Prevalence of Functional Appliance for Growth Modification in Class II Patients - A Retrospective Study
Swapna Sreenivasagan1*, Aravind Kumar Subramanian2, Sri Rengalakshmi3, Nivethigaa B4
1.2,3,4 Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai 600077, Tamil Nadu, India.
*Corresponding Author
Dr. Swapna Sreenivasagan,K,
Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai 600077, Tamil Nadu, India.
E-mail: 151808004.sdc@saveetha.com
Received: July 30, 2021; Accepted: August 10, 2021; Published: August 17, 2021
Citation:Swapna Sreenivasagan, Aravind Kumar Subramanian, Sri Rengalakshmi, Nivethigaa B. Prevalence of Functional Appliance for Growth Modification in Class II Patients - A Retrospective Study. Int J Dentistry Oral Sci. 2021;8(8):3882-3885. doi: dx.doi.org/10.19070/2377-8075-21000794
Copyright: Dr. Swapna Sreenivasagan©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Functional appliance is usually advocated as a method of growth modification in early correction of skeletal class II correction. The ability of functional appliances to reduce overjets by means of Modifying dental relationships. This study aimed at determining the need for functional appliance therapy for correction of skeletal class II malocclusion in growing individuals. The samples for the study were retrieved from patient management software. Many of the reports concerning growth effects of functional appliances have been characterized by poor methodology. Among the cases Class II growing patients were identified and the different treatment plans of functional appliances were assessed. The dental college witnessed a total of 119 growing class II patients of which majority were female patients who seeked treatment. . The criteria considered were severity, age and compliance of patient and type of appliance including removable and fixed functional appliance. The removable twin block appliance was the most commonly advised functional appliance. In younger adults with maxillary prognathism additionally headgear was used either alone or in combination with the various functional appliances.
2.Introduction
3.Conclusion
4.References
Keywords
Functional Appliance; Class II Malocclusion; Orthodontics; Twin Block.
Introduction
The mail goal of orthodontic treatment in children with skeletal
malocclusion is to produce well balanced facial profile and
an acceptable and esthetic smile [33]. In most studies, functional
appliances effects to apply the role of a mandibular protrusive
musculature in protruding condylar cartilage and strengthening
and lengthening mandible with muscle emphasis of the musculature
like lateral pterygoid [17]. It is shown in previous studies
that growing children treated with twin block appliances witness
an increase in mandibular length to a greater extent reflecting an
increase in ramus and length of the body of the mandible [15].
The major aspect of functional appliances therapy for treating
class II malocclusion is that patient cooperation and compliance
are needed [28]. For a young child with severe class II malocclusion
just after eruption of permanent teeth orthodontists are
often at dilemma regarding the ease of appliance usage and compliance
expected from the patient [20]. The treatment provided
should be effective in reducing overjet, improving skeletal relations
and also the child’s self-esteem. Functional appliances are
used for correction of class II malocclusion which is shown to
modify neuromuscular environment of dentition and associated
bones [10]. The class II corrector mechanisms hold the mandible
in the forward position.
Previously our team has a rich experience in working on various
research projects across multiple disciplines. (Jain 2017 [11]), (Varghese
et al. 2019 [26]), (Ashok and Ganapathy 2019 [5]), (Padavala
and Sukumaran 2018), (Ke et al. 2019), (Ezhilarasan 2018 [5]),
(Krishnan et al. 2018 [22]), (Pandian et al. 2018 [22]), (Ramamurthy
and Mg 2015 [40]), (Gupta et al. 2018), (Vikram et al. 2017
[39]), (Paramasivam et al. 2020 [38]), (Palati et al. 2020), (Samuel
et al. 2020 [16]). Now the growing trend in this area motivated us
to pursue this project.
The aim of this study was to determine the prevalence of usage
of functional appliances in growth modification for growing skeletal
class II patients.
Materials And Methods
The methodology of retrospective search helped provide a large
range of data at a given point of time. The study was approved
by the ethical committee of the university’s review board. The
study was done in Saveetha Dental College using the Dias record
keeping software. A limitation of selection dias of appliance and
choice of appliance varies among practitioners. Given the power
of the study to be 90, the estimated sample size was 100 cases
opted for functional appliance therapy. In order to reduce the
non-response bias only the treatment plan was considered.
The evaluation of patients reporting to orthodontic clinics was
segregated to identify class II skeletal patients. The inclusion criteria
for this study are patients who have a retro gnathic mandible
or a combination of skeletal anatomy leading to a class II skeletal
profile, age group of 9 to 16 years. The treatment protocol advised
for each patient was sorted. Total of 1200 case sheets were
reviewed of which 119 cases were within our inclusion criteria.
To avoid bias, patient photographs and radiograph were cross
checked.
The data was tabulated in an excel sheet. The inclusion criteria
included 9 to 16 years of age and the dependent variable are the
type of functional appliances. SPSS statistics (version 19) was
used for statistical analysis.
Results & Discussion
Out of the total 1200 case sheets examined, 478 were identified as
class II patients of which 119 were within our inclusion criteria.
This consisted of 66 female patients and 53 male patients. Among
the 119 patients who were included, 79 were treated with camouflage;
nine of them were treated with a fixed functional appliance
and the remaining with functional or orthopedic appliances. In
all the cases, the fixed functional appliances usage was planned
after the initial period of fixed orthodontic appliance therapy and
hence no entry was made regarding the plan for utilization of
appliances like forsus or advansync during the initial treatment.
Figure 1 represents that camouflage was done most commonly
among patients who had mild to moderate class II and among
the functional appliances twin block was most commonly used
followed by fixed functional appliances and that the in functional
appliances camouflage is most commonly used in males and females
as shown in figure 2.
Of the remaining cases treated with removable functional appliances,
twin block was most commonly used followed by eva appliance, Frankel type 1 and Frankel type 2, oral screen and activator.
In cases where the maxilla was at fault headgear was used
either alone or in combination with other functional appliances.
The choice of removable or fixed functional appliance was based
on different variables like age and growth status of the individual.
The compliance of the patient was important and the patients at
the end of growth phase were mostly treated with fixed functional
appliances.
Class II malocclusion with mandibular retrognathism was mainly
due to reduced mandibular length and dentoalveolar modifications.
All appliances produced measurable changes in skeletal,
dental and soft tissues [3]. For patients in their pubertal peak
growth phase, clinically significant increments in total mandibular
length and ramus height were noted [23]. Hence the utilization of
the pubertal growth spurt in treatment period can be regarded as
a key factor [36].
Fixed functional appliances designed for class II exert a protrusive
force on the mandible. They are rigid enough to advance mandible
based on the principle of inclined plane and its placement in
buccal corridors make it nearly invisible [13].
In certain studies, twin block appliances have shown to reduce
treatment duration [19]. The only factor that influences is the final
discrepancy was the pretreatment relationship and associated
dentoalveolar compensations [28].
After the appliance is fitted, the patient is reviewed once in every
4-6 weeks. The amount of overjet reduction is noted every 2
months. Once the intended tooth movement is obtained and profile
is assessed and the appliance is then discontinued and further
treatment with edgewise fixed appliances is continued if needed
[1].
Class II treatment for growth adaptation is given in children and
adolescents. In case of fixed functional appliance patient cooperation
is not required as it works 24 hours. Treatment is short
because of full time wear [21]. Opinion is emerging that the fixed
functional appliance causes localized proliferation of cells in the
extracellular matrix [18].
Orthodontic treatment involves the application of forces that are
continuous in activity on as many areas of the dentition as possible
and working in the direction in which the teeth are intended to
move [4]. Orthodontic movement of such a tooth is a challenge
to any orthodontist [30, 7]. The fundamental of orthodontics is
that teeth move through the alveolar bone when adequate forces
are delivered [14]. In spite of our knowledge that air abrasion is
inefficient as an enamel conditioning method, we included it in
this study only as a known parameter to highlight the difference in
depth of resin penetration [27]. The data was recorded in the record
sheet prepared for each patient for the purpose of follow up
which included all the required personal details of the patient [31].
Recycling has been the subject of debate within the profession
following the regulations concerning the use and reuse of medical
devices [12]. Elastic traction of the maxilla is done by an acrylic
plate supported on the maxillary dentition and palate [39]. Mini
screws as effective temporary anchorage devices have occupied a
central role in a typical orthodontic setup, since anchorage control
and patient cooperation are very critical [11, 40]. This direction
of applied force is determined by the length of the attachment
and the height of the mini-implant from the base arch wire [7].
While providing absolute anchorage, these devices are used for
specific periods of time and rely only on mechanical retention
with the surrounding bone [34]. Social acceptance, psychological
well-being, and self-esteem of an individual are related to physical
appearance. It has been established that self-esteem is strongly dependent
on facial appearance [22]. Remodeling of bone at the end
of orthodontic extrusion causes new bone formation which occurs
at about 4-5 weeks [8]. To measure the linear cephalometric
dimensions of anterior and posterior segments of the craniofacial
complex sagittally, to establish ratios between different linear dimensions
of sagittal segments and check for dimensional balance
among the various segments in subjects with normal occlusion,
pleasing profile and facial harmony [9].
The limitation of this study is that there are not enough samples
in each appliance and variation in number of patients in camouflage
and appliances. There were also different types of sample
in fixed functional appliances and growth status to be specified.
Our institution is passionate about high quality evidence based
research and has excelled in various fields ( (Pc, Marimuthu and
Devadoss, 2018 [24]; Ramesh et al., 2018 [26]; Vijayashree Priyadharsini,
Smiline Girija and Paramasivam, 2018 [38]; Ezhilarasan,
Apoorva and Ashok Vardhan, 2019 [5]; Ramadurai et al., 2019
[25]; Sridharan et al., 2019 [35]; Vijayashree Priyadharsini, 2019
[37]; Chandrasekar et al., 2020 [2]; Mathew et al., 2020 [16]; R et
al., 2020 [29]; Samuel, 2021 [32]). We hope this study adds to this
rich legacy.
Figure 1: Bar chart depicting the association between age and treatment plan for growth modification in class II patients. X axis represents age from 9-16 years and Y axis represents the number of patients with Class II malocclusion. Association between the age and treatment plan was statistically significant.[ Pearson Chi Square Value- 87.3 , P value is 0.31 which >0.05 and is not statistically significant]. Camouflage was done most commonly among patients who had mild to moderate class II and among the functional appliances twin block was most commonly used followed by fixed functional appliances.
Figure 2: This bar graph represents comparison between the gender of patients who have skeletal class II and the various treatment plans. The X axis represents the gender and the Y axis represents the number of patients with Class II malocclusion. Association between the gender and treatment plan was statistically significant. The Pearson chi-square value is 22.82 and the p value is 0.029 which is statistically significant. The inference from this graph is that the functional appliances camouflage is most commonly used in males and females.
Conclusion
The conclusion from this study is that camouflage is most commonly
attempted in growing children with a mild skeletal Class
II malocclusion; twin block is the most common fixed functional
appliance. The future scope of this study is to undergo a
well-planned RCT for comparison between fixed functional and
removable functional appliances, comparison among various removable
appliances and evaluation.
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