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Zhang L, Cao C, Ma T, Zhang Y, Bi Z, Liu D. Classification and characterization of facial asymmetry in adult patients with skeletal Class III malocclusion using cluster analysis. Am J Orthod Dentofacial Orthop 2024; 166:252-266. [PMID: 38904566 DOI: 10.1016/j.ajodo.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION This study aimed to analyze the comprehensive maxillofacial features of patients with skeletal Class III malocclusion and facial asymmetry to develop a classification system for diagnosis and surgical planning. METHODS A total of 161 adult patients were included, with 121 patients in the asymmetry group (menton deviation >2 mm) and 40 patients in the symmetry group (menton deviation ≤2 mm). Twenty-eight variables were determined, including transverse translation, roll and yaw of each facial unit, transverse width, mandibular morphology, and transverse dental compensation. Principal component (PC) analysis was conducted to extract PCs, and cluster analysis was performed using these components to classify the asymmetry group. A decision tree was constructed on the basis of the clustering results. RESULTS Six PCs were extracted, explaining 80.622% of the data variability. The asymmetry group was classified into 4 subgroups: (1) atypical type (15.7%) showed an opposite roll direction of maxillary dentition than of menton deviation; (2) compound type (34.71%) demonstrated significant ramus height differences, maxillary roll, and mandibular roll and yaw; (3) mandibular yaw type (44.63%) showed slight mandibular yaw without mandibular morphology asymmetry; and (4) maxillary-shift type (4.96%) shared similarities with the compound type but showed significant maxillary translation. The classification and regression tree model achieved a prediction accuracy of up to 85.11%. CONCLUSIONS This study identified 4 distinct phenotypes using cluster analysis and proposed tailored treatment recommendations on the basis of their specific characteristics. The classification results emphasized the importance of spatial displacement features, especially mandibular yaw, in diagnosing facial asymmetry. The established classification and regression tree model enables clinicians to identify patients conveniently.
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Affiliation(s)
- Linlin Zhang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration and Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, Shandong, China
| | - Cong Cao
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration and Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, Shandong, China
| | - Ting Ma
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration and Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, Shandong, China
| | - Yuan Zhang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Shandong, China
| | - Zhiwei Bi
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration and Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, Shandong, China
| | - Dongxu Liu
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University and Shandong Key Laboratory of Oral Tissue Regeneration and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration and Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, Shandong, China.
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Cai S, Liu J, Chen Y, Yang X, Yan Y, Zheng D, Lu Y, Xu L. A unilateral increase in the occlusal vertical dimension of growing rats results in mandibular deviation. Orthod Craniofac Res 2024. [PMID: 39193636 DOI: 10.1111/ocr.12851] [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: 06/16/2024] [Revised: 08/01/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVE The effects of unilateral increased occlusal vertical dimension (iOVD) on bilateral craniofacial, mandibular and alveolar development in growing rats were investigated via cone-beam computed tomography (CBCT). The role of Wnt/β-catenin signalling in this process was examined. MATERIALS AND METHODS Forty-eight female Sprague-Dawley rats were randomly allocated into unilateral iOVD and sham groups. At 2, 4 and 8 weeks, the rats were scanned via CBCT to analyse cranial, maxillary, mandibular and dental morphology. Changes in temporomandibular joint (TMJ) cartilage histology and Wnt/β-catenin signalling were assessed by histochemical and immunohistochemical staining and qRT-PCR. RESULTS Dorsal cephalograms revealed that the mandible in the iOVD group tilted approximately 4° to the right. Unilateral iOVD had little effect on cranial and maxillary growth but inhibited mandibular growth (mandibular length and ramal height), especially on the deviated side (DS). Moreover, unilateral iOVD increased the length of the lower incisors and decreased the height of the molars on the DS. Unilateral iOVD induced bilateral osteoarthritis-like changes in the bilateral TMJ condylar cartilage and activated Wnt/β-catenin signalling in the condylar cartilage, especially on the contralateral side (CLS). CONCLUSION Occlusion with unilateral iOVD induced mandibular deviation, significantly inhibited mandibular growth and produced compensatory changes in the alveolar bone. In the iOVD group, the mandibular body length and ramal height were greater on the CLS than on the DS. Moreover, the greater β-catenin protein expression in the TMJ condylar cartilage on the CLS than on the DS may account for the difference in asymmetrical mandibular development.
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Affiliation(s)
- Senxin Cai
- Department of Orthodontics, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
- Key Laboratory of Stomatology of Fujian Province, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Jing Liu
- Fujian Maternal and Child Health Hospital, Fuzhou, China
| | - Yao Chen
- Key Laboratory of Stomatology of Fujian Province, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Xinhan Yang
- Key Laboratory of Stomatology of Fujian Province, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Yuxiang Yan
- Key Laboratory of Stomatology of Fujian Province, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Dali Zheng
- Key Laboratory of Stomatology of Fujian Province, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Youguang Lu
- Department of Preventive Dentistry, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Linyu Xu
- Department of Orthodontics, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
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Chen YJ, Tsai CY, Chang ZC, Yao CC, Kok SH. Differential outcomes of jaw bone position after surgical-orthodontic treatment in three types of skeletal Class III asymmetry patients. J Formos Med Assoc 2024:S0929-6646(24)00305-X. [PMID: 38987030 DOI: 10.1016/j.jfma.2024.07.002] [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: 04/27/2024] [Revised: 05/22/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND/PURPOSE Facial asymmetry is common in Class III patients requiring orthognathic surgery. This study aimed to analyze jaw bone position after surgical-orthodontic treatment in three types of skeletal Class III asymmetry patients. METHODS The retrospective study included 30 Class III patients who underwent surgical-orthodontic treatment comprising LeFort I osteotomy and bilateral sagittal split osteotomy (BSSO) without genioplasty. Cone-beam computed tomography (CBCT) images obtained before surgery (T1) and after post-surgical orthodontic treatment (T2) were superimposed with voxel-based registration. Patients were classified into three groups based on T1 CBCT scans. Groups 1 and 2 exhibited menton and ramus deviated to the same side. Menton deviation was larger than ramus width asymmetry in group 1, while the reverse was true for group 2. Group 3 had menton deviation contralateral to the side with greater ramus width. RESULTS Menton deviation after treatment was improved in all groups. Ramus width asymmetry and coronal ramus angle difference decreased in groups 1 and 2. Neither improvement nor deterioration of ramus width asymmetry was noted for group 3. Comparing to groups 1 and 2, group 3 had greater roll and yaw rotations of distal segment, more upward pitch of proximal segment on chin deviation side, and largest inward yaw as well as backward translation of proximal segment on non-deviation side. CONCLUSION The positional changes of osteotomy segments differed among three types of mandibular asymmetry. Special attention should be given to the atypical mandibular asymmetry with mandibular body and ramus deviating to opposite directions during surgical correction of jaw deflection.
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Affiliation(s)
- Yi-Jane Chen
- Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Yen Tsai
- Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Zwei-Chieng Chang
- Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Chen Yao
- Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Sang-Heng Kok
- Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
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Peng J, Jiang Y, Shang F, Yang Z, Qi Y, Chen S, Yang Y, Jiang R. Changes in masseter muscle morphology after surgical-orthodontic treatment in patients with skeletal Class III malocclusion with mandibular asymmetry: The automatic masseter muscle segmentation model. Am J Orthod Dentofacial Orthop 2024; 165:638-651. [PMID: 38466248 DOI: 10.1016/j.ajodo.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 01/01/2024] [Accepted: 01/01/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION This study evaluated the masseter muscle changes after surgical-orthodontic treatment in patients with a skeletal Class III malocclusion using automatic segmentation. METHODS Images of 120 patients with skeletal Class III malocclusion were obtained and reconstructed at T0 (pretreatment), T1 (presurgery), and T2 (6-12-month postsurgery). The patients were divided into symmetrical and asymmetrical groups. The volume, major axis length, maximum cross-sectional area, horizontal cross-sectional area 5 mm above the mandibular foramen (CSAF), and orientation were calculated automatically. RESULTS In the asymmetrical group, the volume and major axis length on the deviated side were lower than on the nondeviated side at T0, T1, and T2 (P <0.05). There were no significant differences in maximum cross-sectional area and CSAF bilaterally. The orientation was coronally more vertical and sagittally more forward on the deviated side (both P <0.001). In the symmetrical group, there were no significant bilateral differences at T0, T1, and T2. The volume, major axis length, and CSAF decreased, and the coronal orientation was more vertical on the nondeviated side at T2 than at T0 in both groups (P <0.05). The coronal plane orientation was more inclined on the deviated side at T2 than at T0 in the asymmetrical group (P <0.05). CONCLUSIONS The smaller volume on the deviated side at T2 indicates the need for myofunctional training after surgery. The masseter muscle volume and the cross-sectional area did not recover to the preorthodontic levels. Studies with longer follow-up durations are needed to confirm these findings.
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Affiliation(s)
- Jiale Peng
- Department of Orthodontics, Cranial-Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China; National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory for Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Yiran Jiang
- Department of Stomatology, Peking University Third Hospital, Beijing, China
| | | | - Zhongpeng Yang
- Department of Orthodontics, Cranial-Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China; National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory for Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Yuhan Qi
- Department of Orthodontics, Cranial-Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China; National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory for Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Siting Chen
- Department of Orthodontics, Cranial-Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China; National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory for Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Yehui Yang
- Intelligent Healthcare Unit, Baidu, Beijing, China
| | - RuoPing Jiang
- Department of Orthodontics, Cranial-Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China; National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory for Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China.
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Supmaneenukul Y, Khemla C, Parakonthun K. Soft tissue compensation evaluation in patients with facial asymmetry using cone-beam computed tomography combined with 3D facial photographs. Heliyon 2024; 10:e27720. [PMID: 38496872 PMCID: PMC10944279 DOI: 10.1016/j.heliyon.2024.e27720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
Objectives This study aimed to evaluate bilateral soft tissue, hard and soft-tissue thickness at various anatomical levels in patients with facial asymmetries. Moreover, we attempted to find out correlation between soft-tissue compensation and severity of asymmetry by using cone-beam computed tomography (CBCT) combined with 3D facial photographs. Study design Based on menton deviation (MD), twenty-four subjects were divided into: mild-asymmetry group (n=12) and moderate-to-severe-asymmetry group (n = 12). CBCT images were superimposed with 3D facial photographs. Distance from the midsagittal plane to the outermost point of soft-tissue and hard-tissue were measured and calculated soft-tissue thickness. Comparison of soft-tissue thickness between deviated and contralateral side at any anatomical levels were performed within group, and correlation between bilateral soft-tissue thickness subtractions (soft-tissue compensation) and MD values was evaluated. Results Within group, Soft- and hard-tissue distances were greater in deviated side than contralateral side at any levels. In moderate-to-severe group, significant differences were found at gonion and body of mandible level, whereas soft-tissue thickness was only found to be higher on deviated side at the level of mandibular ramus. Soft tissue compensation was negatively correlated with MD value at level of mandibular ramus (R = -0.5, P < 0.05). Conclusions Asymmetry was found to be larger in the lower third of the face and was notably remarkable in the moderate-to-severe group. Soft-tissue thickness was thicker on the deviated side of the mandibular ramus. Thus, the soft-tissue compensation seems to be minimized in patients with more severe asymmetry.
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Affiliation(s)
- Yannapat Supmaneenukul
- Residency Training in Orthodontics, Orthodontic Division, Department of Pedodontics and Preventive Dentistry, Faculty of Dentistry, Srinakharinwirot University, Bangkok, 10110, Thailand
| | - Chinnachote Khemla
- Oral Surgery Section, Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, Srinakharinwirot University, Bangkok, 10110, Thailand
| | - Kulthida Parakonthun
- Orthodontic Division, Department of Pedodontics and Preventive Dentistry, Faculty of Dentistry, Srinakharinwirot University, Bangkok, 10110, Thailand
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Li J, Wu S, Mei L, Wen J, Marra J, Lei L, Li H. Facial asymmetry of the hard and soft tissues in skeletal Class I, II, and III patients. Sci Rep 2024; 14:4966. [PMID: 38424179 PMCID: PMC10904784 DOI: 10.1038/s41598-024-55107-4] [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: 09/11/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
To investigate and compare the facial asymmetry (hard and soft tissues) among skeletal Class I, II, and III patients. A total of 221 subjects, including skeletal Class I (n = 80), skeletal Class II (n = 75), and skeletal Class III (n = 66), were included in the study. CBCT, 22 skeletal landmarks, and 10 soft tissue landmarks were used for the measurements and the asymmetry index was calculated to assess the facial asymmetry. Statistical analyses included one-way ANOVA, Kruskal-Wallis test, and Spearman correlation analysis. The skeletal Class III patients presented greater asymmetry than Class II patients for 10 hard tissue landmarks and 3 soft tissue landmarks (p < 0.05). High correlation of asymmetry was found between four soft tissue landmarks and their corresponding skeletal landmarks (rs ≥ 0.71), as well as Me and ANS (r > 0.86). The ANS and Me in 21.3% patients deviated to contralateral sides. The skeletal Class III patients had more facial asymmetry than the Class II patients. Soft tissues showed similar asymmetry as the underlying hard tissues rather than a compensation of the hard tissue asymmetry. The inconsistency in the deviation of Me and ANS may exacerbate facial asymmetry.
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Affiliation(s)
- Jialing Li
- Department of Orthodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, People's Republic of China
| | - Sujuan Wu
- Department of Orthodontics, Nanjing Lishui Stomatological Hospital, Nanjing, People's Republic of China
| | - Li Mei
- Discipline of Orthodontics, Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Juan Wen
- Department of Orthodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, People's Republic of China
| | - Jamie Marra
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Lang Lei
- Department of Orthodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, People's Republic of China.
| | - Huang Li
- Department of Orthodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University, Nanjing, People's Republic of China.
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Kim HJ, Noh HK, Park HS. Differences in facial soft tissue deviations in Class III patients with different types of mandibular asymmetry: A cone-beam computed tomography study. Korean J Orthod 2023; 53:402-419. [PMID: 37989577 PMCID: PMC10663576 DOI: 10.4041/kjod23.106] [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: 05/11/2023] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 11/23/2023] Open
Abstract
Objective : This study assessed the differences in soft tissue deviations of the nose, lips, and chin between different mandibular asymmetry types in Class III patients. Methods : Cone-beam computed tomography data from 90 Class III patients with moderate-to-severe facial asymmetry were investigated. The sample was divided into three groups based on the extent of mandibular rolling, yawing, and translation. Soft tissue landmarks on the nose, lips, and chin were investigated vertically, transversely, and anteroposteriorly. A paired t test was performed to compare variables between the deviated (Dv) and nondeviated (NDv) sides, and one-way analysis of variance with Tukey's post-hoc test was performed for intergroup comparisons. Pearson's correlation coefficient was calculated to assess the relationship between the soft and hard tissue deviations. Results : The roll-dominant group showed significantly greater differences in the vertical positions of the soft tissue landmarks between the Dv and NDv than other groups (P < 0.05), whereas the yaw-dominant group exhibited larger differences in the transverse and anteroposterior directions (P < 0.05). Moreover, transverse lip cant was correlated with the menton (Me) deviation and mandibular rolling in the roll-dominant group (P < 0.001); the angulation of the nasal bridge or philtrum was correlated with the Me deviation and mandibular yawing in the yaw-dominant group (P < 0.01). Conclusions : The three-dimensional deviations of facial soft tissue differed based on the mandibular asymmetry types in Class III patients with similar amounts of Me deviation. A precise understanding of soft tissue deviation in each asymmetry type would help achieve satisfactory facial esthetics.
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Affiliation(s)
- Ho-Jin Kim
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Hyung-Kyu Noh
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Hyo-Sang Park
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, Korea
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Vernucci RA, Da Mommio L, Vellone V, De Stefano A, Barbato E, Di Giorgio R, Galluccio G. 'Study of the maxillary yaw on cone beam computed tomography: A preliminary report and comparison between two different dento-skeletal malocclusions'. Orthod Craniofac Res 2023; 26:576-584. [PMID: 36912723 DOI: 10.1111/ocr.12652] [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: 11/01/2022] [Revised: 01/22/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES To assess the skeletal and dental maxillary transverse compensation (yaw) on the cone beam computed tomography (CBCT) three-dimensional reconstructed image of the skull in two groups of patients, both clinically affected by a class III malocclusion with deviation of the lower midline. MATERIALS AND METHODS An observational retrospective study was designed to analyse differences in two groups of patients, the first one was composed by patients affected by horizontal condylar hyperplasia, the second one by patients affected by dento-skeletal asymmetric class III malocclusion. Each group was composed by 15 patients. Transverse analysis was performed by measuring five landmarks (three bilateral and two uneven) with respect to a mid-sagittal plane; sagittal analysis was performed by measuring the sagittal distance on the mid-sagittal plane between bilateral points. Means were compared through inferential analysis. RESULTS In the condylar hyperplasia group, all differences between the two sides were not statistically significant, nor for canines' difference (P = .0817), for molars (P = .1105) or for jugular points (.05871). In the class III group, the differences between the two sides were statistically significant for molars (P = .0019) and jugular points (P = .0031) but not for canines (P = .1158). Comparing the two groups, significant differences were found only for incisors' midline deviation (P = .0343) and canine (P = .0177). CONCLUSION The study of the yaw on CBCT should be integrated into three-dimensional cephalometry and could help in differentiating the various malocclusion patterns.
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Affiliation(s)
- R A Vernucci
- Department of Oral and Maxillofacial Sciences, School of Dentistry, 'Sapienza' University of Rome, Rome, Italy
- Department of Sense Organs, 'Sapienza' University of Rome, Rome, Italy
| | - L Da Mommio
- Department of Oral and Maxillofacial Sciences, School of Dentistry, 'Sapienza' University of Rome, Rome, Italy
| | - V Vellone
- Department of Oral and Maxillofacial Sciences, School of Dentistry, 'Sapienza' University of Rome, Rome, Italy
| | - A De Stefano
- Department of Oral and Maxillofacial Sciences, School of Dentistry, 'Sapienza' University of Rome, Rome, Italy
| | - E Barbato
- Department of Oral and Maxillofacial Sciences, School of Dentistry, 'Sapienza' University of Rome, Rome, Italy
| | - R Di Giorgio
- Department of Oral and Maxillofacial Sciences, School of Dentistry, 'Sapienza' University of Rome, Rome, Italy
- Department of Sense Organs, 'Sapienza' University of Rome, Rome, Italy
| | - G Galluccio
- Department of Oral and Maxillofacial Sciences, School of Dentistry, 'Sapienza' University of Rome, Rome, Italy
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Kim HJ, Noh HK, Park HS. Mandibular asymmetry types and differences in dental compensations of Class III patients analyzed with cone-beam computed tomography. Angle Orthod 2023; 93:695-705. [PMID: 37407513 PMCID: PMC10633797 DOI: 10.2319/013023-73.1] [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: 01/01/2023] [Accepted: 05/01/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES To assess differences in dental compensation of the incisors and first molars in skeletal Class III patients with roll-, yaw-, and translation-dominant mandibular asymmetries. MATERIALS AND METHODS A total of 90 skeletal Class III adult patients (mean age, 22.00 ± 3.31 years; range, 18-37.9 years) with facial asymmetry were enrolled and divided into the roll-, yaw-, and translation-dominant type groups (n = 30 per group). The vertical, transverse, and anteroposterior distances and axial angles of the teeth were measured using cone-beam computed tomography images. The measurements were compared between the deviated and nondeviated sides using a paired t-test and among the three groups using one-way analysis of variance with a Tukey post hoc test. RESULTS The roll-dominant groups showed the greatest values for the bilateral difference in the vertical position of the maxillary (2.42 ± 1.24 mm) and mandibular molars (2.23 ± 1.28 mm; P < .001). The transverse deviations of the maxillary (2.19 ± 1.51 mm) and mandibular incisors (-2.11 ± 1.39 mm) were greater in the yaw-dominant groups than those of other groups. Regarding tooth axial angle, the yaw-dominant group showed the greatest tipping of the mandibular incisor (-4.13 ± 3.30°; P < .001). CONCLUSIONS Dental compensation differed depending on the type of facial asymmetry. The roll-dominant type showed more vertical compensation of the posterior teeth, whereas the yaw-dominant type exhibited more tipping of the molars and incisors. By precisely assessing dental compensation in each asymmetry type, sufficient dental decompensation could be achieved.
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Affiliation(s)
| | | | - Hyo-Sang Park
- Corresponding author: Dr Hyo-Sang Park, Professor, Department of Orthodontics, School of Dentistry, Kyungpook National University, 2175, Dalgubul-Daero, Jung-Gu, Daegu, Korea 41940 (e-mail: )
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Li J, Liu Y, Ge X, Liu Z, Guan H, Wang L, Ma W. A cross-sectional study on three-dimensional compensatory characteristics of maxillary teeth in patients with different types of skeletal Class III malocclusion with mandibular asymmetry. Clin Oral Investig 2023; 27:4973-4985. [PMID: 37417986 DOI: 10.1007/s00784-023-05116-w] [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: 01/09/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The purpose of this study was to analyze three-dimensional dental compensation in patients with different types of skeletal Class III malocclusion with mandibular asymmetry, using cone-beam computed tomography (CBCT) and three-dimensional reconstruction measurement technology, thereby providing clinical guidance and reference for combined orthodontic and orthognathic treatment. METHODS 81 patients with skeletal Class III malocclusion with mandibular asymmetry were selected in accordance with the inclusion criteria. According to a new classification method based on the direction and amount of menton deviation relative to ramus deviation, patients were divided into three groups called Type 1, Type 2, and Type 3. In Type 1, the direction of menton deviation was consistent with that of ramus deviation and the amount of menton deviation was greater than that of ramus deviation. In Type 2, the direction of menton deviation was consistent with that of ramus deviation and the amount of menton deviation was smaller than that of ramus deviation. In Type 3, the direction of menton deviation was inconsistent with that of ramus deviation. The maxillary occlusal plane (OP), anterior occlusal plane (AOP), and posterior occlusal plane (POP) were measured on reconstructed CBCT images. The vertical, transverse, and anteroposterior distances from maxillary teeth to reference planes and the 3D angles between the long axis of these teeth and reference planes were measured. These dental variables measured from the deviated and non-deviated sides were compared within each group, as well as among each other. RESULTS Of the 81 patients with asymmetrical Class III malocclusion, 52 patients were categorized in Type 1, 12 patients in Type 2, and 17 patients in Type 3. There were significant differences between deviated and non-deviated sides in Type 1 and Type 3 (p < 0.05). In Type 1, the vertical distances of maxillary teeth on the deviated side were lower than those on the non-deviated side, and AOP, OP, and POP on the deviated side were larger than those on the non-deviated side (p < 0.05). In Type 3, the vertical distances of the maxillary teeth on the deviated side were lower (p < 0.05), and the AOP and OP on the deviated side were larger than those on the non-deviated side. In all three groups, the transverse distances of the maxillary teeth from the mid-sagittal plane on the deviated side were larger than those on the non-deviated side (p < 0.05), and the angles between the long axis of maxillary teeth and the mid-sagittal plane on the deviated side were larger, respectively (p < 0.05). CONCLUSIONS The maxillary teeth on the deviated side were observed to have smaller eruption heights in Type 1 and Type 3. In Type 1, AOP, POP, and OP were greater on the deviated side, while in Type 3, only AOP and OP were greater on the deviated side. The maxillary teeth of patients in all three groups on the deviated side were buccal and buccally inclined. Larger sample observations are still needed to further verify these findings.
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Affiliation(s)
- Jie Li
- Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Yang Liu
- Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Xiaolei Ge
- Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Ziyang Liu
- Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Huibo Guan
- Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Linna Wang
- Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Wensheng Ma
- Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China.
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Kim SS, Jung KS, Kim YI, Park SB, Kim SH. Unilateral condylar hyperplasia treated with simultaneous 2-jaw orthognathic surgery and posterior segmental osteotomy. Angle Orthod 2022; 93:488282. [PMID: 36350296 PMCID: PMC9933568 DOI: 10.2319/060122-401.1] [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: 06/01/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
A 25-year-old woman presented with left condylar hyperplasia, canting-type facial asymmetry, mandibular prognathism, and arch width discrepancy. Bone scintigraphy confirmed the inactive status of the condyle, and the temporomandibular joint functioned within the normal range; thus, orthognathic surgery without condylectomy was performed. To correct facial asymmetry successfully through orthognathic surgery, sufficient dentoalveolar decompensation must be achieved in the presurgical orthodontic phase. In cases of canting-type facial asymmetry, teeth on the nondeviated side are extruded as dentoalveolar compensation. Therefore, vertical decompensation is required for intrusion of the extruded teeth. A miniscrew and resin build-ups were used for the intrusion of teeth, and posterior segmental osteotomy was simultaneously performed with orthognathic surgery for further intrusion. The canting-type facial asymmetry was notably corrected through successful vertical decompensation and close cooperation between orthodontists and maxillofacial surgeons. After 2 years of retention, the treatment results remained stable.
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Ha SW, Kim SJ, Choi JY, Baek SH. Characterization of facial asymmetry phenotypes in adult patients with skeletal Class III malocclusion using three-dimensional computed tomography and cluster analysis. Korean J Orthod 2022; 52:85-101. [PMID: 35321948 PMCID: PMC8964472 DOI: 10.4041/kjod.2022.52.2.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/22/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To classify facial asymmetry (FA) phenotypes in adult patients with skeletal Class III (C-III) malocclusion. Methods A total of 120 C-III patients who underwent orthognathic surgery (OGS) and whose three-dimensional computed tomography images were taken one month prior to OGS were evaluated. Thirty hard tissue landmarks were identified. After measurement of 22 variables, including cant (°, mm), shift (mm), and yaw (°) of the maxilla, maxillary dentition (Max-dent), mandibular dentition, mandible, and mandibular border (Man-border) and differences in the frontal ramus angle (FRA, °) and ramus height (RH, mm), K-means cluster analysis was conducted using three variables (cant in the Max-dent [mm] and shift [mm] and yaw [°] in the Man-border). Statistical analyses were conducted to characterize the differences in the FA variables among the clusters. Results The FA phenotypes were classified into five types 1) non-asymmetry type (35.8%); 2) maxillary-cant type (14.2%; severe cant of the Max-dent, mild shift of the Man-border); 3) mandibular-shift and yaw type (16.7%; moderate shift and yaw of the Man-border, mild RH-difference); 4) complex type (9.2%; severe cant of the Max-dent, moderate cant, severe shift, and severe yaw of the Man-border, moderate differences in FRA and RH); and 5) maxillary reverse-cant type (24.2%; reverse-cant of the Max-dent). Strategic decompensation by pre-surgical orthodontic treatment and considerations for OGS planning were proposed according to the FA phenotypes. Conclusions This FA phenotype classification may be an effective tool for differential diagnosis and surgical planning for Class III patients with FA.
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A preliminary study of buccal and lingual alveolar bone thickness of posterior teeth in patients with skeletal Class III malocclusion and mandibular asymmetry. Am J Orthod Dentofacial Orthop 2022; 162:66-79.e6. [DOI: 10.1016/j.ajodo.2021.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/23/2022]
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Moon HW, Nam W, Ahn HW, Oh SH, Kook YA, Kim SH. Development of a maxillomandibular arch form based on the center of resistance of teeth using cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2021; 161:208-219. [PMID: 34753591 DOI: 10.1016/j.ajodo.2020.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Controlling transverse discrepancies is necessary to ensure stable and functional occlusion. Altered molar inclinations can camouflage the transverse relationship. The purpose of this research was to evaluate the maxillomandibular relationship of the center of resistance (CR) of the arch form created by the CR of teeth and compare these CR arch forms by their skeletal patterns. METHODS Sixty patients with minor crowding and normal posterior overjet were divided into 3 groups according to ANB angle: skeletal Class I group had ANB angle between 0° and 4° (n = 20), skeletal Class II group had ANB angle >4° (n = 20), and skeletal Class III group had ANB angle <0° (n = 20). The 3-dimensional coordinates of the CR were estimated using cone-beam computed tomography images and projected on the CR occlusal plane to obtain the 2-dimensional coordinates. The CR arch forms were constructed and evaluated using Matlab (MathWorks, Natick, Mass). RESULTS On comparing maxillomandibular CR arch form widths, the maxilla was significantly larger than the mandible of the canine and first premolar. The mandible was larger in the first molar of the skeletal Class III group. The maxillomandibular CR arch form width ratios were between 0.97 and 1.35. On comparing maxillomandibular CR arch form areas, the maxilla was significantly larger than the mandible in the anterior segment, and the mandible was larger in the posterior segment. The ratios were between 0.86 and 2.25. In between-group comparison, the skeletal Class III group showed significantly greater arch forms in the mandible. CONCLUSIONS CR arch forms had significant maxillomandibular differences throughout the arch. The maxillomandibular ratios could be a reference for site-specific transverse discrepancy analysis.
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Affiliation(s)
- Hyung-Wook Moon
- Department of Orthodontics, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Woochul Nam
- School of Mechanical Engineering, Chung-Ang University, Seoul, South Korea
| | - Hyo-Won Ahn
- Department of Orthodontics, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Song Hee Oh
- Department of Oral and Maxillofacial Radiology, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Yoon-Ah Kook
- Department of Orthodontics, Postgraduate School of Dentistry, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul, South Korea
| | - Seong-Hun Kim
- Department of Orthodontics, Graduate School, Kyung Hee University, Seoul, South Korea.
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Noh HK, Park HS. Does maxillary yaw exist in patients with skeletal Class III facial asymmetry? Am J Orthod Dentofacial Orthop 2021; 160:573-587. [PMID: 34332794 DOI: 10.1016/j.ajodo.2020.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/01/2020] [Accepted: 05/01/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This study aimed to evaluate maxillary skeletal and dental yaw in patients with skeletal Class III facial asymmetry and investigate its correlation with menton deviation. METHODS Initial cone-beam computed tomography data from 60 patients with skeletal Class III malocclusion were used. There were 30 patients in both the symmetrical group (menton deviation <2 mm) and the asymmetrical group (menton deviation >4 mm). After reconstruction of 3-dimensional (3D) cone-beam computed tomography data, maxillary yaw and 3D positions of skeletal and dental landmarks were measured and compared between the groups. After that, correlations between menton deviation and the other variables were assessed. RESULTS No significant difference was noted in maxillary skeletal and dental yaw between the 2 groups. In the assessment of 3D positions, translation of the maxillary bone and maxillary dentition toward the menton deviation was observed (P <0.01). Maxillary skeletal and dental yaw was not significantly correlated with menton deviation in the asymmetrical group. CONCLUSIONS Maxillary skeletal and dental yaw was not evident in either group. Therefore, when planning maxillary surgery for patients with skeletal Class III facial asymmetry malocclusion, it may be appropriate to shift the focus of decompensation from maxillary yaw to maxillary translation.
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Affiliation(s)
- Hyung-Kyu Noh
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - Hyo-Sang Park
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, South Korea.
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Aghazada H, Vernucci RA, Ramieri V, Cascone P, Barbato E, Silvestri A, Galluccio G. Assessment of maxillary canting on cone beam computed tomography and digital models: A retrospective study and proposal of a method. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:128-135. [PMID: 33774259 DOI: 10.1016/j.jormas.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/23/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The mounting of the plaster casts on articulator procedure is routinely performed in orthognathic surgery to assess canting of the maxillary occlusal plane, but the currently used protocols and reference plane could be source of errors which affect reliability. Nowadays the assessment of canting of the maxillary occlusal plane could be also performed with an entirely digital protocol. Aim of the study was to propose a method to evaluate canting in patients affected by Unilateral Condylar Hyperplasia, comparing the measurements performed on digital models matched on CBCT with those made on traditional articulator. MATERIALS AND METHODS A retrospective cross-sectional study was designed on 20 patients affected by vertical Unilateral Condylar Hyperplasia treated in the Units of Orthodontics and Maxillo-Facial Surgery. The canting of the maxillary occlusal plane was measured on plaster casts mounted on the conventional articulator and the measures were compared with those made on digital models matched on CBCT, according the protocol developed in our Unit. Molar, canine and basal difference were measured. To compare the two protocols and to test the agreement, we performed descriptive statistics, comparison between means and Bland Altman analysis. P value was set at 0.05. RESULTS Statistic comparison demonstrated agreement between measurements performed with the digital protocol and conventional physical method. CONCLUSION Measurements of canting with digital protocol are comparable to the physical standard method. A total digital protocol allows faster availability and storage of patient's data and better communication between orthodontist and maxillo-facial surgeon, especially in patients affected by three-dimensional malocclusions.
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Affiliation(s)
- Huseynagha Aghazada
- Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Via Caserta, 6, 00161 Rome, Italy
| | - Roberto Antonio Vernucci
- Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Via Caserta, 6, 00161 Rome, Italy.
| | - Valerio Ramieri
- Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Via Caserta, 6, 00161 Rome, Italy.
| | - Piero Cascone
- Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Via Caserta, 6, 00161 Rome, Italy.
| | - Ersilia Barbato
- Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Via Caserta, 6, 00161 Rome, Italy.
| | - Alessandro Silvestri
- Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Via Caserta, 6, 00161 Rome, Italy.
| | - Gabriella Galluccio
- Department of Oral and Maxillofacial Sciences, School of Dentistry, "Sapienza" University of Rome, Via Caserta, 6, 00161 Rome, Italy.
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Sha HN, Lim SY, Kwon SM, Cha JY. Camouflage treatment for skeletal Class III patient with facial asymmetry using customized bracket based on CAD/CAM virtual orthodontic system. Angle Orthod 2021; 90:607-618. [PMID: 33378502 DOI: 10.2319/102318-768.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/01/2019] [Indexed: 11/23/2022] Open
Abstract
When considering camouflage orthodontic treatment for Class III malocclusion with skeletal facial asymmetry, it is crucial to preserve the favorable compensated posterior occlusion. Once the inclination of the compensated occlusion is changed during orthodontic treatment, unstable occlusion, such as crossbite or scissor bite may occur. A 23-year-old female patient had anterior spacing with Class III malocclusion and a mandibular asymmetry. A nonsurgical approach was adopted. The treatment objectives were to establish a Class I molar relationship with compensated inclination of the posterior dentition and to correct the midline deviation. To achieve these goals, the computer-aided design/computer-aided manufacturing (CAD/CAM) orthodontic system plus customized brackets was applied, and miniscrews were used to distalize the left mandibular dentition for midline correction. The results suggested that the CAD/CAM-based customized brackets can be efficiently used in camouflage treatment to achieve a correct final occlusion.
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Kim MS, Lim SH, Jeong SR, Park JH. Maxillary molar intrusion and transverse decompensation to enable mandibular single-jaw surgery with rotational setback and transverse shift for a patient with mandibular prognathism and asymmetry. Am J Orthod Dentofacial Orthop 2020; 157:818-831. [PMID: 32487312 DOI: 10.1016/j.ajodo.2019.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 10/24/2022]
Abstract
When performing single-jaw surgery for mandibular setback, the distal segment of the mandible is brought distally along the occlusal plane, leaving the relationship of the B-point and pogonion unchanged. Double-jaw surgery for rotation of the maxillomandibular complex can be considered for solving this problem. However, maxillary surgery for rotational setback of the mandible can be replaced with orthodontic intrusion of the maxillary molars. Correcting the mandibular asymmetry that frequently accompanies mandibular prognathism often requires corrections of roll, yaw, and transverse shift of the mandible. Performing these corrections in mandibular single-jaw setback surgery requires transverse decompensation and orthodontic correction of maxillary occlusal-plane canting. This case report describes the simultaneous achievement of maxillary molar intrusion, transverse decompensation, and canting correction using a palatal lever supported by 2 midpalatal mini-implants. After creating a lateral open bite, mandibular setback surgery was performed with a 13.5° clockwise rotation, 2.9° roll correction, 3.5° yaw correction, and 3.5-mm transverse shift. The application of rotational setback significantly improved the facial esthetics. This case report demonstrates that orthodontic intrusion of the maxillary molars and transverse decompensation can replace maxillary surgery in the treatment of mandibular prognathism with asymmetry.
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Affiliation(s)
- Min-Su Kim
- Department of Orthodontics, College of Dentistry, Chosun University, Gwangju, Korea
| | - Sung-Hoon Lim
- Department of Orthodontics, College of Dentistry, Chosun University, Gwangju, Korea.
| | - Seo-Rin Jeong
- Department of Orthodontics, College of Dentistry, Chosun University, Gwangju, Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz; Graduate School of Dentistry, Kyung Hee University, Seoul and Seoul, Korea
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Hu X, Huang X, Gu Y. Assessment of buccal and lingual alveolar bone thickness and buccolingual inclination of maxillary posterior teeth in patients with severe skeletal Class III malocclusion with mandibular asymmetry. Am J Orthod Dentofacial Orthop 2020; 157:503-515. [PMID: 32241357 DOI: 10.1016/j.ajodo.2019.04.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the buccal and lingual alveolar bone thickness and buccolingual inclination of maxillary posterior teeth in patients with severe skeletal Class III malocclusion with and without mandibular asymmetry and compare with those in patients with skeletal Class I malocclusion. METHODS Cone-beam computed tomography images of 69 patients with severe skeletal Class III malocclusion and 30 patients with skeletal Class I malocclusion were collected and reconstructed with Dolphin 3D software. Based on the distance from menton to the sagittal plane (d), the patients with skeletal Class III malocclusion were divided into a symmetry group (d ≤ 2 mm) and an asymmetry group (d ≥ 4 mm). Buccal and lingual alveolar bone thickness and buccolingual inclination of maxillary posterior teeth were measured and compared. Correlations among dental measurements, severity of sagittal discrepancy, and mandibular deviation were analyzed. RESULTS Maxillary posterior teeth on the deviated side in Class III asymmetry group and symmetry group were buccally inclined compared with the Class I group (P < 0.001). A significant negative correlation was noted between buccolingual inclination of maxillary posterior teeth and ANB value with Spearman correlation coefficient of maxillary first molar, second premolar, and first premolar of -0.687, -0.485 and -0.506, respectively (P < 0.001). Maxillary first molar showed thinner buccal alveolar bone on deviated side in asymmetry group and symmetry group of Class III, compared with the Class I group, with average values of 1.21 mm, 1.19 mm, and 1.83 mm, respectively (P < 0.05). The maxillary first premolar also showed thinner buccal alveolar bone on deviated side in Class III asymmetry group compared with the Class I group, with average values of 0.87 mm and 1.28 mm, respectively (P < 0.05). CONCLUSIONS Decompensation of buccally inclined posterior teeth in patients with skeletal Class III malocclusion should be more cautious owing to thinner buccal alveolar bone to avoid a high risk of fenestration and dehiscence.
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Affiliation(s)
- Xinnong Hu
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoyi Huang
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yan Gu
- Department of Orthodontics, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.
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Abou Chebel N, Saadeh M, Haddad R. Unilateral sagittal split osteotomy: effect on mandibular symmetry in the treatment of class III with laterognathia. Prog Orthod 2020; 21:19. [PMID: 32627109 PMCID: PMC7335760 DOI: 10.1186/s40510-020-00319-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/10/2020] [Indexed: 11/12/2022] Open
Abstract
The bilateral sagittal split osteotomy is considered the standard surgery to correct facial asymmetries. More recently, unilateral sagittal split osteotomy (USSO) was used to treat such malocclusions. AIM To assess facial symmetry following USSO in the treatment of class III laterognathia. METHODS Frontal facial photographs of four groups of patients were assessed: (1) pre-surgical group (n = 30) with skeletal asymmetry, (2) postsurgical group assessing patients of the first group 2 years after USSO, (3) control group (n = 30) of patients judged to have harmonious facial norms, and (4) mirrored group (n = 30) in which the control photographs were altered by duplicating the right half side of the face to replace the left half, thus creating perfectly symmetrical faces. All 120 photographs were distributed to 40 expert orthodontists to evaluate and score facial symmetry using the visual analog scale. Skin sensitivity and temporomandibular joint (TMJ) disorders were also assessed clinically pre and postsurgically. RESULTS Statistically significant differences were observed between the pre-surgical group and each of the postsurgical and control groups (p < 0.001). The control and postsurgical groups received similar scores of symmetry (p = 0.774). The mirrored group received statistically significantly higher symmetry scores than either of the control or the postsurgical groups (p < 0.001). A reduction in TMJ disorders was noted after USSO and all patients reported normal skin sensation 2 years post-surgery. CONCLUSION When indicated, USSO is a dependable and practical surgical approach to correct facial asymmetries associated with class III malocclusion.
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Affiliation(s)
- Naji Abou Chebel
- Division of Orthodontics and Dentofacial Orthopedics, Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Maria Saadeh
- Division of Orthodontics and Dentofacial Orthopedics, Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Orthodontics, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
- Department of Forensic Odontostomatology and Human Identification, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Ramzi Haddad
- Division of Orthodontics and Dentofacial Orthopedics, Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Radiation dosimetry analyses of radiographic imaging systems used for orthodontic treatment: comparison among child, adolescent, and adult patients. Oral Radiol 2020; 37:245-250. [PMID: 32361820 DOI: 10.1007/s11282-020-00439-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to compare the effective doses of orthodontic radiographs in children, adolescents, and adults. METHODS We exposed a child, an adolescent (simulated by an adult female phantom), and adult male phantoms using common scanning protocols for panoramic radiography, cephalography, and cone-beam computed tomography (CBCT). Glass dosimeters were placed in the organs of the phantom to measure the absorbed doses. The effective doses were deduced using tissue weighting factors as defined in the ICRP Publication 103. RESULTS For panoramic imaging, the parotid gland had the highest absorbed dose in the child and the submandibular glands had the highest absorbed dose in both the adolescent and adult phantoms. For cephalography, the organs and tissues located closest to the X-ray tube had the highest absorbed dose values. For CBCT, the lenses of the eyes received the highest absorbed dose. Effective doses with CBCT were the greatest in the adolescent phantom, followed by in the adult and child phantoms. CONCLUSIONS Dental practitioners should be aware of patient age, as younger patients will incur greater risks from radiation.
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Chen YJ, Yao CC, Chang ZC, Lai HH, Yeh KJ, Kok SH. Characterization of facial asymmetry in skeletal Class III malocclusion and its implications for treatment. Int J Oral Maxillofac Surg 2019; 48:1533-1541. [DOI: 10.1016/j.ijom.2019.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/23/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022]
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Analysis of dental compensation in patients with facial asymmetry using cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2019; 156:493-501. [DOI: 10.1016/j.ajodo.2018.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 10/25/2022]
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Thiesen G, Freitas MPM, Gribel BF, Kim KB. Comparison of maxillomandibular asymmetries in adult patients presenting different sagittal jaw relationships. Dental Press J Orthod 2019; 24:54-62. [PMID: 31508707 PMCID: PMC6733234 DOI: 10.1590/2177-6709.24.4.054-062.oar] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 10/22/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The present study aims at using cone beam computed tomography (CBCT) to analyze the maxillomandibular characteristics present in adults with mandibular asymmetries and different sagittal jaw relationships. METHODS 360 patients were selected and divided into three groups (Class I, Class II, and Class III), with 120 individuals per group. The groups were then subdivided according to the intensity of lateral deviation of the gnathion point, into: 1) relative symmetry, 2) moderate asymmetry, and 3) severe asymmetry. Three planes of reference were established in the CBCT images and several measurements were taken to compare the bilateral skeletal differences between the intensities of asymmetry for the different sagittal jaw relationships. RESULTS When the groups were compared by the intensity of asymmetry, significant differences among patients with relative symmetry and moderate to severe asymmetry were found. This was especially noticed for severe asymmetry, suggesting that the deviation of the chin did not constitute the only morphological alteration for these patients, especially because a series of measurements showed significant bilateral differences. When comparing sagittal jaw relationships, the only significant finding was the vertical positioning of the gonion between Class II and III patients with severe asymmetry. CONCLUSIONS When comparing the three sagittal jaw relationships with the same intensity of asymmetry, most maxillofacial aspects were quite similar. The only difference was found for patients with severe asymmetry, as the individuals with Class II showed greater bilateral difference in the vertical positioning of the gonion, when compared to patients with Class III.
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Affiliation(s)
- Guilherme Thiesen
- Universidade do Sul de Santa Catarina, Departamento de Ortodontia (Florianópolis/SC, Brazil)
| | | | | | - Ki Beom Kim
- Saint Louis University, Department of Orthodontics (Saint Louis/MO, USA)
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Lee JY, Han SH, Ryu HS, Lee HM, Kim SC. Cone-beam computed tomography analysis of transverse dental compensation in patients with skeletal Class III malocclusion and facial asymmetry. Korean J Orthod 2018; 48:357-366. [PMID: 30450328 PMCID: PMC6234112 DOI: 10.4041/kjod.2018.48.6.357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/07/2018] [Accepted: 04/04/2018] [Indexed: 11/24/2022] Open
Abstract
Objective The purpose of this study was to analyze the transverse dental compensation in reference to the maxillary and mandibular basal bones using cone-beam computed tomography (CBCT) and evaluate the correlations between transverse dental compensation and skeletal asymmetry variables in patients with skeletal Class III malocclusion and facial asymmetry. Methods Thirty patients with skeletal Class I (control group; 15 men, 15 women) and 30 patients with skeletal Class III with menton deviation (asymmetry group; 16 men, 14 women) were included. Skeletal and dental measurements were acquired from reconstructed CBCT images using OnDemand3D 1.0 software. All measurements were compared between groups and between the deviated and nondeviated sides of the asymmetry group. Correlation coefficients for the association between skeletal and dental measurements were calculated. Results Differences in the ramus inclination (p < 0.001), maxillary canine and first molar inclinations (p < 0.001), and distances from the canine and first molar cusp tips to the midmaxillary or midmandibular planes (p < 0.01) between the right and left sides were significantly greater in the asymmetry group than in the control group. In the asymmetry group, the ramus inclination difference (p < 0.05) and mandibular canting (p < 0.05) were correlated with the amount of menton deviation. In addition, dental measurements were positively correlated with the amount of menton deviation (p < 0.05). Conclusions Transverse dental compensation was correlated with the maxillary and mandibular asymmetry patterns. These results would be helpful in understanding the pattern of transverse dental compensation and planning surgical procedure for patients with skeletal Class III malocclusion and facial asymmetry.
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Affiliation(s)
- Ji-Yea Lee
- Department of Orthodontics, School of Dentistry, Wonkwang University, Iksan, Korea
| | - Sung-Hoon Han
- Department of Orthodontics, School of Dentistry, Wonkwang University, Iksan, Korea
| | - Hyeong-Seok Ryu
- Department of Orthodontics, School of Dentistry, Wonkwang University, Iksan, Korea
| | - Hee-Min Lee
- Department of Orthodontics, School of Dentistry, Wonkwang University, Iksan, Korea
| | - Sang-Cheol Kim
- Department of Orthodontics, School of Dentistry, Wonkwang University, Iksan, Korea
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Zheng X, Wang L, Zhang B, Bai X, Qin K, Tian Y, Zhao R, Liu S, Wang J, Zhao Z. Accuracy of two midsagittal planes in three-dimensional analysis and their measurement in patients with skeletal mandibular deviation: a comparative study. Br J Oral Maxillofac Surg 2018; 56:600-606. [PMID: 29980353 DOI: 10.1016/j.bjoms.2018.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/21/2018] [Indexed: 11/30/2022]
Abstract
Our aim was to evaluate the accuracy of two midsagittal planes (MSP) to provide a better reference plane for studying the 3-dimensional structural symmetry in patients with skeletal mandibular deviation. Thirty adult patients with facial asymmetry were admitted to the Department of Orthodontics, Hospital of Stomatology, between January 2015 and 2017. The DICOM data were collected and reconstructed using ProPlan CMF® 2.0 (Materialise). Two sets of reference planes were set up. In the orbital margin plane group, the plane crossing the nasion (N) point and perpendicular to the frontozygomatic (FZ) suture line was used as the MSP. In the skull base plane group, the MSP was established using the sella turcica (S), N, and basion (Ba). The distances from the craniofacial skeletal and soft tissue midline landmarks to the two MSP were separately measured, and the significance of differences between measurements corresponding to two reference planes were assessed using the paired t test. Except for the posterior nasal spine (PNS)-MSP, the distances from other soft and hard tissue landmarks to the MSP in the orbital margin plane group were significantly shorter than those in the skull base plane group. In the 3-dimensional measurement analysis, the skeletal and soft tissue anatomical midline landmarks were closer to the MSP in the orbital margin plane group. The MSP crossing point N, perpendicular to the FZ suture line, was more accurate and suitable.
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Affiliation(s)
- X Zheng
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Orthodontic Department, Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, Guangdong, China
| | - L Wang
- Orthodontic Department, Stomatological Hospital of Dandong, Dandong 118002, Liaoning, China
| | - B Zhang
- Oral and Maxillofacial Surgery, China Medical University School & Hospital of Stomatology, Shenyang 110002, Liaoning, China
| | - X Bai
- Oral and Maxillofacial Surgery, China Medical University School & Hospital of Stomatology, Shenyang 110002, Liaoning, China
| | - Ke Qin
- The Second Orthodontic Department, China Medical University School & Hospital of Stomatology, Shenyang 110002, Liaoning, China; Key Laboratory of oral diseases of Liaoning Province, the Second Orthodontic Department, China Medical University School & Hospital of Stomatology, Shenyang 110002, Liaoning, China
| | - Y Tian
- The Second Orthodontic Department, China Medical University School & Hospital of Stomatology, Shenyang 110002, Liaoning, China; Key Laboratory of oral diseases of Liaoning Province, the Second Orthodontic Department, China Medical University School & Hospital of Stomatology, Shenyang 110002, Liaoning, China
| | - R Zhao
- The Second Orthodontic Department, China Medical University School & Hospital of Stomatology, Shenyang 110002, Liaoning, China; Key Laboratory of oral diseases of Liaoning Province, the Second Orthodontic Department, China Medical University School & Hospital of Stomatology, Shenyang 110002, Liaoning, China
| | - S Liu
- The Second Orthodontic Department, China Medical University School & Hospital of Stomatology, Shenyang 110002, Liaoning, China; Key Laboratory of oral diseases of Liaoning Province, the Second Orthodontic Department, China Medical University School & Hospital of Stomatology, Shenyang 110002, Liaoning, China
| | - J Wang
- The Second Orthodontic Department, China Medical University School & Hospital of Stomatology, Shenyang 110002, Liaoning, China; Key Laboratory of oral diseases of Liaoning Province, the Second Orthodontic Department, China Medical University School & Hospital of Stomatology, Shenyang 110002, Liaoning, China
| | - Z Zhao
- The Second Orthodontic Department, China Medical University School & Hospital of Stomatology, Shenyang 110002, Liaoning, China; Key Laboratory of oral diseases of Liaoning Province, the Second Orthodontic Department, China Medical University School & Hospital of Stomatology, Shenyang 110002, Liaoning, China.
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Yu J, Hu Y, Huang M, Chen J, Ding X, Zheng L. A three-dimensional analysis of skeletal and dental characteristics in skeletal class III patients with facial asymmetry. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2018; 26:449-462. [PMID: 29562577 DOI: 10.3233/xst-17333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the skeletal and dental characteristics in skeletal class III patients with facial asymmetry and to analyse the relationships among various parts of the stomatognathic system to provide a theoretical basis for clinical practice. METHODS Asymmetric cone-beam computed tomography data acquired from 56 patients were evaluated using Mimics 10.0 and 3-Matic software. Skeletal and dental measurements were performed to assess the three-dimensional differences between two sides. Pearson correlation analysis was used to determine the correlations among measurements. RESULTS Linear measurements, such as ramal height, mandible body length, ramal height above the sigmoid notch (RHASN), maxillary height, condylar height, buccal and total cancellous bone thickness, and measurements of condylar size, were significantly larger on the nondeviated side than on the deviated side (P < 0.05). Crown root ratio and buccolingual angle of mandibular first molar were found to be significantly smaller on the nondeviated side than on the deviated side (P < 0.05). A negative correlation was also discovered between the buccolingual angle of mandibular first molar and the ramal height (P < 0.01). CONCLUSIONS In patients with facial asymmetry, asymmetries in the mandible, maxilla and condylar morphology, and skeletal canting served as major components of skeletal asymmetry. Furthermore, a reduced thickness of buccal cancellous bone and a larger crown root ratio were found on the deviated side, indicating that orthodontic camouflage has limitations and potential risks. A combination of orthodontics and orthognathic surgery may be the advisable choice in patients with a menton deviation greater than 4 mm. An important association between vertical skeletal disharmony and dental compensation was also observed.
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Affiliation(s)
- Jinfeng Yu
- The Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yun Hu
- The Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Mingna Huang
- The Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jun Chen
- The Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Xiaoqian Ding
- The Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Leilei Zheng
- The Affiliated Stomatology Hospital, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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Song HS, Choi SH, Cha JY, Lee KJ, Yu HS. Comparison of changes in the transverse dental axis between patients with skeletal Class III malocclusion and facial asymmetry treated by orthognathic surgery with and without presurgical orthodontic treatment. Korean J Orthod 2017; 47:256-267. [PMID: 28670567 PMCID: PMC5466908 DOI: 10.4041/kjod.2017.47.4.256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/31/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate transverse skeletal and dental changes, including those in the buccolingual dental axis, between patients with skeletal Class III malocclusion and facial asymmetry after bilateral intraoral vertical ramus osteotomy with and without presurgical orthodontic treatment. Methods This retrospective study included 29 patients with skeletal Class III malocclusion and facial asymmetry including menton deviation > 4 mm from the midsagittal plane. To evaluate changes in transverse skeletal and dental variables (i.e., buccolingual inclination of the upper and lower canines and first molars), the data for 16 patients who underwent conventional orthognathic surgery (CS) were compared with those for 13 patients who underwent preorthodontic orthognathic surgery (POGS), using three-dimensional computed tomography at initial examination, 1 month before surgery, and at 7 days and 1 year after surgery. Results The 1-year postsurgical examination revealed no significant changes in the postoperative transverse dental axis in the CS group. In the POGS group, the upper first molar inclined lingually on both sides (deviated side, −1.8° ± 2.8°, p = 0.044; nondeviated side, −3.7° ± 3.3°, p = 0.001) and the lower canine inclined lingually on the nondeviated side (4.0° ± 5.4°, p = 0.022) during postsurgical orthodontic treatment. There were no significant differences in the skeletal and dental variables between the two groups at 1 year after surgery. Conclusions POGS may be a clinically acceptable alternative to CS as a treatment to achieve stable transverse axes of the dentition in both arches in patients with skeletal Class III malocclusion and facial asymmetry.
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Affiliation(s)
- Han-Sol Song
- Department of Orthodontics, The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sung-Hwan Choi
- Department of Orthodontics, The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jung-Yul Cha
- Department of Orthodontics, The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Joon Lee
- Department of Orthodontics, The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung-Seog Yu
- Department of Orthodontics, The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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Ahn J, Kim SJ, Lee JY, Chung CJ, Kim KH. Transverse dental compensation in relation to sagittal and transverse skeletal discrepancies in skeletal Class III patients. Am J Orthod Dentofacial Orthop 2017; 151:148-156. [PMID: 28024769 DOI: 10.1016/j.ajodo.2016.06.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 06/01/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purposes of this study were to compare the buccolingual inclinations of the posterior teeth in skeletal Class III patients with and without facial asymmetry with those of skeletal Class I patients and to investigate their relationships with sagittal and transverse skeletal discrepancies. METHODS Sixty-three skeletal Class III adult patients were divided into 2 groups according to the degree of menton deviation: a symmetry group with deviation less than 2 mm (n = 30), and an asymmetry group with deviation greater than 4 mm (n = 33). The control group comprised 25 skeletal Class I patients. The buccolingual inclinations of the posterior teeth measured on cone-beam computed tomography images were compared among the 3 groups, and regression analysis was performed to investigate the relationships between the inclinations and the sagittal and transverse skeletal discrepancies. RESULTS The symmetry group showed greater buccal inclinations of the maxillary posterior teeth and lingual inclinations of the mandibular second molars than did the control, and this was correlated with the ANB angles. The deviated sides in the asymmetry group showed the greatest transverse dental compensation, which was correlated with menton deviation, whereas the nondeviated sides showed no significant transverse dental compensation. CONCLUSIONS Transverse dental compensation is closely related to sagittal and transverse skeletal discrepancy in skeletal Class III patients.
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Affiliation(s)
- Jaechan Ahn
- Department of Orthodontics, School of Dentistry, Yonsei University, Seoul, Korea
| | - Sung-Jin Kim
- Department of Orthodontics, School of Dentistry, Yonsei University, Seoul, Korea
| | - Ji-Yeon Lee
- Department of Orthodontics, National Health Insurance Service, Ilsan Hospital, Goyang, Gyeonggi-do, Korea
| | - Chooryung J Chung
- Department of Orthodontics, Gangnam Severance Hospital, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kyung-Ho Kim
- Department of Orthodontics, Gangnam Severance Hospital, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea.
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Koo YJ, Choi SH, Keum BT, Yu HS, Hwang CJ, Melsen B, Lee KJ. Maxillomandibular arch width differences at estimated centers of resistance: Comparison between normal occlusion and skeletal Class III malocclusion. Korean J Orthod 2017; 47:167-175. [PMID: 28523243 PMCID: PMC5432438 DOI: 10.4041/kjod.2017.47.3.167] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the differences in maxillomandibular transverse measurements at either the crown or the estimated center of resistance (CR), and to compare values between normal occlusion and Class III malocclusion groups. METHODS Dental casts and computed tomography (CT) data from 30 individuals with normal occlusion and 30 with skeletal Class III malocclusions were evaluated. Using the casts, dental arch widths (DAWs) were measured from the cusp tips, and basal arch widths (BAWs-cast) were measured as the distance between the points at the mucogingival junction adjacent to the respective cusp tips. The BAWs determined from CT (BAWs-CT) images were measured from the estimated CRs of the teeth. RESULTS None of the DAW measurements or maxillomandibular DAW differences showed statistically significant intergroup differences. In contrast, the maxillary BAWs-CT and BAWs-cast were lesser in the Class III malocclusion group than in the normal occlusion group. The mandibular BAWs-CT were significantly greater in the Class III malocclusion group than in the normal occlusion group. Moreover, the maxillomandibular BAW differences on both CT and cast showed significant intergroup differences in all transverse measurements. CONCLUSIONS The maxillomandibular DAW differences showed no significant intergroup differences. In contrast, the maxillomandibular BAW differences on both CT and cast showed significant intergroup differences in all transverse measurements. The maxillomandibular BAW differences at the estimated CRs, measured using CT or casts, can reveal underlying transverse maxillary basal arch deficiencies in patients with skeletal Class III malocclusions.
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Affiliation(s)
- Yun-Jin Koo
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sung-Hwan Choi
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Byeong-Tak Keum
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung-Seog Yu
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Chung-Ju Hwang
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Birte Melsen
- Department of Orthodontics, University of Aarhus, Aarhus, Denmark
| | - Kee-Joon Lee
- Department of Orthodontics, Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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Kim KA, Lee JW, Park JH, Kim BH, Ahn HW, Kim SJ. Targeted presurgical decompensation in patients with yaw-dependent facial asymmetry. Korean J Orthod 2017; 47:195-206. [PMID: 28523246 PMCID: PMC5432441 DOI: 10.4041/kjod.2017.47.3.195] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/20/2016] [Accepted: 09/28/2016] [Indexed: 11/10/2022] Open
Abstract
Facial asymmetry can be classified into the rolling-dominant type (R-type), translation-dominant type (T-type), yawing-dominant type (Y-type), and atypical type (A-type) based on the distorted skeletal components that cause canting, translation, and yawing of the maxilla and/or mandible. Each facial asymmetry type represents dentoalveolar compensations in three dimensions that correspond to the main skeletal discrepancies. To obtain sufficient surgical correction, it is necessary to analyze the main skeletal discrepancies contributing to the facial asymmetry and then the skeletal-dental relationships in the maxilla and mandible separately. Particularly in cases of facial asymmetry accompanied by mandibular yawing, it is not simple to establish pre-surgical goals of tooth movement since chin deviation and posterior gonial prominence can be either aggravated or compromised according to the direction of mandibular yawing. Thus, strategic dentoalveolar decompensations targeting the real basal skeletal discrepancies should be performed during presurgical orthodontic treatment to allow for sufficient skeletal correction with stability. In this report, we document targeted decompensation of two asymmetry patients focusing on more complicated yaw-dependent types than others: Y-type and A-type. This may suggest a clinical guideline on the targeted decompensation in patient with different types of facial asymmetries.
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Affiliation(s)
- Kyung-A Kim
- Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Ji-Won Lee
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jeong-Ho Park
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Byoung-Ho Kim
- Private Practice, Seoul, Korea.,Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, Korea
| | - Hyo-Won Ahn
- Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Su-Jung Kim
- Department of Orthodontics, Kyung Hee University School of Dentistry, Seoul, Korea
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