Botulinum Toxin Versus Dextrose Prolotherapy: Which is More Effective for Temporomandibular Joint Subluxation? A Randomized Clinical Trial.

PURPOSE: Botulinum toxin type A (BTX-A) therapy or dextrose prolotherapy (DP) has been used to treat temporomandibular joint (TMJ) disorders. However, the superiority of one method over the other has not been studied in patients with TMJ subluxation. Therefore, this study aims to answer the following clinical question: among patients with TMJ subluxation, do those undergoing BTX-A injection into lateral pterygoid muscles, compared to those undergoing intra- and periarticular DP injections, have better outcomes in terms of locking episodes and patient satisfaction? METHODS: A randomized clinical trial was implemented in adult patients with TMJ subluxation. The sample was composed of patients with TMJ subluxation with painful open-locking during wide mouth opening and/or yawning at baseline. The subjects were treated randomly with one of two treatment techniques with equal numbers as follows: one-session BTX-A injection into lateral pterygoid muscles (BTX-A group) or three sessions of dextrose injections around TMJ (prolotherapy group). The predictor variable was the treatment technique (BTX-A or prolotherapy injections). The primary outcome variable was the frequency of locking episodes. The secondary outcome variable was patient satisfaction. The primary outcome variable was recorded at baseline and 8-12 months following the injections. The secondary outcome variable was recorded only 8-12 months following the injections. Descriptive and bivariate statistics were computed. The data were analyzed with the Wilcoxon and Mann-Whitney U tests. RESULTS: The baseline sample was composed of 30 patients with TMJ subluxation. However, the follow-up sample comprised 25 subjects: 11 (9 females, 2 males; 25.64 years) in the BTX-A group and 14 (10 females, 4 males; 32.37 years) in the prolotherapy group. Locking episodes decreased significantly in the two groups with no significant difference (P < .01). Seven patients in the BTX-A group (7 of 11 patients; 63.6 percent) and eight (8 of 14 patients; 57.1 percent) in the prolotherapy group reported no complaint of locking at the end of follow-up, with no significant difference between the groups (P > .05). Patient satisfaction showed no significant difference between the groups (P > .05). CONCLUSION: These findings suggested that BTX-A injection is no more effective than DP for any outcome variables of TMJ subluxation assessed.

An alternative treatment approach for patients with resistant otitis media with effusion and dysfunctional Eustachian tube.

OBJECTIVES: To determine whether dysfunctional Eustachian tubes of children with resistant otitis media with effusion (OME), ventilation tube placement indication, and maxillary constriction will recover after rapid maxillary expansion (RME). MATERIALS AND METHODS: The RME group consisted of 15 children (mean age: 10.07 years) with maxillary constriction, Eustachian tube dysfunction (ETD), and resistant OME. The control group consisted of 11 healthy children (mean age: 8.34 years) with no orthodontic and/or rhinologic problems. Recovery of Eustachian tube dysfunction was evaluated by Williams' test at three timepoints: before RME/at baseline (T0); after RME (T1); and after an observation period of 10 months (T2). The control group was matched to all these periods, except T1. RESULTS: In the control group, functioning Eustachian tubes were observed in all ears at baseline (T0), and tubes showed no worsening and no change during the observation period (T2) (P > .05). In the RME group, functioning Eustachian tubes were observed in eight of 30 ears and ETD was observed in the remaining 22 ears at baseline (T0). The RME group showed significant improvements in tube functions after RME and the observation period (P < .05). Fifteen of 22 dysfunctional ears recovered (68.2%) and started to exhibit normal Eustachian tube function after RME (T1) and the observation period (T2). CONCLUSIONS: The findings suggest that ears having poorly functioning Eustachian tubes are restored and recovered after RME in most of children with maxillary constriction and resistant OME. Thus, RME should be preferred as a first therapy alternative for children with maxillary constriction and serous otitis media.

Orthodontic Intervention to Impacted and Transposed Lower Canines.

Impacted and transposed teeth cause serious difficulties in tooth eruption and movement as well as esthetic and functional outcomes. Proper treatment planning including good biomechanical control is essential in order to avoid side effects during traction and aligning of the impacted and/or transposed teeth. The purpose of the present study was to present a successfully treated female patient having transposed and impacted lower canines by means of a modified lingual arch and fixed orthodontic appliance. A female patient aged 13 years and 9 months presented to the orthodontic department with a chief compliant of bilateral spacing and missing teeth in mandibular dentition. After leveling and creating sufficient space in the mandibular arch for the canines, a modified lingual arch was cemented to the mandibular first molars. The lingual arch had two hooks extending to the distobuccal areas of the canine spaces. Elastic chains were applied between the hooks on the lingual arch and the ligatures tied to the attachments on the canine crowns. The light forces generated by elastic materials caused impacted canines to erupt and tend towards their own spaces in the dental arch. As a result, impacted and transposed lower canines were properly positioned in their spaces, and the treatment results were stable during the retention period.

Rapid maxillary expansion versus middle ear tube placement: Comparison of hearing improvements in children with resistance otitis media with effusion.

OBJECTIVE: To test the null hypothesis that there are significant differences in hearing improvements of children with resistance otitis media with effusion (OME) who undergo a rapid maxillary expansion (RME) procedure or ventilation tube placement. METHODS: Forty-two children between 4.5 and 15 years old were divided into three groups: RME, ventilation tube, and control groups. The RME group consisted of 15 children with maxillary constriction and resistance OME that indicated ventilation tube placement. The ventilation tube group consisted of 16 children for whom ventilation tube placement was indicated but no maxillary constriction. The control group consisted of 11 children with no orthodontic and/or rhinologic problems. Hearing thresholds were evaluated with three audiometric records: (1) before RME/ventilation tube placement (T0); (2) after RME/ventilation tube placement (T1), and (3) after an observation period of 10 months (T2). The control group was matched to these periods, except T1. RESULTS: Hearing thresholds decreased significantly in both the RME and ventilation tube groups (P < .001). Hearing thresholds decreased approximately 15 and 17 decibels in the RME and ventilation tube groups, respectively, but differences in improvements were insignificant between the two study groups (P > .05). Slight changes were observed in the control groups. CONCLUSION: The null hypothesis was rejected. RME showed similar effects as ventilation tube placement for release of otitis media and improvement of hearing thresholds levels. RME should be preferred as a first treatment option for children with maxillary constriction and resistance OME.

Do children with Wilson's disease have distinct craniofacial morphology? A cephalometric study.

OBJECTIVES: Patients with Wilson's disease (WD) develop osseous changes such as osteoporosis, spontaneous fractures, areas of sclerosis and demineralization of maxillary and mandibular bones, and neurologic symptoms including swallowing dysfunctions, which may affect dento-facial growth. However, dento-maxillo-facial structures of these patients have never been investigated. The present study aimed to discover if subjects with WD have different dentofacial structures. METHODS: Lateral cephalometric films of 13 children (5 males and 8 females) with WD and of 15 normal subjects (6 males and 9 females) were evaluated. Mean ages of the patients and controls were 12.62 ± 3.09 years and 12.01 ± 1.38 years, respectively. Lateral cephalometric cranial films of all subjects were taken in the same cephalostat in a habitual and unstrained body posture. Thirteen linear and 11 angular parameters were measured to describe the craniofacial characteristics of the subjects. RESULTS: Statistical analysis showed that there is no statistically significant difference between parameters of normal children and children with WD, with the exception of palatal plane inclination. The inclination of palatal plane was higher in children with WD than in normal subjects. CONCLUSIONS: Children with WD and healthy children have approximately the same dento-maxillo-facial structures. However, increased palatal plane inclination may be a finding of WD.

Effects of force magnitude on relapse: An experimental study in rabbits.

INTRODUCTION: The aims of this study were to investigate the effects of 2 force levels on the amount of relapse and to determine whether there is a relationship between the rates of tooth movement and relapse. METHODS: Approximately 20-g (group I) and 60-g (group II) forces were applied to the maxillary central incisors of 25 young adult (14 weeks of age) New Zealand female rabbits. Active tooth movement lasted 20 days. Then, the appliances were removed, and the incisors were released. The distance between the incisors was measured daily from the midlevels of the crowns by using a digital caliper during the active phase of tooth movement for 20 days, and then relapse was measured at the same level for 37 days. Analysis of variance and the Bonferroni multiple range test were used for statistical analyses. RESULTS: After active tooth movement, the mean total opening amounts were 3.98 ± 0.59 mm in group I and 4.82 ± 0.82 mm in group II, and the mean difference was approximately 0.8 mm. A rapid relapse was observed on the initial days in both groups, and its rate decreased with time. Significant relapse was observed in the first 5 and 8 days of the experiment in 20-g and 60-g force groups, respectively. The relapse in group II was significantly greater than in group I only on the first day of experiment. Statistically significant correlations were found between total tooth movement and relapse (R = 0.896, P <0.001). CONCLUSIONS: These results showed a close relationship between the amount of relapse and orthodontic force magnitude. Greater relapse occurred during the initial days after appliance removal, and this indicates that retention appliances are needed immediately after the removal of orthodontic appliances.

Effects of the functional regulator III on transversal changes: a postero-anterior cephalometric and model study.

Studies assessing the transversal treatment changes caused by the functional regulator III (FR-3) are limited in number. This clinical study was planned to analyse the transversal effects of the FR-3 appliance therapy. The treatment group consisted of 17 patients (8 males and 9 females) with Class III malocclusion, who were treated with the FR-3 appliance. The control group consisted of 17 subjects (7 males and 10 females) with a normal occlusion. Mean ages of the subjects were 10.73 and 10.66 years in the treatment and control groups, respectively. Postero-anterior radiographs and stone casts were obtained before (T1) and after (T2) treatment/observation. The results of the Student's t-test comparing initial values showed that maxillary dentoalveolar and skeletal widths are significantly larger in the control group than those in the treatment group. At the end of the treatment, significant transverse increments occurred only at the dentoalveolar level of the maxilla. The transversal changes in the mandible were not statistically significant. Buccal shields of FR-3 did not stimulate the growth of maxillary apical base but caused an enhanced and supplementary widening of maxillary dental and alveolar structures.

Effects of rapid-slow maxillary expansion on the dentofacial structures.

BACKGROUND: To date, no study has determined if rapid followed by slow maxillary expansion (also termed 'semi-rapid' expansion) has the same effects on the dentofacial skeleton as rapid maxillary expansion. OBJECTIVE: To determine the vertical and sagittal changes in the facial skeleton during and following rapid then slow maxillary expansion (R-SME). METHODS: Bonded maxillary expansion appliances were used to separate the maxillae over six days by activating the midline screws twice a day. The screws were then activated three times a week until sufficient expansion was obtained (Mean: 3.4 months) and used as retainers for six months. Cephalometric measurements at the start of expansion (T1), end of expansion (T2) and end of retention (T3) were compared with paired t-tests. Pearson correlation coefficients were used to determine the associations between the expansion (dental and skeletal) and the cephalometric changes. RESULTS: The maxillae moved forward a small, but statistically significant, extent during expansion. The upper molars were extruded and the mandible 'rotated' downward and backward. Although the vertical height of the facial skeleton (SN/GoMe, S-Go, N-Me, ANS-Me) increased significantly during expansion, the changes were small and highly variable. Some dimensions (SN/GoMe) relapsed during retention, while others (S-Go, N-Me) increased. CONCLUSIONS: Rapid then slow maxillary expansion caused a small, but statistically significant, forward movement of the upper facial skeleton, a small downward and backward rotation of the mandible and a small increase in face height. The changes were similar to those found during rapid maxillary expansion.

McNamara norms for Turkish adolescents with balanced faces and normal occlusion.

BACKGROUND: There are no norms for the McNamara analysis for Turkish adolescents. OBJECTIVE: To obtain cephalometric standards for the McNamara analysis for Turkish adolescents with balanced faces and Class I occlusions, and to compare the standards with published data. METHODS: The cephalometric radiographs of 116 children (83 female, 33 male) between 11 and 16 years of age with Turkish grandparents and Class I occlusion, well-aligned upper and lower dental arches, no anterior and/or posterior crossbites and normal dentofacial structures were used. The eight linear and two angular measurements in the McNamara analysis were measured on images of the scanned radiographs. Measurements of the male and female subjects were compared with each other and with published norms for North American adolescents and adults. RESULTS: The Co-Gn, Co-A, ANS-Me and Ui-A were larger in the male subjects. Comparisons between the present study and McNamara's original study revealed that Anatolian Turkish adolescents, particularly girls, have smaller midfacial and mandibular lengths and longer and more retrusive faces than North American adolescents and adults. CONCLUSIONS: The small, but statistically significant, gender differences in mandibular and midfacial lengths and lower anterior face height may not be clinically significant. A single set of Turkish norms for the McNamara analysis may be appropriate.

Associations between upper lip activity and incisor position.

BACKGROUND: Muscle activity in the upper lip may influence the positions of the upper and lower incisors. OBJECTIVE: To determine the associations between muscle activity in the upper lip and the inclinations of the incisors, overjet and overbite. METHODS: Forty-five subjects (29 girls, 16 boys), between 11 and 15 years of age with predominantly Class I malocclusion, were used. The inclinations of the incisors, overjet and overbite were measured on lateral cephalometric radiographs. Bipolar electrodes were placed on the upper lip to record the activity in orbicularis oris muscle at rest, during maximal clenching, chewing hazelnuts and swallowing. Correlation coefficients between the cephalometric variables and the electromyographic (EMG) activity in the upper lip were calculated. RESULTS: There was no gender difference in the EMG activity in the upper lip. There were no statistically significant associations between the EMG activities in the upper lip and the inclinations of the incisors, overjet and overbite. CONCLUSIONS: The positions of the incisors do not appear to be influenced by muscle activity in the upper lip.

Effects of the functional regulator III on profile changes in subjects with maxillary deficiency.

The aim of this study was to determine the hard and soft tissue profile changes in Class III malocclusion subjects following functional regulator III (FR-3) treatment. The material comprised the cephalometric films of 15 patients (11 males and four females; mean ages 10.22 and 10.44 years, respectively) with a Class III malocclusion and a concave profile treated with the FR-3, and a control group of 15 subjects (11 males and four females; mean ages 10.39 and 10.27 years, respectively) with a Class I malocclusion matched for chronological age and observation period with the study group. Fourteen linear and seven angular measurements were measured on the cephalometric films taken before (T1) and after (T2) treatment/observation. The results of the Student's t-test showed that the treatment group had a concave facial profile when compared with the controls. At the end of treatment, the maxilla and surrounding soft tissues showed significant anterior movement (P < 0.001 and P < 0.01, respectively), whereas mandibular growth was restricted. The vertical dimensions increased, the upper incisors proclined, and the lower incisors retroclined significantly (P < 0.001). The FR-3 appliance produced significant improvements in the hard and soft tissues of Class III subjects with a concave profile.

Effects of rapid maxillary expansion with a memory palatal split screw on the morphology of the maxillary dental arch and nasal airway resistance.

The purpose of this study was to investigate the effects of rapid maxillary expansion (RME) with a memory palatal split screw on the morphology of the maxillary dental arch and nasal airway resistance (NAR). The material consisted of the rhinomanometric records and study models of 15 patients (8 females and 7 males) with mean age of 12.89 ± 1.20 years. Data were collected before expansion (T1), immediately after expansion (T2), and after a retention period of 6 months (T3). Maxillary expansion was completed within 8 days in all subjects. The data were analysed by analysis of variance. The least significant difference test was also used to determine between which periods the changes in the measurements were significant. Statistical analyses showed that NAR decreased (P < 0.01) and intermolar and interpremolar distances increased (P < 0.001) significantly at all observation periods, except between T2 and T3. RME using a memory palatal split screw is effective for improvement of nasal respiration via a widening effect on the nasal cavity.

Leptin levels in gingival crevicular fluid during orthodontic tooth movement.

OBJECTIVES: To test if leptin can be detected in the gingival crevicular fluid (GCF) around moving teeth, and to determine whether any changes occur during orthodontic tooth movement. MATERIALS AND METHODS: An upper canine requiring distal movement served as the test tooth; the contralateral canine was used as a control tooth. The control tooth was included in the orthodontic appliance, but was not subjected to the orthodontic force. GCF sampling from the distal sites of the test and control teeth was done at baseline, 1 hour, 24 hours, and 168 hours. RESULTS: Leptin concentrations of the test teeth decreased in a time-dependent manner. When compared with the baseline measurement, the decrease was significant at 168 hours (P < .05). CONCLUSIONS: The concentration of leptin in GCF is decreased by orthodontic tooth movement; the results of the present study also suggest that leptin may have been one of the mediators responsible for orthodontic tooth movement.

Soft tissue profile changes following maxillary protraction in Class III subjects.

SUMMARY: The dentoskeletal effects of maxillary protraction (MP) therapy have been extensively investigated, while those relating to soft tissue profile changes are limited. Thus, the aim of this study was to determine the degree of soft tissue profile changes following MP therapy. The material consisted of the cephalometric films of 24 female subjects (12.69 +/- 1.08 years) with a Class III malocclusion who underwent MP therapy; these were compared with a control group of 15 females (12.13 +/- 0.63 years) with a Class I occlusion and matched for chronological age and observation period. Cephalometric films were available for all subjects before (T1) and after (T2) treatment/observation. The initial measurements and treatment/control changes were compared between the groups by means of a Student's t-test. The subjects in the MP group had a concave facial profile when compared with the controls. Comparison of the changes induced by MP therapy showed that the maxilla and surrounding soft tissues showed significant anterior movement (P < 0.001), whereas the mandible and surrounding soft tissues showed a backward and downward rotation. The improvement in facial profile predominantly resulted from maxillary soft tissue changes and mandibular hard tissue changes. The concave soft tissue profiles of the Class III subjects were corrected by anterior movement of the maxilla and a concomitant increase in the fullness of the upper lip. The concave skeletal profiles were, however, corrected mainly by backward and downward rotation of the mandible.

Effects of force magnitude on tooth movement: an experimental study in rabbits.

The aim of the present study was to investigate the effects of two different force levels on the amount of total and daily tooth movement in rabbits and to determine whether any increase in tooth movement is equal to the increase in force. Forces of approximately 20 (group I) and 60 (group II) g (19.6 and 58.8 cN) were applied to the upper central incisors of 25 young adult (14 weeks of age) New Zealand female rabbits. The distance between the incisors was measured daily from the mid-levels of the crowns using a digital calliper for 20 days. Analysis of variance and Bonferroni multiple range test were used for statistical analyses. The distance between the teeth in group II was significantly greater than that in group I during the first 3 days. Between days 4 and 14, no significant difference was observed. During the last 6 days, except for day 19, tooth movement in group II again increased, resulting in the distance between the teeth being greater in group II. The mean total opening was 3.98 +/- 0.59 mm in group I and 4.82 +/- 0.82 mm in group II, and the mean difference was approximately 0.8 mm. The results of this study show that there was a close relationship between tooth movement and force magnitude. However, higher forces did not produce force-equal tooth movements.

Changes in soft tissue profile and electromyographic activity after activator treatment.

BACKGROUND: To date, few studies have correlated the changes in muscle activity and specific soft tissue variables in adolescents with malocclusions. OBJECTIVE: To determine associations between the soft tissue profile and electromyographic activities in temporalis, masseter and orbicularis oris muscles in children with Class II division 1 malocclusions treated with activators. METHODS: For this prospective study, 25 subjects with Class II division 1 malocclusions were randomly assigned to either a Treatment group (N=15) or a Control group (N=10). The mean skeletal ages of the subjects in the Treatment and Control groups were 11.3 +/- 1.1 and 11.0 +/- 1.3 years, respectively. The subjects in the Treatment group were treated with activators and the subjects in the Control group were untreated. Lateral cephalometric radiographs and EMG recordings of the anterior temporalis and masseter muscles during clenching, chewing and swallowing and the orbicularis oris muscle during whistling were obtained at the start of the study and 12 months later. Changes in the soft tissue profile were correlated with changes in the EMG activities in anterior temporalis, superficial masseter and orbicularis oris muscles. RESULTS: The upper lip to E line distance (UL-E) decreased more in the Treatment group than the Control group (p < 0.05) and the H angle decreased in the Treatment group, but increased in the Control group (p < 0.01). The EMG activities of temporalis and masseter muscles increased significantly in both groups. All between-group EMG differences were statistically significant with the exception of the activities in the temporalis and masseter muscles during swallowing. In the Treatment group, a significant positive correlation (r = .57) was found between the changes in UL-E and anterior temporalis activity during swallowing, and significant negative correlations were observed between the EMG activity of masseter muscle during swallowing and changes in LL-E (r = -.54), OLp-UL (r = -.55) and OLp-LL (r = -.67). CONCLUSIONS: Activator therapy is accompanied by changes in the lips and temporalis and masseter activities during swallowing.

Facial asymmetry in subjects with class III malocclusion.

BACKGROUND: Facial skeletal asymmetries in Class III subjects seeking orthognathic surgery may complicate subsequent treatment. OBJECTIVE: The purpose of this study was to investigate facial asymmetry in orthognathic surgery patients with Class III malocclusion. METHODS: The Class III group consisted of 29 orthognathic surgery patients 114 female, 15 male; Mean age: 21.44 years) with Class III malocclusions. The Control group consisted of 32 subjects (16 female, 16 male; Mean age: 19.20 years) with excellent Class I occlusal relationships. Facial skeletal asymmetry, based on the skeletal midline, was measured on posteroanterior radiographs. In the Class III group, the chin point deviated to the ipsilateral side. The side-to-side and between group differences were compared. RESULTS: In the Class III group, the antegonial notch--skeletal midline distance was significantly larger (p < 0.05) and menton-antegonial notch distance was significantly different (p < 0.05). There were no statistically significant differences between the right and left side measurements in the Control group. Between-group comparisons showed that subjects in the Class III group had greater skeletal asymmetries in lower face. In 78 per cent of the subjects in the Class III group the chin point was displaced more than 2 mm to one side. CONCLUSIONS: Subjects with Class III malocclusion may have facial skeletal asymmetries, predominantly in the lower face. Frontal asymmetries should be considered during diagnosis and treatment planning.

Effects of rapid maxillary expansion on nasal breathing and some naso-respiratory and breathing problems in growing children: a literature review.

OBJECTIVE: Rapid maxillary expansion (RME) is a dentofacial orthopedic treatment procedure which has been routinely used in young patients. Main goal of RME is to correct the existing posterior crossbite and to widen the maxilla and maxillary dental arch. However, a concomitant and contributing benefit of this procedure is an improvement on nasal airway which facilitates nasal respiration. RME brings about not only an increase in nasopharyngeal airway dimensions and an improvement in nasal respiration but also a decrease in naso-respiratory problems of the patients having maxillary constriction and mouth breathing. The purpose of this article is to review the effects of RME on naso-respiratory and breathing problems caused by maxillary constriction and mouth breathing in growing children. CONCLUSION: Although orthodontic treatment is carried out to correct dental and skeletal discrepancies, some authors showed that treatment outcomes of RME could also effective on naso-respiratory and sleep-disordered breathing problems of the growing children. However, it must be kept in mind that this respect of RME was evaluated in a little number of studies and had a low-level of evidence.

Effects of early unilateral first molar extraction on skeletal asymmetry.

INTRODUCTION: The purpose of this study was to investigate dental and skeletal asymmetry in patients who had unilateral first molar extractions. METHODS: Two study groups were formed according to the location of the extracted first molars. Group I included 25 subjects who had a maxillary permanent first molar extracted (mean age, 18.25 years). Group II included 26 subjects who had a mandibular permanent first molar extracted (mean age, 17.75 years). The control group included 30 subjects with no missing teeth and normal occlusion (mean age, 18.50 years). Dental and skeletal asymmetry values were computed on posteroanterior radiographs for all subjects. Data were analyzed statistically with paired t tests to determine intragroup differences and with ANOVA and Scheffé tests to determine intergroup differences. RESULTS: Unilateral first molar extractions caused dental midline deviations in both arches, but this was more prominent in the mandibular arch. Unilateral first molar extraction during growth and development can result in remarkable skeletal asymmetry, especially in the lower third of face. CONCLUSIONS: Patients who had early unilateral first molar extraction can have skeletal and dental asymmetries.

Effects of rapid maxillary expansion on Holdaway soft tissue measurements.

The objective of the present study was to evaluate short-term soft tissue changes caused by rapid maxillary expansion (RME) in 18 subjects (15 females and 3 males) (mean age 13 years 6 months) with a bilateral posterior crossbite. Lateral cephalograms of the patients were obtained at three different time points: before RME (T1), after maxillary expansion (mean = 0.82 month) (T2), and after retention (mean = 5.95 months) (T3). Holdaway soft tissue measurements were used for the evaluation of soft tissue changes. Data were analysed statistically by means of paired t-tests. The facial soft tissue angle decreased (P < 0.05), and H angle and skeletal profile convexity increased significantly (P < 0.001) at T2. During T3, the increase in the facial soft tissue angle and the decrease in H angle were minimal and not significant, while skeletal profile convexity significantly decreased (P < 0.001). The results of this study indicate that RME may affect Holdaway soft tissue measurements.