Dimensional Changes of Masticatory Muscles Following Camouflage Orthodontic Treatment in Skeletal Class III Patients: A Pilot MRI-Based Clinical Trial

Objectives: To evaluate dimensional changes in masticatory muscles, dentoskeletal relationships, and correlations between muscular and vertical skeletal changes following Class III camouflage treatment.

Methods: This clinical trial included ten participants with skeletal Class III malocclusion who met the eligible criteria and provided them non-extraction camouflage treatment using Class III elastics. MR images (T1W) and lateral cephalograms were taken before treatment (T0) and after achieving normal occlusion (T1). Length, width, and cross-sectional area (CSA) of the masseter (MM), temporalis (TM), lateral pterygoid (LPM), and medial pterygoid (MPM) muscles were measured using MicroDicom DICOM viewer software. Dentoskeletal changes were assessed by Dolphin® imaging software. Statistical analyses were conducted using IBM® SPSS® software to analyze differences between T0 and T1, and correlations.

Results: Significant changes were observed in jaw-closing muscles, with increased length (MM 1.0±0.4 mm, TM 0.7±0.2 mm, MPM 0.5±0.5 mm), decreased thickness (MM 1.3±0.7 mm, TM 0.2±0.2 mm, MPM 0.8±0.6 mm), and decreased CSA (MM 79.3±70.5 mm2, TM 16.2±14.9 mm2, MPM 16.2±8.8 mm2). Minimal changes were noted in lateral pterygoid muscles. No significant correlations were found between muscular changes and vertical skeletal changes.

Conclusions: Masseter, temporalis, and medial pterygoid muscles exhibited significant changes following Class III camouflage treatment using Class III elastics, but no significant correlations were observed between muscular dimensional changes and vertical skeletal changes.

1. Stellzig-Eisenhauer A, Lux CJ, Schuster G. Treatment decision in adult patients with class III malocclusion: orthodontic therapy or orthognathic surgery?. Am J Orthod Dentofac Orthop. 2002;122(1):27–8.

2. Ngan P, Moon W. Evolution of class III treatment in orthodontics. Am J Orthod Dentofac Orthop. 2015;148(1): 22-36.

3. Park JH, Yu J, Bullen R. Camouflage treatment of skeletal Class III malocclusion with conventional orthodontic therapy. Am J Orthod Dentofac Orthop. 2017;151(4):804-11.

4. Sakoda KL, Pinzan A, Cury SEN, Bellini-Pereira S, Castillo AA-D, Janson G. Class III malocclusion camouflage treatment in adults: a systematic review. J Dent Open Access. 2019;1(1):1-12.

5. de Alba y Levy JA, Chaconas SJ, Caputo AA. Effects of orthodontic intermaxillary class III mechanics on craniofacial structures. part II - computerized cephalometrics. Angle Orthod. 1979;49(1):29-36.

6. Hisano M, Chung C ryung J, Soma K. Nonsurgical correction of skeletal class III malocclusion with lateral shift in an adult.Am J Orthod Dentofac Orthop. 2007;131(6):797-804.

7. Burns NR, Musich DR, Martin C, Razmus T, Gunel E, Ngan P. Class III camouflage treatment: what are the limits?. Am J Orthod Dentofac Orthop. 2010;137(1):9.e1-9.e13.

8. Nakamura M, Kawanabe N, Kataoka T, Murakami T, Yamashiro T, Kamioka H. Comparative evaluation of treatment outcomes between temporary anchorage devices and class III elastics in class III malocclusions. Am J Orthod Dentofac Orthop. 2017;151(6):1116-24.

9. Pan Y, Chen S, Shen L, Pei Y, Zhang Y, Xu T. Thickness change of masseter muscles and the surrounding soft tissues in female patients during orthodontic treatment: a retrospective study. BMC Oral Health. 2020;20(1):1-10.

10. Suchato W CJ. Cephalometric evaluation of the dentofacial complex of Thai adults. J Dent Assoc Thai. 1984;34(5): 233-43.

11. Sutthiprapaporn P Manosudprasit A, Manosudprasit M, Pisek P, Phaoseree N, Manosudprasit A. Establishing esthetic lateral cephalometric values for Thai adults after orthodontic treatment. Khon Kaen Dent J. 2020;23(2):31-41.

12. Uslu O, Arat ZM, Beyazoya M, Taskiran OO. Muscular response to functional treatment of skeletal open-bite and deep-bite cases: an electromyographic study. World J Orthod. 2010;11(4):85-94.

13. Piancino MG, Falla D, Merlo A, Vallelonga T, De Biase C, Dalessandri D, et al. Effects of therapy on masseter activity and chewing kinematics in patients with unilateral posterior crossbite. Arch Oral Biol. 2016;67:61-7.

14. Lione R, Kiliaridis S, Noviello A, Franchi L, Antonarakis GS, Cozza P. Evaluation of masseter muscles in relation to treatment with removable bite-blocks in dolichofacial growing subjects: a prospective controlled study. Am J Orthod Dentofac Orthop. 2017;151(6):1058-64.

15. Paes-Souza S de A, Garcia MAC, Souza VH, Morais LS, Nojima LI, Nojima M da CG. Response of masticatory muscles to treatment with orthodontic aligners: a preliminary prospective longitudinal study. Dental Press J Orthod. 2023;28(1):1-26.

16. Jokaji R, Ooi K, Yahata T, Nakade Y, Kawashiri S. Evaluation of factors related to morphological masseter muscle changes after preoperative orthodontic treatment in female patients with skeletal class III dentofacial deformities. BMC Oral Health. 2022;22(1):1-7.

17. Zanon G, Contardo L, Reda B. The impact of orthodontic treatment on masticatory performance: a literature review. Cureus. 2022;14(10):e30453.

18. Narici M. Human skeletal muscle architecture studied in vivo by non-invasive imaging techniques: functional significance and applications. J Electromyogr Kinesiol. 1999;9(2): 97-103.

19. Katti G, Ara SA, Shireen A. Magnetic resonance imaging (MRI)–a review. Int J Dent Clin. 2011;3(1):65-70.

20. Amabile C, Moal B, Chtara OA, Pillet H, Raya JG, Iannessi A, et al. Estimation of spinopelvic muscles’ volumes in young asymptomatic subjects: a quantitative analysis. Surg Radiol Anat. 2017;39(4):393-403.

21. Murakami M, Iijima K, Watanabe Y, Tanaka T, Iwasa Y, Edahiro A, et al. Development of a simple method to measure masseter muscle mass. Gerodontology. 2020;37(4):383-8.

22. Georgiakaki I, Tortopidis D, Garefis P, Kiliaridis S. Ultrasonographic thickness and electromyographic activity of masseter muscle of human females. J Oral Rehabil. 2007;34(2):121-8.

23. Celakil D, Ozdemir F, Eraydin F, Celakil T. Effect of orthognathic surgery on masticatory performance and muscle activity in skeletal class III patients. Cranio. 2018;36(3):174-80.

24. Spronsen PH van, Weijs WA, Valk J, Prahl-Andersen B, Ginkel FC van. Relationships between jaw muscle cross-sections and craniofacial morphology in normal adults, studied with magnetic resonance imaging. Eur J Orthod. 1991;13(5):351-61.

25. Changsiripun C, Pativetpinyo D. Masticatory function after bite-raising with light-cured orthodontic band cement in healthy adults. Angle Orthod. 2020;90(2):263-8.

26. Antonarakis GS, Kiliaridis S. Predictive value of masseter muscle thickness and bite force on class II functional appliance treatment: a prospective controlled study. Eur J Orthod. 2015;37(6):570-7.

27. Wasinwasukul P, Thongudomporn U. Masticatory muscle responses to orthodontic bite-raising appliances. J Dent Assoc Thai. 2022;72(3):427-33.

28. Carter LA, Geldenhuys M, Moynihan PJ, Slater DR, Exley CE, Rolland SL. The impact of orthodontic appliances on eating - young people’s views and experiences. J Orthod. 2015;42(2):114-22.

29. Weijs WA, Hillen B. Correlations between the crosssectional area of the jaw muscles and craniofacial size and shape. Am J Phys Anthropol. 1986;70(4):423-31.

30. Togninalli D, Antonarakis GS, Papadopoulou AK. Relationship between craniofacial skeletal patterns and anatomic characteristics of masticatory muscles: a systematic review and meta-analysis. Prog Orthod. 2024;25(1):36.

Panpitakkul P, Jorns TP, Phuttharak W, Chaichit R, Sutthiprapaporn P. Dimensional Changes of Masticatory Muscles Following Camouflage Orthodontic Treatment in Skeletal Class III Patients: A Pilot MRI-Based Clinical Trial: Original articles. Oral Sci Rep [Internet]. 2025 Sep 19 [cited 2025 Oct 23];46(3):170-181. Available from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=513

Panpitakkul, P., Jorns, TP., Phuttharak, W., Chaichit, R. & Sutthiprapaporn, P. (2025). Dimensional Changes of Masticatory Muscles Following Camouflage Orthodontic Treatment in Skeletal Class III Patients: A Pilot MRI-Based Clinical Trial. Oral Sci Rep, 46(3), 170-181. Retrieved from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=513

Panpitakkul, P., Teekayu Plangkoon Jorns,Warinthorn Phuttharak,Rajda Chaichit and Pipop Sutthiprapaporn. 2025. "Dimensional Changes of Masticatory Muscles Following Camouflage Orthodontic Treatment in Skeletal Class III Patients: A Pilot MRI-Based Clinical Trial." Oral Sci Rep, 46(3), 170-181. https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=513

Panpitakkul, P. et al. 2025. 'Dimensional Changes of Masticatory Muscles Following Camouflage Orthodontic Treatment in Skeletal Class III Patients: A Pilot MRI-Based Clinical Trial', Oral Sci Rep, 46(3), 170-181. Retrieved from https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=513

Panpitakkul, P., Jorns, TP., Phuttharak, W., Chaichit, R. and Sutthiprapaporn, P. "Dimensional Changes of Masticatory Muscles Following Camouflage Orthodontic Treatment in Skeletal Class III Patients: A Pilot MRI-Based Clinical Trial", Oral Sci Rep, vol.46, no. 3, pp. 170-181, Sep. 2025.

Panpitakkul, P., Jorns, TP., Phuttharak, W., et al. "Dimensional Changes of Masticatory Muscles Following Camouflage Orthodontic Treatment in Skeletal Class III Patients: A Pilot MRI-Based Clinical Trial." Oral Sci Rep, vol.46, no. 3, Sep. 2025, pp. 170-181, https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=513