SEARCH WITHIN CONTENT
Citation Information : Australasian Orthodontic Journal. Volume 33, Issue 1, Pages 3-13, DOI: https://doi.org/10.21307/aoj-2020-079
License : (CC BY 4.0)
Published Online: 30-July-2021
Objectives: The aim of the present study was to evaluate the dentoskeletal and airway effects of three different functional appliances (Frankel-2, Trainer and X-Bow) in prepubertal Class II division 1 patients.
Methods: The sample consisted of 54 patients with a Class II relationship as a result of mandibular retrognathia and relative maxillary constriction. Group I included 15 patients treated with a Frankel-2 appliance. Group II consisted of 14 patients treated with a T4-K Trainer. Group III consisted of 15 patients treated with the X-Bow appliance. Group IV consisted of 10 untreated Class II patients who served as a control group. Pretreatment (T1) and post-treatment (T2) cephalograms were used to evaluate dentoskeletal and airway changes. Parametric one-way variance analysis (ANOVA) and a paired t-test were used to perform statistical analysis.
Results: The decrease in SNA angle was significant in groups I and III, compared with the control group (p < 0.05). SNB angle and Co-GN length changes from T1 to T2 were statistically significant in groups I and II (p < 0.05), but not relative to the control group. The upper and lower incisors were significantly retruded and protruded, respectively, in all treatment groups (p < 0.05). Except PNS-AD2 and MAS measurements in group I, nasopharyngeal and oropharyngeal airway dimensions did not significantly change from T1 to T2 in all groups.
Conclusions: The Frankel-2 and X-Bow appliances were efficient in restricting the forward growth of the maxilla. The Frankel-2 and Trainer appliances produced a larger sagittal increase in mandibular length than the X-Bow appliance. Lower incisor proclination was more pronounced in the X-Bow group. The effect of the treatment protocols was similar and matched the control group with respect to the airway.
1. Bishara SE. Textbook of Orthodontics. 1st ed. Philadelphia: Saunders Company, 2001.
2. Marinelli A, Mariotti M, Defraia E. Transverse dimensions of dental arches in subjects with Class II malocclusion in the early mixed dentition. Prog Orthod 2011;12:31-7.
3. Lux CJ, Conradt C, Burden D, Komposch G. Dental arch widths and mandibular-maxillary base widths in Class II malocclusions between early mixed and permanent dentitions. Angle Orthod 2003;73:674-85.
4. Shu R, Han X, Wang Y, Xu H, Ai D, Wang L et al. Comparison of arch width, alveolar width and buccolingual inclination of teeth between Class II division 1 malocclusion and Class I occlusion. Angle Orthod 2013;83:246-52.
5. Perillo L, Johnston LE Jr, Ferro A. Permanence of skeletal changes after function regulator (FR-2) treatment of patients with retrusive Class II malocclusions. Am J Orthod Dentofacial Orthop 1996;109:132-9.
6. Usumez S, Uysal T, Sari Z, Basciftci FA, Karaman AI, Guray E. The effects of early preorthodontic trainer treatment on Class II, division 1 patients. Angle Orthod 2004;74:605-9.
7. Owen AH 3rd. Morphologic changes in the transverse dimension using the Fränkel appliance. Am J Orthod 1983;83:200-17.
8. Gibbs SL, Hunt NP. Functional appliances and arch width. Br J Orthod 1992;19:117-25.
9. Miller RA, Tieu L, Flores-Mir C. Incisor inclination changes produced by two compliance-free Class II correction protocols for the treatment of mild to moderate Class II malocclusions. Angle Orthod 2013;83:431-6.
10. Achilleos S, Krogstad O, Lyberg T. Surgical mandibular advancement and changes in uvuloglossopharyngeal morphology and head posture: a short- and long-term cephalometric study in males. Eur J Orthod 2000;22:367-81.
11. Ozbek MM, Memikoglu TU, Gögen H, Lowe AA, Baspinar E. Oropharyngeal airway dimensions and functional-orthopedic treatment in skeletal Class II cases. Angle Orthod 1998;68:327-36.
12. Hänggi MP, Teuscher UM, Roos M, Peltomäki TA. Long-term changes in pharyngeal airway dimensions following activatorheadgear and fixed appliance treatment. Eur J Orthod 2008;30:598- 605.
13. Godt A, Koos B, Hagen H, Göz G. Changes in upper airway width associated with Class II treatments (headgear vs activator) and different growth patterns. Angle Orthod 2011;81:440-6.
14. Yassaei S, Bahrololoomi Z, Sorush M. Changes of tongue position and oropharynx following treatment with functional appliance. J Clin Pediatr Dent 2007;31:287-90.
15. Hassel B, Farman AG. Skeletal maturation evaluation using cervical vertebrae. Am J Orthod Dentofacial Orthop 1995;107:58-66.
16. McNamara JA Jr, Brudon WL. Orthodontic and orthopedic treatment in the mixed dentition. Ann Arbor: Needham Press Inc, 1993.
17. Gianelly AA. Rapid palatal expansion in the absence of crossbites: added value? Am J Orthod Dentofacial Orthop 2003;124:362-5.
18. Flores-Mir C, Barnett G, Higgins DW, Heo G, Major PW. Shortterm skeletal and dental effects of the Xbow appliance as measured on lateral cephalograms. Am J Orthod Dentofacial Orthop 2009;136:822-32.
19. Perinetti G, Primožič J, Franchi L, Contardo L. Treatment effects of removable functional appliances in pre-pubertal and pubertal Class II patients: a systematic review and meta-analysis of controlled studies. PloS One 2015;10:e0141198.
20. Perillo L, Femiano A, Palumbo S, Contardo L, Perinetti G. Skeletal and dental effects produced by functional regulator-2 in pre-pubertal class II patients: a controlled study. Prog Orthod 2013;14:18.
21. Janson GR, Toruño JL, Martins DR, Henriques JF, de Freitas MR. Class II treatment effects of the Fränkel appliance. Eur J Orthod 2003;25:301-9.
22. Chadwick SM, Aird JC, Taylor PJ, Bearn DR. Functional regulator treatment of Class II division 1 malocclusions. Eur J Orthod 2001;23:495-505.
23. Cope JB, Buschang PH, Cope DD, Parker J, Blackwood HO 3rd. Quantitative evaluation of craniofacial changes with Jasper Jumper therapy. Angle Orthod 1994;64:113-22.
24. Covell DA Jr, Trammell DW, Boero RP, West R. A cephalometric study of class II Division 1 malocclusions treated with the Jasper Jumper appliance. Angle Orthod 1999;69:311-20.
25. Ehsani S, Nebbe B, Normando D, Lagravere MO, Flores-Mir C. Dental and skeletal changes in mild to moderate Class II malocclusions treated by either a Twin-block or Xbow appliance followed by full fixed orthodontic treatment. Angle Orthod 2015;85:997-1002.
26. Freeman DC, McNamara JA Jr, Baccetti T, Franchi L, Fränkel C. Long-term treatment effects of the FR-2 appliance of Fränkel. Am J Orthod Dentofacial Orthop 2009;135:570 e1-6; discussion 570-1.
27. Rushforth CD, Gordon PH, Aird JC. Skeletal and dental changes following the use of the Frankel functional regulator. British J Orthod 1999;26:127-34.
28. Nielsen IL. Facial growth during treatment with the function regulator appliance. Am J Orthod 1984;85:401-10.
29. Franchi L, Alvetro L, Giuntini V, Masucci C, Defraia E, Baccetti T. Effectiveness of comprehensive fixed appliance treatment used with the Forsus Fatigue Resistant Device in Class II patients. Angle Orthod 2011;81:678-83.
30. Cacciatore G, Alvetro L, Defraia E, Ghislanzoni LT, Franchi L. Active-treatment effects of the Forsus fatigue resistant device during comprehensive Class II correction in growing patients. Korean J Orthod 2014;44:136-42.
31. Giuntini V, Vangelisti A, Masucci C, Defraia E, McNamara JA Jr, Franchi L. Treatment effects produced by the Twin-block appliance vs the Forsus Fatigue Resistant Device in growing Class II patients. Angle Orthod 2015;85:784-9.
32. Bilgiç F, Hamamci O, Başaran G. Comparison of the effects of fixed and removable functional appliances on the skeletal and dentoalveolar structures. Aust Orthod J 2011;27:110-6.
33. McNamara JA Jr, Howe RP, Dischinger TG. A comparison of the Herbst and Fränkel appliances in the treatment of Class II malocclusion. Am J Orthod Dentofacial Orthop 1990;98:134-44.
34. Tallgren A, Christiansen RL, Ash M Jr, Miller RL. Effects of a myofunctional appliance on orofacial muscle activity and structures. Angle Orthod 1998;68:249-58.
35. Erbas B, Kocadereli I. Upper airway changes after Xbow appliance therapy evaluated with cone beam computed tomography. Angle Orthod 2014;84:693-700.
36. Bilgiç F, Başaran G, Hamamci O. Comparison of Forsus FRD EZ and Andresen activator in the treatment of class II, division 1 malocclusions. Clin Oral Investig 2015;19:445-51.
37. Gao H, Xiao D, Zhao Z. [Effects of Fränkel II appliance on sagittal dimensions of upper airway in children]. Hua Xi Kou Qiang Yi Xue Za Zhi 2003;21:116-7. Chinese.
38. Jena AK, Singh SP, Utreja AK. Effectiveness of twin-block and Mandibular Protraction Appliance-IV in the improvement of pharyngeal airway passage dimensions in Class II malocclusion subjects with a retrognathic mandible. Angle Orthod 2013;83:728- 34.
39. Kinzinger G, Czapka K, Ludwig B, Glasl B, Gross U, Lisson J. Effects of fixed appliances in correcting Angle Class II on the depth of the posterior airway space: FMA vs. Herbst appliance--a retrospective cephalometric study. J Orofac Orthop 2011;72:301-20.
40. Ozdemir F, Ulkur F, Nalbantgil D. Effects of fixed functional therapy on tongue and hyoid positions and posterior airway. Angle Orthod 2014;84:260-4.
41. O’Brien K, Wright J, Conboy F, Sanjie Y, Mandall N, Chadwick S et al. Effectiveness of treatment for Class II malocclusion with the Herbst or twin-block appliances: a randomized, controlled trial. Am J Orthod Dentofacial Orthop 2003;124:128-37.