Types Of Skeletal Malocclusions Research Articles

A CBCT Study Comparing the Outcomes of Volumetric Bone Mass and Mini-Implant Success with Different Types of Malocclusions

Objective: The present study aimed to determine the favorable site for orthodontic mini-implant insertion in both the maxilla andmandible in terms of cortical and trabecular bone thickness and density in different types of skeletal malocclusion using cone-beamcomputed tomography (CBCT).
 Methods: In this study, seventy-five CBCT examinations that were requested for different purposes were used, twenty-five in eachmalocclusion group (class I, class II and class III), class I (ANB: 2°-4°), class II (ANB > 4°), and class III (ANB < 2°) groups. RadiAntDicom Viewer was utilized, measurements were done at different sites in the jaws using standardized orientations, and the threemalocclusion groups were compared for cortical bone thickness and density as well as the density of trabecular bone, using the Kruskal-Wallis and Mann-Whitney test for non-parametric data and one-way ANOVA for parametric data.
 Results: The highest cortical bone thickness was between 1st and 2nd molars at a 6 mm distance from the alveolar crest ranging from1.03 mm to 1.2 mm in maxilla and 2.13 mm to 2.26 mm in the mandible. The difference between groups was only noticed betweencanine and 1st premolar which showed less buccal cortical bone thickness in class II cases with 1.07 mm. Cortical bone density wasnot significantly different between the three groups with maximum density between canine and 1st premolar with a density of 997.9 to1078 HU in the maxilla and the mandible 1245.4 to 1329.3 HU. The trabecular bone density was also highest between canine and 1stpremolar of both jaws, in maxilla 422.13 to 564.15 HU and mandible 509.81 to 799.04 HU. The difference between the groups wasonly in the anterior location between canine and 1st premolars which was less in class III cases with 509.81 HU.
 Conclusions: Skeletal relations can have an impact on the thickness of the cortical bone, although all skeletal classes have the samepattern in the maxilla, in the mandible between the canine and the 1st premolar, variations in bone thickness and trabecular densitymay be seen in various skeletal malocclusions. So, it is important to properly consider the placement of mini-implants with the skeletalrelation to achieve the maximum primary stability. Further researches are recommended, with long term follow up, on stability of mini-implants and its correlation with bone thickness and density.

Reliability of Point M as landmark for analysis of sagittal relation of maxilla

Most of the several cephalometric analyses used for the diagnosis of sagittal dysplasia, Point A is the most widely used indicator for ascertaining of maxillary position. By the virtue of difficulty in locating point A in many cases, alternative methods had been proposed for precise location of point A but there are only few studies on the reliability of these alternative points. Point M is one such indicator for evaluating the sagittal position of maxilla. The objective of this study is to measure and compare the reliability of point A and point M.Lateral cephalogram of 50 subjects (11-20 years) were included in the study consisting of all types of skeletal malocclusions. Point A and point M were identified by two different group of orthodontists. Linear and angular measurements through both the points were analysed and compared between the observers using interclass correlation. Interclass correlation coefficient of linear and angular parameters of point M was found to be higher than point A. Point M may be considered as more reliable alternative for point A in two dimensional cephalometric analysis.

Correlation of dermatoglyphics and Class II skeletal malocclusion – Original research

Dermatoglyphics is a study of the unique pattern in the skin of fingers, palms, soles, and toes. These dermatoglyphics has played an important role in various fields like forensic medicine, genetics, and anthropology.Sir Francis Galton stated that an individual’s dermal pattern remained constant throughout their lifetime. Many studies have suggested the possible relation between dermatoglyphics and occlusion.Studies have suggested that dermatoglyphics could be used as a tool to identify the underlying skeletal malocclusion. As the dermal pattern and oral structures develop together, the genetic information in the dermal pattern could be used to assess the different types of skeletal malocclusions. Hence, the study was aimed to compare and evaluate the correlation between dermatoglyphics and class II skeletal malocclusion in horizontal and vertical growth patterns. The total of 50 samples were taken and divided into horizontal and vertical growth pattern consisting of 25 samples each. The dermatoglyphic pattern between the right and left hand and the pattern such as arches, loops, and whorls were evaluated. The data was analyzed by Kolmogorov – Smirnov and Shapiro Wilk test. There was a statistically significant association between class 2 malocclusion and the dermatoglyphic pattern.

Tridimensional assessment of the mandibular angle in patients with different skeletal patterns by cone-beam computed tomography scans: a retrospective study

BackgroundSince the muscles of chewing are involved in the region of the mandibular angle, important structures in surgical and orthodontic procedures, to study its morphological aspects and the possible influence of different patterns of skeletal development would be of interest. Thus, this study aimed to assess the influence of patient characteristics - such as sex, skeletal malocclusion (Class I, Class II, and Class III) and facial type (brachycephalic, mesocephalic, and dolichocephalic) - on the width, height, thickness, and volume of the mandibular angle, using cone-beam computed tomography (CBCT) scans.MethodsCBCT scans were assessed − 144 men and 154 women, total of 298 - and classified according to skeletal patterns (skeletal malocclusions and facial types). Width, height, and thickness of the mandibular angle were measured using OnDemand 3D software. The volumetric measures of the mandibular angle were obtained using the ITK-SNAP software. Analysis of Variance (multiway ANOVA) with Tukey’s post-hoc test compared the data, with a 5% significance level.ResultsAmong the factors studied, sex significantly influenced all the analyzed variables (height, width, thickness, and volume of the mandibular angle) (p < 0.05); in general, male individuals presented higher values than females. In some cases, the skeletal malocclusion and facial type factors influenced only the width and height variables (p < 0.05); in general, the Class III and dolichocephalic individuals presented higher values in relation to the other types of skeletal malocclusions and facial types.ConclusionsVariations in the craniofacial growth pattern, considering the different skeletal malocclusions and facial types, had some influence in the width and height dimensions of the mandibular angle. Furthermore, sex influenced all the studied variables.

Cephalometric evaluation of posterior airway space in Chinese and Egyptian races

Objectives: The aim of this study was to evaluate the size of posterior airway space (PAS) and hyoid bone position in Chinese and Egyptian races in both genders using cephalometry. Material and Methods: Lateral Cephalometric X-ray were collected from 195 healthy young adults (96 Chinese subjects and 99 Egyptian subjects). Twenty cephalometric measurements (linear and angular) of the nasopharynx, oropharynx, hypopharynx, tongue, and hyoid bone were recorded. Considering gender, according to the ANB angle, the subjects were classified into three types of skeletal malocclusion: class I (1° ≤ ANB ≤ 3°), class II (ANB &gt; 3°), and class III (ANB &lt; 1°). Probability (P) ≤ 0.05 was considered statistically significant. Confident intervals of 95% were used and P &lt; 0.05 was considered to represent statistically significant differences. Results: Significant differences were founded in (PNS-V) (P ≤ 0.01), (TT-V) (P ≤ 0.05), ([Hy-Me-MP] [P ≤ 0.01] [Hyoid–MP-Prep] [P ≤ 0.05] [Hy-C3] [P ≤ 0.01] and [Hy-S] [P ≤ 0.05]), and (PNS-U) between Class II and Class III (P ≤ 0.05) in Chinese group. Significant differences were founded in (TT_FH) (P &lt; 0.001), (Hy_RGn) (P &lt; 0.001), Hyoid bone and C3 (Hy_C3) (P &lt; 0.05), (DeepPharyxatPog) (P &lt; 0.05), and (Hy_C3) between Class I and Class II (P &lt; 0.05) in Egyptian group. Conclusion: There is no direct clinical implication of this study. However, the study shows a reference of the average size of PAS in both genders of Egyptian and Chinese races. Gender showed a significant influence on the PAS dimensions in both Chinese and Egyptian individuals. Sexual dimorphism may account for larger airway dimensions and hyoid bone geometry in both Chinese and Egyptian males.

Evaluation of Orbit Vector Relationships in Different Types of Skeletal Malocclusions

Evaluation of Orbit Vector Relationships in Different Types of Skeletal Malocclusions

Overall Shape of Cranial Base may Dictate and Predict Skeletal Malocclusion

Skeletal malocclusion can present early in childhood and, in some cases, progress into adulthood. If the malocclusion or dentofacial deformity is severe enough, surgical correction through orthognathic surgery is inevitable. The ability to accurately predict the direction and magnitude of craniofacial growth is very limited and based on empirical knowledge. Growth is a key consideration when clinically managing skeletal malocclusion, as it has a direct impact on the timing and method of treatment. Without tools to predict or assess the risk of developing a severe malocclusion, the current practice is to “wait and watch” until growth is complete, and the malocclusion has completely manifested itself. This is frustrating to the patient, orthodontist, and oral surgeon. However, the growth of the cranial base is completed first, followed by the face and mandible, and there are indications that there are morphological and developmental correlations between these structures. This is based on 2-dimensional data with conflicting literature. Moreover, the role of genetics in many malocclusion types has been validated1 and the prevalence of inherited dentofacial deformities in families is well-known. Thus, it may be possible to predict craniofacial growth based on overall 3-dimensional craniofacial shape, particularly in families with skeletal malocclusions. The aims of this study are to establish the distinct 3D geometric morphometric variations between the 3 types of skeletal malocclusion (Angle's classification), demonstrate that this variation is largely attributed to the shape of the cranial base, and confirm feasibility in identifying at-risk craniofacial shape variation in a family trio.In total, 300 CBCTs from a curated dataset of Class I, II, and III healthy (non-syndromic) controls were used for 3D geometric morphometric analysis (Procrustes Superimposition, Principal Components and Partial-Least Square [PLS] regression analyses) to compare the shape of cranial base, face, and mandible between the 3 Classes; mean age 24.8 (14-58) years, 56% females. Validated 3D landmarks2 were applied to the CBCTs, P < .05 statistically significant. The CBCTs were obtained on Planmeca Promax with consistent parameters. Pre- and postoperative CBCTs from a 17-year-old female with skeletal Class III and those of her unaffected parents (53 and 56 years old) were analyzed against the controls. All participants were consented onto and CBCTs gathered through IRB-approved protocols.The 3 skeletal Classes segregated distinctly with the first 3 PCs, explaining 38.7% of variation. In the PLS analysis, integration and correlation were present between cranial base shape, face, and mandible with differences between Angle's classification (P = .001). In the family trio, the pre- and postoperative craniofacial shape of the proband remained within the Class III cluster, despite the normal postoperative jaw relationships. Moreover, the father appeared on the same plot as a Class III outlier, despite his normal clinical phenotype. The mother clustered within the Class II group consistent with her clinical phenotype (Image 1).The authors demonstrate that overall craniofacial shape segregates based on the 3 skeletal malocclusion types and that the cranial base shape correlates with the position of the face and mandible. Thus, the cranial base may be a significant driver in the development of a skeletal malocclusion. In addition, the position of the postoperative proband shape within the Class III cluster confirms that the cranial base contributes to the Class III phenotype even after surgical correction of jaw relationship. Finally, the shape association between the proband and her father is promising and indicates that craniofacial shape of parents will contribute to the development of more accurate growth prediction models.

CBCT analysis of pharyngeal airway volume and comparison of airway volume among patients with skeletal Class I, Class II, and Class III malocclusion: A retrospective study

ABSTRACT Objective: To study the influence of skeletal malocclusion on the oropharyngeal airway volume and the difference in the airway volume among gender and the different types of skeletal malocclusion. Methods: A retrospective analysis of 180 full-field of view (FOV) CBCT scans (55 in Class 1, 55 in Class II, and 70 in Class III) were assessed to measure the oropharyngeal airway volume, ANB angle, SNB angle, and Wits appraisal. The values were compared among different skeletal malocclusions and were correlated to gender. Result: There was a significant result in terms of oropharyngeal airway volume among different types of skeletal malocclusion and ANB angle, SNB angle, and Wits appraisal among males and females. Conclusion: CBCT is a cheaper, more convenient option than polysomnography (PSG) when assessing airways, and thus, a maxillofacial radiologist is importantly placed in the assessment of the retropalatal and retroglossal volume of the oropharyngeal airway.

Influence of different surgical concepts for moderate skeletal class II and III treatment on the nasopharyngeal airway space

PurposeThis study aimed to compare the effects of different orthognathic and camouflage treatments for correcting moderate skeletal class II and III malocclusions on the pharyngeal airway space (PAS). Materials and methodsLateral cephalograms of 89 patients with moderate skeletal class II and III malocclusion (WITS up to 7 mm, −7 mm respectively) were evaluated before and after treatment. PAS was divided into 6 levels (P1: nasopharynx, P2-4: oropharynx, P5-6: laryngopharynx), and 7 groups were formed depending on the type of treatment: 1) class II, mandibular advancement; 2) class II, maxillary setback/mandibular advancement; 3) class II, upper premolar extraction; 4) class III, mandibular setback; 5) class III, maxillary advancement; 6) class III, maxillary advancement/mandibular setback; and 7) class III, lower premolar extraction. ResultsSignificant changes occurred only in patients with class II malocclusion (groups 1 and 2) before and after surgery in the nasopharyngeal and oropharyngeal space. Furthermore, significant differences between the patients with class II malocclusion were found when compared to the premolar extraction group: group 1 vs. group 3 (P3: −1.31 mm (SD 1.74 mm) vs. 0.89 mm (SD 1.79 mm); P4: −0.72 mm (SD 2.82 mm) vs. 1.42 mm (SD 2.16 mm); P ≤ 0.05), group 2 vs. group 3 (P2: 0.35 mm (SD 1.96 mm) vs. 2.28 mm (SD 1.88 mm), P3: −1.31 mm (SD 1.74 mm) vs. 0.35 mm (SD 1.96 mm), P4: −0.72 mm (SD 2.82 mm) vs. 2.84 mm (SD 2.16 mm), P ≤ 0.05). ConclusionsOrthognathic surgery in patients with moderate skeletal class II and III malocclusion seems to affect PAS only slightly. Premolar extractions for compensation (camouflage treatment) can result in a reduction of the oropharynx airway space in both types of skeletal malocclusions. Therefore, in borderline patients with presence of OSAS, orthognathic surgery should be considered.

The crown-root morphology of central incisors in different skeletal malocclusions assessed with cone-beam computed tomography

BackgroundTo determine the discrepancy of crown-root morphology of central incisors among different types of skeletal malocclusion using cone-beam computed tomography (CBCT) and to provide guidance for proper torque expression of anterior teeth and prevention of alveolar fenestration and dehiscence.MethodsIn this retrospective study, a total of 108 CBCT images were obtained (ranging from 18.0 to 30.0 years, mean age 25.8 years). Patients were grouped according to routine sagittal and vertical skeletal malocclusion classification criteria. The patients in sagittal groups were all average vertical patterns, with Class I comprised 24 patients—14 females and 10 males; Class II comprised 20 patients—13 females and 7 males; and Class III comprised 22 subjects—13 females and 9 males. The patients in vertical groups were all skeletal Class I malocclusions, with low angle comprised 21 patients—12 females and 9 males; average angle comprised 24 patients; and high angle comprised 21 patients—11 females and 10 males. All the CBCT data were imported into Invivo 5.4 software to obtain a middle labio-lingual section of right central incisors. Auto CAD 2007 software was applied to measure the crown-root angulation (Collum angle), and the angle formed by a tangent to the central of the labial surface of the crown and the long axis of the crown (labial surface angle). One-way analysis of variance (ANOVA) and Scheffe’s test were used for statistical comparisons at the P < 0.05 level, and the Pearson correlation analysis was applied to investigate the association between the two measurements.ResultsThe values of Collum angle and labial surface angle in maxillary incisor of Class II and mandibular incisor of Class III were significantly greater than other types of sagittal skeletal malocclusions (P < 0.05); no significant difference was detected among vertical skeletal malocclusions. Notably, there was also a significant positive correlation between the two measurements.ConclusionsThe maxillary incisor in patients with sagittal skeletal Class II malocclusion and mandibular incisor with Class III malocclusion present remarkable crown-root angulation and correspondingly considerable labial surface curvature. Equivalent deviation during bracket bonding may cause greater torque expression error and increase the risk of alveolar fenestration and dehiscence.

Cheiloscopy: Association of lip prints in different skeletal malocclusions

Aim: The aim of this study was to assess the association between lip print pattern and different types of skeletal malocclusion. Materials and Methods: A sample of 60 individuals (18–30 years old) with skeletal Class I, Class II Division 1, Class II Division 2, and Class III malocclusion as confirmed by Angle between point A and point B. angle were taken for the study and were named as Groups I, II, III, and IV, respectively. Lip print was recorded by lipstick-paper method and was classified according to Tsuchihashi classification as Type I, Type I', Type II, Type III, Type IV, Type V. Results: It was seen that partial vertical groove (PVG) lip pattern was most prevalent for all the groups. In skeletal Class I, PVG lip pattern was most prevalent, whereas in skeletal Class II Division 1, intersecting groove, in skeletal Class II Division 2, PVG, and in skeletal Class III, complete vertical groove were prevalent. The difference between the four malocclusion groups of each type of lip print was significant except for Type II. Conclusion: Lip print will help in sorting out participants in more reliable manner in cases of mass disaster or criminal investigations. Furthermore, they help in predicting type of malocclusion beforehand for the successful execution of preventive and interceptive orthodontic procedures.

A Cephalometric Evaluation of Sexual Dimorphism of the Angle Sella-Nasion-Frankfort Horizontal Plane in Different Sagittal Classes of Malocclusion in South Indian Population.

Aims and Objectives:The present study aims to evaluate the gender dimorphism of the angle SN-FH between the sella-nasion (SN) plane and the Frankfort horizontal (FH) plane among the three types of skeletal malocclusion in South Indian population. The objectives included measurement of angle SN-FH, FH to the nasion (NFH), FH to the sella (SFH), and the difference of NFH and SFH (Δ). The null hypothesis was that there exists no variation of the angle SN-FH, NFH, SFH, and Δ between males and females and in the different skeletal relationship of jaws.Materials and Methods:Cephalometric data were retrieved from the archived records of 180 patients, comprising 90 males and 90 females, within three subgroups. Class I (60), Class II (20), and Class III (10) in each of the gender class were examined. Student's “t” test was used to analyze means of the gender differences and analysis of variance between subgroups, and significance was set at P < 0.05.Results:The average values obtained from this study for the overall population are 8.06 ± 3.34; for males, it is 7.42 ± 3.62, and for females, it is 8.7 ± 3.48. The gender difference is statistically significant only in Class I malocclusion (0.002). There is no statistical difference between different skeletal classes of malocclusion.Conclusion:The null hypothesis is partially rejected for as significant difference is established only for some of the parameters under the study.

The association between soft palate shape and Need's ratio in various sagittal skeletal malocclusions: A digital lateral cephalometric study

Aim: The present study was aimed to investigate the variation of soft palate morphology and Need's ratio in various sagittal skeletal malocclusions. Materials and Methods: The study was conducted on 300 individuals (aged 15–25 years) who presented to the department of orthodontics for orthodontic treatment. The participants were divided into skeletal Class I, II, and III based on ANB angle on the lateral cephalogram. The soft palate morphology was examined and individuals were grouped into six types. The Need's ratio was calculated for all the participants by division of pharyngeal depth by soft palate length. The results were then subjected to statistical analysis to find the association between morphological variants of soft palate and skeletal malocclusions. Results: The most common type of soft palate was leaf shaped and the least common was S shaped. Leaf-shaped soft palate was the most common in males and rat tail-shaped soft palate was common in females. Individuals with skeletal Class I malocclusion were most frequently found to have leaf-shaped soft palate, skeletal Class II malocclusion had rat tail type, and skeletal Class III had leaf shape and crooked shape in equal proportions. Need's ratio was maximum in skeletal Class III and minimum in Class II malocclusions. Conclusions: There was a significant correlation between the variants of soft palate and the types of skeletal malocclusion in North Indian individuals. The knowledge of morphological variants of soft palate helps the clinician in etiological study of obstructive sleep apnea syndrome, snoring, and other conditions.

Correlation of clivoaxial angle to skeletal malocclusions: A prescreening for future risk of neurodegenerative disorders

Objectives To find out if there exists any correlation between clivoaxial angle (CXA) and skeletal malocclusions. Materials and Methods: Lateral cephalograms of 33 filipino patients equally divided in three types of skeletal malocclusions were traced, and cephalometric parameters CXA, BaSN, ANB, SNMPA, FMA, MMPA, and Y-axis were traced. Data underwent bivariate correlation and curve estimation analysis in SPSS 17.0 statistical software at confidence interval of 95% and 0.05 significance level. Results A highly significant (P = 0.003) strong negative correlation was revealed in Class III patients between CXA and BaSN. Conclusion Class III patients seem to have higher chances of craniocervical junction anomalies and thus might be at risk of developing neurodegenerative disorders in future.

Reliability of frontal sinus with that of maxillary sinus in assessment of different types of skeletal malocclusions

Reliability of frontal sinus with that of maxillary sinus in assessment of different types of skeletal malocclusions

Reliability of frontal sinus with that of maxillary sinus in assessment of different types of skeletal malocclusions

Introduction: Paranasal sinus plays an important role in the formation of facial contours. Therefore, knowledge of the development and size of the maxillary sinus and frontal sinus may be crucial for diagnosing and treating various classes of malocclusion. Aim: To evaluate the reliability of frontal sinus with that of maxillary sinus in the assessment of different types of skeletal malocclusions. Settings and Design: Sample consisted of lateral cephalograms of 240 patients with three different skeletal malocclusions. Material and Methods: The sample for the study consists of 240 patients (120 males and 120 females) with age of the subjects ranging from 16 to 25 years divided into skeletal Class I, II, and III on the basis of ANB angle (each 40 patients). Linear and angular cephalometric measurements were assessed and correlate with maxillary and frontal sinus size, which is obtained through AutoCAD program. Statistical Analysis: Pearson's correlation coefficient used. Results: The results show a significant correlation of frontal sinus with skeletal malocclusion ( P Conclusions: (1) Frontal sinus is more reliable as compared to maxillary sinus in depicting skeletal malocclusion. (2) Frontal sinus area larger in skeletal Class III malocclusion as compared to skeletal Class I and Class II malocclusion. (3) There is no significant variation in maxillary sinus area in males and females whereas frontal sinus shows significant variations in both males and females in different skeletal malocclusions.

Variation of hyoid bone position in different sexes and different types of skeletal malocclusions

Objective: This study was carried out to ascertain if the position of the hyoid bone demonstrates sexual dimorphism. Materials and Methods: This was a retrospective cross-sectional study conducted using patient records from the institution. Institutional Ethical Committee approval was obtained prior to the study. A total of 60 subjects were divided into three groups and studied. Hyoid triangle analysis by Bibby and Preston was carried out to determine the position of the hyoid bone. All radiographs were traced by a single operator and they were retraced to check for measurement error. Results: Student's t -tests and Mann-Whitney U-test were used to find out whether any sexual dimorphism exists. The horizontal distance from the hyoid bone to the retrognathion was found to be significantly larger in males than in females. The hyoid bone is positioned at a lower level in class I and II in males than in females. Also, it was observed that the hyoid angle was significantly greater in males than in females in class II group. Conclusion: Sexual dimorphism was observed in the sample studied.

Evaluation of hyoid bone position and its correlation with pharyngeal airway space in different types of skeletal malocclusion.

Introduction:The hyoid bone and its relation with the pharyngeal space in health and disease has been an intriguing subject for years.Aim:This study attempts to evaluate the hyoid bone position and to ascertain any correlations with pharyngeal airway space in skeletal class I, II, and III malocclusions.Materials and Methods:McNamara's airway analysis was carried out to assess the upper and lower airway widths and Hyoid triangle analysis by Bibby and Preston was carried out to determine the position of the hyoid bone.Conclusion:A positive correlation was found between the lower airway and horizontal distance from the hyoid bone to the retrognathion in class I skeletal pattern with average growth pattern.

Prevalence of malocclusions in school-age children attending the orthodontics department of Shiraz University of Medical Sciences.

To provide quantitative data about the prevalence of malocclusions in the Shiraz orthodontic population, we studied the records of 700 patients (391 girls and 309 boys) aged 6-14 years attending the undergraduate Department of Orthodontics at Shiraz University of Medical Sciences. The prevalence of Angle class I, II and III malocclusion of first molars was 52.0%, 32.6% and 12.3% respectively. Skeletal class I, II and III malocclusion was found in 18.0%, 70.0% and 12.0% respectively. There were no significant differences between the sexes in the prevalence of different types of skeletal malocclusion. Children with class III were significantly younger (mean age 8.9 years) than those with class I (9.6 years) or class II (9.7 years) malocclusions. Orthodontics students need more education and training in the management of class II malocclusion to improve the overall quality of care for patients.