Skeletal Class II malocclusion has been called the common orthodontic problem in orthodontic clinics. These malocclusions are often due to mandibular deficiency. Various fixed and removable functional appliances have been used for the treatment of skeletal Class II malocclusion in patients who are undergoing a pubertal growth spurt. The results obtained from human and experimental animal studies showed that functional treatment of skeletal Class II treatment enhances the backward and upward growth potential of the mandibular condyle, and this mechanism provides forward movement of the lower jaw. Many studies reported that the adaptive remodeling of condylar cartilage and glenoid fossa increases with the aid of mechanical forces sourced from a functional appliance. One of the most important factors in mandibular advancement is to provide the condylar cellular activity in a shorter treatment time. The duration of functional appliance therapy depends on several factors such as patient age, sex, severity of the skeletal problem, and appliance type. The functional treatment period varies between 6 and 24 months. The patients undergoing orthodontic treatment often complain about the length of treatment time. In many studies, different techniques such as low level laser, ultrasound stimulation, anabolic steroids, growth hormone, and cyclosporine have been used to reduce functional treatment time and stimulate the condylar cartilage and bone. The purpose of this review is to describe biostimulation of mandibular condyle growth and evaluate the various techniques for mandibular condyle biostimulation.

Accurate patient's record and reliable information are keys to our understanding of orthodontics. The development of integrated three-dimensional tools for diagnosis and treatment planning is one of the most exciting developments in orthodontics as the specialty moves into the 21 ^st century. Three-dimensional imaging techniques provide extensive possibilities for the detailed and precise analysis of the whole craniofacial complex, for virtual (on-screen) simulation and real simulation of orthognathic surgery cases on biomodels before treatment, as well as for the detailed evaluation of the effects of treatment.

Growth biologically and histologically is a composite of morphogenetic and histogenetic changes occurring continuously over a period in response to genetic coding and environmental influence. It is one of the most myriad variations and plays an important role in the etiology of malocclusion and also in the evaluation of diagnosis, treatment planning retention and stability of any case. In this review, various methods currently used as skeletal maturity indicators have been discussed.

Nickel (Ni) is a common component in many orthodontic materials. An allergy to Ni is commonly seen in the population, more frequently in women. Possible allergy to Ni should be a question in the initial patient health history questionnaire. The orthodontic practitioner should be mindful of this allergy during the course of treatment and know how to diagnose a Ni allergy if it appears and subsequent action in treatment and referral if it is suspected. This paper provides a summary of Ni allergy, its epidemiology, diagnosis and recommendations and alternatives to treatment.

Objective: This study was carried out to ascertain if the position of the hyoid bone demonstrates sexual dimorphism. Materials and Methods: This was a retrospective cross-sectional study conducted using patient records from the institution. Institutional Ethical Committee approval was obtained prior to the study. A total of 60 subjects were divided into three groups and studied. Hyoid triangle analysis by Bibby and Preston was carried out to determine the position of the hyoid bone. All radiographs were traced by a single operator and they were retraced to check for measurement error. Results: Student's t-tests and Mann-Whitney U-test were used to find out whether any sexual dimorphism exists. The horizontal distance from the hyoid bone to the retrognathion was found to be significantly larger in males than in females. The hyoid bone is positioned at a lower level in class I and II in males than in females. Also, it was observed that the hyoid angle was significantly greater in males than in females in class II group. Conclusion: Sexual dimorphism was observed in the sample studied.

Aim: The aim of the present study was to investigate the computed tomographic (CT) analysis of condyle-fossa relationship in skeletal Class I and Class II vertically growing males. Materials and Methods: The selected cases were divided into Group I: Control group, which comprised of 15 cases of skeletal Class I occlusion and Group II: Experimental group, which comprised of 15 cases of skeletal Class II malocclusion with cephalometric evaluation done to categorize the growth pattern. Occlusal state was evaluated on study models to exclude dentition with cross-bite, rotations, premature contacts, and absence of teeth. CT scan analyses were done to evaluate temporomandibular joint in both axial and coronal sections in centric occlusion. Results: Patients in Group II showed more angulated condyle, reduced posterior joint space, and decreased superior joint space with significant statistical difference (P < 0.05) in comparison to Group I. Group II also showed decreased glenoid-fossa width, less medial joint space, less condylar width anteroposteriorly but more mediolaterally in comparison to Group I, but it was statistically insignificant. Conclusion: Group II patient with retrognathic mandible showed more angulated condyle, which was positioned more posteriorly in the glenoid fossa with decreased superior joint space and constricted glenoid width in comparison with Group I patient.

Objective: To evaluate the vertical facial morphology in untreated orthodontic patients with Class II division 1 malocclusion. Materials and Methods: The sample comprised of 113 patients (61 females and 52 males) between 8 and 13 years of age, having Class II malocclusion with overjet of >4 mm, no prior history of orthodontic treatment, no craniofacial anomalies and no missing first permanent molars. Skeletal parameters were assessed using pretreatment lateral cephalograms of these patients. Overjet was measured on the study casts, using digital vernier caliper. Descriptive statistics was calculated for age and different vertical facial cephalometric angles. Pearson's correlation was used to correlate various parameters. One-way analysis of variance was used for comparison of means of vertical facial cephalometric angles among three overjet groups (Group I = 5-7 mm, Group II =8-10 mm, Group III = >10 mm). Results: The means of all vertical facial cephalometric parameters were in the normal range representing average facial pattern in patients with Class II division 1 malocclusion, except Jarabak ratio which indicated a tendency toward long facial pattern. No statistically significant correlation was found between overjet and parameters of vertical facial morphology. Frankfort mandibular plane angle was found to have a moderately significant positive correlation with Steiner's mandibular plane angle (r = 0.789**) and Y-axis (r = 0.604**). Conclusion: Patients with Class II division 1 malocclusion have an average vertical growth pattern, Overjet value is not a predictor of vertical facial morphology, There is no significant correlation between overjet and parameters used to assess vertical facial morphology.

Objectives: The objective was to evaluate the effect of corticotomy/corticectomy surgery combined with fixed appliances on tooth movement during the canine retraction phase. Materials and Methods: We assessed 13 postpubertal patients (3 males and 10 females) requiring extraction of both maxillary first premolars. One side of the upper dental arch was treated with a PG retraction spring as a control, while the other side was treated with combined corticotomy/corticectomy surgery and a PG spring. A force of 100 g was used for canine retraction on both sides, with activation of the spring monthly on the control side and once every 15 days on the combined treatment side. A paired t-test was used to assess the difference between the two sides. Results: There was a small but statistically significant reduction in the duration of canine retraction (P < 0.05) and an increase in the rate of canine retraction (P < 0.05) (mm/month) in the combined treatment group. No difference in anchorage loss was observed between the groups. Tipping per millimeter of retraction was significantly different between the groups (P < 0.05). Conclusion: Corticotomy-assisted orthodontics increased the rate of tooth movement during canine retraction in 20% ratio. Relative bodily tooth movement was achieved with the corticotomy combined treatment.

Introduction: As significant tooth size discrepancies prevent an ideal occlusion being produced at the end of orthodontic treatment, absence of a tooth size discrepancy is the seventh "key" for an ideal occlusion. Present study aimed to assess diagnostic reliability of Bolton's ratio for different Angle's malocclusion. Materials and Methods: The study models of 144 patients were divided in three groups based on malocclusion.The mesiodistal tooth width from permanent first molar to first molar were measured on the orthodontic study models. The readings were obtained using a digital vernier caliper to the nearest 0.01mm, with the blades of the caliper held perpendicular to the long axis of the tooth. Results: ANOVA showed no significant difference between all groups except between anterior ratio of Class II group. The mean ratio for the Class III sample was significantly greater than Class I and Class II subjects (P < 0.05). The overall ratio was significantly larger for the Class III subjects than other groups, but with no significance for either gender. Regarding absolute values, mean overall ratio for the different groups was in the order Class III > Class I > Class II with significant difference between the Class I and Class II groups. Conclusion: Subjects with Class III group had a significantly greater prevalence of tooth size discrepancies than Class I and Class II group. Statistically significant difference was seen in the anterior ratio between the males and females of Class II malocclusion and no significant difference between other groups.

Introduction: Bimaxillary protrusion (BP) is a condition that results in the convexity of the face and lip incompetence. There are two forms of BP, a dentoalveolar type and a skeletal type each requiring a different treatment plan. Aims: The aims of this study were to cephalometrically determine the skeletal, dental and soft-tissue features of a sample of Sudanese adults with BP to establish the origin, growth pattern, and presence of gender dimorphism. Design: Descriptive, retrospective study. Setting: Orthodontic Clinics in University of Khartoum, Khartoum Dental Teaching Hospital and University of Science and Technology. Materials and Methods: Pretreatment lateral cephalometric radiographs of 60 patients (30 males and 30 females) with BP (mean age 25.4 ± 6 years) were collected and manually traced. Twenty-two variables were assessed and compared to Sudanese norms (n = 73) which included (35 males and 38 females) of similar age (22.5 ± 3 years) using Student t-test and one sample t-test. Results: The sample revealed significantly smaller SNA, SNB angles and increased incisor protrusion and lip thickness than Sudanese norms (P < 0.05). However, the sample showed significantly higher SNMP, MMPA, upper facial height (UFH), lower facial height, FP% (P < 0.05). Only five gender differences were demonstrated; UFH, U1L1, LlNB mm, LlNB (°), and lower lip length. Conclusion: It can be concluded that facial convexity in Sudanese patients with class 1 molars is a result of bimaxillary dentoalveolar protrusion and increased lip thickness. The patients also revealed a vertical growth pattern with males and females demonstrating similar cephalometric profiles. Treatment of such patient entails extraction of all first premolars with maximum anchorage.

The aim of this report was to present the results of most effective intraoral upper molar distalization system supported with mini-screw. The mini-screws with a 2.0 mm diameter and 8 mm length were used for intra-osseous anchorage. The screws were placed right and left buccal side of the maxilla. Nickel-titanium (NiTi) coil springs were set bilaterally on a 0.016 inch diameter NiTi archwire between the first molar tubes and the first premolar braces. The first premolars were ligated to the mini-screw to provide anchorage. Other mini-screws with a 2.0 mm diameter and 10 mm length were placed right and left palatal side. A spring consisted of a 0.017 × 0.025 inch beta-titanium-alloy wire situated palatally. The activated wire was inserted among the first molar palatal sheath and the mini-screw. Distalization of the upper molars was achieved in average 5 months. According to the results, the maxillary first molars showed mean 4 mm distal movement and 4° distal tipping.

Pycnodysostosis (the Toulouse - Lautrec syndrome), a rare autosomal-recessive disorder is caused by cathepsin K mutation. The main features of the disorder are osteosclerosis, bone fragility, short stature, acro-osteolysis, and delayed closure of the cranial sutures. Other common features are prominent eyes with blue sclera, beaked nose, clavicular dysplasia, obtused mandibular gonial angle, and in some cases visceromegaly. The aim of this case report is to emphasize the main aspects of interest to the orthodontists to give the right treatment to this population.