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.

Evaluation of the accuracy of a fully digital method of measuring sagittal condylar inclination.

OBJECTIVES: This clinical study aimed to evaluate the accuracy of a fully digital technique for measuring sagittal condylar inclination (SCI), as well as validating whether differences existed between the left and right SCI values of the same participant, to provide a reference for clinical practice. METHODS: Ten participants with good occlusal relationship and normal temporomandibular joint were recruited. Three methods were used to measure the SCI values of the participants, namely, A (mechanical facebow transferring and mechanical articulator-based measuring method with physical protrusive interocclusal registration), B (face scan-based virtual facebow and virtual articulator-based measuring method with digital protrusive interocclusal registration), and C (jaw motion tracking system-based measuring method). With the group subjected to methods A and C as the control, the SCI values obtained by the three methods were statistically analyzed. The left and right SCI values of the same participant were also compared. RESULTS: The left and right SCI values measured by method A were 41.70°±7.09° and 42.80°±8.62°, those by method B were 35.09°±12.49° and 37.63°±12.10°, and those by method C were 39.43°±8.72° and 38.45°±6.91°. No significant difference existed among the SCI values measured by the three methods (P>0.05). Meanwhile, no statistical difference existed between the SCI values on the left and right sides of the same participant (P>0.05). CONCLUSIONS: The accuracy of the virtual facebow and digital protrusive occlusal registration based SCI measuring method was the same as that of mechanical facebow based and jaw motion tracking system-based methods. The SCI values on the left and right sides of the same participant were similar. Clinically, an appropriate SCI measurement and setting strategy can be selected based on the actual situations.

A comparison of maxillary posterior changes following facemask therapy: Skeletal anchorage versus tooth-borne anchorage.

OBJECTIVE: To compare changes in the maxillary posterior structure as seen in cone-beam computed tomography (CBCT) images resulting from facemask therapy using skeletal (miniplate/FM) anchorage versus tooth-borne anchorage (RME/FM). MATERIALS AND METHODS: A retrospective study was conducted on 20 patients divided into the miniplate/FM group (nine patients aged 9.5 ± 1.4 years) and the RME/FM group (11 patients aged 9.2 ± 1.4 years). CBCT images before and after facemask therapy were evaluated to assess changes in the maxillary posterior structure. RESULTS: The miniplate/FM group had greater advancement of the maxilla and midface compared to the RME/FM group (p < .05). Specifically, there was about three times more advancement of the pterygomaxillary suture in the miniplate/FM group than in the RME/FM group (p < .05). Moreover, the advancement of the pterygomaxillary suture was about half the advancement of A point in the miniplate/FM group, while only about 25% in the RME/FM group. Finally, the miniplate/FM group showed an increase in the transverse dimension of the posterior and superior parts of the maxilla (p < .05). CONCLUSION: There was greater forward movement of the pterygomaxillary suture with facemask therapy using the skeletal anchorage compared to tooth-borne anchorage, leading to a more significant advancement of the maxilla and midface.

Vertical effects of cervical headgear in growing patients with Class II malocclusion: a systematic review and meta-analysis.

BACKGROUND: Cervical headgear (cHG) has been shown to be effective in Class II correction both with dental and orthopaedic effects but has traditionally been associated with vertical adverse effects in terms of posterior mandibular rotation. OBJECTIVE: To assess the treatment effects of cHG treatment in the vertical dimension. SEARCH METHODS: Unrestricted literature search of five databases up to May 2023. SELECTION CRITERIA: Randomized/non-randomized clinical studies comparing cHG to untreated controls, high-pull headgear (hp-HG), cHG adjuncts, or other Class II treatment alternatives (functional appliances or distalisers). DATA COLLECTION AND ANALYSIS: After duplicate study selection, data extraction, and risk-of-bias assessment according to Cochrane, random-effects meta-analyses of mean differences (MD)/standardized mean diffences (SMD) and their 95% confidence intervals (CIs) were performed, followed by meta-regressions, sensitivity analyses, and assessment of certainty on existed evidence. RESULTS: Two randomized/16 non-randomized studies (12 retrospective/4 prospective) involving 1094 patients (mean age 10.9 years and 46% male) were included. Compared to natural growth, cHG treatment was not associated on average with increases in mandibular (eight studies; SMD 0.22; 95% CI -0.06, 0.49; P = 0.11) or maxillary plane angle (seven studies; SMD 0.81; 95% CI -0.34, 1.95; P=0.14). Observed changes translate to MDs of 0.48° (95% CI -0.13, 1.07°) and 1.22° (95% CI -0.51, 2.94°) in the SN-ML and SN-NL angles, respectively. No significant differences were seen in y-axis, facial axis angle, or posterior face height (P > 0.05). Similarly, no significant differences were found between cHG treatment and (i) addition of a lower utility arch, (ii) hp-HG treatment, and (iii) removable functional appliance treatment (P > 0.05 for all). Meta-regressions of patient age, sex, or duration and sensitivity analyses showed relative robustness, while our confidence in these estimates was low to very low due to the risk of bias, inconsistency, and imprecision. CONCLUSIONS: cHG on average is not consistently associated with posterior rotation of the jaws or a consistent increase in vertical facial dimensions among Class II patients. REGISTRATION: PROSPERO registration (CRD42022374603).

Cervical headgear effectiveness in distalizing molars in relation to patient compliance.

OBJECTIVES: The purpose of this study was to measure the effectiveness of the cervical headgear for distalizing first permanent maxillary molars in relation to hours of use. METHODS: This was a one-centre, prospective, clinical study conducted at the Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece. Participants (N = 26; 17 females, 9 males) were patients with no history of orthodontic treatment, no syndromes or clefts, and Angle's Class II malocclusion, where the treatment plan included a cervical headgear. They were instructed to wear the appliance for at least 12 h per day. A TheraMon® microsensor was embedded in the headgear's strap to objectively measure wear-time. To measure tooth movement, pre- and post-treatment digital models were superimposed, using the palate as a reference area; translation and rotation were measured along three axes. Superimposition and movement measurements were made with the Viewbox 4 software. RESULTS: Average treatment time and headgear wear were 130 days and 55 days, respectively, i.e. 10.1 h/day. During this period, distal movement averaged 1.75 mm with high variability (min 0.2 mm, max 4.5 mm). Distal tipping and rotation had an average of approximately 5 °C. Cumulative headgear wear was significantly correlated with distal movement (r2 = 0.32, P < .002), distal tipping (r2 = 0.27, P < .01), and distal rotation around the long axis of the tooth (r2 = 0.20, P < .05). CONCLUSION: Compliance is critical for having a successful clinical outcome. Distalization of the molar with a cervical headgear is correlated with the cumulative hours of appliance use, with hours per day being a weaker predictor.

Comparison of the skeletodental effects of miniscrew-anchored and tooth-anchored facemask treatment in growing patients with skeletal class III malocclusions.

INTRODUCTION: This retrospective study aimed to evaluate the skeletal and dental effects of the miniscrew-anchored facemask in skeletal Class III growing patients and compare them with those of conventional tooth-anchored facemasks. METHODS: Retrospectively a total of 50 patients with skeletal Class III (mean ANB: -1.12°) were investigated and divided into two groups according to the treatment modality. Twenty-five patients were treated using the conventional tooth-anchored facemask (T group: mean age 9.3 ± 1.1 years, mean ANB: -0.93°) whereas the other 25 were treated using a miniscrew-anchored facemask (M group: mean age 9.7 ± 1.3 years. mean ANB: -1.61°). Two miniscrews were placed on the palate for bone anchorage. In both T and M groups, facemasks applied a force of 20-30° down on the occlusal plane, and the force increased from 200 g to 300-350 g per side throughout the treatments. The patients were instructed to wear facemasks for at least 14 h per day. A total of 16 angular and 11 linear cephalometric measurements were analysed to determine the skeletal and dental changes before and after facemask treatment. A paired t-test was used to verify the effects before and after treatment in each group. RESULTS: All miniscrews were well maintained during treatment. The values of SNA, SN-ANS, ANB and A to N-Perp, which indicate anterior protraction of the maxilla, were significantly higher in the M group compared with the T group (P < .05). Proclination of the maxillary incisors, extrusion and mesialization of the maxillary molars were significantly greater in the T group (P < .05). CONCLUSIONS: Miniscrew-anchored facemask treatment increased the amount of maxillary protraction and reduced the dental side effects compared with conventional tooth-anchored facemask treatment in growing patients with skeletal Class III malocclusion.

Class III treatment with mini-implants anchorage in young adult patients: short and long-term results.

INTRODUCTION: Class III malocclusion should be intercepted and treated at early age, to prevent the necessity of future complex and expensive procedures. The orthopedic facemask therapy has the goal to achieve skeletal changes, minimizing side effects on dentition. The use of skeletal anchorage, combined with Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol, may be effective in treating a greater number of growing Class III patients. OBJECTIVE: To summarize the existing evidence-based literature on Class III malocclusion treatment in young adult patients, and to illustrate its application and effectiveness, by presenting an emblematic case report. CONCLUSION: The resolution of the present case, its long-term follow up, along with the studies conducted on a larger sample, demonstrate the effectiveness of the strategic combination of orthopedic and orthodontic treatments by using an hybrid rapid palatal expander and Alt-RAMEC protocol for treating Class III malocclusions in adult patients.

Long-term stability after high-pull headgear combined with fixed appliances: A retrospective cohort study of growing class II patients.

BACKGROUND: High-pull headgear with fixed appliances is a common therapeutic plan in class II growing individuals, especially in those with a tendency to hyperdivergence. The stability of this approach has not been adequately assessed in the long-term. The aim of this retrospective study was to assess that long-term stability by means of lateral cephalograms. Seventy-four consecutive patients were included and examined at three time-points: pre-treatment (T1), end of treatment (T2), and at least five years post-treatment (T3). RESULTS: The average initial age of the sample was 9.3 years (standard deviation, SD: 1.6). At T1, the mean ANB was 5.1 degrees (SD: 1.6), the mean SN-PP 5.6 (SD: 3.0) and the mean MP-PP 28.7 degrees (SD: 4.0). The median follow-up time was 8.6 years with an interquartile range of 2.7. A statistically significant, but of small magnitude increase in the SNA angle was noted at T3 compared to T2 after adjusting for the pre-treatment SNA value (mean difference (MD): 0.75; 95% CI: 0.34, 1.15; P<0.001). The inclination of the palatal plane appeared stable in the post-treatment period, while the MP-PP angle showed scarce evidence of decrease during the post-treatment period after adjusting for sex, pre-treatment SNA and SN-PP angles (MD: -2.29; 95% CI: -2.85, -1.74; P<0.001). CONCLUSIONS: The sagittal position of the maxilla and the inclination of the palatal plane appeared to be stable after treatment with high-pull headgear and fixed appliances in the long-term. Continuous mandibular growth, both sagittaly and vertically, contributed to the stability of class II correction.

The effect of tooth borne versus skeletally anchored Alt-RAMEC protocol in early treatment of Class III malocclusion: a single-centre randomized clinical trial.

TRIAL DESIGN: This was a randomized, controlled trial designed to compare outcomes between the use of dental and skeletal anchorage, using the Face mask/Alternate Rapid Maxillary Expansion and Contraction (FM/Alt-RAMEC) protocol. METHODS AND PARTICIPANTS: The study was carried out at Mater Dei Hospital, Malta and included prepubertal skeletal Class III malocclusion patients where the aetiology was primarily maxillary hypoplasia. INTERVENTIONS: Two groups were assigned. Group I was treated with FM/Alt-RAMEC and group II was treated with skeletally anchored FM/Alt-RAMEC. Wear-time (WT) of the FM was monitored using TheraMon microsensors. Patients were instructed to wear the FM for 12-14 hours/day for 9 months. Changes were evaluated with lateral cephalograms and analysed with Wilcoxon and Mann-Whitney U tests. ANOVA was used to analyse the effect of gender on compliance parameters. Spearman's correlation coefficient was used to assess the correlation between compliance and skeletal changes. OBJECTIVE: To compare the skeletal and dentoalveolar changes in patients treated with these two protocols. OUTCOMES: The primary outcome was to assess skeletal and dentoalveolar outcomes in patients treated with skeletally anchored FM/RME and tooth-borne FM/RME; utilizing Alt-RAMEC protocol. The secondary outcome was compliance rate and adherence to FM wear among patients. RANDOMIZATION: Randomizer software and the sealed envelope technique were used to randomly allocate patients 1:1 into either group I (tooth-borne FM/Alt-RAMEC) or group II (skeletally anchored FM/Alt-RAMEC). BLINDING: It was not possible to blind to treatment allocation, but blinding was used when assessing the outcomes. RESULTS: Numbers randomized and analysed. Thirty-five patients were allocated. Group I consisted of 18 subjects and group II consisted of 17 subjects. One patient in group I dropped out due to illness, so 17 subjects in each group completed the study. OUTCOMES: Post-treatment changes in group I showed significant increases in SNA (2.10°), ANB (3.90°), Wits (4.70 mm), and overjet (5.40 mm). Group II showed significant increases in ANB (3.10°), Wits (3.20 mm), and overjet (4.50 mm). Wearing time for group I patients was 7.87 ± 2.88 hours/day and for group II was 6.98 ± 2.68 hours/day, with no significant difference between the groups. LIMITATIONS: Lack of long-term follow-up post-treatment, making the conclusion applicable only in the short term. HARMS: No harm was observed in both groups. CONCLUSION: Despite the large difference between the measured and the patient-reported daily WT, both tooth-borne and skeletally anchored FM/Alt-RAMEC showed positive, similar, skeletal and dental effects. CLINICAL TRIAL REGISTRATION: ISRCTN12197405.

Skin irritation in children undergoing orthodontic facemask therapy.

Orthodontic facemasks are extraoral orthodontic appliances that influence maxillary and mandibular development in children with skeletal Class III malocclusion. While a facemask is most effective in patients before the growth spurt, skin irritation is common during the treatment. Therefore, this retrospective study aimed to investigate the prevalence and pattern of such skin changes and identify their possible associated risk factors. We included 177 patients with skeletal Class III malocclusion who underwent facemask therapy. Patient age and sex, orthodontic parameters expressing the severity of malocclusion, the presence of complaints in the temporomandibular joint (TMJ) areas, and the level of patient cooperation were evaluated. Additionally, the severity and onset time of skin reactions were further analyzed. The results indicated that 43.5% of patients developed skin changes typical of irritant contact dermatitis. Skin irritation was significantly associated with the presence of TMJ complaints and female sex. Furthermore, skin irritation was more common in younger patients. Clinicians should pay special attention to the skin areas that come into contact with the appliance during each follow-up visit to detect potential problems. Moreover, patients and their parents should be given adequate information about the possibility, prevention, and management of skin problems during facemask therapy.

Stability of Class II malocclusion treatment with Class II elastics.

INTRODUCTION: The objective of this study was to compare the long-term cephalometric stability after successful therapy of nonextraction Class II malocclusion with elastics and with headgear. METHODS: The sample comprised 43 patients with Class II malocclusion and was divided into 2 groups. The elastic group (EG) consisted of 20 patients treated with fixed appliances associated with Class II elastics, and the headgear group (HG) consisted of 23 patients treated with fixed appliances and extraoral headgear. Pretreatment, posttreatment, and long-term posttreatment lateral radiographs were evaluated; t tests were used to compare the long-term posttreatment changes between the groups. RESULTS: The groups were matched regarding initial age, time of long-term posttreatment evaluation, initial malocclusion severity, quality of treatment result, and all pretreatment cephalometric variables. Intergroup comparisons of long-term posttreatment changes showed that the HG group presented significantly greater mandibular protrusion, occlusal plane angle decrease, and maxillary molar mesialization. However, long-term posttreatment stability was similar in overjet, overbite, and molar relationships. CONCLUSIONS: Nonextraction Class II malocclusion treatment with elastics or extraoral headgear have similar long-term posttreatment stability.

The effect of orthodontic treatment on smile attractiveness: a systematic review.

BACKGROUND: Smile attractiveness is a primary factor for patients to seek orthodontic treatment, however, there is yet no systematic evaluation of this topic in the literature. OBJECTIVES: To assess the current evidence on the effect of orthodontic treatment on smile attractiveness. SEARCH METHODS: Seven electronic databases (MEDLINE, Cochrane Library, Virtual Health Library, SCOPUS, Web of Science, Google Scholar and Embase) were searched on 14 September 2022. SELECTION CRITERIA: Studies evaluating smile attractiveness before and after orthodontic treatment or only after completion of orthodontic treatment. DATA COLLECTION AND ANALYSIS: Extracted data included study design and setting, sample size and demographics, malocclusion type, treatment modality and method for outcome assessment. Risk of bias was assessed with the ROBINS-I tool for non-randomised studies. Random-effects meta-analyses of mean differences and their 95% confidence intervals (CIs) were planned a priori. METHODS: After elimination of duplicate studies, data extraction and risk of bias assessment according to the Cochrane guidelines, an evaluation of the overall evidence was performed. The included studies were evaluated based on the characteristics of their study and control groups and based on their main research question. Also, all outcome measures were standardized into a common assessment scale (0-100), in order to obtain more easily interpretable results. RESULTS: Ten studies were included in this review, nine of which were assessed as being at serious risk of bias and one at moderate risk of bias. The large heterogeneity between the included studies did not allow for a meta-analysis. Orthodontic treatment has a moderately positive effect on smile attractiveness. When compared to no treatment, orthodontic treatment with premolar extractions improves smile attractiveness by 22%. Also, surgical correction of Class III cases increases smile attractiveness by 7.5% more than camouflage treatment. No other significant differences were shown between different types of treatment. CONCLUSION: Based on the available data, orthodontic treatment seems to moderately improve the attractiveness of the smile. There is significant bias in the current literature assessing the effect of orthodontics on smile attractiveness; therefore, the results cannot be accepted with certainty.

A retrospective comparison of two protocols for correction of skeletal Class III malocclusion in prepubertal children: hybrid hyrax expander with mandibular miniplates and rapid maxillary expansion with face mask.

BACKGROUND: This study compared the skeletal and dental effects of a hybrid maxillary expander with mandibular miniplates (HE-MP) and Class III elastics to conventional tooth-borne rapid maxillary expander and face mask (RME-FM) in skeletal Class III treatment. METHODS: This retrospective study included 36 skeletal Class III patients. Eighteen patients (mean age 10.24 ± 1.31 years) were treated with a hybrid expander, two mandibular L-shaped miniplates and full-time Class III elastics (HE-MP group). Their results were compared to a group of patients treated with conventional RME-FM (n = 18; mean age 10.56 ± 1.41 year). Radiographs were taken before (T1) and after treatment (T2). All patients were in cervical maturation stages CS1-CS3 at T1. The measured outcomes were the changes in sagittal and vertical skeletal and dental cephalometric measurements. RESULTS: Treatment time was approximately 15.5 ± 2.8 months with the HE-MP and 11.85 ± 3.41 months for the RME-FM. The Class III malocclusion was corrected in both groups with significant changes. The maxilla advanced more in the HE-MP group, with an increase in SNA of 4.26° ± 2.15° compared to 1.14 ± 0.93 in the RME-FM group (p < 0.001). The effect on the mandible was similar in both groups, while the overall skeletal change was significantly greater with HE-MP, with an increase in the ANB of 5.25° ± 2.03° and a Wits appraisal increase of 6.03 ± 3.13 mm, as opposed to 2.04° ± 1.07° and 2.94 ± 1.75 mm with the RME-FM (p < 0.001). Dental changes were significantly higher with RME-FM, with an increase in incisor inclination (U1-SN) of 5.02° ± 3.93° (p < 0.001), with no significant changes in the HE-MP group. The mandibular incisors retroclined by 5.29° ± 3.57° at L1-MP with the RME-FM, while they advanced slightly with the HE-MP by 2.87° ± 5.37° (p < 0.001). CONCLUSION: The use of skeletal anchorage for maxillary expansion and protraction significantly increases skeletal effects and reduces dental side effects compared to tooth-borne maxillary expansion and protraction. These results need to be investigated in the long term.

Comparison of the short-term effects of facemask therapy preceded by conventional rapid maxillary expansion or by an alternate rapid maxillary expansions and constrictions protocol : A retrospective study.

PURPOSE: We aimed to compare the short-term effects of alternate rapid maxillary expansion and constriction (Alt-RAMEC) with conventional rapid maxillary expansion (RME) followed by facemask (FM) therapy. METHODS: A total of 30 patients who had received facemask therapy after RME or Alt-RAMEC protocols were included in the study. The Alt-RAMEC/FM and RME/FM groups were created to be well-matched regarding cervical vertebral maturation stage and sex. In the Alt-RAMEC group (10 males and 5 females, 10.99 ± 1.80 years), expansion screws were activated for a week (two turns/day), then deactivated in the following week (two turns/day). The activation-deactivation protocol continued for 6 or 7 weeks. In the RME/FM group (10 males and 5 females, 11.61 ± 1.20 years), screw activation was performed according to the patients' requirements. Lateral cephalograms which had been taken at the beginning of treatment and at the end of the facemask therapy were analyzed. Intragroup and intergroup differences were statistically analyzed. RESULTS: Both groups showed a significant sagittal advancement of the maxilla. However, the Alt-RAMEC/FM group showed statistically greater improvements than the RME/FM group for SNA (3.11 ± 1.79 vs. 1.45 ± 1.34, p = 0.008), ANB (4.29 ± 1.80 vs. 2.95 ± 1.19, p = 0.023), convexity (8.91 ± 4.29 vs. 5.61 ± 2.51, p = 0.016), and overjet (5.86 ± 2.29 vs. 4.61 ± 2.10, p < 0.001). The sagittal mandibular, vertical skeletal, dental, and soft tissue changes were similar between the groups (p > 0.05). CONCLUSION: The Alt-RAMEC protocol was found to be more effective in the correction of skeletal class III malocclusion in the short term.

Reverse Forsus vs. facemask/rapid palatal expansion appliances in growing subjects with mild class III malocclusions : A randomized controlled clinical study.

PURPOSE: To investigate the skeletal, dental, and soft tissue effects of reverse Forsus (RF; 3M Unitek, Monrovia, CA, USA) and facemask/rapid palatal expansion (FM/RPE) appliances in growing subjects with class III malocclusions. METHODS: The data of this prospective randomized controlled trial (RCT) were derived from pre- and posttreatment/observation lateral cephalograms of 45 subjects with mild class III malocclusions: group 1 (8 girls, 7 boys; mean age 10.54 years) received a FM/RPE appliance; group 2 (6 girls, 9 boys; mean age 10.49 years) received the RF appliance; and an untreated control group (7 girls, 8 boys; mean age 10.66 years) was matched to the treatment groups with regard to sagittal skeletal and dental classifications. Angular and linear measurements were evaluated using lateral cephalograms. Statistical analyses were performed by one-way analysis of variance, Kolmogorov-Smirnov test, Kruskal-Wallis, paired-samples t­test, and Wilcoxon test, whereby p < 0.05 was accepted to be statistically significant. RESULTS: The intermaxillary (ANB), interdental (overjet), and sagittal lip relations in the FM/RPE and RF groups showed significant improvements compared to the control group (p < 0.05). Although the anterior and inferior traction of the maxilla was greater in the FM/RPE group compared to the RF group (p < 0.05), both treatment groups showed similar clockwise rotation of the mandible compared to the control group. While significantly more proclination of maxillary incisors occurred in the RF group compared to the FM/RPE and control groups (p < 0.05), both treatments led to significantly retroclined mandibular incisors compared to the control group (p < 0.001). CONCLUSION: Both therapies led to intermaxillary and interdental improvements. The RF appliance had a limited effect on the maxilla and it mostly had dentoalveolar effects when compared to FM/RPE therapy.

Effects produced by the facemask with and without skeletal anchorage for the orthopaedic treatment of Class III malocclusion in growing patients: a systematic review and meta-analysis of RCTs.

BACKGROUND: Skeletally anchored facemask has been proposed to maximize skeletal effects and minimize dental effects in the treatment of Class III malocclusion in growing patients. OBJECTIVE: To compare the dento-skeletal effects produced by the facemask with or without skeletal anchorage for the treatment of Class III malocclusion in growing patients. MATERIALS AND METHODS: PubMed, Cochrane Library, Scopus, Embase, Web of Science, and OpenGrey were used for the electronic search without language, publication status, and year restrictions. Only RCTs were included. Inclusion criteria were: growing patients (age under 18 years) with Class III malocclusion, with indications for treatment with the facemask. Data were extracted by two independent reviewers. GRADE statement was executed. The mean of differences (MD) and the risk ratio (RR) were used. RESULTS: Three articles with a total of 123 patients were included. One article was at low risk of bias while two were at high risk of bias. There were no significant differences between the two groups in ANB angle, Wits appraisal, SNB angle, and SN-MP angle. SNA angle was significantly increased in the skeletally anchored facemask (pooled MD = 0.80 favouring skeletal anchorage, 95% CI from 0.29 to 1.31, P = 0.002, I2 = 12 per cent, three studies, GRADE moderate). The U1-SN angle was significantly reduced in the skeletally anchored facemask (pooled MD = -5.91 favouring skeletal anchorage, 95% CI from -7.64 to -4.27, P < 0.00001, I2 = 0 per cent, two studies, GRADE moderate). There were significantly less complications in tooth-anchored facemask (pooled RR = 7.98 favouring dental anchorage, 95 per cent CI from 1.04 to 61.27, P = 0.05, I2 = 0 per cent, two studies, GRADE low). LIMITATIONS: Few RCTs (three) were included, and two studies were at high risk of bias. There were no long-term RCTs comparing skeletally anchored facemask with dental-anchored facemask. Only Asiatic patients were included in this systematic review. CONCLUSIONS: Skeletally anchored facemask was associated to a greater increase of SNA angle at the end of treatment though clinically not significant. Facemask with skeletal anchorage determined a reduced inclination of maxillary incisors compared to dental-anchored facemask with greater risks of complications. REGISTRATION: PROSPERO register (CRD42020221982).

Efficacy of Different Methods of Bone-Anchored Maxillary Protraction in Cleft Lip and Palate Children: A Systematic Review and Meta-Analysis.

INTRODUCTION: Bone-anchored maxillary protraction (BAMP) is an effective option for adolescent cleft patients with maxillary hypoplasia. Hence, this study was conducted to access the effectiveness of the many techniques of BAMP in cleft lip and palate patients. METHODS AND MATERIALS: Data was compiled through a global search of random and nonrandom studies that investigated the efficacy of various techniques of BAMP in cleft lip and palate patients. The searches were conducted in ISI Web of Science, EMBASE, Scopus, Medline, and Cochrane Central Register of Controlled Trials from the beginning until October 12, 2021. The pertinent data of the comprised studies were extracted using predetermined extraction forms. Meta-analysis results were obtained by using inverse-variance to calculate the pooled results of the outcome measures. RESULTS: Five studies were submitted for meta-analysis. The BAMP therapeutic methods investigated in the studies were facemask attached to miniplates (FM-MP) and class III elastics attached to maxillary and mandibular miniplates (C3-IE: class III intermaxillary elastic). The mean differences of A-VRP, A-N Prep., ANB, wits, overjet, and SNA landmarks indicated posttreatment was encouraging, showing maxillary protrusion, and correction of class III malocclusion. SNB landmark showed no statistically significant alterations posttreatment. Subgroup analysis of the C3-IE and FM-MP subgroups indicated that the changes in ANB, SNA, and overjet parameters in the FM-MP subgroup were more pronounced than in the C3-IE subgroup. No statistically significant differences were found when the results of these 2-treatment method were compared, except for in the overjet subgroup. CONCLUSION: After undergoing BAMP treatment, the maxilla showed a more horizontal growth, but no changes in the vertical dimension were observed and the mandible did not rotate clockwise. In addition, using facemask-miniplates was more effective in increasing overjet compared with using class III elastics with bone anchors. In conclusion, BAMP treatment is a suitable alternative for adolescents with cleft lip and palate malformation.

Long term stability of a high-angle skeletal Class II open bite treated with high-pull headgear and modified transpalatal arch: A case report.

This case report describes the treatment of an adolescent patient with an Angle Class II malocclusion, severe open bite and overjet, proclined incisors, skeletal Class II anteroposterior dysplasia, high mandibular plane angle and convex profile. The importance of stopping of a prolonged thumb sucking habit, which was a major causative factor of the open bite is discussed. A combination of a high-pull headgear and a modified transpalatal arch with a loop embedded with resin, at a distance from the palate, were used along with an Edgewise appliance. Treatment timing, favourable growth and good patient response led to an optimal outcome with excellent stability of the treatment results five years and five months post-treatment.