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OBJECTIVES: To assess the association between scores on the Child Perceptions Questionnaire for 11-14 year olds (CPQ11-14) and clinical and self-perceived measures of malocclusion. METHODS: Children were recruited from an orthodontic clinic just prior to starting orthodontic treatment. They completed a copy of the CPQ11-14 and a short questionnaire concerning their feelings about the condition of their teeth. Study models were taken and rated according to the Dental Aesthetic Index (DAI) and the Peer Assessment Rating (PAR) index by two sets of three examiners. Intra and inter-rater reliabilities for the two sets of examiners ranged from 0.80 to 0.99. CPQ11-14 scores were calculated for the full 35-item version and for 16 and 8-item short forms by summing the item response codes. The association between these scores, the DAI and PAR ratings and self-perceived measures of malocclusion were examined using appropriate parametric and nonparametric tests. RESULTS: Complete data were collected for 141 children, 63 boys and 78 girls. The mean age was 12.5 (SD = 1.0). DAI scores ranged from 17.0 to 58.0 with a mean of 35.0 (SD = 8.0). The distribution of subjects across the four severity categories was minor/none - 6.6%, definite - 35.2%, severe - 15.6% and handicapping 42.6%. PAR scores ranged from 8.0 to 66.0 with a mean of 31.4 (SD = 11.1). Eight percent had scores of 50 or above indicating marked deviation from an ideal occlusion. Both the long and the short forms of the CPQ11-14 identified substantial variability in the impacts of malocclusion. Correlations between CPQ11-14 scores and the orthodontic indices ranged from 0.26 to 0.31 (P < 0.01). There was a clear gradient in CPQ11-14 scores across four categories of the PAR based on quartiles. The gradient across the DAI categories was less clear. There were significant associations between all CPQ11-14 scores and the children's self-ratings of oral health, ratings of the extent to which the condition of the teeth affected life overall and expressions of happiness with the appearance and arrangement of the teeth. CONCLUSION: The results provide some evidence of the validity of the CPQ11-14 when used with children needing orthodontic treatment. However, because clinical samples are biased the study needs to be repeated in different treatment settings in order to confirm the utility of the measure. [ABSTRACT FROM AUTHOR]

Background: Advances in bonding techniques and materials allow for reliable bracket placement on ectopically positioned teeth. This prospective study evaluates the outcome of forced orthodontic eruption of impacted canine teeth in both palatal and labial positions. Methods: Eighty-two impacted maxillary canines in 54 patients were included in the study and were observed for 18 to 30 months after exposure. Following exposure by means of a palatal flap or an apically repositioned buccal flap, an orthodontic traction hook, with a ligation chain attached, was bonded to each impacted tooth using a light cured orthodontic resin cement. A periodontal dressing was placed over the surgical site for a period of time. Results: All teeth were successfully erupted. Complications consisted of: failure of initial bond, at the time of surgery, which required rebonding; premature debonding at the time of pack removal and; debonding of brackets during orthodontic eruption. There was no infection, eruption failure, ankylosis, resorption or periodontal defect (pocket greater than 3 mm) associated with any of the exposed teeth. Attached gingiva of less than 3 mm was seen in only two of the buccally positioned canines (9%). Conclusion: Forced orthodontic eruption of impacted maxillary canines with a well bonded orthodontic traction hook and ligation chain, used in conjunction with a palatal flap or an apically repositioned labial flap, results in predictable orthodontic eruption with few complications. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to quantify the properties of commercially available nickel-titanium open-coil springs. Methods: Eleven springs from 3 manufacturers were tested 5 times over a 12-week period. A universal testing machine was used to measure the force generated when open-coil springs were compressed to half of their original length and then gradually allowed to decompress. Results: The average forces generated at the initial recording session for uniformly wound springs from GAC International (Bohemia, NY) and 3M Unitek (Monrovia, Calif) were 19.3% to 42.7% and 9.7% to 38.8% below the manufacturers' labeled force levels, respectively. GAC's 100-, 150-, and 200-g stop-wound coils demonstrated statistically and clinically significant stepwise force degradation over the 12-week experimental period (P <0.0001). GAC's uniformly wound light (100 g) coils generated the lowest load-deflection ratios (23.7 g/mm). Conclusions: Open coils might need to be compressed by more than one-third of their original length to produce the labeled forces. Uniformly wound coils generally produce lower load-deflection ratios and maximum forces, which are generally more acceptable for tooth movement. [ABSTRACT FROM AUTHOR]

Purpose: This study measured oral health-related quality of life for children, which involved the construction of child perceptions questionnaires (CPQs) for ages 6 to 7, 8 to 10, and 11 to 14. The purpose of this study was to present the development and evaluation of the CPQ for 8- to 10-year-olds (CPQ8-10). Methods: Questions (N=25) were selected from the CPQ for 11- to 14-year-olds based on the child development literature and input from parents, child psychologist, and teacher of grades 3 and 4 . Validity and reliability were evaluated on 68 and 33 children, respectively. Results: There was a positive moderate correlation between the CPQ8-10 score and overall well-being rating (R=.45). The level of impact was slightly higher in the orofacial than in the pediatric dentistry group (mean score= 19.1 vs 18.4, respectively). Hypotheses concerning the relationship between the CPQ8-10 score and number of decayed surfaces were confirmed with R=.29, and the mean score higher in caries-afflicted than caries-free children (21.1 vs 14.7). The Cronbach's alpha and intraclass correlation coefficients were 0.89 and 0.75, respectively. Conclusions: Results suggest good construct validity, internal consistency, reliability and test-retest reliability, but do not demonstrate discriminative validity. This is consistent, however, with theoretical models of oral disease and its consequences. Further research is required, as these are preliminary findings based on convenience sampling. [ABSTRACT FROM AUTHOR]

Background: Cannabis contains hundreds of chemical constituents beyond delta-9-tetrahydrocannabinol (THC), which is believed to drive most of its acute pharmacodynamic effects. The entourage effect theory asserts that non-THC constituents can impact acute cannabis effects, but few empirical studies have systematically evaluated this theory in humans. This study assessed whether the cannabis terpenoid d-limonene mitigates the acute anxiogenic effects of THC., Methods: Twenty healthy adults completed nine, double-blind outpatient sessions in which they inhaled vaporized THC alone (15mg or 30mg), d-limonene alone (1mg or 5mg), the same doses of THC and d-limonene together, or placebo; a subset of participants (n=12) completed a tenth session in which 30mg THC+15mg d-limonene was administered. Outcomes included subjective drug effects, cognitive/psychomotor performance, vital signs, and plasma THC and d-limonene concentrations., Results: When d-limonene was administered alone, pharmacodynamic outcomes did not differ from placebo. Administration of 15mg and 30mg THC alone produced subjective, cognitive, and physiological effects typical of acute cannabis exposure. Ratings of anxiety-like subjective effects qualitatively decreased as d-limonene dose increased and concurrent administration of 30mg THC+15mg d-limonene significantly reduced ratings of "anxious/nervous" and "paranoid" compared with 30mg THC alone. Other pharmacodynamic effects were unchanged by d-limonene. D-limonene plasma concentrations were dose orderly, and concurrent administration of d-limonene did not alter THC pharmacokinetics., Conclusions: D-limonene selectively attenuated THC-induced anxiogenic effects, suggesting this terpenoid could increase the therapeutic index of THC. Future research should determine whether this effect extends to oral dose formulations and evaluate the interactions between other cannabis terpenoids or cannabinoids and THC., Competing Interests: Declaration of Competing Interest Dr. Tory Spindle has served as a consultant for Canopy Health Innovations Inc. and has received research funding from Cultivate Biologics. Dr. Ryan Vandrey has served as a consultant or received honoraria from Mira1a Therapeutics Inc., Jazz Pharmaceuticals, Charlotte’s Web, Syqe Medical Ltd., and WebMD. Dr. Ethan Russo is the founder and CEO of CReDo Science and a scientific advisor to True Terpenes. A patent application (PCT/US2022/014296) has been submitted by Johns Hopkins University on behalf of Drs. Vandrey, Spindle, and Russo for the use of d-limonene to reduce THC-induced anxiety based on the data presented in this manuscript (the submission occurred after the trial had concluded and data was analyzed). Minimization of bias was ensured by posting of the trial on ClinicalTrials.gov before it commenced. The study was conceived and designed by Drs Vandrey and Russo. Drs. Spindle, Vandrey, and Zamarripa had full access to the data and worked together to write the first draft of the manuscript and each take responsibility for the integrity of the reported data. Remaining authors contributed to the manuscript by reviewing the completed draft and providing critical feedback and edits. Johns Hopkins played no role in the production of this manuscript. The remaining authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective:  The aim of this study was to evaluate dentoskeletal changes in the treatment of Class II malocclusion with the Herbst Cantilever Bite Jumper (CBJ) appliance, associated with multibracket appliances after the growth peak, at pretreatment., Materials and Methods:  A sample of 37 individuals was divided into two groups: the experimental group comprised 16 patients treated consecutively for a mean period of 2.52 years with the Herbst CBJ appliance associated with multibracket appliances. A total of 21 subjects (10 males and 11 females) with Class II malocclusion and mean age at T1 of 16.08 years were followed for a mean period of 2.12 years composed the control group. Comparisons between the two groups were performed using initial and final lateral cephalograms. Comparisons between experimental and control groups at pretreatment and of the treatment changes were performed by Mann-Whitney or independent t -tests., Results:  Experimental group exhibited a significantly greater labial inclination of the mandibular incisors in comparison to the control group. Additionally, significantly greater corrections in overbite, overjet, and molar relationship were observed in the experimental than in the control groups., Conclusion:  The effects of the Herbst CBJ appliance, associated with fixed appliances after the growth peak in Class II malocclusion treatment are correction in molar relationship toward a Class I relationship, decrease of the overjet, decrease of the overbite, and mandibular incisors labial inclination., Competing Interests: None declared., (European Journal of Dentistry. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Objective: The aim of this retrospective study was to evaluate the cephalometric and occlusal changes of orthodontically treated Class III malocclusion patients., Methods: The experimental groups comprised 37 Class III patients treated: G1) without (n=19) and G2) with extractions (n=18) . The control group (G3), matched by age and sex with the experimental groups, consisted of 18 subjects with untreated Class III malocclusion. Cephalometric (radiographs) and occlusal (study models) changes were assessed between the beginning (T1) and the end (T2) of treatment. Intergroup comparisons were performed with one-way ANOVA followed by Kruskal-Wallis tests (p< 0.05). Occlusal changes were evaluated by the peer assessment rating (PAR) index (ANOVA and Kruskal-Wallis tests), and the treatment outcomes were evaluated by the Objective Grading System (OGS) (t-tests)., Results: The experimental groups showed a restrictive effect on mandibular anterior displacement and a discrete improvement in the maxillomandibular relationship. Extraction treatment resulted in a greater retrusive movement of the incisors and significant improvements in the overjet and molar relationship in both groups. The PAR indexes were significantly reduced with treatment, and the OGS scores were 25.6 (G1) and 28.6 (G2), with no significant intergroup difference., Conclusions: Orthodontic treatment of Class III malocclusion patients with fixed appliances improved the sagittal relationships, with greater incisor retrusion in the extraction group. Both the extraction and non-extraction treatments significantly decreased the initial malocclusion severity, with adequate and similar occlusal outcomes of treatment.

The aim of this study was to evaluate the possible effect of low intensity pulsed ultrasound (LIPUS) on tooth movement and root resorption in orthodontic patients. Twenty-one patients were included in a split-mouth study design (group 1). Ten additional patients were included with no LIPUS device being used and this group was used as the negative control group (group 2). Group 1 patients were given LIPUS devices that were randomly assigned to right or left side on upper or lower arches. LIPUS was applied to the assigned side that was obtained by randomization, using transducers that produce ultrasound with a pulse frequency of 1.5 MHz, a pulse repetition rate of 1 kHz, and average output intensity of 30 mW/cm 2 . Cone-beam computed tomography (CBCT) images were taken before and after treatment. The extraction space dimensions were measured every four weeks and root lengths of canines were measured before and after treatment. The data were analyzed using paired t -test. The study outcome showed that the mean rate of tooth movement in LIPUS side was 0.266 ± 0.092 mm/week and on the control side was 0.232 ± 0.085 mm/week and the difference was statistically significant. LIPUS increased the rate of tooth movement by an average of 29%. For orthodontic root resorption, the LIPUS side (0.0092 ± 0.022 mm/week) showed a statistically significant decrease as compared to control side (0.0223 ± 0.022 mm/week). The LIPUS application accelerated tooth movement and minimized orthodontically induced tooth root resorption at the same time.

Objectives: To describe qualitatively and quantitatively the directions and magnitudes of rotations of permanent maxillary central incisors and first molars in the mixed dentition in repaired complete unilateral cleft lip and palate (UCLP) and study their associations with absence of teeth in their vicinity., Materials and Methods: Dental casts and orthodontic records taken prior to orthodontic preparation for alveolar bone grafting of 74 children with repaired UCLP (53 male, 21 female; aged 8.9 ± 1.0 years) were studied. Directions and magnitudes of permanent maxillary central incisor and first molar rotations were recorded. Tooth absence was confirmed from longitudinal radiographic records. Incisor and molar rotations were analyzed in relation to the absence of teeth in their vicinity., Results: Distolabial rotation of the permanent maxillary central incisor was noted in 77.14% on the cleft side, while distopalatal rotation was noted in 82.19% on the noncleft side. Incisor rotation was greater when a permanent tooth was present distal to the cleft side central incisor, in the greater segment. The permanent maxillary first molar showed mesiopalatal rotation, which was greater on the cleft side and when there was absence of one or more teeth in the buccal segment., Conclusions: Presence and absence of teeth were associated with the severity of incisor and molar rotations in UCLP. Crowding of anterior teeth in the greater segment was associated with a greater magnitude of rotation of the cleft side permanent central incisor. Absence of one or more buccal segment teeth was associated with greater magnitude of rotation of the molar.

Microstomia, an abnormally small oral orifice, is a complication of perioral facial burns. In this case, contraction of the circumoral tissues and hypotonia of the musculature is responsible for this microstomia, which can produce aesthetic and functional impairment with eating, swallowing, communication (speech and facial expressions), compromised dental care and maintenance due to limited oral access, social interactions, and psychological well-being. Conservative management involves providing physical resistance to scar contracture, with opposing horizontal and vertical circumoral forces by means of appliances that aim to stretch the commissures and fibrotic muscles. Numerous appliances, either intraoral or extraoral, have been described to prevent or treat microstomia by delivering a static or dynamic stretch horizontally or vertically, with most designed to stretch the mouth horizontally. Finding a comfortable effective way to stretch the mouth vertically has proved to be a challenge. This article describes the fabrication of a dynamic commissural appliance, constructed using acrylic resin and expansion screws, which provide simultaneous horizontal and vertical circumoral forces. This appliance is constructed easily and inexpensively without the need for taking impressions, can be adjusted so that it is almost painlessly inserted, and is progressively activated. It is convenient for use because the patient controls the pressure that is applied by the appliance. Its use in a case is described where the appliance has improved mouth opening and consequently functional outcomes.

Objective: To compare the mixed dentition incisor and molar overjet, severity of contraction of the dental arch, and the sagittal molar relationship on the cleft side vs the noncleft side in children with repaired complete unilateral cleft of the lip and palate (UCLP)., Materials and Methods: Orthodontic records taken prior to orthodontic preparation for alveolar bone grafting were screened to select study casts from patients with nonsyndromic repaired complete UCLP who did not have mandibular skeletal or dental asymmetry. The study sample comprised dental casts from 74 children aged 8.9 ± 1 years. Standardized digital photographs were acquired at 1:1 magnification. A coordinate system was developed using digital image-processing software (Photoshop CS4 and Adobe Illustrator). Incisor and molar overjet, Angle's classification, and arch contraction were recorded. Descriptive statistics, paired t-tests, and kappa statistics were used to compare the cleft and noncleft sides., Results: A negative overjet of -1 to -5 mm was often present at the incisors, with greater frequency and magnitude on the cleft side. Class II molar relation was more frequent on the cleft side (61.1%) than on the noncleft side (47.2%). Significantly greater contraction of the cleft side deciduous canine and deciduous first molar was noted, while the difference was very minor at the first permanent molar., Conclusions: Cleft side maxillary arch contraction was most severe in the deciduous canine and first deciduous molar region and progressively less severe in the posterior region of the arch. A greater frequency and severity of negative overjet and Class II molar relationship was seen on the cleft side.

Introduction: The influence of 4 commonly used fixed orthodontic appliances on artifact formation and diagnostic quality of magnetic resonance (MR) images of the head produced by a 3-T MR scanner was studied., Methods: Stainless steel brackets, ceramic brackets, combination of ceramic brackets and steel molar tubes, and multistranded steel mandibular lingual retainers were embedded into custom-made trays for each of 10 adult subjects. Head MR scans of 9 regions were acquired for each subject wearing these trays. Sagittal T1-weighted, axial T2-weighted, axial gradient-recalled, axial diffusion-weighted, noncontrast axial MR angiography, and axial fluid-attenuated inversion recovery MR sequences were included. Two neuroradiologists evaluated image distortions and diagnostic qualities of the 1314 acquired images (13860 image slices)., Results: The images were affected by appliance, head region, and MR sequence. Stainless steel brackets and molar tubes affected the images the most, and ceramic brackets caused minimal image distortion., Conclusions: Head MR images are differentially affected by orthodontic appliances. The appliance, region imaged, and MR sequence should be considered before imaging patients wearing fixed orthodontic appliances., (Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: Increasing the rate of orthodontic tooth movement (OTM) can reduce risks such as periodontal disease and caries., Trial Design: This split-mouth randomized controlled clinical trial investigated whether light emitting diode (LED) phototherapy could accelerate the rate of OTM., Setting: The study was conducted at the Graduate Orthodontics Clinic at the University of Toronto, Faculty of Dentistry., Participants and Methods: 17 dental arches from 11 orthodontic participants with bilaterally symmetrical extraction of premolars were included. During space closure of single tooth extraction sites, LED phototherapy was applied to one side of the dental arch for a specified time and the contralateral side acted as the control. Space closure was measured immediately prior to, during and later in space closure., Results: All participants were compliant with LED application. Our results revealed no significant changes in the rate of OTM with LED phototherapy over 3 months of extraction space closure., Conclusions: Our findings were contrary to previous findings of the effect of laser phototherapy on regulating the rate of OTM. Further investigations are warranted to analyse whether the duration or method of LED delivery would have an effect on the rate of OTM. Toronto. This trial was registered at clinicaltrials.gov (NCT01490385).

Hemifacial microsomia is a hypoplastic disorder of the first and second branchial arches that significantly impacts on the development of the jaws, leading to malocclusion and facial asymmetry. There is little in the literature regarding the application of orthodontic/orthognathic approaches to the correction of these deformities and the stability of the surgical results. To address this, a retrospective chart review of 10 patients with complete orthodontic records and greater than 1 year of follow-up was performed. Posteroanterior cephalograms were assessed by modified Grummons analysis to determine mandibular offset (deviation of the chin point from the skeletal midline) and occlusal cant. These measurements were performed at 3 time points (T1: preoperative, T2: immediate postoperative, T3: follow-up) to elucidate the surgical movement (T2-T1), the postoperative relapse (T3-T2), and the net gain movement (T3-T1). Maxillary movements were quantified, and the occlusal cant was expressed as a ratio between vertical heights of the maxilla at the first molar on each side. One sample t test demonstrated statistically significant surgical movement and net gain. Relapse was statistically insignificant. Repeated-measures analysis of variance demonstrated similar results for chin point position relative to the putative midline. Our results suggest that a combined orthodontic/orthognathic approach at skeletal maturity delivers improved occlusal outcomes in the long term as assessed by chin point deviation and occlusal cant, but secondary surgery rates are higher than those for orthognathic surgery in other patient groups. We advocate limiting surgery to skeletal maturity whenever possible to achieve stable long-term results while limiting morbidity and number of procedures.

Introduction: In this retrospective longitudinal study, we aimed to study differences in the soft-tissue profiles in growing children with clefts in comparison with controls through the period of facial growth from 7 to 18 years., Methods: Lateral cephalometric measurements made at 7 years (T1), 11.1 years (T2), and 17.9 years (T3) of age of 70 white children (35 boys, 35 girls) with complete unilateral cleft lip and palate (UCLP) who received primary lip and palate repair surgeries at The Hospital for Sick Children, Toronto, were compared with those of a control group of similar ages, sexes, and racial backgrounds, and having skeletal Class I facial growth, selected from the Burlington Growth Study. None of the included subjects had received any surgeries other than the primary lip and palate repairs, and none had undergone nasal septum surgery or nasal molding during infancy. Between-group comparisons were made at each time point using generalized linear models adjusted for age and sex effects. Longitudinal comparisons across all time points were conducted using the mixed model approach, adjusting for these effects and their interactions with time., Results: Bimaxillary retrognathism, progressive maxillary retrognathism, and increasing lower anterior face height with downward and backward growth rotation of the mandible in the UCLP group were seen. Unlike the hard-tissue face height ratio, their soft-tissue face height ratio was not affected. The upper lips in the UCLP group were shorter by 1.81 mm at T2 (P <0.001) and by 1.16 mm at T3 (P = 0.018), whereas their lower lips were 2.21 mm longer at T3 (P = 0.003). A reduced upper lip to lower lip length ratio at T2 and T3 (P <0.001) resulted. Their upper lips were relatively retruded by 1.44 mm at T1, 1.66 mm at T2, and 1.86 mm at T3 (all, P <0.001), and their lower lips were relatively protruded by 1.07 mm at T1 (P = 0.003), 1.40 mm at T2 (P <0.001), and 1.62 mm at T3 (P <0.001). Nose depths in the UCLP group were shallower by at least 1 mm from T1 to T3, and columellar length was shorter by almost 2 mm (all, P <0.001). Their columellae and nose tips rotated downward with growth, with the most significant rotations experienced from T2 to T3, and progressive reductions in their soft-tissue profile convexity were seen from T1 to T3 (P <0.001)., Conclusions: Key attributes of the imbalance in the soft-tissue profile in children with repaired UCLP were identified in the lip and nose regions. Although many profile differences were visible as early as 7 years of age, they became more apparent by 11 years of age and increased in severity thereafter. The short upper lip combined with a long lower lip resulted in the characteristic lip length imbalance, whereas the progressively retruding upper lip and protruding lower lip led to developing a step relationship in the sagittal lip profile during the adolescent growth period. Their columellae and nose tips rotated downward during this time., (Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Objective: To compare posttreatment and postretention occlusal changes with the physiologic occlusal changes caused by natural development of untreated subjects., Materials and Methods: The sample was divided into three groups. Group 1 comprised 97 subjects treated with four premolar extractions at a mean pretreatment (T0) age of 13.03 years, a mean posttreatment (T1, first observation) age of 15.12 years, and a mean postretention (T2, second observation) age of 20.52 years. The mean observation period (T2-T1) was 5.39 years. Group 2 comprised 58 subjects treated nonextraction at a mean pretreatment age of 12.83 years, a mean posttreatment age of 14.99 years, a mean postretention age of 20.22 years, and a mean observation period of 5.22 years. Group 3 comprised 114 untreated subjects at a mean age at T1 of 14.91 years and at T2 of 20.48 years. The mean observation period was 5.56 years. Dental casts were evaluated using the Peer Assessment Rating (PAR) index and the Little irregularity index in maxillary and mandibular arches. Changes in PAR and Little indexes were compared among the three groups by analysis of variance and Tukey tests., Results: Intergroup comparison showed that at T1 and T2 the treated groups presented smaller PAR and Little indexes than the untreated group. In the observation period, the treated groups showed greater increase in PAR and Little maxillary indexes than the untreated group. The extraction group showed a greater increase of the Little mandibular index than the untreated group., Conclusions: The treated groups showed more changes according to PAR and Little maxillary indexes than the untreated group. The posttreatment change of the mandibular anterior crowding of the treated extraction group was greater than the mandibular crowding caused by physiologic changes in the untreated group.

Introduction: Coinciding treatment with periods of accelerated skeletal growth and maturation might be advantageous in clinical practice. Better understanding of the concordance between skeletal and chronologic ages during the period that children frequently receive orthodontic treatment is needed. The literature on skeletal age determination from hand-wrist radiographs lacks reports based on longitudinal data, creating lacunae in the understanding of the magnitudes and variations of differences between skeletal and chronologic ages. The aims of this research were to comprehensively analyze the concordance between skeletal and chronologic ages determined by using the Greulich and Pyle method at different ages in the preadolescent and adolescent periods, and to determine any age- and sex-related differences in the concordance., Methods: By using the Greulich and Pyle method, skeletal age determinations were made from 572 hand-wrist radiographs of 68 white children with normal facial growth, selected from the records of the Burlington Growth Centre, spanning the growth period from 9 to 18 years. Skeletal age and chronologic age differences for each sex were analyzed by using paired t tests and Wilcoxon signed rank tests at yearly intervals. Differences over the longitudinal duration were examined by using the mixed model approach. The limits of agreement were determined by using the Bland-Altman method. In each yearly chronologic age group, differences were clinically categorized based on the proximity of the skeletal and chronologic ages., Results: Overall, a slightly greater proportion of the total skeletal age determinations made in girls (41.9%) were within 0.5 year of their chronologic age, compared with 38% in boys. The largest proportions of subjects having skeletal age-chronologic age differences within 0.5 year were in the 10-year age group in girls (64.5%) and the 13-year age group in boys (64.7%). Mean skeletal age-chronologic age differences were significantly larger in the 13- to 16-year age groups in girls and in the 16- and 17-year age groups in boys, but the differences were not statistically significant at other ages. Several patterns of variations were identified in the direction of differences when individual plots were examined., Conclusions: This longitudinal analysis of differences between skeletal and chronologic ages showed wide ranges and distributions of differences at each yearly age group during the growth period from 9 to 18 years, even when mean differences were small. Variations in the magnitude and direction of differences observed at different ages highlighted the variability in skeletal maturation among normally growing young people. Overall, the differences in skeletal and chronologic ages were positively related to age, with little effect of sex or its interaction with age., (Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Introduction: The cervical vertebrae have been proposed as a method of determining biologic maturity. The purposes of this study were to establish a pattern of mandibular growth and to relate this pattern to the stages of cervical vertebral maturation., Methods: Cephalometric radiographs, taken annually from ages 9 to 18 years, were evaluated for 90 boys from the Burlington Growth Center, Toronto, Ontario, Canada. Mandibular lengths were measured from articulare to gnathion, and incremental growth was determined. Cervical vertebral maturation stages were assessed by using a 6-stage method. Advanced, average, and delayed maturation groups were established., Results: The prepubertal mandibular growth minimum velocity occurred during cervical stages 1 through 4 (P = 0.7327). Peak mandibular growth velocity occurred most frequently during stage 4 in all 3 maturation groups, with a statistical difference in the average and delayed groups (P <0.0001) and the advanced group (P = 0.0143). The average number of years spent in stage 4 was 3.79 (P <0.0001). The average amount of mandibular growth occurring during stage 4 was 9.40 mm (P <0.0001). The average amount of growth in stages 5 and 6 combined was 7.09 mm., Conclusions: Progression from cervical stages 1 through 6 does not occur annually; time spent in each stage varies depending on the stage and the maturation group. Cervical vertebral maturation stages cannot accurately identify the mandibular prepubertal growth minimum and therefore cannot predict the onset of the peak in mandibular growth. The cervical vertebral maturation stages should be used with other methods of biologic maturity assessment when considering both dentofacial orthopedic treatment and orthognathic surgery., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Introduction: Although the associations between oral biologic variables such as malocclusion and oral-health-related quality of life (OHRQOL) have been explored, little research has been done to address the influence of psychological characteristics on perceived OHRQOL. The aim of this study was to assess OHRQOL outcomes in orthodontics while controlling for individual psychological characteristics. We postulated that children with better psychological well-being (PWB) would experience fewer negative OHRQOL impacts, regardless of their orthodontic treatment status., Methods: One hundred eighteen children (74 treatment and 44 on the waiting list), aged 11 to 14 years, seeking treatment at the orthodontic clinics at the University of Toronto, participated in this study. The child perception questionnaire (CPQ11-14) and the PWB subscale of the child health questionnaire were administered at baseline and follow-up. Occlusal changes were assessed by using the dental aesthetic index. A waiting-list comparison group was used to account for age-related effects., Results: Although the treatment subjects had significantly better OHRQOL scores at follow-up, the results were significantly modified by each subject's PWB status (P <0.01). Furthermore, multivariate analysis showed that PWB contributed significantly to the variance in CPQ11-14 scores (26%). In contrast, the amount of variance explained by the treatment status alone was relatively small (9%)., Conclusions: The results of this study support the postulated mediator role of PWB when evaluating OHRQOL outcomes in children undergoing orthodontic treatment. Children with better PWB are, in general, more likely to report better OHRQOL regardless of their orthodontic treatment status. On the other hand, children with low PWB, who did not receive orthodontic treatment, experienced worse OHRQOL compared with those who received treatment. This suggests that children with low PWB can benefit from orthodontic treatment. Nonetheless, further work, with larger samples and longer follow-ups, is needed to confirm this finding and to improve our understanding of how other psychological factors relate to patients' OHRQOL., (Copyright © 2011. Published by Mosby, Inc.)

Objective: To evaluate nasal morphology, symmetry, and nostril shape in patients with unilateral cleft lip and palate following mixed-dentition alveolar bone grafting., Design: Prospective stereophotogrammetric study., Setting: Hospital-based., Patients: Thirty-nine patients with a history of repaired unilateral cleft lip and palate who received an iliac crest alveolar bone graft were recruited prospectively to participate in the study. Each patient served as his/her own control., Interventions: Partial facial impressions of all patients were acquired before and a minimum of 6 months after the alveolar bone grafting procedure. Image acquisition and analysis of the casts constructed from these models were carried out using three-dimensional stereophotogrammetry., Main Outcome Measures: Surface-based registrations and linear measurements were performed to assess nasal morphology and nostril shape. A modified Procrustes technique was used to determine the change in nasal symmetry. A two-tailed, paired t test and an analysis of covariance were used to assess statistical significance., Results: Significant side-to-side asymmetry exists in the nasal region of patients with unilateral cleft lip and palate, both before and after alveolar bone grafting. No significant changes were observed between pre-alveolar bone graft and post-alveolar bone graft images based on linear measurements, asymmetry scores, and registrations. Gender and surgeon were not significant factors., Conclusion: Under the conditions of this study, mixed-dentition alveolar bone grafting appears to have no significant long-term effect on nasal morphology, symmetry, or nostril shape.

Introduction: Studies of computer-aided learning (CAL) in orthodontics have documented both objective and subjective outcomes; however, to date, no studies have attempted to correlate these 2 outcome measures., Methods: The main objective outcome measured was performance on a written test covering material in the orthodontic diagnosis electronic tutorial (ODET) administered to 92 fourth-year undergraduate dental students. The main subjective outcome measured was a 12-statement questionnaire to elicit students' perception of the ODET and CAL as teaching modalities., Results: In the male and female subgroups, a statistically significant difference in mean lecture test scores favoring women (72.46%) over men (67.08%) was observed (P = 0.05). This difference was not observed for mean ODET test scores (P = 0.52). Although responses to the questionnaire were mostly positive, the students are not prepared to replace lectures with CAL tutorials. Responses showed that male students preferred self-instruction as a mode of learning more than female students did (P = 0.05). When linking objective and subjective outcomes, the mean ODET test score had a statistically significant (P = 0.025), but weak, positive correlation (r = 0.243) with self-reported time spent reviewing the ODET but not with any other statement in the questionnaire., Conclusions: Despite a difference in lecture test scores between male and female students, there was no difference in mean ODET test scores between the 2 subgroups. This might be explained by sex differences: male students preferred self-instruction more than female students did. Improved performance on the ODET test was noted for students who reported longer times spent reviewing the tutorial. Because students are not prepared to replace lectures with CAL tutorials, from their perspective, the ODET should continue to be used with traditional modes of learning., (Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Objectives: To assess the functional and psychosocial impact of oligodontia in children aged 11-14 years., Methods: Children aged 11-14 years with oligodontia were recruited from orthodontic clinics when they presented for orthodontic evaluation. All completed a copy of the Child Perceptions Questionnaire for 11- to 14-year olds, a measure of the functional and psychosocial impact of oral disorders. Information on the number and pattern of missing teeth for each child were obtained from charts and radiographs., Results: Thirty-six children were included in the study. The number of missing teeth ranged from one to 14 (mean = 6.8). Just over three-quarters of the subjects reported experiencing one or more functional and psychosocial impacts 'Often' or 'Everyday/almost everyday'. Correlations between scale and sub-scale scores and the number of missing teeth were weak and nonsignificant., Conclusions: Children with oligodontia experience substantial functional and psychosocial impacts from the condition. When compared with other clinical groups, children with oligodontia appear to have worse oral health-related quality of life than children with dental decay and malocclusion, but better oral health-related quality of life than children with oro-facial conditions.

Introduction: M-Wire (Sportswire LLC, Langley, OK) is reportedly created by altering alloy temperatures during the manufacturing process of GT series X instruments (Dentsply Tulsa Dental Specialties, Tulsa, OK). Currently, there are few published studies looking at torsional profiles of these instruments. The purpose of this study was to investigate the torsional profiles of new and used 20/0.06 GT series X (GTX) and GT (GT) instruments (Dentsply Tulsa Dental Specialties)., Methods: Thirty instruments were allocated to one of eight groups and were used 2, 6, or 10 times in simulated canals or remained as unused controls. Testing of torque (TF) and angle at fracture (AF) were conducted in accordance with American National Standards Institute/American Dental Association (ANSI/ADA) specification No. 28. Data analyses were performed by using one- and two- way analysis of variance with honesty significance difference post hoc comparison with alpha = 0.05., Results: Overall, there were significant differences in TF and AF among the experimental groups (p < 0.001). GTX instruments showed a significant initial increase in TF with two and six uses (p < 0.001) in contrast to the GT, which showed a linear reduction in TF with increased use (p < 0.004). Both GTX and GT instruments showed no statistical difference in AF of new instruments but did show a significant decrease in AF in all groups except the GT two-use group (p < 0.02)., Conclusion: The GTX instruments had a higher resistance to torsional failure after use as compared with the GT.

Objective: To quantify dental anomalies in permanent dentition associated with complete unilateral cleft lip and palate and to survey treatment modalities used to address these problems., Method: Retrospective study of 116 children with complete unilateral cleft lip and palate treated at SickKids since birth. Presence and morphology of lateral incisors and second premolars were determined. Orthodontic, surgical, and/or prosthetic procedures were analyzed., Results: The cleft-side lateral incisor was absent in 93.1% of finished cases. The lateral incisor mesial to the cleft was present in 4.3%, absent due to agenesis in 75.9%, and extracted in 19.8% of cases. The lateral distal to the cleft was present in 2.6%, absent due to agenesis in 33.6%, and extracted in 63.8% of cases. Of 105 lateral incisors, only one had normal morphology. Noncleft-side lateral incisors were absent in 16% of finished cases. Absence was due to agenesis in 12.1% of cases and extraction in 4.3%. When the lateral incisor was missing, closure of the dental space occurred by orthodontic tooth movement after alveolar bone grafting (45%); surgical closure with simultaneous alveolar bone grafting (35%); prosthetic closure (17%); and 3% were failures. Agenesis of premolars occurred in 12.1% of cleft-side and 10.3% of noncleft-side maxillary second premolars., Conclusions: The cleft-side lateral incisor is rarely present at the conclusion of orthodontic and surgical treatment of complete unilateral cleft lip and palate. Often absent due to agenesis, when present it is typically abnormal in size and bone support and is commonly extracted in favor of canine substitution.

Introduction: Many young patients are asked to wear headgear or functional appliances during sleep as part of their orthodontic treatment. The objective of this clinical study was to assess the impact of these appliances on sleep quality., Methods: Twenty-two subjects (8 boys, 14 girls) between 10 and 15 years of age wearing either a headgear or a removable appliance for 3 to 12 months were enrolled in a sleep study. Each subject participated in 2 overnight sleep studies with and without the appliance. There was a 1-week interval after an adaptation night. The studies were performed at the Sleep Research Laboratory at Toronto Western Hospital in Canada. Each subject served as his or her own control. Twelve subjects had an extraoral headgear appliance, and 10 had intraoral functional (5 Fränkel, 5 Twin-block) appliances. No subject reported any sleep or medical disorder. The primary outcome variable was sleep efficiency., Results: Sleep efficiencies were 90.7% (SD, 7.9) and 91.6% (SD, 4.3) with and without the appliances, respectively. When sleep quality was compared with and without appliances, analysis of variance (ANOVA) showed no significant difference in sleep efficiency or other sleep variables such as sleep onset latency, rapid eye movement onset latency, rapid eye movement percentage, short-wave sleep percentage, or respiratory disturbance index. Sex and body mass index were not confounding variables. In addition, the use of extraoral or intraoral appliances did not affect sleep quality., Conclusions: In young orthodontic patients, there appears to be no difference in sleep quality with or without the overnight use of these appliances after they have been worn for a minimum of 3 months.

Introduction: The purpose of this study was to examine the relationship between self-esteem and oral-health-related quality of life (OHRQoL) in a sample of children seeking orthodontic treatment in Toronto, Ontario, Canada., Methods: This was a cross-sectional study of children aged 11 to 14 years, evaluating the associations among the child perception questionnaire (CPQ11-14), the self-esteem subscale of the child health questionnaire, and the dental aesthetic index (DAI)., Results: The CPQ11-14 scores were significantly related to the self-esteem scores and the DAI ratings. Regression analysis showed that self-esteem contributed significantly to the variance in CPQ11-14 scores. However, the amount of variance explained by normative measures of malocclusion was relatively small., Conclusions: The impact of malocclusion on quality of life is substantial in children with low self-esteem. Compared with normative measures of malocclusion, self-esteem is a more salient determinant of OHRQoL in children seeking orthodontic treatment. Longitudinal data will be of value to confirm this finding.

Objective: This study aimed to assess the ability of the Child Oral Health Quality of Life Questionnaire (COHQoL) to detect change following provision of orthodontic treatment., Methods: Children were recruited from an orthodontic clinic just prior to starting orthodontic treatment. They completed a copy of the Child Perception Questionnaire, while their parents completed a copy of the Parents Perception Questionnaire and the Family Impact Scale. Normative outcomes were assessed using the Dental Aesthetic Index (DAI) and the Peer Assessment Rating (PAR) index. Change scores and effect sizes were calculated for all scales., Results: Complete data were collected for 45 children and 26 parents. The mean age was 12.6 years (standard deviation = 1.4). There were significant pre-/posttreatment changes in DAI and PAR scores and significant changes in scores on all three questionnaires (P < 0.05). Effect sizes for the latter were moderate. Global transition judgments also confirmed pre-/posttreatment improvements in oral health and wellbeing., Conclusion: The results provide preliminary evidence of the sensitivity to change of the COHQoL questionnaires when used with children receiving orthodontic treatment. However, the study needs to be repeated in different treatment settings and with a larger sample size in order to confirm the utility of the measure.

Introduction: Advances in skeletal stabilization techniques have led to the use of titanium devices for rigid fixation. Their advantages include strength and skeletal stability, but they also have disadvantages. The purpose of this study was to investigate the stability of a resorbable copolymer as a potential alternative to titanium for fixation of Le Fort I maxillary impaction., Methods: Fifty consecutive patients underwent maxillary impaction with nonsegmental monopiece Le Fort I osteotomy. Twenty-five patients were treated with titanium fixation; 25 patients were treated with resorbable copolymer fixation (82% poly-L-lactic acid: 18% polyglycolic acid). Lateral cephalograms were obtained 1 week preoperatively, 1 week postoperatively, and a minimum of 8 months postoperatively. Linear and angular measurements were recorded digitally to evaluate 2-dimensional skeletal changes., Results: Statistical analysis showed no significant radiographic differences (P <0.05) in long-term stability in or between the 2 groups. No clinical or radiographic evidence of wound healing problems was noted., Conclusions: These results support the use of resorbable copolymer fixation for Le Fort I impaction as a viable alternative to titanium fixation.

Introduction: In this prospective clinical study, we investigated the effects of rapid maxillary expansion (RME) on the electromyographic (EMG) activities of the anterior temporal and superficial masseter muscles., Methods: The sample included 18 subjects (11 girls, 7 boys; mean age, 12.54 years) with unilateral or bilateral posterior crossbites involving 3 or more posterior teeth. There was no control group in this study because of the short observation period. The EMG activity was recorded simultaneously from both muscles during swallowing a sip of water and unilateral gum chewing., Results: The mean EMG (mEMG) activities of the right and left anterior temporal muscles showed no statistically significant difference during swallowing and unilateral chewing. The mEMG activities of the right and left masseter muscles showed a statistically significant difference at unilateral chewing (P <0.01). There were a decrease of the mEMG activities for both muscles after RME and an increase during the observation period for unilateral chewing (P <0.05). Swallow-related mEMG activities of both muscles showed increases after RME and during the observation period (P <0.05)., Conclusions: RME affected the EMG activities of the anterior temporal and superficial masseter muscles during swallowing and unilateral chewing. These findings suggest that the alterations in the EMG activities of these muscles should be considered in both the treatment and the the stability of maxillary transverse deficiencies.

Introduction: The aim of this prospective study was to assess temporomandibular joint (TMJ) condyle-disc positions at the sagittal and coronal planes of magnetic resonance images (MRIs) before and after rapid maxillary expansion (RME)., Methods: The study included 18 subjects (11 girls, 7 boys) with a mean age of 12.54 years with unilateral or bilateral posterior crossbite that included at least 3 posterior teeth. The clinical and radiographic assessments of the TMJ were done before (T1) and 18 weeks after (T2) RME. A Haas-type expansion appliance was used for an average treatment time of 3.5 weeks., Results: A visual MRI analysis of pretreatment condyle-disc positions showed that 8 TMJs had medial disc displacement, 3 had anteromedial disc displacement, and 2 had lateral disc displacement. The disc positions remained unchanged at T2 except in 1 subject, who developed unilateral anterior disc displacement. Unilateral joint sounds developed in 3 subjects without changes in the disc positions., Conclusions: Posterior crossbite can be considered a minor risk factor for temporomandibular disorder (TMD). RME is neither a risk factor nor a prevention for TMD. Coronal MRIs contribute complementary information for optimal diagnosis of TMD.

Introduction: In this prospective clinical study, we used bilateral temporomandibular joint (TMJ) magnetic resonance images (MRIs) to investigate the condylar response to rapid maxillary expansion (RME)., Methods: Bilaterial MRIs of the TMJs of 18 subjects (11 girls, 7 boys; mean age, 12.54 years; range, 9.75-14.8 years) were assessed. All subjects had unilateral or bilateral posterior crossbites involving 3 or more posterior teeth. There was no control group because of the short observation period. The MRI protocol included closed-mouth parasagittal proton density weighted spin echo and fat-suppressed short T1 inversion recovery sequences. The MRIs were taken before treatment (Tx 1), and at 6 weeks (Tx 2) and at 18 weeks (Tx 3) after treatment. Alterations in the signal intensities of the TMJ region were examined visually by a radiologist who was blinded to the subjects' characteristics., Results: Increased signal intensities appeared as bright areas on the MRIs, indicating red bone marrow edema that is a sign of condylar remodeling. There were no bright areas in the condylar regions at Tx 2 in the 36 TMJs. Bright areas at the condylar region were observed both in proton density and fat-suppressed spin echo sequences at Tx 3 in 32 TMJs. Twenty-two TMJs had bright areas localized at the condylar head, and 10 TMJs had bright areas that extended through both the condyle and the mandibular ramus. No bright areas were seen at Tx 2 or Tx 3 for 4 TMJs., Conclusions: A condylar response to RME was observed in 32 TMJs at 18 weeks after expansion. Both the extensive orthopedic and the functional occlusal forces associated with RME have roles in condylar and ramal responses.

Background: Treacher Collins syndrome is an autosomal dominant condition of varying severity, affecting the tissues of the first and second branchial arches. The aim of this article is to present a cephalometric analysis of the craniofacial skeleton in Treacher Collins syndrome and provide an age- and sex-matched comparison as a standard control sample., Methods: Twenty-four Treacher Collins syndrome patients (11 male patients and 13 female patients; mean age, 17.99 +/- 1.96 years) underwent cephalometric studies, including orthopantomography and lateral and anteroposterior cephalography, as part of their preparation for bimaxillary surgery. Cephalometric parameters assessing the relationships of the skull base, maxilla, and mandible were analyzed and compared with age- and sex-matched control data (mean age, 17.75 +/- 1.95 years)., Results: Cephalometric analysis before orthognathic surgery documented that the Treacher Collins syndrome mandible and midface are expectedly short in the anteroposterior plane; however, the ratio of maxillomandibular deficiency is particularly significant in the female patient. The mandibular plane angle is obtuse, affecting female patients in particular, in whom there is also a posteriorly placed chin point. Affected individuals have a high antegonial notch height. Although the parameters of anterior lower facial height proportion in control and syndrome individuals are similar, posterior face height in Treacher Collins syndrome is reduced., Conclusions: This study quantifies the cephalometric dysmorphology of patients with Treacher Collins syndrome and compares it to that of age-matched controls. These cephalometric characteristics have clinical significance in Treacher Collins syndrome and in the planning of bimaxillary advancement and genioplasty in syndrome patients.

Objectives: To determine if self-weighting of the items in an oral health-related quality of life questionnaire improves its psychometric properties., Methods: The Surgical Orthodontic Outcome Questionnaire (SOOQ) was designed to assess the oral health-related quality of life of individuals before and after corrective surgery. Each of its 33 'items' consists of two questions: a question concerning the frequency with which a given functional or psychosocial problem had been experienced and a 'weighting' question which asked about how much the individual was bothered by that problem. The questionnaire was completed by three groups of individuals: (i) pretreatment; (ii) immediate (i.e. 2-6 months) postsurgery and (iii) postsurgery (i.e. more than 2 years after surgery). Unweighted scale scores were obtained by summing the response codes to the frequency question and weighted scores by summing the products of the frequency and bother questions. These scores were calculated for the full questionnaire and a short form consisting of 15 items. The discriminative and correlational construct validity of these scores was compared along with internal consistency reliability. The sensitivity to change and longitudinal construct validity of unweighted and weighted scores was assessed in a simulated evaluative study in which pretreatment and postsurgery subjects were paired., Results: For both the long and short forms of the questionnaire, unweighted and weighted scores discriminated between the groups enrolled in the study. Correlations with a general health rating were similar, as were Cronbach's alpha values and test-retest reliabilities. The simulated evaluative study suggested no differences in sensitivity to change or longitudinal construct validity. When subscale scores were examined, there was a suggestion that weighting improved their reliability., Conclusions: Self-weighting of items did not substantially improve the performance of the SOOQ. Domain weights should be developed and tested to determine if they have an effect on its properties.

Background: Mandible advancement osteotomy in juvenile rheumatoid arthritis patients for class II anterior open-bite malocclusion is controversial; however, there is no literature discussing outcomes of surgery in this group of patients. An evaluation of such outcomes was undertaken at The Hospital for Sick Children., Methods: A retrospective chart review revealed that eight patients with juvenile arthritis underwent orthognathic surgery during a period of 5 years. All of the patients had a bilateral sagittal split osteotomy of the mandible, six had a simultaneous Le Fort I osteotomy, and four had an additional advancement genioplasty. The age of the patients at the time of surgery ranged between 17 and 22 years (mean, 18 years), with three male patients and five female patients. The patients were under follow-up for a minimum of 8 months after surgery, and measurements were performed studying preoperative and postoperative lateral cephalometric radiographs., Results: All patients have an improved occlusion and improved facial aesthetics. One patient continued to suffer from temporomandibular joint pain. The mean mandible advancement was 9.6 mm (range, 3.9 to 18.3 mm). The mean mandible relapse after surgery was 2.1 mm (range, 1 to 3.1 mm). No exacerbation of the juvenile rheumatoid arthritis was encountered as a result of the surgical procedure., Conclusions: Orthognathic surgery in juvenile rheumatoid arthritis patients improves the patient's occlusion, facial aesthetics, and therefore quality of life. The relapse rate postoperatively did not significantly affect the clinical outcome, and the authors recommend orthognathic surgery for this patient population. Future presurgical plans in this patient population will include a small posterior open bite and positioning the incisors edge to edge to allow for some postoperative relapse.

Background: Traditional Le Fort III osteotomies have been described by several authors; however, few have reported the distances advanced and stability over time., Methods: The authors assessed their last 30 Le Fort III osteotomies with respect to the immediate incisor advancement achieved at surgery and long-term advancement as measured at the A-point from preoperative and postoperative cephalometric tracings. The authors then compared their results with those in the literature for Le Fort III distraction techniques. Comparisons were made with respect to distraction distance maintained, the need for bone grafting, airway results, morbidity, and cost., Results: The mean incisor advancement at the time of surgery as recorded in 14 patients was 21.6 mm (range, 12 to 28 mm). The long-term cephalometric A-point measurements in 14 patients demonstrated a mean of 14.14 mm (range, 8 to 25 mm)., Conclusion: The authors conclude that, at the present time, no significant improvement in the results using Le Fort III distraction osteogenesis when compared with traditional methods has been shown.