Comparison treatment effects of twin block appliance between hyperdivergent and normovergent patients

Main Article Content

Jurairat Cheewapornpimol
Nathaphon Tangjit
Surachai Dechkunakorn
Niwat Anuwongnukroh

Abstract

Objective: A retrospective study to compare skeletal and dentoalveolar changes between hyperdivergent and normovergent Class II division 1 Thai patients treated with twin block appliance.
Materials and Methods: Pretreatment and posttreatment lateral cephalometric radiographs of 17 hyperdivergent [9 boys, 8 girls] and 26 normovergent [16 boys, 10 girls] Class II division 1 Thai subjects treated with twin block appliance were analysed. The subjects were divided into 2 different vertical growth patterns, hyperdivergent and normovergent groups by SN-MP angle. Cephalometric analysis and Pancherz analysis were performed and the treatment effects between 2 groups were compared by using an independent t-test.
Results: Pretreatment SN-MP of hyperdivergent group was 38.98 ± 1.84°, while it was 30.06 ± 2.71° in normovergent group. According to MU analysis, normovergent group showed a statistically significant greater improvement in sagittal skeletal changes (increased SNB, decreased ANB, improved AF-BF and increased Pg to N perpend) when compared to the hyperdivergent group. There was no significant difference of vertical skeletal changes between the two groups except the mandibular angle which showed a slight increase after twin block treatment in the normovergent group. According to Pancherz analysis, the skeletal/ dental contribution for overjet correction was 36.6 /63.4 percent and molar correction was 47.5 /52.5 percent in hyperdivergent group. While the skeletal/ dental contribution for overjet correction in normovergent group was 52.1 /47.9 percent and molar correction was 58.7 /41.3 percent. However, skeletal change is not significant between hyperdivergent and normovergent group.
Conclusions: Normovergent patients responded to the twin block appliance more favorably than hyperdivergent patients according to MU analysis but skeletal change in term of mandibular advancement was similar.

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1.
Cheewapornpimol J, Tangjit N, Dechkunakorn S, Anuwongnukroh N. Comparison treatment effects of twin block appliance between hyperdivergent and normovergent patients . M Dent J [Internet]. 2019 Dec. 27 [cited 2024 Nov. 18];39(3):277-91. Available from: https://he02.tci-thaijo.org/index.php/mdentjournal/article/view/194563
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References

Gill D, & Naini, F. B. Orthodontics: Principles and Practice: John Wiley & Sons; 2012.

Clark WJ. Twin Block Functional Therapy: Applications in Dentofacial Orthopaedics: Mosby; 2002.

Mills CM, McCulloch KJ. Treatment effects of the twin block appliance: a cephalometric study. Am J Orthod Dentofacial Orthop 1998;114:15-24.

Graber LW, Vanarsdall Jr, R. L., & Vig, K. W. . Orthodontics: current principles and techniques: Elsevier Health Sciences; 2011.

Bishara SE, Ziaja RR. Functional appliances: a review. Am J Orthod Dentofacial Orthop 1989;95:250-8.

Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics St. Louis: Mosby Elsevier; 2007.

Stockli PW, Willert HG. Tissue reactions in the temporomandibular joint resulting from anterior displacement of the mandible in the monkey. Am J Orthod 1971;60:142-55.

Petrovic AG. Mechanisms and regulation of mandibular condylar growth. Acta Morphol Neerl Scand 1972;10:25-34.

McNamara JA, Jr., Carlson DS. Quantitative analysis of temporomandibular joint adaptations to protrusive function. Am J Orthod 1979;76:593-611.

Elgoyhen JC, Moyers RE, McNamara JA, Jr., Riolo ML. Craniofacial adaptation of protrusive function in young rhesus monkeys. Am J Orthod 1972;62:469-80.

Charlier JP, Petrovic A, Herrmann-Stutzmann J. Effects of mandibular hyperpropulsion on the prechondroblastic zone of young rat condyle. Am J Orthod 1969;55:71-4.

Lund DI, Sandler PJ. The effects of Twin Blocks: a prospective controlled study. Am J Orthod Dentofacial Orthop 1998;113:104-10.

Illing HM, Morris DO, Lee RT. A prospective evaluation of Bass, Bionator and Twin Block appliances. Part I--The hard tissues. Eur J Orthod 1998;20:501-16.

Toth LR, McNamara JA, Jr. Treatment effects produced by the twin-block appliance and the FR-2 appliance of Frankel compared with an untreated Class II sample. Am J Orthod Dentofacial Orthop 1999;116:597-609.

Jena AK, Duggal R, Parkash H. Skeletal and dentoalveolar effects of Twin-block and bionator appliances in the treatment of Class II malocclusion: a comparative study. Am J Orthod Dentofacial Orthop 2006;130:594-602.

Giuntini V, Vangelisti A, Masucci C, Defraia E, McNamara JA, Jr., et al. Treatment effects produced by the Twin-block appliance vs the Forsus Fatigue Resistant Device in growing Class II patients. Angle Orthod 2015;85:784-9.

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.

O'Brien K, Wright J, Conboy F, Chadwick S, Connolly I, et al. Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 2: Psychosocial effects. Am J Orthod Dentofacial Orthop 2003;124:488-94; discussion 94-5.

Hirzel HC, Grewe JM. Activators: a practical approach. Am J Orthod 1974;66:557-70.

Skieller V, Bjork A, Linde-Hansen T. Prediction of mandibular growth rotation evaluated from a longitudinal implant sample. Am J Orthod 1984;86:359-70.

Tulley WJ. The scope and limitations of treatment with the activator. Am J Orthod 1972;61:562-77.

Clark WJ. The twin block traction technique. Eur J Orthod 1982;4:129-38.

Clark WJ. The twin block technique. A functional orthopedic appliance system. Am J Orthod Dentofacial Orthop 1988;93:1-18.

Pancherz H. A cephalometric analysis of skeletal and dental changes contributing to Class II correction in activator treatment. Am J Orthod 1984;85:125-34.

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.

Suchato W, Chaiwat J. Cephalometric evaluation of the dentofacial complex of Thai adults: J Dent Assoc Thai; 1984 [cited 34];34; 233].

Grave KC, Brown T. Skeletal ossification and the adolescent growth spurt. Am J Orthod 1976;69:611-9.

Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307-10.

D'Anto V, Bucci R, Franchi L, Rongo R, Michelotti A, et al. Class II functional orthopaedic treatment: a systematic review of systematic reviews. J Oral Rehabil 2015;42:624-42.

Sidlauskas A. The effects of the Twin-block appliance treatment on the skeletal and dentolaveolar changes in Class II Division 1 malocclusion. Medicina (Kaunas) 2005;41:392-400.

Chung CH, Wong WW. Craniofacial growth in untreated skeletal Class II subjects: a longitudinal study. Am J Orthod Dentofacial Orthop 2002;122:619-26.

Riedel RA. The relation of maxillary structures to cranium in malocclusion and normal occlusion. Angle Orthod 1952;22:142-5.

Karlsen AT. Craniofacial growth differences between low and high MP-SN angle males: a longitudinal study. Angle Orthod 1995;65:341-50.

Ruf S, Pancherz H. The mechanism of Class II correction during Herbst therapy in relation to the vertical jaw base relationship: a cephalometric roentgenographic study. Angle Orthod 1997;67:271-6.

Siara-Olds NJ, Pangrazio-Kulbersh V, Berger J, Bayirli B. Long-term dentoskeletal changes with the Bionator, Herbst, Twin Block, and MARA functional appliances. Angle Orthod 2010;80:18-29.

Nanda SK. Growth patterns in subjects with long and short faces. Am J Orthod Dentofacial Orthop 1990;98:247-58.

Lundstrom A, Woodside DG. Longitudinal changes in facial type in cases with vertical and horizontal mandibular growth directions. Eur J Orthod 1983;5:259-68.

Garcia-Morales P, Buschang PH. Longitudinal stability of divergent growth patterns. J Dent Res 2002;81:388.

Buschang PH, Sankey W, English JD. Early treatment of hyperdivergent open-bite malocclusions. 2002;8:130-40.

Baysal A, Uysal T. Soft tissue effects of Twin Block and Herbst appliances in patients with Class II division 1 mandibular retrognathy. Eur J Orthod 2013;35:71-81.

Prahl-Andersen B, Ligthelm-Bakker AS, Wattel E, Nanda R. Adolescent growth changes in soft tissue profile. Am J Orthod Dentofacial Orthop 1995;107:476-83.

Phuntsho U, Komoltri J, Viwattanatipa N. Comparison of Skull Dimension and Geometric Formulas Method to Solve Projection Errors in 2D Cephalometric Radiographs. Biomedical Journal 2018;1:12.