|
1
|
Macrì M, Di Carmine M, Scarano A, Festa F. Oral Implications of Herbst Device Modification: A Case Report. CHILDREN (BASEL, SWITZERLAND) 2025; 12:531. [PMID: 40426710 PMCID: PMC12110008 DOI: 10.3390/children12050531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2025] [Revised: 03/31/2025] [Accepted: 04/19/2025] [Indexed: 05/29/2025]
Abstract
BACKGROUND Many studies analyse the effectiveness of the Herbst device in the treatment of dentoskeletal Class II malocclusion due to mandibular retrusion. This fixed device was devised by Emil Herbst for Class II treatment using a bite jumping, i.e., a device that holds the jaw in a forced anterior position. Comparison of the results obtained in numerous studies is difficult because they are often not comparable and not congruent due to a number of variables that prevent standardization. METHODS The purpose of the present study is to report some clinical-level considerations that may be important in order to obtain more predictable therapeutic outcomes. The simplified design of the Herbst device offers better patient comfort and easier cleanability but may show some disadvantages, such as less anchorage. RESULTS The device was evaluated in conjunction with the multi-bracket phase that preceded Herbst therapy and concluded after the device was removed. The therapy was performed in the absence of skeletal anchorage. CONCLUSIONS In our opinion, standardization of therapy according to precise protocols may positively affect the therapeutic outcomes by achieving faster occlusal stabilization, more proper neuro-muscular balance, less stress on anchor units, and shorter treatment time.
Collapse
Affiliation(s)
- Monica Macrì
- Department of Innovative Technologies in Medicine & Dentistry, University “G. d’Annunzio” of ChietiPescara, 66100 Chieti, Italy
| | | | | | | |
Collapse
|
|
2
|
Atole S, Kamble R, Jadhav VV, Kaiser J, Singh S, Tidke S. Revolutionizing Class II Division 1 Malocclusion Treatment With Forsus Appliance: A Clinical Case. Cureus 2024; 16:e66930. [PMID: 39280555 PMCID: PMC11401629 DOI: 10.7759/cureus.66930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 08/15/2024] [Indexed: 09/18/2024] Open
Abstract
Angle's Class II Division 1 malocclusion is illustrated as a prominent maxilla along with protrusive maxillary anteriors, mandibular retrognathism, or both, often leading to functional and aesthetic concerns. Effective management of this condition in growing patients typically involves a combination of functional and orthodontic appliances to correct dental and skeletal discrepancies. Treating this malocclusion in the deceleration stages of growth is often challenging for orthodontists. This case report exemplifies the potency of Forsus appliance in addressing Class II Division 1 malocclusion in growing patients, underscoring its role in achieving favorable orthodontic outcomes.
Collapse
Affiliation(s)
- Srushti Atole
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ranjit Kamble
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vikrant V Jadhav
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Japneet Kaiser
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shefali Singh
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samiksha Tidke
- Department of Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
|
3
|
Cattaneo PM, Holm A, Yung AKC, Isidor S, Cornelis MA. A Three-Dimensional Evaluation of Skeletal and Dentoalveolar Changes in Growing Class II Patients after Functional Appliance Therapy: A Retrospective Case-Control Study. J Clin Med 2024; 13:1315. [PMID: 38592176 PMCID: PMC10932136 DOI: 10.3390/jcm13051315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/02/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Background: The aim was to assess three-dimensionally mandibular and maxillary changes in growing Class II patients treated with removable functional appliances followed by fixed appliances. Methods: Twenty-four Class II patients (age range: 9 to 14, mean: 12.1 ± 1.1 years) treated with removable functional appliances followed by fixed appliances (functional appliance group-FAG) were retrospectively selected and compared to an age-matched control group (CG) treated with fixed appliances only. To be included in the study, pre- and post-treatment CBCT scans had to be available. The CBCTs were used to analyze, in 3D, the changes following treatment and growth. Results: Before treatment, overjet (FAG: 9 mm ± 2.8 (mean ± standard deviation); CG: 4 mm ± 1.7), ANB (FAG: 5.7° ± 2.0; CG: 3.2° ± 1.4), and effective mandibular length (FAG: 113.0 mm ± 4.1; CG: 116.6 mm ± 5.9) were statistically significantly different between the two groups. After treatment, overjet (FAG: -6.8 mm ± 2.8; CG: -1.8 mm ± 1.8) and effective mandibular length (FAG: 6.3 mm ± 2.6; CG: 3.9 mm ± 2.6) statistically significantly changed. There was a significant difference in the treatment effect between the FAG and the CG in overjet, ANB, and effective mandibular length. Conclusions: The results indicate that functional appliances are effective in correcting Class II malocclusions. The growth modification in the FAG resulted in an increase in mandibular length. Yet, the final length of the mandible in the FAG was smaller when compared to the CG.
Collapse
Affiliation(s)
- Paolo M. Cattaneo
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, 720 Swanston Street, Carlton, Melbourne, VIC 3053, Australia;
| | - Annemarie Holm
- Private Practice, Fisketorvet 4-6, 7.sal, 5000 Odense, Denmark
| | | | | | - Marie A. Cornelis
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, 720 Swanston Street, Carlton, Melbourne, VIC 3053, Australia;
| |
Collapse
|
|
4
|
Austro-Martinez MD, Nicolás-Silvente AI, Requena MA, Carazo-Austro M, Alarcón JA. Stability of class II correction with the Austro Repositioner associated with multi-brackets fixed appliances in dolichofacial patients. BMC Oral Health 2024; 24:44. [PMID: 38191391 PMCID: PMC10773075 DOI: 10.1186/s12903-023-03692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The purposes of the present study were to evaluate the changes produced by the Austro Repositioner, and to assess the stability of Class II malocclusion treatment with the Austro Repositioner associated with fixed appliances and its capacity to control the vertical dimension in dolichofacial patients. METHODS A group of patients with Class II malocclusion due to mandibular retrognathism and a dolichofacial growth pattern treated with the Austro Repositioner combined with fixed appliances were compared to a matched untreated control group of subjects with Class II malocclusion. Evaluations were made on the basis of lateral cephalograms taken at T1 (initial records), T2 (end of treatment), and T3 (1 year after treatment). Statistical comparisons were performed with paired- and two-sample t tests. RESULTS The experimental (treated) group comprised 30 patients, 14 boys and 16 girls, and the control group comprised 30 subjects (15 boys and 15 girls) with similar ages at T1, T2 and T3. In the treated group, a significant decrease in the ANB angle was found (- 3.79 ± 1.46; p < 0.001). No significant differences were found in the maxillary skeletal measurements. In contrast, the SNB angle showed a significant increase of 3.77 ± 1.49 in the treated group compared with a nonsignificant increase of 0.77 ± 1.55 in the control group (p = 0.002). Vertical changes showed a significant decrease in the FMA angle (- 3.36 ± 1.62), while the lower anterior facial height distance and the overbite increased significantly in the treated group, reflecting a change in vertical dimensions after treatment. No significant changes were observed in either the treated or control group during the one-year posttreatment period; thus, the treatment results remained stable. CONCLUSIONS The Austro Repositioner combined with fixed appliances could be considered an optimal treatment modality in Class II dolichofacial patients.
Collapse
Affiliation(s)
- María Dolores Austro-Martinez
- Department of Restorative Dentistry, School of Dentistry, CEIR Campus Mare Nostrum, University of Murcia, Murcia, 30008, Spain
| | - Ana I Nicolás-Silvente
- Department of Dental Pathology and Therapeutics, School of Dentistry, CEIR Campus Mare Nostrum, University of Murcia, Murcia, 30008, Spain
| | | | - Marta Carazo-Austro
- Undergraduate student, Faculty of Odontology, University of Granada, Granada, 18071, Spain
| | - José Antonio Alarcón
- Department of Stomatology, Section of Orthodontics, Faculty of Odontology, University of Granada, Granada, 18071, Spain.
| |
Collapse
|
|
5
|
Palone M, Cremonini F, Guiducci D, Lombardo L. Combined use of F22 aligners and intermaxillary elastics in mild skeletal Class II: Two case reports. J Orthod 2023; 50:77-85. [PMID: 36112856 DOI: 10.1177/14653125221122054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The aim of these two case-reports is to illustrate and compare the therapeutic effects of Class II elastics in combination with F22 aligners in an adult and an adolescent patient, respectively. CASE PRESENTATION Two patients with a mild skeletal Class II malocclusion, associated with mild-to-moderate crowding, presented for orthodontic treatment. The first patient was 12 years old, while the second was 40 years old. In both cases, the goal was to obtain bilateral molar and canine Class I with ideal overjet and overbite, and Class II skeletal relationship improvement in the young patient as well. Both treatments were approached without extractions and using clear aligners (CAs) in combination with Class II elastics, giving the patient the opportunity to take advantage of a therapy that is both comfortable and aesthetic. DISCUSSION Final records of both cases demonstrate how appropriate analysis and diagnosis enable CAs in conjunction with Class II elastics to be used with considerable efficiency and efficacy for Class II treatment. In the first case, the key to success was exploiting residual jaw growth, while in the second case it was careful orthodontic digital planning. CONCLUSION In the presence of good patient compliance, CAs associated with Class II elastics provide satisfactory occlusal outcomes if biomechanics and digital set-up are carefully evaluated and executed and if diagnosis is appropriate.
Collapse
|
|
6
|
Janson G, Niederberger ALG, Janson G, Valerio MV, Caldas W, Valarelli FP. Stability of Class II malocclusion treatment with Class II elastics. Am J Orthod Dentofacial Orthop 2023; 163:609-617. [PMID: 36775752 DOI: 10.1016/j.ajodo.2021.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 02/13/2023]
Abstract
INTRODUCTION The objective of this study was to compare the long-term cephalometric stability after successful therapy of nonextraction Class II malocclusion with elastics and with headgear. METHODS The sample comprised 43 patients with Class II malocclusion and was divided into 2 groups. The elastic group (EG) consisted of 20 patients treated with fixed appliances associated with Class II elastics, and the headgear group (HG) consisted of 23 patients treated with fixed appliances and extraoral headgear. Pretreatment, posttreatment, and long-term posttreatment lateral radiographs were evaluated; t tests were used to compare the long-term posttreatment changes between the groups. RESULTS The groups were matched regarding initial age, time of long-term posttreatment evaluation, initial malocclusion severity, quality of treatment result, and all pretreatment cephalometric variables. Intergroup comparisons of long-term posttreatment changes showed that the HG group presented significantly greater mandibular protrusion, occlusal plane angle decrease, and maxillary molar mesialization. However, long-term posttreatment stability was similar in overjet, overbite, and molar relationships. CONCLUSIONS Nonextraction Class II malocclusion treatment with elastics or extraoral headgear have similar long-term posttreatment stability.
Collapse
Affiliation(s)
- Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Gabriela Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Marcelo Vinicius Valerio
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil.
| | - Waleska Caldas
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | | |
Collapse
|
|
7
|
Matthaios S, Tsolakis AI, Haidich AB, Galanis I, Tsolakis IA. Dental and Skeletal Effects of Herbst Appliance, Forsus Fatigue Resistance Device, and Class II Elastics-A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:6995. [PMID: 36498570 PMCID: PMC9741176 DOI: 10.3390/jcm11236995] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/13/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Our study aimed to systematically summarize the dentoskeletal effects of Herbst appliance; Forsus fatigue resistance device; and Class II elastics in adolescent Class II malocclusion. Methods: Five databases; unpublished literature; and reference lists were last searched in August 2022. Randomized clinical trials and observational studies of at least 10 Class II growing patients that assessed dentoskeletal effects through cephalometric/CBCT superimpositions were eligible. The included studies quality was assessed with the RoB 2 and ROBINS-I tools. A random-effects model meta-analysis was performed. Heterogeneity was explored with subgroup and sensitivity analyses. Results: Among nine studies (298 patients); two-to-three studies were included in each meta-analysis. Less post-treatment upper incisor retroclination (<2) and no overbite; overjet; SNA; SNB; and lower incisor inclination differences were found between Herbst/Forsus and Class II elastics. No differences in maxilla; condyle; glenoid fossa; and most mandibular changes were found between Herbst and Class II elastics; except for a greater 1.5 mm increase in mandibular length and right mandibular ramus height (1.6 mm) with Herbst. Conclusions: Herbst and Class II elastics corrected the molar relationship; but Herbst moved the lower molars more mesially. Apart from an additional mandibular length increase; no other dental and anteroposterior skeletal difference was found. Forsus was more effective in molar correction; overjet reduction; and upper incisor control than Class II elastics. Trial registration number OSF: 10.17605/OSF.IO/8TK3R.
Collapse
Affiliation(s)
- Stefanos Matthaios
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Apostolos I. Tsolakis
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Ioannis Galanis
- 2nd Propaedeutic Department of Surgery, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Ioannis A. Tsolakis
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| |
Collapse
|
|
8
|
Stability of Class II Malocclusion Treatment with the Austro Repositioner Followed by Fixed Appliances in Brachyfacial Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189793. [PMID: 34574718 PMCID: PMC8465120 DOI: 10.3390/ijerph18189793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/02/2022]
Abstract
One of the goals of functional-appliance devices is to modify the vertical growth pattern, solving several kinds of malocclusion. This study aimed to evaluate Class II malocclusion treatment’s stability with Austro Repositioner, followed by fixed appliances, and assess its capacity to modify vertical dimensions in brachyfacial patients. A test group of 30 patients (16 boys and 14 girls, mean 11.9 years old) with Class II malocclusion due to mandibular retrognathism and brachyfacial pattern treated with Austro Repositioner and fixed appliance were compared to a matched untreated Class II control group of 30 patients (17 boys and 13 girls, mean age 11.7 years old). Lateral cephalograms were taken at T1 (initial records), T2 (end of treatment), and T3 (one year after treatment). Statistical comparisons were performed with a paired-sample t-test and two-sample t-tests. Significant improvements in the skeletal Class II relationship were observed in the treated group. The ANB angle decreased (4.75°), the SNB angle increased (3.92°), and the total mandibular length (Co-Pg) increased (8.18 mm) (p < 0.001). Vertical dimensions were also significantly modified, the FMA angle increased (3.94°), LAFH-distance increased (3.15 mm), and overbite decreased (3.35 mm). These changes remained stable one year after treatment. The Austro Repositioner was adequate for treating the skeletal Class II malocclusion resulting from the mandible retrusion in brachyfacial patients.
Collapse
|
|
9
|
Effective and Efficient Correction of Severe Skeletal Class II Division 1 Malocclusion with Intermaxillary Elastics. Case Rep Dent 2021; 2021:6663563. [PMID: 33747573 PMCID: PMC7943309 DOI: 10.1155/2021/6663563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022] Open
Abstract
Treatment of Class II malocclusion accompanied with a skeletal discrepancy is challenging. The approach of correction depends on several factors such as the status and pattern of growth, severity of the malocclusion, and patient cooperation. This case report describes a successful management of a 12-year-old young adolescent boy that was presented with a Class II division 1 malocclusion with an underlying skeletal discrepancy in horizontal and vertical dimensions. Growth modification was achieved by means of bite opening and unlocking the mandible together with Class II elastics and mechanics. Treatment was highly effective and efficient by achieving all treatment goals within a period of 18 months.
Collapse
|
|
10
|
Shetty P, Shetty M, Chalapati M, Kori C, Soans CR, S. MP. Comparative Evaluation of Hard-Tissue and Soft-Tissue Changes following Fixed Functional Appliance Treatment in a Skeletal Class II Malocclusion Using Forsus and PowerScope. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2021. [DOI: 10.1055/s-0041-1722821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Introduction The purpose of this study was to evaluate and compare the skeletal, dentoalveolar and soft-tissue effects of 2 fixed functional appliance; Forsus Fatigue Resistance Device (FFRD) and PowerScope appliance in treating patients with skeletal class II division 1 malocclusion.
Materials and Methods This comparative prospective two-group study included 20 patients with a mean age of 11.2 ± 1.6 years with skeletal class II malocclusion with retrognathic mandible. One group was treated with FFRD, and second group was treated with PowerScope appliance. Lateral cephalograms were evaluated at T1 (pre-functional appliance treatment)) and at T2 (postappliance treatment). Cephalometric values were calculated and assessed to evaluate skeletal, dentoalveolar and soft-tissue changes.
Results Sagittal correction of class II malocclusion appeared to be mainly achieved by dentoalveolar changes in the PowerScope group. The FFRD was able to induce both skeletal and dentoalveolar changes. A favorable influence on facial convexity was achieved by both groups. A significant increase in upper pharynx and lower pharynx dimension was seen in the PowerScope group. A statistically significant decrease in upper lip protrusion, increase in lower lip protrusion, increased nasolabial angle, and decrease in inferior labial sulcus were noted in both the groups. Lower incisors proclined more in the PowerScope group.
Conclusion Both appliances were effective in correcting class II malocclusion. Forsus had more skeletal effects on the mandible, whereas PowerScope had less skeletal effects on the mandible and more dentoalveolar effects, contributing to class II correction. Both groups showed a significant improvement in soft-tissue profile. PowerScope group showed a significant increase in airway dimensions.
Collapse
Affiliation(s)
- Prajwal Shetty
- Department of Orthodontics and Dentofacial Orthopaedics, A.B. Shetty Memorial Institute of Dental Science, Nitte (Deemed to be) University, Deralakatte, Karnataka, India
| | - Mukul Shetty
- Department of Orthodontics and Dentofacial Orthopaedics, A.B. Shetty Memorial Institute of Dental Science, Nitte (Deemed to be) University, Deralakatte, Karnataka, India
| | - Maitreyi Chalapati
- Orthodontics and Dentofacial Orthopaedics, Private Clinic, Hyderabad, Telangana, India
| | - Chaitra Kori
- Orthodontics and Dentofacial Orthopaedics, Private Clinic, Hubli, Karnataka, India
| | - Crystal Runa Soans
- Department of Orthodontics and Dentofacial Orthopaedics, A.B. Shetty Memorial Institute of Dental Science, Nitte (Deemed to be) University, Deralakatte, Karnataka, India
| | - Murali P. S.
- Department of Orthodontics and Dentofacial Orthopaedics, A.B. Shetty Memorial Institute of Dental Science, Nitte (Deemed to be) University, Deralakatte, Karnataka, India
| |
Collapse
|
|
11
|
Soft tissue profile changes in Angle class II patients treated with Twin Force or intermaxillary elastics-a comparison. J Orofac Orthop 2020; 82:71-81. [PMID: 33210180 DOI: 10.1007/s00056-020-00260-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/05/2020] [Indexed: 10/23/2022]
Abstract
PROPOSITION This study aimed to compare soft tissue profile changes in Angle class II malocclusion patients treated with a Twin Force appliance (Ortho Organizers, Inc., Carlsbad, CA, USA) or class II elastics. METHODS The sample comprised 47 class II malocclusion patients treated orthodontically without extractions, divided into two groups. Group 1 (Twin Force): 25 patients were treated with the Twin Force, with initial and final mean ages of 17.91 and 20.45 years, respectively, and mean treatment time of 2.53 years. Group 2 (elastics): 22 patients were treated with class II elastics, with initial and final mean age of 15.87 and 18.63 years, respectively, and mean treatment time of 2.75 years. The lateral cephalograms were evaluated at the initial and final stages. Intragroup comparisons were performed with dependent t-tests and intergroup comparisons were performed with independent t-tests. RESULTS Treatment-related changes in the Twin Force group included reduction of facial convexity, retrusion of the upper lip, increase of the H‑Nose distance, and decrease in Sn‑H distance, indicating improvement in facial profile. In the elastics group, treatment resulted in an increase in nasolabial angle, retrusion of the upper lip, increase of the H‑Nose distance, and decrease in Sn‑H distance, indicating improvement in facial profile. The Twin Force group showed a greater reduction of the facial convexity with treatment than the elastics group. CONCLUSIONS Class II patients treated with the Twin Force appliance showed greater reduction in facial convexity than patients treated with class II elastics. The other soft tissue changes were similar for both groups.
Collapse
|
|
12
|
Wei RY, Atresh A, Ruellas A, Cevidanes LHS, Nguyen T, Larson BE, Mangum JE, Manton DJ, Schneider PM. Three-dimensional condylar changes from Herbst appliance and multibracket treatment: A comparison with matched Class II elastics. Am J Orthod Dentofacial Orthop 2020; 158:505-517.e6. [PMID: 32828608 DOI: 10.1016/j.ajodo.2019.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/01/2019] [Accepted: 09/01/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of this study was to quantify and qualify the 3-dimensional (3D) condylar changes using mandibular 3D regional superimposition techniques in adolescent patients with Class II Division 1 malocclusions treated with either a 2-phase or single-phase approach. METHODS Twenty patients with Herbst appliances who met the inclusion criteria and had cone-beam computed tomography (CBCT) images taken before, 8 weeks after Herbst removal, and after the completion of multibracket appliance treatment constituted the Herbst group. They were compared with 11 subjects with Class II malocclusion who were treated with elastics and multibracket appliances and who had CBCT images taken before and after treatment. Three-dimensional models generated from the CBCT images were registered on the mandible using 3D voxel-based superimposition techniques and analyzed using semitransparent overlays and point-to-point measurements. RESULTS The magnitude of lateral condylar growth during the orthodontic phase (T2-T3) was greater than that during the orthopedic phase (T1-T2) for all condylar fiducials with the exception of the superior condyle (P <0.05). Conversely, posterior condylar growth was greater during the orthopedic phase than the subsequent orthodontic phase for all condylar fiducials (P <0.05). The magnitude of vertical condylar development was similar during both the orthopedic (T1-T2) and orthodontic phases (T2-T3) across all condylar fiducials (P <0.05). Posterior condylar growth during the orthodontic phase (T2-T3) of the 2-phase approach decreased for all condylar fiducials with the exception of the posterior condylar fiducial (P <0.05) when compared with the single-phase approach. CONCLUSIONS Two-phase treatment using a Herbst appliance accelerates condylar growth when compared with a single-phase regime with Class II elastics. Whereas the posterior condylar growth manifested primarily during the orthopedic phase, the vertical condylar gains occurred in equal magnitude throughout both phases of the 2-phase treatment regime.
Collapse
Affiliation(s)
- Robert Y Wei
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia.
| | - Arjun Atresh
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Tung Nguyen
- Department of Orthodontics, University of North Carolina, Chapel Hill, NC
| | - Brent E Larson
- Division of Orthodontics, University of Minnesota, Minneapolis, Minn
| | - Jonathan E Mangum
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia; Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Australia
| | - David J Manton
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia; Centrum voor Tandheelkunde en Mondzorgkunde UMCG, University of Groningen, Groningen, The Netherlands
| | - Paul M Schneider
- Growth and Development, Melbourne Dental School, University of Melbourne, Melbourne, Australia
| |
Collapse
|
|
13
|
Zitouni M, Acar YB. Treatment outcome and long-term stability of class II correction with forsus fatigue resistant device in non-growing patients. Orthod Craniofac Res 2020; 24:130-136. [PMID: 32757406 DOI: 10.1111/ocr.12416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Forsus™ Fatigue Resistant Device (FRD) is one of the commonly used semirigid fixed functional devices. Purpose of the present study was to investigate effects and long-term stability of Class II correction following use of Forsus FRD in a retrospective clinical study. SETTING AND SAMPLE POPULATION Records of 20 patients (mean age 18.3 ± 2.5 years) with Class II malocclusion, who had undergone fixed functional treatment protocol with Forsus FRD, were collected from our clinical archive. MATERIALS AND METHODS Lateral cephalometric radiographs at pre-treatment (T0), end of comprehensive treatment (T1) and post-retention period (T2, mean duration: 19 ± 3 months) were analysed and superimposed to assess skeletal and dental changes on the long-term. Repeated measurement one way ANOVA was used for the study of the significant differences among the mean values of cephalometric parameters at T0, T1, and T2. To analyse the nature of the bilateral significant differences between two different time points, Bonferroni test was used. RESULTS Sagittal and vertical skeletal changes at T0-T1 were statistically insignificant while all dentoalveolar parameters exhibited highly significant changes. At T1-T2, all skeletal and dentoalveolar parameters were stable except the slight relapse in overjet (0.3 ± 0.5 mm; P < .05). At T0-T2 interval, no significant skeletal changes were recorded while the dentoalveolar changes remained significantly improved. CONCLUSION Correction of Class II malocclusion achieved with Forsus FRD was dentoalveolar and treatment effects were stable in the 19 ± 3 months follow-up period.
Collapse
Affiliation(s)
| | - Yasemin Bahar Acar
- Department of Orthodontics, Marmara University Dental Faculty, Istanbul, Turkey
| |
Collapse
|
|
14
|
Taylor KL, Evangelista K, Muniz L, Ruellas ACDO, Valladares-Neto J, McNamara J, Franchi L, Kim-Berman H, Cevidanes LHS. Three-dimensional comparison of the skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed appliances: A CBCT study. Orthod Craniofac Res 2019; 23:72-81. [PMID: 31514261 DOI: 10.1111/ocr.12345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/02/2019] [Accepted: 09/06/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare three-dimensional (3D) skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed orthodontic treatment in growing patients. SETTING AND SAMPLE POPULATION A sample of 35 adolescents with cone-beam computed tomography scans obtained prior to Herbst and Pendulum treatment (T1) and immediately after fixed appliance treatment (T2). MATERIALS AND METHODS Patients with Class II malocclusion was assessed retrospectively and divided into two treatment groups: Herbst group (n = 17, age: 12.0 ± 1.6 years) and Pendulum group (n = 18, age: 12.1 ± 1.5 years), with a mean treatment duration of 2.8 ± 0.8 years and 2.5 ± 0.7 years, respectively. Reconstructions of the maxillomandibular and dentoalveolar regions and data in 3D were obtained relative to cranial base, maxillary and mandibular regional superimpositions. Treatment outcomes (T2-T1) were compared between both groups using t tests for independent samples (P<.05). RESULTS Significant increase in mandibular length was observed in the Herbst group (7.3 ± 3.5 mm) relative to the Pendulum group (4.6 ± 4.5 mm). Inferior and anterior displacements of Pogonion were 2.2 mm and 1.6 mm greater in the Herbst group, respectively. The mesial displacement of the lower first molars was significantly greater in the Herbst group (1.9 mm). The upper first molars had contrasting results in sagittal displacement, with 0.6 ± 1.7 mm of distal displacement with the Pendulum and 1.4 ± 2.1 mm of mesial displacement with the Herbst. Lower incisor projection and proclination were similar between groups. CONCLUSIONS The Herbst and Pendulum appliances followed by comprehensive orthodontic treatment effectively corrected Class II malocclusion in growing patients, but with differing skeletal and dentoalveolar effects.
Collapse
Affiliation(s)
- Kyle L Taylor
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Karine Evangelista
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.,School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - Luciana Muniz
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | | | | | - James McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, Orthodontics, Università degli Studi di Firenze, Florence, Italy
| | - Hera Kim-Berman
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | | |
Collapse
|
|
15
|
Outcomes of early versus late treatment of severe Class II high-angle patients. Am J Orthod Dentofacial Orthop 2019; 156:375-382. [PMID: 31474267 DOI: 10.1016/j.ajodo.2018.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The aim of this work was to compare the skeletal and dental outcomes of 1- versus 2-phase treatment in Class II subjects with difficult-to-treat high-angle severe Class II malocclusions. METHODS The sample of 120 cases was collected from the private offices of 3 experienced clinicians. The following selection criteria were used: (1) ANB ≥6°, (2) SN-GoGn ≥37° or mandibular plane to Frankfort horizontal plane ≥30°; and (3) overjet ≥6 mm. Patients were classified into either the early or the late treatment group according to dental age (early Tx: ≥5 primary teeth; late Tx: otherwise). Thirty-four angular, linear, and proportional measurements were determined for each patient. Statistical significance was assessed with the use of a 2-tailed t test, analysis of covariance test, and chi-square test. RESULTS The results showed that early 2-phase treatment for severe Class II high-angle patients offered no skeletal anteroposterior advantages over late 1-phase treatment. Severe high-angle Class II patients also showed similar dental anteroposterior outcomes with the use of both approaches. Vertically there was a higher frequency of increased mandibular plane angles and extrusion of upper incisors and lower molars in the late treatment group. CONCLUSIONS Early 2-phase treatment for severe Class II high-angle patients offered no skeletal or dental advantage over late 1-phase treatment.
Collapse
|
|
16
|
Kawamura J, Park JH, Kojima Y, Kook Y, Kyung H, Chae J. Biomechanical analysis for total mesialization of the mandibular dentition: A finite element study. Orthod Craniofac Res 2019; 22:329-336. [DOI: 10.1111/ocr.12331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/09/2019] [Accepted: 06/15/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jun Kawamura
- Private Practice in Kawamura Dental Office Gifu Japan
| | - Jae Hyun Park
- Postgraduate Orthodontic Program Arizona School of Dentistry & Oral Health, A.T. Still University Mesa Ariz
- Graduate School of Dentistry Kyung Hee University Seoul Korea
| | | | - Yoon‐Ah Kook
- Department of Orthodontics, Seoul St. Mary's Hospital Catholic University of Korea Seoul Korea
| | - Hee‐Moon Kyung
- Department of Orthodontics, School of Dentistry Kyungpook National University Daegu Korea
| | - Jong‐Moon Chae
- Postgraduate Orthodontic Program Arizona School of Dentistry & Oral Health, A.T. Still University Mesa Ariz
- Department of Orthodontics, School of Dentistry, Wonkwang Dental Research Institute University of Wonkwang Iksan Korea
| |
Collapse
|
|
17
|
Moro A, Borges SW, Spada PP, Morais ND, Correr GM, Chaves CM, Cevidanes LHS. Twenty-year clinical experience with fixed functional appliances. Dental Press J Orthod 2018; 23:87-109. [PMID: 29898162 PMCID: PMC6018450 DOI: 10.1590/2177-6709.23.2.087-109.sar] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/23/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction: Considering the large number of fixed functional appliances, choosing the best device for your patient is not an easy task. Objective: To describe the development of fixed functional appliances as well as our 20-year experience working with them. Methods: Fixed functional appliances are grouped into flexible, rigid and hybrid. They are different appliances, whose action is described here. Four clinical cases will be reported with a view to illustrating the different appliances. Conclusions: Rigid fixed functional appliances provide better skeletal results than flexible and hybrid ones. Flexible and hybrid appliances have similar effects to those produced by Class II elastics. They ultimately correct Class II with dentoalveolar changes. From a biomechanical standpoint, fixed functional appliances are more recommended to treat Class II in dolichofacial patients, in comparison to Class II elastics.
Collapse
Affiliation(s)
- Alexandre Moro
- Universidade Federal do Paraná, Programa de Pós-graduação em Ortodontia (Curitiba/PR, Brazil).,Universidade Positivo, Programa de Mestrado e Doutorado em Odontologia Clínica (Curitiba/PR, Brazil)
| | - Suellen W Borges
- Mestre em Odontologia Clínica, Universidade Positivo (Curitiba/PR, Brazil)
| | - Paula Porto Spada
- Universidade Positivo, Programa de Mestrado e Doutorado em Odontologia Clínica (Curitiba/PR, Brazil).,Mestre em Odontologia Clínica, Universidade Positivo (Curitiba/PR, Brazil)
| | - Nathaly D Morais
- Universidade Positivo, Programa de Mestrado e Doutorado em Odontologia Clínica (Curitiba/PR, Brazil).,Mestre em Odontologia Clínica, Universidade Positivo (Curitiba/PR, Brazil)
| | - Gisele Maria Correr
- Universidade Positivo, Programa de Mestrado e Doutorado em Odontologia Clínica (Curitiba/PR, Brazil)
| | - Cauby M Chaves
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem (Fortaleza/CE, Brazil)
| | - Lucia H S Cevidanes
- University of Michigan, School of Dentistry, Orthodontics and Pediatric Dentistry (Ann Arbor, EUA)
| |
Collapse
|
|
18
|
Atresh A, Cevidanes LHS, Yatabe M, Muniz L, Nguyen T, Larson B, Manton DJ, Schneider PM. Three-dimensional treatment outcomes in Class II patients with different vertical facial patterns treated with the Herbst appliance. Am J Orthod Dentofacial Orthop 2018; 154:238-248.e1. [PMID: 30075926 PMCID: PMC6151354 DOI: 10.1016/j.ajodo.2017.11.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The aims of this study were to evaluate, using 3-dimensional superimposition techniques, the skeletal changes in Class II subjects with different vertical facial patterns treated with the Herbst appliance and to compare these skeletal changes to those of Class II controls treated with elastics. METHODS Sixteen Herbst patients who met the inclusion criteria were divided into 2 equal groups based on vertical facial pattern as determined by the Frankfort mandibular plane angle (brachyfacial, ≤22°; mesofacial, 23°-29°) and had cone-beam computed tomographs taken before treatment, 8 weeks after Herbst appliance removal, and after subsequent fixed appliance treatment. Eleven Class II control patients treated with fixed appliances and elastics had cone-beam computed tomographs taken before and after treatment. Three-dimensional models were generated from the cone-beam computed tomography images, registered on the anterior cranial bases, and analyzed using color maps and point-to-point measurements. RESULTS There were minimal differences in treatment response between the 2 Herbst groups across all skeletal parameters measured. The Herbst subjects showed a greater inferior displacement of anterior nasal spine compared with the Class II controls (Herbst brachyfacial, -1.44 mm; Herbst mesofacial, -1.95 mm) with other maxillary changes being clinically insignificant. The Herbst subjects showed greater inferior displacement of B-point compared with the Class II controls (Herbst brachyfacial, -2.59 mm; Herbst mesofacial, -2.75 mm). There were no statistically significant differences in mean linear mandibular measurements. All groups showed a trend toward posterior displacement of the condyles and glenoid fossae from the start to the end of treatment, with no significant differences across the 3 groups. There were minimal differences in the changes in gonial angle and Frankfort mandibular plane angle across all groups. CONCLUSION Approximately 2 years after Herbst treatment, the Herbst subjects with different vertical facial patterns showed similar patterns of skeletal change compared with the Class II controls treated with elastics.
Collapse
Affiliation(s)
- Arjun Atresh
- Department of Orthodontics, University of Melbourne, Melbourne, Australia
| | | | - Marilia Yatabe
- Department of Orthodontics, University of Michigan, Ann Arbor, Mich
| | - Luciana Muniz
- Department of Orthodontics, University of Michigan, Ann Arbor, Mich
| | - Tung Nguyen
- Department of Orthodontics, University of North Carolina, Chapel Hill, NC
| | - Brent Larson
- Department of Orthodontics, University of Minnesota, Minneapolis, Minn
| | - David J Manton
- Department of Orthodontics, University of Melbourne, Melbourne, Australia
| | - Paul M Schneider
- Department of Orthodontics, University of Melbourne, Melbourne, Australia.
| |
Collapse
|
|
19
|
Kang Y, Franchi L, Manton DJ, Schneider PM. A cephalometric study of the skeletal and dento-alveolar effects of the modified Louisiana State University activator in Class II malocclusion. Eur J Orthod 2018; 40:164-175. [PMID: 29016763 DOI: 10.1093/ejo/cjx044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives To analyse the skeletal and dento-alveolar effects of the modified Louisiana State University activator (MLSUA) in Class II treatment. Materials and methods A test group of 46 participants (25 females, 21 males) with Class II malocclusion treated with MLSUA followed by fixed appliances was compared with a matched Class II control group. Lateral cephalograms were taken at T1 (initial records), T2 (completion of MLSUA treatment), and T3 (before deband). The participants were also divided into two groups: pre-pubertal and pubertal according to skeletal maturity and three groups of different vertical facial patterns at the start of the treatment: brachyfacial, mesofacial, and dolichofacial. Statistical comparisons were performed with t-tests and analysis of variance (ANOVA). Results Statistically significant supplementary mandibular growth (Co-Gn) in the test group (2.6 mm) was associated with improvement of overjet (OJ), overbite (OB), and molar relationship. Short-term mandibular growth was greater in pubertal than pre-pubertal groups (2.4 mm, P < 0.05). Mandibular incisors retroclined by 2.1 degrees after MLSUA treatment. The brachyfacial group showed greater reduction in the ANB angle and forward movement of pogonion. Mandibular, palatal, and occlusal plane angles showed insignificant change regardless of the facial type. Conclusions MLSUA treatment corrected the Class II malocclusion by accelerating mandibular growth in the short-term with minimal dento-alveolar compensation, and the correction was maintained before deband. The treatment may be more effective if started at puberty. The mandibular, palatal, and occlusal planes remained stable throughout the treatment. Brachyfacial patients showed more favourable horizontal growth.
Collapse
Affiliation(s)
- Yunlong Kang
- Melbourne Dental School, University of Melbourne, Australia
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, Unit of Orthodontics, Università degli Studi di Firenze, Firenze, Italy
| | - David J Manton
- Melbourne Dental School, University of Melbourne, Australia
| | | |
Collapse
|
|
20
|
Batista KBSL, Thiruvenkatachari B, Harrison JE, O'Brien KD, Cochrane Oral Health Group. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents. Cochrane Database Syst Rev 2018; 2018:CD003452. [PMID: 29534303 PMCID: PMC6494411 DOI: 10.1002/14651858.cd003452.pub4] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Prominent upper front teeth are a common problem affecting about a quarter of 12-year-old children in the UK. The condition develops when permanent teeth erupt. These teeth are more likely to be injured and their appearance can cause significant distress. Children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of their teeth. If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait and provide treatment in adolescence. OBJECTIVES To assess the effects of orthodontic treatment for prominent upper front teeth initiated when children are seven to 11 years old ('early treatment' in two phases) compared to in adolescence at around 12 to 16 years old ('late treatment' in one phase); to assess the effects of late treatment compared to no treatment; and to assess the effects of different types of orthodontic braces. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 27 September 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 8), MEDLINE Ovid (1946 to 27 September 2017), and Embase Ovid (1980 to 27 September 2017). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials of orthodontic treatments to correct prominent upper front teeth (Class II malocclusion) in children and adolescents. We included trials that compared early treatment in children (two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces versus late treatment in adolescents (one-phase) with any type of orthodontic braces or head-braces, and trials that compared any type of orthodontic braces or head-braces versus no treatment or another type of orthodontic brace or appliance (where treatment started at a similar age in the intervention groups).We excluded trials involving participants with a cleft lip or palate, or other craniofacial deformity/syndrome, and trials that recruited patients who had previously received surgical treatment for their Class II malocclusion. DATA COLLECTION AND ANALYSIS Review authors screened the search results, extracted data and assessed risk of bias independently. We used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes, and mean differences (MDs) and 95% CIs for continuous outcomes. We used the fixed-effect model for meta-analyses including two or three studies and the random-effects model for more than three studies. MAIN RESULTS We included 27 RCTs based on data from 1251 participants.Three trials compared early treatment with a functional appliance versus late treatment for overjet, ANB and incisal trauma. After phase one of early treatment (i.e. before the other group had received any intervention), there was a reduction in overjet and ANB reduction favouring treatment with a functional appliance; however, when both groups had completed treatment, there was no difference between groups in final overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18; 343 participants) (low-quality evidence) or ANB (MD -0.02, 95% CI -0.47 to 0.43; 347 participants) (moderate-quality evidence). Early treatment with functional appliances reduced the incidence of incisal trauma compared to late treatment (OR 0.56, 95% CI 0.33 to 0.95; 332 participants) (moderate-quality evidence). The difference in the incidence of incisal trauma was clinically important with 30% (51/171) of participants reporting new trauma in the late treatment group compared to only 19% (31/161) of participants who had received early treatment.Two trials compared early treatment using headgear versus late treatment. After phase one of early treatment, headgear had reduced overjet and ANB; however, when both groups had completed treatment, there was no evidence of a difference between groups in overjet (MD -0.22, 95% CI -0.56 to 0.12; 238 participants) (low-quality evidence) or ANB (MD -0.27, 95% CI -0.80 to 0.26; 231 participants) (low-quality evidence). Early (two-phase) treatment with headgear reduced the incidence of incisal trauma (OR 0.45, 95% CI 0.25 to 0.80; 237 participants) (low-quality evidence), with almost half the incidence of new incisal trauma (24/117) compared to the late treatment group (44/120).Seven trials compared late treatment with functional appliances versus no treatment. There was a reduction in final overjet with both fixed functional appliances (MD -5.46 mm, 95% CI -6.63 to -4.28; 2 trials, 61 participants) and removable functional appliances (MD -4.62, 95% CI -5.33 to -3.92; 3 trials, 122 participants) (low-quality evidence). There was no evidence of a difference in final ANB between fixed functional appliances and no treatment (MD -0.53°, 95% CI -1.27 to -0.22; 3 trials, 89 participants) (low-quality evidence), but removable functional appliances seemed to reduce ANB compared to no treatment (MD -2.37°, 95% CI -3.01 to -1.74; 2 trials, 99 participants) (low-quality evidence).Six trials compared orthodontic treatment for adolescents with Twin Block versus other appliances and found no difference in overjet (0.08 mm, 95% CI -0.60 to 0.76; 4 trials, 259 participants) (low-quality evidence). The reduction in ANB favoured treatment with a Twin Block (-0.56°, 95% CI -0.96 to -0.16; 6 trials, 320 participants) (low-quality evidence).Three trials compared orthodontic treatment for adolescents with removable functional appliances versus fixed functional appliances and found a reduction in overjet in favour of fixed appliances (0.74, 95% CI 0.15 to 1.33; two trials, 154 participants) (low-quality evidence), and a reduction in ANB in favour of removable appliances (-1.04°, 95% CI -1.60 to -0.49; 3 trials, 185 participants) (low-quality evidence). AUTHORS' CONCLUSIONS Evidence of low to moderate quality suggests that providing early orthodontic treatment for children with prominent upper front teeth is more effective for reducing the incidence of incisal trauma than providing one course of orthodontic treatment in adolescence. There appear to be no other advantages of providing early treatment when compared to late treatment. Low-quality evidence suggests that, compared to no treatment, late treatment in adolescence with functional appliances, is effective for reducing the prominence of upper front teeth.
Collapse
Affiliation(s)
- Klaus BSL Batista
- Rio de Janeiro State UniversityDepartment of Preventive and Public DentistryBoulevard 28 de Setembro, 157, Vila IsabelRio de JaneiroBrazilCEP: 20551‐030
| | | | - Jayne E Harrison
- Liverpool University Dental HospitalOrthodontic DepartmentPembroke PlaceLiverpoolMerseysideUKL3 5PS
| | - Kevin D O'Brien
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterHigher Cambridge StreetManchesterUKM15 6FH
| | | |
Collapse
|
|
21
|
Karamesinis K, Basdra EK. The biological basis of treating jaw discrepancies: An interplay of mechanical forces and skeletal configuration. Biochim Biophys Acta Mol Basis Dis 2018; 1864:1675-1683. [PMID: 29454076 DOI: 10.1016/j.bbadis.2018.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/06/2018] [Accepted: 02/12/2018] [Indexed: 10/18/2022]
Abstract
Jaw discrepancies and malrelations affect a large proportion of the general population and their treatment is of utmost significance for individuals' health and quality of life. The aim of their therapy is the modification of aberrant jaw development mainly by targeting the growth potential of the mandibular condyle through its cartilage, and the architectural shape of alveolar bone through a suture type of structure, the periodontal ligament. This targeted treatment is achieved via external mechanical force application by using a wide variety of intraoral and extraoral appliances. Condylar cartilage and sutures exhibit a remarkable plasticity due to the mechano-responsiveness of the chondrocytes and the multipotent mesenchymal cells of the sutures. The tissues respond biologically and adapt to mechanical force application by a variety of signaling pathways and a final interplay between the proliferative activity and the differentiation status of the cells involved. These targeted therapeutic functional alterations within temporo-mandibular joint ultimately result in the enhancement or restriction of mandibular growth, while within the periodontal ligament lead to bone remodeling and change of its architectural structure. Depending on the form of the malrelation presented, the above treatment approaches, in conjunction or separately, lead to the total correction of jaw discrepancies and the achievement of facial harmony and function. Overall, the treatment of craniofacial and jaw anomalies can be seen as an interplay of mechanical forces and adaptations occurring within temporo-mandibular joint and alveolar bone. The aim of the present review is to present up-to-date knowledge on the mechano-biology behind jaw growth modification and alveolar bone remodeling. Furthermore, future molecular targeted therapeutic strategies are discussed aiming at the improvement of mechanically-driven chondrogenesis and osteogenesis.
Collapse
Affiliation(s)
- Konstantinos Karamesinis
- Department of Biological Chemistry, Cellular and Molecular Biomechanics Unit, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Efthimia K Basdra
- Department of Biological Chemistry, Cellular and Molecular Biomechanics Unit, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
| |
Collapse
|
|
22
|
Cakir E, Malkoç S, Kirtay M. Treatment of Class II malocclusion with mandibular skeletal anchorage. Am J Orthod Dentofacial Orthop 2017; 151:1169-1177. [PMID: 28554462 DOI: 10.1016/j.ajodo.2016.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/01/2016] [Accepted: 05/01/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this case report was to present the dentofacial changes obtained with bone anchorage in a Class II patient with moderate to severe crowding. METHODS A boy, aged 14.5 years, with a dolichofacial type, convex profile, and skeletal and dental Class II relationships was examined. After evaluation, functional treatment with bone anchorage and 4 first premolar extractions was decided as the treatment approach. Miniplates were placed on the buccal shelves of the mandibular third molars. The hook of the anchor was revealed from the first molar level. After surgery, the 4 first premolars were extracted to retract the protrusive mandibular incisors. The maxillary and mandibular first molars were banded, and a lip bumper was inserted to apply elastics and to help distalize the maxillary first molars. Orthodontic forces of 300 to 500 g were applied immediately after placement, originating from the miniscrews to the hooks of the appliance to advance the mandible. RESULTS After 20 months of treatment, the patient had a dental and skeletal Class I relationship, the mandible was advanced, the maxilla was restrained, and overjet was decreased. CONCLUSIONS The combination of a bone anchor, Class II elastics, and an inner bow is a promising alternative to functional treatment, along with extractions, in Class II patients.
Collapse
Affiliation(s)
- Ezgi Cakir
- Department of Orthodontics, Faculty of Dentistry, Inönü University, Malatya, Turkey
| | - Siddik Malkoç
- Department of Orthodontics, Faculty of Dentistry, Inönü University, Malatya, Turkey.
| | - Mustafa Kirtay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Inönü University, Malatya, Turkey
| |
Collapse
|
|
23
|
Jayachandran S, Wiltshire WA, Hayasaki SM, Pinheiro FHSL. Comparison of AdvanSync and intermaxillary elastics in the correction of Class II malocclusions: A retrospective clinical study. Am J Orthod Dentofacial Orthop 2016; 150:979-988. [PMID: 27894547 DOI: 10.1016/j.ajodo.2016.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/01/2016] [Accepted: 05/01/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Our objectives were to compare the skeletal, dentoalveolar, and soft tissue effects of the AdvanSync appliance (Ormco, Glendora, Calif) with intermaxillary elastics in the correction of Class II malocclusions in growing patients. METHODS A retrospective study was conducted using lateral cephalograms of patients taken before and after comprehensive orthodontic treatment; 41 patients consecutively treated with the AdvanSync were compared with 41 similar patients treated with intermaxillary Class II elastics. All patients had significant growth potential during treatment, as assessed by cervical vertebral maturation. A comparison group was generated from historical data bases and matched to the experimental groups for skeletal age, sex, and craniofacial morphology. Treatment changes were evaluated between the time points using a custom cephalometric analysis generating 31 variables as well as regional superimpositions. Data were analyzed using 1-way analysis of variance and Tukey-Kramer tests. RESULTS The effects of the AdvanSync and fixed orthodontics included maxillary growth restriction, protrusion, proclination, and intrusion of the mandibular incisors as well as mesialization of the mandibular molars (P <0.01). The effects of Class II elastics and fixed orthodontics were similar to AdvanSync, with the exceptions of less maxillary growth restriction and greater retrusion and retroclination of the maxillary incisors (P <0.01). Significant mandibular growth stimulation, relative to the untreated controls, did not occur with either modality. CONCLUSION AdvanSync and intermaxillary elastics were effective in normalizing Class II malocclusions during comprehensive fixed orthodontics. AdvanSync produced its effects through maxillary skeletal growth restriction and mandibular dentoalveolar changes. Class II elastics worked primarily through dentoalveolar changes in both the maxilla and the mandible.
Collapse
Affiliation(s)
- Santhosh Jayachandran
- Resident, Department of Preventive Dental Science, Division of Orthodontics, Faculty of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William A Wiltshire
- Professor and head, Department of Preventive Dental Science, Division of Orthodontics, Faculty of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Fabio H S L Pinheiro
- Assistant professor, Department of Preventive Dental Science, Division of Orthodontics, Faculty of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada.
| |
Collapse
|
|
24
|
Tomblyn T, Rogers M, Andrews L, Martin C, Tremont T, Gunel E, Ngan P. Cephalometric study of Class II Division 1 patients treated with an extended-duration, reinforced, banded Herbst appliance followed by fixed appliances. Am J Orthod Dentofacial Orthop 2016; 150:818-830. [PMID: 27871709 DOI: 10.1016/j.ajodo.2016.04.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The Herbst appliance has been used in the treatment of Class II malocclusions with deficient mandibles. Various protocols, including different durations of the orthopedic treatment phase and stepwise advancement of the mandible, have been advocated for increasing the orthopedic effects. The objective of this study was to investigate the skeletal and dental changes in patients treated with a reinforced banded Herbst appliance for an extended duration and fixed appliance therapy. METHODS The study group consisted of 30 patients (16 boys, 14 girls; mean age, 12.3 ± 2.5 years) with Class II Division 1 malocclusions who were successfully treated with the new Herbst protocol followed by fixed appliances. Lateral cephalometric radiographs were taken before treatment, at the completion of Herbst treatment, and after removal of fixed appliances. The average treatment times were 1.5 ± 0.7 years for the Herbst treatment and 1.8 ± 0.5 years for the fixed appliances. A control Class II sample from the Bolton-Brush study was used to subtract growth from treatment changes to determine the appliance effect. Data were analyzed using analysis of variance and the Tukey-Kramer test. RESULTS After the Herbst treatment, the incisal relationships of all subjects had been overcorrected to end-to-end relationships. Overjet was reduced by 7.2 mm after subtracting changes from growth. The skeletal contribution was 2.5 mm (35%), and the dental contribution was 4.7 mm (65%). The molar relationship was overcorrected to a more Class I relationship by 7.5 mm. The Wits appraisal was improved by 4.2 mm. Vertically, overbite was decreased by 3.3 mm. The maxillary and mandibular molars were extruded by 1 mm. The occlusal plane rotated clockwise by 5° with little change in the mandibular plane angle. After the treatment with fixed appliances, the overjet correction was maintained at 7.6 mm. The skeletal contribution was 2.9 mm (38%), and the dental contribution was 4.7 mm (62%). The molar relationship was corrected to a Class I relationship by 5.9 mm. The Wits appraisal was improved by 3.2 mm. Vertically, overbite was decreased by 4.2 mm. The maxillary and mandibular molars were extruded by 0.3 and 0.8 mm, respectively. The occlusal plane rotated clockwise by 1.2° with little change in the mandibular plane angle. CONCLUSIONS Doubling the usual orthopedic treatment time with the reinforced Herbst appliance followed by fixed appliance therapy was effective in correcting Class II Division 1 malocclusions with excess overjet and overbite. In this sample of successfully treated patients, most changes after Herbst and fixed appliance therapy were dentoalveolar (62%). However, the skeletal changes attained in the orthopedic phase of treatment were maintained after fixed appliance therapy.
Collapse
Affiliation(s)
| | | | | | - Chris Martin
- Professor, Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, WVa
| | - Timothy Tremont
- Clinical associate professor, Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, WVa
| | - Erdogan Gunel
- Professor, Department of Biostatistics, West Virginia University, Morgantown, WVa
| | - Peter Ngan
- Professor and chair, Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, WVa.
| |
Collapse
|
|
25
|
Aras I, Pasaoglu A. Class II subdivision treatment with the Forsus Fatigue Resistant Device vs intermaxillary elastics. Angle Orthod 2016; 87:371-376. [PMID: 27762602 DOI: 10.2319/070216-518.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of comprehensive fixed appliance treatments implemented in combination with Forsus or intermaxillary elastics in Class II subdivision subjects. MATERIALS AND METHODS Twenty-eight Class II subdivision patients were allocated to two groups using matched randomization: Forsus group (mean age, 14.19 ± 1.02 years) and elastics group (mean age, 13.75 ± 1.16 years). Patients received fixed appliance therapy in combination with either Forsus or intermaxillary elastics. The study was conducted on lateral cephalograms and digital models acquired before orthodontic treatment and 10-12 weeks after the fixed appliances were removed. RESULTS The treatment phase comprising the use of Forsus (4.53 ± 0.91 months) was significantly shorter compared with elastics application (6.85 ± 1.08 months). This was also true for comparing duration of overall comprehensive treatment in both groups. Extrusion and palatal tipping of maxillary incisors and clockwise rotation of the occlusal plane were greater in the elastics group (P < .05). The mandibular incisors were proclined in both groups (P < .001), but no significant difference was observed between groups (P > .05). The mandibular incisors showed intrusion in the Forsus group and extrusion in the elastics group; the difference between groups was significant (P < .05). Overbite was decreased in both groups (P < .001) in similar amounts. Improvement in overjet, mandibular midline deviation, and correction of molar relationship on the Class II side were greater in the Forsus group (P < .05). CONCLUSION Forsus is more effective for correcting Class II subdivision malocclusion in a shorter treatment period with minimal patient compliance required.
Collapse
|
|
26
|
Dianiskova S, Calzolari C, Migliorati M, Silvestrini-Biavati A, Isola G, Savoldi F, Dalessandri D, Paganelli C. Tooth loss caused by displaced elastic during simple preprosthetic orthodontic treatment. World J Clin Cases 2016; 4:285-289. [PMID: 27672645 PMCID: PMC5018627 DOI: 10.12998/wjcc.v4.i9.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/04/2016] [Accepted: 07/13/2016] [Indexed: 02/05/2023] Open
Abstract
The use of elastics to close a diastema or correct tooth malpositions can create unintended consequences if not properly controlled. The American Association of Orthodontists recently issued a consumer alert, warning of “a substantial risk for irreparable damage” from a new trend called “do-it-yourself” orthodontics, consisting of patients autonomously using elastics to correct tooth position. The elastics can work their way below the gums and around the roots of the teeth, causing damage to the periodontium and even resulting in tooth loss. The cost of implants to replace these teeth would well exceed the cost of proper orthodontic care. This damage could also occur in a dental office, when a general dentist tries to perform a simplified orthodontic correction of a minor tooth malposition. The present case report describes a case of tooth loss caused by a displaced intraoral elastic, which occurred during a simple preprosthetic orthodontic treatment.
Collapse
|
|
27
|
Paulose J, Antony PJ, Sureshkumar B, George SM, Mathew MM, Sebastian J. PowerScope a Class II corrector - A case report. Contemp Clin Dent 2016; 7:221-5. [PMID: 27307671 PMCID: PMC4906867 DOI: 10.4103/0976-237x.183044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Managing mild to moderate Class II malocclusion is a one of the common and major challenges to orthodontists. Class II discrepancies with mandibular deficiency during active growth are usually treated by myofunctional appliances. Fixed functional appliances evolved due to the noncompliance with conventional myofunctional appliances. This case report illustrates the efficiency of PowerScope in correction of skeletal Class II with mandibular deficiency in a patient aged 13 years who has reported to the department with a chief complaint of forwardly placed upper front teeth. This case with functional jaw retrusion was treated initially with MBT 0.022” prescription followed by PowerScope. Pre-, mid- and post-treatment cephalograms were obtained, and cephalometric analysis was performed. Stable and successful results were obtained with a substantial improvement in facial profile, skeletal jaw relationship, and overall esthetic appearance of the patient. A significant forward displacement of the mandible was the principal element for successful correction of Class II malocclusion. PowerScope provides the best results for Class II management, thus enables us to treat such cases by a nonextraction approach rather than contemplating extractions.
Collapse
Affiliation(s)
- Joby Paulose
- Department of Orthodontics, Mar Baselios Dental College, Kothamangalam, Kerala, India
| | | | - Brijesh Sureshkumar
- Department of Orthodontics, Mar Baselios Dental College, Kothamangalam, Kerala, India
| | - Susha Mariam George
- Department of Orthodontics, Mar Baselios Dental College, Kothamangalam, Kerala, India
| | - Manu Mundackal Mathew
- Department of Orthodontics, Mar Baselios Dental College, Kothamangalam, Kerala, India
| | - Joseph Sebastian
- Department of Orthodontics, Mar Baselios Dental College, Kothamangalam, Kerala, India
| |
Collapse
|
|
28
|
Basavaraddi S, Gandedkar NH, Belludi A, Patil A. Correction of an adult Class II division 2 individual using fixed functional appliance: A noncompliance approach. Contemp Clin Dent 2016; 7:82-6. [PMID: 27041908 PMCID: PMC4792063 DOI: 10.4103/0976-237x.177114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This case report describes the application of fixed functional appliance in the treatment of an adult female having Class II division 2 malocclusion with retroclination of upper incisors. Fixed functional appliance was used to correct the overjet after the uprighting of upper incisors. Fixed functional appliance was fitted on a rigid rectangular arch wire. Application of fixed functional appliance achieved a good Class I molar relationship along with Class I canine relationship with normal overjet and overbite. Fixed functional appliance is effective in the treatment of Class II malocclusions, even in adult patients, and can serve as an alternate choice of treatment instead of orthognathic surgery. This is a case; wherein, fixed functional appliance was successfully used to relieve deep bite and overjet that was ensued after leveling and aligning. We demonstrate that fixed functional appliance can act as a “noncompliant corrector” and use of Class II elastics can be avoided.
Collapse
Affiliation(s)
- Shrinivas Basavaraddi
- Department of Orthodontics and Dentofacial Orthopedics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
| | - Narayan H Gandedkar
- Cleft and Craniofacial Centre and Dental Service, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - Anup Belludi
- Department of Orthodontics and Dentofacial Orthopedics, KLE Institute of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Anand Patil
- Department of Orthodontics and Dentofacial Orthopedics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
| |
Collapse
|
|
29
|
Barber SK, Forde KE, Spencer RJ. Class II Division 1: An Evidence- Based Review of Management and Treatment Timing in the Growing Patient. DENTAL UPDATE 2015; 42:632-642. [PMID: 26630861 DOI: 10.12968/denu.2015.42.7.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Class II division 1 malocclusion is common and various methods have been suggested for successful treatment in the growing patient. A number of recent high-quality studies have been undertaken to assess the efficacy of these treatments. We aim to outline the existing best evidence that supports current practice, with a review of the effect of treatment timing on outcome. This will provide a sound evidence-base for General Dental Practitioners for assessing, advising and referring young patients for treatment. CPD/CLINICAL RELEVANCE: General Dental Practitioners should understand the management options and optimal time for treating growing patients with a Class II division 1 malocclusion.
Collapse
|
|
30
|
Change of mandibular position during two-phase orthodontic treatment of skeletal class II in the Chinese population. ScientificWorldJournal 2015; 2015:804831. [PMID: 25695103 PMCID: PMC4324960 DOI: 10.1155/2015/804831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/20/2014] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate the change in mandibular position during a two-phase orthodontic treatment of skeletal Class II malocclusion. Thirty consecutively treated Chinese male adolescents who had undergone two-phase treatment with Herbst appliance and fixed appliance and fulfilled the specific selection criteria were sampled. Cephalograms taken at T0 (before treatment), T1 (at the end of functional appliance treatment), and T2 (at the end of fixed appliance treatment) were analyzed. The change in sagittal positioning of the mandible was 6.8±3.44 mm in phase I (T0-T1), 0.4±2.79 mm in phase II (T1-T2), and 7.2±4.61 mm in total. The mandible came forward in 100% of the patients at T1. In phase II, it came forward in one-third (positive group) remained unchanged in one-third (stable group) and went backward in one-third (negative group) of the patients. At T2, it came forward twice as much in the positive group compared to the negative group. Mandibular length was significantly increased in 100% of the patients in both phases. In conclusion, during the treatment with functional appliance, the mandibular prognathism increases in all patients, whereas during the treatment with fixed appliance there is no significant change in mandibular prognathism.
Collapse
|
|
31
|
Sandifer CL, English JD, Colville CD, Gallerano RL, Akyalcin S. Treatment effects of the Carrière distalizer using lingual arch and full fixed appliances. J World Fed Orthod 2014. [DOI: 10.1016/j.ejwf.2014.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
|
32
|
LeCornu M, Cevidanes LHS, Zhu H, Wu CD, Larson B, Nguyen T. Three-dimensional treatment outcomes in Class II patients treated with the Herbst appliance: a pilot study. Am J Orthod Dentofacial Orthop 2014; 144:818-30. [PMID: 24286905 DOI: 10.1016/j.ajodo.2013.07.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/01/2013] [Accepted: 07/01/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aims of this study were to analyze 3-dimensional skeletal changes in subjects with Class II malocclusion treated with the Herbst appliance and to compare these changes with treated Class II controls using 3-dimensional superimposition techniques. METHODS Seven consecutive Herbst patients and 7 Class II controls treated with Class II elastics who met the inclusion criteria had cone-beam computed tomographs taken before treatment, and either after Herbst removal or at posttreatment for the control subjects. Three-dimensional models were generated from the cone-beam computed tomography images, registered on the anterior cranial bases, and analyzed using color maps and point-to-point measurements. RESULTS The Herbst patients demonstrated anterior translation of the glenoid fossae and condyles (right anterior fossa, 1.69 ± 0.62 mm; left anterior fossa, 1.43 ± 0.71 mm; right anterior condyle, 1.20 ± 0.41 mm; left anterior condyle, 1.29 ± 0.57 mm), whereas posterior displacement predominated in the controls (right anterior fossa, -1.51 ± 0.68 mm; left anterior fossa, -1.31 ± 0.61 mm; right anterior condyle, -1.20 ± 0.41 mm; left anterior condyle, -1.29 ± 0.57 mm; P <0.001). There was more anterior projection of B-point in the Herbst patients (2.62 ± 1.08 mm vs 1.49 ± 0.79 mm; P <0.05). Anterior displacement of A-point was more predominant in the controls when compared with the Herbst patients (1.20 ± 0.53 mm vs -1.22 ± 0.43 mm; P <0.001). CONCLUSIONS Class II patients treated with the Herbst appliance demonstrated anterior displacement of the condyles and glenoid fossae along with maxillary restraint when compared with the treated Class II controls; this might result in more anterior mandibular projection.
Collapse
|
|
33
|
Thiruvenkatachari B, Harrison JE, Worthington HV, O'Brien KD. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children. Cochrane Database Syst Rev 2013:CD003452. [PMID: 24226169 DOI: 10.1002/14651858.cd003452.pub3] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prominent upper front teeth are a common problem affecting about a quarter of 12-year old children in the UK. The correction of this condition is one of the most common treatments performed by orthodontists. This condition develops when the child's permanent teeth erupt and children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of the teeth. These teeth are more likely to be injured and their appearance can cause significant distress.If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait until the child is older and provide treatment in early adolescence. OBJECTIVES To assess the effects of orthodontic treatment for prominent upper front teeth when this treatment is initiated when the child is seven to 11 years old compared to when they are in early adolescence, or when treatment uses different types of orthodontic braces. SEARCH METHODS We searched the following databases: Cochrane Oral Health Group's Trials Register (to 17 April 2013), CENTRAL (The Cochrane Library 2013, Issue 3), MEDLINE (OVID) (1946 to 17 April 2013) and EMBASE (OVID) (1980 to 17 April 2013). There were no restrictions regarding language or publication date. SELECTION CRITERIA Randomised controlled trials of children and/or adolescents (age < 16 years) on early treatment (either one or two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces compared with late treatment with any type of orthodontic braces or head-braces; or, on any type of orthodontic braces or head-braces compared with no treatment or another type of orthodontic brace or appliance (with treatment starting in children of similar ages in both groups) to correct prominent upper front teeth. DATA COLLECTION AND ANALYSIS Review authors screened the search results, extracted data and assessed risk of bias independently, used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes, mean differences (MDs) and 95% CIs for continuous outcomes and a fixed-effect model for meta-analyses as there were fewer than four studies. MAIN RESULTS We included 17 studies based on data from 721 participants.Three trials (n = 343) compared early (two-phase) treatment (7-11 years of age) with a functional appliance, with adolescent (one-phase) treatment. Statistically significant differences in overjet, ANB and PAR scores were found in favour of functional appliance when the first phase of early treatment was compared with observation in the children due to receive treatment in adolescence. However, at the end of treatment in both groups, there was no evidence of a difference in the overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18) (low quality evidence), final ANB (MD -0.02, 95% CI -0.47 to 0.43, P = 0.92), PAR score (MD 0.62, 95% CI -0.66 to 1.91, P = 0.34) or self concept score (MD 0.83, CI -2.31 to 3.97, P = 0.60). However, two-phase treatment with functional appliance showed a statistically significant reduction in the incidence of incisal trauma (OR 0.59, 95% CI 0.35 to 0.99, P = 0.04) (moderate quality evidence). The incidence of incisal trauma was clinically significant with 29% (54/185) of patients reporting new trauma incidence in the adolescent (one-phase) treatment group compared to only 20% (34/172) of patients receiving early (two-phase) treatment.Two trials (n = 285), compared early (two-phase) treatment using headgear, with adolescent (one-phase) treatment. Statistically significant differences in overjet and ANB were found in favour of headgear when the first phase of early treatment was compared with observation in the children due to receive treatment in adolescence. However, at the end of treatment in both groups, there was no evidence of a difference in the overjet (MD 0.22, 95% CI -0.56 to 0.12, P = 0.20) (low quality evidence), final ANB (MD -0.27, 95% CI -0.80 to 0.26, P = 0.32) or PAR score (MD -1.55, 95% CI -3.70 to 0.60, P = 0.16). The incidence of incisal trauma was, however, statistically significantly reduced in the two-phase treatment group (OR 0.47, 95% CI 0.27 to 0.83, P = 0.009) (low quality evidence). The adolescent treatment group showed twice the incidence of incisal trauma (47/120) compared to the young children group (27/117).Two trials (n = 282) compared different types of appliances (headgear and functional appliance) for early (two-phase) treatment. At the end of the first phase of treatment statistically significant differences, in favour of functional appliances, were shown with respect to final overjet only. At the end of phase two, there was no evidence of a difference between appliances with regard to overjet (MD -0.21, 95% CI -0.57 to 0.15, P = 0.26), final ANB (MD -0.17, 95% CI -0.67 to 0.34, P= 0.52), PAR score (MD -0.81, 95% CI -2.21 to 0.58, P = 0.25) or the incidence of incisal trauma (OR 0.79, 95% CI 0.43 to 1.44, P = 0.44).Late orthodontic treatment for adolescents with functional appliances showed a statistically significant reduction in overjet of -5.22 mm (95% CI -6.51 to -3.93, P < 0.00001) and ANB of -2.37° (95% CI -3.01 to -1.74, P < 0.00001) when compared to no treatment (very low quality evidence).There was no evidence of a difference in overjet when Twin Block was compared to other appliances (MD 0.01, 95% CI -0.45 to 0.48, P = 0.95). However, a statistically significant reduction in ANB (-0.63°, 95% CI -1.17 to -0.08, P = 0.02) was shown in favour of Twin Block. There was no evidence of a difference in any reported outcome when Twin Block was compared with modifications of Twin Block.There was insufficient evidence to determine the effects of Activator, FORSUS FRD EZ appliances, R-appliance or AIBP. AUTHORS' CONCLUSIONS The evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth is more effective in reducing the incidence of incisal trauma than providing one course of orthodontic treatment when the child is in early adolescence. There appears to be no other advantages for providing treatment early when compared to treatment in adolescence.
Collapse
Affiliation(s)
- Badri Thiruvenkatachari
- School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH
| | | | | | | |
Collapse
|
|
34
|
Janson G, Sathler R, Fernandes TMF, Branco NCC, Freitas MRD. Correction of Class II malocclusion with Class II elastics: a systematic review. Am J Orthod Dentofacial Orthop 2013; 143:383-92. [PMID: 23452973 DOI: 10.1016/j.ajodo.2012.10.015] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 10/01/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Although Class II elastics have been widely used in the correction of Class II malocclusions, there is still a belief that their side effects override the intended objectives. The aim of this systematic review was to evaluate the true effects of Class II elastics in Class II malocclusion treatment. METHODS A search was performed on PubMed, Scopus, Web of Science, Embase, Medline, and Cochrane databases, complemented by a hand search. Study eligibility criteria were the application of Class II elastics in Class II malocclusion treatment and the presentation of dental or skeletal outcomes of treatment. All age groups were included. RESULTS The search identified 417 articles, of which 11 fulfilled the inclusion criteria. Four studied the isolated effects of Class II elastics, and 7 were comparisons between a single use of elastics and another method for Class II malocclusion correction. Because of the differences in treatment modalities in these articles, a meta-analysis was not possible. CONCLUSIONS Based on the current literature, we can state that Class II elastics are effective in correcting Class II malocclusions, and their effects are primarily dentoalveolar. Therefore, they are similar to the effects of fixed functional appliances in the long term, placing these 2 methods close to each other when evaluating treatment effectiveness. Little attention has been given to the effects of Class II elastics on the soft tissues in Class II malocclusion treatment.
Collapse
Affiliation(s)
- Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil.
| | | | | | | | | |
Collapse
|
|
35
|
Booij JW, Goeke J, Bronkhorst EM, Katsaros C, Ruf S. Class II treatment by extraction of maxillary first molars or Herbst appliance: dentoskeletal and soft tissue effects in comparison. J Orofac Orthop 2013; 74:52-63. [PMID: 23299649 DOI: 10.1007/s00056-012-0112-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 05/25/2012] [Indexed: 11/30/2022]
Abstract
AIM To compare dentoskeletal and soft tissue treatment effects of two alternative Class II division 1 treatment modalities (maxillary first permanent molar extraction versus Herbst appliance). METHODS One-hundred-fifty-four Class II division 1 patients that had either been treated with extractions of the upper first molars and a lightwire multibracket (MB) appliance (n = 79; 38 girls, 41 boys) or non-extraction by means of a Herbst-MB appliance (n = 75; 35 girls, 40 boys). The groups were matched on age and sex. The average age at the start of treatment was 12.7 years for the extraction and for 13.0 years for the Herbst group. Pretreatment (T1) and posttreatment (T2) lateral cephalograms were retrospectively analyzed using a standard cephalometric analysis and the sagittal occlusal analysis according to Pancherz. RESULTS The SNA decrease was 1.10° (p = 0.001) more pronounced in the extraction group, the SNB angle increased 1.49° more in the Herbst group (p = 0.000). In the extraction group, a decrease in SNB angle (0.49°) was observed. The soft tissue profile convexity (N-Sn-Pog) decreased in both groups, which was 0.78° more (n. s.) pronounced in the Herbst group. The nasolabial angle increased significantly more (+ 2.33°, p = 0.025) in the extraction group. The mechanism of overjet correction in the extraction group was predominantly dental (65% dental and 35% skeletal changes), while in the Herbst group it was predominantly skeletal (58% skeletal and 42% dental changes) in origin. CONCLUSION Both treatment methods were successful and led to a correction of the Class II division 1 malocclusion. Whereas for upper first molar extraction treatment more dental and maxillary effects can be expected, in case of Herbst treatment skeletal and mandibular effects prevail.
Collapse
Affiliation(s)
- Johan Willem Booij
- Department of Orthodontics and Oral Biology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
| | | | | | | | | |
Collapse
|
|
36
|
Cabrera MDC, Cabrera CAG, Freitas KMSD, Freitas MRD, Janson G, Cabrera LDC. Cephalometric effects of the use of 10-hour Force Theory for Class II treatment. Dental Press J Orthod 2012. [DOI: 10.1590/s2176-94512012000600012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: This study aimed to evaluate the cephalometric effects promoted by the orthodontic treatment of Class II malocclusion patients with the use of the 10-Hour Force Theory, that consists in the use of fixed appliances with 8 hours a day using a cervical headgear appliance and 16 hours a day using Class II elastics, 8 hours on the first mandibular molar and 8 hours in the second mandibular molar. METHODS: Sample comprised 31 patients with mean initial age of 14.90 years, final mean age of 17.25 years and mean treatment time of 2.35 years. The lateral cephalograms in pre-treatment and post-treatment stages were evaluated. Evaluation of cephalometric changes between initial and final treatment phases was performed by paired t test. RESULTS: The cases treated with the 10-Hour Force Theory presented a slight restriction of anterior displacement of the maxilla, increase in the effective length of the mandible, significant improvement of the maxillomandibular relationship, significant increase in anterior lower face height, distal tipping of the maxillary premolar crowns, extrusion and distal tipping of the roots of maxillary molars, significant proclination and protrusion of mandibular incisors, significant extrusion and mesialization of mandibular molars, besides a significant correction of the molar relationship, overjet and overbite. CONCLUSION: The use of the 10-Hour Force Theory in treatment of Class II malocclusion provided satisfactory results.
Collapse
|
|
37
|
Fontana M, Cozzani M, Caprioglio A. Soft tissue, skeletal and dentoalveolar changes following conventional anchorage molar distalization therapy in class II Non-growing subjects: a multicentric retrospective study. Prog Orthod 2012; 13:30-41. [DOI: 10.1016/j.pio.2011.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 07/20/2011] [Accepted: 07/21/2011] [Indexed: 12/01/2022] Open
|
|
38
|
Wigal TG, Dischinger T, Martin C, Razmus T, Gunel E, Ngan P. Stability of Class II treatment with an edgewise crowned Herbst appliance in the early mixed dentition: Skeletal and dental changes. Am J Orthod Dentofacial Orthop 2011; 140:210-23. [PMID: 21803259 DOI: 10.1016/j.ajodo.2010.02.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 02/01/2010] [Accepted: 02/01/2010] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The objectives of this research were to assess skeletal and dental changes in patients with Class II malocclusion treated with the edgewise crowned Herbst appliance in the early mixed dentition and to measure the stability of treatment after a second phase of fixed appliance therapy. METHODS Twenty-two patients (ages, 8.4 ± 1.0 years) with Class II Division 1 malocclusion treated consecutively with the edgewise crowned Herbst appliance in the early mixed dentition were studied. Lateral cephalograms were taken before Herbst treatment, immediately after Herbst treatment, and after a second phase of fixed appliance therapy. The results were compared with a control group of untreated Class II subjects selected from the Bolton-Brush study, matched by age, sex, and craniofacial morphology. A total of 37 sagittal, vertical, and angular cephalometric variables were evaluated. Changes in overjet and molar relationship were calculated. Changes due to growth were subtracted to obtain the net changes due to treatment. The data were analyzed by using analysis of variance (ANOVA) and the t tests. RESULTS Overcorrection with the Herbst appliance resulted in an average reduction in overjet of 7.0 mm and a change in molar relationship of 6.6 mm. Several factors contributed to the change in overjet: restraint of the forward movement of the maxilla (0.4 mm), forward movement of the mandible (2.0 mm), backward movement of the maxillary incisors (3.7 mm), and forward movement of the mandibular incisors (0.9 mm). Skeletal changes together with a 3.1-mm backward movement of the maxillary molars and a 1.1-mm forward movement of the mandibular molars contributed to the changes in molar relationship. After the second phase of fixed appliance therapy, the change in overjet was reduced to 2.8 mm. Most of the remaining overjet corrections were contributed by the restraint of maxillary growth (2.8 mm). The mandible moved posteriorly by 1.6 mm, and the mandibular incisors moved forward by 0.2 mm. Change in molar relationship was reduced to 2.2 mm. The maxillary molars moved backward by 0.2 mm, and the mandibular molars moved forward by 0.8 mm. CONCLUSIONS Overcorrection of Class II malocclusion with the edgewise crowned Herbst appliance in the early mixed dentition resulted in a significant reduction in overjet and correction of the molar relationship. A portion of the correction was maintained after a second phase of fixed appliance therapy because of the continuous restraint of maxillary growth and the dentoalveolar adaptations.
Collapse
Affiliation(s)
- Timothy G Wigal
- Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, WV 26506, USA
| | | | | | | | | | | |
Collapse
|
|
39
|
Jones G, Buschang PH, Kim KB, Oliver DR. Class II Non-Extraction Patients Treated with the Forsus Fatigue Resistant Device Versus Intermaxillary Elastics. Angle Orthod 2008; 78:332-8. [DOI: 10.2319/030607-115.1] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 05/01/2007] [Indexed: 11/23/2022] Open
Abstract
Abstract
Objective: To evaluate the Forsus Fatigue Resistant Device (FRD) as a compliance-free alternative to Class II elastics.
Materials and Methods: A sample of 34 (14 female, 20 male) consecutively treated nonextraction FRD patients (12.6 years of age) were matched with a sample of 34 (14 female, 20 male) consecutively treated nonextraction Class II elastics patients (12.2 years of age) based on four pretreatment variables (ANB, L1-GoMe, SN-GoMe, and treatment duration). Pretreatment and posttreatment cephalometric radiographs were traced and analyzed using the pitchfork analysis and a vertical cephalometric analysis. t-Tests were used to evaluate group differences. Group differences were evaluated using t-tests.
Results: No statistically significant differences were found in the treatment changes between the groups. There was a general trend for mesial movement of the maxilla, mandible, and dentition during treatment for both groups. The mandibular skeletal advancement and dental movements were greater than those in the maxilla, which accounted for the Class II correction. Lower incisor proclination was evident in both groups. Vertically, the maxillary and mandibular molars erupted during treatment in both groups, while lower incisors proclined. With the exception of lower molar mesial movements and total molar correction, which were significantly (P < .05) greater in the Forsus group, there were no statistically significant group differences in the treatment changes.
Conclusions: The Forsus FRD is an acceptable substitute for Class II elastics for noncompliant patients.
Collapse
Affiliation(s)
| | - Peter H. Buschang
- b Professor, Department of Orthodontics, Baylor College of Dentistry, Dallas, Tex
| | - Ki Beom Kim
- c Assistant Professor, Department of Orthodontics, Saint Louis University, St. Louis, Mo
| | - Donald R. Oliver
- d Assistant Professor, Department of Orthodontics, Saint Louis University, St. Louis, Mo
| |
Collapse
|
|
40
|
Nelson B, Hägg U, Hansen K, Bendeus M. A long-term follow-up study of Class II malocclusion correction after treatment with Class II elastics or fixed functional appliances. Am J Orthod Dentofacial Orthop 2007; 132:499-503. [DOI: 10.1016/j.ajodo.2005.10.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Revised: 09/23/2005] [Accepted: 10/14/2005] [Indexed: 10/22/2022]
|
|
41
|
Uzel A, Uzel I, Toroglu MS. Two different applications of Class II elastics with nonextraction segmental techniques. Angle Orthod 2007; 77:694-700. [PMID: 17605495 DOI: 10.2319/071006-283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2006] [Accepted: 09/01/2006] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the relative effects of Class II elastics applied directly with utility arches (UAs) or with the Reciprocal Mini-Chin Cup (RMCC) appliance. MATERIALS AND METHODS Thirty patients with Class II division 1 malocclusion were included. Fifteen of them were treated with the RMCC appliance and the other 15 treated with Class II elastics on UAs. Lateral cephalograms of an additional 15 untreated persons having the same characteristics as the treatment groups were used as a control group. RESULTS The mean control period was 10 months. Class I molar and canine relationships were achieved in a mean treatment time of 4.6 months with the RMCC appliance and in 8.5 months with the elastics on UAs. The amount of overjet reduction was 4.7 mm in the RMCC group (87.87% dental) and 5.2 mm in the UA group (80.76% dental). The molar correction was 4.5 mm in the RMCC group (87.36% dental) and 2.0 mm in the UA group (51.47% dental). The anterior lower facial height increased in both of the treatment groups. CONCLUSIONS The RMCC appliance is a valuable alternative for Class II elastic use in Class II cases in which the upper molars need to be moved to the distal more than the upper incisors.
Collapse
Affiliation(s)
- Aslihan Uzel
- Department of Orthodontics, Faculty of Dentistry, Cukurova University, Adana, Turkey.
| | | | | |
Collapse
|
|
42
|
Harrison JE, O'Brien KD, Worthington HV. Orthodontic treatment for prominent upper front teeth in children. Cochrane Database Syst Rev 2007:CD003452. [PMID: 17636724 DOI: 10.1002/14651858.cd003452.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Prominent upper front teeth are an important and potentially harmful type of orthodontic problem. This condition develops when the child's permanent teeth erupt and children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of the teeth. If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait until the child is older and provide treatment in early adolescence. When treatment is provided during adolescence the orthodontist may provide treatment with various orthodontic braces, but there is currently little evidence of the relative effectiveness of the different braces that can be used. OBJECTIVES To assess the effectiveness of orthodontic treatment for prominent upper front teeth, when this treatment is provided when the child is 7 to 9 years old or when they are in early adolescence or with different dental braces or both. SEARCH STRATEGY The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. The handsearching of the key international orthodontic journals was updated to December 2006. There were no restrictions in respect to language or status of publication. Date of most recent searches: February 2007. SELECTION CRITERIA Trials were selected if they met the following criteria: design - randomised and controlled clinical trials; participants - children or adolescents (age < 16 years) or both receiving orthodontic treatment to correct prominent upper front teeth; interventions - active: any orthodontic brace or head-brace, control: no or delayed treatment or another active intervention; primary outcomes - prominence of the upper front teeth, relationship between upper and lower jaws; secondary outcomes: self esteem, any injury to the upper front teeth, jaw joint problems, patient satisfaction, number of attendances required to complete treatment. DATA COLLECTION AND ANALYSIS Information regarding methods, participants, interventions, outcome measures and results were extracted independently and in duplicate by two review authors. The Cochrane Oral Health Group's statistical guidelines were followed and mean differences were calculated using random-effects models. Potential sources of heterogeneity were examined. MAIN RESULTS The search strategy identified 185 titles and abstracts. From this we obtained 105 full reports for the review. Eight trials, based on data from 592 patients who presented with Class II Division 1 malocclusion, were included in the review.Early treatment comparisons: Three trials, involving 432 participants, compared early treatment with a functional appliance with no treatment. There was a significant difference in final overjet of the treatment group compared with the control group of -4.04 mm (95% CI -7.47 to -0.6, chi squared 117.02, 2 df, P < 0.00001, I(2) = 98.3%). There was a significant difference in ANB (-1.35 mm; 95% CI -2.57 to -0.14, chi squared 9.17, 2 df, P = 0.01, I(2) = 78.2%) and change in ANB (-0.55; 95% CI -0.92 to -0.18, chi squared 5.71, 1 df, P = 0.06, I(2) = 65.0%) between the treatment and control groups. The comparison of the effect of treatment with headgear versus untreated control revealed that there was a small but significant effect of headgear treatment on overjet of -1.07 (95% CI -1.63 to -0.51, chi squared 0.05, 1 df, P = 0.82, I(2) = 0%). Similarly, headgear resulted in a significant reduction in final ANB of -0.72 (95% CI -1.18 to -0.27, chi squared 0.34, 1 df, P = 0.56, I(2) = 0%). No significant differences, with respect to final overjet, ANB, or ANB change, were found between the effects of early treatment with headgear and the functional appliances. Adolescent treatment (Phase II): At the end of all treatment we found that there were no significant differences in overjet, final ANB or PAR score between the children who had a course of early treatment, with headgear or a functional appliance, and those who had not received early treatment. Similarly, there were no significant differences in overjet, final ANB or PAR score between children who had received a course of early treatment with headgear or a functional appliance. One trial found a significant reduction in overjet (-5.22 mm; 95% CI -6.51 to -3.93) and ANB (-2.27 degrees; 95% CI -3.22 to -1.31, chi squared 1.9, 1 df, P = 0.17, I(2) = 47.3%) for adolescents receiving one-phase treatment with a functional appliance versus an untreated control.A statistically significant reduction of ANB (-0.68 degrees; 95% CI -1.32 to -0.04, chi squared 0.56, 1 df, P = 0.46, I(2) = 0%) with the Twin Block appliance when compared to other functional appliances. However, there was no significant effect of the type of appliance on the final overjet. AUTHORS' CONCLUSIONS The evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth is no more effective than providing one course of orthodontic treatment when the child is in early adolescence.
Collapse
Affiliation(s)
- J E Harrison
- Liverpool University Dental Hospital, Orthodontic Department, Pembroke Place, Liverpool, Merseyside, UK, L3 5PS.
| | | | | |
Collapse
|
|
43
|
Bendeus M, Hägg U, Rabie B. Growth and treatment changes in patients treated with a headgear-activator appliance. Am J Orthod Dentofacial Orthop 2002; 121:376-84. [PMID: 11997762 DOI: 10.1067/mod.2002.122177] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to investigate growth and treatment changes in patients with Class II Division 1 malocclusion treated with a combined headgear-activator appliance. The sample consisted of 20 consecutive male patients treated with headgear-activator. Their compliance was checked after 2 months of treatment, and 3 patients dropped out. Lateral cephalograms, obtained 6 months before treatment, at the start of treatment, after 6 and 12 months of treatment, and 24 months after treatment, were analyzed by the method of Pancherz. The results disclosed that during growth, on average, overjet, molar relationship, and jaw-base relationship improved, and the mandibular incisors became retruded; the changes were statistically significant over a 2-year period. There was no significant change in the overbite. During the 12 months of treatment, there was no maxillary forward growth, and the jaw relationship improved (P <.001) because of forward growth of the mandible (P <.001). The molar relationship and the overbite improved (P <.001). Significant treatment effects included reduction in overjet (P <.001) and overbite (P <.01), and improvement of jaw-base (P <.05) and molar (P <.001) relationships. There was significant restraint of maxillary forward growth (P <.05). The eruption of the maxillary incisors and molars was restrained (P <.05). The average basic growth pattern in Class II Division 1 malocclusion resulted in small favorable changes in overjet, molar relationship, and jaw-base relationship. The main effect of the headgear-activator appliance was a favorable dental change, limited to restraint of maxillary forward growth but not affecting the vertical dimension.
Collapse
Affiliation(s)
- Margareta Bendeus
- Department of Orthodontics, Faculty of Dentistry, The University of Hong Kong, SAR China.
| | | | | |
Collapse
|
|
44
|
Bass NM. From treatment planning to treatment results: The luck of the draw? Am J Orthod Dentofacial Orthop 2001; 119:13A-14A. [PMID: 11244409 DOI: 10.1067/mod.2001.113289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|