Characteristic Features of Bimaxillary Proclination: A 5-Year Review in Najran, a Saudi Arabian Sub-population.

Background Bimaxillary proclination (BP) has been described as a clinical condition depicted by proclined upper and lower incisors with an amplified lip incompetence. The current study aimed to investigate the prevalence and characteristic features of bimaxillary proclination in Najran. Methods This was a retrospective study to appraise bimaxillary proclination in an orthodontic specialist clinic and research complex in Najran, Saudi Arabia from January 2018 to December 2022. Patients requesting orthodontic treatment for malocclusion were evaluated. Data retrieved include: age, gender, presence of bimaxillary proclination, and facial profile of affected patients. IBM SPSS Statistics for IOS Version 25 (Armonk, NY: IBM Corp) was used for analysis. Results were presented as simple frequencies and descriptive statistics. Results Three hundred and twenty-six (326) patients sought treatment for different types of malocclusion out of which 277 (84.9%) had bimaxillary proclination. There were 123 (44.4%) males and 154 (55.6%) females with an M:F ratio of 1:1.3. Age ranged from 6 to 55 years with a mean SD of 22.6 ± 8.98. More females had bimaxillary proclination. The majority of the patients with bimaxillary proclination had convex facial profiles and a Class I relationship (241 (73.9%) and (135 (48.7%)), respectively. Conclusion Bimaxillary proclination is a common orthodontic health issue with high prevalence in the Najran region. Female preponderance was observed. Most of the patients have a Class I Angle's relationship.

Evaluation of Incisor Position in a Sample of Orthodontic Patients.

BACKGROUND: To achieve a successful result, the orthodontist must use a systematic approach to plan the orthodontic treatment. Defining the correct position of the upper and lower incisors and evaluating their relationship with intermaxillary discrepancy and facial divergence have been recognized as the starting point for the diagnostic decision regarding extractions and anchorage requirements. The aim of our study was to analyze the relationship between intermaxillary discrepancy (ANPg^), mandibular inclination (SN^GoGn), lip incompetence, and the positioning of the upper and lower incisors (UIPs and LIPs) in a group of orthodontic patients. This retrospective study included 290 lateral cephalograms in 122 males (42.1%) and 168 females (57.9%) aged 8 to 53 years (median 14; interquartile range IQR 12-17). Data were analyzed by means of one-way Analysis of Variance (ANOVA) and linear regression analysis. RESULTS: This study showed a statistically significant increase in LIP values in patients with lip incompetence (p < 0.001). Moreover, the distribution of LIPs in groups with various SN^GoGn and ANPg^ angles was significantly different (p < 0.001). The regression analysis also showed a positive association between the LIP and SN^GoGn and between the LIP and ANPg^. CONCLUSION: The LIP presented a statistically significant difference in patients with and without lip incompetence, which varied significantly in subjects with different sagittal malocclusions and vertical face patterns.

Surgical-orthodontic approach for correcting Vertical Maxillary Excess: Case report.

This report describes a patient with Vertical Maxillary Excess without open bite in whom surgical orthodontic treatment to reduce lower facial height remarkably improved function and facial esthetics. The patient was a 22-year-old male whose main concern was crowding and temporomandibular joint clicking sounds. The clinical and radiological findings led to the diagnosis of Vertical Maxillary Excess with a mild skeletal class II malocclusion. The proposed treatment plan comprised a bimaxillary surgery without premolar extractions. LeFort I osteotomy was planned to reposition the maxilla superiorly by 7-8 mm. This surgery was combined with a bilateral sagittal split osteotomy for mandibular anterior derotation to adjust the mandible to the occlusal and anteroposterior change. Postoperatively, the mandibular plane angle (GoGn-SN) was decreased by 4° and skeletal class I was achieved (ANB, 4°). In addition, lip incompetence was corrected and the excessive gingiva exposure upon smiling was significantly improved. The patient was satisfied with the treatment result and reported the temporomandibular joint clicking sounds disappearing after surgery.

Impact of initial lip competence on the outcome of class II functional appliances therapy.

OBJECTIVES: The aim of this prospective clinical study was to evaluate the impact of initial lip position on class II functional appliance therapy. MATERIALS AND METHODS: In total, 34 class II division 1 patients (23 females, 19 males; mean age 12.4 ± 0.9 years) that met the inclusion criteria (> ½ class II molar relationship, overjet > 6 mm, ANB > 4°, neutral or horizontal growth pattern, cervical vertebral maturation stage (CVMS) II - III, mean wear-time > 10 h/day) were consecutively divided into two groups (lip incompetence (LI); lip competence (LC)). All patients were treated with the Sander bite jumping appliance (BJA). Wear time was microelectronically measured. Lateral cephalograms were taken at the beginning (T0) and after 1 year of treatment (T1). An untreated class II group served as a control (CG). Inter-group comparisons were determined with Mann-Whitney U tests for independent samples. RESULTS: Significant skeletal treatment effects were found in both treated groups when compared to the CG with significantly more pronounced mandibular skeletal effects in the LI than in the LC group (mandibular base length p < 0.001, composite mandibular base length p < 0.001, condylar head growth p = 0.002, co-pg p < 0.00, go-pg p = 0.003, reduction of the ANB angle p = 0.009, and Wits appraisal p < 0.001). CONCLUSION: The more pronounced mandibular effects in the LI group were composed of the functional orthopedic effect plus harmonization of the lip competence. CLINICAL RELEVANCE: Functional harmonization of lip incompetence with BJA enhances mandibular growth stimulation. Lip incompetence seems to impede mandibular growth and its harmonization seems to be a preventive approach.

Dental trauma in the anterior sector: an analysis of the predisposing factors in a group of orthodontic patients.

AIM: The aim of this study was to analyze the predisposing factors of upper incisal trauma in children candidates for orthodontic treatment. METHODS: This is a retrospective study involving 102 consecutive patients who requested orthodontic therapy at Pediatric Dentistry Clinic of Bari University's Dental School during the time frame 2012-2019. The distribution of reported dental trauma was analyzed according to gender, type of trauma, etiology, overjet and labial competence. RESULTS: No substantial association between gender and trauma emerged from our study. Patients between the age range of 11-15 years appear to be at increased risk. A statistically significant correlation between increase in overjet and traumatic events was found. A link was discovered between labial incompetence and trauma, since this condition increases the risk of trauma by exposing part of the surface of the upper incisors. A correlation also emerged between Skeletal Class II and the increased risk of traumatic injury. CONCLUSIONS: Dental trauma, especially in the anterior sector, is a fairly frequent occurrence in pediatric and adolescent patients and is linked to several factors. In our study subjects with Skeletal Class II division I malocclusion with elevated overjet are more predisposed to dental trauma. The limitations of our study are the low number of subjects in the examined sample, and the heterogeneity of the trauma presentation.

The relationship between malocclusion, lip competence and gingival health in a group of schoolchildrenp / Relação entre má-oclusão, incompetência labial e saúde gengival num grupo de crianças em idade escolar

Objectives: The aim of this study was to determine the relationship between malocclusion, lip competenceand gingival health among a sample of school children. Material and method: A multi stagesampling technique was used to randomly select 239 school children. Malocclusion was evaluated andgraded from the children’s dental casts using the Dental Aesthetics Index (DAI) and Littles’ IrregularityIndex (LII). The lips were examined for competence according to Jackson’s classifi cation. Gingival healthwas assessed using the Plaque Index and Index of gingival infl ammation. Results: A mean DAI scoreof 26.37 ± 6.67 was obtained while the mean score of the LII was 1.88 ± 1.68 mm. Majority of thechildren (97.1%) had competent lips. Results of correlation tests between DAI scores and the periodontalindices were low and not statistically signifi cant, while that of the LII score and periodontal indiceswere also low but statistically signifi cant (p < 0.05). Conclusion: A cause and effect relationship couldnot be established between malocclusion and gingivitis. A weak correlation exists between malocclusionassessed by the DAI and LII and periodontal indices used. This supports the opinion that prescribingorthodontic treatment solely for the purpose of maintaining periodontal health is not justified.

Objetivos: O objetivo deste estudo foi determinar a relação entre má-oclusão, incompetência labial e saúde gengivalnuma amostra de crianças em idade escolar. Material e método: A técnica de amostragem em estágios múltiplos foiutilizada para selecionar aleatoriamente 239 crianças escolares. A má-oclusão foi avaliada e graduada por modelosdentários das crianças utilizando o índice dentário estético (DAI) e o índice de irregularidades de Little (LII). Oslábios foram examinados e classifi cados – quanto à competência – pela classifi cação de Jackson. A saúde gengival foideterminada pelo índice de placas e índice de infl amação gengival. Resultados: O escore médio DAI de 26,37 ± 6,67foi obtido, enquanto o escore médio LII foi 1,88 ± 1,68 mm. A maioria das crianças (97,1%) tinha lábios competentes.Os resultados dos testes de correção entre escores DAI e índices periodontais foram baixos e não estatisticamentesignifi cantes, enquanto o escore LII e os índices periodontais foram também baixos, mas estatisticamente signifi cantes(p < 0,05). Conclusão: Não foi possível estabelecer uma relação de causa e efeito entre má-oclusão e gengivite.Uma correlação fraca existe entre má-oclusão determinada por DAI e LII e os índices periodontais utilizados. Issosuporta a opinião de que prescrever tratamento ortodôntico apenas com a fi nalidade de manter a saúde periodontalnão se justifica.

Chin ptosis: classification, anatomy, and correction.

For years, the notion of chin ptosis was somehow integrated with the concept of witch's chin. That was a mistake on many levels because chin droop has four major causes, all different and with some overlap. With this article, the surgeon can quickly diagnose which type and which therapeutic modality would work best. In some cases the problem is a simple fix, in others the droop can only be stabilized, and in the final two, definite corrective procedures are available. Of note, in certain situations two types of chin ptosis may overlap because both the patient and the surgeon may each contribute to the problems. For example, in dynamic ptosis, a droop that occurs with smile in the unoperated patient can be exacerbated and further produced by certain surgical methods also. This paper classifies the variations of the problems and explains the anatomy with the final emphasis on long-term surgical correction, well described herein. This article is the ninth on this subject and a review of them all would be helpful (greatly) for understanding the enigmas of the lower face.