Orthodontic Treatment Of Skeletal Class Research Articles

Face Mask Therapy and Comprehensive Orthodontic Treatment for Skeletal Class III Malocclusion: A Case Report

Face Mask Therapy and Comprehensive Orthodontic Treatment for Skeletal Class III Malocclusion: A Case Report

Exploring the Impact of Orthodontic Treatment on Temporomandibular Joint Health

ABSTRACT Background: Currently, one of the most prevalent oral abnormalities is malocclusion. There is a rising percentage of patients who are willing to undertake orthodontic procedures. Aim: To evaluate the impact of orthodontic treatment on the morphology of temporomandibular joint (TMJ) in patients with malocclusion associated with TMJ abnormality such as skeletal class II deep bite malocclusion using CBCT. Methods and Materials: In total, 80 patients who underwent orthodontic treatment for skeletal class II deep bite malocclusion over a duration of 3 years were included. Parameters of the morphology of the condyle and glenoid fossa on CBCT scan both before and after orthodontic therapy were measured. Results: The maximum cross-sectional area of the condyle decreased from 99.84 ± 18.89 mm2 to 81.32 ± 16.80 mm2 after orthodontic treatment. The anterior condyle oblique inclination increased from 34.14 ± 2.98° to 36.52 ± 3.41° after orthodontic therapy. The articular eminence to the FH plane angle increased from 29.65 ± 2.53° to 33.29 ± 4.18° after orthodontic therapy. Conclusion: Orthodontic treatment is significantly correlated with improvement in TMJ health in patients of malocclusion.

Radiographic Imaging for the Diagnosis and Treatment of Patients with Skeletal Class III Malocclusion.

Skeletal Class III malocclusion is one type of dentofacial deformity that significantly affects patients' facial aesthetics and oral health. The orthodontic treatment of skeletal Class III malocclusion presents challenges due to uncertainties surrounding mandibular growth patterns and treatment outcomes. In recent years, disease-specific radiographic features have garnered interest from researchers in various fields including orthodontics, for their exceptional performance in enhancing diagnostic precision and treatment effect predictability. The aim of this narrative review is to provide an overview of the valuable radiographic features in the diagnosis and management of skeletal Class III malocclusion. Based on the existing literature, a series of analyses on lateral cephalograms have been concluded to identify the significant variables related to facial type classification, growth prediction, and decision-making for tooth extractions and orthognathic surgery in patients with skeletal Class III malocclusion. Furthermore, we summarize the parameters regarding the inter-maxillary relationship, as well as different anatomical structures including the maxilla, mandible, craniofacial base, and soft tissues from conventional and machine learning statistical models. Several distinct radiographic features for Class III malocclusion have also been preliminarily observed using cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI).

Evaluation of root resorption in the lower incisors after orthodontic treatment of skeletal Class III malocclusion by three-dimensional volumetric measurement with cone-beam computed tomography.

To investigate the volumetric changes of the lower incisor roots in skeletal Class III orthodontic patients with anterior crossbite after premolar extraction therapy. Thirty-six adults, aged 18-28 years, had four-premolar extraction treatment. Pre- and posttreatment cone-beam computed tomography (CBCT) images were used to assess the thickness and height of alveolar bone, root volume, and length. A paired t-test was used to detect changes in root volume and length before and after treatment. Pearson's correlation analysis was applied to estimate the correlation between root volume and dentoskeletal morphology. Both the central and lateral incisors had intrusion and tipping movement after treatment. Compared with pretreatment data, root length decreased significantly. The lingual root volume of root cervical, apical third, and the labial root volume of the root apical third decreased significantly (P < .05), among which the percentage of tooth loss at the tip volume was the highest. The pretreatment height of the alveolar ridge crest, thickness of the alveolar bone, and type of incisor movement were related to the volume and length loss. Volume and length loss in the apical third of the lower incisor roots in skeletal Class III patients treated with a Class III bicuspid extraction pattern is common. The pretreatment height of the alveolar ridge crest, thickness of the alveolar bone, and type of tooth movement are related to the loss.

Augmented corticotomy-assisted presurgical orthodontic treatment to prevent alveolar bone loss in patients with skeletal Class III malocclusion

The objective of this study was to explore the effect of augmented corticotomy (AC) on anterior alveolar bone morphology in presurgical orthodontic treatment for skeletal Class III malocclusion. Thirty-six surgical patients with skeletal Class III malocclusion with high-angle were included: 18 (AC group) accepted AC surgery during presurgical orthodontic treatment, and 18 (control group) accepted traditional presurgical orthodontic treatment. Cone-beam computed tomography scans were obtained before treatment (T0) and after presurgical orthodontic treatment (T1). The alveolar bone morphology, root length, dehiscence, and movement of mandibular central incisors were measured by cone-beam computed tomography using Dolphin software. Statistical analyses were performed with independent-sample t tests, paired t tests, and multiple linear regression. After presurgical orthodontic treatment, the whole alveolar bone thickness at each level, alveolar bone area, and alveolar bone height decreased significantly in the control group but increased or remained unchanged in the AC group. In the AC group, the lower the labial alveolar bone height at T0 was, the greater the increase after T1; the change in alveolar bone thickness was related to ΔL1-MP and sex. At T0, the incidences of dehiscence were similar in the 2 groups, ranging from 11.11% to 16.67%. At T1, the labial and lingual incidences of dehiscence in the AC group were 0% and 27.78%, compared with 55.56% and 66.67% in the control group. During presurgical orthodontic treatment, AC is effective in preventing alveolar bone resorption and dehiscence without additional root resorption. AC can be recommended for high-angle skeletal Class III patients with thin alveolar bone around anterior teeth during presurgical orthodontic treatment.

True vertical changes in patients with skeletal class III malocclusion after nonsurgical orthodontic treatment—a retrospective study comparing different vertical facial patterns

Background/purposeRotating mandible backward downward is one of the treatment options in non-surgical skeletal class III malocclusion. The purpose of this study was to compare the true vertical changes after camouflage orthodontic treatment of adult patients with skeletal class III malocclusion categorized by vertical facial type. Materials and methodsThis retrospective study included 27 adult patients (age >18 years) with skeletal class III malocclusion (ANB<1°) who underwent nonsurgical orthodontic treatment at Taipei Veterans General Hospital. The patients were divided into the low-angle (SN-MP<28°), high-angle (SN-MP>36°), and normal-angle (28°≤ SN-MP ≤ 36°) groups according to the original vertical facial pattern. Pretreatment (T1) and post-treatment (T2) lateral cephalograms were superimposed and treatment changes were evaluated. ResultsIn all cases, proper overjet and occlusion were achieved after treatment, and the lower anterior facial height increased with the backward rotation of the mandibular plane. Increase in vertical dimension was the most obvious in the high-angle group, while it was the least obvious in the low-angle group. Extrusion of both the maxillary and mandibular incisors was observed in the high-angle group; however, intrusion of the maxillary and mandibular incisors and decreased overbite were observed in the low-angle group. ConclusionCamouflage orthodontic treatment of skeletal class III malocclusion improves the facial profile by increasing the vertical dimension and clockwise rotation of the mandible. According to our results, patients with a high mandibular plane angle showed better response to vertical dimension increment treatment mechanics than those with low and normal mandibular plane angles.

Surgical Orthodontic Treatment for Skeletal Class I with Facial Asymmetry and Occlusal Cant: A Case Report

Background: Cases of facial asymmetry with chin deviation and canted occlusal plane represent a challenge in orthodontic treatment. Case Report: We report successful surgical orthodontic treatment for skeletal Class I with severe facial asymmetry. Miniscrew anchorage was used to decompensate the canted occlusal plane in presurgical orthodontic treatment with a fixed appliance by the intrusion of the maxillary right molars and extrusion of the left molars. Then, orthognathic surgery consisting of bilateral sagittal split osteotomy for asymmetric mandibular setback was performed. Treatment resulted in marked improvement of facial asymmetry. Conclusion: The use of miniscrew implant anchorage may represent a superior presurgical orthodontic treatment and expand the possibility of treatment by one-jaw surgery.

Treatment decision of camouflage or surgical orthodontic treatment for skeletal Class III patients based on analysis of masticatory function

Background/purposeSurgical orthodontic treatment is recommended for patients with severe dentoskeletal discrepancies, while camouflage orthodontic treatment is recommended for patients with mild to moderate discrepancies. However, the decision as to which treatment should be chosen is complicated. The purpose of this study was to determine differences in masticatory function in patients who underwent camouflage and surgical orthodontic treatment for skeletal Class III malocclusion, as well as the usefulness of Wits appraisal in treatment decision based on masticatory functional analysis. Materials and methodsThe study subjects were 45 patients with skeletal Class III malocclusion (15 cases with camouflage orthodontics and 30 cases with orthognatic surgery) and 12 individuals with normal occlusion. We analyzed the pre-treatment records of electromyographic activities of masseter and temporalis muscles and jaw movements. ResultsThere were no significant differences in various functional measurements between the camouflage and surgery groups. However, there were significant but not strong correlations between ANB and both masseter muscle activity (r = 0.36, p < 0.01) and expression ratio of abnormal chewing (r = −0.54, p < 0.01). Division of patients into two groups using a cutoff value of −6.0 mm for Wits appraisal showed a significant difference in masseter muscle activity between −6.0 mm or less group and the control (p < 0.01) but none between more than −6.0 mm group and the control. ConclusionCamouflage orthodontic treatment is inappropriate for patients with relatively severe dentoskeletal discrepancies. Wits appraisal of −6.0 mm is a potentially useful parameter for treatment decision.

Orthodontic Treatment of Skeletal Class II Malocclusion with Bilateral Second Molar Scissors Bite

Orthodontic Treatment of Skeletal Class II Malocclusion with Bilateral Second Molar Scissors Bite

Nonextraction Camouflage Orthodontic Treatment of Skeletal Class III Malocclusion with Severe Crowding Using Microimplant Assisted Rapid Palatal Expansion

Nonextraction Camouflage Orthodontic Treatment of Skeletal Class III Malocclusion with Severe Crowding Using Microimplant Assisted Rapid Palatal Expansion

Changes in Upper Airway Dimensions Following Orthodontic Treatment of Skeletal Class II Malocclusion with Twin Block Appliance: A Systematic Review.

This systematic review intends to evaluate the dimensional changes in upper airway dimensions (UAD) of the respiratory tract subsequent to orthodontic treatment of skeletal Class II malocclusion with Twin Block Appliance (TBA). The quality of reporting systematic reviews and meta-analyses was decided by the PRISMA standards with PROSPERO registration number CRD42017060317. The systematic search included EMBASE, MEDLINE, Psych INFO, Scopus, CINAHL, and other reference journals and review articles. The article search was performed from March 2017 until November 2017. Cochrane's risk of bias in non-randomized studies - of interventions (ROBINS-I) was used to grade the methodological quality of the included studies. The screening procedure identified 302 studies, among which seven studies satisfied the inclusion criteria for eligibility. The UAD at the pretreatment time varied from 7.2 mm to 41.9 mm with a mean of 14.16 mm. The post-treatment change in UAD ranged from 8.2 mm to 43.7 mm with a mean of 15.6 mm. There was a significant increase in UAD following the TBA treatment in the patient group as compared to the control group.

Three-dimensional evaluation of dentofacial transverse widths in adults with different sagittal facial patterns.

The aim of this study was to evaluate the dentofacial transverse dimensions of subjects with different sagittal facial patterns using 3-dimensional cone-beam computed tomography images. Cone-beam computed tomography images of 63 men and 80 women were divided into skeletal Class I, Class II, and Class III groups. Skeletal and dental evaluations were made on frontal views and coronal cross-sections of the images. Independent 2-sample t tests and 1-way analysis of variance followed by post hoc Tukey tests were used for sex and group differences. Pearson correlation analysis was used to identify factors related to changes in ANB angle. The Class II subjects did not show differences in maxillomandibular width and maxillary width compared with Class I subjects; however, their maxillary molars were more lingually tipped. The Class III subjects showed greater maxillomandibular width differences and smaller maxillary widths and maxillary buccolingual alveolar widths at midroot level compared with Class I subjects. The maxillary molars were buccally inclined, and the mandibular molars were lingually compensated in Class III subjects. The ANB angle showed positive correlations with jugal process width, maxillary width, and maxillary buccolingual alveolar width at midroot level as well as mandibular molar buccal inclination; negative correlations were found in maxillomandibular width difference, mandibular width at midroot level, and maxillary molar buccal inclination. A relative comparison of Class I, Class II, and Class III subjects showed that dental compensation had occurred to overcome the transverse skeletal discrepancies in the maxillary posterior segments of Class II and Class III subjects. This could escalate unidentified periodontal and functional problems in the long term. Future studies of transverse dentofacial dimensions, including periodontal evaluations and occlusal forces, would be useful for delivering proper orthodontic treatment for skeletal Class II and Class III subjects.

Pharyngeal airway dimensional changes after premolar extraction in skeletal class II and class III orthodontic patients.

OBJECTIVE:To assess and compare the changes in pharyngeal airway space dimensions following orthodontic treatment of skeletal class II and class III facial deformities with premolar extraction.MATERIALS AND METHODS:Sixty pre and posttreatment lateral cephalometric radiographs of patients who underwent fixed orthodontic treatment with premolar extraction were collected. The sample was divided into two groups – 32 patients with skeletal class II and 28 patients with skeletal class III malocclusion. Both groups were subdivided into growing patients (<16 years old) and adults (>16 years old). Nasopharyngeal, palatopharyngeal, and glossopharyngeal airway space dimensions were measured in the pretreatment (T0) and posttreatment (T1) cephalometric radiographs using Dolphin Imaging 11.7 software. Two-way, repeated-measures analysis of variance was used to assess the in-treatment changes.RESULTS:Nasopharyngeal airway dimension showed similar significant increase in class II (P = 0.042) and class III (P = 0.049) patients from T0 to T1, whereas palatopharyngeal and glossopharyngeal dimensions were insignificantly decreased in both groups. However, both malocclusions followed the same pattern of changes in relation to airway dimensions. In addition, no significant statistical difference was found in the airway spaces between growing and adult patients.CONCLUSIONS:Extraction of premolars did not affect the pharyngeal dimensions except those of the nasopharynx, which showed a significant increase after extraction in both groups.

Abstract: Can a Surgery-First Orthognathic Approach Reduce the Total Treatment Time?

INTRODUCTION: A traditional orthognathic approach requires presurgical orthodontic treatment for an average of approximately 17 months,1 followed by surgery and postsurgical orthodontic treatment for approximately 6–12 months. Therefore, the total treatment time for the conventional orthognathic approach takes approximately 18–36 months.2–4 Because traditional orthognathic surgery requires 2–3 years to complete, it is a rarely adopted procedure. Therefore, shortening the total treatment time would be extremely beneficial for patients. Although presurgical orthodontic treatment has been approved as an inevitable process for stable orthognathic correction before surgery, recent advances in the application of mini-screws and presurgical simulational orthodontic management skills on a dental model show that it is possible to perform a surgery-first orthognathic approach without presurgical orthodontic treatment.5 MATERIALS AND METHODS: We assessed 45 consecutive Asian patients with skeletal class III dentofacial deformities with surgery-first orthognathic surgery compared to 52 patients with conventional two-jaw orthognathic surgery. Using cephalometric landmark data for the patients with a surgery-first approach, we analyzed postoperative changes in vertical and horizontal facial, denture, and soft tissue patterns. Assuming that tooth extraction is a factor that affects the total treatment time, both groups were divided into two subgroups. RESULTS: The treatment duration of the surgery-first group was significantly less than that of the orthodontics-first group. Overall, the analysis revealed that the total treatment time period in the surgery-first orthognathic approach averaged 14.6 months compared to 22.0 months of treatment in an orthodontic-first orthognathic approach. Among the surgery-first cases without tooth extraction, the average treatment interval was only 13.6 months versus 24.8 months for the six that required tooth extraction (p < 0.001). In contrast, the average treatment period of traditional orthodontics-first cases without tooth extraction was roughly comparable to the nine cases that required tooth extraction (21.7 months vs. 21.6 months, respectively). The difference between immediate postoperative and preoperative, postoperative and immediate postoperative cephalometric data revealed factors that have correlation with total treatment duration. CONCLUSION: Surgery-first orthognathic surgery can dramatically shorten the total treatment time with no major complications. By analyzing the cephalometric landmark data we identified several possible factors that have an effect on the total treatment time. DISCLOSURES/FINANCIAL SUPPORT:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Luther F, Morris DO, Hart C: Orthodontic preparation for orthognathic surgery: how long does it take and why? A retrospective study. Br J Oral Maxillofac Surg 41:401–406, 2003. 2. Van Sickels JE, Loftus MJ, Weiss WW, Jr: Orthognathic surgery: a team approach. Bull Phila Cty Dent Soc. 45:8–9, 1979. 3. Slavnic S, Marcusson A: Duration of orthodontic treatment in conjunction with orthognathic surgery. Swed Dent J. 34:159–166, 2010. 4. Dowling PA, Espeland L, Krogstad O, Stenvik A, Kelly A: Duration of orthodontic treatment involving orthognathic surgery. Int J Adult Orthodon Orthognath Surg. 14:146–152, 1999. 5. Choi JW, Lee JY, Yang SJ, Koh KS: The reliability of a surgery-first orthognathic approach without presurgical orthodontic treatment for skeletal class III dentofacial deformity. Ann Plast Surg. 74:333–341, 2015.

The Reliability of a Surgery-First Orthognathic Approach Without Presurgical Orthodontic Treatment for Skeletal Class III Dentofacial Deformity

Orthognathic surgery with presurgical and postsurgical orthodontic treatment is the most widely accepted method for the correction of skeletal or dentoalveolar malocclusion. However, recent advancements in presurgical orthodontic simulations and postsurgical orthodontic treatments using miniscrews have shown remarkable stability and control of the occlusion after orthognathic surgery. Thus, we have adopted a surgery-first orthognathic approach without presurgical orthodontic treatment, based on a novel presurgical simulation process using a dental model. We hypothesized that this treatment modality will be feasible for skeletal class III dentofacial deformity patients. This prospective study investigated intervention outcomes in 24 standard and 32 surgery-first approaches for patients with skeletal class III dentofacial deformity. The patients underwent orthognathic surgery between December 2007 and July 2010. In the surgery-first approach, a dental model was created and a novel preoperative orthodontic simulation of the standard presurgical orthodontic treatment was performed to determine the final occlusion between the maxilla and mandible. Changes in cephalometric landmarks were compared between the standard and surgery-first groups in the preoperative, immediate postoperative, and postoperative periods. The Student t test, Kruskal-Wallis test, and a linear mixed model were used for statistical analysis. The follow-up period ranged from 12 to 36 months (average, 20.5 months). The average age of the patients was 22.4 years, with 16 male and 40 female patients. We found that a surgery-first approach without presurgical orthodontic treatment is possible and can give similar results to standard orthognathic surgery. The statistical analysis showed that changes in skeletal cephalometric landmarks were similar between the surgery-first and standard approach groups, according to each period. However, the cephalometric landmarks relating to the dental component showed changes between treatment groups at different time points but similar final values. This suggests that the benefits of postsurgical orthodontic treatment after the surgery-first approach could be similar to those obtained via the standard approach. The surgery-first orthognathic approach without presurgical orthodontic treatment was found to be predictable and applicable to treat class III dentofacial deformities, and we recommend consideration of the technique as an effective alternative for treating this condition.

Nonsurgical Correction of Skeletal Class III Malocclusion by Multibends Edgewise Archwire Technique in an Adult

ABSTRACT Skeletal class III malocclusion treated with orthognathic surgery usually can achieve a better facial profile and stable occlusion outcome. We describe a 37-year-old patient who sought orthodontic treatment for skeletal class III, but refused recommendations for orthognathic surgery because of personal considerations. After careful analysis of the X-ray images and study models, this patient was subjected to active orthodontic treatment to correct malocclusion using upper and lower arch with improved superelastic NiTi alloy wire (ISW) for efficient leveling of the teeth. In the lower arch, the multibends edgewise archwire (MEAW) technique was used to tip back and intrude the canine and posterior teeth. After the completion of treatment, anterior teeth crossbite was successfully corrected and proper occlusal relationships were reestablished. How to cite this article Chang YC, Jian-Hong YU, Tsai YY, Chien-Chih Y, Pan PW. Nonsurgical Correction of Skeletal Class III Malocclusion by Multibends Edgewise Archwire Technique in an Adult. Int J Experiment Dent Sci 2015;4(2): 137-142.

Influence of lateral cephalometric radiographs on extraction decision in skeletal class I patients

BackgroundRadiographic examination is considered ‘justified’ only when detection of a condition that would change the mechanisms and timing of treatment is possible. Radiographic safety guidelines have restricted the indication of lateral cephalometric radiographs (LCRs) to presence of distinct skeletal Class II or Class III. However, they are taken routinely in clinical practice and considered to be part of the ‘gold’ standard for orthodontic diagnosis. Therefore, the aim of this study was to test the null hypothesis that lateral cephalometric radiograph (LCR) evaluation would not alter the extraction/non-extraction decision in orthodontic treatment planning of skeletal Class I patients.Materials and methodsIntraoral and extraoral photographs, dental casts and extraoral radiographs of 60 skeletal Class I patients were prepared digitally for assessment using a presentation software. One experienced (EO) and inexperienced orthodontist (IO) was asked to decide on extraction or non-extraction on a Likert-type linear scale for treatment planning. This procedure was repeated 4 weeks later with a mixed order of patients and the LCRs being omitted. Kappa, Weighted Kappa (WK) and McNemar scores were computed to test decision consistency and Bland-Altman plots together with 95% limits of agreement were used to determine measurement accuracy and presence of systematic bias.ResultsBoth EO (WK = 0.67) and IO (WK = 0.64) had good level of decision agreement with and without LCR evaluation. EO did not present a shift towards extraction nor non-extraction with LCR evaluation (McNemar = 0.999) whereas IO showed a tendency to extraction (McNemar = 0.07) with LCR data. Including LCR evaluation created a systematic inconsistency between EO and IO (Line of equality = 0.8, Confidence interval = 0.307-0.707).ConclusionsLateral cephalometric radiograph evaluation did not influence the extraction decision in treatment planning of skeletal Class I patients. Reconsidering the necessity of lateral cephalograms in orthodontic treatment of skeletal Class I patients may reduce the amount of ionizing radiation. Key words: Lateral cephalometric radiograph, extraction, treatment planning, skeletal Class I.

Orthodontic treatment of Skeletal Class II Division 1 Malocclusion: A case report

DOI: http://dx.doi.org/10.3329/bjdre.v2i1.15575 Bangladesh Journal of Dental Research &amp; Education Vol.2(1) 2012: 24-28

Surgical Orthodontic treatment of Skeletal Class II malocclusion

Traditional technique for correcting Class II in a growing patient is by growth modulation. In adults Class II discrepancy are treated either by orthodontic or comaflauge or by surgical correction. Class II discrepancies with mandibular deficiency are treated surgically by mandibular advancement surgery. Mandibular advancement by BSSO is found to be a stable procedure. An 18year old patient reported to the department with complains of forwardly placed upper front teeth. On examination patient had a retrognathic mandible with Class II relation. Intra orally patient had a Class II molar and incisor relation with increased overjet and overbite. The treatment plan of combination of orthodontics and surgery was employed to correct the discrepancy and obtain an aesthetic, harmonious facial profile. The mandibular advancement surgery was done which accomplished the objectives of the treatment.

Surgical and orthodontic treatment of skeletal Class III featuring severe transversal and sagittal discrepancy

Anterior cross-bite is a difficult malocclusion to treat in adult patients, especially if compounded by skeletal discrepancy. The present study describes a dentoskeletal Class III case and aims to provide the clinician with rational guidelines for presurgical orthodontic preparation and postsurgical finishing. In this case, a 20-year-old male patient, R.M, was treated for severe dental and skeletal Class III malocclusion on both the transversal and anteroposterior planes via combined orthodontics and surgery. Initially, the treatment involved surgically-assisted expansion of the upper jaw (total 1 month), followed by a fixed-orthodontics phase to decompensate for the malocclusion in preparation for movement of the osseous bases with the aim of achieving maximum coordination of the dental arches. After 19 months of orthodontic preparation, the patient underwent combined orthognathic surgery (upper and lower jaws). In the subsequent 4 months, orthodontic stabilization and finishing were performed, and debonding was carried out 24 months after the start of active treatment. The combined orthodontic and surgical treatment adequately corrected the severe Class III over a period of 2 years, leading to a satisfactory occlusal, functional and aesthetic result. Thorough diagnosis and close communication between the orthodontist and maxillofacial surgeon, operating as an interdisciplinary team, ensures good outcomes, even in complex orthodontic and surgical cases.