Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Oral Health
Published in: BMC Oral Health 1/2023

Open Access 01-12-2023 | Digital Volume Tomography | Research

Comparison of invisalign mandibular advancement and twin-block on upper airway and hyoid bone position improvements for skeletal class II children: a retrospective study

Authors: Zheng Yue, Zian Yi, Xinyi Liu, Mengting Chen, Shuhui Yin, Qianqian Liu, Xuefeng Chen, Jiangtian Hu

Published in: BMC Oral Health | Issue 1/2023

Login to get access

Abstract

Background

This study is to evaluate and compare the improvement of upper airway morphology and hyoid bone position in children with Class II mandibular retrusion treated with Invisalign mandibular advancement (MA) and Twin-Block (TB) appliances, utilizing cone beam computed tomography (CBCT).

Methods

32 children aged between 8 and 11.5 years old were included in this study, with an average age of 10.2 years old. These children were divided into two groups, MA and TB, with 16 children in each group. Changes in upper airway morphology and hyoid bone position before and after treatment were analyzed using CBCT.

Results

(1) Changes in upper airway before and after treatment: the oropharynx volume (Or-V), the oropharynx minimum cross-sectional area (Or-mCSA), the hypopharynx volume (Hy-V), and the hypopharynx minimum cross-sectional area (Hy-mCSA) in both the MA and TB groups increased after treatment, and the differences were statistically significant (P < 0.05) compared to pre-treatment status. (2) Changes in hyoid bone position before and after treatment: The distances between H point and third cervical vertebra (H-C3), H point and pogonion (H-RGN), H point and mandibular plane (H-MP), H point and Frankfort horizontal plane (H-FH), H and S point (H-S), and H point and palatal plane (H-PP) in both the MA and TB groups increased after treatment, and the differences were statistically significant (P < 0.05).

Conclusion

Both MA and TB appliances effectively improved the structural narrowness of the upper airway and reduced respiratory resistance, thus improving breath quality. However, MA showed more effectiveness in improving the narrowest part of the hypopharynx compared to TB. Both appliances also promoted anterior downward movement of the hyoid bone, which opens the upper airway of the oropharynx and hypopharynx and helps the upper airway morphology return to normal range.
Appendix
Available only for authorised users
Literature
1.
Lv W, Nie Q, Gu Y. Three-dimensional analysis of mandibular characteristics in patients with skeletal class II malocclusion and chin deviation. Am J Orthod Dentofac Orthopedics: Official Publication Am Association Orthodontists Its Constituent Soc Am Board Orthod. 2021;160(3):392–400.CrossRef
2.
3.
Batool-Anwar S, Goodwin JL, Kushida CA, Walsh JA, Simon RD, Nichols DA, Quan SF. Impact of continuous positive airway pressure (CPAP) on quality of life in patients with obstructive sleep apnea (OSA). J Sleep Res. 2016;25(6):731–8.CrossRefPubMedPubMedCentral
4.
Liu Y, Chen W, Wei Y, Zhang G, Zhang X, Sharhan HM, Cao B. The effect of orthodontic vertical control on the changes in the upper airway size and tongue and hyoid position in adult patients with hyperdivergent skeletal class II. BMC Oral Health. 2022;22(1):532.CrossRefPubMedPubMedCentral
5.
Hartfield PJ, Janczy J, Sharma A, Newsome HA, Sparapani RA, Rhee JS, Woodson BT, Garcia GJM. Anatomical determinants of upper airway collapsibility in obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev. 2022;68:101741.CrossRefPubMed
6.
Samaha CJ, Tannous HJ, Salman D, Ghafari JG, Amatoury J. Role of surgical hyoid bone repositioning in modifying upper airway collapsibility. Front Physiol. 2022;13:1089606.CrossRefPubMedPubMedCentral
7.
8.
Leiter JC. Upper airway shape: is it important in the pathogenesis of obstructive sleep apnea? Am J Respir Crit Care Med. 1996;153(3):894–8.CrossRefPubMed
9.
Wang R, Mihaicuta S, Tiotiu A, Corlateanu A, Ioan IC, Bikov A. Asthma and obstructive sleep apnoea in adults and children - an up-to-date review. Sleep Med Rev. 2022;61:101564.CrossRefPubMed
10.
Baka ZM, Fidanboy M. Pharyngeal airway, hyoid bone, and soft palate changes after class II treatment with twin-block and Forsus appliances during the postpeak growth period. Am J Orthod Dentofacial Orthop. 2021;159(2):148–57.CrossRefPubMed
11.
Caruso S, Nota A, Caruso S, Severino M, Gatto R, Meuli S, Mattei A, Tecco S. Mandibular advancement with clear aligners in the treatment of skeletal class II. A retrospective controlled study. Eur J Paediatr Dent. 2021;22(1):26–30.PubMed
12.
Aboudara C, Nielsen I, Huang JC, Maki K, Miller AJ, Hatcher D. Comparison of airway space with conventional lateral headfilms and 3-dimensional reconstruction from cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2009;135(4):468–79.CrossRefPubMed
13.
Garcia-Usó M, Lima TF, Trindade IEK, Pimenta LAF, Trindade-Suedam IK. Three-dimensional tomographic assessment of the upper airway using 2 different imaging software programs: a comparison study. Am J Orthod Dentofacial Orthop. 2021;159(2):217–23.CrossRefPubMed
14.
Guijarro-Martínez R, Swennen GRJ. Three-dimensional cone beam computed tomography definition of the anatomical subregions of the upper airway: a validation study. Int J Oral Maxillofac Surg. 2013;42(9):1140–9.CrossRefPubMed
15.
Han M, Wang RY, Liu H, Zhu XJ, Wei FL, Lv T, Wang NN, Hu LH, Li GJ, Liu DX, et al. Association between mandibular posterior alveolar morphology and growth pattern in a chinese population with normal occlusion. J Zhejiang Univ Sci B. 2013;14(1):25–32.CrossRefPubMedPubMedCentral
16.
Idris G, Hajeer MY, Al-Jundi A. Acceptance and discomfort in growing patients during treatment with two functional appliances: a randomised controlled trial. Eur J Paediatr Dent. 2012;13(3):219–24.PubMed
17.
Baccetti T, Franchi L, McNamara JA Jr. An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod. 2002;72(4):316–23.PubMed
18.
de Water VR, Saridin JK, Bouw F, Murawska MM, Koudstaal MJ. Measuring upper airway volume: accuracy and reliability of Dolphin 3D software compared to manual segmentation in craniosynostosis patients. J Oral Maxillofac Surg. 2014;72(1):139–44.CrossRefPubMed
19.
Arens R, Marcus CL. Pathophysiology of upper airway obstruction: a developmental perspective. Sleep 2004, 27(5).
20.
Shete CS, Bhad WA. Three-dimensional upper airway changes with mandibular advancement device in patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 2017;151(5):941–8.CrossRefPubMed
21.
Tsuiki S, Lowe AA, Almeida FR, Kawahata N, Fleetham JA. Effects of mandibular advancement on airway curvature and obstructive sleep apnoea severity. Eur Respir J. 2004;23(2):263–8.CrossRefPubMed
22.
Jugé L, Knapman FL, Humburg P, Burke PGR, Lowth AB, Brown E, Butler JE, Eckert DJ, Ngiam J, Sutherland K et al. The relationship between mandibular advancement, tongue movement, and treatment outcome in obstructive sleep apnea. Sleep 2022, 45(6).
23.
Teresi LM, Lufkin RB, Vinuela F, Dietrich RB, Wilson GH, Bentson JR, Hanafee WN. MR imaging of the nasopharynx and floor of the middle cranial fossa. Part I. normal anatomy. Radiology. 1987;164(3):811–6.CrossRefPubMed
24.
Sayinsu K, Isik F, Arun T. Sagittal airway dimensions following maxillary protraction: a pilot study. Eur J Orthod. 2006;28(2):184–9.CrossRefPubMed
25.
da Costa ED, Roque-Torres GD, Brasil DM, Bóscolo FN, de Almeida SM, Ambrosano GMB. Correlation between the position of hyoid bone and subregions of the pharyngeal airway space in lateral cephalometry and cone beam computed tomography. Angle Orthod. 2017;87(5):688–95.CrossRefPubMed
26.
Auvenshine RC, Pettit NJ. The hyoid bone: an overview. Cranio 2020, 38(1).
27.
Bilal R. Position of the Hyoid Bone in Anteroposterior Skeletal Patterns. J Healthc Eng 2021, 2021:7130457.
28.
Wu Y, Yu Q, Xia Y, Wang B, Chen S, Gu K, Zhang B, Zhu M. Does mandibular advancement with clear aligners have the same skeletal and dentoalveolar effects as traditional functional appliances? BMC Oral Health. 2023;23(1):65.CrossRefPubMedPubMedCentral
29.
Amatoury J, Kairaitis K, Wheatley JR, Bilston LE, Amis TC. Peripharyngeal tissue deformation, stress distributions, and hyoid bone movement in response to mandibular advancement. J Appl Physiol (1985). 2015;118(3):282–91.CrossRefPubMed
30.
Ning R, Guo J, Martin D. Effect of premolar extraction on upper airway volume and hyoid position in hyperdivergent adults with different mandibular length. Am J Orthod Dentofac Orthopedics: Official Publication Am Association Orthodontists Its Constituent Soc Am Board Orthod. 2022;161(4):e390–9.CrossRef
31.
Shi X, Chen H, Lobbezoo F, Berkhout E, de Lange J, Guo J, Aarab G. Effects of miniscrew-assisted orthodontic treatment with premolar extractions on upper airway dimensions in adult patients with class II high-angle malocclusion. Am J Orthod Dentofacial Orthop. 2021;159(6):724–32.CrossRefPubMed
32.
Cho H-N, Yoon HJ, Park JH, Park Y-G, Kim S-J. Effect of extraction treatment on upper airway dimensions in patients with bimaxillary skeletal protrusion relative to their vertical skeletal pattern. Korean J Orthod. 2021;51(3):166–78.CrossRefPubMedPubMedCentral
33.
Blackham SS. A study of short-term skeletal, dental, and soft tissue effects of class II malocclusions treated with Invisalign® with Mandibular Advancement feature or Twin Block appliance compared with historical controls. Text. 2020.
34.
Ehsani S, Nebbe B, Normando D, Lagravere MO, Flores-Mir C. Short-term treatment effects produced by the twin-block appliance: a systematic review and meta-analysis. Eur J Orthod. 2015;37(2):170–6.CrossRefPubMed
35.
Londono LCR. Maxillary and mandibular expansion treatment with Invisalign First: a retrospective study of virtual prediction Versus Clinical Outcomes. The University of Alabama at Birmingham; 2021.
36.
Clark W, Clark WJ. Twin block functional therapy. JP Medical Ltd; 2014.
37.
Coughlan A, Hennessy J, Najjar A, Auyang E, Batanghari W, Cartwright C. Invisalign: Orthodontics Unwired. Kellogg School of Management Cases 2017:1–18.
Metadata
Title
Comparison of invisalign mandibular advancement and twin-block on upper airway and hyoid bone position improvements for skeletal class II children: a retrospective study
Authors
Zheng Yue
Zian Yi
Xinyi Liu
Mengting Chen
Shuhui Yin
Qianqian Liu
Xuefeng Chen
Jiangtian Hu
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-023-03295-2

Other articles of this Issue 1/2023

BMC Oral Health 1/2023 Go to the issue

Research

Association between retinol intake and periodontal health in US adults

Research

Evaluation of different models of intrusive force application and temporary anchorage device (TAD) placement in total arch intrusion using clear aligners; a finite element analysis

Research

Perceptions of orthodontic residents toward the implementation of dental technologies in postgraduate curriculum

Research

The prevalence and predictive factors of dentine hypersensitivity among adults in Turkey

Research

Photodynamic therapy (PDT) for oral leukoplakia: a systematic review and meta-analysis of single-arm studies examining efficacy and subgroup analyses

Research

Clinical outcomes of arch expansion with Invisalign: a systematic review