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Abdalla Y, Sonnesen L. Association between orthodontic treatment and upper airway changes in children assessed with cone-beam computed tomography (CBCT): A systematic review. J Oral Rehabil 2024. [PMID: 38978295 DOI: 10.1111/joor.13797] [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: 03/18/2024] [Revised: 06/07/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Some orthodontic devices used in children share similar design principles to appliances used to treat obstructive sleep apnoea in adults. As well as treating malocclusion, orthodontic appliances used in children may therefore also have effects on the upper airway. OBJECTIVE A review of the literature to assess the effects of orthodontic treatment on the upper airway dimensions in children assessed on CBCT. MATERIALS AND METHODS Following registration of the protocol (PROSPERO CRD42023439056), a systematic electronic search of published studies was performed using several databases (PubMed; Scopus, Web of Science and Science Direct) in accordance with the PRISMA guidelines. Inclusion criteria were as follows: age under 18 years, orthodontic treatment with any appliance, a control group who received no treatment or a non-active alternative treatment and airway measurement using CBCT. RoB-2 and ROBINS-I tools were used to assess risk of bias and quality of the evidence. RESULTS In total, 341 studies were identified following the initial search. Title and abstract screening resulted in 45 studies for further full-text analysis. On completion of the screening process, a total of 23 studies met the inclusion criteria. Study interventions included functional appliances (10 studies), rapid maxillary expansion (RME) (9 studies), reverse-pull headgear (1 study) and 4 premolar dental extractions (3 studies). The included studies had moderate to high risk of bias, and the quality of evidence was low. CONCLUSION The scientific evidence shows that functional appliances are associated with significant improvements in both upper airway volume and constriction when used in children however, the effects on the nasal cavity are limited. RME was associated with a significant increase in nasal cavity and nasopharyngeal dimensions, but not the upper pharyngeal airway. Neither reverse-pull headgear nor dental extractions were associated with any change in airway dimensions; however, the evidence is limited. Functional appliances may reduce the severity of obstructive sleep apnoea (OSA) in children.
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Affiliation(s)
- Yousef Abdalla
- Department of Orthodontics, School of Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Liselotte Sonnesen
- Section for Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Mao F, Lu C, Liu N, Liu Z, Zhang Y, Qi H, Hu M. Effects of Twin-Block with an expanding device on the upper airway in growing children with skeletal class II malocclusion-a retrospective study based on the consistency of three-dimensional and two-dimensional data. Clin Oral Investig 2023; 28:4. [PMID: 38123880 DOI: 10.1007/s00784-023-05388-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Skeletal class II malocclusion is one of the most common malocclusions. Among the functional appliances for skeletal class II malocclusion, the Twin-Block appliance with a maxillary expander is effective in repositioning the mandible forward. In this study, we focused our efforts on investigating the effects of Twin-Block appliances with maxillary expanders on the upper airway in growing children with skeletal class II malocclusion by tracing and measuring lateral cephalograms after evaluating the consistency of three-dimensional CBCT data and two-dimensional lateral cephalogram data. MATERIALS AND METHODS A total of 102 patients ranging from 9 to 15 years old (11.37 ± 2.80, male/female ratio = 1:1) with skeletal class II malocclusion were selected to evaluate the consistency of CBCT data and lateral cephalogram data. The strongly and moderately correlated segments were then selected to study the effects of Twin-Block with a maxillary expander on the upper airway in 66 growing children with skeletal class II malocclusion (11.31 ± 1.23 years old, male/female ratio = 1:1) by lateral cephalograms. RESULTS The results showed a strong significant correlation in the nasopharynx (r = 0.708) and moderate significant correlations in the overall upper airway (r = 0.641), palatopharynx (r = 0.553), and glossopharynx (r = 0.575) but a weak correlation in the hypopharynx (r = 0.323). The corresponding determination coefficient (R2) was also determined by scatter plot analysis. Moreover, compared with the pretreatment data (T1), the total area of the upper airway and the areas of the nasopharynx, palatopharynx, and glossopharynx after functional treatment (T2) increased statistically and significantly. CONCLUSIONS Lateral cephalograms can reflect the volume of the nasopharynx and oropharynx in skeletal class II children to a certain extent, while Twin-Block appliances with maxillary expanders can widen the volume of the nasopharynx and oropharynx significantly. CLINICAL RELEVANCE The lateral cephalogram is reliable for analyzing the nasopharynx, palatopharynx, and glossopharynx in orthodontic clinical practice. Twin-Block appliances with maxillary expanders have a positive effect on skeletal class II patients with airway stenosis.
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Affiliation(s)
- Feng Mao
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, People's Republic of China
| | - Chenmeng Lu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, People's Republic of China
- Department of Orthodontics, Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Nan Liu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, People's Republic of China
- Department of Orthodontics, Suzhou Stomatological Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Zhiqing Liu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, People's Republic of China
| | - Yi Zhang
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, People's Republic of China
| | - Huichuan Qi
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, People's Republic of China.
| | - Min Hu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Changchun, Jilin, People's Republic of China.
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Madian AM, Elfouly D. Cephalometric changes in pharyngeal airway dimensions after functional treatment with twin block versus myobrace appliances in developing skeletal class II patients: a randomized clinical trial. BMC Oral Health 2023; 23:998. [PMID: 38093237 PMCID: PMC10720117 DOI: 10.1186/s12903-023-03701-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Several appliances have been used for correction of developing skeletal Class II, including different myofunctional appliances as Twin block (TB)as well as the new pre-fabricated Myobrace (MB) appliance. However, the effects of these devices on the pharyngeal airways have not been compared in the literature. Thus, the aim of this study was to compare the effects of two Class II correction appliances; TB and MB on the sagittal pharyngeal airway dimension (SPAD), including the nasopharyngeal airway area (NPAA), the oropharyngeal airway area (OPAA), and the laryngopharyngeal airway area (LPAA). METHODS This is a two parallel arms randomized comparative clinical trial. Twenty-six children of 9-12 years with Skeletal Class II malocclusion due to mandibular deficiency and normal maxillary growth as confirmed by lateral cephalometric X-ray readings (ANB angle > 4° and SNB angle < 78) and Cervical vertebral maturational index (CVMI) 1 or 2 were randomly assigned into two equal groups. Group I: TB, Group II: MB (prefabricated functional appliance, Myofunctional Research Co., Australia). Lateral cephalograms were taken for all patients in both groups before treatment (T1) and after treatment (6 months later) (T2). The primary aim was to assess pre and post treatment changes in the SPAD in each group, and compare between the two study groups. The secondary aim was to evaluate the sagittal skeletal measurements such as the SNA, SNB, ANB, Wits appraisal, as well as vertical skeletal measurements represented by the Frankfurt-mandibular plane angle (FMA) measured pre- and post-treatment. The independent samples t-test was used to compare the two study groups, and the mean difference and 95% confidence intervals (CI) were computed. The paired samples t-test was used to compare various parameters between T1 and T2 within each group. The cutoff for significance was p-value < 0.05. Data were analyzed using IBM SPSS for Windows (Version 26.0). RESULTS By Comparing changes in airway measurements within each group, it was found that NPAA, OPAA, and LPAA increased significantly after treatment within each group of MB and TB. TB group showed significantly higher mean difference (T2-T1) in both NPAA and OPAA than MB group with 28.39 (± 56.75) and 40.46 (± 52.16) respectively. The increase in LPAA values was not statistically significant at (T2-T1) between both groups. Regarding skeletal changes, there was a significant increase in the SNB values between T1 and T2 within each group with 2.82 (± 3.32) for MB group and 3.79 (± 3.06) for TB group Moreover, there was a significant decrease in the ANB values between T1 and T2 within each group by 2.42 (± 2.70) for MB group and 3.06 (± 1.14) for TB group. Similarly, there was a significant decrease in the ANB values between T1 and T2 within each group by -2.13 (± 0.62) for MB group and - 2.46 (± 0.72) for TB group. No significant differences were found between both groups in SNA, SNB, ANB and Wits appraisal at p = 0.06, p = 0.45, p = 0.43 and p = 0.22 respectively. FMA did not show significant difference between T1 and T2 within each group, nor showed a significant mean difference between both groups at T2-T1. CONCLUSIONS TB was more effective than MB in improving the upper (NPAA) and middle (OPAA) airways, while no difference was found regarding the lower airway (LPAA). Both TB and MB reduced the severity of developing skeletal class II due to mandibular retrognathism by forward posturing of the mandible. Thus, patients with airway problems would benefit more from TB than MB.
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Affiliation(s)
- Ahmed M Madian
- Department of Orthodontics, Faculty of Dentistry, Alexandria University, Champollion St., P.O. Box 21521, Azarita, Alexandria, Egypt
| | - Dina Elfouly
- Department of Orthodontics, Faculty of Dentistry, Alexandria University, Champollion St., P.O. Box 21521, Azarita, Alexandria, Egypt.
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Bhosale TB, Shetty V, Bhandary M, Nayak PP. Salivary biomarker C-reactive protein levels in children with sleep problems and Class II malocclusion before and after twin-block therapy. J Indian Soc Pedod Prev Dent 2023; 41:190-196. [PMID: 37861632 DOI: 10.4103/jisppd.jisppd_338_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Context Disturbances in sleep affects the overall quality of a child's life, with several short- and long-lasting consequences. Hence, early diagnosis and monitoring is crucial in the management of sleep disorders in children. Aims The aim of this study was to evaluate salivary C-reactive protein (CRP) levels in a group of children with Class II malocclusion and sleep problems before and after twin-block appliance therapy. Settings and Design The study was a prospective clinical study with a 9-month follow-up period. Subjects and Methods Eleven children aged 8-12 years with skeletal Class II malocclusion and at least one sleep disorder were enrolled in the study. All children were subjected to a recording of their sleep history and a clinical as well as radiographic examination. Pretreatment levels of salivary CRP were recorded. A twin-block appliance was custom made and delivered to every child. At the end of 9-month follow-up, all children were recalled for a re-evaluation of salivary biomarker levels. Statistical Analysis Pretreatment and posttreatment changes in biomarker levels were assessed statistically using the students paired t-test. Results Levels of salivary biomarker CRP were significantly decreased in children following myofunctional therapy using a twin-block appliance (P < 0.001). There was a considerable improvement in the clinical symptoms such as a decrease in snoring and noisy breathing in most children post-twin-block therapy. Conclusion The measurement of salivary biomarker CRP could be used as an alternative and noninvasive method to evaluate prognosis of oral myofunctional therapy for children with sleep disordered breathing.
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Affiliation(s)
- Trupti B Bhosale
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Vabitha Shetty
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Meghna Bhandary
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Prajna P Nayak
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
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Vasilyeva MB, Guseynov NA. Adaptability of the tongue during orthodontic apparatus treatment. RUDN JOURNAL OF MEDICINE 2023. [DOI: 10.22363/2313-0245-2023-27-1-101-109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
To date, most dentoalveolar deformities are associated with bad habits such as thumb sucking, tongue sticking out, and so on. According to the authors, protrusion of the tongue is normal in newborns, in which the tongue lies between the gingival pads, and the lower jaw is stabilized by the facial muscles during swallowing. With the eruption of temporary teeth, this physiological phenomenon disappears. The authors pointed out that there are such concepts as «simple tongue push» and «complex tongue push». The first relates to open bite push-outs. The second is observed in children with an open bite, as well as with respiratory complications and / or with a history of chronic diseases of the nasopharynx. The act of swallowing in the physiological sense is divided into 3 stages: oral, pharyngeal and esophageal. Each stage is characterized by different positions of the tongue in the oral cavity. Orthodontic hardware treatment of such patients is aimed at eliminating these habits, as well as correcting the bite. Although many studies have been conducted since 1965, to this day, aimed at studying the tongue protrusion in infantile swallowing, as well as in various malocclusion deformities, the authors found that these studies have shortcomings. For each patient, the shape, size, as well as the trajectory of movements may vary due to anatomical features (short frenulum of the tongue). In this review article, the authors consider such concepts as the adaptive ability of the tongue during infantile swallowing, as well as its trajectory of movements when using various methods of hardware treatment; various orthodontic devices for the treatment of tongue misalignments, their components and their purposes are described. The current classification, main characteristics of this pathological condition and its connection with the dentoalveolar system are considered. Based on the study, it can be concluded that there are several directions in the treatment of infantile swallowing. One of these areas is hardware treatment in the form of the use of plates with a flap for the tongue.
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Effectiveness of orthopaedic treatments on the enlargement of the upper airways: Overview of systematic reviews. Int Orthod 2023; 21:100745. [PMID: 36871416 DOI: 10.1016/j.ortho.2023.100745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE The aims of this overview are to evaluate the three-dimensional effects of orthopaedic treatment (OT) and myofunctional therapy (MT) on the enlargement of the upper airways (UA). METHODS A search of the MEDLINE/PubMed and EMBASE databases was conducted up to July 2022 and completed by hand search. After selection of the title and abstract, systematic reviews (SR) dealing with the impact of OT and/or MT on UA containing only controlled studies were included. The methodological quality of the SR was assessed by the AMSTAR-2, Glenny and ROBIS tools. A quantitative analysis was done with Review Manager 5.4.1. RESULTS Ten SR were included. The risk of bias was judged low for one SR according to ROBIS. Two SR presented a high level of evidence according to AMSTAR-2. In the quantitative analysis and about the orthopaedic mandibular advancement therapies (OMA), while a significant increase in superior (SPS) [(Mean difference (MD): 1.19; CI 95% [0.59; 1.78]; P<0.0001)] and middle (MPS) pharyngeal space [(MD: 1.10; CI 95% [0.22; 1.98]; P=0.01)] existed in the short-term for both OMA, it was greater for removable. On the other hand, there was no significant change in the inferior pharyngeal space (IPS). Four other SR targeted the short-term efficacy of class III OT. Only treatments with face mask (FM) or face mask+rapid maxillary expansion (FM+RME) allowed a significant increase in SPS [(MD FM: 0.97; CI 95% [0.14; 1.81]; P=0.02/MD FM+RME: 1.54; CI 95% [0.43; 2.66]; P=0.006)]. This was neither the case for chin cup nor in all cases in IPS. The last two SR explored the effectiveness of RME, whether or not associated with bone anchorage, on the dimensions of the UA or on the reduction of the apnoea/hypopnea index (AHI). A significant superiority of the effects of the devices with mixed or only bone anchorages existed concerning the width of the nasal cavity, the nasal airflow and the reduction of the nasal resistance. But, the qualitative analysis showed no significant reduction in AHI after RME. CONCLUSIONS Despite the heterogeneity of the included systematic reviews and their unfortunately not always low risk of bias, this synthesis showed that orthopaedics could provide some short-term improvement in AU dimensions, mainly in the upper and middle areas. Indeed, no devices improved the IPS. Class II orthopaedics improved SPS and MPS; class III orthopaedics, except for the chin cup, improved only SPS. RME, optimised with bone or mixed anchors, mostly improved the nasal floor.
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Kanwal L, Sukhia RH, Fida M. Analysis of facial proportions in skeletal Class II subjects treated with Clark's twin block appliance, followed by nonextraction fixed mechanotherapy: A retrospective longitudinal study. J World Fed Orthod 2022; 11:164-169. [DOI: 10.1016/j.ejwf.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022]
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An introduction to cumulative meta-analysis. Am J Orthod Dentofacial Orthop 2022; 161:474-476. [DOI: 10.1016/j.ajodo.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 11/22/2022]
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Chou AHK, Park JH, Shoaib AM, Lee NK, Lim HJ, Abdulwhab AA, Alfawaz F, Kook YA. Total maxillary arch distalization with modified C-palatal plates in adolescents: A long-term study using cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2021; 159:470-479. [PMID: 33558030 DOI: 10.1016/j.ajodo.2020.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 01/01/2020] [Accepted: 02/01/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The aims of this study were to evaluate the long-term skeletodental effects, the volume of maxillary tuberosity, and airway space changes after maxillary molar distalization using modified C-palatal plate (MCPP) in adolescents with Class II malocclusion. METHODS The sample consisted of 20 adolescent patients (MCPP group; mean age, 12.9 ± 1.0 year) who underwent bilateral distalization of their maxillary dentition and 20 subjects as a control group. In the MCPP group, cone-beam computed tomography images were taken before distalization, at the end of the treatment, and during retention with a minimum of a 3-year posttreatment follow up period. Repeated measures ANOVA followed by post-hoc analysis with the Bonferroni test were used to identify significant differences between time points. RESULTS After the long-term observation period, sagittal skeletal and dental relationships were maintained (there were no significant changes in ANB, occlusal plane angle, and overjet postretention). The vertical skeletal dimension did not change during treatment and was stable at the long-term follow-up (the mandibular plane angle and ANS-Me were relatively well maintained). The volume of the maxillary tuberosity showed no significant change during long-term retention. However, the volume was significantly smaller in the treatment group than in the control group (P <0.0001). There were no significant airway space changes after distalization and the postretention period. In addition, there was no significant difference between the MCPP and control groups. CONCLUSIONS Improved sagittal skeletal and dental relationships because of treatment were maintained in the long-term evaluation. There was no negative long-term effect on airway space associated with the maxillary arch distalization. Therefore, these findings might be beneficial for clinicians in diagnosis and treatment planning for Class II malocclusion in adolescents.
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Affiliation(s)
- Alex Hung Kuo Chou
- Division of Orthodontics, Dentistry Hospital, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Ariz Graduate School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Ahmed M Shoaib
- Division of Orthodontics, Dentistry Hospital, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Nam-Ki Lee
- Department of Orthodontics, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Gyeonggi Province, South Korea
| | - Hee Jin Lim
- Division of Orthodontics, Dentistry Hospital, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Ahmad Ali Abdulwhab
- Division of Orthodontics, Dentistry Hospital, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Fawaz Alfawaz
- Division of Orthodontics, Dentistry Hospital, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yoon-Ah Kook
- Division of Orthodontics, Dentistry Hospital, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
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Orthopedic Treatment for Class II Malocclusion with Functional Appliances and Its Effect on Upper Airways: A Systematic Review with Meta-Analysis. J Clin Med 2020; 9:jcm9123806. [PMID: 33255537 PMCID: PMC7759817 DOI: 10.3390/jcm9123806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023] Open
Abstract
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.
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Thakur VK, Londhe SM, Kumar P, Sharma M, Jain A, Pradhan I. Evaluation and quantification of airway changes in Class II division 1 patients undergoing myofunctional therapy using twin block appliance. Med J Armed Forces India 2020; 77:28-31. [PMID: 33487862 DOI: 10.1016/j.mjafi.2020.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/19/2020] [Indexed: 10/24/2022] Open
Abstract
Background The purpose of the present study was to determine the airway changes in skeletal class II division 1 malocclusion patients with mandibular retrognathism, treated with Twin-Block (TB) appliance. Methods Airway assessment was carried for twelve patients (mean age 11.7 ± 1.1 years) who underwent myofunctional therapy using TB appliance for correction of skeletal class II division 1 malocclusion with mandibular retrognathism. Acoustic pharyngometry (AP) was used to assess and quantify the comparative changes in the upper airway, pretreatment and posttreatment. Results Data acquired was subjected to appropriate statistical analysis. The paired 't' test was used to compare pre-treatment (T0) and after the positive pterygoid response (T1). TB appliance increased mean minimum airway area by 0.28 ± 0.25 cm2 and mean airway by 0.47 ± 0.44 cm2 with 95% CI. Posttreatment minimum airway and mean area changes were found to be statistically significant (P-value<0.01). Conclusion TB appliance therapy has a positive effect on upper airway and is beneficial for the treatment of sleep-related disorders associated with Class II division 1 malocclusion for achieving positive functional changes, esthetics, and healthier quality of life.
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Affiliation(s)
- Vivek Kumar Thakur
- Resident, Department of Dental Surgery & Oral Health Sciences, Armed Forces Medical College, Pune 411040, India
| | - S M Londhe
- Director General Dental Services & Colonel Commandant, O/o DGDS, 'L' Block, IHQ of MOD (Army), New Delhi 110010, India
| | - Prasanna Kumar
- Professor, Department of Dental Surgery & Oral Health Sciences, Armed Forces Medical College, Pune 411040, India
| | - Mohit Sharma
- Associate Professor, Department of Dental Surgery & Oral Health Sciences, Armed Forces Medical College, Pune 411040, India
| | - Amit Jain
- Associate Professor, Department of Dental Surgery & Oral Health Sciences, Armed Forces Medical College, Pune 411040, India
| | - Ishan Pradhan
- Resident, Department of Dental Surgery & Oral Health Sciences, Armed Forces Medical College, Pune 411040, India
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Mohamed RN, Basha S, Al-Thomali Y. Changes in Upper Airway Dimensions Following Orthodontic Treatment of Skeletal Class II Malocclusion with Twin Block Appliance: A Systematic Review. Turk J Orthod 2020; 33:59-64. [PMID: 32284900 DOI: 10.5152/turkjorthod.2020.19028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022]
Abstract
Objective This systematic review intends to evaluate the dimensional changes in upper airway dimensions (UAD) of the respiratory tract subsequent to orthodontic treatment of skeletal Class II malocclusion with Twin Block Appliance (TBA). Methods The quality of reporting systematic reviews and meta-analyses was decided by the PRISMA standards with PROSPERO registration number CRD42017060317. The systematic search included EMBASE, MEDLINE, Psych INFO, Scopus, CINAHL, and other reference journals and review articles. The article search was performed from March 2017 until November 2017. Cochrane's risk of bias in non-randomized studies - of interventions (ROBINS-I) was used to grade the methodological quality of the included studies. Results The screening procedure identified 302 studies, among which seven studies satisfied the inclusion criteria for eligibility. The UAD at the pretreatment time varied from 7.2 mm to 41.9 mm with a mean of 14.16 mm. The post-treatment change in UAD ranged from 8.2 mm to 43.7 mm with a mean of 15.6 mm. Conclusion There was a significant increase in UAD following the TBA treatment in the patient group as compared to the control group.
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Affiliation(s)
- Roshan Noor Mohamed
- Department of Pedodontics, Taif University School of Dentistry, Taif, Saudi Arabia
| | - Sakeenabi Basha
- Department of Preventive and Community Dentistry, Taif University School of Dentistry, Taif, Saudi Arabia
| | - Yousef Al-Thomali
- Department of Orthodontics, Taif University School of Dentistry, Taif, Saudi Arabia
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V A, Jena AK, Sharan J. Effects of functional appliance treatment on pharyngeal airway passage dimensions in Class II malocclusion subjects with retrognathic mandibles: A systematic review. APOS TRENDS IN ORTHODONTICS 2019. [DOI: 10.25259/apos_59_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective:The objective of this study was to assess the pharyngeal airway passage (PAP) dimension changes following functional appliance treatment in Class II malocclusion subjects with retrognathic mandibles.Materials and Methods:Two authors independently searched various electronic databases such as PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus, NCBI, and Google Scholar for the available literature within the period from January 1, 2001, to December 31, 2018. On the basis of population, intervention, comparison, and outcome, “changes in PAP dimensions following functional appliance therapy in skeletal Class II malocclusion subjects associated with mandibular retrusion” was considered as search question of the study. After the selection and removal of duplicate articles, assessment for risk of bias was calculated and the data from the included articles were extracted by two authors independently.Results:From six databases and additional hand searching, a total of 5784 articles were extracted. Of 5784 articles, 3754 articles were screened after removal of 2030 duplicates. After going through the title and abstract, 3197 articles were excluded and 40 articles were assessed for full text. From these 40 articles, eight articles fulfilled our inclusion and exclusion criteria for the qualitative synthesis review.Conclusions:The correction of mandibular deficiency by functional appliances has minimum effect on the nasopharynx. Functional appliance treatment has a significant effect on the improvement of the oropharyngeal airway. Changes of hypopharyngeal airway passage need to be studied further among Class II malocclusion subjects with retrognathic mandibles.
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Entrenas I, González‐Chamorro E, Álvarez‐Abad C, Muriel J, Menéndez‐Díaz I, Cobo T. Evaluation of changes in the upper airway after Twin Block treatment in patients with Class II malocclusion. Clin Exp Dent Res 2019; 5:259-268. [PMID: 31249707 PMCID: PMC6585589 DOI: 10.1002/cre2.180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 12/21/2022] Open
Abstract
The purpose of this prospective case control study is to describe in growing patients with mandibular hypoplasia, treatment outcomes following functional therapy in terms of volumetric changes in nasopharynx and oropharynx, that is, upper and lower pharynx. We recruited 60 study participants aged between 8 and 12 years having mandibular Class II malocclusion and a reduced upper airway (UA) size, as determined by McNamara cephalometric analyses. Forty patients received Twin Block treatment, whereas the remaining 20 patients did not receive treatment, thus constituting the control group. The control group included patients who did not start treatment after their first visit but returned for a consultation one or 2 years later. All patients underwent an initial teleradiography examination of the skull and a final teleradiography examination to measure changes using McNamara cephalometric analysis of the UA. Pretreatment and posttreatment changes were assessed using Student's t test for independent samples with a significance level of 0.05. Both anatomical structures analyzed-the upper pharynx (nasopharynx) and lower pharynx (oropharynx)-showed significant increases after treatment regardless of whether the patients were boys or girls. The controls showed a decrease in UA size on average after approximately 2 years of growth. A clear relationship exists between the mandibular advancement achieved with TB treatment and an increased UA size. Therefore, the appliance is considered suitable for improving the respiratory quality of growing patients with a decreased UA size.
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Affiliation(s)
- Inmaculada Entrenas
- Orthodontics DivisionUniversidad de Oviedo. Instituto Asturiano de OdontologiaOviedoSpain
| | - Elena González‐Chamorro
- Orthodontics DivisionUniversidad de Oviedo, Surgery and Medical‐Surgical Specialities, Instituto Asturiano de OdontologiaOviedoSpain
| | - Covadonga Álvarez‐Abad
- Orthodontics DivisionUniversidad de Oviedo, Surgery and Medical‐Surgical Specialities, Instituto Asturiano de OdontologiaOviedoSpain
| | - Juan Muriel
- Diagnostic Imaging DivisionUniversidad de Oviedo Instituto Asturiano de OdontologiaOviedoSpain
| | - Iván Menéndez‐Díaz
- Orthodontics DivisionUniversidad de Oviedo. Instituto Asturiano de OdontologiaOviedoSpain
| | - Teresa Cobo
- Orthodontics DivisionUniversidad de Oviedo. Instituto Asturiano de OdontologiaOviedoSpain
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Kamal AT, Fida M. Evaluation of cervical spine posture after functional therapy with twin-block appliances: A retrospective cohort study. Am J Orthod Dentofacial Orthop 2019; 155:656-661. [DOI: 10.1016/j.ajodo.2018.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 10/26/2022]
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Pavoni C, Cretella Lombardo E, Franchi L, Lione R, Cozza P. Treatment and post-treatment effects of functional therapy on the sagittal pharyngeal dimensions in Class II subjects. Int J Pediatr Otorhinolaryngol 2017; 101:47-50. [PMID: 28964309 DOI: 10.1016/j.ijporl.2017.07.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/22/2017] [Accepted: 07/23/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the craniofacial changes induced by functional appliances with special regard to the oro and nasopharyngeal sagittal airway dimensions in subjects with dentoskeletal Class II malocclusions when compared with an untreated Class II control group immediately after therapy and at long-term observation. METHODS A group of 40 patients (21 females and 19 males) with Class II malocclusion treated consecutively either with a Bionator or an Activator followed by fixed appliances was compared with a matched control group of 31 subjects (16 females and 15 males) with untreated Class II malocclusion. The treated sample was evaluated at T1, start of treatment (mean age: 9.9 ± 1.4 years); T2, end of functional treatment and prior to fixed appliances (mean age: 11.9 ± 1.3 years); and T3, long-term observation at the end of growth (mean age: 18.2 ± 2.1 years). Statistical comparisons were performed with independent sample t tests at T1 (baseline characteristics) and for the T1-T2, T2-T3, and T1-T3 changes. RESULTS During active treatment the treated group showed a significant increment in lower airway dimension (PNS-AD1), as well as a significant improvement in the upper airway dimension (PNS-AD2). A significant decrease in the upper adenoid size (AD2-H) was also found. In the longterm evaluation, a significant increase in both lower and upper airway thickness (PNS-AD1; PNS-AD2) and a significant decrease in the upper adenoid thickness were still present in the treated group. CONCLUSION The treatment with functional appliances produced significant favorable changes during active treatment in the oro- and nasopharyngeal sagittal airway dimensions in dentoskeletal Class II subjects when compared with untreated controls, and these changes were stable in the long-term.
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Affiliation(s)
- Chiara Pavoni
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy.
| | | | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy; Thomas M. Graber Visiting Scholar, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, The University of Michigan, Ann Arbor, MI, USA
| | - Roberta Lione
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy
| | - Paola Cozza
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Italy; Department of Orthodontics, University Zoja e Këshillit të Mirë, Tirane, Albania
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Xiang M, Hu B, Liu Y, Sun J, Song J. Changes in airway dimensions following functional appliances in growing patients with skeletal class II malocclusion: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2017; 97:170-180. [PMID: 28483230 DOI: 10.1016/j.ijporl.2017.04.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The purpose of the study was to evaluate the treatment effects of functional appliances (FAs) on upper airway dimensions in growing Class II patients with mandibular retrognathism. METHODS Five databases and the references of identified articles were electronically searched for relevant studies that met our eligibility criteria. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. The effects of FAs on airway dimensions were combined by meta-analysis using the RevMan and STATA software. RESULTS Seven studies (177 treated patients with mean age: 11.48 years and 153 untreated controls with mean age: 11.20 years) were included in this review. Compared to the control group, the oropharyngeal dimensions in the treatment group subjects were significantly increased at the superior pharyngeal space (MD = 1.73 mm/year, 95% CI, 1.13-2.32 mm, P < 0.00001), middle pharyngeal space (MD = 1.68 mm/year, 95% CI, 1.13-2.23 mm, P < 0.00001) and inferior pharyngeal space (MD = 1.21 mm/year, 95% CI, 0.48-1.95 mm, P = 0.001). No significant differences were found in nasopharyngeal and hypopharyngeal dimensions and the position of hyoid bone (P > 0.05). Soft palate length and soft palate inclination were improved significantly in the treatment group (P < 0.05). CONCLUSIONS The results showed that FAs can enlarge the upper airway dimensions, specifically in the oropharyngeal region, in growing subjects with skeletal Class II malocclusion. The early intervention for mandibular retrognathism with FAs may help enlarge the airway dimensions and decrease potential risk of obstructive sleep apnea syndrome for growing patients in the future.
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Affiliation(s)
- MingLi Xiang
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Bo Hu
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yang Liu
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jicheng Sun
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jinlin Song
- College of Stomatology, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
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