Assessment of Frontal Sinus Volume and Cranial Base Length Based on Different Vertical Skeletal Patterns: A Cone Beam Computed Tomographic Study.

Introduction Evaluating craniofacial growth is an essential component of orthodontic treatment, and it is assessed by examining the cranial base. The anterior cranial base is regarded as a stable structure, and the frontal sinus is also recognised as a contributing component in the formation of the cranial base. The frontal sinus, a cavity present in the frontal bone, displays variation in both size and shape and has an impact on the overall structure of the skull and face. This study aims to evaluate the impact of vertical skeletal pattern and gender on the volume of the frontal sinus. Materials and methodology In this study, 90 cone beam computed tomography (CBCT) scans from the record's section were included, comprising 46 males (55.44%) and 44 females (48.88%) aged 20 to 35 undergoing orthodontic treatment. The assessment involved evaluating vertical skeletal patterns using a lateral cephalogram derived from the CBCT scans, and volumetric analysis of the frontal sinus was conducted using Dolphin Imaging software (version 11.9; Dolphin Imaging and Management Solutions, Chatsworth, California). Statistical analysis was performed on the collected data using SPSS software, version 20.0 (IBM Corp., Armonk, NY). Pearson correlation, a one-way ANOVA test to determine any statistically significant differences between the means of both frontal sinus volume and cranial base length groups individually and an independent t-test to compare the sample means between the frontal sinus volume and cranial base length groups were performed. Results: A non-significant association was observed between frontal sinus volume and cranial base length in skeletal open bite (p = 0.73) and skeletal deep bite (p = 0.12) between males and females, which implies there is no substantial association between frontal sinus volume (p = 0.08) and cranial base length (p = 0.41) in the different vertical skeletal patterns.  Conclusion: Frontal sinus volume was similar in subjects with a skeletal open bite and a deep bite. Males and females did not show a difference in frontal sinus volume. Hence, it was concluded that frontal sinus volume and anterior cranial base cannot be used as parameters to predict vertical malocclusions.

Comparative Assessment of Various Cephalometric Parameters Used for Determining Vertical Skeletal Dysplasia.

INTRODUCTION: The aim of the study is to assess and correlate the different cephalometric parameters used to determine the vertical jaw relationship. METHODS: Cephalometric radiographs from 148 patients were assessed and comparison was made using all eight parameters. Statistical analysis was performed using mean, standard deviation and coefficient of variance. A correlation was found between different variables using the Pearson's correlation coefficient. RESULTS: In the entire sample, the basal plane angle displayed the most variable distribution, while the R angle displayed the most homogeneous distribution. There was a significant correlation found between the Jarabak ratio, Steiner's mandibular plane angle (SN-GoGn), Frankfort mandibular plane angle (FMA), R angle, and DR angle. There was a moderate to weak correlation between the Y-axis, basal plane angle, and facial height ratio with other skeletal analyses. CONCLUSION: Among angular variables DR angle, R angle, SN-GoGn and FMA can be used and among linear variables Jarabak ratio could be used reliably to assess the growth pattern. It suggested that in order to obtain an accurate evaluation of the vertical jaw relationship, a variety of measurements should be combined.

Evaluation of modified clear Twin Block aligner in treating adolescents with skeletal class II malocclusion: A two-centre cephalometric study.

INTRODUCTION: The purpose of this study was to evaluate the therapeutic effect of modified clear Twin Block (CTB) aligner and traditional twin block (TB) appliance from skeletal, dentoalveolar and soft tissue changes in adolescents with skeletal class II malocclusion. METHODS: A total of 80 adolescents, included in this study from two medical centres, were distributed into CTB group, TB group and control group based on the treatment they received. Lateral cephalograms at pre-treatment (T1) and post-treatment (T2) were measured by modified Pancherz's cephalometric analysis, and dentoskeletal and soft tissue changes were analysed by independent-sample t-test, paired-sample t-test, ANOVA test and Scheffe's Post Hoc test. RESULTS: Seventy-five adolescents completed the study, including 32 in the CTB group, 32 in the TB group and 11 in the control group. Both CTB and TB treatment showed significant differences in most dentoskeletal and soft tissue measurements. Compared with the control group, improvements were observed in class II molar relationship through significant different in S Vert/Ms-S Vert/Mi in the CTB group (P < .01) and the TB group (P < .001), as well as deep overjet through significant different in S Vert/Is-S Vert/Ii in the CTB group (P < .001) and the TB group (P < .001). Besides, the CTB group also showed less protrusion of lower incisors and resulted in a more significant improvement in profile with fewer adverse effects on speaking, eating and social activities. CONCLUSIONS: For adolescents with skeletal class II malocclusion, CTB appliance was as effective as TB on improving dentoskeletal and soft tissue measurements, featuring more reliable teeth control and patient acceptance.

Effectiveness of Invisalign Treatment on Open Bite Correction.

Background: Open bite is a common orthodontic malocclusion that can have functional and aesthetic implications. Traditional orthodontic treatments have been used to correct open bites, but the effectiveness of Invisalign, a clear aligner therapy, in open bite correction remains a topic of interest. Materials and Methods: A retrospective analysis was conducted on a cohort of 50 patients with open bites who underwent Invisalign treatment. Pre-treatment and post-treatment records, including cephalometric radiographs, dental models, and clinical photographs, were assessed. The open bite was defined as a negative overbite greater than 2 mm. Treatment duration, number of aligners used, and patient compliance were also recorded. Statistical analysis, including paired t-tests and subjective patient feedback, was employed to evaluate the treatment outcomes. Results: The mean pre-treatment open bite was -3.5 mm (SD = 1.2), and the mean treatment duration was 18 months (SD = 2.5). On average, patients received 24 sets of aligners (SD = 4.1) during the treatment. Post-treatment evaluation showed that the mean overbite improved to + 1.5 mm (SD = 0.8), indicating successful open bite correction. The paired t-test revealed a statistically significant difference between pre-treatment and post-treatment open bite measurements (P < 0.001). Patient satisfaction was high, with 90% of participants reporting improved aesthetics and comfort. Conclusion: Invisalign treatment demonstrates effectiveness in correcting open bites, with statistically significant improvements in overbite measurements.

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

Background: Class II malocclusions are a common dental issue characterized by the misalignment of the upper and lower teeth. Early orthodontic treatment is often considered to correct these malocclusions, but its long-term effectiveness remains unclear. Materials and Methods: In this study, we examined the impact of early orthodontic treatment on the long-term stability of Class II malocclusions. We conducted a retrospective analysis of dental records from a sample of 150 patients who had received early orthodontic treatment for Class II malocclusions. The treatment involved braces and other orthodontic appliances. We compared their dental measurements before and after treatment, with a follow-up period of 5 years. Results: Our analysis revealed that the early orthodontic treatment led to a significant improvement in the alignment of upper and lower teeth, as indicated by a reduction in the overjet (the horizontal distance between upper and lower incisors). The mean overjet reduction was 3.2 millimeters. Furthermore, the Angle's Class II molar relationship was corrected in 80% of the cases. Conclusion: Early orthodontic treatment for Class II malocclusions demonstrated positive long-term stability, as evidenced by a reduction in overjet and improvement in molar relationships.

Evaluation of Glenoid Fossa Position in Class II Malocclusion Associated with Mandibular Retrusion and Class III Malocclusion Associated with Mandibular Protrusion.

Objective: This study examined the glenoid fossa in Class II and Class III malocclusions with mandibular retrusion and protrusion. Materials and Methods: A retrospective investigation examined 60 Class II and 60 Class III cephalometric radiographs. Cephalometric landmarks and glenoid fossa measurements were taken. Statistical analysis contrasted the two malocclusion groups' glenoid fossas. Results: Class II malocclusion had a much lower mean Sella-Nasion-Condylion (SNCd) angle (glenoid fossa sagittal position) than Class III (14.6° ± 1.9). Class II malocclusion had a lower mean Sella-Nasion-Gonion (SNGo) angle (32.5° ± 4.3) than Class III (36.2° ± 3.9). The SNCd angle and SNGo angle in both groups demonstrated a negative correlation, demonstrating a relationship between the glenoid fossa and the mandibular sagittal axis. Conclusion: The glenoid fossa location differs significantly between Class II malocclusion with mandibular retrusion and Class III with protrusion. Class II malocclusion has a posterior glenoid fossa, while Class III has a less posterior one. Understanding these links may help patients receive more personalized treatment.

The Prevalence of Malocclusion and Orthodontic Treatment Need in 13-15 Years Old School Going Children of Mehsana District, Gujarat: An Epidemiological Study.

Aim: The current study's objective was to find out the prevalence of malocclusion and the need for orthodontic treatment in 13- to 15-year-old school students in the Mehsana District of Gujarat using the IOTN. Materials and Methods: A descriptive cross-sectional epidemiological survey was planned among 13- to 15-year-old school-going children of Mehsana district. The sample comprised of 1290 school children. DHC-IOTN was applied to evaluate normative need for orthodontic treatment. Perceived orthodontic treatment was described by the Aesthetic component of the IOTN index. Results: Results showed that 33.7 percent of participants required little/no treatment need, 43.9 percent of participants required moderate orthodontic treatment need, and 22.4 percent of participants required severe orthodontic treatment need in the district. Conclusion: To prepare for public orthodontic and dental services, the current study provides baseline data on the need for orthodontic treatment among school-aged children.

Impact of Orthodontic Treatment on the Incidence of Dental Caries in Adolescents: A Prospective Cohort Study.

BACKGROUND: Orthodontic treatment is a widely embraced intervention aimed at enhancing dental aesthetics and correcting malocclusions among adolescents. However, concerns persist regarding its potential impact on oral health, particularly on the development of dental caries. This study aimed to systematically investigate the relationship between orthodontic treatment and the incidence of new carious lesions among adolescents. METHODS: A prospective cohort design involving adolescents aged 12-18 years was employed. A total of 82 patients met the inclusion criteria. In addition, an age-matched control group of 82 participants who did not undergo orthodontic treatment was included. The study included both a treatment group undergoing orthodontic treatment (braces or aligners) and an age-matched control group that did not undergo any orthodontic intervention. Demographic characteristics, orthodontic treatment details, and oral hygiene practices were documented at baseline and throughout the study period. Dental examinations at six-month intervals post-treatment were conducted to track the incidence and progression of carious lesions. RESULTS: The demographic characteristics, baseline oral health status, orthodontic treatment details, and oral hygiene practices were comparable between the treatment and control groups. Post-orthodontic treatment assessment revealed a slightly higher incidence of new carious lesions in the treatment group (14.6%) than in the control group (9.8%), although this difference was not statistically significant (p = 0.15). Dental examinations at six-month intervals demonstrated a gradual increase in caries incidence over time in both groups, with no substantial disparities observed. CONCLUSIONS: This study provides a comprehensive examination of the relationship between orthodontic treatment and the incidence of new carious lesions among adolescents. While a trend towards higher caries incidence in the treatment group was observed, the difference was not statistically significant. These findings contribute to the existing body of knowledge and emphasize the need for ongoing research to guide clinical practice.

Contextual and individual factors associated with traumatic dental injuries in deprived 12-year-old schoolchildren: A cohort study.

AIM: Traumatic dental injuries (TDIs) among children and adolescents have been acknowledged as of public health concern worldwide. The aim of the study was to assess the relationship between contextual and individual characteristics and TDIs in 12-year-old schoolchildren. MATERIALS AND METHODS: A cohort study was conducted with 355 schoolchildren living in deprived communities in the city of Manaus, Brazil. Contextual factors (place of residence and socio-economic indicators) and individual characteristics, including sex, family income, parents/guardians years of schooling, overjet and open bite (Dental Aesthetic Index), self-esteem (Rosenberg Self-Esteem Scale), sense of coherence (Sense of Coherence Scale), oral health beliefs, social support (Social Support Appraisals) were assessed at baseline. TDIs were measured at baseline and at 2-year follow-up using the O'Brien Index. Data were analysed through confirmatory factor analysis and structural equation modeling. RESULTS: The baseline prevalence of TDIs was 17.6% and the incidence of TDIs at 2-year follow-up was 26.8%. Better psychosocial status had a direct protective effect on the incidence of TDIs (ß = -.184). Better contextual characteristics (ß = -.135) and greater overjet (ß = -.203) were directly associated with poor psychosocial status. Higher schooling of parents/guardians directly predicted better psychosocial status (ß = .154). Psychosocial status mediated the relationship of greater overjet (ß = .036), contextual factors (ß = .024) and parental/guardian schooling (ß = -.027) with TDIs. CONCLUSIONS: Contextual factors and individual characteristics predicted TDIs. Psychosocial status was a relevant individual attribute in the causal network of TDIs, due to the direct effect on the incidence of TDIs as well as a mediator on the influence of contextual factors, overjet and parents/guardians schooling on the incidence of TDIs.

Assessment of maximal inspiratory and expiratory pressures in skeletal Class II patients with different growth patterns.

OBJECTIVES: To evaluate maximal inspiratory (MIP) and expiratory (MEP) pressures, which are reflective of respiratory muscle strength, in skeletal Class II patients with different growth patterns (horizontal, average, and vertical) and to correlate those with airway dimension. MATERIALS AND METHODS: Patients with a Class II skeletal base seeking orthodontic treatment were assigned to the following groups: average, horizontal, and vertical growth pattern. The control group (n = 14) comprised patients with a Class I skeletal base and average growth pattern. Airway dimensions were obtained using cone-beam computed tomography scans, and a spirometer with a pressure transducer was used for assessment of MIP and MEP. Routine spirometry for assessment of lung function was also performed. RESULTS: No significant differences were found in maximal inspiratory and expiratory pressures for the study groups in comparison with the control group. Class I patients had significantly greater oropharyngeal and nasopharyngeal airway volumes compared with the study groups. No significant difference in minimal cross-section area of the airway was observed among groups. A weak positive correlation between maximal inspiratory pressure and airway volume was observed. CONCLUSIONS: Although Class I patients displayed significantly greater oropharyngeal and nasopharyngeal airway volumes, there was no significant difference in respiratory muscle strength or airway function between Class II patients with different growth patterns and the Class I control group. The findings underscore the significance of exploring factors beyond craniofacial growth patterns that may contribute to sleep-related breathing disorders.

Long-term skeletodental changes with early and late treatment using modified C-palatal plates in hyperdivergent Class II adolescents.

OBJECTIVES: To compare skeletodental changes between early and late treatment groups using modified C-palatal plates (MCPP) and long-term retention outcomes in hyperdivergent Class II adolescents. MATERIALS AND METHODS: Seventy-one hyperdivergent Class II patients were divided into four groups according to treatment modality and treatment timing: group 1, early treatment with MCPP (n = 16; 9.9 ± 0.9 years); group 2, late treatment with MCPP (n = 19; 12.3 ± 0.8 years); group 3, early treatment with headgear (HG; n = 18; 9.6 ± 0.8 years); and group 4, late treatment with HG (n = 18; 12.1 ± 1.2 years). Lateral cephalograms were taken and skeletal and dental variables were measured. For statistical analysis, paired t-tests, independent t-tests, and multiple regression were performed. RESULTS: The early MCPP group showed a more significant decrease in mandibular plane angle than the late MCPP group did, and vertical control was more efficient in the early group than in the late group. In the MCPP groups, both FMA and SN-GoGn were increased with late treatment but decreased with early treatment, and the difference was statistically significant (P < .01). The early-treatment MCPP group had a significant decrease in SN-GoGn of 0.6° compared with an increase of 1.7° in the early treatment HG group (P < .01). Posttreatment stability of both the early and late MCPP groups was maintained in long-term retention. CONCLUSIONS: Early MCPP showed more significant vertical control than late MCPP. However, there was no difference in long-term stability between early and late groups.

Effects of eruption guidance appliance in the early treatment of Class III malocclusion.

OBJECTIVES: To evaluate the dentoskeletal effects and effectiveness of the eruption guidance appliance in Class III patients in the mixed dentition. MATERIALS AND METHODS: The experimental group comprised 22 patients with Class III malocclusion and anterior cross-bite (12 males, 10 females, mean age 7.63 ± 0.96 years) treated with the eruption guidance appliance over a mean period of 1.72 ± 0.48 years. The control group comprised 22 untreated subjects (12 males, 10 females, mean age 7.21 ± 0.60 years) with Class III malocclusion. Lateral cephalometric radiographs were obtained at pretreatment (T1) and posttreatment (T2). Intergroup comparisons were performed with Mann-Whitney and t-tests (P < .05). RESULTS: In the experimental and control groups, the anteroposterior relationship between the maxilla and mandible (ANB angle) remained stable during the treatment period (T1 to T2). The mandibular plane angle decreased in the experimental group and increased in the control group. In the experimental group, the lower anterior face height increase and maxillary molar vertical development were significantly smaller compared to controls. Positive overjet was achieved in 54% of the experimental group. CONCLUSIONS: The eruption guidance appliance produced no change in the skeletal anteroposterior relationship. The anterior cross-bite/edge-to-edge relationship was corrected in only about half of the treated subjects.

Cranial Base Measurements in Skeletal Malocclusion among Orthodontic Patients.

BACKGROUND: Facial growth and development is necessary for proper orthodontic diagnosis and treatment planning. Growth of cranial base is linked to the overall growth of facial bones, especially the maxilla and mandible. Any change in the amount and direction of growth of the cranial base can have direct or indirect effects on the developing maxilla and mandible. Thus the aim of this study was to determine the linear and angular cranial base measurements in different skeletal malocclusion in Nepalese population. METHODS: Pretreatment lateral cephalograms of 225 patients aged between 17-30 years were collected. Linear measurements Sella-Nasion (S-N), Sella-Articulare (S-Ar), Articulare-Gonion (Ar-Go), Gonion-Gnathion (Go-Gn) and angular measurements Saddle angle (N-S-Ar), Articular angle (S-Ar-Go) and Gonial angle (Ar-Go-Gn) were measured. RESULTS: In angular measurements statistically significant differences were found in the saddle and gonial angles between class I, II, and III skeletal pattern. In linear measurements, anterior and posterior cranial base lengths were not significantly different among groups however, ramal height and mandibular body length were significantly different among groups with a P value < 0.05. CONCLUSIONS: Skeletal class III has a larger gonial angle, ramal height and mandibular length. Males have larger linear measurements and females have larger angular measurements.

Contributions of Digital Simulation to Orthodontic Therapeutic Decision-Making: A Case Report.

Adult orthodontics aims to achieve optimal functional and aesthetic corrections. However, for several reasons, some patients will wish to benefit from a limited treatment where only certain aspects of a malocclusion will be corrected. In these clinical situations, the therapeutic objectives must be adjusted to the individual needs of the patient insofar as they can bring them real benefits. The use of digital technology makes it possible to study the therapeutic possibilities better and visualize the occlusal results before choosing the best therapeutic approach, especially in cases requiring customization. The aim of this clinical case report is to illustrate the orthodontic compromise made after the analysis of the digital setup in an adult patient who presented with a class III malocclusion but refused orthodontic-surgical therapy and requested an alternative treatment.

Electromyographic Assessment of Muscle Activity in Children Undergoing Orthodontic Treatment-A Systematic Review.

Background: Surface electromyography (sEMG) can provide an objective and quantitative image of the functional state of neuromuscular balance in the stomatognathic system. The objective of this systematic review is to examine current scientific evidence regarding the effects of orthodontic treatment on muscle electromyographic (EMG) activity in children. Methods: The search strategy included the PubMed, PubMed Central, Web of Science, Scopus, and Embase databases. The inclusion criteria were studies assessing EMG muscle activity in children undergoing orthodontic treatment compared with untreated children. The Cochrane risk-of-bias tool (RoB2) and the Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the studies. The quality of evidence assessment was performed using GRADE analysis. The PRISMA diagram visually represented the search strategy, as well as screening and inclusion process. Results: The search strategy identified 540 potential articles. Fourteen papers met the inclusion criteria. Six studies were judged at a low risk of bias. The certainty of evidence was rated as moderate to low, according to the GRADE criteria. Studies showed alterations in EMG muscle activity in children undergoing orthodontic treatment. Conclusions: Orthodontic treatment appears to affect muscle activity in children undergoing orthodontic treatment. However, the quality of evidence is low and, therefore, it is not possible to definitively state this effect. Further long-term studies are needed to confirm the findings of this review. Study protocol number in PROSPERO database: CRD42023491005.

Prevalence of Malocclusions among Schoolchildren from Southwestern Romania.

Malocclusions have a continuously increasing prevalence from one generation to another as a result of climate change, soil, atmosphere, and water pollution. All of these aspects have unfavorable consequences for the nutritional scheme. Thus, nutrition, together with other etiopathogenic factors, contributes to complex alterations in the somatic development of the entire organism and, implicitly, of the cephalic extremity. The study group included 4147 children from randomly selected schools from Vâlcea County, Romania. The aim of this study is to determine the prevalence of malocclusions in schoolchildren in Vâlcea County, Romania, according to the three main classes of malocclusions (according to Angle's classification), age groups (from 6 to 10 years old and from 11 to 14 years old), gender (male and female), and place of origin (rural and urban). For Angle class I malocclusions, we recorded the highest prevalence (48.78% of the total number of schoolchildren with malocclusions), followed by Angle class II malocclusions (45.85% of the total number of schoolchildren with malocclusions), and for Angle class III malocclusions we found the lowest prevalence (5.37% of the total number of schoolchildren with malocclusions). According to gender, we found the highest prevalence in the female gender (29.90% of the total number of female subjects), while in the male gender, we recorded a prevalence of 27.70% of the total number of male subjects. Regarding the place of origin, there is a higher prevalence of malocclusions in urban areas (29.16%). The study subgroup included 140 children randomly selected from the total number of subjects in the study group. They were included in a more advanced study. The aim is to find potential associations between the presence of malocclusions and various oral variables. Categorical variables were expressed as numerical values and percentages, and their association was evaluated with either the Chi-square test of association or homogeneity, or the Fisher Exact test. The acquired data were incorporated into a binomial logistic regression model to assess the likelihood of developing malocclusions in relation to the following variables: defective phonation, bruxism, frequency of teeth brushing, onychophagia, oral respiration, infantile deglutition, placing objects between the maxillaries, thumb sucking, and salivary aspects. It is also aimed at comparing the results obtained with similar ones from the specialized literature.

Is malocclusion a predictor of pain in patients suffering from TMD pain?

BACKGROUND: Temporomandibular disorders (TMD) affect the masticatory muscles, temporomandibular joints (TMJs) and associated structures. The relationship between occlusion and TMD is a contentious issue in the dental field. OBJECTIVES: Although there is a strong argument against invasive and irreversible therapeutic TMD procedures, the TMD biopsychosocial model is still not accepted by some clinicians. Hence, this study aimed to verify whether malocclusions are related to TMD pain. MATERIAL AND METHODS: The study included 49 adult patients with one or multiple TMD diagnoses and without any other diseases that could mimic TMD. A reliable investigator diagnosed the patients using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) protocol. The sample was divided into pain and non-pain TMD groups, and the predictor of malocclusion was categorized as the dependent variable. There were 33 patients in the TMD pain group and 16 patients in the non-pain TMD group. Analyses were conducted at a significance level of 0.05. The χ2 test (with Yates' correction for 2 × 2 matrix) was used to compare qualitative variables between the groups. RESULTS: Malocclusion was present in 13 patients in the pain group and 7 patients in the non-pain group. CONCLUSIONS: According to our study, there is no correlation between malocclusion and TMD pain.

Robotic Archwire Bending in Orthodontics: A Review of the Literature.

Malocclusion is a widespread oral health issue that adversely affects individuals' health and well-being. Currently, fixed orthodontics is considered the most efficient treatment for correcting malocclusion, with archwire bending playing a key role in orthodontic treatment. Traditionally, orthodontists manually performed archwire bending using various handheld pliers and other mechanical tools, requiring a significant amount of time, precision, and specialized training yet being unable to guarantee appliance accuracy. The process of shaping orthodontic wire is challenging due to its high stiffness and superelasticity, resulting in a time-consuming, laborious process that is prone to human errors. With advancements in orthodontics, traditional methods have taken a backseat, making way for innovative technologies that provide more accurate and personalized treatment options. The continuous efforts to enhance treatment efficiency, accuracy, efficacy, and patient experience have led to the integration of robotics into various orthodontic procedures. The use of robotics in archwire bending represents a breakthrough in orthodontics, offering unparalleled precision, consistency, and efficiency. This technology reduces treatment time and patient discomfort, overcoming the limitations of manual bending and enhancing orthodontic treatment overall. Hence, the present study aims to review the literature on robotic archwire bending in orthodontics, including their drawbacks and their impact on orthodontic treatment.

Patient's Perception of Outcome after Extracapsular Fractures of the Mandibular Condyle Differs from Objective Evaluation-Experience of a Third-Level Hospital.

Background: The aim of this study is to assess patients' subjective perception of treatment outcome after extracapsular fractures of the mandibular condyle. Methods: A questionnaire survey regarding facial nerve palsy (FNP), malocclusion, pain, reduction in maximum mouth opening (MMO) and further discomfort after 3, 6, and 12 months was carried out. Patients aged 18 or more presenting with an extracapsular condylar fracture between 2006 and 2020 were identified by purposive sampling Questionnaires were received from 115 patients. Fractures were classified on the basis of the pre-treatment imaging, the way of treatment was obtained from patients' medical records. Data were analyzed using Pearsons' chi-square-test, descriptive statistics and Student's t-test. Results: 93.0% of the fractures were treated by open reduction and internal fixation (ORIF). MMO reduction was the most common post-treatment complication (55.6%). ORIF was associated with less pain after 3 months (p = 0.048) and lower VAS scores compared to conservative treatment (p = 0.039). Comminuted fractures were more frequently associated with post-treatment malocclusion (p = 0.048), FNP (p = 0.016) and MMO reduction (p = 0.001). Bilateral fractures were significantly accompanied by malocclusion (p = 0.029), MMO reduction (p = 0.038) and pain occurrence (p < 0.001). Conclusions: Patients report less pain after ORIF. Comminuted and bilateral fractures seem to be major risk factors for complications. Subjective perception of complications after extracapsular condylar fractures differs from objectively assessed data.

The TSAR-osteotomy, a total subapical and ramus osteotomy: A technical note.

There are several treatment options to treat a class II dentofacial deformity with a pronounced chin. A total subapical osteotomy is one of these options. This type of osteotomy was refined to total subapical and ramus (TSAR) osteotomy. In this technical note, a detailed and schematic presentation of the TSAR osteotomy is presented step by step. The surgical approach to the TSAR osteotomy is divided into three parts. The first part consists of the horizontal osteotomy at the level of the ramus, the second part approaches the corticotomy to release and protect the mental nerve and the third part consists of connecting the horizontal ramus osteotomy and the local corticotomy around the mental nerve. In this third part, it is important that the inferior alveolar nerve (IAN) is actively sought and protected.