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Kwon TG, Elnagar MH, Shirazi S, Goben AH, Miloro M, Han MD. Orthodontic correction of anterior open bite using skeletal anchorage: systematic review and meta-analysis. Int J Oral Maxillofac Surg 2024; 53:393-404. [PMID: 37949782 DOI: 10.1016/j.ijom.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
The purpose of this study was to investigate the scientific evidence on the short- and long-term effects of orthodontic correction of anterior open bite (AOB) using skeletal anchorage (SA). Clinical studies on the use of SA for AOB in patients with permanent dentition, or at least 12 years of age, were searched. Short- and long-term (≥2 years) outcomes were collected. Mean differences were calculated from pooled data. Twenty-four eligible articles with a total of 362 subjects were selected for inclusion in the meta-analysis. There was a significant increase in overbite (3.88 mm, P < 0.001) and maxillary molar intrusion (-2.15 mm, P < 0.001). The mandible showed counterclockwise rotation with anterosuperior chin movement (all P < 0.001). Long term, the decrease in overbite was 19.9% and decrease in molar intrusion was 22.9%. The decrease in the mandibular projection was 14.6% for ANB (A-point-nasion-B-point angle) and 46.2% for mandibular anteroposterior position. The overall risk of bias in the included studies was rated as moderate to high, and publication bias existed for several key variables. SA for maxillary molar intrusion effectively improved dental and skeletal outcomes, but there was a long-term decrease in overbite and maxillary molar position. The variable data quality, heterogeneity, and publication bias in investigated outcomes are limitations in interpreting the findings.
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Affiliation(s)
- T-G Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, South Korea
| | - M H Elnagar
- Department of Orthodontics, University of Illinois Chicago, College of Dentistry, Chicago, IL, USA
| | - S Shirazi
- Virginia Commonwealth University, School of Dentistry, Richmond, VA, USA
| | - A H Goben
- Library of the Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - M Miloro
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, College of Dentistry, Chicago, IL, USA
| | - M D Han
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, College of Dentistry, Chicago, IL, USA.
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Chamberland S, Nataf N. Noninvasive conservative management of anterior open bite treated with TADs versus clear aligner therapy. Clin Oral Investig 2024; 28:236. [PMID: 38556610 DOI: 10.1007/s00784-024-05634-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 03/23/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES Anterior open bite can be treated non-surgically via molar intrusion using temporary skeletal devices (TAD). Clear aligner therapy (CAT) is recognized as a viable therapeutic modality for non-extraction treatment of adults with mild open bite. This study aimed to compare the treatment effect and mechanisms of open bite closure between patients treated with braces and TADs double arch intrusion and those treated with CAT. Treatment success at T3 was based on 1- positive overbite on ceph; 2- Change in the vertical dimension 3- post treatment POSI score equal to zero. MATERIAL AND METHODS The TAD group includes 18 consecutively treated patients from the main author. The CAT group consisted of 16 selected patients from three different orthodontists. The observation time points were as follows: pretreatment (T1), end of molar intrusion and positive overbite achieved (T2), end of treatment (T3), at least 6-month follow-up (T4). Treatment changes were assessed by cephalometric analysis and frontal intraoral photo. RESULTS At the end of treatment, 100% of the patient of the TAD group and 78,6% of the CAT group had a posi score of 0. The TAD group showed a significant reduction in vertical measurements (SN-MPA: -1,55° ± 0.41, LAFH: -3,05 ± 0.51 mm, U6-PP: -1.48 ± 0.30 mm), but the CAT group did not have significant changes for these variables. Both groups had significant increases in overbite from T1 to T3 (TAD: 4,32 ± 0,5 mm; CAT: 2,33 ± 0.56 mm), and overbite remained stable at T4. The CAT group did not have a significant upper molar intrusion, but a significant extrusion of 1.22 ± 0.42 mm of the lower incisor occurred. CONCLUSION The TAD group achieved bite closure by upper molar intrusion, lower molar and incisors vertical control, and mandibular plane counterclockwise rotation, resulting in an improved AP and vertical relationship. The CAT group achieved bite closure through the lower incisor extrusion without significant change in the vertical dimension. CLINICAL RELEVANCE This study provides relevant information about the skeletal and dental changes of open bite treatment with TADs double arch intrusion. The comparison with a control group treated with CAT confirms known information.
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Hsu LF, Liu YJ, Wang SH, Chen YJ, Chen YJ, Yao CCJ. Orthodontic correction of acquired open bite with TMJ degeneration: A retrospective study of outcomes and stability. J Formos Med Assoc 2024; 123:452-460. [PMID: 37865535 DOI: 10.1016/j.jfma.2023.10.006] [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: 03/10/2023] [Revised: 08/15/2023] [Accepted: 10/02/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND/PURPOSE Newly developed temporary anchorage devices (TADs) serve a strong orthodontic anchorage to intrude molars for correction of anterior open bite (AOB). We measured cephalometric changes in skeletal open bite patients which developed subsequently to temporomandibular joint disorders with bilateral point contacts at terminal molars. METHODS We retrospectively recruited 32 patients who had been treated their TMD before orthodontic correction (overbite: -3.14 ± 1.86 mm). Partial orthodontic appliances were used to intrude posterior teeth using TADs until positive OB obtained (T1). Full fixed appliances were then used to achieve proper overjet and overbite (T2). We collected lateral cephalograms before (T0), during (T1) and after (T2) treatment, and at follow-ups (T3). Using ANOVA, we analyzed the differences among these time points to determine treatment changes and stability of orthodontic results. RESULTS In this group predominantly comprising young adult women, orthodontic treatment with TADs significantly reduced upper posterior dental heights (T2-T0:-1.84 ± 0.66 mm) and facilitated the retraction and uprighting upper incisors (T2-T0: -9.92 ± 1.72°), to achieve appropriate OJ (T2-T0: -3.21 ± 0.49 mm) and OB (T2-T0: 4.10 ± 0.28 mm) with p < 0.05. Except upper posterior dental height, most of cephalometric changes including OJ, OB, and upper incisal axis remained significant at follow-ups with retention time of 3.7 ± 2.6 years. Only three out of 30 patients experienced small amount of open bite at T3. CONCLUSION Orthodontic correction of OJ remained relatively stable among 90 % of patients with TMJ degeneration by intrusion via TADs. This modern but conservative orthodontic approach can improve occlusal functions in skeletal open bites.
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Affiliation(s)
- Li-Fan Hsu
- Department of Dentistry, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yi-Jen Liu
- Division of Orthodontics and Dentofacial Orthopedics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Yunn-Jy Chen
- Division of Prosthetics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Jane Chen
- Division of Orthodontics and Dentofacial Orthopedics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan; Faculty of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Division of Orthodontics and Dentofacial Orthopedics, Dental Department, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.
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Bian C, Bai Y, Zhang N. Adult female skeletal anterior open bite treated by customized lingual orthodontic appliance with miniscrews-assisted in vertical control for perfect orthodontic compensation: A case report with 5-year follow-up. Int Orthod 2024; 22:100820. [PMID: 37952500 DOI: 10.1016/j.ortho.2023.100820] [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: 09/20/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023]
Abstract
The benefits of lingual orthodontics go beyond appearance. In this case study, a 30-year-old female patient was treated with a custom lingual orthodontic appliance for a Class II high-angle malocclusion, anterior open bite, incisor biprotrusion and crossbite, unilateral second molar scissor bite and dysfunctional tongue thrust. To achieve a counterclockwise rotation of the mandible, implant anchorage was used to control the vertical height. To complete the compensatory therapy, four first premolars were removed. As well as ensuring aesthetics over the 20-month treatment period, the treatment also established a Class I molar relationship, normal overbite and overjet, and improved the facial profile. After a five-year follow-up, the treatment results remained stable.
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Affiliation(s)
- Ce Bian
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Yuxing Bai
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Ning Zhang
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China.
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Choi YJ, Suh H, Park JJ, Park JH. Anterior open bite correction via molar intrusion: Diagnosis, advantages, and complications. J World Fed Orthod 2024; 13:2-9. [PMID: 38185583 DOI: 10.1016/j.ejwf.2023.12.006] [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: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 01/09/2024]
Abstract
Anterior open bite can be effectively treated nonsurgically via molar intrusion. This technique, involving the intrusion of posterior teeth using temporary skeletal anchorage devices, prompts counterclockwise rotation of the mandible. This rotation not only corrects anterior open bite but also contributes to a decrease in anterior facial height, improvements in lip incompetency, and forward movement of the chin. For successful outcomes, temporary skeletal anchorage devices, installed on both the buccal and palatal sides, must deliver equivalent intrusion force to the maxillary teeth. Treatment planning should consider factors such as skeletal discrepancies, vertical excess, incisor exposure, and configuration of the occlusal plane. Clinicians are advised to closely monitor periodontal changes and consider overcorrection to ensure lasting stability and maintenance of incisal overlap post-treatment.
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Affiliation(s)
- Yoon Jeong Choi
- Professor, Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea; Visiting Scholar, Division of Plastic and Reconstructive Surgery, Department of Surgery, Pediatric Craniofacial and Airway Orthodontics and Dental Sleep Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California
| | - Heeyeon Suh
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California
| | - Jung Jin Park
- Department of Orthodontics, Dental Hospital, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jae Hyun Park
- Professor and Chair, Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Arizona; International Scholar, Graduate School of Dentistry, Kyung Hee University, Seoul, Korea.
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Lee J, Choi YJ, Park JH, Chung CJ, Lee JH, Kim KH. Surgical vs nonsurgical treatments in patients with anterior open-bite have similar effects in occlusal function: A 2-year follow-up study. Am J Orthod Dentofacial Orthop 2024; 165:38-45. [PMID: 37665311 DOI: 10.1016/j.ajodo.2023.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION This study aimed to investigate changes in bite force (BF) and occlusal contact area after anterior open-bite (AOB) treatment and compare the changes in surgical vs nonsurgical treatment. METHODS This retrospective study included patients with AOB compared with normal occlusion. AOB was corrected by either intrusion of the maxillary molars (intrusion group, n = 19) or orthognathic surgery (surgery group, n = 37). The control group (n = 35) had a normal overbite relationship. Records of lateral cephalograms, BF, and occlusal contact area taken before (T0), immediately after (T1), and 2 years after (T2) orthodontic treatment were compared within and among the 3 groups. RESULTS The open-bite group, including intrusion and surgery groups, had a lower BF and less occlusal contact area than the control group at T0 and T1 (P <0.001). However, there were no significant differences among the 3 groups at T2 (P >0.05). The intrusion and surgery groups showed no significant differences throughout the observation period extending from T0 to T2 (P >0.05). Although BF and occlusal contact area decreased at T1 compared with T0, they increased during retention and showed higher values at T2 than at T0. CONCLUSIONS Treatment of AOB improved BF and occlusal contact area 2 years posttreatment. Orthognathic surgery and molar intrusion using orthodontic miniscrews can improve occlusal function similarly. Orthodontists can select either method depending on malocclusion severity and patient demand.
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Affiliation(s)
- Joongoo Lee
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Yoon Jeong Choi
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz
| | - Chooryung J Chung
- Department of Orthodontics, Gangnam Severance Dental Hospital, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ji-Hyun Lee
- Department of Orthodontics, Gangnam Severance Dental Hospital, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Kyung-Ho Kim
- Department of Orthodontics, Gangnam Severance Dental Hospital, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea.
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Omidkhoda M, Bardideh E, Jahanbin A, Zarei M. Effects of posterior intrusion using skeletal anchorage on treating anterior open bite: A systematic review and meta-analysis. J Dent Res Dent Clin Dent Prospects 2023; 17:196-210. [PMID: 38584993 PMCID: PMC10998167 DOI: 10.34172/joddd.2023.40754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/02/2023] [Indexed: 04/09/2024] Open
Abstract
Background Posterior intrusion with skeletal anchorage is one of the effective methods in the treatment of anterior open bite. Knowing the effects of posterior intrusion, the amount of possible molar intrusion using skeletal anchorage, and its impact on clinical and cephalometric indicators can help the clinician choose the optimal treatment method, especially in borderline surgical cases. Methods In this systematic review, a series of articles were collected through a systematic search in databases, and the titles and summaries of all these articles were reviewed. After removing the irrelevant articles, the full texts of the related articles were read carefully, and their validity was evaluated. Only RCTs and observational studies that complied with PICO questions were included. The Cochrane Risk of Bias 2.0 (RoB 2), ROBINS-I, and GRADE were used to assess the risk of bias in the included studies. The relevant information on selected articles was extracted, and a meta-analysis was performed with Review Manager 5.4 software. Results The meta-analysis revealed a significant average molar intrusion of 2.89 mm using temporary anchorage devices (TADs). A subgroup analysis showed that miniplates achieved greater intrusion (3.29 mm) compared to miniscrews (2.25 mm) (P=0.03). The level of applied force did not significantly affect the degree of intrusion. Dental parameters such as overbite and overjet were notably altered, with overbite increasing by 4.81 mm and overjet decreasing by 2.06 mm on average. As for the skeletal cephalometric characteristics, SNB, ANB, and SN-Pog increased while mandibular plane angle and lower anterior facial height (LAFH) decreased, and these changes were significant. Meanwhile, SNA and palatal angle changes were not significant. Conclusion TADs have proved effective in achieving significant intrusion of maxillary molars, leading to marked improvements in dental and skeletal characteristics in patients with open bite malocclusion. Miniplates proved more effective in achieving greater intrusion.
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Affiliation(s)
| | | | | | - Milad Zarei
- Department of Orthodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Le Y, Li F, Wu S, Li M, Zhu C, Wan Q. Influence of differences in mandibular incisor inclination on skeletal stability after orthognathic surgery in patients with skeletal Class III malocclusion. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 125:101747. [PMID: 38141825 DOI: 10.1016/j.jormas.2023.101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/10/2023] [Accepted: 12/20/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE The preoperative inclination angle of mandibular incisors was crucial for surgical and postoperative stability while the effect of proclined mandibular incisors on skeletal stability has not been investigated. This study aimed to evaluate the effects of differences in presurgical mandibular incisor inclination on skeletal stability after orthognathic surgery in patients with skeletal Class III malocclusion. METHODS A retrospective cohort study of 80 consecutive patients with skeletal Class III malocclusion who underwent bimaxillary orthognathic surgery was conducted. According to incisor mandibular plane angle (IMPA), patients were divided into 3 groups: retroclined inclination (IMPA < 87°), normal inclination (87° ≤ IMPA < 93°) and proclined inclination (IMPA ≥ 93°). Preoperative characteristics, surgical changes and postoperative stability were compared based on lateral cephalograms obtained 1 week before surgery (T0), 1 week after surgery (T1), and at 6 to 12 months postoperatively (T2). RESULTS The mandible demonstrated a forward and upward relapse in all three groups. No significant differences in skeletal relapse were observed in the 3 groups of patients. However, the proclined inclination group showed a negative overbite tendency postoperatively compared with the other two groups and a clinically significant mandibular relapse pattern. Proclined IMPA both pre- and postoperatively was correlated with mandibular relapse. CONCLUSION Sufficient presurgical mandibular incisor decompensation was of crucial importance for the maintenance of skeletal stability in patients with skeletal Class III malocclusion who subsequently underwent orthognathic surgery.
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Affiliation(s)
- Yushi Le
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University; Department of Orthognathic & Cleft Lip and Palate Plastic Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Feng Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University; Department of Orthognathic & Cleft Lip and Palate Plastic Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Shuxuan Wu
- Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Mingjuan Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University; Department of Orthognathic & Cleft Lip and Palate Plastic Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Chongjie Zhu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University; Department of Orthognathic & Cleft Lip and Palate Plastic Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qilong Wan
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University; Department of Orthognathic & Cleft Lip and Palate Plastic Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
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Kumar V, Verma RK, Singh SP, Verma S. Regarding mini-implant-assisted posterior intrusion. Am J Orthod Dentofacial Orthop 2023; 164:308-309. [PMID: 37634926 DOI: 10.1016/j.ajodo.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/25/2023] [Indexed: 08/29/2023]
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Theodoridou MZ, Zarkadi AE, Zymperdikas VF, Papadopoulos MA. Long-term effectiveness of non-surgical open-bite treatment: a systematic review and meta-analysis. Prog Orthod 2023; 24:18. [PMID: 37258750 DOI: 10.1186/s40510-023-00467-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/31/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The etiology of open bite is complex, involving various genetic or environmental factors. Several treatment alternatives have been suggested for the correction of open bite, yet their long-term effectiveness remains controversial. OBJECTIVE To assess the long-term effectiveness of open-bite treatment in treated with non-surgical approaches versus untreated patients, through lateral cephalometric radiographs. SEARCH METHODS Unrestricted search of 16 electronic databases and manual searches up to November 2022. SELECTION CRITERIA Randomized or non-randomized controlled trials reporting on the long-term effects of open-bite treatment through angular lateral cephalometric variables. DATA COLLECTION AND ANALYSIS Only angular variables on lateral cephalometric radiographs were considered as primary outcomes. For each outcome, the mean differences and 95% confidence intervals were calculated using the random-effects model to consider existing heterogeneity. The revised Cochrane risk-of-bias tool (R.o.B. 2.0) and the risk-of-bias tool for non-randomized studies for interventions (ROBINS-I) were utilized for the randomized and non-randomized trials, respectively. RESULTS From the initially identified 26,527 hits, only 6 studies (1 randomized and 5 retrospective controlled trials) were finally included in this systematic review reporting on 244 open-bite individuals (134 patients and 110 untreated controls), while five of them were included in the meta-analyses, assessing either the interval ranging from treatment start to post-retention (T3-T1) or from end of treatment to post-retention period (T3-T2). Regarding the vertical plane, for the T3-T2 interval, no significant differences were found for the assessed skeletal measurements, indicating a relative stability of the treatment results. Similarly, with regard to the T3-T1 interval, no significant differences could be identified for the examined skeletal variables, implying that the produced effects are rather minimal and that the correction of the open bite was performed mainly through dentoalveolar rather than skeletal changes. Further, no significant changes could be identified regarding the inclination of the upper and lower incisors. Only the nasolabial angle was significantly reduced in the treated patients in the long term. CONCLUSIONS According to existing evidence, the influence of non-surgical treatment of open bite on the skeletal tissues and the inclination of the incisors is rather minimal in the long term, while only the nasolabial angle was significantly reduced.
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Affiliation(s)
- Maria-Zoi Theodoridou
- Department of Public Health, Faculty of Medicine, European University of Cyprus, Nicosia, Cyprus
| | - Athanasia-Eirini Zarkadi
- Department of Paediatric Dentistry, School of Dentistry, Scholl of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios F Zymperdikas
- Department of Orthodontics, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- Dental Department, 424 Military Hospital of Thessaloniki, Thessaloniki, Greece.
- Department of Midwifery, School of Health Sciences, University of Western Macedonia, Ptolemaida, Greece.
| | - Moschos A Papadopoulos
- Department of Orthodontics, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Huang ZW, Yang R, Gong C, Zhang CX, Wen J, Li H. Treatment of severe open bite and mandibular condyle anterior displacement by mini-screws and four second molars extraction: A case report. World J Clin Cases 2023; 11:3599-3611. [PMID: 37383903 PMCID: PMC10294191 DOI: 10.12998/wjcc.v11.i15.3599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/07/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Temporomandibular joint (TMJ) disorders are closely related to high-angle and skeletal Class II malocclusion. Sometimes pathological changes in the mandibular condyle can cause open bite to occur after growth is complete.
CASE SUMMARY This article is about the treatment of an adult male patient with a severe hyperdivergent skeletal Class II base, an unusual and gradually occurring open bite and an abnormal mandibular condyle anterior displacement. Because the patient refused surgery, four second molars with cavities and root canal therapy were extracted, and four mini-screws were used for intrusion of the posterior teeth. The treatment duration was 22 mo, and after the treatment, the open bite was corrected and the displaced mandibular condyles were seated back to the articular fossa as shown by cone-beam computed tomography (CBCT). Based on the patient’s open bite history, the result of clinical examinations and CBCT comparisons, we believe it is possible that the occlusion interference was eliminated after the four second molars were extracted and the posterior teeth were intruded, and the patient's condyle spontaneously returned to its physiologic position. Finally, a normal overbite was established, and stable occlusion was achieved.
CONCLUSION This case report suggested that identifying the cause of open bite is essential, and the TMJ factors for hyperdivergent skeletal Class II cases should be particularly examined. For these cases, intruding posterior teeth may place the condyle in a more appropriate position and provide an environment suitable for TMJ recovery.
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Affiliation(s)
- Zi-Wei Huang
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
| | - Ren Yang
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
| | - Cheng Gong
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
| | - Cai-Xia Zhang
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
| | - Juan Wen
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
| | - Huang Li
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
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Liu Y, Chen W, Wei Y, Zhang G, Zhang X, Sharhan HM, Cao B. The effect of orthodontic vertical control on the changes in the upper airway size and tongue and hyoid position in adult patients with hyperdivergent skeletal class II. BMC Oral Health 2022; 22:532. [PMID: 36424588 PMCID: PMC9686087 DOI: 10.1186/s12903-022-02580-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND At present, there are still controversies about the influence of orthodontic treatment on the size of upper airway and the position of hyoid bone. We investigated the effect of orthodontic vertical control therapy on the size of the upper airway and position of the tongue and hyoid bone in adult patients with hyperdivergent skeletal Class II. METHODS Overall, 15 adults with hyperdivergent skeletal Class II and normal occlusion, respectively, were selected as the experimental and control groups. The angle and line of the craniofacial structure, upper airway, hyoid bone position and three-dimensional (3D) upper airway indexes were measured using the Uceph 4.2.1 standard version and Mimics 21.0 software, respectively. The paired t-test, Wilcoxon symbol rank test, t-test of two independent samples, two independent sample nonparametric tests, Mann-Whitney U test, Pearson correlation analysis, the Univariate linear regression analysis and Multiple linear regression analysis were performed. RESULTS After treatment, the S-Go/N-Me (%) and the MP-SN and XiPm-SN angles were significantly different (P < 0.01). The U-MPW and PAS significantly increased (P < 0.05), sagittal diameter L2 increased significantly, and transverse diameter L2 decreased significantly (P < 0.01). Although no significant correlation was observed between the vertical change in the jaw and that in U-MPW and PAS, the sagittal diameter L2 showed a significant correlation (P < 0.05). The Multiple linear regression analysis showed that there was a significant negative correlation between the variables MP-SN and sagittal diameter L2 and positive correlation between S-Go/N-Me(%) and H-MP (P < 0.05). Furthermore, significant differences between the Hv (P < 0.01) and sagittal diameter L1(P < 0.05) were observed before and after treatment. CONCLUSIONS After the orthodontic vertical control therapy in patients with hyperdivergent skeletal Class II, the upper airway only underwent adaptive changes during treatment without substantial size changes, the position of tongue body and hyoid bone did not change significantly. Furthermore, compared with normal occlusion, the velopharyngeal segment airway of patients with hyperdivergent skeletal Class II remains narrow and long after treatment.
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Affiliation(s)
- Yining Liu
- grid.32566.340000 0000 8571 0482School/Hospital of Stomatology Lanzhou University, No. 222, Tianshui South Road, Chengguan District, Lanzhou, 730000 Gansu Province China
| | - Wenyuanfeng Chen
- grid.32566.340000 0000 8571 0482School/Hospital of Stomatology Lanzhou University, No. 222, Tianshui South Road, Chengguan District, Lanzhou, 730000 Gansu Province China
| | - Yu Wei
- grid.32566.340000 0000 8571 0482School/Hospital of Stomatology Lanzhou University, No. 222, Tianshui South Road, Chengguan District, Lanzhou, 730000 Gansu Province China
| | - Guorui Zhang
- grid.32566.340000 0000 8571 0482School/Hospital of Stomatology Lanzhou University, No. 222, Tianshui South Road, Chengguan District, Lanzhou, 730000 Gansu Province China
| | - Xinzhu Zhang
- grid.32566.340000 0000 8571 0482School/Hospital of Stomatology Lanzhou University, No. 222, Tianshui South Road, Chengguan District, Lanzhou, 730000 Gansu Province China
| | - Hasan M. Sharhan
- grid.32566.340000 0000 8571 0482School/Hospital of Stomatology Lanzhou University, No. 222, Tianshui South Road, Chengguan District, Lanzhou, 730000 Gansu Province China
| | - Baocheng Cao
- grid.32566.340000 0000 8571 0482School/Hospital of Stomatology Lanzhou University, No. 222, Tianshui South Road, Chengguan District, Lanzhou, 730000 Gansu Province China
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Vertical Control of a Severe Hyperdivergent Skeletal Class II Malocclusion with Steep Posterior Occlusal Plane in a Camouflage Case. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091217. [PMID: 36143895 PMCID: PMC9502811 DOI: 10.3390/medicina58091217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022]
Abstract
Severe hyperdivergent skeletal Class II malocclusion may be ideally treated with orthognathic surgery in adult patients. Here, we report a camouflage treatment of a 23-year-old female patient. She was diagnosed with a skeletal Class II malocclusion with extreme high mandibular plane angle, retrusive mandible, steep posterior occlusal plane, anterior open bite, and severe overjet. The treatment plan included extraction of all second premolars and intrusion of the maxillary anterior teeth and mandibular posterior teeth using miniscrews. These contributed to an effective counterclockwise rotation of the mandible, decreased lower face height, and improvement in anterior overbite. This case report shows a vertical control strategy on severe hyperdivergent skeletal Class II malocclusions, which achieves well-controlled sagittal and vertical dimensions and a favorable facial appearance. The treatment and retention results were well balanced and aesthetically pleasing.
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Intrusion of Maxillary Posterior Teeth by Skeletal Anchorage: A Systematic Review and Case Report with Thin Alveolar Biotype. J Clin Med 2022; 11:jcm11133787. [PMID: 35807072 PMCID: PMC9267289 DOI: 10.3390/jcm11133787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
This study aimed to review the literature related to the intrusion of maxillary posterior teeth in subjects needing pre-prosthetic restoration or orthodontic treatment due to anterior open bite, and to report a thin alveolar biotype case needing a pre-prosthetic intrusion of maxillary teeth by introducing a novel, personalized method of intrusion measurement. An electronic search was conducted between February 2022 and March 2022 in the following databases: PubMed, Scopus, Embase, Web of Science, and Lilacs; the terms “tooth movement techniques”, “orthodontic anchorage procedures”, “tooth intrusion”, “intrusion”, “molar”, “premolar”, and “human” were surveyed. Eighteen articles were included in this review; the mean amount of intrusion ranged from between 2.1 ± 0.9 mm and 4.57 ± 0.98 mm (being mostly 2–3 mm). The intrusion force varied between 100 and 500 g; 10 articles reported miniscrews (MS), 7 reported zygomatic plates (ZP), and 1 publication reported both anchorage types. The average treatment time was 6.9 months for MS and 7.9 months for ZP. Levelling the occlusal plane by intrusion of the upper posterior teeth can be achieved by skeletal anchorage. The stability of the obtained results, shortening treatment time, and controlling treatment outcome are the main goals for a complex surgical and orthodontic treatment approach.
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Suh H, Garnett BS, Mahood K, Mahjoub N, Boyd RL, Oh H. Treatment of anterior open bites using non-extraction clear aligner therapy in adult patients. Korean J Orthod 2022; 52:210-219. [PMID: 35527369 PMCID: PMC9117790 DOI: 10.4041/kjod21.180] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/10/2021] [Accepted: 11/19/2021] [Indexed: 12/02/2022] Open
Abstract
Objective The purpose of this study was to examine the effectiveness and mechanism of clear aligner therapy for the correction of anterior open bite in adult nonextraction cases. Methods Sixty-nine adult patients with anterior open bite were enrolled and classified into Angle’s Class I, II, and III groups. Fifty patients presented with skeletal open bite (mandibular plane angle [MPA] ≥ 38°), whereas 19 presented with dental open bite. Fifteen cephalometric landmarks were identified before (T1) and after (T2) treatment. The magnitudes of planned and actual movements of the incisors and molars were calculated. Results Positive overbite was achieved in 94% patients, with a mean final overbite of 1.1 ± 0.8 mm. The mean change in overbite was 3.3 ± 1.4 mm. With clear aligners alone, 0.36 ± 0.58 mm of maxillary molar intrusion was achieved. Compared with the Class I group, the Class II group showed greater maxillary molar intrusion and MPA reduction. The Class III group showed greater mandibular incisor extrusion with no significant vertical skeletal changes. Conclusions Clear aligners can be effective in controlling the vertical dimension and correcting mild to moderate anterior open bite in adult nonextraction cases. The treatment mechanism for Class III patients significantly differed from that for Class I and Class II patients. Maxillary incisor extrusion in patients with dental open bite and MPA reduction with mandibular incisor extrusion in patients with skeletal open bite are the most significant contributing factors for open bite closure.
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Affiliation(s)
- Heeyeon Suh
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, USA
| | - Bella Shen Garnett
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, USA
- Private Practice, San Francisco, CA, USA
| | - Kimberly Mahood
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, USA
| | | | - Robert L. Boyd
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, USA
| | - Heesoo Oh
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, USA
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Noh HK, Park HS. Considerations for vertical control with microimplants in a idiopathic condylar resorption patient: A case report. J Orthod 2021; 48:172-182. [PMID: 33761768 DOI: 10.1177/14653125211002211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Idiopathic condylar resorption (ICR) is a rare, destructive temporomandibular joint disease characterised by progressive resorption of the condyles. This case report presents a record of an orthodontically treated patient with ICR with favourable posttreatment remodelling of the condyles. An 18-year-old woman sought treatment for ICR. A severe Class II high-angle facial pattern with resorption of bilateral condyles was evident. The treatment plan was determined after careful examination of condylar radiographs and comprised forward rotation of the mandible through full-arch intrusion with microimplants after extraction of the four premolars. The treatment was completed in 35 months, and the patient was noted to have a straight profile, good interdigitation and slightly increased condylar volume. Two years after retention, the condyles were stable, and the patient's profile and occlusion remained acceptable despite a mild relapse of the mandibular position. ICR was successfully corrected with orthodontic treatment. Counter-clockwise mechanics applied during the ICR remission period not only improved facial aesthetics but were also suitable for condylar unloading.
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Affiliation(s)
- Hyung-Kyu Noh
- School of Dentistry, Kyungpook National University, Jung-gu, Daegu, Republic of Korea
| | - Hyo-Sang Park
- School of Dentistry, Kyungpook National University, Jung-gu, Daegu, Republic of Korea
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Le Keux F, Frapier L. Lingual treatment of an adult patient with an iatrogenic class II anterior open bite: Report of a case with a non-surgical orthodontic approach. Int Orthod 2021; 19:170-181. [PMID: 33573882 DOI: 10.1016/j.ortho.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The treatment of adult patients presenting an open bite is a real challenge for orthodontists due to the complexity of the malocclusion. The diagnosis is essential to identify aetiological factors and establish the best aesthetic and functional therapeutic prognosis. Among the aetiological factors, iatrogenic treatment history has to be considered. It is the case here where a regrettable unsuitable splint for bruxism treatment forced an open bite to appear. MATERIAL AND METHOD This case report presents an adult women with a large open bite due to an occlusal splint not covering the last mandibular molars. It was not really a vertical skeletal excess but more a mandibular clockwise rotation linked to the molar extrusions, which created a dento-alveolar open bite and labio-mental contractions during lip closure. Treatment objectives were the intrusion of the third and second molars, the extrusion of incisors to obtain a counter clockwise mandibular rotation. The patient was treated with an aesthetic and customized lingual appliance with no orthognathic surgery. A physiotherapy was followed by the patient when the open bite was closed in order to facilitate and stabilize the intercuspation. RESULTS A complete closing of the open bite was reached after two years of treatment. The superimposition showed the anticlockwise mandibular rotation. The levelling with posterior intrusion and the incisors extrusion reduced the vertical dimension with success. After 3years of retention, the occlusal stability was obtained. CONCLUSION The intrusion of the molars associated with a counter clockwise mandibular rotation made it possible the incisor extrusion. The occlusal balance with physiotherapy and patient compliance maintained the closure. In this way, the iatrogenic effects of the poorly designed bite splint were repaired.
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Affiliation(s)
- Fanny Le Keux
- University of Montpellier I, Department of Orthodontics, Montpellier, France.
| | - Laure Frapier
- University of Montpellier I, Department of Orthodontics, Montpellier, France
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Greco M, Rossini G, Rombolà A. Simplifying the approach of open bite treatment with aligners and selective micro-osteoperforations: An adult case report. Int Orthod 2020; 19:159-169. [PMID: 33358878 DOI: 10.1016/j.ortho.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Open bite treatment represents one of the most challenging malocclusions because it has a multifactorial aetiology and in particular because its dental correction strongly depends on the possibility to manage the posterior intrusion with a reliable system controlling the vertical position of upper and lower molars. Clear Aligner system proved to be an efficient way to control the hyper divergent patients performing posterior intrusion and managing the counterclockwise rotation of the mandible. This technique has shown to be predictable for molar intrusion up to 1mm. METHODS This case report shows a successful open bite orthodontic treatment in which the molar intrusion effect has been amplified in the digital setup and facilitated by means of micro-osteo perforations (MOPs) performed selectively only in the molar areas in order to stimulate the bone in a specific movement direction. The digital setup was set to create molar intrusion in upper and lower molars up to 3mm and thus favouring a counterclockwise mandible rotation, supported and controlled by elastics. The posterior intrusion was combined with an anterior extrusion following smile arc exposure and the treatment was completed in 16 months overall. RESULTS The final cephalometric analysis showed a significant reduction of SN/Go-Gn angle of 4° with consequent counterclockwise rotation of the mandible. The mandibular superimposition showed a 2.5mm molar intrusion without root resorption and with a controlled incisor proclination. A solid Class I bilateral occlusion was achieved with normal overjet and overbite, the dental arches were well aligned and levelled with good intra-arch symmetry and regular arch form. The frontal aesthetic analysis showed an improvement of the dental exposure with a normalized smile arc due to a combination of relative and pure extrusion. CONCLUSION The present alternative approach to treat severe open bite combining selective MOPs in the posterior and lateral sectors and clear aligners could predictably control molar vertical position avoiding the use of auxiliary and eliminating the risk of root resorption. Arch development, molar intrusion, and overbite correction with counterclockwise mandible rotation could be predictably achieved respecting digital setup and creating proper Class I bilateral occlusion.
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Affiliation(s)
- Mario Greco
- Department of Paediatric, Dentistry, University of L'Aquila, L'Aquila, Italy; Private Practice, Rome, Italy.
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Jindal P, Juneja M, Siena FL, Bajaj D, Breedon P. Mechanical and geometric properties of thermoformed and 3D printed clear dental aligners. Am J Orthod Dentofacial Orthop 2019; 156:694-701. [PMID: 31677678 DOI: 10.1016/j.ajodo.2019.05.012] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The aim of this research was to compare compressive mechanical properties and geometric inaccuracies between conventionally manufactured thermoformed Duran clear dental aligners and 3D printed Dental Long Term (LT) resin-based clear aligners using 3D modeling and printing techniques. METHODS Impressions of the patient's dentition were scanned and using 3D modeling software, dental models were designed and 3D printed. These printed models then underwent vacuum thermoforming to thermoform a clear Duran thermoplastic sheet of 0.75-mm thickness into clear dental aligners of the same thickness of 0.75 mm. For the same dental model, aligners were also designed and 3D printed to 0.75-mm thickness creating biocompatible clear dental aligners using Dental LT resin utilizing a Formlabs 3D printing machine for direct usage by the patients. Five observers calculated teeth height for both types of aligners for evaluation of geometric deviations. Both types of aligners were subjected to compression loading of 1000 N to evaluate their load vs displacement behavior. RESULTS 3D printed cured clear dental aligners were found to be geometrically more accurate with an average relative difference in tooth height of 2.55% in comparison with thermoformed aligners (4.41%). Low standard deviations (0.03-0.09 mm) were observed for tooth height measurements taken by all the observers for both types of aligners. 3D printed aligners could resist a maximum load of nearly 662 N for a low displacement of 2.93 mm; whereas, thermoformed aligners could resist a load on only 105 N for 2.93-mm displacement. Thermoformed aligners deformed plastically and irreversibly for large displacements; whereas, 3D printed aligners deformed elastically with reversibility for lower displacements. CONCLUSIONS 3D printed and suitably cured Dental LT resin-based clear dental aligners are suggested to be more suitable for patient use as they are geometrically more accurate; this presents an opportunity to make processing time savings while ensuring an aligner is mechanically stronger and elastic in comparison with the conventionally produced thermoplastic-based thermoformed clear dental aligners.
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Affiliation(s)
- Prashant Jindal
- University Institute of Engineering and Technology, Panjab University, Chandigarh, India
| | - Mamta Juneja
- University Institute of Engineering and Technology, Panjab University, Chandigarh, India
| | - Francesco Luke Siena
- Medical Engineering Design Research Group, Nottingham Trent University, Nottingham, United Kingdom
| | - Divya Bajaj
- University Institute of Engineering and Technology, Panjab University, Chandigarh, India
| | - Philip Breedon
- Medical Engineering Design Research Group, Nottingham Trent University, Nottingham, United Kingdom.
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Lee K, Hwang SJ. Change of the upper airway after mandibular setback surgery in patients with mandibular prognathism and anterior open bite. Maxillofac Plast Reconstr Surg 2019; 41:51. [PMID: 31824889 PMCID: PMC6877677 DOI: 10.1186/s40902-019-0230-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
Purpose It has been reported before that the amount of pharyngeal airway space (PAS) significantly decreases following mandibular setback (MS) surgery in patients with mandibular prognathism (MP). Further, MP patients with an anterior open-bite (AOB) presentation may show a larger decrease in PAS compared with those without AOB. However, studies on postoperative PAS changes in MP patients with AOB remain rare. This study sought to evaluate changes in PAS and hyoid bone positioning following MS surgery in MP patients with and without AOB. Patients and methods Twenty patients who underwent two jaw surgery involving MS movement were included. Patients were divided into a non-AOB group (n = 10; overbite > 2 mm) and an AOB group (n = 10; overbite < - 4 mm). Three-dimensional changes in PAS and hyoid bone positioning were compared and statistically evaluated pre- and postoperatively using computed tomography (CT). Results The mean magnitude of MS was 6.0 ± 2.8 mm and 5.6 ± 3.2 mm in the non-AOB group and AOB group, respectively. The oropharyngeal volume and upper hypopharyngeal volume were significantly reduced after surgery in both the groups (p = 0.006 and p = 0.003), while the retroglossal cross-sectional area was significantly reduced only in the AOB group (p = 0.028). Although the AOB group showed a larger decrease in PAS, the difference was not statistically significant between the groups. The position of the hyoid bone showed significant posterior and inferior displacement only in the AOB group, while the vertical displacement of the hyoid bone showed a statistically significant difference between the two groups. Conclusion PAS was significantly decreased after MS in both the groups, while only the AOB group presented a statistically significant reduction in the retroglossal cross-sectional area. Vertical displacement of the hyoid bone showed a statistically significant difference between the groups, while the PAS change was not. Surgeons should be aware of potential postoperative airway problems that may arise when performing MS surgeries.
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Affiliation(s)
- Kyungjin Lee
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Soon Jung Hwang
- HSJ Dental Clinic for Oral and Maxillofacial Surgery, Wannam Building 2,3F, 349 Gangnam-daero, Seocho-gu, Seoul, 06626 Republic of Korea
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Predictability of Mandibular Autorotation After Le Fort I Maxillary Impaction in Case of Vertical Maxillary Excess. J Craniofac Surg 2019; 30:1102-1104. [PMID: 31022143 DOI: 10.1097/scs.0000000000005544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
A retrospective study of 20 patients treated for vertical maxillary excess between 2009 and 2010, solely by superior surgical repositioning of the maxilla. Clinical and radiological cephalometric parameters were analyzed statistically and their impact on achieving the predicted postoperative mandibular autorotation and on relapse. According to our study, patients presenting with an anterior open bite and a low occlusal plane angle might fail to achieve the predicted mandibular autorotation and are prone to postoperative relapse. No correlation was found between the extent of maxillary impaction and the presence of autorotation.
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