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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (1): 86-92. doi: 10.19723/j.issn.1671-167X.2019.01.016

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Orthodontic-orthognathic treatment stability in skeletal class Ⅲ malocclusion patients

Xiu-jing WANG1,Yi-mei ZHANG1,Yan-heng ZHOU2,△()   

  1. 1. First Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing 100081, China
  • Received:2018-10-07 Online:2019-02-18 Published:2019-02-26
  • Contact: Yan-heng ZHOU E-mail:yanhengzhou@vip.163.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(81801014)

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Abstract:

Objective:To investigate stability of skeletal hard tissues, dental hard tissues and soft tissues after orthodontic-orthognathic treatment in a long term. This study reviewed longitudinal changes in orthodontic-orthognathic patients of skeletal class Ⅲ malocculsion, using lateral cephalometric radiographs in 3-12 years after treatment in comparison to treatment finishing. Methods: Twenty-two patients with skeletal Class Ⅲ malocclusion following orthodontic-orthognathic surgery in Peking University School and Hospital of Stomatology from January 1, 2000 to January 1, 2009 were observed. The lateral cephalometric radiographs of the following stages were collected: treatment finishing (T1), 3 to 12 years after treatment (T2). Statistical analyses of cephalometrics were evaluated. Paired student t test was performed by SPSS 17.0. Results: Data of all the 22 patients were studied in longitudinal timeline after treatment and 3-12 years after treatment. From T1 to T2, we evaluated 11-SN (angle between the upper incisors axis and SN plane), 11-NA angle (angle between the upper incisors axis and NA plane), 11-NA mm (perpendicular distance from upper incisors to NA plane), 11-41(angle between the upper incisors axis and lower incisors axis), 41-NB angle (angle between lower incisors and NB plane), 41-NB(perpendicular distance from lower incisors to NB plane), 41-MP angle (angle between lower incisors and GoGn plane), and IMPA [angle between lower incisor and mandibular plane (tangent line to submandibular border)]. Most hard tissues of the teeth remained stable but upper anterior teeth angulations decreased, indicating by significantly reducing 11-SN (T1:110.98°±6.77°; T2: 109.21°±5.80°; P=0.005); reducing 11-NA(T1: 28.31°±6.80°;T2: 26.49°±6.18°; P=0.002); increasing 11-41 (T1:123.51°±8.14°;T2:125.7°±10.01°;P=0.035). From T1 to T2, we also evaluated SNA (angle of sella-nasion-A-point ), SNB (angle of sella-nasion-B-point), ANB (angle of A-point-nasion-B-point), GoGn-SN(angle between GoGn and SN plane), GoGn-FH (angle between GoGn and Frankfort plane), Y axis(angel between Sella-Gn and Frankfort plane), N-ANS (distance from nasion point to ANS point), ANS-Me (distance from ANS point to Menton point), N-Me (distance from nasion point to Menton point), ANS-Me/N-Me% (proportion of ANS-Me to N-Me), and FMA (angle between Frankfort and mandibular plane), Wits appraisal (horizontal distance between points A and B on functional occlusal plane). Skeletal hard tissues also remained relatively stable, only N-Me value changed significantly with a decreasing facial height (T1:124.98°±11.98°; T2:122.4°±11.05°; P=0.024). From T1 to T2, we finally evaluated FH-NsPg angle (angle between NsPg and Frankfort plane), H angle (angel between H line and NB), FH-A’UL angle (angle between A’UL and Frankfort plane), FH-B’LL angle (angle between B’LL and Frankfort plane), UL-LL (angle between UL and LL), UL-EP (distance between UL and E line), LL-EP (distance between LL and E line), Sn-H(perpendicular distance between Sn point and H line), Nls-H (distance of nose-lip-sulcus to H line), Li-H (lower lip to H line), Si-H (lower lip sulcus to H line), and NLA (nasolabial angle, angle of Cm-Sn-UL-point).Soft tissues changes were observed in decreasing UL-EP [T1: (-2.78±2.20) mm; (-3.29±2.44) mm; P=0.02] and H angle(T1: 8.27°±3.71°; 7.32°±3.83°; P=0.006).Other soft tissues remained relatively stable by retruding upper lip position and chin changes with no statistical significance. Conclusion: Orthodontic-orthognathic treatment can improve esthetics and occlusal function in patients of skeletal class Ⅲ malocclusion with a stable long-term outcome.

Key words: Malocclusion, Maxillary retrognathism, Mandibular prognathism, Orthognathic surgery

CLC Number: 

  • R783.5

Table 1

Comparison of skeletal measurements after treatment (Tfinished) and 3-12 years after treatment (Tfinished 3-12) in skeletal class Ⅲ patients"

Variables Tfinished Tfinished 3-12 t P
SNA/(°) 82.87±4.62 82.87±4.54 -0.008 0.990
SNB/(°) 81.76±4.80 81.91±4.33 -0.320 0.752
ANB/(°) 1.10±2.26 0.97±2.35 0.657 0.518
GoGn-SN/(°) 37.17±7.77 36.52±7.44 1.124 0.274
GoGn-FH/(°) 33.61±8.00 33.70±6.36 -0.096 0.925
Y axis/(°) 70.08±4.81 69.83±4.34 0.660 0.517
N-ANS/mm 55.88±5.22 54.84±5.49 2.003 0.058
ANS-Me/mm 69.34±7.91 67.76±6.93 1.981 0.061
N-Me/mm 124.98±11.98 122.40±11.05 2.437 0.024*
ANS-Me/N-Me/% 55.60±2.48 55.50±2.42 0.260 0.797
FMA/(°) 34.72±9.51 35.16±7.93 -0.432 0.671
Wits value/mm -4.71±2.48 -5.11±2.74 1.455 0.160

Table 2

Comparison of dentition measurements after treatment (Tfinished) and 3-12 years after treatment (Tfinished 3-12) in skeletal class Ⅲ patients"

Variables Tfinished Tfinished 3-12 t P
11-SN/(°) 110.98±6.77 109.21±5.80 3.085 0.005#
11-NA angle/(°) 28.31±6.80 26.49±6.18 3.471 0.002#
11-NA/mm 10.04±8.63 8.87±6.07 0.870 0.394
11-41/(°) 123.51±8.14 125.70±10.01 -2.251 0.035*
41-NB angle/(°) 27.13±6.95 26.80±8.15 0.425 0.675
41-NB/(mm) 7.56±5.74 6.94±4.59 0.782 0.442
41-MP/(°) 88.24±9.04 88.33±10.18 -0.097 0.923
IMPA/(°) 87.38±8.90 87.45±9.92 -0.078 0.928

Table 3

Comparison of soft tissue measurements after treatment (Tfinished) and 3 to 12 years after treatment (Tfinished 3-12) in skeletal class Ⅲ patients"

Variables Tfinished Tfinished 3-12 t P
FH-NsPg/(°) 89.22±8.63 88.64±7.69 0.723 0.478
H angle/(°) 8.27±3.71 7.32±3.83 3.031 0.006#
FH-A’UL/(°) 70.62±8.89 72.24±8.67 -1.279 0.215
FH-B’LL/(°) 47.61±19.11 46.26±17.88 1.422 0.170
UL-LL/(°) 110.64±25.60 115.30±12.98 -0.960 0.348
UL-EP/mm -2.78±2.20 -3.29±2.44 2.511 0.020*
LL-EP/mm 0.03±2.17 -0.26±2.44 1.113 0.278
Sn-H/mm 4.22±3.52 4.99±3.73 -2.051 0.053
Nls-H/mm 7.77±2.33 10.09±14.49 -0.757 0.457
Li-H/mm 1.49±1.42 1.35±1.79 0.601 0.555
Si-H/mm 5.51±1.51 5.47±1.33 0.199 0.845
NLA/(°) 90.66±12.55 92.66±10.01 -1.387 0.180

Figure 1

Intraoral photographs and radiographs before treatment A,frontal view of face;B,lateral profile of face;C,cephalometric radiograph;D,occlusion of right;E, occlusion of frontal view;F,occlusion of left;G,occlusion of upper arch;H,occlusion of lower arch;I,overjet."

Figure 2

Intraoral photographs and radiographs during treatment A,frontal view of face;B,lateral profile of face;C,cephalometric radiograph;D,occlusion of right;E,occlusion of frontal view;F,occlusion of left;G,occlusion of upper arch;H,occlusion of lower arch;I,overjet."

Figure 3

Intraoral photographs and radiographs finishing treatment A,frontal view of face;B,lateral profile of face;C,cephalometric radiograph;D,occlusion of right;E,occlusion of frontal view;F,occlusion of left;G,occlusion of upper arch;H,occlusion of lower arch;I,overjet."

Figure 4

Intraoral photographs and radiographs of 9.4 years after treatment A,frontal view of face;B,lateral profile of face;C,cephalometric radiograph;D,occlusion of right;E,occlusion of frontal view;F,occlusion of left;G,occlusion of upper arch;H,occlusion of lower arch;I,overjet."

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