Evaluation of anterior teeth crown-root morphology and alveolar bone structure in patients with closed deep overbite using cone beam computed tomography

This retrospective study used cone-beam computed tomography to investigated the crown-root morphology and alveolar bone structure in incisors region in subjects with closed deep overbite and comparison the difference between gender and age. The CBCT images for 40 subjects (group C) with Angle II division 2 were selected from patients of the HeFei Stomatological Hospital from November 2023 to March 2024.20 individual normal occlusion subjects (group A),20 patients with Angle II division 1(group B) were included. The crown-root ratio of the maxillary and mandibular anterior teeth, crown-root angle and alveolar bone structure were measured on the CBCT images, the data were statistically analyzed. In addition to mandibular lateral incisor, the crown-root ratio of maxillary and mandibular anterior teeth in the Class II division 2 group was higher than that in the individual normal occlusion group and the Class II division 1 (P < 0. 05). The crown-root angle of maxillary anterior teeth in the Class II division 2 group was smaller than that in the individual normal occlusion group and the Class II division 1 (P < 0. 05). The alveolar bone thickness of the maxillary central incisor was comparatively smaller, while the alveolar bone height was relatively higher in the Class II division 2 group. Age and gender were associated with change in root lengths and crown-root angle for the Class II division 2 group (P < 0. 05). Patients with closed deep overbite malocclusion exhibit a significant difference compared to the controls for most measurements. The patients presenting with Class II division 2 malocclusion exhibit excessive inward positioning of the anterior teeth, resulting in evident crown-root angle, a large crown-root ratio, and minimal labial alveolar bone. In order to keep the tooth movement within the safe range of alveolar bone movement, it is necessary to strictly control the torque and use appropriate orthodontic force to reduce the risk of bone fenestration, bone dehiscence, gingival recession and root resorption.

Relationship between interincisal angles and TMJ morphology/position and trabecular structure: a retrospective study

BACKGROUND

TMJ morphology/position and trabecular structure are influenced by various factors. The role of the interincisal angle, an indicator of the anterior occlusal relationship, on TMJ remains unclear. This study aims to investigate the morphology, trabecular bone structure, and position of the condyle, as well as the glenoid fossa's morphology in skeletal class II populations with different interincisal angles.

MATERIALS AND METHODS

A total of 150 adult patients with normodivergent facial types and skeletal class II malocclusions were selected and divided into three groups based on their interincisal angles: normal, small, and large angle groups. The indexes of TMJ were measured using cone-beam computed tomography (CBCT) data and analyzed using Dolphin Imaging, Mimics, and ImageJ.

RESULTS

The small angle group had the smallest anteroposterior diameter (APD), while the large angle group had a greater mediolateral diameter (MLD). The large angle group exhibited significantly the largest maximum axial area, bone surface area, and bone volume (P < 0.05). Small and large angle groups exhibited greater bone trabeculae (Tb. N) and thinner trabecular thickness (Tb. Th). Compared to the normal angle group, the small angle group exhibited a larger horizontal condylar angle and smaller bilateral condylar angles on the axial plane, while the large angle group showed the opposite trend. Small and large angle groups showed a reduced vertical condyle angle on the coronal plane, with the largest reduction observed in the large angle group (P < 0.05). Small and large angle groups had higher heights of the glenoid fossa (GFH). The large angle group exhibited the greatest GFH and width of the glenoid fossa (GFW) (P < 0.05).

CONCLUSION

The large angle group had elongated oval and large condyles, and deeper glenoid fossae, while a flattened-oval and smaller condyle, and wider and shallower glenoid fossae were observed in the small angle group. Small and large interincisal angle affects the structure of condylar trabeculae, resulting in thinner Tb. Th and greater Th. N. In the condylar position, small and large angle groups exhibit condylar rotation in the axial and coronal planes. Therefore, the interincisal angle affects the morphology, position, and trabecular structure of the TMJ. This implies that we must pay attention to the impact of the interincisal angle on TMJ, and it is crucial to restore the normal interincisal angle during orthodontic treatment.

Radiologic study of the distance between the maxillary central incisor root and the incisive canal according to skeletal malocclusion classification

The aim of this study was to evaluate the distance between the maxillary central incisor root and the incisive canal based on skeletal malocclusion classification and to analyze the morphology of the incisive canal using cone-beam computed tomography (CBCT). Skeletal malocclusion was categorized into Class I, II, and III using lateral cephalometric analysis. Measurements of the distance between the maxillary central incisor root and the incisive canal were taken at two levels: 2 mm (L1) and 4 mm (L2) superior to the labial cementoenamel junction of the maxillary central incisor. At L1, the distance was found to be closer in the Class II group compared to the Class I or Class III groups. Similarly, at L2, the Class II group exhibited a closer distance than the Class III group. Interestingly, females showed a closer distance compared to males at both L1 and L2. Further analysis revealed a significant gender difference in the Class I and III groups, but not in the Class II group. These findings emphasize the significance of evaluating the distance between the maxillary central incisor root and the incisive canal in patients with skeletal Class II malocclusion, regardless of gender.

Evaluation of the Best Method for Orthodontic Correction of Skeletal Deep Bites in Growing Patients: A Systematic Review

This review aimed to evaluate the currently available evidence regarding the best method of correcting deep bites in growing patients. In September 2023, a search was conducted electronically across the following databases: PubMed®, Web of Science™, Scopus®, Embase®, Google™ Scholar, and Cochrane Library. In this systematic review, randomized control trials (RCTs), controlled clinical trials (CCTs), and cohort studies of growing patients with deep bite malocclusion who received treatment with the primary objective of treating the deep bite were included. Risk of bias of the included studies was assessed using two different tools; one tool was applied for RCTs and the other one for the CCTs and cohort studies. One RCT, one CCT, and one cohort study were included (85 patients). The flat fixed acrylic bite plane was superior in terms of duration of treatment when compared to the inclined fixed acrylic bite plane and the utility arch with posterior intermaxillary elastics. Limited evidence indicates that the inclined fixed acrylic bite plane causes a significant increase in the lower incisor inclination and a significant increase in the angle between the mandible and the anterior cranial base (SNB). However, limited evidence indicates that the utility arch with posterior intermaxillary elastics causes a significant decrease in the angle between the maxilla and the anterior cranial base (SNA). Regarding the vertical skeletal changes, it was found that the three methods were comparable; in each case, the vertical dimension of the face increased because of a significant increase in the lower first molar height. There is a need for further studies to strengthen the evidence of the treatment efficacy of the employed methods, with more RCTs to be conducted in this regard.

Evaluation of Mandibular Projection in Class II Division 2 Subjects Following Orthodontic Treatment Using Clear Aligners

AIM

The purpose of this study was to evaluate the mandibular growth and/or projection following maxillary incisor proclination, overbite correction, and maxillary dentoalveolar expansion without the use of any class II mechanics, in growing class II division 2 patients treated with clear aligners.

MATERIALS AND METHODS

Before and after treatment cone-beam computed tomographic (CBCT) generated lateral and posteroanterior cephalograms of thirty-two patients with skeletal class II division 2, 16 in the treatment group and 16 in the untreated group, were reviewed to evaluate treatment-related changes. Upper incisors were proclined and protruded, as well as upper arch expansion and overbite correction were performed as part of their regular treatment. Cephalometric analysis was performed to evaluate skeletal and dental changes. Unpaired statistical t-tests were performed to determine if significant skeletal class II correction was achieved in the treatment group.

RESULTS

In the treatment group, after treatment, the upper incisors became more proclined and protruded, and the inter-molar width increased while the overbite was reduced compared to the control group. An increase in skeletal mandibular growth and forward projection was also observed, thus contributing to an improvement of the sagittal skeletal relationship as evidenced by ANB and Wits values compared to the control group.

CONCLUSION

A combination of upper incisor proclination, correction of deep overbite, and maxillary dentoalveolar expansion using clear aligners appears to contribute to an improvement of the skeletal class II relationship in growing patients with class II division 2.

CLINICAL SIGNIFICANCE

This study shows that unlocking the mandible by correcting a deep overbite, proclining upper incisors, and expanding the upper arch in growing class II division 2 patients can improve skeletal class II using clear aligners. How to cite this article: Mirzasoleiman P, El-Bialy T, Wiltshire WA, et al. Evaluation of Mandibular Projection in Class II Division 2 Subjects Following Orthodontic Treatment Using Clear Aligners. J Contemp Dent Pract 2024;25(4):295-302.

Comparison of masticatory myofunctional rehabilitation combined with conventional functional appliances for the treatment of class Ⅱ, division 1 malocclusion. A retrospective cohort study

OBJECTIVE

To estimate the clinical efficacy of early masticatory myofunction rehabilitation combined with conventional functional appliances for the treatment of class Ⅱ, division 1 malocclusion in orthodontic children during the growing phase.

MATERIALS AND METHOD

A comparative retrospective cohort study, enrolled patients diagnosed with class Ⅱ/1 in the stage of late mixed or early permanent dentition. Patients were divided into a TBA group (Cohort 1): receiving Twin-block appliance treatment; and a MMR group (Cohort 2): receiving either early masticatory myofunction rehabilitation as adjunctive therapy combined with the same conventional functional appliances. The study variables were active (Phase 1) treatment duration, oral esthetic subjective impact score (OASIS), several cephalometric indices calculated from X-ray photographs, the maximum voltage (mV) and asymmetry index (AsI) of anterior temporalis (TA) and masseter muscles (MM) before and after treatment. Complications were also recorded.

RESULTS

A total of 424 cases were enrolled. The mean treatment duration in the MMR group was 168.33 days (SD: 25.43) and 215.00 days (SD: 28.81) in the TBA group; mean difference: -46.67 days (95% CI: [-81.62, -11.71]), P<0.001. For the OASIS outcome measure, there was no statistically significant difference between the mean total scores for the MMR group (18.83±7.73) or TBA group (17.67±6.47) groups adjusted to include pre-treatment OASIS scores (P = 0.783). After treatment, sella-nasion-B point (SNB), mandibular incisor angle, maxillary base and mandibular base in both two groups were significantly increased, while AB plane angle (ANB), maxillary incisor angle, overjet and overbite were significantly decreased. The mV and AsI of TA and MM were also improved following treatment. However, no significant differences were observed between two groups.

CONCLUSION

Our results confirmed that early masticatory myofunction rehabilitation in combination with conventional TBA for patients in the growing phase was significantly effective in the management of class Ⅱ/1 in orthodontic treatment, which could significantly shorten the treatment duration and had the similar improvement in the cephalometry data, OASIS scores and masticatory muscles function when comparing to conventional TBA alone.

Skeletal Class II Malocclusion: From Clinical Treatment Strategies to the Roadmap in Identifying the Genetic Bases of Development in Humans with the Support of the Collaborative Cross Mouse Population

Depending on how severe it is, malocclusion, which may involve misaligned teeth, jaws, or a combination of the two, can hurt a person's overall facial aesthetics. The maxillary molar develops before the mandibular molar in class II malocclusion, which affects 15% of the population in the United States. With a retrusive mandible, patients typically have a convex profile. The goal of this study is to classify the skeletal and dental variability present in class II malocclusion, to reduce heterogeneity, present the current clinical treatment strategies, to summarize the previously published findings of genetic analysis, discuss these findings and their constraints, and finally, propose a comprehensive roadmap to facilitate investigations aimed at determining the genetic bases of malocclusion development using a variety of genomic approaches. To further comprehend the hereditary components involved in the onset and progression of class II malocclusion, a novel animal model for class II malocclusion should be developed while considering the variety of the human population. To overcome the constraints of the previous studies, here, we propose to conduct novel research on humans with the support of mouse models to produce contentious findings. We believe that carrying out a genome-wide association study (GWAS) on a large human cohort to search for significant genes and their modifiers; an epigenetics-wide association study (EWAS); RNA-seq analysis; integrating GWAS and the expression of quantitative trait loci (eQTL); and the testing of microRNAs, small RNAs, and long noncoding RNAs in tissues related to the skeletal class II malocclusion (SCIIMO) phenotype, such as mandibular bone, gum, and jaw in humans and the collaborative cross (CC) mouse model, will identify novel genes and genetic factors affecting this phenotype. We anticipate discovering novel genetic elements to advance our knowledge of how this malocclusion phenotype develops and open the venue for the early identification of patients carrying the susceptible genetic factors so that we can offer early prevention treatment strategies.

Effectiveness of clear aligners in achieving proclination and intrusion of incisors among Class II division 2 patients: a multivariate analysis

BACKGROUND

The predictability of incisor movement achieved by clear aligners among Class II division 2 patients is poorly understood. The aim of this retrospective study was to determine the effectiveness of clear aligners in proclining and intruding upper incisors and its influencing factors.

METHODS

Eligible patients with Class II division 2 malocclusion were included. For clear aligner therapy, three types of incisor movements were designed: proclination, intrusion and labial movement. Pre-treatment and post-treatment dental models were superimposed. The differences between predicted and actual (DPA) tooth movement of incisors were analyzed. Univariate and multivariate linear regression were used to analyze the potential influencing factors.

RESULTS

A total of 51 patients and their 173 upper incisors were included. Actual incisor proclination and intrusion were less than predicted ones (both P < 0.001), while actual labial movement was greater than predicted one (P < 0.001). Predictability of incisor proclination and intrusion was 69.8% and 53.3%, respectively. Multivariate linear regression revealed that DPA of proclination was significantly positively associated with predicted proclination (B = 0.174, P < 0.001), ipsilateral premolar extraction (B = 2.773, P < 0.001) and ipsilateral canine proclination (B = 1.811, P < 0.05), while negatively associated with molar distalization (B = - 2.085, P < 0.05). The DPA of intrusion was significantly positively correlated with predicted intrusion (B = 0.556, P < 0.001) while negatively associated with labial mini-implants (B = - 1.466, P < 0.001). The DPA of labial movement was significantly positively associated with predicted labial movement (B = 0.481, P < 0.001), while negatively correlated with molar distalization (B = - 1.004, P < 0.001), labial mini-implants (B = - 0.738, P < 0.001) and age (B = - 0.486, P < 0.05).

CONCLUSIONS

For Class II division 2 patients, predicted incisor proclination (69.8%) and intrusion (53.3%) are partially achieved with clear aligner therapy. Excessive labial movement (0.7 mm) of incisors may be achieved. Incisor movement is influenced by predicted movement amount, premolar extraction, canine proclination, molar distalization, mini-implants and age.

Skeletal and dentoalveolar effects of class II malocclusion treatment using bi-maxillary skeletal anchorage: a systematic review

BACKGROUND

The goal of this systematic review was to assess the available evidence regarding the skeletal and dentoalveolar effects of bi-maxillary skeletal anchorage devices (BMSADs) used in treating growing class II malocclusion patients.

METHODS

A comprehensive search was conducted on PubMed, Scopus, Science Direct, Web of Science, Cochrane, and LILACS up to November 2021, which was augmented by a manual search. The studies included were clinical trials (RCTs) and/or follow-up observational studies (retrospective and prospective). The outcomes of interest were the skeletal, dentoalveolar, and occlusal treatment-induced changes obtained from pre- and post-cephalometric measurements. The risks of bias of the included studies were assessed using an assessment tool from previous publications.

RESULTS

Out of 742 screened articles, only 4 were eligible and thus included in the qualitative synthesis. They showed a moderate overall risk of bias. The results are presented as mean changes in both the study and control groups. All studies reported retrusion of the maxillary base and advancement of the mandible (meaning reduced ANB angle). Three of the included studies reported an increase in the vertical jaw relation, which was contrary to what the fourth study reported. Three studies reported an increase in the maxillary incisors' inclination or position, while one study reported their retroclination. Proclination of the mandibular incisors happened in two studies, whereas the other two studies reported retroclination. The overjet was reduced in all included studies.

CONCLUSION

Apart from the protrusive effects on the mandible, retrusive effects on the maxilla, and the consequent reduction of the overjet, BMSADs results in inconsistent skeletal and dentoalveolar effects. However, the current evidence is limited due to the variability in the biomechanics of the intermaxillary components, type of anchorage, and comparable groups in the included studies. Further RCTs with more standardized methodologies are highly encouraged.

CLINICAL RELEVANCE

BMSADs (using miniscrews or miniplates on both jaws) induces more skeletal than dentoalveolar effects. However, this must be practiced with caution, based on the benefit to risk (surgical insertion) ratio, and the limited evidence available in hand so far. Registration The protocol for this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42020199601).

Substantial Improvements in Facial Morphology through Surgical-Orthodontic Treatment: A Case Report and Literature Review

Background and Objectives: The long face type is associated with excessive vertical facial growth and most often with anterior open bite. In many cases of anterior open bite of high severity associated with bimaxillary dento-alveolar protrusion, lips are unable to form an adequate seal at rest. This leads to many issues, including facial dysmorphism. The aim of this study was to describe the case of a 15 year old girl who addressed the orthodontist in November 2015, having complaints related to the skeletal and dental open bite. Case Description: A 15.7 year old patient required a consultation with the orthodontic service for impaired dento-facial aesthetics at rest, smile and speech due to an exaggerated superior protrusion of the upper frontal teeth, labial incompetence with excessive gingival exposure at rest and smile associated with upper and lower anterior teeth crowding. The orthodontic diagnostic consisted of skeletal open bite with a hyperleptoprosop morphological facial type, high degree of hyperdivergence, bimaxillary dento-alveolar protrusion, 7 mm skeletal open-bite, 3 mm vertical inocclusion of the anterior teeth, skeletal class II relationships, bilateral half cusp class II molar and canine relationships, labial incompetence, highly increased interlabial gap, facial asymmetry, excessive gingival exposure of 7 mm at smiling and bimaxillary anterior crowding. Because the patient initially refused orthognathic surgery, prior to starting the orthodontic treatment, the patient was recommended to receive a bilateral extraction of the first upper premolars. Key objectives of pre-surgical orthodontic treatment were to achieve a retroclined position of the upper incisors under their normal inclination for the planned upward maxillary rotation, to maintain slightly lower incisor proclination. The orthognathic surgery consisted of Le Fort I impaction osteotomy with 8 mm anterior impactation, bilateral sagittal split osteotomy, and mandibular repositioning using occlusal splint. Conclusions: At the end of the orthodontic-surgical treatment, the patient presented significant improvement in dento-facial aesthetics, and optimal skeletal, muscular and dental balance.

Evaluation of the efficiency of computerized algorithms to formulate a decision support system for deepbite treatment planning

INTRODUCTION

This study aimed to evaluate the efficiency of a newly constructed computer-based decision support system (DSS) on the basis of artificial intelligence technology and designed to plan treatment for patients with a deep overbite.

METHODS

With the help of information technology, a DSS was developed specifically for treatment planning of deepbite malocclusion. The program inputs were the components and the contributing factors used commonly by the orthodontic clinicians in deepbite diagnosis. The program outputs were the treatment planning options for deepbite treatment. A total of 357 decisions made by the algorithm were evaluated for accuracy by comparing them to the actual treatment changes of 51 patients with a well-treated deepbite.

RESULTS

The decisions made by the algorithm were precise, with 94.4% having a very good agreement with actual treatment changes determined using Cohen's kappa coefficient.

CONCLUSIONS

The constructed DSS was shown to be an efficient tool for planning treatment of deep overbite malocclusion in the permanent dentition; thus, the artificial intelligence could be used to formulate a customized plan for orthodontic clinicians.

Tomographic evaluation of buccal bone in different skeletal patterns and incisors inclination

OBJECTIVE

The aim of this study was to correlate the absence of BB with skeletal patterns and incisor inclination using cone-beam computed tomography (CBCT).

METHODS

The sample comprised CBCT images of 45 patients undergoing orthodontic treatment. BB was classified in each third of the anterior teeth as critical, slender, regular, and thick. The skeletal pattern was determined by the ANB (A point, nasion, B point) angle and the incisor inclination using the 1.NA and 1.NB measurements and the interincisal angle (1:1).

RESULTS

In both analyses, the skeletal pattern of class II revealed better BB in the cervical and middle thirds than classes I and III. A higher proportion of critical BB was found in the middle thirds, and the apical third presented the best regular and thick BB conditions, mainly class I. Less BB was observed in middle and apical thirds in the upper incisors and in cervical thirds in lower incisors, mostly when they were more upright.

CONCLUSIONS

Knowledge of alveolar bone height and thickness can alter the treatment plan in orthodontics. During orthodontic treatment, more attention should be paid to the lower incisors and vertical teeth because of poor BB conditions, especially in class III skeletal patterns.

Effect of Class II camouflage treatment on anterior arch length ratio and canine relationship

INTRODUCTION

To evaluate the influence of compensatory tipping of maxillary and mandibular incisors on the anterior arch length ratio and canine relationship in skeletal Class II malocclusion.

METHODS

The study was based on posttreatment lateral head films and dental casts of 88 patients. The sample was divided into a Class II malocclusion group (32 patients; ANB ≥5° and mean [± standard deviation] age, 20.82 ± 7.67 years) and a Class I malocclusion group (56 patients; 1° ≤ ANB ≤ 2.5° and mean [± standard deviation] age, 19.20 ± 5.04 years). Measurements obtained for anterior arch length and width, Bolton discrepancy, canine relationship, growth pattern, and incisor position were compared between the groups. The canine relationship was correlated with dental and skeletal variables (P <0.05).

RESULTS

The mean ANB angles were 6.21° and 1.78° for the Class II and Class I malocclusion groups, respectively. The skeletal Class II group presented significantly larger mandibular anterior arch length, producing an unbalanced anterior arch length ratio. The canine relationship was more displaced toward Class II in this group. Anterior arch length ratio was the most influential variable in the canine relationship. The mandibular incisors had a higher compensation degree than the maxillary incisors. The groups were similar regarding overjet, overbite, and growth pattern.

CONCLUSIONS

Class II malocclusion camouflage treatment with excessive proclination of the mandibular incisors was associated with an increase in mandibular arch length, negatively influencing the anterior arch length ratio and the final canine relationship. Mandibular anterior arch length reduction by interproximal stripping may be necessary in moderate to severe skeletal Class II malocclusion orthodontic treatment.

Craniofacial characteristics of Syrian adolescents with Class II division 1 malocclusion: a retrospective study

Background

Malocclusion characteristics vary across different ethnic groups and populations. Limited data are available regarding the characteristics of Syrian adolescents with Class II division 1 (Class II-1) malocclusion, and the recent inflow of Syrian refugees and immigrants into Europe and many areas worldwide demonstrate the need for updated studies to discover the craniofacial characteristics of these new immigrants.

Objectives

The present compound cephalometric and tooth-size study sought to assess the dentofacial morphology, upper-airway dimensions, and tooth-size characteristics of Syrian adolescents with Class II-1 malocclusion and compare the results with established Syrian population norms.

Materials and Methods

The study sample consisted of 43 Syrian patients including 24 females and 19 males with Class II-1 malocclusion (age: 14.3 (±1.5) years, mean (±SD)). Cephalometric radiographs and orthodontic casts were analyzed using special orthodontic software (OnyxCeph3^™) and a universal digital caliper, respectively. Statistics were calculated using the SPSS software.

Results

In Syrian adolescents with Class II-1 malocclusion, the position of the mandible relative to the nasion perpendicular (mean (95% confidence interval)) was −11.01 (−12.45, −9.57) mm. Facial axis angle showed a negative value: −6.25 (−7.65, −4.85) degrees. An obtuse nasolabial angle was observed: 104.05 (101.77, 106.33) degrees. The average width of the upper pharynx was 11.50 (10.53, 12.47) mm; however, there was no prevalence of an upper-pharyngeal width of 5 mm or less. The average value of the anterior tooth-size ratio was 80.69 (79.85, 81.53) percent. In total, 39.5% of the investigated subjects had anterior ratios outside two standard deviations from Bolton’s norm, while 25.6% of the investigated subjects had anterior ratios outside two standard deviations from Syrian population norm.

Conclusions

In this study, the inter-maxillary discrepancy of Class II-1 Syrian adolescents was a consequence of their hyperdivergent facial pattern. The observed small pharyngeal widths were not clinically significant, while the anterior tooth-size discrepancy might be clinically relevant.

Management of skeletal class II malocclusion using bimaxillary skeletal anchorage supported fixed functional appliances : A novel technique

AIM

To evaluate the treatment effects in growing skeletal class II patients subjected to a novel treatment technique, i.e., bimaxillary miniplates supported fixed functional appliance. The null hypothesis was that there is no statistically significant difference in skeletal changes of patients with class II malocclusion treated with bimaxillary skeletal anchorage supported fixed functional appliance and those who were not provided any intervention.

METHODS

The sample comprised 32 skeletal class II subjects (17 males and 15 females) with a Cervical Vertebrae Maturity Index (CVMI) demonstrating peak of pubertal growth spurt. Sixteen patients (12.37 ±1.09 years of age) were treated with bimaxillary skeletal anchorage supported fixed function appliance, while 16 well-matched subjects (12.06 ± 1.34 years of age) were included as controls. For both groups, cephalograms (T1, T2) were taken with a matched observational interval of about 7.5 months; 17 linear and 10 angular measurements were recorded. The intraclass correlation coefficient (ICC) was used to determine reliability of measurements recorded. Student t test was carried out to determine the changes produced by the treatment relative to control.

RESULTS

When compared with the control group, the treatment group demonstrated significant maxillary retrusion. No significant changes were seen in mandibular growth pattern, whereas mandibular length increased significantly more than in the control group (B-VP: 3.05 mm; Co-Gn: 2.65 mm). Treatment mechanics had minimal effects on maxillary dentition. Mandibular incisors proclined by an average of 3.06°. Maxilla-mandibular relation improved significantly (ANB: -4.29°; NA-Pog: -3.76°).

CONCLUSION

The new bimaxillary skeletal anchorage supported fixed functional appliance technique was found to be highly effective in the treatment of class II malocclusion with significant skeletal changes.

Dentoskeletal and tooth-size differences between Syrian and Hungarian adolescents with Class II division 1 malocclusion: a retrospective study

Objectives

Malocclusion features differ across various populations and ethnicities. At this time, no data are available regarding the dentofacial differences between Syrian and European adolescents with Class II division 1 malocclusion, which is one of the most frequently treated pathologies in orthodontic practice. The present combined cephalometric and tooth-size study aimed to compare the dentoskeletal and tooth-size characteristics of Syrian and Hungarian adolescents with Class II division 1 malocclusion.

Results

Class II division 1 malocclusion in Hungarian adolescents was a sagittal discrepancy, while in Syrian adolescents, it was a result of excessive vertical development. Syrian adolescents had a significantly excessive vertical development when compared with Hungarian adolescents, regardless of sex (p < 0.01). Hungarian boys had significantly more protruded maxillae (p < 0.001) and less retruded mandibles (p < 0.01) when compared with Syrian boys, while Hungarian girls had significantly shorter mandibles relative to those of Syrian girls (p < 0.01). Syrian girls had significantly more protrusive lower incisors (p < 0.001), accompanied by significantly larger anterior tooth-size ratios when compared to Hungarian girls (p < 0.001). In conclusion, these findings underscore the importance of considering ethnic differences during orthodontic diagnosis and may have implications for optimizing orthodontic treatments in Syrian and Hungarian adolescents with Class II division 1 malocclusion.

Differential skeletal and dental effects after orthodontic treatment with bite jumping appliance or activator: a retrospective cephalometric study

OBJECTIVES

The aim of this retrospective cephalometric study was to compare treatment outcomes with "bite jumping appliance" (BJA) or Andresen-Häupl type activator. It especially focused on skeletal and dental structures in patients with class II malocclusion. The study hypothesis was that differences in treatment-related changes would occur between patients treated with BJA or activator.

MATERIAL AND METHODS

Pre- and posttreatment lateral cephalograms of 73 patients with a class II malocclusion were analyzed. Thirty-seven patients (22 females, 15 males) received treatment with a BJA (pretreatment age 11.1 ± 1.07 years) and 36 patients (20 females, 16 males) with an activator (pretreatment age 11.3 ± 1.12 years). Treatment time was 14.0 ± 1.8 months with BJA and 12.0 ± 2.0 months with activator. Paired t tests were used for intragroup and t tests for independent samples for intergroup comparisons. Results were considered statistically significant at P < 0.05.

RESULTS

The comparison of sagittal and vertical skeletal changes after BJA and activator treatment did not reveal significant differences. Significant changes occurred for lower incisor inclination (P = 0.0367) and overjet (P = 0.0125) only. The reduction of overjet and proclination of lower incisors were more pronounced in BJA patients.

CONCLUSIONS

Both "bite jumping appliance" (BJA) and Andresen-Häupl type activator were able to improve the occlusion of patients with a class II malocclusion. Dental effects were more pronounced for the BJA.

CLINICAL RELEVANCE

Marked lower incisor proclination contributed significantly to overjet correction in BJA patients. This ought to be respected when choosing a removable functional appliance for patients whose lower incisors are already proclined prior to treatment.

Relationship between skeletal Class II and Class III malocclusions with vertical skeletal pattern

OBJECTIVE

The purpose of this study was to establish the association between sagittal and vertical skeletal patterns and assess which cephalometric variables contribute to the possibility of developing skeletal Class II or Class III malocclusion.

METHODS

Cross-sectional study. The sample included pre-treatment lateral cephalogram radiographs from 548 subjects (325 female, 223 male) aged 18 to 66 years. Sagittal skeletal pattern was established by three different classification parameters (ANB angle, Wits and App-Bpp) and vertical skeletal pattern by SN-Mandibular plane angle. Cephalometric variables were measured using Dolphin software (Imaging and Management Solutions, Chatsworth, Calif, USA) by a previously calibrated operator. The statistical analysis was carried out with Chi-square test, ANOVA/Kruskal-Wallis test, and an ordinal multinomial regression model.

RESULTS

Evidence of association (p< 0.05) between sagittal and vertical skeletal patterns was found with a greater proportion of hyperdivergent skeletal pattern in Class II malocclusion using three parameters to assess the vertical pattern, and there was more prevalent hypodivergence in Class III malocclusion, considering ANB and App-Bpp measurements. Subjects with hyperdivergent skeletal pattern (odds ratio [OR]=1.85-3.65), maxillary prognathism (OR=2.67-24.88) and mandibular retrognathism (OR=2.57-22.65) had a significantly (p< 0.05) greater chance of developing skeletal Class II malocclusion. Meanwhile, subjects with maxillary retrognathism (OR=2.76-100.59) and mandibular prognathism (OR=5.92-21.50) had a significantly (p< 0.05) greater chance of developing skeletal Class III malocclusion.

CONCLUSIONS

A relationship was found between Class II and Class III malocclusion with the vertical skeletal pattern. There is a tendency toward skeletal compensation with both vertical and sagittal malocclusions.

Dentoskeletal morphology in adults with Class I, Class II Division 1, or Class II Division 2 malocclusion with increased overbite

INTRODUCTION

The treatment options for adults with increased overbite are limited to dentoalveolar changes that camouflage the condition. Because of high relapse tendency, defining the problem area is important when creating a treatment plan. This study aimed to evaluate dentoskeletal morphology in skeletal Class I and II anomalies associated with Angle Class I, Class II Division 1 (Class II/1), and Class II Division 2 (Class II/2) malocclusions with increased overbite compared with normal occlusion.

METHODS

Pretreatment cephalograms of 306 patients (131 men, 175 women; overall ages 18-45 years) were evaluated. Four groups were constructed. Three groups had increased overbite (>4.5 mm): group 1 (n = 96) skeletal Class I (ANB = 0.5°-4°), group 2 (n = 85) skeletal Class II (ANB >4.5°) with Class II/1; and group 3 (n = 79) skeletal Class II with Class II/2 malocclusion. Group 4 as a control (n = 46) skeletal Class I normal overbite. Dental and skeletal characteristics of the groups were compared by sex. For statistical evaluations, analysis of variance followed by Tukey post hoc, Mann-Whitney U, and Kruskall-Wallis tests were used. Additionally correlation coefficients between overbite and skeletal/dental parameters were calculated.

RESULTS

Between sexes, with regard to skeletal parameters, the men had greater values in millimetric measurements, and the women had higher SN/GoGn values. Maxillary/mandibular molar heights and the mandibular incisor heights were higher in men. In group 1, decreased lower anterior facial height (LAFH), retrusive mandibular incisors, and increased interincisal degree were determined. The maxillary molars were intrusive, whereas the vertical position of the mandibular molars and incisors in both jaws were normal. In group 2, retrognathic mandible, increased LAFH and mandibular plane angle, extrusive maxillary/mandibular incisors, protrusive mandibular incisors, and decreased interincisal degree were found. In group 3, decreased LAFH, increased interincisal degree, and retrusive incisors in both jaws were determined. There were significant negative correlations between SN/GoGN, palatal plane, and overbite in group 2 and between ANS-SN and overbite in group 3, and positive correlation between interinsical angle and overbite in all increased overbite groups.

CONCLUSIONS

Dental morphology seems to be the main factor of increased overbite. Differences between groups were related primarily to inclinations and vertical positions of the incisors, rather than molar positions.

Pharyngeal airway spaces in different skeletal malocclusions: a CBCT 3D assessment

Objective: To three-dimensionally evaluate the upper pharyngeal airway spaces in adults with different anteroposterior and vertical skeletal malocclusions.Methods: In this retrospective study, three-dimensional airway volume and the minimum constricted areas of 120 adults were measured from cone beam computed tomography volume scans. The sample was divided into skeletal Class I and Class II and subdivided into average and long face malocclusions in each skeletal Class. Airway volumes of the naso-, palato-, and glossopharynx, and the minimum constricted area were measured and compared.Results: Skeletal Class II reduced glossopharyngeal airway volume and larger total minimum constricted area in average faces and more nasal minimum constricted area in long faces. Skeletal Class II with long face significantly increased palatopharyngeal and glossopharyngeal airway volumes as well as larger palatopharyngeal minimum constricted area (p < 0.05).Conclusion: This paper found a likely association between jaw skeletal classification and airway dimensions.

Facial analysis using a new clinical device: The Kattan Facio-meter

BACKGROUND

The aim of the study was to attempt to set average faciometric standards for Egyptians using the Kattan Facio-meter.

MATERIAL AND METHODS

The sample consisted of 180 faculty students with age range 17-25 years. It was divided into three groups; Angle Class I, II and III. Class II was further subdivided into divisions 1 and 2. Linear and angular facial measurements in relation to K plane were taken using the Kattan facio-meter. The measurements were correlated to Angle's classification and between genders.

RESULTS

On comparing the different classes, Class II division 1 showed the statistically highest mean value for Orbitale-soft tissue A; p=0.042, Class II divisions 1 and 2 for Orbitale- Labrale superius; p=0.002 and soft tissue ANB; p<0.001. Females showed significantly higher mean value than males for the upper incisor/K plane; p=0.031. Males showed significantly higher mean value for the inter-incisal angle than females; p=0.001.

CONCLUSIONS

Within the limitations of the current study, it was found that both linear and angular soft tissue measurements conformed to the antroposterior skeletal relation of the jaws and that Class II division 1 was due to protruded maxilla. Males had more prominent lips and deeper mentolabial sulcus. Egyptians had less prominent noses than Caucasians. The Kattan Facio-meter was a valuable tool for clinical analysis without the hazards of irradiation. Key words:Kattan Facio-meter, Angle Class I, II and III.

Evaluation of the miniplate-anchored Forsus Fatigue Resistant Device in skeletal Class II growing subjects: A randomized controlled trial

OBJECTIVES

To evaluate the use of direct miniplate anchorage in conjunction with the Forsus Fatigue Resistant Device (FFRD) in treatment of skeletal Class II malocclusion.

MATERIALS AND METHODS

Forty-eight females with skeletal Class II were randomly allocated to the Forsus plus miniplates (FMP) group (16 patients, age 12.5 ± 0.9 years), Forsus alone (FFRD; 16 patients, age 12.1 ± 0.9 years), or the untreated control group (16 subjects, age 12.1 ± 0.9 years). After leveling and alignment, miniplates were inserted in the mandibular symphysis in the FMP group. The FFRD was inserted directly on the miniplates in the FMP group and onto the mandibular archwires in the FFRD group. The appliances were removed after reaching an edge-to-edge incisor relationship.

RESULTS

Data from 46 subjects were analyzed. The effective mandibular length significantly increased in the FMP group only (4.05 ± 0.78). The mandibular incisors showed a significant proclination in the FFRD group (9.17 ± 2.42) and a nonsignificant retroclination in the FMP group (-1.49 ± 4.70). The failure rate of the miniplates was reported to be 13.3%.

CONCLUSIONS

The use of miniplates with the FFRD was successful in increasing the effective mandibular length in Class II malocclusion subjects in the short term. The miniplate-anchored FFRD eliminated the unfavorable mandibular incisor proclination in contrast to the conventional FFRD.

Correlation between vertical components and skeletal Class II malocclusion in ethnic Javanese

Introduction

The dentoskeletal morphology of Class II malocclusion has been analyzed in several cephalometric investigations. It is crucially important to understand the vertical components in orthodontic treatment. Defining the facial type of an individual is an essential key to obtain an accurate orthodontic diagnosis.

Aim

The aim of this study was to understand the correlation of vertical components in Class II skeletal malocclusion.

Materials and methods

This is a observational descriptive study. This study used lateral cephalograms of Class II skeletal malocclusion from Universitas Airlangga Dental Hospital, between April 2015 and 2016. Cephalometric analysis was performed using digital software by a single examiner. This analysis measured gonial (Go), upper gonial (Go₁), lower gonial (Go₂), Yaxis-SN angle, the length of anterior face height, and posterior face height. The correlation between each variable was analyzed using the Pearson correlation test (P<0.01).

Results

There was a correlation between vertical components and Class II skeletal malocclusion.

Conclusion

Vertical components were correlated with Class II skeletal malocclusion. The greater ANB angle will be followed by greater Go₂, which worsens the condition of Class II skeletal malocclusion.

Comparative tomographic study of the maxillary central incisor collum angle between Class I, Class II, division 1 and 2 patients

INTRODUCTION:

It has been reported that Class II, division 2 maxillary central incisors frequently demonstrate increased collum angles, which indicates an excessive palatal “bend” of the crown. However, evidence supporting such observation is mostly derived from radiographic studies.

OBJECTIVE:

The objective of this study was to evaluate and compare the collum angle of maxillary central incisors in Class I, Class II, division 1, and Class II, division 2 cases using cone-beam computed tomography.

MATERIALS AND METHODS:

Forty-eight consecutive orthodontic cases (16 Class I, 16 Class II, division 1, and 16 Class II, division 2 malocclusion) with cone-beam computed tomography as part of their initial diagnostic records were evaluated. Cross-sections including maxillary right and left central incisors were used to calculate the angulation between the crown and root long axes (collum angle). Comparisons between groups were performed using analysis of variance for multiple and post-hoc Tukey for paired analyses.

RESULTS:

Mean collum angle observed in Class II, division 2 cases was significantly larger (5.2 ± 1.3°) than the ones obtained for Class I (1.1 ± 4.2°) (P = 0.034) or Class II, division 1 cases (0.1 ± 0.7°) (P = 0.014).

CONCLUSIONS:

Our findings suggest that Class II, division 2 individuals demonstrate accentuated lingual inclination of the maxillary central incisor crown compared to the other types of malocclusion studied here. Such morphological feature indicates the need for better tooth movement planning, especially in regard to root palatal torqueing of the maxillary central incisors.

The Influence of Class II Division 2 Malocclusions on the Harmony of the Human Face Profile

BACKGROUND Persons with class II division 2 malocclusion are characterized by a very specific dento-skeletal and soft-tissue profile (a profile in which a protruding nose and chin, retruding lips, concave and shortened lower third of the face, and gummy smile are dominant), which is the opposite of the currently modern profiles (convex profile of protruding lips and small chin). The aim of this research was to determine the differences in parameters of harmonies of facial profiles between persons with class II division 2 malocclusions and class I, and to establish the significance of those differences. MATERIAL AND METHODS For this study, 50 patients with class II division 2 malocclusions and 50 patients with class I were selected; profile photos were recorded and a photometric analysis was done: a type of profile according to Schwarz, the shape of a nose, the prominence of chin, biometrical field, the position of lips in relation to the tangent Sn-Pg, S-line (Steiner), E-line (Riketts) and a facial angle according to Arnett. RESULTS The significant differences in profiles of persons with class II division 2 compared to class I were: position and prominence of the chin, the position of the lower and upper lip in relation to the S-line, and smaller value of a facial angle in relation to persons with class I. CONCLUSIONS The differences seen in skeletal profiles were not associated with significant differences in the profiled facial contours of the examined groups. The compensatory role of the fullness of soft tissues of the lips is probably the reason why there were not significant deviations in all the examined parameters.

Maxillary and mandibular contribution to the establishment of class II malocclusion in an adult Lebanese population

INTRODUCTION

The main aim of this study was to describe the contribution of the maxilla and the mandible to the establishment of a Class II skeletal malocclusion in an adult Lebanese population. Secondary aims were to detect the presence of sex-based dimorphism and to study the influence of the vertical dimension on the Class II skeletal pattern.

MATERIAL AND METHOD

A sample of 90 adults in skeletal Class II was recruited and equally distributed according to sex and vertical typology. The study describes the skeletal and dentoalveolar cephalometric characteristics of the Class II sample, essentially according to Coben's cephalometric analysis.

RESULTS

The total effective depth of the cranial base and the anterior cranial base angle (SN-BaH) were both greater in the Class II sample. In females, the effective depth of the maxilla (Ptm-A) was larger than normal while SNB was smaller. The parameters describing the size and shape of the body of the mandible were significantly different from those of normal subjects. The upper incisors were in a retrusive position, while the axis of the lower incisors was located normally. The mandibular molars had a more distal sagittal position. Hyperdivergent subjects had more significant posterior alveolar growth, a more retrusive mandibular position and smaller mandibular dimensions than the other two vertical sub-groups.

CONCLUSION

The cranial base contributes to the establishment of a Class II malocclusion, and mandibular retrusion cannot be considered as a characteristic shared by all skeletal Class II subjects. Lessening of the absolute length of the mandibular body is the second most frequent etiological factor noted in the Class II sample studied. Most individuals in skeletal Class II have an associated dental Class II malocclusion, and the vertical dimension has an influence on the Class II skeletal pattern.

Craniofacial features affecting mandibular asymmetries in skeletal Class II patients

OBJECTIVES

The aim of this study was to evaluate the characteristics affecting different intensities of mandibular asymmetry in skeletal Class II adults using three-dimensional images. This study is clinically relevant since it allows professionals to evaluate the morphological components related to these deformities and more carefully obtain correct diagnosis and treatment plan for such patients.

METHODS

Cone-beam computed tomography data of 120 Class II patients (40 with relative symmetry, 40 with moderate asymmetry, and 40 with severe asymmetry) were imported to SimPlant Ortho Pro^® 2.0 software (Dental Materialise, Leuven, Belgium). Three reference planes were established and linear measurements were performed from specific landmarks to these planes, comparing the deviated side and the contralateral side in each group, as well as the differences between groups. The correlation between midline mandibular asymmetry and other variables was also evaluated. Statistical analyses considered a significance level of 5%.

RESULTS

Comparing the values obtained on the deviated side and on the contralateral side, there were significant differences for patients with moderate asymmetry and severe asymmetry. However, differences were seen more often in severe mandibular asymmetries. In those patients, there was a significant correlation of the gnathion deviation with lower dental midline deviation, difference in the lateral gonion positions, difference in the mandibular rami heights, and difference in the jugale vertical displacements.

CONCLUSIONS

For skeletal Class II patients with mandibular asymmetry, some craniofacial features are related to chin deviation and require proper evaluation, including the bilateral differences in the ramus height, mandibular body length, transverse and vertical positioning of the gonion and jugale points.

Evaluation of Bone Thickness and Density in the Lower Incisors' Region in Adults with Different Types of Skeletal Malocclusion using Cone-beam Computed Tomography

OBJECTIVES

To evaluate the bone thickness and density in the lower incisors' region in orthodontically untreated adults, and to examine any possible relationship between thickness and density in different skeletal patterns using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

The CBCT records of 48 patients were obtained from the archive of orthodontic department comprising three groups of malocclusion (class I, II and III) with 16 patients in each group. Using OnDemand 3D software, sagittal sections were made for each lower incisor. Thicknesses and densities were measured at three levels of the root (cervical, middle and apical regions) from the labial and lingual sides. Accuracy and reliability tests were undertaken to assess the intraobserver reliability and to detect systematic error. Pearson correlation coefficients were calculated and one-way analysis of variance (ANOVA) was employed to detect significant differences among the three groups of skeletal malocclusion.

RESULTS

Apical buccal thickness (ABT) in the four incisors was higher in class II and I patients than in class III patients (p < 0.05). There were significant differences between buccal and lingual surfaces at the apical and middle regions only in class II and III patients. Statistical differences were found between class I and II patients for the cervical buccal density (CBD) and between class II and III patients for apical buccal density (ABD). Relationship between bone thickness and density values ranged from strong at the cervical regions to weak at the apical regions.

CONCLUSIONS

Sagittal skeletal patterns affect apical bone thickness and density at buccal surfaces of the four lower incisors' roots. Alveolar bone thickness and density increased from the cervical to the apical regions.

Three-dimensional effects of the mini-implant-anchored Forsus Fatigue Resistant Device: A randomized controlled trial

OBJECTIVE

To detect three-dimensionally the effects of using mini-implant anchorage with the Forsus Fatigue Resistant Device (FFRD).

MATERIALS AND METHODS

The sample comprised 43 skeletal Class II females with deficient mandibles. They were randomly allocated into three groups: 16 patients (13.25 ± 1.12 years) received FFRD alone (Forsus group), 15 subjects (13.07 ± 1.41 years) received FFRD and mini-implants (FMI group), and 12 subjects (12.71 ± 1.44 years) were in the untreated control group. Three-dimensional analyses of cone beam computed tomographic images were completed, and the data were statistically analyzed.

RESULTS

Class I relationship and overjet correction were achieved in 88% of the cases. None of the two treatment groups showed significant mandibular skeletal effects. In the FMI group, significant headgear effect, decrease in maxillary width, and increase in the lower facial height were noted. In the FMI group, retroclination of maxillary incisors and distalization of maxillary molars were significantly higher. Proclination and intrusion of mandibular incisors were significantly greater in the Forsus group.

CONCLUSIONS

FFRD resulted in Class II correction mainly through dentoalveolar effects and with minimal skeletal effects. Utilization of mini-implant anchorage effectively reduced the unfavorable proclination and intrusion of mandibular incisors but did not produce additional skeletal effects.

Phenotypic diversity in white adults with moderate to severe Class II malocclusion

INTRODUCTION

Class II malocclusion affects about 15% of the population in the United States and is characterized by a convex profile and occlusal disharmonies. The specific etiologic mechanisms resulting in the range of Class II dentoskeletal combinations observed are not yet understood. Most studies describing Class II phenotypic diversity have used moderate sample sizes or focused on younger patients who later in life might outgrow their Class II discrepancies; such a focus might also preclude the visualization of adult Class II features. The majority have used simple correlation methods resulting in phenotypes that might not be generalizable to different samples and thus might not be suitable for studies of malocclusion etiology. The purpose of this study was to address these knowledge gaps by capturing the maximum phenotypic variations in a large sample of white Class II subjects selected with strict eligibility criteria and rigorously standardized multivariate reduction analyses.

METHODS

Sixty-three lateral cephalometric variables were measured from the pretreatment records of 309 white Class II adults (82 male, 227 female; ages, 16-60 years). Principal component analysis and cluster analysis were used to generate comprehensive phenotypes to identify the most homogeneous groups of subjects, reducing heterogeneity and improving the power of future malocclusion etiology studies.

RESULTS

Principal component analysis resulted in 7 principal components that accounted for 81% of the variation. The first 3 components represented variation on mandibular rotation, maxillary incisor angulation, and mandibular length. The cluster analysis identified 5 distinct Class II phenotypes.

CONCLUSIONS

A comprehensive spectrum of Class II phenotypic definitions was obtained that can be generalized to other samples to advance our efforts for identifying the etiologic factors underlying Class II malocclusion.

The relationship between vertical facial morphology and overjet in untreated Class II subjects

OBJECTIVE

To evaluate the association between vertical facial morphology and overjet in untreated Class II subjects.

MATERIALS AND METHODS

The lateral cephalograms of 140 untreated Class II subjects (68 males and 72 females) between 8 and 11 years of age were divided into three groups based on their overjet value as measured on study casts: Group I normal overjet (less than 3 mm), Group II increased overjet (more than 3 mm but less than or equal to 6 mm), and Group III extreme overjet (more than 6 mm). Mean values and standard deviations of 28 variables measured on lateral cephalograms were calculated. Differences between the three groups were tested using one-way analysis of variance (ANOVA), followed by Bonferroni tests. Additionally, cephalometric differences between groups and available normal values for the Syrian population were evaluated using an independent t-test.

RESULTS

Subjects with normal overjet showed a horizontal facial pattern and posterior inclination of the maxilla, whereas increased overjet subjects exhibited a neutral facial pattern. In contrast, subjects with extreme overjet had a vertical facial pattern and anterior inclination of the maxilla. The mandible was retrognathic and the maxilla was normally positioned in the three groups.

CONCLUSIONS

A positive association was found between the overjet and the tendency toward a hyperdivergent pattern.

Cephalometric characteristics of Class II division 1 malocclusion in a Saudi population living in the western region

OBJECTIVE

To describe and analyze the cephalometric dento-skeletal characteristics associated with Angle's Class II, division 1 malocclusion in Saudi population living in the western region.

MATERIALS AND METHODS

The material examined included 149 lateral head radiographs comprising two series: (1) 85 films of children with Class II, division 1 malocclusion and (2) 62 films of children with "normal" occlusion. Age range of the representing children was 10-13 years.

RESULTS

In Class II division 1 subjects, the maxilla was prognathic in relation to anterior cranial base. The mandible was normally positioned in relation to anterior cranial base. Upper incisors were proclined and lower incisors were normally positioned. The cranial base angle was not different between the two groups.

CONCLUSIONS

In the western region of Saudi Arabia, Class II division 1 malocclusion has specific characteristics. The presence of prognathic maxilla, in this sample, indicates that the use of head gear therapy might be more appropriate than functional appliances when treating Class II division 1 malocclusion in Saudis living in the Western region.