Skeletal Discrepancy Research Articles

Evaluation of Local Application of Glucosamine Sulfate and Chondroitin Sulfate on Temporomandibular Joint Response and Alleviation of Pain and Tension During the Functional Treatment of Skeletal Class II Patients: A Randomized Control Clinical Trial.

This study was conducted to assess the effects of applying a gel ofcombined glucosamine sulfate and chondroitin sulfate on the temporomandibular joint (TMJ) area in patients with skeletal Class II malocclusion treated by removable functionalappliances in terms of TMJ internal proportions, levels of pain, and tension. The study included 36 patients aged 10-13 years with skeletal Class II malocclusion due to retrusion of the mandible characterized by:4-8 degrees of the sagittal skeletal discrepancy (ANB) angle,4-7 mm of overjet,72-76 degrees of the sagittal mandibular positioning (SNB) angle, and a bone maturity stage locatedat pubertal growth spurt. Patients were distributed to the experimental group (Twin-Block appliance + Jointance®gel)or thecontrol group (conventional treatment with the Twin-Block appliance). An allocation ratio of 1:1 was employed. Pre- and post-treatment digital lateral cephalometric radiograms were taken, and the TMJ joint spaces were measured using the Viewbox software (dHAL Software, Kifissia, Greece). The pain and discomfort levels were evaluated using a questionnaire with a four-point Likert scale at three assessment times. The anterior and posterior glenoid and anterior condylar distances to the pterygoid vertical (PTV) reference planesignificantly decreased after treatment (p<.001), and the anterior joint space decreased significantly (p<.001). In contrast, the superior distance of the condyle to the Frankfort horizontal reference planeincreased significantly after treatment, and the same results were found for the posterior and superior joint spaces (p<.05). There were no significant differences between the two groups in the evaluatedlinear variables. No significant differences were found when comparing pain and tension levels between the two groups at each assessment time. A gradual decrease in pain and tension levels was observed between the three evaluation times in both groups. A combinationof glucosamine sulfate and chondroitin sulfate did not affect the temporomandibular joint spaces, pain, and tension levelsin patients with skeletal Class II malocclusions treated by removable functional appliances.

Definitive Rhinoplasty and Orthognathic Surgery for Patients with Cleft Lip Palate.

While primary cleft lip nasal deformity has been well described, secondary cleft lip nasal deformity reflects the combination of residual deformity that follows primary operative maneuvers and growth-related nasal distortions. Secondary cleft lip nasal deformities are further associated with underlying skeletal and dentofacial abnormalities along with soft tissue constriction adding to the complexity of the deformity and posing major aesthetic and functional challenges to the multidisciplinary care team. Definitive rhinoplasties are performed to address these deformities and improve the quality of life in cleft patients following skeletal maturity and ideally after all underlying skeletal discrepancies have been corrected by orthognathic surgery. Maxillary advancement with or without mandibular setback is often required after careful planning and orthodontic preparation. Patients with cleft lip benefit tremendously from definitive rhinoplasty irrespective of inevitable residual discrepancies that remain and adjuvant therapies could enhance the overall outcome.

Correlation of diagnostic tests ANB Angle, Wits assessment and A:B ratio in determination of intermaxillary sagital relationship

INTRODUCTION: Among the diagnostic tests to evaluate sagittal maxillomandibular skeletal discrepancies and the different changes that occur during growth, the following are presented: ANB angle, (Riedel 1948); the Wits Assessment, (Jacobson 1975) of linear type and the A:B Ratio (Terreros 2020), study of geometric proportions, as alternative diagnostic tests to establish the intermaxillary sagittal relationship. OBJECTIVE: To analyze the correlation of intermaxillary sagittal appreciation between angular diagnostic tests (ANB), linear (WITS) and A:B ratio (geometric proportional) in different facial types. MATERIALS AND METHODS: Comparative radiographic study with a quantitative, cross-sectional, retrospective approach in search of 55 cephalometric radiographs of boys and girls aged 8 to 13 years, descriptive-analytical design study, deductive method. RESULTS: In this study it was shown that between the ANB Angle and the A:B Ratio there is a moderate negative relationship of -0.59, between the Wits assessment and the A:B Ratio the correlation is -0.504, which indicates that there is a moderate negative relationship and Angle ANB with the Wits Rating the value is 0.501 which indicates that there is a moderate positive correlation. CONCLUSION: It is established that the ANB angle diagnostic test uses the Nasion point as a reference and that its position affects its diagnosis. There is a moderate to good correlation between the diagnostic tests ANB Angle, A:B Ratio and Wits Assessment in the determination of the intermaxillary sagittal relationship.

Assessment of mandibular asymmetry in different skeletal malocclusions and vertical patterns in adult individuals: A cone-beam computed tomography study

The study aims to measure the mandibular condylar height (CH), ramus height (RH), total height (CH+RH), asymmetry index, and condylar volume (Cvol) in individuals with different anteroposterior and vertical skeletal discrepancies.The study sample consisted of 131 subjects (60 females and 71 males) with a mean age of 35.06 ± 12.79 years. Pre-existing CBCT images were divided into groups according to the anteroposterior and vertical skeletal discrepancies. The investigator analyzed the data using t-tests to assess the mandibular bilateral sides of the individuals and gender differences. The mean difference between groups was determined using a one-way analysis of variance (ANOVA). The Chi-square test was used to study the association between the asymmetry index and groups.Each individual's bilateral sides exhibited statistically significant differences in CH, RH, and Cvol (P = 0.033, P = 0.039, P = 0.005, respectively), but not in CH+RH (P = 0.458). There were, however, statistically significant gender differences in CH+RH (P < 0.001). Skeletal Class III and hypodivergent groups revealed the highest linear and volumetric values compared to other groups. The asymmetry index was increased in CH (P = 0.006) and Cvol (P = 0.002) in skeletal Class II subjects.Significant differences in CH, RH, and Cvol were found on the right and left sides of the same individual. This study found increased linear and volumetric values in males, skeletal Class III, and hypodivergent subjects. Class II individuals had an increased CH and Cvol asymmetry index. This study highlights in-depth knowledge of mandibular asymmetry, which is extremely important to achieve an accurate diagnosis and provide the best treatment outcome.

Non-Surgical Treatment of Class II Division 1 Malocclusion in an Adult Patient with a Missing Lower Lateral Incisor Tooth: A Case Report

Class II Division 1 malocclusion is clinically more widespread than any other form of malocclusion and can be managed in a variety of ways, taking into account variables such as patient compliance, age, and anteroposterior disparity. Orthodontic camouflage treatment, aimed at masking the underlying skeletal discrepancy, is an acceptable option for most patients. This typically involves the extraction of two maxillary premolars in cases without mandibular arch crowding, or the extraction of two maxillary and two mandibular premolar teeth when crowding is present. The present case report aimed to discuss the successful treatment of a unique case involving a 19-year-old adult female patient with Class II Division 1 malocclusion, a missing mandibular left lateral incisor, and an overjet of 7 mm. Since the patient declined surgical and prosthetic treatment, an alternative, novel, and unorthodox method of camouflage treatment was employed, which involved the extraction of maxillary first premolars combined with symmetrical incisor space closure. The achieved treatment outcomes included a functionally and aesthetically acceptable occlusion, reduced overjet, and an improved soft tissue profile.

Correlation between Skeletal Malocclusion and the Dimensions of Maxillary and Frontal Sinuses using Lateral Cephalograms: A Cross-sectional Study

Introduction: Lateral cephalograms are routinely used in orthodontics for accurate assessment and treatment planning of malocclusion. Paranasal air sinuses, such as the maxillary and frontal sinuses, are visible in the lateral cephalogram. However, a direct correlation between the area of these sinuses and the tendency to develop skeletal discrepancies has not been studied in the literature. Aim: To determine the cephalometric correlation between different skeletal malocclusions and the dimensions of the frontal and maxillary sinuses. Materials and Methods: A cross-sectional cephalometric study was conducted at a Tertiary Care Centre in Siliguri district of West Bengal, India. The duration of the study was two years, from August 2019 to September 2021. A total of 150 patients were included and they were divided into three equal groups: skeletal class I (n=50), skeletal class II (n=50), and skeletal class III (n=50). Multiple cephalometric parameters were traced on the radiographs using Dolphin and AutoCAD software, and they were compared among the three groups. The data were analysed using Pearson’s correlation test. Results: The results showed a statistically significant correlation between Maxillary Sinus Area (MSA) and Gonial angle (r=0.468, p=0.001) in skeletal class I malocclusion. In skeletal class II malocclusion, a significant negative correlation was found between Frontal Sinus Area (FSA) and total mandibular length (r=-0.30, p=0.009). However, no significant negative correlation was found between MSA and any cephalometric parameter in skeletal class II malocclusion. Conclusion: The present study highlights there was an increase in the size of the maxillary and frontal sinuses was observed in skeletal class II and skeletal class III malocclusion. However, no correlation could be found between skeletal class I malocclusion and the areas of the frontal sinus.

Comparison of Cervical Vertebral Maturation with Fishman’s Skeletal Maturity Index Method in Assessment of Growth Status

Assessment of skeletal maturity is paramount for orthodontists since optimal use and effectiveness of orthodontic and orthopedic appliances depends on it. Objective: To compare the cervical vertebral maturation (CVM) with Fishman’s hand wrist radiograph (HWR) method in assessment of growth status. Methods: This comparative cross sectional study was conducted at the Orthodontics department at the Khyber College of dentistry, Peshawar on 100 participants. The patients with 9 to 15 years of age, relatively well aligned arches, both genders, mild to moderate skeletal discrepancy, minimal dental compensations, vertical normal angle, and without temporomandibular joint disorders were included. Along with age and gender, stages of HWR and CVM were recorded. HWRs were acquired by standardized method and lateral cephalograms were taken in natural head position. The staging of HWR was done by using Fishman method while CVM staging. Comparison of CVM stages and Fishmann’s HWR stages were done using chi-square test. Results: The mean age was 11.79 ± 1.62 years. The females were 53(53%) and males were 47(47%). Most common stage of CVM was III (n=33, 33%) followed by IV (n=27, 27%). Similarly, common stage of hand wrist radiograph was III (n=32, 32%) followed by IV (n=28, 28%).There was no statistically significant different between two methods for assessing skeletal growth status (p=0.697). Conclusions: Cervical vertebral maturation can have used as an alternative to hand wrist radiograph for growth assessment without an extra radiation

Effects of Two-Phase Treatment with Functional Appliances Followed by Extraction versus One-Phase Treatment with Extraction in Class II Growing Patients: A Case-Control Study.

Objectives: Fixed appliance treatment with premolar extraction is often required after functional appliance treatment to relieve crowding and improve facial aesthetics in the Asian population. This study compared the treatment efficacy of two approaches for treating Class II division 1 malocclusion: functional appliance followed by fixed appliance treatment with extraction (two-phase) and fixed appliance treatment with extraction (one-phase). Methods: Growing skeletal Class II patients with an overjet of ≥6 mm treated with two- or one-phase orthodontics were included. The two groups consisted of 29 patients (mean age = 12.55) and 30 patients (mean age = 12.72), respectively. Pre- and post-treatment cephalograms were analysed and skeletal, dental, and soft tissue characteristics were compared using independent t-tests. Treatment changes were compared within and between groups using paired and independent t-tests, respectively. Stepwise discriminant analysis was performed to identify the variables that best predicted pre-treatment group allocations. Results: At baseline, there were no significant between-group differences in age, gender, cervical vertebral maturation, or overjet. The two-phase group had greater Class II skeletal discrepancies (ANB angle and Wits appraisal). During treatment, the two-phase group showed greater improvements in intermaxillary relationship and facial convexity compared with the one-phase group (p < 0.01). Following treatment, the two-phase group had a greater L1/APog distance (p < 0.05). Facial convexity and Wits appraisal were identified as parameters significantly influencing the clinicians’ decision to use a one- or two-phase approach. Conclusions: In patients requiring premolar extraction, two-phase (vs. one-phase) treatment produced greater improvements in the intermaxillary relationship and facial convexity.

Class II Malocclusion in Adult Patients: What Are the Effects of the Intermaxillary Elastics with Clear Aligners? A Retrospective Single Center One-Group Longitudinal Study.

Aim: To evaluate the dental effects of the treatment with clear aligners and intermaxillary elastics in adult patients with Class II malocclusion. Material and methods: A sample of 20 Class II patients treated with Invisalign aligners (5 M and 15 F; mean age of 27.6 ± 6.3 years) was included in this single-center one-group longitudinal study. Dental cast and cephalometric records were analyzed before (T0) and after treatment (T1). Data were analyzed with a t-test for paired data (p < 0.05). Results: There was a significant reduction of the Overjet (OVJ= −1.4 ± 0.2; p ≤0.001) and a retroposition of upper incisors (U1-NPo = −1.3 ± 1.7; p < 0.001). Furthermore, distalization of upper molars with an improvement of molar class (U6-PT Vertical = −0.93 ± 0.97; p < 0.001; Molar Relation = −0.75 ± 0.45; p < 0.001) was observed. A good control of the lower and upper incisor inclination was present, highlighted by the non-significant changes in these values (L1-GoGn = −0.12 ± 5.4; p = 0.923; U1-AnsPns = −1.1 ± 8.1; p = 0.551). In the lower arch, an increase in the intermolar diameter (0.6 ± 1.0; p = 0.01) was present. Finally, there were no statistically significant changes in all the skeletal variables (ANPg = 0.005 ± 0.687; p = 0.974; SN/MP = −0.47 ± 1.9; p = 0.298). Conclusions: Treatment with Invisalign aligners shows a reduction of the Overjet, a retroposition of the upper incisors, good control of the lower incisors, and an improvement of the molar relationship.

Conservative orthodontic and multidisciplinary approaches for patients with cleidocranial dysplasia in late adolescence or young adulthood

This case series describes conservative orthodontic and multidisciplinary approaches for treating two patients diagnosed with cleidocranial dysplasia in late adolescence and young adulthood. Most of the impacted permanent teeth erupted spontaneously within 3 to 4 years after surgical extraction of the deciduous and supernumerary teeth. The remaining unerupted permanent teeth were facilitated with traction or extracted followed by implantation or restoration. Repositioning of the maxilla and mandible via orthognathic surgery was also applied to correct skeletal and occlusal discrepancies and lead to satisfying results.

Temporomandibular Joint Disorder and Airway in Class II Malocclusion: A Review.

In class II malocclusion, there is an anteroposterior disparity between the upper dentition and the lower dentition, which may or may not be accompanied by a skeletal discrepancy. For orthodontists, this is one of the common malocclusions encountered during clinical practice. This might be due to excess maxillary growth or retarded growth of the mandible or a combination of both. In such types of malocclusion, both the upper and lower airways are affected, the lower one most commonly. Characteristic features seen are a narrow maxillary arch, a proclined upper anterior, and mouth breathing as a developing habit. Also, the position of the condyle in the skeletal type of class II malocclusion plays a vital role in the development of temporomandibular joint disorders. Treating such disparity in a growing individual leads to better results in the long term as well as prevention of malocclusion taking a severe form. Myofunctional appliances are useful for repositioning the mandible as well as the condyle. In adults, extraction of the upper premolars is most commonly done for the correction of class II malocclusion. This provides the patient with a better esthetic appearance.In addition to this, various treatment modalities, such as splint therapy, exercise, and prolotherapy, are beneficial for pain relief and temporomandibular disorder (TMD) correction. This article deals with the characteristics, development, etiology, and comprehensive treatment options of class II malocclusion and its co-relation with the upper and lower airway along with the severity of temporomandibular joint disorders. Repositioning of the condyle in the glenoid fossae is the key to the correction of this disorder.

Evaluation of effects of Forsus Fatigue Resistance device in correction of class II division 1 malocclusion in adolescent patient: A case report

Introduction: Class II malocclusion is one of the most prevalent malocclusions. The Class II malocclusions are caused due to forwardly placed maxilla, the backward position of the mandible, or a combination of both these factors. This disparity in skeletal base growth and position can be corrected during growth spurts using functional and fixed functional appliances. Description: An adolescent boy with Class II division 1 malocclusion, retrusive mandible, and increased overjet was treated with a pre-adjusted edgewise appliance (0.022-slot Gemini 3M -MBT prescription) along with a fixed functional appliance, Forsus TM Fatigue Resistant Device. The Skeletal age of the patient assessment using Hand wrist radiograph and CVM showed a major part of the adolescent growth spurt to be completed. Pre-treatment and post-functional cephalograms were traced and superimposed to compare changes in the skeletal base and dental structures. Result: The Class II molar and canine relationships were corrected to class I and the mandible showed forward positioning leading to correction for the skeletal base to class I. The facial profile showed marked improvement to an orthognathic pleasing profile. Conclusion: The purpose of this case report is to emphasize on use of fixed functional appliances in the treatment of adolescents with skeletal base discrepancies like Class II division 1 malocclusion. Intervention with fixed functional appliances at the appropriate skeletal age can prevent the need for extractions or other surgical procedures that may be needed to correct the malocclusion.

Skeletal discrepancies in patients with skeletal class 2 malocclusion treated at a private dental hospital - an OP report

Aim: The purpose of this study was to determine whether patients with class 2 skeletal malocclusion in a private dental hospital had skeletal discrepancies.Materials and methods: This was a descriptive, retrospective study, and the dental information archiving software was used to collect all the data from the patients who attended the dental clinics at Saveetha Dental College, SIMATS, Chennai, India (DIAS). March 2020 through March 2021 saw the collection of patient records. We gathered and tabulated the data. The gathered data underwent additional processing, was entered into Microsoft Excel, and then went through statistical analysis using IBM SPSS statistics analyzer v.23.0.Results: The current study used a total sample size of 88950 patients. Skeletal class 2 malocclusion was seen in 0.01 percent of cases overall. The data in this study was examined for the occurrence of different skeletal inconsistencies. Results were satisfactory and showed that there were skeletal differences. A gender bias was evident, with 50.4 percent of the sample population being female. Mandibular deficit was the most frequent skeletal discrepancy, and class 2 div 1 dental malocclusion was most frequently detected.Conclusion: Mandibular deficit was shown to be the most common skeletal discrepancy within the constraints of the current investigation, and a substantial correlation between the skeletal discrepancies and the gender of the study group was found.

Evaluation of mandibular condylar position in different malocclusion with Gelb’s grid

To assess condylar position using Gelb’s grid in subjects with different malocclusion. Pre- treatment lateral cephalogram of 45 subjects (aged above 18yrs) were taken and equally divided in three groups, Group I(skeletal Class I malocclusion), Group II-(skeletal Class II malocclusion) and Group III (Class III malocclusion) based on three Cephalometric parameters (ANB, Yen angle and Wits appraisal). Condylar position in relation to glenoid fossa was assessed with Gelb’s grid. For Group I condyle was positioned normally (4,7) in 86.66% of subjects and was positioned posteriorly (5,8)13.33% of subjects. For Group II condyle was displaced posteriorly (5,8) in 86.66% of subjects and in normal position (4,7) for remaining subjects. For Group III subjects condyle was again found in posteriorly displaced 66.66% of subjects and normally positioned in rest of subjects. It can be suggested that the condylar position showed variability in three malocclusion groups. Class I malocclusion group with no skeletal discrepancy was associated with more symmetric normal condylar position than malocclusion groups with skeletal discrepancy (Class II and Class III).

Cephalometric Assessment of Pharyngeal Airway Dimensions in Sagittal and Vertical Growth Patterns

Setting: Determination of patency of airway in sagittal and vertical growth patterns in patients visiting LUMHS Institute of Dentistry, Jamshoro. Methods: This cross-sectional study took place in the Orthodontic Department, Institute of Dentistry, LUMHS Jamshoro. Patients in the age group of 12 to 28 years were included. All subjects were categorized into two groups: Group 1 consists of patients with vertical growth, and Group 2 consists of patients with horizontal growth. Measurements were done by McNamara analysis; the skeletal type was analyzed using ANB, FMA, and SN-GOGN measurements were plotted on the Y-axis, measuring the angle between the S-N plane and sella-gnathion. Results: A total of 62 patients were studied; their mean age was 20.74+3.36 years. The majority were females 77.4% and males 22.6%. two groups were made according to growth patterns, group 1 consisted of vertical growers and group 2 was of horizontal grower patients. 37.1% of patients were found to have an obstructive lower pharyngeal airway. Mean ANB, FMA, Y-Axis, SN-GOGN, upper pharyngeal airway, and lower pharyngeal airway was 5.42±3.52 degree, 27.90±7.93 degree, 66.31±6.56 degree, 34.24±7.95 degree, 14.5±2.24 mm and 9.2±2.04mm respectively. The results show a positive and negligible correlation between ANB and pharyngeal airways. Conclusion: There was a positive and negligible correlation between sagittal growth patterns and pharyngeal airway, with class II cases having obstructive pharyngeal airway and class III cases having patent pharyngeal airway. Keywords: Patency of Airway, Sagittal, Skeletal Discrepancies, Vertical

Assessment and Correlation of Dactyloscopy, Cheiloscopy, and Rugoscopy Among Individuals With Different Skeletal Malocclusion—A Cross-Sectional Study

Background and Objectives A probable association between dermatoglyphics and malocclusions related to skeletal discrepancy may exist as dermal ridges, and craniofacial structures develop from the same embryonic tissues during the same embryonic period. The study aims to assess and correlate the pattern of fingerprints, lip prints, and palatal rugae in individuals with malocclusions related to skeletal discrepancy. Materials and Methods The 180 samples collected in the study were divided into 3 groups based on cephalometric analysis into class I, II, and III malocclusion. The fingerprints, lip prints, and palatal rugae patterns were obtained for each participant and pattern analysis was done. Results Class I malocclusion with no skeletal discrepancy showed a statistically significant difference in the loop fingerprint patterns on all fingers except the first finger on the right and left hand, branched lip pattern, and straight palatal rugae pattern in primary rugae 1 and 4. Class II malocclusion related to skeletal discrepancy showed a statistically significant difference in the loop pattern on all fingers except in the fourth finger of the right hand which showed a whorl pattern, branched lip pattern, and straight palatal rugae pattern in primary rugae 1, 4, and 5. Class III malocclusion related to skeletal discrepancy showed a statistically significant difference in the loop pattern on all fingers except in the fourth finger of the right hand which showed an absence of arch pattern, vertical lip print pattern, and straight palatal rugae pattern in primary rugae 1. Conclusion Dermatoglyphics analysis can be used to indicate developing malocclusions related to skeletal discrepancies. at an early age, thereby aiding the development of treatment aiming to establish favorable occlusion. Prospective and various ethnic and racial-based studies would be valuable for the establishment of dermatoglyphic markers of malocclusion.

Assessment of Dentofacial Characteristics and Pharyngeal Airway in Children with Class II Malocclusion and Mouth Breathing

Abstract Background In growing patients with skeletal discrepancies, early diagnosis, evidence-based explanation of etiology, and assessment of functional factors can be vital for the restoration of normal craniofacial growth and the stability of treatment needs. Aims The aim of the study was to assess dentofacial characteristics as well as upper and lower pharyngeal airway in children with skeletal class II malocclusion with mouth breathing, and to investigate possible significant relationships and correlations among the studied cephalometric variables and the airway morphology in these children. Materials and Methods Sixty untreated children, aged 9 to 13 years, were divided into three groups according to clinical findings and cephalometric analysis of dentofacial characteristics as well as the presence of mouth breathing habit: Group I (20 children with normal jaw relation/class I), Group II (20 children with skeletal class II), and Group III (20 children with skeletal class II with confirmed mouth breathing habit). Cephalometric variables and upper/lower airway widths were recorded. Intergroup comparison of all measurements was performed by post hoc Tukey test, and Pearson's correlation was used to determine the correlation among the variables. Results Significant changes existed in more than half of the dentofacial measurements among the three groups. Significantly greater skeletal anteroposterior jaw discrepancy and mandibular retrognathism were found in both groups II and III as determined by specific anteroposterior determinants. Children in group III showed significantly increased angle between Sella-Nasion and mandibular plane (SN-MP) angle, y-axis, and a vertical growth pattern. Significant increases in dental measurements, namely upper incisor to Nasion- point A (NA), lower incisor to Nasion - point B (NB), and overjet, were found in group II and group III, while overbite showed a significant decrease. Upper pharyngeal airway width was found to be significantly decreased in group III followed by a smaller though significant decrease in group II. No significant differences were found in lower pharyngeal airway width between the groups. There were statistically significant dentofacial characteristics that showed fair to good correlation with the upper airway width. Conclusion Children with skeletal class II malocclusion with and without mouth breathing showed significant differences in dentofacial measurements and a significantly narrower upper pharyngeal airway as compared with children with normal jaw/class I relation.

A New Cephalometric Innovation for Assessing Vertical Skeletal Discrepancy: the MSG Angle

Purpose: The aim of the study was to introduce a new cephalometric parameter, the MSG angle; and to assess the effectiveness of the MSG angle to diagnose the vertical skeletal discrepancy of the face.

The role of anterior segmental osteotomies in orthognathic surgery for protrusive faces in a Southeast Asian population: 10-year retrospective data of 51 patients treated in a single centre

Bimaxillary protrusion is a dentofacial deformity common in the East Asian population. It is often difficult to decide between orthodontic and surgical retraction to treat patients with bimaxillary protrusion, especially if surgery to correct skeletal base discrepancies is also required. The objective of this study was to investigate the treatment outcomes of surgical versus orthodontic retraction in patients with bimaxillary protrusion undergoing orthognathic surgery. A retrospective cohort study was conducted, where the medical records and radiographs of 51 patients with bimaxillary protrusion who had an anterior segmental osteotomy concomitant with orthognathic surgery were examined. Patients who had bimaxillary anterior segmental osteotomies were more likely to achieve an inter-incisal angle of 135 ± 5° at the end of treatment, when compared to patients who had orthodontic retraction (P < 0.01). The total treatment duration of patients who had bimaxillary anterior segmental osteotomies was significantly shorter as compared to that of the patients who only had these osteotomies in the maxilla (P < 0.001) or mandible (P = 0.012). Complications and permanent long-term sequelae following anterior segmental osteotomies were uncommon. It is concluded that bimaxillary anterior segmental osteotomies are a viable alternative for patients with concomitant bimaxillary protrusion and skeletal base discrepancies. This allows for a significantly shorter treatment time and greater correction of inter-incisal angles, without a significant increase in complications.

Early orthodontic treatment in the early permanent dentition

The early orthodontic treatment of malocclusion includes the growth modification of skeletal discrepancy, preventive and interceptive orthodontic treatment of the dental malocclusion or oral habit. Therefore, early orthodontic treatment is to guide the normal dento-maxillafacial growth and development, eliminate the adverse effect on function of masticatory system and the health of dental and periodontal tissues. Most of the patients in the early permanent dentition are still in their pubertal growth period. Although all kind of comprehensive orthodontic treatment could be started from early permanent dentition, early orthodontic treatment can still be used in the cases such as class Ⅱ malocclusion caused by underdevelopment of mandible and crossbite caused by underdevelopment of maxilla in the early permanent dentition. The article will discuss class Ⅱ malocclusion caused by underdevelopment of mandible and anterior and posterior crossbite caused by underdevelopment of maxilla which are feasible for early orthodontic treatment.