Short-term dentoskeletal changes following Class II treatment using a fixed functional appliance: the Austro Repositioner

A pilot study
  • M. Dolores Austro
  • Encarnación González
  • M. Angustias Peñalver
  • Domingo Pérez
  • José Antonio Alarcón
Original Article
  • 5 Downloads

Abstract

Objective

Purpose of this prospective study was to evaluate the skeletal and dentoalveolar effects of a fixed functional appliance, the Austro Repositioner, in dolicho- and brachyfacial skeletal Class II patients.

Material and methods

In all, 20 dolicho- and 25 brachyfacial consecutive patients treated with the Austro Repositioner were compared with untreated controls (20 dolicho- and 20 brachyfacial patients) with the same initial dentoskeletal features. Lateral cephalograms were acquired before and 1.0±0.2 year after therapy.

Results

Significant improvements in skeletal Class II relationships were observed in both groups. The ANB angle decreased (3.56° in dolicho- and 3.13° in brachyfacial patients, P < 0.001) due to changes localized exclusively in the mandible, the SNB angle increased to 3.20° in dolicho- and 3.02° in brachyfacial patients, and the total mandibular length (Co-Pg) increased to 6.47 mm in dolicho- and 5.78 mm in brachyfacial patients (P < 0.001). A favorable guidance of vertical pattern was also achieved in both groups, and no significant changes were observed in the upper and lower incisors in both groups.

Conclusions

The Austro Repositioner was effective for short-term treatment of skeletal Class II malocclusion resulting from the retrusion of the mandible in both dolicho- and brachyfacial patients.

Keywords

Fixed functional appliance Angle Class II Mandibular retrusion Brachyfacial facial pattern Dolichofacial facial pattern 

Dentoskelettale Veränderungen nach einjähriger Klasse-II-Behandlung mit einer festsitzenden funktionellen Apparatur: der Austro-Repositioner

Eine Pilotstudie

Zusammenfassung

Ziel

In der vorliegenden prospektiven Studie sollten die skelettalen und dentoalveolären Effekte einer festsitzenden funktionellen Apparatur (Austro-Repositioner) bei Patienten mit skelettaler Angle Klasse-II und dolicho- bzw. brachyfazialem Wachstumsmuster evaluiert werden.

Material und Methoden

Insgesamt wurden 45 konsekutive Patienten (20 dolicho- und 25 brachyfazial) mit dem Austro-Repositioner behandelt und mit unbehandelten Kontrollpatienten (20 dolicho- und 20 brachyfazial) verglichen, die zu Behandlungsbeginn die gleichen initialen dentoskelettalen Befunde aufwiesen. Vor der Behandlung sowie 1,0±0,4Jahr nach Behandlungsbeginn wurden Fernröntgenseitenbilder angefertigt.

Ergebnisse

Hinsichtlich der skelettalen Klasse-II-Relation ließen sich in beiden Gruppen statistisch signifikante Verbesserungen beobachten, wobei die Veränderungen ausschließlich den Unterkiefer betrafen: Verringerung des ANB-Winkels (3,56° bei dolicho-, 3,13° bei brachyfazialen Patienten; p < 0,001), Vergrößerung des SNB-Winkels (3,20° bei dolicho- und 3,02° bei brachyfazialen Patienten) und Erhöhung der Unterkiefergesamtlänge (Co-Pg) auf 47 mm bei dolicho- und 5,78 mm bei brachyfazialen Patienten (p < 0,001). In beiden Gruppen wurde das vertikale Wachstumsmuster günstig beeinflusst. Bei der Stellung oberer wie unterer Inzisivi wurden keine statistisch signifikanten Änderungen beobachtet.

Schlussfolgerungen

Sowohl Klasse II-Patienten mit dolicho- als auch mit brachyfazialem Wachstumstyp profitierten von der einjährigen Behandlung mit dem Austro-Repositioner.

Schlüsselwörter

Festsitzende funktionelle Apparatur Angle Klasse-II Unterkieferrücklage Brachyfaziales Wachstumsmuster Dolichofaziales Wachstumsmuster 

Notes

Acknowledgements

The authors are deeply grateful to Dr. Enrique Bejarano, for his helpful contribution in the conception and design of the new appliance presented in this work.

Compliance with ethical guidelines

Conflict of interest

M.D. Austro, E. González, M.A. Peñalver, D. Pérez and J.A. Alarcón declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Baccetti T, Franchi L, McNamara JA Jr. (2005) The cervical vertebral maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedics. Semin Orthod 11:119–129CrossRefGoogle Scholar
  2. 2.
    Baccetti T, Franchi L, Toth LR, McNamara JA Jr. (2000) Treatment timing for twin-block therapy. Am J Orthod Dentofacial Orthop 118:159–170.  https://doi.org/10.1067/mod.2000.105571 CrossRefPubMedGoogle Scholar
  3. 3.
    Ballester A, Langlade M (2001) Unlocking the malocclusion with a semifixed bite plate. J Clin Orthod 35:544–548PubMedGoogle Scholar
  4. 4.
    Baysal A, Uysal T (2014) Dentoskeletal effects of twin block and Herbst appliances in patients with class II division 1 mandibular retrognathy. Eur J Orthod 36:164–172.  https://doi.org/10.1093/ejo/cjt013 CrossRefPubMedGoogle Scholar
  5. 5.
    Burhan AS, Nawaya FR (2015) Dentoskeletal effects of the bite-jumping appliance and the twin-block appliance in the treatment of skeletal class II malocclusion: a randomized controlled trial. Eur J Orthod 37:330–337.  https://doi.org/10.1093/ejo/cju052 CrossRefPubMedGoogle Scholar
  6. 6.
    Cozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA Jr. (2006) Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review. Am J Orthod Dentofacial Orthop 129:599.e1–599.e12.  https://doi.org/10.1016/j.ajodo.2005.11.010 (discussion e591–596)Google Scholar
  7. 7.
    De Almeida MR, Henriques JF, Ursi W (2002) Comparative study of the Frankel (FR-2) and bionator appliances in the treatment of class II malocclusion. Am J Orthod Dentofacial Orthop 121:458–466CrossRefPubMedGoogle Scholar
  8. 8.
    Franchi L, Alvetro L, Giuntini V, Masucci C, Defraia E, Baccetti T (2011) Effectiveness of comprehensive fixed appliance treatment used with the forsus fatigue resistant device in class II patients. Angle Orthod 81:678–683.  https://doi.org/10.2319/102710-629.1 CrossRefPubMedGoogle Scholar
  9. 9.
    Franchi L, Baccetti T, McNamara JA Jr. (1999) Treatment and posttreatment effects of acrylic splint Herbst appliance therapy. Am J Orthod Dentofacial Orthop 115:429–438CrossRefPubMedGoogle Scholar
  10. 10.
    Ghislanzoni LT, Toll DE, Defraia E, Baccetti T, Franchi L (2011) Treatment and posttreatment outcomes induced by the mandibular advancement repositioning appliance; a controlled clinical study. Angle Orthod 81:684–691.  https://doi.org/10.2319/111010-656.1 CrossRefPubMedGoogle Scholar
  11. 11.
    Giuntini V, Vangelisti A, Masucci C, Defraia E, McNamara JA Jr., Franchi L (2015) Treatment effects produced by the twin-block appliance vs the forsus fatigue resistant device in growing class II patients. Angle Orthod 85:784–789.  https://doi.org/10.2319/090514-624.1 CrossRefPubMedGoogle Scholar
  12. 12.
    Jakobsone G, Latkauskiene D, McNamara JA Jr. (2013) Mechanisms of class II correction induced by the crown Herbst appliance as a single-phase class II therapy: 1 year follow-up. Prog Orthod 14:27.  https://doi.org/10.1186/2196-1042-14-27 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Jena AK, Duggal R, Parkash H (2006) 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 130:594–602.  https://doi.org/10.1016/j.ajodo.2005.02.025 CrossRefPubMedGoogle Scholar
  14. 14.
    Lund DI, Sandler PJ (1998) The effects of twin blocks: a prospective controlled study. Am J Orthod Dentofacial Orthop 113:104–110.  https://doi.org/10.1016/S0889-5406(98)70282-3 CrossRefPubMedGoogle Scholar
  15. 15.
    Martina R, Cioffi I, Galeotti A, Tagliaferri R, Cimino R, Michelotti A, Valletta R, Farella M, Paduano S (2013) Efficacy of the Sander bite-jumping appliance in growing patients with mandibular retrusion: a randomized controlled trial. Orthod Craniofac Res 16:116–126.  https://doi.org/10.1111/ocr.12013 CrossRefPubMedGoogle Scholar
  16. 16.
    McNamara JA Jr. (1981) Components of class II malocclusion in children 8–10 years of age. Angle Orthod 51:177–202.  https://doi.org/10.1043/0003-3219(1981)051<0177:COCIMI>2.0.CO;2 PubMedGoogle Scholar
  17. 17.
    McNamara JA Jr. (1984) A method of cephalometric evaluation. Am J Orthod 86:449–469CrossRefPubMedGoogle Scholar
  18. 18.
    McNamara JA Jr., Howe RP, Dischinger TG (1990) A comparison of the Herbst and Frankel appliances in the treatment of class II malocclusion. Am J Orthod Dentofacial Orthop 98:134–144.  https://doi.org/10.1016/0889-5406(90)70007-Y CrossRefPubMedGoogle Scholar
  19. 19.
    Nance HN (1947) The limitations of orthodontic treatment; mixed dentition diagnosis and treatment. Am J Orthod 33:177–223PubMedGoogle Scholar
  20. 20.
    O’Brien K, Wright J, Conboy F, Sanjie Y, Mandall N, Chadwick S, Connolly I, Cook P, Birnie D, Hammond M, Harradine N, Lewis D, McDade C, Mitchell L, Murray A, O’Neill J, Read M, Robinson S, Roberts-Harry D, Sandler J, Shaw I (2003) Effectiveness of early orthodontic treatment with the twin-block appliance: a multicenter, randomized, controlled trial. Part 1: dental and skeletal effects. Am J Orthod Dentofacial Orthop 124:234–243.  https://doi.org/10.1016/S0889540603003524 (quiz 339)CrossRefPubMedGoogle Scholar
  21. 21.
    O’Brien K, Wright J, Conboy F, Sanjie Y, Mandall N, Chadwick S, Connolly I, Cook P, Birnie D, Hammond M, Harradine N, Lewis D, McDade C, Mitchell L, Murray A, O’Neill J, Read M, Robinson S, Roberts-Harry D, Sandler J, Shaw I (2003) Effectiveness of treatment for class II malocclusion with the Herbst or twin-block appliances: a randomized, controlled trial. Am J Orthod Dentofacial Orthop 124:128–137.  https://doi.org/10.1016/S0889540603003457 CrossRefPubMedGoogle Scholar
  22. 22.
    Pancherz H (1982) The mechanism of class II correction in Herbst appliance treatment. A cephalometric investigation. Am J Orthod 82:104–113CrossRefPubMedGoogle Scholar
  23. 23.
    Pancherz H, Zieber K, Hoyer B (1997) Cephalometric characteristics of class II division 1 and class II division 2 malocclusions: a comparative study in children. Angle Orthod 67:111–120. https://doi.org/10.1043/0003-3219(1997)067〈0111:CCOCID〉2.3.CO;2PubMedGoogle Scholar
  24. 24.
    Pangrazio MN, Pangrazio-Kulbersh V, Berger JL, Bayirli B, Movahhedian A (2012) Treatment effects of the mandibular anterior repositioning appliance in patients with class II skeletal malocclusions. Angle Orthod 82:971–977.  https://doi.org/10.2319/120511-748.1 CrossRefPubMedGoogle Scholar
  25. 25.
    Perinetti G, Cordella C, Pellegrini F, Esposito P (2008) The prevalence of malocclusal traits and their correlations in mixed dentition children: results from the Italian OHSAR Survey. Oral Health Prev Dent 6:119–129PubMedGoogle Scholar
  26. 26.
    Phelan A, Tarraf NE, Taylor P, Honscheid R, Drescher D, Baccetti T, Darendeliler MA (2012) Skeletal and dental outcomes of a new magnetic functional appliance, the Sydney Magnoglide, in class II correction. Am J Orthod Dentofacial Orthop 141:759–772.  https://doi.org/10.1016/j.ajodo.2012.01.014 CrossRefPubMedGoogle Scholar
  27. 27.
    Proffit WR, Fields HM, Sarver DM (2013) Contemporary orthodontics, 5th edn. Elsevier, St. LouisGoogle Scholar
  28. 28.
    Proffit WR, Fields HM, Sarver DM (2007) Contemporary orthodontics, 4th edn. CV Mosby, St. LuisGoogle Scholar
  29. 29.
    Ricketts RM (1981) Perspectives in the clinical application of cephalometrics. The first fifty years. Angle Orthod 51:115–150.  https://doi.org/10.1043/0003-3219(1981)051<0115:PITCAO>2.0.CO;2 PubMedGoogle Scholar
  30. 30.
    Riolo ML, Moyers RE, McNamara JA Jr, Hunter WS (1974) An atlas of craniofacial growth: cephalometric standards from The University School Growth Study, The University of Michigan. Monograph 2, Craniofacial Growth Series, Center for Human Growth and Development. Ann Arbor, Mich: The University of Michigan.Google Scholar
  31. 31.
    Rosenblum RE (1995) Class II malocclusion: mandibular retrusion or maxillary protrusion? Angle Orthod 65:49–62.  https://doi.org/10.1043/0003-3219(1995)065<0049:CIMMRO>2.0.CO;2 PubMedGoogle Scholar
  32. 32.
    Spalding O (2001) Treatment of class II malocclusion. In: Bishara S (ed) Text book of orthodontics. International edition. W.B. Saunders Company, Philadelphia, pp 324–374Google Scholar
  33. 33.
    Steiner CC (1953) Cephalometrics for you and me. Am J Orthod 39:729–755CrossRefGoogle Scholar
  34. 34.
    Toth LR, McNamara JA Jr. (1999) 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 116:597–609CrossRefPubMedGoogle Scholar
  35. 35.
    Tulloch JF, Proffit WR, Phillips C (2004) Outcomes in a 2-phase randomized clinical trial of early class II treatment. Am J Orthod Dentofacial Orthop 125:657–667.  https://doi.org/10.1016/S088954060400160X CrossRefPubMedGoogle Scholar
  36. 36.
    Tumer N, Gultan AS (1999) Comparison of the effects of monoblock and twin-block appliances on the skeletal and dentoalveolar structures. Am J Orthod Dentofacial Orthop 116:460–468CrossRefPubMedGoogle Scholar
  37. 37.
    Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–363PubMedGoogle Scholar
  38. 38.
    Wahl N (2006) Orthodontics in 3 millennia. Chapter 9: functional appliances to midcentury. Am J Orthod Dentofacial Orthop 129:829–833.  https://doi.org/10.1016/j.ajodo.2006.03.019 CrossRefPubMedGoogle Scholar
  39. 39.
    Windmiller EC (1993) The acrylic-splint Herbst appliance: a cephalometric evaluation. Am J Orthod Dentofacial Orthop 104:73–84.  https://doi.org/10.1016/0889-5406(93)70030-R CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • M. Dolores Austro
    • 1
  • Encarnación González
    • 2
  • M. Angustias Peñalver
    • 2
  • Domingo Pérez
    • 3
  • José Antonio Alarcón
    • 4
  1. 1.Department of Stomatology, Section of Pediatric Dentistry, Faculty of Odontology, Hospital General Universitario Morales MeseguerUniversity of MurciaMurciaSpain
  2. 2.Department of Stomatology, Section of Pediatric Dentistry, Faculty of OdontologyUniversity of GranadaGranadaSpain
  3. 3.Department of Stomatology, Section of Statistics, Faculty of OdontologyUniversity of MurciaMurciaSpain
  4. 4.Department of Stomatology, Section of Orthodontics, Faculty of OdontologyUniversity of GranadaGranadaSpain

Personalised recommendations