Early treatment of Class III malocclusion
Masucci C, Franchi L, Giuntini V, Defraia E. Short-term effects of a modified Alt-RAMEC protocol for early treatment of Class III malocclusion: a controlled study. Orthod Craniofac Res 2014;17:259-69
Over the past several years, the orthopedic treatment of choice for Class III malocclusions was the use of a facemask associated with rapid maxillary expansion (RME). The skeletal changes were attributed to improvements in the anteroposterior position of the mandible, but the maxillary protraction almost completely relapsed over time. In 2005, alternate RME and constriction (Alt-RAMEC) was demonstrated as a more effective way to open the circummaxillary sutures than traditional RME, facilitating maxillary protraction. Researchers began to explore the outcomes of Alt-RAMEC combined with facemasks, and the results varied between studies. Thus, the aim of this retrospective study was to analyze the effectiveness of a modified Alt-RAMEC and facemask protocol for the correction of Class III dentoskeletal malocclusions. Thirty-one patients with a Class III malocclusion were treated with a modified Alt-RAMEC and facemask protocol at the Department of Orthodontics of the University of Florence in Italy. Lateral cephalograms were taken 4 to 5 months after the active phase of treatment was completed. A second group of 31 patients with a Class III dentoskeletal disharmony was treated with conventional RME and facemask therapy, and reevaluated with lateral cephalograms 4 to 5 months after treatment. The authors found that both the Alt-RAMEC and facemask and the RME and facemask treatments led to significant improvements in the Class III malocclusions. The alternate expander was more effective at advancing the maxilla and improving the intermaxillary relationship when compared with RME and facemask therapy. However, no significant differences were noted regarding mandibular projection and length and vertical skeletal relationships. They concluded that Alt-RAMEC and facemask therapy produced more favorable short-term effects compared with RME and facemask treatment in patients with a Class III dentoskeletal disharmony. The results of the modified Alt-RAMEC and facemask protocol are promising and would benefit from further studies of its long-term effects.
Reviewed by Alexandra Best
Pain level comparison of Invisalign and edgewise appliances
Fujiyama K, Honjo T, Suzuki M, Matsuoka S, Deguchi T. Analysis of pain level in cases treated with Invisalign aligner: comparison with fixed edgewise appliance therapy. Prog Orthod 2014;15:64
Pain and discomfort are the most negative concerns during orthodontic treatment. These authors evaluated pain levels in adults treated with edgewise appliances (EG, n = 55), Invisalign (IG, n = 38), and both (EIG, n = 52). The EIG group had EG therapy followed by IG treatment. The subjects marked their levels of pain on a visual analog scale at regular intervals during the initial 3 treatment stages (1, 3, and 5 weeks) and at the completion of treatment. The reasons for IG pain were categorized into 3 problems: nonsmoothed marginal ridge or missing materials, deformation of attachments, and deformation of the tray; 86% of the IG problems were caused by deformation of the tray. For pain at stage 1, the EG group scored significantly higher than did the EIG and IG groups at 3 and 4 days. For pain at stage 2, the EG group scored higher than did the EIG and IG groups at 1, 2, and 3 days. In all groups at stage 3, the patients had higher pain scores at 2 and 3 days. At the completion of treatment, the intensity of pain, the number of days, and the discomfort levels in the EG group were significantly higher than those in the IG group. The combination approach in the EIG group also caused significantly less pain than did EG treatment alone. The authors concluded that patients experienced less pain with IG compared with EG appliances, but clinicians should check for problems such as tray deformation during IG treatment. The authors changed the wires every 2 weeks in the EG group rather than every 4 to 8 weeks, so the pain levels could have been artificially high in this group. Further studies are needed to account for force applications and amounts of tooth movement when assessing the pain levels from IG and fixed therapy.
Reviewed by Danny Noll