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Abo-Elmahasen MMF, Elsaharty M, Abotaha NF, Mohamed AAS. Assessment of the condylar response of two differently anchored fixed functional appliances in class II malocclusion in young adult orthodontic patients: A randomized clinical trial. J Orthod Sci 2024; 13:3. [PMID: 38516116 PMCID: PMC10953695 DOI: 10.4103/jos.jos_112_23] [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: 06/11/2023] [Revised: 09/01/2023] [Accepted: 01/08/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE Measuring the condylar volume changes after treatment with skeletally anchored type IV Herbst appliance vs. Twin Force Bite Corrector (TFBC) in class II malocclusion in young adult patients. MATERIALS AND METHODS Twenty class II malocclusion participants were randomly involved in our randomized clinical study. They are divided equally into two groups: group I (10 patients with an age range of 16 to 18 years and a mean age of (17.15 ± 0.62) (five males and five females) with a mean Angle formed between (A) point and (Nasion) point and (B) point, to determine anteroposterior relation between maxilla and mandible (ANB) of 6.20 (1.03) and a mean mandibular length of 106.1 (1.7), who were treated by a skeletally anchored type IV Herbst appliance, supported at the mandible by two mini-plates fixed bilaterally at the mandibular symphysis; group II (10 patients with an age range of 15 to 18 years and a mean age of (16.85 ± 0.33) (six males and four females) with a mean ANB of 6.80 (0.89) and a mean mandibular length of 107.3 (2.36), who were treated by a TFBC that was installed just mesial to the tube of the maxillary first permanent molar and distal to the bracket of the lower canine for 4 months. According to the Index of Orthognathic Functional Treatment Need (IOFTN) index, the participants in both groups have grade 4 (great need for treatment) as they have excessive overjet (6-9 mm). Cone-beam computed tomography (CBCT) was taken just before installing fixed functional appliances and after the removal. The condylar volume was measured using Dolphin software. Parametric measurements were performed by the independent t-test, while non-parametric variables (percent change) were compared by the Mann-Whitney U-test. RESULTS On the right side, the Herbst group recorded a percent increase (median = 1.23%), while TFBC recorded a median percent decrease (-7.85%). This change is statistically significant (P = 0.008). CONCLUSIONS The difference in the condylar volume was significantly higher with the mini-plate anchored Herbst appliance than with the dentally anchored TFBC group.
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Affiliation(s)
| | - Mohamed Elsaharty
- Department of Orthodontics, Faculty of Dentistry, Tanta University, Egypt
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Shi Y, Luo S, Wang H, Yao Q, Shi Y, Cheng J. Three-dimensional bone remodelling of glenoid fossa in patients with skeletal Class III malocclusion after bimaxillary orthognathic surgery. Int J Oral Maxillofac Surg 2024; 53:133-140. [PMID: 37442687 DOI: 10.1016/j.ijom.2023.06.006] [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: 11/08/2022] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
This study aimed to characterize three-dimensional quantitative morphological changes of glenoid fossa in patients with skeletal Class III malocclusion treated with bimaxillary orthognathic surgery. Ninety-five eligible patients (50 male, 45 female; mean age 22.09 years) were enrolled retrospectively. Cone beam computed tomography obtained at 1 week preoperatively (T0), immediately after surgery (T1), and at ≥ 12 months postoperatively (T2) were registered based on cranial base using voxel-based registration in 3D Slicer. Glenoid fossa surface was divided spatially into four regions, and bone modelling in these regions was visualized with color maps. Our data revealed that the mean surface variations of glenoid fossa were small, with modest bone formation as a whole. No significant associations between anteroposterior or vertical mandibular displacement and overall glenoid fossa remodeling were found (P > 0.05). Moreover, bone deposition was frequently observed in the anterior-lateral region of glenoid fossa in patients with a larger mandibular movement during T0-T1 (P < 0.001). Paired bone formation in the anterior-lateral region of glenoid fossa and bone resorption in the anterior-lateral region of condylar head was frequently observed. Collectively, our results revealed that glenoid fossa underwent complex but modest bone remodeling after bimaxillary surgery in skeletal Class III patients.
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Affiliation(s)
- Y Shi
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, PR China
| | - S Luo
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, PR China; Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, PR China
| | - H Wang
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China
| | - Q Yao
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China
| | - Y Shi
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China
| | - J Cheng
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, PR China; Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, PR China.
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Fan Y, Han B, Zhang Y, Guo Y, Li W, Chen H, Meng C, Penington A, Schneider P, Pei Y, Chen G, Xu T. Natural reference structures for three-dimensional maxillary regional superimposition in growing patients. BMC Oral Health 2023; 23:655. [PMID: 37684645 PMCID: PMC10492283 DOI: 10.1186/s12903-023-03367-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Assessment of growth-related or treatment-related changes in the maxilla requires a reliable method of superimposition. Such methods are well established for two-dimensional (2D) cephalometric images but not yet for three-dimensions (3D). The aims of this study were to identify natural reference structures (NRS) for the maxilla in growing patients in 3D, opportunistically using orthodontic mini-screws as reference; and to test the applicability of the proposed NRS for maxillary superimposition by assessing the concordance of this approach with Björk's 'stable reference structures' in lateral projection. METHODS The stability of the mini-screws was tested on longitudinal pairs of pre- and post-orthodontic cone-beam computed tomography (CBCT) images by measuring the distance changes between screws. After verifying the stability of the mini-screws, rigid registration was performed for aligning the stable mini-screws. Then, non-rigid registration was used to establish the dense voxel-correspondence among CBCT images and calculate the displacement of each voxel belonging to the maxilla relative to the mini-screws. The displacement vectors were transformed to a standardized maxillary template to categorize the stability of the internal structures statistically. Those voxels that displaced less relative to the mini-screws were considered as the natural reference structures (NRS) for the maxilla. Test samples included another dataset of longitudinal CBCT scans. They were used to evaluate the applicability of the proposed NRS for maxillary superimposition. We assessed whether aligning the maxilla with proposed NRS is in concordance with the maxillary internal reference structures superimposition in the traditional 2D lateral view as suggested by Björk. This was quantitively assessed by comparing the mean sagittal and vertical tooth movements for both superimposition methods. RESULTS The stability of the mini-screws was tested on 10 pairs of pre- and post-orthodontic cone-beam computed tomography (CBCT) images (T1: 12.9 ± 0.8 yrs, T2: 14.8 ± 0.7 yrs). Both the loaded and the unloaded mini-screws were shown to be stable during orthodontic treatment, which indicates that they can be used as reference points. By analyzing the deformation map of the maxilla, we confirmed that the infraorbital rims, maxilla around the piriform foramen, the infrazygomatic crest and the hard palate (palatal vault more than 1 cm distal to incisor foramen except the palatal suture) were stable during growth. Another dataset of longitudinal CBCT scans (T1: 12.2 ± 0.63 yrs, T2: 15.2 ± 0.96 yrs) was used to assess the concordance of this approach with Björk's 'stable reference structures'. The movement of the maxillary first molar and central incisor showed no statistically significant difference when superimposing the test images with the proposed NRS or with the classic Björk maxillary superimposition in the lateral view. CONCLUSIONS The infraorbital rims, maxilla around the piriform foramen, the infrazygomatic crest and the hard palate (palatal vault more than 1 cm posterior to incisal foramen except the palatal suture) were identified as stable regions in the maxilla. These stable structures can be used for maxillary superimposition in 3D and generate comparable results to Björk superimposition in the lateral view.
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Affiliation(s)
- Yi Fan
- Third Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Bing Han
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yungeng Zhang
- Key Laboratory of Machine Perception (MOE), Department of Machine Intelligence, School of Artificial Intelligence and Technology, Peking University, Beijing, China
| | - Yixiao Guo
- Key Laboratory of Machine Perception (MOE), Department of Machine Intelligence, School of Artificial Intelligence and Technology, Peking University, Beijing, China
| | - Wei Li
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Huanhuan Chen
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chenda Meng
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Anthony Penington
- Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Melbourne, Australia
- Facial Science, Murdoch Children's Research Institute, Melbourne, Australia
| | - Paul Schneider
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
| | - Yuru Pei
- Key Laboratory of Machine Perception (MOE), Department of Machine Intelligence, School of Artificial Intelligence and Technology, Peking University, Beijing, China
| | - Gui Chen
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Tianmin Xu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.
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Wang Y, Xu Y, Gong Z, Pan J, Liu Y. Efficacy of an innovative Herbst appliance with TADs for patients with hyperdivergent class II malocclusion: study protocol for a randomised controlled trial. BMJ Open 2023; 13:e071840. [PMID: 37620276 PMCID: PMC10450085 DOI: 10.1136/bmjopen-2023-071840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Class II treatment with mandibular retrusion often involves the Herbst appliance due to its efficiency and low requirement of cooperation. Despite its advantages, it causes side effects concerning the occlusal plane and pogonion in terms of clockwise rotation that hinder the desired mandibular advancement for hyperdivergent patients. In this study, we will use a newly designed Herbst appliance, and a protocol that is accompanied by TADs for vertical control to avoid maxillary clockwise rotation. We hypothesise that the effect of the Herbst appliance with the vertical control approach will be beneficial for maintaining or even decreasing the skeletal divergence in hyperdivergent class II patients compared with conventional Herbst treatment. METHODS AND ANALYSIS This study is a randomised, parallel, prospective controlled trial that will study the efficacy of Herbst with or without vertical control in children with hyperdivergent skeletal class II malocclusion. A total of 44 patients will be enrolled and randomised in a ratio of 1:1 to either Herbst treatment or Herbst treatment with vertical control. Participants will be recruited at the Shanghai Stomatological Hospital, Shanghai, China. The primary endpoint is the change in the angle indicating the occlusal plane and Sella-Nasion plane from baseline (T0) to the primary endpoint (T2) on cephalometric measurements by lateral X-ray examination. Important secondary outcomes include the root length of the anterior teeth, and the assessment score of the Visual Analogue Scale Questionnaire, etc. Safety endpoints will also be evaluated. ETHICS AND DISSEMINATION This study has been approved by the ethics committee of the Shanghai Stomatological Hospital (Approval No. (2021) 012). Before enrolment, a qualified clinical research assistant will obtain written informed consent from both the participants and their guardians after full explanation of this study. The results will be presented at national or international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2100049860, Chinese Clinical Trial Registry.
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Affiliation(s)
- Yuhui Wang
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Yichen Xu
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Zhicheng Gong
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
- Department of Prosthodontic Technology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
| | - Jie Pan
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Yuehua Liu
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
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Gurgel ML, de Oliveira Ruellas AC, Bianchi J, McNamara JA, Tai S, Franchi L, Deleat-Besson R, Le C, Logan C, Turkestani NA, Massaro C, Del Castillo AA, Arruda KEM, Benavides E, Yatabe M, Cevidanes L. Clear aligner mandibular advancement in growing patients with Class II malocclusion. AJO-DO CLINICAL COMPANION 2023; 3:93-109. [PMID: 37636594 PMCID: PMC10454533 DOI: 10.1016/j.xaor.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Treatment effects occurring during Class II malocclusion treatment with the clear aligner mandibular advancement protocol were evaluated in two growing patients: one male (12 years, 3 months) and one female (11 years, 9 months). Both patients presented with full cusp Class II molar and canine relationships. Intraoral scans and cone-beam computed tomography were acquired before treatment and after mandibular advancement. Three-dimensional skeletal and dental long-axis changes were quantified, in which the dental long axis was determined by registering the dental crowns obtained from intraoral scans to the root canals in cone-beam computed tomography scans obtained at the same time points. Class II correction was achieved by a combination of mandibular skeletal and dental changes. A similar direction of skeletal and dental changes was observed in both patients, with downward and forward displacement of the mandible resulting from the growth of the mandibular condyle and ramus. Dental changes in both patients included mesialization of the mandibular posterior teeth with flaring of mandibular anterior teeth. In these two patients, clear aligner mandibular advancement was an effective treatment modality for Class II malocclusion correction with skeletal and dental effects and facial profile improvement.
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Affiliation(s)
- Marcela Lima Gurgel
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Antonio Carlos de Oliveira Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
- Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jonas Bianchi
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, Calif
| | - James A. McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Sandra Tai
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, School of Dentistry, University of Florence, Florence, Tuscany, Italy
| | - Romain Deleat-Besson
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Celia Le
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Candice Logan
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Najla Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
- Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Camila Massaro
- Department of Orthodontics, School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Aron Aliaga Del Castillo
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Erika Benavides
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
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Bock NC, Jungbauer R, Rudzki I, Proff P, Ruf S. Long-term (≥ 15 years) outcome quality after Class II:1 bionator or Herbst multibracket appliance treatment : A comparison. J Orofac Orthop 2023:10.1007/s00056-023-00457-3. [PMID: 36826527 DOI: 10.1007/s00056-023-00457-3] [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: 01/18/2022] [Accepted: 10/19/2022] [Indexed: 02/25/2023]
Abstract
PURPOSE To compare the long-term outcome quality (≥ 15 years) of Class II:1 treatment using either a bionator (BIO) or a Herbst-multibracket appliance (HMB). METHODS Patients who underwent functional treatment during the ideal treatment period for the respective approach (prepuberty vs. peak/postpeak) were assessed. Inclusion criteria were overjet ≥ 4 mm, skeletal Class II and availability of study casts from before, after and ≥ 15 years after treatment. The study casts were assessed using the Peer Assessment Rating (PAR) index and standard orthodontic cast measurements. RESULTS During treatment, PAR score, overjet and sagittal occlusal relationship improved significantly in all groups. Long-term, there was a significant increase of incisor irregularity in the upper (HMB) and lower (BIO) arch and a significant decrease of lower arch width 3 - 3 (BIO). PAR score, overjet, and sagittal occlusal relationship remained stable long-term. Intergroup comparisons revealed significant differences between the BIO and HMB groups in terms of lower arch width (6 - 6), upper and lower arch width (3 + 3/3 - 3) as well as sagittal molar relationship. CONCLUSIONS The achieved improvement in PAR score, overjet, and sagittal occlusion remained comparably stable long-term in all groups. The long-term changes are probably a consequence of natural aging.
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Affiliation(s)
| | - Rebecca Jungbauer
- Department of Orthodontics, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Ingrid Rudzki
- Faculty of Medicine, Ludwig Maximilian University, Munich, Germany
| | - Peter Proff
- Department of Orthodontics, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Sabine Ruf
- Department of Orthodontics, Justus Liebig University, Giessen, Germany
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A Semi-Automatic Approach for Holistic 3D Assessment of Temporomandibular Joint Changes. J Pers Med 2023; 13:jpm13020343. [PMID: 36836577 PMCID: PMC9959062 DOI: 10.3390/jpm13020343] [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: 01/10/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
The literature lacks a reliable holistic approach for the three-dimensional (3D) assessment of the temporomandibular joint (TMJ) including all three adaptive processes, which are believed to contribute to the position of the mandible: (1) adaptive condylar changes, (2) glenoid fossa changes, and (3) condylar positional changes within the fossa. Hence, the purpose of the present study was to propose and assess the reliability of a semi-automatic approach for a 3D assessment of the TMJ from cone-beam computed tomography (CBCT) following orthognathic surgery. The TMJs were 3D reconstructed from a pair of superimposed pre- and postoperative (two years) CBCT scans, and spatially divided into sub-regions. The changes in the TMJ were calculated and quantified by morphovolumetrical measurements. To evaluate the reliability, intra-class correlation coefficients (ICC) were calculated at a 95% confidence interval on the measurements of two observers. The approach was deemed reliable if the ICC was good (>0.60). Pre- and postoperative CBCT scans of ten subjects (nine female; one male; mean age 25.6 years) with class II malocclusion and maxillomandibular retrognathia, who underwent bimaxillary surgery, were assessed. The inter-observer reliability of the measurements on the sample of the twenty TMJs was good to excellent, ICC range (0.71-1.00). The range of the mean absolute difference of the repeated inter-observer condylar volumetric and distance measurements, glenoid fossa surface distance measurements, and change in minimum joint space distance measurements were (1.68% (1.58)-5.01% (3.85)), (0.09 mm (0.12)-0.25 mm (0.46)), (0.05 mm (0.05)-0.08 mm (0.06)) and (0.12 mm (0.09)-0.19 mm (0.18)), respectively. The proposed semi-automatic approach demonstrated good to excellent reliability for the holistic 3D assessment of the TMJ including all three adaptive processes.
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Wu Y, Yu Q, Xia Y, Wang B, Chen S, Gu K, Zhang B, Zhu M. Does mandibular advancement with clear aligners have the same skeletal and dentoalveolar effects as traditional functional appliances? BMC Oral Health 2023; 23:65. [PMID: 36732724 PMCID: PMC9896678 DOI: 10.1186/s12903-023-02709-5] [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: 11/16/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The study aimed to compare the dentoskeletal effects of Vanbeek Activator, Herbst, Twin-Block and Mandibular Advancement with clear aligners in children with skeletal Class II malocclusions. METHODS A sample with sixty-three patients (37 males, 26 females) was included and divided into untreated control group (C, n = 12), Vanbeek Activator group (V, n = 14), Herbst group (H, n = 11), Twin-Block group (TB, n = 12) and MA group (MA, n = 14). Cephalometric analysis and Johnston Pitchfork analysis were performed to quantify the skeletal and dentoalveolar components in molar relationship and overjet correction. Compare the differences of cephalometric data and Johnston-analysis data. RESULTS The treatment changes showed significant differences in SNB, FH-NP, NA-PA, Co-Go, Co-Pog, ANB, lower facial height ratio, U1-PP, U6-PP, L1-MP and U1-L1. All the appliances improved overjet relationships significantly (Vanbeek, Herbst, Twin-Block and MA were 2.77 mm, 5.53 mm, 4.73 mm and 3.66 mm respectively) with significant retraction of maxillary incisors. The lower incisor displacement of group V and MA was negative, while that of group H and TB was positive and there were significant differences. Molar relationships were also improved by 3.45 mm, 6.85 mm, 3.48 mm and 0.92 mm for Vanbeek, Herbst, Twin-Block and MA. Mandible displacement showed a trend of group H > TB > V > MA. The displacement of maxillary molars in group H was greater than that in group C, TB and MA, and that of mandibular ones was greater than that in group C, V and MA, significantly. Herbst, Twin-Block and MA have more significant dentoalveolar effect than Vanbeek, while Vanbeek has more skeletal effect than the others especially in restraining maxillary growth. CONCLUSIONS Four appliances are all effective in mandibular advancement, modification of class II molar relationship and deep overjet, with unavoidable increase in lower facial ratio. Vanbeek Activator has the most skeletal effects. Vanbeek and MA have a good control of mandibular incisors while more compensatory lower incisors proclination in Herbst and Twin-Block. Herbst has greater maxillary molar distalization. MA allows aligning and leveling meanwhile leading the mandible forward.
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Affiliation(s)
- Yanqi Wu
- grid.16821.3c0000 0004 0368 8293Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011 China ,grid.412523.30000 0004 0386 9086National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011 China
| | - Qian Yu
- Department of Pediatric Dentistry, Shanghai Xuhui District Dental Center, Shanghai, 200032 China
| | - Yunhui Xia
- grid.16821.3c0000 0004 0368 8293Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011 China ,grid.412523.30000 0004 0386 9086National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011 China
| | - Bo Wang
- grid.16821.3c0000 0004 0368 8293Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011 China ,grid.412523.30000 0004 0386 9086National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011 China
| | - Siyue Chen
- grid.16821.3c0000 0004 0368 8293Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011 China ,grid.412523.30000 0004 0386 9086National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011 China
| | - Kaijun Gu
- grid.16821.3c0000 0004 0368 8293Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011 China ,grid.412523.30000 0004 0386 9086National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011 China
| | - Bojun Zhang
- grid.16821.3c0000 0004 0368 8293Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011 China ,grid.412523.30000 0004 0386 9086National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011 China
| | - Min Zhu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China. .,College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China. .,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, 200011, China. .,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, 200011, China.
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9
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Matthaios S, Tsolakis AI, Haidich AB, Galanis I, Tsolakis IA. Dental and Skeletal Effects of Herbst Appliance, Forsus Fatigue Resistance Device, and Class II Elastics-A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11236995. [PMID: 36498570 PMCID: PMC9741176 DOI: 10.3390/jcm11236995] [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: 10/17/2022] [Revised: 11/13/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Our study aimed to systematically summarize the dentoskeletal effects of Herbst appliance; Forsus fatigue resistance device; and Class II elastics in adolescent Class II malocclusion. Methods: Five databases; unpublished literature; and reference lists were last searched in August 2022. Randomized clinical trials and observational studies of at least 10 Class II growing patients that assessed dentoskeletal effects through cephalometric/CBCT superimpositions were eligible. The included studies quality was assessed with the RoB 2 and ROBINS-I tools. A random-effects model meta-analysis was performed. Heterogeneity was explored with subgroup and sensitivity analyses. Results: Among nine studies (298 patients); two-to-three studies were included in each meta-analysis. Less post-treatment upper incisor retroclination (<2) and no overbite; overjet; SNA; SNB; and lower incisor inclination differences were found between Herbst/Forsus and Class II elastics. No differences in maxilla; condyle; glenoid fossa; and most mandibular changes were found between Herbst and Class II elastics; except for a greater 1.5 mm increase in mandibular length and right mandibular ramus height (1.6 mm) with Herbst. Conclusions: Herbst and Class II elastics corrected the molar relationship; but Herbst moved the lower molars more mesially. Apart from an additional mandibular length increase; no other dental and anteroposterior skeletal difference was found. Forsus was more effective in molar correction; overjet reduction; and upper incisor control than Class II elastics. Trial registration number OSF: 10.17605/OSF.IO/8TK3R.
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Affiliation(s)
- Stefanos Matthaios
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
- Correspondence:
| | - Apostolos I. Tsolakis
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Ioannis Galanis
- 2nd Propaedeutic Department of Surgery, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Ioannis A. Tsolakis
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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10
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Sangalli KL, Dutra-Horstmann KL, Correr GM, Topolski F, Flores-Mir C, Lagravère MO, Moro A. Three-dimensional skeletal and dentoalveolar sagittal and vertical changes associated with cantilever Herbst appliance in prepubertal patients with Class II malocclusion. Am J Orthod Dentofacial Orthop 2022; 161:638-651.e1. [PMID: 35016812 DOI: 10.1016/j.ajodo.2020.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 11/01/2022]
Abstract
INTRODUCTION This study aimed to assess sagittal and vertical skeletal and dentoalveolar changes through the use of 3-dimensional imaging in prepubertal Class II malocclusion patients treated with a cantilever Herbst appliance (HA). Condyle-glenoid fossa positional changes were also quantified. METHODS This retrospective cohort study assessed 22 children (11.2 years ± 1.2) consecutively treated with a cantilever HA for 12 months and 11 untreated children (aged 9.3 ± 0.30 years) that served as controls. Cone-beam computed tomography was performed at baseline (T1) and at the end of the observation period (T2). Movements in the regions of interest were measured as linear displacements from cone-beam computed tomography images through algebraic calculations. A Student t test for independent samples was used for group equivalence testing at T1, and the treatment differences between T2 and T1 were evaluated by 2 analyses of covariance, one considering the expected growth unit as a covariate and the other with an annualized factor. RESULTS The largest dental movement was a mesial movement of mandibular molars (3.70 mm), whereas the largest skeletal changes consisted of a larger relative length of the mandible (difference of 1.2 mm) in the HA group than in the control group. CONCLUSIONS Within the study limitations (retrospective cohort, historical control group, and sample size), 3-dimensional imaging suggests that HA corrected Class II malocclusion in a predominantly prepubertal sample through more dental than skeletal changes. The changes were more significant in the sagittal than in the vertical direction. In addition, relative stability in the condyle-fossa relationship was noted.
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Affiliation(s)
- Kamilla Leonardo Sangalli
- School of Health Sciences, Graduate Program in Dentistry, Universidade Positivo, Curitiba, Paraná, Brazil
| | | | - Gisele Maria Correr
- School of Health Sciences, Graduate Program in Dentistry, Universidade Positivo, Curitiba, Paraná, Brazil
| | - Francielle Topolski
- School of Health Sciences, Graduate Program in Dentistry, Universidade Positivo, Curitiba, Paraná, Brazil
| | - Carlos Flores-Mir
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Manuel O Lagravère
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Alexandre Moro
- School of Health Sciences, Graduate Program in Dentistry, Universidade Positivo, Department of Orthodontics, Federal University of Paraná, Curitiba, Paraná, Brazil.
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11
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Holte MB, Nielsen TW, Sæderup H, Pinholt EM. Does the Glenoid Fossa Change following Orthognathic Surgery? J Oral Maxillofac Surg 2022; 80:1007-1017. [DOI: 10.1016/j.joms.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
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12
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Three-Dimensional Evaluation of Condyle-Glenoid Fossa Complex Following Treatment with Herbst Appliance. J Clin Med 2021; 10:jcm10204730. [PMID: 34682852 PMCID: PMC8538158 DOI: 10.3390/jcm10204730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
The purpose of the present retrospective observational study was to compare the effects of treatment with Herbst appliance and fixed therapy with elastics on the condyle and glenoid fossa complex. Thirty patients aged between twelve and sixteen years with skeletal Class II malocclusion who met the inclusion criteria were included in the study: fifteen patients treated with Herbst appliance (Group 1), and fifteen patients treated with orthodontic camouflage using MBT prescription (MBTTM Versatile+ Appliance System) (Group 2). For Group 2, patients had CBCT scans taken before treatment either after Herbst appliance removal or at the end of treatment. CBCT scans were evaluated for changes in condyle-glenoid fossa complex using the In Vivo Dental 5.1 software. Statistical significance was set at p ≤ 0.05. On inter-group comparison, the Herbst group showed statistically significant increases in the condylar height of 1.35 mm (p ≤ 0.001) on the right and 1.21 mm (p ≤ 0.01) on the left side, and a condylar volume of 111.03 mm3 (p ≤ 0.01) on the right and 127.80 mm3 (p ≤ 0.001) on the left side. The Herbst group showed anterior remodelling on the postero-superior aspect of glenoid fossa. Herbst appliance treatment induced growth at the condylar head and anterior remodelling of glenoid fossa, thereby improving the maxilla-mandibular relationship in growing skeletal Class II patients.
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13
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Stability of Class II Malocclusion Treatment with the Austro Repositioner Followed by Fixed Appliances in Brachyfacial Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189793. [PMID: 34574718 PMCID: PMC8465120 DOI: 10.3390/ijerph18189793] [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: 08/10/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/02/2022]
Abstract
One of the goals of functional-appliance devices is to modify the vertical growth pattern, solving several kinds of malocclusion. This study aimed to evaluate Class II malocclusion treatment’s stability with Austro Repositioner, followed by fixed appliances, and assess its capacity to modify vertical dimensions in brachyfacial patients. A test group of 30 patients (16 boys and 14 girls, mean 11.9 years old) with Class II malocclusion due to mandibular retrognathism and brachyfacial pattern treated with Austro Repositioner and fixed appliance were compared to a matched untreated Class II control group of 30 patients (17 boys and 13 girls, mean age 11.7 years old). Lateral cephalograms were taken at T1 (initial records), T2 (end of treatment), and T3 (one year after treatment). Statistical comparisons were performed with a paired-sample t-test and two-sample t-tests. Significant improvements in the skeletal Class II relationship were observed in the treated group. The ANB angle decreased (4.75°), the SNB angle increased (3.92°), and the total mandibular length (Co-Pg) increased (8.18 mm) (p < 0.001). Vertical dimensions were also significantly modified, the FMA angle increased (3.94°), LAFH-distance increased (3.15 mm), and overbite decreased (3.35 mm). These changes remained stable one year after treatment. The Austro Repositioner was adequate for treating the skeletal Class II malocclusion resulting from the mandible retrusion in brachyfacial patients.
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14
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Silva FPLD. Mandibular orthopedic advancement in different facial patterns and distinct stages of skeletal maturation. Dental Press J Orthod 2021; 26:e21bbo2. [PMID: 34008742 PMCID: PMC8130370 DOI: 10.1590/2177-6709.26.2.e21bbo2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/22/2021] [Indexed: 11/22/2022] Open
Abstract
The Herbst appliance can be very effective in treatment of Class II patients with mandibular retrognathism. Because of the continuous action in a full-time basis, treatment time using it normally takes from six to ten months, and is usually followed by a second phase of full fixed appliances, in order to obtain both occlusal refinement and long term stability. Despite Herbst appliance's effectiveness in the occlusal and dentoalveolar perspectives, its facial results may differ among patients with different growth patterns, as well as in distinct stages of skeletal maturation. In the current paper, two patients with different facial patterns are presented, who were treated under the same protocol, using Herbst and full fixed appliances in different skeletal maturation stages, and both dentoalveolar and facial results are compared and discussed.
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15
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Ehardt L, Ruellas A, Edwards S, Benavides E, Ames M, Cevidanes L. Long-term stability and condylar remodeling after mandibular advancement: A 5-year follow-up. Am J Orthod Dentofacial Orthop 2021; 159:613-626. [PMID: 33712310 DOI: 10.1016/j.ajodo.2019.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This study evaluated whether presurgical characteristics, the magnitude of mandibular advancement, and changes in mandibular plane angle are correlated with long-term stability and postsurgical condylar remodeling and adaptations using 3-dimensional imaging. METHODS Forty-two patients underwent bilateral sagittal split osteotomies for mandibular advancement using rigid fixation. Cone-beam computed tomography (CBCT) scans were acquired before surgery (T1), immediately after surgery (T2), and at long-term follow-up (T3). The average follow-up period was 5.3 ± 1.7 years after surgery. Anatomic landmark identification on the cone-beam computed tomographies and subsequent quantification of the changes from T1 to T2 and T2 to T3 were performed in ITK-SNAP (version 2.4; itksnap.org) and 3DSlicer (version 4.7; http://www.slicer.org) software. Surgical displacements, mandibular plane angle changes, and skeletal stability were measured relative to cranial base superimposition, whereas condylar remodeling was measured relative to regional condylar registration. Partial correlation coefficients were used to assess relationships between clinical and surgical variables, condylar remodeling, and long-term surgical relapse while controlling for variability in the length of follow-up. RESULTS B-point relapsed more than 2 mm posteriorly in 55% of the patients. The only variables strongly associated with the posterior movement of B-point long-term were mesial yaw of the condyle during surgery (P ≤0.01) and the length of follow-up from T2 to T3 (P ≤ 0.01). There was no relationship between the magnitude of advancement or presurgical mandibular plane angle and relapse or condylar resorption. Condylar resorption was strongly associated with relapse of B-point in the posterior direction (P ≤0.01) and clockwise rotation of the mandibular plane long-term (P ≤0.01). Twenty-nine percent of subjects showed resorption of more than 2 mm in the inferior direction at the lateral pole, and 17% of the subjects showed resorption of more than 2 mm in the inferior direction at condylion. Compared with male subjects, females exhibited significantly greater condylar remodeling (P ≤0.01) and slightly greater relapse at B-point (P ≤0.05). CONCLUSIONS Surgical relapse at B-point may occur slowly over time and is primarily due to condylar resorption in mandibular advancement patients. Mesial yaw of the condyle during surgery may lead to condylar resorption postsurgically. In addition, females are at greater risk of condylar resorption postsurgically.
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Affiliation(s)
- Lauren Ehardt
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich.
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich; Department of Orthodontics and Pediatric Dentistry, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sean Edwards
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Erika Benavides
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | | | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
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16
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Sendyk M, Cevidanes LHS, Ruellas ACDO, Fattori L, Mendes FM, Paiva JBD, Rino Neto J. Three-dimensional evaluation of dental decompensation and mandibular symphysis remodeling on orthodontic-surgical treatment of Class III malocclusion. Am J Orthod Dentofacial Orthop 2020; 159:175-183.e3. [PMID: 33390311 DOI: 10.1016/j.ajodo.2019.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/29/2022]
Abstract
INTRODUCTION The purposes of this research were to identify the buccolingual inclinations of the mandibular teeth and the mandibular symphysis remodeling that result from the orthodontic decompensation movement. METHODS The sample consisted of 30 adults with Class III dentofacial deformity, who had presurgical orthodontic treatment. Three-dimensional images were generated by cone-beam computed tomography scans at 2 different times (initial and before orthognathic surgery). Three-dimensional virtual models were obtained and superimposed using automated voxel-based registration at the mandible to evaluate B-point displacement, mandibular molar and incisor decompensation movement, and symphysis inclination and thickness. The 3-dimensional displacements of landmarks at the symphysis were quantified and visualized with color-coded maps using 3D Slicer (version 4.0; www.slicer.org) software. RESULTS The measurements showed high reproducibility. The patients presented mandibular incisor proclination, which was consistent with the movement of tooth decompensation caused by the presurgical orthodontic treatment. Statistically significant correlations were found between the inclination of the mandibular incisors, symphysis inclination, and B-point displacement. Regarding the thickness of the symphysis and the inclination of the incisors, no statistically significant correlation was found. CONCLUSIONS The buccolingual orthodontic movement of the mandibular incisors with presurgical leveling is correlated with the inclination of the mandibular symphysis and repositioning of the B-point but not correlated to the thickness of the symphysis.
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Affiliation(s)
- Michelle Sendyk
- Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | | | | | - Liana Fattori
- Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Fausto Medeiros Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - João Batista de Paiva
- Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - José Rino Neto
- Department of Orthodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
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17
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Wei RY, Atresh A, Ruellas A, Cevidanes LHS, Nguyen T, Larson BE, Mangum JE, Manton DJ, Schneider PM. Three-dimensional condylar changes from Herbst appliance and multibracket treatment: A comparison with matched Class II elastics. Am J Orthod Dentofacial Orthop 2020; 158:505-517.e6. [PMID: 32828608 DOI: 10.1016/j.ajodo.2019.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/01/2019] [Accepted: 09/01/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of this study was to quantify and qualify the 3-dimensional (3D) condylar changes using mandibular 3D regional superimposition techniques in adolescent patients with Class II Division 1 malocclusions treated with either a 2-phase or single-phase approach. METHODS Twenty patients with Herbst appliances who met the inclusion criteria and had cone-beam computed tomography (CBCT) images taken before, 8 weeks after Herbst removal, and after the completion of multibracket appliance treatment constituted the Herbst group. They were compared with 11 subjects with Class II malocclusion who were treated with elastics and multibracket appliances and who had CBCT images taken before and after treatment. Three-dimensional models generated from the CBCT images were registered on the mandible using 3D voxel-based superimposition techniques and analyzed using semitransparent overlays and point-to-point measurements. RESULTS The magnitude of lateral condylar growth during the orthodontic phase (T2-T3) was greater than that during the orthopedic phase (T1-T2) for all condylar fiducials with the exception of the superior condyle (P <0.05). Conversely, posterior condylar growth was greater during the orthopedic phase than the subsequent orthodontic phase for all condylar fiducials (P <0.05). The magnitude of vertical condylar development was similar during both the orthopedic (T1-T2) and orthodontic phases (T2-T3) across all condylar fiducials (P <0.05). Posterior condylar growth during the orthodontic phase (T2-T3) of the 2-phase approach decreased for all condylar fiducials with the exception of the posterior condylar fiducial (P <0.05) when compared with the single-phase approach. CONCLUSIONS Two-phase treatment using a Herbst appliance accelerates condylar growth when compared with a single-phase regime with Class II elastics. Whereas the posterior condylar growth manifested primarily during the orthopedic phase, the vertical condylar gains occurred in equal magnitude throughout both phases of the 2-phase treatment regime.
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Affiliation(s)
- Robert Y Wei
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia.
| | - Arjun Atresh
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Tung Nguyen
- Department of Orthodontics, University of North Carolina, Chapel Hill, NC
| | - Brent E Larson
- Division of Orthodontics, University of Minnesota, Minneapolis, Minn
| | - Jonathan E Mangum
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia; Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Australia
| | - David J Manton
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia; Centrum voor Tandheelkunde en Mondzorgkunde UMCG, University of Groningen, Groningen, The Netherlands
| | - Paul M Schneider
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia
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18
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Fan Y, Schneider P, Matthews H, Roberts WE, Xu T, Wei R, Claes P, Clement J, Kilpatrick N, Penington A. 3D assessment of mandibular skeletal effects produced by the Herbst appliance. BMC Oral Health 2020; 20:117. [PMID: 32299402 PMCID: PMC7164294 DOI: 10.1186/s12903-020-01108-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/06/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND A functional appliance is commonly used to optimize the development of the facial skeleton in the treatment of Class II malocclusion. Recent three-dimensional(3D) image-based analysis offers numerous advantages in quantitative measurement and visualization in orthodontics. The aim of this study was to localize in 3D the skeletal effect produced by the Herbst appliance on the mandible using the geometric morphometric technique. METHODS Twenty patients treated with a Herbst appliance and subsequent fixed appliances were included. Cone-beam computed tomography (CBCT) images were taken before treatment (T1), 8 weeks after Herbst appliance removal (T2), and after subsequent fixed appliance treatment (T3). Spatially dense morphometric techniques were used to establish the corresponding points of the mandible. The mandibular morphological changes from T1-T2, T2-T3, and T1-T3 were calculated for each patient by superimposing two mandibular models at two time points with robust Procrustes superimposition. These changes were then compared to the morphological changes estimated from normative mandibular growth curves over the same period. The proportion of cases exceeding the growth expression for controls was compared to a normal population using a one tailed binomial test. RESULTS Approximately 1.5-2 mm greater condylar changes and 0.5 mm greater changes in the chin occurred from Tl to T2. This effect lasted until the completion of treatment (T1-T3), but there was no obvious skeletal effect during the orthodontic phase (T2-T3). Approximately 40-50% of the patient sample exceeded condylar growth by > 1.5 mm compared to untreated controls (p < .05). However, changes at the chin were not statistically significant. CONCLUSIONS The principal skeletal effect of Herbst appliance treatment was additional increase in condylar length for about half of the sample. This inconsistency may relate to the degree of mandibular growth suppression associated with a specific malocclusion.
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Affiliation(s)
- Yi Fan
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, 10081, China
- Melbourne Dental School, University of Melbourne, Melbourne, 3053, Australia
- Facial Science, Murdoch Children's Research Institute, Melbourne, 3052, Australia
| | - Paul Schneider
- Melbourne Dental School, University of Melbourne, Melbourne, 3053, Australia
| | - Harold Matthews
- Facial Science, Murdoch Children's Research Institute, Melbourne, 3052, Australia
- Department of Human Genetics, 3000, Leuven, KU, Belgium
- Medical Imaging Research Centre, Universitair Ziekenhuis, 3000, Leuven, Belgium
| | - Wilbur Eugene Roberts
- Department of Orthodontics and Oral Facial Genetics, Indiana University-Purdue University Indianapolis, Indianapolis, 46236, USA
| | - Tianmin Xu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, 10081, China
| | - Robert Wei
- Melbourne Dental School, University of Melbourne, Melbourne, 3053, Australia
| | - Peter Claes
- Facial Science, Murdoch Children's Research Institute, Melbourne, 3052, Australia
- Department of Human Genetics, 3000, Leuven, KU, Belgium
- Medical Imaging Research Centre, Universitair Ziekenhuis, 3000, Leuven, Belgium
- Department of Electrical Engineering, KU Leuven, Leuven, 3000, Belgium
| | - John Clement
- Melbourne Dental School, University of Melbourne, Melbourne, 3053, Australia
| | - Nicky Kilpatrick
- Facial Science, Murdoch Children's Research Institute, Melbourne, 3052, Australia
- The University of Melbourne Department of Paediatrics at the Royal Children's Hospital, 50 Flemington Rd, Parkville VIC, Melbourne, 3052, Australia
| | - Anthony Penington
- Facial Science, Murdoch Children's Research Institute, Melbourne, 3052, Australia.
- The University of Melbourne Department of Paediatrics at the Royal Children's Hospital, 50 Flemington Rd, Parkville VIC, Melbourne, 3052, Australia.
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Jiang YY, Sun L, Wang H, Zhao CY, Zhang WB. Three-dimensional cone beam computed tomography analysis of temporomandibular joint response to the Twin-block functional appliance. Korean J Orthod 2020; 50:86-97. [PMID: 32257934 PMCID: PMC7093662 DOI: 10.4041/kjod.2020.50.2.86] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/06/2020] [Accepted: 02/08/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To propose a three-dimensional (3D) method for evaluating temporomandibular joint (TMJ) changes during Twin-block treatment. Methods Seventeen patients with Class II division 1 malocclusion treated using Twin-block and nine untreated patients with a similar malocclusion were included in this research. We collected their cone beam computed tomography (CBCT) data from before and 8 months after treatment. Segmentations were constructed using ITK-SNAP. Condylar volume and superficial area were measured using 3D Slicer. The 3D landmarks were identified on CBCT images by using Dolphin software to assess the condylar positional relationship. 3D models of the mandible and glenoid fossa of the patients were constructed and registered via voxel-based superimposition using 3D Slicer. Thereafter, skeletal changes could be visualized using 3DMeshMetric in any direction of the superimposition on a color-coded map. All the superimpositions were measured using the same scale on the distance color-coded map, in which red color represents overgrowth and blue color represents resorption. Results Significant differences were observed in condylar volume, superficial area, and condylar position in both groups after 8 months. Compared with the control group (CG), the Twin-block group exhibited more obvious condyle-fossa modifications and joint positional changes. Moreover, on the color-coded map, more obvious condyle-fossa modifications could be observed in the posterior and superior directions in the Twin-block group than in the CG. Conclusions We successfully established a 3D method for measuring and evaluating TMJ changes caused by Twin-block treatment. The treatment produced a larger condylar size and caused condylar positional changes.
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Affiliation(s)
- Yuan-Yuan Jiang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Lian Sun
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China.,Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Hua Wang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China.,Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Chun-Yang Zhao
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China.,Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Wei-Bing Zhang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China.,Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
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20
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Güven BA, Ciğer S. Evaluation of the Effect of Fixed Anterior Biteplane Treatment on Temporomandibular Joint in Patients with Deep Bite. Turk J Orthod 2020; 33:8-12. [PMID: 32284893 PMCID: PMC7138230 DOI: 10.5152/turkjorthod.2020.19108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/17/2020] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To investigate the effects of fixed anterior biteplane treatment on temporomandibular joint in deep bite patients. METHODS The sample comprised 17 Class II patients with deep bite and decreased lower anterior facial height. The average patient age was 9.9±0.9 years. Transcranial temporomandibular joint radiographs were obtained from the subjects before (T0) and after fixed anterior biteplane treatment (T1). Anterior joint space, posterior joint space, superior joint space, anteroposterior thickness of the condylar head, vertical height of the articular fossa, and the articular fossa slope were measured on temporomandibular joint radiographs to evaluate the position of the mandibular condyles in the glenoid fossa. RESULTS The average treatment duration was 8.5±2.1 months. Slope of the articular fossa, vertical height of the articular fossa, anteroposterior thickness of the condyle, posterior joint space, superior joint space, and anterior joint space showed no statistically significant difference between T0 and T1 (p>0.05). CONCLUSION Fixed anterior biteplane appliance treatment did not change the condyle fossa relationship in Class II deep bite patients at the time of appliance removal.
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Affiliation(s)
- Bengisu Akarsu Güven
- Department of Orthodontics, Hacettepe University School of Dentistry, Ankara, Turkey
| | - Semra Ciğer
- Department of Orthodontics, Hacettepe University School of Dentistry, Ankara, Turkey
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21
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Influence of Vertical Facial Growth Pattern on Herbst Appliance Effects in Prepubertal Patients: A Retrospective Controlled Study. Int J Dent 2020; 2020:1018793. [PMID: 32399031 PMCID: PMC7201793 DOI: 10.1155/2020/1018793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/24/2019] [Accepted: 12/09/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction The Herbst device is widely used for correction of class II malocclusions; however, most of the researches carried out on the Herbst appliance in literature do not take into account patients with a different mandibular divergence. The aim of this study was to investigate the effects of Herbst on dental and skeletal structures and to evaluate possible influence of vertical facial growth patterns. Methods A retrospective study was conducted on lateral cephalograms of 75 growing patients (mean age: 9.9 ± 1.9 years) with class II malocclusion treated with Herbst. Subjects were divided into 3 groups using the mandibular divergence index (SN and GoMe angle). Cephalometric parameters were evaluated using the modified SO (sagittal occlusion) Pancherz's analysis. A statistical analysis was conducted to evaluate differences among groups using ANOVA. Results Our study showed differences in response to treatment depending on patient's facial vertical growth pattern. Cranial base angle and mandibular rotation were significantly different (p < 0.05) between hypodivergent patients and normodivergent patients and between hypodivergent and hyperdivergent subjects. Conclusion Hypodivergent patients increased their mandibular divergence during treatment to a greater extent than normodivergents; moreover, hyperdivergent patients exhibited a decreased mandibular divergence at the end of the treatment.
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22
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Yatabe M, Prieto JC, Styner M, Zhu H, Ruellas AC, Paniagua B, Budin F, Benavides E, Shoukri B, Michoud L, Ribera N, Cevidanes L. 3D superimposition of craniofacial imaging-The utility of multicentre collaborations. Orthod Craniofac Res 2019; 22 Suppl 1:213-220. [PMID: 31074129 DOI: 10.1111/ocr.12281] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 01/18/2023]
Abstract
Clinical applications of 3D image registration and superimposition have contributed to better understanding growth changes and clinical outcomes. The use of 3D dental and craniofacial imaging in dentistry requires validate image analysis methods for improved diagnosis, treatment planning, navigation and assessment of treatment response. Volumetric 3D images, such as cone-beam computed tomography, can now be superimposed by voxels, surfaces or landmarks. Regardless of the image modality or the software tools, the concepts of regions or points of reference affect all quantitative of qualitative assessments. This study reviews current state of the art in 3D image analysis including 3D superimpositions relative to the cranial base and different regional superimpositions, the development of open source and commercial tools for 3D analysis, how this technology has increased clinical research collaborations from centres all around the globe, some insight on how to incorporate artificial intelligence for big data analysis and progress towards personalized orthodontics.
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Affiliation(s)
- Marilia Yatabe
- Department for Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, Michigan
| | | | - Martin Styner
- University of North Carolina, Chapel Hill, North Carolina
| | - Hongtu Zhu
- University of North Carolina, Chapel Hill, North Carolina
| | - Antonio Carlos Ruellas
- Department for Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, Michigan
| | | | | | - Erika Benavides
- Department for Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Brandon Shoukri
- Department for Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Loic Michoud
- Department for Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Nina Ribera
- Department for Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Lucia Cevidanes
- Department for Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, Michigan
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23
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Brito DBDA, Henriques JFC, Fiedler CF, Janson G. Effects of Class II division 1 malocclusion treatment with three types of fixed functional appliances. Dental Press J Orthod 2019; 24:30-39. [PMID: 31721944 PMCID: PMC6833931 DOI: 10.1590/2177-6709.24.5.030-039.oar] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 11/25/2018] [Indexed: 11/22/2022] Open
Abstract
Objective: This study aimed at comparing the dentoskeletal changes in patients with Class II division 1 malocclusion, treated with three types of fixed functional appliances. Methods: A sample comprising 95 patients with the same malocclusion, retrospectively selected, and divided into four groups, was used: G1 consisted of 25 patients (mean age 12.77 ± 1.24 years) treated with Jasper Jumper appliance; G2, with 25 patients (mean age 12.58 ± 1.65 years) treated with the Herbst appliance; G3, with 23 patients (mean age 12.37 ± 1.72 years) treated with the Mandibular Protraction Appliance (MPA); and a Control Group (CG) comprised of 22 untreated subjects (mean age 12.66 ± 1.12 years). Intergroup comparison was performed with ANOVA, followed by Tukey test. Results: The Jasper Jumper and the Herbst group showed significantly greater maxillary anterior displacement restriction. The Jasper Jumper demonstrated significantly greater increase in the mandibular plane angle, as compared to the control group. The MPA group demonstrated significantly greater palatal inclination of the maxillary incisors. Vertical development of the maxillary molars was significantly greater in the Herbst group. Conclusions: Despite some intergroup differences in the amount of dentoskeletal changes, the appliances were effective in correcting the main features of Class II malocclusions.
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Affiliation(s)
| | | | - Camilla Foncatti Fiedler
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ortodontia (Bauru/SP, Brazil)
| | - Guilherme Janson
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ortodontia (Bauru/SP, Brazil)
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24
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Taylor KL, Evangelista K, Muniz L, Ruellas ACDO, Valladares-Neto J, McNamara J, Franchi L, Kim-Berman H, Cevidanes LHS. Three-dimensional comparison of the skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed appliances: A CBCT study. Orthod Craniofac Res 2019; 23:72-81. [PMID: 31514261 DOI: 10.1111/ocr.12345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/02/2019] [Accepted: 09/06/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare three-dimensional (3D) skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed orthodontic treatment in growing patients. SETTING AND SAMPLE POPULATION A sample of 35 adolescents with cone-beam computed tomography scans obtained prior to Herbst and Pendulum treatment (T1) and immediately after fixed appliance treatment (T2). MATERIALS AND METHODS Patients with Class II malocclusion was assessed retrospectively and divided into two treatment groups: Herbst group (n = 17, age: 12.0 ± 1.6 years) and Pendulum group (n = 18, age: 12.1 ± 1.5 years), with a mean treatment duration of 2.8 ± 0.8 years and 2.5 ± 0.7 years, respectively. Reconstructions of the maxillomandibular and dentoalveolar regions and data in 3D were obtained relative to cranial base, maxillary and mandibular regional superimpositions. Treatment outcomes (T2-T1) were compared between both groups using t tests for independent samples (P<.05). RESULTS Significant increase in mandibular length was observed in the Herbst group (7.3 ± 3.5 mm) relative to the Pendulum group (4.6 ± 4.5 mm). Inferior and anterior displacements of Pogonion were 2.2 mm and 1.6 mm greater in the Herbst group, respectively. The mesial displacement of the lower first molars was significantly greater in the Herbst group (1.9 mm). The upper first molars had contrasting results in sagittal displacement, with 0.6 ± 1.7 mm of distal displacement with the Pendulum and 1.4 ± 2.1 mm of mesial displacement with the Herbst. Lower incisor projection and proclination were similar between groups. CONCLUSIONS The Herbst and Pendulum appliances followed by comprehensive orthodontic treatment effectively corrected Class II malocclusion in growing patients, but with differing skeletal and dentoalveolar effects.
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Affiliation(s)
- Kyle L Taylor
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Karine Evangelista
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.,School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - Luciana Muniz
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | | | | | - James McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, Orthodontics, Università degli Studi di Firenze, Florence, Italy
| | - Hera Kim-Berman
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
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25
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Cheib Vilefort PL, Farah LO, Gontijo HP, Moro A, Ruellas ACDO, Cevidanes LHS, Nguyen T, Franchi L, McNamara JA, Souki BQ. Condyle-glenoid fossa relationship after Herbst appliance treatment during two stages of craniofacial skeletal maturation: A retrospective study. Orthod Craniofac Res 2019; 22:345-353. [PMID: 31419375 DOI: 10.1111/ocr.12338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To perform a three-dimensional evaluation of the position of the condyles in patients treated with Herbst appliance (HA) in two stages of cervical vertebral maturation. SETTING AND SAMPLE POPULATION Retrospective case-control study. Pubertal Herbst group (PHG; n = 24, mean age 14.5 years, CS 3 and CS 4) and pre-pubertal Herbst group (PPHG; n = 17, mean age 9.9 years, CS 1 and CS 2) were contrasted with comparison groups of non-orthopaedically treated Class II patients in pubertal (PCG; n = 17, mean age 13.9 years) and pre-pubertal maturational stages (PPCG; n = 18, mean age 10.6 years). MATERIALS AND METHODS Cone-beam computer tomography scans were taken before treatment (T0) and at T1 after 8 to 12 months. Point-to-point measurements of the displacement of the condyles between T0 and T1, relative to the glenoid fossae, were performed in the X, Y, Z and 3D perspectives. Qualitative assessments using semi-transparent overlays and colour mapping also were produced. RESULTS The displacement of the condyles within the glenoid fossae in the treated groups was small (<0.75 mm; P > .05). Relative to the glenoid fossa, condylar position at T1 was similar to T0 in pre-pubertal and pubertal groups (P > .05). Similar condylar rotations from T0 to T1 were observed in Herbst and comparison groups, and no significant difference was found between pre-pubertal and pubertal patients. CONCLUSIONS Regardless the stage of skeletal maturation, HA treatment did not change the condyle-glenoid fossa relationship.
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Affiliation(s)
| | | | - Henrique Pársia Gontijo
- Graduate Program in Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
| | - Alexandre Moro
- Graduate Program in Dentistry, University Positivo, Curitiba, Brazil
| | | | | | - Tung Nguyen
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Lorenzo Franchi
- School of Dentistry, University of Florence, Florence, Italy
| | - James A McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Bernardo Quiroga Souki
- Graduate Program in Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Brazil
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26
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Kyburz KS, Eliades T, Papageorgiou SN. What effect does functional appliance treatment have on the temporomandibular joint? A systematic review with meta-analysis. Prog Orthod 2019; 20:32. [PMID: 31402395 PMCID: PMC6689567 DOI: 10.1186/s40510-019-0286-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/24/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of the current systematic review was to compare the radiologic effects of functional appliance Class II treatment compared to no treatment on the temporomandibular joint and its components. METHODS Nine databases were searched up to June 2019 for randomized or prospective non-randomized clinical trials comparing Class II patients treated with functional appliances to untreated patients. After duplicate study selection, data extraction, and risk of bias assessment with the Cochrane tool and the ROBINS-I tool, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by the assessment of the quality of evidence with GRADE. RESULTS A total of 11 papers on 8 unique trials with 377 patients (39.8% male; average age 10.3 years) were finally included. Limited evidence indicated that compared to untreated growing patients functional appliance treatment was associated with increased condylar width (2 studies; MD 1.1 mm; 95% CI 0.1 to 2.2 mm; very low evidence quality), decreased anterior joint space (2 studies; MD - 0.7 mm; 95% CI - 0.5 to - 0.9 mm; very low evidence quality), increased superior joint space (2 studies; MD 0.7 mm; 95% CI 0.5 to 1.0 mm; very low evidence quality), increased posterior joint space (2 studies; MD 1.0 mm; 95% CI 0.9 to 1.2 mm; very low evidence quality), and vertical displacement of the glenoid fossa (2 studies; MD 0.4 mm; 95% CI 0.1 to 0.7 mm; very low evidence quality). The main limitations affecting the validity of the present findings were the inclusion of non-randomized studies with methodological issues, imprecision due to limited samples of the included studies, and inconsistencies among studies. CONCLUSIONS Currently existing evidence from controlled clinical studies on humans indicates that functional appliance treatment is associated with positional and skeletal alterations of the temporomandibular joint in the short term compared to untreated controls. However, the clinical relevance of these changes remains unclear, while the quality of existing evidence is low due to methodological issues of existing studies. REVIEW REGISTRATION PROSPERO, CRD42018109271.
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Affiliation(s)
- Karma Shiba Kyburz
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, Zurich, Switzerland
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, Zurich, Switzerland
| | - Spyridon N. Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, Zurich, Switzerland
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