Craniofacial pattern of Class III deciduous dentition.

The purpose of this study was to investigate the morphological characteristics of the cranio-dento-facial complex of children with deciduous dentition and Class III malocclusion. Forty Chinese children in Taiwan with normal occlusion and 40 with Class III malocclusion in deciduous dentition were selected for cephalometric analysis. Mandibular length was significantly greater and the mandible was situated farther forward in the Class III group. The maxilla was also slightly backward in this group, perhaps in association with the shorter maxillary length. The mandibular incisors were tipped lingually to compensate for the intermaxillary skeletal dysplasia and the maxillary incisors were tipped lingually by the retroinclined mandibular incisors.     

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.     

Corticotomy-assisted maxillary protraction with skeletal anchorage and Class III elastics

Objective:To analyze the treatment effects of corticotomy-assisted maxillary protraction with skeletal anchorage and Class III elastics in patients with Class III malocclusions.Materials and Methods:The study group consisted of 19 patients with a mean age of 13.12 ± 1.28 years. Initially, patients were monitored for 5 months before treatment to evaluate growth changes. Changes during control, protraction and fixed orthodontic treatment periods were compared with the cephalometric radiographs taken initially, before protraction, after protraction, and after fixed orthodontic treatment. Treatment outcomes also were compared with the growth effects.Results:Sagittal measurements of maxilla showed significant improvements (3.59 ± 1.32 mm) during the protraction period (3.85 ± 1.12 months) whereas no significant changes were seen during the control period. Upper and lower incisor inclinations were increased, and the upper occlusal plane angle showed significant counterclockwise rotation during protraction. Significant soft-tissue changes also reflected the underlying skeletal changes. Maxillary advancement was stable during fixed orthodontic treatment.Conclusion:Compared with control period of the patients, this protocol produced significant improvements in skeletal and soft-tissue structures.     

Long-term stability of miniscrew anchored maxillary molar distalization in Class II treatment

ObjectiveTo investigate treatment stability of miniscrew-anchored maxillary distalization in Class II malocclusion.Materials and MethodsThis retrospective study included a distalization (n = 19) and a control (n = 19) group; a patient group with minor corrections served the control. Lateral cephalograms of 38 adult patients were taken before (T0), immediately after (T1), and 3–4 years after (T2) treatment. Horizontal and vertical movement and tipping of the maxillary first molars (U6) and central incisors (U1) were measured along with skeletal craniofacial parameters at three time points to compare the two groups regarding the achieved treatment effects and their stability.ResultsTotal arch distalization therapy led to 4.2 mm of distal movement of U6 without distal crown tipping (0.6° of axis change) and 3.3° of occlusal plane steepening. Over an average retention period of 42 months, maxillary total arch distalization provided high stability of treatment results, showing the same amount of mesial movement (0.7 mm) as the control group.ConclusionsIn Class II treatment, miniscrew-anchored maxillary total arch distalization can provide stable distal movement of the maxillary first molars and central incisors.     

Camouflage treatment of skeletal Class III malocclusion with asymmetry using a bone-borne rapid maxillary expander

This case report presents the successful use of palatal mini-implants for rapid maxillary expansion and mandibular distalization in a skeletal Class III malocclusion. The patient was a 13-year-old girl with the chief complaint of facial asymmetry and a protruded chin. Camouflage orthodontic treatment was chosen, acknowledging the possibility of need for orthognathic surgery after completion of her growth. A bone-borne rapid expander (BBRME) was used to correct the transverse discrepancy and was then used as indirect anchorage for distalization of the lower dentition with Class III elastics. As a result, a Class I occlusion with favorable inclination of the upper teeth was achieved without any adverse effects. The total treatment period was 25 months. Therefore, BBRME can be considered an alternative treatment in skeletal Class III malocclusion.     

Bone-anchored maxillary protraction long-term outcomes in UCLP:: A case report

This case report presents a 12-year-old boy with unilateral complete cleft lip and palate and severe maxillary retrusion treated with bone-anchored maxillary protraction (BAMP) therapy followed by fixed appliances. The follow-up period extended until the end of growth. Initially, the patient demonstrated a Goslon 4 interarch relationship with an overjet of −3.5 mm and a Wits appraisal of −7.9 mm. Six months after the secondary alveolar bone graft, Bollard miniplates were fixed bilaterally at the infrazygomatic region in the maxilla and between the canines and lateral incisors in the mandible. Class III elastics were used bilaterally full time for 12 months. After treatment, the overjet increased 5.9 mm. Significant maxillary advancement (SNA +3.2°) and skeletal convexity improvement (NA-APo +12.4°) were observed. Retrusion of the anteroposterior position of the mandible was observed (SNB –2.1°). Comprehensive orthodontic treatment was performed after BAMP therapy with nighttime bone-anchored Class III elastics as active retention until the end of growth. Occlusion and facial esthetics were satisfactory at the end of orthodontic treatment and growth. Le Fort I surgery for maxillary advancement was not required. BAMP therapy demonstrated an adequate orthopedic outcome, preventing the need for orthognathic surgery in unilateral complete cleft lip and palate.     

Class III correction using an inter-arch spring-loaded module

Background

A retrospective study was conducted to determine the cephalometric changes in a group of Class III patients treated with the inter-arch spring-loaded module (CS2000®, Dynaflex, St. Ann, MO, USA).

Methods

Thirty Caucasian patients (15 males, 15 females) with an average pre-treatment age of 9.6 years were treated consecutively with this appliance and compared with a control group of subjects from the Bolton-Brush Study who were matched in age, gender, and craniofacial morphology to the treatment group. Lateral cephalograms were taken before treatment and after removal of the CS2000® appliance. The treatment effects of the CS2000® appliance were calculated by subtracting the changes due to growth (control group) from the treatment changes.

Results

All patients were improved to a Class I dental arch relationship with a positive overjet. Significant sagittal, vertical, and angular changes were found between the pre- and post-treatment radiographs. With an average treatment time of 1.3 years, the maxillary base moved forward by 0.8 mm, while the mandibular base moved backward by 2.8 mm together with improvements in the ANB and Wits measurements. The maxillary incisor moved forward by 1.3 mm and the mandibular incisor moved forward by 1.0 mm. The maxillary molar moved forward by 1.0 mm while the mandibular molar moved backward by 0.6 mm. The average overjet correction was 3.9 mm and 92% of the correction was due to skeletal contribution and 8% was due to dental contribution. The average molar correction was 5.2 mm and 69% of the correction was due to skeletal contribution and 31% was due to dental contribution.

Conclusions

Mild to moderate Class III malocclusion can be corrected using the inter-arch spring-loaded appliance with minimal patient compliance. The overjet correction was contributed by forward movement of the maxilla, backward and downward movement of the mandible, and proclination of the maxillary incisors. The molar relationship was corrected by mesialization of the maxillary molars, distalization of the mandibular molars together with a rotation of the occlusal plane.     

Class II subdivision treatment with the Forsus Fatigue Resistant Device vs intermaxillary elastics

Objective:To compare the effectiveness of comprehensive fixed appliance treatments implemented in combination with Forsus or intermaxillary elastics in Class II subdivision subjects.Materials and Methods:Twenty-eight Class II subdivision patients were allocated to two groups using matched randomization: Forsus group (mean age, 14.19 ± 1.02 years) and elastics group (mean age, 13.75 ± 1.16 years). Patients received fixed appliance therapy in combination with either Forsus or intermaxillary elastics. The study was conducted on lateral cephalograms and digital models acquired before orthodontic treatment and 10–12 weeks after the fixed appliances were removed.Results:The treatment phase comprising the use of Forsus (4.53 ± 0.91 months) was significantly shorter compared with elastics application (6.85 ± 1.08 months). This was also true for comparing duration of overall comprehensive treatment in both groups. Extrusion and palatal tipping of maxillary incisors and clockwise rotation of the occlusal plane were greater in the elastics group (P < .05). The mandibular incisors were proclined in both groups (P < .001), but no significant difference was observed between groups (P > .05). The mandibular incisors showed intrusion in the Forsus group and extrusion in the elastics group; the difference between groups was significant (P < .05). Overbite was decreased in both groups (P < .001) in similar amounts. Improvement in overjet, mandibular midline deviation, and correction of molar relationship on the Class II side were greater in the Forsus group (P < .05).Conclusion:Forsus is more effective for correcting Class II subdivision malocclusion in a shorter treatment period with minimal patient compliance required.     

Three-dimensional cone-beam computed tomography comparison of shorty and standard Class II Carriere Motion appliance

ObjectivesTo compare treatment effects of the standard and shorty Class II Carriere Motion appliances (CMAs) on adolescent patients.Materials and MethodsFifty adolescents with Class II malocclusion formed group 1, who were treated with shorty CMA (n = 25, 12.66 ± 1.05 years), and age- and sex–matched group 2, who were treated with standard CMA (n = 25, 12.73 ± 1.07 years). Treatment effects were analyzed by tracing with Invivo software to compare pretreatment (T1) cone-beam computed tomography (CBCT) images with post-CMA (T2) CBCT images. A total of 23 measurements were compared within and between groups.ResultsIn groups 1 and 2, maxillary first molars showed significant distal movement from T1 to T2 (1.83 ± 2.11 mm and 2.14 ± 1.34 mm, respectively), with distal tipping and rotation in group 1 (6.52° ± 3.99° and 3.15° ± 7.52°, respectively) but only distal tipping (7.03° ± 3.45°) in group 2. Similarly, in both groups, the maxillary first premolars experienced significant distal movement with distal tipping but no significant rotation. In group 1, maxillary canines did not undergo significant distal movement. In both groups 1 and 2, mandibular first molars experienced significant mesial movement (1.85 ± 1.88 mm and 2.44 ± 2.02 mm, respectively). Group 1 showed statistically significantly less reduction in overjet and less canine distal movement with less distal tipping than group 2 (α < .05).ConclusionsThe shorty CMA achieved Class II correction similarly to the standard CMA, with less change in overjet and distal tipping movement of the maxillary canines.     

Asymmetric severe skeletal Class II division 1 patient with temporomandibular joint disorder treated with zygomatic anchorage devices and Ni-Ti alloy wires

Objective:To describe the orthodontic treatment of a nongrowing 30-year-old woman with asymmetric severe skeletal Class II malocclusions (asymmetric Angle Class II), large overjet (16 mm), large overbite (8 mm), two congenitally missing mandibular incisors (presenting a deciduous anterior tooth), and signs and symptoms of temporomandibular joint disorder (TMD).Materials and Methods:We used novel improved super-elastic Ni-Ti alloy wires (ISWs) combined with Ni-Ti alloy coil springs, power hooks, and a zygomatic implant as reinforced anchorage to provide a constant and continuous mild force to the dentition.Results:We successfully distalized maxillary molars, premolars, and retracted anterior teeth and corrected the asymmetric Angle Class II molar relationship using this system of zygomatic anchorage in conjunction with ISWs, Ni-Ti alloy open-coil springs, and crimpable power hook. The maxillary molars were distalized, and postero-occlusal relationships were improved to achieve Class I canine and molar relationships on both sides. Intrusion of the upper molars made the mandibular plane close. Ideal overbite and overjet relationships were established. Facial esthetics were improved with decreased upper and lower lip protrusion, and no symptoms of TMD were observed after treatment.Conclusion:The orthodontic treatment described here is a promising anchorage technique alternative to traditional techniques to improve severe skeletal Class II with TMD.     

A comparative study between the effect of reverse curve of Spee archwires and anterior bite turbos in the treatment of deep overbite cases:: A randomized clinical trial

ObjectivesTo compare deep overbite treatment using 0.016 × 0.022 nickel-titanium lower reverse curve of Spee archwire (LRCA) or metal anterior bite turbos (ABTs).Materials and Methods48 patients with deep overbite malocclusion were randomly allocated into two groups. Group I (age = 18.4 ± 2.8 years, overbite = 5.8 ± 0.6 mm) was treated with LRCA, while Group II (age = 18.2 ± 3.1 years, overbite = 5.2 ± 0.4 mm) was treated with ABTs bonded to the palatal surface of the upper central incisors. Two cephalograms were taken for each patient, at post-alignment stage (T1) and post-leveling stage (T2). The primary outcomes were the anteroposterior and vertical changes of the lower teeth. The secondary outcomes were the effect on upper incisor inclination and the vertical linear changes of upper teeth, to assess the sagittal and vertical skeletal changes, and to compare the duration of overbite correction.Results42 of the 48 patients recruited completed the study (21 in each group). At T2, the lower incisors proclined more in Group I (P ≤ .001). Both lower second molars (P ≤ .001) and lower first molars (P = .001) tipped more distally, while the lower first premolar tipped more mesially, in Group I (P < .05). All cusps of both lower molars showed more extrusion in Group II (P < .05) except for the mesial cusp of lower second molars (P = .095). The duration of overbite correction was shorter using the ABTs by 1.7 months (4.85 ± 1.56 and 3.15 ± 0.93 months for Group I and Group II, respectively).ConclusionsLRCA causes lower incisor proclination with distal tipping of lower molars, while ABTs result in lower posterior tooth extrusion.     

Three-dimensional effects of the mini-implant–anchored Forsus Fatigue Resistant Device: A randomized controlled trial

Objective:To detect three-dimensionally the effects of using mini-implant anchorage with the Forsus Fatigue Resistant Device (FFRD).Materials and Methods:The sample comprised 43 skeletal Class II females with deficient mandibles. They were randomly allocated into three groups: 16 patients (13.25 ± 1.12 years) received FFRD alone (Forsus group), 15 subjects (13.07 ± 1.41 years) received FFRD and mini-implants (FMI group), and 12 subjects (12.71 ± 1.44 years) were in the untreated control group. Three-dimensional analyses of cone beam computed tomographic images were completed, and the data were statistically analyzed.Results:Class I relationship and overjet correction were achieved in 88% of the cases. None of the two treatment groups showed significant mandibular skeletal effects. In the FMI group, significant headgear effect, decrease in maxillary width, and increase in the lower facial height were noted. In the FMI group, retroclination of maxillary incisors and distalization of maxillary molars were significantly higher. Proclination and intrusion of mandibular incisors were significantly greater in the Forsus group.Conclusions:FFRD resulted in Class II correction mainly through dentoalveolar effects and with minimal skeletal effects. Utilization of mini-implant anchorage effectively reduced the unfavorable proclination and intrusion of mandibular incisors but did not produce additional skeletal effects.     

Biomechanical considerations for total distalization of the mandibular dentition in the treatment of Class III malocclusion

Class III malocclusions with mild to moderate skeletal discrepancies can be camouflaged by orthodontic tooth movement. Conventional methods using Class III elastics can correct Class III into Class I molar relationships. These mechanics show side-effects such as labioversion and intrusion of the maxillary incisors, extrusion of the maxillary molars, linguoversion and extrusion of the mandibular incisors, and intrusion of the mandibular molars along with flattening of the occlusal plane. Conventional mechanics can improve occlusal relationships and some profile esthetics but may produce detrimental smile esthetics by reducing the amount of maxillary incisor exposure. Recently, with the advent of temporary skeletal anchorage devices (TSADs), clinicians are able to achieve total distalization of the mandibular dentition and therefore improve the occlusal relationship without worsening smile esthetics. With the use of TSADs, the en masse movement of an entire dentition can be easily accomplished using a statically determinate force system, which makes treatment plans easier and treatment results more predictable. Finite element studies have identified the location of the center of resistance of the entire dentition and simulated displacement of the dentition depending on the force angulations (FAs) and have thus provided the theoretical basis for 3-dimensional tooth movement patterns. This article provides the biomechanical considerations and clinical applications of total distalization of the mandibular dentition depending on various FAs to the mandibular occlusal plane for camouflage treatment of various types of skeletal Class III malocclusions.     

Comparison of arch width,alveolar width and buccolingual inclination of teeth between Class II division 1 malocclusion and Class I occlusion

Objective:To compare the arch width, alveolar width, and buccolingual inclination of maxillary and mandibular posterior teeth between Class II division 1 malocclusion and Class I occlusion.Materials and Methods:Forty-five subjects with Class I occlusion and 45 subjects with Class II division 1 malocclusion were selected to measure the maxillary and mandibular arch width and alveolar width of premolars and first molars with digital caliper. Buccolingual inclination of maxillary and mandibular premolars and first molars were measured with a modified universal bevel protractor.Results:All of the posterior teeth in both groups were lingually tilted. The maxillary premolars and first molars were significantly more lingually tilted (P < .05) in Class II division 1 malocclusion than in Class I occlusion. Mandibular first premolars were significantly less lingually tilted in Class II division 1 malocclusion than in Class I occlusion. No significant difference of buccolingual inclination was found in mandibular second premolars and first molars between the two groups. No significant difference in maxillary and mandibular arch width and alveolar width was found between the two groups.Conclusions:Buccolingual inclination rather than arch width and alveolar width plays an important role in transverse discrepancy of Class II division 1 malocclusion.     

Modified tandem traction bow appliance compared with facemask therapy in treating Class III malocclusions

Objective:To compare the effects of the modified tandem traction bow appliance (MTTBA) and the facemask in treating patients with Class III malocclusion.Materials and Methods:The material consisted of the pre-post treatment\pre-post observation lateral cephalograms of 65 subjects with skeletal and dental Class III malocclusion. In the first group 21 patients (mean age: 10 years, 6 months) were treated with a Delaire-type facemask (FM). In the second group 22 patients treated (mean age: 10 years) with MTTBA. The remaining 22 children (mean age: 9 years, 7 months) were observed without treatment for 11 months.Results:Increase in SNA, N-FH ⊥ A, and ANB angles were significantly greater in the treatment groups compared to the control group. However, ANB angle showed a significantly greater increase in the FM group (2.8 ± 0.30°) than in the MTTBA group (2.0 ± 0.18°). The overjet and molar relation increased significantly in both treatment groups, but in the FM group (5.2 ± 0.40 mm) increase in overjet was significantly greater than in the MTTBA group (4.0 ± 0.27 mm). Mesial movement of upper molar and incisor were found to be greater in the FM group compared to the modified TTBA group.Conclusions:Both appliances were found to be effective in the treatment of Class III malocclusion. Their skeletal and dental effects showed differences due to their design.     

Treatment of Class III malocclusion using miniscrew-anchored inverted Forsus FRD: Controlled clinical trial

Objectives:To evaluate the skeletal, dental, and soft tissue changes after the use of miniscrew-anchored inverted Forsus fatigue-resistant device (FRD) in treatment of Class III malocclusion.Materials and Methods:In this controlled clinical trial, 16 patients (9 girls and 7 boys; age 12.45 ± 0.87 years) were consecutively treated with miniscrew-anchored inverted Forsus FRD. This group was compared with a matched control group of 16 untreated patients (8 girls and 8 boys; age 11.95 ± 1.04 years). Miniscrews were inserted bilaterally between the maxillary canine and first premolar. Forsus FRD was selected and inserted in an inverted manner mesial to the mandibular headgear tube and distal to the maxillary canine bracket.Results:Class I molar and canine relationships with positive overjet were achieved in an average period of 6.4 ± 1.46 months. Maxillary forward growth showed a statistically significant increase (SNA°: 1.73 ± 0.53, P < .5), maxillary incisor proclination was statistically significant (U1 to NA°: −0.39 ± 0.33, P > .5), and the lower incisors exhibited significant retroclination (L1 to NB°: 1.65 ± 0.83, P < .5). Significant lower lip retrusion and upper lip protrusion were obvious treatment outcomes (P < .5).Conclusions:The use of miniscrew-anchored inverted FRD could effectively increase maxillary forward growth, but it did not prevent mesial movement of the maxillary dentition. Significant lower incisor retroclination was observed. Significant esthetic improvement of the facial profile was achieved primarily because of lower lip retrusion and upper lip protrusion.     

An evaluation of insertion sites for mini-implants: A micro-CT study of human autopsy material

Objective:(1) To report the thickness of the cortical bone in insertion sites commonly used for orthodontic mini-implants, (2) to assess the impact of a change in insertion angle on primary cortical bone-to-implant contact, and (3) to evaluate the risk of maxillary sinus perforation.Materials and Methods:At autopsy, 27 human samples containing three to five adjacent teeth were excised and scanned using a table-top micro-computed tomography system. Bone thickness measurements were taken at 45° and 90° to the long the axis of the adjacent teeth, simulating a mini-implant insertion at the mid-root level.Results:In the maxilla, the overall mean cortical thickness at 90° was 0.7 mm buccally in the lateral region, 1.0 mm buccally in the anterior region, and 1.3 mm palatally. In the mandible, the mean cortical thickness was 0.7 mm buccally and 1.8 mm lingually in the anterior region; 1.9 mm buccally and 2.6 mm lingually in the lateral region. Changing the insertion angle from 90° to 45° increased the cortical bone-to-implant contact by an average of 47%. Perpendicular insertion at the mid-root level only rarely interfered with the sinus, whereas apically inclined insertion increased the risk of sinus perforation.Conclusions:Buccally and palatally in the maxilla and buccally in the anterior mandible, the thickness of the alveolar cortical bone is often less than 1 mm. In contrast, the alveolar cortical bone is frequently thicker than 2 mm laterally in the mandible. Changing the insertion angle to 45° will generally enhance implant stability but increase the risk of perforation to the maxillary sinus.     

Combined use of miniscrews and continuous arch for intrusive root movement of incisors in Class II division 2 with gummy smile

Adequate intrusion and torque control of the retroclined maxillary incisors are critical for the treatment of Class II division 2 (div2) malocclusion. In addition, anterior retraction via lingual root movement can be challenging. This case report demonstrates a combined use of miniscrews and continuous arch with additional torque for intrusion, retraction, and torque control of maxillary incisors in the Class II div2 with gummy smile. A 20-year-old woman presented with multiple issues, including impacted canine, lip protrusion, prolonged retained mandibular primary molar, and two missing maxillary premolars. In order to improve her facial profile and eliminate the need for prosthetic work, the mandibular primary molar and contralateral premolar were extracted. Two miniscrews were placed at the maxillary buccal alveolar bone to apply the posterosuperior force for retraction of anterior teeth, with additional labial crown torque on the arch wire. The results were the intrusion (4 mm) and lingual root movement (17°) of the maxillary incisors without anchorage loss of maxillary molars, flattening of the Curve of Spee, and Class I molar relation that were maintained after 50 months of retention period. The combined use of miniscrews and continuous arch could be a reliable and effective treatment modality for torque control and intrusion of retroclined maxillary incisors in the Class II div2 patient.     

Three-dimensional evaluation of soft tissue change gradients after mandibular setback surgery in skeletal Class III malocclusion

Objective:To evaluate whether mandibular setback surgery (MSS) for Class III patients would produce gradients of three-dimensional (3D) soft tissue changes in the vertical and transverse aspects.Materials and Methods:The samples consisted of 26 Class III patients treated with MSS using bilateral sagittal split ramus osteotomy. Lateral cephalograms and 3D facial scan images were taken before and 6 months after MSS, and changes in landmarks and variables were measured using a Rapidform 2006. Paired and independent t-tests were performed for statistical analysis.Results:Landmarks in the upper lip and mouth corner (cheilion, Ch) moved backward and downward (respectively, cupid bow point, 1.0 mm and 0.3 mm, P < .001 and P < .01; alar curvature-Ch midpoint, 0.6 mm and 0.3 mm, both P < .001; Ch, 3.4 mm and 0.8 mm, both P < .001). However, landmarks in stomion (Stm), lower lip, and chin moved backward (Stm, 1.6 mm; labrale inferius [Li], 6.9 mm; LLBP, 6.9 mm; B′, 6.7 mm; Pog′, 6.7 mm; Me′, 6.6 mm; P < .001, respectively). Width and height of upper and lower lip were not altered significantly except for a decrease of lower vermilion height (Stm-Li, 1.7 mm, P < .001). Chin height (B′-Me′) was decreased because of backward and upward movement of Me′ (3.1 mm, P < .001). Although upper lip projection angle and Stm-transverse projection angle became acute (Ch_Rt-Ls-Ch_Lt, 5.7°; Ch_Rt-Stm-Ch_Lt, 6.4°, both P < .001) because of the greater backward movement of Ch than Stm, lower lip projection angle and Stm-vertical projection angle became obtuse (Ch_Rt-Li-Ch_Lt, 10.8°; Ls-Stm-Li, 23.5°, both P < .001) because of the larger backward movement of Li than labrale superius (Ls).Conclusions:Three-dimensional soft tissue changes in Class III patients after MSS exhibited increased gradients from upper lip and lower lip to chin as well as from Stm to Ch.