Treatment effects of the Sander II appliance in class II therapy : A cephalometric, retrospective case-control study.

A Comparison of Clear Aligners and Fixed Appliances in Orthodontic-Surgical Treatment of Non-Extraction Skeletal Class III Malocclusion.

Temporal changes in treatment selection criteria for skeletal Class III: a comparison of surgical orthodontic and orthodontic camouflage treatments

Advances in orthodontic treatment mechanics, particularly the introduction of particularly the increasing use of skeletal anchorage, may have altered the boundary between surgical orthodontic and orthodontic camouflage treatments in patients with skeletal Class III. This study explored temporal changes in treatment selection criteria and assessed the diagnostic performance of cephalometric parameters. This study included 160 post-adolescent patients with skeletal Class III treated between 2008 and 2022. Patients were stratified into two periods: P1 (2008–2011) and P2 (2012–2022). In each period, 40 patients from each treatment modality were selected to achieve balanced group sizes after stratification by period and treatment modality. Cephalometric measurements were compared between groups and periods. Receiver operating characteristic (ROC) analysis was conducted for the ANB angle and Wits appraisal. In both periods, the surgical group exhibited significantly smaller ANB angles and Wits appraisal values than the camouflage group ( p  < 0.05). In the camouflage group, both measurements were significantly smaller in P2 than in P1, suggesting that more severe skeletal Class III cases were increasingly treated without surgery. ROC analysis revealed that Wits appraisal demonstrated greater diagnostic performance than ANB angle (P1: area under the curve (AUC) = 0.904 vs. 0.824; P2: AUC = 0.775 vs. 0.609). The cutoff values shifted from − 1.60° to − 2.65° for the ANB angle and from − 9.50 mm to − 11.50 mm for the Wits appraisal. The boundary between surgical and orthodontic camouflage treatments for skeletal Class III has shifted over time, likely reflecting advances in orthodontic treatment mechanics. Wits appraisal demonstrated superior discriminatory ability and is a potentially useful indicator for contemporary treatment decision-making.

A Retrospective Cohort Study Comparing the Surgery-First and Orthodontic-First Protocols for Correcting Skeletal Class II Malocclusion.

BACKGROUND The surgery-first approach (SFA) with mandibular anterior subapical osteotomy (MASO) is increasingly utilized to overcome the limitations of conventional preoperative orthodontic decompensation and achieve earlier correction of facial deformities in skeletal class II patients. However, it also caused greater surgical trauma, and there are currently insufficient clinical data available for analyzing the surgical outcome. METHODS We conducted a retrospective study to compare the skeletal stability, overall treatment duration, and incidence of major complications between the SFA and the orthodontics-first approach (OFA). The study included 42 patients (21 each from the SFA and OFA groups) who underwent bimaxillary orthognathic surgery. Cephalometric measurements were performed at the preoperative (T0) stage and at immediate postoperative (T1), 6-month (T2), and ≥12-month (T3) follow-ups. RESULTS No significant differences in skeletal relapse at T2 or T3, blood loss, or major complications (nonunion, neurosensory deficits) were found between groups (P>0.05). While the SFA group required longer surgery time (240.7 versus 202.1 min; P<0.01), it significantly reduced total treatment duration (16.8 versus 38.1 mo; P<0.001). Due to the implementation of MASO, minor tooth injuries were more frequent in the SFA group but resulted in no long-term consequences. CONCLUSION Both SFA and OFA achieve comparable long-term skeletal stability in skeletal class II patients. While SFA significantly reduces the total treatment duration, it is associated with longer operative times and a higher incidence of minor dental injuries.

Effects of functional jaw orthopedics with maxillary expansion on palatal morphology, mandibular growth, airway dimensions, and oral function in Class II malocclusion: A randomized controlled trial

Objective The skeletal pattern of a Class II malocclusion can increase the probability of problems with oronasal function. This study aimed to analyze the relationship between the clinical effects of dentofacial orthopedics and oral function in deficient mandibles with proclined maxillary incisors during puberty. Methods Of 120 randomized participants, 63 with complete records were included in the final analysis (median age 12 years; 38% females). Subjects were treated with the Sander bite jumping appliance (BJA; n = 34) or the twin block appliance (TB; n = 29) with a maxillary expansion jackscrew. The growth effect was monitored by comparisons with the findings in 63 historical untreated Class II cases. Palatal scans and cephalograms were analyzed before and at one-year intervals after treatment. Both the children and their parents reported oral symptoms and functional limitations (FLs). Results Palatal volume increased in both appliance groups (BJA 860.3 mm3 [95% confidence interval (CI) 481.6–1,150.1] and TB 958.9 mm3 [95% CI 555.1–1,446.3]) in comparison with the untreated group (287.0 mm3 [95% CI 193.4–426.5]; P < 0.001). However, the treatment did not affect airways. In comparison with the untreated group, the treated groups showed greater mandibular length and reduced overjet (P ≤ 0.002). No linear correlations were found between changes in dentofacial, palatal, or airway characteristics and changes in oral function. However, the palatal volume of the treated children who experienced improvement in FLs increased more than that of those who showed no FL improvement (1,220.6 mm3 [95% CI 772.6–1,616.4] and 760.5 mm3 [95% CI 491.6–1,002.1]; P = 0.035). Conclusions Both appliances promoted mandibular growth and increased oral space, but did not significantly influence the measured upper airway widths.

Hard- and soft-tissue changes after adult Class II Division 1 orthodontic treatment: a retrospective CBCT-based observational study

Background Restoring facial balance is now central to adult orthodontic care, yet evidence describing hard-soft tissue coupling and short-term retention stability in non-growing adults with Angle Class II Division 1 malocclusion remains limited. Methods In this observational study, 236 consecutively treated adults (≥18 years) underwent clinically archived cone-beam computed tomography (CBCT) before treatment (T0) and within 2 weeks after debonding (T1). Ten hard- and five soft-tissue variables were measured on the T0 and T1 three-dimensional reconstructions and used for the treatment-change analysis. For the 12-month analysis (T2, n = 224) the T0 and T1 volumes were reformatted into orthogonally synthesized lateral cephalograms and re-measured, so that stability was assessed between two lateral cephalograms of the same geometrical type, the T2 record being the standardized digital lateral cephalogram taken at the routine retention review. Each T1–T2 change was judged against a variable-specific combined smallest detectable difference (SDD) derived from the method error of both cephalometric records, at group and at individual level. Paired tests with mean change, 95% CIs and Cohen's dz, correlations with multiplicity control, change-score correlations and multivariable linear regression evaluated change and hard–soft coupling. Results From T0 to T1, ANB, U1-NA and L1-NB decreased and the interincisal angle increased (all P < 0.001), while SNA and SNB were unchanged. The nasolabial and mentolabial angles and chin thickness increased, and both lips retracted toward the aesthetic plane (all P < 0.001). Between T1 and T2 no variable showed a mean change that reached its combined SDD, and 92.5% to 98.7% of the T0–T1 change was still present at 1 year; 2.2%−6.7% of individual patients nevertheless crossed the SDD in the relapse direction. In adjusted models, maxillary incisor retraction remained independently associated with nasolabial-angle increase (B = −0.96° per degree; 95% CI −1.20 to −0.72) and with upper-lip retraction (B = +0.24 mm per millimeter; 95% CI +0.18 to +0.30), and mandibular incisor retraction with lower-lip retraction (B = +0.16; 95% CI +0.10 to +0.22). Adjusted R2 ranged from 0.146 to 0.397 and the maximum variance inflation factor (VIF) was 1.76. Conclusions In non-growing adults, treatment was accompanied by predominantly dentoalveolar correction and by coupled soft-tissue change that was maintained at 1 year at group level, no mean change exceeding the error of the method. The coupling was consistent on average but explained a minority of the between-patient variance, and a small proportion of individuals showed measurable rebound, so the individual soft-tissue response remains difficult to predict. These observational data describe association and short-term stability, not causal benefit.

Changes in temporomandibular joint morphology, condylar position, and mandibular functional movement induced by orthodontic treatment in class ii malocclusion: a retrospective study based on CBCT and electronic articulator technology