Class III camouflage orthodontic treatment in adult patient with anterior crossbite and abnormal functional shift: A case report

@#Skeletal Class III malocclusion is a complex malformation with a prevalence of 81.6% in Airlangga University Dental Hospital, distributed in patients aged 15-45 years old. Camouflage treatment of skeletal Class III malocclusion improves prognosis with a mild-to-moderate shift. This study aimed to discuss orthodontic camouflage as an option for adult patients with Class III malocclusion, emphasizing its indications, implications, and expected results. This report presents the case of a 17-year-old male patient with poor facial aesthetics associated with protruded chin, abnormal functional shift, and temporomandibular joint pain. The facial profile was concave with lower anterior multiple diastemas, mandibular lip protrusion, mandibular displacement, and anterior crossbite. This case was treated by camouflage therapy using straight wire appliance system combined with elastic class III. After 24 months of treatment during the pandemic, the mandibular displacement and the crossbite were corrected, the teeth were arched, the anterior crossbite fixed, and the profile became convex. Camouflage orthodontic treatment can be an effective management option to achieve functional occlusion, stability, and a satisfactory aesthetic impression in adult patients with mild to moderate skeletal Class III deformities, anterior cross bite, and functional shift.

Tratamento da classe III com disjunção maxilar e tração reversa da maxila: relato de caso clínico / Class III treatment weth maxillary disjunction and reverse maxillary traction: clinical case report

Objetivo: A má oclusão classe III de Angle se caracteriza por protrusão mandibular, retrusão maxilar ou pela combinação de ambas. Além de prejudicar a estética facial do paciente, essa má oclusão pode causar alterações funcionais e respiratórias. Uma das alternativas de tratamento para esses casos é o uso da máscara de Petit e do aparelho disjuntor de Hyrax. Este estudo tem como objetivo avaliar por meio da cefalometria ortodôntica se o tratamento com expansão maxilar em conjunto com a tração reversa da maxila diminuem os agravos estéticos e funcionais do paciente Classe III. Relato de caso: o relato de caso descrito no presente trabalho é sobre uma paciente que foi submetida a esse tratamento, sendo descrito por meio de análises cefalométricas, exames radiográficos, fotos intrabucais e achados clínicos. Considerações finais: A verificação dos resultados obtidos após o término do tratamento mostrou que a paciente teve uma boa adesão ao uso desses aparelhos e obteve resultados satisfatórios na sua função mastigatória, na sua oclusão e na sua estética facial e dentária.(AU)

Objective: Angle class III malocclusion is characterized by mandibular protrusion, maxillary retrusion or a combination of both. In addition to impairing the patient's facial aesthetics, this malocclusion can cause functional and respiratory changes. One of the treatment alternatives for these cases is the use of the Petit mask and the Hyrax breaker device. This study aims to evaluate, through orthodontic cephalometry, whether the treatment with maxillary expansion in conjunction with the reverse traction of the maxilla reduces the aesthetic and functional problems of Class III patients. Case report: the case report described in the present work is about a patient who underwent this treatment, being described through cephalometric analysis, radiographic examinations, intraoral photos and clinical findings. Final considerations: The verification of the results obtained after the end of the treatment showed that the patient had a good adherence to the use of these devices and obtained satisfactory results in her masticatory function, in her occlusion and in her facial and dental aesthetics.(AU)

Non-extraction camouflage treatment of skeletal class III malocclusion

@#Class III malocclusion can be defined as a skeletal facial deformity that is characterized by a forward mandibular position with respect to the cranial base and or the maxilla. We present a case of a 15-year-old man with skeletal Class III malocclusion who was treated with non-extraction orthodontic camouflage treatment using an orthodontic conventional technique. A fixed appliance, straight wire appliance (SWA) technique was used with a non-extraction treatment plan. Treatment was accompanied by intermaxillary Class III elastics. The total duration of active treatment was 23 months. There was a significant improvement in his occlusion, smile esthetics, and soft tissue profile pattern. Orthodontic camouflage can be considered an effective therapy for correcting milder cases of skeletal Class III malocclusion.

Class III treatment with mini-implants anchorage in young adult patients: short and long-term results

ABSTRACT Introduction: Class III malocclusion should be intercepted and treated at early age, to prevent the necessity of future complex and expensive procedures. The orthopedic facemask therapy has the goal to achieve skeletal changes, minimizing side effects on dentition. The use of skeletal anchorage, combined with Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol, may be effective in treating a greater number of growing Class III patients. Objective: To summarize the existing evidence-based literature on Class III malocclusion treatment in young adult patients, and to illustrate its application and effectiveness, by presenting an emblematic case report. Conclusion: The resolution of the present case, its long-term follow up, along with the studies conducted on a larger sample, demonstrate the effectiveness of the strategic combination of orthopedic and orthodontic treatments by using an hybrid rapid palatal expander and Alt-RAMEC protocol for treating Class III malocclusions in adult patients.

RESUMO Introdução: A má oclusão de Classe III deve ser interceptada e tratada em idade precoce, a fim de evitar uma futura necessidade de procedimentos complexos e invasivos. O tratamento com máscara facial ortopédica tem o objetivo de obter alterações esqueléticas, minimizando os efeitos colaterais na dentição. O uso de ancoragem óssea em mini-implantes, associada ao protocolo Alt-RAMEC (Alternate Rapid Maxillary Expansion and Constriction) pode ser eficaz no tratamento de um grande número de pacientes Classe III em crescimento. Objetivo: Realizar uma síntese da literatura baseada em evidência sobre o tratamento da má oclusão de Classe III em pacientes adultos jovens, e ilustrar sua aplicação e eficácia por meio do relato de um caso emblemático. Conclusão: A resolução e o acompanhamento em longo prazo do caso apresentado, juntamente com estudos conduzidos em uma amostra maior, demonstram a eficácia da combinação estratégica dos tratamentos ortopédico e ortodôntico usando um expansor palatal híbrido e o protocolo Alt-RAMEC para corrigir a má oclusão de Classe III em pacientes adultos.

Assessment of influence of facemask treatment with skeletal anchorage on the temporomandibular joint using magnetic resonance imaging: a preliminary study

ABSTRACT Objective: The aim of the study was to investigate the influence of facemask treatment with skeletal anchorage on the temporomandibular joint (TMJ) using magnetic resonance imaging (MRI), in patients with Class III malocclusion, accompanied by maxillary retrusion. Methods: Fifteen patients with a mean age of 12.1±1.43 years were included in the study. All patients were treated using facemask with skeletal anchorage after eight weeks of Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol. Magnetic resonance imaging was performed before and immediately after facemask treatment for TMJ evaluation. Disc position, condylar translation, degenerative changes of the condyles, and joint effusion were evaluated. To assess whether the alterations associated with the treatment were statistically significant, McNemar and marginal homogeneity tests were used. Results: After facemask treatment, a statistically significant change was observed in the disc position (an anterior disc displacement with/without reduction in five TMJs) (p<0.05). The alteration in the condylar translation was not statistically significant (p>0.05). This treatment did not cause degenerative changes of the condyles or effusion in any of the TMJs. Conclusion: Facemask treatment with skeletal anchorage following the Alt-RAMEC protocol had a minimal influence on the TMJ, only by means of disc position, which was not negligible. Long-term results of such treatment are required for following up the changes observed in the TMJs.

RESUMO Objetivo: O objetivo desse estudo foi investigar a influência do tratamento com máscara facial com ancoragem esquelética na articulação temporomandibular (ATM), por meio de ressonância magnética (RM), em pacientes com má oclusão de Classe III acompanhada de retrusão maxilar. Métodos: Quinze pacientes com idade média de 12,1±1,43 anos foram incluídos no estudo. Todos os pacientes foram tratados com máscara facial com ancoragem esquelética após oito semanas de protocolo de Expansão Rápida da Maxila e Constrição Alternadas (Alt-RAMEC). Os exames de ressonância magnética foram realizados antes e imediatamente após o tratamento com máscara facial, para avaliação da ATM. Foram avaliados posição do disco, translação condilar, alterações degenerativas dos côndilos e derrame articular. Os testes de McNemar e de homogeneidade marginal foram utilizados para avaliar se as alterações associadas ao tratamento foram estatisticamente significativas. Resultados: Após o tratamento com máscara facial, uma mudança estatisticamente significativa foi observada na posição do disco (deslocamento anterior do disco com/sem redução em cinco ATMs) (p<0,05). A alteração na translação condilar não foi estatisticamente significativa (p>0,05). Esse tratamento não causou alterações degenerativas dos côndilos ou derrame em qualquer das ATMs. Conclusão: O tratamento com máscara facial com ancoragem esquelética ápós o protocolo Alt-RAMEC teve uma influência mínima na ATM, apenas quanto à posição do disco, que não foi desprezível. Resultados em longo prazo desse tratamento são necessários para acompanhar as mudanças observadas nas ATMs.

Los bloques gemelos en el tratamiento de las maloclusiones clase III. Revisión / Twin blocks in the treatment of class III malocclusions. Review / Blocos gêmeos no tratamento das más oclusões de classe III. Revisão

RESUMEN El tratamiento de las maloclusiones clase III en pacientes en crecimiento suele realizarse con aparatos de ortopedia intraoral o extraoral. El objetivo fue analizar el uso de los bloques gemelos en el tratamiento de las maloclusiones de clase III. Se realizó una revisión sistemática siguiendo los lineamientos PRISMA versión 2009. Las búsquedas se realizaron en las bases de datos Pubmed, Embase, Scopus y Cochrane, así como en una base de datos de literatura gris, y se complementaron con búsquedas manuales. Se incluyeron cinco artículos de los cuales se registraron las siguientes variables: autor, año de publicación, país y resultados. De acuerdo a la bibliografía revisada, los bloques gemelos clase III constituyen una opción terapéutica que producen una mejoría de la estética facial al modificarse la relación esquelética máxilomandibular, la relación de oclusión dentaria anterior y la posición de los tejidos blandos.

ABSTRACT Treatment of class III malocclusions in growing patients is usually performed with intraoral or extraoral braces. The objective was to analyze the skeletal changes by treating class III malocclusions with twin blocks. A systematic review was carried out following the PRISMA 2009 version guidelines. Searches were carried out in the Pubmed, Embase, Scopus and Cochrane databases, as well as in a gray literature database, and were supplemented by hand searches. Five articles were included, of which the following variables were recorded: author, year of publication, country, and results. According to the reviewed bibliography, class III twin blocks constitute a therapeutic option that produces an improvement in facial aesthetics by modifying the maxillomandibular skeletal relationship, the anterior dental occlusion relationship, and the position of the soft tissues.

RESUMO O tratamento das más oclusões de classe III em pacientes em crescimento geralmente é realizado com aparelho intraoral ou extraoral. O objetivo foi analisar o uso de blocos gêmeos no tratamento das más oclusões de classe III. Uma revisão sistemática foi realizada seguindo as diretrizes do PRISMA versão 2009. As pesquisas foram realizadas nos bancos de dados Pubmed, Embase, Scopus e Cochrane, bem como em um banco de dados de literatura cinza, e foram complementadas por pesquisas manuais. Foram incluídos cinco artigos, dos quais foram registradas as seguintes variáveis: autor, ano de publicação, país e resultados. De acordo com a bibliografia revisada, os bloqueios gêmeos de classe III constituem uma opção terapêutica que produz uma melhora na estética facial ao modificar a relação esquelética maxilomandibular, a relação de oclusão dentária anterior e a posição dos tecidos moles.

Compensation in Class III Malocclusions: Analysis of Tooth Crown Inclination on Digital Dental Casts / Compensação da Má Oclusão de Classe III: Análise da Inclinação das Coroas dos Dentes em Modelos Digitais

The objective of this study was to evaluate the tooth crown inclination in maxillary and mandibular arches in Class III malocclusion individuals, to identify the presence and magnitude of compensation. The study was conducted on 46 plaster casts of individuals with Class III malocclusion, of both genders (25 males and 21 females), with mean age 21 years and 1 month, with indication for compensatory orthodontic treatment. The dental casts models were scanned and the tooth crown inclinations were measured and compared with standard values by the independent t test. All tests considered a significance level of 5% (p<0.05). According to the results there was extensive variation in tooth inclination in Class III malocclusions. Values distribution for incisors highlighted the significant concentration of maxillary incisors in the area of positive values, compared with a very expressive concentration of mandibular incisors in the area of negative values. Compared with normal standards, in Class III malocclusions, the maxillary posterior teeth exhibited smaller palatal inclination than normal, while the mandibular incisors and second molars presented greater lingual inclination. It was concluded that the analysis of inclinations of all crowns of both dental arches in Class III malocclusions, compared with normal standards, evidenced the presence of natural compensation for maxillary posterior teeth, with reduced palatal inclination, as well as increased lingual inclination in mandibular incisors. The parameters of compensation naturally present in Class III malocclusions described, especially in lower incisors, would help clinicians when compensatory treatment is considered. (AU)

O objetivo deste estudo foi avaliar a inclinação das coroas dentárias nas arcadas superior e inferior em indivíduos com má oclusão de Classe III, para identificar a presença e a magnitude da compensação. O estudo foi realizado em 46 modelos de gesso de indivíduos com má oclusão de Classe III, de ambos os sexos (25 homens e 21 mulheres), com média de idade de 21 anos e 1 mês, com indicação de tratamento ortodôntico compensatório. Os modelos de gesso foram digitalizados e as inclinações da coroa dos dentes foram medidas e comparadas com os valores de normalidade pelo teste t independente. Todos os testes estatísticos adotaram um nível de significância de 5% (p <0,05). De acordo com os resultados, houve grande variação na inclinação dentária nas más oclusões de Classe III. A distribuição dos valores para os incisivos destacou a concentração significativa de incisivos superiores na área de valores positivos, em comparação com uma concentração muito expressiva de incisivos inferiores na área de valores negativos. Comparados aos padrões de normalidade, nas más oclusões de Classe III, os dentes posteriores superiores exibiram inclinação palatina menor que o normal, enquanto os incisivos e segundos molares inferiores apresentaram inclinação lingual maior. Concluiu-se que a análise das inclinações de todas as coroas de ambas as arcadas dentárias nas más oclusões de Classe III, comparadas aos padrões de normalidade, evidenciou a presença de compensação natural para os dentes posteriores superiores, com diminuição da inclinação palatina, bem como aumento da inclinação lingual dos incisivos inferiores. Os parâmetros de compensação naturalmente presentes nas más oclusões de Classe III descritos, especialmente nos incisivos inferiores, podem auxiliar o clínico quando o tratamento compensatório é considerado. (AU)

Diagnóstico e tratamento precoce da má oclusão de Classe III com Aparelho Disjuntor Hyrax e Máscara Facial de Petit com avaliação do tempo de uso com micro-sensor: relato de caso clínico / Early diagnosis and treatment of Class III occlusion with Hyrax Isolating Appliance and Petit Face Mask with evaluation of the time of use with micro-sensor: a clinical case report

O sucesso do tratamento precoce da classe III depende de um bom diagnóstico e da cooperação do paciente na utilização do aparelho extrabucal. Neste trabalho, por meio de um chip (Theramon) instalado na Máscara Facial de Petit da paciente, foi possível monitorar a quantidade de horas que a paciente utilizou o aparelho por dia, durante um período de quatro meses. Paciente do sexo feminino, 7 anos e 11 meses de idade portadora da má oclusão de classe III, utilizou o aparelho de disjunção da maxila (Hyrax) modificado, seguido da Máscara Facial de Petit com chip (Theramon) instalado. A média de uso foi maior do que 11 horas de uso diário. O uso deste dispositivo auxilia no monitoramento do tempo de uso do aparelho, cujo sucesso do tratamento depende da utilização deste pelo paciente(AU)

The success of early treatment of class III depends on a good diagnosis and the cooperation of the patient in the use of the extra oral appliance. In this study, the patient was able to monitor the number of hours the patient used the device per day during a period of four months using a Theramon chip installed in the Patient's Facial Mask. A 7-year, 11-month-old male with Class III malocclusion used the modified maxillary disjunction (Hyrax), followed by the Petit Facial Mask with a Theramon chip installed. The average use was greater than 11 hours of daily use. The use of this device assists in the monitoring of the time of use of the device, whose success of the treatment depends on the use of this by the patient(AU)

Osteotomía Le Fort III modificada en un paciente no sindrómico / Modified Le Fort III osteotomy in a non-syndromic patient

Las discrepancias dento-esqueletales severas presentan un reto para el cirujano maxilofacial, existe una versatilidad de osteotomías para las diferentes anomalías del crecimiento y desarrollo, sin embargo, son pocas las que permiten mejorar la proyección malar. La osteotomía Le Fort III modificada fue utilizada en un principio en pacientes con algún síndrome craneofacial, pero actualmente es una alternativa útil para discrepancias severas en pacientes no sindrómicos, ya que permite un avance cigomático-maxilar, favorece la proyección malar y disminuye la exposición escleral con un número limitado de complicaciones. Se presenta el caso de un paciente masculino de 33 años con antecedente de fractura orbitocigomática y piso orbitario izquierda con una discrepancia dento-esqueletal severa, la que fue tratada mediante osteotomía Le Fort III modificada, osteotomías sagitales mandibulares para un avance máxilo-malar y retroceso mandibular respectivamente y una genioplastia de avance; logrando un resultado funcional y estético adecuado.

The dento-skeletal severe discrepancies present a challenge for the maxillofacial surgeon, there is a versatility of osteotomies for the different growth and development anomalies, however, a few of them make possible to improve malar projection. The modified Le Fort III osteotomy was originally used in patients with some craniofacial syndrome, but now it is a useful alternative for severe discrepancies in non-syndromic patients, since it allows a zygomatic-maxillary advance, favors malar projection and reduces scleral exposure with a limited number of complications. The case of a 33-year-old male patient with a history of orbitozygomatic fracture and left orbital floor with a severe dento-skeletal discrepancy is presented, who was treated by modified Le Fort III osteotomy, mandibular sagittal osteotomies for maxillo-malar advancement and retrogression mandibular respectively and geniplasty for advance; achieving a suitable functional and aesthetic result.

Lower incisor changes following non-extraction orthodontic decompensation in Class III surgical cases

@#The amount of incisor decompensation during pre-surgical orthodontics may affect the outcome of Class III orthognathic cases. The purpose of this study was to assess the lower incisor changes post-orthodontic decompensation in Class III surgical cases and to investigate the amount of crowding as a predictive factor. This was a retrospective study reporting on 22 Class III orthognathic cases. The lower incisor angulation (LIA) and distance of the lower incisor edge to the A-Pogonion line (Li-APo) were measured on pre-treatment and presurgical lateral cephalograms whereas crowding was measured on digitised pre-treatment study models. Pearson’s correlation (p <0.05) was used to assess the correlation of crowding with LIA and Li-APo changes, and prediction of the lower incisor decompensation was conducted using linear regression analysis. Results showed lower incisors were retroclined at 79.84° ± 7.08° and positioned ahead of APo line by 6.52 mm ± 2.97 mm at the start of treatment. Pre-surgical LIA and Li-APo were found to increase following orthodontic decompensation to 90.43° ± 5.96° and 10.34 mm ± 3.25 mm, respectively. There was a moderate positive correlation (r = 0.592) between crowding and Li-APo changes which was statistically significant, p value = 0.004, and had a strong predictor with 31.8% predictability. However, LIA showed a weak correlation (r = 0.329) with crowding and was not statistically significant (p = 0.135). Li-APo changes during orthodontic decompensation can be predicted with 31.8% predictability using the formula; Li-APo change = 2.064 + 0.503 (crowding).

A Rehabilitation of Missing Maxillary Anterior Teeth in a Severe Skeletal Class III Malocclusion Patient Requiring Implants

@#Management of traumatic dental injuries (TDI) in a young patient may range from simple to complex. In a situation where teeth are lost, a reliable and conservative treatment option is an implant-supported fixed dental prosthesis (i-FDP), as this treatment option negates the need to prepare sound abutment teeth as in the case of conventional fixed bridges. However, the placement of implants is usually prosthetically driven to allow for a 3D functional and aesthetic restoration. In the presence of severe skeletal Class III malocclusion, treatment may incorporate pre-surgical orthodontic treatment, followed by jaw surgery to correct the skeletal discrepancies and finally post-surgical orthodontic treatment before the rehabilitation with implants. A multidisciplinary treatment approach in a stepwise manner is required to address the patient’s overall treatment needs. This case report presents a joint prosthodontics, orthodontics and oral maxillofacial surgical management of a young adult male patient with a Skeletal Class III malocclusion who required rehabilitation of avulsed missing anterior teeth sustained from childhood TDI. The severity of the skeletal relationship required a Le Fort I maxillary advancement and a bilateral sagittal split osteotomy for the setback of the mandible in combination with orthodontics for correction of malocclusion and arch relationship prior to implant placement. Correction of the malocclusion and jaw deformity allowed the functional and aesthetic rehabilitation of the missing teeth using an i-FDP.

Orthodontic camouflage as a treatment alternative for skeletal Class III

ABSTRACT Introduction: Skeletal Class III malocclusion is a deformity of complex treatment, with few intervention alternatives, which are further limited in nongrowing patients. In most cases, orthognathic surgery is the ideal treatment for adults, an option often refused by patients. Mild to moderate skeletal Class III malocclusions and acceptable facial esthetics can benefit from a course of treatment in which dental movements are used to compensate for the skeletal discrepancy. Objective: This study aimed to discuss orthodontic camouflage as an option for adult patients with Class III malocclusion, emphasizing its indications, implications and expected results.

RESUMO Introdução: A má oclusão esquelética de Classe III é uma deformidade de difícil tratamento e com poucas alternativas de intervenção, que ficam ainda mais limitadas em pacientes sem crescimento. Na maior parte dos casos, o tratamento ideal para adultos é a cirurgia ortognática, opção muitas vezes recusada pelo paciente. As más oclusões esqueléticas de Classe III leve a moderada e com estética facial aceitável podem se beneficiar de um plano de tratamento no qual movimentações dentárias são realizadas para compensar a discrepância esquelética. Objetivo: O objetivo do presente estudo foi discutir a camuflagem ortodôntica como opção para pacientes adultos com má oclusão de Classe III, ressaltando suas indicações, implicações e resultados esperados.

Protraction facemask followed by mandibular cervical headgear: an alternative in the treatment of class III malocclusion with severe anterior open-bite / Máscara facial para protração seguida de aparelho extra-bucal mandibular: uma alternativa para o tratamento da má oclusão de classe III com mordida aberta anterior severa

The present case report describes a conservative and uncommon treatment for class III malocclusion in a woman growing patient with aged eight years and four months. An unconventional treatment modality was used for the treatment of this malocclusion, reverse-pull headgear and distalisation of lower teeth using mandibular cervical headgear in the lower arch. At the end of the treatment (after 33 months), there was correction of the transversal and sagittal occlusal relationship between maxilla and mandible and correct dental intercuspation (AU)

O presente relato de caso descreve um tratamento conservador e incomum para má oclusão de classe III em uma paciente em crescimento com idade de oito anos e quatro meses. Uma modalidade de tratamento não convencional foi utilizada que consistiu no uso de tração reversa maxilar e aparelho extra-bucal inferior para distalização. Ao final do tratamento (após 33 meses), houve correção da relação oclusal sagital e transversal entre maxila e mandíbula e correta intercuspidação dentária (AU)

Morphological changes of frankel functional regulator III in mixed dentition with class III malocclusion / Cambios morfológicos del regulador funcional frankel III en dentición mixta con maloclusión clase III

The aim of this study was to evaluate the hard and soft tissue profile changes following treatment of functional and mild skeletal class III malocclusion in mixed dentition by means of the Frankel functional regulator (FR-3) appliance, and to reveal the mechanism and effectiveness of treatment with FR-3 appliance. Twenty-six patients (chronological mean age, 8.7±1.4 years; mean treatment duration, 10.3±1.3 months) with functional and mild skeletal class III malocclusion were selected and treated with FR-3 appliances. Lateral cephalogram was taken pre- and post-treatment, and the data was analyzed by paired-samples t test with SPSS22.0 software package. Differences were considered statistically significant at P < 0.05. The results demonstrated that the FR-3 appliance produced a statistically significant decrease in L1-NB, L1-MP, U1-L1 (P<0.01) and an increase greatly in ANB, MP-FH, Y axis, ANSMe, ANS-Me/N-Me and overjet (P<0.01). SNA, SNB were increased significantly (P<0.05). Meanwhile, N'-Sn-Pog', ULSn-SN, LLSiSN increased, S-N'-Si, LL-EP decreased with significant difference (P<0.01). S-N'-Sn, Cm-Sn-UL, UL-EP, Sn-Mes and Ns-Mes increased with significant difference (P<0.05). Therefore it was concluded that after FR-3 treatment, the position of mandible may rotate clockwise backwards and downwards, with the labioversion of upper incisors and linguoversion of lower incisors. Although point A moved mesially, the length and position of the maxilla did not change significantly. With the protrusion of upper lip and the retrusion of lower lip, the relationship among nose, upper lip, lower lip and chin become harmonious, the profile of soft tissue is more coordinated and attractive.

El objetivo de este estudio fue evaluar los cambios en el perfil de los tejidos duros y blandos después del tratamiento de la maloclusión funcional y leve de la clase III esquelética en la dentición mixta mediante el aparato regulador funcional Frankel (FR-3), y revelar el mecanismo y efectividad del tratamiento con el aparato FR-3. Veintiseis pacientes (edad media 8,7 ± 1,4 años; duración media del tratamiento, 10,3 ± 1,3 meses) con maloclusión funcional y leve de clase esquelética III fueron seleccionados y tratados con aparatos FR-3. El cefalograma lateral se tomó antes y después del tratamiento, y los datos se analizaron mediante la prueba t de muestras con el software SPSS22.0. Las diferencias se consideraron estadísticamente significativas a P <0,05. Los resultados demostraron que el dispositivo FR-3 produjo una disminución estadísticamente significativa en L1-NB, L1MP, U1-L1 (P <0,01) y un gran aumento en ANB, MP-FH, eje Y, ANS-Me, ANS -Me / N-Me y overjet (P <0,01). SNA, SNB se incrementaron significativamente (P <0,05). Mientras tanto, N'Sn-Pog', ULSn-SN, LLSi-SN aumentaron, S-N'-Si, LL-EP disminuyeron con una diferencia significativa (P <0,01). S-N'-Sn, Cm-Sn-UL, UL-EP, Sn-Mes y Ns-Mes aumentaron con una diferencia significativa (P <0,05). Por lo tanto, se concluyó que después del tratamiento con FR-3, la posición de la mandíbula puede girar en sentido reloj hacia atrás y hacia abajo, con labioversión de los incisivos superiores y linguoversión de los incisivos inferiores. Aunque el punto A se movió mesialmente, la longitud y la posición del maxilar no cambiaron significativamente. Con la protuberancia del labio superior y la retrusión del labio inferior, la relación entre la nariz, el labio superior, el labio inferior y el mentón se armoniza, el perfil del tejido blando es más coordinado y atractivo.

Cephalometric and occlusal changes of Class III malocclusion treated with or without extractions

ABSTRACT Objective: The aim of this retrospective study was to evaluate the cephalometric and occlusal changes of orthodontically treated Class III malocclusion patients. Methods: The experimental groups comprised 37 Class III patients treated: G1) without (n=19) and G2) with extractions (n=18) . The control group (G3), matched by age and sex with the experimental groups, consisted of 18 subjects with untreated Class III malocclusion. Cephalometric (radiographs) and occlusal (study models) changes were assessed between the beginning (T1) and the end (T2) of treatment. Intergroup comparisons were performed with one-way ANOVA followed by Kruskal-Wallis tests (p< 0.05). Occlusal changes were evaluated by the peer assessment rating (PAR) index (ANOVA and Kruskal-Wallis tests), and the treatment outcomes were evaluated by the Objective Grading System (OGS) (t-tests). Results: The experimental groups showed a restrictive effect on mandibular anterior displacement and a discrete improvement in the maxillomandibular relationship. Extraction treatment resulted in a greater retrusive movement of the incisors and significant improvements in the overjet and molar relationship in both groups. The PAR indexes were significantly reduced with treatment, and the OGS scores were 25.6 (G1) and 28.6 (G2), with no significant intergroup difference. Conclusions: Orthodontic treatment of Class III malocclusion patients with fixed appliances improved the sagittal relationships, with greater incisor retrusion in the extraction group. Both the extraction and non-extraction treatments significantly decreased the initial malocclusion severity, with adequate and similar occlusal outcomes of treatment.

RESUMO Objetivos: O objetivo desse estudo retrospectivo foi avaliar as alterações cefalométricas e oclusais de pacientes com má oclusão de Classe III tratados ortodonticamente. Método: Os grupos experimentais compreenderam 37 pacientes Classe III tratados: 19 com extrações dentárias (G1) e 18 sem (G2). O grupo controle (G3), compatibilizado em idade e sexo com os grupos experimentais, consistiu de 18 indivíduos com má oclusão de Classe III não tratada. Alterações cefalométricas (radiografias) e oclusais (modelos de estudo) foram avaliadas ao início (T1) e ao fim (T2) do tratamento. Comparações intergrupos foram realizadas com testes ANOVA a um critério e Kruskal-Wallis (p< 0,05). As alterações oclusais foram avaliadas pelo índice PAR (testes ANOVA e Kruskal-Wallis) e os resultados oclusais dos tratamentos, pelo índice Objective Grading System (OGS) (testes t). Resultados: Os grupos experimentais apresentaram um efeito restritivo no posicionamento anterior da mandíbula e uma discreta melhora na relação maxilomandibular. Os tratamentos com extrações resultaram em um maior movimento retrusivo dos incisivos e melhoras significativas no trespasse horizontal e na relação molar em ambos os grupos. Os índices PAR foram reduzidos significativamente com o tratamento, e os índices OGS foram iguais a 25,6 (G1) e 28,6 (G2), sem diferença significativa entre os grupos. Conclusões: O tratamento ortodôntico de pacientes com má oclusão de Classe III com aparelhos corretivos fixos melhorou as relações sagitais, com maior retrusão dos incisivos no grupo com extrações. Ambos os tratamentos, com e sem extrações dentárias, diminuíram significativamente a severidade inicial da má oclusão, com resultados oclusais do tratamento adequados e similares.

Biomechanics of extra-alveolar mini-implants

ABSTRACT It is undeniable that extra-alveolar mini-implants anchorage has revolutionized Orthodontics. Correspondingly, the proper understanding of mini-implants biomechanics allowed to broaden the range of dental movements as never seen before in clinical practice. However, in order to produce better treatments, especially regarding the effects in occlusal plane, it is important to be aware of the numerous possibilities of applying force systems based on skeletal anchorage. Thus, this paper aims to address, by means of clinical cases, the application of biomechanics concepts that are extremely relevant to the proper employment of extra-alveolar mini-implants.

RESUMO É inegável que a ancoragem com mini-implantes extra-alveolares revolucionou a nossa especialidade. No mesmo sentido, o correto entendimento da biomecânica com mini-implantes permitiu ampliar a gama de movimentos dentários como nunca visto na prática clínica. Deve-se, porém, atentar às diversas possibilidades dos sistemas de aplicação das forças decorrentes do uso da ancoragem esquelética, com vistas a produzir tratamentos cada vez mais eficientes, principalmente em relação aos efeitos no plano oclusal. Assim, o presente artigo versa, por meio de casos clínicos, sobre a aplicação de conceitos da biomecânica que são extremamente relevantes para o correto emprego dos mini-implantes extra-alveolares.

Implant treatment on anterior cross-bite of a patient who had orthognathic surgery 20 years ago / 대한치과보철학회지

Orthognathic surgery of skeletal Class III malocclusion improves oral function and facial appearance. The greater amount of skeletal discrepancy, the greater amount of teeth movement required for decompensation, and this often causes pathological changes in periodontal tissue especially in lower anterior dentition. We made a Top-Down treatment plan with personalized analysis using Face Hunter, Plane System and ARCUS Digma II, in order to resolve severe mobility and cross-bite of lower anterior teeth for 49-year-old female patient who had undergone orthognathic surgery 20 years ago due to skeletal Class III malocclusion and mandibular prognathism. Lower anterior teeth were extracted and alveoloplasty was done. After healing of the wound, immediate loading was conducted immediately after implant placement. Final restorations were fabricated Zirconia using CAD/CAM, and inserted intraorally screw-retained type. During 6-month follow-up, no abnormal episodes of restorations were observed, and obtained satisfactorily both of functional and esthetic outcomes.

Effect of Developmental Disorders of Maxillary First Molars on Orofacial Morphology / 대한소아치과학회지

This study was aimed to evaluate orofacial morphologies on the cases of developmental disorders of maxillary first molars.Panoramic radiographs, lateral cephalographs, and clinical photos of 2983 children who attended the Pediatric Dental Clinic of Pusan National University Dental Hospital from 2006 to August 2017 were assessed retrospectively. 34 patients were selected whose maxillary first molars were missed or developmentally delayed unilaterally or bilaterally. Demirjian' s method was used for estimating dental age, then which was compared to chronologic age of children. Parameters expressing skeletal and dentoalveolar disharmony were checked and compared with control. Additionally, occlusion relationship was evaluated.Maxillary dental age was significantly delayed compared to chronologic age. Several parameters which show skeletal open-bite tendency and skeletal class III malocclusion with maxillary retrusion were statistically significant. Anterior crossbite and edge-bite were expected in most of these cases, but compensation by occlusion and soft tissue was also verified which might mask skeletal class III tendency.Congenital missed or developmentally delayed maxillary first molars might be related with declined growth of maxilla. If developmental disorders of maxillary first molars were verified during clinical examination, careful monitoring of orofacial growth was necessary during puberty and timed orthopedic and orthodontic intervention were considered.

Surgery-first approach with 3D customized passive self-ligating brackets and 3D surgical planning: Case report

ABSTRACT It is possible to unify three-dimensional customized orthodontic techniques and three-dimensional surgical technology. In this case report, it is introduced a treatment scheme consisting of passive self-ligation customized brackets and virtual surgical planning combined with the orthognathic surgery-first approach in a Class III malocclusion patient. Excellent facial and occlusal outcomes were obtained in a reduced treatment time of five months.

RESUMO É possível unificar técnicas ortodônticas personalizadas e tecnologia de planejamento cirúrgico 3D. No presente relato de caso, apresenta-se um plano de tratamento envolvendo o uso de braquetes autoligáveis passivos personalizados e planejamento cirúrgico virtual, combinado com cirurgia ortognática de benefício antecipado, em um paciente com má oclusão de Classe III. Foram obtidos excelentes resultados faciais e oclusais em um tempo reduzido de tratamento, de 5 meses.

Morphological changes of skeletal class III malocclusion in mixed dentition with protraction combined activities / Cambios morfológicos en maloclusión de la clase esquelética III en dentición mixta con actividades combinadas de protracción

The objective of the study was to investigate the morphological changes of skeletal class III malocclusion in mixed dentition with light force protraction combined activities. Randomly selected 30 cases of orthodontics in Shanxi Medical University orthodontics patients (ages: 6-10 years) of the lateral cephalograms. Using the oral maxillary casting type of pre-traction device, according to the condition of maxillary dentition to select the corresponding activities of the movable expansion appliance, each side of the force of about 150-200 g, requiring patients to wear 10-12 hours a day, the appliance should be removed after reaching normal occlusion. The correlation cephalometric profile of the cranial lateral radiographs before and after orthodontic treatment was measured. All patients with skeletal class III malocclusion were improved, concave type became direct type, measurements SNA, ANB, A-Ptm, MP-SN, ANS-Me/N-Me increased, maxillary advancement and reconstruction are more obvious; mandible rotates clockwise; the increase of lip inclination of anterior teeth compensatory changes, lower anterior tooth inclination changes smaller; upper lip forward, nasolabial angle decreased, improved appearance significantly. Light force protraction combined activities can make the mixed dentition of skeletal class III malocclusion in patients with significant improvement in profile appearance.

El objetivo de este estudio fue investigar los cambios morfológicos de la maloclusión clase esquelética III, en la dentición mixta, con actividades combinadas de protracción de la fuerza ligera. Se seleccionaron aleatoriamente 30 casos de ortodoncia en pacientes de ortodoncia de la Universidad Médica de Shanxi (edades: 6-10 años) a partir de cefalogramas laterales, utilizando el tipo de dispositivo de pretracción de vaciado maxilar oral, de acuerdo con la condición de la dentición maxilar para seleccionar las actividades correspondientes del dispositivo de expansión móvil, cada lado con fuerza de alrededor de 150-200 g, requiriendo que los pacientes los utilizaran de 10 a 12 horas al día. El dispositivo debía ser retirado después de alcanzar la oclusión normal. Se midió el perfil cefalométrico de correlación de las radiografías laterales craneales, antes y después del tratamiento ortodóncico. Se observó mejoramiento en todos los pacientes con maloclusión de clase esquelética. Las mediciones SNA, ANB, APtm, MP-SN, ANS-Me / N-Me aumentaron, el avance y la reconstrucción maxilar fueron los cambios más significativos; la mandíbula giró en el sentido de las agujas del reloj, se observó un aumento de la inclinación labial de los dientes anteriores. Fue reducida la inclinación anterior del diente inferior, el ángulo nasolabial disminuyó y en general mejoró significativamente la apariencia. Las actividades combinadas de protrusión de la fuerza radiante pueden llevar a una mejora signficativa en el perfil de pacientes con dentición mixta de maloclusión clase III.