Long-term skeletal and dental effects and treatment timing for functional appliances in Class II malocclusion

Abstract

Objective: To analyze the long-term skeletal and dentoalveolar effects and to evaluate treatment timing of Class II treatment with functional appliances followed by fixed appliances. Materials and Methods: A group of 40 patients (22 females and 18 males) with Class II malocclusion consecutively treated either with a Bionator or an Activator followed by fixed appliances was compared with a control group of 20 subjects (9 females and 11 males) with untreated Class II malocclusion. Lateral cephalograms were available at the start of treatment (mean age 10 years), end of treatment with functional appliances (mean age 12 years), and longterm observation (mean age 18.6 years). The treated sample also was divided into two groups according to skeletal maturity. The early-treatment group was composed of 20 subjects (12 females and 8 males) treated before puberty, while the late-treatment group included 20 subjects (10 females and 10 males) treated at puberty. Statistical comparisons were performed with analysis of variance followed by Tukey's post hoc tests. Results: Significant long-term mandibular changes (Co-Gn) in the treated group (3.6 mm over the controls) were associated with improvements in the skeletal sagittal intermaxillary relationship, overjet, and molar relationship (,3.0-3.5 mm). Treatment during the pubertal peak was able to produce significantly greater increases in total mandibular length (4.3 mm) and mandibular ramus height (3.1 mm) associated with a significant advancement of the bony chin (3.9 mm) when compared with treatment before puberty. Conclusion: Treatment of Class II malocclusion with functional appliances appears to be more effective at puberty. (Angle Orthod. 2013;83:334-340.)

Morphometric analysis of long-term dentoskeletal effects induced by treatment with Balters bionator

“…However, there are still controversies concerning the long-term effects of FJO on the maxilla and the mandible. [9][10][11][12][13] All of the conflicting findings could be due to discrepancies in age selection, skeletal maturity, matching with control groups, treatment duration, and great variability in the cephalometric variables adopted by the different investigators. Furthermore, conventional cephalometric analysis (CCA), despite being individualized, does not always prove effective in determining accurately the location and mode in which changes in shape and size occur within the craniofacial complex.…”

Re: response to: Long-term skeletal and dental effects and treatment timing for functional appliances in Class II malocclusion. The Angle Orthodontist 2013(2) 334-340

“…An important point, however, is to avoid treatment outcomes that would change the ratios in the wrong direction, as for example, treatment with interarch elastics that could rotate the mandible downward in a patient whose face already is too long for its width. 1 As for the long-term vertical skeletal effects produced by functional appliances, our study 2 found that treatment did not induce any significant increase in vertical skeletal relationships, as assessed either by the inclination of the palatal plane to Frankfort horizontal or with the inclination of the mandibular plane to the Frankfort horizontal and to the palatal plane. In the Discussion we reported that ''A significant increase in lower anterior facial height in the treated group was associated with a significant increase in the height of the mandibular ramus in the long term.…”

Craniofacial Contribution to Residual Obstructive Sleep Apnea after Adenotonsillectomy in Children: A Preliminary Study

“…Furthermore, Japanese adult OSA patients tend to have small mandible rather than maxillary constriction, both of which are considered as the pathogenesis of OSA. 31,32 Therefore, the use of orthodontic treatment to facilitate the growth of the mandible 33 may become a radical treatment option for residual OSA after, and even before, AT in these patients. One of the significant study limitations is patient recruitment.…”