A comparison of maxillary posterior changes following facemask therapy: Skeletal anchorage versus tooth-borne anchorage

OBJECTIVE

To compare changes in the maxillary posterior structure as seen in cone-beam computed tomography (CBCT) images resulting from facemask therapy using skeletal (miniplate/FM) anchorage versus tooth-borne anchorage (RME/FM).

MATERIALS AND METHODS

A retrospective study was conducted on 20 patients divided into the miniplate/FM group (nine patients aged 9.5 ± 1.4 years) and the RME/FM group (11 patients aged 9.2 ± 1.4 years). CBCT images before and after facemask therapy were evaluated to assess changes in the maxillary posterior structure.

RESULTS

The miniplate/FM group had greater advancement of the maxilla and midface compared to the RME/FM group (p < .05). Specifically, there was about three times more advancement of the pterygomaxillary suture in the miniplate/FM group than in the RME/FM group (p < .05). Moreover, the advancement of the pterygomaxillary suture was about half the advancement of A point in the miniplate/FM group, while only about 25% in the RME/FM group. Finally, the miniplate/FM group showed an increase in the transverse dimension of the posterior and superior parts of the maxilla (p < .05).

CONCLUSION

There was greater forward movement of the pterygomaxillary suture with facemask therapy using the skeletal anchorage compared to tooth-borne anchorage, leading to a more significant advancement of the maxilla and midface.

Comparative assessment of facemask therapy with and without skeletal anchorage in growing Class III patients with unilateral cleft lip and palate (UCLP): A single-center, prospective randomized clinical trial

OBJECTIVE

The purpose of this study was to evaluate the maxillary protraction effect of facemask therapy with and without skeletal anchorage in growing Class III patients with unilateral cleft lip and palate (UCLP).

MATERIALS AND METHODS

Thirty patients (aged 9-13 years) with UCLP having a GOSLON score 3 were selected for this prospective clinical study. The patients were allocated into two groups using computer generated random number table. Group I (facemask therapy along with two I shaped miniplates, FM + MP) and Group II (facemask mask along with tooth-anchored appliance, FM). Skeletal and dental parameters were evaluated on pre- and post-treatment lateral cephalograms and pharyngeal airway on cone-beam computed tomography systems (CBCT) for assessment of the treatment changes.

RESULTS

Both methods proved to be effective with statistically significant improvements in skeletal and dental parameters (p < .05). Skeletal parameters (e.g., SNA, convexity-point A, ANB) with the FM + MP group showed greater change compared to those with FM group (SNA, 2.56°; convexity-point A, 1.22°; ANB, 0.35°). Significant proclination of maxillary incisors was observed in the FM group as compared to FM + MP group (U1 to NA, 5.4°; 3.37 mm). A statistically significant increase in pharyngeal airway volume was noted in both groups (p < .05).

CONCLUSION

While both therapies are effective in protracting the maxilla in growing patients with UCLP, the FM + MP allows for a greater skeletal correction, minimizing the dental side effects seen with FM therapy alone. Thus, FM + MP appears to be a promising adjunct in reducing the severity of Class III skeletal correction needed in patients with cleft lip and palate (CLP).

Mini-Implant Insertion Using a Guide Manufactured with Computer-Aided Design and Computer-Aided Manufacturing in an Adolescent Patient Suffering from Tooth Eruption Disturbance

Due to dental diseases, anatomical restrictions, and mixed dentition, the reduction in the number of teeth and the displacement of tooth germs pose challenges in orthodontic treatment, limiting anchorage options. The presented case demonstrates an advanced treatment solution using digital CAD/CAM-technologies and medical imaging for the creation of a mini-implant template. A 12-year-old male patient experiencing delayed tooth eruption, multiple impacted germs, and maxillary constriction underwent intraoral scanning and CBCT. Utilizing coDiagnostiXTM Version 10.2 software, the acquired data were merged to determine the mini-implant placement and to design the template. The template was then manufactured through stereolithography using surgical-guide material. Mini-implants were inserted using the produced appliance, enabling safe insertion by avoiding vital structures. Surgically exposed displaced teeth were aligned using a Hyrax screw appliance anchored on the mini-implants for rapid palatal expansion (RPE) and subsequently used as fixed orthodontics to align impacted teeth. The screw was activated daily for 10 weeks, resulting in a 7 mm posterior and 5 mm anterior maxillary transversal increase. Skeletal anchorage facilitated simultaneous RPE and tooth alignment, ensuring accuracy, patient safety, and appliance stability. The presented case shows a scenario in which computer-aided navigation for mini-implant positioning can enhance precision and versatility in challenging anatomical cases.

Interdisciplinary treatment of mutilated dentition and transverse maxillary deficiency with microimplant-assisted rapid palatal expansion, microimplants, and dental implants

OBJECTIVE

This case report demonstrates an interdisciplinary approach to treat a 26-year-old male patient with hyperdivergent Class II skeletal pattern, maxillary transverse deficiency, slight anterior open bite, and multiple hopeless teeth with root rests.

CLINICAL CONSIDERATIONS

An interdisciplinary treatment was required for oral hygiene improvement, caries treatment, extraction of residual roots and hopeless teeth, maxillary expansion using microimplant-assisted rapid palatal expansion, improvement of skeletal and dental relationship using orthodontic microimplants, and prosthetic restorations with the aid of dental implants.

CONCLUSION

Consequently, esthetic and functional occlusal rehabilitation was achieved.

CLINICAL SIGNIFICANCE

Hyperdivergent Class II facial and skeletal patterns with multiple missing teeth can be effectively treated using orthodontic skeletal anchorage. In young adults, the transverse discrepancy can be resolved using MARPE, which is also useful for improving the sagittal and vertical relationships. In the case of multiple missing teeth, orthodontic treatment can provide the proper space to facilitate dental implants to achieve optimal esthetics and function.

Computer-guided miniscrew insertion in the paramedian and parapalatal area of the palatal vault: low failure rate and no learning curve required to obtain predictable results?

AIM

To evaluate the failure rate of palatal computer-guided miniscrews, placed in paramedian and parapalatal regions for orthodontic purposes. In addition, to investigate the presence of a learning curve using computer guided miniscrew insertion, and to evaluate the peri-implant soft tissues response at 2-, 6- and 12- month follow-ups.

MATERIALS AND METHODS

202 palatal computer-guided miniscrews were inserted in 78 subjects for orthodontic purposes. A surgical guide was designed after planning the appropriate insertion sites on three-dimensional images created by the fusion of cone-beam computed tomography (CBCT) and digital dental model images. The devices were disassembled monthly to perform the percussion test and to evaluate the mobility of each miniscrew. To determine the presence of a learning curve, the time of miniscrew failures and the number of surgeries were evaluated. Bleeding on probing (BOP) and probing pocket depth (PPD) were recorded for each miniscrew, at 2- (T0), 6- (T1), and 12-month follow ups (T2).

RESULTS

An immediate failure rate of 4.95%, due to lack of primary stability immediately following miniscrew insertion, was recorded, with statistically significant higher failure rate of parapalatal miniscrews (P= 0.00). Miniscrew failure occurred at random time, with an absence of a learning curve. The BOP (mean: 3.13%) and PPD (mean: 1.68mm) measurements remained stable over time.

CONCLUSIONS

Computer-guided miniscrew insertion in the palatal vault showed a low failure rate without a determined learning curve to obtain predictable results and with long-term stability of peri-implant soft tissues indexes.

Dentoalveolar and Soft Tissue Changes Following en-Masse Anterior Retraction With Different Force Vectors in Subjects With Bidental Protrusion: A Retrospective Evaluation

Introduction The aim of the study is to determine the effects of different vertical force vectors acting on dentoalveolar and soft tissues while applying a retraction force using various anchorage sources and their effects on these tissues. Material and methods Based on the selection criteria, a total of 35 patient case records with Angle's Class I bidental malocclusion and incompetent lips treated with four premolar extractions were included. Retraction was achieved using a NiTi coil spring with two different force vectors. The anchorage in group 1 was enhanced by a transpalatal arch (TPA) and Lower Stabilizing Arch (LSA) in the upper and lower arch, respectively, with a force vector parallel to the occlusal plane, whereas in group 2, the force vector using Temporary Anchorage Devices (TADs) was 15 - 20 degrees to the occlusal plane. The skeletal, dental, and soft tissue were obtained using 40 parameters. Intra-group comparisons between pre- and post-treatment records were conducted using a paired t-test, while inter-group comparisons were conducted using an independent t-test. Result Significant anchor loss was observed in group 1, indicated by mesial movement of molar crowns by (-2.10±0.50) in the maxillary arch and (-1.75±0.38) in the mandibular arch. Distal movement of incisors following premolar extractions with both studied force vectors resulted in an improvement in lip procumbency and incisor inclinations, without any significant skeletal changes. Molar mesial movement was observed in subjects treated with conventional anchorage. Conclusion En masse anterior retraction did lead to anchorage loss when carried out without TADs. Altering the force vector did not produce significant changes in tooth movement along the vertical plane.

Multidisciplinary Approach to Patient-Specific Implants (PSIs): A Case Report and Review of Literature

Orthodontic treatment often faces challenges in achieving proper anchorage. While orthodontic mini-implants have gained popularity, no universally accepted design and insertion protocol exists for these implants. However, their relatively modest failure rate indicates their clinical reliability. To address complex geometries in the maxilla and mandible, patient-specific implants (PSIs) have emerged as a solution. PSI is currently employed in various domains of oral and maxillofacial surgery like temporomandibular joint (TMJ), total joint replacement, reconstruction of the facial skeleton, and orthognathic surgery. PSI allows for the creation of customized implant fits, leading to shorter rehabilitation times. This case report presents a multidisciplinary approach involving oral surgery and orthodontics, specifically focusing on the design of PSI, surgical placement of PSI, and use of PSI in maxillary protraction in orthodontics. The report highlights the design process of designing PSI and emphasizes its role in orthodontic treatment. By incorporating PSI as a temporary anchorage device (TAD), enhanced stability, precise control over tooth movement, and accurate repositioning of jaws can be achieved. The collaborative effort between orthodontists and oral surgeons is crucial in integrating PSI into the overall treatment plan. Despite the higher costs associated with PSI, their numerous advantages outweigh these drawbacks. PSI plays a vital role in providing enhanced stability, appropriate treatment plan, and achieving desired treatment in orthodontic and oral surgery procedures.

Nasal Septum Changes in Adolescents Treated with Tooth-Borne and Bone-Borne Rapid Maxillary Expansion: A CBCT Retrospective Study Using Skeletal Tortuosity Ratio and Deviation Analysis

Background: Using three-dimensional (3D) images, this study evaluated the impact of Rapid Maxillary Expansion (RME) on changes in Nasal Septal Deviation (NSD). Methods: Cone-beam computed tomography (CBCT) scan of 40 children with transverse maxillary deficiency, who received tooth-borne (TB) RME or bone-borne (BB) RME, were included in this investigation. Two CBCT scans were performed: one before to appliance installation (T0) and one after a 6-month retention period (T1). The analysis was performed by dividing the actual length of the septum by the desired length in the mid-sagittal plane to measure NSD based on the tortuosity ratio (TR). Results: Subjects in the TB group showed a statistically significant reduction (p < 0.05) of the TR value from T0 to T1, according to the paired Student t test. Subjects in the BB group showed similar findings, with a statistically significant reduction (p < 0.05) of the TR value from T0. No statistically significant differences were found between the mean changes of TR between TB group and BB group. Conclusions: RME may have some effects in reducing the degree of NSD; however, no differences were found between RME performed with TB and BB anchorage systems.

ATM technique - A novel radiographic technique to assess the position of Buccal Shelf Implants

OBJECTIVES

Success of the buccal shelf implants depends on its proper placement. Radiographic techniques like cone beam computed tomography (CBCT), posteroanterior cephalogram (PA cephalogram) have been used to evaluate the position of buccal shelf implant placement. However, these techniques have disadvantages like increased radiation exposure, metal artefact, less availability in dental offices and are more expensive.The aim of Arvind's Trans Mandibular (ATM) technique is to overcome this drawback by using an intraoral periapical radiograph (IOPA) film or radiovisiography (RVG) sensor to assess the post-operative placement of buccal shelf implants.

METHODS

Radiographs were taken for four patients after the placement of buccal shelf implants. The IOPA sensor was placed beneath the lower border of the mandible using this modified extra oral technique to access the position of the buccal shelf implants in relation to the adjacent molars. The findings from the IOPA image were verified with CBCT images.

RESULTS

The radiographic images taken using ATM technique were compared with the gold standard CBCT technique. The ATM technique was able to accurately assess the postoperative bucco-lingual position of the implant with respect to the roots of molars in all the four cases. The proximity of the implant to the roots of the molar can be clearly visualized in all the cases.

CONCLUSIONS

ATM is a novel radiographic technique using IOPA radiographic film or RVG sensor to assess the post-operative bucco-lingual placement of buccal shelf implants in relation to lower molar roots.

Outcomes and Stability of Anterior Open Bite Treatment with Skeletal Anchorage in Non-Growing Patients and Adults Compared to the Results of Orthognathic Surgery Procedures: A Systematic Review

The objective of this review is to evaluate, on the basis of the available literature, if anterior open bite (AOB) can be successfully treated with the intrusion of molar teeth using skeletal anchorage in non-growing patients and adults and if this treatment modality provides comparable results to those obtained by orthognathic surgery procedures.

METHODS

A systematic review of published data in major databases from 2000 to 2021 was performed.

RESULTS

In total, 92 articles were included in title and abstract screening, and only 16 articles (11 concerning AOB correction by molar intrusion with skeletal anchorage, and five considering AOB treatment by orthognathic surgical intervention) qualified for thorough data extraction and analysis.

CONCLUSIONS

On the basis of this review, it seems to be possible to obtain successful results for AOB treatment in non-growing patients and adults by means of the intrusion of molar teeth with skeletal anchorage. However, due to the different methods of assessing treatment outcomes used by different authors, it is not possible to state conclusively whether the treatment of AOB by means of molar intrusion with skeletal anchorage provides long-term results that are comparable to orthognathic surgery procedures.

Effects of Photobiomodulation on the Upper First Molar Intrusion Movement Using Mini-Screws Anchorage: A Randomized Controlled Trial

Objective: The aim of this study was to quantify the changes obtained when the molar intrusion movement is complemented by photobiomodulation (PBM). Background: A common problem in adult patients is the super-eruption of maxillary molars caused by the loss of the antagonist tooth. Super-erupted molars impair oral rehabilitation and can cause both occlusal and functional problems. There is increasing research confirming the benefits of adjunctive PBM during orthodontic treatment. Methods: Twenty patients with indication of a maxillary first molar intrusion for oral rehabilitation were selected. Patients were randomized into two groups to receive orthodontic intrusion (control group) or the same treatment complemented by PBM (PBM group) in repeated doses (days 0, 1, 2, 3, 4, and 7 from the start of the intrusion and in each monthly follow-up) by using a low-power red laser diode (670 nm, 150 mW, 12 min around the molar). Plaque index (PI), probing depth (PD), and bleeding of probing (BOP) were assessed at 0, 1, 2, 3, and 6 months. Stereolithography models generated from an intraoral scanner were taken at 0, 3, and 6 months and cone beam computed tomography (CBCT) records were taken at 0 and 6 months. Mean intrusion distance, mean intrusion velocity, and volumetric resorption were calculated. Results: Periodontal clinical assessments (PI, PD, and BOP) and mean intrusion distance or mean intrusion velocity yielded no differences (p > 0.05) between groups. However, PBM group showed lower values of all these scores during the first 3 months. Intraoral scanner and CBCT were equally effective in accurately monitoring the intrusion distance (p > 0.05). CBCT records allowed volumetric evaluation of the root resorption process, being lesser in the PBM group, but not significantly (p > 0.05). Conclusions: During orthodontic intrusion process, the adjunctive application of PBM may provide better periodontal records and lower progression of root resorption at the expense of a little lower intrusion distance and velocity.

Tooth-borne versus tooth-bone-borne rapid maxillary expanders according to a stereophotogrammetric evaluation of facial soft tissues: A randomized clinical trial

OBJECTIVES

To evaluate the effects of tooth-borne and tooth-bone-borne rapid maxillary expansion (RME) on soft tissue with stereophotogrammetry.

SETTING AND SAMPLE POPULATION

Thirty two patients (15 males and 17 females) who met inclusion criteria were divided into two groups. In the first group, tooth-borne RME appliance (hyrax) was applied to 16 patients (9 males and 7 females mean age 13.4 ± 1.3 years), and in the second group, tooth-bone-borne RME appliance (hybrid hyrax) was applied to 16 patients (6 males and 10 females, mean age 13.05 ± 1.24 years).

MATERIALS AND METHODS

Changes in soft tissues before RME (T0) and post-retention (T1) period were evaluated by stereophotogrammetry. Linear and angular measurements were performed. Independent- and dependent-sample t tests were used to compare intra- and inter-group differences at P < .05 significance level.

RESULTS

The data revealed statistically significant changes in nasal width, mid-face width, upper lip vermillion length/lower lip vermillion length ratio and upper lip angle in hyrax group. (P < .05) Also nasal width, lower lip length, lower lip vermillion length, anterior face height, lower face height, convexity angle and mandibular angle showed statistically significant changes in hybrid hyrax group. (P < .05) In the inter-group evaluation, no significant differences were found except upper lip and mandible angle. (P < .05).

CONCLUSION

Both hyrax and hybrid hyrax expanders had effects on soft tissue profile. Anterior face height and lower face height increased in both groups. Upper lip length increased by 0.36 mm in the hybrid group and 0.10 mm in the hyrax group.

TRIAL REGISTRATION

This trial was registered at Clinicaltrials.gov (Identifier: NCT04828213).

Determining the short-term effects of different maxillary protraction methods on pharyngeal airway dimensions

OBJECTIVE

This study sought to evaluate the effects of different maxillary protraction methods on the pharyngeal airway in Class III patients with maxillary retrognathia.

SETTING AND SAMPLE POPULATION

A total of 59 individuals (31 females and 28 males) with a mean age of 11.38 ± 1.24 years were included in this study.

MATERIAL AND METHODS

Fifty-nine treated maxillary retrognathic patients who underwent different protraction methods were evaluated. Twenty patients treated with RME (Rapid Maxillary Expansion) made up the first group, and 20 patients treated with 5-week Alt-RAMEC (Alternate Rapid Maxillary Expansion and Constriction) protocol comprised the second group. Lastly, 19 patients on whom face masks with miniplates were applied were included in the skeletal anchorage (SA) group. Sixteen linear and four areal pharyngeal airway measurements were made on lateral cephalograms before and after treatment. Differences between the groups were assessed using analysis of variance (ANOVA) tests.

RESULTS

The mean maxillary protraction levels were determined as 2.7, 3.69 and 4.01 mm in the RME, Alt-RAMEC and SA groups, respectively. In the nasopharynx, AD1-PNS, AD2-PNS, PNS-Ba and PNS-Ho measurements revealed a significant increase in the SA group compared to the other groups (P < .05). In the oropharynx, PNS-Ep measurement increased significantly in the RME group (P < .05). In the total pharyngeal airway area, an increase was detected in the SA, Alt-RAMEC, and RME groups.

CONCLUSION

The most effective protraction method in terms of pharyngeal airway dimensions, especially in the nasopharynx, is the application of the face mask with skeletal anchorage. A greater increase in vertical airway length (PNS-Ep) was observed with RME.

Consecutive use of mini-implants in the palate to treat skeletal maxillary constriction and Class II malocclusion in an adult case

This report describes the successful use of two multifunctional mini-implants that were inserted into the palate in the treatment of an 18-year-old woman in whom the maxilla was skeletally narrowed and the molars have migrated mesially on both sides. Three different appliances were used in sequence in the course of treatment: first, an appliance supported by bone and teeth (hybrid hyrax) for surgically-assisted rapid maxillary expansion (SARME); second, a distalization device supported by mini-implants to achieve molar distalization; and third, a transpalatal arch (TPA) stabilized by mini-implants to allow indirect anchorage during retraction of the incisors. The mini-implants in the palate led to a reduction in the adverse effects of the SARME procedure and made treatment with cervical headgear unnecessary. TPA stabilized by the mini-implant was also used to retract the anterior teeth en masse, with no need for alterations in the treatment mechanism and using routine orthodontic methods.

Skeletally anchored forsus fatigue resistant device for correction of Class II malocclusions-A systematic review and meta-analysis

The use of skeletal anchorage with fixed functional appliances (FFA) has been proposed by various authors to produce skeletal changes and reduce lower incisor proclination. To compare the skeletal and dentoalveolar effects of Forsus Fatigue Resistant Device (FFRD) with or without skeletal anchorage (miniplates and mini-implants). The electronic database PubMed, Cochrane Library, Medline, Embase and Google Scholar along with a manual search of orthodontic journals till the year 2019. Only randomized control trials (RCTs) were included in the systematic review. One controlled clinical trial (CCT) which involved FFRD was included in the review since it was a continuation of an RCT which was expanded to a CCT. Skeletal and dentoalveolar outcome data were extracted to collect study characteristics. After evaluating risk of bias, the standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. Three RCTs and one prospective CCT were evaluated. The analysis included data from 116 Class II subjects [(58) treated with FFA along with skeletal anchorage and (58) treated with FFA]. There were no significant difference between the two groups with respect to mandibular length changes (P value = .10) and SNB angle changes (P value = .22). With respect to lower incisor inclination however, there was a significant difference between the two groups (P value = .005) signifying better results with respect to skeletal anchorage. The studies reviewed provide insufficient evidence to form a conclusion regarding the effects of the use of skeletal anchorage with FFRD. The available weak evidence suggests that the use of skeletal anchorage with FFRD has no superior skeletal effects but is able to reduce proclination of the lower incisors. Control of lower incisor proclination remains the most significant advantage of skeletal reinforcement, and miniplate-anchored FFRD showed more promising results in preventing lower incisor proclination than miniscrew-anchored FFRD.

Comparison of treatment effects of different maxillary protraction methods in skeletal class III patients

OBJECTIVE

The aim of this study was to compare treatment outcomes with different maxillary protraction methods in patients with skeletal Class III malocclusion resulting from maxillary retrognathia.

SETTING AND SAMPLE POPULATION

A total of 55 individuals consisting of 29 females and 26 males with a mean age of 11.4 ± 1.06 years were included in this study.

MATERIAL AND METHODS

Fifty-five treated maxillary retrognathic patients who underwent different protraction facemask methods were evaluated. Eighteen patients treated with RME were in the first group, and 19 patients treated with a modified Alt-RAMEC protocol were in the second group; eighteen patients on whom face masks with miniplates were applied were included in the skeletal anchorage (SA) group. Thirty measurements were made on lateral cephalometric radiographs before and after treatment. Differences between the groups were assessed with the ANOVA test.

RESULTS

The mean age was higher in the SA group (11.96 ± 0.92 years) compared with the other groups. The mean ANB angle increased by 2.96°, 4.91° and 3.86° in the RME, Alt-RAMEC and SA groups, respectively. The forward movement of the maxilla was similar between the groups. However, while the rate of protraction was higher in the modified Alt-RAMEC group, a greater skeletal effect was found in the SA group.

CONCLUSION

The most effective method in terms of skeletal effect is the application of the face mask with skeletal anchorage; the modified Alt-RAMEC protocol can be applied before face mask to obtain faster protraction.

The Use of Mini-Plates for the Treatment of a High-Angle, Dual Bite, Class II Malocclusion

To present a case report of an orthodontic treatment of a high-angle, dual bite, Class II malocclusion without extractions and with the use of mini-plates. Class II malocclusion treatment protocols vary according to the morphological component of the malocclusion and the magnitude and direction of craniofacial growth. It is generally agreed that the cooperation of the patient and careful planning of anchorage are the key determinants of successful treatment. Protrusion of the upper and lower lip and a retrognathic mandible were the patient's chief concerns. The patient had learned to project her mandible forward to disguise the overjet. The patient's parents elected to correct the malocclusion with the use of bilateral infrazygomatic mini-plates. Pre-treatment condylar stabilization with an orthotic established a stable centric relation position, followed by mounting of the models on a semi-adjustable Panadent articulator. This allowed diagnosis and treatment planning from a stable condylar position and eliminated possible misdiagnosis due to the dual bite. Distal retraction and vertical control of the upper teeth enabled correction of the Class II malocclusion with minimal patient cooperation. Mini-plate-assisted treatment corrected the excessive overbite and overjet. The patient completed treatment with a stable occlusion and no longer postured her jaw forward. The parents and patient were completely satisfied with the positive treatment outcome. A 2-year follow-up confirmed the clinical stability.

Comparison of the change in inferior sclera exposure after maxillary protraction with or without skeletal anchorage

Aim

The aim of this retrospective study was to evaluate the change in inferior sclera exposition after maxillary protraction with or without skeletal anchorage in patients with maxillary retrognathia.

Materials and Methods

Fifteen patients (Group 1) who applied maxillary protraction with teeth-supported appliance and fifteen patients who applied maxillary protraction with skeletal anchorage (Group 2) were compared in order to investigate the effect of different maxillary protraction methods on the visibility of sclera. The patients in both groups had dental and skeletal Class III malocclusion with maxillary retrusion (ANB <0; SNA <80), increased vertical growth pattern (SnGoGn> 32) (long face), increased sclera exposure, and no congenital anomalies and dentofacial deformities. Pre- and posttreatment records were used to assess the amount of visible sclera on facial photographs using Adobe Photoshop CS6 program and the change in the movement of maxilla on cephalometric film. The pretreatment and after maxillary protraction values were compared statistically by the Wilcoxon signed-rank test (level of significance, P < 0.05).

Results

The amount of inferior sclera exposure to eye height decreased in the right and left eyes of the 30 patients with maxillary protraction. The amount of inferior sclera exposure to eye height of the right and left eyes decreased from 3.59 to 3.5 and from 3.44 to 3.39, respectively, in Group I (P = 0.001 and P < 0.001, respectively). The amount of inferior sclera exposure to eye height of the right and left eyes decreased from 4.17 to 3.93 and from 3.86 to 3.68, respectively, in Group II (P = 0.001 and P < 0.001, respectively).

Conclusion

There were important results in both of the two methods. Although more improvement was obtained in the skeletal anchorage group, statistically no significant differences were found between the groups.

The clinical outcome of skeletal anchorage in interceptive treatment (in growing patients) for class III malocclusion

A systematic review of the literature was performed regarding the clinical outcome (effectiveness) of bone anchorage devices in interceptive treatment for class III malocclusion. A search of Embase, PubMed and Web of Science databases yielded 285 papers. An additional two articles were retrieved through manual searching of the reference lists. After initial abstract selection, 32 potentially eligible articles were screened in detail, resulting in a final number of eight articles included in this review. Insufficient evidence was found regarding the effects of skeletal anchorage in interceptive class III treatment to support definitive conclusions on long-term skeletal effects and stability. In the short term, it seems that bone anchors can provide more skeletal effect with less dentoalveolar compensations and less unwanted vertical changes. This does not always exclude the use of a face mask. The use of miniscrews as skeletal anchorage device does not seem to provide more skeletal effect, although it could minimize the unwanted dental effects in the upper jaw. No information regarding the need for orthognathic surgery, orthodontic treatment time or patient compliance and complications was found in the selected articles.

Anterior open-bite treatment by means of zygomatic miniplates: a case report

This case report presents the treatment of a patient with skeletal Cl II malocclusion and anterior open-bite who was treated with zygomatic miniplates through the intrusion of maxillary posterior teeth. A 16-year-old female patient with a chief complaint of anterior open-bite had a symmetric face, incompetent lips, convex profile, retrusive lower lip and chin. Intraoral examination showed that the buccal segments were in Class II relationship, and there was anterior open-bite (overbite -6.5 mm). The cephalometric analysis showed Class II skeletal relationship with increased lower facial height. The treatment plan included intrusion of the maxillary posterior teeth using zygomatic miniplates followed by fixed orthodontic treatment. At the end of treatment Class I canine and molar relationships were achieved, anterior open-bite was corrected and normal smile line was obtained. Skeletal anchorage using zygomatic miniplates is an effective method for open-bite treatment through the intrusion of maxillary posterior teeth.

Bone anchors--can you hitch up your wagon?

The purpose of this review was to address and understand the current status of mini-screw implants (MSI) that are used in orthodontics. Understanding the biologic adaptation of MSI to its adjacent bone is one of the critical factors to their success. The review explores factors that are associated with failure of MSI, with special focus on an understanding of osseointegration as it relates to MSI. The rationale and importance of measuring bone contact and dynamic bone remodeling in animal studies are outlined. The utility of microcomputed tomography (μCT) as a substitute for conventional histomorphometry is debated. Finally, alveolar physiology and rigidity of implants are explored to understand potential reasons for the high failure rate of MSI when compared to endosseous implants.

Noninvasive palatal implant removal

OBJECTIVE

Orthodontic palatal implants are commonly used and do provide reliable absolute anchorage to assist orthodontic treatment. However, once treatment is completed, removal of these temporary implants is not considered easy or risk free. This short communication presents a clinical case in which a novel noninvasive procedure was applied to remove an osseointegrated palatal implant.

MATERIAL AND METHODS

A customized explantation tool, tightly fixed to the implant and precisely grasping the implant's head, was used in combination with a ratchet to unscrew the implant instead of the traditional removal by trephine.

RESULTS

Only a topical anesthetic was necessary before the implant-bone contact was broken by turning the ratchet counterclockwise. The implant was retrieved without any local anesthesia. The explanted palatal implant had no bone appending to it, except in its apical anti-rotational grooves, and the healing process thereafter was unproblematic.

CONCLUSIONS

Noninvasive palatal implant removal offers a simple and fast approach for explantation. Moreover, it might reduce the risk of adverse patient reactions, iatrogenic tooth and nerve injuries, and possible oro-antral communications.

An active, skeletally anchored transpalatal appliance for derotation, distalization and vertical control of maxillary first molars

OBJECTIVE

The objective of this investigation was to evaluate treatment outcomes of the skeletally anchored 'Frog' appliance.

DESIGN

A single-centre, retrospective study was performed.

SETTING

Private orthodontic practice.

PARTICIPANTS

Patients who had undergone comprehensive orthodontic treatment with the skeletally anchored 'Frog' appliance.

METHODS

43 participants (20 males and 23 females) who had received treatment with the skeletally anchored 'Frog' appliance where included. In order to explore dentoalveolar and skeletal treatment outcomes, pre- (T1) and post- (T2) treatment measurements were performed on patients' plaster models and cephalometric images. Comparisons between T1 and T2 were made by means of a Student's t-test. All statistical analyses were conducted at the 0·05 level of statistical significance.

RESULTS

Study model analysis revealed a statistically significant derotation of maxillary molars (μΔT2-T1=9·5°, P<0·001) as well as an increase in transverse arch dimensions at the end of treatment (μΔT2-T1=2·2 mm, P<0·001). Cephalometric changes included bodily distalization of maxillary molars (μΔ(T2-T1)=-1·9 mm, P<0·001), as well as noticeable angular displacement (μΔT2-T1=4·1°, P=0·004). No significant anchorage loss was observed, as displayed by the limited change in maxillary incisor position (μΔ(T1-T2)=0·2 mm, P=0·45). In addition, excellent vertical control of the maxillary molars was achieved, with no change in the mandibular plane (ML/NSL) angle (μΔT2-T1=0·3°, P=0·38).

CONCLUSIONS

The skeletal 'Frog' is effective in derotating and distalizing maxillary molars without anchorage loss and with excellent vertical control.

Maxillary molar distalization with MGBM-system in class II malocclusion

AIMS

Objective of this retrospective study was to evaluate the treatment effects of the MGBM-System (G.B Maino, A. Giannelly, R. Bernard, P. Mura), a new intraoral device to treat Class II malocclusions.

MATERIALS AND METHODS

A retrospective study was conducted to compare the pre-distalization and post-distalization cephalograms and dental model casts of 30 patients (15 male, 15 female) with Class II malocclusion treated with MGBM-System. Mean age at the beginning of treatment was 13.3 years (standard deviation 3.3). Angular, horizontal and vertical measurements were recorded to monitor skeletal and dental-alveolar changes. Molar movements in horizontal plane were monitored by making dental measurements on dental model casts.

RESULTS

The MGBM-System produced a rapid molar distalization and Class II relationship was corrected in 8 months ± 2.05, on average. The maxillary first molars were distalized of 4.14 (PTV-6 cemento-enamel junction), associated with a significant distal axis incline of 10. 5° referred to SN and a significant intrusion of 1.3 mm (PP). As for anchorage loss, the first premolar exhibited a significant mesial movement of 0.86 mm, associated with a significant mesial axis incline of 2.46°. No significative changes in either sagittal or vertical skeletal relationship were observed.

CONCLUSION

The results suggest that the MGBM-System is an efficient and reliable device for distalizing the maxillary permanent first and second molars.

Treatment of a skeletal Class II malocclusion using fixed functional appliance with miniplate anchorage

Based on our literature search, we found that the use of miniplate anchorage with Forsus fatigue-resistance device (FRD) has not yet been reported. Therefore, the aim of the present case report was to present the treatment of a patient with skeletal Class II malocclusion with mandibular retrusion using Forsus FRD with miniplate anchorage. Fixed appliances with 0.022-inch slots were attached to the maxillary teeth and after 8 months of the leveling and alignment of the upper arch, 0.019 × 0.025-inch stainless steel archwire was inserted and cinched back. Two weeks after the placement of the miniplates bilaterally at the symphysis of the mandible, Forsus FRD was adjusted to the miniplates with a 35-mm length of rod chosen. Nine months after the skeletal anchored Forsus worn, Class I canine and molar relations were achieved and overjet was eliminated.

Mini-implant stability at the initial healing period: a clinical pilot study

OBJECTIVE

To evaluate the changes of mini-implant stability over the initial healing period in humans.

MATERIAL AND METHODS

A sample of 19 consecutively treated patients (mean age 15.5 ± 7.3 years) was examined. In each patient, a mini-implant of a size of 2 × 9 mm was inserted into the anterior palate. Implant stability was assessed using resonance frequency analysis (RFA) immediately after insertion (T0), 2 weeks later (T1), 4 weeks later (T2), and 6 weeks later (T3). Insertion depth (ID) and the maximum insertion torque (IT) were measured. Data were tested for correlations between RFA, ID, and IT. All RFA values were tested for statistically significant differences between the different times.

RESULTS

The mean ID was 7.5 ± 0.6 mm, and the mean IT was 16.8 ± 0.6 Ncm. A correlation was found between RFA and ID (r = .726, P < .0001), whereas no correlations between RFA and IT or between IT and ID were observed. From T0 to T1, the stability (36.1 ± 6.1 implant stability quotient [ISQ]) decreased nonsignificantly by 4.9 ± 6.1 ISQ values (P > .05). Between T1 and T2, the stability decreased highly significantly (P < .001) by 7.9 ± 5.9 ISQ values. From T2 on, RFA remained nearly unchanged (-1.7 ± 3.5 ISQ; P > .05).

CONCLUSIONS

Mini-implant stability is subject to changes during the healing process. During weeks 3 and 4, a significant decrease of the stability was observed. After 4 weeks, the stability did not change significantly.

The effect of insertion angle on orthodontic mini-screw torque

BACKGROUND

Primary stability is an important factor for the clinical success of orthodontic mini-screws. The present study made an attempt to evaluate the effect of insertion angle changes on the maximum insertion and removal torque of orthodontic mini-screws.

MATERIALS AND METHODS

In this experimental study, 72 mini-screws (Dual Top Anchor System, Jeil, 1.6 mm diameter, 8 mm length) were used. They were randomly divided into four equal groups and inserted in poly-carbonate plates with 3 mm thickness. Then, their maximum insertion torque (MIT) and maximum removal torque (MRT) were recorded using a digital torque tester/screwdriver. Each group had a different insertion angle (90°, 75°, 60° and 45°). The data were analyzed by SPSS software (version 18) using one-way ANOVA and post-hoc Tukey's tests. The level of significance was set at 0.05.

RESULTS

The maximum MIT was observed in 45° insertion angle (14.84 Ncm) and the minimum MIT was reported in 75° insertion angle (12.66 Ncm). The maximum MRT was observed in 45° insertion angle (23.21 Ncm) and the minimum MRT was reported in the 90° insertion angle (17.43 Ncm).

CONCLUSION

Oblique insertion of the mini-screws results in higher insertion and removal torques and probably more primary stability compared to the vertical insertion.

Comparison between Herbst appliances with or without miniscrew anchorage

Background:

Herbst appliance is largely used in orthodontics for the correction of Class II. The aim of this paper was to analyze dental and skeletal effects of a splints Herbst-miniscrews combined device in comparison to a mandibular splints Herbst appliance.

Materials and Methods:

Fifty Class II division 1 patients (27 males and 23 females with a mean age of 11.8 ± 1.7 years) were included in the study. Lateral headfilms of 25 patients with a mandibular resin splint and a miniscrew anchorage (test group) and of 25 patients with mandibular acrylic resin splints (control group) were analyzed before (T0) and after (T1) the Herbst treatment. The mean and standard deviation (SD) of each variable were calculated; paired t-test was used to evaluate statistical changes before and after the treatment, in each group and Student t-test was used to compare the two groups.

Results:

Significant differences were observed for P < 0.05. At the end of the Herbst treatment, mandibular incisor proclination was significantly lower in the test group (2.8°) in comparison to the control group (7.4°).

Conclusions:

The miniscrew-Herbst system, described in the present study, allows correction of Class II malocclusion, with a lower anchorage loss, in form of mandibular incisor proclination, during the treatment, in comparison to mandibular acrylic splints Herbst.

The dynforce archwire

This article is a presentation of a clinical methodology aimed at minimizing binding in fixed orthodontic appliances. The dynforce archwire is explained. The dynforce archwire has a full size anterior segment (e.g. .021×.025) and undersized posterior segments with rectangular cross-section (e.g. .018×.025 or .018×.022), and is used in the orthodontic phase of space closure with or without TAD miniscrews. Two clinical cases are presented.