Severe Skeletal Malocclusions Research Articles

Treatment of Orthognathic Surgical Class III Patient with Coffin–Siris Syndrome: A Case Report

We present a case report of a 26-year-old female suffering from Coffin–Siris Syndrome, who underwent orthodontic treatment and surgery to solve her malocclusion and to improve her aesthetics and functional occlusion. Methods: The presurgical phase involved multibracket self-ligating attachments, namely a Damon prescription. The patient underwent maxillofacial surgery to correct the severe skeletal malocclusion and to relocate the bone bases to the right position. Post-surgical orthodontic treatment was performed to complete the alignment. Results: The patient’s aesthetics and functional abilities improved. Conclusions: Syndromic patients can undergo orthodontic treatment if comorbidities and collaboration allow it. The support and collaboration of families and psychotherapists must be considered, but clinical cases of syndromic patients can be faced and solved. Obviously, each syndromic patient is considered unique, and the risk–benefit ratio must be correctly assessed for each one.

Assessment and Comparison of Temporomandibular Joint for Occurrence and Severity of Disorders in Adult Cases with Unilateral Cleft Lip and Palate and Non-cleft Class I: An Observational Study

Background: Cleft Lip and Palate (CLP) are hereditary deformity of craniofacial structure. Temporomandibular disorder has number of clinical problems affecting muscles of mastication and its associated structures. There are several methods used to evaluate temporomandibular dysfunction (MRI, etc), Helkimo index is a settler in advancing indices, other indices used are CMI, MFIQ, FONSECA. The design of the following study was to evaluate the TMJ disorders in UCLP, if any, and compare with the non-cleft cases.
 Methodology: Total 30 patients aged 16 to 20 years, will be selected from the patients coming to smile train Out Patient Department (OPD) of Orthodontics and Dentofacial Orthopaedics, Wardha. The total cases will be divided into two groups: a) Group I - unliteral cleft lip and palate cases b) Group II - non cleft class I cases Digital records of the patient (lateral cephalogram, photograph, models) will be taken and stored. Helkimo, MFIQ, CMI, Fonseca will be recorded on all patients participated in study. The Helkimo index will be taken to assess the presence and severity and MFIQ index will be taken to assess mandibular functioning in cleft cases based on the questionnaire.
 Expected Results: The dental apparatus (interdental relation of maxillary and mandibular dentition) plays an important role in the temporomandibular joint's well-being. Trauma due to the occlusal instability has definite effect on the TMJ in long run. Cleft is always associated with inter jaw malocclusion and therefore TMDs in the cleft patient is thought to occur. The treatment protocol for grown cases with severe skeletal malocclusion is orthognathic surgery. The TMJ correction remains untouched. It can be expected that altered TMJ anatomy can lead to TMDs in cleft lip and palate cases.
 Conclusion: To convey the occurrence of TMDs in cleft due to the inter jaw malocclusion and its early treatment approach for TMJ deprogramming along with dental and surgical correction in CLP.

Quasi-least squares regression method with dentistry data.

In dentistry, single-jaw surgery or double-jaw surgery is performed depending on the patient's need to correct severe skeletal malocclusions. The effect of these surgical methods used in treatment is to be investigated with quasi-least squares regression (QLS), which is a new data analysis method for correlated data obtained by extending generalized estimating equations (GEE). The aim of this study is to investigate whether jaw surgery methods (single jaw and double jaw) and time are effective on some outcome variables (C point menton distance, cervical plane angle, distance from point C to pogonion perpendicular, angle between cervical plane and facial plane) using QLS method. In application, 114 measurements were performed on the lateral cephalometric radiographs of 34 patients aged 18 years and older who received orthodontic treatment and underwent surgery in the period of 2000-2018. The effects of time and group variables on four dependent variables were investigated and evaluated using QLS and GEE methods. Single-jaw surgery and double-jaw surgery as a group variable on all outcome variables were not significant. Among the working correlation structures used in QLS, the highest correlation value was obtained by "Markov" working correlation structure. Single-jaw surgery and double-jaw surgery were found to be statistically insignificant for outcome variables examined. QLS is superior to GEE in cases where repeated measurements are performed at unequal time intervals and there are missing observations.

Therapeutic effect analysis of skeletal class Ⅲ malocclusion treatment by transmission straight wire technique

This study aimed to investigate the therapeutic effects and advantages of skeletal class Ⅲ malocclusion treatment by transmission straight wire technique. Ninety-seven patients who receivedtreatmentfor skeletal class Ⅲ malocclusion atthe Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2012 to January 2017 were selected for this retrospective study. All these patients refused surgery. They were divided into two groups in accordance with the type of skeletal malocclusion: mild-to-moderate skeletal malocclusion group (-4°≤ANB <0°) and severe skeletal malocclusion group (-8°≤ANB<-4°). Each of the two groups was divided further into two small groups in accordance with the technique used: T group (transmission straight wire technique) and M group (MBT technique). The crossbite of all 59 patients in the mild-to-moderate skeletal malocclusion group was successfully treated. The molars were classified as classⅠrelationship, and the facial profile improved. Significant differences were found in the values of U1/SN angle, L1/MP angle, and Lip-Diff between the T and M groups before and after the treatment (P<0.05). The extent of incisor root resorption was lighter in the T group than in the M group (P<0.05). In the severe skeletal malocclusion group, the crossbite of all 38 patients was cured or partially cured. Fourteen patients showed severe lower anterior teethinclination (five in the T group and nine in the M group), and the profiles did not significantly improve. Significant differences were observed in the values of U1-NA value, U1/SN angle, L1-NB value, L1/MP angle, LLP, and Lip-Diff between the T and M groups before and after the treatment (P<0.05). The extent of incisor root resorption was lighter in the T group than in the M group (P<0.05). Relative to the MBT technique, the transmission straight wire technique has great advantages in improving facial profile, reducing the compensatory inclination of the upper and lower anterior teeth, and reducing the risk of root resorption in the treatment of skeletal class Ⅲ malocclusion.

Bilateral sagittal split osteotomy for mandibular retrognathism: Two case reports

Adult patients with severe skeletal malocclusions require orthognathic surgeries. Two case reports with skeletal Class II malocclusion due to retrognathic mandible discussed in this article were treated by bilateral sagittal split osteotomy mandibular advancement. Treatment results showed good improvement in facial profile, Angle Class I molar and canine relation, good occlusion after surgery for both the cases.

Quality of Life in Subjects Suffering from Severe Skeletal Malocclusion before Orthodontic Treatment

Objective: The objective of this study was to determine the occurrence of oral health impacts among patients with severe skeletal malocclusions and dentofacial skeletal deformities before orthodontic treatment.&#x0D; Methods: A cross-sectional study comprising of 45 adult patients referred for orthodontic or surgical- orthodontic treatment to the orthodontics department, Karachi Medical and Dental College, Abbasi Shaheed Hospital Karachi were included. The study group consisted of 29 females and 15 males with a mean age of 21.5 ± 5.4 years. Study was conducted for six months from 30th Oct 2016 to 30th April 2017. A purposive sampling was done on the bases of survey base study design. A self-com- pleted Oral Health Impact Profile (OHIP)-14 questionnaire was used to measure the quality of life before orthodontic treatment.&#x0D; Inclusion criteria were subjects seeking orthodontic treatment at the department of orthodontics, den- tal OPD Karachi Medical and Dental College, Abbasi Shaheed Hospital, Karachi, Pakistan. Patients who had perceived a need for orthodontic treatment and who were about to undergo orthodontic therapy were included.&#x0D; Subjects with chronic medical conditions, previous orthodontic treatment, and craniofacial anomalies such as cleft lip and palate, untreated dental caries, and poor periodontal health status as indicated by a community periodontal index score of 3 or more were excluded. The frequency, extent, and sever- ity scores were calculated from the OHIP-14. Malocclusions were registered at clinical examination. The frequency and mean extent and severity scores were compared among malocclusion groups and between genders. Descriptive and inferential statistical method was applied.&#x0D; Results: Frequency of oral impact in malocclusion patient was 27.3% though test value was 56 (p value &gt;0.00). Mean value for male and female patients with malocclusion is 22.06 + 7.1 and 21.34 + 4.4 (p value &gt;0.626), respectively, which shows no significant difference present. Mean value for class I, II and III was 24.5, 28.9 and 30.5 (p value &gt;0.44), respectively, which shows no significant differ- ence.&#x0D; Conclusion: There was no difference noted in the class of skeleton malocclusion in quality of life of patients and there was no gender difference noted in oral health impact of patients.

Orthodontics or surgery? – what to do first

The combined treatment of orthognathic surgery with orthodontics for severe skeletal malocclusion can dramatically improve facial aesthetics. The traditional treatment plan for a skeletal malocclusion is orthognathic surgery, including a pre-orthodontic and post-orthodontic phase. Pre-orthodontic treatment increases the total treatment time and is sometimes considered the worst part of the treatment by the patient. Surgery followed by orthodontic treatment gives a good result and reduces the treatment duration for certain selected cases. The purpose of the present study was to report our experience with the ‘Surgery First’ approach for skeletal malocclusions. CPD/Clinical Relevance: Skeletal malocclusions where the dental discrepancy is not severe can be treated first with orthognathic surgery followed by orthodontic treatment. This may reduce the overall treatment time.

A Case of Amniotic Band Sequence Complicated by Severe Skeletal Malocclusion

This clinical report describes the management of a patient who was diagnosed with amniotic band sequence (ABS) complicated with severe skeletal malocclusion, associated with severe muscle weakness. The patient was a 23-year-old male who underwent treatment in our hospital to improve chewing, phonation, and swallowing difficulties caused by severe abnormality of the maxillofacial skeleton. We evaluated chewing, swallowing and language functions preoperatively, and started muscle function and oral rehabilitation therapy. We performed 2-jaw osteotomy after preoperative orthodontic treatment. The patient continued with postoperative orthodontic treatment and oral rehabilitation. Postoperatively, the patient showed improved maxillofacial morphology, but was unable to attain sufficient improvement of masticatory and language functions due to atrophy and poor development of the masticatory muscles. These results suggest that obtaining sufficient therapeutic effect on oral functions is not possible if the masticatory muscles are not sufficiently strong due to atrophy or hypoplasia.

Tratamiento de una maloclusión clase III en dentición decidua y mixta con expansión rápida palatina y máscara facial

Reportamos el seguimiento de un caso clínico de mordida cruzada que en un inicio comprometió el uso de un aparato de expansión palatina adhesivo de acrílico, que después de la estabilización del tratamiento y coincidente con el recambio dentario anterosuperior, sufrió recidiva de la mordida cruzada anterior, la cual fue corregida con el uso de máscara facial. El propósito de corregir la mordida cruzada en edades tempranas permite que se produzca mejoras en el patrón esquelético de clase III y reduce la cantidad de compensaciones dentales y discrepancias esqueléticas que generalmente están asociadas a la maloclusión esquelética severa en la adolescencia, sin embargo, la desventaja es el tiempo de tratamiento prolongado y la potencial inestabilidad de los cambios obtenidos. Independientemente de cuál sea el factor determinante de la recidiva, se recomienda la sobrecorreción del resalte y de la relación molar como una herramienta para la estabilidad a largo plazo.

Intra-oral mandibular sagittal osteotomy technique to correct mandibular distocclusion and mesio-occlusion

Skeletal malocclusions may be due to disturbances in the growth of the mandible or maxilla. In most cases, discomfort is the result of tooth-to-tooth malocclusion or tooth-to-soft-tissue contact. Currently, in veterinary medicine, these problems are treated palliatively. In humans, orthognathic surgery is indicated to correct severe skeletal malocclusions, offering aesthetic and functional benefits to the patients. This research evaluated the effects of an intra-oral mandibular sagittal split osteotomy in 20 dog cadavers with skeletal malocclusion. After sagittal osteotomy and mandibular repositioning, the osteotomies were fixed with titanium mini-plates and 1.5 mm diameter screws or 1.5 mm bicortical screws. The statistical analysis revealed a significant occlusion difference in the treated cadavers (Wilcoxon test, p<0.05). In 19/20 cadavers there was correction of the angular osteotomy while the mandibular alveolar vessels and nerve were preserved during osteotomy and fixation in all cadavers. In conclusion, intra-oral mandible sagittal osteotomy allowed correction of malocclusion in cadavers. However, it would be important to prepare a preoperative orthodontic-surgical treatment plan to obtain a satisfactory occlusion during the surgery in clinical patients.

Piezoelectric Decortication Applied in Periodontally Accelerated Osteogenic Orthodontics

Our aim was to evaluate the application of piezoelectric decortication in periodontally accelerated osteogenic orthodontics (PAOO). One hundred fifty-six patients with severe skeletal malocclusions were enrolled in this study. Ultrasonic decortications were performed in 187 labial or lingual PAOO of the maxillary and mandibular anterior teeth. Orthodontic decompensation started from the fifth day after operation. All patients healed uneventfully and no severe periodontic complications were recorded. Rapid teeth movement and relatively short treatment duration were realized. Alveolar fenestration and bony dehiscence was successfully addressed. With physical and mechanical properties of absence of macrovibration, ease of use and control, piezosurgery showed its great values in PAOO.

Cervical Vertebral Column Morphology Associated with Head Posture and Craniofacial Morphology

Significant associations have previously been described between craniofacial morphology, posture of the head and neck, and obstruction of the upper airways as seen in patients with obstructive sleep apnea. Morphological deviations in the cervical vertebral column have also been described in relation to craniofacial syndromes and to cleft lip and/or palate. New findings have been made concerning associations between fusion of the cervical vertebral column and craniofacial morphology, including the cranial base, in patients with severe skeletal malocclusions. Another new finding was the association between fusion of the cervical vertebral column and head posture and between fusion of the cervical vertebral column and obstructive sleep apnea. Accordingly, it is suggested that fusion of the cervical vertebral column is associated with the development and function of the craniofacial morphology in the sagittal, vertical, and transversal planes. Significant associations have previously been described between craniofacial morphology, posture of the head and neck, and obstruction of the upper airways as seen in patients with obstructive sleep apnea. Morphological deviations in the cervical vertebral column have also been described in relation to craniofacial syndromes and to cleft lip and/or palate. New findings have been made concerning associations between fusion of the cervical vertebral column and craniofacial morphology, including the cranial base, in patients with severe skeletal malocclusions. Another new finding was the association between fusion of the cervical vertebral column and head posture and between fusion of the cervical vertebral column and obstructive sleep apnea. Accordingly, it is suggested that fusion of the cervical vertebral column is associated with the development and function of the craniofacial morphology in the sagittal, vertical, and transversal planes.

The prevalence of TMJ osteoarthritis in asymptomatic patients with dentofacial deformities: a cone-beam CT study

Osteoarthritis of the temporomandibular joint (TMJ) can be described as non-inflammatory arthritic condition that results in degenerative changes of the joint structures. The aim of this study was to evaluate the skeletal morphology of the TMJ in patients with osteoarthritis with severe skeletal malocclusions (Class II and Class III) and patients with Class I occlusion as controls. Cone beam computed tomography images of 45 Class I, 28 Class II and 44 Class III joints of Caucasian patients were assessed for the presence of any degenerative changes in the condyle and fossa/eminence complex as described in the research diagnostic criteria for temporomandibular disorders (RDC/TMD). In all groups, the most commonly observed features were articular surface flattening and subcortical sclerosis. A combination of features that corresponds to a diagnosis of osteoarthritis was observed in 3% Class I, 43% Class II and 20% Class III patient joints. In conclusion, degenerative TMJ changes were more common in patients with skeletal jaw discrepancies, but wide inter-individual variations can be observed even in patients with clinically similar malocclusions.

Associations between the Cervical Vertebral Column and Craniofacial Morphology

Aim. To summarize recent studies on morphological deviations of the cervical vertebral column and associations with craniofacial morphology and head posture in nonsyndromic patients and in patients with obstructive sleep apnoea (OSA). Design. In these recent studies, visual assessment of the cervical vertebral column and cephalometric analysis of the craniofacial skeleton were performed on profile radiographs of subjects with neutral occlusion, patients with severe skeletal malocclusions and patients with OSA. Material from human triploid foetuses and mouse embryos was analysed histologically. Results. Recent studies have documented associations between fusion of the cervical vertebral column and craniofacial morphology, including head posture in patients with severe skeletal malocclusions. Histological studies on prenatal material supported these findings. Conclusion. It is suggested that fusion of the cervical vertebral column is associated with development and function of the craniofacial morphology. This finding is expected to have importance for diagnostics and elucidation of aetiology and thereby for optimal treatment.

Lengths of the maxillary central incisor, the nasal bone, and the anterior cranial base in different skeletal malocclusions

Objective. Based on the results of previous studies of osseous structures within the frontonasal field in patients with a known malformation in the frontonasal field, the aim of the present study was to clarify whether the same structures were malformed in patients with severe skeletal malocclusions. Material and methods. Incisor, nasal, and cranial base lengths were measured on lateral radiographs of adult patients with skeletal malocclusions, including open bite (n=35), mandibular overjet (n=56), maxillary overjet (n=31), deep bite (n=19), and compared with those of a control group with neutral occlusion and normal craniofacial morphology (n=39). Two-way ANOVA tests were used to evaluate differences in lengths between groups and gender. Results. Statistically shorter maxillary central incisor length was found in the open bite group (p<0.05), the mandibular overjet group (p<0.001), and in the deep bite group (p<0.001) compared to the controls. Nasal bone length was shorter in the maxillary overjet group compared to controls (p<0.05). Conclusions. The lengths of the maxillary central incisor and nasal bone, both parameters located in the frontonasal field, are affected in different skeletal malocclusions. The present findings, especially the deviation of the upper incisor length in different skeletal malocclusions, are considered relevant for orthodontic diagnostics and treatment.

MRI of TMJ in Patients with Severe Skeletal Malocclusion Following Surgical/Orthodontic Treatment

The aim of this study was to evaluate temporomandibular joints (TMJ) by magnetic resonance imaging (MRI) in patients who had undergone surgical/orthodontic or orthodontic treatment in a three-year follow-up study. Subjects consisted of 20 patients (40 TMJ), 16 females and four males (mean age 33.7 years, range 19-53 years), with severe temporomandibular disorders (TMD) referred to the Oral and Maxillofacial Department at Oulu University Hospital due to skeletal jaw discrepancy. All patients underwent extensive surgical/orthodontic or orthodontic treatment between 1996 and 2003. Clinical stomatognathic examination and MRI examinations were performed before the surgical/orthodontic or orthodontic treatment and one year after the completion of the treatment. The average treatment time was 23 months (range 12-34 months). MRI revealed a marked decrease, especially in the number of TMJ with joint effusion after the treatment. There were only a few changes in the number of diagnosed disk dislocations before and after the treatment. In five joints with anterior disk dislocation with reduction (r-ADD), a change to anterior disk dislocation without reduction (nr-ADD) was found. In 25 of the 40 condyles, the condylar configuration was normal on MRI before the treatment and in 19 condyles one year after the treatment. TMD signs and symptoms according to the Helkimo dysfunction index showed a statistically significant decrease after the treatment.

Speech, velopharyngeal function, and hearing before and after orthognathic surgery

Articulation, voice, resonance, hearing sensitivity, and middle ear function were examined in 34 patients before and 3, 6, 9, and 12 months after orthognathic surgery. Thirty of the 34 patients had articulation errors before surgery. Errors on the sibilants /s/ and /z/ occurred most frequently, followed by those on /j,zh,ch/ and /sh/. Errors were predominantly distortions with both visual and acoustic components. After surgery, articulation improved spontaneously in the absence of intervention. Most of the preoperative articulation errors were eliminated by 3 months postoperative, but, thereafter, a gradual decline was noted so that by 12 months, errors occurred on /s/ and /z/. Voice, resonance, velopharyngeal port area, and hearing sensitivity were not altered by surgery. This study suggests that severe skeletal malocclusions requiring surgical correction have deleterious effects on the patients' articulation of consonants and that surgical alteration leads to the correction of most of these errors.

Clinico-Statistical observations on cases with severe skeletal malocclusion corrected by oral and plastic surgery

Clinico-Statistical observations on cases with severe skeletal malocclusion corrected by oral and plastic surgery

Erratum to : Clinico-Statistical observations on cases with severe skeletal malocclusion corrected by oral and plastic surgery

Erratum to : Clinico-Statistical observations on cases with severe skeletal malocclusion corrected by oral and plastic surgery