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Guo YN, Cui SJ, Liu Y, Fu Y, Zhang JN, Zhou YH, Wang XD. Quantitative evaluation of vertical control in orthodontic camouflage treatment for skeletal class II with hyperdivergent facial type. Head Face Med 2024; 20:31. [PMID: 38745246 PMCID: PMC11092056 DOI: 10.1186/s13005-024-00432-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND In this study, we sought to quantify the influence of vertical control assisted by a temporary anchorage device (TAD) on orthodontic treatment efficacy for skeletal class II patients with a hyperdivergent facial type and probe into the critical factors of profile improvement. METHODS A total of 36 adult patients with skeletal class II and a hyperdivergent facial type were included in this retrospective case-control study. To exclude the effect of sagittal anchorage reinforcement, the patients were divided into two groups: a maxillary maximum anchorage (MMA) group (N = 17), in which TADs were only used to help with anterior tooth retraction, and the MMA with vertical control (MMA + VC) group (N = 19), for which TADs were also used to intrude the maxillary molars and incisors. The treatment outcome was evaluated using dental, skeletal, and soft-tissue-related parameters via a cephalometric analysis and cast superimposition. RESULTS A significant decrease in ANB (P < 0.05 for both groups), the retraction and uprighting of the maxillary and mandibular incisors, and the retraction of protruded upper and lower lips were observed in both groups. Moreover, a significant intrusion of the maxillary molars was observed via the cephalometric analysis (- 1.56 ± 1.52 mm, P < 0.05) and cast superimposition (- 2.25 ± 1.03 mm, P < 0.05) of the MMA + VC group but not the MMA group, which resulted in a remarkable decrease in the mandibular plane angle (- 1.82 ± 1.38°, P < 0.05). The Z angle (15.25 ± 5.30°, P < 0.05) and Chin thickness (- 0.97 ± 0.45°, P < 0.05) also improved dramatically in the MMA + VC group, indicating a better profile and a relaxed mentalis. Multivariate regression showed that the improvement in the soft tissue was closely related to the counterclockwise rotation of the mandible plane (P < 0.05). CONCLUSIONS TAD-assisted vertical control can achieve intrusion of approximately 2 mm for the upper first molars and induce mandibular counterclockwise rotation of approximately 1.8°. Moreover, it is especially important for patients without sufficient retraction of the upper incisors or a satisfactory chin shape.
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Affiliation(s)
- Yan-Ning Guo
- Department of Orthodontics, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, No.22, Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
- Dental Medical Center, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Sheng-Jie Cui
- Department of Orthodontics, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, No.22, Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
| | - Ye Liu
- Department of Orthodontics, the School of Stomatology, The Key Laboratory of Stomatology, Hebei Medical University, Shijiazhuang, 050017, China
| | - Yu Fu
- Fourth Division Department, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Jie-Ni Zhang
- Department of Orthodontics, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, No.22, Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
| | - Yan-Heng Zhou
- Department of Orthodontics, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, No.22, Zhongguancun South Avenue, Haidian District, Beijing, 100081, China
| | - Xue-Dong Wang
- Department of Orthodontics, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, No.22, Zhongguancun South Avenue, Haidian District, Beijing, 100081, China.
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Miao Z, Zhang H, Yang Y, Han Y, Leng J, Wang S. Influence of maxillary molar distalization with clear aligners on three-dimensional direction: molar distal movement, intrusion, distal tip and crown buccal torque. Prog Orthod 2023; 24:48. [PMID: 38151662 PMCID: PMC10752857 DOI: 10.1186/s40510-023-00500-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/22/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the distal movement, vertical movement, distal tipping and crown buccal torque of maxillary molars after the completion of distalization by comparing the predicted movement with the achieved movement using palatal rugae registration. METHODS The study included 22 clear aligner patients (7 males and 15 females), and 79 molars were measured. Two digital models were generated before treatment and after molar distalization and were superimposed after selecting the palatal rugae area for registration in GOM inspect suite software 2022 (GOM; Braunschweig, Germany). The predicted and achieved movements of molar distalization, intrusion, distal tip and crown buccal torque were measured and compared. RESULT The achieved distalization (1.25 ± 0.79 mm vs. 2.17 ± 1.03 mm, P < 0.001; 1.41 ± 1.00 mm vs. 2.66 ± 1.15 mm, P < 0.001), intrusion (0.47 ± 0.41 mm vs. 0.18 ± 0.54 mm, P < 0.01; 0.58 ± 0.65 mm vs. 0.10 ± 1.12 mm, P < 0.01), distal tip (5.30 ± 4.56° vs. 1.53 ± 2.55°, P < 0.001; 4.87 ± 4.50° vs. - 1.95 ± 4.32°, P < 0.001) and crown buccal torque (1.95 ± 4.18° vs. - 1.15 ± 4.75°, P < 0.001; 0.43 ± 4.39° vs. - 4.27 ± 6.42°, P < 0.001) were significantly different from the predicted values in the two groups (first molar, second molar). Significant regression relationships were found between the achieved distal movement and deviational intrusion (R2 = 0.203, P < 0.0001), distal tip (R2 = 0.133, P < 0.001) and crown buccal torque (R2 = 0.067, P < 0.05). There was a significant correlation between the deviational movements of intrusion and the distal tip (R = 0.555, P < 0.0001). CONCLUSION Approximately 2 mm maxillary molar distalization was achieved in this study. Deviational movement of intrusion, distal tip and crown buccal torque beyond the clear aligner virtual design appeared to a certain degree after distalization. Thus, more attention should be given to molar intrusion and distal tip and crown buccal torque as the designed distalization increases.
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Affiliation(s)
- Zeyao Miao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Haijuan Zhang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuxuan Yang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yandong Han
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jing Leng
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shuang Wang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
- Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Balboni A, Cretella Lombardo E, Balboni G, Gazzani F. Vertical effects of distalization protocol with Clear aligners in Class II patients: a prospective study. Minerva Dent Oral Sci 2023; 72:291-297. [PMID: 37162331 DOI: 10.23736/s2724-6329.23.04783-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND The aim of the present prospective study was to detect the effects on vertical dentoskeletal dimension produced by molar distalization with Clear Aligners in a group of subjects with Class II malocclusion. METHODS The Clear Aligners Group (CAG) comprised 20 patients (13 females, seven males) with a mean age of 17.2±3.2 years. The same standardized protocol of sequential distalization was applied in all subjects. For each patient lateral cephalograms have been analyzed before treatment (T1) and at the end of the therapy (T2). RESULTS At the end of treatment, clear aligners were effective in the correction of Class II dental relationship with the correction of the overjet (-1.3 mm). The treated group showed statistically significant reduction in FMA angle (-1.3°) associated with a counterclockwise rotation of the occlusal plane (POccl^PF -3.1°; SN^POccl -4.2°) and a slight intrusion of maxillary first molars to palatal plane (-0.9 mm). Finally, statistically significant differences were detected in anterior facial height (N-Me) and in the ArGo^GoMe angle (-1.2 mm and -3.4°, respectively). CONCLUSIONS Upper molar distalization with clear aligners represents a valid alternative to non-extraction treatment of Class II malocclusion, reducing the extrusion of maxillary first molars and improving the control of the occlusal plane and of the vertical dimension.
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Affiliation(s)
- Alessia Balboni
- Department of Systems Medicine, Tor Vergata University, Rome, Italy -
| | | | - Giulia Balboni
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
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Al-Tayar B, Al-Somairi MAA, ALshoaibi LH, Wang X, Wang J, Liu J, Al-Tayar B, An X, Si Q. Impact of molar teeth distalization by clear aligners on temporomandibular joint: a three-dimensional study. Prog Orthod 2023; 24:25. [PMID: 37455279 DOI: 10.1186/s40510-023-00474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/15/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Maxillary molar distalization is a common technique used in the non-extraction treatment of Angle Class II malocclusion that can effectively correct the molar relationship and create spaces for anterior teeth alignment. However, this approach may also impact the temporomandibular joint (TMJ) due to predictable changes in the posterior vertical dimension. Despite its widespread use, Class II malocclusions correction by molar distalization with clear aligners has not been investigated for their effects on the TMJ. Therefore, this study aimed to analyze the impact of sequential molar distalization using clear aligners on the TMJ. METHODS Three-dimensional CBCT scans of 23 non-growing patients (7 males, 16 females; mean age 29.8 ± 4.6 years) with skeletal class I or II malocclusion and a bilateral molar class II relationship treated by sequential upper molars distalization with orthodontic clear aligners (Invisalign, Align Technology, San Josè, Ca, USA). A total of 46 joints were examined before and after molar distalization using Anatomage InvivoDental 6.0.3. Linear and angular measurements of the mandibular joint were measured, including joint parameters, inclination, position, and the dimension of the condyle and articular fossa. In addition, 3D volumetric spaces of the joint were analyzed. All data were statistically analyzed by paired T test to determine the differences between the pre-and post-orthodontic procedures. RESULTS No statistically significant differences were found in all primary effects resulting from maxillary molars distalization by clear aligners on TMJ components measurements and joint spaces between T0 and T1. Meanwhile, statistically significant differences were observed in the linear position of the upper molars and the molar relationship parameter with at least P ≤ 0.05. CONCLUSION Treatment by sequential upper molars distalization with clear aligners does not lead to significant TMJ parameters changes in condyle and fossa spaces, dimensions, and positions.
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Affiliation(s)
- Barakat Al-Tayar
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, 730000, China
- Orthodontics Division, Faculty of Medicine and Health Sciences, Taiz University, Taiz, Yemen
| | - Majedh A A Al-Somairi
- Orthodontics Department, School of Stomatology, China Medical University, Shenyang, 110000, China
| | - Lina H ALshoaibi
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, 730000, China
| | - Xiaoli Wang
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, 730000, China
| | - Junbin Wang
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, 730000, China
| | - Jiajie Liu
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, 730000, China
| | - Baher Al-Tayar
- Graduate Student of Dental Health Science, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Dentistry, Faculty of Medical Sciences, Aljanad University for Science and Technology, Taiz, Yemen
| | - Xiaoli An
- Department of Orthodontics, School of Stomatology, Lanzhou University, Lanzhou, 730000, China.
| | - Qingzong Si
- Department of Oral Medicine, School of Stomatology, Lanzhou University, Lanzhou, 730000, China
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Ji L, Li B, Wu X. Evaluation of biomechanics using different traction devices in distalization of maxillary molar with clear aligners: a finite element study. Comput Methods Biomech Biomed Engin 2023; 26:559-567. [PMID: 35543236 DOI: 10.1080/10255842.2022.2073789] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The study aimed to mechanically evaluate the tooth displacement of molar distalization by clear aligners combined with micro-implant through different traction devices using finite element analysis. A three-dimensional finite element model of complete maxillary dentition was constructed. Simultaneously move the maxillary first and second molars 0.2 mm distally at the height of 4 mm and 6 mm of micro-implant, and 150 g force was applied to button, precision cut and angelbutton respectively. Initial tooth movement in six different conditions of anterior tooth and molars was analyzed and calculated with ANSYS software. All the upper anterior tooth exhibited uncontrolled labial tipping and intrusion upon the six conditions, and the central incisor showed the largest tendency of crown labial inclination. Among the absolute values of crown-root displacement difference of the anterior tooth in sagittal direction, the angelbutton was the smallest, which means the torque control ability was superior to others. However, button played a more accurate role in the sagittal and vertical control of canine. With the increase of micro-implant height, the torque control ability of anterior tooth was decreased, but the intrusion trend increased. The controlled distal inclination with extrusion of the first molar and uncontrolled distal inclination with intrusion of the second molar were observed, and the angelbutton had more effective horizontal and vertical control on molars, which was close to bodily movement than others. As a new type of traction device, angelbutton has excellent anchorage control effect in clear aligners therapy of molar distalization, which further realizes the accurate expression of orthodontic force.
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Affiliation(s)
- Lili Ji
- Dental Hospital of Shanxi Medical University, Taiyuan, P. R. China
| | - Bing Li
- Dental Hospital of Shanxi Medical University, Taiyuan, P. R. China
| | - Xiuping Wu
- Dental Hospital of Shanxi Medical University, Taiyuan, P. R. China
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Lione R, Balboni A, Di Fazio V, Pavoni C, Cozza P. Effects of pendulum appliance versus clear aligners in the vertical dimension during Class II malocclusion treatment: a randomized prospective clinical trial. BMC Oral Health 2022; 22:441. [PMID: 36217134 PMCID: PMC9552402 DOI: 10.1186/s12903-022-02483-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022] Open
Abstract
Background The aim of the present study was to compare the effects on vertical dentoskeletal dimension produced by Pendulum appliance and Clear Aligners in patients with Class II malocclusion.
Trial design This is a prospective two-arm parallel group randomized clinical trial with 1:1 allocation ratio. Methods The Pendulum Group (PG) consisted of 20 patients (15F, 5 M) with a mean age of 17.2 ± 4.3 years. The Clear Aligners Group (CAG) comprised 20 patients (13F, 7 M) with a mean age of 17.2 ± 3.2 years. Distalization’s protocol in PG involved the activation of TMA wires till the achievement of Class I molar relationship. A protocol of sequential distalization was applied in the CAG. For each subject lateral cephalograms have been analyzed before treatment (T1) and at the end of the therapy (T2). Descriptive statistics and statistical between-group comparisons (PG vs CAG) were calculated for the craniofacial starting forms at T1 and for the T2–T1 changes. Statistical between-group comparisons for the T2–T1 changes were performed with independent samples t-tests (P < 0.05).
Results The PG showed significantly greater increases in SN^GoGn° when compared with CAG (+ 2.1 and − 0.3 degrees, respectively). Clockwise rotation of the occlusal plane with significantly greater increase of SN^POccl angle was observed in PG (+ 2.8 degrees) when compared with CAG (− 4.2 degrees). The PG revealed a significant increase in the N-Me variable with a mean change of + 4.4 mm compared to the CAG with mean values of − 1.2 mm. The PG showed an increase in the ArGo^GoMe angle (+ 0.7° degrees) compared to the CAG (− 3.4° degrees). The PG showed significantly greater increases in both maxillary and mandibular first molar to palatal plane (+ 1.3 and + 2.1 mm, respectively) when compared with CAG (− 0.9 and − 0.2 mm, respectively).
Conclusions Upper molar distalization with clear aligners represents a valid alternative to non-extraction treatment of Class II malocclusion, reducing the extrusion of maxillary first molars and improving the management of the occlusal plane and vertical dimension. Trial registration: ClinicalTrials.gov, NCT05298280. Registered 28 March 2022—Retrospectively registered, https://clinicaltrials.gov.
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Affiliation(s)
- Roberta Lione
- Department of Systems Medicine, University of Rome 'Tor Vergata', Viale Oxford, 81, 00133, Rome, Italy. .,Department of Dentistry, UNSBC, Tirana, Albania. .,Department of Faculty of Medicine and Surgery, UniCamillus International Medical University, Rome, Italy.
| | - Alessia Balboni
- Department of Systems Medicine, University of Rome 'Tor Vergata', Viale Oxford, 81, 00133, Rome, Italy
| | - Valentina Di Fazio
- Department of Systems Medicine, University of Rome 'Tor Vergata', Viale Oxford, 81, 00133, Rome, Italy
| | - Chiara Pavoni
- Department of Systems Medicine, University of Rome 'Tor Vergata', Viale Oxford, 81, 00133, Rome, Italy.,Department of Dentistry, UNSBC, Tirana, Albania
| | - Paola Cozza
- Department of Dentistry, UNSBC, Tirana, Albania.,Department of Faculty of Medicine and Surgery, UniCamillus International Medical University, Rome, Italy
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Fan Z, Zhang Q, Jiang Y, Qin Q, Huang S, Guo J. Mandibular retromolar space in adults with different sagittal skeletal patterns. Angle Orthod 2022; 92:483764. [PMID: 35849081 PMCID: PMC9374353 DOI: 10.2319/112021-854.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/01/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To analyze the mandibular retromolar space among normal-divergent adult patients with different sagittal skeletal patterns by cone-beam computed tomography (CBCT). MATERIALS AND METHODS CBCTs of a total of 120 normal-divergent adult patients were investigated. Patients were categorized into the following three groups according to their ANB angle: skeletal Class I (48 patients), skeletal Class II (36 patients), and skeletal Class III (36 patients). Four different planes parallel to the mandibular occlusal plane were used to measure the retromolar space. The retromolar space was measured by two reference lines and then compared between different sagittal skeletal patterns groups. The incidence of root contact with the inner lingual cortex was compared among the three groups. RESULTS The retromolar space of the Class III patients was significantly larger than that of Class I patients and Class II patients. Compared with Class I and Class III patients, Class II patients had a smaller retromolar space and higher incidence of contact with the inner cortex of the mandible. CONCLUSIONS Class III patients had a larger retromolar space than Class I patients and Class II patients in four different planes. The mandibular retromolar space should be evaluated by CBCT in patients who need mandibular molar distalization.
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Verma P, George AM. Efficacy of clear aligners in producing molar distalization: Systematic review. APOS TRENDS IN ORTHODONTICS 2022. [DOI: 10.25259/apos_37_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:
The aim of this review is to systematically analyze the efficacy of molar distalization using clear aligners in non-growing Class II patients.
Materials and Methods:
A complete search across the electronic database through PubMed, Cochrane, Google scholar, LILACS, and manual search of orthodontic journals were done till 2019. Studies were selected on the basis of PRISMA guidelines.
Results:
A total of four articles were included in this review. The amount of molar distalization reported was 2–3 mm.
Conclusion:
Out of the four studies included. In all the studies a significant amount of distalization was reported. Three retrospective studies concluded that distalization with aligners is the most effective of all tooth movements. One study concluded that aligners effectively achieved distalization with an efficacy of 87%, other two studies concluded that aligners effectively distalized the molars with good control over vertical dimension and mesiodistal tipping.
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Affiliation(s)
- Purva Verma
- Department of Orthodontics, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India,
| | - Ashwin Mathew George
- Department of Orthodontics, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India,
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Braga Santos SR, Martins de Araújo T, Vogel CJ, Bastos de Oliveira M, Vieira Bittencourt MA, Braga E. Evaluation of anteroposterior and vertical stability 25 years after Angle class II division 1 treatment with cervical headgear. J Orofac Orthop 2021; 82:382-390. [PMID: 33929557 DOI: 10.1007/s00056-020-00277-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The goal was to investigate long-term (minimum 20 years) skeletal and dental changes in Angle class II division 1 patients treated with full-fixed orthodontic appliances and cervical pull headgear. METHODS A longitudinal retrospective study was performed with 20 orthodontic patients, who were treated exclusively by one experienced clinician and whose treatment had been completed a minimum of 20 years ago. Former patients who had been treated from the mid-1970s to the early 1990s were actively sought. After the recall, 20 patients agreed to participate in the study. Lateral cephalometric radiographs at pretreatment (T1), posttreatment (T2), and long-term follow-up (T3) were digitized and measurements were performed. Angular variables used were SNA, SNB, ANB, OcclPl-FH, PalPl-FH, GoMe-FH, 1‑NA, and Y axis. Linear measures were A‑NPerp, Pg-NPerp, 1‑NAmm, Wits, and LAFH. RESULTS From T1 to T2, a significant reduction (p < 0.01) in ANB angle from 4.70 to 2.48° and in Wits value from 3.42 to 0.98 mm were observed. It was also noticed a significant increase (p < 0.01) in LAFH from 62.02 to 67.39 mm, probably due to normal facial growth. From T2 to T3, these variables remained stable. No significant changes were observed for any other measure in any of the periods studied. CONCLUSIONS In the assessed sample, Angle class II division 1 patients treated with cervical pull headgear presented cephalometric outcome stability of treatment, even after a long-term follow-up of a mean of 25 years postretention.
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Affiliation(s)
- Sara Ramos Braga Santos
- Department of Orthodontics, Federal University of Bahia, Av. Araújo Pinho, 62, Canela, Salvador, Bahia, Brazil
| | - Telma Martins de Araújo
- Department of Orthodontics, Federal University of Bahia, Av. Araújo Pinho, 62, Canela, Salvador, Bahia, Brazil
| | - Carlos Jorge Vogel
- Department of Orthodontics, Federal University of Bahia, Av. Araújo Pinho, 62, Canela, Salvador, Bahia, Brazil
| | - Márcio Bastos de Oliveira
- Department of Orthodontics, Federal University of Bahia, Av. Araújo Pinho, 62, Canela, Salvador, Bahia, Brazil
| | | | - Emanuel Braga
- Department of Orthodontics, Federal University of Bahia, Av. Araújo Pinho, 62, Canela, Salvador, Bahia, Brazil.
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Serafin M, Fastuca R, Castellani E, Caprioglio A. Occlusal Plane Changes After Molar Distalization With a Pendulum Appliance in Growing Patients with Class II Malocclusion: A Retrospective Cephalometric Study. Turk J Orthod 2021; 34:10-17. [PMID: 33828873 DOI: 10.5152/turkjorthod.2021.20050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/12/2020] [Indexed: 11/22/2022]
Abstract
Objective This study aimed to evaluate the skeletal and dental changes after distalization with a pendulum appliance in growing patients with Class II malocclusion, focusing on the occlusal plane (OP). Methods The sample included 24 patients with Class II malocclusion (10 boys, 14 girls); their mean age was 12.1 years. All patients underwent molar distalization and had 2 serial cephalograms traced at baseline (T1) and after distalization (T2). Angular and linear dental changes were calculated by taking the sella-nasion (SN), palatal plane (PP), and pterygoid vertical as reference. OP inclination was compared with SN, PP, and mandibular plane. The collected data were computed for all the tested variables, and one-way paired t-test was used to assess the significance of the differences between the time points. α was set at 0.05. Multiple linear regressions were used to predict the OP changes. Results The mean total treatment time was 8±2 months to obtain a super Class I molar relationship. In T1-T2 interval, statistically significant incisor buccal tipping of 5°±3.6° (p<0.05), first molar distal tipping of 8.9°±8.3° (p<0.001), and second molar tipping of 8.2°±8.1° (p<0.001) were observed. The maxillary first and second molars moved significantly backward by 2.8±3.2 mm (p<0.05) and 3.7±2.7 mm (p<0.001), respectively. Only the premolars showed a statistically significant anchorage loss of 2.7±3.3 mm (p<0.05); overjet increased significantly at 1.3±1.2 mm (p<0.05). Regarding the OP, none of the tested variables showed any statistically significant changes between T1-T2. Conclusion The pendulum appliance showed efficacy in distalizing the maxillary first and second molars at the expense of anterior anchorage loss. The OP did not show statistically significant changes after molar distalization.
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Affiliation(s)
- Marco Serafin
- Division of Orthodontics, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | | | - Alberto Caprioglio
- Division of Orthodontics, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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ROSA AJ, VILELLA ODV. Skeletal changes produced by cervical and parietal headgears: a cephalometric evaluation. REVISTA DE ODONTOLOGIA DA UNESP 2021. [DOI: 10.1590/1807-2577.02221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction Extraoral strength is the most common strategy to correct Angle Class II malocclusion, restricting and redirecting the maxillary growth. Objective To evaluate the skeletal changes resulting from the use of headgear, with cervical and parietal anchorages, associated with a full fixed orthodontic appliance, in growing patients with Class II malocclusion (Angle) treated in the clinic of an orthodontic training center. Material and method The ages at the beginning and end of the treatment, anchorage type, and the values of some cephalometric variables were obtained from the clinical files. After applying the inclusion and exclusion criteria, 56 patient files were selected. Then, the sample was divided into two groups, according to the anchorage type: cervical (n=30) and parietal (n=26). The differences between the initial (T1) and final (T2) values of cephalometric measurements SNA, SNB, ANB, AO-BO, GoGn.SN and LHF (percentage of lower facial height to total facial height) were evaluated in both groups. Result Significant differences between T1 and T2 were found relative to SNB and ANB variables in both groups. The AO-BO variable presented a statistically significant difference only in the cervical group. The remaining variables did not show significant differences between T1 and T2. Conclusion The skeletal changes resulting from the use of cervical or parietal anchorage were very similar. There was a decrease in the sagittal discrepancy between the maxillary bones due to forward displacement of the mandible, without significant vertical changes.
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Rosa AJ, Nascimento RRD, Mucha JN, Vilella ODV. Effects of the cervical headgear in growing Angle Class II malocclusion patients: a prospective study. Dental Press J Orthod 2020; 25:25-31. [PMID: 32490924 PMCID: PMC7265674 DOI: 10.1590/2177-6709.25.2.025-031.oar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 02/20/2019] [Indexed: 11/22/2022] Open
Abstract
Objective: Evaluate dental and skeletal changes resulting from the exclusive use of the cervical headgear for 15 ± 4 months in the treatment of patients with Class II division 1 malocclusion. Methods: Differences between the beginning (T1) and immediately after the end of the therapy (T2) with the cervical headgear in growing patients (Experimental Group, EG, n = 23) were examined and compared, during compatible periods, with those presented by a group of untreated individuals (Control Group, CG, n =22) with similar malocclusions and chronological age. The cephalometric variables evaluated were: ANB, GoGn.SN, AO-BO, S'-ANS, S'-A, S'-B, S'-Pog and S'-U6 (maxillary first molar). The Shapiro-Wilk and Levene tests were used to evaluate the results. Results: Significant differences were found relative to the ANB, S'-U6, AO-BO, S'-ANS, S'-A, S'-B and S'-Pog variables between T1 and T2 when comparing both groups. No statistically significant variation was found regarding the GoGn.SN angle. Conclusions: The use of cervical headgear promoted distal movement of the maxillary first molars and restricted the anterior displacement of the maxilla, without significantly affecting the GoGn.SN angle.
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Affiliation(s)
- Anderson Jaña Rosa
- Departamento de Ortodontia, Faculdade de Odontologia, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | | | - José Nelson Mucha
- Departamento de Ortodontia, Faculdade de Odontologia, Universidade Federal Fluminense, Niterói, RJ, Brazil
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Vilanova L, Henriques JFC, Patel MP, Reis RS, Grec RHDC, Aliaga-Del Castillo A, Bellini-Pereira SA, Janson G. Class II malocclusion treatment changes with the Jones jig, Distal jet and First Class appliances. J Appl Oral Sci 2020; 28:e20190364. [PMID: 32348442 PMCID: PMC7185979 DOI: 10.1590/1678-7757-2019-0364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/19/2019] [Indexed: 11/22/2022] Open
Abstract
Objective Maxillary molar distalization with intraoral distalizer appliances is a non-extraction orthodontic treatment used to correct molar relationship in patients with Class II malocclusion presenting maxillary dentoalveolar protrusion and minor skeletal discrepancies. This study compares the changes caused by three distalizers with different force systems. Methodology 71 patients, divided into three groups, were included. The Jones jig group (JJG, n=30; 16 male, 14 female, 13.17 years mean age) was treated with the Jones jig for 0.8 years. The Distal jet group (DJG, n=25; 8 male, 17 female, 12.57 years mean age) was treated with the Distal jet for 1.06 years. The First Class group (FCG, n=16; 6 male, 10 female, 12.84 years mean age) was treated with the First Class for 0.69 years. Intergroup treatment changes were compared using one-way ANOVA, followed by post-hoc Tukey's tests. Results Intergroup comparisons showed significantly greater maxillary incisor protrusion in DJG than in FCG (2.56±2.24 mm vs. 0.74±1.39mm, p=0.015). The maxillary first premolars showed progressive and significantly smaller mesial angulation in JJG, FCG and DJG, respectively (14.65±6.31º, 8.43±3.99º, 0.97±3.16º; p<0.001). They also showed greater mesialization in JJG than FCG (3.76±1.46 mm vs. 2.27±1.47 mm, p=0.010), and greater extrusion in DJG compared to JJG (0.90±0.77 mm vs 0.11±0.60 mm, p=0.004). The maxillary second premolars showed progressive and significantly smaller mesial angulation and mesialization in JJG, FCG and DJG, respectively (12.77±5.78º, 3.20±3.94º, -2.12±3.71º and 3.87±1.34 mm, 2.25±1.40 mm, 1.24±1.26 mm, respectively; p<0.001). DJG showed smaller distal angulation of maxillary first molars (-2.14±5.09º vs. -7.73±4.28º and -6.05±3.76º, for the JJG and FCG, respectively; p<0.001) and greater maxillary second molars extrusion (1.17±1.41 mm vs -0.02±1.16 mm and 0.16±1.40 mm, for the JJG and FCG, respectively; p=0.003). Overjet change was significantly larger in DJG compared to FCG (1.79±1.67 mm vs 0.68±0.84; p=0.046). Treatment time was smaller in FCG (0.69±0.22 years vs 0.81±0.33 years and 1.06±0.42 years, comparing it with the JJG and DJG, respectively; p=0.005). Conclusion The three appliances corrected the Class II molar relationship by dentoalveolar changes. The Distal jet produced smaller molar distal angulation than the Jones jig and First Class. The First Class appliance showed less anchorage loss, greater percentage of distalization and shorter treatment time than the Jones jig and Distal jet.
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Affiliation(s)
- Lorena Vilanova
- Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - José Fernando Castanha Henriques
- Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - Mayara Paim Patel
- Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - Rachelle Simões Reis
- Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - Roberto Henrique da Costa Grec
- Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - Aron Aliaga-Del Castillo
- Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - Silvio Augusto Bellini-Pereira
- Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - Guilherme Janson
- Departamento de Odontopediatria, Ortodontia e Saúde Coletiva, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
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Caruso S, Nota A, Ehsani S, Maddalone E, Ojima K, Tecco S. Impact of molar teeth distalization with clear aligners on occlusal vertical dimension: a retrospective study. BMC Oral Health 2019; 19:182. [PMID: 31409348 PMCID: PMC6692944 DOI: 10.1186/s12903-019-0880-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/07/2019] [Indexed: 11/24/2022] Open
Abstract
Background A common strategy in the non-extraction treatment of Class II molar relationship is maxillary molar distalization, which could increase lower face height and cause clockwise mandibular rotation. The aim of this retrospective study was to analyse the effects on vertical dentoskeletal dimension of young adults treated with sequential distalization with orthodontic aligners. Methods Lateral cephalometric radiographs of 10 subjects (8 females 2 males; mean age 22.7 ± 5.3 years) treated with upper molars sequential distalization with orthodontic aligners (Invisalign, Align Technology, San Josè, California, USA) were analyzed. Results No statistically significant difference was observed for the primary outcome SN-GoGn between T0 and T1 and it was recorded a mean variation of 0.1 ± 2.0 degrees. Statistically significant differences were found in the linear position of the upper molars (6-PP, 7-PP) the molar class relationship parameter (MR) and the upper incisive inclination (1^PP) with at least p < 0.01. Conclusions Upper molar distalization with orthodontic aligners guarantee an excellent control of the vertical dimension representing an ideal solution for the treatment of hyperdivergent or openbite subjects. It also allows an excellent control of the incisal torque without loss of anchorage during the orthodontic procedure.
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Affiliation(s)
- Silvia Caruso
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Coppito, Italy
| | - Alessandro Nota
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Coppito, Italy. .,Dental School, Vita-Salute University and IRCCS San Raffaele Hospital, Via Olgettina, 58, 20132, Milan, Italy.
| | - Shideh Ehsani
- Dental School, Vita-Salute University and IRCCS San Raffaele Hospital, Via Olgettina, 58, 20132, Milan, Italy
| | - Elena Maddalone
- Dental School, Vita-Salute University and IRCCS San Raffaele Hospital, Via Olgettina, 58, 20132, Milan, Italy
| | - Kenji Ojima
- Private Practice of Orthodontics, Tokyo, Japan
| | - Simona Tecco
- Dental School, Vita-Salute University and IRCCS San Raffaele Hospital, Via Olgettina, 58, 20132, Milan, Italy
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Julku J, Pirilä-Parkkinen K, Tolvanen M, Pirttiniemi P. Comparison of effects of cervical headgear treatment on skeletal facial changes when the treatment time is altered: a randomized controlled trial. Eur J Orthod 2019; 41:631-640. [DOI: 10.1093/ejo/cjz053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Summary
Background
There is a lack of evidence based on longitudinal information in the field of Class II malocclusion management with cervical headgear (CH), especially in a randomized setting.
Objectives
The main objective of this study was to evaluate skeletal facial changes, particularly in vertical dimensions, after Kloehn-type CH treatment in children when the timing of treatment is altered.
Trial design
Prospective, parallel-group, randomized controlled trial.
Methods
Screened children with Class II malocclusion were randomized in 1:1 ratio to two groups of equal size by sealed-envelope randomization: the early group (EG), where active CH treatment was started at the age of 7.8 years, and the late group (LG), where CH treatment was started at the age of 9.5 years. The active treatment was continued until normal Class I occlusion on first molars was achieved. Cephalograms were taken at three different time points. Changes in cephalometric measurements were compared between groups and genders. Blinding was applicable for outcome evaluation.
Results
Of 67 randomized children, 56 completed the study. Upper face height increased during the CH treatment phase, as the parameter N–ANS increased significantly during the active treatments of EG (P < 0.05) and LG (P < 0.05). Also, the parameter NSL–PL increased significantly during the treatment of EG (P < 0.01) and during the treatment of LG (P < 0.01). The Gonial angle decreased significantly in the early CH treatment group compared to the later treatment group (T0–T2: P < 0.01). CH improved the antero-posterior jaw relationship. No harms were encountered.
Conclusions
Although the upper face height increased, the mandible showed anterior rotation after CH treatment. The Gonial angle was significantly decreased in the EG compared to the LG. There were gender-specific differences in both sagittal and vertical dimensions when examining interrelations in dimensional changes. The differences found between the early and later treatment groups were not clinically important when the cephalometric results are considered.
Clinical registration
ClinicalTrials.gov (NCT02010346).
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Affiliation(s)
- Johanna Julku
- Oral and Maxillofacial Department, Oulu University Hospital, Finland
- Department of Oral Development and Orthodontics, Research Unit of Oral Health Sciences, University of Oulu, Finland
- MRC Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Kirsi Pirilä-Parkkinen
- Oral and Maxillofacial Department, Oulu University Hospital, Finland
- MRC Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Mimmi Tolvanen
- Department of Community Dentistry, Institute of Dentistry, University of Turku, Finland
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Finland
| | - Pertti Pirttiniemi
- Oral and Maxillofacial Department, Oulu University Hospital, Finland
- Department of Oral Development and Orthodontics, Research Unit of Oral Health Sciences, University of Oulu, Finland
- MRC Oulu, Oulu University Hospital and University of Oulu, Finland
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