Objectives: To evaluate the cephalometric changes in skeletal, dentoalveolar and soft tissue variables induced by Clark's Twin Block (CTB) in Class II, Division 1 malocclusion patients and to compare these changes in different cervical vertebral maturation stages.Methods: Pre- and post-treatment/observation lateral cephalograms of 53 Class II, Division 1 malocclusion patients and 60 controls were compared to evaluate skeletal, dentoalveolar and soft tissue changes. Skeletal maturity was assessed according to cervical vertebral maturation stages. Pre- and post-treatment/observation mean changes and differences (T2-T1) were compared by means of Wilcoxon sign rank and Mann-Whitney U-tests, respectively. Intergroup comparisons between different cervical stages were performed by means of Kruskal-Wallis test and Mann-Whitney U-test (p ≤ 0.05) .Results: When compared with controls, there was a significant reduction in ANB angle (p < 0.001), which was due to a change in SNB angle in CS-2 and CS-3 (p < 0.001), and in SNA (p < 0.001) and SNB (p = 0.016) angles in the CS-4 group. There was significant increase in the GoGn-SN angle in CS-2 (p = 0.007) and CS-4 (p = 0.024), and increase in Co-Gn and Go-Gn amongst all cervical stages (p < 0.05). There was significant decrease in U1-SN and increase in IMPA amongst all cervical stages (p < 0.05). There was significant retraction of the upper lip in CS-3 (p = 0.001), protrusion of the lower lip in CS-2 (p = 0.005), increase in nasolabial angle in CS-4 (p = 0.006) and Z-angle in CS-3 (p = 0.016), reduction in H-angle in CS-2 (p = 0.013) and CS-3 (p = 0.002) groups. When pre- and post-treatment mean differences were compared between different cervical stages, significant differences were found for SNA, SNB and UI-SN angles and overjet. .Conclusions: The Twin-Block along with the normal craniofacial growth improves facial esthetics in Class II, Division 1 malocclusion by changes in underlying skeletal and dentoalveolar structures. The favorable mandibular growth occurs during any of the cervical vertebral maturation stages, with more pronounced effect during CS-3 stage.

Pycnodysostosis is an autosomal recessive disorder that manifests as osteosclerosis of the skeleton due to the defective osteoclasts mediated bone turnover. The diagnosis of this disorder is established on the basis of its characteristic features and must be differentially diagnosed with other bone disorders. Dental surgeons should be aware of the limitations and possible adverse oral complications such as osteomyelitis of bone in these patients. This will guide them in planning realistic treatment goals. This paper reports the clinical and radiographic features of pycnodysostosis with the great emphasis on its dentofacial characteristics. The aim of this case report is to give an insight into the etiology, pathogenesis, and differential diagnosis of this disorder and to prepare the dentists and maxillofacial surgeons to overcome the challenges in treating these patients.

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Objectives: Are to compare the soft palate length (SPL), width and nasopharyngeal depth (PD) in different sagittal and vertical skeletal patterns and to see the influence of different skeletal malocclusions on need's ratio (PD/SPL).Material & Methods: Lateral cephalograms of 372 patients were equally divided into sagittal (class I, II, III) and vertical skeletal patterns (normodivergent, hypodivergent, hyperdivergent) by measuring ANB and SN-MP angles, respectively. SPL, velar width (VW) and PD were recorded using Rogan Delft View Pro-X software. Kruskal Wallis test was used to compare SPL, VW, PD and need's ratio between sagittal and vertical skeletal groups. Intergroup comparisons were performed using Mann-Whitney U-test. Level of significance was kept at p≤0.05.Results: Statistically significant differences were found for VW (p=0.008) and need's ratio (p=0.035) amongst sagittal groups. Amongst vertical groups, significant differences were found for SPL (p<0.001), VW (p=0.021) and needs ratio (p=0.020). On intergroup comparison, SPL (p=0.031), VW (p=0.011) and Need's ratio (p=0.013) were significantly different between skeletal class I and III and VW (p = 0.005) between skeletal class II and III malocclusions. The SPL was significantly different between normodivergent and hypodivergent (p=0.004) and normodivergent and hyperdivergent groups (p<0.001). The VW was significantly different between hyperdivergent and hypodivergent groups (p=0.005) and needs ratio between normodivergent and hyperdivergent groups (p=0.001). Gender difference was significant for SPL which was larger in males as compared to females in skeletal class III malocclusion (p=0.001). Conclusion:Soft palate length, width and need's ratio may vary with the underlying skeletal malocclusion.