COMPARATIVE CEPHALOMETRIC ANALYSIS OF TWIN BLOCK AND MODIFIED FUNCTIONAL APPLIANCES ON UPPER AIRWAY DIMENSIONS IN CLASS II MALOCCLUSION PATIENTS WITH NARROWED UPPER AIRWAY
DOI:
https://doi.org/10.35220/2078-8916-2023-48-2.21Keywords:
Class II malocclusion, Twin-block, Modified functional appliance, Cephalometric radiographs, Upper airwayAbstract
Introduction: Class II malocclusion is a common issue in orthodontics, particularly in patients with a retrognathic mandible. Functional appliances, such as the twin-block appliance, are often used to encourage mandibular growth during orthodontic treatment. However, the effect of this appliance on upper airway dimensions remains unclear. Objective: The objective of this study was to compare the effectiveness of the twin-block and modified functional appliances in terms of cephalometric parameter changes during orthodontic treatment for patients with skeletal Class II malocclusion, retrognathic mandible, and narrowed upper airway. The study aimed to monitor changes in these parameters over time to evaluate the efficacy of the appliances. Methods: This study analyzed cephalometric radiographs of 104 children, aged 7 to 13, with skeletal Class II malocclusion, retrognathic mandible, and narrowed upper airway during the mixed dentition stage at the pubertal stages of CS3 and CS4. These children received treatment at the Department of Orthodontics of the Shupyk National Healthcare University of Ukraine. Results: The modified functional appliance (MFA) proposed in this study for children with Class II malocclusion has the ability to eliminate morphological, physiological and aesthetic disorders, restore the function of the masticatory system, normalize the position of the hyoid bone, adjust the inclination of the soft palate, adapt the cervical spine, and correct the tilt of the head. Additionally, it can widen the upper airway (oropharynx and hypopharynx) and provide aesthetic treatment results in a shorter amount of time when compared to using a twin-block appliance. Conclusions: The results indicate that functional orthopedic treatment can be an effective treatment option for patients with upper airway and malocclusion issues.
References
Proffit, W.R., & Moray, L.J. (1998). Prevalence of malocclusion and orthodontic treatment need in the United States. Int J Adult Orthodon Orthognath Surg.,13(2), 97-106.
Henry, R.G. (1957). A classification of Class II, division 1 malocclusion. Angle Orthod., 27(2), 83-92.
Moyers, R.E., Riolo, M.L., Guire, K.E., Wainright, R.L., & Bookstein, F.L. (1980). Differential diagnosis of Class II malocclusions: Part 1, facial types associated with Class II malocclusions. Am J Orthod.,78(5), 477-494.
Lin, J.X. (1995). Contemporary Orthodontics. Beijing: Chinese Medical Science & Technology Press.
Indriksone, I., & Jakobsone, G. (2014). The upper airway dimensions in different sagittal craniofacial patterns: A systematic review. Stomatologija, 16(4), 109-117.
Abdelkarim, A. (2012). A cone beam CT evaluation of oropharyngeal airway space and its relationship to mandibular position and dentocraniofacial morphology. J World Fed Orthod., 1(2), 55-59.
El, H., & Palomo, J.M. (2011). Airway volume for different dentofacial skeletal patterns. Am J Orthod Dentofacial Orthop., 139(4), 511-521.
Gonçales, E.S., Rocha, J.F., Gonçales, A.G., Yaedu, R.Y., & Sant'Ana, E. (2014). Computerized cephalometric study of the pharyngeal airway space in patients submitted to orthognathic surgery. J Maxillofac Oral Surg., 13(3), 253-258.
Jose, N.P., Shetty, S., Mogra, S., Shetty, V.S., Rangarajan, S., & Mary, L. (2014). Evaluation of hyoid bone position and its correlation with pharyngeal airway space in different types of skeletal malocclusion. Contemp Clin Dent., 5(2), 187-189.
Drohomyretska MC, &Mohammed Sadek AS. (2022). Assessment of anthropometric and cephalographic indicators in patients with distal bite with normal and impaired external breathing function. J Dentistry, 120(3), 83-92.
Drohomyretska, M.C., & Mohammed, Sadek A.S. (2022). Assessment of the position of the hyoid bone in patients with a distal bite with normal and impaired airway function. Innovations in Dentistry, (1), 25-31.
Ozbek, M.M., Miyamoto, K., Lowe, A.A., & Fleetham, J.A. (1998). Natural head posture, upper airway morphology and obstructive sleep apnoea severity in adults. Eur J Orthod., 20(2), 133-143.
Katyal, V., Pamula, Y., Martin, A.J., & et al. (2013). Craniofacial and upper airway morphology in Paediatric sleep-disordered breathing and changes in quality of life with rapid maxillary expansion. Am J Orthod Dentofacial Orthop., 143(1), 20–30. PMID: 23273357.
Graber, T.M., Rakosi, T., & Petrovic, A. (1997). Dentofacial Orthopedics with Functional Appliances. St Louis, Mo: Mosby. 346–352.
Hanggi, M.P., Teuscher, U.M., Roos, M., & Peltomaki, T.A. (2008). Long-term changes in pharyngeal airway dimensions following activator-headgear and fixed appliance treatment. Eur J Orthod,. 30, 598-605.
Ghodke, S., Utreja, A.K., Singh, S.P., & Jena, A.K. (2014). Effects of twin-block appliance on the anatomy of pharyngeal airway passage (PAP) in class II malocclusion subjects. Prog Orthod., 15, 68. doi: 10.1186/s40510-014-0068-3.
Xiang, M., Hu, B., Liu, Y., Sun, J., & Song, J. (2017). Changes in airway dimensions following functional appliances in growing patients with skeletal class II malocclusion: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol, 97, 170-80.
Clark, W.J. (1982). The twin-block traction technique. Eur J Orthod., 4, 129-38.
Li, L., Liu, H., Cheng, H., Han, Y., Wang, C., Chen, Y., & et al. (2014). CBCT evaluation of the upper airway morphological changes in growing patients of class II division 1 malocclusion with mandibular retrusion using twin block appliance: a comparative research. PLoS One, 9, 0094378.
Jena, A.K., Singh, S.P., & Utreja, A.K. (2013). Effectiveness of twin-block and Mandibular Protraction Appliance-IV in the improvement of pharyngeal airway passage dimensions in Class II malocclusion subjects with a retrognathic mandible. Angle Orthod., 83, 728-34.
Ali, B., Shaikh, A., & Fida, M. (2015). Effect of Clark's twin-block appliance (CTB) and non-extraction fixed mechano-therapy on the pharyngeal dimensions of growing children. Dental Press J Orthod., 20, 82-8.
Vinoth, S.K., Thomas, A.V., & Nethravathy, R. (2013). Cephalomteric changes in airway dimensions with twin block therapy in growing Class II patients. J Pharm Bioallied Sci, 5(Suppl 1), 25-9.
Verma, G., Tandon, P., Nagar, A., Singh G,P., & Singh, A. (2012). Cephalometric evaluation of hyoid bone position and pharyngeal spaces following treatment with Twin block appliance. J Orthod Sci, 1, 77-82.
Elfeky, Hy., & Fayed, MMS. (2015). Threedimensional effects of twin block therapy on pharyngeal airway parameters in Class II malocclusion patients. J World Federation of Orthod., 4, 114-9.
Chand, K., Jacob, S., & Charles, A. (2017). Assessment of changes in the sagittal pharyngeal airway dimensions post twin block therapy using polar planimeter. J Res Dent Sci, 3, 51-7.
Zhang, C., He, H., & Ngan, P. (2013). Effects of twin-block appliance on obstructive sleep apnea in children: a preliminary study. Sleep Breath, 17, 1309-14.
O'Brien, K., Wright, J., Conboy, F., Sanjie, Y., Mandall, N., Chadwick, S., & et al. (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, 234-43.
McNamara, J.A. (1984). Influence of respiratory pattern on craniofacial growth. Angle Orthod., 54, 283-311.
Freitas, M.R., Alcazar, NMPV., Janson, G., Freitas, KMS., & Henriques, JFC. (2006). Upper and lower pharyngeal airways in subjects with Class I and Class II malocclusions and different growth patterns. Am J Orthod Dentofacial Orthop., 130, 742-745.
