Effects of orthodontic camouflage treatment vs orthodontic-orthognathic surgical treatment on condylar stability in Class II hyperdivergent patients with severe temporomandibular joint osteoarthrosis: a retrospective observational study

Objectives: To investigate the differences in profile changes and stability of the condyles between orthodontic camouflage treatment assisted by vertical control and that accomplished via orthognathic surgery in Class II hyperdivergent patients with TMJ osteoarthrosis (TMJOA). Materials and Methods: This study included 27 Class II hyperdivergent TMJOA patients (54 condyles) who received orthodontic camouflage treatment (13 patients) or orthognathic surgery (14 patients) Cone-beam computerized tomography (CBCT) scans were taken before treatment (T1) and 1 year after treatment (T2). Cephalometric and TMJ measurement analyses were conducted to evaluate the change in profile and condyles from T1 to T2 using independent samples t-test and paired t-test. Three-dimensional (3D) deviation analysis was also performed to evaluate the stability of condyles from T1 to T2. Results: Both groups showed significant profile improvement from T1 to T2. The changes in Z angle and ANB angle were larger in the surgical group than in the orthodontic group. Condylar width, length, and height remained stable after treatment in the orthodontic group (P > .05), while they reduced by 0.67 & PLUSMN; 0.85 mm, 1.14 & PLUSMN; 1.10 mm, and 1.07 & PLUSMN; 1.34 mm, respectively, in the surgical group (P < .05). Superior, posterior, medial, and lateral joint spaces were significantly reduced in the orthodontic group (P < .05). 3D deviations intuitively showed that condylar bone in the orthodontic group was more stable than that in the surgical group.Conclusions: For Class II hyperdivergent patients with severe TMJOA, orthodontic camouflage treatment with vertical control can effectively maintain the stability of condyles while significantly improving the profile. Surgical treatment yields a better profile but may increase the risk of condyle resorption. (Angle Orthod. 2023;93:458-466.)