Patient selection Patients in the study groups were selected from the growing Korean patients diagnosed by the Department of Orthodontics, Wonkwang University Dental Hospital from July 2000 to June 2011. This retrospective study was approved by the institutional review board of the Dental Hospital of Wonkwang University (approval number WKDIRB201408-01). Patients were classified into either a Class III activator treatment group (AG) or a Class III control group (CG). The AG was comprised of 22 patients (9 boys, 13 girls) treated with Class III activator over the mandibular growth peak without combination or alteration with other growth modification appliances. The CG was comprised of 17 patients (6 boys, 11 girls) who were not treated with removable appliances that could modify growth or mandibular position (). Values are presented as mean ± standard deviation or total number: number of boys/girls. AG, Class III activator treatment group; CG, Class III control group; T1, initial stage; T2, post-activator treatment or post-mandibular growth peak stage; T3, long-term follow-up stage.


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Inclusion criteria included skeletal Class III discrepancy beyond the normal range (normal mean ± 1 standard deviation) based on the ANB angle and Wits appraisal measurements according to individual growth state; premandibular growth peak stage at the time of diagnosis; no previous orthodontic treatment; no craniofacial anomalies including cleft lip and palate; and availability of adequate specific supplementary data including diagnostic records, treatment progress notes, and lateral cephalometric radiographs. Skeletal maturity The total treatment period was divided into three stages; the initial stage (T1), the post-activator treatment or post-mandibular growth peak stage (T2), and the long-term follow-up stage (T3). Skeletal maturation was determined by lateral cephalometric radiographs using a modified version of the cervical vertebral maturation method (modified CVM method), independently of chronologic age. The stages of cervical vertebral maturation were all classified by the same investigator (HKR). All patients were in pre-mandibular growth peak stage (CS1-CS3) at T1, post-mandibular growth peak stage (CS4-CS5) at T2, and more than a year after mandibular growth peak stage (CS5-CS6) at T3. Treatment protocols In the AG, the construction bite of the activator was taken in the most posterior mandibular position with various heights, according to the patients' individual conditions.

The appliances fitted well in the patients' mouths. Clinicians instructed the patients to wear the appliances for at least 14 hours per day. All AG patients were treated via the same protocol by the residents, under the supervision of faculty supervisors.

AG patients wore the activator consistently until post-mandibular growth peak stage (T2), at which time the second phase of fixed appliance treatment was recommended. After activator treatment, comprehensive orthodontic treatment was initiated in 18 patients (8 boys, 10 girls).

Orthodontic treatment combined with orthognathic surgery was recommended to 4 other patients (1 boy, 3 girls). CG patients were treated via various means depending on their individual conditions.

Four girls were observed for habit control, 5 patients (3 boys, 2 girls) were treated with removable appliances for dental alignment, and 8 patients (3 boys, 5 girls) initially underwent fixed appliance treatment on only their maxillary dentition. After T2, 13 patients (5 boys, 8 girls) received comprehensive orthodontic treatment and 4 patients (1 boy, 3 girls) were observed regularly for possible further growth of the jaws. Orthodontic treatment combined with orthognathic surgery was recommended to 3 patients (1 boy, 2 girls) at T3. Cephalometric analysis Lateral cephalometric radiographs were acquired via a Planmeca PM 2002 cc Proline Ceph (Planmeca, Helsinki, Finland) until October 31st 2002, then via a Planmeca Promax Dimax3 Ceph (Planmeca) thereafter, with the patients in natural head position. Descargar libro lazarillo de tormes vicens vives libros pdf. Lateral cephalometric radiographs were taken at T1, T2, and T3 in each patient. Original films taken with the Planmeca PM 2002 cc Proline Ceph were scanned and converted into a digital format via a Vidar Diagnostic Pro Plus Film Digitizer (Vidar Systems Corporation, Herndon, VA, USA). All lateral cephalometric radiographs were digitized and calculated using V-ceph 6.0 software (Osstem Implant Co., Ltd., Seoul, Korea) by the same investigator (HKR).

Magnification was corrected for all the lateral cephalometric radiographs. Cephalometric analysis was conducted to identify the changes in 20 measurements ( and, and ). Landmarks and reference planes. Statistical analysis Prior to statistical analysis, intra-examiner variation was evaluated. Evaluations of stages of the cervical vertebrae were performed twice, 2 weeks apart, and there was no difference. Also, 10 randomly selected radiographs were retraced and remeasured by the same investigator (HKR) 2 weeks after the initial analysis, the paired t-test was used to compare the two data-sets of registrations, and there was no significant difference between the data-sets ( p > 0.05). All of the intraclass correlational coefficients were above 0.904, suggesting that intra-examiner agreement was excellent.

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