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Bravo Vallejo G, Alcaraz Ros GDD, Peloso RM, Gambardela-Tkacz CM, Cotrin P, Freitas KMS, de Freitas MR. Long-term profile attractiveness of patients with Class I and II malocclusion treated with and without extractions: A 35-year follow-up. Am J Orthod Dentofacial Orthop 2024; 165:513-519. [PMID: 38231168 DOI: 10.1016/j.ajodo.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION The objective of this study was to compare the profile attractiveness in subjects treated with and without extractions after the long-term 35-year follow-up, according to laypeople, dentists, and orthodontists. METHODS A total of 40 patients with Class I and II malocclusion were divided into 2 groups, according to the treatment protocol: extraction (E) group, extractions of 4 premolars (n = 24), with mean pretreatment (T1), posttreatment (T2), and long-term posttreatment (T3) ages of 13.13, 15.50 and 49.56 years, respectively. The mean treatment time (T2 - T1) was 2.37 years, and the long-term follow-up (T3 - T2) was 34.19. Nonextraction (NE) group (n = 16), with mean ages at T1, T2, and T3 of 13.21, 15.07, and 50.32 years, respectively. The mean (T2 - T1) was 1.86 years, and the (T3 - T2) was 35.25 years. Lateral cephalograms were used to perform profile facial silhouettes, and an online evaluation was performed by 72 laypeople, 63 dentists, and 65 orthodontists, rating the attractiveness from 1 (least attractive) to 10 (most attractive). The intragroup comparison was performed with the repeated measures analysis of variance and Tukey tests. Intergroup comparison was performed with t tests, 1-way analysis of variance, and Tukey tests. RESULTS The E group had a longer treatment time than that of the NE group. In the pretreatment, posttreatment, and long-term posttreatment stages, the E and NE groups showed similar profile attractiveness. Laypersons and dentists were more critical than orthodontists. CONCLUSIONS At long-term posttreatment follow-up, profile attractiveness was similar in patients treated with and without extractions.
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Affiliation(s)
- Gabriel Bravo Vallejo
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil.
| | | | - Renan Morais Peloso
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Paula Cotrin
- Department of Orthodontics, Ingá University Center UNINGÁ, Maringá, Paraná, Brazil
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Santori F, Masedu F, Ciavarella D, Staderini E, Chimenti C, Tepedino M. Effect of Class II functional treatment on facial attractiveness, as perceived by professionals and laypeople. Sci Rep 2021; 11:13989. [PMID: 34234201 PMCID: PMC8263773 DOI: 10.1038/s41598-021-93343-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022] Open
Abstract
The literature offers different perspectives for and against two-phase treatment of skeletal Class II malocclusion. Facial attractiveness is an important aspect to take into account, given that children with skeletal Class II are often bullied by their peers and have low self-esteem and a lower social perception. The aim of the present study was to evaluate the aesthetic perception of facial profiles by a large number of observers, before and after treatment with a functional appliance, compared to untreated controls. The pre- and post-treatment cephalograms of 20 Class II subjects treated with Sander’s bite-jumping appliance and 20 untreated historical controls were collected and transformed into black and white silhouettes depicting only the lower third of the face. An online questionnaire comprising the silhouettes of the two groups, three “calibration” profiles and an “ideal” profile was submitted to dentists, orthodontists, undergraduates and laypeople, asking them to rate the profile’s attractiveness using a Visual Analogue Scale (VAS). The effect of treatment, and observers’ age, expertise and gender were analysed. The calibration images and the ideal profiles were used to evaluate the coherence of each observer’s judgement. The protocol was approved by the local Ethics Committee. Nine-hundred and ten questionnaires were collected. Treated subjects showed a larger improvement of facial attractiveness compared to controls. A significant effect of gender on the observer’s ratings was observed. Some observers showed incoherent judgement, which had a significant effect on the regression model. In conclusion, early treatment with functional appliances seems to improve patients’ facial aesthetics. This improvement is perceived equally by dental professionals and laypeople.
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Affiliation(s)
- Federica Santori
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, V.Le San Salvatore, Edificio Delta 6, 67100, L'Aquila, Italy
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, V.Le San Salvatore, Edificio Delta 6, 67100, L'Aquila, Italy
| | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
| | - Edoardo Staderini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, Istituto di Clinica Odontoiatrica e Chirurgia Maxillo-Facciale, Rome, Italy
| | - Claudio Chimenti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, V.Le San Salvatore, Edificio Delta 6, 67100, L'Aquila, Italy
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, V.Le San Salvatore, Edificio Delta 6, 67100, L'Aquila, Italy
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Changes in the craniofacial structures and esthetic perceptions of soft-tissue profile alterations after distalization and Herbst appliance treatment. Am J Orthod Dentofacial Orthop 2021; 159:292-304. [PMID: 33487502 DOI: 10.1016/j.ajodo.2019.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 11/01/2019] [Accepted: 12/01/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The purpose of this prospective clinical trial is to evaluate the changes of soft tissues and designate the esthetic perceptions of children with Class II malocclusion after Herbst appliance therapy and maxillary molar distalization using stereophotogrammetry. METHODS Thirty patients were allocated either to Herbst (6 boys and 9 girls; mean age = 11.60 ± 0.82 years) or distalization (4 boys and 11 girls; mean age = 11.46 ± 1.30 years) groups. Dentoskeletal and soft-tissue treatment changes were examined objectively by cephalometric analysis and stereophotogrammetry, respectively. Pre- and posttreatment profile views were evaluated subjectively by orthodontists and laypeople using the 7-point Likert scale. Intra- and intergroup comparisons for the repeated measurements were performed with 2-way variance analysis. Bonferroni test was used for multiple comparisons (P ≤0.05). RESULTS Greater skeletal changes were observed in the Herbst group than in the distalization group. Maxillary incisor retrusion and mandibular incisor protrusion were observed in the distalization and Herbst groups, respectively. Stereophotogrammetric measurements showed that mandibular body length and lower and anterior facial height increased in both treatment groups. Convexity angle (P = 0.020) and labiomental angle (P = 0.033) were greater in the Herbst group than the distalization group. CONCLUSIONS The skeletal contribution to correction of maxillomandibular discrepancy was greater in the Herbst group than the distalization group. Significant profile improvements were recorded for both groups with treatment. After both treatments, orthodontists were found to have higher rates of detection in the profiles than laypeople. The esthetic contribution of treatments to the facial profile was found similar in both groups.
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Moresca AHK, de Moraes ND, Topolski F, Flores-Mir C, Moro A, Moresca RC, Correr GM. Esthetic perception of facial profile changes in Class II patients treated with Herbst or Forsus appliances. Angle Orthod 2020; 90:571-577. [PMID: 33378491 PMCID: PMC8028457 DOI: 10.2319/052719-362.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the esthetic perceptions of orthodontists and laypersons for facial profile changes after orthodontic treatment using Herbst or Forsus appliances. MATERIALS AND METHODS Pre- and posttreatment facial profile contour images of 20 Class II patients treated with Herbst (group H; n = 10) and Forsus (group F; n = 10) appliances were analyzed by 30 orthodontists and 30 laypersons, who graded them from 1 (unattractive) to 10 (very attractive) using a visual analog scale. Two assessments were carried out with a 15 day-interval. In the first evaluation, 40 images were presented in a random sequence. In the second evaluation, initial and final facial profile images of each patient were randomly presented side by side. To compare groups in relation to treatment method, Mann-Whitney tests were used. To evaluate differences between time points, Wilcoxon tests were used. RESULTS In the first evaluation, there was a significant difference between initial and final images only for group H, for both laypersons (P = .017) and orthodontists (P = .037). There was also a significant difference between laypersons and orthodontists in their ratings of posttreatment Herbst appliance profiles (P = .028). There was no significant difference between initial and final facial profile images for group F and no significant differences between or within evaluator groups in their ratings of initial or final Forsus appliance profiles. In the second evaluation, there was a significant difference between appliance groups only for laypersons, who considered cases treated with the Herbst appliance more attractive than those treated with the Forsus (P = .031). Laypersons also considered Herbst profiles more attractive than did orthodontists (P = .047). CONCLUSIONS Class II malocclusion treatment using the Herbst appliance may produce a more esthetically improved facial profile silhouette compared with Forsus appliances. The magnitude of perceived changes may not be considered clinically relevant.
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Zouloumi ME, Tsiouli K, Psomiadis S, Kolokitha OE, Topouzelis N, Gkantidis N. Facial esthetic outcome of functional followed by fixed orthodontic treatment of class II division 1 patients. Prog Orthod 2019; 20:42. [PMID: 31761963 PMCID: PMC6875534 DOI: 10.1186/s40510-019-0294-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/24/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives To assess the perceived facial changes in class II division 1, convex profile patients treated with functional followed by fixed orthodontic appliances. Subjects and methods The study sample consisted of 36 pairs of pre- and post-treatment photographs (frontal and profile, at rest) of 12 patients treated with activator, 12 with twin-block, and 12 controls with normal profiles, treated without functional appliances. All photographs were presented in pairs to 10 orthodontists, 10 patients, 10 parents, and 10 laypersons. Visual analog scale (VAS) ratings of changes in facial appearance were assessed. Results The patient groups were similar in sex distributions, age, and treatment duration. The different rater groups showed strong to excellent agreement. There were no significant differences among treatment groups (F = 0.91; P = 0.526; Wilks lambda = 0.93), raters (F = 1.68; P = 0.054; Wilks lambda = 0.83), and when testing the combined effect of treatment and rater on the results (F = 0.72; P = 0.866; Wilks lambda = 0.85). The raters detected slightly more positive changes in the activator and twin-block groups, compared to the control group, regarding the lower face and the lips, but these findings did not reach significance. Furthermore, their magnitude hardly exceeded 1/20th of the total VAS length. Limitations Retrospective study design. Conclusions The perceived facial changes of convex profile patients treated with functional, followed by fixed orthodontic appliances, did not differ from those observed in normal profile patients, when full-face frontal and profile photos were simultaneously assessed. Consequently, professionals should be skeptical regarding the improvement of a patient’s facial appearance when this treatment option is used.
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Affiliation(s)
- Mary-Eleni Zouloumi
- Faculty of Dentistry, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | | | - Simeon Psomiadis
- Department of Oral and Maxillofacial Surgery, Dental School, National and Kapodistrian University of Athens, Thivon 2, Goudi, 11527, Athens, Greece
| | - Olga-Elpis Kolokitha
- Department of Orthodontics, Faculty of Dentistry, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Nikolaos Topouzelis
- Department of Orthodontics, Faculty of Dentistry, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Nikolaos Gkantidis
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
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Paduano S, Rongo R, Bucci R, Carvelli G, Cioffi I. Impact of functional orthodontic treatment on facial attractiveness of children with Class II division 1 malocclusion. Eur J Orthod 2019; 42:144-150. [DOI: 10.1093/ejo/cjz076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Summary
Background/objectives
Whether orthodontic treatment with functional appliances improves facial aesthetics is still under debate. This study aimed to determine whether functional orthodontic treatment improves the facial attractiveness of patients with Class II division 1 malocclusion.
Materials/method
Extraoral lateral photographs of 20 children with Class I (CLI, 11.7 ± 0.8 years), and before (T1) and after treatment (T2) photographs of patients with Class II division 1 (CLII T1 and CLII T2; mean age ± SD = 11.1 ± 0.6 years) treated with functional appliances, were transformed into black silhouettes. Three panels of examiners including 30 orthodontists (39.0 ± 10.1 years), 30 dentists (40.0 ± 9.7) and 30 laypersons (39.0 ± 9.2) evaluated the attractiveness of patients’ silhouettes using a 100-mm visual analogue scale, and the sagittal position of patients’ upper lip, lower lip, and chin using a 3-point Likert scale. Two-way ANOVA and a chi-square test were used to test differences among groups. Statistically significance was set as P < 0.05.
Results
The silhouettes of CLII T2 individuals were more attractive than those of the other groups (all Ps < 0.001). The upper lip, lower lip, and the chin of these individuals were judged to be normally positioned in 69.5 per cent, 74.9 per cent, and 72.3 per cent of the assessments, respectively (all Ps < 0.05).
Limitations
This study did not account for the psychological profile of the examiners, which may have affected the ratings.
Conclusions/implications
Orthodontic treatment with functional appliances is associated with a superior facial profile attractiveness. Functional treatment should be considered as a treatment option to improve the facial appearance of children with Class II division 1 malocclusion.
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Affiliation(s)
- Sergio Paduano
- Department of Health, University “Magna Graecia” of Catanzaro, Italy
| | - Roberto Rongo
- Discipline of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples “Federico II”, Italy
| | - Rosaria Bucci
- Discipline of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples “Federico II”, Italy
| | - Giuseppe Carvelli
- Department of Health, University “Magna Graecia” of Catanzaro, Italy
| | - Iacopo Cioffi
- Discipline of Orthodontics, Department of Dentistry, University of Toronto, Canada
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MARQUES GA, MENEZES CCD, VENEZIAN GC, HENRIQUES JFC, VEDOVELLO SAS, DEGAN VV. Association between normative and perceived esthetic results after treatment of mandibular retrognathism. REVISTA DE ODONTOLOGIA DA UNESP 2019. [DOI: 10.1590/1807-2577.06619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction This cross-sectional study aimed to associate the normative cephalometric results of mandibular retrognathism treatment with patient perception on the esthetic improvement of facial profile. Objective this cross-sectional study aimed to associate the normative cephalometric results of mandibular retrognathism treatment with patient perception on the esthetic improvement of facial profile. Material and method The normative cephalometric results were obtained from lateral cephalometric radiographs of a sample of 24 Class II malocclusion patients in the pubertal growth spurt. Such patients were treated with a mandibular advancement device and evaluated by comparing pre- and post-treatment variables. The same radiographs were used to produce standardized black silhouettes that were randomly arranged. Patients were instructed to choose their preferred profile and indicate the changes perceived using a 7-point Likert scale. The data were compared with cephalometric results using a mixed-model methodology for time-repeated measures, Student’s t-test, and t-test for heterogeneous variances, at 5% significance level. Result A rate of 75% of patients preferred post-treatment silhouettes and changes were perceived regardless of the choice of either pre- or post-treatment profile. There was no significant difference between the cephalometric variables of the tracings that produced the silhouettes considered better or worse after the evaluation. Conclusion There was no association between the cephalometric results after treatment and the perception of esthetic improvement by patients treated for mandibular retrognathia.
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Al-Jewair T, Stellrecht E, Lewandowski L, Chakaki R. American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection in the orthodontic literature—use and trends: A systematic review. Am J Orthod Dentofacial Orthop 2018; 153:15-25.e10. [DOI: 10.1016/j.ajodo.2017.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/01/2017] [Accepted: 07/01/2017] [Indexed: 10/18/2022]
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Tsiouli K, Topouzelis N, Papadopoulos MA, Gkantidis N. Perceived facial changes of Class II Division 1 patients with convex profiles after functional orthopedic treatment followed by fixed orthodontic appliances. Am J Orthod Dentofacial Orthop 2017; 152:80-91. [PMID: 28651771 DOI: 10.1016/j.ajodo.2016.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/01/2016] [Accepted: 12/01/2016] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aim of this research was to investigate the perceived facial changes in Class II Division 1 patients with convex profiles after functional orthopedic treatment followed by fixed orthodontic appliances. METHODS Pretreatment and posttreatment profile photographs of 12 Class II Division 1 patients treated with activators, 12 Class II Division 1 patients treated with Twin-block appliances, and 12 controls with normal profiles treated without functional appliances were presented in pairs to 10 orthodontists, 10 patients, 10 parents, and 10 laypersons. The raters assessed changes in facial appearance on a visual analog scale. Two-way multivariate analysis of variance was used to evaluate differences among group ratings. RESULTS Intrarater reliability was strong in most cases (intraclass correlation coefficients, >0.7). The internal consistency of the assessments was high (alpha, >0.87), both within and between groups. The raters consistently perceived more positive changes in the Class II Division 1 groups compared with the control group. However, this difference hardly exceeded 1/10th of the total visual analog scale length in its highest value and was mostly evident in the lower face and chin. No significant differences were found between the activator and the Twin-block groups. CONCLUSIONS Although the raters perceived improvements of the facial profiles after functional orthopedic treatment followed by fixed orthodontic appliances, these were quite limited. Thus, orthodontists should be tentative when predicting significant improvement of a patient's profile with this treatment option.
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Affiliation(s)
- Kleopatra Tsiouli
- Department of Orthodontics, Faculty of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Topouzelis
- Department of Orthodontics, Faculty of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Moschos A Papadopoulos
- Department of Orthodontics, Faculty of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Gkantidis
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland.
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PITHON MM, LACERDA-SANTOS R, de OLIVEIRA DL, ALVES JV, BRITTO JP, SOUZA EDS, ALVES LP, BARBOSA G, COQUEIRO RDS, SANTOS AFD. Esthetic perception of facial profile after treatment with the Thurow appliance. Braz Oral Res 2015; 29:S1806-83242015000100230. [DOI: 10.1590/1807-3107bor-2015.vol29.0043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 11/24/2014] [Indexed: 11/22/2022] Open
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Mann KR, Marshall SD, Qian F, Southard KA, Southard TE. Effect of maxillary anteroposterior position on profile esthetics in headgear-treated patients. Am J Orthod Dentofacial Orthop 2011; 139:228-34. [PMID: 21300252 DOI: 10.1016/j.ajodo.2010.04.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 04/01/2010] [Accepted: 04/01/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Headgears have been used to treat Class II malocclusions for over a century. The purpose of this retrospective study was to investigate the profile esthetic changes resulting from headgear use in growing Class II patients with protrusive, normal, and retrusive maxillae. METHODS Profile silhouettes were created from pretreatment and posttreatment lateral cephalometric tracings of growing Class II patients treated with headgear followed by conventional fixed appliances. Ten patients had an initially protrusive maxilla (FH:NA, >92°), 10 had an initially normally positioned maxilla (FH:NA, 88°-92°), and 10 had an initially retrusive maxilla (FH:NA, <88°). A panel of 20 laypersons judged the profile esthetics of the randomly sorted silhouettes. Descriptive statistics, correlation analysis, and anlaysis of variance (ANOVA) with post-hoc Tukey-Kramer tests were used to ascertain differences between groups and the effects of treatment. RESULTS A significant moderate correlation was found between initial ANB magnitude and the improvement in profile esthetic score with treatment (r = 0.49, P <0.01). No significant correlations were found between the initial anteroposterior position of the maxilla (FH:NA) and the initial, final, or change in profile esthetic scores. There were average improvements with headgear treatment in profile esthetics for all groups. CONCLUSIONS In Class II growing patients with protrusive, normally positioned, or retrusive maxillae, headgear treatment used with fixed orthodontic appliances is effective in improving facial profile esthetics: the greater the initial ANB angle, the greater the profile esthetic improvement with treatment.
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Affiliation(s)
- Kyle R Mann
- Department of Orthodontics, College of Dentistry, University of Iowa, Iowa City, IA 52242, USA
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Virkkula T, Kantomaa T, Julku J, Pirttiniemi P. Long-term soft-tissue response to orthodontic treatment with early cervical headgear—a randomized study. Am J Orthod Dentofacial Orthop 2009; 135:586-96. [DOI: 10.1016/j.ajodo.2007.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Revised: 05/10/2007] [Accepted: 05/10/2007] [Indexed: 10/20/2022]
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Sloss EAC, Southard KA, Qian F, Stock SE, Mann KR, Meyer DL, Southard TE. Comparison of soft-tissue profiles after treatment with headgear or Herbst appliance. Am J Orthod Dentofacial Orthop 2008; 133:509-14. [PMID: 18405814 DOI: 10.1016/j.ajodo.2006.04.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 04/12/2006] [Accepted: 04/20/2006] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Herbst and headgear appliances are considered effective for correcting Class II malocclusions in growing patients, although their skeletal and dental effects differ. In the literature, there is no comparison between profile esthetic outcomes with the Herbst and headgear. The purpose of this study was to provide that comparison. METHODS Lateral cephalometric radiographs of 48 matched pairs of growing Class II Division 1 patients treated with either the Herbst appliance or headgear (both combined with fixed appliances) were used to generate pretreatment and posttreatment standardized silhouettes. The silhouettes were randomly arranged and judged by lay people and orthodontic residents using a 7-point Likert scale. Statistical analyses including nonparametric procedures and intraclass correlation were used to compare initial, final, and change profile esthetic scores for the 2 groups of subjects and agreement between evaluators. RESULTS Both groups of subjects had significant profile improvements with treatment (P <.05), and there were no statistically significant differences between the groups in average final profile scores. Overall, there was strong agreement between the evaluations of laypersons and orthodontic residents. CONCLUSIONS Class II Division 1 growing patients treated with either Herbst appliance or headgear (both combined with fixed appliances) will benefit from significantly improved profiles that are equally attractive.
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Marşan G. Effects of activator and high-pull headgear combination therapy: skeletal, dentoalveolar, and soft tissue profile changes. Eur J Orthod 2007; 29:140-8. [PMID: 17488997 DOI: 10.1093/ejo/cjm003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The aim of this study was to evaluate skeletal, dentoalveolar, and soft tissue profile changes with activator and high-pull headgear combination therapy in patients with Class II malocclusions caused by maxillary prognathism and mandibular retrognathism. The subjects, all in the mixed dentition, were selected from a single centre and were divided into two groups: 28 patients were treated with an incisor double capping activator and a high-pull headgear combination appliance (13 girls, 15 boys mean chronological age 11.7 +/- 1.2 years, skeletal age 12.1 +/- 1.4 years) and an untreated group of 28 subjects (14 girls, 14 boys mean chronological mean age 11.9 +/- 1.1 years, skeletal age 12.3 +/- 1.3 years). The skeletal, dentoalveolar, and soft tissue profile changes that occurred were compared on lateral cephalograms taken before treatment (T0) and after 1.1 +/- 0.3 years when the combination appliance was removed (T1). In the control group, the radiographs were obtained at the start (T0) and after an observation period 1.2 +/- 0.4 years (T1). Statistical analysis was undertaken with Wilcoxon's ranked-sum test for intra-group comparisons and differences between groups with t-test and Bonferroni's test at a level of significance of P < 0.05. Activator and high-pull headgear combination treatment in these growing patients resulted in a correction of the skeletal Class II relationship (ANB -3.4 degrees), a restriction of maxillary growth (SNA -2.0 degrees, OLp-A -2.3 mm), an advancement of the mandibular structures (SNB +2.6 degrees, FH-NPg +2.3 degrees, OLp-B +2.7 mm, OLp-Pg +2.2 mm), an increase in lower face height (ANS-Me +3.9 mm), a correction of the overjet (-5.4 mm), an improvement in overbite (-2.2 mm), uprighting of the maxillary incisors (U1-FH -5.3 degrees, OLp-U1 -2.5 mm), protrusion of the mandibular incisors (IMPA +2.0 degrees, OLp-L1 +2.7 mm), and a correction of the dental Class II malocclusion (OLp-L6 +3.5 mm). The soft tissue profile changes were a correction of facial convexity (G'-Sn-Pg' angle 2.3 degrees, Mlf-Li-x-axis angle 9.1 degrees), and an increase in lower antero-posterior (Mlf-y-axis 5.6 mm, Pg'-y-axis 5.3 mm), and lower vertical (Sls-x-axis 3.8 mm, Pg'-x-axis 3.8 mm, Me'-x-axis 5.1 mm) soft tissue dimensions. The mentolabial fold depth (Mlf-E line) also significantly decreased, -0.8 mm in the treated group. The activator and high-pull headgear combination appliance was effective in treating growing patients with maxillary prognathism, mandibular deficiency, and facial convexity by a combination of skeletal and dentoalveolar changes and improvement in the soft tissue facial profile.
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Affiliation(s)
- Gülnaz Marşan
- Department of Orthodontics, Faculty of Dentistry, Istanbul University, Capa, Istanbul, Turkey.
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Fogle LL, Southard KA, Southard TE, Casko JS. Treatment outcomes of growing Class II Division 1 patients with varying degrees of anteroposterior and vertical dysplasias, Part 1. Cephalometrics. Am J Orthod Dentofacial Orthop 2004; 125:450-6. [PMID: 15067261 DOI: 10.1016/j.ajodo.2003.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this retrospective study was to evaluate the differences in orthodontic treatment outcomes for 5 groups of growing Class II Division 1 patients with various anteroposterior and vertical skeletal dysplasias. Pretreatment and posttreatment cephalograms of 100 patients were evaluated for soft and hard tissue treatment effects and differences between groups. Changes from pretreatment to posttreatment differed between groups in correction of overjet and change in ANB angle (P <.05). Those with the largest skeletal dysplasias had the greatest skeletal correction but also retained the largest ANB angles posttreatment. Additional correction was achieved through dentoalveolar change with the greatest uprighting of maxillary incisors occurring in patients who initially were the most severely affected (P <.05); this effect was accompanied by an increase in nasolabial angle. All groups had similar changes in mandibular incisor positions, and final positions of the mandibular incisors did not differ between groups. Compared with norms, Z angles and facial contour angles showed discrimination between the most and least severely affected patients based on combined anteroposterior and vertical dysplasias (P <.05). However, there were no clear-cut divisions between the groups, especially with regard to soft tissue cephalometric outcomes. Further evaluation of profile esthetics follows in Part 2. We conclude that conventional orthodontic therapy successfully corrects Class II Division 1 malocclusions in growing patients through a combination of skeletal and dentoalveolar changes, with the greatest changes occurring in patients who initially have the most severe skeletal dysplasias.
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Affiliation(s)
- Laura L Fogle
- Department of Orthodontics, S-221 Dental Science Building, University of Iowa, Iowa City, IA 52242, USA
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