Mean ANB Research Articles

Establishing H Angle Hard Tissue and H Angle Soft Tissue Norms in Skeletal Class I Malay Adult Females and the Correlation between the H Angles and Visual Perception of Laypersons.

This study aimed to establish the cephalometric norms of H angle soft tissue and H angle hard tissue of Malaysian Malay adult females, and to evaluate the correlation between H angles and visual perception in skeletal Class I Malay adult females. Eighty-five lateral cephalograms of skeletal Class I (mean ANB value = 3.15 ± 0.77) Malaysian Malay female patients aged 20 to 40 years (mean age = 28.6 ± 5.86 degrees) taken from October 2017 to December 2021 were measured for H angle soft tissue and H angle hard tissue. Twenty silhouettes were then converted from cephalometric films and were rated according to facial convexity/concavity by 20 laypersons, with re-evaluation after 2 weeks for intra- and interexaminer reliabilities. The means of the H angle soft tissue and H angle hard tissue were 15.75 ± 4.16 degrees and 11.64 ± 4.71 degrees, respectively. The intraexaminer reliability test for visual perception ranged from -0.89 to 0.99 indicating poor to excellent reliability, whereas the interexaminer reliability test was 0.82 indicating good reliability. A highly statistically significant association between the H angle soft tissue and H angle hard tissue (r = 0.938; p < 0.01) was found. There was no correlation between H angles and visual perception. The cephalometric norms of H angle hard tissue and H angle soft tissue in the Malaysian Malay female population were established: 11.64 degrees (±4.71 degrees) and 15.75 degrees (±4.16 degrees), respectively. There was a strong correlation between H angle soft tissue and H angle hard tissue among skeletal Class I Malay adult females. There was no correlation between H angles and the visual perception of laypersons.

A retrospective investigation of orthognathic patients and functional needs

Abstract Purpose The present study aimed to explore the malocclusion trends, sagittal skeletal discrepancies, and the index of orthognathic functional treatment need (IOFTN) scores in a sample of Iranian and Turkish orthognathic patients. Methods Four hundred and three orthognathic patients were retrospectively examined (203 Iranian/200 Turkish, 229 females/174 males, aged between 16 and 50 years). The following variables were recorded: malocclusion type (incisor-based), overjet, sagittal skeletal relationship (ANB angle) and IOFTN scores. The sagittal skeletal relationships and malocclusion patterns of the orthognathic patients were statistically examined using Chi-square tests and further explored graphically. The relationship between the IOFTN scores and overjet, as well as the sagittal skeletal discrepancies (ANB angle) was evaluated using box plots and at the 95% confidence interval (CI) in different IOFTN treatment categories (1–3,4,5). The characteristics of a subgroup sample of orthognathic patients and previous studies that identified with low IOFTN scores (1–3) were also explored. Results Class III malocclusions and Class III skeletal patterns were the most prevalent (62.3%), forming 69% and 55.7% of the Turkish and Iranian samples, respectively. Turkish and Iranian samples had more Class III [Mean (SD) ANB angle = -1.24° (4.75°)] and Class II cases [Mean (SD) ANB angle=1.06° (5.63°)], respectively. The mean overjet and reverse overjet for Class II and III malocclusions were 6.96 mm (95% CI, 6.40–7.53 mm) and 3.26 mm (95% CI, 2.87–3.65 mm), respectively. The mean ANB angle for Class II and III malocclusions was 6.64° (95% CI, 6.15°–7.13°) and -3.57° (95% CI, -3.92° to -3.21°), respectively. IOFTN scores of 4 or 5 were identified in 93.8% of the sample. Patients with low IOFTN scores (&lt;4) presented with a nearly normal overjet (mean = 3.19 mm, 95% CI, 2.62-3.76 mm, range = 1–5 mm), accompanied by a wide range of ANB angles [mean (SD)=3.44° (3.86°), range = -4° to 9°] Conclusions The findings at the 95% CI for overjet and the ANB angle can be used as identifiers for patients who would benefit from orthognathic surgery. Analysing patients with a low IOFTN score, particularly with scores of 3.3, 3.10, 2.8, and 1.14, revealed that IOFTN could be used in conjunction with a clinical examination plus diagnostic imaging to facilitate the identification of orthognathic surgery patients.

Comparison of the skeletodental effects of miniscrew-anchored and tooth-anchored facemask treatment in growing patients with skeletal class III malocclusions.

This retrospective study aimed to evaluate the skeletal and dental effects of the miniscrew-anchored facemask in skeletal Class III growing patients and compare them with those of conventional tooth-anchored facemasks. Retrospectively a total of 50 patients with skeletal Class III (mean ANB: -1.12°) were investigated and divided into two groups according to the treatment modality. Twenty-five patients were treated using the conventional tooth-anchored facemask (T group: mean age 9.3 ± 1.1 years, mean ANB: -0.93°) whereas the other 25 were treated using a miniscrew-anchored facemask (M group: mean age 9.7 ± 1.3 years. mean ANB: -1.61°). Two miniscrews were placed on the palate for bone anchorage. In both T and M groups, facemasks applied a force of 20-30° down on the occlusal plane, and the force increased from 200 g to 300-350 g per side throughout the treatments. The patients were instructed to wear facemasks for at least 14 h per day. A total of 16 angular and 11 linear cephalometric measurements were analysed to determine the skeletal and dental changes before and after facemask treatment. A paired t-test was used to verify the effects before and after treatment in each group. All miniscrews were well maintained during treatment. The values of SNA, SN-ANS, ANB and A to N-Perp, which indicate anterior protraction of the maxilla, were significantly higher in the M group compared with the T group (P < .05). Proclination of the maxillary incisors, extrusion and mesialization of the maxillary molars were significantly greater in the T group (P < .05). Miniscrew-anchored facemask treatment increased the amount of maxillary protraction and reduced the dental side effects compared with conventional tooth-anchored facemask treatment in growing patients with skeletal Class III malocclusion.

Long-term stability after high-pull headgear combined with fixed appliances: A retrospective cohort study of growing class II patients

High-pull headgear with fixed appliances is a common therapeutic plan in class II growing individuals, especially in those with a tendency to hyperdivergence. The stability of this approach has not been adequately assessed in the long-term. The aim of this retrospective study was to assess that long-term stability by means of lateral cephalograms. Seventy-four consecutive patients were included and examined at three time-points: pre-treatment (T1), end of treatment (T2), and at least five years post-treatment (T3). The average initial age of the sample was 9.3 years (standard deviation, SD: 1.6). At T1, the mean ANB was 5.1 degrees (SD: 1.6), the mean SN-PP 5.6 (SD: 3.0) and the mean MP-PP 28.7 degrees (SD: 4.0). The median follow-up time was 8.6 years with an interquartile range of 2.7. A statistically significant, but of small magnitude increase in the SNA angle was noted at T3 compared to T2 after adjusting for the pre-treatment SNA value (mean difference (MD): 0.75; 95% CI: 0.34, 1.15; P<0.001). The inclination of the palatal plane appeared stable in the post-treatment period, while the MP-PP angle showed scarce evidence of decrease during the post-treatment period after adjusting for sex, pre-treatment SNA and SN-PP angles (MD: -2.29; 95% CI: -2.85, -1.74; P<0.001). The sagittal position of the maxilla and the inclination of the palatal plane appeared to be stable after treatment with high-pull headgear and fixed appliances in the long-term. Continuous mandibular growth, both sagittaly and vertically, contributed to the stability of class II correction.

Assessment of condylar positional changes in severe skeletal class II malocclusion after surgical-orthodontic treatment.

This study aimed to determine the positional changes in the condyle in the temporomandibular joint (TMJ) of severe skeletal class II malocclusion patients treated with surgical-orthodontics. The measurements of TMJ space in 97 severe skeletal class II malocclusion patients (20 males, 77 females, mean age, 24.8 years, mean ANB = 7.41°) were assessed using limited cone-beam computed tomography (LCBCT) images acquired before orthodontics (T0) and 12 months after surgery (T1). 3D remodeling of the TMJ and measurements of the anterior space (AS), superior space (SS), and posterior space (PS) were performed to determine the position of the condyle for each joint. All data were analyzed by t test, correlation analysis, and Pearson correlation coefficient. The mean AS, SS, and PS values after the therapy changed from 1.684 to 1.680 mm (0.24%), 3.086 to 2.748 mm (10.968%), and 2.873 to 2.155 mm (24.985%), respectively. The decreases in SS and PS were statistically significant. Positive correlations were found in the mean AS, SS, and PS values between the right and left sides. The combination of orthodontic and surgical treatment makes the condyle move counterclockwise in the TMJ in severe skeletal class II patients. Studies of temporomandibular joint (TMJ) intervals changes in patients with severe skeletal class II after sagittal split ramus osteotomy (SSRO) are limited. The postoperative joint remodeling, resorption, and related complications remain unstudied.

Orofacial anatomical and occlusal changes in patients with sickle cell disease in Kuwait

ObjectiveSickle cell disease (SCD) is the most common hemoglobinopathy where morphologic changes to red blood cells affect the development of hard and soft tissues. The purpose of this study is to identify the craniofacial characteristics and maxillomandibular relationship in SCD patients and compare with unaffected subjects, through cephalometric radiographic assessment. Materials and MethodsThe study included 44 Kuwaiti SCD patients (20 female, 24 male) as well as 44 age and gender matched controls. Digital lateral cephalometric, radiographs were recorded. SNA and ANB angles were measured and compared. ResultsThe mean SNA angle was found to be higher among the SCD cases (83.00 ± 3.22) than in controls (81.78 ± 4.58), but the difference was not statistically significant, (p = 0.146). The mean ANB angle in SCD cases (5.27 ± 2.36) was significantly higher, than that in controls (3.97 ± 2.23). The difference in means was statistically significant, (p = 0.01). Almost 50% of the SCD patients had class II malocclusion and 61.5% of the patients had prognathic maxilla. ConclusionsPatients with SCD in Kuwait exhibited characteristics of skeletal class II pattern malocclusion. They also showed evidence of compensatory maxillary expansion.

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.

Cephalometric Assessment of Pharyngeal Airway Dimensions in Sagittal and Vertical Growth Patterns

Setting: Determination of patency of airway in sagittal and vertical growth patterns in patients visiting LUMHS Institute of Dentistry, Jamshoro. Methods: This cross-sectional study took place in the Orthodontic Department, Institute of Dentistry, LUMHS Jamshoro. Patients in the age group of 12 to 28 years were included. All subjects were categorized into two groups: Group 1 consists of patients with vertical growth, and Group 2 consists of patients with horizontal growth. Measurements were done by McNamara analysis; the skeletal type was analyzed using ANB, FMA, and SN-GOGN measurements were plotted on the Y-axis, measuring the angle between the S-N plane and sella-gnathion. Results: A total of 62 patients were studied; their mean age was 20.74+3.36 years. The majority were females 77.4% and males 22.6%. two groups were made according to growth patterns, group 1 consisted of vertical growers and group 2 was of horizontal grower patients. 37.1% of patients were found to have an obstructive lower pharyngeal airway. Mean ANB, FMA, Y-Axis, SN-GOGN, upper pharyngeal airway, and lower pharyngeal airway was 5.42±3.52 degree, 27.90±7.93 degree, 66.31±6.56 degree, 34.24±7.95 degree, 14.5±2.24 mm and 9.2±2.04mm respectively. The results show a positive and negligible correlation between ANB and pharyngeal airways. Conclusion: There was a positive and negligible correlation between sagittal growth patterns and pharyngeal airway, with class II cases having obstructive pharyngeal airway and class III cases having patent pharyngeal airway. Keywords: Patency of Airway, Sagittal, Skeletal Discrepancies, Vertical

Early Secondary Alveolar Bone Grafting and Facial Growth of Patients with Complete Unilateral Cleft Lip and Palate.

To investigate the craniofacial growth outcomes of early secondary alveolar bone grafting(ABG) around 6 years of age. Retrospective cohort study. 1 North-American and 5 Northern-European cleft centers. 33 subjects with CUCLP consecutively treated with secondary ABG around 6 years of age were compared to 105 subjects from 4 centers treated with late secondary ABG and 19 subjects from 1 center with primary ABG. Preorthodontic standardized lateral cephalometric radiographs taken after 12 years of age were traced and analyzed according to the Eurocleft Study protocol. Fourteen angular and two proportional measurements were performed. Measurement means from the Study Center(SC) were compared to 5 Northern-European centers using analysis of variance and Welch's modified t-tests, and P < .05 was considered statistically significant. For the SC, the mean age ± SD at the time of bone graft was 5.85 ± 0.71 years and the mean age at the time of the lateral cephalogram was 13.4 ± 1.8 years. The sagittal maxillary prominence of the SC was favorably comparable to the 5 Northern-European centers. The mean SNA (78.1 ± 4.3) for the SC was significantly higher compared to 4 of the 5 Northern-European centers(all P < .05), and the mean ANB angle was comparable to 4 of the 5 centers. Similarly, the mean soft tissue ANB angle was not significantly different to the 5 centers. The soft tissue vertical proportions compared favorably to all 5 Northern-European centers(all P < .01). Craniofacial growth outcomes of early secondary ABG around 6 years compare favorably to the outcomes of late secondary ABG.

Lower Incisor Positions in Different Malocclusions and Facial Pattern

Aims: The position of lower incisor has been of significant concern when seeking orthodontic treatment plan, it has been recognized as one of diagnostic key and play an important in the development of normal occlusion and facial pattern. This study was aimed at the determination of lower incisor position and its possible association with different sagittal malocclusions and facial patterns.&#x0D; Study Design: Descriptive Cross-sectional Study&#x0D; Place and Duration of Study: Department of Orthodontics Institute of Dentistry Liaquat University Medical and Health Sciences (LUMHS) Jamshoro between June 2019 to July 2020.&#x0D; Methodology: Ninety-seven pre-treatment lateral cephalometric radiographies were taken, and they were classified sagittally into skeletal class I, II and III, and vertically into normodivergent, hyperdivergent and hypodivergent facial pattern using ANB and SNMP, respectively. Lower incisor position was assessed by means of FMIA and IMPA. One way analysis of variance (ANOVA) was applied to check any association between lower incisor position and sagittal malocclusion and facial pattern. P value of 0.05 was considered statistically significant.&#x0D; Results: The study sample consisted of 97 patients. The mean age of the patients was 25.55 SD ±3.93. The mean SNMP value was 28.84 SD ±7.354 and mean ANB value 4.809 SD ±3.85. Mean Incisor position based on IMPA was 98.598 SD ± 9.413 and FMIA 54 SD ±9.995. Intra and interobserver reliability was assessed with intraclass correlation coefficient values ranging between 0.825 and 0.990 respectively. The ANOVA test results showed significant relationship between the sagittal malocclusion and incisor position with P value .036. The Bonferroni analysis indicated that statistically significant association existed in term of lower incisor position between Class II and Class III malocclusion with P value .047. Test results further indicated that there is no significant difference in the position of lower incisor in relation to facial pattern with P value .355.&#x0D; Conclusions: Statistically significant association was found between lower incisor position with respect to the sagittal malocclusion. However, no significant association was found between facial pattern and lower incisor position.

Pre and post orthodontic treatment changes in the sagittal and vertical skeletal dimension following all four first premolar extractions.

Objectives: To determine mean change in sagittal and vertical skeletal dimension in patients undergoing orthodontic treatment with all four first premolar extractions. Study Design: Quasi-experimental study design. Setting: Department of Orthodontics, Dr. Ishrat-Ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi. Period: Six months from 18th August 2015 to 18th February 2016. Material &amp; Methods: 50 cases treated with all first premolar extractions were included in this study. The analysis was done on pretreatment cephalogram taken at time of enrolment and post treatment lateral cephalogram taken after 12 months of orthodontic treatment and then their measurements were compared to find out changes in the sagittal and vertical dimension. Results: Pre and post mean SNA, SNB, ANB and Pog-Nperp was not significant while mean A-Nperp was significantly changed after 12 month treatment (p=0.002). Regarding angular measurement, pre and post mean SNMP, FHMP, MMA, Go-OP, SN-OP, Y axis was not significant while mean SN-PP, UI_SN, IMPA was significantly reduced after 12 month treatment. Similarly vertical measurement, pre and post mean LAFH, PFH was not significant while mean UAFH and, TAFH was significantly reduced after 12 months of treatment. Conclusion: Sagittal and vertical skeletal dimension showed no significant change in patients undergoing orthodontic treatment with all four first premolar extractions. Some degree of extrusion was noted in all orthodontic patients who have undergone all four first premolar extractions.

Effect of Class II camouflage treatment on anterior arch length ratio and canine relationship

To evaluate the influence of compensatory tipping of maxillary and mandibular incisors on the anterior arch length ratio and canine relationship in skeletal Class II malocclusion. The study was based on posttreatment lateral head films and dental casts of 88 patients. The sample was divided into a Class II malocclusion group (32 patients; ANB ≥5° and mean [± standard deviation] age, 20.82±7.67years) and a Class I malocclusion group (56 patients; 1°≤ANB≤2.5° and mean [± standard deviation] age, 19.20±5.04years). Measurements obtained for anterior arch length and width, Bolton discrepancy, canine relationship, growth pattern, and incisor position were compared between the groups. The canine relationship was correlated with dental and skeletal variables (P<0.05). The mean ANB angles were 6.21° and 1.78° for the Class II and Class I malocclusion groups, respectively. The skeletal Class II group presented significantly larger mandibular anterior arch length, producing an unbalanced anterior arch length ratio. The canine relationship was more displaced toward Class II in this group. Anterior arch length ratio was the most influential variable in the canine relationship. The mandibular incisors had a higher compensation degree than the maxillary incisors. The groups were similar regarding overjet, overbite, and growth pattern. Class II malocclusion camouflage treatment with excessive proclination of the mandibular incisors was associated with an increase in mandibular arch length, negatively influencing the anterior arch length ratio and the final canine relationship. Mandibular anterior arch length reduction by interproximal stripping may be necessary in moderate to severe skeletal Class II malocclusion orthodontic treatment.

Assessment of Orthodontic Treatment Outcomes in Maxillary Protrusion Enhanced by Guided Piezoelectric Corticotomy with Bone Graft (Comparative study)

Purpose: This study aimed to compare orthodontic treatment outcomes in maxillary protrusion enhanced by piezoelectric Corticotomy with and without bone graft guided by 3D surgical template. Subjects and Methods: sample of 20 patients with age range (18-25) year-old allocated randomly into 2 groups, Group I: patients were treated with piezocision corticotomy without bone graft guided by surgical template. Group II: patients were treated with piezocision corticotomy with bone graft guided by surgical template. Treatment changes were evaluated for each group and compared between groups. Data were analyzed using Paired t-test for each group and Student t-test to compare between the two groups. Results: There was a significant decrease in mean SNA, ANB, H angles, SN-U1, MP-L1, overjet measurements and significant increase in mean interincisal and nasolabial angles for both groups. While there was a non-significant difference between mean differences in skeletal, dental and soft tissue measurements between the two groups (p < 0.05). Both groups revealed decrease in the mean en masse retraction time. Conclusion: Maxillary protrusion cases treated with piezoelectric corticotomy revealed improvements in profile, esthetics and acceleration in orthodontic tooth movement.

Comparison of Profile Attractiveness between Class III Orthodontic Camouflage and Predictive Tracing of Orthognathic Surgery.

Objective The aim of this study was to compare the profile attractiveness between orthodontic camouflage of the Class III malocclusion and the predictive tracing simulating orthognathic surgery evaluated by dentists and laypeople. Settings and sample population. The sample consisted of 21 patients (9 male; 12 female) with Class III malocclusion treated with orthodontic camouflage and Class III intermaxillary elastics. Material and Methods. The mean initial age of the patients was 24.38 years (SD 3.32), and the mean ANB angle was −1.91° (SD 0.83°). Patients presented skeletal Class III and normal growth patterns. Initial and final lateral cephalograms of each patient were used. The initial cephalogram was used to perform the treatment simulation of orthognathic surgery, and its silhouette was compared to the silhouette obtained from the final cephalogram after Class III orthodontic camouflage. A subjective analysis of profile attractiveness was performed by 47 laypeople and 60 dentists, with scores from 1 (less attractive) to 10 (most attractive). Mann–Whitney tests were used to compare profile attractiveness between the orthodontic treatment and the predictive tracing groups and between dentists and laypeople. Results The predictive tracing of orthognathic surgery showed to be statistically significantly more attractive (mean score 4.57, SD 2.47) than that of the Class III camouflage orthodontic treatment (mean score 4.22, SD 2.40), with a mean numerical but significant difference of 0.35 (SD 2.01) (P < 0.001). Laypeople were more critical than dentists in evaluating profile attractiveness, but numerical difference between the groups was also small. Conclusion The profile silhouette of predictive tracing simulating orthognathic surgery showed to be more attractive than that of Class III camouflage orthodontic treatment; however, differences were small but statistically significant. Laypeople showed to be more critical than dentists.

Comparison of treatment effects of different maxillary protraction methods in skeletal class III patients.

The aim of this study was to compare treatment outcomes with different maxillary protraction methods in patients with skeletal Class III malocclusion resulting from maxillary retrognathia. A total of 55 individuals consisting of 29 females and 26 males with a mean age of 11.4±1.06years were included in this study. Fifty-five treated maxillary retrognathic patients who underwent different protraction facemask methods were evaluated. Eighteen patients treated with RME were in the first group, and 19 patients treated with a modified Alt-RAMEC protocol were in the second group; eighteen patients on whom face masks with miniplates were applied were included in the skeletal anchorage (SA) group. Thirty measurements were made on lateral cephalometric radiographs before and after treatment. Differences between the groups were assessed with the ANOVA test. The mean age was higher in the SA group (11.96±0.92years) compared with the other groups. The mean ANB angle increased by 2.96°, 4.91° and 3.86° in the RME, Alt-RAMEC and SA groups, respectively. The forward movement of the maxilla was similar between the groups. However, while the rate of protraction was higher in the modified Alt-RAMEC group, a greater skeletal effect was found in the SA group. The most effective method in terms of skeletal effect is the application of the face mask with skeletal anchorage; the modified Alt-RAMEC protocol can be applied before face mask to obtain faster protraction.

Skeletal growth in class II malocclusion from childhood to adolescence: does the profile straighten?

BackgroundThere is relatively little appreciation of the changes in maxillary-mandibular relationships occurring during adolescence among subjects with normal and increased overjet. The aim of this study was to assess differences in changes in maxillo-mandibular relationships during the adolescent growth period based on the presence of a normal (< 4 mm) or increased (> 4 mm) overjet in childhood. Our hypothesis was that there is no difference in the change of the A point, nasion, B point (ANB) angle during growth between these two overjet groups. Lateral cephalograms were obtained from 65 subjects taken from the American Association of Orthodontists Foundation (AAOF) Craniofacial Growth Legacy Collections Project. Cephalograms were obtained at ages 7–10 (T0) and 14–17 (T1) with allocation into two groups based on baseline overjet (> 4 mm: group 1, 2-4 mm: group 2). Random effects linear regression was used to account for multiple within -patient measurements with dependent variables including antero-posterior skeletal pattern (based on sella, nasion, A point (SNA); sella, nasion, B point (SNB); and ANB angles).ResultsWe included a similar number of males (n = 34; 52.3%) and females (n = 31; 47.7%). The mean ANB was higher at baseline in group 1 (5.42, SD 2.16°) than in group 2 (3.08, SD 1.91°). The hypothesis was rejected as the ANB angle reduced by 1.92° more in the larger overjet group with the association being statistically significant after accounting for age and gender (P < 0.001; 95% CI 1.06 to 2.77). No significant gender-related effect (P = 0.624; 95% CI − 0.637 to 1.07) was observed overall. However, there was no significant increase in SNA angle in the > 4 mm overjet group compared to the 2–4 mm group (0.857°, P = 0.271; 95% CI − 0.669 to 2.383). The SNB angle increased by 1.15° more in the higher overjet group but there was only weak evidence of an association (P = 0.086; 95% CI − 2.464 to 0.164).ConclusionsA slight straightening of the facial profile was observed in both groups with a statistically significant greater reduction in ANB arising in the group with larger baseline overjet. This translated into a marginal reduction in the overjet in this group.

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: maxillary growth at eight years of age.

To assess differences in craniofacial growth at 8 years of age according to the different protocols for primary cleft surgery in the Scandcleft project. Prospective, randomized, controlled clinical trial (RCT) involving 10 centres, including non-syndromic Caucasians with unilateral cleft lip and palate (UCLP). In Trial 1, a common surgical method (1a) with soft palate closure at 3-4 months of age and hard palate closure at 12 months of age was tested against similar surgery but with hard palate repair at 36 months (delayed hard palate closure) (1b). In Trial 2, the common method (2a) was tested against simultaneous closure of both hard and soft palate at 1 year (2c). In Trial 3, the common method (3a) was tested against hard palate closure together with lip closure at 3 months of age and soft palate closure at 1 year of age (3d). Participants were randomly allocated by use of a dice. Operator blinding was not possible but all raters of all outcomes were blinded. The total number of participating patients at 8 years of age was 429. Lateral cephalograms (n = 408) were analysed. The cephalometric angles SNA and ANB were chosen for assessing maxillary growth for this part of the presentation. Within each trial (Trial 1a/1b, Trial 2a/2c, and Trial 3a/3d), there was no difference in cephalometric values between the common and the local arm. There were no statistically significant differences in the SNA and ANB angles between the common arm in Trial 1a (mean SNA 77.8, mean ANB 2.6) and Trial 2a (mean SNA 79.8, mean ANB 3.6) and no difference between Trial 1a and Trial 3a, but a statistical difference could be seen between Trial 2a and Trial 3a (mean SNA 76.9, mean ANB 1.7). However, the confidence interval was rather large. Intra- and inter-rater reliability were within acceptable range. The timing and the surgical method is not of major importance as far as growth outcomes (SNA and ANB) in UCLP are concerned. ISRCTN29932826. The protocol was not published before trial commencement.

Palatally displaced maxillary lateral incisors maybe a causative factor of mandibular deficiency

Introduction: Several factors play a role in the etiology of skeletal Class II malocclusion. Displaced maxillary incisors might have a hindering effect on mandibular growth potential. Aim of the study: The aim of this cross-sectional study was to evaluate the influence of palatally displaced maxillary incisors on mandibular growth in a group of Egyptian patients. Subjects and Methods: The sample consisted of the digital lateral cephalometric radiographs of untreated 24 patients (12 females and 12 males) with age range of 15-30 years and a mean age of 22.4 years during the permanent dentition stage. The radiographs were selected from the patient database of private practice in Cairo. The sample was divided into 2 groups each consisting of 12 patients. Group A had palatally displaced maxillary lateral incisors without crossbite. Group B had palatally displaced maxillary lateral incisors with crossbite. Linear and angular cephalometric measurements (ANB & Witts appraisal) were used to assess the anteroposterior skeletal malocclusion and the position of the apical bases of the jaws in both groups. Independent samples t-test was performed to compare the results between the two groups. Results: Cephalometric measurements revealed statistically significant differences between groups A and B showing a mild skeletal Class II malocclusion with a retrognathic mandible in Group A (mean ANB = 4.4˚ ± 1.85), (mean Witts= 1.85 mm ± 3.22) while Group B had skeletal Class I pattern with mild skeletal Class III tendency (mean ANB= 0.8˚± 1.88), (mean Witts=-2.5mm ± 2.33). Conclusions: Palatally displaced maxillary lateral incisors without crossbite cause restraining effect on normal mandibular growth which results in mild skeletal Class II with mandibular deficiency. However, palatally displaced maxillary lateral incisors that are in crossbite have no restraining effect on mandibular growth which results in normal to slightly excessive mandibular growth. This can be used as a tool for early prediction of mandibular growth pattern that necessitates immediate intervention.

Evaluation of skeletally anchored therapy using miniplates and micro-implants in skeletal Class III treatment

Abstract Background/aim To compare the outcomes of skeletally-anchored (SA) or face mask (FM) therapy in the management of patients presenting with maxillary retrognathia. Methods Forty-four consecutively treated maxillary retrognathic patients who underwent SA or FM therapies followed by fixed orthodontics were evaluated. Two micro-implants between the maxillary first molar and the second premolar and two mandibular miniplates were inserted to facilitate the use of Class III elastics in the SA group (23 patients). Facemasks with full occlusal-coverage acrylic appliances were applied in the FM group (21 patients). Lateral cephalometric radiographs obtained before treatment (T0), after orthopaedic treatment (T1), and after fixed orthodontic treatment (T2) were traced and 31 measurements compared. Results No statistically significant differences were found between the groups related to treatment duration and gender distribution. The mean age was significantly higher in the SA group (11.70±0.25 years) compared with the FM group (10.57±0.35 years) at T0. The mean ANB angle increased by 3.34° and 3.15° and the mean Wits value reduced by 6.16 mm and 4.13 mm in the FM and SA groups, respectively. Forward movement of the maxilla was similar between the groups. The vertical plane angle increased in both groups following maxillary protraction. However, it decreased in the SA group during fixed orthodontic therapy, which was contrary to what occurred in the FM group. The lower incisors were retracted/retroclined in the FM group and protracted/proclined in the SA group. Conclusions/implications Maxillary protraction was achieved in both groups and was maintained during fixed orthodontic therapy. Undesired lower incisor retraction and an increase of the vertical plane angle encountered with FM therapy were minimised by SA therapy.

Comparison and Evaluation of Alveolar Bone Around Lower Central Incisors in Class III and Class I Patients

Objectives: The aim was to compare the alveolar bone support of mandibular central incisors in subjects with Class III and Class I skeletal patterns using cone-beam computed tomography (CBCT). Materials and Methods: Group 1 included 20 patients (mean age=19.78±2.80) with Class III malocclusion (mean ANB°=-2.77±3.69), mesofacial growth pattern (FMA°=27.03 ±5.11) and lingual-inclined mandibular incisors (IMPA°&amp;lt;85). Group 2 included 20 patients (mean age=20.85±3.97) with Class I malocclusion (mean ANB°=2.94 ±1.46), mesofacial growth pattern (FMA°=25.67±6.83) and normal inclined mandibular incisors (85&amp;lt;IMPA°&amp;lt;95). Vertical alveolar bone level and alveolar bone thickness (ABT) of total 80 mandibular central incisors (40 from each group) were evaluated. Buccal, lingual and total ABT were measured at the crestal, midroot, and apical levels. Buccal (BACH) and lingual (LACH) alveolar crestal heights were also evaluated. Mann-Whitney U, independent samples-t-tests, and Spearman’s rank correlation analysis were applied for statistical analysis. Results: The lingual ABT at the crestal and midroot level, buccal ABT at the apical level, and total ABT at all levels were significantly lower in Group 1 than Group 2 (p&amp;lt;0.05). There was a negative correlation between the buccal (r=-0.324; p=0.042) ABT at the apical level and mandibular plane angle. The change in mandibular incisor inclination was positively correlated with buccal ABT at the apical level (r=0.463; p=0.003) and lingual ABT at the crestal level (r=0.550;p&amp;lt;0.001). BACH was significantly higher in Group 1 (2.21±1.48 mm) compared to Group 2 (1.42±0.17 mm) (p &amp;lt; 0.05). Conclusions: In subjects with Class III deformities, mandibular central incisors have less bone support especially at the buccal side of the alveolar bone at the apical level and lingual side of the alveolar bone at the crestal and midroot levels. Rate of change in mandibular incisor inclination and mandibular plane angle can be thought as significant factors that may influence alveolar bone thickness.