Two-phase Orthodontic Treatment Research Articles

Two-phase rehabilitation of patients with a forced position of the lower jaw: a clinical case

Relevance. Malocclusion correction in children very frequently requires several orthodontic appliances throughout the entire treatment period. The high prevalence of dental abnormalities in childhood determines the issue's relevance.Clinical cases' description. The article presents summaries from the records of the patients who presented for orthodontic care with malocclusion complicated by the forced position of the lower jaw. The authors implemented a two-phase orthodontic treatment protocol and achieved acceptable aesthetic and functional results.Conclusion. Laboratory-made plates with occlusal pads in the first phase of treatment of patients with mixed dentition contributes to the normalization of the lower jaw position and the alignment of the occlusal plane. In the second phase of orthodontic treatment, a standard silicone aligner allows for the improvement of dental arch relationship in the vertical, sagittal and transversal planes, normalization of dental arch form, and the correction of displaced teeth.

Evaluation of apical root resorption in Class III patients who received one- or two-phase orthodontic treatment

Objectives: The aim of this study was to compare the incidence root resorption and dilaceration between the patients with and without previous orthopedic treatment after the fixed orthodontic treatment. Materials and Methods: The pre- and post-treatment digitized panoramic films of 40 Class III adult patients meeting the inclusion criteria were selected from patient population of the orthodontic department. Half of the patients were treated with two-phase treatment (orthopedic therapy followed by fixed appliance treatment; Group 1), while the others wore only fixed appliances (Group 2). Root resorption was evaluated from the first molar to the first molar for each arch using the ImageJ software (Bethesda, Maryland, USA). The presence of root dilacerations was also recorded on the pre-treatment panoramic radiographs. Paired samples t-test and Mann– Whitney U-test were used to compare root length. Results: Intragroup comparisons for each tooth indicated that the upper and lower incisors, first molars and upper left second premolars presented a significant decrease in Group 1 (P < 0.05). In contrast, in Group 2, a significant decrease in tooth length was found only in the upper incisors (P < 0.05). Intergroup comparisons for root length change indicated statistically significant differences for the lower incisors, upper second premolars, and all first molars except for the upper left molars (P < 0.05). Nevertheless, the prevalence of root dilaceration in Group 1 was higher than that in Group 2. Conclusion: Class III patients who received two-phase treatments experienced more root resorption and dilaceration compared with patients who received one-phase treatments. It should be remembered that early orthopedic forces may have potential adverse effects on a dental root in the long-term.

Two-phase orthodontic treatment of two different types of tooth transposition in the same patient.

Orthodontic treatment is thoroughly planned considering the patient's facial and dental characteristics, the main complaint, treatment time and the orthodontist's experience. Transposition is a form of ectopia, in which two adjacent teeth exchange positions in the dental arch. Transposition can be partial or complete. This article reports the treatment of a female patient with two kinds of tooth transposition managed in the mixed and permanent dentitions. A girl, aged eight years and three months, came to routine paediatric consultation with an ectopic permanent mandibular left lateral incisor in the mixed dentition. Radiographic analysis indicated partial transposition of the permanent mandibular left lateral incisor and canine (Md.L2.C), and development of a complete tooth transposition between the permanent maxillary right first pre-molar and canine (Mx.C.P1). The patient was treated in two phases. The first, in the mixed dentition, and the second, in the permanent dentition with a three-year follow-up between them. These challenging treatment approaches are described in detail, including the mechanics used. The key points of this treatment were early diagnosis of the ectopic mandibular lateral incisor, use of light forces and interphase patient follow-up. These determined the best time to start the second treatment phase, enabling achievement of aesthetic and functional outcomes, and the results remained stable one year after the end of orthodontic treatment.

Perspectives of Indonesian Orthodontists on the Ideal Orthodontic Treatment Time.

ObjectiveThe aim of this study was to explore the types of orthodontic treatment provided by Indonesian orthodontists and to analyse their perspectives on the ideal time to initiate orthodontic treatment.Materials and MethodsA cross‑sectional survey was conducted using the Google Drive questionnaire template. This electronic questionnaire was sent to a sample of orthodontists across different regions of Indonesia. The participants were asked to report the stage at which they would start orthodontic treatment, as well as answer questions about occlusal abnormalities and functional problems. Descriptive statistics for all variables were determined, including both practice characteristics and orthodontic treatment timing.ResultsA total of 152 orthodontists agreed to participate in the study, of which 64.5% were female and 35.5% were male. Indonesian orthodontists prefer two-phase orthodontic treatment. Sucking habits and open bite were found to be the most frequent indications for treatment in the primary dentition. Anterior crossbite was found to be the most frequent indication for treatment during the early mixed dentition stage. Severe Class II was found to be the most frequent indication for treatment during the late mixed dentition stage. Indonesian orthodontists are more concerned about impacted canines and midline diastema than other occlusal deviations in the permanent dentition.ConclusionBased on the results of this study, we can conclude that Indonesian orthodontists favor two-phase orthodontic treatment. They also prefer to treat sucking habits and open bite in the primary dentition, anterior crossbite in the early mixed dentition, and severe Class II during the late mixed dentition stage.

Predisposing factors for external apical root resorption associated with orthodontic treatment.

ObjectiveThis study aimed to identify possible risk factors for external apical root resorption (EARR) in the maxillary incisors after orthodontic treatment.MethodsThe root length of 2,173 maxillary incisors was measured on periapical radiographs of 564 patients who received orthodontic treatment. The Kappa test was performed to evaluate intraexaminer and interexaminer reproducibility. Multiple binary logistic regression was used to determine the association between EARR and various factors. Odds ratios and 95% confidence intervals were reported.ResultsThe risk of developing EARR was 70% higher in orthodontic treatment with maxillary premolar extraction (p = 0.004), 58% higher in patients with increased overjet (p = 0.012), 41% lower in two-phase orthodontic treatment (p = 0.037), and 33% lower in patients with deep bite (p = 0.039). The lateral incisors were 54% more likely to develop EARR (p < 0.001), dilacerated roots were 2.26 times more likely to develop EARR (p < 0.001), and for each additional millimeter of root length, the risk of EARR increased by 29% (p < 0.001).ConclusionsThe potential risk factors for EARR after orthodontic treatment included treatment with maxillary premolar extraction, increased overjet at the beginning of treatment, and dilacerated roots.

Two-phase orthodontic treatment in a unilateral cleft lip and palate patient with 1-year follow-up results

Treatment of a patient with cleft lip and palate can be challenging. A 10-year and 10-month-old girl presented with uneven and crowded teeth. She had unilateral cleft lip and palate on left side for which she had undergone primary lip repair and palatoplasty when she was younger. On examination, she had concave facial appearance, crossbite of upper arch with reverse overjet of 2 mm, wits appraisal of 6 mm and impacted 23. She was treated with two-phase orthodontic treatment; growth modification appliances followed by fixed mechanotherapy. Total treatment time was 5 years. 1-year follow-up shows that results have been stable with good facial aesthetics and functional occlusion.

One-phase or two-phase orthodontic treatment?

Data sourcesMedline, Embase, Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, BBO, ClinicalTrials.gov, the National Research Register and Pro-Quest Dissertation Abstracts and Thesis database.Study selectionRandomised controlled trials (RCTs) and controlled trials (CCTs) in children under 11 years at the beginning of treatment for interventions including; interceptive extractions, space maintenance, crossbite correction and habit dissuasion were considered.Data extraction and synthesisTwo reviewers independently extracted data and assessed study quality using the Cochrane Risk of Bias tool. Meta-analysis was possible for 11 comparisons.ResultsTwenty-two studies (18 RCTs, three CCTs) were included with 20 being considered to be at low or unclear risk of bias. For Class II correction in the short-term, meta-analyses demonstrated a statistically significant reduction in ANB (-1.4 degrees, 95 CI: -2.17, -0.64) and overjet (-5.81mm, 95 CI: -6.37, -5.25) with both functional appliances and headgear versus control. For Class II correction in the long-term, however, statistical significance was not found for the same outcomes. Treatment duration was prolonged with both functional appliances (6.85 months, 95 CI: 3.24, 10.45) and headgear (12.47 months, 95 CI: 8.67, 16.26) compared to adolescent treatments. Meta-analyses were not possible for comparisons of other interceptive treatments due to heterogeneity and methodological limitations. The overall quality of the evidence based on the GRADE assessment suggested that the level of evidence was low to moderate.ConclusionsThe results suggest a lack of evidence to prove that early treatment carries additional benefit over and above that achieved with treatment commencing later; however, this does not imply that early treatment is ineffective. The additional cost and burden to the patient, parent and clinician may, therefore, generally negate early treatment. Further trials of high quality of evidence are required assessing the effectiveness of interceptive treatment for a range of occlusal problems, particularly those not known to hinge on growth potential, with long-term follow up to ascertain whether short-term effects are maintained once growth has ceased and to delineate the effects of intervention timing on the overall treatment duration.

Dental and skeletal changes in mild to moderate Class II malocclusions treated by either a Twin-block or Xbow appliance followed by full fixed orthodontic treatment.

To compare the short-term skeletal and dental effects of two-phase orthodontic treatment including either a Twin-block or an XBow appliance. This was a retrospective clinical trial of 50 consecutive Class II cases treated in a private practice with either a Twin-block (25) or XBow (25) appliance followed by full fixed orthodontic treatment. To factor out growth, an untreated Class II control group (25) was considered. A MANOVA of treatment/observation changes followed by univariate pairwise comparisons showed that the maxilla moved forward less in the treatment groups than in the control group. As for mandibular changes, the corpus length increase was larger in the Twin-block group by 3.9mm. Dentally, mesial movement of mandibular molars was greater in both treatment groups. Although no distalization of maxillary molars was found in either treatment group, restriction of mesial movement of these teeth was seen in both treatment groups. Both treatment groups demonstrated increased mandibular incisor proclination with larger increases for the XBow group by 3.3°. The Wits value was decreased by 1.6mm more in the Twin-block group. No sex-related differences were observed. Class II correction using an XBow or Twin-block followed by fixed appliances occurs through a relatively similar combination of dental and skeletal effects. An increase in mandibular incisor inclination for the XBow group and an increased corpus length for the Twin-block group were notable exceptions. No overall treatment length differences were seen.

Two-phase orthodontic treatment of a complex malocclusion: Giving up efficiency in favor of effectiveness, quality of life, and functional rehabilitation?

The interceptive orthodontic treatment of patients with complex dentofacial abnormalities is frequently inefficient and produces less than ideal outcomes. Therefore, postponing therapy to a single-phase surgical-orthodontic approach might be considered a reasonable option. However, other relevant aspects of the patient's quality of life, such as possible psychosocial problems and functional impairments, should also be considered before deciding whether to intercept a severe dentofacial malocclusion while the patient is still growing, or wait and treat later. This case report describes the nonsurgical treatment of a young patient with a severe Class III open-bite malocclusion associated with a cervical cystic lymphangioma. Despite the poor interceptive therapy prognosis, a 2-phase approach was effective. A reflection about giving up efficiency in favor of effectiveness, functional rehabilitation, and the patient's quality of life is included.

Outcomes of two-phase orthodontic treatment of deepbite malocclusions

The objective of this prospective controlled study was to assess the outcomes of two-phase treatment of deepbite patients revaluated at the end of circumpubertal growth, 1 year after the end of a phase-2 treatment. A sample of 58 subjects with deepbite (mean age 9.7 years, overbite greater than 4.5 mm) was treated consecutively with a two-phase protocol. Lateral cephalograms were taken before treatment (T1), at the completion of phase 1 (T2), and 1 year after the completion of phase 2 with fixed appliances (T3, mean age 15.8 years). The T1-T2, T2-T3, and T1-T3 changes were compared with those of the 29 subjects (mean age at T1 = 9.1 years) with untreated deepbite (t-tests for independent samples). Prevalence rates for improved overbite during the T1-T3 interval and for corrected overbite at T3 were contrasted in the treated vs untreated groups (z tests on proportions). Overbite was reduced by 1.9 mm in the treated group as a result of overall treatment; this group also displayed a significant reduction in the interincisal angulation (-6.6°) due to a significant proclination of upper incisors (4.1°) and a significant increase in the projection of the lower incisors (2.0 mm). The average amount of deepbite correction 1 year into retention was modest, and it was mainly due to a significant proclination of the incisors. The prevalence rate of subjects with a corrected overbite in the treated sample at T3 (74%) was not significantly different from that of the untreated sample (52%).

Malocclusioni di Classe II prima divisione: considerazioni sulla scelta di eseguire una o due fasi di trattamento

Objectives To determine the appropriate timing for treatment of Class II Division 1 malocclusion. Materials and methods We conducted a review of the literature to analyze the controversy surrounding the use single-phase versus two-phase orthodontic treatment for this type of malocclusion. Results The evidence shows that early orthodontic treatment is effective in specific clinical situations, but in many other cases, later single-phase treatment is more appropriate. Conclusions The practicing orthodontist should tailor treatment timing to the specific clinical situation.

Movement of a maxillary central incisor across the midline

This report describes the two-phase orthodontic treatment of a 7-year-, 6-month-old girl who presented with bilateral gemination of the central incisors. The left side demonstrated a complete gemination, resulting in two separate teeth (#9 and #9a). On the right side the gemination was incomplete, resulting in a large tooth mass (#8) that was 11.5 mm wide with a large pulp chamber and two apices. The tooth mass was extracted and the left central incisor (#9) was successfully moved across the midline (through the midpalatal suture area). The supernumerary incisor (#9a) was then used in the upper left central incisor area.

Future practice plans of orthodontic residents in the United States

The purpose of this study was to investigate the future clinical practice plans of orthodontic residents in the United States. All program chairs and directors of the 65 US orthodontic residency programs were contacted by e-mail and telephone and asked for permission to e-mail their residents and invite them to take part in an anonymous 57-item questionnaire online. A total of 335 e-mails from 37 programs were obtained, and the survey was sent in May 2007. Basic statistics including chi-square comparative analyses were performed by sex, age, and year of program. A total of 63.04% of orthodontic residents plan to use self-ligating brackets; 84.06% plan to use Invisalign (Align Technology, Santa Clara, Calif); 92.03% plan to use temporary anchorage devices, and 72.26% plan on placing them themselves; 28.26% plan to use cone-beam computerized tomography; 92.75% plan to use a digital imaging program; 45.65% plan to use indirect bonding; and 10.87% plan to use lingual orthodontics. A total of 70.07% plan to use 2-phase treatment, and 61.59% said they will use functional appliances. A total of 81.16% plan to become certified by the American Board of Orthodontics, but only 18.12% thought certification should be mandatory for licensure; 36.50% indicated that a master of science degree should be required in their program, and 77.94% believe that a 24- to 30-month program adequately prepares them for future orthodontic practice. Newer orthodontic technologies such as self-ligating brackets, temporary anchorage devices, and Invisalign as well as functional appliances are expected to grow in popularity in the United States because of projected future use by orthodontic residents. Two-phase orthodontic treatment with functional appliance mechanics will continue to be used. Most orthodontic residents will become certified by the American Board of Orthodontics but do not believe it should be necessary for licensure. Orthodontic residents in the United States believe that a 2-year program adequately prepares them for private practice.

Correcção de uma Má-Oclusão de Classe Ii Divisão 1 em Duas Fases de Tratamento

The influence of functional appliances on craniofacial growth as well as the two-phase orthodontic treatment philosophy are still controversial subjects. The main purpose of the two-phase treatment involving activators is to promote dento-alveolar changes. The goal of the second phase is creating an occlusion according to functional occlusion patterns. The aim of this article is to present the sequence of a Class II Division 1 treatment case in two phases, in which a Teuscher activator appliance is used in the first phase.

One- or two-phase orthodontic treatment for Class II malocclusion does not change the occlusal outcome

Original Article King GJ, McGorray SP, Wheeler TT, Dolce C, Taylor M. Comparison of peer assessment ratings (PAR) from 1-phase and 2-phase treatment protocols for Class II malocclusions. Am J Orthod Dentofacial Orthop 2003;123(5):489–96. Level of Evidence 4 Purpose To compare the outcome of 1-phase with 2-phase orthodontic treatment in Children with Class II malocclusion. Does the occlusal outcome differ if a Class II malocclusion is treated early in a 2-phase treatment approach compared with treating later in 1 phase? Source of Funding NIH/NIDCR #DE8715 Type of Study/Design Randomized controlled trial

An evaluation of two-phase treatment with the herbst appliance and preadjusted edgewise therapy

The purpose of this study was to evaluate the skeletal and dentoalveolarchanges occurring during two-phase orthodontic treatment. A cephalometric study of Class II correction was carried out in 40 subjects (20 females, 20 males) who had been treated with the acrylic-splint Herbst appliance immediately followed by a second phase of preadjusted edgewise therapy. The average age at the start of Herbst therapy was 12.5 ± 0.8 years for females and 13.6 ±1.2 years for males. Descriptive cephalometric data were compared with the normative values derived from the University of Michigan Elementary and Secondary School Growth Study. Control values were generated for each of the 40 Herbst patients based on gender, initial age, and duration of treatment. The results of this study indicate that the Class II correction achieved during Phase I treatment with Herbst appliance was due mainly to an increase in mandibular length, as well as distal movement of the maxillary molars and mesial movement of the mandibular molars and incisors. The accelerated mandibular growth rate observed during Herbst therapy was followed by a diminished growth rate during the edgewise phase that was less than control values. The overall increase in mandibular length was slight ≈1 mm), but significantly greater than control data for the whole group and the male subgroup; however, it was not significantly different between the treatment group and control data in the female subgroup. There were no significant treatment effects on lower anterior facial height and the mandibular plane angle at the end of either phase of treatment. The skeletal changes contributed to 55% of the molar correction during the Herbst therapy, whereas at the end of the second phase of treatment, skeletal change accounted for 80%. Significant anteroposterior dentoalveolar rebound was seen during the edgewise phase.