ABSTRACT
Introduction:
The timing of orthodontic treatment can significantly impact skeletal and dental development, particularly during the adolescent growth spurt. This study investigates the influence of early, mid, and late-treatment initiation on mandibular growth, dental alignment, and occlusal correction in adolescents.
Methods:
A total of 60 adolescents were divided into three groups based on their skeletal maturity: early, mid, and late. Key parameters including mandibular growth, dental alignment, and occlusal changes were measured at baseline, mid-treatment, and post-treatment. A two-year follow-up was conducted, and a cephalometric analysis was performed.
Results:
The early-treatment group showed the most significant skeletal changes, particularly in mandibular growth. The mid and late groups demonstrated better dental alignment outcomes. Statistical analysis revealed significant differences in mandibular growth between groups (P < 0.05).
Conclusion:
Treatment timing plays a critical role in determining skeletal and dental outcomes. Early treatment enhances skeletal changes, while later treatment is more effective for dental alignment.
KEYWORDS: Adolescent growth spurt, dental alignment, mandibular growth, orthodontic treatment timing, skeletal development
INTRODUCTION
Orthodontic treatment timing is crucial in optimizing skeletal and dental outcomes in adolescents. During the adolescent growth spurt, the skeletal system is more malleable, and orthodontic interventions can result in significant skeletal changes. Early treatment, especially in cases involving Class II malocclusions, can help guide mandibular growth and improve skeletal structure.[1,2,3,4,5]
Research by Hamidaddin (2024) underscores the importance of aligning orthodontic treatment with growth spurts to achieve the best outcomes.[2] However, delayed treatment can still lead to significant dental improvements, even if skeletal changes are less pronounced, as seen in the findings of Baccetti et al. (2012).[4] Individual factors such as body mass index (BMI) can also influence the timing and results of orthodontic treatment, as shown by DuPlessis et al. (2016).[6] This study aims to evaluate the impact of early-, mid-, and late-treatment initiation on skeletal and dental development in adolescents.
MATERIALS AND METHODS
This study was designed as a longitudinal cohort investigation involving 60 adolescents aged 12 to 16 years. The participants were categorized into three groups: early, mid, and late, based on skeletal maturity determined by hand-wrist radiographs. The inclusion criteria were adolescents with malocclusions requiring orthodontic treatment, no previous orthodontic intervention, and the absence of any craniofacial abnormalities.
PARAMETERS EVALUATED
Skeletal Growth: Assessed through mandibular length measurements (Condylion-Gnathion) using cephalometric radiographs.
Dental Alignment: Measured using dental casts and Little’s Irregularity Index, assessing crowding and spacing.
Occlusal Adjustments: Evaluated using Angle’s classification, focusing on Class II and Class III malocclusions.
Each group underwent comprehensive orthodontic treatment using fixed appliances. Follow-up assessments were conducted at baseline, mid-treatment (12 months), and post-treatment (24 months). Data were analyzed using repeated measures ANOVA, with a significance level of P < 0.05.
RESULTS
The study demonstrated significant variations in skeletal and dental outcomes based on treatment timing. Early treatment resulted in the most pronounced skeletal changes, particularly in mandibular growth, while dental alignment improved across all groups. The mid-treatment group showed balanced results in both skeletal and dental parameters, whereas the late-treatment group displayed minimal skeletal changes but better dental alignment [Tables 1 and 2].
Table 1.
Mandibular growth changes (mean growth in mm)
| Group | Baseline (mm) | Mid-treatment (mm) | Post-treatment (mm) | P |
|---|---|---|---|---|
| Early | 72.3±3.0 | 75.0±3.4 | 78.2±3.2 | <0.05 |
| Mid | 73.2±3.1 | 74.6±3.5 | 76.1±3.5 | <0.05 |
| Late | 73.0±2.9 | 73.9±3.2 | 74.4±3.3 | >0.05 |
Table 2.
Dental alignment changes (mean crowding score reduction)
| Group | Baseline | Mid-treatment | Post-treatment | P |
|---|---|---|---|---|
| Early | 8.5 | 5.3 | 2.0 | <0.05 |
| Mid | 8.7 | 6.0 | 2.4 | <0.05 |
| Late | 8.9 | 6.2 | 2.6 | <0.05 |
DISCUSSION
The results of this study align with previous research emphasizing the importance of treatment timing in orthodontics. Sandhu et al. (2024) found that early intervention during mixed dentition can significantly enhance skeletal outcomes, particularly mandibular growth.[1] Our findings corroborate this, as the early-treatment group exhibited the greatest mandibular growth.
Hamidaddin (2024) and Szemraj-Folmer et al. (2021) have both emphasized the role of growth spurts in maximizing skeletal changes during orthodontic treatment.[2,3] In this study, the early-treatment group benefited most from skeletal modifications, while the mid and late groups achieved better dental alignment, consistent with the findings of Baccetti et al. (2012).[4]
The late-treatment group showed minimal skeletal changes, which aligns with Talic (2011), who warned of the limitations in skeletal adaptability in the later stages of adolescence.[5] However, dental alignment improvements were more significant in this group, supporting the idea that late treatment may be more appropriate for addressing dental concerns rather than skeletal issues.
DuPlessis et al. (2016) highlighted the relationship between BMI and dental eruption patterns, suggesting that individual growth trajectories should be considered when planning orthodontic interventions.[6] This supports the need for personalized treatment plans that account for the patient’s growth phase and individual factors.[7,8,9,10]
CONCLUSION
This study demonstrates that the timing of orthodontic treatment has a profound impact on skeletal and dental development in adolescents. Early intervention during the adolescent growth spurt leads to significant skeletal changes, particularly in mandibular growth. In contrast, mid and late treatments are more effective in improving dental alignment. These findings emphasize the importance of individualized treatment planning based on the patient’s growth phase to optimize treatment outcomes. Further studies should explore additional factors such as body mass index and genetic influences to enhance understanding of treatment timing in orthodontics.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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