Soft and hard tissue changes of hyperdivergent class Ⅱ patients before and after orthodontic extraction treatment / 北京大学学报(医学版)

Objective:To investigate the hard and soft tissue changing trend and contributing factors of skeletal class Ⅱ hyperdivergent patients before and after orthodontic camouflage treatment by analyzing the cephalogram and the three dimensional(3D)facial scan data.Methods:Eighteen skeletal class Ⅱhyperdivergent adult female patients who finished camouflage orthodontic treatment were selected.Skele-tal and dental measurements were carried out with the cephalometric analysis before and after the treat-ment.3D facial data before and after orthodontic treatment were acquired and the anatomical landmarks were set after the repositioning and superimposition process.Hard tissue measurement included 17 mea-surement indicators(sella-nasion-subspinale angle,sella-nasion-supramental angle,subspinale-nasion-supramental angle,facial angle,angle of convexity,Frankfort horizontal plane-mandibular plane angle(FH-MP),Y axis angle,sella-nasion plane-mandibular plane angle(MP-SN),pogonion-nasion-supra-mental distance,upper incisor-nasion-subspinale distance,upper incisor to sella-nasion,lower incisor-nasion-supramental distance,lower incisor-nasion-supramental angle,upper incisor to lower incisor,up-per incisor to sella-nasion,lower incisor-mandibular plane angle,and Z angle),and the changes before and after treatment were measured for 11 of them.Twenty soft tissue landmarks(left/right cheekbone,left/right chelion,left/right crista philtra,soft tissue gnathion,left/right gonion,glabella,labrale infe-rius,labrale superius,soft tissue menton,left/right mid-mandibular border,soft tissue pogonion,stomi-on superius,sublabial,subnasale,and supralabial)and 9 soft tissue indicators(lower lip height,facial convexity,lower vermilion height,mandibular contour,nasolabial angle,philtral length,philtral width,upper lip height,and upper vermilion height)were measured and recorded for treatment changes.Linear-regression analysis and correlation analysis were carried out for analyzing the relationship between hard and soft tissue changes before and after the treatment.Results:Significant differences were noticed for 18 out of the 20 cephalometric measurements and facial measurements before and after the treatment(P＜0.05),which mainly represented the sagittal retraction of lip area after the treatment.Significant vertical displacements were revealed for soft tissue menton after treatment[(1.88±2.61)mm,P＜0.05].Significant sagittal displacements were revealed for left/right cheilion[(-2.95±1.9)mm,(-2.90±1.92)mm],labrale inferius[(-4.94±1.95)mm],labrale superius[(-3.25±1.44)mm],sublabial[(-3.10±3.5)mm],and subnasale[(-1.23±1.06)mm]after treatment(P＜0.05).An average of 4.10°±2.57° increasement was noticed for Z angle after treatment.High correla-tion(r＞0.7)was noticed for the displacement of menton after treatment with FH-MP,with the rate of-0.183:1,and MP-SN,with the rate of-0.157:1.Moderate correlations(0.7≥r＞0.4)were no-ticed for the other measurements with correlations(P＜0.05).Conclusion:A certain extent of facial improvements could be achieved with orthodontic camouflage treatment for skeletal class Ⅱ hyperdiver-gent patients,which were mostly represented by the improvement of sagittal relationship of nose,lips,and chin.Certain correlations were noticed for the hard and soft tissue changes.

Treatment of adult patient with hyperdivergent retrognathic phenotype and anterior open bite: report of a case with non-surgical orthodontic approach

ABSTRACT Adult patients with anterior open bite and hyperdivergent retrognathic phenotype demand complex treatments, as premolar extractions, molar intrusion or orthognathic surgery. In the present clinical case, a young adult patient without significant growth, with Class I and anterior open bite, was treated with four premolar extractions. The therapeutic result shows good intercuspation, good facial esthetic, good function balance, and stability in a two-year post-fixed treatment follow-up.

RESUMO Pacientes adultos com mordida aberta anterior e fenótipo hiperdivergente retrognata demandam tratamentos complexos, com extrações de pré-molares, intrusão de molares ou cirurgia ortognática. No presente caso clínico, uma jovem adulta sem potencial significativo de crescimento, apresentando Classe I e mordida aberta anterior, foi tratada com extrações de quatro primeiros pré-molares. O resultado terapêutico alcançou boa intercuspidação, boa estética facial e bom equilíbrio funcional, e mostrou-se estável depois de dois anos da remoção do aparelho fixo.

Como os padrões esqueléticos horizontal e vertical influenciam na espessura do tecido mole facial - um estudo longitudinal em adolescentes / How the horizontal and vertical skeletal patterns affect the facial soft tissue thickness: a longitudinal study with adolescents

Introdução: Esse estudo teve como objetivo avaliar as alterações e desenvolvimento do perfil mole (espessuras labiais superior e inferior) no período entre 10 e 15 anos de idade. Material e método: Uma amostra homogênea Franco-Canadense de 185 indivíduos não tratados ortodonticamente (106 meninas e 79 meninos) foi selecionada. Seis medidas de espessura de tecido mole (ENA', ponto A', lábios superior e inferior, ponto B' e pogônio) foram avaliadas. Indivíduos Classe I (ANB entre 0º a 4º) e Classe II (ANB ≥ 4º) foram comparados, bem como indivíduos classificados como hipodivergentes (MPA = 31.8º ± 2.4º) e hiperdivergentes (MPA = 40.9º ± 2.6º). O dimorfismo sexual também foi avaliado. Resultados: Embora a espessura do tecido mole tenha aumentado entre os 10 e 15 anos de idade, não houve diferenças significativas entre indivíduos Classe I e Classe II, bem como entre hipodivergentes e hiperdivergentes. As diferenças encontradas entre os indivíduos Classe I e Classe II se limitaram ao ponto A' e L1' (10 anos de idade) e L1' e ponto B' (15 anos de idade). Quando os grupos hipo- e hiperdivergentes foram comparados, as mudanças foram em relação ao U1', ponto B', e Pog'(10 e 15 anos de idade). Embora adolescentes masculinos apresentassem tecidos moles mais espessos em quatro (10 anos de idade) e em todas as seis (15 anos de idade) das espessuras avaliadas, apenas a parte do tecido mole maxilar apresentou um maior desenvolvimento entre os cinco anos de avaliação, quando comparados com as adolescentes femininas. Conclusão: O tecido mole torna-se mais espesso durante a adolescência com um padrão semelhante aos indivíduos Classe I, quando comparados com Classe II e também quando indivíduos hipodivergentes são comparados com hiperdivergentes. Adolescentes masculinos apresentaram tecido mole facial mais espesso que o das adolescentes femininas precoce (10 anos de idade) e tardiamente (15 anos de idade), mas apenas em relação aos tecidos maxilares apresentaram um espessamento durante o crescimento (dos 10 aos 15 anos de idade). (AU)

Introduction: The purpose of this study was to identify changes and growth of the soft tissue (upper and lower lip thicknesses) evaluating subjects from 10 to 15 years old. Material and Methods: A homogeneous French-Canadian sample of 185 orthodontically untreated subjects (106 girls and 79 boys) was selected. Six measurements of soft tissue thickness (ENA', point A´, upper and lower lips, point B´ and pogonion) were evaluated. Class I subjects (0º < ANB < 4º) and Class II (ANB ≥ 4º) were compared, as well as subjects classified as hypodivergents (MPA = 31.8º ± 2.4º) and hyperdivergents (MPA = 40.9º ± 2.6º). Sexual dimorphism was also evaluated. Results: Although the soft tissue thickness increased between 10 and 15 years of age, there were no significant differences between Class I and Class II subjects, as well as between hypodivergents and hyperdivergents. The differences between Class I and Class II subjects were related to point A' and L1' (10 year old) and L1' and point B' (15 year old). When hypodivergent and hyperdivergent groups were compared, the changes were restricted to U1', point B' and Pog' (10 and 15 year old). Although male teenagers showed thicker soft tissue than girls in four measurements (10 year old) and in all six measurements (15 year old) of the thickness assessed, only the maxillary soft tissue showed greater growth, between the five years of assessment for boys compared to girls. Conclusion: The soft tissue becomes thicker during the adolescence and this development is similar in subjects Class I, when compared to Class II subjects and also when subjects classified as hypodivergent and hyperdivergent are compared. Male teenagers showed thicker soft tissue than female teenagers precociously (10 year old) and late (15 year old), but only in relation to the maxilla tissue they presented tickening during their growth (from 10 to 15 year of age). (AU)

Extracciones de primeros premolares simétricos en paciente con apiñamiento severo: Reporte de un caso

Cuando se presenta apiñamiento severo, en muchas ocasiones la ubicación que adoptan las estructuras dentarias dificultan el tratamiento, por lo cual se sugiere extracciones asimétricas para permitir de esta manera un tratamiento menos prolongado y con resultados satisfactorios. En este artículo se reporta un caso de biprotrusión dentaria tratado con extracciones de 4 premolares, en una paciente femenina de 20 años y 6 meses, Clase II esquelética, hiperdivergente, con un patrón dolicofacial, Clase III molar bilateral, Clase I canina bilateral, línea media superior coincidente e inferior 4 mm desviada a la izquierda, y no presenta hábitos. En los objetivos de tratamiento se planteó: extracciones asimétricas de primeros premolares superiores e inferiores, corregir el apiñamiento maxilar y mandibular, obtener líneas medias coincidentes, obtener la Clase I molar bilateral, mantener la Clase I canina bilateral. Se logró corregir el apiñamiento severo con una forma de arco adecuada.

In cases of severe crowding, many times the location of dental structures impede treatment, so asymmetrical extractions is suggested to allow a less prolonged treatment with satisfactory results. This article presents a case of dental extractions biprotrution treated with 4 premolars reported, a case of 20 years and 6 months old female patient, skeletal Class II, hyperdivergent, with bilateral dolichofacial pattern, molar Class III bilateral, canine Class I bilateral, upper midline coincident and lower midline 4mm left deviated, is reported and no habits. The goals of treatment are proposed: a symmetric extractions of first premolars upper and lower, correct the maxillary and mandibular crowding, achieve midlines, and obtain bilateral Class I molar and maintain bilateral Class I canine. It was possible to correct severe crowding with a suitable form of arch.

The effects of the vertical holding appliance in the extraction treatment of patients with hyperdivergence / 实用口腔医学杂志

Objective:To observe the effects of the vertical holding appliance (VHA) in the extraction treatment of patients with hyperdivergence.Methods:40 hyperdivergent patients orthodonticly treated by 4 first premolar extraction with(VHA group) and without VHA(control group) (n =20) respectively.Cephalometric radiographs were taken before and after orthodontic treatment and measured digitally by Winceph 8.06 software.Results:After treatment,the L6-MP,S-Go,N-Me,ANS-Me increased in the VHA group(P ＜ 0.05).The MP-SN,Y-axis,U1-PP,U6-PP,L6-MP,S-Go,N-ANS,N-Me,ANS-Me,ANS-Me/N-Me increased and the S-Go/N-Me decreased in the control group(P ＜0.05).The changes of the MP-SN,Y-axis,U6-PP,L6-MP,N-Me,ANS-Me,ANS-Me/N-Me,S-Go/N-Me were smaller in the VHA group than those in the control group (P ＜ 0.05).Conclusion:VHA is effective in the control of the height of molars in the extraction treatment of patients with hyperdivergence.

Photographic assessment of hyperdivergent skeletal Class II patients / Avaliação fotográfica de pacientes padrão esquelético classe II hiperdivergentes

Desordens temporomandibulares, distúrbios do sono por obstrução das vias aéreas e alterações na postura crânio cervical constituem alguns dos problemas que têm sido relacionados com o paciente padrão esquelético classe II hiperdivergente. Embora as telerradiografias laterais representem o padrão ouro para o diagnóstico da morfologia cranio facial na prática clínica, este exame pode não ser viável para aplicação em estudos epidemiológicos de larga escala. Objetivo: O objetivo deste estudo foi testar a validade de um novo método fotográfico no diagnóstico de pacientes classe II hiperdivergentes para fins de investigação epidemiológica. Material e Métodos: Telerradiografias laterais e fotografias de perfil foram obtidas a partir de 123 indivíduos distribuídos em dois grupos: 51 pacientes compuseram o grupo de pacientes classe II hiperdivergente, enquanto que os outros 72 pacientes formaram um segundo grupo. A análise discriminante descreveu um modelo matemático para melhor diagnosticar pacientes padrão esquelético classe II hiperdivergente através de fotografias. Resultados: Uma função canônica discriminante composta por duas variáveis fotográficas classificou corretamente 85% dos pacientes classe II hiperdivergentes durante a validação interna (p < 0,001). O método mostrou 83% de sensibilidade e 73% de especificidade no processo de validação externa. Conclusão: O método fotográfico pode ser considerado como uma alternativa viável e prática para diagnosticar o paciente classe II hiperdivergente, particularmente se existir a necessidade de um método não invasivo e de baixo custo.

Temporomandibular disorders, sleep disturbances by airway obstruction and craniocervical posture changes constitute some of the problems that have been related to hyperdivergent skeletal Class II patients. Although cephalometric radiographs represent the gold standard for diagnosing craniofacial morphology in clinical practice, it might not be feasible for large-scale epidemiological research. Objectives: The aim of this study was to test the validity of a new photographic method in diagnosing hyperdivergent skeletal Class II patients for epidemiological research purposes. Material and Methods: Lateral cephalograms and profile photographs were obtained from 123 subjects assigned into two groups. 51 patients comprised the hyperdivergent skeletal Class II group and the other 72 composed a second group. Discriminant analysis described a mathematical model to better diagnose hyperdivergent skeletal Class II patients through photographs. Results: A canonical discriminant function composed of two photographic variables correctly classified 85% of the hyperdivergent skeletal Class II patients during internal validation (p < 0.001). The method showed 83% sensitivity and 73% specificity in external validation procedure. Conclusion: The photographic method may be a feasible and practical alternative for diagnosing the hyperdivergent skeletal Class II patient, particularly if there is a need for a low-cost and noninvasive method.

Airway size in malocclusions with hyperdivergent skeletal pattern / 대한치과교정학회지

The pharynx have significant locations and functions because it forms a part of the unit in which respiration and deglutition are carried out. Because of the closed relationship between the pharynx and the dentofacial and craniofacial structure, many studies are carried out on this subjects. The purpose of this study were to compare the airway size including pharynx, soft palate, tongue and hyoid bone between normal and hyperdivergent skeletal pattern and to evaluate the change of those size in different age. The sample of this study were consisted of 51 subjects in normal group, 52 subjects in hyperdivergent group. Each was divided into two subgroups by age ; child group(9-12yr old) and adult group(18yr old over). The lateral cephalometric radiographs were taken and the distance, angle and ratio of the facial skeleton, pharynx, soft palate, tongue and hyoid bone were measured and evaluated statistically. The result obtained were summarized as follows : 1. SN-Mn angle, FMA, and Pal-Mn angle were significantly larger in child group than adult group, but the lower anterior facial height(LAFH) and facial height ratio(FHR) were significantly smaller in child group than adult group. Occlu-Mn angle was significantly steep in hyperdivergent group than normal, but not significantly different between child group and adult group. 2. Hyperdivergent group and child group had the stronger correlation between SN-Mn angle, FMA, Pal-Mn angle, LAFH and FHR and airway size than normal group and adult group. Hyperdivergent child group had significant negative correlation between SN-Mn angle, FMA, Pal-Mn angle and sagittal skeletal dimension of nasopharynx and sagittal depth of nasopharyngeal lumen. Significant positive correlation were seen between LAFH and vertical measurement of airway. 3. There was no difference of the linear measurement of airway size between hyperdivergent group and normal group. 4. Adult group had smaller posterior pharyngeal wall, larger nasopharyngeal depth longer nasopharyngeal height and longer pharyngeal length than child group. 5. The sagittal measurement of hyoid bone had no difference between child group and adult group. But adult group had larger vertical measurement of hyoid bone than child group.

Dentoalveolar compensation of hyperdivergent skeletal pattern in children and adults / 대한치과교정학회지

Although there is a severe underlying skeletal deformity, the dentition has often maintained some occlusal contact and interdigitation by the teeth compensating in their positions for the skeletal problem, and these dental compensations are manifested in all three planes of space. The purposes of present investigation were 1) to study the pattern of dentoalveolar compensation of hyperdivergent skeletal pattern : and 2) to compare the centoalveolar compensations of hyperdivergent skeletal pattern in children with adults. The samples selected for this study were consisted of 60 subjects in normal group, 60 subjects in hperdivergent group. each was divided into two subgroups by age ; child groups(8~12yr old) and adult groups(17yr old over). The findings of this study were as follows; 1. In child, hyperdivergent subjects had smaller posterior lower facial height(p<0.01) and slightly longer anterior lower facial height than normal ones. In adults, they still expressed smaller posterior lower facial height and much longer anterior lower facial height than normal ones(p<0.01). 2. Hyperdivergent subjects had larger amount of upper and lower incisor relative eruption to their basal bone length than normal ones(p<0.05). In adult, relative eruption of upper incisor was increasing(p<0.05), although relative eruption of lower incisor remained the same as the child. 3. In child, there was no difference between hyperdivergent group and normal one in the upper and lower molar relative eruption to their basal bone length. In adult, hyperdivergent group had larger amount of upper molar relative eruption than normal ones(p<0.01), but relative eruption of lower molar was similar to normal ones. 4. hyperdivergent group had larger angle between lower occlusal plane and mandibular plane than normal group(p<0.01). Upper occlusal plane of adult group rotated more antero-superiorly than child groups, and adult hyperdivergent group had steeper upper occlusal plane than normal group(p<0.05).