1
|
Kandasamy S. Obstructive sleep apnea and early orthodontic intervention: How early is early? Am J Orthod Dentofacial Orthop 2024; 165:500-502. [PMID: 38180391 DOI: 10.1016/j.ajodo.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Sanjivan Kandasamy
- Center for Advanced Dental Education, Saint Louis University, St Louis, Mo; Dental School, The University of Western Australia, Nedlands, Western Australia, Australia; Private practice, West Australian Orthodontics, Midland, Western Australia, Australia.
| |
Collapse
|
2
|
Kim J, Lee NK, Kook YA, Kim Y, Park CO, Chou AHK, Han SH, Park JH. Long-term skeletodental changes with early and late treatment using modified C-palatal plates in hyperdivergent Class II adolescents. Angle Orthod 2024; 94:303-312. [PMID: 38639455 PMCID: PMC11050452 DOI: 10.2319/081123-556.1] [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: 08/01/2023] [Accepted: 11/01/2023] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES To compare skeletodental changes between early and late treatment groups using modified C-palatal plates (MCPP) and long-term retention outcomes in hyperdivergent Class II adolescents. MATERIALS AND METHODS Seventy-one hyperdivergent Class II patients were divided into four groups according to treatment modality and treatment timing: group 1, early treatment with MCPP (n = 16; 9.9 ± 0.9 years); group 2, late treatment with MCPP (n = 19; 12.3 ± 0.8 years); group 3, early treatment with headgear (HG; n = 18; 9.6 ± 0.8 years); and group 4, late treatment with HG (n = 18; 12.1 ± 1.2 years). Lateral cephalograms were taken and skeletal and dental variables were measured. For statistical analysis, paired t-tests, independent t-tests, and multiple regression were performed. RESULTS The early MCPP group showed a more significant decrease in mandibular plane angle than the late MCPP group did, and vertical control was more efficient in the early group than in the late group. In the MCPP groups, both FMA and SN-GoGn were increased with late treatment but decreased with early treatment, and the difference was statistically significant (P < .01). The early-treatment MCPP group had a significant decrease in SN-GoGn of 0.6° compared with an increase of 1.7° in the early treatment HG group (P < .01). Posttreatment stability of both the early and late MCPP groups was maintained in long-term retention. CONCLUSIONS Early MCPP showed more significant vertical control than late MCPP. However, there was no difference in long-term stability between early and late groups.
Collapse
|
3
|
Ghislanzoni LH, Kiliaridis S, Antonarakis GS. Headgear therapy in children with Class II malocclusion and the role of compliance on treatment outcome: A nine-month randomized controlled trial. Orthod Craniofac Res 2024. [PMID: 38685769 DOI: 10.1111/ocr.12802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES To evaluate three-dimensional movements of maxillary teeth during headgear treatment in Class II growing children, using digital analytical tools, and to determine the effects of compliance on these movements. MATERIALS AND METHODS A 9-month parallel-group randomized controlled trial was carried out on 40 children with Class II malocclusion, aged 8-12 years, half assigned to receive a cervical headgear and half to a no-treatment group, using block randomization. Subjects in the treatment group were instructed to wear the headgear for 12 hours daily and monitored using an electronic module. After 9 months, the following dental outcomes were measured: first maxillary molar distalisation, rotation, tip and torque, arch depth, and interpremolar and intermolar distances. Caregivers and participants were not blinded to group assignments, but those assessing outcomes were. Linear regression models were used to detect differences between groups and correlation coefficients to find correlations between compliance and dental outcomes. RESULTS All 40 included patients were analysed. A significant difference in molar distalisation was observed between the treatment (1.2 mm) and control groups (-0.2 mm). Arch depth change was also increased to a larger extent in the treatment groups (1.3 mm vs 0.1 mm), as was the interpremolar distance (1.9 mm vs 0.4 mm). In contrast, no significant differences in molar rotation or torque change were observed. With regard to compliance, average compliance was 55%. A significant correlation was found between molar distalisation and compliance in the treatment group. CONCLUSIONS Headgear therapy has significant effects on molar distalisation, arch depth, and arch width. Compliance has a significant positive effect on molar distalisation.
Collapse
Affiliation(s)
- Luis Huanca Ghislanzoni
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Stavros Kiliaridis
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Gregory S Antonarakis
- Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
4
|
Gandhi V, Mehta F, Patel D, Joshi H, Tadinada A, Yadav S, Malek F. Evaluation of Skeletal and Dentoalveolar Changes in Patients With Class II Div 1 Malocclusion Treated With Twin Block Appliance. Cureus 2023; 15:e49364. [PMID: 38024011 PMCID: PMC10673708 DOI: 10.7759/cureus.49364] [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] [Accepted: 11/24/2023] [Indexed: 12/01/2023] Open
Abstract
Objective The study was focused on evaluating the change in mandibular morphology following the Twin Block appliance therapy and recording its effect on the maxilla and maxillary dentoalveolar complex. Also, the results of the Twin Block appliance between males and females were compared. Material and methods In this two-armed retrospective cephalometric study, 30 patients (mean age 12 years) treated with Twin Block appliance for the period of 8-12 months were chosen, and their records were obtained to analyze. These results were compared with 15 control subjects of the same age group chosen from the American Association of Orthodontics Foundation (AAOF) growth legacy collection: Michigan Growth Study Class II subjects. Cephalometric tracing was done, and data was processed for descriptive statistical analysis. Results Paired sample t-test and ANOVA test were performed to evaluate the differences in the pre-treatment (T1) and post-functional (T2) values. ∠ANB showed a mean difference of -4.71°±1.55° for males and 6.22°±6.78° for females, which is significant. The mandibular length (Co-Gn), for male subjects, the mean difference was 5.14±1.74 mm, and for female subjects, it was 6±2mm, which is highly significant; 49.88% of skeletal changes and 50.12% of dentoalveolar changes were reported to bring about Class II correction with Twin Block. Conclusion A successful increase in mandibular length was achieved using a Twin Block as a functional appliance. Also, the significant maxillary restraining effect was recorded. More skeletal changes were observed in males than females.
Collapse
Affiliation(s)
- Vaibhav Gandhi
- Orthodontics and Dentofacial Orthopaedics, Candian Orthodontic Partners, Red Deer, CAN
| | - Falguni Mehta
- Orthodontics and Dentofacial Orthopaedics, Government Dental College and Hospital, Ahmedabad, IND
| | - Dolly Patel
- Orthodontics and Dentofacial Orthopaedics, AMC (Ahmedabad Municipal Corporation) Dental College and Hospital, Ahmedabad, IND
| | | | - Aditya Tadinada
- Oral and Maxillofacial Radiology, University of Connecticut, Farmington, USA
| | - Sumit Yadav
- Growth and Development, University of Nebraska Medical Center, Lincoln, USA
| | - Farheen Malek
- Prosthodontics, Louisiana State University School of Dentistry, New Orleans, USA
| |
Collapse
|
5
|
Gross A, Buschang PH, Shakya A, Jing Y. Short-term effects of mechanical loading on the transdifferentiation of condylar chondrocytes. Am J Orthod Dentofacial Orthop 2023; 164:201-214. [PMID: 36922241 PMCID: PMC10659147 DOI: 10.1016/j.ajodo.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Transdifferentiation of chondrocytes into bone cells explains most of the prenatal and early postnatal condylar growth, but its role during later postnatal growth and the mechanisms regulating transdifferentiation remain unknown. This study aimed to quantify the effects of mechanical loading on chondrocyte-derived osteogenesis during late postnatal condylar growth using a short-term mandibular laterotrusion model. METHODS Thirty 4-week-old Aggrecan-CreERT2, R26RtdTomato, and 2.3Col1a1-GFP compound mice received tamoxifen injections and were divided into control and experimental groups. Appliances were bonded to shift the mandibles of the experimental mice for 5 days, causing protrusion and retrusion of the right and left condyles, respectively. Radiographic, microcomputed tomographic, and histomorphometric analyses were performed. RESULTS The experimental and control groups showed substantial transdifferentiation of chondrocytes into bone cells. The experimental mice developed asymmetric mandibles, with the protrusive side significantly longer than the retrusive side. The protrusive condyles showed significantly increased chondrogenesis and greater numbers of chondrocyte-derived osteogenic cells, especially in the posterior third. The opposite effects were seen on the retrusive side. CONCLUSIONS Transdifferentiation of chondrocytes into bone cells occurs during late postnatal condylar growth. Laterotrusion regulates condylar chondrogenesis and chondrocyte transdifferentiation, which alters the amount and direction of condylar growth. Our study demonstrated that chondrocytes are key players in condylar bone formation and should be the focus of studies to control and further understand condylar growth.
Collapse
Affiliation(s)
- Amanda Gross
- Department of Orthodontics, Texas A&M University School of Dentistry, Dallas, Tex
| | - Peter H Buschang
- Department of Orthodontics, Texas A&M University School of Dentistry, Dallas, Tex
| | - Ajay Shakya
- Department of Biomedical Sciences, Texas A&M University School of Dentistry, Dallas, Tex
| | - Yan Jing
- Department of Orthodontics, Texas A&M University School of Dentistry, Dallas, Tex.
| |
Collapse
|
6
|
Gurgel ML, de Oliveira Ruellas AC, Bianchi J, McNamara JA, Tai S, Franchi L, Deleat-Besson R, Le C, Logan C, Turkestani NA, Massaro C, Del Castillo AA, Arruda KEM, Benavides E, Yatabe M, Cevidanes L. Clear aligner mandibular advancement in growing patients with Class II malocclusion. AJO-DO CLINICAL COMPANION 2023; 3:93-109. [PMID: 37636594 PMCID: PMC10454533 DOI: 10.1016/j.xaor.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Treatment effects occurring during Class II malocclusion treatment with the clear aligner mandibular advancement protocol were evaluated in two growing patients: one male (12 years, 3 months) and one female (11 years, 9 months). Both patients presented with full cusp Class II molar and canine relationships. Intraoral scans and cone-beam computed tomography were acquired before treatment and after mandibular advancement. Three-dimensional skeletal and dental long-axis changes were quantified, in which the dental long axis was determined by registering the dental crowns obtained from intraoral scans to the root canals in cone-beam computed tomography scans obtained at the same time points. Class II correction was achieved by a combination of mandibular skeletal and dental changes. A similar direction of skeletal and dental changes was observed in both patients, with downward and forward displacement of the mandible resulting from the growth of the mandibular condyle and ramus. Dental changes in both patients included mesialization of the mandibular posterior teeth with flaring of mandibular anterior teeth. In these two patients, clear aligner mandibular advancement was an effective treatment modality for Class II malocclusion correction with skeletal and dental effects and facial profile improvement.
Collapse
Affiliation(s)
- Marcela Lima Gurgel
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Antonio Carlos de Oliveira Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
- Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jonas Bianchi
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, Calif
| | - James A. McNamara
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Sandra Tai
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lorenzo Franchi
- Department of Experimental and Clinical Medicine, School of Dentistry, University of Florence, Florence, Tuscany, Italy
| | - Romain Deleat-Besson
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Celia Le
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Candice Logan
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Najla Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
- Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Camila Massaro
- Department of Orthodontics, School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Aron Aliaga Del Castillo
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Erika Benavides
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| |
Collapse
|
7
|
Lombardo EC, Lione R, Franchi L, Gaffuri F, Maspero C, Cozza P, Pavoni C. Dentoskeletal effects of clear aligner vs twin block-a short-term study of functional appliances. J Orofac Orthop 2023:10.1007/s00056-022-00443-1. [PMID: 36651930 DOI: 10.1007/s00056-022-00443-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 11/29/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE The twin block (TB) is one of the most widely used functional appliances for the correction of class II malocclusions. Align Technology (San Jose, CA, USA) developed the Invisalign® mandibular advancement (MA) that replicates the mechanism of action of a functional appliance. The aim of this study was to compare the changes produced by the TB versus those by MA. METHODS The records of 56 class II patients treated with the TB (TB group: n = 35) or the MA (MA group: n = 21) were compared to a control sample of 15 untreated class II subjects (UC2). RESULTS The TB and MA groups showed a significant reduction of the ANB angle, compared to the controls (TB group: -1.5°; MA group: -1.5°; UC2 group: +0.2°). For the Co-Gn values, the TB and MA groups showed significant differences when compared with the UC2 group with an increase of 8.4 mm in TB patients and of 8.3 mm in MA patients. The increase of the distance of Pg to the true vertical line (TVL) was the only measurement where significant differences between the three groups were found with a greater advancement of the soft tissue pogonion in the TB group compared with the MA group and the UC2 group (TB group: +3 mm; MA group: +0.9 mm; UC2 group: -1.6 mm). The angle between the palatal plane and mandibular plane revealed a more relevant reduction in the TB and MA groups. Both appliances were able to reduce overjet and vertical overbite values. CONCLUSIONS Treatment with the MA and TB appliances produced a significant elongation of the mandible with an improvement in sagittal relationship, overjet, and vertical overbite and with good control of the vertical relationship. TB subjects showed a greater advancement of the soft tissue chin.
Collapse
Affiliation(s)
| | - Roberta Lione
- Department of Dentistry, UNSBC, Tirana, Albania
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Francesca Gaffuri
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinco, Milan, Italy
| | - Cinzia Maspero
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinco, Milan, Italy
| | - Paola Cozza
- Department of Dentistry, UNSBC, Tirana, Albania
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Chiara Pavoni
- Department of Systems Medicine, University of Rome 'Tor Vergata', Viale Oxford 81, 00133, Rome, Italy.
- Department of Dentistry, UNSBC, Tirana, Albania.
| |
Collapse
|
8
|
Kirtane RS, Wiltshire WA, Thiruvenkatachari B, Shah A, Bittencourt Dutra Dos Santos P, Henrique de Sa Leitao Pinheiro F. Cephalometric effects of Twin-block and van Beek Headgear-Activator in the correction of Class II malocclusion. Am J Orthod Dentofacial Orthop 2023; 163:677-689. [PMID: 36621351 DOI: 10.1016/j.ajodo.2022.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/01/2022] [Accepted: 05/01/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The Twin-block (TB) and the van Beek Headgear-Activator (vBHGA) are indicated for patients with Class II malocclusion with a retrognathic mandible. Although the former is commonly prescribed for horizontally growing patients, the latter is often recommended for those growing vertically. This study aimed to compare the skeletal, dentoalveolar, and soft-tissue short-term effects of TB and vBHGA, taking growth patterns into account. METHODS Immediate prefunctional (T1) and postfunctional appliance (T2) lateral cephalometric radiographs were retrospectively obtained for vBHGA (n = 46), TB (n = 45), and untreated control (n = 45) groups. The interaction of several variables at T1, T2, and T2 - T1, as well as the resultant treatment effect, were analyzed using the analysis of covariance regression models at the 5% significance level. RESULTS Except for a greater reduction in Wits measurement (3.0 mm; P <0.0001) in the TB group, no anteroposterior (AP) skeletal difference was observed between the 2 appliances (ANB, 0.530; P = 0.07) (Harvold, 0.13 mm; P = 0.81). Both improved the AP skeletal relationship (ANB and Harvold) compared with the control (P <0.05). Although this mostly occurred because of the forward positioning of the mandible with the TB (SNB, 0.960; P = 0.01), the maxillary restriction was the main mechanism with the vBHGA (SNA, 1.590; P <0.01). Dentoalveolar compensations were more pronounced with the TB (IMPA, 1.92; P = 0.02), leading to greater overbite and overjet correction. Only the inclination of the maxillary incisors showed interaction with the growth pattern, with the TB horizontal growers experiencing more retroclination (U1-NA°. 3.620; P = 0.0067). CONCLUSIONS Both appliances produced similar modest AP skeletal changes that, together with dentoalveolar compensations, were able to correct the Class II malocclusion regardless of growth pattern.
Collapse
Affiliation(s)
- Rohan S Kirtane
- Department of Preventive Dental Sciences, Division of Orthodontics, Faculty of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William A Wiltshire
- Department of Preventive Dental Sciences, Division of Orthodontics, Faculty of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Badri Thiruvenkatachari
- Sree Balaji Dental College and Hospital, Bharath University, Chennai, India School of Dentistry, University of Manchester, Manchester, United Kingdom
| | - Adnan Shah
- Department of Dental Diagnostics and Surgical Sciences, Faculty of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | |
Collapse
|
9
|
The effectiveness of adjuncts or alternatives to the use of orthodontic retainers in preserving posttreatment outcomes: A systematic review. Am J Orthod Dentofacial Orthop 2023; 163:9-21.e3. [PMID: 36335023 DOI: 10.1016/j.ajodo.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The objective of this study was to systematically evaluate the efficacy of adjuncts or alternatives to mechanical retention in preserving postorthodontic treatment outcomes. METHODS Electronic databases, unpublished literature, and ongoing trials were searched until July 22, 2022 (PROSPERO CRD42021291165). Randomized and nonrandomized controlled trials investigating the efficacy of adjuncts and alternatives to conventional orthodontic retainers were included. Stability, periodontal effects, cost-effectiveness, and patient-reported outcomes were to be evaluated. The Cochrane Risk of Bias Tool and Risk of Bias In Nonrandomized Studies of Interventions (ROBINS-I) were used for risk of bias assessment. The certainty of the evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation system. Exploratory sensitivity analysis was undertaken to calculate the weighted treatment effects of the intervention. RESULTS A total of 5128 records were screened. Seven trials fulfilled the inclusion criteria, of which 5 were randomized controlled trials. Five trials were judged to be at high risk of bias, with 2 studies of unclear risk of bias. Heterogeneity between the limited number of included studies precluded the conduct of meta-analysis. Circumferential supracrestal fibrotomy resulted in less increase in the mandibular Little's Irregularity Index (mean difference, -2.30 mm; 95% confidence interval, -2.86 to -1.74). The overall level of evidence was of very low quality. CONCLUSIONS Adjuncts and alternatives to mechanical retention have promise, but based on the existing evidence, the reliance on mechanical retention cannot be reduced. There is weak evidence supporting circumferential supracrestal fibrotomy to improve stability outcomes. Further high-quality prospective research focusing on the predictability and acceptability of these approaches is needed.
Collapse
|
10
|
Cobourne MT, DiBiase AT, Seehra J, Papageorgiou SN. Should we recommend early overjet reduction to prevent dental trauma? Br Dent J 2022; 233:387-390. [PMID: 36085463 PMCID: PMC9463065 DOI: 10.1038/s41415-022-4916-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022]
Abstract
There is an association between increased overjet and risk of trauma to the maxillary incisor teeth in children and adolescents. It would therefore seem sensible to recommend overjet reduction as early as possible to help reduce this risk. However, orthodontic outcomes are essentially the same whether you start treatment in the early or late mixed dentition, while early treatment carries a heavier burden on compliance - taking longer and involving more appointments. This article explores the complex association between early overjet reduction and dental trauma in the context of current best evidence. Careful case selection is advised when justifying early intervention for increased overjet based on reducing trauma risk.
Collapse
Affiliation(s)
- Martyn T Cobourne
- Department of Orthodontics, Centre for Craniofacial and Regenerative Biology, Faculty of Dental, Oral and Craniofacial Sciences, King´s College London, London, UK.
| | - Andrew T DiBiase
- Department of Orthodontics, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, UK
| | - Jadbinder Seehra
- Department of Orthodontics, Centre for Craniofacial and Regenerative Biology, Faculty of Dental, Oral and Craniofacial Sciences, King´s College London, London, UK
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Paediatric Dentistry, Centre of Dental Medicine, University of Zurich, Zurich, Switzerland
| |
Collapse
|
11
|
Does Early Treatment Improve Clinical Outcome of Class II Patients? A Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020232. [PMID: 35204952 PMCID: PMC8870289 DOI: 10.3390/children9020232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023]
Abstract
The present study was carried out to evaluate the benefits from one-phase Class II Early Treatment (ET) using extraoral forces and functional appliances but without intermaxillary forces and eventual lower leeway space preservation compared to two-phase Class II Late Treatment (LT) with the need for extractions and full fixed appliances as well as lower incisor proclination. The ET group (n = 239, 115 M, 124 F, mean age 10.6 ± 1.2 years), with first premolars not in contact and the second deciduous lower molars preserved, was compared to the LT group (n = 288, 137 M, 151 F, mean age 12.4 ± 1.5 years). The ET group was first treated with headgears, growth guide appliances, or Teuscher activators and, in borderline crowding cases, with lower space maintenance by a lingual arch, lip bumper, or fixed utility arch. The LT group and the second phase of ET were treated with full fixed appliances including intermaxillary forces such as Class II elastics or noncompliance devices; headgear and a growth guide appliance were also used. Cephalograms and plaster models were taken before (T1) and after treatment (T2) to calculate cephalometric changes and space balance discrepancies. The differences between T1 and T2 were analyzed by a t-test for normally distributed data and by the Mann-Whitney Test for nonnormally distributed data at a level of p < 0.05. The groups were defined as statistically homogeneous at T1. A statistical analysis showed that the ET group (mean treatment time 35.3 ± 13.3 months) was significantly associated with a 22.2% lower extraction rate, 15.9% less need for a full fixed appliance, and more than 5° less incisor proclination in the nonextraction cases compared to the LT group (mean treatment time 25.9 ± 8.1 months); treatment time significantly increased in the ET group compared to the LT group. Early Class II treatment resulted in a significant treatment effort reduction in more than one third of the patients and less lower incisor proclination, even if it clinically increased treatment time.
Collapse
|
12
|
Wilson B, Konstantoni N, Kim KB, Foley P, Ueno H. Three-dimensional cone-beam computed tomography comparison of shorty and standard Class II Carriere Motion appliance. Angle Orthod 2021; 91:423-432. [PMID: 33560300 PMCID: PMC8259752 DOI: 10.2319/041320-295.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To compare treatment effects of the standard and shorty Class II Carriere Motion appliances (CMAs) on adolescent patients. MATERIALS AND METHODS Fifty adolescents with Class II malocclusion formed group 1, who were treated with shorty CMA (n = 25, 12.66 ± 1.05 years), and age- and sex-matched group 2, who were treated with standard CMA (n = 25, 12.73 ± 1.07 years). Treatment effects were analyzed by tracing with Invivo software to compare pretreatment (T1) cone-beam computed tomography (CBCT) images with post-CMA (T2) CBCT images. A total of 23 measurements were compared within and between groups. RESULTS In groups 1 and 2, maxillary first molars showed significant distal movement from T1 to T2 (1.83 ± 2.11 mm and 2.14 ± 1.34 mm, respectively), with distal tipping and rotation in group 1 (6.52° ± 3.99° and 3.15° ± 7.52°, respectively) but only distal tipping (7.03° ± 3.45°) in group 2. Similarly, in both groups, the maxillary first premolars experienced significant distal movement with distal tipping but no significant rotation. In group 1, maxillary canines did not undergo significant distal movement. In both groups 1 and 2, mandibular first molars experienced significant mesial movement (1.85 ± 1.88 mm and 2.44 ± 2.02 mm, respectively). Group 1 showed statistically significantly less reduction in overjet and less canine distal movement with less distal tipping than group 2 (α < .05). CONCLUSIONS The shorty CMA achieved Class II correction similarly to the standard CMA, with less change in overjet and distal tipping movement of the maxillary canines.
Collapse
|
13
|
Braga Santos SR, Martins de Araújo T, Vogel CJ, Bastos de Oliveira M, Vieira Bittencourt MA, Braga E. Evaluation of anteroposterior and vertical stability 25 years after Angle class II division 1 treatment with cervical headgear. J Orofac Orthop 2021; 82:382-390. [PMID: 33929557 DOI: 10.1007/s00056-020-00277-9] [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: 03/27/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The goal was to investigate long-term (minimum 20 years) skeletal and dental changes in Angle class II division 1 patients treated with full-fixed orthodontic appliances and cervical pull headgear. METHODS A longitudinal retrospective study was performed with 20 orthodontic patients, who were treated exclusively by one experienced clinician and whose treatment had been completed a minimum of 20 years ago. Former patients who had been treated from the mid-1970s to the early 1990s were actively sought. After the recall, 20 patients agreed to participate in the study. Lateral cephalometric radiographs at pretreatment (T1), posttreatment (T2), and long-term follow-up (T3) were digitized and measurements were performed. Angular variables used were SNA, SNB, ANB, OcclPl-FH, PalPl-FH, GoMe-FH, 1‑NA, and Y axis. Linear measures were A‑NPerp, Pg-NPerp, 1‑NAmm, Wits, and LAFH. RESULTS From T1 to T2, a significant reduction (p < 0.01) in ANB angle from 4.70 to 2.48° and in Wits value from 3.42 to 0.98 mm were observed. It was also noticed a significant increase (p < 0.01) in LAFH from 62.02 to 67.39 mm, probably due to normal facial growth. From T2 to T3, these variables remained stable. No significant changes were observed for any other measure in any of the periods studied. CONCLUSIONS In the assessed sample, Angle class II division 1 patients treated with cervical pull headgear presented cephalometric outcome stability of treatment, even after a long-term follow-up of a mean of 25 years postretention.
Collapse
Affiliation(s)
- Sara Ramos Braga Santos
- Department of Orthodontics, Federal University of Bahia, Av. Araújo Pinho, 62, Canela, Salvador, Bahia, Brazil
| | - Telma Martins de Araújo
- Department of Orthodontics, Federal University of Bahia, Av. Araújo Pinho, 62, Canela, Salvador, Bahia, Brazil
| | - Carlos Jorge Vogel
- Department of Orthodontics, Federal University of Bahia, Av. Araújo Pinho, 62, Canela, Salvador, Bahia, Brazil
| | - Márcio Bastos de Oliveira
- Department of Orthodontics, Federal University of Bahia, Av. Araújo Pinho, 62, Canela, Salvador, Bahia, Brazil
| | | | - Emanuel Braga
- Department of Orthodontics, Federal University of Bahia, Av. Araújo Pinho, 62, Canela, Salvador, Bahia, Brazil.
| |
Collapse
|
14
|
Antonarakis GS, Ameur S, Giannopoulou C, Kiliaridis S. Perception of pain in Class II malocclusion children treated with cervical headgear: a randomized controlled trial. Eur J Orthod 2021; 43:222-228. [PMID: 32812021 DOI: 10.1093/ejo/cjaa048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES The aims of this study were: 1. to evaluate the experience of pain perceived by children during separator placement and headgear wear; 2. to find possible associations between the perceived intensity of pain and the levels of Substance P (SP) and interleukin-1 beta (IL-1β) in the gingival crevicular fluid (GCF) during these procedures; 3. to identify other factors, such as previous pain experience, which could be associated to the patients' perceived discomfort or pain during treatment. TRIAL DESIGN Nine-month parallel-group randomized controlled trial. METHODS Forty Class II malocclusion children (8-12 years) were included, half of which received a cervical headgear while the other half did not receive any treatment during the study period. Baseline pain data were recorded including previous experience to general and dental pain, Corah's Dental Anxiety Scale, and baseline pain using a visual analogue scale (VAS). Elastic separators were placed in children for 1 week, followed by molar band and cervical headgear placement. Children were seen at various time points throughout the 9-month period where at each appointment, a VAS assessment of pain as well as GCF sampling was carried out to quantify the levels of SP and IL-1β. Multiple regression analysis was performed to ascertain the influence of factors including sex, age, time, headgear wear, and baseline pain data on pain severity. RESULTS Pain severity and SP and IL-1β levels in the GCF follow a similar pattern, with peaks being observed 1 day after orthodontic elastic separator placement. Pain was more severe after the placement of orthodontic separators than following cervical headgear wear. With regard to pain predictors, pain is more severe in older children, those with a worse previous general pain experience, and those with higher levels of IL-1β, particularly after elastic separator placement. CONCLUSIONS Orthodontic pain and discomfort following orthodontic separator placement and cervical headgear wear depends on factors including age, previous pain experience, and the level of IL-1β in the GCF.
Collapse
Affiliation(s)
- Gregory S Antonarakis
- Division of Orthodontics and University Clinics of Dental Medicine, University of Geneva, Switzerland
| | - Sofian Ameur
- Division of Orthodontics and University Clinics of Dental Medicine, University of Geneva, Switzerland
| | - Catherine Giannopoulou
- Division of Periodontology, University Clinics of Dental Medicine, University of Geneva, Switzerland
| | - Stavros Kiliaridis
- Division of Orthodontics and University Clinics of Dental Medicine, University of Geneva, Switzerland
| |
Collapse
|
15
|
Changes in the craniofacial structures and esthetic perceptions of soft-tissue profile alterations after distalization and Herbst appliance treatment. Am J Orthod Dentofacial Orthop 2021; 159:292-304. [PMID: 33487502 DOI: 10.1016/j.ajodo.2019.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 11/01/2019] [Accepted: 12/01/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The purpose of this prospective clinical trial is to evaluate the changes of soft tissues and designate the esthetic perceptions of children with Class II malocclusion after Herbst appliance therapy and maxillary molar distalization using stereophotogrammetry. METHODS Thirty patients were allocated either to Herbst (6 boys and 9 girls; mean age = 11.60 ± 0.82 years) or distalization (4 boys and 11 girls; mean age = 11.46 ± 1.30 years) groups. Dentoskeletal and soft-tissue treatment changes were examined objectively by cephalometric analysis and stereophotogrammetry, respectively. Pre- and posttreatment profile views were evaluated subjectively by orthodontists and laypeople using the 7-point Likert scale. Intra- and intergroup comparisons for the repeated measurements were performed with 2-way variance analysis. Bonferroni test was used for multiple comparisons (P ≤0.05). RESULTS Greater skeletal changes were observed in the Herbst group than in the distalization group. Maxillary incisor retrusion and mandibular incisor protrusion were observed in the distalization and Herbst groups, respectively. Stereophotogrammetric measurements showed that mandibular body length and lower and anterior facial height increased in both treatment groups. Convexity angle (P = 0.020) and labiomental angle (P = 0.033) were greater in the Herbst group than the distalization group. CONCLUSIONS The skeletal contribution to correction of maxillomandibular discrepancy was greater in the Herbst group than the distalization group. Significant profile improvements were recorded for both groups with treatment. After both treatments, orthodontists were found to have higher rates of detection in the profiles than laypeople. The esthetic contribution of treatments to the facial profile was found similar in both groups.
Collapse
|
16
|
Heino T, Kokko H, Vuollo V, Pirttiniemi P. Effect of cervical headgear on dental arch area, shape and interarch dimensions : A randomized study. J Orofac Orthop 2020; 82:153-162. [PMID: 33270142 PMCID: PMC8076135 DOI: 10.1007/s00056-020-00264-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 10/14/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The goal was to study the effects of early cervical headgear treatment on maxillary and mandibular dental arch area, shape and interarch dimensions. METHODS The total study group comprised 67 children aged 7.6 years (standard deviation 0.3) with Angle class II malocclusion collected between 1992 and 1996. The children were randomly divided into two groups of equal size. In the first group, cervical headgear treatment was started immediately and undertaken for 2 years. The remaining patients served as untreated controls. Dental casts were taken and scanned at the beginning of treatment (T0) and at the 2‑year (T1) and 4‑year follow-up (T2). Three-dimensional landmarks describing the positions of maxillary and mandibular incisors, canines, first and second premolars and first molars were used to calculate and visualize the maxillary and mandibular dental arch area and shape using the polynomial equation y = Ax6 + Bx2. RESULTS Significant changes in the shape and area of both maxillary and mandibular dental arches were induced with cervical headgear. The headgear increased dental arch area, sagittal dimensions at the mid-sagittal line and transversal dimensions at all of the measured levels in both dental arches compared to the control group. CONCLUSIONS Cervical headgear is an effective treatment device to gain space in both dental arches. Furthermore, when used as an early phase treatment, relapse is relatively small compared to the gained space.
Collapse
Affiliation(s)
- Toni Heino
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Heta Kokko
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Ville Vuollo
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Pertti Pirttiniemi
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland. .,Medical Research Center, Oulu University Hospital, Oulu, Finland.
| |
Collapse
|
17
|
Patel MP, Henriques JFC, Freitas KMS, Almeida R, Janson G. Stability of class II treatment with Pendulum and Jones jig followed by fixed appliances. Orthod Craniofac Res 2020; 24:370-378. [PMID: 33259104 DOI: 10.1111/ocr.12447] [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: 07/04/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The present study aimed to evaluate and compare the long-term stability of Class II correction with the Pendulum or Jones jig followed by fixed appliances. SETTINGS AND SAMPLE POPULATION Group 1 comprised 20 Class II malocclusion patients with a mean initial age of 13.97 years (SD = 1.57), treated with Pendulum and fixed appliances for a mean period of 4.72 years (SD = 0.98), and mean long-term post-treatment evaluation of 4.72 years (SD = 0.97). Group 2 consisted of 18 Class II patients with a mean initial age of 13.19 years (SD = 1.26), treated with Jones jig and fixed appliances for a mean period of 3.96 years (SD = 0.92). Mean long-term post-treatment time was 5.50 years (SD = 1.57). METHODS Lateral cephalograms were evaluated at three stages: initial (T1), final (T2) and long-term post-treatment (T3). Intragroup comparisons were performed with repeated measures ANOVA and Tukey's test and intergroup comparisons with independent t test. RESULTS Many treatment changes were observed in both groups. From the long-term post-treatment periods, there was stability for most of the variables. Maxillary second molars and mandibular first molars extruded in the Jones jig group and slightly intruded in the Pendulum appliance group. The nasolabial angle decreased in the Pendulum group and increased in the Jones jig group. CONCLUSION The correction of a Class II malocclusion was shown to be stable with similar long-term post-treatment results with Pendulum or Jones jig followed by fixed orthodontic appliances.
Collapse
Affiliation(s)
- Mayara Paim Patel
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil.,Department of Orthodontics, Guarulhos University UNG, Guarulhos, Brazil
| | | | - Karina Maria Salvatore Freitas
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil.,Department of Orthodontics, Ingá University Center Uningá, Maringá, Brazil
| | - Renato Almeida
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil
| | - Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil
| |
Collapse
|
18
|
Julku J, Hannula M, Pirilä-Parkkinen K, Tolvanen M, Pirttiniemi P. Dental arch effects after early and later timed cervical headgear treatment-a randomized controlled trial. Eur J Orthod 2020; 41:622-630. [PMID: 30601990 DOI: 10.1093/ejo/cjy083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Cervical headgear (CH) is a commonly used orthodontic appliance and its dentoalveolar changes are known. However, the effects related to gender and timing have gained less attention. OBJECTIVES To examine dimensions of dental arches among children with Class II occlusion without posterior mandibular rotation according to timing of Kloehn-type CH treatment. TRIAL DESIGN Prospective, randomized, parallel-group controlled trial. METHODS Sixty-seven seven-year-old children with a Class II occlusion were included in the study. The children were randomized into two equal-size groups in 1:1 ratio by sealed-envelope randomization. The early group (EG, n = 33) was treated between T0 and T1 (26 months), right after eruption of the first maxillary molars. The late group (LG, n = 34) was treated between T1 and T2 (24 months). The children were treated with CH until normal Class I occlusion on first molars was achieved. Impressions for dental casts were taken from all participants at T0, T1, and T2. Blinding was applicable for outcome assessors. Changes in dental cast measurements were compared between the groups and genders using t-test, Mann-Whitney U-test, and repeated measures analysis of variance. RESULTS Of the children, 56 completed the study. The maxillary arch length and the transversal changes between the upper canines and upper first molars were significantly increased in EG at T0-T1 (P < 0.001). At T2, the transversal dimension between the upper first molars was larger (P < 0.05), and in the lower arch the mandibular arch length (P < 0.05) and the transversal dimension between the lower first molars (P < 0.01) were increased in EG males compared to LG males. No harms were encountered. CONCLUSIONS The male gender benefits most from early timing of the CH treatment, showing larger dimensions at the end of the follow-up. The results clearly indicated a wider and longer upper dental arch and spontaneous expansion of the lower dental arch after treatment. CLINICAL REGISTRATION NCT02010346.
Collapse
Affiliation(s)
- Johanna Julku
- Oral and Maxillofacial Department, Oulu University Hospital, Finland.,Department of Oral Development and Orthodontics, Research Unit of Oral Health Sciences, University of Oulu, Finland.,MRC Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Matti Hannula
- Department of Oral Development and Orthodontics, Research Unit of Oral Health Sciences, University of Oulu, Finland.,MRC Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Kirsi Pirilä-Parkkinen
- Oral and Maxillofacial Department, Oulu University Hospital, Finland.,MRC Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Mimmi Tolvanen
- Department of Community Dentistry, Institute of Dentistry, University of Turku, Finland.,Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Finland
| | - Pertti Pirttiniemi
- Oral and Maxillofacial Department, Oulu University Hospital, Finland.,Department of Oral Development and Orthodontics, Research Unit of Oral Health Sciences, University of Oulu, Finland.,MRC Oulu, Oulu University Hospital and University of Oulu, Finland
| |
Collapse
|
19
|
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: 10] [Impact Index Per Article: 2.5] [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
|
20
|
Areepong D, Kim KB, Oliver DR, Ueno H. The Class II Carriere Motion appliance. Angle Orthod 2020; 90:491-499. [PMID: 33378493 PMCID: PMC8028468 DOI: 10.2319/080919-523.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To determine three-dimensional treatment changes produced by the Class II Carriere Motion appliance (CMA) in Class II adolescent patients with Class I and Class II skeletal relationships. MATERIALS AND METHODS The sample included 59 adolescents (16 boys and 43 girls) with unilateral or bilateral Class II molar and bilateral Class II canine relationship. They were divided into group 1 with skeletal Class I (N = 27; ANB 2.90° ± 1.40°; 13.30 ± 1.53 years) and group 2 with skeletal Class II (N = 32; ANB 6.06° ± 1.64°; 13.26 ± 1.76 years). Cone beam computed tomography images were traced with Invivo software pretreatment (T1) and post-CMA usage (T2). The treatment changes in 36 measurements were calculated in each group, and the changes in 16 measurements were compared between them. RESULTS In group 1 and 2, maxillary first molars underwent significant distal movement (1.92 mm ± 0.80 mm and 1.67 mm ± 1.56 mm, respectively) with distal tipping and rotation, maxillary canines underwent significant distal movement (2.34 mm ± 1.07 mm and 2.24 mm ± 1.91 mm, respectively) with distal tipping and rotation, and mandibular molars underwent significant mesial movement (-1.37 mm ± 1.23 mm and -2.51 mm ± 1.51 mm, respectively) with mesial tipping. Between the groups, there were significant differences in mandibular molar mesial movement and the U1-SN changes (P < .05). CONCLUSIONS The CMA corrected Class II malocclusion through distal tipping and rotational movement of maxillary canines and molars and corrected mesial tipping of mandibular molars. Significantly more mandibular molar mesial movement and maxillary incisor flaring were observed in patients with skeletal Class II.
Collapse
|
21
|
Song YL, Tan ELY, Chua BCJ, Ng RJY, Lam NKP. Interceptive orthodontic treatment in Singapore: A descriptive study. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105820922569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The benefits of interceptive orthodontic treatment have always been a subject of much debate, and it is understandable that clinicians are confused about how to advise parents of potential interceptive orthodontic patients. Objective: The aim is to study the treatment outcomes of interceptive orthodontics associated with different appliances. Demographic information on patients presenting for interceptive treatment, prevalence and types of dental conditions treated, types and frequency of appliances used, treatment duration and the number of visits taken were also investigated. Methods: This study involved analyzing records of interceptive orthodontic patients seen at the National Dental Centre Singapore from January 2011 to December 2017. Treatment outcomes were divided into success, improvement and failure according to pre-determined treatment objective parameters. Results: A total of 1324 patient records (654 females, 670 males) were studied, with an average age of 10.6±1.9 years. The most common dental condition seen was the anterior crossbite while the most common interceptive orthodontic appliance used was the bite plate. Average treatment duration was 10.8±6.8 months (9.8±9.2 visits) for fixed appliances, 7.5±6.5 months (6.9±3.4 visits) for removable appliances and 10.8±3.2 months (12.6±3.3 visits) for a combination. Interceptive orthodontic treatment had an overall success rate of 75.5%, improvement rate of 9.5% and failure rate of 15.0%. The most common reason for failure was attributed to non-compliance. Conclusion: The data above shed light on interceptive orthodontic treatment in an Asian population and gives useful information for primary care clinicians to provide for concerned parents.
Collapse
Affiliation(s)
- Yi Lin Song
- National Dental Research Institute Singapore, National Dental Centre Singapore
- Oral Health Academic Clinical Programme, Duke-NUS Medical School
| | - Elaine Li Yen Tan
- National Dental Research Institute Singapore, National Dental Centre Singapore
- Oral Health Academic Clinical Programme, Duke-NUS Medical School
| | | | | | | |
Collapse
|
22
|
Rédua RB. Different approaches to the treatment of skeletal Class II malocclusion during growth: Bionator versus extraoral appliance. Dental Press J Orthod 2020; 25:69-85. [PMID: 32490927 PMCID: PMC7265671 DOI: 10.1590/2177-6709.25.2.069-085.bbo] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/06/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Class II malocclusion, which has a significant incidence in the population, may compromise facial esthetics and the smile, as well as the masticatory and respiratory functions. Often associated with skeletal abnormalities, it severely affects and compromises quality of life. An accurate diagnosis is fundamental to prepare a treatment plan to correct dental and skeletal anomalies. OBJECTIVES This study discusses treatment alternatives to the correction of Class II division 1 and 2 malocclusion in growing patients, using a Bionator and an extraoral appliance.
Collapse
|
23
|
Keski-Nisula K, Keski-Nisula L, Varrela J. Class II treatment in early mixed dentition with the eruption guidance appliance: effects and long-term stability. Eur J Orthod 2020; 42:151-156. [PMID: 31750513 DOI: 10.1093/ejo/cjz092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Our aim was to analyse dentoskeletal effects and long-term stability of Class II treatment carried out with an eruption guidance appliance (EGA) in early mixed dentition. MATERIALS AND METHODS Sixty-five Class II patients (38 females and 27 males), treated with an EGA in early mixed dentition, were compared with 58 children (26 females and 32 males) with untreated Class II malocclusion. The mean age in the treatment group at the start (T1) and end of treatment (T2) was 5.4 years (±0.4) and 8.5 years (±0.9), respectively, and at the final examination in the early permanent dentition (T3) 16.7 years (±0.4). In the control group, the mean age at T1 and T2 were 5.1 years (±0.5) and 8.4 years (±0.5), respectively. The independent and dependent sample t-tests, Chi-square test, and Fisher's test were used in the statistical evaluation. RESULTS In the treatment group, the frequency of Class II decreased from 100 to 14% during the treatment (T1-T2) and a significant correction took place in all occlusal variables. At T2, the treatment and control groups showed statistically significant differences (P < 0.05) in all occlusal variables. In the treated children, mandibular length increased 5 mm more (P < 0.001) from T1 to T2 compared to the control children, and the ANB angle became significantly smaller (P = 0.006). During the post-treatment period (T2-T3), the frequency of Class II in the treatment group decreased from 14 to 2% (P < 0.05), overbite increased from 2.2 to 3.1 mm (P < 0.05), and lower crowding increased from 2to 14% (P < 0.05). Post-treatment changes in overjet and upper crowding were not statistically significant. At T3, the mean values of the SNA, SNB, and ANB angles were 83.0° (SD 3.9°), 81.3° (SD 3.8°), and 2.4° (SD 1.5°), respectively. CONCLUSIONS A clinically significant correction of the molar relationship, overjet, overbite, incisor alignment, and growth enhancement of the mandible were observed after treatment in early mixed dentition. The treatment results remained largely stable in the early permanent dentition. However, an increase was observed in overbite and lower crowding. None of the children treated in early mixed dentition needed a second treatment phase.
Collapse
Affiliation(s)
- Katri Keski-Nisula
- Department of Oral Development and Orthodontics, University of Turku, Turku, Finland
| | - Leo Keski-Nisula
- Department of Oral Development and Orthodontics, University of Turku, Turku, Finland
| | - Juha Varrela
- Department of Oral Development and Orthodontics, University of Turku, Turku, Finland.,City of Turku Welfare Division, Oral Health Care, Turku, Finland
| |
Collapse
|
24
|
Pupulim DC, Henriques JFC, Janson G, Henriques FP, Freitas KMS, Garib D. Comparison of dentoskeletal and soft tissue effects of Class II malocclusion treatment with Jones Jig appliance and with maxillary first premolar extractions. Dental Press J Orthod 2020; 24:56-65. [PMID: 31116288 PMCID: PMC6526763 DOI: 10.1590/2177-6709.24.2.056-065.oar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 04/24/2018] [Indexed: 11/22/2022] Open
Abstract
Objective: The aim of this study was to compare the cephalometric changes in Class II division 1 malocclusion patients treated with Jones Jig appliance or with maxillary first premolar extractions. Methods: The sample consisted of 88 lateral cephalograms of 44 patients, divided into two groups. Group 1 consisted of 21 patients treated with Jones Jig appliance, with a mean initial age of 12.88 ± 1.23 years and final mean age of 17.18 ± 1.37 years, and a mean treatment time of 4.29 years. Group 2 comprised 23 patients treated with maxillary first premolar extractions, with a mean initial age of 13.59 ± 1.91 years and mean final age of 16.39 ± 1.97 years, and a mean treatment time of 2.8 years. Intergroup treatment changes were compared with t and Mann-Whitney tests. Results: Class II correction in G2 (maxillary first premolar extractions) presented significantly greater maxillary retrusion, reduction of anteroposterior apical base discrepancy, smaller increase in the lower anterior face height and significantly greater overjet reduction than G1 (Jones Jig). Conclusions: Treatment with maxillary first premolar extractions produced greater overjet reduction, but the two treatment protocols produced similar changes in the soft tissue profile.
Collapse
Affiliation(s)
- Daniela Cubas Pupulim
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ortodontia (Bauru/SP, Brazil)
| | | | - Guilherme Janson
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ortodontia (Bauru/SP, Brazil)
| | - Fernanda Pinelli Henriques
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ortodontia (Bauru/SP, Brazil)
| | | | - Daniela Garib
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ortodontia (Bauru/SP, Brazil)
| |
Collapse
|
25
|
Stocker LO, Patcas R, Schätzle MA. Improving headgear wear: why force level and direction of traction matter. Eur J Orthod 2020; 42:174-179. [DOI: 10.1093/ejo/cjaa003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Summary
Background
Empiric data on headgear wear are scarce. The aim was to examine a possible discrepancy between the duration of wearing and force application, and whether such a difference is influenced by force level or direction of traction.
Materials and methods
In this retrospective analysis, 122 consecutive patients were included. All were treated with headgear (three subgroups: high-pull headgear [n = 60], cervical-pull headgear [n = 32], and high-pull headgear in combination with an activator [n = 30]) and were monitored for three successive months using an electronic module. The device recorded chronographically the measured force magnitude and temperature, allowing to differentiate between the duration of headgear wear (recorded body temperature) and actual force application (recorded force).
Results
For all subgroups, the average recorded force application was lower than wear time (mean inactivity during wear: 15.9 ± 22.8 minutes/night). The direction of traction significantly influenced the extent and length of wear time without force application (P < 0.001): patients with cervical-pull headgear were more prone to inactive wear time (27.7 minutes/night) than patients with high-pull headgear (13.7 minutes/night) or with headgear–activator (7.8 minutes/night). The observed inter-individual variability of inactive wear time was considerable (0–134 minutes/night). The mean applied force was highly significantly associated with inactive wear time (correlation coefficient: −0.575; P < 0.001), and force levels below 250 g seem particularly related to episodes of inactivity.
Conclusions
There is a clear incongruity between the duration of headgear wear and the duration of force application. Inactive wear time is influenced by the direction of traction and force level applied. Clinicians should be aware of the likelihood of periods of inactive wear time and researchers should search for options to reduce or even eliminate these periods.
Collapse
Affiliation(s)
- Larissa Olivia Stocker
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| | - Raphael Patcas
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| | - Marc Andreas Schätzle
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Switzerland
| |
Collapse
|
26
|
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: 4] [Impact Index Per Article: 0.8] [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
|
27
|
An updated systematic review regarding early Class II malocclusion correction. J World Fed Orthod 2019. [DOI: 10.1016/j.ejwf.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
28
|
Kyburz KS, Eliades T, Papageorgiou SN. What effect does functional appliance treatment have on the temporomandibular joint? A systematic review with meta-analysis. Prog Orthod 2019; 20:32. [PMID: 31402395 PMCID: PMC6689567 DOI: 10.1186/s40510-019-0286-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/24/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of the current systematic review was to compare the radiologic effects of functional appliance Class II treatment compared to no treatment on the temporomandibular joint and its components. METHODS Nine databases were searched up to June 2019 for randomized or prospective non-randomized clinical trials comparing Class II patients treated with functional appliances to untreated patients. After duplicate study selection, data extraction, and risk of bias assessment with the Cochrane tool and the ROBINS-I tool, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by the assessment of the quality of evidence with GRADE. RESULTS A total of 11 papers on 8 unique trials with 377 patients (39.8% male; average age 10.3 years) were finally included. Limited evidence indicated that compared to untreated growing patients functional appliance treatment was associated with increased condylar width (2 studies; MD 1.1 mm; 95% CI 0.1 to 2.2 mm; very low evidence quality), decreased anterior joint space (2 studies; MD - 0.7 mm; 95% CI - 0.5 to - 0.9 mm; very low evidence quality), increased superior joint space (2 studies; MD 0.7 mm; 95% CI 0.5 to 1.0 mm; very low evidence quality), increased posterior joint space (2 studies; MD 1.0 mm; 95% CI 0.9 to 1.2 mm; very low evidence quality), and vertical displacement of the glenoid fossa (2 studies; MD 0.4 mm; 95% CI 0.1 to 0.7 mm; very low evidence quality). The main limitations affecting the validity of the present findings were the inclusion of non-randomized studies with methodological issues, imprecision due to limited samples of the included studies, and inconsistencies among studies. CONCLUSIONS Currently existing evidence from controlled clinical studies on humans indicates that functional appliance treatment is associated with positional and skeletal alterations of the temporomandibular joint in the short term compared to untreated controls. However, the clinical relevance of these changes remains unclear, while the quality of existing evidence is low due to methodological issues of existing studies. REVIEW REGISTRATION PROSPERO, CRD42018109271.
Collapse
Affiliation(s)
- Karma Shiba Kyburz
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, Zurich, Switzerland
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, Zurich, Switzerland
| | - Spyridon N. Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, Zurich, Switzerland
| |
Collapse
|
29
|
|
30
|
Bilbo EE, Marshall SD, Southard KA, Allareddy V, Holton N, Thames AM, Otsby MS, Southard TE. Long-term skeletal effects of high-pull headgear followed by fixed appliances for the treatment of Class II malocclusions. Angle Orthod 2018; 88:530-537. [PMID: 29667470 DOI: 10.2319/091517-620.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The long-term skeletal effects of Class II treatment in growing individuals using high-pull facebow headgear and fixed edgewise appliances have not been reported. The purpose of this study was to evaluate the long-term skeletal effects of treatment using high-pull headgear followed by fixed orthodontic appliances compared to an untreated control group. MATERIALS AND METHODS Changes in anteroposterior and vertical cephalometric measurements of 42 Class II subjects (n = 21, mean age = 10.7 years) before treatment, after headgear correction to Class I molar relationship, after treatment with fixed appliances, and after long-term retention (mean 4.1 years), were compared to similar changes in a matched control group (n = 21, mean age = 10.9 years) by multivariable linear regression models. RESULTS Compared to control, the study group displayed significant long-term horizontal restriction of A-point (SNA = -1.925°, P < .0001; FH-NA = -3.042°, P < .0001; linear measurement A-point to Vertical Reference = -3.859 mm, P < .0001) and reduction of the ANB angle (-1.767°, P < .0001), with no effect on mandibular horizontal growth or maxillary and mandibular vertical skeletal changes. A-point horizontal restriction and forward mandibular horizontal growth accompanied the study group correction to Class I molar, and these changes were stable long term. CONCLUSIONS One phase treatment for Class II malocclusion with high-pull headgear followed by fixed orthodontic appliances resulted in correction to Class I molar through restriction of horizontal maxillary growth with continued horizontal mandibular growth and vertical skeletal changes unaffected. The anteroposterior molar correction and skeletal effects of this treatment were stable long term.
Collapse
|
31
|
Batista KBSL, Thiruvenkatachari B, Harrison JE, O'Brien KD. 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: 6.3] [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
|
32
|
Nucera R, Militi A, Lo Giudice A, Longo V, Fastuca R, Caprioglio A, Cordasco G, Papadopoulos MA. Skeletal and Dental Effectiveness of Treatment of Class II Malocclusion With Headgear: A Systematic Review and Meta-analysis. J Evid Based Dent Pract 2018; 18:41-58. [DOI: 10.1016/j.jebdp.2017.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
|
33
|
Ciavarella D, Laurenziello M, Guida L, Montaruli G, Gallo C, Tepedino M, Lo Muzio L. Dentoskeletal modifications in Class II deep bite malocclusion treatment with anterior bite plane functional appliance. J Clin Exp Dent 2017; 9:e1029-e1034. [PMID: 28936295 PMCID: PMC5601104 DOI: 10.4317/jced.54092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/28/2017] [Indexed: 02/05/2023] Open
Abstract
Background A treatment modality for Class II division 1 malocclusion is discussed. Orthodontic treatment of patients with deep bite and Class II malocclusion is an important challenge in clinical practice. The aim of this work is to compare the efficacy of anterior bite plane functional appliance (ABPFA) by assessing the changes in different times with untreated patients by literature. Material and Methods The study group comprised 22 subjects with Class II division 1 malocclusion and hypo-divergent. Eligibility criteria for this study were: dental Class II division 1 malocclusion, hypo-divergent skeletal pattern, late mixed or permanent dentition. We analyzed with the use of stable bone structure (ASCB) at two different times: pre-treatment (T0) and post-treatment (T1) after 24 months. Inter-group differences were evaluated with paired samples t-test at the P<0.05 level. Results No statistical significant differences were found in cephalometric skeletal measurements, whereas dental parameters showed a significant different overjet, which was significantly reduced (6 mm at T0 vs. 5 mm at T1) in our series. Conclusions In ABPFA group, the treatment effects were reduce mainly Class II malocclusion, overjet and overbite alteration. This appliance seems to suggest a significant beneficial effect in mandible displacement by reducing the counter clockwise rotation of the mandible, which is further confirmed by the almost absence of modifications of ArGoMe and SNGoMe angles. The ABPFA is particularly suitable to reduce the non-desirable dental effects represented by lower incisors pro inclination, and upper incisors retro-inclination. Key words:Orthodontics, Functional orthodontics, Class II malocclusion, Anterior bite plane functional appliance.
Collapse
Affiliation(s)
- Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Laura Guida
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Graziano Montaruli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Crescenzio Gallo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Michele Tepedino
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| |
Collapse
|
34
|
Bahreman AA. Retention considerations in the assessment of long-term stability in early versus late orthodontic treatment. Semin Orthod 2017. [DOI: 10.1053/j.sodo.2016.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
35
|
Abstract
The treatment of children presenting with a Class II division I malocclusion involves one of two approaches. The first provides treatment in two phases; one of intervention during the mixed dentition (phase I) followed by a second definitive course of appliance treatment in early adolescence (phase II). The second approach involves providing a single course of comprehensive therapy during adolescence. The debate for and against early treatment is discussed alongside key, clinically relevant evidence related to Class II division I malocclusions.
Collapse
Affiliation(s)
| | - A DiBiase
- Kent & Canterbury Hospital, Canterbury, Kent, UK
| | - P J Sandler
- Chesterfield Royal Hospital, Chesterfield, UK
| |
Collapse
|
36
|
Behrents RG. Author's response. Am J Orthod Dentofacial Orthop 2017; 151:9-10. [PMID: 28024791 DOI: 10.1016/j.ajodo.2016.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 10/13/2016] [Accepted: 10/13/2016] [Indexed: 11/17/2022]
|
37
|
DiBiase AT, Cobourne MT, Lee RT. The use of functional appliances in contemporary orthodontic practice. Br Dent J 2016; 218:123-8. [PMID: 25686429 DOI: 10.1038/sj.bdj.2015.44] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/09/2022]
Abstract
Functional appliances have been used for over 100 years in orthodontics to correct Class II malocclusion. During this time numerous different systems have been developed often accompanied by claims of modification and enhancement of growth. Recent clinical evidence has questioned whether they really have a lasting influence on facial growth, their skeletal effects appearing to be short term. However, despite these findings, the clinical effectiveness of these appliances is acknowledged and they can be very useful in the correction of sagittal arch discrepancies. This article will discuss the clinical use of functional appliances, the underlying evidence for their use and their limitations.
Collapse
Affiliation(s)
- A T DiBiase
- Maxillofacial Unit, William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent, TN24 0LZ
| | - M T Cobourne
- King's College London, Hon Consultant in Orthodontics, Guy's and St Thomas NHS Foundation Trust, King's College London Dental Institute, London, SE1 9RT
| | - R T Lee
- Centre for Oral Growth and Development, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, New Road, London, E1 1BB
| |
Collapse
|
38
|
Abstract
Extra-oral appliances are used in orthodontics to apply forces to the jaws, dentition or both and the popularity of these appliances is cyclical. Although the use of retraction headgear for the management of Class II malocclusion has declined over the last 20 years with the refinement of non-compliance approaches, including temporary anchorage devices, headgear still has a useful role in orthodontics. The use of protraction headgear has increased as more evidence of its effectiveness for the treatment of Class lIl malocclusion has become available. This paper describes the mechanics and contemporary uses of headgear in orthodontics for primary care dentists and specialist orthodontists. CPD/CLINICAL RELEVANCE: Extra-oral appliances have specific uses in orthodontic biomechanics. Clinicians using retraction headgear and protraction headgear should be familiar with their clinical indications, the potential problems and how these can be avoided.
Collapse
|
39
|
Selecting subjects with high craniofacial shape homogeneity for clinical trials. Am J Orthod Dentofacial Orthop 2016; 148:1026-35. [PMID: 26672709 DOI: 10.1016/j.ajodo.2015.05.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 05/01/2015] [Accepted: 05/01/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Morphologic homogeneity is desirable in sample selection of clinical studies that evaluate methods of treating craniofacial discrepancies in orthodontics. The purposes of this study were to assess sample selection criteria commonly used in the orthodontic literature regarding their effectiveness in achieving morphologic homogeneity, and to propose a method that can guarantee selection of a homogeneous sample, for which the degree of homogeneity and the average skeletal pattern can be specified a priori. METHODS Pretreatment lateral cephalograms from 170 consecutive patients (82 boys, 88 girls) aged 7 to 17 years were used. Sixteen skeletal and 4 dental landmarks were digitized and processed with Procrustes superimposition and principal component analysis. The sample was bootstrapped to a virtual population of 10,000 subjects by random sampling from the normal distribution for each principal component. A systematic literature search of randomized controlled trials showed that the most prevalent sample selection criteria, in addition to molar relationship, included overjet, ANB, and SN-GoGn. Each criterion was applied to the virtual population. The morphologic homogeneity of the samples was assessed as the percentage of shape variance of each sample relative to the shape variance of the population. RESULTS The first 3 principal components incorporated approximately 53% of shape variability. The evaluated criteria achieved low or moderate morphologic homogeneity scores (range, 28%-63%), and the selected patients were widely spread in the shape space. Although the criteria are commonly applied for selecting samples with skeletal discrepancies, a considerable number of subjects with an average shape were selected. The proposed procedure entails selecting a skeletal pattern appropriate for the study's purpose, setting limits in shape space within which the sample should be confined, and testing candidate patients against these limits. The patients within these boundaries have, by definition, a similar shape to the selected skeletal pattern and form a homogeneous sample. CONCLUSIONS The cephalometric variables that have been used in randomized controlled trials do not result in samples of high morphologic homogeneity. The proposed method guarantees high morphologic homogeneity. The extent of homogeneity, the average shape of the sample, and the sample's relationship to the general population's average can be specified a priori.
Collapse
|
40
|
Wellens HLL, Kuijpers-Jagtman AM. Connecting the new with the old: modifying the combined application of Procrustes superimposition and principal component analysis, to allow for comparison with traditional lateral cephalometric variables. Eur J Orthod 2016; 38:569-576. [PMID: 26739558 DOI: 10.1093/ejo/cjv096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The combination of generalized Procrustes superimposition (GPS) and principal component analysis (PCA) has been hypothesized to solve some of the problems plaguing traditional cephalometry. This study demonstrates how to establish the currently unclear relationship between the shape space defined by the first two principal components to the ANB angle, Wits appraisal, and GoGnSN angle, and to elucidate possible clinical applications thereof. METHODS Digitized landmarks of 200 lateral cephalograms were subjected to GPS and PCA, after which the sample mean shape was deformed along/parallel to principal components (PC) 1 and 2, recording the ANB, Wits, and GoGnSN value at each location. Trajectories were then calculated through the PC1-PC2 space connecting locations with the same values. These were finally utilized to renormalize the PC1-PC2 space. RESULTS The trajectories for the Wits appraisal were almost straight and parallel to PC1.Those for the ANB angle were angled approximately 20degrees downward relative to PC1, with a more accentuated curvature. The GoGnSN curves were mildly angled relative to the PC2 axis, their curvature increasing slightly with increasing PC1 scores. By combining the aforementioned trajectories, it was possible to delineate the region of the PC1-PC2 shape space which would be regarded as normodivergent and skeletal Class I in traditional cephalometry. Geometric distortion could be avoided by assigning patients the ANB, Wits, or GoGnSN value of the sample mean shape, deformed to the patient's position within the PC1-PC2 plot. CONCLUSION The methodology successfully relates the shape space resulting from the GPS-PCA results with traditional cephalometric variables.
Collapse
Affiliation(s)
- Hans L L Wellens
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Anne M Kuijpers-Jagtman
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, The Netherlands
| |
Collapse
|
41
|
Čirgić E, Kjellberg H, Hansen K. Treatment of large overjet in Angle Class II: division 1 malocclusion with Andresen activators versus prefabricated functional appliances-a multicenter, randomized, controlled trial. Eur J Orthod 2015; 38:516-24. [PMID: 26543061 DOI: 10.1093/ejo/cjv080] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the clinical effectiveness in reducing large overjet between a prefabricated functional appliance (PFA) and a slightly modified Andresen activator (AA). SETTING AND SAMPLE POPULATION Public Dental Service, Gothenburg, Sweden. PARTICIPANTS, STUDY DESIGN, AND METHODS A multicentre, prospective randomized clinical trial was conducted with patients from 12 general dental practices. One hundred and five patients with an Angle Class II, division 1 malocclusion and an overjet of ≥6mm were eligible for the study. Eight patients were excluded due to various reasons and the sample consisted thus of 97 subjects (44 girls, 53 boys) with a mean age of 10.3 years. The study was designed as intention to treat and the patients were randomly allocated by lottery to treatment with either a PFA or an AA. The PFA and AA group consisted of 57 subjects (28 girls, 29 boys) and 40 subjects (16 girls, 24 boys), respectively. Overjet, overbite, lip seal, and sagittal molar relationship were recorded before, at the end of treatment and 1-year post-treatment. Blinding was not performed. The endpoint of treatment was set to overjet ≤3mm and after this a 6 months retention period followed. RESULTS No significant difference was found in overjet, overbite, sagittal relation, and lip seal between the two groups for the total observation period. The treatment of 40 (70 per cent) patients with PFA and 21 (53 per cent) with AA were considered unsuccessful mainly due to poor compliance. LIMITATIONS No cephalometric records were taken as only patient-centred clinical outcome were used as an indicator for treatment success. The criteria of reduction of overjet to as low as 3mm could have affected the success rate. CONCLUSION No difference in effectiveness could be shown between PFAs and AAs in correcting overjet, overbite, sagittal molar relation, and lip seal. The success rate in treatment with both appliances is, however, low. REGISTRATION This trial was registered in "FoU i Sverige" (http://www.fou.nu/is/sverige), registration number: 97131. PROTOCOL The protocol was not published before trial commencement.
Collapse
Affiliation(s)
- Emina Čirgić
- *Department of Orthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Sweden and
| | - Heidrun Kjellberg
- **Department of Orthodontics, University Clinics of Odontology, Public Dental Service,Gothenburg, Sweden
| | - Ken Hansen
- **Department of Orthodontics, University Clinics of Odontology, Public Dental Service,Gothenburg, Sweden
| |
Collapse
|
42
|
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
|
43
|
Thiruvenkatachari B, Harrison J, Worthington H, O'Brien K. Early orthodontic treatment for Class II malocclusion reduces the chance of incisal trauma: Results of a Cochrane systematic review. Am J Orthod Dentofacial Orthop 2015; 148:47-59. [DOI: 10.1016/j.ajodo.2015.01.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 01/01/2015] [Accepted: 01/01/2015] [Indexed: 11/16/2022]
|
44
|
Is orthodontics prior to 11 years of age evidence-based? A systematic review and meta-analysis. J Dent 2015; 43:477-86. [DOI: 10.1016/j.jdent.2015.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 02/03/2015] [Accepted: 02/04/2015] [Indexed: 11/19/2022] Open
|
45
|
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
|
46
|
Predictive value of masseter muscle thickness and bite force on Class II functional appliance treatment: a prospective controlled study. Eur J Orthod 2015; 37:570-7. [DOI: 10.1093/ejo/cju089] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
47
|
Cozzani M, Mazzotta L, Cozzani P. Early interceptive treatment in the primary dentition – a case report. J Orthod 2014; 40:345-51; quiz 353. [DOI: 10.1179/1465313313y.0000000068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
48
|
Vaid NR, Doshi VM, Vandekar MJ. Class II treatment with functional appliances: A meta-analysis of short-term treatment effects. Semin Orthod 2014. [DOI: 10.1053/j.sodo.2014.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
49
|
Su H, Han B, Li S, Na B, Ma W, Xu TM. Factors predisposing to maxillary anchorage loss: a retrospective study of 1403 cases. PLoS One 2014; 9:e109561. [PMID: 25299164 PMCID: PMC4192127 DOI: 10.1371/journal.pone.0109561] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/29/2014] [Indexed: 11/19/2022] Open
Abstract
Anchorage loss is very disturbing for orthodontists and patients during orthodontic treatment, which usually results in bad treatment effects. Despite the same treatment strategy, different patients show different tendencies toward anchorage loss, which influences the treatment results and should preferably be predicted before the treatment is begun. However, relatively little research has been conducted on which patients are more likely to lose anchorage. The mesial tipping of the first molar marks the onset of anchorage loss, and changes in the angulation of the first molar are closely related to anchorage loss. This cross-sectional study aimed to determine how the mesiodistal angulation of the upper first molars changes during general orthodontic treatment and to identify the individual physiologic factors leading to these changes in a large sample of 1403 patients with malocclusion. The data indicate that the upper first molars tend to be tipped mesially during orthodontic treatment, and this constitutes a type of anchorage loss that orthodontists should consider carefully. Compared to treatment-related factors, patients' physiologic characteristics have a greater influence on changes in the angulation of the upper first molars during orthodontic treatment. The more distally tipped the upper first molars are before treatment, the more they will tip mesially during treatment. Mesial tipping of the upper first molars, and therefore, anchorage loss, is more likely to occur in adolescents, males, patients with class II malocclusion and patients who have undergone maxillary premolar extraction. This finding is of clinical significance to orthodontists who wish to prevent iatrogenic anchorage loss by tipping originally distally tipped upper molars forward, and provides a new perspective on anchorage during orthodontic treatment planning.
Collapse
Affiliation(s)
- Hong Su
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Bing Han
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Sa Li
- Department of Stomatology, Shenzhen People's Hospital, Shenzhen, China
| | - Bin Na
- Peking University School and Hospital of Stomatology, Beijing, China
| | - Wen Ma
- Peking University School and Hospital of Stomatology, Beijing, China
| | - Tian-Min Xu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- * E-mail:
| |
Collapse
|
50
|
Neves LS, Janson G, Cançado RH, de Lima KJRS, Fernandes TMF, Henriques JFC. Treatment effects of the Jasper Jumper and the Bionator associated with fixed appliances. Prog Orthod 2014; 15:54. [PMID: 25182030 PMCID: PMC4150943 DOI: 10.1186/s40510-014-0054-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 08/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effects of Class II malocclusion treatment with the Jasper Jumper and the Bionator, associated with fixed appliances. METHODS The sample comprised 77 young individuals divided into 3 groups: Group 1 consisted of 25 patients treated with the Jasper Jumper appliance associated with fixed appliances for a mean period of 2.15 years; group 2 had 30 patients, treated with the Bionator and fixed appliances, for a mean treatment time of 3.92 years; and the control group included 22 subjects followed for a mean period of 2.13 years. The initial and final lateral cephalograms of the patients were evaluated. Intergroup comparison at the initial stage and of the treatment changes were performed by analysis of variance. RESULTS Their effects consisted in a restrictive effect on the maxilla, a slight increase in anterior face height, retrusion and extrusion of the maxillary incisors, labial tipping and protrusion of the mandibular incisors in both groups and intrusion with the Jasper Jumper appliance, maxillary molar distalization with the Jasper Jumper, extrusion and mesialization of the mandibular molars, both appliances provided significant improvement of the maxillomandibular relationship, overjet, overbite and molar relationship. CONCLUSIONS The effects of both appliances in class II malocclusion treatment are similar; however, treatment with the Jasper Jumper was shorter than with the Bionator.
Collapse
Affiliation(s)
- Leniana Santos Neves
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil.
| | - Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil.
| | - Rodrigo Hermont Cançado
- Department of Orthodontics, Ingá Faculty, Rodovia PR 317, n° 6114, Maringá, PR, 87035-510, Brazil.
| | | | | | | |
Collapse
|