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Tagawa DT, Wolosker AMB, Florez BM, Dominguez GC, Yamashita HK, Aidar LADA, Junior HC. Temporomandibular joint disc position and shape in patients submitted to two protocols of rapid maxillary expansion and face mask therapy: A randomized clinical trial. Orthod Craniofac Res 2024; 27:615-625. [PMID: 38456750 DOI: 10.1111/ocr.12777] [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] [Accepted: 03/03/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE The objective of this prospective study was to assess possible changes in the position and shape of the temporomandibular joint (TMJ) articular disc in patients treated with two protocols of rapid maxillary expansion (RME) and face mask (FM) therapy. METHODS A sample of 88 patients with Class III or Class III subdivision malocclusions, aged between 6 and 13 years, were consecutively selected and divided into three groups (G): G1-34 patients were treated with RME, followed by FM therapy; G2-34 patients were treated using RME according to modified alternate rapid maxillary expansion and constriction (ALT-RAMEC) protocol, followed by FM therapy. These treated groups were randomly (1:1 allocation ratio) distributed according to the two treatment protocols. G3 - Control Group - 20 untreated patients were followed. Magnetic resonance imaging (MRI) TMJs were obtained before (T1) and after (T2) a treatment period or follow-up. McNemar test, Fisher's exact test and intra- and inter-observer concordance (K) were performed (p ≤ .05). RESULTS There were no statistically significant differences in the baseline cephalometric variables at T1 between the groups. There were statistically significant differences between the groups (p < .001) in relation to the disc shape in T1, since G1 (8 TMJs -11.76%) presented higher occurrences of altered forms in comparison with G2 (no changes). No significant differences were observed in disc position CM and OM (G1 - p > .999; G2 - p = .063; G3 - p = .500) and shape (G1 - p > 0.999; G2 - p = .250; G3 - not calculable), between T1 × T2, in any of the groups studied. CONCLUSION The two treatment protocols did not have adverse effects on the position and shape of the TMJ disc, in a short-term evaluation.
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Affiliation(s)
- Daniella Torres Tagawa
- Graduate Program in Medicine (Clinical Radiology), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Department of Orthodontics, Universidade Santa Cecília, Santos, Brazil
| | - Angela Maria Borri Wolosker
- Graduate Program in Medicine (Clinical Radiology), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | - Helio Kiitiro Yamashita
- Graduate Program in Medicine (Clinical Radiology), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Henrique Carrete Junior
- Graduate Program in Medicine (Clinical Radiology), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Minervini G, Di Blasio M, Franco R, Marrapodi MM, Vaienti B, Cicciù M, Ronsivalle V. Prevalence of temporomandibular disorders diagnosis in patients treated with Herbst appliance: a systematic review and meta-analysis. BMC Oral Health 2024; 24:137. [PMID: 38281907 PMCID: PMC10822183 DOI: 10.1186/s12903-023-03738-w] [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: 09/22/2023] [Accepted: 12/05/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The Herbst appliance is an excellent therapy for treating class II malocclusions with increased overjet. Its mechanics involve propelling the mandibular bone using two pistons the patient cannot remove. The so-called bite-jumping keeps the mandible in a more anterior position for a variable period, usually at least 6 months. This appliance does not inhibit joint functions and movements, although there are scientific papers in the literature investigating whether this appliance can lead to temporomandibular disorders. This systematic review aims to evaluate whether Herbst's device can cause temporomandibular diseases by assessing the presence of TMD in patients before and after treatment. METHODS A literature search up to 3 May 2023 was carried out on three online databases: PubMed, Scopus and Web of Science. Only studies that evaluated patients with Helkimo scores and Manual functional analysis were considered, as studies that assessed the difference in TMD before and after Herbst therapy. Review Manager version 5.2.8 (Cochrane Collaboration) was used for the pooled analysis. We measured the odds ratio (OR) between the two groups (pre and post-Herbst). RESULTS The included papers in this review were 60. Fifty-seven were excluded. In addition, a manual search was performed. After the search phase, four articles were considered in the study, one of which was found through a manual search. The overall effect showed that there was no difference in TMD prevalence between pre-Herbst and post-Herbst therapy (OR 0.74; 95% CI: 0.33-1.68). CONCLUSION Herbst appliance seems not to lead to an increase in the incidence of TMD in treated patients; on the contrary, it appears to decrease it. Further studies are needed to assess the possible influence of Herbst on TMDs.
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Affiliation(s)
- Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India.
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Caserta, 81100, Italy.
| | - Marco Di Blasio
- Department of Medicine and Surgery, University Center of Dentistry, University of Parma, Via Gramsci 14, 43126, Parma, Italy.
| | - Rocco Franco
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00100, Rome, Italy.
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", 80121, Naples, Italy.
| | - Benedetta Vaienti
- Department of Medicine and Surgery, University Center of Dentistry, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123, Catania, Italy
| | - Vincenzo Ronsivalle
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123, Catania, Italy
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Aldayel AM, AlGahnem ZJ, Alrashidi IS, Nunu DY, Alzahrani AM, Alburaidi WS, Alanazi F, Alamari AS, Alotaibi RM. Orthodontics and Temporomandibular Disorders: An Overview. Cureus 2023; 15:e47049. [PMID: 38021494 PMCID: PMC10644174 DOI: 10.7759/cureus.47049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
The relationship between orthodontics and temporomandibular disorders (TMDs) constitutes a subject of paramount significance in dental and craniofacial health. This abstract embarks upon an in-depth examination of the intricate connection between orthodontic practices and TMD, primarily focusing on evaluating the impact of orthodontic treatment modalities on the health and functionality of the temporomandibular joint (TMJ). This exploration elucidates the multifaceted interplay between orthodontic interventions and TMD by traversing a landscape of scholarly research and empirical investigations. The review draws from a broad spectrum of studies to analyze the potential influence of orthodontic treatments, which encompass occlusal adjustments and alterations in jaw positioning, on the development and management of TMD symptoms. The inquiry delves into the diverse range of TMD conditions, considering the implications of orthodontic techniques on occlusal stability, condylar alignment, and overall TMJ function. Through a comprehensive synthesis of the available body of knowledge, this abstract aspires to equip dental practitioners, orthodontists, and researchers with a nuanced understanding of the complex dynamics that govern the relationship between orthodontics and TMD. This knowledge, in turn, offers a foundation for informed clinical decision-making and the formulation of effective treatment strategies for patients presenting with TMD symptoms. By shedding light on the intricate interactions between orthodontic procedures and TMJ health, this abstract contributes to the advancement of clinical practices, promoting improved patient outcomes and well-being in the context of both orthodontics and TMDs.
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Affiliation(s)
- Abdullah M Aldayel
- Dental Clinic at King Khalid University Hospital, King Saud University, Riyadh, SAU
| | | | | | - Duaa Y Nunu
- General Dentistry, Ministry of Health, Najran, SAU
| | | | | | - Fahad Alanazi
- General Dentistry, King Abdulaziz Medical City, Jeddah, SAU
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Rustia S, Lam J, Tahir P, Kharafi LA, Oberoi S, Ganguly R. Three-dimensional morphological changes in the temporomandibular joint in asymptomatic patients who undergo orthodontic treatment: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:397-406. [DOI: 10.1016/j.oooo.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
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Michelotti A, Rongo R, D'Antò V, Bucci R. Occlusion, orthodontics, and temporomandibular disorders: Cutting edge of the current evidence. J World Fed Orthod 2020; 9:S15-S18. [DOI: 10.1016/j.ejwf.2020.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/11/2022]
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Moro A, Mattos CFP, Borges SW, Flores-Mir C, Topolski F. Stability of Class II corrections with removable and fixed functional appliances: A literature review. J World Fed Orthod 2020; 9:56-67. [PMID: 32672656 DOI: 10.1016/j.ejwf.2020.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Class II functional appliances have been used in orthodontics for over 100 years. Although the stability of corrections is one of the main goals of orthodontic treatment, there is a paucity of longitudinal studies on the long-term stability of treatment of Class II malocclusion based on functional appliances. METHODS This narrative review attempts to summarize the limited related evidence available and discusses the clinical implications of important aspects related to occlusal and skeletal changes that arise after Class II malocclusion treatment with functional appliances. RESULTS The occlusal changes obtained through Class II functional treatment do mostly exhibit long-term stability. While mild posttreatment changes occurred, they were most likely due to physiologic aging processes and not likely associated with actual treatment relapse. Long-term retention in the lower jaw would be particularly beneficial. A stable occlusion with good intercuspation in the posterior arches seems more likely to preserve a Class I occlusion after treatment through dentoalveolar compensatory mechanisms. After treatment, the maxilla and the mandible do grow anteriorly, with the mandible growing more than the maxilla. Patients treated with functional appliances are not likely to develop TMJ disorders over the long term. CONCLUSIONS Long term skeletal corrections achieved with functional appliances seem to be overall stable. Class II molar and overjet relapses can be likely explained by a combination of tooth movement and an unfavorable posttreatment maxillomandibular growth pattern, especially when combined with unstable interdigitation of the posterior teeth. No specific intermaxillary retention approach has been assessed yet.
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Affiliation(s)
- Alexandre Moro
- Professor, School of Health Sciences, Universidade Positivo, Curitiba, Paraná, Brazil; Professor, Department of Orthodontics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
| | - Camila F P Mattos
- Student, MSc Program in Dentistry, School of Health Sciences, Universidade Positivo, Curitiba, Paraná, Brazil
| | - Suelen W Borges
- Student, PhD Program in Dentistry, School of Health Sciences, Universidade Positivo, Curitiba, Paraná, Brazil
| | - Carlos Flores-Mir
- Professor, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Francielle Topolski
- Professor, School of Health Sciences, Universidade Positivo, Curitiba, Paraná, Brazil
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Chen Z, Mai Z, Tu S, Lu H, Chen L, Ai H. Expression of lubricin in rat posterior mandibular condylar cartilage following functional mandibular forward repositioning. J Orofac Orthop 2019; 80:128-135. [PMID: 30953086 DOI: 10.1007/s00056-019-00173-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 02/20/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the present study was to investigate the effects of mandibular forward repositioning on expression of lubricin in rat posterior condylar cartilage. METHODS In total, fifty 5‑week-old female Sprague Dawley rats were divided randomly into experimental groups and control groups. The animals in the experimental groups were fitted with modified acrylic inclined planes to advance the mandible, whereas rats in the normal control groups were left intact. Rats were sacrificed on days 3, 7, 14, 21, and 30, and temporomandibular joint (TMJ) samples were collected. The expression of lubricin of the posterior mandibular condylar cartilage was evaluated by immunohistochemistry. RESULTS In the control groups, higher expression of lubricin was observed in the proliferative zone of the posterior mandibular condylar cartilage compared with the hypertrophic zone during the experimental period. Compared with the control group, the positive signals for lubricin of the posterior mandibular condylar cartilage in the experimental animals were significantly higher on days 7, 14, and 21; however, no statistical difference was found on day 3 or 30. CONCLUSIONS Data analyses suggest that the bite jumping appliance temporarily enhanced lubricin expression, providing a good mechanical environment for the physiologic growth of the condyle and mandible, and contributes to TMJ remodeling by the regulation of condylar chondrocyte proliferation.
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Affiliation(s)
- Zheng Chen
- Department of Stomatology, The Third Affiliated Hospital, Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, China
| | - Zhihui Mai
- Department of Stomatology, The Third Affiliated Hospital, Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, China
| | - Shaoqin Tu
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology and Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Hongfei Lu
- Department of Stomatology, The Third Affiliated Hospital, Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, China
| | - Lin Chen
- Department of Stomatology, The Third Affiliated Hospital, Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, China
| | - Hong Ai
- Department of Stomatology, The Third Affiliated Hospital, Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, China.
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Ruf S, Bock NC. Long-term (≥15 years) effects of Class II treatment: a longitudinal and cross-sectional study on signs and symptoms of temporomandibular disorders. Eur J Orthod 2018; 41:172-179. [DOI: 10.1093/ejo/cjy040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sabine Ruf
- Department of Orthodontics, University of Giessen, Germany
| | - Niko C Bock
- Department of Orthodontics, University of Giessen, Germany
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Jiménez-Silva A, Carnevali-Arellano R, Venegas-Aguilera M, Tobar-Reyes J, Palomino-Montenegro H. Temporomandibular disorders in growing patients after treatment of class II and III malocclusion with orthopaedic appliances: a systematic review. Acta Odontol Scand 2018; 76:262-273. [PMID: 29252064 DOI: 10.1080/00016357.2017.1416165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine if the use of orthopaedic appliances in growing patients applied to correct Class II and III malocclusion is related to the development of temporomandibular disorders (TMD). MATERIAL AND METHODS A systematic review was conducted between 1960 and July 2017, based on electronic databases: PubMed, Cochrane Library, Embase, Medline, Scopus, EBSCOhost, Scielo, Lilacs and Bireme. Controlled clinical trials (CCTs) and randomized controlled trials (RCTs) were identified. The articles were selected and analyzed by two authors independently. The quality of the evidence was determined according to the guidelines of the Cochrane Risk Bias Assessment Tool and the Cochrane Quality Study Guide. RESULTS Seven articles were included, four CCTs and three RCTs. The studies were grouped according to malocclusion treatment in (a) class II appliances (n = 4) and (b) class III appliances (n = 3). The quality of evidence was low due to the high risk of bias, independent of the association reported. All studies concluded that the use of orthopaedic appliances would not contribute to the development of TMD. CONCLUSIONS The quality of evidence available is insufficient to establish definitive conclusions, since the studies were very heterogeneous and presented a high risk of bias. However, it is suggested that the use of orthopaedic appliances to correct class II and III malocclusion in growing patients would not be considered as a risk factor for the development of TMD. High-quality RCTs are required to draw any definitive conclusions.
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Affiliation(s)
- Antonio Jiménez-Silva
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
- Ortodoncia y Ortopedia Dentomaxilofacial, Facultad de Odontología, Universidad Andrés Bello, Santiago, Chile
| | - Romano Carnevali-Arellano
- Ortodoncia y Ortopedia Dentomaxilofacial, Facultad de Odontología, Universidad Andrés Bello, Santiago, Chile
| | | | | | - Hernán Palomino-Montenegro
- Ortodoncia y Ortopedia Dentomaxilofacial, Facultad de Odontología, Universidad Andrés Bello, Santiago, Chile
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Bock NC, Saffar M, Hudel H, Evälahti M, Heikinheimo K, Rice DP, Ruf S. Long-term (≥15 years) post-treatment changes and outcome quality after Class II:1 treatment in comparison to untreated Class I controls. Eur J Orthod 2018; 40:206-213. [PMID: 29016736 DOI: 10.1093/ejo/cjx051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim To investigate the long-term (≥15 years) post-treatment (Tx) occlusal changes and outcome quality after Class II:1 Tx. Subjects and Methods Herbst-MBA Tx had been performed at age 12.8 ± 2.7 years in 119 patients. A recall was conducted and study models from before and after active Tx, after retention as well as after recall were evaluated using standard occlusal variables and the PAR index. These data were compared to 31 untreated Class I controls. Results 52 out of 119 patients could be located and participated at 33.6 ± 3.1 years. Compared to the 67 patients who did not participate in the recall, the pre- and post-Tx occlusal data of the participants did not differ systematically; however, the PAR scores were higher by 3.0-4.7 points at all times. Pre-Tx, the mean values of the 52 participants were: PAR = 27.2 ± 7.6, Class II molar relationship (MR) = 0.7 cusp widths (cw), overjet = 8.2 mm, overbite = 4.1 mm. After Tx, the PAR score was 3.4 ± 2.2. A Class I MR (0.0 ± 0.1 cw) with normal overjet (2.3 ± 0.7 mm) and overbite (1.3 ± 0.7 mm) existed. At recall, a mild PAR score increase to 8.2 ± 5.5 points had occurred; this was mainly due to increased overjet and overbite values (3.6 ± 1.1 and 2.8 ± 1.6 mm) while the MR was stable (0.0 ± 0.2 cw). For all these variables, similar findings were made in the untreated controls. Conclusion The occlusal outcome of Class II:1 Tx showed very good long-term stability. While mild changes occur post-Tx, the long-term result is similar to untreated Class I controls.
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Affiliation(s)
- Niko C Bock
- Department of Orthodontics, University of Giessen, Germany
| | | | - Helge Hudel
- Department of Medical Statistics, University of Giessen, Germany
| | - Marjut Evälahti
- Orthodontics, Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Kaisa Heikinheimo
- Orthodontics, Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - David P Rice
- Orthodontics, Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sabine Ruf
- Department of Orthodontics, University of Giessen, Germany
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Long-term effects of Class II orthodontic treatment on oral health. J Orofac Orthop 2018; 79:96-108. [PMID: 29464289 DOI: 10.1007/s00056-018-0125-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
AIM To investigate the long-term (≥15 years) benefit of orthodontic Class II treatment (Tx) on oral health (OH). SUBJECTS AND METHODS All patients (Department of Orthodontics, University of Giessen, Giessen, Germany) who underwent Class II correction (Herbst-multibracket Tx, end of active Tx ≥ 15 years ago) and agreed to participate in a recall (clinical examination, interview, impressions, and photographs) were included. Records after active Tx were used to assess the long-term OH effects. Data were compared to corresponding population-representative age-cohorts as well as to untreated Class I controls without orthodontic Tx need during adolescence. RESULTS Of 152 treated Class II patients, 75 could be located and agreed to participate at 33.7 ± 3.0 years of age (pre-Tx age: 14.0 ± 2.7 years). The majority (70.8%) were fully satisfied with their teeth and with their masticatory system. The Decayed, Missing, Filled Teeth Index (DMFT) was 7.1 ± 4.8 and, thus, almost identical to that of the untreated Class I controls (7.9 ± 3.6). In contrast, the DMFT in the population-representative age-cohort was 56% higher. The determined mean Community Periodontal Index (CPI) maximum score (1.6 ± 0.6) was also comparable to the untreated Class I controls (1.7 ± 0.9) but in the corresponding population-representative age-cohort it was 19-44% higher. The extent of lower incisor gingival recessions did not differ significantly between the treated Class II participants and the untreated Class I controls (0.1 ± 0.2 vs. 0.0 ± 0.1 mm). CONCLUSION Patients with orthodontically treated severe Class II malocclusions had a lower risk for oral health impairment than the general population. The risk corresponded to that of untreated Class I controls (without orthodontic Tx need during adolescence).
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