The korean journal of orthodontics (대한치과교정학회지)

The Korean Association Of Orthodontists (대한치과교정학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of growth changes induced by functional appliances in children with Class II malocclusion: Superimposition of lateral cephalograms on stable structures

  • Oh, Eunhye (Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen) ;
  • Ahn, Sug-Joon (Department of Orthodontics, School of Dentistry, Seoul National University) ;
  • Sonnesen, Liselotte (Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen)
  • Received : 2019.09.03
  • Accepted : 2019.12.13
  • Published : 2020.05.25
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: To compare short- and long-term dentoalveolar, skeletal, and rotational changes evaluated by Björk's structural method of superimposition between children with Class II malocclusion treated by functional appliances and untreated matched controls. Methods: Seventy-nine prepubertal or pubertal children (mean age, 11.57 ± 1.40 years) with Class II malocclusion were included. Thirty-four children were treated using an activator with a high-pull headgear (Z-activator), while 28 were treated using an activator without a headgear (E-activator). Seventeen untreated children were included as controls. Lateral cephalograms were obtained before treatment (T1), after functional appliance treatment (T2), and after retention in the postpubertal phase (T3). Changes from T1 to T2 and T1 to T3 were compared between the treated groups and control group using multiple linear regression analysis. Results: Relative to the findings in the control group at T2, the sagittal jaw relationship (subspinale-nasion-pogonion, p < 0.001), maxillary prognathism (sella-nasion-subspinale, p < 0.05), and condylar growth (p < 0.001) exhibited significant improvements in the Z- and E-activator groups, which also showed a significantly increased maxillary incisor retraction (p < 0.001) and decreased overjet (p < 0.001). Only the E-activator group exhibited significant backward rotation of the maxilla at T2 (p < 0.01). The improvements in the sagittal jaw relationship (p < 0.01) and dental relationship (p < 0.001) remained significant at T3. Condylar growth and jaw rotations were not significant at T3. Conclusions: Functional appliance treatment in children with Class II malocclusion can significantly improve the sagittal jaw relationship and dental relationships in the long term.

Keywords

References

  1. Cozza P, Baccetti T, Franchi L, De Toffol L, Mc-Namara JA Jr. Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review. Am J Orthod Dentofacial Orthop 2006;129:599.e1-12; discussion e1-6. https://doi.org/10.1016/j.ajodo.2005.11.010
  2. Zelderloo A, Cadenas de Llano-Perula M, Verdonck A, Fieuws S, Willems G. Cephalometric appraisal of Class II treatment effects after functional and fixed appliances: a retrospective study. Eur J Orthod 2017;39:334-41.
  3. Batista KB, Thiruvenkatachari B, Harrison JE, O'Brien KD. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents. Cochrane Database Syst Rev 2018;3:CD003452.
  4. Tulloch JF, Proffit WR, Phillips C. Outcomes in a 2-phase randomized clinical trial of early Class II treatment. Am J Orthod Dentofacial Orthop 2004;125:657-67. https://doi.org/10.1016/j.ajodo.2004.02.008
  5. Cross JJ. Facial growth: before, during, and following orthodontic treatment. Am J Orthod 1977;71:68-78. https://doi.org/10.1016/0002-9416(77)90177-4
  6. Arat ZM, Turkkahraman H, English JD, Gallerano RL, Boley JC. Longitudinal growth changes of the cranial base from puberty to adulthood. A comparison of different superimposition methods. Angle Orthod 2010;80:537-44.
  7. Bjork A. Prediction of mandibular growth rotation. Am J Orthod 1969;55:585-99. https://doi.org/10.1016/0002-9416(69)90036-0
  8. Bjork A, Skieller V. Facial development and tooth eruption. An implant study at the age of puberty. Am J Orthod 1972;62:339-83. https://doi.org/10.1016/S0002-9416(72)90277-1
  9. Bjork A, Skieller V. Normal and abnormal growth of the mandible. A synthesis of longitudinal cephalometric implant studies over a period of 25 years. Eur J Orthod 1983;5:1-46. https://doi.org/10.1093/ejo/5.1.1
  10. Teuscher U. A growth-related concept for skeletal class II treatment. Am J Orthod 1978;74:258-75. https://doi.org/10.1016/0002-9416(78)90202-6
  11. Andresen V. The Norwegian system of functional gnatho-orthopedics. Acta Gnathol 1936;1:5-36.
  12. Baccetti T, Franchi L, McNamara Jr JA. The cervical vertebral maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedics. Semin Orthod 2005;11:119-29. https://doi.org/10.1053/j.sodo.2005.04.005
  13. Siersbæk-Nielsen S, Solow B. Intra- and interexaminer variability in head posture recorded by dental auxiliaries. Am J Orthod 1982;82:50-7. https://doi.org/10.1016/0002-9416(82)90546-2
  14. Solow B, Tallgren A. Head posture and craniofacial morphology. Am J Phys Anthropol 1976;44:417-35. https://doi.org/10.1002/ajpa.1330440306
  15. Sandham A. Cervical vertebral anomalies in cleft lip and palate. Cleft Palate J 1986;23:206-14.
  16. Huggare J. Association between morphology of the first cervical vertebra, head posture, and craniofacial structures. Eur J Orthod 1991;13:435-40. https://doi.org/10.1093/ejo/13.6.435
  17. Oh E, Ahn SJ, Sonnesen L. Ethnic differences in craniofacial and upper spine morphology in children with skeletal Class II malocclusion. Angle Orthod 2018;88:283-91. https://doi.org/10.2319/083017-584.1
  18. Sonnesen L, Kjaer I. Cervical vertebral body fusions in patients with skeletal deep bite. Eur J Orthod 2007;29:464-70. https://doi.org/10.1093/ejo/cjm043
  19. Dahlberg G. Statistical methods for medical and biological students. New York: Interscience; 1940. p. 122-32.
  20. Houston WJ. The analysis of errors in orthodontic measurements. Am J Orthod 1983;83:382-90. https://doi.org/10.1016/0002-9416(83)90322-6
  21. Papageorgiou SN, Koretsi V, Jager A. Bias from historical control groups used in orthodontic research: a meta-epidemiological study. Eur J Orthod 2017;39:98-105. https://doi.org/10.1093/ejo/cjw035
  22. Oh E, Ahn SJ, Sonnesen L. Ethnic differences in craniofacial and upper spine morphology between European and Asian children with skeletal Class III malocclusion. Am J Orthod Dentofacial Orthop 2019;156:502-11. https://doi.org/10.1016/j.ajodo.2018.10.024
  23. Arntsen T, Sonnesen L. Cervical vertebral column morphology related to craniofacial morphology and head posture in preorthodontic children with Class II malocclusion and horizontal maxillary overjet. Am J Orthod Dentofacial Orthop 2011;140:e1-7. https://doi.org/10.1016/j.ajodo.2010.10.021
  24. Sonnesen L, Kjaer I. Anomalies of the cervical vertebrae in patients with skeletal Class II malocclusion and horizontal maxillary overjet. Am J Orthod Dentofacial Orthop 2008;133:188.e15-20. https://doi.org/10.1016/j.ajodo.2007.07.018
  25. Melsen B. Time of closure of the spheno-occipital synchondrosis determined on dry skulls. A radiographic craniometric study. Acta Odontol Scand 1969;27:73-90. https://doi.org/10.3109/00016356909033580
  26. Solow B. The dentoalveolar compensatory mechanism: background and clinical implications. Br J Orthod 1980;7:145-61. https://doi.org/10.1179/bjo.7.3.145
  27. Petrovic AG, Stutzmann JJ. The concept of mandibular tissue-level growth potential and the responsiveness to a functional appliance. In: Graber LW, Graber TM, eds. Orthodontics, state of the art, essence of the science. St. Louis: Mosby Co; 1986. p. 59-74.
  28. Turkkahraman H, Sayin MO. Effects of activator and activator headgear treatment: comparison with untreated Class II subjects. Eur J Orthod 2016;28:27-34. https://doi.org/10.1093/ejo/cji062

Cited by

  1. Functional appliance treatment in children with morphologic deviations in the upper spine vol.160, pp.3, 2020, https://doi.org/10.1016/j.ajodo.2021.06.006
  2. Authors’ response vol.160, pp.3, 2020, https://doi.org/10.1016/j.ajodo.2021.06.007