Pharyngeal dimensional changes in class II malocclusion treatment when using Forsus® or intermaxillary elastics - An exploratory study.

OBJECTIVE: Pharyngeal airway obstruction can facilitate some forms of sleep disorder breathing (SDB) in susceptible children, especially in those having class II malocclusion. Changes in the anatomic areas surrounding the pharyngeal region during orthodontic treatment could hypothetically impact the pharyngeal airway dimensions. Management of a class II malocclusion on a growing individual with either intermaxillary elastics or different removable or fixed class II appliance designs have been proposed over the last century. The objective of this retrospective exploratory cohort study is to investigate to what extent the class II malocclusion treatment with either intermaxillary elastics (IME) or Forsus® fatigue resistance device (FFRD) leads to changes in oropharyngeal airway dimensions. MATERIALS AND METHODS: Twenty-nine patients diagnosed as class II with an average age of 12.7years were included in this study, (11 males, 18 females). The sample was divided into group 1: IME and group 2: FFRD. CBCT's scans before (T1) and after treatment (T2) were obtained and analysed using Dolphin software. Reliability was obtained using Intraclass Correlation Coefficient (ICC). Descriptive statistics, ANOVA and paired t-test were used for analysis. RESULTS: Intra-rater reliability test was excellent in all measurements for both groups. There were no statistically significant differences in pharyngeal airway dimensions between both groups (P=0.919). A statistically significant correlation was found for sex, where male patients had the highest increase in oro-space area (ORS), and in oropharyngeal volume. Children under 14-year-old in IME group showed statistically negative correlation for sub-mandibular (SM) and for ORS, meaning the younger the greatest increase. Additionally, individuals younger than 14years had a statistically significant increase in the vertical dimension. CONCLUSIONS: Both orthodontic treatment approaches appear to be associated with a similar increase in oropharyngeal airway dimensions. Male patients under 14-year-old had a greater significant increase compared to female patients and older children. Normal pharyngeal dimensions changes were not accounted for.

Comparison between Classic Twin-block and a Modified Clear Twin-block in Class II, Division 1 Malocclusions: A Randomized Clinical Trial.

AIM: The aim of this study was to compare dentoskeletal effects and patient's satisfaction with a modified twin-block (clear twin-block) and classic twin-block. MATERIALS AND METHODS: A total of 62 patients with skeletal class II malocclusion contributing to mandibular retrognathism with a minimum of 4 mm overjet, the FMA angle between 20 to 25 degree and being in stage 2 to 3 of cervical vertebral maturation participated in this study. Subjects were randomized in 1:1 ratio to classic and clear twin-block. Lateral cephalograms were taken at two stages-Pre- and post-treatment (when the overjet reduced to 1 to 0 mm). All the measurements were done with Dolphin software version 10.5. Four months after the start of the treatment the patients were asked to fill the questioners regarding their compliance from the appliances. RESULTS: Both classic and clear twin-block groups showed mandibular advancement without statistically significant difference between them. However, SNB angle increased slightly more in clear group than the classic one. "Headgear effect" is not statistically noticeable in both groups. However, SNA angle decreased slightly more in classic group. Increased in lower incisors proclination was happening in both groups, but in a clear group, this increase was significantly less. Overbite reduction could be seen in both groups with significantly more reduction in the classic group. CONCLUSION: Increase in lower incisors proclination was less in clear group than the classic one. Overbite reduction was more in the classic group than the classic one. CLINICAL SIGNIFICANCE: Clear twin-block is more beneficial in skeletal class II patients with proclined lower incisors and vertical growth pattern.

Effect of removable functional appliances on mandibular length in patients with class II with retrognathism: systematic review and meta-analysis.

BACKGROUND: Orthopedic functional devices, are used to improve mandibular length in skeletal class II patients. However, the orthopedic functional device with the best effect to increasing the mandibular length, has not been identified before. Thus, the aim of the present investigation was to evaluate Randomized Controlled Trials (RCT), to determine the best functional appliance improving mandibular length in subjects with retrognathism. METHODS: A systematic review and meta-analysis was performed, including studies published and indexed in databases between 1966 and 2016. RCTs evaluating functional appliances' effects on mandibular length (Condilion-Gnation (Co-Gn) and Condilion-Pogonion (Co-Po)), were included. Reports' structure was evaluated according to 2010 CONSORT guide. The outcome measure was distance between Co-Gn and/or Co-Po after treatment. Data were analyzed with Cochran Q Test and random effects model. RESULTS: Five studies were included in the meta-analysis. The overall difference in mandibular length was 1.53 mm (Confidence Interval (CI) 95% 1.15-1.92) in comparison to non-treated group. The Sander Bite Jumping reported the greatest increase in mandibular length (3.40 mm; CI 95% 1.69-5.11), followed by Twin Block, Bionator, Harvold Activator and Frankel devices. CONCLUSIONS: All removable functional appliances, aiming to increase mandibular length, are useful. Sander Bite Jumping was observed to be the most effective device to improve the mandibular length.

Kooperation von Kieferorthopädie, Kieferchirurgie und Prothetik bei der umfassenden Rehabilitation von DysgnathiepatientInnen. Teil 2: Fallbeispiel Klasse-II-Malokklusion, Tiefbiss, Hypodontie.

Dental aplasia of heterogenous etiology may cause jaw growth disturbance, malocclusion, esthetic discontent and psychosocial impairment. By a case report of a young patient suffering from hypodontia, class II malocclusion and a deep bite the intricate interdisciplinary diagnosis- and treatment-protocol targeting the functional and esthetic rehabilitation is illustrated.

A hinged two-part partial denture used in conjunction with severely tilted teeth: a case report.

A two-part sectional denture can be a useful treatment option when the presence of severe hard tissue undercuts compromises the provision of a satisfactory conventional prosthesis. This article presents a case report illustrating the effective use of a hinged two-part denture in restoring a mandibular Kennedy Class IV edentulous area. A sectional denture approach was selected because of severe proximal and lingual undercuts.

The influence of functional therapy on facial and dental structures. Case presentation.

In the era of fixed appliances, some orthodontic practitioners seem to forget about functional therapy. Functional appliances are the only capable of orthopedically changes during the growth spurt. Activators of all types, classic or opened, are elected appliances in growing subjects with class II/1 anomalies. The appropriate case selection, along with patient compliance, lead to improved facial aesthetic and dental occlusion, at affordable prices. With this case presentation, we want to show our protocol in the management of these cases.

An implant-supported overdenture design with a horizontal path of insertion.

The rehabilitation of the atrophic maxilla by means of implant-supported prostheses cannot always be achieved with fixed prostheses because of anatomic, esthetic, or economic issues, so for some patients the treatment of choice is a removable prosthesis. This article analyzes a new design for implant-supported overdentures with horizontal or faciolingual insertion. Its retention system is based on frictional forces or stepped interlocking horizontal surfaces and is appropriate for patients with skeletal Class II or III relationships with severe maxillary atrophies. The design facilitates implant-prosthetic hygiene and improved esthetics in patients with nonparallel implants by hiding abutment screws.

Virtual surgical planning for treatment of severe mandibular retrognathia with collapsed occlusion using contemporary surgical and prosthodontic protocols.

PURPOSE: To meet functional and esthetic needs in an older adult for treatment of complex skeletal and dentoalveolar deformities using contemporary surgical and prosthodontic protocols. METHODS: An older adult with dentoalveolar complex and skeletal deformity (mandibular retrognathia) was treated by a combination of virtual planning and current surgical and prosthodontic protocols. Treatment planning steps and sequencing are presented. RESULTS: Skeletal, soft tissue, and dental harmonies were attained without biological or mechanical complications. Definitive oral rehabilitation was completed with a maxillary complete denture and a mandibular metal ceramic fixed implant-retained prosthesis. CONCLUSIONS: A surgical and prosthodontic team approach in combination with technologic advances can predictably optimize esthetic and functional outcomes for patients with complex skeletal and dentoalveolar deformities.

Are there differences on tooth movement between different sectional canine retractors?

The aim of this study was to compare the effects of two retraction springs, demonstrating differences in reactivation and constancy of force, on tooth movement during canine distalization. Upper and lower canines of 16 patients (9 females, 7 males; mean age 14.6±1.7 years) with Angle Class I or II malocclusion were included in the study. Left upper and lower canines were distalized using Poul Gjessing (PG) retractors, whereas right canines of the same patients were distalized using Hybrid retractors. Angular and linear measurements were performed on lateral cephalometric radiographs and dental models taken prior to and at the end of canine distalization. Paired Samples t-test, Repeated Measures of Analysis of Variance and Greenhouse-Geisser tests were used for statistical analysis. The mean rates of canine distalization in PG retractors were 1.03 and 0.88 mm/months and 1.13 and 0.93 mm/months for Hybrid retractors for upper and lower canines, respectively. No significant differences were detected in the rate of canine distalization, sagittal and vertical movement of canines, and first molars between retractors or arches. Despite the differences in reactivation and constancy of the forces between PG and Hybrid retractors, both revealed similar canine distalization, distal tipping, rotation, and anchorage loss of molars. As a clinical point of view, Hybrid retractors could provide more benefits due to fewer activation requirements.

Class II division 2 treatment--does skeletal maturity influence success and stability?

AIM: To analyze the influence of skeletal maturity on Herbst multibracket (MB) treatment of Class II division 2 malocclusions and its stability. MATERIAL AND METHODS: A total of 37 patients fulfilled the inclusion criteria (Class II division 2, fully erupted premolars and canines, Class II molar relationship ≥1/2 cusp widths bilaterally or 1 cusp width unilaterally, retention period ≥24 months). According to pretreatment hand wrist skeletal maturity the subjects were assigned to the groups EARLY (n=9), LATE (n=14) and ADULT (n=14). Lateral headfilms (T1: before treatment, T2: after Herbst MB treatment, T3: after retention) were analyzed using the Sagittal-Occlusal analysis and standard cephalometrics. RESULTS: During Herbst MB treatment (T2-T1), significant (p<0.001) molar relationship improvement was seen in all groups (EARLY: 3.6 mm; LATE: 3.7 mm; ADULT: 3.2 mm). The amount of skeletal effects contributing to molar correction varied markedly between the groups (EARLY: 19%; LATE: 62%; ADULT: 31%). Improvement (p<0.01) was also seen for ssNB angle (EARLY: 1.8°; LATE: 1.8°; ADULT: 0.9°) and overbite (EARLY: 3.3 mm; LATE: 4.5 mm; ADULT: 4.3 mm). During retention (T3-T2), minimal changes of molar relationship (<0.2 mm) and ssNB angle (<0.5°) were seen in all groups. Also the overbite relapsed (EARLY: 0.5 mm; LATE: 1.0 mm; ADULT: 1.1 mm) only to a clinically irrelevant extent. CONCLUSION: Irrespective of skeletal maturity, Herbst MB treatment of Class II division 2 malocclusions showed to be successful and stable. However, the LATE group showed the highest amount of skeletal effects contributing to the correction of the molar relationship.

Changes in soft-tissue profiles after treatment of class II/1 patients with bite-jumping appliances.

We performed this study to describe changes in the soft-tissue profile after orthodontic treatment with Tränkmann's bite-jumping appliances. A total of 69 patients thus treated were compared to a control group of 36 age-matched patients based on cephalograms. Statistical analysis included mean values, standard deviations, t-tests, and Pearson's correlation testing. Highly significant (p<0.001) changes in total profile angle (N'-Ns-Pog') were observed over the course of treatment. Furthermore, a mildly significant (p<0.05) correlation with SNA angles was noted. Changes in the soft-tissue profile angle (N'-Sn-Pog') were moderately significant (p<0.001). The profile angles of the upper lip (Sn-SS-Ls) and lower lip (Pog'-Sm-Li) did not reveal significant changes. We observed highly significant (p<0.001) findings in the esthetic line (NsPog') advancement relative to the Ls and Li landmarks and in increases in lower-face height. Midface heights remained unchanged. Our results indicate that treatment with bite-jumping appliances results in increased facial convexity, advancement of the esthetic line, and increased lower-face height. The cumulative effects of growth and treatment do not, however, appear pronounced enough to result in a preference for or against treatment with a bite-jumping appliance.

Therapeutic changes in the occlusal plane inclination using intermaxillary elastics.

AIM: The goal of the study was the evaluation of opposing intermaxillary elastics concerning potential change in the occlusal plane inclination relative to relevant vertical structures. PATIENTS AND METHODS: Thirty-two late adolescent, skeletally homogeneous patients (basal-sagittal relationship: neutral; basal-vertical: neutral; no transverse discrepancies) were treated either with Class II (group A; n=16) or Class III elastics (group B; n=16) for unimaxillary space closure. Mean wearing times were 26 (A) and 24 months (B). Cephalograms at the start and end of treatment were analyzed. Changes in the inclination of the occlusal plane (BOP according to Downs) relative to three reference planes (NL, ML, NSL), as well as changes in the reference planes toward each other underwent statistical testing with a two-tailed Student t-test. RESULTS: The occlusal plane shift differed significantly when opposing elastics were applied (p<0.001). The induced shift with Class II elastics (A) was clockwise, while Class III elastics were counterclockwise (A: NL-BOP: +0.9°, ML-BOP: -2.1°; B: NL-BOP: -3.1°, ML-BOP: +3°). Reference planes NL and ML underwent insignificant change towards one another (A: -1.2°; B: -0.1°). The maxillo-mandibular complex itself rotated counterclockwise toward the anterior cranial base (NSL) (A: NL-NSL: -0.8°, ML-NSL: -2°; B: NL-NSL: -0.6°, ML-NSL: -0.7°). Thus, almost no change in BOP (+0.1°, n.s.) relative to NSL was detected when Class II elastics were applied, whereas the use of Class III elastics led to a significant counterclockwise rotation (-3.7°, p<0.001) CONCLUSION: Class III elastics enhance the physiologic inclination of the maxillo-mandibular complex at the level of the occlusal plane, whereas Class II elastics oppose or even eliminate the process.

Myofunctional and speech rehabilitation after orthodontic-surgical treatment of dento-maxillofacial dysgnathia.

OBJECTIVES: The lingual dysfunctions play a considerable role in the pathogenesis of dentoskeletal dysmorphisms. The treatment of dento-maxillofacial dysgnathia implies a functional rehabilitation to re-harmonize the stomatognathic system. This study aims to demonstrate the importance of a rehabilitation protocol of functional orofacial parameters at the end of a surgical-orthodontic treatment in order to achieve long-term success. MATERIALS AND METHODS: After orthognathic surgery, facial expression exercises and jaw exercises are prescribed to promote the recovery of neuromuscular function. At the end of treatment, a sample of 30 dysgnathic patients underwent a functional evaluation of the orofacial district to identify any lingual or articulatory dysfunctions. The information gathered led to an individual re-education program that consisted of an active myofunctional-logopedic approach integrated with appliances used as retention. RESULTS: 19 patients needed myofunctional therapy to re-educate deglutition and tongue posture. Articulatory disorders were found in 7 patients originally suffering from Class III and/or open-bite skeletal disharmony; 5 of these completed rehabilitation with speech therapy. After rehabilitation the functional parameters were completely normalized in 12 patients; in 5 cases, partial improvements were obtained, while in 2 cases the therapy was ineffective. CONCLUSIONS: In a patient undergoing post-surgical reconsolidation of his/her functional equilibrium even an uncontrolled speech defect may lead to an instable result. Only through an interdisciplinary approach it is possible to intercept and re-educate all the functions that are not compliant with the structural changes and to eliminate a tendency to relapse of the dysgnathia.

Correction of Class II, Division 2 malocclusions using a completely customized lingual appliance and the Herbst device.

AIM: The purpose of the present study was to examine the efficiency of correcting a Class II, Division 2 malocclusion using a completely customized lingual appliance. MATERIALS AND METHODS: In 18 consecutively completed, Class II, Division 2 malocclusion patients, the correction of the upper incisor inclination, deep and distal bite were assessed by means of plaster casts, digital lateral cephalograms, and intraoral photographs taken at the time of debond. Furthermore, two independent calibrated examiners determined the weighted Peer Assessment Rating index (PAR Index) of the initial and end models. RESULTS: All Class II, Division 2 patients were treated successfully: upper incisor inclination using the palatal plane as a reference improved on average from 95.4° to 111.2°. The deep bite was reduced on average from 3.6 mm to 1.7 mm. Neutral occlusion was achieved in all patients who had undergone correction of an initially pronounced distal occlusion (4.5 mm on average). An 86.2% marked improvement was observed in the weighted PAR index score from an average of 24.7 at the beginning of treatment to 2.9 at the end of treatment, with no patient classified as "worse or no different." CONCLUSION: Class II, Division 2 malocclusions can be efficiently and reliably treated by a combination of a completely customized lingual appliance and the Herbst device.

Complete transition from failing restorations to implant-supported fixed prostheses in a patient with scleroderma.

In a case involving a patient with scleroderma, the authors demonstrate how to treatment plan and sequence the transition from a failing restored dentition to complete implant-supported fixed prostheses with sequential extractions and implant placements. The article also presents surgical and prosthodontic considerations for a complete-mouth implant-supported fixed rehabilitation while achieving optimal esthetics without compromising function in patients with this condition. Sequential treatment provided the patient with fixed provisional restorations during treatment in multiple, short surgical appointments with less psychosocial trauma. This case posed treatment challenges due to limited oral access, unpredictable disease progression, and limited data on the success of treatment with endosseous dental implants in these patients.

Effects of fixed appliances in correcting Angle Class II on the depth of the posterior airway space: FMA vs. Herbst appliance--a retrospective cephalometric study.

OBJECTIVE: The objective of this retrospective study based on the metric evaluation of lateral cephalograms was to investigate the extent to which treatment with two different fixed appliances for the correction of Angle Class II influenced the morphology of the extrathoracic airway space (the posterior airway space, PAS). PATIENTS AND METHODS: A total of 43 patients with Angle Class II malocclusion were classified into two groups according to the appliance used for treatment: the functional mandibular advancer (FMA; n = 18) or the Herbst appliance (n = 25). Lateral cephalograms were taken of each patient at the start of functional jaw orthopedic treatment (time point T1) and at its completion (time point T2). Specific distances and angles were measured and analyzed in a cephalometric analysis. RESULTS: We observed major differences among the 43 patients in the depth of the posterior airway space during treatment with fixed appliances for Angle Class II correction. Regression analysis revealed that changes in sagittal and vertical positions had different effects on the depth of specific PAS sections: increases in anterior facial height are associated proportionately with increases in PAS width, particularly in the upper region. On the other hand, increases in posterior facial height and in the mandible's forward displacement correlated inversely to the decreases in depth, particularly in the central and lower PAS regions. The two treatment appliances (FMA, Herbst appliance) had the same effects on extrathoracic airway depth. CONCLUSIONS: Analyses of lateral cephalograms indicate that Angle Class II treatment with fixed appliances does not prevent sleep apnea in patients at risk. Nevertheless, this study does not permit absolutely reliable conclusions about the dimensions of the pharyngeal airway space. As the lateral cephalogram provides good images of structures in the midsagittal plane but is incapable of imaging the transverse dimension, there is an automatic lack of information concerning the precise width and volume of the extrathoracic airway space.

Mandibular distraction osteogenesis reconstructed the upper airway in a case of Melnick-Needles syndrome.

INTRODUCTION: We report a 16-year-old female with Melnick-Needles syndrome complicated with severe obstructive sleep apnea-hypoxia syndrome. CLINICAL REPORT: An overnight sleep study demonstrated that the patient had severe obstructive sleep apnea with an apnea-hypopnea index of 95/h. The lowest oxygen saturation was only 34%. The distraction osteogenesis technique was used to lengthen her mandible for the reconstruction of her upper airway. RESULT AND DISCUSSION: Postoperative panorex showed that the bilateral body of her mandible had been distracted about 16 mm singulorumly in the end of our distraction. Lateral radiograph revealed that the diameter of oral pharynx widen nearly 5 mm. The patient recovered after the upper airway reconstruction.

Modified camouflage therapy in an adult class I patient with TMJ complaints. A case report.

The present case report documents the hitherto unusual application of camouflage orthodontics in one of our patients. Our female patient had previously been treated orthodontically alio loco and had also undergone bimaxillary orthognathic surgery. She presented with TMJ complaints, with associated pains. Despite a dental Class I and centrally seated condyles, her discs had prolapsed anteriorly without reduction and she had developed a massive degenerative-inflammatory TMJ disease. Skeletally, she was a Class II case despite previous orthognathic surgery. In addition, there was also an initial suspicion of rheumatic involvement that could not be confirmed. We distalized the entire lower dental arch without bicuspid extraction. Then we advanced the mandible with the Mandibular Anterior Repositioning Appliance (MARA).We discuss exactly how the modified camouflage therapy was structured and how the individual treatment steps took place.

Complex prosthodontic treatment with dental implants for a patient with polymyalgia rheumatica: a clinical report.

Prosthodontic and implant treatment for a patient with polymyalgia rheumatica can be complicated not only by its symptoms, but also by the side effects of long-term use of certain medications, particularly systemic glucocorticoids. This clinical report presents a polymyalgia rheumatica patient who required full-mouth rehabilitation with dental implants. The patient had a sensitive gag reflex and refused the use of any removable prostheses. She presented clinically with a skeletal Class II malocclusion with severe overbite and overjet. All her remaining dentition was determined to be unrestorable. Full-mouth extractions and immediate placement of implants followed by early implant loading were performed. The use of systemic glucocorticoids might have exacerbated her type 4 maxillary bone and compromised her healing capacity and consequently made implant surgery challenging. Her treatment with full-arch fixed implant-supported dentures to correct her severe overbite and overjet and manage misaligned dental implants is summarized here. The effects of polymyalgia rheumatica in prosthodontic and dental implant treatments are reviewed and discussed.

Class II treatment with fixed functional orthodontic appliances before and after the pubertal growth peak - a cephalometric study to evaluate differential therapeutic effects.

OBJECTIVE: The aim of this clinical trial was to investigate and compare outcomes after treating a skeletal Class II malocclusion with two fixed functional orthodontic appliances, the Herbst appliance and the Functional Mandibular Advancer, by evaluating their skeletal and dentoalveolar effects and the repercussion on the profile in relation to patient age. PATIENTS AND METHODS: The sample population comprised 42 subjects with skeletal Class II malocclusion. They were divided into two groups depending on age. Group A (n = 21) included nine female subjects aged up to 12 years and twelve male subjects aged up to 14 years. Group B (n = 21) comprised twelve females older than 12 years and nine males older than 14 years. Treatment course was documented cephalometricly. The net therapeutic effects were calculated with reference to the control group. RESULTS: A significant reduction of the overjet was achieved in both treatment groups. Within the two groups there were no significant sagittal effects in terms of mandibular advancement. However, there was an inhibiting effect on the maxilla, which counteracted the natural growth process. Significant changes in vertical direction were detected mainly in the younger patients in the sense of lengthening of the lower face. Significant dental changes were predominantly found in the group of older patients. For instance, treatment with fixed functional orthodontic appliances led to retrusion of the upper incisors by a mean of 2.21 mm +/- 2.66 mm (p = 0.0015), protrusion of the lower incisors by a mean of 2.28 mm +/- 2.39 mm (p =