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Patients with skeletal Class Ⅱ often show symptoms such as protrusion of maxillary anterior teeth, mandibular retraction, open lips and teeth, deep overbite, and deep overjet, which seriously affect the facial appearance. This article reports a case of an adolescent male patient with skeletal Class Ⅱ combined with impacted teeth treated by one-stage early correction and two-stage fixation. After treatment, the patient’s skeletal Class Ⅱ symptoms improved significantly, including the improvement of mandibular retraction. The problem of open lips and teeth was solved; the facial appearance tended to be straight, and there was no obvious abnormality of the temporomandibular joint. This case shows that early correction can achieve good therapeutic effects on this kind of patients and can avoid or reduce the possibility of orthognathic surgery for these patients in adulthood.

Abstract Background In this study, we sought to quantify the influence of vertical control assisted by a temporary anchorage device (TAD) on orthodontic treatment efficacy for skeletal class II patients with a hyperdivergent facial type and probe into the critical factors of profile improvement. Methods A total of 36 adult patients with skeletal class II and a hyperdivergent facial type were included in this retrospective case–control study. To exclude the effect of sagittal anchorage reinforcement, the patients were divided into two groups: a maxillary maximum anchorage (MMA) group (N = 17), in which TADs were only used to help with anterior tooth retraction, and the MMA with vertical control (MMA + VC) group (N = 19), for which TADs were also used to intrude the maxillary molars and incisors. The treatment outcome was evaluated using dental, skeletal, and soft-tissue-related parameters via a cephalometric analysis and cast superimposition. Results A significant decrease in ANB (P

Purpose: Anterior segmental osteotomy (ASO) following the surgery-first approach is a long-established treatment modality to resolve lip protrusion in patients with skeletal class II patterns. However, the indications and effectiveness of ASO still remain uncertain. The objective of this study is to investigate the effectiveness of ASO in Asian skeletal class II patients by evaluating the skeletal and soft tissue changes and analyzing pre-treatment variables that determine successful outcomes in occlusal as well as esthetic aspects. Methods: The lateral cephalograms of 44 skeletal class II patients who underwent ASO and orthodontic treatment for resolving lip protrusion were retrospectively collected. Hard and soft tissue variables of two groups, normalized (NG) and unnormalized (UNG) ANB after treatment were compared and analyzed. The rotational effect of the anterior segment on the hard and soft tissue was also investigated. Results: ASO was successful in correcting the skeletal class II relationship and lip protrusion (ΔANB − 2.3°, 4–5 mm lips retraction) in most cases. However, for patients with severely camouflaged skeletal class II incisors involving a large ANB and SNA, a large ANB still remained post-treatment. The study also found that rotation of the upper and lower anterior segments further augmented the amount of lip retraction. Conclusions: ASO was found to successfully correct ANB of skeletal class II patients under the following conditions (ANB 5.3° ± 1.5°, SNB 77.3° ± 4.5°, U1 to FH 115° ± 7.5, L1 to FH 48.0° ± 4.6). However, patients with larger ANB and SNA values may require bi-maxillary surgery. In addition, ASO has limitations in correcting gummy smile in cases of extreme maxillary excess. For patients requiring a large amount of lip retraction, rotation of the anterior segment may be beneficial in conjunction with bi-maxillary surgery. [ABSTRACT FROM AUTHOR]

Background: Class II discrepancies were primarily perceived as sagittal problems. Class II malocclusions usually cause aesthetic and functional problems, depending on the degree of anterior-posterior mismatch and interaction with adjacent soft tissues. Purpose: This case report aimed to evaluate the effect of modified sagittal guidance twin-block (SGTB) for Class II Skeletal and Dental Changes in a growing patient. Case: A 10-year-old patient presented with her parents and complained mainly of aesthetic problems. Diagnosis showed skeletal Class II pattern (ANB 6º) with retrognathic mandible, angle Class II molar relationship, convex facial profile, lower dental midline shift, crowding in the lower anterior teeth, and incompetent lips. Case Management: A growth modification treatment plan was considered for the patient, using modified SGTB. Both bonded and removable had the same design. In the SGTB, the bite block was angled at 70º, pushed toward the occlusal plane to maximize horizontal force toward the mandible. As a result, the mandible is guided forward and optimally positioned during occlusion. Conclusion: An ideal overjet and slight correction on lower anterior crowding teeth were achieved after full-time wear of a modified SGTB for 12 months. A modified SGTB appliance is effective in treating skeletal Class II with a retrognathic mandible.

Objectives: A randomized controlled trial was undertaken to investigate the orthopaedic effect of functional appliances on the pharyngeal airway space and nocturnal breathing of children with skeletal class II due to mandibular retrusion. Materials and Methods: Forty patients were randomized into a 1:1 ratio study (Twin block) group and a control (fixed appliance) group. Each group included equal numbers of boys and girls. Diagnosis with sleep‐disordered breathing was not an inclusion criterion. The duration of the trial was 12 months (T0 ‐ T12). Eligibility criteria included skeletal Class II division 1 malocclusion with mandibular retrognathism, SNA ≥82, SNB ≤78, ANB ≥4, overjet ≥6 mm, and patients in circumpubertal stage CVM2 and CVM3. The main outcomes were pharyngeal airway volume, oxygen desaturation index (ODI), and maximum expiratory pressure (MEP), while the secondary outcomes were skeletal and dental changes of the maxilla and mandible. Randomization was accomplished with random blocks of 20 patients with allocation concealed in sequentially numbered, opaque, and sealed envelopes. Blinding was only applicable for data analysis of radiographic measurements and data extracted from the pulse oximeter. Results: The mean age of the patients was 10 ± 1.5 and 10 ± 1.2 at (T0) for the Twin Block and the control groups, respectively. The changes in the oropharyngeal (2.66 cc and 0.056; P =.03) and nasopharyngeal (1.3 cc and 0.84; P =.053) airway volumes for the Twin block and control groups, respectively, were significantly different for the oropharynx. There was a significant decrease in ODI by [median −3.55 (−5.05 to 0.50); P ≤.001] and a significant increase [median 45 (0.0–110); P ≤.001] in MEP for the Twin block group. A significant inverse correlation (r = −.589; P =.006) could be found between the total volume of the oropharynx and ODI. No serious harm was observed. Conclusions: The Twin block group showed significant change in oropharyngeal airway volume and improvement of nocturnal breathing. Registration: This trial was registered at https://www.clinicaltrials.gov, registration number NCT04255511. [ABSTRACT FROM AUTHOR]

This document provides a citation for two research articles that discuss the treatment of skeletal Class II malocclusion with a retrognathic mandible using functional appliances. The articles explore the use of the twin-block (TB) appliance and its modified version, the sagittal guidance twin-block (SGTB) appliance, in correcting the malocclusion. The treatment plans involve orthopedic and dentoalveolar corrections and have shown positive results in improving occlusion and facial aesthetics. The articles are available online under a CC-BY-SA license. [Extracted from the article]

Objective To explore the relationships among pharyngeal airway morphology, craniocervical posture, and anterior teeth position in hyperdivergent skeletal Class Ⅱ female adults and provide a reference for orthodontic clinical diagnosis and treatment. Methods Lateral cephalometric radiographs of 104 untreated skeletal Class Ⅱ (ANB ≥ 4.7°) female adults were included and divided into a hyperdivergent group (MP-SN ˃ 37°) (n = 52) and a normodivergent group (29° ≤ MP-SN ≤ 37°) (n = 52) by mandibular plane angle. The pharyngeal airway sagittal size, craniocervical angulation and anterior teeth position of the two groups were measured. Results Compared to the normodivergent group, hyperdivergent subjects exhibited narrower nasopharyngeal, velopharyngeal, and glossopharyngeal airways (P

Objective To evaluate the vertical distance between the maxillary first molars (MFMs) and the maxillary sinus floor (MSF) and its interrelationship with sex, age, and vertical facial pattern in skeletal ClassⅡ patients to provide a reference for clinical orthodontic treatment. Methods Sixty teenagers and sixty adults with skeletal Class Ⅱ malocclusion who met the inclusion criteria were selected to evaluate the vertical relationship between the MFMs and the MSF on cone-beam CT (CBCT) images. The vertical distance between the roots of the MFMs and the MSF was measured. Statistical analysis was used to assess differences between patients by sex, age, and vertical facial pattern. Results The contact percent of the roots of MFMs and MSF was 85% and 56% in skeletal Class Ⅱ teenagers and adults, respectively. The contact percent and penetration percent of the roots with MSF were higher in teenagers than in adults（P0.05); No significant difference was found between different sexes of skeletal Class Ⅱ patients when comparing the distance of the MFMs and the MSF (P>0.05). The MFMs of skeletal Class Ⅱ teenagers were closer to the MSF than those of adults (P0.05). In the teenager group, the MFMs were more closely related to the MSF in the NA and HA groups than in the LA group. Among them, the difference between the mesiobuccal roots and distalbuccal roots was significantly different (P0.05). Conclusion The MFMs were closer to the MSF in skeletal Class Ⅱ teenagers than in adults. The distance between the MFMs and MSF was associated with the vertical facial pattern in skeletal Class Ⅱ teenagers, while it was not associated with the vertical facial pattern in adult patients.

Objective To compare the hyoid bone position among patients with different sagittal skeletal malocclusions to provide a reference for clinicians to formulate treatment plans. Methods Lateral cephalograms of 284 orthodontic patients were selected. According to ANB angles, the types of skeletal malocclusion of patients were determined as follows: Class Ⅰ (1° ≤ ANB ≤ 5°), Class Ⅱ (ANB>5°) and Class Ⅲ (ANB0.05). The angle between the Gonion-hyoid point line and the hyoid point-Menton line (Go-Hy-Me) of Class Ⅱ patients was significantly smaller than that of Class Ⅰ patients, and the angle between the most anterior and inferior point of the third cervical vertebra-hyoid point line and the hyoid point-Sella line (C3-Hy-S) of Class Ⅲ patients was smaller than that of Class I patients (P0.05). Conclusions Compared with Class Ⅰ patients, the hyoid bone of Class Ⅱ patients in adult females was farther away from the mandible and that of Class Ⅲ patients in juveniles was farther away from the cervical vertebra and posterior cranial base.

• Ideal golden proportion was absent in facial proportions of Clark's twin block treated patients. • Facial proportion ratios came closer to golden proportion after treatment with Clark's twin block. • Golden proportion can be used as a guide in treatment planning of patients. This study aimed to determine the influence of Clark's twin block (CTB) appliance therapy on achieving golden proportion in post-treatment facial profiles in skeletal Class II patients. A retrospective longitudinal study was conducted on a sample of 44 skeletal Class II subjects treated with CTB, followed by nonextraction mechanotherapy. Ricketts' 13 dentoskeletal ratios were measured on pre- and post-treatment lateral cephalograms. Paired Student's t test was used to analyze the existence of golden proportion in the values of the pre- and post-treatment ratios. The influence of pretreatment variables was tested on post-treatment ratio 4 using simple and multiple linear regression analyses. A statistically significant difference in pre- and post-treatment values was found for ratios 4 (P = 0.02), 9 (P = 0.04), 10 (P < 0.001), and 13 (P = 0.01). Ratios 4, 9, and 13 moved closer to the golden proportion, whereas ratio 10 moved away from the golden proportion after CTB therapy. Simple linear regression analysis showed a statistically significant association of post-treatment ratio 4 with pretreatment ratios 1, 4, 8, 9, and 12. Multiple linear regression analysis showed a statistically significant association of post-treatment ratio 4 with pretreatment ratios 4 and 12. Treatment with CTB appliance may well move various facial ratios in individual patients toward the published Ricketts ideals. Ricketts' published golden proportion may be used as one guide when planning for attempted dentofacial change in individual patients. [ABSTRACT FROM AUTHOR]

Objectives: The location of the maxillary sinus significantly affects the orthodontic treatment, particularly when temporary anchorage devices (TADs) are taking place. The current study aims to evaluate the maxillary sinus size and location in a skeletal class II population. Materials and methods: The pre-orthodontic treatment CBCT images of the skeletal class II population were selected. The sinus's volumetric size, height, width, and depth were measured and compared among different skeletal vertical patterns and between genders. In addition, the height and width of the alveolar bone surrounding the maxillary sinus floor were quantified in the same manner. Results: Patients who displayed a high-angle skeletal pattern had significantly greater maxillary sinus dimensions, shorter vertical distance between the maxillary sinus floor and the alveolar bone crest, and thinner alveolar bone surrounding the maxillary sinus. Meanwhile, the maxillary sinus dimension measurements were positively correlated with the SN-MP angle in both genders but only correlated with ANB angle in females. On the other hand, the vertical distance between the maxillary sinus floor and the alveolar bone crest was negatively correlated with the SN-MP angle in males but the ANB angle in females. Conclusions: In the skeletal class II population, the high-angle patients faced a higher risk of maxillary sinus perforations by TADs. In addition, gender-related variations were noticed warranting clinical attention, as males have a higher potential for maxillary sinus penetration from TAD placement than females. Clinical relevance: Maxillary posterior alveolar TADs are often prescribed to achieve the distalization of maxillary posterior teeth in class II patients. The current study provided more insight into the "safe zone" for TAD placement related to the maxillary sinus. [ABSTRACT FROM AUTHOR]

Abstract Background This study is aimed to (1) investigate the influence of sagittal and vertical patterns on mandibular cross-sectional morphology and to (2) provide visualized mandibular cross-sectional morphology in different groups with General Procrustes Analysis (GPA), canonical variance analysis (CVA) and discriminant function analysis (DFA). Methods 324 cone-beam computed tomography (CBCT) images were collected to analyze mandibular cross-sectional morphology and were categorized into 12 groups according to sagittal and vertical pattern and gender. One-way analysis of variance (ANOVA) was used to compare the difference among the groups. Thirty equidistant points were marked along the contour of mandibular cross-section and GPA, CVA and DFA were applied. Results (1) Mandibular height in hyperdivergent groups was significantly higher than that in normodivergent and hypodivergent groups (P 0.05). (3) Class II hyperdivergent group showed narrowest lower third width in the molar region, with the mean value of 12.03 mm in females and 11.98 mm in males. (4) For males and females, the ratio between height and lower third width at symphysis was significantly higher in Class II hyperdivergent group than that in Class I hyperdivergent group (P

Deep curve of Spee is a very common problem among Class II malocclusion patients associated with mandibular deficiency. The curve of Spee is maintained and leveled following surgical mandibular advancement. The same surgical splint which is used to guide the mandibular advancement can also be used for the leveling of deep curve of Spee. This case report highlights the leveling of deep curve of Spee by the same surgical splint used during the surgical mandibular advancement. Thus, it helps to increase the lower facial height and also improves the overall facial appearance. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this study was to assess the difference of palatal morphology in different vertical patterns between skeletal Class I subjects and skeletal Class II subjects with retrusive mandible. Methods Seventy-six skeletal Class II subjects with retrusive mandible (38 females, 38 males) and 85 skeletal Class I subjects (45 females, 40 males) were collected retrospectively and divided into hyperdivergent, normodivergent and hypodivergent groups. CBCT images of these subjects were reoriented by Dolphin 3D Imaging software. Three-dimensional (3D) maxilla was segmented by ProPlan software before using Geomagic Studio software to reconstruct 3D palatal morphology. Deviation patterns on 3D colored map analysis was performed to compare the difference of 3D palatal morphology between different groups. Results 3D colored map analysis showed that male’s palate was higher and wider than that of female in the posterior part, regardless of different sagittal and vertical patterns. In skeletal Class II subjects with retrusive mandible, males with hyperdivergent and normodivergent showed higher and narrower in the posterior part of palate, while females with hyperdivergent and normodivergent had a higher but no obviously narrow palate compared with the hypodivergent subjects. Skeletal Class II subjects with retrusive mandible showed flatter and narrower in the posterior part of palate than that of skeletal Class I subjects. Conclusions Sagittal and vertical patterns have great influence on the palatal morphology and as the vertical dimension increased, the palate tended to be higher and narrower.

Class II malocclusion is the most common issue encountered in orthodontic practice. Myofunctional appliances are the most effective treatment option for skeletal class II malocclusion in growing age. Twin block is the most commonly used removable functional appliance, although its success is dependent upon patient compliance. The aim of this article is to present an effective modification of the conventional twin block appliance that can be used as an alternative to the fixed functional appliance in noncompliant skeletal class II patients with mandibular retrusion., How to Cite This Article: Khera AK, Raghav P, Wadhwa P. Mini-fixed Twin Block Appliance: An Alternative to Fixed Functional Appliance in Noncompliant Class II Patients. Int J Clin Pediatr Dent 2024;17(7):815-821., Competing Interests: Source of support: Nil Conflict of interest: None Patient consent statement: The author(s) have obtained written informed consent from the patient’s parents/legal guardians for publication of the case report details and related images.Conflict of interest: None, (Copyright © 2024; The Author(s).)

Objectives: Currently, there is no reliable automated measurement method to study the changes in the condylar process after orthognathic surgery. Therefore, this study proposes an automated method to measure condylar changes in patients with skeletal class II malocclusion following surgical-orthodontic treatment., Methods: Cone-beam CT (CBCT) scans from 48 patients were segmented using the nnU-Net network for automated maxillary and mandibular delineation. Regions unaffected by orthognathic surgery were selectively cropped. Automated registration yielded condylar displacement and volume calculations, each repeated three times for precision. Logistic regression and linear regression were used to analyse the correlation between condylar position changes at different time points., Results: The Dice score for the automated segmentation of the condyle was 0.971. The intraclass correlation coefficients (ICCs) for all repeated measurements ranged from 0.93 to 1.00. The results of the automated measurement showed that 83.33% of patients exhibited condylar resorption occurring six months or more after surgery. Logistic regression and linear regression indicated a positive correlation between counterclockwise rotation in the pitch plane and condylar resorption (P < .01). And a positive correlation between the rotational angles in both three planes and changes in the condylar volume at six months after surgery (P ≤ .04)., Conclusions: This study's automated method for measuring condylar changes shows excellent repeatability. Skeletal class II malocclusion patients may experience condylar resorption after bimaxillary orthognathic surgery, and this is correlated with counterclockwise rotation in the sagittal plane., Advances in Knowledge: This study proposes an innovative multi-step registration method based on CBCT, and establishes an automated approach for quantitatively measuring condyle changes post-orthognathic surgery. This method opens up new possibilities for studying condylar morphology., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology and the International Association of Dentomaxillofacial Radiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background Upper airway obstruction (UAO) is a significant clinical concern due to its potential to lead to serious health issues, including obstructive sleep apnea (OSA) and cardiovascular diseases. Traditional diagnostic methods, such as spirometry, are often invasive and complex. This study aims to validate a portable ventilatory airway screening (PVAS) device as a non-invasive, cost-effective alternative for measuring upper airway breathing pressure and respiratory flow. Objectives To validate the accuracy of the PVAS device in measuring upper airway breathing pressure and respiratory flow by comparing its readings with those obtained from standard spirometry tests. Methods This cross-sectional analytical study involved 40 growing individuals aged 10-14 years, divided into two groups based on cephalometric analysis: Skeletal Class I (20 patients) and Skeletal Class II with retrognathic mandible (20 patients). Breathing pressure, volume, and velocity measurements were recorded using both the PVAS device and spirometry, and their accuracy was compared. Results The PVAS device showed high concordance with spirometry results, demonstrating significant accuracy in measuring breathing pressure, volume, and velocity. Skeletal Class II individuals exhibited significantly higher breathing pressure and reduced respiratory flow compared to Class I individuals, as measured by the PVAS device. Conclusion The PVAS device is a valid and accurate tool for non-invasive measurement of upper airway breathing pressure and respiratory flow. Its ease of use and reliability make it a valuable tool for clinical practice, particularly in the early diagnosis and management of airway obstructions., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Datta Meghe Institute of Medical Sciences, Institutional Ethics Committee issued approval DMIMS(DU)/IEC/2021/243. The Institutional Ethics Committee has approved the research. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hazare et al.)

The following case is one of the 8 presented by Dr. Maria Dolores Campoy for the European Board of orthodontics (EBO) and exemplifies the format and records necessary for the correct adaptation to the examination regulations. She is a 13 years and 9 months patient with a angle Class II division 1 and skeletal Class II with horizontal growth pattern. Upper protrusion and slightly upper and lower crowding. An orthodontic treatment was performed with fixed appliances and MBT prescription and the treatment plan consisted of the extraction of two upper premolars. In the end of treatment and retention records, we found that the results are satisfactory and stable over time. [ABSTRACT FROM AUTHOR]

Great variation has been found in sagittal condylar inclination (SCI) values among individuals with different skeletal structures. Therefore, average value articulators cannot fully represent the physiological characteristics of the mandible, or reproduce its sagittal movements. The purpose of this study was to measure the SCI value of skeletal Class II patients by two different three-dimensional assessments, and to evaluate the correlation and consistency between the two methods. A total of 23 patients (aged 15–65 years) diagnosed with skeletal Class II malocclusion were recruited from the Stomatological Center of Shunde Hospital, Southern Medical University. Subjects were divided into three groups based on different A point–nasion–B point angle (ANB), and angle between the upper central incisor and Frankfort horizontal plane (U1-FH). Bilateral SCI values were measured using computer-aided diagnosis axiography (CADIAX) and cone-beam computed tomography (CBCT). Statistical analysis showed that the SCI value measured by CADIAX was significantly higher than that measured by CBCT. Significant differences were found among different ANB and U1-FH groups, and the average value of the 6 ∘ < ANB ≤ 8 ∘ group was the highest. Our findings indicate that the measurement of SCI by CADIAX cannot be replaced by CBCT, and it is recommended that personalized measurements of SCI values in skeletal class II patients be carried out. Individual SCI measurement can help coordinate the physiological characteristics of patients in dental treatment, benefit the health of temporomandibular joint and improve the long-term outcome. Our results suggest that the SCI values obtained by CBCT is different from the real SCI values of patients, and we will look for a simpler and more accurate clinical method to measure SCI value in future research. [ABSTRACT FROM AUTHOR]

Purpose: This case report describes the lingual orthodontic treatment of an adult skeletal Class II division 1 patient with lip protrusion, mandibular retrusion, severe overjet and deep overbite, proclined upper and lower incisors and mild crowding in both arches. Materials and methods: The overjet was corrected with upper first premolar extraction with the help of skeletal absolute anchorage. Also, 4 third molars were extracted and miniscrew-assisted total distalization was performed in mandibular arch to decrease the proclination of lower incisors after aligning and levelling. Results: After 25-month treatment, satisfactory facial aesthetics and good occlusion were achieved. A two-year follow-up after confirmed that the outcome was stable. Conclusion: Maxillary first premolar extraction combined with total arch distalization with skeletal anchorage could greatly reduce the excessive overjet and lip protrusion in skeletal Class II cases. [ABSTRACT FROM AUTHOR]

Abstract Background Little information is available on the treatment of open bite with temporomandibular joint disorder by intrusion of molars using miniscrews. Case presentation This case report describes a 42-year-old Japanese woman with a skeletal class II severe anterior open bite and temporomandibular joint disorder. The pretreatment magnetic resonance imaging of both temporomandibular joints revealed osteoarthritis and anterior disc displacement without reduction in both temporomandibular joints. A stabilization splint was used before orthodontic treatment and bilateral upper and lower premolars were extracted. Miniscrews were inserted into the palatal region to intrude the maxillary molars and avoid loss of anchorage. The maxillary left first molar was also extracted to improve the molar relationship and the dental midline. Normal overjet and overbite with Angle class I molar relationship were achieved, and the upper and lower midlines coincided. Our patient’s teeth continued to be stable and her temporomandibular joint was asymptomatic after a retention period of 2 years. Conclusions Intrusion of molars by miniscrews is available for skeletal class II severe open bite.

Adult patients with severe skeletal malocclusions require orthognathic surgeries. Two case reports with skeletal Class II malocclusion due to retrognathic mandible discussed in this article were treated by bilateral sagittal split osteotomy mandibular advancement. Treatment results showed good improvement in facial profile, Angle Class I molar and canine relation, good occlusion after surgery for both the cases.

Background: This study is aimed to (1) investigate the influence of sagittal and vertical patterns on mandibular cross-sectional morphology and to (2) provide visualized mandibular cross-sectional morphology in different groups with General Procrustes Analysis (GPA), canonical variance analysis (CVA) and discriminant function analysis (DFA). Methods: 324 cone-beam computed tomography (CBCT) images were collected to analyze mandibular cross-sectional morphology and were categorized into 12 groups according to sagittal and vertical pattern and gender. One-way analysis of variance (ANOVA) was used to compare the difference among the groups. Thirty equidistant points were marked along the contour of mandibular cross-section and GPA, CVA and DFA were applied. Results: (1) Mandibular height in hyperdivergent groups was significantly higher than that in normodivergent and hypodivergent groups (P < 0.05). (2) Hypodivergent groups showed significantly wider upper third of mandibular width from symphysis to molar region than that in hyperdivergent group (P < 0.05), except for the premolar and molar regions in male groups (P > 0.05). (3) Class II hyperdivergent group showed narrowest lower third width in the molar region, with the mean value of 12.03 mm in females and 11.98 mm in males. (4) For males and females, the ratio between height and lower third width at symphysis was significantly higher in Class II hyperdivergent group than that in Class I hyperdivergent group (P < 0.05). Conclusions: (1) The influence of vertical facial patterns on mandibular cross-sectional morphology is more obvious than that of sagittal skeletal pattern. (2) Subjects with increased vertical dimension presented with a remarkable "slimer" mandibular cross-sectional morphology at symphysis. (3) A deeper curve along the anterior contour of symphysis in Class II hyperdivergent group was noted with GPA. [ABSTRACT FROM AUTHOR]

Treatment of skeletal Class II patients with dual bite and idiopathic condylar resorption (ICR) is challenging for orthodontists because of the unstable position of the mandible as well as skeletal relapse attributed to improper seating of the mandibular condyles. This case report describes the successful treatment of an 18-year-old Mongolian man diagnosed with centric relation–maximum intercuspation discrepancy and ICR. After making a definitive diagnosis from verified centric relation using bilateral manipulation, orthodontic treatment was initiated followed by three-dimensional computer-aided design/computer-aided manufacturing prebent titanium plate–guided sagittal split ramus osteotomy and genioplasty. Postoperative 3D superimposition demonstrated that this surgical guide approach provided accurate repositioning of the condyles, which were well positioned in the fossae. Complete orthodontic and surgical treatment time was 24 months. The patient's facial appearance and occlusion improved significantly, and a stable result was obtained with a 1-year follow-up. [ABSTRACT FROM AUTHOR]

Background: In this study, we sought to quantify the influence of vertical control assisted by a temporary anchorage device (TAD) on orthodontic treatment efficacy for skeletal class II patients with a hyperdivergent facial type and probe into the critical factors of profile improvement., Methods: A total of 36 adult patients with skeletal class II and a hyperdivergent facial type were included in this retrospective case-control study. To exclude the effect of sagittal anchorage reinforcement, the patients were divided into two groups: a maxillary maximum anchorage (MMA) group (N = 17), in which TADs were only used to help with anterior tooth retraction, and the MMA with vertical control (MMA + VC) group (N = 19), for which TADs were also used to intrude the maxillary molars and incisors. The treatment outcome was evaluated using dental, skeletal, and soft-tissue-related parameters via a cephalometric analysis and cast superimposition., Results: A significant decrease in ANB (P < 0.05 for both groups), the retraction and uprighting of the maxillary and mandibular incisors, and the retraction of protruded upper and lower lips were observed in both groups. Moreover, a significant intrusion of the maxillary molars was observed via the cephalometric analysis (- 1.56 ± 1.52 mm, P < 0.05) and cast superimposition (- 2.25 ± 1.03 mm, P < 0.05) of the MMA + VC group but not the MMA group, which resulted in a remarkable decrease in the mandibular plane angle (- 1.82 ± 1.38°, P < 0.05). The Z angle (15.25 ± 5.30°, P < 0.05) and Chin thickness (- 0.97 ± 0.45°, P < 0.05) also improved dramatically in the MMA + VC group, indicating a better profile and a relaxed mentalis. Multivariate regression showed that the improvement in the soft tissue was closely related to the counterclockwise rotation of the mandible plane (P < 0.05)., Conclusions: TAD-assisted vertical control can achieve intrusion of approximately 2 mm for the upper first molars and induce mandibular counterclockwise rotation of approximately 1.8°. Moreover, it is especially important for patients without sufficient retraction of the upper incisors or a satisfactory chin shape., (© 2024. The Author(s).)

A 22-year-old woman with severe skeletal Class II malocclusion was referred to our clinic. A clinical examination revealed a convex soft tissue profile and increased teeth and gingiva exposure both while smiling and in the natural rest position. She had Class II molar and canine relationship with increased overjet, moderate crowding in both upper and lower jaws, and proclined upper and lower incisors. Skeletally, she showed transverse maxillary deficiency, maxillary vertical excess, and mandibular retrognathia. We planned orthodontic- orthognathic surgery with multipiece Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) to achieve ideal occlusion, stability, and facial esthetics. During orthodontic decompensation to relieve the crowding and to gain an ideal incisor inclination, four bicuspid extractions were performed. Because we used continuous mechanics, at the end of the decompensation period, we cut the maxillary arch wire distal to the lateral incisors into three pieces and waited for 3 months for vertical and transversal dental relapse. During the double jaw surgical procedure, the maxilla expanded and impacted with multisegmented Le Fort I osteotomy and the mandible advanced with BSSO. After the orthodontic and orthognathic surgical treatment, the skeletal and dental imbalance was corrected, and functional occlusion and dental and skeletal Class I relationship were achieved. The treatment results were stable at the 1-year follow-up.

Skeletal class II and III malocclusions are craniofacial disorders that negatively impact people’s quality of life worldwide. Unfortunately, the growth patterns of skeletal malocclusions and their clinical correction prognoses are difficult to predict largely due to lack of knowledge of their precise etiology. Inspired by the strong inheritance pattern of a specific type of skeletal malocclusion, previous genome-wide association studies (GWAS) were reanalyzed, resulting in the identification of 19 skeletal class II malocclusion-associated and 53 skeletal class III malocclusion-associated genes. Functional enrichment of these genes created a signal pathway atlas in which most of the genes were associated with bone and cartilage growth and development, as expected, while some were characterized by functions related to skeletal muscle maturation and construction. Interestingly, several genes and enriched pathways are involved in both skeletal class II and III malocclusions, indicating the key regulatory effects of these genes and pathways in craniofacial development. There is no doubt that further investigation is necessary to validate these recognized genes’ and pathways’ specific function(s) related to maxillary and mandibular development. In summary, this systematic review provides initial insight on developing novel gene-based treatment strategies for skeletal malocclusions and paves the path for precision medicine where dental care providers can make an accurate prediction of the craniofacial growth of an individual patient based on his/her genetic profile.

Objectives: To evaluate the presence of dehiscences and changes in alveolar bone height and width in the area of the mandibular central incisors pre- and post-orthodontic treatment. Materials and Methods: In 60 skeletal Class II patients, cone-beam computed tomographic (CBCT) images were obtained and the patients were divided into four groups based on the presence of dehiscences at pre- and post-orthodontic treatment. The alveolar bone height and width were measured on CBCT in cross section along the long axis of the teeth. Lateral cephalograms were analyzed. Results: The changes in L1-NB and IMPA appeared to be correlated with vertical bone loss and dehiscence. Alveolar bone height appeared to follow a segmented relationship with these two variables, with changes below a threshold (L1-NB = 0.71 mm, IMPA = 3.028) having relatively minimal or no effect on bone loss but with changes beyond the threshold correlated with extensive bone loss. Similarly, increases in L1-NB or IMPA correlated with decreases in alveolar bone width (L1-NB: -0.25 mm/mm, IMPA: -0.07 mm/8) and increased the probability of developing dehiscences, with an estimated 50% probability of vertical bone loss at a L1-NB change of 2.00 mm or, equivalently, an IMPA change of 8.028 was estimated. Conclusions: When treating skeletal Class II patients, the limits of incisor proclination/protraction are less than previously thought. To prevent undesired periodontal outcomes, careful threedimensional diagnosis is advisable. Furthermore, when excessive protrusion and/or proclination is planned, additional treatment modalities, including orthognathic surgery, tooth extraction, and corticotomy with bone graft, should be considered. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the difference of palatal morphology in different vertical patterns between skeletal Class I subjects and skeletal Class II subjects with retrusive mandible. Methods: Seventy-six skeletal Class II subjects with retrusive mandible (38 females, 38 males) and 85 skeletal Class I subjects (45 females, 40 males) were collected retrospectively and divided into hyperdivergent, normodivergent and hypodivergent groups. CBCT images of these subjects were reoriented by Dolphin 3D Imaging software. Three-dimensional (3D) maxilla was segmented by ProPlan software before using Geomagic Studio software to reconstruct 3D palatal morphology. Deviation patterns on 3D colored map analysis was performed to compare the difference of 3D palatal morphology between different groups. Results: 3D colored map analysis showed that male's palate was higher and wider than that of female in the posterior part, regardless of different sagittal and vertical patterns. In skeletal Class II subjects with retrusive mandible, males with hyperdivergent and normodivergent showed higher and narrower in the posterior part of palate, while females with hyperdivergent and normodivergent had a higher but no obviously narrow palate compared with the hypodivergent subjects. Skeletal Class II subjects with retrusive mandible showed flatter and narrower in the posterior part of palate than that of skeletal Class I subjects. Conclusions: Sagittal and vertical patterns have great influence on the palatal morphology and as the vertical dimension increased, the palate tended to be higher and narrower. [ABSTRACT FROM AUTHOR]

Introduction: In orthognathic surgery, we often experience that model mounting by the occlusal bite record taken at centric relation under the conscious condition in the sitting position does not always correctly replicate the actual maxilla–mandibular relationship under general anesthesia. Mandible often moves backward further in the latter condition. The present study was carried out to investigate the degree of extra retrusion of the mandible under general anesthesia and to determine the characteristics in each of the three original skeletal class patterns in a Japanese population. Patients and methods: Fifty patients with jaw deformities (14 males and 36 females) were enrolled in this prospective study, their ages ranging from 16 to 49 years. The occlusal bite record at the incisor region obtained from a mounted articulator was compared with the records from the oral cavity of the patient under general anesthesia before surgery. Results: Retrusion in the supine position under general anesthesia was observed in all skeletal classes, and it was significantly greater in skeletal Class II, compared to skeletal Class I and Class III. Conclusion: This study clearly revealed the difference among three different skeletal classes, and the mandible in the skeletal Class II moved backward significantly compared to other classes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the hard and soft tissue changing trend and contributing factors of skeletal class Ⅱ hyperdivergent patients before and after orthodontic camouflage treatment by analyzing the cephalogram and the three dimensional (3D) facial scan data., Methods: Eighteen skeletal class Ⅱ hyperdivergent adult female patients who finished camouflage orthodontic treatment were selected. Skeletal and dental measurements were carried out with the cephalometric analysis before and after the treatment. 3D facial data before and after orthodontic treatment were acquired and the anatomical landmarks were set after the repositioning and superimposition process. Hard tissue measurement included 17 mea-surement indicators (sella-nasion-subspinale angle, sella-nasion-supramental angle, subspinale-nasion-supramental angle, facial angle, angle of convexity, Frankfort horizontal plane-mandibular plane angle (FH-MP), Y axis angle, sella-nasion plane-mandibular plane angle (MP-SN), pogonion-nasion-supramental distance, upper incisor-nasion-subspinale distance, upper incisor to sella-nasion, lower incisor-nasion-supramental distance, lower incisor-nasion-supramental angle, upper incisor to lower incisor, upper incisor to sella-nasion, lower incisor-mandibular plane angle, and Z angle), and the changes before and after treatment were measured for 11 of them. Twenty soft tissue landmarks (left/right cheekbone, left/right chelion, left/right crista philtra, soft tissue gnathion, left/right gonion, glabella, labrale infe-rius, labrale superius, soft tissue menton, left/right mid-mandibular border, soft tissue pogonion, stomion superius, sublabial, subnasale, and supralabial) and 9 soft tissue indicators (lower lip height, facial convexity, lower vermilion height, mandibular contour, nasolabial angle, philtral length, philtral width, upper lip height, and upper vermilion height) were measured and recorded for treatment changes. Linear-regression analysis and correlation analysis were carried out for analyzing the relationship between hard and soft tissue changes before and after the treatment., Results: Significant differences were noticed for 18 out of the 20 cephalometric measurements and facial measurements before and after the treatment ( P < 0.05), which mainly represented the sagittal retraction of lip area after the treatment. Significant vertical displacements were revealed for soft tissue menton after treatment [(1.88±2.61) mm, P < 0.05]. Significant sagittal displacements were revealed for left/right cheilion [(-2.95±1.9) mm, (-2.90±1.92) mm], labrale inferius[(-4.94±1.95) mm], labrale superius[(-3.25±1.44) mm], sublabial [(-3.10±3.5) mm], and subnasale [(-1.23±1.06) mm] after treatment ( P < 0.05). An average of 4.10°±2.57° increasement was noticed for Z angle after treatment. High correlation ( r >0.7) was noticed for the displacement of menton after treatment with FH-MP, with the rate of -0.183 :1, and MP-SN, with the rate of -0.157 :1. Moderate correlations (0.7≥ r >0.4) were noticed for the other measurements with correlations ( P < 0.05)., Conclusion: A certain extent of facial improvements could be achieved with orthodontic camouflage treatment for skeletal class Ⅱ hyperdivergent patients, which were mostly represented by the improvement of sagittal relationship of nose, lips, and chin. Certain correlations were noticed for the hard and soft tissue changes.

Objective: To study the difference in mandibular asymmetry between patients with skeletal Class I and skeletal Class II malocclusions and analyze the correlation between mandibular asymmetry and different facial skeletal sagittal patterns based on CBCT measurements., Methods: One hundred and twenty patients were selected according to the inclusion and exclusion criteria. Patients were divided into two groups (60 in the skeletal Class I group and 60 in the skeletal Class II group) based on ANB angles and Wits values. Patients' CBCT data were collected. Dolphin Imaging 11.0 was used to determine the mandibular anatomic landmarks and calculate the linear distance in patients in the two groups., Results: Intragroup comparison: in skeletal Class I group, measurements of the most posterior point of the condyle (Cdpost), the outer lateral point of the condyle (Cdlat), sigmoid notch point (Sn)), coronoid process point (Cop), gonion point (GO) and antimony notch point (Ag), right>left (P<0.05); in skeletal Class II group, measurements of Cdpost and Cop, right>left (P<0.05). Intergroup comparison: for measurements of GO and Ag, skeletal Class I group>skeletal Class II group (P<0.05). The asymmetry of the Ag and GO points was negatively correlated with the ANB angle (p<0.05)., Conclusion: Mandibular asymmetry was significantly different between patients with skeletal Class I and skeletal Class II malocclusions. The asymmetry of the mandible angle region in the former group was greater than that in the latter group, and the asymmetry of the mandibular angle was negatively correlated with the ANB angle., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objectives: This prospective study aimed to analyze 3‐dimensional changes in the temporomandibular joint (TMJ) complex with a synergistic effect of functional jaw orthopedics using a fixed functional appliance and low‐intensity pulsed ultrasound (LIPUS) therapy. Methods: Forty patients with skeletal class II malocclusion were randomly assigned to 4 groups (2 control groups and 2 test groups) of 10 patients each. After insertion of the fixed functional appliance, the test group was stimulated with LIPUS therapy in the TMJ region bilaterally for 20 minutes daily for first 10 days and thereafter at least 3 times per week until complete mandibular advancement was achieved. Three‐dimensional images obtained with a cone beam computed tomographic scanner were used to analyze the changes in the TMJ complex at the prefunctional stage and after completion of functional appliance therapy. Direct intragroup and intergroup comparisons for different morphometric variables were conducted with the Student t test. Results: The 40 patients included 20 male and 20 female patients between the ages of 12 and 16 years (mean age ± SD, 13.2 ± 1.8 years). Both the test groups and the control groups showed statistically significant variable changes in condylar head position and morphometric changes in relation to the joint space analysis (mean differences, –1.000 and –1.080 mm; P < .05). However, no significant differences were found during the intergroup comparisons at the prefunctional and postfunctional stages for the variables examined, except for the measurements of the linear distance of the condyle to the external auditory meatus on both the right and left sides at the prefunctional phase. Conclusions: Low‐intensity pulsed ultrasound therapy positively affects the quantum of the joint space, thus proving to be a promising adjunct in enhancing treatment outcomes of functional jaw orthopedics in growing patients with skeletal class II malocclusions. [ABSTRACT FROM AUTHOR]

Introduction: Planning successful treatment for the correction of anatomic abnormalities of the upper airways, by surgical advancement of the mandible, depends on extensive knowledge of the pharyngeal airway space (PAS). However, there is limited scientific evidence about changes in PAS after mandibular advancement surgery.Aim: To evaluate the immediate changes in superior posterior airway space (SPAS) in Class II patients, after mandibular advancement surgery.Materials and Methods: A cephalometric evaluation of 37 patients with skeletal Class II deformity was performed at 2 distinct time intervals: Pre-operative (T0) and immediate post-operative (T1), using Dolphin Image & Management Solutions, version 11.9, according to the method of Arnett/Gunson FAB Surgery. The differences due to the surgical intervention were assessed with Student's t test, and a Principal Component Analysis was used to evaluate the relationship between mandibular advancement and SPAS variables. Anticlockwise and clockwise rotation groups were also evaluated with Mann-Whitney tests. The statistical analysis was conducted in SPSS and R assuming a 0.05 level of significance.Results: As an effect of mandibular advancement, an anteroposterior statistically significant increase in SPAS (P < 0.001) was perceived at all points measured.Conclusion: Our findings indicate that mandibular advancement surgery is a viable option to achieve widening of the SPAS in patients with Class II skeletal morphology. [ABSTRACT FROM AUTHOR]

Forsus appliance is the most widely used rigid fixed functional appliance. It is used along with conventional fixed appliance and cannot be removed by the patient. Forsus Fatigue Resistant Device is very effective in correction of class II malocclusion by bringing about a combination of skeletal and dentoalveolar modifications. This appliance can lead mandibular growth and favourable dentoalveolar changes in patients at or before the peak phase of pubertal growth. On the other hand, mostly dental changes are encountered for the patients at post-pubertal period. [ABSTRACT FROM AUTHOR]

Adult patients with severe skeletal malocclusions require orthognathic surgeries. Two case reports with skeletal Class II malocclusion due to retrognathic mandible discussed in this article were treated by bilateral sagittal split osteotomy mandibular advancement. Treatment results showed good improvement in facial profile, Angle Class I molar and canine relation, good occlusion after surgery for both the cases. [ABSTRACT FROM AUTHOR]

This study presents a novel technique utilizing high-frequency vibration to shorten treatment time and preserve alveolar bone in challenging orthodontic cases that have been treated with Invisalign® clear aligners. Four non-growing orthodontic patients (age range 14–47 years old) with Class II skeletal patterns (convex profiles with retrognathic mandibles) who sought correction of their crowded teeth and non-surgical correction of their convex profiles were included in this study. These patients were treated using Invisalign clear aligners together with high-frequency vibration (HFV) devices (120 Hz) (VPro5™) that were used by all patients for five minutes per day during active orthodontic treatment. Vertical control and forward rotation of the mandible for each patient was achieved through pre-programming the Invisalign to produce posterior teeth intrusion. Successful forward rotation of the mandibles achieved in all patients led to improvement of their facial convex profiles (apical base relationship (ANB) improved 2.1 ± 0.5 degrees; FMA (Frankfurt mandibular plane angle) improved 1.2 + 1.1 degrees). Dental decompensation was achieved by lingual tipping of the lower incisors and palatal root torque of upper incisors. The use of HFV together with Invisalign facilitated achieving these results within a 12 ± 6 months period. In addition, more bone labial to the lower incisors after their lingual movement was noted. In conclusion, the use of HFV concurrent with SmartTrack Invisalign aligners allowed complex tooth movement and forward mandibular projection without surgery in non-growing patients with skeletal Class II relationships. The clinical impact and implications of this case series are: (1) the use of HFV facilitates complex orthodontic tooth movement including posterior teeth intrusion and incisor decompensation; (2) forward mandibular projection of the mandible and increased bone formation labial to lower incisors can be achieved in non-growing patients that may minimize the need for surgical intervention in similar cases or gum recession due to lower incisors labial inclination.

A 22-year-old woman with severe skeletal Class II malocclusion was referred to our clinic. A clinical examination revealed a convex soft tissue profile and increased teeth and gingiva exposure both while smiling and in the natural rest position. She had Class II molar and canine relationship with increased overjet, moderate crowding in both upper and lower jaws, and proclined upper and lower incisors. Skeletally, she showed transverse maxillary deficiency, maxillary vertical excess, and mandibular retrognathia. We planned orthodontic-orthognathic surgery with multipiece Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) to achieve ideal occlusion, stability, and facial esthetics. During orthodontic decompensation to relieve the crowding and to gain an ideal incisor inclination, four bicuspid extractions were performed. Because we used continuous mechanics, at the end of the decompensation period, we cut the maxillary arch wire distal to the lateral incisors into three pieces and waited for 3 months for vertical and transversal dental relapse. During the double jaw surgical procedure, the maxilla expanded and impacted with multisegmented Le Fort I osteotomy and the mandible advanced with BSSO. After the orthodontic and orthognathic surgical treatment, the skeletal and dental imbalance was corrected, and functional occlusion and dental and skeletal Class I relationship were achieved. The treatment results were stable at the 1-year follow-up. [ABSTRACT FROM AUTHOR]

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A well-balanced face has its good proportions in all three planes of space, i.e. transverse, sagittal and vertical. The vertical proportions of the face are important in determining the esthetics and harmony of the face. Dental arch form is a reflection of underlying bone morphology, size and its shape. Correct identification of patient's arch form is an important aspect of achieving a stable, functional and esthetic orthodontic treatment result. The objective of current study was to determine a relationship between vertical proportions and arch form in skeletal class II in local Pakistani population. A sample of 100 nontreated skeletal class II patients fulfilling all the inclusion and exclusion criteria were selected. Lateral head cephalograms and pre-treatment plaster study models were measured. For each subject, Sella Nasion- mandible plane angle (SN-MP) was measured. Angular measurements and linear relationships were measured manually on both dental arches. Intermolar, inter canine and anterior angle were measured. A weak but significant (r=0.23)correlation between anterior mandibular angle and SN-MP was observed, with increase in SN-MP, the intermolar and intercanine distance was decreased in maxilla and mandibular arch. Intercanine, intermolar widths and anterior angle values calculated on the maxillary and mandibular casts of individuals with different facial forms show no significant difference statistically. A weak but significant correlation(r=0.23) was found between anterior mandibular angle and SN-MP. [ABSTRACT FROM AUTHOR]

Objective: To compare soft and hard tissue responses based on the degree of maxillary incisor retraction using maximum anchorage in patients with Class II division 1 malocclusion. Materials and Methods: This retrospective study sample was divided into moderate retraction (<8.0 mm; n = 28) and maximum retraction (≥8.0 mm; n = 29) groups based on the amount of maxillary incisor retraction after extraction of the maxillary and mandibular first premolars for camouflage treatment. Pre- and posttreatment lateral cephalograms were analyzed. Results: There were 2.3 mm and 3.0 mm of upper and lower lip retraction, respectively, in the moderate group; and 4.0 mm and 5.3 mm, respectively, in the maximum group. In the moderate group, the upper lip was most influenced by posterior movement of the cervical point of the maxillary incisor (β = 0.94). The lower lip was most influenced by posterior movement of B-point (β = 0.84) and the cervical point of the mandibular incisor (β = 0.83). Prediction was difficult in the maximum group; no variable showed a significant influence on upper lip changes. The lower lip was highly influenced by posterior movement of the cervical point of the maxillary incisor (β = 0.50), but this correlation was weak in the maximum group. Conclusions: Posterior movement of the cervical point of the anterior teeth is necessary for increased lip retraction. However, periodic evaluation of the lip profile is needed during maximum retraction of the anterior teeth because of limitations in predicting soft tissue responses. [ABSTRACT FROM AUTHOR]

This case report illustrates the successful treatment of anterior rotation of the mandible due to intrusion of the entire maxillary arch, using miniscrew anchorage in an adult. A woman, aged 24 years and 8 months, had a convex profile, which she desired to improve. She was diagnosed with a skeletal Class II jaw-base relationship with a high mandibular plane angle. After extraction of four premolars, three miniscrews were implanted at the median palatine suture and the distal alveolus of the maxillary lateral incisors. Anterior rotation of the mandible was achieved by intrusion of the entire maxillary arch. The total active treatment period was 32 months. Acceptable occlusion and an improved facial profile were maintained after 29 months of retention. [ABSTRACT FROM AUTHOR]