Clear Aligner Use Following Surgery-First Mandibular Prognathism Correction.

This case report introduces a treatment in mandibular prognathism correction by combining the surgery-first (SF) approach and clear aligners. An intraoral scanner (TRIOS 3, 3Shape, Copenhagen, Denmark) and a virtual setup program (OrthoAnalyzer, 3Shape) were used for treatment simulation. All clear aligners were fabricated using a 3-dimensional printer. The total treatment was completed within 3 months after surgery. An immediate improvement of the facial profile was obtained using the SF approach, and rapid and esthetic tooth movement was achieved using clear aligners. This case report demonstrated that the combination of the SF approach and clear aligners could be a patient-oriented surgical-orthodontic treatment method.

Comparison of the Efficacies of Dry Needling and Botox Methods in the Treatment of Myofascial Pain Syndrome Affecting the Temporomandibular Joint.

BACKGROUND: To compare the efficacies of botulinum toxin-A injection and dry needling methods in the treatment of patients with myofascial pain syndrome (MPS) in the temporomandibular joint (TMJ). METHODS: In this prospective study, 40 MPS patients (29 women, 11 men) were randomly assigned to abobotulinum toxin-A injection (Group 1, n = 20) or dry needling (Group 2, n = 20) groups. Pain, crepitation, functional limitation, maximum mouth opening, jaw strength were evaluated at baseline and 6 weeks, and the results in both groups were compared. RESULTS: The average age of the authors' patients was 33.8±8.1. There was a remarkable difference between 2 groups regarding visual analog scale for TMJ pain at rest (P = 0.048). The pain at rest was relieved more effectively in Group 2 at the end of 6 weeks. Improvement in jaw protrusion angles on the right (P = 0.009) and left (P = 0.002) sides was more evident in Group 2 after 6 weeks. There were significant pain relief and functional improvement after treatment in both groups. In Group 2, recovery of the TMJ function was more obvious in 6 weeks following dry needling (P = 0.002). CONCLUSION: The authors suggest that abobotulinum toxin-A injection and dry needling yield satisfactory therapeutic outcomes regarding pain relief and restoration of function in patients with MPS involving TMJ. Further multicentric, randomized, controlled trials on larger series are warranted to obtain more accurate and reliable information.

Implant Treatment after Sagittal Splitting Ramus Osteotomy and Alveolar Ridge Augmentation in Patient with Mandibular Prognathism and Multiple Missing Maxillary Teeth.

An abnormal maxillomandibular ridge relationship frequently hinders oral implant treatment in patients with jaw deformities. Here, we describe a patient who was experiencing difficulty using dentures due to multiple maxillary tooth loss and mandibular prognathism. Treatment comprising sagittal splitting ramus osteotomy and alveolar ridge augmentation using bone grafts harvested from the mandibular ramus followed by implant treatment yielded good outcomes. The patient was a 47-year-old woman presenting with an unstable upper partial denture. Although prior prosthetic treatment for mandibular prognathism had resulted in normal overbite, she had since lost an increasing number of teeth due to advanced periodontal disease, impairing support for the denture. She was referred to the Department of Oral Implantology at the Tokyo Dental College Chiba Hospital in October 2008. Subsequent treatment comprised implant treatment following maxillary alveolar ridge augmentation and sagittal splitting ramus osteotomy to correct the maxillary-mandibular relationship. In January 2010, sagittal splitting ramus osteotomy and alveolar bone augmentation using a bone graft from the mandibular ramus were performed under general anesthesia. In July and August 2010, a total of 7 implants were placed in the maxilla and implant superstructure preparation started after 3 months. Taking both the patient's wishes and ease of maintenance into account, retrievable superstructures made of Auro Galvano Crown were fitted in April 2011. The jaw-to-jaw alveolar ridge relationship was improved by sagittal splitting ramus osteotomy, rendering subsequent treatment, from implant placement to superstructure preparation, feasible by conventional methods. The use of surplus bone generated during sagittal splitting ramus osteotomy for bone augmentation avoided the need to harvest bone from another area.

Effectiveness of early orthopaedic treatment with headgear: a systematic review and meta-analysis.

Background: Although the headgear appliance has been used extensively to correct anteroposterior discrepancies, its treatment effects have not yet been adequately assessed in an evidence-based manner. Objective: Aim of this systematic review was to assess the therapeutic and adverse effects of early headgear treatment from controlled clinical trials on human patients in an evidence-based manner. Search methods: An unrestricted electronic search of six databases from inception to December 2015. Selection criteria: Randomized and prospective non-randomized controlled trials assessing the effects of headgear treatment on human patients. Data collection and analysis: After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MDs) and relative risks (RRs), including their 95% confidence intervals (CIs) were performed, followed by subgroup and sensitivity analyses. Results: A total of 18 unique studies with a total of 930 (56% male/44% female) patients were included. Headgear treatment was associated with a posterior translation of the anterior maxilla border in the short term, as seen by the mean annualized change in the SNA angle (MD = -1.63°/year; 95% CI = -2.20 to -1.06°/year; high quality evidence) compared to untreated patients. This effect was independent of the rotation of the palatal plane and the inclination of the upper incisors, while a proportional relationship with the initial discrepancy in SNA was seen. The clinical significance of this improvement diminished in the long term, although only limited evidence existed. Additionally, early headgear treatment might decrease the risk of dental trauma during the following years (RR = 0.34; 95% CI = 0.14 to 0.80; moderate quality evidence). Low quality evidence on the effect of headgear on the rotation of the palatal plane, the nasolabial angle, the occlusal outcome, and signs of temporomandibular disorders precluded robust assessments, due to risk of bias, inconsistency, imprecision, and small-study effects. Conclusions: Based on existing trials, headgear is a viable treatment option to modify sagittal growth of the maxilla in the short term in Class II patients with maxillary prognathism. Registration: PROSPERO (CRD42015029837). Funding: None.

Comparison of Orthodontics-First and Surgery-First Approach in Positional Changes of the Condyle After Mandibular Setback Surgery Using Three-Dimensional Analysis.

PURPOSE: To examine and compare the 3-dimensional (3D) postoperative changes of the condylar position after mandibular setback surgery using the orthodontics-first approach (OFA) and surgery-first approach (SFA). MATERIALS AND METHODS: This retrospective cohort study included patients who had undergone bilateral sagittal split ramus osteotomy for mandibular prognathism using OFA or SFA. Computed tomography images were obtained and analyzed preoperatively (T0), postoperatively (T1), and at the 6-month follow-up visit (T2). The bodily shift of the condylar center and rotational movement of the condylar head were measured using the 3D coordinate system between each time point and compared between the OFA and SFA groups. Repeated measures analysis of variance with a Bonferroni post hoc test was used to compare the time course changes of the condylar position for the 2 surgical-orthodontic approaches. RESULTS: A total of 55 patients (mean age 21.9 years; 31 males, 24 females) were evaluated. Of the 55 patients, 29 had undergone OFA and 26, SFA. In both groups, the condyle showed perioperative lateral and inferior displacement with inward rotation, followed by returning to its preoperative position during the 6 months postoperatively. No significant difference was found between the 2 groups in the time course change of the condylar position. CONCLUSIONS: Regardless of the timing of the operation (OFA vs SFA), the perioperative and postoperative changes of the condylar position after mandibular setback surgery are equivalent.

Strategic camouflage treatment of skeletal Class III malocclusion (mandibular prognathism) using bone-borne rapid maxillary expansion and mandibular anterior subapical osteotomy.

This case report presents the camouflage treatment that successfully improved the facial profile of a patient with a skeletal Class III malocclusion using bone-borne rapid maxillary expansion and mandibular anterior subapical osteotomy. The patient was an 18-year-old woman with chief complaints of crooked teeth and a protruded jaw. Camouflage treatment was chosen because she rejected orthognathic surgery under general anesthesia. A hybrid type of bone-borne rapid maxillary expander with palatal mini-implants was used to correct the transverse discrepancy, and a mandibular anterior subapical osteotomy was conducted to achieve proper overjet with normal incisal inclination and to improve her lip and chin profile. As a result, a Class I occlusion with a favorable inclination of the anterior teeth and a good esthetic profile was achieved with no adverse effects. Therefore, the hybrid type of bone-borne rapid maxillary expander and a mandibular anterior subapical osteotomy can be considered effective camouflage treatment of a skeletal Class III malocclusion, providing improved inclination of the dentition and lip profile.

Class III malocclusion treated with distalization of the mandibular dentition with miniscrew anchorage: A 2-year follow-up.

This case report describes the orthodontic camouflage treatment for a 16-year-old Chinese girl with a Class III malocclusion. The treatment included extractions of the mandibular second molars, fixed appliance therapy, and miniscrew-aided mandibular arch distalization. Pretreatment, posttreatment, and 2-year follow-up records are shown. The anterior negative overjet and the Class III molar and canine relationships were corrected. The patient's facial profile was greatly improved. The mandibular third molars erupted into the second molar spaces, with acceptable intercuspation with the maxillary dentition.

Sagittal correction of adolescent patients with modified palatal anchorage plate appliances.

The palate has been reported to be a suitable skeletal anchorage site in adolescents and adults. This article introduces new treatment modalities for correction of sagittal discrepancies by molar protraction and distalization with a modified palatal anchorage plate appliance. The effectiveness and versatility of this method are demonstrated in 2 adolescent patients.

Class III orthognathic surgical cases facilitated by accelerated osteogenic orthodontics: a preliminary report.

OBJECTIVES: To describe a multidisciplinary treatment approach that includes corticotomy, orthodontic force and orthognathic surgery for the management of skeletal Class III surgical cases. The main advantage of the combined techniques is a reduction in treatment time for young adult patients. METHOD: Accelerated Osteogenic Orthodontics (AOO) was delivered to three young adult patients during their pre-surgical orthodontic treatment. After aligning and levelling the dental arches, a piezosurgical corticotomy was performed to the buccal aspect of the alveolar bone. Bone graft materials were used to cover the decorticated area and soft tissue flaps were replaced. RESULTS: The mean time for extraction space closure was 5.4 ± 1.3 months and the mean time for pre-surgical orthodontic treatment was 12.0 ± 0.9 months. The average total treatment time was 20.4 ± 2.4 months. A pre-existing bony fenestration in the buccal cortex adjacent to the right lateral incisor root apex of Case 1 was corrected. CONCLUSION: The facial aesthetics of three patients improved following multidisciplinary treatment. This approach may be an efficient method for the orthognathic patient who desires a reduced treatment time, but further clinical research is required.

Anterior open bite--simplified non surgical technique to correct in adults.

Skeletal Anterior open bite abnormality in adults is probably the most difficult to correct in orthodontics just behind Skeletal Class III abnormality. Literature research shows various techniques to correct this problem, often via orthognathic surgery, but it was difficult to find in the literatures a simplified non-surgical technique. This author propose, a simplified, non-surgical technique to correct skeletal anterior open bite in adults using non-ligating, frictionless brackets and vertical elastics. Some indications and contra-indications will be discussed

Extreme Dental Compensation in an Adult Skeletal Class III Malocclusion: 3-Year Follow-up of a Successfully Compromised Treatment.

Nonsurgical orthodontic treatment of a patient with severe skeletal Class III malocclusion, negative overjet, increased overbite and maxillary crowding is described Although the treatment options included an orthodontic-surgical approach, high cost of the surgical procedure was the main reason for extreme dental compensation to have been performed. Four-premolar extraction protocol associated with intermaxillary Class III elastics were used to correct the malocclusion at the expense of increasing the initial dental compensation without producing any noticeable skeletal change. Satisfactory and stable occlusion was achieved with dental and smile esthetics improvement, but the amount of facial changes was limited by the nonsurgical protocol. The clinical results and implications of compensatory treatment as well as its relevance within the patient context are discussed based on scientific evidences.

Augmented corticotomy-assisted surgical orthodontics decompensates lower incisors in Class III malocclusion patients.

PURPOSE: To quantitatively evaluate lower incisor decompensation and the surrounding periodontal region after augmented corticotomy-assisted surgical orthodontics in patients with Class III malocclusion. MATERIALS AND METHODS: This prospective study enrolled patients with severe Class III malocclusion who underwent augmented corticotomy in the lower anterior region before orthodontic surgery. Cone-beam computed tomograms and lateral cephalograms were obtained before treatment (T0), after presurgical orthodontic treatment (T1), and at removal of the orthodontic surgical appliances (T2). Repeated measures analysis of variance was used to compare variables at each time point: root length (RL), anterior vertical alveolar bone level at the labial side (AVBL), posterior vertical alveolar bone level at the lingual side (PVBL), labial alveolar bone thickness at the apex (LA), lingual alveolar bone thickness at the apex (LP), and angle of the incisor to the mandibular plane (L1-MP). RESULTS: In the 8 subjects studied, RL was maintained from T0 to T2 (P > .05), whereas AVBL and PVBL increased from T0 to T1 (P < .05) and then decreased from T1 to T2 (P < .05). LA and L1-MP increased from T0 to T1 (P < .001) but remained steady from T1 to T2 (P > .05). LP decreased from T0 to T1 (P < .05) but increased from T1 to T2 (P < .05) with no further change. CONCLUSIONS: Augmented corticotomy-assisted surgical orthodontics can achieve adequate tooth decompensation with minimal periodontal side-effects in the lower anterior region in patients with Class III malocclusion.

Stability of mandibular setback surgery with and without presurgical orthodontics.

PURPOSE: The purpose of this study was to compare stability after mandibular setback surgery in patients with skeletal Class III malocclusion with and without presurgical orthodontics. MATERIALS AND METHODS: This retrospective cohort study included consecutive patients with skeletal Class III malocclusion who underwent only mandibular surgery. Patients treated with the surgery-first approach without presurgical orthodontics (SF group) were compared with a control group (conventional surgery with presurgical orthodontics; CS group) using lateral cephalograms taken preoperatively, immediately postoperatively, and at the time of debonding. Predictor variables (group and timing), outcome variables (cephalometric measurements over time), and other variables, such as baseline characteristics, were evaluated to determine the difference in stability of mandibular positions such as the B point. RESULTS: Sixty-one patients were enrolled in this study (CS group, n = 38; SF group, n = 23). Baseline demographic variables were similar in the 2 groups except for orthodontic treatment period. The mean setback of the mandible at the B point was similar (CS group, 8.7 mm; SF group, 9.1 mm; difference, P > .05), but the horizontal relapse in the SF group (2.4 mm) was significantly greater than in the CS group (1.6 mm; P < .05). Patients with a horizontal relapse greater than 3 mm comprised 39.1% of the SF group compared with 15.8% of the CS group (P < .05). CONCLUSION: Mandibular sagittal split ramus osteotomy without presurgical orthodontic treatment was less stable than conventional orthognathic surgery for mandibular prognathism. Before performing a surgery-first approach, skeletal stability needs to be considered.

Amelogenesis imperfecta with multiple impacted teeth and skeletal class III malocclusion: complete mouth rehabilitation of a young adult.

Amelogenesis imperfecta is an autosomal dominant disorder. It is a group of hereditary diseases showing abnormal enamel density and crown malformation. This clinical report describes the oral rehabilitation of a young adult diagnosed with a variant of hypoplastic amelogenesis imperfecta with multiple impacted teeth and skeletal class III malocclusion. The treatment procedures of teeth extractions, endodontic treatment of remaining teeth followed by post and core restorations, esthetic and functional crown lengthening, and metal ceramic fixed dental prostheses were performed sequentially in the maxillary arch. The mandibular arch was restored with an overdenture. One-year follow-up revealed satisfactory results.

Long-term orthodontic and surgical treatment and stability of a patient with Beckwith-Wiedemann syndrome.

Beckwith-Wiedemann syndrome (BWS) is a congenital growth disorder. Children born with BWS develop enlarged organs, including the tongue, a large body, and other signs. A woman with BWS was treated and followed for 30 years. Treatment consisted of tongue reduction, orthopedic and orthodontic treatment, orthognathic surgery, and retention. The patient was first treated when she was 5 years old. Her original orthodontic problems included macroglossia, anterior open bite, anterior crossbite, and a skeletal Class III jaw relationship caused by significant mandibular protrusion. The jaw-base relationships did not improve in the early preadolescent period after phase 1 of orthodontic treatment with a vertical chincap. With the growth spurt accompanying puberty, she developed a severe skeletal Class III jaw relationship and a constricted maxillary arch. Surgically assisted rapid maxillary expansion was performed at 23 years of age to correct the severe discrepancy between the maxillary and mandibular dental arch widths. Then, at 26 years, a LeFort I osteotomy, a horseshoe osteotomy, a bilateral sagittal split ramus osteotomy, and genioplasty were performed after presurgical orthodontic treatment with extraction of the mandibular first molars. Both the facial profile and the occlusion were stable after 6 years of retention. This case report discusses the result of long-term observation of a patient with BWS who underwent tongue reduction, early orthodontic treatment, and surgical-orthodontic treatment.

Orthodontic decompensation and correction of skeletal Class III malocclusion with gradual dentoalveolar remodeling in a growing patient.

An 8-year-old girl with a skeletal Class III malocclusion was treated in 2 phases. Maxillary expansion and protraction were carried out as the early intervention. However, her maxillary hypoplasia and mandibular hyperplasia deteriorated with age. The phase 2 comprehensive treatment began with proper mechanics when she was 12 years old with growth potential. In the maxillary arch, an auxiliary rectangular wire was used with a round main wire and an opening spring to create space for the impacted teeth and to bodily move the anterior teeth forward. Decompensation of mandibular incisors and correction of the Class III malocclusion were achieved by short Class III elastics with light forces and a gentle interaction between the rectangular wires and the lingual root-torque slots. The phase 2 active treatment period was 4 years 8 months. The 2-year follow-up indicated that our treatment results were quite stable.

An efficient biomechanical approach for the management of an impacted maxillary central incisor.

Treatment of an impacted maxillary central incisor poses a unique challenge to the orthodontist because of its position within the esthetic zone, requiring careful management of the soft tissues and an effective biomechanical setup for alignment. This article describes a novel method of extending an extrusion wire from cross tubes attached on the base archwire for forced eruption of impacted central incisors. The effectiveness and versatility of this method are demonstrated with 2 patients.

Effects of maxillary protraction for early correction of class III malocclusion.

This prospective study investigated the skeletal, dental, and soft-tissue effects of a mini maxillary protractor appliance in class III subjects with maxillary retrusion and mandibular protrusion and compared these changes with those of untreated, well matched control sample with normal occlusions. Twenty patients with class III malocclusion (mean age 11.1 ± 0.8 years) and 20 subjects with normal occlusion (mean age 10.9 ± 0.4 years) were included to this study. The class III subjects were treated with the mini maxillary protractor appliance, and the others were used as control subjects. Paired t-test and Student's t-test were used to determine the within- and between-group differences, respectively. In the study group, the maxilla moved forward (SNA, 2.0 degrees and A-Y, 2.4mm) (P < 0.001) with a slight rotation of palatal and occlusal planes (SN-PP, -0.8 degree and SN-OP, -0.7 degree) (P > 0.05). The mandible displaced backwards and downwards (SNB, -1.1 degrees; SND, -0.9 degree; B-Y, -0.9 mm and Pog-Y, -0.3mm; P < 0.001). These movements in the maxilla and mandible caused a significant improvement in intermaxillary sagittal relationship (ANB, 3.0 degrees; Convexity, 6.3 degrees; Wits, 4.6mm; P < 0.001). The maxillary incisors moved forward (2.2 degrees) while the mandibular ones backward (-1.9 degrees). The improvement in overjet was 5.0mm, and 66.1 per cent of this change (3.3mm) was skeletal (A-Y; 2.4mm and B-Y; -0.9 mm), and the remaining (1.7 mm) dentoalveolar (U1-NA; 0.9 mm and L1-NB; -0.8mm). The change in Ls-E measurement was more in the study group (2.1mm), and the difference between the groups was statistically significant (P < 0.001).

Occlusal concepts application in resolving implant prosthetic failure: case report.

The prosthetic management of a poor implant treatment is presented in this case report. The recommended occlusion concepts for implant-supported prostheses were applied for the resolution of the case. The rehabilitation of the posterior segments provided a mutually protected occlusion with adequate distribution of the axial and lateral bite forces with stable posterior occlusion. The clinical exam indicated the need for modification in the vertical dimension of occlusion. Sufficient interocclusal rest space was present to test the alteration in the vertical dimension. The aim was to achieve an occlusion scheme that followed four specific criteria: (1) centric contacts and centric relation of the jaw-to-jaw position; (2) anterior guidance only; (3) shallow anterior angle of tooth contact; and (4) vertical dimension of occlusion with acceptable tooth form and guidance. The success of an oral rehabilitation relies in following the aforementioned criteria, appropriate interaction between the dental laboratory technician and the clinician, careful elaboration of the provisional rehabilitation with all the desired details to be reproduced in the final prosthetic restoration and sufficient follow-up time of the provisional prostheses before placing the final restoration.

Prosthetic rehabilitation of a cleidocranial dysplasia patient with vertical maxillofacial deficiency: a clinical report.

Cleidocranial dysplasia (CCD) is a rare congenital disorder characterized by skeletal and dental anomalies. This clinical report describes the prosthodontic approach to treating a CCD patient who presented with decreased facial height and relative mandibular protrusion due to maxillary hypoplasia after orthodontic treatment. Functional and esthetic rehabilitation was achieved using telescopic detachable prostheses in the maxilla and osseointegrated implants and metal-ceramic fixed dental prostheses in the mandible. These treatment approaches precluded the need for orthognathic surgical correction and presented a favorable prognosis during the 5-year observation period.