Abstract:Objective: The aim of this study was to compare the skeletal, dental, and soft tissue effects of the Mandibular Protraction Appliance (MPA) application in adolescent and adult Class II malocclusion patients. Methods: The sample comprised the pretreatment and posttreatment lateral cephalograms of 39 subjects presenting Class II malocclusion treated with the MPA and fixed appliances. Sample was divided into two groups: Group 1 comprised 23 subjects (10 male; 13 female), at a mean pretreatment age of 11.75 years,… Show more
“…One study [ 29 ] was excluded post hoc, since it included only one adult patient, which made statistical comparisons between adolescents and adults patients difficult. Eventually, 11 papers pertaining to 11 unique studies (1 prospective and 10 retrospective non-randomized studies), which were published as journal papers, were finally included (Table 1 ) [ 1 , 31 – 40 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…II/1; all permanent teeth except M3 Full Tx ≥ ½ Cl. II MR SE FA 0.022” (elastics, HG, sliding jigs) 4xPM Furquim 2018 [ 31 ] rNRS; Pract; BR AD: 23 (10/13); 11.8 ADU: 16 (7/9); 22.4 Cl. II Full Tx NR FA and MPA NR Harris 1990 [ 32 ] rNRS; Pract; US AD c : 29 (0/29); 12.5 ADU c : 30 (0/30); 27.9 Cl.…”
Objectives
Adults with fixed orthodontic appliances are increasing nowadays. Compared with adolescents, adults present biological differences that might influence treatment duration. Therefore, the aim of the study was to compare duration of treatment with fixed appliances between adults and adolescents.
Materials and methods
Eight databases were searched up to September 2019 for randomized and non-randomized clinical studies comparing treatment duration with fixed appliances in adolescents and adult patients. After duplicate study selection, data extraction, and risk of bias assessment with the Cochrane ROBINS-I tool, random effects meta-analyses of mean differences (MD) and their 95% confidence intervals (CIs) were performed, followed by assessment of the quality of evidence with GRADE.
Results
A total of 11 unique studies (one prospective and 10 retrospective non-randomized) with 2969 adolescents and 1380 adult patients were finally included. Meta-analysis of 7 studies found no significant difference in the duration of comprehensive treatment with fixed appliances (MD = − 0.8 month; 95% CI = − 4.2 to 2.6 months; P = 0.65; I2 = 92%) between adults and adolescents. Similarly, both distalization of upper first molars with skeletal anchorage for class II correction and the retraction of canines into the premolar extraction spaces lasted similarly long among adults and adolescents. On the other hand, alignment of palatally displaced canines lasted considerably longer in adults compared to adolescents (1 study; MD = 3.8 months; 95% CI = 1.4 to 6.2 months; P = 0.002). The quality of evidence for the meta-analysis was low due to the inclusion of non-randomized studies with considerable risk of bias.
Conclusions
While existing evidence does not indicate a difference in the overall duration of treatment with fixed appliances between adults and adolescents, the alignment of palatally displaced canines lasted significantly longer in adults. However, our confidence in these estimates is low due to the risk of bias in the included studies.
Trial registration
PROSPERO: (CRD42019148169)
“…One study [ 29 ] was excluded post hoc, since it included only one adult patient, which made statistical comparisons between adolescents and adults patients difficult. Eventually, 11 papers pertaining to 11 unique studies (1 prospective and 10 retrospective non-randomized studies), which were published as journal papers, were finally included (Table 1 ) [ 1 , 31 – 40 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…II/1; all permanent teeth except M3 Full Tx ≥ ½ Cl. II MR SE FA 0.022” (elastics, HG, sliding jigs) 4xPM Furquim 2018 [ 31 ] rNRS; Pract; BR AD: 23 (10/13); 11.8 ADU: 16 (7/9); 22.4 Cl. II Full Tx NR FA and MPA NR Harris 1990 [ 32 ] rNRS; Pract; US AD c : 29 (0/29); 12.5 ADU c : 30 (0/30); 27.9 Cl.…”
Objectives
Adults with fixed orthodontic appliances are increasing nowadays. Compared with adolescents, adults present biological differences that might influence treatment duration. Therefore, the aim of the study was to compare duration of treatment with fixed appliances between adults and adolescents.
Materials and methods
Eight databases were searched up to September 2019 for randomized and non-randomized clinical studies comparing treatment duration with fixed appliances in adolescents and adult patients. After duplicate study selection, data extraction, and risk of bias assessment with the Cochrane ROBINS-I tool, random effects meta-analyses of mean differences (MD) and their 95% confidence intervals (CIs) were performed, followed by assessment of the quality of evidence with GRADE.
Results
A total of 11 unique studies (one prospective and 10 retrospective non-randomized) with 2969 adolescents and 1380 adult patients were finally included. Meta-analysis of 7 studies found no significant difference in the duration of comprehensive treatment with fixed appliances (MD = − 0.8 month; 95% CI = − 4.2 to 2.6 months; P = 0.65; I2 = 92%) between adults and adolescents. Similarly, both distalization of upper first molars with skeletal anchorage for class II correction and the retraction of canines into the premolar extraction spaces lasted similarly long among adults and adolescents. On the other hand, alignment of palatally displaced canines lasted considerably longer in adults compared to adolescents (1 study; MD = 3.8 months; 95% CI = 1.4 to 6.2 months; P = 0.002). The quality of evidence for the meta-analysis was low due to the inclusion of non-randomized studies with considerable risk of bias.
Conclusions
While existing evidence does not indicate a difference in the overall duration of treatment with fixed appliances between adults and adolescents, the alignment of palatally displaced canines lasted significantly longer in adults. However, our confidence in these estimates is low due to the risk of bias in the included studies.
Trial registration
PROSPERO: (CRD42019148169)
“…Therefore, the uprighting effect of both appliances on the maxillary incisors led to forward relocation of A-point because of appositional changes at that alveolar area. Since the MPA group had more palatal tipping of the maxillary incisors [9], this could have camouflaged the restrictive effect of the MPA on the maxilla. Other researchers also reported A-point relocation related to the incisor inclination [22,25,26].…”
Section: Treatment Changes Comparisonmentioning
confidence: 99%
“…In general, MPA and JJ associated with fixed appliances corrected the Class II malocclusion, and this was due to some skeletal and mainly dentoalveolar changes [8 -10, 18 -22, 24, 27]. This way, both appliances can be used in growing patients as well as in adults, that do not present growth potential [9,10,16,18]. However, these skeletal and dentoalveolar changes presented important differences between the two appliances, that must be remembered when planning an orthodontic treatment.…”
This study aimed to compare the effects of Mandibular Protraction Appliance (MPA) and Jasper Jumper (JJ), associated with fixed orthodontic appliances for Class II malocclusion treatment. Materials and Methods: Sample comprised of 71 subjects, divided into 3 groups: Group 1: 24 patients, mean initial age 12.36 years, treated with MPA for 2.74 years; Group 2: 25 patients, mean initial age 12.72 years, treated with JJ for 2.15 years; Control Group: 22 subjects, mean age of 12.67 years, with untreated Class II malocclusion, followed for 2.12 years. Initial and final variables and treatment changes were compared between groups by ANOVA and Tukey tests. Results: JJ group presented greater restriction of growth and maxillary retrusion and MPA showed a greater increase of mandibular effective length. MPA and JJ groups showed improvement of maxillomandibular relationship. Maxillary incisors showed greater retrusion and retroclination in MPA group. MPA presented greater proclination of mandibular incisors and JJ showed greater protrusion. MPA and JJ groups presented a decrease in overbite and overjet. Conclusion: MPA showed a significant increase in mandibular effective length and great dentoalveolar compensation. JJ showed significant restriction of maxillary anterior displacement and also important dentoalveolar compensations. JJ must be indicated mainly in cases with maxillary protrusion, and MPA, especially in cases with mandibular deficiency.
“…The advantage of treating Class II malocclusion during growth, that is, in the mixed or early permanent dentition stage, is the possibility of changing the patient's growth pattern [18][19][20] and reducing the risk of trauma to maxillary incisors. In addition, it increases airway space in the oropharyngeal region and results in an ideal and stable occlusion 18 .…”
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.
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