Class II malocclusion. Time and cost of a combined orthodontic and surgical treatment

During orthodontic treatment of 29 patients with a Class II malocclusion, the remaining overjet was corrected surgically by intraoral mandibular distraction osteogenesis. The patients were divided in two groups. Group A was treated orthodontically in a two-phase approach, using functional and fixed appliances. Group B was treated in a one-phase approach with only fixed appliances. Before treatment the differences in age, gender and severity of the malocclusion between the groups, were not statistically significant. After distraction-osteogenesis, all orthodontic treatments could be finished successfully. The mean treatment time was for group A 44.2 and for group B 28.6 months. The difference was statistically significant (p < 0.001). The mean orthodontic treatment time after distraction osteogenesis was 9.1 months. The mean cost for the orthodontic treatment was not statistically significant different between the groups.     

Postretention assessment of deep overbite correction in Class II Division 2 malocclusion

The purposes of this study were to evaluate the long-term stability of deep overbite correction in Class II Division 2 malocclusion and to search for predictors of postretention overbite. The sample of 62 (31 males, 31 females) was limited to Class II Division 2 patients with initial deep overbite and successful orthodontic treatment as judged clinically at the end of treatment. Study models and cephalograms were analyzed before treatment, after treatment, and out of retention (average 15 years). The sample was divided into two groups according to the degree of postretention overbite: Group 1 (N=33; overbite > or = 4.0 mm at T3, mean = 5.17 +/- 0.87) and group 2 (N=29; overbite <4.0 mm at T3, mean = 2.95 +/- 0.87). The results showed that patients with very upright pretreatment maxillary and mandibular incisors tended to have deeper initial overbite and a tendency to return to their original relationship by the postretention stage. Posttreatment vertical growth contributed to maintenance of overbite correction. By stepwise multiple regression analysis, initial overbite was selected as the most important predictor of postretention overbite. Initial overbite was positively related with postretention overbite.     

骨性安氏Ⅱ类错He的外科与正畸联合治疗

目的：探讨外科与正畸联合治疗骨性安氏Ⅱ类错Ｈｅ的方法和特点。方法：总结分析近年一经外科与正畸联合治疗的骨性安氏Ⅱ类错Ｈｅ病例２２例,介绍典型病例治疗过程,着重讨论拔牙时机,术前后正畸治疗特点及术式选择。结果：本研究２２例患者经联合治疗后,颌骨关系正常,牙弓形态衣Ｈｅ曲线正常,牙排列整齐,咬合关系好,面形及功能均获明显改善,疗效满意。     

上前牙缺失伴深覆(牙合)的修复前正畸

上前牙位于面部突出位置,常因外伤而缺失,当前牙深覆[牙合]时,上下牙之间的颌间隙过小,甚至下牙的切缘咬在上颌牙槽嵴的黏膜卜,没有足够的修复空间,如果勉强去修复,不但影响美观,还会影响牙颌系统的正常功能,有些甚至成为不良修复体,给患造成痛苦。我们用小平导,首先矫治深覆[牙合],取得足够的修复空间后,再进行修复治疗,取得了良好的临床效果。     

Differential diagnosis and treatment planning of the surgical orthodontic Class III malocclusion

The decision to reposition the mandible posteriorly or the maxilla anteriorly in the treatment of Class III malocclusions depends upon multiple clinical, cephalometric, and biomechanical considerations. In each case the decision must be made on the basis of frontal and profile treatment objectives, occlusion, and the needs of the patient. In many instances, depending upon the magnitude of the disharmony, the treatment plan will be based upon the clinical judgment and experience of the surgeon and orthodontist. Surgery for the Class III patient is equally predictable and stable, whether the maxilla or the mandible is moved. This article discusses the diagnostic criteria by which one might evaluate and plan treatment for a patient with a Class III malocclusion and facial disharmony.     

Treatment of Class II deep bite by orthodontic and surgical means

Conventional orthodontic correction of the Class II deep-bite deformity with a decreased lower anterior facial height tendency can be mechanically difficult, inefficient and, in many instances, impossible. Orthodontic treatment alone of either adults or adolescents with such deformities frequently can neither increase lower anterior facial height sufficiently to achieve ideal facial proportions nor achieve long-term occlusal stability. Despite the need for surgical intervention to achieve satisfactory occlusal and esthetic results, many patients with such deformities are still being treated in clinical practice by traditional orthodontic procedures, with less than ideal esthetic and/or occlusal results. The challenge to achieve efficient and stable treatment of this deformity has been met by the use of various surgical techniques in combination with orthodontic treatment. This combined surgical-orthodontic approach can provide increased treatment efficiency, long-term stability, and optimal esthetic results. The proper sequencing and correct selection of orthodontic mechanotherapy are essential to ensure the desired results. This article purposes to detail basic problems involved in diagnosis and treatment planning for the combined surgical-orthodontic approach to patients exhibiting Class II deep bite and decreased lower facial height. Orthodontic and surgical treatment objectives are explained, and representative case reports are presented and discussed to illustrate this method of treatment. Extraction patterns, control of the transverse dimension, arch wire selection, auxiliary wires, elastics, and extraoral appliance use are described. Surgically, the dentofacial disharmony associated with this deformity may defy treatment by surgical advancement of the mandible only. Genioplasty, Le Fort I osteotomy, symphyseal osteotomy, anterior or total mandibular subapical osteotomy, body osteotomy, submental lipectomy, and rhinoplasty are adjunctive procedures that are described and may be used in concert with mandibular advancement surgery.     

Clinical predictive factors for temporomandibular disorders following combined orthodontic and orthognathic surgical treatment in patients with Class III malocclusion

Objective: The aim of this study was to identify clinical factors predisposing to the development or worsening of temporomandibular disorders (TMDs) following orthodontic surgical treatment for Class III malocclusion.

Methods: A retrospective cohort study was performed on 88 patients with Class III malocclusion having undergone a combined orthodontic and orthognathic surgical treatment. Temporomandibular joint and masticatory muscle examinations were available prior to treatment and one year post-operatively. Multivariate logistic regression was used to predict the development of post-operative TMDs, and linear regression was used to predict the worsening of TMDs using Helkimo indices.

Results: Patients with Class III malocclusion presenting with pre-treatment anamnestic TMJ clicking (OR = 5.8; p = 0.03) and undergoing bimaxillary osteotomy procedures (OR = 18.6; p = 0.04) were more at risk for the development of TMDs.

Discussion: TMDs must be evaluated, monitored, and managed with caution in patients with Class III malocclusion presenting with pre-treatment joint clicking and who are planned for bimaxillary osteotomies.     

The combined orthodontic and surgical treatment of traumatic Class II division 2 in the adult

A mild Class II division 2 incisal relationship is often associated with a pleasing facial profile and aesthetically acceptable arrangement of the teeth. Severe cases, however, have the potential to cause trauma and a number of older patients present with extensive soft and hard tissue damage. Management options may range from simple preventive advice to complicated surgical orthodontics. Detailed assessment of the case is paramount in developing an appropriate treatment plan.     

Predictors of patient compliance during Class II division 1 malocclusion functional orthodontic treatment

ObjectivesTo determine factors that could predict Class II/1 malocclusion patient compliance during functional treatment.Materials and MethodsThe sample consisted of 77 subjects (aged 11–13 years; 47% girls) presenting with Class II/1 malocclusion. Inclusion criteria were distal molar relationship, overjet greater than 5 mm, and confirmed pubertal growth spurt. Removable functional appliances (62% Twin Block [TB], 38% Sander Bite Jumping [BJ]) with built-in maxillary expansion screws were used. Follow-up period was 1 year. Patients and parents independently filled out the Child Perception Questionnaire, Parental/Caregiver Perception Questionnaire, and Family Impact Scale to assess emotional and social well-being, oral symptoms, functional limitations, parental emotions, family activities, conflicts, and financial burden as possible predictors of compliance during treatment. Sex, overjet, and appliance type were also analyzed.ResultsThere were more noncompliant than compliant patients (55% vs 45%). Parental perception of altered emotional well-being of their children was the strongest predictor, increasing compliance odds 3.4 times (95% confidence interval [CI], 1.2–9.4; P = .017). Patients were 3.2 times (95% CI, 1.1–9.3; P = .033) more likely to cooperate with TB compared with BJ appliance. OJ ≥ 8 mm increased compliance odds 3.1 times (95% CI, 1.0–9.4; P = .044).ConclusionsParental perception of child''s emotional well-being alteration, severity of malocclusion, and type of appliance are major predictors of compliance. Psychosocial issues and oral function limitations reported by children and family impact are of negligible influence.     

用组合式矫治装置治疗前牙深覆(牙合)

目的：介绍一种组合式矫治装置及其应用。方法：该矫治方法由前牙平导板、高弹性方弓丝、第二磨牙设计支抗、后牙颌间垂直牵引等组成。结果：经临床应用２年,共６２例,效果良好。平均疗程４个月。该矫治方法的优点包括：１,前牙平（斜）导板在压低前牙和升高后牙的同时,还起到了肌激动器的作用,促使下颌骨长度与高度的发育;２,第二磨牙加入支抗系统使矫治力趋于合理,有利于牙弓的整平;３,高弹性方丝有利于牙弓的排齐和整平,同时能较好控制牙齿的位置和倾斜度;４,后牙早期颌间垂直牵引有助于后牙按一定方向萌出,并建立理想咬合关系,减小前牙覆牙合。结论：该矫治方法符合正畸生物力学原理,其疗效好,疗程短,适合于非高角型前牙深覆牙合特别是低角型深覆牙合的矫治。     

Management of a Class II deep bite malocclusion with combined straightwire appliance and bioprogressive therapy.

Development of straightwire appliances and improvement in archwire technology have simplified fixed appliance therapy in orthodontics. Although straightwire appliances are routinely used to treat most malocclusions, there are inherent limitations and it is necessary to look at the needs of each individual case rather than to simply proceed through a "cookbook" series of archwires to achieve a desired result. The Bioprogressive Therapy, although biomechanically complex, offers several advantages that can be integrated with the straightwire appliances to overcome the latter's shortcomings. This article illustrates the use of simplified Bioprogressive mechanics by means of utility arch in the treatment of a Class II deep bite malocclusion with high anchorage requirement.     

早期矫治乳牙反牙合的临床研究

目的 介绍儿童乳牙反He的早期矫治方法和意义。方法 反覆He深的用下颌联冠式斜面导板，反覆He浅的用He垫式活动矫治器附双曲舌簧，来调整上下颌骨间的关系。结果 经X线投影测量SNA SNB ANB MP/FH S-Gn/FH U1-FH MP-L1 1-NP 1-NB都发生了变化。结论 乳牙期的反He多为功能性的，宜早期矫治。     

Modifications in Class I and Class II Div. 1 malocclusion during orthodontic treatment and their association with TMD problems

ABSTRACT

Objective: To observe changes in tooth movements of patients with Class I and Class II malocclusion during the first 6 months of orthodontic treatment and to investigate the relation between TMJ problems and these changes.

Methods: The sample was comprised of 63 individuals (20 control, 25 Class I malocclusion, 18 Class II Div. 1 malocclusion). Occlusion analysis was performed through T-Scan® record and chewing pattern examination before and after the 6-month period. The existence of TMD was evaluated using joint vibration analysis (JVA). Patients with malocclusion had active fixed orthodontic treatment.

Results: Disclusion time reduced in the patients group during the treatment period. No association was observed between the first 6-month period of the orthodontic treatment and TMD.

Discussion: It is suggested that occlusion analyses should be done before any orthodontic treatment, and disclusion time should be minimized as much as possible.     

Severe Class II division 1 malocclusion treated by orthodontic miniplate with tube

A miniplate with tube (C-tube) was placed in the interdental spaces between both left and right upper second premolars and first molars in a 15-year-8 month-old male patient with a Class II malocclusion who with severe anterior protrusion and lower anterior crowding. The treatment plan consisted of extracting both upper first premolars, en masse retraction of the upper six anterior teeth and lower anterior decrowding. C-tubes were used as substitutes for posterior dental anchorage during upper anterior retraction. The particular design of the C-tubes made it possible to retract fully with minimal gingival irritation. The correct overbite and overjet were obtained by intruding and retracting the maxillary incisors to their proper positions and this correction remained stable for at least 27 months after debonding. Also, facial balance was improved. The active treatment period was 14 months. The application of this new appliance, consideration of case selection, and sequence of treatment are presented.