Nonsurgical class III correction in adolescence using modified fixed reverse twin-block therapy and fixed appliances - a case series.

Skeletal class III malocclusion is a therapeutic challenge in orthodontic practice. Reverse functional appliances such as reverse twin block (RTB) are used to correct class III skeletal and occlusal disharmonies associated with functional anterior shift in growing patients. However, treatment options become limited with increasing age, especially when patients desire nonsurgical and nonextraction camouflage treatment. This report illustrates the successful nonsurgical treatment of class III malocclusion during adolescence and adulthood, exacerbated by a functional anterior shift that resulted in overclosure of the mandible. A modified fixed RTB was utilized to posture the mandible backwards, thereby inducing active clockwise rotation of the mandible. After treatment, patients demonstrated significantly improved maxillomandibular relationships, well-maintained stable occlusion, and facial esthetics. Satisfactory occlusal, esthetic, and functional outcomes achieved in the present cases underline the fact that dentoalveolar changes induced by fixed RTB can be utilized even past a patient's peak pubertal growth period to obtain changes that aid in correcting a class III malocclusion. A synergistic combination of modified fixed RTB therapy accompanied by comprehensive fixed mechanotherapy is a viable treatment alternative for the correction of aptly selected mild to moderate skeletal class III malocclusions associated with functional anterior shift, anterior crossbites, and mandibular overclosure.

Association between mandibular prognathism and Matrilin-1, bone morphogenic protein, Tyr67Asn, homeobox protein hox-A2, Rho-GTPase activating protein, and Myosin 1H genes in the Indian population.

INTRODUCTION: Mandibular prognathism (MP) patients present with aesthetic concerns and functional issues, including difficulties in mastication and pronunciation. Studies revealed that mandibular prognathism had definitive Mendelian inheritance patterns. This study aimed to ascertain distinct genetic markers associated with mandibular prognathism in individuals of Indian descent, focusing on exploring the prevalent genetic variations associated with certain genes. This study sought to identify the association of the following gene markers with mandibular prognathism: 1) Matrilin-1 (MATN1) (rs1065755), 2) Bone morphogenic protein 3 (BMP-3) (Tyr67Asn), 3) Homeobox protein hox-A2 (HOXA2) (Val327Ile), 4) Rho-GTPase activating protein (ARHGAP 21) (Gly1121Ser), 5) Myosin 1H (MYO1H) (rs10850110).

Preventive Effects of Gonadotropin-Releasing Hormone Treatment on Urinary Bladder and Kidney Damage in Spinal Cord Injured Rats.

INTRODUCTION: One of the main causes of a neurogenic bladder is spinal cord injury (SCI),(SCI), which induces little or no bladder reflex activity. Because of this alteration, there is an increased risk of developing urinary tract infections and kidney damage. Gonadotropin-releasing hormone (GnRH) treatment has been shown to improve micturition in a rat model of SCI. AIM: The present study was aimed at determining whether GnRH administration is capable to reduce bladder and kidney damage in rats with SCI. METHODS: Ovariectomized female Wistar rats were divided into three groups: sham, SCI with saline solution (SCI), and SCI treated with GnRH (SCI+GnRH) for 6 weeks. SCI was induced by compression at the T10 spinal level. At the end of the experiment, bladders and kidneys were processed for morphological and immunofluorescence analysis. For morphometric analysis, the thickness of the urothelium and the muscular layer of the bladder was measured, as well as the intensity of staining related to collagen in the kidney. RESULTS: At the end of the experiment, all animals in the sham group showed normal urination (100%), in contrast, the percentage of untreated injured rats (SCI) that did not require manual stimulation for micturition was 19%, while the treated group (SCI+GnRH) was 68%. A significative increase in bladder weight, urothelial and muscle thickness, and collagen-related coloration in the kidney was observed in SCI when compared to sham rats. CONCLUSION: GnRH administration decreased damage to the urinary bladder and kidneys after SCI in rats. These results suggest that this hormone could be a potential preventive treatment for SCI patients at risk of neurogenic bladder and kidney damage. TRIAL REGISTRATION: Not applicable.

Lateral cephalometric parameters among Arab skeletal classes II and III patients and applying machine learning models.

BACKGROUND: The World Health Organization considers malocclusion one of the most essential oral health problems. This disease influences various aspects of patients' health and well-being. Therefore, making it easier and more accurate to understand and diagnose patients with skeletal malocclusions is necessary. OBJECTIVES: The main aim of this research was the establishment of machine learning models to correctly classify individual Arab patients, being citizens of Israel, as skeletal class II or III. Secondary outcomes of the study included comparing cephalometric parameters between patients with skeletal class II and III and between age and gender-specific subgroups, an analysis of the correlation of various cephalometric variables, and principal component analysis in skeletal class diagnosis. METHODS: This quantitative, observational study is based on data from the Orthodontic Center, Jatt, Israel. The experimental data consisted of the coded records of 502 Arab patients diagnosed as Class II or III according to the Calculated_ANB. This parameter was defined as the difference between the measured ANB angle and the individualized ANB of Panagiotidis and Witt. In this observational study, we focused on the primary aim, i.e., the establishment of machine learning models for the correct classification of skeletal class II and III in a group of Arab orthodontic patients. For this purpose, various ML models and input data was tested after identifying the most relevant parameters by conducting a principal component analysis. As secondary outcomes this study compared the cephalometric parameters and analyzed their correlations between skeletal class II and III as well as between gender and age specific subgroups. RESULTS: Comparison of the two groups demonstrated significant differences between skeletal class II and class III patients. This was shown for the parameters NL-NSL angle, PFH/AFH ratio, SNA angle, SNB angle, SN-Ba angle. SN-Pg angle, and ML-NSL angle in skeletal class III patients, and for S-N (mm) in skeletal class II patients. In skeletal class II and skeletal class III patients, the results showed that the Calculated_ANB correlated well with many other cephalometric parameters. With the help of the Principal Component Analysis (PCA), it was possible to explain about 71% of the variation between the first two PCs. Finally, applying the stepwise forward Machine Learning models, it could be demonstrated that the model works only with the parameters Wits appraisal and SNB angle was able to predict the allocation of patients to either skeletal class II or III with an accuracy of 0.95, compared to a value of 0.99 when all parameters were used ("general model"). CONCLUSION: There is a significant relationship between many cephalometric parameters within the different groups of gender and age. This study highlights the high accuracy and power of Wits appraisal and the SNB angle in evaluating the classification of orthodontic malocclusion.

Long-term effects of protraction facemask combined with fixed appliance therapy in severe skeletal Class III adolescent: A case report with 5-year follow-up.

INTRODUCTION AND IMPORTANCE: The decision between orthodontic camouflage therapy and orthodontic-orthognathic surgical treatment for developing skeletal Class III malocclusion presents a significant challenge for orthodontists. CASE PRESENTATION: This case report describes the camouflage treatment of a severe skeletal Class III adolescent at the post-pubertal stage. CLINICAL DISCUSSION: Protraction facemask combined with a bonded acrylic splint expander was initially used to correct the developing skeletal Class III malocclusion. Then the patient received fixed appliance therapy. The duration of active treatment was 14 months. Anterior crossbite was corrected, along with stable occlusion and harmonious facial condition. The results remain stable at the 5-year follow-up period. CONCLUSION: Treatment with protraction facemask followed by fixed appliance therapy was possibly effective in a long-term observation, even in skeletal Class III adolescent at the post-pubertal stage.

Changes in mandibular width and frontal-lower facial profile after orthognathic surgery using sagittal split ramus osteotomy with removal of internal bone interference in patients with class III skeletal malocclusion.

BACKGROUND: The purpose of this study is to analyze changes in mandibular width and frontal view ramus inclination using cone beam CT in patients with skeletal class III malocclusion who underwent BSSRO, with the removal of bone interference between segments. METHODS: For all 20 subjects, cone-beam CT imaging was performed prior to surgery (T1), immediately post-surgery (T2), and 6 months after surgery (T3). Reorientation was performed using R2GATE software (MegaGen, Seoul, Korea). The gonion and antegonial notch were used as reference points in the sagittal view, and the most lateral point of the condyle head was used as the reference point in the frontal view. All measurements were recorded in the frontal view. RESULTS: Inter-gonial width decreased by 2.64 mm at T3-T2 (P < .001) and by 2.58 mm at T3-T1 (P < .05). Inter-antegonial width decreased by 1.75 mm at T3-T2 (P < .05) and by 3.5 mm at T3-T1 (P < .001). In the frontal view, the right ramus inclination based on the gonion increased by 2.07° at T3-T1 (P < .05). The left ramus inclination based on gonion increased by 2.45° at T2-T1 (P < .05) and by 3.94° at T3-T1 (P < .001). The right ramus inclination based on antegonial notch increased by 2.35° at T2-T1 (P < .05) and by 3.04° at T3-T1 (P < .01). The left ramus inclination based on antegonial notch increased by 2.73° at T2-T1 (P < .001) and by 3.18° at T3-T1 (P < .001). CONCLUSIONS: During bilateral sagittal split osteotomy, removing bone interference between the proximal and distal segments results in a reduction of postoperative mandibular width and an increase in frontal view ramus inclination.

Correlation between oral cavity volume and upper airway changes in skeletal Class III patients undergoing bimaxillary orthognathic surgery: a pilot cone-beam computed tomography study.

OBJECTIVES: To evaluate changes of the upper airway and oral cavity volumes in patients with skeletal Class III malocclusion undergoing bimaxillary orthognathic surgery, and to analyze the correlation between postoperative upper airway decrease and the amount of jaw movement and oral cavity volume reduction. MATERIALS AND METHODS: Thirty patients (16 males and 14 females) undergoing bimaxillary surgery were included. Three-dimensional reconstruction of the upper airway and oral cavity were performed using preoperative (T0) and postoperative (T1) (6 months) cone-beam computed tomography scans. RESULTS: The volume, sagittal area and minimum cross-sectional area of the upper airway were diminished (P < .001). The decrease in volume and minimum cross-sectional area in the oropharyngeal region of the upper airway were weakly correlated with B-point posterior movement (P < .05). Total oral cavity volume was decreased, with maxillary oral volume increasing and mandibular oral volume decreasing (P < .001). Upper airway decrease was highly correlated with total oral volume reduction and mandibular oral volume reduction, with the most significant correlation being with total oral volume reduction (P < .001). CONCLUSIONS: Class III bimaxillary surgery reduced the volume, sagittal area, and minimum cross-sectional area of the upper airway as well as oral cavity volume. Upper airway changes were weakly correlated with anterior-posterior mandibular movement but significantly correlated with oral cavity volume changes. Thus, oral cavity volume reduction is a crucial factor of upper airway decrease in patients with skeletal Class III malocclusion undergoing bimaxillary orthognathic surgery.

Changes in the upper airway and its surrounding structures after bimaxillary surgery in patients with cleft-related Class III deformity.

OBJECTIVES: To compare upper airway changes following bimaxillary surgery for correction of Class III deformity between patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) and to compare the preoperative and postoperative upper airway among patients with UCLP and BCLP to healthy controls. MATERIALS AND METHODS: Sixty adults with CLP-related skeletal Class III deformity (30 UCLP and 30 BCLP) who consecutively underwent bimaxillary surgery were studied retrospectively. Cone-beam computed tomography (CBCT) was performed before and after surgery to measure upper airway and movements of facial skeletal and surrounding structures. CBCT images from 30 noncleft skeletal Class I adults, matched by age, gender, and body mass index and without surgical intervention, served as controls. RESULTS: After surgery, the volume of the nasopharynx increased in patients with CLP (both P < .001). Patients with CLP did not differ from controls in postoperative volume of the nasopharynx or oropharynx. However, the nasal cavity differed significantly between patients with CLP and controls (P < .001). CONCLUSIONS: After bimaxillary surgery, the nasal cavity of patients with CLP differed significantly compared with the controls. Volumes of the nasopharynx and oropharynx did not differ between patients with CLP after surgery and controls.

Lower incisor position in skeletal Class III malocclusion patients: a comparative study of orthodontic camouflage and orthognathic surgery.

OBJECTIVES: To determine the difference between orthodontic camouflage and orthodontic-orthognathic surgery using the traditional cephalometric measurement IMPA and the newly proposed IA/PAMD, the angle between the long axis of the lower incisor (IA) and the principal axis of the mandibular alveolus (PAMD). MATERIALS AND METHODS: This study included 40 cases each in the orthodontic camouflage group (OG) and orthodontic-orthognathic surgery group (SG). The differences between the IMPA and IA/PAMD before and after treatment were compared between the two groups. T0 lateral cephalometric images of the 10 cases with the highest and lowest increase in the IA/PAMD were analyzed to identify characteristics associated with a higher risk of overdecompensation of the lower incisors during presurgical orthodontic treatment. RESULTS: Both the OG and SG showed a significant improvement in hard- and soft-tissue measurements. However, in the OG, there was significant lingual inclination of the lower incisor but only a small change in the IA/PAMD. In the surgical group, the IMPA was close to 90° after treatment, but the IA/PAMD significantly increased. CONCLUSIONS: In orthodontic camouflage, the lower anterior teeth were significantly moved lingually with a better root-bone relationship. However, this relationship deteriorated in some surgical patients. Therefore, it is important to conduct cephalometric or cone-beam computed tomography examinations during preoperative orthodontics to identify and prevent possible periodontal risks.

Simultaneous labial and lingual augmented corticotomy assisted presurgical orthodontics in class III patients: the morphological aspects of the mandibular anterior ridge with cone-beam computed tomography.

OBJECTIVES: This study aims to investigate the changes in alveolar bone following the simultaneous performance of labial and lingual augmented corticotomy (LLAC) in patients with insufficient alveolar bone thickness on both the labial and lingual sides of the mandibular anterior teeth during presurgical orthodontic treatment. MATERIALS AND METHODS: Thirth-five surgical patients with skeletal Class III malocclusion were included: 19 (LLAC group) accepted LLAC surgery during presurgical orthodontic treatment, and 16 (non-surgery group, NS) accepted traditional presurgical orthodontic treatment. Cone-beam computed tomography (CBCT) scans were obtained before treatment (T0) and at the completion of presurgical orthodontic treatment (T1). The amount of vertical alveolar bone and contour area of the alveolar bone in the labial and lingual sides of mandibular incisors were measured. RESULTS: After presurgical orthodontic treatment, the contour area of the alveolar bone at each level on the lingual side and alveolar bone level on both sides decreased significantly in the NS group (P < 0.001). However, the labial and lingual bone contour area at each level and bone level increased significantly in the LLAC group (P < 0.001). The bone formation rate in the lingual apical region was the highest, significantly different from other sites (P < 0.001). CONCLUSIONS: During presurgical orthodontic treatment, LLAC can significantly increase the contour area of the labio-lingual alveolar bone in the mandibular anterior teeth to facilitate safe and effective orthodontic decompensation in skeletal Class III patients. CLINICAL RELEVANCE: This surgery has positive clinical significance in patients lacking bone thickness (< 0.5 mm) in the labial and lingual sides of the lower incisors.

Evaluation of the Effects of Orthopedic Treatment on the Dentofacial Structure and Upper Airway of Subjects with Skeletal Class III Malocclusion.

Objective: The present study aimed to evaluate the effect of rapid maxillary expansion (RME) and face mask treatment on the upper airway in patients with maxillary retrusion in two dimensions using digital cephalograms and volumetric evaluation using acoustic rhinometric measurements. Methods: A total of 22 individuals with a concave profile and skeletal and dental Class III malocclusion during growth and development with a mean age of 9.9±1.38 years were included in the study. A bonded RME appliance and a petit face mask were adapted for the patients. Before treatment (T0) and after maxillary protraction (T1), lateral cephalometric films and acoustic rhinometric recordings were obtained. The dependent sample t-test was used for statistical evaluation. Results: Cephalometric analysis revealed forward movement of the maxilla and backward downward rotation of the mandible. A significant increase was observed in the nasopharyngeal and oropharyngeal regions of the upper airway. Three-dimensional evaluation of the upper airway by acoustic rhinometry revealed only an increase in the volumes of the left nasal cavity after decongestant administration. A statistically significant increase in acoustic rhinometric measurements in nasal valves. When the correlation of the cephalometric findings of the nasopharyngeal region with the acoustic rhinometry findings was examined, no statistically significant relationship was found. Conclusion: As a result of this study, we observed an increase in the cephalometric measurements of the nasopharyngeal and oropharyngeal areas. A significant increase was observed in the minimal cross-sectional area measured by acoustic rhinometry.

Evaluation of Maxillary Protraction Using a Mini Screw-Retained Palatal C-Shaped Plate and Face Mask.

Objective: To evaluate a newly designed minimally invasive palatal-plate face mask combination for the management of developing Class III malocclusion due to maxillary deficiency. Methods: A sample of 16 Class III patients due to maxillary deficiency in the early mixed dentition (8 boys and 8 girls) aged between 7 and 9 years participated in this study and were treated with a combination of palatal plate face masks. Extra-oral elastics were attached between the intra-oral and extra-oral appliances; the elastics were set at 30° to the occlusal plane. The force magnitude was 250-300 g per quadrant. Cephalometric radiographs were taken before and immediately after maxillary protraction. In addition, skeletal measurements were measured, tabulated, and statistically analyzed. The pre- and post-protraction measurements were compared using the Student's t-test, and the significance level was set at a p-value <0.05. Results: A statistically significant increase in SNA angle and maxillary length was observed by 3.13±1.52 degrees and 2.60±0.75 mm (p<0.05), respectively, indicating forward maxillary growth. The skeletal and soft tissue patterns were also improved, as evidenced by the statistically significant increase in the ANB angle, Wits appraisal, and H angle by 4.50±1.28 degrees, 5.30±1.86 mm, and 5.02±3.24 degrees (p<0.05), respectively. A favorable clockwise mandibular rotation was observed as evidenced by the increase in the SN/MP angle and the decrease in the SNB angle by 1.46±1.96 degrees and -1.38±1.86 degrees (p<0.05), respectively. Conclusion: The palatal-plate facemask combination is an effective treatment alternative for Class III malocclusion due to maxillary deficiency with minimal pain and discomfort.

The use of miniplates for nontraditional orthodontic treatment: clinical considerations for referring general dentists.

Distalization of mandibular molars comes with significant challenges, especially in adult and young adult patients. In selected cases, third molar extraction procedures offer the opportunity to place miniplates for anchorage to distalize mandibular molars, providing additional solutions to the traditional extraction of premolars or a single incisor. This approach can be of special interest to adult patients, who may have life commitments and time restraints that limit traditional orthodontic and surgical treatment options, and it can improve the efficiency of dental care. This case series describes 3 clinical scenarios in which miniplates were placed with minimal invasiveness during the removal of impacted third molars, offering the patients nontraditional orthodontic treatment options. Awareness of these options is essential for general dentists so that they can explain all treatment possibilities and provide appropriate referrals to patients with impacted third molars.

Stepwise surgical management of binder syndrome with skeletal class III malocclusion in adults.

Our study aimed to evaluate a stepwise treatment of class III malocclusion accompanied with flat nasal deformity, using orthodontics, orthognathic surgery, and rhinoplasty, as well as stability during long-term follow-up. In total, 27 patients with nasomaxillary hypoplasia and skeletal class III malocclusion were enrolled in this study. All patients had accepted orthodontic and orthognathic surgery, followed by rhinoplasty with costal cartilage as the second surgical procedure. Clinical results were evaluated by radiography, medical photography, questionnaire, and cephalometric analysis. All patients were satisfied with the surgical results and no serious complications occurred. During the follow-up, the patients showed well-corrected midface contour and nasal projection, and stable occlusion. The costal cartilage grafts were well fixed, without obvious absorption deformation. Lateral cephalometric analysis and overlay results showed that the postoperative point A had advanced approximately 5.20 ± 1.43 mm and the SNA angle had increased by approximately 5.59 ± 2.86°. Soft-tissue measurements showed a 14.22 ± 6.56° decrease in the facial lobe, while the nasolabial angle had increased by 16.83 ± 6.65° postoperatively. The results suggested that stepwise orthodontic-orthognathic surgery and rhinoplasty produce a predictable and stable result in long-term follow-up.

A preliminary investigation into the impact of soft tissue augmentation-based periodontal phenotype modification therapy for patients exhibiting class III decompensation.

BACKGROUND: Patients with skeletal angle Class III malocclusion usually have inadequate hard and soft tissue volume at the mandibular anterior teeth. The labial proclination at the teeth may lead to gingival recession. The purpose of this study was to explore whether periodontal phenotype modification therapy with soft tissue augmentation (PhMT-s) can prevent gingival recession in these patients. METHODS: Four patients with skeletal Class III malocclusion and a thin periodontal phenotype underwent surgical-orthodontic treatment. Prior to tooth movement, they underwent a minimally invasive vestibular incision with subperiosteal tunnel access combined with autogenous connective tissue grafts for periodontal phenotype modification with soft tissue augmentation (PhMT-s). The labial gingival thickness of the anterior mandibular teeth was measured at three distinct levels: at the cementoenamel junction (GT0), 3 mm apical to the CEJ (GT3), and 6 mm apical to the CEJ (GT6). These measurements were taken at baseline, three months following PhMT-s, and after tooth decompensation. Additionally, a biopsy sample was obtained from the PhMT-s site of one patient. All sections were subsequently stained using hematoxylin and eosin, Masson trichrome, Sirius Red, and immunohistochemistry. RESULTS: The thickness of the labial gingiva was increased about 0.42 to 2.00 mm after PhMT-s. At the end of pre-orthognathic surgical orthodontic treatment, the thickness of the labial gingiva was increased about - 0.14 to 1.32 mm compared to the baseline and no gingival recession occurred after the pre-orthognathic surgical orthodontic treatment. The histologic results demonstrated that the grafts obtained from the PhMT-s site exhibited increased deposition of collagen fibers. Moreover, the proportion of type III collagen increased and the grafts displayed significantly reduced positive expression of CD31 and OCN. CONCLUSIONS: PhMT-s increased the thickness of the soft tissue, stabilizing the gingival margin for teeth exhibiting a thin periodontal phenotype and undergoing labial movement. This is attributed to the increased deposition of collagen fibers.

Class III Obesity as a Risk Factor for Persistent Asthma.

BACKGROUND: The burden of asthma remains steady with no decline observed in the past few decades. Obesity prevalence has been steadily increasing with a rate of 41.9% in the United States between 2017-2020. Obesity is an inflammatory chronic condition that may partially contribute to the burden and severity of asthma. This study aimed to examine whether the association between obesity and asthma varies with the categories of obesity (class I, II, and III) and persistent asthma (mild, moderate, and severe asthma). We hypothesized that subjects with elevated body mass index (BMI) are more likely to be diagnosed with persistent asthma than subjects without obesity with asthma. METHODS: As a retrospective and cross-sectional study, this study used a total of 1,977 records of subjects with asthma (age ≥ 19 y) hospitalized in Nevada between 2016-2021. BMI and persistent asthma were evaluated as the main exposure and outcome of interest. Logistic regression was used to estimate the magnitude of the association between obesity and persistent asthma. RESULTS: Among the selected subject records, subjects with obesity were more likely to be diagnosed with persistent asthma compared to subjects without obesity (odds ratio 1.50 [CI 1.10-2.05]). Subgroup analyses revealed that subjects with class III obesity (BMI ≥ 40) were more likely than subjects without obesity to be diagnosed with mild persistent asthma (odds ratio 2.21 [CI 1.18-4.16]) and severe persistent asthma (odds ratio 1.74 [CI 1.12-2.70]). CONCLUSIONS: Obesity was identified as a risk factor for persistent asthma, particularly class III obesity. This in turn increases the potential for greater health care utilization and economic burden. Public health and clinical interventions are necessary among those with comorbid asthma and obesity.

Achieving Aesthetics and Function in Class III Malocclusion Through Orthodontic Camouflage: A Clinical Case Report.

Class III malocclusion is a challenging dental and skeletal condition characterized by a protrusive mandible, retrusive maxilla, or a combination of both. Treatment options include growth modification, orthodontic camouflage, and orthognathic surgery. While surgery often provides definitive results for severe cases, orthodontic camouflage is a viable alternative for managing mild to moderate skeletal discrepancies in adults. This case report illustrates the successful use of orthodontic camouflage in a 19-year-old female with skeletal and dental class III malocclusion, emphasizing nonsurgical strategies to achieve functional and aesthetic improvements. The patient presented with concerns about her bite and facial profile. Clinical examination revealed a concave profile, prominent mandible, and class III molar and canine relationships with a negative overjet. The radiographic analysis confirmed a skeletal class III relationship (ANB angle of -2°) and normal vertical growth patterns. The chosen nonsurgical treatment plan involved fixed orthodontic appliances and class III intermaxillary elastics to correct the malocclusion and improve facial aesthetics. The treatment phases included initial alignment, class III elastic application to adjust the occlusion, and detailed finishing to refine results. After 20 months, the treatment resulted in a positive overjet, class I molar and canine relationships, and improved facial aesthetics with reduced mandibular prominence. The patient expressed satisfaction with both functional and aesthetic outcomes. This case demonstrates that orthodontic camouflage can effectively manage mild to moderate class III malocclusion in non-growing patients. Successful outcomes depend on precise treatment planning, patient compliance, and regular monitoring. While surgical options remain necessary for severe cases, orthodontic camouflage provides a less invasive alternative for suitable patients, significantly improving dental function and facial aesthetics.

Class III correction and enhanced periodontal health with aligner treatment in a 53-year-old patient.

In this case report, we describe the successful camouflage treatment of a 53-year-old female with dental and skeletal Class III malocclusion combined with anterior crossbite, gingival recession, and mobility of the lower incisors, using clear aligners. The treatment involved periodontal debridement followed by orthodontic treatment. The mandibular posterior teeth were distalized to correct the anterior crossbite and to establish Class I molar relationships. During treatment, the mandibular incisors were intruded, and the mandibular occlusal plane underwent a clockwise rotation due to slight extrusion of the maxillary buccal segments and distalization of the mandibular posterior teeth. Following treatment, all objectives were achieved, including resolution of the anterior crossbite, significant reduction of gingival recession and tooth mobility, and improved functional occlusion. The dental and skeletal Class III malocclusion was corrected, and the marginal alveolar bone dehiscence was significantly reduced. The results remained stable over a 3-year retention period, with enhanced molar intercuspation and gingival growth progression. This case adds to the evidence supporting the adaptability and effectiveness of clear aligners in treating orthodontic patients with compromised periodontium. The treatment outcomes support that orthodontic treatment using clear aligners, combined with periodontal monitoring, can assist in managing alveolar bone defects, gingival recession, and tooth mobility.

Face Mask Therapy and Comprehensive Orthodontic Treatment for Skeletal Class III Malocclusion: A Case Report.

Aim: This article aims to report a case of face mask therapy and comprehensive orthodontic treatment for skeletal class III malocclusion in a 16-year-old girl. Background: Treating skeletal class III malocclusion in a growing patient is crucial, as it can help avoid the need for additional surgery. Early treatment also lessens the negative impacts of the patient's facial abnormality on their social life because surgery is only done later. Case description: In this case report, a 14-year-old female patient presented with skeletal class III malocclusion with primary complaints of anterior crossbite. There was no relevant medical history. Face mask therapy and fixed appliance therapy were components of the treatment approach that successfully corrected the malocclusion. The total period of treatment was 20 months. Conclusion: The treatment resulted in a harmonious face, a well-aligned smile arch, stable dental and skeletal relationships, and significant esthetic improvements, including improved facial symmetry and profile. Significance: A growing teen who has a skeletal class III malocclusion and a maxillary deficit may be helped by a combination of face mask therapy and thorough orthodontic treatment. This case report outlines the use of the aforementioned technique to successfully treat a 14-year-old child with class III malocclusion and maxillary deficiencies.Early management of skeletal class III malocclusion in developing adolescents is vital as it can potentially eliminate the necessity for future surgical intervention, leading to improved treatment outcomes.Careful case selection, patient cooperation, and long-term stability enable a successful, stable, and esthetically pleasing treatment outcome. How to cite this article: Le LN, Do TT, P Le KV. Face Mask Therapy and Comprehensive Orthodontic Treatment for Skeletal Class III Malocclusion: A Case Report. Int J Clin Pediatr Dent 2024;17(3):368-376.

Fractal analysis of mandibular trabecular pattern following protraction facemask therapy : A pilot study.

OBJECTIVE: To assess the remodeling effects of protraction facemask therapy on the trabecular pattern of the mandible and identify quantitatively the regions of the mandible undergoing maximum changes in the trabecular pattern. MATERIALS AND METHODS: The retrospective study was conducted in 30 subjects divided into two groups. The treatment group (group 1) consisted of 15 subjects with skeletal class III malocclusion treated with a facemask (mean age: 9.1 ± 2.1 years). Digital panoramic radiographs (OPG) were obtained before treatment (T0) and at the end of active facemask therapy (T1) with a mean duration of 16.1 ± 2.5 months. In all, 15 skeletal class I subjects who did not undergo any orthodontic treatment (mean age 9.1 ± 2.2 years) comprised the control group (group 2) who had two OPGs at a mean interval of 13.6 ± 2.2 months. The fractal dimensional (FD) value was calculated in three regions: angular, condylar, and corpus region. RESULTS: Intragroup comparisons revealed a significant increase in the FD values in the right condylar (T0 = 1.2 ± 0.2; T1 = 1.4 ± 0.1) and left condylar (T0 = 1.2 ± 0.1; T1 = 1.4 ± 0.1) region (p < 0.05) and in the corpus region (FD values: right T0 = 1.2 ± 0.1, T1 = 1.4 ± 0.1; left T0 = 1.2 ± 0.1, T1 = 1.4 ± 0.1; p < 0.05). The intergroup comparison demonstrated that the treatment group showed greater changes compared with the controls in the condylar process (mean difference: right = 0.19, left = 0.20; p < 0.05) and the corpus region (0.172; p < 0.05). CONCLUSION: FD analysis demonstrated that the condylar process and the corpus region underwent the most significant change in the trabecular pattern in subjects treated with protraction facemask therapy.