Changes in lateral standing posture following orthognathic surgery: a cohort study.

Altering neuromuscular and musculoskeletal relationships also affects standing body posture, particularly in the head and neck areas. This prospective cohort study assessed the effects of orthognathic surgery on head posture in the lateral standing view. Thirty-one patients who underwent single-jaw orthognathic mandibular surgery were included. The patients underwent cephalometric and photographic evaluations of their habitual posture before and 6 months after surgery. The craniovertebral angle and Frankfort angle were determined and measured using MB-Ruler software. Mandibular positional changes were also measured by superimposing lateral cephalograms and recording changes in the menton point. All data were analysed by paired t-test. The craniovertebral angle increased significantly in patients with Class II malocclusion (P = 0.001) and decreased significantly in Class III patients (P = 0.004). Furthermore, the Frankfort angle was significantly increased in both Class II (P = 0.005) and Class III (P = 0.012) patients. The tendency towards forward head posture decreased in Class II patients, and the neck posture improved. Conversely, a slight but significant tendency towards a forward head posture was observed in Class III patients after surgery. Furthermore, the natural head position changed in both study groups, leading to a more upright head posture.

Evaluating malocclusion patterns in children with autism spectrum disorder using the index of complexity, outcome and need: a cross-sectional study.

BACKGROUND: The purpose of this study was to evaluate the complexity of malocclusion and existing patterns in children with autism spectrum disorders (ASD) using the index of complexity, outcome and need (ICON). METHODS: This cross-sectional study included children diagnosed with ASD, aged 9-15 years. A group of healthy children with the same demographic characteristics was randomly selected as the control group. Malocclusion was assessed according to ICON scoring protocol. The following parameters were recorded: dental aesthetics, upper arch crowding/spacing, presence of crossbite, anterior-vertical relationship (open and deep bite) and buccal segment anterior-posterior relationship. Finally, an overall ICON score was derived and reported for each patient. Descriptive analysis was performed for all investigated variables. Significance level was set at p < 0.05. RESULTS: A total of 324 children, divided into ASD (162) and control (162) groups, comprised the study population. Our results demonstrated that the average overall ICON score was significantly higher in the ASD group compared to the control group (38.77 vs. 27.43, p < 0.001). ASD children also obtained significantly higher scores regarding the dental aesthetics component (3.84 vs 2.78, p < 0.001). Study groups were significantly different in terms of the prevalence of incisor overbite and open bite (p = 0.002 and p < 0.001, respectively). Patients in the ASD group showed a higher prevalence of Class II and Class III malocclusions (p < 0.001). CONCLUSION: ASD children obtained significantly higher overall ICON scores, indicating more complex and severe malocclusions. These children also exhibited a greater tendency towards Class II and III malocclusions.

Mapping the evolving trend of research on Class III malocclusion: a bibliometric analysis.

OBJECTIVES: This study aimed to provide visualized knowledge maps to show the evolving trends and key focal points of Class III malocclusion research through a comprehensive bibliometric analysis. MATERIALS AND METHODS: Class III malocclusion research published between 2000 and 2023 was retrieved from the Web of Science Core Collection. VOSviewer was utilized to count the citation and publication number of authors, institutions, countries and journals. Co-occurrence, co-citation, and cluster analyses and burst detection were conducted using CiteSpace. RESULTS: A total of 3,682 publications on Class III malocclusion were included in the bibliometric analysis. During 2000-2023, both the annual publication count and citation frequency exhibited a gradual upward trajectory, with a noticeable surge in recent years. In terms of production and citation counts of Class III malocclusion research, the core journal is the American Journal of Orthodontics and Dentofacial Orthopedics. Furthermore, apart from the primary keyword 'Class III malocclusion', 'orthognathic surgery' was identified as keyword with the most frequency. The cluster analysis of cited references reveals that the research focal points have shifted to 'skeletal anchorage' and 'surgery-first approach'. Furthermore, the burst detection identified 'quality of life' as a potential research hotspot since it has recently gained increasing scholarly attention. CONCLUSIONS: The current study provides scholars with the knowledge maps of evolving trends and prominent topics of Class III malocclusion research and a summary of research progress on various priorities during different periods. These findings are expected to provide a valuable guidance to facilitate the future research on Class III malocclusion.

The Influence of the Tongue on the Development of Dental Malocclusion.

The tongue supports the upper dental arch and encourages healthy dental arch development when it rests against the roof of the mouth. On the other hand, over time, malocclusion can result from incorrect tongue position, such as lying low in the mouth or thrusting forward during swallowing or speaking. As a muscular organ, the tongue applies forces to the jaws and teeth that may help with malocclusion or hinder it from aligning properly. The dentition and jaws grow and align according to the way the tongue, teeth, and surrounding structures interact. The tongue's morphogenetic function includes forming the arches and having an important impact on the maxillary complex's development. The tongue frequently assumes a balancing and compensatory function in subsequent phases, functioning more or less like a natural orthodontic bite. In adults, the tongue is able to compensate for problems like open bites, teeth that are out of alignment, or differences in the occlusal and sagittal planes of the spine. In this context, the tongue's ability to sustain occlusion during malocclusion can be considered a compensatory response. This is comparable to how lingual dysfunction may contribute to malocclusion or act as a potential source of recurring orthodontic instability. In order to diagnose and treat orthodontic issues, dental professionals must know the connection between tongue position and dental malocclusion. Malocclusion can be prevented or minimized with early intervention, such as myofunctional therapy to correct tongue position and habits, improving dental health and well-being overall.

Investigation of Malocclusion and Associated Factors in Preschoolers: A Cross-Sectional Questionnaire Study.

This study aims to describe the prevalence of malocclusion and identify associated factors in preschool children. Completed in 2022-2023, this cross-sectional study included 523 children aged 26 to 80 months in municipal schools in Salvador. An oral examination was carried out on the children, and a questionnaire was self-administered by the parents. Descriptive analyses and multivariate logistic regression (the backward method, p-value ≤ 0.05, 95% CI) were conducted. The majority of children were female (51.82%), over 54 months old (52.2%), Black or mixed race (90.63%), and not affected by COVID-19 (92.35%). The prevalence of malocclusion was 43.21%, with open bite as the most common condition. There was a significant association between malocclusion and screen time (OR: 1.34; p: 0.116; CI: 1.0-1.94), physical/psychological aggression (OR: 2.55; p: 0.031; CI: 1.0-5.98), consumption of ultra-processed foods (OR: 1.77; p: 0.003; CI: 1.22-2.57), digital suction (OR: 3.1; p: 0.001; CI: 1.56-6.16), and the habit of biting objects (OR: 1.56; p: 0.121; CI: 1.0-2.73). The promotion of comprehensive health in early childhood and psychosocial interventions are recommended, aiming to reduce screen time, aggression, consumption of ultra-processed foods, thumb sucking, and the habit of biting objects to prevent malocclusion.

Exploring Temporomandibular Disorders (TMDs) and Occlusion Debate in Dentistry: Biting Into Controversy.

Some conditions known as temporomandibular disorders (TMDs) affect surrounding muscles and jaw joints. In dentistry, there has been discussion and research on the connection between TMDs and occlusion, which is how the upper and lower teeth meet. Although some dental experts have proposed a direct link between TMDs and occlusion, the specifics of this relationship are still unclear and have many facets. More particularly, the research facets of "occlusion" remain one of the most contentious subjects in TMDs. This abstract aims to provide an overview of TMDs and occlusion, summarizing the key points from the literature. The etiological factors contributing to the TMDs, including occlusal, psychological, and hormonal factors, are also analyzed. The second part of the article includes the concept of malocclusion, emphasizing its significance in masticatory function and overall health. Anterior open and posterior open bites and the potential influence of occlusal factors on TMDs are elucidated.

Orthognathic surgery improves compromised natural head position and pharyngeal airway in patients with Skeletal Class II or III malocclusion.

BACKGROUND: Natural head position (NHP), pharyngeal airway and maxillofacial growth pattern are correlated. The author's previous studies proved that following surgical correction of Skeletal Class II malocclusion, the over-extended NHP returned upright, and the pharyngeal airway space (PAS) dimension expanded. OBJECTIVE: The present study compares the post-operative change in NHP and PAS after orthognathic surgery in Skeletal Class II and III malocclusion patients. METHODS: Patients receiving orthognathic procedures to correct Skeletal Class II or III malocclusions were reviewed in this retrospective study. Pre-operative and 6-week post-operative cone-beam computed tomography datasets were collected. Variables representing the craniofacial pattern, the NHP and the PAS were measured three-dimensionally. Post-operative variables were compared with their pre-operative counterparts using either repeat-measure 2-way analysis of variance or Wilcoxon matched-pairs signed rank test. RESULTS: Thirty cases of Skeletal Class II malocclusion and 13 cases of Skeletal Class III malocclusion were collected. Preoperatively, the inter-group differences were significant in craniofacial pattern (68.14 ± 3.552 degree vs. 79.63 ± 2.497 degree, p < .0001) and the NHP (68.77 ± 11.02 degree vs. 82.83 ± 7.738 degree, p = .0002) while not significant in PAS; after surgery, the intergroup differences in craniofacial pattern and the NHP between groups decreased, and the PAS increased in both groups. CONCLUSION: Orthognathic surgery may improve compromised NHP and increase PAS in Skeletal Class II and III malocclusion patients.

"The impact of orthognathic surgery on articulation proficiency and speech intelligibility in skeletal Class III malocclusion: 18 months follow up".

Introduction: Orthognathic surgery results in the positional change of the maxilla and mandible that may affect speech. The present study evaluated the effect of combined maxillary advancement and mandibular setback surgery on articulation proficiency and speech intelligibility in patients with non-syndromic skeletal Class III malocclusion. Methods: In this prospective study, twenty-five patients with skeletal class III malocclusion and consecutively treated with Lefort-1 maxillary advancement and mandibular setback (BSSO) orthognathic surgery were included in this study. The speech sample was recorded with a digital audio tape recorder one day before surgery and at 3, 6, 9, 12 and 18 months after surgery. Three qualified and experienced speech and language pathologists evaluated articulation errors and intelligibility of speech samples. Repeated One-way analysis of variance was used to compare articulation proficiency and speech intelligibility at different time intervals. Results: The substitution, omission, distortion and addition errors showed no significant changes at 3 months and 6 months. The total articulation errors decreased to zero at 9 months and no significant increase was observed till 18 months (P < 0.05). Speech intelligibility showed statistically non-significant improvement at any time interval. Cephalometric skeletal parameters SNA and N l A°. were significantly correlated with addition and total articulation errors at 18 months follow up. Conclusions: The ortho-surgical treatment improves speech (decreases. articulation errors) in most of the patients usually 6-9 months post-surgery. Speech intelligibility is not affected by bimaxillary orthognathic surgery in skeletal class III patients. The articulation errors were correlated to changes in position of maxilla.

Evaluation of the skeletal and dental effects of a hybrid aesthetic functional appliance (HAF) in skeletal class II division 1 malocclusion: A prospective uncontrolled clinical trial.

Background: The present study investigated the skeletal and dental effect in class II division I growing patients due to mandibular deficiency treated with the hybrid aesthetic functional (HAF) appliance. Methods: A sample of 16 growing patients (5 boys and 11 girls; mean age: 9.50 years, standard deviation: 1.15) with class II division I malocclusion were treated using the HAF appliance for an average period of 10±3 months. For each patient, a cephalometric radiograph was taken before and after treatment, and digital analysis was applied using the WebCeph program. The statistical analysis was performed to evaluate dental and skeletal changes associated with the HAF appliance and determine if there were any statistically significant variations in anatomical measurements between the start and completion of the treatment. Results: The data showed a significant increase in SNB angle (P=0.002), leading to a significant decrease in ANB angle (P=0.001). The mandibular length significantly increased (P=0.008), the lower incisors were flared significantly (P=0.028), and the lower molars were extruded significantly (P≤0.001). Also, this study revealed a significant decrease in Wits appraisal (P≤0.001), overjet (P≤0.001), and overbite (P=0.041). Additionally, a significant increase in lower anterior facial height (P≤0.001), total facial height (P=0.001), and posterior facial height (P=0.037) were observed. Conclusion: The HAF appliance showed that it could be used to correct class II division 1 skeletal discrepancy by mandibular advancement. The HAF appliance increased all facial heights significantly.

Evaluation of Malocclusion Types in Adult Patients with Nasal Septal Defects - An Observational Cross-Sectional Analysis.

Introduction: The nasal septum is crucial in the development of the craniofacial structures. Deviated nasal septum is one of the anatomical causes of mouth breathing which in turn lead to malocclusion. Aims and Objectives: To evaluate the dentofacial and cephalometric characteristics in individuals with nasal breathing obstruction brought on by nasal septal deviation, as well as the relationship between these defects and various malocclusions and the degree of facial asymmetry. Materials and Methods: A two-point evaluation was adopted for the selected patients, one at the ENT department using clinical examination and CT-PNS and the severity classified according to the Mladina classification and another at the dental department, using clinical examinations, PA cephalograms, lateral cephalograms, and facial photographs. Results and Discussion: The association between malocclusion and various grades of septal deviation was statistically significant with a P value of 0.006. Results showed that 13 patients are with Class I skeletal pattern, 20 patients with Class II, and 7 patients with Class III skeletal pattern. None of the grade 7 nasal septal deviation patients had class I malocclusion and none of the grade 2 nasal septal deviation patients had class III malocclusion. Class II division I malocclusion was the most common type noted in patients with nasal septal deviation. Grade 7 nasal septal deviation was associated with the maximum amount of ANS and mentioned deviation indicating significant facial asymmetry. Conclusion: Class-II Division-1 malocclusion was the most common type noted and Class III malocclusion was more common in higher grades of nasal septal deviation. Maxillary and mandibular asymmetry worsens significantly with an increase in the grade of nasal septal deviation and is one of the significant factors in causing facial asymmetry.

Effect of Early Orthodontic Treatment on Long-Term Stability of Class II Malocclusions.

Background: Class II malocclusions are a common orthodontic problem, often requiring comprehensive treatment to achieve proper occlusion and facial harmony. Early orthodontic intervention in the mixed dentition phase has been advocated to address these issues. Materials and Methods: A retrospective analysis was conducted on a cohort of 150 patients with class II malocclusions who underwent early orthodontic treatment between the ages of 7 and 10 years. The treatment included fixed or removable appliances, headgear, and functional appliances, depending on individual needs. Records of their initial malocclusion severity, treatment modalities, and long-term follow-up data (mean follow-up duration of 10 years) were collected and analyzed. Stability was assessed by evaluating overjet and overbite changes from post-treatment to the long-term follow-up. Results: The initial mean overjet and overbite values were 8.5 mm and 4.0 mm, respectively. Following early orthodontic intervention, these values were significantly reduced to 3.0 mm and 1.5 mm, respectively (P < 0.001). At the long-term follow-up, the mean overjet and overbite remained stable at 3.2 mm and 1.6 mm, respectively. Analysis revealed that 85% of patients maintained their corrected class II occlusion within clinically acceptable limits, while 15% experienced minor relapse requiring minimal additional treatment. Conclusion: Early orthodontic treatment in class II malocclusions can lead to significant improvements in overjet and overbite, and these corrections tend to remain stable over the long term.

Knowledge, Attitude and Perception Regarding Myofunctional Appliance among Children-Prospective Study of Parents' View.

Aim: The current purpose of the survey is to completely evaluate parents' attitudes, knowledge, and perceptions of myofunctional appliances. Materials and Methods: Parents in Chennai participated in this cross-sectional web-based questionnaire survey. Pilot study was carried out to determine the sample size, and 500 individuals were the final sample size. The 10 organized, predesigned, and validated questions are on awareness of myofunctional appliance. Results: The result of the survey showed that in 500 subjects, 79.8% were aware of skeletal problems. The proportion of parents willing to recommend the use of such treatments is about 70%, while 69% believe that myofunctional appliances are important in correcting skeletal problems. Conclusion: The present study has established that most parents know about the functional appliance and have an understanding of how to distinguish between skeletal problems. In order to diagnose skeletal issues in an appropriate age range for the individual, more awareness about appliances is necessary and needs to be developed.

Assessment of Aesthetic Smile Components in Patients With Skeletal Class II Vertical and Horizontal Growth Patterns Compared to Class I Cases.

Introduction In orthodontics, having a beautiful smile is very important. It is frequently the main driving force behind people's efforts to enhance their oral health and professional opportunities. Orthodontic and dental treatment planning might benefit greatly when evaluating the aesthetic components of a patient's smile in individuals with varying skeletal growth patterns. In order to help orthodontists achieve the best possible functional and aesthetic results for their patients, the eight elements of a balanced smile are essential to orthodontic therapy. This study aims to evaluate, in comparison to Skeletal Class I Average instances, eight balanced smile components in patients with Skeletal Class II Vertical and Horizontal growth patterns. Methodology A total of 45 patients aged 14-30 were selected from the Orthodontics and Dentofacial Orthopedics Out-Patient Department (OPD). They were divided into three groups: Skeletal Class I Average, Skeletal Class II Vertical, and Skeletal Class II Horizontal cases based on their malocclusion type. Patients were made to smile in response to a joke or social conversation and their photos were analyzed using Photopea software (Photopea Inc., Prague, Czech Republic) to determine the eight components of a balanced smile. Result Three skeletal classes' worth of smile components were examined in this study. Lip line measurements varied greatly; the highest mean measurement was found in the Skeletal Class II Vertical group (p-value < 0.01). There were no noteworthy correlations found between smile arc and upper lip curvature. Measurements of lateral negative space did not show any significant group differences. On the other hand, a significant correlation was seen in smile symmetry, where asymmetrical smiles were more prevalent in Skeletal Classes I and II Vertical groups (p-value is 0.00072). While arch symmetry suggested a potential relationship between the groups, dental midline alignment revealed possible associations. Conclusion Assessing the aesthetic components of smiles in patients with varying skeletal growth patterns, i.e., contrasting Class II Vertical and Horizontal growth patterns with Class I Average cases, provides valuable information about the connection between smile aesthetics and facial skeletal structure. The results suggest that when compared to Class I typical instances, Skeletal Class II Vertical and Horizontal growth patterns may show clear variations in certain aspects of an attractive smile. Comprehending these variations is essential for devising treatment strategies for patients, and additional investigation is needed. In order to obtain optimal aesthetic outcomes, treatment strategies should strive to optimize smile aesthetics while addressing personalized treatment plans that take into account the patient's unique facial features, smiling preferences, and functional requirements.

Relation between orthodontic malocculusion and maxillary sinus volume.

BACKGROUND: This study aimed to determine maxillary sinus volume (MSV) in different skeletal malocclusion classes and the correlation between MSV and craniofacial morphology on Cone Beam Computed Tomography (CBCT). MATERIALS AND METHODS: The study was performed retrospectively on CBCT images of individuals aged 12-24 years. A total of 129 patients (70 females, 59 males) with a normal vertical growth pattern (27° ≤ SNGoMe ≤ 38°) were divided into three groups according to malocclusion. Group 1 consisted of Class I (1 ≤ ANB ≤ 4) (n = 46) patients, Group 2 consisted of Class II (ANB > 4) (n = 47) patients, and Group 3 consisted of Class III (ANB < 1) (n = 36) patients. Four angular (SNA, SNB, ANB, SNGoMe) and linear (S-N, ANS-PNS, S-Ar, N-ANS) parameters were measured to evaluate craniofacial morphology. Right and left MSV were measured using Dolphin 11.0 (Dolphin Imaging, Chatsworth, CA, USA) Imaging software. Pearson's correlation analysis was performed to assess statistical correlation. RESULTS: MSV was larger in males than females (male AMSV = 14244.1 ± 4735.8, female AMSV = 12778.2 ± 4606.9 p = 0.011) in the general population, but just the Class II group showed this (male AMSV = 16089.6 ± 4330.4, female AMSV= 12705.9 ± 3210.2, p = 0.008). RMSV and LMSV were similar (female p = 0.181 male p = 0.097), and MSV showed no significant differences between the different malocclusion classes in both sex (female p = 0.315, male p = 0.118). In the Class III group, SNB was positively correlated with RMSV (r = 416, p = 0.012). MSV showed significant positive correlation with N-ANS in all groups (Class I r = 0.359, p = 0.014, Class II r = 0.336, p = 0.021, Cl III r = 0.387, p = 0.02). In the Class II and Cl III groups, there is a statistically significant correlation between MSV and the S-N parameter (Class II r = 0.304, p = 0.038, Class III r = 0.412, p = 0.013). ANS-PNS parameter was measured at the lowest statistically significant level (female 43.1 ± 3.9a, p < 0.001, male 43.1 ± 4.3a, p < 0.001) in the Class III group but no correlation was found with MSV. Only Class II group showed a weak positive correlation between MSV and ANS-PNS (r = 0.314, p = 0.032). CONCLUSIONS: There was no difference regarding MSV between malocclusion classes. Class II males exhibit significantly larger MSV compared to females. There is a correlation between MSV and SNB, S-N, N-ANS and ANS-PNS parameters for various orthodontic skeletal patterns. Further studies are needed to understand the relationship between MSV and different skeletal structures.

Family-based GWAS for dental class I malocclusion and clefts.

BACKGROUND: Individuals born with cleft lip and/or palate who receive corrective surgery regularly have abnormal growth in the midface region such that they exhibit premaxillary hypoplasia. However, there are also genetic contributions to craniofacial morphology in the midface region, so although these individuals appear to have Class III skeletal discrepancy, their molar relationship may be Class I. Past genome-wide association studies (GWASs) on skeletal Class II and III malocclusion suggested that multiple genetic markers contribute to these phenotypes via a multifactorial inheritance model, but research has yet to examine the genetic markers associated with dental Class I malocclusion. Thus, our goal was to conduct a family based GWAS to identify genes across the genome that are associated with Class I malocclusion, as defined by molar relations, in humans with and without clefts. METHODS: Our cohort consisted of 739 individuals from 47 Filipino families originally recruited in 2006 to investigate the genetic basis of orofacial clefts. All individuals supplied blood samples for DNA extraction and genotyping, and a 5,766 single nucleotide polymorphism (SNP) custom panel was used for the analyses. We performed a transmission disequilibrium test for participants with and without clefts to identify genetic contributors potentially involved with Class I malocclusion. RESULTS: In the total cohort, 13 SNPs had associations that reached the genomic control threshold (p < 0.005), while five SNPs were associated with Class I in the cohort of participants without clefts, including four associations that were identified in the total cohort. The associations for the SNPs ABCA4 rs952499, SOX1-OT rs726455, and RORA rs877228 are of particular interest, as past research found associations between these genes and various craniofacial phenotypes, including cleft lip and/or palate. CONCLUSIONS: These findings support the multifactorial inheritance model for dental Class I malocclusion and suggest a common genetic basis for different aspects of craniofacial development.

The Prevalence and Association of Non-metric Dental Traits With Dentoskeletal Malocclusion and ABO Blood Groups in the Maharashtrian Population.

Introduction Non-metric dental traits (NMDTs) are a fundamental data source in forensic dentistry. Nevertheless, the insufficiency of data regarding the occurrence of these traits has instigated the present research endeavor aimed at ascertaining the prevalence, sexual dimorphism, and extent of inter-trait correlations within the Maharashtrian population of India. The secondary objective was to determine the correlations between NMDTs, dentoskeletal malocclusion, and ABO blood groups. Materials and methods This prospective, observational study included 528 individuals aged 18-30 years with dentoskeletal Class I, II, and III malocclusions. NMDTs such as the presence of Cusp of Carabelli (CoC) on the upper first molars, hypocone on the upper second molars, and tri- or bicuspid lower second premolars were observed on the dental casts of all individuals. The dental relationship was assessed clinically according to Angle's system for the classification of malocclusion. The skeletal relationship was assessed using lateral cephalograms of the individuals. ABO blood groups were obtained from their medical records. The Chi-square test of independence was used to assess the associations between various variables. The correlation between each measurement was determined using Spearman's correlation test. Multivariate analysis enabled the identification of parameters that exhibited independent associations with NMDTs. A multinomial logistic regression model was constructed using NMDTs as the outcome variable. Results The mean age of males was 20.82 ± 1.71 years and 21.15 ± 1.76 years was in females. NMDTs were predominantly seen in females (n=394, 75%), with Class II dentoskeletal malocclusion (n=265, 50%) and B blood group ((n=199, 38%). All traits showed bilateral predominance. A statistically significant association was found between CoC, dentoskeletal malocclusion, hypocone, and tricuspid lower second premolars (p <0.05). All NMDTs showed a negative correlation with sex, a positive correlation between age and the presence of hypocones and CoC, a negative correlation between age and tricuspid lower second premolars, a strong positive correlation with dentoskeletal malocclusion, and a weak positive correlation with ABO blood groups. Multinomial logistic regression model analysis revealed that none of the independent variables were statistically significant predictors of the presence of CoC and tricuspid lower second premolars, while dentoskeletal malocclusion and sex were significant predictors of the presence of the hypocone trait. Conclusion NMDTs showed a female predilection with bilateral predominance. A significant association was observed between these traits and dentoskeletal malocclusions. The most commonly observed NMDT was the presence of a hypocone on the upper second molars, followed by the tricuspid lower second premolars and the CoC.

Addressing Acromegaly-Related Malocclusion With Surgery-First Orthognathic Surgery: A Clinical Case Report.

Angle's class III malocclusions are characterized by the anterior positioning of the mandible in relation to the maxilla. The discrepancy can be caused by an anterior deficiency of the maxilla, excessive mandibular prognathism, or a combination of both. Acromegaly is a dysfunction caused by the excessive production of growth hormone (GH), which leads to systemic changes and orofacial manifestations. In acromegaly caused by a pituitary adenoma, which secretes an excessive amount of GH, disproportionate mandibular growth may occur, leading to skeletal class III malocclusion in adulthood. Excessive growth stops when the tumor is removed, but the skeletal deformity persists, requiring orthognathic surgery to reposition the mandible. This article reports the case of a 31-year-old man referred to the maxillofacial surgery consultation due to severe Angle's class III malocclusion, with prognathism, mandibular asymmetry, and maxillary retrusion. He had a history of disproportionate soft tissue growth (hands and feet) up to 18 years old, less evident after that age. Considering the possibility of acromegaly due to a pituitary adenoma, imaging studies (CT scan and magnetic resonance imaging (MRI)) and directed analytical studies were requested. When the diagnosis was confirmed, the patient was referred to endocrinology and neurosurgery consultations. After undergoing endoscopic resection of the pituitary adenoma, the patient underwent surgery-first orthognathic surgery to correct the dental malocclusion.

Positional, morphologic, and volumetric differences in TMJ in unilateral posterior crossbites and controls: A retrospective CBCT study.

OBJECTIVES: The objective of this study was to evaluate if there are any morphologic, positional, and volumetric differences in the temporomandibular joint (TMJ) of patients with unilateral posterior crossbite (UPC) compared to controls. Another objective was to analyse the discrepancy in the TMJ between the crossbite versus non-crossbite side in UPC versus right and left sides in controls. Additionally, this study aimed to evaluate the differences in the bone density at the masseteric insertion site at the angle of mandible in the UPC group and control group. MATERIAL AND METHODS: One hundred and thirty-two CBCTs were analysed with 66 patients in UPC group and 66 patients in control group (non-crossbite). Temporomandibular joint spaces - Anterior joint space (AJS), Superior joint space (SJS), Posterior joint space (PJS), Medial joint space (MJS), Middle joint space (MiJS), and Lateral joint space (LJS) were measured. Additionally, bone density at angle of mandible and volume of mandibular condyle were evaluated. The measurements were compared between the groups as well as between the crossbite and non-crossbite sides within the UPC group and between right and left sides within the control group. Furthermore, the associations between UPC and changes in TMJ regarding joint space availability, bone density, condylar head volume, and the effects of sex and age were evaluated using regression analysis. RESULTS: It was observed that UPC group showed a greater condylar volume, than the control group. Additionally, a larger mean discrepancy was observed between the crossbite side and non-crossbite side within the UPC group concerning condylar volume than controls. Concerning age, condylar volume was observed to be larger in adults than children. Adults showed significantly greater bone density and condylar volume than adolescents. Concerning sex, it was observed that males showed a larger SJS (right), MiJS, LJS, and bone density at the mandibular angle than females. CONCLUSION: There is a difference in the TMJ parameters particularly condylar volume in patients with UPC compared to controls.

Accuracy of patient-specific implants versus CAD/CAM splints with the mandible-first approach in bimaxillary orthognathic surgery for skeletal Class II malocclusion.

This retrospective study aimed to compare the accuracy of patient-specific implants (PSI) versus mandible-first computer-aided design and manufacturing (CAD/CAM) splints for maxilla repositioning in orthognathic surgery of skeletal Class II malocclusion patients. The main predictor was the surgical method (PSI vs. splints), with the primary outcome being the discrepancy in maxilla centroid position, and secondary outcomes being translation and orientation discrepancies. A total of 82 patients were enrolled (70 female, 12 male; mean age 25.5 years), 41 in each group. The PSI group exhibited a median maxillary position discrepancy of 1.25 mm (interquartile range (IQR) 1.03 mm), significantly lower than the splint group's 1.98 mm (IQR 1.64 mm) (P < 0.001). In the PSI group, the largest median translation discrepancy was 0.74 mm (IQR 1.17 mm) in the anteroposterior direction, while the largest orientation discrepancy was 1.83° (IQR 1.63°) in pitch. In the splint group, the largest median translation discrepancy was 1.14 mm (IQR 1.37 mm) in the anteroposterior direction, while the largest orientation discrepancy was 3.03° (IQR 2.11°) in pitch. In conclusion, among patients with skeletal Class II malocclusion, the application of PSI in orthognathic surgery yielded increased precision in maxillary positioning compared to mandible-first CAD/CAM splints.

A comprehensive national survey on malocclusion prevalence among Palestinian children.

BACKGROUND: This study aims to evaluate the prevalence of malocclusion and orthodontic features among schoolchildren in the West Bank, Palestine. METHODS: A stratified cluster sample of 1278 schoolchildren (620 males, 658 females, mean age 12 years and 5 months (± 0.5)) were examined. Candidates who had not received any previous orthodontic treatment were only included. Dental anomalies like missing and ectopic teeth were recorded. The anteroposterior occlusal relationship was assessed based on Angle classification. Overjet and overbite were measured. Crowding and spacing were recorded subjectively. In addition, crossbite, openbite, and midline displacement were recorded. The chi-square test and descriptive analysis were used statistically. RESULTS: The study found Angle Class I molar relationship in 65%, Class II div 1 in 17%, Class II div 2 in 6%, and Class III in 12% of the sample. An overjet (OJ) of more than 4 mm was present in 17%, and 4% had OJ of more than 6 mm; an OJ of at least 0 mm or less in 36%, and 6% had a reverse OJ. A normal overbite was observed in 53%, while 28% had an increase and 19% had a decreased overbite. An anterior openbite (AOB) was present in 9%, and a scissor bite or anterior crossbite in 6% and 14%, respectively. A posterior crossbite was observed in 12% (9% unilateral and 3% bilateral). Midline displacement was found in (9%). Crowding was observed in 35% and 31% and spacing in 24% and 15% of the maxillary and mandibular arches, respectively. A statistically significant relationship between gender and midline shift, a diastema, spacing in the upper arch, and most dental anomalies was found; males were more affected (p < 0.05). CONCLUSION: This study reported a high prevalence of malocclusion among schoolchildren in Palestine. A collaborative effort should be directed to obtain more monitoring and surveillance of malocclusion more frequently to prevent and control the exacerbation of the problem.