Academic literature on the topic 'Orthodontic camouflage'

Two female patients presented with gummy smile, maxillary dentoalveolar protrusion and total vertical maxillary excess, retroclined incisors, and increased overbite received orthodontic camouflage with straight-wire mechanics by general dentists. The treatments caused severe bowing of upper occlusal plane which aggravated the gummy smile and had led them to seek specialist care. They were successfully managed by orthodontic camouflage and combined surgical-orthodontic treatment, respectively, in conjunction with the application of miniscrews on straight-wire mechanics. Aggravation of gummy smile by straight-wire mechanics, use of visual treatment objective to differentiate between orthodontic camouflage and surgical cases, and LeFort I segmentalization were discussed.

For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment. Surgery is not a substitute for orthodontics in these patients. Instead, it must be properly coordinated with orthodontics and other dental treatments to achieve good overall results. Dramatic progress in recent years has made it possible for combined surgical orthodontic treatment to be carried out successfully for patients with a severe dentofacial problem of any type. This case report provides an overview of the current treatment methodology in managing a combination of asymmetrical mandibular prognathism and vertical maxillary excess.

ABSTRACT Class III treatment is a considerable clinical challenge and commonly includes (a) growth modification involving a chincup to restrain mandibular growth or a facemask to protract the maxilla, (b) dentoalveolar compensation or camouflage involving dental extractions and (c) orthognathic surgery. Surgical treatment is the preferred and most stable treatment for adult patients with severe skeletal class III malocclusion. Patients with borderline dentoalveolar compensation who are not willing to accept the costs, risks and potential complications of surgery can sometimes be treated successfully with camouflage orthodontics. In more extreme cases, however, conservative orthodontic treatment may lead to adverse side effects, such as periodontal disease and root resorption as well as poor long-term stability. It is not clear which mechanics are most appropriate or which patients are most likely to benefit from an orthodontic approach to severe skeletal class III malocclusion. In this list of alternatives, orthodontic treatment is often seen as either a less-desirable alternative to surgery or a treatment reserved for milder skeletal problems. This report questions this hierarchy of treatment options. How to cite this article Doshi SS, Jayarama M, Gaikwad S Mhatre A, Ravindranath. Nonsurgical Treatment of a Patient with Class III Malocclusion and Missing Maxillary Lateral Incisors: A Combined Orthodontic-Prosthodontic Approach. J Contemp Dent 2012;2(2):57-63.

Objective. The aim of this study was to compare the profile attractiveness between orthodontic camouflage of the Class III malocclusion and the predictive tracing simulating orthognathic surgery evaluated by dentists and laypeople. Settings and sample population. The sample consisted of 21 patients (9 male; 12 female) with Class III malocclusion treated with orthodontic camouflage and Class III intermaxillary elastics. Material and Methods. The mean initial age of the patients was 24.38 years (SD 3.32), and the mean ANB angle was −1.91° (SD 0.83°). Patients presented skeletal Class III and normal growth patterns. Initial and final lateral cephalograms of each patient were used. The initial cephalogram was used to perform the treatment simulation of orthognathic surgery, and its silhouette was compared to the silhouette obtained from the final cephalogram after Class III orthodontic camouflage. A subjective analysis of profile attractiveness was performed by 47 laypeople and 60 dentists, with scores from 1 (less attractive) to 10 (most attractive). Mann–Whitney tests were used to compare profile attractiveness between the orthodontic treatment and the predictive tracing groups and between dentists and laypeople. Results. The predictive tracing of orthognathic surgery showed to be statistically significantly more attractive (mean score 4.57, SD 2.47) than that of the Class III camouflage orthodontic treatment (mean score 4.22, SD 2.40), with a mean numerical but significant difference of 0.35 (SD 2.01) (P<0.001). Laypeople were more critical than dentists in evaluating profile attractiveness, but numerical difference between the groups was also small. Conclusion. The profile silhouette of predictive tracing simulating orthognathic surgery showed to be more attractive than that of Class III camouflage orthodontic treatment; however, differences were small but statistically significant. Laypeople showed to be more critical than dentists.

This case report describes orthodontic camouflage treatment for a 32-year-old African American male patient with Class III malocclusion. The treatment included nonextraction, nonsurgical orthodontic camouflage by en masse distalization of the mandibular teeth using skeletal anchorage devices. The total treatment time was 23 months. Normal overjet and overbite with Class I occlusion were obtained despite the compensated dentition to the skeletal malocclusion. His smile esthetics was significantly improved at the completion of his treatment.

INTRODUCTION: This case report describes the orthodontic treatment of an adult patient with skeletal Class III malocclusion and anterior crossbite. A short cranial base led to difficulties in establishing a cephalometric diagnosis. The patient's main complaint comprised esthetics of his smile and difficulties in mastication. METHODS: The patient did not have the maxillary first premolars and refused orthognathic surgery. Therefore, the treatment chosen was orthodontic camouflage and extraction of mandibular first premolars. For maxillary retraction, the vertical dimension was temporarily increased to avoid obstacles to orthodontic movement. RESULTS: At the end of the treatment, ideal overjet and overbite were achieved. CONCLUSION: Examination eight years after orthodontic treatment revealed adequate clinical stability. This case report was submitted to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) as part of the requirements to become a BBO diplomate.

The present case report addresses the treatment of an Angle Class II malocclusion in an adult female patient, long face pattern, with posterior open bite and dental arches extremely expanded, due to previous treatment. The patient and parents rejection to a treatment with orthognathic surgery led to orthodontic camouflage of the skeletal discrepancies. This clinical case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) as one of the requirements to become a BBO Diplomate.

Treating skeletal class III malocclusions is one of the biggest challenges in Orthodontics. Given the complexity of these cases, orthognathic surgery is often the best treatment option. However, many patients refuse this treatment due to its risks, morbidity, and costs involved. Alternatively, dental compensation can be planned for some of these skeletal problems. This case report presents a dentoalveolar compensation in the orthodontic treatment of a 20-year-old female patient with class III malocclusion, concave profile, anterior crossbite, mandibular prognathism, maxillary retrusion, and a vertical deficiency in the posterior region. Treatment planning involved a multiloop edgewise archwire (MEAW) associated with intermaxillary elastics with counterclockwise rotation of the occlusal plane in the posterior region of the maxilla aiming at obtaining an increased posterior vertical dimension. After 24 months of treatment, the severe anterior crossbite was corrected, and the skeletal class III relationship was camouflaged. At the end of the orthodontic treatment, it was possible to observe an improved facial profile, a nice smile, and a functional occlusion. The results remained stable at a three-year follow-up. The MEAW, associated with the use of elastics, seems to be an effective treatment option for class III camouflage with reduced posterior vertical dimension with no need for additional anchoring devices but requiring adequate bending of wires and patient compliance.

Thesis (M.S.)--West Virginia University, 2008.
Title from document title page. Document formatted into pages; contains ix, 204 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 136-139).

Objetivo: Comparar os resultados cefalométricos obtidos com tratamentos compensatórios e tratamentos orto-cirúrgicos para pacientes que apresentam Classe III esquelética. Metodologia: Foram selecionadas de forma retrospectiva telerradiografias iniciais e finais de 97 pacientes Classe III esquelética. Os critérios de inclusão foram: dentição permanente completa até primeiros molares, relação molar de Classe III, ausência de extrações dentárias durante o tratamento, ausência de problemas periodontais severos, Wits menor que -2mm, telerradiografia em normalateral iniciais e finais, fotografias intra e extra-bucais iniciais e modelos de gesso iniciais. Os pacientes foram divididos em 3 grupos. Grupo C: pacientes que foram submetidos ao tratamento ortodôntico associado à cirurgia ortognática (uni ou bimaxilar) totalizando 30 pacientes (idade média inicial 25,07 [22,90-25,56]). Grupo R pacientes que foram submetidos ao tratamento ortodôntico compensatório usando a prescrição Roth totalizando 30 pacientes (idade média inicial 16,22 [15,68-23,90]). Grupo B pacientes que foram submetidos ao tratamento ortodôntico compensatório usando a prescrição Biofuncional para Classe III totalizando 37 pacientes (idade média inicial 19,97 [18,53–24,68]). A severidade da Classe III foi determinada pela relação posterior e dividida em ¼, ½, ¾ e completa. Todas as telerradiografias foram digitalizadas e seus traçados foram realizados pelo mesmo examinador no software Dolphin (Dolphin Imaging Versão 11.9). As variáveis estudadas foram divididas em grupos: Alterações Maxilares, Mandibulares, Maxilo-Mandibulares, Convexidade Facial, Padrão Facial, Posição dos dentes superiores, Posição dos dentes inferiores e Perfil Tegumentar. A análise estatística foi realizada utilizando o software SPSS, versão 18.0. [SPSS Inc. lançado 2009. PASW Statistics for Windows, Versão 18.0. Chicago: SPSS Inc.]. As variáveis contínuas simétricas foram expressas como média e erro padrão da média (± SEM) ou mediana e intervalo de confiança de 95% ([IC 95%]), definido pelo teste de Shapiro-Wilk. As variáveis categóricas foram descritas por frequências absolutas (n) e relativas (n%). Para comparação de meios entre grupos independentes, foi aplicada uma Análise de Variância Unidireccional (ANOVA) com teste post hoc de Tukey ou teste de Kruskal-Wallis com teste post hoc Dunn. Além disso, o teste de classificação assinado por Wilcoxon foi usado para dados emparelhados (por exemplo, medições pré e pós-tratamento). Por outro lado, as variáveis categóricas foram comparadas intragrupo pelo teste do Qui-Quadrado com análise residual ajustada padronizada. Todos os dados foram avaliados usando o SPSS, versão 18.0. O nível de significância foi fixado em 5%.Resultados: O grupo C apresentou uma severidade maior do 8 que os demais grupos tendo 73,3% dos pacientes com uma Classe III severa (3/4 e completa). Houve um avanço do ponto A (projeção da maxila) nos Grupos B e C e um recuo do mesmo no Grupo R. Já na mandíbula, apenas o Grupo C apresentou um recuo estatisticamente significativo. Os três grupos apresentaram uma melhora na relação Wits estatisticamente significativa. Contudo, apenas os grupos C e B apresentaram uma melhora significativa nas medidas ANB e NAP, mostrando que nestes grupos houve uma melhora no perfil dos pacientes. Em relação ao posicionamento dentário, o Grupo R apresentou uma vestibuloversão, extrusão e projeção dos incisivos superiores e uma linguoversão, retrusão e extrusão dos incisivos inferiores. Já o grupo Biofuncional apenas apresentou uma extrusão dos incisivos superiores e inferiores, sem alteração em relação à inclinação. O Grupo C apresentou uma descompensação com vestibuloversão dos incisivos inferiores e palatoversão dos incisivos superiores. Nos grupos C e B, os lábios superiores foram posicionados mais para anterior e os lábios inferiores mais para posterior, melhorando o perfil tegumentar. Já no grupo R, o lábio superior foi posicionado mais para posterior, deixando o perfil tegumentar mais côncavo. Conclusões: O grupo C e B apresentaram um avanço da maxila (Ponto A) semelhantes, enquanto que o Grupo R mostrou um recuo da mesma. Alterações mandibulares só ocorreram no grupo C. Houve uma melhora na convexidade facial e pefil tegumentar nos grupos C e B e houve uma piora no grupo R. O Grupo R apresentou maiores características de compensação dentária do que o grupo B, sendo que este último apresentou os melhores resultados quando opta-se pela camuflagem ortodôntica. Quando existe envolvimento de ambas as bases ósseas (maxila e mandíbula), o melhor tratamento é a associação de tratamento ortodôntico e cirurgia ortognática. Quando o envolvimento é apenas da maxila, o tratamento com a prescrição Biofuncional apresenta resultados semelhantes ao tratamento com ortodontia e cirurgia. A prescrição Biofuncional apresenta resultados de camuflagem melhores do que a prescrição Roth em todas as situações.
Objective: To compare cephalometric results obtained with compensatory treatments and ortho-surgical treatments for patients with skeletal Class III. Methods: Initial and final cephalograms of 97 skeletal Class III patients were retrospectively selected. Inclusion criteria were: complete permanent dentition until first molars, Class III molar relationship, absence of dental extractions during treatment, absence of severe periodontal problems, Wits less than -2mm, teleradiography at initial and final, intra and extra photographs and initial gypsum models. Patients were divided into 3 groups. Group C: patients who underwent orthodontic treatment associated with orthognathic surgery (uni or bimaxillary) totaling 30 patients (initial mean age 25,07 [22,90-25,56]). Group R patients who underwent compensatory orthodontic treatment using the Roth prescription totaling 30 patients (initial mean age 16,22 [15,68-23,90]). Group B patients who underwent compensatory orthodontic treatment using the Biofunctional prescription for Class III totaling 37 patients (Initial mean age 19,97 [18,53-24,68]). The severity of Class III was determined by the posterior relationship and divided into ¼, ½, ¾ and complete. All cephalograms were digitized and their tracings were performed by the same examiner in Dolphin software (Dolphin Imaging Version 11.9). The variables studied were divided into groups: Maxillary, Mandibular, Maxillo-Mandibular, Facial Convexity, Facial Pattern, Upper Teeth Position, Lower Teeth Position and Tegumentary Profile. Statistical analysis was performed using SPSS software, version 18.0. [SPSS Inc. released 2009. PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc.]. The symmetric continuous variables were expressed as mean and standard error of the mean (± SEM) or median and 95% confidence interval ([95% CI]), defined by the Shapiro-Wilk test. Categorical variables were described by absolute (n) and relative (n%) frequencies. For comparison of means between independent groups, a Univirectional Variance Analysis (ANOVA) was applied with Tukey post hoc test or Kruskal-Wallis test with Dunn post hoc test. In addition, the Wilcoxon-signed classification test was used for paired data (for example, pre- and post-treatment measurements). On the other hand, the categorical variables were compared intra-group by the chi-square test with standardized adjusted residual analysis. All data were evaluated using SPSS, version 18.0. The level of significance was set at 5%. Results: Group C had a higher severity than the other groups, with 73,3% of patients with a severe Class III (3/4 and complete). There was a progression of point A (projection of the maxilla) in Groups B and C and a retreat of the same in Group R. In the mandible, only Group C presented a statistically significant 10 decrease. The three groups showed a statistically significant improvement in the Wits ratio. However, only groups C and B showed a significant improvement in ANB and NAP measurements, showing that in these groups there was an improvement in the patients' profile. Regarding tooth positioning, Group R presented vestibuloversion, extrusion and projection of the upper incisors and a linguoversion, retrusion and extrusion of the lower incisors. On the other hand, the Biofunctional group presented only an extrusion of the upper and lower incisors, with no change in relation to the inclination. Group C presented a decompensation with vestibuloversion of the lower incisors and palatoversion of the upper incisors. In groups C and B, the upper lips were positioned more anteriorly and the lower lips more posteriorly, improving the tegumentary profile. In the Roth group, the upper lip was positioned posteriorly, leaving the tegmental profile more concave. Conclusions: Group C and B presented similar maxillary advancement (Point A), while Group R showed a decrease of the same. Mandibular changes occurred only in group C. There was an improvement in facial convexity and tegumentary skin in groups C and B and there was worsening in group R. Group R presented higher tooth compensation characteristics than group B, and the latter presented the best results when opted for orthodontic camouflage. When there is involvement of both bone bases (maxilla and mandible), the best treatment is the association of orthodontic treatment and orthognathic surgery. When the involvement is only of the maxilla, the treatment with the prescription Biofuncional presents results similar to the treatment with orthodontics and surgery. The Biofunctional prescription presents better camouflage results than the Roth prescription in all situations.

El tratamiento de compensación o camuflaje de las Maloclusiones de Clase III, estuvo orientado tradicionalmente a la extracción de primeras premolares inferiores, distalización de caninos y lingualización de incisivos inferiores con la finalidad de obtener un overbite y overjet aceptables. El propósito de este reporte es describir el diagnóstico y plan de tratamiento de una maloclusión clase III, en un paciente adulto, soportado por una revisión bibliográfica. El caso fue tratado con el sistema Multiloop Edgewise Arch Wire (MEAW) y se realizaron exodoncias de terceras molares inferiores. El sistema MEAW utiliza arcos con dobleces colocados en los espacios dentarios interproximales, desde la parte distal de los incisivos laterales hasta la última pieza en el sector posterior, al cual se le realizan ciertas activaciones según la maloclusión. Podemos concluir que con este sistema podemos compensar los casos de Clase III, mediante la reconstrucción del plano oclusal, evitando así el realizar exodoncias de premolares inferiores controlando el efecto de lingualización de los incisivos inferiores para generar correcto overjet y overbite y relaciones caninas Clase I.
The treatment of compensation or camouflage of Class III malocclusions was traditionally oriented to the extraction of first lower premolars, canine distalization and lingualization of lower incisors in order to obtain an acceptable overbite and overjet. The purpose of this report is to describe the diagnosis and treatment plan of a Class III malocclusion in an adult patient, supported by a literature review. The case was treated with the Multiloop Edgewise Arch Wire (MEAW) system and extraction of lower third molars. The MEAW system uses arches with Loops placed in the interproximal dental spaces, from the distal part of the lateral incisors to the last piece in the posterior sector, to which certain activations are performed according to the malocclusion. We can conclude that with this system we can compensate Class III cases, through the reconstruction of the occlusal plane, avoiding extraction of lower premolars controlling the lingualization effect of the lower incisors to generate correct overjet and overbite and canine relations Class I.
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Class II malocclusion in non-growing individuals is treated in one of two ways - masking or surgery. If the dentoskeletal discrepancy is great enough, masking usually involves extraction of two maxillary premolars and subsequent incisor retraction and closure of overjet. This is the option of choice for patients without profile concerns, or who have medical or financial concerns. However, this treatment modality can sometimes result in less-than-ideal results. In the present study, we sought to understand what factors may influence the outcomes of this type of treatment. 65 subjects were included in this study. The total sample was divided into good and compromised finish categories based on objective criteria of overbite, overjet, and AP position of the maxillary canines. The good finish group was further subdivided into two groups, acceptable and excellent finishes. Several variables were measured on each subject's initial and final casts and compared between groups to determine whether any were associated with a particular finish group. At the initial time point, a mesial displacement of the maxillary right first molar by 3.35mm or less was found to correspond significantly to an excellent finish. This may indicate that if an individual presents with molars that are Class II by 3 mm or less, the prognosis is better than if that same individual had a greater Class II discrepancy. None of the other variables for the initial time point were found to be significantly different, suggesting that treatment mechanics, rather than a pre-existing occlusal factor, plays a predominant role in treatment outcome. At the final time point, we found that the maxillary arch length and tooth-size arch-length discrepancy were greater in the compromised group, indicative of excess spacing in this group at the end of treatment. Based on the other findings of this study, we attribute this result to differences in the mechanics used by individual practitioners. This hypothesis is further supported by our findings that none of the variables measuring patient compliance were found to be different between the good and compromised group. In the future, studies examining the particular mechanics used, and compliance where applicable, in this population will yield valuable insights into this area of patient research.

INTRODUÇÃO: A deformidade dentofacial é definida como uma alteração no crescimento ósseo do sistema estomatognático que conduz a alterações no desenvolvimento dos maxilares. Esta condição pode levar a problemas funcionais, degenerativos, estéticos e psicossociais. Deste modo, estas deformidades necessitam de um estudo multidisciplinar que abranja conhecimentos cirúrgicos, ortodônticos, médico-dentários gerais, psicológicos, biológicos e fisiopatológicos. A camuflagem é uma das opções de tratamento após o surto de crescimento e irá produzir uma compensação dentária relativamente à discrepância esquelética. OBJETIVOS: Devido à índole incapacitante destas deformidades, este estudo tem como objetivos avaliar a qualidade de vida e a autoestima em pacientes com indicação para Tratamento- ortodôntico- cirúrgico- ortognático, submetidos a camuflagem ortodôntica e verificar o impacto do género, idade, grau de escolaridade e deformidade esquelética na qualidade de vida e a autoestima destes pacientes. MATERIAIS E MÉTODOS: Foram aplicados 2 questionários - Questionário de avaliação da qualidade de vida da Organização Mundial de Saúde - WHOQoL-Bref e Escala de autoestima Global de Rosenberg – RSES a 23 pacientes com indicação para Tratamento- ortodôntico-cirúrgico-ortognático, submetidos a camuflagem ortodôntica (grupo de esctudo) e a 22 pacientes sujeitos a tratamento exclusivamente ortodôntico sem indicação cirúrgica (grupo de controlo). RESULTADOS: Não foram encontradas diferenças estatisticamente significativas na qualidade de vida e autoestima entre o grupo de estudo e o grupo de controlo. Os participantes do grupo de estudo com classe II esquelética apresentaram uma qualidade de vida diminuída a nível do domínio psicológico e meio ambiente relativamente aos participantes do grupo de estudo com classe III esquelética. CONCLUSÕES: O género, a idade e o nível educacional parecem não influenciar a qualidade de vida e autoestima em pacientes com deformidade dentofacial submetidos a camuflagem ortodôntica. No entanto, a deformidade esquelética subjacente influencia a qualidade de vida destes pacientes.
INTRODUCTION: Dentofacial deformity is defined as a change in bone growth of the stomatognathic system that leads to changes in the development of the jaws. This condition can lead to functional, degenerative, aesthetic and psychosocial problems. Thus, these deformities need a multidisciplinary study that includes surgical, orthodontic, general medical, psychological, biological and pathophysiological knowledge. Camouflage is one of the treatment options after the growth spurt and will produce dental compensation for skeletal discrepancy. AIMS: Taking into account the incapacitating nature of these deformities, this study aims to measure quality of life and self-esteem in patients with indication for Orthodontic-Surgical-Orthognathic Treatment, submitted to orthodontic camouflage and to verify the impact of gender, age, education level and skeletal deformity on the quality of life and the self-esteem of these patients. MATERIALS AND METHODS: Two questionnaires were applied - World Health Organization quality of life assessment questionnaire (WHOQoL-Bref) and Rosenberg's Global Self-Esteem Scale (RSES) to 23 patients with indication for Orthodontic-Surgical-Orthognathic Treatment, submitted to orthodontic camouflage (study group) and 22 patients undergoing exclusively orthodontic treatment without surgical indication (control group). RESULTS: There were no statistically significant differences in quality of life and self-esteem between the study group and the control group. The participants in the study group with skeletal class II showed a lower quality of life in terms of the psychological domain and the environment compared to the participants in the study group with skeletal class III. CONCLUSIONS: Gender, age and educational level do not seem to influence quality of life and self-esteem in patients with dentofacial deformity submitted to orthodontic camouflage. However, the underlying skeletal deformity influences the quality of life of these patients.

This chapter reviews T-Scan use in orthodontics from diagnosis to case finishing, and then in retention, while defining normal T-Scan recording parameters for orthodontically-treated subjects versus untreated subjects. T-Scan use in the case-finishing process is also described, which compensates for changes in the occlusion that occur during “post-orthodontic settling,” as teeth move freely within the periodontium to find an equilibrium position when the orthodontic appliances have been removed. T-Scan implementation is necessary because, often, despite there being a post treatment, visually “perfect” angle's Class I relationship established with the orthodontic treatment, ideal occlusal contacts do not result solely from tooth movement. Creating simultaneous and equal force occlusal contacts following fixed appliance removal can be accomplished using T-Scan data to optimize the end-result occlusal contact pattern. The T-Scan software's force distribution and timing indicators (the two- and three-dimensional force views, force percentage per tooth and arch half, the center of force trajectory and icon, the occlusion time [OT], and the disclusion time [DT]), all aid the Orthodontist in obtaining an ideal occlusal force distribution during case-finishing. Fortunately, most orthodontic cases remain asymptomatic during and after tooth movement. However, an occlusal force imbalance or patient discomfort may occur along with the malocclusion that needs orthodontic treatment. Symptomatic cases require special documentation at the baseline, and careful monitoring throughout the entire orthodontic process. The clinical use of T-Scan in these “fragile” cases of patient muscle in-coordination, mandibular deviation, atypical pain, and/or TMJ idiopathic arthritis, are illustrated by several case reports. The presented clinical examples highlight combining T-Scan data recorded during case diagnosis, tooth movement, and in case finishing, with patients that underwent lingual orthodontics and orthognathic surgery, orthodontic treatment using clear aligners, or conventional fixed treatment with a camouflage treatment plan, which require special occlusal finishing (when premolars are extracted in only one arch).