Significant Proclination Research Articles

A comparative evaluation of pre-treatment and post-treatment outcomes in patients subjected to lower incisor extraction

Mandibular incisor crowding is the most frequently occurring characteristic of malocclusion, which can be resolved by removing single lower incisor. The aim of this study was to evaluate and compare the pre- and post-treatment outcomes through model and cephalometric analysis of the patients subjected to single lower incisor extraction. In this retrospective study pre- and post-treatment lateral cephalograms and models of 23 patients who underwent fixed orthodontic treatment with single incisor extraction on lower arch were evaluated. The study subjects were classified into two groups based on extraction pattern (Group I: Upper premolar and lower single incisor extraction; Group II: Upper non extraction and lower single incisor extraction). Both cephalometric and model analysis were carried out using Ilexis FACAD AB-2014 Version3.8.0.0 (Ilexis AB, Sweden). Wilcoxon Signed Rank test was used to compare the pre and post-treatment quantitative parameters. A significant decrease was observed in the maxillary intermolar width, mandibular intercanine width, mandibular intermolar width, mandibular arch length and anterior Bolton’s ratio. Group I subjects revealed a greater decrease in maxillary intermolar width compared to Group II, whereas a greater decrease in mandibular intercanine width, mandibular intermolar width and anterior Bolton’s ratio was documented in Group II subjects compared to Group I. Cephalometric analysis revealed significant proclination and extrusion effect of lower incisors along with protrusive tendency of the lower lip. The findings of the present study provide an additional option of extracting single lower incisor, in borderline or Class II camouflage treatment cases.

Conventional Twin-Block Versus Cervical Headgear and Twin-Block Combination: Therapeutic Effects on the Craniofacial Structures in Growing Subjects.

To compare the short-term effects of the conventional twin-block (TB) appliance and the cervical headgear TB (CHG-TB) appliance on craniofacial structures. The retrospective controlled study examined lateral cephalograms taken from 46 growing subjects. Individuals were divided into two groups according to the treatment. Group I consisted of 15 individuals (9 girls, 6 boys, mean age: 12.34±1.23 years) treated with the TB appliance and Group II consisted of 16 individuals (9 girls, 7 boys) treated with the CHG-TB appliance (mean age: 12.50±1.30 years). To distinguish the treatment effects of these appliances on growth, a control group of 15 untreated individuals (9 girls, 6 boys, mean age: 11.82±1.16 years) was included from the archives. Significant improvements were found in the interdental and maxillo-mandibular measurements in the treatment groups (p<0.001). Significant differences were observed in the SNA, SN/PP, and SN/GoGn values in the CHG-TB group compared to other groups (p<0.05). The mandible showed a significant downward movement in both treatment groups compared with the control group (p<0.001), while the change in SNB angle was statistically significant only in the TB group compared to the control group (p<0.05). Lower incisors showed significant proclination only in the TB group (p<0.05). The CHG-TB appliance was found to be more effective in limiting maxillary growth and preventing lower incisor proclination compared with the TB appliance, whereas the TB appliance was more effective in anterior mandibular movement.

Evaluation of the relationship between incisor torque and profile aesthetics in patients having orthodontic extractions compared to non-extractions

ObjectiveThe aim of the present study was to evaluate the relationship between soft tissues aesthetics and incisor torque, as well as the effect of crowding, anchorage, and extraction pattern, in adult patients treated without extraction or with two or four extractions.Materials and methodsSeventy-seven subjects with permanent dentition were selected retrospectively. Among these, 24 patients were treated with four extractions, 24 with two extractions and 29 without extractions. Lateral cephalograms and photographies taken before (T0) and after (T1) treatment were retrieved. The amount of crowding and the type of anchorage were recorded, and a cephalometric analysis was performed. A one-way ANOVA was used to compare the variables within and between groups. Linear regressions were performed to evaluate the effect of different predictors on soft tissues variables at T1.ResultsThe statistical analysis showed no differences within and between groups for soft tissue aesthetics. A significant reduction of the angle obtained from the intersection of Frankfurt plane and mandibular plane was observed in the four-extractions group, and a significant proclination of the lower incisors was observed in the two-extraction group. Linear regressions revealed that the change in soft tissue profile aesthetics was affected by the type of anchorage and the two-extractions pattern.ConclusionsSimilar soft tissue aesthetics were observed after treatment in the three groups, despite the presence of some skeletal and dental differences.Clinical relevanceA well-controlled incisor torque helps to preserve soft tissues aesthetics. The type of anchorage could influence soft tissues.

Assessment of the Treatment Outcomes of Skeletal Class III Malocclusion Using Forsus Fatigue Resistant Device Versus Intermaxillary Elastics

Purpose: This research aimed to evaluate the effect of treatment with Forsus Fatigue Resistant Device (FFRD) and traditional Class III elastics in treating class III malocclusion. Patients and Methods: The present study was applied to twenty female patients divided into two groups equally and randomly with age ranged from 14 to 16 years old, Group I treated with inverted FFRD which was attached to the mandibular first molar extra-oral tube and distal to the bracket of the maxillary canine and conventional class III elastics used in Group II. Results: Significant increase revealed in ANB angle in both groups while, there was significant decrease in S-A distance in FFRD group while, in relation to vertical skeletal measurement SN to mandibular plane angle (SN-MP) there was significant decrease in FFRD group and significant increase in intermaxillary elastic group. There was also significant proclination in maxillary anterior teeth and significant retroclination of the mandibular one. Conclusions: In class III malocclusion the use of inverted FFRD and elastics is successful treatment method to improve the maxilla-mandibular relationship by improving anteroposterior relationship (ANB angle). The FFRD is suggested in uncooperative patients as it did not require patient cooperation as class III elastics.

Three-dimensional cone-beam computed technology evaluation of skeletal and dental changes in growing patients with Class II malocclusion treated with the cervical pull face-bow headgear appliance

This study aimed to 3-dimensionally quantify and compare the outcomes of growing patients with Class II malocclusion treated with the cervical pull face-bow headgear appliance in combination with full fixed orthodontic appliances. The study sample consisted of 22 patients with Class II malocclusion with the following inclusion criteria: ANB>4.75°, Class II molar relationship, and SN-GoGn<37°. The mean age of patients was 12.5 ± 1.1 years at baseline. The average treatment time was 27.7 ± 7.3 months. Cone-beam computed tomography scans were superimposed in the cranial base, maxillary regional, and mandibular regional to evaluate growth, treatment displacements, and bone remodeling. Relevant statistically and clinically significant skeletal changes included average decreases in ANB (2.1 ± 1.1°) and SNA (1.8 ± 1.1°); posterior (1.3 ± 1.4 mm) and inferior (4.6 ± 2.2 mm) displacement of A-point; inferior displacements of B-point (5.4 ± 2.8 mm) and Pogonion (5.8 ± 2.6 mm); superior displacement of Condylion (6.9 ± 2.4 mm); increase in mandibular length (5.4 ± 2.0 mm); and clockwise rotation of palatal plane (1.9 ± 1.9°). Significant proclination of the maxillary incisors (9.8 ± 11.1°) and nonsignificant proclination of the mandibular incisors (4.7 ± 9.6°) were also noted. Class II skeletal correction was primarily achieved by posterior, inferior displacement of the sagittal position of the maxilla. Change in the sagittal position of the mandible/chin (B-point, Pogonion) was not significant; rather, mandibular displacement was significant in an inferior vertical direction without backward rotation, as seen from marked condylar and ramus growth.

Effects of Orthodontic Functional Appliances in Relation to Skeletal Maturation of Cervical Vertebrae In Class II Malocclusion.

To evaluate the effects produced by functional orthodontic appliances at dental and skeletal level in relation to the level of skeletal maturation in class II patients Study design: Longitudinal and observational study Patients selected for the study had been wearing Sander Bite Jumping Appliance (SBJA) for at least 12 months; they were first diagnosed (T1) with skeletal class II according to Ricketts' cephalometric analysis, and had had lateral cephalograms taken before and after orthopaedic treatment (T2). Variables studied at T1 and T2 were: facial convexity, inclination of the upper and lower incisors, and facial depth. Results were compared between T1 and T2 for each variable and in relation to cervical maturation stage (CVS) according to the Lamparski analysis. Statistical analysis was performed using Shapiro-Wilk, t-student, Analysis of Variance (ANOVA) and multiple comparison tests, taking as statistically significant a p-value <0.05. A final sample of 235 patients was obtained. Statistically significant differences were found in the inclination of the mandibular incisors between T1 and T2 and among the different cervical stages when the functional appliances were placed in CVS1 (p = 0.000), CVS2 (p = 0.04) or CVS5 (p = 0.048). For the remaining variables, significant differences were also found between T1 and T2, but these differences were similar in all cervical stages. A significant proclination of the mandibular incisors was found when the functional appliance was placed during CVS1, CVS2, or CVS5. Time of placement of the functional appliances was not statistically significant for the remaining variables studied.

Effects of Orthodontic Functional Appliances in Relation to Skeletal Maturation of Cervical Vertebrae in Class II Malocclusion.

To evaluate the effects produced by functional orthodontic appliances at dental and skeletal level in relation to the level of skeletal maturation in class II patients. Longitudinal and observational study. Patients selected for the study had been wearing Sander Bite Jumping Appliance (SBJA) for at least 12 months; they were first diagnosed (T1) with skeletal class II according to Ricketts' cephalometric analysis, and had had lateral cephalograms taken before and after orthopaedic treatment (T2). Variables studied at T1 and T2 were: facial convexity, inclination of the upper and lower incisors, and facial depth. Results were compared between T1 and T2 for each variable and in relation to cervical maturation stage (CVS) according to the Lamparski analysis. Statistical analysis was performed using Shapiro-Wilk, t-student, Analysis of Variance (ANOVA) and multiple comparison tests, taking as statistically significant a p-value <0.05. A final sample of 235 patients was obtained. Statistically significant differences were found in the inclination of the mandibular incisors between T1 and T2 and among the different cervical stages when the functional appliances were placed in CVS1 (p = 0.000), CVS2 (p = 0.04) or CVS5 (p = 0.048). For the remaining variables, significant differences were also found between T1 and T2, but these differences were similar in all cervical stages. A significant proclination of the mandibular incisors was found when the functional appliance was placed during CVS1, CVS2, or CVS5. Time of placement of the functional appliances was not statistically significant for the remaining variables studied.

Long-term periodontal changes associated with oral appliance treatment of obstructive sleep apnea.

To characterize the mandibular anterior teeth crown height as a marker of periodontal changes and bone loss as a side effect of an oral appliance worn for a minimum of 4.5 years. This retrospective study conducted in patients with healthy baseline periodontium recruited participants among consecutive sleep apnea patients treated with an oral appliance between 2004 to 2014. Eligible participants were recalled for a follow-up visit at which a periodontal examination was performed and a lateral cephalogram and dental impressions were obtained. Clinical crown height for mandibular anterior teeth and cephalometric variables were measured and compared before and after treatment. A full periodontal evaluation was performed at the follow-up visit. Twenty-one patients enrolled with a mean treatment length of 7.9 ± 3.3 years. For the mandibular anterior teeth, clinical crown height did not change over the evaluated period. At follow-up, all the periodontal assessed variables were within normal limits, with the mean probing depth of 1.4 ± 0.5 mm, recession 0.6 ± 1.1 mm, and clinical attachment loss 0.8 ± 1.0 mm. Compared with baseline, there was a significant proclination of mandibular incisors (mean increase of 5.1 degrees) with the continued use of an oral appliance. Gingival levels were maintained with clinically insignificant changes during the observation period. Inclination of the mandibular incisors increases significantly with the use of an oral appliance in patients with obstructive sleep apnea. Positional changes in these teeth were not associated with any measured evidence of increase in clinical crown height or gingival recession. Heda P, Alalola B, Almeida FR, Kim H, Peres BU, Pliska BT. Long-term periodontal changes associated with oral appliance treatment of obstructive sleep apnea. J Clin Sleep Med. 2021;17(10):2067-2074.

Estimation of the dental movements caused by Narval® Oral Appliance in the treatment of adult obstructive sleep apnea hypopnea syndrome

Objective: oral appliances are one of the treatments of obstructive sleep apnea hypopnea syndrome. They all have dental anchoring points, causing potential changing in the dental occlusion with time. The aim of the study was to evaluate dental displacement induced by Narval® oral appliance in the treatment of the adult mild to severe obstructive sleep apnea hyponea syndrome. Material and methods: The study was based on 15 adults with mild to severe obstructive sleep apnea hypopnea syndrome treated with a Narval® oral appliance for more than one year. Before oral appliance delivery and more than one year after oral appliance delivery, dental impressions were performed and digitized by a 3D scanner. The dental positions were calculated by the software 3D Reshaper® and compared. Results: The mean wearing time of the Narval® oral appliance was 13.5 months (±2.1). The mean mandibular advancement was 6mm (±2). For the maxillary arch, there was a significant distalization of molar and premolar-canine blocks from 0.12 to 0.20mm (all p&lt;0.05) and a significant proclination of incisal blocks of 0.18mm (p&lt;0.05). For the mandibular arch, there was a significant mesialization of the molar and premolar-canine blocks of 0.14 to 0.25 mm (p&lt;0.05) and a non-significant retoclination of the incisors of 0.09 mm. Conclusions: The Narval® oral appliance produced minimal but significant teeth movements on the maxillary and mandibular at the short and medium term.

Evaluation of the splint-supported Forsus Fatigue Resistant Device in skeletal Class II growing subjects.

To evaluate the use of the Forsus Fatigue Resistant Device (FFRD), supported with bimaxillary splints, in treatment of skeletal Class II malocclusion. Data from 46 skeletal Class II females who received either conventional Forsus alone (FFRD group) (15 patients, 12.54 ± 0.90 years), FFRD and bimaxillary splints (splint-FFRD group) (15 patients, 12.29 ± 0.82 years), or were untreated controls (16 subjects, 12.1 ± 0.9 years) were retrieved from previous clinical trials. FFRD was inserted onto the mandibular archwire in the FFRD group after leveling and alignment with multibracket appliances. In the splint-FFRD group, Forsus was inserted between fixed maxillary and mandibular splints. Treatment continued until reaching an edge-to-edge incisor relationship. Both treatment groups failed to induce significant mandibular skeletal effects compared to the normal growth exhibited by untreated controls. The splint-FFRD group showed significant reduction of SNA (-0.88° ± 0.51°) and ANB (-1.36° ± 0.87°). The mandibular incisors showed significant proclination in the FFRD (9.17° ± 2.42°) and splint-FFRD groups (7.06° ± 3.34°). The newly proposed splint-supported FFRD was equally effective as the conventional FFRD in treatment of Class II malocclusion with dento-alveolar changes and additional maxillary restricting effect. It has an additional advantage of immediate initiation of the Class II correction.

Evaluation of Root Resorption, Tooth Inclination and Changes in Supporting Bone in Class II Malocclusion Patients Treated with Forsus Appliance.

The aim of our study was to evaluate apical root resorption and changes in tooth inclinations, marginal bone height, and labio-lingual bone thickness at the mid-root and apical level in mandibular anterior teeth during the Forsus treatment using cone beam computed tomography (CBCT). CBCT scans of 16 subjects (8 males and 8 females) with Class II malocclusion (age group: 13-29 years) taken before and 6 months after the Forsus treatment were evaluated for apical root resorption, tooth inclination, marginal bone height, and thickness of bone at the mid-root and apical level in mandibular anterior teeth. There was statistically significant root resorption of central incisors (0.39 mm) and canines (0.66 mm); a decrease in the angle of inclination for all teeth; an increase in the marginal bone measurement in labial (1.31 mm) and decrease in lingual (0.93 mm) aspect at the canine region; and an increase in bone width by 0.87 mm and 0.75 mm in central and lateral incisor regions, respectively, at the mid-root level lingually. At the apex level in the canine region, bone width increased by 1.4 mm labially, while it decreased by 2.18 mm lingually; it increased significantly for incisors in the lingual region. The Forsus appliance therapy causes clinically insignificant root resorption and bone changes, and clinically significant proclination of mandibular anterior teeth. The findings of the present study aid clinicians in proper case selection and reinforce the prevention of incisor proclination while using the Forsus therapy to achieve better treatment results and stability.

Evaluation of the miniplate-anchored Forsus Fatigue Resistant Device in skeletal Class II growing subjects: A randomized controlled trial.

To evaluate the use of direct miniplate anchorage in conjunction with the Forsus Fatigue Resistant Device (FFRD) in treatment of skeletal Class II malocclusion. Forty-eight females with skeletal Class II were randomly allocated to the Forsus plus miniplates (FMP) group (16 patients, age 12.5 ± 0.9 years), Forsus alone (FFRD; 16 patients, age 12.1 ± 0.9 years), or the untreated control group (16 subjects, age 12.1 ± 0.9 years). After leveling and alignment, miniplates were inserted in the mandibular symphysis in the FMP group. The FFRD was inserted directly on the miniplates in the FMP group and onto the mandibular archwires in the FFRD group. The appliances were removed after reaching an edge-to-edge incisor relationship. Data from 46 subjects were analyzed. The effective mandibular length significantly increased in the FMP group only (4.05 ± 0.78). The mandibular incisors showed a significant proclination in the FFRD group (9.17 ± 2.42) and a nonsignificant retroclination in the FMP group (-1.49 ± 4.70). The failure rate of the miniplates was reported to be 13.3%. The use of miniplates with the FFRD was successful in increasing the effective mandibular length in Class II malocclusion subjects in the short term. The miniplate-anchored FFRD eliminated the unfavorable mandibular incisor proclination in contrast to the conventional FFRD.

Class III Treatment with Skeletal and Dental Anchorage: A Review of Comparative Effects.

Objectives This review addresses the comparative effects of skeletal anchored maxillary protraction (MP) versus dental anchored MP. Materials and Methods The studies retrieved had to have both test and control groups treated by the use of a facemask with or without the use of skeletal anchorage though either (palatal/buccal) maxillary or mandibular miniscrews/miniplates, respectively. Results Nine articles were included. Dentoalveolar changes were seen in all the studies. In particular, a significant proclination of the upper incisors was documented in the group treated with a dental anchorage facial mask, as compared to that treated with skeletal anchorage. Comparing the two methods, almost all the studies indicated a greater maxillary advancement in the group treated with skeletal anchorage. Conclusions Therapies with skeletal anchorage produce greater maxillary protraction, reducing undesirable dental effects.

Treatment effects produced by the Twin-block appliance vs the Forsus Fatigue Resistant Device in growing Class II patients.

To compare the dentoskeletal changes produced by the Twin-block appliance (TB) followed by fixed appliances vs the Forsus Fatigue Resistant Device (FRD) in combination with fixed appliances in growing patients having Class II division 1 malocclusion. Twenty-eight Class II patients (19 females and 9 males; mean age, 12.4 years) treated consecutively with the TB followed by fixed appliances were compared with a group of 36 patients (16 females and 20 males; mean age, 12.3 years) treated consecutively with the FRD in combination with fixed appliances and with a sample of 27 subjects having untreated Class II malocclusion (13 females and 14 males; mean age, 12.2 years). Mean observation interval was 2.3 years in all groups. Cephalometric changes were compared among the three groups by means of ANOVA and Tukey's post hoc tests. The FRD produced a significant restraint of the maxilla compared with the TB and control samples (SNA, -1.1° and -1.8°, respectively). The TB sample exhibited significantly greater mandibular advancement and greater increments in total mandibular length than either the FRD or control groups (SNB, 1.9° and 1.5°, respectively; and Co-Gn, 2.0 mm and 3.4 mm, respectively). The FRD produced a significantly greater amount of proclination of the mandibular incisors than what occurred with the TB or the control samples (2.9° and 5.6°, respectively). The TB appliance produced greater skeletal effects in terms of mandibular advancement and growth stimulation while the Forsus caused significant proclination of the mandibular incisors.

Treatment effects of Forsus fatigue resistant device on class II malocclusion cases: A cephalometric evaluation

BackgroundThis study was designed to evaluate dental and skeletal changes after a comprehensive orthodontic treatment protocol involving the use of Forsus fatigue-resistant device. MethodsPre- and post-treatment cephalometric radiographs of 19 subjects (mean age 12 ± 1.22 years) treated with the Forsus device were selected based on several criteria, including, but not limited to ANB and Angle molar classification. Treatment group records were evaluated, matched, and compared to an untreated control group. The control group's lateral cephalometric radiographs were obtained from the archives of a longitudinal growth study. The Student's t test was used, with a significance level of P < 0.05. ResultsThe treatment group showed a statistically significant reduction in ANB angle; SNA angle; and angle of convexity. Mandibular incisors showed significant proclination. The maxillary first molar showed no significant intrusion or distal movement. ConclusionsBased on the treatment protocol used in this study, Class II malocclusion correction was achieved mainly by dental changes in the mandible in the form of mandibular incisor proclination and some skeletal changes in the maxilla. Whether the changes in the maxilla were true skeletal changes remains to be verified.

Dentofacial effects of skeletal anchored treatment modalities for the correction of maxillary retrognathia

The aim of this clinical study was to investigate the skeletal, dentoalveolar, and soft-tissue effects of 2 skeletal anchorage rationales for Class III treatment compared with an untreated Class III control group. Fifty-one subjects who were in the prepubertal or pubertal growth period were included in the study. In group 1 (n= 17), facemasks were applied from miniplates placed in the lateral nasal walls of the maxilla, and intermaxillary Class III elastics were applied from symphyseal miniplates to a bonded appliance on the maxilla in group 2 (n= 17). These skeletal anchored groups were compared with an untreated control group (n= 17). Lateral cephalometric radiographs were obtained at the beginning and the end of the observation periods in all groups and analyzed according to the structural superimposition method. Differences between the groups were assessed with the Wilcoxon signed rank test or the paired-samples t test. The treatment periods were 7.4 and 7.6 months in groups 1 and 2, respectively, and the untreated control group was observed for 7.5 months. The maxilla moved forward by 3.11 mm in group 1 and by 3.82 mm in group 2. The counterclockwise rotation of the maxilla was significantly less in group 1 compared with group 2 (P<0.01). The mandible showed clockwise rotation and was positioned downward and backward in the treatment groups, and it was significantly greater in group 2 compared with group 1 (P<0.01). Changes in the maxillary incisor measurements were negligible in group 1 compared with group 2. A significant amount of mandibular incisor retroclination was seen in group 1, and a significant proclination was seen in group 2. The maxillomandibular relationships and the soft-tissue profiles were improved remarkably in both treatment groups. The protocols of miniplates with facemasks and miniplates with Class III elastics offer valid alternatives to conventional methods in severe skeletal Class III patients. However, the 2 maxillary protraction protocols demonstrated significant skeletal and dentoalveolar effects. The miniplate with facemask protocol is preferred for patients with severe maxillary retrusion and a high-angle vertical pattern, whereas in patients with a decreased or normal vertical pattern and retroclined mandibular incisors, miniplates with Class III elastics can be the intraoral treatment option. Therefore, the exact indication of the procedure should be considered carefully.

Augmented Corticotomy Combined With Accelerated Orthodontic Forces in Class III Orthognathic Patients: Morphologic Aspects of the Mandibular Anterior Ridge With Cone-Beam Computed Tomography

This study used cone-beam computed tomography to evaluate morphologic changes of the mandibular anterior ridge after using augmented corticotomy plus accelerated orthodontia to decompensate mandibular incisors in patients with surgical skeletal Class III. Fourteen patients (8 men, 6 women; mean age, 26.14 yr) with skeletal Class III were treated before orthognathic surgery with a technique that combined corticotomy, bone grafting, and accelerated orthodontic forces to decompensate the lower incisors. Three-dimensional cone-beam computed tomograms were taken before treatment (T0) and at the completion of presurgical orthodontic treatment (T1). Measurements of the amount of vertical alveolar bone changes and horizontal bone thickness at the midroot and root apex levels of the mandibular incisors were evaluated. All patients showed significant proclination of the mandibular incisors at T1. The mean alveolar bone thickness from T0 to T1 increased buccally at the midroot and apex levels, showing statistically significant horizontal bone augmentation at the labial side of the lower anterior mandibular teeth (P < .05). The mean amount of vertical bone change did not show any significant vertical loss of alveolar bone. This new combined technique provided adequate decompensation of the mandibular incisors by increasing horizontal bone thickness in the labial aspect of the mandibular anterior area, without any vertical bone loss. This approach decreases the risk of the typical periodontal complications associated with traditional orthodontics, such as marginal bone loss and gingival recession.

Labio-lingual root control of lower anterior teeth and canines obtained by active and passive self-ligating brackets

To investigate the torque capabilities of passive and active self-ligating (SL) brackets on mandibular incisors and canines using three-dimensional (3D) imaging analysis. Two types of SL bracket systems were analyzed: a passive and an active. Both brackets had a 0.022 × 0.028-inch slot size. Treatment protocol and wire sequences were followed as recommended by the manufacturers. Twenty-six patients were included in the passive group and 20 were included in the active group; all received pretreatment and posttreatment cone-beam computed tomography (CBCT) scanning. Based on the CBCT scans, a customized 3D analysis was developed to assess labiolingual inclination of the roots of mandibular canines and incisors with respect to the occlusal plane before and after treatment. Following treatment, a statistically significant labiolingual proclination of the teeth was seen in both groups. Moreover, in both SL systems the roots exhibited a large variation in labiolingual inclination between adjacent teeth even after treatment. A significant proclination was seen for the mandibular front teeth; the claimed third-order torque control of SL systems could not be demonstrated. Therefore, a considerable play between the wire and the brackets could be hypothesized, even more in relation to the passive than the active SL brackets.

Cephalometric effects of the use of 10-hour Force Theory for Class II treatment

OBJECTIVE: This study aimed to evaluate the cephalometric effects promoted by the orthodontic treatment of Class II malocclusion patients with the use of the 10-Hour Force Theory, that consists in the use of fixed appliances with 8 hours a day using a cervical headgear appliance and 16 hours a day using Class II elastics, 8 hours on the first mandibular molar and 8 hours in the second mandibular molar. METHODS: Sample comprised 31 patients with mean initial age of 14.90 years, final mean age of 17.25 years and mean treatment time of 2.35 years. The lateral cephalograms in pre-treatment and post-treatment stages were evaluated. Evaluation of cephalometric changes between initial and final treatment phases was performed by paired t test. RESULTS: The cases treated with the 10-Hour Force Theory presented a slight restriction of anterior displacement of the maxilla, increase in the effective length of the mandible, significant improvement of the maxillomandibular relationship, significant increase in anterior lower face height, distal tipping of the maxillary premolar crowns, extrusion and distal tipping of the roots of maxillary molars, significant proclination and protrusion of mandibular incisors, significant extrusion and mesialization of mandibular molars, besides a significant correction of the molar relationship, overjet and overbite. CONCLUSION: The use of the 10-Hour Force Theory in treatment of Class II malocclusion provided satisfactory results.

Soft tissue, skeletal and dentoalveolar changes following conventional anchorage molar distalization therapy in class II Non-growing subjects: a multicentric retrospective study

ObjectivesThe purpose of this retrospective prolective study is to evaluate soft tissue, dentoalveolar and skeletal vertical changes following conventional anchorage molar distalization therapy in adult patients. Materials and methodsForty-six patients (34 females, mean age 25 years 6 months; and 12 males, mean age 28 years 4 months) were recruited from 4 specialists Board Certified. All subjects underwent molar distalization therapy according different distalization mechanics. Cephalometric headfilms were available for all subjects before (T0) and at the end of comprehensive treatment (T1). The initial and final measurements and treatment changes were compared by means of a paired t-test or a paired Wilcoxon test. ResultsMean total treatment time was 3 years 3 months ± 8 months. Maxillary first and second molars distalized 2.16±0.84mm and 2.01±0.69mm respectively, but also maintained a slight distal tipping of 1.45° (min 2.22°, max -6.45°) and 3.35° (min 0.47°, max -15.48°) at the end of treatment. Distal movement of maxillary first molar contributed 57.6% to molar correction, and 42.4% was due to a mesial movement of mandibular first molar (1.59±0.46mm). Dentoalveolar changes contributed to overjet correction; maxillary incisors retroclined 5.78°±3.17°, lower incisors proclined 7.49°±4.52° and occlusal plane rotated down and backward 2.32°±2.10°. A significant clockwise rotation of the mandible (1.97°±1.32°) and a significant increase in lower facial height (3.35±1.48) mm were observed. Upper lip slightly retruded (-1.76±1.70mm) and lower lip protruded (0.96±0.99mm) but these changes had a negligible impact on clinical appearance. ConclusionsAlthough maxillary molar distalization therapy can be performed in adult patients, significant proclination of the lower incisors, clockwise rotation of the occlusal plane and increase in vertical facial dimension should be expected. Nevertheless, in absence of maxillary third molars and in presence of mandibular third molars this procedure could be recommended.