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International Poster Journal of Dentistry and Oral Medicine



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Int Poster J Dent Oral Med 14 (2012), No. 2     15. June 2012

Int Poster J Dent Oral Med 2012, Vol 14 No 2, Poster 597

Fixed Mandibular Growth Modification Appliance Treatment: A 3-D Analysis of the Hard Tissues Changes

Language: English

PhD Postgraduate Dr. Osama Al-ali, Teaching Assistant, Prof. Dr. Nasser Sawan, HOD, Assoc. Prof. Dr. Ayham Kaddah,
Department of Orthodontics, Faculty of Dentistry, Damascus University, Damascus, Syria
Prof. Dr. Balvinder Khambay,
Department of Orthodontics, Glasgow Dental Hospital and School, United Kingdom

19-23 June, 2011
87th Congress of the European Orthodontic Society
Istanbul, Turkey


Fixed Lingual Mandibular Growth Modification Appliance (FLMGMA) is a novel Class II functional appliance, designed by Dr. Al-ali and its effects are presented in the case report by 3D cone beam CT data.

Fig. 1: FLMGMA

Case Details

A 12.7 year old female presented with a Cl II skeletal pattern with a mildly increased vertical relationship (Table 1). The patient was in the "MP3cap" maturation stage.1 The treatment aim was to stimulate mandibular forward growth to correct the underlying skeletal discrepancy. This would be followed by fixed appliance treatment on a non-extraction basis.

Fig. 2a: Initial Fig. 2b: Initial
Fig. 2c: Initial Fig. 2d: Initial
Fig. 2e: Initial Fig. 3a: Beginning
Fig. 3b: Beginning Fig. 3c: Beginning
Fig. 3d: Beginning Fig. 3e: Beginning
Fig. 4a: After 8 Months Fig. 4b: After 8 Months
Fig. 4c: After 8 Months Fig. 4d: After 8 Months
Fig. 4e: After 8 Months


The FLMGMA in this single patient encouraged forward mandibular growth (SNB), increased total mandibular length and distal movement of the upper dentition in the A-P direction. There was a negligible change in the vertical dimension both skeletally and dentally, (Table 1). 3D Images and Analysis were created using InVivo 5 Dental software (trademark of Anatomage Inc., 111 N. Market St. #800, San Jose, Calif, CA 95113).

Fig. 5a: Initial Fig. 5b: Initial
Fig. 5c: Initial Fig. 5d: Initial
Fig. 5e: Initial Fig. 5f: Initial
Fig. 6a: After 8 Months Fig. 6b: After 8 Months
Fig. 6c: After 8 Months Fig. 6d: After 8 Months
Fig. 6e: After 8 Months Fig. 6f: After 8 Months
Fig. 7a: 3D Superimposition Fig. 7b: 3D Superimposition
Fig. 7c: 3D Superimposition Fig. 7d: 3D Superimposition
Fig. 7e: 3D Superimposition Fig. 7f: 3D Superimposition
Fig. 8a: 3-D Cephalometric Superimposition / Cutaway view Fig. 8b: 3-D Cephalometric Superimposition / Cutaway view
Fig. 8c: 3-D Cephalometric Superimposition / Cutaway view
Fig. 9: 3-D Cephalometric Tracing
Anteroposterior Analysis
Skeletal   before after
SNA (°) 82,5 81,8
SNB (°) 75,8 78,0
ANB (°) 6,7 3,8
Wits appraisal (mm) 5,2 1,0
Mx Length (mm) 54,2 54,0
R Md Total Length (mm) 109,2 111,5
L Md Total Length (mm) 108,3 112,4
R Md Body Length (mm) 76,7 76,8
L Md Body Length (mm) 78,1 78,5
Dental   before after
Overjet (mm) 8,6 4,2
U1 Sagit Inclination (°) 117,9 115,4
L1 Sagit Inclination (°) 99,6 95,9
U6 Sagit Inclination (°) 83,4 74,2
U6 Sagit Position (mm) 0,2 2,5
L6 Sagit Inclination (°) 77,2 76,3
L6 Sagit Position (mm) 36,3 34,3
Vertical Analysis
Skeletal   before after
Mx Sagit Line Ang (°) 7,6 9,9
R Md Sag Line Ang (°) 36,3 38,0
L Md Sag Line Ang (°) 37,0 39,3
R Gonial Ang (°) 131,8 134,7
L Gonial Ang (°) 131,5 133,9
Me(z) (mm) 102,3 105,8
R Go(z) (mm) 75,5 78,3
L Go(z) (mm) 73,9 76,1
R Md Ramal Height (mm) 47,5 49,6
L Md Ramal Height (mm) 45,4 49,2
Low Fac Height (mm) 59,0 60,2
Dental   before after
Overbite (mm) 4,2 2,7
U1 Ver Develop (mm) 25,7 26,1
U6 Ver Develop (mm) 20,2 19,1
L1 Ver Develop (mm) 35,7 35,6
L6 Ver Develop (mm) 23,3 23,2
Transversal Analysis
Skeletal   before after
Cranial Base Width (mm) 92,0 94,0
Mx Base Width (mm) 69,6 69,6
Md Base Width (mm) 81,3 82,2
Dental   before after
Mx 3-3 Crown Width (mm) 37,0 38,4
Mx 3-3 Root Width (mm) 23,6 24,8
Md 3-3 Crown Width (mm) 29,8 28,6
Md 3-3 Root Width (mm) 20,4 22,9
Mx 6-6 Crown Width (mm) 52,0 55,0
Mx 6-6 Root Width (mm) 52,0 55,2
Md 6-6 Crown Width (mm) 46,8 47,3
Md 6-6 Root Width (mm) 55,3 56,9
Tab. 1: Three Dimensional Cephalometric Analysis (According to Cho, 2009)2


The FLMGMA is aesthetic, cost effective to produce and clinically easy to handle. It is efficient, 8 months treatment time in this patient, and may produce favorable skeletal and dental changes. The FLMGMA needs further clinical evaluation to provide robust clinical evidence for its routine use including the use of a control group.


  1. Uysal T, Ramoglu S I, Basciftci F A, Sari Z. Chronologic age and skeletal maturation of the cervical vertebrae and hand-wrist: Is there a relationship? Am J Orthod Dentofacial Orthop 2006;130:622-8
  2. Cho H J. A Three-Dimensional Cephalometric Analysis. J Clin Orthod 2009;43(4):235-252.


FLMGMA: Fixed Lingual Mandibular Growth Modification Appliance
3D: three dimensional
"MP3cap": Skeletal maturation stage, evaluated on hand X-ray radiographs according to the method of Björk, and Grave and Brown.1
A-P direction: anterio-posterior direction
Cone Beam CT: Cone Beam Computed Tomography

This Poster was submitted by Dr. Osama Al-ali.

Correspondence address:
PhD Postgraduate Dr. Osama Al-ali
Damascus University
Faculty of Dentistry, Department of Orthodontics
P.O.Box: 10256