Different approaches to the treatment of skeletal Class II malocclusion during growth: Bionator versus extraoral appliance

Abstract

Introduction: Class II malocclusion, which has a significant incidence in the population, may compromise facial esthetics and the smile, as well as the masticatory and respiratory functions. Often associated with skeletal abnormalities, it severely affects and compromises quality of life. An accurate diagnosis is fundamental to prepare a treatment plan to correct dental and skeletal anomalies. Objectives: This study discusses treatment alternatives to the correction of Class II division 1 and 2 malocclusion in growing patients, using a Bionator and an extraoral appliance.

Mandibular orthopedic advancement in different facial patterns and distinct stages of skeletal maturation

“…These results are in agreement with literature regarding the Herbst appliance effects, such as maintenance or reduction of maxillary incisors proclination, associated to maxillary dental arch retraction, as well as mandibular incisors proclination and forward movement of the mandibular teeth, 10 - 15 which are linked to positive although temporary stimulus of Herbst appliance on mandibular growth, and also on condyle and glenoid fossa forward remodeling. 26 , 32 , 33 …”

“…On the other hand, the hyperdivergent patients usually present a limited facial improvement after the same orthopedic approach, with more effect on dentoalveolar structures. [10][11][12][13][14][15]33 It must also be emphasized that the minor mandibular growth response in Case 1 can be attributed to the early skeletal maturation stage of the patient in which orthopedic treatment took place -in other words, before the peak of pubertal growth spurt.…”

“…These results are in agreement with literature regarding the Herbst appliance effects, such as maintenance or reduction of maxillary incisors proclination, associated to maxillary dental arch retraction, as well as mandibular incisors proclination and forward movement of the mandibular teeth, [10][11][12][13][14][15] which are linked to positive although temporary stimulus of Herbst appliance on mandibular growth, and also on condyle and glenoid fossa forward remodeling. 26,32,33 There were no false expectations among orthodontist and parents about an ideal facial improvement, and that was very important in Case 1 treatment. In these terms, is very important to highlight the positive but transitory effect of Herbst appliance on facial profile.…”

Importance of orthodontic intervention of the Class III malocclusion in mixed dentition

“…In these periods there is a greater predisposition to anterior displacement of the maxilla, increasing the growth in the maxillary and circummaxillary sutures, which are regular and wide before 8 years of age and become more strongly interdigited near puberty. 2 In the initial stage of mixed dentition, the best orthopedic responses are observed in the correction of posterior skeletal crossbite, 24 anterior open bite, 25 and skeletal Class III. 1 The therapeutic decisions made for the first phase guaranteed the results obtained at the end of the entire treatment.…”

Changes in health-related quality of life after orthognathic surgery: a multicenter study

“…Depending on the relationship between the upper first molar and the lower first molar: Class I presents normal molar relationship, but there is crowding or misalignment of the teeth, cross bites, among other irregularities; Class II malocclusion is defined as the mesiobuccal cusp of the upper first molar being mesially (anteriorly) positioned relative to the buccal groove of the lower first molar; while in Class III, the mesiobuccal cusp of the upper first molar is distally (posteriorly) positioned relative to the buccal groove of the lower first molar [ 25 ]. Malocclusion may be associated with skeletal abnormalities [ 26 ] and reflect maxillo–mandibular disharmony defined for skeletal Class II as underdevelopment of mandibular growth and/or maxillary excess, leading to a facial convex profile and for skeletal Class III when discrepancies are caused by maxillary retrognathia and/or mandibular protrusion (concave profile) [ 27 ].…”