Effect of Clark's twin-block appliance (CTB) and non-extraction fixed mechano-therapy on the pharyngeal dimensions of growing children

Abstract

Introduction: Narrow airway dimensions due to mandibular deficiency can predispose an individual to severe respiratory distress. Hence, treatment with mandibular advancement devices at an early age might help improving the pharyngeal passage and reduce the risk of respiratory difficulties. Therefore, the aim of the current study was to evaluate the mean changes in the pharyngeal dimensions of children with mandibular deficiency treated with Clark's twin-block appliance (CTB) followed by fixed orthodontic treatment. Methods: Orthodontic records of 42 children with mandibular deficiency were selected. Records comprised three lateral cephalograms taken at the start of CTB treatment, after CTB removal and at the end of fixed appliance treatment, and were compared with 32 controls from the Bolton-Brush study. Friedman test was used to compare pre-treatment, mid-treatment and post-treatment pharyngeal dimensions. Wilcoxon signed rank test was used to compare the airway between pre-treatment and post follow-up controls. Mann-Whitney U test was applied to compare the mean changes in pharyngeal dimensions between treatment group and controls from T2 to T0. Post-hoc Dunnet T3 test was used for multiple comparisons of treatment outcomes after CTB and fixed appliances, taking a p-value of ≤ 0.05 as statistically significant. Results: Superior pharyngeal space (p < 0.001) and upper airway thickness (p = 0.035) were significantly increased after CTB, and the change in superior pharyngeal space remained stable after fixed mechano-therapy. Conclusion: CTB can have a positive effect in improving pharyngeal space and the resultant increase in airway remains stable on an average of two and a half years.

Evaluation of changes in the upper airway after Twin Block treatment in patients with Class II malocclusion

“…This study shows that correction of mandibular retrognathism with a TB appliance in growing patients not only improves the facial profile and intermaxillary relationship but also increases UA dimensions (Ali et al, ; Roque‐Torres, Meneses‐López, Bóscolo, de Almeida, & Neto, ), thus reducing the risk of future respiratory problems (Verma et al, ) and representing a suitable oral appliance to treat children with SAHS (Caridi & Galluccio, ; Zhang et al, ). However, few studies have shown the long‐term effectiveness of TB appliances; therefore, their permanency remains to be determined.…”

“…However, lateral teleradiography of the skull is commonly used in routine clinical practice due to its relative simplicity, accessibility, low cost, and low radiation exposure (Feng et al, ; Rojas, Corvalán, Messen, & Sandoval, ; Santamaria‐Villegas, Manrique‐Hernandez, Alvarez‐Varela, & Restrepo‐Serna, ). Teleradiography remains a valuable diagnostic tool for evaluating the airways (Ali et al, ; Elfeky & Fayed, ; Ghodke et al, ; Jena et al, ; Pavoni et al, ) and can be used to predict OSA (Armalaite & Lopatiene, ). Furthermore, this method has been shown to provide reliable linear measurements and is a valid tool for measuring the dimensions of the nasopharyngeal and retropalatal regions.…”

“…Radiographic computer tomography (CT) provides a more accurate estimate of the UA volume and more detail compared with teleradiography (Abdelkarim, ; Iwasaki et al, ; Li et al, ; Maspero et al, ). However, the patient, and in this case the growing child, becomes exposed to higher radiation contrary to the ALARA principle and is difficult to justify from a research ethics perspective (Ali et al, ; Ghodke et al, ).…”

“…The indication to treat the cause of obstruction should be established by a pediatrician, otolaryngologist, or allergist, although orthodontics and dentofacial orthopedics can also improve such obstructions; therefore, interdisciplinary coordination is essential (Morales & Varela, ). Malocclusion and other dentofacial abnormalities can also cause SAHS, with mandibular retrognathism as one of the most important risk factors in children (Ali, Shaikh, & Fida, ; Jena, Singh, & Utreja, ; Pupneja, Utreja, Singh, Aggarwal, & Jena, ). Furthermore, patients with RSDs often exhibit a retracted position of the jaw in relation to the skull base (Caridi & Galluccio, ; Ghodke, Utreja, Singh, & Jena, ; Jena et al, ; Maspero, Giannini, Galbiati, Kairyte, & Farronato, ; More et al, ; Pavoni et al, ).…”

“…The use of functional appliances to correct mandibular retrognathia is very common among orthodontists and is increasingly recommended as a treatment option for obstructive sleep apnoea (OSA; Abdelkarim, ; Ali et al, , ; Caridi & Galluccio, ; Elfeky & Fayed, ; Maspero et al, ; Zhang et al, ). Previous studies have reported improvements in UA dimensions after functional therapy (Elfeky & Fayed, ; Ghodke et al, ; Maspero et al, ; Pavoni et al, ), with Twin Block (TB) being one of the most common and popular functional appliances due to its effectiveness in correcting skeletal Class II malocclusion (Abdelkarim, ; Al‐Anezi, ; Brunharo, Quintão, Almeida, Motta, & Barreto, ; Burhan & Nawaya, ; Elfeky & Fayed, ; Ghodke et al, ; Li et al, ; Schaefer, McNamara, Franchi, & Baccetti, ; Sharma, Sachdev, Singla, & Kirtaniya, ; SuchitaTarvade, Yamyar, Choudhari, & Biday, ; Verma, Tandon, Nagar, Singh, & Singh, ; Zhang et al, ).…”