Three-dimensional changes in the upper airway and craniomaxillofacial morphology of patients with Angle Class III malocclusion treated with a Frankel III appliance

Background Angle Class III malocclusion, characterized by a concave profile, can cause serious harm to children’s physical and mental health. The Frankel III appliance is an effective treatment for Angle Class III malocclusion in mixed denition. We explored three-dimensional changes in the upper airway and craniomaxillofacial morphology, after one year of Frankel III appliance treatment, in children with Angle Class III malocclusion. Methods We included 20 children (9 males), aged 8–10 years, with Angle Class III malocclusion from the Orthodontics Department of our hospital. Each child was treated with a Frankel III appliance for one year. Cone beam computed tomography was performed before and after treatment to evaluate three-dimensional changes in the upper airway and craniomaxillofacial morphology. Results After one year of treatment, in the upper airway, we observed significant increases in the nasopharynx volume and height (P < 0.05); the velopharyngeal volume, height, and average cross-sectional area (P < 0.05); the glossopharynx volume and minimum cross-sectional area (P < 0.05); and the laryngopharynx height (P < 0.05). Accordingly, the total upper airway volume, height, and average cross sectional area increased significantly (P < 0.05). An examination of craniomaxillofacial morphology showed significant increases in some bone tissues (P < 0.05) and dental measurements, and a significant reduction in the inclination of the mandibular central incisor (P < 0.05). Conclusion Children with Angle class III malocclusion treated with a Frankel III appliance showed no upper airway narrowing, even after repositioning the mandible posteriorly. Moreover, treatment promoted forward maxilla development and increased its width, in both the dental arch and alveolar bone, which provided a more harmonious craniofacial morphology.

Aesthetic and functional advantages of early orthodontic treatment in a child with Asperger's Syndrome: case report

Angle Class III malocclusion results in aesthetic and functional concerns, thus it is essential that this malocclusion is treated as early as possible, so that dentocraniofacial development occurs properly. A 7-year-old male patient with Asperger's syndrome had a Class III subdivision right malocclusion, anterior and posterior crossbite. To gain the patient's trust and collaboration, we used the behavioral management technique tell-show-do, in addition to the behavioral analysis method. Orthodontic treatment started using the Hyrax palatal expander, but the patient was not able to adapt to it. Correction of the crossbite was achieved using a removable expander with digital springs, which was better accepted by the patient and provided aesthetic and functional improvement.

Intervention Proposal for Infant Prognathism: A Case Report in a Non-Syndromic Pediatric Patient

Treating Class III malocclusions has been presently considered one of the most challenging and complex interventions of orthodontic daily practice. In this study, we report a case of a 17-month-old female patient, initially diagnosed with Angle Class III malocclusion, mandibular protrusion, and without genetic syndromes. Upon initial admission at the dental office, patient’s parents reported an inadequate bite pattern while the patient tried to eat solid food. Upon dental examination, a negative overjet of 8 millimeters was noticed and a two-phased treatment plan was established: 1. Performance of functional exercises; 2. Implementation of protractor device associated with masticatory guidance exercises. Radiographic examination and cephalometric analyses were performed throughout the case follow-up. Overall, the digital compression protocol carried out reverted the primary mandibular protrusion of -8 millimeters to +1 millimeters overbite, during the 6 months of treatment. In addition, the use of premaxillary protractor appliance increased the overbite to + 2 millimeters. The patient responded satisfactory to the treatment plan performed, and after 2 years, a proper primary occlusion, oral functionality, and facial aesthetics were improved.

Three-dimensional changes in the upper airway and craniomaxillofacial morphology of patients with Angle Class III malocclusion treated with a Frankel III appliance

Background Angle Class III malocclusion, characterized by a concave profile, can cause serious harm to children’s physical and mental health. The Frankel III appliance is an effective treatment for Angle Class III malocclusion in mixed denition. We explored three-dimensional changes in the upper airway and craniomaxillofacial morphology, after one year of Frankel III appliance treatment, in children with Angle Class III malocclusion. Methods We included 20 children (9 males), aged 8-10 years, with Angle Class III malocclusion from the Orthodontics Department of our hospital. Each child was treated with a Frankel III appliance for one year. Cone beam computed tomography was performed before and after treatment to evaluate three-dimensional changes in the upper airway and craniomaxillofacial morphology. Results After one year of treatment, in the upper airway, we observed significant increases in the nasopharynx volume and height (P<0.05); the velopharyngeal volume, height, and average cross-sectional area (P<0.05); the glossopharynx volume and minimum cross-sectional area (P<0.05); and the laryngopharynx height (P<0.05). Accordingly, the total upper airway volume, height, and average cross sectional area increased significantly (P<0.05). An examination of craniomaxillofacial morphology showed significant increases in some bone tissues (P<0.05) and dental measurements, and a significant reduction in the inclination of the mandibular central incisor (P<0.05). Conclusion Children with Angle class III malocclusion treated with a Frankel III appliance showed no upper airway narrowing, even after repositioning the mandible posteriorly. Moreover, treatment promoted forward maxilla development and increased its width, in both the dental arch and alveolar bone, which provided a more harmonious craniofacial morphology.

1249 A 3D Morphable Model of the Apert Mandible

Aim Assess the three-dimensional Morphable Model (3DMM) of the Apert mandible, investigate differences between sex and age, and characterise growth by age. Additionally, compare with a healthy mandible 3DMM. Method High-quality CT scans of children with Apert’s Syndrome (without previous mandibular surgery) between November1987-January2020 were sourced from Great Ormond Street (GOSH) and Necker Hospitals. DICOM files were constructed to 3D meshes through isolation of mandibles and artifact removal (MeshMixer, Mimics) and annotation using standardized landmarks (Wrapped). A 3DMM was constructed using an existing pipeline, and experiments performed to compare with the healthy mandible 3DMM, investigating differences between sex and age, and to characterise growth by age. A healthy mandible 3DMM has been created by our team using healthy mandible CT scans sourced from a GOSH database. Results A 3DMM of the unoperated Apert mandible was successfully constructed from 276 Apert CT scans, male=137 (aged0-20), female=139 (aged0-23), and the first components of the morphable model identified. Conclusions Apert’s Syndrome is a rare genetic condition, with characteristic extremity (syndactyly) and craniofacial features (craniosynostosis), however breathing problems, sleep apnoea, relative prognathism and Angle class III malocclusion have been reported. Few studies have analysed the potential role of the Apert mandible. 3DMMs are statistical tools used to represent 3D shapes and have been used to create shape and texture parameters for anatomical areas. The 3DMM of the unoperated Apert mandible has potential applications for further understanding of Apert’s Syndrome, diagnostic purposes and may be used to develop further management of these patients, such as surgical planning.

Multiprofessional approach for class III malocclusion rehabilitation with autogenous calvarial bone graft followed by Le Fort 1 osteotomy and implant-supported prostheses – case report

Extensive treatments can eventually be challenging. Even more so when the patient has limitations such as extensive tooth loss and skeletal changes, including overgrowth of the lower jaw. When indicated, these treatments tend to discourage patients due to the history of previous failures. Therefore, in addition to an interdisciplinary dental team composed of oral and maxillofacial surgeons, and prosthodontists, a nutrologist, a speech therapist, and a psychotherapist were involved in the treatment of this case. A 52-year-old female patient, Angle Class III malocclusion, with few teeth and extensive maxillary bone loss, attended the dental clinic of the Brazilian Association of Dentistry in Uberlândia. The treatment involved reverse planning, extraction of the dental remnants, calvarial bone grafting, placement of 6 titanium implants (Neodent) in the maxilla (upper jaw) and 5 in the mandible (lower jaw), orthognathic surgery, and installation of implant-supported fixed complete dentures in both jaws. Furthermore, psychotherapeutic and nutrologist’s interventions were necessary during the dental treatment, concluding the treatment with speech therapy. Within the limitations of this case, the multidisciplinary approach proved to be efficient. It promoted the reestablishment of the stomatognathic system functions without compromising nutrition during the periods when it was impossible to wear prostheses for better healing of the tissues.

Analysis of Tongue Function from the Orthodontist’s Point of View: Not Only a Matter of Deglutition

Many studies report that maxillofacial growth is influenced by genetic and environmental elements and that incorrect breathing, chewing, sucking, and swallowing are promoting factors of malocclusion. This study aims to evaluate the function and the influence of the tongue positions in patients with Angle class III malocclusion, maxillary hypoplasia, and posterior crossbite. One hundred patients, aged between 6 and 12 years old, were enrolled for the study. In the first group, patients with a diagnosis of class III malocclusion, affected by maxillary hypoplasia, skeletal class III, and posterior dental crossbite were recruited. In the control group, not treated patients with no malocclusion, skeletal class I, and without posterior dental crossbite were selected. Regarding atypical deglutition, no statistical differences were reported between the two groups, and 14% of patients reported ankyloglossia. Statistical differences were found in tongue rest position and during the execution of “hold and pull” and “chuck” exercises. Results obtained in this observational study showed that the clinician (orthodontist or general dentist) should analyze the presence/absence of atypical swallowing, the anatomical and functional aspects, and the tongue behavior in the rest position.