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Changes of mandibular dental arch during surgical-orthodontic treatment in skeletal class III malocclusion individuals
Original Article

Korean J Orthod 2008;38(4):283-298.

Published online: 19 January 2008

DOI: https://doi.org/10.4041/kjod.2008.38.4.283

Changes of mandibular dental arch during surgical-orthodontic treatment in skeletal class III malocclusion individuals

Hyung-Jin Nam, DDS, MSDa, Woo-Sung Son, DDS, MSD, PhDb, Soo-Byung Park, DDS, MSD, PhDc, Seong-Sik Kim, DDS, MSD, PhDd

aResident, Department of Orthodontics, School of Dentistry, Pusan National University

bProfessor, Department of Orthodontics, School of Dentistry, Pusan National University

cProfessor, Department of Orthodontics, School of Dentistry, Pusan National University

dAssociate Professor, Department of Orthodontics, School of Dentistry, Pusan National University

Corresponding author: Woo-Sung Son. Department of Orthodontics, School of Dentistry, Pusan National University Hospital, 305, Gudeokro, Seo-gu, Busan 623-739, Korea. +82 51 240 7443; e-mail, wsson@pusan.ac.kr.

Received 1 January 2008       Revised 20 June 2008       Accepted 23 June 2008

Copyright © 2008 The Korean Association of Orthodontists

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective:

The purpose of this study was to investigate changes in the mandibular dental arch from presurgical orthodontic treatment and orthognathic surgery, and to evaluate the relationships between the pretreatment records and changes of mandibular dental arch in skeletal Class III malocclusion individuals.

Methods:

Lateral cephalometric radiographs and mandibular study models of 31 adults with skeletal class III malocclusion were taken and measured. All measurements were evaluated statistically by ANOVA, Scheffe's Post Hoc, and paired t-test, and correlation coefficients were evaluated.

Results:

No significant difference in Mn-LMMC, Mn-LIE, Mn-MnOcc was detected between pretreatment and presurgical groups. Statistically significant but low correlations were demonstrated between the initial arch length discrepancy (ALD) and change in ICW, IPW1 (r = 0.492, 0.615) and change in arch length (r = 0.641). No association was seen between the initial depth of curve of Spee and change in mandibular incisor angle and arch width or arch length. Regression analysis showed that the amount of change for arch length and IPW1 could be explained by 64.0% and 75.8% of the pretreatment variables respectively.

Conclusions:

This study suggests that orthognathic surgery results can be predictable by measuring the pretreatment records.

Keywords: Class III surgical-orthodontics, Dental decompensation, Lower dental arch

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Fig 1.
Landmarks of lateral cephalometric films. 1, S (sella); 2, Na (nasion); 3, Or (orbitale); 4, Po (porion); 5, A (point A); 6, B (point B); 7, Me (menton); 8, Go (gonion); 9, LIE (lower incisor edge); 10, LIRA (lower incisor root apex); 11, LMMC (lower molar mesio-buccal cusp).
kjod-38-283f1.tif
Fig 2.
Angular measurement of lateral cephalometric films. 1, SNA (SN plane to NA plane); 2, SNB (SN plane to NB plane); 3, ANB (NA plane to NB plane); 4, SN-Mn (SN plane to mandibular plane); 5, FH-Mn (FH plane to mandibular plane); 6, IMPA (lower incisor to mandibular plane); 7, FH-LI (FH plane to lower incisor); 8, SN-MnOcc (SN plane to mandibular occlusal plane); 9, Mn-MnOcc (mandibular plane to mandibular occlusal plane).
kjod-38-283f2.tif
Fig 3.
Linear measurement of lateral cephalometric films. 1, AFH (anterior facial height); 2, PFH (posterior facial height); 3, Mn-LMMC (vertical distance between mandibular plane to lower molar mesio-buccal cusp); 4, Mn-LIE (vertical distance between mandibular plane to lower incisal edge).
kjod-38-283f3.tif
Fig 4.
Measurement of curve of Spee. A, Dental surveyor to allow measurement of angulation and inclination of each tooth and curve of Spee. B, surgical-orthodontic model calipers to measure curve of Spee.
kjod-38-283f4.tif
Fig 5.
Set-up model gauge.
kjod-38-283f5.tif
Fig 6.
Comparison of cephalometric measurements. Pretx, pretreatment; presurg, presurgical; postsurg, postsurgical.
kjod-38-283f6.tif
Fig 7.
Mean difference between before and after treatment in arch width and arch length.
kjod-38-283f7.tif
Fig 8.
(A) Difference in angulation between before and after treatment. Positive angulation values indicate distal tipping of clinical crown; negative values, mesial tipping. (B) Difference in inclination between before and after treatment. Positive inclination values indicate lingual tipping of clinical crown; negative values, labial tipping.
kjod-38-283f8.tif
Table 1.
Mean values and comparison of cephalometric measurements
Measurement Group Mean ± SD Significance
Skeletal angular (o)
SNA T0 79.24a 3.45  
  T1 79.40a 3.14 ∗
  T2 80.43b 4.15  
SNB T0 83.58a 3.75  
  T1 83.47a 3.50 †
  T2 79.30b 3.66  
ANB T0 -3.35a 3.50  
  T1 -4.07a 3.55 †
  T2 1.13b 3.44  
SN-Mn T0 39.75 6.52  
  T1 39.77 6.15  
  T2 42.52 5.82  
FH-Mn T0 32.16 5.86  
  T1 31.85 5.72  
  T2 34.54 5.00  
Skeletal linear (mm)
AFH T0 144.96 10.43  
  T1 145.33 9.71  
  T2 142.37 9.25  
PFH T0 90.01 7.46  
  T1 90.79 7.25  
  T2 87.21 8.76  
PFH/AFH T0 0.62 0.04  
  T1 0.63 0.04  
  T2 0.61 0.05  
Dental angular (o)
IMPA T0 78.52a 7.62  
  T1 89.03b 8.31 †
  T2 83.45c 7.22  
FH-LI T0 69.60a 7.18  
  T1 59.18b 8.00 ∗
  T2 62.26b 8.05  
Dental linear (mm)
Mn-LMMC T0 38.09 3.52  
  T1 38.54 3.61  
  T2 36.64 3.80  
Mn-LIE T0 47.73 4.35  
  T1 48.90 4.14  
  T2 49.00 3.86  
Occlusal angular(o)
SN-MnOcc T0 19.28 13.26  
  T1 18.25 5.12  
  T2 15.94 4.85  
Mn-MnOcc T0 22.91a 4.62  
  T1 21.28a 4.20 †
  T2 26.31b 4.73  

Pretreatment (T0), Presurgical (T1), Postsurgical (T2). SD, standard deviation; Positive values indicate decrease between the groups; negative values, increase; ＜ 0.05;

∗ p

† p ＜ 0.001;

a ,b,cThe same supers-cripts indicate no statistically significant difference between the indicated groups (p ＞ 0.05).

Table 2.
Mean values and comparison between before treatment model and after treatment model in arch length discrepancy and curve of Spee of mandible (paired t-test)
Measurement Group Mean ± SD Difference (before-after)
Mean Significance
ALD (mm) Beforet reatment -3.40 2.19 -3.35 ∗
  After treatment -0.05 0.20    
II (mm) Before treatment 5.09 2.90 4.45 ∗
  After treatment 0.63 0.85    
COS (mm) Before treatment 1.68 0.61 0.86 ∗
  After treatment 0.82 0.40    

ALD, arch length discrepancy; II, irregularity index; COS,curve of Spee; SD, standard deviation;

∗ p ＜ 0.001.

Table 3.
Mean values and comparison between before treatment model and after treatment model in arch width and arch length of mandible (paired t-test)
Measurement Group Mean ± SD Difference (before-after)
Mean Rate(%) Significance
Arch width(mm)            
ICW Before treatment 27.22 2.49 -0.52 -1.90  
  After treatment 27.73 1.80      
IPW1 Before treatment 34.34 3.04 -2.69 -7.84 †
  After treatment 37.03 1.95      
IPW2 Before treatment 41.55 3.45 -1.99 -4.78 †
  After treatment 43.54 1.75      
IMW1 Before treatment 47.87 2.74 -0.41 -0.86  
  After treatment 48.28 2.26      
IMW2 Before treatment 53.52 3.61 -1.46 -2.72 ∗
  After treatment 54.98 3.52      
Arch length(mm) Before treatment 42.79 3.50 -2.99 -7.00 †
  After treatment 45.79 3.07      

ICW, inter-canine arch width; IPW1, inter-1

st premolar arch width;IPW2, inter-2

nd premolar arch width; IMW1, inter-1

st molar arch width; IMW2, inter-2

nd molar arch width; SD,standard deviation; Positive values indicate decrease between the groups; negative values, increase; Rate, (before-after)/before×100;

∗ p ＜ 0.01;

† p ＜ 0.001.

Table 4.
Comparison between before treatment model and after treatment model in angulation and inclination of mandibular teeth (paired t-test)
  Difference (before-after)
Tooth number Angulation(o) Inclination(o)
  Mean ± SD Significance Mean ± SD Significance
31 -2.10 4.00 † -10.11 7.07 ‡
32 -4.79 5.51 ‡ -9.35 6.89 ‡
33 -3.60 5.15 † -3.55 5.86 †
34 1.61 4.65   -5.82 7.11 ‡
35 3.06 4.83 † -3.66 7.72 ∗
36 3.45 5.23 † 0.42 6.12  
37 2.84 4.86 † -3.21 5.84 †
41 -1.18 3.95   -9.45 7.85 ‡
42 -2.50 4.11 † -8.79 6.76 ‡
43 -2.76 6.57 ∗ -4.39 5.94 ‡
44 1.53 4.76   -9.02 7.74 ‡
45 2.48 5.73 ∗ -4.45 8.82 †
46 2.95 4.24 † 2.94 7.75 ∗
47 0.02 5.81   -2.48 7.52  

SD, standard deviation; Tooth No., tooth number (FDI system);Positive angulation values indicate distal tipping of clinical crown; negative values, mesial tipping; Positive inclination values indicate lingual tipping of the clinical crown;

‡ p ＜ 0.001.

† p ＜ 0.01; negative values, labial tipping;

∗ p ＜ 0.05;

Table 5.
Correlation coefficient analysis between pretreatment cephalometric measurements and each change (pretreatment to presurgical, n = 31)
ΔPretx-Presurg IMPA FH-LI ALD II COS ICW- IPW1 IPW2 IMW1 IMW2 AL
Pretx
SNB 0.063 0.013 0.217 -0.284 0.008 -0.201 0.117 -0.155 -0.178 -0.005 0.031
SN-Mn -0.033 -0.048 -0.209 0.203 0.083 0.083 -0.212 -0.024 0.090 -0.036 -0.054
FH-Mn -0.023 -0.033 -0.216 0.211 0.063 0.089 -0.271 -0.109 0.087 -0.011 -0.075
AFH 0.184 -0.249 -0.018 0.022 0.256 0.227 -0.055 0.143 0.057 -0.172 0.140
PFH 0.129 -0.132 0.090 -0.053 0.248 0.212 0.165 0.229 0.018 -0.101 0.135
PFH/AFH -0.037 0.100 0.123 -0.081 0.022 0.013 0.252 0.113 -0.039 0.062 0.018
IMPA 0.236 -0.199 0.060 0.065 0.107 0.145 0.101 0.346 -0.070 -0.185 0.328
FH-LI -0.275 0.271 0.072 -0.183 -0.173 -0.211 0.079 -0.307 0.027 0.217 -0.280
Mn-LMMC 0.073 -0.094 0.013 0.143 0.083 0.125 -0.038 0.098 0.089 0.090 0.088
Mn-LIE 0.143 -0.181 0.084 0.098 0.194 0.128 -0.050 0.041 -0.209 -0.190 0.231
SN-MnOcc 0.258 -0.297 -0.219 0.035 0.460∗ 0.050 -0.156 0.333 0.042 -0.173 0.007
Mn-MnOcc -0.181 0.152 0.154 -0.156 0.250 0.047 0.105 0.016 -0.299 -0.255 -0.041

∗ p ＜ 0.01.

Table 6.
Correlation coefficient analysis between pretreatment model measurements and each change (pretreatment to presurgical, n = 31)
ΔPretx-Presurg IMPA FH-LI ALD II COS ICW IPW1 IPW2 IMW1 IMW2 AL
Pretx
ALD 0.351 -0.329 0.996‡ -0.635‡ -0.198 0.492† 0.615‡ 0.287 0.287 0.197 0.641‡
II -0.312 0.283 -0.765‡ 0.958‡ -0.045 -0.425∗ -0.509† -0.347 -0.438∗ -0.088 -0.595‡
COS 0.009 -0.007 0.007 -0.241 0.839‡ 0.170 -0.067 0.331 -0.076 -0.351 0.132
Arch width                      
ICW -0.016 0.005 0.387∗ -0.171 0.156 0.707‡ 0.212 0.365∗ 0.015 -0.036 0.537†
IPW1 0.241 -0.206 0.587† -0.413∗ 0.015 0.425∗ 0.775‡ 0.507† 0.170 -0.028 0.540†
IPW2 0.242 -0.217 0.273 -0.309 0.450∗ 0.471† 0.437∗ 0.870‡ 0.265 -0.234 0.429∗
IMW1 0.124 -0.103 0.202 -0.310 0.271 0.376∗ 0.294 0.490† 0.571 0.204 0.247
IMW2 -0.102 0.118 0.158 -0.214 0.230 0.261 0.170 0.276 0.442∗ 0.346 0.070
ICW-IMW1 -0.144 0.111 0.154 0.160 -0.133 0.275 -0.104 -0.164 -0.576† -0.245 0.249
Arch length 0.205 -0.187 0.116 0.043 0.130 0.110 -0.054 0.084 -0.253 -0.189 0.486†

∗ p ＜ 0.05;

† p ＜ 0.01;

‡ p ＜ 0.001.

Table 7.
Correlation coefficient analysis between pretreatment model measurements (angulation) and each change (pretreatment to presurgical, n = 31)
ΔPretx-Presurg IMPA FH-LI ALD II COS ICW IPW1 IPW2 IMW1 IMW2 AL
Pretx
Angulation                      
31 0.134 -0.106 0.342 -0.283 -0.106 0.243 0.358∗ 0.262 0.343 0.118 0.283
32 0.306 -0.284 0.505† -0.359∗ 0.143 0.368∗ 0.596‡ 0.506† 0.198 -0.140 0.274
33 -0.075 0.050 -0.152 0.337 -0.017 -0.082 -0.014 -0.131 -0.194 -0.037 -0.099
34 -0.137 0.129 -0.395∗ 0.044 0.421∗ -0.029 -0.252 0.002 -0.117 -0.466† -0.025
35 -0.174 0.177 -0.190 0.061 0.233 0.021 -0.134 0.009 0.104 -0.071 -0.052
36 -0.076 0.068 0.001 -0.173 0.438∗ 0.027 0.056 0.157 0.137 -0.006 0.048
37 0.476† -0.464† 0.460† -0.445∗ 0.068 0.097 0.380∗ 0.208 0.186 -0.025 0.376∗
41 0.120 -0.147 0.303 -0.054 -0.155 0.064 0.075 0.071 0.125 0.143 -0.007
42 0.450∗ -0.435∗ 0.116 -0.076 0.008 -0.063 0.329 0.280 0.417∗ 0.168 0.125
43 -0.235 0.207 -0.277 0.437∗ -0.021 -0.091 -0.012 -0.012 -0.210 -0.038 -0.155
44 -0.256 0.201 -0.353 0.482† 0.149 0.136 -0.408∗ -0.091 -0.143 0.023 -0.292
45 -0.109 0.037 -0.101 0.254 0.048 0.206 -0.150 -0.120 0.090 0.125 -0.115
46 0.094 -0.124 0.125 -0.138 0.336 0.210 -0.120 -0.018 0.041 0.054 0.198
47 0.234 -0.221 0.231 -0.183 0.233 -0.175 -0.068 -0.233 -0.017 0.234 0.105

Tooth number (FDI system).

∗ p ＜ 0.05;

† p ＜ 0.01;

‡ p ＜ 0.001.

Table 8.
Correlation coefficient analysis between pretreatment model measurements (inclination) and each change (pretreatment to presurgical, n = 31)
ΔPretx-Presurg IMPA FH-LI ALD II COS ICW IPW1 IPW2 IMW1 IMW2 AL
Pretx
Inclination                      
31 0.309 -0.316 0.119 -0.112 0.242 0.280 0.172 0.456∗ -0.071 -0.344 0.533†
32 0.272 -0.236 0.356∗ -0.282 0.303 0.383∗ 0.334 0.599‡ 0.053 -0.274 0.374∗
33 -0.044 0.031 -0.009 0.056 0.304 0.438∗ 0.027 0.368∗ -0.052 -0.308 0.323
34 0.339 -0.307 0.357∗ -0.279 0.031 0.368∗ 0.694‡ 0.530† 0.132 -0.198 0.433∗
35 0.250 -0.204 0.170 -0.197 0.412∗ 0.313 0.330 0.811‡ 0.461† -0.101 0.225
36 0.295 -0.252 0.201 -0.335 0.192 0.280 0.351 0.518† 0.661‡ 0.145 0.183
37 0.099 -0.046 0.329 -0.289 0.155 0.142 0.380∗ 0.459† 0.480† 0.265 0.173
41 0.258 -0.236 0.095 -0.043 0.284 0.274 0.219 0.458† -0.040 -0.263 0.471†
42 0.099 -0.059 0.236 -0.192 0.226 0.373∗ 0.214 0.499† 0.025 -0.262 0.363∗
43 0.169 -0.143 0.055 -0.032 0.080 0.275 0.250 0.359∗ 0.121 -0.057 0.343
44 0.176 -0.110 0.256 -0.289 0.075 0.279 0.591‡ 0.504† 0.109 -0.189 0.343
45 0.179 -0.130 0.107 -0.163 0.281 0.395∗ 0.334 0.743‡ 0.167 -0.345 0.251
46 -0.038 0.117 0.185 -0.184 -0.089 0.385∗ 0.302 0.438∗ 0.264 0.095 0.252
47 0.009 0.054 0.022 -0.157 0.192 0.138 0.175 0.394∗ 0.271 0.168 -0.004

Tooth number (FDI system).

∗ p ＜ 0.05;

† p ＜ 0.01;

‡ p ＜ 0.001.

Table 9.
Correlation coefficient analysis between each change of measurements (pretreatment to presurgical, n = 31)
  IMPA FH-LI ALD II COS ICW IPW1 IPW2 IMW1 IMW2 AL
IMPA 1.000                    
FH-LI -0.978‡ 1.000                  
ALD 0.337 -0.317 1.000                
II -0.259 0.230 -0.664‡ 1.000              
COS -0.011 0.020 -0.188 -0.134 1.000            
ICW 0.047 -0.110 0.498† -0.384∗ 0.006 1.000          
IPW1 0.273 -0.256 0.630‡ -0.492† -0.206 0.484† 1.000        
IPW2 0.217 -0.200 0.301 -0.363∗ 0.333 0.503† 0.552† 1.000      
IMW1 0.169 -0.122 0.281 -0.402∗ -0.070 0.220 0.311 0.424∗ 1.000    
IMW1 -0.119 0.140 0.166 0.057 -0.373∗ -0.142 -0.021 -0.220 0.515† 1.000  
AL 0.486† -0.504† 0.638‡ -0.511† -0.127 0.571† 0.466† 0.375∗ 0.226 -0.054 1.000

∗ p ＜ 0.05;

† p ＜ 0.01;

‡ p ＜ 0.001.

Table 10.
Sexual differences of pretreatment cephalometric and model measurements
  Male Female Significance
  Mean ± SD Mean ± SD
Pretreatment cephalometric measurements
SNB 83.73 3.47 83.44 4.07 NS
SN-Mn 39.14 6.43 40.24 6.74 NS
FH-Mn 31.28 6.81 32.88 5.04 NS
AFH 149.58 10.39 141.15 9.04 NS
PFH 95.36 6.91 85.60 4.46 NS
PFH/AFH 0.63 0.04 0.60 0.04 NS
IMPA 78.72 8.94 78.34 6.61 NS
FH-LI 70.61 8.82 68.75 5.62 NS
Mn-LMMC 38.62 3.83 36.83 2.75 NS
Mn-LIE 49.22 4.15 46.49 4.22 NS
SN-MnOcc 20.69 4.48 18.11 7.00 NS
Mn-MnOcc 23.28 4.75 22.60 4.63 NS
Pretreatment model measurements
ALD -3.58 1.96 -3.25 2.40 NS
II 5.42 3.09 4.80 2.79 NS
COS 1.86 0.57 1.53 0.60 NS
ICW 27.07 2.85 27.32 2.22 NS
IPW1 35.14 2.89 33.67 3.08 NS
IPW2 43.02 3.65 40.34 2.81 NS
IMW1 49.10 2.65 46.84 2.42 NS
IMW2 55.15 3.95 52.17 2.72 NS
Archlength 42.89 3.82 42.71 3.32 NS

NS, statistically not significant.

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