Hybrid treatment of varied orthodontic appliances for a patient with skeletal class II and temporomandibular joint disorders:A case report and review of literature

BACKGROUND The relation between orthodontic treatment and temporomandibular disorders(TMDs)is under debate;the management of TMD during orthodontic treatment has always been a challenge.If TMD symptoms occur during orthodontic treatment,an immediate pause of orthodontic adjustments is recommended;the treatment can resume when the symptoms are managed and stabilized.CASE SUMMARY This case report presents a patient(26-year-old,female)with angle class I,skeletal class II and TMDs.The treatment was a hybrid of clear aligners,fixed appliances and temporary anchorage devices(TADs).After 3 mo resting and treatment on her TMD,the patient’s TMD symptom alleviated,but her anterior occlusion displayed deep overbite.Therefore,the fixed appliances with TAD were used to correct the anterior deep-bite and level maxillary and mandibular deep curves.After the levelling,the patient showed dual bite with centric relation and maximum intercuspation discrepancy on her occlusion.After careful examination of temporomandibular joints(TMJ)position,the stable bite splint and Invisible Mandibular Advancement appliance were used to reconstruct her occlusion.Eventually,the improved facial appearance and relatively stable occlusion were achieved.The 1-year follow-up records showed there was no obvious change in TMJ morphology,and her occlusion was stable.CONCLUSION TMD screening and monitoring is of great clinical importance in the TMD susceptible patients.Hybrid treatment with clear aligners and fixed appliances and TADs is an effective treatment modality for the complex cases.

Efficacy of invisible advancement correction for mandibular retraction in adolescents based on Pancherz analysis

BACKGROUND Mandibular retraction is the main etiological mechanism of class II malocclusion in China and the subsequent distal molar relationship can cause functional discomfort in mastication,breathing and the temporomandibular joint.The use of mandibular advancement(MA)devices has recently emerged as an adolescent mandibular retraction treatment;however,current studies regarding the effect thereof are relatively few,and there is lack of sufficient clinical support.AIM To investigate the clinical effect of invisalign MA on the treatment of mandibular retraction in adolescents.METHODS This study included 30 adolescent patients who underwent treatment with the MA appliances from December 2017 to June 2021.The lateral cephalometric data before and after treatment were collected and imported into Dolphin Imaging software.The changes were measured by linear measurement superimposed with lateral cephalometric trajectory based on the Pancherz technology.RESULTS There was no significant difference in the length and position of maxilla before and after the treatment.The position of the mandible moved 3.13 mm,the length increased 4.14 mm,the mandibular ramus length increased 4.09 mm,the body length increased 4.25 mm,and the position of the condyle moved 1.03 mm forward after treatment.Additionally,changes in the incisor sagittal position and labial inclination were observed.The position of the upper incisor point moved back 1.33 mm,without statistical difference,the inclination and tooth angle decreased by 3.44°and 4.06°,respectively;the position of the lower incisor point was moved 2.98 mm,and the inclination and tooth angle increased by 2.62°and 1.23°,respectively.Furthermore,changes in the incisor overjet and molar relationship were seen.Overjet decreased by 4.31 mm,of which 1.78 mm was due to dental factors,accounting for 41.3%of the effect as opposed to 58.7%due to skeletal factors.Molar relationship improved 3.87 mm,with 1.34 mm due to dental factors,and dental and skeletal factors were accounted for 34.6%and 65.4%of the effect,respectively.CONCLUSION For adolescent patients with mandible retraction,invisalign MA can effectively promote the mandible growth,and it was proven to be mainly due to skeletal effects.