Korean J Orthod.  2021 Jul;51(4):250-259. 10.4041/kjod.2021.51.4.250.

Mandibular skeletal posterior anatomic limit for molar distalization in patients with Class III malocclusion with different vertical facial patterns

• Kim SH
• Cha KS
• Lee JW
• Lee SM

• KMID: 2518518
• DOI: http://doi.org/10.4041/kjod.2021.51.4.250

Abstract

Objective
The aim of this study was to compare the differences in mandibular posterior anatomic limit (MPAL) distances stratified by vertical patterns in patients with skeletal Class III malocclusion by using cone-beam computed tomography (CBCT).
Methods
CBCT images of 48 patients with skeletal Class III malocclusion (mean age, 22.8 ± 3.1 years) categorized according to the vertical patterns (hypodivergent, normodivergent, and hyperdivergent; n = 16 per group) were analyzed. While parallel to the posterior occlusal line, the shortest linear distances from the distal root of the mandibular second molar to the inner cortex of the mandibular body were measured at depths of 4, 6, and 8 mm from the cementoenamel junction. MPAL distances were compared between the three groups, and their correlations were analyzed.
Results
The mean ages, sex distribution, asymmetry, and crowding in the three groups showed no significant differences. MPAL distance was significantly longer in male (3.8 ± 2.6 mm) than in female (1.8 ± 1.2 mm) at the 8-mm root level. At all root levels, MPAL distances were significantly different in the hypodivergent and hyperdivergent groups (p < 0.001) and between the normodivergent and hyperdivergent groups (p < 0.01). MPAL distances were the shortest in the hyperdivergent group. The mandibular plane angle highly correlated with MPAL distances at all root levels (p < 0.01).
Conclusions
MPAL distances were the shortest in patients with hyperdivergent patterns and showed a decreasing tendency as the mandibular plane angle increased. MPAL distances were significantly shorter (~3.16 mm) at the 8-mm root level.

Keyword

Class III treatment; Computed tomography; Distalization; Alveolar bone housing

Figure

• 

  Figure 1 Cone-beam computed tomography-reconstructed image of the left lingual side of the mandible. Mylohyoid ridge (yellow line) and submandibular fossa (dotted red line).

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  Figure 2 Measurement of mandibular posterior anatomic limit (MPAL) distance. A, Axial slice at the crown level; dotted red line, posterior occlusal line (POL). B, Axial slice at the root level; orange line, MPAL distance. C, Close-up view of the black box in B; white line, inner cortex; dotted white line, outer cortex of the mandibular body.

• 

  Figure 3 Intraexaminer agreements in mandibular posterior anatomic limit distance measurements by using the Bland-Altman plots. A, Depth of 4 mm, D4mm. B, Depth of 6 mm, D6mm. C, Depth of 8 mm from the cementoenamel junction, D8mm. “95% limit of agreement (LoA)” represents the mean difference ± 1.96 standard deviations. T1, the first measurement; T2, the second measurement, 2 weeks after T1.

• 

  Figure 4 Comparison of mandibular posterior anatomic limit distances between the groups. A, Depth of 4 mm, D4mm. B, Depth of 6 mm, D6mm. C, Depth of 8 mm from the cementoenamel junction, D8mm. Significant differencese are indicated by asterisk (**, ***).

• 

  Figure 5 Scatter plots of depths according to the mandibular plane angles. A, Depth of 4 mm, D4mm. B, Depth of 6 mm, D6mm. C, Depth of 8 mm from the cementoenamel junction, D8mm. PCC, Pearson correlation coefficient. **Correlation is significant at the 0.01 level.

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