence of orthodontic treatment on adults' psychosocial outcomes: An Australian cohort study.

To assess the influence of orthodontic treatment on psychosocial outcomes in 30-year-olds. The research hypothesis tested was that participants previously treated orthodontically would have better psychosocial outcomes. A prospective longitudinal cohort design was used to follow-up a sample of 1859 30-year-olds from Adelaide, South Australia, who had previously participated in an oral epidemiology study. Clinical examination in 1988-1989 recorded participants' malocclusion severity. In 2005-2006, participants were invited to complete a questionnaire collecting data on socio-demographic characteristics, dental health behaviours, receipt of orthodontic treatment and psychosocial factors. Data were analysed descriptively and by linear regression models. Data for 448 participants were available; 56% of participants were female. Over a third of participants had received orthodontic treatment. Higher income earners had the best psychosocial outcomes while participants with a basic level of secondary education had the lowest. Regardless of initial malocclusion severity, orthodontic treatment was not associated with better psychosocial outcomes. Instead, a pattern of better psychosocial outcome was observed amongst untreated participants, regardless of malocclusion severity, this being significant for optimism. Adjusted models controlling for socio-demographic, dental health behaviour and malocclusion severity showed no association between orthodontic treatment and self-efficacy, health competence or social support. There was, however, a strong association with optimism. There was no difference in long-term psychosocial outcomes based on orthodontic treatment. Our study does not support the contention that orthodontic treatment produces better psychosocial functioning later in life.

The efficacy of orthodontic treatments for anterior crowding with Invisalign compared with fixed appliances using the Peer Assessment Rating Index.

The purpose of this retrospective study was to determine the efficacy of Invisalign in a large sample of patients compared to fixed appliances. The test group consisted of 100 patients treated with Invisalign compared with a control group treated with conventional fixed appliances matched for sex, age, and initial severity of malocclusion based on the amount of anterior dental crowding (Little Index) and the Peer Assessment Rating (PAR Index) scores. The retainer used was a 0.0175-inch multistranded stainless-steel wire bonded from canine-to-canine in the mandibular arch and from lateral inisor-to-lateral incisor in the maxillary arch. A paired t test was used to compare both initial and final PAR scores. There was an overall 80.9% improvement, and 63 subjects did not need any refinement. The mean number of aligners used was 14 (+ 15 for the refinements) in the maxillary arch and 29 (+ 14 for the refinements) in the mandibular arch. The mean duration of treatment was 14 months (+ 7 months for the refinements). Significant statistical differences were found in the posttreatment scores, within both the Invisalign group and the control group. No differences were found in the follow-up scores. Additionally, the duration of treatment was 4 months longer in the control group. More than 90% of the subjects treated with Invisalign achieved a significant improvement, as shown by the PAR scores. A need for additional aligners was reported for 37% of the patients. Fixed bonded retainers seem to be a good option in preventing tooth relapse after Invisalign and fixed conventional treatments.

Prevalence of extraction space reopening in different orthodontic treatment protocols.

In this study, we aimed to compare the amount and frequency of extraction space reopening after 2- and 4-premolar extraction treatments in Class II and 4-premolar extractions in Class I malocclusion patients. The sample comprised 105 subjects with full-cusp Class II and Class I malocclusions, divided into 3 groups. Group 1 consisted of 33 full-cusp Class II malocclusion patients treated with a 2-premolar extraction protocol. Group 2 had 34 full-cusp Class II malocclusion patients treated with 4-premolar extractions, and group 3 included 38 Class I malocclusion patients treated with 4-premolar extractions. The Peer Assessment Rating index was used to assess initial malocclusion severity and quality of the occlusal outcome, measured on dental casts. The amounts of extraction spaces were measured with a digital caliper on the final and long-term posttreatment dental casts, after an average of 9.79years posttreatment. Intergroup comparisons were performed by analysis of variance, followed by Tukey tests and chi-square tests. There were no significant differences regarding the amount and frequency of extraction space reopening among the groups. Two- and 4-premolar extractions in Class II and 4-premolar extraction treatment in Class I malocclusion patients show similar reopening of extraction spaces in the long term.

Facial profile esthetics change of class II malocclusion patients treated with the Herbst appliance as perceived by orthodontists and laypersons

Introduction/Objective. The recognition of differences in individual assessment of facial attractiveness could be valuable assistance in planning the orthodontic treatment. The aim of this study was to compare facial profile attractiveness changes of patients treated with the Herbst appliance perceived by orthodontists and laypersons. Methods. The patient sample comprised 33 young Caucasian still-growing patients, aged 14?18 years, with skeletal class II malocclusion treated with the Herbst and multibracket appliances. Facial profile photographs before and after the treatment were shown to 54 orthodontists and 50 laypersons. In the esthetics oriented poll, the evaluators rated the change in facial appearance. Results. The attractiveness scores differed between the two rater groups (p &lt; 0.001), with orthodontists being more generous, whereas there was no significant difference between female and male evaluators in both groups (p &gt; 0.05). However, scores differed significantly in grading female and male patients (p &lt; 0.001), so that female patients got higher scores; younger evaluators graded more critically between different age groups of the evaluators (p &lt; 0.001), as well as between the patients with different initial severity of malocclusion (p &lt; 0.001). Conclusion. The difference in attractiveness scores differed between two groups, with laypersons being more critical than orthodontists. Higher scores were given to female patients by both groups, as well as by the evaluators in the older age group.

Outcomes of comprehensive fixed appliance orthodontic treatment: A systematic review with meta-analysis and methodological overview.

ObjectiveThe aim of this systematic review was to assess the occlusal outcome and duration of fixed orthodontic therapy from clinical trials in humans with the Objective Grading System (OGS) proposed by the American Board of Orthodontics.MethodsNine databases were searched up to October 2016 for prospective/retrospective clinical trials assessing the outcomes of orthodontic therapy with fixed appliances. After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of the mean OGS score and treatment duration were performed and 95% confidence intervals (CIs) were calculated.ResultsA total of 34 relevant clinical trials including 6,207 patients (40% male, 60% female; average age, 18.4 years) were identified. The average OGS score after treatment was 27.9 points (95% CI, 25.3–30.6 points), while the average treatment duration was 24.9 months (95% CI, 24.6–25.1 months). There was no significant association between occlusal outcome and treatment duration, while considerable heterogeneity was identified. In addition, orthodontic treatment involving extraction of four premolars appeared to have an important effect on both outcomes and duration of treatment. Finally, only 10 (39%) of the identified studies matched compared groups by initial malocclusion severity, although meta-epidemiological evidence suggested that matching may have significantly influenced their results.ConclusionsThe findings from this systematic review suggest that the occlusal outcomes of fixed appliance treatment vary considerably, with no significant association between treatment outcomes and duration. Prospective matched clinical studies that use the OGS tool are needed to compare the effectiveness of orthodontic appliances.

Stability of class II subdivision malocclusion treatment with 3 and 4 premolar extractions

BackgroundThe purpose of this study was to compare the occlusal stability of class II subdivision malocclusion treatment with 3 and 4 first premolar extractions. A sample of 156 dental casts from 52 patients with class II subdivision malocclusion was divided into two groups according to the extraction protocol. Group 1 comprised 24 patients treated with 3 premolar extractions and group 2 included 28 patients treated with 4 premolar extractions.MethodsPeer assessment rating (PAR) indexes were measured on the dental casts obtained before (T1) and after treatment (T2) and at a mean of 6.9 years after the end of treatment (T3). The groups were matching regarding sex distribution, pretreatment, posttreatment and long-term posttreatment ages, and treatment and long-term posttreatment times. They were also comparable concerning the initial malocclusion severity and the occlusal results at the end of treatment. Stability evaluation was calculated by subtracting the posttreatment from the long-term posttreatment index values (T3 − T2). T tests were used to compare the amount and percentage of long-term posttreatment changes.ResultsThere were no intergroup differences regarding the amount and percentage of long-term posttreatment changes.ConclusionTreatment of class II subdivision malocclusion with 3 and 4 premolar extractions have a similar long-term posttreatment occlusal stability.

Retrospective analysis of long-term stable and unstable orthodontic treatment outcomes

The purpose of this study was to compare groups of patients with the most stable and the most unstable treatment results as rated by the peer assessment rating (PAR) index to identify factors associated with stability. All factors with significant crude odds ratios were investigated to create a multiple logistic regression model that could be used to predict stability. The sample of 86 patients (30 male, 56 female), from the post-retention archives at the University of Washington, was not restricted to specific malocclusion types or treatment modalities with the exception of Angle Class III patients, who were excluded. The sample was divided into 2 groups, stable (n = 45) and unstable (n = 41), based on post-retention unweighted PAR scores and PAR score changes between posttreatment and post-retention. Model and radiographic measurements were made before treatment, after treatment, and after retention (average 14.4 years). The results showed that male sex and a sustained period of growth were related, and both were associated with increased instability. The initial severity of malocclusion, as graded by the PAR index and the irregularity index, was negatively correlated with post-retention stability-ie, patients with more severe index scores before treatment tended to be less stable. Differences in American Board of Orthodontics scores after treatment were diminished after retention. The factors associated with predicting stability were pretreatment arch length, pretreatment PAR score, molar classification, and sex.

Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system

This treatment-outcome assessment objectively compares Invisalign (Align Technology, Santa Clara, Calif) treatment with braces. This study, a retrospective cohort analysis, was conducted in New York, NY, in 2004. Records from 2 groups of 48 patients (Invisalign and braces groups) were evaluated by using methods from the American Board of Orthodontics Phase III examination. The discrepancy index was used to analyze pretreatment records to control for initial severity of malocclusion. The objective grading system (OGS) was used to systematically grade posttreatment records. Statistical analyses evaluated treatment outcome, duration, and strengths and weaknesses of Invisalign compared with braces. The Invisalign group lost 13 OGS points more than the braces group on average, and the OGS passing rate for Invisalign was 27% lower than that for braces. Invisalign scores were consistently lower than braces scores for buccolingual inclination, occlusal contacts, occlusal relationships, and overjet. Invisalign's OGS scores were negatively correlated to initial overjet, occlusion, and buccal posterior crossibite. Invisalign patients finished 4 months sooner than those with fixed appliances on average. P < .05 was used to determine statistically significant differences. According to the OGS, Invisalign did not treat malocclusions as well as braces in this sample. Invisalign was especially deficient in its ability to correct large anteroposterior discrepancies and occlusal contacts. The strengths of Invisalign were its ability to close spaces and correct anterior rotations and marginal ridge heights. This study might help clinicians to determine which patients are best suited for Invisalign treatment.

Commentary

My main concern about this article is that its purpose was to determine the quality of treatment results that an ABO-certified orthodontist could achieve using Invisalign compared with fixed appliances. The method assumes that there is equivalency between his skills with the 2 techniques. However, the outcomes of the first 48 patients that an orthodontist has finished using a new, emerging technique compared with outcomes of patients treated with another method that he has used for more than 30 years and is considered an expert in is certainly not a valid comparison for the stated purpose of the study. The outcome can only be as good as the orthodontist’s skill in each method. It takes time for a practitioner to develop expertise with any appliance, especially if it is new. Although it is technically impossible, the study would have been more valid from a scientific point of view if the authors had used the practitioner’s first 48 fixed cases and compared them with his first 48 Invisalign cases. Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading systemAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 128Issue 3PreviewIntroduction: This treatment-outcome assessment objectively compares Invisalign (Align Technology, Santa Clara, Calif) treatment with braces. Methods: This study, a retrospective cohort analysis, was conducted in New York, NY, in 2004. Records from 2 groups of 48 patients (Invisalign and braces groups) were evaluated by using methods from the American Board of Orthodontics Phase III examination. The discrepancy index was used to analyze pretreatment records to control for initial severity of malocclusion. Full-Text PDF

The effectiveness of phase I orthodontic treatment in a Medicaid population

The effectiveness of early orthodontic treatment for Medicaid-enrolled children in the mixed dentition was assessed and compared with results in a population of private-pay patients. Pre- and posttreatment casts from 196 subjects treated with interceptive orthodontics in the mixed dentition were evaluated by using the peer assessment rating (PAR) index and the index of complexity, outcome, and need (ICON). Ninety-six of the patients were treated at Odessa Brown Community Clinic in Seattle; their treatment was paid by Medicaid. One hundred private-pay patients were treated at the University of Washington graduate orthodontic clinic. The Medicaid and private-pay populations were comparable with respect to initial severity of malocclusion, as assessed by both indexes. PAR and ICON scores fell by similar amounts in the Medicaid (44.1% and 37.5%, respectively) and private-pay (46.8% and 37.3%, respectively) populations. Thus, the groups exhibited similar degrees of improvement with interceptive orthodontic treatment. According to the PAR and ICON, midline discrepancy, overjet, and esthetics exhibited the greatest improvement. The Medicaid population missed significantly more appointments and had poorer oral hygiene than the private-pay group, but these factors did not appear to worsen the outcomes, as measured by the 2 indexes. An appliance with 2 bands and 4 brackets was the most commonly used, and it produced the most significant treatment effect. Phase I orthodontic treatment significantly reduces malocclusion severity in Medicaid and private-pay populations. There was no difference in initial severity or final outcome, as assessed by the PAR and ICON, between Medicaid and private-pay populations. The degree of improvement in PAR scores did not appear to be associated with compliance.