Dental Compensation Research Articles

Comparison of Cervical Vertebral Maturation with Fishman’s Skeletal Maturity Index Method in Assessment of Growth Status

Assessment of skeletal maturity is paramount for orthodontists since optimal use and effectiveness of orthodontic and orthopedic appliances depends on it. Objective: To compare the cervical vertebral maturation (CVM) with Fishman’s hand wrist radiograph (HWR) method in assessment of growth status. Methods: This comparative cross sectional study was conducted at the Orthodontics department at the Khyber College of dentistry, Peshawar on 100 participants. The patients with 9 to 15 years of age, relatively well aligned arches, both genders, mild to moderate skeletal discrepancy, minimal dental compensations, vertical normal angle, and without temporomandibular joint disorders were included. Along with age and gender, stages of HWR and CVM were recorded. HWRs were acquired by standardized method and lateral cephalograms were taken in natural head position. The staging of HWR was done by using Fishman method while CVM staging. Comparison of CVM stages and Fishmann’s HWR stages were done using chi-square test. Results: The mean age was 11.79 ± 1.62 years. The females were 53(53%) and males were 47(47%). Most common stage of CVM was III (n=33, 33%) followed by IV (n=27, 27%). Similarly, common stage of hand wrist radiograph was III (n=32, 32%) followed by IV (n=28, 28%).There was no statistically significant different between two methods for assessing skeletal growth status (p=0.697). Conclusions: Cervical vertebral maturation can have used as an alternative to hand wrist radiograph for growth assessment without an extra radiation

Anterior crossbite in children – Literature review

Introduction: The anterior crossbite is the oral encounter of the mandibular anterior teeth with the maxillary anterior teeth when it is in a central relationship. Objective: To determine the risk factors associated with CAM and what type of treatment is most recommended for the correction of CAM. Methodology: For this article we began the search for the information for which we accessed the following databases, PubMed, ESCOPUS, EBSCO. Results: The crossbite initially showed promise with the use of an acrylic adhesive palatine expander that, after fixation and coinciding with the replacement of the maxillary incisor and a reflex anterior sclera, was corrected with masking. The goal of correcting cross-over defects at an early age is to allow improvement of type III bone pattern and reduce the amount of dental compensation and bone misalignment typically associated with severe skeletal abnormalities in childhood; however, the inferiority is long treatment time depending on the types of treatments we are going to use. Conclusions: It is concluded that there must be an early diagnosis so that in this way an early treatment is carried out and thus future problems can be avoided, in such a way that it is necessary to comply with different factors to perform some type of treatment that the patient requires.

Evaluation of factors related to morphological masseter muscle changes after preoperative orthodontic treatment in female patients with skeletal class III dentofacial deformities

BackgroundThe purpose of the current study was to investigate factors related to morphological changes in the masseter muscle after preoperative orthodontic treatment in patients with skeletal class III dentofacial deformities for analysis of muscle changes and malocclusions.MethodsTwenty female patients with dentofacial deformities were included in the study. Computed tomography was performed before and after preoperative orthodontic treatment, and the lengths, widths, and cross-sectional areas of the masseter muscles were measured. Changes in these parameters were evaluated, and factors related to changes in masseter muscle area after preoperative orthodontic treatment were analyzed.ResultsThe lengths, widths, and areas of masseter muscles were significantly smaller after preoperative orthodontic treatment. Smaller masseter muscle area was significantly associated with changes in overbite and pretreatment values of SNA angle.ConclusionsAtrophy of the masseter muscle during preoperative orthodontic treatment was greater in patients with increased open bite due to improved dental compensation in patients with skeletal class III dentofacial deformities with maxillary retraction.

A surgeon’s perspective on the uncorrected skeletal deformity. Part I: Unintended consequences on facial structures and esthetic harmony

It is not uncommon for orthodontists to encounter patients whose malocclusion results, at least in part, from an underlying skeletal discrepancy. In many patients, these discrepancies can be fully corrected with growth modification with or without dental compensation to achieve a Class I occlusal relationship. A subset of patients with moderate skeletal deformities in whom surgery is ideally indicated but who choose to defer surgical treatment may be at risk for long-term adverse consequences on facial esthetics. As a surgeon who performs both orthognathic and facial esthetic surgery, the senior author has had the opportunity to appreciate the contributions of underlying skeletal deformities to his patients' esthetic concerns. These patients often present years after orthodontic treatment with complaints of early facial soft tissue laxity, facial disproportion, and overall dissatisfaction with facial appearance. The authors hope to illustrate to the orthodontic community the clinical picture of adult patients who present to the offices of surgeons dissatisfied with their appearance secondary to the uncorrected skeletal deformity. This paper aims to increase orthodontists' awareness of the long-term effects of uncorrected skeletal dysplasia on facial appearance. The ultimate goal is to allow the informed consent process to incorporate these esthetic consequences and to facilitate patient decision making. This article serves as Part I of a 2-part series reviewing a surgeon's approach to patients who present with facial skeletal disharmony after orthodontic treatment with dental compensation.

A surgeon’s perspective on the uncorrected skeletal deformity. Part II: The role of esthetic surgery for orthognathic camouflage

Orthognathic camouflage refers to the use of procedures other than traditional orthognathic surgery for correction of facial dysmorphology that reflects underlying skeletal discrepancy that was either not addressed on initial orthodontic evaluation or not corrected by nonsurgical treatment of the malocclusion. The authors aim to illustrate to the orthodontic community the common clinical presentation of patients who seek consultation from a surgeon citing dissatisfaction with their facial appearance secondary to orthodontic correction of the malocclusion with dental compensation but without surgical correction of the underlying skeletal discrepancy. This article summarizes the orthognathic camouflage procedures that are available as options for correction of such deformities without subjecting the patient to the potential morbidity and prolonged recovery associated with orthognathic surgery. This manuscript represents Part II of a two-part series describing a surgeon's approach to patients who present with facial skeletal disharmony after orthodontic treatment with dental compensation for malocclusions associated with an underlying skeletal discrepancy.

The influence of orofacial functions on sagittal growth and development of occlusion

Introduction. Orthodontics experience has shown that dental compensation of some skeletal irregularities is under the positive influence of external factors. During sagittal development of cranial base and dental arches, they can be placed in relationship of I, II or III skeletal and dentoalveolar class. Malocclusion may be caused by a skeletal irregularity. Despite that, normal occlusion can be achieved by dentoalveolar compensation. The aim of this study was to investigate the influence of orofacial functions on maxillary and mandibular growth, as well as occlusion development in sagittal plane. Material and method. This study consisted of 60 male and female adolescents (average age 15.9). Types of respiration and deglutition were clinically determined. Molar relation and length of dental arch were evaluated from study models. On the lateral cephalograms the following parameters were measured: angles SNA, SNB, ANB, I/SpP and i/MP. Results showed that 78.8% of patients with regular orofacial functions and 11.1% of patients with irregular functions had developed molar class I. Patients with skeletal Class I and Class III and irregular orofacial functions, had protrusion of upper incisors in 88.9% (I) and 80% (III) and high length of maxillary dental arches in 58.8% (I) and 70%(III). Conclusion. There is relationship between orofacial functions and dental compensation of sagittal skeletal irregularities.

Comparative efficacy of the bone‐anchored maxillary protraction protocols for orthopaedic treatment in skeletal Class III malocclusion: A Bayesian network meta‐analysis

To compare the treatment effects of five bone-anchored maxillary protraction protocols (BAC3E, BAMP, BARME-FM, BARME-ME, SAFM) for skeletal Class III malocclusion. We conducted a systematic literature search through CENTRAL, EBSCO, PubMed and Web of Science and included the randomized controlled trials and clinical controlled trials, which met the criteria. A Bayesian network meta-analysis (NMA) for SNA, SNB, ANB, SN-MP and Wits appraisal was performed in R software using a random consistency model. The additional analyses included node-splitting analysis, statistical heterogeneity analysis, sensitivity analysis and ranking probability by SUCRA. A total of 598 articles were initially obtained; 13 articles involving 482 individuals were eventually included. Among the five bone-anchored maxillary protraction protocols, the largest increment in SNA and Wits appraisal was observed in the BAMP group and BAC3E group, respectively; the SAFM, BAC3E and BAMP groups showed similar capability in terms of changes of ANB; least clockwise rotation of the mandible was found in the BARME-ME group, followed by the BAMP group; dental compensation appears to be most pronounced in the BAC3E group; and intermaxillary traction seems to reduce the lingual inclination of lower incisors and even cause labial inclination. The SAFM, BAMP and BAC3E groups seem to be advantageous in the improvement of the maxillo-mandibular relationship, followed by the BARME-FM and BARME-ME groups. The findings of this study should be interpreted with caution as only short-term effects were compared and the quality of evidence ranged from very low to moderate. More RCTs with high-quality and long-term investigation are needed.

Interception of Class III malocclusion with facemask: cases' report

A skeletal Class III malocclusion is one of the most difficult anomalies to treat. Class III malocclusion with retruded maxilla can be orthopedically corrected with facemask in deciduous or mixed dentition in mild to moderate cases. The treatment should be carried out as early as possible before the malocclusion becomes severe. These are two case reports of successful treatment of developing skeletal class III malocclusion, on a 7-year-old female patient in early mixed dentition and on a 9-year-old female patient in mixed dentition. Both present a skeletal Class III due to a deficient maxilla. The treatment plan included protraction of the maxilla by a reverse pull Delaire type facemask. The post treatment results showed significant improvement in Class III skeletal relationship and the facial profile, with the correction of the overjet. The purpose of early orthodontic treatment of Class III is to intercept the developing malocclusion and redirect it to physiological development. Cases that show skeletal maxillary retrognathism are cases opt for treatment with facemask. The latter acts by promoting maxillary growth while restricting mandibular growth. Thus, it improves the skeletal relationships, minimizes excessive dental compensation and improves occlusal function. It also provides more pleasing facial aesthetics and may eliminate the necessity for orthognathic surgery treatment in some cases. Early Class III treatment can be done successfully when proper diagnosis and proper treatment plan are carried out carefully.

English

Treatment of complex malocclusion poses a challenge for the orthodontist because of its multifactorial aetiology. Class II malocclusion is the most frequently encountered and treated malocclusion in orthodontic practice and affects approximately 14.6 % of the North Indian population.1 A common reason for Class II malocclusion is mandibular skeletal retrusion which is the most common characteristic, as reported by McNamara.2 This can be caused by genetic or hereditary factors. When evaluating treatment options for Class II patients, the extent of the skeletal discrepancy and the skeletal maturity of the patient needs to be considered. Treatment may range from dental compensation including camouflage with extractions to surgical procedures targeted at moving the jaw at fault. In growing patients, growth modification with functional appliances offers an intermediate treatment option. Functional appliances are basically of two types; Removable and Fixed. Removable functional appliances such as Activator, Bionator, Frankel Function regulator and Twin Block appliance change Class II relationship by the transmission of soft tissue tension to the dentition. Treatment success with these appliances relies heavily on patient compliance. Therefore, in non-compliant patients, fixed Class II correctors in conjunction with fixed orthodontic appliances are the best choice.3 Fixed functional appliances generate continuous stimuli for mandibular growth without break and permit better adaptation to functions like mastication, swallowing, speech and respiration.1 The Herbst fixed functional appliance has been used routinely for Class II patients and has undergone many design variations over time.4 The AdvanSync2 Class II corrector is a recently introduced fixed functional appliance. It has a much smaller size than the conventional Herbst appliances, is easier to place, activate and remove and most importantly, can be used in conjunction with full-arch fixed appliances throughout.3 Here we describe a case report of a patient treated with the AdvanSync2 Class II corrector and the findings observed in the sagittal and vertical dimensions

Utilizing virtual surgical planning and orthognathic surgery to correct severe facial asymmetry without orthodontic treatment

Combining double-jaw surgery and orthodontic treatment to correct dentofacial asymmetry is a standard procedure but time consuming and costly. In order to provide alternative solutions, previewing the possible results with precise virtual surgical planning (VSP) system can help clinicians select patients suited for correcting facial asymmetry surgically without orthodontic treatment. In our experiences, after rigid or semirigid fixation of the maxilla, using intermaxillary fixation (IMF) without mandibular bony fixation is another key. This kind of fixation can minimize the chances of changing the condylar position and occlusion after the rotation of the maxillomandibular complex. If the original occlusion can be maintained, then orthodontic treatment can be avoided. Here we presented two facial asymmetry cases who requested surgical correction and refused orthodontic treatment. With careful preoperative planning using VSP, double-jaw surgery with maxillary bony fixation and IMF was conducted and both patients were satisfied by their aesthetic outcomes. With minimal dental compensation, the long-term results were relatively stable.

Extraoral vertical ramus osteotomy combined with internal fixation for the treatment of mandibular deformities

Extraoral vertical ramus osteotomy (EVRO) is used in orthognathic surgery for the treatment of mandibular deformities. Originally, EVRO required postoperative intermaxillary fixation (IMF). EVRO has been developed using rigid fixation, omitting postoperative IMF. We examined retrospectively the long-term stability and postoperative complications for patients with mandibular deformities who underwent EVRO with internal rigid fixation. Patients who were treated with EVRO for a mandibular deformity in the period 2008–2017 at the Clinic of Oral and Maxillofacial Surgery, Mölndal, Sweden were included (N = 26). Overjet and overbite were calculated digitally and cephalometric analyses were performed preoperatively, and at three days, six months, and 18 months postoperatively. There was a general setback of the mandible, decreased gonial angle and reduced degree of skeletal opening. Excellent dental and vertical skeletal stabilities were seen up to 18 months postoperatively, although relapse was seen sagitally up to six months postoperatively. Since the overjet did not show any significant change over time, the sagittal skeletal changes have been attributed to dental compensation. There was no permanent damage to the facial nerve and 5.8% neurosensory damage to the inferior alveolar nerve was observed.

Maxillary Changes Following Facial Bipartition - A Three-Dimensional Quantification.

Children with Apert syndrome have hypertelorism and midfacial hypoplasia, which can be treated with facial bipartition (FB), often aided by rigid external distraction. The technique involves a midline osteotomy that lateralizes the maxillary segments, resulting in posterior cross-bites and midline diastema. Varying degrees of spontaneous realignment of the dental arches occurs postoperatively. This study aims to quantify these movements and assess whether they occur as part of a wider skeletal relapse or as dental compensation. Patients who underwent FB and had high quality computed tomography scans at the preoperative stage, immediately postsurgery, and later postoperatively were reviewed. DICOM files were converted to three-dimensional bone meshes and anatomical point-to-point displacements were quantified using nonrigid iterative closest point registration. Displacements were visualized using arrow maps, thereby providing an overview of the movements of the facial skeleton and dentition. Five patients with Apert syndrome were included. In all cases, the arrow maps demonstrated initial significant anterior movement of the frontofacial segment coupled with medial rotation of the orbits and transverse divergence of the maxillary arches. The bony position following initial surgery was shown to be largely stable, with primary dentoalveolar relapse correcting the dental alignment. This study showed that spontaneous dental compensation occurs following FB without compromising the surgical result. It may be appropriate to delay active orthodontic for 6-months postoperatively until completion of this early compensatory phase.

Variables associated with stability after Le Fort I osteotomy for skeletal class III malocclusion

The purpose of this study was to assess skeletal stability and predictors of relapse in patients undergoing an isolated Le Fort I osteotomy. A retrospective cohort study of 92 subjects undergoing Le Fort I osteotomy for Class III malocclusion was implemented. Predictor variables were demographic and perioperative factors. The primary outcome variable was postoperative skeletal position with relapse defined as >2mm sagittal and/or vertical change at A-point on serial lateral cephalograms at immediate postoperative, 1 year, and latest follow-up time points. Mean advancement at A-point was 6.28±2.63mm and mean lengthening was 0.92±1.76mm. Eight subjects (8.70%) had relapse (>2mm) in the sagittal plane, and two subjects (2.17%) in the vertical plane. No subjects required reoperation for relapse as overbite and overjet remained in an acceptable range due to dental compensation. In regression analysis, magnitude of maxillary advancement was an independent predictor of relapse in the sagittal plane (P=0.008). There were no significant predictors of relapse in the vertical plane. This study suggests that isolated Le Fort I osteotomy for correction of skeletal Class III malocclusion is a stable procedure and that greater advancement is an independent risk factor for sagittal relapse.

Classification for mandibular deviation and facial asymmetry and its clinical significance

Judged from the clinical manifestations, etiological mechanisms and jaw morphological structures, malocclusions with mandibular deviation and facial asymmetry are classified into three main categories, i.e., those with mandibular positioning factors, those with mandibular condyle defects, and those with jaw congenital deformities. In the first category, three subtypes, including mandibular rotation caused by dentitional irregularities, by dental compensation and by habitual posturing, are further defined. In the second category, mandibular deviation caused by condylar asymmetrical resorption or hyperplasia are defined as the two subtypes. The third category is further divided into two subtypes, i.e., jaw and facial asymmetry resulting from maxillary or mandibular structural deformities. The prime goal of orthodontic therapy is to displace and restore the deviated mandible to its right position, followed by correction of occlusal intercuspation. As an important procedure of the whole treatment protocol, It is critical to detect and localize the correct mandibular position by manipulation and then register it by wax pattern and articulator transferring. For the cases with mandibular functional elements and condylar asymmetrical length, the treatment modalities include orthopedic repositioning of the mandible by using occlusal and bite plane, SGTB and SGHB therapies; for cases with growth and developmental anomalies, orthognathic intervention should be an optimal solution.

Orthognathic Surgery in Skeletal Class l Patient with Facial Asymmetry

The purpose of this case report was to describe the considerations in surgical orthodontic treatment of a patient with skeletal Class I malocclusion and facial asymmetry. A 22-year-old male presented with a chief complaint of facial asymmetry. Clinical examination showed severe facial asymmetry to the right side at his chin point. Also he showed lip canting and straight facial profile. Intraorally, he exhibited posterior crossbite in the right side with severe mandibular dental midline deviation to the right. After presurgical orthodontic treatment with dental decompensation was done, sagittal split ramus osteotomy (SSRO) with mandibular body shaving was done to correct the mandibular asymmetry. After orthodontic treatment, posterior crossbite and midline of the dentition was corrected, and asymmetry of the mandible was improved. For the patient with facial asymmetry, it is critical to eliminate dental compensation orthodontically and to move the teeth to their proper positions to avoid relapse and obtain stability.

Management of the Vertical Dimension in the Camouflage Treatment of an Adult Skeletal Class III Malocclusion

Treating skeletal class III malocclusions is one of the biggest challenges in Orthodontics. Given the complexity of these cases, orthognathic surgery is often the best treatment option. However, many patients refuse this treatment due to its risks, morbidity, and costs involved. Alternatively, dental compensation can be planned for some of these skeletal problems. This case report presents a dentoalveolar compensation in the orthodontic treatment of a 20-year-old female patient with class III malocclusion, concave profile, anterior crossbite, mandibular prognathism, maxillary retrusion, and a vertical deficiency in the posterior region. Treatment planning involved a multiloop edgewise archwire (MEAW) associated with intermaxillary elastics with counterclockwise rotation of the occlusal plane in the posterior region of the maxilla aiming at obtaining an increased posterior vertical dimension. After 24 months of treatment, the severe anterior crossbite was corrected, and the skeletal class III relationship was camouflaged. At the end of the orthodontic treatment, it was possible to observe an improved facial profile, a nice smile, and a functional occlusion. The results remained stable at a three-year follow-up. The MEAW, associated with the use of elastics, seems to be an effective treatment option for class III camouflage with reduced posterior vertical dimension with no need for additional anchoring devices but requiring adequate bending of wires and patient compliance.

Camouflage treatment of posterior bite collapse in a patient with skeletal asymmetry by using posterior maxillary segmental osteotomy

Orthodontic treatment of posterior bite collapse due to early loss of molars and the consequent drift of adjacent teeth is complicated. When the posterior bite collapse occurs in patients with facial asymmetry, both transverse and vertical compensation are necessary for camouflage orthodontic treatment. In such cases, posterior maxillary segmental osteotomy (PMSO) can be an effective alternative procedure that simplifies the orthodontic treatment and shows long-term stability through dental compensation within the alveolar bone housing. This case report aimed to describe the orthodontic treatment of maxillary occlusal plane canting caused by severely extruded maxillary teeth in a patient with skeletal facial asymmetry that was corrected with PMSO along with protraction of the lower second molar to replace the space of the extracted first molar. The treatment duration was 18 months, and stable results were obtained after 2 years of retention.

Stepwise versus single-step mandibular advancement with functional appliance in treating classII patients : Ameta-analysis.

Difference in the functional orthopedic effect between stepwise mandibular advancement (SWA) and single-step mandibular advancement (SSA) in Angle classII patients remains unclarified. To compare the treatment effects of SWA and SSA on skeletal and dentoalveolar changes in classII patients. Randomized controlled trials (RCTs) and nonrandomized studies that compared differences in skeletal and dentoalveolar effects on classII patients between SWA and SSA were identified in PubMed, Embase, CENTRAL, and Web of Science. The grey literature was also searched. The primary outcomes were the mandibular length, L1-MP, and (ANB). Secondary outcomes included Pog sagittal, SNB, overjet, and mandibular plane angle. Seven studies, including three RCTs and four cohort studies, were retrieved. Meta-analyses revealed pooled mean differences (95% confidence interval) of 0.79 mm (0.45 to 1.12 mm) for Pog sagittal, 0.53° (0.19 to 0.87°) for SNB, -0.51° (-0.83 to -0.20°) for ANB, -0.17° (-0.72 to 0.39°) for the mandibular plane angle, -0.41 mm (-0.90 to 0.09 mm) for overjet, -1.87° (-3.23 to -0.52°) for L1-MP, and 1.03 mm (0.63 to 1.42 mm) for the mandibular length. Publication bias was not observed, except for Pog sagittal. The quality of evidence for each outcome was judged as low (mandibular length, SNB and overjet) and very low (Pog sagittal, ANB, L1-MP and mandibular plane angle). Although the magnitude of differences in clinical practice was limited, SWA might be more appropriate because it produces agreater skeletal change and less dental compensation than SSA. As the level of current evidence is low, more high-quality RCTs are needed.

Posterior dental compensation and occlusal function in adults with different sagittal skeletal malocclusions

ObjectiveThe aim of this study was to compare posterior tooth inclinations, occlusal force, and contact area of adults with different sagittal malocclusions.MethodsTransverse skeletal parameters and posterior tooth inclinations were evaluated using cone beam computed tomography images, and occlusal force as well as contact area were assessed using pressure-sensitive films in 124 normodivergent adults. A linear mixed model was used to cluster posterior teeth into maxillary premolar, maxillary molar, mandibular premolar, and mandibular molar groups. Differences among Class I, II, and III groups were compared using an analysis of variance test and least significant difference post-hoc test. Correlations of posterior dental inclinations to occlusal function were analyzed using Pearson's correlation analysis.ResultsIn male subjects, maxillary premolars and molars had the smallest inclinations in the Class II group while maxillary molars had the greatest inclinations in the Class III group. In female subjects, maxillary molars had the smallest inclinations in the Class II group, while maxillary premolars and molars had the greatest inclinations in the Class III group. Occlusal force and contact area were not significantly different among Class I, II, and III groups.ConclusionsPremolar and molar inclinations showed compensatory inclinations to overcome anteroposterior skeletal discrepancy in the Class II and III groups; however, their occlusal force and contact area were similar to those of Class I group. In subjects with normodivergent facial patterns, although posterior tooth inclinations may vary, difference in occlusal function may be clinically insignificant in adults with Class I, II, and III malocclusions.

Second Class Functional Treatment: Andreasen Activator vs Twin Block.

ABSTRACTAimThe purpose of this research is to analyze and compare the dental and skeletal changes induced by two functional devices, Andreasen Activator and Clark's twin block, on the sagittal and vertical plane, by means of cephalometric analysis, of the lateral cephalograms prescribed at the beginning and at the end of the treatment for a second skeletal class, first division with normal or deep bite.Materials and methodsTwenty patients, 8 females and 12 males, fulfilling criteria for inclusion, were divided randomly into two groups: group I was treated with Andreasen activator, the second group with Clark's twin block. The duration of the therapy was about 18 months plus less 2 months. Pretreatment and posttreatment cephalometric radiographs were analyzed using angular (SNA, SNB, ANB, SnaSnp–GoGn angles), linear (Sna–Snp, Co–Gn, Co–Go, Go–Gn) skeletal parameters and dental one (U1–SnaSnp angle, L1–GoGn angle, Overjet and Overbite). To evaluate the posttreatment changes in the single groups and between them, paired and unpaired t-test was used.ResultsIn both of the two groups analyzed, all the sagittal and vertical, angular and linear, skeletal measurements appear to be increased in a statistically significant way, except SNA angle and the distance Sna–Snp. Regarding the dental parameters, in the group treated with Andreasen activator, only Overjet and Overbite showed statistically significant differences. On the other hand, twin block induced statistical changes about Overjet, Overbite and also U1/SnaSnp, but not about L1/GoGn. The advancement of the mandible determines a greater prominence of the chin and lower lip, an increment of the labial mental angle and a reduction of the convexity of the profile. Also, the decrease of the overjet and, consequently, of the dental exposure improve the esthetic appearance of the patient's face.ConclusionBoth functional treatments showed a lower jaw advanced on the sagittal plane and increased in size. In the upper jaw no significant changes were observed. It was also evident a dental compensation both on sagittal and vertical planes.Clinical significanceThe functional devices studied, Andreasen activator and twin block, seem to obtain more skeletal than dental results when the patients were treated at the peak of pubertal growth.How to cite this articleBaccaglione G, Rota E, Ferrari M, et al. Second Class Functional Treatment: Andreasen Activator vs Twin Block. Int J Clin Pediatr Dent 2020;13(2):144–149.