Combined rapid maxillary expansion and protraction facemask in the treatment of Class III malocclusions in growing children: a prospective long-term study

A prospective study of 28 growing children (mean age of 8 years 3 months) with Class III malocclusions was consecutively treated using rapid maxillary expansion and maxillary protraction. All patients were treated from a negative overjet to a positive overjet and from a Class III dental malocclusion to a Class I dental relationship. For each patient, a lateral cephalogram was taken before treatment (T1), immediately posttreatment (T2), and after an observation period (T3) averaging 2 years 5 months. Using analysis of variance, the cephalograms were analyzed to determine skeletal and dental changes resulting from treatment. Long-term changes (2 years 5 month observation period) were also evaluated. Results showed that immediately posttreatment, the maxilla moved anteriorly a mean of 1.54 mm and Sella-Nasion-A point increased 0.87 degree. The maxillary teeth moved anteriorly 2.73 mm and proclined 5.23 degrees, while the mandible rotated in a downward and backward direction. Long-term, the anterior position of the maxilla was maintained, but some of the Class III correction was lost because of mandibular growth. Comparison of this study's results to Riolo's longitudinal Class I data showed that, overall, rapid palatal expansion and maxillary protraction produced a small orthopedic effect with a moderate dentoalveolar effect which together contributed to the correction of the Class III malocclusion.

Morphologic determinants in the etiology of class III malocclusions: a review

Morphospatial disharmony of the craniomaxillary and mandibular complexes may yield apparent mandibular prognathism, but Class III malocclusions can exist with any number of aberrations of the craniofacial complex. Deficient orthocephalization of the cranial base allied with a smaller anterior cranial base component has been implicated in the etiology of Class III malocclusions. Whereas the more acute cranial base angle may affect the articulation of the condyles resulting in their forward displacement, the reduction in anterior cranial size may affect the position of the maxilla. As well, intrinsic skeletal elements of the maxillary complex may be responsible for maxillary hypoplasia that may exacerbate the anterior crossbite seen in the Class III condition. Conversely, with an orthognathic maxilla, condylar hyperplasia and anterior positioning of the condyles at the temporo-mandibular joint may produce an anterior crossbite. Aside from the skeletal components, soft tissue matrices, particularly labial pressure from the circumoral musculature, may influence the final outcome of craniofacial growth of a child skeletally predisposed to Class III conditions. Indeed, as some Asian ethnic groups demonstrate an increased prevalence of Class III malocclusions, it is likely that the skeletal components and soft tissues matrices are genetically determined. Presumably, the co-morphologies of the craniomaxillary and mandibular complexes are likely dependent upon candidate genes that undergo gene-environmental interactions to yield Class III malocclusions. The identification of such genes is a desirable step in unraveling the complexity of Class III malocclusions. With this knowledge, the clinician may elect an early course of dentofacial orthopedic and orthodontic treatments aimed at preventing the development of Class III malocclusions.

Facial templates: a new perspective in three dimensions

PURPOSE

This paper describes the use of adult facial template in gender-specific facial analysis.

SUBJECTS AND METHODS

Eighty adults, mean age 24.5, were selected for the study. Laser-scanned images of the subjects were obtained under a reproducible and controlled environment with two Minolta Vivid 900 (Osaka, Japan) optical laser-scanning devices assembled as a stereo-pair. A set of left and right scanned images was taken for each subject and each scan took an average of 2.5 s. These scanned images were processed and merged to form a composite three-dimensional soft tissue reproduction of the subjects using commercially available reverse modelling software. The differences in facial morphology were measured using shell deviation colour maps. The facial template was used to compare differences between males vs. females groups and two subjects with facial disproportions.

RESULTS

The difference between the male and female facial templates was 1.28 +/- 1.02 mm. The areas of greatest deviation were at the nasal, zygomatic area and lower jaw line. The results of the surface deviation maps between the templates and subjects with facial disproportion showed that the results could be applied for orthodontic diagnosis.

CONCLUSIONS

The construction of the adult facial templates provides an interesting perspective into measuring changes in groups of patients and also acts as a useful template for the comparison of skeletal disproportion.

Diagnostic criteria for pseudo-Class III malocclusion

The aim of this study is to identify the diagnostic criteria for pseudo-Class III malocclusion and compare it with Class I malocclusion in the southern Chinese population. Sixty-seven patients (mean age, 10.9 +/- 1.8 years) were included in this study; 36 patients represented pseudo-Class III malocclusion. Selection criteria included the following: (1) anterior crossbite (at least 2 incisors with negative overjet and overbite); (2) mandibular displacement; (3) all patients were southern Chinese who had been followed after the growth spurt, none had developed a skeletal Class III malocclusion; (4) the patients were treated for an average of 7 months to procline upper incisors and retrocline lower incisors. None of the cases received any treatment that might affect skeletal growth. Thirty-one patients with Class I malocclusion were included in the Class I malocclusion group for the comparison of dentoskeletal characteristics with the pseudo-Class III malocclusion group. Selection criteria included the following: (1) skeletal Class I malocclusion with normal overjet and overbite, (2) mild to moderate crowding with Class I molar relationship, (3) straight facial profile. The following were included in the assessment of pseudo-Class III malocclusion cases: (1) family history, (2) molar and canine relationships at habitual occlusion and centric relation, and (3) dentoskeletal morphology. The results were that 72% of the examined cases in the pseudo-Class III malocclusion group showed no family history and 75% showed Class I molar relationship at habitual occlusion. Compared with the Class I malocclusion group, subjects in the pseudo-Class III malocclusion group showed a significantly decreased midface length, increased maxillary-mandibular difference, more retroclined upper incisors, and a retrusive upper lip. In conclusion, a pseudo-Class III malocclusion is characterized by retroclined upper incisors, retrusive upper lip, decreased midface length, and increased maxillary-mandibular difference. Findings of this study showed that patients with a pseudo-Class III malocclusion exhibit certain morphologic, dental, and skeletal characteristics that should be of aid in the diagnosis of pseudo-Class III malocclusion.

Accuracy of video imaging for predicting the soft tissue profile after mandibular set-back surgery

The purpose of this study was to compare the accuracy of two video-imaging programs for predicting the soft tissue outcomes of mandibular set-back surgery for patients with skeletal class III malocclusion. The sample consisted of 30 previously treated, nongrowing, white patients who had undergone isolated mandibular set-back surgery. An objective comparison was made of each program's cephalometric prediction using a customized analysis, as well as a subjective comparison of the predicted images as evaluated by a panel of six raters. The results showed that both programs produced similar cephalometric and video image predictions. The cephalometric visual treatment objective predictions were found to be most accurate in the horizontal plane; approximately 30% of cases showed errors greater than 2.0 mm, whereas in the vertical plane, the error rate was greater (50%). The resulting video image predictions were judged by the panel as being in the "fair" category. A particular problem was noted when significant vertical compression of the soft tissue images was required. Video imaging was suitable for patient education but not accurate enough for detailed diagnosis and treatment planning.

Determination of Class II and Class III skeletal patterns: receiver operating characteristic (ROC) analysis on various cephalometric measurements

Receiver operating characteristic analysis is an excellent method for evaluating and comparing the performance of diagnostic tests. The purpose of this study was to use the receiver operating characteristic analysis to evaluate the diagnostic ability of several cephalometric measurements in determining the presence of Class II and Class III skeletal patterns. Receiver operating characteristic analysis was performed on 976 cases. Fifteen cephalometric measurements were evaluated. A computer software program ROC ANALYZER was used to tabulate the areas under the curves and to perform the statistical comparison between the curves. The results of this study indicated that the Anteroposterior Dysplasia Indicator had the best diagnostic ability in identifying cases with Class II and Class III skeletal patterns. WITS Appraisal and Overjet were highly effective in diagnosing cases with Class II skeletal pattern. WITS Appraisal, Convexity, AB Plane Angle and Overjet also performed well in diagnosing cases with Class III skeletal pattern.

Clinical and radiologic aspects of maxillonasal dysostosis (Binder syndrome)

Maxillonasal dysostosis, described by Binder in 1962, is probably more common than one would think from the small number of cases that have been published (fewer than 40). We have seen 37 cases of this syndrome over a period of 8 years. Diagnosis of the syndrome is easy because of its characteristic anomalies of the upper lip and nose: smallness of the nose, a groove under the columella, a "half-moon" appearance of the nasal apertures, absence of the nasal spine, and projection of the chin. In addition, we have observed several associated abnormalities: convergent strabismus (2 cases), mongolism (1 case), labiomaxillopalatine cleft (1 case), and, of particular note, numerous abnormalities of the cervical spine, frequently associated with mandibular prognathism. In view of the frequency of the latter abnormalities. Binder syndrome might well be called a "nasomaxillovertebral syndrome."

Comparative study of diagnostic measures in borderline surgical cases of unilateral cleft lip and palate and noncleft Class III malocclusions

Patients with complete unilateral cleft lip and palate present difficult growth problems. Their anteroposterior discrepancies in jaw and dentition are frequently so severe that some epidemiologic studies report the necessity of orthognathic surgery in 25% of their sample. The aims of this study were three-fold: (1) to delineate diagnostic measures in borderline surgical cases of unilateral cleft lip and palate, (2) to verify the significance of negative overjet as a measure of anteroposterior discrepancy, and (3) to compare these diagnostic measures with those of borderline surgical cases of noncleft Class III malocclusions. The sample consisted of 29 patients with unilateral cleft lip and palate and 25 noncleft Class III Korean patients (mean age, 18.69 years); all had crossbites of all four incisors. Each of their pretreatment study casts and cephalograms were analyzed. The group with unilateral cleft lip and palate was divided into two subgroups on the basis of the method of their anterior crossbite resolution; 18 subjects were treated with orthodontics alone (Cleft-NS) and 11 subjects with orthognathic surgery (Cleft-Surg). The noncleft Class III group was divided into two subgroups; 6 of the subjects were orthodontically treated (Cl III-NS), and 19 were surgically treated (Cl III-Surg). The group with unilateral cleft lip and palate showed smaller SNA and SNB angles than the noncleft Class III group, but the ANB angles and the amount of anterior crossbites showed no statistical differences. When the Cleft-NS and the Cleft-Surg groups were compared, the ANB angle and the Wits measurements were significantly different. When the Cl III-NS and Cl III-Surg groups were compared, the SNB, ANB, L1GoGn, Wits, and the crossbite showed significant differences. For borderline surgical Class III unilateral cleft lip and palate cases, ANB angle, Wits appraisal, and ABGoGn angle were critical diagnostic parameters. On the other hand, the magnitude of anterior crossbite, the negative overjet, was shown not to be a significant measure of anteroposterior discrepancy.

Three-Dimensional Evaluation of the Upper Airway Morphological Changes in Growing Patients with Skeletal Class III Malocclusion Treated by Protraction Headgear and Rapid Palatal Expansion: A Comparative Research

Objective

The aim of this study was to evaluate the morphological changes of upper airway after protraction headgear and rapid maxillary expansion (PE) treatment in growing patients with Class III malocclusion and maxillary skeletal deficiency compared with untreated Class III patients by cone-beam computed tomography (CBCT).

Methods

Thirty growing patients who have completed PE therapy were included in PE group. The control group (n = 30) was selected from the growing untreated patients with the same diagnosis. The CBCT scans of the pre-treatment (T1) and post-treatment (T2) of PE group and the control group were collected. Reconstruction and registration of the 3D models of T1 and T2 were completed. By comparing the data obtained from T1, T2 and control group, the morphological changes of the upper airway during the PE treatment were evaluated.

Results

Comparing with the data from T1 group, the subspinale (A) of maxilla and the upper incisor (UI) of the T2 group were moved in the anterior direction. The gnathion (Gn) of mandible was moved in the posterior-inferior direction. The displacement of the hyoid bone as well as the length and width of dental arch showed significant difference. The volume and mean cross-sectional area of nasopharynx, velopharynx and glossopharynx region showed significant difference. The largest anteroposterior/the largest lateral (AP/LR) ratios of the velopharynx and glossopharynx were increased, but the AP/LR ratio of the hypopharynx was decreased. In addition, the length and width of the maxillary dental arch, the displacement of the hyoid bone, the volume of nasopharynx and velopharynx, and the AP/LR ratio of the hypopharynx and velopharynx showed significant difference between the data from control and T2 group.

Conclusion

The PE treatment of Class Ⅲ malocclusion with maxillary skeletal hypoplasia leads to a significant increase in the volume of nasopharynx and velopharynx.

The proportionate template as a diagnostic aid

Many traditional cephalometric analyses used do not consistently reflect the extent of anteroposterior or vertical jaw dysplasias. Nor do such analyses give accurate information as to which jaw(s) is at fault. The proportionate template is designed as a diagnostic aid which enables the clinician to identify and determine rapidly the extent of craniofacial skeletal jaw discrepancies in adults. The template is found to be particularly useful for orthodontists and surgeons engaged in orthognathic surgery. (Proportionate templates are available upon request from the author).

Genetic and environmental factors in the development of so-called pseudo- and true mesiocclusions

Separation of genetic and environmental factors related to the development of so-called pseudo- and true mesioclusions was attempted and the classification, which is in common use in clinical orthodontics, reconsidered. A differential diagnosis of these two types of mesioclusions was made depending on whether or not the mandible slid forward into displacement by incisal guidance. By means of lateral roentgenographic cephalograms obtained from 66 pseudo- and 48 true mesioclusion patients and 52 control subjects, and their respective parents, the craniofacial morphogenetic characteristics of each mesioclusion were determined. A familial tendency to prognathic skeletal profile was noted in cases of both pseudo- and true mesioclusions. Nearly all of the significant morphogenetic differences between the two groups of patients with mesioclusion were related to environmental factors. The terms "pseudo" and "true" are probably misleading expressions for these mesioclusions.

Orthodontic treatment with growth hormone therapy in a girl of short stature

The purpose of this article is to review the characteristics of craniofacial morphology in children of short stature and the effects of human growth hormone (HGH) therapy on the craniofacial complex. Changes in body height, facial growth, and dental maturity of a 9-year-old girl who received HGH therapy during orthodontic treatment were observed. Orthodontists need to understand the skeletal characteristics of the craniofacial complex of short-stature patients before beginning orthodontic treatment and consider how the differences between chronologic and skeletal ages affect the timing and method of orthodontic treatment. If short-stature children are undergoing HGH therapy, its cranioskeletal effect should be considered; if possible, it is better to delay orthodontic treatment until HGH is finished. However, if orthodontic treatment is performed, the following should be considered: (1) HGH therapy affects the growth of the mandible more than the growth of the maxilla, (2) the amount and pattern of growth during HGH administration are unpredictable, and (3) HGH therapy rarely affects dental maturity.

A cephalometric evaluation of patients presenting with persistent digit sucking habits

Persistent digit sucking habits are an important aetiological factor for malocclusion, and patients with persistent habits are frequently referred for orthodontic treatment. The present study investigated the effects of digit sucking habits on vertical and anteroposterior dentofacial characteristics by employing a cephalometric analysis of patients with persistent digit sucking habits compared with patients without such habits. Significant differences were seen in maxillary prognathism, relative prognathism, maxillary incisor angulation, interincisal angle, maxillary length and maxillary plane angulation. No significant differences were observed for mandibular prognathism or length, maxillary mandibular plane angle, cranial base measurements nor any measurement of facial height. The digit sucking group were also found to have a larger variation of lower incisor angulation than the controls, although no significant difference in the mean value for this variable was detected. It is concluded that persistent digit sucking may cause largely dentoalveolar change, together with some minor effects on the skeletal pattern.

CASES--clinical audit; scenarios for evaluation and study

CASES, an audit and continuing education programme, evaluated aspects of current orthodontic practice and allowed orthodontists to identify areas where their practice differed from regional and national results. Evaluation of the CASES programme verified its value in audit and continuing education and the authors hope it will encourage similar projects in other disciplines too.

Maxillofacial considerations for diagnosis and treatment in Gorlin's syndrome: access osteotomies for cyst removal and orthognathic surgery

Gorlin's syndrome is a complex hamartomatous/neoplastic syndrome with multisystemic manifestations involving the skin, central nervous system, and bony skeleton. The purpose of this article is to describe how a patient with Gorlin's syndrome was managed with a multipronged approach that included exposure osteotomies for keratocyst removal combined with orthognathic surgery. This case demonstrates the advantages of standard maxillofacial osteotomies to gain access for the removal of odontogenic cysts and benign tumors.

Mandibular instantaneous centers of rotation in patients with and without temporomandibular dysfunction

PATIENTS AND METHODS

The free opening movement of the mandible was examined in 30 patients with and without dysfunctions, using the CADIAX electronic axiography system. All patients in the diseased group showed dysfunctions in the left temporomandibular joint. Half of the 20 asymptomatic patients were skeletal Class II, the other half skeletal Class III. Based on the data collected for the left temporomandibular joint, the movement of the mandible during the mouth-opening movement in the sagittal and vertical planes was described as the pathway over time of the various instantaneous centers of rotation (ICR), using physico-biomechanical factors.

RESULTS AND CONCLUSION

It emerged that the ICR path in the patients with dysfunctions was irregular with erratic changes of direction. A harmonious ICR path beginning near the condyle was typical of the healthy group; as the mouth opened, the path moved toward downward backward and finally shifted toward forward and forward upward. Therefore, such an ICR path pattern can be used as an indicator in detecting dysfunctions.

The identification of Class III malocclusions by discriminant analysis

Lateral cephalometric radiographs of 210 control and 285 Class III subjects were traced, digitized, and 43 calculated variables submitted to a stepwise discriminant analysis. A 10-factor model was generated, giving 95.2 per cent correct classification of the control children and 95.1 per cent accurate identification of the Class III group. Ten control and 14 Class III children were categorized incorrectly. To test the validity of the analysis, radiographs of these 24 individuals were examined in detail. In all cases, a satisfactory reason for the misgrouping was identified. This investigation underlined the importance of rigorous standards of case selection when compiling the groups. The robustness of the 10-factor model was also examined. Subjects were arbitrarily split into two groups, the odd- and the even-numbered cases, and the discriminant analysis repeated on each. Both new models contained the same 10 variables, but with slightly different values for their accompanying coefficients. The cases erroneously identified by the whole group analysis were again misclassified, together with a few additional cases. Each new model performed equally well on the data from the opposing group as on that from which it had been derived. Thus, the model generated in this study was both valid and acceptably robust. It would therefore appear that discriminant analysis may be a viable tool in the identification and classification of groups of individuals.

Orthodontic correction of a class III malocclusion in an adolescent patient with a bonded RPE and protraction face mask

A case report of a 14-year-old Hispanic male with a Class-III skeletal profile and dental malocclusion with a long mandibular body and ramus and retrusive maxilla. The patient was initially referred for a surgical evaluation for a LeFort I maxillary advancement, but he wanted to avoid surgery. The Class-III malocclusion was corrected with a bonded rapid palatal expander and a maxillary protraction mask followed by nonextraction orthodontic treatment. A Class-I molar and canine relationship was achieved, and the facial profile improved. This case report demonstrates the orthodontic correction of a Class-III malocclusion in an adolescent patient with a bonded rapid palatal expander and protraction face mask. This case was presented to American Board of Orthodontics as partial fulfillment of the requirements for the certification process conducted by the Board.

Case report: developmental characterization of skeletal Class III malocclusion

Skeletal Class III malocclusion is usually characterized by a steep mandibular plane angle, obtuse gonial angle, overdeveloped mandible, underdeveloped maxilla, and a small cranial base angle which may displace the glenoid fossa anteriorly to cause a forward positioning of the mandible. These factors are generally thought to contribute to the development of skeletal malocclusion as well as facial deformities, and are believed to originate from genetic and/or environmental factors. The posterior discrepancy is an important etiological factor in the development of a skeletal Class III malocclusion because it affects the occlusal plane. This idea must be amended for an appropriate clinical approach to the treatment of Class III malocclusion.

The Denture Frame Analysis: an additional diagnostic tool

The purpose of this study was to evaluate the Denture Frame Analysis. This adjunctive cephalometric analysis of the lateral headfilm was introduced in Japan, but no data exist for the Caucasian population at present. One-hundred-and-six Caucasians were randomly selected and assigned to one of four groups, according to their malocclusion: Angle Classes I, II, and III, and anterior open bite. Statistical testing showed significant differences among the four groups for most of the measurements investigated. The Denture Frame Analysis distinguished the different types of malocclusion, and evaluated skeletal and dental relationships. The occlusal plane aids in the determination of the objectives and limits of orthodontic therapy.

Size discrepancy of apical bases and treatment success in angle Class III malocclusion

The aim of this retrospective clinical study was to measure the apical bases and determine their size relationship in Class III malocclusion cases before and after orthodontic treatment, in order to evaluate their significance for the treatment success. Maxillary and mandibular apical bases were measured on study models of 104 Class III cases treated by conventional orthodontics, using a specifically constructed conveyance apparatus, and related to each other as an index. Treatment success was quantitatively assessed as the percentage change of PAR scores obtained from the pretreatment and posttreatment study models. Statistically significant relationships were disclosed between the measurements of the apical bases and several other evaluated parameters. The results obtained indicate a high prognostic value of the size relationship of the apical bases for the treatment success of Class III malocclusion.

Complications of misdiagnosis of maxillary canine ectopic eruption

Ectopic eruption of maxillary canines can be associated with root resorption of adjacent teeth. This case report describes and discusses an interesting case of a 15-year-old girl with a Class III malocclusion and an impacted maxillary canine. Because of the unfavorable position of the ectopic canine and the severe root resorption of the maxillary left central and lateral incisors, the treatment options included extraction of the maxillary permanent canines. The mandibular first premolars were extracted to compensate for the Class III malocclusion. A panoramic radiograph taken earlier in the mixed dentition already indicated a possible eruption disturbance of the maxillary left permanent canine. The importance of early diagnosis of maxillary canine ectopic eruption is highlighted in this case report. The early identification of radiographic signs of an ectopic pathway of eruption should be followed by deciduous canine extraction to prevent canine retention and maxillary incisor root resorption.

Orthodontic treatment and tongue surgery in a class III open-bite malocclusion. A case report

Cases such as this are a real challenge to clinical orthodontists. They require patience as well as proper diagnosis and treatment planning. The orthodontist must also help the patient psychologically by treating the teeth and surrounding structures and by treating the patient as an individual. It is the feeling of both the Author and the Plastic surgeon in this case, Dr. Fernando Ortiz Monasterio, that this type of surgery would be successful in most non-pathological macroglossia cases. It appears that the sutured areas might be said to develop more dense epithelial tissue, not allowing the tongue to expand and readapt so readily to the position of the teeth in the mandibular arch. This is indicated in the present case, as is demonstrated by the decrease in width of the mandibular arch from the first molar area to the anterior part of the mouth. It should be noted that orthognathic surgery was not as widely used at the time that this patient was studied and treated as it is today. If this case had presented for the first time this year, it is likely that the treatment plan of most orthodontists would have combined orthognathic and tongue surgery, with orthodontics to lessen trauma to the supporting structures of the teeth from the extreme and complicated mechanics which would have to be used in treatment. The psychological aspects of this case were of tremendous importance; the treatment results have undoubtedly changed his life completely (Fig. 10). Once unable to speak clearly with his oversize tongue, he has since gone on to complete his education and is now a successful orthodontist.

[Treatment of Class III malocclusions]

Current knowledge about cranio-facial growth, the identification of different anatomic types by architectural cephalometric analysis, the new therapeutic methods and a multidisciplinary have changed the mode and the results of these treatments. However the key of success is: begin the treatment as soon as possible. The correction of skeletal anomalies and the normalization of all the oro-facial functions need a lot of time. It is advisable to be efficient at the good time with the good appliance. The quality of the result will be estimated at the end of the growth. In this way, a lot of orthognathic surgery can be avoided. So, certainly the results reward the efforts.

[The differential diagnostic value of skeletal, dental and soft-tissue analyses in the planning of orthodontic-oral surgical therapy. A retrospective study of treated patients with skeletal Angle class III]

The study evaluated the orthodontic documentation gathered in the course of conducting combined surgical-orthodontic therapy on 45 skeletal angle class III patients. In 15 of the patients Le Fort I osteotomy of the maxilla was performed, in 15 sagittal split osteotomy of the mandible, and in the last 15 patients bimaxillary surgery. The purpose of the study was to evaluate by means of a retrospective analysis of cephalograms taken prior to surgery the role hard tissue, soft tissue, and dental cephalometric variables play in the choice of the type of surgery to be performed. Discriminate analysis was used to determine the ability of the individual parameters to predicate accurately the type of the surgery that had been carried out. The study revealed that the skeletal relationship diagnosed in the x-rays was suitable primarily in the differentiation of the monomaxillary and bimaxillary patients who had undergone surgery. Using discriminate analysis the accuracy to predict group membership was 75.6% for the skeletal parameters of the McNamara analysis and 67.5% for those of the Bergen analysis. Differentiation between the cases where surgery had been performed solely in the maxilla and those where surgery had been performed only in the mandible was most successful using the soft tissue parameters describing the position of the subnasale and the position of the lower lip in relation to the aesthetic line according to Ricketts. In addition, the arrangement of the lower incisors was more retrusive in the cases with isolated surgery in the maxilla. Discriminate analysis applying a combination of skeletal, dental, and soft tissue parameters had a capability to predict accurately in 93.3% of the patients the form of the chosen surgical procedure.