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Thin-plate spline analysis of mandibular shape changes induced by functional appliances in Class II malocclusion

A long-term evaluation

TPS (“thin-plate spline”)-Analyse morphologischer Unterkieferveränderungen durch funktionelle Apparaturen bei Klasse-II-Malokklusion

Eine langfristige Evaluation

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

Abstract

Aims

The purpose of this work was to evaluate the long-term morphological mandibular changes induced by functional treatment of Class II malocclusion with mandibular retrusion.

Methods

Forty patients (20 females, 20 males) with Class II malocclusion consecutively treated with either a Bionator or an Activator followed by fixed appliances were compared with a control group of 40 subjects (19 females, 21 males) with untreated Class II malocclusion. Lateral cephalograms were available at the start of treatment (T1, mean age 9.9 years), at the end of treatment with functional appliances (T2, mean age 12.2 years), and for long-term follow-up (T3, mean age 18.3 years). Mandibular shape changes were analyzed on lateral cephalograms of the subjects in both groups via thin-plate spline (TPS) analysis. Shape differences were statistically analyzed by conducting permutation tests on Goodall F statistics.

Results

In the long term, both the treated and control groups exhibited significant longitudinal mandibular shape changes characterized by upward and forward dislocation of point Co associated with a vertical extension in the gonial region and backward dislocation of point B.

Conclusion

Functional appliances induced mandible’s significant posterior morphogenetic rotation over the short term. The treated and control groups demonstrated similar mandibular shape over the long term.

Zusammenfassung

Aims

Ziel dieser Arbeit war die Evaluation langfristiger morphologischer Unterkieferveränderungen durch die funktionelle Behandlung einer Klasse-II-Malokklusion mit mandibulärer Retrusion.

Methoden

Insgesamt 40 Patienten (20 weiblich, 20 männlich) mit Klasse-II-Malokklusion wurden behandelt, zunächst mit einem Bionator bzw. Aktivater, anschließend mit festen Apparaturen. Zum Vergleich diente eine Kontrollgruppe mit 40 Individuen (19 w, 21 m) mit unbehandelter Klasse-II-Malokklusion. Zu Beginn der Behandlung (T1, durchschnittliches Alter 9,9 Jahre) standen Fernröntgenseitaufnahmen zur Verfügung, ebenso bei Beendigung der Behandlung mit funktionellen Apparaturen (T2, durchschnittliches Alter 12,2) und für einen späten Follow-up-Termin (T3, durchschnittliches Alter 18,3). Die Veränderungen wurden auf den Fernröntgenseitaufnahmen der Individuen beider Gruppen mittels TPS (“thin-plate spline”)-Analyse evaluiert. Morphologische Unterschiede wurden anhand von Permutationstests (Goodall-F-Statistiken) analysiert.

Ergebnisse

Langfristig zeigten sich im longitudinalen Vergleich sowohl in der Behandlungsgruppe als auch in der Kontrollgruppe erhebliche Formveränderungen im Unterkiefer. Sie zeichneten sich aus durch eine Dislokation des Punktes Co nach oben und vorn in Verbindung mit einer vertikalen Verlagerung im Bereich des Gonium und einer Verschiebung des Punktes B nach posterior.

Schlussfolgerungen

Funktionelle Apparaturen induzierten kurzfristig eine erhebliche posteriore morphogenetische Rotation. Langfristig zeigte sich allerdings in beiden Gruppen eine ähnliche Unterkieferform.

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References

  1. Al-Abdwani R, Moles DR, Noar JH (2009) Change of incisor inclination effects on points A and B. Angle Orthod 79:462–467

    Article  PubMed  Google Scholar 

  2. Antunes CF, Bigliazzi R, Bertoz FA et al (2013) Morphometric analysis of treatment effects of the Balters bionator in growing Class II patients. Angle Orthod 83:455–459

    Article  PubMed  Google Scholar 

  3. Baccetti T, Franchi L, McNamara JA Jr (2005) The cervical vertebral maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedics. Sem Orthod 11:119–129

    Article  Google Scholar 

  4. Bigliazzi R, Franchi L, de Magalhaes Bertoz AP et al (2015) Morphometic analysis of long-term dentoskeletal effects induced by treatment with Balters bionator. Angle Orthod 85:790–798

    Article  PubMed  Google Scholar 

  5. Björk A (1969) Prediction of mandibular growth rotation. Am J Orthod 55:585–599

    Article  PubMed  Google Scholar 

  6. Bookstein FL (1991) Morphometric tools for landmark data. Cambridge University Press, New York

    Google Scholar 

  7. Cozza P, Baccetti T, Franchi L et al (2006) Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review. Am J Orthod Dentofacial Orthop 129:599.e1–12

    Google Scholar 

  8. Cozza P, De Toffol L, Iacopini L (2004) An analysis of the corrective contribution in activator treatment. Angle Orthod 74:741–748

    PubMed  Google Scholar 

  9. Franchi L, Baccetti T, Stahl F et al (2007) Thin-plate spline analysis of craniofacial growth in Class I and Class II subjects. Angle Orthod 77:595–601

    Article  PubMed  Google Scholar 

  10. Franchi L, Pavoni C, Faltin K Jr et al (2013) Long-term skeletal and dental effects and treatment timing for functional appliances in Class II malocclusion. Angle Orthod 83:334–340

    Article  PubMed  Google Scholar 

  11. Bookstein FL (1997) Landmark methods for forms without landmarks: morphometrics of group differences in outline shape. Med Image Anal 1:225–243

    Article  PubMed  Google Scholar 

  12. Heinrichs DA, Martin C, Razmus T et al (2014) Treatment effects of a fixed intermaxillary device to correct class II malocclusions in growing patients. Prog Orthod 15:45

    Article  PubMed  PubMed Central  Google Scholar 

  13. Johnston LE Jr (1996) Functional appliances: a mortgage on mandibular position. Aust Orthod J 14:154–157

    PubMed  Google Scholar 

  14. Kelly JE, Harvey C (1977) An assessment of the teeth of youths 12–17 years. DHEW Publication No (HRA) 77-1644. National Center for Health Statistics, Washington, DC

    Google Scholar 

  15. Lux CJ, Rubel J, Starke J et al (2001) Effects of early activator treatment in patients with Class II malocclusion evaluated by thin-plate spline analysis. Angle Orthod 71:120–126

    PubMed  Google Scholar 

  16. Malta LA, Baccetti T, Franchi L et al (2010) Long-term dentoskeletal effects and facial profile changes induced by bionator therapy. Angle Orthod 80:10–17

    Article  PubMed  Google Scholar 

  17. McLain JB, Proffit WR (1985) Oral health status in the United States: prevalence of malocclusion. J Dent Educ 49:386–396

    PubMed  Google Scholar 

  18. McNamara JA Jr, Brudon WL (2001) Orthodontics and dentofacial orthopedics. Needham Press, Ann Arbor

    Google Scholar 

  19. McNamara JA Jr (1981) Components of a Class II malocclusion in children 8-10 years of age. Angle Orthod 51:177–202

    PubMed  Google Scholar 

  20. Moyers RE, Bookstein FL (1979) The inappropriateness of conventional cephalometrics. Am J Orthod 75:599–617

    Article  PubMed  Google Scholar 

  21. Neves LS, Janson G, Cançado RH et al (2014) Treatment effects of the Jasper Jumper and the Bionator associated with fixed appliances. Prog Orthod 15:54

    Article  PubMed  PubMed Central  Google Scholar 

  22. Pandis N (2012) Use of controls in clinical trials. Am J Orthod Dentofac Orthop 141:250–251

    Article  Google Scholar 

  23. Petrovic A (1985) Research findings in craniofacial growth and the modus operandi of functional appliances. In: Graber TM, Rakosi T, Petrovic A (eds) Dentofacial orthopedics with functional appliances. Mosby, St. Louis, Missouri, USA, pp 36–38

  24. Proffit WR, Fields HW, Moray LJ (1998) Prevalence of malocclusion and orthodontic treatment need in the United States: estimates from the N-HANES III survey. Int J Adult Orthod Orthognath Surg 13:97–106

    Google Scholar 

  25. Rohlf FJ, Slice DE (1990) Extensions of the procrustes method for the optimal superimposition of landmarks. Syst Zool 39:40–59

    Article  Google Scholar 

  26. Singh GD, McNamara JA Jr, Lozanoff S (1997) Thin-plate spline analysis of the cranial base in subjects with Class III malocclusion. Eur J Orthod 19:341–353

    Article  PubMed  Google Scholar 

  27. Springate SD (2012) The effect of sample size and bias on the reliability of estimates of error: a comparative study of Dahlberg’s formula. Eur J Orthod 34:158–163

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery and Translational Medicine, The University of Florence, Via del Ponte di Mezzo, 46-48, 50127, Florence, Italy

    Lorenzo Franchi

  2. Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, USA

    Lorenzo Franchi

  3. Department of Clinical Sciences and Translational Medicine, University of Rome ‘Tor Vergata’, Rome, Italy

    Chiara Pavoni, Francesca Gazzani & Paola Cozza

  4. Department of Orthodontics, School of Dentistry, University Nostra Signora del Buon Consiglio, Tirana, Albania

    Chiara Pavoni & Paola Cozza

  5. Department of Orthodontics, School of Dentistry, University Paulista, São Paulo, Brazil

    Kurt Faltin & Renato Bigliazzi

  6. Department of Pediatric and Social Dentistry, Dental School of Araçatuba, São Paulo State University “Júlio de Mesquita Filho”, Araçatuba, Brazil

    Renato Bigliazzi

Authors
  1. Lorenzo Franchi
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  2. Chiara Pavoni
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  3. Kurt Faltin
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  4. Renato Bigliazzi
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  5. Francesca Gazzani
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  6. Paola Cozza
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Corresponding author

Correspondence to Lorenzo Franchi.

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Conflict of interest

L. Franchi, C. Pavoni, K.Faltin, R. Bigliazzi, F. Gazzani, and P. Cozza state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Franchi, L., Pavoni, C., Faltin, K. et al. Thin-plate spline analysis of mandibular shape changes induced by functional appliances in Class II malocclusion. J Orofac Orthop 77, 325–333 (2016). https://doi.org/10.1007/s00056-016-0041-5

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  • DOI: https://doi.org/10.1007/s00056-016-0041-5

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