Abstract
BackgroundThe etiology of Class II division 2 (CII/2) malocclusion focuses on heredity; however lip, cheek, and tongue pressures that are associated with the environmental effect are considered to have an effect. The aim of this study was to evaluate the relation between perioral pressures and the upper incisor inclination in CII/2 malocclusion.MethodsTwenty patients (8 females, 12 males; mean age 10.29 ± 0.90 years) with CII/2 malocclusion were included in the study group, and 15 patients (5 females, 10 males; mean age 10.56 ± 1.06 years) with Class I malocclusion were included. The upper incisors were protruded with a utility arch (0.016 × 0.022 in. blue elgiloy wire). Perioral pressure assessment was made with the Iowa Oral Pressure Instrument. Upper lip pressure, lower lip pressure, vertical lip pressure, left-right buccal pressures, swallowing, and maximum tongue pressures were measured. Repeated measure ANOVA was used to test the intragroup differences. Intergroup comparisons were made using two-way repeated measure ANOVA with Bonferroni correction. Relationships between the variables were analyzed using rank correlation (Spearman’s rho). The significance for all statistical tests was predetermined at p < 0.05.ResultsA significant change occurred in the upper lip pressure, lower lip pressure, and vertical lip pressure; however, significant difference was not found between the groups. Upper lip pressure increased significantly in both groups. In the CII/2 group, lower lip pressure increased after protrusion and decreased after retention, while vertical lip pressure decreased and then increased significantly. Left buccal pressure changes between the groups were not parallel. Right buccal pressure, swallowing, and maximum tongue pressure changes were not statistically significant. Statistically significant correlation was found between U1-NA (mm) and vertical lip pressure (r −0.467).ConclusionsIn the CII/2 group, upper lip pressure increased only in retention. Lower lip pressure increased and vertical lip pressure decreased after protrusion. Nevertheless, these changes did not remain stable after the retention period. The difference between groups was not statistically significant at the end of retention.
Highlights
The etiology of Class II division 2 (CII/2) malocclusion focuses on heredity; lip, cheek, and tongue pressures that are associated with the environmental effect are considered to have an effect
The identification of the etiology is quite important for the success of the orthodontic treatment
In studies among twins and triplets, strong evidences were obtained regarding the fact that genetics is the fundamental etiologic factor in the development of CII/2 malocclusion [1,2,3], though other etiologic factors are lip, cheek, and tongue-related environmental factors
Summary
The etiology of Class II division 2 (CII/2) malocclusion focuses on heredity; lip, cheek, and tongue pressures that are associated with the environmental effect are considered to have an effect. Previous studies have shown that the lips and cheeks, rather than the tongue, are the most important environmental factors of teeth position [4,5,6]. It has been shown that for individuals with CII/ 2 malocclusion exposed to significantly higher resting lip pressure than those with Class I malocclusion, the high lower lip line and its pressure were found to be related to the retroclination of the upper incisors in CII/2 malocclusion [10]. In another study, it was mentioned that the pressure from the lips is a result of the incisor position [7]
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