Skip to main content
Top
Published in: international journal of stomatology & occlusion medicine 2/2011

01-09-2011 | review article

Do functional orthodontic appliances stimulate mandibular growth in class II division 1 patients?

A systematic review of the literature

Authors: Dr. Michael Hans Bertl, Carina Mandl, Adriano Giacomo Crismani

Published in: international journal of stomatology & occlusion medicine | Issue 2/2011

Login to get access

Abstract

Background

The effectiveness of functional orthodontic treatment and the resulting skeletal response have always been discussed controversially. Therefore a systematic review of the literature was conducted on this subject with special attention to mandibular growth.

Methods

Based on Cochrane Collaboration® recommendations a research of the literature was carried out. The meta-analysis examined 3 appliances for the period between 1996 and 2008: Herbst appliance (HA), activator (AC) and headgear-activator (HAC). The cephalometric parameters under review were SNA, SNB, ANB, OLp-A, OLp-Pg (distances between the occlusal line perpendicular and A/Pg), Co-Gn and the PPl angle (angle between ANS-PNS and N-S plane).

Results

A total of 11 studies were considered. Maxillary changes through SNA and OLp-A were most prominent for the HAC (- 1.93°mm and - 2.6 mm, respectively). Mandibulary changes through SNB and OLp-Pg were almost identical for all 3 appliances. The HAC showed the greatest intermaxillary effect (∆ANB = - 2.54°) although a decrease in SNA accounted for most of it. The biggest increase in the vertical parameter PPl angle and the mandibular length Co-Gn were recorded for the AC (+ 2.25°mm and + 4.01 mm, respectively).

Conclusions

The HA, AC and HAC appliances significantly influenced the evaluated cephalometric parameters. The desired forward placement of the mandible is clinically inferior and always accompanied by a constraint of the maxilla. Therefore the decision to treat with functional appliances has to be carefully evaluated based on the benefits and possible side-effects for the individual patient.
Literature
1.
go back to reference Cozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA Jr. Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review. Am J Orthod Dentofacial Orthop. 2006;129:599.e1-12; discussion e1-6.PubMed Cozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA Jr. Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review. Am J Orthod Dentofacial Orthop. 2006;129:599.e1-12; discussion e1-6.PubMed
2.
go back to reference Patel HP, Moseley HC, Noar JH. Cephalometric determinants of successful functional appliance therapy. Angle Orthod. 2002;72:410–7.PubMed Patel HP, Moseley HC, Noar JH. Cephalometric determinants of successful functional appliance therapy. Angle Orthod. 2002;72:410–7.PubMed
3.
go back to reference Aelbers CM, Dermaut LR. Orthopedics in orthodontics: Part I. Fiction or reality—a review of the literature. Am J Orthod Dentofacial Orthop. 1996;110:513–9.PubMedCrossRef Aelbers CM, Dermaut LR. Orthopedics in orthodontics: Part I. Fiction or reality—a review of the literature. Am J Orthod Dentofacial Orthop. 1996;110:513–9.PubMedCrossRef
4.
go back to reference Harrison JE, O’Brien KD, Worthington HV. Orthodontic treatment for prominent upper front teeth in children. Cochrane Database Syst Rev. 2007;CD003452. Harrison JE, O’Brien KD, Worthington HV. Orthodontic treatment for prominent upper front teeth in children. Cochrane Database Syst Rev. 2007;CD003452.
5.
go back to reference Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.0.0 [updated February 2008]. 2008. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.0.0 [updated February 2008]. 2008.
6.
go back to reference Pancherz H. The mechanism of Class II correction in Herbst appliance treatment. A cephalometric investigation. Am J Orthod. 1982;82:104–13.PubMedCrossRef Pancherz H. The mechanism of Class II correction in Herbst appliance treatment. A cephalometric investigation. Am J Orthod. 1982;82:104–13.PubMedCrossRef
7.
go back to reference Lewis S, Clarke M. Forest plots: trying to see the wood and the trees. Br Med J. 2001;322:1479–80.CrossRef Lewis S, Clarke M. Forest plots: trying to see the wood and the trees. Br Med J. 2001;322:1479–80.CrossRef
8.
go back to reference Franchi L, Baccetti T, McNamara JA Jr. Treatment and posttreatment effects of acrylic splint Herbst appliance therapy. Am J Orthod Dentofacial Orthop. 1999;115:429–38.PubMedCrossRef Franchi L, Baccetti T, McNamara JA Jr. Treatment and posttreatment effects of acrylic splint Herbst appliance therapy. Am J Orthod Dentofacial Orthop. 1999;115:429–38.PubMedCrossRef
9.
go back to reference Cozza P, De Toffol L, Colagrossi S. Dentoskeletal effects and facial profile changes during activator therapy. Eur J Orthod. 2004;26:293–302.PubMedCrossRef Cozza P, De Toffol L, Colagrossi S. Dentoskeletal effects and facial profile changes during activator therapy. Eur J Orthod. 2004;26:293–302.PubMedCrossRef
10.
go back to reference Croft RS, Buschang PH, English JD, Meyer R. A cephalometric and tomographic evaluation of Herbst treatment in the mixed dentition. Am J Orthod Dentofacial Orthop. 1999;116:435–43.PubMedCrossRef Croft RS, Buschang PH, English JD, Meyer R. A cephalometric and tomographic evaluation of Herbst treatment in the mixed dentition. Am J Orthod Dentofacial Orthop. 1999;116:435–43.PubMedCrossRef
11.
go back to reference Janson G, Caffer Dde C, Henriques JF, de Freitas MR, Neves LS. Stability of Class II, division 1 treatment with the headgear-activator combination followed by the edgewise appliance. Angle Orthod. 2004;74:594–604.PubMed Janson G, Caffer Dde C, Henriques JF, de Freitas MR, Neves LS. Stability of Class II, division 1 treatment with the headgear-activator combination followed by the edgewise appliance. Angle Orthod. 2004;74:594–604.PubMed
12.
go back to reference Lai M, McNamara JAJ. An evaluation of two-phase treatment with the Herbst appliance and preadjusted edgewise therapy. Semin Orthod. 1998;4:46–58.PubMedCrossRef Lai M, McNamara JAJ. An evaluation of two-phase treatment with the Herbst appliance and preadjusted edgewise therapy. Semin Orthod. 1998;4:46–58.PubMedCrossRef
13.
go back to reference Marsan G. Effects of activator and high-pull headgear combination therapy: skeletal, dentoalveolar, and soft tissue profile changes. Eur J Orthod. 2007;29:140–8.PubMedCrossRef Marsan G. Effects of activator and high-pull headgear combination therapy: skeletal, dentoalveolar, and soft tissue profile changes. Eur J Orthod. 2007;29:140–8.PubMedCrossRef
14.
go back to reference VanLaecken R, Martin CA, Dischinger T, Razmus T, Ngan P. Treatment effects of the edgewise Herbst appliance: a cephalometric and tomographic investigation. Am J Orthod Dentofacial Orthop. 2006;130:582–93.PubMedCrossRef VanLaecken R, Martin CA, Dischinger T, Razmus T, Ngan P. Treatment effects of the edgewise Herbst appliance: a cephalometric and tomographic investigation. Am J Orthod Dentofacial Orthop. 2006;130:582–93.PubMedCrossRef
15.
go back to reference Basciftci FA, Uysal T, Buyukerkmen A, Sari Z. The effects of activator treatment on the craniofacial structures of Class II division 1 patients. Eur J Orthod. 2003;25:87–93.PubMedCrossRef Basciftci FA, Uysal T, Buyukerkmen A, Sari Z. The effects of activator treatment on the craniofacial structures of Class II division 1 patients. Eur J Orthod. 2003;25:87–93.PubMedCrossRef
16.
go back to reference de Almeida MR, Henriques JF, de Almeida RR, Weber U, McNamara JAJ. Short-term treatment effects produced by the Herbst appliance in the mixed dentition. Angle Orthod. 2005;75:540–7.PubMed de Almeida MR, Henriques JF, de Almeida RR, Weber U, McNamara JAJ. Short-term treatment effects produced by the Herbst appliance in the mixed dentition. Angle Orthod. 2005;75:540–7.PubMed
17.
go back to reference Sari Z, Goyenc Y, Doruk C, Usumez S. Comparative evaluation of a new removable Jasper Jumper functional appliance vs an activator-headgear combination. Angle Orthod. 2003;73:286–93.PubMed Sari Z, Goyenc Y, Doruk C, Usumez S. Comparative evaluation of a new removable Jasper Jumper functional appliance vs an activator-headgear combination. Angle Orthod. 2003;73:286–93.PubMed
18.
go back to reference Türkkahraman H, Sayin MO. Effects of activator and activator headgear treatment: comparison with untreated Class II subjects. Eur J Orthod. 2006;28:27–34.PubMedCrossRef Türkkahraman H, Sayin MO. Effects of activator and activator headgear treatment: comparison with untreated Class II subjects. Eur J Orthod. 2006;28:27–34.PubMedCrossRef
19.
go back to reference Björk A. The principle of the Andresen method of orthodontic treatment. A discussion based on cephalometric x-ray analysis of treated cases. Am J Orthod. 1951;37:437–58.PubMedCrossRef Björk A. The principle of the Andresen method of orthodontic treatment. A discussion based on cephalometric x-ray analysis of treated cases. Am J Orthod. 1951;37:437–58.PubMedCrossRef
20.
go back to reference Luder HU. Skeletal profile changes related to two patterns of activator effects. Am J Orthod. 1982;81:390–396.PubMedCrossRef Luder HU. Skeletal profile changes related to two patterns of activator effects. Am J Orthod. 1982;81:390–396.PubMedCrossRef
21.
go back to reference McNamara JAJ, Bookstein FL, Shaughnessy TG. Skeletal and dental changes following functional regulator therapy on class II patients. Am J Orthod. 1985;88:91–110.PubMedCrossRef McNamara JAJ, Bookstein FL, Shaughnessy TG. Skeletal and dental changes following functional regulator therapy on class II patients. Am J Orthod. 1985;88:91–110.PubMedCrossRef
22.
go back to reference Perillo L, Johnston LEJ, 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.PubMedCrossRef Perillo L, Johnston LEJ, 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.PubMedCrossRef
23.
go back to reference Jakobsson SO, Paulin G. The influence of activator treatment on skeletal growth in angle Class II: 1 cases. A roentgenocephalometric study. Eur J Orthod. 1990;12:174–84.PubMed Jakobsson SO, Paulin G. The influence of activator treatment on skeletal growth in angle Class II: 1 cases. A roentgenocephalometric study. Eur J Orthod. 1990;12:174–84.PubMed
24.
go back to reference Buschang PH, Stroud J, Alexander RG. Differences in dental arch morphology among adult females with untreated Class I and Class II malocclusion. Eur J Orthod. 1994;16:47–52.PubMed Buschang PH, Stroud J, Alexander RG. Differences in dental arch morphology among adult females with untreated Class I and Class II malocclusion. Eur J Orthod. 1994;16:47–52.PubMed
25.
go back to reference Tulloch JF, Medland W, Tuncay OC. Methods used to evaluate growth modification in Class II malocclusion. Am J Orthod Dentofacial Orthop. 1990;98:340–7.PubMedCrossRef Tulloch JF, Medland W, Tuncay OC. Methods used to evaluate growth modification in Class II malocclusion. Am J Orthod Dentofacial Orthop. 1990;98:340–7.PubMedCrossRef
26.
go back to reference Jones G, Buschang PH, Kim KB, Oliver DR. Class II non-extraction patients treated with the Forsus fatigue resistant device versus intermaxillary elastics. Angle Orthod. 2008;78:332–8.PubMedCrossRef Jones G, Buschang PH, Kim KB, Oliver DR. Class II non-extraction patients treated with the Forsus fatigue resistant device versus intermaxillary elastics. Angle Orthod. 2008;78:332–8.PubMedCrossRef
27.
go back to reference Kim YH. Overbite depth indicator with particular reference to anterior open-bite. Am J Orthod. 1974;65:586–611.PubMedCrossRef Kim YH. Overbite depth indicator with particular reference to anterior open-bite. Am J Orthod. 1974;65:586–611.PubMedCrossRef
28.
go back to reference Kim YH, Vietas JJ. Anteroposterior dysplasia indicator: an adjunct to cephalometric differential diagnosis. Am J Orthod. 1978;73:619–33.PubMedCrossRef Kim YH, Vietas JJ. Anteroposterior dysplasia indicator: an adjunct to cephalometric differential diagnosis. Am J Orthod. 1978;73:619–33.PubMedCrossRef
29.
go back to reference Nielsen IL, Lagerstrom LO. Individual response to treatments using Teuscher activator. Tandlaegebladet. 1991;95:882–91.PubMed Nielsen IL, Lagerstrom LO. Individual response to treatments using Teuscher activator. Tandlaegebladet. 1991;95:882–91.PubMed
30.
go back to reference Teuscher U. A growth-related concept for skeletal class II treatment. Am J Orthod. 1978;74:258–75.PubMedCrossRef Teuscher U. A growth-related concept for skeletal class II treatment. Am J Orthod. 1978;74:258–75.PubMedCrossRef
31.
go back to reference Van Beek H. Overjet correction by a combined headgear and activator. Eur J Orthod. 1982;4:279–90.PubMed Van Beek H. Overjet correction by a combined headgear and activator. Eur J Orthod. 1982;4:279–90.PubMed
32.
go back to reference Sander FG. Biomechanical studies on the movement of the mandible in headgear activator treatment. J Orofac Orthop. 1985;46:297–310. Sander FG. Biomechanical studies on the movement of the mandible in headgear activator treatment. J Orofac Orthop. 1985;46:297–310.
33.
go back to reference Singh GD, Thind BS. Effects of the headgear-activator Teuscher appliance in the treatment of Class II Division 1 malocclusion: a geometric morphometric study. Orthod Craniofac Res. 2003;6:88–95.PubMed Singh GD, Thind BS. Effects of the headgear-activator Teuscher appliance in the treatment of Class II Division 1 malocclusion: a geometric morphometric study. Orthod Craniofac Res. 2003;6:88–95.PubMed
34.
go back to reference McSherry PF, Bradley H. Class II correction-reducing patient compliance: a review of the available techniques. J Orthod. 2000;27:219–25.PubMed McSherry PF, Bradley H. Class II correction-reducing patient compliance: a review of the available techniques. J Orthod. 2000;27:219–25.PubMed
35.
go back to reference O’Brien K, Wright J, Conboy F, 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.PubMedCrossRef O’Brien K, Wright J, Conboy F, 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.PubMedCrossRef
36.
go back to reference Wieslander L. Intensive treatment of severe Class II malocclusions with a headgear-Herbst appliance in the early mixed dentition. Am J Orthod. 1984;86:1–13.PubMedCrossRef Wieslander L. Intensive treatment of severe Class II malocclusions with a headgear-Herbst appliance in the early mixed dentition. Am J Orthod. 1984;86:1–13.PubMedCrossRef
37.
go back to reference Dahlberg G. Statistical methods for medical and biological students. New York: Interscience Publications; 1940. Dahlberg G. Statistical methods for medical and biological students. New York: Interscience Publications; 1940.
38.
go back to reference Proffit WR, Fields HW, Sarver DM. Contemporary orthodontics. St. Louis: Mosby; 2007. Proffit WR, Fields HW, Sarver DM. Contemporary orthodontics. St. Louis: Mosby; 2007.
39.
go back to reference Riolo ML. An atlas of craniofacial growth. Ann Arbor: University of Michigan, Center for Human Growth and Development; 1974. Riolo ML. An atlas of craniofacial growth. Ann Arbor: University of Michigan, Center for Human Growth and Development; 1974.
40.
go back to reference Koroluk LD, Tulloch JF, Phillips C. Incisor trauma and early treatment for Class II Division 1 malocclusion. Am J Orthod Dentofacial Orthop. 2003;123:117–25; discussion 125–6.PubMedCrossRef Koroluk LD, Tulloch JF, Phillips C. Incisor trauma and early treatment for Class II Division 1 malocclusion. Am J Orthod Dentofacial Orthop. 2003;123:117–25; discussion 125–6.PubMedCrossRef
Metadata
Title
Do functional orthodontic appliances stimulate mandibular growth in class II division 1 patients?
A systematic review of the literature
Authors
Dr. Michael Hans Bertl
Carina Mandl
Adriano Giacomo Crismani
Publication date
01-09-2011
Publisher
Springer Vienna
Published in
international journal of stomatology & occlusion medicine / Issue 2/2011
Print ISSN: 1867-2221
Electronic ISSN: 1867-223X
DOI
https://doi.org/10.1007/s12548-011-0009-4

Other articles of this Issue 2/2011

international journal of stomatology & occlusion medicine 2/2011 Go to the issue