The Effects of Presurgical Orthodontic Treatment on the Outcome of Secondary Bone Graft for Individuals With Cleft Lip and Palate.

BACKGROUND/OBJECTIVE: Alveolar bone graft (ABG) or repair has become a routine part of treatment protocols for individuals with cleft lip and/or palate. However, the necessity and potential benefits of presurgical orthodontic treatment in influencing the outcomes of secondary alveolar bone grafting remain inconclusive. This systematic review aimed to assess the impact of presurgical orthodontics on preparing patients for secondary alveolar bone grafts. STUDY DESIGN: The authors systematically searched for relevant articles in PubMed, Web of Science, and Embase databases spanning the period from January 1, 2000, to December 31, 2023, using keywords related to alveolar bone grafting and orthodontic treatment for patients with cleft lip and/or palate. The review encompassed various study designs, including prospective and retrospective studies, observational studies, cross-sectional studies, randomized and nonrandomized clinical trials, cohort studies, and case-control studies. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the risk of bias was evaluated in studies selected for full-text review. RESULTS: The search strategy identified 809 publications. After initial screening and application of exclusion criteria, 11 studies were included for final review. Three were prospective studies, 8 were retrospective studies, and 3 were cross-sectional cohort studies. On the basis of ROBINS-I and RoB 2 risk assessment, 9 studies were found to be of moderate risk of bias, one study was categorized as of high risk of bias, and 1 study was categorized as low risk of bias. CONCLUSIONS: Drawing from the latest and most reliable studies, 7 out of 11 included studies provided compelling evidence that presurgical orthodontics preceding alveolar bone grafting (ABG) leads to significantly improved outcomes compared with cases without presurgical orthodontic intervention. Notably, individuals with specific conditions, such as severely collapsed upper arch and mispositioned upper incisors, appear to derive the greatest benefits from presurgical orthodontic treatment. However, a call for additional studies characterized by high methodological quality and with longer follow-up periods is emphasized to enhance the safety considerations for both practitioners and patients concerning the utilization of presurgical orthodontics in the treatment of individuals with cleft lip and palate.

Comparison of Alveolar Bone Grafting Outcomes using CBCT in Individuals with UCLP Based on the Presurgical Orthodontic Treatment Methods.

OBJECTIVE: The purpose is to evaluate outcomes of alveolar bone grafting based on the pre-grafting orthodontic preparation methods. DESIGN: Retrospective analysis of individuals with unilateral cleft lip and palate. SUBJECTS AND SETTINGS: 28 individuals with non-syndromic UCLP from two craniofacial centers, 14 individuals each from XXXX and XXXX. INTERVENTIONS: The alignment group underwent maxillary expansion with incisors alignment while the non-alignment group underwent only maxillary expansion for presurgical orthodontic preparation. METHODS: Initial and post-surgical CBCT scans were compared to observe changes in angulation of the incisor adjacent to the cleft site, alveolar bony root coverage, and bone graft outcomes. RESULTS: In the alignment group, the buccolingual rotation decreased by 32.35 degrees (p = .0002), the anteroposterior inclination increased by 14.01 degrees (p = .0004), and the mesiodistal angulation decreased by 17.88 degrees (p = .0001). Alveolar bony coverage did not change after bone graft in both groups, and no difference was observed between the groups. Chelsea scale showed satisfactory bone graft outcome (category A, C) in 12 cases (85.71%) in the alignment group and 11 cases (78.51%) in the non-alignment group. The volumetric measurement showed the alignment group had better bone fill of 69.85% versus 51.45% in the non-alignment group (p = .0495). CONCLUSIONS: Alveolar bony coverage on the tooth adjacent to cleft sites did not change with alveolar bone grafting surgery in either of the alignment and non-alignment group. Presurgical orthodontic alignment does not induce root exposure nor poorer bone grafting outcome.

Third-party Compliance With State-Mandated Orthodontic Coverage for Cleft Palate and Craniofacial Care in California: An Insurance Claim Thematic Analysis.

BACKGROUND: California Senate Bill 630 (SB630) enacted statutorily mandated health plan coverage for orthodontic care of patients with cleft palate and craniofacial anomalies in 2009, which was effective from July 1, 2010. In this qualitative analysis, third-party compliance with SB630 in a university-based cleft and craniofacial orthodontic program is evaluated. METHODS: Privately insured patients that experienced a coverage delay or denial of orthodontic treatment for cleft lip and palate in the University of California, San Francisco Cleft and Craniofacial Orthodontic Program between July 1, 2010 and October 28, 2020 were identified. A thematic analysis of reasons for delay or denial was conducted. RESULTS: Nearly three quarters of patients experienced coverage delay and/or denials. The most common reason given was that services were not covered. CONCLUSIONS: Despite state-mandated coverage, inappropriate denials of orthodontic care for patients with cleft lip and palate by private insurers persist in California.

Three-dimensional morphologic changes in the temporomandibular joint in asymptomatic patients who undergo orthodontic treatment: A systematic review.

OBJECTIVE: This systematic review aimed to summarize the morphologic changes in the temporomandibular joint (TMJ) in patients who underwent orthodontic treatment and were assessed by 3-dimensional (3D) imaging techniques (e.g., magnetic resonance imaging, cone beam computed tomography, and multidetector computed tomography). STUDY DESIGN: The authors searched PubMed, Web of Science, and Embase databases to identify original articles from 2014 to 2021 containing keywords for morphologic changes in the TMJ, orthodontic treatment, and three-dimensional imaging methods. Prospective and retrospective studies, including observational, cross-sectional, randomized, and nonrandomized clinical trials, cohort studies, and case-control studies, were reviewed. The review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The risk of bias was assessed in studies selected for the full-text review. RESULTS: The search strategy yielded 294 publications. After an initial screening and the application of exclusion criteria, 13 studies were selected for the final review. CONCLUSION: Differences were found in condylar positioning, typically in an anterior position; condylar morphology, primarily with increased diameter or head height; and articular disk position within the anterior-posterior plane post-treatment. Changes in the glenoid fossa were not consistent between the studies. The overall risk of bias among studies was moderate. The influence of orthodontic treatment on morphologic changes in the TMJ remains unclear.

Impact of COVID-19 pandemic on orthodontics in predoctoral and postdoctoral programs in the United States.

INTRODUCTION: The study aimed to characterize the impact of the coronavirus disease 2019 (COVID-19) pandemic on predoctoral and postdoctoral orthodontic education. METHODS: Electronic surveys were distributed via e-mail to predoctoral orthodontic directors at accredited dental schools (n = 66), postgraduate orthodontic program directors at orthodontic programs (n = 73), and craniofacial orthodontic fellowship directors (n = 5) in the United States and Canada. RESULTS: The predoctoral orthodontic survey received a response rate of 38%, of the which 62% indicated significant curriculum modifications. However, orthodontic curriculum hours were largely unchanged because of the COVID-19 pandemic. Of the responding predoctoral orthodontic programs with graduate orthodontic programs in which dental students can gain clinical experience (n = 14), all but 2 reported not allowing or limiting observation or assisting opportunities. The postdoctoral orthodontic survey received a response rate of 39% and was affected by clinic modifications, including financial limitations, severe acute respiratory syndrome coronavirus 2 testing, decreased clinical hours, among other modifications. CONCLUSIONS: COVID-19 pandemic has had a measurable impact on orthodontic clinical education for the predoctoral and postdoctoral orthodontic programs evaluated. Overall, less patient care was delivered, potentially resulting in delayed treatment for patients and fewer training opportunities for learners, particularly for predoctoral dental students, whose clinical observation and assisting hours were limited.

Accuracy and reliability of the expected root position setup to evaluate root proximity of an edentulous site.

INTRODUCTION: It is important to achieve proper root position during orthodontic treatment involving future dental implant placement. However, current methods to evaluate root position are either inaccurate or expose patients to relatively high radiation levels. A new approach using an expected root position (ERP) setup has previously demonstrated the potential to accurately monitor root position with minimal radiation. This study aimed to evaluate whether the ERP setup is an accurate and reliable method to determine if the roots adjacent to an edentulous site are appropriate for the anticipated dental implant. METHODS: In this retrospective study, the ERP setup was generated for 22 edentulous sites selected from the University of California San Francisco Division of Orthodontics patient database. The mesiodistal angulation of all teeth adjacent to the edentulous sites and the mesiodistal space between the teeth were measured in the ERP setup and compared with the posttreatment cone-beam computed tomography (CBCT) scan, which served as the control. The intraoperator and interoperator reliability and agreement between the ERP setup and the posttreatment CBCT scan were assessed using Bland-Altman analysis. The correlation between measurements was further evaluated by the Pearson correlation coefficient. RESULTS: The Bland-Altman plots and the Pearson correlation coefficient displayed strong agreement between the ERP setup and the posttreatment CBCT scan, with only 11.4% mesiodistal angulation measurements beyond the clinically acceptable range of ± 2.5°. All mesiodistal angulations and distances were strongly correlated with high intraoperator and interoperator reliabilities. CONCLUSION: The method to generate an ERP set up to evaluate the mesiodistal angulation and space of an edentulous site prepared for a future dental implant has been demonstrated to be accurate and reliable.

The Significance of Utilizing A Corticotomy on Periodontal and Orthodontic Outcomes: A Systematic Review and Meta-Analysis.

PURPOSE: This systematic review compares the clinical and radiographic outcomes for patients who received only a corticotomy or periodontal accelerated osteogenic orthodontics (PAOO) with those who received a conventional orthodontic treatment. METHODS: An electronic search of four databases and a hand search of peer-reviewed journals for relevant articles published in English between January 1980 and June 2021 were performed. Human clinical trials of ≥10 patients treated with a corticotomy or PAOO with radiographic and/or clinical outcomes were included. Meta-analyses were performed to analyze the weighted mean difference (WMD) and confidence interval (CI) for the recorded variables. RESULTS: Twelve articles were included in the quantitative analysis. The meta-analysis revealed a localized corticotomy distal to the canine can significantly increase canine distalization (WMD = 1.15 mm, 95% CI = 0.18-2.12 mm, p = 0.02) compared to a conventional orthodontic treatment. In addition, PAOO also showed a significant gain of buccal bone thickness (WMD = 0.43 mm, 95% CI = 0.09-0.78 mm, p = 0.01) and an improvement of bone density (WMD = 32.86, 95% CI = 11.83-53.89, p = 0.002) compared to the corticotomy group. CONCLUSION: Based on the findings of the meta-analyses, the localized use of a corticotomy can significantly increase the amount of canine distalization during orthodontic treatment. Additionally, the use of a corticotomy as a part of a PAOO procedure significantly increases the rate of orthodontic tooth movement and it is accompanied by an increased buccal bone thickness and bone density compared to patients undergoing a conventional orthodontic treatment.

Association between degenerative temporomandibular joint disorders, vertical facial growth, and airway dimension.

BACKGROUND: The goal of this study was to determine whether preexisting degenerative temporomandibular joint (TMJ) disorders are associated with hyperdivergent facial phenotype and decreased airway dimensions. METHODS: Cone-beam computed tomography scans of adult female and male individuals, 16 years of age and older, distributed in a case group defined as those with degenerative temporomandibular joint disorder (dTMJD; n = 31) or controls with normal TMJ findings (n = 242) were included. Odds ratios were calculated based on facial type and gender. Analysis of variance was used to compare the airway volume and cross section and mandibular measurements between the groups. RESULTS: Condylar, ramus, and mandibular heights were significantly smaller in the case group compared with the control group. The odds of having a long face subject was significantly higher (P < 0.00001) in the dTMJD group than in the control group with 81% of the dTMJD subjects versus 11% of the control group having long vertical facial dimensions. The smallest cross-sectional area of the airway of the dTMJD group was significantly narrower (P < 0.0361) compared with the controls. Within the control group, ramus height and mandibular alveolar housing for central incisors were significantly smaller (P < 0.0001; P < 0.007) in the long face subjects. CONCLUSIONS: The study shows that a long facial type is associated with findings of degenerative TMJ disorders and related condylar growth disturbances. These degenerative and growth changes may contribute to specific skeletal and dentofacial adaptations resulting in smaller condylar process, mandibular ramus, and body height; thinner alveolar housing at the lower incisor region; and smaller cross-sectional area of the airway.

Craniofacial Analysis May Indicate Co-Occurrence of Skeletal Malocclusions and Associated Risks in Development of Cleft Lip and Palate.

Non-syndromic orofacial clefts encompass a range of morphological changes affecting the oral cavity and the craniofacial skeleton, of which the genetic and epigenetic etiologic factors remain largely unknown. The objective of this study is to explore the contribution of underlying dentofacial deformities (also known as skeletal malocclusions) in the craniofacial morphology of non-syndromic cleft lip and palate patients (nsCLP). For that purpose, geometric morphometric analysis was performed using full skull cone beam computed tomography (CBCT) images of patients with nsCLP (n = 30), normocephalic controls (n = 60), as well as to sex- and ethnicity- matched patients with an equivalent dentofacial deformity (n = 30). Our outcome measures were shape differences among the groups quantified via principal component analysis and associated principal component loadings, as well as mean shape differences quantified via a Procrustes distance among groups. According to our results, despite the shape differences among all three groups, the nsCLP group shares many morphological similarities in the maxilla and mandible with the dentofacial deformity group. Therefore, the dentoskeletal phenotype in nsCLP could be the result of the cleft and the coexisting dentofacial deformity and not simply the impact of the cleft.

Case Report of Floating-Harbor Syndrome With Bilateral Cleft Lip.

Floating-Harbor syndrome (FHS) is a rare genetic disorder caused by heterozygous mutations in the Snf2-related CREBBP activator protein (SRCAP) gene. The syndrome is characterized by proportional short stature, delayed bone maturation, delayed speech development, and facial dysmorphism. Submucous cleft palate and cleft lip have been reported in FHS, but to our knowledge orofacial clefting in this condition has not been assessed in detail. Here, we report on a case of bilateral cleft lip in a patient with FHS confirmed by exome sequencing.

Accuracy and reliability of the expected root position setup on clinical decision making of root position at midtreatment.

INTRODUCTION: Accurate root position is imperative for successful orthodontic treatment that is stable and functional. Current methods to monitor root position are either inaccurate or use relatively high levels of radiation. A method to generate an expected root position (ERP) setup has been reported to have the potential to accurately evaluate root position with minimal radiation. The purpose of this study was to determine the accuracy and reliability of the clinical decisions made on root position using the ERP setup. METHODS: This retrospective study included 10 subjects who had pretreatment and midtreatment cone-beam computed tomography (CBCT) scans and study models. An ERP setup was generated for all patients at midtreatment. Four examiners assessed both the CBCT scan and ERP setup and made clinical decisions regarding the root position with each method. Cohen's kappa was determined to assess intraoperator and intermethod reliability. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to determine the accuracy of the ERP setup. RESULTS: The kappa values for intraoperator reliability for both the CBCT scan and ERP setup fell within the 0.61-0.80 range. The kappa values for intermethod reliability between the CBCT scan and ERP setup fell within the 0.61-0.80 range for all tooth groups. The sensitivity of the ERP setup ranged from 0.72 to 0.90, specificity ranged from 0.89 to 0.97, positive predictive value ranged from 0.57 to 0.85, and negative predictive value ranged from 0.93 to 0.99. CONCLUSIONS: This study demonstrated that the ERP setup, when compared with the gold standard CBCT scan, was accurate and reliable in making clinical decisions regarding root position at midtreatment.

Three-Dimensional Analysis of Cortical Bone Thickness in Individuals With Non-Syndromic Unilateral Cleft Lip and Palate.

PURPOSE: The aim of this study was to measure the cortical bone thickness of the infrazygomatic crest area in individuals with unilateral cleft lip and palate using cone beam computed tomography for placement of miniplates used for bone anchored maxillary protraction. MATERIALS AND METHODS: CBCT scans were obtained from 31 non-syndromic UCLP children diagnosed with maxillary hypoplasia (17 males, 14 females, mean age: 11.9 years). 5 horizontal and 5 vertical reference planes were drawn at the infrazygomatic crest area. The cortical bone thickness at 25 intersection points on the cleft side and the non-cleft side was measured. RESULTS: The mean cortical bone thickness of the 25 measured points was 1.19 mm on the cleft side and 1.17 mm on the non-cleft side with no significant difference. The greatest cortical bone thickness was found to be at the most superior, posterior point (H+6, V+0), which was 1.49 mm on the cleft side and 1.47 mm on the non-cleft side. The thinnest mean cortical bone thickness was measured at the most inferior, anterior point (H-2, V-8), which was 0.94 mm on the cleft side and 0.95 mm on the non-cleft side. There was no significant difference between males and females.

Effect of maxillary expansion and protraction on the oropharyngeal airway in individuals with non-syndromic cleft palate with or without cleft lip.

INTRODUCTION: The aim of this study was to evaluate three dimensionally the effect of the combined maxillary expansion and protraction treatment on oropharyngeal airway in children with non-syndromic cleft palate with or without cleft lip (CP/L). METHODS: CBCT data of 18 preadolescent individuals (ages, 8.4 ± 1.7 years) with CP/L, who underwent Phase I orthodontic maxillary expansion with protraction, were compared before and after treatment. The average length of treatment was 24.1± 7.6 months. The airway volume and minimal cross-sectional area (MCA) were determined using 3DMD Vultus imaging software with cross-sectional areas calculated for each 2-mm over the entire length of the airway. A control group of 8 preadolescent individuals (ages, 8.7 ± 2.6 years) with CP/L was used for comparison. RESULTS: There was a statistically significant increase in pharyngeal airway volume after phase I orthodontic treatment in both groups, however, there was no statistically significant change in minimal cross-sectional area in neither study nor control group. CONCLUSION: The findings showed that maxillary expansion and protraction did not have a significant effect on increasing oropharyngeal volume and MCA in patients with CP/L.

Compliance monitoring via a Bluetooth-enabled retainer: A prospective clinical pilot study.

OBJECTIVES: To conduct a prospective pilot trial to test the clinical efficacy and accuracy of a newly developed Bluetooth-enabled retainer, which was synchronized with an iOS mobile application, cloud database and provider webpage. SETTING AND SAMPLE POPULATION: Five orthodontic residents in a university setting. MATERIAL AND METHODS: At the delivery of the retainers (T0), each participant was given an Bluetooth-enabled retainer, logbook and iPod Touch installed with the mobile application. Participants were instructed to wear the retainer for 12 hours per day and record in the logbook each time the retainer was inserted or removed and trained to synchronize the device daily to the mobile application. After the 5-day study period (T1), statistical analysis was performed comparing the device-reported data to the logbook data using two calculation methods. RESULTS: From T0 - T1, the participants wore their retainers for a median of 11.55 hours per day and the median difference between the self-reported (logbook) data and the device data was 35 minutes or 5.1% over the 5-day study period. Using an adjusted method to calculate the device-reported wear time, the median error was 13 minutes or 1.9%. CONCLUSION: Subjects were able to successfully wear the retainer and upload the data to the mobile application and cloud database. Patient compliance and technical issues could be monitored daily via the provider webpage, and early intervention was possible with reminder messaging. The Bluetooth-enabled retainer showed a clinically acceptable level of accuracy and usability that validates it for future clinical testing.

Accuracy and reliability of the expected root position setup methodology to evaluate root position during orthodontic treatment.

INTRODUCTION: Current methods to evaluate root position either are inaccurate (panoramic radiograph) or expose patients to relatively large amounts of radiation (cone-beam computed tomography [CBCT]). A method to evaluate root position by generating an expected root position (ERP) setup was recently reported but has not been validated. The purpose of this study was to quantitatively assess the accuracy and reliability of the ERP setup with adequate statistical power. METHODS: This retrospective study included 15 subjects who had completed phase 2 orthodontic treatment. An ERP setup was generated for all patients after treatment. The ERP setup was compared with the posttreatment CBCT scan, which served as the control. The mesiodistal angulation and buccolingual inclination of all teeth in both the ERP setup and the posttreatment CBCT scan were measured and compared. Bland-Altman analysis was used to assess interoperator reliability, intraoperator reliability, and agreement between the ERP setup and the posttreatment CBCT scan. RESULTS: Bland-Altman plots showed high interoperator and intraoperator reliabilities. These plots also showed strong agreement between the ERP setup and the posttreatment CBCT scan; 11.8% of teeth measured for mesiodistal angulation and 9.6% of teeth measured for buccolingual inclination were outside the ±2.5° range of clinical acceptability. CONCLUSIONS: We validated that the method to generate an ERP setup to evaluate root position for posttreatment orthodontic assessment is accurate and reliable.

Three-dimensional evaluation of root position at the reset appointment without radiographs: a proof-of-concept study.

BACKGROUND: Accurate root position is integral for successful orthodontic treatment. Current methods of monitoring root position are either inaccurate, exhibit poor resolution, or use relatively large amount of radiation relative to the benefits for the patient. The purpose of this study was to present an approach that can monitor root position during orthodontic treatment with minimal radiation. METHODS: Cone-beam computed tomography (CBCT) scans were taken for a patient at pre-treatment and at a dedicated reset appointment. An extra-oral laser scan of a poured up cast was taken at the reset appointment. An expected root position (ERP) setup, an approximation of the root position at the reset appointment, was generated using the pre-treatment CBCT scan and reset appointment cast. The ERP setup was compared to the CBCT scan taken at the reset appointment which served as the control. Color displacement maps were generated to measure any differences between the expected and true root positions. RESULTS: Color map displacement analysis after indirect superimposition found displacement differences of 0.021 mm ± 0.396 mm for the maxillary roots and 0.079 mm ± 0.499 mm for the mandibular roots. CONCLUSIONS: This approach was demonstrated in a patient at the reset appointment to have the potential to accurately monitor root positions during treatment in three dimensions without the need for additional radiographs.

Congenital and acquired mandibular asymmetry: Mapping growth and remodeling in 3 dimensions.

INTRODUCTION: Disordered craniofacial development frequently results in definitive facial asymmetries that can significantly impact a person's social and functional well-being. The mandible plays a prominent role in defining facial symmetry and, as an active region of growth, commonly acquires asymmetric features. Additionally, syndromic mandibular asymmetry characterizes craniofacial microsomia (CFM), the second most prevalent congenital craniofacial anomaly (1:3000 to 1:5000 live births) after cleft lip and palate. We hypothesized that asymmetric rates of mandibular growth occur in the context of syndromic and acquired facial asymmetries. METHODS: To test this hypothesis, a spherical harmonic-based shape correspondence algorithm was applied to quantify and characterize asymmetries in mandibular growth and remodeling in 3 groups during adolescence. Longitudinal time points were automatically registered, and regions of the condyle and posterior ramus were selected for growth quantification. The first group (n = 9) had a diagnosis of CFM, limited to Pruzansky-Kaban type I or IIA mandibular deformities. The second group (n = 10) consisted of subjects with asymmetric, nonsyndromic dentofacial asymmetry requiring surgical intervention. A control group (n = 10) of symmetric patients was selected for comparison. A linear mixed model was used for the statistical comparison of growth asymmetry between the groups. RESULTS: Initial mandibular shape and symmetry displayed distinct signatures in the 3 groups (P <0.001), with the greatest asymmetries in the condyle and ramus. Similarly, mandibular growth had unique patterns in the groups. The dentofacial asymmetry group was characterized by significant asymmetry in condylar and posterior ramal remodeling with growth (P <0.001). The CFM group was characterized by asymmetric growth of the posterior ramus (P <0.001) but relatively symmetric growth of the condyles (P = 0.47). CONCLUSIONS: Forms of CFM are characterized by active and variable growth of the dysplastic side, which has a distinct pattern from other disorders of mandibular growth.

Evaluation of mandibular anterior alveolus in different skeletal patterns.

BACKGROUND: The boundaries for orthodontic tooth movement are set by the bony support of the dentition. This study compares the mandibular anterior alveolar housing in individuals with low, average, and high mandibular plane angles before orthodontic treatment and measures alveolar bone loss and root resorption after orthodontic treatment. METHODS: Pretreatment cone-beam computed tomography (CBCT) images of 75 non-growing individuals, 25 in three groups: low-angle (sella-nasion to mandibular plane ≤28°), average-angle (30°-37°), and high-angle (≥39°), were analyzed. Buccolingual bone thickness was measured at the root apex, mid-root, and alveolar crest of the mandibular right central incisor. Pre- and posttreatment CBCT images of 11 low-angle, 20 average-angle, and 27 high-angle patients were compared to determine changes in the alveolus and mandibular incisor root after orthodontic treatment. RESULTS: The pretreatment anterior alveolar bone widths were significantly different, wider in low-angle than in average- and high-angle individuals (p value = 0.000). High-angle individuals also had greater posttreatment external root resorption, even though the bony housing changed minimally. CONCLUSIONS: Negative sequelae of orthodontic treatment are more frequently found in individuals with high mandibular plane angles and could be linked to their thin pre-existing alveolar housing.