Mandibular Incisor Proclination Research Articles

Mandibular Advancement and Skeletal Anchorage in Class II Malocclusion Patients: A Systematic Review with Meta-Analysis

(1) Objectives: The purpose of this review was to compare the effects of combining skeletal anchorage and Class II devices, both from an overall perspective and individually for each type of appliance, considering as main outcomes the vertical dimensions and the inclination of the mandibular and maxillary incisors. (2) Materials and Methods: A search without time restrictions was performed up to February 2024 in PubMed, PubMed Central, Scopus, and Medline for randomized controlled trials, as well as prospective and retrospective cohort studies, considering Class II patients treated with and without skeletal anchorage. The effect measure used for the meta-analytic evaluation was the standardized mean difference (SMD). The SMD calculation was obtained by subtracting the mean values of T1–T0 for each individual treatment and then calculating the SMD between the treatments involved. The meta-analysis was performed using the standardized mean difference of the mean difference of the T1–T0 change in the outcome between the different treatments evaluated as the effect size. (3) Results: A total of 1217 documents were initially retrieved. According to the PRISMA protocol, 18 studies comparing different skeletal anchorage protocols (upper/lower miniscrews and miniplates), combined with four appliances (Herbst, Forsus, Carriere Motion, and elastics), were included in the analysis. No significant difference in skeletal divergence was found between groups from an overall point of view (SMD: 0.19 (−0.48 to 0.83) according to the random-effects model). A statistically significant reduction in IMPA° was found in patients treated with temporary anchorage devices (TADs) (SMD of 5.58 (3.40 to 7.75)), except for the elastics group (SMD: 3.76 (−0.91 to 8.43)). The effect on the upper incisors’ inclination appeared to be strictly dependent on the type of anchorage (TADs in one or both of the arches). Some limitations must be considered when interpreting the results: the small number of studies included and the heterogeneity among them are among the limitations, and the temporal disparity among some studies; the ages of the patients were not always comparable; and, finally, the clinical relevance of the effects of TADs is sometimes questionable. (4) Conclusions: The vertical dimension seems not to be significantly affected by skeletal anchorage; instead, the proclination of mandibular incisors is generally reduced when TADs are used. Skeletal anchorage might be useful if lingual tipping of the upper incisors is required; however, it is influenced by the anchorage protocol.

Clinical effectiveness of customized versus noncustomized orthodontic appliances: A systematic review.

To evaluate the clinical effectiveness of treatment with customized compared to noncustomized fixed orthodontic appliances. A comprehensive search was performed using 13 databases until February 20, 2024. Study eligibility criteria were based on studies that compared orthodontic treatment with customized fixed appliances (labial or lingual) with noncustomized appliances. All ages and types of malocclusions were included. The search identified 95 studies, of which only four fulfilled the inclusion criteria. Three studies compared labial customized brackets with self-ligating brackets, while one study compared lingual customized brackets with labial conventional brackets. There were no significant differences between these systems for treatment duration, outcome, number of appointments, analgesic consumption, patient satisfaction, and the archwire bends requirement. On the other hand, treatment planning was longer and the finishing and detailing phase was shorter in the customized appliances. There was a greater tendency for mandibular incisor proclination and bracket repositioning in the noncustomized appliances group and a greater number of bracket failures, complaints, and requirements for archwire changes in the customized appliances. Qualitative synthesis was applied due to heterogeneity in investigating the difference between the two appliance systems. Based on the current limited evidence, the clinical effectiveness of customized and noncustomized orthodontic appliances was similar for the majority of clinical outcomes. Further high-quality clinical studies are required to confirm this finding. Proper treatment planning and clinical management are the key factors for adequate outcomes apart from the type of appliance used.

Establishment of Cephalometric Hard Tissue Profile among Bengali and Caucasian Populations for Orthognathic Surgery

ABSTRACT The study aimed to compare cephalometric hard tissue profile values and analysis between Bengali and Caucasian populations. The study included 100 individuals (50 males, 50 females) aged 18–35. Subjects having class I molar occlusions and well-balanced facial profiles were included in the study. Lateral cephalograms were taken with consent, and a prestructured proforma recorded relevant information and cephalometric measurements. Our study found increased posterior cranial base length in Bengali males and increased anterior cranial base length in both sexes. Bengali males had a less convex profile, while females had a more convex profile compared to Caucasians with similar mandibular features. Increased maxillary and mandibular incisor proclination was observed. Our findings indicate the necessity for separate norms for orthognathic surgery in normal ethnic Bengali adults.

Comparison of transverse dimensional and incisor changes between wide and narrow orthodontic archwires: a randomized controlled trial.

To clinically compare the effects of broader archwires to standard archwires, using conventional brackets in both cases, on the transverse and incisor changes in maxillary and mandibular arches during leveling and alignment. Fifty-two patients presenting with crowding were allocated into two groups; one group received the broad Damon archwires while the other received standard 3M OrthoForm III Ovoid archwires. All participants were treated with conventional brackets using similar archwire sequences (0.014, 0.018, 0.016 × 0.022/0.016 × 0.025, 0.019 × 0.025 NiTi/CuNiTi archwires). Digital casts were obtained from alginate impressions before treatment (T0) and six weeks after inserting 0.019 × 0.025 NiTi archwires (T1). Pretreatment (T0) and post-alignment (T1) lateral cephalograms were obtained for each patient. The primary outcomes were the changes in the transverse arch dimensions and incisor inclination. The secondary outcomes were the horizontal and vertical linear changes in incisor position. Complete data were collected for 47 patients. There was a significant increase in arch width during treatment within each group, except for upper inter-molar width in 3M group (P = 0.071). Damon wire induced a statistically significant increase in maxillary inter-second premolar width (P = 0.042), and mandibular inter-first premolar (P = 0.043), inter-second premolar (P = 0.008) and inter-molar widths (P = 0.033) compared to 3M group. The increase in incisor proclination and the linear change in incisor position were significant within each group, with less mandibular incisor proclination (P = 0.004) and horizontal advancement (P = 0.038) in the Damon group. Damon archwires created a comparatively greater increase in the maxillary inter-second premolar width and the mandibular inter-first premolar, inter-second premolar, and inter-molar widths, and less proclination and horizontal advancement in mandibular incisors. The study provides invaluable evidence that using broad archwires with self-ligating brackets is the reason behind any greater expansion observed in this system rather than the unique mechanical and biological features exerted by the self-ligating system. Our results suggest that Damon archwire might be a better alternative compared to the narrower standard archwires that are usually used with conventional brackets, especially in the mandibular arch, in cases where mild to moderate crowding is planned to be resolved with a non-extraction approach. However, as arch expansion in the absence of posterior crossbites raises the question of long-term stability, the reported advantage of the use of wide wires should be interpreted with caution and should be considered in the retention phase, bearing in mind that achieving a good post-treatment occlusion is important for enhancing post-treatment stability.

Evaluation of the correlation of mandibular ramus to base ratio with mandibular incisor angulation: A cephalometric study

: The cephalometric evaluation of an individual case using floating norms is the contemporary approach in orthodontic diagnosis. This study aimed to evaluate the correlation of mandibular ramus to the mandibular base ratio with mandibular incisor proclination in a mixed Indian population.A total of 100 cephalograms were selected from the archives of the department of orthodontics fulfilling inclusion and exclusion criteria.The mean age of cases studied was 17.09 ± 2.61 years, with an age range of 13–26 years. The sample comprised 47 males and 53 females. The results of this study showed that the higher incisor mandibular plane angle (IMPA) has statistically and clinically significant association with a higher ramus to mandibular base ratio in both male and female groups. The unit increase in IMPA is significantly associated with a 0.004 unit increase in the ratio of ramus to mandibular base. This study concludes that the IMPA and ratio of ramus to mandibular base are the closest counterparts of each other and explains the variations in the IMPA even in the population group with similar skeletal characteristics. These two components interacts with each other to give a balanced occlusion and function.

Efficacy of clear aligner therapy over conventional fixed appliances in controlling orthodontic movement: A systematic review.

The purpose of the current systematic review was to answer the clinical research question "Is Clear Aligner Therapy (CAT) effective in controlling the orthodontic movement?" by bringing together the most up-to-date information about the available evidence for CAT. On January 1, 2023, a search was conducted in PubMed, ERIC, Embase, and CINHAL for any research papers published in the previous 10 years that provided an overview of the PICO questions. Both the titles and abstracts of the selected studies were evaluated independently by two different authors, and if there was any disagreement between the two review authors, a third reviewer was brought in to settle it. Among included studies, three were retrospective non-randomized and two studies were prospective randomized clinical trials. Various authors reported better outcome for fixed orthodontic appliances than for clear aligner treatment (CAT) in relation to mandibular incisor proclination. The mean objective grading system score was better for braces (17) than for CAT (12) with no clinically significant difference, while staging had a significant impact on treatment efficacy. The results of this study suggest that clear aligners may be an effective alternative to traditional braces, but more research is needed to confirm these findings and determine the optimal size of future prospective studies evaluating this treatment.

Association of Mandibular Incisor Proclination and Mandibular Arch Widths with The Levelling of Curve of Spee

Background: In this study, we aimed to determine the changes in mandibular incisor proclination and mandibular arch widths after leveling the curve of Spee (COS). Methods: Patients included in this quasi-experimental study were scheduled for fixed orthodontic treatment with a non-extraction therapy in the mandibular arch, no posterior crowding, eruption of all mandibular teeth except third molars, no spacing and Little’s irregularity index greater than 2. The COS depth and mandibular arch widths (inter-canine and inter-molar widths) were measured on plaster casts and recorded in millimeters. Mandibular incisors inclinations were measured on a cephalometric radiograph according to the incisor mandibular plane angel (IMPA) and lower incisor to NB (L1) angle. The pre-treatment and post-treatment values were compared using paired sample T-test. Pearson correlation was used to analyze the association between COS changes and other variables. P-value <0.05 was considered statistically significant. Results: A total of 58 subjects with an average age of 25.10±6.81 years participated in this study. COS depth values significantly reduced after treatment (2.34±0.78mm vs 1.75±0.56mm), (P<0.001). Average IMPA and L1-NB values significantly increased following COS flattening (P<0.001). Mandibular inter-canine and inter-molar widths also showed significant increase after treatment (P<0.001). Pearson’s correlation revealed a significant and inverse correlation between COS changes and mandibular arch width and mandibular incisor proclination values (P<0.001 for both). Patient’s age and gender did not have a significant effect on COS depth. Conclusion: Flattening of COS leads to an increase in lower incisor proclination and mandibular arch width.

Cone-beam computed tomographic evaluation of mandibular incisor alveolar bone changes for the intrusion arch technique: A retrospective cohort research.

: Alveolar bone loss is a common adverse effect of intrusion treatment. Mandibular incisors are prone to dehiscence and fenestrations as they suffer from thinner alveolar bone thickness. : Thirty skeletal class II patients treated with mandibular intrusion arch therapy were included in this study. Lateral cephalograms and cone-beam computed tomography images were taken before treatment (T1) and immediately after intrusion arch removal (T2) to evaluate the tooth displacement and the alveolar bone changes. Pearson's and Spearman's correlation was used to identify risk factors of alveolar bone loss during the intrusion treatment. : Deep overbite was successfully corrected (P < 0.05), accompanied by mandibular incisor proclination (P < 0.05). There were no statistically significant change in the true incisor intrusion (P > 0.05). The labial and lingual vertical alveolar bone levels showed a significant decrease (P < 0.05). The alveolar bone is thinning in the labial crestal area and lingual apical area (P < 0.05); accompanied by thickening in the labial apical area (P < 0.05). Proclined incisors, non-extraction treatment, and increased A point-nasion-B point (ANB) degree were positively correlated with alveolar bone loss. : While the mandibular intrusion arch effectively corrected the deep overbite, it did cause some unwanted incisor labial tipping/flaring. During the intrusion treatment, the alveolar bone underwent corresponding changes, which was thinning in the labial crestal area and thickening in the labial apical area vice versa. And increased axis change of incisors, non-extraction treatment, and increased ANB were identified as risk factors for alveolar bone loss in patients with mandibular intrusion therapy.

A comparison of skeletal and dental changes in patients with a Class II relationship treated with clear aligner mandibular advancement and Herbst appliance followed by comprehensive orthodontic treatment

The objective of this study was to compare the skeletal and dental changes of patients with a Class II relationship treated with clear aligner mandibular advancement (MA) and Herbst appliances followed by comprehensive orthodontic treatment. The participants included 20 patients treated with MA and 20 with the Herbst appliance. Orthodontic records were taken before treatment, after the functional appliance, and completion of phase II treatment. The skeletal and dental changes across the 3-time periods were evaluated using a matched paired t test for each treatment. A 2-sample t test was used to examine the changes across periods between 2 treatment groups (P<0.05). Significant reduction in overjet, overbite, and change in molar relationship were obtained by both appliances with similar skeletal and dental contributions. This was contributed by a forward movement of the mandible and mandibular molars, backward movement of the maxillary molars, and retraction of the maxillary incisors. After phase II treatment, both appliances could maintain the skeletal and dental changes achieved during the advancement phase. Greater change in overbite (2.4 mm vs 1.4 mm), an eruption of maxillary incisors (0.9 mm vs 0.1 mm), and proclination of mandibular incisors were found with the Herbst group (3.9° vs -2.1°). The average total treatment time was similar with the 2 appliances. Both functional appliances were equally effective in reducing the overjet and overbite and achieving a Class I molar relationship with a similar length of treatment time. The Herbst design lacked control of the mandibular incisor proclination, and clear aligners offered better vertical control and management of the mandibular incisor inclination.

Effects of skeletal anchorage on mandibular rotation with fixed functional appliance therapy in class II malocclusion patients – A systematic review and meta-analysis

Objectives: The study aimed to systematically investigate the effect of skeletal anchorage on mandibular rotation during FFA therapy during Class II correction in adolescents. Material and Methods: The review protocol was registered under the PROSPERO database (CRD42021256690). Electronic searches of databases and screening were performed up to May 2022. Only randomized clinical trials (RCT) and non-randomized controlled trials (non-RCT) were included in the study. Revised Cochrane risk-of-bias tool for RCTs (RoB 2) and risk of bias in non-randomized studies-of interventions tool for non-RCT were used for studies. Meta-analysis was performed and a forest plot was obtained. The primary outcome was mandibular rotation. Other outcomes assessed were angles SNA, SNB, ANB, mandibular incisor proclination, and failure rates of mini-screws and mini plates. Results: Twelve studies (eight RCTs and four non-RCTs) were included fulfilling inclusion criteria. Evidence showed a low-to-moderate risk of bias for different domains. Meta-analysis for mandibular rotation revealed a greater increase in mandibular plane angle in patients who received FFA with skeletal anchorage as compared to patients who did not receive skeletal anchorage. Conclusion: With or without skeletal anchorage, mandibular rotational changes during FFA therapy are similar. FFA when combined with skeletal anchorage causes more skeletal changes in sagittal parameters than conventional FFA used alone. FFA with skeletal anchorage reduces lower incisor proclination.

The Effect of Leveling the Curve of Spee on the Inclination of Mandibular Incisors: A Retrospective Cephalometric Study.

To assess mandibular incisor inclination after leveling the curve of Spee (CoS) in patients treated with fixed appliances. This was a retrospective study, which included 80 consecutive patients with a mild CoS treated without extraction but with various biomechanical approaches. The depth of CoS was digitally measured on scanned plaster casts and mandibular incisor inclination was assessed with lateral cephalograms pre- and posttreatment. Patients were treated with 0.018"-slot edgewise fixed appliances and cinched back wires. Data were analyzed using linear regression modeling at 5%. A total of 80 patients (40% female; mean age 13.8 years) were included with mean ANB = 4.4 ± 1.9°, mean SN/ML = 31.7 ± 4.7°, mean L1/ML = 95.0 ± 7.7°, and a mean depth of CoS = 1.1 ± 0.4 mm. The depth of CoS was leveled by -0.85 ± 0.39 mm to a post-treatment median of 0.18 mm (interquartile range = 0.09 to 0.35 mm). A small mandibular incisor proclination was observed through treatment (2.49 ± 9.1°), but this was not associated with the reduction in the depth of CoS (p > 0.05) and no statistically significant modifying effect from the different treatment mechanics was observed. Under the limitations of this study, leveling a mild CoS was not associated with mandibular incisor proclination during fixed-appliance treatment.

Bone Remodeling during Orthodontic Movement of Lower Incisors-Narrative Review.

The tooth movement in the alveolus is possible due to bone remodeling. This process could be the risk factor for the formation of gingival recessions-the most common side effects of orthodontic therapy. Gingival recessions are found 5.8-11.5% more frequently among the orthodontically treated patients. What is more, anterior mandibular teeth are the ones most prone to gingival recession dehiscences and fenestrations. The aim of this narrative review was to evaluate, based on CBCT (Cone beam computed tomography) scans, the changes in the alveolar bone of lower incisors in adolescent and adult patients after orthodontic tooth movements. From the pool of 108 publications, a total of 15 fulfilled the criteria of this review. Both retrospective and prospective longitudinal studies-using CBCT or CT (Computed Topography) and evaluating alveolar bone changes in mandibular incisors during orthodontic treatment performed before and after teeth movement-were included. In the group of growing patients, either proclination or retroclination of mandibular incisors led to increase of the distance from CEJ (cementoenamel junction) to marginal bone crest. The difference in bone loss was greater on the lingual side of the incisors in both types of tooth movement. The results were similar for adults patients. The thickness of the alveolar bone was reduced after proclination (total bone thickness) among growing and non-growing patients and retraction (lingual and buccal) of lower anterior teeth in the group of growing patients. The only improvement was measured for buccal thickness of mandibular incisor in bimaxillary protrusion patients treated with extraction therapy. The control of retraction movement (more root than crown movement) enhanced preservation on bone height and thickness. In order to minimize possible deterioration and place teeth in the center of alveolus, CBCT monitoring and scrupulous clinical evaluation are recommended.

R.M.S. bite corrector: A novel appliance for the correction of mandibular prognathism in growing children-Part one: Skeletal and dental changes

Introduction and Aim: Mandibular prognathism is one of the most challenging conditions in clinical dental practice. No appliance has yet been introduced to manage this strenuous condition. Hence, a modified appliance, R.M.S. (removable acrylic splint) bite corrector was fabricated combining the principles of three conventional appliances. The aim was to evaluate the skeletal and dental changes following R.M.S bite corrector in growing children with mandibular prognathism, using lateral cephalograms. Materials and Methods: Twenty children between the age group 9 - 13 years, presenting with class III malocclusion with prognathic mandible were selected. R.M.S bite corrector was fabricated, which consist of reverse twin block with RME (Rapid Maxillary Expansion) incorporated in the upper block. Hooks integrated in the molar region of the upper block, and between the lateral incisors and canines in the lower block. A gradual increasing force was delivered by engaging intraoral intermaxillary elastics. After 10 months, skeletal, dental, and dentoalveolar parameters and linear measurements of jaw bases were compared using pre- and post-operative lateral cephalograms. Results: After 10 months, skeletal changes included a significant retrusion of the mandible and maxillary protraction. Dental changes comprised of an increase in proclination of maxillary and mandibular incisors, which was not significant. A significant increase in the length of the maxillary base, non-significant change in the linear measurements of the mandibular base and ramal length leading to relocation of the mandible in a relatively new position with better esthetics. Conclusion: Desirable skeletal and dental changes were observed following R.M.S. bite correction.

Evaluation of the effectiveness of modified aligner appliance with nickel-titanium springs in treatment of mild crowding of lower incisors: A randomized controlled clinical trial

This study aimed to evaluate the effectiveness of modified aligner appliances with nickel-titanium springs (MAAs) in treating mild mandibular crowding and assess the overall alignment treatment duration, alignment improvement percentage, and mandibular incisor proclination. This two-armed, parallel-group randomized controlled trial included 36 patients (7 men, 29 women) with mild mandibular incisor crowding according to Little's Irregularity Index. Patients were randomly assigned to two groups: the MAA group (mean age=22.56 ± 3.50 years) and the conventional fixed bracket group (control group; mean age=20.89 ± 2.90 years). The duration of alignment treatment of the lower anterior teeth was calculated. The progress of alignment was evaluated every 2 weeks on the study casts, which were taken at fixed intervals: pretreatment (T0) and 2 (T1), 4 (T2), 6 (T3), and 8 (T4) weeks after beginning the treatment. Change of mandibular incisor proclination was evaluated by measuring and comparing pretreatment and postalignment lateral cephalograms. No statistically significant difference was detected between the two groups in terms of alignment treatment duration (P=0.097), whereas a significant difference was observed in the alignment improvement percentage at T1 (P=0.000), T2 (P=0.001), and T3 (P=0.022). In addition, the MAA group had a lower change of mandibular incisor proclination than the control group (P=0.000). The clinical application of MAAs may be effective in lower incisor decrowding, with a reduction in lower incisor inclination compared with conventional fixed brackets. This trial was registered at ClinicalTrials.gov (identifier: NCT04988373).

An Umbrella Review of Systematic Reviews With or Without Meta-Analysis Assessing Treatment Outcomes and Efficiency of Self-Ligating Brackets

Introduction Self-ligating bracket systems are popular and seem to demonstrate lesser friction, allowing tooth movement without exerting unwanted forces on surrounding structures. This umbrella review aimed to compare self-ligating and conventional bracket systems for treatment efficiency. Methods An electronic search in 8 databases was performed for literature published between January 1, 1990, and October 1, 2021, with manual hand-searching of references of retrieved articles. Quality assessment was performed using the risk of bias in a systematic tool by 2 independent reviewers. Data were extracted using a prepiloted form (Joanna Briggs Institute) for evidence synthesis. Corrected covered area was calculated to quantify study overlaps across systematic reviews with or without meta-analysis. Results 605 articles were retrieved, of which 16 were selected. Most included studies had a low risk of bias, except for 6 that showed an unclear risk of bias. Data analysis revealed a reduction in lower incisor proclination, bacterial accumulation, and oral malodor using self-ligating appliances. Conclusions Self-ligating systems reduce mandibular incisor proclination, bacterial accumulation, external apical root resorption, chairside time, and oral malodor. No other differences could be demonstrated in comparison with conventional appliance systems.

How much should incisors be decompensated? periodontal bone defects during presurgical orthodontic treatment in class III double-jaw orthognathic surgery patients

IntroductionThe aims of this study were to evaluate periodontal bone defects around the lower and upper incisors and to identify changes in the buccolingual inclination of the incisors during orthodontic decompensation in skeletal Class III orthognathic surgery patients. Materials and MethodsThe sample consisted of 26 adults with skeletal Class III deformity who had undergone presurgical orthodontic treatment and orthognathic surgery. Lateral cephalograms obtained before orthodontic treatment and before surgery were used to determine the inclination and position changes of the incisors. Cephalometric measurements were taken using Dolphin Imaging 11.95. Three-dimensional images were generated from cone-beam computed tomography (CBCT) scans prior to surgery and used to detect periodontal bone defects, including fenestration (F) and dehiscence (D). ResultsIntraclass correlation coefficients (ICC) were determined and the measurements showed high reproducibility. The cephalometric data showed normal distribution and there were no differences between genders in terms of cephalometric changes, dehiscence, fenestration, or coexistent (D-F/DF) formation. The patients presented maxillary incisor retroclination and mandibular incisor proclination, which was consistent with the tooth decompensation. CBCT assessment was performed for a total of 208 teeth; while 81 upper and 94 lower incisors had D-F/DF formation, 23 upper and 10 lower incisors were healthy. Statistically significant correlations were not found between the inclination degree of the incisors and D-F/DF formation. ConclusionsDecompensation of incisors during presurgical orthodontic treatment increases the risk of periodontal defects. There is no linear relationship between the increase in the inclination degrees of incisors and D-F/DF formation.

Comparison of the treatment duration and effects of magnetic mandibular repositioning appliances and non-magnetic twin block in the treatment of growing patients with skeletal Class II malocclusion due to mandibular retrognathism – A systematic review

Over the past two decades, magnets have been used in orthodontics and dentofacial orthopedics and various attempts have been made to evaluate the biological implications of magnets and magnetic fields. This systematic review aims to provide a detailed comparison between magnetic mandibular repositioning appliances and non-magnetic twin blocks on mandibular growth modification. The objective was to evaluate the treatment duration and effects of magnetic mandibular repositioning appliances and non-magnetic twin block in growing children with skeletal Class II malocclusion due to mandibular retrognathism. Literature search of electronic databases and additional manual search was done till June 2021. Randomized controlled clinical trials (CCTs), non-randomized CCTs, case reports, case series, and retrospective clinical trials in which magnetic appliances and non-magnetic twin blocks were used for the correction of skeletal Class II malocclusion are included in the present review. Correction of skeletal Class II malocclusion was achieved in a shorter treatment duration with magnetic mandibular repositioning appliances. Similar dental and skeletal effects were observed with both the appliances; however, maxillary restraining effect and reduced mandibular incisor proclination was evident with magnetic mandibular repositioning appliances. Magnetic appliance is proven to be more effective in correction of skeletal Class II malocclusion with mandibular retrognathism and maxillary prognathism with proclined lower incisors. This systematic review was registered on Prospero with registration number CRD42020165297.

Correction of Class II malocclusion in a patient using the forsus fatigue resistant appliance – A case report

Functional appliances, fixed or removable, are primarily orthopaedic tools used to influence the facial skeleton in a growing child. Class II malocclusion with a retrognathic mandible in a non -compliant post pubertal patient can be treated using the fixed functional appliances. One such appliance which is in common use in clinical practice today is the Forsus Fatigue Resistant Device. To treat a 13 year old female patient having a class II base, a retrognathic mandible, horizontal growth pattern, convex profile, an overjet of 7mm, mild proclination of maxillary and mandibular incisors, Class II molar and canine relationship bilaterally and a positive VTO.

Oral appliance-generated malocclusion traits during the long-term management of obstructive sleep apnea in adults.

To identify malocclusion characteristics generated after using oral appliances (OAs) for at least 5 years for the management of snoring and obstructive sleep apnea (OSA) in adults. PubMed, MEDLINE (Ovid), Scopus, CINAHL, and Informit were searched without language restrictions through January 20, 2021. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and the Pro-Quest Dissertation Abstracts and Thesis database. Authors were contacted when necessary, and reference lists of the included studies were screened. Risk of bias was assessed through the revised Cochrane Risk of Bias tool for randomized controlled trials (RoB2) and Non-Randomized Studies of Interventions for non-RCTs and uncontrolled before-after studies (ROBINS-I). A random-effects meta-analysis was conducted only on studies that used the same OAs to exclude biomechanical differences. Risk of bias across studies was assessed with the Grading of Recommendations, Assessment, Development and Evaluation tool. A total of 12 studies were included in the final qualitative synthesis. Eight included studies had high, one had moderate, and three had low risks of bias. Significant progressive decreases of overjet (OJ; -1.43 mm; 95% confidence interval [CI], -1.66 to -1.20) and overbite (OB; -1.94 mm; 95% CI, -2.14 to -1.74) associated with maxillary incisor retroclination and mandibular incisor proclination were reported long term. Although most studies showed no sagittal skeletal changes, some degree of vertical skeletal changes were noted. Based on a very low evidence level, inevitable anterior teeth positional changes seem to be a common long-term adverse effect of OAs. The magnitude of those changes could be considered clinically irrelevant for most pretreatment occlusions, but in occlusions with limited OJ and OB, it may be worth clinical consideration.

Long-term periodontal changes associated with oral appliance treatment of obstructive sleep apnea.

To characterize the mandibular anterior teeth crown height as a marker of periodontal changes and bone loss as a side effect of an oral appliance worn for a minimum of 4.5 years. This retrospective study conducted in patients with healthy baseline periodontium recruited participants among consecutive sleep apnea patients treated with an oral appliance between 2004 to 2014. Eligible participants were recalled for a follow-up visit at which a periodontal examination was performed and a lateral cephalogram and dental impressions were obtained. Clinical crown height for mandibular anterior teeth and cephalometric variables were measured and compared before and after treatment. A full periodontal evaluation was performed at the follow-up visit. Twenty-one patients enrolled with a mean treatment length of 7.9 ± 3.3 years. For the mandibular anterior teeth, clinical crown height did not change over the evaluated period. At follow-up, all the periodontal assessed variables were within normal limits, with the mean probing depth of 1.4 ± 0.5 mm, recession 0.6 ± 1.1 mm, and clinical attachment loss 0.8 ± 1.0 mm. Compared with baseline, there was a significant proclination of mandibular incisors (mean increase of 5.1 degrees) with the continued use of an oral appliance. Gingival levels were maintained with clinically insignificant changes during the observation period. Inclination of the mandibular incisors increases significantly with the use of an oral appliance in patients with obstructive sleep apnea. Positional changes in these teeth were not associated with any measured evidence of increase in clinical crown height or gingival recession. Heda P, Alalola B, Almeida FR, Kim H, Peres BU, Pliska BT. Long-term periodontal changes associated with oral appliance treatment of obstructive sleep apnea. J Clin Sleep Med. 2021;17(10):2067-2074.