Evaluation of tongue posture & dimensions in relation to skeletal Class I and Class II patterns- A cephalometric study

Association of tongue posture with dental and facial skeletal pattern have been suggested in past. This study was undertaken to assess tongue posture and dimensions in Class I and Class II Dentoskeletal patterns to determine whether any correlation exists between tongue posture and skeletal pattern of an individual. Cephalograms of 150 individuals (aged 18-23 years), taken in Natural Head Position (NHP) and tongue at rest were divided into three groups i.e. Group 1 – Class I Normal occlusion, Group 2 – Class II Division 1 Normodivergent and Group 3 – Class II Division 1 Hypodivergent, consisting of 50 samples each. To ensure the rest position of tongue, patient was asked to relax for 30 seconds after coating the tongue with barium sulphate in midline and then to swallow, and the X-ray was taken at the end of swallowing. Each group was divided into two subgroups according to sex. Groups were constituted according to the Frankfort mandibular plane angle (FMA) angle. The subjects who had skeletal Class II pattern due to mandibular retrusion and not due to maxillary prognathism were only included in the study group. Statistical analysis was done using the software SPSS version 21.0. The statistical tests used were unpaired t-test and One-way ANOVA test with post-hoc bonferroni test. The p-value was considered significant if less than 0.05.The dorsum of the tongue was higher at back and lower in front in Class II Division 1 Hypodivergent group as compared to Class I Normal occlusion group (P<.05). Tongue height and tongue length were significantly reduced in Class II Division 1 Normodivergent and Class II Division 1 Hypodivergent malocclusion groups when compared to Class I control group (P<.05).The study supports the existence of a relationship between posture & dimensions of the tongue with Class I and Class II skeletal patterns.

Dentoskeletal effects of Twin Block appliance in patients with Class II malocclusion

Background and aim. Class II malocclusions are most commonly seen in orthodontic practice and in the recent times Twin Block appliance has been the most popular and widely used among removable functional appliances for the correction of Class II malocclusion in growing patients. The aim of this retrospective study was to evaluate the dentoskeletal effects produced by the Twin Block appliance for the correction of Class II division 1 malocclusion with retrognathic mandible. Methods. Pre-treatment (T1) and post-treatment (T2) lateral cephalograms of 30 patients treated with Twin Block appliance (mean age = 10.8 ± 1.2 years) for the correction of class II division 1 malocclusion were compared with the 30 untreated class II control patients (mean age 11.2 ± 0.8 years) who did not undergo any treatment during this period. Both the groups were evaluated for the dentoskeletal changes using 24 angular and linear cephalometric measurements. The differences between the pre and post-treatment were calculated using a paired t-test. Results. The cephalometric analysis revealed that the Twin Block appliance stimulated mandibular growth and statistically significant differences were found between the two groups. Twin Block patients showed a statistically very high significant (p<0.001) increase in mandibular length (6.02 mm) compared with the control group (0.3 mm). ‘Headgear effect’ on the maxilla, increase in lower anterior facial height, significant reduction of overjet, overbite and Class I molar relationship was achieved in the Twin Block group. However, no significant changes appeared in the control group. Conclusion: The results of the present study conclude that the Twin Block appliance is effective in the treatment of Class II malocclusion and this is due to a combination of skeletal and dentoalveolar changes in both the arches.

Management of Class II Division 1 Subdivision malocclusion using unilateral bicuspid extractions and fixed functional appliance: A Two Year Follow-Up

Introduction: Management of Class II Subdivision cases pose a clinical dilemma and require a careful diagnosis to ascertain the source of asymmetry. Various treatment modalities involving: different protocols of tooth extractions; molar distalization; fixed functional appliances or orthognathic surgery have been proposed for the same. Objective: This article reports a unique approach for management of a severe skeletal Class II with Angle’s Class II Division 1 subdivision malocclusion using unilateral bicuspid extractions in mandibular and maxillary arches and a fixed functional appliance. Results: A 13 year 1 month old male in CVMI transition stage was successfully treated. Extraction of #44 was done to alleviate crowding in the mandibular anterior region and #15 was extracted to protract #16 to achieve a Class II molar relationship. A pre-functional Class II molar and canine relationship with co-incident midlines was achieved. The functional phase consisted of a fixed functional appliance (Forsus FRD) for mandibular advancement to correct the severe skeletal Class II. Class I molar and canine relationships were achieved with reduction of facial convexity and overjet. Result remained stable 24 months after treatment. The improvement can be quantified by the reduction in scores of orthodontic indices measured pre and post treatment. Conclusions: Management of Class II subdivision malocclusion requires careful planning. This paper presents a unique approach utilizing unilateral extractions and fixed functional appliance to address severe skeletal Class II discrepancy and the subdivision dilemma.

The twin-block appliance for correction of class II division 1 malocclusion

The twin-block appliance is a widely used functional appliance for the correction of Class II division 1 malocclusion in growing children and adolescents. This article outlines the indications and case assessment, the steps in clinical management and appliance design. Evidence regarding the mode of action, effects and prediction of treatment outcome of the twin-block appliance for Class II division 1 malocclusion are also presented. CPD/Clinical Relevance: The twin-block appliance is a widely used functional appliance in the UK for the correction of Class II division 1 malocclusion in growing children and adolescents.

Comparative Evaluation of Esthetic and Structural Aspects in Class II Functional Therapy. A Case-Control Retrospective Study

To compare the skeletal, dental, and esthetic changes produced by three functional devices, Fränkel-2 appliance (FR-2), Twin Block (TB), and Occlus-o-Guide® (O-o-G®), for the treatment of Class II malocclusion. Methods: Sixty-five patients with Class II Division 1 malocclusion were divided into three groups and were analyzed through cephalometric analysis of skeletal, dental, and esthetic variables before and after treatment. The first group of 23 patients (F: 9; M: 14; mean age: 10.3 ± 1.08 years) was treated with FR-2, the second group of 18 patients (F: 8; M: 10; mean age 10.7 ± 1.05 years) was treated with TB, the third group (F: 11; M: 13; mean age: 9.05 ± 0.39 years) of 24 patients was treated with O-o-G®. The structural effects of the three devices were compared with a control group generated by the growth variations reported in the cephalometric atlas of Bhatia and Leighton. Esthetic analysis was performed comparing the results of the patients treated with a control group of 20 subjects with mandibular retrognathia and Class II Division 1 malocclusion, not subjected to therapy. Results: The three devices resulted in a significant increase in mandibular length, with higher results obtained for FR-2 and TB. A statistically significant increase in the IMPA angle was found for the O-o-G® group, and a notable reduction of both overjet and overbite was detected in all three groups of treated patients. The esthetic evaluation showed overall more significant results in the TB group, especially with regard to the reduction of facial convexity. The retrusion of the upper lip was on average more significant in the O-o-G® group, followed by that in the TB. Conclusion: All three devices have proven to be effective overall in resolving skeletal changes and improving facial esthetics.

Long Term Stability of Skeletal Class II Treatment with Modified Bionator Followed by Fixed Appliance - A Case Report

The most prevalent malocclusion seen in day-to-day practice is Class II division 1 malocclusion. Most patients with malocclusions in class II division 1 have an underlying skeletal difference between the maxilla and the mandible. The treatment of skeletal class II division 1 depends on the patient's age, the ability of growth potential, the seriousness of malocclusion, and the patient's adherence to treatment. Myofunctional equipment can be successfully used to treat rising patients with deficient mandible class II division 1 malocclusion. This case report shows a focus on Class II Division 1 care due to mandibular deficiency using modified bionator appliances accompanied by fixed mechanotherapy with growth modification approach. Class II Division 1 is one of the most widely encountered form of malocclusion in human populations. The common characteristic of Class II Div 1 malocclusion in growing children is mandibular retrusion, according to Dr. James McNamara.1 The prevalence of Skeletal Class II malocclusion is 15 % of the world's total population. Underlying difference between Maxillary & Mandibular jaw makes the Class II Div 1 malocclusion more complex than it appears. It’s due to a contribution of only maxilla, or only mandible, or a combination of both. The treatment of Class II division 1 relies on the patient's age, growth ability, degree of malocclusion, and patient compliance with therapy.1,2 The cases with retrognathic mandible must be addressed by altering the direction & amount of mandibular growth by using functional appliances.3 The Bionator is a tooth-borne appliance that significantly changes dental and skeletal component of the face through a repositioning of mandible in a more protrusive & balanced way, selective eruption of teeth and profile enhancement.4-7 The Balters Bionator was first introduced in 1960 by Wilhelm Balters as a functional appliance & still one of the most widely used removable appliances for correction of mandibular retrognathism.8 In functional orthopaedics, all aspects of genetically determined individual growth patterns are important, most particularly time, potential, and growth direction. Although during the prepubertal phase there is limited skeletal development, substantial growth occurs during puberty, but with great individual variation. To prevent damage to erupting teeth and to normalize jaw growth, early functional orthopaedic intervention in the prepubertal phase is used.9,10,11 The purpose of this case report is to illustrate how satisfactory results were obtained in the treatment of Class II division 1 malocclusion with modified Bionator in young patients. The positive facial, dental and cephalometric improvements are also illustrated, with the aid of proper diagnosis, amplified by excellent patient cooperation in case selection.