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Edward H Angle first gave the classification for malocclusions into Classes I, II and III. Amongst these, Class II is the most prevalent and commonly treated at orthodontic clinics. Treatment of Class II malocclusion with mandibular deficiency in adult patients is usually managed with ortho-surgical treatment modality. In this article a case of Skeletal Class II malocclusion with vertical growth pattern is represented which was treated with BSSRO and mandibular advancement was carried out. Keywords: Skeletal Class II, Bilateral Sagittal Split Ramus Osteotomy/BSSRO, Mandibular Advancement.

Around half of all malocclusions that need orthodontic treatment are Class II in nature. Patients with Class II malocclusion primarily seek treatment for aesthetic improvement. Most of the skeletal class II malocclusions are because of mandibular deficiency, and can be best treated during the growing phase of development by removable functional appliances. The objective of this review is to evaluate and compare skeletal and dentoalveolar effects of various removable functional appliances in the treatment of class II malocclusion. Manual and electronic databases were searched, and out of 5,711 articles, 221 abstracts were shortlisted and reviewed. A total of 19 articles that fulfilled the selection criteria was then retrieved and analyzed. A significant increase in mandibular length and dentoalveolar effects with an increase in vertical dimension in a short time was observed with Twin-Block appliance treatment, followed by Bionator appliance treatment. The long-term stability of results achieved with Twin-Block appliance treatment is still questionable. In addition, Frankel appliance treatment effects are more skeletal in nature, with better control in the vertical dimension. However, it takes a more extended treatment duration to produce similar effects. Based on available evidence, we are convinced that removable functional appliances are valuable tools for correction of the Class II malocclusion at a growing age with a horizontal growth pattern.

Introduction: Angle’s Class II Div 1 malocclusion is one of the most common malocclusions in orthodontics. In cases of Angle’s Class II Div 1 malocclusion with mandibular deficiency, myofunctional appliances are often used with the intent of stimulating mandibular growth. Twin block is one of the most popular myofunctional appliances. Aim: The aim of this study was to find out “Does the length of mandible increase with Twin Block appliances” using cephalometric radiograph. Materials and Methods: Cephalometric radiographs of 15 patients who had Class II Div I malocclusion, before and after treatment were examined. The mean changes after Twin Block were compared with pre-treatment parameters using independent‘t’ test. Results: There were statistically significant differences in Pre and Post-treatment mandibular length. Patients treated with twin block appliance showed a mean increase of 4 mm in the mandibular length. Conclusion: Twin Block is an effective myofunctional appliance which can be used to increase the effective mandibular length in patients with skeletal Class II Div I malocclusion. Keywords: Functional appliance, Class II malocclusion, Twin block

Objective: to compare the condylar volume and mandibular length changes of skeletally versus dentally anchored Herbst appliance in the treatment of Class II division 1 patients due to mandibular deficiency. Materials and Methods: The current study was conducted on 17 female patients with their age ranged between 14 and 20 years. All patients were treated by Type IV Herbst appliance. The active group (Group A) comprising 10 patients at whose the Herbst was anchored to the mandible directly by two reconstruction plates located bilaterally in the mandible between the canine and first premolar, while attached to the maxilla through dental splints utilizing orthodontic bands, while the control group (Group B) comprising 7 patients, their CBCT data were taken from a previous study at which the Herbst appliance was anchored with custom made vitalium splints for both the maxillary and mandibular dental arches. The condylar volume and the 3D effective mandibular length was measured using Dolphin software (Dolphin imaging software ver.11.95, Patterson Dental, USA). Statistical analysis was performed with Assistant 7.6 statistics software for Windows (Campina Grande, Paraiba state, Brazil) Results: Condylar volume showed no statically significant change with treatment in both groups, while the 3D effective mandibular length showed statistically significant increase with treatment in both groups. Conclusions: Skeletally anchored Herbst has same mandibular skeletal effect when compared with dentally anchored Herbst.

Aim Achieving a satisfactory facial esthetics is of utmost importance in the practice of orthodontics. Cl II div 1 patients often suffer from numerous adverse facial characteristics which may impair their social well-being. The objective of the current study was to evaluate the esthetic changes in such patients by using a modified twin block appliance. Materials and methods Seventy adolescent patients with mandibular deficiency consecutively underwent treatment with a modified twin block appliance for a mean period of 13 months. Soft tissue analyzes of Burstone and Mcnamara were applied to evaluate the changes before and after the treatment. The esthetic changes before and after the therapy were compared using parametric paired t tests analysis. p values less than 0.05 were considered significant. Results Facial convexity, lip incompetence, upper lip protrusion, and columellar inclination significantly decreased (p < 0.05) while Merrifield's Z-angle nasolabial angle, lower lip length, and mentolabial angle significantly increased (p < 0.05). Vertical facial height ratio, lower lip protrusion, upper lip length as well as nasal projection and inclination, did not change significantly (p > 0.05) Conclusion Our findings indicated that a modified form of the twin block appliance can be substantially effective in the improvement of several aspects of patients’ facial balance with minimum untoward effects. Clinical significance Adolescents suffering from mandibular deficiency can gain substantial facial balance with the twin block appliance. The whole face attractiveness, however, is another subject and should not be conflicted with the facial balance. How to cite this article Shahamfar M, Atashi MHA, Azima N. Soft Tissue Esthetic Changes Following a Modified Twin Block Appliance Therapy: A Prospective Study. Int J Clin Pediatr Dent 2020;13(3):255–260.

Severe mandibular deficiency caused by temporomandibular joint (TMJ) ankyloses produces functional and aesthetic problems that require complicated long-term treatment. In this case report, we describe the benefits of using microimplant mechanics for controlling the direction of distraction during distraction osteogenesis and for performing the movement of teeth. We also present its remarkable results and long-term stability. A 20-year-old girl presented with a convex profile due to severe mandibular retrognathia after a history of several TMJ surgeries for bilateral TMJ ankyloses. Mandibular distraction osteogenesis (MDO) was performed, and elastics were placed between the microimplants to control the direction of distraction. Subsequently, after retraction of the maxillary anterior teeth and distalisation of the whole mandibular dentition, the facial profile was markedly improved, and good interdigitation was obtained. The six-year follow-up retention and overall stability were satisfactory with good interdigitation and jaw function.

Background: The demand for interdisciplinary orthodontic treatment has increased significantly in the past few years, especially in adult patients. This kind of treatment requires careful clinical management, as consequence of the possible complications and limits related to adult age. However, the use of skeletal anchorage and three-dimensional (3D) digital technology has deeply revolutionised diagnostic planning and treatment strategies. Methods: A fully digital approach to the treatment of a Class II patient with a gummy smile and mandibular deficiency and deviation, consisting of initial surgery followed by the use of aligners and skeletal anchorage, is described. Results: The 3D, fully digital pre-evaluation enabled clinicians to accurately and reliably plan the surgical procedure and subsequent orthodontics, including the individualised positioning of stabilisation plates and a splint for maxillary and chin surgical movements. This allowed for the improvement of the patient’s facial aesthetics and dental occlusion without the use of visible orthodontic appliances or the occurrence of pre-surgical aesthetic worsening. Conclusions: This approach could be very effective for adult patients seeking aesthetic treatment options for facial and dental aesthetic improvement.

Aim or Purpose Clark's Twin-Block (CTB) functional appliance is commonly used to treat mandibular deficiency in skeletal class II growing patients. This study was conducted to identify cephalometric predictors for favorable soft tissue profile outcomes with CTB appliance. Materials and Methods Using pre- and post-functional lateral cephalograms of 50 subjects treated with CTB, profile silhouettes were evaluated by a panel of orthodontists to assess improvement using the Visual Analogue Scale (VAS). Subjects were divided into favorable and unfavorable groups on the basis of VAS scores. Independent sample t-test was used to compare cephalometric skeletal and soft tissue measurements between the groups. Predictors of favorable and unfavorable outcomes were identified using the logistic regression analysis. Results Statistically significant differences in multiple pre-treatment values between favorable and unfavorable groups were observed. Multivariable logistic regression analysis found the decreased value of lower lip to E line (95% CI: 0.142, 0.800) and decreased pogonion to nasion perpendicular distance (95% CI: 1.05, 1.85) to be significantly associated with favorable soft tissue profile outcomes. Conclusions Pre-treatment hypodivergent skeletal pattern, reduced ANB, reduced lower incisor to pogonion distance and soft tissue recumbency were identified as predictors of favorable soft tissue outcomes for CTB treatment in growing patients with mandibular retrognathism.

Objective: The objective of this study was to assess the pharyngeal airway passage (PAP) dimension changes following functional appliance treatment in Class II malocclusion subjects with retrognathic mandibles. Materials and Methods: Two authors independently searched various electronic databases such as PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus, NCBI, and Google Scholar for the available literature within the period from January 1, 2001, to December 31, 2018. On the basis of population, intervention, comparison, and outcome, “changes in PAP dimensions following functional appliance therapy in skeletal Class II malocclusion subjects associated with mandibular retrusion” was considered as search question of the study. After the selection and removal of duplicate articles, assessment for risk of bias was calculated and the data from the included articles were extracted by two authors independently. Results: From six databases and additional hand searching, a total of 5784 articles were extracted. Of 5784 articles, 3754 articles were screened after removal of 2030 duplicates. After going through the title and abstract, 3197 articles were excluded and 40 articles were assessed for full text. From these 40 articles, eight articles fulfilled our inclusion and exclusion criteria for the qualitative synthesis review. Conclusions: The correction of mandibular deficiency by functional appliances has minimum effect on the nasopharynx. Functional appliance treatment has a significant effect on the improvement of the oropharyngeal airway. Changes of hypopharyngeal airway passage need to be studied further among Class II malocclusion subjects with retrognathic mandibles.

Introduction: Several factors play a role in the etiology of skeletal Class II malocclusion. Displaced maxillary incisors might have a hindering effect on mandibular growth potential. Aim of the study: The aim of this cross-sectional study was to evaluate the influence of palatally displaced maxillary incisors on mandibular growth in a group of Egyptian patients. Subjects and Methods: The sample consisted of the digital lateral cephalometric radiographs of untreated 24 patients (12 females and 12 males) with age range of 15-30 years and a mean age of 22.4 years during the permanent dentition stage. The radiographs were selected from the patient database of private practice in Cairo. The sample was divided into 2 groups each consisting of 12 patients. Group A had palatally displaced maxillary lateral incisors without crossbite. Group B had palatally displaced maxillary lateral incisors with crossbite. Linear and angular cephalometric measurements (ANB & Witts appraisal) were used to assess the anteroposterior skeletal malocclusion and the position of the apical bases of the jaws in both groups. Independent samples t-test was performed to compare the results between the two groups. Results: Cephalometric measurements revealed statistically significant differences between groups A and B showing a mild skeletal Class II malocclusion with a retrognathic mandible in Group A (mean ANB = 4.4˚ ± 1.85), (mean Witts= 1.85 mm ± 3.22) while Group B had skeletal Class I pattern with mild skeletal Class III tendency (mean ANB= 0.8˚± 1.88), (mean Witts=-2.5mm ± 2.33). Conclusions: Palatally displaced maxillary lateral incisors without crossbite cause restraining effect on normal mandibular growth which results in mild skeletal Class II with mandibular deficiency. However, palatally displaced maxillary lateral incisors that are in crossbite have no restraining effect on mandibular growth which results in normal to slightly excessive mandibular growth. This can be used as a tool for early prediction of mandibular growth pattern that necessitates immediate intervention.

Introduction Treacher Collins syndrome (TCS) and nonsyndromic Pierre Robin sequence (PRS) share mandibular deficiency as a similar clinical finding. This study aimed to compare the mandibular size and morphology of subjects with TCS and PRS. Methods Group TCS was composed of 17 subjects (7 male, 10 female) with a mean age of 11.5 years (standard deviation, 4.4) from a single center. Group PRS was composed of 17 subjects paired by age and sex with group TCS. Preorthodontic cone-beam computed tomography examinations of all patients were evaluated using Mimics Innovation Suite 17.0 (Materialise, Leuven, Belgium). Nine 3-dimensional measurements were performed in segmented 3D images of the mandible. Intragroup comparisons were performed using paired t tests. Intergroup comparisons were performed using analysis of variance and Tukey tests. The significance level considered was 5%. Results TCS showed a significant dimensional difference between less and more affected sides for ramus, condyles, and mandibular body. The mandibular dimensions in PRS were more symmetrical. Group TCS presented a smaller mandibular effective length and mandibular body length compared with PRS. The condyle width and height and the ramus width were also decreased in TCS. The gonial angle was greater in TCS compared with the PRS group. Conclusions Young subjects with TCS presented a smaller, more vertical, and more asymmetrical mandible compared with nonsyndromic PRS.

Background Class II is one of the most common malocclusions. The prevailing aspect in Class II patients is a mandibular deficiency. Various removable and fixed functional therapies are used in order to enhance the mandibular growth or position. The aim of this prospectively controlled study was to evaluate long-term dentoskeletal changes obtained by a functional appliance for Class II. Methods Prospective controlled study, based on a sample size calculation. 26 Class II Division 1 patients (11.8±1.5 years) were consecutively treated with the propulseur universal light (PUL) appliance and a multi bracket appliance (PG), they were compared to a sample of 26 Class II untreated patients (11.5±0.8 years) (CG). Lateral cephalograms were taken before and after the PUL therapy, and after multibracket treatment. Interaction analysis was carried out to test whether the PUL parameters in treatment groups were different according to the acquisition times, using the Linear Mixed-Effects Model. Results Significant ANB, Overjet and WITS differences existed in treatment groups according to the time. In particular, comparing to T1 vs. T0, the relative difference (RD) means in the control group were -0.34, -0.31 and 0.17 for ANB, Overjet and WITS, respectively. The corresponding RD means in the treated group PG were -1.58, -4.27 and -2.38. Comparing to T2 vs. T0, the RD means in the control group were -0.36, -0.51 and 0.63 for ANB, Overjet and WITS, respectively. While the corresponding RD means in the treated group were -2.08, -5.12 and -2.50. Conclusions The PUL appliance successfully corrected class II malocclusion. The long term correction was mainly due to dentoalveolar effects: therapy success was 91% for overjet correction and 76% for ANB correction. During the post functional appliance period, overjet was stable in 77% of the treated subjects, and ANB in 74% of the treated subjects.

Background: The purpose of this study was to evaluate the stability on dental and skeletal aspect after surgical advancement and counterclockwise rotation for the correction of the mandibular deficiency in patients with high mandibular plane angle (MPA). Methods: We analyzed the records of patients who had undergone surgical treatment for dentofacial deformities with mandibular deficiency and high MPA. Clinical and radiological data were taken 1 month before surgery (T0), 6 weeks after surgery (T1) and 1 year after surgery (T2). Cephalometric values of the MPA were recorded and compared. The cephalometric changes in the different time periods were defined as follows: A: postsurgical changes (T0–T1), B: one-year changes (T1–T2), and C: short term changes (T0–T2). Results: Twenty-seven patients had prominent mandibular deficiency with an MPA of over 35° (high angle). The mean age of patients at surgery was 29.7 years. Seven patients had a single jaw procedure, 20 patients had bilateral sagittal split osteotomy (BSSO) combined with a Le Fort I osteotomy, and 14 patients had additional genioplasty. MPA values differed significantly between the time periods (p < 0.05) with an observed relapse of the angle. However, satisfactory clinical improvement was achieved in the dental and skeletal presentation. The overjet improvement was evident from 8.815 ± 2.085 mm (T0) to 3.426 ± 1.253 mm (T2). Conclusion: Counterclockwise surgical advancement of the mandible to correct mandibular deficiency in patients with a high mandibular plane angle showed an overall acceptable stability during one-year follow-up.

Correction of skeletal Class II malocclusion has become a major challenge for orthodontists. Class II jaw discrepancies characterized by mandibular deficiency are treated with fixed functional appliances when there is no active growth present. This case report illustrates the application of PowerScope in 16 years young adolescent male having skeletal Class II Div 2 with mandibular deficiency who was reported with forwardly and irregularly placed upper front teeth with closed bite. The case was treated initially with MBT 0.022” prescription followed by PowerScope. Successful results were obtained with a substantial improvement in facial profile, skeletal jaw relationship and overall aesthetic appearance. PowerScope produced a significant forward movement of mandible which obliterated the need of extractions

Objective: This study aimed to determine the cephalometric association of mandibular size/length to the surface area and dimensions of the frontal and maxillary sinuses. Materials and Methods: This descriptive study was conducted on 116 digital lateral cephalograms of 38 patients with skeletal Class I malocclusion (normal), 40 patients with skeletal Class II malocclusion with mandibular deficiency, and 38 patients with skeletal Class III malocclusion with mandibular excess. Both male and female patients were included. Using AutoCAD 2016 software, the anteroposterior dimension, height and surface area of the frontal and maxillary sinuses, mandibular body length and cephalometric indices including anterior and posterior cranial bases, and growth pattern indices were measured on lateral cephalograms. Results: Dimensions and surface area of the frontal and maxillary sinuses in skeletal Class III malocclusion were greater than those in other groups. These variables were significantly correlated with the mandibular body length. The coefficient for the correlation of height, width, and surface area of the frontal sinus with mandibular body length was 0.253, 0.284, and 0.490, respectively. The coefficient for the correlation of height, length, and surface area of the maxillary sinus with mandibular body length was 0.346, 0.657, and 0.661, respectively. These variables (except for the frontal sinus width) had a significant correlation with the anterior and posterior cranial bases. The frontal sinus width had a significant correlation with the anterior cranial base. These variables in males were greater than those in females. Conclusion: The dimensions and surface area of the frontal and maxillary sinuses in skeletal Class III malocclusion were greater than those in other groups. These variables (except for the frontal sinus width) had a significant correlation with the anterior and posterior cranial bases and mandibular body length.

Introduction A Class II malocclusion is a common orthodontic problem that may affect social acceptance and the self-esteem of the patient. The aim of the present study was to evaluate the effect of functional appliance therapy on the oral health-related quality of life (OHRQOL) of patients presenting with a skeletal Class II malocclusion due to mandibular deficiency. Methods Forty-nine patients (11 to 14 years old) with a Class II malocclusion due to mandibular deficiency were included as the experimental group. A control group of 49 subjects was selected from school children without malocclusion. The Child Oral Impact on Daily Performance (Child-OIDP) index was administered, repeated and differences were evaluated following functional therapy using the Clark Twin Block appliance. Results At baseline, the most common oral impact on daily performance in the experimental group was emotional stability (35 patients, 71.4%) and smiling without shame (34 patients, 69.4%), which respectively decreased to 12.2% (six cases) and 20.4% (10 cases) after functional therapy. The mean (±SD) of the Child-OIDP Overall Impact score in the experimental group at baseline was 25.94 (±17.84), which significantly decreased to 2.77 (±2.09) after therapy (p < 0.001). Conclusion Functional therapy using the Clark Twin Block appliance had a significant effect in improving OHRQOL of children presenting with mandibular deficiency.

Objective The present study aimed to compare dentoskeletal changes in mandibular-deficient patients treated with Bionator and Farmand appliances. Methods This study included 54 subjects treated for class II division I malocclusion. All subjects fulfilled the following criteria: ANB>5°, SNB 5 mm. The Bionator group consisted of 27 patients (15 girls, 12 boys) with the mean age of 11 (SD 1) years and the Farmand group consisted of 27 patients (17 girls, 10 boys) with the mean age of 11.1 (SD 1.4) years. Statistical analyses were performed using t-test, paired t-test, Wilcoxon, and Mann-Whitney test. Results In the Farmand group, SNB significantly increased from 74.3° (SD 1.7) to 77.6° (SD 2.3) and ANB decreased by 3.2° (SD 1.7) (p

Silver-Russell syndrome (SRS) is a very rare genetic disorder characterized by intrauterine growth retardation, short stature, and typical craniofacial abnormalities including micrognathia. While growth hormone (GH) therapy in children with SRS significantly improves somatic growth, functional orthopedic treatment can also be effective in adolescents with mandibular deficiency. We report the effects of Phase 1 functional orthopedic treatment of a twin-block appliance in conjunction with GH administration in a 9-year-old boy with GH deficiency and SRS, and the result of the subsequent Phase 2 orthodontic treatment.

Introduction Transverse mandibular deficiency has been traditionally managed by orthodontic compensation. However, without resolving the underlying skeletal hypoplasia it leads to high relapse rates. Few studies have reviewed the long-term experience and potential complications of mandibular symphyseal distraction osteogenesis (MSDO) as an alternative treatment method. Materials and method A retrospective review of 20 patients (range: 4–19 years; mean: 11.9 years) treated with a hybrid MSDO device over the period of 1996–2017 was conducted. Epidemiological data, medical and dental history as well as photographic and cephalometric analyses were carried out. Furthermore, pre-operative and long-term post-operative status including dental occlusion and tooth-jaw discrepancies were recorded. Results The distraction amount ranged from 3 mm to 15 mm (mean: 10 mm) with an average distraction period of 30.9 days. In long-term follow-up (mean: 7.3 years), 14 patients presented a class I and 6 patients presented a class II relationship. Correction of overjet, tooth jaw discrepancy and arch length discrepancy were obtained in 18, 20 and 17 cases respectively. A device malfunction was experienced in 6 patients. Conclusion Mandibular widening using a hybrid MSDO device can be efficiently and safely performed in a paediatric population. Further studies confirming our results and analysing facial aesthetic outcomes are warranted.

The bilateral sagittal split osteotomy (BSSO) technique is commonly used to correct mandibular deficiency. If the patient is exposed to excessive external forces after the procedure, occlusal changes or nonunion may occur. However, previous studies only focused on single external forces on the mandible and did not conduct relevant research on the forces exerted by different occlusion conditions. The main purpose of this study was to use finite element analysis methods to determine the biomechanics of four common occlusion conditions after BSSO surgical treatment. This study constructed a finite element analysis computer model of a miniplate implanted in the lower jaw. The structure of the model consisted of the mandible, miniplate, and screws. In addition, external forces were applied to the superficial masseter, deep masseter, medial pterygoid, anterior temporalis, middle temporalis, and posterior temporalis muscles to simulate the incisal clench, intercuspal position (ICP), right unilateral molar clench (RMOL), and right group function occlusion conditions. Subsequently, this study observed the effects of these conditions on the miniplate, screws, and mandible, including the von Mises stress values. The results showed that all of the different occlusion conditions that this study evaluated placed high stress on the miniplate. In the ICP and RMOL occlusion conditions, the overall mandibular structure experienced very high stress. The screw on the proximal segment near the bone gap experienced high stress, as did the screw on the buccal side. According to the present analysis, although the data were not directly obtained from clinical practice, the finite element analysis could evaluate the trend of results under different external forces. The result of this study recommended that patients without intermaxillary fixation avoid the ICP and RMOL occlusion conditions. It can be used as a pilot study in the future for providing clinicians more information on the biomechanics of implantation.

This report describes the correction of a clinical case of malocclusion with anteroposterior discrepancy and transverse, sagittal and vertical deficiencies. A nonextraction technique was used to preserve space in the dental arches and control facial growth for the correction of the sagittal skeletal relationship and of overbite. The mechanics adopted efficiently corrected malocclusion: all functional and esthetic goals were achieved, and results remained stable eight years after treatment completion. This case was presented to the Committee of the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) as part of the requirements necessary to obtain the BBO Diploma.

Joint arthroplasty coupled with distraction osteogenesis is an attractive treatment option for correction of TMJ ankylosis associated with secondary mandibular deformity. Lately, advances in surgical techniques and equipment have greatly widened the horizon for application of distraction osteogenesis in correction of skeletal deformities. Despite the availability of several surgical techniques, treatments still continue to be challenging. Search for a technique that will reduce the frequency of complications while providing more predictable outcomes is still continuing. In the case report described here, interpositional gap arthroplasty using temporomyofascial flap and extra-oral distraction osteogenesis were combined in a single surgical operation to treat a young adult for unilateral TMJ ankylosis with mandibular deficiency. A modified distraction technique was employed wherein two extra-oral distractors were placed on the affected side to provide more effective and predictable distraction. Marked improvement in aesthetics, function and occlusion could be appreciated with the use of this modified technique.

Class II malocclusions are one of the most common problems in orthodontic treatment. There are a variety of effective and simple treatments to correct them, such as headgear and functional appliances. Functional appliances are commonly used for the treatment of class II malocclusions with mandibular deficiency. The success of treatment with a functional appliance relies on the patient’s cooperation and favourable mandibular growth. Treatment with a functional appliance usually lasts for 9–12 months and requires a proper retention time to ensure complete musculoskeletal adaptation. A second stage of treatment with a full-fixed appliance is often required to achieve proper alignment and good interdigitation of the dentition. In the present case, a prepubertal twelve year female with a class II malocclusion and retrusive mandible was treated first with an activator for 17 months. The activator successfully resolved the problem of the retrusive mandible with favourable mandibular growth. This was followed by 10 months of fixed orthodontic treatment to finalize the occlusion without extractions. This two phase treatment yielded a pleasing profile and good occlusion in this patient.

Skeletal Class II malocclusion with mandibular deficiency and maxillary excess is a severe skeletal problem encountered in growing individuals. Correction of mandibular deficiency and maxillary excess in a skeletal Class II patient with a vertical growth pattern poses a great challenge. The control of vertical dimension becomes very important as downward and backward rotation of mandible will exaggerate the facial convexity. The present case signifies the importance of functional jaw orthopedic treatment in a vertically growing female patient with mandibular deficiency and maxillary vertical excess. Activator headgear combination was used for skeletal correction which was followed by fixed mechanotherapy. Superimposition of pretreatment and posttreatment cephalometric tracings shows desired treatment outcomes.

A Classe II de Angle, além de ser uma das más oclusões mais procuradas para tratamento, é também um grande desafio para os ortodontistas. Quando um paciente se apresenta com deficiência mandibular e ainda em fase de crescimento, os aparelhos funcionais, geralmente, são escolhidos para a correção deste problema. Porém, em algumas situações, a falta de colaboração do paciente no uso destes aparelhos, especialmente os removíveis, podem comprometer o resultado do tratamento ortodôntico. Com a evolução dos aparelhos propulsores mandibulares, vários modelos funcionais começaram a surgir no mercado e, dentre estes, o PowerScope, um propulsor fixo híbrido. Entretanto, um dos efeitos esperados de todos os propulsores, sejam eles removíveis ou fixos, além da remodelação dento-alveolar, é a inclinação labial excessiva dos incisivos inferiores. Desta forma, o objetivo desse estudo foi demonstrar o uso do PowerScope II, na correção de Classe II de Angle em um paciente de 12 anos com deficiência mandibular, braquifacial e com incisivos superiores e inferiores vestibularizados. Após planejamento detalhado, optou-se por utilizar aparatologia fixa com prescrição Roth 0,022”, seguida pelo PowerScope II e mini parafusos inferiores bilaterais, como forma de ancoragem, para conter a vestibularização excessiva dos incisivos inferiores. Ao fim do tratamento o paciente manteve o perfil convexo com correção da má oclusão pela compensação dentoalveolar e conseguiu um bom controle de inclinação dos incisivos inferiores. Assim, pode-se concluir que a utilização desse dispositivo associado aos mini parafusos de ancoragem permitem uma abordagem conservadora em tratamentos de Classe II.

Objective This study was designed to evaluate the skeletal, dental and soft tissue effects of mandibular deficiency treatment with the mandibular protraction appliance (MPA) using 12 factors of the Ricketts analysis. Material and method This cross-sectional retrospective study sample consisted of a group (n = 27), with Class II malocclusion, convex facial profile, increased horizontal trespass and mandibular deficiency, with initial mean age of 12.27 and final of 15.18 years, treated with fixed appliance combined with the MPA, in an average time of 2.9 years. Initial and final radiographs were investigated using Ricketts analysis. The dependent t-test was used to compare the initial and final phases of the MPA group, with a significance level of 5%. Result Statistically significant differences were observed for dental changes such as retrusion (p=0.000) and palatal inclination of the maxillary incisors (p=0.000); protrusion (p=0.000) and buccal inclination of the mandibular incisors (p=0.000); increased interincisal angle (p=0.002) and improved molar ratio (p=0.003). There was also a restriction of the anterior displacement of the maxilla (p=0.000) and a decrease in the mandibular plane angle (p=0.024). The variable inferior labial protrusion with significance (p=0.000), reiterated the improvement in the profile. Conclusion The effects of MPA on correction of malocclusion Class II, verified by Ricketts analysis occurred predominantly by dentoalveolar changes, decrease in the Mandibular Plane Angle, and restriction of anterior displacement of the maxilla, which contributed to the improvement in the patient's profile. Resumo Objetivo Este estudo analisou as alterações dentárias, esqueléticas e tegumentares promovidas pelo Aparelho de Protração Mandibular (APM) por meio da análise de Ricketts. Material e método A amostra contou com 27 pacientes (14 meninas e 13 meninos) com má oclusão de Classe II, perfil facial convexo, trespasse horizontal aumentado e deficiência mandibular, com idade média inicial de 12,27 e final de 15,18 anos, tratados com aparelho fixo combinado com o APM. A comparação das telerradiografias iniciais (T1) e finais (T2) foi realizada pelo teste t dependente, com nível de significância de 5%. Resultado Observou-se diferença estatisticamente significante para a retrusão (p=0.000) e lingualização dos incisivos superiores (p=0.000), protrusão (p=0.000) e vestibularização dos incisivos inferiores (p=0.000), aumento do ângulo interincisivos (p=0.002), melhora da relação molar (p=0.003), restrição do deslocamento anterior da maxila (p=0.000), diminuição do ângulo do plano mandibular (p=0.024) e melhora do perfil facial (p=0.000). Conclusão O APM promoveu alterações dentoalveolares, observadas principalmente pela diminuição do ângulo do plano mandibular e restrição do deslocamento para anterior da maxila que contribuíram para a melhora do perfil do paciente.

Background The orthosurgical treatment of a 13-year-old girl who had undergone two previous unsuccessful orthodontic treatments is described and discussed. She presented with a Class II, Division 1 malocclusion with marked discrepancy between maxilla and mandible, pronounced overjet, and convex profile. Methods Orthodontic preparation was performed with a full fixed orthodontic appliance (Standard Edgewise, 0.022 × 0.028 in), followed by orthognathic surgery with mandibular advancement and genioplasty at age 14, when she was at the end of growth. Results At the end of treatment, the patient exhibited a good facial appearance, a pleasant smile with coincident midlines, adequate gingival display, and correct dental relationships that remained stable after a 2-year follow-up. Conclusions In cases of patients with mandibular deficiency and marked discrepancy between the maxilla and mandible, orthosurgical treatment can be performed by sagittal split osteotomy and genioplasty with predictable and stable results in female patients who are in the final stage of craniofacial growth and exhibit harmonious growth.

The correction of most cases of skeletal class II mandibular deficiency requires surgical advancement of the mandible for treatment of the malocclusion. Often genioplasty is included in the procedure to improve the soft tissue profile. Long-term skeletal stability is an important goal for the surgeon and orthodontist following bilateral sagittal split osteotomy (BSSO) and is influenced by the muscles attached to the mandible. Following the surgical advancement of the mandible, the suprahyoid muscle complex is stretched and even more so when the procedure is combined with surgical advancement of the chin. This retrospective comparative study determined the long-term skeletal stability of patients who had undergone surgical advancement of the mandible by means of BSSO with an advancement genioplasty, compared to those who had undergone mandibular advancement surgery (BSSO) without an advancement genioplasty. This study concluded that the postoperative hard tissue relapse following BSSO advancement, with or without genioplasty, was clinically insignificant.

Functional appliances have been used for treatment of Class II patients for a long time. The main objective of therapy with functional appliances is to induce supplementary lengthening of the mandible by stimulating increased growth at the condylar cartilage. The Twin Block appliance is one of the most commonly used functional appliances. The aim of this paper is to present a case report of mandibular deficiency treatment with Twin Block appliance in a female patient whose sexual maturation (one and a half years after menarche) and cervical vertebral maturation stage indicated the end of the growth peak. The treatment started with bonding 0.022 in MBT prescription brackets on the upper arch in order to align upper teeth and create a symmetric overjet. When reaching alignment, a modified Twin Block was given to the patient for 8 months. Final coordination was achieved with fixed appliances in both arches. At the end of the treatment, profile of the patient improved, crowding was relieved, and Cl I relationship with normal overjet and overbite was achieved.

Background Class II malocclusion is one of the most common orthodontic problems. In cases of class II malocclusion with mandibular deficiency, functional appliances often are used with the intent of stimulating mandibular growth. Bionator and twin block are two of the more popular functional appliances. The aim of this study was to compare the treatment outcomes of these two appliances using cephalometric radiographs. Material and Methods Cephalometric radiographs of 33 patients who had class II division I malocclusion, before and after treatment were digitalized. The mean changes in twin block and bionator groups were compared using independent t test. Results Twin block and bionator showed no statistically significant differences in cephalometric parameters except for ANB, NA-Pog, Basal and Ar-Go-Me angles. Conclusions There were no statistically significant differences in dentoalveolar and mandibular position between twin block and bionator (p>0.1). Twin block was more efficient in inhibition of forward movement of maxilla (p

Dentofacial deformities involve deviations from the normal facial proportions and dental relationships and can range from mild to being severe enough to be severely handicapping.The term handicapping malocclusions though not a term commonly used, involves a fortunately small section (2-4%) of patients who can suffer from esthetic,psychological and functional problems. Craniofacial Orthodontics is the area of orthodontics that treats patients with congenital and acquired deformities of the integument and it's underlying musculoskeletal system within the craniofacial area and associated structures.This case report of a young woman with severe mandibular deficiency and facial asymmetry due to condylar ankylosis highlights the importance of team work in rehabilitation of such severe craniofacial deformities.

The purpose of this research was to simulate mandibular movement calculated from three-dimensional computed tomography (CT) data to determine the linear distractor position to correct mandibular deformities in a series of patients with hemifacial microsomia (HFM). Preoperative CT scans from 6 HFM patients were obtained and imported into a CT-based software program (Mimics) to produce three-dimensional images and data. After measurement of the mandibular deficiency in 3 dimensions (horizontal and vertical), the angle between the distraction device and the ramus was determined by a geometric calculation, and then the surgery was performed on the three-dimensional model constructed using the rapid prototyping technique. This planning method was finally used in the treatment of 6 HFM patients. The HFM was corrected, and a symmetrical facial contour obtained without any complications in these 6 patients. The results matched the expectation before surgery that the distractor elongation would range from 18 to 22 mm. The distraction tracing model fitted the actual postdistraction tracing to within 2 mm. The preoperative design and three-dimensional modeling technique are considered to be helpful in enhancing the predictability and improving the outcome of the treatment of distraction osteogenesis.

Introduction: The purpose of this study was to investigate the alterations in the pharyngeal airway dimensions after mandibular advancement surgery and to assess its postsurgical stability. Materials and methods: A total of 40 adult patients with skeletal class II jaw relation, treated by mandibular advancement surgery, were included in the study. Lateral cephalogram was obtained before surgery (T0), 1 month after surgery (T1), and 6 months postsurgery (T2). The cephalograms obtained were hand traced; various soft and hard tissue points identified, and linear and angular measurements were carried out to evaluate the changes postsurgery. The results thus obtained were subjected to statistical analysis. Results: The hyoid bone adapted to a more anterior (AH-C3 Hor) and superior position (AH-s Ver, AH-FH Ver, AH-ML Ver and AH-C3 Ver), the head assumed a more upright position (NSL/CVT and NSL/OPT) and there was a significant widening of the posterior airway space at all levels (pm-UPW, U-MPW, V-LPW, and PASmin) postmandibular advancement surgery. Conclusion: The study concludes that mandibular advancement surgeries bring about significant widening of the posterior airway space and also long-term changes in hyoid bone position and head posture and, therefore, it could be used in the treatment of selected cases of obstructive sleep apnea.

Distraction osteogenesis is a worldwide accepted recent approach in the field of surgery. As on date the craniofacial surgeons, across the globe, prefer the distraction osteogenesis technique over conventional reconstructive surgery by bone graft. This paper attempts to review a brief knowledge of the mandibular distraction osteogenesis and the latest developments in the field.