Severe Skeletal Discrepancies Research Articles

Predictors of Long-Term Protraction Headgear Success in Patients With Cleft Lip and Palate: A 5-Year Follow-Up.

Patients with cleft lip and palate (CLP) characteristically present with maxillary hypoplasia and class III malocclusion. Protraction headgear (PHG) is a commonly used treatment for this type of malocclusion, with the goal of reducing future surgical needs. The purpose of this study was to evaluate the long-term effects of PHG treatment and determine the pretreatment predictors of long-term PHG success in patients with CLP. Twenty-nine patients with CLP who had undergone PHG treatment from 2012 to 2017 at a single institution were retrospectively analyzed. Patients were included if they had a lateral cephalogram or CBCT before, immediately after, and at least 5 years after their PHG treatment. Patients were divided into surgery and nonsurgery groups based on their 5-year follow-up clinical presentation. Student t tests, Wilcoxon signed-rank test, and a multivariate logistic regression model were used to compare pretreatment and post-treatment changes in both groups. Immediately post-treatment, the maxilla advanced 2.6mm, the maxillary dentition advanced 4.7mm, and the mandible rotated downward 5.0mm and backward 2.6mm. At long-term follow up the maxilla advanced 0.0mm while the mandible advanced an additional 7.5mm. Thus, PHG treatment is effective at improving class III malocclusion in the short term, but may not prevent future surgical need for patients with more severe skeletal discrepancies. Variables predictive of future surgical need include ANB, anterior facial height, overjet, and starting age of treatment, with ANB as the most reliable early predictor.

Dentoalveolar bone height in Class I adults with different vertical patterns: A cross-sectional study

Facial divergence during growth and development affects both the anterior and posterior alveolar bone dimensions in the maxilla and mandible, and the dentoalveolar compensation mechanism in severe vertical skeletal discrepancies remains unclear. To evaluate the: (1) difference in dentoalveolar heights among subjects with different vertical facial patterns; (2) association between the dentoalveolar bone height and other cephalometric variables; (3) effect of sex on dentoalveolar height measurements. Non-growing subjects with skeletal Class I (0°<ANB<4°), Class I canine and molar relationship and complete fully erupted dentition were included in the study. Cephalometric measurements were taken on lateral cephalograms and patients were stratified into hyperdivergent, hypodivergent, and normodivergent groups based on MP/SN angle. A two-way analysis of variance (ANOVA) was used to compare cephalometric measurements between the divergence and sex groups. Measurements on a total of 204 patients (81 males, 123 females) were analysed. At the level of the incisor and premolar regions, both dentoalveolar and alveolar bone heights were significantly larger in hyperdivergent group when compared to hypodivergent group, whereas at the level of the molar region, no difference was found among groups. Moderate to strong correlations were found between dentoalveolar bone and vertical skeletal measurements. In the maxilla and mandible, the dentoalveolar compensation mechanism in skeletal Class I subjects results in an increased vertical height in the anterior dentoalveolar segment in hyperdivergent subjects and a reduced one in hypodivergent subjects.

Enhancing Surgical Outcomes via Three-Dimensional-Assisted Techniques Combined with Orthognathic Treatment: A Case Series Study of Skeletal Class III Malocclusions

(•) Orthognathic surgery is a necessary procedure for the correction of severe skeletal discrepancies, among which are skeletal Class III malocclusions. Currently, both conventional fixed braces and clear aligners can be used in orthognathic surgery. However, the use of clear aligners remains a little-chosen option. The present study aimed to evaluate the skeletal and aesthetic improvements in adults with Class III malocclusion after surgical treatment and compare the results achieved by fixed appliances versus clear aligners. The study sample included four patients (three males and one female, aged 18 to 34 years) with skeletal Class III malocclusion, three of whom underwent a bimaxillary surgery and one of whom underwent only a bilateral sagittal split osteotomy. Two patients were treated with fixed appliances and two with clear aligners. The pre- and post-surgical hard and soft tissue cephalometric measurements were performed and compared for each patient and between fixed appliances and clear aligners. One year after surgery, all patients showed an essential modification of the face’s middle and lower third with an increase in the convexity of the profile and the Wits index and a reduction in the FH^NB angle. No differences were noted between fixed appliances and aligners. Therefore, thanks to the 3D-assisted surgery associated with orthodontics, every participant achieved proper occlusal function and an improved facial aesthetics. In addition, the clear aligners can be considered a valid alternative for pre- and post-surgical orthodontic treatment.

Rehabilitation of severe dentofacial deformity after early radiotherapy of retinoblastoma: a case report

BackgroundRetinoblastoma is an intraocular cancer of infancy and childhood, which has been treated with radiation therapy and chemotherapy. Radiation on growing patients can cause deterioration in maxillofacial growth and development that leads to severe skeletal discrepancies between the maxilla and mandible, and dental problems such as crossbite, openbite, and hypodontia.Case presentationWe present the case of a 19-year-old Korean man with chewing disability and dentofacial deformities. He had undergone enucleation of the right eye and radiation therapy of the left eye due to retinoblastoma 100 days after birth. Subsequently, he received cancer therapy for the secondary nasopharyngeal cancer at the age of 11 years. He was diagnosed with severe skeletal deformity including sagittal, transverse, and vertical growth deficiency of the maxilla and midface, and with class III malocclusion, severe anterior and posterior crossbite, posterior openbite, multiple missing upper incisors, right premolars, and second molars, and impaction of the lower right second molars. To restore impaired functions and esthetics of the jaw and dentition, the orthodontic treatment combined with two jaw surgery was performed. At the end of surgical orthodontics, dental implants were placed for prosthetic treatment of missing teeth. Additional plastic surgery for zygoma elevation was done with calvarial bone graft followed by fat graft. Facial esthetics and occlusal functions of patient were favorably enhanced with the improvement of skeletal discrepancy and the rehabilitation of maxillary dentition by prosthetic work. At the 2-year follow-up, the skeletal and dental relationships and implant prosthetics were well maintained.ConclusionIn an adult patient with dentofacial deformities caused by early cancer therapy in the head and neck area, interdisciplinary interventions including additional plastic surgery of zygoma depression and prosthetic work of missing teeth as well as surgical–orthodontic treatment could establish favorable facial esthetics and oral rehabilitation.

Mini implant ‘Safe Zones’ in orthodontics: A comprehensive review

In prosthetic dentistry the quality of life of patients with tooth loss have been significantly enhanced with the use of dental implants likewise in Orthodontics mini implants has been instrumental in expanding the envelope of treatment possibility. The incorporation of mini implants into orthodontic treatment planning has allowed for predictable anchorage control and has increased the ability to correct severe skeletal and dental discrepancies. Despite the great interest in anchorage control with Mini Implants, the safe implantation of the mini implant in different regions is of major concern. Thus learning about the anatomy and safe zones for placing Mini Implants are of paramount importance.

Management of malocclusion with pre-fabricated myofunctional appliance in the primary dentition

The most common malocclusion presented during primary dentition are anterior crossbite and deep overbite.If the primary dentition does not show severe skeletal discrepancy, it is possible to treat malocclusion using pre-fabricated myofunctional appliance that is easily applied to children. By improving the malocclusion in the primary dentition, normalization of the oral muscle function can be induced. In addition, the normal occlusion of the primary incisor region and ideal position of the lips can make a desirable occlusal relationship at the transition of incisors. If factors such as growth pattern, patient cooperation, and post-treatment maintenance are carefully judged and implemented, the interceptive treatment of primary dentition can contribute to normal growth and development.

Finite element analysis between Hunsuck/Epker and novel modification of Low Z plasty technique of mandibular sagittal split osteotomy.

A novel modification of the Low Z plasty (NM-Low Z) technique for bilateral sagittal split osteotomy was recently proposed. The osteotomy line was modified more inferiorly than in the conventional Hunsuck-Epker (HE) approach. The NM-Low Z technique enhances the mandibular setback distance and degree of rotation in severe skeletal discrepancies. This study aimed to investigate the biomechanical behavior under simulated forces, and to compare the NM-Low Z and HE techniques on the mandible with Class III skeletal deformity at 1 week, 3 weeks, and 6 weeks post-operation. Physiological muscular and occlusal loads were simulated using the finite element (FE) method. Stresses on the miniplate, screws, and bone were observed and compared between the two models. The elastic strain at the fracture site was observed for the optimal bone-healing capacity. The NM-Low Z model exhibited a lower stress than the HE model at every stage post-operation. Both models demonstrated elastic strains within the normal range for bone healing. In summary, the biomechanical behavior of the NM-Low Z technique is comparable to that of the conventional EH technique. NM-Low Z could facilitate post-operation skeletal stability by reducing the stress on fixation materials during bone healing.

A severe skeletal Class III malocclusion treated with Le Fort I combined with sagittal split ramus osteotomy, mandibular body ostectomy and tongue reduction surgery. A case report

This case report describes the orthodontic-orthognathic management of a 17-year-old male patient with extremely severe skeletal Class III malocclusion due to a marked mandibular protrusion with a small and narrowed upper jaw which increased the remarkable concave facial profile. Dental articulation was entirely lacking, resulting in great difficulty in masticating food. A two-jaw surgery combined with mandibular body ostectomy was performed to correct mandibular asymmetry and the severe sagittal skeletal discrepancy (Wits appraisal –36.5 mm and ANB angle –14.3°). Bi-maxillary surgery was performed in two-stages; the first surgery consisted of maxillary advancement with Le Fort I osteotomy followed by a second surgery where a combination of sagittal split ramus osteotomy (SSRO) and mandibular body ostectomy was performed to correct the severe mandibular prognathism. A partial glossectomy was also carried out to address macroglossia. After a total treatment time of 32 months, a Class I occlusion with a favorable facial profile and lip competence were obtained. The occlusion was made approximately ideal, and mastication improved remarkably. Three years after retention, the occlusion was stable and no relapse was observed. The patient’s complaints and orthodontic problems were completely resolved. Therefore, a combination of two-jaw surgeries with Le Fort I maxillary osteotomy, mandibular SSRO, mandibular ostectomy, and glossectomy may be a viable option in the correction of extremely severe anteroposterior skeletal discrepancy.

Ortho-surgical management of a Class II division 2 Malocclusion- A case report

A Class II division 2 malocclusion is characterized by retroclination of two or more maxillary incisors, Class II molar relationship and an increased overbite.This article describes a case report of a 17-year-old female patient who was concerned about an irregularly placed tooth. The clinical and radiographic investigations revealed that the patient had Class II skeletal relation, mesoprosopic facial form, deep labiomental fold, average growth pattern and Angle’s Class II div 2 type D malocclusion. Camouflage line of treatment with severe skeletal discrepancy would compromise on facial esthetic. Therefore, Bilateral sagittal split osteotomy (BSSO) with mandibular advancement was performed which resulted in favourable esthetic outcome. Keywords: Class II div 2 malocclusion,Skeletal Class II malocclusion, Mandibular retrognathism, Bilateral sagittal split osteotomy.

Interdisciplinary Approach for the Treatment of Complex Bilateral Cleft Lip and Palate With Missing Premaxilla.

Complex craniofacial deformities such as complete bilateral cleft lip and palate require interdisciplinary approach for proper diagnosis and treatment. A severe skeletal discrepancy caused by bilateral cleft lip and palate and missing premaxilla was successfully managed with orthodontic preparation and distraction osteogenesis. Conventional prosthodontic treatment combined with orthodontic preparation was proven to be a viable option to manage multiple missing teeth in cleft lip and palate.

Terapija skeletnih anomalija ortodontskom kamuflažom

Camouflage is a therapeutic procedure used to treat orthodontic anomalies after the cessation of pubertal growth acceleration. The goal of camouflage is to treat skeletal inconsistencies based on tooth extraction. In that way, good intercuspation of lateral teeth and a correct ratio of incisors are achieved, despite skeletal discrepancy. Indications for this procedure refer to patients with moderate and mild distal bites, patients with mild mesial bites, patients who are "too old" for growth modification therapy, and patients with good vertical proportions. Contraindications refer to patients with crowded teeth and incisions of the incisors, patients with good growth potential (it is necessary to use functional orthodontic appliances), severe skeletal discrepancies (when orthognathic surgery is performed) and patients with pronounced vertical disproportions. The method of treatment involves placing an orthodontic appliance in the upper and lower jaw. Retention is mandatory after removing the upper and lower appliance because the teeth tend to return to their original position. Possible side effects are instability and unpredictability of therapeutic results over time (relapses), and patients are sometimes only partially satisfied with aesthetic changes.

A case of extreme skeletal class III Malocclusion beyond the envelope of discrepancy, managed effectively by a modified ortho-surgical protocol

Correction of severe anteroposterior skeletal discrepancy, as described in this case of Extreme Skeletal Class III Malocclusion, can be challenging and fraught with difficulties. Conventional, single stage Bi-jaw Orthognathic surgery, with pre-and post-surgical orthodontics is associated with drawbacks such as risk of relapse and an unsatisfactory outcome, with persisting occlusal discrepancies and skeletal abnormalities, especially when the magnitude of skeletal correction is large. Excessive mandibular setback restricts tongue space, narrows the posterior airway and pharyngeal spaces, and is prone to relapse from the forward pterygomasseteric pull; while large maxillary advancements are accompanied by wound dehiscence, bone exposure and delayed union at the site of pterygomaxillary disjunction, and risk of relapse due to backward palatopharyngeal pull. Bi-jaw surgeries invariably involve considerable blood loss and prolonged operating time with its attendant anaesthetic risks.These drawbacks may be obviated by employing a two staged protocol of Bi-jaw surgeries allowing a minimum time period of 3 months to elapse between them, which allows the oral and maxillofacial musculature to adapt itself to the new jaw position following the first surgery, thus creating a better and more stable environment for the succeeding one. This reduces the chance of relapse thereafter, and produces more effective and stable long term results. The intervening time period also allows for observation of the repositioned jaw and arch relations achieved, and scrutiny for any positional changes in this post-surgical phase, which thereby allows modifications in the planned surgery of the next jaw, thereby achieving the most ideal final outcome.

Maxillary arch expansion along with fixed mechanotherapy using different expansion devices

Malocclusions can exist in all the three planes of space i.e in antero – posterior, vertical and transverse plane. Transverse discrepancies can manifest as dental, skeletal or functional discrepancies. Maxillary expansion is one of the most common treatment modality for arch length augmentation, posterior crossbite correction and removing cross arch interferences. Skeletal correction is done by orthopedic expansion or surgical expansion. Rapid Maxillary Expansion and Head Gears, produces orthopedic correction. Severe skeletal discrepancies require surgical correction of underlying skeletal deformity by using SARPE (Surgically Assisted Rapid Palatal Expansion) or surgical expansion of palatal shelves by midline osteotomies. Dental correction can be done using Rapid expansion in growing children and by slow expansion using Quad Helix, W Arches, Coffin Spring and certain modification of Jack screw appliances in other cases. In patients treated with fixed mechanotherapy expansions can not only be achieved by Arch wires, auxillary Jockey arches, cross elastics etc. but also by slow or rapid expansion devices that can be amalgamated with fixed orthodontic treatment. In this article, the use of slow maxillary expansion appliances in treatment of the three patients with transverse maxillary deficiency and undergoing fixed mechanotherapy will be discussed. Keywords: Expansion

Orthodontic bone screws: A quick update and its promising future.

Orthodontic bone screws (OBSs) provide intraoral anchorage by penetrating oral mucosa and seating firmly in basilar bone (BB). Retromolar (prosthetic-type) implants introduced the extra-alveolar (E-A) concept for BB anchorage to move teeth throughout the alveolar process, but the clinical procedures were complex and expensive. Titanium alloy (Ti) miniscrews placed in inter-radicular (I-R) alveolar bone are more convenient and provide some tooth movement potential, but multiple screws are usually required and the devices often interfere with the path of tooth movement. The advantages of BB anchorage and the convenience of miniscrew are combined into the E-A OBS system. These miniscrews are relatively large in diameter (2mm), and strong (stainless steel), which are placed intraorally in the BB of the infra-zygomatic crest (IZC) and mandibular buccal shelf (MBS). E-A OBSs provide osseous anchorage to retract the dentition and/or rotate either arch. Recovery of impactions is effectively managed with lever arm springs anchored with IZC or MBS bone screws. An emerging frontier is BB anchorage for correcting severe malocclusions with clear aligners. Since the osseous-anchored mechanics are complementary, fixed appliances and clear aligners can be used individually or in tandem to resolve a broad variety of malocclusions. This report summarizes current concepts for conservatively managing complex malocclusions such as severe crowding, skeletal discrepancies, asymmetries and impactions with the OBS system.

A Case of Extreme Skeletal Class III Malocclusion Beyond the Envelope of Discrepancy, Managed Effectively by a Modified Ortho-Surgical Protocol.

Correction of a severe anteroposterior skeletal discrepancy, as described in this case of extreme skeletal class III malocclusion, can be quite challenging and fraught with difficulties. Conventional, single-stage bi-jaw orthognathic surgery with pre-and post-surgical orthodontics is associated with drawbacks such as the risk of relapse and an unsatisfactory overall long-term outcome, with persisting occlusal discrepancies and skeletal abnormalities, especially when the magnitude of skeletal correction required is large. Excessive mandibular setback can restrict tongue space, cause narrowing of posterior airway and pharyngeal space, and be prone to relapse from the forward pterygomasseteric muscle pull, while large maxillary advancements are often accompanied by wound dehiscence and bone exposure at the site of pterygomaxillary disjunction, delayed union or malunion at the osteotomy and disjunction sites, and risk of relapse due to backward palatopharyngeal muscle pull. In addition, bi-jaw surgeries invariably involve an appreciable blood loss and a prolonged operating time with its attendant anaesthetic risks such as respiratory insufficiency. To develop an orthosurgical protocol wherein excessive skeletal discrepancy can be successfully managed, achieving the desired magnitude of correction, with little or no relapse. To assess its efficacy and superiority over the hitherto-employed single-stage bi-jaw procedures in the management of severe skeletal discrepancies. A two-staged, shorter 'single-jaw at a time' operative procedure with an intervening period of three months between the two surgical phases was employed. Drawbacks of conventional orthognathic surgery may be obviated by employing a two-staged protocol of bi-jaw surgeries allowing a minimum time period of 3 months to elapse between them. This period of time intervening between the maxillary advancement and mandibular setback allows the oral and maxillofacial musculature to adapt itself to the new jaw position following the first surgery, thus creating a better and more stable environment for the succeeding one, thereby reducing the chances of relapse thereafter, and producing more effective and stable long-term results. Moreover, the intervening time period also allows for observation of the repositioned jaw and arch relations achieved, and scrutiny for any positional changes in this post-surgical phase, which thereby allows modifications in the planned surgery of the next jaw, so as to achieve the most ideal final outcome following the second jaw surgery. A shorter operating time, reduced operator fatigue and less blood loss are other obvious advantages over the conventional bi-jaw procedures. An effective and stable correction of the extreme class III skeletal deformity and malocclusion was achieved, with a dramatic enhancement of facial balance, symmetry and proportion in this patient, following a modified orthosurgical management protocol. The staged protocol of 'maxilla first and mandible after' orthognathic surgery with conventional pre- and post-surgical orthodontics helped in pushing the envelope of skeletal discrepancy correctable by orthognathic surgery, thereby achieving large quantum of jaw movements, with ideal and stable functional as well as aesthetic results. This is suggestive of its efficacy and superiority over the hitherto-employed single stage bi-jaw procedures in the management of severe skeletal discrepancies.

Bimaxillary orthognathic surgery in skeletal class III malocclusion

Background: Skeletal Class III malocclusions can vary in severity, with different levels of treatment available to reflect this variance. In cases of moderate to severe skeletal discrepancy, orthodontic treatment in conjunction with orthognathic surgery is a common treatment option. This case report outlines an orthosurgical treatment approach for a patient with severe skeletal Class III malocclusion. Case Report: A 23-year-old female presented with skeletal Class III malocclusion. Pre-surgical orthodontic treatment was done after 1.5 years. The lateral profile view showed a concave profile, incompetent lip closure, deficiency in paranasal area, acute nasolabial angle, and obtuse labiomental fold. Intraorally, she had a negative 5.5 mm overjet and 2 mm overbite. The surgical procedures performed included high-level Le Fort I osteotomy, bilateral intraoral vertical ramus osteotomies (IVRO), and genioplasty. Conclusion: The treatment of skeletal Class III dentofacial deformity should be planned according to the malocclusion and facial profile to achieve a functional and esthetic outcome. A systematic treatment plan that takes into consideration the patient’s expectations and concerns must be created and implemented for a satisfactory outcome.

Efficiency and Duration of Orthodontic/Orthognathic Surgery Treatment.

To investigate the combined orthodontic-orthognathic treatment times at an academic hospital in the UK and to consider the level of occlusal change in delivering this treatment by the way of comparing peer assessment rating (PAR) scores pre- and post-treatment. It was a retrospective longitudinal study of orthognathic patients between 2010 and 2013 who had completed orthognathic treatment. Analysis of records of 50 patients was carried out. Age, gender malocclusion, and skeletal pattern, extraction/nonextraction of teeth, duration of active orthodontic treatment, number of appointments, transfer of patients between orthodontists mid-treatment, and PAR scores pre and post-treatment were recorded for each patient. The skeletal pattern was III in 70% of and II in 28% of patients. Mean duration of active orthodontic treatment was 27.9 months. Age, gender, malocclusion, and skeletal pattern did not seem to affect treatment times. Extraction of teeth and transfer of operators increased treatment times. The mean PAR reduction was 89% with the PAR efficiency factor (reduction in PAR scores divided by duration of treatment in months) of 1.61. Younger patients, those with class III malocclusions and patients starting with higher PAR scores, achieved greater PAR reductions. Gender, number of appointments, extractions, transfer of operators, and total duration of treatment were not shown to affect the PAR % reduction. Combined orthodontic-orthognathic treatment has been effective in treating patients with severe skeletal discrepancies. Transfer of operators and extractions protracted treatment times. Younger patients and those with class III malocclusions achieved higher PAR % reduction.

Management of severe maxillary hypoplasia with distraction osteogenesis in patients with cleft lip and palate

Maxillary hypoplasia is a common finding in patients with cleft lip and palate. Clinically, this manifests as a concave profile, midface deficiency, and Class III skeletal malocclusion. Management is in accordance with the severity of the malocclusion. In the case of moderate to severe skeletal discrepancy, combined orthodontic and surgical correction is required to obtain optimal results. In most instances, definitive orthognathic surgery is pursued at skeletal maturity. In the most severe cases however, early surgical correction has been achieved with Le Fort I osteotomy and distraction osteogenesis. The technique enables successful correction of a large maxillomandibular discrepancy in a growing patient with stable results. There are also applications in a skeletally mature patient with severe maxillary deficiency.

Long-Term Follow-Up of UCLP Patients: Surgical and Orthodontic Burden of Care during Growth and Final Orthognathic Surgery Need

The goal of this study was to evaluate the craniofacial morphology at 5 and 10 years of age and at the completion of growth, the need for final orthognathic surgery, and the orthodontic burden in a sample of patients with unilateral cleft lip and palate consecutively treated by the same surgeon with the same two-step protocol. A sample of 62 adult patients with unilateral cleft lip and palate was retrospectively collected (mean age, 17.5 years). Lateral cephalograms at three time points were traced. The need for orthognathic surgery was assessed, subdividing the sample into an orthognathic surgery group and nonorthognathic surgery group. Time and modality of orthodontic treatment were recorded. Cephalometric values related to maxillary growth (SNA, SNAns) and maxillomandibular relation (ANB, NAPg) were significantly different between the two groups already at 5 and 10 years of age. All patients presenting an ANB smaller than 2° at 5 years needed a Le Fort I osteotomy. Mandibular protrusion (SNB, SNPg) was not different at 5 and 10 years, but was different at the completion of growth. Patients with the same initial maxillomandibular relation did not show better growth when subjected to earlier or longer orthodontic treatment. Patients needing final jaw surgery had a more severe skeletal discrepancy during early childhood. The ANB angle at 5 years allowed doctors to identify 45% of the need for orthognathic surgery. The final craniofacial pattern does not seem to change significantly with early or prolonged orthodontic treatment.

Oral health–related quality of life changes in standard, cleft, and surgery patients after orthodontic treatment

The purpose of this study was to investigate the effect of orthodontic treatment on oral health-related quality of life (OHRQoL) in groups of standard patients with severe malocclusions; cleft lip, cleft palate, or cleft lip and palate patients; and orthognathic surgery patients. The study sample consisted of 83 consecutive patients undergoing treatment at the orthodontic unit of Christchurch Hospital, Christchurch, New Zealand, divided into 3 groups: 30 adolescents with severe malocclusions; 24 adolescents with cleft lip, cleft palate, or cleft lip and palate; and 29 adults with severe skeletal discrepancies requiring both orthognathic surgery and orthodontic treatment. Each patient completed the Short Form of the Oral Health Impact Profile (OHIP-14) questionnaire before and after orthodontic treatment. The baseline OHIP-14 subscale scores among the 3 study groups were significantly different, with the surgery patients having nearly twice the OHIP-14 scores of the other 2 groups for nearly half of the items (P <0.05). The surgery patients experienced the greatest reduction in OHIP-14 scores (ie, improvement in OHRQoL), with the largest effect sizes reported for the psychological discomfort (+2.73) and disability (+2.65) domains. The group with clefts experienced the smallest changes in OHIP-14 scores across all 7 domains (-0.03 to +0.63). After adjusting for age and sex, the surgical patients had a significantly greater reduction in pretreatment OHIP-14 scores than did the standard and the cleft patients (P <0.01). The effect of orthodontic treatment on OHRQoL varies for different patient groups even after adjusting for age and sex. The greatest improvement in OHRQoL occurred in adults with a need for orthognathic surgery, whereas the least improvement seemed to occur in adolescents with cleft lip, cleft palate, or cleft lip and palate.