Abstract
Objective This study aimed to compare dentoskeletal changes in skeletal class-II malocclusion with removable twin block appliance and fixed AdvanSync2 appliance. Materials and Methods A prospective randomized clinical trial was conducted over a span of 1 year at AFID at Rawalpindi. Thirty patients with skeletal class-II malocclusion, 16 males (53.3%) and 14 females (46.6%), were randomly selected and divided in two equal groups (15 each) to be treated with either fixed functional appliances (FFAs) or with removable functional appliances (RFAs). Out of 30 patients, 15 between cervical vertebral maturation (CVM) stages of 2 and 3 were treated with RFA (twin block appliances) and remaining 15 between CVM stages of 4 and 5 were treated with FFA (AdvanSync2 appliances). Pretreatment (T 1 ) and posttreatment (T 2 ), angular variable, and linear variable were measured to compare the dentoskeletal effects between the two groups. Statitical Analysis Paired sample t-test was used to assess significant difference between variables at T1 (Pre-treatment) and T2 (Post-treatment) stage for both RFA and FFA group. Comparison among the RFA and FFA group was made using non-parametric Mann-Whitney U Test. IBM SPSS version 25.0 was used for evaluation. Results No significant difference was found in angular variables between the RFA and FFA groups ( p > 0.05) with the exception of linear variables. Sella-posterior nasal spine (S-PNS) length significantly increased and Jarabak's ratio significantly decreased for FFA group ( p = 0.010 and 0.045, respectively), when compared with RFA group. Conclusion Both the appliances, twin block (RFA) and AdvanSync2 (FFA), are effective for correction of skeletal class-II malocclusion. Both the appliances produced similar effects in the sagittal plane but for better vertical control twin block should be the appliance of choice. AdvanSync2 appliance could be preferred over twin block appliance when dentoalveolar and slight retrusive effect on the maxilla is desired especially for individuals in postpubertal growth spurt.
Highlights
The most frequently reported cases in orthodontics are of class-II malocclusion.[1]
16 males (53.3%) and 14 females (46.6%), were recruited in two equal groups, one was treated with twin block (RFA) and the other with AdvanSync[2] (FFA). Both the appliance groups showed positive and somewhat similar changes in linear and angular variables when comparison between T1 and T2 was made individually using paired ttest. ►Table 2 shows changes exhibited by the two groups which include significant decrease in ANB angle
P 1⁄4 0.000; fixed functional appliances (FFA), p 1⁄4 0.001), a significant increase in the value of SN point B angle (SNB) angle (p 1⁄4 0.006 and 0.000 for removable functional appliances (RFA) and FFA, respectively), significant increase in mandible length indicated by Mandibular corpus length (MCL) and gonion–menton (Go–Me) values; a significant increase in nasion–Me (N–Me) pointed an increase in mandibular height which improved facial profile
Summary
The most frequently reported cases in orthodontics are of class-II malocclusion.[1]. According to Tariq et al,2 41% of total orthodontic cases in Pakistani population are of class-II malocclusion. Class-II malocclusion occurs as a result of maxillary protrusion, or mandibular retrusion or combination of both which can be corrected by treating the skeletal and dentoalveolar discrepancies. Out of many recommended treatment options, one can make use of either removable and/or fixed functional appliances (FFAs).[3] Headgear is one of the classic appliances used for the correction of class-II malocclusion.[4] Other removable functional appliances (RFAs) include Frankel’s functional regulators (FR), Balter’s bionator, and Sander’s bite jumping appliances. Herbst appliance, and mandibular anterior repositioning appliance (MARA) are some of the FFAs used in treatment of class-II discrepancy. All these modalities are designed to modify the arches by reorienting their position in both sagittal and vertical dimensions to bring about correction of main features of class-II malocclusion.[5,6]
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