Skeletal Changes Seen in Nonsurgically Treated Patients with Skeletal Class II Malocclusion
Keerthan Shashidhar, Chrysl Castelino, MN Kuttappa, US Krishna Nayak, Pooja Rai, Rashida Dawal, Tarona A Subba
Camouflage, Class II, Extraction, Facial height, Orthodontic camouflage, Premolar, Prognathic maxilla, Skeletal class II, Vertical dimension of occlusion
Citation Information :
Shashidhar K, Castelino C, Kuttappa M, Nayak UK, Rai P, Dawal R, Subba TA. Skeletal Changes Seen in Nonsurgically Treated Patients with Skeletal Class II Malocclusion. World J Dent 2021; 12 (2):144-149.
Aims and objectives: To evaluate and compare the skeletal changes before and after the treatment of skeletal class II malocclusion with the extraction of premolars followed by fixed appliance therapy.
Materials and methods: Thirty individuals, with class II skeletal patterns due to a prognathic maxilla, were selected as per the inclusion criteria. Pretreatment and posttreatment lateral cephalograms of the selected study participants were obtained, analyzed, and compared to assess the changes that might have occurred. Descriptive statistics mean and standard deviation were calculated for all variables. The pretreatment and posttreatment changes were calculated using the paired t-test. A value of p < 0.05 is considered to be statistically significant.
Results: There was a decrease in mean SNA posttreatment, i.e., 1.82° and there was a decrease in mean SNB posttreatment, i.e., 0.65°. The mean ANB values also showed a significant decrease of 1.17°. Both the SN-GoGn and the FMA increased significantly by 0.83 and 1°, respectively. There was a significant increase in all facial height values [total anterior facial height (TAFH), lower anterior facial height (LAFH), and posterior facial height (PFH)]. The WITS values were observed to significantly decrease by 0.79 mm. There was also a statistically significant increase in the n-B and N-Pog values.
Conclusion: The results showed that extraction therapy in skeletal class II patients due to a prognathic maxilla (with class II div 1 malocclusion) has an overall improvement of the patients’ skeletal profile since most of the reduction in the sagittal parameters was due to the remodeling of point A rather than the forward displacement of point B. An increase in the overall facial height was also observed in all the study participants. This in turn led to a backward displacement of point B leading to a potential worsening of the facial profile which was overcome by the significant remodeling of point A.
Clinical significance: An important factor to be taken into consideration is the control of vertical height while retracting the anteriors as this study proves that there was a definite increase in the anterior facial height and TAFH of patients at the end of the treatment. The use of head gear/mini implants is mandatory to maintain the vertical relationship of the molars especially while treating patients who have a hyperdivergent growth pattern.
Saniç K, Novruzov Z, Aliyeva R. The effect of tooth extraction on vertical dimension change in patients with class II malocclusion. Mod Dentis. 2015;5:90–93.
Shetty A, Patil A, Ganeshkar S. Comparison of skeletal, dental and soft tissue changes in young adults with class II malocclusion, treated either by camouflage, fixed functional appliance or orthognathic surgery—A prospective study on Indian subjects. Open J Stomatol 2012;2(04):373–382. DOI: 10.4236/ojst.2012.24065.
Dwivedi S, Sonwane S, Chokotiya H, et al. Effect of premolar extractions on facial vertical dimension — a cephalometric study. Indian J Orthodont Dentofac Res 2016;2(4):194–196. DOI: 10.18231/2455-6785.2016.0012.
Zierhut EC, Joondeph DR, Artun J, et al. Long-term profile changes associated with successfully treated extraction and nonextraction class II division 1 malocclusions. Angle Orthod 2000;70:208–219.
Paquette DE, Beattie JR, Johnston Jr LE. A long-term comparison of nonextraction and premolar extraction edgewise therapy in “borderline” Class II patients. Am J Orthod Dentofacial Orthop 1992;102(1):1–14. DOI: 10.1016/0889-5406(92)70009-Y.
Bishara SE, Cummins DM, Jacobsen JR, et al. Dentofacial and soft tissue changes to class II division 1 cases treated with and without extractions. Am J Orthod Dentofacial Orthop 1995;107(1):28–37. DOI: 10.1016/S0889-5406(95)70154-0.
Young T, Smith R. Effects of orthodontics on the facial profile: a comparison of change during nonextraction and four premolar extraction treatment. Am J Orthod Dentofacial Orthop 1993;103(5):452–458. DOI: 10.1016/S0889-5406(05)81796-2.
Klapper L, Navarro SF, Bowman D, et al. The influence of extraction and nonextraction orthodontic treatment on brachyfacial and dolichofacial growth patterns. Am. J Orthod. Dentofac. Orthop. 1992;101(5):426–430. DOI: 10.1016/0889-5406(92)70116-R.
Staggers JA. Vertical changes following first premolar extractions. Am J Orthod Dentofacial Orthop 1994;105(1):19–24. DOI: 10.1016/S0889-5406(94)70095-8.
Ülgen M. Ortodontik Tedavi Prensipleri. Ankara: Ankara Üniversitesi; 1983. p. 71.
Wyatt WE. Preventing adverse effects on the temporomandibular joint through orthodontic treatment. Am J Ortho Dentofac Orthod 1987;91(6):493–499. DOI: 10.1016/0889-5406(87)90006-0.
McLaughlin RP, Bennett JC. The extraction-nonextraction dilemma as it relates to TMD. Am J Ortho Dentofac Orthod 1995;65(3):175–186.
Major P, Kamelchuk L, Nebbe B, et al. Condyle displacement associated with premolar extraction and nonextraction orthodontic treatment of class I malocclusion. Am J Orthod Dentofacial Orthop 1997;112(4):435–440. DOI: 10.1016/S0889-5406(97)70052-0.
Gianelly A, Hughes H, Wohlgemuth P, et al. Condylar position and extraction treatment. Am J Orthod Dentofacial Orthop 1988;93(3):201–205. DOI: 10.1016/S0889-5406(88)80004-0.
Gianelly AA, Cozzani M, Boffa J. Condylar position and maxillary first premolar extraction. Am J Orthod Dentofacial Orthop 1991;99(5):473–476. DOI: 10.1016/S0889-5406(05)81581-1.
Gianelly AA, Anderson CK, Boffa J. Longitudinal evaluation of condylar position in extraction and nonextraction treatment. Am J Orthod Dentofacial Orthop 1991;100(5):416–420. DOI: 10.1016/0889-5406(91)70080-G.
Luecke 3rd PE, Johnston Jr LE. The effect of maxillary first premolar extraction and incisor retraction on mandibular position: testing the central dogma of “functional orthodontics”. Am J Orthod Dentofacial Orthop 1992;101(1):4–12. DOI: 10.1016/0889-5406(92)70075-L.
Reynders RM. Orthodontics and temporomandibular disorders: a review of the literature (1966-1988). Am J Orthod Dentofacial Orthop 1990;97(6):463–471. DOI: 10.1016/S0889-5406(05)80026-5.
Schudy FF. The rotation of the mandible resulting from growth: its implications in orthodontic treatment. Angle Orthod 1965;35:36–50.
Schudy FF. The control of vertical overbite in clinical orthodontics. Angle Orthod 1968;38(1):19–39.
Kuhn R. Control of anterior vertical dimension and proper selection of extraoral anchorage. Angle Orthod 1968;38:340–349.
Pearson LE. Vertical control in treatment of patients having backward rotational growth tendencies. Angle Orthod 1978;48:132–140.
Isaacson JR, Isaacson RJ, Speidel TM, et al. Extreme variation in vertical facial growth and associated variation in skeletal and dental relations. Angle Orthod 1971;41:219–229.
Nanda SK. Patterns of vertical growth in the face. Am J Orthod Dentofacial Orthop 1998;93(2):103–116. DOI: 10.1016/0889-5406(88)90287-9.
Kafle D, Ulrich Z. Skeleto-dental changes after camouflage treatment in class II div 1 adult patients with average mandibular plane angle. Orthodontic Journal of Nepal 2011;1(1):31–35. DOI: 10.3126/ojn.v1i1.9364.
Heravi F, Shojaeian S, Sadafi M. A comparative study of dentoskeletal changes following orthodontic treatment with first premolar extraction in long face and normal patients. J Dent Mater Tech 2012;1(2):63–69.
Kim TK, Kim JT. First or second premolar extraction effects on facial vertical dimension. Angle Orthodontist 2005;75:177–182.
Kocadereli I. The effect of first premolar extraction on vertical dimension. Am J Orthod Dentofacial Orthop 1999;116(1):41–45. DOI: 10.1016/S0889-5406(99)70301-X.
Tarvade S, Chaudhari C, Satish H. Vertical changes during Begg's and PEA — a comparative study. IOSR-JDMS 2017;9(4):48–53. DOI: 10.9790/0853-0944853.
Ahn JG, Schneider BJ. Cephalometric appraisal of posttreatment vertical changes in adult orthodontic patients. Am J Orthod Dentofacial Orthop 2000;118(4):378–384. DOI: 10.1067/mod.2000.109312.
Sivakumar A, Valiathan A. Cephalometric assessment of dentofacial vertical changes in class I subjects treated with and without extraction. Am J Orthod Dentofacial Orthop 2008;133(6):869–875. DOI: 10.1016/j.ajodo.2006.05.041.
Zafarmand AH, Zafarmand MM. Premolar extraction in orthodontics: does it have any effect on patient's facial height? J Int Soc Prevent Communit Dent 2015;5(1):64–68. DOI: 10.4103/2231-0762.151980.
Makino M, Choi Y, Nojima K, et al. Characteristics of dentoskeletal morphology and treatment changes in 2-maxillary premolar extraction: a comparison with 4-premolar extraction. J World Federat Orthod 2013;2(2):e71–e76. DOI: 10.1016/j.ejwf.2013.02.004.
Dyer G, Harris E, Vaden J. Age effects on orthodontic treatment: adolescents contrasted with adults. Am J Orthod Dentofacial Orthop 1991;100(6):523–530. DOI: 10.1016/0889-5406(91)70092-B.