Surgical Orthodontic Treatment Research Articles

Surgical Orthodontic Treatment of Class III Malocclusion with Unstable Condylar Position and Facial Asymmetry

Surgical Orthodontic Treatment of Class III Malocclusion with Unstable Condylar Position and Facial Asymmetry

Multiple dental retentions: literature review

Multiple dental inclusions are a relatively rare pathology. They are often part of complex dysmorphoses which require an interrogatory, clinical and radiological examination. The most frequent etiologies of inclusion are local. However, the presence of multiple inclusions can also be correlated with genetic syndromes or metabolic or hormonal pathologies, as well as idiopathic etiologies. There are as many therapeutic approaches as there are forms of inclusions; therapeutic abstention, extraction followed by prosthetic restoration or surgical-orthodontic treatment. Developing a treatment sequence, determining the appropriate anchorage, and biomechanical planning can be a challenge. The aim of our work is to establish an up-to-date state of knowledge regarding the epidemiology, etiological factors and appropriate treatment strategies for multiple dental inclusions.  Â

Do Gender and Age Influence Nasal Soft Tissue Widening After Bone-Borne Transpalatal Distraction?

Widening of the nasal soft tissue after transpalatal distraction (TPD) is a well-known consequence of this treatment method used to correct transverse maxillary deficiency. However, because literature is scarce about the influence of gender and age, the purpose of this study is to estimate changes in the nasal soft tissue after TPD and to measure the association of gender and age with these observed changes. In this retrospective cohort study, patients with transverse maxillary deficiency underwent combined orthodontic-surgical treatment. Maxillary and nasal anatomical landmarks were compared using superimposed cone beam computed tomography images preoperatively and approximately 1year postoperatively. Measurements included nasal soft tissue, nasal skeletal, and maxillary parameters. Significant differences in nasal soft tissue changes were correlated with patient gender, age, maxillary, and nasal skeletal changes using regression models. Ninety one patients were included of which 33 were men (36%) and 58 women (64%). Independent of the maxillary widening, the mean nasal soft tissue widening was limited to 2mm. Nasal soft tissue expansion was 60% to 80% of the nasal skeletal width and 25% to 31% of the skeletal maxillary width. The alar nasal base increased approximately 57% more than the alar nasal width. Significant gender-related differences in nasal soft tissue widening were observed. Age-related differences were identified only as a trend. Small age-related and gender-related differences may not be relevant clinically since there are no established threshold values to assess a layperson's perception of nasal width variations. Technical and/or aesthetic concerns regarding TPD surgery can be addressed without patient's gender and/or age consideration.

Comparative Assessment of Perception about Angle Inclination of Mandibular and Maxillary Incisors on the Cephalometric Analysis between Skeletal Class 3 and Orthognathic Cases

Before orthognathic surgery, a thorough diagnosis of the maxillofacial structure is performed for combined orthodontic–surgical treatment planning. One of the tools that are used for this collaboration is the cephalometric radiograph. Cephalometric analysis is a method for measuring the location of specific anatomical landmarks upon a cephalogram. Some of these parameters are more difficult to define accurately in cases of dentofacial deformities. Therefore, the data obtained from different examiners are characterized by high variability. The present study aimed to examine whether there is a significant variation in the physicians’ measurements between orthognathic Class I (normal) cases and the cases of skeletal deformity Class III. The study involved ten physicians with a mean age of 27. All physicians underwent appropriate instruction for reading and analyzing cephalometric radiographs, and all physicians were instructed about their role in the study. Each participant received 100 cephalometric radiographs, consisting of 50 radiographs of patients with a regular facial structure (Class-I = orthognathic) and 50 photographs of patients with a specific skeletal deformity (Class-III = prognathic). According to the Frankfort Horizontal plane, each physician marked the upper incisor (U1) longitudinal axis on the radiograph and the lower incisor (L1) longitudinal axis according to the mandibular plane. Then, we measured the angle degree with the Cephninja® application. Afterward, we performed a statistical analysis of the t-test with Bonferroni correction to check whether there is a significantly large standard deviation between the indices in the orthognathic cases compared to the prognathic cases. In the group of physicians who participated in this sample of these cephalometric radiographs, we found that in prognathic patients, the upper incisor angle measurements showed significantly more t variance relative to those physicians’ corresponding measurements radiographs of orthognathic patients. Variability increases as skeletal deformity become more severe (p = 0.026) in U1 TO FH and (p = 0.014) L1 TO MP. Cephalometric measurements, which are essential for the correct diagnosis and planning of combined orthodontic treatment, suffer from a significant examiner-based bias that is greater as deformity becomes more severe. This conclusion has implications for the accuracy of the model on which the entire plan process of the combined treatment of facial and jaw deformities is based. The surgeon should use CBCT (cone-beam computed tomography) for its three-dimensional superiority over cephalometric imaging, which will result in a more accurate evaluation of surgery planning and performance.

Effect of occlusal coverage depths on the precision of 3D-printed orthognathic surgical splints

BackgroundPrecise orthognathic surgical splints are important in surgical-orthodontic treatment. This study aimed to propose a standardized protocol for three-dimensional (3D)-printed splints and assess the precision of splints with different occlusal coverage on the dentition (occlusal coverage depth, OCD), thus optimizing the design of 3D-printed splints to minimize the seemingly unavoidable systematic errors.MethodsResin models in optimal occlusion from 19 patients were selected and scanned. Intermediate splints (ISs) and final splints (FSs) with 2-mm, 3-mm, 4-mm, and 5-mm OCDs were fabricated and grouped as IS-2, IS-3, IS-4, IS-5, FS-2, FS-3, FS-4, and FS-5, respectively. The dentitions were occluded with each splint and scanned as a whole to compare with the original occlusion. Translational and rotational deviations of the lower dentition and translational deviations of the landmarks were measured.ResultsFor vertical translation, the lower dentitions translated inferiorly to the upper dentition in most of the splints, and the translation increased as OCD got larger. Vertical translations of the dentitions in 89.47% of IS-2, 68.42% of IS-3, 42.11% of IS-4, 10.53% of IS-5, 94.74% of FS-2, 63.16% of FS-3, 26.32% of FS-4, and 21.05% of FS-5 splints were below 1 mm, respectively. For pitch rotation, the lower dentitions rotated inferiorly and posteriorly in most groups, and the rotation increased as OCD got larger. Pitch rotations of the dentitions in 100% of IS-2, 89.47% of IS-3, 57.89% of IS-4, 52.63% of IS-5, 100.00% of FS-2, 78.95% of FS-3, 52.63% of FS-4, and 47.37% of FS-5 splints were below 2°, respectively. On the other hand, the transversal and sagittal translations, roll and yaw rotations of most groups were clinically acceptable (translation < 1 mm and rotation < 2°). The deviations of ISs and FSs showed no statistical significance at all levels of coverage (P > 0.05).ConclusionsA protocol was proposed to generate 3D-printed ISs and FSs with normalized basal planes and standardized OCDs. Deviations of the ISs and FSs were more evident in the vertical dimension and pitch rotation and had a tendency to increase as the OCD got larger. ISs and FSs with both 2-mm and 3-mm OCD are recommendable regarding the precision relative to clinical acceptability. However, considering the fabrication, structural stability, and clinical application, ISs and FSs with 3-mm OCD are recommended for accurate fitting.

Effects of sex, age, choice of surgical orthodontic treatment, and skeletal pattern on the psychological assessments of orthodontic patients

We aimed to examine the effects of sex, age, choice of surgical orthodontic treatment, and skeletal pattern on psychological assessment scores of orthodontic patients before edgewise treatment. They completed the State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI)-II, and the psychological domain of the World Health Organization Quality of Life 26 (Psych-QOL) for assessment of anxiety, depression, and body image, respectively. No significant effects on psychological assessment scores due to sex or age differences were found. Surgical orthodontic treatment patients and patients with skeletal Class III had significantly higher STAI-Trait and/or BDI-II scores and lower Psych-QOL score. Based on the linear mixed-effects model, the choice of surgical orthodontic treatment had a significant effect on the STAI-Trait, BDI-II, and Psych-QOL scores. No significant interaction effect was found between the choice of surgical orthodontic treatment and the skeletal pattern by ANB angle. Patients with skeletal Class I or III who chose surgical orthodontic treatment had higher STAI-Trait and/or BDI-II scores and/or lower body image score, respectively. These results suggest that patients who chose surgical orthodontic treatment, particularly those with skeletal Class I and III, may be more prone to experience anxiety and depression and have body image dissatisfaction.

Current Trends in Skeletal Borderline Patients: Surgical versus Orthodontic Treatment Decisions—What Is the Evidence?

Background: The aim is to assess the current evidence-based knowledge about treatment decisions for skeletal malocclusion in adult borderline patients. Methods: A literature search was conducted through three databases. Inclusion criteria were restricted to systematic reviews, prospective, retrospective, and control studies. Only articles comparing orthodontic camouflage and orthognathic surgical treatment for Class II and Class III malocclusions in adult patients were selected to be reviewed. Results: Seven articles concerning Class II and nine concerning Class III met the inclusion criteria. Scientific evidence was poor due to low methodological quality. Conclusions: Surgical treatment was found to better improve skeletal and soft-tissue cephalometric values, whereas camouflage treatment mainly involved dentoalveolar movements. Aesthetic changes, as perceived by the patient, were not significantly different in the two groups. Recently improved surgical techniques, differing from those described in the analyzed articles, may provide similar or more stable outcomes compared with orthodontic-only treatment. Although some cephalometric variables can be helpful, the most important parameters for treatment selection are the patient’s presenting complaint and their self-image perception. Further studies with larger sample sizes and similar pretreatment conditions, and considering patient self-evaluation of esthetics and function, should be undertaken.

Orthodontic-Surgical Treatment of a Skeletal Class II Malocclusion: A Case Report

Two methods for treating skeletal problems in adults are camouflage orthodontic treatment and orthognathic surgery. This case report aimed to present the successful treatment of an adult female patient with skeletal Class II malocclusion due to retrognathic mandible through orthognathic surgery. After the fixed orthodontic treatment, the necessary decompensation treatment was applied to the patient who presented to our clinic with the complaint of retrusive mandible and was operated. The dental and skeletal Class I relationship was achieved with functional occlusion after orthodontic and orthognathic surgery. The total treatment time was 23 months. The treatment results showed good improvement in the facial profile.

Surgical-Orthodontic Treatment of Skeletal Class II Malocclusion with Obstructive Sleep Apnea and Multiple Missing Teeth

In the treatment of skeletal Class II retrognathic mandible, the airway should be considered for the progress and outcome of the treatment. The case report demonstrates combined orthodontic and orthognathic surgery in a 39-year-old woman with chief complaint of maxillary protrusion. The clinical examination and X-ray revealed skeletal Class II with a retrognathic mandible, high mandibular plane, vertical maxillary excess (VME), bilateral deformed condyles, and narrow posterior airway space. Moreover, the patient had several missing teeth with a posterior lingual crossbite. Polysomnography revealed obstructive sleep apnea (OSA), with a high apnea–hypopnea index (AHI) of 12.1/h. Her body mass index was low at 17.2. The preoperative orthodontic treatment included leveling, alignment, and molar uprighting. Maxillary segmental LeFort I was designed to expand her maxillary intermolar width and impact the anterior part of her maxilla. Also, bilateral sagittal split osteotomies were performed to advance her mandible position with a counterclockwise rotation of the maxillomandibular complex. The postoperative orthodontic treatment included settling the bite, monitoring the relapse, and managing the dental space for future prosthodontic rehabilitation. After a total treatment time of 1 year and 10 months, her profile was improved, her airway volume was enlarged, and her OSA was resolved, with the AHI changed to 4.3/h at 11 months after surgery then further decreased to 0/h when debonded.

A soft tissue analysis for central India population

Based on surgical-orthodontic treatment planning and prediction system Tony G. McCollum(TOMAC), the present study aims to determine surgical norms for Central India population and to evaluate the variation between Central India males and females. Digital lateral cephalograms of hundred subjects (50 males and 50 females) of 15- 25 years of age were obtained. These radiographs were manually traced by single operator based on the parameterstaken from TOMAC soft tissue analysis. The data obtained was statistically analyzed using Mann-Whitney U test and One-sample Wilcoxon Signed Rank test. Statistically significant difference were observed between the Central India population and Caucasian population and also significant sexual dimorphism was noted among the population of Central India. There exist racial diversity between Central India population and the Caucasian population.Therefore, it becomes necessary to have separate norms for different ethnic groups and choose the norms carefully suited to the treatment needs of individual population.

Ortho-surgical treatment in Class II skeletal patients with mandibular retrognathism: a concise systematic review

Introduction: In the setting of class II malocclusion corrections, the union of orthodontic and surgical procedures was developed. Bilateral sagittal split osteotomy is standard protocol for correcting mandibular retrognathism. Class II dental malocclusion with deep bite needs to be treated early by orthodontics. Thus, the commonly used technique combines BSSO for mandibular advancement and recoil genioplasty to correct the resulting chin protrusion. Objective: To carry out a systematic review of the main considerations of ortho-surgical treatments in class II patients with mandibular retrognathism. Methods: Experimental and clinical studies (case reports, retrospective, prospective and randomized) with qualitative and/or quantitative analysis were included, following the rules of the systematic review-PRISMA. Results and Conclusion: A total of 128 articles was found involving class II malocclusion and ortho-surgical treatments. After, a total of 64 articles were fully evaluated and 24 were included and discussed in this study. A meta-analysis study evaluated the best functional appliance improving mandibular length in individuals with retrognathism. Sander Bite Jumping reported the greatest increase in mandibular length, with 3.40 mm. Another meta-analysis study compared dental, skeletal, and aesthetic outcomes between orthodontic camouflage and orthodontic-surgical treatment in patients with Class II skeletal malocclusion and retrognathic mandible with anterior growth. The difference between treatments was not statistically significant regarding SNA angle, linear measure of the lower lip to the Ricketts aesthetic line, convexity of the skeletal profile or soft tissue profile excluding the nose. In contrast, orthodontic-surgical treatment was more effective to the ANB, SNB and ML/NSL angles and the soft tissue profile including the nose.

Risk assessment of external apical root resorption associated with orthodontic treatment using computed tomography texture analysis.

This study aimed to quantitatively assess maxillary central incisor roots using pre-orthodontics computed tomography (CT) texture analysis as part of a radiomics quantitative analysis. This retrospective case-control study included 16 patients with external apical root resorption (EARR) and 16 age- and sex-matched patients without EARR, after orthodontic treatment who underwent pre-orthodontics CT for jaw deformities. All patients were treated with a fixed orthodontic appliance before and after surgical orthodontic treatment. EARR was defined as root resorption ≥ 2mm of the left and right maxillary central incisors on CT images more than 2years after the start of orthodontic treatment. Texture features of the maxillary central incisor with and without EARR after orthodontic treatment were analyzed using the open-access software, MaZda Ver. 3.3. Ten texture features were selected using the Fisher method in MaZda from 279 original parameters, which were calculated for each of the maxillary central incisors with and without EARR. The results were tested using the Student's t test, Welch's t test, or Mann-Whitney U test. Four gray-level run length matrix features and six gray-level co-occurrence matrix features displayed significant differences between both the groups (p < 0.01). CT texture analysis was able to quantitatively assess maxillary central incisor roots and distinguish between maxillary central incisor roots with and without EARR. CT texture analysis may be a useful method for predicting EARR after orthodontic treatment.

Impacted Central Incisors in the Upper Jaw in an Adolescent Patient: Orthodontic-Surgical Treatment—A Case Report

The inclusion of both maxillary permanent central incisors is uncommon. This condition compromises face aesthetics, phonation and masticatory function. Therefore, early diagnosis is essential to avoid complications and failures. There are various reasons for inclusion, but supernumerary teeth are the leading cause. Early causes of removal and rapid expansion of the palate determine a high probability of success with the spontaneous eruption of the impacted elements. However, it is often necessary to proceed with a surgical–orthodontic treatment. The inclination of teeth in relation to the midline and the root maturation degree determine prognosis and therapeutic timing. In this case report, the orthopantomogram (OPG) X-ray of a 9-year-old boy revealed two impacted supernumerary teeth in the anterior maxillary region, preventing the eruption of the permanent upper central incisors. The impacted supernumerary teeth were surgically removed at different times. A straight wire multibrackets technique associated with a fixed palatal appliance was used. The palatal appliance featured an osteomucous resin support at the level of the retroincisal papilla. Subsequently, surgical exposure was carried out using the closed eruption technique and elastic traction, bringing 11 and 21 back into the arch.

Oral health-related quality of life before, during, and after orthodontic-orthognathic treatment: a systematic review and meta-analysis.

The effect of combined orthodontic-orthognathic treatment was estimated, specifically the impact of pre-surgical orthodontic treatment, on oral health-related quality of life (OHRQoL). The research question was formulated using the PICO method. The search was carried out in MEDLINE via PubMed, CINAHL, psychINFO, Embase, and Cochrane (until February 3, 2020). Inclusion criteria were patients aged ≥ 17years who underwent combined orthodontic-surgical treatment, quality of life assessment, and study design of randomized controlled trial, controlled clinical trial, prospective cohort study, observational study, intervention study, or cross-sectional study. The ROBINS-1 tool was used to assess the risk of bias within studies. A random effects meta-analysis was conducted when appropriate. The quality of evidence was assessed using the GRADE approach. Six studies were analyzed. The OHIP-14 and/or OQLQ-22 questionnaires were used to measure the OHRQoL. All six studies had a serious risk of bias. Two studies (87 participants) were included in a meta-analysis showing improvement of OHRQoL when comparing before and after treatment were compared (mean 14.85 scale points, 95% confidence interval 10.36;19.35). Studies indicate a decrease in OHRQoL during the pre-surgical orthodontic treatment phase but improvement after orthodontic-orthognathic treatment. Data substantiating these results are limited, and the quality of evidence is low. Further research is needed to assess the impact of pre-surgical orthodontic treatment on the OHRQoL in an orthognathic trajectory. Patients should be well informed about the effect facial/esthetic changes may have on their OHRQoL during sequential phases of orthodontic-orthognathic treatment.

Oral Health-Related Quality of Life Changes in Patients with Dentofacial Deformities Class II and III after Orthognathic Surgery: A Systematic Review and Meta-Analysis.

Our aim was to assess the impact of combined orthodontic–surgical treatment on patients’ oral health-related quality of life (OHRQoL) according to type of dentofacial deformities, by synthesizing the available evidence. Methods: Search was conducted in the PubMed, Embase/MEDLINE, Scopus, and Cochrane databases. The eligibility criteria were studies that measured OHRQoL before–after orthognathic surgery, with results disaggregated by Class II and III. Two researchers independently performed the selection process, data extraction, and methodological quality assessment. Meta-analysis of the standard mean differences (SMD) was performed using random effect models. Results: The search identified 1047 references. Thirteen studies met the inclusion criteria, and four were included in the meta-analysis. The SMD of OHRQL global score showed large improvement 4–7 months after surgery in Class II and III patients (2.09, 95% CI 0.68 to 3.49 and 1.96, 95% CI 1.22 to 2.70, respectively). The sensitivity analyses, excluding studies with weak methodological quality, showed that Class III patients’ improvement in functional limitation was significantly higher than in Class II patients (SMD 0.57, 95% CI 0.12–1.02). Conclusions: There is not enough evidence to support differences between Class II and III patients in the OHRQoL impact after orthognathic surgery, but findings suggest lower improvement of some domains in Class II patients.

Impact of Maximum Tongue Pressure in Patients with Jaw Deformities Who Underwent Orthognathic Surgery.

Malocclusion and morphological abnormalities of the jawbone often affect the stomatognathic function and long-term postoperative stability in patients with jaw deformities. There are few reports on the effect of maximum tongue pressure (MTP) in these patients. We investigated the relationship between the MTP and jawbone morphology and the effect of the MTP on surgery in 42 patients with jaw deformity who underwent surgical orthodontic treatment at Hiroshima University Hospital. The MTP was measured using a tongue pressure measurement device; the average value was considered as the MTP. Based on the MTP measured before surgery, patients were classified into the high- or the low-MTP group. The clinical findings and results of the cephalometric analysis were compared. Posterior movement of the mandible in the high-MTP group was significantly lower than that in the low-MTP group. The ANB angle, overjet, and overbite in the high-MTP group were significantly smaller than those in the low-MTP group. On the other hand, there was no difference between the two groups in the measured values, indicating a labial inclination of the anterior teeth (U1 to SN, U1 to FH, IMPA, and FMIA). MTP has been suggested to affect mandibular prognathism in patients with jaw deformities.

Orthodontics Surgical Assistance (Piezosurgery®): Experimental Evidence According to Clinical Results

Orthodontic tooth movement (OTM) is based on intermitted or continuous forces applied to teeth, changing the mechanical loading of the system and arousing a cellular response that leads to bone adaptation. The traditional orthodontic movement causes a remodeling of the alveolar bone and changes in the periodontal structures that lead to tooth movement. The use of a piezoelectric instrument in orthodontic surgery has already shown great advantages. The purpose of this study is to rank the behavior of inflammatory mediators in accelerating orthodontic tooth movement. Ten patients with malocclusion underwent orthodontic surgical treatment, which included a first stage of surgically guided orthodontic movement (monocortical tooth dislocation and ligament distraction, MTDLD) to accelerate orthodontic movements. In all cases, corticotomy was performed by Piezosurgery. Bone and dental biopsy was executed to evaluate changes in the cytokines IL-1beta, TNF-alpha and IL-2 in different time intervals (1, 2, 7, 14 and 28 days). The molecular mediators are IL-1 beta, TNF-alpha and IL-2. Immediately after the surgical procedure there was a mild expression of the three molecular markers, while the assertion of IL-1 beta and TNF-alpha reached the maximum value after 24 h and 48 h, indicating a strong activation of the treated tissues. The Piezosurgery® surgical technique induces an evident stress in short times, within 24–48 h from the treatment, but it decreases significantly during the follow-up.

A rare case of transmigrated mandibular canine and combined orthodontic–surgical management

Canines are paramount teeth for esthetics and function. Transmigration of the lower permanent canine is a rare process of alteration of the eruption path toward the opposite part of the mandible. The position of the migrating tooth varies at different ages, so early detection of the tendency to cross the midline is crucial; canines that have already passed through the center of the mandible can be impossible to realign. Transmigration can start any time before the normal age of eruption. Comparing two radiographic images taken at different ages offers important diagnosis information. Camilleri & Scerri (2003) described a progressive alteration of the tooth position in four steps, from the normal appearance to a low position inside the corpus of the mandible. Following this classification, this article’s aim was to present a case of an impacted lower canine that was diagnosed between the second and third stage of transmigration, around the age of 10, and to detail the combined orthodontic–surgical treatment strategy for “recapturing” and the orthodontic mechanics used to align it. After the examination of cone-beam computed tomography, we have decided to use a lingual arch as a space maintainer and anchorage tool and to surgically expose the tooth. The canine’s initial position and the direction of the force of traction used allowed a proper alignment of the tooth inside the dental arch. The periodontal tissues management was important for good healing, stability, and aesthetics. The early detection allowed a proper interdisciplinary orthodontic–surgical management, and a successful outcome.

Elucidation of Factors Affecting Morphological Changes in the Alveolar Region of the Mandible Associated with Surgical Orthodontic Treatment

Elucidation of Factors Affecting Morphological Changes in the Alveolar Region of the Mandible Associated with Surgical Orthodontic Treatment

Quality of Life of Patients with Jaw Deformities

Recently, the importance of subjective measures such as patient satisfaction and quality of life has been recognized in clinical practice. Surgical orthodontic treatment for patients with jaw deformities not only improves maxillofacial morphology and occlusion, but also has a positive impact on oral and maxillofacial function, psychological and social aspects, and improves the quality of life of the patients. The Orthognathic Quality of Life Questionnaire, which was developed as a jaw deformity disease-specific quality-of-life scale, is also a useful method for assessing the quality of life in patients with jaw deformities. On the other hand, patient satisfaction is an important quality-of-life measure, but not all patients are satisfied with the results of surgical orthodontic treatment. Therefore, in order to increase patient satisfaction, it is essential to carefully analyze the patient’s complaints during the preoperative medical interview based on a correct diagnosis of jaw deformities, to fully discuss the surgical technique and the direction and amount of jaw movement with the patient, and to obtain sufficient informed consent for any possible complications.