Background: There is relatively little appreciation of the changes in maxillary-mandibular relationships occurring during adolescence among subjects with normal and increased overjet. The aim of this study was to assess differences in changes in maxillo-mandibular relationships during the adolescent growth period based on the presence of a normal (< 4 mm) or increased (> 4 mm) overjet in childhood. Our hypothesis was that there is no difference in the change of the A point, nasion, B point (ANB) angle during growth between these two overjet groups. Lateral cephalograms were obtained from 65 subjects taken from the American Association of Orthodontists Foundation (AAOF) Craniofacial Growth Legacy Collections Project. Cephalograms were obtained at ages 7-10 (T0) and 14-17 (T1) with allocation into two groups based on baseline overjet (> 4 mm: group 1, 2-4 mm: group 2). Random effects linear regression was used to account for multiple within-patient measurements with dependent variables including anteroposterior skeletal pattern (based on sella, nasion, A point (SNA); sella, nasion, B point (SNB); and ANB angles). Results: We included a similar number of males (n = 34; 52.3%) and females (n = 31; 47.7%). The mean ANB was higher at baseline in group 1 (5.42, SD 2.16°) than in group 2 (3.08, SD 1.91°). The hypothesis was rejected as the ANB angle reduced by 1.92°more in the larger overjet group with the association being statistically significant after accounting for age and gender (P < 0.001; 95% CI 1.06 to 2.77). No significant gender-related effect (P = 0.624; 95% CI − 0.637 to 1.07) was observed overall. However, there was no significant increase in SNA angle in the > 4 mm overjet group compared to the 2-4 mm group (0.857°, P = 0.271; 95% CI − 0.669 to 2.383). The SNB angle increased by 1.15°m ore in the higher overjet group but there was only weak evidence of an association (P = 0.086; 95% CI − 2.464 to 0.164). Conclusions: A slight straightening of the facial profile was observed in both groups with a statistically significant greater reduction in ANB arising in the group with larger baseline overjet. This translated into a marginal reduction in the overjet in this group.
Orthognathic surgery is a major elective procedure that can pose a significant amount of psychological distress to patients before, during and after surgery. These patients tend to have higher levels of state anxiety and a poor (facial) body image of themselves. Patients less satisfied by their outcomes tend to have had particularly high expectations of surgery beforehand. Therefore, it is important to ensure that there are effective and supportive psychology services in place. Here, we assess the utility and the role of clinical psychology in modern, holistic orthognathic surgery and the tools used to assess patients for further psychological intervention. CPD/Clinical Relevance: Clinicians should be aware of the services available to patients who are transitioning through the orthognathic surgery pathway.
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