Exploring long-term changes and influencing factors of the upper airway in patients with a skeletal Class II relationship after mandibular advancement with maxillary setback surgery: A comprehensive 2-year follow-up investigation.

INTRODUCTION: The objective of this study was to investigate the 2-year postoperative change and influencing factors of the upper airway after mandibular advancement with maxillary setback surgery for patients with a skeletal Class II relationship. METHODS: Fifty-seven participants who underwent mandibular advancement with maxillary setback surgery were enrolled consecutively. Cone-beam computed tomography was performed preoperatively, 3 months postoperatively (T1), and 2 years (T2) postoperatively. All parameters were measured using Dolphin Imaging software (Dolphin Imaging and Management Solutions, Chatsworth, Calif). RESULTS: The total volume (V), minimum cross-sectional area (CSAmin), and glossopharynx increased significantly in both the short-term (V, 13.33%; CSAmin, 33.03%; glossopharynx, 26.73%) and long-term (V, 10.19%; CSAmin, 23.18%; glossopharynx, 18.27%) after the surgery. Mandibular advancement, mandibular width increase, preoperative CSAmin, and body mass index (BMI) significantly affected 2-year postoperative V increases. Mandibular advancement and BMI significantly affected 2-year postoperative glossopharynx increases. Backward movement of point PNS may lead to a reduction of the nasopharynx; however, downward movement of point PNS, upward movement of point A, and increased maxillary width may compensate for this effect by increasing the likelihood of the nasopharynx opening. Furthermore, mandibular body length at T1 is positively associated with relapse rate ([T2 - T1] / T1) of V and CSAmin. CONCLUSIONS: Mandibular advancement amount, mandibular width increase, preoperative CSAmin, and BMI are the 4 factors for long-term V changes. Patients with a longer mandibular body length might have a lower relapse rate.

The surgical outcomes of anterior segmental osteotomy in Asian skeletal class II patients.

PURPOSE: Anterior segmental osteotomy (ASO) following the surgery-first approach is a long-established treatment modality to resolve lip protrusion in patients with skeletal class II patterns. However, the indications and effectiveness of ASO still remain uncertain. The objective of this study is to investigate the effectiveness of ASO in Asian skeletal class II patients by evaluating the skeletal and soft tissue changes and analyzing pre-treatment variables that determine successful outcomes in occlusal as well as esthetic aspects. METHODS: The lateral cephalograms of 44 skeletal class II patients who underwent ASO and orthodontic treatment for resolving lip protrusion were retrospectively collected. Hard and soft tissue variables of two groups, normalized (NG) and unnormalized (UNG) ANB after treatment were compared and analyzed. The rotational effect of the anterior segment on the hard and soft tissue was also investigated. RESULTS: ASO was successful in correcting the skeletal class II relationship and lip protrusion (ΔANB - 2.3°, 4-5 mm lips retraction) in most cases. However, for patients with severely camouflaged skeletal class II incisors involving a large ANB and SNA, a large ANB still remained post-treatment. The study also found that rotation of the upper and lower anterior segments further augmented the amount of lip retraction. CONCLUSIONS: ASO was found to successfully correct ANB of skeletal class II patients under the following conditions (ANB 5.3° ± 1.5°, SNB 77.3° ± 4.5°, U1 to FH 115° ± 7.5, L1 to FH 48.0° ± 4.6). However, patients with larger ANB and SNA values may require bi-maxillary surgery. In addition, ASO has limitations in correcting gummy smile in cases of extreme maxillary excess. For patients requiring a large amount of lip retraction, rotation of the anterior segment may be beneficial in conjunction with bi-maxillary surgery.

Invisible treatment with lingual appliance for the correction of an adult class II subdivision with asymmetrical Wilson and Spee curves: A case report.

This article describes a class II subdivision malocclusion successfully treated by an invisible lingual appliance. The combination of en-masse distalization by interradicular palatal mini-screws and inner unilateral class II auxiliaries, first by intermaxillary elastic, later by a class II coil spring, resulted in a dento-alveolar correction, allowing one to maintain the appliance completely invisible. At the same time, the inclination of buccal sectors was normalized by a correct torque expression with set-up overcorrections, resulting in a significant improvement of the buccal corridors. This case report demonstrates the possibility of successfully solving class II division 2 subdivision malocclusion in adult patients without surgery by means of a completely invisible appliance. It also demonstrates that correct levelling and torque expression, for the correction of asymmetrical Spee and Wilson curves, are achievable with an accurate set-up planning. On the other hand, it underlines the necessity of mini-screws, auxiliaries and set-up overcorrections in order to obtain the best results.

Changes of Temporomandibular Joint Morphology and Symptoms in Class II Malocclusion Patients With Bilateral Sagittal Split Ramous Osteotomy.

This study included 46 patients with class II malocclusion ranging in age from 19 to 39 years old treated with bilateral sagittal split ramous osteotomy (BSSRO). Left and right temporomandibular joints (TMJs) of each subject were evaluated independently with cone-beam computed tomography (CBCT) before operation (T1), 1 week after operation (T2), and 1 year after operation (T3) and assessed the effects of orthognathic surgery (OGS) on the temporomandibular joint disease (TMD) symptoms. Temporomandibular joint morphology evaluation included condylar volume, condylar area, cortical bone thickness, depth of the mandibular fossa, fossa thickness, joint nodule angle, joint space, and condyle-fossa relationship, which were calculated by using the Mimics software and 3-matic software. Data were statistically analyzed with SPSS software (P <0.05 means statistically significant). In our study, bilateral TMJs have no difference in T3. Bilateral sagittal split ramous osteotomy had no significant effect on the articular fossa. The condyle volume and surface area decreased from T1 to T3, but the cortical thickness of the bone did not change significantly. More anterior condyle positions in T1 and more posterior in T3.21 patients had at least 1 sign or symptom of TMD in T1 and 27 patients in T3. Four patients who were asymptomatic in T1 developed pain after surgery, 10 developed noises, 12 showed limited mouth opening, and 8 had abnormal opening patterns. It is concluded that more condylar posterior position after BSSRO and the reduction of condyle may be related to the enlargement of anterior space. The number of patients with joint symptoms increased postoperative, and the impact of BSSRO on TMD may be negative.

Comparative study of changes in the airway dimensions following the treatment of Class II malocclusion patients with the twin-block and Seifi appliances.

BACKGROUND: Functional appliances are frequently used to stimulate mandibular growth in cases of Class II malocclusion with mandibular deficiency. Many studies have reported improved pharyngeal airway passage (PAP) dimensions following functional appliance therapy in children. OBJECTIVES: The present study aimed to assess changes in the airway dimensions following the treatment of Class II malocclusion patients with the twin-block and Seifi appliances. MATERIAL AND METHODS: Lateral cephalograms of 37 patients with Class II malocclusion and mandibular deficiency treated with the twin-block appliance (n = 20) or the Seifi appliance (n = 17) were assessed in this before-and-after study. The preoperative and postoperative lateral cephalograms were compared to determine changes in the airway dimensions at the level of the palatal plane (PP), the occlusal plane (OP) and the 2nd-4th cervical vertebrae (C2-C4) in the 2 groups. The results were analyzed with the t test and the one-way analysis of covariance (ANCOVA). RESULTS: After treatment, significant changes occurred in the point A-nasion-point B (ANB) and sellanasion-point B (SNB) skeletal cephalometric indices in the twin-block appliance group, and in ANB, SNB and incisor-mandibular plane angle (IMPA) in the Seifi appliance group. The airway dimensions at the level of PP, OP and the 3rd cervical vertebra (C3) significantly increased postoperatively as compared to the baseline in the twin-block appliance group (p < 0.05). The increases in the airway dimensions at the level of PP and C3 in the twin-block appliance group were significantly greater than in the Seifi appliance group (p < 0.05). CONCLUSIONS: The treatment of Class II Division I malocclusion with the twin-block appliance significantly increased the airway dimensions at the level of PP, OP and C3, whereas the Seifi appliance did not cause any significant changes in the airway dimensions.

Assessment of condylar positional changes in severe skeletal class II malocclusion after surgical-orthodontic treatment.

OBJECTIVES: This study aimed to determine the positional changes in the condyle in the temporomandibular joint (TMJ) of severe skeletal class II malocclusion patients treated with surgical-orthodontics. MATERIALS AND METHODS: The measurements of TMJ space in 97 severe skeletal class II malocclusion patients (20 males, 77 females, mean age, 24.8 years, mean ANB = 7.41°) were assessed using limited cone-beam computed tomography (LCBCT) images acquired before orthodontics (T0) and 12 months after surgery (T1). 3D remodeling of the TMJ and measurements of the anterior space (AS), superior space (SS), and posterior space (PS) were performed to determine the position of the condyle for each joint. All data were analyzed by t test, correlation analysis, and Pearson correlation coefficient. RESULTS: The mean AS, SS, and PS values after the therapy changed from 1.684 to 1.680 mm (0.24%), 3.086 to 2.748 mm (10.968%), and 2.873 to 2.155 mm (24.985%), respectively. The decreases in SS and PS were statistically significant. Positive correlations were found in the mean AS, SS, and PS values between the right and left sides. CONCLUSIONS: The combination of orthodontic and surgical treatment makes the condyle move counterclockwise in the TMJ in severe skeletal class II patients. CLINICAL RELEVANCE: Studies of temporomandibular joint (TMJ) intervals changes in patients with severe skeletal class II after sagittal split ramus osteotomy (SSRO) are limited. The postoperative joint remodeling, resorption, and related complications remain unstudied.

Condylar remodelling in a severe class II deep bite dento-skeletal malocclusion treated with an ortho-surgical approach: A five-year follow-up case report.

Condylar displacement and remodelling are phenomena closely related to orthognathic surgery and critically involved in occlusal and skeletal stability. The aim of the present case report is to describe over time condylar displacement and surface remodelling after bilateral split sagittal osteotomy (BSSO) in an adult patient with severe class II skeletal malocclusion treated with ortho-surgical approach. A male of 21years comes to our observation. The extraoral examination shows a symmetrical square-shaped face, a convex profile, an acute nasolabial angle and a deep labiomental fold. Intraoral examination reveals a class II division 2 with a 2mm deviation of the mandibular midline to the left and the presence of a scissor bite of the bicuspids between quadrants II and III. The Spee curve and overbite are extremely accentuated (OV 14.3mm) as the overjet (11.1mm). Axiographic reconstructions of CBCT show a normal shape and position of both condyles. The cephalometric analysis shows a reduced lower facial height, a normal upper jaw position, a mandibular underdevelopment masked by a very developed symphysis and an extremely low divergence (FMA 11.2°). BSSO for mandibular setback was performed in the 13th month of orthodontic therapy. Original CBCT data before surgery (T0), at the end of treatment (T1), 2years postoperatively (T2) and 5years postoperatively (T3) were collected and reconstructed for 3-dimensional (3D) qualitative analyse. At the end of the surgical-orthodontic treatment (26months), good function and good aesthetics were achieved. The qualitative and comparative analysis of the superimpositions and the cuts made on the CBCT at T0, T1, T2, T3 showed a physiological remodelling and adaptation of the condyles.

Mandibular asymmetry in patients with skeletal class I and skeletal class II Malocclusions: A cone-beam computed tomography study.

OBJECTIVE: To study the difference in mandibular asymmetry between patients with skeletal Class I and skeletal Class II malocclusions and analyze the correlation between mandibular asymmetry and different facial skeletal sagittal patterns based on CBCT measurements. METHODS: One hundred and twenty patients were selected according to the inclusion and exclusion criteria. Patients were divided into two groups (60 in the skeletal Class I group and 60 in the skeletal Class II group) based on ANB angles and Wits values. Patients' CBCT data were collected. Dolphin Imaging 11.0 was used to determine the mandibular anatomic landmarks and calculate the linear distance in patients in the two groups. RESULTS: Intragroup comparison: in skeletal Class I group, measurements of the most posterior point of the condyle (Cdpost), the outer lateral point of the condyle (Cdlat), sigmoid notch point (Sn)), coronoid process point (Cop), gonion point (GO) and antimony notch point (Ag), right>left (P<0.05); in skeletal Class II group, measurements of Cdpost and Cop, right>left (P<0.05). Intergroup comparison: for measurements of GO and Ag, skeletal Class I group>skeletal Class II group (P<0.05). The asymmetry of the Ag and GO points was negatively correlated with the ANB angle (p<0.05). CONCLUSION: Mandibular asymmetry was significantly different between patients with skeletal Class I and skeletal Class II malocclusions. The asymmetry of the mandible angle region in the former group was greater than that in the latter group, and the asymmetry of the mandibular angle was negatively correlated with the ANB angle.

Alveolar bone height changes in the anterior tooth region before and after orthodontic treatment for Angle's Class II division 1 malocclusion and related factors.

BACKGROUND: The aim of this study was to observe the alveolar bone height changes in the anterior tooth region after orthodontic treatment for Angle's Class II division 1 malocclusion. METHODS: Ninety-three patients treated from January 2015 to December 2019 were retrospectively analyzed, of whom 48 received tooth extraction and 45 did not. RESULTS: After orthodontic treatment, the alveolar bone heights in the anterior tooth regions of tooth extraction and non-extraction groups decreased by 67.31% and 66.94%, respectively. Except for the maxillary and mandibular canines in the tooth extraction group as well as the labial side of maxillary anterior teeth and the palatal side of maxillary central incisors of the non-extraction group, the alveolar bone heights of other sites significantly reduced (P<0.05). The reduction in the alveolar bone height of the tooth extraction group significantly exceeded that of the non-extraction group on the palatal side of maxillary incisors and the lingual side of mandibular anterior teeth (P<0.05). CONCLUSIONS: Alveolar bone height in the anterior tooth region decreases after orthodontic treatment for Angle's Class II division 1 malocclusion, being closely related to tooth position together with movement direction and amplitude.

[Three-dimensional assessment of positional changes of the mandibular condyles following orthognathic surgery]. / Trekhmernaya otsenka izmeneniya polozheniya sustavoobrazuyushchikh elementov nizhnei chelyusti v rezul'tate ortognaticheskoi operatsii.

THE AIM THE STUDY: This study aims to assess the postoperative condylar displacement after orthognathic surgery using three-dimensional analysis of computed tomography. MATERIAL AND METHODS: This retrospective study included 64 condyles from 32 patients with skeletal Class II (Group 1, n=16) and III (Group 2, n=16) deformities. All patients underwent a bimaxillary surgery. The three-dimensional CT images were evaluated to assess condylar displacement. RESULTS: The condyle exhibited mainly superior and lateral torque immediately after surgery. Posterior displaced condyles were found in two cases in group 1 (Class II malocclusion). CONCLUSION: The present study found the condyle displacement that can be mistaken as posterior displacement of condyle in analysis of sagittal sections of CT scans.

Treatment Strategy for Condyle/Ramus Deficiency Using 3D Virtual Surgery and CAD/CAM Technologies; Total Joint Replacement or Inverted-L Osteotomy.

OBJECTIVE: To introduce a guideline for selecting proper surgical modalities for correction of skeletal Class II malocclusion with moderate-to-severe vertical height deficiency (VHD) of the condyle/ramus complex (CRC) using bimaxillary surgery in conjunction with total joint replacement (TJR) or inverted-L osteotomy (ILO) assisted by 3D virtual surgical planning and CAD/CAM technologies. CASES: Four cases of severe skeletal Class II patients with moderate-to-severe VHD of CRC were presented. They underwent bimaxillary surgery using Le Fort I osteotomy in the maxilla and TJR or ILO in the mandible, with the help of virtual surgical planning (VSP) and computer-aided design/computer-aided manufacturing (CAD/CAM)-printed surgical guides and osteosynthesis plates. Guidelines are as follows: (1) if a patient has a moderate degree of VHD and the function of the temporomandibular joint (TMJ) is normal, ILO would be preferred for vertical elongation of the ramus; (2) if a patient has congenitally small condyle or severe condylar resorption, TJR would be preferred to resolve severe VHD of CRC; and (3) when a patient has a metal allergy, foreign body reaction or anatomic limitations (ie, thin cranial base cortex for fossa fixation), ILO would be a better option than TJR. RESULTS: TJR or ILO using VSP and CAD/CAM-printed surgical guides, wafers, and customized plates can provide a proper selection of the surgical plan, accurate transfer of surgical plans to actual surgical procedures, and esthetic improvement of the facial profile. CONCLUSION: This guideline based on the degree of VHD and functional aspects of CRC might help clinicians to select effective surgical modality for correction of skeletal Class II malocclusion with moderate-to-severe VHD of CRC.

Non-surgical occlusal plane cant resolution with lingual straight-wire appliance and miniscrews in a class II asymmetric adult patient.

This case report describes a complex class II case with important maxillo-mandibular asymmetry in an adult patient treated with lingual straight-wire appliance. With the twofold aim of obtaining dramatic aesthetic improvement, since the patient refused surgical option, and ideal occlusal relationship, accurate set-up planification and biomechanical strategies with TADS for occlusal plane cant correction are needed to achieve the planned results. This case report demonstrates the possibility of solving successfully class II malocclusion with significant asymmetry in adult patient without surgery by means of an aesthetic appliance; on the other hand, it underlines the necessity of miniscrews and auxiliaries in order to obtain the best results.

Comparing the esthetic impact of virtual mandibular advancement, bichectomy, jawline, and their combination.

INTRODUCTION: The purpose of this study was to compare the effects of mandibular advancement (MA), bichectomy, jawline, and their combination on facial attractiveness. The 3-dimensional (3D) visual sculpting is a method to perform the task. METHODS: FaceBuilder software, a Blender 2.93 LTS add-on, was used to generate a 3D head and face model of a female patient with Class II Division I malocclusion. MA, bichectomy, jawline, and combination modifications were performed on the model using a 3D virtual sculpting tab, and 4 new head models were created. Five hundred thirteen participants scored lateral and frontal views of the modified and reference models. The Mann-Whitney U, Kruskal-Wallis, and Wilcoxon tests were used for statistical analysis. RESULTS: MA modification received the highest frontal and lateral image scores. The raters found the jawline frontal photograph to be the least attractive. Significant differences were observed between the lateral and frontal attractiveness scores in all modifications except bichectomy. The combination of 3 modifications in both frontal and lateral images received the second-lowest score. CONCLUSIONS: Facial esthetic modifications receive different attractiveness scores in lateral or frontal evaluations. MA outperforms bichectomy and jawline augmentation in terms of improving facial attractiveness.

Long term stability of a high-angle skeletal Class II open bite treated with high-pull headgear and modified transpalatal arch: A case report.

This case report describes the treatment of an adolescent patient with an Angle Class II malocclusion, severe open bite and overjet, proclined incisors, skeletal Class II anteroposterior dysplasia, high mandibular plane angle and convex profile. The importance of stopping of a prolonged thumb sucking habit, which was a major causative factor of the open bite is discussed. A combination of a high-pull headgear and a modified transpalatal arch with a loop embedded with resin, at a distance from the palate, were used along with an Edgewise appliance. Treatment timing, favourable growth and good patient response led to an optimal outcome with excellent stability of the treatment results five years and five months post-treatment.

Comparison of two different therapeutic approaches for skeletal Class II patients with temporomandibular degenerative joint disease.

OBJECTIVES: To compare two different therapeutic approaches for skeletal Class II patients with temporomandibular degenerative joint disease. MATERIALS AND METHODS: A total of 47 patients were included in this study. Group anterior repositioning splint (ARS) was treated with temporomandibular joint (TMJ) disc surgery followed by an ARS and camouflage orthodontic treatment. Group stabilization splint (SS) was treated with an SS followed by orthodontic treatment combined with orthognathic surgery. Cephalometric analysis of lateral radiographs and measurements of condylar height were evaluated before and after splints. RESULTS: In group ARS, mandibular advancement was observed after treatment in 21 of 24 patients (87.5%). The SNB angle increased by an average of 1.40 ± 1.01°. The ANB angle, overjet, Wits, and convexity decreased. Facial angle and soft tissue N Vert to pogonion increased. Vertically, MP-FH, MP-SN, y-axis, and vertical ratio decreased and ANS-Me/N-Me and S-Go/N-Me increased, suggesting a counterclockwise rotation of the mandible. In group SS, 18 of 23 patients (78.3%) showed a backward change tendency. The SNB angle reduced by 0.90 ± 0.93°. The ANB angle, overjet, Wits, convexity, and y-axis increased. The facial angle and soft tissue N Vert to soft tissue pogonion (ST N Vert to ST pogonion) decreased. Magnetic resonance imaging showed condylar height increased by 1.45 ± 3.05 mm (P = .002) in group ARS. In group SS, condylar height change was not consistent. CONCLUSIONS: TMJ disc surgery followed by ARS promoted condylar bone remodeling and regeneration. The SNB angle increased, and the severity of skeletal Class II was improved. The SS enabled the mandible to withdraw backward and revealed a retrognathic but true mandible position.

An unusual extraction pattern for retreatment in a patient with dental protrusion and a deficient soft-tissue chin.

A patient with dental protrusion and deficient soft-tissue chin, previously treated with maxillary first premolar extraction, sought retreatment to improve his facial profile. Orthognathic surgery was proposed as the ideal treatment option, but the patient declined. Therefore, other orthodontic options were considered. The combined intrusion and retraction force systems supported with skeletal anchorage on both arches and a midpalatal miniscrew successfully reduced the protrusion and rotated the mandible counterclockwise to improve the facial profile and chin projection. Sagittal correction enhanced by active vertical control with skeletal anchorage and de-wedging with posterior extraction was illustrated. In addition, advancement genioplasty was performed after orthodontic treatment to improve the chin projection further. The mechanics and results of this retreatment case were discussed.

The Effects of Occlusal Plane Inclination and Dental Decompensation on the Overall Result of Surgical Correction of Class II Malocclusion.

PURPOSE: To evaluate the effects of upper occlusal plane (UOP) inclination and incisor decompensations on the outcome of surgical Class II patients. MATERIALS AND METHODS: Pretreatment (T0), preoperative (T1), and posttreatment (T2) cephalograms of 30 surgical Class II patients were included. Cephalometric measurements were performed using the Dolphin Imaging Software in this retrospective study. The differences between time points were analyzed with repeated measures ANOVA. Spearman correlation test was used to determine any correlations between either the UOP alterations or incisor decompensations and the cephalometric variables. RESULTS: A significant improvement was obtained in the sagittal skeletal, dental variables, and soft tissue B point. Significant correlations were found between the decompensation achievement ratio and the change of the convexity angle. The relative percentage ratio (RPR) of the lower incisor was correlated with Wits appraisal, ANB, and Convexity Angle at the T2 stage. The RPR of the upper incisor was found to be correlated with lip strain. The relative surgical correction ratio of the UOP angle was found to be correlated with the surgical change of Wits appraisal and convexity angle. The RPR of the UOP angle was correlated with the SNB, ANB, and SN-GOGN angles at the T2 stage. CONCLUSIONS: Significant improvement in the incisor inclinations was achieved, but the incisors were inadequately decompensated at the preoperative phase. Surgical correction was limited by the inadequate presurgical decompensation. The surgical alteration of the UOP should be taken into consideration for the surgical planning to obtain better outcomes for Class II patients.

Correlation Analysis between Three-Dimensional Changes in Pharyngeal Airway Space and Skeletal Changes in Patients with Skeletal Class II Malocclusion following Orthognathic Surgery.

INTRODUCTION: Studies on the pharyngeal airway space (PAS) changes using three-dimensional computed tomography (CT) have shed more light on patients with Class III than Class II malocclusion. This paper focuses on analyzing the long-term changes in the PAS and evaluating the postoperative association between these PAS and skeletal changes in patients with skeletal Class II malocclusion who have undergone orthognathic surgery. METHODS: The records of 21 patients with skeletal Class II malocclusion who had undergone orthognathic surgery were included. The anatomical modifications in both jaws, changes in volume, sectional area (SA), minimum sectional area (MSA), and anterior-posterior (AP) and transverse (TV) width in the airway at one month before surgery (T0), and one month (T1) and one year (T2) after surgery were analyzed using CT images. The association between the skeletal and airway changes was evaluated between T0, T1, and T2. RESULTS: After surgery, the ANS, A point, and PNS demonstrated significant posterior and superior movement. The B point and the pogonion exhibited substantial anterior and superior movement. The total and inferior oropharyngeal volumes (vol 3, vol 4) notably increased, while the nasopharyngeal volume (vol 1) decreased. The anterior-posterior movement at the ANS and PNS after surgery was significantly associated with the total volume, vol 2, vol 3, SA 1, MSA, and TV width 1, while substantial association with the total volume was found at the pogonion. CONCLUSION: Thus, an ideal treatment plan can be formulated for patients with skeletal Class II malocclusion by considering the postoperative PAS changes.

Short-Term Stability After Segmental Le Fort I Maxillary Impaction Surgery With Mandibular Autorotation in Seven High-Angle Class II Patients: A Case Series.

PURPOSE: To retrospectively evaluate skeletal stability after Le Fort I maxillary impaction surgery and mandibular autorotation without bilateral sagittal split osteotomy (BSSO) in high-angle class II patients. MATERIALS AND METHODS: Seven female high-angle class II patients who underwent maxillary impaction surgery and mandibular autorotation without bilateral sagittal split osteotomy were included in this study. Surgical changes and relapse were measured on lateral cephalograms taken preoperatively and at 1 month, 6 months and 1 year postoperatively. RESULTS: The horizontal movement of the maxilla at point A was 5.8 ±â€Š3.3 mm backward, and the upward movement at the posterior nasal spine was 3.3 ±â€Š1.4 mm. The mean horizontal change at point A during the 1-year follow-up period was 0.1 ±â€Š0.2 mm, and the vertical change at posterior nasal spine was 0.2 ±â€Š1.3 mm, which were not statistically significant. The horizontal surgical change at point B was 4.0 ±â€Š1.8 mm forward and the vertical surgical change at point B was 4.7 ±â€Š1.8 mm upward. Postoperative relapse was 10.9% and 13.7% in the horizontal and vertical directions, respectively. CONCLUSIONS: Le Fort I maxillary impaction surgery with mandibular autorotation may be 1 of the suitable procedures for high-angle class II patients.

Treatment of Class II malocclusion with a customized lingual appliance combined with a Class II corrector.

Correcting a complete Class II malocclusion in an adult patient can be quite difficult. If the patient has a large skeletal discrepancy, orthognathic surgery is the treatment of choice. However, if the discrepancy is small or if the situation is borderline and the mandibular incisors are retroclined, Class II correctors can be used. This clinical report presents the orthodontic treatment of a 24-year-old woman with Class II malocclusion. Clinically, her maxilla was slightly protruded, and the mandible was well-positioned. She had uprighted maxillary and mandibular anterior teeth and a deepbite, and she opted for a more esthetically appealing orthodontic appliance. The treatment plan included leveling and alignment of the teeth in both arches, Class II correction, establishing Class I molar and canine relationships, correction of overbite and overjet, adjustment of midlines, and improvement of facial and dental esthetics. Orthodontic treatment consisted of customized lingual appliances combined with a Class II fixed corrector.