Noninvasive conservative management of anterior open bite treated with TADs versus clear aligner therapy.

OBJECTIVES: Anterior open bite can be treated non-surgically via molar intrusion using temporary skeletal devices (TAD). Clear aligner therapy (CAT) is recognized as a viable therapeutic modality for non-extraction treatment of adults with mild open bite. This study aimed to compare the treatment effect and mechanisms of open bite closure between patients treated with braces and TADs double arch intrusion and those treated with CAT. Treatment success at T3 was based on 1- positive overbite on ceph; 2- Change in the vertical dimension 3- post treatment POSI score equal to zero. MATERIAL AND METHODS: The TAD group includes 18 consecutively treated patients from the main author. The CAT group consisted of 16 selected patients from three different orthodontists. The observation time points were as follows: pretreatment (T1), end of molar intrusion and positive overbite achieved (T2), end of treatment (T3), at least 6-month follow-up (T4). Treatment changes were assessed by cephalometric analysis and frontal intraoral photo. RESULTS: At the end of treatment, 100% of the patient of the TAD group and 78,6% of the CAT group had a posi score of 0. The TAD group showed a significant reduction in vertical measurements (SN-MPA: -1,55° ± 0.41, LAFH: -3,05 ± 0.51 mm, U6-PP: -1.48 ± 0.30 mm), but the CAT group did not have significant changes for these variables. Both groups had significant increases in overbite from T1 to T3 (TAD: 4,32 ± 0,5 mm; CAT: 2,33 ± 0.56 mm), and overbite remained stable at T4. The CAT group did not have a significant upper molar intrusion, but a significant extrusion of 1.22 ± 0.42 mm of the lower incisor occurred. CONCLUSION: The TAD group achieved bite closure by upper molar intrusion, lower molar and incisors vertical control, and mandibular plane counterclockwise rotation, resulting in an improved AP and vertical relationship. The CAT group achieved bite closure through the lower incisor extrusion without significant change in the vertical dimension. CLINICAL RELEVANCE: This study provides relevant information about the skeletal and dental changes of open bite treatment with TADs double arch intrusion. The comparison with a control group treated with CAT confirms known information.

Maxillary expansion in nongrowing patients. Conventional, surgical, or miniscrew-assisted, an update.

Maxillary transverse deficiency can occur in various clinical dentoskeletal deformities and include unilateral or bilateral posterior crossbite, narrow, tapering, or high palatal arch. The development of temporary anchorage devices led to a new generation of tooth-bone-borne expansion appliance using two or four screws to apply the mechanical forces to the bone and reduce the stress to the anchored teeth. The aim of these new devices is to reduce the adverse dentoalveolar effect and achieve more skeletal expansion than conventional tooth-borne rapid palatal expansion. This article reviews the age limitation and complication and soft tissue change of nonsurgical maxillary expansion. We discuss the approach of surgical maxillary expansion with maxillary skeletal expander device. The clinical case will show the benefit of nonsurgical and surgical tooth-bone-borne rapid palatal expansion.

Assessment of soft-tissue vs hard-tissue changes after isolated functional genioplasty / Évaluation des modifications des tissus mous par rapport aux tissus durs après une génioplastie fonctionnelle isolée

Introduction: This study aimed to determine the vertical and horizontal soft-tissue vs hard-tissue changes after isolated functional genioplasty and to revisit hard-tissue remodeling at the symphysis. Methods: Seventy-five patients who underwent genioplasty as an isolated procedure at the end of their orthodontic treatment were divided into three groups on the basis of their age at surgery: < 15 years (group 1), 15-18 years (group 2) and ≥ 19 years (group 3). Patients were evaluated at three time points: immediately before surgery (T1), immediately after surgery (T2) and two years after surgery (T3). In addition, 25 patients who did not accept genioplasty, were age-matched with group 1, and had a follow-up radiograph two years after the end of their orthodontic treatment were used as a control group. Results: From T2 to T3, group 1 showed less forward horizontal hard-tissue and soft-tissue changes at pogonion (Pg) than the control group; however, no difference was noted for vertical changes at Me & Me'. From T1 to T3, the horizontal hard-tissue and soft-tissue changes at Pg were 6.39 mm and 6.72 mm, respectively, for surgical groups. Vertical hard-tissue change at menton (Me) showed a reduction of 1.63 mm (95% confidence interval [CI], -3.37 to 0.11) and 3.89 mm (95% CI, -5.83 to -1.95) in nongrowing female and male patients, respectively. The vertical soft-tissue change reduction was similar for nongrowing male and female patients (1.7 mm [95% CI, -2.96 to -0.45]). Soft-tissue thickness change at Pg (0.33 mm) was not significant. In contrast, a small but significant increase in soft-tissue thickness was noted at Me (0.54 mm). Linear regressions were calculated for all groups and allowed for predicting long-term soft-tissue changes (T3-T1) using the amount of surgical displacement (T2-T1). Conclusions: The horizontal hard-tissue change was stable for nongrowing patients, and the horizontal soft-tissue change was 92% of hard-tissue. Vertical soft-tissue change is less predictable. Variation of soft-tissue thickness after genioplasty can be explained by skeletal changes and the achievement of an unforced labial occlusion. These results support the functional and esthetic benefits of this surgery. Comparison with the control group showed that genioplasty does not change the growth pattern, and bone remodeling is likely to explain the difference noted at Pg.

Introduction: Cette étude avait pour but de déterminer les modifications verticales et horizontales des tissus cutanés par rapport aux tissus osseux après une génioplastie fonctionnelle isolée et d'évaluer le remodelage des tissus osseux au niveau de la symphyse. Méthodes: Soixante-quinze patients qui ont subi une génioplastie comme procédure isolée à la fin de leur traitement orthodontique ont été divisés en trois groupes sur la base de leur âge au moment de la chirurgie : moins de 15 ans (groupe 1), de 15 à 18 ans (groupe 2) et de 19 ans et plus (groupe 3). Les patients ont été évalués à trois moments : immédiatement avant la chirurgie (T1), immédiatement après la chirurgie (T2) et deux ans après la chirurgie (T3). En outre, 25 patients qui n'ont pas accepté la génioplastie, dont l'âge correspondait à celui du groupe 1 et qui ont subi une téléradiographie de profil de contrôle deux ans après la fin de leur traitement orthodontique ont été utilisés comme groupe témoin. Résultats: De T2 à T3, le groupe 1 a montré moins de changements horizontaux des tissus durs et mous vers l'avant au niveau du pogonion (Pg) que le groupe témoin ; cependant, aucune différence n'a été notée pour les changements verticaux au niveau de Me & Me'. De T1 à T3, les changements horizontaux des tissus osseux et cutanés à Pg étaient respectivement de 6,39 mm et 6,72 mm pour les groupes chirurgicaux. La modification verticale des tissus osseux au niveau du menton (Me) a montré une réduction de 1,63 mm (IC 95 %, -3,37 à 0,11) et de 3,89 mm (IC95 %, -5,83 à -1,95) chez les patients féminins et masculins sans croissance, respectivement. La réduction verticale de la modification des tissus mous était similaire chez les patients homme et femme qui ne sont pas en croissance (1,7 mm [IC 95 %, -2,96 à -0,45]). La modification de l'épaisseur des tissus mous à Pg (0,33 mm) n'était pas significative. En revanche, une augmentation faible mais significative de l'épaisseur des tissus cutanés a été observée à Me (0,54 mm). Des régressions linéaires ont été calculées pour tous les groupes et permettent de prédire les changements à long terme des tissus cutanés (T3-T1) en utilisant la quantité de déplacement chirurgical (T2-T1). Conclusions: Le changement horizontal des tissus osseux est stable pour les patients qui ne grandissent pas et le changement horizontal des tissus mous représente 92 % des tissus durs. Le changement vertical des tissus cutanés est moins prévisible. La variation de l'épaisseur des tissus cutanés après une génioplastie peut s'expliquer par les changements squelettiques et l'obtention d'une occlusion labiale non forcée. Ces résultats confirment les avantages fonctionnels et esthétiques de cette chirurgie. La comparaison avec le groupe témoin a montré que la génioplastie ne modifie pas le schéma de croissance et le remodelage osseux est susceptible d'expliquer la différence constatée à Pg.

Asymmetric Maxillary Expansion Introduced by Surgically Assisted Rapid Palatal Expansion: A Systematic Review.

PURPOSE: A commonly reported complication of surgically assisted rapid palatal expansion (SARPE) that has not been explored extensively is uneven expansion between left and right sides, which requires secondary surgery for correction. This systematic review aims to analyze the prevalence and potential causes of asymmetric expansion in the transverse dimension after SARPE to guide the clinical practice. METHODS: Electronic databases and manual search were used to search for original articles published on SARPE on March 11, 2022. Original human studies that recorded the number and percentage of asymmetric expansion after two-piece SARPE were included. The 2020 Preferred Reporting Items for Systemic Reviews and Meta-Analyses guideline was implemented for the quality assessment and data analysis of the included articles. The study was registered at the International Prospective Register of Systematic Reviews under the number CRD42022300782. RESULTS: After applying inclusion and exclusion criteria, 13 articles were included in the final review. The risk of bias was high in 8 studies and medium in the other 5 studies. Overall, the prevalence of asymmetric expansion in the transverse dimension (different amount of expansion between left and right sides) was 7.52%, with 12.90% of patients involved receiving a second surgery for correction. Expander design did not significantly affect the rate of asymmetry expansion. Pterygomaxillary fissure release significantly increased the rate of asymmetry expansion (11.02% vs 5.08%, P < .001). In comparison, lateral nasal wall osteotomy (4.26% vs 14.77%, P < .001) and release of the nasal septum (5.22% vs 17.15%, P < .001) significantly lowered the rate of asymmetry expansion, respectively. CONCLUSIONS: Asymmetric dentoskeletal expansion between left and right sides is a common complication of SARPE procedures, mostly caused by variations in surgical cuts. However, the risk of bias in currently available publications is high. Further studies are warranted to fully understand the causes of asymmetric expansion.

Assessment of soft-tissue vs hard-tissue changes after isolated functional genioplasty.

INTRODUCTION: This study aimed to determine the vertical and horizontal soft-tissue vs hard-tissue changes after isolated functional genioplasty and to revisit hard-tissue remodeling at the symphysis. METHODS: Seventy-five patients who underwent genioplasty as an isolated procedure at the end of their orthodontic treatment were divided into 3 groups on the basis of their age at surgery: <15 years (group 1), 15-18 years (group 2), and ≥19 years (group 3). Patients were evaluated at 3 time points: immediately before surgery (T1), immediately after surgery (T2), and 2 years after surgery (T3). In addition, 25 patients who did not accept genioplasty, were age-matched with group 1, and had a follow-up radiograph 2 years after the end of their orthodontic treatment were used as a control group. RESULTS: From T2 to T3, group 1 showed less forward horizontal hard-tissue and soft-tissue changes at pogonion (Pg) than the control group; however, no difference was noted for vertical changes at Me & Me'. From T1 to T3, the horizontal hard-tissue and soft-tissue changes at Pg were 6.39 mm and 6.72 mm, respectively, for surgical groups. Vertical hard-tissue change at menton (Me) showed a reduction of 1.63 mm (95% confidence interval [CI], -3.37 to 0.11) and 3.89 mm (95% CI, -5.83 to -1.95) in nongrowing female and male patients, respectively. The vertical soft-tissue change reduction was similar for nongrowing male and female patients (1.7 mm [95% CI, -2.96 to -0.45]). Soft-tissue thickness change at Pg (0.33 mm) was not significant. In contrast, a small but significant increase in soft-tissue thickness was noted at Me (0.54 mm). Linear regressions were calculated for all groups and allowed for predicting long-term soft-tissue changes (T3-T1) using the amount of surgical displacement (T2-T1). CONCLUSIONS: The horizontal hard-tissue change was stable for nongrowing patients, and the horizontal soft-tissue change was 92% of hard-tissue. Vertical soft-tissue change is less predictable. Variation of soft-tissue thickness after genioplasty can be explained by skeletal changes and the achievement of an unforced labial occlusion. These results support the functional and esthetic benefits of this surgery. Comparison with the control group showed that genioplasty does not change the growth pattern, and bone remodeling is likely to explain the difference noted at Pg.

Progressive idiopathic condylar resorption: Three case reports.

Progressive condylar resorption, also known as idiopathic condylar resorption, is an uncommon, aggressive, degenerative disease of the temporomandibular joint (TMJ) seen mostly in adolescent girls and young women. This condition leads to loss of condylar bone mass, decrease of mandibular ramal height, steep mandibular and occlusal plane angles, and an anterior open bite. In 3 case reports, we review the pathogenesis of TMJ degenerative disease and the clinical management of TMJ arthrosis. We emphasize that TMJ arthritic disease should be discussed in dental circles as a pathologic entity in the same way that orthodontists discuss arthritic disease in orthopedic circles. Regarding the degenerative pathology of the TMJ, treatment goals include restored function and pain reduction. The treatment methods used to achieve these goals can range from noninvasive therapy to minimally invasive and invasive surgery. Most patients can be treated noninvasively, and the importance of disease prevention and conservative management in the overall treatment of TMJ disease must be acknowledged. The decision to manage TMJ osteoarthrosis surgically must be based on evaluation of the patient's response to noninvasive treatments, mandibular form and function, and effect of the condition on his or her quality of life.

[Functional genioplasty in growing patients]. / Génioplastie fonctionnelle chez les patients en croissance∗.

Objective - To evaluate the role of age as a moderator of bone regeneration patterns and symphysis remodeling after genioplasty. Method - Fifty-four patients who underwent genioplasty at the end of their orthodontic treatment were divided into three age groups: younger than 15 years at the time of surgery (group 1), 15 to 19 years (group 2), and 20 years or older (group 3). Twenty-three patients who did not accept genioplasty and had a follow-up radiograph two years after the end of their orthodontic treatment were used as a control group. Patients were evaluated at three time points: immediate preoperative (T1), immediate postoperative (T2) and two years postsurgery (T3). Results - The mean genial advancement at surgery was similar for the three age groups, but the extent of remodeling around the repositioned chin was greater in group 1, less in group 2, and still less in group 3. Symphysis thickness increased significantly during the two-years postsurgery interval for the three groups, and this increase was significantly greater in group 1 than in group 3. Remodeling above and behind the repositioned chin also was greater in the younger patients. This was related to greater vertical growth of the dentoalveolar process in the younger patients. There was no evidence of a deleterious effect on mandibular growth. Conclusion - The outcomes of forward-upward genioplasty include increased symphysis thickness, bone apposition above B point, and remodeling at the inferior border. When indications for this type of genioplasty are recognized, early surgical correction (before age 15) produces a better outcome in terms of bone remodeling.

Functional genioplasty in growing patients.

OBJECTIVE: To evaluate the role of age as a moderator of bone regeneration patterns and symphysis remodeling after genioplasty. METHOD: Fifty-four patients who underwent genioplasty at the end of their orthodontic treatment were divided into three age groups: younger than 15 years at the time of surgery (group 1), 15 to 19 years (group 2), and 20 years or older (group 3). Twenty-three patients who did not accept genioplasty and had a follow-up radiograph 2 years after the end of their orthodontic treatment were used as a control group. Patients were evaluated at three time points: immediate preoperative (T1), immediate postoperative (T2,) and 2 years postsurgery (T3). RESULTS: The mean genial advancement at surgery was similar for the three age groups, but the extent of remodeling around the repositioned chin was greater in group 1, less in group 2, and still less in group 3. Symphysis thickness increased significantly during the 2-year postsurgery interval for the three groups, and this increase was significantly greater in group 1 than in group 3. Remodeling above and behind the repositioned chin also was greater in the younger patients. This was related to greater vertical growth of the dentoalveolar process in the younger patients. There was no evidence of a deleterious effect on mandibular growth. CONCLUSION: The outcomes of forward-upward genioplasty include increased symphysis thickness, bone apposition above B point, and remodeling at the inferior border. When indications for this type of genioplasty are recognized, early surgical correction (before age 15) produces a better outcome in terms of bone remodeling.

Short-term and long-term stability of surgically assisted rapid palatal expansion revisited.

INTRODUCTION: The purpose of this article is to present further longitudinal data for short-term and long-term stability, following up our previous article in the surgery literature with a larger sample and 2 years of stability data. METHODS: Data from 38 patients enrolled in this prospective study were collected before treatment, at maximum expansion, at removal of the expander 6 months later, before any second surgical phase, at the end of orthodontic treatment, and at the 2-year follow-up, by using posteroanterior cephalograms and dental casts. RESULTS: With surgically assisted rapid palatal expansion (SARPE), the mean maximum expansion at the first molar was 7.60 ± 1.57 mm, and the mean relapse was 1.83 ± 1.83 mm (24%). Modest relapse after completion of treatment was not statistically significant for all teeth except for the maxillary first molar (0.99 ± 1.1 mm). A significant relationship (P < 0.0001) was observed between the amount of relapse after SARPE and the posttreatment observation. At maximum, a skeletal expansion of 3.58 ± 1.63 mm was obtained, and this was stable. CONCLUSIONS: Skeletal changes with SARPE were modest but stable. Relapse in dental expansion was almost totally attributed to lingual movement of the posterior teeth; 64% of the patients had more than 2 mm of dental changes. Phase 2 surgery did not affect dental relapse.

Closer look at the stability of surgically assisted rapid palatal expansion.

PURPOSE: To assess the amount of dental and skeletal expansion and stability after surgically assisted rapid maxillary expansion (SARPE). PATIENTS AND METHODS: Data from 20 patients enrolled in this prospective study were collected before treatment, at maximum expansion, at the removal of the expander 6 months later, before any second surgical phase, and at the end of orthodontic treatment, using posteroanterior cephalograms and dental casts. RESULTS: With SARPE, the mean maximum expansion at the first molar was 7.48 +/- 1.39 mm, and the mean relapse during postsurgical orthodontics was 2.22 +/- 1.39 mm (30%). At maximum, a 3.49 +/- 1.37 mm skeletal expansion was obtained, and this expansion was stable, such that the average net expansion was 67% skeletal. CONCLUSION: Clinicians should anticipate a loss of about one third of the transverse dental expansion obtained with SARPE, although the skeletal expansion is quite stable. The amount of postsurgical relapse with SARPE appears quite similar to the changes in dental-arch dimensions after nonsurgical rapid palatal expansion, and also quite similar to dental-arch changes after segmental maxillary osteotomy for expansion.