OBJECTIVE: To evaluate the changes of periodontal phenotype (width of keratinized gingiva, thickness and height of alveolar bone) of lower anterior teeth in patients with skeletal class Ⅲ malocclusion before and after the periodontal-orthodontic-orthognathic combined treatment. METHODS: In the study, 20 patients with skeletal class Ⅲ malocclusion (6 males and 14 females) completed the periodontal-orthodontic-orthognathic combined treatment were included from March 2017 to June 2022, with 39 central incisors, 40 lateral incisors and 40 canines. The mean age was (25.40±4.27) years (20-34 years). The mean follow-up time was (3.70±1.05) years from the beginning of periodontal corticotomy regenerative surgery (PCRS) to the end of the combined treatment. Cone-beam computed tomography (CBCT) was used to measure the thickness, area and height of alveolar bone by the same researcher, taken before the PCRS (T0), 6 months after the PCRS (T1), 12 months after the PCRS (T2), before the orthognathic surgery (T3), and after the periodontal-orthodontic-orthognathic combined treatment (T4). The periodontal clinical parameters were used to evaluate changes in the soft tissue by another researcher, measured before the PCRS (T0) and after the combined treatment (T4). Changes of soft and hard tissue were evaluated by the periodontal phenotype. RESULTS: The width of keratinized gingiva increased significantly (all P < 0.001) in lower anterior teeth, the central incisors, lateral incisors and canines increased by (1.82±1.57) mm, (2.03±1.48) mm and (2.05±1.27) mm, respectively. The proportion of thick periodontal biotype in the central and lateral incisors increased significantly (all P < 0.001), while the changes of periodontal biotypes in the lower canines were not obvious. The thickness of labial alveolar bone of lower anterior teeth all increased significantly after periodontal corticotomy regenerative surgery and the combined treatment (all P < 0.001). The area of labial alveolar bone of lower anterior teeth also increased significantly after the combined treatment (all P < 0.001). The whole area of labial and lingual alveolar bone of central and lateral incisors increased (P < 0.001), while the whole area of canines remained the same. All The height of the alveolar bone increased (all P < 0.001) on the labial side after the treatment. CONCLUSION The periodontal phenotypes of lower anterior teeth were significantly improved after the periodontal-orthodontic-orthognathic combined treatment in patients with skeletal Angle class Ⅲ malocclusion. The improvement was long-termly stable, and the periodontal risk was reduced.
Male ; Female ; Humans ; Malocclusion, Angle Class III/surgery* ; Oral Surgical Procedures ; Incisor ; Cone-Beam Computed Tomography/methods*

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

OBJECTIVE: To explore the method of measuring root volume with cone-beam computed tomography (CBCT) three-dimensional reconstruction technology, and to study root length and root volume of upper and lower central incisors in patients with skeletal Class Ⅲ malocclusion treated by surgical orthodontic treatment. METHODS: Twenty patients with skeletal Class Ⅲ malocclusion undergoing surgical orthodontic treatment were selected. CBCT data at three time points, before decompensation treatment (T0), after decompensation treatment (before orthognathic surgery, T1), and the end of post-operative orthodontic treatment (T2) were collected. Three-dimensional reconstruction technology was used to measure the root length and root volume of the upper and lower central incisors (including total root volume, cervical root and apical root), calculate the percentage of reduction volume, and measure the distance of tooth movement after orthodontic treatment. Data were statistically analyzed by SPSS 20.0 software. Least significant difference (LSD) method was used for pair comparison between the groups subject to normal distribution, and non-parametric test was used for comparison between the groups not subject to normal distribution. The differences of root length and root volume of upper and lower incisors were compared, and the characteristics of root absorption were analyzed. RESULTS: Root length and root volume of the upper and lower central incisors were reduced during the surgical orthodontic treatment (P < 0.05) in cases. Both the root volume of cervical root and apical root were significantly reduced (P < 0.05), the reduction of apical root was more significant. The percentage of root volume reduction of the upper central incisor was (30.51±23.23)%, and lower central incisor (23.24±11.96)%. Compared with the upper central incisor, the root volume reduction amount and percentage of the lower central incisor were smaller, and apical root volume reduction of the upper central incisor was greater than that of the lower central incisor, which was statistically significant (P < 0.05). During pre-surgical orthodontic treatment, maxillary central incisor palatal moving was in a controlled tipping manner, and the mandibular central incisor tipped labially. CONCLUSION In patients with skeletal Class Ⅲ malocclusion, root length and total root volume of upper and lower central incisors decreased during surgical orthodontic treatment. Root volume measurement indicated that the cervical root also had root resorption. The difference in root resorption of the upper and lower central incisors might be related to the distance and direction of teeth movement. CBCT three-dimensional reconstruction will compensate for the limitation of root length measurement in evaluating root resorption.
Cone-Beam Computed Tomography/methods* ; Humans ; Incisor/diagnostic imaging* ; Malocclusion, Angle Class III/surgery* ; Maxilla/surgery* ; Root Resorption/etiology*

In case of loss of many teeth due to dental caries or periodontal disease, improvement of masticatory function and aesthetics can be obtained through implant treatment. However, if the patient does not have a normal intercondylar relationship, it is difficult to achieve an ideal occlusal relationship with only prosthetic treatment. In particular, oral reconstruction with orthodontic treatment or orthognathic surgery is necessary for patients with mandibular prognathism. However, if the posterior occlusion collapses due to severe caries or periodontal disease, orthognathic surgery may be difficult. The occlusal vertical stop is very important for the stability of the mandibular position during occlusal reconstruction through orthognathic surgery. The patient in this case had posterior occlusion collapsed due to the caries of a large number of posterior teeth, and showed mandibular prognathism and long face. We planned a full arch restoration with orthognathic surgery and extracted the hopeless teeth. To secure the vertical stop required for orthognathic surgery, the implant was placed before surgery. After the orthognathic surgery and the final prosthesis application, the results were satisfactory for the improvement of the aesthetics and the restoration of the masticatory function.
Dental Caries ; Dental Implants ; Esthetics ; Humans ; Malocclusion ; Malocclusion, Angle Class III ; Orthognathic Surgery* ; Periodontal Diseases ; Prognathism* ; Prostheses and Implants ; Tooth*

We report a case involving a young female patient with severe mandibular retrognathism accompanied by mandibular condylar deformity that was effectively treated with Le Fort I osteotomy and two genioplasty procedures. At 9 years and 9 months of age, she was diagnosed with Angle Class III malocclusion, a skeletal Class II jaw relationship, an anterior crossbite, congenital absence of some teeth, and a left-sided cleft lip and palate. Although the anterior crossbite and narrow maxillary arch were corrected by interceptive orthodontic treatment, severe mandibular hypogrowth resulted in unexpectedly severe mandibular retrognathism after growth completion. Moreover, bilateral condylar deformities were observed, and we suspected progressive condylar resorption (PCR). There was a high risk of further condylar resorption with mandibular advancement surgery; therefore, Le Fort I osteotomy with two genioplasty procedures was performed to achieve counterclockwise rotation of the mandible and avoid ingravescence of the condylar deformities. The total duration of active treatment was 42 months. The maxilla was impacted by 7.0 mm and 5.0 mm in the incisor and molar regions, respectively, while the pogonion was advanced by 18.0 mm. This significantly resolved both skeletal disharmony and malocclusion. Furthermore, the hyoid bone was advanced, the pharyngeal airway space was increased, and the morphology of the mandibular condyle was maintained. At the 30-month follow-up examination, the patient exhibited a satisfactory facial profile. The findings from our case suggest that severe mandibular retrognathism with condylar deformities can be effectively treated without surgical mandibular advancement, thus decreasing the risk of PCR.
Cleft Lip ; Congenital Abnormalities* ; Female ; Follow-Up Studies ; Genioplasty* ; Humans ; Hyoid Bone ; Incisor ; Jaw ; Malocclusion ; Malocclusion, Angle Class III ; Mandible ; Mandibular Advancement ; Mandibular Condyle ; Maxilla ; Molar ; Orthognathic Surgery ; Osteotomy* ; Palate ; Polymerase Chain Reaction ; Retrognathia* ; Tooth

OBJECTIVEThis study aims to analyze the long-term stability of the anterior teeth and hard tissue of skeletal class III malocclusion after a three-year orthodontic surgery by systematic review.

METHODSAll studies about skeletal class III malocclusion with orthodontic-surgery were searched by computer-based retrieval and manual retrieval; the deadline is December 2013. The literature, filtered according to the inclusion criteria and exclusion criteria, was performed with quality. assessment. The same indicators of the anterior location and hard tissue stability were combined and evaluated with metaanalysis and descriptive analysis by Rev Man5.2.

RESULTSFour before-and-after comparison study articles with 180 cases were included. The grades of the four literature evaluation were A. The meta-analysis results showed that comparing the three-year post-orthodontic-surgery and post-orthodontic-surgery, the total weighted mean difference (WMD) of Ul-SN was 4.29 (P<0.05); the WMD of Ll-MP, OB, OJ, SNA, SNB, ANB, and MP-SN were -1.58, 0, -0.41, -0.58, 0.25, -0.70, and 0.39, respectively (P>0.05). The measurement methods of A and B point position were different, hence the qualitative description were as follows: point A remained at a relatively stable position, and point B had some replacement compared with post-operative (P<0.05).

CONCLUSIONTo the skeletal class III malocclusion after three-year orthodontic-surgery, the position of the lower anterior teeth could be kept stable, as well as the overbite and the overjet of the anterior teeth; only the upper inci- sor has a lip-inclined relapse. The maxillary could also be kept stable, and the mandibular had a little relapse.

Cephalometry ; Humans ; Malocclusion, Angle Class III ; surgery ; Mandible ; Maxilla ; Overbite

OBJECTIVETo analyze the three-dimensional changes of pharyngeal airway in patients with skeletal Class III malocclusion after the combined orthodontic and orthognathic treatment.

METHODSTwenty patients (9 males, 11 females) and 40 subjects with normal occlusion were involved in the study. Cone-beam computed tomography (CBCT) were performed on patients one week and six months after treatment. Raw data were reconstructed into three-dimensional model and sagittal and transversal measurements, cross sectional areas, partial and total volumes were computed.

RESULTSAfter treatment, the sagittal diameters of each section were significantly reduced by (2.7 ± 3.5), (3.0 ± 3.8), (2.7 ± 3.3) mm, respectively (P < 0.05). The transversal diameter of laryngopharyngeal airway constricted significantly by (4.8 ± 4.1) mm (P < 0.05). Cross sectional areas and volumes of each part in patients after surgery were significantly narrower compared with those of the controls.

CONCLUSIONSAfter combined therapy the pharyngeal airway space decreased.

Adolescent ; Adult ; Cone-Beam Computed Tomography ; Female ; Humans ; Hypopharynx ; diagnostic imaging ; Imaging, Three-Dimensional ; Male ; Malocclusion, Angle Class III ; diagnostic imaging ; surgery ; therapy ; Orthodontics, Corrective ; Osteotomy, Sagittal Split Ramus ; Pharynx ; diagnostic imaging ; Young Adult

OBJECTIVETo evaluate the effect of extraction and non-extraction decompensation to bimaxillary orthognathic surgery in skeletal class III malocclusion and the effect on postoperative.

METHODSRecords of 36 completed surgical-orthodontic treatment skeletal class III malocclusion patients were obtained from School of Stomatology, China Medical University, 18 underwent maxillary premolar extraction, the other 18 underwent non-extraction. Their post-decompensation and postsurgery cephalometric radiographs were analyzed objectively, and their profile scissors-shadows in different groups were evaluated subjectively.

RESULTSThe cephalometric index of post-presurgical orthodontics showed that there were significant deviations between the extraction and non-extraction groups including U1-SN, Overjet and Cm-Sn-UL values (P<0.05). During surgery, mandible was retruded (8.66 +/- 1.42) mm in extraction group compared with (6.21 +/- 3.06) mm in non-extraction group (P<0.05). After surgery, the extraction group achieved more normal ANB, U1-SN, NA-PA values (P>0.05).

CONCLUSIONMaxillary premolar extraction can make incisor decompensation more complete so that mandible can be retruded to more ideal position and concave face can be successfully corrected.

Bicuspid ; Cephalometry ; Face ; Humans ; Incisor ; Male ; Malocclusion, Angle Class III ; Mandible ; Orthognathic Surgery ; Treatment Outcome

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

PURPOSE: The purpose of this study was to measure the anteroinferior changes and the degree of vertical changes to facilitate the prediction of treatment outcome in patients undergoing genioplasty only, genioplasty with bilateral sagittal split ramus osteotomy (BSSRO), genioplasty, or BSSRO and Lefort I osteotomy. MATERIALS AND METHODS: Serial cephalometry was performed on 25 patients at 1-year follow-up after genioplasty, to assess skeletal changes and relapse. Surgery was performed using conventional techniques. RESULTS: The mean ratio was 0.9 : 1 of soft tissue to skeletal movement at pogonion, but the average difference between hard and soft tissue was large; thus, the prediction of anteroposterior soft tissue changes was quite inaccurate. CONCLUSION: We observed a good correlation between the amount of hard versus soft tissue change with surgery in the horizontal direction, but a poor correlation in the vertical plane.
Adolescent ; Adult ; Female ; Humans ; Male ; Malocclusion, Angle Class III/pathology/*surgery ; Mandible/pathology/*surgery ; Osteotomy/methods ; Osteotomy, Le Fort/methods ; Reconstructive Surgical Procedures/*methods ; Treatment Outcome ; Young Adult