Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Association for Cranio Maxillo Facial Surgery (대한두개안면성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Assessment of upper airway and temporomandibular joint changes in growing patients with Class II Division 1 malocclusion, treated with the Twin Block appliance: a retrospective cone-beam computed tomography study

  • Ioannis Anagnostopoulos (Department of Orthodontics, College of Dental Medicine, University of Sharjah) ;
  • Snigdha Pattanaik (Department of Orthodontics, College of Dental Medicine, University of Sharjah) ;
  • Ahmed Zaky (Department of Orthodontics, Faculty of Dentistry, Ain Shams University) ;
  • Ahmed El-Motayam (Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University) ;
  • Shishir Ram Shetty (Department of Oral Radiology, College of Dental Medicine, University of Sharjah) ;
  • Mais M Sadek (Department of Orthodontics, College of Dental Medicine, University of Sharjah)
  • Received : 2024.12.30
  • Accepted : 2025.06.02
  • Published : 2025.06.20
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The Twin Block (TWB) appliance is widely employed for treating Class II malocclusion in children and adolescents. This study aimed to evaluate the three-dimensional treatment effects of the TWB on the upper airway and temporomandibular joint (TMJ), and to investigate the association between airway changes and TMJ alterations. Methods: This retrospective study examined 24 cone-beam computed tomography (CBCT) scans from 12 patients (mean age, 12.30±1.24 years) diagnosed with Class II Division 1 malocclusion and treated with the TWB appliance. CBCT scans were acquired both at pretreatment (T0) and posttreatment (T1). Romexis 6.2.1 imaging software was used to assess changes in the upper airway and TMJ. The paired t-test was used to compare the pretreatment and posttreatment measurements, while Pearson correlation coefficient analysis evaluated the relationship between the upper airway and TMJ measurements. Results: A statistically significant increase was observed in the upper airway volume, condylar volume, and condylar dimensions after treatment. No significant correlation was detected between the upper airway and TMJ measurements at T0, T1, or in the net changes (T1-T0) during TWB therapy. Conclusion: Growing patients treated with the TWB appliance demonstrated a statistically significant increase in upper airway volume. In addition, there was a significant increase in condylar volume, width, and length, with the condyle repositioned more anteriorly within the glenoid fossa. However, no statistically significant correlation was found between the TMJ and upper airway measurements.

Keywords

References

  1. Ghafari JG, Macari AT. Component analysis of Class II, Division 1 discloses limitations for transfer to Class I phenotype. Semin Orthod 2014;20:253-71. https://doi.org/10.1053/j.sodo.2014.09.003
  2. Bishara SE. Class II malocclusions: diagnostic and clinical considerations with and without treatment. Semin Orthod 2006;12:11-24. https://doi.org/10.1053/j.sodo.2005.10.005
  3. Clark WJ. The Twin Block traction technique. Eur J Orthod 1982;4:129-38. https://doi.org/10.1093/ejo/4.2.129
  4. Bjork A. Variations in the growth pattern of the human mandible: longitudinal radiographic study by the implant method. J Dent Res 1963;42:400-11. https://doi.org/10.1177/00220345630420014701
  5. Koretsi V, Zymperdikas VF, Papageorgiou SN, Papadopoulos MA. Treatment effects of removable functional appliances in patients with Class II malocclusion: a systematic review and meta-analysis. Eur J Orthod 2015;37:418-34. https://doi.org/10.1093/ejo/cju071
  6. Schellenberg JB, Maislin G, Schwab RJ. Physical findings and the risk for obstructive sleep apnea: the importance of oropharyngeal structures. Am J Respir Crit Care Med 2000;162(2 Pt 1):740-8. https://doi.org/10.1164/ajrccm.162.2.9908123
  7. Kirjavainen M, Kirjavainen T. Upper airway dimensions in Class II malocclusion: effects of headgear treatment. Angle Orthod 2007;77:1046-53. https://doi.org/10.2319/081406-332
  8. Xiang M, Hu B, Liu Y, Sun J, Song J. Changes in airway dimensions following functional appliances in growing patients with skeletal Class II malocclusion: a systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2017;97:170-80. https://doi.org/10.1016/j.ijporl.2017.04.009
  9. Pancherz H, Ruf S, Kohlhas P. "Effective condylar growth" and chin position changes in Herbst treatment: a cephalometric roentgenographic long-term study. Am J Orthod Dentofacial Orthop 1998;114:437-46. https://doi.org/10.1016/S0889-5406(98)70190-8
  10. Yildirim E, Karacay S, Erkan M. Condylar response to functional therapy with Twin-Block as shown by cone-beam computed tomography. Angle Orthod 2014;84:1018-25. https://doi.org/10.2319/112713-869.1
  11. Ivorra-Carbonell L, Montiel-Company JM, Almerich-Silla JM, Paredes-Gallardo V, Bellot-Arcis C. Impact of functional mandibular advancement appliances on the temporomandibular joint: a systematic review. Med Oral Patol Oral Cir Bucal 2016;21:e565-72. https://doi.org/10.4317/medoral.21180
  12. Wen XL, Wu BZ, Li Y, Yi B, Peng X. Analysis of the aerodynamic characteristics of the upper airway in obstructive sleep apnea patients. J Dent Sci 2024;19:329-37. https://doi.org/10.1016/j.jds.2023.03.013
  13. Chou ST, Tsai PL, Chen SC, Lin SH, Chen CM, Tseng YC. Condylar and ramus volume in asymmetric and symmetric skeletal Class III malocclusion: a cone-beam computed tomography study. J Dent Sci 2023;18:175-83. https://doi.org/10.1016/j.jds.2022.06.016
  14. Chou ST, Wang JL, Chen SC, Pan CY, Chen CM, Tseng YC. Correlation between facial asymmetry of skeletal Class III jaw relationship and morphology of the temporomandibular joint: a cone beam computed tomography study. J Dent Sci 2023;18:1031-41. https://doi.org/10.1016/j.jds.2022.11.031
  15. Bayome M, Park JH, Kook YA. New three-dimensional cephalometric analyses among adults with a skeletal Class I pattern and normal occlusion. Korean J Orthod 2013;43:62-73. https://doi.org/10.4041/kjod.2013.43.2.62
  16. Hilgers ML, Scarfe WC, Scheetz JP, Farman AG. Accuracy of linear temporomandibular joint measurements with cone beam computed tomography and digital cephalometric radiography. Am J Orthod Dentofacial Orthop 2005;128:803-11. https://doi.org/10.1016/j.ajodo.2005.08.034
  17. Pullinger A, Hollender L. Variation in condyle-fossa relationships according to different methods of evaluation in tomograms. Oral Surg Oral Med Oral Pathol 1986;62:719-27. https://doi.org/10.1016/0030-4220(86)90270-7
  18. Ren YF, Isberg A, Westesson PL. Condyle position in the temporomandibular joint: comparison between asymptomatic volunteers with normal disk position and patients with disk displacement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80:101-7. https://doi.org/10.1016/S1079-2104(95)80025-5
  19. Rizk S, Kulbersh VP, Al-Qawasmi R. Changes in the oropharyngeal airway of Class II patients treated with the mandibular anterior repositioning appliance. Angle Orthod 2016;86:955-61. https://doi.org/10.2319/042915-295.1
  20. Rajkumar B, Parameswaran R, Parameswaran A, Vijayalakshmi D. Evaluation of volume change in oral cavity proper before and after mandibular advancement. Angle Orthod 2021;91:81-7. https://doi.org/10.2319/052420-474.1
  21. Afzal E, Fida M. Evaluation of the change in the tongue posture and in the hyoid bone position after Twin Block appliance therapy in skeletal Class II subjects. Dent Med Probl 2019;56:379-84. https://doi.org/10.17219/dmp/111976
  22. Elfeky HY, Fayed MMS. Three-dimensional effects of Twin Block therapy on pharyngeal airway parameters in Class II malocclusion patients. J World Fed Orthod 2015;4:114-9.
  23. Alhammadi MS, Elfeky HY, Fayed MS, Ishaq RA, Halboub E, Al-Mashraqi AA. Three-dimensional skeletal and pharyngeal airway changes following therapy with functional appliances in growing skeletal Class II malocclusion patients: a controlled clinical trial. J Orofac Orthop 2019;80:254-65. https://doi.org/10.1007/s00056-019-00185-7
  24. Yildirim E, Karacay S. Volumetric evaluation of pharyngeal airway after functional therapy. Scanning 2021;2021:6694992. https://doi.org/10.1155/2021/6694992
  25. Baka ZM, Fidanboy M. Pharyngeal airway, hyoid bone, and soft palate changes after Class II treatment with Twin-Block and Forsus appliances during the postpeak growth period. Am J Orthod Dentofacial Orthop 2021;159:148-57. https://doi.org/10.1016/j.ajodo.2019.12.016
  26. Elfeky HY, Fayed MS, Alhammadi MS, Soliman SA, El Boghdadi DM. Three-dimensional skeletal, dentoalveolar and temporomandibular joint changes produced by Twin Block functional appliance. J Orofac Orthop 2018;79:245-58. https://doi.org/10.1007/s00056-018-0137-1
  27. Jiang YY, Sun L, Wang H, Zhao CY, Zhang WB. Three-dimensional cone beam computed tomography analysis of temporomandibular joint response to the Twin-Block functional appliance. Korean J Orthod 2020;50:86-97. https://doi.org/10.4041/kjod.2020.50.2.86
  28. Chavan SJ, Bhad WA, Doshi UH. Comparison of temporomandibular joint changes in Twin Block and Bionator appliance therapy: a magnetic resonance imaging study. Prog Orthod 2014;15:57. https://doi.org/10.1186/s40510-014-0057-6
  29. Ruf S, Pancherz H. Temporomandibular joint growth adaptation in Herbst treatment: a prospective magnetic resonance imaging and cephalometric roentgenographic study. Eur J Orthod 1998;20:375-88. https://doi.org/10.1093/ejo/20.4.375
  30. Kinzinger G, Kober C, Diedrich P. Topography and morphology of the mandibular condyle during fixed functional orthopedic treatment: a magnetic resonance imaging study. J Orofac Orthop 2007;68:124-47. https://doi.org/10.1007/s00056-007-0650-0
  31. Truong L, Reher P, Doan N. Correlation between upper airway dimension and TMJ position in patients with sleep disordered breathing. Cranio 2023;41:331-9. https://doi.org/10.1080/08869634.2020.1853465
  32. O'Brien K, Wright J, Conboy F, Sanjie Y, Mandall N, Chadwick S, et al. Effectiveness of early orthodontic treatment with the Twin-Block appliance: a multicenter, randomized, controlled trial: part 1: dental and skeletal effects. Am J Orthod Dentofacial Orthop 2003;124:234-43. https://doi.org/10.1016/S0889-5406(03)00352-4