Effect of functional appliance therapy on the quality of life in skeletal Class II malocclusion


Share / Export Citation / Email / Print / Text size:

Australasian Orthodontic Journal

Australian Society of Orthodontists

Subject: Dentistry, Orthodontics & Medicine


ISSN: 2207-7472
eISSN: 2207-7480





Volume / Issue / page

Volume 38 (2022)
Volume 37 (2021)
Volume 36 (2020)
Volume 35 (2019)
Volume 34 (2018)
Volume 33 (2017)
Volume 32 (2016)
Volume 31 (2015)
Related articles

VOLUME 34 , ISSUE 2 (November 2018) > List of articles

Effect of functional appliance therapy on the quality of life in skeletal Class II malocclusion

Mohammad Moslem Imani / Elaheh Seyed Tabaii * / Saba Jamshidi / Sepideh Arab

Citation Information : Australasian Orthodontic Journal. Volume 34, Issue 2, Pages 225-231, DOI: https://doi.org/10.21307/aoj-2020-074

License : (CC BY 4.0)

Published Online: 20-July-2021



Introduction: A Class II malocclusion is a common orthodontic problem that may affect social acceptance and the self-esteem of the patient. The aim of the present study was to evaluate the effect of functional appliance therapy on the oral health-related quality of life (OHRQOL) of patients presenting with a skeletal Class II malocclusion due to mandibular deficiency.

Methods: Forty-nine patients (11 to 14 years old) with a Class II malocclusion due to mandibular deficiency were included as the experimental group. A control group of 49 subjects was selected from school children without malocclusion. The Child Oral Impact on Daily Performance (Child-OIDP) index was administered, repeated and differences were evaluated following functional therapy using the Clark Twin Block appliance.

Results: At baseline, the most common oral impact on daily performance in the experimental group was emotional stability (35 patients, 71.4%) and smiling without shame (34 patients, 69.4%), which respectively decreased to 12.2% (six cases) and 20.4% (10 cases) after functional therapy. The mean (±SD) of the Child-OIDP Overall Impact score in the experimental group at baseline was 25.94 (±17.84), which significantly decreased to 2.77 (±2.09) after therapy (p < 0.001).

Conclusion: Functional therapy using the Clark Twin Block appliance had a significant effect in improving OHRQOL of children presenting with mandibular deficiency.

Content not available PDF Share



1. Cunningham SJ, Garratt AM, Hunt NP. Development of a condition-specific quality of life measure for patients with dentofacial deformity: 1. Reliability of the instrument. Community Dent Oral Epidemiol 2000;28:195-201.

2. Laing E, Cunningham SJ, Jones S, Moles D, Gill D. Psychosocial impact of hypodontia in children. Am J Orthod Dentofacial Orthop 2010;137:35-41.

3. Hassan AH, Amin HE-S. Association of orthodontic treatment needs and oral health-related quality of life in young adults. Am J Orthod Dentofacial Orthop 2010;137:42-7.

4. Gava EC, Miguel JA, de Araújo AM, de Oliveira BH. Psychometric properties of the Brazilian version of the Orthognathic Quality of Life Questionnaire. J Oral Maxillofac Surg 2013;71:1762.e1-8.

5. Palomares NB, Celeste RK, de Oliveira BH, Miguel JA. How does orthodontic treatment affect young adults’ oral health-related quality of life? Am J Orthod Dentofacial Orthop 2012;141:751-8.

6. Feu D, de Oliveira BH, de Oliveira Almeida MA, Kiyak HA, Miguel JA. Oral health-related quality of life and orthodontic treatment seeking. Am J Orthod Dentofacial Orthop 2010;138:152-9.

7. Dauravu LM, Vannala V, Arafath M, Singaraju GS, Cherukuri SA, Mathew A. The assessment of sagittal changes with twin block appliance in patients with decelerating growth phase. J Clin Diagn Res 2014;8:ZC81-4.

8. Silvola AS, Varimo M, Tolvanen M, Rusanen J, Lahti S, Pirttiniemi P. Dental esthetics and quality of life in adults with severe malocclusion before and after treatment. Angle Orthod 2013;84:594-9.

9. Kadkhoda S, Nedjat S, Shirazi M. Comparison of oral‐health‐ related quality of life during treatment with headgear and functional appliances. Int J Paediatr Dent 2011;21:369-73.

10. Gherunpong S, Tsakos G, Sheiham A. Developing and evaluating an oral health-related quality of life index for children; the CHILDOIDP. Community Dent Health 2004;21:161-9.

11. Bernabé E, Sheiham A, Tsakos G. A comprehensive evaluation of the validity of Child-OIDP: further evidence from Peru. Community Dent Oral Epidemiol 2008;36:317-25.

12. Bowman AC, Saltaji H, Flores-Mir C, Preston B, Tabbaa S. Patient experiences with the Forsus Fatigue Resistant Device. Angle Orthod 2012;83:437-46.

13. Varlık SK, Gültan A, Tümer N. Comparison of the effects of Twin Block and activator treatment on the soft tissue profile. Eur J Orthod 2008;30:128-34.

14. Cavand G, Yunesian F, Saffar shahroudi A, Dori M, Akbarzade baghban A, Khoshnevisan MH. Evaluating the oral health related quality of life in 11-14 years Iranian children by the child – OIDP index. Part 1: Validity, reliability, frequency and severity of impairment in daily function. Shahid Beheshti Dental J Med Sci 2010;27:187-96.

15. Yusuf H, Gherunpong S, Sheiham A, Tsakos G. Validation of an English version of the Child-OIDP index, an oral health-related quality of life measure for children. Health Qual Life Outcomes 2006;4:38.

16. Vera C, Moreno X & Rivera D. Adaptation and validation of Child Oral Impact on daily performance index in 11-14-year-old Chilean school children. J Oral Res 2013;2:119-24.

17. Cicchetti DV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instrument in psychology. Psychol Assess 1994;6:284-90.

18. Reisine ST. Dental health and public policy; the social impact of dental disease. Am J Public Health 1985;75:27-30.

19. Draft Guidance for Industry. Patient-Reported Outcomes Measures: Use in Medical Products Development to Support Labeling Claims. Docket 2006D0044, Rockville, MD: FDA Federal Register, 2009.

20. EMEA/CHAMP/EWP/139391/2004. Reflection Paper on the Regulatory Guidance for the Use of Health-Related Quality of Life (HRQL) Measures in the Evaluation of Medicinal Products. London: EMEA, 2006.

21. Locker D. Measuring oral health: a conceptual framework. Community Dent Health 1988;5:3-18.

22. Inglehart MR, Filstrup SL, Wandera A. Oral health and quality of life in children. Chicago: Quintessence Publishing Co., 2002;79-88.

23. Nucã C, Amariei C, Martoncsak E, Tomi DD. Study regarding the correlation between the Child-OIDP index and the dental status in 12-year-old children from Harsova, Constanta county. J Oral Health Dent Manag 2005;4:4-13.

24. Rebok G, Riley A, Forrest C, Starfield B, Green B, Robertson J et al: Elementary school-aged children’s reports of their health: reports of their health: a cognative interviewing study. J Qual Life Res 2001;10:59-70.

25. Barbosa TS, Gavião MB. Oral health-related quality of life in children: Part I. How well do children know themselves. A systematic review. Int J Dent Hyg 2008;6:93-9.

26. Feu D, Miguel JA, Celeste RK, Oliveira BH. Effect of orthodontic treatment on oral health-related quality of life. Angle Orthod 2013;83:892-8.

27. Clark WJ. Twin-block functional therapy: applications in dentofacial orthopaedics. 2nd ed. London: Mosby, 2002.

28. Clark WJ. The twin-block technique. In: Graber TM, Rakosi T, Petrovic AG, eds. Dentofacial orthopedics with functional appliances. 2nd ed. St. Louis: Mosby, 1997;268-98.

29. Tsakos G, Allen PF, Steele JG, Locker D. Interpreting oral healthrelated quality of life data. Community Dent Oral Epidemiol 2012;40:193-200.

30. Taylor KR, Kiyak A, Huang GJ, Greenlee GM, Jolley CJ, King GJ. Effects of malocclusion and its treatment on the quality of life of adolescents. Am J Orthod Dentofacial Orthop 2009;136:382-92.

31. Masood Y, Masood M, Zainul NN, Araby NB, Hussain SF, Newton T. Impact of malocclusion on oral health related quality of life in young people. Health Qual Life Outcomes 2013;11:25.

32. de Oliveira CM, Sheiham A. Orthodontic treatment and its impact on oral health-related quality of life in Brazilian adolescents. J Orthod 2004;31:20-7.

33. Marques LS, Ramos-Jorge ML, Paiva SM, Pordeus IA. Malocclusion: esthetic impact and quality of life among Brazilian schoolchildren. Am J Orthod Dentofacial Orthop 2006;129:424-7.

34. Liu Z, McGrath C, Hägg U. The impact of malocclusion/orthodontic treatment need on the quality of life: a systematic review. Angle Orthod 2009;79:585-91.

35. Terada I, Hyde C. The SF-36: an instrument for measuring quality of life in ESRD patients. EDTNA ERCA J 2002;28:73-6, 83.

36. Azuma S, Kohzuiki M, Saeki Sh, Tajima M, Igarashi K, Sugawara J. Beneficial effects of orthodontic treatment on quality of life in patients with malocclusion. Thoku J Exp Med 2008;214:39-50.

37. Locker D, Jokovic A, Clarke M. Assessing the responsiveness of measures of oral health-related quality of life. Community Dent Oral Epidemiol 2004;32:10-8.

38. Esperão PT, de Oliveira BH, de Oliveira Almeida MA, Kiyak HA, Miguel JA. Oral health-related quality of life in orthognathic surgery patients. Am J Orthod Dentofacial Orthop 2010;137:790-5.