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Patient treated with cantilever Herbst appliance. T1 ¼ before treatment; T2 ¼ immediately after Herbst appliance placement; T3 ¼ at the end of fixed appliance treatment (age 15); T4 ¼ 5 years after treatment (age 20).
Source publication
Background
Class II functional appliances have been used in orthodontics for over 100 years. Although the stability of corrections is one of the main goals of orthodontic treatment, there is a paucity of longitudinal studies on the long-term stability of treatment of Class II malocclusion based on functional appliances.
Methods
This narrative revi...
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Objective
To propose a method to develop 3-dimensional (3D) models of regular and orthodontic typodonts using their 2-dimensional (2D) images, as an alternate method to 3D scanners.
Materials and methods
The mandibles of two typodonts; regular occlusion and malocclusion were scanned using a 3D scanner to generate their models. Captured scans were...
Citations
... The occlusal results proved to be stable in the long term, and the changes that occurred are associated with physiological aging processes and not with relapse. Relapses in the molar relationship and overjet can be explained by the combination of tooth movement and an unfavorable post-treatment maxillomandibular growth pattern, especially when combined with failure to intercuspidate the posterior teeth (Moro et al., 2020) Another study evaluated the stability of Class II treatment with headgear followed by edgewise mechanotherapy after 5.75 years of treatment. Sample was divided into an experimental group treated as explained, and two control groups: one with untreated Class II malocclusion, and the other with normal occlusion individuals. ...
Objective: class II malocclusion is one of the most frequent problems in orthodontics and is characterized by maxillary prognathism, mandibular retrognathism, or both. The aim of this study is to report the case of a patient with Angle Class I and Skeletal Class II malocclusion in the growth phase treated in two phases with AEB and orthodontic mini-implant. Case report: female patient, 9 years old, reported an accentuated projection of the anterior teeth. She had the habit of interposing the lower lip, dolichofacial pattern, Angle Class I molars, and great projection of the upper incisors. In the first phase was used AEB, and in the second phase an interradicular mini screw with sliding jig to finalize Class II correction on the left side. Conclusion: it’s evident the benefits of first orthopedic/functional phase in overbite correction and success of the proposed treatment through the stability after 4 years of case management.
... Functional appliances reduce excessive overjet in Class II malocclusion through dentoalveolar effects, modification of the soft tissue and mandibular advancement, relying on the patient's growth peak [6]. According to a recent review by Moro et al., the skeletal correction of the Class II malocclusion obtained with functional appliances seems to be stable in a long-term observation [7]. ...
The aim of the current study was to evaluate the changes in body posture in pubertal subjects characterized by Skeletal Class II with mandibular retrusion pre- and post-Fränkel II (FR-2). The treatment of Skeletal Class II with functional therapy has been already correlated with changes in cervical posture, but no previous studies investigated the possible relation with the posture of the whole body. This is an observational longitudinal study conducted on 17 Caucasian subjects (6 males, 11 female) with average age 10.7 ± 3.5. Posturostabilometric evaluation was performed before the beginning of the orthodontic treatment (t0), after 12 ± 2 months (t1) and after 24 ± 3 months at the end of the treatment with FR-2 (t2). The following stabilometric parameters were extracted: weight distribution (WD), bar torsion angle (BTA), and barycenter (Xmm). Both WD (p = 0.0154) and BTA (p = 0.0003) showed a significant improvement during the treatment with Friedman test and ANOVA test, respectively, showing how the overall balance and weight distribution of the body can benefit from a functional therapy with jaw advancement. The posturostabilometric platform can be considered a functional indicator of therapy effectiveness because it shows the improving trend of the parameters. Future research is needed, based on the promising results obtained in the current study.
... All anatomical landmarks near CS6 remained stable, with no significant variations over time or differences between the two groups. Again, long term stability skeletal corrections achieved with functional appliances was recently confirmed, with no specific intermaxillary retention approach needed [24]. This information is clinically very important, and confirms the high stability of orthopaedic changes brought by functional treatment implemented during the pubertal growth spurt. ...
Objective: The purpose of this retrospective preliminary study was to analyze the skeletal and dentoalveolar effects of a new clear functional appliance in a sample of patients close to growth spurt with class II malocclusion attributable to mandibular retrusion. Materials and methods: A sample of growing patients underwent functional Class II correction using F22® (Sweden and Martina, Due Carrare (PD), Italy) Young, realized combining the aesthetic characteristics of the F22® clear aligner with the structural features of a functional appliance. For each patient, a digital setup was performed by a single operator to plan a mandibular advancement to the therapeutic position. Cephalometric analysis before and after treatment was performed. The purpose of the statistical analysis was to evaluate dental and skeletal changes associated with F22® Young device, and whether there were statistically significant differences in anatomical measurements between the beginning and end of treatment. Results: 15 patients, 7 females and 8 males of average age 10.3, were treated with the F22® Young appliance for an average period of 10 months ± 0.5 (maximum 11.5 months, minimum 10.5 months). The data showed that the SNB angle increase was statistically significant from T0 to T1, leading to a reduction in the ANB angle. Values for the mandible length, both total (Co-Gn) and at the base (Go-Pg), significantly increased. Conclusions: According to this preliminary study, F22® Young appliance is effective in promoting mandibular advancement when used near the pubertal growth peak. The device is comfortable and aesthetic, which certainly promoted patient compliance, a key factor for treatment success.
... Functional therapy with various orthodontic appliances is usually the first choice of treatment in cases of mandibular retrognathism [11], [12]. The main goal of Class II malocclusion functional appliance treatment is to utilize the forces exerted by the muscles of mastication, tongue, cheeks, and lips to induce neuromuscular changes and can affect masticatory muscle activity and stimulate mandibular growth [3], [6]. ...
Background: Class II malocclusion is a common condition. The most common clinical presentation is a mandibular deficiency. Treatment with functional devices is an option that can be used for the treatment of malocclusion. In an era of evolving treatments, Bionator is still widely used in clinical practice. Objective: The purpose of this systematic review was to analyze the effectiveness of the treatment of class II malocclusion with the Bionator device in the growth and development phase. Methods: Data collection was carried out by searching literature on article search sites, namely Pubmed, Cochrane, Wiley, Google Scholar and Science Direct which were published from 2011 to 2021. The search was carried out from March to April 2021. Data search was carried out systematically using the bionator keyword. malocclusion class II, orofacial muscles, growth and development. Results: After eliminating published articles, the title and abstract of each article in the analysis amounted to 132 articles, 106 articles were excluded. The full text articles from the exclusion results were re-analyzed and 16 articles were excluded. The text of the article is complete and meets the eligibility of as many as 10 articles. Conclusion: From all the studies reviewed, the Bionator device can improve class II malocclusion in children.
... Furthermore, the longstanding expectation of surgery during childhood and adolescence will worsen patients' physical, social, and psychological health. In order to avoid surgical operations and the consequences associated with such treatments, a large amount of effort has been dedicated to developing growth modification appliances for skeletal class II and III malocclusion correction, especially those that can be delivered around the puberty stage to achieve the normal dentition without surgery [18][19][20][21]. Unfortunately, despite the tremendous efforts that have been devoted to developing a diversity of treatment technologies [11,[18][19][20][21][22][23][24][25], dental care providers are not yet able to predict whether an orthodontic functional appliance will successfully correct a patient's skeletal discrepancy or if that patient will not respond to early orthopedic correction and require surgery to properly rectify their malocclusion later. ...
... In order to avoid surgical operations and the consequences associated with such treatments, a large amount of effort has been dedicated to developing growth modification appliances for skeletal class II and III malocclusion correction, especially those that can be delivered around the puberty stage to achieve the normal dentition without surgery [18][19][20][21]. Unfortunately, despite the tremendous efforts that have been devoted to developing a diversity of treatment technologies [11,[18][19][20][21][22][23][24][25], dental care providers are not yet able to predict whether an orthodontic functional appliance will successfully correct a patient's skeletal discrepancy or if that patient will not respond to early orthopedic correction and require surgery to properly rectify their malocclusion later. In other words, people's expected development of skeletal malocclusion and their clinical correction prognoses are currently difficult to predict, which can be largely attributed to the present lack of knowledge of the precise etiology of skeletal class II and III malocclusions. ...
Skeletal class II and III malocclusions are craniofacial disorders that negatively impact people’s quality of life worldwide. Unfortunately, the growth patterns of skeletal malocclusions and their clinical correction prognoses are difficult to predict largely due to lack of knowledge of their precise etiology. Inspired by the strong inheritance pattern of a specific type of skeletal malocclusion, previous genome-wide association studies (GWAS) were reanalyzed, resulting in the identification of 19 skeletal class II malocclusion-associated and 53 skeletal class III malocclusion-associated genes. Functional enrichment of these genes created a signal pathway atlas in which most of the genes were associated with bone and cartilage growth and development, as expected, while some were characterized by functions related to skeletal muscle maturation and construction. Interestingly, several genes and enriched pathways are involved in both skeletal class II and III malocclusions, indicating the key regulatory effects of these genes and pathways in craniofacial development. There is no doubt that further investigation is necessary to validate these recognized genes’ and pathways’ specific function(s) related to maxillary and mandibular development. In summary, this systematic review provides initial insight on developing novel gene-based treatment strategies for skeletal malocclusions and paves the path for precision medicine where dental care providers can make an accurate prediction of the craniofacial growth of an individual patient based on his/her genetic profile.
... Based on the newly combined data from 37 studies enrolling around 11,000 subjects, the prevalence of Class II malocclusion is estimated to be 9.91% (95% CI: 7.41%-13.79%) in Chinese school children, calling for proactive and effective interventions [1]. Indeed, several types of functional appliances that aim for the correction of class II division 1 malocclusion in actively growing patients have been applied for decades, including Twin Block, activator, herbst, bionator, etc [2]. Yet, the nature of the treatment effect induced by functional appliances is still controversial. ...
Background
Despite the widespread use of functional appliances, broad variations are reported on the treatment response. This retrospective study aims to investigate the pre-treatment cephalometric predictors on the treatment outcome of Twin block in growing patients with class II malocclusion
Methods
After screening, a total of 90 patients treated by Twin block were included in the study. The treatment outcome was the advancement of the chin position, assessed by the distance of skeletal pogonion to the vertical reference plane perpendicular to Frankfurt plane (△Pog-VRP). Moreover, △Pog-VRP is adjusted by facial growth evaluated by △N-Ba to minimize the growth discrepancy among individuals (adj△Pog-VRP). The pre-treatment cephalometric measurements were compared with independent t-test. Stepwise multivariate regression analysis was performed to determine the pre-treatment cephalometric predictors for the treatment outcome.
Results
Patients were equally divided into good response group (GRG/adjGRG, N = 45) and poor response group (PRG/adjPRG, N = 45) respectively based on the median value of △Pog-VRP/adj△Pog-VRP. Patients with greater chin advancement had a significantly reduced cephalometric measurements in the vertical dimensions including ∠Na-Go-Me, ∠MP-OP and sum of angels (P < 0.05). And such differences increased after adjustments in comparison between adjGRG and adjPRG. Importantly, ∠Na-Go-Me was found to be independent predicter on Pog advancement before (β=-0.26, 95%CI, -0.06 to -0.01, P = 0.01) and after adjustments (β=-0.29,95%CI -0.06, -0.01, P < 0.01).
Conclusion
With the limitation of the study, we provide evidence that patients with a smaller Na-Go-Me angle are more likely to experience a greater chin advancement following Twin block treatment.
... O aparelho de Herbst é, provavelmente, o aparelho funcional que mais foi investigado até hoje. Seus efeitos dentoesqueléticos no tratamento da má oclusão de Classe II estão bem descritos na literatura 4,[11][12][13] . ...
Background:
Herbst therapy is an effective treatment for Class II malocclusions. However, the maintenance of the effects after fixed appliances treatment remains questionable. This retrospective study aimed to assess, using digital dental models, the sagittal and transverse dental arch changes in young patients during two Class II Division 1 treatment phases, first with modified Herbst appliance (HA) and then with fixed appliances.
Methods:
The treated group (TG) comprised 32 patients (17 boys, 15 girls; mean age, 12.85 ± 1.16 years) treated with HA and fixed appliances. The control group comprised 28 patients (13 boys, 15 girls; mean age, 12.21 ± 1.35 years) with untreated Class II malocclusions. Digital models were obtained immediately before and after HA therapy and after fixed appliances. Data were statistically analyzed.
Results:
Compared with the control group, the TG showed an increase in maxillary and mandibular arch perimeters and in intercanine and intermolar arch widths, a decrease in overjet and overbite, and an improvement in canine and molar relationships. In the time after HA therapy until the end of fixed appliances treatment, the TG showed a decrease in maxillary and mandibular arch perimeters, overjet, upper and lower intermolar widths; an increase in molar Class II relationship; and no changes in canine relationship, overbite, and upper and lower intercanine widths.
Conclusions:
In this sample of patients treated with HA, on average, there was an improvement in the Class II relationship, which seemed to remain after fixed appliances. The transverse dental changes achieved in HA phase relapsed after treatment with fixed appliances.
Class II Division 2 malocclusion is characterized by the distal position of the mandibular arch, retroclination of the maxillary incisors and a deep overbite. The clinical management of growing patient with Class II Division 2 malocclusion is challenging in diagnosis, treatment and retention. This case report describes the orthodontic and orthopedic treatment of an adolescent Class II Division 2 with mandibular retrognathism and excessive overbite using Invisalign aligners with mandibular advancement precision wing features. The treatment results demonstrated that growth modification was achieved with minimal dental compensation and reduced treatment duration.
