Dentoalveolar Changes Research Articles

Evaluation of clinical effects of Advansync 2 fixed functional appliance in skeletal Class II malocclusion: A retrospective cephalometric study

To evaluate the treatment effects of AdvancSync 2 in patients of skeletal Class II malocclusion in selected skeletal, dental, soft tissue and airway parameters. Pretreatment and post-functional lateral cephalograms of 12 patients (06 males and 06 females with mean age of 14.25+0.75) with skeletal Class II malocclusion treated using AdvanSync 2 were evaluated. Paired t-test and Wilcoxon rank-sum intraclass correlation (ICC) test results were calculated.Statistically significant changes were found in skeletal parameters ofSNB, Wits, maxillo-mandibular differential, Björk’s sum, basal plane angle, Sn-GoGn, lower anterior facial height (LAFH), Na-perp-Pog. Changes in dental parameters U1-NA (angular and linear), L1 to NB (angular and linear), U1-SN angle, IMPA, Inter-incisal angle, L1 to A-Pog and U1 to A-Pog were also observed to be statistically significant at T1. Soft tissue skeletal convexity and nasolabial angle improved significantly post treatment, while, statistically significant change was observed only in posterior pharyngeal airway space among the chosen cephalometric airway parameters.Treatment with AdvanSync 2 corrected the Class II malocclusion by producing skeletal and dentoalveolar changes. Soft tissue facial convexity and nasolabial angle improved with treatment. Further, linear dimension of the posterior pharyngeal airway space showed significant improvement with AdvanSync 2 therapy.

A comparison of treatment effects produced by AdvanSync and forsus fatigue resistant device in growing class II patients - An study

Class II malocclusion second most common malocclusion after class I. The prevalence of Class II malocclusion was reported 19.56% globally(2) and 14.6% in India. Management of class II malocclusion becomes intricate because of its variable etiology and the age at which the patient presents to the orthodontists. During 1900 first fixed functional appliances (FFA) emerged and then plethora of appliances followed. Amongst various appliances AdvanSync™ appears to be the latest addition to FFA in orthodontist’s arsenal whereas Forsus™ Fatigue Resistance Device (FFRD) is the most widely accepted and used FFA. The aim of this study is to compare the differences in the skeletal, dentoalveolar and soft tissue changes produced by AdvanSync™2 and FFRD. The sample comprised of 30 patients presented to the Department of Orthodontics and Dentofacial Orthopaedics, as outpatients. Total 15 patients in each group were treated and analyzed using Lateral cephalograms at two time period, pretreatment and post functional orthodontic treatment. Both the appliances were effective in normalising class II malocclusions with mandibular deficiency. Both the appliances showed more of dentoalveolar effects when compared to skeletal. They both have a positive effect on the profile. The FFRD and AdvanSync™2 both the appliances were effective in treating class II division malocclusion. AdvanSync™2 demonstrated greater headgear effect but less mandibular advancement as compared to FFRD. Both appliances caused significant dentoalveloar changes and soft tissue changes.

The Efficacy of Naso-Alveolar Molding on Premaxilla Pushback and Dentoalveolar Changes in Patients With Bilateral Cleft Lip and Palate.

To evaluate the extent of naso-alveolar molding (NAM) in pushing the premaxilla posteriorly in patients with bilateral cleft lip and palate (BCLP). Naso-alveolar molding application in cleft lip and palate cases bridges the cleft gap and increases nasal tip projection. In BCLP, NAM potentially mobilizes the premaxilla posteriorly to allow tension-free primary lip closure. However, some patients with BCLP with NAM history still necessitate osteotomy during labioplasty, questioning the efficacy of NAM for BCLP management. This single-center retrospective study was conducted using medical records of nonsyndromic patients with BCLP. Twenty-six patients with BCLP were enrolled over a 5-year period with a history of NAM application before primary labioplasty. The changes in premaxilla width (P), anterior arch width (A), posterior arch width (R), and anteroposterior projection of the premaxilla (P'-A') were statistically analyzed at 2 time points: (1) at the start of NAM application (T1) and (2) after completion of NAM before surgery (T2). The average age at NAM initiation was 46.2 ± 40.4 days, and the average duration of NAM usage was 125.14 ± 62.94 days. A and P-A showed significant differences between T1 and T2 (P < 0.0001), whereas the rest did not show significant differences in value following NAM application (P > 0.05). Naso-alveolar molding successfully pushed back the premaxilla portion about 4.68 ± 2.83mm on average. Naso-alveolar molding can push back the premaxillary protrusion up to 5mm, which can serve as a cutoff point for the consideration of combined modalities. Prenatal diagnosis, counseling, and cleft education should be the benchmark in cleft centers to improve overall patient outcomes.

Favourable dentoalveolar changes after lower premolar extractions for Class III camouflage with completely customized lingual appliances

BackgroundThe aim of the investigation was to evaluate if the inclination of the lower anterior teeth can be controlled reliably after lower premolar extraction for Class III camouflage treatment with completely customized lingual appliances (CCLAs). Treatment outcome was tested against the null hypothesis that lower premolar extractions for non-surgical camouflage treatment of a Class III malocclusion will lead to further compensation by retroclining mandibular incisors during CCLA treatment.MethodsThis retrospective study included 25 patients (f/m 12/13; mean age 20.7 years, SD 9.5 years) with uni- or bilateral Class III molar relationship and a Wits value of ≤ -2 mm. In all consecutively debonded patients, lower premolars were extracted to correct the sagittal relationship with a non-surgical camouflage approach. Lateral head films prior to (T1) and at the end of lingual orthodontic treatment (T2) were used to evaluate skeletal and dentoalveolar effects. A paired t-test with alpha = 5% was used to define differences between the endpoints. The linear correlation between the inclination of the mandibular incisors at T1 and the achieved correction was measured with the Pearson correlation coefficient (PCC). A Schuirmann’s TOST equivalence test was used to check if the final lower incisor inclination was within the defined norms.ResultsThe null hypothesis was rejected as the mean lower incisor inclination was improved by 1.8° despite lower premolar extractions (T1: 86.8°/ T2: 88.6°). There was a strong correlation (-0.75) between the lower incisor inclination at T1 and the achieved correction indicating a controlled correction towards the norm regardless of the initial incisor position. At T2, the interincisal angle as well as the lower incisor inclination were within the norm.ConclusionLower premolar extractions for non-surgical camouflage treatment of a Class III malocclusion will not lead to undesired retroclining of mandibular incisors during CCLA treatment even in severe cases.

Cephalometric Evaluation of the Pre- and Posttreatment Changes after the Correction of Class II Division 1 Malocclusion with Twin Block Appliance in Mixed Dentition.

To evaluate the pretreatment cephalometric records on the dental, skeletal, soft tissue, and incisor relationship with a twin block functional appliance in class II malocclusion patients in and around Mahe; evaluate the posttreatment cephalometric records on the dental, skeletal, soft tissue, and incisor relationship with a twin block functional appliance in class II malocclusion patients in these children; and to compare cephalometrically certain dental, skeletal, and soft tissue points in pretreatment and posttreatment cephalograms in them. This study was conducted on 20 class II patients in the mixed dentition period, who were treated with twin block therapy. Each had to meet the following criteria-(1) skeletal class II malocclusion with retrognathic mandible; (2) full cusp class II molar relationship; and (3) an angle of ANB of 50 or greater at the start of treatment. All patients wore the appliance 24 hours/day. The pretreatment cephalometric head films for the group were taken using standard cephalometric X-ray equipment. The length of time required to achieve a class I molar relationship was assessed. Appointments during the twin block phase were scheduled at intervals of 8 weeks. Lateral head films were obtained again at the posttreatment follow-up stage. There was a significant increase in effective mandibular length, ramus height, SNB, ANB, overjet, overbite, and I to NA (mm and degrees) after twin block therapy. The maxillary incisor position showed a decrease in its value by 4° in five cases. Thus, in the present study, evidence of skeletal and dentoalveolar changes leading to the correction of class II division 1 malocclusion with the twin block functional appliance has been established. However, further studies with a longer period of follow-up and a larger sample are required to substantiate the results of the present investigation. Bimalrag BR, Ephraim R, Ayilliath A, et al. Cephalometric Evaluation of the Pre- and Posttreatment Changes after the Correction of Class II Division 1 Malocclusion with Twin Block Appliance in Mixed Dentition. Int J Clin Pediatr Dent 2024;17(7):783-789.

Three-dimensional assessment on digital cast of spontaneous upper first molar distorotation after Ni-ti leaf springs expander and rapid maxillary expander: A two-centre randomized controlled trial.

The aim of this randomized controlled trial (RCT) was to evaluate the spontaneous distorotation of upper first permanent molars and the transverse dentoalveolar changes on digital casts in growing patients following maxillary expansion treatment using either the Leaf Expander® or the rapid maxillary expander (RME), both anchored to the deciduous second molar. This study was a two-arm, parallel-assignment, RCT with a dual-centre design conducted at two teaching hospitals in Italy. Inclusion criteria included maxillary transverse deficiency, prepubertal development stage (cervical vertebra maturation stage [CVMS] 1-2) and early mixed dentition with fully erupted upper first permanent molars. Exclusion criteria were systemic diseases or syndromes, CVMS 3-6, agenesis of upper second premolars, unavailability of the second deciduous molar for anchorage and Class III malocclusion. Patients were randomly assigned to the Leaf Expander® or RME group using a computer-generated randomization list created by a central randomization centre. Randomization was conducted immediately before the start of treatment. The intervention involved treatment with either the Leaf Expander® or the RME. Both devices were anchored to the second deciduous molars. Following randomization, patients were further categorized based on the presence of no crossbite, unilateral crossbite or bilateral crossbite. The primary outcome measure was the distorotation of the upper first molar (U6). Secondary outcomes included measurements of interdental linear dimensions, specifically upper inter-canine width (53-63), upper inter-molar width (MV16-MV26) and upper inter-deciduous second molar width (55-65). The examiner analysing the digital casts was blinded to the treatment groups to prevent detection bias and ensure objective assessment. However, due to the nature of the intervention, blinding was not feasible for the patients and clinicians involved in administering the treatment. A total of 150 patients were enrolled and randomly assigned to two groups: 75 to the Leaf Expander® group and 75 to the RME group. Recruitment started in November 2021 and was completed in November 2022. At the time of analysis, the trial was complete with no ongoing follow-ups. ANOVA tests revealed no significant differences between the three subgroups (no-cross, unilateral-cross and bilateral-cross) within both the Leaf Expander® and RME groups at T0. The Leaf Expander® demonstrated significantly greater distorotation in the unilateral crossbite subgroup compared to the RME (p = .014). In terms of total molar distorotation, the Leaf Expander® appliance showed a significantly greater effect (12.66°) compared with conventional RME (7.83°). Linear regression analysis demonstrated a significant correlation between the extent of expansion and the degree of molar rotation. Maxillary expansion resulted in significant spontaneous molar distorotation when the appliance was bonded to the second deciduous molars. The Leaf Expander® exhibited significantly greater molar distorotation compared with conventional RME. The degree of molar distorotation was correlated with the extent of expansion obtained on the second deciduous molar. The trial was registered at ClinicalTrials.gov (ID: NCT05135962).

Occlusal Plane, Mandibular Position and Dentoalveolar Changes during the Orthodontic Treatment with the Use of Mini-Screws.

This study aimed to describe the changes produced on the occlusal plane (OP), the mandibular position and the dentoalveolar compensations of patients with distalization of the maxillary/mandibular arch assisted by mini-screws (MS). A descriptive case-series study was performed using the digital lateral cephalograms (DLC) of nine patients who underwent orthodontic treatment and required the use of MS for a complete distalization of the maxillary/mandibular arch. Records were collected at three different times (T1-T2-T3) and digitally analyzed (variables: Skeletal diagnosis; maxillary occlusal plane; position of the maxilla/mandible; and dentoalveolar changes of the distalization arch tracing the longitudinal axis of incisors/molars regarding the palatal/mandibular plane). Findings show that the OP varied from T1-T2-T3 in all cases, indicating its stepping or flattening. ODI, APDI, SNA, SNB, and ANB changed minimally in all cases, without variations in the mandibular position or in the skeletal diagnosis. Dentoalveolar measurements also showed differences between T1-T2-T3. In summary, conventional orthodontic treatment modified the OP during the first phase of treatment. Moreover, the distalization mechanics with MS changed the OP and produced dentoalveolar changes, mainly in the inclination of incisors and molars. Other measures considered in the study did not change substantially.

Retention efficacy and patient experience with customized clear retainer and wrap-around circumferential retainer among non-extraction orthodontic patients: A 12-month follow-up cohort study.

The aim of this study was to evaluate retention efficacy by assessing retention stability and patient perspectives according to type of circumferential retainer: the wrap-around circumferential retainer (WCR) and customized clear retainer (CCR). This cohort follow-up study involved 52 patients aged 18-62 who underwent fixed-appliance orthodontic treatment without extractions or orthognathic surgery. Following screening consenting participants were divided into WCR and CCR groups. All participants before follow-up received fixed retainers for the upper and lower anteriors and respective removable retainers within 2 weeks post-debond. Intraoral scans and lateral cephalograms were taken immediately after debonding (T0) and again 12 months later. Dentoalveolar changes in several measurements were compared to evaluate retention efficacy. Surveys were conducted at 1 month (T1) and 12 months (T2) post-debonding to assess changes in patient experiences. Outcome assessments were blinded. Paired T-tests and independent T-tests were used for intragroup and intergroup comparisons of dentoalveolar measurements, respectively. Survey responses were analysed using the Pearson Chi-Square test. The final assessment included 32 participants. Model analysis revealed no significant differences between the groups, except for maxillary intermolar width (p = .033). In the WCR group, the cephalometric analysis indicated a significant increase in the incisor mandibular plane angle (p = .002) and a decrease in the interincisal angle (p = .014), while changes in the CCR group were statistically non-significant. Patient attitude evaluation showed similar trends for wear time and overall satisfaction. However, a higher percentage of respondents in the WCR group reported irritation when wearing the retainers (p = .037) at T1 and discomfort related to speech (p = .038) at T2. CCR showed better retention efficacy in terms of lower incisor inclination. Patients experienced relatively less irritation and speech discomfort with CCRs.

Middle and lower third face changes in patients with Oral Respiration treated by Rapid Maxillary Expansion

Oral respiration is a syndrome that affects the growth and development of the individual who suffers from this anomaly and also causes alterations at the skeletal level, damaging the craniofacial structures adjacent to this problem; facial, demonstrating a hyperdivergent and functional growth pattern that is absent and producing changes in the nasal cavity, mandible, maxilla, tongue, lips and the presence of dental crowding due to the imbalance of the new respiratory pattern. The aim of the present study was to describe the facial changes in the middle and lower third of the face in patients with oral respiration after being treated with rapid palatal expansion. The following is a systemic review where the analysis of 15 scientific articles that met the inclusion criteria was performed, among which are systemic reviews, meta-analysis, case reports obtained in databases such as: PubMed, Lilacs, Dialnet, Elsevier, Clinical Key, ScieLO, AMOLCA. It was found that rapid maxillary expansion is an orthopedic method that is applied to produce dentoalveolar changes, thus influencing the transversal correction also in the nasal complex resulting in the elimination of skeletal problems, with positive changes at facial, dental and functional level, as long as the therapy such as rapid maxillary expansion is recommended at early ages. However, the efficacy of the treatment depends on being within the age range so that there is no recurrence in the future

Three-dimensional evaluation of dentoalveolar and skeletal transverse changes between rapid maxillary expansion and slow maxillary expansion in growing subjects – A systematic review and meta-analysis

Three-dimensional evaluation of dentoalveolar and skeletal transverse changes between rapid maxillary expansion and slow maxillary expansion in growing subjects – A systematic review and meta-analysis

Comparative analysis of treatment outcomes between Bi-Maxillary Plates and Facemask for treating class III malocclusion in growing subjects. A retrospective study.

To comparatively analyse the skeletal and dento-alveolar changes after treatment with Class III Bi-Maxillary Plates (BMPs) and FM appliances in growing patients with Class III skeletal malocclusion. BMPs with class III elastics provided a similar pattern of skeletal and dento-alveolar changes compared to FMs, however supported by slightly greater dentoalveolar effects that contribute to the correction of the class III malocclusion in growing subjects.

Evaluation of dentoalveolar changes following maxillary incisor intrusion with one vs two anterior miniscrews in subjects with gummy smile: a randomized clinical trial.

To examine dentoalveolar changes following intrusion of maxillary incisors with one or two anterior miniscrews in subjects with gummy smile and deep bite. Forty-three subjects were selected and divided into two groups: group I (22 subjects: 15 women, 7 men; mean age 30 ± 10 years) received one miniscrew between the upper central incisors, and group II (21 subjects: 16 women, 5 men; mean age 30 ± 10 years) received two miniscrews between the canines and lateral incisors. Dentoalveolar parameters, including amount of intrusion, root resorption, incisor inclination, alveolar bone thickness, and buccal alveolar crest height (cementoenamel junction to labial alveolar crest), were evaluated using cone-beam computed tomography scans obtained before and after intrusion. The intergroup comparison was analyzed using a paired t-test and unpaired t-test to determine significant changes within and between groups. The amount of intrusion was significantly greater in group II than in group I (P < .05). No statistically significant differences were found between groups I and II for changes in incisor inclination, labial bone thickness, and buccal alveolar crest height (P > .05). Maxillary central and lateral incisor intrusion was significantly greater in subjects treated with two miniscrews. Root resorption of the maxillary central incisors was notably greater in subjects with one miniscrew, while maxillary lateral incisor resorption was greater in subjects treated with two miniscrews.

Spontaneous Mandibular Dentoalveolar Changes after Rapid Maxillary Expansion (RME), Slow Maxillary Expansion (SME), and Leaf Expander-A Systematic Review.

This systematic review aims to analyze the spontaneous dentoalveolar changes in the mandibular arch after maxillary expansion in growing patients obtained with different expansion protocols: Rapid Maxillary Expansion (RME), Slow Maxillary Expansion (SME), and Leaf Expander. The study adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eligibility criteria were established in the PICO format, involving patients who underwent slow, rapid, or leaf maxillary expansion during the mixed or early permanent dentitions. A comprehensive search of electronic databases and manual searches was conducted up to December 2023. The outcome measures included inter-mandibular first permanent molar width, inter-deciduous molar and canine width, arch perimeter, and arch length; both short- and long-term results were considered. The articles that met the inclusion criteria were included in this systematic review and were qualitatively evaluated using a methodological quality scoring system with a 13-point scale. To assess the inter-examiner agreement concerning the article selection and the qualitative assessment of the included studies, Kappa statistics were computed. A total of 1184 articles were identified through electronic and manual searches. After the removal of duplicates and the initial examination of the titles and abstracts, 57 articles were considered for the full text analysis, and according to the eligibility and exclusion criteria, 22 studies were finally selected, composed of 8 randomized controlled trials (RCTs) and 14 retrospective/case-control studies. The qualitative assessment of the included studies showed the following scores: 6 papers have high research quality, 5 have moderate quality, and 11 have low quality. SME demonstrated negligible mandibular changes, with less than 1 mm variation on average (range 0.46-2.00 mm) in the selected parameters and relapses observed in the long term. RME induced more significant increases, particularly in intermolar width greater than 1 mm, which ranged between 0.93 and 3.3 mm, and good stability over the long term. Leaf Expander exhibited promising short-term lower intermolar width increases greater than 1 mm and ranged from 0.5 to 1.69 mm, but long-term stability was not thoroughly evaluated. SME results in negligible short- and long-term effects, while RME, especially with Haas-type appliances, exhibits significant intermolar width increases that remain stable over the years. Leaf Expander shows short-term lower intermolar width increases, requiring further investigation into long-term stability.

Skeletal, dentoalveolar and soft tissue changes after stabilization splint treatment for patients with temporomandibular joint disorders

BackgroundTemporomandibular disorder (TMD) is a grouping of heterogeneous disorders with multifactorial origins. Stabilization splints (SS) have demonstrated an acceptable treatment effect in TMD. The possible changes at the skeletal, dental, and soft tissue levels need to be addressed to evaluate the benefit/risk ratio of this therapeutic procedure. Accordingly, this study aimed to three‑dimensionally evaluate skeletal, dentoalveolar and soft tissue changes after SS treatment for patients with TMD.MethodsThis retrospective study included 74 adult patients with myofascial and/or intra-articular disorders (25 males and 49 females), with an average age of 22.88 ± 4.8 years, who underwent SS treatment. Pre- and post-treatment Cone beam computed tomography were analysed using Invivo 6.0.3 software. The primary outcome was the vertical skeletal and dentoalveolar changes, while the secondary outcomes were the anteroposterior skeletal, dentoalveolar and soft tissue changes. Paired t-test and Wilcoxon rank sum test were used for statistical analyses.ResultsFor the primary outcome; skeletally, there was a significant increase in mandibular plane inclination (difference: 0.82°±1.37), decrease facial height ratio (difference: 0.45%±1.07) and at the dentoalveolar level, the inclination of the functional (FOP-SN, FOP-FH) and bisecting (BOP-SN, BOP-FH) occlusal planes exhibited a significant increase too (difference: 0.38 ± 1.43°, 0.49 ± 1.62°, 0.44 ± 1.29° and 0.41 ± 1.17°, respectively) and also a decrease in the overbite (difference: -0.54 ± 0.83). For the secondary outcomes; there was a significant decrease in mandibular position (SNB) (difference: 1.60 ± 1.36°) and increase in the overjet (difference: 0.93 ± 1.04, p < 0.001) and a significant lower lip retrusion (difference: 0.33 ± 1.01 mm p < 0.01), was observed too.ConclusionsSS therapy resulted in significant vertical skeletal and dentoalveolar changes that were manifested mainly by facial height ratio, mandibular and occlusal plane changes, and to a lesser extent, significant anteroposterior skeletal, dentoalveolar, and soft tissue changes in the form of mandibular position, increased overjet and a more retrusive lower lip. These changes should be considered during patients’ selection prior to initiating SS therapy.

Severe Crowding Associated with Lower Canine Premature Resorption: Interceptive Treatment with Clear Aligners-A Pilot Study.

Early mixed dentition represents a critical phase since crowding conditions can occur. The interceptive resolution of dental crowding allows favorable arch and occlusal development. The aim of the present investigation was to evaluate dentoalveolar changes of clear aligner treatment planned to manage lower incisor crowding, loss of arch length, and midline deviation in early mixed dentition. A total of 13 patients (7 females, 6 males, 9.4 ± 1.2 age) treated with clear aligners were selected. Arch dimensions and incisor inclinations were evaluated before (T0) and at the end of interceptive treatment (T1). A paired t-test was chosen to compare T1-T0 changes. The level of significance was set at 5%. The greatest significant increase in mandibular width was observed at the level of the first deciduous molars (+2.44 ± 1.4 mm), followed by the second permanent molars (+2.16 ± 1.4 mm). Lower arch length and arch depth showed a statistically relevant increase (2 ± 0.6 mm and 4.5 ± 1.6 mm, respectively). The mean lower dental midline changes were statistically significant (1.42 ± 0.73 mm). Early treatment with clear aligners, including the combination of transversal arch development, maintenance of leeway space, and guidance of eruption, represents a valid treatment strategy in early mixed dentition to manage arch crowding and occlusion development.

Evaluation of modified clear Twin Block aligner in treating adolescents with skeletal class II malocclusion: A two-centre cephalometric study.

The purpose of this study was to evaluate the therapeutic effect of modified clear Twin Block (CTB) aligner and traditional twin block (TB) appliance from skeletal, dentoalveolar and soft tissue changes in adolescents with skeletal class II malocclusion. A total of 80 adolescents, included in this study from two medical centres, were distributed into CTB group, TB group and control group based on the treatment they received. Lateral cephalograms at pre-treatment (T1) and post-treatment (T2) were measured by modified Pancherz's cephalometric analysis, and dentoskeletal and soft tissue changes were analysed by independent-sample t-test, paired-sample t-test, ANOVA test and Scheffe's Post Hoc test. Seventy-five adolescents completed the study, including 32 in the CTB group, 32 in the TB group and 11 in the control group. Both CTB and TB treatment showed significant differences in most dentoskeletal and soft tissue measurements. Compared with the control group, improvements were observed in class II molar relationship through significant different in S Vert/Ms-S Vert/Mi in the CTB group (P < .01) and the TB group (P < .001), as well as deep overjet through significant different in S Vert/Is-S Vert/Ii in the CTB group (P < .001) and the TB group (P < .001). Besides, the CTB group also showed less protrusion of lower incisors and resulted in a more significant improvement in profile with fewer adverse effects on speaking, eating and social activities. For adolescents with skeletal class II malocclusion, CTB appliance was as effective as TB on improving dentoskeletal and soft tissue measurements, featuring more reliable teeth control and patient acceptance.

Modified Essix Twin Block Appliance: Successful Application in Adult Patient- A Case Report

Twin-block appliance has proven its efficiency in adolescents. William Clark has given this appliance to non-growing patients also. Here we gave the appliance to a 20-year-old male. Appliance fabrication was done with a thermoformed sheet and acrylic. With this appliance, we achieved dento-alveolar and skeletal changes in a 20-year-old male patient. Generally, twin block has disadvantages like lower incisor proclination, poor periodontal health issues, and patient hesitance to wear the appliance. In this design, we have overcome the issues mentioned above. Soft tissue profile has also improved. Total treatment for appliance therapy was 8 months.

A Three-Dimensional Evaluation of Skeletal and Dentoalveolar Changes in Growing Class II Patients after Functional Appliance Therapy: A Retrospective Case-Control Study.

Background: The aim was to assess three-dimensionally mandibular and maxillary changes in growing Class II patients treated with removable functional appliances followed by fixed appliances. Methods: Twenty-four Class II patients (age range: 9 to 14, mean: 12.1 ± 1.1 years) treated with removable functional appliances followed by fixed appliances (functional appliance group-FAG) were retrospectively selected and compared to an age-matched control group (CG) treated with fixed appliances only. To be included in the study, pre- and post-treatment CBCT scans had to be available. The CBCTs were used to analyze, in 3D, the changes following treatment and growth. Results: Before treatment, overjet (FAG: 9 mm ± 2.8 (mean ± standard deviation); CG: 4 mm ± 1.7), ANB (FAG: 5.7° ± 2.0; CG: 3.2° ± 1.4), and effective mandibular length (FAG: 113.0 mm ± 4.1; CG: 116.6 mm ± 5.9) were statistically significantly different between the two groups. After treatment, overjet (FAG: -6.8 mm ± 2.8; CG: -1.8 mm ± 1.8) and effective mandibular length (FAG: 6.3 mm ± 2.6; CG: 3.9 mm ± 2.6) statistically significantly changed. There was a significant difference in the treatment effect between the FAG and the CG in overjet, ANB, and effective mandibular length. Conclusions: The results indicate that functional appliances are effective in correcting Class II malocclusions. The growth modification in the FAG resulted in an increase in mandibular length. Yet, the final length of the mandible in the FAG was smaller when compared to the CG.

Comparison of Twin Block appliance and Herbst appliance in the treatment of Class II malocclusion among children: a meta-analysis

BackgroundOur meta-analysis aimed to evaluate the efficacy of applying Herbst and Twin Block appliances in the treatment of Class II malocclusion among children.MethodsDatabases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China VIP Database (VIP), and Wanfang were thoroughly searched from inception to August 9, 2023. The outcomes included skeletal, dental, and soft tissue changes. The weighted mean difference (WMD) was used as the effect indicator, and the effect size was expressed with a 95% confidence interval (CI). The heterogeneity of each outcome effect size was tested, and the heterogeneity statistic I2 ≥ 50% was analyzed by the random-effect model, otherwise, the fixed-effect model was conducted. Sensitivity analysis was performed.ResultsA total of 12 studies involving 574 patients were included in this meta-analysis. Herbst appliance had a statistically significant increase in mandibular body length (WMD: 1.44, 95% CI: 0.93 to 1.96, P < 0.001) compared with the Twin Block appliance. More increases in angle and distance of L1 to mandibular plane (MP) were found in the Herbst appliance compared with the Twin Block appliance. Significant and greater improvements in molar relationship (WMD: 0.79, 95% CI: 0.28 to 1.29, P = 0.002), posterior facial height (WMD: -1.23, 95% CI: -2.08 to -0.38, P = 0.005), convexity angle (WMD: -1.89, 95% CI: -3.12 to -0.66, P = 0.003), and Sella-Nasion plane angle (U1 to SN) (WMD: 3.34, 95% CI: 2.25 to 4.43, P < 0.001) were achieved in the Twin Block appliance. Herbst and Twin Block appliances produced similar effects in the skeletal and dentoalveolar changes including Sella-Nasion-point A (SNA), Sella-Nasion-point B, point A-Nasion-point B (ANB), overjet, and overbite.ConclusionAs the findings revealed both Herbst and Twin Block appliances contributed successfully to the correction of Class II malocclusion. Compared with the Twin Block appliance, the Herbst appliance may have more advantages in mandibular bone movement. Twin Block therapy resulted in more improvement in the aesthetics of the face.

Dento-Alveolar Changes after Maxillary Hybrid Expansion and Multi-Bracket Therapy: A Comparative Study at Three Different (Vertebral) Maturation Stages

Background: Rapid maxillary expansion is a common therapy when a palatal transversal discrepancy occurs. Different anchorage solutions have been proposed to obtain an effective skeletal expansion, even for adult patients. The aim of the present research was to evaluate the dentoskeletal effects of a hybrid expander and multi-bracket therapy, considering three groups of patients with different cervical vertebral maturation (CVM) stages. Materials and Methods: The study evaluated 68 consecutively treated patients. The age of the patients varied from 7 to 27 years old (mean age 13.45). The sample was divided into the following three groups based on CVM stage at the start of treatment: Group 1 (CS1–CS2) included 21 patients (mean age 10.21, SD 1.34), Group 2 (CS3–CS4) included 28 patients (mean age 13.37, SD 1.37) and Group 3 (CS5–CS6) was composed of 19 patients (mean age 17.14, SD 3.48). Each patient underwent orthodontic therapy where the first step was a palatal expansion by means of a hybrid expander; afterwards, the therapy was completed with a multi-bracket appliance. Expansion and torque values were observed at the end of treatment on digital models. Results: Significant intragroup differences in transversal expansion were found over time for all parameters in all groups. No significant differences were found among groups for longitudinal changes. No significant differences were found among groups for longitudinal changes of torque. Conclusions: The tooth–bone-borne maxillary expander and multi-bracket produced a significant clinical expansion with negligible dental compensation. The effect of the maxillary expansion and multi-bracket therapy showed no differences among the maturation groups in regard to transversal diameter changes and torque values.