Mandibular Repositioning Research Articles

Management Strategies for Open Bite Relapse: A Systematic Review and Meta-Analysis.

The purpose of orthodontic therapy is to correct malocclusion and produce a stable outcome that endures over time. Long-term stability can be difficult to achieve, and many patients relapse after treatment, particularly in instances of open bite relapse (OBR). This systematic review aimed to analyze different types of management strategies for OBR and conduct a meta-analysis to find the best method of dealing with relapse. A comprehensive search was carried out across six major online databases using relevant keywords pertaining to our study, including "open bite relapse," "orthodontic retention," "orthodontic surgery," "orthodontic appliance," "orthodontic management," "orthodontic treatment," "orofacial myofunctional therapy (OMT)," "skeletal anchorage," and "treatment follow-up period." Eleven studies were selected after the application of relevant inclusion and exclusion strategies. The mean follow-up period of treatment for the studies ranged from six months to 4.5 years. Of all the management strategies assessed, OMT was found to be the least effective for OBR management. Surgical management modalities, such as mandibular repositioning and molar intrusion using skeletal anchorage, in conjunction with the usage of orthodontic appliances, were found to be noticeably effective, especially in the cases of participants who were <18 years of age. However, when utilized on a singular basis, either of them was found to be lacking the desired effect. The overall odds ratio (OR) of 0.48 (0.37, 0.64) and risk ratio (RR) of 0.62 (0.51, 0.74) were obtained after the meta-analysis of the different interventions for OBR, indicating statistical significance. There were only 11 studies included in the study, so it's possible that not all management strategies for OBR were fully understood. The limited number of studies may also have affected the generalizability of the findings. Although statistical differences were obtained to a certain degree, more clinical trials are needed to assess the effect of such surgical modalities as a viable management tool for OBR, since these represent a significant limiting factor in terms of the overall cost of the treatment placed upon the patient. Prior to the start of the research, registration was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The research protocol was created to meet the goals and was properly filed with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023401991).

Clinical and MRI-Based Assessment of Patients with Temporomandibular Disorders Treated by Controlled Mandibular Repositioning.

Occlusal splints and anterior repositioning splints (ARSs) are widely accepted treatments for temporomandibular disorders (TMDs). However, there is uncertainty with regard to the most suitable amount of mandibular repositioning. The aim of this study is to evaluate the clinical and functional effects of the therapeutic position (ThP) established based on the Controlled Mandibular Repositioning (CMR) method. In this clinical trial, 20 subjects with 37 joints with disc displacement with reduction were recruited. The initial standard functional diagnostic protocol, MRI, and digital condylography were performed, and ThP was calculated with the CMR method. After a 6-month follow-up, the standard diagnostic protocol was repeated. The change in disc position was evaluated by means of MRI after 6 months of CMR therapy. The MRI findings in the parasagittal plane demonstrated that out of the 37 joints presenting disc displacement, 36 discs were successfully repositioned; thus, the condyle-disc-fossa relationship was re-established. Therefore, the success rate of this pilot study was 97.3%. The mean position of the displaced discs was at 10:30 o'clock of the TMJ joint and at 12:00 o'clock after CMR therapy. The ThP determined using the CMR approach reduced all of the anteriorly displaced discs (except one). The CMR method allowed to define an optimum ThP of the mandible thus supporting patients' effective adaptation to treatment position.

Temporomandibular disorders, occlusal splints, and treatment options: a survey-based investigation

Background: The term "temporomandibular disorders" (TMDs) refers to a group of painful conditions that affect both the hard and soft orofacial anatomical structures. The primary objectives of TMD treatment are to lessen pain and enhance mandibular movements, re-establishing proper functioning. One of the widely used treatment options for TMDs pathology is the occlusal splint. This non-invasive intraoral device, determines both the muscle relaxation and reversibly repositions the temporomandibular joint structures. The study aimed to compare the efficacy of different occlusal splint designs or materials in managing TMD symptoms. Methods: Twenty-six patients, nineteen of whom were female and seven of whom were male, ranging in age from twenty to seventy, met the criteria needed participate in this study. Two different questionnaires were formulated: a patient-focused and a clinician-focused questionnaire. The patient's data encompassed general health status and TMD signs and symptoms, whereas the clinician's questions addressed assessment and treatment alternatives, including the particularities of occlusal splint therapy. Results: The majority of the patients were diagnosed with disc displacement with reduction (61.5%), followed by myalgia (26.9%). The only form of treatment preferred by physicians was the Michigan occlusal splint, which was mainly used on the maxillary dental arch (84,6%). After the splint therapy was completed and the intended results were obtained, the treatment plan was finished using selective grinding, prosthetic dental restorations, orthodontic therapy, or a combination of these procedures. The patient was required to continue physical therapy (7,7%), wear a full-arch night guard (42.3%), and undergo rigorous periodic control sessions (34.6%) to maintain the final aesthetic and functional results. Conclusions: Occlusal splints are an efficient and reliable initial therapy preference for patients with temporomandibular disorders. In addition to improving symptoms in the temporomandibular joint, occlusal splints may determine mandibular repositioning, which also implies a variety of treatment approaches, ranging from the minimally invasive to the most complex, to achieve a functional occlusal status.

Mandibular Distalisation for Tooth Wear in Patients Requiring Mandibular Protrusion for Sleep Apnoea.

Pathological tooth wear is an increasing concern and may require intervention and occlusal rehabilitation. Often the treatment includes distalisaton of the mandible to restore the dentition in centric relation. Obstructive sleep apnoea (OSA) is another condition treated my mandibular repositioning but in this case by an advancement appliance. The authors have a concern that there could be a group of patients with both conditions where distalisation for their tooth wear management would be contrary to their OSA treatment. This paper aims to look at this potential risk. A literature search was carried out using the following keywords (OSA or sleep apnoea or apnea or snoring or AHI or Epworth score) and for tooth surface loss (TSL or distalisation or centric relation or tooth wear or full mouth rehabilitation). No studies were identified which considered the effect of mandibular distalisation on OSA. There is a theoretical risk that dental treatment involving distalisation may adversely affect patients at risk of OSA or worsening their condition due to the modification of airway patency. Further study is recommended.

Orthodontic Marvel: Correction of Class II Malocclusion with the Churro Jumper Appliance

Class II malocclusion is a common orthodontic issue characterised by an excessive overjet, where the upper front teeth are significantly ahead of the lower ones. It often leads to aesthetic concerns and functional problems. Orthodontic treatment is the preferred solution to correct Class II malocclusion, and among the diverse range of appliances available, the Churro Jumper Appliance has emerged as a groundbreaking innovation. The present case report is about a 15-year-old male patient with Class II division 1 malocclusion and a retrognathic mandible. The MBT 0.022" prescription was used for bonding. After levelling and aligning both the upper and lower arches, and closing the anterior spacing, the Churro Jumper was used as a fixed functional appliance for mandibular repositioning. The required results were achieved using the appliance, and the patient’s occlusion was brought to a Class I molar and canine relationship, while also improving the profile. The treatment was completed in 17 months. Although several fixed functional appliances are available in the market for Class II correction, the Churro Jumper appliance was used in the present case.

Use of Submental Intubation in the Full-Face Makeover (Orthognathic Surgery, Facial Prosthesis Combined With Rhinoplasty).

Submental intubation is an intubation technique used for the management of airways in patients who suffered from complex maxillofacial trauma. Few studies focused on the role of submental intubation during Full-Face Makeover, like orthognathic surgery, facial prothesis, and rhinoplasty. Authors describe a case series of 5 patients who underwent to Full-Face Makeover with submental intubation to manage the airways. The authors started with the Le Fort I subspinal osteotomy. The maxillary repositioning was guided through a 3D printed intermediate splint in all cases (previously simulated with Dolphin software).Subsequentially, the bilateral sagittal split osteotomy was performed. The mandibular repositioning was guided through a 3D printed final splint. The genioplasty was performed with a horizontal osteotomy after a labial mucosa incision. After the genioplasty, the authors used the incision previously used for the Le Fort I osteotomy to bluntly dissect the tissues in order to insert a custom-made polyether ether ketone zygomatic prosthesis. Lastly, an open rhinoplasty was performed. All the surgery lasted a mean less 6 hours. The submental intubation was removed in the operating room, at the end of the surgery. The patients were then discharged from the hospital 2 days after the surgery in all cases. Submental intubation is a valid method for the airway management in maxillofacial trauma and can be extended in case of Full-Face Makeover like orthognathic surgery combined with rhinoplasty. The absence of nasal traumatism during surgery leads to a more accurate rhinoplasty, with a greater satisfaction for the patient.

Comparative evaluation of treatment effects between two fixed functional appliances for correction of class II malocclusion

Background: The purpose of the current study was to analyze and compare the effects of the PowerScope Appliance and the Carriere Distalizer Appliance in the treatment of Class II malocclusion. Twenty patients aged 14 to 18, with Angle Class II Division 1 malocclusion and showed for therapy with fixed functional equipment, were divided into two groups. (n1=10) for the PowerScope Appliance (American Orthodontics, Sheboygan, Wis.) and (n2=10) for the Carriere Distalizer Appliance (Henry Schein company, New York, USA). Cephalometric analysis was performed on pre- and post-treatment lateral cephalogram. PowerScope and Carriere Distalizer appliances' skeletal and dentoalveolar effects were compared. Secondary outcomes included patient comfort and operator convenience. The PowerScope device restricted maxillary development while allowing substantial mandibular expansion, whereas the Carriere Distalizer did not cause any statistically significant correction in the skeletal component. There was no difference in treatment time seen with either appliance. There was no difference in treatment time seen with either appliance. Conclusions:The PowerScope appliance effectively corrects Class II Division 1 malocclusion in adolescent patients by promoting anterior maxillary displacement restriction with considerable forward mandibular repositioning, which minimizes both skeletal and soft tissue profile convexities.

Condylar repositioning according to digital bite registration method for virtual orthognathic surgery planning: A series of 49 consecutive patients

The accurate mandibular condylar positioning for orthognathic surgical planning is fundamental in obtaining a planned occlusal result. The differences between the position of condyles seen on computed tomography or cone-beam computed tomography (CBCT) scans and during surgery reduce the accuracy of the result. This study aimed to assess the differences between the condylar position recorded on CBCT and a numerical 3-dimensional (3D) model created after mandibular repositioning for orthognathic surgery planning. This study retrospectively evaluated 49 patients who underwent virtual orthognathic surgery planning. The procedure involved recording a computed tomography or CBCT of the skull and dental surface using an intraoral digital scanner. The mandible was repositioned on the numerical 3D model according to the superimposed virtual bite registration in centric relation. Linear and angular measurements of the right and left condyles were recorded before and after mandibular repositioning. The positions of 98 condyles were compared. Linear measurements of the posterior and superior joint spaces revealed a significant difference. Subgroup analyses displayed statistically significant differences for patients with skeletal Class II malocclusion. According to the digital bite registration method, the difference between the mandibular position recorded on CBCT and on the numerical 3D model after repositioning may have clinical significance. Further studies are needed to validate this theory and test the accuracy of the clinical results.

A digital workflow for diagnosis and therapy of a TMD patient: a case report

A 38-year-old female patient referred to the gnathology team of the San Raffaele Hospital (Milan) complaining of temporomandibular joint (TMJ) pain, especially during the night, and diffuse muscular pain referable to the areas of the masseter, temporal, and cervical muscles, accompanied by migraine, the sensation of occlusal instability, and sometimes vertigo. The purpose of this case report was to show a digital workflow of a gnathological treatment to achieve mandibular repositioning and occlusal stability. After a clinical examination, a digital workflow was followed in order to acquire patient's data: 3D models of the patient's arches, masticatory muscles’ surface electromyography (EMG), a study of the mandibular cinematic with ModJaw® and cervical ROM (Range of Motion) examination with an accelerometer. The mandibular therapeutic position for the occlusal splints was obtained through ModJaw®. After 4 months of therapy, the patient's cervical ROM was retested to observe if any ROM improvement was achieved. In a TMD (temporomandibular disorder) patient, digital records helped the clinician make a diagnosis and a therapy plan. Moreover, the digital measurement of cervical ROM allowed to observe an increase in cervical movement angles up to 44% (right lateral bending). The digital evaluation of static and dynamic parameters of a TMD patient can help the clinician to explore mandibular cinematics and improve the clinical management of the patient.

Comprehensive virtual orthognathic planning concept in surgery-first patients

The surgery-first concept is becoming increasingly popular in orthognathic surgery since it offers major advantages such as a reduction of treatment duration and an increase in patient satisfaction by eliminating phases of presurgical orthodontic decompensation. Here, we present a novel interdisciplinary pathway of a fully virtual orthodontic-surgical planning concept in a surgery-first setting using a 3D-printed cutting guide and a customised maxillary implant for the Le Fort I osteotomy as well as a CAD/CAM-based stereolithographic final splint. Patient data from cone-beam computed tomography of the skull and a full arch dental scan were processed using the OnyxCeph3TM software (Image Instruments). A mutual computer-aided surgical simulation was conducted by the orthodontist and the oral and maxillofacial surgeon to determine the three-dimensional maxillary and mandibular movements. In a separate virtual planning session, the surgeon designed a customised maxillary guide and implant for precise intraoperative transfer (Geomagic Freeform Plus software, 3DSystems). A 3D-printed CAD/CAM-based final splint was fabricated by the orthodontist and used for accurate mandibular repositioning. We established a comprehensive virtual interdisciplinary orthognathic workflow and successfully applied this concept with a high level of accuracy in a series of surgery-first patients with different types of dentofacial anomalies. This novel fully computer-based pathway offers a high potential to improve the outcomes of orthognathic surgery and reduce total treatment time in the management of the orthognathic patient.

In-home mandibular repositioning during sleep using MATRx plus predicts outcome and efficacious positioning for oral appliance treatment of obstructive sleep apnea.

Oral appliance therapy is not commonly used to treat obstructive sleep apnea due to inconsistent efficacy and lack of established configuration procedures. Both problems may be overcome by information gathered while repositioning the mandible during sleep. The purpose of this investigation was to determine if an unattended sleep study with a mandibular positioner can predict therapeutic success and efficacious mandibular position, assess the contribution of artificial intelligence analytics to such a system, and evaluate symptom resolution using an objective titration approach. Fifty-eight individuals with obstructive sleep apnea underwent an unattended sleep study with an auto-adjusting mandibular positioner followed by fitting of a custom oral appliance. Therapeutic outcome was assessed by the 4% oxygen desaturation index with therapeutic success defined as oxygen desaturation index < 10 h-1. Outcome was prospectively predicted by an artificial intelligence system and a heuristic, rule-based method. An efficacious mandibular position was also prospectively predicted by the test. Data on obstructive sleep apnea symptom resolution were collected 6 months following initiation of oral appliance therapy. The artificial intelligence method had significantly higher predictive accuracy (sensitivity: 0.91, specificity: 1.00) than the heuristic method (P = .016). The predicted efficacious mandibular position was associated with therapeutic success in 83% of responders. Appliances titrated based on oxygen desaturation index effectively resolved obstructive sleep apnea symptoms. The MATRx plus device provides an accurate means for predicting outcome to oral appliance therapy in the home environment and offers a replacement to blind titration of oral appliances. Registry: ClinicalTrials.gov; Name: Predictive Accuracy of MATRx plus in Identifying Favorable Candidates for Oral Appliance Therapy; Identifier: NCT03217383; URL: https://clinicaltrials.gov/ct2/show/NCT03217383. Mosca EV, Bruehlmann S, Zouboules SM, etal. In-home mandibular repositioning during sleep using MATRx plus predicts outcome and efficacious positioning for oral appliance treatment of obstructive sleep apnea. J Clin Sleep Med. 2022;18(3):911-919.

Pain Assessment during Gnathological Treatment of Temporomandibular Myofascial Pain through Mandibular Repositioning Splints Designed after a Posture-Stabilometric Evaluation

The aim of the study is to evaluate the effectiveness of two complementary mandibular repositioning splints (SVED and MORA) designed after a preliminary patients’ posture-stabilometric evaluation in treatment for temporomandibular myofascial pain (TMP) using the Pain-Intensity Numeric Rating Scale (PI-NRS) assessment. Eighty-six consecutive sportive non-agonistic subjects with TMP were randomly divided in two groups. Forty-two wear mandibular repositioning splints designed by a posture-stabilometric evaluation, thus constituting the test group. The other 44 subjects were not subjected to any treatment, thus represented the control group. To record pain intensity, subjects in both groups were asked to fill in a PI-NRS which ranged from 0 (no pain) to 10 (worst imaginable pain). In the test group, PI-NRS was assessed three times: before starting therapy (t0), after 4 months (t1) and after 8 months (t2) of treatment. Instead, in the control group PI-NRS was recorded during the first visit (t0) and after 8 months (t2). The Friedman test showed a statistically significant decrease in PI-NRS mean scores after 4 (t1) and 8 (t2) months from the start of the gnathological therapy with mandibular repositioning splints, (p &lt; 0.001) in test group. There is enough evidence to assess that occlusal splint therapy for mandibular repositioning (MORA and SVED) designed through a posture-stabilometric evaluation could be considered in the treatment of temporomandibular myofascial pain.

Mandibular advancement device as treatment trial for catathrenia (nocturnal groaning).

Catathrenia is a rare disease, classified as isolated symptoms and normal variants under sleep-related breathing disorders in the International Classification of Sleep Disorders, third edition. Because of its rarity, the research on its pathogenesis and treatment is insufficient. This study aimed to evaluate whether the mandibular advancement device (MAD) could be considered an alternative treatment trial and if so, to explore factors predicting its effectiveness. Thirty patients (12 men and 18 women, aged 16-67 years) with catathrenia participated in the study. They underwent standard clinical evaluation, questionnaires, physical examinations, craniofacial evaluations, video polysomnography, and imaging of the upper airway before and after the insertion of the MAD. The groaning index (groaning episodes per hour of sleep) and apnea-hypopnea index were evaluated, and anatomic factors predicting effectiveness were explored. The sleep efficiency of most patients was higher than 80%, and groaning was present throughout all stages of sleep. With the insertion of the MAD, the groaning index decreased significantly from 5.8 (2.7-14.3) to 2.8 (1.3-12.2) events/h (P = .014). Age had a negative effect on efficacy. Mandibular repositioning of the MAD, especially the amount of vertical opening and changes of the cross-sectional area of the hypopharynx, was positively related with efficacy. The MAD could be considered a possible treatment trial for those seeking treatment for groaning. Registry: Chinese Clinical Trial Register; Name: The etiology of catathrenia based on oral and maxillofacial system; URL: http://www.chictr.org.cn/showproj.aspx?proj=22286; Identifier: ChiCTR-COC-17013239. Yu M, Hao Z, Xu L, Wen Y, Han F, Gao X. Mandibular advancement device as treatment trial for catathrenia (nocturnal groaning). J Clin Sleep Med. 2021;17(9):1767-1776.

Prognostic Indicators for Anterior Mandibular Repositioning in Adolescents with Class II Malocclusion: A Cross-Sectional Cephalometric Study.

To investigate the cephalometric changes following anterior repositioning of the mandible for predicting the treatment effects in Class II adolescent patients. Lateral cephalograms of 28 patients (ANB > 4°) were taken in centric occlusion (CO) and edge-to-edge bite (EtoE) before orthodontic treatment. The patients were classified into two groups according to their mandibular plane angle [MPA; low MPA (LMPA) ≤ 28° and high MPA (HMPA) > 28°]. Cephalometric changes of hard and soft tissues were measured and analyzed with an x-y cranial base coordinate system. For CO to EtoE, there were no significant cephalometric changes between HMPA and LMPA, but the horizontal ratio of soft to hard tissue pogonion (H-Pog'/H-Pog) change was significantly greater with LMPA than with HMPA while the vertical ratio (V-Pog'/V-Pog) showed vice versa. For CO to EtoE, MPA showed significant correlations with H-Pog'/H-Pog and V-Pog'/V-Pog. Y-axis angle, V-Pog'/V-Pog and H-Pog'/H-Pog can be used as good tools to discriminate between HMPA and LMPA. Cephalometric findings for CO to EtoE may be useful in predicting the vertical and horizontal changes of hard and soft tissues with the treatment of growing adolescents having various vertical skeletal patterns of Class II malocclusion.

Effects on the Facial Growth of Rapid Palatal Expansion in Growing Patients Affected by Juvenile Idiopathic Arthritis with Monolateral Involvement of the Temporomandibular Joints: A Case-Control Study on Posteroanterior and Lateral Cephalograms.

Background: Juvenile idiopathic arthritis (JIA) affecting temporomandibular joints (TMJ) in growing patients results in maxillofacial deformities, especially if only one condyle has been affected by the rheumatic disease. Mandibular hypoplasia is the most common issue and it may be associated with maxillary hypoplasia. The aim of this retrospective case-control study is to evaluate the effects of rapid maxillary expansion (RME) in these patients. Methods: 25 growing patients affected by maxillary hypoplasia, currently in a quiescent phase of JIA for at least one year and monolateral involvement of the TMJs, were treated with RME. Data gathered from posteroanterior and lateral cephalograms before and after 1 year from RME were compared to those of 25 non-JIA controls. Results: Nasal cavity width, maxillary width and upper and lower intermolar width statistically increased. Maxillary and mandibular symmetry indexes presented a statistically significant increase, so did the skeletal class. No signs or symptoms of TMJ activity of JIA occurred according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) criteria. No difference was found when comparing JIA and non-JIA patients apart from the better improvement of several mandibular symmetry indexes in the affected TMJ side of JIA patients. This event is allegedly due to a worse baseline asymmetry in JIA patients that underwent a bigger relative improvement after treatment. Conclusions: Results suggest that solving maxillary hypoplasia and, therefore, premature contacts are likely to have allowed mandibular repositioning and condylar growth. RME is a safe and effective solution that can substantially improve maxillary and mandibular symmetry in growing patients affected by JIA with TMJ involvement.

Relevance of 3D virtual planning in predicting bony interferences between distal and proximal fragments after sagittal split osteotomy

After sagittal split osteotomy, the mandibular distal and proximal fragments do not always align themselves passively to one another, resulting in bony interferences and subsequent anomalous settlement of the condyles. Predicting these interferences could be an important ancillary procedure for avoiding intra- and postoperative surgical complications, rendering orthognathic surgery more effective and safer. This study evaluated the relevance of virtual surgical planning in assessing the displacement of the proximal segments after virtual distal segment repositioning, for predicting bony interferences between the segments and thus avoiding related intra- and postoperative surgical complications. The presence of interferences between the distal and proximal segments was compared between virtually predicted (computer-assisted simulation surgery, Dolphin software) and real cases in 100 consecutive patients diagnosed with dentofacial deformities who underwent orthognathic surgery with mandibular repositioning (using a short lingual osteotomy (SLO)). The results indicated that clockwise rotation of the mandible was the mandibular movement most prone to segment interference. Furthermore, virtual planning was sensitive (100%) but had low specificity (51.6%) in predicting proximal and distal segment interferences. This low specificity was due to the software-based automated design of the mandibular osteotomy, where the length of the distal segment was longer than the real SLO, and the mandibular ramus sagittal split was located just behind Spix’s spine. Thus, more precise simulated osteotomies are needed to further validate the accuracy of virtual planning for this purpose.

Le repositionnement mandibulaire : une alternative à la chirurgie chez des patients adultes ? Un suivi sur deux ans

A number of adult patients with skeletal discrepancies refuse surgical intervention. The aim was to assess the reaction to mandibular repositioning in simulating a skeletal correction in such patients. 32 consecutive patients without any signs of temporo-mandibular dysfunction (TMD) were offered mandibular repositioning, as a non-invasive alternative and it was explained to them that the approach was based on the results described in case reports. Before initiating any treatment initial records, headfilms, study casts and photos were taken (T0) and the mandible was repositioned to camouflage the skeletal discrepancy by means of an occlusal built-up in Triad® Gel. Three months later (T1) 23 patients had adapted to the new occlusion reflected in absence of functional problems and lack of fracture of the built-up. In these patients the mandibular position was maintained by orthodontics adjusting the occlusion to the built-up position (T1). The skeletal changes occurring during repositioning were assessed on sagittal and frontal head films while intra-articular changes occurring during a 2-year follow-up period (T2) were evaluated on images constructed from CBCT images. No significant changes, neither in the direction of a relapse nor in the direction of further normalization of the condylar positioning, were observed during the 2-year observation period. Repositioning is a non-invasive intervention and may be considered a valid alternative to surgery in some patients. Morphological variables from the radiographs taken at T0 and the results of the initial clinical evaluation of dysfunction yielded only vague and insignificant indications regarding the predictability of adaptation to the repositioning.

Multidisciplinary treatment of complex skeletal class III malocclusion

Introduction. Skeletal malocclusions, especially those with a prominent vertical component, always present a challenge for the interdisciplinary approach to their treatment planning. The aim of this report is to present a patient with a complex skeletal deformity in all three directions (vertical, sagittal and transverse). Case report. A twenty-four year old female patient with a skeletal Class III malocclusion, open bite and laterognathia, was firstly treated by orthodontic fixed appliances, whereas the dental decompensation of dentoalveolar structures was carried out and adjusted to their bone structures, thus enabling an adequate and sufficient reposition of the jaw. A surgical correction included bi-maxillary osteotomy due to pronounced vertical cephalometric parameters, necessitating a posterior maxillary intrusion and mandibular repositioning. In that manner, the relapse was prevented and a long-term stable result obtained. In the retention period, the patient wore removable bi-maxillary retention devices. Conclusion. The combined orthodontic-surgical treatment provided the Class I occlusion with aesthetic and functionally satisfactory results which were envisioned by the treatment plan.

Biomimetic Oral Appliance Therapy in Adults with Mild to Moderate Obstructive Sleep Apnea Using Combined Maxillo-Mandibular Correction

Although mandibular advancement devices (MADs) are utilized for the management of mild to moderate OSA, there are concerns about temporo-mandibular joint (TMJ) issues. Biomimetic oral appliance therapy (BOAT) differs from MADs as it aims to achieve midfacial redevelopment in combination with mandibular repositioning. In this study, we tested the hypothesis that mild to moderate cases of OSA can be addressed with combined maxillo-mandibular correction using BOAT.

A Fully Digital Workflow and Device Manufacturing for Mandibular Repositioning Devices for the Treatment of Obstructive Sleep Apnea: A Feasibility Study

A Fully Digital Workflow and Device Manufacturing for Mandibular Repositioning Devices for the Treatment of Obstructive Sleep Apnea: A Feasibility Study