The effect of different hybrid rigid internal fixation techniques on the postoperative stability following a mandibular advancement using a bilateral sagittal split ramus osteotomy: A retrospective three-dimensional comparative study.

OBJECTIVE: To three-dimensionally evaluate post-operative mandibular stability following bilateral sagittal split ramus osteotomies between hybrid and non-hybrid rigid internal fixation techniques. MATERIALS AND METHOD: Seventy adults with skeletal class II deformity who underwent bilateral split sagittal osteotomy with mandibular advancement were included. Patients were divided into four groups based on their fixation techniques: hybrid technique (HT) groups I, II, and IV received a 4-hole 2 mm miniplate with either a bicortical screw (BS), additional 2 mm 4-hole miniplate, or two-hole miniplate, while non-HT group III received a 4-hole 2 mm miniplate with four mini-screws (MS). Measurements were taken pre-operatively (T0), immediately postoperatively (T1), and ≥1 year after surgery (T2) using 3D Slicer software. RESULTS: Age, sex, and follow-up period did not correlate significantly with postoperative relapse or stability. Significant differences were observed in the advancement on the right side between groups II, III, and IV and on the left side between groups I, III, and IV. However, the type of surgical intervention showed no significant effect on postoperative relapse and stability. All groups of fixations showed satisfactory stability with irrelevant relapse (< 2 mm or 2°). CONCLUSION: The study demonstrated satisfactory and comparable stability among different fixation groups on patients undergoing mandibular advancement following bilateral split sagittal osteotomy. The results highlighted the importance of considering the degree of advancement when planning orthognathic surgery and managing postoperative outcomes.

Functional therapy and adenotonsillectomy clinical trial for class II malocclusion (FACT-II): protocol for a randomised controlled trial.

INTRODUCTION: Class II malocclusion with mandibular retrognathia is a common complication of paediatric obstructive sleep apnoea (OSA), often accompanied by transverse maxillary deficiency. In early orthodontic treatment, a twin block (TB) is a regular functional appliance for correcting this malocclusion. For paediatric OSA, the most common risk factor is adenotonsillar hypertrophy (AHT). Untreated AHT may lead to the persistence and worsening of obstructive sleep-disordered breathing traits, including habitual mouth breathing. Additionally, the clockwise mandibular rotation associated with AHT-induced pharyngeal crowding can undermine the effectiveness and stability of TB treatment. Adenotonsillectomy (T&A) is currently the first-line treatment for paediatric OSA. This proposed trial will investigate the impact of T&A surgery timing on the efficacy and stability of TB functional treatment in children with class II mandibular retrognathia and ATH. METHODS AND ANALYSIS: This will be a single-centre, parallel-group, superiority randomised controlled trial with participants randomised to intervention (T&A followed by TB treatment) or control arms (TB treatment followed by T&A) in a 1:1 ratio. A total of 40 patients aged 8-14 years, diagnosed with class II mandibular retrognathia and co-existing ATH-induced OSA, and indicated for both T&A surgery and TB treatment, will be recruited at the School and Hospital of Stomatology, Wuhan University. The primary outcomes will be the changes in the apnoea-hypopnoea index and the point A-nasion-point B angle from baseline to postorthodontic treatment between the two groups. Secondary outcomes will include other dental, skeletal, upper airway and soft tissue changes, as well as subjective sleep-related and oral-related quality of life. Outcome changes within each group and between groups will be analysed. ETHICS AND DISSEMINATION: This study is approved by the Ethics Committee of the School and Hospital of Stomatology, Wuhan University (no. 2022-D07). The research findings will be faithfully disseminated through scientific conferences or published articles. TRIAL REGISTRATION NUMBER: ChiCTR2200061703 (https://www.chictr.org.cn).

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.

Surgery-first in interdisciplinary class II cases.

OBJECTIVES: To present an interdisciplinary case treated with a surgery-first orthognathic approach, followed by orthodontic and prosthodontic treatment. CLINICAL CONSIDERATIONS: After an accurate pre-operative virtual planning, a young patient with skeletal class II, retrognathia, and an anterior open bite was treated with bimaxillary orthognathic surgery without pre-surgical orthodontic decompensation. Orthodontic treatment was carried out post-operatively. The treatment was completed with a prosthodontic phase to improve the final esthetic outcome of the smile. CONCLUSIONS: A surgery-first approach allowed to achieve esthetic and functional results in a reduced treatment duration that remained stable over the course of 1 year. The outcomes were consistent with prior research in terms of advantages brought by following an accurately planned surgery-first protocol. Nevertheless, longer-term follow-up was required to evaluate the treatment stability. CLINICAL SIGNIFICANCE: An accurately planned surgery-first approach significantly helped in shortening the duration of the treatment, while providing a stable, functional, and esthetic solution to the patient's problems.

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.

Thematic Analysis of Parental Experiences of Patients' Orthognathic Surgery.

Orthognathic surgery often requires extensive orthodontic preparation and a prolonged postoperative recovery that can be stressful for patients and their families. Parents are a primary source of support for patients; accordingly, a better understanding of the parents' experience of orthognathic surgery can help inform clinical care. Using a prospective cross-sectional qualitative study design, 4 focus groups (2 English and 2 Spanish; mean length 65 min) were held with parents of patients who had completed orthognathic surgery for class II/III malocclusion. Thematic content analysis of the group transcriptions was conducted. Participants were 10 mothers and 3 fathers of 12 children (50% with cleft lip/palate) ages 17 to 23 who completed LeFort I (41.7%), LeFort I with bilateral sagittal split osteotomy (BSSO; 41.7%), or BSSO (16.7%) within the prior 3 to 16 months. Themes fit within a chronological framework: (1) Preparing for Surgery included their larger health context, anticipating surgery, surgery preparation by team and family, and religious faith; (2) Challenges after Surgery consisted of complications, pain, frustration, nutritional challenges, parental anxiety, activity changes, sleep, breathing issues, swelling, and unanticipated aspects of surgery; and (3) Supports after Surgery were nutritional support, appreciation of medical team, postoperative improvements, appearance changes, communicating, supporting patient, and patient coping. Parents also offered advice for families and medical teams. Surgeons and other providers who are part of orthognathic surgical preparation can implement recommendations based on parental experiences to increase patient and family readiness for surgery by providing early education, assisting with advocacy, focusing on nutrition, and supporting coping.

Three-dimensional assessment of periodontal support of lower incisors for skeletal Class II malocclusion undergoing presurgical orthodontic treatment with different vertical skeletal patterns.

BACKGROUND: The aim of the present study was to compare periodontal support changes during retraction of mandibular anterior teeth for skeletal Class II malocclusion with different facial divergence and to analyze relevant factors influencing bone remodeling by applying three-dimensional (3D) cone-beam computed tomography (CBCT) reconstruction technology. METHODS: Forty-eight patients with Class II malocclusion requiring surgical orthodontic treatment enrolled in the study were divided into the hyperdivergent group (n = 16), normodivergent group (n = 16) and hypodivergent group (n = 16) according to their vertical skeletal patterns. Cone-beam computed tomography (CBCT) scans were obtained before treatment (T1) and after presurgical orthodontic treatment (T2). The two-dimensional (2D) alveolar bone morphology, movement of mandibular central incisors and volume of the alveolar bone around incisors were measured on the labial and lingual sides by 3D CBCT reconstruction technology. Statistical analyses were performed with one-way ANOVA, paired t tests and multiple linear regression. RESULTS: During presurgical orthodontic treatment, the alveolar bone height on the labial side of the hyperdivergent group decreased significantly (P ≤ 0.05), but was maintained in the normodivergent and hypodivergent groups (P > 0.05). However, the alveolar bone volume, alveolar bone thickness at each level and alveolar bone height on the lingual side decreased significantly for all the groups. Apart from the initial morphometric measurements at T1, the morphology of lingual alveolar bone at T2 was significantly influenced by the direction and amount of tooth movement. Horizontal retraction and vertical protrusion of the root apex were negatively related to the alveolar bone on the lingual side after presurgical orthodontic treatment. CONCLUSION: For Class II malocclusion patients undergoing presurgical orthodontic treatment, the changes in the periodontal support of the lower central incisors varied in different vertical skeletal patterns. There exists a great periodontal risk of alveolar bone resorption on the lingual side for various vertical types. To avoid alveolar bone deterioration, it is essential to investigate the bone remodeling of patients with different alveolar bone conditions and cautiously plan tooth movement prior to orthodontic treatment. Moreover, 3D measurements based on CBCT construction can provide complementary information to traditional 2D measurements.

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.

Effect of Bimaxillary Orthognathic Surgery on Pharyngeal Airway Volume / Efecto de Cirugía Ortognática Bimaxilar en el Volumen de la Vía Aérea Faríngea

SUMMARY: Subjects with maxillary skeletal classes II and III not only express alterations in the hard and soft maxillofacial tissues, but also in the morphology and dimensions of the upper airway. A small space in the upper airway has been associated with sleep disorders, such as snoring and mainly obstructive sleep apnea/hypopnea syndrome (OSAHS). Consequently, interest has increased due to the influence of orthognathic surgery in the airway space. Although there are studies in the literature that have compared upper airway spaces, most have evaluated the changes using two-dimensional images, mainly lateral skull X-rays. The present study aimed to determine the airway volume in subjects with skeletal classes II and III who underwent bimaxillary orthognathic surgery. 80 CBCT exams from 40 subjects obtained before and 6 months after surgery were used. There were 20 class II and 20 class III subjects. For the volumetric analysis, a 3D rendering of the upper airway was made in previously established segments, and then the airway volume was calculated using the 3D Slicer® software version 4.11 (Slicer, USA). The statistical analysis by t-test of related samples revealed statistically significant volumetric increases in the nasopharynx, laryngopharynx, and total volume in class II patients. However, in class III patients, there were significant increases in the nasopharynx and total volume, while the volume was maintained in the oropharynx and laryngopharynx.

Sujetos con clases esqueletales II y III maxilares, no solamente expresan alteraciones en los tejidos duros y blandos maxilofaciales, sino también en la morfología y dimensiones de la vía aérea superior. Un espacio reducido a nivel de la vía aérea superior se asocia a trastornos del sueño como ronquidos y principalmente el síndrome de apnea/hipoapnea obstructiva del sueño (AOS); debido a esto, ha aumentado el interés por la influencia de la cirugía ortognática en el espacio de la vía aérea. Si bien existen en la literatura estudios que han comparado los espacios de la vía aérea superior, la mayoría de los estudios han evaluado los cambios utilizando imágenes bidimensionales, principalmente radiografías laterales de cráneo. El objetivo del presente estudio fue determinar el volumen de la vía aérea en sujetos con clases esqueletales II y III sometidos a cirugía ortognática bimaxilar. Se utilizaron 80 exámenes CBCT pertenecientes a 40 sujetos obtenidos previo a la cirugía y 6 meses después de realizada. Veinte sujetos clase II y 20 clase III. Para el análisis volumétrico se realizó un renderizado 3D de la vía área superior en segmentos previamente establecidos y posteriormente se calculó el volumen de dicha vía aérea con la utilización del software 3D Slicer ®versión 4.11 (Slicer, USA). El análisis estadístico realizado por t-test de muestras relacionadas, arrojó en pacientes clase II aumentos volumétricos estadísticamente significativos en nasofaringe, laringofaringe y volumen total. Mientras que en pacientes clase III, se observó aumentos significativos en Nasofaringe y volumen total y mantención de volumen en orofaringe y laringofaringe.

Impact of Mandibular Symphyseal Distraction Osteogenesis (MSDO) on the Sagittal Dimension and Long-Term Skeletal stability.

OBJECTIVE: To evaluate the long-term effects of mandibular symphyseal distraction osteogenesis (MSDO) on the correction of class II malocclusion correction and dental crowding. MATERIALS AND METHODS: Twenty-two patients received MSDO and presented class II malocclusion with transverse mandibular discrepancy. The authors collected data on 2 different cephalometric analyses. On Tweed analysis, The authors recorded ANB, SNA, SNB, and FMA angles. On Delaire analysis, we recorded the distance from Pti (pterygoid inferior) to ENAt (anterior nasal spine) and the distance from Cos (superior condyle) to Pog (pogonion). Superimpositions studies were performed at pre-treatment phase (T1) and post-treatment phase (T2) to evaluate the new position and changes in the dimensions of the mandible and maxilla. RESULTS: On superimposition of Tweed analysis of T1 and T2, reduction of ANB was seen in 18 patients, no change in ANB in 2 patients, and increase in ANB (by 1 deg) in 2 patients. Superimposition of Delaire analysis showed a mean difference of 0.3 mm (SD, 3.6 mm) between T1 and T2 for the maxilla and a mean difference of 6.0 mm (SD, 7.3 mm) for the mandible. CONCLUSIONS: Mandibular symphyseal distraction osteogenesis performed after the pubertal growth peak can effectively correct class II malocclusion and dental crowding with a single light surgical procedure.

Evaluation of pharyngeal airway space after orthodontic extraction treatment in class II malocclusion integrating with the subjective sleep quality assessment.

Orthodontic treatment with premolar extractions is typically used to relieve dental crowding and retract anterior teeth for lip profile improvement. The aim of the study is to compare the changes in regional pharyngeal airway space (PAS) after orthodontic treatment with Class II malocclusion and to identify the correlations between questionnaire results and PAS dimensions after orthodontic treatment. In this retrospective cohort study, 79 consecutive patients were divided into normodivergent nonextraction, normodivergent extraction, and hyperdivergent extraction groups. Serial lateral cephalograms were used to evaluate the patients' PASs and hyoid bone positions. The Pittsburgh Sleep Quality Index and STOP-Bang questionnaire were used for sleep quality evaluation and obstructive sleep apnea (OSA) risk assessment, respectively, after treatment. The greatest airway reduction was observed in hyperdivergent extraction group. However, the changes in PAS and hyoid positions did not differ significantly among three groups. According to questionnaire results, all three groups had high sleep quality and low risk of OSA, with no significant intergroup differences. Moreover, pretreatment-to-posttreatment changes in PAS were not correlated with sleep quality or risk of OSA. Orthodontic retraction with premolar extractions nither exhibit significant reduction in airway dimensions nor increase their risk of OSA.

Three-dimensional dentoskeletal effects of the Angelalign A6 clear aligners in a skeletal Class II growing patient: A case report.

This case report illustrates the successful nonsurgical and nonextraction treatment of a 12-year-old boy with skeletal Class II deep bite malocclusion undergoing two-phase clear aligner treatment. During A6 mandibular advancement phase, Class II buccal segment relationship was corrected by differential forward growth of the mandible, unplanned distalization of maxillary posterior teeth, and unplanned mesialization of mandibular posterior teeth. The maxillary sagittal curve of occlusion was deepened, the mandibular curve of Spee was not fully levelled, and the maxillary arch experienced downward-backward rotation resulting in premature contact on anterior and posterior open bite. Buccal crown tipping of maxillary posterior teeth was observed after arch expansion. The forward growth of the mandible improved the skeletal relationship, and the advancement of the chin position and sagittal movements of the incisors altered the nose-lip-chin relationship, resulting in an improved profile of the patient. During refinement phase, the posterior open bite was corrected. The mandibular plane angle did not increase throughout the treatment. The patient was satisfied with the aesthetic and functional outcome.

Torque control with set-up and auxiliary spring in an adult severe class II case treated by lingual straight-wire appliance, premolar extractions and orthognathic surgery.

This case report describes a complex full-step class II high angle case in an adult patient treated with lingual straight-wire appliance, premolar extractions and orthognathic surgery. With the twofold aim of obtaining ideal occlusal relationship and aesthetic improvement, surgical treatment with appropriate biomechanical strategies, including extraction choice and torque control during space closure, are needed to achieve the planned results. This case report demonstrates the possibility of solving successfully severe sagittal, transverse and vertical discrepancies in an adult patient with surgical treatment by means of an invisible technique. This report also underlines the need for precise biomechanical control, including set-up overcorrections and an auxiliary spring to manage teeth inclination, in lingual orthodontics extraction cases.

Effects of vertical control on anatomic and aerodynamic characteristics of the oropharyngeal airway during premolar extraction treatment of Class II hyperdivergent nonsevere crowding malocclusion.

INTRODUCTION: This study aimed to analyze the effects of premolar extraction treatment with vertical control on changes in the anatomy and aerodynamics of the oropharynx in Class II hyperdivergent malocclusion with nonsevere crowding. METHODS: Thirty-nine patients with Class II hyperdivergent malocclusion were enrolled consecutively. All the participants underwent 4 premolar extractions. The high-pull J-hook and mini-implants were used to provide vertical control. Cone-beam computed tomography was performed before and after treatment. The participants were divided into a decreased lower vertical facial height group (n = 23) and an increased lower vertical facial height group (n = 16) on the basis of superimposition. The aerodynamic characteristics, including airway resistance (inspiration, Rin; expiration, Rex) and maximum velocity (inspiration, Vmaxin; expiration, Vmaxex) at inspiration and expiration, were calculated using computational fluid dynamics. Anatomic characteristics, including volume and cross-sectional area (CSAmin), were measured using the Dolphin Imaging software (Dolphin Imaging and Management Solutions, Chatsworth, Calif). RESULTS: After treatment, the median volume and CSAmin increased by 2357 mm3 and 43 mm2, respectively, and median Rin and Vmaxex decreased by 0.15 Pa/L/min and 0.24 m×s-1, respectively, in decreased lower vertical facial height group. In contrast, the median CSAmin decreased by 9.5 mm2 in the increased lower vertical facial height group. All the changes were statistically significant (all P <0.05). Significant differences in volume, CSAmin, Rin, and Vmaxex were observed between the 2 groups. CONCLUSIONS: Vertical control might improve the anatomic and aerodynamic characteristics of the oropharyngeal airway during premolar extraction treatment of Class II hyperdivergent malocclusion with nonsevere crowding.

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.

Ortho- perio- prosthetic interdisciplinary approach of an adult class II division 2 with multiple premolar agenesis: A case report.

The aim of this case report is to illustrate the fixed orthodontic, surgical and periodontal implant management of a young adult with multiple agenesis associated with a class II division 2 malocclusion. The challenge here was the multidisciplinary synchronisation in order to achieve a coordinated treatment with the best possible aesthetic, prosthetic and functional prognosis. The patient suffered from a total of 10 agenesis including third molars and underwent implant replacement with bone grafting and periodontal planning of the 6 missing premolars. The orthodontic treatment lasted 22months and was followed by a period of just under a year for periodontal and implant prosthetic completion. The 3-year follow-up after the orthodontic phase showed an excellent prognosis in terms of aesthetics, function and stability.

[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.

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.