Orthognathic surgery has been used regularly to treat dentofacial deformities. The surgical procedures affect both the facial appearance as well as the posterior airway space (PAS). Our current literature indicates that setback procedures produce an inferior repositioning of the hyoid bone and posterior displacement of the tongue and the soft palate. These movements cause anteroposterior and lateral narrowing of the PAS. Most authors agree that these effects are permanent. The PAS changes in turn produce an adaptive posturing, with an increased craniocervical angle to open up the PAS. Even though most patients do not display snoring and obstructive sleep apnoea (OSA) post-surgery, there is certainly an increased possibility in patients with already compromised airways. Therefore, patients who are undergoing orthognathic surgery should be screened for excessive daytime somnolence, snoring, increased body mass index (BMI) and medical conditions related to OSA and sent for an overnight polysomnography (PSG) if OSA is suspected. Then the proposed treatment plan may be modified according to the risk of potential airway compromise or even to improve it. Conversely, advancement of the maxilla and mandible causes widening of the airway in both the anteroposterior and lateral dimensions. This effect would translate to better airflow and decreased airway resistance. This is supported by the evidence showing high success rates when orthognathic surgery, especially maxillomandibular advancement (MMA), is utilised to treat OSA.
Airway Obstruction ; etiology ; surgery ; Cephalometry ; Humans ; Malocclusion ; complications ; pathology ; surgery ; Malocclusion, Angle Class II ; surgery ; Malocclusion, Angle Class III ; surgery ; Mandibular Advancement ; Oral Surgical Procedures ; Osteotomy ; Treatment Outcome

OBJECTIVEThis study is to evaluate the soft tissue change of Angle's Class II division 1 malocclusion patients with vertical growth pattern after tooth extraction orthodontic treatment, and to provide experimental results to help to make orthodontic treatment plan and treatments.

METHODS38 Angle's Class II division 1 malocclusion patients with vertical growth pattern and with tooth extraction orthodontic treatment were included in this study. The pre- and post-treatment cephalometric X-rays were made and 26 measurement items were measured. The change value of pre- and post-treatment, youngsters and adults were compared.

RESULTSTUL-EP, TLL-EP, upper and lower lip position, Stoms-Stomi, U1-Ptm were reduced after treatment. Upper lip sulcus and flange thickness, upper and lower lip length, upper and lower lip inclination angle, nasolabial angle, Z angle, mentolabial sulcus inclination angle were enlarged after treatment. The upper lip sulcus thickness, lower lip length and A'-Ptm of adolescent were enlarged, but adult were on the contrary. The change of upper lip length, mentolabial sulcus inclination angle and U1-Ptm between adolescent and adult was statistically different.

CONCLUSIONThe best treatment period of patients with Angle's Class II division 1 malocculsion with vertical growth pattern was in the rapid growth and development period of adolescent.

Adolescent ; Adult ; Cephalometry ; Humans ; Lip ; anatomy & histology ; Malocclusion, Angle Class II ; pathology ; surgery ; Tooth Extraction

OBJECTIVE: To evaluate the decompensation effectiveness and alveolar bone remodeling of mandibular anterior teeth after preoperative orthodontic treatment in high-angle patients with skeletal class Ⅱ malocclusion using lateral cephalogram and cone-beam computed tomography (CBCT). METHODS: Thirty high-angle patients with skeletal class Ⅱ malocclusion who had received preoperative orthodontic treatment and orthognathic surgery in Peking University School and Hospital of Stomatology between Ja-nuary 2017 and August 2022 and had taken lateral cephalogram and CBCT before and after preoperative orthodontic treatment were selected. Items were measured with lateral cephalogram including: The lower central incisor (L1)-Frankfort plane angle (L1-FH), the L1-mandibular plane angle (L1-MP), the L1-nasion-supramental angle (L1-NB) and the vertical distance from the incisal edge of lower central incisor to NB line (L1-NB distance), etc. The incidence of dehiscence/fenestration and the length of dehiscence at labial side (d-La) and lingual side (d-Li) were measured using CBCT. Pearson correlation analysis was used to evaluate the correlation between the changes of d-Li of L1 and age, duration of preoperative orthodontic treatment and the cephalometric measurements before preoperative orthodontic treatment to screen out risk factors affecting the periodontal risk of preoperative orthodontic treatment in high-angle patients with skeletal class Ⅱ malocclusions. RESULTS: After preoperative orthodontic treatment, L1-FH, L1-MP, L1-NB and L1-NB distances changed by 11.56°±5.62°, -11.13°±5.53°, -11.57°±5.43° and (-4.99±1.89) mm, respectively, and the differences were all statistically significant (P < 0.05). Among the 180 measured mandibular anterior teeth, 45 cases with labial dehiscence/fenestration before preoperative orthodontic treatment (T0) had no longer labial dehiscence/fenestration after preope-rative orthodontic treatment (T1); 142 cases without lingual dehiscence/fenestration at T0 had lingual dehiscence/fenestration at T1. After preoperative orthodontic treatment, the d-La of lower lateral incisors (L2), lower canines (L3) and lower anterior teeth (L1+L2+L3) decreased by (0.95±2.22) mm, (1.20±3.23) mm and (0.68±2.50) mm, respectively, and the differences were statistically significant (P < 0.05); the d-Li of L1, L2, L3 and L1+L2+L3 increased by (4.43±1.94) mm, (4.53±2.35) mm, (3.19±2.80) mm and (4.05±2.46) mm, respectively, and the differences were statistically significant (P < 0.05). The increase of d-Li of L1 was positively correlated with L1-FH (r=0.373, P=0.042). CONCLUSION This study showed that high-angle patients with skeletal class Ⅱ ma-locclusion could achieve ideal decompensation effect of mandibular anterior teeth after preoperative orthodontic treatment with bilateral mandibular first premolars extracted, but the lingual periodontal risk of mandibular anterior teeth was increased. This risk could be correlated to L1-FH before preoperative orthodontic treatment, which should be paid more attention in the design of orthodontic-orthognathic surgical treatment.
Humans ; Malocclusion, Angle Class III ; Malocclusion, Angle Class II/surgery* ; Facial Bones ; Incisor ; Orthognathic Surgical Procedures ; Cone-Beam Computed Tomography ; Mandible

Fingersucking ; adverse effects ; Humans ; Malocclusion ; etiology ; therapy ; Malocclusion, Angle Class II ; therapy ; Malocclusion, Angle Class III ; therapy ; Orthodontic Brackets ; Orthodontics, Corrective ; methods ; Orthodontics, Interceptive ; methods ; Palatal Expansion Technique ; Time Factors ; Tongue Habits ; adverse effects ; Tooth Extraction ; Tooth, Impacted ; surgery

A Brazilian girl aged 14 years and 9 months presented with a chief complaint of protrusive teeth. She had a convex facial profile, extreme overjet, deep bite, lack of passive lip seal, acute nasolabial angle, and retrognathic mandible. Intraorally, she showed maxillary diastemas, slight mandibular incisor crowding, a small maxillary arch, 13-mm overjet, and 4-mm overbite. After the diagnosis of severe Angle Class II division 1 malocclusion, a mandibular protraction appliance was placed to correct the Class II relationships and multiloop edgewise archwires were used for finishing. Follow-up examinations revealed an improved facial profile, normal overjet and overbite, and good intercuspation. The patient was satisfied with her occlusion, smile, and facial appearance. The excellent results suggest that orthodontic camouflage by using a mandibular protraction appliance in combination with the multiloop edgewise archwire technique is an effective option for correcting Class II malocclusions in patients who refuse orthognathic surgery.
Crowding ; Diagnosis ; Diastema ; Female ; Follow-Up Studies ; Humans ; Incisor ; Lip ; Malocclusion* ; Malocclusion, Angle Class II* ; Mandible ; Mandibular Advancement ; Orthognathic Surgery ; Overbite ; Tooth

OBJECTIVETo evaluate the posttreatment stability of four first bicuspid extraction cases with the Alexander technique.

METHODSFifteen patients, 8 males and 7 females in the permanent dentition were selected. The age range of the patients was 10.3 to 16.2 years old. Four first bicuspids of every patient were extracted and all patients were treated with the Alexander technique. The study casts were taken before (T(1)), after treatment (T(2)) and 27.8 months averagely follow-up (T(3)). Data were correlated by means of paired t tests.

RESULTSAlthough maxillary and mandibular intercanine widths were increased by 0.98 mm and 0.87 mm, respectively, during treatment, they were decreased by 0.37 mm and 0.72 mm, respectively, during follow-up period. Maxillary and mandibular crowding were increased by 0.53 mm and 0.98 mm, respectively, during follow-up period. No statistical significance were found. Upper and lower arch depth were decreased significantly due to retraction of anterior teeth and remained stable during follow-up period.

CONCLUSIONSAccording to this study, the design of the Alexander appliance and the Alexander technique are helpful for stability of extraction therapy. Follow-up is still necessary to evaluate the long-term stability.

Adolescent ; Bicuspid ; surgery ; Child ; Dental Models ; Female ; Follow-Up Studies ; Humans ; Male ; Malocclusion, Angle Class I ; therapy ; Malocclusion, Angle Class II ; therapy ; Orthodontics, Corrective ; methods ; Tooth Extraction ; Treatment Outcome

OBJECTIVETo study the relationship between severity of skeletal Class III malocclusion and the patient's emotional status, as well as motivation for seeking surgical correction and satisfaction with the outcome of the surgery.

METHODSOne hundred and forty consecutive Chinese patients with skeletal Class III malocclusion who had been treated with a combined orthodontic and surgical approach were studied. Sixty-seven percent (40 males and 54 females) responded to a questionnaire. Fifty-four percent had two jaw deformities, 32% mandibular hyperplasia and 14% maxillary hypoplasia. Surgical procedures: 77% received two jaw surgeries, 15% maxillary advancement and 8% mandibular setback. This was a retrospective study based on questionnaires with numerical scale ranked answers (0: not at all; 1: a little; 2: moderately; 3: quite a bit; and 4: extremely).

RESULTSANB angle was significantly negatively correlated with feelings about the nickname related to their facial problems (embarrassment: gamma =-0.30, P < 0.01; worn out gamma =-0.32, P < 0.01; angry gamma =-0.24, P < 0.05). ANB angle also had a significant negative correlation with the reasons for having the surgery (pressure from their friends: gamma =-0.21, P < 0.05, and referred by physician: gamma =-0.24, P < 0.05). Changes in life style as a result of surgery were significantly negatively correlated with the ANB angle before treatment, positive influence on relationships with the opposite sex (gamma =-0.25, P < 0.05), positive influence in social activities (gamma =-0.22, P < 0.05).

CONCLUSIONThe psychological status before surgery and the outcome following orthognathic surgery in patients with skeletal Class III malocclusion were closely related to severity of the malocclusion.

Adolescent ; Adult ; Female ; Humans ; Jaw Abnormalities ; surgery ; Male ; Malocclusion, Angle Class II ; pathology ; psychology ; surgery ; Mandible ; abnormalities ; Maxilla ; abnormalities ; Motivation ; Retrospective Studies

OBJECTIVETo discuss the pre-surgical orthodontic treatment of skeletal class II patients with gingiva smile corrected by AMSO.

METHODSWe analyzed the clinical features of 20 skeletal class II patients treated by AMSO combined with Orthodontic treatment and evaluated the effects of AMSO by means of cephalometric analysis.

RESULTSAfter the AMSO treatment, ANB angle, the height of anterior maxilla, the protrusion of the upper anterior teeth, and the of A point had reduced significantly (P < 0.05). After AMSO, the appearance of patients had been improved markedly.

CONCLUSIONSAMSO can correct the protrusion of the maxilla and gingival smie efficiently. The anchorage of molars should be controlled carefully. The anterior part of the upper arch should be expended orthodontically to make arch relationship. Extract the upper bicuspid half a year before the surgery was recommended. When necessary, genioplasty could be performed.

Adult ; Female ; Humans ; Male ; Malocclusion, Angle Class II ; surgery ; Maxillofacial Abnormalities ; surgery ; Oral Surgical Procedures ; methods ; Orthodontics, Corrective ; methods ; Osteotomy ; methods ; Treatment Outcome

OBJECTIVEOne of the prime concerns of both the orthodontist and the oral surgeon must be the final soft tissue profile and the esthetic appearance of the patient. The purpose of this study was to evaluate the amount, direction, and predictability of the soft tissue changes associated with simultaneous skeletal changes.

METHODSThe authors analyzed the recent 22 cases with skeletal class II maloclusion in Orthodontic Department, College of Stomatology, West China University of Medical Sciences with 7 male and 15 female from 20 to 30 years old. Each patient was taken standardized lateral cephalograms before the treatment and 6-12 months after the treatment. A total of 16 hard and soft tissue landmarks were evaluated in both horizontal and vertical directions.

RESULTSIn the horizontal directions, the soft tissue maxillary landmarks (superior labial sulcus, labrale superius, and upper lip stomion) moved posterior with a range of 2.17 to 2.33 mm. The strongest correlations were found between the posterior movement of the upper incisal edge and the three soft tissue parameters: superior labial sulcus r = 0.78, labrale superius r = 0.81, upper lip stomion r = 0.75. The soft/hard tissue ratios of the mandible anterior movement is 0.83:1 between inferior labial sulcus and B point, and 0.95:1 for Pog' to Pog. In the vertical directions, all the soft tissue mandible landmarks (Pog', inferior labial sulcus, labrale inferius, lower lip stomion) moved upward more than 2 mm. And the soft/hard tissue ratio is from 1.07:1 to 1.34:1.

CONCLUSIONThe combined orthodontic and surgical treatment is an efficient way to cure skeletal class II malocclusion. All the patients regained satisfactory face appearance and profile. Although the soft tissue movement is less than the hard tissue in both jaws in the horizontal direction, the vertical movement of the mandibular soft tissue is greater than that of the underlying hard tissue.

Adult ; Cephalometry ; Face ; anatomy & histology ; Female ; Humans ; Male ; Malocclusion, Angle Class II ; surgery ; therapy ; Mandible ; surgery ; Orthodontics, Corrective ; Osteotomy ; Outcome Assessment (Health Care)

OBJECTIVETo explore the feasibility of surgical design for mandibular retrusion using three-dimensional software.

METHODSThree-dimensional reconstruction was performed by Mimics software based on the preoperative CT data. The model of the maxillofacial region was imported into Rapidform software for measuring the associated parameters and Geomagic software for simulation of osteotomy. The reliability of the virtual operation was validated during the surgery.

RESULTSThe model of mandibular retrusion was reconstructed and successfully used to simulate the surgery. The simulation result was applied in subsequent actual surgery and good surgical outcomes were achieved.

CONCLUSIONThe three-dimensional software can be used to simulate the surgery for mandibular retrusion and improve the predictability and accuracy of the surgery.

Computer Simulation ; Feasibility Studies ; Humans ; Image Processing, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; methods ; Male ; Malocclusion, Angle Class II ; surgery ; therapy ; Mandible ; abnormalities ; diagnostic imaging ; surgery ; Maxilla ; diagnostic imaging ; Models, Anatomic ; Retrognathia ; diagnostic imaging ; surgery ; Software ; Surgery, Computer-Assisted ; methods ; Tomography, X-Ray Computed ; Young Adult