Orthodontic Camouflage Research Articles

Orthodontic Camouflage Treatment of Skeletal Class III Patient with Transverse Discrepancy and Congenital Missing of Lower Second Premolars

Orthodontic Camouflage Treatment of Skeletal Class III Patient with Transverse Discrepancy and Congenital Missing of Lower Second Premolars

Decision-making patterns among expert and novice orthodontists and oral maxillofacial surgeons in the management of adults with Class III malocclusions and moderate degree of skeletal discrepancies.

To explore the decision-making patterns among expert and novice orthodontists and oral maxillofacial surgeons in the management of adults with Class III malocclusions and moderate skeletal discrepancies. Self-administered questionnaire survey. Faculty of Dentistry, National University of Singapore and the University Dental Cluster, National University Hospital, Singapore. A total of 55 clinicians, comprising 13 expert orthodontists, 20 novice orthodontists, 10 expert oral maxillofacial surgeons and 12 novice oral maxillofacial surgeons. Clinicians assessed six adults with a Class III malocclusion and moderate skeletal discrepancy. They were asked to decide who could be managed exclusively by orthodontic camouflage, who would require combined orthodontic-orthognathic surgery as the only viable treatment, or who could be offered both treatment options. The study found variable decision-making patterns among the clinicians in each case. Only 18.2%-40.0% of clinicians agreed that the cases selected were of moderate skeletal discrepancies and could be offered both treatment options whereas the rest were either more inclined to recommend orthodontic camouflage or orthognathic surgery. Intra-clinician agreement (n = 20) was only fair (Kappa value = 0.31). There was only slight inter-clinician agreement (n = 55) on their clinical decisions (Kappa value = 0.10). Clinical experience and dental specialty did not significantly influence clinicians' decisions. Oral and maxillofacial surgeons were 1.98 times more likely to indicate orthognathic surgery as the only viable treatment compared to the orthodontists (95% confidence interval = 1.15-3.42). Variability in the patterns of decision-making for adults with a Class III malocclusion and moderate skeletal discrepancy was observed among the clinicians with low repeatability and agreement.

Management of Class III malocclusion by orthodontic clockwise rotation of maxillo-mandibular complex – A case report

Severe Skeletal Class III malocclusions in adult patients are managed by surgical orthodontic correction and orthodontic camouflage especially in borderline cases. An orthodontic camouflage is best opted in situations where the patient is either reluctant to have an invasive procedure or mitigate other ways to obtain an ideal interincisal relation, best esthetic outcome and function. There are many ways suggested to treat Class III malocclusions non-surgically like fixed appliance with class III intermaxillary elastics, extraction of mandibular first bicuspids, extraction of mandibular first and maxillary second bicuspids and enmasse distalization of mandibular arch using temporary anchorage devices. Clockwise rotation of maxillo-mandibular occlusal complex gives promising treatment outcome in selected cases with extrusion of upper arch and possible clockwise rotation of the mandible for improving mandibular prognathism. This case report aims to illustrate a Class III non-growing patient treated by clockwise rotation of maxillo-mandibular occlusal complex for achieving optimum facial esthetics and function.

Management of deepbite in Class II division 2 malocclusion with two different techniques- A case series

Class II division 2 malocclusion cases are usually challenging to treat with very limited treatment modalities. Growth modification, with the use of functional appliances, is often the ideal treatment in growing patients. In non-growing patients, orthognathic surgery is the treatment of choice, which most patients refuse either due to financial or other concerns. Orthodontic camouflage, with or without extraction is then the only option left, but it also carries a risk of soft tissue compromise, thus management of Class II division 2 cases requires a careful treatment planning. Here, in this case series, we have tried to show the treatment of Class II division 2 cases, with upper premolar extraction and different mechanics, leading to satisfactory post treatment outcomes.

Class III Malocclusion Camouflage Treatment Using a Conventional Orthodontic Appliance in a Non-Growing Patient

The treatment of skeletal and dental Class III malocclusions is a challenge for orthodontists, and one of the treatment alternatives for a non-growing patient is orthodontic camouflage treatment. Different approaches may result in different outcomes; therefore, a proper diagnosis and treatment plan are needed to avoid undesirable effects. In this case, a 21-year-old female patient presented with a skeletal Class III malocclusion, with a normal maxilla, prognathic mandible, moderate crowding, and an acceptable facial profile. The treatment modality for orthodontic camouflage treatment was a conventional orthodontic appliance with the extraction of mandibular first premolars to resolve crowding. At the end of the treatment, a Class I canine and incisor relationship was achieved while maintaining a Class III molar relationship. After 25 months of treatment, the patient had a more pleasant smile with improved functional occlusion.

Correction of class III malocclusion using enmasse distalization with tad

Skeletal class III malocclusion in adult patients are generally managed by orthognathic surgery. However, the prognosis is poor when the patient refuses surgical line of treatment. In such cases orthodontic camouflage through dentoalveolar compensation may be attempted. Presently, with the advent of stationary anchorage, en mass distalization appears to be a common choice. This article demonstrates an en mass distalization carried out in the upper and lower arches in a class III skeletal case, refusing surgery. After initial levelling and alignment, TADs (temporary anchorage devices) were placed bilaterally mesial to the first molars in upper and lower arches. After a month, distalization was initiated with 300 gms force applied per side using elastomeric chain. At the end of the treatment, the anterior cross bite and crowding was resolved and the patients profile improved. Thus, en masse distalization with TADs appears be a good choice in class III skeletal cases refusing surgery. It is minimally invasive and cost effective.

Non-Surgical Camouflage Treatment of a Skeletal Class III Patient with Anterior Open Bite and Asymmetry Using Orthodontic Miniscrews and Intermaxillary Elastics

This case report presents the non-surgical orthodontic camouflage treatment of an 18-year-old male patient with skeletal Class III asymmetry and severe anterior open bite. The anterior open bite was corrected by extrusion of the maxillary and mandibular anterior teeth and clockwise and counterclockwise rotation of the maxillary and mandibular occlusal plane, respectively, using intermaxillary Class III elastics between the maxillary posterior buccal miniscrews and mandibular canines and anterior vertical elastics between the maxillary and mandibular canines. Class III dental relationships and dental asymmetry were corrected via unilateral distalization of the mandibular dentition on the left side using a closed coil spring between the buccal shelf screw and hook. The patient’s smile esthetics and dental relationship were improved with a more favorable facial profile, and facial asymmetry was slightly alleviated after orthodontic camouflage treatment. The total treatment time was 15 months. A modified wraparound retainer with a scalloped labial bow, tongue crib, and tooth positioner was used simultaneously to prevent the potential relapse.

Interdisciplinary orthodontic camouflage treatment with extraction of fractured maxillary central incisor and tooth substitution to treat skeletal bimaxillary protrusion- A case report

Malformed or fractured central incisors with poor prognosis could be the choice of teeth for extraction when space is required for orthodontic treatment. This case report refers to a 14-year-old girl who had a fractured upper left central incisor associated with bimaxillary protrusion. She expressed her concern to correct her dental appearance and enhance her smile aesthetics. The patient had class I malocclusion with bimaxillary proclination and severe crowding in the lower arch. Due to the increased space requirement, extraction of teeth was required as part of orthodontic treatment. Patient had a class 2 skeletal profile with prominent upper front teeth and therefore increased space requirement in the upper arch in order to retract the prominent teeth to achieve favourable aesthetics. The choice of teeth for extraction were 14,34,44 and 21. In the second quadrant the central incisor was extracted due to its poor prognosis, and the lateral incisor, canine and first premolar were substituted for the central incisor, lateral incisor and canine respectively. In the lower dental arch the first premolars were extracted. The end of treatment objectives- class 1 molars, canines, incisors were achieved with greatly improved smile aesthetics. KEYWORDS Interdisciplinary orthodontics, Teeth substitution, Poor prognosis, Incisor extraction.

Non-Surgical Treatment of Class II Division 1 Malocclusion in an Adult Patient with a Missing Lower Lateral Incisor Tooth: A Case Report

Class II Division 1 malocclusion is clinically more widespread than any other form of malocclusion and can be managed in a variety of ways, taking into account variables such as patient compliance, age, and anteroposterior disparity. Orthodontic camouflage treatment, aimed at masking the underlying skeletal discrepancy, is an acceptable option for most patients. This typically involves the extraction of two maxillary premolars in cases without mandibular arch crowding, or the extraction of two maxillary and two mandibular premolar teeth when crowding is present. The present case report aimed to discuss the successful treatment of a unique case involving a 19-year-old adult female patient with Class II Division 1 malocclusion, a missing mandibular left lateral incisor, and an overjet of 7 mm. Since the patient declined surgical and prosthetic treatment, an alternative, novel, and unorthodox method of camouflage treatment was employed, which involved the extraction of maxillary first premolars combined with symmetrical incisor space closure. The achieved treatment outcomes included a functionally and aesthetically acceptable occlusion, reduced overjet, and an improved soft tissue profile.

Camouflage Treatment of Skeletal Anterior Open Bite with Tongue Training

The aim of this case report was to present an adult patient who suffered from poor occlusal function and poor aesthetic appearance due to skeletal anterior open bite. After orthodontic treatment, she was satisfied with improvements of mastication and esthetics. A case of 20-year-old female with skeletal Class II jaw relationship, mandible retrognathism and anterior open bite without signs and symptoms of temporomandibular disorder. Intraoral examination showed premature contact over bilateral posterior teeth and the forward resting position of tongue. Our treatment plan was orthodontic camouflage with extraction of all first premolars and tongue training. As forward resting position of tongue was noted, a tongue crib soldered on molar bands was used and the patient was instructed with tongue exercises. Normal overbite and overjet were achieved within four years of treatment. Her profile became more harmony after correction of anterior open bite. Although the stability of occlusion relies on the position of tongue, the current masticatory and facial profile provide a better quality of life. Orthodontic treatment of skeletal anterior open bite should be very careful. Appropriate diagnosis, differentiation of etiology and proper selection of mechanics must be verified before initiating treatment.

A quantitative analysis of facial changes after orthodontic treatment with vertical control in patients with idiopathic condylar resorption.

This study aimed to investigate temporomandibular joint (TMJ) stability and three-dimensional (3D) facial changes in class II hyperdivergent patients with stable idiopathic condylar resorption (ICR) after orthodontic camouflage treatment with vertical control by using temporary anchorage devises (TADs). Nineteen skeletal class II hyperdivergent patients who were diagnosed with stable ICR underwent bicuspid extraction orthodontic treatment with vertical control via TADs were enrolled. TMJ was evaluated with the cone beam computerized tomography (CBCT) and clinical records before and after treatment. Changes in dental and skeletal parameters were evaluated with cephalometric and dental cast measurements. The 3D morphable model (3DMM) method was performed with the MeshMonk toolbox for the 3D facial analysis. After the reposition and landmark setting process, 3D facial heatmaps were used to illustrate facial changes, and the 3D deviations of landmarks were calculated. Both the imaging evaluation and clinical examination proved that TMJs remained stable after treatment. The retrusion of the upper and lower incisors reached 6.63 ± 0.79 mm and 3.78 ± 1.49 mm. The intrusion of the upper first molar reached 2.65 ± 0.75 mm, with a 2.27 ± 0.82° counterclockwise rotation of the mandibular plane. An upward shift of the soft tissue pogonion (2.34 ± 2.03 mm) and protrusion of Po-NB (0.82 ± 0.70 mm) was gained. Larger intrusion was found in the lower lip (3.29 ± 0.80 mm) than in the upper lip (2.20 ± 0.69 mm). Camouflage orthodontic treatment with TAD for vertical control is acceptable for skeletal class II hyperdivergent patients with ICR, which can improve the facial profile.

An Orthodontic Treatment Case of a TMD Patient with Maxillary Posterior Intrusion Using TSADs

The orthodontic treatment of patients having temporomandibular disorders are some of the most complicated cases to treat. The positions of the mandibular condyles are often unstable, which means clinicians find it difficult to have definite criteria for making an accurate and reliable orthodontic diagnosis. This article reports the orthodontic treatment of a patient showing skeletal Class II and temporomandibular disorders with condylar resorption. To stabilize her condylar position and to relieve her symptoms in the temporomandibular joint, a stabilization splint was used before orthodontic tooth movement. After the splint therapy, the patient exhibited significantly increased open bite and a more severe Class II occlusal relationship as her mandibular condyles were seated anteriorly and superiorly in the articular fossae. The occlusion and facial esthetics of the patient were improved by orthodontic camouflage treatment with the proper use of temporary skeletal anchorage devices and treatment mechanics.

Nonsurgical management of class II division 1 malocclusion in an adult patient using fixed functional appliance: A case report

This case report highlights the effective and efficient usage of fixed functional appliance in the management of class II div 1 malocclusion with retrognathic mandible and deep overbite in an adult individual. Orthognathic surgery and Orthodontic camouflage with premolar extraction were not considered in the present case. The Mandibular Protraction Appliance (MPA type 2) was considered due to ease of fabrication, placing it simultaneously along with fixed mechanotherapy.

Expanding the concept of orthodontic camouflage for a skeletal Class II camouflage case through the use of skeletal anchorage system

This study aimed to report the treatment steps in a 26-year male patient, presented with a class II div 1 incisor relationship on a class II skeletal base with increased vertical proportions. The case was complicated by missing lower second premolars and retained lower second deciduous molars. Severe crowding was evident in the lower arch with mild crowding in the upper arch. The overbite and the overjet were increased. Scissor bite was evident in the left buccal segment. Treatment involved extraction of upper first premolars and lower second deciduous molars, utilizing moderate anchorage using a preadjusted edgewise fixed appliance (0.022’’ X 0.028”) with Roth prescription. Treatment duration was 20 months in total. The envelope of discrepancy specifies strict rules when camouflaging class II cases. The ability to retract incisors and the use of class II mechanics are within limited range to avoid damage to the periodontium. The current case report showed that the ability of the clinician to retract incisors using TADs could be carried out with high rate of success and safety.

Adult skeletal Class III malocclusion with periodontal complications treated by orthodontic camoufl age: A case report

ABSTRACT Treatment of skeletal class III malocclusions is a challenging one for orthodontists. In non-growing adults, this becomes even more difficult to treat due to the limited treatment options available. The ideal treatment for adults with Class III malocclusion is often orthognathic surgery. However, the only way to camouflage the skeletal Class III condition in patients who decline surgery is through dentoalveolar compensations. This case report presents the case of a 64-year-old man with a class III skeletal base treated with non-surgical orthodontic camouflage treatment. The patient presented with periodontal problems, and orthodontic treatment placed the teeth in a more stable occlusal position to prevent further breakdown. In this particular case, the functional demands outweigh the esthetic demands, and hence orthodontic treatment was aimed at fulfilling these demands. Keywords: Adult orthodontics, Mini-implant, Occlusal rehabilitation, Orthodontic camouflage, Skeletal class III malocclusion.

Orthosurgical management of deckbiss malocclusion (Class-II Div 2) in adult patients: A case series

Class II malocclusion cases are of interest to orthodontists since they constitute a significant chunk of cases they treat. Still, they're one of the most grueling malocclusions to diagnose and treat.There lies a significant difference in the frequency of Class II malocclusion among various populations. The frequency of Class II malocclusion in India varies from 1.9% in Rajasthan to 8.37% in South India. Class II division 2 (Deckbiss) malocclusion is characterized by mandibular incisors positioned posterior to the cingulum of retroclined maxillary incisors. It usually presents with reduced overjet and increased overbite.The treatment approach of Class II division 2 malocclusion is different for different age groups. In growing cases, growth modulation with myofunctional appliances is recommended but in adult cases, orthodontic camouflage or orthognathic surgery is the recommended treatment modality. When orthodontic treatment alone is ineffective or when facial aesthetics is grossly undermined, orthognathic surgery is the choice of treatmentIn the present case series, two adult cases of severe Class II division 2 (Deckbiss) malocclusion were treated orthosurgically with BSSO. This case series demonstrates that treatment of Class II division 2 (Deckbiss) malocclusion in adult patients is a challenging task and a combined orthodontic-surgical approach can be used to obtain optimum aesthetics & functional efficiency.

Current Trends in Skeletal Borderline Patients: Surgical versus Orthodontic Treatment Decisions—What Is the Evidence?

Background: The aim is to assess the current evidence-based knowledge about treatment decisions for skeletal malocclusion in adult borderline patients. Methods: A literature search was conducted through three databases. Inclusion criteria were restricted to systematic reviews, prospective, retrospective, and control studies. Only articles comparing orthodontic camouflage and orthognathic surgical treatment for Class II and Class III malocclusions in adult patients were selected to be reviewed. Results: Seven articles concerning Class II and nine concerning Class III met the inclusion criteria. Scientific evidence was poor due to low methodological quality. Conclusions: Surgical treatment was found to better improve skeletal and soft-tissue cephalometric values, whereas camouflage treatment mainly involved dentoalveolar movements. Aesthetic changes, as perceived by the patient, were not significantly different in the two groups. Recently improved surgical techniques, differing from those described in the analyzed articles, may provide similar or more stable outcomes compared with orthodontic-only treatment. Although some cephalometric variables can be helpful, the most important parameters for treatment selection are the patient’s presenting complaint and their self-image perception. Further studies with larger sample sizes and similar pretreatment conditions, and considering patient self-evaluation of esthetics and function, should be undertaken.

Ortho-surgical treatment in Class II skeletal patients with mandibular retrognathism: a concise systematic review

Introduction: In the setting of class II malocclusion corrections, the union of orthodontic and surgical procedures was developed. Bilateral sagittal split osteotomy is standard protocol for correcting mandibular retrognathism. Class II dental malocclusion with deep bite needs to be treated early by orthodontics. Thus, the commonly used technique combines BSSO for mandibular advancement and recoil genioplasty to correct the resulting chin protrusion. Objective: To carry out a systematic review of the main considerations of ortho-surgical treatments in class II patients with mandibular retrognathism. Methods: Experimental and clinical studies (case reports, retrospective, prospective and randomized) with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results and Conclusion: A total of 128 articles was found involving class II malocclusion and ortho-surgical treatments. After, a total of 64 articles were fully evaluated and 24 were included and discussed in this study. A meta-analysis study evaluated the best functional appliance improving mandibular length in individuals with retrognathism. Sander Bite Jumping reported the greatest increase in mandibular length, with 3.40 mm. Another meta-analysis study compared dental, skeletal, and aesthetic outcomes between orthodontic camouflage and orthodontic-surgical treatment in patients with Class II skeletal malocclusion and retrognathic mandible with anterior growth. The difference between treatments was not statistically significant regarding SNA angle, linear measure of the lower lip to the Ricketts aesthetic line, convexity of the skeletal profile or soft tissue profile excluding the nose. In contrast, orthodontic-surgical treatment was more effective to the ANB, SNB and ML/NSL angles and the soft tissue profile including the nose.

Orthognathic versus Camouflage Treatment of Class III Malocclusion: A Systematic Review and Meta-Analysis

This systematic review (SR) and meta-analysis (MA) aimed to compare the treatment effects of orthognathic surgery and orthodontic camouflage treatment in adult subjects with Class III malocclusion (C-III-M). Two independent reviewers conducted the literature search comprehensively from 1990 to 8 November 2021. PubMed, Science Direct, Scopus, EBSCOhost and Google Scholar databases were included for literature search. Moreover, a manual search of references from relevant studies was performed. Based on the literature search, a total of six articles were selected for SR and three articles fulfilled the criteria of a MA. Standardized mean difference (SMD) was used to evaluate and compare the treatment effects of orthodontic camouflage treatment and orthognathic surgery in adult C-III-M patients. Test for overall effect from the studies was used to estimate the treatment effect of C-III-M. However, Significant heterogeneity and publication bias was apparent among the selected studies. More research on the treatment effects of orthodontic camouflage treatment and orthognathic surgery in C-III-M is necessary to conclude possible interactions with better specificity.

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

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