Treatments for adults with prominent lower front teeth
ABSTRACT Prominent lower front teeth may be associated with a large or prognathic lower jaw (mandible) or a small or retrusive upper jaw (maxilla). Edward Angle, who may be considered the father of modern orthodontics, classified the malocclusion in this situation as Class III. The individual is described as having a negative or reverse overjet as the lower front teeth are more prominent than the upper front teeth.
The purpose of this systematic review was to evaluate different treatments of Angle Class III malocclusion in adults.
The following databases were searched: Cochrane Oral Health Group Trials Register (to 22 March 2012); CENTRAL (The Cochrane Library 2012, Issue 1); MEDLINE via OVID (1950 to 22 March 2012); EMBASE via OVID (1980 to 22 March 2012); LILACs (1982 to 22 March 2012); BBO (1986 to 22 March 2012); and SciELO (1997 to 22 March 2012).
All randomized or quasi-randomized controlled trials of treatments for adults with an Angle Class III malocclusion were included.
Three review authors independently assessed the eligibility of the identified reports. Two review authors independently extracted data and assessed the risk of bias in the included studies. The mean differences with 95% confidence intervals were calculated for continuous data.
Two randomized controlled trials were included in this review. There are different types of surgery for this type of malocclusion but only trials of mandible reduction surgery were identified. One trial compared intraoral vertical ramus osteotomy (IVRO) with sagittal split ramus osteotomy (SSRO) and the other trial compared vertical ramus osteotomy (VRO) with and without osteosynthesis. Neither trial found any difference between the two treatments. The trials did not provide adequate data for assessing effectiveness of the techniques described.
There is insufficient evidence from the two included trials, to conclude that one procedure is better or worse than another. The included trials compared different interventions and were at high risk of bias and therefore no implications for practice can be given. Further high quality randomized controlled trials with long term follow-up are required.
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ABSTRACT: The purpose of this study was to examine morphological changes of the mandibular region using frontal cephalograms following bilateral sagittal split osteotomy (BSSO) for mandibular setback. Furthermore, we compared the stability between screw and plate fixation. Pre and postoperative frontal cephalograms were taken of 26 patients. Parameters, Angle "A" which is formed by constructed lines along the mandibular ramus, and mandibular width at the angle were calculated. The subjects were analyzed according to the types of bony fixation, whether by screws or plates. Angle "A" and mandibular angular width of total numbers did not widely change at early period following operation. Late postoperatively, mandibular width of total numbers decreased in conjunction with increasing Angle "A". When comparing the parameters between screw and plate groups, the plate group showed a decrease of Angle "A" as an early change. Late postoperatively, the plate group showed an increase of Angle "A" and a decrease of mandibular width, while the screw group had smaller changes. We demonstrate postoperative inclination of mandibular lower ramus towards the facial midline. We suggest that the types of rigid fixation have an influence on frontal skeletal morphology, namely that screw fixation has higher stability.Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 06/2009; 37(7):412-6. DOI:10.1016/j.jcms.2009.04.012 · 2.60 Impact Factor
American Journal of Orthodontics 07/1965; 51(6):437-45. DOI:10.1016/0002-9416(65)90241-1
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ABSTRACT: Eighty patients, who had previously been evaluated by an oral surgeon and an orthodontist as requiring orthognathic surgery, completed questionnaires rating their perceptions of their own profiles. Half of the patients had decided to undergo surgical correction of their jaw deformities, while the other half had decided against surgical treatment. In addition, booklets containing pretreatment photographs of all 80 patients were mailed to 37 oral surgeons, 46 orthodontists, and 43 lay persons. These three groups of evaluators rated the patients' profiles, using the same rating scales that the patients had used. Cephalometrically, the two patient groups were statistically the same in all skeletal and soft-tissue measures except for ANB (mean difference = 1.8 degrees) and soft-tissue AN-pogonion (mean difference = 2.4 degrees). Differences in these dimensions were considered in subsequent data analyses. Results of this study support the following conclusions: In spite of the fact that surgical treatment may be recommended by dental specialists and indicated by cephalometric measurements, self-perceptions of profile are more important in the patient's decision to elect surgical correction; the perception by others that the profiles of patients deciding against surgery are closer to ideal may have some influence on their decision against surgical correction of their jaw deformities; oral surgeons and orthodontists evaluate facial profiles similarly, but surgeons are more likely to recommend surgical correction; lay persons are more likely to rate an individual's profile as being normal than are dental specialists in orthodontics and oral surgery; in contrast, individuals perceive their own profiles differently than orthodontists, oral surgeons, and lay persons, particularly with respect to the mandibular and dentoalveolar dimensions.American Journal of Orthodontics 11/1985; 88(4):323-32. DOI:10.1016/0002-9416(85)90132-0