Post-treatment Cephalograms Research Articles

Changes in the curvature of upper and lower lips following the first premolar extraction in Class I bimaxillary protrusion - A cephalometric study

Bimaxillary dentoalveolar protrusion is a condition characterized by protrusion of the maxillary and mandibular incisors with increased procumbency of the lips. The treatment of choice for these patients is fixed orthodontic treatment after extraction of four first premolars. This treatment would result in the retraction of anterior teeth with a resultant decrease in soft tissue convexity. Objective of the study is to find out how the curvature of upper and lower lip change following fixed appliance therapy in patients with class I Bimaxillary protrusion following extraction of first premolars. A total of 32 subjects, 13 males and 19 females in the age group of 13-21 years diagnosed with BMP were included in the study. Pre-treatment and post-treatment cephalograms were obtained from subjects satisfying the inclusion and exclusion criteria. Cephalometric landmarks, lines used in the study were marked and analysed. The soft tissue parameters were measured and compared using paired t test and Pearson’s correlation coefficient. The overall effect of orthodontic correction of bimaxillary protrusion from subjects were analysed by evaluating the soft tissue changes between pre-treatment and post treatment cephalometric radiographs. There is a statistically significant difference with decrease in ULST, B`-PM line, B`-LiPog`, A`-PM line, LLIT, LLVT, Pog-Pog` and no statistically significant difference in A`-NtLs and ULVT. The results showed a reduction in lip procumbency. Among the soft tissue parameter studied, there is a statistically significant decrease observed for ULST, B`-PM line, B`-LiPog`, A`-PM line, LLIT, LLVT and Pog-Pog`.

Cephalometric Evaluation of the Pre- and Posttreatment Changes after the Correction of Class II Division 1 Malocclusion with Twin Block Appliance in Mixed Dentition.

To evaluate the pretreatment cephalometric records on the dental, skeletal, soft tissue, and incisor relationship with a twin block functional appliance in class II malocclusion patients in and around Mahe; evaluate the posttreatment cephalometric records on the dental, skeletal, soft tissue, and incisor relationship with a twin block functional appliance in class II malocclusion patients in these children; and to compare cephalometrically certain dental, skeletal, and soft tissue points in pretreatment and posttreatment cephalograms in them. This study was conducted on 20 class II patients in the mixed dentition period, who were treated with twin block therapy. Each had to meet the following criteria-(1) skeletal class II malocclusion with retrognathic mandible; (2) full cusp class II molar relationship; and (3) an angle of ANB of 50 or greater at the start of treatment. All patients wore the appliance 24 hours/day. The pretreatment cephalometric head films for the group were taken using standard cephalometric X-ray equipment. The length of time required to achieve a class I molar relationship was assessed. Appointments during the twin block phase were scheduled at intervals of 8 weeks. Lateral head films were obtained again at the posttreatment follow-up stage. There was a significant increase in effective mandibular length, ramus height, SNB, ANB, overjet, overbite, and I to NA (mm and degrees) after twin block therapy. The maxillary incisor position showed a decrease in its value by 4° in five cases. Thus, in the present study, evidence of skeletal and dentoalveolar changes leading to the correction of class II division 1 malocclusion with the twin block functional appliance has been established. However, further studies with a longer period of follow-up and a larger sample are required to substantiate the results of the present investigation. Bimalrag BR, Ephraim R, Ayilliath A, et al. Cephalometric Evaluation of the Pre- and Posttreatment Changes after the Correction of Class II Division 1 Malocclusion with Twin Block Appliance in Mixed Dentition. Int J Clin Pediatr Dent 2024;17(7):783-789.

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.

A Novel Algorithm for Forensic Identification Using Geometric Cranial Patterns in Digital Lateral Cephalometric Radiographs in Forensic Dentistry.

Lateral cephalometric radiographs are crucial in dentistry and orthodontics for diagnosis and treatment planning. However, their use in forensic identification, especially with burned bodies or in mass disasters, is challenging. AM (antemortem) and PM (postmortem) radiographs can be compared for identification. This study introduces and evaluates a novel algorithm for extracting cranial patterns from digital lateral cephalometric radiographs for identification purposes. Due to the unavailability of AM cephalograms from deceased individuals, the algorithm was tested using pre- and post-treatment cephalograms of living individuals from an orthodontic archive, considered as AM and PM data. The proposed algorithm encodes cranial patterns into a database for future identification. It matches PM cephalograms with AM records, accurately identifying individuals by comparing cranial features. The algorithm achieved an accuracy of 97.5%, a sensitivity of 97.7%, and a specificity of 95.2%, correctly identifying 350 out of 358 cases. The mean similarity score improved from 91.02% to 98.10% after applying the Automatic Error Reduction (AER) function. Intra-observer error analysis showed an average Euclidean distance of 3.07 pixels (SD = 0.73) for repeated landmark selections. The proposed algorithm shows promise for identity recognition based on cranial patterns and could be enhanced with artificial intelligence (AI) algorithms in future studies.

Evaluation of the facial profile of skeletal Class III patients undergoing camouflage orthodontic treatment: a retrospective study.

To identify objective metrics for evaluating the esthetics of facial profiles in skeletal Class III patients undergoing camouflage orthodontic treatment. Eighty Asian-Chinese patients classified as skeletal Class III were included. Thirty cephalometric measurements of pre- and posttreatment cephalograms were analyzed. Ten orthodontists assigned visual analog scale (VAS) scores to the pre- and posttreatment profiles based on standardized lateral photographs. Correlations between subjective VAS scores and objective measurements were assessed using Pearson correlation and stepwise multiple linear regression analysis. Lower incisor (L1) protrusion, nasolabial angle, lower lip-E line distance, SNB angle, and L1 to AP plane were significantly correlated with VAS scores of pretreatment profiles of skeletal Class III patients. Factors such as retraction of the lower incisor, increased interincisal angle and overjet, reduction of lower lip-E line distance, as well as augmentation of the Z angle and nasolabial angle were significantly correlated with the changes in VAS scores post-camouflage orthodontic treatment. Stepwise multiple linear regression analysis revealed that pretreatment nasolabial angle, changes in the lower lip-E line distance, and pretreatment Pog-NB distance were the key factors influencing the posttreatment facial profile esthetics of skeletal Class III patients with camouflage orthodontic treatment. Several cephalometric measurements correlate with subjective facial esthetic evaluations of skeletal Class III patients. Changes in lower lip prominence, the pretreatment nasolabial angle, and Pog-NB distance are the main factors related to facial esthetics in skeletal Class III patients after camouflage orthodontic treatment.

Does planned molar intrusion with aligners assist with closure of anterior open bite?

This study aimed to determine whether prescribed molar intrusion, with or without virtual occlusal bite-blocks (BB), resulted in actual molar intrusion and assisted with anterior open bite (AOB) correction in adult patients treated with Invisalign clear aligners (Align Technology, Santa Clara, Calif). A retrospective study was conducted with 36 adult patients with AOB. Subjects were divided into 2 treatment groups: planned molar intrusion (PMI) and no-PMI (No-PMI). PMI was obtained from the tooth movement tables in the ClinCheck software. Patients with PMI were further categorized by the presence or absence of virtual posterior BB (PMI-BB and PMI-No BB, respectively). Treatment success was determined on the basis of positive vertical incisor overlap in posttreatment cephalograms. Treatment changes were assessed using pretreatment and posttreatment cephalometric radiographs (Welch 2-sample t test, 95% confidence interval, P= 0.05). Finally, treatment stability was assessed at least 1-year posttreatment using the Photographic Open Bite Severity Index (POSI). There were 15 patients with No-PMI and 21 without PMI (total n= 36). The mean overbite change was 2.5 ± 1.0 mm for No-PMI and 3.2 ± 1.8 mm for patients with PMI (P= 0.12). All patients had positive vertical incisor overlap in posttreatment cephalograms, indicating 100% treatment success. Open bites were corrected primarily by incisor retroclination and extrusion in both treatment groups. The average measured molar intrusion for the PMI group was 0.71 mm greater than the change for the No-PMI group, but the difference was not statistically significant after controlling for potentially confounding variables (P= 0.074). A total of 14 patients from the original sample were assessed for stability using the POSI analysis. Of those, 12 (85.7%) had a POSI score of0. Regardless of whether the molar intrusion was planned or not, the modality of AOB correction with Invisalign clear aligners was primarily incisor extrusion and retroclination. Overall, aligners are an effective appliance for the treatment of adult AOB. Based on our limited sample, treatment stability was similar to that reported for fixed appliances.

Does Upper Incisors Procline following Rapid Maxillary Expansion Facemask Therapy?

Background: The present study is intended to evaluate the changes in upper incisor angulation, skeletal and dental parameters, soft-tissue and airway dimensions following rapid palatal expansion and maxillary protraction. Materials and Methods: Twenty class III subjects (mean age 11.3 years) were given bonded rapid maxillary expansion (RME) and facemask (FM) for 6 months. Pre- and posttreatment cephalogram were compared and dental, skeletal, soft-tissue, and airway changes were quantified. Results: The mean increase in SNA was 1.85° (P < 0.001) while SNB decreased by 1.85° (P < 0.001). Upper and lower face height increased (UFH 1.1 mm, P < 0.05; LFH 2.92 mm, P < 0.001). Upper lip moved forward (E line U/lip 1.27 mm, P < 0.001; S line U/lip 1.3 mm, P < 0.01). 1-SN decreased by 4.35° and 1-NA decreased by 4.50° with P < 0.01. Overjet improved by 3.07 mm (P < 0.001). Conclusion: RME and FM therapy resulted in maxillary forward movement; mandible rotated downward and backward; UFH and LFH increased. The upper lip exhibited forward movement, resulting in a less concave profile. Upper incisor retroclined and there was increase in overjet and no changes in airway dimensions. The upper incisors following RME and FM does not always procline; it is decided by the interaction of four factors – mesial dental movement, rotation of maxillary/occlusal plane, amount of expansion with RME (expansion effect), and reverse twin block if incorporated with FM.

A comparative study on anterior teeth retraction-related hard and soft tissue changes with physiologic anchorage control technique

Aim of this comparative cross-sectional study was to evaluate the effect of anterior teeth retraction and related hard and soft tissue change under physiologic anchorage control in patients with chief complain of protrusive teeth. 68 Class I or II orthodontic patients undergoing four-premolar extraction and requiring maximum or medium anchorage were included. Patients were treated with physiologic anchorage control technique (PASS group, n = 34, 18.6 ± 7.7 years, 10 male and 24 female) and self-ligation technique (Damon group, n = 34, 17.5 ± 5.4 years, 13 male and 21 female), respectively. TADs were used for anchorage reinforcement in Damon group. Pre- and post-treatment cephalograms were collected. Twenty-six skeletal, dental and soft tissue items were measured and analyzed using a blinded method. T test and paired rank-sum test were used for statistical analysis. The baseline characteristics were similar between groups (P > 0.05). After treatment, inter-group comparison showed statistically significant differences in the decrease of skeletal measurements ∠ANB (− 0.73 ± 1.05° in PASS group and − 0.25 ± 0.84° in the Damon group), Wits value (− 2.56 ± 2.29 mm in PASS group and − 0.47 ± 2.15 mm in Damon group) and soft tissue measurement UL-E (− 2.75 ± 1.36 mm in PASS group and − 2.03 ± 1.30 mm in Damon group) and the increase of FCA and Z angle, which was 2.03 ± 2.12°and 9.52 ± 4.78°in PASS group and 0.97 ± 2.12°and 6.96 ± 4.43°in Damon group, respectively (P < 0.05). Our results indicated that significant anterior teeth retraction and profile improvement could be achieved with PASS technique without additional anchorage devices. Appropriate application of physiologic anchorage control could reduce the dependence of TADs for anterior teeth retraction.

Facial profile evaluation and prediction of skeletal class II patients during camouflage extraction treatment: a pilot study

BackgroundThe evaluation of the facial profile of skeletal Class II patients with camouflage treatment is of great importance for patients and orthodontists. The aim of this study is to explore the key factors in evaluating the facial profile esthetics and to predict the posttreatment facial profile esthetics of skeletal Class II extraction patients.Methods124 skeletal Class II extraction patients were included. The pretreatment and posttreatment cephalograms were analyzed by a trained expert orthodontist. The facial profile esthetics of pretreatment and posttreatment lateral photographs were evaluated by 10 expert orthodontists using the visual analog scale (VAS). The correlation between subjective facial profile esthetics and objective cephalometric measurements was assessed. Three machine-learning methods were used to predict posttreatment facial profile esthetics.ResultsThe distances from lower and upper lip to the E plane and U1-APo showed the stronger correlation with profile esthetics. The changes in lower lip to the E plane and U1-APo during extraction exhibited the stronger correlation with changes in VAS score (r = − 0.551 and r = − 0.469). The random forest prediction model had the lowest mean absolute error and root mean square error, demonstrating a better prediction accuracy and fitting effect. In this model, pretreatment upper lip to E plane, pretreatment Pog-NB and the change of U1-GAll were the most important variables in predicting the posttreatment score of facial profile esthetics.ConclusionsThe maxillary incisor protrusion and lower lip protrusion are key objective indicators for evaluating and predicting facial profile esthetics of skeletal Class II extraction patients. An artificial intelligence prediction model could be a new method for predicting the posttreatment esthetics of facial profiles.

Soft tissue and incisor position changes in class I bimaxillary subjects after retraction using friction and frictionless mechanics

Aim: Bimaxillary protrusion is a common condition observed irrespective of race and ethnicity and is a chief concern for patients who seek orthodontic treatment. The aim of this study was to compare and evaluate changes in soft tissue structures and incisor positions in class I bimaxillary protrusion subjects undergoing orthodontic therapy when friction and frictionless mechanics were used. Methods: Two groups with a total of 40 patients aged 18–30 years diagnosed with class I bimaxillary protrusion treated by extracting first premolars were considered for this study. Patients treated with friction mechanics were included in Group 1 and those treated with frictionless mechanics in Group 2. The digital lateral cephalograms were calibrated and analyzed using Nemoceph software. Selected landmarks were marked on pre- and post-treatment cephalograms and assessed for intra- and inter-group soft tissue and incisor position changes. Student’s t-test was used to analyze the collected data using SPSS 20 software. Result: Intragroup comparison revealed significant changes in both groups. Inter-group comparison of the selected parameters between groups 1 and 2 showed differences but without any statistical significance, except for the inter-incisal angle. Conclusion: Pre- and post-treatment comparison analysis revealed significant soft tissue changes in both groups. However, the comparison between friction and frictionless mechanics showed no statistically significant changes.

Evaluation of Dentoskeletal and Profile Changes with Distal Jet in Moderate Skeletal Class II Patients

In an orthodontic treatment, upper molar distalization is mandatory to gain space in upper arch. Objective: To evaluate the nature of molar distalization &amp; its effects on soft tissue profile, dentoalveolar structures &amp; skeletal structures. Methods: This was a retrospective study design. 20 subjects were found to be eligible for the distalization with average age of 19.4 yrs. Only Distal jet was used for distalization and one operator was there for all the subjects. Pre and post treatment cephalograms were taken to analyze dentoalveolar &amp; soft tissue changes. Paired sample T test was used. Results: Notable amount of molar distalization and increased lower face height was achieved. Conclusions: This study verified definite distalization of maxillary first molars using distal jet showing a better bodily movement with less tipping movement, with certain unwanted &amp; reactionary effects on incisor position &amp; limited effects on facial soft tissues.

Profile Changes in Class III Malocclusion using Protraction Facemask in Indonesian Young Patients (Cephalometric Study)

Background: The prevalence of Class III malocclusion is highest in Southeast Asia. In countries such as Malaysia and Indonesia, the prevalence is as high as 15.80%. Treatment timing and options are very important in treating Class III malocclusion. A protraction facemask or also known as reverse headgear is one of the most used appliances as an interceptive tool for Class III malocclusion in young patients. Objectives: This study aims to evaluate the profile changes in treating Indonesian young patients using a protraction facemask. Methods: The sample consisted of 63 subjects, 25 males and 38 females. Lateral cephalograms were traced and analyzed using CephaloMetrics AtoZ™ ver. 12 (Yasunaga Computer Systems, Co. Inc., Hanando-Minami, Fukui, Japan). A total of 16 traditional cephalometric measurements (13 skeletal measurements and 3 dental measurements) were used to describe changes between pretreatment and posttreatment cephalograms. All recorded data were analyzed using IBM SPSS version 21 (IBM Corporation, Armonk, New York, USA). Results: SNA (p˂0.030), ANB (p=0.000), and Wits appraisal values (p=0.000) showed significant differences out of all measurements. FMA and occlusal plane also showed changes and indicated that a facemask is helpful with treatment. Conclusion: Timing, duration, and patient compliance are very important in the management of Class III skeletal malocclusion using a protraction facemask. The use of facemask therapy among Indonesian pediatric patients resulted in an anterior and downward movement of the maxilla, backward rotation of the mandible, and a better orthopedic response.

Mesial movement of maxillary first molars and vertical dimensional changes in orthodontic extraction treatment for patients with different facial morphology

Objectives: Primarily, to compare anchorage loss and changes in mandibular plane (MP) angle, overbite, and amount of horizontal, vertical, and angular movements of maxillary incisors in groups of hypodivergent, hyperdivergent, and normodivergent patients. Secondarily, to analyze the relationship between those factors. Methods: Pre- and post-treatment cephalograms of 89 patients treated with extraction of four bicuspids or two maxillary bicuspids were analyzed. The sample was divided into three groups based on their facial pattern measured by SN-MP angle (hypodivergent: &lt; 270, hyperdivergent: &gt;380, and normodivergent: 270-380). Linear and angular measurements included the distances of U1 tip and U6 mesial height of contour to Y-axis (i.e., line perpendicular to the X-axis, passing through Sella turcica), distance of U1 tip to Sella on X-axis, overbite, angulation of U1 to palatal plane, and SN-MP and ANB angles. Inferential statistics included one-way ANOVA, Chi-square test, independent t-test, and Pearson’s correlation coefficients. Results: Facial morphology did not primarily affect anchorage loss, because other factors such as crowding, severity of Class II molar relationship, and extraction modality played more impactful role (P&lt; 0.01). Change in mandibular plane angle was neither influenced by, nor correlated with, initial facial morphology or anchorage loss (P&gt; 0.05). Positive change in overbite was significantly correlated with facial pattern, incisor extrusion and retroclination (r= 0.30, 0.44, and -0.35, respectively, P&lt; 0.01). Conclusion: Anchorage loss in extraction orthodontic treatment is not influenced primarily by initial facial morphology. Anchorage loss is not significantly associated with MP angle reduction. Change in overbite can be achieved through incisor extrusion and retroclination.

Effects of Two-Phase Treatment with Functional Appliances Followed by Extraction versus One-Phase Treatment with Extraction in Class II Growing Patients: A Case-Control Study.

Objectives: Fixed appliance treatment with premolar extraction is often required after functional appliance treatment to relieve crowding and improve facial aesthetics in the Asian population. This study compared the treatment efficacy of two approaches for treating Class II division 1 malocclusion: functional appliance followed by fixed appliance treatment with extraction (two-phase) and fixed appliance treatment with extraction (one-phase). Methods: Growing skeletal Class II patients with an overjet of ≥6 mm treated with two- or one-phase orthodontics were included. The two groups consisted of 29 patients (mean age = 12.55) and 30 patients (mean age = 12.72), respectively. Pre- and post-treatment cephalograms were analysed and skeletal, dental, and soft tissue characteristics were compared using independent t-tests. Treatment changes were compared within and between groups using paired and independent t-tests, respectively. Stepwise discriminant analysis was performed to identify the variables that best predicted pre-treatment group allocations. Results: At baseline, there were no significant between-group differences in age, gender, cervical vertebral maturation, or overjet. The two-phase group had greater Class II skeletal discrepancies (ANB angle and Wits appraisal). During treatment, the two-phase group showed greater improvements in intermaxillary relationship and facial convexity compared with the one-phase group (p < 0.01). Following treatment, the two-phase group had a greater L1/APog distance (p < 0.05). Facial convexity and Wits appraisal were identified as parameters significantly influencing the clinicians’ decision to use a one- or two-phase approach. Conclusions: In patients requiring premolar extraction, two-phase (vs. one-phase) treatment produced greater improvements in the intermaxillary relationship and facial convexity.

Cephalometric evaluation and comparison of upper pharyngeal airway space in cleft lip and cleft palate patients treated with maxillary advancement and camouflage

Introduction: Pharyngeal airway space has become an important criterion for diagnosis and treatment planning and this has led to a paradigm shift towards soft tissue evaluation for orthodontic diagnosis and treatment planning, The aims and objectives of the study were to evaluate and compare upper pharyngeal airway space in Cleft Lip &amp; Cleft Palate patients who underwent orthodontic treatment under different treatment modalities like Camouflage treatment &amp; Maxillary Advancement. Methods: This is a retrospective cephalometric study in which 20 Pre-treatment Cephalograms and 20 Post-treatment Cephalograms of Cleft Lip and Palate patients were taken. Orthodontic treatment involving Camouflage therapy and Maxillary Advancement were studied in each respective group. The Cephalogram was traced on Matt acetate paper and the pharyngeal airway space was measured using the McNamara analysis method. Results: Statistically significant difference was observed in the Pre-treatment and Post-treatment mean values in both groups, where the Post-treatment mean was higher than the Pre-treatment means in both groups. A highly significant mean was noted in the Cleft Surgical group as compared to the Camouflage (xiii) group, where, the post-treatment upper airway mean was higher in the Cleft Surgical group than the Cleft Camouflage group. Conclusion: There is a significant increase in upper pharyngeal airway space in patients with CLCP treated with Maxillary Advancement and Camouflage modality. The significance is comparatively more in the Maxillary Advancement group than in the Camouflage group.

Validity and reproducibility of a tripoding method in point registration-based 3D superimposition software compared to a conventional cephalometric method

Abstract Objective: The present study aimed to assess the validity and reproducibility of a tripoding reference method for digital study cast superimposition to measure maxillary tooth movement. Methods: This retrospective study used 30 treated orthodontic cases which required premolar extractions. Pre- and post-treatment cephalograms were conventionally superimposed, while digitised study casts were superimposed using point registration-based software (Materialise 3-matic Research 12.0) and a tripoding method. This method involved superimposing the digital study casts using the medial two-thirds of the third palatal rugae, and the bilateral depression of the greater palatine foramen as references. Incisor and molar orthodontic tooth movements in the vertical and horizontal planes were measured using the Pancherz analysis for cephalograms and Materialise 3-matic software for the digitised study casts. Validity and agreement were assessed by a paired t test and a Bland-Altman analysis while reproducibility was assessed by an intraclass correlation coefficient (ICC) and a paired t test. Clinical significance was set at 2 mm. Results: The paired t tests found no statistically significant differences (p &gt; 0.05) in tooth movements between the cephalometric and digitised cast measurements, and between the same measurement methods. However, the Bland-Altman analysis showed the 95% limits of agreement were greater than 2 mm but less than 4.3 mm for all measurements. The ICC showed all measurements had good to excellent reproducibility. Conclusion: The tripoding method is a valid and reliable method to superimpose the maxillary study casts for measuring incisor and molar orthodontic movements but it is not interchangeable with the Pancherz analysis.

The Effects of Occlusal Plane Inclination and Dental Decompensation on the Overall Result of Surgical Correction of Class II Malocclusion.

To evaluate the effects of upper occlusal plane (UOP) inclination and incisor decompensations on the outcome of surgical Class II patients. Pretreatment (T0), preoperative (T1), and posttreatment (T2) cephalograms of 30 surgical Class II patients were included. Cephalometric measurements were performed using the Dolphin Imaging Software in this retrospective study. The differences between time points were analyzed with repeated measures ANOVA. Spearman correlation test was used to determine any correlations between either the UOP alterations or incisor decompensations and the cephalometric variables. A significant improvement was obtained in the sagittal skeletal, dental variables, and soft tissue B point. Significant correlations were found between the decompensation achievement ratio and the change of the convexity angle. The relative percentage ratio (RPR) of the lower incisor was correlated with Wits appraisal, ANB, and Convexity Angle at the T2 stage. The RPR of the upper incisor was found to be correlated with lip strain. The relative surgical correction ratio of the UOP angle was found to be correlated with the surgical change of Wits appraisal and convexity angle. The RPR of the UOP angle was correlated with the SNB, ANB, and SN-GOGN angles at the T2 stage. Significant improvement in the incisor inclinations was achieved, but the incisors were inadequately decompensated at the preoperative phase. Surgical correction was limited by the inadequate presurgical decompensation. The surgical alteration of the UOP should be taken into consideration for the surgical planning to obtain better outcomes for Class II patients.

Comparison of soft tissue changes between incisor tipping and translation after premolar extraction.

ObjectiveThis study compared soft tissue changes after extraction of the four premolars followed by maximum retraction of the anterior teeth according to the type of anterior teeth movement tipping and translation.MethodsPatients who had undergone orthodontic treatment involving the extraction of four premolars were retrospectively selected and divided into either the tipping (n = 27) or translation (n = 26) groups based on the retraction of the incisor root apex and the axis changes of the incisors during the treatment period. Lateral pre- and post-treatment cephalograms were analyzed.ResultsThere were no significant differences between the tipping and translation groups before treatment. The retraction amounts of the root apex of the upper and lower incisors in the tipping group were 0.33 and 0.26 mm, respectively, and 5.02 and 5.31 mm, respectively, in the translation group (p < 0.001). The posterior movements of soft tissue points A and B in the tipping group were 0.61 and 1.25 mm, respectively, and 1.10 and 3.25 mm, respectively, in the translation group (p < 0.01). The mentolabial sulcus angle increased by 5.89° in the tipping group, whereas it decreased by 8.13° in the translation group (p < 0.001).ConclusionsAn increased amount of retraction of the incisor root apex led to the increased posterior movement of soft tissue points A and B, and this appeared more distinct in cases involving the lower incisor and lower lip.

Prediction accuracy of Dolphin software for soft-tissue profile in Class I patients undergoing fixed orthodontic treatment

Simulation and prediction can facilitate the decision between an extraction versus nonextraction treatment plan. This study aimed to assess the accuracy of Dolphin Imaging software in predicting profile changes in class I borderline cases. In this retrospective study, class I borderline patients (i.e., both extraction and nonextraction treatment plans were possible for them) aged 15-35 years were enrolled. All of the cephalometric analyses were done by DolphinImagingsoftware, version 11.8Premium. The initial cephalograms were superimposed on initial photographs. The final values for the 7 angular and linear landmarks of the upper and lower incisors were extracted from post-treatment cephalograms and inserted in the "Goals" tab of the Dolphin Imaging software. Post-treatment images of patients were simulated. Final post-treatment photographs were superimposed on the simulated pictures. The differences between the real and simulated pictures were calculated in relation to the reference lines. The P value was set at 0.05. A total of 70 patients (36 with tooth extraction, and 34 without tooth extraction) were included. In the extraction group, the horizontal position of both lips was predicted to be significantly more protruded than it actually was, whereas in the nonextraction group, the only difference between the simulated and actual results was that the vertical position of the lower lip, which was simulated as being more inferior than it actually was. Despite the statistically significant differences between the real and simulated pictures, the differences were small and clinically insignificant. Prediction via Dolphin Imaging software can be an appropriate guide in extraction-nonextraction borderline cases.

Comparison of the hard and soft tissue changes of bimaxillary protrusion patients treated with Begg and MBT techniques: a cephalometric study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The effective treatment of bimaxillary protrusion needs a sound knowledge of the mechanics and expertise to control the tooth movement and the unwanted side effects. To obtain a desired finish there is a need to study and compare the mechanics used for correction of bimaxillary protrusion. The aim of this study was to quantify and compare the skeletal, dentoalveolar and soft tissue effects of Begg and MBT mechanotherapies in the treatment of bimaxillary protrusion cases.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In the present study, cephalometric comparison of the two mechanotherapies, Begg and MBT appliances was done retrospectively. The subjects were selected on the basis of pretreatment characteristics. The sample consisted of 40 patients (20 in each group) with an age range of 12-24 years. Pre- and post-treatment cephalograms were taken and traced on 75μm lacquered polyester acetate tracing papers using a 0.05” lead pencil.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The present study showed that Begg and the MBT appliances were equally effective in treating bimaxillary protrusion with first premolar extraction to satisfactory end results. Treatment with both the appliances resulted in significant amount of upper and lower anterior retraction and achievement of a pleasing facial appearance and profile.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Good torque control, if used in Begg mechanotherapy will result in achieving similar treatment outcome as obtained with MBT technique.&lt;/p&gt;