Long-term three-dimensional condylar remodeling during presurgical orthodontics and after orthognathic surgery of mandibular retrognathia with high mandibular plane angle

Al-Rezami, Khadeegh F.; Abotaleb, Bassam; Alkebsi, Khaled; Wang, Ruiyu; Al-Nasri, Akram; Sakran, Karim Ahmed; Aladimi, Mohammed; Pu, Yang

doi:10.1007/s00784-022-04686-5

Cited by 9 publications

(8 citation statements)

References 30 publications

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“…Therefore, the treatment for children with long-face growth patterns should incorporate vertical control methods that may help prevent the continued increase in the mandibular plane and improve the facial profile in both sagittal and vertical dimensions. Most studies on vertical control have focused on orthognathic surgery and compensatory orthodontic treatment in adult patients with high mandibular plane angles 31 32. But few studies have investigated the improvement in mandibular advancement in children with hyperdivergent mandibular retrognathia.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a modified twin block appliance compared with the traditional twin block appliance in children with hyperdivergent mandibular retrognathia: protocol for a single-centre, single-blind, randomised controlled trial

Liu,

Zhang,

Zhang

et al. 2023

BMJ Open

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IntroductionCompensatory mouth breathing, caused by nasopharyngeal obstructive diseases, is the main cause of hyperdivergent mandibular retrognathia in children. Such deformities require effective growth guidance before pubertal growth peaks. The traditional mandibular advancement device, twin block (TB), can guide the forward development of the mandible. However, the side effect of increasing the vertical dimension of the lower facial third, worsens the facial profile of children with divergent growth trends. To solve this problem, a modified TB (LLTB) appliance was designed to control the vertical dimension by intruding incisors and inhibiting the elongation of posterior teeth during the advancement of the mandible, which could avoid the side effects of traditional appliances and effectively guide the growth of the mandible in a normal direction.Methods and analysisThe study was designed as a single-centre, single-blind, randomised, parallel controlled trial. We aim to enrol 60 children aged 9–14 years with hyperdivergent skeletal class II malocclusion, using a 1:1 allocation ratio. The participants were will be randomly assigned to receive either the TB or LLTB treatment. The primary outcome will be a change in the angle of the mandibular plane relative to the anterior cranial base. The secondary outcomes will include changes in the sagittal maxillomandibular relation, occlusal plane, facial height, morphology of the mandible and upper airway width. Safety endpoints will also be evaluated.Ethics and disseminationEthical approval was obtained from the ethics committee of Shanghai Stomatological Hospital. Both participants and their guardians will be fully informed of the study and sign an informed consent form before participating in the trial. The results will be publicly available in peer-reviewed scientific journals.Trial registration numberChiCTR2000035882.

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Section: Discussionmentioning

confidence: 99%

Efficacy of a modified twin block appliance compared with the traditional twin block appliance in children with hyperdivergent mandibular retrognathia: protocol for a single-centre, single-blind, randomised controlled trial

Liu,

Zhang,

Zhang

et al. 2023

BMJ Open

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“…Hypoplasia of the mandibular ramus, resulting from either underdevelopment, or shortening by diseases like idiopathic condylar resorption, is characterized as the retruded pogonion and Class II malocclusion, 1 which has severe impact on patient's facial appearance, oral function, somatic and psychological health, and can even cause obstructive sleep apnea 2 . Treatment of mandibular hypoplasia often involves orthognathic surgery in adulthood 3 . Nevertheless, if this deformity could be improved during adolescence, it would greatly benefit for the young patient.…”

Section: Introductionmentioning

confidence: 99%

“…hypoplasia often involves orthognathic surgery in adulthood. 3 Nevertheless, if this deformity could be improved during adolescence, it would greatly benefit for the young patient. Efforts have been made to promote mandibular growth in adolescence using various functional appliances, however with limited effects.…”

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confidence: 99%

Local injection of abaloparatide promotes mandibular condyle lengthening in adolescent rats via enhancing chondrogenesis and ossification

Xu,

Li,

Mei

et al. 2023

J of Oral Rehabilitation

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BackgroundMandibular condylar hypoplasia negatively affects patient's facial appearance and dentofacial function.ObjectiveTo investigate the effect of local injection of the drug abaloparatide (ABL), an analogue of parathyroid hormone related protein (PTHrP), on promoting lengthening of the mandibular condyle.MethodsThirty adolescent male Sprague–Dawley rats were randomly divided into two groups, which received the injection of ABL or normal saline (the control) every 3 days in the temporomandibular joint (TMJ) cavity. Cone‐beam computed tomography and immunohistochemistry assays were performed at 2, 4 and 6 weeks since the injection. Mandibular condylar chondrocytes (MCC) and pre‐osteoblasts were treated with ABL or PBS, followed by the CCK‐8 detection, IC50, real‐time PCR assay, Western Blot and immunofluorescence staining.ResultsIn vivo, compared with the control, the ABL group significantly increased the mandibular condylar process length (by 1.34 ± 0.59 mm at 6 weeks), the thickness of the cartilage layer, and enhanced the matrix synthesis. The ABL group had significant up‐regulation of SOX 9, COL II, PTHrP and PTH1R, down‐regulation of COL X in the cartilage, up‐regulation of RUNX 2, and unchanged osteoclastogenesis in the subchondral bone. In vitro, the intra‐TMJ injection of ABL promoted the MCC proliferation, with up‐regulated expression of chondrogenic genes, and enhanced osteogenic differentiation of the pre‐osteoblasts.ConclusionsIntra‐TMJ injection of abaloparatide promotes mandibular condyle lengthening in the adolescent rats via enhancing chondrogenesis in the mandibular condylar cartilage and ossification in the subchondral bone.

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“…S keletal class II malocclusions in adult patients often require the combination of orthodontic and orthognathic treatment. 1 However, patients with preoperative idiopathic condylar resorption (ICR) or patients with risk factors such as high mandibular plane angle and anterior open bite often showed progressive relapse and condylar resorption with temporomandibular joint (TMJ) disorder following orthognathic surgery, which lead to unwanted esthetic results. [2][3][4][5] The earliest clinical or radiological signs of postoperative ICR (pICR) with occlusal disturbance or condylar resorption can occur 6 months after surgery; however, pICR is often observed instead at 1 or 2 years after surgery in most patients 4,[6][7][8][9][10][11][12] and ultimately leads to long-term relapse with decreased posterior facial height, progressive mandibular retrusion, and anterior open bite.…”

mentioning

confidence: 99%

“…Skeletal class II malocclusions in adult patients often require the combination of orthodontic and orthognathic treatment 1 . However, patients with preoperative idiopathic condylar resorption (ICR) or patients with risk factors such as high mandibular plane angle and anterior open bite often showed progressive relapse and condylar resorption with temporomandibular joint (TMJ) disorder following orthognathic surgery, which lead to unwanted esthetic results 2–5 .…”

mentioning

confidence: 99%

Long-term Stability Over 2 Years After Isolated Maxillary Orthognathic Surgery Combined With Mandibular Autorotation in Risk Patients for Condylar Resorption

Xiong

Yang

Kim

et al. 2023

Journal of Craniofacial Surgery

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Objective: Counterclockwise rotation of mandible can cause condylar resorption and condylar displacement posteroinferiorly after maxillary orthognathic surgery with mandibular in patients with high-angle mandibular retrognathism. This study was aimed to evaluate long-term stability >2 years and postoperative changes of condylar displacement. Materials and methods: In 15 patients who underwent Le Fort I osteotomy with mandibular autorotation, postoperative stability was cephalometrically investigated until 2 years. Condylar changes were analyzed with transcranial temporomandibular joint projection. Correlation between condylar displacement and surgical movement was analyzed. Results: Significant clockwise relapse of mandible (P<0.01 for SNB reduction and backward movement of point B) was observed between 6 months and >2 years after surgery, even though the values were small (0.5±0.1 degrees and 1.14±0.13 mm, respectively). The condyle was displaced posteroinferiorly immediately after surgery; however, it achieved a stable position at postoperative 6 weeks. The amount of vertical condylar displacement was significantly correlated with surgical change in mandibular posterior border sagittal angle, palatal plane angle, facial height ratio, and point B in the horizontal dimension. Greater mandibular rotation prompted more vertical condylar displacement. Conclusions: Small mandibular relapse in long term should be considered after maxillary orthognathic surgery with mandibular autorotation, although it is regarded as a surgical maneuver to minimize mandibular instability in patients susceptible to postoperative condylar resorption.

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Long-term three-dimensional condylar remodeling during presurgical orthodontics and after orthognathic surgery of mandibular retrognathia with high mandibular plane angle

Cited by 9 publications

References 30 publications

Efficacy of a modified twin block appliance compared with the traditional twin block appliance in children with hyperdivergent mandibular retrognathia: protocol for a single-centre, single-blind, randomised controlled trial

Efficacy of a modified twin block appliance compared with the traditional twin block appliance in children with hyperdivergent mandibular retrognathia: protocol for a single-centre, single-blind, randomised controlled trial

Local injection of abaloparatide promotes mandibular condyle lengthening in adolescent rats via enhancing chondrogenesis and ossification

Long-term Stability Over 2 Years After Isolated Maxillary Orthognathic Surgery Combined With Mandibular Autorotation in Risk Patients for Condylar Resorption

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