Noninvasive conservative management of anterior open bite treated with TADs versus clear aligner therapy.

OBJECTIVES: Anterior open bite can be treated non-surgically via molar intrusion using temporary skeletal devices (TAD). Clear aligner therapy (CAT) is recognized as a viable therapeutic modality for non-extraction treatment of adults with mild open bite. This study aimed to compare the treatment effect and mechanisms of open bite closure between patients treated with braces and TADs double arch intrusion and those treated with CAT. Treatment success at T3 was based on 1- positive overbite on ceph; 2- Change in the vertical dimension 3- post treatment POSI score equal to zero. MATERIAL AND METHODS: The TAD group includes 18 consecutively treated patients from the main author. The CAT group consisted of 16 selected patients from three different orthodontists. The observation time points were as follows: pretreatment (T1), end of molar intrusion and positive overbite achieved (T2), end of treatment (T3), at least 6-month follow-up (T4). Treatment changes were assessed by cephalometric analysis and frontal intraoral photo. RESULTS: At the end of treatment, 100% of the patient of the TAD group and 78,6% of the CAT group had a posi score of 0. The TAD group showed a significant reduction in vertical measurements (SN-MPA: -1,55° ± 0.41, LAFH: -3,05 ± 0.51 mm, U6-PP: -1.48 ± 0.30 mm), but the CAT group did not have significant changes for these variables. Both groups had significant increases in overbite from T1 to T3 (TAD: 4,32 ± 0,5 mm; CAT: 2,33 ± 0.56 mm), and overbite remained stable at T4. The CAT group did not have a significant upper molar intrusion, but a significant extrusion of 1.22 ± 0.42 mm of the lower incisor occurred. CONCLUSION: The TAD group achieved bite closure by upper molar intrusion, lower molar and incisors vertical control, and mandibular plane counterclockwise rotation, resulting in an improved AP and vertical relationship. The CAT group achieved bite closure through the lower incisor extrusion without significant change in the vertical dimension. CLINICAL RELEVANCE: This study provides relevant information about the skeletal and dental changes of open bite treatment with TADs double arch intrusion. The comparison with a control group treated with CAT confirms known information.

Assessment of soft-tissue vs hard-tissue changes after isolated functional genioplasty / Évaluation des modifications des tissus mous par rapport aux tissus durs après une génioplastie fonctionnelle isolée

Introduction: This study aimed to determine the vertical and horizontal soft-tissue vs hard-tissue changes after isolated functional genioplasty and to revisit hard-tissue remodeling at the symphysis. Methods: Seventy-five patients who underwent genioplasty as an isolated procedure at the end of their orthodontic treatment were divided into three groups on the basis of their age at surgery: < 15 years (group 1), 15-18 years (group 2) and ≥ 19 years (group 3). Patients were evaluated at three time points: immediately before surgery (T1), immediately after surgery (T2) and two years after surgery (T3). In addition, 25 patients who did not accept genioplasty, were age-matched with group 1, and had a follow-up radiograph two years after the end of their orthodontic treatment were used as a control group. Results: From T2 to T3, group 1 showed less forward horizontal hard-tissue and soft-tissue changes at pogonion (Pg) than the control group; however, no difference was noted for vertical changes at Me & Me'. From T1 to T3, the horizontal hard-tissue and soft-tissue changes at Pg were 6.39 mm and 6.72 mm, respectively, for surgical groups. Vertical hard-tissue change at menton (Me) showed a reduction of 1.63 mm (95% confidence interval [CI], -3.37 to 0.11) and 3.89 mm (95% CI, -5.83 to -1.95) in nongrowing female and male patients, respectively. The vertical soft-tissue change reduction was similar for nongrowing male and female patients (1.7 mm [95% CI, -2.96 to -0.45]). Soft-tissue thickness change at Pg (0.33 mm) was not significant. In contrast, a small but significant increase in soft-tissue thickness was noted at Me (0.54 mm). Linear regressions were calculated for all groups and allowed for predicting long-term soft-tissue changes (T3-T1) using the amount of surgical displacement (T2-T1). Conclusions: The horizontal hard-tissue change was stable for nongrowing patients, and the horizontal soft-tissue change was 92% of hard-tissue. Vertical soft-tissue change is less predictable. Variation of soft-tissue thickness after genioplasty can be explained by skeletal changes and the achievement of an unforced labial occlusion. These results support the functional and esthetic benefits of this surgery. Comparison with the control group showed that genioplasty does not change the growth pattern, and bone remodeling is likely to explain the difference noted at Pg.

Introduction: Cette étude avait pour but de déterminer les modifications verticales et horizontales des tissus cutanés par rapport aux tissus osseux après une génioplastie fonctionnelle isolée et d'évaluer le remodelage des tissus osseux au niveau de la symphyse. Méthodes: Soixante-quinze patients qui ont subi une génioplastie comme procédure isolée à la fin de leur traitement orthodontique ont été divisés en trois groupes sur la base de leur âge au moment de la chirurgie : moins de 15 ans (groupe 1), de 15 à 18 ans (groupe 2) et de 19 ans et plus (groupe 3). Les patients ont été évalués à trois moments : immédiatement avant la chirurgie (T1), immédiatement après la chirurgie (T2) et deux ans après la chirurgie (T3). En outre, 25 patients qui n'ont pas accepté la génioplastie, dont l'âge correspondait à celui du groupe 1 et qui ont subi une téléradiographie de profil de contrôle deux ans après la fin de leur traitement orthodontique ont été utilisés comme groupe témoin. Résultats: De T2 à T3, le groupe 1 a montré moins de changements horizontaux des tissus durs et mous vers l'avant au niveau du pogonion (Pg) que le groupe témoin ; cependant, aucune différence n'a été notée pour les changements verticaux au niveau de Me & Me'. De T1 à T3, les changements horizontaux des tissus osseux et cutanés à Pg étaient respectivement de 6,39 mm et 6,72 mm pour les groupes chirurgicaux. La modification verticale des tissus osseux au niveau du menton (Me) a montré une réduction de 1,63 mm (IC 95 %, -3,37 à 0,11) et de 3,89 mm (IC95 %, -5,83 à -1,95) chez les patients féminins et masculins sans croissance, respectivement. La réduction verticale de la modification des tissus mous était similaire chez les patients homme et femme qui ne sont pas en croissance (1,7 mm [IC 95 %, -2,96 à -0,45]). La modification de l'épaisseur des tissus mous à Pg (0,33 mm) n'était pas significative. En revanche, une augmentation faible mais significative de l'épaisseur des tissus cutanés a été observée à Me (0,54 mm). Des régressions linéaires ont été calculées pour tous les groupes et permettent de prédire les changements à long terme des tissus cutanés (T3-T1) en utilisant la quantité de déplacement chirurgical (T2-T1). Conclusions: Le changement horizontal des tissus osseux est stable pour les patients qui ne grandissent pas et le changement horizontal des tissus mous représente 92 % des tissus durs. Le changement vertical des tissus cutanés est moins prévisible. La variation de l'épaisseur des tissus cutanés après une génioplastie peut s'expliquer par les changements squelettiques et l'obtention d'une occlusion labiale non forcée. Ces résultats confirment les avantages fonctionnels et esthétiques de cette chirurgie. La comparaison avec le groupe témoin a montré que la génioplastie ne modifie pas le schéma de croissance et le remodelage osseux est susceptible d'expliquer la différence constatée à Pg.

Assessment of soft-tissue vs hard-tissue changes after isolated functional genioplasty.

INTRODUCTION: This study aimed to determine the vertical and horizontal soft-tissue vs hard-tissue changes after isolated functional genioplasty and to revisit hard-tissue remodeling at the symphysis. METHODS: Seventy-five patients who underwent genioplasty as an isolated procedure at the end of their orthodontic treatment were divided into 3 groups on the basis of their age at surgery: <15 years (group 1), 15-18 years (group 2), and ≥19 years (group 3). Patients were evaluated at 3 time points: immediately before surgery (T1), immediately after surgery (T2), and 2 years after surgery (T3). In addition, 25 patients who did not accept genioplasty, were age-matched with group 1, and had a follow-up radiograph 2 years after the end of their orthodontic treatment were used as a control group. RESULTS: From T2 to T3, group 1 showed less forward horizontal hard-tissue and soft-tissue changes at pogonion (Pg) than the control group; however, no difference was noted for vertical changes at Me & Me'. From T1 to T3, the horizontal hard-tissue and soft-tissue changes at Pg were 6.39 mm and 6.72 mm, respectively, for surgical groups. Vertical hard-tissue change at menton (Me) showed a reduction of 1.63 mm (95% confidence interval [CI], -3.37 to 0.11) and 3.89 mm (95% CI, -5.83 to -1.95) in nongrowing female and male patients, respectively. The vertical soft-tissue change reduction was similar for nongrowing male and female patients (1.7 mm [95% CI, -2.96 to -0.45]). Soft-tissue thickness change at Pg (0.33 mm) was not significant. In contrast, a small but significant increase in soft-tissue thickness was noted at Me (0.54 mm). Linear regressions were calculated for all groups and allowed for predicting long-term soft-tissue changes (T3-T1) using the amount of surgical displacement (T2-T1). CONCLUSIONS: The horizontal hard-tissue change was stable for nongrowing patients, and the horizontal soft-tissue change was 92% of hard-tissue. Vertical soft-tissue change is less predictable. Variation of soft-tissue thickness after genioplasty can be explained by skeletal changes and the achievement of an unforced labial occlusion. These results support the functional and esthetic benefits of this surgery. Comparison with the control group showed that genioplasty does not change the growth pattern, and bone remodeling is likely to explain the difference noted at Pg.