Three-dimensional evaluation of dentopalatal changes after rapid maxillary expansion in growing children.

INTRODUCTION: In growing children with transverse malocclusion problems, various types of rapid maxillary expanders (RMEs) have been effectively used in skeletal and dental expansions. We evaluated 3-dimensional dentopalatal changes in growing children who underwent maxillary expansion using RMEs and bonded RMEs. METHODS: We investigated dentopalatal changes in 20 patients treated with bonded RMEs, 19 with RMEs, and 38 control patients. Dental plaster models before and after expansion were scanned 3-dimensionally and superimposed to evaluate transverse expansion, expansion ratio, angular expansion, and palatal expansion height ratio. RESULTS: Using bonded RMEs, similar anterior and posterior dental expansions were achieved with an efficiency of 69%-76% (expansion ratio), and palatal soft-tissue expansion occurred more apically in the posterior area (palatal expansion height ratio, 1.00) than in the anterior area (palatal expansion height ratio, 0.64). Using RMEs, a larger posterior dental expansion was achieved, with an efficiency of 106%-117% (expansion ratio), than anterior dental expansion (55%-60%), and palatal soft-tissue expansion occurred more apically in the posterior area (palatal expansion height ratio, 0.99) than anterior area (palatal expansion height ratio, 0.23). CONCLUSIONS: Dental expansions in the anterior and posterior areas were similar using bonded RMEs, whereas the posterior dental expansions were larger than those of the anterior area using RMEs. The entire palatal soft-tissue slope expanded in the posterior area, whereas the occlusal part expanded in the anterior area using RMEs and bonded RMEs.

Association among craniofacial morphology, ethnicity, and risk of pediatric sleep-related breathing disorders: A multicenter study.

INTRODUCTION: Craniofacial morphology and ethnicity may be risk factors for sleep-related breathing disorder (SRBD) in children but have not yet been assessed in an international multicenter study. The objectives of this study were to assess the association among craniofacial features, self-reported ethnicity, and risk of SRBD in children undergoing orthodontic treatment. METHODS: Children aged 5-18 years who presented for orthodontic evaluation were enrolled in the United States, South Africa, South Korea, Saudi Arabia, and Japan. The risk of SRBD was defined as answering ≥0.33 positive responses to the Pediatric Sleep Questionnaire. Craniofacial features included measurements in sagittal and vertical dimensions to evaluate the cranial base, maxillomandibular and dental relationships, and nasopharyngeal airway dimensions. Logistic regression was performed to assess the association among craniofacial features, ethnicity, age, body mass index, and risk of SRBD. RESULTS: Data were obtained from 602 patients from 5 sites. A total of 76 patients (12.6%) had a risk of SRBD. The mean age was 12.5 years. Male gender (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.0-3.4; P = 0.041), Middle Eastern ethnicity (OR, 10.2; 95% CI, 4.1-25.4; P = 0.001), body mass index (OR, 1.1; 95% CI, 1.04-1.10; P = 0.001), gonial angle (OR, 0.91; 95% CI, 0.85-0.98; P = 0.011), and inferiorly positioned hyoid (OR, 1.1; 95% CI, 1.0-1.2; P = 0.002) were significantly associated with the risk of SRBD. CONCLUSIONS: In an ambidirectional cohort study across 5 sites, male gender, Middle Eastern ethnicity, body mass index, gonial angle, and inferiorly positioned hyoid were associated with the risk of SRBD in children undergoing orthodontic treatment.

Multistability and hysteresis in states of oral microbiota: Is it impacting the dental clinical cohort studies?

INTRODUCTION: Microbiome from a "healthy cohort" is used as a reference for comparison to cases and intervention. However, the studies with cohort-based clinical research have not sufficiently accounted for the multistability in oral microbial community. The screening is limited to phenotypic features with marked variations in microbial genomic markers. Herein, we aimed to assess the stability of the oral microbiome across time from an intervention-free "healthy" cohort. METHODS: We obtained 33 supragingival samples of 11 healthy participants from the biobank. For each participant, we processed one sample as baseline (T0) and two samples spaced at 1-month (T1) and 3-month (T2) intervals for 16S ribosomal RNA gene sequencing analysis. RESULTS: We observed that taxonomic profiling had a similar pattern of dominant genera, namely, Rothia, Prevotella, and Hemophilus, at all time points. Shannon diversity revealed a significant increase from T0 (p < .05). Bray Curtis dissimilarity was significant (R = -.02, p < .01) within the cohort at each time point. Community stability had negative correlation to synchrony (r = -.739; p = .009) and variance (r = -.605; p = .048) of the species. Clustering revealed marked differences in the grouping patterns between the three time points. For all time points, the clusters presented a substantially dissimilar set of differentially abundant taxonomic and functional biomarkers. CONCLUSION: Our observations indicate towards the presence of multistable states within the oral microbiome in an intervention-free healthy cohort. For a conclusive and meaningful long-term reference, dental clinical research should account for multistability in the personalized therapy approach to improve the identification and classification of reliable markers.

Correlation of masticatory muscle activity and occlusal function with craniofacial morphology: a prospective cohort study.

OBJECTIVES: Masticatory function, including masticatory muscle activity and occlusal function, can be affected by craniofacial morphology. This study aimed to investigate the relationship between craniofacial morphology and masticatory function in participants who had completed orthodontic treatment at least two years before and had stable occlusion. MATERIALS AND METHODS: Fourty-two healthy participants were prospectively enrolled and divided into three vertical cephalometric groups according to the mandibular plane angle. Masticatory muscle activity (MMA) in the masseter and anterior temporalis muscles was assessed using surface electromyography. The occlusal contact area (OCA) and occlusal force (OF), defined as occlusal function in this study, were evaluated using occlusal pressure mapping system. Masticatory muscle efficiency (MME) was calculated by dividing MMA by OF. The craniofacial morphology was analyzed using a lateral cephalogram. The masticatory function was compared using one-way analysis of variance. Pearson correlations were used to assess relationships between craniofacial morphology and masticatory function. RESULTS: The hypodivergent group had the lowest MMAand the highest MME in the masseter (167.32 ± 74.92 µV and 0.14 ± 0.06 µV/N, respectively) and anterior temporalis muscles (0.18 ± 0.08 µV/N, p < 0.05). MMA in the masseter showed a positive relationship with mandibular plane angle (r = 0.358), whereas OCA (r = -0.422) and OF (r = -0.383) demonstrated a negative relationship (p < 0.05). The anterior temporalis muscle activity negatively correlated with ramus height (r = -0.364, p < 0.05). CONCLUSIONS: Vertical craniofacial morphology was related to masticatory function. Hypodivergent individuals may have low MMA and high occlusal function, resulting in good masticatory muscle efficiency. CLINICAL RELEVANCE: Hypodivergent individuals require careful consideration in orthodontic diagnosis and prosthetic treatment planning.

Reliability and time-based efficiency of artificial intelligence-based automatic digital model analysis system.

OBJECTIVES: To compare the reliability, reproducibility, and time-based efficiency of automatic digital (AD) and manual digital (MD) model analyses using intraoral scan models. MATERIAL AND METHODS: Two examiners analysed 26 intraoral scanner records using MD and AD methods for orthodontic modelling. Tooth size reproducibility was confirmed using a Bland-Altman plot. The Wilcoxon signed-rank test was conducted to compare the model analysis parameters (tooth size, sum of 12-teeth, Bolton analysis, arch width, arch perimeter, arch length discrepancy, and overjet/overbite) for each method, including the time taken for model analysis. RESULTS: The MD group exhibited a relatively larger spread of 95% agreement limits when compared with AD group. The standard deviations of repeated tooth measurements were 0.15 mm (MD group) and 0.08 mm (AD group). The mean difference values of the 12-tooth (1.80-2.38 mm) and arch perimeter (1.42-3.23 mm) for AD group was significantly (P < 0.001) larger than that for the MD group. The arch width, Bolton, and overjet/overbite were clinically insignificant. The overall mean time required for the measurements was 8.62 min and 0.56 min for the MD and AD groups, respectively. LIMITATIONS: Validation results may vary in different clinical cases because our evaluation was limited to mild-to-moderate crowding in the complete dentition. CONCLUSIONS: Significant differences were observed between AD and MD groups. The AD method demonstrated reproducible analysis in a considerably reduced timeframe, along with a significant difference in measurements compared to the MD method. Therefore, AD analysis should not be interchanged with MD, and vice versa.

Effectiveness of remote monitoring and feedback on objective compliance with a mandibular advancement device for treatment of obstructive sleep apnea.

Compliance with a mandibular advancement device is important for the optimal treatment of obstructive sleep apnea. Recent advances in information and communication technology-based monitoring and intervention for chronic diseases have enabled continuous monitoring and personalized management. Self-evaluation and self-regulation through objective monitoring and feedback may improve compliance. The aim of this study was to evaluate the effects of information and communication technology-based remote monitoring and feedback services, using a smartphone application, on the objective compliance with a mandibular advancement device in patients with obstructive sleep apnea. Forty individuals who were diagnosed with obstructive sleep apnea by polysomnography were randomly assigned to groups A and B. During an initial 6-week evaluation period, the mandibular advancement device-wearing time was monitored with the smartphone application in group B, but not in group A. The two groups then switched the monitoring procedures during the second 6-week period (the smartphone application was then used by group B, but not by group A). If no input data were indicated on the cloud server of the smartphone application during the monitored period, push notifications were provided twice daily. Objective compliance, monitored by a micro-recorder within the mandibular advancement device, was noted and compared based on whether the monitoring service was provided. The number of mandibular advancement device-wearing days was significantly higher in the monitored period than in the unmonitored period. The mandibular advancement device-wearing time did not differ significantly between the two groups. In conclusion, information and communication technology-based remote monitoring and feedback services demonstrated a potential to increase the objective measures of compliance with mandibular advancement devices.

Targeted next-generation sequencing for comprehensive genetic analysis of external apical root resorption during orthodontic treatment with premolar extraction in the Korean population.

INTRODUCTION: External apical root resorption (EARR) is one of the most common unfavorable consequences of orthodontic treatment and causes loss of tooth structure. The present study aimed to investigate the genetics of EARR using next-generation sequencing comprehensively. METHODS: Targeted next-generation sequencing was performed for comprehensive genetic analysis of 118 Korean orthodontic patients. The patients were divided into 2 groups on the basis of their EARR value. The association of clinical and genetic parameters with EARR was assessed using the χ2 test or t test for matched pairs, followed by Bonferroni correction and linear regression analysis. In addition, haplotype analysis and in silico prediction were conducted to evaluate functional effects. RESULTS: No statistically significant difference was observed between clinical and treatment-related parameters and EARR. The single nucleotide polymorphisms SPP1 rs9138 (P = 0.001) and SFRP2 rs3810765 (P = 0.04) showed only nominal significance between EARR groups. However, these 2 SNPs were not significant after Bonferroni correction for multiple testing (cutoff P = 0.05/142 = 3.52 × 10-4). Variations in SPP1 rs9138 and SFRP2 rs3810765 may be related to EARR during orthodontic treatment. In summary, not only genes related to inflammatory reactions but also those related to Wnt signaling to affect the degree of EARR during orthodontic teeth movement.

Accuracy of 3-dimensional printed bracket transfer tray using an in-office indirect bonding system.

INTRODUCTION: In this study, we aimed to evaluate and compare the bracket positioning accuracy of the indirect bonding (IDB) transfer tray fabricated in-clinic using the tray printing (TP) and marker-model printing methods (MP). METHODS: The TP group was further divided into 2 groups (single-tray printing [STP] and multiple-tray printing [MTP]) depending on the presence of a tray split created using the 3-dimensional (3D) software. Five duplicated plaster models were used for each of the 3 experimental groups, and a total of 180 artificial teeth, except the second molar, were evaluated in the experiment. The dental model was scanned using a model scanner (E3; 3Shape Dental Systems, Copenhagen, Denmark). Virtual brackets were placed on facial axis points, and the IDB trays were designed and fabricated using a 3D printer (VIDA; EnvisionTEC, Mich). The accuracy of bracket positioning was evaluated by comparing the planned bracket positions and the actual bracket positions using 3D analysis on inspection software. The main effects and first-order interaction effects were analyzed together by analysis for the analysis of variance. RESULTS: The mean distance and height errors were significantly lower in the STP group than those in the MP and MTP groups (P <0.05). The mean distance error was 0.06 mm in the STP group and 0.09 mm in the MP and MTP groups. The mean height error was 0.10 mm in the STP group and 0.15 mm and 0.18 mm in MP and MTP groups, respectively. However, no significant differences were observed in the angular errors among the 3 groups. CONCLUSIONS: The in-office-fabricated IDB system with computer-aided design and 3D printer is clinically applicable after considering the linear and angular errors. We recommend IDB trays fabricated using the STP method owing to the lower frequency of bracket positioning errors and ease of fabrication.

Evaluation of success rate and biomechanical stability of ultraviolet-photofunctionalized miniscrews with short lengths.

INTRODUCTION: The aim of this research was to verify that ultraviolet light (UV)-photofunctionalization improves the success rate and biomechanical stability of miniscrews regardless of length, and to evaluate the comparability of biomechanical stability between UV-photofunctionalized miniscrews with short lengths and untreated miniscrews with conventional lengths. METHODS: Eight male beagles (age, 12-15 months; weight, 10-13 kg) received a total of 64 miniscrews, including 7-mm and 4-mm untreated and UV-photofunctionalized, acid-etched miniscrews with the use of a random block design. The cumulative success rates were examined in all studied groups. The insertion and removal torques and screw mobility were measured. Microcomputed tomographic scans and histomorphometric analyses were performed at 8 weeks postoperatively. RESULTS: The success rates of 7-mm UV-untreated and UV-photofunctionalized miniscrews were 87.5% and 100%, respectively, vs 43.8% for the 4-mm UV-untreated and 4-mm UV-photofunctionalized miniscrews. The rates were significantly different in accordance with the length (P <0.001). There were no differences in the insertion and removal torque and screw mobility between groups according to the length or UV treatment. However, the 4-mm UV-untreated miniscrews yielded a mean bone area ratio of 6.35 ± 7.43%, whereas the 7-mm UV-photofunctionalized miniscrew yielded a mean ratio of 32.17 ± 8.34% (P = 0.037). CONCLUSIONS: The UV-photofunctionalization significantly increased the biomechanical stability and led to increased bone and miniscrew contact area in dogs with miniscrews of the same length. However, the most important factor that affected the success rate of the miniscrew was the length.

Differences in soft-tissue thickness changes after bimaxillary surgery between patients with vertically high angle and normal angle.

INTRODUCTION: We evaluated soft-tissue thickness changes after bimaxillary surgery according to vertical facial patterns in patients with skeletal Class III malocclusion with mandibular prognathism. METHODS: Forty-three Korean patients (16 men and 27 women; mean age, 22.6 ± 4.1 years) with skeletal Class III malocclusion who underwent bimaxillary surgery were divided into 2 groups: normal-angle group (N group) and high-angle group (H group), on the basis of the presurgical angle of the mandibular plane relative to the sella-nasion plane (SN-MP). Changes in hard-tissue landmarks and soft-tissue thickness before and after surgery were analyzed from reconstructed 3-dimensional cone-beam computed tomography images. Postoperative soft-tissue thickness in both groups was compared with that in 40 patients with normal skeletal Class I malocclusion in the reference group. RESULTS: Group N (27°-37°) and group H (>37°) did not differ significantly in terms of sex and age before surgery. Preoperative pogonion (Pog) thickness was significantly less in group H (9.7 ± 1.6 mm) than in group N (10.8 ± 1.9 mm) (P = 0.042). Adjusted multiple linear regression analysis showed a weak positive linear relationship between the SN-MP before surgery and soft-tissue Pog thickness change (R2 of 0.361; P = 0.001) after surgery, but the area below the lower lips was not completely normalized despite surgery. CONCLUSIONS: The thickness of the soft-tissue Pog may increase slightly after surgery in patients with skeletal Class III malocclusion with a higher preoperative mandibular plane angle, but normalization in the area cannot be completely achieved despite surgery.

Accuracy of bracket position using thermoplastic and 3D-printed indirect bonding trays.

AIM: The positional accuracy of bracket placement planned through tooth setup vs actual placement was evaluated by means of conventional thermoplastic indirect bonding trays and customized 3D-printed indirect bonding trays. MATERIALS AND METHODS: A total of 280 bracket positions placed on the crowns of 10 dental plaster models were evaluated. The manual setup method and a thermoplastic indirect bonding tray were used for the manual group. For the CAD/CAM group, the bracket was positioned using a digital setup and a corresponding 3D-printed tray. The positional accuracy of the bracket placement on the duplicated gypsum model using the trays was evaluated by means of 3D software. Six errors of bracket position (height, depth, mesiodistal, torque, rotation, and tip errors), including linear and angular errors, were measured. Differences in variables were compared across subgroups using the independent t test or the Mann-Whitney U test. RESULTS: Only the height error differed significantly (P < 0.05) between groups (manual: 0.2 mm; CAD/CAM: 0.12 mm). For both incisors and molars, the manual group showed significantly greater height errors than the CAD/CAM group (P < 0.05). The analysis of variance of the position error to the whole bracket showed statistically significant differences between tooth positions, linear measurements, and angular measurements (P < 0.05). CONCLUSION: A 3D-printed indirect bonding tray showed accuracy similar to that of conventional methods for bracket placement, with slightly greater bracket height accuracy. Further studies should strive to improve accuracy in terms of tooth positions.

How Is the Created Alveolar Space Finally Restored After Maxillary Anterior Segmental Distraction Osteogenesis?

OBJECTIVE: Maxillary anterior segmental distraction osteogenesis (MASDO) for cleft and palate patients is the alternative treatment option to correct malocclusion with maxillary arch deficiency and severe crowding. After MASDO, prosthetic considerations are crucial for patients with cleft lip and palate because it is related to facial esthetics and occlusal function. The objectives of this study were to investigate the final restoration type for created alveolar space by MASDO. METHODS: Thirteen patients with cleft lip and palate who underwent MASDO and orthodontic treatment from the years 2000 to 2010 in Yonsei University were examined. Final restorations are classified as dental implants, conventional prosthesis, and orthodontic space closure. The relationship between the distracted areas and final restoration type was investigated. The authors evaluated lateral cephalograms obtained at predistraction osteogenesis (pre-DO; T1), postdistraction osteogenesis (post-DO; T2), and debond (T3), and measured changes from T1 to T2 and from T2 to T3. RESULTS: There was no significant difference of final restoration percentage of dental implants, conventional prosthesis, and space closure with orthodontic treatment. However, dental implants and conventional prostheses were applied more frequently in the posterior area and in the anterior area, respectively. The relapse rate was observed as 36.7% and 22.4% in the values of N-A distance and ANB angulation in T2-T3 stage. CONCLUSION: The MASDO site should be decided, based on final restoration goal. Among the created alveolar spaces, implants were applied mainly to the posterior site and the conventional prostheses were mostly restored to the anterior site. For space closure by orthodontic approach, the area could be both anterior or posterior.

Registration of digital dental models and cone-beam computed tomography images using 3-dimensional planning software: Comparison of the accuracy according to scanning methods and software.

INTRODUCTION: The registration of cone-beam computed tomography (CBCT) images and digital dental models is required for the design and manufacturing of dental devices such as implant guides and surgical wafers. This study aims to register intraoral scan (IS) models and cast scan (CS) models onto CBCT images using 3-dimensional (3D) planning software and evaluate the registration accuracy according to scanning methods and 3D planning software. METHODS: The CBCT image of an artificial skull model with reference markers was taken. The CS model and the IS model were obtained from the same skull model, registered onto the CBCT image using 3D planning software packages providing manual registration (MR) function and point-based registration (PR) functions, and set as the experimental groups. After registration, shell to shell deviations and positional differences between the reference model and the experimental models were evaluated. RESULTS: The shell to shell deviations ranged from 0.03 to 0.18 mm. Deviations in both the maxilla and mandible were significantly different according to scanning methods and software packages. In the anteroposterior direction, the IS-MR and CS-MR groups showed significantly different positions. In the superoinferior direction, the MR and PR groups showed significantly different positions. CONCLUSIONS: The registration using the PR function of the 3D planning software packages was significantly more accurate than the registration using the MR function. There was no significant difference between the registrations using the IS model and the CS model when using the PR functions.

Intraoral Premaxillary Distraction in a Patient With Maxillary Retrognathic Cleft Lip and Palate: A Case Report.

Patients with cleft lip and palate sometimes have a retruded maxilla. Here, we describe the case of a young man in whom crowding of the maxillary teeth and an anteroposterior discrepancy of the maxilla were resolved by premaxillary distraction osteogenesis (DO) using 3 individual intraoral distractors. Our experience in this patient confirms that premaxillary DO with 3 intraoral distractors and preoperative simulation can achieve stable maxillary advancement and arch expansion without impairing velopharyngeal incompetence.

Outcomes of early versus late treatment of severe Class II high-angle patients.

INTRODUCTION: The aim of this work was to compare the skeletal and dental outcomes of 1- versus 2-phase treatment in Class II subjects with difficult-to-treat high-angle severe Class II malocclusions. METHODS: The sample of 120 cases was collected from the private offices of 3 experienced clinicians. The following selection criteria were used: (1) ANB ≥6°, (2) SN-GoGn ≥37° or mandibular plane to Frankfort horizontal plane ≥30°; and (3) overjet ≥6 mm. Patients were classified into either the early or the late treatment group according to dental age (early Tx: ≥5 primary teeth; late Tx: otherwise). Thirty-four angular, linear, and proportional measurements were determined for each patient. Statistical significance was assessed with the use of a 2-tailed t test, analysis of covariance test, and chi-square test. RESULTS: The results showed that early 2-phase treatment for severe Class II high-angle patients offered no skeletal anteroposterior advantages over late 1-phase treatment. Severe high-angle Class II patients also showed similar dental anteroposterior outcomes with the use of both approaches. Vertically there was a higher frequency of increased mandibular plane angles and extrusion of upper incisors and lower molars in the late treatment group. CONCLUSIONS: Early 2-phase treatment for severe Class II high-angle patients offered no skeletal or dental advantage over late 1-phase treatment.

Precision and trueness of dental models manufactured with different 3-dimensional printing techniques.

INTRODUCTION: In this study, we assessed the precision and trueness of dental models printed with 3-dimensional (3D) printers via different printing techniques. METHODS: Digital reference models were printed 5 times using stereolithography apparatus (SLA), digital light processing (DLP), fused filament fabrication (FFF), and the PolyJet technique. The 3D printed models were scanned and evaluated for tooth, arch, and occlusion measurements. Precision and trueness were analyzed with root mean squares (RMS) for the differences in each measurement. Differences in measurement variables among the 3D printing techniques were analyzed by 1-way analysis of variance (α = 0.05). RESULTS: Except in trueness of occlusion measurements, there were significant differences in all measurements among the 4 techniques (P <0.001). For overall tooth measurements, the DLP (76 ± 14 µm) and PolyJet (68 ± 9 µm) techniques exhibited significantly different mean RMS values of precision than the SLA (88 ± 14 µm) and FFF (99 ± 14 µm) techniques (P <0.05). For overall arch measurements, the SLA (176 ± 73 µm) had significantly different RMS values than the DLP (74 ± 34 µm), FFF (89 ± 34 µm), and PolyJet (69 ± 18 µm) techniques (P <0.05). For overall occlusion measurements, the FFF (170 ± 55 µm) exhibited significantly different RMS values than the SLA (94 ± 33 µm), DLP (120 ± 28 µm), and PolyJet (96 ± 33 µm) techniques (P <0.05). There were significant differences in mean RMS values of trueness of overall tooth measurements among all 4 techniques: SLA (107 ± 11 µm), DLP (143 ± 8 µm), FFF (188 ± 14 µm), and PolyJet (78 ± 9 µm) (P <0.05). For overall arch measurements, the SLA (141 ± 35 µm) and PolyJet (86 ± 17 µm) techniques exhibited significantly different mean RMS values of trueness than DLP (469 ± 49 µm) and FFF (409 ± 36 µm) (P <0.05). CONCLUSIONS: The 3D printing techniques showed significant differences in precision of all measurements and in trueness of tooth and arch measurements. The PolyJet and DLP techniques were more precise than the FFF and SLA techniques, with the PolyJet technique having the highest accuracy.

Treatment satisfaction and its influencing factors among adult orthodontic patients.

INTRODUCTION: The aim of this study was to investigate the level of satisfaction for orthodontic treatment among adult patients. In addition, the influencing host factors were monitored for their associations with satisfaction. METHODS: A questionnaire was designed to measure the level of satisfaction in 10 items; overall satisfaction, tooth alignment, facial appearance, eating and chewing, confident smile and self-image, retention state, treatment duration, treatment costs, intention to recommend, and relief of previous concerns, using a 5-point Likert scale. Total satisfaction was calculated by averaging the Likert scores from the 10 items. The survey was conducted, and the results from 298 adults were evaluated. RESULTS: For the overall satisfaction item, 45.0% were very satisfied, and 39.9% were satisfied, resulting in a satisfaction ratio of 84.9%. Total satisfaction score was 3.9. The level of satisfaction for tooth alignment and confident smile and self-image were significantly higher than facial appearance and eating and chewing (P <0.001). Patients aged 50 and above were more satisfied than the younger ones, and men were more satisfied than women (P <0.05). CONCLUSIONS: Overall, adult patients were highly satisfied with orthodontic treatment. Age, sex, motivation, expected concern, and discomfort influenced the level of satisfaction.

Intraoral Vertical Ramus Osteotomy Results in Good Long-Term Mandibular Stability in Patients With Mandibular Prognathism and Anterior Open Bite.

PURPOSE: Few studies have evaluated the outcomes of intraoral vertical ramus osteotomy (IVRO) for the correction of skeletal Class III malocclusion with an anterior open bite and the potential for postoperative relapse. Therefore, this study evaluated the stability of outcomes of IVRO for mandibular prognathism with and without an anterior open bite. MATERIAL AND METHODS: This retrospective cohort study included consecutive patients with skeletal Class III malocclusion with (AOB group) and without (NAOB group) an anterior open bite who underwent IVRO at Yonsei Dental Hospital (Seoul, Korea). Lateral cephalograms were analyzed for predictor (open bite, yes or no) and outcome (horizontal and vertical relapse in the mandible) variables before and 7 days, 1 year, and 2 years after surgery. Other variables included the patients' demographic characteristics. Data were analyzed using independent t tests, repeated measures analysis of variance, Pearson correlation coefficients, and multiple linear regression analysis. RESULTS: The 2 groups (n = 15 each) were matched for baseline demographic characteristics. During the 2-year postoperative period, anterior and superior mandibular movements were observed in the NAOB group, whereas posterior and superior movements were observed in the AOB group. However, there were no meaningful intergroup differences in horizontal and vertical relapses of the mandible at all time points, although the amount of postoperative inferior relapse increased with a decrease in the amount of initial overbite. CONCLUSIONS: IVRO for the correction of skeletal Class III malocclusion resulted in good postoperative stability over time, regardless of the presence of a preoperative open bite, although the amount of postoperative inferior relapse showed a weak negative correlation with the initial overbite. Thus, IVRO can be a clinically acceptable treatment for skeletal Class III malocclusion with an anterior open bite.

Is There a Difference in Stability After Intraoral Vertical Ramus Osteotomy Between Vertically High-Angle and Normal-Angle Patients?

PURPOSE: Few studies have evaluated the relapse pattern of intraoral vertical ramus osteotomy (IVRO) for the correction of mandibular prognathism with a high angle. The aim of this study was to measure the association between vertical facial types (high and normal mandibular plane angle) and relapse after IVRO for the management of mandibular prognathism. MATERIALS AND METHODS: The retrospective cohort study sample (skeletal Class III patients) was divided into 2 groups according to the angle of the sella-nasion plane relative to the mandibular plane (SN-MP) at the initial examination. Lateral cephalograms were analyzed for the predictor (facial type) and outcome (cephalometric changes over time) variables before surgery, 7 days after surgery, and 12 months after surgery. The 2 groups were matched for sample size (n = 20 in each). Data were analyzed using repeated-measures analysis of variance with Bonferroni correction. RESULTS: The normal-angle group (group N, SN-MP from 27° to 37°) and high-angle group (group H, SN-MP >37°) were not significantly different in terms of gender and age at the initial examination. Seven days after surgery, the mandibles in group H moved 2.5 mm more superiorly than those in group N (P = .013); consequently, the amount of overbite correction in group H was approximately 2 mm greater than that in group N (P = .002). Nevertheless, 12 months after surgery, there was no statistically significant difference in relapse of the maxilla and mandible between the 2 groups. In the 2 groups, the mandible moved approximately 0.7 mm superiorly during retention. CONCLUSIONS: These findings suggest that IVRO is a clinically acceptable and stable treatment modality for mandibular prognathism with a high angle.

Changes in the craniofacial complex and alveolar bone height of young adults: Applications to dental medicine.

The few studies on craniofacial complex changes in adults have reported contradictory findings. The aim of this study was to radiographically evaluate changes in the craniofacial complex and alveolar bone height of young adults over a 4-year period. This prospective study included 82 young adults (62 men; mean age, 19.0 ± 0.8 years; 20 women; mean age, 18.8 ± 0.9 years). Three radiographic examinations were performed longitudinally: the first (T0) was conducted at the start of the study, the second (T1) was conducted 2 years later, and the third (T2) was conducted at the end of the study period. As part of these examinations, lateral cephalograms, maxillary and mandibular anterior periapical radiographs, and bilateral posterior bitewing radiographs were obtained. During the 4-year follow-up period, all linear cephalometric measurements were significantly greater in men than in women. The amount of increase in the anterior facial height between T1 and T2 was lower in women than in men (P = 0.029). The rate of uprighting of the upper incisors was lower in men than in women over time (P = 0.020). The apex of the nose moved inferiorly between T0 and T2 (P = 0.006). The average overall change in the alveolar bone height was 0.27 mm and the yearly change was 0.07 mm over the 4-year period (P< 0.001). Significant changes in the skeletal, dental, and soft tissue, as well as, natural changes in alveolar bone, occur in young adults over time. Clin. Anat. 29:1011-1017, 2016. © 2016 Wiley Periodicals, Inc.