Application of PAR index and cephalometrics for camouflage therapy and orthodontic-orthognathic surgery in adults with skeletal Class Ⅲ malocclusion

doi:10.19439/j.sjos.2023.04.015

Abstract

Abstract: PURPOSE: To investigate the value of PAR index combined with cephalometry in evaluating the efficacy of mild to moderate skeletal Class Ⅲ malocclusion. METHODS: Sixty-five adult patients with skeletal Class Ⅲ malocclusion were selected and divided into group C (camouflage therapy) and group S (orthodontic-orthognathic surgery)according to different treatment methods. PAR index and cephalometric values before and after treatment in each group were compared, and then the differences of PAR index and cephalometric values before and after treatment between the two groups were compared. The clinical effect was evaluated by these indexes. SPSS 25.0 software package was used for data analysis. RESULTS: In PAR index, the tooth alignment, occlusion, overjet, overbite, midline, total score and weighted total score after treatment of both groups were all significantly lower than those before treatment(P<0.001). The differences of left and right buccal bite and total posterior bite of group S before and after treatment was significantly larger than those of group C(P<0.001). In cephalometric measurement, the differences of SNA, NA-PA, L1-NB, U1-L1, U1-SN and L1-MP in group C before and after treatment were significantly different(P<0.05), while those in group S before and after treatment were SNA, SNB, ANB, NP-FH, NA-PA, L1-NB, U1-L1U1-SN and L1-MP(P<0.001). The differences of SNB, ANB and NP-FH before and after treatment in group S were significantly greater than those in group C(P<0.001). CONCLUSIONS: Both treatments are effective for adult patients with mild to moderate skeletal Class Ⅲ malocclusion. The effect of orthodontic-orthognathic treatment is better than camouflage therapy in occlusal relationship of posterior teeth, the position of mandible relative to cranium, the mutual position of upper jaw and lower jaw relative to cranium, and the degree of mandibular convexity. PAR index combined with cephalometric measurement can effectively judge the clinical effect of adult patients with mild to moderate skeletal Class Ⅲ malocclusion, which is a good evaluation method.

Key words: PAR index, Cephalometric measurements, Skeletal Class Ⅲmalocclusion, Orthodontic camouflage therapy, Orthodontic-orthognathic surgery

CLC Number:

R783.5

LI Xin-ran, CHEN Bin, LI Meng, DU Chen, MENG Jian. Application of PAR index and cephalometrics for camouflage therapy and orthodontic-orthognathic surgery in adults with skeletal Class Ⅲ malocclusion[J]. Shanghai Journal of Stomatology, 2023, 32(4): 417-421.

References

[1] Eslami S, Faber J, Fateh A, et al.Treatment decision in adult patients with Class Ⅲ malocclusion: surgery versus orthodontics[J]. Prog Orthod, 2018, 19(1): 28-33.
[2] Martinez P, Bellot-Arcís C, Llamas JM, et al.Orthodontic camouflage versus orthognathic surgery for Class Ⅲ deformity: comparative cephalometric analysis[J]. Int J Oral Maxillofac Surg, 2017, 46(4): 490-495.
[3] Richmond S, Shaw WC, Roberts CT, et al.The PAR index(peer assessment rating): methods to determine outcome of orthodontic treatment in terms of improvement and standards[J]. Eur J Orthod, 1992, 14(3): 180-187.
[4] Doraczynska-Kowalik A, Nelke KH, Pawlak W, et al.Genetic factors involved in mandibular prognathism[J]. J Craniofac Surg, 2017, 28(5): e422-e431.
[5] Kajii TS, Oka A, Saito F, et al.Whole-exome sequencing in a Japanese pedigree implicates a rare non-synonymous single-nucleotide variant in BEST3 as a candidate for mandibular prognathism[J]. Bone, 2019,122(1): 193-198.
[6] Dehesa-Santos A, Iber-Diaz P, Iglesias-Linares A.Genetic factors contributing to skeletal Class Ⅲ malocclusion: a systematic review and meta-analysis[J]. Clin Oral Investig, 2021, 25(4): 1587-1612.
[7] Rakosi T, Schilli W.Class Ⅲ anomalies: a coordinated approach to skeletal, dental, and soft tissue problems[J]. J Oral Surg, 1981, 39(11): 860-870.
[8] 谷妍, 王华, 王林. 伴宽度不调的成人骨性Ⅲ类畸形掩饰性治疗后横向代偿的锥形束CT分析[J]. 上海口腔医学, 2019, 28(1): 36-40.
[9] 程锋, 简志杉, 朱莹, 等. 传动直丝弓技术矫正骨性Ⅲ类错的疗效分析[J].华西口腔医学杂志, 2020, 38(3): 301-307.
[10] Kim YH.Anterior openbite and its treatment with multiloop edgewise archwire[J]. Angle Orthod, 1987, 57(4): 290-321.
[11] 林久祥. 传动直丝弓矫治器及技术的研发和临床初步应用[J].中华口腔正畸学杂志, 2011, 18(2): 61-67.
[12] 薛磊, 李萍, 张疆弢. 正畸疗效的评价指数及影响因素的研究进展[J].新疆医学, 2020, 50(6): 612-616.
[13] Bock NC, Killat S, Ruf S.Efficiency and outcome quality of Herbst-Multibracket appliance therapy in Class Ⅱ: 2 patients[J]. Eur J Orthod, 2022, 44(2): 117-124.
[14] Booij JW, Kuijpers-Jagtman AM, Bronkhorst EM, et al.Class Ⅱ DivisionⅠmalocclusion treatment with extraction of maxillary first molars: evaluation of treatment and post-treatment changes by the PAR index[J]. Orthod Craniofac Res, 2021, 24(1): 102-110.
[15] Campbell C, Millett D, Kelly N, et al.Frankel 2 appliance versus the Modified Twin Block appliance for phase 1 treatment of Class Ⅱ division 1 malocclusion in children and adolescents: a randomized clinical trial[J]. Angle Orthod, 2020, 90(2): 202-208.
[16] 曹宇皎, 邵玶, 安晶涛, 等. 轻中度骨性Ⅲ类错矫治后牙关系的PAR指数评价[J]. 口腔医学, 2007, 27(6): 298-299.
[17] Johnson EK, Fields HW Jr, Beck FM, et al.Role of facial attractiveness in patients with slight-to-borderline treatment need according to the Aesthetic Component of the Index of Orthodontic Treatment Need as judged by eye tracking[J]. Am J Orthod Dentofacial Orthop, 2017, 151(2): 297-310.
[18] 赵志河. 口腔正畸学[M]. 第7版. 北京: 人民卫生出版社, 2020: 59.
[19] 张曦. 多曲方丝弓技术治疗成人轻度骨性Ⅲ类错的临床研究[D].大连:大连医科大学, 2017: 19.
[20] Guo Y, Qiao X, Yao S, et al.CBCT analysis of changes in dental occlusion and temporomandibular joints before and after MEAW orthotherapy in patients with nonlow angle of skeletal Class Ⅲ[J]. Biomed Res Int, 2020, 2020: 7238263.
[21] Ueki K, Moroi A, Sotobori M, et al.Evaluation of recovery in lip closing pressure and occlusal force and contact area after orthognathic surgery[J]. J Craniomaxillofac Surg, 2014, 42(7): 1148-1153.
[22] Martinez P, Bellot-Arcís C, Llamas JM, et a1. Orthodontic camouflage versus orthognathic surgery for Class Ⅲ deformity: comparative cephalometric analysis[J]. Int J Oral Maxillofac Surg, 2017, 46(4): 490-495.
[23] Troy BA, Shanker S, Fields HW, et al. Comparison of incisor inclination in patients with Class Ⅲ malocclusion treated with orthognathic surgery or orthodontic camouflage[J]. Am J Orthod Dentofacial Orthop, 2009, 135(2): 146.e1-9.
[24] 林久祥, 谷岩. 18例12~20岁严重骨性Ⅲ类牙颌畸形非手术正畸治疗的初步研究[J].中华口腔医学杂志, 2004, 39(2): 91-96.