Changes In Soft And Hard Tissues And Changes Of OHRQOL After Orthodontic-orthognathic Treatment Of Adult Patients With Skeletal Class Ⅲ Malocclusion

Objective:1. To analyze the cephalometric changes of soft and hard tissues in adult patients with Skeletal Angle Class Ⅲ malocclusion after orthodontic-orthognathic treatment and to discuss the clinical effects of the treatment.2. To evaluate the changes in oral health related quality of life(OHRQOL) following the treatment in these patients by using OHIP-14 measure and to discuss the impact of orthognathic treatment on these patients’ OHRQOL. Methods:1. 24 patients with skeletal class Ⅲ malocclusion were selected according to certain standards, each patient were treated by orthodontic-orthognathic treatment in the Orthodontic Department of the First Affiliated Hospital of Zhengzhou University from Sept.2011 to Dec.2014. Posteroanterior and lateral radiographs were taken before and after treatment and measured through Winceph 8.0 software. All statistical analysis were conducted using SPSS 17.0. Descriptive statistics were calculated for all measurements,and the paired-sample T test was used to evaluate the changes after the treatment.2. After the exclusion of 3 patients who were lost to follow-up, complete data were obtained in 21 patients. These patients were evaluated at baseline(T0), 1 weeks preoperatively(T1), 1 month postoperatively(T2) and 1 month after the postoperative orthodontic therapy(T3). The OHRQOL was assessed by the OHIP-14. the measure included 14 items, contributing to 7 domains(2 items per domain). Responses of each item are made on a Likert-type scale. The overall OHIP-14 scores can range from 0 to 56 while the individual domain scores can range from 0 to 8, with higher scores indicating greater impact on OHRQOL. Mean and standard deviations were calculated and the changes in OHRQOL scores between T0-T1, T1-T2, T2-T3 and T0-T3 were evaluated by the Wilcoxon Signed Rank test. Probabilities of P<0.05 were assumed as statistically significant. Results:1. After the orthodontic-orthognathic treatment, ∠ANB, Wits value, ∠NA-PA significantly increased(P<0.01), which implied the improvement of the saggital skeletal relationship. ∠SNB,∠NP-FH,∠FMA, lower facial height(ANS-Me) and facial vertical height ratio(ANS-Me/N-Me) decreased and have passed the statistical difference level, which means the setback and clockwise rotation of mandible, the profiles of these patients were corrected into ClassⅠ. The upper incisors resumed a normal labial inclination, while the lower incisors became more upright than ever. The values of overjet and overbite have reached into the normal range. As for the chages in the soft tissues, the lower lip protrusion decreased significantly and the upper lip move forward a little, resulting in a more straighter facial profile. In patients with mandibular protrusion and deviation, the postero-anterior radiographs also showed a dramatic change in the asymmetry of jawbone. The ratio of Q-Go(%), D-Go(mm) decreased and have passed the statistical difference level, which means that the horizontal and vertical asymmetry of mandibular angle were reduced. The value of Me-SRL decreased(P<0.01) implied the correction of the chin deviation. In summary the jawbone became more symmetric after the treatment.2. OHIP-14 scores varied during the trajectory of treatment. Compared with baseline(T0), there was immediate deterioration of OHRQOL at 1 weeks preoperatively(T1) and 1 month postoperatively(T2)(P<0.05), then, 1 month after all the treatment has finished(T3) there was a significant decrease in the overall OHIP-14 score and in all 7 domains(P <0.05), which indicates an improvement in OHRQOL. Conclusion:1. Significant improvements of appearance and oral function can be achieved by orthodontic-orthognathic treatment in patients with Skeletal class Ⅲ malocclusion.2. Orthodontic-orthognathic treatment does affect the patients’ OHRQOL, during the treatment, a substantial deterioration in OHRQOL can be observed in immediate period before and after surgical intervention, but after all the treatment has finished there is significant improvements in OHRQOL. Overall, The OHRQOL of Patients with Skeletal class Ⅲ malocclusion can be improved by orthodontic-orthognathic treatment.