Adult Class III treatment using a J-hook headgear to the mandibular arch

Comparison of posttreatment stability after total mandibular arch distalization with mini-implants and mandibular setback surgery

OBJECTIVES

To compare posttreatment stability in skeletal Class III patients between those treated by total mandibular arch distalization (TMAD) with buccal mini-implants and those by mandibular setback surgery (MSS).

MATERIALS AND METHODS

The samples included 40 Class III adults, 20 treated by TMAD using buccal interradicular mini-implants and 20 treated with MSS. Lateral cephalograms were taken at pretreatment, posttreatment, and at least 1-year follow-up, and 24 variables were compared using statistical analysis.

RESULTS

Mandibular first molars moved distally 1.9 mm with intrusion of 1.1 mm after treatment in the TMAD group. The mandibular incisors moved distally by 2.3 mm. The MSS group exhibited a significant skeletal change of the mandible, whereas the TMAD group did not. During retention, there were no skeletal or dental changes other than 0.6 mm labial movement of the mandibular incisors (P < .05) in the MSS group. There was 1.4° of mesial tipping (P < .01) and 0.4 mm of mesial movement of the mandibular molars and 1.9° of labial tipping (P < .001) and 0.8 mm of mesial movement of the mandibular incisors in the TMAD group. These dental changes were not significantly different between the two groups.

CONCLUSIONS

The TMAD group showed a slightly decreased overjet with labial tipping of the mandibular incisors and mesial tipping of the first molars during retention. Posttreatment stability of the mandibular dentition was not significantly different between the groups. It can be useful to plan camouflage treatment by TMAD with mini-implants in mild-to-moderate Class III patients.

Orthognathic versus Camouflage Treatment of Class III Malocclusion: A Systematic Review and Meta-Analysis

This systematic review (SR) and meta-analysis (MA) aimed to compare the treatment effects of orthognathic surgery and orthodontic camouflage treatment in adult subjects with Class III malocclusion (C-III-M). Two independent reviewers conducted the literature search comprehensively from 1990 to 8 November 2021. PubMed, Science Direct, Scopus, EBSCOhost and Google Scholar databases were included for literature search. Moreover, a manual search of references from relevant studies was performed. Based on the literature search, a total of six articles were selected for SR and three articles fulfilled the criteria of a MA. Standardized mean difference (SMD) was used to evaluate and compare the treatment effects of orthodontic camouflage treatment and orthognathic surgery in adult C-III-M patients. Test for overall effect from the studies was used to estimate the treatment effect of C-III-M. However, Significant heterogeneity and publication bias was apparent among the selected studies. More research on the treatment effects of orthodontic camouflage treatment and orthognathic surgery in C-III-M is necessary to conclude possible interactions with better specificity.

Comparative evaluation of treatment outcomes between temporary anchorage devices and Class III elastics in Class III malocclusions

INTRODUCTION

Our objective was to elucidate the differences in treatment outcomes caused by the different mechanics of temporary anchorage devices (TADs) and Class III elastics in patients with Class III malocclusions.

METHODS

Records of 23 patients with Angle Class III malocclusion were selected retrospectively. All had been treated with nonextraction comprehensive orthodontic treatment; 11 were treated with TADs and 12 with Class III elastics. Pretreatment and posttreatment lateral cephalograms were used for evaluation of the treatment outcomes. A paired t test and a Student t test were used for statistical analysis.

RESULTS

In both groups, proper overjet and Class I molar relationships were achieved, and the occlusal plane was rotated counterclockwise. In the elastics group, distal tipping of the mandibular molars, extrusion of the mandibular incisors and maxillary molars, clockwise rotation of the mandibular plane angle, and increased ANB angle were observed. In the TADs group, distal tipping and intrusion of the mandibular molars, bodily movement of the mandibular incisors, and reduced mandibular plane angle were observed.

CONCLUSIONS

In nonextraction treatment for Class III malocclusions, the mandibular plane angle was increased in the elastics group, whereas it was decreased in TADs group. Thus, we suggest that Class III elastics are preferred for low-angle, short-face patients, whereas TADs are preferred for high-angle, long-face patients.

Orthodontic camouflage of skeletal Class III malocclusion with miniplate: a case report

Introduction:

Skeletal Class III malocclusion is often referred for orthodontic treatment combined with orthognathic surgery. However, with the aid of miniplates, some moderate discrepancies become feasible to be treated without surgery.

Objective:

To report the case of a 24-year-old man with severe skeletal Angle Class III malocclusion with anterior crossbite and a consequent concave facial profile.

Methods:

The patient refused to undergo orthognathic surgery; therefore, orthodontic camouflage treatment with the aid of miniplates placed on the mandibular arch was proposed.

Results:

After 18 months of treatment, a Class I molar and canine relationship was achieved, while anterior crossbite was corrected by retraction of mandibular teeth. The consequent decrease in lower lip fullness and increased exposure of maxillary incisors at smiling resulted in a remarkable improvement of patient's facial profile, in addition to an esthetically pleasing smile, respectively. One year later, follow-up revealed good stability of results.

Extraction of the lateral incisors to treat maxillary protrusion: quantitative evaluation of the stomatognathic functions

To treat morphological abnormalities, impaction, and severe malposition of the teeth, the lateral incisors are sometimes extracted, followed by orthodontic space closure. This procedure often requires special consideration, not only with regard to esthetics but also for functional issues. However, thus far, few reports that have performed a functional evaluation in such cases. The purpose of this article is to report the successful treatment of an adult patient with a Class II division 1 malocclusion who was treated with extraction of the upper lateral incisors. The female patient, aged 23 years and 6 months, had a chief complaint of maxillary incisal protrusion and crooked teeth. In this patient, the upper lateral incisors were extracted to fulfill the patient's strong request, followed by orthodontic treatment using edgewise appliances. A high-pull J-hook headgear on the lower dental arch was used to prevent further labial inclination of the lower incisors. The total active treatment period was 37 months. The resulting occlusion and a satisfactory facial profile were maintained during a 4-year retention period. Additionally, this treatment did not affect the stomatognathic functions as assessed by the following criteria: range of the incisal path or condylar motion during maximal open-close movement, protrusive excursion, lateral excursion, and the chewing test. In conclusion, extraction of the upper lateral incisors can be an effective treatment choice when the upper lateral incisors are dwarfed, are nonvital, or demonstrate severe malposition.

Camouflage treatment of skeletal Class III malocclusion with multiloop edgewise arch wire and modified Class III elastics by maxillary mini-implant anchorage

OBJECTIVE

To evaluate the effect of the multiloop edgewise arch wire (MEAW) technique with maxillary mini-implants in the camouflage treatment of skeletal Class III malocclusion.

MATERIALS AND METHODS

Twenty patients were treated with the MEAW technique and modified Class III elastics from the maxillary mini-implants. Twenty-four patients were treated with MEAW and long Class III elastics from the upper second molars as control. Lateral cephalometric radiographs were obtained and analyzed before and after treatment, and 1 year after retention.

RESULTS

Satisfactory occlusion was established in both groups. Through principal component analysis, it could be concluded the anterior-posterior dental position, skeletal sagittal and vertical position, and upper molar vertical position changed within groups and between groups; vertical lower teeth position and Wits distance changed in the experimental group and between groups. In the experimental group, the lower incisors tipped lingually 2.7 mm and extruded 2.4 mm. The lingual inclination of the lower incisors increased 3.5°. The mandibular first molars tipped distally 9.1° and intruded 0.4 mm. Their cusps moved 3.4 mm distally. In the control group, the upper incisors proclined 3°, and the upper first molar extruded 2 mm. SN-MP increased 1.6° and S-Go/N-ME decreased 1.

CONCLUSIONS

The MEAW technique combined with modified Class III elastics by maxillary mini-implants can effectively tip the mandibular molars distally without any extrusion and tip the lower incisors lingually with extrusion to camouflage skeletal Class III malocclusions. Clockwise rotation of the mandible and further proclination of upper incisors can be avoided. The MEAW technique and modified Class III elastics provided an appropriate treatment strategy especially for patients with high angle and open bite tendency.