Retrognathic Mandible Research Articles

Long-term three-dimensional condylar remodeling during presurgical orthodontics and after orthognathic surgery of mandibular retrognathia with high mandibular plane angle.

Patients with high mandibular plane facial morphology are the most dominant facial type who experience TMJ abnormalities with resultant condylar resorption, affecting the orthodontic and orthognathic treatment outcomes. The study aimed to quantitatively assess the three-dimensional condylar remodeling during the presurgical orthodontics and after orthognathic surgery of the retrognathic mandible with a high mandibular plane angle. The study also investigated the correlation between the resultant remodeling based on the hypothesis that condylar resorption following orthognathic surgery is a part of a progressive presurgical resorption process. The study included adults with mandibular retrognathism and high mandibular plane angle who have computed tomography scans (CT) obtained before any treatment (T0), after completion of presurgical treatment before surgery (T1), and at long-term follow-up after surgery (T2). DICOM of CT scan was gathered and processed using ITK-SNAP and 3D Slicer software. The interval between T0 and T1 was represented as a presurgical phase, while between T1 and T2 was defined as a postsurgical phase (T1-T2). Twenty-five patients (50 condyles) were included with a mean age of 23 ± 3.2years. The mean of the follow-up during the presurgical phase was 19.8 ± 7.1months and 15.5 ± 5.5months during the postsurgical phase. The condylar volume during the presurgical phase (T0-T1) was relatively stable (- 3.3 ± 37.2mm3). However, during the postsurgical phase (T1-T2), the volume was significantly reduced - 113.8 ± 98.3mm3 (P < 0.001). Localized condylar surface resorption during the postsurgical phase was significantly higher than during the presurgical phase (P < 0.05). No correlation was found between the localized condylar surface remodeling during the presurgical and postsurgical phases. However, a negative statistically significant correlation existed between the overall condylar volume changes during the presurgical and postsurgical phases (r = 0.502, P < 0.001). Significant condylar resorption following orthognathic surgery of the retrognathic mandible with a high mandibular plane angle might occur regardless of the presurgical status of the condyle. The study provided anevidence to be discussed with the patients and considered throughout the treatment of mandibular retrognathia with high mandibular plane angle.

Evaluation of Quantitative Aspects of Craniofacial Deformities in Transfusion Dependent Beta-Thalassemia Major Patients: A Cephalometric Study.

To evaluate the quantitative (cephalometric) aspects of the craniofacial deformities in transfusion-dependent beta-thalassemia (TDT) patients. Sixty-five TDT patients receiving a regular blood transfusion in the Department of Pediatrics of age group 5 to 8 years (younger) and 15 years and above (older) were compared with control groups of similar age using cephalograms (lateral and posterior-anterior view). The prevalence of skeletal class II tendency is higher in thalassemic patients that do not improve with age. The thalassemic patients were found to show large angle ANB i.e. Angle between points point a, nasion and point B (ANB), large flexure angle, small angle SNB i.e. Angle between points sella, nasion and point B (SNB), and normal angle SNA i.e. Angle between points sella, nasion and point A (SNA) angles suggestive of retrognathic mandible. The thalassemic patients were observed to have smaller transverse widths and thickened calvarium on the posterior-anterior view. The skeletal class II malocclusion appears to be a manifestation of generalized growth retardation/delayed puberty in thalassemic patients leading to diminished mandibular growth, rather than maxillary prognathism due to marrow hyperplasia.

Functional clear aligner technique in the treatment of class II malocclusion in juvenile: A case report and literature review

AimThe current study described an 11-year-old female patient with Angle's Class II relationship and skeletal Class II base relationship with retrognathic mandible and orthognathic maxilla. MethodsThe patient was treated by mandibular advancement (MA). She was instructed to wear each aligner 20 h a day and to change aligners every 14 days. After the deciduous teeth had been replaced by the permanent teeth, 30 additional appliances were produced for MA. ResultsDuring the 28-month treatment period, MA led to widening of the upper dental arch, alignment of the upper teeth, forward movement of the lower jaw, reduction of the anterior teeth coverage and improvement of the molar relationship. ConclusionInvisalign MA is simple and comfortable. It can expand the arch, align and even the dentition at the same time, therefore, it can shorten the treatment course effectively.

Transforming Growth Factor Beta Receptor 2 (TGFBR2) Promoter Region Polymorphisms May Be Involved in Mandibular Retrognathism

Skeletal malocclusions are common phenotypes in humans and have a strong influence on genetic factors. Transforming growth factor beta (TGFβ) controls numerous functions of the human body, including cell proliferation, differentiation, and migration. Thus, this study is aimed at evaluating whether genetic polymorphisms in TGFB1 and its receptor TGFBR2 are associated with mandibular retrognathism in German children and adolescents. Children and teenagers older than 8 years in the mixed or permanent dentition were included in this study. Patients with syndromes and facial trauma and patients with congenital alterations were excluded. Digital cephalometric tracings were performed using the anatomical landmarks point A, point B, sella (S), and nasion (N). Patients that have a retrognathic mandible (SNB < 78°) were selected as case group, and the patients with an orthognathic mandible (SNB = 78°– 82°) were selected as the control group. Genomic deoxyribonucleic acid (DNA) from saliva was used to evaluate four genetic polymorphisms in TGFB1 (rs1800469 and rs4803455) and TGBR2 (rs3087465 and rs764522) using real-time PCR. Chi-square or Fisher exact tests were used to compare gender, genotype, and allele distribution among groups. Genotype distribution was calculated in an additive and recessive model. Haplotype analysis was also performed. The established alpha of this study was 5%. A total of 146 patients (age ranging from 8 to 18 years) were included in this epidemiological genetic study. The genetic polymorphism rs3087465 in TGFBR2 was associated with mandibular retrognathism. Carrying the AA genotype in the rs3087465 polymorphism decreased the chance of having mandibular retrognathism (odds ratio = 0.25, confidence interval 95% = 0.06 to 0.94, p = 0.045). None of the haplotypes was associated with mandibular retrognathism (p > 0.05). In conclusion, we found that the genetic polymorphism rs3087465 in the promoter region of the TGFBR2 was associated with mandibular retrognathism in Germans.

Effect of Twin-block Appliance on Pharyngeal Airway, Sleep Patterns, and Lung Volume in Children with Class II Malocclusion

In this study, we sought to evaluate the effect of the twin-block appliance on pharyngeal airway dimensions, sleep patterns, and lung volumes in growing children with class II malocclusion with a retrognathic mandible. Twenty children aged 9-12 years with class II malocclusion with a retrognathic mandible participated in the study. A validated sleep questionnaire assessed the sleep patterns and the sleep problems of the children. The pre-treatment cephalometric variables and the pharyngeal airway passage (PAP) dimensions were analyzed. Spirometry tests were performed to evaluate lung volumes. A custom-made twin-block appliance was fabricated, and children were instructed to wear it for a minimum of 10 months. All variables including sleep problems, cephalometric variables, and pharyngeal airway measurements were evaluated post-treatment. Spirometry tests were re-evaluated at the end of the twin-block treatment. All data were statistically analyzed. Post-twin-block appliance treatment, there was a definite decrease in snoring, noisy breathing, and sleeping with mouth open. The sella-nasion to B point angle (SNB), mandibular length, the depths of oropharynx, nasopharynx, and hypopharynx as well as the height of nasopharynx (HNP) were significantly increased post-treatment (p <0.001). The length and thickness of soft palate (SPI) increased significantly (p <0.001), while its inclination decreased significantly (p <0.001). We found improvements in forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV1); however, the changes were statistically not significant (p = 0.88 and p = 0.78). Twin-block appliance significantly increased the pharyngeal airway dimensions and improved the length and thickness of the soft palate in children with class II malocclusion. Post-twin-block treatment showed a considerable reduction in the sleep problems of the children. The lung volume measurements showed improvement; however, it was not statistically significant. Twin block may be used not only to correct the facial disharmony of children with a retrognathic mandible but also to improve the airway dimensions and lung volume as well as to reduce the sleep-disordered symptoms.

Effectiveness of Surgical Mandibular Advancement in Improving Airway Dimensions in Nongrowing Skeletal Class II Patients With Obstructive Sleep Apnea—A CBCT Study

Background: Skeletal nongrowing class II patients with retrognathic mandible are often at risk of developing obstructive sleep apnea (OSA). This skeletal discrepancy, when severe enough, is often addressed by surgical mandibular advancement which not only achieves aesthetics, structural balance, and functional efficiency but also improves the airway function. Objective: The aim of the study was to evaluate the effectiveness of surgical mandibular advancement on airway dimensions, in nongrowing skeletal class II patients with mandibular retrognathism associated with OSA. Materials and Methods: The sample consisted of 8 patients with skeletal class II due to retrognathic mandible associated with OSA. Screening was done with functional outcomes of sleep questionnaire (FOSQ) score and confirmed with polysomnography. Pretreatment and posttreatment airway dimensions/volume were assessed and calculated on cone beam computed tomography (CBCT). Three months post surgery, oxygen saturation was recorded. Results: A statistically significant improvement in mean oxygen saturation level was observed from 87.62 ± 7.70 to 97.75 ± 0.46 and mean increase in airway volume was from 48.60 ± 7.17 to 69.48 ± 26.22. The smallest cross section increased from 137 ± 74.37 to 253.75 ± 76.67. Anteroposterior dimensions increased significantly from 6.17 ± 1.78 to 9.33 ± 2.07 and transversed from 24.56 ± 6.41 to 30.14 ± 3.35. FOSQ score improved from 9.37 ± 2.61 to 15.25 ± 0.88. Conclusion: Surgical mandibular advancement is an effective treatment option in improving airway dimensions in nongrowing skeletal class II patients with mandibular retrognathism associated with OSA.

Orthodontic-Surgical Treatment of a Skeletal Class II Malocclusion: A Case Report

Two methods for treating skeletal problems in adults are camouflage orthodontic treatment and orthognathic surgery. This case report aimed to present the successful treatment of an adult female patient with skeletal Class II malocclusion due to retrognathic mandible through orthognathic surgery. After the fixed orthodontic treatment, the necessary decompensation treatment was applied to the patient who presented to our clinic with the complaint of retrusive mandible and was operated. The dental and skeletal Class I relationship was achieved with functional occlusion after orthodontic and orthognathic surgery. The total treatment time was 23 months. The treatment results showed good improvement in the facial profile.

Effects of modified twin block appliance in growing Class II high angle cases: A cephalometric study

Background: Class II malocclusions represent anteroposterior dysplasia usually resulting from mandibular retrusion. Along with a retropositioned mandible, it can be associated with either upward or backward jaw rotation. High angle cases are often associated with a short ramal height, steeper mandibular plane, and large gonial angle. Twin block is a commonly used myofunctional appliance that incorporates bite planes that direct the occlusal forces in a more favorable direction for correction of the retrognathic mandible. We aimed to evaluate skeletal, dental, and soft tissue changes following modified twin block appliance therapy in high-angle cases. Methods: A cephalometric study was performed on 15 growing (10-14 years) high angle (Frankfort mandibular angle 28-35°) Class II Division I malocclusion patients undergoing twin block therapy. Skeletal, dental, and soft tissue changes were evaluated by cephalometric analysis using Dolphin software. Results: Pre- and post-treatment changes in cephalograms were assessed by analysis of variance and paired t-test. Significant changes in the position of the mandible (angle between Sella-Nasion-Point B [SNB] increased by 3.9 degrees, P=0.02), Wits appraisal (decreased by 2.46 mm, P=0.04), maxillo-mandibular relationship (angle between Point A-Nasion-Point B [ANB] decreased by 3.73 degrees, P=0.02) were observed. Soft tissue changes like the nasolabial angle were also significant, increasing by 3.8 degrees (P=0.04) and lower lip relation to E-line (reduction in lower lip protrusion) by 2 mm (P=0.04). Vertical parameters showed non-significant changes, like the Frankfort mandibular angle (FMA) increased by 0.07 degrees, (P=0.67), the angle between Sella-Nasion and Gonion-Gnathion (SN-Go-Gn) increased by 0.33 degrees, (P=0.67), Y-axis increased by 0.2 degrees, (P=0.32). The upper incisor inclination decreased non-significantly from 5.60±1.24 to 4.20±0.86 degrees, (P=0.31) and lower incisor increased non-significantly from 100.13±2.23 to 101.80 ±1.37 degrees, (P=0.08). Conclusions: Modified twin block appliance can be used to successfully treat Class II Division I high angle cases with good vertical control.

Surgical-Orthodontic Treatment of Skeletal Class II Malocclusion with Obstructive Sleep Apnea and Multiple Missing Teeth

In the treatment of skeletal Class II retrognathic mandible, the airway should be considered for the progress and outcome of the treatment. The case report demonstrates combined orthodontic and orthognathic surgery in a 39-year-old woman with chief complaint of maxillary protrusion. The clinical examination and X-ray revealed skeletal Class II with a retrognathic mandible, high mandibular plane, vertical maxillary excess (VME), bilateral deformed condyles, and narrow posterior airway space. Moreover, the patient had several missing teeth with a posterior lingual crossbite. Polysomnography revealed obstructive sleep apnea (OSA), with a high apnea–hypopnea index (AHI) of 12.1/h. Her body mass index was low at 17.2. The preoperative orthodontic treatment included leveling, alignment, and molar uprighting. Maxillary segmental LeFort I was designed to expand her maxillary intermolar width and impact the anterior part of her maxilla. Also, bilateral sagittal split osteotomies were performed to advance her mandible position with a counterclockwise rotation of the maxillomandibular complex. The postoperative orthodontic treatment included settling the bite, monitoring the relapse, and managing the dental space for future prosthodontic rehabilitation. After a total treatment time of 1 year and 10 months, her profile was improved, her airway volume was enlarged, and her OSA was resolved, with the AHI changed to 4.3/h at 11 months after surgery then further decreased to 0/h when debonded.

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

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

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 &gt; 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.

CBCT evaluation of changes in condylar position following fixed functional appliance therapy: A comparative in vivo study

Objective: to evaluate and compare the condylar positional changes after the treatment of class ii malocclusion patients using powerscope appliance and forsus fatigue resistant device using pre-treatment and post-treatment CBCT images.Materials and Method: twenty subjects of adult age group having class ii division 1 malocclusion, horizontal to average growth pattern, orthognathic maxilla, retrognathic mandible, increased overjet were included in this study. The subjects were divided into two groups, forsus group and power scope group. A pre-treatment cbct scan was taken before the start of the treatment using Kodak 9000 3d extraoral imaging system. In group i, forsus fatigue resistant appliance was used to achieve class i occlusion. After completion of the forsus therapy another CBCT scan was taken. In group ii, powerscope appliance was used to achieve class i occlusion. Sequential activation of the powerscope appliance was done using crimpable shims depending on the amount of skeletal discrepancy in each patient’s mouth, until edgeto-edge bite was obtained. After completion of the powerscope appliance therapy, another CBCT scan was taken. After the pre and post treatment CBCT scans were analyzed, position of the condyle were assessed on the dicom images, using the cs 3d imaging software. The field of view was confined to the right and left TMJ. This was done so that condylar head, glenoid fossa and external auditory meatus were visualized and the data obtained were subjected to statistical analysis. Comparison of all the pre & post treatment parameters were done by paired-t test. Comparison of forsus and power scope group was done using independent t-test.Results: an average forward shift of mandibular condyle by. 85 mm was seen after 7- 9 months of treatment in forsus appliances therapy and. 79 mm after powerscope therapy indicating that the forward mandibular condylar shift is greater in forsus group than the powerscope group, the forward condylar shift of two groups was statistically insignificant with a mean difference of. 060 mm.Although both the forsus and powerscope groups showed a downward shift of mandibular condyle, there was a greater downward shift in forsus group (2.69 mm) compared to the powerscope group (2.29 mm), the downward condylar shift of two groups was statistically insignificant with a mean difference of 0.42mm.Conclusion: forsus appliance brought about a more anterior and downward shift in the mandibular condylar position, compared to power scope group but the difference were not statistically significant between the two appliances i.e. Forsus and powerscope.

Modified tandem appliance for early correction of class III malocclusion – A case report

Class III malocclusion is associated with a sagittal malrelationship of the maxilla and the mandible, characterized by a deficient maxilla, retrognathic mandible, or a combination of both. The early treatment of Class III malocclusions provides facial balance, modifies the maxillofacial growth and development, and prevents future surgical treatment by increasing the stability. 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 major problem with extraoral anchorage has been of patient compliance due to its physical appearance. The case report presents an intraoral modified tandem appliance for maxillary protraction that has been used clinically to achieve successful results without relying much on patient co‑operation.

Assessment of the Morphology and Degenerative Changes in the Temporomandibular Joint Using CBCT according to the Orthodontic Approach: A Scoping Review.

Background Available knowledge about disorders of temporomandibular joint structures and their association with orthodontic variables are still lacking. Objectives This article is aimed at to identifying studies and presenting current information on the relationship between morphology diversity and the occurrence of degenerative changes in structures of the temporomandibular joint (TMJ) assessed by cone-beam computed tomography (CBCT) in the context of craniofacial morphology and malocclusion. Search Methods. The review was conducted by analyzing the PubMed (including Medline), Cochrane Library, Web of Science, and Scopus electronic databases up to November 2021 using two different comprehensive search strategies based on keywords as well as additional manual searches. Eligibility Criteria. Selection of the literature was carried out according to the PRISMA-ScR checklist. Methodological quality of the selected studies was evaluated using JBI Critical Appraisal Tool. Results The electronic databases search revealed 3331 records. After applying the eligibility criteria and JBI assessment, a total of 33 studies were extracted and selected to the study. The review was divided into 4 parts, in which the following correlations were assessed in terms of orthodontic variables: TMJ degenerative changes, joint space and condylar position, condylar shape, TMJ articular eminence, and fossa. Conclusions Skeletal and dental class II malocclusion with a retrognathic mandible, a hypodivergent skeletal pattern with a steep mandibular plane, and significant lateral mandibular displacement can be risk factors for developing radiographically detectable degenerative changes. Patients with skeletal and dental class III malocclusion as well as a hyperdivergent skeletal pattern may be at greater risk of TMD occurrence compared with other groups. Further studies are necessary to clarify the relationship between the position of the condylar processes and the presence of degenerative changes in the temporomandibular joints among orthodontic patients.

Correction of Class II malocclusion in a patient using the forsus fatigue resistant appliance – A case report

Functional appliances, fixed or removable, are primarily orthopaedic tools used to influence the facial skeleton in a growing child. Class II malocclusion with a retrognathic mandible in a non -compliant post pubertal patient can be treated using the fixed functional appliances. One such appliance which is in common use in clinical practice today is the Forsus Fatigue Resistant Device. To treat a 13 year old female patient having a class II base, a retrognathic mandible, horizontal growth pattern, convex profile, an overjet of 7mm, mild proclination of maxillary and mandibular incisors, Class II molar and canine relationship bilaterally and a positive VTO.

ORTHODONTIC CAMOUFLAGE OF CLASS II DIVISION I WITH EXTRACTION OF UPPER PREMOLARS

Class II Division I is the commonest malocclusion found in orthodontic population and a deep overbite is frequently encountered along with it. Many protocols have been utilised in treating such type of malocclusion from removable to fixed appliances with or without extractions. This case report is about a 15-year-old female patient who came to the Department of Orthodontics with a prognathic maxilla and a retrognathic mandible with 11 mm overjet. The patient refused fixed functional treatment thus a upper premolar extraction camouflage treatment was done. The chief complaint of the patient was successfully addressed and overall good treatment results were obtained with improved facial profile and reduced overjet. Keywords: Class II Division I malocclusion, Deep bite, Camouflage

Incidence of inferior alveolar nerve sensory deficit and intra-operative nerve encounters after advancement of retrognathic mandible - A cross-sectional survey study.

The aim of the current cross-sectional study was to conduct a survey among the oral and maxillofacial surgeons of South India regarding their experiences of incidence of inferior alveolar nerve (IAN) neurosensory deficit after bilateral sagittal split osteotomy (BSSO) for correction of mandibular retrognathism and to assess the intra-operative nerve encounters and its effect on the inferior alveolar neurosensory deficit (NSD), 6 months post-operatively. A self-administered questionnaire (SAQ) was prepared using Google Forms (Google Inc.) and sent to the prospective participants through various social media outlets such as Facebook, WhatsApp groups etc., of the maxillofacial surgery specialty for a period of 3 months. SAQ from surgeons with more than 5 years of experience in orthognathic surgery were included. The incidence of NSD post-BSSO advancement surgery from 859 cases after 6 months was 15.1% (130). After splitting the mandible, the IAN was seen in the proximal fragment in 472 sites and needed dissection. The nerve was transected and neurorrhaphy was carried out in 26 sites. A Chi-square test was used to analyse the qualitative variables. The IAN was not visible post-osteotomy in 140 sites and in the distal fragment in 1080 sites. These groups had decreased incidence of NSD. The NSD was significantly higher in cases where the nerve was transected and sutured, P value <0.001 as compared with the other nerve status, followed by the nerve in the proximal fragment needing dissection. The IAN status intra-operatively can be assumed to have a significant role in persisting NSD.

Comparison of AdvanSync2® and Twin Block Appliances in Treatment of Class II Malocclusion With Retrognathic Mandible—An Observational Retrospective Study

Objectives: To evaluate the treatment outcomes between Twin Block and AdvanSync2® appliances by comparing the skeletal, dentoalveolar, and soft tissue changes. Materials and Methods: Radiographic data of 20 patients were retrospectively analyzed. Data were selected from patients in their skeletal growth spurt as evaluated by the cervical vertebral maturation method (CVMI 2, 3, and 4), with class II malocclusion characterized with retrognathic mandible (ANB &gt; 4°, SNB &lt; 77°, FMA = 25 ± 5°, overjet &gt; 5 mm). There were 10 patients in each group that underwent orthodontic correction for class II malocclusion: either using Twin Block or AdvanSync2®. Independent t test and Paired t test and chi-square tests were used for the data analysis. The level of statistical significance was set at P value ≤.05. Results: The chronological and skeletal age were similar in both the groups. Records were taken for the functional treatment with mean treatment span of 8 ± 1 month. Changes in SNB (group I = 1.59°, group II = 3.11°) ( P &lt; .01), Co-Gn (group I = 2.89 mm, group II = 5.34 mm), and U1-L1° (group I = −1.51°, group II = 2.97°) showed statistically different outcome between the groups, when the pre-post data were studied. Rest of the variables—cranial base, maxillary skeletal, mandibular skeletal, intermaxillary, vertical skeletal, maxillary dentoalveolar, mandibular dentoalveolar, and soft tissue—showed similar outcome ( P &gt; .05). Conclusion: Both appliances lead to desirable outcomes in the correction of class II malocclusion. AdvanSync2® resulted in inducing more of changes in SNB and effective mandibular length as compared to Twin Block. Overjet and molar relation improved significantly with both the appliances. Both the appliances resulted in similar skeletal, dentoalveolar, and soft tissue changes.

Effectiveness of Titratable Oral Appliance in Management of Moderate to Severe Obstructive Sleep Apnea-A Prospective Clinical Study with Acoustic Pharyngometry.

To assess effectiveness of titratable Oral Appliance (OA) in management of moderate to severe cases of Obstructive Sleep Apnea (OSA). Thirty Polysomnography (PSG) diagnosed cases of moderate to severe OSA were subjected to a thorough cranio-facial-dental evaluation, a detailed sleep history and three dimensional assessment of upper airway geometry utilising Acoustic Pharyngometry (AP) (Eccovision, sleep group solutions). A titratable OA was delivered to all patients for mandibular advancement. Apnea Hypopnea Index (AHI), Oxygen Saturation (SPO2), Epworth's Sleepiness Scale (ESS), Mean area and volume of upper airway were recorded at Baseline (T0) and after 08weeks of appliance delivery (T1). The mean AHI & ESS scores were significantly lower and SPO2 was significantly higher at T1 compared to T0 (P-value < 0.05 for all). The mean area and volume of upper airway at T1 were significantly higher compared to values at T0 (P-value < 0.05 for both). The mean area showed 19.51% increase at T1 whereas mean volume increased by 18.55%. OA therapy is highly efficacious in cases with moderate to severe OSA, especially, in those with retrognathic mandible. This modality should be considered as an effective alternate to Continuous Positive Airway Pressure (CPAP) therapy in non-compliant patients rather than no treatment. AP is an effective modality to predict airway changes after advancement with OA, to ascertain follow up changes and is highly recommended in routine clinical practice. Large scale, multicenter studies are recommended to elaborate the findings of the present study and to add better quality evidence in this regard.

Glenoid fossa position in skeletal class-II malocclusion due to retrognathic mandible and skeletal class-I malocclusion in Pakistani population

BACKGROUND &amp; OBJECTIVE: Different dental and skeletal abnormalities interact with each other to cause multiple malocclusions of various areas of the dentofacial region. Association of the mandible and cranial base influence the malocclusions in anteroposterior and vertical dimensions that influences the evaluation of the skeletal components of a particular patient, so the relationship of glenoid fossa to adjacent craniofacial components must be taken into account. This research is conducted for the comparison of glenoid fossa position in subjects presenting with class II skeletal malocclusion due to retrognathic mandible and class I skeletal malocclusion.&#x0D; METHODOLOGY: Standardized lateral cephalograms of 130 patients were selected according to inclusion criteria from the orthodontic department. These radiographs were traced, and different angular and linear measurements were recorded. Then the position of glenoid fossa was compared in subjects of class II malocclusion with retrognathic mandible and class I malocclusion. SPSS version 17 was used for data analysis. Cephalometric measurements were analyzed, and glenoid fossa position was compared in both groups by using student’s t-test. Statistical level of significance using student t test was p&lt; 0.05&#x0D; RESULTS: Position of glenoid fossa in subjects with class II malocclusion is more distal and posterior as compared to the subjects with class I malocclusion. The effective parameters for the measurements of glenoid fossa are GF-S on FH, GF-Ptm on FH, and GF-FMN with p value 0.0001.&#x0D; CONCLUSION: A distally and posteriorly placed glenoid fossa is an important diagnostic feature of Class II skeletal malocclusion with the retrognathic mandible.&#x0D;