Stability of Class II malocclusion treatment with the distal jet followed by fixed appliances.

INTRODUCTION: This retrospective study aimed to assess the stability of Class II malocclusion treatment with the distal jet, followed by fixed appliances. METHODS: Seventy-five cephalograms of 30 subjects were divided into 2 groups. The treated group consisted of 15 patients who were evaluated at the pretreatment, posttreatment, and long-term posttreatment stages. The control group consisted of 15 subjects with normal occlusion, comparable to the experimental group at the long-term posttreatment period. Intergroup comparison of posttreatment changes was evaluated with t tests. RESULTS: In the long-term posttreatment period, there was no significant change in the anteroposterior position of the maxilla and mandible to the cranial base. The lower anterior face height had a significantly smaller increase in the treated than in the control group. The maxillary molars in the treated group had significantly smaller vertical development, and the mandibular incisors had significantly greater labial tipping and protrusion than the control group. The treatment produced significant improvement in molar relationship and reduction of overbite and overjet, which remained stable in the long-term posttreatment period. There was greater upper lip protrusion in the experimental than in the control group in the long-term posttreatment period. CONCLUSIONS: Treatment of Class II malocclusions with the distal jet, followed by fixed appliances, showed good long-term stability in molar relationship, overbite, and overjet.

Long-term stability of Class II treatment with the Jasper jumper appliance.

INTRODUCTION: Treatment of Class II Division 1 malocclusion with orthopedic devices combined with fixed orthodontic appliances has shown excellent results when used in growing patients. We aimed to evaluate the long-term stability of the cephalometric changes obtained during Class II malocclusion correction with the Jasper jumper associated with fixed appliances. METHODS: The treatment group comprised 24 patients who were evaluated at 3 stages: pretreatment, posttreatment, and long-term posttreatment. The control group comprised 15 subjects with normal occlusion. Intratreatment group comparisons among the 3 stages were performed with repeated measures analysis of variance, followed by Tukey tests. Intergroup comparisons of posttreatment changes and normal growth changes of the treatment group were performed with t tests. RESULTS: Apical base relationship, maxillary incisor anteroposterior position, and overjet demonstrated significant relapses in relation to the control group. CONCLUSIONS: Most dentoalveolar changes obtained with the Jasper jumper followed by fixed appliances during treatment remained stable in the long term. However, apical base relationship, maxillary incisor anteroposterior position, and overjet demonstrated significant relapses in relation to the control group. Therefore, active retention time should be increased in the posttreatment period.

Treatment effects of the MARA appliance and Activator-Headgear combined with fixed appliances in Class II division 1 malocclusion patients: A retrospective longitudinal study.

INTRODUCTION: Class II division 1 malocclusion treatment with functional devices offers acceptable results. These devices can be removable or fixed, and the essential difference between them is the need for compliance. It is clinically important to investigate if there are differences in the treatment effects of these devices that present different characteristics. OBJECTIVE: This retrospective longitudinal study compared the treatment effects of Class II correction with the MARA appliance, Activator-Headgear (AcHg) combination, both followed by multibracket fixed appliances, and an untreated control group. MATERIAL AND METHODS: Each experimental group was composed of 18 patients, with a baseline mean age of 11.70 and 10.88 years, treated for 3.60 and 3.17 years. The control group consisted of 20 subjects with baseline mean age of 11.07 years. The groups were evaluated before (T1) and after (T2) treatment. Lateral radiographs were used to evaluate the treatment changes with treatment (T2-T1), compared to the control group. Intergroup comparisons were performed using repeated-measures analysis of variance (ANOVA), followed by Tukey's test. RESULTS: The AcHg group showed significantly greater maxillary growth restriction than the MARA, while the mandibular changes were due to natural growth. Both devices promoted significantly greater maxillary incisors retrusion, mandibular incisors labial inclination, and improvement of overjet and molar relationships, compared to the control. CONCLUSIONS: Both functional devices followed by multibracket appliances were effective to correct Class II malocclusion. Nonetheless, the AcHg combination presents superior skeletal effects, due to significantly greater maxillary growth restriction compared to the MARA appliance. Moreover, the appliances presented similar dentoalveolar effects.

Treatment effects of the MARA appliance and Activator-Headgear combined with fixed appliances in Class II division 1 malocclusion patients: A retrospective longitudinal study

ABSTRACT Introduction: Class II division 1 malocclusion treatment with functional devices offers acceptable results. These devices can be removable or fixed, and the essential difference between them is the need for compliance. It is clinically important to investigate if there are differences in the treatment effects of these devices that present different characteristics. Objective: This retrospective longitudinal study compared the treatment effects of Class II correction with the MARA appliance, Activator-Headgear (AcHg) combination, both followed by multibracket fixed appliances, and an untreated control group. Material and Methods: Each experimental group was composed of 18 patients, with a baseline mean age of 11.70 and 10.88 years, treated for 3.60 and 3.17 years. The control group consisted of 20 subjects with baseline mean age of 11.07 years. The groups were evaluated before (T1) and after (T2) treatment. Lateral radiographs were used to evaluate the treatment changes with treatment (T2-T1), compared to the control group. Intergroup comparisons were performed using repeated-measures analysis of variance (ANOVA), followed by Tukey's test. Results: The AcHg group showed significantly greater maxillary growth restriction than the MARA, while the mandibular changes were due to natural growth. Both devices promoted significantly greater maxillary incisors retrusion, mandibular incisors labial inclination, and improvement of overjet and molar relationships, compared to the control. Conclusions: Both functional devices followed by multibracket appliances were effective to correct Class II malocclusion. Nonetheless, the AcHg combination presents superior skeletal effects, due to significantly greater maxillary growth restriction compared to the MARA appliance. Moreover, the appliances presented similar dentoalveolar effects.

RESUMO Introdução: O tratamento da má oclusão de Classe II divisão 1 com dispositivos funcionais oferece resultados aceitáveis. Esses dispositivos podem ser removíveis ou fixos, e a diferença essencial entre eles é a necessidade de colaboração. É clinicamente importante investigar se existem diferenças nos efeitos do tratamento desses dispositivos que apresentam características diferentes. Objetivo: O presente estudo retrospectivo longitudinal comparou os efeitos do MARA e da combinação Aparelho Extrabucal-Ativador (AEB-At) no tratamento da Classe II, ambos seguidos por aparelho fixo, adicionando também um grupo controle não tratado. Métodos: Cada grupo experimental foi composto por 18 pacientes; respectivamente, com média de idade inicial de 11,70 e 10,88 anos, tratados por 3,60 e 3,17 anos. O grupo controle foi composto por 20 indivíduos, com idade média inicial de 11,07 anos. Os grupos foram avaliados antes (T1) e após (T2) o tratamento. Radiografias de perfil foram utilizadas para avaliar as alterações do tratamento (T2-T1), em comparação com o grupo controle. As comparações intergrupos foram realizadas por meio da análise de variância para medidas repetidas (ANOVA), seguida pelo teste de Tukey. Resultados: O AEB-At apresentou uma restrição do crescimento maxilar significativamente maior que o MARA, enquanto as alterações mandibulares foram decorrentes do crescimento natural. Ambos os dispositivos promoveram significativamente mais retrusão dos incisivos superiores, inclinação vestibular dos incisivos inferiores e melhora da sobressaliência e relação molar, em comparação com o controle. Conclusões: Ambos os dispositivos funcionais associados ao aparelho fixo foram efetivos na correção da má oclusão de Classe II. No entanto, a combinação AEB-At apresenta efeitos esqueléticos superiores, devido à restrição de crescimento maxilar significativamente maior do que com o aparelho MARA. Além disso, os aparelhos apresentaram efeitos dentoalveolares semelhantes.

Long-term stability of Class II division 1 treatment with the MARA combined with fixed appliances / Avaliação da estabilidade em longo prazo da correção da Classe II divisão 1 com aparelho MARA associado ao aparelho ortodôntico fixo

Introduction: Successful treatment of class II Division 1 malocclusion is also implied to the long-term stability of treatment changes and many are the factors that can influence that. Objective: This research aimed to evaluate the long-term stability of the cephalometric changes obtained during Class II malocclusion correction with the MARA (Mandibular Anterior Repositioning Appliance) associated with fixed appliances. Methods: The treatment group comprised 12 patients who were evaluated at three stages: pretreatment (T1), posttreatment (T2) and long-term posttreatment (T3). The mean initial age of the patients was 12.35 years and the mean final age was 15.65 years. The mean age at the long-term posttreatment stage was 22.53 years and the mean long-term posttreatment period was 6.88 years. The control group comprised 12 subjects with normal occlusion and no orthodontic treatment with ages comparable to the treatment group at the posttreatment and long-term posttreatment stages. Intra-treatment group comparison between the three stages was performed with repeated measures analysis of variance (ANOVA), followed by Tukey tests. Intergroup comparison of posttreatment changes and normal growth changes of the treatment group were performed with t tests. Results: reduction of the maxillary protrusion and improvement of the maxillomandibular relationships remained stable during the long-term posttreatment period. Maxillary incisors inclination and overjet presented a tendency to relapse in relation to the control group Conclusions: Despite the different amount of growth potential, the reduction of the maxillary protrusion and maxillomandibular relationship improvement remained stable with no difference from normal occlusion behavior. Palatal inclination of the maxillary incisors and the overjet improvement showed a slight tendency towards relapse when compared to normal occlusion. Therefore, an increase of active retention time could be recommended to prevent that.(AU)

Introdução: o tratamento bem-sucedido da má oclusão de classe II Divisão 1 está implícito na estabilidade em longo prazo das correções e muitos são os fatores que podem influenciar esta estabilidade. Objetivos: observando que a terapia com o aparelho MARA (Mandibular Anterior Repositioning Appliance) associado ao aparelho ortodôntico fixo mostrou-se eficaz na correção da Classe II, este trabalho estabeleceu como objetivo avaliar cefalometricamente a estabilidade em longo prazo das correções obtidas durante este tratamento. Materiais e métodos: foram analisadas as alterações durante e após o tratamento através das telerradiografias em norma lateral de 12 pacientes (09 meninos e 03 meninas) nas fases: inicial (T1), final (T2) e pós-tratamento (T3), com idade média inicial de 12,35 anos e 15,65 anos ao final do tratamento. A idade media no estágio de pós tratamento em longo prazo foi de 22,53 e o tempo de acompanhamento pós tratamento foi em media 6,88 anos. As alterações foram comparadas a um Grupo Controle com oclusão normal, não tratados ortodonticamente, com idades compatíveis ao grupo experimental nos estágios final e pós tratamento em longo prazo. Os dados obtidos foram analisados através da análise de variância (ANOVA) para medidas repetidas e o teste de comparações múltiplas de Tukey. As alterações ocorridas no período de póstratamento foram comparadas com as alterações do Grupo Controle durante o período correspondente utilizando o teste t independente. Resultados: Observou-se uma redução da protrusão maxilar, assim como, uma melhora das relações maxilomandibulares, as quais, permaneceram estáveis durante o período de póstratamento. A inclinação dos incisivos superiores e o overjet apresentaram tendência à recidiva em relação ao grupo controle. Conclusões: A redução da protrusão maxilar e melhora da relação maxilomandibular mantiveram-se estáveis, sem diferença estatisticamente significante do comportamento na oclusão normal. A retroinclinação dos incisivos superiores e a melhora do overjet mostraram uma ligeira tendência à recidiva quando comparada ao comportamento da oclusão normal. Portanto, um aumento do tempo de retenção ativo pode ser recomendado para evitar essa recidiva.(AU)

Estabilidade do tratamento não-cirúrgico da Classe III / Stability of nonsurgical treatment of Class III malocclusion

O objetivo desta revisão sistemática foi avaliar a literatura disponível no que diz respeito à estabilidade a longo prazo do tratamento não cirúrgico e sem extrações da má oclusão de Classe III, ao final do crescimento craniofacial ativo. Foi conduzida uma busca na literatura nas bases de dados PubMed, Embase, Central Cochrane de Cadastro de Ensaios Controlados, Scopus e Google Scholar até a primeira semana de Outubro de 2015. Os critérios de inclusão foram aplicados com o propósito de avaliar a estabilidade do tratamento da Classe III em pacientes acompanhados até o término do crescimento. Uma avaliação qualitativa dos estudos foi realizada. A busca identificou 220 artigos, dos quais 11 preencheram os critérios de inclusão. Após a análise qualitativa, 10 estudos foram classificados como de valor moderado de evidência científica e serviram de base para as conclusões do presente estudo e 1 estudo foi classificado como de baixo valor de evidência. Com base nos estudos avaliados, quando pacientes Classe III foram acompanhados até o final do crescimento craniofacial ativo, o tratamento obteve resultados positivos em cerca de 54% a 88,5% dos indivíduos estudados. O fator de maior influência sobre o sucesso a longo prazo do tratamento da Classe III foi a quantidade e direção de crescimento mandibular durante e após a adolescência. A contenção ativa deve ser utilizada em pacientes em crescimento para evitar a recidiva da Classe III devido à tendência de crescimento anterior mandibular pós-tratamento.

The aim of this systematic review was to assess the available literature about long-term stability of nonsurgical and nonextraction Class III malocclusion treatment at the end of active craniofacial growth. A literature survey was performed until October of 2015 on PubMed, Embase, Cochrane Central of Controlled Trials, Scopus and Google Scholar databases. The inclusion criteria were applied for the purpose of assessing the stability of Class III treatment in subjects followed-up until the end of growth. Qualitative assessment of the studies was performed. The search returned 220 articles from which 11 fulfilled the inclusion criteria. After qualitative assessment, 10 studies were classified as of moderate value of scientific evidence and served as a basis for the conclusions of the present study and one was graded as of low value of scientific evidence. Based on the studies assessed, when Class III subjects follow-up was performed until the end of active facial growth, the treatment presented successful outcomes in about 54% to 88.5% of subjects studied. The major factor that determined longterm success of Class III treatment was the amount and direction of mandibular growth during and after adolescence. The active retention should be used in subjects growing up to avoid Class III relapse, due to the tendency of anterior mandibular growth post-treatment.