This prospective controlled trial aimed to evaluate the skeletal effect of 3.5-years bone anchored maxillary protraction (BAMP) in growing cleft subjects with a Class III malocclusion. Subjects and Method: Nineteen cleft patients (11.4 ± 0.7-years) were included from whom cone beam computed tomography (CBCT) scans were taken before the start of BAMP (T0), 1.5-years after (T1) and 3.5 y after (T2). Seventeen age- and malocclusion-matched, untreated cleft subjects with cephalograms available at T0 and T2 served as the control group. Three dimensional skeletal changes were measured qualitatively and quantitatively on CBCT scans. Two dimensional measurements were made on cephalograms. Results: Significant positive effects have been observed on the zygomaticomaxillary complex. Specifically, the A-point showed a displacement of 2.7 mm ± 0.9 mm from T0 to T2 (p < 0.05). A displacement of 3.8 mm ± 1.2 mm was observed in the zygoma regions (p < 0.05). On the cephalograms significant differences at T2 were observed between the BAMP and the control subjects in Wits, gonial angle, and overjet (p < 0.05), all in favor of the treatment of Class III malocclusion. The changes taking place in the two consecutive periods (ΔT1-T0, ΔT2-T1) did not differ, indicating that not only were the positive results from the first 1.5-years maintained, but continuous orthopedic effects were also achieved in the following 2-years. Conclusions: In conclusion, findings from the present prospective study with a 3.5-years follow-up provide the first evidence to support BAMP as an effective and reliable treatment option for growing cleft subjects with mild to moderate Class III malocclusion up to 15-years old.

Jaw motion tracking functionalities of cone beam computed tomography (CBCT)-scanners can visualize, record, and analyze movements of the mandible. In this explorative study, the validity of the 4D-Jaw Motion module (4D-JM) of the ProMax 3D Mid CBCT scanner (Planmeca, Helsinki, Finland) was tested in vitro. The validity of the 4D-JM was accepted if values differed less than 0.6 mm (three voxels sizes) from the gold standard. Three dry human skulls were used. CBCT scans, the gold standard, were taken in eight jaw positions and exported as three-dimensional (3D) models. Individualized 3D-printed dental wafers ensured the correct positioning of the mandible. Jaw positions were recorded with the 4D-JM tracking device and exported as 3D models. The coordinates of six reference points for both superimposed 3D models were obtained. The differences in the x, y and z-axis and the corresponding vector differences between gold standard 3D models and 4D-JM models were calculated. For the mandible 10% and for the maxilla 90% of the vector differences fell within 0.6 mm of the gold standard. With an increasing vertical jaw opening, larger differences between the gold standard and the 4D-JM 3D models were found. The smallest differences of the mandible were observed on the x axis. In this study, the 4D-JM validity was not acceptable by the authors’ predefined standards.

This study aimed to analyze the image quality of standard dose orthopantomograms (sd-PAN), extracted PAN from standard dose cone-beam computed tomography (CBCT [extr-PAN]), and from reduced-dose ultra low dose-low dose CBCT (rd-PAN). Image pairs, sd-CBCT and sd-PAN, of patients were selected if taken within 6 months of each other. From the sd-CBCT, an extr-PAN was extracted, and a simulated rd-PAN (sim rd-PAN) was constructed using a filtering technique. Three experienced orthodontists assessed image quality by means of 9 yes-and-no statements. For subjective statements (1-5), observers' opinions of technical acceptability and visibility of anatomic structures, observers indicated their disagreement or agreement. For objective statements (6-9), regarding comparability to a gold standard, observers indicated the presence of dental structures. Positive response rates were calculated for the subjective statements. Agreement rates with the gold standard were calculated for the objective statements. Thresholds for acceptable image quality were if ≥2 observers agreeing with the subjective statements or agreeing with the gold standard (objective statements) for 90% for sd-PANs and 85% for both extr-PANs and sim rd-PANs. In total, images of 43 patients were included. For the subjective statements, only the sd-PAN met the threshold for technical adequacy (95.3%) and suitability for orthodontic treatment planning (95.3%). For objective statements 6, 7, and 9, extr-PAN and sim rd-PAN images met the threshold for acceptable quality, whereas the sd-PAN met the threshold for statements 6 and 9. Differences in agreement with the gold standard among images were small (85.7%-87.8%). Sd-PAN images demonstrated superior image quality. Although extr-PAN and sim rd-PAN showed reduced diagnostic image quality for orthodontic diagnosis, differences among the 3 types of PAN regarding the gold standard were small.

Background/objectives: This retrospective longitudinal outcome study comparing orthodontic extraction modalities, including extraction of maxillary first or second molars, aimed to compare the three-dimensional tooth movement of maxillary canines (C), premolars (P1, P2), and molars (M1, M2) in Class II division 1 malocclusion treatment with fixed appliances. Methods: A sample of 98 patients (mean age 13.20 ± 1.46 years) was selected for the M1 group, and 64 patients (mean age 13.20 ± 1.36 years) were chosen for the M2 group. Tooth movement was analyzed three-dimensionally on pre-treatment (T0) and post-treatment (T1) digital dental casts. Regression analyses compared the tooth movements (in mm) between the M1 and M2 groups. Results: The mean treatment duration for the M1 group was 2.51 ± 0.55 year, while, for the M2 group, it was 1.53 ± 0.37 year. The data showed limited distal movements of the C, P1, and P2 of approximately 2 mm in the M1 group and 1 mm in the M2 group during orthodontic treatment, but the M1 group exhibited significantly more distal movements than the M2 group (mean difference 1.11 to 1.24 mm). Vertical movements of the C, P1, and P2 in both groups were also minor (0.16 to 1.26 mm). The differences between groups did not exceed 0.2 mm and were not significant. Both treatment modalities resulted in a significant degree of anchorage loss with a distinct mesialization (8.40 ± 1.66 mm) of M2 in the M1 group and limited distalization (0.83 ± 0.98 mm) of M1 in the M2 group. Conclusions: The findings highlight the importance of thorough case evaluation when choosing between extraction modalities in Class II treatment. If a large distal movement of canines and premolars is required, additional anchorage mechanics should be considered.