Early Class II treatment

Myobrace versus twin block in the treatment of class II malocclusion in Children: A systematic review

Background

One of today's largest global problems is malocclusion. We must prevent this through the screening and early treatment of young children, because malocclusion treatment conducted during a child's growth and development stage either the primary or mixed dentition era yields the best outcomes. Functional appliances are usually used during initial orthodontic treatment, such as myobrace and twin block appliances. Myobraces come in various sizes. The size chosen depends on the treatment objectives, which may include correcting class II malocclusions. The twin block appliance is a functional device commonly employed to treat class II malocclusions.

Purpose

This investigation's main goal was to compare the efficacy of the myobrace and twin block appliances in class II malocclusion treatment to select a more appropriate pediatric dentistry device.

Results

A total of 5 articles were selected from 306 articles based on relevant keywords. All selected studies were conducted within the last 10 years.

Discussion

Myobrace and twin block appliances can address overjet issues and achieve significant overjet measurement reductions. This appliance promotes mandibular growth and enhances the facial profiles of individuals with class II malocclusions.

Conclusion

In order to treat individuals with class II malocclusions, the myobrace and the twin block both address skeletal and dentoalveolar discrepancies. But compared to the myobrace, the twin block appliance had more noteworthy outcomes.

Optimal Treatment Timing in Orthodontics: A Scoping Review

The appropriate timing for orthodontic intervention has been a subject of debate for a long time, concerning not only the immediate effects but also the long-term benefits of such treatment. This review aimed to find the appropriate treatment timing for the intervention of various orthodontic problems. A literature search was performed in all major databases, including PubMed and Cochrane Library, until February 20, 2023. All observational and experimental studies published in English that compared early versus late orthodontic treatment in different types of orthodontic problems were included. Data selection and charting were undertaken by a single investigator. A total of 32 studies were identified that discussed various aspects of interventions, including Class II and Class III malocclusion, pseudo-Class III malocclusion, anterior and posterior crossbite, extractions, and long-term benefits. Overall, early intervention was not found to be superior in terms of effectiveness, overall duration of appliances, and cost-benefit ratio. Early intervention should be reserved for specific conditions or localized malocclusions that have psycho-social benefits, or to significantly reduce the severity of problems to be dealt with in comprehensive treatment in the permanent dentition.

Orthodontic management of traumatic dental injuries in Norway and orthodontists' perceptions of referral routines: A quality assurance survey

BACKGROUND/AIM

Orthodontic treatment of patients with traumatic dental injuries is challenging, with limited evidence of routines and outcomes. The aims of this study were: (i) to describe how orthodontists perceive the information on traumatic dental injuries received by referral from the Public Dental Health Service before orthodontic treatment and (ii) to assess orthodontists' knowledge and working routines in managing traumatic dental injuries.

MATERIALS AND METHODS

Data were obtained through a survey of all practicing orthodontists registered as members of the Norwegian Association of Orthodontists (n = 203).

RESULTS

Eighty-three orthodontists were enrolled, most of whom had received their dental degree (73.0%) and specialist orthodontic training (88.5%) in Norway. They reported examining patients with a history of traumatic dental injury at weekly (34.2%) or monthly (38.0%) basis. In 85.5% of cases, they obtained a history of traumatic dental injury from patients. Half of the respondents (51.3%) favoured two-phase early orthodontic treatment for patients with an overjet ≥6 mm. The observation time and treatment strategy showed considerable discrepancies across traumatic dental injury diagnoses. Most (59.1%) orthodontists considered the information on previous traumatic dental injuries provided by the Public Dental Health Services referral 'inadequate', more commonly in cases of mild (83.5%) than severe (57.5%) traumatic dental injuries.

CONCLUSIONS

Orthodontic management of patients with traumatic dental injuries was characterised by lack of uniformity in both recommended observation time before orthodontic treatment and management strategy. The referral routines by the Public Dental Health Services for patients with traumatic dental injuries were perceived as 'inadequate' in terms of frequency and quality. The results indicate the requirement of standardisation of routines related to orthodontic management of traumatic dental injuries and referral routines by the Public Dental Health Services.

Interceptive Treatment with Invisalign® First in Moderate and Severe Cases: A Case Series

The increasing demand for more aesthetic/comfortable orthodontic alternatives fostered the utilization of clear aligners in recent years. However, the efficacy of clear aligners for treating complex malocclusions is often treated with scepticism. This case series aims to evaluate the predictability of the Invisalign® First system in moderate and severe cases requiring interceptive orthodontic treatments in mixed dentition. A total of 23 patients with 102 interceptive orthodontic malocclusion traits were selected for orthodontic treatment with Invisalign® First and were examined over 18 months (Phase 1). Clinical assessments included ClinCheck® predictions, cephalometric measurements, and measuring tools commonly used to quantify tooth movement. Measurements taken at the beginning and end of the treatment were compared. The complexity degree of each case was established based on the set of problems presented by each patient. All treatment objectives were achieved within 18 months, except for two Class II cases, with 69% of them solved with the first set of aligners. Additional aligners were used in the remaining cases. Even though these 23 cases suggest that the Invisalign® First (Phase 1) may be effective in most interceptive problems, controlled randomized clinical trials are required to evaluate movement predictability and how this relates to the problem complexity and additional aligners required.

Does Early Treatment Improve Clinical Outcome of Class II Patients? A Retrospective Study

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.

Rapid Palatal Expansion and Utilization of E-space in Mixed Dentition: Mechanics that Helps in the Corrective Orthodontic Treatment

Aim and objective

The objective of this article was to report two clinical cases, showing the benefits of interceptive treatment using rapid palatal expansion (RPE) and the preservation of E-space.

Background

It is important to follow-up child throughout its development to detect irregularities in their occlusion and to avoid or attenuate orthodontic treatments in the future. Posterior crossbite and transverse maxillary deficiency can easily be corrected by RPE that enhances the width of the maxilla and promotes a gain of space in the arch. Another way to gain space in the arch is by using the E-space, which is the difference between the mesiodistal distance of the second primary molar in relation to the second premolar. This additional space can be used to resolve negative, mild, or moderate crowding.

Case descriptions

Two clinical cases that presented malocclusions due to lack of space and maxillary deficiency, along with clinical technic of how the RPE and E-space can be used to bring those patients back to normality.

Conclusion

We concluded that with a right diagnosis, correct interceptive timing, and using what growth provides, the development can be reestablished.

Clinical significance

The clinical importance of this report is that RPE and E-space are efficient interceptive orthodontic treatments to correct skeletal posterior crossbite (SPC) and gain space in dental arches.

How to cite this article

Lopes BKB, Scheicher GV, Matsumoto MAN, et al. Rapid Palatal Expansion and Utilization of E-space in Mixed Dentition: Mechanics that Helps in the Corrective Orthodontic Treatment. Int J Clin Pediatr Dent 2021;14(1):133–139.

Comparison of objective wear time between monoblock and twin-block appliances measured by microsensor

OBJECTIVES

To assess the objective compliance levels in skeletal Class II patients with mandibular retrognathia wearing monoblock and twin-block appliances.

MATERIALS AND METHODS

A prospective clinical study was conducted with 30 patients between 10 and 15 years old who were equally divided into two study groups. Group 1 was treated with monoblock, and group 2 was treated with twin-block appliances. The patients were instructed to wear their appliance for 15 hours per day. Wear times were monitored by a microsensor. (TheraMon; MCTechnology, Hargelsberg, Austria) for an average of six appointments. Patients were also instructed to record their wear times on a chart, and this record was admitted as subjective wear time. Statistical analysis was performed with the data derived from both the patients' charts and the monitoring records.

RESULTS

The mean wear time by the patients was 10.67 ± 3.93 hours, which was less than the 15 hours prescribed by the orthodontist, with no difference between the two appliances (P > .05). The regular use rate, which included the days with a wear time of 8 hours or more per day, was 75%. Compliance levels decreased by 35% throughout the six control appointments. Patients declared that their wear time was more than their objective wear time by an average of 3.76 hours.

CONCLUSIONS

Despite their different designs, there was no significant difference between the monoblock and twin-block appliances in terms of compliance.

Distalization in Orthodontics: A Review and Case Series

Distalization is a conservative method that is utilized in orthodontics to gain space by moving posterior teeth distally. It may be combined with other space gaining strategies, such as expansion, or can be used alone. Many methods have been used for distalization. These methods differ significantly in their place, whether to be extraoral or intraoral, site of action in upper and/or lower arch, and cooperation needed by the patient if it is removable or fixed. This review illustrates some of the most commonly used methods for distalization with a brief presentation of three cases that incorporated successful distalization techniques.