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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).
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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
... Fixed appliances like Herbst and Forsus may offer advantages, including less reliance on patient compliance and increased robustness; however, they also present disadvantages such as greater bulk, reduced aesthetics, and challenges with oral hygiene [6,71]. Consequently, orthodontists should consider selecting a specific appliance for treatment based on patient-specific characteristics, as the overall effects appear to be mostly analogous across different appliances. ...
Recent developments in aligner materials have enabled them to be a feasible choice for children and adolescents. Aligners offer a treatment modality for Class II correction in growing patients claiming to address a mandibular deficiency. This study aimed to assess the effectiveness of functional aligners in skeletal Class II treatment through a systematic review and meta‐analysis of the existing literature. A comprehensive search was conducted in MEDLINE, Web of Science, EMBASE, Scopus and Cochrane's CENTRAL up to April 2024, with no language or date restrictions. Clinical studies that complied with the PICO question model were included, and the ROBINS‐I tool was used to assess their risk of bias. We extracted relevant data from the included studies using customised data forms and pooled the results via a random‐effects inverse variance meta‐analysis. Different treatment approaches for growth modification, including Twin‐Block, were compared to clear aligners. The primary outcomes measured were ANB, SNB and overjet. Additionally, secondary outcomes included SNA, wits appraisal, mandibular total length, ramal length, angle of convexity, overbite, molar relationship, vertical positions of incisors and molars, incisor angular shifts, interincisal angle, gonial angle, mandibular plane angle, lower anterior facial height, as well as soft tissue changes, such as the distance of the lips from the E‐line. In our analysis of 21 studies evaluating the treatment outcomes of functional aligners for growing skeletal Class II patients, we observed significant reductions ( p < 0.05) in ANB, Wits appraisal, angle of convexity, overbite, overjet, molar relationship, maxillary incisor angle. In addition, we found that SNB, mandibular incisor angle (IMPA), mandibular incisor horizontal position, mandibular molar vertical position, interincisal angle (L1‐U1), mandibular total length, mandibular base length, ramal length and lower anterior facial height all exhibited a significant increase ( p < 0.05). Thirteen of the included studies indicated no significant treatment difference between functional aligners and other functional appliances except for mandibular plane angle, lower incisor horizontal position, interincisal angle and ramal length. The findings show that aligners might be a viable option in addressing mild to moderate skeletal Class II malocclusions of growing patients. Compared to other functional appliances, there were no treatment differences in most parameters studied. Based on limited evidence, our results should be interpreted with caution and evaluated with further high‐quality studies with long‐term observation.
Trial Registration: PROSPERO (#CRD42023478039)
... 6 Whilst some evidence suggests that functional appliances can increase overall skeletal growth, 7-9 these effects have been shown to be minimal and likely of negligible clinical importance when natural growth is considered. [10][11][12][13][14] Ultimately, functional appliances treat Class II malocclusions by dento-alveolar and soft tissues changes that, in effect, camouflage the skeletal discrepancy. 15 Functional appliances have known characteristics. ...
Background
If detected at the appropriate age, a Class II malocclusion can be improved or camouflaged by utilising functional appliances to manipulate a child’s skeletal growth spurt to advantage.
Aim
The aim of this study was to evaluate the use of functional appliances by orthodontists currently practising in Australia.
Methods
This was a cross-sectional study design that utilised a nation-wide online survey consisting of 22 questions related to: clinic/clinician demographics, appliance preference and treatment timing, the provision of first phase functional appliance treatment and treatment protocols for removable functional appliance therapy. The survey was distributed via the Australian Society of Orthodontists to its 428 members. Statistical analysis was conducted through Qualtrics XM® data analysis software, version 04/30/2023 (Qualtrics XM®, Provo, UT, USA. https://www.qualtrics.com ) with a significance level set at P < 0.05.
Results
A total of 166 responses were received representing a response rate of 38.8%. Ninety-nine per cent of survey respondents ( n = 139) reported prescribing functional appliances to correct a Class II malocclusion with the Twin Block appliance as the most-commonly prescribed. It was found that a two phase, removable functional appliance followed by fixed appliances was the preferred choice for Class II treatment when utilising a functional appliance. The most common age to commence functional appliance therapy was between 10 and 12 years, incorporating 9 to 12 months of full-time wear, followed by a 4- to 6-month retention period. There appears to be a clear relationship between an orthodontist’s preferred choice of Class II treatment when employing functional appliances and their orthodontic training institution.
Conclusion
It is common practice for orthodontists in Australia, to utilise functional appliances in the management of a Class II malocclusion. However, the prescribing patterns for functional appliance therapy are not uniform. Variations appear evidenced-based depending on the practice location and the institution from which the orthodontist graduated.
... [1]. For decades, several types of functional appliances including twin-block, activator, herbst, bionator, etc. have been applied to correct class II division 1 malocclusion in actively growing patients [2]. So far, the nature of the treatment effect induced by functional appliances is still controversial. ...
In spite of the widespread use of functional appliances, broad variations were applied the treatment response. The aim of this study is to investigate the pre-treatment cephalometric predictors on the chin advancement of twin-block in growing Chinese patients with class II malocclusion. After screening, 90 patients treated by twin-block were included in the study. The treatment outcome was assessed by the alterations in the distance of skeletal pogonion (Pog) to the vertical reference plane perpendicular to the Frankfurt plane (ΔPog-VRP). Moreover, ΔPog-VRP was divided by the cranial growth indicated by the Nasion to Basion changes (ΔN-Ba) to minimize the growth discrepancy among individuals (adjΔPog-VRP). Patients with ΔPog-VRP/adjΔPog-VRP above the median value were categorized into good response group (GRG/adjGRG, N = 45), while the rest were poor response group (PRG/adjPRG, N = 45). Independent t-test was used to compare the pre-treatment cephalometric measurements between GRG/adjGRG and PRG/adjPRG. Stepwise multivariate regression models were used to determine the pre-treatment cephalometric predictors for the chin advancement. Generally, there were not any significant differences between GRG/adjGRG and PRG/adjPRG regarding age, gender and cervical stage before twin-block treatment. Patients from GRG had significantly reduced cephalometric measurements in the vertical dimensions, including ∠N-Go-Me, ∠Mandibular plane-Occlusal plane (∠MP-OP) and the sum of angles (p < 0.05) in comparison to PRG. When the individual growth was taken account, similar findings were observed. The patients from adjGRG had a significantly lower ∠Sella Nasion line-MP (∠SN-MP), ∠Ar-Go-Me and ∠N-Go-Me, as well as an increased Posterior facial height (PFH)/Anterior facial height (AFH) (p < 0.05) compared with their counterparts. ∠N-Go-Me variable was the independent predictor on Pog advancement with (β = -0.26, 95% CI: -0.06 to -0.01, p = 0.01) and without (β = -0.29, 95% CI: -0.06 to -0.01, p < 0.01) adjustments on individual growth. The results of this study showed that patients with a reduced N-Go-Me angle are more likely to experience a greater chin advancement following twin-block treatment.
... Although there is sufficient evidence that functional appliances, and in particular the twin block, decrease the OVJ, the clinical significance of the mandibular skeletal effects is still questioned, with large variability between studies. [3][4][5] Predictive models in medicine are statistical tools designed to analyse patterns in data, allowing for predictions about future outcomes based on those patterns. These models can be of various types. ...
Aim
This study aimed to identify pretreatment cephalometric variables as possible predictors of the mandibular length increase in Class II patients with mandibular retrusion, treated by means of the Bite Jumping Appliance (BJA).
Materials and Methods
Forty‐three subjects (22 males and 21 females) with Class II malocclusion, treated with a BJA, were selected on the basis of the following inclusion criteria: full Class II molar relationship, Overjet (OVJ) ≥ 6 mm and a skeletal Class II malocclusion with mandibular retrusion at the start of the treatment (T0); cervical vertebral maturation stage 2 or 3 at time 0 (T0). The following mandibular structural features were measured on lateral cephalograms at time 0 and time 1 (15 months of treatment): the width and height of the mandibular symphysis and its width/height ratio, the width and height of the mandibular ramus and its width/height ratio, the antegonial notch depth and the Condilion–Gonion–Menton (Co–Go–Me) angle. Post‐treatment changes were assessed by Pancherz's cephalometric analysis, evaluating the increases in mandibular length. A regression statistical model was used to test the association between morphologic variables and mandibular length changes.
Results
At T1, a significant increase in mandibular length (7.1 + 3.4 mm, p < .001) was measured. A significant negative association between the pretreatment Co–Go–Me angle and mandibular length change was found ( p < .05). IMPA angle was negatively associated with mandibular length change. All the others morphological feature were not statistically related to mandibular length change.
Conclusion
Co–Go–Me angle and IMPA angle at T0 can be used as predictors for mandibular response to the treatment with BJA.
... Overall, while the Herbst appliance is a valuable orthodontic treatment option for patients with skeletal Class II malocclusions, it is essential to be aware of the potential risk of TMD associated with its use. By carefully evaluating patients for TMJ health and monitoring them closely during treatment, orthodontists can minimize the risk of TMD and ensure the best possible outcomes for their patients [26,27]. ...
Background
The Herbst appliance is an excellent therapy for treating class II malocclusions with increased overjet. Its mechanics involve propelling the mandibular bone using two pistons the patient cannot remove. The so-called bite-jumping keeps the mandible in a more anterior position for a variable period, usually at least 6 months. This appliance does not inhibit joint functions and movements, although there are scientific papers in the literature investigating whether this appliance can lead to temporomandibular disorders. This systematic review aims to evaluate whether Herbst’s device can cause temporomandibular diseases by assessing the presence of TMD in patients before and after treatment.
Methods
A literature search up to 3 May 2023 was carried out on three online databases: PubMed, Scopus and Web of Science. Only studies that evaluated patients with Helkimo scores and Manual functional analysis were considered, as studies that assessed the difference in TMD before and after Herbst therapy. Review Manager version 5.2.8 (Cochrane Collaboration) was used for the pooled analysis. We measured the odds ratio (OR) between the two groups (pre and post-Herbst).
Results
The included papers in this review were 60. Fifty-seven were excluded. In addition, a manual search was performed. After the search phase, four articles were considered in the study, one of which was found through a manual search. The overall effect showed that there was no difference in TMD prevalence between pre-Herbst and post-Herbst therapy (OR 0.74; 95% CI: 0.33–1.68).
Conclusion
Herbst appliance seems not to lead to an increase in the incidence of TMD in treated patients; on the contrary, it appears to decrease it. Further studies are needed to assess the possible influence of Herbst on TMDs.
... could be explained by the force applied below the center of resistance of the maxillary. These results agreed with those of [29], [30], [28]. ...
The aim of this clinical study was to detect dental, skeletal and soft tissue changes associated with use of indirect mini-implants anchorage with CS4 springs for stimulation of the growth of mandibular The sample size was 16 patient (11 males,5 females) aged (12.33+-0.75years) with skeletal class II malocclusion due to mandibular retrusion. 2 mini-implants were fixed bilaterally in mandibular oblique ridge, and used CS4 spring to correcting class II. skeletal and dental changes were evaluated using before and after achieve treatment lateral cephaloetric radiographs. The resulting data were statistically analyzed used spss. Analyzed were done using paired samples T test to compare the changes in all variables between T1andT2. Class I molar relationship and over jet correction were achieved in the sample. Mandibular growth was statistically significant, and Mandibular incisor proclination by (2.4°) maxillary incisor retroclination by (6.87°) and distalization of maxillary molars were non-significant, but it was there mesial movements to lower molars were significantly (2.8mm). The CS4 spring was successful in treatment of class II though dentoalveolar and souft tissues changes and significant skeletal changes. The mini-implants with CS4 decreased the mandibular dentoalveolar side effects.
... Functional appliances are two types, fixed functional appliances are bonded to the teeth by an orthodontist and can produce very accurate movement in the teeth, and removable functional appliances which are not bonded to the teeth and can be removed by the patient. Removable appliances are usually used by patients who have a high degree of compliance with their orthodontic treatment [41]. They work by applying forces to the teeth and jaws, which stimulate bone growth and remodelling [41,42]. ...
... Removable appliances are usually used by patients who have a high degree of compliance with their orthodontic treatment [41]. They work by applying forces to the teeth and jaws, which stimulate bone growth and remodelling [41,42]. They compel the patient to function with the lower jaw forward and could stimulate mandibular growth, thereby correcting a class II problem [42]. ...
Abstract
Skeletal class II malocclusion with anterior crossbite presents a significant challenge in the field of orthodontics. Although anterior crossbite association with Class II malocclusion is not common in literature, this condition not only impacts the patient’s quality of life by affecting his facial appearance and resembling cosmetic concerns, but it can also affect masticatory and respiratory functions. The management of skeletal malocclusion class II with anterior crossbite requires a comprehensive approach that takes into account the severity of the condition, the patient's age, and their treatment preferences. A comprehensive search of prominent databases has revealed a range of management strategies used in clinical practice. This review categorizes these intervention methods into orthodontic, and surgical interventions to provide clinicians with an evidence-based decision-making foundation and help determine the best management plan that will provide optimal outcomes for patients with this complicated malocclusion. In conclusion, further high quality evidence is needed to accurately determine the incidence of Class II malocclusion with anterior crossbite and the varying outcomes according to the management strategy.
... could be explained by the force applied below the center of resistance of the maxillary. These results agreed with those of [29], [30], [28]. ...
classII anchorage fixed functional appliances CS4 skeletal changes The aim of this clinical study was to detect dental, skeletal and soft tissue changes associated with use of indirect mini-implants anchorage with CS4 springs for stimulation the growth of mandibular The sample size was 16 patient (11males,5 females) aged (12.33+-0.75years) with skeletal class II malocclusion due to mandibular retrusion. 2 mini-implants were fixed bilaterally in mandibular oblique ridge, and used CS4 spring to correcting class II. skeletal and dental changes were evaluated using befor and after active treatment lateral cephaloetric radiographs. The resulting data were statistically analyzed used spss. Analyzed were done using paired samples T test to compare the changes in all variables between T1andT2. Class I molar relationship and overjet correction were achived in the sample. Mandibular growth was statistically significant, and Mandibular incisor proclination by (2.4°) maxillary incisor retroclination by (6.87°) and distalization of maxillary molars were nonsignificant but it was there mesial movements to lower molars were significantly (2.8mm). The CS4 spring was successful in treatment of class II though dentoalveolarand souft tissues changes and significant skeletal changes. the mini-implants with CS4 decreased the mandibular dentoalveolar side effects. This work is licensed under a Creative Commons Attribution Non-Commercial 4.0 International License.
... 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.
