Oropharyngeal airway dimensions and functional-orthopedic treatment in skeletal Class II cases

Comparison of oropharyngeal airway dimensional changes in patients with skeletal Class II and Class III malocclusions after orthognathic surgery and functional appliance treatment: A systematic review

Objective

To compare the dimensional changes in the oropharyngeal airway in patients with skeletal Class II and Class III malocclusion before and after orthognathic surgery and treatment with a functional appliance.

Methods

The protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and was registered to the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42020170901. Furthermore, the reporting of the present SR was performed based on the PRISMA checklist.

Results

The use of removable functional appliances increased the volume of the oropharyngeal airway in patients with skeletal Class II malocclusion. Furthermore, the increase in the volume of the oropharyngeal airway following the removable functional appliance treatment was more than that observed after fixed functional appliance treatment in growing patients. For patients with skeletal Class III malocclusion, who underwent the bimaxillary orthognathic surgery, resulted in no change in the dimensions of the oropharyngeal airway.

Conclusion

Growing patients who receive removable functional appliance treatment have a more favorable long-term prognosis with regard to the oropharyngeal airway when compared with those who receive fixed functional appliance. Alternatively, in patients aged from (18–22) years with skeletal class III malocclusion Bimaxillary orthognathic surgery was found to be the recomended and superior method of treatment.

Changes of epiglottis and hyoid bone position after orthodontic treatment with cast splint fixed functional appliances

OBJECTIVES

Angle Class II malocclusions including a retrognathic mandible are the most frequent orthodontic problems. Both removable and fixed functional appliances can be used for mandibular advancement. Mandibular advancement after treatment with any fixed functional appliance has numerous therapeutic effects, such as stretching of masticatory muscles, ligaments, membranes and surrounding soft tissues, thus causing positional changes of the hyoid bone and epiglottis. This retrospective study investigates and compares treatment effects upon epiglottis- and hyoid bone position and posterior airway space in class II patients who received mandibular advancement through two different cast splint fixed functional appliances.

MATERIAL AND METHODS

Two groups of 21 patients each ('Functional Mandibular Advancer' (FMA) and Herbst appliance) were investigated. The same experienced orthodontist performed the treatment in all patients, employing a single-step advancement protocol. The mandible always received initial protrusion into an edge-to-edge position. Conventional lateral cephalograms were available pre-treatment (T1) and immediately after appliance removal (T2) for all patients. The measurements comprised (I) hyoid bone, (II) epiglottis or (III) posterior airway space. Treatment-related changes were analysed with one-sample Student's t tests for intragroup comparisons and independent Student's t tests for intergroup comparisons. Statistical significance was set at p < 0.05.

RESULTS

Measurements of the hyoid bone showed mostly increases for both appliances after treatment. Intergroup comparisons were not significant for FMA patients but significant for selected measurements in Herbst appliance patients. Intergroup comparisons showed insignificant changes. The posterior airway space was always insignificantly increased after treatment. The greatest increase was found caudally. Intergroup comparisons showed insignificant changes.

CONCLUSIONS

Both fixed functional appliances cause an anterior and caudal displacement of epiglottis and hyoid bone and enlarge the posterior airway space. The therapeutic effects of the Herbst appliance are slightly larger, although not significantly.

CLINICAL RELEVANCE

Treatment with either Herbst appliance of FMA alters the hyoid bone position and enlarges the posterior airway space. Still, long-term data are as yet unavailable; it remains unknown if the effects upon posterior airway space remain stable, and if a resulting posterior airway space enlargement may have clinical influence upon obstructive sleep apnoea syndrome.

Orthopedic Treatment for Class II Malocclusion with Functional Appliances and Its Effect on Upper Airways: A Systematic Review with Meta-Analysis

Aim of this systematic review was to assess the effects of orthopedic treatment for Class II malocclusion with Functional Appliances (FAs) on the dimensions of the upper airways. Eight databases were searched up to October 2020 for randomized or nonrandomized clinical studies on FA treatment of Class II patients with untreated control groups. After duplicate study selection, data extraction, and risk of bias assessment according to Cochrane guidelines, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta-regression analyses and assessment of the quality of evidence. A total of 20 nonrandomized clinical studies (4 prospective/16 retrospective) including 969 patients (47.9% male; mean age 10.9 years) were identified. Orthopedic treatment with FAs was associated with increased oropharynx volume (MD = 2356.14 mm³; 95% CI = 1276.36 to 3435.92 mm³; p < 0.001) compared to natural growth. Additionally, significant increases in nasopharynx volume, minimal constricted axial area of pharyngeal airway, and airway were seen, while removable FAs showed considerably greater effects than fixed FAs (p = 0.04). Finally, patient age and treatment duration had a significant influence in the effect of FAs on airways, as had baseline matching and sample size adequacy. Clinical evidence on orthopedic Class II treatment with FAs is associated with increased upper airway dimensions. However, the quality of evidence is very low due to methodological issues of existing studies, while the clinical relevance of increases in airway dimensions remains unclear.

Changes in the upper airway, hyoid bone and craniofacial morphology between patients treated with headgear activator and Herbst appliance: A retrospective study on lateral cephalometry

Background

The present study compared the treatment changes in the upper airway, hyoid bone position and craniofacial morphology between two groups of children with skeletal class II malocclusion treated with the headgear activator (HGA) and Herbst appliance (Herbst).

Setting and sample population

Orthodontic population from the Faculty of Dentistry of the University of Hong Kong.

Methods

Thirty‐four skeletal class II patients treated with the HGA (17 patients, mean age 10.6 ± 1.5 years) and the Herbst (17 patients, mean age 11.0 ± 1.4 years) were matched for sex, age, overjet, skeletal class and mandibular divergence. The patients received lateral cephalometric radiographs (LCRs) at the beginning of treatment (T₁), after treatment (T₂) and at follow‐up (T₃). In the HGA group, patients underwent LCRs 7 months before the beginning of treatment (T₀), which were used as growth reference for intra‐group comparison. Paired Student's t tests were used for intra‐ and inter‐group comparisons (α = .05).

Results

Treatment changes (T₂‐T₁) did not differ significantly between the groups. However, at follow‐up (T₃‐T₁) the Herbst group showed a smaller increase than the HGA group in the vertical position of the hyoid bone relative to the Frankfort plane (P = .013) and mandibular plane (P = .013).

Conclusions

There were no significant differences in the upper airway, hyoid bone position and craniofacial morphology between the groups at the end of treatment. However, the Herbst may provide better long‐term control of the vertical position of the hyoid bone than the HGA in children with skeletal class II malocclusion.

Effects of the long-term use of maxillary protraction facemasks with skeletal anchorage on pharyngeal airway dimensions in growing patients with cleft lip and palate

Objective

To investigate the effects of the long-term use of a maxillary protraction facemask with miniplate (FM-MP) on pharyngeal airway dimensions in growing patients with cleft lip and palate (CLP).

Methods

The study included 24 boys with CLP (mean age, 12.2 years; mean duration of FM-MP therapy, 4.9 years), divided into two groups according to the amount of A point advancement to the vertical reference plane (VRP): Group 1, > 4 mm; Group 2, < 2 mm; n = 12/group. After evaluating the skeletodental and airway variables using lateral cephalograms acquired before and after FM-MP therapy, statistical analyses were performed.

Results

Group 1 showed greater forward and downward displacements of the posterior maxilla (posterior nasal spine [PNS]-horizontal reference plane [HRP]; PNS-VRP), greater increase in ANB, more forward tongue position (tongue tip-Pt vertical line to Frankfort horizontal plane), and greater increase in the oropharynx (superior posterior airway space [SPAS]; middle airway space [MAS]) and upper nasopharynx (PNS-adenoid2) than did Group 2. While maxillary advancement (A-VRP and PNS-VRP) correlated with increases in SPAS, MAS, and PNS-adenoid2, downward displacement of the PNS (PNS-HRP) correlated with increases in SPAS, MAS, PNS-adenoid1, and PNS-adenoid2, and with a decrease in vertical airway length (VAL). Mandibular forward displacement and decrease in mandibular plane correlated with increases in MAS.

Conclusions

FM-MP therapy had positive effects on the oropharyngeal and nasopharyngeal airway spaces without increases in VAL in Group 1 rather than in Group 2. However, further validation using an untreated control group is necessary.

Evaluation of Airway Measurements in Class II Patients Following Functional Treatment

Objective

This study aimed to evaluate the effect of fixed and removable functional treatment on pharyngeal airway measurements in class II patients.

Methods

In this study, patients treated with fixed (Forsus Fatigue Resistant Device-FRD) and removable (twin-block-TWB) appliances were included (n=15, eight females, seven males in each group). These groups were compared with untreated individuals as the control group (n=10). The mean age of individuals was 13.22±2.39 years. Initial and post-treatment cephalometric radiographs were digitized, and the sagittal pharyngeal airway changes were evaluated. The pharyngeal airway was divided into the nasopharynx, oropharynx, and hypopharynx. The one-way ANOVA, Kruskal-Wallis test, and paired samples t-test were used for statistical analyses.

Results

At the initial values, no statistically significant difference was observed between the groups. Only the ANB values differed between the groups (p<0.05). Although the skeletal effects of removable and fixed treatment were not exactly the same, the changes of the airway dimensions were similar.

Conclusion

The TWB and FRD appliances lead to an increase in nasopharynx, oropharynx, and hypopharynx sagittal dimensions. However, in terms of the effect on airway sagittal dimensions, there was no significant difference between treatment groups and the control group.

Orthopaedic treatment effects of functional therapy on the sagittal pharyngeal dimensions in subjects with sleep-disordered breathing and Class II malocclusion

The purpose of this cephalometric study was to evaluate the craniofacial changes induced by functional treatment of mandibular advancement with special regard to pharyngeal sagittal airway dimensions, tongue and hyoid bone position in subjects with sleep-disordered breathing (SDB) and dentoskeletal Class II malocclusions compared with an untreated Class II control group. 51 subjects (24 female, 27 male; mean age 9.9 ± 1.3 years) with Class II malocclusion and SDB consecutively treated with a functional appliance (Modify Monobloc, MM) were compared with a control group of 31 subjects (15 males, 16 females; mean age 10.1 ± 1.1) with untreated Class II malocclusion. For the study group, mode of breathing was defined by an otorhinolaryngologist according to complete physical examination. The parents of all participants completed a modified version of the paediatric sleep questionnaire, PSQ-SRBD Scale, by Ronald Chervin (the Italian version in 22 items form) before and after the trial. Lateral cephalograms were available at the start and end of treatment with the MM. Descriptive statistics were used for all cephalometric measurements in the two groups for active treatment changes. Significant, favourable skeletal changes in the mandible were observed in the treated group after T2. Significant short-term changes in sagittal airway dimensions, hyoid position and tongue position were induced by functional therapy of mandibular advancement in subjects with Class II malocclusion and SDB compared with untreated controls. After orthodontic treatment, a significant reduction in diurnal symptoms was observed in 45 of the 51 participants who had received an oral appliance. Orthodontic treatment is considered to be a potential therapeutic approach for SDB in children. Orthodontists are playing an increasingly important role in managing snoring and respiratory problems by oral mandibular advancement devices and rapid maxillary expansion.

Cephalometric appraisal of the effects of orthodontic treatment on total airway dimensions in adolescents

Aim

This retrospective study was performed to rule out any jeopardizing effect of extraction therapy of four first premolars on airway at any level of its anatomic course.

Materials and methods

Lateral cephalograms of 50 adolescent patients divided into two groups of 25 each, based on orthodontic treatment by first premolar extraction as group I and without extraction as group II, were selected for the study. 13 angular and 11 linear measurements were compared pre-and post-treatment via statistical analyses using SPSS (Version 17.5, SPSS, Chicago) software. Paired 't' tests were used to assess the variability. P-value < 0.05 was considered to be statistically significant.

Results

Comparison of angular parameters showed that the average percentage (%) change in SNA, SNB, ANB, IMPA, FMA, saddle, articulare, gonial, total angle and hyoid did not differ significantly across two study groups (P > 0.05), but values of UI/LI, UI/NA, LI/NB, differed significantly among both groups. Similarly, linear parameters showed that the average % change in nasopharyngeal airway space (NAS) and width of soft palate differed significantly across two study groups (P-value<0.05), whereas the average % change in posterior airway space (PAS), hypopharyngeal airway space (HAS), hyoid distance and length of tongue did not differ significantly (P-value>0.05). However, no significant differences were observed during intragroup and intergroup comparisons of the combined angular and linear measurements of both groups.

Conclusions

Present study showed no significant change on airway after therapeutic orthodontic tooth movement with or without extraction treatment.

Three-dimensional evaluation of changes in upper airway volume in growing skeletal Class II patients following mandibular advancement treatment with functional orthopedic appliances

OBJECTIVES

The aim of this study was to assess three-dimensionally the upper airway changes following functional appliance treatment in growing Class II patients.

MATERIALS AND METHODS

Pre-and post-treatment Cone beam computed tomography scans of 20 patients (age range: 9 to 12; mean: 11.4 ± 1.0 years) were retrieved from the list of patients previously treated with functional appliances in the Postgraduate Clinic at the Section of Orthodontics, Aarhus University, Denmark. Total and partial volumes of the upper airway (ie, lower nasopharynx, velopharynx, and oropharynx) were calculated. To rule out the effect of growth, the changes in the functional appliance group were compared to an age-matched Class I group of 18 patients (age range: 8 to 14; mean: 11.8 ± 1.4 years).

RESULTS

In the functional appliance group, all the partial and total volumes were significantly larger at the end of treatment when compared to the start of treatment ( P < .003). On the other hand, when comparing the changes for the total and partial volumes of the upper airway in the functional appliance group with the Class I group, a statistical difference was seen only for the oropharynx ( P = .022) and total volume ( P = .025), with the functional appliance group showing a larger volume increment.

CONCLUSIONS

An increase in the upper airway volume was found after treatment with functional appliances. This difference was mainly related to the changes at the oropharynx level, which differed significantly from what was observed in the Class I group.

Effect of Clark's twin-block appliance (CTB) and non-extraction fixed mechano-therapy on the pharyngeal dimensions of growing children

Introduction:

Narrow airway dimensions due to mandibular deficiency can predispose an individual to severe respiratory distress. Hence, treatment with mandibular advancement devices at an early age might help improving the pharyngeal passage and reduce the risk of respiratory difficulties. Therefore, the aim of the current study was to evaluate the mean changes in the pharyngeal dimensions of children with mandibular deficiency treated with Clark's twin-block appliance (CTB) followed by fixed orthodontic treatment.

Methods:

Orthodontic records of 42 children with mandibular deficiency were selected. Records comprised three lateral cephalograms taken at the start of CTB treatment, after CTB removal and at the end of fixed appliance treatment, and were compared with 32 controls from the Bolton-Brush study. Friedman test was used to compare pre-treatment, mid-treatment and post-treatment pharyngeal dimensions. Wilcoxon signed rank test was used to compare the airway between pre-treatment and post follow-up controls. Mann-Whitney U test was applied to compare the mean changes in pharyngeal dimensions between treatment group and controls from T₂ to T₀. Post-hoc Dunnet T3 test was used for multiple comparisons of treatment outcomes after CTB and fixed appliances, taking a p-value of ≤ 0.05 as statistically significant.

Results:

Superior pharyngeal space (p < 0.001) and upper airway thickness (p = 0.035) were significantly increased after CTB, and the change in superior pharyngeal space remained stable after fixed mechano-therapy.

Conclusion:

CTB can have a positive effect in improving pharyngeal space and the resultant increase in airway remains stable on an average of two and a half years.

Effect of functional appliances on the airway dimensions in patients with skeletal class II malocclusion: A systematic review

OBJECTIVES

The aim of the present systematic review was to assess the effect of functional appliances on the airway dimensions in patients with skeletal Class II malocclusion.

MATERIALS AND METHODS

Articles were identified through a literature survey carried out through the following databases: (1) PUBMED, (2) Google Scholar, (3) The Cochrane Library, (4) Embase, (5) Lilac, and (6) Web of Scholars. The systematic review analyzed 12 articles comprising removable functional appliances, 3 articles with fixed functional appliances, and 2 articles having both fixed and removable functional appliances.

RESULTS

Qualitative assessment was done for all the 17 studies. The effect of functional appliances in the dimensions of three airway spaces - nasopharynx, oropharynx, and hypopharynx were analyzed.

CONCLUSIONS

Significant increase in the dimensions of nasopharynx and oropharynx was observed with Activator. Significant increase in the nasopharynx and hypopharynx (male patients) was observed with Bionator. Insignificant increase in the oropharynx was observed with the same. Significant increase in the oropharynx and hypopharynx was observed with Twin Block. Insignificant increase in the nasopharynx was observed with the same. Significant increase was observed only in the hypopharynx for Frankel II. Decreased or insignificant change was observed with FMA, MPA IV, and Herbst appliances.

Pharyngeal airway dimensions in skeletal class II: A cephalometric growth study

Purpose

This retrospective study aimed to evaluate the nasopharyngeal and oropharyngeal dimensions of individuals with skeletal class II, division 1 and division 2 patterns during the pre-peak, peak, and post-peak growth periods for comparison with a skeletal class I control group.

Materials and Methods

Totally 124 lateral cephalograms (47 for skeletal class I; 45 for skeletal class II, division 1; and 32 for skeletal class II, division 2) in pre-peak, peak, and post-peak growth periods were selected from the department archives. Thirteen landmarks, 4 angular and 4 linear measurements, and 4 proportional calculations were obtained. The ANOVA and Duncan test were applied to compare the differences among the study groups during the growth periods.

Results

Statistically significant differences were found between the skeletal class II, division 2 group and other groups for the gonion-gnathion/sella-nasion angle. The sella-nasion-B-point angle was different among the groups, while the A-point-nasion-B-point angle was significantly different for all 3 groups. The nasopharyngeal airway space showed a statistically significant difference among the groups throughout the growth periods. The interaction among the growth periods and study groups was statistically significant regarding the upper oropharyngeal airway space measurement. The lower oropharyngeal airway space measurement showed a statistically significant difference among the groups, with the smallest dimension observed in the skeletal class II, division 2 group.

Conclusion

The naso-oropharyngeal airway dimensions showed a statistically significant difference among the class II, division 1; class II, division 2; and class I groups during different growth periods.

Comparison of the effects on the pharyngeal airway space of maxillary protraction appliances according to the methods of anchorage

Background

The purpose of the study is to compare the effects on the pharyngeal airway space of skeletal anchored face mask with those of tooth-borne facemask.

Methods

We used two types of facemask for maxillary protraction, the tooth-borne facemask (TBFM) and the skeletal anchored facemask (SAFM), and evaluated the effects of each facemask on the pharyngeal airway. Twenty-eight patients (mean age 10.3 years) were treated with the TBFM and 24 patients (mean age 11.2 years) were treated with the SAFM. Lateral cephalometric radiographs were taken before treatment (T1) and after treatment (T2) to assess changes in the dimensions of the upper airway. Statistical analysis was performed with independent t tests, matched t tests, Mann-Whitney U tests, and Kruskal-Wallis tests.

Results

There were marked increases in upper airway dimensions in both groups following treatment, but the SAFM group had a significantly greater increase in airway dimensions than the TBFM group. Also, the SAFM subgroups showed more improved airway measurements than the TBFM subgroups in both the superior and inferior pharyngeal airways.

Conclusions

SAFM is more effective than TBFM in increasing upper airway dimensions.

Effects of two different removable functional appliances on depth of the posterior airway space : A retrospective cephalometric study

OBJECTIVES

Aim of the study was the comparison of treatment effects upon pharyngeal depth in patients treated with either (1) S-II-appliance or (2) Activator.

METHODS

Pre- and posttreatment lateral cephalograms of 73 patients were analyzed using a customized set of measurements. According to predefined criteria, patients were either treated with S-II-appliance or Activator. Pharyngeal depth was assessed from cranial to caudal at six levels (P1 to P6). Paired t tests were used for intragroup and t tests for independent samples for intergroup comparisons. Results were considered statistically significant at p ≤ 0.05.

RESULTS

37 (22 female, 15 male) patients were treated with the S-II-appliance (mean pretreatment age 11.1 ± 1.07 years), and 36 (20 female, 16 male) patients with an Activator (mean pretreatment age 11.3 ± 1.12 years). Mean treatment time was 14 months for the S-II-appliance and 12 months for the Activator. Most measurements at the different levels showed an average increase ranging from approximately 0.5 mm to almost 2 mm. Changes were more pronounced in S-II patients. In contrast to intergroup comparisons, some intragroup comparisons revealed statistically significant differences at levels P5 (p = 0.0062) and P6 (p = 0.0155) in S-II patients and at P1-level (p = 0.0197) in Activator patients.

CONCLUSIONS

Both appliances similarly led to an increase of the pharyngeal depth. The sites of statistically significant changes differed.

Upper airway changes following single-step or stepwise advancement using the Functional Mandibular Advancer

OBJECTIVES

Purpose of the present study was to determine and compare possible changes in the dimensions of the pharyngeal airway, morphology of the soft palate, and position of the tongue and hyoid bone after single-step or stepwise mandibular advancement using the Functional Mandibular Advancer (FMA).

PATIENTS AND METHODS

The sample included 51 peak-pubertal Class II subjects. In all, 34 patients were allocated to two groups using matched randomization: a single-step mandibular advancement group (SSG) and a stepwise mandibular advancement group (SWG). Both groups were treated with FMA followed by fixed appliance therapy; the remaining 17 subjects who underwent only fixed appliance therapy constituted the control group (CG). The study was conducted using pre- and posttreatment lateral cephalometric radiographs. Data were analyzed by paired t test, one-way analysis of variance, and Pearson's correlation coefficient.

RESULT

In the SWG and SSG, although increases in nasopharyngeal airway dimensions were not significant compared with those in the CG, enlargements in the oropharyngeal airway dimensions at the level of the soft palate tip and behind the tongue, and decreases in soft palate angulation, were significant. Tongue height increased significantly only in the SWG. Compared with the CG, while forward movement of the hyoid was more prominent in SSG and SWG, the change in the vertical movement of the hyoid was not significant. No significant difference between SWG and SSG was observed in pharyngeal airway, soft palate, tongue or hyoid measurements.

CONCLUSIONS

The mode of mandibular advancement in FMA treatment did not significantly affect changes in the pharyngeal airway, soft palate, tongue, and hyoid bone.

Impact of different orthodontic treatment modalities on Airway: A literature review

This review focused on airway dysfunctions and orthodontic treatment modalities. A systematic search of the dental literature was performed using PubMed and Web of Science library database. Different combinations of search terms related to airway and orthodontic treatment were used. Any Non-English articles were excluded. Among titles found, abstract and full articles were reviewed. References from all the relevant articles were hand-searched to include more articles. Forty articles which were found relevant were included in the review. Surgical, orthopedic and fixed appliance therapy has been advocated by clinicians to treat patients with airway dysfunctions. These treatment modalities differ from patient to patient and have to be considered based on lot of criterion.

The reviewed studies were not convincing in providing information about the orthodontic treatment modalities; further research regarding the same could be encouraging.

Effects of Two-Phase Treatment with the Herbst and Preadjusted Edgewise Appliances on the Upper Airway Dimensions

Aims. To assess the effects of two-phase treatment with the Herbst and the preadjusted edgewise appliances on upper airway dimensions and to investigate the correlation between changes in the upper airway dimensions and skeletal morphologies. Methods. A total of 27 Chinese male adolescents aged 12.8 ± 1.3 years were selected. Lateral cephalograms were collected to assess the skeletal morphology and upper airway dimensions. Results. Following Herbst appliance treatment, the upper airway space was significantly enlarged, with the retropalatal (U-MPW) increasing by 1.1 ± 1.6 mm (P < 0.001), the retroglossal (PASmin) increasing by 1.3 ± 2.9 mm (P < 0.05), and the hypopharynx (V-LPW) enlarging by 1.6 ± 3.0 mm (P < 0.01). PASmin was found to show a negative correlation to the mandibular plane angle (MnPl-SN) by r = −0.413 (P < 0.05). There was no significant change (P > 0.05) in upper airway dimensions during the second-phase treatment. Conclusions. Herbst appliance treatment increased the oropharyngeal and hypopharyngeal airway dimensions among adolescents with Class II malocclusion, and the effects were maintained throughout the second treatment phase with a preadjusted edgewise appliance. There was a negative correlation between the change in the depth of the retroglossal pharynx and the mandibular plane angle.

Changes in airway dimensions and hyoid bone position following class II correction with forsus fatigue resistant device

OBJECTIVE

The objective of this study was to investigate the effects of fixed functional therapy on oropharyngeal airway dimensions and hyoid bone positions in Class II patients and make comparison with an untreated Class II group.

MATERIALS AND METHODS

Eighteen patients (8 girls, 10 boys; mean age 13.62 ± 1.92 years) who were treated with Forsus Fatique Resistant Device (FFRD) and 19 patients (11 girls, 8 boys; mean age 12.74 ± 0.91 years) who served as control were enrolled. Cephalograms were used to assess linear, angular, and area measurements. Intragroup comparisons were made by paired t and Wilcoxon tests and intergroup comparisons were performed by independent t test.

RESULTS

With respect to controls, FFRD group showed increased airway dimensions at soft palate (P < 0.05) and more forward positioning of the hyoid bone (P < 0.05). Dentoalveolar changes exhibited mesial movement of lower incisors and molars and reduction in overjet (P < 0.001) in FFRD group.

CONCLUSIONS

Positive effects in oropharyngeal airway dimensions and increased values of hyoid bone displacement to a more forward position were found after fixed functional therapy.

CLINICAL RELEVANCE

Treatment with fixed functional appliances is mostly based on mesial movement of mandibular dentition, which might influence changes in tongue posture. The present results might indicate that oropharyngeal airway dimensions may be affected by postural changes of the hyoid bone in consequence of dentoalveolar changes. Clinically, these may be considered especially in Class II cases with reduced airway dimensions.

Effects of twin-block appliance on the anatomy of pharyngeal airway passage (PAP) in class II malocclusion subjects

Background

The use of functional appliances for the correction of retrognathic mandible is very common in orthodontics. Similar appliances known as oral appliances are also frequently used in adults for the treatment of mild to moderate obstructive sleep apnea (OSA). Many studies have reported improvement of pharyngeal airway passage (PAP) dimensions following functional appliance therapy in children and oral appliance therapy in adults. There is only one study in the literature that discussed the effect of oral appliance therapy on posterior pharyngeal wall thickness (PPWT) among subjects with OSA. The effect of functional appliance therapy on PPWT has never been investigated. Thus the present study was conducted to evaluate the effects of twin-block appliance on pharyngeal airway passage (PAP) dimensions and posterior pharyngeal wall thickness (PPWT) in class II malocclusion subjects with retrognathic mandibles.

Methods

Thirty-eight class II malocclusion subjects in the age range of 8 to 14 years with mandibular retrusion were divided into a treatment (n = 20) and control (n = 18) group. Mandibular retrusion in the treatment group subjects was corrected by twin-block appliance. The effect of twin-block appliance on PAP and PPWT dimensions were evaluated from lateral cephalograms recorded prior-to and after 6 months of appliance therapy in the treatment group subjects and the changes were compared with the changes in the control group subjects. Student’s t-test was used for statistical analysis; P-value of 0.05 was considered a statistically significant level.

Results

The depth of the oropharynx was increased significantly in the treatment group subjects (P < 0.001) as compared to the control group subjects (P < 0.05). The depth of the hypopharynx increased significantly in treatment group subjects (P < 0.01). The PPWT at the level of the nasopharynx, oropharynx, and hypopharynx were maintained in the treatment group subjects; whereas in control group subjects, the PPWT was further reduced although the changes were not statistically significant.

Conclusions

Correction of mandibular retrusion by twin-block appliance in class II malocclusion subjects increased the PAP dimensions and maintained the pre-treatment thickness of posterior pharyngeal wall.

Cephalometric evaluation of hyoid bone position and pharyngeal spaces following treatment with Twin block appliance

OBJECTIVE

To evaluate the position of hyoid bone in the subjects treated with Twin block appliance.

MATERIALS AND METHODS

The sample consisted of 40 Angle's Class II division 1 subjects treated with Twin block appliance. Lateral radiographs were taken before and after treatment. According to Schudy's facial divergence angle (SN-MP), the subjects were classified in to three groups: group I (hypodivergent, SN-MP: <31° (27°-30°), n=15), group II (normodivergent, SN-MP: 31°-34°, n=15), and group III (hyperdivergent, SN-MP: >34° (35°-38°), n=10). Lateral cephalograms were traced and analyzed manually. After measurements of variables, Student's t-test and one-way analysis of variance (ANOVA) were performed.

RESULTS

Post treatment with Twin block therapy, hyoid bone shifted significantly (P<0.01) forward in horizontal dimension in all three groups, although it was highest in group III. However, there was no significant difference amongst the groups. In vertical dimension, hyoid bone shifted in upward direction in all three groups; however, the shift was significant (P<0.01) only in group I and there was a significant difference between group I and rest of the two groups. Width of upper airway significantly (P<0.01) increased and ANB angle significantly (P<0.001) decreased in all three groups with forward movement of mandible.

CONCLUSIONS

After treatment with Twin block appliance, significant changes occurred in horizontal dimension (anterior displacement), which resulted in significant increase in width of upper pharynx in all three groups.

Long-term pharyngeal airway changes after bionator treatment in adolescents with skeletal Class II malocclusions

Objective

The aim of this study was to evaluate long-term changes in the pharyngeal airway dimensions after functional appliance treatment in adolescents with skeletal Class II malocclusions.

Methods

Pharyngeal airway dimensions were compared between subjects with skeletal Class II malocclusions (n = 24; mean age: 11.6 ± 1.29 years) treated with a Class II bionator and age-matched control subjects with skeletal Class I occlusions (n = 24; mean age: 11.0 ± 1.21 years) using a series of lateral cephalograms obtained at the initial visit (T0), after treatment (T1), and at the completion of growth (T2).

Results

The length of the nasopharyngeal region was similar between adolescents with skeletal Class I and Class II malocclusions at all time points, while the lengths of the upper and lower oropharyngeal regions and the pharyngeal airway areas were significantly smaller in the skeletal Class II adolescents before treatment when compared to the control adolescents (p < 0.05). However, following treatment with a functional appliance, the skeletal Class II adolescents had increased pharyngeal airway dimensions, which became similar to those of the control subjects.

Conclusions

Functional appliance therapy can increase the pharyngeal airway dimensions in growing adolescents with skeletal Class II malocclusions, and this effect is maintained until the completion of growth.

Confirming nasal airway dimensions observed on panoramic and posterior-anterior cephalometric radiographs using an acoustic rhinometer

AIM

This study aimed to confirm the nasal airway dimensions observed in standard dental radiographs through analysis of the anterior nasal cross-sectional area and nasal volume with acoustic rhinometry.

METHOD

Participants were chosen from the patient population under consideration for interceptive orthodontic treatment at Tufts University's Pediatric Dentistry Clinic. A total of 55 Caucasian subjects, of both sexes (males=28, females =27), and ranging from age 6-9 years (mean= 7.33) were enrolled. Utilizing the ImageJ program, the subjects' panoramic and PA cephalometric radiographs were analyzed for radiolucent anterior nasal cross-sectional area. Subjects were then examined with the Eccovision Acoustic Rhinometer, which measured anterior nasal cross-sectional area and nasal volume. Data were grouped together, and areas and volume gathered from the radiographs and rhinometer analyzed for any correlation. Statistical analysis was performed using the SPSS program. Data was further divided into right and left nasal side, and a Pearson Correlation Matrix was created for 8 predictor variables (right and left panoramic area, right and left cephalometric area, right and left rhinometer area, and right and left rhinometer volume).

RESULTS

Values in this correlation matrix ranged from 0.712 to 0.988; all were statistically significant at the <0.01 level (2-tailed test).

CONCLUSION

A very strong correlation was found between the anterior nasal cross-sectional area calculated from the radiographs, and the anterior nasal cross-sectional area and nasal volume from the rhinometer.