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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

Effekte der Behandlung mit festsitzender funktionaler SUS 2 (Sabbagh Universal Spring 2)-Feder im Vergleich zur Extraktionsmethode bei Klasse-II/1-Patienten nach dem pubertären Wachstumsschub

Eine randomisierte klinische Studie

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to evaluate the therapeutic effects of the Sabbagh Universal Spring 2 (SUS 2) fixed functional appliance compared to the premolar extraction method in correcting class II/1 malocclusion in patients who had passed their peak of postpubertal growth (stages 4–6 of Cervical Vertebral Maturation Index).

Methods

In all, 40 class II/1 patients were randomized to receive SUS 2 application (7 males, 13 females, age 15.75 ± 1.02 years) or maxillary premolar extraction (8 males, 12 females, age 15.40 ± 0.99 years). Pre- and posttreatment digital cephalographs were traced at least twice. A paired t test was used to compare the pre- and posttreatment measurements. Treatment changes were compared using an independent samples t test (P ≤ 0.05).

Results

The extent of change was significant in the following variables: ANB, nasolabial angle, Mand1-ML, 1L-NB, anterior and posterior facial heights, N-A-Pog, 1U-NF, 6L-MP, Ar-Go, OP-HP, A-B, A-Sn, B-Sm, APDI, NAPog, AB-NPog, POr-DOP, SN-OcP, POr-OcP, Wits, 1 l-APog, 1LMeLm, S-Go:N-Me, N-ANS-Pog, Ap1LAp1u-DOP, ANS-Cond, Pog-Cond, SS-Ls, A-N-Pog, Pog–Pog′, MeGoOcP, 1L-Npog, Go-Me, Go-Me:N-S, S-Me, Ls-(Sn-Pog′), Stms–Stmi, N′-Gn′, N′NsPog′, 6u-PTV, 1u-NA, FMIA, and IMPA.

Conclusions

SUS 2 corrected class II/1 malocclusion of patients in the postpubertal growth period by inhibiting the maxilla’s forward growth, advancing the mandible, decreasing the nasolabial and interincisal angles, proclining the incisors, increasing the facial height, and clockwise rotation of the occlusal plane. Extraction reduced the interincisal angle and protruded the lower incisors. However, it did not change the soft tissue thickness and did not cause a clockwise rotation in the occlusal plane.

Zusammenfassung

Ziel

Evaluiert werden sollten die Effekte einer Behandlung mit der SUS 2 (Sabbagh Universal Spring 2)-Feder im Vergleich mit denen einer Prämolarenextraktion im Oberkiefer zur Korrektur einer Klasse-II/1-Malokklusion bei Patienten nach dem pubertären Wachstumsschub [CVMI („cervical maturation index“)-Stadien 4–6].

Methoden

Insgesamt 40 Klasse-II/1-Patienten wurden randomisiert in 2 Gruppen eingeteilt: eine mit SUS 2-Behandlung (7 männliche, 13 weibliche, 15,75 ± 1,02 Jahre), die andere mit Prämolarenextraktion im Oberkiefer (8 männliche, 12 weibliche, 15,40 ± 0,99 Jahre). Vor und nach Behandlung erstellte digitale Kephalogramme wurden mindestens zweimal ausgewertet. Zum Vergleich prä- und posttherapeutischer Messungen diente der gepaarte t-Test, zum Vergleich der Veränderungen nach Behandlung der t-Test für unabhängige Stichproben (p ≤ 0,05).

Ergebnisse

Bei den im Folgenden aufgeführten Variablen war das Ausmaß der Veränderungen signifikant: ANB, Nasolabialwinkel, Mand1-ML, 1L-NB, anteriore und posteriore Gesichtshöhe, N-A-Pog, 1U-NF, 6L-MP, Ar-Go, OP-HP, A-B, A-Sn, B-Sm, APDI, NAPog, AB-NPog, POr-DOP, SN-OcP, POr-OcP, Wits, 1 l-APog, 1LMeLm, S-Go:N-Me, N-ANS-Pog, Ap1LAp1u-DOP, ANS-Cond, Pog-Cond, SS-Ls, A-N-Pog, Pog–Pog′, MeGoOcP, 1L-Npog, Go-Me, Go-Me:N-S, S-Me, Ls-(Sn-Pog′), Stms–Stmi, N′-Gn′, N′NsPog′, 6u-PTV, 1u-NA, FMIA und IMPA.

Schlussfolgerungen

Die SUS 2-Feder korrigierte eine Klasse-II/1-Malokklusion bei Patienten nach der pubertären Hauptwachstumsphase durch Hemmung des Oberkieferwachstums nach anterior, Vorverlagerung der Mandibula, Verringerung der nasolabialen und interinzisiven Winkel, Proklination der Schneidezähne, gesteigerte Gesichtshöhe und Rotation der Okklusalebene nach rechts. Eine Prämolarenextraktion dagegen verringerte den interinzisiven Winkel und führte zu einer Protrusion der Unterkieferschneidezähne. Die Weichteildicke dagegen veränderte sich nicht und es zeigte sich keine Rotation nach rechts in der Okklusalebene.

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Authors’ contributions

Siamak Hemmatpour searched the literature, performed the orthodontic treatments, re-traced a number of cephalographs, and mentored the thesis. Ali Mokhtar searched the literature, conceived and designed the study, traced all cephalographs, collected the data, wrote the thesis, and contributed to justification of findings in the paper. Vahid Rakhshan searched the literature, double-checked data consistency, performed thesis analyses, conceived extra analyses for the article (more variables, comparison of before-after data in each method), prepared the figures with written permission from OnyxCeph, and drafted/revised/submitted the article.

Author information

Authors and Affiliations

  1. Orthodontic Department, Dental Branch, Islamic Azad University, PO Box 19585-175, Tehran, Iran

    Siamak Hemmatpour & Ali Mokhtar

  2. Department of Dental Anatomy and Morphology, Dental Branch, Islamic Azad University, Tehran, Iran

    Vahid Rakhshan

Authors
  1. Siamak Hemmatpour
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  2. Ali Mokhtar
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  3. Vahid Rakhshan
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Corresponding author

Correspondence to Ali Mokhtar.

Ethics declarations

Funding

The study was self-funded by the authors and their institution.

Conflict of interest

S. Hemmatpour, A. Mokhtar, and V. Rakhshan declare that they have no competing interest.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional information

Assistant Professor: Siamak Hemmatpour; Former Resident: Ali Mokhtar; Lecturer: Vahid Rakhshan.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Figure 1. Important landmarks, measurements, and terminologies used in the Bergen-Hasund analysis

Figure 2. Important landmarks, measurements, and terminologies used in the Burstone analysis

Figure 3. Important landmarks, measurements, and terminologies used in the Burstone Profile analysis

Figure 4. Important landmarks, measurements, and terminologies used in the Downs analysis

Figure 5. Important landmarks, measurements, and terminologies used in the Dual Plane analysis

Figure 6. Important landmarks, measurements, and terminologies used in the Frankfort analysis

Figure 7. Important landmarks, measurements, and terminologies used in the Harvold analysis

Figure 8. Important landmarks, measurements, and terminologies used in the Holdaway analysis

Figure 9. Important landmarks, measurements, and terminologies used in the Jarabak (Skeletal) analysis

Figure 10. Important landmarks, measurements, and terminologies used in the Jarabak (Dental) analysis

Figure 11. Important landmarks, measurements, and terminologies used in the Legan-Burstone analysis

Figure 12. Important landmarks, measurements, and terminologies used in the Profile analysis

Figure 13. Important landmarks, measurements, and terminologies used in the Steiner analysis

Figure 14. Important landmarks, measurements, and terminologies used in the Tweed analysis

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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. J Orofac Orthop 78, 41–51 (2017). https://doi.org/10.1007/s00056-016-0060-2

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