Simple and effective method for treating severe adult skeletal class II malocclusion: A case report

BACKGROUND Severe skeletal class II malocclusion is the indication for combined orthodontic and orthognathic treatment.CASE SUMMARY A woman with a chief complaint of a protruding chin and an inability to close her lips requested orthodontic camouflage.The treatment plan consisted of extracting the right upper third molar,right lower third molar,left lower second molar,and left upper third molar and moving the maxillary dentition distally using a convenient method involving microimplant nail anchors,push springs,long arm traction hooks,and elastic traction chains.After 52 months of treatment,her overbite and overjet were normal,and her facial profile was favorable.CONCLUSION This method can be used for distal movement of the maxillary dentition and to correct severe skeletal class II malocclusion in adults.

Orthodontic-surgical treatment for severe skeletal class Ⅱ malocclusion with vertical maxillary excess and four premolars extraction: A case report

BACKGROUND Patient satisfaction with facial appearance at the end of orthodontic camouflage treatment is very important, especially for skeletal malocclusion. This case report highlights the importance of the treatment plan for a patient initially treated with four-premolar-extraction camouflage, despite indications for orthognathic surgery.CASE SUMMARY A 23-year-old male sought treatment complaining about his unsatisfactory facial appearance. His maxillary first premolars and mandibular second premolars had been extracted, and a fixed appliance had been used to retract his anterior teeth for two years without improvement. He had a convex profile, a gummy smile, lip incompetence, inadequate maxillary incisor inclination, and almost a class I molar relationship. Cephalometric analysis showed severe skeletal class Ⅱ malocclusion(A point-nasion-B point = 11.5°) with a retrognathic mandible(sella-nasion-B point = 75.9°), a protruded maxilla(sella-nasion-A point = 87.4°), and vertical maxillary excess(upper incisor to palatal plane = 33.2 mm). The excessive lingual inclination of the maxillary incisors(upper incisor to nasion-A point line =-5.5°)was due to previous treatment attempts to compensate for the skeletal class Ⅱ malocclusion. The patient was successfully retreated with decompensating orthodontic treatment combined with orthognathic surgery. The maxillary incisors were repositioned and proclined in the alveolar bone, the overjet was increased, and a space was created for orthognathic surgery, including maxillary impaction, anterior maxillary back-setting, and bilateral sagittal split ramus osteotomy to correct his skeletal anteroposterior discrepancy. Gingival display was reduced, and lip competence was restored. In addition, the results remained stable after 2 years. The patient was satisfied with his new profile as well as with the functional malocclusion at the end of treatment.CONCLUSION This case report provides orthodontists a good example of how to treat an adult with severe skeletal class Ⅱ malocclusion with vertical maxillary excess after an unsatisfactory orthodontic camouflage treatment. Orthodontic and orthognathic treatment can significantly correct a patient’s facial appearance.

Root Resorption in Anterior Open Bite Malocclusions Due to Vertical Correction: A Radiometric Pilot Study

Introduction: One of the most common risks of fixed orthodontic therapy is the evidence of root resorption post orthodontic treatment ranging from mild root blunting to severe root resorption of significant portions of the root structure. The etiology of apical root resorption is multifactorial but largely depends upon the type of orthodontic tooth movement and treatment duration. Study Objective: The primary aim of this study is to examine the association of external apical root resorption and vertical correction in anterior open bite malocclusions using panoramic radiographs for evaluation. Materials and Methods: Pre-treatment and post-treatment panoramic radiographs of 16 patients with anterior open bite malocclusions were scored to assess root resorption of anterior teeth (U/L 3-3). Initial and final root length and total tooth length for U/L 3-3 were measured on panoramic radiographs in Dolphin imaging. Results: Of the 24 pairs of measurements, 7 had a significant p-value (p Conclusions: A statistically significant amount of root resorption was observed, from pre-treatment to post-treatment radiographs. All mandibular anterior teeth except the mandibular right lateral incisors showed evidence of root resorption.

Compensation trends of the angulation of first molars:retrospective study of 1403 malocclusion cases

We investigated the compensatory trends of mesiodistal angulation of first molars in malocclusion cases. We compared differences in the angulation of first molars in different developmental stages, malocclusion classifications and skeletal patterns. The medical records and lateral cephalogrammes of 1 403 malocclusion cases taken before treatment were measured to evaluate compensation of molar angulation in relation to the skeletal jaw. The cases were stratified by age, Angle classification and skeletal patterns. Differences in the mesiodistal angulation of the first molars were compared among the stratifications. We observed three main phenomena. First,angulation of the upper first molar varied significantly with age and tipped most distally in cases aged,12 years and least distally in cases aged.16 years. The lower first molar did not show such differences. Second, in Angle Class II or skeletal Class II cases, the upper first molar was the most distally tipped, the lower first molar was the most mesially tipped, and opposite angulation compensation was observed in Class III cases. Third, in high-angle cases, the upper and lower first molars were the most distally tipped, and opposite angulation compensation was observed in low-angle cases. These data suggest that the angulation of the molars compensated for various growth patterns and malocclusion types. Hence, awareness of molar angulation compensation would help to adjust occlusal relationships, control anchorage and increase the chances of long-term stability.

Eysenck personality and psychosocial status of adult patients with malocclusion

Objective:To evaluate the personality and psychosocial status of adult malocclusion patients through the Eysenck Personality Questionnaire(EPQ) and the Symptom Checklist 90(SCL-90). Methods:The EPQ and the SCL-90 were administered to 348 adult respondents with Angle’s ClassⅠ,Ⅱ,Ⅲmalocclusion and normal occlusion.Personality and psychosocial traits were analyzed and compared among the groups.Results:Patients in Angle’s ClassⅠ,D andⅢgroups scored lower on the EPQ-E and higher on the EPQ-N than those in the normal occlusion group, whereas patients in the Class II group scored higher on the EPQ-P.The mean scores of ClassⅠ,ⅡandⅢgroups were significantly higher than those of the normal group on somatization, obsessive-compulsiveness,interpersonal sensitivity,depression,anxiety,and paranoid ideation. All SCL-90 scores were significantly positively correlated with EPQ-N.Psychoticiam and neuroticism scores of female respondents were higher than those of male respondents.The impact of education was greatest on the EPQ-P and the EPQ-E of adult personality,whereas the impact of deformity was greatest on the EPQ-N of adult personality.Conclusions:Personality and psychosocial status show differences in adult patients with ClassⅠ,Ⅱ,Ⅲmalocclusion and normal occlusion and can be influenced by gender,deformity,age and education.

Prevalence of angle class III malocclusion: A systematic review and meta-analysis

Objective: This study seeks to review current and relevant literature on global Angle class III malocclusion prevalence. Materials and Methods: The electronic databases PubMed, ISI Web of Knowledge, and the Cochrane Database of Systematic Review were searched using specific inclusion criteria to obtain applicable articles. All pertinent references were also examined for acceptability. Results: A total of 20 articles were identified using the inclusion criteria. The prevalence of Angle class III malocclusion ranged from 0 to 26.7% in different populations reported in the literature examined. Meta-regression analysis showed no statistically significant association between prevalence rates and the method of assessment, age group and year of the study. However, much of the study-to-study variation (approximately 40%) could be explained by population. Conclusion: These results suggest that the prevalence of Angle class III malocclusion varies greatly within different races and geographic regions. Chinese and Malaysian populations have a higher prevalence of Angle class III malocclusion compared to other racial groups, while Indian populations have a lower prevalence than all other racial groups examined.

Clinical Effect of Tip-Edge plus Appliance in Children with Angle Ⅱ1 Malocclusion

The effects of Tip-Edge plus appliance in the treatment of Angle Ⅱ1 malocclusion and the mechanism were investigated. Fifty-two Angle Ⅱ1 children, aged from 12.3-14.2 years, with mandibu- lar retrusion in permanent dentition were selected and treated with Tip-Edge plus appliance. Lateral cephalometric films taken before and after treatment were analyzed. The arithmetic mean and standard deviation were calculated for each variable. Paired t-test was performed to evaluate the significant treatment change. Results showed that the average treatment time was 16 months. Normal overjet and overbite were established with retroclination of upper incisors and proclination of lower incisors. U1-NA was decreased by 15.4° （P〈0.01）. ANB and Y axial angle were decreased significantly （P〈0.05） Soft tissue measurements showed that FCA and UL-E were decreased dramatically （P〈0.05）, and LL-E was increased significantly （P〈0.05）. Remarkable soft tissue change was noted after the treatment and convex facial profile changed to the straight profile. In conclusion, Tip-Edge plus technique can quickly and efficiently correct anterior bite and lateral outlook.

Pressure from the lips and the tongue in children with class III malocclusion

Objective： To discuss possible relationships between class In malocclusion and perioral forces by measuring the pressure from the lips and the tongue of children with class nI malocclusion. Methods： Thirty-one children with class In malocclusion were investigated and their perioral forces were measured at rest and during swallowing under natural head position by a custom-made miniperioral force computer measuring system. Results： The resting pressures exerted on the labial side and palatine side of the upper lett incisor, as well as the labial side and lingual side of the lower lett incisor, were 0 g/cm^2, 0 g/cm^2, 0.57 g/cm^2 and 0.23 g/cm^2, respectively. Correspondingly, the swallowing forces were 2.87 g/cm^2, 5.97 g/cm^2, 4.09 g/cm^2 and 7.89 g/cm^2, respectively. No statistical difference between muscular pressure and gender existed. During swallowing, the lingual forces were significantly higher than the labial forces （P〈0.01）, however, at rest there was no significantly different force between these two sides. Compared to the normal occlusion patients, children with class Ⅲ malocclusion had lower pedoral forces. The upper labial resting forces （P〈0.01）, the lower labial resting forces （P〈0.05） and all the swallowing pressures from the lips and the tongue （P〈0.01） showed statistical differences between the two different occlusion conditions. Meanwhile, no significant difference was found for the resting pressure from the tongue between class Ⅲ malocclusion and normal occlusion. Conclusion： Patients with class Ⅲ malocclusion have lower perioral forces and this muscle hypofunction may be secondary to the spatial relations of the jaws. The findings support the spatial matrix hypothesis.

The Correction of Class Ⅱ,Division 1 Malocclusion with Bionator Headgear Combination Appliance

The purpose of this study was to evaluate skeletal and dental effects of bionator headgear combination appliances on patients in development period with Class Ⅱ, division 1 malocclusion. The comparison of computerized X-ray cephalometric measurements between the 26 treated children and 26 untreated children was made.The results showed that ANB angle was significantly reduced and horizontal mandibular growth development tended to be normal in the treated group.It was suggested that the bionator headgear combination appliance can restrain the maxillary growth early and promote the forward mandibular growth which contribute the functional jaws correction.

Successful Treatment of Postpeak Stage Patients with ClassⅡ Division 1 Malocclusion Using Non-extraction and Multiloop Edgewise Archwire Therapy: A Report on 16 Cases

Aim To determine cephalometrically the mechanism of the treatment effects of non-extraction and multiloop edgewise archwire （MEAW） technique on postpeak Class Ⅱ Division 1 patients. Methodology In this retrospective study, 16 postpeak Class Ⅱ Division 1 patients successfully corrected using a non-extraction and MEAW technique were cephalometrically evaluated and compared with 16 matched control subjects treated using an extraction technique. Using CorelDRAW software, standardized digital cephalograms preand post-active treatments were traced and a reference grid was set up. The superimpositions were based on the cranial base, the mandibular and the maxilla regions,and skeletal and dental changes were measured. Changes following treatment were evaluated using the paired-sample t-test. Student＇s t-test for unpaired samples was used to assess the differences in changes between the MEAW and the extraction control groups. Results The correction of the molar relationships comprised 54% skeletal change （mainly the advancement of the mandible） and 46% dental change. Correction of the anterior teeth relationships comprised 30% skeletal change and 70% dental change. Conclusion The MEAW technique can produce the desired vertical and sagittal movement of the tooth segment and then effectively stimulate mandibular advancement by utilizing the residual growth potential of the condyle.

Distalization of maxillary molars for Class Ⅱ malocclusion with Chinese Ni-Ti coil-springs appliance

Objective: To evaluate the effects of the Chinese Ni-Ti coil-springs appliance on distalization of maxillary molars and the reciprocal effects on the anchorage teeth. Methods:Twenty-four adolescent patients(12 boys,12 girls) with Class Ⅱ malocclusion were selected and the coil-springs appliance was used during the treatment. Pre- and postdistalization lateral cephalometric radiographs were analyzed and compared. Results: The average time for the correction of Class Ⅱ molar relationship was 4.6 months. And the mean distance of molar distalization was 4.4 mm. The Chinese Ni-Ti coil-springs also demostrated less tipping and better bodily movement of maxillary molars. Conclusion: This study suggests that the Chinese Ni-Ti coil-springs appliance distalizes the upper molar significantly, while there is no remarkable loss of anchorage because of patients’ wearing headgear with J hooks at night and Class Ⅱ elastics in the day time.

Malocclusion May Be Attributed to Variation among 10 Genes

Introduction: The goal of this study was to utilize physical characteristics instead of placing subjects in arbitrary diagnostic categories to test for associations with genetic variants. Methods: Forty-four single nucleotide polymorphisms were tested for association with specific cephalometric measurements in thirty-nine University of Pittsburgh Dental Registry and DNA Repository orthodontic subjects. Cephalometric measurements included an evaluation of FMA, a Wits appraisal, and a Steiner’s ANB analysis. Genetic markers were genotyped using polymerase chain reaction and Taqman chemistry. Chi-square and Fischer’s exact tests (α = 0.05) were used in investigation of overrepresentation of marker alleles. Samples were divided into groups based upon having an FMA, Wits, or ANB measurement above or below the mean of the cohort studied. Secondary analysis was done for sex and ethnicity to determine their effect on FMA, Wits, or ANB. Results: An association between FMA measurements was discovered in the following genes: ACTN3, CASP4, ESR1, FGF13, KRT7, and PITX2. An association between Wits measurements was discovered in the following genes: ACTN2, BTBD11, CASP4, FGF3, and FGF10. No associations were found with ANB. Conclusions: Genetic markers in several genes at different loci may contribute to craniofacial deformities in humans. This approach of using physical measurements may be an advantage to placing patients in arbitrary diagnostic categories.

Prevalence of Malocclusions and Normative Orthodontic Treatment Need Using IOTN Index for Patients in Yalgado Ouédraogo Teaching Hospital

Introduction: The assessment of health care needs must be reproducible, independent of the operator, hence the use of indexes like the Index of Orthodontic Treatment Need (IOTN). The aim of this study was to assess both, the prevalence of malocclusions among patients received in the Dental Surgery Unitat Yalgado Ouédraogo Teaching Hospital and their care needs according to IOTN index. Materials and Methods: It is a prospective, cross-cutting diagnostic study of malocclusions at Yalgado Ouédraogo Teaching Hospital (CHUYO), conducted from January 1 to December 31, 2016. The examiner with an examination tray records on the 12- to 16-year-old patients’ medical recorded, the variables based on the polychromatic pictures series, the IOTN rule, and the dental health component table. Results: On the whole, 81 patients were included, with 60.5% of girls and 39.5% of boys. 16- and 12-year-old patients were dominant. The average age was 14.05 years old. Various types of malocclusions were encountered. The need for orthodontic care was 56.8%. For 14 patients, 17.28%, their aesthetic component score is higher than the assessment made by the orthodontist. Conclusion: Aesthetics was an important factor in the need for orthodontic care. The aesthetic deficit entails a psychological impact that should be taken into account in the assessment of care needs.

Orthopedic Correction of Class III Malocclusions during Mixed Dentition

Objective: The aim of this study was to compare the effect of face mask (FM) and Maxillary Bite Block (BB) in skeletal class III patients during mixed dentition with control group of the same class during their growth. Materials & Methods: Forty-two patients were selected based on clinical and cephalometric examination, with age ranged from 6 to 8 years according to definite criteria. Patients were classified into two groups: treated and control groups;all records were taken for every patient. Lateral cephalometric films were traced before and after treatment and analyzed. Results: Intermaxillary skeletal variables showed significant improvement in the treated group with an average increase of ANB angle (Maxilo mandibular difference angle) of 3.14°and an average increase in wits appraisal 2.15 mm. Conclusion: The study concluded that, treatment with face mask and maxillary bite block induced significant dentoskeletal changes.

Nonsurgical orthodontic treatment for an adult with skeletal open bite, class III malocclusion and posterior crossbite: A case report

Class III malocclusion associated with skeletal anterior open bite pattern in adults can be a challenging orthodontic problem, especially for the nonsurgical treatment. Conventionally, several treatment alternatives are available such as tooth extraction, molar intrusion, and absolute anchorage system or orthognathic surgical correction. Although correction with surgery may be the most effective and stable way, many patients refused surgical treatment plan because of the costs and traumas it may bring. We reported a nonsurgical orthopedic treatment of 22-year-old male with severe skeletal anterior open bite, dental Class III malocclusion, posterior crossbite and a high mandibular plane angle. The patient refused surgery and extraction. So we formulated a treatment plan consisting of using rapid palatal expansion appliance to expand the maxilla, standard edgewise brackets to align the teeth, Class III elastics to correct the canines, premolars, and molars relationship, reverse curve of the nickel-titanium wire combined with anterior vertical elastics to intrude molars and correct open bite. In this case, without suffering of surgery, the posterior crossbite was ideally corrected, and ideal overjet and overbite relationships and functional occlusion were all achieved. The patient obtained satisfactory occlusal as well as functional and stable results.

Effect of Malocclusion on Quality of Life among Persons Aged 7 - 25 Years: A Cross-Sectional Study

Background: The theory of Oral Health Related Quality Of Life (OHRQOL) has manifold qualities. It endeavors to address social and/or emotional concerns as well as any symptoms or functional problems related to the teeth and jaws from the patients view point. The difficulty of utilizing any one standard evaluation tool to determine how the patient feels about problems with malocclusions or arising from them, led to the development of this construct/theory. Aim: To evaluate the impact of malocclusion on the socio-functional and psychological wellbeing of persons 7 - 25 years old. Method: 100 patients within the ages of 7 - 25 years who visited the Orthodontics Unit of the Oral Health Directorate of Komfo Anokye Teaching Hospital (KATH), Kumasi, were conveniently sampled and surveyed. Participants were given questionnaires to assess the effects of malocclusion on their Oral Health Related Quality of Life and also to determine if their educational status had any influence on the impact of malocclusion on their oral health related quality of life. Results: The modal age of the participants was 10 - 15 years with 40% as it frequency followed by 7 - 9 years while the age with least frequency was 16 - 25 years which stood at 22.0%. 28 respondents reported negative effects on their functional domain. 71 of the participants reported negative effects on psychological well-being and 49 of them reported negative effects on social well-being. Conclusion: Malocclusion has an overall negative impact on Oral Health Related Quality of Life and its related purviews. It was observed to be highest for the psychological discomfort domain and the lowest in the functional well-being domain.

A Case of Amniotic Band Sequence Complicated by Severe Skeletal Malocclusion

This clinical report describes the management of a patient who was diagnosed with amniotic band sequence (ABS) complicated with severe skeletal malocclusion, associated with severe muscle weakness. The patient was a 23-year-old male who underwent treatment in our hospital to improve chewing, phonation, and swallowing difficulties caused by severe abnormality of the maxillofacial skeleton. We evaluated chewing, swallowing and language functions preoperatively, and started muscle function and oral rehabilitation therapy. We performed 2-jaw osteotomy after preoperative orthodontic treatment. The patient continued with postoperative orthodontic treatment and oral rehabilitation. Postoperatively, the patient showed improved maxillofacial morphology, but was unable to attain sufficient improvement of masticatory and language functions due to atrophy and poor development of the masticatory muscles. These results suggest that obtaining sufficient therapeutic effect on oral functions is not possible if the masticatory muscles are not sufficiently strong due to atrophy or hypoplasia.

Comprehensive management of malocclusion in maxillary fibrous dysplasia:A case report

BACKGROUND Fibrous dysplasia(FD)is a developmental hamartomatous bone disease characterized by a blend of fibrous and osseous entities.Though rarely malignant,the tumor can vary from being small and asymptomatic,to a fairly large sized lesion,progressing gradually,compromising occlusion and facial esthetics.Treatment approach depends on the stage of skeletal maturity.It primarily involves surgical management for stabilizing the disease process.Post-surgical comprehensive dental treatment is necessary for restoring form and function of the jaws and teeth.This article describes comprehensive orthodontic management of severe malocclusion in a surgically operated case of FD maxilla.CASE SUMMARY A 19-year female presented with a chief complaint of excessive gingival display when smiling.Dental history included swelling of gums around the upper right front teeth,diagnosed at the age of 15 as FD of the right anterior maxillary segment and treated with surgical recontouring of the dysplastic bone.The clinical and radiological examinations showed adequate post-surgical healing.The surgically treated dysplastic area presented with right canting of the maxillary anterior occlusal plane.The maxillary teeth were torqued palatally,with the root of the right maxillary canine exposed clinically.We discuss sequential management of the associated malocclusion with comprehensive fixed orthodontics,along with special precautions taken to prevent reactivation of the quiescent and healed lesion.CONCLUSION The adequate healing of fibro-dysplastic bone post-surgery must be allowed before initiating orthodontic tooth movement in the dysplastic bone.Periodic follow-ups are needed to monitor stability of occlusion and any relapse of the lesion.

以舌肌功能训练为主导的干预模式在错[牙合]畸形患者早期矫正中的应用价值

【目的】探讨以舌肌功能训练为主导的干预模式在错[牙合]畸形患者早期矫正中的应用价值。【方法】选取2018年11月至2021年2月青岛大学附属青岛市中心医院收治122例错[牙合]畸形患者,根据家属意愿将其分为观察组(n=70)和对照组(n=52)。对照组给予常规干预模式,观察组在常规干预基础上给予舌肌功能训练为主导的干预模式。比较两组患者干预前后咬合功能和口腔相关生活质量。【结果】干预后,两组[牙合]力不对称指数(AOF)、[牙合]接触面积不对称指数(AOA)、[牙合]干扰指数(OII)均低于干预前,[牙合]接触点数(NOC)高于干预前,且观察组AOF、AOA、OII低于对照组,NOC高于对照组,差异有统计学意义(P<0.05)。干预后,两组口腔健康影响程度量表(OHIP-14)各领域评分及总分均低于干预前,且观察组低于对照组,差异有统计学意义(P<0.05)。【结论】于错[牙合]畸形患者早期矫正中开展以舌肌功能训练为主导的干预模式,能有效改善患者咬合能力,对提高患者口腔相关生活质量具有重要意义。

正畸治疗与颞下颌关节紊乱病的研究进展

颞下颌关节紊乱病(temporomandibular disorders,TMD)是一组影响颞下颌关节、咀嚼肌系统、牙齿咬合甚至全身多种结构的病症,因其病因机制不清、临床表现复杂,使其成为口腔医学领域的临床难点之一。TMD是正畸初诊患者中的常见症状之一,正畸医生在临床工作中不可避免地会接触到相关问题。因此正畸医生需要积极面对并通过深入地学习,更加深刻地理解TMD的分类、诊断及其发病机制并学习相关的治疗手段,积极应对临床中的TMD相关问题,并努力在TMD的多学科联合治疗中起到更加重要的作用。