Bimaxillary surgery to correct high-angle class II malocclusion: does a simultaneous genioplasty affect long-term stability?

Influence of differences in mandibular incisor inclination on skeletal stability after orthognathic surgery in patients with skeletal class III malocclusion

OBJECTIVE

The preoperative inclination angle of mandibular incisors was crucial for surgical and postoperative stability while the effect of proclined mandibular incisors on skeletal stability has not been investigated. This study aimed to evaluate the effects of differences in presurgical mandibular incisor inclination on skeletal stability after orthognathic surgery in patients with skeletal Class III malocclusion.

METHODS

A retrospective cohort study of 80 consecutive patients with skeletal Class III malocclusion who underwent bimaxillary orthognathic surgery was conducted. According to incisor mandibular plane angle (IMPA), patients were divided into 3 groups: retroclined inclination (IMPA < 87°), normal inclination (87° ≤ IMPA < 93°) and proclined inclination (IMPA ≥ 93°). Preoperative characteristics, surgical changes and postoperative stability were compared based on lateral cephalograms obtained 1 week before surgery (T0), 1 week after surgery (T1), and at 6 to 12 months postoperatively (T2).

RESULTS

The mandible demonstrated a forward and upward relapse in all three groups. No significant differences in skeletal relapse were observed in the 3 groups of patients. However, the proclined inclination group showed a negative overbite tendency postoperatively compared with the other two groups and a clinically significant mandibular relapse pattern. Proclined IMPA both pre- and postoperatively was correlated with mandibular relapse.

CONCLUSION

Sufficient presurgical mandibular incisor decompensation was of crucial importance for the maintenance of skeletal stability in patients with skeletal Class III malocclusion who subsequently underwent orthognathic surgery.

Comprehensive 3-dimensional Positional and Morphological Analyses of Condyle and Glenoid Fossa in Patients with Skeletal Class II Malocclusion following Bimaxillary Orthognathic Surgery

This study aimed to comprehensively and quantitatively characterize 3-dimensional (3D) positional and morphological changes of the condyle and glenoid fossa in patients with skeletal Class II malocclusion treated with bimaxillary orthognathic surgery. Twenty eligible patients treated at our institution from January 2016 to December 2021 with more than 12 months of postoperative follow-up were retrospectively enrolled. Radiographic data of cone-beam computed tomography (CBCT) for each patient were collected at 3 stages: 1 week preoperatively (T0), immediately after surgery (T1), and at least 12 months postoperatively (T2). Positional changes, surface and volumetric alterations of condyle, and bone remodeling in glenoid fossa were measured and compared based on voxel- and surface registrations in visual 3D methods. Most patients exhibited a tendency for condyles to shift posteriorly, laterally, superiorly, and rotated outward, downward, and forward immediately after surgery. Posterior, medial, superior movement and outward, upward, and backward rotation of condyles were observed during follow-up (T1-T2). Bone resorption frequently occurred in the posterior area of condylar surfaces, while bone remodeling was more common in the anterior region of the glenoid fossa. Reduced volume of the condyle was found in most cases, which was not associated with the amount of mandibular advancement. Overall, the condyle and its corresponding glenoid fossa remained relatively stable during the follow-up. Our results reveal positional and morphological alterations in the condyle and the glenoid fossa after bimaxillary orthognathic surgery in patients with skeletal class II malocclusion. These changes predominantly fall within the spectrum of physical adaption.

Adult female skeletal anterior open bite treated by customized lingual orthodontic appliance with miniscrews-assisted in vertical control for perfect orthodontic compensation: A case report with 5-year follow-up

The benefits of lingual orthodontics go beyond appearance. In this case study, a 30-year-old female patient was treated with a custom lingual orthodontic appliance for a Class II high-angle malocclusion, anterior open bite, incisor biprotrusion and crossbite, unilateral second molar scissor bite and dysfunctional tongue thrust. To achieve a counterclockwise rotation of the mandible, implant anchorage was used to control the vertical height. To complete the compensatory therapy, four first premolars were removed. As well as ensuring aesthetics over the 20-month treatment period, the treatment also established a Class I molar relationship, normal overbite and overjet, and improved the facial profile. After a five-year follow-up, the treatment results remained stable.

The cross-sectional effects of ribbon arch wires on Class II malocclusion intermaxillary traction: a three-dimensional finite element analysis

BACKGROUND

The application of intermaxillary traction is often accompanied by the unexpected movement of dentition, especially anchorage teeth. The aim of this study was to comprehensively compare the influence of cross-sectional shape of ribbon arch wires with edgewise and round wires on intermaxillary traction in Class II malocclusion treatment using FEA simulation.

METHODS

The dentofacial structure was simulated in finite element software. A retraction force of 1.5 N was applied to different cross-sectional orthodontic arch wires: a ribbon wire (0.025 × 0.017-in. and 0.025 × 0.019-in.), a rectangular wire (0.017 × 0.025-in. and 0.019 × 0.025-in.) and a round wire (Φ 0.018-in. and Φ 0.020-in.).

RESULTS

Among the three groups, ribbon wire (0.025 × 0.017-in. and 0.025 × 0.019-in.) exhibited the lowest displacement in the X-axis (12.61 μm and 12.77 μm, respectively) and Z-axis (8.99 μm and 9.06 μm, respectively). However, the 0.025 × 0.017-in. ribbon wire showed the highest Y-axis displacement. In the round wire group, Φ 0.020-in. wire displayed less rotation than Φ 0.018-in. wire, where the sagittal, frontal and occlusal rotation of Φ 0.020-in. wire was almost half of that of Φ 0.018-in. wire. The movement of the first molar region was intermediate between the ribbon arch group and the round wire group. Notably, the values of the 0.025 × 0.017-in. arch wire displacement, which were higher than those of any other group, peaked at 0.019 mm in the central incisor region with a spike-like shape. The deformation range of the Φ 0.018-in. wire group was the largest in this study.

CONCLUSIONS

The cross-section of the arch wire influenced force delivery in Class II intermaxillary traction. With the same shape, a larger cross-sectional area led to less mandibular dentition movement. For the rectangular arch wire and ribbon arch wire groups, since the height and width were inverted, the vertical displacement of anchorage teeth in the ribbon wire group was reduced, but the possibility of buccal tipping in mandibular anterior teeth also increased.