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

Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children

BACKGROUND

Prominent lower front teeth (Class III malocclusion) may be due to jaw or tooth position or both. The upper jaw (maxilla) can be too far back or the lower jaw (mandible) too far forward; the upper front teeth (incisors) may be tipped back or the lower front teeth tipped forwards. Orthodontic treatment uses different types of braces (appliances) fitted inside or outside the mouth (or both) and fixed to the teeth. A facemask is the most commonly reported non-surgical intervention used to correct Class III malocclusion. The facemask rests on the forehead and chin, and is connected to the upper teeth via an expansion appliance (known as 'rapid maxillary expansion' (RME)). Using elastic bands placed by the wearer, a force is applied to the top teeth and jaw to pull them forwards and downward. Some orthodontic interventions involve a surgical component; these go through the gum into the bone (e.g. miniplates). In severe cases, or if orthodontic treatment is unsuccessful, people may need jaw (orthognathic) surgery as adults. This review updates one published in 2013.

OBJECTIVES

To assess the effects of orthodontic treatment for prominent lower front teeth in children and adolescents.

SEARCH METHODS

An information specialist searched four bibliographic databases and two trial registries up to 16 January 2023. Review authors screened reference lists.

SELECTION CRITERIA

We looked for randomised controlled trials (RCTs) involving children and adolescents (16 years of age or under) randomised to receive orthodontic treatment to correct prominent lower front teeth (Class III malocclusion), or no (or delayed) treatment.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Our primary outcome was overjet (i.e. prominence of the lower front teeth); our secondary outcomes included ANB (A point, nasion, B point) angle (which measures the relative position of the maxilla to the mandible).

MAIN RESULTS

We identified 29 RCTs that randomised 1169 children (1102 analysed). The children were five to 13 years old at the start of treatment. Most studies measured outcomes directly after treatment; only one study provided long-term follow-up. All studies were at high risk of bias as participant and personnel blinding was not possible. Non-surgical orthodontic treatment versus untreated control We found moderate-certainty evidence that non-surgical orthodontic treatments provided a substantial improvement in overjet (mean difference (MD) 5.03 mm, 95% confidence interval (CI) 3.81 to 6.25; 4 studies, 184 participants) and ANB (MD 3.05°, 95% CI 2.40 to 3.71; 8 studies, 345 participants), compared to an untreated control group, when measured immediately after treatment. There was high heterogeneity in the analyses, but the effects were consistently in favour of the orthodontic treatment groups rather than the untreated control groups (studies tested facemask (with or without RME), chin cup, orthodontic removable traction appliance, tandem traction bow appliance, reverse Twin Block with lip pads and RME, Reverse Forsus and mandibular headgear). Longer-term outcomes were measured in only one study, which evaluated facemask. It presented low-certainty evidence that improvements in overjet and ANB were smaller at 3-year follow-up than just after treatment (overjet MD 2.5 mm, 95% CI 1.21 to 3.79; ANB MD 1.4°, 95% CI 0.43 to 2.37; 63 participants), and were not found at 6-year follow-up (overjet MD 1.30 mm, 95% CI -0.16 to 2.76; ANB MD 0.7°, 95% CI -0.74 to 2.14; 65 participants). In the same study, at the 6-year follow-up, clinicians made an assessment of whether surgical correction of participants' jaw position was likely to be needed in the future. A perceived need for surgical correction was observed more often in participants who had not received facemask treatment (odds ratio (OR) 3.34, 95% CI 1.21 to 9.24; 65 participants; low-certainty evidence). Surgical orthodontic treatment versus untreated control One study of 30 participants evaluated surgical miniplates, with facemask or Class III elastics, against no treatment, and found a substantial improvement in overjet (MD 7.96 mm, 95% CI 6.99 to 8.40) and ANB (MD 5.20°, 95% CI 4.48 to 5.92; 30 participants). However, the evidence was of low certainty, and there was no follow-up beyond the end of treatment. Facemask versus another non-surgical orthodontic treatment Eight studies compared facemask or modified facemask (with or without RME) to another non-surgical orthodontic treatment. Meta-analysis did not suggest that other treatments were superior; however, there was high heterogeneity, with mixed, uncertain findings (very low-certainty evidence). Facemask versus surgically-anchored appliance There may be no advantage of adding surgical anchorage to facemasks for ANB (MD -0.35, 95% CI -0.78 to 0.07; 4 studies, 143 participants; low-certainty evidence). The evidence for overjet was of very low certainty (MD -0.40 mm, 95% CI -1.30 to 0.50; 1 study, 43 participants). Facemask variations Adding RME to facemask treatment may have no additional benefit for ANB (MD -0.15°, 95% CI -0.94 to 0.64; 2 studies, 60 participants; low-certainty evidence). The evidence for overjet was of low certainty (MD 1.86 mm, 95% CI 0.39 to 3.33; 1 study, 31 participants). There may be no benefit in terms of effect on ANB of alternating rapid maxillary expansion and constriction compared to using expansion alone (MD -0.46°, 95% CI -1.03 to 0.10; 4 studies, 131 participants; low-certainty evidence).

AUTHORS' CONCLUSIONS

Moderate-certainty evidence showed that non-surgical orthodontic treatments (which included facemask, reverse Twin Block, orthodontic removable traction appliance, chin cup, tandem traction bow appliance and mandibular headgear) improved the bite and jaw relationship immediately post-treatment. Low-certainty evidence showed surgical orthodontic treatments were also effective. One study measured longer-term outcomes and found that the benefit from facemask was reduced three years after treatment, and appeared to be lost by six years. However, participants receiving facemask treatment were judged by clinicians to be less likely to need jaw surgery in adulthood. We have low confidence in these findings and more studies are required to reach reliable conclusions. Orthodontic treatment for Class III malocclusion can be invasive, expensive and time-consuming, so future trials should include measurement of adverse effects and patient satisfaction, and should last long enough to evaluate whether orthodontic treatment in childhood avoids the need for jaw surgery in adulthood.

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.

Dentoalveolar effects of skeletally anchored extrusion arch in anterior open bite patients: A prospective clinical trial

OBJECTIVE

The purpose of this prospective clinical trial was to explore the dental and soft tissue changes accompanying the use of skeletally anchored nickel-titanium (NiTi) extrusion arch in the correction of anterior open bite (AOB).

MATERIAL AND METHODS

Twenty female patients with a mean age of 16.5 ± 1.5 years and a mean dentoalveolar AOB of 2.38±0.7 mm participated in this study. All patients were treated with an maxillary 0.017×0.025-in NiTi extrusion arch, with the aid of miniscrews inserted between the maxillary second premolars and first molars bilaterally, to act as indirect anchorage. Three-dimensional digital models and lateral cephalometric radiographs were taken just before the insertion of the extrusion arch (T0) and after 10 months (T1). Paired-sample t-tests were used in analyzing the data, to evaluate the changes after treatment (T1-T0). A significance level of p < 0.05 was used.

RESULTS

AOB was successfully closed in all patients, with a 4.35 ± 0.61 mm increase in the overbite. Maxillary incisors significantly extruded (2.52 ± 1.02 mm) and significantly reclined (5.78 ± 0.77°), with a resultant decrease in the overjet of 1.58 ± 0.5mm. A significant intrusion of maxillary first molars with no change in their inclination was observed. The upper lip showed a significant retraction tendency to the E-plane, and a significant increase in the nasolabial angle was observed.

CONCLUSION

The skeletally anchored NiTi extrusion arch was an effective technique in treating AOB, with no adverse effects on the molars.

Improved super-elastic Ti-Ni alloy wire for treating adult skeletal class III with facial asymmetry: A case report

BACKGROUND

Correcting severe skeletal class III malocclusion with facial asymmetry in adults through orthodontic treatment alone is difficult.

CASE SUMMARY

In this case report, we describe orthodontic treatment and lower incisor extraction without orthognathic surgery for a 27-year-old man with a transverse discrepancy. The extraction sites were closed using an elastic chain. The use of intermaxillary elastics, improved super-elastic Ti-Ni alloy wire, and unilateral multibend edgewise arch wire was crucial for correcting facial asymmetry and the midline deviation.

CONCLUSION

After treatment, the patient had a more symmetrical facial appearance, acceptable overjet and overbite, and midline coincidence. The treatment results remained stable 3 years after treatment. This case report demonstrates that a minimally invasive treatment can successfully correct severe skeletal class III malocclusion with facial asymmetry.

Effects of an intraoral device (IOD) on electromyographic activity on the masseter and temporal muscles in Class III patients

OBJECTIVE

Class III malocclusion is characterized by a loss of vertical dimension associated with muscle imbalance. The present study was designed to determine electromyographic amplitude changes in temporal (T) and masseter (M) at rest and during clenching in Class III patients treated with an intraoral device (IOD) over a 24-hour period for 30 days with transcutaneous electrical nerve stimulation (TENS).

METHODS

Twelve patients with Class III (mean age 27.7 ± 1.2 years) were treated with TENS and IOD. Ten untreated patients composed the control group. Data were analyzed using Wilcoxon test and ANOVA.

RESULTS

Patients treated with TENS and IOD showed a marked decrease in hyperactivity of M and T at rest (p = 0.001) and an increase during clenching (p = 0.001). The control group maintained similar activity in both positions.

CONCLUSION

This study confirms that using TENS and IOD in patients improves muscle activity of T and M.

Long-Term CBCT Evaluation of Mandibular Third Molar Changes after Distalization in Adolescents

Introduction: This study aimed to evaluate mandibular molar changes after distalization using Class III elastics and modified C-palatal plates (MCPPs) in the maxilla and to use CBCT to specifically analyze the third-molar position after long-term retention in adolescents. Methods: The sample consisted of 65 mandibular third molars from 35 subjects, divided into two groups. Twenty-six of the third molars were from fourteen adolescent patients with Class I bimaxillary protrusion (mean age, 12.8 years) who had undergone bilateral maxillary distalization using an MCPP and mandibular distalization with Class III elastics with non-extraction treatment. For the control group, 39 third molars from 21 Class I normal-occlusion subjects were used. In the treated group, CBCT images were taken before distalization (T1), after molar distalization (T2), and at a long-term observation point (6.1 ± 2.7 years) (T3). Repeated measures ANOVA and a post hoc test with Bonferroni correction were used to analyze significant differences in the positions at the three points in time. Results: There were 2.3 and 1.7 mm of distal movement at the crown of the mandibular first and second molars, with distal tipping of 5.2° and 5.3°, respectively, and 3.0° of distal tipping of the third molars. Comparing the treated group with the control group at T3, there was a significant change in the angulation of the third molars (p < 0.001). In the long-term, the third molars from the treated group showed a downward and buccal position after distalization. Conclusions: In the long term, the developing mandibular third molar buds had downward and buccal positional changes after total arch distalization. These findings suggest the need for clinicians to consider the possibility of the impaction of developing third molars after mandibular total arch distalization in adolescents.

The Practitioner’s Eye: The Ricketts Technique Elements in Non-Extraction Treatment Camouflaging Skeletal Class III with Bite Asymmetry—A Case Series Presentation

The study presents four cases of camouflage treatment of skeletal Class III with occlusal asymmetry in adult patients. Cephalometric analysis was performed using two different reference lines, S-N and FH. The treatment was carried out without the use of additional fixed appliances, no extraoral elastics for maxillary protection, and no extraction of teeth in the mandible. In addition to the characteristic elements and archwires taken from the Ricketts technique, NiTi, TMA, Wilcock archwires, Class III asymmetric intraoral elastic and criss-cross as well as individualized biomechanical systems were used. It has been proven that mild and moderate skeletal Class III with occlusal asymmetry can be treated with orthodontic camouflage, without additional fixed appliances for expansion or protraction of the maxilla. Moreover, it has been shown that it is possible to effectively treat this defect without extracting the teeth in the mand.

Intrusion of the maxillary posterior teeth with a single buccal mini-implant positioned bilaterally in young adults with a tendency towards hyperdivergence: A clinical study

BACKGROUND

Skeletal anchorage systems have been used for intrusion of the posterior teeth with satisfactory results. To achieve this, mini-implants are placed at anatomically challenging sites such as the palate or require several mini-implants to produce the desired effect.

OBJECTIVE

To determine the magnitude of intrusion of the maxillary posterior teeth achieved on a continuous arch wire using a single buccal mini-implant placed bilaterally in young patients with a tendency towards hyperdivergence and to evaluate its influence on the skeletal, dental and soft-tissue structures.

METHODS

A total of 17 patients with proclination of the anterior teeth, tendency towards hyperdivergence and clockwise rotation of the mandible were selected. First premolars were extracted as part of treatment protocol. A 0.022-MBT bracket prescription was used. Mini-implants were placed bilaterally on the buccal aspect at the mucogingival junction or slightly gingival to it between the maxillary second premolar and first permanent molar. A total of 200 g of intrusive force was placed from a continuous 0.019 × 0.025 inch stainless-steel arch wire to the mini-implant by means of an elastomeric thread on both sides. Lateral cephalograms and study models were taken before the start of intrusion and six months later. Parametric and non-parametric tests were done to assess treatment results.

RESULTS

Significant intrusion was observed in the maxillary molar and premolar region with tendency towards intrusion in the anterior region. There was significant decrease in lower anterior facial height (LAFH) with anti-clockwise mandibular rotation, decrease in facial proportion index and total facial height. No changes were observed in the transverse plane.

CONCLUSION

Intrusion of the permanent maxillary molar can be achieved on a continuous arch wire with a single buccal mini-implant placed bilaterally with improvement in facial aesthetics, especially in the vertical plane. This method may be beneficial in patients with borderline vertical discrepancy treated with conventional friction mechanics during space closure after first premolar extractions.

Nonsurgical treatment of a hyperdivergent skeletal Class III patient with mini-screw-assisted mandibular dentition distalization and flattening of the occlusal plane

Treatment of hyperdivergent skeletal Class III malocclusion is challenging for orthodontists, and orthognathic-orthodontic treatment is usually required. This report presents the successful nonsurgical treatment of a 20-year-old man who had a skeletal Class III malocclusion with anterior open bite, anterior and posterior crossbite, hyperdivergent growth pattern, steep occlusal plane, early loss of three first molars, and an uncommon convex profile with a retruded chin. An orthodontic camouflage treatment plan was chosen based on the etiology and the patient's complaints. Tooth #37 was extracted. Miniscrews were used for uprighting and intruding of the lower molars, distalization of the lower dentition, and flattening of the occlusal plane. After 34 months of active treatment, Class I relationships, proper anterior overjet and overbite, flat occlusal plane, and an esthetic facial profile were achieved. The results demonstrated that the biomechanics involved in the nonsurgical treatment assisted with miniscrews to distalize the mandibular dentition and flatten the occlusal plane while keeping the mandibular plane stable was effective for treating this hyperdivergent skeletal Class III patient with a convex profile and anterior open bite.

Evaluation of adolescent and adult patients treated with the Carriere Motion Class III appliance followed by fixed appliances

OBJECTIVES

To determine dentoalveolar and skeletal effects produced in mature patients by the Carriere Motion Class III (CM3) appliance followed by fixed appliances.

MATERIALS AND METHODS

This retrospective study evaluated 32 patients at three time points: T1 (initial), T2 (removal of CM3), and T3 (posttreatment). Serial cephalograms were traced and digitized, and best-fit regional superimpositions were constructed. Eleven linear and 7 angular variables were measured. The starting forms of the CM3 patients were compared with a sample of untreated subjects with normal occlusions and well-balanced faces.

RESULTS

The CM3 phase lasted 6.3 months, followed by a phase of fixed appliances lasting 12.9 months; the total duration of treatment was 19.2 months. Minimal skeletal changes were measured sagittally, with only a slight increase in lower anterior facial height observed during treatment. Most treatment changes were dentoalveolar in nature. Wits appraisal increased 4.0 mm during treatment. The molar relationship improved by 6.0 mm during phase I, a value that rebounded slightly during phase II, resulting in an improvement toward Class I of 4.8 mm. Best-fit regional superimpositions revealed anterior movement of upper molars relative to the maxilla and posterior movement of lower molars relative to the mandible.

CONCLUSIONS

The Carriere Motion Class III appliance is an effective and efficient method of resolving occlusal problems in minimally growing Class III patients. Primary treatment effects are dentoalveolar in nature with minimal skeletal alterations.

Nonsurgical treatment of an adult with skeletal Class III malocclusion, anterior crossbite, and an impacted canine

Class III malocclusion presents some complexity in terms of diagnosis and treatment and affects not only the jaws but the whole craniofacial complex. Besides, functional forward displacement of the mandible may be diagnosed in a patient presenting Class III malocclusion, as the 2 entities are not incompatible or mutually exclusive. This case report describes the multidisciplinary, nonsurgical, orthodontic treatment of an adult patient with a skeletal Class III malocclusion, anterior crossbite, and a palatally impacted canine, treated with fixed appliances and skeletal anchorage. To upright the mandibular molars, distalize the whole mandibular arch, and avoid excessive inclination of maxillary incisors to improve dentofacial esthetics, miniscrews were placed in the retromolar area. The treatment results were very satisfactory and remained stable after a reasonable retention period.

Management of the Vertical Dimension in the Camouflage Treatment of an Adult Skeletal Class III Malocclusion

Treating skeletal class III malocclusions is one of the biggest challenges in Orthodontics. Given the complexity of these cases, orthognathic surgery is often the best treatment option. However, many patients refuse this treatment due to its risks, morbidity, and costs involved. Alternatively, dental compensation can be planned for some of these skeletal problems. This case report presents a dentoalveolar compensation in the orthodontic treatment of a 20-year-old female patient with class III malocclusion, concave profile, anterior crossbite, mandibular prognathism, maxillary retrusion, and a vertical deficiency in the posterior region. Treatment planning involved a multiloop edgewise archwire (MEAW) associated with intermaxillary elastics with counterclockwise rotation of the occlusal plane in the posterior region of the maxilla aiming at obtaining an increased posterior vertical dimension. After 24 months of treatment, the severe anterior crossbite was corrected, and the skeletal class III relationship was camouflaged. At the end of the orthodontic treatment, it was possible to observe an improved facial profile, a nice smile, and a functional occlusion. The results remained stable at a three-year follow-up. The MEAW, associated with the use of elastics, seems to be an effective treatment option for class III camouflage with reduced posterior vertical dimension with no need for additional anchoring devices but requiring adequate bending of wires and patient compliance.

Complex clinical case with Class III and open bite: stability after seven years

A healthy 15-year-old boy with anterior open bite, edge-to-edge transverse discrepancy, and Class III skeletal relationship sought a nonsurgical orthodontic treatment. The patient was treated with premolars extraction, a Hyrax expander and intrusion mechanics with vertical elastics. This mechanics allowed for excellent facial and occlusal results. The final occlusion presented Class I molar and canine relationships, ideal overjet and overbite, and straight facial profile. Analysis of the posttreatment and follow-up radiographs showed that the treatment outcomes remained stable seven years after active orthodontic treatment. Thus, although combined orthodontic and surgical treatment should be considered for patients with this skeletal malocclusion, this case report proves that well controlled orthodontic movement with the patient's cooperation can be a valid alternative treatment, with good and stable outcomes for patients who refuse surgery.

CBCT Analysis of Changes in Dental Occlusion and Temporomandibular Joints before and after MEAW Orthotherapy in Patients with Nonlow Angle of Skeletal Class III

This study focus on the changes of the position and morphology of jaw and condyle after MEAW (the multiloop edgewise arch wire) treatment in adults with a nonlow angle (mean angle or high angle SN − MP > 27°) of skeletal class III (mild to moderate skeletal classs III means −5° < ANB < 0°) malocclusions measured by CBCT (cone beam computed tomography). Twenty adult patients (aged 17-26) with a nonlow angle of skeletal class III malocclusions were selected in this study taken orthodontic treatment by MEAW. CBCT was taken before and after the treatment to analyze the changes of the jaw and condyle. After treatment, the angle of L7-MP decreased 12.2°, L6-MP decreased 10.5°, L1-MP decreased 8.8° (P < 0.001 for each) and U1-SN increased (P < 0.05). There was no significant changes between anterior and posterior APDI index and between anterior and posterior spaces of the TMJ (temporomandibular joint) (P > 0.05). The linear ratio of the TMJ was the LR > 12 before treatment, while it was −12 < LR < 12 after treatment; however, there was no statistically significant difference between them (P > 0.05). There was also no significant change in anterior and posterior position and morphology of the condyle within the joint fossa after the treatment by MEAW in this study. MEAW technology in correcting the class III with nonlow angle patients mainly relies on the compensation of distally and posterior mandibular teeth, rather than the mandible and condyle moving backward to establish a neutral occlusal. This study was approved by the institutional ethics committee of the Second Hospital of Tianjin Medical University (No. KYJJ2013002).

Three-dimensional evaluation of open-bite patients treated with anterior elastics and curved archwires

INTRODUCTION

One nonsurgical treatment method for a patient with open bite is to use curved nickel-titanium arches and anterior elastics. The aim of this study was to investigate the effects of this technique with cone-beam computed tomography.

METHODS

Eighteen open-bite patients' treatment records were used for this retrospective study. The treatment methods were identical for all patients, beginning with the levelling and alignment of the teeth and the placement of maxillary accentuated and mandibular reverse curved archwires with anterior elastics. Cone-beam tomography images were taken and analyzed 3 dimensionally. The paired-samples t test statistical analysis was performed.

RESULTS

A-point moved anteriorly (0.33 mm) and the SN-MP angle increased slightly (1.17°). Maxillary and mandibular incisors were extruded by 2.16 and 1.49 mm, respectively. Overbite increased (4.38 mm). There were no significant changes in the vertical parameters of the premolars and molars.

CONCLUSIONS

The open bite was eliminated by retraction and extrusion of the anterior teeth while maintaining the vertical positions of the molars.

Efficiency of class III malocclusion treatment with 2-premolar extraction and molar distalization protocols

INTRODUCTION

Different treatment protocols have been implemented for management of Class III malocclusion with aim of achieving ideal occlusal goals. The aim of current study was to compare the efficiency of Class III treatment with mandibular 2-premolar extraction and mandibular molar distalization protocol.

METHODS

This retrospective cross sectional study was conducted on pre-treatment and post-treatment dental casts of 60 orthodontic patients who had Class III malocclusion and were treated with a mandibular dentition distalization and mandibular 2-premolars extraction protocol. The study was conducted at orthodontic departments of Dental Section, Faisalabad Medical University/Punjab Medical College and de'Montmorency College of Dentistry, Pakistan. The sample was classified into 2 groups. Group A consisted of 30 patients (20 females, 10 males) (mean age, 18.02years) treated with distalization protocol and Group B consisted of 30 patients (18 females, 12 males) (mean age, 18.97years) treated with mandibular 2-premolars extraction protocol. To compare the efficiency of the treatment protocol in each group, the initial and final occlusal results were assessed on dental models using PAR index while treatment efficiency was assessed using a treatment efficiency index (TX). The groups were compared with t and Mann-Whitney tests.

RESULTS

There were no significant differences in the initial age, treatment time, treatment efficiency and any occlusal feature between the groups.

CONCLUSION

Treatment efficiency of Class III malocclusions with mandibular 2-premolar extractions or mandibular dentition distalization protocol is similar.

Orthodontic Clockwise Rotation of Maxillomandibular Complex for Improving Facial Profile in Late Teenagers with Class III Malocclusion: A Preliminary Report

Objective

Orthodontic camouflage treatments improve occlusion but might worsen facial profile in patients with Class III malocclusion. It has been reported that surgical clockwise rotation of maxillomandibular complex (MMc) improves facial profile by reducing chin prominence and chin throat length in patients with Class III malocclusion. The purpose of this report was to illustrate two orthodontic techniques for clockwise rotation of the MMc in late teenagers with Class III malocclusion and preliminarily evaluate their clinical effects.

Patients and Methods

Six patients in late teenage with Class III malocclusion were included in this preliminary report. Bite raisers were first placed on the upper molars to open the bite and clockwise rotate the mandible. Intermaxillary elastics were then applied vertically between the upper and lower dentitions in 3 patients for bimaxillary extrusion (Technique-1) or between the upper dentition and the lower temporary anchorage devices (TADs) in another 3 patients (Technique-2) for upper dentition extrusion and closure of the anterior open bite. The three-dimensional cone-beam computed tomography images taken before and after orthodontic treatment were superimposed to evaluate the treatment effects of MMc clockwise rotation for both techniques.

Results

The Technique-1 extruded the upper and lower dentitions, rotated the mandible clockwise 2.01°, moved chin down 2.98 mm, and back −1.64 mm, although the mandible grew 2.47 mm during the treatment period. The Technique-2 extruded the upper dentition, rotated the mandible clockwise 0.90°, moved chin down 1.78 mm, but slightly forward 0.47 mm due to the mandible grew 2.50 mm and lower dentition was not extruded.

Conclusions

The orthodontic clockwise rotation of MMc is an effective technique for orthognathic camouflage. The applications of bite raisers and bimaxillary dentition extrusion could be more effective than single dentition extrusion with TADs in the mandible for clockwise rotation of MMc and improvement of occlusion and facial profile in late teenagers with Class III malocclusion. However, the comprehensive clinical effects and long-term stability need further clinical studies.

Is alternate rapid maxillary expansion and constriction an effective protocol in the treatment of Class III malocclusion? A systematic review

Introduction:

the treatment of Class III malocclusion in early age is one of the greatest challenges for orthodontists, and the establishment of more effective treatment method is a constant concern for these professionals. Thus, the objective of this systematic review is to verify the effectiveness of the therapy protocol for alternate rapid maxillary expansion and constriction (Alt-RAMEC) in the early treatment of Class III malocclusion.

Methods:

searches were performed in the following electronic databases: Cochrane Library, Medline (EBSCO and PubMed), SciELO, LILACS and Scopus. The following inclusion criteria were used: in vivo studies conducted with early intervention (patient in craniofacial development phase) with the use of the Alt-RAMEC protocol. Reviews, case reports, editorials, and studies with syndromic patients or under use of systemic drug were excluded. Duplicates were also excluded. The studies were assessed for methodological quality using the Cochrane tool for assessment of risk of bias, and classified as high or low risk of bias.

Results:

53 articles were found. Duplicates exclusion was thus performed and 35 articles remained. After inclusion analysis, only 5 matched the criteria. Two articles were classified as low risk of bias and three as high risk of bias. It was observed that the Alt-RAMEC enable protraction in less time and with better results, promoting greater effectiveness in the protraction treatment of Class III malocclusion.

Conclusions:

Although there is positive evidence of the effectiveness of early treatment with the Alt-RAMEC protocol in patients with Class III malocclusion, further studies are needed to confirm its effectiveness using long-term methodology.

Treatment of Class III Malocclusion: Atypical Extraction Protocol

The treatment of Angle Class III malocclusion is rather challenging, because the patient's growth pattern determines the success of long-term treatment. Early diagnosis and treatment are still highly discussed issues in orthodontic literature. This type of early intervention has been indicated more frequently in order to eliminate primary etiological factors and prevent an already present malocclusion from becoming severe. However, when a patient is diagnosed in adulthood, manipulation of the bone bases becomes extremely limited, as there is no longer any potential for growth. Treatments are restricted to dental compensations when possible or orthognathic surgery. However, owing to the high cost and inherent risk of the surgical procedure, this treatment option is often denied by the patient; in such a case, the orthodontist has little choice but to perform, where possible, compensatory treatments to restore a functional occlusion and improve facial esthetics. This article reports a case of Class III malocclusion in a patient who opted for compensatory treatment with lower molar extraction that allowed for correction of the midline and the overjet. Good facial esthetics and functional normal occlusion were achieved at the end of the treatment.

Compensation of skeletal Class III malocclusion by isolated extraction of mandibular teeth: Part 2: Skeletal, dentoalveolar and soft tissue parameters in comparison with nonextraction Class III therapies

OBJECTIVES

To retrospectively compare two compensatory approaches taken in skeletal Class III patients during the main treatment stage, including a study group of multiband treatment plus isolated extraction of mandibular teeth and a control group of multiband treatment without extraction of teeth.

PATIENTS AND METHODS

The extraction group included 22 (12 female, 10 male) patients receiving compensatory multiband treatment for a mean of 3.47 ± 1.14 years and 16.22 ± 1.92 years old at debonding. The nonextraction group included 24 (14 female, 10 male) patients undergoing multiband treatment for 2.76 ± 1.28 years and 15.38 ± 1.46 years old at debonding. Lateral cephalograms obtained at baseline and upon completion of active treatment were traced for skeletal, dentoalveolar, and soft tissue parameters. Welch and Wilcoxon tests were used to analyze intergroup differences (initial values, final values, initial-to-final changes) and within-group differences (p < 0.05).

RESULTS

Upon completion of active treatment, the only significant intergroup differences were noted for U1NA and L1ML. Significant within-group changes over the courses of treatment were seen for SNB, MLNL, U1NA, U1NL, L1NB, L1ML, H-angle, ULipEL, and LLipEL (extraction group) or for SNB, ANB, individual ANB, Wits appraisal, U1NA, U1NL, H-angle, Naslab-a, ULipEL, and LLipEL (nonextraction group). Parameters that changed by significantly different amounts in both groups included Wits appraisal, L1NB, L1ML, and LLipEL.

CONCLUSION

The added value of isolated extraction therapy basically lies in increasing the potential for retruding the lower incisor inclinations, so that compensatory treatment becomes an option even in selected patients presenting with adverse occlusal situations that would otherwise require orthognathic surgery. Given the successful outcomes in both groups, which had been established by Peer Assessment Rating (PAR) scores, it was possible to define the skeletal, dentoalveolar, and soft tissue characteristics of successful treatment more precisely than before.

Dental compensation for skeletal Class III malocclusion by isolated extraction of mandibular teeth. Part 1: Occlusal situation 12 years after completion of active treatment

OBJECTIVES

The purpose of this work was to statistically evaluate the outcomes achieved by isolated extraction of mandibular teeth (second premolars or first molars) for Class III compensation.

MATERIALS AND METHODS

Part A of the study dealt with the quality of outcomes at the end of active treatment, using weighted Peer Assessment Rating (PAR) scores determined on the basis of casts for 25 (14 female and 11 male) consecutive patients aged 16 ± 1.7 years at the time of debonding. These results were compared to the scores in a randomly selected control group of 25 (14 female and 11 male) patients who were 14.7 ± 1.9 years old at debonding. Part B evaluated the long-term stability of the outcomes based on 12 (all of them female) patients available for examination after a mean of 11.8 years. The mean weighted PAR scores obtained in both study parts were analyzed for statistical differences using a two-tailed paired Student's t-test at a significance level of p ≤ 0.05.

RESULTS

Mean weighted PAR scores of 4.76 ± 3.94 and 3.92 ± 3.44 were obtained in the Class III extraction group and the control group, respectively, at the end of active treatment. This difference was not significant (p = 0.49). Among the 12 longitudinal patients, the mean score increased from 4 ± 3.46 at debonding to 6.25 ± 3.67 by the end of the 11.8-year follow-up period. This difference was significant (p = 0.0008).

CONCLUSION

Treatment of Class III anomalies by isolated extraction of lower premolars or molars can yield PAR scores similar to those achieved by standard therapies. These scores, while increasing significantly, remained at a clinically acceptable level over 11.8 years. Hence this treatment modality--intended for cases that border on requiring orthognathic surgery--may also be recommended from a long-term point of view.

A Mini-review on the Effect of Mini-implants on Contemporary Orthodontic Science

The purpose of this literature review was to screen the valuable published articles regarding to the impacts of mini-implants on orthodontic science, briefly. The searching category was performed on the Pubmed using MeSH words such as "dental (mini) implants, orthodontic anchorage procedures, and orthodontic appliances." After preliminary sketch, they were grouped as follow: Those evaluating (a) common appliances for providing orthodontic anchorage, (b) biomechanical details of mini-implants and their insertion, (c) clinical application of mini-implants for orthognathic treatments, (d) limitations and possible complications. In conclusion, mini-implant evolved the orthodontic treatment plans and compromised the required orthognathic surgery. Malocclusion treatment and pure orthodontic or orthopedic movements in the three-dimensions have become recently possible by using mini-implant to provide skeletal anchorage.

Compensatory orthodontic treatment for maxillary deficiency: a 4-year follow-up

In this article, we report the orthodontic treatment of a boy (age 12 years 9 months) who had a midface deficiency, a concave facial profile with maxillary retrusion, a complete crossbite (anterior and posterior), and the maxillary right canine retained in the alveolus. Rapid maxillary expansion was performed followed by complete orthodontic treatment with fixed appliances combined with Class III elastics and anterior vertical elastics. Time was allowed to elapse until growth was virtually over before removing the fixed appliances (at age 18 years 4 months), and no retainer of any type was used. As a result of treatment, significant improvement was noted in his facial appearance, with a proper maxillomandibular relationship, total correction of the maxillary atresia, and satisfactory overjet and overbite. The results remained stable at the 4-year follow-up. Therefore, it can be argued that the use of Class III elastics combined with rapid maxillary expansion has a beneficial effect in the treatment of transverse and sagittal maxillary deficiency in growing patients. Excellence in how the treatment was finished and discontinuation of treatment and control in the final stages of growth contributed to the stability of the final results.

Camouflage treatment of skeletal class III malocclusion with asymmetry using a bone-borne rapid maxillary expander

This case report presents the successful use of palatal mini-implants for rapid maxillary expansion and mandibular distalization in a skeletal Class III malocclusion. The patient was a 13-year-old girl with the chief complaint of facial asymmetry and a protruded chin. Camouflage orthodontic treatment was chosen, acknowledging the possibility of need for orthognathic surgery after completion of her growth. A bone-borne rapid expander (BBRME) was used to correct the transverse discrepancy and was then used as indirect anchorage for distalization of the lower dentition with Class III elastics. As a result, a Class I occlusion with favorable inclination of the upper teeth was achieved without any adverse effects. The total treatment period was 25 months. Therefore, BBRME can be considered an alternative treatment in skeletal Class III malocclusion.

Molar heights and incisor inclinations in adults with Class II and Class III skeletal open-bite malocclusions

INTRODUCTION

The aim of this research was to compare maxillary and mandibular molar heights and incisor inclinations in patients with skeletal open-bite Class II, patients with skeletal open-bite Class III, and an untreated control group.

METHODS

Pretreatment lateral cephalograms of 70 orthodontic patients (34 men, 36 women) between 16 and 40 years of age were examined. The sample was divided into 3 groups according to facial growth pattern and overbite. The control group (n = 25) included normodivergent Class I subjects with adequate overbite; the skeletal open-bite Class II group (n = 25) and the skeletal open-bite Class III group (n = 20) included hyperdivergent Class II or Class III subjects with negative overbite. Measurements considered were ANB angle, palatal and mandibular plane angles, maxillary incisor palatal plane angulation, and mandibular incisor mandibular plane angulation, as well as the distance from the palatal or the mandibular plane to the mesial cusp of the molars. Multivariate analysis of covariance and multivariate analysis of variance tests were used to determine the differences between the groups, followed by the Tukey post-hoc test. Additionally, the Mann-Whitney U test and Kruskall-Wallis test were performed.

RESULTS

Significant differences in molar height were found (P <0.001). A 4-mm difference in maxillary molar height between the skeletal open-bite and control groups was found. Mandibular molar height was greater in the skeletal open-bite Class II group (P <0.001). Maxillary incisor palatal plane angulation was greater in the skeletal open-bite Class III group by approximately 6°. Mandibular incisor to mandibular plane angulation was 10° more lingual in the skeletal open-bite Class III group (P <0.001).

CONCLUSIONS

The skeletal open-bite groups had greater molar heights than did the control group. The skeletal open-bite Class II group had more eruption of the mandibular molars. The maxillary incisors were more proclined and the mandibular incisors were more lingual in the skeletal open-bite Class III group.