Assessing the Efficacy of Early versus Late Orthodontic Intervention in the Management of Class II Malocclusion: A Comparative Analysis.

Background: Class II malocclusion is a common orthodontic issue characterized by the excessive protrusion of the upper teeth relative to the lower teeth. Early intervention during mixed dentition has been advocated to guide skeletal growth and potentially reduce the severity of malocclusion. Materials and Methods: A comparative analysis was conducted to evaluate the efficacy of early (before the pubertal growth spurt) versus late (after the pubertal growth spurt) orthodontic intervention in managing Class II malocclusion. A cohort of 100 patients diagnosed with Class II malocclusion was divided into two groups: early intervention group (n = 50) and late intervention group (n = 50). Treatment outcomes including changes in overjet, molar relationship, and cephalometric measurements were assessed before and after orthodontic treatment. Results: In the early intervention group, the mean reduction in overjet was 5.2 mm (SD = 1.3), while in the late intervention group, it was 3.8 mm (SD = 1.6). The improvement in molar relationship was greater in the early intervention group (mean change = 4.5 mm, SD = 1.1) compared to the late intervention group (mean change = 3.1 mm, SD = 1.4). Cephalometric analysis revealed significant differences in skeletal and dental parameters between the two groups, with greater improvements observed in the early intervention group. Conclusion: Early orthodontic intervention shows superior efficacy in managing Class II malocclusion compared to late intervention. Early treatment leads to greater reductions in overjet, improvements in molar relationship, and favorable changes in skeletal and dental parameters. These findings underscore the importance of timely orthodontic intervention, particularly during the mixed dentition stage, for optimal management of Class II malocclusion.

Prediction on the chin advancement of the twin block functional appliance in growing Chinese patients using the cephalometric markers: a retrospective study.

In spite of the widespread use of functional appliances, broad variations were applied the treatment response. The aim of this study is to investigate the pre-treatment cephalometric predictors on the chin advancement of twin-block in growing Chinese patients with class II malocclusion. After screening, 90 patients treated by twin-block were included in the study. The treatment outcome was assessed by the alterations in the distance of skeletal pogonion (Pog) to the vertical reference plane perpendicular to the Frankfurt plane (ΔPog-VRP). Moreover, ΔPog-VRP was divided by the cranial growth indicated by the Nasion to Basion changes (ΔN-Ba) to minimize the growth discrepancy among individuals (adjΔPog-VRP). Patients with ΔPog-VRP/adjΔPog-VRP above the median value were categorized into good response group (GRG/adjGRG, N = 45), while the rest were poor response group (PRG/adjPRG, N = 45). Independent t-test was used to compare the pre-treatment cephalometric measurements between GRG/adjGRG and PRG/adjPRG. Stepwise multivariate regression models were used to determine the pre-treatment cephalometric predictors for the chin advancement. Generally, there were not any significant differences between GRG/adjGRG and PRG/adjPRG regarding age, gender and cervical stage before twin-block treatment. Patients from GRG had significantly reduced cephalometric measurements in the vertical dimensions, including ∠N-Go-Me, ∠Mandibular plane-Occlusal plane (∠MP-OP) and the sum of angles (p < 0.05) in comparison to PRG. When the individual growth was taken account, similar findings were observed. The patients from adjGRG had a significantly lower ∠Sella Nasion line-MP (∠SN-MP), ∠Ar-Go-Me and ∠N-Go-Me, as well as an increased Posterior facial height (PFH)/Anterior facial height (AFH) (p < 0.05) compared with their counterparts. ∠N-Go-Me variable was the independent predictor on Pog advancement with (ß = -0.26, 95% CI: -0.06 to -0.01, p = 0.01) and without (ß = -0.29, 95% CI: -0.06 to -0.01, p < 0.01) adjustments on individual growth. The results of this study showed that patients with a reduced N-Go-Me angle are more likely to experience a greater chin advancement following twin-block treatment.

Comparison between clear aligners and twin-block in treating class II malocclusion in children: a retrospective study.

The study herein evaluated and compared the efficacy of Clear Aligners (CA) and Twin-Block (TB) appliances as the early orthodontic treatments of developing class II division 1 malocclusion. Twenty-four patients each for CA (11.73 ± 0.33 y) and TB (11.87 ± 0.34 y) groups were selected according to the inclusion and exclusion criteria. The cephalometric X-rays and intraoral photos were taken for the patients after nearly 12 months of treatment. Treatment impacts were evaluated by the molar correction and overjet reduction. The vertical and sagittal changes were analyzed through cephalometric measurements. Sella-nasion-point B angle (SNB), point A-nasion-point B angle (ANB), Wits Appraisal (AO-BO) and overjet were statistically significant regarding the sagittal changes analyzed before and after the treatments in both groups, respectively. So, no significant difference was noted in the sagittal changes between CA and TB groups. However, for the vertical changes, OP (occlusal plane) angle of CA group and OP angle, AFH (anterior facial height) and PFH (posterior facial height) of TB group were statistically significant. Moreover, the Z angle and cranial facial difficulty (C.F. difficulty) were also statistically significant in both groups. Class II children with retrognathic mandible are effectively treated by employing the CA, which has almost the same impact as of TB in sagittal and vertical changes. Resultantly, the patient profile is improved. The CA and TB treatments thus minimize the subsequent treatment difficulty by reducing the C.F. difficulty.

Effect of various active reminders via mobile phone on cooperation of orthodontic teenage patients regarding oral hygiene and Class II elastics use : A three-month follow-up prospective cohort study.

INTRODUCTION: The purpose of this prospective cohort study was to assess the impact of reminders via mobile phone, such as text messages or video/multimedia images, on orthodontic patients' cooperation with regard to oral hygiene and the use of Class II intermaxillary elastics. METHODS: The study included 124 orthodontic patients aged 12-20 years (mean age 14.06 ± 2.0 years, 63 females and 61 males). The patients were divided into two groups: group 1 (n = 56) was evaluated for oral hygiene, while group 2 (n = 68) was evaluated for the use of Class II intermaxillary elastics. Each main group was divided into three subgroups: text message group, video message group, and control group. Specific messages were sent to the participants in the study groups twice a week for 12 weeks. Data were collected at the beginning of the study (T0), after 6 weeks (T1), and 12 weeks (T2) and compared to determine the impact of the reminders. Oral hygiene was evaluated using plaque and gingival index scores, and the use of Class II elastics was evaluated using digital model measurements. Between-subject comparisons were performed using Kruskal-Wallis or one-way analysis of variance (ANOVA). For within-subject comparisons (T0-T1, T1-T2, and T0-T2 time intervals), one-way repeated measures ANOVA or Friedman test was performed. RESULTS: There was no significant difference between the control group (1.49 ± 0.22) and the message groups (video: 1.58 ± 0.34 and text: 1.51 ± 0.28) in terms of plaque index scores and gingival index (control: 1.56 ± 0.26, text: 1.51 ± 0.36, video: 1.52 ± 0.26) scores. However, in the intragroup comparison, it was observed that both plaque index scores and gingival index scores at T0, T1, and T2 increased for both the study and control groups. While there was no difference between the subgroups in overjet measurement at T0 (control: 3.46 ± 1.20, video: 3.34 ± 1.20, text: 2.73 ± 1.03; p = 0.51), there was a significant difference at T2 (control: 2.62 ± 0.85, video: 2.32 ± 1.41, text: 1.48 ± 0.72, p < 0.01). CONCLUSION: Mobile active reminders had no effect on improving oral hygiene. Despite repeated reminders, hygiene worsened over time. The use of Class II elastics seemed to have increased as a result of the mobile reminders.

Clear aligner treatment of an adult open bite with bilateral missing mandibular first molars through molar protraction with Albert cantilever arms.

Premature loss of first permanent molars is a common occurrence in clinical practice, leading to abnormal occlusion and inefficient mastication for patients. This case report presented the orthodontic retreatment of a 32-year-old female patient who suffered from premature loss of mandibular bilateral first molars. The mesial tipping of the mandibular second molars led to an occlusal interference, resulting in a clockwise rotation of the lower jaw and an anterior open bite (AOB). We achieved long-distance molar mesialization using clear aligners with Albert cantilever arms. After 42 months of treatment, the patient's occlusion and facial profile significantly improved. The cantilever combined with the cleat aligner treatment has been clinically effective for the protraction of mandibular posterior teeth, extending the field of application of clear aligners.

Impact of maxillary expansion on the sagittal skeletal and dental parameters of growing Class II patients: A systematic review with meta-analysis.

A "spontaneous" correction of the Class II malocclusion has been described after maxillary expansion (ME) treatment. The aim of the present review was to systematically summarize changes in the sagittal dentoskeletal parameters of growing Class II patients after ME. The study protocol was developed according to the PRISMA statement and registered in PROSPERO before literature search, data extraction and analysis. The PICO model was followed in the definition of the research question, search strategies and study selection criteria. Randomized and non-randomized studies on the sagittal effects of ME published in English language without date restrictions were electronically searched across the Cochrane Library, Scopus and MEDLINE/PubMed databases. Changes in sagittal dentoskeletal cephalometric parameters were analysed. The risk of bias in randomized and nonrandomized studies was assessed using the Rob2 and ROBINS-I tools, respectively. A narrative synthesis was performed, focusing on the investigated population, intervention, comparison, and main outcomes. Pairwise meta-analyses were used to compare the outcomes assessed in subjects who underwent ME versus untreated subjects. Ten studies met the inclusion criteria, four were included in the pairwise meta-analyses due to the presence of a control group. Slight but significant improvements in OVJ (MD: -0.36; 95%; CI [-0.69 to -0.01]; p = .04) and 6/6 molar relation (MD: 1.5; 95%; CI [0.69 to 1.61]; p < .0001) were found in patients who underwent ME compared with untreated subjects, whereas no improvement in skeletal parameters was observed. However, the limitations of a small body of moderate-quality evidence and possible confounding factors should be considered. Evidence on the sagittal skeletal and dental effects of ME in Class II patients is still ambiguous, suggesting the need for more clinical trials, including appropriate control subjects, randomization and blinding during outcome assessment.

Revolutionizing Class II Division 1 Malocclusion Treatment With Forsus Appliance: A Clinical Case.

Angle's Class II Division 1 malocclusion is illustrated as a prominent maxilla along with protrusive maxillary anteriors, mandibular retrognathism, or both, often leading to functional and aesthetic concerns. Effective management of this condition in growing patients typically involves a combination of functional and orthodontic appliances to correct dental and skeletal discrepancies. Treating this malocclusion in the deceleration stages of growth is often challenging for orthodontists. This case report exemplifies the potency of Forsus appliance in addressing Class II Division 1 malocclusion in growing patients, underscoring its role in achieving favorable orthodontic outcomes.

Treatment of Vertical Maxillary Excess and Skeletal Class II Malocclusion: A Case Report.

Class II malocclusion is a recurrent problem that may occur at a young age. If treated initially, the malocclusion can be corrected by redirecting the growth without invasive modalities and avoiding orthognathic surgeries. A female patient aged 10 years three months came to the department of orthodontics having a complaint of upper front teeth placed forwardly, diagnosed with skeletal class II due to retrusive mandible and vertical maxillary excess with hyper divergent growth pattern with increased anterior facial height, with Angle's molar class II division 1 malocclusion, increased overjet of 13 mm and overbite of 7 mm, acute nasolabial angle, deep mentolabial sulcus, and hyperactive mentalis. It was treated using an activator with medium-high-pull headgear (modified Herren activator) passing through the maxillary center of resistance. A fixed mechanotherapy with high-pull headgear was given using the anterior inclined plane acrylic plate in the maxilla and McLaughlin, Bennett, and Trevisi (MBT). Begg's wrap was used for the retention plan. This case report shows the significance of proper treatment results obtained due to correct identification and planning in treating malocclusion. This case report shows the significance of proper treatment results obtained due to correct identification and planning in treating malocclusion.

Network analysis of three-dimensional hard-soft tissue relationships in the lower 1/3 of the face: skeletal Class I-normodivergent malocclusion versus Class II-hyperdivergent malocclusion.

BACKGROUND: The determining effect of facial hard tissues on soft tissue morphology in orthodontic patients has yet to be explained. The aim of this study was to clarify the hard-soft tissue relationships of the lower 1/3 of the face in skeletal Class II-hyperdivergent patients compared with those in Class I-normodivergent patients using network analysis. METHODS: Fifty-two adult patients (42 females, 10 males; age, 26.58 ± 5.80 years) were divided into two groups: Group 1, 25 subjects, skeletal Class I normodivergent pattern with straight profile; Group 2, 27 subjects, skeletal Class II hyperdivergent pattern with convex profile. Pretreatment cone-beam computed tomography and three-dimensional facial scans were taken and superimposed, on which landmarks were identified manually, and their coordinate values were used for network analysis. RESULTS: (1) In sagittal direction, Group 2 correlations were generally weaker than Group 1. In both the vertical and sagittal directions of Group 1, the most influential hard tissue landmarks to soft tissues were located between the level of cemento-enamel junction of upper teeth and root apex of lower teeth. In Group 2, the hard tissue landmarks with the greatest influence in vertical direction were distributed more forward and downward than in Group 1. (2) In Group 1, all the correlations for vertical-hard tissue to sagittal-soft tissue position and sagittal-hard tissue to vertical-soft tissue position were positive. However, Group 2 correlations between vertical-hard tissue and sagittal-soft tissue positions were mostly negative. Between sagittal-hard tissue and vertical-soft tissue positions, Group 2 correlations were negative for mandible, and were positive for maxilla and teeth. CONCLUSION: Compared with Class I normodivergent patients with straight profile, Class II hyperdivergent patients with convex profile had more variations in soft tissue morphology in sagittal direction. In vertical direction, the most relevant hard tissue landmarks on which soft tissue predictions should be based were distributed more forward and downward in Class II hyperdivergent patients with convex profile. Class II hyperdivergent pattern with convex profile was an imbalanced phenotype concerning sagittal and vertical positions of maxillofacial hard and soft tissues.

The Efficacy of the RME II System Compared with a Herbst Appliance in the Treatment of Class II Skeletal Malocclusion in Growing Patients: A Retrospective Study.

(1) Background: The objective of this study was to evaluate the efficacy of the Rapid Maxillary Expander (RME) II System compared to a Herbst appliance and a control group in the treatment of class II skeletal malocclusions in growing patients. (2) Methods: A total of 30 class II patients treated using the RME II System (group R) were compared with 30 patients treated with a Herbst appliance (group H) and 30 untreated class II children (group C). Cephalograms were compared at the start (T0) and after 24 months (T1). Nine cephalometric parameters were analyzed: SN-MP, SN-PO, ANB, AR-GO-ME, AR-GO-N, N-GO-ME, SN-PP, LFH, CO-GN, 1+SN, IMPA, OVERJET, and OVERBITE. Since the variables failed the normality test, a Wilcoxon test was performed for a pairwise comparison of the cephalometric measurements taken at T0 (pre-treatment) and at T1 (post-treatment). ANOVA with Tukey post hoc correction was used to evaluate the differences among the groups. (3) Results: ANOVA showed a statistically significant difference for all analyzed variables except for AR-GO-ME, AR-GO-N, and N-GO-ME. Post hoc Tukey's HSD test showed the following difference: the SN-PO angle in group H was 3.59° greater than in group R; the LFH in group H was 4.13 mm greater than in group R. The mandibular length (CO-GN) in group H was 3.94 mm greater than in group R; IMPA in group H was 6.4° greater than in group R; and the ANB angle in group H was 1.47° greater than in group R. (4) Conclusions: The RME II System is an effective therapeutic device for class II skeletal malocclusion treatment in growing patients.

Adolescent Patient's Perceptions During Treatment With Class II Elastics.

The article presents a case of a 13-year-old adolescent male patient who started orthodontic treatment at the age of 12. Before treatment, he was diagnosed with narrow maxilla, proclination of upper incisors, deep overbite, distal occlusion bilaterally with significant sagittal overjet in frontal area, skeletal Class II, and hypodivergent growth pattern. During treatment, the patient is in his pubertal growth spurt. About 2 months after intermaxillary Class II elastics (1/4 heavy, 6.5 Oz) were applied, he complained of pain during mastication, wide opening of the mouth, and sometimes during protrusive and lateral movements in the right TMJ. The TMJ X-ray examination did not reveal abnormal morphological changes. Occlusion was evaluated by an electromyographic device, Teethan. The result was typical for Class II malocclusion. During the bilateral palpation of the zones of TMJ and opening of the mouth and chewing, the patient reported pain on the right side. There was no clicking in the joint. The elastic wear was stopped, and soon afterwards, the pain disappeared. These complaints point to a possible relationship between orthodontic treatment and TMJ pain. However, the disappearance of complaints after the removal of the Class II elastics points that the temporomandibular joint disorder (TMD) symptoms are reversible and resolved.

"Sagittal First" Approach Using Carriere Motion 3D Appliance: A Case Report.

Aim: To present a case with skeletal class II malocclusion and mandibular retrusion treated using Carriere Motion Appliance (CMA). Background: Management of class II malocclusion in adolescent patients by growth modulation is one of the most debated topics in orthodontics. Fixed functional appliances are generally used in the patients who are at the end of the postpubertal growth spurt. However, most of the fixed functional appliances are placed only after the initial alignment and leveling, which takes up considerable duration of time. The Carriere Motion 3D is an efficient and effective way of correcting the sagittal component of class II malocclusion within the first half year of treatment followed by comprehensive therapy using fixed appliances. Case description: A 15-year-old male patient reported with the chief compliant of forwardly placed upper front teeth and functional jaw retrusion. It was treated initially with CMA and class II elastics for mandibular advancement. Simultaneously, lower arch was bonded with MBT 0.022" prescription for alignment and leveling. After 6 months, class I molar and canine relationship was achieved before proceeding with full orthodontic treatment. After 12 months of fixed orthodontics, the treatment goals were achieved. Conclusion: Carriere Distalizer appears to be more comfortable, offer a more positive overall experience, and has fewer side effects. The changes were mainly dentoalveolar in nature, but there were some skeletal changes, particularly in the sagittal and vertical dimensions. Clinical significance: A significant forward displacement of the mandible was the principal element for successful correction of class II malocclusion. CMA provides the best results for class II management, enabling us to treat such cases with a nonextraction approach rather than contemplating extractions. How to cite this article: P SD, Ahmed N, Urukalan H, et al. "Sagittal First" Approach Using Carriere Motion 3D Appliance: A Case Report. Int J Clin Pediatr Dent 2024;17(4):490-496.

Cone-Beam Computed Tomography Study of Incisive Canal and Maxillary Central Incisors in Dravidian Population.

INTRODUCTION:  En-masse maxillary anterior retraction is necessary to attain an esthetic profile in Angle's class I bimaxillary dentoalveolar protrusion and Angle's class II division 1 malocclusion. The objective of this study was to evaluate configurational relationships between maxillary incisors and incisive canal in Angle's class I bialveolar protrusion and Angle's class II division 1 malocclusion by cone-beam computed tomography (CBCT). METHODS: A total of 108 adult CBCT scans of 54-skeletal class I bialveolar protrusion and 54-skeletal class II division 1 malocclusions were retrospectively analyzed. Angles between palatal plane and axis of maxillary alveolar border (θ1), incisive canal (θ2), and maxillary right central incisor (θ3) were measured in relation to the midsagittal plane. Linear measurements such as incisive canal width (IC-IC), medial inter-root distance (Rm-Rm), posterior inter-root distance (Rp-Rp), anteroposterior distance from Rm to tangent of right central incisor (11 Rm-Cat), and left central incisor (21 Rm-Cat) corresponding to three vertical levels (L1, L2, and L3) were assessed in axial cross-sectional plane. Association among angular measurements was examined by Spearman correlation coefficient analysis. Mann-Whitney U test compared variables of linear measurements at three vertical levels. RESULTS:  Estimated distance from incisor root to incisive canal was 5-6 mm in both groups slightly influenced by skeletal class and vertical levels but not gender. Mann-Whitney test demonstrated significant differences between groups at three vertical levels (p<0.05). Only θ2 revealed a significant difference (p<0.05) between malocclusions compared to θ1 and θ3. The angular measurements for both malocclusions were positively correlated (p<0.05). CONCLUSION:  Sagittal root-canal cortical plate distance varied significantly in both malocclusions (5-6 mm). Inter-root distance (Rp-Rp) was greater than incisive canal width (IC-IC) at all three vertical levels indicating a reduced possibility of canal invasion after maximum retraction at posterior levels.

Class II Correction and Crowding Treatment Using In-House Direct Printed Clear Aligners: A Literature Review and Case Report.

Clear aligner therapy has significantly improved orthodontic treatment by offering patients a more aesthetically pleasing option compared to traditional braces. This literature review and case report specifically focus on the effectiveness of directly printed clear aligners in treating Class II malocclusions and crowding. Class II malocclusions are characterized by excessive overjet, which often results from skeletal or dental discrepancies between the upper and lower jaws. Crowding refers to the lack of space for teeth within the dental arch, leading to misalignment and potential functional issues. The review and case report highlight the increasing importance of directly printed clear aligners in modern orthodontics and provide clinicians with a valuable tool to effectively address complex malocclusions and crowding while also meeting patient needs for discretion and comfort. Further research is necessary to validate the long-term stability and outcomes of directly printed clear aligner therapy in various orthodontic cases. A detailed case report demonstrates the successful treatment of a patient with Class II malocclusion and mild crowding using directly printed clear aligners. Treatment outcomes include improvements in dental alignment, occlusion, and facial aesthetics, showcasing the effectiveness of this innovative approach.

Clinical effects of twin-block combined with maxillary expansion on the upper airway in adolescents with Class II malocclusion.

BACKGROUND: Class II malocclusion, particularly class II division 1, poses a significant orthodontic challenge with implications for both aesthetics and health. This study aimed to explore the impact of twin-block (TB) combined with maxillary expansion treatment (TB-ME) on upper airway dimensions and inflammatory profiles in adolescents with skeletal Class II Division 1 malocclusion in adolescent. METHODS: Ninety-two eligible patients were randomly assigned to two groups: TB-ME treatment and traditional McLaughlin Bennett Trevisi (MBT) straight-wire orthodontic treatment (Control). Cephalometric lateral X-ray scans were conducted before and after treatment to assess skeletal changes, including SNA, ANB, and SNB angles, which are essential to assess the anteroposterior relationships of the maxilla and mandible to the cranial base. We also measured the upper airway volumes and areas. Concentrations of inflammatory factors including intercellular adhesion molecule 1 (ICAM-1), matrix metallopeptidase 2 (MMP2), and interleukin 8 (IL-8) of gingival crevicular fluid analysis (GCF) were detected by enzyme-linked immunosorbent assay. RESULTS: TB-ME treatment induced significant improvement in cephalometric parameters, including a decrease in SNA and ANB angles and an increase in SNB angle. Upper airway volumes and areas increased significantly in both groups, with TB-ME showing greater improvements. GCF analysis revealed a reduction in ICAM-1, MMP2, and IL-8 concentrations in the TB-ME group compared to the Control group. CONCLUSIONS: TB-ME treatment demonstrates multifaceted improvements in skeletal malocclusion, upper airway dimensions, and inflammatory profiles in adolescents with class II division 1 malocclusion, showing the promise of TB-ME in addressing the complexities associated with class II malocclusion.

Comparative assessment of the clinical outcomes of clear aligners compared to fixed appliance in class II malocclusion.

OBJECTIVE: This study compared clinical outcomes between aligners and fixed appliances in class II adolescent patients. MATERIALS AND METHODS: Records of 31 aligners and 35 fixed class II patients, aged 13.5 ± 1.6 years were compared. Class II elastics was the mechanism employed for correcting the malocclusion. DI scores were used to compare initial complexity, and the PAR index scores were used to compare the clinical outcomes. Data on demographics, treatment and finishing durations, number of visits and refinements, duration of class II correction, and changes in the IMPA were collected. RESULTS: The mean pre-, post-treatment, and overall reduction in PAR index scores between the groups were not significantly different (P > 0.05). The clear aligners group had significantly shorter treatment duration (20.0 ± 11.6 months) than the fixed group (27.4 ± 9.1 months) (P < 0.001). The number of visits for the aligners' group was significantly less (12.7 ± 6.2) than in the fixed group (17.8 ± 5.8) (P < 0.001). Duration for class II correction was significantly shorter for clear aligners (13.3 ± 10.0 months) compared to the fixed group (17.4 ± 9.0 months) (P = 0.026). A smaller post-treatment change in IMPA (2 ± 6°) was detected in the aligners group compared to the fixed group (5 ± 6°) (P < 0.05). CONCLUSIONS: Treatment outcomes for aligners in class II adolescent patients were comparable to those achieved in fixed appliances. Shorter treatment and class II correction durations, fewer visits, and better control for the IMPA were noticed in the aligners' group. CLINICAL RELEVANCE: Treating class II adolescent patients with aligners seems promising and demands shorter treatment time and fewer visits.

Combined Periodontal-Orthodontic Treatment with Periodontal Corticotomy Regenerative Surgery in an Adult Patient Suffering from Periodontitis and Skeletal Class II Malocclusion: A Case Report with 5-Year Longitudinal Observation.

A thick periodontal phenotype with thick gingiva and alveolar bone volume is required for safe orthodontic tooth movement and long-term stability. A high incidence of dehiscence and fenestration in the labial aspect of mandibular anterior teeth may limit the correction of deformity and orthodontic treatment, especially when the lower anterior teeth are needed to have a large range of movement. This study reports a combination of periodontal therapy and orthodontic therapy with periodontal corticotomy regenerative surgery (PCRS) in a 25-year-old patient suffering from skeletal Class II malocclusion and periodontitis. The patient received periodontal therapy 5 years ago and commenced orthodontic treatment 4.5 years ago. During the 4 years of follow-up for PCRS, the clinical and radiographic evaluations revealed significant improvements in the periodontal phenotype of the mandibular anterior region. The periodontal phenotypes in the mandibular incisors region were all modified from thin to thick. Supplementing orthodontic treatment with labial PCRS could be a promising treatment strategy to maintain long-term periodontal health in adult patients with alveolar deficiency and thin gingiva tissue.

Accuracy of patient-specific implants versus CAD/CAM splints with the mandible-first approach in bimaxillary orthognathic surgery for skeletal Class II malocclusion.

This retrospective study aimed to compare the accuracy of patient-specific implants (PSI) versus mandible-first computer-aided design and manufacturing (CAD/CAM) splints for maxilla repositioning in orthognathic surgery of skeletal Class II malocclusion patients. The main predictor was the surgical method (PSI vs. splints), with the primary outcome being the discrepancy in maxilla centroid position, and secondary outcomes being translation and orientation discrepancies. A total of 82 patients were enrolled (70 female, 12 male; mean age 25.5 years), 41 in each group. The PSI group exhibited a median maxillary position discrepancy of 1.25 mm (interquartile range (IQR) 1.03 mm), significantly lower than the splint group's 1.98 mm (IQR 1.64 mm) (P < 0.001). In the PSI group, the largest median translation discrepancy was 0.74 mm (IQR 1.17 mm) in the anteroposterior direction, while the largest orientation discrepancy was 1.83° (IQR 1.63°) in pitch. In the splint group, the largest median translation discrepancy was 1.14 mm (IQR 1.37 mm) in the anteroposterior direction, while the largest orientation discrepancy was 3.03° (IQR 2.11°) in pitch. In conclusion, among patients with skeletal Class II malocclusion, the application of PSI in orthognathic surgery yielded increased precision in maxillary positioning compared to mandible-first CAD/CAM splints.

Effect of Early Orthodontic Treatment on Long-Term Stability of Class II Malocclusions.

Background: Class II malocclusions are a common orthodontic problem, often requiring comprehensive treatment to achieve proper occlusion and facial harmony. Early orthodontic intervention in the mixed dentition phase has been advocated to address these issues. Materials and Methods: A retrospective analysis was conducted on a cohort of 150 patients with class II malocclusions who underwent early orthodontic treatment between the ages of 7 and 10 years. The treatment included fixed or removable appliances, headgear, and functional appliances, depending on individual needs. Records of their initial malocclusion severity, treatment modalities, and long-term follow-up data (mean follow-up duration of 10 years) were collected and analyzed. Stability was assessed by evaluating overjet and overbite changes from post-treatment to the long-term follow-up. Results: The initial mean overjet and overbite values were 8.5 mm and 4.0 mm, respectively. Following early orthodontic intervention, these values were significantly reduced to 3.0 mm and 1.5 mm, respectively (P < 0.001). At the long-term follow-up, the mean overjet and overbite remained stable at 3.2 mm and 1.6 mm, respectively. Analysis revealed that 85% of patients maintained their corrected class II occlusion within clinically acceptable limits, while 15% experienced minor relapse requiring minimal additional treatment. Conclusion: Early orthodontic treatment in class II malocclusions can lead to significant improvements in overjet and overbite, and these corrections tend to remain stable over the long term.

Evaluating the Effects of Carriere Motion Appliance and Twin Block Appliances in Class II Correction-A Retrospective Study.

This retrospective study compared Class II orthodontic non-extraction treatment using Carriere Motion Appliance (CMA) and Twin Block (TB) appliances. METHODS: The treatment of 38 patients was assessed. Pre- and post-treatment cephalometric radiographs were analyzed to evaluate skeletal, dental, and soft tissue treatment outcomes and efficacy. RESULTS: Both appliances effectively corrected the Class II molar relationship. When measured at the distal aspect of the first molar, TB achieved 4.22 mm, while CMA had a 2.55 mm correction. When measured in the mesial aspect, the CMA achieved a 3.9 mm correction. The changes in SNB and ANB were statistically significant only in the TB group. The CMA appliance demonstrated statistically significantly less protrusion of the mandibular incisors and less upper incisor retrusion without vertical changes compared to the TB appliance. The TB demonstrated statistically significant lower lip protrusion compared to the CMA. CONCLUSION: The CMA corrects Class II malocclusions only by exerting a dentoalveolar influence and does not demonstrate the added effects associated with TB, such as elongation of lower facial height (LFH) and less loss of lower anchorage. Nonetheless, the correction in the TB group comprised both dentoalveolar and skeletal components. The CMA promotes a multidirectional upper and lower molar movement, and despite our 2D cephalometric analysis, we were able to estimate the extent of upper molar derotation.