Skeletal ClassII Research Articles

Three-dimensional skeletal, dentoalveolar and temporomandibular joint changes produced by Twin Block functional appliance.

The aim of this study was to three-dimensionally analyze the net skeletal, dental, and temporomandibular joint (TMJ) treatment changes using Twin Block functional therapy in comparison to untreated subjects. The study (Twin Block) group comprised 22female patients with skeletal ClassII malocclusion due to mandibular retrusion. A total of 18skeletal ClassII untreated female subjects were included as controls. Skeletal, dental, and TMJ changes were evaluated using pre- and posttreatment/observational by cone beam computed tomography (CBCT) images. The treatment changes were compared with the growth changes observed in the control group using independent t‑tests. Compared to the changes induced by normal growth, the effective mandibular length, ramus, and corpus lengths increased by 3.19, 3.47, and 2.69 mm (P < 0.001 for all), respectively. The maxillary and mandibular incisors inclination and position were significantly reduced and increased, respectively (P < 0.001). The maxillary first molars were significantly moved distally and intruded by 1 and 0.36 mm, respectively, while the lower first molars moved mesially and intruded by 2.18 and 0.59 mm, respectively. There was asignificant change in the condylar dimensions: increase in length, width, and height by 1.28, 0.88, 1.59 on the right and by 1.60, 0.53, and 1.10 mm on the left sides, respectively. There was significant forward positioning of the right and left condyle by 1.5 and 1.3 mm, respectively. Treatment with the Twin Block functional appliance results in significant skeletal, dentoalveolar, and condylar changes in both dimensions and positions.

Outcome stability of orthopaedic treatment of Skeletal Class III Malocclusion: A study of prognostic agreement between three models

Introduction: Long-term stability of the treatment outcome of skeletal Class III malocclusion is always not achievable, therefore several prediction models of stability of orthopaedic treatment of the Class III malocclusion have been proposed.Aim: This cross-sectional study was aimed at the evaluation of the prognostic agreement and association between three different prediction models based on skeletal parameters recorded on lateral cephalograms.Materials and methods: A total of 75 subjects (34 females and 41 males, age range 7-11, mean age 9.1±1.2 years) having skeletal ClassIII malocclusion were included in the study. Prediction models reported by Baccetti et al. 2004 (prediction model 1), Moon et al. 2005 (prediction model 2) and Yoshida et al. 2006 (prediction model 3), were considered. Percentage agreement and unweighted kappa coefficient evaluated the agreement between the prediction models in terms of stable or unstable cases. Multiple regressions were run to evaluate the association between the absolute scores obtained from each of the prediction model (prediction scores).Results: Percentage agreement ranged from 77.3% (models 2 and 3) to 89.3%, (models 1 and 2) and corresponding unweighted kappa coefficients ranged from 0.099 (models 1 and 3) to 0.205 (models 2 and 3). The prediction score from model 3 was significantly associated with those from both the other models; on the contrary, prediction scores from models 1 and 2 were not significantly associated.Conclusions: Agreement in terms of stability or instability outcome derived from these models is only partial and not satisfactory,even though significant association between the prediction scores denotes a common biological meaning of the models.

Circumpubertal skeletal Class II patient treated using herbst functional appliance an comprehensive fixed mechanotheraphy

Skeletal classII div I malocclusion are common orthodontic problem due to mandibular deficiencies. This problem could be addressed by stimulating sagittal mandibular growth by using functional and fixed functional appliance which can be used during pre and post pubertal growth period. Herbst appliance being rigid fixed functional appliance is beneficial in treatment of post pubertal skeletal class II patients and does not depend on patients compliance. A female patient of age 12 years with post pubertal growth status by 6 months, reported to the department of orthodontics. On extraoral examination she had a convex profile with retrognathic mandible and everted lower lip. Intraoral examination revealed class II molar relationship and end on canine relationship on both side, over jet of 7 mm and overbite of 4 mm. Since patient was post pubertal by 6 months growth modulation procedure was carried out with Herbst appliance for a period of 8 months followed by fixed appliance therapy for one year 4 months to correct the dento alveolar problems. Post treatment results showed that combination of Herbst and fixed mechanotheraphy using 0.022 slot was effective in the treatment of skeletal and dental irregularities in a short period of time.

Research of treatment effects of double parabolic lingual springs appliance and open vertical loops in combination with straight wire appliance therapy on skeletal classIII malocclusion in early permanent dentition

Objective To evaluate the treatment effects of double parabolic lingual springs appliance and open vertical loops in combination with straight wire appliance therapy on skeletal classⅢmalocclusion in early permanent dentition. Methods 30 cases with skeletal classⅢ malocclusion in early permanent dentition were treated by double parabolic lingual springs appliance and open vertical loops in combination with straight wire appliance.Cephalometric tracing measurement was taken to analyze and compare between pretreatment and posttreatment. Results The comparison of before and after orthodontic treatment showed angle SNA increased (3.20±0.36)°,angle SNB decreased(-0.39±0.48)°,angle ANB decreased(4.69±1.34)°,Ls-E increased(3.50±1.14)mm(t=-4.65,2.73,-8.42,-4.32,all P< 0.01). Conclusion The above metioned technique could be a reliable way to treat mild and moderate skeletal classⅢ malocclusion. Key words: Tooth abnormalities; Orthodontic appliances; Orthotic devices

İSKELETSEL SINIF III MALOKLÜZYONUN KAPAKLI BRAKETLERLE ORTODONTİK VE CERRAHİ TEDAVİSİ: OLGU RAPORU

This case report presents the orthodontic andorthognathic surgery treatment of a non-growingpatient with class III malocclusion. A 17 year oldfemale patient presented a dental and skeletal classIII malocclusion characterized by mandibulerprognathism and maxillary retrognathism. Selfligating brackets were preferred for pre-surgicalorthodontic management which lasted for 14mounths. Bimaxillary orthognathic surgery wasperformed to correct maxillary-mandibulerdiscrepancy after the pre-surgical orthodontictreatment. Final teeth positions and the occlusionwas improved by post–surgical orthodontictreatment, class I dental and skeletal occlusion anda straight soft tissue profile were achieved withoutextraction. Using self-ligating brackets duringorthodontic and orthognathic surgery treatment ofclass III patients provides more aesthetic and stableresults by improving the treatment efficiency.

Three-dimensional investigation of facial surface asymmetries in skeletal malocclusion patients before and after orthodontic treatment combined with orthognathic surgery

The goal of the following study was to quantify facial soft-tissue asymmetry in patients with pronounced skeletal malocclusion anomalies before and after orthodontic treatment combined with orthognathic surgery. In addition, the facial attractiveness of these patients was rated by dental specialists and laypersons both before and after treatment based on the three-dimensional (3D) data. An optical sensor was used to noninvasively capture the 3D facial surface data of 60adult patients including two groups of 20patients with skeletal ClassII or III anomalies and a control group of another 20subjects with ClassI relationships. Facial surface asymmetries were evaluated immediately before the surgical procedure and 1year thereafter. In addition, subjective ratings of facial attractiveness were obtained based on a questionnaire from orthodontists, maxillofacial surgeons, and laypersons. No differences in facial soft-tissue asymmetry were observed between the ClassII and III patients either pre- or postoperatively, but asymmetry was found to be more pronounced in the skeletal malocclusion groups than in the ClassI control group both pre- and postoperatively. The subjective ratings of facial attractiveness by the various rater groups yielded more favorable results for the post- than preoperative patient images, reflecting differences that reached overall statistical significance. Quantitative analysis of facial soft-tissue asymmetry and calculating a cutoff value allowed us to distinguish patients with skeletal malocclusion from a control group solely on the basis of asymmetry. Combined regimens of orthodontic treatment and orthognathic surgery go some way in reducing asymmetry toward the levels seen in untreated control subjects, while the asymmetry pattern characteristic of this type of malocclusion will persist. Nevertheless, the asymmetry reduction is noticeable enough to result in more favorable ratings of attractiveness.

Evaluation of relapse after orthodontic therapy combined with orthognathic surgery in the treatment of skeletal class III

Multidisciplinary treatment of skeletal malocclusion by orthognathic surgery in addition to orthodontics is a routine strategy believed to offer good functional and esthetic outcomes. Postoperative relapse is, however, a problem. The present study was conducted to analyze the stability of outcomes achieved by surgical treatment of skeletal classIII patients in terms of the rate and extent of relapses. A total of 30patients who had undergone orthodontic treatment combined with orthognathic surgery were included. The primary inclusion criterion was a skeletal classIII treated by mandibular setback (Obwegeser/DalPont) surgery alone or combined with maxillary advancement (Le FortI) surgery. Analysis was based on one preoperative and two postoperative cephalograms per patient. We observed relapse (defined, in accordance with Proffit, as changes >2mm or 2°) at a rate of 24% after bimaxillary procedures, compared to a lower rate of 21% after mandibular setback procedures only. The relapse rate was 21% among patients who had undergone upper-jaw surgery versus 27% among those who had undergone lower-jaw surgery, which was statistically significant. The majority of patients exhibited stable treatment outcomes. Maxillary advancement procedures were found to be less susceptible to relapse-resulting in more stable outcomes-and mandibular setback distances correlated positively with the degree of the relapse. No statistically significant differences were observed between the procedures conducted in both jaws versus in the lower jaw only, or in the extent of upper-jaw repositioning.

Miniscrew-assisted mandibular molar distalization in a patient with skeletal class-III malocclusion: A clinical case report

In nongrowing patients with mild skeletal Class-III malocclusion, premolar extraction or molar distalization in the lower arch can be done as a part of camouflage treatment. Temporary anchorage devices are widely used for this purpose because they do not produce undesirable reciprocal effects and do not depend on the patient's cooperation. However, most reported cases in this regard have used interradicular miniscrews in the mandibular arch and these have a risk of failure as they can loosen due to collision with adjacent roots. This article showcases mandibular molar distalization utilizing miniscrews, inserted at the retromolar area to correct a Class-III problem. A 24-year-old girl with a mild skeletal Class-III malocclusion and dental Class-III molar and canine relationship bilaterally was referred for orthodontic treatment. The treatment plan included distalization of the lower molars bilaterally followed by full fixed appliance therapy, after third molar extractions. For the lower molar distalization, the miniscrews were inserted at the retromolar pad. At the end of 21 months, a Class-I molar and canine relationship, normal overjet and overbite were obtained. The average amount of distalization of mandibular first molar was 3.2 mm at the crown level. In conclusion, placing miniscrews at the retromolar pad area for lower molar distalization was found to be a simple and effective method for correcting anterior cross bite and mandibular anterior crowding or protrusion, without the need for patient compliance.

Stability of the swallow-triangle on lateral cephalograms in skeletal ClassIII cases treated by mandibular setback surgery

Stability of the swallow-triangle on lateral cephalograms in skeletal ClassIII cases treated by mandibular setback surgery

Juvenile idiopathic arthritis—and now?

To conduct a systematic literature review on the impact of juvenile idiopathic arthritis (JIA) on craniofacial morphology. Several electronic databases (PubMed, Medpilot, Web of Science, DIMDI) were systematically searched for studies that were published up to and including May 2011. In addition, a manual search of the orthodontic and rheumatologic literature was conducted, and reference lists of the selected articles were checked for relevant publications. The identified articles were independently assessed by two investigators and selected according to a three-step process (title/abstract/full text). After completion of the selection procedure, 19articles were identified possessing great heterogeneity. In most of them, no differentiated analysis of the various JIA subtypes was performed, and type-specific analyses according to mandibular joint effects were seldom. Additional factors such as patient age, disease duration, medication, previous orthodontic treatment as well as the inclusion of a control group were also highly inhomogeneous, which made a meta-analysis of the data impossible. Nevertheless, it appears as if JIA patients tend to develop a hyperdivergent vertical jaw base relationship and a skeletal ClassII pattern. Due to the heterogeneous patient samples, it is currently not possible to draw a differentiated conclusion on the influence of various types of JIA on craniofacial morphology.

Analysis of variation of sagittal position of the jaw bones in skeletal class III malocclusion

Skeletal Class III malocclusion is a discrepancy in the sagittal jaw relationship, due to imbalances in their development and/or position, resulting in the dominant appearance of the lower jaw in facial profile. The aim of this study was to determine variations in the sagittal position of the jaw bones to the cranial base in subjects with skeletal Class III, for the earliest possible diagnosis of malocclusion. Fifty children and as many adults with skeletal Class III, both sexes, were examined and selected, based on the findings of sagittal interjaw relationship (ANB) < or = 0 degrees from the cephalometric analysis of tele-x-ray profile head shots. The subjects were grouped according to age. The first group consisted of children aged 6-12 years, and another group, of adults aged 18-26 years. We measured the angles of maxillary prognathism (SNA), mandibular prognathism (SNB) and ANB. Based on these results, within the respective groups subclassification into the subgroups was done, among which a significant difference measured values was evaluated. In both groups a significant correlation of the determined values was evaluated. An average SNA angle ranged 77.36 +/- 3.58 in children and 77.32 +/- 4.88 in adults, while an average SNB angle was 79.46 +/- 3.91 in the group of children and 81.12 +/- 3.76 in adults. An average ANB angle was -2.10 +/- 2.07 in children, and -4.00 +/- 2.34 in adults. In both groups, a significant correlation between the measured values and a significant difference in the values of all the measured parameters were found between patients from different subgroups (p < 0.01). The most common morphological variation of sagittal position of the upper jaw is its retrognatism, which is equally present in both children and adults. Sagittal position of the lower jaw in most of the adults was prognathic, while mandible prognathism in the children was less present.

Surgical Orthodontic Treatment Of Skeletal Class Iii Facial Asymmetry

Correction of class III facial asymmetries is still a major problem in need of an adequate solution. Prominent abnormalities of the facial structures play an important role in a growing individual’s developing identity. Class III skeletal asymmetries are treated with a combination of orthodontic and orthopedic mechanics in growing individuals. In adulthood, correction of the asymmetries usually requires complex surgical procedures. In this case report treatment strategies of class III facial asymmetries are described.

A case report of an adult skeletal classIII malocclusion corrected by changing the occlusal plane

A case report of an adult skeletal classIII malocclusion corrected by changing the occlusal plane