FUNCTIONAL TREATMENT OBJECTIVE-ROLE IN TWO PHASE TREATMENT

ABSTRACT A distal occlusion exerts restraining occlusal forces on the mandibular dentition, and the maxillary dental arch is narrow from distal positioning of the lower dentition. These factors may not allow the mandible to grow to its full genetic potential In severe class II. In the hands of an experienced clinician, full time functional appliances are most efficient in correcting severe class II malocclusion than conventional fixed appliance techniques without mandibular propulsion. This is especially true when the treatment is timed to coincide with the pubertal growth spurt. A case successfully treated with two phase treatment to meet the functional treatment objective is presented.

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Two-Phase Treatment of a Growing Patient with a Skeletal Class II

Journal of Contemporary Dentistry ◽

10.5005/jp-journals-10031-1033 ◽

2013 ◽

Vol 3 (1) ◽

pp. 40-43

Author(s):

Shashank Sharad Gaikwad ◽

Manish Suresh Sonawane ◽

Girish Ramchandra Karandikar ◽

Priyanka Anil Pawar ◽

Shaili Sanjay Shah

Keyword(s):

Class Ii ◽

Two Phase ◽

Lower Lip ◽

Fixed Appliance ◽

Twin Block ◽

Skeletal Class ◽

Skeletal Class Ii ◽

Space Closure ◽

Skeletal Change ◽

Functional Appliances

ABSTRACT Functional appliances have been used for many years in the treatment of class II malocclusions. They redirect the growth of mandible bringing about a skeletal change in a growing patient. In case of any remaining dental discrepancy, a fixed appliance is obligatory. This patient was an 11-year-old growing female with a convex profile, receding chin, lower lip trap, class II skeletal and dental relationship, a large overjet and overbite and a high maxillary labial frenum attachment. Treatment started with the Twin-block appliance with an expansion screw to achieve transverse correction, promote growth of the mandible and improve her profile. This was followed by fixed appliance mechanotherapy to align and level the dentition, close spaces and retract the maxillary anteriors. Frenectomy was carried out after space closure. How to cite this article Sonawane MS, Karandikar GR, Gaikwad SS, Pawar PA, Shah SS. Two-Phase Treatment of a Growing Patient with a Skeletal Class II. J Contemp Dent 2013;3(1):40-43.

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Functional and Orthodontic Treatment of a Class II Malocclusion: Case Report

Open Access Journal of Dental Sciences ◽

10.23880/oajds-16000295 ◽

2021 ◽

Vol 6 (2) ◽

Author(s):

Sarah Saif

Keyword(s):

Orthodontic Treatment ◽

Negative Impact ◽

Periodontal Diseases ◽

Dental Trauma ◽

Class Ii ◽

Growth Spurt ◽

Second Phase ◽

Class Ii Malocclusion ◽

Two Phase ◽

Fixed Appliance

Class II malocclusion, the distal relationship between mandibular and maxillary molars, is very frequent in the population. In growing patients it carries a great risk of dental trauma, a more negative perception of facial and dental aesthetics a negative impact on the quality of life and self-esteem, a greater predisposition to periodontal diseases and a greater incidence of sleep disorders. It has different etiologies. Thus many treatment approaches can be used to correct this condition, either an orthopedic treatment and orthodontic treatment or a combination protocol. Functional devises have been widely used for the correction of the sagittal intermaxillary relationship in growing patients, but especially in the treatment of Class II. The success of a two phase treatment depends on its initiation during the growth period and on the patient’s degree of implication. This case illustrates a two phase treatment where sagittal correction was undertaken before transverse correction to make optimal use of the patient's pubertal growth spurt in first phase followed by a second phase of fixed appliance therapy during adolescence to achieve optimal results.

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TWO PHASE FOR A BETTER FACE!! TWIN BLOCK AND HEADGEAR FOLLOWED BY FIXED THERAPY FOR CLASS II CORRECTION

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703896 ◽

2015 ◽

Vol 05 (02) ◽

pp. 074-079

Author(s):

U S Krishna Nayak ◽

Ashutosh Shetty ◽

Crystal Runa Soans ◽

Vivek Bhaskar

Keyword(s):

Single Phase ◽

Class Ii ◽

Functional Appliance ◽

Two Phase ◽

Facial Profile ◽

Fixed Appliance ◽

Twin Block ◽

Early Correction ◽

The Social ◽

Two Phases

AbstractCorrection of a skeletal sagittal Class II in a growing child can be done either in one single phase of treatment, or in two phases, i.e a first phase of functional appliance to reduce the severity of the skeletal discrepancy, followed by fixed appliance therapy to refine the occlusion. This 2 phase treatment has quite a few advantages such as early correction of the facial profile is seen by the child and parent, which motivates them, as well as, reduces the social handicap produced as a result of the malocclusion. Hence, this case report describes the treatment of a Class II child, with a Twin block appliance followed by fixed orthodontic treatment.

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Indian Board of Orthodontics Case Report: Management of Class II Skeletal Malocclusion Using 2-Phase Treatment

The Journal of Indian Orthodontic Society ◽

10.1177/03015742211055910 ◽

2021 ◽

Vol 55 (4) ◽

pp. 418-423

Author(s):

T. Shobbana Devi

Keyword(s):

Case Report ◽

Class Ii ◽

Maturation Stage ◽

Lower Lip ◽

Fixed Appliance ◽

Skeletal Malocclusion ◽

Horizontal Growth ◽

Growth Modification ◽

Treatment Objective ◽

Cervical Maturation

KL, a 12-year-old boy, presented with a class II Div I malocclusion on a class II skeletal base (retrognathic mandible) with a 7-mm overjet and a horizontal growth pattern. He had a convex profile, incompetent lips, lip trap, deep mentolabial sulcus, everted lower lip, and positive visual treatment objective (VTO). KL had a CS2 cervical maturation stage, which indicates 65% to 85% adolescent growth remaining. Treatment involved growth modification using a removable Twin Block with midpalatal expansion screw. This was followed by upper and lower fixed appliance using 0.022” × 0.028” slot Mclaughlin Bennet and Trevisi (MBT) prescription. The retention protocol involved upper wrap around and lower lingual bonded retainer.

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The Effects of Functional Appliances on Female Patients with Skeletal Class II Malocclusion 6 Months after Menarche

The Journal of Contemporary Dental Practice ◽

10.5005/jp-journals-10024-1843 ◽

2016 ◽

Vol 17 (4) ◽

pp. 286-293

Author(s):

Ali AM Jouybari ◽

Valiallah Arash ◽

Saeid Tavanafar ◽

Soraya Khafri ◽

Zahra Dehghan

Keyword(s):

Soft Tissue ◽

Class Ii ◽

Growth Spurt ◽

Class Ii Malocclusion ◽

Skeletal Class ◽

Female Patients ◽

Skeletal Class Ii ◽

Soft Tissue Profile ◽

Functional Appliances ◽

The Mean

ABSTRACT Aim To investigate the skeletal, dental, and soft tissue changes in girls with class II division 1 malocclusion after growth spurt peak under the effect of activator appliance. Materials and methods In this clinical trial study, 15 female patients, with skeletal class II and mandibular growth deficiency and at least 5 mm overjet, were randomly selected 6 months after their menarche. The mean of their ages at the beginning was 12.33 ± 0.81 years, and in the end it was 13.73 ± 0.79 years; the mean duration of treatment was 12.2 ± 3.18 months. Lateral, cephalometric radiographs were taken from all the patients before and after the treatment. Data were analyzed with Statistical Package for the Social Sciences (SPSS) 20 using paired t-test. Results On an average, the ANB angle, the angle of the upper incisors with the S-N, facial convexity, and overjet decreased by 2.6° ± 0.9, 5.4° ± 0.8, 3.8° ± 3.4, and 5.6 ± 1.8 mm respectively. The SNB angle, the angle of the lower incisors with the N-B, the labiomental angle, the total length of the mandible, the lower anterior facial height, the lower lip distance, the first molar of the mandible, and the soft tissue pogonion to the vertical line from the S point increased by 2.8° ± 1.8, 3.4° ± 3, 14.7 ± 15, 3.7 ± 2.6, 2.1 ± 1.6, 6.3 ± 2.5, 4.4 ± 2.4, and 6 ± 3.3 mm respectively. All these figures were statistically significant (p = 0.000). Conclusion The functional appliance improved the dental–skeletal relations and the soft tissue profile of patients after growth spurt peak of puberty in a group of Iranian girls, whereas dental changes were more than skeletal ones. Clinical significance Functional appliances can be used for correction of skeletal class II malocclusion 6 months after menarche in girls. How to cite this article Jouybari AAM, Arash V, Tavanafar S, Khafri S, Dehghan Z. The Effects of Functional Appliances on Female Patients with Skeletal Class II Malocclusion 6 Months after Menarche. J Contemp Dent Pract 2016;17(4):286-293.

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Indian Board of Orthodontics Case Report: Management of a Skeletal Cl II Malocclusion Using Two-phase Treatment with a Standard Twin Block Appliance

The Journal of Indian Orthodontic Society ◽

10.1177/0301574219861790 ◽

2019 ◽

Vol 53 (3) ◽

pp. 219-226

Author(s):

Hrushikesh Aphale

Keyword(s):

Class Ii ◽

Growth Modulation ◽

Two Phase ◽

Lower Lip ◽

Twin Block ◽

Long Term Stability ◽

Curve Of Spee ◽

Facial Esthetics ◽

Treatment Objective ◽

Two Phases

NK, a 12-year-old male patient, presented with a Class II division 1 incisor relation on a Class II skeletal base with a decreased maxillomandibular plane angle and decreased face-height ratio. He had a convex profile, incompetent lips, lip trap, deep mentolabial sulcus, everted lower lip and a positive VTO (Visual Treatment Objective). Intraorally, he presented with bilaterally Angle’s Class II molar relation and canine relation, scissor bite in the region of first premolars bilaterally, a closed bite and a 13 mm overjet. He presented with mild spacing in the upper arch and mild crowding in the lower arch with a pronounced curve of Spee. This was further complicated as the LR6 was endodontically treated and temporarily restored; also, enamel hypoplasia was seen in all permanent first molar region. The treatment was carried out in two phases, Phase I involved growth modulation done with a twin block appliance, and Phase II was the postfunctional orthodontic phase for dental corrections and finishing and detailing of occlusion, which was done with a preadjusted edgewise appliance (0.022 × 0.028˝ slot) with MBT (McLaughlin, Bennett, Trevisi) prescription. The posttreatment results were highly satisfactory, showing improvement in facial esthetics and occlusal traits as well as good long-term stability as was evident in the 3-year retention records.

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The Third Finger Middle Phalanx Maturation (MPM) Method to Assess Timing of Functional Treatment for Skeletal Class II Malocclusion: Report of Three Cases

Case Reports in Dentistry ◽

10.1155/2019/8382612 ◽

2019 ◽

Vol 2019 ◽

pp. 1-16

Author(s):

Giuseppe Perinetti

Keyword(s):

Sagittal Plane ◽

Class Ii ◽

Functional Treatment ◽

Individual Growth ◽

Growth Spurt ◽

Class Ii Malocclusion ◽

Middle Phalanx ◽

Skeletal Class ◽

Skeletal Class Ii ◽

Skeletal Effects

A deficient mandibular growth on the sagittal plane is the most frequent diagnostic finding in dentoskeletal Class II malocclusion. Evidence indicated that functional treatment for such malocclusion is efficient only if performed during the pubertal growth spurt, as identified through radiographical growth indicators. With the aim of reducing the radiation to the patients and to follow longitudinally individual growth phases, the use of the sole third finger middle phalanx maturation (MPM), as a 5-stage method, has been proposed. Herein, three clinical cases of skeletal Class II malocclusion in growing patients treated by removable functional appliances (with or without full-fixed appliance treatment) are reported. Timing of intervention was strictly planned according to the MPM method, and skeletal effects have been recorded up to 21 months of follow-up. In all the cases, noteworthy skeletal effects have been achieved in terms of mandibular elongation, with relevant occlusal and aesthetic outcomes. It has also been showed that results are stable or slightly improved after functional treatment. These results would be achieved irrespective of the appliance used and support the use of the MPM method in everyday clinical practice.

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Reliability of Growth Indicators and Efficiency of Functional Treatment for Skeletal Class II Malocclusion: Current Evidence and Controversies

BioMed Research International ◽

10.1155/2017/1367691 ◽

2017 ◽

Vol 2017 ◽

pp. 1-19 ◽

Cited By ~ 7

Author(s):

Giuseppe Perinetti ◽

Luca Contardo

Keyword(s):

Class Ii ◽

Functional Treatment ◽

Current Evidence ◽

Growth Spurt ◽

Class Ii Malocclusion ◽

Pubertal Growth Spurt ◽

Skeletal Class ◽

Pubertal Growth ◽

Skeletal Class Ii ◽

Growth Indicators

Current evidence on the reliability of growth indicators in the identification of the pubertal growth spurt and efficiency of functional treatment for skeletal Class II malocclusion, the timing of which relies on such indicators, is highly controversial. Regarding growth indicators, the hand and wrist (including the sole middle phalanx of the third finger) maturation method and the standing height recording appear to be most reliable. Other methods are subjected to controversies or were showed to be unreliable. Main sources of controversies include use of single stages instead of ossification events and diagnostic reliability conjecturally based on correlation analyses. Regarding evidence on the efficiency of functional treatment, when treated during the pubertal growth spurt, more favorable response is seen in skeletal Class II patients even though large individual responsiveness remains. Main sources of controversies include design of clinical trials, definition of Class II malocclusion, and lack of inclusion of skeletal maturity among the prognostic factors. While no growth indicator may be considered to have a full diagnostic reliability in the identification of the pubertal growth spurt, their use may still be recommended for increasing efficiency of functional treatment for skeletal Class II malocclusion.

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Comparative Analysis of Dentoskeletal Changes of the Twin Block Appliance and the AdvanSync2 Appliance in Treatment of Skeletal Class-II Malocclusion in Pakistani Population: A Randomized Clinical Trial

European Journal of Dentistry ◽

10.1055/s-0041-1739543 ◽

2021 ◽

Author(s):

Fareena Ghaffar ◽

Abdullah Jan ◽

Obaid Akhtar ◽

Alaina T. Mughal ◽

Rooma Shahid ◽

...

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Class Ii ◽

Growth Spurt ◽

Class Ii Malocclusion ◽

Twin Block ◽

Skeletal Class ◽

Skeletal Class Ii ◽

Significant Difference ◽

Functional Appliances

Abstract Objective This study aimed to compare dentoskeletal changes in skeletal class-II malocclusion with removable twin block appliance and fixed AdvanSync2 appliance. Materials and Methods A prospective randomized clinical trial was conducted over a span of 1 year at AFID at Rawalpindi. Thirty patients with skeletal class-II malocclusion, 16 males (53.3%) and 14 females (46.6%), were randomly selected and divided in two equal groups (15 each) to be treated with either fixed functional appliances (FFAs) or with removable functional appliances (RFAs). Out of 30 patients, 15 between cervical vertebral maturation (CVM) stages of 2 and 3 were treated with RFA (twin block appliances) and remaining 15 between CVM stages of 4 and 5 were treated with FFA (AdvanSync2 appliances). Pretreatment (T1) and posttreatment (T2), angular variable, and linear variable were measured to compare the dentoskeletal effects between the two groups. Statitical Analysis Paired sample t-test was used to assess significant difference between variables at T1 (Pre-treatment) and T2 (Post-treatment) stage for both RFA and FFA group. Comparison among the RFA and FFA group was made using non-parametric Mann-Whitney U Test. IBM SPSS version 25.0 was used for evaluation. Results No significant difference was found in angular variables between the RFA and FFA groups (p > 0.05) with the exception of linear variables. Sella-posterior nasal spine (S-PNS) length significantly increased and Jarabak's ratio significantly decreased for FFA group (p = 0.010 and 0.045, respectively), when compared with RFA group. Conclusion Both the appliances, twin block (RFA) and AdvanSync2 (FFA), are effective for correction of skeletal class-II malocclusion. Both the appliances produced similar effects in the sagittal plane but for better vertical control twin block should be the appliance of choice. AdvanSync2 appliance could be preferred over twin block appliance when dentoalveolar and slight retrusive effect on the maxilla is desired especially for individuals in postpubertal growth spurt.

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Dentofacial changes after treatment with prefabricated functional appliance T4CII

Stomatoloski glasnik Srbije ◽

10.2298/sgs1302093a ◽

2013 ◽

Vol 60 (2) ◽

pp. 93-98

Author(s):

Ema Aleksic ◽

Maja Lalic ◽

Jasmina Milic ◽

Mihajlo Gajic ◽

Zdenka Stojanovic

Keyword(s):

Female Patient ◽

Orthodontic Treatment ◽

Class Ii ◽

Dental Arch ◽

Functional Appliance ◽

Orthodontic Appliance ◽

Deep Bite ◽

Fixed Appliance ◽

Division 1 ◽

Class Ii Division 1

Introduction. Functional maxillary orthodontics has a large number of different mobile devices with different effects on craniomandibular system and great capabilities in solving many orthodontic problems. The aim of this article was to show the effects of 9-month treatment of malocclusion class II, division 1 in a 14-year-old female patient using pre-fabricated functional appliance Trainer T4CII. Case Outline. Skeletal distal relation, deep bite, increased overjet, narrowness and irregular position of upper and lower frontal teeth are indicated for orthodontic treatment with fixed appliance. After refusal of fixed appliance therapy, a female patient was proposed treatment with mobile orthodontic appliance. A pre-fabricated functional appliance Trainer T4CII was delivered to the patient. She was motivated and she was wearing appliance at night and 2-3 hours during the day. After 9 months of treatment there was a significant improvement in the position of upper and lower frontal teeth and reshaping of upper and lower dental arch, yet overbite and overjet were corrected. Conclusion. Surprisingly good and fast improvement of all problems within class II, division 1 in a 14-year-old patient was achieved with prefabricated functional appliance Trainer T4CII.

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