Treating Class II malocclusion in children. Vertical skeletal effects of high-pull or low-pull headgear during comprehensive orthodontic treatment and retention

Long-term skeletodental changes with early and late treatment using modified C-palatal plates in hyperdivergent Class II adolescents

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.

Long-term stability after high-pull headgear combined with fixed appliances: A retrospective cohort study of growing class II patients

BACKGROUND

High-pull headgear with fixed appliances is a common therapeutic plan in class II growing individuals, especially in those with a tendency to hyperdivergence. The stability of this approach has not been adequately assessed in the long-term. The aim of this retrospective study was to assess that long-term stability by means of lateral cephalograms. Seventy-four consecutive patients were included and examined at three time-points: pre-treatment (T1), end of treatment (T2), and at least five years post-treatment (T3).

RESULTS

The average initial age of the sample was 9.3 years (standard deviation, SD: 1.6). At T1, the mean ANB was 5.1 degrees (SD: 1.6), the mean SN-PP 5.6 (SD: 3.0) and the mean MP-PP 28.7 degrees (SD: 4.0). The median follow-up time was 8.6 years with an interquartile range of 2.7. A statistically significant, but of small magnitude increase in the SNA angle was noted at T3 compared to T2 after adjusting for the pre-treatment SNA value (mean difference (MD): 0.75; 95% CI: 0.34, 1.15; P<0.001). The inclination of the palatal plane appeared stable in the post-treatment period, while the MP-PP angle showed scarce evidence of decrease during the post-treatment period after adjusting for sex, pre-treatment SNA and SN-PP angles (MD: -2.29; 95% CI: -2.85, -1.74; P<0.001).

CONCLUSIONS

The sagittal position of the maxilla and the inclination of the palatal plane appeared to be stable after treatment with high-pull headgear and fixed appliances in the long-term. Continuous mandibular growth, both sagittaly and vertically, contributed to the stability of class II correction.

Evaluation of anteroposterior and vertical stability 25 years after Angle class II division 1 treatment with cervical headgear

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.

Skeletal changes produced by cervical and parietal headgears: a cephalometric evaluation

Abstract Introduction Extraoral strength is the most common strategy to correct Angle Class II malocclusion, restricting and redirecting the maxillary growth. Objective To evaluate the skeletal changes resulting from the use of headgear, with cervical and parietal anchorages, associated with a full fixed orthodontic appliance, in growing patients with Class II malocclusion (Angle) treated in the clinic of an orthodontic training center. Material and method The ages at the beginning and end of the treatment, anchorage type, and the values of some cephalometric variables were obtained from the clinical files. After applying the inclusion and exclusion criteria, 56 patient files were selected. Then, the sample was divided into two groups, according to the anchorage type: cervical (n=30) and parietal (n=26). The differences between the initial (T1) and final (T2) values of cephalometric measurements SNA, SNB, ANB, AO-BO, GoGn.SN and LHF (percentage of lower facial height to total facial height) were evaluated in both groups. Result Significant differences between T1 and T2 were found relative to SNB and ANB variables in both groups. The AO-BO variable presented a statistically significant difference only in the cervical group. The remaining variables did not show significant differences between T1 and T2. Conclusion The skeletal changes resulting from the use of cervical or parietal anchorage were very similar. There was a decrease in the sagittal discrepancy between the maxillary bones due to forward displacement of the mandible, without significant vertical changes.

Effects of the cervical headgear in growing Angle Class II malocclusion patients: a prospective study

Objective:

Evaluate dental and skeletal changes resulting from the exclusive use of the cervical headgear for 15 ± 4 months in the treatment of patients with Class II division 1 malocclusion.

Methods:

Differences between the beginning (T₁) and immediately after the end of the therapy (T₂) with the cervical headgear in growing patients (Experimental Group, EG, n = 23) were examined and compared, during compatible periods, with those presented by a group of untreated individuals (Control Group, CG, n =22) with similar malocclusions and chronological age. The cephalometric variables evaluated were: ANB, GoGn.SN, AO-BO, S'-ANS, S'-A, S'-B, S'-Pog and S'-U6 (maxillary first molar). The Shapiro-Wilk and Levene tests were used to evaluate the results.

Results:

Significant differences were found relative to the ANB, S'-U6, AO-BO, S'-ANS, S'-A, S'-B and S'-Pog variables between T₁ and T₂ when comparing both groups. No statistically significant variation was found regarding the GoGn.SN angle.

Conclusions:

The use of cervical headgear promoted distal movement of the maxillary first molars and restricted the anterior displacement of the maxilla, without significantly affecting the GoGn.SN angle.

Additional appointments and discomfort associated with compliance-free fixed Class II corrector treatment: a systematic review

OBJECTIVE

A critical analysis of the literature to determine the prevalence and type of emergency/additional appointments, and discomfort levels associated with fixed Class II correctors.

METHODS

Studies examining patient's sources of discomfort or emergency appointments associated with compliance-free Class II correctors were included. Comprehensive searches up to July 2018 were conducted using the following databases: MEDLINE (OvidSP), PubMed, Web of Science, and Embase. A partial grey literature search was taken using Google Scholar and OpenGrey. Two reviewers independently performed the selection process and risk of bias assessment. The Newcastle-Ottawa Scale for cross-sectional studies were used. A summary of the overall strength of evidence was presented using 'Grading of Recommendations, Assessment, Development and Evaluation' (GRADE) tool. Included studies were evaluated according to their design, study quality, consistency, and directness.

RESULTS

The selected studies were published between 2001 and 2018, and the number of patients per studied group ranged from 8 to 182. One thousand five hundred forty-two patients were evaluated in total. The patients' mean age at start of treatment ranged from 10 to 16.9 years and the fixed Class II corrector treatment duration ranged from 4 to 12 months. The included studies in this systematic review were too clinically heterogeneous (different appliances, different data recollection processes) to justify a meta-analysis.

LIMITATIONS

This review was not previously registered. A low level of evidence was observed among the two randomized trials, the 10 cohorts and three cross-sectional studies identified.

CONCLUSIONS

The main source of discomfort from Forsus-type appliances appears to be soreness in the cheeks (low level of evidence with a weak recommendation strength). Most evaluated patients treated with a Herbst appliance, regardless of design, will experience complications (fractures and/or dislodging) requiring emergency appointments (low level of evidence with a weak recommendation strength).

REGISTRATION

The review protocol was not registered.