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Treatment of skeletal class III malocclusion using a combined clear aligner and surgery-early approach

Assessment based on the American Board of Orthodontics Objective Grading System

Behandlung von skelettalen Klasse-III-Fehlstellungen mit einer Kombination aus Clear Aligner und früher chirurgischer Intervention

Bewertung auf der Grundlage des ABO-OGS (American Board of Orthodontics Objective Grading System)

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Purpose

To evaluate whether clear aligner therapy (CAT) combined with a surgery-early approach can achieve good therapeutic effects in patients with skeletal class III malocclusion.

Methods

Thirty consecutive skeletal class III malocclusion cases treated with clear aligners combined with early surgery were selected. Treatment time, lateral cephalograms and American Board of Orthodontics Objective Grading System (ABO-OGS) scores of the treatment models were measured to evaluate the treatment efficiency, facial profile, and occlusion.

Results

The results showed that early surgery was achieved after 7.71 months of presurgical orthodontics, on average. ANB decreased by 5.57° (P < 0.001), and STissue N Vert to Pog’ decreased by 7.29 mm (P = 0.001), both reaching normal values. The posttreatment ABO-OGS scores were 26.600 on average, meeting its standards.

Conclusions

With the assistance of CAT, early surgery can be accomplished in patients with skeletal class III malocclusion, improving their facial profile and achieving functional occlusion.

Zusammenfassung

Ziel

Es sollte untersucht werden, ob sich mit der Clear-Aligner-Therapie (CAT) in Kombination mit einem frühen operativen Ansatz gute therapeutische Effekte bei Patienten mit skelettaler Klasse-III-Malokklusion erzielen lassen.

Methoden

Dreißig konsekutive Fälle von mit Clear Alignern in Kombination mit einer frühzeitigen operativen Intervention behandelten skelettalen Klasse-III-Malokklusionen wurden ausgewählt. Die Behandlungszeit, die seitlichen Kephalogramme und die ABO-OGS(American Board of Orthodontics Objective Grading System)-Scores der Behandlungsmodelle wurden gemessen, um Behandlungseffizienz, Gesichtsprofil und Okklusion zu bewerten.

Ergebnisse

Die Ergebnisse zeigten, dass eine frühe Operation im Durchschnitt nach 7,71 Monaten präoperativer Kieferorthopädie erreicht wurde. ANB verringerte sich um 5,57° (p < 0,001), STissue N Vert bis Pogʼ um 7,29 mm (p < 0,001), beide erreichten Normalwerte. Die ABO-OGS-Scores lagen nach der Behandlung im Durchschnitt bei 26.600 und entsprachen damit den Standards.

Schlussfolgerungen

Mit Unterstützung der CAT können Patienten mit skelettalen Klasse-III-Malokklusionen frühzeitig operiert werden, um ihr Gesichtsprofil zu verbessern und eine funktionelle Okklusion zu erreichen.

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Abbreviations

ABO-OGS:

American Board of Orthodontics Objective Grading Systems

ALFH/PLFH:

Anterior lower facial height/posterior lower facial height

ANB:

Point A-nasion-point B

CAT:

Clear aligner therapy

CT:

Computed tomography

L1-MP:

L1 to mandibular plane angle

L1-NB:

L1 to nasion-point B angle

MP-FH:

Mandibular plane to Frankfurt horizontal plane angle

Mx Occ Plane to FH:

Maxillary occlusal plane to Frankfurt horizontal plane angle

SD:

Standard deviation

SNA:

Sella-nasion-point A angle

SNB:

Sella-nasion-point B angle

STissue N Vert to Pog’:

Nasion of soft tissue vertical to pogonion of soft tissue

U1-NA:

U1 to nasion-point A angle

U1-Mx Occ Plane:

U1 to maxillary occlusal plane angle

U1-PP:

U1 to palatal plane angle

U6-PP:

U6 to palatal plane angle

U1-SN:

U1 to sella-nasion angle

U1-L1:

U1 to L1 angle

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Acknowledgements

Not applicable.

Funding

This study was supported by the Clinical Research Plan of SHDC (No. SHDC2020CR3009A).

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Authors and Affiliations

  1. Department of Orthodontics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, 500 Quxi Road, 200011, Shanghai, China

    Guoli Zhou, Fei Yu Ph.D.,  Hongbo Yu,  Lunguo **a, Lingjun Yuan &  Bing Fang

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  1. Guoli Zhou
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  3. Hongbo Yu
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  4. Lunguo **a
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Contributions

GZ and FY collected the data, interpreted the data and drafted the manuscript; LY and BF analyzed the data and revised the manuscript; HY, LX and BF conceived the work and supervised it. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bing Fang.

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Conflict of interest

G. Zhou, F. Yu, H. Yu, L. **a, L. Yuan and B. Fang declare that they have no competing interests.

Ethical standards

This retrospective study was approved by the institutional review board of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine (SH9H-2020-T16-2). As waiving consent to participate would not harm the participates, this study had been granted an exemption from requiring consent to participate. Consent for publication: Not applicable.

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The authors Guoli Zhou and Fei Yu contributed equally to the manuscript.

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Zhou, G., Yu, F., Yu, H. et al. Treatment of skeletal class III malocclusion using a combined clear aligner and surgery-early approach. J Orofac Orthop (2023). https://doi.org/10.1007/s00056-023-00458-2

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