Evaluation of Upper Airway Dimensional Changes and Hyoid Position Following Mandibular Advancement in Patients With Skeletal Class II Malocclusion

Class II malocclusion has a high incidence in the population, which may compromise smile aesthetics, occlusion function and stability. Skeletal Class II may affect facial aesthetics and upper airway volume. Class II malocclusion is routinely associated with skeletal Class II condition, having as treatment alternatives the use of Extra Buccal Appliance (EBA) or removable or fixed propulsor appliance. This article describes a case of a patient who did not accept the use of EBA and so it was fitted a Flex Developer propulsor for Class II correction and discussed the advantages and disadvantages of therapeutic alternatives for Class II correction.

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A combined Surgical-Orthodontic treatment in skeletal Class II malocclusion patients

Journal of Dental Panacea ◽

10.18231/j.jdp.2021.018 ◽

2021 ◽

Vol 3 (2) ◽

pp. 82-87

Author(s):

Prathyaksha Shetty ◽

Dipjyothi Baruah ◽

Amit Rekhawat ◽

Karthik Cariappa ◽

Sujala Ganapati Durgekar ◽

...

Keyword(s):

Orthodontic Treatment ◽

Class Ii ◽

Mandibular Advancement ◽

Class Ii Malocclusion ◽

Skeletal Class ◽

Sagittal Split Osteotomy ◽

Skeletal Class Ii ◽

Facial Esthetics ◽

Bilateral Sagittal Split Osteotomy ◽

Common Problems

Skeletal Class II malocclusion with mandibular deficiency is one of the most common problems that patients seek treatment. Adult patients with severe skeletal Class II malocclusion need orthognathic surgery for successful treatment. Bilateral sagittal split osteotomy (BSSO) is the most often preferred technique for these patients. This case report briefs about two male patient of age 24 years presented with Class II Skeletal relation, mesoprosopic facial form, horizontal growth pattern and Angle’s Class II div 1 malocclusion who were treated with Bilateral sagittal split osteotomy (BSSO) mandibular advancement. The ideal anteroposterior relation was established along with a Class I molar, incisor, canine relationship and ideal overjet, overbite and the overall facial esthetics were significantly improved. Combined surgical-orthodontic treatment aims to obtain a more harmonious facial, skeletal, dental and soft tissue relationship with an added patient self esteem.

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Evaluation of Postsurgical Stability And Condylar Morphology In Skeletal Class II Patients With Condylar Resorption Following Orthognathic Surgery

10.21203/rs.3.rs-1185890/v1 ◽

2021 ◽

Author(s):

Minjiao Wang ◽

Hanjiang Zhao ◽

Xiangyu Wang ◽

Yifeng Qian ◽

Hongbo Yu ◽

...

Keyword(s):

Orthognathic Surgery ◽

Class Ii ◽

Mandibular Advancement ◽

Class Ii Malocclusion ◽

Skeletal Class ◽

Skeletal Class Ii ◽

Condylar Morphology ◽

Ramus Height ◽

Condylar Volume

Abstract Background: To retrospectively evaluate postsurgical stability and condylar morphology for skeletal class II malocclusion patients with condylar resorption (CR) treated with orthognathic surgery.Methods: Thirty-five patients treated with combined orthodontic and orthognathic surgery between 2014 and 2018 were enrolled in this retrospective study. CT scans were acquired preoperatively (T0), 2–7 days after surgery (T1), and 1 year postoperatively (T2). The amount of mandibular advancement, postsurgical relapse, condylar morphology and joint spaces were analysed respectively. Statistical analysis was performed using R, version 3.4.3 (R Development Core Team 2010).Results: The average mandibular advancement and counter-clockwise rotation were 5.51 mm and -2.82 degrees respectively. The average relapse was 1.08 mm (19.6% of the advancement) and 1.13 degrees. The condylar volume showed a postoperative reduction of 161.86 mm3(13.7% of initial condylar volume). AJS increased after surgery and gradually returned to its original state, while SJS and PJS decreased and remained stable. Surgical advancement of B point was significantly correlated with skeletal relapse. The optimal cut-off values were as follows: MP-FH (40.75°); ramus height (51.125 mm); SJS (1.63 mm); surgical displacement (4.72 mm); CCR (-4.3°); AJSC (1.07 mm).Conclusions: Skeletal class II patients with CR have a high risk of postsurgical condylar resorption, which was most related to nonsurgical risk factors such as gender(female) and condylar angle. Condylar had moved posteriorly to the concentric position after surgery and remained quite stable through the 1-year follow-up. Preoperative skeletal patterns such as lower ramus height and surgical procedures such as larger advancement of the mandible were closely associated with sagittal relapse of the mandible.

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Changes in Upper Airway Dimensions Following Orthodontic Treatment of Skeletal Class II Malocclusion with Twin Block Appliance: A Systematic Review

Turkish Journal of Orthodontics ◽

10.5152/turkjorthod.2020.19028 ◽

2020 ◽

Vol 33 (1) ◽

pp. 59-64 ◽

Cited By ~ 1

Author(s):

Roshan Noor Mohamed ◽

◽

Sakeenabi Basha ◽

Yousef Al-Thomali ◽

◽

...

Keyword(s):

Systematic Review ◽

Orthodontic Treatment ◽

Upper Airway ◽

Class Ii ◽

Class Ii Malocclusion ◽

Twin Block ◽

Skeletal Class ◽

Skeletal Class Ii ◽

Airway Dimensions

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Management of severe Class II malocclusion with sequential modified twin block and fixed orthodontic appliances

APOS Trends in Orthodontics ◽

10.4103/2321-1407.177966 ◽

2016 ◽

Vol 6 ◽

pp. 113-118

Author(s):

Sonal Chowdhary

Keyword(s):

Class Ii ◽

Mandibular Advancement ◽

Orthodontic Appliances ◽

Class Ii Malocclusion ◽

Functional Appliance ◽

Deep Bite ◽

Twin Block ◽

Skeletal Class ◽

Skeletal Class Ii ◽

Fixed Orthodontic Appliances

Functional appliance is an effective way of treating skeletal Class II malocclusion in children and adolescents. A 12 months stepwise mandibular advancement protocol with Herbst appliance has been proved to enhance condylar growth and improve mandibular prognathism. The present case report documents a 12-year-old boy presenting with Angle’s Class II, division 1 malocclusion associated with excessive overjet (11 mm), 100% deep bite, and retrognathic mandible. He was treated by a phase I growth modification therapy using twin block appliance with lip pads in a stepwise mandibular advancement protocol followed by a phase II preadjusted Edgewise appliance therapy.

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Ortho-surgical Management of Severe Skeletal Class II Div 2 Malocclusion in Adult

Orthodontic Journal of Nepal ◽

10.3126/ojn.v7i1.18902 ◽

2017 ◽

Vol 7 (1) ◽

pp. 44-50 ◽

Cited By ~ 1

Author(s):

Suchita Tarvade Daokar ◽

Gauri Agrawal ◽

Charushila Chaudhari ◽

Sheetal Yamyar

Keyword(s):

Case Report ◽

Surgical Approach ◽

Class Ii ◽

Mandibular Advancement ◽

Class Ii Malocclusion ◽

Growth Modulation ◽

Skeletal Class ◽

Skeletal Class Ii ◽

Bilateral Sagittal Split Osteotomy ◽

Mandibular Retrognathism

Skeletal Class II malocclusion is attributed to maxillary prognathism, mandibular retrognathism or combination of both. In adolescent cases, the treatment includes growth modulation with headgear or myofunctional appliances. However in adults, optimum esthetic and functional efficacy can be achieved by orthodontic-surgical combination. This case report describes a 21 years old post-pubertal male with severe skeletal Class II discrepancy with normal maxilla and retrognathic mandible. The case was treated with bilateral sagittal split osteotomy (BSSO) with mandibular advancement approach. Straight profile, pleasing esthetics, bilateral Class I molar and canine relationship, normal overjet and overbite were achieved because of a combined ortho-surgical approach.

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Bimaxillary surgery to correct high-angle class II malocclusion: does a simultaneous genioplasty affect long-term stability?

European Journal of Orthodontics ◽

10.1093/ejo/cjz055 ◽

2019 ◽

Vol 42 (4) ◽

pp. 426-433

Author(s):

Nina Torgersbråten ◽

Arild Stenvik ◽

Lisen Espeland

Keyword(s):

Class Ii ◽

Open Bite ◽

Mandibular Advancement ◽

Class Ii Malocclusion ◽

High Angle ◽

Skeletal Class ◽

Angle Class Ii ◽

Post Surgery ◽

Angle Class ◽

Skeletal Class Ii

Summary Background and objectives High-angle skeletal Class II malocclusion is one of the most challenging dentofacial deviations to treat and, in adults, a combination of orthodontic treatment and bimaxillary orthognathic surgery is often indicated. This study examines the rate of clinically significant relapse and whether a genioplasty affects the treatment outcome of high-angle Class II malocclusions. Material and methods Cephalometric tracings of 36 consecutively treated high-angle Class II patients were evaluated from pre-surgery to 3 years post-surgery. All patients had undergone bimaxillary surgery (Le Fort I and BSSO), 13 of them had in addition a genioplasty. Results The maxilla remained stable, whereas relapse (greater than or equal to 2 mm) of the mandibular advancement was seen in 40 per cent of the patients. Advancement greater than 10 mm increased the risk for horizontal relapse. The overjet was normalized and remained stable despite mandibular relapse. Half of the patients had an anterior open bite 3 years post-surgery. A supplemental genioplasty did not affect the relapse rate. Conclusions and implications Overjet was normalized and remained stable long term; there was an open bite in half of the patients. Combined orthodontic and bimaxillary surgical treatment of high-angle Class II patients showed skeletal relapse (greater than or equal to 2 mm) of the mandible in 40 per cent of patients. Mandibular advancement greater than 10 mm increased the risk for relapse. There was no increased risk for dental or skeletal instability associated with a genioplasty in combination with maxillary and mandibular surgery in the treatment of high-angle skeletal Class II malocclusion.

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Three-dimensional evaluation of changes in upper airway volume in growing skeletal Class II patients following mandibular advancement treatment with functional orthopedic appliances

The Angle Orthodontist ◽

10.2319/083117-587.1 ◽

2018 ◽

Vol 88 (5) ◽

pp. 552-559 ◽

Cited By ~ 8

Author(s):

Stig Isidor ◽

Gabriele Di Carlo ◽

Marie A. Cornelis ◽

Flemming Isidor ◽

Paolo M. Cattaneo

Keyword(s):

Upper Airway ◽

Class Ii ◽

Class I ◽

Mandibular Advancement ◽

Functional Appliance ◽

Skeletal Class ◽

Skeletal Class Ii ◽

Partial Volumes ◽

Functional Appliances ◽

Age Range

ABSTRACT Objectives: The aim of this study was to assess three-dimensionally the upper airway changes following functional appliance treatment in growing Class II patients. Materials and Methods: Pre-and post-treatment Cone beam computed tomography scans of 20 patients (age range: 9 to 12; mean: 11.4 ± 1.0 years) were retrieved from the list of patients previously treated with functional appliances in the Postgraduate Clinic at the Section of Orthodontics, Aarhus University, Denmark. Total and partial volumes of the upper airway (ie, lower nasopharynx, velopharynx, and oropharynx) were calculated. To rule out the effect of growth, the changes in the functional appliance group were compared to an age-matched Class I group of 18 patients (age range: 8 to 14; mean: 11.8 ± 1.4 years). Results: In the functional appliance group, all the partial and total volumes were significantly larger at the end of treatment when compared to the start of treatment (P < .003). On the other hand, when comparing the changes for the total and partial volumes of the upper airway in the functional appliance group with the Class I group, a statistical difference was seen only for the oropharynx (P = .022) and total volume (P = .025), with the functional appliance group showing a larger volume increment. Conclusions: An increase in the upper airway volume was found after treatment with functional appliances. This difference was mainly related to the changes at the oropharynx level, which differed significantly from what was observed in the Class I group.

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Three-dimensional study of the upper airway in different skeletal Class II malocclusion patterns

The Angle Orthodontist ◽

10.2319/112117-806.1 ◽

2018 ◽

Vol 89 (1) ◽

pp. 93-101

Author(s):

Fernando C. Brito ◽

Daniel P. Brunetto ◽

Matilde C. G. Nojima

Keyword(s):

Linear Regression Analysis ◽

Three Dimensional ◽

Upper Airway ◽

Class Ii ◽

Class I ◽

Class Ii Malocclusion ◽

Skeletal Class ◽

Skeletal Class Ii ◽

Intergroup Comparison ◽

Reconstruction Software

ABSTRACT Objectives: To characterize upper airway volume and morphology in patients with different skeletal patterns of Class II malocclusion compared to Class I. Materials and Methods: A total of 197 individuals who had cone-beam computed tomography were allocated into groups according to ANB, SNA, and SNB angles (Class I, Class II maxillary protrusion, Class II mandibular retrusion), each subdivided into hypodivergent, normal, and hyperdivergent. Nasopharynx (NP), oropharynx (OP), and hypopharynx (HP) were assessed with three-dimensional image reconstruction software. Results: Intergroup comparison did not detect significant differences in volume and morphology of NP, OP, and HP. The males displayed larger OP and HP volume than the females. Positive correlations between age and NP, OP, HP volume and between craniocervical angle and OP and HP volume were observed. Linear regression analysis detected a tendency for OP and HP volume to increase as maxillary and mandibular length increased. Conclusions: Upper airway volume and morphology were similar in different skeletal patterns of Class II malocclusion. Actual upper and lower jaw lengths were more closely related to upper airway volume and morphology than the angles that reflected their position relative to the cranial base.

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Orthosurgical management of skeletal class-II malocclusion with vertical growth pattern- A case report

IP Indian Journal of Orthodontics and Dentofacial Research ◽

10.18231/j.ijodr.2021.039 ◽

2021 ◽

Vol 7 (3) ◽

pp. 245-250

Author(s):

Ashish Kamboj ◽

S S Chopra ◽

Tushar Deshmukh ◽

Gagandeep Kochar ◽

Deepak Chauhan ◽

...

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Growth Pattern ◽

Class Ii ◽

Mandibular Advancement ◽

Class Ii Malocclusion ◽

Skeletal Class ◽

Vertical Growth ◽

Skeletal Class Ii ◽

Vertical Growth Pattern

Edward H Angle first gave the classification for malocclusions into Classes I, II and III. Amongst these, Class II is the most prevalent and commonly treated at orthodontic clinics. Treatment of Class II malocclusion with mandibular deficiency in adult patients is usually managed with ortho-surgical treatment modality. In this article a case of Skeletal Class II malocclusion with vertical growth pattern is represented which was treated with BSSRO and mandibular advancement was carried out.

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