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Management of skeletal class II malocclusion using bimaxillary skeletal anchorage supported fixed functional appliances

A novel technique

Behandlung skelettaler Klasse-II-Malokklusion mit bimaxillärer skelettverankerungsgestützter festsitzender funktioneller Apparatur

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Aim

To evaluate the treatment effects in growing skeletal class II patients subjected to a novel treatment technique, i.e., bimaxillary miniplates supported fixed functional appliance. The null hypothesis was that there is no statistically significant difference in skeletal changes of patients with class II malocclusion treated with bimaxillary skeletal anchorage supported fixed functional appliance and those who were not provided any intervention.

Methods

The sample comprised 32 skeletal class II subjects (17 males and 15 females) with a Cervical Vertebrae Maturity Index (CVMI) demonstrating peak of pubertal growth spurt. Sixteen patients (12.37 ±1.09 years of age) were treated with bimaxillary skeletal anchorage supported fixed function appliance, while 16 well-matched subjects (12.06 ± 1.34 years of age) were included as controls. For both groups, cephalograms (T1, T2) were taken with a matched observational interval of about 7.5 months; 17 linear and 10 angular measurements were recorded. The intraclass correlation coefficient (ICC) was used to determine reliability of measurements recorded. Student t test was carried out to determine the changes produced by the treatment relative to control.

Results

When compared with the control group, the treatment group demonstrated significant maxillary retrusion. No significant changes were seen in mandibular growth pattern, whereas mandibular length increased significantly more than in the control group (B-VP: 3.05 mm; Co-Gn: 2.65 mm). Treatment mechanics had minimal effects on maxillary dentition. Mandibular incisors proclined by an average of 3.06°. Maxilla–mandibular relation improved significantly (ANB: −4.29°; NA-Pog: −3.76°).

Conclusion

The new bimaxillary skeletal anchorage supported fixed functional appliance technique was found to be highly effective in the treatment of class II malocclusion with significant skeletal changes.

Zusammenfassung

Ziel

Evaluierung der Effekte der Therapie heranwachsender Patienten mit Klasse-II-Malokklusion, die mittels einer neuen Methode mit einer bimaxillären miniplattengestützten festsitzenden funktionellen Apparatur behandelt wurden. Die Nullhypothese war, dass es keinen statistisch signifikanten Unterschied in den skelettalen Veränderungen von Patienten mit Klasse-II-Malokklusion gibt, die mit bimaxillärer skelettverankerungsgestützter fixierter funktioneller Apparatur behandelt wurden, und solchen, die keine Intervention erhielten.

Methoden

Die Stichprobe umfasste 32 skelettale Klasse-II-Probanden (17 Jungen, 15 Mädchen), bei denen der CVMI (Cervical Vertebrae Maturity Index) den Peak des pubertären Wachstumsschubs anzeigte. Sechzehn Patienten (12,37 ±1,09 Jahre) wurden mit einer bimaxillären skelettverankerungsgestützten festsitzenden funktionellen Apparatur behandelt. Insgesamt wurden 16 gut übereinstimmende Probanden (12,06 ±1,34 Jahre) als Kontrollen eingeschlossen. Für beide Gruppen wurden Kephalogramme (T1, T2) mit einem gematchten Beobachtungsintervall von etwa 7,5 Monaten aufgenommen; 17 lineare und 10 Winkelmessungen wurden dokumentiert. Der Intraklassenkorrelationskoeffizient (ICC) wurde zur Bestimmung der Reliabilität der erfassten Messwerte verwendet. Um die durch die Behandlung hervorgerufenen Veränderungen im Vergleich zu den Kontrollen zu bestimmen, wurde der Student-t-Test durchgeführt.

Ergebnisse

Im Vergleich mit der Kontrollgruppe zeigte die Behandlungsgruppe eine signifikante maxilläre Retrusion. Es wurden keine signifikanten Veränderungen im Wachstumsmuster des Unterkiefers festgestellt, während die Unterkieferlänge signifikant stärker zunahm als in der Kontrollgruppe (B-VP: 3,05 mm; Co-Gn: 2,65 mm). Die Behandlungsmechanik hatte minimale Auswirkungen auf die Oberkieferbezahnung. Die Unterkieferinzisiven proklinierten im Durchschnitt um 3,06°. Die maxillomandibuläre Kieferrelation verbesserte sich signifikant (ANB: -4,29°; NA-Pog: -3,76°).

Schlussfolgerung

Die vorgestellte Technik – durch bimaxilläre skelettale Verankerung unterstützte festsitzende funktionelle Apparatur – erwies sich als sehr effektiv in der Behandlung von Klasse-II-Malokklusionen mit signifikanten skelettalen Effekten.

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Author information

Authors and Affiliations

  1. Government Dental Center, Pathankot, India

    Gagan Deep Kochar & Anubhav Shivpuri

  2. ADC R&R Hospital, New Delhi, India

    SM Londhe, SS Chopra & Rajat Mitra

  3. Government Dental Center, Chandigarh, India

    Munish Verma

  4. 61 Ashirwad Apartment, Pat Par Ganj Bus Depot, IP Extension, New Delhi, India

    Gagan Deep Kochar

Authors
  1. Gagan Deep Kochar
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  2. SM Londhe
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  3. Anubhav Shivpuri
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  4. SS Chopra
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  5. Rajat Mitra
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  6. Munish Verma
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Corresponding author

Correspondence to Gagan Deep Kochar.

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Conflict of interest

G.D. Kochar, S. Londhe, A. Shivpuri, S. Chopra, R. Mitra and M. Verma declare that they have no competing interests.

Ethical standards

Informed consent was obtained from parents of all the subjects. The research proposal was approved by the institutional research ethics committee (09/200/2071).

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Kochar, G.D., Londhe, S., Shivpuri, A. et al. Management of skeletal class II malocclusion using bimaxillary skeletal anchorage supported fixed functional appliances. J Orofac Orthop 82, 42–53 (2021). https://doi.org/10.1007/s00056-020-00239-1

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  • DOI: https://doi.org/10.1007/s00056-020-00239-1

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