Skeletal Class Research Articles

Sagittal Split Ramus Osteotomy Without Segmental Fixation in Skeletal Class II.

The new orthognathic treatment strategy of non-segmental fixation (non-fix) sagittal split ramus osteotomy (SSRO) with jaw exercise initiation on the second postoperative day, the so-called physiological positioning strategy (PPS), induces good skeletal stability with few temporomandibular joint (TMJ) symptoms after surgery in skeletal class III. This study aimed to clarify whether non-fix SSRO with modified PPS can be applied to skeletal class II. This retrospective study included skeletal class II patients who underwent non-fix SSRO to correct mandibular retrognathia. Jaw exercise was initiated within 10 postoperative days. Cephalometric analyses were performed before (T1), immediately after (T2), and more than 6 months after (T3) surgery. Skeletal and dental stability, and TMJ symptoms were evaluated. Twelve patients (2 men, 10 women; mean age 22.9±7.1y) were included. The mean mandibular advancement was 6.8±1.8mm. angle between S-N and N-B. was 73.6±4.5, 77.1±3.9, and 75.1±4.4 degrees at T1, T2, and T3, meaning 60.5% relapse. The Menton moved forward by 6.3mm from T1 to T2 and relapsed by 4.6mm at T3. The duration of intermaxillary traction showed a moderate negative correlation with angle between S-N and N-B. relapse (r=-0.42, P=0.1787). Only 2 TMJ symptoms (2/24, 8.3%) developed postoperatively. This study suggests that non-fix SSRO with modified PPS is a suitable method for skeletal class II malocclusion. Further research with a larger sample size and detailed analysis of the effect of intermaxillary traction on skeletal stability after surgery is needed.

Treatment of severe skeletal Class III patient with buccally impacted canines and severe crowding using a bone-anchored facemask and Alt-RAMEC protocol: A case report

A 14-year-10-month-old female patient presented with a chief complaint of being dissatisfied with the looks of her teeth and face. She had a pronounced misalignment of her dentition, defined by a Class III skeletal relationship and an average vertical proportion of the face. The patient had an anterior crossbite and bilateral posterior crossbites, with the upper left canine impacted in a buccal position. After a comprehensive consultation with the patient and her parents, we decided to implement a treatment strategy that entailed utilizing a maxillary bone borne expander in conjunction with a facemask. This treatment followed a protocol that consisted of alternating between rapidly expanding and contracting the maxilla. The purpose of this was to stimulate the advancement of the midface. After the treatment was carried out to treat the crossbites, a fixed appliance (MBT prescription) was bonded on the maxillary and mandibular arches. In addition, four premolars were extracted, and the upper left canine was brought to occlusion. Temporary anchorage devices were used in the lower arch to provide skeletal anchorage. The patient underwent active treatment for a period of 24 months following which we were able to achieve satisfactory occlusal and esthetic results.

An evaluation and correlation of airway space of pharynx, mandibular morphology, and tongue volume in skeletal classes and facial patterns – A cone beam computed tomography study

Objectives: Respiration and its function have a direct relationship with the pharyngeal airway, mandibular morphology, and tongue. The objective of this study was to evaluate and correlate pharyngeal airway space, mandibular morphology, and tongue volume in various skeletal classes and facial patterns. Material and Methods: A total of 120 pre-treatment cone beam computed tomography (CBCT) images were randomly classified into 3 skeletal classes (40/group). Each class was further categorized into hyperdivergent and hypodivergent growth patterns. Linear and angular measurements were estimated using three-dimensional digital imaging programs (Kavo 3D OnDemand software), and pharyngeal airway and tongue space were volumetrically analyzed by ITK-SNAP segmentation software. Results: All the measured variables showed highly significant differences except for the anterior-posterior angle of the mandible, which was statistically insignificant with P = 0.675. The simple regression was formulated to assess the volume of airway space. Conclusion: Hyperdivergent subjects had reduced pharyngeal airway space and tongue volume when compared to hypodivergent subjects. Among all the subgroups, Class III hypodivergent showed the highest pharyngeal airway volume and tongue volume, and the least was found in Class II hypodivergent. A direct relationship was estimated between airway mandibular morphology and tongue volume, recommending thorough analysis of oropharyngeal structures in a non-individualized way for orthodontic diagnosis and treatment planning.

Surgical Orthodontic Treatment of Class III Malocclusion with Unilateral Open Bite Due to Impacted Premolar with Dilacerated Root: A Case Report

Background Dilacerated teeth may interfere with eruption and movement, making orthodontic treatment difficult. Case Report This case report describes successful surgical orthodontic approaches for a 14-year-old girl with skeletal Class III malocclusion, a unilateral open bite caused by a severely dilacerated mandibular left first premolar, and severe crowding in the mandibular dentition. The patient underwent surgical subluxation of the dilacerated premolar, followed by a combination of non-extraction orthodontic therapy and orthognathic surgery. A left lateral open bite caused by a severely dilated mandibular left first premolar was corrected through tooth traction after subluxation for root apical transection. Class I molar relationships and improved facial profiles were achieved with maxillary advancement, adjunctive counterclockwise mandibular rotation, and genioplasty. Conclusion This case report suggests using subluxation in severely dilacerated teeth to enable orthodontic tooth movement with high stability, thereby expanding the possibility of non-extraction treatment.

Management of a severe skeletal Class II hyperdivergent patient with asymmetric missing teeth with lingual appliances and mandibular osteotomy: A case report.

Orthognathic surgery cases are inherently challenging to treat with lingual appliances due to the complexities of orthodontic management and difficulties in achieving intermaxillary fixation during surgery. This challenge is further amplified in cases involving asymmetric space closure, such as those with a missing molar on one side and a premolar on the other, a scenario not yet documented in the literature. This case report presents the orthodontic-orthognathic management of an adult patient requiring space closure of asymmetric missing lower teeth. A 30-year-old female patient presented with a severe skeletal Class II patient with a retruded mandible, hyperdivergent facial pattern, excessive overjet and overbite, and asymmetric missing lower teeth. The patient was diagnosed with a Class II malocclusion and asymmetric missing mandibular posterior teeth on a skeletal hyperdivergent Class II relationship. The treatment involved orthodontic decompensation with fixed lingual appliances in combination with mandibular advancement osteotomy and genioplasty. Mini-screws were utilized for anchorage control during asymmetric space closure in the presurgical stage and entire lower arch distalization in the postsurgical stage. A significant facial esthetic and functional improvement was achieved posttreatment. The combination of mini-screws and lingual appliances may offer effective anchorage management in both presurgical and postsurgical orthodontic stages for optimal orthodontic-orthognathic treatment outcomes. This approach allows for precise tooth movement and control during space closure in the presence of challenging asymmetric missing tooth patterns.

Rotations of teeth—a systematic review

BackgroundRotations are frequently evaluated through various assessment methods of crowding and arch dimension, with relatively few studies discussing the extent or direction of rotations and even fewer addressing the reliability of such assessments. This systematic review aims to comprehensively analyze existing classification systems for rotated teeth and assess rotation in anterior and posterior teeth, its clinical applicability, and its impact on retention and relapse.Search methodsTwo investigators conducted a comprehensive search in six databases, namely, PubMed, Scopus, Ovid, LILACS, Web of Science, and Cochrane CENTRAL, up to 28 March 2024. No specific start date was defined to ensure the inclusion of all relevant studies from the inception of each database, maximizing the comprehensiveness of our review. The search criteria included retrospective studies and the inclusion criteria were patients who were assessed for rotation in any age group. The exclusion criteria were patients who had undergone orthodontic treatment, who had fractured restorations or crowns, or who had any other tooth anomaly.Data collection and analysisIn total, 10 studies satisfying the inclusion criteria were included and 9 provided quantitative outcomes for the rotation of various teeth, while the remaining study offered qualitative results. The risk of bias assessment was performed with the help of the Newcastle–Ottawa quality assessment tool.ResultsThe skeletal Class II and Class III groups exhibited similar average positions of the first molar. Upper molar rotation was primarily observed in dental Class II patients, with a higher mesial rotation angle of 78.6°. Only one study measured the rotation for all permanent teeth. Seven studies used the mid-palatal raphe as the reference line for measuring molar rotation. No gender differences were found. It was found that there was no statistical significance in the mean values of molar rotation for the right and left sides as well as the maxillary and mandibular arches. The incisors demonstrated the highest degree of rotation (7.4°–20.2°), while the premolars and canines exhibited a slightly lower degree of rotation (3.3°–9.2°). In contrast, the molars displayed the lowest degree of rotation (0.8°–7.4°).ConclusionAfter reviewing all the studies, it was found that there is no adequate classification system to assess the rotation of anterior teeth and mandibular teeth. A universally accepted classification of tooth rotation, including a common reference line, is needed. The existing systems for posterior teeth need to be standardized and have a clinical utility to be widely accepted.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024524654, PROSPERO (CRD42024524654).

Feasibility study of low-dose computed tomography (CT) technology for maxillofacial bone three-dimensional (3D) printing in skeletal class III malocclusion.

Skeletal class III malocclusion is among the most common dental and maxillofacial malformations. Three-dimensional (3D) printing technology has become widely applied in orthopaedics. The data source for 3D printing of maxillofacial bones is computed tomography (CT). The issue of the CT radiation dose caused by maxillofacial bone 3D printing has attracted increasing attention. This study aimed to explore the feasibility of low-dose CT technology in maxillofacial bone 3D printing and the clinical value of low-dose maxillofacial bone 3D printing. Ninety patients with class III malocclusion who planned to undergo maxillofacial bone 3D printing and 3D-CT were prospectively enrolled and randomly divided into the conventional CT dose 3D printing group (Group A, n=28), low-CT dose 3D printing group (Group B, n=32) and 3D-CT control group (Group C, n=30). The quality of maxillofacial bone 3D printing was subjectively evaluated, and a Likert-scale questionnaire was used to assess the clinical value of maxillofacial bone 3D printing. No significant differences in the general demographic characteristics were detected among Groups A, B, and C. Compared with that in Group A (0.8±0.1 mSv), the radiation effective dose (ED) in Group B (0.3±0.1 mSv) was reduced by approximately 63%. There were no significant differences between Groups A and B in 3D printing quality indices (including clarity, integrity, accuracy or artefacts) (all P>0.05). There were significantly higher subjective scores for the clinical value of maxillofacial bone 3D printing (Group A=4.1±0.5, 4.0±0.5, 4.0±0.4 and 4.1±0.5; Group B=4.0±0.5, 4.0±0.4, 4.0±0.5 and 4.0±0.5) than for 3D-CT (Group C=3.1±0.5, 3.1±0.4, 2.9±0.4 and 3.0±0.4) in diagnosing and classifying, formulating the surgical plan, simulating the surgical process, and predicting postoperative recovery (all P<0.05). Low-dose CT technology can be effectively applied for maxillofacial bone 3D printing, reducing the radiation dose without affecting the 3D printing quality. Maxillofacial bone 3D printing technology is superior to 3D-CT in class III malformations.

Adenoidal nasopharyngeal ratio and its correlation with skeletal class II malocclusion in children: A cross-sectional study

Introduction: The relationship between skeletal class II malocclusion and airway has gained significant interest in the field of orthodontics and is crucial for accurate diagnosis and treatment planning. Various etiologies contribute to airway obstruction, which may disrupt the breathing pattern and swallowing functions, affecting the development of the craniofacial complex and consequently resulting in the development of skeletal Class II malocclusion. Adenoid hypertrophy (AH) has been linked to cardiopulmonary complications, craniofacial growth disturbances and obstructive sleep apnea. Patients with AH often exhibit a characteristic adenoid face and mouth breathing pattern with a narrow constricted maxillary arch and retrognathic mandible. Adenoidal- nasopharyngeal ratio is a simple linear measurement obtained from lateral cephalograms that can reliably express adenoidal size and patency of the nasopharyngeal airway and give further insight into the etiology of development of class II malocclusion and correlation with the same. Materials and methods: Sample of 40 individuals between 10-16 years of age was divided into two groups of 20 each based on their ANB angle, Group A comprised of individuals showing skeletal class I and group B showing skeletal class II malocclusion respectively. Lateral cephalograms were taken and AN ratio was assessed using the Fujioka et al method for both groups. AN ratios were correlated with skeletal class of malocclusion and values of both groups were compared.

Comparison and analysis of alveolar bone structure characteristics in skeletal Class II and Class III malocclusion in the mandibular incisor region.

The aim of this study was to explore the differences in alveolar bone structure characteristics in skeletal class II and class III malocclusion in the mandibular incisor region. From January 2021 to November 2023, 100 cases of skeletal malocclusion patients were selected from our hospital, including 56 cases of skeletal Class II malocclusion and 44 cases of skeletal Class III malocclusion. The alveolar bone structure characteristics in the mandibular incisor region of skeletal class II and class III malocclusion patients are compared. The labial alveolar bone attachment height and lingual alveolar bone attachment height were compared between patients with skeletal Class II and Class III malocclusion (P < .05). The labial alveolar bone thickness at the root apex in patients with skeletal Class II malocclusion was (3.96 ± 0.63) mm, which was higher than that in Class III malocclusion patients (P < .05). In patients with skeletal Class II malocclusion, the cementoenamel junction was 2, 4, 6 mm below, and at the root apex, the alveolar bone thickness was (0.19 ± 0.05) mm, (0.93 ± 0.10) mm, (2.10 ± 0.10) mm, and (12.26 ± 2.10) mm, respectively, which was higher than that in Class III malocclusion patients (P < .05). In patients with skeletal Class II malocclusion, the labial side alveolar bone area at the root apex was (3.89 ± 0.72) mm2, which was higher than in Class III malocclusion patients (P < .05). On the lingual side, the alveolar bone thickness below cementoenamel junction at 6 mm and at the root apex was (1.95 ± 0.45) mm2 and (1.92 ± 0.51) mm2, respectively, which were higher than in Class III malocclusion patients (P < .05). Compared to skeletal Class II malocclusion, in skeletal Class III malocclusion, the alveolar bone thickness in the mandibular incisor area is thinner and narrower. This should be given special attention during orthodontic treatment.

Assembly of Custom Implant and Ready-Made Distractor for Precise Maxillary Movement Vector Control in Cleft Patient With Midfacial Hypoplasia.

This study presents a novel approach for maxillary advancement in a patient with cleft lip and palate, utilizing the assembly of a custom titanium implant and a ready-made distractor. The patient exhibited significant maxillary hypoplasia and had concerns regarding the possible deterioration of hypernasality after conventional surgical methods. Distraction osteogenesis was initiated to address these challenges. A custom plate was designed using 3-dimensional printing technology. Integrating the plates with off-the-shelf distractors enables precise control of the distraction vector to optimize surgical precision and outcomes. The treatment plan involved Le Fort I osteotomy, followed by a distraction protocol that achieved a skeletal Class I relationship and total advancement of 7.5mm and elongation of 2mm, with no reported complications. This case demonstrates that combining custom implants with standard distractors can provide precise maxillary repositioning at reasonable costs, while mitigating the risks associated with traditional surgical interventions and reducing the need for secondary corrective surgeries.

Soft tissue paradigm based Treatment planning in skeletal class III.

This study aimed to propose guidelines for the indications of non-extraction, extraction camouflage treatment, and orthognathic surgery by comparing the degree of soft tissue improvement effects. This comparison focused on changes in CKHA, a soft tissue indicator corresponding to the major hard tissue indicator, ANB. Sixty-six patients, 25 males and 41 females, aged between 18 and 50 years and diagnosed with skeletal Class III malocclusion (ANB < 0°), were enrolled in the study. Participants were categorized into three groups based on the treatment approach: G1, non-extraction (n = 20); G2, extraction (n = 20); and G3, orthognathic surgery (n = 26). To assess variations in treatment outcomes, measurements derived from lateral cephalometric radiographs obtained before and after treatment were analyzed and compared across the different treatment methods. Significant differences were observed in the ANB between the G1 and G2/G3 groups. However, no significant differences were observed in CKHA levels after treatment. Furthermore, in G2, the CKHA approached the normal range at -1.8° (normal range: -2.0°), suggesting that soft tissue responses can normalize despite minimal changes in the skeletal structure. Although surgery resulted in the most significant skeletal changes, both camouflage groups demonstrated distinct advantages in the soft tissue paradigm. In G2, a noticeable posterior movement of the lower lip was observed along with a corresponding posterior shift in the soft tissue B point. This study provides guidelines for non-extraction, extraction and surgical treatment selection aimed at achieving soft tissue objectives.

Optimal sites for mini-implant insertion into the infrazygomatic crest according to different craniofacial morphologies: A cross-sectional cone-beam computed tomography study

The infrazygomatic bone crest and other extraalveolar regions represent a viable option for the placement of temporary anchorage devices when distalizing the maxillary arch. This approach allows for the movement of the dentition without concern for potential collisions among dental structures. Nevertheless, it is of the utmost importance to conduct a thorough examination of the anatomy of this region before the placement of mini-implants to prevent potential injuries, such as maxillary sinus perforations. The objective of this study was to quantify the depth of the infrazygomatic crest and evaluate its correlations with age, gender, skeletal classification, and vertical pattern. The study sample of this cross-sectional, retrospective study consisted of 201 cone-beam computed tomography scans collected from patients treated at the master's program in orthodontics at the University of Valencia and at a private dental clinic. The cone-beam computed tomography scans were collected for 5 years, from January 2017 to May 2022. The total and intraalveolar lengths were defined and measured at 3 points: the distal roots of the maxillary second molars, the distal roots of the maxillary first molars, and the mesial roots of the maxillary first molars. These measurements were taken on both the right and left sides using the Carestream 3D Imaging System (Atlanta, Ga). The total length (TL) at the mesiobuccal level of the first molars was found to be significantly longer on both sides (P= 0.001). The intraalveolar length exhibited statistically significant differences between the right and left sides, with those of the left side exhibiting greater length (P<0.001). The normodivergent patterns demonstrated lower TL values than hypodivergent (P= 0.006) and hyperdivergent patterns (P= 0.033). A statistically significant inverse relationship was observed between the distance from the cementoenamel junction to the vestibular bone crest and the total and intraalveolar lengths in the studied regions. The TL was greatest in the region of the mesiobuccal root of the maxillary first molars, followed by the region of the distal root of the second molars, and finally, the region of the distobuccal root of the maxillary first molars. Patients with normodivergent patterns exhibited the lowest total infrazygomatic ridge height.

Lingual Orthodontic Retreatment of an Adult Patient with Protruded Lips and a Missing Lower Incisor: A Case Report

AbstractOrthodontic retreatment in adult patients presents unique challenges and considerations. Previous dental intervention or even missing teeth may influence treatment planning and pose challenges for bracket bonding.A 23-year-old female patient sought orthodontic retreatment to address her chief complaint of upper lip protrusion. She had previously completed fixed labial orthodontic treatment involving the extraction of a lower central incisor.The diagnosis was a skeletal maxillary protrusion and mandibular dentoalveolar protrusion on dental class I and skeletal class II relationships.A nonsurgical camouflage treatment option was chosen, which involved the removal of the upper first premolars and lower right first premolar. The lower left canine, lateral, and central incisor were substituted with the lower left first premolar, canine, and lateral incisor, respectively. Lingual self-ligating brackets, straight archwires, and temporary anchorage devices were utilized. The treatment was completed after 32 months with an improved facial profile and a stable occlusion.This case report demonstrates the successful retreatment of an adult patient with lip protrusion and relapse of lower arch crowding using straight-wire lingual appliances and premolar extractions. This approach achieved optimal aesthetics and a stable occlusion, highlighting the effectiveness of lingual appliances in complex adult retreatment cases.

To evaluate the divine proportion on silhouette photographs of skeletal class I bimaxillary protrusion cases treated with first premolar extraction- An in-vitro study

Objectives: The aim of the study is to assess the divine proportion of soft tissues seen in bimaxillary protrusion cases and compare this proportion on pre-treatment and post-treatment Silhouette photographs of skeletal (Sk) Class I bimaxillary protrusion patients treated by premolars extraction. Material and Methods: This research was conducted on 50 samples of pre-treatment along with post-treatment outline form photographs of Sk Class I bimaxillary protrusion patients aged 18–30 years in an orthodontics and dentofacial orthopedics department. The samples had an equal distribution with 25 males and females. All profile photos with Class I bimaxillary protrusion were converted into silhouette form. To assess the divine proportion in patient profiles, each silhouette photograph was marked by five anatomic landmarks, which were as follows: Soft-tissue nasion (N), trichion (Tr), subnasale (Sn), stomion (St), and a soft-tissue menton (Me) which was followed by the measurement of six linear dimensions; ratios were measured as R1, R2, R3, R4, and R5. These ratios of the patient’s profile, both before and after the treatment, were then compared to find out the soft-tissue alterations that have taken place in patients having Class I bimaxillary protrusion corrected by the first four premolars extraction. Results: The findings indicate that all post-treatment proportions in males indicated highly noticeable changes in contrast to pre-treatment ratios. However, females revealed highly noticeable differences in R1, R2, and R4 ratios, statistically evident differences were shown by R3 and R5 ratios in contrast to ratios before the treatment. Thus, the proportions appeared to be closer to the divine proportion. Conclusion: The results showed that all the ratios were found to be closer to divine proportion, and thus, premolars extraction in cases with convex facial form does help us to achieve esthetically pleasing faces.

Distalization of mandibular molar with iatrogenic root fracture in Class III malocclusion: a case report

BackgroundPlacement of interradicular orthodontic miniscrews poses a potential risk of root damage, including superficial root contact and root fracture. This case report describes the iatrogenic root-injured tooth movement of a 27-year-old male with skeletal Class III malocclusion as nonsurgical orthodontic treatment.Case presentationAn orthodontic miniscrew between the mandibular right first and second molars perforated the distal root of the mandibular first molar. A root fracture was discovered 4 months after miniscrew placement. Owing to the potential risk of ankylosis related to surgical intervention, a direct orthodontic distalizing force was applied towards the fractured distal root segment without additional treatment, resulting in considerable movement of the fractured tooth with maintaining tooth vitality. However, gradual root resorption of a fractured tooth with a separate root segment was observed. The mandibular arch distalization of skeletal Class III malocclusion was successfully performed and retained for 3 years 8 months with stable occlusion.ConclusionsThis case reveals a clinical remedy when root movement of a tooth with root fracture is indicated. The use of extra-alveolar miniscrews or miniplates can be considered for mandibular arch distalization to prevent potential root injuries caused by miniscrew placement.Clinical trial numberNot applicable.

Comparative evaluation of the reliability of MNG angle with other anteroposterior skeletal dysplasia indicators – A retrospective cephalometric study

The aim of the study was to evaluate the reliability of the MNG angle for various skeletal malocclusions and to compare and correlate it with ANB angle, Beta angle, Yen angle and W angle in Gujarati population. Lateral cephalograms of 50 Gujarati adults, were divided into three groups based on the ANB angle and the Beta angle measurements. The Yen angle, W angle and MNG angle were measured for all the cephalograms. The mean value for MNG angle was derived for each group. The one-way analysis of variance (ANOVA) and Bonferroni post hoc tests were used to compare the differences between the mean values of the 3 groups. Spearman’s correlation analysis was used to determine correlations among the five skeletal parameters. Analysis of the obtained data revealed a mean MNG angle of -1.22° ± 3.9°, 3.11° ± 2.8° and -6.0° ± 1.5° for Class I, II and III respectively. Spearman’s correlation analysis demonstrated a significant co-relation between ANB angle, Beta angle and MNG angle with a p value of ≤ 0.05 for skeletal Class I and Class II malocclusions. The MNG angle can be used as a dependable maker to assess the antero-posterior discrepancy, especially for Class II skeletal pattern.

Evaluation of clinical effects of Advansync 2 fixed functional appliance in skeletal Class II malocclusion: A retrospective cephalometric study

To evaluate the treatment effects of AdvancSync 2 in patients of skeletal Class II malocclusion in selected skeletal, dental, soft tissue and airway parameters. Pretreatment and post-functional lateral cephalograms of 12 patients (06 males and 06 females with mean age of 14.25+0.75) with skeletal Class II malocclusion treated using AdvanSync 2 were evaluated. Paired t-test and Wilcoxon rank-sum intraclass correlation (ICC) test results were calculated.Statistically significant changes were found in skeletal parameters ofSNB, Wits, maxillo-mandibular differential, Björk’s sum, basal plane angle, Sn-GoGn, lower anterior facial height (LAFH), Na-perp-Pog. Changes in dental parameters U1-NA (angular and linear), L1 to NB (angular and linear), U1-SN angle, IMPA, Inter-incisal angle, L1 to A-Pog and U1 to A-Pog were also observed to be statistically significant at T1. Soft tissue skeletal convexity and nasolabial angle improved significantly post treatment, while, statistically significant change was observed only in posterior pharyngeal airway space among the chosen cephalometric airway parameters.Treatment with AdvanSync 2 corrected the Class II malocclusion by producing skeletal and dentoalveolar changes. Soft tissue facial convexity and nasolabial angle improved with treatment. Further, linear dimension of the posterior pharyngeal airway space showed significant improvement with AdvanSync 2 therapy.

The Comparison of The Quality of Life Between Conventional Orthognathic Surgery and Surgery-first Orthognathic Surgery in Skeletal Class III Deformity Patients

Objectives: This prospective cohort study aimed to compare the quality of life (QoL) of patients with skeletal Class III deformities undergoing either conventional orthognathic surgery (CS) or surgery-first orthognathic surgery (SF) using the Orthognathic Quality of Life Questionnaire (OQLQ) and the Oral health Impact (OHIP-14) tools. Methods: The OQLQ was translated into Thai. Thirty-four patients were enrolled, with 17 in each group according to their orthodontic treatment plans. Patients completed the OQLQ and OHIP-14 assessments on the day before surgery (T1) and at 1 month (T2), 3 months (T3), and 6 months (T4) post-surgery. Data collection occurred from October 2021 to April 2022. Independent sample T-tests and one-way repeated measures ANOVA were used for statistical analysis (p&lt;0.05). Results: At T1, the QoL was significantly lower in the CS group compared to the SF group. The CS group exhibited significant QoL improvements at T2 (OQLQ) and T3 (OHIP-14) compared to T1. The SF group had a lower QoL at T2 but showed significant improvement at T4 (OQLQ and OHIP-14). Conclusions: There was no significant difference in QoL between the two groups after surgery. Both surgical approaches led to improvements in patients' QoL. Thus, the choice of surgical method should be based on appropriate indications and patient-doctor agreement.

Comparison of treatment effects of herbst and advansync appliances on hyoid bone position and cervical posture in skeletal class II malocclusion – A prospective randomized clinical trial

Mandibular retrusion is the most common cause of Class II Division 1 malocclusion, which needs correction of the underlying skeletal discrepancy. The objective of this study was to evaluate the Hyoid bone position and cervical posture changes following treatment with two fixed functional appliances - Herbst and Advansync (Ormco, Orange, CA, USA) appliances in skeletal Class II malocclusion using pre and post treatment lateral cephalograms.For this randomized controlled trial,40 patients(21males and 19 females) were divided into two groups Group I, Herbst Appliance group (mean age: 12.6 +/- 0.67 years) and Group II, Advansync group (mean age: 12.8 +/- 0.66yrs). Pre and post-treatment (after appliance therapy of 8 months duration) lateral cephalograms were evaluated using Planmeca Romexis software 5.0.0.R version for hyoid bone position and cervical posture changes. The Hyoid bone had displaced anteriorly by 1.64 mm in Group I and in Group II by 1.97 mm. There was downward displacement of hyoid bone by 1.73 mm in Group I and 2.03 mm in Group II with reference to the Frankfort horizontal (FH) plane. The Mandibular plane-Odontoid process tangent angle used for determining upper cervical posture decreased by 7.13 in Group I, while by 0.33in Group II. This study concluded that both Herbst and Advansync appliances showed an improvement in hyoid bone position and the cervical posture while Advansync appliance demonstrated greater uprighting of cervical posture which was statistically significant.

Radiological assessment of Sella Turcica morphology correlates with skeletal classes in an Austrian population: an observational study.

This study aimed to analyze variations in the sella turcica (ST) concerning its size, shape, and bridging, providing first reference values in Austrian individuals. Additionally, it assessed associations between these morphological and demographic parameters and their correlation with patients' skeletal class. 208 lateral cephalometric radiographs (154 female, 54 male; age 8-58 years) from DPU Dental Clinic (Austria) were included. Size, skeletal class, shape, age, and gender of ST were tested for significance in correlation using, (M)ANOVA, and chi-square. Linear dimensions of ST ranged from 11.1 to 12.9mm across readers, with a standard deviation of 2.0-2.2mm. Normal ST (49.76%) and round ST (58.77%) were the most frequent. ST bridging was detected in 6.97%. Skeletal class I appeared most frequently (54.8%). Statistical significance was observed between age, gender, and ST length, with further significant age effects on ST shape. Moreover, age showed significant modification of ST shape, while skeletal parameters appeared unaffected by other ST parameters. These preliminary findings define normal ST dimensions in an Austrian population, offering reference values for clinical interpretation and broadening the available European data. Clear associations between morphological and demographic parameters were detected. Additionally, these findings may contribute to diagnostic and therapeutic strategies in orthodontics and craniofacial pathology. Future studies employing cone beam computed tomography (CBCT) along a larger sample size could enhance the generalizability of these findings.