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OBJECTIVES@#To evaluate the effects of a Twin-block appliance on the condyles of patients with ClassⅡmalocclusion by conducting a systematic review and a Meta-analysis.@*METHODS@#Pubmed, Embase, Cochrane Library, Chinese BioMedical Literature Database, China National Knowledge Infrastructure, and VIP Database were electronically searched. Randomized controlled trials, controlled clinical trials, and single-arm trials on condylar changes produced by a Twin-block appliance in patients with ClassⅡmalocclusion were included. Two reviewers independently extracted and assessed the risk of bias. Meta-analyses were conducted with Review Manager 5.3.@*RESULTS@#Eight studies were included; among which, seven were of high quality. After treatment with a twin block appliance, condyles moved anteriorly. The anterior joint spaces decreased (P<0.000 01), whereas the posterior spaces increased (P<0.000 01). The superior spaces were not changed (P=0.11). Moreover, a significant difference was observed in the increase of the condylar space index (P<0.000 01). After treatment, the anteroposterior diameters of the condyles and condylar height increased (P=0.000 2 and P<0.000 01, respectively). By contrast, no significant changes were discovered in the medial external diameters of the condyles (P=0.42).@*CONCLUSIONS@#A Twin-block appliance can promote the growth of a condyle in the posterior and upper direction and move it forward in favor of the correction of Class Ⅱ malocclusion.
Subject(s)
Humans , Malocclusion, Angle Class II/therapy , Temporomandibular Joint , Bone and Bones , China , Orthodontic Appliances, Functional , CephalometryABSTRACT
@#A 9-year-old male ADHD patient with class II dentoskeletal malocclusion came to the Pediatric Department of Universitas Airlangga, Surabaya, with a chief complaint of a protrusive look. The patient had a behavior disorder of ADHD (Attention Deficit Hyperactivity Disorder), in which its symptoms may be challenging in dental treatment since it heavily depends on the patient’s obedience and case selection. References and similar studies of myofunctional therapy in Class II Malocclusion Patients with ADHD are still scarce. Most patients with class II malocclusion present with hyperactive perioral muscle and altered tongue position. Hence, myofunctional appliance is a reliable treatment choice. A special rule where the patient was asked to focus on the operator’s instruction for 10 minutes and then a 5-minute break, was applied to this patient to overcome ADHD symptoms as a behavior management strategy. This is in line with a theory stating that children with ADHD are prone to distraction, causing them to have a shorter duration of focus, limited sustained attention span, poor impulse control, and motor overactivity compared to normal children. This strategy gave a positive result in maintaining the cooperation of the patient using the twin block for 6 months which is lead to positive progress in malocclusion correction.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Myofunctional TherapyABSTRACT
@#Introduction: The aim of the study was to compare the changes in the skeletal and dentoalveolar structures in Malay patients with Class II Division 1 malocclusion treated by prefabricated re-mouldable customizable functional appliance (T4FTM) and Twin Block (TB) appliance. Methods: A randomised clinical trial was carried out with samples randomly assigned to active (TB appliance) and experimental (T4FTM appliance) groups. Pre- and post-treatment lateral cephalometric radiographs were taken for each subject and the overjet was clinically measured at the same intervals. 20 angular and linear measurements were chosen and measured separately. Results: Independent t test was used to compare the changes between the two groups. A significant difference between the groups was seen with overjet at 2.14 mm (p < 0.01), Sv_Pog distance at 1.83mm (p < 0.05), Sv_ii distance at 2.55 mm (p < 0.001), horizontal distance from the upper to the lower incisor tip at 1.81 mm which was statistically significant (p < 0.05). The other variables SNB and ANB angles too showed a significant difference. However, all the favourable changes were noted in the TB group. Conclusion: T4FTM appliance could be an effective appliance for the management of British Standard Institute's Class II Division 1 malocclusion on Class II skeletal pattern. However, the TB group differed significantly and had a more favourable correction in terms of the sagittal skeletal and dentoalveolar discrepancy.
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Twin Block appliances are largely used for the correction of skeletal class II malocclusions due to mandibular retrognathism. Due to its patient comfort and ease, this appliance became the major tool for class II skeletal correction. Literature review on this appliance shows mixed responses, some claiming that the results are good and stable while others just put this as an appliance giving temporal acceleration in growth. Hence a study was designed to investigate the stability attained in antero posterior skeletal correction attained with Twin Block appliance. 30 subjects who were treated for mandibular retrognathism were identified. Average age group was 12.9[T1], 14.8 [T2] and 16.5 years [T3]. Pre-treatment, post treatment and a minimum of one year post treatment cephalograms were collected and analyzed. Results obtained from the present study showed that the treatment outcomes that were achieved immediately after twin block therapy was stable and that twin block appliance could be recommended in patients with sufficient growth with mandibular retrognathism.
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Objective: To detect the clinical effect of T win-Block appliance in the treatment of the patients with Class II division 1 malocclusion, and to provide the basis for clinical treatment. Methods: A total of 30 patients with class II division 1 malocclusion were treated with Twin-Block appliance. The variables of the patients before and after treatment were measured with Ricketts cephalometric radiographys. Results: Compared with before treatment, the length of corpora mandibulae (Xi-Pm) of the patients after treatment was increased by 2. 50 mm (P<0. 05), the SNB angle was increased by 2. 58° (P<0. 05), and the ANB was decreased by 2. 71 (P<0. 01); the molar relationship distance and the Overjet were decreased by 2. 81 mm and 3. 68 mm, respectively (P<0. 01); the Ll-OP was decreased by 1.89 mm, the distance of Ll-APog was increased by 1.84 mm, and the angle Ul-APog was decreased by 7. 35° (P<0. 01); the Ls-TVL was increased by 1. 85 mm, the Sm-TVL was increased by 2. 12 mm (P<0. 05), and the Pos-TVL was increased by 2. 89 mm (P<0. 05). Conclusion: The Twin-Block appliance could obviously promote the development of mandibular bone, upright the anterior teeth and improve the lip angle of upper anterior teeth and the proflie in the treatment of the patients with class II division 1 malocclusion in the growth development period.
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Myofunctional appliances become active through muscular forces that bring about the dentoalveolar and skeletal changes. Functional appliances can be both removable or fixed. Twin block appliance given by William Clark is one of the most popular functional appliance owing to its ease of fabrication for the orthodontist and its ease of wear for the patient. It is known to bring about both skeletal and dental changes and has been used extensively in Class II growing patients. This was a case report of a 12-year-old patient treated in two phases, first the functional phase using the twin block, followed by the second phase of fixed orthodontic appliance.
Subject(s)
Child , Female , Humans , Malocclusion, Angle Class II/epidemiology , Malocclusion, Angle Class II/therapy , Orthodontic Appliance Design , Orthodontic Appliances, Functional , Orthodontics, Corrective/instrumentation , Orthodontics, Corrective/methodsABSTRACT
Objective; To evaluate the efficacy of Twin-block appliance in Class Ⅱ division 1 of adolescents. Methods: Several e-lectronic databases (PubMed, The Cochrane library, Embase, CBMdisk, CNKI, VIP)were searched. Abstract that appears to fulfill the initial selection criteria were selected by consensus and original articles were retrieved. Five Chinese journals were hand searched for possible missing articles. Randomized controlled trials(RCTs) that evaluate the efficacy of Twin-block appliance in Class Ⅱ division I adolescents without any surgical intervention or syndromic characteristics were considered. A comparable untreated control group was required to factor out normal growth changes. The quality of included studies was evaluated according to Cochrane Reviewers Handbook 4.2.6 Meta-analysis was performed by using RevMan 5.0.0 software. Results: Four RCTs including 289 patients were identified. The results of our meta-analysis showed a significant increase on SNB angle, Ar-Gn, Nasolabial angle and Labial-mental fold compared with control group(P<0.05). Whereas overjet, overbite, ANB angle and Ls-E had a significant decrease. In addition, SNA angle and Li-E didnt show statistical significant changes(P>0. 05). Conclusion; In Class II division 1 of adolescents, Twin-block appliance can effectively decrease their overjet, overbite, ANB angle, and induce anterior-posterior growth of mandible. The effect on restrain forward growth of the maxilla was unclear. More RCTs are required to evaluate the efficacy of Twin-block appliance.
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Objective To evaluate the curative effects of the modified fixed reverse Twin-block ap-pliance (TBA)combined Edgewise in the treatment of adult Angle Ⅲ anterior crossbite. Methods The appliance was used in 18 subjects with adult Angle Ⅲ skeletal malocclusion and clinical characters and X-ray cephalometry were then compared before and after treatment. Results The mandibular soft tissue changes could be achieved fast and the profile had changed effectively. Moderate labioclination of maxil-lary anterior teeth played a role in the improvement of axillary soft tissue protrusion. The cases were fol-lowed up as long as 3 years. No relapse occurred in all the patients. Anterior occlusion was normal. Con-clusion All findings indicate that adult Angle Ⅲ anterior crossbite can be quickly corrected with the mod-ified fixed reverse TBA combined Edgewise. The effect on mandibular soft tissue is significant.
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Objective: To evaluate the effects of the modified fixed r everse Twin-block appliance(TBA) combined with maxillary protraction appliance( MPA) in the treatment of early Angle Ⅲ skeletal anterior crossbite. Met hods:TBA combined with MPA was used in 15 growing subjects with early An gle Ⅲskeletal malocclusion (group TBA-MPA). Another 15 subjects with the same type of malocclusion were treated by MPA(group MPA). The effects of treatment we re studied by cephalometric measurments.Results:3-5 months afte r treatment SNB, B-Vert T, Po-Vert T,NPo-FH,Co-Po and 1-NB in group 1 were decreased more than those in group 2 (P0.05).Conclusion:Angle Ⅲ skeletal ante rior crossbite can be corrected successfully with reverse TBA combined with maxi llary protraction appliance by mandible retrusion and maxilla forward growth.