Cephalometric facial soft tissue changes with the twin block appliance in Class II division 1 malocclusion patients. A systematic review

Craniofacial and Oral Health Evidence-based Practice Group, Faculty of Medicine and Dentistry, University of Alberta, Canada.
The Angle Orthodontist (Impact Factor: 1.23). 10/2006; 76(5):876-81. DOI: 10.1043/0003-3219(2006)076[0876:CFSTCW]2.0.CO;2
Source: PubMed


To evaluate facial soft tissue changes after the use of the twin block appliance in Class II division 1 malocclusion patients.
Several electronic databases (PubMed, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cochrane databases, EMBASE, Web of Science, and LILACS) were searched with the help of a senior health-sciences librarian. Abstracts that appeared to fulfill the initial selection criteria were selected by consensus, and the original articles were retrieved. The article references were hand-searched for possible missing articles. Clinical trials that assessed facial soft tissue changes with the use of the twin block appliance without any surgical intervention or syndromic characteristics were considered. A comparable untreated control group was required to factor out normal growth changes.
Two articles fulfilled the selection criteria and quantified facial soft tissue changes. Although some statistically significant changes in the soft tissue profile were found, the magnitude of the changes may not be perceived as clinically significant. Changes produced in the upper lip seem to be controversial, although the study with sounder methodological quality did not report significant changes. No change in the anteroposterior position of the lower lip and the soft tissue menton or improvement of the facial convexity was found.
Three-dimensional quantification of the soft tissue changes is required to overcome current limitations in our understanding of the soft tissue changes obtained after the use of the twin block appliance in Class II division 1 malocclusion patients.

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    ABSTRACT: Das Ziel dieser Untersuchung war es, retrospektiv die Effizienz und das Resultat zweier unterschiedlicher Behandlungsmethoden zur Korrektur einer Klasse II/1 Verzahnung zu vergleichen. Die erste Methode erforderte die Extraktion beider ersten oberen Molaren. Die Distalverzahnung wurde anschließend mittels festsitzender Apparatur (Begg-Technik) und intra- sowie intermaxillären Gummizügen in eine Neutralverzahnung überführt. Die zweite Methode verzichtet auf Extraktionen und korrigiert die Distalverzahnung mit einem festsitzenden funktionskieferorthopädischen Gerät (Herbst-Scharnier) und anschließender festsitzender Apparatur. Hierzu wurden Fernröntgenseitbilder (FRS) von 79 Klasse II/1 Extraktions-Patienten und von 75 Klasse II/1 Patienten Herbst-Patienten ausgewertet. In beiden Gruppen lagen FRS von vor (T1) und nach (T2) der Behandlung vor. Die FRS wurden mittels einer Standard-Analyse und der SO-Analyse ausgewertet. Mit beiden Behandlungsmethoden konnte eine erfolgreiche Korrektur einer Klasse II/1 Malokklusion durchgeführt werden, wobei bei einer Extraktions-Behandlung eher dentale und maxilläre Effekte zu erwarten sind, während bei der Herbst-Behandlung eher skelettale und mandibuläre Effekte überwiegen. The purpose of this study was to compare retrospectively the efficiency and result of two contrasting forms of treatment for a class II division I malocclusion. The first group comprising extractions of the upper, first molars and correction of the malocclusion with space closure in the upper arch by means of class I and class II mechanics applied to a Begg-appliance. The second group was treated non-extraction by means of a bonded Herbst-appliance followed by a fixed appliance phase. Lateral cephalograms of 79 class II division I extraction patients and 75 class II division I Herbst patients were traced. For both groups pre-treatment (T1) and post-treatment (T2) cephalograms and records were available. They were analysed using a standard analysis and the SO-analysis according to Pancherz. In conclusion it can be said, that both treatment methods were successful and lead to a correction of the class II division I malocclusion. Whereas in case of extraction treatment more dental and maxillary effects can be expected, in case of Herbst treatment skeletal and mandibulary effects prevail.

  • American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 07/2006; 129(6):716-7; author reply 717. DOI:10.1016/j.ajodo.2006.04.003 · 1.38 Impact Factor
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