Test-retest reliability of smile tasks using three-dimensional facial topography

Objectives:To evaluate the test-retest reliability of three types of facial expression tasks using three-dimensional (3D) facial topography.Materials and Methods:Twelve adult volunteers were enrolled in this study. They were instructed to perform three different facial expression tasks: rest posture, posed smile, and maximum effort smile. Each task was recorded using a 3D image-capturing device on two separate occasions with an interval of 1 week between sessions. The images of two sessions were superimposed based on the forehead. For each participant and for each facial expression, a wire mesh fitting was conducted. This method generated 6,017 points on the wire mesh. Intraindividual reliability between sessions for each task was statistically tested by intraclass correlation coefficients (ICCs) and the 95% confidence interval minimal detectable change (MDC₉₅).Results:The MDC₉₅ for the repeated measures of the rest posture, posed smile, and maximum effort smile exhibited means of 0.8, 1.5, and 1.3 mm, respectively, on the z-axis. The ICCs ranged from substantial to almost perfect agreement for repeated measures for the rest posture and maximum effort smile (0.60 < ICC ≤ 1.00). The right corner of the mouth in the posed smile showed moderate agreement (0.40 < ICC ≤ 0.60).Conclusions:The overall test-retest reliability of the maximum effort smile and rest posture showed substantial to almost perfect agreement, and this was clinically acceptable.     

Cephalometric Characteristics of Korean Children with Class III Malocclusion in the Deciduous Dentition

Objective:To compare the cephalometric characteristics of children with Class III malocclusion to those of children with normal occlusion during the deciduous dentition phase.Materials and Methods:Cephalometric measurements of 27 children (mean age: 5.03 years) diagnosed with Class III malocclusion were compared with 32 children (mean age: 4.85 years) diagnosed with normal occlusion in the following four categories: sagittal skeletal analysis, vertical skeletal analysis, dentoalveolar analysis, and soft tissue analysis.Results:Significant differences were seen in all categories except vertical skeletal analysis. Sagittal skeletal measurements included ANB (Class III group: −0.91 ± 1.60; normal group: 5.28 ± 1.29), facial convexity (Class III group: 0.47 ± 4.32; normal group: 13.65 ± 3.44), Wits appraisal (Class III group: −5.54 ± 2.36; normal group: −0.84 ± 1.91), and A to N-perpendicular (Class III group: −2.94 ± 3.05; normal group: 0.78 ± 2.53). Dentoalveolar measurements included U1 to NA (Class III group: 11.98 ± 5.25; normal group: 8.12 ± 5.43), IMPA (Class III group: 81.34 ± 7.40; normal group: 86.57 ± 5.67), and interincisal angle (Class III group: 152.65 ± 8.82; normal group: 145.03 ± 7.34). Soft tissue measurements included soft tissue convexity (Class III group: 2.47 ± 4.20; normal group: 12.71 ± 3.95), nasofacial angle (Class III group: 22.68 ± 4.22; normal group: 26.24 ± 3.84), and upper lip to esthetic plane (Class III group: −0.65 ± 2.74; normal group: 3.07 ± 1.90).Conclusions: There are significant differences between the craniofacial patterns of normal children and those of children with Class III malocclusion that can be identified with cephalometric analysis as early as the deciduous dentition phase.     

Facial soft-tissue changes after rapid maxillary expansion analyzed with 3-dimensional stereophotogrammetry: A randomized,controlled clinical trial

Objective:To evaluate three-dimensional (3-D) soft tissue facial changes following rapid maxillary expansion (RME) and to compare these changes with an untreated control group.Materials and Methods:Patients who need RME as a part of their orthodontic treatment were randomly divided into two groups of 17 patients each. Eligibility criteria included having maxillary transverse deficiency with crossbite, and to be in the normal range according to body mass index. In the first group (mean age  =  13.4 ± 1.2 years), expansion was performed. The second group received no treatment initially and served as untreated control (mean age  =  12.8 ± 1.3 years). Skeletal and soft tissue changes were evaluated using posteroanterior cephalograms and 3-D facial images. The primary outcome of this study was to assess the soft tissue changes. The secondary outcomes were evaluation hard tissue and soft tissue relations. Randomization was done with preprepared random number tables. Blinding was applicable for outcome assessment only. MANOVA, t-test, and correlation analyses were used (P  =  .05).Results:In both groups, there was a general trend of increase for the transverse skeletal measurements, but these increases were more limited in the control group. Alar base width was greater in the treatment group (P  =  .002). Pogonion soft tissue point (P  =  .022) was located more posteriorly in the expansion group compared with the control group.Conclusions:Soft tissue changes between groups were similar, except for the alar base, which became wider in the treatment group. Weak correlations were found between the skeletal and soft tissue changes.     

A three-dimensional soft tissue analysis of Class III malocclusion: a case-controlled cross-sectional study

Objective: The present study used the optical surface laser scanning technique to compare the facial features of patients aged 8–18 years presenting with Class I and Class III incisor relationship in a case-control design.

Materials and methods: Subjects with a Class III incisor relationship, aged 8–18 years, were age and gender matched with Class I control and underwent a 3-dimensional (3-D) optical surface scan of the facial soft tissues.

Results: Landmark analysis revealed Class III subjects displayed greater mean dimensions compared to the control group most notably between the ages of 8–10 and 17–18 years in both males and females, in respect of antero-posterior (P?=?0.01) and vertical (P?=?0.006) facial dimensions. Surface-based analysis, revealed the greatest difference in the lower facial region, followed by the mid-face, whilst the upper face remained fairly consistent.

Conclusion: Significant detectable differences were found in the surface facial features of developing Class III subjects.     

Longitudinal study of cephalometric soft tissue profile traits between the ages of 6 and 18 years

Objective:To study the longitudinal changes in 19 soft tissue cephalometric traits (according to the Bergman cephalometric soft tissue facial analysis).Materials and Methods:Cephalograms and photographs of 40 subjects (20 male, 20 female, from the Burlington Growth Centre) that were obtained at ages 6, 9, 12, 14, 16, and 18 years were used. Subjects were orthodontically untreated whites and had Class I dentoskeletal relationships (ideal overjet and overbite). Images were obtained with the lips in a relaxed position or lightly touching.Results:Three groups of soft tissue traits were identified: (1) traits that increased in size with growth (nasal projection, lower face height, chin projection, chin-throat length, upper and lower lip thickness, upper lip length, and lower lip–chin length); (2) traits that decreased in size with growth (interlabial gap and mandibular sulcus contour [only in females]); and (3) traits that remained relatively constant during growth (facial profile angle, nasolabial angle, lower face percentage, chin-throat/lower face height percentage, lower face–throat angle, upper incisor exposure, maxillary sulcus contour, and upper and lower lip protrusion).Conclusion:Current findings identify areas of growth and change in individuals with Class I skeletal and dental relationships with ideal overjet and overbite and should be considered during treatment planning of orthodontic and orthognathic patients.     

Bimaxillary Protrusion in the Caucasian: A Cephalometric Study of the Morphological Features

Abstract

The skeletal morphology of bimaxillary dental protrusion has been investigated in a comparative cephalometric study. Because this is considered a subset of Class I malocclusions, the null hypothesis is that there should be no significant skeletal differences between this group and a Class I control group.

There were 30 Caucasians in each group with no bias for age and sex differences between them. Eighteen radiographic landmarks were identified from which 33 skeletal, dental and soft tissue parameters were computed. The bimaxillary group had an average interincisal angle of 115° versus the controls 135°, and showed the following morphological features which persisted over a 5-year growth period: 1. A shorter posterior cranial base.

2. A longer and more prognathic maxilla.

3. Similar mandibular dimensions and prognathism.

4. A mild Class II skeletal pattern.

5. A smaller upper and posterior face height.

6. Diverging facial planes.

7. A procumbent soft tissue profile with a low lip line.

These findings indicate that there is a distinctive difference between the underlying skeletal patterns found in the two groups.     

Masseter muscle changes following orthognathic surgery: A long-term three-dimensional computed tomography follow-up

Objective:To evaluate the long-term changes of masseter muscle morphology in skeletal Class III patients with facial asymmetry following two-jaw orthognathic surgery (Le Fort I osteotomy + intraoral vertical ramus osteotomy).Materials and Methods:Using computed tomography (CT), a longitudinal study was conducted on 17 skeletal Class III patients with facial asymmetry. Measurements from the reconstructed three-dimensional (3D) CT images were compared from T1 (before surgery), T2 (1 year after surgery), and T3 (4 years after surgery). The maximum cross-sectional area (CSA), orientation, thickness, and width of the masseter muscle were measured on both the deviated and nondeviated sides. The control group included 17 volunteers with skeletal and dental Class I relationships without dentofacial deformities.Results:At T1, there were no significant differences in CSA, thickness, or width of masseter muscle between the deviated and nondeviated sides. Masseter muscle orientation was significantly more vertical on the nondeviated side than on the deviated side at T1 (P < .01); no significant bilateral differences were noted at T2 and T3. At T1, masseter muscle measurements were significantly lower than controls (P < .01). During T1–T3, a significant increase was noted in CSA, thickness, and width (P < .01) of masseter muscle. At T3, no significant difference was noted between the study and control groups.Conclusion:After surgery, the masseter muscle measurements of skeletal Class III asymmetry patients showed no significant differences compared with the control group within the 4-year follow-up period, indicating adaptation to the new skeletal environments and increased functional demand.     

A Comparison Study of Upper Airway among Different Skeletal Craniofacial Patterns in Nonsnoring Chinese Children

Objective:Patients with OSAS (obstructive sleep apnea syndrome) demonstrate decreased upper airway dimension and craniofacial skeletal abnormalities. The study was performed to analyze whether upper airway dimensions differed among Chinese nonsnoring children of different sagittal and vertical skeletal facial morphologies.Materials and Methods:Lateral cephalometric records were used to measure the dimensions of the upper airway. Two groups of subjects were studied. A group of subjects with a normodivergent facial pattern (n  =  190; FH-MP angle between 23.5° and 30.5°) was divided into three subgroups according to ANB angle (Class I, II, or III). A second group of subjects with a normal sagittal facial pattern (n  =  180; ANB angle between 0.7° and 4.7°) was divided into three subgroups according to the FH-MP angle (low angle, normal angle, or high angle). All subgroups were matched for age and sex.Results:In the group of subjects with a normodivergent facial pattern, a significant tendency for reduced upper airway dimension in the inferior part (palatopharyngeal and hypopharynx) was found in the Class III, Class I, and Class II subgroups, in that order. In the group of subjects with a normal sagittal facial pattern, the superior part of the airway (nasopharyngeal and palatopharyngeal) decreased with increasing mandibular plane angle.Conclusion:The sagittal and vertical skeletal patterns may be contributory factors for the variation of the inferior and superior part of the upper airway, respectively. Skeletal deficiency of nonsnoring Chinese children may predispose them to upper airway obstruction.     

Correlation between occlusal abnormalities and parameters investigated by three-dimensional facial photography

Objective:To clarify, by three-dimensional (3D) facial scans, if 4- to 6-year-old children with intraoral sagittal discrepancies and open-bite occlusion show differences in facial morphology when compared to children without anomalies.Materials and Methods:Scans of 290 children presenting with occlusal abnormalities were compared to 1772 face scans of age-matched individuals photographed with a faceSCAN II® 3D data acquisition system. From these, three study groups were formed comprising 188 children with distal occlusion/increased overjet (Class II), 37 with mesial occlusion/inverse overjet (Class III), and 65 with open-bite occlusion. These groups were evaluated by age and gender for each group compared to the control individuals.Results:The Class II group showed statistically significant reduced dimensions of head width, upper face width, and midface length. In addition, the mean values for mouth width and lip thickness were higher, and their upper lips were located more anteriorly than in the control group. The Class III group exhibited more markedly retruded upper lips. The facial profile of female 5-year-old Class III patients was significantly more concave. Patients in the open-bite group showed reduced upper lip length, with differences only being statistically significant in male 4-year-olds.Conclusion:Dental Class II with increased overjet and dental Class III with decreased overjet influence soft tissue morphology and are represented on 3D facial scans.     

Three-dimensional cone beam computed tomographic image reorientation using soft tissues as reference for facial asymmetry diagnosis

Objective:To investigate discrepancies in results of facial asymmetry analysis using different cone beam computed tomography (CBCT) image reorientation methods and the effectiveness of soft tissue as a reorientation reference for analysis of facial asymmetry.Materials and Methods:An asymmetric group of 30 patients with 4 mm or more of chin point (menton [Me]) deviation and a symmetric group of 30 patients with less than 4 mm of deviation of Me were chosen as study subjects. Three orientation methods were used to calculate and compare Me deviation values of the 60 subjects. Two methods used only skeletal landmarks for reference, and one method included the soft tissue landmarks around the eye. Preferences of an expert group for the facial midline as determined by each reorientation method were also examined.Results:The examinations showed significant discrepancies in Me deviation values between the three reorientation methods. The expert group showed the greatest preference for the facial midline reorientation method that incorporated soft tissue landmarks of the eye.Conclusions:These study findings suggest that the inclusion of soft tissue landmarks, especially those around the eyes, is effective for three-dimensional CBCT image reorientation for facial asymmetry analysis.     

Effects of skeletally anchored Class II elastics: A pilot study and new approach for treating Class II malocclusion

Objective:To evaluate the skeletal, dentoalveolar, and soft tissue effects of skeletally anchored Class II elastics and compare them with a matched control group treated by a monobloc appliance for the correction of skeletal Class II malocclusion due to mandibular retrusion.Materials and Methods:Twelve patients (6 girls, 6 boys) were randomly divided into two groups. In the elastics group, six patients (12.9 ± 1.5 years of age; 3 boys, 3 girls) were treated with skeletally anchored Class II elastics. Two miniplates were placed bilaterally at the ramus of the mandible and the other two miniplates were placed at the aperture piriformis area of the maxilla. In the monobloc group (3 boys and 3 girls; mean age, 12.3 ± 1.6 years), patients used the monobloc appliance. The changes observed in each phase of treatment were evaluated using the Wilcoxon matched-pair sign test. Intergroup comparisons at the initial phase of treatment were analyzed by the Mann-Whitney U test.Results:There were statistically significant group differences in Co-Gn, B-VRL, U1-PP, U1-VRL, Ls-VRL, with significant increases in these parameters in the elastics group (P < .05). The mandibular incisors were protruded in the monobloc group (5.45 ± 1.23°), whereas they were retruded in the elastics group (−3.01 ± 1.66°; P < .01).Conclusions:The undesirable dentoalveolar effects of the monobloc appliance were eliminated by using miniplate anchorage. Favorable skeletal outcomes can be achieved by skeletal anchorage therapies which could be an alternative to treat skeletal Class II patients with mandibular deficiency.     

Evaluation of soft tissue changes around the lips after bracket debonding using three-dimensional stereophotogrammetry

Objective:To evaluate the changes in soft tissue around the lips after orthodontic bracket debonding using three-dimensional (3-D) stereophotogrammetry.Materials and Methods:3-D facial images of 20 subjects (10 men and 10 women; mean age, 26.81 ± 7.23 years) were taken with a white light scanner before and after debonding the labial brackets. Two images acquired from each subject were superimposed, and 15 soft tissue landmarks around the lips were plotted and analyzed. Statistical analysis was performed using both paired and independent t-tests (P < .05).Results:There were no significant changes in position of any landmark on the x (left-right)- or y (vertical)-axes after removal of the brackets. However, the landmarks in the oral commissures and lower lip (LLP, −0.55 mm; Li, −0.44 mm; Ch-L, −0.56 mm, all P < .05) on the z (anteroposterior)-axis showed statistically significant differences. There were no significant positional changes of most landmarks on the x-, y-, or z- axes after bracket removal among the various genders and lip thicknesses.Conclusions:There was a slight retrusion in the oral commissure and lower lip areas after debonding, but no changes were found in the upper lip area. This study showed that 3-D stereophotogrammetry can be useful in evaluating facial soft tissue changes in orthodontic patients.     

Mandibular symphysis morphology and dimensions in different anteroposterior jaw relationships

Objective:To assess the morphology and dimensions of mandibular symphysis (MS) in different anteroposterior jaw relationships and to investigate whether craniofacial parameters have any correlation with its shape and/or dimensions.Materials and Methods:Lateral cephalograms of subjects with Class I, Class II, and Class III skeletal relationships were traced. Several craniofacial and MS parameters were measured. MS parameters were compared between the three groups using analysis of variance and were correlated with the craniofacial parameters using the Pearson correlation coefficient.Results:Larger angle of concavity of the chin, more inclination of the alveolar bone toward the mandibular plane, and larger MS dimensions and area (P < .001) were found with a Class III skeletal relationship compared to Class I and Class II relationships. The Pearson correlation coefficient between Id-Me and AFH was r  =  0.83 and between Id-Me and LAFH it was r  =  0.81.Conclusions:The dimensions and configuration of MS in the Class III relationship were different than those in Class I and Class II relationships; the alveolar part of MS compensated for the skeletal relationship in the Class III pattern. MS dimensions were strongly correlated to anterior facial dimensions.     

Long-Term Dentoskeletal Effects and Facial Profile Changes Induced by Bionator Therapy

Objective:To evaluate the long-term skeletal and soft tissue changes induced by the bionator in Class II subjects.Materials and Methods:The treatment sample consisted of 20 Class II patients (6 males and 14 females) treated consecutively with the bionator. The sample was evaluated at T1, start of treatment; T2, end of bionator therapy; and T3, long-term observation (including fixed appliances). Mean age at the start of treatment was 10 years 2 months (T1); at posttreatment, 12 years 4 months (T2); and at long-term follow-up, 18 years 11 months (CS 6). The control group consisted of 20 subjects (8 males and 12 females) with untreated Class II malocclusions. Lateral cephalograms were analyzed at the three time points for all groups. Student''s t-tests were used for comparisons of starting forms, and of the T1–T2 and T1–T3 changes between groups.Results:The bionator group showed significant, favorable T1–T2 changes both at the skeletal and dentoalveolar levels. The vertical dimension was increased. Significant modifications were assessed for the soft tissues as well. The treated group showed a final improvement in soft tissue pogonion of about 2.5 mm. Significant mandibular changes were noted in the treated group, with a net average 3.3 mm long-term increase in mandibular length compared with untreated Class II controls.Conclusions:This study suggests that bionator treatment of Class II malocclusion maintains favorable results over the long-term with a combination of skeletal, dentoalveolar, and soft tissue changes.     

A sparse principal component analysis of Class III malocclusions

Objectives:To identify the most characteristic variables out of a large number of anatomic landmark variables on three-dimensional computed tomography (CT) images. A modified principal component analysis (PCA) was used to identify which anatomic structures would demonstrate the major variabilities that would most characterize the patient.Materials and Methods:Data were collected from 217 patients with severe skeletal Class III malocclusions who had undergone orthognathic surgery. The input variables were composed of a total of 740 variables consisting of three-dimensional Cartesian coordinates and their Euclidean distances of 104 soft tissue and 81 hard tissue landmarks identified on the CT images. A statistical method, a modified PCA based on the penalized matrix decomposition, was performed to extract the principal components.Results:The first 10 (8 soft tissue, 2 hard tissue) principal components from the 740 input variables explained 63% of the total variance. The most conspicuous principal components indicated that groups of soft tissue variables on the nose, lips, and eyes explained more variability than skeletal variables did. In other words, these soft tissue components were most representative of the differences among the Class III patients.Conclusions:On three-dimensional images, soft tissues had more variability than the skeletal anatomic structures. In the assessment of three-dimensional facial variability, a limited number of anatomic landmarks being used today did not seem sufficient. Nevertheless, this modified PCA may be used to analyze orthodontic three-dimensional images in the future, but it may not fully express the variability of the patients.     

Association of the three-dimensional skeletal variables with self-recognition of facial asymmetry in skeletal Class III patients

ObjectivesTo investigate the association between three-dimensional (3D) skeletal variables and self-recognition of facial asymmetry in skeletal Class III patients.Materials and MethodsQuestionnaires and cone beam computed tomography of 74 patients (42 men and 32 women; mean age: 22.8 ± 4.5 years) with skeletal Class III and facial asymmetry were collected retrospectively. Patients were classified into three groups: group Sy (recognition of symmetry), group NS (not sure), and group Asy (recognition of asymmetry), according to their responses to the questionnaires. To assess 3D anatomic differences in the maxillomandibular region, six 3D hard tissue variables: maxillary height, ramal length, frontal ramal inclination (FRI), lateral ramal inclination (LRI), mandibular body length (Mn BL), and mandibular body height (Mn BH) were compared among the three self-recognition groups. Six 3D hard tissue variables and Menton deviation were reduced into three factors and their association with the self-recognition of facial asymmetry was investigated.ResultsMaxillary height, FRI, LRI, Mn BH, and Menton deviation demonstrated significant differences among the three self-recognition groups. The reduced factors, which consisted of transverse and vertical parameters, and vertical parameter of the mandibular corpus, demonstrated significant differences among the three self-recognition groups. The difference in Mn BH influenced the self-recognition of facial asymmetry.ConclusionsBoth the transverse and vertical parameter of the skeleton were determinant in self-recognition of facial asymmetry. Identification of the skeletal difference in the lateral view involving LRI and Mn BH should be included for assessment of facial asymmetry.     

Treatment effects of skeletally anchored Forsus FRD EZ and Herbst appliances: A retrospective clinical study

Objective:To evaluate the skeletal, dentoalveolar, and soft tissue effects of the Forsus FRD appliance with miniplate anchorage inserted in the mandibular symphyses and to compare the findings with a well-matched control group treated with a Herbst appliance for the correction of a skeletal Class II malocclusion due to mandibular retrusion.Materials and Methods:The sample consisted of 32 Class II subjects divided into two groups. Group I consisted of 16 patients (10 females and 6 males; mean age, 13.20 ± 1.33 years) treated using the Forsus FRD EZ appliance with miniplate anchorage inserted in the mandibular symphyses. Group II consisted of 16 patients (9 females and 7 males; mean age, 13.56 ± 1.27 years) treated using the Herbst appliance. Seventeen linear and 10 angular measurements were performed to evaluate and compare the skeletal, dentoalveolar, and soft tissue effects of the appliances using paired and Student''s t-tests.Results:Both appliances were effective in correcting skeletal class II malocclusion and showed similar skeletal and soft tissue changes. The maxillary incisor was statistically significantly more retruded in the skeletally anchored Forsus FRD group (P < .01). The mandibular incisor was retruded in the skeletally anchored Forsus FRD group (−4.09° ± 5.12°), while it was protruded in the Herbst group (7.50° ± 3.98°) (P < .001).Conclusion:Although both appliances were successful in correcting the skeletal Class II malocclusion, the skeletally anchored Forsus FRD EZ appliance did so without protruding the mandibular incisors.     

Camouflage treatment of skeletal Class III malocclusion with multiloop edgewise arch wire and modified Class III elastics by maxillary mini-implant anchorage

Objective:To evaluate the effect of the multiloop edgewise arch wire (MEAW) technique with maxillary mini-implants in the camouflage treatment of skeletal Class III malocclusion.Materials and Methods:Twenty patients were treated with the MEAW technique and modified Class III elastics from the maxillary mini-implants. Twenty-four patients were treated with MEAW and long Class III elastics from the upper second molars as control. Lateral cephalometric radiographs were obtained and analyzed before and after treatment, and 1 year after retention.Results:Satisfactory occlusion was established in both groups. Through principal component analysis, it could be concluded the anterior-posterior dental position, skeletal sagittal and vertical position, and upper molar vertical position changed within groups and between groups; vertical lower teeth position and Wits distance changed in the experimental group and between groups. In the experimental group, the lower incisors tipped lingually 2.7 mm and extruded 2.4 mm. The lingual inclination of the lower incisors increased 3.5°. The mandibular first molars tipped distally 9.1° and intruded 0.4 mm. Their cusps moved 3.4 mm distally. In the control group, the upper incisors proclined 3°, and the upper first molar extruded 2 mm. SN-MP increased 1.6° and S-Go/N-ME decreased 1.Conclusions:The MEAW technique combined with modified Class III elastics by maxillary mini-implants can effectively tip the mandibular molars distally without any extrusion and tip the lower incisors lingually with extrusion to camouflage skeletal Class III malocclusions. Clockwise rotation of the mandible and further proclination of upper incisors can be avoided. The MEAW technique and modified Class III elastics provided an appropriate treatment strategy especially for patients with high angle and open bite tendency.     

Treatment outcomes of various force applications in growing patients with skeletal Class III malocclusion:: A comparative lateral cephalometric study

ObjectivesTo evaluate skeletal, dentoalveolar, and soft tissue changes between intraoral light force application and extraoral heavy force application in growing patients with skeletal Class III malocclusion.Materials andMethods: A retrospective study was conducted with pretreatment and posttreatment lateral cephalometric data from 50 subjects with skeletal Class III malocclusion. In the first group (15 boys, 10 girls; 8.67 ± 2.13 years old), each subject wore a biocreative horseshoe appliance (CHS) with two Class III elastics that exerted a force of 200 g. In the second group (13 boys, 12 girls; 8.96 ± 1.82 years old), each subject wore a Petit-type facemask and a lingual arch with hooks fixed to the maxillary arch with a total force of 700 g. Both groups of patients were instructed to wear the appliance approximately 14 hours a day, and 22 linear measurements and 8 angular measurements were evaluated. Changes of measurements from each group were compared by paired t-tests, considering a 5% significance level.ResultsForward growth of the maxilla, improvement of the maxilla–mandible relationship, and upper incisor flaring were achieved in both groups without any statistically significant difference between them. Lateral cephalometric analysis also showed that U1 exposure, IMPA (Angle between mandibular plane and mandibular incisor axis), FMIA (Angle between FH plan and mandibular incisor axis), and L1-APog (Angle formed by the intersection of tooth axis of lower incisor and A-Pog line, Distance from lower incisor edge to A-Pog line) showed statistically significant differences. Lower incisors were inclined lingually in the CHS group.ConclusionsDuring treatment of skeletal Class III malocclusion, the CHS with light Class III intermaxillary elastics therapy exhibits similar orthopedic changes to the maxillary complex and more dental changes to the lower anterior teeth compared with facemask therapy.     

The Class II Carriere Motion appliance:: A 3D CBCT evaluation of the effects on the dentition

ObjectivesTo determine three-dimensional treatment changes produced by the Class II Carriere Motion appliance (CMA) in Class II adolescent patients with Class I and Class II skeletal relationships.Materials and MethodsThe sample included 59 adolescents (16 boys and 43 girls) with unilateral or bilateral Class II molar and bilateral Class II canine relationship. They were divided into group 1 with skeletal Class I (N = 27; ANB 2.90° ± 1.40°; 13.30 ± 1.53 years) and group 2 with skeletal Class II (N = 32; ANB 6.06° ± 1.64°; 13.26 ± 1.76 years). Cone beam computed tomography images were traced with Invivo software pretreatment (T1) and post-CMA usage (T2). The treatment changes in 36 measurements were calculated in each group, and the changes in 16 measurements were compared between them.ResultsIn group 1 and 2, maxillary first molars underwent significant distal movement (1.92 mm ± 0.80 mm and 1.67 mm ± 1.56 mm, respectively) with distal tipping and rotation, maxillary canines underwent significant distal movement (2.34 mm ± 1.07 mm and 2.24 mm ± 1.91 mm, respectively) with distal tipping and rotation, and mandibular molars underwent significant mesial movement (–1.37 mm ± 1.23 mm and –2.51 mm ± 1.51 mm, respectively) with mesial tipping. Between the groups, there were significant differences in mandibular molar mesial movement and the U1-SN changes (P < .05).ConclusionsThe CMA corrected Class II malocclusion through distal tipping and rotational movement of maxillary canines and molars and corrected mesial tipping of mandibular molars. Significantly more mandibular molar mesial movement and maxillary incisor flaring were observed in patients with skeletal Class II.