Cephalometric evaluation of changes in vertical dimension and molar position in adult non-extraction treatment with clear aligners and traditional fixed appliances

ABSTRACT Introduction: Orthodontists have been using clear aligners to treat malocclusions, and one potential effect of treatment with orthodontic aligners is the intrusion and/or resists extrusion of the posterior teeth. This “bite-block effect” is primarily anecdotal due to the frequent occurrence of posterior open bites in patients after clear aligner therapy. Objective: The purpose of this study was to compare changes promoted by clear aligners and traditional fixed appliances in cephalometric measurements of the vertical dimension and molar position in adult patients with Class I malocclusion treated with non-extraction. Methods: Pre- and post-treatment lateral cephalometric radiographs of adult patients treated with either clear aligners (n=44) or traditional fixed appliances (n=22) were selected for retrospective analysis. Eight interval measurements and one nominal measurement were evaluated: anterior overbite (OB), mandibular plane angle related to cranial base (SN_MP) and related to Frankfort (FMA), lower molar height (L6H) and upper molar height (U6H), palatal plane to mandibular plane angle (PP_MP), lower facial height (LFH), total facial height (TFH), and posterior open bite (Posterior_OB). A single evaluator traced all cephalographs, and changes in select measures of the vertical dimension were compared within and between groups. Results: OB decreased (1.15 mm) and L6H increased (0.63 mm) in the traditional fixed appliance group. Mandibular plane angles (related to cranial base and to Frankfort) increased (0.43° and 0.53°, respectively) in the clear aligner group, but just FMA showed significant difference between groups (difference of 0.53°). LFH and TFH increased (ranging from 0.52 mm to 0.80 mm) in both groups, with no differences between treatment modality. Presence of visible posterior open bite significantly increased over the course of treatment. OB, FMA and L6H exhibited an interaction between treatment stage (pre- and post-treatment) and modality (clear aligner therapy and traditional fixed appliances), but no interaction among these three variables was found. Conclusions: The evidence does not support the theory that clear aligner therapy produces better vertical dimension control than traditional fixed appliances. Traditional fixed appliance therapy slightly extruded the lower molar, and clear aligner therapy produced a slightly mandibular backward rotation.

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Cephalometric comparison of adult anterior open bite treatment using clear aligners and fixed appliances

The Angle Orthodontist ◽

10.2319/010418-4.1 ◽

2018 ◽

Vol 89 (1) ◽

pp. 3-9 ◽

Cited By ~ 7

Author(s):

Bella Shen Garnett ◽

Kimberly Mahood ◽

Mai Nguyen ◽

Aliaa Al-Khateeb ◽

Siqi Liu ◽

...

Keyword(s):

Vertical Dimension ◽

Open Bite ◽

Plane Angle ◽

Anterior Open Bite ◽

Treatment Groups ◽

Mandibular Plane ◽

Fixed Appliances ◽

Clear Aligner ◽

Cephalometric Measurements ◽

Mandibular Plane Angle

ABSTRACT Objectives: To compare fixed appliances and clear aligner therapy in correcting anterior open bite and in controlling the vertical dimension in adult patients with hyperdivergent skeletal patterns. Materials and Methods: In this retrospective study, two treatment groups of adult (≥18 years old) hyperdivergent patients (mandibular plane angles of ≥38°) with anterior open bites were included: 17 fixed appliance patients and 36 clear aligner patients. Thirteen cephalometric measurements representing the vertical dimension were reported for each group. A two-sample t-test was used to assess differences in changes in mandibular plane angle and overbite between the two treatment groups. Results: There were no statistical differences found in the magnitude of overbite correction and the changes in any of the cephalometric measurements for vertical control. The clear aligner group showed a slightly greater amount of lower incisor extrusion (P = .009). The main mechanism of open bite correction was similar between the two treatment groups and was accomplished through retroclination of the upper and lower incisors while maintaining the vertical position of the upper and lower molars. Conclusions: Cephalometric comparison of anterior open bite correction and changes in the mandibular plane angle associated with use of clear aligners and fixed appliances did not demonstrate statistically significant differences in adult hyperdivergent patients.

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

Journal of Clinical Pediatric Dentistry ◽

10.17796/1053-4625-45.6.11 ◽

2021 ◽

Vol 45 (6) ◽

pp. 433-440

Author(s):

Sunock Yun ◽

Jae Hyun Park ◽

Na-Young Chang ◽

Hye Young Seo ◽

Jae-Hyun Sung ◽

...

Keyword(s):

Study Design ◽

Cranial Base ◽

Female Adolescents ◽

Plane Angle ◽

Mini Implants ◽

Facial Height ◽

Mandibular Plane ◽

Lateral Cephalograms ◽

Implant Anchorage ◽

Stable Structures

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.

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The maxillary incisor display at rest: analysis of the underlying components

Dental Press Journal of Orthodontics ◽

10.1590/2177-6709.23.6.048-055.oar ◽

2018 ◽

Vol 23 (6) ◽

pp. 48-55 ◽

Cited By ~ 1

Author(s):

Waqar Jeelani ◽

Mubassar Fida ◽

Attiya Shaikh

Keyword(s):

Soft Tissue ◽

Linear Regression ◽

Linear Regression Analysis ◽

Plane Angle ◽

Upper Lip ◽

Facial Height ◽

Mandibular Plane ◽

Lateral Cephalograms ◽

The Relationship ◽

Mandibular Plane Angle

ABSTRACT Introduction: Maxillary incisal display is one of the most important attributes of smile esthetics. Objective: The aim of this study was to determine the relationship between maxillary incisal display at rest (MIDR) and various soft tissue, hard tissue and dental components. Methods: A cross-sectional study was conducted on 150 subjects (75 males, 75 females) aged 18-30 years. The MIDR was recorded from the pretreatment orthodontic records. The following parameters were assessed on lateral cephalograms: ANB angle, mandibular plane angle, palatal plane angle, lower anterior and total anterior facial heights, upper incisor inclination, upper anterior dentoalveolar height, and upper lip length, thickness and protrusion. The relationship between MIDR and various skeletal, dental and soft tissue components was assessed using linear regression analyses. Results: The mean MIDR was significantly greater in females than males (p = 0.011). A significant positive correlation was found between MIDR and ANB angle, mandibular plane angle and lower anterior facial height. A significant negative correlation was found between MIDR and upper lip length and thickness. Linear regression analysis showed that upper lip length was the strongest predictor of MIDR, explaining 29.7% of variance in MIDR. A multiple linear regression model based on mandibular plane angle, lower anterior facial height, upper lip length and upper lip thickness explained about 63.4% of variance in MIDR. Conclusions: Incisal display at rest was generally greater in females than males. Multiple factors play a role in determining MIDR, nevertheless upper lip length was found to be the strongest predictor of variations in MIDR.

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Dental-skeletal dimensions in growing individuals with variations in the lower facial height

Brazilian Dental Journal ◽

10.1590/s0103-64402004000100013 ◽

2004 ◽

Vol 15 (1) ◽

pp. 68-74 ◽

Cited By ~ 10

Author(s):

Carla Enoki ◽

Carlos de Souza Telles ◽

Mírian Aiko Nakane Matsumoto

Keyword(s):

Class I ◽

Plane Angle ◽

Linear Measurements ◽

Positive Correlation ◽

Face Height ◽

Facial Height ◽

Mandibular Plane ◽

Skeletal Pattern ◽

Angular Measurements ◽

Facial Proportions

The dental and skeletal dimensions of individuals with Class I skeletal pattern in puberty were compared. Eighty patients with Class I malocclusion were selected, independent of the vertical relations (overbite) of the incisors. The sample was divided into 3 groups: normal, short and excessive lower anterior face height, based on facial proportions. The dental and skeletal measurements of the 3 groups were compared among themselves. In the angular measurements, the results showed no correlation in the mandibular plane angle. In the linear measurements, the mandibular length was significantly greater in the group of patients with short lower anterior face height, with a positive correlation among the three groups. The dentoalveolar heights of the incisors had a positive correlation among the three groups in relation to the lower anterior face height, showing that they are responsible for its variation.

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Cephalometric evaluation of adult anterior open bite non-extraction treatment with Invisalign

Dental Press Journal of Orthodontics ◽

10.1590/2177-6709.22.5.030-038.oar ◽

2017 ◽

Vol 22 (5) ◽

pp. 30-38 ◽

Cited By ~ 6

Author(s):

Shuka Moshiri ◽

Eustáquio A. Araújo ◽

Julie F. McCray ◽

Guilherme Thiesen ◽

Ki Beom Kim

Keyword(s):

Open Bite ◽

Therapeutic Modality ◽

Occlusal Plane ◽

Anterior Open Bite ◽

Lower Incisor ◽

Mandibular Plane ◽

Lateral Cephalograms ◽

Treatment Changes ◽

Extraction Treatment ◽

Lower Molar

ABSTRACT Objective: The purpose of this study was to evaluate, by means of cephalometric appraisal, the vertical effects of non-extraction treatment of adult anterior open bite with clear aligners (Invisalign system, Align Technology, Santa Clara, CA, USA). Methods: Lateral cephalograms of 30 adult patients with anterior open bite treated using Invisalign (22 females, 8 males; mean age at start of treatment: 28 years and 10 months; mean anterior open bite at start of treatment: 1.8 mm) were analyzed. Pre- and post-treatment cephalograms were traced to compare the following vertical measurements: SN to maxillary occlusal plane (SN-MxOP), SN to mandibular occlusal plane (SN-MnOP), mandibular plane to mandibular occlusal plane (MP-MnOP), SN to mandibular plane (SN-MP), SN to palatal plane (SN-PP), SN to gonion-gnathion plane (SN-GoGn), upper 1 tip to palatal plane (U1-PP), lower 1 tip to mandibular plane (L1-MP), mesiobuccal cusp of upper 6 to palatal plane (U6-PP), mesiobuccal cusp of lower 6 to mandibular plane (L6-MP), lower anterior facial height (LAFH), and overbite (OB). Paired t-tests and descriptive statistics were utilized to analyze the data and assess any significant changes resulting from treatment. Results: Statistically significant differences were found in overall treatment changes for SN-MxOP, SN-MnOP, MP-MnOP, SN-MP, SN-GoGn, L1-MP, L6-MP, LAFH, and OB. Conclusions: The Invisalign system is a viable therapeutic modality for non-extraction treatment of adult anterior mild open bites. Bite closure was mainly achieved by a combination of counterclockwise rotation of the mandibular plane, lower molar intrusion and lower incisor extrusion.

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

The Angle Orthodontist ◽

10.2319/032221-228.1 ◽

2021 ◽

Author(s):

Ahmed I. Masoud ◽

T. Peter Tsay

Keyword(s):

Open Bite ◽

Amelogenesis Imperfecta ◽

Radiographic Examination ◽

Orthodontic Appliances ◽

Plane Angle ◽

Anterior Open Bite ◽

Posterior Teeth ◽

Anterior Teeth ◽

Mandibular Plane ◽

Mandibular Plane Angle

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.

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Radiographic Comparison of Vertical Skeletal and Dental Parameters in Skeletal Open Bite

Acta Medica Marisiensis ◽

10.1515/amma-2016-0034 ◽

2016 ◽

Vol 62 (3) ◽

pp. 330-333

Author(s):

Mártha Krisztina Ildiko ◽

Pálffy Balázs Ákos ◽

Panaite Irinel

Keyword(s):

Pearson Correlation ◽

Statistical Significance ◽

Randomized Study ◽

Correlation Method ◽

Open Bite ◽

Cephalometric Analysis ◽

X Rays ◽

Facial Height ◽

Mandibular Plane ◽

Skeletal Open Bite

AbstractObjective: The purpose of our randomized study was to compare the skeletal and dental values in open bite cases using lateral cephalometric analysis and panoramic X-rays analysis and to evaluate if PR is a reliable diagnostic method in skeletal malocclusions.Methods: 21 (6 boys, 15 girls) patient with skeletal open bite were selected and both radiological examinations were performed. “Modified cephalometric analysis” on panoramic X-rays and Steiner’s cephalometric analysis was performed using AudaxCeph software. Statistical analysis was performed using the Pearson correlation method and SPSS statistical software for comparison.Results: Skeletal values like anterior facial height (AFH), angles between Frankfort horizontal and mandibular/palatal plane (ML/H and NL/H) showed no statistical significance, mandibular plane/ramus tangent angle (goniac angle) and mandibular plane/palatal plane angle (ML/RL, ML/NL) showed high or moderate (posterior facial height - PFH) significant statistical interrelation (r=0.46-0.80). Almost all dental parameters were statistically significant, from moderate to high (r=0.56-0.79). The only statistically insignificant dental parameter was the mesial cusp tip of the upper first molar/palatal plane (ms-NL) distance (r=0.32). Vertical skeletal and dental parameters on panoramic X-rays can moderately approximate lateral cephalomteric values. This means that mostly in skeletal malocclusions, panoramic X-rays cannot be used for quantitative determination of the parameters.

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Do orthopedic corrections of growing retrognathic hyperdivergent patients produce stable results?

The Angle Orthodontist ◽

10.2319/061818-460.1 ◽

2019 ◽

Vol 89 (4) ◽

pp. 552-558 ◽

Cited By ~ 4

Author(s):

Alec J. Rice ◽

Roberto Carrillo ◽

Phillip M. Campbell ◽

Reginald W. Taylor ◽

Peter H. Buschang

Keyword(s):

Post Treatment ◽

Maxillary Incisor ◽

Relative Reduction ◽

Plane Angle ◽

Miniscrew Implants ◽

Vertical Control ◽

Orthodontic Therapy ◽

Facial Height ◽

Mandibular Plane ◽

Maxillary Incisors

ABSTRACT Objectives: To determine if posterior dental intrusion produces stable orthodontic and orthopedic corrections in growing retrognathic hyperdivergent patients. Materials and Methods: The sample included 14 subjects (five males and nine females), who were 13.4 ± 0.7 years pretreatment, treated for 3.5 years, and followed for 3.6 years posttreatment. During the initial orthopedic phase, 150 g NiTi coil springs were attached to two palatal miniscrew implants (MSIs) for maxillary intrusion; two buccal mandibular MSIs were used for posterior vertical control. Full orthodontic therapy was initiated to correct the malocclusions during the orthodontic phase. Patients were recalled a minimum of 1 year posttreatment (mean 3.6 ±1.6 years). Patients were compared to matched untreated controls. Results: Relative to the untreated controls, during treatment and retention, maxillary and mandibular molars underwent 2.8 mm and 3.7 mm of relative posterior intrusion, respectively. Maxillary incisors were extruded 1.3 mm and the mandibular incisors underwent 2.9 mm of relative intrusion. Overall orthopedic changes included a reduction in the mandibular plane angle (MPA; 3.3°), an increase in SN-Pg (2.4°), an increase in S-N-B (2.1°), and a 4.3 mm relative reduction in anterior facial height. The maxillary incisors, which showed 0.6 mm of intrusion (relative to controls), was the only dental or skeletal measure to show a statistically significant between-group posttreatment difference. Conclusions: Except for maxillary incisor position, the substantial dental intrusion and associated orthopedic corrections that were produced during treatment remained stable post-treatment.

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Dental and skeletal components of Class II open bite treatment with a modified Thurow appliance

Dental Press Journal of Orthodontics ◽

10.1590/2176-9451.19.1.019-025.oar ◽

2014 ◽

Vol 19 (1) ◽

pp. 19-25 ◽

Cited By ~ 3

Author(s):

Helder Baldi Jacob ◽

Ary dos Santos-Pinto ◽

Peter H. Buschang

Keyword(s):

Class Ii ◽

Open Bite ◽

Control Group ◽

State University ◽

Plane Angle ◽

Anterior Open Bite ◽

Skeletal Changes ◽

Mandibular Plane ◽

School Of Dentistry ◽

Experimental Group

INTRODUCTION: Due to the lack of studies that distinguish between dentoalveolar and basal changes caused by the Thurow appliance, this clinical study, carried out by the School of Dentistry - State University of São Paulo/Araraquara, aimed at assessing the dental and skeletal changes induced by modified Thurow appliance. METHODS: The sample included an experimental group comprising 13 subjects aged between 7 and 10 years old, with Class II malocclusion and anterior open bite, and a control group comprising 22 subjects similar in age, sex and mandibular plane angle. Maxillary/mandibular, horizontal/vertical, dental/skeletal movements (ANS, PNS, U1, U6, Co, Go, Pog, L1, L6) were assessed, based on 14 landmarks, 8 angles (S-N-ANS, SNA, PPA, S-N-Pog, SNB, MPA, PP/MPA, ANB) and 3 linear measures (N-Me, ANS-Me, S-Go). RESULTS: Treatment caused significantly greater angle decrease between the palatal and the mandibular plane of the experimental group, primarily due to an increase in the palatal plane angle. ANB, SNA and S-N-ANS angles significantly decreased more in patients from the experimental group. PNS was superiorly remodeled. Lower face height (ANS-Me) decreased in the experimental group and increased in the control group. CONCLUSIONS: The modified Thurow appliance controlled vertical and horizontal displacements of the maxilla, rotated the maxilla and improved open bite malocclusion, decreasing lower facial height.

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Maxillary protraction and vertical control utilizing skeletal anchorage for midfacial-maxillary deficiency

Dental Press Journal of Orthodontics ◽

10.1590/2177-6709.26.6.e2120114.oar ◽

2021 ◽

Vol 26 (6) ◽

Author(s):

Kensuke MATSUMOTO ◽

Nipul TANNA

Keyword(s):

Case Report ◽

Vertical Dimension ◽

Skeletal Anchorage ◽

Plane Angle ◽

Class Iii ◽

Skeletal Class ◽

Maxillary Protraction ◽

Vertical Control ◽

Mandibular Plane ◽

Mandibular Plane Angle

ABSTRACT Introduction: The efficacy and efficiency of early treatment of skeletal Class III patients with facemask therapy are well-documented; however, very few cases for adolescents or adults were reported. Objective: The aim of this case report was to demonstrate skeletal and dental correction of a post-pubertal-growth-spurt patient whose malocclusion consisted of a skeletal Class III with slight transverse deficiency, a high mandibular plane angle, and a retrusive maxillary complex. Case report: A 13-year-5-months old Hispanic female was diagnosed as a retrognathic maxilla and mandible, a high mandibular plane angle, open bite pattern, a bilateral Angle Class I molar relationship with an anterior crossbite on the maxillary lateral incisors. A TAD-supported Haas rapid palatal expander was utilized for maxillary protraction combined with a facemask, vertical control, and maxillary molar distalization with fixed appliance. Results: The total treatment time was 26 months. An improved facial profile with maxillary lip support and more prominent cheeks was established. Adequate vertical control prevented a change in the mandibular plane angle even though facemask treatment can increase the vertical dimension. After the 18-month retention, excellent stability of the treatment results was shown. Conclusion: With skeletal anchorage and facemask treatment, orthodontists have the ability of expanding and protracting the maxilla without tipping maxillary molars buccally and without the risk of unfavorable periodontal consequences. A TAD-supported Haas rapid palatal expander allowed to control the vertical dimension and distalize molars, while minimizing undesired consequences.

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