Maxillary Retrognathism Research Articles

Quantum of incisal compensation in skeletal class III malocclusion: a cross-sectional study.

Skeletal class III malocclusion presents either with maxillary retrognathism, mandibular excess, or a combination. Dentoalveolar compensations occur with maxillary incisor proclination and mandibular incisor retroclination. The aim of this study is to quantify the amount of incisal compensation in class III skeletal malocclusion and correlate it to the severity of the skeletal base. Eleven angular and 7 linear cephalometric measurements were digitized from 57 patients. Axial inclination of the upper and lower incisors was evaluated for compensation. Pearson's correlation coefficient was used to determine the dentoalveolar parameter among those measuring upper and lower incisor position and inclination that correlated most highly with the severity of class III. Linear regression analysis was used to identify the quantum of the incisal compensation. Upper incisors were proclined and placed anteriorly. However, correlation analysis suggested a less responsive incisor with progressive change in skeletal base. Lower incisors began to compensate only as the severity of class III increased. For every degree of reduction of ANB angle from normal, the incisor mandibular plane angle (IMPA) and L1-GoMe decreased by 0.79° and the L1-GoGn decreased by 0.81°. The upper incisors contributed more to compensation compared to the lower incisors in a class III skeletal base. As class III severity increased, the upper incisor compensation decreased while that of lower incisors increased. For every degree of reduction in ANB angle, the IMPA and L1-GoMe decreased by 0.79° and the L1-GoGn decreased by 0.81°.

Nonsurgical orthodontic treatment using bone-anchored maxillary protraction in a patient with unilateral cleft lip and palate.

Class III malocclusion due to a retrognathic maxilla is common in patients with cleft lip and palate. Skeletally anchored maxillary protraction using screw-anchored mini-plates combined with intraoral elastics has shown promising results in achieving orthopedic changes and maintaining the outcome until the completion of the growth. This case report presents the course of treatment in a patient with unilateral cleft lip and palate and multiple congenitally missing teeth treated with bone-anchored maxillary protraction until the end of growth. Four mini-plates (Bollard plates) were used during comprehensive fixed orthodontic treatment to protract the dentition and close the space where teeth were missing, extrude the canine, and force eruption of the second premolar using extension arms and cantilevers. A 2-year follow-up at age 17 showed stable occlusion and maintenance of soft tissue results. Bone-anchored maxillary protraction treatment in a patient with cleft lip and palate demonstrates proper orthopedic results and could be a viable alternative to orthognathic surgery.

Is Incisor Compensation Related to Skeletal Discrepancies in Skeletal Class III? A Retrospective Cephalometric Study.

This study investigated compensation in skeletal Class III subjects to compare various severities of abnormal jaws. A retrospective analysis of 137 skeletal Class III cephalograms (63 males and 74 females) was conducted, with cephalometric assessments determining skeletal and dental values. The results were compared with Class I cephalograms. Incisor compensation was examined by pairing normal jaws with varied abnormal jaws, classified by severity using one standard deviation (SD). Statistical analyses included Kruskal-Wallis tests, Bonferroni tests, Spearman's correlations, and multiple linear regression. Four skeletal Class III groups were identified: OMx+PMd, RMx+OMd, OMx+OMd, and PMx+PMd (P = prognathic; O = orthognathic; R = retrognathic; Mx = maxilla; Md = mandible.). The upper central incisor (U1) showed proclination, and the lower central incisor (L1) showed retroclination across all groups except for U1 in PMx+PMd and L1 in OMx+OMd, which exhibited normal inclination. U1 exhibited limited compensation even with progressive maxillary retrognathism, while L1 showed limited compensation after one SD of mandibular prognathism. Maxilla (SNA) and jaw discrepancy (ANB) were inversely related to the U1 degree, whereas only jaw discrepancy (ANB) was positively related to the L1 degree. U1 in PMx+PMd and L1 in OMx+OMd showed no incisor compensation. U1 had limited compensation even with progressive maxillary retrognathism while L1 showed limited compensation after one SD mandibular prognathism.

Calcification patterns and morphology of Sella turcica are related to anteroposterior skeletal malocclusions: A cross-sectional study

BackgroundThe sphenoid bone is an irregular, unpaired, symmetrical bone located in the middle of the anterior skull and is involved in craniofacial growth and development. Since the morphology of Sella turcica (ST) is associated with different craniofacial patterns, this study aimed to investigate if there is a correlation between ST morphology on the one hand and sagittal craniofacial patterns on the other hand. MethodsThis study was conducted with a convenience sample that included Brazilian individuals undergoing orthodontic treatment. Lateral cephalograms were used to evaluate the calcification pattern and morphology of ST, as well as skeletal class by analyzing the ANB angle. Pearson's chi-square test with Bonferroni post-hoc test was performed to evaluate the association between ST calcification pattern and morphology, and anteroposterior skeletal malocclusion. The established significance level was 0.05. ResultsThe study collective was comprised of 305 orthodontic patients (178 (58.4 %) female, 127 (41.6 %) male), who had a mean age of 23.2 (±10.6) years. 131 participants (42.9 %) presented skeletal class I, 142 (46.6%) skeletal Class II, and 32 (10.5%) had a skeletal class III. The degree of prognathism of the mandible showed a homogenous distribution within the study collective (91 (29.9 %) orthognathic, 100 (32.9 %) retrognathic, 113 (37.2 %) prognathic mandible). Concerning the maxilla, 92 (30.2%) individuals presented an orthognathic upper jaw, whereas 60 (19.7%) showed maxillary retrognathism and 153 (50.2%) maxillary prognathism. Compared to patients with skeletal class I, skeletal class III individuals presented significantly more hypertrophic posterior clinoid process (p<0.007) and pyramidal shape of the dorsum of the ST (p<0.038). ConclusionsOur results suggest that the hypertrophic posterior clinoid process and pyramidal shape of the ST dorsum are more prevalent in individuals with skeletal class III malocclusion.

Axenfeld-Rieger syndrome – A report of a rare case and review

A typical case of Axenfeld-Rieger syndrome (ARS), a rare autosomal dominant condition manifesting with ocular, craniofacial, and dental abnormalities, is presented. The patient showed dental features such as oligodontia, microdontia, abnormally shaped teeth, hyperplastic maxillary labial frenum, and maxillary retrognathism. Early diagnosis of the syndrome from its dentofacial manifestations and a multidisciplinary approach is required for the management of patients with ARS.

Upotreba Delerove maske za lice u lečenju malokluzije III klase

Introduction: Different orthodontic appliances like reverse headgear and face masks are recommended for patients in the growing period with skeletal Class III malocclusion characterized by maxillary retrognathism, among moderate to severe cases. For most patients with Class III malocclusion seen in the early mixed dentition or late deciduous dentition, a Delaire face mask is the customary choice. Aim: Taking into account the aforementioned factors, as well as the growing importance of aesthetics in modern society, the main goal of this research was to analyse the relevant aspects of using face masks in the treatment of Class III malocclusion. Adequate literature research was performed to fulfil the main goal. Delaire face mask is commonly used for protraction of the maxilla. Conclusion: Some authors recommend early usage of face masks because they are more efficient in early treatment time and other studies do not show the relationship between the effect of maxillary face mask protraction and treatment timing. The principle of maxillary protraction is to apply tensile force on the circummaxillary sutures and stimulate bone apposition in the suture areas. Most of the authors conclude a positive effect of face mask treatment with significant improvement of skeletal parameters, and no significant difference between expansion/nonexpansion treatments. In conclusion, we can note that the effects of the treatment of Class III malocclusion with face masks largely depend on the knowledge of biological, orthopaedic and clinical aspects of their usage.

Comparing the efficiency of maxillary protraction using digital cooperation monitoring in ages 4–7 and 8–11: a prospective study

Abstract Objectives This study compares the effectiveness of face mask therapy applied after rapid maxillary expansion (RME) in 4- to 11-year-old patients with objective co-operation data collected using thermal sensors. The null hypothesis was that there would be no difference in the effectiveness of the maxillary protraction. Materials and method Initial and post-treatment lateral cephalometric radiographs were taken of patients with maxillary retrognathia, aged between 4 to 7 years (6.1 ± 1.88, n = 13) and 8 to 11 years (9.4 ± 1, n = 12) of age. An RME was performed for at least 10 days. The face mask protraction force was set to 450 g per side, and the recommended usage was 10 hr per day. TheraMon® microsensors were integrated into the face mask. Results The daily usage was significantly higher in the younger age group (8.9 ± 1.8 hr) compared to the older group (7.1 ± 0.9 hr). The SNA angle, A-Nasionperp (mm), ANB angle, Wits (mm), maxillary depth, ANS-Me (mm), the molar relationship (mm) and overjet (mm) significantly increased in both groups. Co-A (mm), the saddle angle, articular angle and UL-E Line (mm) showed a significant increase only in the older group, while the L1-A/Pg decreased significantly. The SNB angle decreased significantly only in the younger group. There was no statistically significant difference in the delta values between the two groups. Conclusion The null hypothesis was partly rejected since no difference was observed in the examined skeletal and soft tissue parameters.

Maxillary Protraction Via Bone Anchorage: A Straightforward Strategy for Complex Dilemmas - An Illustrative Case Report

Class III malocclusion is one of the most challenging malocclusions to treat. Approximately 40 of skeletal Class III malocclusion is caused due to maxillary retrognathism. Various treatment approaches have been mentioned in the literature concerning the management of skeletal Class III malocclusion in growing patients. Conventional treatment for young Class III patients often involves reverse-pull headgear which is extraoral in nature and heavily depends on patient acceptance and compliance. Moreover the limitation of this approach is that the forces are directly applied to teeth resulting in unpredictable skeletal and frequently unwanted dentoalveolar effects which are ultimately prone to relapse. Bone Anchored Maxillary Protraction BAMP employs intra-oral skeletal plates and intermaxillary elastics to bring about true skeletal changes without dentoalveolar side-effect. It is also found to be effective when implemented at a later age. This case report attempts to present the case of a 15 year old female patient with skeletal class III malocclusion who was successfully treated with Bone anchored maxillary protraction

Interim use of Hyrax Screw Assembly for Single-Step Closure of Small Alveolar Cleft before Anterior Maxillary Distraction Osteogenesis

Anterior maxillary distraction osteogenesis (AMDO) is often used for the correction of maxillary retrognathia in select cleft lip and palate cases. The restoration of alveolar arch continuity is desirable before the initiation of AMDO in these cleft maxillary deformities; however, AMDO is technically difficult in a patient with coexisting alveolar cleft where there is a discontinuity of the defect that presents a challenge in terms of adequate vector control of the movement of the anterior segment and the potential risk of tipping of teeth, which already have compromised anchorage/bone support on the cleft side. The treatment becomes more challenging when ongoing management is compounded by failed previous alveolar cleft grafting procedures, along with the patient’s reluctance to undergo further grafting of alveolar clefts. This technical note demonstrates a novel application of the modification of the Hyrax screw where an initially fully opened Hyrax screw was utilised as an interim assembly for accomplishing the single-step closure of a small alveolar cleft before the commencement of anterior maxillary distraction osteogenesis. This technique may prove to be feasible for patients presenting with alveolar cleft defects of smaller widths of up to 5 mm and relatively well-aligned upper arches. Keywords: Distraction Osteogenesis; Cleft Palate; Cleft Alveolar; Maxillary Osteotomy; India.

Self-designed three-dimensional printed skeletal anchorage titanium device for orthopaedic traction in a growing Class III patient

Maxillary retrusion in a growing skeletal class III patient can be treated with growth modification by facemask therapy with skeletal anchorage. A 12-year-old boy presented with Skeletal Class III relationship, retrognathic maxilla and paranasal deficiency. Cone beam computer tomography (CBCT) was taken for the design of the customized skeletal anchorage device with a 3D planning computer software. Two pairs of skeletal anchorage surgical guides and plates were designed with the correct vector and location, and to avoid tooth roots in the fixation. The plates were printed with titanium and fixed onto the patient for the facemask therapy. CAD-CAM technology allows customization and precise execution of the skeletal anchorage for the facemask therapy. Self-designed 3D printed skeletal anchorage device, with the advantages of increased rigidity, ease of placement and accuracy of force application, can be a valid alternative to stock titanium plates.

Comparative evaluation of the forces produced by tongue on circummaxillary sutures in skeletal Class III malocclusion with maxillary hypoplasia using tongue crib with that of facemask therapy - A FEM study

Background: Class III malocclusion has the lowest incidence when compared to other malocclusions. Class III malocclusion can be present in retrognathic maxilla, prognathic mandible or a combination. Various modalities have been used in treatment. Facemask with expansion is an effective appliance used for protraction in case of retrognathic mandible; although it is effective, dentists have to deal with patient compliance. Efforts have been directed to simplify the design of appliance to redirect growth. The finite element method can be used to simulate conditions to check various hypothesis. Methods: A finite element method (FEM) study was performed in two important steps: generation of model and model analysis. A tongue force of 4-6 pounds was applied to cribs (Group I) based on the frequency of swallowing per day (minimum to maximum). In facemask therapy (Group II), a downward force at 30 degrees along with transverse expansion of 1N was applied. Mean values of both sides were considered. Results: Von-Mises stresses in Group I and Group II showed a non-significant difference (p=0.535). Displacement in Group I and Group II showed a significant difference (p=0.0001). Maximum amount of displacement was seen in maxillary dentition on canines and incisors, and minimum stress was seen on posterior teeth in both interventional therapies, even though the Von-Mises stresses generated were different in both groups. Overall displacement in both Group I and Group II was similar. Conclusions: Both modalities were effective in the treatment of Class III malocclusion. The force transmission varied and overall displacement was similar in both modalities, which implies both modalities are effective in treating Class III malocclusion.

Dentofacial effects of miniscrew-anchored maxillary protraction on prepubertal children with maxillary deficiency: a randomized controlled trial

BackgroundThe introduction of bone-anchored maxillary protraction eliminated the side effects of facemask in the early treatment of patients with maxillary retrusion. This study aimed to evaluate the effects of miniscrew-anchored maxillary protraction (MAMP) and compare them with the growth changes in an untreated control group in growing patients with Class III malocclusion.MethodsForty growing patients with Class III malocclusion and retrognathic maxilla were randomly allocated into two groups: treated and control groups. In the treated group, patients were treated with full-time intermaxillary Class III elastics (C3E) anchored by a hybrid hyrax (HH) in the maxilla and a bone-supported bar in the mandible. Protraction was stopped after obtaining a positive overjet. Cephalometric radiographs were acquired before and after the treatment. Data were statistically analyzed on an intention-to-treat basis. Intergroup comparisons were also made using analysis of covariance with the readings at T0 as a covariate.ResultsForty patients agreed to participate, and 30 of them completed the study (treated group, n = 17; control group, n = 13). The average treatment duration was 11.9 months. MAMP resulted in a significant maxillary advancement (A-VR, 4.34 mm) with significant control over the mandibular growth. No significant increase in the mandibular plane angle was found in the treated group compared with the control group. The upper and lower incisors showed significant protrusion in the treated group.ConclusionsWithin the limitations of this study and high attrition rate, the MAMP protocol can effectively increase maxillary forward growth with good control over the growth of the mandible antero-posteriorly and vertically.

Comparative evaluation of dermatoglyphic patterns between skeletal class I and skeletal class III malocclusion.

Background: Dermatoglyphics is the study of various dermal configurations on the fingers, palms, and soles. These appear during the 12th week of intrauterine life and develop completely by the 24th week. It is said that they remain constant thereafter. The aim of the present study was to compare and assess the association of dermatoglyphic patterns between skeletal class I and skeletal class III malocclusion. Methods: Finger and palm prints were collected using the ink and roller method from 604 subjects who were divided into skeletal class I, class III with maxillary retrognathism and class III with mandibular prognathism based on lateral cephalogram assessment. Results: Loop pattern was more predominant in skeletal class I malocclusion subjects and whorl pattern was more frequent in the other two groups. Total finger ridge count and atd angle also showed significant difference between the study groups. Conclusions: The present study attempted in assessing the association between dermatoglyphic patterns and skeletal malocclusion. Analysing dermal configurations may aid in indicating the type of developing malocclusion and thus help in interceptive and preventive orthodontics.

Clinical Evaluation of Modified Technique of Alar Base Cinch Suture to Prevent Widening of Alar Base.

Following Lefort I osteotomy, widening of the alar base is the most common secondary postoperative change resulting in deepening of the alar facial groove, which may be unaesthetic. Therefore, various surgical techniques to control lateralization of the alar base have been widely described in the literature. The purpose of this study was to analyze the cause and to prevent the changes in the nasolabial region, especially excessive widening of the alar base following Lefort I osteotomy by using modified alar base cinch suture. Twenty patients with the diagnosis of maxillary retrognathism or vertical maxillary excess requiring Lefort I osteotomy with superior repositioning or advancement were included in this prospective, non-randomized clinical study. Following Lefort I osteotomy, the widening of alar base was managed using modified alar base cinch suture. The mean alar width preoperatively was 41.09 ± .38mm, intra-operatively it was 43.69 ± .28mm, and after 6months, it was 41.93 ± .47mm. Statistical analysis using paired t test revealed that there was a significant change in alar width after placing alar base cinch suture. The results of the current study show that the modified alar cinch suture technique is effective in preventing flaring of the alar base in case of Lefort I osteotomies with superior repositioning or advancement.

Face Mask Protocol in An İndividual with Skeletal Class III in Malocclusion: A Case Report

In this case presentation, it was aimed to treat a male patient aged 12 years and 1 month with Skeletal Class III anomaly characterized by maxillary retrognathia and achieve Skeletal Class I bite without the need for future orthognathic sur- gical procedures. In order to easily bypass the anterior crossbite of the patient, an intraoral clear plate to increase the occlusion was used. In order to rectify the maxillary retrognathia, a petit-type face mask was used for 8 weeks. With the application of the face mask, a successful treatment was achieved. Significant corrections were achieved in the skeletal, dental and soft tissue values of the patient.

Comparison study of the Le Fort I osteotomy using 2- and 4-plate fixation.

This study was conducted to evaluate the postsurgical stability of Le Fort I osteotomy using zygomatic buttress internal fixation alone with no piriform aperture internal fixation. Patients with maxillary retrognathia and mandibular prognathism underwent the Le Fort I osteotomy with a bilateral sagittal split ramus osteotomy. In group I, fixation was accomplished using titanium plate and screws placed at the piriform aperture and the zygomatic buttress (4 plates). In group II, fixation was accomplished using titanium plate and screws placed at the zygomatic buttress (2 plates). Lateral cephalometric radiographs were taken preoperatively (T1), immediately after surgery (T2), and at 6 months to 1 year (T3) to evaluate skeletal movement. In total, 32 patients were included in this study. None of the patients had wound infection, dehiscence, bone fragment instability, and long-term malocclusion. Regarding point A and the posterior nasal spine (PNS), vertical and horizontal relapse in groups I and II did not differ significantly. In most hospitals, the maxilla was fixed using four plates (piriform aperture and zygomatic buttress); however, within the limitations of the study, the choice of the number of plates for osteosynthesis following Le Fort I osteotomy and repositioning of the maxilla can be left to the discretion of the surgeon without putting the patients at risk for increased relapse by careful intraoperative management.

Craniofacial and dental features of Axenfeld-Rieger syndrome patients with PITX2 mutations.

We aimed to characterize the genetic basis and craniofacial and dental features of Finnish patients with Axenfeld-Rieger syndrome (ARS). Mutational analyses of seven patients in five families were performed by sequencing or comparative genomic hybridization. Phenotypic analysis was based on both clinical and radiographic examinations, as well as on medical data. Lateral cephalometric radiographs of five patients were analysed using Viewbox 3.1-Cephalometric Software. The cephalometric values were compared to Finnish population-standard values of the same age and gender. Two frameshift mutations and three whole gene deletions were detected in five families. Class III skeletal relationship with retrognathic maxilla and mildly retrognathic mandible were detected in all five patients studied. Significant differences compared with the control values were in SNA (P=.0014), ANB (P=.0043) and SNB angles (P=.013). Five patients had anterior crossbite. Six patients showed tooth agenesis. The average number of missing teeth (third molars excluded) was 9 (range 0-15). The tooth agenesis rate was 52% in maxilla and 26% in mandible. Maxillary central and lateral permanent incisors were most often missing (rate 71% equally) while no one lacked canines or first molars in mandible. Two patients had a supernumerary mandibular permanent incisor. Six patients had either taurodontic and/or single-rooted molars. Our results suggest that class III skeletal relationship with maxillary and mandibular retrognathism, anterior crossbite, maxillary incisor agenesis and taurodontic, even pyramidal, roots are common determinants of ARS caused by PITX2 mutations.

Correction of the class III skeletal base with different mechanics: Three-year follow-up

Class III malocclusion worsens with age, necessitating early orthopaedic therapy to restore facial equilibrium and regulate maxillofacial growth and development. A 12-year-old prepubertal male with a Class III skeletal base, anterior crossbite, retrognathic maxilla, and prognathic mandible is described in this report. To treat the anteroposterior plane and improve the profile, the ALT-RAMAC approach was used with reverse pull headgear. Following that, fixed mechanotherapy was used to get the desired effects. After that, the patient was monitored for another three years.

What to Expect of Feeding Abilities and Nutritional Aspects in Achondroplasia Patients: A Narrative Review.

Achondroplasia is an autosomal dominant genetic disease representing the most common form of human skeletal dysplasia: almost all individuals with achondroplasia have identifiable mutations in the fibroblast growth factor receptor type 3 (FGFR3) gene. The cardinal features of this condition and its inheritance have been well-established, but the occurrence of feeding and nutritional complications has received little prominence. In infancy, the presence of floppiness and neurological injury due to foramen magnum stenosis may impair the feeding function of a newborn with achondroplasia. Along with growth, the optimal development of feeding skills may be affected by variable interactions between midface hypoplasia, sleep apnea disturbance, and structural anomalies. Anterior open bite, prognathic mandible, retrognathic maxilla, and relative macroglossia may adversely impact masticatory and respiratory functions. Independence during mealtimes in achondroplasia is usually achieved later than peers. Early supervision of nutritional intake should proceed into adolescence and adulthood because of the increased risk of obesity and respiratory problems and their resulting sequelae. Due to the multisystem involvement, oral motor dysfunction, nutrition, and gastrointestinal issues require special attention and personalized management to facilitate optimal outcomes, especially because of the novel therapeutic options in achondroplasia, which could alter the progression of this rare disease.

Comparative evaluation of dermatoglyphic patterns between skeletal class I and skeletal class III malocclusion

Background: Dermatoglyphics is the study of various dermal configurations on the fingers, palms, and soles. These appear during the 12th week of intrauterine life and develop completely by the 24th week. It is said that they remain constant thereafter. The aim of the present study was to compare and assess the association of dermatoglyphic patterns between skeletal class I and skeletal class III malocclusion. Methods: Finger and palm prints were collected using the ink and roller method from 604 subjects who were divided into skeletal class I, class III with maxillary retrognathism and class III with mandibular prognathism based on lateral cephalogram assessment. Results: Loop pattern was more predominant in skeletal class I malocclusion subjects and whorl pattern was more frequent in the other two groups. Total finger ridge count and atd angle also showed significant difference between the study groups. Conclusions: The present study attempted in assessing the association between dermatoglyphic patterns and skeletal malocclusion. Analysing dermal configurations may aid in indicating the type of developing malocclusion and thus help in interceptive and preventive orthodontics.