Wits Appraisal Research Articles

Perception of facial esthetics and cephalometric correlations in Class II patients: a comparison between two-phase and one-phase treatments

An effective orthodontic treatment should not only aim for satisfactory occlusal outcomes but also consider its impact on facial esthetics. The study aims to evaluate and compare the perception of profile esthetics of skeletal Class II patients treated with two orthodontic modalities: (1) Two-phase approach involving functional appliances followed by fixed appliances with premolar extractions, or (2) One-phase approach using fixed appliances with premolar extractions. Additionally, the study aims to evaluate the correlation between the perceived esthetics and the corresponding cephalometric measurements. The study included 40 skeletal Class II adolescents who underwent either two-phase (n = 20, mean age = 12.38 ± 1.18) or one-phase (n = 20, mean age = 12.53 ± 0.79) orthodontic treatments. Eighty profile silhouettes (pre- and post-treatment) were assessed by 64 raters, including 23 orthodontists, 21 general dental practitioners, and 20 laypersons. The raters used a visual analog scale (VAS) to access profiles, upper and lower lips, and chin esthetics. At pre-treatment, all three groups of raters gave significantly lower scores to the profile silhouettes of the two-phase group compared to the one-phase group (P < 0.01); however, after treatment, they rated the two-phase group significantly higher (P ≤ 0.001). The two-phase group exhibited greater improvements in profile and upper and lower lip esthetics as perceived by all raters (P ≤ 0.001). Furthermore, cephalometric results revealed greater reductions in SNA, ANB, Wits appraisal, and G’-Sn-Pog’ in the two-phase group compared to the one-phase group (P < 0.05). Five cephalometric parameters (SNB, SNPog, overjet, overbite, and UL-SnPog’) demonstrated significant correlations with VAS scores given by orthodontists (P < 0.05). In conclusion, the two-phase group showed greater subjective and objective improvements in facial esthetics than the one-phase group. Additionally, the anteroposterior mandibular position and upper lip protrusion may be the primary cephalometric parameters correlated with subjective facial profile perceptions.

Dentofacial and skeletal effects of two orthodontic maxillary protraction protocols: bone anchors versus facemask

BackgroundMaxillary retrognathia and/or mandibular prognathia are resulting in class III malocclusion. Regarding orthodontic class III malocclusion treatment, the literature reports several treatment approaches. This comparative clinical study investigated two maxillary protraction protocols including bone anchors and Delaire type facemask.MethodsCephalometric radiographs of n = 31 patients were used for data acquisition. The patients were divided into two groups according to their treatment protocol: bone anchored protraction (n = 12, 8 female, 4 male; mean age 11.00 ± 1.76 years; average application: 13.50 ± 5.87 months) and facemask protraction (n = 19, 11 female, 8 male; mean age 6.74 ± 1.15 years; average application: 9.95 ± 4.17 months). The evaluation included established procedures for measurements of the maxilla, mandibula, incisor inclination and soft tissue. Statistics included Shapiro-Wilk- and T-Tests for the radiographs. The level of significance was set at p < 0.05.ResultsThe cephalometric analysis showed differences among the two groups. SNA angle showed significant improvements during protraction with bone anchors (2.30 ± 1.18°) with increase in the Wits appraisal of 2.01 ± 2.65 mm. SNA angle improved also during protraction with facemask (1.22 ± 2.28°) with increase in the Wits appraisal of 1.85 ± 4.09 mm. Proclination of maxillary incisors was larger in patients with facemask (3.35 ± 6.18°) and ML-SN angle increased more (1.05 ± 1.51°) than in patients with bone anchors. Loosening rate of bone anchors was 14.58%.ConclusionsBoth treatment protocols led to correction of a class III malocclusion. However, this study was obtained immediately after protraction treatment and longitudinal observations after growth spurt will be needed to verify the treatment effects over a longer period. The use of skeletal anchorage for maxillary protraction reduces unwanted side effects and increases skeletal effects needed for class III correction.

Upper airways changes associated with orthodontic molar distalization by Pendulum appliance in adolescent patients: a multicenter retrospective cephalometric study

ObjectivesThe purpose of this multicenter retrospective study was to perform a two-dimensional analysis of upper airway changes in adolescent patients following molar distalization with the Pendulum appliance.Materials and methodsThe study involved the cephalometric analysis of 88 patients, retrospectively categorized into two groups: skeletal Class II with a dental Class II molar relationship (36 patients, mean age 12.6 ± 1.1 years) and skeletal Class I with a dental Class II molar relationship (54 patients, mean age 12.3 ± 1.2 years). Changes were observed using lateral radiographs before (T0) and after Pendulum appliance removal (T1); treatment time averaged 7 months. Upper airways were subsequently analyzed by tracing lateral radiographs. The Shapiro-Wilk test showed a normal distribution of the data, therefore parametric tests were used for statistical analysis. Intragroup changes between T0 and T1 were evaluated using paired t-tests, and intergroup differences were assessed using independent student t-tests; statistical significance was set at 0.05.ResultsStatistically significant differences were observed in the skeletal measurements that characterized both groups, particularly in ANB and Wits appraisal, at T0 (P < 0.001). After molar distalization, Class I and Class II groups reported no statistically significant differences with changes almost equal to zero between timepoints (P > 0.05). Additionally, intergroup comparisons of airway changes at T1 did not show statistically significant differences (P > 0.05).ConclusionsThe Pendulum appliance does not significantly change the upper airway dimensions in Class I and Class II malocclusion patients, thereby minimizing potential respiratory risks.

Evaluation of Maxillary Protraction Using a Mini Screw-Retained Palatal C-Shaped Plate and Face Mask.

To evaluate a newly designed minimally invasive palatal-plate face mask combination for the management of developing Class III malocclusion due to maxillary deficiency. A sample of 16 Class III patients due to maxillary deficiency in the early mixed dentition (8 boys and 8 girls) aged between 7 and 9 years participated in this study and were treated with a combination of palatal plate face masks. Extra-oral elastics were attached between the intra-oral and extra-oral appliances; the elastics were set at 30° to the occlusal plane. The force magnitude was 250-300 g per quadrant. Cephalometric radiographs were taken before and immediately after maxillary protraction. In addition, skeletal measurements were measured, tabulated, and statistically analyzed. The pre- and post-protraction measurements were compared using the Student's t-test, and the significance level was set at a p-value <0.05. A statistically significant increase in SNA angle and maxillary length was observed by 3.13±1.52 degrees and 2.60±0.75 mm (p<0.05), respectively, indicating forward maxillary growth. The skeletal and soft tissue patterns were also improved, as evidenced by the statistically significant increase in the ANB angle, Wits appraisal, and H angle by 4.50±1.28 degrees, 5.30±1.86 mm, and 5.02±3.24 degrees (p<0.05), respectively. A favorable clockwise mandibular rotation was observed as evidenced by the increase in the SN/MP angle and the decrease in the SNB angle by 1.46±1.96 degrees and -1.38±1.86 degrees (p<0.05), respectively. The palatal-plate facemask combination is an effective treatment alternative for Class III malocclusion due to maxillary deficiency with minimal pain and discomfort.

Three-Stage Non-Surgical Treatment of Skeletal Class III Malocclusion in Adolescents—A Report of Four Cases with Long-Term Follow-Up

(1) Background: Postponing orthodontic treatment in Class III malocclusion until deterioration and growth cessation to perform orthognathic surgery does not seem to be an optimal solution for every patient. This report describes short- and long-term outcomes for nonsurgical treatment of four adolescents with severe Class III malocclusion. (2) Methods: Four patients (aged 13–15 y) with skeletal Class III (Wits appraisal below 7.5 mm) started a three-stage treatment, consisting of a six-month-long phase I and involving orthopedic treatment with an individual chin-cup. Phase II involved orthopedic treatment with a bonded Haas-type expander on acrylic splints, a face-mask, a lower fixed appliance and Class III elastics; phase III involved full fixed appliance, elastics and reuse of the individual chin-cup. Pre and posttreatment cephalograms were analyzed and superimposed. (3) Results: Improved skeletal and dental relationships and facial appearance was achieved in all patients. Wits appraisal, angles ANB, ANPg and lower face height increased; an improvement of overbite was noted. (4) Conclusions: Severe skeletal Class III in adolescents may be successfully treated with combined orthopedic/camouflage treatment with a Haas-type expander on acrylic splints, Class III elastics, fixed appliance and orthopedic devices (individual chin-cup and facemask) with a very good compliance.

Lateral cephalometric parameters among Arab skeletal classes II and III patients and applying machine learning models

BackgroundThe World Health Organization considers malocclusion one of the most essential oral health problems. This disease influences various aspects of patients’ health and well-being. Therefore, making it easier and more accurate to understand and diagnose patients with skeletal malocclusions is necessary.ObjectivesThe main aim of this research was the establishment of machine learning models to correctly classify individual Arab patients, being citizens of Israel, as skeletal class II or III. Secondary outcomes of the study included comparing cephalometric parameters between patients with skeletal class II and III and between age and gender-specific subgroups, an analysis of the correlation of various cephalometric variables, and principal component analysis in skeletal class diagnosis.MethodsThis quantitative, observational study is based on data from the Orthodontic Center, Jatt, Israel. The experimental data consisted of the coded records of 502 Arab patients diagnosed as Class II or III according to the Calculated_ANB. This parameter was defined as the difference between the measured ANB angle and the individualized ANB of Panagiotidis and Witt. In this observational study, we focused on the primary aim, i.e., the establishment of machine learning models for the correct classification of skeletal class II and III in a group of Arab orthodontic patients. For this purpose, various ML models and input data was tested after identifying the most relevant parameters by conducting a principal component analysis. As secondary outcomes this study compared the cephalometric parameters and analyzed their correlations between skeletal class II and III as well as between gender and age specific subgroups.ResultsComparison of the two groups demonstrated significant differences between skeletal class II and class III patients. This was shown for the parameters NL-NSL angle, PFH/AFH ratio, SNA angle, SNB angle, SN-Ba angle. SN-Pg angle, and ML-NSL angle in skeletal class III patients, and for S-N (mm) in skeletal class II patients. In skeletal class II and skeletal class III patients, the results showed that the Calculated_ANB correlated well with many other cephalometric parameters. With the help of the Principal Component Analysis (PCA), it was possible to explain about 71% of the variation between the first two PCs. Finally, applying the stepwise forward Machine Learning models, it could be demonstrated that the model works only with the parameters Wits appraisal and SNB angle was able to predict the allocation of patients to either skeletal class II or III with an accuracy of 0.95, compared to a value of 0.99 when all parameters were used (“general model”).ConclusionThere is a significant relationship between many cephalometric parameters within the different groups of gender and age. This study highlights the high accuracy and power of Wits appraisal and the SNB angle in evaluating the classification of orthodontic malocclusion.

The effect of different functional appliances on the sagittal pharyngeal airway dimension in skeletal class II: a retrospective study

The aim of this study was to compare the changes in the sagittal pharyngeal airway dimension (SPAD) in adolescents with Class II mandibular retrusion treated with Invisalign Mandibular Advancement (IMA), prefabricated Myobrace (MB), and Twin block (TB). For this retrospective study, the pre-treatment and post-treatment lateral cephalograms of 60 patients who underwent myofunctional treatment, using either one of the tested appliances were gathered from the files of treated patients. Changes in the SPAD were measured in each group, and comparisons were carried out between the three study groups. Additionally, sagittal skeletal measurements were carried out. Comparisons of the study variables at T0 and T1 between the three groups were performed using one-way ANOVA, while comparisons of the difference (T1–T0) were performed using Kruskal Wallis test. A significant SPAD increase has been reported using the three tested appliances (p < 0.05), with the least change documented with MB use (p < 0.05). Significant antero-posterior improvements have been found with IMA, MB, and TB with an increase in the SNB°, and a decrease in ANB° and Wits appraisal (p < 0.05). Non-significant FMA° changes have been observed post-treatment in the three test groups (p > 0.05). The IMA, MB, and TB generated significant SPAD and sagittal changes, with both IMA and TB surpassing MB in the airway area improvement post-treatment. Moreover, the three tested Class II functional appliances did not affect the vertical dimension.

Impact of tonsillectomy on the efficacy of Alt-RAMEC/PFM treatment protocols in children with class III malocclusion and tonsillar hypertrophy: protocol for a cluster randomised controlled trial

IntroductionOrthodontic treatment using face mask protraction combined with an alternate rapid maxillary expansion and constriction/protraction face mask (Alt-RAMEC/PFM) protocol is effective in the early treatment of patients with class III...

Evaluation of different machine learning algorithms for extraction decision in orthodontic treatment.

The extraction decision significantly affects the treatment process and outcome. Therefore, it is crucial to make this decision with a more objective and standardized method. The objectives of this study were (1) to identify the best-performing model among seven machine learning (ML) models, which will standardize the extraction decision and serve as a guide for inexperienced clinicians, and (2) to determine the important variables for the extraction decision. This study included 1000 patients who received orthodontic treatment with or without extraction (500 extraction and 500 non-extraction). The success criteria of the study were the decisions made by the four experienced orthodontists. Seven ML models were trained using 36 variables; including demographic information, cephalometric and model measurements. First, the extraction decision was performed, and then the extraction type was identified. Accuracy and area under the curve (AUC) of the receiver operating characteristics (ROC) curve were used to measure the success of ML models. The Stacking Classifier model, which consists of Gradient Boosted Trees, Support Vector Machine, and Random Forest models, showed the highest performance in extraction decision with 91.2% AUC. The most important features determining extraction decision were maxillary and mandibular arch length discrepancy, Wits Appraisal, and ANS-Me length. Likewise, the Stacking Classifier showed the highest performance with 76.3% accuracy in extraction type decisions. The most important variables for the extraction type decision were mandibular arch length discrepancy, Class I molar relationship, cephalometric overbite, Wits Appraisal, and L1-NB distance. The Stacking Classifier model exhibited the best performance for the extraction decision. While ML models showed a high performance in extraction decision, they could not able to achieve the same level of performance in extraction type decision.

Metallic vs Ceramic Bracket Failures After 12 Months of Treatment: A Prospective Clinical Trial

IntroductionOrthodontic treatment with fixed vestibular appliances is still widely used worldwide. When choosing the aesthetic alternative of ceramic brackets, the possibility of failure and cracking of braces should be considered. Therefore, the aim of the present study was to compare the failure rates of ceramic and metal brackets in a 12-month clinical study. MethodsEighty patients undergoing fixed orthodontic treatment with vestibular appliances were enrolled and divided into 2 equal groups: MET for metal brackets and CER for ceramic brackets. After bonding, bracket failures were recorded for 12 months, along with the archwire placed at the time of failure. Angle's dental class, skeletal class, Wits appraisal, Little's irregularity index, overjet, overbite, age, and gender of the patients were recorded from pretreatment cephalometric tracings and study casts. The data were statistically analysed (P < .05). ResultsSignificantly higher failure rates were found for ceramic brackets in the overall analysis, in the mandibular arch, and in the posterior region. Regression analysis revealed a significant influence of round nickel-titanium archwires on higher failure rates, whilst a significant influence of rectangular archwires was found on lower failure rates. ConclusionsCeramic brackets showed higher failure rates. Patients should be aware that orthodontic treatment with ceramic brackets may involve delays and inconvenience due to the higher failure rate compared to metal brackets.

Effects of modified twin block appliance in growing Class II high angle cases: A cephalometric study

Background Class II malocclusions represent anteroposterior dysplasia usually resulting from mandibular retrusion. Along with a retropositioned mandible, it can be associated with either upward or backward jaw rotation. High angle cases are often associated with a short ramal height, steeper mandibular plane, and large gonial angle. Twin block is a commonly used myofunctional appliance that incorporates bite planes that direct the occlusal forces in a more favorable direction for correction of the retrognathic mandible. We aimed to evaluate skeletal, dental, and soft tissue changes following modified twin block appliance therapy in high-angle cases. Methods A cephalometric study was performed on 15 growing (10-14 years) high angle (Frankfort mandibular angle 28-35°) Class II Division I malocclusion patients undergoing twin block therapy. Skeletal, dental, and soft tissue changes were evaluated by cephalometric analysis using Dolphin software. Results Pre- and post-treatment changes in cephalograms were assessed by analysis of variance and paired t-test. Significant changes in the position of the mandible (angle between Sella-Nasion-Point B [SNB] increased by 3.9 degrees, P=0.02), Wits appraisal (decreased by 1.54 mm, P=0.04), maxillo-mandibular relationship (angle between Point A-Nasion-Point B [ANB] decreased by 3.74 degrees, P=0.02) were observed. Soft tissue changes like the nasolabial angle were also significant, increasing by 3.8 degrees (P=0.04) and lower lip relation to E-line (reduction in lower lip protrusion) by 2 mm (P=0.04). Vertical parameters showed non-significant changes, like the Frankfort mandibular angle (FMA) increased by 0.07 degrees, (P=0.67), the angle between Sella-Nasion and Gonion-Gnathion (SN-Go-Gn) increased by 0.33 degrees, (P=0.67), Y-axis increased by 0.2 degrees, (P=0.32). The upper incisor inclination decreased non-significantly from 115.27±1.33 to 113.42±1.65 degrees, (P=0.12) and lower incisor increased non-significantly from 100.13±2.23 to 101.80 ±1.37 degrees, (P=0.08). Conclusions Modified twin block appliance can be used to successfully treat Class II Division I high angle cases with good vertical control.

A New Approach for the Assessment of True Maxillomandibular Sagittal Relationship: A Zeta Angle.

The assessment of sagittal skeletal dysplasia is crucial for accurate diagnosis and treatment planning, thus necessitating a thorough evaluation. A novel cephalometric parameter, known as the Zeta angle, was proposed in this study for the evaluation of the maxillomandibular relationship in the sagittal plane. This observational study was carried out using 291 pre-treatment lateral cephalograms of participants aged between 15 and 25 years, categorized into skeletal class I, II, and III relationships based on Wits appraisal, ANB angle, and Beta angle. The individuals reported to the Department of Orthodontics from January 2021 to October 2023, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies, Faridabad. The Zeta angle was constructed using three skeletal reference points as point Pt (pterygoid), point M (center of premaxilla), and point Pm (suprapogonion)and was measured perpendicular to point M on the Pt-Pm line and the M-Pm line to determine the severity and type of maxillomandibular discrepancy in the sagittal plane. Statistical tests were used to obtain the mean values for the Zeta angle. Analysis of variance (ANOVA), followed by the Bonferroni post-hoc test, was used to assess skeletal differences between the groups. Receiver operating characteristic (ROC) curves were used to evaluate the sensitivity and specificity of this angle. The results indicated that a Zeta angle between 57° and 64° had a class I skeletal jaw pattern, a Zeta angle less than 57° indicated a class II skeletal jaw pattern, and a Zeta angle greater than 64° indicated a class III skeletal jaw pattern. ROC curves showed that a Zeta angle less than 57.5° had 80% sensitivity and 82.5% specificity in distinguishing class II from the class I subset. A Zeta angle greater than 64.5° has a sensitivity and specificity of 92.5% in distinguishing class III from the class I subset. The Zeta angle may serve as an additional diagnostic tool for the reliable determination of sagittal jaw relationships due to its establishment based on stable anatomical points, thus remaining unaffected by jaw rotations and orthodontic treatments.

Evaluation of different approaches for sagittal skeletal discrepancy assessment

Introduction The accurate assessment of the sagittal jaw relationship between the maxilla and mandible plays a pivotal role in orthodontic diagnosis and treatment planning. Researchers have introduced both linear and angular measurements to establish a precise method for evaluating sagittal base discrepancies. Aim The aim was to assess the different approaches for sagittal skeletal discrepancy assessment. Material and methods The study included 180 pretreated lateral cephalometric radiographs of Egyptian orthodontic patients of both sexes with varying skeletal malocclusion patterns from the Orthodontic Department clinic at Tanta University. These radiographs were meticulously traced onto lead acetate paper using a 0.5 mm lead pencil and an LED tracing screen for adequate illumination. A total of 60 cephalometric radiographs were grouped based on the ANB angle into three skeletal categories: group 1 (class I, ANB° 2°–4°), group 2 (class II, ANB° &gt;4°), and group 3 (class III, ANB° &lt;2°). To analyze the data, each linear and angular parameter (including ANB°, Wits appraisal, AF-BF distance, APDI angle, Beta angle, Yen angle, and W angle) was compared among these three skeletal groups using the F test (analysis of variance), to compare between more than two groups, for normally distributed quantitative variable. Additionally, the Spearman coefficient test was employed to examine the correlations between various linear and angular measurements studied. Results All the performed parameters ANB, Yen, W, Beta, Wits appraisal, and AF-BF distance showed significantly differences for skeletal classes I, II, III. APDI angle differed significantly between both classes I and III and also classes II and III, but did not differ significantly between classes I and II. Strong correlations were found among the studied parameters except between Wits appraisal and AF-BF distance which showed nonsignificant correlation. Conclusion The previous parameters are equally important in terms of diagnosis and reliability, allowing them to serve as alternative analyses under challenging circumstances.

Evaluation of the skeletal and dental effects of a hybrid aesthetic functional appliance (HAF) in skeletal class II division 1 malocclusion: A prospective uncontrolled clinical trial.

The present study investigated the skeletal and dental effect in class II division I growing patients due to mandibular deficiency treated with the hybrid aesthetic functional (HAF) appliance. A sample of 16 growing patients (5 boys and 11 girls; mean age: 9.50 years, standard deviation: 1.15) with class II division I malocclusion were treated using the HAF appliance for an average period of 10±3 months. For each patient, a cephalometric radiograph was taken before and after treatment, and digital analysis was applied using the WebCeph program. The statistical analysis was performed to evaluate dental and skeletal changes associated with the HAF appliance and determine if there were any statistically significant variations in anatomical measurements between the start and completion of the treatment. The data showed a significant increase in SNB angle (P=0.002), leading to a significant decrease in ANB angle (P=0.001). The mandibular length significantly increased (P=0.008), the lower incisors were flared significantly (P=0.028), and the lower molars were extruded significantly (P≤0.001). Also, this study revealed a significant decrease in Wits appraisal (P≤0.001), overjet (P≤0.001), and overbite (P=0.041). Additionally, a significant increase in lower anterior facial height (P≤0.001), total facial height (P=0.001), and posterior facial height (P=0.037) were observed. The HAF appliance showed that it could be used to correct class II division 1 skeletal discrepancy by mandibular advancement. The HAF appliance increased all facial heights significantly.

Volumetric comparison of mandibular condyles and mandibles in the different skeletal classes in the Saudi population.

Assessing the relationship between the condyle and mandible volume and the various skeletal classes is essential in orthodontic diagnosis. The current study evaluated this relationship using volumetric cone-beam computed tomography (CBCT), cephalometric methods, and the correlations between them. The study examined 37 full-head CBCTs (74 condyles) from adults in the Saudi population. The condyle and mandible were separated from within the CBCT images. The volume of each segment was compared to measurements from multiple cephalometric analyses. The combined total condylar volume has a moderate correlation with the maxillomandibular differential in each of the genders and in the total sample. Mandibular volume has a significant correlation with the Wits appraisal (sagittal classification) in males. It was also significantly correlated with the vertical classification using gonial angles in females and in the total sample. The relationship between mandible and condyle volume and cephalometric measurements is both dimensional and within the maxillomandibular complex rather than positional or related to the cranial base. Also, the correlation between the condylar and mandibular volumes and the sagittal and vertical dimensions in the orthodontic skeletal classes provides better insight into the mandibular complex.

Maxillofacial growth changes after maxillary protraction therapy in children with class III malocclusion: a dual control group retrospective study

PurposeTo investigate the balance between post-treatment effect and continued nature growth after maxillary protraction treatment in patients with skeletal class III malocclusion.Methods31 patients aged 8.79 ± 1.65 years with skeletal Class III malocclusion had been treated with maxillary protraction and the treatment lasted an average of 1.16 years. The average observation duration after treatment in the maxillary protraction group was 2.05 ± 0.39 years. In the control groups, a sample of 22 patients (9.64 ± 2.53 years) with untreated skeletal class III malocclusion and 24 patients (9.28 ± 0.96 years) with skeletal class I malocclusion were matched to the treatment group according to age, sex and observation period. The mean observation interval of the control groups was 2.39 ± 1.29 years in the class III group and 1.97 ± 0.49 years in the class I group.ResultsThe active orthopedic treatment effect showed a opposite trend to the natural craniomaxillofacial growth effect after treatment in many aspects. In the observation duration of treatment group, decrease in ANB, Wits appraisal and BAr-AAr were statistically significant compared to class I control group (p < 0.001), and there was a significant increase in NA-FH (P < 0.001) which was contrary to class III control group. Treatment group presented a significant increase in Gn-Co (P < 0.01) and Co-Go (P < 0.001), except for changes in the extent of the mandibular base (Pog-Go, P = 0.149) compared to class I control group. The vertical maxillomandibular skeletal variables (Gonial; MP-SN; MP-FH; Y-axis) in treatment group decreased significantly compared to those in class III control group (P < 0.01). U1-SN and L1-MP showed a significant increase, which was similar to the class I group (P > 0.05), and overjet decreased significantly relative to both of the two control groups (P < 0.05).ConclusionMaxillary protraction therapy led to stable outcomes in approximately 77.42% of children with Class III malocclusion approximately 2 years after treatment. Unfavorable skeletal changes were mainly due to the greater protrusion of the mandible but maxillary protraction did have a certain degree of postimpact on the mandibular base. Protraction therapy does not fundamentally change the mode of maxillary growth in Class III subjects except for the advancement of the maxilla. Craniomaxillofacial region tend to restabilize after treatment and lead to skeletal growth rotation and more dentoalveolar compensation.

Correlation of mandibular third molar orientation and available retromolar space with arch length discrepancy in subjects with different growth pattern.

To evaluate, compare, and correlate the mandibular third molar orientation and available retromolar space with arch length discrepancy in subjects with skeletal class II malocclusion and different growth pattern. A total of 250 patients (age >18 yrs) having skeletal class II malocclusion (based on YEN angle and WITS appraisal) were divided into two groups. Both the groups (Group I with erupted mandibular third molars {N = 150} and Group II with impacted mandibular third molars {N = 100}) were subdivided into subgroups IA (n = 71), IB (n = 19), IC (n = 71) and Group IIA (n = 54), IIB (n = 30) and IIC (n = 16) for normo-, hypo- and hyperdivergent growth patterns, respectively (based on Jarabak ratio and Sn-Go-Gn angle). Four parameters, that is, retromolar space, width of third molar, third molar angulation, and mandibular incisor angulation were measured on orthopantomogram whereas arch length discrepancy was calculated with the help of lateral cephalogram and study model. Intragroup, intergroup comparisons (using unpaired Student's 't' test), and Pearson's correlation coefficient for assessed parameters were obtained. Third molar angulation and retromolar space were significantly higher in Group I than in Group II (hyperdivergent pattern of Group II had highest value). The width of third molar was less than retromolar space in Group II and vice versa for Group I. Mandibular incisor angulation and arch length discrepancy were more in Group II than in Group I, but difference was statistically nonsignificant. Strong positive correlation was observed for mandibular third molar angulation and available retromolar space in normo- and hyperdivergent growth patterns. Lack of retromolar space along with increased amount of arch length discrepancy and mandibular incisor angulation is responsible for increased chances of third molar impaction in some subjects with class II malocclusion.

Assessment of oropharyngeal respiratory volume and sleep apnoea scores using peripheral arterial tonometry may improve diagnosis and treatment planning of combined dysgnathia therapy approaches.

Increased daytime sleepiness is a frequently reported symptom in patients with pronounced dysgnathia. This study investigated possible correlations using home peripheral arterial tonometry (PAT) and oropharyngeal airway volume determination in patients with dysgnathia and daytime sleepiness. Twenty patients (13 male, median age 27.6 ± 6.8 years) with abnormal sleep history and 10 skeletal neutral configured controls (6 male, median age 29.5 ± 4.2 years) with normal sleep history were examined. Patients and controls were evaluated for apnoea-hypopnoea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), snoring volume (dB), total sleep time (TST) and REM-percentage (REM). Airway volumetry was measured via CBCT. Individual user experience for PAT was assessed using the User Experience Questionnaire (UEQ). Patients had significantly higher respiratory scores than controls. AHI increased 4.6-fold (p = .006), RDI 2.5-fold (p = .008) and ODI 6.4-fold (p < .001). Oropharyngeal volumes showed a 30% decrease (p = .003). dB, TST and REM showed no significant differences. AHI (r = -.51; p = .005), ODI (r = -.60; p < .001) and RDI (r = -.45; p = .016) correlated negatively with pharyngeal volume. Wits appraisal correlated negatively with oropharyngeal volume (r = -.47; p = .010) and positively with AHI (r = .41; p = .03) and ODI (r = .49; p = .007). dB and TST (r = -.49; p = .008) and REM and RDI (r = -.43; p = .02) correlated negatively. UEQ-KPI (2.17 ± 0.24) confirmed excellent usability of PAT. Patients with mandibular retrognathia and abnormal sleep history showed significantly higher respiratory indices and smaller oropharyngeal volumes than neutrally configured controls. The dygnathia severity directly influenced the risk of obstructive sleep apnoea.

Cephalometric changes in pharyngeal airway dimensions after functional treatment with twin block versus myobrace appliances in developing skeletal class II patients: a randomized clinical trial

BackgroundSeveral appliances have been used for correction of developing skeletal Class II, including different myofunctional appliances as Twin block (TB)as well as the new pre-fabricated Myobrace (MB) appliance. However, the effects of these devices on the pharyngeal airways have not been compared in the literature. Thus, the aim of this study was to compare the effects of two Class II correction appliances; TB and MB on the sagittal pharyngeal airway dimension (SPAD), including the nasopharyngeal airway area (NPAA), the oropharyngeal airway area (OPAA), and the laryngopharyngeal airway area (LPAA).MethodsThis is a two parallel arms randomized comparative clinical trial. Twenty-six children of 9–12 years with Skeletal Class II malocclusion due to mandibular deficiency and normal maxillary growth as confirmed by lateral cephalometric X-ray readings (ANB angle > 4° and SNB angle < 78) and Cervical vertebral maturational index (CVMI) 1 or 2 were randomly assigned into two equal groups. Group I: TB, Group II: MB (prefabricated functional appliance, Myofunctional Research Co., Australia). Lateral cephalograms were taken for all patients in both groups before treatment (T1) and after treatment (6 months later) (T2). The primary aim was to assess pre and post treatment changes in the SPAD in each group, and compare between the two study groups. The secondary aim was to evaluate the sagittal skeletal measurements such as the SNA, SNB, ANB, Wits appraisal, as well as vertical skeletal measurements represented by the Frankfurt-mandibular plane angle (FMA) measured pre- and post-treatment. The independent samples t-test was used to compare the two study groups, and the mean difference and 95% confidence intervals (CI) were computed. The paired samples t-test was used to compare various parameters between T1 and T2 within each group. The cutoff for significance was p-value < 0.05. Data were analyzed using IBM SPSS for Windows (Version 26.0).ResultsBy Comparing changes in airway measurements within each group, it was found that NPAA, OPAA, and LPAA increased significantly after treatment within each group of MB and TB. TB group showed significantly higher mean difference (T2-T1) in both NPAA and OPAA than MB group with 28.39 (± 56.75) and 40.46 (± 52.16) respectively. The increase in LPAA values was not statistically significant at (T2-T1) between both groups. Regarding skeletal changes, there was a significant increase in the SNB values between T1 and T2 within each group with 2.82 (± 3.32) for MB group and 3.79 (± 3.06) for TB group Moreover, there was a significant decrease in the ANB values between T1 and T2 within each group by 2.42 (± 2.70) for MB group and 3.06 (± 1.14) for TB group. Similarly, there was a significant decrease in the ANB values between T1 and T2 within each group by -2.13 (± 0.62) for MB group and − 2.46 (± 0.72) for TB group. No significant differences were found between both groups in SNA, SNB, ANB and Wits appraisal at p = 0.06, p = 0.45, p = 0.43 and p = 0.22 respectively. FMA did not show significant difference between T1 and T2 within each group, nor showed a significant mean difference between both groups at T2-T1.ConclusionsTB was more effective than MB in improving the upper (NPAA) and middle (OPAA) airways, while no difference was found regarding the lower airway (LPAA). Both TB and MB reduced the severity of developing skeletal class II due to mandibular retrognathism by forward posturing of the mandible. Thus, patients with airway problems would benefit more from TB than MB.

Comparison of upper and lower lip position, length and thickness in sagittal and vertical malocclusion

This study aimed to compare the upper and lower lips position, length, and thickness in different malocclusions, in randomly selected 180 patients’ pre-treatment lateral cephalograms. The subjects were grouped sagittally by using Steiner’s analysis and Wits appraisal and vertically based on Frankfort horizontal and mandibular plane (FHMP) angle and lower facial height. One-way ANOVA was applied to compare the upper and lower lip positions, thickness, and length in sagittal and vertical malocclusion and independent sample T test was applied for comparison between genders among soft tissue variables. Post-hoc Dunnett T3 was performed for comparison of lip variables in adjacent malocclusion groups. The level of significance was not less than or equal to 0.05 The anteroposterior position of the upper and lower lips with respect to E and S planes and upper and lower lip thicknessaried significantly (p &lt; 0.05) in all classes of sagittal malocclusion, ---Continue