ABSTRACT Functional appliances have been used over a century in clinical orthodontic treatments for skeletal Class II malocclusion patients. Its popularity is attributed to its high patient adaptability and ability to produce rapid treatment changes. The twin block and lip bumper can be combined depending on the patient’s cases. The purpose of therapy with twin block is effective in mandibular growth deficiencies to induce supplementary lengthening of mandibular by stimulating increased growth at the condylar cartilage. The patient was a ten-year-old male patient with skeletal Class II malocclusion. He had a convex facial profile, SNA (sella, nasion, A point) angle of 77.5°, SNB (sella, nasion, B point) angle of 73.0°, ANB (A point, nasion, B point) angle of 4.5°, overjet of 6.5 mm, overbite of 11/41 = 5.0 mm, 21/31 = 4.5 mm, abnormal upper labial frenulum, crossbite in the second left premolar of maxilla, crowded anterior teeth of mandibular, deficiency of mandibular growth, lower lip sucking habit, anterior teeth of maxilla with diastema and proclination. Orthodontic treatment for patient is a combination of twin block and lip bumper appliances. After seven months, frenectomy is used to eliminate and correct the spacing in the frenulum. After 10 months, the patient’s skeletal and profile had improved to skeletal Class I malocclusion, SNA angle of 78.0°, SNB angle of 75.0°, ANB angle of 3.0°, overbite and overjet of 4.0 mm, and the lower lip sucking habit had stopped. Twin block and lip bumper appliances are particularly good alternative treatment in managing selected cases of skeletal Class II malocclusion.
Malocclusion, Angle Class II

Increased overbite has always been a challenging orthodontic problem in treating most periodontal-associated problems. This case report described the management of a class II division 2 malocclusion with cover bite without extraction. A 19-year-old female patient came with a chief complaint of irregularities on the anterior teeth. A fixed appliance was placed without extraction. The patient was instructed to use intermaxillary elastic band class II to correct the canine and molar relation. Treatment time was 16 months. A class I canine and molar relation with good interdigitation was achieved. The treatment of class II division 2 malocclusion without extraction in the adult patient showed promising results.
Angle Class II Malocclusion ; Class II Malocclusion ; Malocclusion Class II Division 2 ; Orthodontic Treatment

OBJECTIVEThis study aimed to analyze the condylar position changes produced by functional appliances in class Ⅱ malocclusion by systematic review.

METHODSElectronic search was conducted using Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, Medline, Embase, Pubmed, and Cochrane Central Register of Controlled Trials. Studies on condylar position changes produced by functional appliances in class Ⅱ malocclusion were included. Risk of bias assessment and data extraction of included studies were conducted by two reviewers independently. The meta-analysis was carried out using Revman 5.1.

RESULTSSix studies were included (five high quality and one low quality). The condylar position showed no changes after Herbst treatment. The condylar posterior space after Twin-block treatment averagely increased by 0.31 mm (P<0.000 01), whereas the condylar anterior space averagely reduced by 0.32 mm (P<0.000 01).

CONCLUSIONSTwin-block appliance enables forward movement of the condylar position. This result contributes to the correction of class Ⅱ malocclusion.

Databases, Factual ; Humans ; Malocclusion, Angle Class II

OBJECTIVE: Intraoral noncompliance upper molar distalization techniques have gained in popularity and have subsequently found to be successful in Class II correction. The aim of the present study was to introduce a screw supported intraoral distalization appliance and investigate its efficiency. METHODS: Twenty-one subjects (11 females, 10 males; average age of 14.9 years) with Angle Class II malocclusion participated in this study. Two screws were inserted behind the incisive foramen and immediately loaded to distalize the upper first molars. An intraoral screw supported distalization appliance was used to distalize the upper molars in order to achieve a Class I molar relationship. Skeletal and dental changes were evaluated using cephalometric and three-dimensional (3D) model analysis. RESULTS: Upper molars were distalized 3.95 mm on average and a Class I molar relationship was achieved without any anchorage loss. The upper molars were tipped only 1.49degrees and the upper right and left molars were rotated only 0.54degrees and 0.74degrees respectively which were statistically non-significant (p > 0.05). CONCLUSIONS: The newly designed screw supported noncompliance distalization appliance was found to be an effective device for achieving bodily molar distalization without any anchorage loss.
Female ; Humans ; Malocclusion ; Malocclusion, Angle Class II ; Molar

OBJECTIVETo study the association of vertical facial skeletal types and sagittal facial skeletal types with anterior alveolar bone thickness.

METHODSAmong 168 cases with malocclusion in early permanent dentition stage, 93 patients were male and 75 patients were female. All patients (aged 10-14 years) were divided into 9 groups by different facial skeletal types, mandibular anterior alveolar bone thickness in patients' lateral cephalometric films were measured. ANOVA were performed to measurement results with the SPSS 13.0 statistical software.

RESULTSThough sagittal facial skeletal types were the same, there were significant differences between different vertical facial types groups. The order was low-angle group, average-angle group and high-angle group according to the size. A high-angle individual often had a thin anterior alveolar bone while a low-angle individual often had the opposite morphology character. There was no statistical significance between skeletal type I, II and III. But group of skeletal type III also had a thin alveolar bone thickness which had no significant difference with high-angle group. Low-angle group III had no significant difference with average-angle group I and II in alveolar bone thickness.

CONCLUSIONSagittal facial skeletal types have little influence on anterior alveolar morphology, but the vertical facial skeletal types have strong connection with anterior alveolar bone thickness.

Adult ; Cephalometry ; Face ; Female ; Humans ; Male ; Malocclusion ; Malocclusion, Angle Class II ; Malocclusion, Angle Class III ; Mandible

OBJECTIVE: This study aimed to investigate the therapeutic effects and advantages of skeletal class Ⅲ malocclusion treatment by transmission straight wire technique. METHODS: Ninety-seven patients who received treatment for skeletal class Ⅲ malocclusion at the Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2012 to January 2017 were selected for this retrospective study. All these patients refused surgery. They were divided into two groups in accordance with the type of skeletal malocclusion: mild-to-moderate skeletal malocclusion group (-4°≤ANB <0°) and severe skeletal malocclusion group (-8°≤ANB<-4°). Each of the two groups was divided further into two small groups in accordance with the technique used: T group (transmission straight wire technique) and M group (MBT technique). RESULTS: The crossbite of all 59 patients in the mild-to-moderate skeletal malocclusion group was successfully treated. The molars were classified as classⅠrelationship, and the facial profile improved. Significant differences were found in the values of U1/SN angle, L1/MP angle, and Lip-Diff between the T and M groups before and after the treatment (P<0.05). The extent of incisor root resorption was lighter in the T group than in the M group (P<0.05). In the severe skeletal malocclusion group, the crossbite of all 38 patients was cured or partially cured. Fourteen patients showed severe lower anterior teeth inclination (five in the T group and nine in the M group), and the profiles did not significantly improve. Significant differences were observed in the values of U1-NA value, U1/SN angle, L1-NB value, L1/MP angle, LLP, and Lip-Diff between the T and M groups before and after the treatment (P<0.05). The extent of incisor root resorption was lighter in the T group than in the M group (P<0.05). CONCLUSIONS Relative to the MBT technique, the transmission straight wire technique has great advantages in improving facial profile, reducing the compensatory inclination of the upper and lower anterior teeth, and reducing the risk of root resorption in the treatment of skeletal class Ⅲ malocclusion.
Cephalometry ; Humans ; Malocclusion ; Malocclusion, Angle Class II ; Malocclusion, Angle Class III ; Maxilla ; Retrospective Studies

OBJECTIVETo figure out the differences of the morphological characteristics of mandibular symphysis between Class II and Class III adult skeletal malocclusions with different abnormal vertical skeletal patterns.

METHODS109 Chinese female adults of skeletal Class II and Class III were chosen and divided into four groups according to vertical and sagittal skeletal pattern: Class II--vertical-growth-pattern group (n=30), Class III--vertical-growth-pattern group (n=25), Class II--horizontal-growth-pattern group (n=29), Class III--horizontal-growth-pattern (n=25). Lateral cephalograms were taken. The symphyseal widths and heights, along with lower incisor positions were evaluated. Observation and statistics analysis were done to clarify the morphological characteristics of the symphyseal region of different skeletal patterns.

RESULTSThere were morphological differences of symphyseal region between Class II and Class III skeletal malocclusions, but not significant in width and total height. With a vertical-growth-pattern, Class II malocclusions had higher alveolus than Class III, but smaller chin prominence and lower basal bone (P < 0.01). With a horizontal-growth-pattern, Class II malocclusions had higher alveolus (P < 0.05) and larger alveolar top width (P < 0.001). With a same sagittal skeletal pattern, vertical-growth-pattern group had thinner but higher symphyseal region and bigger chin prominence (P < 0.001 in Class II while P < 0.05 in Class III). Besides, a vertical-growth-pattern malocclusion was prone to have a cucurbit-morph chin, of which Id width was larger than basal width (P < 0.01).

CONCLUSIONThere are morphological differences in symphyseal region between Class II and Class III skeletal malocclusions with different abnormal vertical skeletal patterns. The influence of abnormal vertical skeletal pattern to symphyseal morphological characteristics is greater than that of abnormal sagittal skeletal pattern. There is a risk of orthodontic movement of low incisors in vertical-growth-pattern skeletal malocclusion.

Adult ; Female ; Humans ; Malocclusion, Angle Class II ; pathology ; Malocclusion, Angle Class III ; pathology ; Mandible ; pathology

OBJECTIVETo study the characteristics of the arch form of skeletal Class III malocclusion and provide references for diagnosis and treatment plan.

METHODS7 indexes in dental casts of 47 patients with skeletal Class III malocclusion and 50 individuals with normal occlusion were measured respectively. And differences between corresponding upper and lower measurements were calculated. Independent samples t-test was employed for comparing between the two groups by SPSS 17.0.

RESULTSCompared with normal occlusion sample, Class III malocclusion group had smaller anterior segment lengths and larger canine angles (P<0.05). Differences between upper and lower first premolar widths were larger in males with skeletal Class III malocclusion. And differences between upper and lower anterior segment lengths were smaller in males with skeletal Class III malocclusion (P<0.05).

CONCLUSIONArch widths of patients with skeletal Class III malocclusion are basically normal. The lengths of anterior segment are smaller and the anterior arch forms are straighter.

Bicuspid ; Dental Arch ; Dental Occlusion ; Female ; Humans ; Male ; Malocclusion, Angle Class II ; Malocclusion, Angle Class III

OBJECTIVEThe purpose of this investigation is to compare the differences of hard tissue changes and stability in patients with Class II division 1 treated with extraction of four first premolars by Begg appliance and Edgewise appliance.

METHODSThe study was conducted using lateral cephalometric radiographs taken pretreatment, posttreatment and following-up. Thirty patients who had an Angle's Class II division 1 malocclusion were treated with first premolar extractions (19 by Begg appliance and 11 by Edgewise appliance). Cephalometric radiographs were scanned and the data were analyzed according to the paired and unpaired t-test.

RESULTSThe differences between the pretreatment and posttreatment periods were statistically significant for all the incisor and molar cephalometric variables (P<0.05) except UMA-PPV and UMC-PPV by Edgewise appliance. During treatment the incisors moved lingual-inclined and extrusively, the molar moved mesially and extrusively except that the upper molar of the Edgewise group stayed relatively stable anteroposteriorly. During the follow-up period the anterior teeth moved forward and extrusively, the upper molar moved mesially and extrusively. There was no significant differences of tooth movement and stability between Begg appliance and Edgewise appliance (P>0.05).

CONCLUSIONThere is no significant differences of hard tissue changes and stability between Begg appliance and Edgewise appliance.

Bicuspid ; Cephalometry ; Humans ; Incisor ; Male ; Malocclusion ; Malocclusion, Angle Class I ; Malocclusion, Angle Class II ; Molar ; Tooth ; Tooth Movement Techniques

Background: The incidence rate of Angle Class I and Class II malocclusions in mixed dentition is higher than Class III. In orthodontic interceptive treatment, it is necessary to identify pubertal growth spurt peak individually because the best growth modification could be obtained during this period. One of the methods in assessing the pubertal growth spurt peak is cervical vertebrae maturation (CVM), which is done using a lateral cephalometric radiograph. CVM evaluates potential growth and skeletal maturity by assessing cervical vertebrae anatomy. Identifying the duration of growth spurt peak on both malocclusion classes is the most pivotal aspect of optimizing remodeling and correction of children’s malocclusion. Objective: Distinguishing the duration of pubertal growth spurt peak of children with Angle Class I and II malocclusions based on CVM analysis in Deutero-Malay children so that it can be used in determining optimal orthodontic treatment plan and timing in children with Class I and Angle II malocclusion for Deutero-Malay children. Methods: Analytical observational with cross-sectional approach was applied using lateral cephalometric radiographic images from patients’ medical records attending or had attended orthodontic treatment in the Pediatric Dentistry Clinic, Airlangga University Dental Hospital, Surabaya, Indonesia, in 2014-2019 that met the inclusion criteria and were analyzed with Baccetti’s method of CVM analysis. This study involved 66 conventional lateral cephalometric photographs that were selected using total sampling. The data were analyzed using Independent T-Test and Mann Whitney U Test. Result: The duration of pubertal growth spurt peak in Angle Class I and II malocclusions was 11 and 7 months, respectively. The age of onset for Class I with CS3 was 9 years and 5 months, while for Angle Class II malocclusion starts entering the stage at 10 years 3 months of age, while for CS4 skeletal maturity we found that the age of onset for subjects with Angle Class I and II were 11 years 2 months and 12 years 4 months, respectively. The average duration of the pubertal growth spurt peak in female and male patients was 11.3 months and 18.2 months, respectively. All of these results were statistically significant (p ≤ 0.001) and representative of the population, in this case, Deutero-Malays. Conclusion Four-month differences in the duration of pubertal growth spurt peak of children with Angle Class I and II were found. This may lead to a shorter treatment duration of 4 months in children with Angle Class II malocclusion when compared to children with Angle Class I malocclusion. Angle Class II malocclusion exhibit shorter pubertal growth spurt peak duration, which may account for the difference in mandibular growth on the two malocclusion classes.
Puberty ; Malocclusion ; Malocclusion, Angle Class I ; Malocclusion, Angle Class II ; Cervical Vertebrae ; Age Determination by Skeleton ; Cephalometry ; Asian People ; Age of Onset