Nonextraction treatment of a skeletal Class III malocclusion

Comparison of facial profile attractiveness in pattern III patients treated with facial filling or orthognathic surgery

OBJECTIVE

To compare facial profile attractiveness according to orthodontists, dentists, and laypeople in pattern III patients treated with facial filling or orthognathic surgery.

MATERIALS AND METHODS

Thirty pattern III patients were retrospectively divided into two groups. Group 1 comprised 15 patients (10 females, five males; mean age 37.40 years, SD = 14.50) treated with a hyaluronic acid facial filling. Group 2 comprised 15 patients (seven females, eight males; mean age 31.76 years, SD = 9.85) treated with dental decompensation and orthognathic surgery. Facial profile silhouettes from photographs were evaluated by laypeople (n = 80), dentists (n = 60), and orthodontists (n = 68), who rated attractiveness on a scale from 0 (least attractive) to 10 (most attractive). Profile attractiveness was compared between groups using independent t-tests. Evaluator group scores were compared using one-way ANOVA and Tukey tests.

RESULTS

Both the facial filling and surgery groups significantly improved profile attractiveness. Initially (T1), both groups had similar profile attractiveness. Post-treatment (T2), the surgical group had a significantly more attractive profile than the facial filling group. Orthodontists recorded the highest profile attractiveness ratings, dentists gave intermediate scores, and laypeople recorded the lowest, both before and after treatment. Correct answer percentages were similar across the evaluator groups for both treatments.

CONCLUSION

Both treatments significantly improved profile attractiveness, with the surgical group showing greater improvement.

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

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

Skeletal, Dental, and Soft Tissue Changes after Applying Active Skeletonized Sutural Distractor (ASSD) for Class III Malocclusion Patients

Background: Nonsurgical treatment of Class III malocclusion may reduce the chances for orthognathic surgery in the future. This study aimed to determine the post-treatment skeletal, dental and soft tissue changes in the anteroposterior plane applying active skeletonized sutural distractor (ASSD) in late adolescent Class III malocclusion patients. Materials and Methods: After screening 13,500 students from 18 secondary schools, a sample of 26 subjects was recruited for this study, with a mean age of 15(±1.4) years after considering the inclusion and exclusion criteria. ASSD appliances were inserted into patients, and lateral cephalometric x-rays were taken for pre- and post-treatment analysis. Dental casts of the patients were also taken and scanned using a 3D laser scanner for comparisons. Results: The intraclass correlation coefficients (ICC) for inter-examiner were 0.87 to 0.99 and 0.96 to 0.99 for lateral cephalometric and dental cast measurements, respectively. The difference in pre- and post-treatment of cephalometric measurements of the mandible showed statistically significant changes for mandibular plane angle (p < 0.001) and SNB angle (p = 0.029). The dental cast measurements showed statistically significant changes of inter-molars width (p < 0.001) as well as palatal (p = 0.002). Conclusions: The results showed statistically significant improvement in skeletal, dental, and soft tissue changes after treatment applying ASSD for Class III malocclusion patients.

Smile attractiveness in class III patients after orthodontic camouflage or orthognathic surgery

OBJECTIVE

The study's objective was to compare the smile attractiveness in patients with class III malocclusion treated with orthodontic camouflage or orthognathic surgery.

MATERIAL AND METHODS

The sample consisted of 30 patients with class III malocclusion treated without extractions divided into two groups, according to the treatment performed: G1, orthodontic camouflage, consisting of 15 patients (9 female; 6 male) with mean initial age of 21.26 years (SD = 7.39) and mean final age of 24.52 years (SD = 7.10). The mean treatment time was 3.26 years (SD = 1.50). G2, ortho-surgical, consisting of 15 patients (8 females; 7 males), with mean initial age of 23.12 years (SD=7.37), mean final age of 25.82 years (SD = 7.14) and mean treatment time of 2.71 years (SD = 0.90). The smile attractiveness was evaluated in black and white photographs of posed smiles taken before and after treatment, with a numerical rating scale from 1 to 10, with 1 being the least attractive and 10 the greatest smile attractiveness. The smiles were evaluated in a questionnaire by 111 participants, 67 orthodontists (mean age 41.31 years, SD = 9.44) and 44 laypeople (mean age 41.41 years, SD = 14.38). Intergroup comparison was performed with independent t test.

RESULTS

There was a significant improvement in the smile attractiveness with both camouflage and ortho-surgical treatments. The smile attractiveness was similar between the camouflage and surgical groups at the beginning. There was a significantly greater improvement in smile attractiveness with treatment in the surgical group than in the camouflage group, and at the end of treatment, the surgical group showed greater smile attractiveness than the camouflage group. Orthodontists considered the smiles more attractive both at the beginning and the end of treatment when compared to the assessment made by laypeople.

CONCLUSION

The ortho-surgical treatment promoted a greater improvement in the smile attractiveness, and at the final stage, a greater smile attractiveness than the orthodontic camouflage.

CLINICAL RELEVANCE

Smile attractiveness is an important characteristic of the final result of orthodontic treatment. Knowing which treatment protocol will provide a better improvement and outcome regarding smile esthetics is essential.

Comparative evaluation of treatment outcomes between temporary anchorage devices and Class III elastics in Class III malocclusions

INTRODUCTION

Our objective was to elucidate the differences in treatment outcomes caused by the different mechanics of temporary anchorage devices (TADs) and Class III elastics in patients with Class III malocclusions.

METHODS

Records of 23 patients with Angle Class III malocclusion were selected retrospectively. All had been treated with nonextraction comprehensive orthodontic treatment; 11 were treated with TADs and 12 with Class III elastics. Pretreatment and posttreatment lateral cephalograms were used for evaluation of the treatment outcomes. A paired t test and a Student t test were used for statistical analysis.

RESULTS

In both groups, proper overjet and Class I molar relationships were achieved, and the occlusal plane was rotated counterclockwise. In the elastics group, distal tipping of the mandibular molars, extrusion of the mandibular incisors and maxillary molars, clockwise rotation of the mandibular plane angle, and increased ANB angle were observed. In the TADs group, distal tipping and intrusion of the mandibular molars, bodily movement of the mandibular incisors, and reduced mandibular plane angle were observed.

CONCLUSIONS

In nonextraction treatment for Class III malocclusions, the mandibular plane angle was increased in the elastics group, whereas it was decreased in TADs group. Thus, we suggest that Class III elastics are preferred for low-angle, short-face patients, whereas TADs are preferred for high-angle, long-face patients.

Non-surgical treatment of skeletal class III malocclusion

The incidence of skeletal class III malocclusion has a mean of 3% in the Caucasian population, 5% in African-American adolescents and about 14% in the Asian population. In India, the incidence of class III malocclusion is reported to be 3.4%. A patient having class III malocclusion shows findings ranging from edge-to-edge bite to large reverse overjet, with extreme variations of underlying skeletal jaw bases and craniofacial form. This is a case report of a 20-year-old man having skeletal class III malocclusion with concave profile, anterior crossbite and a negative overjet of 3 mm treated non-surgically with extraction of only one lower left first premolar.