Aim: This research aimed to evaluate the effects of modified Sagittal-guidance twin-block (SGTB) appliance on class II skeletal and dental alterations among developing pt.
Methodology: A total of 25 adolescent adults in class II div 1 made up the sample, which split equally between the twin-block (TB) and SGTB groups. The course therapy lasted 11.56 ± 1.73 months.
Results: There was no discernible distinction between T1 and T2 in terms of lingual bone height, lingual and overall dental bony volume, and whole alveolar bone width ( < 0.05).
Conclusion: In maturing children having class II div 1, labial bone decrease surrounding the mandibular incisors was noted following intervention with the two kinds of prostheses.
GreenMedInfo, Journal of pharmacy & bioallied sciences
Objective The study was focused on evaluating the change in mandibular morphology following the Twin Block appliance therapy and recording its effect on the maxilla and maxillary dentoalveolar complex. Also, the results of the Twin Block appliance between males and females were compared. Material and methods In this two-armed retrospective cephalometric study, 30 patients (mean age 12 years) treated with Twin Block appliance for the period of 8-12 months were chosen, and their records were obtained to analyze. These results were compared with 15 control subjects of the same age group chosen from the American Association of Orthodontics Foundation (AAOF) growth legacy collection: Michigan Growth Study Class II subjects. Cephalometric tracing was done, and data was processed for descriptive statistical analysis. Results Paired sample t-test and ANOVA test were performed to evaluate the differences in the pre-treatment (T1) and post-functional (T2) values. ∠ANB showed a mean difference of -4.71°±1.55° for males and 6.22°±6.78° for females, which is significant. The mandibular length (Co-Gn), for male subjects, the mean difference was 5.14±1.74 mm, and for female subjects, it was 6±2mm, which is highly significant; 49.88% of skeletal changes and 50.12% of dentoalveolar changes were reported to bring about Class II correction with Twin Block. Conclusion A successful increase in mandibular length was achieved using a Twin Block as a functional appliance. Also, the significant maxillary restraining effect was recorded. More skeletal changes were observed in males than females.
Background: This study was conducted to evaluate the differences in soft tissue as well as dental compensation in skeletal Class II div 1 malocclusion.
Methods and Materials: The study sample consists of pre-treatment lateral cephalograms of 100 subjects of both gender having skeletal Class II and dental Class II div 1 malocclusion visiting the Department of Orthodontics and Dentofacial Orthopaedics, Bharati Vidyapeeth Dental College, and Hospital Navi Mumbai. Cephalograms of the subjects fulfilling the inclusion criteria were included in this study.
Results: This research was conducted to assess dental and soft tissue compensation in skeletal Class II div 1 malocclusion and comparative assessment of lip prominence measured from two soft tissue vertical reference lines. The 100 subjects selected randomly out of which 44 men and 56 women, age ranging from 18 to 35 years.
Conclusion: ARNETT'S method and PROFFIT'S method showed statistically significant as < 0.0001. PROFFIT'S method and LEGAN-BURSTONE'S method showed statistically significant as < 0.0001.
GreenMedInfo, Journal of pharmacy & bioallied sciences
INTRODUCTION: Getting acceptable cosmetic results in the soft tissues of the face serves as the foundation for orthodontic treatment planning. Also, in order to achieve healthy static and dynamic occlusal interactions, the teeth must be positioned within the basal bone at the correct position, angle, and inclination. To avoid periodontal issues, provide stability, and achieve a functional occlusion, it is essential to ascertain the individual's dental arch form before starting of treatment and thus to utilise the mechanics that follow throughout the treatment.
OBJECTIVES: To evaluate and compare variation in Curve of Spee and Curve of Wilson in Class II Div.-1, Class II-Div-2 and Class-III as against Class I malocclusion in central India population.
METHODOLOGY: Irreversible hydrocolloid impression will be taken with perforated metal stock trays and stone cast will be poured. This will be scanned using CAD CAM machine and curve of Spee and Wilson will be measured using reverse engineering.
EXPECTED RESULT: It will assist us in treatment planning for preventing periodontal issues, assuring stability, and achieving functional occlusion by evaluating and comparing the Spee and Wilson curves in Class II Divison-1, Class II Divison-2, and Class-III malocclusion with Class-I malocclusion.
CONCLUSION: Every single patient receiving orthodontic treatment has the COS, which is crucial to achieving a stable occlusion. Almost every patient who receives orthodontic treatment eventually experiences the Spee Curve. Since there aren't many studies examining the relationship between the Curves of Spee and Wilson, their impact on dentoskeletal morphology, and their role in occlusal stability.
INTRODUCTION: Twin-block appliance therapy in patients with Class II Div 1 malocclusion positions the mandible anteroinferior leading to possible alterations in tongue pressure, tongue length, and the oropharynx.
OBJECTIVES: To evaluate the changes in tongue pressure, tongue length and dimension of the pharyngeal airway in Class II Division 1 subjects before and after twin-block therapy.
MATERIALS AND METHODS: Twenty-four subjects were selected, in the range of 10-14 years (mean-12 years). The tongue pressure was recorded at three regions with sensors placed at the incisive papilla and bilaterally at the molar region of the palate for four minutes. The root mean square (RMS) values were recorded and used for further analysis. Evaluation of tongue length and pharyngeal airway dimension was done using a lateral cephalogram. All the measurements were done before and after twin-block appliance therapy. The paired -test was performed to compare the changes.
RESULTS: Resting tongue pressures decreased from pre-treatment levels to post-treatment at all three regions. Change in ANB angle was found to have a significant negative correlation with tongue length, and pharyngeal airway dimension, a significant positive correlation with pressure at incisive papilla and left molar region and no correlation at right molar region.
CONCLUSION: There was a decrease in resting tongue pressure as the malocclusion was corrected from Class II to Class I. Hence, this decrease in pressure could be a contributory factor in the maintenance of the dental equilibrium as lighter forces exist in the oral cavity.
No randomized controlled trial has compared the treatment outcome between surgical mandibular advancement and premolar extractions in class II malocclusion. This 2-arm parallel randomized controlled trial evaluated the treatment effects and lip profile changes in skeletal class II adult patients subjected to bilateral sagittal split ramus osteotomy for mandibular advancement and those treated with premolar extractions. Seventy skeletal class II patients were accessed and forty-six subjects who fulfilled inclusion criteria were distributed randomly into Group CG (patients: 23, mean age: 21.28 ± 2.69 years) and Group SG (patients: 23, mean age: 21.15 ± 2.64 years). Group CG was subjected to extraction of maxillary first premolars and mandibular second premolars followed by implant supported space closure and Group SG was managed by surgical mandibular advancement. Skeletal, dental, and soft-tissue changes were analyzed. The study was single-blinded (statistical analyzer). Groups were closely matched for baseline parameters. In the present trial there was no loss to follow-up. Though overjet and overbite were optimized in both the groups but significant improvement was seen in surgical cases. Group CG demonstrated statistically significant point "A" remodeling, dentoalveolar changes, and increase in nasolabial angle. Group SG exhibited significant sagittal and vertical skeletal improvement and lip position change. Surgical mandibular advancement was found to be a better treatment modality compared to premolars extraction for managing skeletal class II div 1 malocclusion as it permits greater improvement of the profile and skeletal relationship.
Kochar GD, Londhe S, Chopra SS, Kohli S, Kohli VS, Chakranarayan A, Kambojh A, Bhatt S, The Journal of craniofacial surgery
: To observe changes in tooth movements of patients with Class I and Class II malocclusion during the first 6 months of orthodontic treatment and to investigate the relation between TMJ problems and these changes. : The sample was comprised of 63 individuals (20 control, 25 Class I malocclusion, 18 Class II Div. 1 malocclusion). Occlusion analysis was performed through T-Scan® record and chewing pattern examination before and after the 6-month period. The existence of TMD was evaluated using joint vibration analysis (JVA). Patients with malocclusion had active fixed orthodontic treatment. : Disclusion time reduced in the patients group during the treatment period. No association was observed between the first 6-month period of the orthodontic treatment and TMD. : It is suggested that occlusion analyses should be done before any orthodontic treatment, and disclusion time should be minimized as much as possible.
Giray B, Sadry S, Cranio : the journal of craniomandibular practice
AIM: The aim of this study was to assess the changes in maxillary and mandibular third molar inclinations in individuals with class II div 1 malocclusion, before and after orthodontic treatment with extraction of all four first premolars.
MATERIALS AND METHODS: This retrospective study consisted of the pretreatment and posttreatment records of 30 patients that were obtained from the archives of the department of orthodontics and dentofacial orthopedics in A B Shetty Memorial Institute of Dental Sciences. The maxillary third molar's relation to the palatal plane and the mandibular third molar's relation to the mandibular plane were measured. The paired test was used to calculate pre- and posttreatment changes. A value of < 0.05 was considered to be statistically significant.
RESULTS: The maxillary third molars showed a mean correction of 6.15° ( < 0.001) and the mandibular third molars showed a mean correction of 5.10° ( < 0.001).
CONCLUSION: Maxillary third molars showed more uprighting when compared to the mandibular third molars and that both maxillary and mandibular third molars showed an improvement in their angulations to their respective planes after extraction of the first premolars. However, the results of the study cannot be analyzed to state if the third molars do become fully functional.
GreenMedInfo, Journal of International Society of Preventive & Community Dentistry
BACKGROUND: Restricted mandibular growth is observed in Class II Div 2 malocclusions. The fixed functional appliances are used to effect the skeletal changes in patients with end stages of skeletal maturity.
AIM: This cephalometric study aimed to distinguish the skeletal and dental corrections done in the mandible on skeletal Class II Div 2 subjects when treated with PowerScope appliance (American Orthodontics, Sheboygan, WI).
MATERIALS AND METHODS: This is a cephalometric study based on the retrospective data. The patients selected for this study were with Class II Div 2 malocclusion and assessed to be in decelerating phase of skeletal growth. A total of 12 patients were selected after applying inclusion and exclusion criteria. A PowerScope was placed after incisor correction and followed up till Class I molar relation was achieved. The initial values (T1) at the time of placement of the appliance and the final values at the end of the molar correction (T2) were noted. The cephalometric parameters at T1 and T2 were assessed using sagittal occlusal (SO) analysis by Pancherz. The paired Student's -test was used to analyze pre- and posttreatment changes.
RESULTS: There was sufficient lengthening of the mandible (4.38 mm). Both the dental and skeletal alterations were observed in the mandible. These changes were marked compared to the maxilla. The pre- and posttreatment changes were statistically significant for the mandibular skeletal changes ( < 0.001) as well as mandibular incisor proclination ( < 0.001).
CONCLUSION: The PowerScope can be used as a propeller for sagittal mandibular correction in Class II Div 2 patients.
GreenMedInfo, Journal of pharmacy & bioallied sciences
INTRODUCTION: Crowding of teeth is one of the most common problem that motivates the patient to seek orthodontic treatment. Determination of etiology of crowding could have a significant effect on treatment planning and prognosis of Class II malocclusion.
AIM: Aim of this study was to evaluate the relationship of skeletal and dental parameters to amount of dental crowding in patients with Class II Divison 1 (div.1) malocclusion.
MATERIALS AND METHODS: Pretreatment lateral cephalograms and dental casts of 60 patients with skeletal Class II malocclusion were collected for the study. The sample was divided into two groups according to severity of pretreatment mandibular crowding. Group I consisted of cases with crowding ≥3 mm and Group II with crowding <3 mm. Lateral cephalograms for each patient was manually traced and skeletal parameters (effective maxillary and mandibular length, mandibular plane angle, Y Axis, lower anterior face height) and dental parameters (axial inclination of lower incisor, inclination of lower incisor to mandibular plane, interincisal angle) were measured. Unpaired t-test was used for intergroup comparison and relationship between different measurements was investigated using Pearson correlation coefficient.
RESULTS: Among the skeletal parameters measured, only effective mandibular length exhibited statistically significant difference between the two groups. No statistically significant difference was found between the two groups for any of the dental parameters. Significant inverse correlation was found between mandibular crowding and effective mandibular length.
CONCLUSION: Subjects with Class II div.1 malocclusion and moderate to severe mandibular crowding have significantly smaller effective mandibular base length than subjects with the same malocclusion and slight mandibular crowding.
GreenMedInfo, Journal of clinical and diagnostic research : JCDR
BACKGROUND: Nonsurgical correction of deep bite involves either extrusion of posterior teeth, intrusion of incisors, or combination of both. The introduction of skeletal anchorage device with microimplant provides near absolute anchorage without producing any untoward effects on anchor unit. Connecticut Intrusion Arch (CIA) provided an efficient system of intruding anterior segment without producing much adverse affects on anchor teeth.
METHODS: The study comprised of 30 patients of Class II Div 1 malocclusion with overbite of >6 mm and required therapeutic extractions of all first premolars, randomly distributed into two groups. Group 1 was treated using orthodontic microimplants, while Group 2 treated with CIA. Lateral cephalograms were taken pre-intrusion (T1) and post-intrusion at the end of six months (T2).
RESULTS: The rate of intrusion was 0.51 and 0.34 mm/month for Group 1 and Group 2 respectively. The average amount of change in centroid point to PP distance and U1-SN angle was significantly higher in Group 1 compared to Group 2 ( < 0.001). The average amount of change in U6 to PP distance did not differ significantly between two study groups ( > 0.05).
CONCLUSION: The amount of intrusion is significantly higher in SAD group. Although vertical molar positional change was higher in CIA group than the SAD group, it was not changed significantly in both treatment modalities. SAD group overall had better results and was easier in handling during intrusion.
This case report describes the orthodontic treatment of a male, aged 13.2 years, with permanent aentition, sagittal skeletal Class II division 2 malocclusion. His chiefcompliant was the position of the maxillary incisors, displaced too palatally, and an impaired facial profile. Twin block and 0.022 x 0.028 inch pre-adjusted-edge wise appliance, were used to correct the sagittal discrepancy and to improve the attractiveness of the impaired facial profile. The total treatment duration was decreased with the use of synergistic approach.
Shastri D, Tandon P, Singh GP, International journal of orthodontics (Milwaukee, Wis.)
STATEMENT OF PROBLEM: A thorough knowledge of the salient features of malocclusion makes the practitioner to come to a proper diagnosis and to formulate proper mechanotherapy. It also helps to predict the prognosis, prior to the onset of treatment process. Among the various malocclusions, Class II div 2 occurs the least often. The literature review does not clearly describe the classical skeletal and dental features of Angle's Class II div 2 malocclusion.
PURPOSE OF STUDY: The aim of this study is to describe the unique features of Angle's Class II division 2 malocclusion.
MATERIALS AND METHODS: A total of 612 pre-treatment records (study models and cephalograms), with age ranging from 14 to 25 years, were obtained from the hospital records of Drs Sudha and Nageswar Rao Siddhartha Institute of Dental Sciences. Among these samples, 317 were Class II div 1 and 295 were Class II div 2. The lateral cephalograms were analyzed by using Kodak software and the arch width analysis was calculated by using digital vernier calipers.
RESULTS: Student's t test was used for the study. On the cephalograms, the vertical skeletal measurements and few of the dental variables showed a significant difference. On the plaster models, the maxillary transverse measurements revealed a notable discrimination between the groups.
CONCLUSION: Angle's Class II div 2 malocclusion has a marked horizontal growth pattern with decreased lower facial thirds, palatally inclined upper anteriors, and remarkably increased transverse maxillary arch dimensions.
GreenMedInfo, Journal of International Society of Preventive & Community Dentistry
INTRODUCTION: Tooth extraction to provide sufficient space, or camouflage of underlying skeletal problems is quite common in orthodontics. The present study evaluated soft tissue changes after upper first premolars extraction in class ΙΙ div 1 patients.
MATERIAL AND METHODS: 20 cases (15 females, 5 males), with a mean age of 17.8±2.9 years with class ΙΙ div1 malocclusion and normal vertical height, who needed upper first premolars extraction were selected. Pre- and post-treatment lateral cephalometric radiographs were digitized. Image analysis was conducted by View Box 3.1.1 software. Paired t-test was used for comparison of pre- and post-treatment results.
RESULTS: The relationship of upper and lower lip to E-line and B-line had significant reduction. Dental variables of U1-NA(mm), U1-NA(°), overjet and overbite showed statistically significant reduction. Interincisal angle had significant increase. There were no significant difference in lower incisor variables and skeletal variables like SN-GoGn and FMA.
CONCLUSIONS: Extraction of upper first premolars in patients with class ΙΙ div 1 malocclusion resulted in normal position of lips as presented by Holdaway, Legan and Ricketts which play a role in aesthetic profile. However, the amount of lip retraction was different from patient to patient. Key words:Soft tissue, fixed orthodontic treatment, class ΙΙ div 1, upper first premolar extraction.
Amirabadi GE, Mirzaie M, Kushki SM, Olyaee P, Journal of clinical and experimental dentistry
Should treatment of a Class II div. 1 malocclusion begin in the early, in mixed dentition or later in the adolescent dentition? In a Cochrane review, the authors conclude: "The evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth is no more effective than providing one course of orthodontic treatment when the child is in early adolescence." So, should you wait to treat ? Certainly not ! Many arguments in favor of early treatment are: reduction of the risk of fracture of prominent incisors, esthetic factors, increase in patient self-esteem and reduction of negative social experiences, reduction of the length of fixed appliance therapy thereby reducing possible iatrogenic effects, creating an environment more favorable to harmonious growth and development, without forgetting the legal concept of loss of opportunity. These elements will be developed in a literature review and illustrated by a clinical case.
In our opinion, the main goal of orthodontic treatment has now shifted from attaining normal occlusion to achieving a pleasing soft tissue profile. The following case report presents a case in which normal dental and skeletal relations as well as a pleasing soft tissue profile was achieved. The female growing patient presented with convex profile and incompetent lips with deep mentolabial sulcus. On examination she exhibited a normal maxilla, deficient mandible with a horizontal growth pattern and Class II, Div I malocclusion dentally. Her growth potential was utilized fully with the twin block functional appliance followed by fixed orthodontic treatment. A favorable skeletal, dental and soft tissue relationship was achieved using this two phase therapy.
Jyothikiran H, Shanthraj R, Kumar YP, Subbiah P, International journal of orthodontics (Milwaukee, Wis.)
AIMS: To determine if the palatal rugae have a characteristic pattern in untreated class II div 1 malocclusions compared to normal class I occlusions, and to provide a valuable insight whether palatal rugae can be taken up as additional criteria for classifying malocclusions.
MATERIALS AND METHODS: The study was conducted on initial maxillary dental casts of 24 individuals with untreated class II div 1 malocclusion with an overjet of minimum of 5mm, of whom 12 were females and 12 were males, with age ranging from 16 to 24 years and compared with Class I patients casts.
RESULTS: There was no statistically significant difference in the mean intermolar widths of the two groups. The first, second and third palatal rugae were shorter in class II div 1 patients than in class I patients which was statistically significant. All the patients with Angle's class I occlusion had good pattern of palatal rugae falling in the score range of 1-3, whereas 22% of the patients with class II div 1 had poor pattern of palatal rugae, with score 4 and 2 patients exhibiting a score of 4 and 5, respectively, but this was not statistically significant.
CONCLUSION: There was a significant constriction of the palatal rugae in class II div 1 individuals as compared to class I individuals, though they were matched for the same intermolar widths. There was a distinct pattern of palatal rugae between the two groups.
Gandikota C, Venkata YP, Challa P, Juvvadi SR, Mathur A, Journal of pharmacy & bioallied sciences
This case report describes the use of an osseointegrated implant to maximize anchorage in a 24-year-old female orthodontic patient with an Angle Class II, Division 1 malocclusion. Preadjusted edgewise appliance therapy was performed by extraction of only the maxillary first premolars. The osseointegrated implant was placed in the median-sagittal region of the hard palate for maximum orthodontic anchorage and connected to maxillary first molar bands via a transpalatal arch. Total treatment time was 2 years and 8 months. Cephalometric superimposition revealed the achievement of maximum molar anchorage in the maxilla, resulting in satisfactory occlusal and facial improvements. Histological analysis of the implant-bone interface demonstrated that the fixture was successfully osseointegrated. In conclusion, the osseointegrated implant placed in the median-sagittal palate was shown to be an effective orthodontic system that can be used clinically as a rigid intraoral anchorage.
Nojima K, Komatsu K, Isshiki Y, Ikumoto H, Hanai J, Saito C, The Bulletin of Tokyo Dental College
A study was conducted using dermatoglyphics to predict and compare Class I, Class II, div. 1, div.2 and Class III malocclusions. A total of 96 subjects were divided into 3 malocclusion groups, i.e. Class I (control group), Class II, div.1, div.2 and Class III (experimental group) in the ages of 12-14 years. The dermatoglyphic findings revealed that the craniofacial Class II, div. 1, div.2 pattern was associated with increased frequency of arches and ulnar loops and decreased frequency of whorls, whereas in Class III, there was an increased frequency of arches and radial loops with decreased frequency of ulnar loops. In predicting Class III malocclusion, based on frequency of arches, the sensitivity values were found to be higher and more reliable than the sensitivity values of Class II, div.1 and div.2 malocclusion.
Reddy S, Prabhakar AR, Reddy VV, Journal of the Indian Society of Pedodontics and Preventive Dentistry
Craniofacial characteristics in two groups of children were compared. In one group (n = 22) the children had Angle Class II division 2 malocclusion combined with extreme deep bite. The other group (n = 25) was composed of children with ideal occlusion. The mean ages of the children were 12.8 and 12.9 years respectively. In the Class II-2 group the distance between gonion and B-point was underdeveloped, causing B-point to have a retruded position in relation to both A-point and cranial base. The Class II-2 children also had a retroclination of the symphysis, which gave the B-point a retruded position in relation to pogonion. As for vertical dimensions, Class II-2 children had a smaller anterior lower facial height than normal. Furthermore, Class II-2 had a discrepancy between the maxillary incisal and molar heights, i.e. a slightly larger incisal height and a slightly smaller molar height. Finally, children with Class II-2 had a high lip line and a very large interincisal angle. Three variables--the sagittal distance between points A and B, the inclination of the symphysis, and the relationship between the maxillary incisal and molar heights--in combination, differentiated nearly 100% correctly between Class II-2 and normal occlusion.
Karlsen AT, The Angle orthodontist
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