Malocclusion In Adults Research Articles

Stepwise surgical management of binder syndrome with skeletal class III malocclusion in adults

Our study aimed to evaluate a stepwise treatment of class III malocclusion accompanied with flat nasal deformity, using orthodontics, orthognathic surgery, and rhinoplasty, as well as stability during long-term follow-up.In total, 27 patients with nasomaxillary hypoplasia and skeletal class III malocclusion were enrolled in this study. All patients had accepted orthodontic and orthognathic surgery, followed by rhinoplasty with costal cartilage as the second surgical procedure. Clinical results were evaluated by radiography, medical photography, questionnaire, and cephalometric analysis.All patients were satisfied with the surgical results and no serious complications occurred. During the follow-up, the patients showed well-corrected midface contour and nasal projection, and stable occlusion. The costal cartilage grafts were well fixed, without obvious absorption deformation. Lateral cephalometric analysis and overlay results showed that the postoperative point A had advanced approximately 5.20 ± 1.43 mm and the SNA angle had increased by approximately 5.59 ± 2.86°. Soft-tissue measurements showed a 14.22 ± 6.56° decrease in the facial lobe, while the nasolabial angle had increased by 16.83 ± 6.65° postoperatively.The results suggested that stepwise orthodontic-orthognathic surgery and rhinoplasty produce a predictable and stable result in long-term follow-up.

A Case Study on Orthodontic-Surgical Management of Skeletal Class III Malocclusion in Adults: Clinical Approach and Outcomes

This article presents a case study illustrating the successful management of skeletal Class III malocclusion in an adult through an orthodontic-surgical approach. The clinical case outlines the entire process, from initial assessment to post-treatment outcomes, conducted within our service. Key steps include diagnostic planning using advanced tools such as 3D imaging and virtual surgery simulation. Pre-surgical orthodontic treatment was carefully planned to prepare dental and skeletal structures for surgical correction. Orthognathic surgery was performed precisely according to the established plan, followed by a post-surgical orthodontic phase to finalize occlusion. Short-term and long-term outcomes are evaluated, highlighting significant improvement in facial aesthetics, occlusal function, and post-treatment stability. This case study demonstrates the effectiveness of our integrated approach in managing skeletal Class III malocclusions in adults, underscoring the importance of interdisciplinary collaboration for optimal outcomes

Progressive malocclusion in adults: atypical aetiology resulting in iatrogenic acromegaly

Progressive malocclusion in adults: atypical aetiology resulting in iatrogenic acromegaly

The Potency of Invisalign® in Class II Malocclusion in Adults: A Narrative Review.

In recent years, a greater number of adult patients are seeking orthodontic treatment, not only for esthetics but for better functioning and hygiene purposes. However, they are more focused on comfortable and invisible treatment alternatives to conventional metal brackets. This abstract is a multifaceted interplay between Invisalign® and different treatments of class II malocclusion, which embarks on the potency of Invisalign® in treating this condition in adult patients. The review delves into analyzing the efficacy of Invisalign® in molar distalization, class II elastics, extraction treatment, class II division 2 patients, their limitations, challenges, and future prospects. This article aspires the orthodontists understand the complex nature of class II malocclusion treatment in adults with Invisalign® and its application in clinical practice with improved patient outcomes.

Mandibular Molar Distalization in Class III Malocclusion: A Systematic Review

Class III Malocclusion presents a complex orthodontic challenge with various treatment options, including orthodontic camouflage and orthognathic surgery. Among these, mandibular molar distalization stands as an orthodontic approach for treating Class III Malocclusion in adults. This systematic review aims to evaluate the current evidence regarding mandibular molar distalization techniques in the treatment of Class III. The search across PubMed, Scopus, Cochrane, and Web of Science databases yielded 582 articles, from which eight met the inclusion criteria. These inclusion criteria were as follows: English language, full text, studies randomized clinical trials, and retrospective studies that evaluated various methods of mandibular distalization for Class III Malocclusion in adult patients, from 2013 to May 2023. Lower molar distalization has gained attention as a non-surgical alternative with effective and efficient outcomes. However, various treatment modalities have limitations, including reliance upon malocclusion severity, diagnosis, patient cooperation, and operator experience. From the studies analyzed, it was found that techniques using skeletal anchorage with TADs, mini-plates, or ramal plates, offer stable anchorage and controlled tooth movement, they allow unilateral action in cases of asymmetry, and they are the most effective methods for achieving distal body displacement of the tooth. Despite the promising results, the relatively small number of studies calls for more high-quality research to explore the efficacy and outcomes of different mandibular molar distalization approaches. The lack of standardized protocols and guidelines for mandibular molar distalization in Class III Malocclusion is also attributed to the limited available literature.

Adjunctive orthodontics – A review

In the recent years, number of adults seeking orthodontic treatment has significantly increased because of many factors including easier access to orthodontists, the availability of aesthetic treatment alternatives that make the appliance invisible, or improved awareness. Adults not only have malocclusions of different severity when they first arrive, but they also have additional restorative and periodontal considerations that need for interdisciplinary care that is well-coordinated. The two primary types of orthodontic therapy suggested for adult malocclusion are adjunctive and comprehensive. The goal of this article is to evaluate the various adjunctive orthodontic treatment methods and their treatment sequence for adult patients. This article seeks to provide readers with a better grasp of the most recent developments in adjunctive orthodontic therapy.

Cephalometric analysis of upper lip thickness as a critical aid in formulating a treatment plan in skeletal Class I malocclusion in adults

It is very crucial to understand that both soft tissue drape and the underlying skeletal malocclusion, are sometimes overlooked and this could be misleading for diagnosis and treatment planning .Therefore a sound knowledge of underlying malocclusion and CTP (cephalometric treatment planning) along with accurate clinical examination can aid in better diagnosis and treatment planning. The objective of this study is to understand that soft tissue drape and underlying skeletal malocclusion in Angle’s class I malocclusion could be misleading in treatment planning and therefore to perform necessary cephalometric hard and soft tissue analysis. Lateral cephalograms were obtained in NHP (Natural head position) position of size (20×25cm) FUJIFILM and lateral cephalograms were obtained on radiographic films. Evaluation of lateral cephalograms and the above mentioned parameters were traced and assessed by manual tracing of 150 lateral cephalogram was done using tracing papers with the help of tracing backlight box .Tracing was done with lead pencil point (0.3 mm HB). 150 patient of central Indian population with Angle’s class I malocclusion full permanent dentition between ages 18-45 years were included. Out of these 150 patients 75 males and 75 females patients are included in the study. Upper lip anterior and lip angle shows moderate positive correlation with W angle. The key ridge shows a strong positive correlation with W angle. The upper lip thickness can be used as a treatment plan predictor in Angle’s class I malocclusion as it is strong correlated with W angle. Soft tissue drape especially the upper lip thickness is an essential parameter along with identification of underlying skeletal malocclusion with cephalometric treatment planning measurement like W angle, for treatment planning of even a simple Angle’s class I malocclusion case.

Determination of treatment options for Class III malocclusions in adult patients based on cephalometric values: a systematic review

Abstract Objective The present systematic review aimed to determine cephalometric values that may be used as a guide in deciding between orthodontic camouflage and orthognathic surgery to treat a Class III malocclusion in adults. In addition, a secondary aim was to identify treatment complications and aesthetic perceptions by laypersons/orthodontists. Methods Without a language restriction, an electronic search of six databases and a hand search of three orthodontic journals were performed until September 2021. All studies comparing orthodontic camouflage and orthognathic surgery in Class III malocclusion patients, were included. Data extraction was carried out independently by two authors with disagreement resolved by a third author. The risk of bias related to individual studies was appraised using a modified version of the STROBE checklist. The results were summarised qualitatively, and no meta-analysis was undertaken due to the high heterogeneity between the studies. Results With the quality of evidence ranging from moderate to high, six retrospective studies were included. A cephalometric analysis comprising the Holdaway angle, overjet, the Wits appraisal, lower incisor inclination, the maxillary-mandibular ratio, overbite, gonial angle and an additional combination were used as a guide. No treatment complications were reported. One study examined the perception of facial profile attractiveness in borderline surgical Class III malocclusions and found no difference in outcome and significant improvements in both camouflage and surgical groups. Conclusion The existing evidence is insufficient to identify a cephalometric parameter threshold in deciding between orthodontic camouflage and orthognathic surgery. PROSPERO database protocol no. CRD42020165164.

Anterior openbite malocclusion in adults.

To investigate stability and satisfaction in adult anterior open bite (AOB) patients at least 9 months post-treatment, as well as patient and practitioner factors that may be associated with stability and satisfaction. Practitioners and their adult AOB patients were recruited through the National Dental Practice-Based Research Network. Data on patient and practitioner characteristics, treatment recommendations and factors were previously collected. Treatment stability was determined by assessing post-treatment intraoral photographs. Patient satisfaction was determined from post-treatment questionnaires. Treatment was categorized into aligners, fixed appliances, temporary anchorage devices, and orthognathic surgery. Extractions were also investigated. Retention type was categorized into vacuum-formed, Hawley-style, or bonded retainers, and regimens were classified as full-time or part-time wear. Retention data collected from 112 patients had a mean post-treatment time of 1.21 years. There were no statistically significant differences in stability between treatment groups. Depending on whether a qualitative index or a millimetric measure was employed, stability ranged from 65% to 89%. Extractions and less initial lower incisor proclination were associated with higher stability in patients treated with fixed appliances only. High satisfaction was reported by patients at retention. There were no clear differences in stability or satisfaction among retention types or regimens. The stability of adult AOB orthodontic treatment was high, regardless of treatment or retainer modality. Satisfaction in adult AOB patients was high, regardless of retention type or regimen.

Class II Division 1 malocclusion treatment using TADs: Case report

Introduction. Orthodontic treatment of Class II Division 1 (II/1) malocclusions in adults can be challenging since skeletal effects are limited. Possible treatment options are orthodontic camouflage or orthognatic surgery, in severe cases. The aim of this paper was to present a successful management of Class II malocclusion in an adult patient using temporary anchorage devices (TADs). Case report. After detailed clinical examination, study models and cephalometric analysis, a 26 years old patient was diagnosed with Class II malocclusion, an overjet of 12 mm, congenitally missing tooth 41 and midline shifted to the right in upper dental arch. In prior orthodontic treatment, patient had upper premolars extracted. Posterior teeth in upper left quadrant were shifted mesially. The camouflage treatment was considered, using temporary anchorage devices (TADs) to distalize posterior teeth on the left side, and gain space for incisor retraction and midline correction in upper dental arch. Results. Using TADs as additional anchorage in anterior region and coil spring for molar distalization, the space was made for tooth 23, midline correction and incisor retraction. After 40 months, a satisfactory result was achieved, overjet and midline correction, class I canines occlusion and class II molar occlusion. Conclusion. Class II/1 malocclusion in adults can be successfully treated using TADs. The success depends on the severity of malocclusion and patient cooperation.

Effects of clear aligner therapy for Class II malocclusion on upper airway morphology and daytime sleepiness in adults: A case series

To evaluate the effects of clear aligner therapy (CAT) on the upper airway dimensions and on daytime sleepiness in adults with dentoskeletal Class II malocclusion. This study was conducted from August 2017 to February 2019. Inclusion criteria were healthy adults≥18years old, Angle Class II division 1 malocclusion, first-molar relationship of end-to-end or greater, overjet<10mm, and presenting for multi-arch comprehensive orthodontic treatment with aligners. Treatment mechanics included mandibular dentoalveolar advancement with Class II elastics without maxillary sequential distalization programmed into aligners. Post-treatment changes in dentoskeletal and upper airway dimensions were assessed using CBCT images. The treatment effect on daytime sleepiness was evaluated using an Epworth Sleepiness Scale (ESS). Eight subjects were included in this pilot study (mean age at treatment initiation=44.6years [SD=15.3]). The mean treatment duration was 12.2months (SD=3.4). No statistically significant treatment changes were observed in upper airway dimensions or dentoskeletal cephalometric analyses. Subjects with excessive daytime sleepiness at pre-treatment reported an improvement post-treatment, but no significant difference in the mean ESS score was found. Treatment of Class II division 1 malocclusion in adults by mandibular dentoalveolar advancement using CAT has no statistically significant effects on the airway and dentoskeletal measurements, or daytime sleepiness.

Class III malocclusion camouflage treatment in adults: A Systematic Review

Objective: To evaluate the effects of camouflage treatment of Class III malocclusion in adults. Methods: An electronic search was performed in MEDLINE/PubMed, Embase, Scopus, Web of Science, Google Scholar, Lilacs, and Cochrane databases, without limitations regarding publication year or language. Studies evaluating nongrowing individuals with Class III malocclusion undergoing orthodontic camouflage treatment with any orthodontic technique, including extraction and non-extraction approaches, were considered. Study selection, data extraction, and risk of bias assessment according to a modified Downs and Black checklist were performed by two independent reviewers. A third evaluator was included if disagreements emerged. Results: Nine studies were included in the review. Eight presented high risk of bias. Different methods for Class III malocclusion correction were described and included maxillary and mandibular premolar extractions, mandibular incisor extraction, Class III elastics and distalization of the mandibular dentition. Extractions in the mandibular arch resulted in lingual tipping and retrusion of the mandibular incisors, and labial tipping and protrusion of the maxillary incisors. The use of Class III intermaxillary elastics promoted proclination of the maxillary incisors, extrusion of the maxillary molars, distal tipping of the mandibular molars, extrusion of the mandibular incisors, and clockwise rotation of the mandible. Distalization of the mandibular dentition resulted in distal tipping of the mandibular molars, retroclination and retraction of the mandibular incisors, and counter clockwise rotation of the mandible. Conclusions: Treatment changes are influenced by the method used to correct the Class III malocclusion and are primarily dentoalveolar

COMBINED ORTHODONTICS AND SURGICAL APPROACH TO CLASS III MALOCCLUSION WITH ANTERIOR OPEN BITE IN ADULTS

Skeletal anterior open bite with Class III malocclusion in adults is one of the most difficult malocclusions to treat. Surgical intervening is a must, along with orthodontics in such complex cases. The most effective treatment option in adult patients with Class III malocclusion and the skeletal anterior open bite is surgical repositioning of the maxilla or both jaws. The present case report describes the treatment protocol for Class III malocclusion with an anterior open bite in adult, a novel orthodontic- surgical approach. A 24-year old male patient with a Class III malocclusion, anterior open bite (skeletal), poor facial aesthetics, mandibular and chin protrusion. The objective was to achieve ideal overjet and overbite, to achieve class 1 incisor, canine and molar relation. To correct anterior open bite and achieve Class I skeletal jaw bases and to achieve esthetically pleasing profile and functionally stable occlusion. Therefore, by correction of the dental and skeletal jaw relationship, we hoped to improve the patient’s self- esteem, confidence and improved oral health quality of life.

Measurement of Mesiodistal Axial Angulation of the Teeth in Class I Malocclusion in Adults

This study aimed to provide a description of the mesiodistal axial angulation of themaxillary and mandibular teeth in cases of class I malocclusion.The values of the mesiodistal axial angulation of the teeth were measured for 20subjects (10 males and 10 females) from orthopantomograph using computer programand comparisons were made between the right and left sides and between males andfemales.The mean values of the mesiodistal axial angulation of the teeth were higher inmales than in females, and higher on the right side in upper and lower arches than onthe left side for males, females and total sample, however; there was no statisticallysignificant difference between the groups. This study provided a good description ofthe mesiodistal axial angulation of the maxillary and mandibular teeth in cases ofclass I malocclusion.

Ortho-surgical Management of Severe Skeletal Class II Div 2 Malocclusion in Adult

Skeletal Class II malocclusion is attributed to maxillary prognathism, mandibular retrognathism or combination of both. In adolescent cases, the treatment includes growth modulation with headgear or myofunctional appliances. However in adults, optimum esthetic and functional efficacy can be achieved by orthodontic-surgical combination. This case report describes a 21 years old post-pubertal male with severe skeletal Class II discrepancy with normal maxilla and retrognathic mandible. The case was treated with bilateral sagittal split osteotomy (BSSO) with mandibular advancement approach. Straight profile, pleasing esthetics, bilateral Class I molar and canine relationship, normal overjet and overbite were achieved because of a combined ortho-surgical approach.

The correlation between symptoms of malocclusion in adults and their quality of life related to oral health

The correlation between symptoms of malocclusion in adults and their quality of life related to oral health

The Impact of Fixed Orthodontic Therapy in Correction of Malocclusion in Adults

Objective: To measure the impact of fixed orthodontic therapy in the correction of malocclusion in adults and to evaluate the influence of factors associated with this impact. Methods: The sample consisted of 288 adult patients who had undergone fixed orthodontic therapy. The adequacy of orthodontic treatment was assessed by the PAR index in models of initial and final study. Associated factors were divided into two groups: socio-economic demographic variables (gender, education level, type of service, age at end of treatment), and the independent orthodontic variables (DHC-IOTN, AC-IOTN, satisfactory use of retainer, conducting speech therapy, and main complaints). For data analysis, we used the chisquare tests and multivariate logistic regression for a confidence level of 95%. Results: Independent of associated factors, the improvement of the treated cases was greater than 88.2% of the sample, with significant improvement in cases with moderate or severe initial need of treatment (p = 0.008) and in patients older than 25 years at the time of treatment (p = 0.015). Conclusion: The orthodontic therapy resulted in significant improvement, especially in cases with moderate or severe orthodontic treatment need and in adults over the age of 25 years.

Nouvelle approche de la thérapeutique ortho-implantaire de l’adulte partiellement édenté. Partie I : description du protocole Decker

The treatment of adult malocclusion is usually complex and pluridisciplinary. Its prognosis is not reliable. We present a new clinical protocol to improve the management and final result. We use a specific software (Simplant®, OMS®, Materialise Dental) and its accessory modules. It allows visualization of the expected final clinical result of the orthodontic treatment. Combined with guided-surgery, it allows placing implants at the beginning of treatment in a position that is compatible with the final position. The implants serve as absolute anchorage for dental motions during the orthodontic step; it is also used to support the final prosthesis. The treatment is thus optimized and its prognosis is improved. Finally, the reversed surgical sequences shorten the treatment thus promoting the compliance of patients.

Combined Orthodontic and Surgical Management of a Skeletal Class III Malocclusion with Mild Asymmetry–a Non Extraction Approach

Severe orthodontic problem that could neither be treated with growth modification or camouflage often requires combined surgical and orthodontic treatment. As the envelope of discrepancy indicate the limitation in orthodontics a multidisciplinary approach is mandatory while treating a skeletal Class III malocclusion in adults. This case reports describes the management of a 22 year old female patient with skeletal class III malocclusion and mild facial asymmetry treated with a non extraction approach, Decompensation was done before surgery followed by a bilateral sagittal split osteotomy. In reviewing the patient, the goals set at the beginning of treatment were successfully achieved, providing the patient with adequate masticatory function and pleasant facial esthetics.

Treatments for adults with prominent lower front teeth

Prominent lower front teeth may be associated with a large or prognathic lower jaw (mandible) or a small or retrusive upper jaw (maxilla). Edward Angle, who may be considered the father of modern orthodontics, classified the malocclusion in this situation as Class III. The individual is described as having a negative or reverse overjet as the lower front teeth are more prominent than the upper front teeth. The purpose of this systematic review was to evaluate different treatments of Angle Class III malocclusion in adults. The following databases were searched: Cochrane Oral Health Group Trials Register (to 22 March 2012); CENTRAL (The Cochrane Library 2012, Issue 1); MEDLINE via OVID (1950 to 22 March 2012); EMBASE via OVID (1980 to 22 March 2012); LILACs (1982 to 22 March 2012); BBO (1986 to 22 March 2012); and SciELO (1997 to 22 March 2012). All randomized or quasi-randomized controlled trials of treatments for adults with an Angle Class III malocclusion were included. Three review authors independently assessed the eligibility of the identified reports. Two review authors independently extracted data and assessed the risk of bias in the included studies. The mean differences with 95% confidence intervals were calculated for continuous data. Two randomized controlled trials were included in this review. There are different types of surgery for this type of malocclusion but only trials of mandible reduction surgery were identified. One trial compared intraoral vertical ramus osteotomy (IVRO) with sagittal split ramus osteotomy (SSRO) and the other trial compared vertical ramus osteotomy (VRO) with and without osteosynthesis. Neither trial found any difference between the two treatments. The trials did not provide adequate data for assessing effectiveness of the techniques described. There is insufficient evidence from the two included trials, to conclude that one procedure is better or worse than another.The included trials compared different interventions and were at high risk of bias and therefore no implications for practice can be given.Further high quality randomized controlled trials with long term follow-up are required.