Treatment of skeletal class III malocclusion using a combined clear aligner and surgery-early approach : Assessment based on the American Board of Orthodontics Objective Grading System.

PURPOSE: To evaluate whether clear aligner therapy (CAT) combined with a surgery-early approach can achieve good therapeutic effects in patients with skeletal class III malocclusion. METHODS: Thirty consecutive skeletal class III malocclusion cases treated with clear aligners combined with early surgery were selected. Treatment time, lateral cephalograms and American Board of Orthodontics Objective Grading System (ABO-OGS) scores of the treatment models were measured to evaluate the treatment efficiency, facial profile, and occlusion. RESULTS: The results showed that early surgery was achieved after 7.71 months of presurgical orthodontics, on average. ANB decreased by 5.57° (P < 0.001), and STissue N Vert to Pog' decreased by 7.29 mm (P = 0.001), both reaching normal values. The posttreatment ABO-OGS scores were 26.600 on average, meeting its standards. CONCLUSIONS: With the assistance of CAT, early surgery can be accomplished in patients with skeletal class III malocclusion, improving their facial profile and achieving functional occlusion.

Distinguishing neural correlates of context-dependent advantageous- and disadvantageous-inequity aversion.

Humans can integrate social contextual information into decision-making processes to adjust their responses toward inequity. This context dependency emerges when individuals receive more (i.e., advantageous inequity) or less (i.e., disadvantageous inequity) than others. However, it is not clear whether context-dependent processing of advantageous and disadvantageous inequity involves differential neurocognitive mechanisms. Here, we used fMRI to address this question by combining an interactive game that modulates social contexts (e.g., interpersonal guilt) with computational models that enable us to characterize individual weights on inequity aversion. In each round, the participant played a dot estimation task with an anonymous coplayer. The coplayer would receive pain stimulation with 50% probability when either of them responded incorrectly. At the end of each round, the participant completed a variant of dictator game, which determined payoffs for him/herself and the coplayer. Computational modeling demonstrated the context dependency of inequity aversion: when causing pain to the coplayer (i.e., guilt context), participants cared more about the advantageous inequity and became more tolerant of the disadvantageous inequity, compared with other conditions. Consistently, neuroimaging results suggested the two types of inequity were associated with differential neurocognitive substrates. While the context-dependent processing of advantageous inequity was associated with social- and mentalizing-related processes, involving left anterior insula, right dorsolateral prefrontal cortex, and dorsomedial prefrontal cortex, the context-dependent processing of disadvantageous inequity was primarily associated with emotion- and conflict-related processes, involving left posterior insula, right amygdala, and dorsal anterior cingulate cortex. These results extend our understanding of decision-making processes related to inequity aversion.

Social status modulates the neural response to unfairness.

In human society, which is organized by social hierarchies, resources are usually allocated unequally and based on social status. In this study, we analyze how being endowed with different social statuses in a math competition affects the perception of fairness during asset allocation in a subsequent Ultimatum Game (UG). Behavioral data showed that when participants were in high status, they were more likely to reject unfair UG offers than in low status. This effect of social status correlated with activity in the right anterior insula (rAI) and with the functional connectivity between the rAI and a region in the anterior middle cingulate cortex, indicating that these two brain regions are crucial for integrating contextual factors and social norms during fairness perception. Additionally, there was an interaction between social status and UG offer fairness in the amygdala and thalamus, implicating the role of these regions in the modulation of social status on fairness perception. These results demonstrate the effect of social status on fairness perception and the potential neural underpinnings for this effect.

Neural basis of increased costly norm enforcement under adversity.

Humans are willing to punish norm violations even at a substantial personal cost. Using fMRI and a variant of the ultimatum game and functional magnetic resonance imaging, we investigated how the brain differentially responds to fairness in loss and gain domains. Participants (responders) received offers from anonymous partners indicating a division of an amount of monetary gain or loss. If they accept, both get their shares according to the division; if they reject, both get nothing or lose the entire stake. We used a computational model to derive perceived fairness of offers and participant-specific inequity aversion. Behaviorally, participants were more likely to reject unfair offers in the loss (vs gain) domain. Neurally, the positive correlation between fairness and activation in ventral striatum was reduced, whereas the negative correlations between fairness and activations in dorsolateral prefrontal cortex were enhanced in the loss domain. Moreover, rejection-related dorsal striatum activation was higher in the loss domain. Furthermore, the gain-loss domain modulates costly punishment only when unfair behavior was directed toward the participants and not when it was directed toward others. These findings provide neural and computational accounts of increased costly norm enforcement under adversity and advanced our understanding of the context-dependent nature of fairness preference.