Thai Journal of Orthodontics

Correction of Anterior Open Bite with Clear Aligner: A Case Report

2025-09-15T09:10:45+07:00

Background: This case report describes the orthodontic management of a 22-year-old Thai male with anterior open bite and a skeletal Class II hyperdivergent pattern. The patient exhibited a convex profile, increased lower anterior facial height, and severe crowding in the lower arch. Malocclusion presented as a large overjet (6 mm), negative overbite (−3 mm), and Class II canine and Class III molar relationships. A clear aligner system was chosen to address both aesthetic concerns and functional needs. Treatment objectives included correction of anterior open bite, establishment of Class I canine and molar relationships, resolution of crowding, improvement of dental midlines, and enhancement of facial profile. A total of 51 pairs of aligners were used in two sets, with interproximal reduction and expansion employed to create space and correct arch form discrepancies. After 26 months of treatment, normal overjet and overbite were achieved, both arches were well aligned, and a Class I molar and canine relationship was established. The patient’s profile improved with a normal smile line and reduced buccal corridor. Posttreatment records confirmed the stability of results with no root resorption or temporomandibular joint symptoms. Cephalometric evaluation showed improved incisor inclinations and a normalized interincisal angle. The patient successfully entered the retention phase with full-time wear of clear retainers. This case highlights the efficacy of clear aligners in treating complex malocclusions that include anterior open bite when case selection, biomechanics, and compliance are carefully managed.

The Relationship between Skeletal Configuration and Soft Tissue Changes af ter Bracket Debonding using Repeatable Photographic Tool

2025-02-24T09:00:25+07:00

Background: The presence of labial orthodontic appliances may impact final esthetic change after debonding. The skeletal configurations that support the soft tissue profile have not been examined their impact on the lip profile after debonding. Objective: To evaluate the effect of bonded orthodontic brackets on the lip change after the debonding and determine the correlation between the change in the lip profile and skeletal configuration. Materials and methods: Photographs were taken with a head fixer in thirty-three patients who had completed fixed orthodontic treatment before and immediately after bracket debonding to investigate the results of the change in the nasolabial and mentolabial angles using the Paired t test ( = 0.05). The posttreatment lateral cephalometric measurements were used to find the correlation of skeletal configuration to the change in soft tissue profile using Pearson’s correlation and one-way ANOVA. Results: Mentolabial angle significantly increased after debonding (P = 0.04). However, the Pearson correlation between soft tissue changes and underlying skeletal configurations was insignificant. (SNA with nasolabial angle: r = 0.13, P = 0.46; SNB with mentolabial angle: r = - 0.00, P = 0.98). Using one-way ANOVA, skeletal configurations demonstrated no significant difference compared with the mean difference in nasolabial angle (P = 0.69) and mean difference in mentolabial angle (P = 0.15). Conclusion: After debonding, the lower lip profile was flattened, however, the upper lip profile was maintained compared with the nose. There was no significant correlation between the change of nasolabial/mentolabial angles and the skeletal configurations.

Differences between Posteroanterior Cephalometric Analysis By 2D Conventional Posteroanterior Cephalograms and 3D Models Generated from Cone Beam Computed Tomography

2025-03-14T10:13:32+07:00

Background: This study compared the differences in posteroanterior (PA) cephalometric analysis on a two-dimensional (2D)-PA cephalogram with cone beam computed tomography (CBCT) via Dolphin imaging software®. Materials and methods: Retrospective data from 35 patients who required orthodontic treatment (35 2D-PA cephalograms and 35 CBCT images) were obtained. All radiographs were imported into the Dolphin imaging program®, aligned, and calibrated for magnification using patients’ tooth sizes derived from dental models. Landmarks were identified, and linear measurements modified from Grummons analysis were evaluated. 2D-PA cephalograms and CBCT measurements were compared via paired t tests (P < 0.05). Results: According to Grummon PA cephalometric analysis, significant differences (P < 0.05) were observed in 10 horizontal, 2 vertical, and 2 mandibular length variables between 2D-PA cephalograms and CBCT. Conclusion: Compared with CBCT, 2D-PA cephalography could acceptably indicate the degree of menton deviation. However, the measurements above the maxillary area from 2D-PA cephalograms are significantly different from those from CBCT. PA cephalograms could be used as an initial tool to evaluate lower facial asymmetry. However, for cases requiring detailed analysis and comprehensive planning, CBCT might be necessary.

The Differences of Perception of Asymmetry on Chin and Lip in Facial Asymmetry Patients Rated by Laypersons and Orthodontists

2025-05-02T09:11:55+07:00

Background: The perception of facial asymmetry plays a critical role in the diagnosis and treatment planning in orthodontics. Objective: This study aimed to evaluate the perception of chin deviation and lip canting and to compare the differences in perception between laypersons and orthodontists. Materials and methods: Fifty-five new patients presenting with facial asymmetry were examined. Subjects were categorized into four groups based on the severity of chin deviation and lip canting. Three-dimensional (3D) facial images and corresponding mirror images were generated. A total of twenty-six laypersons and orthodontists were asked to compare the original and mirror images, after which they categorized the asymmetry into three levels: normal, acceptable, and unacceptable. Results: For chin deviations of 0–2 mm, laypersons generally perceived the asymmetry as normal, while orthodontists classified it as either normal or acceptable. In cases of chin deviation exceeding 2–4 mm, laypersons tended to rate it as acceptable, whereas orthodontists judged it as unacceptable. When the chin deviation exceeded 4 mm, both groups perceived it as unacceptable. Regarding lip canting of 0–1 mm, both laypersons and orthodontists classified it as normal. When lip canting increased to over 1–2 mm, laypersons still considered it normal, while orthodontists classified it as acceptable. Lip canting exceeding 2–3 mm was generally perceived by both groups as acceptable, and canting greater than 3 mm was considered unacceptable by both laypersons and orthodontists. Conclusion: Orthodontists exhibited greater sensitivity than laypersons in perceiving both chin deviation and lip canting.

Orthodontic Debonding Procedures: A Survey of Thai Orthodontists

2025-08-06T11:01:32+07:00

Background: Orthodontic debonding procedures impact enamel integrity. Despite various proposed techniques, no standardized protocol exists. Understanding commonly used methods among Thai orthodontists may aid in developing practical, evidence-based guidelines. Objective: To investigate current practices of Thai orthodontists regarding bracket removal, adhesive removal, and enamel polishing during debonding, aiming to identify prevailing clinical trends and support standardized protocol development. Materials and methods: A structured four-part questionnaire was distributed to 726 active members of the Thai Association of Orthodontists via electronic message and postal mail. It covered: 1) respondents’ general background; 2) bracket type, surface preparation, and adhesive system frequently used; 3) debonding instruments and procedures for metal and ceramic bracket debonding; and 4) adhesive removal, enamel polishing, and time spent. Descriptive statistical analyses were performed. Results: 389 orthodontists (53.58 %) responded; and 388 responses were analyzed. Bracket debonding pliers were most frequently used, typically applying squeezing force occlusogingivally. For adhesive removal, up to four instruments were used sequentially, with high-speed white stone bur favored in both one- and multi-step methods. Rubber cup with slurry pumice was common for enamel polishing. Water was the primary coolant used in both adhesive removal and enamel polishing. Most entire procedures took under 15 minutes per arch. Conclusion: Variability in orthodontic debonding practices among Thai orthodontists was observed, the findings suggest that instrument selection is influenced by the need to balance clinical effectiveness with procedural efficiency, aiming to achieve optimal outcomes within a reasonable chair time.

Issues of Fake Braces: A Review of Literature

2025-05-16T09:47:51+07:00

The rising trend of fake braces, particularly in Southeast Asia, has raised significant health concerns. Regarded as a fashion statement, fake braces are unregulated orthodontic appliances sold through social media and online marketplaces. Unlike conventional braces, fake braces are often self-applied or installed by unqualified individuals, lacking the oversight of licensed professionals. Adolescents and young adults are drawn to fake braces because of their perception as a status symbol, affordability and potential to be aesthetically customised. However, serious concerns exist around oral health, including periodontal damage, infection, allergic reactions and unintentional ingestion due to the low-quality materials. These risks are further highlighted by reports of mortality and morbidity. According to studies, fake braces exhibit irregular surface textures, encouraging the growth of germs and the creation of biofilms, which exacerbates oral problems such as caries. Despite these risks, research on the toxicity and clinical impacts of fake braces remains sparse. Laboratory analyses indicate the presence of standard alloy components, but the long-term safety of these materials in unregulated devices is unverified. Efforts to regulate the sale and installation of fake braces are undermined by their easy accessibility online. This review examines the sociocultural drivers, material composition, associated risks and regulatory challenges surrounding the use of fake braces. It also emphasises the need for public education, stricter enforcement of medical device regulations, and further research on the detrimental effects of fake braces on oral and systemic health. Robust evidence is crucial for policy interventions to curb this alarming trend.