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VOLUME 25 , ISSUE 4 ( April, 2024 ) > List of Articles

ORIGINAL RESEARCH

Evaluation of Mandibular Projection in Class II Division 2 Subjects Following Orthodontic Treatment Using Clear Aligners

Parnian Mirzasoleiman, Tarek El-Bialy, William A Wiltshire, Patricia B Santos, Fabio Henrique de Sa Leitao Pinheiro

Keywords : Class II division 2, Clear aligners, Incisor proclination, Mandibular advancement, Maxillary expansion

Citation Information : Mirzasoleiman P, El-Bialy T, Wiltshire WA, Santos PB, Pinheiro FH. Evaluation of Mandibular Projection in Class II Division 2 Subjects Following Orthodontic Treatment Using Clear Aligners. J Contemp Dent Pract 2024; 25 (4):295-302.

DOI: 10.5005/jp-journals-10024-3664

License: CC BY-NC 4.0

Published Online: 14-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aim: The purpose of this study was to evaluate the mandibular growth and/or projection following maxillary incisor proclination, overbite correction, and maxillary dentoalveolar expansion without the use of any class II mechanics, in growing class II division 2 patients treated with clear aligners. Materials and methods: Before and after treatment cone-beam computed tomographic (CBCT) generated lateral and posteroanterior cephalograms of thirty-two patients with skeletal class II division 2, 16 in the treatment group and 16 in the untreated group, were reviewed to evaluate treatment-related changes. Upper incisors were proclined and protruded, as well as upper arch expansion and overbite correction were performed as part of their regular treatment. Cephalometric analysis was performed to evaluate skeletal and dental changes. Unpaired statistical t-tests were performed to determine if significant skeletal class II correction was achieved in the treatment group. Results: In the treatment group, after treatment, the upper incisors became more proclined and protruded, and the inter-molar width increased while the overbite was reduced compared to the control group. An increase in skeletal mandibular growth and forward projection was also observed, thus contributing to an improvement of the sagittal skeletal relationship as evidenced by ANB and Wits values compared to the control group. Conclusion: A combination of upper incisor proclination, correction of deep overbite, and maxillary dentoalveolar expansion using clear aligners appears to contribute to an improvement of the skeletal class II relationship in growing patients with class II division 2. Clinical significance: This study shows that unlocking the mandible by correcting a deep overbite, proclining upper incisors, and expanding the upper arch in growing class II division 2 patients can improve skeletal class II using clear aligners.


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  1. Feu D, Catharino F, Duplat CB, et al. Esthetic perception and economic value of orthodontic appliances by lay Brazilian adults. Dental Press J Orthod 2012;17(5):102–114. DOI: https://doi.org/10.1590/S2176-94512012000500015.
  2. Walton DK, Fields HW, Johnston WM, et al. Orthodontic appliance preferences of children and adolescents. Am J Orthod Dentofacial Orthop 2010;138(6):698.e1–e12; discussion 698–699. DOI: 10.1016/j.ajodo.2010.06.012.
  3. Kesling HD. Coordinating the predetermined pattern and tooth positioner with conventional treatment. Am J Orthod Oral Surg 1946;32:285–293. DOI: 10.1016/0096-6347(46)90053-1.
  4. Sharma NS. Management of a growing skeletal class II patient: A case report. Int J Clin Pediatr Dent 2013;6(1):48–54. DOI: 10.5005/jp-journals-10005-1187.
  5. Bratu DC, Bălan RA, Szuhanek CA, et al. Craniofacial morphology in patients with Angle Class II division 2 malocclusion. Rom J Morphol Embryol 2014;55(3):909–913. PMID: 25329119.
  6. Uzuner FD, Aslan BI, Dinçer M. Dentoskeletal morphology in adults with class I, class II division 1, or class II division 2 malocclusion with increased overbite. American Journal of Orthodontics and Dentofacial Orthopedics 2019;156(2):248–256.e2. DOI: 10.1016/j.ajodo.2019.03.006.
  7. Kang H-K, Guo J, Kaczynski R, et al. Effects of maxillary incisor inclination on dentoalveolar changes in class II division 1 and 2 non-extraction treatment for Caucasian children – A retrospective study using CBCT. Int Orthod 2021;19(1):51–59. DOI: 10.1016/j.ortho.2020.11.003.
  8. Al-Jewair T, Kurtzner K, Giangreco T, et al. Effects of clear aligner therapy for class II malocclusion on upper airway morphology and daytime sleepiness in adults: A case series. Int Orthod 2020;18(1): 154–164. DOI: 10.1016/j.ortho.2019.12.002.
  9. Markovic MD. At the crossroads of oral facial genetics. Eur J Orthod 1992;14(6):469–481. DOI: 10.1093/ejo/14.6.469.
  10. Barbosa LAG, Araujo E, Behrents RG, et al. Longitudinal cephalometric growth of untreated subjects with class II division 2 malocclusion. Am J Orthod Dentofacial Orthop 2017;151(5):914–920. DOI: 10.1016/j.ajodo.2016.10.026.
  11. Millett DT, Cunningham SJ, O'Brien KD, et al. Orthodontic treatment for deep bite and retroclined upper front teeth in children. Cochrane Database Syst Rev 2018;2(2):CD005972. DOI: 10.1002/14651858.CD005972.pub4.
  12. Peck S, Peck L, Kataja M. Class II division 2 malocclusion: A heritable pattern of small teeth in well-developed jaws. Angle Orthod 1998;68(1):9–20. DOI: 10.1043/0003-3219(1998)068<0009:CIDMAH> 2.3.CO;2.
  13. Baccetti T, Franchi L, McNamara JA, et al. Early dentofacial features of Class II malocclusion: A longitudinal study from the deciduous through the mixed dentition. Am J Orthod Dentofacial Orthop 1997;111(5):502–509. DOI: 10.1016/s0889-5406(97)70287-7.
  14. McNamara JA, Peterson JE, Alexander RG. Three-dimensional diagnosis and management of Class II malocclusion in the mixed dentition. Semin Orthod 1996;2(2):114–137. DOI: 10.1016/s1073-8746(96)80048-x.
  15. Campbell C, Millett D, Kelly N, et al. Frankel 2 appliance versus the modified twin block appliance for phase 1 treatment of class II division 1 malocclusion in children and adolescents: A randomized clinical trial. Angle Orthod 2020;90(2):202–208. DOI: 10.2319/042419-290.1.
  16. Chen H, Liu L, Han M, et al. Changes of maxillary central incisor and alveolar bone in class II division 2 nonextraction treatment with a fixed appliance or clear aligner: A pilot cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2023;163(4): 509–519. DOI: 10.1016/j.ajodo.2022.02.015.
  17. Hemmatpour S, Mokhtar A, Rakhshan V. Effects of sabbagh universal spring 2 fixed functional appliance on class II/1 patients at their postpubertal-peak growth period compared with the extraction method: A randomized clinical trial. J Orofac Orthop 2017;78(1):41–51. DOI: 10.1007/s00056-016-0060-2.
  18. Young TM, Smith RJ. Effects of orthodontics on the facial profile: A comparison of changes during nonextraction and four premolar extraction treatment. Am J Orthod Dentofacial Orthop 1993;103(5):452–458. DOI: 10.1016/S0889-5406(05)81796-2.
  19. Kirschneck C, Römer P, Proff P, et al. Association of dentoskeletal morphology with incisor inclination in angle class II patients: A retrospective cephalometric study. Head Face Med 2013;9:24. DOI: 10.1186/1746-160X-9-24.
  20. Al-Khateeb EAA, Al-Khateeb SN. Anteroposterior and vertical components of class II division 1 and division 2 malocclusion. Angle Orthod 2009;79(5):859–866. DOI: 10.2319/062208-325.1.
  21. McNamara JA, Howe RP, Dischinger TG. A comparison of the Herbst and Fränkel appliances in the treatment of Class II malocclusion. Am J Orthod Dentofacial Orthop 1990;98(2):134–144. DOI: 10.1016/0889-5406(90)70007-Y.
  22. Windmiller EC. The acrylic-splint Herbst appliance: A cephalometric evaluation. Am J Orthod Dentofacial Orthop 1993;104(1):73–84. DOI: 10.1016/0889-5406(93)70030-R.
  23. Mills CM, McCulloch KJ. Posttreatment changes after successful correction of Class II malocclusions with the twin block appliance. Am J Orthod Dentofacial Orthop 2000;118(1):24–33. DOI: 10.1067/mod.2000.104902.
  24. Baccetti T, Franchi L, Toth LR, et al. Treatment timing for Twin-block therapy. Am J Orthod Dentofacial Orthop 2000;118(2):159–170. DOI: 10.1067/mod.2000.105571.
  25. Basciftci FA. The effects of activator treatment on the craniofacial structures of Class II division 1 patients. Eur J Orthod 2003;25(1):87–93. DOI: 10.1093/ejo/25.1.87.
  26. Karlsen AT, Krogstad O. Morphology and growth in convex profile facial patterns: A longitudinal study. Angle Orthod 1999;69(4): 334–344. DOI: 10.1043/0003-3219(1999)069<0334:MAGICP>2.3.CO;2.
  27. Pancherz H, Zieber K, Hoyer B. Cephalometric characteristics of Class II division 1 and Class II division 2 malocclusions: A comparative study in children. Angle Orthod 1997;67(2):111–120. DOI: 10.1043/0003-3219(1997)067<0111:CCOCID>2.3.CO;2.
  28. Renfroe E. A study of the facial patterns associated with Class I, Class II division 1 and Class II division 2 malocclusions. Angle Orthod 1948;19:12–15.
  29. Ramos DSP, de Lima EM. A longitudinal evaluation of the skeletal profile of treated and untreated skeletal Class II individuals. Angle Orthod 2005;75(1):47–53. DOI: 10.1043/0003-3219(2005)075<0047: ALEOTS>2.0.CO;2.
  30. Isik F, Nalbantgil D, Sayinsu K, et al. A comparative study of cephalometric and arch width characteristics of Class II division 1 and division 2 malocclusions. Eur J Orthod 2006;28(2):179–183. DOI: 10.1093/ejo/cji096.
  31. AL-Nimri K, Abo-Zomor M, Alomari S. Changes in mandibular position in treated Class II division 2 malocclusions in growing and non-growing subjects. Aust Orthod J 2016;32(1):73–81. PMID: 27468594.
  32. Thuer U, Ingervall B, Burgin W, et al. No posterior mandibular displacement in Angle Class II, division 2 malocclusion as revealed with electromyography and sirognathography. Eur J Orthod 1992;14(2):162–171. DOI: 10.1093/ejo/14.2.162.
  33. Demisch A, Ingervall B, Thüer U. Mandibular displacement in Angle Class II, division 2 malocclusion. Am J Orthod Dentofacial Orthop 1992;102(6):509–518. DOI: 10.1016/0889-5406(92)70067-K.
  34. Bishara SE, Fahl JA, Peterson LC. Longitudinal changes in the ANB angle and Wits appraisal: Clinical implications. Am J Orthod 1983;84(2):133–139. DOI: 10.1016/0002-9416(83)90177-x.
  35. Buschang PH, Tanguay R, Turkewicz J, et al. A polynomial approach to craniofacial growth: Description and comparison of adolescent males with normal occlusion and those with untreated Class II malocclusion. Am J Orthod Dentofacial Orthop 1986;90(5):437–442. DOI: 10.1016/0889-5406(86)90009-0.
  36. Williams S, Leighton BC, Nielsen JH. Linear evaluation of the development of sagittal jaw relationship. Am J Orthod 1985;88(3): 235–241. DOI: 10.1016/s0002-9416(85)90218-0.
  37. Hönn M, Schneider C, Dietz K, et al. Treating class II patients with removable plates and functional orthopedic appliances. J Orofac Orthop 2006;67(4):272–288. DOI: 10.1007/s00056-006-0529-5.
  38. You ZH, Fishman LS, Rosenblum RE, et al. Dentoalveolar changes related to mandibular forward growth in untreated Class II persons. Am J Orthod Dentofacial Orthop 2001;120(6):598–607; quiz 676. DOI: 10.1067/mod.2001.119801.
  39. EL-Bialy T, Galante D, Daher S. Orthodontic biomechanics: Treatment of complex cases using clear aligner. Bentham Science Publishers; 2016.
  40. Gugino CF, Dus I. Unlocking orthodontic malocclusions: An interplay between form and function. Semin Orthod 1998;4(4):246–255. DOI: 10.1016/s1073-8746(98)80030-3.
  41. Caprioglio A, Bergamini C, Franchi L, et al. Prediction of Class II improvement after rapid maxillary expansion in early mixed dentition. Prog Orthod 2017;18(1):9. DOI: 10.1186/s40510-017- 0163-3.
  42. Varrela J. Longitudinal assessment of Class II occlusal and skeletal development in the deciduous dentition. Eur J Orthod 1993;15:345.
  43. Selwyn-Barnett BJ. Class II/Division 2 malocclusion: A method of planning and treatment. Br J Orthod 1996;23(1):29–36. DOI: 10.1179/bjo.23.1.29.
  44. Schwarz A. Der Deckbiss (Steilbiss) im Fernröntgenbilt. Fortschritte der Kieferorthopädie 1956;17:89–103.
  45. Tollaro I, Baccetti T, Franchi L, et al. Role of posterior transverse interarch discrepancy in Class II, Division 1 malocclusion during the mixed dentition phase. Am J Orthod Dentofacial Orthop 1996;110(4):417–422. DOI: 10.1016/s0889-5406(96)70045-8.
  46. Mariano Pereira P, Pinhão Ferreira A, Tavares P, et al. Different manifestations of Class II Division 2 incisor retroclination: A morphologic study. Am J Orthod Dentofacial Orthop 2013;143(3): 310–316. DOI: 10.1016/j.ajodo.2012.09.021.
  47. Brezniak N, Arad A, Heller M, et al. Pathognomonic cephalometric characteristics of Angle Class II Division 2 malocclusion. Angle Orthod 2002;72(3):251–257. DOI: 10.1043/0003-3219(2002)072 <0251:PCCOCI>2.0.CO;2.
  48. Woods MG. Sagittal mandibular changes with overbite correction in subjects with different mandibular growth directions: Late mixed-dentition treatment effects. Am J Orthod Dentofacial Orthop 2008;133(3):388–394. DOI: 10.1016/j.ajodo.2006.03.037.
  49. Parker CD, Nanda RS, Currier GF. Skeletal and dental changes associated with the treatment of deep bite malocclusion. Am J Orthod Dentofacial Orthop 1995;107(4):382–393. DOI: 10.1016/s0889-5406(95)70091-9.
  50. Erickson LP, Hunter WS. Class II, division 2 treatment and mandibular growth. Angle Orthod 1985;55(3):215–224. DOI: 10.1043/0003-3219(1985)055<0215:CIDPAM>2.0.CO;2.
  51. Haas AJ. Palatal expansion: Just the beginning of dentofacial orthopedics. Am J Orthod 1970;57(3):219–255. DOI: 10.1016/0002-9416(70)90241-1.
  52. Gianelly AA. Rapid palatal expansion in the absence of crossbites: added value? Am J Orthod Dentofacial Orthop 2003;124(4):362–365. DOI: 10.1016/s0889-5406(03)00568-7.
  53. Swann GC. The diagnosis and interception of Class II, Division 2 malocclusion. Am J Orthod 1954;40:325–340.
  54. Guest SS, McNamara JA, Baccetti T, et al. Improving Class II malocclusion as a side-effect of rapid maxillary expansion: A prospective clinical study. Am J Orthod Dentofacial Orthop 2010;138(5):582–591. DOI: 10.1016/j.ajodo.2008.12.026.
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