Comparison of facemask therapy effects using skeletal and tooth-borne anchorage:

ABSTRACT Objectives To investigate long-term outcomes of dentoskeletal changes induced by facemask therapy using skeletal anchorage in Class III patients and compare them to those of conventional tooth-borne anchorage. Materials and Methods This retrospective study included 20 patients who received facemask (FM) therapy with miniplates as anchorage for maxillary protraction (Miniplate/FM group, 10.6 ± 1.1 years old [mean ± SD]) and 23 patients who were treated with facemask with rapid maxillary expander (RME/FM group, 10.0 ± 1.5 years old [mean ± SD]). Dentoskeletal changes were evaluated using lateral cephalograms at pretreatment (T1), after facemask therapy (T2), and at the post-pubertal stage (T3). Cephalometric changes were compared between groups and clinical success rates at T3 were evaluated. Results SNA and A to N perpendicular to FH increased significantly more in the Miniplate/FM group than in the RME/FM group when comparing short-term effects of facemask therapy (T1–T2). ANB, Wits appraisal, Angle of convexity, mandibular plane angle, and overjet decreased significantly more in the RME/FM group than in the Miniplate/FM group after facemask therapy (T2–T3). A more favorable intermaxillary relationship was observed in the Miniplate/FM group than in the RME/FM group in long-term observations (T1–T3). Clinical success rate at T3 was 95% in the Miniplate/FM group and 85% in the RME/FM group. Conclusions Facemask therapy with skeletal anchorage showed a greater advancement of the maxilla and more favorable stability for correction of Class III malocclusion in the long-term than conventional facemask therapy with tooth-borne anchorage.

Sagittal and Vertical Growth of the Maxillo–Mandibular Complex in Untreated Children: A Longitudinal Study on Lateral Cephalograms Derived from Cone Beam Computed Tomography

The aim of this longitudinal study was to evaluate the sagittal and vertical growth of the maxillo–mandibular complex in untreated children using orthogonal lateral cephalograms compressed from cone beam computed tomography (CBCT). Two sets of scans, on 12 males (mean 8.75 years at T1, and 11.52 years at T2) and 18 females (mean 9.09 years at T1, and 10.80 years at T2), were analyzed using Dolphin 3D imaging. The displacements of the landmarks and rotations of both jaws relative to the cranial base were measured using the cranial base, and the maxillary and mandibular core lines. From T1 to T2, relative to the cranial base, the nasion, orbitale, A-point, and B-point moved anteriorly and inferiorly. The porion moved posteriorly and inferiorly. The ANB and mandibular plane angle decreased. All but one subject had forward rotation in reference to the cranial base. The maxillary and mandibular superimpositions showed no sagittal change on the A-point and B-point. The U6 and U1 erupted at 0.94 and 1.01 mm/year (males) and 0.82 and 0.95 mm/year (females), respectively. The L6 and L1 erupted at 0.66 and 0.88 mm/year (males), and at 0.41 mm/year for both the L6 and the L1 (females), respectively.

Effects of Class II elastics during growth on the functional occlusal plane according to skeletal pattern and extraction vs nonextraction

ABSTRACT Objectives To investigate the effect of Class II intermaxillary elastics on the functional occlusal plane (FOP) of growing patients. Materials and Methods A total of 50 participants aged 11 to 16 years were selected from a university clinic archive >1-year after treatment and after undergoing 6 months of Class II elastic wear, taking pretreatment (T0) and posttreatment (T1) lateral cephalometric radiographs, and consenting to participate at recall (T2). Participants were divided into 3 groups according to skeletal pattern or into 2 groups according to treatment with extraction (E) or nonextraction (NE). Angular changes of FOP relative to the Sella-Nasion (SN), mandibular plane (MP), and Frankfort horizontal (FH) were compared within and between groups. Results A statistically significant reduction of FOP-SN/FH, but not of FOP-MP, was found from T0–T1–T2 when all patients were grouped together. FOP-SN/MP/FH was significantly the largest in the patients with a hyperdivergent skeletal pattern, but lowest in the patients with a hypodivergent skeletal pattern at T0, T1, and T2 (P < .032). FOP-MP at T0–T2 was statistically larger in group E than in group NE (P < .02). No differences were found for FOP changes (change before treatment minus after treatment and change after treatment minus 1 year after treatment) between different skeletal patterns (P > .433) and treatment groups (P > .193). Conclusions Use of Class II elastics during the growth period was not found to show adverse effects on FOP rotation. Neither skeletal pattern nor treatment modality differed in the response to Class II elastics with regard to FOP changes. Individual patient growth pattern must be taken into consideration when treatment planning the use of Class II elastics. Orthodontists should take into account individual skeletal and growth patterns while using Class II elastics.

Relationship between Dental Arch Width and Vertical Facial Morphology in Untreated Adults- A Retrospective Study

Early orthodontic research has focused on the link between face shape and malocclusion. Orthodontic treatment's effectiveness and stability are heavily influenced by a patient's dental and facial anatomy. An orthodontist's knowledge of arch shapes is essential since it affects the patient's treatment and future growth. For this study, the researchers wanted to see if there was a link between vertical face morphology and arch width, and if there was a difference in arch width between males and females. Arch width measurements (in millimetres) were utilised to determine the association. For both males and females, participants with the lowest mandibular plane angle had the widest arch, followed by those with the average mandibular angle and those with the highest.

Nonsurgical treatment of a hyperdivergent skeletal Class III patient with mini-screw–assisted mandibular dentition distalization and flattening of the occlusal plane

ABSTRACT Treatment of hyperdivergent skeletal Class III malocclusion is challenging for orthodontists, and orthognathic-orthodontic treatment is usually required. This report presents the successful nonsurgical treatment of a 20-year-old man who had a skeletal Class III malocclusion with anterior open bite, anterior and posterior crossbite, hyperdivergent growth pattern, steep occlusal plane, early loss of three first molars, and an uncommon convex profile with a retruded chin. An orthodontic camouflage treatment plan was chosen based on the etiology and the patient's complaints. Tooth #37 was extracted. Miniscrews were used for uprighting and intruding of the lower molars, distalization of the lower dentition, and flattening of the occlusal plane. After 34 months of active treatment, Class I relationships, proper anterior overjet and overbite, flat occlusal plane, and an esthetic facial profile were achieved. The results demonstrated that the biomechanics involved in the nonsurgical treatment assisted with miniscrews to distalize the mandibular dentition and flatten the occlusal plane while keeping the mandibular plane stable was effective for treating this hyperdivergent skeletal Class III patient with a convex profile and anterior open bite.

Craniomaxillofacial Changes Using High-Pull J-Hook Headgear and Mini-Implant Anchorage in Adolescents: A Structural Superimposition Method

Objective: The aim of this study was to compare the craniomaxillofacial changes when using high-pull J-hook headgear (HPJH) and mini-implants (MIs) as maxillary anchorage in adolescents. Study Design: 40 female adolescents with dentoalvolar protrusion were divided into 2 groups; the HPJH group (n=20) and the MI group (n=20). Lateral cephalograms taken before treatment (T0) and after anterior tooth retraction (T1) were superimposed on the stable structures and then craniomaxillofacial changes were evaluated. Results: The cranial base angle, SNB, and facial angle decreased in the HPJH group but increased in the MI group. ANB decreased more in the MI group than in the HPJH group. Mandibular plane angle increased in the HPJH group but decreased in the MI group. Facial height index increased in the MI group while it showed no change in the HPJH group. Mandibular true rotation occurred clockwise in the HPJH group and counterclockwise in the MI group. Maxillary central incisors were intruded and retracted more in the MI group than in the HPJH group. Maxillary first molars were extruded in the HPJH group and were intruded in the MI group. Maxillary first molars were protracted more in the HPJH group than in the MI group. Mandibular central incisors were retracted more in the HPJH group than the MI group. Mandibular first molars were extruded more in the MI group than in the HPJH group. Conclusion: More favorable craniomaxillofacial changes occurred in the MI group than in the HPJH group.

A CBCT Evaluation of Midpalatal Bone Density in Various Skeletal Patterns

The purpose of this study was to evaluate midpalatal bone density (BD) by using cone-beam computed tomography (CBCT) according to gender, age, and vertical and horizontal skeletal patterns. CBCT images from 126 subjects (64 females and 62 males) were reoriented and analyzed in order to attain BD values at the midpalatal suture. Four age groups were used for classification (adolescence, 10 ≤ early < 14 years, 14 ≤ middle ≤ 17 years, and 17 < late ≤ 21 years; adult > 21 years). Vertical skeletal pattern categories were differentiated by the Frankfort horizontal line to mandibular plane angle (hypodivergent < 22°, 22° ≤ normovergent ≤ 28°, and 28° < hyperdivergent). Horizontal skeletal pattern differentiation was defined by ANB angle (Class III < 0°, 0° ≤ Class I ≤ 4°, and 4° < Class II). Females showed significantly higher BD than males (p < 0.001). As age increased, BD increased significantly (p < 0.001). There were no significant differences between vertical skeletal patterns. Class II showed significantly less BD than Class III (p < 0.05). With this information, clinicians can better understand BD trends of the midpalatal suture and, thus, better understand our patient’s anatomy and potential hurdles in successful treatment.

Multiloop edgewise archwire treatment for a patient with a severe anterior open bite and amelogenesis imperfecta

ABSTRACT Amelogenesis imperfecta is a rare hereditary disorder that affects dental enamel and is often associated with an anterior open bite. Orthodontic treatment of a 16-year-old female patient with hypocalcified amelogenesis imperfecta and a 9-mm anterior open bite was presented. Radiographic examination revealed a steep mandibular plane angle, an increased lower face height, a Class II skeletal pattern, and a convex profile. Additionally, the patient had stainless steel crowns on all upper and lower posterior teeth and composite veneers on the upper anterior teeth. The patient was treated nonsurgically using a multiloop edgewise archwire (MEAW). MEAW mechanics allowed for successful correction of the anterior open bite, with significant reduction in the mandibular plane angle and improvement in the patient's profile. No fixed retainers were used, results remained stable 78 months after removal of orthodontic appliances. MEAW mechanics should be considered for patients with large anterior open bites, although this technique requires excellent patient compliance.