Long term results of double plate appliance and facemask combination in the treatment of Class III malocclusion: cephalometric analysis

Year 2018, Volume: 35 Issue: 3, 62 - 68, 14.08.2018

Emine Kaygısız , Erdal Bozkaya Tuba Tortop , Dervis Emre Ercan , Sema Yuksel

https://doi.org/10.17214/gaziaot.345052

Abstract

Objective: The aim of this
study was to evaluate the long term results of double plate appliance and
facemask combination (DPA-FM) in treating Class III malocclusions when growth
potential of the patients was close to cease or ceased.

Materials and Method: The material consisted
of the pretreatment (T1), posttreatment (T2), and long term (T3) lateral
cephalometric and the hand-wrist radiographs of 13 patients (5 females, 8 males;
mean chronological age: 11.1±1.40 years) with skeletal and dental Class III
malocclusion treated with DPA-FM combination. The mean DPA-FM treatment time
was 10.8±1.88 months. The hand-wrist growth and developmental stages were MP3u
or Ru at T3. The mean follow-up period was 5.0±1.98 years. Friedman’s Two-Way
ANOVA and Wilcoxon signed-rank tests were used to evaluate the treatment
(T2-T1), follow-up (T3-T2) and overall (T3-T1) results.

Results: With
the DPA-FM therapy, SNA and ANB angles increased (p<0.001); however, no
significant differences were found in these parameters during T3-T2 period
[p=0.655 (SNA), p=0.805 (ANB)]. Significant increases were found in N┴FH-A distance during
the treatment (p<0.01) and follow-up (p<0.05) periods. Molar relation showed
significant increases with DPA-FM in both the treatment and overall period
(p<0.001). Overjet increased significantly during the treatment
(p<0.001), follow-up (p<0.05), and overall (p<0.001) periods.
Significant protrusion of upper incisors (U1/NA) was observed during the
treatment, follow-up, and overall periods (p<0.05). U6/PP and L6/MP angles
did not change during the DPA-FM treatment; however, these parameters decreased
significantly during the follow-up and overall periods (p<0.05).

Conclusion: In the treatment of
Class III malocclusion, the DPA-FM appliance was effective. The skeletal and
dental sagittal changes achieved by orthopedic treatment were maintained in the
long term.

Keywords

Angle Class III, extraoral traction appliances, follow-up studies, malocclusion, orthodontic appliances, orthodontics

Sınıf III maloklüzyonun tedavisinde ağız-içi çift plak ile yüz maskesi kombine uygulamasının uzun dönem sonuçları: sefalometrik analiz

Abstract

Amaç: Sınıf III maloklüzyonun tedavisinde kullanılan ağız-içi çift plak
ile yüz maskesi (AÇP-YM) kombine tedavisinin uzun dönem sonuçlarının büyüme
potansiyeli bitmiş ya da bitmekte olan hastalarda değerlendirilmesidir.

Gereç ve Yöntem: Çalışmanın materyali AÇP-YM kombine tedavisi uygulanmış olan
iskeletsel ve dişsel Sınıf III maloklüzyona sahip 13 hastaya (5 kız, 8 erkek;
ortalama kronolojik yaş: 11.1±1.40 yıl) ait tedavi öncesi (T1), sonrası (T2) ve
uzun dönem takip (T3) lateral sefalometrik ve el bilek radyografilerinden
oluşturuldu. Ortalama AÇP-YM tedavi süresi 10.8±1.88 aydır. T3 döneminde, el
bilek büyüme ve gelişim safhası, MP3u veya Ru dönemidir. Ortalama takip süresi
5.0±1.98 yıldır. Tedavi (T2-T1), takip (T3-T2) ve toplam (T3-T1) değişiklikleri
değerlendirmek için Friedman iki yönlü ANOVA ve Wilcoxon işaretli sıralar
testleri kullanıldı.

Bulgular: AÇP-YM tedavisi ile SNA ve ANB açılarında artış bulundu (p<0.001). Ancak bu
parametrelerde T3-T2 döneminde önemli düzeyde bir değişiklik meydana gelmedi [p=0.655 (SNA), p=0.805
(ANB)]. N┴FH-A mesafesi tedavi
(p<0.01) ve takip (p<0.05) dönemlerinde önemli düzeyde arttı. Molar ilişkide, hem AÇP-YM tedavisi sırasında hem de toplam sürede
önemli düzeyde bir artış meydana geldi (p<0.001). Overjet ise, tedavi
(p<0.001), takip (p<0.05) ve toplam sürede (p<0.001) önemli düzeyde
arttı. Tedavi, takip dönemlerinde ve toplam sürede, üst keserlerde (U1/NA)
önemli düzeyde protrüzyon gözlendi (p<0.05). U6/PP ve L6/MP açıları AÇP-YM
tedavisi ile değişmezken, takip periyodunda ve toplam sürede bu parametrelerde
önemli düzeyde azalma meydana geldi (p<0.05).

Sonuç: AÇP-YM kombine tedavisi, Sınıf III maloklüzyonun tedavisinde etkili
bulundu. Bu ortopedik tedavi ile meydana gelen iskeletsel ve dişsel sagital
değişikliklerin uzun dönem takip periyodunda korunduğu gözlendi.

Keywords

Angle Sınıf 3, ağız dışı çekme aletleri, maloklüzyon, ortodontik cihazlar, ortodonti, takip çalışmaları

References

• Tortop T, Keykubat A, Yuksel S. Facemask therapy with and without expansion. Am J Orthod Dentofacial Orthop 2007;132:467-74.
• Gencer D, Kaygisiz E, Yüksel S, Tortop T. Comparison of double-plate appliance/facemask combination and facemask therapy in treating Class III malocclusions. Angle Orthod 2015;85:278-83.
• Williams MD, Sarver DM, Sadowsky PL, Bradley E. Combined rapid maxillary expansion and protraction facemask in the treatment of Class III malocclusions in growing children: a prospective long-term study. Semin Orthod 1997;3:265-74.
• Ngan PW, Hagg U, Yiu C, Wei SH. Treatment response and long-term dentofacial adaptations to maxillary expansion and protraction. Semin Orthod 1997;3:255-64.
• Hägg U, Tse A, Bendeus M, Rabie ABM. Long‐term follow‐up of early treatment with reverse headgear. Eur J Orthod 2003;25:95-102.
• Westwood PV, McNamara Jr JA, Baccetti T, Franchi L, Sarver DM. Long-term effects of Class III treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances. Am J Orthod Dentofac Orthop 2003;123:306-20.
• Tortop T, Kaygisiz E, Gencer D, Yuksel S, Atalay Z. Modified tandem traction bow appliance compared with facemask therapy in treating Class III malocclusions. Angle Orthod 2014;84:642-8.
• Atalay Z, Tortop T. Dentofacial effects of a modified tandem traction bow appliance. Eur J Orthod 2010;32:655-61.
• Gencer D, Hasanoğlu Nalcı N, Yuksel S, Tortop T. Effects of double plate - facemask appliance on dentofacial structures. GÜ Diş Hek Fak Derg 2009;26: 163-70.
• Seehra J, Fleming PS, Dibiase AT. Reverse Twin Block appliance for early dental Class III correction. J Clin Orthod 2010;44:602-10.
• Fränkel R. Maxillary retrusion in Class 3 and treatment with the function corrector 3. Rep Congr Eur Orthod Soc 1970:249-59.
• Arman A, Toygar TU, Abuhijleh E. Evaluation of maxillary protraction and fixed appliance therapy in Class III patients. Eur J Orthod 2006;28:383-92.
• Baccetti T, Franchi L, McNamara Jr JA. Treatment and posttreatment craniofacial changes after rapid maxillary expansion and facemask therapy. Am J Orthod Dentofacial Orthop 2000;118:404-13.
• Ghiz MA, Ngan P, Gunel E. Cephalometric variables to predict future success of early orthopedic Class III treatment. Am J Orthod Dentofacial Orthop 2005;127:301-6.
• Deguchi T, Kanomi R, Ashizawa Y, Rosenstein SW. Very early face mask therapy in Class III children. Angle Orthod 1999;69:349-55.
• Gallagher R, Miranda F, Buschang P. Maxillary protraction: treatment and posttreatment effects. Am J Orthod Dentofacial Orthop 1998;113:612-9.
• Chen L, Chen R, Yang Y, Ji G, Shen G. The effects of maxillary protraction and its long-term stability—a clinical trial in Chinese adolescents. Eur J Orthod 2012;34:88-95.
• Üçem TT, Üçüncü N, Yüksel S. Comparison of double-plate appliance and facemask therapy in treating Class III malocclusions. Am J Orthod Dentofacial Orthop 2004;126:672-9.
• Grave KC, Brown T. Skeletal ossification and the adolescent growth spurt. Am J Orthod 1976;69:611-9.
• Janson G, Caldas W, Garib DG, Foncatti CF. Long-term stability of Class III malocclusion nonextraction treatment. J World Fed Orthod 2017;6:20-7.
• Mandall N, Cousley R, DiBiase A, Dyer F, Littlewood S, Mattick R, et al. Early class III protraction facemask treatment reduces the need for orthognathic surgery: a multi-centre, two-arm parallel randomized, controlled trial. J Orthod 2016;43:164-75.
• Kaygisiz E, Yuksel S. Evaluation of the long-term results of facemask. Acta Odontol Turc 2014;31:127-33.
• Macdonald KE, Kapust AJ, Turley PK. Cephalometric changes after the correction of Class III malocclusion with maxillary expansion/facemask therapy. Am J Orthod Dentofacial Orthop 1999;116:13-24.
• Shanker S, Ngan P, Wade D, Wade D, Beck M, Yiu C, et al. Cephalometric A point changes during and after maxillary protraction and expansion. Am J Orthod Dentofacial Orthop 1996;110:423-30.
• Chong YH, Ive JC, Årtun J. Changes following the use of protraction headgear for early correction of Class III malocclusion. Angle Orthod 1996;66:351-62.
• Merwin D, Ngan P, Hagg U, Yiu C, Wei SH. Timing for effective application of anteriorly directed orthopedic force to the maxilla. Am J Orthod Dentofacial Orthop 1997;112:292-9.
• Wells AP, Sarver DM, Proffit WR. Long-term efficacy of reverse pull headgear therapy. Angle Orthod 2006;76:915-22.
• Celikoglu M, Yavuz I, Unal T, Oktay H, Erdem A. Comparison of the soft and hard tissue effects of two different protraction mechanisms in class III patients: a randomized clinical trial. Clin Oral Investig 2015;19:2115-22.
• Rongo R, D'Antò V, Bucci R, Polito I, Martina R, Michelotti A. Skeletal and dental effects of Class III orthopaedic treatment: a systematic review and meta-analysis. J Oral Rehabil 2017;44:545-62.
• Cozza P, Baccetti T, Mucedero M, Pavoni C, Franchi L. Treatment and posttreatment effects of a facial mask combined with a bite-block appliance in Class III malocclusion. Am J Orthod Dentofacial Orthop 2010;138:300-10.
• Üçüncü N, Tortop T, Yüksel S. A comparison of chincap and maxillary protraction appliances in the treatment of skeletal Class III malocclusions. Eur J Orthod 2000;22:43-51.
• Baik HS, Jee SH, Lee KJ, Oh TK. Treatment effects of Fränkel functional regulator III in children with Class III malocclusions. Am J Orthod Dentofacial Orthop 2004;125:294-301.
• Masucci C, Franchi L, Defraia E, Mucedero M, Cozza P, Baccetti T. Stability of rapid maxillary expansion and facemask therapy: a long-term controlled study. Am J Orthod Dentofacial Orthop 2011;140:493-500.