Search Results (8)

Background: The majority of Class II malocclusions stem from mandibular deficiency, leading to chin retrusion. In growing patients, the ideal correction—aiming for a skeletal mandibular response—should avoid common pitfalls such as “Point B” dropping postero-inferiorly, excessive labial proclination of mandibular incisors, or the lingual tipping and extrusion of maxillary incisors. When planning mandibular advancement (MA) using clear aligners with integrated advancement features, biomechanical forces are not the only consideration; precise management of the lower incisor position is critical for success. Current literature highlights not a good control in digital planning software: these platforms are primarily dentoalveolar-based and lack integrated cephalometric analysis. Consequently, mandibular advancement is often defined by standard linear parameters (typically 2 mm per step), while incisor position is managed through virtual alignment without correlation to cephalometric landmarks like the Pogonion, NB line, or IMPA. The software cannot monitor real-time sagittal or vertical skeletal relationships, the software will elaborate the treatment planning after doctor’s prescription, the clinician must manually adjust incisor positioning based on external cephalometric analysis to prevent dental compensation or excessive proclination. Aim: This clinical case demonstrates a specific arch preparation protocol designed to optimize mandibular advancement in a growing patient with mandibular retrusion. Methods: A 12-year-old female presented with a skeletal and dental Class II malocclusion, characterized by increased overjet and a normal overbite. Treatment was conducted using Invisalign^® clear aligners (22 h/day wear, weekly changes). The treatment objectives were: transverse: Correct upper dentoalveolar contraction and coordinate arch form while restoring midline alignment; sagittal: establish Class I molar and canine relationships by correcting the overjet and reducing the labial inclination of the lower incisors; vertical: level the curve of Spee. A key clinical condition of our protocol was the pre-advancement phase: the lower arch was reshaped by reducing the buccolingual inclination (retroclination) and intruding the lower incisors. This was specifically intended to increase the available overjet space, creating the necessary room for subsequent mandibular advancement. Results Treatment was completed in 24 months with high patient compliance. Objectives were successfully met, including the correction of skeletal and dental discrepancies, the establishment of harmonious arch forms, and precise overjet reduction through enhanced control of the mandibular incisors. Conclusions: This case report outlines an optimized clinical strategy for Class II correction. Cephalometric Integration: Perform an initial analysis outside the digital planning software to define the ideal IMPA and NB angles. Anatomic Verification: Utilize radiographic overlays to ensure tooth movement remains within alveolar bone limits. Pre-MA Optimization: Prioritize a “pre-advancement” phase to maximize the sagittal inter-arch space (overjet). A larger overjet allows for a more significant orthopedic effect from the MA features. Stepwise Advancement: Implement mandibular advancement in increments (≥2 mm) with periodic clinical reassessment to facilitate the adaptation of the muscular sling and functional occlusion. Full article

Background/Objectives: To Develop a CBCT-based transverse diagnostic method that establishes normative buccolingual inclination values for permanent first molars and objectively distinguishes between dentoalveolar transverse deficiency and skeletal maxillary deficiency. Methods: A total of 1120 initial CBCT scans were reviewed, and 40 subjects with normal occlusion met the inclusion criteria. Volumes were reoriented using a standardized three-plane protocol, and molar angulations were measured relative to reference planes parallel to the occlusal plane. Intra- and inter-examiner reliability were assessed using ICC. Descriptive, comparative, and correlation analyses were performed bilaterally and between arches. Results: No significant right–left differences were observed for upper molar angulation (URM vs. ULM: 99.5° vs. 99.1°; t(19) = 1.560, p = 0.135) or lower molar angulation (LRM vs. LLM: 78.9° vs. 78.9°; t(19) = 0.301, p = 0.767). Non-parametric analysis confirmed these findings (ULM vs. URM: Z = −1.203, p = 0.229; LLM vs. LRM: Z = −0.427, p = 0.669). Significant positive bilateral correlations were observed in both arches (upper: r_S = 0.784, p < 0.001; lower: r_S = 0.837, p < 0.001). A significant negative correlation was found between upper and lower molar angulations (left side: r_S = −0.626, p = 0.003; right side: r_S = −0.858, p < 0.001), demonstrating dentoalveolar compensation. Conclusions: CBCT enables the precise assessment of molar buccolingual inclination and the establishment of normative patterns essential for transverse diagnosis. The proposed method allows the quantification of the maxillary “basal defect” after virtual dental decompensation, providing an objective tool to differentiate dentoalveolar from skeletal transverse discrepancies and guide targeted treatment planning. Full article

Background and Clinical Significance: Treating severe skeletal Class III malocclusions in adults who refuse orthognathic surgery remains challenging. Orthodontic camouflage offers a non-surgical option to improve occlusion and esthetics. Case Presentation: A 26-year-old male with a full bilateral Class III malocclusion and anterior crossbite was treated following the “Sagittal First” philosophy. The Carriere^® Motion 3D Class III appliance was used for mandibular distalization, combined with active maxillary aligners and Class III elastics. After 32 months, a stable Class I occlusion with proper overjet, overbite, and improved sagittal balance was obtained. Cephalometric analysis showed clockwise mandibular rotation and satisfactory dentoalveolar compensation. Conclusions: Combining the Carriere^® Motion 3D appliance with clear aligners can successfully camouflage severe skeletal Class III malocclusions in adults, providing a predictable and esthetic non-surgical alternative. Full article

This study aimed to describe the changes produced on the occlusal plane (OP), the mandibular position and the dentoalveolar compensations of patients with distalization of the maxillary/mandibular arch assisted by mini-screws (MS). A descriptive case–series study was performed using the digital lateral cephalograms (DLC) of nine patients who underwent orthodontic treatment and required the use of MS for a complete distalization of the maxillary/mandibular arch. Records were collected at three different times (T1–T2–T3) and digitally analyzed (variables: Skeletal diagnosis; maxillary occlusal plane; position of the maxilla/mandible; and dentoalveolar changes of the distalization arch tracing the longitudinal axis of incisors/molars regarding the palatal/mandibular plane). Findings show that the OP varied from T1–T2–T3 in all cases, indicating its stepping or flattening. ODI, APDI, SNA, SNB, and ANB changed minimally in all cases, without variations in the mandibular position or in the skeletal diagnosis. Dentoalveolar measurements also showed differences between T1–T2–T3. In summary, conventional orthodontic treatment modified the OP during the first phase of treatment. Moreover, the distalization mechanics with MS changed the OP and produced dentoalveolar changes, mainly in the inclination of incisors and molars. Other measures considered in the study did not change substantially. Full article

Background and Objectives: The objective of this retrospective controlled study is to compare class II growing patients who underwent treatment with two different functional appliances: the Fraenkel regulator (FR-2), utilized as the control group, and the elastodontic device “Cranium Occluded Postural Multifunctional Harmonizers” (AMCOP), utilized as the test group. Materials and Methods: The study sample consisted of 52 patients with class II division I malocclusion (30 males, 22 females, mean age 8.6 ± 1.4 years) who were treated with the two different types of appliances: Group 1 (n = 27, mean age 8 [7.00, 9.00] years, 12 females, 15 males) received treatment with AMCOP, while Group 2 (n = 25, mean age 9.2 years [8.20, 10.00], 10 females, 15 males) received treatment with FR-2. The mean treatment duration for Group 1 was 28.00 [21.50, 38.00] months, while for Group 2 it was 23.70 [17.80, 27.40] months. Cephalometric analyses were performed on lateral cephalograms taken before treatment (T1) and after treatment (T2). Results: Significant intragroup differences were observed over time in Group 1 for 1^/PP. Similarly, significant intragroup differences were observed over time in Group 2 for SNB, ANB, and IMPA. Conclusions: Both treatment modalities resulted in the correction of class II malocclusion with dentoalveolar compensation, although the treatment duration with AMCOP tended to be longer on average. Full article

The aim of this study was to investigate buccolingual tooth movements (tipping/translation) in surgical and nonsurgical posterior crossbite correction. A total of 43 patients (f/m 19/24; mean age 27.6 ± 9.5 years) treated with surgically assisted rapid palatal expansion (SARPE) and 38 patients (f/m 25/13; mean age 30.4 ± 12.9 years) treated with dentoalveolar compensation using completely customized lingual appliances (DC-CCLA) were retrospectively included. Inclination was measured on digital models at canines (C), second premolars (P2), first molars (M1), and second molars (M2) before (T₀) and after (T₁) crossbite correction. There was no statistically significant difference (p > 0.05) in absolute buccolingual inclination change between both groups, except for the upper C (p < 0.05), which were more tipped in the surgical group. Translation, i.e., bodily tooth movements that cannot be explained by pure uncontrolled tipping, could be observed with SARPE in the maxilla and with DC-CCLA in both jaws. Dentoalveolar transversal compensation with completely customized lingual appliances does not cause greater buccolingual tipping compared to SARPE. Full article

Different vertical facial patterns may present different bone and gingival thicknesses at the molar level and can be influenced by the dental compensations that manifest in the presence of transverse bone discrepancies. A retrospective analysis was made of 120 patients divided into three groups according to their vertical facial patterns (mesofacial, dolichofacial or brachyfacial). Each group in turn was divided into two subgroups according to the presence or absence of transverse discrepancies assessed by cone-beam computed tomography (CBCT). The bone and gingival measurements were made integrating a CBCT-3D digital model of the patient dentition. In the brachyfacial patients, the distance from the palatine root to the cortical bone corresponding to the right upper first molar was significantly greater (1.27 mm) than in the dolichofacial (1.06 mm) and mesofacial (1.03 mm) (p < 0.05) patients. The brachyfacial and mesofacial patients with transverse discrepancies presented a greater distance from the mesiobuccal root of the left upper first molar and from the palatine root to the cortical bone, while in the dolichofacial individuals the distances were shorter (p < 0.05); The presence of transverse bone discrepancies in brachyfacial and mesofacial patients without posterior cross-bite implies a better dentoalveolar expansion prognosis than in dolichofacial individuals. Full article

The aim of this study was to compare the crossbite correction of a group (n = 43; f/m 19/24; mean age 27.6 ± 9.5 years) with surgically assisted rapid palatal expansion (SARPE) versus a non-surgical transversal dentoalveolar compensation (DC) group (n = 38; f/m 25/13; mean age 30.4 ± 12.9 years) with completely customized lingual appliances (CCLA). Arch width was measured on digital models at the canines (C), second premolars (P2), first molars (M1) and second molars (M2). Measurements were obtained before treatment (T₀) and at the end of lingual treatment (T₁) or after orthodontic alignment prior to a second surgical intervention for three-dimensional bite correction. There was no statistically significant difference (p > 0.05) in the amount of total crossbite correction between the SARPE and DC-CCLA group at C, P2, M1 and M2. Maxillary expansion was greater in the SARPE group and mandibular compression was greater in the DC-CCLA group. Crossbite correction in the DC-CCLA group was mainly a combination of maxillary expansion and mandibular compression. Dentoalveolar compensation with CCLAs as a combination of maxillary expansion and mandibular compression seems to be a clinically effective procedure to correct a transverse maxillo-mandibular discrepancy without the need for surgical assistance. Full article