Orthodontic Treatment Of Class Research Articles

Three-Stage Non-Surgical Treatment of Skeletal Class III Malocclusion in Adolescents—A Report of Four Cases with Long-Term Follow-Up

(1) Background: Postponing orthodontic treatment in Class III malocclusion until deterioration and growth cessation to perform orthognathic surgery does not seem to be an optimal solution for every patient. This report describes short- and long-term outcomes for nonsurgical treatment of four adolescents with severe Class III malocclusion. (2) Methods: Four patients (aged 13–15 y) with skeletal Class III (Wits appraisal below 7.5 mm) started a three-stage treatment, consisting of a six-month-long phase I and involving orthopedic treatment with an individual chin-cup. Phase II involved orthopedic treatment with a bonded Haas-type expander on acrylic splints, a face-mask, a lower fixed appliance and Class III elastics; phase III involved full fixed appliance, elastics and reuse of the individual chin-cup. Pre and posttreatment cephalograms were analyzed and superimposed. (3) Results: Improved skeletal and dental relationships and facial appearance was achieved in all patients. Wits appraisal, angles ANB, ANPg and lower face height increased; an improvement of overbite was noted. (4) Conclusions: Severe skeletal Class III in adolescents may be successfully treated with combined orthopedic/camouflage treatment with a Haas-type expander on acrylic splints, Class III elastics, fixed appliance and orthopedic devices (individual chin-cup and facemask) with a very good compliance.

Effect of Early Orthodontic Treatment on Long-Term Stability of Class II Malocclusions

ABSTRACT Background: Class II malocclusions are a common orthodontic problem, often requiring comprehensive treatment to achieve proper occlusion and facial harmony. Early orthodontic intervention in the mixed dentition phase has been advocated to address these issues. Materials and Methods: A retrospective analysis was conducted on a cohort of 150 patients with class II malocclusions who underwent early orthodontic treatment between the ages of 7 and 10 years. The treatment included fixed or removable appliances, headgear, and functional appliances, depending on individual needs. Records of their initial malocclusion severity, treatment modalities, and long-term follow-up data (mean follow-up duration of 10 years) were collected and analyzed. Stability was assessed by evaluating overjet and overbite changes from post-treatment to the long-term follow-up. Results: The initial mean overjet and overbite values were 8.5 mm and 4.0 mm, respectively. Following early orthodontic intervention, these values were significantly reduced to 3.0 mm and 1.5 mm, respectively (P < 0.001). At the long-term follow-up, the mean overjet and overbite remained stable at 3.2 mm and 1.6 mm, respectively. Analysis revealed that 85% of patients maintained their corrected class II occlusion within clinically acceptable limits, while 15% experienced minor relapse requiring minimal additional treatment. Conclusion: Early orthodontic treatment in class II malocclusions can lead to significant improvements in overjet and overbite, and these corrections tend to remain stable over the long term.

Buccal corridor changes in orthodontically treated extraction and non-extraction Class 1 patients

Patients seek orthodontic treatment mainly to improve their facial aesthetics and obtain an acceptable smile. It is purported that orthodontic extraction treatment may result in narrow buccal corridors which in turn may lead to unaesthetic smile. To determine if the dimensions of the buccal corridors are influenced by extraction or non-extraction treatment in Class 1 patients. Retrospective record-based study conducted between 2012 and 2017 at University of Pretoria Orthodontic department. Smile pictures of pre- and post-treatment Class 1 patients treated with or without premolar extractions were matched. Buccal corridors between the two groups were measured by measurement of visible maxillary dentition and oral aperture dimensions. Data analysis included frequencies and correlations using chi-square test, with a significance level set at p<0.05. Seventy-one patient records met the selection criteria with the majority being females (70%). The age range was between 10 and 37 with a mean of 17.5 years. Thirty-five patients were treated with extractions and thirty-six patients with non-extraction treatment. There was a significant difference in the visible maxillary dentition pre and post treatment with extraction patients showing a 6 to 6 and non-extraction showing 5 to 5 dentition post treatment (p<0.05). There were no differences in the ratios of the visible maxillary dentition and oral aperture in both groups pre and post treatment (p> 0.05). Orthodontic treatment of Class 1 cases with premolar extraction did not lead to deleterious changes in the buccal corridors.

Surgical Orthodontic Treatment of Class III Malocclusion with Unstable Condylar Position and Facial Asymmetry

Surgical Orthodontic Treatment of Class III Malocclusion with Unstable Condylar Position and Facial Asymmetry

THE CHANGES OF MANDIBULAR ROTATION AND LOWER ANTERIOR FACIAL HEIGHT IN DENTOSKELETAL ORTHODONTIC TREATMENT WITH MALOCCLUSION CLASS II/1 ANGLE

Background: Classification of malocclusion, especially in the class II division, has various biological variations and dental abnormalities with the presence of distocclusion of the first molar relation and proclination of the maxillary fourth incisor and causing the patient's profile to become convex. Aesthetic correction in class II division 1 is determined by the choice of treatment and taking into account the rotational pattern of the mandible. Objectives: To determine the effect of orthodontic treatment in relation to changes in mandibular rotation with lower anterior facial height and to determine the parameters of the effect of mandibular rotation on lower anterior facial height (LAFH) in Angle Class II/1 dentoskeletal malocclusion. Methods: Cephalometric data were obtained from lateral cephalograms presented before and after treatment. Assessed changes in Y-axis FH angle, SN - mandibular plane angle (GoMe) and NPog-FH angle facial angle. Data analysis with Pearson was used to correlate the mandibular rotation parameter (angle) with the lower anterior facial height parameter, namely ANS-Me (linear) (p > 0.05). Results: Group 1 access maxilla, normal mandible showed a significant correlation on the Y-FH Axis with ANS-Me. Group 2 with normal maxillary, retrognathic mandibles, showed a significant correlation between NPog-FH with ANS-Me and NPog-FH with extrusion of the upper/lower first molars. Group 3, the combination group which is the maxillary retrognathic access, showed a significant correlation between Sn-GoMe and ANS-Me. Group 4 is with different teeth, but normal bone (grade 1). Conclusion: There is a relationship between changes in mandibular rotation and changes in lower anterior facial height (LAFH) in the orthodontic treatment of class II/1 Angle dentoskeletal malocclusion.

How much should incisors be decompensated? periodontal bone defects during presurgical orthodontic treatment in class III double-jaw orthognathic surgery patients

IntroductionThe aims of this study were to evaluate periodontal bone defects around the lower and upper incisors and to identify changes in the buccolingual inclination of the incisors during orthodontic decompensation in skeletal Class III orthognathic surgery patients. Materials and MethodsThe sample consisted of 26 adults with skeletal Class III deformity who had undergone presurgical orthodontic treatment and orthognathic surgery. Lateral cephalograms obtained before orthodontic treatment and before surgery were used to determine the inclination and position changes of the incisors. Cephalometric measurements were taken using Dolphin Imaging 11.95. Three-dimensional images were generated from cone-beam computed tomography (CBCT) scans prior to surgery and used to detect periodontal bone defects, including fenestration (F) and dehiscence (D). ResultsIntraclass correlation coefficients (ICC) were determined and the measurements showed high reproducibility. The cephalometric data showed normal distribution and there were no differences between genders in terms of cephalometric changes, dehiscence, fenestration, or coexistent (D-F/DF) formation. The patients presented maxillary incisor retroclination and mandibular incisor proclination, which was consistent with the tooth decompensation. CBCT assessment was performed for a total of 208 teeth; while 81 upper and 94 lower incisors had D-F/DF formation, 23 upper and 10 lower incisors were healthy. Statistically significant correlations were not found between the inclination degree of the incisors and D-F/DF formation. ConclusionsDecompensation of incisors during presurgical orthodontic treatment increases the risk of periodontal defects. There is no linear relationship between the increase in the inclination degrees of incisors and D-F/DF formation.

Adaptive Changes in the Posterior Pharyngeal Wall Following Large Retraction of Incisors During Comprehensive Orthodontic Treatment.

To evaluate the effects of large retraction of incisors on the adaptive changes in the posterior pharyngeal wall and soft palate during comprehensive orthodontic treatment. Twenty-seven females with Class I mild crowding or spacing who required non-extraction treatment (group I) and 34 females with Class I bimaxillary dentoalveolar protrusion who required all first premolars extraction for the retraction of their incisors (group II) were included in the study. The effects of non-extraction and incisor retraction following all first premolars extraction orthodontic treatment on the sagittal dimensions of pharyngeal airway passage and posterior pharyngeal wall thickness were evaluated from pre- and post-treatment cephalograms. The dimensions of pharyngeal airway passage were comparable among the groups. The length of the soft palate increased (P < .01) and the thickness of the soft palate decreased (P < .01) following retraction of incisors, and the difference between the groups was significant (P < .05). The posterior pharyngeal wall thickness was reduced significantly at PPWT2 (P < .05), PPWT3 (P < .001), PPWT4 (P < .001), PPWT5 (P < .001), and PPWT6 (P < .01) regions following retraction of the incisors, and the difference between the groups was statistically highly significant. The large retraction of incisors during comprehensive orthodontic treatment in Class I bimaxillary dentoalveolar protrusion malocclusion subjects did not affect the sagittal dimensions of pharyngeal airway passage, but the thickness of the posterior pharyngeal wall reduced significantly as an adaptation to maintain the patency of the upper airway.

Therapeutic approach in Class I malocclusion with impacted maxillary canines.

ABSTRACTObjective: To emphasize the importance of diagnosis and discuss the therapeutic approaches that can be used in the orthodontic treatment of Class I malocclusion associated with two impacted maxillary canines. The opening of spaces for traction of these teeth by means of rapid maxillary expansion or extraction of maxillary premolars was contraindicated in the case reported. Therefore, it was decided to open spaces with projection of incisors. Results: The obtained results were satisfactory, as a good occlusion was obtained, with adequate functional guides, as well as an improvement in the facial appearance. Conclusion: The projection of the incisors prior to traction of the impacted maxillary canines proved to be a valid option in the case described. Ten years after completion of treatment, the case is stable, maintaining periodontal health.

Evaluation of the Perspectives of Orthodontists and Laypersons About the Effect of Orthodontic Treatment on Facial Aesthetics of Young Turkish Patients

Aim: To compare the perspective of orthodontists and laypersons on the effects of orthodontic treatment on facial aesthetics in young Classes I, II, and III Turkish patients. Materials and Methods: In this cross-sectional study, a total of 60 patients (30 males and 30 females, 9 to 17 years of age) was included using randomization in strata and then divided equally ( n = 15) into four groups according to the Angle classification. Photographs during frontal and lateral resting and also smiling were obtained from each patient before and after orthodontic treatment. A panel consisting 50 laypersons and 50 orthodontists was invited for the evaluation of the initial and final photos by using the visual analogue scale and a five-point scale to determine similarities and differences of their perspectives in the effects of orthodontic treatment on facial aesthetics. The data were analyzed by independent t-test, one-way analysis of variance, and Pearson’s correlation test. Results: The evaluation of facial aesthetics and treatment changes were not affected by the age and gender of the panel members ( P &lt;.05). Angle Class III patients were given lower scores by both orthodontists ( P &lt; .001) and laypersons ( P &lt; .05), but no significant differences were found between any of other classes ( P &gt;.05). Orthodontists reported greater improvement for Class III than in Class II Division 1 ( P &lt; .05) however laypersons did not notice the changes after orthodontic treatment for any of Angle classes ( P &gt;.05). Conclusion: Class III patients received lower scores for aesthetics from both panels. Laypersons may not be concerned about the effects of orthodontic treatment on facial aesthetics in patients with any Angle class. Orthodontists have seen more facial aesthetic changes after orthodontic treatment in Class III patients.

Classe II, divisão 1 – da dentição mista à permanente com aparelho ortopédico funcional e fixo

Orthodontic treatment of Class II, division 1 malocclusion in one or two phases is still controversial in contemporary Orthodontics. The present clinical case presents the orthodontic treatment of a 6-year-old patient with aesthetic complaint regarding the smile and bullying, presenting skeletal Class II, Class II malocclusion, Angle division 1, overjet with exaggerated protrusion of the maxillary incisors, exaggerated overbite with the lower incisors touching the palatal mucosa, absence of lip sealing and concave inferior face profile. In Phase I, rapid maxillary expansion was performed with Hyrax-type expander together with the Herbst fixed functional orthopedic device for 11 months. In Phase II, the fixed orthodontic appliance associated with intermaxillary elastics was used for 13 months. The two-phase treatment of Class II malocclusion, division 1 showed to be effective after 24 months, establishing adequate occlusal and functional results and improving the aesthetics of the lower third of the face.

Quantifying changes in incisor inclination before and after orthodontic treatment in class I, II, and III malocclusions

BackgroundThis study was designed to determine if orthodontic treatment significantly changes the upper incisor position in Class I, II, and III dental and skeletal malocclusions. MethodsNinety nonextraction-treated patients were included in this retrospective cohort study and divided into three groups: Class I, Class II, and Class III. All cephalometric measurements (ANB, Wits, U1-PP, U1-SN, U1-NA, U1 perpendicular to FH and U1-L1) were taken using the Dolphin Management and Imaging Software, Version 05.05.5070.221436 (United States and Canada). ResultsThe posttreatment values of ANB, Wits appraisal, U1-NA mm, U1-FH mm, IMPA and U1-L1° are statistically significant (P < 0.05) among the Class I, II, and III when compared with the normal values. Also ANB° changes after orthodontic treatment in Class I, II, and III were statistically significant with the greater changes in Class III malocclusion. ConclusionsThere is a significant amount of dento-alveolar compensation for the maxillary incisors not only in patients with Class II and III but also in Class I malocclusions that underwent nonextraction treatments.

TREATMENT OF CLASS I MALOCCLUSION WITH MILD CROWDING AND MIDLINE SHIFT

ABSTRACT Background: The main goal of orthodontic treatment is to obtain a normal relationship of the teeth with facial structures and it is generally accepted that orthodontic treatment will have effects on facial proportion. Nowadays, facial appearance has a big influence on someone's appearance. Aesthetic facial appearance will produce a proportional, harmonious, and youthful facial profile. Case: this case report aims to describe that non extraction orthodontic treatment in class I malocclusion with mild crowding and mildline shift is a treatment with considerable success. Case management: A 19 years old female came with a chief complaint of crowding in upper and lower jaw. Intraoral examination revealed bilateral Class I molar and canine relationship. Patient had crowding in upper and lower jaw, and midline shift in lower jaw. Extra oral findings included a flat profile with competent lips. Cephalometric analysis showed skeletal class I with orthognati maxilla and mandible. Patient was bonded with 0.022-inch MBT brackets orthodontic appliance without extraction. After 20 months of treatment, an ideal arch coordination was achieved, the patient felt confident and satisfied with the treatment outcome. Conclusion: Decision to extract a tooth has to be made, not only by considering the amount of crowding, but also the eventual influence of orthodontic tooth displacement on the soft tissue surface of the face. Keywords: Crowding, Midline shift, Non – extraction.

Rapid maxillary expansion facemask therapy in growing patients: A 2 case report and review of literature

Class III malocclusion is progressive in nature and it worsens with age. Class III malocclusion is associated with any deviation in the sagittal relationship of the maxilla and the mandible; it is characterized by a deficient maxilla, retrognathic mandible, or a combination of both. It is very difficult to diagnose and treat Class III malocclusion. Many treatment approaches can be found in the literature regarding orthopedic and orthodontic treatment of Class III malocclusion, including intra- and extra-oral appliances. The early treatment of Class III malocclusions requires orthopedic intervention at the end of primary dentition or the beginning of mixed dentition, prior to growth spurt, which provides successful results, with good facial balance, modifying the maxillofacial growth and development, and prevents future surgical treatment by increasing the stability. Approximately 30%–40% of Class III patients exhibit some degree of maxillary deficiency; therefore, devices can be used for maxillary protraction for orthodontic treatment in early mixed dentition. In cases in which dental components are primarily responsible for Class III malocclusion, early therapeutic intervention is recommended. In this article, we described the treatment options for Class III malocclusion in growing patient with an emphasis on maxillary protraction.

Patients' perception on mini-screws used for orthodontic treatment in Class II Malocclusion

Introduction: The aim of the present study was to clinically evaluate the perception of pain of mini-screws in the maxillary arch for anchorage control for retraction of maxillary anterior segment in conjunction with orthodontic treatment. Materials and Methods: The sample consisted of fifty adult patients with a mean age of 24.5 years, with Class II malocclusion, and the patients were divided into two groups. In Group A, 0.022” McLaughlin, Bennett, and Trevisi Bracket System (MBT) was used in 25 patients as fixed orthodontic treatment and 0.016” nickel-titanium (Ni-Ti) wire was placed for initial alignment, whereas in Group B, a total of fifty mini-screws were placed in 25 patients, one mini-screw on each side in the maxilla between the 2nd premolar and the 1st molar. The patients answered a questionnaire to assess their opinions on treatment. Results: The data of description of pain experienced in 24 h, 2nd day, and 7th day in Group A and Group B are enumerated. In Group A, the pain experienced in 24 h, 2nd day, and 7th day was 49.72 (36.22), 37.17 (35.32), and 17.34 (14.45) and in Group B, it was 24.72 (15.65), 13.32 (14.34), and 12.45 (11.60), respectively. The questionnaire set was completed for functional aspect evaluation. The descriptive data of visual analog scale were presented. During this study, patient had difficulty in eating, food sticking around implant, and interference during tooth brushing was moderate, but there was no any anaesthetic appearance and disturbance in chewing ability was noted. Statistical Analysis: The nonparametric Kruskal–Wallis and Mann–Whitney tests were performed to evaluate the differences between the groups for pain. The Chi-square test was used to determine differences between the procedures. Differences at P Conclusion: The present study stated that the pain experience after mini-screw insertion is significantly low. The peak of the pain and discomfort level was recorded 4 h to 24 h following the insertion. Thus, mini-screws were found to be an acceptable option in providing orthodontic treatment

Facial esthetic outcome of functional followed by fixed orthodontic treatment of class II division 1 patients

ObjectivesTo assess the perceived facial changes in class II division 1, convex profile patients treated with functional followed by fixed orthodontic appliances.Subjects and methodsThe study sample consisted of 36 pairs of pre- and post-treatment photographs (frontal and profile, at rest) of 12 patients treated with activator, 12 with twin-block, and 12 controls with normal profiles, treated without functional appliances. All photographs were presented in pairs to 10 orthodontists, 10 patients, 10 parents, and 10 laypersons. Visual analog scale (VAS) ratings of changes in facial appearance were assessed.ResultsThe patient groups were similar in sex distributions, age, and treatment duration. The different rater groups showed strong to excellent agreement. There were no significant differences among treatment groups (F = 0.91; P = 0.526; Wilks lambda = 0.93), raters (F = 1.68; P = 0.054; Wilks lambda = 0.83), and when testing the combined effect of treatment and rater on the results (F = 0.72; P = 0.866; Wilks lambda = 0.85). The raters detected slightly more positive changes in the activator and twin-block groups, compared to the control group, regarding the lower face and the lips, but these findings did not reach significance. Furthermore, their magnitude hardly exceeded 1/20th of the total VAS length.LimitationsRetrospective study design.ConclusionsThe perceived facial changes of convex profile patients treated with functional, followed by fixed orthodontic appliances, did not differ from those observed in normal profile patients, when full-face frontal and profile photos were simultaneously assessed. Consequently, professionals should be skeptical regarding the improvement of a patient’s facial appearance when this treatment option is used.

Orthodontic treatment of class three malocclusion using clear aligners: A case report

Class III malocclusion is a growth-related challenging condition for orthodontists. We present a case of a 11-year-old girl with a skeletal class III malocclusion with bilateral cross bite, and a functional shift of the lower dental midline. A multiphase clear aligners' treatment was scheduled with the aim of removing all dental interferences which involved an anterior displacement of the mandible. At one-year follow-up, clear aligners’ therapy resulted in skeletal and dental improvements. Clear aligners therapy represents a valid alternative to fixed appliance therapy in the early interception of class III malocclusion. The present manuscript was prepared following the CARE guidelines.

Evaluation of Pain, Discomfort and Acceptance During the Orthodontic Treatment of Class III Malocclusion

Evaluation of Pain, Discomfort and Acceptance During the Orthodontic Treatment of Class III Malocclusion

Non-Surgical Orthodontic Treatment of Class III Adult with Posterior Crossbite, Anterior Open Bite and Asymmetric Occlusion, Using TADs and Auxiliary Wires: A Case Report

Class III malocclusion associated with posterior crossbite, anterior open bite pattern with asymmetric occlusion in adults can be a challenging orthodontic problem, especially for the nonsurgical treatment. Skeletal Class III anteroposterior discrepancies in adult patients are generally managed either by surgical-orthodontic treatment or by orthodontic camouflage through dentoalveolar compensation. Although correction with surgery may be the most effective and stable way, many patients refuse surgical treatment plan because of the costs and traumas it may bring. This case report describes the successful use of TADs with expansion auxiliary wire to treat a 24-year-old man with skeletal class III malocclusion, posterior crossbite, anterior open-bite and asymmetric occlusion, mild upper and lower dental spacing and a chief manifestation of anterior crossbite. The patient refused surgery. A treatment plan was formulated consisting of using auxiliary expansion wire to expand the maxillary arch, 8 mm mini-screws between the roots of the mandibular canines and first premolars, preadjusted edgewise brackets to align the teeth, Class III and asymmetric elastics to correct the canines, premolars, and molars relationship and midline deviation, reverse curve of the nickel-titanium wire combined with anterior vertical elastics to intrude molars and correct the anterior open-bite. In this case, without going through surgery, the posterior cross-bite was corrected, and ideal overjet and overbite relationships, midline coincidence and functional occlusion were all achieved. Satisfactory occlusal, functional, esthetic and stable results were obtained.

Early Orthodontic Treatment of Class II Malocclusion with Functional Appliances

Early Orthodontic Treatment of Class II Malocclusion with Functional Appliances

TADs assisted Camouflage Orthodontic Treatment of Class II Division 1 Malocclusion in a Non Growing Patient: A case report

Class II, Division I malocclusion has been described as the most frequent treatment problem in orthodontic practice. Aim &amp; objectives of the present case report was to evaluate the management of skeletal Class II division 1 malocclusion in non growing patient with extraction of upper first premolars. Clinical and cephalometric evaluation revealed skeletal Class II with Angles Class II division 1 malocclusion with mild mandibular anterior crowding and increased overjet, severe maxillary incisor proclination, mild mandibular crowding, exaggerated curve of spee, convex profile, incompetent lips, increased overjet and overbite. Maxillary first premolars were extracted followed by en-masse retraction of anteriors with the help of temporary anchorage devices (TADs) to avoid anchorage loss. Mandibular incisor was extracted to correct curve of spee. Following treatment marked improvement in patient’s smile, facial profile and lip competence were achieved and there was a remarkable increase in the patient’s confidence and quality of life.