Mandibular incisor inclination and gingival recession after treatment with the Jasper Jumper: a 10-year follow-up

Objective To evaluate the long-term outcomes of Class II treatment with the Jasper Jumper appliance and comprehensive orthodontic treatment concerning inclination of the mandibular incisors and gingival recession. Methods Sixteen patients with Class II malocclusion at a mean age of 12.54y (SD = 1.17) were treated with the Jasper Jumper appliance and comprehensive orthodontic treatment. The mean treatment time was 2.05y (SD = 0.21). Dental records were taken before (T1), after treatment (T2) and 11.90y (SD = 0.48) after debonding (T3). The frequency of gingival recession, clinical crown height and mandibular incisor position were evaluated using intraoral photographs, digital models and lateral cephalograms. Interphase changes were evaluated using dependent t and McNemar’s tests. Correlation between clinical crown height and final position of the mandibular incisors was evaluated using Pearson correlation test (P < 0.05). Results The frequency of gingival recessions increased over time and was observed in 6 (9.4%), 12 (18.8%) and 24 (37.5%) of the mandibular incisors at T1, T2 and T3, respectively. A significant increase in labial inclination and protrusion of the mandibular incisors was observed between T1 and T2 interval. The clinical crown height significantly increased in the follow-up period (T3–T2) and in the complete observation time (T3–T1). There was no correlation between the amount of labial inclination and protrusion of the mandibular incisors and clinical crown height for all time intervals. Conclusion No significant correlation between the amount of labial movement of the mandibular incisor and clinical crown height increase was found.

Smart distalization of the upper arch with an easy, efficient and no-compliance procedure

In conventional Class II treatment, distalisation of the maxillary arch usually requires multiple phases of tooth movement during which anchorage loss can occur. In order to solve this issue, a rational and simple technique has been developed. Instead of using intraoral distalisers along with palatal mini-implants, Ni-Ti superelastic loops are used to obtain molar distalisation while buccal interradicular miniscrews (BIM), preferably placed between the roots of upper premolars, supply the necessary anchorage. Once the distalisation of molars and second premolars is performed, miniscrews are placed between the roots of first molars and second premolars after removing the previous miniscrews. Elastic chains or tie-backs, which go from the new miniscrews to the hooks of a 0.019×0.025-inch stainless-steel archwire, produce the retraction of incisors, canines and first premolars with optimal control of anchorage. Clinical cases are shown to illustrate the technique.

Long Term Stability of Skeletal Class II Treatment with Modified Bionator Followed by Fixed Appliance - A Case Report

The most prevalent malocclusion seen in day-to-day practice is Class II division 1 malocclusion. Most patients with malocclusions in class II division 1 have an underlying skeletal difference between the maxilla and the mandible. The treatment of skeletal class II division 1 depends on the patient's age, the ability of growth potential, the seriousness of malocclusion, and the patient's adherence to treatment. Myofunctional equipment can be successfully used to treat rising patients with deficient mandible class II division 1 malocclusion. This case report shows a focus on Class II Division 1 care due to mandibular deficiency using modified bionator appliances accompanied by fixed mechanotherapy with growth modification approach. Class II Division 1 is one of the most widely encountered form of malocclusion in human populations. The common characteristic of Class II Div 1 malocclusion in growing children is mandibular retrusion, according to Dr. James McNamara.1 The prevalence of Skeletal Class II malocclusion is 15 % of the world's total population. Underlying difference between Maxillary & Mandibular jaw makes the Class II Div 1 malocclusion more complex than it appears. It’s due to a contribution of only maxilla, or only mandible, or a combination of both. The treatment of Class II division 1 relies on the patient's age, growth ability, degree of malocclusion, and patient compliance with therapy.1,2 The cases with retrognathic mandible must be addressed by altering the direction & amount of mandibular growth by using functional appliances.3 The Bionator is a tooth-borne appliance that significantly changes dental and skeletal component of the face through a repositioning of mandible in a more protrusive & balanced way, selective eruption of teeth and profile enhancement.4-7 The Balters Bionator was first introduced in 1960 by Wilhelm Balters as a functional appliance & still one of the most widely used removable appliances for correction of mandibular retrognathism.8 In functional orthopaedics, all aspects of genetically determined individual growth patterns are important, most particularly time, potential, and growth direction. Although during the prepubertal phase there is limited skeletal development, substantial growth occurs during puberty, but with great individual variation. To prevent damage to erupting teeth and to normalize jaw growth, early functional orthopaedic intervention in the prepubertal phase is used.9,10,11 The purpose of this case report is to illustrate how satisfactory results were obtained in the treatment of Class II division 1 malocclusion with modified Bionator in young patients. The positive facial, dental and cephalometric improvements are also illustrated, with the aid of proper diagnosis, amplified by excellent patient cooperation in case selection.

Does daily wear time of Twin Block reliably predict its efficiency of class II treatment?

Purpose The objective of this study was to investigate how daily wear time (DWT) influences class II malocclusion treatment efficiency. Materials and methods The study group consisted of 55 patients (mean age 10.4 years) diagnosed with a class II/1 malocclusion. Twin block appliances, with built-in Theramon® microsensors (MC Technology, Hargelsberg, Austria) to monitor patients’ cooperation (daily wear time assessment), were used for treatment. Cephalograms were taken and the following initial and final measurements were compared: Co-Gn, Co-Go, Co-Olp, Pg-Olp, WITS, SNA, SNB, ANB, Co-Go-Me, overjet, molar and canine relationships. The Shapiro–Wilk test, Wilcoxon signed-rank test, Student’s t-test, Levene’s test, Mann–Whitney U test, Kruskal–Wallis test, χ2 test, and Spearman’s rank correlation coefficient with p < 0.05 set as the statistical significance level were used to determine the correlation of the outcomes with DWT; a ROC (receiver operating characteristic) curve was calculated to illustrate diagnostic ability of the binary classifier system. Results DWT was very highly positively correlated with change of the Pg-Olp parameter and highly with an improvement in the ANB, SNA, and SNB angles, an increase in the WITS parameter and an increase in Co-Gn distance. DWTs < 7.5 h correlated with significantly less improvement of the investigated variables. However, DWT > 7.5 h did not significantly correlate with the improvement of the overjet and most of the linear parameters in the mandible. The ROC curve and its AUC (area under curve) allowed the determination of a DWT of 7 h and 48 min to be capable of establishing a class I relationship with 83% probability. Conclusions Class II treatment efficiency was influenced by DWT; an 8 h threshold value had an 83% probability of establishing a class I relationship.

Perubahan harmoni wajah pasca perawatan kelas II skeletal dengan pencabutan dua premolar satu atas menurut analisis Arnett dan BergmanChanges in facial harmony after skeletal class II treatment with extraction of two maxillary first premolars based on Arnett and Bergman analysis

Pendahuluan: Arnett dan Bergman (1999) membuktikan bahwa perawatan ortodonti, analisis jaringan lunak wajah, diagnosis dan rencana perawatan memiliki parameter nilai harmoni sebagai kunci penetapan estetika wajah. Perawatan maloklusi klas II skeletal disertai proganotisme maksilaris umumnya dilakukan dengan pencabutan dua premolar satu atas untuk mengkoreksi profil wajah pasien. Tujuan penelitian untuk menganalisis perubahan nilai harmoni wajah pasca perawatan maloklusi kelas II dengan pencabutan premolar satu atas menurut analisa Arnett dan Bergman. Metode: Jenis penelitian analitik observasional dengan teknik pengambilan sampel purposive sampling. Sampel penelitian 72 foto sefalometri lateral maloklusi kelas II skeletal sebelum dan setelah perawatan ortodonti. Penilaian harmoni jaringan lunak dibagi menjadi 4, yaitu harmoni intramandibular, harmoni antar rahang, orbita ke rahang dan keseimbangan wajah. Data menggunakan Shapiro Wilk menunjukkan tidak berdistribusi normal. Uji yang digunakan Shapiro Wilk dan analisis Spearman. Hasil: Terdapat perubahan harmoni intramandibular dan keseimbangan wajah pada maloklusi kelas II skeletal dengan pencabutan premolar satu atas sebelum dan setelah perawatan (p=0,025;p=0,032). Tidak terdapat perubahan nilai harmoni antar rahang dan orbita ke rahang pada maloklusi kelas II skeletal dengan pencabutan premolar satu atas sebelum dan setelah perawatan. Ada pengaruh besar retraksi gigi insisivus terhadap nilai harmoni wajah sebelum dan setelah perawatan pada perawatan kelas II dengan pencabutan dua premolar atas (p= 0.001). Simpulan: Perawatan maloklusi kelas II skeletal dengan pencabutan dua premolar satu atas memiliki hubungan antara besar retraksi dengan perubahan nilai harmoni wajah berdasarkan analisa Arnett dan Bergmann. Kata kunci: Maloklusi kelas II skeletal, pencabutan dua premolar pertama atas, nilai harmoni wajah. ABSTRACT Introduction: Arnett and Bergman (1999) have proved that orthodontic treatment, facial soft tissue analysis, diagnosis, and treatment plan have parameters of harmony values as the key to determining facial aesthetics. Treatment of skeletal class II malocclusion with maxillary prognathism is generally performed by extracting two maxillary first premolars to correct the patient’s facial profile. This study was aimed to analyse changes in the facial harmony values after class II malocclusion treatment with the extraction of the maxillary first premolar following Arnett and Bergman’s analysis. Methods: This research was observational analytic with a purposive sampling technique. The study sample was 72 images of skeletal class II malocclusion lateral cephalometry before and after orthodontic treatment. Assessment of soft tissue harmony was divided into four, namely intramandibular harmony, intermaxillary harmony, orbital to jaw harmony, and facial balance. Data was not normally distributed, as resulted from Shapiro Wilk analysis. The analysis in this study was conducted using Shapiro Wilk and Spearman’s analysis. Results: There were changes in intramandibular harmony and facial balance in skeletal class II malocclusion with the maxillary first premolar extraction before and after treatment (p=0.025 and p=0.032, respectively ). There was no change found in the value of intermaxillary harmony and the orbital to the jaw harmony in skeletal class II malocclusion with extraction of the maxillary first premolar before and after treatment. There was a high effect of incisor retraction on the facial harmony values before and after treatment in class II treatment with extraction of two maxillary premolars (p=0.001). Conclusion: Treatment of skeletal class II malocclusion with extraction of two maxillary first premolars has a relationship between the magnitude of retraction and changes in facial harmony values based on Arnett and Bergmann’s analysis.Keywords: Class II skeletal malocclusion, extraction of two maxillary first premolar, facial harmony.